Chapter 19: Screening and Referral Nursing School Test Banks

Chapter 19: Screening and Referral
Test Bank

MULTIPLE CHOICE

1. Why is health screening considered a secondary level of prevention?
a. It distinguishes between populations at high risk for disease from those at low risk for disease.
b. It identifies patients who may need intervention.
c. It diagnoses many easily treated diseases.
d. It promotes health and well-being.
ANS: B
Screening is a major secondary level of prevention measure because secondary prevention is aimed at the early detection and treatment of illness. However, because screening tests are imperfect, screening cannot in itself confirm diagnosis or suggest treatment. But screening can suggest whether certain patients require additional intervention.

DIF: Cognitive Level: Comprehension REF: pp. 486-487

2. Why are results of screening tests referred to as presumptive?
a. If the test result is positive, it may be assumed that the disease is present.
b. The test results lead to recognition of symptoms.
c. The tests detect previously unrecognized signs and symptoms.
d. Because screening test results have less than 100% accuracy, referral for further tests is necessary.
ANS: D
Test results are presumptive because the tests are fallible and thus further testing is necessary to confirm or rule out possible disease. Tests yield occasional inaccurate positive and inaccurate negative results.

DIF: Cognitive Level: Comprehension REF: p. 487

3. Any screening test must absolutely be
a. Accurate in its conclusion.
b. Capable of being administered in a quiet area.
c. Equally effective with both children and adults.
d. Inexpensive and easy to perform.
ANS: D
A screening test by definition must be less expensive than treatment later in the disease process. It must also be inexpensive enough to be given to large numbers of persons at a cost that health agencies or their clients can afford. The tests are held throughout the community, not in medical centers with many resources, and so they must be easy and fairly quick to perform.

DIF: Cognitive Level: Comprehension REF: p. 487

4. A community/public health nurse was planning a prostate cancer screening in cooperation with the local community hospital. Whom should the nurse be sure to invite?
a. Men older than 50 years in the community
b. Anyone who had ever been involved with the local community hospital
c. Anyone who has a family history of cancer
d. Community members from infants to senior citizens
ANS: A
A screening test is often too expensive to use except for groups at high risk for the disease, which for prostate cancer screening would specifically be men older than 50 years. Women and children do not need screening for prostate cancer. Mass screening is the application of screening tests to large populations and in this case is selective of persons who are at higher risk for the disease.

DIF: Cognitive Level: Synthesis REF: p. 487

5. A community/public health nurse had a referral to visit a grandmother in her apartment to follow up on blood pressure readings because she was on a new medication. While in the apartment, the nurse took the blood pressure readings of all the adults and children there. What is the nurse attempting to do?
a. Perform a case finding.
b. Follow the American Heart Association guidelines.
c. Give care to all members of the family, regardless of reimbursement.
d. Involve the family in the care.
ANS: A
Although all of the answers are technically true, case finding is defined as an individual or one-to-one screening while present in a setting for another reason. In case finding, screening tests are used to identify previously unrecognized disease in individuals who present to the health care provider for health maintenance checks or for an unrelated complaint.

DIF: Cognitive Level: Application REF: p. 487

6. A community/public health nurse was responsible for setting up a health fair in a very heavily attended inner-city church, with several screenings being given simultaneously. Within the public health agency, what would the nurse call the health fair?
a. Case finding
b. Community service
c. Multiphasic screening
d. Unreimbursed care
ANS: C
The definition of multiphasic screening is the application of multiple screening tests on the same occasion, such as a health fair.

DIF: Cognitive Level: Application REF: p. 487

7. A local community hospital offers weekly hypertension screenings at the community center. A community/public health nurse was asked by a community member about when the health department would be offering a hypertension screening at the center. Which of the following would be the best response from the community/public health nurse?
a. When the public health department receives additional grant funding.
b. When the residents of the neighborhood request free screenings.
c. When the community/public health nurse has extra time.
d. When the community hospital stops offering screenings.
ANS: D
When planning to offer a screening, the nurse must assess for significant health problems in the community, gather support from the community, and consider all the details. If screening resources are already available at a community center, there is no reason for the public health department to offer such a screening. Currently, the local hospital is meeting their needs for screening.

DIF: Cognitive Level: Analysis REF: p. 487

8. As nursing students were setting up a health screening at a local community center, they reviewed the need to screen for heart disease and cancer. One student asked, But colon cancer is prevalent; why arent we setting up for sigmoidoscopy? How would the instructor reply?
a. A sigmoidoscopy is expensive to perform and invasive.
b. Can you find adequate privacy for a sigmoidoscopy?
c. What a great idea. Would you like to help arrange it?
d. Would you like to administer that test for the screening?
ANS: A
A sigmoidoscopy is highly invasive, not cost-effective, and difficult to administer; many clients find this procedure uncomfortable and it has dangerous, although infrequent, side effects.

DIF: Cognitive Level: Synthesis REF: p. 487

9. The ability of a screening test to distinguish correctly between persons with and without a disease is known as
a. Sensitivity.
b. Validity
c. Reliability.
d. Specificity.
ANS: B
By definition, validity is the ability of the screening test to distinguish correctly between persons with and those without the disease. Sensitivity is the ability of a screening test to accurately identify persons who have the disease. Reliability is the consistency or reproducibility of test results over time and between examiners. Specificity is the ability of the screening test to identify persons who are normal or without disease and whose test results are correctly negative when those persons are screened.

DIF: Cognitive Level: Knowledge REF: p. 487

10. Sensitivity is the ability of a screening test to accurately identify what aspect of the screening?
a. Persons who do not have the disease
b. Persons who have the disease
c. Persons with symptoms of the disease
d. Persons who now have a diagnosis of the disease
ANS: B
By definition, sensitivity is the ability of a screening test to accurately identify persons who have the disease. Because no test is 100% accurate, the test results are not always correct; hence screening results are suggestive, not diagnostic.

DIF: Cognitive Level: Knowledge REF: p. 488

11. Specificity is the ability of a screening test to accurately identify what aspect of the screening?
a. Persons who do not have the disease
b. Persons who have the disease
c. Persons who need follow-up in relation to the disease
d. Persons who were unaware that they had the disease
ANS: A
By definition, specificity is the ability of a screening test to accurately identify most of the people who do not have the disease. Because no test is 100% accurate, the test results are not always correct.

DIF: Cognitive Level: Knowledge REF: p. 488

12. What is the relationship between sensitivity and specificity?
a. The higher the sensitivity, the higher the specificity.
b. The higher the sensitivity, the lower the specificity.
c. The higher the specificity, the higher the sensitivity.
d. The more sensitive a test is, the more specific it becomes.
ANS: B
The relationship between sensitivity and specificity is inverse. The higher the sensitivity is, the lower the specificity will be, and vice versa. The more sensitive a test, the less specific it becomes.

DIF: Cognitive Level: Comprehension REF: p. 488

13. A client received positive results on a screening test. What does this result mean for the client?
a. The client does not have the disease.
b. The client has the disease and needs immediate treatment.
c. The client has a laboratory finding confirming disease.
d. The client will need further testing and follow-up.
ANS: D
Because test results are sometimes falsely positive, the client cannot be assumed to have the disease. Rather, the client will need further testing to confirm the diagnosis and then receive appropriate treatment.

DIF: Cognitive Level: Application REF: p. 488

14. Some nursing students were taking blood pressure measurements at one spot in the large room where many of the health screening stations were set up. A student pulled aside her instructor and said, This mans blood pressure is 220/160. Whom should I call to get him to treatment immediately? What should be the instructors first action?
a. Ask the gentleman if he has health insurance.
b. Call a local ambulance.
c. Follow up with previously determined emergency plans.
d. Check the reliability of the findings.
ANS: D
Although the nurse should have prepared emergency plans for extremely dangerous client findings, and indeed the gentleman may need to be conveyed to a hospital, the first step should be to repeat the blood pressure measurement and confirm the reliability of the findings. Reliability refers to the consistency or reproducibility of test results over time and between examiners.

DIF: Cognitive Level: Synthesis REF: p. 488

15. Which of the following is known to be the leading cause of preventable death in the United States?
a. Obesity
b. Smoking
c. Sun exposure
d. Second-hand smoke
ANS: B
Smoking is known to be the leading cause of preventable death in the United States, accounting for 1 per 5 deaths. Obesity rates continue to rise, but obesity is not the leading cause of preventable death. Exposure to the sun and exposure to second-hand smoke also contribute to preventable deaths, but they are not the leading causes.

DIF: Cognitive Level: Knowledge REF: p. 489

16. The community/public health nurse was asked why a church was chosen as the site for a recent health fair, because not everyone in the community attended this church. What would be the most likely response by the nurse?
a. It is accessible to most of the residents of the community, it is large and has several restrooms, and it is centrally located.
b. Most residents of the neighborhood either do or should attend the church.
c. I am a member of that church and could reserve the site without charge.
d. The church is community serviceoriented, and hosting the screening met its mission.
ANS: A
Unless mobile vans are used, the site chosen should be accessible, be a public place, have adequate space and restroom facilities, and be acceptable to the majority of the target population.

DIF: Cognitive Level: Application REF: p. 489

17. Which of the following events might help document the importance of a health screening to the neighborhood?
a. Absenteeism caused by illness at the local factory decreased.
b. Morbidity statistics related to heart disease decreased over the next year.
c. The incidence and prevalence of hypertension fell precipitously.
d. The incidence and prevalence of hypertension rose precipitously.
ANS: D
If a screening program is effective, the incidence and prevalence of the disease being screened will appear to increase because screening will result in the early detection of previously unrecognized illness.

DIF: Cognitive Level: Application REF: p. 492

18. A woman was found to have a blood glucose reading of 320 mg/dL. What should be the nurses next action?
a. Escort the woman to the next screening station and then prepare to test the blood glucose level of the next client.
b. Explain the blood glucose reading to the woman and ask whether she has a primary care provider.
c. Fill out the form, giving the results accurately for the health departments records.
d. Hand the woman culturally appropriate literature on diabetes and the dangers of lack of treatment.
ANS: B
When a problem is found, the nurse must inform the client and, in collaboration with the client, decide on referrals or how to follow up. After that, the nurse should indeed fill out the appropriate forms, give the client culturally appropriate literature if she seems interested in reading it, and prepare to screen the next client. However, the nurse should not let participants leave the screening until they have secured the number of a health care provider who is appropriate to deal with the identified problems.

DIF: Cognitive Level: Synthesis REF: pp. 495-496

19. What must be stressed to all participants attending a health fair?
a. A screening program is not a substitute for ongoing health supervision from a health care provider.
b. All test results are only tentative, and so participants who receive negative test results may nonetheless be suffering from a disease.
c. Results are true today, but disease can develop any time, so participants should attend any future health fairs as well.
d. There are many other diseases that may be attacking participants that the health fair did not screen for, and so continued vigilance is necessary.
ANS: A
Persons who participate in screening programs commonly believe that they have been checked over adequately. Therefore, participants must be advised that a screening program is not a substitute for ongoing health supervision from a health care provider.

DIF: Cognitive Level: Comprehension REF: p. 496

20. A nurse is planning the evaluation of a mental health screening program in the community. What should be included in the process evaluation of this program?
a. Asking whether program goals were adequately met
b. Determining whether more people sought follow-up care after the screening
c. Determining the number of people who attended and were screened
d. Measuring whether the incidence of disease changed
ANS: C
In process evaluation, investigators examine actual program performance, such as number of people served by the screening. Asking whether program goals were met, determining amount of follow-up care sought, and measuring changes in the incidence of disease are all outcome evaluation measures.

DIF: Cognitive Level: Application REF: p. 499

MULTIPLE RESPONSE

1. Which variables must the nurse consider when planning a health fair? (Select all that apply.)
a. Cost and convenience of possible screening tests
b. Communitys culture and support for such screening tests
c. Number and type of volunteers available to assist
d. The health risks inherent in the target population
e. The best photos to use in community advertising
f. Needs of the local community-based agencies
ANS: A, B, C, D
The primary deciding factor is what health risks are present in the target population. Additional variables to be considered include significant health problems in the community; support available from the community, including cultural issues and possible volunteers; and the use of screening tests that are safe, simple to administer, and cost-effective. Although publicity is often very helpful, photographs should not be a primary consideration. Moreover, although the needs of community agencies may be a consideration, it is not of primary concern in the planning of a health fair.

DIF: Cognitive Level: Application REF: p. 499

2. What variables are considered in the decision as to which screening tests are to be performed at a health fair? (Select all that apply.)
a. A national day dedicated to a specific screening
b. Preferences of the local politicians who support such events
c. Preferences of the local church, which donated space to be used for the event
d. The learning needs of the senior nursing students who are going to be helping
e. The sociodemographics of the population that will probably attend
f. What donations the nurse or the clinic has received
ANS: A, E
On a population level, choice of screening test is based on general sociodemographic factors rather than individual risk factors. Age, gender, and ethnicity factors affect the risk status of a population. Hence, population data are an important consideration in the planning of a health fair. The other population-based screenings can be offered in conjunction with national screening days.

DIF: Cognitive Level: Application REF: p. 499

3. Nursing students were setting up a meeting to finalize plans for a health fair. Of the following people, who must be included? (Select all that apply.)
a. All the health care personnel who will be doing the screenings
b. Community leaders who are actively involved in neighborhood activities
c. Local politicians who will enjoy having their pictures in the media
d. Philanthropists who might contribute funds for additional screening tests if their names are publicized
e. Staff from the health department that is sponsoring the fair
f. Volunteers who will help collect the consent forms and other tasks
ANS: A, B, F
Although the students might invite anyone, the persons who are most important are those who may help secure needed resources or who will help implement the program. These include health care personnel, volunteers, and community leaders.

DIF: Cognitive Level: Application REF: p. 490

4. Which screening tests would be most useful at a health fair at a local YMCA that serves young adults? (Select all that apply.)
a. Measurements of blood pressure, blood glucose level, and cholesterol level
b. Measurements of height and weight
c. Mammography and prostate examination
d. Purified protein-derivative skin test (PPD) and review of immunizations
e. Stool for occult blood and sigmoidoscopy
f. Vision and hearing
ANS: A, B
On the basis of the age group that would be screened, the blood pressure, cholesterol, and diabetes screening would be most useful. Height and weight measurements are useful for assessing obesity, which is a risk factor for heart disease and stroke, two of the three leading causes of death in Americans. Tests such as mammography, prostate examinations, and stool for occult blood and sigmoidoscopy are more typically used in older populations. PPD, review of immunizations, and vision and hearing screenings are not necessary for a population of young adults.

DIF: Cognitive Level: Synthesis REF: p. 496

5. A nurse was trying to determine what resources might be available to support a screening program for middle-aged adults in the local community. The nurse should be sure to assess which variables? (Select all that apply.)
a. Cost and funding sources
b. Equipment and personnel to run the screening tests
c. Free newspaper publicity
d. Local diagnostic and treatment resources
e. Temporary personnel who could be hired to assist
f. Volunteers to help with the screening
ANS: A, B, D, F
Practical resources needed to support screening programs include funding, personnel, equipment, volunteers, follow-up diagnostic and treatment services, and support by key community leaders. Temporary employees would not typically be hired. With the low literacy rates, newspapers should not be the only public notification used. Rather, media should include flyers, mass mailings, and notices on community websites and local advertisements on radio and television, as well as in newspapers.

DIF: Cognitive Level: Synthesis REF: p. 496

6. A volunteer explained to a nurse that a certain client did not wish to fill out the information/consent form. What should the nurse explain to the client as to why the form was required? (Select all that apply.)
a. The agency requires such forms to document personnel time.
b. The information serves as data for duplicating the screening in the future.
c. You may wish to keep these data so that they are available for needed follow-up.
d. The form is needed for student education; the data are collated to determine community-wide needs.
e. Consent is needed before any tests, particularly invasive ones, are administered.
f. The data are used for program evaluation so that more such screenings may be available.
ANS: C, E, F
Easy-to-use forms are typically used to document the data for counseling, instruction, and referral information. They provide test results for the participant and future providers, as well as for program evaluation. Consent is legally required before invasive screening measures such as blood measurements. It is hoped that students will use general sociodemographic variables such as age, gender, and ethnicity rather than a biased sample from one screening for determining community-wide needs. Agencies would assign personnel, so they would not need patients to fill out forms to confirm personnel activity.

DIF: Cognitive Level: Synthesis REF: p. 498

7. The nursing students created a media spot to publicize a free screening for undergraduates to be held at the college. What must the students remember to do? (Select all that apply.)
a. Discuss how listeners would benefit by attending.
b. Emphasize the program is being given for everyones benefit.
c. Keep the message short, at about 30 seconds or 75 words.
d. Require that the ads run late in the evening when most students listen to the radio and watch television.
e. Stress the health risks that students face that may be diagnosed at this screening.
f. Use lots of visual aids to help listeners visualize the experience.
ANS: A, C
Such media spots must be short (30 seconds or 75 words) and clarify how listeners will benefit. Fear (stressing the health risks) is not an effective long-term strategy. Visual aids would not be very effective with radio, which is an auditory medium. The screening is not for everyone, but for the college students (not staff or faculty). Although the students can request a late evening advertisement, the channels air public service announcements at whatever time they choose.

DIF: Cognitive Level: Synthesis REF: p. 499

8. A nurse is referring a client who needs follow-up care. Which of the following actions should the nurse take? (Select all that apply.)
a. Asking whether the client prefers to have the nurse make all the arrangements
b. Assessing whether the client meets the eligibility requirements for the receiving agency
c. Discussing with the client the payment mechanism for follow-up care
d. Determining whether the client is interested in following up at that particular agency
e. Arranging for the client to have transportation and child care available
f. Contacting several agencies in the area to see whether they are willing to accept a referral
ANS: B, C, D
The nurse must be sure the client meets eligibility requirements and is interested in the referral. The nurse must be aware of the payment mechanism that will be used for follow-up care so the client can be given names of community resources that are able to provide care on the basis of the source of payment. Contacting agencies about follow-up before the other actions with a client referral are completed is premature. Most agencies cannot provide free transportation and child care for clients to attend a different agency. It would encourage dependency for the nurse to make all the arrangements and then announce to clients what they should do. The client must be actively involved in follow-up care.

DIF: Cognitive Level: Synthesis REF: pp. 500-501

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