Chapter 7: Epidemiology: Unraveling the Mysteries of Disease and Health Nursing School Test Banks

Chapter 7: Epidemiology: Unraveling the Mysteries of Disease and Health

Test Bank

MULTIPLE CHOICE

1. Who was the first nurse epidemiologist who pioneered the use of statistics to improve public health?

a.

Dorothea Dix

b.

Florence Nightingale

c.

Lillian Wald

d.

Sue Barton

ANS: B

Florence Nightingale used statistics to show changes in outcomes as hospital conditions improved during the war because of nurses.

DIF: Cognitive Level: Knowledge REF: p. 162

2. A nurse noted that 15 people became very ill while eating at the school banquet for the basketball team. To calculate the rate of illness, what other fact does the nurse need?

a.

How many athletes were honored for being on the team

b.

How many parents and family members attended the banquet

c.

How many people ate at the banquet

d.

How many people live in the school district

ANS: C

To be able to calculate the rate, the nurse needs to know how many (15) of the total population (the missing number) became ill at the event. Therefore, the nurse needs to know how many people ate at the banquet.

DIF: Cognitive Level: Application REF: p. 162

3. A rate might be accurately defined as

a.

Another term for ratio.

b.

A way of determining the incidence of disease in a group.

c.

A way to make comparisons among equal-size populations.

d.

The number of events divided by the number of persons at risk.

ANS: D

A rate is a fraction in which the numerator is the actual number of events and the denominator is the total population at risk; this fraction is converted to a standard base to enable comparisons between various population groups of any size.

DIF: Cognitive Level: Knowledge REF: p. 162

4. A nurse was asked whether the agency should offer additional health promotion programming for young mothers in the Two Oaks neighborhood or the Centerville neighborhood. Two Oaks is a village that has a population of 4000 persons, of whom 50 are single mothers, whereas Centerville is an urban area of 15,000 people, of whom 150 are single mothers. On the basis of this information, which of the following would be the best response by the nurse?

a.

Additional programming will be helpful and appropriate in either neighborhood.

b.

The nurse needs to know the total number of children in these neighborhoods before making a decision.

c.

The nurse should choose to focus on single mothers in Centerville.

d.

The nurse should choose to focus on single mothers in Two Oaks.

ANS: D

Single mothers are a population that is considered to be a high-risk group. Because Two Oaks has a higher rate of single moms than Centerville does, it would be important for the nurse to offer additional health promotion programming in this community.

DIF: Cognitive Level: Synthesis REF: p. 170

5. Assuming that City A has a murder rate of 12 per 100,000 population and City B has a murder rate of 24 per 100,000 population, which city has the more worrisome problem?

a.

The answer cannot be determined from these data.

b.

City A has the more worrisome problem.

c.

City B has the more worrisome problem.

d.

Both cities have equally worrisome problems.

ANS: C

Because City B has a murder rate of 24:100,000, whereas City A has a rate of 12:100,000, the murder rate in City B is twice as high as that in City A and hence has the more challenging problem.

DIF: Cognitive Level: Application REF: p. 163

6. A nurse was given the following data about the children attending school in two area communities:

School

Asthmatic Children

Number of Children in School

Number of Persons in Community

Centerville Elementary

25

1000

15,000

Centertown Suburban Elementary

25

1000

15,000

Centerville Junior High

35

1500

15,000

Two Oaks Elementary

5

200

5000

Two Oaks Junior High

10

300

5000

Totals:

100

4000

55,000

What is the rate of asthma in the school-age population?

a.

5:1000

b.

25:1000

c.

100:20,000

d.

400:2000

ANS: B

With 100 asthmatic children among 4000 total children, the rate is 100:4000, simplified to 25:1000.

DIF: Cognitive Level: Application REF: p. 162

7. A community/public health nurse needs to conduct a descriptive study of the health needs of elderly persons attending a congregate meal at the local community center. Therefore, the nurse would

a.

Divide the elderly population into two groups (healthy and unhealthy), teach courses on healthy lifestyles, and then measure any changes.

b.

Use two randomly chosen groups, teach healthy lifestyles to all participants, and then determine learning through a posttest.

c.

Divide the elderly population into two randomly chosen groups, teach healthy lifestyles to one group, and then determine differences in knowledge between the two groups.

d.

Screen each elderly person and look for patterns in the findings related to health problems that necessitate attention.

ANS: D

Descriptive studies focus on the amount and distribution of disease within a population; thus, screening would give the nurse information on the health needs of the elderly population as a whole.

DIF: Cognitive Level: Application REF: p. 163

8. A nurse was assigned to work with technology-dependent schoolchildren. What kind of study would the nurse most likely conduct to help determine the needs of these children?

a.

A case-control study to compare these children with children who are not technology-dependent

b.

A cross-sectional study of school-based variables affecting the children

c.

A descriptive study regarding prevalence of technology dependence among the total school population

d.

An analytic study to determine causes of the childrens problems

ANS: B

There would be no point in comparing the technology-dependent children with children who are not technology-dependent or in trying to determine the causes of the childrens problems. A descriptive study of prevalence might be helpful if it focused on the different types of dependencies, which might provide hints about community problems. However, a cross-sectional study (performed at one time) to determine other needs might be very useful as the nurse plans nursing care for the group.

DIF: Cognitive Level: Synthesis REF: p. 163

9. A school nurse was concerned about the prevalence of obesity in the elementary school classes. On the basis of the literature, the nurse decided to ask each student whether he or she ate breakfast before coming to school in the morning. Which type of study is the nurse conducting?

a.

Experimental

b.

Case-control

c.

Correlational

d.

Clinical trial

ANS: C

In a correlational study, investigators look for associations between two factorsin this case, between obesity and possible contributing factors. Experimental studies must involve two groups of people: a control group and an experimental group. Case-control studies are retrospective because the study begins after the health outcome has already occurred. In this case, a case-control study would be performed if only the obese children were asked the question. A clinical trial is similar to an experimental study.

DIF: Cognitive Level: Application REF: p. 164

10. A school nurse decided to begin a dont smoke, dont start program. To determine whether the program has any effect, an experimental trial study was planned. Which of the following actions would the nurse take?

a.

Divide the students into two groups (smokers and nonsmokers), teach the course to both groups, and then observe for changes in beliefs.

b.

Divide the students into two randomly chosen groups, teach the program to all students, and then determine learning and smoking behaviors through a posttest.

c.

Use two randomly chosen groups, teach the program to one group, and then determine differences in knowledge and smoking behaviors between the two groups.

d.

Screen each student, and look for evidence of smoking behaviors.

ANS: C

Because the nurse is planning an experimental trial study, the only option that demonstrates this type of approach with randomization and control is to randomly choose two groups, teach the program to one group, and then determine the differences between the two groups.

DIF: Cognitive Level: Application REF: p. 164

11. The school nurse set up a dont smoke, dont start program that focused on children who did not smoke. Which of the following stages of disease was the focus of the program?

a.

Adaptation

b.

Convalescence

c.

Pathogenesis

d.

Prepathogenesis

ANS: D

Before smoking, the students would be in the prepathogenesis stage because no disease is currently present. They would be susceptible to disease if they began smoking.

DIF: Cognitive Level: Application REF: p. 165

12. In a dont smoke, dont start program, the school nurse decided to focus on all aspects of the epidemiologic triangle. Which of the following would the nurse include?

a.

The benefits of smoking, the risks of smoking, and the expense of smoking

b.

The pleasures of smoking, the risks of smoking, and the costs of smoking

c.

The risks of nicotine, genetic factors related to nicotine absorption, and media pressures to smoke

d.

The risks of nicotine, the cost of smoking, and the taxes on cigarettes

ANS: C

The three aspects of the epidemiologic triangle are the agent factors, host factors, and environmental factors. This is best represented by the risks of nicotine (agent), genetic factors related to absorption (host), and the media pressures to smoke (environmental).

DIF: Cognitive Level: Analysis REF: p. 165

13. Which is the best reason why children to choose to smoke?

a.

Movies that show heroes and heroines always smoking

b.

Multiple factors, including media and peer pressure

c.

The addictive effects of nicotine

d.

The tobacco companies, which advertise heavily

ANS: B

As the web-of-causation model and other multiple causation models demonstrate, multiple factors, including media and peer pressure, interact to affect health behaviors.

DIF: Cognitive Level: Analysis REF: p. 166

14. Which of the following facts would be most helpful to the nurse who is creating a campaign to prevent teenagers from using alcohol?

a.

The number of advertisements for alcohol that are currently being published in national magazines and newspapers

b.

The number of lead characters in national TV series who consume alcohol on camera

c.

The number of local physicians who stress avoiding alcohol use while examining their teenage clients

d.

The prevalence of alcohol use among students in the nurses school

ANS: D

There are multiple factors associated with the choice made by teenagers to consume alcohol. The nurse must analyze the factors and determine what factors can be influenced through a campaign. All of the answers reflect factors in use of alcohol by teenagers; however, the only factor the nurse can influence is the alcohol use by students at the nurses school.

DIF: Cognitive Level: Synthesis REF: p. 166

15. When the school nurse discovered three sixth-graders smoking behind a delivery truck in the school parking lot, the nurse could accurately conclude that the three smokers were _____ lung disease.

a.

At risk for

b.

In the early lesional stage of

c.

In the latency period of

d.

In the pathogenesis stage of

ANS: A

On the basis of the limited information in the question, only at risk for lung disease can be accurately concluded without more data as to length of smoking, number of cigarettes per day, coughing, other symptoms, and so on.

DIF: Cognitive Level: Analysis REF: p. 167

16. The community/public health nurse is performing tuberculosis screening for newly hired employees at the local hospital. Which of the following best describes this nursing intervention?

a.

Not required by law and unnecessary

b.

Primary prevention

c.

Secondary prevention

d.

Tertiary prevention

ANS: C

This screening constitutes secondary prevention because the screening would lead to possible diagnosis and treatment of those with tuberculosis.

DIF: Cognitive Level: Application REF: p. 167

17. The community/public health nurse invites a dietitian to a healthy lifestyles program to discuss fun ways to eat vegetables and fruits as snacks. Which of the following best describes this nursing intervention?

a.

Disability limitation

b.

Primary prevention

c.

Secondary prevention

d.

Tertiary prevention

ANS: B

This intervention would be considered primary prevention, as poor eating habits may lead to obesity and chronic diseases such as diabetes later in life.

DIF: Cognitive Level: Application REF: p. 166

18. The community/public health nurse leads a support group for clients and their families who have been affected by cancer. Which of the following best describes this nursing intervention?

a.

Specific protection

b.

Primary prevention

c.

Secondary prevention

d.

Tertiary prevention

ANS: D

Support groups are considered tertiary prevention. The clients and their families have already been affected by cancer, and the nurse is assisting them to prevent further problems.

DIF: Cognitive Level: Application REF: p. 168

19. Why is the data from the National Notifiable Diseases Surveillance System (NNDSS) not absolutely accurate?

a.

A great deal of data is lost en route from physician to NNDSS.

b.

Computer operators do not always enter data accurately.

c.

Not all cases of such diseases are managed or are reported.

d.

Not all physicians know or obey the law to report cases to the NNDSS.

ANS: C

The law requires reporting diseases to the state agencies, but reporting to the Centers for Disease Control and Prevention (CDC) or NNDSS is voluntary. Furthermore, not all affected patients receive medical care, and not all treated cases are reported. In addition, the completeness of reporting varies.

DIF: Cognitive Level: Comprehension REF: p. 168

20. Which of the following data is collected by the U.S. Department of Commerce?

a.

Health of businesses in America

b.

Locations of all hospitals and clinics

c.

Property values in each county and state

d.

Growth in areas of the country

ANS: D

The U.S. Department of Commerce collects data related to health and economics, including which area of the country is growing the fastest, which state has the highest median age, household and family data, fertility data, numbers in the labor force, and poverty and unemployment rates.

DIF: Cognitive Level: Knowledge REF: p. 168

21. Which of the following is a problem with using death certificates to determine major causes of death in the population?

a.

The focus is on the immediate cause or disease, not the underlying causes.

b.

The legal cause of death is stated, instead of the medical cause.

c.

Information provided for older adults is more accurate than that for younger adults.

d.

Death certificates are difficult to interpret with all the comorbid conditions.

ANS: A

Death certificates are reports of the immediate cause of death, such as lung cancer, but not the underlying causes of death, such as smoking for 20 years. Because comorbid conditions are not listed, the certificates are more accurate for young adults who die from a particular cause than for older adults who may have died from a combination of health problems. The text in Chapter 7 does not clearly state that immediate causes are reported, but it does imply the problems with reporting the disease, not the cause of the disease.

DIF: Cognitive Level: Comprehension REF: p. 169

22. Which of the following is the rate most widely used to compare the health of populations across countries?

a.

Birth rate

b.

Crude mortality rate

c.

Rate of death from human immunodeficiency virus (HIV) infection

d.

Infant mortality rate

ANS: D

The infant mortality rate is extremely sensitive and, if high, indicates unmet health needs or an unfavorable environment, or both. Therefore, the infant mortality rate is used for determining changes in level of health over time and for cross-country comparisons.

DIF: Cognitive Level: Knowledge REF: p. 172

23. Which of the following factors is positively correlated with having a baby of low birth weight?

a.

Engaging in regular exercise

b.

Receiving early prenatal care

c.

Having multiple sexual partners

d.

Using illicit drugs, alcohol, or tobacco

ANS: D

Low birth weight in newborns is correlated with late prenatal care, maternal age of younger than 18 years, dieting or poor nutrition, and use of illicit drugs, alcohol, or tobacco.

DIF: Cognitive Level: Comprehension REF: pp. 172-173

24. The school nurse decides to implement a health promotion program for the parents of the school-age children. Which of the following topics would be most important for the nurse to include?

a.

Eating a nutritious diet

b.

Exercising and sleeping well

c.

Promoting creative play

d.

Performing a safety check in the home

ANS: D

Although all items would be useful, a focus on safety would be most helpful in avoiding preventable injuries, which is the major cause of death in school-age children.

DIF: Cognitive Level: Analysis REF: p. 178

25. The state legislators were discussing the high injury rate among individuals between 15 and 24 years of age. Which of the following factors is involved in most of these injuries?

a.

Guns

b.

Gangs

c.

Motor vehicles

d.

Sharp objects (knives) and blunt objects (such as baseball bats)

ANS: C

Most injuries among persons between 15 and 24 years of age involve motor vehicles, of which 35% also involve alcohol.

DIF: Cognitive Level: Application REF: p. 179

26. A nurse volunteered to help 1 day a week at the senior citizens center in the community. Which of the following would be the best intervention that the nurse could perform to promote health?

a.

Contribute all fabric and scrapbooking supplies for the participants to use.

b.

Encourage everyone to be involved in a basic physical exercise class.

c.

Lead a life history class with a focus on reminiscence.

d.

Teach good nutrition and low-cost diet choices.

ANS: B

Although all these measures might be useful, the key to physiologic decline is lack of physical activity; therefore, any exercise program would be most helpful.

DIF: Cognitive Level: Analysis REF: p. 180

27. The leading cause of death by a wide margin in young U.S. adults aged 25 to 44 is

a.

Alzheimers disease.

b.

Cardiac disease.

c.

Malignant neoplasms.

d.

Unintentional injury.

ANS: D

According to Table 7-8, the leading cause of death in young U.S. adults aged 25 to 44 is unintentional injury.

DIF: Cognitive Level: Knowledge REF: p. 180

28. The primary causes of death in the United States among adults aged 65 and older are

a.

Alzheimer disease, cardiac disease, and chronic lower respiratory tract diseases.

b.

Alzheimer disease, cardiac disease, and diabetes mellitus.

c.

Cardiac disease, malignant neoplasms, and cerebrovascular disease.

d.

Cardiac disease, cerebrovascular disease, and diabetes mellitus.

ANS: C

According to Table 7-9, the top three causes of death in the United States among adults aged 65 and older are diseases of the heart, malignant neoplasms, and cerebrovascular diseases.

DIF: Cognitive Level: Knowledge REF: pp. 182-183

29. Which of the following groups would be considered most at risk to have poor health?

a.

The adolescents in the high school hobby club

b.

The adults who met for the Stop Shopping therapy group

c.

The women who met once a week to discuss the challenges of single parenthood

d.

The group of homeless women who were trying to find low-rent apartments

ANS: D

Poverty is the factor most highly correlated with poor health. Thus, the homeless women who are trying to find low-rent apartments would be the group most at risk for health problems.

DIF: Cognitive Level: Analysis REF: p. 183

30. Which of the following is the primary underlying factor for differences in health status in the United States?

a.

Minority status

b.

Geographic location

c.

Sexual behavior

d.

Poverty or socioeconomic status

ANS: D

Poverty and socioeconomic status have the greatest effect on differences in health status in the United States.

DIF: Cognitive Level: Comprehension REF: p. 183

MULTIPLE RESPONSE

1. Incidence data are especially helpful for what purposes? (Select all that apply.)

a.

Evaluating treatments that prolong life

b.

Measuring the rate of new illnesses in a population

c.

Assessing risks associated with particular illnesses

d.

Determining health care personnel needs

e.

Illustrating whether interventions are effective

f.

Planning health care services and facilities

ANS: B, C, E

Incidence rates are important because they are a direct measure of the magnitude of new illnesses in a population and enable investigators to assess the risks associated with particular illnesses. Because it is a relatively rapidly changing number, incidence also illustrates whether preventive health measures are effective.

DIF: Cognitive Level: Comprehension REF: p. 184

2. How can prevalence data be helpful? (Select all that apply.)

a.

In evaluating treatments that prolong life

b.

In measuring the rate of new illnesses in a population

c.

In assessing risks associated with particular illnesses

d.

In determining health care personnel needs

e.

In representing new cases of an illness in a population

f.

In planning health care services and facilities

ANS: A, D, F

Prevalence rates represent all cases of an illness and have relevance for planning health care services, resources, and facilities; for determining health care personnel needs; and for evaluating treatments that prolong life. Incidence rates are important because they are a direct measure of the magnitude of new illnesses in a population and enable investigators to assess the risk associated with particular illnesses.

DIF: Cognitive Level: Comprehension REF: p. 184

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