Community - Week 3 (Ch 9 10) - Evolve Questions Flashcards
Clinical medicine and epidemiology differ from each other in the major aspect of: A. practice focus. B. health monitoring. C. determinants of health and disease. D. evaluation of interventions.
A. practice focus.
Epidemiology is the study of populations to monitor the health of the population, understand the determinants of health and disease in communities, and investigate and evaluate interventions to prevent disease and maintain health. Epidemiology focuses on populations, whereas clinical medicine focuses on the diagnosis and treatment of disease in individuals. Epidemiology studies populations to determine the causes of health and disease in communities and to investigate and evaluate interventions that will prevent disease and maintain health. Epidemiologic methods are used extensively to determine to what extent the goals of Healthy People 2020 (U.S. Department of Health and Human Services, 2010) have been met and to monitor the progress of those objectives not fully met at present.
DIF: Cognitive Level: Application
REF: Page 151
Nurses in community health often use epidemiology because in the community it is often difficult to control the environment. Which of the following statements demonstrates an epidemiologic strategy for monitoring disease trends?
A. A nurse in community health conducts an education class for clients newly diagnosed with diabetes.
B. A nurse in community health investigates a breakout of whooping cough in a local middle school.
C. A nurse in community health organizes a health fair at the community health center.
D. A nurse in community health participates on a county school board that addresses student health issues.
B. A nurse in community health investigates a breakout of whooping cough in a local middle school.
Nurses are a key part of the interdisciplinary team in community settings and often use epidemiology to look at health and at disease causation and how to both prevent and treat illness. Nurses use epidemiology in the community to examine factors that affect the individual, family, and population group because it is more difficult to control these factors in the community than in the hospital. Community health nurses who conduct education classes, organize health fairs and address student health issues are using prevention strategies.
DIF: Cognitive Level: Application
REF: Page 154
One of the basic concepts in epidemiology is the concept of risk. Risk refers to the:
A. prevalence of an event occurring.
B. probability that an event will occur within a specified time period.
C. population most likely to develop a disease.
D. rate of development of new cases.
B. probability that an event will occur within a specified time period.
Risk refers to the probability that an event will occur within a specified time period. A population at risk is the population of persons for whom there is some finite probability (even if small) of that event occurring. Incidence rates and proportions measure the rate of new case development in a population and provide an estimate of the risk of disease.
DIF: Cognitive Level: Knowledge
REF: Page 156
Twenty people attended a church picnic the previous weekend. By Monday, four individuals exhibited symptoms of food poisoning. On Tuesday, the nurse in community health records the addition of two new cases. The incidence rate would be: A. two new cases divided by 16 at risk. B. two new cases divided by 20. C. six cases divided by 20. D. four cases divided by 16.
A. two new cases divided by 16 at risk.
An incidence rate quantifies the rate of development of new cases in a population at risk, whereas an incidence proportion indicates the proportion of the population at risk that experiences the event over some period of time (Rothman, 2002). The population at risk is considered to be persons without the event or outcome of interest but who are at risk of experiencing it. People who already have the disease or outcome of interest are excluded from the population at risk for this calculation because they already have the condition and are no longer at risk of developing it.
DIF: Cognitive Level: Application
REF: Page 156
A breast cancer screening program screened 8000 women and discovered 35 women previously diagnosed with breast cancer and 20 women with no history of breast cancer diagnosed as a result of the screening. The prevalence proportion would reflect:
A. current and past breast cancer events in this population of women.
B. newly diagnosed cases of breast cancer in this population of women.
C. past breast cancer events in this population of women.
D. the population of women that had no evidence of breast cancer.
A. current and past breast cancer events in this population of women.
The prevalence proportion is a measure of existing disease in a population at a particular time (i.e., the number of existing cases divided by the current population). A prevalence proportion is not an estimate of the risk of developing disease, because it is a function of both the rate at which new cases of the disease develop and how long those cases remain in the population. In this example, the prevalence of breast cancer in this population of women is a function of how many new cases develop and how long women live after the diagnosis of breast cancer.
DIF: Cognitive Level: Application
REF: Page 157
A business executive develops symptoms of the flu 1 day after returning by air from a cross-Atlantic business trip that ran for 2 consecutive stressful 10-hour days. This individual's development of flu symptoms illustrates the relationship between: A. host and agent. B. host, agent, and environment. C. risk and causality. D. morbidity and disease.
B. host, agent, and environment.
Epidemiologists understand that disease results from complex relationships among causal agents, susceptible persons, and environmental factors. These three elements—agent, host, and environment—are called the epidemiologic triangle. Changes in one of the elements of the triangle can influence the occurrence of disease by decreasing or increasing a person’s risk for disease. The associations between risk and causality, morbidity and disease do not demonstrate the relationship to the development of flu.
DIF: Cognitive Level: Application
REF: Page 159
A nurse in community health who teaches a client with asthma to recognize and avoid exposure to asthma triggers and assists the family in implementing specific protection strategies such as removing carpets and avoiding pets is intervening at the level of: A. assessment. B. primary prevention. C. secondary prevention. D. tertiary prevention.
C. secondary prevention.
Primary prevention refers to interventions that promote health and prevent the occurrence of disease, injury, or disability. Interventions at this level are aimed at individuals and groups who are susceptible to disease but have no discernable pathology (state of prepathogenesis). In this case, the client has already has asthma, so the nurse teaches the client to recognize and avoid exposure to asthma triggers. This is an example of secondary prevention. Health screenings are at the core of secondary prevention. Tertiary prevention includes interventions aimed at limiting disability and interventions that enhance rehabilitation from disease, injury, or disability. Assessment is a component of epidemiology.
DIF: Cognitive Level: Application
REF: Pages 160-161
A nurse is concerned about the accuracy of the PPD test in identifying cases of TB exposure for follow-up chest x-ray. The nurse's concern is addressing the validity measure of: A. reliability. B. sensitivity. C. specificity. D. variation.
B. sensitivity.
Validity of a screening test is measured by sensitivity and specificity. Sensitivity quantifies how accurately the test identifies those with the condition or trait. Sensitivity represents the proportion of persons with the disease whom the test correctly identifies as positive (true positives). High sensitivity is needed when early treatment is important and when identification of every case is important. Reliability is the consistency of repeating a measure and is affected by variation in results. Specificity indicates how accurately the test identifies those without the condition or trait.
DIF: Cognitive Level: Application
REF: Page 162
Analytic epidemiology differs from descriptive epidemiology because it searches for: A. "when" of disease patterns. B. "where" of disease patterns. C. "why" of disease patterns. D. "who" of disease patterns.
C. “why” of disease patterns.
Descriptive epidemiology describes the distribution of disease, death, and other health outcomes in the population according to person, place, and time—the who, where, and when of disease patterns. Analytic epidemiology, on the other hand, searches for the determinants of the patterns observed—the how and why of disease patterns.
DIF: Cognitive Level: Knowledge
REF: Page 164
Which of the following tools are used in analytic epidemiology? (Select all that apply.) A. cohort study B. case-control study C. cross-sectional study D. clinical trials E. community trials
A. cohort study
B. case-control study
C. cross-sectional study
Analytic epidemiology deals with the factors that influence the observed patterns of health and disease and increase or decrease the risk of adverse outcomes. Analytic study designs include cohort studies, case-control studies, and cross-sectional studies. In experimental or intervention studies, the investigator initiates a treatment or intervention to influence the risk or course of disease. These studies test whether interventions can prevent disease or improve health. Clinical trials and community trials are examples of experimental studies.
DIF: Cognitive Level: Knowledge
REF: Pages 166-169
The nurse who works in the community setting must ensure that the application of the best available evidence to improve practice is also:
A. accessible and diverse.
B. competent and compliant.
C. culturally and financially appropriate.
D. reasonable and deliverable in a timely fashion.
C. culturally and financially appropriate.
Applied to nursing, evidence-based practice includes the best available evidence from a variety of sources, including research studies, evidence from nursing experience and expertise, and evidence from community leaders. Culturally and financially appropriate best practices need to be identified when working with communities instead of individuals. The use of evidence to determine the appropriate use of interventions that are culturally sensitive and cost-effective is a must.
DIF: Cognitive Level: Application
REF: Page 176
The gold standard of evidence gathering in evidence-based practice is: A. clinical knowledge and judgment. B. expert opinions. C. randomized clinical trials. D. theories of practice.
C. randomized clinical trials.
A hierarchy of evidence, ranked in order of decreasing importance and use, has been accepted by many health professionals. The double-blind randomized controlled trial (RCT) generally ranks as the highest level of evidence. Some nurses would argue that this hierarchy ignores evidence gained from clinical experience. However, the definition of evidence-based nursing presented above indicates that clinical expertise as evidence, when used with other types of evidence, is used to make clinical decisions.
DIF: Cognitive Level: Knowledge
REF: Page 177
One reason that nursing may be slow in developing evidence-based practice (EBP) in the community setting may be the lack of understanding about the links between EBP and: A. evidence gathering. B. research design. C. research funding. D. research use.
D. research use.
EBP represents a cultural change in practice. It provides an environment to improve both nursing practice and client outcomes. Several factors have been identified in the literature that support implementation of EBP or that will need to be overcome for nursing and other disciplines to successfully implement EBP. These factors include knowledge of research and current evidence and the ability to interpret evidence, among other factors. Gathering of evidence, research design and funding are not associated with the slower development of EBP for nursing.
DIF: Cognitive Level: Application
REF: Page 178
When a community health nurse uses evidence-based practice (EBP) to evaluate effectiveness, accessibility, and quality of personal and population-based services, the nurse is addressing the core public health function of: A. assessment. B. assurance. C. policy development. D. research.
B. assurance.
When a community health nurse uses evidence-based practice (EBP) to evaluate effectiveness, accessibility, and quality of personal and population-based services, the nurse is addressing the core public health function of assurance. Assessment occurs when the nurse uses evidence-based practice for new insights and innovative solutions to health problems. When the nurse develops policies and plans using evidence-based practice that supports individual and community health efforts, the public health function of policy development is being addressed.
DIF: Cognitive Level: Knowledge
REF: Page 185 (Table 10-1)
When applying evidence-based practice (EBP), community-oriented nurses are primarily obligated to ensure that evidence applied to practice is:
A. acceptable to the community.
B. contains cost and reduces legal liability.
C. applied as a universal remedy.
D. limited to research findings.
A. acceptable to the community.
Public health nurses consider EBP as a process to improve practice and outcomes and use the evidence to influence policies that will improve the health of communities.
The following issues relate to the current status of EBP and nursing:
· Cost versus quality—Nurses must question whether the current agenda to contain health care costs creates pressure to focus on those research results that favor cost savings at the expense of quality outcomes for clients.
· What is evidence?—Research findings, knowledge from basic science, clinical knowledge, and expert opinion should all be considered sources of evidence for EBP—none is sufficient alone.
· Individual differences—EBP cannot be applied as a universal remedy without attention to client differences because it may not be sensitive to cultural issues and distinctions and therefore may not be acceptable to the community.
· Appropriate EBP methods for community-oriented nursing practice. Nursing has a legitimate role to play in interdisciplinary community health practice, and nurses are obligated to ensure that evidence applied to practice is acceptable to the community.
DIF: Cognitive Level: Application
REF: Page 183
