Foundations of Nursing 3rd Edition Stanhope Lancaster Test Bank

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Foundations of Nursing 3rd Edition Stanhope Lancaster Test Bank

ISBN: 9780323066556



Foundations of Nursing 3rd Edition Stanhope Lancaster Test Bank

ISBN: 9780323066556




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Stanhope: Foundations of Nursing in the Community: Community-Oriented Practice, 3rd Edition


Chapter 15: Surveillance and Outbreak Investigation


Test Bank




  1. A nurse seriously considered copying last month’s surveillance report and changing the date since the number of occurrences per month had not noticeably changed in the entire time the nurse had worked at the local department. If the data are always about the same, why spend time continuing to collect and report it?
a. Because such data are legally required
b. Because it is still part of the nurse’s responsibilities, even if it is a waste of time
c. To determine a local baseline rate and immediately notice any change
d. To determine differences among communities in need for state assistance



ANS:   C

Disease surveillance helps establish baseline (endemic) rates of disease occurrence and patterns of spread. Surveillance makes it possible to initiate a rapid response to an outbreak of a disease or event that can cause a health problem.


DIF:    Cognitive Level: Application             REF:    p. 273


  1. Why is it so crucial that nurses be knowledgeable about public health surveillance?
a. Because nurses are employed in public health agencies
b. Because nurses are often the first to recognize and respond to a problem
c. Because nurses are responsible for ensuring that action is taken when necessary
d. Because nurses are typically the ones to interact with the public and the media



ANS:   B

Nurses are often in the forefront of responses to be made in the surveillance process whether working in a small rural agency or a large urban agency; within the health department, school, or urgent care center; or on the telephone performing triage services during a disaster. It is the nurse who sees the event first.


DIF:    Cognitive Level: Application             REF:    p. 273


  1. Why would a rural public health nurse spend time reviewing death certificates?
a. To ensure that local causes of death are consistent with national causes of death
b. To confirm that no local health problems are beginning
c. To evaluate effectiveness of health promotion programs
d. To obtain mortality data for the local area



ANS:   D

Mortality data are often the only source of health-related data available for small geographic areas. Vital statistics reports such as death certificates are reviewed. Useful information also comes from administrative data such as discharge reports and billing records.


DIF:    Cognitive Level: Application             REF:    p. 274


  1. What is the type of surveillance when case reports are routinely sent to local health departments by health care providers and laboratories, where the data are then summarized and forwarded to those responsible for monitoring such reports?
a. Active surveillance
b. Passive surveillance
c. Sentinel surveillance
d. Special surveillance



ANS:   B

It is passive surveillance when case reports are sent to local health departments by health care providers or laboratories. The case reports are summarized and forwarded to the state health department, national government, or organizations responsible for monitoring the problem, such as the CDC. In active surveillance, the health department nurse may begin a search for cases through contacts to determine the magnitude of the problem. Sentinel surveillance involves looking for trends. Special surveillance is developed when a particular type of data is sought.


DIF:    Cognitive Level: Knowledge             REF:    p. 276


  1. In which situation would the nurse use active surveillance?
a. A newspaper wants to know the incidence of asthma in the community.
b. A real-time ongoing communication channel is established to monitor a particular symptom.
c. Several children become ill with GI upset at one local school.
d. The nurse is asked to report the incidence of a specific nonreportable common problem in the community.



ANS:   C

In active surveillance, the nurse may begin a search for cases to determine the magnitude of the problem (how widespread it is). An example would be when several school children become ill after eating lunch in the cafeteria or at the local hot dog stand, in which case, active surveillance would be used to investigate the possibility of food poisoning.


DIF:    Cognitive Level: Application             REF:    p. 276


  1. Several children were hospitalized for severe vomiting and diarrhea. Why would the nurse continue to pursue the cause of the illness even after the children have been discharged from the hospital?
a. So that the children’s families know the public health department cared about them
b. So that action could be taken to avoid any such future episodes
c. Because the children’s parents need to know whom to sue for their medical expenses
d. To confirm that the symptoms were due to an infectious disease



ANS:   B

The objectives of an investigation are to control and prevent disease or death by identifying factors that contribute to the occurrence and implementing measures to prevent occurrences. In this case the nurse wanted to make sure children did not become ill again when it could be avoided.


DIF:    Cognitive Level: Application             REF:    p. 277


  1. A child came to school coughing almost constantly. The next day, six other children in the same school room were coughing. What might the nurse assume?
a. A common source outbreak
b. A mixed outbreak
c. A propagated outbreak
d. An intermittent outbreak



ANS:   A

A common source outbreak refers to a group exposed to a common noxious influence, in this case, the ill child who was attending school. The cause of the illness being spread is obvious.


DIF:    Cognitive Level: Application             REF:    p. 277


  1. A nurse noted that of 18 children in a day care center room, 5 became ill. What might be a host factor for some becoming ill and some not becoming ill?
a. Some of the children were from very low socioeconomic families.
b. Some of the children slept during rest time while others only rested.
c. The bacterial cause of the illness was easily removed by handwashing.
d. The day care center room was much warmer on three sides in comparison to the side with the floor to ceiling windows.



ANS:   A

Factors that must be considered as causes of outbreak are categorized as agents, hosts, and environmental factors. Host factors may be age, sex, raceRemember,cioeconomic status, genetics, and lifestyle choices. The cause of the illness is an agent factor, and the difference in temperature in the room is an environmental factor.


DIF:    Cognitive Level: Application             REF:    p. 278


  1. In January, a nurse is listening to colleagues talk about the increase in depressed patients asking for help from their physicians recently. The incidence of complaints of depression was higher in the last month than in the previous 3 months. Should the nurse investigate the community for increased stress levels?
a. No, because depression is known to worsen during the shorter darker days of winter
b. No, because this short-term increase may just be a statistical error or even just a mistaken impression by the involved nurses
c. Yes, because there must be some cause for this noted increase
d. Yes, because this increase may the beginning of an epidemic and should be investigated



ANS:   A

Typically, any unusual increase in incidence should be investigated. But in the majority of cases the increased incidence occurs naturally and/or is predictable when compared with the consistent patterns of previous outbreaks. Many illnesses are seasonal. Seasonal affective disorder (depression) often worsens during the shorter periods of daylight in the winter.


DIF:    Cognitive Level: Application             REF:    p. 278


  1. Which aspect of a biological agent is probably the most frightening to those exposed?
a. The agent’s infectivity
b. The agent’s invasiveness
c. The agent’s pathogenicity
d. The agent’s virulence



ANS:   D

Infectivity refers to the capacity of an agent to enter a susceptible host and produce infection or disease. Invasiveness is the ability of an agent to get into a susceptible host. Pathogenicity measures the proportion of infected people who develop the disease. Virulence refers to the proportion of people with clinical disease who become severely ill or die. It is assumed people could cope with illness but possible death is truly frightening for most.


DIF:    Cognitive Level: Knowledge             REF:    p. 278 (Box 15-5)




  1. How might a public health department be aware of an impending health problem before any problem is reported to the agency? Select all that apply.
a. Doctors are feeling rushed as they interact with each patient.
b. Emergency departments are notably busier than usual.
c. Nurses are calling in ill to the local hospital.
d. Pharmacists are discussing the increase in medication purchases.
e. School nurses are expressing dismay over student absenteeism.
f. X-ray departments and other labs are unusually behind.



ANS:   B, D, E, F

Doctors feeling rushed and nurses calling in ill are not unusual events. Syndromic surveillance systems were developed to monitor illness syndromes or events, as seen in such indirect measures as increased numbers of medication purchases, trips to physicians or emergency departments, orders for cultures or x-rays, and rising levels of school or work absenteeism. These may indicate that an epidemic is developing.


DIF:    Cognitive Level: Application             REF:    p. 272


  1. Surveillance systems were originally developed to monitor and reduce the spread of infectious disease. What are the purposes of such systems now? Select all that apply.
a. To obtain data used to fight for increased budgets from taxpayers
b. To evaluate the effectiveness of public health programs
c. To monitor and reduce the incidence of chronic diseases
d. To note and help prevent occupational exposure and diseases
e. To recognize the most common public health problems in a community
f. To validate the necessity for public health departments in every community



ANS:   B, C, D, E

Although surveillance was initially devoted to monitoring and reducing the spread of infectious diseases, it is now used to monitor and reduce chronic diseases and injuries, as well as environmental and occupational exposures. With tight budgets, public health workers must know which programs should be developed and continued based on the most commonly occurring public health problems. Evaluation of the effectiveness of programs requires valid and reliable data.


DIF:    Cognitive Level: Knowledge             REF:    pp. 272 and 273 (Box 15-2)


  1. When the outpatient health care data show a notable increase in asthma over the numbers treated the previous year, what action should the public health nurse take first? Select all that apply.
a. Analyze educational health programs offered the public last year.
b. Congratulate the public health staff on the success of their asthma awareness program.
c. Determine whether there are any other data sources that might confirm or dispute the apparent increase in asthma.
d. Discuss with school health nurses any changes in the school system during the past year.
e. Meet with local physicians about any changes in morbidity they’ve seen during the previous year.
f. Review data with the outpatient clinic staff such as confirming repeat visits versus newly diagnosed cases.



ANS:   C, F

Before drawing any conclusions, further data should be sought, including confirmation of the current data and their meaning. Data can be inaccurate or collected differently than in the past. What might have led to an increase? Are there other valid sources that might have relevant data? Should surveillance specific to asthma be established?


DIF:    Cognitive Level: Synthesis                REF:    p. 274


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