Community Nursing 3065 Comprehensive Exam with Complete Solutions, Exams of Nursing

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Community Nursing 3065 Comprehensive Exam

with Complete Solutions

Epidemiology - Correct Answer The study of the distribution of health events in populations and the determinants that influence those patterns. Descriptive epidemiology - Correct Answer The study of the distribution of disease. Seeks to answer the question, who, what where and when. Analytic Epidemiology - Correct Answer study of origins and causal factors of the disease (how and why) What is in the epidemiological triangle - Correct Answer host, environment, agent What is an agent? - Correct Answer An inanimate or animate factor that must be present or lacking for a disease or condition to develop What is a Host? - Correct Answer Living species capable of being infected or affected by an agent ., Adult, child, animal ...consider the susceptibility of the host. What is the Environment? - Correct Answer Everything internal or external to a given host or agent and that is influence by and influences the host and/or agent.person: age, sex, ethnicity, relationship status, place of birth Place: location, region, countries, specific work environment What is the web of causality? - Correct Answer Illustrates the complex interrelation of numerous factors sometimes interacting in subtle ways to increase (or decrease) the risk of disease What type of thinking does web of causality promote? - Correct Answer upstream thinking

What is surveillance? - Correct Answer systematic and ongoing collection of data about disease occurrence. What is the difference between reportable disease, non-reportable disease, and contact tracing? - Correct Answer reportable disease is reported to public health (medical health officer), non - reportable disease is not, contact tracing - locating individuals who have had contact with individual affected with the pathology. Which 4 ethical principles are relevant to ethical deliberation of public health? - Correct Answer harm principle principle of least restrictive means reciprocity principle transparency principle which ethical principle sets out the liberty to take action to restrict the liberty of an individual or group in order to prevent harm to others? - Correct Answer Harm Reduction Which ethical principle recognized that a variety of means exist to achieve public health needs, but the full authority and power should be used for exceptional circumstances? - Correct Answer Least restrictive means Which ethical principle includes the belief that society must be prepared to facilitate individuals and communities in their efforts to discharge their duties - Correct Answer Reciprocity Principle What is the iceberg metaphor? - Correct Answer The iceberg phenomenon is a metaphor emphasizing that for virtually every health problem the number of known cases of disease is outweighed by thos that remain undiscovered, much as the unseen part of an iceberg is much larger than the part that is visible. Who examined health and disease in a community by looking at geography, climate, seasons of the year, food and water consumed, and the habits and behaviors of people - Correct Answer Hippocrates

Who showed that the water supply was related to the development of cholera in England - Correct Answer John Snow Who looked at the relationship between environmental conditions and the recovery of the soldiers decreased mortality rates by improving environmental conditions and adding nursing care

• Correct Answer Florance Nightengale What was a major shift of focus in the 20th century? - Correct Answer Shift from looking for single agents as the cause of disease to seeking combinations of factors that contribute to disease Sanitation, clean water, housing, immunizations/vaccination Shift in focus from infectious diseases - now controllable, to chronic diseases related to lifestyle (cancer, heart disease and diabetes) determinants of health What is one type of Threats of biological terrorism - Correct Answer Anthrax What are 2 types of new infectious diseases - Correct Answer SARS and H1N What is one type of The recurrence of drug-resistant strains of older diseases - Correct Answer TB What are 3 types of New and emerging diseases - Correct Answer lyme disease, HIV/AIDS, West Nile what steps do CHN use in their care? - Correct Answer APIE

1. Assessment
2. Planning
3. Implementation

4. Evaluation Define risk - Correct Answer the probability that an event will occur within a specified period. Define high risk population. - Correct Answer those people for whom there exists a greater probability of the event occurring. What is a measure of how quickly something is happening; measures change over a unit of time. - Correct Answer Rate A measure of the frequency of occurrence of a health event in a defined population during a specified period What is a proportion? - Correct Answer A type of ratio that shows the relationship between the total number and the frequency of occurrence in the case of a particular health event What Reflects the number of new cases developing in a population at risk during a specified time - Correct Answer Incidence rate What is the prevalence rate? - Correct Answer Proportion of people in a specific population who have the disease during a specific time period. (old and new cases included) What is the number of deaths due to a particular disease in a population - Correct Answer Mortality rate What is the rate of occurrence that is usual in a population (Ie- malaria in the tropics) normal - Correct Answer endemic What occurs when the rate of disease injury or condition clearly exceeds the usual level for that condition in a given area (ie 0 the incidence of the disease has increased - mumps outbreak among university students) - Correct Answer Epidemic What is the rate of its occrence in geographically widespread populations ie. H1N1. - Correct Answer Pandemic

What three things do endemics, epidemics and pandemics look at? - Correct Answer disease, injury or other condition. What are the three categories that data for epidemiological studies come from? - Correct Answer 1 - routinely collected data (census) 2 - Data for medical or insurance 3 - data for specific epi studies The testing of groups of individuals who are at risk for a certain condition but do not manifest any symptoms, in order to determine the likelihood that these individuals will develop the disease - Correct Answer Screening A Communicable disease - human or animal origin caused by .... - Correct Answer an infectious agent Preventable and controllable; acquired through behaviour that can be avoided or changed (determinants) - Correct Answer Communicable disease/infectous disease What is a CHN's main focus in prevention? - Correct Answer primary prevention Non-vaccine preventable diseases - Correct Answer avian flu, HIV/AIDS, malaria, SARS, TB, West Nile, anthrax Vaccine preventable diseases: - Correct Answer Hep A & B (twinrix), diphtheria, polio, influenza, measles, mumps, meningitis incidence has increased (or at the point of increasing) over the last 20 years (ebola, anthrax, hanta virus, necrotizing fascitis) - Correct Answer Emerging infectious disease removed from a large geographical area (polio) - Correct Answer Elimination worldwide, irreversible termination of infectious agent (smallpox) - Correct Answer Eradication

ability of host to withstand infection - Correct Answer resistance innate resistance to an infectious agent, species determined - babies being borne. - Correct Answer Natural immunity resistance acquired by exposure to infectious agent vaccination- chicken pox - Correct Answer Acquired immunity exposure to antigen (virus or vaccine) to produce antibodies - Correct Answer active immunity : antibodies are transferred (immune globulin), short lived until active immunity has occurred (Hep A, Rabies, tetanus) - Correct Answer Passive immunity Protection offered by immunized group to the unimmunized (80% offers protection). - Correct Answer herd immunity Passing from parent to child via sperm, placenta, milk or vaginal canal - Correct Answer vertical transmission person to person spread - sneeze you get the flu - Correct Answer horizontal : transport from infected to uninfected person by food, water, milk, blood, serum or saliva - Correct Answer common vehicle nonhuman organism, usually insect. - Correct Answer vector Assessment of risk behaviour (history) Interventions to avoid infection (education, immunization) - Correct Answer primary prevention Identification, treatment, follow-up with contacts to prevent further spread (education to prevent self-infection, symptom management, prevention of infection of others - partner notification or contact tracing) - Correct Answer Secondary prevention

Symptom management, psychosocial support - Correct Answer tertiary prevention Fair distribution of society's benefits and responsibilities and consequences - Correct Answer social justice often linked with the concepts of equity and health equity as well as with human rights, empowerment, environmental justice, social determinants of health, democracy, social development, poverty reduction, fairness, and social responsibility. - Correct Answer social justice What is the cycle of oppression? - Correct Answer oppression - results in - putdowns in society, confusion, disoriented ideas(i am less than), negative achievement - rationalizes more TARGET GROUP. Give 5 examples of potential social justice core competencies - Correct Answer 1 - communication 2 - leadership 3 - diversity and inclusivness 4 - partnerships and advocacy (collaboration) 5 - assessment and analysis ...is the application of information and resources to effect systemic changes that shape the way people in a community live. - Correct Answer advocacy - community health nursing ...is intended to benefit aggregates, e.g., to reduce death or disability in groups of people, and uses information and resources to reduce the occurrence or severity of public health problems. - Correct Answer advocacy - public health nursing What is the conceptual framework for advocacy? - Correct Answer information stage strategy stage action stage

What are these: Act in the client's (group's, community's) best interests. Act in accordance with the client's wishes and instructions. Keep the client properly informed. Carry out instructions with diligence and competence. Act impartially and offer frank, independent advice. Maintain client confidentiality. - Correct Answer Ethical principles for advocacy .....can be described as a way of critically looking at issues in health care that encompasses: Deciding what we should do—what decisions are morally right or acceptable based on the values and principles we agree are relevant; Explaining why we should do it—justifying our decision using language of values and principles to explain why; and Describing how we should do it—outlining an appropriate process for enacting the decision. - Correct Answer ethics A branch of philosophy that includes both a body of knowledge about the moral life and a process of reflection for determining what persons ought to do or be, regarding this life - Correct Answer ethics Some general ethical obligations we have as members of society are: - Correct Answer 1. Not to harm others

2. To respect others
3. To tell the truth
4. To keep promises What is the purpose of the CNA Code of Ethics? - Correct Answer - gives guidance for decision making re ethical matters

• means for self-evaluation and self-reflection
• basis for peer feedback
• delineates what nurses should know about their ethical responsibilities
• informs other healthcare professionals about the ethical commitment of nurses
• upholds responsibilities of being a self-regulating profession
• basis for advocating for quality practice environments Two important ethical obligations CHNs face: - Correct Answer accountability confidentiality Who views Advocacy as an important nursing responsibility - Correct Answer CNA code of ethics and CHN Association standards of practice What is veracity? - Correct Answer telling the truth - promotes trust in nurse-client relationship What is consequentialism? - Correct Answer The right action is the one that produces the greatest amount of good or the least amount of harm in a given situation. What is utilitarianism? - Correct Answer is a well-known consequentialist theory that appeals exclusively to outcomes or consequences in determining which choice to make (goal based) An action is "good" or "right" when it maximizes benefit for the greatest good for society When a conflict in outcome occurs, the correct action is the one that will result in the greatest good for the majority Public Health examples: quarantine, mandatory reporting, immunization What is deontology? - Correct Answer normative ethical position that judges the morality of an action based on the action's adherence to a rule or rules. It is sometimes described as "duty" or "obligation" or "rule"-based ethics, because rules "bind you to your duty."

What is Principlism? - Correct Answer Health care professionals have specific obligations that exist because of the practices and goals of the profession: Autonomy Nonmaleficence Beneficence Distributive justice What is Distributive (or social) justice - Correct Answer The allocation of benefits (e.g., basic needs) and burdens to members of society What is Communitarianism? - Correct Answer Connection b/t the person and the community. Virtue ethics The ethic of care- most important for nurses says Joan Feminist ethics What are virtue ethics? - Correct Answer One of the oldest types of ethical theory (dating back to ancient Greek philosophy) Virtues are acquired, excellent traits of character that dispose humans to act in accord with their natural good. Examples of virtues include benevolence, compassion, discernment, trustworthiness, integrity, and conscientiousness. What is caring and the ethic of care? - Correct Answer Based on feminist theory A response to the technological advances in health care science, to the desire of nurses to differentiate nursing practice from medical practice Emphasizes a belief in the morality of responsibility in relationships that emphasize connection and caring. The ethic of care is a core value of community health nursing.

What are feminist ethics? - Correct Answer Supports critical thinking and focus on issues such as gender, power, and socioeconomic status Entails knowledge about and critique of classical ethical theories developed by men and women, and knowledge about the social, cultural, political, economic, environmental, and professional contexts that insidiously and overtly oppress women as individuals or within a family, group, or society When was the CNA last updated? when did it first come out? - Correct Answer 2008 - started in 1985 - has been updated 4X Why do we have the CNA - Correct Answer - gives guidance for decision making re ethical matters

• means for self-evaluation and self-reflection
• basis for peer feedback
• delineates what nurses should know about their ethical responsibilities
• informs other healthcare professionals about the ethical commitment of nurses
• upholds responsibilities of being a self-regulating profession
• basis for advocating for quality practice environments What does IDEA stand for? - Correct Answer I -- Identify the facts (consider clinical indications, patient preferences, evidence, contextual features, personal biases). Ask: What is the ethical issue? D - Determine the relevant ethical principles in conflict (e.g., autonomy, beneficence, non-maleficence, justice). Ask: Have perspectives of relevant individuals been sought? E - Explore the options (consider strengths & limitations, harms & benefits, laws & policies, consistent with mission, vision, & values). Ask: What is the most ethically justifiable option? A - Act (recommend, implement, evaluate). Ask: Am I (are we) comfortable with this decision? What are the steps of ethical decision making? - Correct Answer 1. Identify the ethical issues and dilemmas.

2. Place them within a meaningful context.
3. Obtain all relevant facts.

4. Reformulate ethical issues and dilemmas, if needed.
5. Consider appropriate approaches to actions or options (utilitarianism, deontology, principlism, virtue ethics, ethic of care, feminist ethics).
6. Make decisions and take action.
7. Evaluate the decisions and the action. This principle sets out the manner and context in which decisions are made. All legitimate stakeholders should be involved in the decision-making process, have equal input into deliberations and the process should be as clear and accountable as possible. It should be free of political interference and coercion or domination by specific interests - Correct Answer transparancy This principle articulates that society must be prepared to facilitate individuals and communities in their efforts to discharge their duties. This statement could mean for instance that individuals who are isolated because they are quarantined should be compensated for lost income or have food delivered to them, for example. - Correct Answer reciprocity What are the CHNC standards? - Correct Answer 1. Promoting health ex. Prevention and Health Protection
8. Building individual and community capacity ex. Actions based on empowerment & advocacy foster everyday ethical practice of CHNs
9. Building Relationships ex. Professional boundaries
10. Facilitating access and equity ex taking into account social factors & DoH
11. Demonstrating professional responsibility and accountability ex. Exceptions to confidentiality & consent What are the CNA code of ethics standards? - Correct Answer 1 - safe, compassionate, competent and ethical care

2 - Promoting health and wellbeing 3 - promoting and respecting informed decision making 4 - preserving dignity 5 - maintaining privacy and confidentiality 6 - promoting justice 7 - being accountable What are Health disparities (also known as health inequalities) - Correct Answer The wide variations in health services and in health status among certain population groups Differences in health that could be avoided if reasonable action were taken (therefore, these differences are considered to be unfair and socially unjust) These social, economic, cultural, and political inequities result (directly or indirectly) in health disparities. What is Absolute poverty - Correct Answer "A deprivation of resources that is life threatening" Refers to individuals and families who are unable financially to obtain necessities of life such as food, clothing, and shelter What is Relative poverty: - Correct Answer Refers to individuals and families whose income is considerably less than that of their peers What is Subjective poverty: - Correct Answer Refers to individuals and families who perceive that they have insufficient income to meet their expenses What are the Selected effects of poverty on the health of babies: - Correct Answer Higher rates of prematurity Low birth weight Birth defects and infant mortality

What is at high risk for low income? - Correct Answer Lone parents with at least one child under 18 Unattached individuals between 45 and 64 People with physical and mental disabilities that impede working recent (within the past 10 years) immigrants to Canada Aboriginal Canadians living off reserve People with mental heath struggles are at greater risk of: - Correct Answer Underemployment or unemployment Poverty Suicide Substance abuse Homelessness Personal injury What are the 3 major type of homelessness? - Correct Answer Absolute homelessness Sheltered homelessness Hidden homelessness What are some causes of homelessness? - Correct Answer Increased poverty Lack of affordable housing deinstitutionalization and lack of discharge planning social factors What is the NB Economic and Social Inclusion Plan, unanimously adopted by the Legislature in February 2010, scraps the old assumptions in favour of positive principles: - Correct Answer Everyone has gifts and abilities and the potential to share them in some productive way; the poor are assets, not liabilities People want to work - work generates income as well as self-esteem, respect and inclusion

Support must extend beyond the limits of the welfare system, through the transition from poverty to an adequate livelihood; it's an investment Because poverty affects everybody directly or indirectly, its reduction is a shared responsibility What are the major changes in the NB economic and social inclusion plan? - Correct Answer Policy change: from charity to opportunity Program change: from stagnation to momentum Service delivery: top-down to community-based Shared responsibility: vertical to horizontal (silos to regional intersectoral networks) What are the 4 ideas in a supportive housing network? - Correct Answer Client identified support network household movers and shakers ongoing housing support neighbors and friends What is Canada's Federal Drug strategy? A "four-pillared" comprehensive and coordinated approach. What has it been criticized for? - Correct Answer Prevention and Health Promotion Health Recovery Enforcement Harm Reduction Strategy has been criticized for an overemphasis on illicit drugs and conventional enforcement strategies rather than prevention, health promotion and harm reduction What are the Guiding principles for Substance Abuse Strategies? - Correct Answer Person centered- reflect the needs of the affected population group Inclusiveness Non-stigmatizing

Knowledge and best practices-applying validated research and outcomes from other community initiatives improves results Total community Collaboration What are the three themes of the nursing video bevel up? - Correct Answer Being the Change Reducing the Harm Promoting Dialogue What is : consumption of psychoactive drugs that can result in benefits or harm? - Correct Answer Substance use What is drug use that leads to adverse physical or psychological consequences, may or may not result in dependence? - Correct Answer Substance abuse What are the two dominant approaches to reducing drug use? - Correct Answer Harm reduction prohibition, criminalization and law enforcement What are some examples of harm reduction strategies? - Correct Answer Methadone Maintenance Treatment InSite supervised injection sites Needle exchange programs Street outreach What are the four models of helping and coping - Correct Answer Moral - problem is caused by the person. Person is weak minded and they are responsible for addressing the problem that they are in. Medical - Addiction is a disease. Not always a result of their own failing. They need treatment. Not responsible for their problems or solutions - are a victim of circumstances. Gives person no power.

Enlightenment - 12 step program - makes individuals responsible for their own problems. Looking at help from other powers. AA = good for people who can buy in to this philosophy. Compensatory - person is responsible for solution - but not responsible for getting that way. Harm reduction is most fitting in this category. What are 4 challenges to providing care? - Correct Answer Our own beliefs, values, opinions, etc Trust issues Understanding the determinants Convincing those in power that "Houston, we have a problem!" What are the guiding principles to harm reduction? - Correct Answer Person centered Inclusiveness Non-stigmatizing Knowledge and best practices Total community Collaboration A belief that promotes the recognition of diversity of citizens with respect to their ancestry and supports acceptance and belonging. - Correct Answer Multiculturalism "ethnicity, language, religion, and spiritual beliefs, gender, socio-economic class, age, sexual orientation, geographic origin, group history, education, upbringing, and life experiences" (CNA, 2004, p.126) "The learned, shared, and transmitted values, beliefs, norms, and lifeways of a particular culture that guides thinking, decisions, and actions in patterned ways and often intergenerationally" (Leininger, 2006, p. 13) Sociopolitical construct with underlying power relationships, enacted relationally through history (CANAC, 2013) - Correct Answer culture What does culture stand for? - Correct Answer C. - commonly U. - understood

L. - learned T. - traditions U. - unconscious R. - rules E. - of engagement "Refers to any attribute that happens to be salient to an individual that makes him/her perceive that he/she is different from another individual." (Friday & Friday, 2003) - Correct Answer Diversity What are the two main principles of developing cultural competency? - Correct Answer 1. Maintain a broad, objective, and open attitude toward individuals and their cultures

2. Avoid seeing all individuals as the same What are the 6 key attributes of cultural competence? - Correct Answer 1. Cultural awareness
3. Cultural knowledge
4. Cultural understanding
5. Cultural sensitivity
6. Cultural interaction
7. Cultural skill What does ASKED stand for in relation to culture? - Correct Answer Awareness Skill Knowledge Encounters Desire A combination of culturally congruent behaviours, practice, attitudes, and policies that allow nurses to work effectively in cross-cultural situations. - Correct Answer Competency

Being able to appreciate, respect, and value cultural diversity. Involves a realization about the influence of one's own personal and professional identity on practice. - Correct Answer sensitivity Focuses on the power differentials that are inherent in health care delivery, and redressing these inequities through education and changes in practice. - Correct Answer Safety What are some inhibitors of developing cultural competency? - Correct Answer Ethnocentrism Cultural blindness Cultural imposition Cultural conflict Heterosexism Stereotyping Prejudice Racism What are 3 individual recommendations to becoming more culturally competent? - Correct Answer self awareness communication new and continued learning What is shock? - Correct Answer Tensions experienced when adapting one's nursing skills and knowledge to meet the demands of practicing within another culture, environment, and society" What are some examples of psychosocial environmental factors? - Correct Answer long hours and heavy demands at work What are some examples of physical environmental factors? - Correct Answer air pollution, contaminated drinking water, toxins such as mercury in the food supply The scientific study of the poisonous effects of chemicals - Correct Answer Toxicology

Toxic substances that cause injury, illness, or death to humans and other organisms - Correct Answer poisons What is the difference between point and non point pollution? - Correct Answer A pollutant from a point source is released into the environment from a single site (e.g., a smokestack). A pollutant from a nonpoint source is more diffuse (e.g., traffic, fertilizer, or pesticide runoff into waterways, or animal waste from food production). What is a sink? - Correct Answer A sink is any process, activity, or mechanism that removes a greenhouse gas, aerosol, or precursor of a greenhouse gas from the atmosphere. What is environmental epidemiology? - Correct Answer The study of the effect of physical, chemical, and biological factors in the external environment on human health Assesses both the internal and external environments and is frequently used by researchers to assess population health issues; by organizations to develop, evaluate, and revise programs; and by policy makers to address social, economic, technological, and political issues - Correct Answer Environmental scan What are the Two mnemonics for environmental exposure histories: - Correct Answer I PREPARE: Investigate potential exposures, Present work, Residence, Environmental concerns, Past work, Activities, Referrals and resources, Educate CH2OPD2: Community, Home, Hobbies, Occupation, Personal habits, Diet, Drugs What is the precautionary principle? - Correct Answer Government policy currently incorporates this principle, which suggests that when credible doubt exists, action should be on the side of caution. The chance that a specific health problem will develop in a client because of exposure to certain factors - Correct Answer risk

What is environmental principle #1 - Correct Answer Everything is connected What is environmental principle #2 - Correct Answer Everything has to go somewhere What is environmental principle #3 - Correct Answer The solution to pollution is dilution #4 - Correct Answer Today's solution might be tomorrow's problem What are environmental Health indicators? - Correct Answer Environmental health indicators have been developed by Environment Canada, Statistics Canada, and Health Canada to measure the relationship between environment and health. Canadian Environmental Sustainability Indicators (CESI) include air quality, greenhouse gas emissions, and water quality. Global warming has effected Canada through: - Correct Answer 1. increase exposure to vector-borne disease eg. West Nile Virus

2. higher incidences of water and food borne illnesses
3. more frequent extreme weather events
4. severe heat waves Nurses practice at the intersection of... - Correct Answer public policy and personal lives Key Concept 1: Pathways of Contaminants - What are the 5 components? - Correct Answer the source of contamination the medium through which the contaminant travels the point at which people come in contact with the contaminant; the person, plant or animal that is the receptor of the contaminant; and the route of exposure

Key Concept 2: DEFINITION OF RISK what are the 4 components? - Correct Answer Risk hazard susceptibility exposure