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NURS 2000: Questions with Complete Solutions
Chapter 32: Rural Health Correct Answer-Test bank
- Which of the following descriptions is the most accurate example of a rural community? a. The residents of the community are subject to environmental hazards. b. It takes longer than 30 minutes to get from the community to health care services. c. The community has less than 20,000 residents. d. The residents of the community say, "This is smaller than where I grew up." Correct Answer-ANS: B All of the descriptions could be used in an attempt to define "rural," but each aspect has problems. A definition of "rural" has not yet been decided. However, in relation to health care, the time needed to get to a health care facility has a major influence on care outcomes.
- What is the poverty rate in rural areas? a. 10% b. 20% c. 30% d. 40% Correct Answer-ANS: D
National estimates report that in rural areas, more than 40% of all families live below the poverty level.
- Why are children at risk on their own family's farm? a. Children often help with the work without much regard for training or safety. b. It is expected that children fulfill the roles that are assigned to them. c. Machinery can injure someone faster than a parent can turn the machine off. d. Parents are too busy completing their own tasks to supervise the children. Correct Answer-ANS: A Farming is one of the four most dangerous industries. Agricultural work is inherently dangerous but also must be performed under adverse conditions such as mud or extreme heat or cold. On family farms, spouses, children, and other relatives often help without much regard to competency, training, or safety. Of all industries, agriculture has by far the highest number of injuries and deaths among children.
- An adolescent in a rural community has recently committed suicide. What is the significance of this event in the community? a. Rural residents are less religious than urban residents and less capable of coping with the loss. b. Because of the size of the community, it is likely that no one will discuss what has happened.
RHC Public Law 95-210 was originally passed by Congress in 1977. The law defined core primary care, created reimbursement mechanisms, and encouraged utilization of midwives and nurse practitioners, among others, by providing reimbursement even without a full-time physician available. Reimbursement is based on cost so that additional revenues to eligible rural practices can be generated.
- A program to recruit advanced-practice nurses to practice in a rural community is being developed. The program developers have applied to receive federal training monies to help fund the costs of the program. Which of the following questions must be addressed when they apply for these funds? a. "Does the health of the clients improve as a result of interventions?" b. "Have professional schools increased enrollment?" c. "Are advanced-practice nurses taught to embrace rural cultural values?" d. "Should improvements be made to the buildings and equipment at the agency?" Correct Answer-ANS: A Federal training dollars have been linked to program outcomes. The question of whether the clients' health improves as a result of interventions is the only question that addresses outcomes. For example, the goal is not simply to educate professionals but to prepare providers who are capable and willing to increase access to care for underserved and minority populations.
- A family nurse practitioner is employed in a rural health clinic. What generalization would the practitioner most likely be able to make about the local clients? a. "They carefully budget their money in order to afford health insurance." b. "They define health as self-actualization of potential." c. "They are fatalistic and oriented to the land, nature, and the seasons." d. "They are open to sharing their problems and accepting my advice." Correct Answer-ANS: C Rural families are often fatalistic because both their work and their recreation are dependent on the land throughout the seasons. They usually know everyone in the community, keep their problems within the family, define health as the ability to fulfill their work requirements, and are too poor for health insurance. These are, of course, generalizations, to which there are many exceptions. A new family nurse practitioner at the rural health clinic soon saw much strength in the community. What might be some resources used and accepted by ill people in a rural area? a. Charity efforts that are publicized and coordinated by members of the nearby city b. Family and friends who volunteer to help with food, cleaning, child care, and other tasks c. Use of the extended-care facility in the community until the ill person feels better d. Care that is coordinated by social services and the public health agency Correct Answer-ANS: B
d. "The clients keep asking me when I'm going to get married." Correct Answer-ANS: D Salaries are lower, as is the cost of living in rural areas. Although she is a professional, as a woman she would be expected to fulfill female roles, such as wife and mother, and may be seen primarily in relation to her family relationships.
- A nurse is employed in a rural area. What might be a dismaying reality about this setting of nursing practice? a. Cultural values require clients to refuse pain relief medications. b. Farmers have to visit care providers when not busy in the fields. c. Rural residents have a tendency to use folk healers instead of scientific care providers. d. There is no "off duty" because everyone feels free to request information or service any time. Correct Answer-NS: D There is no distinction between being the nurse on duty at the clinic and being a resident of the community. The newcomer's role will be that of nurse, and everyone will feel free to ask questions at any time and at any place.
- The registered nurse came to see many strengths and resources in the rural area. Among these were that rural residents are a. Diverse, both in ethnic groups and in age groups. b. Politically open to new ideas and approaches. c. Very resourceful and self-reliant.
d. Willing to spend money to improve safety. Correct Answer-ANS: C Rural residents are very resourceful and self-reliant. In addition, they are conservative, often having fewer financial resources available.
- What is the most common definition of health among those living in rural areas? a. Balance or homeostasis b. Capable of fulfilling work requirements c. Feeling of well-being, not merely the absence of disease d. Purposive adaptive response to stimuli Correct Answer-ANS: B Some people living in rural areas define health as "the ability to work and to do what needs to be done," or "illness is not being able to do one's usual work." Therefore, rural residents often do not seek health care until they are too ill to work.
- Which of the following is part of the first level of social support for people living in rural communities? a. Big city charities that rely on agricultural donations to help feed urban poor persons b. Church or civic group assistance, to which a person is expected to contribute when able c. Professional agencies or people who are paid financially for their contribution d. Volunteer assistance by family and friends, which one is expected to reciprocate as needed Correct Answer-ANS: D
Why are rural residents considered a group at high risk for health problems? (Select all that apply.) a. They are very self-sufficient and self-reliant. b. Few health care providers are locally available. c. The residents are exposed to high-powered machinery, extensive sun, and chemicals. d. They have difficulty accessing affordable insurance if they are self- employed. e. They must travel long distances to obtain specialized services. f. They work in dangerous occupations (farming and ranching). Correct Answer-ANS: B, C, D, E, F Rural residents, including elderly persons and children in the family, often work in dangerous occupations without immediately accessible health care. The poverty rate is high, since many are unemployed or retired. Agriculture is considered one of the four most dangerous occupations in America because its workers are exposed to lightning, farm machinery, firearms, drowning, and accidents involving vehicles such as snowmobiles and all-terrain vehicles. In comparison with urban residents, rural residents suffer higher rates of chronic illnesses, mental illness, and stress-related diseases. Problems include machinery accidents, skin cancer from sun exposure, and breathing problems from exposure to chemicals and pesticides. Rural communities find it difficult to recruit or to retain qualified health care providers, and so the residents must travel long distances to obtain care. Being self-employed, few have health insurance or workers' compensation insurance.
A rural family is trying to obtain health care. Which of the following barriers would they be most likely to encounter? (Select all that apply.) a. Fewer health care providers in the community b. Greater travel distances for health care, especially for pregnant women and young children c. Less willingness to accept help from local health care providers d. Little attention being paid to the problems of the rural population by federal legislators e. Many competing insurance companies with different rules and policies f. Providers of health care inadequately prepared to cope with differences between rural and urban lifestyle and values Correct Answer- ANS: A, B, F Problems for rural residents that serve as barriers to obtaining health care, in comparison with urban residents, include greater travel distances for health care, especially for pregnant women and young children; availability of fewer health care providers in the community; less cultural and educational encouragement for health promotion behaviors; lower probability of having health insurance; and, often, lower income. A local community hospital that is highly valued by its community has just announced that it will be closing within the next year. What would be the most anticipated reason for its closure? (Select all that apply.) a. The departure of a health care provider resulted in an inadequate number of providers to staff the hospital.
f. Standards of practice that are different in rural settings Correct Answer-ANS: A, B, D With computers and telemedicine, the nurse can obtain information, but responsibilities can be overwhelming because there are few other resources in the community to assist. There are no other nurses around with whom to discuss clinical situations or from whom to obtain support or consultation. A nurse is teaching the importance of childhood immunizations to a group of postpartum mothers. This is considered which level of preventive care? A. Tertiary prevention B. Primary prevention C. Secondary prevention D. Health screening B. Primary prevention Correct Answer-B. Primary prevention Primary prevention activities protect against a disease before signs and symptoms occur (prepathogenesis stage of disease). Secondary prevention activities promote early detection of disease once pathogenesis has occurred. Tertiary prevention activities occur in the convalescent state of disease and are directed toward minimizing residual disability and helping people to live productively with limitations.
Advocating for an increase in welfare incomes is an example of which health promotion strategy? A. Creating supportive environments B. Strengthening community action C. Developing financial literacy D. Building healthy public policyD. Correct Answer-D. Building healthy public policy An increase in welfare incomes requires policy change. Healthy public policy is public policy that has a positive impact on health. Income is the greatest determinant of health. Efforts to decrease obesity by focusing on factors such as household income and on food advertising and marketing exemplify which approach to health? A. Socioenvironmental B. Medical C. Behavioural D. Psychological Correct Answer-A. Socioenvironmental A socioenvironmental approach focuses on the social and environmental conditions that influence health and health behaviours rather than on the health behaviours per se. In this example, the approach will attempt to change the marketing and advertising of unhealthy products and ensure that people have adequate incomes to purchase nutritious food.
D. Activities that enable people to increase control over the determinants of health and thereby improve their health Correct Answer-D. Activities that enable people to increase control over the determinants of health and thereby improve their health Health promotion activities are actions that strengthen the skills and capabilities of individuals as well as actions that change social, environmental, and economic conditions to make them more health enhancing. These actions are therefore directed toward health determinants and involve individual and social responsibility for health. The major outcome of the Lalonde Report was its emphasis on which of the following determinants? A. Environment B. Health care organization C. Genetics and biology D. Lifestyle Correct Answer-D. Lifestyle Although all of the above were identified in the document, the area that received the most emphasis was lifestyle. Which of the following are the most upstream factors influencing health? A. Behavioural risk factors B. Physiological risk factors
C. Socioenvironmental risk conditions D. Psychosocial risk factors Correct Answer-C. Socioenvironmental risk conditions Socioenvironmental risk conditions such as poverty, education, and housing (i.e., social determinants of health) can influence health directly but also indirectly through psychosocial risk factors, behavioural risk factors, and physiological risk factors. The belief that health is a societal responsibility is most congruent with which approach to health? A. Medical B. Behavioural C. Socioenvironmental D. Public health Correct Answer-C. Socioenvironmental Medical and behavioural approaches focus on health as an individual responsibility. A socioenvironmental approach emphasizes social and environmental conditions, which often require policy-level interventions. The statement, "to change behaviour it may be necessary to change more than behaviour," most clearly reflects which approach to health? A. Behavioural B. Socioenvironmental
D. Advocating living wages and income support Correct Answer-D. Advocating living wages and income support Advocating living wages and income support is the most upstream strategy because it aims to reduce poverty, whereas the other strategies focus on alleviating the effects of poverty. Secondary prevention activities are most closely related to which stage of the natural history of disease? A. Prepathogenesis B. Pathogenesis C. Convalescence D. Incubation Correct Answer-B. Pathogenesis Secondary prevention activities focus on early detection of disease (pathogenesis stage) to facilitate prompt treatment, such as screening for signs of disease before symptoms occur. Primary prevention activities protect against a disease before signs and symptoms occur (prepathogenesis stage of disease). Tertiary prevention activities occur in the convalescent state of disease and are directed toward minimizing residual disability and helping people to live productively with limitations. A public health nursing department seeks data to confirm that its service is most efficiently using limited resources. This type of analysis is known as: A. a cost-benefit analysis.
B. a cost-effectiveness analysis. C. cost documentation. D. productivity analysis. Correct Answer-B The author of a research study states that the lack of statistical significance in the results may be related to the sample size and suggests that the study be replicated with a larger sample. Which statement is accurate? A. An exact replication may produce the same results. B. Replication of a well-designed study is appropriate. C. Sample size is not important if the appropriate statistical techniques are applied. D. Sample size is not related to statistical significance, so the author's suggestion is illogical. Correct Answer-B Which rate is produced by dividing the number of deaths during one year by the estimated (mid-year) population? A. Crude deaths B. Morbidity incidence C. Mortality prevalence D. Proportional population rate Correct Answer-A Within an epidemiological framework, interrelationships among a multitude of factors constitute the:
