Paul is an inner-city community health nurse. The community in which he practices has a higher than average rate of obesity, diabetes, and cardiovascular disease. Paul has decided to focus on improving the nutritional status of the community. One issue is the lack of access the residents have to fresh fruits and vegetables. After meeting with a group of residents and getting approval from city leaders, a partnership was formed, and Paul and the residents were able to plant a garden on a donated empty lot. The partnership has remained active within the community, organizing health fairs, gardening demonstrations, education to local children about gardening, and giving away excess produce to the homeless shelter.

Paul and the community partnership demonstrate a macroscopic approach to the issue of poor nutritional status. Examples of a macroscopic approach to the issue of lead exposure in children include all of the following EXCEPT

a.     identification of children exposed to lead in the home.

b.     examining trends in the prevalence of lead poisoning over time.

c.     estimating the percentage of older homes in a neighborhood that may contain lead pipes or lead-based paint surfaces.

d.     locating industrial sources of lead emissions.

Community Health nurses like Paul have to think “upstream” in order to change the health of an entire population. An example of upstream thinking includes

a.     identification of children at risk for obesity.

b.     giving away excess produce to homeless shelters.

c.     teaching inner-city school children how to garden.

d.     educating parents about how to cook healthy meals.

Which nursing theory demonstrates examination of nursing problems from a macroscopic, upstream thinking perspective?

a.     The Health Belief Model (HBM)

b.     Milio’s Framework for Prevention

c.     Orem’s Self-Care Deficit Theory of Nursing

d.     Virginia Henderson’s Need Theory

Linda is a fair-complexioned, 62-year-old woman, who is preparing for retirement. She doesn’t smoke and rarely drinks alcohol. She mostly eats fruits, vegetables, and white meat; however, she avoids dairy products because they upset her stomach. Her doctor recently started her on cholesterol medication due to hyperlipidemia and instructed her to wear sunscreen every day to prevent skin cancer. Linda has quit taking her cholesterol medication because she says it makes her jittery. She walks her dog a couple miles every day and plays 18 holes of golf at least twice a week. Linda’s goals are to retire within the next 3 months and travel with her husband.

Based on Pender’s Health Promotion Model, the variables that could influence Linda to pursue health promotion include all of the following EXCEPT

a.     Linda’s father died of heart disease at age 55.

b.     Linda feels good after walking her dog.

c.     Linda wants to enjoy many years of retirement with her husband.

d.     Linda’s doctor told her to wear sunscreen to prevent skin cancer.

Linda’s employer offers a wellness program. Linda meets with the wellness program nurse to discuss health promotion opportunities. The nurse plans to do a risk assessment with Linda to determine where Linda has opportunity for health improvement. The steps of a risk assessment include all of the following EXCEPT

a.     hazard mitigation.

b.     risk description.

c.     exposure assessment.

d.     risk estimation.

The nurse reviews with Linda her modifiable and non-modifiable risk factors. The nurse tells Linda her non-modifiable risk factors include

a.     risk of osteopenia due to poor calcium intake.

b.     risk of cardiovascular disease due to familial history.

c.     risk of skin cancer due to sun exposure.

d.     risk of stroke due to poor medication compliance.

Jackie is a community health nurse in a small rural town. The town is located on a stretch of interstate highway near a toxic waste dump. The community has a population of 1,500 people, mostly farmworkers, half of whom live below the poverty level. The town averages about 50 births per year. In the last two years there have been 11 babies born with serious birth defects. Prior to that, there was only one baby in 20 years born with a serious birth defect.

Using the epidemiological triangle, Jackie would analyze all of the following elements EXCEPT

a.     what is causing the birth defects.

b.     who is having babies with birth defects.

c.     what type of birth defects are occurring.

d.     what are the surroundings of the women who are having babies with birth defects.

Of the 50 babies born in the community last year, 5 were born with birth defects. Jackie calculates the number of birth defects per 1000 live births in the community as

a.     100.

b.     1000.

c.     10.

d.     1.

It has been determined that exposure to a certain pesticide is the likely cause of the birth defects in the community. Jackie calculates the rate where the denominator is the number of pregnant women exposed to the pesticide and the numerator is the number of those women who had babies with serious birth defects. This rate is known as the

a.     prevalence rate.

b.     mortality rate.

c.     morbidity rate.

d.     attack rate.

Katelyn is a nurse who has just been offered a job at an elementary school. The school is located in a poor urban neighborhood. The majority of the children are minorities, and some do not speak English. Nutritional status of the children is a big concern voiced by many of the teachers at the school. They told Katelyn many of the children come to school hungry because they cannot afford breakfast.

Katelyn drives through the neighborhood around the school and makes observations about the layout of the community, type and location of businesses, and the people milling about. This type of assessment is called a

a.     census survey.

b.     windshield survey.

c.     needs survey.

d.     community survey.

Katelyn wishes to learn about the community’s population size and the distribution of age, sex, race, and ethnicity. The most appropriate source of data for this information is

a.     morbidity and mortality rates.

b.     vital statistics.

c.     National Health Survey data.

d.     U.S. Census data.

Katelyn does a needs assessment to determine the community’s perspective on the health status of the children. The first step of the needs assessment is

a.     train data collectors.

b.     identify required information.

c.     identify aggregate for assessment.

d.     develop an action plan.

Expert Answer

Paul and the community partnership demonstrate a macroscopic approach to the issue of poor nutritional status. Examples of a macroscopic approach to the issue of lead exposure in children include all of the following EXCEPT a. identification of child…

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