NUR 206 Community Health Exam 2
Study Guide
The chapters the unit exam will cover:
o Chapters 22-24; 29-30; 6, 9, 32

Number of Questions: 50
o multiple choice
o select all that apply
o math problems

Exam Specifics:
o Exam Time Limit: 75 minutes

General questions to review
Math
·
IV calculations
·
Determining equivalents and converting between the systems of measurement
·
Oral and parenteral medication
·
Medication dosages for children
o Review math handouts and do practice questions.

Case study applications of concepts: assessment and prioritization; management of care

Levels of Prevention
·
Primary
·
Secondary
·
Tertiary
**This is not an all-inclusive study guide**
**Helpful Hints: Best practice to prepare for the unit exam**
Review Interactive lectures
Review readings
Review Zoom weekly sessions
Attend unit exam review sessions
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Created: 8/8/2020
Revised: 4/6/2023
NUR 206 Community Health Exam 2
Study Guide
Culture and Migrant Workers:
~The nurse is considered an authority figure that should respect the individual, be able to relate to
the individual, and maintain the individual’s dignity. Mexican individuals prefer polite,
nonconfrontational relationships with others. At times, because of simpatia, individuals and
families may appear to understand what is being said to them (by nodding their heads) when they
do not understand. The nurse should take measures to validate the understanding of these
individuals. Mexican individuals expect to talk about personal matters (chit-chat) for the first few
minutes of an encounter. They expect the nurse not to appear rushed and to be a good listener.
Humor is appreciated and touching as a caring gesture is seen as a positive behavior.
~The physical demands of harvesting crops 12 to 14 hours a day take their toll on the
musculoskeletal system. Back and neck pain were the most common types of chronic pain
reported with many workers leaving or changing their jobs. Low back pain that radiates into 1
leg (sciatica) is consistent with a herniated lumbar disk. The nurse assesses the client to see
whether the pain is aggravated by events that increase intraspinal pressure, such as bending
lifting, sneezing, coughing, or by lifting the leg straight up while supine.
~ Pesticide exposure is the greatest health risk for migrant farmworkers. To prevent exposure,
the nurse should provide access to handwashing stations, which will decrease the transmission of
the pesticides to the workers and family members. Reviewing common pesticides does not
reduce exposure. Surveying for acute health changes is assessing after the exposure. The use of
barrier devices could be helpful but would not necessarily decrease exposure.
Health ATO and Poverty
~HIV is transmitted by intimate sexual contact and the exchange of body fluids, exposure to
infected blood, and passage from an infected woman to her fetus. Clients who fall into the highrisk category for HIV infection include individuals who have used intravenous drugs, individual
who experience persistent and recurrent sexually transmitted infections and individuals who have
multiple sex partners. Homeless adolescents living on the streets exhibit greater risk-taking
behaviors, including earlier onset of sexual activity. They also have poorer health status and
decreased access to health care than do teens in the general population. They are at high risk for
contracting serious communicable diseases, such as AIDS and hepatitis B, and are more likely to
use alcohol and illicit substances. Homeless teens often have histories of runaway behavior,
physical abuse, and sexual abuse. Once on the streets, many homeless adolescents exchange sex
for food, clothing, and shelter. In addition to the increased risk for STDs and other serious
communicable diseases, homeless adolescent girls who exchange sex for survival are at high risk
for unintended pregnancy.
~Poverty directly affects health and well-being, resulting in the following:
• Higher rates of chronic illness
• Higher infant morbidity and mortality
• Shorter life expectancy
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Created: 8/8/2020
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NUR 206 Community Health Exam 2
Study Guide
• More complex health problems
• More significant complications and physical limitations resulting from the higher incidence of
chronic disease, such as asthma, diabetes, and hypertension
• Hospitalization rates greater than those for persons with higher incomes
These poor health outcomes are often secondary to barriers that impede access to health care,
such as an inability to pay for health care, lack of insurance, geographic location, language,
inability to find a health care provider, transportation difficulties, inconvenient clinic hours, and
negative attitudes of health care providers toward poor clients. Access to health care is especially
difficult for the working poor.
~Alcohol should not be consumed when a hypnotic is taken because of its adverse effects.
Phenobarbital is an anticonvulsant and hypnotic agent. The client should not take things that
would depress the central nervous system such as alcohol. This medication does not necessarily
have to be taken with meals. Taking it at the same time would help with compliance and
maintain more stable blood levels and a pillbox could be helpful for some clients but not all.
Nurses have a critical role in the delivery of health care to poor, homeless, mentally ill, and other
high-risk people. To be effective, nurses need strong physical and psychosocial assessment
skills, current knowledge of available resources, and an ability to convey respect, dignity, and
value to each person. Nurses need to be able to work with their clients to promote, maintain, and
restore health. Nurses must be prepared to look at the whole picture: the person, the family, and
the community interacting with the environment. The assessment may take place in the home or
in a community site. Visiting in the home provides a great deal of useful information about the
family, their resources, support systems, and knowledge of common housekeeping and health
issues.
~When implementing population-specific health promotion, the nurse should focus on lifestyle
risk factors specific to the population. For college students, treatment options for smoking
cessation would be appropriate. Exercise classes, education on stress reduction techniques, and
conducting surveys for environmental hazards are a priority for adult clients.
~A client who uses alcohol in excessive amounts is at risk for decreased vitamin B12 and folic
acid levels. Chronic alcohol consumption can also cause confusion and a malnourished state.
Marijuana use does not result in vitamin B12 deficiency or malnourishment. Nicotine and
caffeine consumption do not result in dietary deficiencies, confusion, or malnourishment.
~Caffeine abuse, through the use of energy drinks, can lead to cardiovascular complications
include cardiac dysrhythmias, thus palpitations should be prioritized. Dry mouth, fatigue, and
increased energy are expected side effects of caffeine use or abuse.
~ Vaping oil used to deliver the nicotine contains high concentrations of nicotine and may be
poisonous to young children if they consume this oil orally. This counseling should be
prioritized in a home with young children. The addictive, appealing properties and the risk of
secondhand vapor exposure are not immediately life-threatening.
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Created: 8/8/2020
Revised: 4/6/2023
NUR 206 Community Health Exam 2
Study Guide
~ Secondary prevention involves early identification for early intervention. The use of a
behavioral risk factor survey allows a nurse to identify individuals at high risk for substance
abuse or individuals already abusing substances. Drug education in elementary school is primary
prevention. Rehabilitation and counseling for addicts is tertiary prevention.
~ Risk factors for ATOD problems include a history of childhood trauma, being a victim of
violence, having a parent with addiction, a history of mood disorders, and a lack of adaptive
coping mechanisms.
Mental Health/Illness:
~Responding to the feelings expressed by a client is an effective therapeutic communication
technique. This option does not minimize the client’s experience and facilitates exploration of
the client’s expressed feelings. A “Why” is nontherapeutic.
~Stress contributes to adults’ mental health status. Sources of stress include multiple role
responsibilities, job insecurity, lack of or diminishing resources, and unstable relationships.
These and other conditions can undermine mental health and contribute to serious mental illness,
depression, anxiety disorders, and substance abuse.
~Objectives of Healthy People 2020 are aimed at helping adults access treatment to decrease
associated human and economic costs and to reduce rates of suicide.
~At some time or another, almost all adults will experience a tragic or unexpected loss, a serious
setback, or a time of profound sadness, grief, or distress. Major depressive disorder, however,
differs both in intensity and duration from normal sadness or grief. Depression disrupts
relationships and the ability to function and can be fatal. In terms of suicide, the diagnosable
mental disorder is most likely to be depression. Those with depression are more likely to visit a
physician for some other reason, and the mental health condition may not be noted. Therefore, it
is important that nurses in all settings recognize and screen for depression.
Teens and Health:
~Teens are more likely to experience violence during their pregnancies than adult women. Age
may be a factor in their greater vulnerability to potential perpetrators, who include partners,
family members, and other acquaintances. Violence in pregnancy has been associated with an
increased risk for substance abuse, poor compliance with prenatal care, and poor birth outcome.
In the case of partner violence, young women may be protective of their partners because of fear
or helplessness. Eliciting this history from an adolescent is not easy. The nurse must ask about
violence at each visit. Frequent routine assessments are more revealing than a single inquiry at
the first prenatal visit. Violence that begins in pregnancy may continue for several years after,
with increasing severity. The nurse should look for physical signs of abuse, as well as for
controlling or intrusive partner behavior. Allowing them to acknowledge their feelings in a
nonjudgmental and supportive way will foster a more positive interaction and outcome between
the nurse and patient.
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Created: 8/8/2020
Revised: 4/6/2023
NUR 206 Community Health Exam 2
Study Guide
~The focus with secondary prevention is early identification for early intervention. Education on
the purpose and frequency of Pap smears is secondary prevention. Maintaining a normal BMI
across the lifespan is primary prevention. Using prayer or a low sodium diet for an existing
diagnosis is tertiary prevention.
Primary and Secondary Prevention:
~ The most effective evaluation would be to measure HbA1c six months after beginning the
program, to demonstrate that behavior is changes and glycemic control is improving. A post-test
and return demonstration only reflects that attendees understood what was taught; it does not
demonstrate they are actually using the information in daily life. A survey obtaining feedback
improves the nurse’s delivery but does not demonstrate efficacy.
~ The focus in primary prevention is preventing a problem before it ever occurs, such as a
walking group for health seniors. A blood pressure screening is secondary prevention. Support
groups and counseling of individuals with existing problems is considered tertiary prevention.
~Quality improvement activities are a crucial part of nursing care delivery. Nurses participate in
the following:
• Monitoring care
• Seeing and analyzing opportunities for improving care
• Developing guidelines to improve care
• Collecting data
• Making recommendations
• Implementing activities to enhance quality of care
• Evaluating care and services
~The results of these activities are used to make changes in health care delivery. Clinical data is
of great importance in assessing the quality of care. The care and services the client receives and
any communication between the physicians and other home health providers must be
documented. Increasingly this documentation occurs in electronic health records, often by
entering data into a laptop computer while in the home. It is in the clinical record that nurses
demonstrate that they are delivering quality care and are also identifying means to improve the
quality of care. It is the legal method by which the quality of care can be assessed. This
documentation also demonstrates the client’s ongoing need for services and shows how the
multiple disciplines arrange for continuity and comprehensive care.
~ 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.
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Created: 8/8/2020
Revised: 4/6/2023
NUR 206 Community Health Exam 2
Study Guide
~As nurses, who are some of the most trusted sources of health information to the public, it is
our responsibility to know about environmental health risks. This includes knowing how to
assess them; eliminate or reduce them; and communicate, educate, and advocate for policies that
support a healthier environment. There are 10 principles that comprise the nurse’s responsibility
for environmental health. These principles say that (1) it is essential that nurses know about
environmental health; (2) nurses should not use products or practices that harm health or the
environment; (3) nurses have a right to work in a safe and healthy place, and nurses and other
health care professionals have the right to know in a timely manner about any possible harmful
products, chemicals, pollutants, and hazards to which they may be exposed; (4) multidisciplinary
collaboration is a factor that sustains a healthy environment; (5) the choice of materials,
products, technology, and practices in the environment that affect nurses is based on best
practices; (6 and 7) nurses should respect the diversity of the people whom they serve and also
focus on the quality of the environment in which they and their clients work and live; (8) nurses,
other health care workers, families, patients, and communities have the right to know timely
information about potentially harmful products; and (9 and 10) nurses should participate in both
research and advocacy related to promoting a safe and healthy environment.
~ Primary level of prevention focuses on prevention, such as education. A secondary level of
prevention focuses on screening. The tertiary level of prevention focuses on treatment and
evaluation of the outcomes.
Faith/Hospice Nursing:
~ The nurse should recognize when the family of a client who is actively dying requires support.
Encouraging family members to discuss their concerns will also support the client. During the
dying process, the nurse should encourage the client's family to be present. However, if a family
member voices concerns, the nurse should support the family member by exploring their
feelings.
~ Listening attentively to the client and encouraging the client to talk is an appropriate response.
~ The home health nurse should understand the difference between Medicare and Medicaid, the
two major federally supported programs for home health care. Medicare participation is for
clients 65-years old or disabled, homebound status. The service provided to the client must be a
skilled service. Medicaid is income-based, covers maintenance programs, and the maximum
level is set by state regulations.
~ The home health nurse should assess the environment and identify potential risks to the client.
A refrigerator with a temperature control not working can place the client at risk for
contaminated food. Non-skid mats in the bathroom can prevent falls from the shower or tub.
Carbon monoxide detectors can prevent carbon dioxide poisoning. Prescribed medication should
be stored in the original pharmacy bottles and clearly labeled can prevent taking the wrong
medication or confusion related to the medication.
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Created: 8/8/2020
Revised: 4/6/2023
NUR 206 Community Health Exam 2
Study Guide
~ Nurses often confuse spirituality and religiosity. Spirituality refers to the attitudes and beliefs
related to transcendence or nonmaterial forces of life. Religiosity refers to the behaviors, beliefs,
and practices of a religion.
~ A congregation-based model of parish nursing focuses on autonomous activities that directly
impact the individual community of faith, such as coordinating meals, facilitating a support
group, and establishing childcare services. The institutional-based model focuses on
collaboration with healthcare providers.
~ When visiting a client who is a new mother, the priority of the nurse is to assess the parent and
infant bonding, reinforce a holistic reflection of life transitions, and plan for faith community
support. Breastfeeding techniques, environmental hazards, and infant sleep schedules are
important but are the priority of the parish nurse. The parish nurse is focused on the spiritual
dimensions of care.
Homelessness/Rural Communities and Health:
~ People who are poor want to be treated like everyone else. It is important to not judge people
who cannot pay their bills because there are many complex factors that lead to this situation.
People may be unable to pay for their medications but are embarrassed to admit this, so asking a
direction question such as: “Will you be able to purchase your medication?” may enable the
person to acknowledge this problem and seek assistance. It is also important to learn about
programs in the community that can be of assistance with medication, food, and other necessities
such as utility bills. Examples might be food banks, churches, or clothing centers.
~ Clients in rural communities have an overall decrease in health status when compared to urban
clients. Rural clients are less likely to participate in activities during leisure time, have decreased
compliance with safety precautions, such as wearing a seatbelt, and do not engage in preventive
health screenings. Chronic disease is more prevalent among rural clients.
~ Clients who live in rural communities know each other and are very familiar with each other.
There is a lack of anonymity among rural communities, which makes reporting health issues a
challenge. Clients are far less likely to report sexual assault, drug use, or depression based on the
concern that others in the community will find out.
~ When identifying resources for older adult clients who live in rural communities, the nurse
should focus on the barriers to healthcare access. Transportation is the number one barrier for
older adults living in rural communities. The other options are important, but not the priority.
Environmental Health and Epidemiology:
~ Epidemiology studies report the distribution of a health event within a population by
investigating the proportion, risks, and rate. The risk measures the probability that the health
event will occur in the population. The proportion determines the numbers required to measure
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Created: 8/8/2020
Revised: 4/6/2023
NUR 206 Community Health Exam 2
Study Guide
incidences within a population. The rate is the frequency of a health event that occurs in the
population. Risk factors can predict what can cause a health event.
~ When calculating the cause-specific mortality rate, the nurse will take the number of deaths
divided by the total risk population. This number determines the estimated risk for death from a
cause in a population. The proportion of all deaths divided by the standard population is the
formula to calculate the proportionate mortality rate ratio. The crude death rate is calculated by
estimating the number of deaths based on incidences, while the case fatality rate measures deaths
over a period of time.
~ The epidemiologic triangle focuses on three elements, agent, host, and environment, that
influence the occurrence of a disease. The host is the living species capable of being infected,
and the characteristics that promote the disease occurrence include the immunological status.
The agent is the factor that must be present for the disease to occur, such as bacteria. The
environment is the internal or external factor that influences the disease, such as a plant, water,
and reservoir.
~ When designing an epidemiological study for the first-time, the ecologic design is the best to
use. The ecologic design is quick, easy, and uses readily available existing data. The crosssectional, case-control, and prospective cohort requires time in the collection and interpretation
of data.
~ Environmental health risks are factors that can cause disease or injury from exposures in the
home, work, and community. Assessing for sources of unintentional poisonings, such as mercury
from fish or lead from paint, are environmental risk factors. Storing medication, preparation of
food, and the amount of time watching television are lifestyle risk factors.
~ A Healthy People 2020 environmental health objective that would benefit migrant workers
would be to reduce pesticide exposures that result in the need for healthcare access. A mobile
clinic, tracking system, and screening clinic focus on objectives that prevent disease.
~ When assessing the environmental risk, the nurse should evaluate for issues causing
unintentional accidents or injury, such as poisoning. Older homes have a high risk for paint
containing lead, which could cause damage to developing children. A gate around the pool, an
alarm on a door, and security cameras are appropriate safety initiatives.
~ Some occupations have risk factors for developing respiratory conditions. The occupations
with the highest risk factor include coal miners, glassmakers, and construction works. These
clients have a higher risk of breathing in particles that can cause diseases, such as
pneumoconiosis and silicosis. Clients who work in an office building, on a farm, and with
animals could have risk factors for developing allergies or asthma, not occupational diseases.
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Created: 8/8/2020
Revised: 4/6/2023
NUR 206 Community Health Exam 2
Study Guide
Occupational Health:
~ Trends in occupational health have seen an increase in hazards related to burnout,
nanotechnology, non-ergonomic workstations, complex chemicals, and exhaustion. These
hazards increase the risk of injury to workers.
~ When assessing for physical hazards in the workplace, the nurse will consider factors that
cause tissue trauma, such as temperature and noise levels. The use of lifting devices and
workstation deficiencies reflect environmental, mechanical hazards. Assessing chemical storage
is an assessment specific to chemical hazards. When assessing biological and infectious hazards
safety, the nurse will assess the access to protective equipment.
~ Transmission of TB is a major public health problem and is often spread in workplaces with
close quarters, such as hospitals and correction facilities. The employees work closely with
individuals who are at high risk for TB.
~ The tertiary level of prevention focuses on minimizing complications and reducing the number
of missed workdays. The occupational nurse would implement education on glucose monitoring.
Providing safety equipment, scheduling routine break sessions, and offering healthy snacks are a
primary level of prevention interventions.
~ The function of NIOSH is to conduct research, identify occupational health and safety hazards,
and distribute the research. The function of the Occupational Safety and Health Administration
(OSHA) is to enforce the occupational standards, maintain a database, and establish the
permissible exposure level.
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Created: 8/8/2020
Revised: 4/6/2023