Chapter 05: Epidemiology
Nies: Community/Public Health Nursing, 7th Edition
MULTIPLE CHOICE
1. An epidemiologist has written a summary of a food
poisoning outbreak, including its cause and ways to prevent it
from occurring in the future. Which best describes what has
been done?
a. Analytic epidemiology
b. Descriptive epidemiology
c. Prospective cohort study
d. Retrospective cross-sectional survey
ANS: B
There are two principal types of epidemiology: (1) analytic
epidemiology and (2) descriptive epidemiology. Descriptive
epidemiology describes the amount and distribution of
disease, which may suggest possible causes. These causes can
then be confirmed or corrected through more advanced
methods of research. Analytic epidemiology investigates the
causes of disease by determining why a disease rate is lower in
one population group than another. A prospective cohort study monitors a group of diseasefree individuals to determine whether and when disease occurs. Retrospective studies
compare individuals with a particular condition or disease and those who do not have the
disease.
DIF:
Cognitive Level: Apply (Application)
2. Two brothers played with their cousin. One brother later became quite ill, whereas the other
did not. Which provides the bNestRe x pIlanaGtionBf.oC
r thiM
s occurrence?
T
O
a. Difference in length of timUe exSpos N
ed
b. Difference in how actively the children played
c. Difference in genetic inheritance between the two brothers
d. Difference in lifestyle between the two brothers
ANS: C
Assuming the two brothers lived in the same household, the environment and the agent or
infectious organisms are the same. The only difference could be between the two brothers
themselves and their genetic inheritance.
DIF: Cognitive Level: Apply (Application)
3. In which circumstance would it be more helpful to use the wheel model of epidemiology than
the epidemiological triangle model?
a. When factors outside the triangle model are involved
b. When there are multiple causes for a chronic disease
c. When research has not yet determined the exact cause
d. When trying to explain the situation to a lay person
ANS: B
The epidemiological triangle model of agent-host-environment is very useful, especially with
single-cause infectious diseases. However, with the multiple factors involved in chronic
diseases, the wheel model is more useful in analyzing and identifying the multiple variables.
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DIF:
Cognitive Level: Apply (Application)
4. Which best describes the importance of discovering all of the variables that may be involved
in creating a disease state in some persons?
a. People want an explanation of why they are ill.
b. Knowing causes helps obtain funds for research to try to create a cure.
c. Finding variables that are susceptible to prevention or early intervention is
important.
d. It is important to educate communities on how to avoid any risk factors.
ANS: C
Identifying risk factors is critical to creating or discovering specific prevention and
intervention approaches that reduce chronic disease morbidity and mortality. Because some
risk factors cannot be avoided, knowing other risk factors involved allows for more
possibilities of preventing the problem. These variables need to be identified first so that
health care providers are able to provide an explanation to persons as to why they are ill,
obtain funding for research for the problem, and educate the community about the avoidance
of the known risk factors.
DIF:
Cognitive Level: Apply (Application)
5. Which best describes the advantage of the web of causation model in comparison with the
epidemiological triangle model?
a. The web of causation model is easier to understand and use.
b. The web of causation model is more widely known and publicized.
c. The web of causation model is more recent and current.
d. The web of causation mo del s h o w s t h e r e l a t i o n s hips among variables.
ANS: D
N R I G B.C M
U S N T
O
Although it is a more recently created model, the web of causation model is more useful
because it illustrates the complexity of relationships among causable variables. It is not easier
to understand and use as it has more variables than the three (agent, host, and environment) in
the epidemiological model.
DIF:
Cognitive Level: Understand (Comprehension)
6. Which has been determined to be a major variable in transmission of sexually transmitted
infections?
a. The pathogenesis of the involved agents
b. The susceptibility of the host
c. The environment in which the hosts live
d. The amount of sex education provided in the schools
ANS: C
The researchers concluded that ecosocial or contextual conditions strongly enhance sexually
transmitted infection risk by increasing sexual risk behaviors and likelihood of exposure to
infection. Thus, the environment has been determined to be a more important variable in
sexually transmitted infections than the pathogenesis, susceptibility, and the amount of sex
education provided.
DIF:
Cognitive Level: Understand (Comprehension)
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7. A community health nurse determined exactly how many cases of a particular disease were
currently occurring in the community. Which action should the nurse take before determining
what interventions should be planned?
a. Analyze whether the disease was a priority to the nurse’s agency
b. Compare the current rate with the previous rate of disease
c. Determine what resources are available to intervene
d. Share the findings with the public health agency leadership
ANS: B
No conclusions can really be drawn from just knowing a number. Only by converting that
count to a rate and then comparing the rate with the previous rate, or with the rate in the
broader environment or a similar community nearby, can any conclusions be drawn as to
whether there is a problem or intervention needed. Once the rate has been calculated, the
nurse will be able to share the findings with leadership, determine the resources available to
intervene if necessary, and determine if the disease is a priority.
DIF:
Cognitive Level: Apply (Application)
8. People were very concerned about another outbreak of swine flu. All care providers were
asked to report, without individual names, any new cases to the public health department for
tracking. Which would be most helpful for the local media to report to keep citizens
informed?
a. The ongoing incidence rate
b. The ongoing prevalence of the illness
c. How many were hospitalized
d. How many had died so f a r in loc al h o sp i t a l s a n d c a re facilities
N R I G B.C M
U S N T
O
ANS: A
As only new cases were being reported to the health department, the media could only report
the ongoing incidence rate, that is, the number of new cases reported each day. The prevalence
rate is the number of all cases of a specific disease or condition in a population at a given
point in time which would not assist in knowing the number of new cases. Those infected with
the flu may or may not be hospitalized or have died from the flu.
DIF:
Cognitive Level: Apply (Application)
9. When trying to determine whether the swine flu outbreak was getting worse, which rate
should be carefully observed?
a. The crude death rate
b. The age-specific death rate
c. The swine flu incidence rate
d. The swine flu prevalence rate
ANS: C
The incidence rate of new cases would be most useful for detecting short-term acute disease
changes, because the swine flu duration is usually relatively short. The prevalence rate is the
number of all cases of a specific disease or condition in a population at a given point in time.
Crude death rates summarize the occurrence of mortality. An age-specific death rate
characterizes the death rates of a particular age group in the population.
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DIF: Cognitive Level: Apply (Application)
10. A newspaper published an article stating that the athletic banquet at the local high school had
approximately 1000 family members in attendance. Exactly 650 persons became ill within 24
hours, complaining of severe diarrhea, vomiting, and cramping. Which best describes the
attack rate?
a. 650 persons
b. 1000 persons
c. 650:1000
d. 6.5%
ANS: C
Rates are calculated by the number of people with the problem over the number exposed to
the problem. In this case, 650 persons out of the 1000 at the banquet complained of illness.
Although this rate could be presented as an attack rate of 65%, 6.5% is incorrect.
DIF: Cognitive Level: Apply (Application)
11. In a particular community, the rate of new cases of diabetes and the rate of new cases of flu
during the month of January were precisely the same. Which disease would have the higher
prevalence rate?
a. As an acute condition, flu would have the higher prevalence rate.
b. As a chronic condition, diabetes would have the higher prevalence rate.
c. Flu would have the higher prevalence rate because people can get flu several times
in one season.
d. Flu would have the higher prevalence rate because it is so contagious.
ANS: B
Diabetes would have the higher prevalence rate because it is a long-term chronic condition
that typically does not decrease. Although flu might have a higher incidence rate of new cases,
because flu is typically of short duration, the prevalence rate would remain low. Flu is
contagious, which could increase the incidence rate but not the prevalence rate.
DIF: Cognitive Level: Apply (Application)
12. Which statement best describes why the incidence and prevalence of gonorrhea is unknown?
a. Gonorrhea is not a reportable condition.
b. Gonorrhea can vary in how long the infection remains in the body.
c. Gonorrhea can be cured with antibiotics, so people do not remain infected.
d. People are ashamed to admit they have gonorrhea.
ANS: A
Morbidity rates (incidence and prevalence rates) are not available for many conditions
because surveillance of many chronic diseases is not widely conducted. Furthermore,
morbidity rates may be subject to underreporting when they are available. In other words,
there is no responsibility to report cases of most diseases, including gonorrhea. Information is
only available related to conditions where care providers are required to report that specific
condition or where those affected die and mortality data are available.
DIF: Cognitive Level: Analyze (Analysis)
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13. Which group should be used to determine the community’s pregnancy rate?
a. All persons between 15 and 45 years old in the community
b. The total population of the community
c. The total population of women in the community
d. Women between 15 and 45 years old in the community
ANS: D
Although pregnancy is not specifically addressed, the text stresses that only those susceptible
to a particular condition should be considered in the denominator. In the case of pregnancy,
only women of childbearing age are susceptible.
DIF:
Cognitive Level: Apply (Application)
14. Which research study would determine the attributable risk of a sedentary lifestyle in cardiac
disease?
a. Measuring all cases of cardiac problems in a specific community
b. Comparing the number of persons with cardiac disease among athletes with the
number among nonathletes in a community
c. Subtracting the rate of cardiac disease among athletes from the rate of cardiac
disease among nonathletes
d. Calculating the relative risk and then subtracting the attack rate to determine the
attributable risk
ANS: C
Attributable risk is determined by subtracting the rate of disease among nonexposed
individuals (such as athletes) from the rate of disease among those exposed (the individuals
with a sedentary lifestyle).
U S N T
O
DIF: Cognitive Level: Apply (Application)
15. A nurse conducted a study of two skin lotions: (1) an inexpensive one and (2) an expensive
one. The nurse found that there was a relative risk of 0.7 for skin sores using the inexpensive
one and a relative risk of 1.2 using the expensive one. Which skin lotion should the nurse use?
a. Impossible to tell from the data given
b. It made no difference which lotion was used
c. The expensive lotion
d. The inexpensive lotion
ANS: D
A risk factor of less than one means the factor is actually protective, so the inexpensive lotion
is helpful in preventing skin sores. A risk factor of more than one means the factor increases
risk, so using the expensive lotion increases the probability of getting a skin lesion.
DIF: Cognitive Level: Apply (Application)
16. Which best describes a model that demonstrates the progression of disease from
prepathogenesis through disease outcome?
a. Epidemiological model
b. Ecosocial model
c. Natural history model
d. Wheel model
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ANS: C
The natural history of disease model explains disease from prepathogenesis through resolution
of the disease process. The epidemiological model involves the epidemiological triangle:
agent, host, and environment. The ecosocial model emphasizes the role of evolving
macro-level socioenvironmental factors to understand health and illness. The wheel model
subscribes to multiple-causation rather than single-causation disease theory, and is more
useful in analyzing complex chronic conditions and identifying factors that are amendable to
intervention.
DIF: Cognitive Level: Understand (Comprehension)
17. A student athlete receives a screening examination before being active in school sports.
Which level of prevention is being used?
a. Health prevention
b. Primary prevention
c. Secondary prevention
d. Tertiary prevention
ANS: C
Screening, because it may result in early diagnosis and treatment, is secondary prevention.
Primary prevention refers to interventions that occur before the disease develops. Tertiary
prevention focuses on limitation of disability and the rehabilitation of those with irreversible
disease. Health prevention is not considered to be a level of prevention.
DIF: Cognitive Level: Apply (Application)
18. For which would a screening test be most appropriate?
a. Disease A, which must bN
e cUaR
ugShI
t eNa G
r l yTbBe .
c aCu sOe Ms o c i e t y punishes those known to
have the disease
b. Disease B, which can be controlled if caught early in the disease process
c. Disease C, which people need to know whether they have contracted, even though
there is no treatment for the disease
d. Disease D, because people may want to use that information in family planning
ANS: B
It is extremely useful to the individuals concerned and society if screening can lead to early
diagnosis and successful control of the disease process. There is no point in doing a screening
if there is no treatment or if there is a known risk of social stigma and discrimination if it
becomes known that the person has the disease. Discussion and disagreement continue as to
whether genetic information should be used in family planning.
DIF: Cognitive Level: Understand (Comprehension)
19. One hundred women received notification that their screening tests suggested that they might
have a serious health problem. Which action should the nurse take to ensure that they will
complete follow-up testing?
a. Compliment them on their willingness to be tested and suggest an immediate
appointment before they have too much time to think about the issue.
b. Imply that the test could be wrong; the testing materials may not be effective, but
the only way to be sure is to be tested further.
c. Point out that screening is only suggestive and that not all positive screenings
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mean they actually have the health problem.
d. Reassurance is not therapeutic; reality must be faced. Emphasize the need for
immediate treatment.
ANS: C
Not all positive screening results are confirmed with further diagnostic testing. The positive
predictive value of a test (proportion of true positive results relative to all positive test results)
is usually known for any screening test. Although one could argue that the test could be
wrong, it is more therapeutic—because you want people to attend future screenings—to
emphasize that screening is only suggestive than to say the screening test is inaccurate.
DIF:
Cognitive Level: Apply (Application)
20. Which would be the best method to increase the positive predictive value of a screening test?
a. Test a large population at once
b. Test a group at high risk for the health problem
c. Use a very sensitive screening test
d. Use a very specific screening test
ANS: B
The positive predictive value is affected by what proportion of the tested population has the
problem. To increase the positive predictive value, screen populations most at risk for the
problem. Testing a large population at once, using a very sensitive or very specific screening
test would not increase the positive predictive value of a screening test.
DIF:
Cognitive Level: Understand (Comprehension)
tU
o dIS
e t erNGmTinBe .i fCHe M
a l thy People 2020 is improving the health
21. Which is themost effective wNay R
of Americans?
a. Availability of relatable data on total population’s health problems
b. Comprehensive and systematically collected surveillance data on the health status
of various population groups
c. Increased financing to allow ongoing collation of information
d. Willingness of individuals to share health information with the federal government
ANS: B
Effectiveness of Healthy People 2020 depends on the availability of reliable baseline and
continuing data to characterize health problems and evaluate goal achievement. Surveillance
is crucial. Without surveillance data, there is no relatable data available. Increased financing
will not assist in determining if the health of Americans is improving. Although it is important
for individuals to be willing to share health information so that data collection can be
completed, individual health information alone will not be an effective determinant of the
health of Americans.
DIF:
Cognitive Level: Understand (Comprehension)
22. A researcher is examining potential risk factors in comparison with disease at a specific time
through collecting data regarding current exercise, sleep patterns, and current health status
among 12-year-olds. Which research study would be most appropriate?
a. Cross-sectional study
b. Prospective study
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c. Retrospective study
d. True experiment
ANS: A
By definition, a cross-sectional study examines relationships between potential causal factors
and disease at a specific time. A prospective study monitors a group of disease-free
individuals to determine if and when disease occurs. A retrospective study compares
individuals with a particular condition or disease with those who do not have the disease. A
true experiment involves both an experimental group who receives an intervention and a
control group who does not receive an intervention.
DIF:
Cognitive Level: Apply (Application)
23. A researcher, interested in the onset of early menses, compared the life experiences and
history of 1000 14-year-old girls, half of whom had monthly periods and half of whom did
not, to determine what variables might be observed. Which would be the most appropriate
categorization of this study?
a. Cross-sectional study
b. Prospective study
c. Retrospective study
d. True experiment
ANS: C
When a study looks at individuals with a particular condition in comparison with those who
do not have the disease, based on their exposures to various life situations, it is a retrospective
study; that is, the study requires participants to look back at previous experiences. A
cross-sectional study examines relationships between potential causal factors and disease at a
specific time. A prospective N
stuUdR
y S
mI
onNitGorTsB
a.
grCouOpMof disease-free individuals to determine if
and when disease occurs. A true experiment involves both an experimental group who
receives an intervention and a control group who does not receive an intervention.
DIF:
Cognitive Level: Apply (Application)
24. One famous study followed a cohort of nurses over their lives, collecting data and health
histories as they aged. Which would be the most appropriate categorization of this study?
a. Cross-sectional study
b. Prospective study
c. Retrospective study
d. True experiment
ANS: B
Prospective studies monitor a group of individuals to determine if and when disease occurs. A
cross-sectional study examines relationships between potential causal factors and disease at a
specific time. A retrospective study compares individuals with a particular condition or
disease with those who do not have the disease. A true experiment involves both an
experimental group who receives an intervention and a control group who does not receive an
intervention.
DIF:
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25. A researcher wanted to engage in the best possible research design to obtain reliable
information about the possible cause(s) of a disease. Which design would the researcher
choose?
a. Cross-sectional study
b. Descriptive study
c. Prospective study
d. Retrospective study
ANS: C
The most advantageous research design, because it obtains more reliable information and can
more easily establish a stronger temporal relationship between presumed causal factors and
their effects, is a longitudinal cohort prospective study. A cross-sectional study examines
relationships between potential causal factors and disease at a specific time. A descriptive
study focuses on the amount and distribution of health and health problems within a
population. A prospective study monitors a group of disease-free individuals to determine if
and when disease occurs. A retrospective study compares individuals with a particular
condition or disease with those who do not have the disease.
DIF:
Cognitive Level: Apply (Application)
26. A researcher has limited time and funds. Which research design would be most appropriate?
a. Cohort study
b. Incidence study
c. Longitudinal study
d. Retrospective study
ANS: D
Because longitudinal, c o h o r t ,NoUr R
inS
ciI
deNnG
ceTsB
tu.
diC
esOaM
re costly in terms of resources and staff
and often lose subjects over time, a retrospective study may be used because it is faster and
less demanding of resources.
DIF:
Cognitive Level: Apply (Application)
27. On the basis of findings related to elevated blood levels of cholesterol, a researcher wanted to
determine whether a new drug would notably lower the blood levels of cholesterol in
otherwise healthy persons. Which study would the researcher most likely use?
a. Cross-sectional study
b. Experimental study
c. Prospective study
d. Retrospective study
ANS: B
Experimental design is used to test treatment and prevention strategies. Subjects are randomly
assigned to the experimental group to obtain the new drug while the control group receives a
placebo or alternative. The changes in blood cholesterol level would then be measured. A
cross-sectional study examines relationships between potential causal factors and disease at a
specific time. A prospective study monitors a group of disease-free individuals to determine if
and when disease occurs. A retrospective study compares individuals with a particular
condition or disease with those who do not have the disease.
DIF:
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28. A client has developed pellagra because of a lack of certain B vitamins. Which best describes
the classification of the nutritional deficiency?
a. Relative risk factor
b. Agent factor
c. Environment factor
d. Host factor
ANS: B
Nutritional deficiencies are included under agent factors. Although too much of an agent can
cause disease (such as obesity related to diabetes), so can too little of an agent. Relative risk
indicates the extent of excess risk incurred by exposure relative to nonexposure. Host factors
are intrinsic factors and describe one’s susceptibility or response influence to the exposure to
the agent, such as genetics, age, sex, ethnicity, and human behavior. Environment factors are
extrinsic factors and they influence the existence of the agent, exposure, or susceptibility to
the agent such as physical environment, biological environment, and socioeconomic
environment.
DIF:
Cognitive Level: Apply (Application)
29. Which best describes the Tuskegee Syphilis Study?
a. It provided excellence in research design.
b. It used an extensive subject base leading to confirmed conclusions.
c. It developed information about the causes and treatment of syphilis.
d. It implemented unethical and racist treatment of uninformed subjects.
ANS: D
As treatment was kno wi ngl yNwUit R
h hSelId No G
v e Tr B
m.
anCyOyM
ears resulting in incredible harm to the
subjects and their families, public outrage over unethical, racist, and discriminatory behavior
of the researchers continues today.
DIF:
Cognitive Level: Understand (Comprehension)
MULTIPLE RESPONSE
1. An epidemiologist is gathering data to determine which factors may lead to disease. Which
data will be gathered? (Select all that apply.)
a. Demographic characteristics
b. Disease characteristics
c. Geographic data
d. Health protection measures taken
e. Length of the disease process
f. When disease struck the area
ANS: A, C, F
The person-place-time model suggests epidemiologists examine demographic characteristics
of the community (person characteristics), geographic or environmental factors (place), and
common time factors (time—or when the disease struck). Disease characteristics, health
protection measures taken, and length of the disease process are not used when determining
which factors may lead to disease.
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