NR442 Exam 1 Review

The nurse is caring for a minority client. When assessing for social inequities, which social determinants would be most appropriate for the nurse to consider? Select all that apply.

• Age

• Gender

• Living conditions

• Working conditions

• Access to health care

Answer explanation

✅ Correct Answers:

• → Living conditions – YES. This is a key social determinant of health (SDOH). Poor housing, neighborhood safety, and environmental exposures can affect health outcomes.

• → Working conditions – YES. Job safety, employment status, and benefits (e.g., insurance) influence health.

• → Access to health care – YES. Limited access due to cost, location, or lack of transportation contributes to health inequities.

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🚫 Incorrect Answers:

• →Age – While important in care planning, age alone is a biological factor, not a social determinant of health related to inequity.

• → Gender – While gender can affect health disparities, it's more often considered a demographic or identity factor, not an SDOH unless tied to gender discrimination in healthcare access.

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💡 NCLEX Tip:

When a question asks about social determinants of health, think environment, education, employment, housing, food access, and healthcare access—factors that exist outside the clinical setting but deeply impact health.

_____________ describes and monitors health events through ongoing and systematic collection, analysis, and interpretation of health data for the purpose of planning, implementing, and evaluating public health interventions.

• Outreach

• Surveillance

• Screening

• Collaboration

Answer explanation

✅ Correct Answer:

• → Surveillance

Surveillance refers to the ongoing, systematic collection, analysis, and interpretation of health data. It is essential for monitoring health trends, identifying outbreaks, guiding public health policy, and evaluating interventions. Surveillance helps detect changes in disease patterns, enabling timely responses.

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❌ Incorrect Options:

• → Outreach
  Outreach involves locating populations at risk and connecting them with services, but it does not involve ongoing data collection or analysis.

• → Screening
  Screening is the early identification of disease in individuals who appear healthy, usually through tests or exams. It is not a surveillance method but a separate intervention.

• → Collaboration
  Collaboration refers to working with partners or agencies toward a common goal. It’s a process, not a method of monitoring health events.

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📝 NCLEX Tip:

When you see keywords like “monitor,” “ongoing,” “systematic,” and “data analysis,” think of surveillance—a cornerstone of epidemiology and public health nursing.

Ask ChatGPT

The nurse is caring for a minority client. When assessing for social inequities, which social determinants would be most appropriate for the nurse to consider? Select all that apply.

• Familial support

• Access to education

• Environmental safety

• Living in a populated city

• Access to transportation

Answer explanation

✅ Correct Answers:

→ Familial support

While not traditionally listed among structural determinants like income or housing, familial support can play a critical role in a person's ability to seek care, follow treatment plans, and maintain overall well-being. Emotional, financial, and caregiving support can directly influence health outcomes.

→ Access to education

Education affects health literacy, employment opportunities, income levels, and a person’s ability to navigate healthcare systems.

→ Environmental safety

Living in safe environments (free from violence, pollution, or structural hazards) contributes to better health outcomes and reduces injury and disease risk.

→ Access to transportation

Transportation access enables individuals to attend medical appointments, obtain medications, and receive timely care, especially in underserved areas.

These four factors are all important influences on healthcare access and health outcomes, particularly when viewed through the lens of the social determinants of health.

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🚫 Incorrect Answer:

❌ → Living in a populated city

Although urban living can present challenges (e.g., overcrowding, pollution), it often increases access to healthcare facilities. Living in a city alone is not a consistent barrier to care and may even improve access for many. - However, living in a rural area may affect access to heath care.

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📝 NCLEX Tip:

When answering questions about health determinants, consider both structural/systemic factors (e.g., education, transportation) and personal/social supports (e.g., family), as both can significantly impact health outcomes.

The nurse is working in a very busy outpatient clinic that cares primarily for uninsured clients. The nurse plans care, knowing that the most likely reason for this clinic being so busy is which factor?

• The clients are unemployed.

• The clinic has payment options.

• The clients lack access to preventive health care.

• The clinic can qualify them for Medicaid coverage.

Answer explanation

✅ Correct Answer:

The clients lack access to preventive health care.

Lack of access to preventive health care is a common issue among uninsured individuals. Without regular preventive services (like screenings, immunizations, and early treatment), clients are more likely to seek care only when illness becomes severe, resulting in higher patient volume and more complex health needs at clinics serving uninsured populations.

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❌ Incorrect Options:

• → The clients are unemployed
  While unemployment may contribute to being uninsured, it does not fully explain why the clinic is so busy. Not all uninsured individuals are unemployed.

• → The clinic has payment options
  This might attract some clients, but it’s not the most likely reason for high patient volume compared to the broader issue of lacking preventive care access.

• → The clinic can qualify them for Medicaid coverage
  While this is helpful, Medicaid qualification is a secondary benefit and not the primary reason for seeking care at the clinic.

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📝 NCLEX Tip:

When answering questions about underserved or uninsured populations, prioritize access to care, social determinants of health, and the barriers to preventive services—these are key contributors to health disparities.

A community health nurse working as a school health nurse conducted a community assessment and determined that the focus of programs and health education for the academic year should address the problem of childhood obesity. In planning, it is important for the nurse to allow time for individual nursing assessment and education for children who are overweight or obese and to plan classroom education programs. The nurse is demonstrating an understanding of which important community health nursing concept?

• Health planning

• Aggregate health care

• Community as client

•  Use of the nursing process

Answer explanation

✅ Correct Answer:

• → Community as client

The nurse is using the community as the client approach by identifying a community-level health problem (childhood obesity) and planning interventions that target both the individual (nursing assessments and education) and the larger group (classroom programs). This approach recognizes that the community itself is the unit of care, not just individual students.

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❌ Incorrect Options:

• → Health planning
  Health planning is involved, but it refers more broadly to setting goals and developing policies or strategies. It’s not the best fit for this specific focus on both individual and community interventions.

• → Aggregate health care
  An “aggregate” refers to a subgroup within a population (e.g., children with asthma), but the question emphasizes the community (school) as a whole, not just a specific aggregate.

• → Use of the nursing process
  While the nursing process (assessment, diagnosis, planning, implementation, evaluation) is always applied, the core concept being tested is the nurse’s focus on the community as a client, not the steps of the nursing process.

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📝 NCLEX Tip:

When you see terms like classroom programs, community assessment, or population-level interventions, think “community as client”—this reflects a public health approach rather than individual care only.

The population health nurse is planning to use a "web of causation" to explain the development of a health problem in a group of clients. What should the nurse use as an example of the web of causation?

• Oil refinery, flare emissions, and asthma.

• Mosquitoes, West Nile virus, and decreased mosquito spraying.

• Adolescent pregnancy rate, lower socioeconomic status and education, and close friends with infants.

• Access to alcohol, decreased enforcement of minors, and attractive media portrayal of alcohol that contributes to adolescent alcohol usage.

Answer explanation

✅ Correct Answer:

Access to alcohol, decreased enforcement of minors, and attractive media portrayal of alcohol that contributes to adolescent alcohol usage.

The web of causation model is used in epidemiology to illustrate how multiple interrelated factors contribute to the development of a health condition. It recognizes that health issues rarely have a single cause and instead result from a complex interplay of social, environmental, behavioral, and biological factors.

• It is the best example because it includes multiple interconnected factors (access, legal enforcement, and media influence) that together increase the risk of adolescent alcohol use—demonstrating the web-like complexity of causation.

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❌ Incorrect Options:

• → Oil refinery, flare emissions, and asthma
  This suggests a linear cause-effect model (pollution → asthma), not a web of multiple interrelated causes.

• → Mosquitoes, West Nile virus, and decreased mosquito spraying
  This is a chain of infection, not a complex web. It fits better under chain of transmission rather than web of causation.

• → Adolescent pregnancy rate, lower socioeconomic status and education, and close friends with infants
  This is close, but not as comprehensive or interconnected as Option 4. It hints at risk factors, but doesn't show the dynamic interplay like media, enforcement, and availability do in alcohol use.

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📝 NCLEX Tip:

When you see "web of causation," think multiple, interacting risk factors that influence or reinforce one another—especially in public health or community nursing settings.

The population health nurse notes that the number of cases of diabetes in a community remained stable during the last year. However in January, ten new diagnoses of diabetes were confirmed. What type of data is the nurse analyzing?

• Incidence.

• Morbidity.

• Prevalence.

• Case fatality rate.

Answer explanation

✅ Correct Answer:

• → Incidence

Incidence refers to the number of new cases of a disease or condition that occur in a specific population during a defined time period. In this scenario, the nurse is analyzing ten new diagnoses of diabetes in January, which reflects new occurrences—making it a measure of incidence.

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❌ Incorrect Options:

• → Morbidity
  Morbidity refers to illness or disease in general but doesn’t distinguish between new and existing cases. It’s a broader term.

• → Prevalence
  Prevalence reflects the total number of existing cases (both old and new) at a particular time. The stem indicates a new rise, not overall presence.

• → Case fatality rate
  This is the proportion of people who die from a specific disease among those who have it. This question mentions no deaths, only new diagnoses.

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📝 NCLEX Tip:

• Incidence = NEW cases

• Prevalence = ALL existing cases (new + old)

• Always check for time references and words like "newly diagnosed" in the question to identify incidence.

The health of a community is determined by community resources and the well-being of its residents. Which factor is essential to the health of a community?

• Availability of medical specialists

• Individuals having health insurance

• Everyone having access to health care

• Public Health Nurses working in the community

Answer explanation

✅ Correct Answer:

• → Everyone having access to health care

Access to health care for all individuals is a foundational factor in determining the overall health of a community. Without access, residents may delay or forgo care, leading to poorer outcomes and wider health disparities. Equitable access allows for preventive care, timely treatment, and chronic disease management—key components of a healthy population.

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❌ Incorrect Options:

• → Availability of medical specialists
  While beneficial, specialists serve specific populations and do not guarantee access to general or primary care, which is more critical at the community level.

• → Individuals having health insurance
  Insurance helps, but having insurance alone does not ensure access to care—issues like provider availability, transportation, or cost-sharing may still be barriers.

• → Public Health Nurses working in the community
  They are vital for promoting community health, but their presence alone is not sufficient unless all community members can access services.

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📝 NCLEX Tip:

When asked about essential components for community health, prioritize universal access to care—regardless of income, status, or location. This is a core principle in public health and health equity.

The population health nurse attends a seminar on health care economics. What should the nurse realize as one of the biggest concerns influencing the economic health status of the United States?

• Aging of citizens.

• Declining birth rate.

• Rise in asthma among children.

• Rise of adolescent mental health problems.

Answer explanation

✅ Correct Answer:

• → Aging of citizens

The aging population is one of the biggest concerns influencing the economic health status of the United States. As more citizens live longer and enter retirement age, there is an increased demand for:

• Chronic disease management

• Long-term care services

• Medicare spending

• Healthcare workforce needs

This shift places significant financial pressure on the healthcare system, social security, and public health infrastructure—making it a top concern in healthcare economics.

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❌ Incorrect Options:

• → Declining birth rate
  While it affects future workforce size and demographics, it is less immediate in economic impact compared to the healthcare costs of an aging population.

• → Rise in asthma among children
  This is a public health concern, but it affects a smaller portion of the population and doesn't have the broad economic implications of aging.

• → Rise of adolescent mental health problems
  Also important, but again, the aging population has a much larger-scale economic impact due to long-term care and chronic illness costs.

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📝 NCLEX Tip:

When asked about economic concerns in public or population health, consider large-scale, system-wide impacts—aging, chronic disease, access, and insurance coverage are top priorities.

One dimension of a community, which looks at personal characteristics and risks of a group, is called

• Aggregate of people

• Location in space and time

• Social system

• Census tract

Answer explanation

✅ Correct Answer:

• → Aggregate of people

The aggregate of people refers to a group of individuals who share personal characteristics, risks, or attributes—such as age, gender, ethnicity, health conditions, or behaviors—that affect their health outcomes. This dimension focuses on who makes up the community and what risks or needs they may have in common.

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❌ Incorrect Options:

• → Location in space and time
  Refers to geographic and temporal dimensions of a community (e.g., where and when events occur, such as outbreaks or natural disasters).

• → Social system
  Refers to institutions and relationships that influence how a community functions, like education, government, religion, and health care systems.

• → Census tract
  This is a geographic unit used for statistical purposes by the U.S. Census Bureau. It’s not a conceptual dimension of community like aggregate or social systems.

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📝 NCLEX Tip:

In community health nursing, "aggregate" means a target population or subgroup with shared traits or risks. Always connect this term with assessment and intervention planning for population-focused care.