Surveillance and Outbreak Investigation

1. A nurse considered copying last month’s surveillance report and changing the date because the number of occurrences per month had not noticeably changed. Which of the following best explains why the nurse should continue to spend time collecting and reporting data that is always nearly the same?

a.
Because such data are legally required
b.
Because it is still part of the nurse’s responsibilities, even if it is a waste of time
c.
To determine a local baseline rate and immediately notice any change
d.
To determine differences among communities in need for state assistance

ANS: C

Disease surveillance helps establish baseline (endemic) rates of disease occurrence and patterns of spread. Surveillance makes it possible to initiate a rapid response to an outbreak of a disease or event that can cause a health problem.

DIF: Cognitive Level: Apply (Application) REF: pp. 267-268

2. A nurse attends a conference to learn more about public health surveillance. Why is it so important that the nurse be knowledgeable about this topic?

a.
Because nurses are employed in public health agencies
b.
Because nurses are often the first to recognize and respond to a problem
c.
Because nurses are responsible for ensuring that action is taken when necessary
d.
Because nurses are typically the ones to interact with the public and the media

ANS: B

Nurses are often in the forefront of responses to be made in the surveillance process whether working in a small rural agency or a large urban agency; within the health department, school, or urgent care center; or on the telephone performing triage services during a disaster. It is the nurse who sees the event first.

DIF: Cognitive Level: Apply (Application) REF: p. 268

3. A rural public health nurse is spending time reviewing death certificates. Which of the following best explains the purpose of this activity?

a.
To ensure that local causes of death are consistent with national causes of death
b.
To confirm that no local health problems are beginning
c.
To evaluate effectiveness of health promotion programs
d.
To obtain mortality data for the local area

ANS: D

Mortality data are often the only source of health-related data available for small geographic areas. Vital statistics reports such as death certificates are reviewed. Useful information also comes from administrative data such as discharge reports and billing records.

DIF: Cognitive Level: Apply (Application) REF: p. 268

4. Which of the following types of surveillance is being used when case reports are routinely sent to local health departments by health care providers and laboratories, where the data are then summarized and forwarded to those responsible for monitoring such reports?

a.
Active surveillance
b.
Passive surveillance
c.
Sentinel surveillance
d.
Special surveillance

ANS: B

It is passive surveillance when case reports are sent to local health departments by health care providers or laboratories. The case reports are summarized and forwarded to the state health department, national government, or organizations responsible for monitoring the problem, such as the CDC. In active surveillance, the health department nurse may begin a search for cases through contacts to determine the magnitude of the problem. Sentinel surveillance involves looking for trends. Special surveillance is developed when a particular type of data is sought.

DIF: Cognitive Level: Understand (Comprehension) REF: p. 269

5. In which of the following situations would the nurse most likely use active surveillance?

a.
A newspaper wants to know the incidence of asthma in the community.
b.
A real-time ongoing communication channel is established to monitor a particular symptom.
c.
Several children become ill with GI upset at one local school.
d.
The nurse is asked to report the incidence of a specific nonreportable common problem in the community.

ANS: C

In active surveillance, the nurse may begin a search for cases to determine the magnitude of the problem (how widespread it is). An example would be when several school children become ill after eating lunch in the cafeteria or at the local hot dog stand, in which case, active surveillance would be used to investigate the possibility of food poisoning.

DIF: Cognitive Level: Apply (Application) REF: p. 269

6. Several children were hospitalized for severe vomiting and diarrhea. Which of the following best explains why the nurse would continue to pursue the cause of the illness even after the children have been discharged from the hospital?

a.
So that the children’s families know the public health department cared about them
b.
So that action could be taken to avoid any such future episodes
c.
Because the children’s parents need to know whom to sue for their medical expenses
d.
To confirm that the symptoms were due to an infectious disease

ANS: B

The objectives of an investigation are to control and prevent disease or death by identifying factors that contribute to the occurrence and implementing measures to prevent occurrences. In this case the nurse wanted to make sure children did not become ill again when it could be avoided.

DIF: Cognitive Level: Apply (Application) REF: p. 271

7. A child came to school coughing almost constantly. The next day, six other children in the same school room were coughing. Which of the following types of outbreak would the nurse suspect?

a.
Common source
b.
Mixed
c.
Propagated
d.
Intermittent

ANS: A

A common source outbreak refers to a group exposed to a common noxious influence, in this case, the ill child who was attending school. The cause of the illness being spread is obvious.

DIF: Cognitive Level: Apply (Application) REF: p. 272

8. A nurse noted that of 18 children in a day care center room, 5 became ill. Which of the following best describes a host factor that may be associated with this illness and who became ill?

a.
Some of the children were from very low socioeconomic families.
b.
Some of the children slept during rest time while others only rested.
c.
The bacterial cause of the illness was easily removed by hand washing.
d.
The day care center room was much warmer on three sides in comparison to the side with the floor to ceiling windows.

ANS: A

Factors that must be considered as causes of outbreak are categorized as agents, hosts, and environmental factors. Host factors may be age, sex, race, socioeconomic status, genetics, and lifestyle choices. The cause of the illness is an agent factor, and the difference in temperature in the room is an environmental factor.

DIF: Cognitive Level: Apply (Application) REF: p. 272

9. In January, a nurse is listening to colleagues talk about the increase in depressed patients asking for help from their physicians recently. The incidence of complaints of depression was higher in the last month than in the previous 3 months. Based on this data, which of the following would be the next step for the nurse to take?

a.
No further action is necessary because depression is known to worsen during the shorter darker days of winter.
b.
No further action is necessary because this short-term increase may just be a statistical error or even just a mistaken impression by the involved nurses.
c.
Action should be taken because there must be some cause for this noted increase.
d.
Action should be taken because this increase may the beginning of an epidemic and should be investigated.

ANS: A

Typically, any unusual increase in incidence should be investigated. But in the majority of cases the increased incidence occurs naturally and/or is predictable when compared with the consistent patterns of previous outbreaks. Many illnesses are seasonal. Seasonal affective disorder (depression) often worsens during the shorter periods of daylight in the winter.

DIF: Cognitive Level: Analyze (Analysis) REF: p. 272

10. Which aspect of a biological agent is probably the most frightening to those exposed?

a.
Infectivity
b.
Invasiveness
c.
Pathogenicity
d.
Virulence

ANS: D

Infectivity refers to the capacity of an agent to enter a susceptible host and produce infection or disease. Invasiveness is the ability of an agent to get into a susceptible host. Pathogenicity measures the proportion of infected people who develop the disease. Virulence refers to the proportion of people with clinical disease who become severely ill or die. It is assumed people could cope with illness but possible death is truly frightening for most.

DIF: Cognitive Level: Understand (Comprehension) REF: p. 272

MULTIPLE RESPONSE

1. Which of the following describes the purpose of surveillance systems today? (Select all that apply.)

a.
To obtain data used to fight for increased budgets from taxpayers
b.
To evaluate the effectiveness of public health programs
c.
To monitor and reduce the incidence of chronic diseases
d.
To note and help prevent occupational exposure and diseases

ANS: B, C, D

Although surveillance was initially devoted to monitoring and reducing the spread of infectious diseases, it is now used to monitor and reduce chronic diseases and injuries, as well as environmental and occupational exposures. With tight budgets, public health workers must know which programs should be developed and continued based on the most commonly occurring public health problems. Evaluation of the effectiveness of programs requires valid and reliable data.

DIF: Cognitive Level: Understand (Comprehension) REF: p. 267

2. A public health department becomes aware of an impending health problem before any problem is reported to the agency. Which of the following has most likely occurred within the community? (Select all that apply.)

a.
Doctors are feeling rushed as they interact with each patient.
b.
Emergency departments are notably busier than usual.
c.
Nurses are calling in ill to the local hospital.
d.
Pharmacists are discussing the increase in medication purchases.

ANS: B, D

Doctors feeling rushed and nurses calling in ill are not unusual events. Syndronic surveillance systems were developed to monitor illness syndromes or events, as seen in such indirect measures as increased numbers of medication purchases, trips to physicians or emergency departments, orders for cultures or x-rays, and rising levels of school or work absenteeism. These may indicate that an epidemic is developing.

DIF: Cognitive Level: Analyze (Analysis) REF: p. 271

3. The outpatient health care data show a notable increase in asthma over the numbers treated the previous year. Which of the following actions should the public health nurse take first? (Select all that apply.)

a.
Analyze educational health programs offered to the public last year.
b.
Congratulate the public health staff on the success of their asthma awareness program.
c.
Determine whether there are any other data sources that might confirm or dispute the apparent increase in asthma.
d.
Review data with the outpatient clinic staff such as confirming repeat visits versus newly diagnosed cases.

ANS: C, D

Before drawing any conclusions, further data should be sought, including confirmation of the current data and their meaning. Data can be inaccurate or collected differently than in the past. What might have led to an increase? Are there other valid sources that might have relevant data? Should surveillance specific to asthma be established?

DIF: Cognitive Level: Analyze (Analysis) REF: p. 268