Nursing Community Assessment Service (NCAS) Computer-Based Assessment — Questions and Answers

Question 1: A terminally ill patient asks the community nurse not to tell family members about the prognosis. The nurse should:

Encourage the patient to tell the family but respect the final decision (Correct answer)
Inform the family anyway because they need to plan for caregiving
Refer the decision to the attending physician
Honor the patient's request and maintain confidentiality

Correct answer: Encourage the patient to tell the family but respect the final decision

While respecting confidentiality, the nurse may provide therapeutic communication to encourage disclosure while ultimately honoring the patient's autonomous decision.

Question 2: A patient is receiving IV heparin therapy. Which laboratory value should the nurse monitor to evaluate therapeutic effect?

PT
CBC
INR
aPTT (Correct answer)

Correct answer: aPTT

The aPTT (activated partial thromboplastin time) monitors the intrinsic coagulation pathway and reflects heparin's anticoagulant effect.

Question 3: A community nurse is designing a health education program about hypertension for adults with low health literacy. Which material format is MOST appropriate?

Simple visuals, large font, and materials written at a 6th-grade reading level (Correct answer)
A 90-minute lecture with no visual aids
Textbooks with complex charts and statistical tables
Dense medical literature with clinical terminology

Correct answer: Simple visuals, large font, and materials written at a 6th-grade reading level

For audiences with low health literacy, materials should use plain language at a 6th-grade level or below, large fonts, and visual aids to ensure understanding.

Question 4: Which level of the socio-ecological model addresses policies and regulations that influence health behavior across entire populations?

Interpersonal level
Individual level
Policy/enabling environment level (Correct answer)
Community level

Correct answer: Policy/enabling environment level

The policy or enabling environment level of the socio-ecological model addresses laws, regulations, and institutional policies that create structural conditions affecting population health.

Question 5: Which respiratory infection control measure is recommended for all health care workers in community settings during influenza season?

Annual influenza vaccination (Correct answer)
Daily antiviral prophylaxis
Wearing N95 respirator at all times
Avoiding all patient contact during influenza season

Correct answer: Annual influenza vaccination

Annual influenza vaccination is the primary recommended infection control measure for all health care workers to protect themselves and their patients during influenza season.

Question 6: When performing a sterile dressing change, the nurse accidentally touches the inner surface of the sterile drape with an ungloved hand. What is the correct response?

Apply additional antiseptic to the contaminated area
Continue the procedure if the area touched was small
Obtain a new sterile field and supplies (Correct answer)
Use the outer edge of the drape to cover the contaminated area

Correct answer: Obtain a new sterile field and supplies

Any break in sterile technique requires obtaining a new sterile field because contamination compromises the entire field.

Question 7: Which community intervention has the strongest evidence for reducing cardiovascular disease mortality at the population level?

Individual dietary counseling sessions only
Sodium reduction policies and tobacco control legislation (Correct answer)
Annual cholesterol screening without follow-up
Hospital-based cardiac surgery expansion

Correct answer: Sodium reduction policies and tobacco control legislation

Population-level policies such as sodium reduction in food processing and tobacco control laws have the largest impact on cardiovascular mortality across the entire population.

Question 8: A community nurse is measuring the impact of a physical activity promotion program. Which outcome metric BEST demonstrates program effectiveness?

Number of social media posts about the program
Percentage of participants meeting CDC physical activity guidelines at 6-month follow-up (Correct answer)
Number of program brochures distributed
Amount of funding spent per participant

Correct answer: Percentage of participants meeting CDC physical activity guidelines at 6-month follow-up

Measuring the proportion of participants who meet physical activity guidelines at follow-up directly captures behavior change — the actual intended outcome of the program.

Question 9: Which of the following sexually transmitted infections (STIs) is the most commonly reported infectious disease in the United States?

Chlamydia (Correct answer)
HIV
Gonorrhea
Syphilis

Correct answer: Chlamydia

Chlamydia trachomatis infection is consistently the most reported STI in the US, with over 1.5 million cases annually, disproportionately affecting young women.

Question 10: A community health nurse is running a smoking cessation program. Which counseling approach has the strongest evidence for increasing quit rates?

Brief advice alone without medication
Self-help pamphlets only
Hypnotherapy as the primary intervention
Combining pharmacotherapy (NRT, varenicline, or bupropion) with behavioral counseling (Correct answer)

Correct answer: Combining pharmacotherapy (NRT, varenicline, or bupropion) with behavioral counseling

Combined pharmacotherapy and behavioral counseling has the strongest evidence base for smoking cessation, with much higher quit rates than either approach alone.

Question 11: A nurse is administering metformin to a newly admitted patient. Which condition is an absolute contraindication for this medication?

Renal impairment (Correct answer)
Osteoporosis
Hypertension
Hyperlipidemia

Correct answer: Renal impairment

Metformin is contraindicated in significant renal impairment because decreased clearance leads to drug accumulation and risk of lactic acidosis.

Question 12: Which of the following best describes the purpose of mapping community assets during a health assessment?

To audit hospital financial records
To track individual patient medication lists
To identify existing strengths and resources that can support health improvement (Correct answer)
To document property values in the neighborhood

Correct answer: To identify existing strengths and resources that can support health improvement

Asset mapping identifies existing community strengths — such as clinics, schools, and social organizations — that can be leveraged for health interventions.

Question 13: A community health nurse wants to assess the health status of a rural population. Which method is MOST appropriate when literacy levels are low?

In-person interviews with visual aids (Correct answer)
Complex statistical reports
Written self-administered questionnaires
Online digital surveys

Correct answer: In-person interviews with visual aids

In-person interviews using visual aids are most appropriate for populations with low literacy, ensuring accurate data collection without excluding participants.

Question 14: Which approach to health education is MOST consistent with the principles of health literacy and patient empowerment?

Relying solely on pharmaceutical company pamphlets
One-way lecture from nurse to patient
Teach-back method: asking patients to explain the information back in their own words (Correct answer)
Providing written materials only without discussion

Correct answer: Teach-back method: asking patients to explain the information back in their own words

The teach-back method confirms patient understanding by asking them to explain information back, identifying and correcting misunderstandings in real time.

Question 15: Which of the following is an example of PRIMARY prevention identified during a community health assessment?

Screening for early-stage hypertension
Managing chronic diabetes with insulin
Providing chemotherapy for cancer patients
Implementing school-based HPV vaccination programs (Correct answer)

Correct answer: Implementing school-based HPV vaccination programs

Primary prevention prevents disease before it occurs; school-based vaccination programs prevent HPV infection and HPV-related cancers from developing.

Question 16: Which of the following describes a community that practices phenomenology?

Census tract #1017 of the US Census Bureau
The region of Miami Valley
The Delco Manufacturing staff (Correct answer)
The Yellow Springs village

Correct answer: The Delco Manufacturing staff

Due to their shared experience of working for the same company, Delco Manufacturing employees might be viewed as an example of a phenomenologic community. They might experience comparable obstacles, follow comparable work schedules, and form a feeling of identification and belonging as members of the Delco Manufacturing community. The foundation of this community is their common understanding and interpretation of their experiences and work environment within the organization.

Question 17: When caring for a patient in contact precautions, which personal protective equipment (PPE) must be donned before entering the room?

Surgical mask and gloves only
N95 respirator and eye shield only
Gown and gloves (Correct answer)
Gown, gloves, N95 respirator, and face shield

Correct answer: Gown and gloves

Contact precautions require a gown and gloves upon room entry to prevent transmission of organisms spread by direct or indirect contact.

Question 18: A community health nurse notices a high rate of childhood obesity in a low-income neighborhood. What is the FIRST step in addressing this?

Conduct a comprehensive community assessment to identify contributing factors (Correct answer)
Refer all obese children to a specialist
Issue a community-wide diet directive
Immediately implement a weight-loss intervention program

Correct answer: Conduct a comprehensive community assessment to identify contributing factors

The first step is always assessment — identifying root causes such as food deserts, lack of safe play spaces, or cultural dietary patterns before planning interventions.

Question 19: The nurse is presenting community health assessment findings to a local health board. Which format best communicates disease prevalence across zip codes?

Individual patient case reports
Geographic information system (GIS) mapping (Correct answer)
Narrative summary paragraphs only
Handwritten tally sheets

Correct answer: Geographic information system (GIS) mapping

GIS mapping visually displays health data geographically, making it easy to identify clusters of disease across different zip codes or neighborhoods.

Question 20: Which of the following is the CDC's recommended sequence for donning (putting on) PPE in a health care setting?

Face shield, gloves, gown, mask
Gown, mask/respirator, eye protection, gloves (Correct answer)
Mask, gown, gloves, face shield
Gloves, gown, mask, face shield

Correct answer: Gown, mask/respirator, eye protection, gloves

The CDC donning sequence is: gown first, then mask/respirator, then eye protection/face shield, and finally gloves, ensuring each layer protects the next.

Question 21: A patient is prescribed warfarin for chronic atrial fibrillation. What dietary instruction should the nurse emphasize regarding vitamin K?

Increase vitamin K intake to enhance warfarin
Avoid all foods containing vitamin K
Eat consistent amounts of vitamin K-containing foods (Correct answer)
Vitamin K has no effect on warfarin therapy

Correct answer: Eat consistent amounts of vitamin K-containing foods

Consistent vitamin K intake is recommended because fluctuations in dietary vitamin K significantly alter warfarin's anticoagulant effect and INR values.

Question 22: Which community health action is MOST important after identifying a case of active meningococcal disease?

Administer antifungal treatment to all household members
Isolate the patient for 30 days without notifying contacts
Identify and provide prophylactic antibiotics to close contacts within 24 hours (Correct answer)
Vaccinate the entire community immediately

Correct answer: Identify and provide prophylactic antibiotics to close contacts within 24 hours

Close contacts of meningococcal disease cases should receive antibiotic chemoprophylaxis (rifampin, ciprofloxacin, or ceftriaxone) within 24 hours to prevent secondary cases.

Question 23: A community nurse identifies a cluster of influenza cases in a school. The FIRST public health action should be:

Administer antiviral medication to all students without testing
Immediately close all schools in the district
Report the cluster to the local health department and implement influenza prevention measures (Correct answer)
Wait for laboratory confirmation before any action

Correct answer: Report the cluster to the local health department and implement influenza prevention measures

Reporting infectious disease clusters to the local health department is a mandatory public health duty, initiating official investigation and coordinated response.

Question 24: Which US law mandates that insurance coverage for mental health and substance use disorders be comparable to coverage for medical and surgical care?

Mental Health Parity and Addiction Equity Act (MHPAEA) (Correct answer)
Americans with Disabilities Act (ADA)
HIPAA Privacy Rule
Affordable Care Act (ACA) only

Correct answer: Mental Health Parity and Addiction Equity Act (MHPAEA)

The MHPAEA (2008) and its 2010 ACA amendments require that mental health and substance use disorder benefits be provided on par with medical/surgical benefits.

Question 25: A community health nurse wants to build a coalition to address opioid overdose deaths. Which is the MOST important first step?

Hire a marketing firm to design the campaign
Apply for federal funding before forming the coalition
Identify and engage diverse stakeholders including public health, law enforcement, treatment providers, and people with lived experience (Correct answer)
Develop the intervention program before consulting the community

Correct answer: Identify and engage diverse stakeholders including public health, law enforcement, treatment providers, and people with lived experience

Effective coalition building begins with broad, inclusive stakeholder engagement — including community members with lived experience — before designing any intervention.

Question 26: A community health nurse is assessing food security in a neighborhood. Which question BEST screens for food insecurity?

'What is your favorite food?'
'Do you have a primary care physician?'
'In the past year, did you ever run out of food before you had money to buy more?' (Correct answer)
'Have you been hospitalized in the past year?'

Correct answer: 'In the past year, did you ever run out of food before you had money to buy more?'

This validated question from the USDA Household Food Security Survey is a standard screening tool for food insecurity in community health assessments.

Question 27: A nurse is documenting care after administering pain medication. Which documentation practice is correct?

Document before administering to save time
Have another nurse cosign before documenting
Document immediately after administration (Correct answer)
Document at the end of the shift for all medications given

Correct answer: Document immediately after administration

Documentation should occur immediately after administration to ensure accurate records and prevent duplicate dosing.

Question 28: The ethical concept of paternalism in nursing refers to:

Fathers or male relatives making decisions for female patients
Following physician orders without questioning clinical rationale
Overriding a patient's autonomous choices for their perceived benefit (Correct answer)
Nurses acting as patient advocates in institutional settings

Correct answer: Overriding a patient's autonomous choices for their perceived benefit

Paternalism occurs when healthcare providers substitute their judgment for the patient's in the name of the patient's well-being.

Question 29: Which of the following best describes what a community is?

Individuals who share a common identity or feeling of belonging (Correct answer)
People came together to work on a certain issue.
People that live in a specific location but have no limits
Individuals that share at least one demographic trait

Correct answer: Individuals who share a common identity or feeling of belonging

A community is a collection of individuals who have a shared identity or sense of belonging. This indicates that members of a community have a common sense of identity and feel a sense of connectedness to one another. The significance of social ties and a sense of community among community members is emphasized in this concept. It places more emphasis on the psychological and emotional bonds that unite members of a community than it does on physical borders or particular demographic traits.

Question 30: A community health nurse conducting a health fair uses the opportunity to screen for prediabetes. This activity exemplifies which level of prevention?

Tertiary prevention
Secondary prevention (Correct answer)
Quaternary prevention
Primary prevention

Correct answer: Secondary prevention

Screening asymptomatic individuals to detect prediabetes before it progresses to Type 2 diabetes is secondary prevention, aimed at early detection and intervention.

Question 31: A community nurse is evaluating health disparities in cancer screening rates. Disparities in preventive service use are MOST often driven by:

Lack of insurance, language barriers, and low health literacy (Correct answer)
Patient refusal based on fully informed choice
Genetic differences in screening acceptance
Overabundance of screening facilities

Correct answer: Lack of insurance, language barriers, and low health literacy

Disparities in preventive service use are primarily driven by systemic barriers including lack of insurance coverage, language and cultural barriers, and low health literacy.

Question 32: Which epidemiological concept describes the minimum proportion of a population that must be immune to prevent ongoing disease transmission?

Herd immunity threshold (Correct answer)
Attack rate
Incubation period
Case fatality rate

Correct answer: Herd immunity threshold

The herd immunity threshold is the proportion of a population that must be immune (through vaccination or prior infection) to prevent sustained disease transmission.

Question 33: For a patient with hypertension, the Joint National Committee (JNC) target blood pressure for most adults under 60 is:

Less than 150/90 mmHg
Less than 160/100 mmHg
Less than 140/90 mmHg (Correct answer)
Less than 120/80 mmHg at all ages

Correct answer: Less than 140/90 mmHg

For most adults, the JNC and ACC/AHA guidelines recommend a blood pressure target of less than 140/90 mmHg to reduce cardiovascular risk.

Question 34: Which element of health communication makes public health messages MOST persuasive and actionable for community audiences?

Comprehensive presentation of all available scientific data
Technical language that signals credibility
A specific, easy, single call to action that the audience can perform immediately (Correct answer)
Use of fear appeals without self-efficacy messages

Correct answer: A specific, easy, single call to action that the audience can perform immediately

Health communication research consistently shows that messages including a specific, simple, immediately actionable step drive behavior change better than information-heavy or fear-only messages.

Question 35: Under which circumstances should a community health nurse implement droplet precautions?

Only for patients with HIV infection
For patients with suspected TB only
For all patients regardless of diagnosis
For patients with influenza, meningococcal meningitis, or pertussis (Correct answer)

Correct answer: For patients with influenza, meningococcal meningitis, or pertussis

Droplet precautions are used for infections spread by large respiratory droplets (>5 microns), including influenza, bacterial meningitis, and pertussis.

Question 36: Which of these statements about a group is most accurate?

People who frequently communicate face-to-face (Correct answer)
Individuals that reside in the same geographic region
People who honor one another's viewpoints
Individuals who belong to the same community of phenomenology

Correct answer: People who frequently communicate face-to-face

The ideal way to characterize a group is as individuals who frequently communicate face-to-face. This indicates that a group is made up of people who regularly engage in face-to-face interactions with one another. This sets a group apart from other possibilities, which might not always require direct and frequent face-to-face connection, such as residing in the same geopolitical region, belonging to the same phenomenologic community, or accepting one another's viewpoints.

Question 37: Which type of health promotion program evaluation measures whether the program produced the desired change in health outcomes?

Formative evaluation
Needs assessment
Process evaluation
Outcome evaluation (Correct answer)

Correct answer: Outcome evaluation

Outcome evaluation measures whether a health promotion program achieved its intended health behavior changes or health status improvements.

Question 38: Which federal data system is a primary source for community health assessment in the United States?

Medicare Claims Ledger
Joint Commission Accreditation Database
Hospital Incident Reporting System
Behavioral Risk Factor Surveillance System (BRFSS) (Correct answer)

Correct answer: Behavioral Risk Factor Surveillance System (BRFSS)

The BRFSS is a CDC-managed state-based phone survey system that provides state and local community health data for assessment purposes.

Question 39: Which US public health initiative set national targets for reducing chronic disease and is updated every 10 years?

Joint Commission National Patient Safety Goals
Centers for Disease Control Priority Agenda
Healthy People (currently Healthy People 2030) (Correct answer)
National Health Interview Survey

Correct answer: Healthy People (currently Healthy People 2030)

Healthy People, now in its fifth iteration as Healthy People 2030, sets science-based national objectives for improving health across the US over a decade.

Question 40: Which of the following is a PRIMARY goal of community health assessment under the NCAS model?

To eliminate the need for physician input
To guide development of targeted, evidence-based community health interventions (Correct answer)
To reduce hospital admissions by 50% immediately
To replace individual clinical assessments

Correct answer: To guide development of targeted, evidence-based community health interventions

The primary goal of community health assessment is to provide data that guides the development of targeted, evidence-based public health programs and interventions.

Question 41: In the US, which racial/ethnic group has the highest rate of infant mortality, representing a major maternal-child health disparity?

Asian American infants
Non-Hispanic Black infants (Correct answer)
Non-Hispanic White infants
Hispanic infants

Correct answer: Non-Hispanic Black infants

Non-Hispanic Black infants die at more than twice the rate of non-Hispanic White infants in the US, reflecting systemic racial health disparities.

Question 42: A community health nurse is creating a chronic disease self-management program. Which approach, developed at Stanford University, is most evidence-based for community settings?

Chronic Disease Self-Management Program (CDSMP) (Correct answer)
Population pyramid analysis
Medical Outcomes Study Short Form
Agency for Healthcare Research PCMH model

Correct answer: Chronic Disease Self-Management Program (CDSMP)

The Stanford CDSMP is an evidence-based peer-led workshop proven to improve self-efficacy, health behaviors, and outcomes for people with chronic conditions.

Question 43: Which health behavior change model describes five stages through which individuals move when changing a health behavior: precontemplation, contemplation, preparation, action, and maintenance?

Social Cognitive Theory
Health Belief Model
PRECEDE-PROCEED Model
Transtheoretical Model (Stages of Change) (Correct answer)

Correct answer: Transtheoretical Model (Stages of Change)

The Transtheoretical Model (Prochaska and DiClemente) describes behavior change as a progression through five distinct stages from not considering change to maintaining new behavior.

Question 44: A nurse applying the structural-functional framework to a community's assessment understands that every community needs

Enable a sense of identity and socializing. (Correct answer)
Attend to residents' financial needs.
Perform tasks that have measurable outcomes.
Mandate the construction of public safety infrastructure.

Correct answer: Enable a sense of identity and socializing.

A nurse applying the structural-functional framework to a community's assessment understands that all communities need to offer opportunities for socializing and self-identification. This is due to the fact that socializing aids in the acquisition and internalization of the customs, beliefs, and behaviors of a society, hence fostering social cohesiveness and a feeling of inclusion. For people to support a common purpose and set of objectives, as well as for the community as a whole to comprehend who they are, they need to feel a sense of identity. A community's general health and well-being are influenced by both socialization and a sense of identity.

Question 45: In Bandura's Social Cognitive Theory, 'self-efficacy' is best defined as:

The frequency of a behavior performed in social settings
A person's confidence in their ability to perform a specific behavior successfully (Correct answer)
External rewards provided to reinforce behavior
Social norms that pressure behavior change

Correct answer: A person's confidence in their ability to perform a specific behavior successfully

Self-efficacy is a person's belief in their own capability to successfully execute a specific behavior, and it is a central predictor of health behavior change in Social Cognitive Theory.

Question 46: A nurse is caring for a postoperative patient whose urinary output has been 20 mL/hour for the past 3 hours. What is the priority nursing action?

Document the finding and reassess in 1 hour
Encourage the patient to drink more oral fluids
Notify the physician and assess for signs of fluid deficit (Correct answer)
Increase the IV fluid rate to 200 mL/hour without an order

Correct answer: Notify the physician and assess for signs of fluid deficit

Urine output below 30 mL/hour indicates oliguria, which may signal hypovolemia or acute kidney injury requiring prompt physician notification.

Question 47: How does one go about starting a community assessment?

describing the information required and locating potential sources
defining the community and establishing its limits or specifications (Correct answer)
Selecting locals who may be willing to give their perspectives
Establishing a time and financial budget for the assessment process

Correct answer: defining the community and establishing its limits or specifications

Determining the community's definition and parameters is the first stage in starting a community assessment. This is significant since it aids in defining the assessment's parameters and identifying the target population. The evaluation can concentrate on obtaining pertinent information and insights from the right people and sources by clearly identifying the community and its boundaries. It guarantees that all facets of the community are taken into account and offers a clear beginning point for the assessment.

Question 48: A community health nurse screens adults for anxiety using the GAD-7. A score of 10 or higher suggests:

Minimal anxiety requiring no action
A normal stress response
Severe depression, not anxiety
Moderate to severe anxiety warranting further evaluation and possible intervention (Correct answer)

Correct answer: Moderate to severe anxiety warranting further evaluation and possible intervention

A GAD-7 score of 10 or higher indicates moderate to severe generalized anxiety disorder, and scores of 10–14 and 15+ indicate moderate and severe anxiety, respectively.

Question 49: When assessing a patient's pain, which tool is most appropriate for a patient who is intubated and unable to speak?

Wong-Baker FACES Scale
Behavioral Pain Scale (BPS) (Correct answer)
Numeric Rating Scale (NRS) 0-10
McGill Pain Questionnaire

Correct answer: Behavioral Pain Scale (BPS)

The Behavioral Pain Scale assesses pain through observable behaviors such as facial expressions and limb movements in non-verbal patients.

Question 50: During a head-to-toe assessment, the nurse auscultates the lungs and hears crackles (rales) in the bases bilaterally. This finding is most consistent with:

Bronchospasm
Normal breath sounds in elderly patients
Pleural friction rub
Fluid accumulation in the alveoli (Correct answer)

Correct answer: Fluid accumulation in the alveoli

Bilateral basilar crackles are associated with fluid in the alveoli, as seen in pulmonary edema or heart failure.

Question 51: Which tool is most commonly used in community health assessment to identify priority health needs of a population?

Medication reconciliation form
Laboratory blood panel
Individual patient interview
Windshield survey (Correct answer)

Correct answer: Windshield survey

A windshield survey allows nurses to observe community health determinants such as housing, resources, and environmental hazards by driving through the area.

Question 52: A nurse is preparing to administer digoxin to a patient. What is the most important assessment to perform before administration?

Blood glucose level
Blood pressure
Respiratory rate
Apical pulse for one full minute (Correct answer)

Correct answer: Apical pulse for one full minute

Digoxin is withheld and the provider notified if the apical pulse is below 60 bpm, as the medication slows cardiac conduction.

Question 53: Which of the following is the MOST effective community-level strategy to reduce Type 2 diabetes incidence in high-risk populations?

Eliminating all carbohydrates from school menus
Annual diabetes screening without follow-up
CDC-recognized Diabetes Prevention Program (DPP) offering structured lifestyle intervention (Correct answer)
Universal insulin distribution

Correct answer: CDC-recognized Diabetes Prevention Program (DPP) offering structured lifestyle intervention

The CDC-recognized DPP, which promotes modest weight loss through diet and physical activity, reduces Type 2 diabetes risk by 58% in high-risk adults.

Question 54: Which concept from community health describes the process of enabling people to increase control over and improve their own health?

Health surveillance
Disease management
Clinical governance
Health empowerment / Health promotion (WHO Ottawa Charter definition) (Correct answer)

Correct answer: Health empowerment / Health promotion (WHO Ottawa Charter definition)

The WHO Ottawa Charter (1986) defines health promotion as the process of enabling people to increase control over and improve their health — emphasizing empowerment over disease treatment.

Question 55: The Health Belief Model proposes that a person will take a health action when they believe:

The government mandates the health action
Other people in their community are taking the action
They are susceptible to the condition, the condition is serious, and the benefits of action outweigh barriers (Correct answer)
Their doctor tells them to take action regardless of personal belief

Correct answer: They are susceptible to the condition, the condition is serious, and the benefits of action outweigh barriers

The Health Belief Model predicts health action based on perceived susceptibility, severity, benefits, barriers, and cues to action interacting together.

Question 56: Which epidemiological measure would a community health nurse use to compare disease burden between two communities of different sizes?

Total hospital admissions
Raw case count
Mean age of patients
Rate (cases per 1,000 or 100,000 population) (Correct answer)

Correct answer: Rate (cases per 1,000 or 100,000 population)

Rates standardize data by population size, allowing fair comparison of disease burden between communities regardless of their size.

Question 57: Which data source provides the most objective information about mortality rates in a US community?

Social media health posts
Patient satisfaction surveys
Death certificates and vital statistics records (Correct answer)
Community focus groups

Correct answer: Death certificates and vital statistics records

Vital statistics records and death certificates are the authoritative, objective source for mortality data used in community health assessments.

Question 58: A nurse is caring for a patient with a stage 2 pressure injury. Which intervention is the highest priority?

Massage the reddened area to increase circulation
Apply a wet-to-dry dressing
Reposition the patient every 2 hours (Correct answer)
Administer prescribed antibiotics

Correct answer: Reposition the patient every 2 hours

Repositioning every 2 hours relieves pressure and is the cornerstone intervention for preventing worsening of pressure injuries.

Question 59: A nurse is using the PRECEDE-PROCEED model to plan a community obesity prevention program. In the PRECEDE phase, the nurse should FIRST:

Implement the educational intervention
Evaluate program outcomes
Secure funding for the program
Conduct a social assessment to identify quality of life concerns of the target community (Correct answer)

Correct answer: Conduct a social assessment to identify quality of life concerns of the target community

The PRECEDE phase begins with a social assessment of the community's quality of life concerns to ensure the program addresses real community priorities from the start.

Question 60: A community assessment reveals a high prevalence of hypertension among Black adults in a specific US county. This is an example of:

A health disparity requiring targeted community intervention (Correct answer)
Normal population variation with no action needed
An issue only addressed by individual clinicians
A data collection error to be corrected

Correct answer: A health disparity requiring targeted community intervention

Disproportionate disease burden among a specific racial or ethnic group is a health disparity that demands targeted community-level intervention and advocacy.

Question 61: A community nurse is educating a patient about hepatitis C transmission. Which route accounts for the MAJORITY of new hepatitis C infections in the US?

Sexual contact
Injection drug use with shared needles (Correct answer)
Mother-to-child transmission
Blood transfusions

Correct answer: Injection drug use with shared needles

Injection drug use with shared equipment accounts for over 60% of new hepatitis C virus infections in the United States.

Question 62: What does the term 'interconception care' refer to in maternal-child health programs?

Neonatal intensive care for premature infants
Health care provided to women between pregnancies to improve outcomes for future pregnancies (Correct answer)
Prenatal care during the first trimester
Health services for women who choose not to have children

Correct answer: Health care provided to women between pregnancies to improve outcomes for future pregnancies

Interconception care addresses risk factors and chronic conditions between pregnancies to improve health before the next conception, reducing adverse birth outcomes.

Question 63: A nurse is preparing to administer blood products. Which IV solution is compatible with blood transfusions?

Dextrose 5% in 0.45% NaCl
Normal saline (0.9% NaCl) (Correct answer)
Dextrose 5% in water (D5W)
Lactated Ringer's solution

Correct answer: Normal saline (0.9% NaCl)

Only normal saline (0.9% NaCl) is compatible with blood products; dextrose solutions can cause hemolysis and Lactated Ringer's can cause clotting.

Question 64: The Title V Maternal and Child Health Block Grant program in the US primarily aims to:

Administer Medicare benefits
Improve the health of mothers, children, and children with special health needs through state-run programs (Correct answer)
Provide housing assistance for low-income adults
Fund adult oncology services

Correct answer: Improve the health of mothers, children, and children with special health needs through state-run programs

Title V provides federal funding to states to improve maternal and child health, with specific focus on reducing infant mortality and supporting children with special health care needs.

Question 65: The nurse completes a community health assessment and finds the top three health priorities. What should happen NEXT in the NCAS process?

Develop a community health improvement plan with measurable goals and interventions (Correct answer)
Refer all findings to the state health department and take no local action
Publish findings in a medical journal before taking action
Repeat the assessment in 6 months

Correct answer: Develop a community health improvement plan with measurable goals and interventions

After identifying health priorities, the next step is to develop a community health improvement plan (CHIP) with specific, measurable goals and targeted interventions.

Question 66: A community nurse teaches a patient with asthma to use a peak flow meter. The 'yellow zone' (50–79% of personal best) indicates:

Good control requiring no action
Caution: worsening asthma requiring use of rescue inhaler and possible medical contact (Correct answer)
Emergency requiring immediate 911 call
Need to stop all medications immediately

Correct answer: Caution: worsening asthma requiring use of rescue inhaler and possible medical contact

The yellow zone in peak flow monitoring signals caution and worsening asthma control, requiring rescue bronchodilator use and evaluation of whether further care is needed.

Question 67: Which element is essential for valid informed consent in community nursing practice?

Agreement from the patient's next of kin
A physician's signature on the consent form
Consent witnessed by two registered nurses
Patient comprehension of risks, benefits, and alternatives (Correct answer)

Correct answer: Patient comprehension of risks, benefits, and alternatives

Valid informed consent requires that the patient understands and voluntarily agrees to the procedure, including its risks, benefits, and alternatives.

Question 68: What is the primary goal of contact tracing in infectious disease control?

To prosecute individuals who spread disease knowingly
To collect genetic samples from all exposed persons
To identify and notify individuals exposed to an infectious disease so they can be tested and isolated if necessary (Correct answer)
To determine the cost of an outbreak to the health system

Correct answer: To identify and notify individuals exposed to an infectious disease so they can be tested and isolated if necessary

Contact tracing identifies people who may have been exposed to an infectious disease so they can receive testing, treatment, and isolation instructions to interrupt further transmission.

Question 69: Which vaccine-preventable disease is characterized by a prodrome of Koplik's spots followed by a maculopapular rash spreading from head to trunk?

Rubella
Roseola
Varicella (chickenpox)
Measles (rubeola) (Correct answer)

Correct answer: Measles (rubeola)

Koplik's spots (bluish-white spots on the buccal mucosa) followed by a cephalocaudal maculopapular rash are classic presentations of measles.

Question 70: A community nurse is managing a norovirus outbreak at a long-term care facility. Which action is MOST important to contain spread?

Apply alcohol hand sanitizer exclusively throughout the facility
Allow well residents to visit ill residents to build immunity
Administer antiviral medications to all residents
Cohort ill residents, implement Contact Precautions, enforce hand hygiene with soap and water (Correct answer)

Correct answer: Cohort ill residents, implement Contact Precautions, enforce hand hygiene with soap and water

Norovirus outbreaks in congregate settings require cohorting ill persons, Contact Precautions, and soap-and-water handwashing because alcohol hand rub is less effective against norovirus.

Question 71: In the US, the childhood immunization schedule is jointly recommended by which organizations?

CMS and the FDA
State health departments independently
CDC, AAP, and AAFP (Correct answer)
WHO and UNICEF only

Correct answer: CDC, AAP, and AAFP

The US childhood immunization schedule is developed and recommended jointly by the CDC's Advisory Committee on Immunization Practices (ACIP), the AAP, and the AAFP.

Question 72: A nurse is preparing to administer a medication through a nasogastric tube. Which action should be taken first?

Elevate the head of the bed to 45 degrees
Crush the medication and dissolve it
Verify tube placement (Correct answer)
Flush the tube with 30 mL of water

Correct answer: Verify tube placement

Verifying tube placement is the priority to ensure the tube is in the stomach and prevent aspiration.

Question 73: Which approach would be most effective for assessing a community's health?

Find out from the locals whether they are content with their homes. (Correct answer)
Find out from the police department which areas have the lowest rates of criminal activity.
Find out from a firefighter which communities experience the fewest fires.
Find out from a realtor which communities have the priciest homes.

Correct answer: Find out from the locals whether they are content with their homes.

The greatest method to assess the well-being of a neighborhood is to ask its residents if they are content with their current residence. Members of the community and their contentment with their living circumstances are intimately involved in this method. Their contentment is a reflection of the general health and standard of living in the neighborhood. A comprehensive picture of the community's health is provided by the consideration of multiple criteria, including general contentment, social connections, safety, and facilities. The opinions of the neighborhood's residents are essential to determining the general well-being of the community.

Question 74: Which community-based mental health program model emphasizes peer support specialists who have lived experience with mental illness?

Hospital-based inpatient only
Assertive Community Treatment (ACT) only
Peer support program / Certified Peer Specialist model (Correct answer)
Crisis stabilization without peer support

Correct answer: Peer support program / Certified Peer Specialist model

Certified Peer Specialists use their personal recovery experience to provide support, encouragement, and role modeling for community members with mental illness.

Question 75: Which statement by a patient indicates a correct understanding of incentive spirometry use?

'I will use it only when I feel short of breath.'
'I will use it once a day after meals.'
'I will inhale slowly and deeply to raise the ball or piston.' (Correct answer)
'I should exhale forcefully into the device.'

Correct answer: 'I will inhale slowly and deeply to raise the ball or piston.'

Incentive spirometry requires slow, sustained maximal inspiration to fully expand the lungs and prevent atelectasis.

Question 76: A nurse was doing a neighborhood assessment close to the health agency. As she drove around, the nurse noted how the community's walkways, buildings, and residents were doing. Which of the following sums up the nurse's activities the best?

An observation from the neighborhood
A brief synopsis
Windshield survey (Correct answer)
A drive-through

Correct answer: Windshield survey

In order to perform a windshield survey, the nurse must drive around the neighborhood and note the state of the homes, walkways, and residents. By doing this kind of survey, the nurse can learn more about the general health and wellbeing of the community without having to speak with people face-to-face. It gives a brief synopsis of the social and physical surroundings of the community.

Question 77: A patient's nasogastric tube has been ordered for continuous feedings. Which assessment finding requires immediate action?

Absent bowel sounds with abdominal distension (Correct answer)
Blood glucose of 140 mg/dL
Tube feeding rate of 50 mL/hr
Gastric residual of 150 mL

Correct answer: Absent bowel sounds with abdominal distension

Absent bowel sounds with abdominal distension may indicate an ileus or obstruction and requires immediate physician notification and tube feeding cessation.

Question 78: Which of the following best describes 'upstream' interventions in health promotion?

Addressing the root social, economic, and environmental determinants of health rather than individual symptoms (Correct answer)
Treating disease after onset with medications
Screening individuals for early disease detection
Providing acute care in emergency settings

Correct answer: Addressing the root social, economic, and environmental determinants of health rather than individual symptoms

Upstream interventions address the fundamental social, economic, and environmental conditions — like poverty, housing, or food access — that create health problems in the first place.

Question 79: A community nurse calculates the incidence rate of Type 2 diabetes in a town. Incidence rate specifically measures:

Total existing cases of a disease at one point in time
New cases of a disease in a population over a specific time period (Correct answer)
The ratio of disease to healthy individuals
The mortality rate from a specific disease

Correct answer: New cases of a disease in a population over a specific time period

Incidence rate measures the number of NEW cases of a disease arising in a defined population during a specified period.

Question 80: Which of the following incidents best exemplifies how a community as a system is impacted by the supra system?

Buildings for homeless people must be constructed, according to a subgroup within the community.
A bill requiring all localities to provide some homes for the homeless is passed by the state legislature. (Correct answer)
Concerned locals draw attention to the growing number of homeless people living in the area.
People who are homeless choose to demonstrate in front of the city hall.

Correct answer: A bill requiring all localities to provide some homes for the homeless is passed by the state legislature.

A bill requiring all localities to provide some homes for the homeless is passed by the state legislature. This incident serves as an example of how the state legislature, or the supra system, influences the community as a whole. All municipalities are directly impacted by the law's passage and are now required to address the homelessness problem. This illustrates how choices made at a higher level can affect and mold how a community system functions and behaves.

Question 81: A community nurse suspects a homebound elderly patient is being financially exploited by a family member. The nurse's primary ethical and legal obligation is to:

Report the suspected abuse to adult protective services (Correct answer)
Ask the patient to confirm abuse before taking any action
Document observations and wait for more evidence before acting
Discuss the concern with the family member to give them a chance to explain

Correct answer: Report the suspected abuse to adult protective services

Suspected elder abuse must be reported to adult protective services; nurses are mandated reporters and waiting for confirmation is not required.

Question 82: A community nurse is counseling a patient who was exposed to hepatitis B through a needle stick. Which post-exposure prophylaxis is recommended for an unvaccinated individual?

Hepatitis B immune globulin (HBIG) plus initiation of the hepatitis B vaccine series within 24 hours (Correct answer)
Prophylactic antibiotics and observation only
Hepatitis B vaccine series alone started within 1 week
Antiviral medications only

Correct answer: Hepatitis B immune globulin (HBIG) plus initiation of the hepatitis B vaccine series within 24 hours

Unvaccinated individuals exposed to hepatitis B should receive HBIG for immediate passive immunity plus start the hepatitis B vaccine series within 24 hours of exposure.

Question 83: The community nurse is assessing the effectiveness of a vaccination campaign against influenza. Which metric BEST evaluates campaign effectiveness?

Number of health care workers trained
Influenza vaccination coverage rate in the target population (Correct answer)
Number of vaccine doses purchased
Media impressions from campaign advertising

Correct answer: Influenza vaccination coverage rate in the target population

Vaccination coverage rate — the percentage of the target population that received the vaccine — directly measures the immunization campaign's reach and effectiveness.

Question 84: A patient's telemetry shows a heart rate of 48 bpm with regular rhythm. The patient is asymptomatic. What is the nurse's priority action?

Continue monitoring and notify the physician of the finding (Correct answer)
Immediately call a code
Administer atropine per protocol
Increase the IV fluid rate

Correct answer: Continue monitoring and notify the physician of the finding

An asymptomatic bradycardic patient should be monitored closely and the physician notified to determine if intervention is needed.

Question 85: A community mental health nurse uses the Assertive Community Treatment (ACT) model. ACT is BEST described as:

A peer-led support group model only
A medication management program without therapy
A multidisciplinary team providing intensive, comprehensive, and flexible community-based psychiatric services (Correct answer)
Brief inpatient stabilization followed by discharge

Correct answer: A multidisciplinary team providing intensive, comprehensive, and flexible community-based psychiatric services

ACT provides comprehensive mental health care through a multidisciplinary team including nurses, social workers, and psychiatrists who deliver services in the community rather than clinic settings.

Question 86: Which stakeholder group is MOST important to involve in community health assessment planning to ensure cultural relevance?

Community members and local leaders (Correct answer)
National insurance company representatives
Only state health department officials
Hospital finance administrators

Correct answer: Community members and local leaders

Involving community members and local leaders ensures the assessment reflects the actual experiences, values, and cultural context of the population being studied.

Question 87: The community health nurse is teaching proper hand hygiene. According to CDC guidelines, which situation requires handwashing with soap and water rather than alcohol-based hand rub?

Before preparing medications
When hands are visibly soiled or after contact with a patient with Clostridioides difficile (C. diff) (Correct answer)
After removing clean gloves
After contact with intact patient skin only

Correct answer: When hands are visibly soiled or after contact with a patient with Clostridioides difficile (C. diff)

Soap and water are required for visibly soiled hands and after caring for C. diff patients, as alcohol-based hand rubs are ineffective against C. diff spores.

Question 88: A nurse prepares to collect a midstream clean-catch urine specimen. Which instruction to the patient is correct?

'Void the entire stream into the specimen container.'
'Collect the first few drops of urine in the container.'
'Refrigerate the urine for 2 hours before bringing it to the lab.'
'Start urinating, stop briefly, then collect the middle portion.' (Correct answer)

Correct answer: 'Start urinating, stop briefly, then collect the middle portion.'

The midstream technique discards the initial urine stream to flush urethral organisms, then collects the middle portion for accurate culture results.

Question 89: Which framework does the CDC recommend for planning, implementing, and evaluating public health programs in community settings?

CDC Framework for Program Evaluation in Public Health (6-step framework) (Correct answer)
Balanced scorecard approach
SWOT analysis only
FMEA (Failure Mode and Effects Analysis)

Correct answer: CDC Framework for Program Evaluation in Public Health (6-step framework)

The CDC's Framework for Program Evaluation includes six steps: engage stakeholders, describe the program, focus the evaluation design, gather credible evidence, justify conclusions, and ensure use of findings.

Question 90: Which communication channel is MOST effective for reaching older adults in a rural US community with health promotion messages?

AI-powered chatbots
Instagram and TikTok social media platforms
Local radio, newspapers, and faith community networks (Correct answer)
Email newsletters only

Correct answer: Local radio, newspapers, and faith community networks

Older rural adults are best reached through traditional channels including local radio, newspapers, and trusted faith community networks, which have high reach in this population.

Question 91: A nurse is preparing to perform a blood glucose finger-stick. After obtaining the blood sample, what is the next action?

Apply pressure to the puncture site (Correct answer)
Immediately document the result before reading it
Wipe the finger with alcohol before applying pressure
Recap the lancet and dispose in the trash

Correct answer: Apply pressure to the puncture site

Applying pressure to the puncture site stops bleeding and prevents hematoma formation at the capillary puncture site.

Question 92: In the NCAS framework, which of the following best defines a community needs assessment?

A checklist completed by individual patients at clinic visits
A billing audit for community health services
A review of a single patient's chronic conditions
A process to identify gaps between current health status and desired health outcomes (Correct answer)

Correct answer: A process to identify gaps between current health status and desired health outcomes

A community needs assessment systematically identifies gaps between where the community is and where it should be in terms of health outcomes.

Question 93: During a community health assessment, a nurse identifies that 30% of residents lack health insurance. This finding is best classified as which type of community health determinant?

Biological determinant
Environmental toxin
Genetic risk factor
Social determinant of health (Correct answer)

Correct answer: Social determinant of health

Lack of health insurance is a social determinant of health, reflecting economic and policy conditions that affect access to care.

Question 94: Which ethical principle is MOST directly violated when a nurse shares a patient's HIV status with the patient's employer without consent?

Beneficence
Veracity
Justice
Confidentiality (Correct answer)

Correct answer: Confidentiality

Unauthorized disclosure of protected health information violates the principle of confidentiality.

Question 95: During community assessment, a nurse reviews the local community health improvement plan (CHIP). The CHIP is BEST described as:

A state-mandated medication formulary
A billing structure for community clinics
A strategic plan developed to address priority health issues identified in the community health assessment (Correct answer)
A personal health record system

Correct answer: A strategic plan developed to address priority health issues identified in the community health assessment

A Community Health Improvement Plan (CHIP) is a long-term strategic document that outlines how identified community health priorities will be addressed.

Question 96: A patient on bed rest develops sudden onset of calf pain, warmth, and swelling. The nurse suspects deep vein thrombosis (DVT). What is the priority intervention?

Encourage the patient to ambulate to improve circulation
Elevate the leg and apply a warm compress
Maintain bed rest and notify the physician immediately (Correct answer)
Massage the affected leg to reduce swelling

Correct answer: Maintain bed rest and notify the physician immediately

Suspected DVT requires immediate physician notification and bed rest to prevent embolization of the clot.

Question 97: A community health nurse is providing education about Lyme disease prevention in an endemic area. Which protective measure is MOST effective?

Avoiding all outdoor activities year-round
Using EPA-registered insect repellents containing DEET and conducting daily tick checks (Correct answer)
Wearing light-colored clothing only, with no other measures
Taking prophylactic antibiotics daily during summer

Correct answer: Using EPA-registered insect repellents containing DEET and conducting daily tick checks

DEET-based repellents and daily tick checks after outdoor exposure are the most effective primary prevention strategies for Lyme disease in endemic regions.

Question 98: Which social determinant of health is MOST strongly associated with mental health outcomes in the US?

Geographic distance to beaches
Height and body weight
Eye color
Poverty and income inequality (Correct answer)

Correct answer: Poverty and income inequality

Poverty and income inequality are the social determinants most consistently and strongly associated with depression, anxiety, and serious mental illness across US populations.

Question 99: A nurse is asked to participate in a research study involving vulnerable community members without IRB approval. The nurse should:

Ask the principal investigator to obtain approval after data collection
Refuse and report the absence of IRB oversight to the appropriate authority (Correct answer)
Participate only if participants give verbal consent
Participate if the study seems beneficial to the community

Correct answer: Refuse and report the absence of IRB oversight to the appropriate authority

IRB oversight is required before research involving human subjects begins; proceeding without it is an ethical and regulatory violation.

Question 100: Which of the following urine characteristics in a catheterized patient warrants immediate reporting to the physician?

Light yellow color
Output of 40 mL/hour
Specific gravity of 1.015
Cloudy urine with sediment (Correct answer)

Correct answer: Cloudy urine with sediment

Cloudy urine with sediment suggests a urinary tract infection, which requires prompt medical evaluation and treatment.

Nursing Community Assessment Service (NCAS) Computer-Based Assessment

The NCAS Computer-Based Assessment evaluates entry-level competencies of internationally educated nurses seeking registration in Canada, assessing clinical decision-making through authentic patient scenarios across medical, community, and complex care settings.

100

Questions

180 min

Time Limit

70%

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