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

Question 1: Which of the following best describes the purpose of mapping community assets during a health assessment?

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
To audit hospital financial records

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

Beneficence
Confidentiality (Correct answer)
Veracity
Justice

Correct answer: Confidentiality

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

Question 3: Which of the following is an example of PRIMARY prevention identified during a community health assessment?

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

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 4: Which brief validated tool is most widely used in community settings to screen for depression in adults?

Beck Depression Inventory-II (BDI-II)
Patient Health Questionnaire-9 (PHQ-9) (Correct answer)
GAD-7 for anxiety only
Mini-Mental State Examination (MMSE)

Correct answer: Patient Health Questionnaire-9 (PHQ-9)

The PHQ-9 is a 9-item validated screening tool widely used in primary care and community settings to screen for and monitor depression severity.

Question 5: 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
National Health Interview Survey
Healthy People (currently Healthy People 2030) (Correct answer)

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

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

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

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
To collect genetic samples from all exposed persons
To prosecute individuals who spread disease knowingly

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 8: A nurse is providing discharge medication teaching to a patient with heart failure. Which instruction is most critical for medication safety at home?

Store all medications in the bathroom for easy access
Double the dose if symptoms worsen before the next scheduled dose
Never stop a prescribed medication without consulting the provider first (Correct answer)
Share leftover antibiotics with family who have similar symptoms

Correct answer: Never stop a prescribed medication without consulting the provider first

Abruptly stopping certain medications, such as beta-blockers or corticosteroids, can cause serious adverse effects, making provider consultation essential before any changes.

Question 9: In the NCAS framework, which of the following best defines a community needs assessment?

A billing audit for community health services
A review of a single patient's chronic conditions
A checklist completed by individual patients at clinic visits
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 10: A community nurse is measuring the impact of a physical activity promotion program. Which outcome metric BEST demonstrates program effectiveness?

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

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 11: Which antihypertensive medication class is considered first-line therapy for patients with both hypertension and type 2 diabetes due to its additional renal protective effects?

ACE inhibitors (Correct answer)
Loop diuretics
Beta-blockers
Non-dihydropyridine calcium channel blockers

Correct answer: ACE inhibitors

ACE inhibitors reduce intraglomerular pressure and proteinuria, making them preferred antihypertensives for diabetic patients to slow progression of diabetic nephropathy.

Question 12: A patient is prescribed potassium chloride 40 mEq IV. The nurse knows that the safe infusion rate for IV potassium should not exceed:

40 mEq/hour
20 mEq/hour
60 mEq/hour
10 mEq/hour (Correct answer)

Correct answer: 10 mEq/hour

IV potassium should not exceed 10 mEq/hour peripherally to prevent cardiac arrhythmias and vein irritation.

Question 13: 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?

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

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 14: An nurse overhears a colleague making derogatory comments about a patient's lifestyle choices. The MOST ethical response is to:

Document the incident without speaking to the colleague
Address the behavior with the colleague and report it if it continues (Correct answer)
Ignore the comment to avoid workplace conflict
Agree with the colleague to maintain team cohesion

Correct answer: Address the behavior with the colleague and report it if it continues

Derogatory comments about patients are unprofessional and potentially harmful; nurses must address such behavior to uphold patient dignity.

Question 15: Which stakeholder group is MOST important to involve in community health assessment planning to ensure cultural relevance?

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

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 16: A community nurse is providing psychoeducation to a family of a patient with bipolar disorder. Which warning sign of an impending manic episode should the family PRIORITIZE monitoring?

Social withdrawal and flat affect
Gradual onset of depressive symptoms over weeks
Increased appetite and hypersomnia
Decreased need for sleep (sleeping only 3–4 hours but feeling rested) (Correct answer)

Correct answer: Decreased need for sleep (sleeping only 3–4 hours but feeling rested)

Decreased need for sleep is one of the earliest and most reliable warning signs of an impending manic episode in bipolar disorder and warrants prompt clinical contact.

Question 17: A patient is prescribed a transdermal nitroglycerin patch. Which nursing instruction regarding application is most accurate?

Apply over a bony prominence to ensure firm adhesion
Apply only to the inner forearm and do not rotate
Apply to a clean, dry, hairless skin area and rotate sites with each dose (Correct answer)
Apply it directly over the precordial area for maximum cardiac effect

Correct answer: Apply to a clean, dry, hairless skin area and rotate sites with each dose

Transdermal patches should be applied to clean, dry, hairless skin on non-bony areas, with site rotation to prevent skin irritation and ensure consistent absorption.

Question 18: Which communication channel is MOST effective for reaching older adults in a rural US community with health promotion messages?

Instagram and TikTok social media platforms
AI-powered chatbots
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 19: A community health nurse is running a smoking cessation program. Which counseling approach has the strongest evidence for increasing quit rates?

Hypnotherapy as the primary intervention
Brief advice alone without medication
Self-help pamphlets only
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 20: 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 strategic plan developed to address priority health issues identified in the community health assessment (Correct answer)
A personal health record system
A billing structure for community clinics

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

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

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

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

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 23: A patient with a urinary catheter complains of bladder spasms and the urge to void despite the catheter being in place. What should the nurse do first?

Assess catheter patency and check for kinks or obstruction (Correct answer)
Remove the catheter and insert a new one
Administer an antispasmodic medication immediately
Irrigate the catheter with 500 mL of normal saline

Correct answer: Assess catheter patency and check for kinks or obstruction

Catheter-related bladder spasms are often caused by obstruction or kinking of the catheter, so checking patency is the first assessment step.

Question 24: Which route of medication administration provides the fastest onset of drug action?

Oral
Intravenous (Correct answer)
Intramuscular
Subcutaneous

Correct answer: Intravenous

Intravenous administration delivers medication directly into systemic circulation, bypassing all absorption barriers for immediate effect.

Question 25: 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
Verify tube placement (Correct answer)
Flush the tube with 30 mL of water
Crush the medication and dissolve it

Correct answer: Verify tube placement

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

Question 26: What effects might it have to know where people in the community work, or what their vocations are?

When and how the residents of the village like to relax
Where locals shop for groceries and what they usually purchase
How and whether people in the community worship
The illnesses or wounds for which they could be vulnerable (Correct answer)

Correct answer: The illnesses or wounds for which they could be vulnerable

The diseases or injuries that community members may be susceptible to can be affected by knowing where they work. Certain jobs may expose workers to particular risks to their health or safety. For instance, those who work in construction may be vulnerable to accidents or falls that result in injuries, while those who work in healthcare may be exposed to infectious infections. Comprehending the professions of individuals within the community might aid in recognizing possible health issues and creating focused interventions or preventive actions.

Question 27: Which level of the socio-ecological model addresses policies and regulations that influence health behavior across entire populations?

Policy/enabling environment level (Correct answer)
Interpersonal level
Individual level
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 28: The nurse completes a community health assessment and finds the top three health priorities. What should happen NEXT in the NCAS process?

Publish findings in a medical journal before taking action
Repeat the assessment in 6 months
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

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 29: A nurse is caring for a patient receiving total parenteral nutrition (TPN). Which complication should the nurse monitor for most closely?

Metabolic alkalosis from amino acid infusion
Hyperglycemia due to high dextrose concentration (Correct answer)
Hypoglycemia from excessive insulin release
Hyponatremia due to water retention

Correct answer: Hyperglycemia due to high dextrose concentration

TPN solutions contain high concentrations of dextrose, placing patients at significant risk for hyperglycemia requiring close blood glucose monitoring.

Question 30: Which epidemiological measure would a community health nurse use to compare disease burden between two communities of different sizes?

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

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

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

Correct answer: Document immediately after administration

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

Question 32: Which type of health promotion program evaluation measures whether the program produced the desired change in health outcomes?

Needs assessment
Formative evaluation
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 33: Which federal data system is a primary source for community health assessment in the United States?

Medicare Claims Ledger
Hospital Incident Reporting System
Joint Commission Accreditation Database
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 34: A community health nurse discovers a colleague is falsifying home visit documentation. The nurse's FIRST obligation is to:

Discuss the situation with other team members for consensus
Report the behavior to the appropriate supervisor or authority (Correct answer)
Confront the colleague privately and give a warning
Document personal observations and wait for a pattern to develop

Correct answer: Report the behavior to the appropriate supervisor or authority

Nurses have a professional obligation to report unethical conduct that endangers patient safety to the appropriate authority.

Question 35: A community health nurse wants to assess the health status of a rural population. Which method is MOST appropriate when literacy levels are low?

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

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 36: 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:

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

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

SWOT analysis only
Balanced scorecard approach
CDC Framework for Program Evaluation in Public Health (6-step framework) (Correct answer)
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 38: When a patient with limited English proficiency requires informed consent, the nurse should:

Delay the procedure until the patient learns sufficient English
Ask a bilingual family member to translate the consent form
Use a professional medical interpreter to facilitate understanding (Correct answer)
Have the patient sign the form and document language as a barrier

Correct answer: Use a professional medical interpreter to facilitate understanding

A qualified medical interpreter ensures accurate, unbiased communication and protects the patient's right to informed consent.

Question 39: Which data source provides the most objective information about mortality rates in a US community?

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

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 40: Safe sleep recommendations from the AAP to reduce sudden infant death syndrome (SIDS) include:

Co-sleeping in the parental bed for bonding
Using crib bumpers for safety
Placing infants on their back on a firm, flat surface without soft bedding (Correct answer)
Placing infants on their stomach to prevent reflux

Correct answer: Placing infants on their back on a firm, flat surface without soft bedding

The AAP's safe sleep guidelines specify placing infants supine on a firm, flat surface without soft objects, loose bedding, or pillows to reduce SIDS risk.

Question 41: In community-based chronic disease programs, what does the acronym 'SMART' refer to when setting health goals?

Simple, Monitored, Accurate, Reported, Timed
Shared, Managed, Agreed, Referenced, Tested
Structured, Medical, Assessed, Reviewed, Tracked
Specific, Measurable, Achievable, Relevant, Time-bound (Correct answer)

Correct answer: Specific, Measurable, Achievable, Relevant, Time-bound

SMART goals (Specific, Measurable, Achievable, Relevant, Time-bound) provide a structured framework for setting realistic chronic disease management objectives.

Question 42: Which vaccine-preventable disease is characterized by a prodrome of Koplik's spots followed by a maculopapular rash spreading from head to trunk?

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

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

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

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 44: Which of the following would be the main objective of a nurse assessing a community using an epidemiologic framework?

speaking with medical professionals about the community
Finding out about the population's health in the community
investigating results from studies on epidemiology
identifying the community's most vulnerable categories of residents (Correct answer)

Correct answer: identifying the community's most vulnerable categories of residents

When evaluating a community using an epidemiologic framework, a nurse would concentrate on identifying the populations within the community that are most vulnerable. The reason for this is that epidemiology is the study of health and disease situations in communities, with a focus on patterns, causes, and effects. Targeted interventions and prevention measures are based on the identification of those most at risk. The nurse can better address the unique needs of these at-risk populations and enhance community health outcomes by recognizing them and allocating resources and interventions accordingly.

Question 45: When assessing a patient's pain, which tool is most appropriate for a patient who is intubated and unable to speak?

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

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 46: 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?

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

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 47: 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
A data collection error to be corrected
An issue only addressed by individual clinicians

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

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

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

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

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 50: Which of the following is the MOST effective strategy to prevent health care-associated infections (HAIs) at the community health facility level?

Consistent hand hygiene compliance by all health care workers (Correct answer)
Daily facility fumigation
Antibiotic prophylaxis for all patients
Universal patient isolation

Correct answer: Consistent hand hygiene compliance by all health care workers

Hand hygiene compliance is the single most effective, evidence-based strategy for preventing health care-associated infections across all settings.

Question 51: A nurse notices that patients from lower socioeconomic backgrounds in the community receive fewer follow-up home visits than wealthier patients. This disparity MOST directly violates the principle of:

Beneficence
Justice (Correct answer)
Fidelity
Autonomy

Correct answer: Justice

Justice requires equitable distribution of nursing services regardless of socioeconomic status; unequal access constitutes an injustice.

Question 52: Which approach to health education is MOST consistent with the principles of health literacy and patient empowerment?

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
Relying solely on pharmaceutical company pamphlets

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 53: 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 vaccine series alone started within 1 week
Prophylactic antibiotics and observation only
Hepatitis B immune globulin (HBIG) plus initiation of the hepatitis B vaccine series within 24 hours (Correct answer)
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 54: A nurse is preparing to insert a peripheral IV catheter. After successful venipuncture and blood flashback is visible, what is the next step?

Tape the catheter in place immediately
Remove the needle while advancing the catheter (Correct answer)
Apply a tourniquet above the insertion site
Withdraw the entire catheter and reinsert

Correct answer: Remove the needle while advancing the catheter

Once blood flashback confirms vein entry, the needle is withdrawn while the flexible catheter is advanced into the vein.

Question 55: Which position is most appropriate for a patient who is unconscious and breathing spontaneously to prevent aspiration?

Supine with head of bed elevated 30 degrees
Trendelenburg position
Prone position
Lateral (recovery) position (Correct answer)

Correct answer: Lateral (recovery) position

The lateral recovery position allows secretions and vomitus to drain away from the airway, reducing aspiration risk.

Question 56: A community health nurse conducting a health fair uses the opportunity to screen for prediabetes. This activity exemplifies which level of prevention?

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

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 57: 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)
Increase the IV fluid rate
Immediately call a code
Administer atropine per protocol

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 58: Which of the following sums up a community's basic qualities?

A location or shared demographic traits
A location along with values or beliefs
A specific location over time for shared objectives (Correct answer)
A region with well-defined borders

Correct answer: A specific location over time for shared objectives

A community's primary attribute is that it has evolved into a specific location over time for shared goals. This indicates that a community is a particular place where people congregate and engage in activities and goals that are shared, rather than merely a geographical area with clearly defined limits. It is centered on people's shared sense of purpose and belonging within a particular location rather than just geographical borders or demographics.

Question 59: A nurse is preparing to apply antiembolism stockings (TEDs). Which assessment finding is a contraindication to their use?

History of deep vein thrombosis greater than 6 months ago
Peripheral arterial disease with absent pedal pulses (Correct answer)
Lower extremity edema that pits 1+
Bilateral knee replacement 4 weeks ago

Correct answer: Peripheral arterial disease with absent pedal pulses

Peripheral arterial disease with absent pulses is a contraindication because compression stockings further reduce already compromised arterial blood flow.

Question 60: Which of the following best describes 'upstream' interventions in health promotion?

Treating disease after onset with medications
Addressing the root social, economic, and environmental determinants of health rather than individual symptoms (Correct answer)
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 61: Which of these statements about a group is most accurate?

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

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

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

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

HIV
Gonorrhea
Syphilis
Chlamydia (Correct answer)

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

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

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

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

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 66: A nurse working in a community clinic is asked by a pharmaceutical representative to recommend their product to patients in exchange for gifts. The nurse should:

Consult colleagues before making a decision
Accept only educational materials, not cash or food
Decline and report the offer per the facility's conflict-of-interest policy (Correct answer)
Accept gifts under a set dollar threshold as allowed by most facilities

Correct answer: Decline and report the offer per the facility's conflict-of-interest policy

Accepting gifts from vendors creates a conflict of interest that compromises objectivity and professional integrity.

Question 67: Which tool is most commonly used in community health assessment to identify priority health needs of a population?

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

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 68: Which federal agency leads substance use disorder prevention and treatment services in the United States?

CMS (Centers for Medicare and Medicaid Services)
DEA (Drug Enforcement Administration)
SAMHSA (Substance Abuse and Mental Health Services Administration) (Correct answer)
CDC (Centers for Disease Control and Prevention)

Correct answer: SAMHSA (Substance Abuse and Mental Health Services Administration)

SAMHSA leads federal public health efforts to reduce substance use disorders and mental illness, funding treatment programs and establishing national policy.

Question 69: A community nurse is evaluating health disparities in cancer screening rates. Disparities in preventive service use are MOST often driven by:

Patient refusal based on fully informed choice
Lack of insurance, language barriers, and low health literacy (Correct answer)
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 70: Which of the following is the CDC's recommended sequence for donning (putting on) PPE in a health care setting?

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

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 71: In community health nursing, justice as an ethical principle is BEST demonstrated by:

Ensuring every patient receives the same treatment regardless of diagnosis
Prioritizing care for patients who comply with treatment recommendations
Providing the highest-quality care to the most severely ill patients first
Allocating scarce resources based on patient need and equitable access (Correct answer)

Correct answer: Allocating scarce resources based on patient need and equitable access

Justice in healthcare requires fair distribution of resources based on need, not social status or ability to pay.

Question 72: Which of the following urine characteristics in a catheterized patient warrants immediate reporting to the physician?

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

Correct answer: Cloudy urine with sediment

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

Question 73: A community nurse calculates the incidence rate of Type 2 diabetes in a town. Incidence rate specifically measures:

New cases of a disease in a population over a specific time period (Correct answer)
Total existing cases of a disease at one point in time
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 74: When providing culturally competent mental health care in the community, a nurse should FIRST:

Assume all patients share the same mental health belief systems
Assess the patient's cultural beliefs, explanatory models for illness, and preferences for care (Correct answer)
Apply Western psychiatric diagnostic frameworks universally without adaptation
Translate only language, not cultural context

Correct answer: Assess the patient's cultural beliefs, explanatory models for illness, and preferences for care

Culturally competent care begins with exploring the patient's own explanatory model — their beliefs about the cause, meaning, and preferred treatment for their mental health concerns.

Question 75: 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?

Environmental toxin
Genetic risk factor
Biological determinant
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 76: A community health nurse wants to build a coalition to address opioid overdose deaths. Which is the MOST important first step?

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

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 77: When performing tracheal suctioning, which action reduces the risk of hypoxemia?

Pre-oxygenate with 100% oxygen before suctioning (Correct answer)
Apply suction while inserting the catheter
Suction continuously for 30 seconds to clear secretions
Use a clean (non-sterile) technique for the procedure

Correct answer: Pre-oxygenate with 100% oxygen before suctioning

Pre-oxygenating with 100% oxygen before suctioning compensates for the oxygen removed during the suctioning procedure.

Question 78: Which health behavior change model describes five stages through which individuals move when changing a health behavior: precontemplation, contemplation, preparation, action, and maintenance?

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

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 79: 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
Media impressions from campaign advertising
Number of vaccine doses purchased
Influenza vaccination coverage rate in the target population (Correct answer)

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

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

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

They are susceptible to the condition, the condition is serious, and the benefits of action outweigh barriers (Correct answer)
The government mandates the health action
Other people in their community are taking the action
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 82: A community mental health nurse uses the Assertive Community Treatment (ACT) model. ACT is BEST described as:

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

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 83: The ethical concept of paternalism in nursing refers to:

Following physician orders without questioning clinical rationale
Fathers or male relatives making decisions for female patients
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 84: A community nurse is managing a norovirus outbreak at a long-term care facility. Which action is MOST important to contain spread?

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

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 85: In mental health first aid, which framework guides the community responder's response to a mental health crisis?

RICE: Rest, Ice, Compression, Elevation
ALGEE: Assess risk, Listen non-judgmentally, Give reassurance, Encourage professional help, Encourage self-help (Correct answer)
ABCDE: Airway, Breathing, Circulation, Disability, Environment
SBAR: Situation, Background, Assessment, Recommendation

Correct answer: ALGEE: Assess risk, Listen non-judgmentally, Give reassurance, Encourage professional help, Encourage self-help

The ALGEE action plan is the evidence-based framework taught in Mental Health First Aid courses to guide lay responders in supporting someone experiencing a mental health crisis.

Question 86: Which community-level intervention has the strongest evidence for reducing suicide rates in the US?

Mandatory psychiatric hospitalization for all at-risk individuals
Means restriction (e.g., safe storage of firearms, bridge barriers) (Correct answer)
General wellness campaigns
Eliminating all outpatient mental health services

Correct answer: Means restriction (e.g., safe storage of firearms, bridge barriers)

Means restriction — making lethal methods less accessible — is one of the most evidence-based suicide prevention strategies at the community level.

Question 87: Which element of health communication makes public health messages MOST persuasive and actionable for community audiences?

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

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 88: A community nurse is planning a hypertension management program. Which dietary approach has the strongest evidence for lowering blood pressure?

Gluten-free diet
Mediterranean diet only
DASH (Dietary Approaches to Stop Hypertension) diet (Correct answer)
Atkins low-carbohydrate diet

Correct answer: DASH (Dietary Approaches to Stop Hypertension) diet

The DASH diet, rich in fruits, vegetables, whole grains, and low-fat dairy while low in sodium and saturated fat, has the strongest clinical evidence for reducing blood pressure.

Question 89: Which concept from community health describes the process of enabling people to increase control over and improve their own health?

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

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 90: Which of the following is the LEADING cause of injury death among US children aged 1–4 years?

Burns
Falls
Drowning (Correct answer)
Motor vehicle accidents

Correct answer: Drowning

Drowning is the leading cause of injury death in US children aged 1–4, making water safety education a critical community health priority.

Question 91: A patient is diagnosed with active pulmonary tuberculosis. Which type of transmission-based precautions should the community nurse recommend?

Droplet Precautions with surgical mask
Standard Precautions only
Contact Precautions with gloves and gown only
Airborne Precautions with negative pressure room and N95 respirator (Correct answer)

Correct answer: Airborne Precautions with negative pressure room and N95 respirator

Active TB requires Airborne Precautions including a negative pressure isolation room and an N95 respirator because TB bacilli travel on small airborne particles.

Question 92: A patient refuses a prescribed medication. What is the most appropriate nursing action?

Inform the patient of the consequences and document the refusal (Correct answer)
Call security to ensure the patient takes the medication
Administer the medication anyway since it is prescribed
Crush the medication and place it in food or drink

Correct answer: Inform the patient of the consequences and document the refusal

Competent patients have the right to refuse treatment; the nurse should educate, respect the decision, and document the refusal.

Question 93: Which assessment finding is most consistent with dehydration in an adult patient?

Bounding pulse, peripheral edema
Poor skin turgor, concentrated urine, tachycardia (Correct answer)
Bradycardia, hypertension, weight gain
Crackles in lung bases, jugular vein distension

Correct answer: Poor skin turgor, concentrated urine, tachycardia

Dehydration presents with poor skin turgor, dark concentrated urine, and tachycardia as the body compensates for reduced circulating volume.

Question 94: 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.'
'Start urinating, stop briefly, then collect the middle portion.' (Correct answer)
'Refrigerate the urine for 2 hours before bringing it to the lab.'

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 95: 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)
Dense medical literature with clinical terminology
Textbooks with complex charts and statistical tables
A 90-minute lecture with no visual aids

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

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

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 97: Which pharmacokinetic process refers to the biotransformation of a drug into active or inactive metabolites?

Absorption
Metabolism (Correct answer)
Excretion
Distribution

Correct answer: Metabolism

Drug metabolism (biotransformation) primarily occurs in the liver, where enzymatic reactions convert drugs into metabolites that are more easily excreted.

Question 98: Which of the following is a PRIMARY goal of community health assessment under the NCAS model?

To guide development of targeted, evidence-based community health interventions (Correct answer)
To eliminate the need for physician input
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 99: In community chronic disease management, which of the following is an example of SECONDARY prevention?

Childhood immunization against hepatitis B
Cardiac rehabilitation after myocardial infarction
Smoking cessation to prevent lung cancer
Colorectal cancer screening with colonoscopy in asymptomatic adults over 45 (Correct answer)

Correct answer: Colorectal cancer screening with colonoscopy in asymptomatic adults over 45

Secondary prevention detects disease early in asymptomatic individuals; colonoscopy screening identifies colorectal cancer before symptoms appear.

Question 100: Which of the following best describes a community health nurse's role in tertiary prevention for a patient with Type 2 diabetes?

Preventing complications such as nephropathy through medication adherence and annual foot and eye exams (Correct answer)
Teaching newly diagnosed patients about blood sugar monitoring
Administering vaccines to prevent infections
Screening undiagnosed community members for prediabetes

Correct answer: Preventing complications such as nephropathy through medication adherence and annual foot and eye exams

Tertiary prevention in established disease focuses on preventing complications and disability; in diabetes, this includes regular foot/eye exams and medication adherence.

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

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180 min

Time Limit

70%

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