Chapter 16 - Health and Wellness

3. Immunizations are not an objective as defined by Healthy People 2010 because immunizations are largely for children and children are not included in the Healthy People 2010 initiative. A. True B. False

B. False Rationale: Immunizations and infection control are a priority component of the Healthy People 2010 initiative for improving the health of all people in the United States.

2. Trevor knows that receiving an immunization is included in which hierarchy of need according to Maslow? A. Physiological B. Safety and security C. Love and belonging needs D. Self-esteem E. Self-actualization

B. Safety and security Rationale: Receiving an immunization falls into the "physical safety" subdivision of Maslow's "safety and security" hierarchy.

Trevor is a nursing student who works at a local clinic as a medical assistant three times a week while he is in nursing school. He has been a medical assistant for 6 years and decided to attend nursing school this semester to expand his career options. Trevor kept his medical assisting job in hopes that gaining the "hands on" experience would make nursing school more manageable; plus he needed the income to help offset the cost of nursing school. At the clinic Trevor cares for a wide range of patients from newborns to the older adult. Today the clinic is hosting a "Love Your Child" health drive and is providing wellness examinations and immunizations for children. 1. Trevor is assigned to the immunization station at the health drive where he is responsible for administering vaccines to the children. Immunizations are an example of _________________ and _____________ prevention.

Answer: primary and illness Rationale: Primary prevention precedes disease or dysfunction and is applied to patients considered physically and emotionally healthy. It includes health education programs, immunizations, and physical and nutritional fitness activities. Illness prevention activities such as immunization programs protect patients from actual or potential threats to health

4. A nurse approached an overweight patient about lifestyle modifications to reduce the risk for heart disease. The patient demonstrates lack of perceived susceptibility by making which statement? a. "I'm only a little overweight; there is no way I can have a heart attack." b. "I should lose a few pounds and try to exercise more often." c. "I don't think a little weight loss is related to heart disease." d. "I will investigate the online Weight Watchers programs that helped me in the past."

a. "I'm only a little overweight; there is no way I can have a heart attack." The patient does not perceive being overweight as a risk factor for cardiovascular disease. Education and nutrition counseling would be helpful in this patient's case. The patient's statement of weight loss not being related is part of perceived severity. The other answers acknowledge the need to lose weight, on some level of understanding. LO: 16.2 DIF: Understanding MSC: NCLEX Client Needs: Health Promotion and Maintenance

1. The nurse conducting community wellness events recognizes that which elements contribute to an individual's health and wellness? (Select all that apply.) a. Age b. Genetics c. Access to health care d. Culture e. Environmental f. Health policies

a. Age b. Genetics c. Access to health care d. Culture e. Environmental f. Health policies All factors are at play in determining a person's health and wellness. LO: 16.6 DIF: Remembering MSC: NCLEX Client Needs: Health Promotion and Maintenance

6. Three weeks after delivery, a patient started a diet of 800 calories per day and started jogging 2 miles twice per day. The nurse recognizes the patient's behavior may be most influenced by which motivating factor? a. Body image b. Environment c. Illness behavior d. Chronic illness

a. Body image Body image is a self-ascribed attribute that influences a person's ability and desire to change, and it may be a motivating factor to maintain the change. Self-concept is a general and broader factor that motivates less specific responses. The environment is not an influencing factor because this is a personal and possibly self-destructive behavior pattern for weight loss. Pregnancy is not a chronic illness. LO: 16.6 Blooms: Applying NCLEX Client Needs: Physiological Integrity: Pathophysiology

3. A nurse providing preventive care to an overweight patient with a family history of diabetes should engage in which priority care-planning activity for this patient? a. Calculating the patient's body mass index (BMI) and recommending a daily exercise routine b. Instructing the patient to perform blood glucose monitoring once daily c. Giving the patient a month's supply of insulin needles and syringes d. Suggesting the patient participate in diabetes education classes offered at a local health facility

a. Calculating the patient's body mass index (BMI) and recommending a daily exercise routine The patient does not have diabetes but is overweight and at risk due to a family history of diabetes. The best way to prevent diabetes is to keep the BMI in the optimal range (<25). Beginning an exercise program with walking and progressing as tolerated increases muscle mass, improves depression, and strengthens the heart. LO: 16.4 Blooms: Applying NCLEX Client Needs: Health Promotion and Maintenance: Health Promotion/Disease Prevention

2. Which activity best illustrates the use of the Health Promotion Model (HPM) by the nurse to increase the level of well-being for a patient immediately after surgery? a. Holding a pillow across his chest when coughing and deep breathing b. Encouraging the patient to eat his entire evening meal c. Changing his surgical dressing daily as ordered by the physician d. Asking his family to step out of the room during dressing changes1.

a. Holding a pillow across his chest when coughing and deep breathing The HPM describes an individual's interaction with his environment as he engages in behaviors that promote health. The patient using a pillow as a splint is interacting with his environment to prevent atelectasis and infection. LO: 16.2 Blooms: Understanding NCLEX Client Needs: Health Promotion and Maintenance: Health Prevention/Disease Prevention

2. A patient recognizes that a family history of a terminal disease predisposes him to the same disease. The nurse recognizes this realization as which component of the Health Belief Model? a. Perception of susceptibility b. Likelihood of action c. Modification of factors d. Adherence to factors

a. Perception of susceptibility The first component of the Health Belief Model (HBM) is an individual's perception of susceptibility, that he/she can actually acquire a given disease. Risk for a disease is often due to a family history or a genetic trait. The second component of the HBM is the perception of the severity of the disease, and the third is the likelihood the individual will take action. LO: 16.2 DIF: Understanding MSC: NCLEX Client Needs: Health Promotion and Maintenance

9. The nurse enters a patient's room and notices that the patient has not been out of bed since the previous day. The patient states that his condition has made him bedridden, although the nurse knows that he is capable of independent ambulation. Which type of reaction is the patient exhibiting? a. Ambivalence to symptoms b. Illness behavior c. Diminished functional ability d. Overreaction to illness

b. Illness behavior The patient is defining and interpreting his disease symptoms according to his beliefs about illness and how to respond to it. The patient's ability to ambulate is intact. Overreaction to illness is a subjective anomaly, and the patient is not ambivalent about his diagnosis. LO: 16.5 Blooms: Analyzing NCLEX Client Needs: Psychosocial Integrity: Coping Mechanisms

5. The nurse has assessed that the patient has the confidence in the ability to take action. What is this concept is called? a. Perceived benefits b. Cues to action c. Perceived severity d. Self-efficacy

d. Self-efficacy The final concept to be added to the Health Belief Model is self-efficacy, the belief in one's own ability to perform a task. Perceived benefits are defined as beliefs about the effectiveness of taking action to reduce risk or seriousness. Cues to action are the factors that activate readiness to make a change. Perceived severity is the belief about the seriousness of a condition and its consequences. LO: 16.2 DIF: Applying MSC: NCLEX Client Needs: Health Promotion and Maintenance

4. An active older patient has been frequently evaluated for minor problems at the clinic since the death of her husband 3 months earlier. During one of her visits, she states that she has no energy to get through the day and no desire to keep up with her Tuesday night bridge club. Which type of holistic health model intervention should the nurse employ to help the patient cope with the loss of her husband? a. Encouraging prn use of antianxiety medication ordered by her provider b. Sharing the value of music therapy to address anxiety about her loss c. Explaining that she will be over the loss of her husband in a few months d. Encouraging a gradual reentry into social interaction and activities with friends

b. Sharing the value of music therapy to address anxiety about her loss Sharing the value of using music therapy to reduce anxiety surrounding her loss is the most appropriate intervention listed. This type of distraction is a holistic technique that works well in the form of music, painting, and expressive dance. Instructing the patient to use drugs is not part of the holistic approach. The patient may not be ready to re-engage in a full activity schedule, and it is unlikely that her feelings of loss will ever totally resolve. LO: 16.2 Blooms: Applying NCLEX Client Needs: Physiological Integrity: Pathophysiology

10. A patient is seeking information about leading indicators that show the importance of health promotion and illness prevention in the United States. To which government-sponsored resource would the nurse refer the patient for the best comprehensive source of information? a. The American Cancer Society website b. The Healthy People 2020 website c. The Centers for Disease Control and Prevention (CDC) Morbidity and Mortality Weekly Report d. The American Association of Hospitals home page

b. The Healthy People 2020 website Healthy People 2020 is the most up-to-date site for health indicators in the United States, and it is presented in an easy to understand format. The CDC Morbidity and Mortality Weekly Report does not cover all of the indicators, and it may be overly technical for the patient. The same holds true for the American Association of Hospitals home page. The American Cancer Society website would supply the consumer with information specific to cancers as opposed to the comprehensive health information found in the Healthy People 2020 document. LO: 16.3 Blooms: Applying NCLEX Client Needs: Health Promotion and Maintenance: Health Promotion/Disease Prevention

5. An 8-year-old girl is newly diagnosed with type 1 diabetes. The nurse may expect fear and crying when teaching the child how to self-administer insulin injections due to which influencing factor? a. Self-concept b. Self-esteem c. Developmental level d. Hierarchy of needs

c. Developmental level Even when the child understands about having the disease, she is less likely to understand the need for insulin therapy due to her emotional and comprehension level of development. A child's self-concept is not well established at this point, and self-esteem is not a major factor. Hierarchy of needs is not yet fully developed because the child depends on her parents for the basic level of needs. LO: 16.2 Blooms: Applying NCLEX Client Needs: Physiological Integrity: Basic Care and Comfort

8. A patient diagnosed with an aggressive cancer is estimated to have 6 months to live. Two months later, the patient's wife calls the nurse's office because she is upset that her husband has taken up motorcycle racing and has already been injured twice. The nurse knows that the patient is experiencing a behavioral change in which factor due to the prognosis of his illness? a. Spirituality b. Physical attributes c. Self-concept d. Personal affect

c. Self-concept Self-concept is profoundly affected by the diagnosis of a terminal disease. The individual often tries to reinvent himself or herself and behaves in an uncharacteristic manner. LO: 16.6 Blooms: Understanding NCLEX Client Needs: Psychosocial Integrity: Coping Mechanisms

3. A patient undergoing chemotherapy for bone cancer states that using guided imagery in conjunction with pain medications helps in tolerating bone marrow aspirations. The nurse recognizes guided imagery as a component of which health promotion model? a. The Health Function Model b. Lifestyle Fatality Model c. Model for Human Disease Progression d. Holistic Health Model

d. Holistic Health Model Guided imagery, music therapy, reminiscence, and relaxation therapy are all examples of therapies used in holistic health models. Holistic health models do not discourage the use of biomedical drugs in conjunction with alternative therapies, but often view drugs and alternative therapies as enhancing one another. LO: 16.2 DIF: Applying MSC: NCLEX Client Needs: Health Promotion

1. According to Maslow's hierarchy of needs, the nurse understands that which element(s) must be maintained first before a patient can reach self-actualization? a. Self-esteem b. Safety c. Love and belonging d. Nutrition

d. Nutrition According to Maslow's hierarchy of needs, nutrition must be maintained before any of the higher-level needs can be met. Then safety, love and belonging, and self-esteem are necessary in a step-wise progression before self-actualization can occur. LO: 16.2 DIF: Applying MSC: NCLEX Client Needs: Health Promotion and Maintenance

1. Which of the listed basic needs identified by Maslow must be addressed first when providing nursing care? a. Self-esteem b. Love and belonging c. Self-actualization d. Nutrition and elimination

d. Nutrition and elimination Nutrition and elimination must be addressed first before concerns about self-esteem, love and belonging, and self-actualization, according to Maslow's hierarchy of needs. According to Maslow, the lower level needs must be fulfilled and maintained before the higher level needs can be met. LO: 16.2 Blooms: Applying NCLEX Client Needs: Physiological Integrity: Basic Care and Comfort

8. A 65-year-old male patient has been a one-pack-per-day smoker for 40 years. He was recently diagnosed with chronic obstructive pulmonary disease (COPD) and would like to attend a smoking cessation class. The nurse recognizes smoking cessation as which level of prevention for this patient? a. Primary prevention b. Secondary prevention c. Statutory prevention d. Tertiary prevention

d. Tertiary prevention According to the stages for disease prevention, primary prevention is implemented for the absence of disease, secondary prevention applies to the early stages of disease or recently diagnosed risk factors, and tertiary preventive care is offered for permanent and irreversible disease. In this case, even though the patient's COPD was recently diagnosed, the care would be considered tertiary prevention because his condition is permanent. LO: 16.4 Blooms: Understanding NCLEX Client Needs: Health Promotion and Maintenance: Health Promotion/Disease Prevention