Chapter 3 PrepU
A client comes to the health center for a routine visit. During the visit, the client tells the nurse, "I'm motivated to do things now to make sure I'm the healthiest I can be." When planning this client's care, the nurse should focus on which area?
Health promotion
A client has had a total knee replacement and is receiving care that includes learning to walk with a walker. What level of prevention is most applicable to this client?
Tertiary prevention
A client has been admitted to the hospital for the treatment of diabetic ketoacidosis, with a random blood glucose reading of 575 mg/dL (31.91 mmol/L), vomiting, and shortness of breath. This client has experienced which phenomenon?
Exacerbation. This client has experienced a significant exacerbation of a chronic disease (diabetes mellitus), which has manifested as an acute threat to the client's health. Morbidity is an epidemiological statistic of the frequency of a disease. The client's problem does not have an infectious etiology. A risk factor is any attribute, characteristic, or exposure of an individual that increases the likelihood of developing a disease or injury.
Which nursing activity reflects secondary prevention?
Making a referral for a mammogram
A pregnant client at 10 weeks' gestation is receiving education by the nurse about the importance of abstaining from alcohol while pregnant. What statement made by the client demonstrates an understanding of the education provided?
"I should abstain from alcohol to prevent the development of a fetal alcohol spectrum disorder."
Which are characteristics of chronic conditions? (Select all that apply.)
Are rarely curable Require lifelong management Have a prolonged course Chronic conditions typically have a slower onset and prolonged course, do not resolve spontaneously, are rarely curable, and require lifelong management. Acute conditions typically have a rapid onset and short course and resolve spontaneously or are curable.
Why are health promotion and illness prevention a key responsibility of nurses?
Chronic illnesses are the leading health problem in the world.
A nurse is planning a health fair in the community to highlight promotion and prevention of the leading cause of death in the United States. Which disease process should the nurse address?
Coronary artery disease
When caring for a client who has just been diagnosed with a chronic illness, the nurse understands the importance of promoting health by highlighting which concept?
Focus on what is possible.
Which definition of health is the best?
Health is a state of complete well-being. Explanation: A classic definition of health is that health is a state of complete physical, mental, and social well-being, not merely the absence of disease or physical symptoms. Health encompasses a state of mind and not just how a client feels.
The nurse is preparing to talk to a local community group regarding chronic illness. The nurse informs the group that both external and internal factors influence a person's health. When discussing the fact that the male client has a higher chance of developing lung cancer due to his gender, which dimension is the nurse referring to?
Physical dimension
Which is an example of tertiary health promotion?
Rehabilitation. Tertiary health promotion and disease prevention begin after an illness is diagnosed and treated to reduce disability and to help rehabilitate clients to a maximum level of functioning. Therefore, rehabilitation is an example of tertiary health promotion. Family counseling and Pap tests are examples of secondary health promotion. Water treatment is an example of primary health promotion.
Consultation and diagnostic tests are included in which level of health care?
Secondary care Explanation: Consultation and diagnostic tests are included in the secondary level of health care. The first contact with a general physician is the primary care, and the reference to a highly specialized facility for desensitization is the tertiary care level. The secondary and tertiary care facilities are equipped to provide highly specialized care. Extended care is care provided to clients who no longer require acute hospital care.
The nurse is caring for a client with a diagnosis of heart failure. This admission is the client's third admission within 90 days. The nurse educates the client with the goal of preventing readmission. Which nursing activity for this client would represent tertiary level prevention?
Teaching about adhering to a low-sodium diet
A nurse is caring for a 17-year-old client whose left leg was amputated after being crushed in a motor vehicle accident. Which intervention might the nurse perform to address the client's intellectual dimension?
Teaching her how to care for the stump and explaining the rehabilitation program
Which model is most useful in examining the cause of disease in an individual, based upon external factors?
The Agent-Host-Environment Model. The Agent-Host-Environment Model is useful for examining the cause of disease in an individual. The agent, host, and environment interact in ways that create risk factors. The Health-Illness Continuum is a way to measure a person's level of health. The High-Level Wellness Model is characterized by functioning to one's maximum potential while maintaining balance and purposeful direction in the environment. The Health Belief Model is used to describe health behaviors.
The nurse in a free clinic caring for clients uses the Health Belief Model, which is based on three components. What is the main focus for this model?
What people believe to be true about their health Explanation: The Health Belief Model focuses on what people perceive or believe to be true about themselves in relation to their health. The Health Promotion Model focuses on how people interact with their environments, as they pursue health. The Health-Illness Continuum Model focuses on health as a constantly changing state, whereas The Agent-Host-Environment Model explains how certain factors place a person at risk for an infectious disease.
A client has a Staphylococcus infection in a decubitus ulcer. In this case, Staphylococcus is the:
agent. Explanation: The agent is any factor that leads to illness. The client is the host of the infection. The environment is setting in which the infection occurs. The disease is a pathological process that can result from the infection.
A community health nurse arranges for a dentist to teach local children in the school district how to properly brush their teeth. Which goal will the nurse set for this event?
health promotion
As the staff reports for duty, each nurse and unlicensed assistive personnel (UAP) checks the assignment board (above) to see what he or she will be responsible for during that shift. Which method of nursing is this facility utilizing to provide care to the clients?
functional nursing
Which is the most accurate definition of health?
Health is a state of complete physical, mental, and social well-being.
Which lifestyle factor is associated with an increased risk for chronic diseases?
Smoking
Which needs are being met when a nurse recommends a senior citizen community center for an older client who is living alone?
Sociocultural needs
When chronic illnesses and disabilities are present, individuals benefit most from activities that:
help them maintain independence.
Risk factors for illness are divided into six categories. Working with carcinogenic chemicals is an example of which type of risk factor?
Environmental risk factor. Working and living environments may contribute to disease. Working with cancer-causing chemicals is an example of an environmental risk factor for illness. Physiologic risk factors are those relating to an individual's body or biology. Lifestyle risk factors are habits or behaviors people choose to engage in. A health habit risk factor is any attribute, characteristic, or exposure of an individual that increases the likelihood of developing a disease or injury.
The nurse is caring for a client admitted to the hospital with pneumonia and associated pleuritic chest pain. Which would be a priority when creating the nursing care plan?
Monitoring airway clearance. Explanation: Priority management, according to Maslow's hierarchy, starts at physiological needs, such as the need for oxygen, food, water, rest, and elimination. Therefore, difficulty breathing is the priority issue that the nurse must manage because it affects the ability of the client to get adequate oxygen. Symptoms such as pain, thirst, and needing to urinate, although important, are not a priority over difficulty breathing. Likewise, infection control is important but is not priority.
The nurse manager of the acute care unit has decided to implement a team nursing approach for client care. One of the staff members asks, "Will we each take care of our own clients?" What is the appropriate response by the manager?
"The care will be divided and the registered nurse (RN) will have a licensed practical/vocational nurse (LPN/LVN) and unlicensed assistive personnel (UAP) to provide care together." Explanation: The team nursing approach is organized and directed by a team leader who assigns and supervises the care of the team and may also contribute to the care. Functional nursing is when each nurse is assigned specific tasks to perform, such as medication administration or wound care. This is more of a task-oriented role. A case-based approach is used when the nurse manager assigns tasks based on the client's diagnosis.
A client who has recently been diagnosed with a chronic illness appears to be depressed. When the nurse asks if there is something wrong, the client states, "Nothing will ever be the same for me since I have this disease." What is the most appropriate response for the nurse?
"If you maintain a positive self-concept, you can live as normally as possible." Explanation: To successfully adapt to a chronic illness a person must learn to live as normally as possible and maintain a positive self-concept and sense of hope. Telling the person that he or she will never be able to do what was done before (such as caring for themselves or living normally) is not appropriate or therapeutic. Telling the client that other people can take care of them is also nontherapeutic.
Which are factors that impact how a client defines health? Select all that apply.
Family Culture Community Society Explanation: Each client defines health in terms of the client's own values and beliefs. The person's family, culture, community, and society also influence this personal perception of health. Music does not affect how a person defines health.
A client with chronic obstructive pulmonary disease (COPD) is admitted to the hospital for the second time in 2 months with wheezing, dyspnea, and use of accessory muscles when breathing. Which type of situation does the nurse identify is occurring with this client?
The client is having an exacerbation of the COPD.
A client comes to a scheduled appointment with a new flyer from the insurance company (above) and asks the nurse how all these things can be included. How should the nurse respond?
This is referred to as an integrated delivery system. Everyone is working together to provide their clients the best possible care.
The recognition of health as an ongoing process toward a person's highest potential of functioning is defined as:
high-level wellness. Explanation: High-level wellness is defined as recognizing health as an ongoing process toward a person's highest potential of functioning. The Health Belief Model focuses on how the client's beliefs about health influence the client's health and response to health and health care. Illness is a person's response to disease. the Agent-Host-Environment model explores the factors that contribute to infection in a client.
Which nursing activity provides an example of primary prevention?
Teaching a family how to recognize and avoid environments containing lead paint Explanation: Primary prevention focuses on health promotion and preventing disease, such as teaching a family how to recognize lead paint so that they can avoid exposure to it. Secondary prevention focuses on screening or early detection of disease, such as assessing a home for evidence of lead paint, to which a family has already been exposed, or screening school-aged children for exposure to lead. Tertiary prevention occurs after diagnosis and treatment and focuses on restoring the client to health and preventing further disease progression or complications, such as suggesting alternative housing options for a family after a case of lead poisoning.
What have the models of health promotion and illness prevention been used for?
To help health care providers understand health-related behaviors. Several models of health promotion and illness prevention have been used to help health care providers understand health-related behaviors and adapt care to people from diverse economic and cultural backgrounds. The models include the health belief model, the health promotion model, the health-illness continuum model, and the agent-host-environment model. These models do not define a medical framework in the care of the disabled; these models do not create a forum for improving rehabilitative care; and these models do not formulate care plans for use with the disabled.
Chronic illness may be characterized by periods of remission. Remission is best defined as:
the presence of a disease with the absence of symptoms. Remission is defined as the presence of a disease, but the person does not experience the symptoms. Exacerbation is the reappearance of symptoms of a disease. Disease is a pathologic change in the structure of function of the body or mind. Illness is the response of a person to a disease.
Which is an example of the sociocultural dimension influencing a person's health-illness status?
A single mother of two applies for food stamps in order to feed her family. Explanation: The sociocultural dimension refers to health practices and beliefs that are strongly influenced by a person's economic level, lifestyle, family, and culture. In general, low-income groups are less likely to seek medical care to prevent illness, and high-income groups are more prone to stress-related habits and illness. The family living in a city environment with high air pollution is an example of the environmental dimension. The father who refuses a blood transfusion for his son is an example of the spiritual dimension. The teenager who worries that his scars will cost him friends is an example of the emotional dimension.
A teenaged client reports having diarrhea before every test in school. The nurse recognizes that this client needs to focus on which dimension of health?
Emotional dimension Explanation: This is an example of the emotional dimension. Long-term stress affects body systems, and anxiety affects health habits. The intellectual dimension encompasses cognitive abilities and past experiences, whereas the physical dimension includes factors such as genetics, gender, and race. The sociocultural dimension relates to a client's economic level, lifestyle, family, and culture.
An exacerbation refers to the reactivation of a disease. Which condition is associated with exacerbation?
Chronic illness
What level of prevention is represented by educating a group of clients on carseat safety?
Primary prevention Explanation: Primary prevention focuses on the health of a person with the goal of preventing disease or illness. Carseat safety education is primary prevention. Secondary prevention refers to screening and early detection of disease. Tertiary prevention refers to rehabilitation and prevention of complications after diagnosis with a disease. Educational is not a level of prevention.
A nurse refers an HIV-positive client to a local support group. This is an example of what level of preventive care?
Tertiary. Tertiary health promotion and illness prevention begins after an illness is diagnosed and treated, with the goal of reducing disability and helping rehabilitate clients to a maximum level of functioning. Referring an HIV-positive client to a local support group would be an example of tertiary preventive care. Primary health promotion and illness prevention are directed toward promoting health and preventing the development of disease processes or injury. Secondary health promotion and illness prevention focus on screening for early detection of disease, with prompt diagnosis and treatment of any found. The term chronic is not related to health promotion.
A nurse is caring for a client with chronic obstructive pulmonary disease (COPD). The nurse explains to the client that COPD is a chronic disease. Why is COPD considered a chronic disease?
It has a gradual onset and lasts for a long time. Chronic illness has a gradual onset and lasts for a long time. It is usually seen in old age. It may or may not be due to acute illness. Chronic diseases are a major cause of morbidity in the population.
A nurse is performing health promotion activities for clients at a local health care clinic. Which nursing actions exemplify the focus of secondary preventive care? Select all that apply.
Screening clients for hypertension Scheduling a mammogram for a client Referring a client to family counseling Explanation: Secondary health promotion and illness prevention focus on screening for early detection of disease, with prompt diagnosis and treatment of any symptoms found. The goals of secondary preventive care are to identify an illness, reverse or reduce its severity or provide a cure, and thereby return the person to maximum health as quickly as possible. Scheduling a mammogram, screening for hypertension, and referring a client to family counseling are all examples of secondary preventive care. Primary health promotion and illness prevention are directed toward promoting health and preventing the development of disease processes or injury. Scheduling immunizations and educating parents about child safety in the home are both examples of primary preventive care. Tertiary health promotion and illness prevention begins after an illness is diagnosed and treated, with the goal of reducing disability and helping rehabilitate clients to a maximum level of functioning. Performing range-of-motion exercises is an example of tertiary preventive care.
A nurse is caring for a client who has COPD, a chronic illness of the lungs. The client is in remission. Which statement best describes a period of remission in a client with a chronic illness?
Symptoms are not experienced. Chronic illnesses usually have a slow onset and many have periods of remission (the disease is present but the client does not experience symptoms). Exacerbation is when the symptoms of the disease reappear. Chronic illnesses do not go away; the disease continues to be present.
The nurse is using Leavell and Clark's Agent-Host-Environment Health Model to help plan nursing interventions for clients in a hospital setting. Which examples of nursing actions to prevent hospital-acquired infections (HAIs) best illustrate the principles of this model? Select all that apply.
The nurse should assess the clients for risk factors for infection when planning nursing care. The nurse should consider the client's family history and age when assessing risk factors for infection. The nurse should examine environmental stressors in clients' lives to see how these stressors might affect their recovery and ability to ward off infection. Explanation: The Agent-Host-Environment model of health and illness, developed by Leavell and Clark (1965), views the interaction between an external agent, a susceptible host, and the environment as causes of disease in a person. It is a traditional model that explains how certain factors place some people at risk for an infectious disease. These factors are constantly interacting, and a combination of factors may increase the risk of illness. The nurse assessing the clients for risk factors for infection when planning nursing care helps to illustrate this model. The nurse assessing the client's family history and age when assessing risk factors for infection helps to illustrate this model. The nurse assessing environmental stressors in clients' lives is another example to illustrate this model. The other options are not examples illustrating the Agent-Host-Environment health model.
