Exam 3

What statements made by the patient indicate that the patient's self-concept is improving following treatment? Select all that apply.

"I am pretty comfortable with my crutches It is easier to administer insulin than I had imagined. "Physical therapy is going well. I'm going to be on my feet soon." Acceptance of the use of assistive devices and understanding teaching, such as how to administer insulin, suggest good progress. Positive attitudes toward returning to previous levels of functioning also indicate good progress. Not wanting to put additional efforts into rehabilitation and not wanting to socialize indicate negative self-concept. Test-Taking Tip: Narrow the choices by first eliminating answers you know are incorrect. For this question, the statements "The prosthesis hurts; I cannot endure it" and "I don't find the social gathering very interesting" are examples of a patient displaying negative responses. Those responses do not correlate with what the question is asking—improved self-concept—so you know to eliminate them as possibilities.

A patient with a 20-year history of diabetes mellitus had a lower leg amputation. Which statement made by the patient indicates that he is experiencing a problem with body image?

"I don't go out very much because everyone stares at me." The amputation resulted in a change in physical appearance that caused a change in body image. Reactions of patients and families to changes in body image depend on the type of changes (e.g., loss of a limb or an organ), their adaptive capacity, the rate at which changes take place, and the support services available. When a change in body image such as results from a leg amputation occurs, the patient generally adjusts in the following phases: shock, withdrawal, acknowledgment, acceptance, and rehabilitation. The patient's statement indicates he is in the stage of withdrawal.

The nurse is developing a health promotion program on healthy eating and exercise for high school students using the health belief model as a framework. Which statement made by a high school student is related to the individual's perception of susceptibility to an illness?

"I'm worried about becoming overweight and getting diabetes because my father has diabetes The statement indicates that the patient is concerned about developing diabetes and believes that there is a risk or susceptibility based on recognition of a familial link for the disease. Once this link is recognized, the patient may perceive the personal risk for diabetes.

Which intervention comes under active strategies of health promotion?

A weight reduction program for obese people Active strategies of health promotion require a person to be actively involved in the measures taken to improve a condition and reduce the risk of disease. Therefore, a weight reduction program for obese people is an active strategy. In passive strategies of health promotion, individuals gain from the activities of others without acting themselves. Therefore interventions such as fortification of milk with vitamin D, fluoridation of municipal drinking water, and fortification of cereals with vitamin A, are classified as passive strategies.

A nurse is caring for a patient who is quadriplegic. According to Maslow's hierarchy of needs, which patient needs should be given priority over others? Select all that apply.

Feeding the patient Ensuring adequate fluid intake Assisting with bladder or bowel elimination According to Maslow's hierarchy of needs, some human needs are more basic than other needs. These basic needs should be met before other needs are met. Food, water, and elimination are basic needs and should be given priority over others. Reassurance helps to make the patient emotionally secure. A visit by family members makes the patient feel loved.

A head nurse is teaching student nurses about internal and external variables related to the development of a disease. Which factors would come under external variables? Select all that apply.

Cultural background Employment status Family practices Both internal and external variables influence a person's health. External variables that affect the health of a person include socioeconomic factors like cultural background, employment status, and family practices. Internal variables include developmental stage, intellectual background, emotional factors, and spiritual factors.

A patient diagnosed with major depressive disorder has a nursing diagnosis of chronic low self-esteem related to negative view of self. Which would be the most appropriate cognitive intervention by the nurse?

Focus on identifying strengths and accomplishments A humanistic approach to healthcare focuses on strengths of individuals rather than weaknesses or illness (i.e., physiologic disease or mental disorder). Focusing on strengths and accomplishments to minimize the emphasis on failures assists the patient to alter distorted and negative thinking. The other interventions are important, but they are not designed to impact thoughts

The nurse is obtaining a health history for a patient with a recent diagnosis of atherosclerosis and cardiovascular disease. The nurse determines that the patient's father also had a diagnosis of cardiac disease at the same age. Which risk factor does the nurse identify as significant in influencing the patient's health?

Genetics Many factors influence an individual's health. Some diseases are passed on genetically from generation to generation. The individual's susceptibility to a disease may be genetically passed on from a parent to the offspring. Age is a strong indicator of susceptibility to a disease. For example, some diseases are more common in neonates and infants due to their immature immune system, whereas other diseases are found more in older adults. Gender may also influence susceptibility to an illness such as hemophilia, which is passed on to male children from the mother. Lifestyle may also influence susceptibility to an illness by affecting the risk factors. Lifestyle-related risk factors can include contracting hepatitis or human immunodeficiency

The nurse identifies a patient whose health status is affected by attitudes, values, and cultural practices. Which health model would be the best to identify the relationship between the patient's cultural practices and health status?

Health Belief Model (HBM) The Health Belief Model identifies the impact of patient's attitudes and beliefs on the patient's susceptibility to illness, the severity of the illness, barriers to adopting a healthy lifestyle, and self-care during an illness. The nurse provides culturally competent and congruent care to the patient based on the Health Belief Model. The Holistic Health Model deals with promotion of natural healing methods and collaborative care. The Health Promotion Model deals with providing preventive care. The nurse follows the Basic Human Needs Model to categorize the areas of patient need.

The nurse is caring for a Chinese patient who prefers traditional healing practices over Western medicine. Which health model should the nurse follow to promote the patient's health and wellness?

Holistic Health Model (HHM) In holistic health care, the patient is an active participant. Because the patient prefers to use traditional healing practices, the nurse should follow the Holistic Health Model. This model includes natural remedies, alternative therapies, and complementary interventions. The nurse uses the Health Belief Model to explore the relationship between the patient's beliefs and health behaviors. The nurse uses the Health Promotion Model for nursing care to provide a primary level of prevention care. The nurse follows the Basic Human Needs Model to identify and prioritize the patient's needs.

An elderly patient is admitted to a hospital for management of depression. The patient asks a nurse for permission to do meditation and breathing exercises for 15 minutes in the evening. The nurse has given the permission to do so. Which health model is reflected in these beliefs?

Holistic health model The holistic health model emphasizes that all the dimensions of an individual should be considered, including emotional and spiritual well-being dimensions, for the total wellness of an individual. Therefore, the approach used in this case comes under the holistic health model. The health promotion model focuses on individual characteristics and experiences, behavior-specific knowledge and affect, and behavioral outcomes. The health belief model addresses the relationship between a person's beliefs and behavior. Restoration and rehabilitation fall under tertiary prevention.

When illness occurs, different attitudes about it cause people to react in different ways. What do medical sociologists call this reaction to illness?

Illness behavior Illness behavior involves how people monitor their bodies, define and interpret their symptoms, take remedial actions, and use the resources in the health care system. Personal history, social situations, social norms, and past experiences can affect illness behavior.

Arrange an individual's basic needs in the order of highest to lowest priority using Maslow's hierarchy pyramid.

In the basic human needs model, Maslow's hierarchy explains the basic requirements for survival and desires that drive personal growth and development. Human needs are represented in a pyramid consisting of five levels. The highest priority and first level represents physiological needs and includes food, water, breathing, sleep, and sex. The next highest priority and second need are safety needs, and this includes security, employment, family, wealth, and property. The third level of hierarchy is love and belonging. These include family, friendship, confidence, and achievement. The fourth level consists of self-esteem needs. These include respect of others and respect by others. The fifth concept, with the lowest priority, is the need for self-actualization. This includes integration of cognition, consciousness, and problem-solving.

What amount of physical activity should the nurse recommend for healthy adults?

Moderate-intensity physical activity for 30 minutes 5 or more days per week The nurse should instruct healthy adults to participate in moderate-intensity physical activity for at least 30 minutes 5 or more days per week. Engaging in physical activity helps reduce the risk of illness and promotes health. The exercise recommendation for obese and overweight people is to perform vigorous activity for 30 to 60 minutes 5 or more days per week. Moderate-intensity activity for at least 30 minutes 3 or more days is recommended for older adults.

A patient at the community clinic asks the nurse about health promotion activities that she can do because she is concerned about getting diabetes mellitus since her grandfather and father both have the disease. This statement reflects that the patient is in what stage of the health belief model? A) Perceived threat of the disease B) Likelihood of taking preventive health action C) Analysis of perceived benefits of preventive action D) Perceived susceptibility to the disease.

Perceived susceptibility to the disease. The health belief model addresses the relationship between a person's beliefs and behaviors. It provides a way of understanding and predicting how patients will behave in relation to their health and how they will comply with health care therapies. In the perceived susceptibility to the disease phase, the patient recognizes the familial link to the disease.

A nurse administers a polio vaccine to an infant. What is this level of prevention called?

Primary prevention aims at health promotion and taking preventive steps before the disease or problem starts. Giving a vaccination to the infant is an example of primary prevention. Secondary prevention measures are taken by people who are suffering from diseases and are at risk for developing complications. Tertiary prevention includes measures taken to minimize the harmful effects of disease or disability.

Which is an example of the nurse participating in primary care activities?

Providing prenatal teaching on nutrition to a pregnant woman during the first trimester Primary prevention is focused on health promotion. Health-promotion programs contribute to quality healthcare by helping patients acquire healthier lifestyles. Health-promotion activities keep people healthy through exercise, good nutrition, rest, and adopting positive health attitudes.

The nursing instructor is discussing various concepts of the Health Belief Model with student nurses. To which concept is the nursing instructor referring when discussing patient's beliefs about the costs of being healthy?

The Health Belief Model proposes six constructs that influence a patient's decision-making regarding disease prevention, screening, and control of illness. Perceived barriers are beliefs about the material and psychological costs of taking action related to health; these may pose a barrier during health promotion activities. Beliefs about the effectiveness of taking action to reduce the risk or severity of disease indicate perceived benefits. Perceived severity is the ability to comprehend the stage and the consequences of an illness. Perceived susceptibility is the risk of developing a disease.

A nurse works in a special care unit for children with severe immunology problems and is caring for a 3-year-old boy from Greece. The boy's father is with him while his mother and sister are back in Greece. The nurse is having difficulty communicating with the father. What action does the nurse take?

Search for help with interpretation and understanding of the cultural differences by contacting someone from the local Greek community The nurse needs to understand how the Greek culture impacts the father's health beliefs and communication with health care providers. Cultural variables must be incorporated into the child's plan of care. Cultural background influences beliefs, values, and customs. It influences the approach to the health care system, personal health practices, and the nurse-patient relationship. Cultural background may also influence an individual's beliefs about causes of illness and remedies or practices to restore health. If nurses are not aware of their own and other cultural patterns of behavior and language, they may not be able to recognize and understand a patient's behavior and beliefs and may have difficulty interacting with the patient.

A patient who has a family history of breast cancer reports breast tenderness. On examination, the nurse finds a lump in the breast and instructs the patient to undergo mammography. Which level of preventive care does the nurse provide to the patient?

Secondary prevention There are three levels of prevention: primary, secondary, and tertiary. Secondary prevention involves early diagnosis and prompt treatment. Because the patient is at risk of developing breast cancer due to family history, the nurse assesses the symptoms and does an examination to determine the condition. The nurse instructs the patient to undergo mammography to diagnose the disease. Primary prevention is aimed at reducing risk factors or delaying the occurrence of an illness. This includes interventions for health promotion and specific protection. Tertiary prevention care is provided to severely ill or diseased patients to reduce the number and impact of complications. Statutory prevention is unrelated to breast cancer and is relevant to lifestyle-related habits such as smoking.

In the pyramid of Maslow's Hierarchy of Needs, which need of the patient is placed at the highest level?

Self-actualization Maslow's hierarchy of needs model is used to understand the interrelationships of basic human needs. According to this model, basic needs are at the bottom and self-actualization is on the top. Self-actualization is considered the highest expression of one's individual potential and it allows for the continual discovery of self. When this model is applied to each patient individually, the best result can be expected. Food is a basic need which is placed at the bottom. The need for love follows the need for physical safety.

The nurse is participating in a community workshop for prevention of noncommunicable chronic diseases. Which diseases does the nurse educator emphasize while educating the community? Select all that apply.

Stroke Childhood obesity Cardiovascular disease Noncommunicable chronic diseases are long-term diseases that do not spread from one person to another. These include stroke, childhood obesity, and cardiovascular disease. For the prevention and control of chronic diseases, the nurse should educate the community about preventive measures such as controlling blood pressure, maintaining a desirable weight, and including exercise in their lives. The flu and tuberculosis are examples of communicable diseases. These diseases spread from one person to another.

The nurse is caring for a patient with an illness. Arrange the stages of illness in the order described by Suchman.

Symptom experience Assumption of the sick role Medical care contact Dependent patient role Perceived recovery The Stages of Illness Model by Suchman describes illness behavior and how individuals arrive at coping mechanisms necessary to manage these conditions. Stage I is symptom experience, during which a person experiences clinical manifestations of the disease. The person acknowledges that something is wrong and seeks treatment. Stage II is assumption of the sick role. The person decides that the illness is genuine and care is necessary. The person is temporarily excused from typical social and personal obligations. Stage III is the medical care contact. The person seeks professional advice from health care providers, and the health care providers identify, validate, and legitimize the sick role. Stage IV is the dependent patient role. During this stage, the person is designated as a patient and is dependent on others for treatment. Stage V is perceived recovery. The person is well and abandons the sick role to resume usual tasks and roles to the greatest degree possible.

A nurse works in collaboration with a physiotherapist to help aid the ambulatory functions of a patient who suffered from a motor accident. What is this level of prevention called?

Tertiary prevention Tertiary prevention involves minimizing the adverse effects of any disease or disability. This also includes rehabilitation. Indirect care is a process by which there is no direct contact between nurse and patient, but the nurse works for the benefit of the patient. Primary prevention aims at health promotion and taking preventive steps before the disease or problem starts. Secondary prevention refers to measures taken for people who are suffering from a disease or are at risk for developing complications.

According to the World Health Organization (WHO), what is the definition of health?

The state of complete physical, mental, and social well-being The World Health Organization (WHO) defines health as a "state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity." Health is not only the state of being free from illness or injury, or the absence of signs and symptoms. Health does not refer to the state of total absence of all diseases, disorders, and syndromes, but also includes the mental health and spiritual health components.

Which techniques should the nurse use to draw the patient's attention away from a painful wound debridement and dressing change? Select all that apply.

Therapeutic touch Breathing techniques Relaxation techniques Therapeutic touch and breathing and relaxation techniques are alternative methods of physical and mental health promotion. The nurse's therapeutic touch gives the patient a sense of comfort and support. Breathing techniques divert the patient's attention away from the dressing and promote oxygenation of the wound site. Relaxation techniques such as mindfulness, visualization, and meditation help the patient to relax during the painful procedure of debriding the wound and changing the dressing. Yoga is not a viable technique for the patient as the patient may be in pain during a dressing change and unable to do yoga. Acupuncture involves stimulation of specific points in the body to control pain. This stimulation is accompanied with application of heat, cool, laser, or penetration of thin needles. These stimulation techniques are not helpful during wound debridement and dressing change.

A nurse understands that levels of preventive care include primary, secondary, and tertiary prevention. Which activities are included in the primary prevention? Select all that apply.

health education programs Immunizations Physical fitness activities Health education programs, immunizations, and physical fitness activities aim at preventing illness and promoting health. These primary prevention activities are targeted towards physically and emotionally healthy people. Diagnostic tests and drug therapy are secondary levels of care and are performed when the disease has already occurred.

During a visit to a family clinic, the nurse teaches a mother about immunizations, car seat use, and home safety for an infant and toddler. Which type of nursing interventions are these?

health promotion activities Health promotion activities focus on interventions designed to maintain the physical, social, emotional, and spiritual health of the family unit. They can include information about specific health behaviors, family coping techniques, and growth and development

When taking care of patients, the nurse routinely asks them if they take any vitamins or herbal medications, encourages family members to bring in music that the patient likes to help the patient relax, and frequently prays with her patients if that is important to them. The nurse is practicing which model?

holistic The nurse is using a holistic model of care that considers emotional and spiritual well-being and other dimensions of an individual to be important aspects of physical wellness. The holistic health model of nursing attempts to create conditions that promote optimal health. Nurses using the holistic nursing model recognize the natural healing abilities of the body and incorporate complementary and alternative interventions such as music therapy, reminiscence, relaxation therapy, therapeutic touch, and guided imagery because they are effective, economical, noninvasive, nonpharmacological complements to traditional medical