CH 4
A public health nurse is preparing to hold a series of health-promotion classes for middle-aged adults that will address a variety of topics. Which site would best meet the learning needs of this population? A) A well-respected physicians office B) A large, local workplace C) The local hospital D) An ambulatory clinic
Ans: B Feedback: The workplace has become a center for health-promotion activity. Health-promotion programs can generally be offered almost anywhere in the community, but the workplace is often more convenient for the adult, working population. This makes this option preferable to a hospital, doctors office, or ambulatory clinic.
A nurse who provides care at the campus medical clinic of a large university focuses many of her efforts on health promotion. What purpose of health promotion should guide the nurses efforts? A) To teach people how to act within the limitations of their health B) To teach people how to grow in a holistic manner C) To change the environment in ways that enhance cultural expectations D) To influence peoples behaviors in ways that reduce risks
Ans: D Feedback: The purpose of health promotion is to focus on the persons potential for wellness and to encourage appropriate alterations in personal habits, lifestyle, and environment in ways that reduce risks and enhance health and well-being. The other options are incorrect because the purpose of health promotion is not to teach people how to grow in a holistic manner, to accommodate their limitations, or to change the environment in ways that enhances cultural expectations.
Health care professionals are involved in the promotion of health as much as in the treatment of disease. Health promotion has evolved as a part of health care for many reasons. Which of the following factors has most influenced the growing emphasis on health promotion? A) A changing definition of health B) An awareness that wellness exists C) An expanded definition of chronic illness D) A belief that disease is preventable
Ans: A Feedback: The concept of health promotion has evolved because of a changing definition of health and an awareness that wellness exists at many levels of functioning. The other options are incorrect because health promotion has not evolved because we know that wellness exists or a belief that disease is preventable. No expanded definition of chronic illness has caused the concept of health promotion to evolve.
A public health nurse is planning educational interventions that are based on Beckers Health Belief Model. When identifying the variables that affect local residents health promotion behaviors, what question should the nurse seek to answer? A) Do residents believe that they have ready access to health promotion resources? B) Why have previous attempts at health promotion failed? C) How much funding is available for health promotion in the community? D) Who is available to provide health promotion education in the local area?
Ans: A Feedback: Barriers, Beckers second variable, are defined as factors leading to unavailability or difficulty in gaining access to a specific health promotion alternative. The other listed questions do not directly relate to the four variables that Becker specified.
28. A nurse recognizes that individuals of different ages have specific health promotion needs. When planning to promote health among young adults, what subject is most likely to meet this demographic groups learning needs? A) Family planning B) Management of risky behaviors C) Physical fitness D) Relationship skills training
Ans: A Feedback: Because of the nationwide emphasis on health during the reproductive years, young adults actively seek programs that address prenatal health, parenting, family planning, and womens health issues. The other options are incorrect because they are not health promotion classes typically sought out by young adults.
You are the oncoming nurse and you have just taken end-of-shift report on your patients. One of your patients newly diagnosed with diabetes was admitted with diabetic ketoacidosis. Which behavior best demonstrates this patients willingness to learn? A) The patient requests a visit from the hospitals diabetic educator. B) The patient sets aside a dessert brought in by a family member. C) The patient wants a family member to meet with the dietician to discuss meals. D) The patient readily allows the nurse to measure his blood glucose level.
Ans: A Feedback: Emotional readiness also affects the motivation to learn. A person who has not accepted an existing illness or the threat of illness is not motivated to learn. The patients wiliness to learn is expressed through the action of seeking information on his or her own accord. Seeking information shows an emotional readiness to learn. The other options do not as clearly demonstrate a willingness to learn.
The nurse is teaching a local community group about the importance of disease prevention. Why is the nurse justified in emphasizing disease prevention as a component of health promotion? A) Prevention is emphasized as the link between personal behavior and health. B) Most Americans die of preventable causes. C) Health maintenance organizations (HMOs) now emphasize prevention as the main criterion of health care. D) External environment affects the outcome of most disease processes.
Ans: A Feedback: Healthy People 2020 defines the current national health-promotion and disease-prevention initiative for the nation. The overall goals are to (1) increase the quality and years of healthy life for people and (2) eliminate health disparities among various segments of the population. Most deaths are not classified as being preventable. HMO priorities do not underlie this emphasis. The external environment affects many disease processes, but the course of illness is primarily determined by factors intrinsic to the patient.
Health promotion ranks high on the list of health-related concerns of the American public. Based on current knowledge, what factor should the nurse prioritize in an effort to promote health, longevity, and weight control in patients? A) Good nutrition B) Stress reduction C) Use of vitamins D) Screening for health risks
Ans: A Feedback: It has been suggested that good nutrition is the single most significant factor in determining health status, longevity, and weight control. A balanced diet that uses few artificial ingredients and is low in fat, caffeine, and sodium constitutes a healthy diet. Stress reduction and screening for health risks are correct answers, just not the most significant factors. Vitamin use is not normally necessary when an individual eats a healthy diet, except in specific circumstances.
A public health nurse is assessing the nutritional awareness of a group of women who are participating in a prenatal health class. What outcome would most clearly demonstrate that the women possess nutritional awareness? A) The women demonstrate an understanding of the importance of a healthy diet. B) The women are able to describe the importance of vitamin supplements during pregnancy. C) The women can list the minerals nutrients that should be consumed daily. D) The women can interpret the nutrition facts listed on food packaging.
Ans: A Feedback: Nutritional awareness involves an understanding of the importance of a healthy diet that supplies all of the essential nutrients. The other options are incorrect because vitamin supplements are not necessary for a healthy diet, a certain amount of all minerals need to be eaten daily, and understanding what constitutes the recommended daily nutrients is not necessary for nutritional awareness.
A nurse is planning an educational event for a local group of citizens who live with a variety of physical and cognitive disabilities. What variable should the nurse prioritize when planning this event? A) Health-promotion needs of the group B) Relationships between participants and caregivers C) Wellness state of each individual D) Learning needs of caregivers
Ans: A Feedback: The nurse must be aware of the participants specific health-promotion needs when teaching specific groups of people with physical and mental disabilities. This is a priority over the relationships between participants and caregivers, each persons wellness state, or caregivers learning needs.
A gerontologic nurse has observed that patients often fail to adhere to a therapeutic regimen. What strategy should the nurse adopt to best assist an older adult in adhering to a therapeutic regimen involving wound care? A) Demonstrate a dressing change and allow the patient to practice. B) Provide a detailed pamphlet on a dressing change. C) Verbally instruct the patient how to change a dressing and check for comprehension. D) Delegate the dressing change to a trusted family member.
Ans: A Feedback: The nurse must consider that older adults may have deficits in the ability to draw inferences, apply information, or understand major teaching points. Demonstration and practice are essential in meeting their learning needs. The other options are incorrect because the elderly may have problems reading and/or understanding a written pamphlet or verbal instructions. Having a family member change the dressing when the patient is capable of doing it impedes self-care and independence.
Nurses who are providing patient education often use motivators for learning with patients who are struggling with behavioral changes necessary to adhere to a treatment regimen. When working with a 15-year-old boy who has diabetes, which of the following motivators is most likely to be effective? A) A learning contract B) A star chart C) A point system D) A food-reward system
Ans: A Feedback: Using a learning contract or agreement can also be a motivator for learning. Such a contract is based on assessment of patient needs; health care data; and specific, measurable goals. Young adults would not respond well to the use of star charts, point systems, or food as reward for behavioral change. These types of motivators would work better with children.
Middle-aged adults are part of an age group that is known to be interested in health and health promotion, and the nurse is planning health promotion activities accordingly. To what suggestions do members of this age group usually respond with enthusiasm? Select all that apply. A) How lifestyle practices can improve health B) How to eat healthier C) How exercise can improve your life D) Strategies for adhering to prescribed therapy E) Exercise for the aging
Ans: A, B, C Feedback: Young and middle-aged adults represent an age group that not only expresses an interest in health and health promotion but also responds enthusiastically to suggestions that show how lifestyle practices can improve health; these lifestyle practices include nutrition and exercise. Middle-aged adults may not respond positively to teaching aimed at the aging. Adherence is not noted to be a desired focus in this age group.
. A parish nurse is describing the relationships between health and physical fitness to a group of older adults who all attend the same church. What potential benefits of a regular exercise program should the nurse describe? Select all that apply. A) Decreased cholesterol levels B) Delayed degenerative changes C) Improved sensory function D) Improved overall muscle strength E) Increased blood sugar levels
Ans: A, B, D Feedback: Clinicians and researchers who have examined the relationship between health and physical fitness have found that a regular exercise program can promote health in the following ways: by decreasing cholesterol and low-density lipoprotein levels; delaying degenerative changes, such as osteoporosis; and improving flexibility and overall muscle strength and endurance. Physical fitness does not improve the senses or increase blood sugar.
You are the clinic nurse providing patient education to a teenage girl who was diagnosed 6 months ago with type 1 diabetes. Her hemoglobin A1C results suggest she has not been adhering to her prescribed treatment regimen. As the nurse, what variables do you need to assess to help this patient better adhere to her treatment regimen? Select all that apply. A) Variables that affect the patients ability to obtain resources B) Variables that affect the patients ability to teach her friends about diabetes C) Variables that affect the patients ability to cure her disease D) Variables that affect the patients ability to maintain a healthy social environment E) Variables that affect the patients ability to adopt specific behaviors
Ans: A, D, E Feedback: Nurses success with health education is determined by ongoing assessment of the variables that affect a patients ability to adopt specific behaviors, to obtain resources, and to maintain a healthy social environment. The patients ability to teach her friends about her condition is not a variable that the nurse would likely assess when educating the patient about her treatment regimen. Type 1 diabetes is not curable.
A nurse has planned a teachinglearning interaction that is aimed at middle school-aged students. To foster successful health education, the nurses planning should prioritize which of the following components? A) Pretesting B) Social and cultural patterns C) Patient awareness D) Measurable interventions
Ans: B Feedback: A patients social and cultural patterns must be appropriately incorporated into the teachinglearning interaction. Pretesting may or may not be used; patient awareness is a phrase that has many meanings, none of which make the teachinglearning interaction successful. Interventions are not measured; goals and outcomes are.
As the nurse working in a gerontology clinic, you know that some elderly people do not adhere to therapeutic regimens because of chronic illnesses that require long-term treatment by several health care providers. What is the most important consideration when dealing with this segment of the population? A) Health care professionals must know all the dietary supplements the patient is taking. B) Health care professionals must work together to provide coordinated care. C) Health care professionals may negate the efforts of another health care provider. D) Health care professionals must have a peer witness their interactions with the patient.
Ans: B Feedback: Above all, health care professionals must work together to provide continuous, coordinated care; otherwise, the efforts of one health care professional may be negated by those of another. Interactions do not necessarily need to be witnessed. The care team should be aware of the patients use of supplements, but this is not a priority principle that guides overall care.
A community health nurse has been asked to participate in a health fair that is being sponsored by the local senior center. The nurse should select educational focuses in the knowledge that older adults benefit most from what kind of activities? A) Those that help them eat well B) Those that help them maintain independence C) Those that preserve their social interactions D) Those that promote financial stability
Ans: B Feedback: Although their chronic illnesses and disabilities cannot be eliminated, the elderly can benefit most from activities that help them maintain independence and achieve an optimal level of health. For many older adults, this is a priority over social interaction, finances, or eating well, even though each of these subjects is important.
A team of public health nurses are doing strategic planning and are discussing health promotion activities for the next year. Which of the following initiatives best exemplifies the principles of health promotion? A) A blood pressure clinic at a local factory B) A family planning clinic at a community center C) An immunization clinic at the largest local mall D) A workplace safety seminar
Ans: B Feedback: Health promotion may be defined as those activities that assist people in developing resources that maintain or enhance well-being and improve their quality of life. A family planning clinic meets these criteria most closely. Workplace health and safety would be considered a protection service. A blood pressure clinic and immunization clinic would fall under the category of preventive services.
A nurse is working with a male patient who has recently received a diagnosis of human immunodeficiency virus (HIV). When performing patient education during discharge planning, what goal should the nurse emphasize most strongly? A) Encourage the patient to exercise within his limitations. B) Encourage the patient to adhere to his therapeutic regimen. C) Appraise the patients level of nutritional awareness. D) Encourage a disease-free state,
Ans: B Feedback: One of the goals of patient education is to encourage people to adhere to their therapeutic regimen. This is a very important goal because if patients do not adhere to their therapeutic regimen, they will not attain their optimal level of wellness. In this patients circumstances, this is likely a priority over exercise or nutrition, though these are important considerations. A disease-free state is not obtainable
A nurse has been studying research that examines the association between stress levels and negative health outcomes. Which relationship should underlie the educational interventions that the nurse chooses to teach? A) Stress impairs sleep patterns. B) Stress decreases immune function. C) Stress increases weight. D) Stress decreases concentration.
Ans: B Feedback: Studies have shown the negative effects of stress on health and a cause-and-effect relationship between stress and infectious diseases, traumatic injuries (e.g., motor vehicle crashes), and some chronic illnesses. It is well known that stress decreases the immune response, thereby making individuals more susceptible to infectious diseases. The other options can also be correct in certain individuals, but they are not those that best support stress-reduction initiatives.
An elderly female patient has come to the clinic for a scheduled follow-up appointment. The nurse learns from the patients daughter that the patient is not following the instructions she received upon discharge from the hospital last month. What is the most likely factor causing the patient not to adhere to her therapeutic regimen? A) Ethnic background of health care provider B) Costs of the prescribed regimen C) Presence of a learning disability D) Personality of the physician
Ans: B Feedback: Variables that appear to influence the degree of adherence to a prescribed therapeutic regimen include gender, race, education, illness, complexity of the regimen, and the cost of treatments. The ethnic background of the health care provider and the personality of the physician are not considered variables that appear to influence the degree of adherence to a prescribed therapeutic regimen. A learning disability could greatly affect adherence, but cost is a more likely barrier.
A nurse is working with a teenage boy who was recently diagnosed with asthma. During the current session, the nurse has taught the boy how to administer his bronchodilator by metered-dose inhaler. How should the nurse evaluate the teaching learning process? A) Ask the boy specific questions about his medication. B) Ask the boy whether he now understands how to use his inhaler. C) Directly observe the boy using his inhaler to give himself a dose. D) Assess the boys respiratory health at the next scheduled visit.
Ans: C Feedback: Demonstration and practice are essential ingredients of a teaching program, especially when teaching skills. It is best to demonstrate the skill and then give the learner ample opportunity for practice. By observing the patient using the inhaler, the nurse may identify what learning needs to be enhanced or reinforced. Asking questions is not as an accurate gauge of learning. Respiratory assessment is a relevant, but indirect, indicator of learning. Delaying the appraisal of the patients technique until a later clinic visit is inappropriate because health problems could occur in the interval.
A recent nursing graduate is aware that the nursing scope of practice goes far beyond what is characterized as bedside care. Which of the following is a nurses primary responsibility? A) To promote activities that enhance community cohesion B) To encourage individuals self-awareness C) To promote activities that foster well-being D) To influence individuals social interactions
Ans: C Feedback: As health care professionals, nurses have a responsibility to promote activities that foster well-being, self-actualization, and personal fulfillment. Nurses often promote activities that enhance the community and encourage self-awareness; however, they are not a nurses central responsibility. As professionals, nurses do not actively seek to influence social interactions.
You are the nurse planning to teach tracheostomy care to a patient who will be discharged home following a spinal cord injury. When preparing your teaching, which of the following is the most important component of your teaching plan? A) Citing the evidence that underlies each of your teaching points B) Alleviating the patients guilt associated with not knowing appropriate self-care C) Determining the patients readiness to learn new information D) Including your nursing colleagues in the planning process
Ans: C Feedback: Assessment in the teachinglearning process is directed toward the systematic collection of data about the person and familys learning needs and readiness to learn. Patient readiness is critical to accepting and integrating new information. Unless the patient is ready to accept new information, patient teaching will be ineffective. Citing the evidence base will not likely enhance learning. Patient guilt cannot be alleviated until the patient understands the intricacies of the condition and his physiologic response to the disease. Inclusion of colleagues can be beneficial, but this does not determine the success or failure of teaching.
Positive patient outcomes are the ultimate goal of nursepatient interactions, regardless of the particular setting. Which of the following factors has the most direct influence on positive patient-care outcomes? A) Patients age B) Patients ethnic heritage C) Health education D) Outcome evaluation
Ans: C Feedback: Health education is an influential factor directly related to positive patient-care outcomes. The other options are incorrect because ethnicity, the patients age, and outcome evaluation are less influential factors related to positive patient-care outcomes, though each factor should be considered when planning care.
A nursing student is collaborating with a public health nurse on a local health promotion initiative and they recognize the need for a common understanding of health. How should the student and the nurse best define health? A) Health is an outcome systematically maximizing wellness. B) Health is a state that is characterized by a lack of disease. C) Health is a condition that enables people to function at their optimal potential. D) Health is deliberate attempt to mitigate the effects of disease.
Ans: C Feedback: Health is viewed as a dynamic, ever-changing condition that enables people to function at an optimal potential at any given time. Health does not necessarily denote the absence of disease, an effort to maximize wellness, or mitigate the effects of disease.
The nursing instructor has given an assignment to a group of certified nurse practitioner (CNP) students. They are to break into groups of four and complete a health-promotion teaching project and present a report to their fellow students. What project most clearly demonstrates the principles of health- promotion teaching? A) Demonstrating an injection technique to a patient for anticoagulant therapy B) Explaining the side effects of a medication to an adult patient C) Discussing the importance of preventing sexually transmitted infections (STI) to a group of high school students D) Instructing an adolescent patient about safe and nutritious food preparation
Ans: C Feedback: Health promotion encourages people to live a healthy lifestyle and to achieve a high level of wellness. Discussing the importance of STI prevention to a group of high school students is the best example of a health-promotion teaching project. This proactive intervention is a more precise example of health promotion than the other cited examples.
Research has shown that patient adherence to prescribed regimens is generally low, especially when the patient will have to follow the regimen for a long time. Which of the following individuals would most likely benefit from health education that emphasizes adherence? A) An older adult who is colonized with methicillin-resistant Staphylococcus aureus (MRSA) B) An 80-year-old man who has a small bowel obstruction C) A 52-year-old woman who has a new diagnosis of multiple sclerosis D) A child who fractured her humerus in a playground accident
Ans: C Feedback: Many people do not adhere to their prescribed regimens; rates of adherence are generally low, especially when the regimens are complex or of long duration (e.g., therapy for tuberculosis, multiple sclerosis, and HIV infection and hemodialysis). This is less likely in a person with MRSA, an arm fracture, or a bowel obstruction.
The nurse is working with a male patient who has diagnoses of coronary artery disease and angina pectoris. During a clinic visit, the nurse learns that he has only been taking his prescribed antiplatelet medication when he experiences chest pain and fatigue. What nursing diagnosis is most relevant to this assessment finding? A) Acute pain related to myocardial ischemia B) Confusion related to mismanagement of drug regimen C) Ineffective health maintenance related to inappropriate medication use D) Ineffective role performance related to inability to manage medications
Ans: C Feedback: This patients actions suggest that by taking his medications incorrectly he is not adequately maintaining his health. Role performance is not directly applicable to the patients actions and confusion suggests a cognitive deficit. Pain is not central to the essence of the problem.
The nurse is planning to teach a 75-year-old patient with coronary artery disease about administering her prescribed antiplatelet medication. How can the nurse best enhance the patients ability to learn? A) Provide links to Web sites that contain evidence-based information. B) Exclude family members from the session to prevent distraction. C) Use color-coded materials that are succinct and engaging. D) Make the information directly relevant to the patients condition.
Ans: D Feedback: Studies have shown that older adults can learn and remember if the information is paced appropriately, relevant, and followed by appropriate feedback. Family members should be included in health education. The nurse should not assume that the patients color vision is intact or that the patient possesses adequate computer skills
A nurse has been working with Mrs. Griffin, a 71-year-old patient whose poorly controlled type 1 diabetes has led to numerous health problems. Over the past several years Mrs. Griffin has had several admissions to the hospital medical unit, and the nurse has often carried out health promotion interventions. Who is ultimately responsible for maintaining and promoting Mrs. Griffins health? A) The medical nurse B) The community health nurse who has also worked with Mrs. Griffin C) Mrs. Griffins primary care provider D) Mrs. Griffin
Ans: D Feedback: American society places a great importance on health and the responsibility that each of us has to maintain and promote our own health. Therefore, the other options are incorrect.
An adult patient will be receiving outpatient intravenous antibiotic therapy for the treatment of endocarditis. The nurse is preparing to perform health education to ensure the patients adherence to the course of treatment. Which of the following assessments should be the nurses immediate priority? A) Patients understanding of the teaching plan B) Quality of the patients relationships C) Patients previous medical history D) Characteristics of the patients culture
Ans: D Feedback: Before beginning health teaching, nurses must conduct an individual cultural assessment instead of relying only on generalized assumptions about a particular culture. This is likely a priority over previous medical history and relationships, though these are relevant variables. The teaching plan would not be created at this early stage in the teaching process
The nurse is preparing discharge teaching for a 51-year-old woman diagnosed with urinary retention secondary to multiple sclerosis. The nurse will teach the patient to self-catheterize at home upon discharge. What teaching method is most likely to be effective for this patient? A) A list of clear instructions written at a sixth-grade level B) A short video providing useful information and demonstrations C) An audio-recorded version of discharge instructions that can be accessed at home D) A discussion and demonstration between the nurse and the patient
Ans: D Feedback: Demonstration and practice are essential ingredients of a teaching program, especially when teaching skills. It is best to demonstrate the skill and then give the learner ample opportunity for practice. When special equipment is involved, such as urinary catheters, it is important to teach with the same equipment that will be used in the home setting. A list of instructions, a video, and an audio recording are effective methods of reinforcing teaching after the discussion and demonstration have taken place.
A nurse is planning care for an older adult who lives with a number of chronic health problems. For which of the following nursing diagnoses would education of the patient be the nurses highest priority? A) Risk for impaired physical mobility related to joint pain B) Functional urinary incontinence related decreased mobility C) Activity intolerance related to contractures D) Risk for ineffective health maintenance related to nonadherence to therapeutic regimen
Ans: D Feedback: For some nursing diagnoses, education is a primary nursing intervention. These diagnoses include risk for ineffective management of therapeutic regimen, risk for impaired home management, health-seeking behaviors, and decisional conflict. The other options do not have patient education as the highest priority, though each necessitates a certain degree of education.
A public health nurse understands that health promotion should continue across the lifespan. When planning health promotion initiatives, when in the lifespan should health promotion begin? A) Adolescence B) School age C) Preschool D) Before birth
Ans: D Feedback: Health promotion should begin prior to birth because the health practices of a mother prior to the birth of her child can be influenced positively or negatively. This makes the other options incorrect.
The nursing profession and nurses as individuals have a responsibility to promote activities that foster well-being. What factor has most influenced nurses abilities to play this vital role? A) Nurses are seen as nurturing professionals. B) Nurses possess a baccalaureate degree as the entry to practice. C) Nurses possess an authentic desire to help others. D) Nurses have long-established credibility with the public.
Ans: D Feedback: Nurses, by virtue of their expertise in health and health care and their long-established credibility with consumers, play a vital role in health promotion. The other options are incorrect because they are not the most influential when it comes to health promotion by nursing and nurses.
A 20-year-old man newly diagnosed with type 1 diabetes needs to learn how to self-administer insulin. When planning the appropriate educational interventions and considering variables that will affect his learning, the nurse should prioritize which of the following factors? A) Patients expected lifespan B) Patients gender C) Patients occupation D) Patients culture
Ans: D Feedback: One of the major variables that influences a patients readiness to learn is the patients culture, because it affects how a person learns and what information is learned. Other variables include illness states, values, emotional readiness, and physical readiness. Lifespan, occupation, and gender are variables that are usually less salient.
An occupational health nurse is in the planning stages of a new health promotion campaign in the workplace. When appraising the potential benefits of the program, the nurse should consider that success depends primarily on what quality in the participants? A) Desire to expand knowledge B) Self-awareness C) Adequate time- and task-management D) Taking responsibility for oneself
Ans: D Feedback: Taking responsibility for oneself is the key to successful health promotion, superseding the importance of desire to learn information, self-awareness, or time-management.
A school nurse is facilitating a health screening program among junior high school students. What purpose of health screening should the nurse prioritize when planning this program? A) To teach students about health risks that they can expect as they grow and develop B) To evaluate the treatment of students current health problems C) To identify the presence of infectious diseases D) To detect health problems at an early age so they can be treated promptly
Ans: D Feedback: The goal of health screening in the adolescent population has been to detect health problems at an early age so that they can be treated at this time. An additional goal includes efforts to promote positive health practices at an early age. The focus is not on anticipatory guidance or evaluation of treatment. Health screening includes infectious diseases, but is not limited to these.
