Ch 1: Concepts of Health & Disease
A nurse is evaluating findings from the Nurses' Health Study, a study that has followed a group of nurses since 1976 to study the relationship between oral contraceptive use and breast cancer. The nurse evaluates the findings using criteria for which type of study? -Cohort -Cross-sectional -Case control -Qualitative
Cohort A cohort study, also known as a longitudinal study, follows a group of people over a period of time to observe specific health outcomes. Because the Nurses' Health Study followed the same group of nurses since 1976, it is an example of a cohort, or longitudinal, study.
Researchers have designed a study where the health of a large group of babies will be followed for several years. What type of study is this? -Repetition -Double-blind placebo -Case-control -Cohort
Cohort Persons enrolled in a cohort study (also called a longitudinal study) are followed over a period of time to observe one or more specific health outcomes. A case-control study is done on an individual, case-by-case situation. The double-blind placebo is a drug study. Repetition is a type of study carried out in a laboratory with very tight controls in place.
Which of the nurse's assessment questions most directly addresses the client's level of health, based on the World Health Organization's definition of health? -"Would you consider yourself to be more healthy, less healthy, or average?" -"How would you rate your overall sense of well-being?" -"What are the things that give you the most joy in your life?" -"How often have you been sick over the past 12 months?"
"How would you rate your overall sense of well-being?" The WHO defines health as a "state of complete physical, mental, and social well-being and not merely the absence of disease and infirmity." For this reason, an assessment question that directly addresses overall well-being is reflective of this definition. The other listed questions are clinically relevant, but none directly reflects the WHO definition of health.
A client has recently been diagnosed with pancreatic cancer and is meeting with an oncologist for the first time. Which statement best describes the client's prognosis? -"Your likelihood of 5-year survival of pancreatic cancer is a very low percentage." -"The plan of treatment will be based on the stage of your cancer, your response to therapy, and your preferences." -"I've determined that your cancer is at stage II B, which I'll explain to you." -"The formal name for what you have is pancreatic intraepithelial neoplasia III."
"Your likelihood of 5-year survival of pancreatic cancer is a very low percentage." Prognosis refers to the probable outcome and prospect of recovery from a disease. For many diseases, it is expressed as a percentage. Cancer of the pancreas is a leading cause of cancer death each year in the United States. It is difficult to diagnose early because the pancreas is hidden and surrounded by other organs. Treatment has limited results, and 5-year survival rates are low. None of the other listed statements directly addresses the client's chances for recovery.
When the nurse is assisting with the diagnostic process for a client with an illness, what is a prioritywhen compiling all of the data to have an accurate diagnosis? Select all that apply. -A careful history -Diagnostic tests -Detailed physical examination -Financial information -Social data
-A careful history -Diagnostic tests -Detailed physical examination The diagnostic process requires a careful history, physical examination, and diagnostic tests. The history is used to obtain a person's account of his or her symptoms and their progression, and the actors that contribute to a diagnosis. The physical examination is done to observe for signs of altered body structure or function. The diagnostic tests are ordered to validate what is thought to be the problem. They are also performed to determine other possible health problems that were not obtained from the history and physical examination, but may be present given the signs and symptoms identified.
Which clients are exhibiting sequelae of disease? Select all that apply -A toddler who develops bronchiolitis after being treated for respiratory syncytial virus (RSV) -A client with diabetes who has developed a loss of vision. -A client who has a mastectomy to treat stage T3 breast cancer. -An older adult client who experienced liver failure after overdosing on acetaminophen in a suicide attempt. -A client who has a prescribed serologic test and has discovered she is positive for human immunodeficiency virus (HIV)
-A toddler who develops bronchiolitis after being treated for respiratory syncytial virus (RSV) -A client with diabetes who has developed a loss of vision. Sequelae are lesions or impairments that follow or are caused by a disease. Children who develop RSV, for example, frequently have bronchiolitis in the months and years following. Cancer, liver failure, and HIV are not normally the direct pathophysiologic consequences of other diseases. Retinopathy is a common sequela of diabetes.
Which client conditions would be considered a congenital defect? Select all that apply. -Cleft lip and palate -Hypospadius -Club foot -Colon cancer -Rheumatoid arthritis
-Cleft lip and palate -Hypospadius -Club foot Congenital defects are present at birth and occur as a result of neonatal factors and may be influenced by genetic influences, environmental factors, maternal drug use, and radiation. Acquired defects are those that develop as a result of events after birth, including exposure to infectious agents, injury, inadequate nutrition, lack of oxygen, inappropriate immune response, and neoplasia.
When attempting to reach a health diagnosis, the health care provider commonly applies four primary steps. Place the steps for reaching a diagnosis in order. Use all the options. -Obtain clinical history -Conduct a physical examination -Perform diagnostic testing -Determine the most likely cause of the client's presentation
-Obtain clinical history -Conduct a physical examination -Perform diagnostic testing -Determine the most likely cause of the client's presentation The client's presentation, including clinical history and any initial complaints, helps to direct the rest of the steps. For example, when a client presents reporting chest pain, this will direct the focus of the examination and diagnostic testing. This course would be different for a client presenting with hip pain. The findings of the physical examination will direct more specific diagnostic testing, though some basic investigations may be done concurrently with the examination. Finally, the health care provider would need to weigh the findings against client characteristics and determine the most likely cause of the clinical findings.
Which concepts would be included in the study of the science of pathophysiology? Select all that apply. -Study of the structure of cells -Effect of environment on the body -Function of tissues -The effect disease has on human organs -Body's response to disease
-Study of the structure of cells -Function of tissues -The effect the disease has on human organs -Body's response to disease Pathology deals with the study of the structural and functional changes in cells, tissues, and organs of the body that cause or are caused by disease. Physiology deals with the functions of the human body. Thus, pathophysiology deals not only with the cellular and organ changes that occur with disease, but with the effects that these changes have on total body function. Normal effects of external influences on the body would not be considered an aspect of pathophysiology.
Which action will a nurse teach as tertiary prevention of disease? Select all that apply. -Taking antihypertensives for clients post-myocardial infarction -Daily foot inspection by clients with diabetes mellitus -Annual Pap test for women -Measles-mumps-rubella (MMR) vaccination to school-aged children -Wearing a seat belt when in a motor vehicle -Colonoscopy at age 50 and every 10 years
-Taking antihypertensives for clients post-myocardial infarction -Daily foot inspection by clients with diabetes mellitus Tertiary prevention is for clients who already have a disease or disorder to minimize the impact of the disease by preventing further deterioration and reducing complications. These activities include medications that help regulate a disease, community support, and examinations for complications. Primary prevention is intended to prevent a client from acquiring a disease by removing all risk factors, including vaccines, healthy lifestyles, and safety interventions such as seat belts. Secondary prevention focuses on early detection and treatment and would include diagnostic testing according to protocols.
A client with hypertension is given an IV medication and has an anaphylactic reaction. This is considered to be: -a complication -a sequelae -a syndrome -a subacute presentation
-a complication Complications are possible adverse extensions of a disease or outcome from treatment. An example is an anaphylactic reaction to a medication.
A nurse documenting a client's health history places hypertension under which category? -Acquired -Congenital -Mortality -Complications
Acquired An acquired condition, such as hypertension, is caused by events that occur after birth.
A client is diagnosed with Crohn's disease and is informed that there is no cure; however, the client will have periods when there are no symptoms nor periods of exacerbations. Which type of clinical course does the nurse determine the client will have? -Acute -Chronic -Subacute -Carrier state
Chronic A chronic disease implies a continuous, long-term process. It can run a continuous course or can present with exacerbations and remissions. An acute disorder is one that is relatively severe, but self-limiting. A subacute disease is intermediate or between acute and chronic. It is not as severe as an acute disease and not as prolonged as a chronic disease.
During an assessment, a client tells the nurse that he has suffered from asthma since childhood. He is not experiencing any symptoms at this time but takes an inhaled steroidal medication daily. The nurse should document the asthma as being which type of condition? -Acute -Chronic -Subclinical -Subacute
Chronic Chronic disease is one that has a long, continuous course. It can present with exacerbations and remissions. Acute disease is one that is relatively severe, but self-limiting. Subclinical disease is not clinically apparent and not destined to become so. Subacute disease is not as severe as an acute disease and not as prolonged as a chronic disease.
When considering the clinical course, a disease that is characterized by remissions and exacerbations is considered to be: -chronic -acute -subclinical -preclinical
Chronic The clinical course describes the evolution of a disease. A disease can have an acute or chronic course. Chronic disease implies a continuous, long-term process. A chronic disease can run a continuous course or can present with exacerbations (aggravation of symptoms and severity of the disease) and remissions (a period during which there is a decrease in severity and symptoms). An acute disorder is one that is relatively severe, but self-limiting. The terms preclinical and subclinical are used when discussing the severity of the disease.
A client delivers a child born with an extra digit. The client states that she had the same thing when she was born. What term would the nurse document in the record regarding this defect? -A chronic defect -An acute defect -Acquired defect -Congenital condition
Congenital condition Congenital conditions are defects that are present at birth, although they may not be evident until later in life or may never manifest. Congenital conditions may be caused by genetic influences, environmental factors, maternal drug use, irradiation, or gestational problems in utero, or a combination of genetic and environmental factors.
A client delivers a child via vaginal birth after having an uneventful prenatal course. After the infant is born, the nurse discovers an extra digit. The client states that she had the same thing when she was born. What does the nurse recognize that this defect is considered? -A chronic defect -An acute defect -Acquired defect -Congenital condition
Congenital condition Congenital conditions are defects that are present at birth, although they may not be evident until later in life or may never manifest. Congenital conditions may be caused by genetic influences, environmental factors, maternal drug use, irradiation, or gestational problems in utero, or a combination of genetic and environmental factors.
The Framingham cohort study examined characteristics of people who would later develop which disease? -Coronary disease -Chronic obstructive pulmonary disease (COPD) -Lung cancer -Seizures
Coronary disease The Framingham cohort studied examined the characteristics of the people who would later develop coronary disease. The study was set up in 1950 by the U.S Public Health Service.
Which question is an example of an epidemiologic study? -Does smoking cause heart disease? -How does smoking constrict the bronchi? -What is more effective in the treatment of cardiac disease, metoprolol or atenolol? -Does oxygen improve the quality of life of lung cancer clients?
Does smoking cause heart disease? Epidemiologic studies look for patterns of people affected with a particular disorder such as age, race, or lifestyle habits. Epidemiologists are concerned with whether something happens versus how it happens or the best treatment for a particular disease.
Signs and symptoms describe the structural and functional changes that accompany a disease. Symptoms are what the client describes to the caregiver. Signs are what the caregiver observes. Which is considered a sign? -Elevated white cell count and fever of 101.5°F (38.6°C) -Headache and dizziness -Pain especially when swallowing cold food -Excess stress due to lack of sexual performance
Elevated white cell count and fever of 101.5°F (38.6°C) The only objective signs in this list of signs/symptoms are the elevated white cell count and fever of 101.5°F (38.6°C). The other choices are subjective symptoms (reported by the client) like headache, dizziness, pain, or the embarrassment the client feels when not able to perform sexually. The nurse/health care provider cannot physically evaluate whether the symptom is accurate or not.
Which science is called on to study the risk factors in multifactorial diseases? -Scientology -Morphology -Histology -Epidemiology
Epidemiology Epidemiology is the study of patterns of disease, such as the spread of a disease in an epidemic. It has also emerged as a science to study the risk factors in multifactorial diseases, such as heart disease and cancer. Scientology is a religion. Morphology refers to the fundamental structure or form of cells or tissues. Histology deals with the study of the cells and extracellular matrix of body tissues.
What do morbidity and mortality statistics refer to? -Functional effects and death-producing characteristics of a disease -Long-term consequences and recovery rates of a disease -Cause of death and impact on the family because of a disease -Effects a disease has on a person's life and treatment
Functional effects and death-producing characteristics of a disease Morbidity and mortality statistics provide information about the functional effects (morbidity) and death-producing (mortality) characteristics of a disease. Morbidity statistics do address the effects a disease has on a person's life and the long-term consequences of the disease state, but morbidity and mortality statistics taken together have a broader scope. Neither morbidity nor mortality statistics address recovery rates from a disease or treatment modalities for a disease. Although mortality does address the causes of death in a given population, morbidity does not address the impact the disease state has on the family.
Nurses are discussing a new blood test that helps establish a differential diagnosis between shortness of breath with a cardiac etiology and shortness of breath with a respiratory/pulmonary etiology. A positive result is known to indicate a cardiac etiology. The marketers of the test report that 99.8% of clients who have confirmed cardiac etiologies test positive in the test. However, 1.3% of clients who do not have cardiac etiologies for their shortness of breath also test positive. Which statement best characterizes this blood test? -High sensitivity, low specificity -Low validity, high reliability -High specificity, low reliability -High sensitivity, low reliability
High sensitivity, low specificity A large number of clients would receive the correct positive diagnosis (high sensitivity), while a significant number would receive a false-positive diagnosis (low specificity). The information given does not indicate low reliability or low validity.
Pathogenesis is the term used to describe the sequence of cellular and tissue events that occur from the time of first contact with an etiologic agent until the disease becomes evident. What is another way of defining pathogenesis? -How the disease process evolves -What sets the disease process in motion -Multiple factors that predispose a person to a particular disease -The causes of disease
How the disease process evolves The pathogenesis of a disease is the mechanism by which an etiologic factor causes the disease. Etiology is what sets the disease process in motion, or what causes the disease. Risk factors are multiple factors that predispose a person to a particular disease.
The parents of a child with spina bifida ask what caused the condition. Which factor would the nurse identify as the most likely etiologic factor in the child's history? -Insufficient maternal folic acid intake -Birth trauma during delivery -Neonatal infection -Domestic violence
Insufficient maternal folic acid intake Congenital defects may be caused by genetic influences or environmental factors such as a maternal infection, diet, drug use, or fetal position. The congenital defect called spina bifida is not caused by events following birth but develops while the infant is still in utero.
Despite using the same screening tools as previous years (which have been confirmed as highly valid, reliable, sensitive, and specific), the public health nurse notes an increase in the number of people in the population testing positive for type 2 diabetes this year. What action should the nurse take? -Investigate the population for factors that would cause an increase in the prevalence of diabetes. -Ask all people who tested positive to return to the screening clinic to be retested -Send all people who test positive to a laboratory for assessment using a different diagnostic test -Examine the commonalities of those people who did not test positive for diabetes
Investigate the population for factors that would cause an increase in the prevalence of diabetes. Since the validity, reliability, sensitivity, and specificity of the test has been confirmed, the reason for the increase in prevalence should be investigated. Repeating the same test on the same people would be a measure of reliability; this has already been established. Sending the people for laboratory testing would only be needed if validity was in question. Examining the commonalities of those who did not test positive is not the priority compared to investigating the commonalities of those who did test positive.
Which attribute is a benefit of health care providers using an evidence-based practice guideline? -It directs research into forming a diagnosis and treatment for a certain condition. -Once a practice guideline is well developed, it does not require modification. -It uses one research method for delivery of care. -With continued use, it will decrease healing time for clients.
It directs research into forming a diagnosis and treatment for a certain condition. Evidence-based practice guidelines often use methods to combine evidence from different studies to produce a more precise estimate of the accuracy of a diagnostic method or the effects of an intervention method. Practice guidelines require continuous updates as new research is conducted and supported. Practice guidelines are developed on numerous research studies. Not all research is directed toward healing time.
The nurse is caring for a client in the burn unit who has sustained partial and full thickness burns over 16 percent of the body. What type of etiologic factor does the nurse recognize these burns are? -Physical forces -Biologic agents -Chemical agents -Psychological factors
Physical forces The causes of disease are known as etiologic factors. Among the recognized etiologic agents are biologic agents (e.g., bacteria, viruses), physical forces (eg., trauma, burns, radiation), chemical agents (e.g., poisons, alcohol), one's genetic inheritance, and nutritional excess or defects.
The nurse is providing a prenatal class for a group of women at the local women's center. The nurse informs the group about the importance of taking their folic acid supplements for the prevention of neural tube defects. What type of prevention is the nurse providing? -Primary prevention -Secondary prevention -Tertiary prevention -Initial prevention
Primary prevention Primary prevention is directed at keeping disease from occurring by removing all risk factors. Examples of primary prevention include the administration of folic acid to pregnant women and women who may become pregnant to prevent fetal neural tube defects; giving immunizations to children to prevent communicable disease; and counseling people to adopt healthy lifestyles as a means of preventing heart disease. Primary prevention is often accomplished outside the health care system at the community level. Some primary prevention measures are mandated by law.
When a client's temperature is taken with a faulty electronic thermometer, which diagnostic component should be questioned? -Reliability -Specificity -Validity -Predictability
Reliability Reliability refers to the extent to which an observation, if repeated, gives the same result. A faulty electronic thermometer may give inconsistent measurements of temperature, either too high or too low. Predictive value is the extent to which an observation or test result is able to predict the presence of a given disease or condition. Specificity refers to the proportion of people without the disease who are negative on a given test or observation. Validity refers to the extent to which a measurement tool measures what it is intended to measure, and is assessed by comparing a measurement method with the best possible method of measure that is available.
The nurse documents which assessment data as a symptom? -Report of pain -Elevated temperature -Pinpoint pupil size -Enlarged lymph node
Report of pain A symptom is a subjective complaint that is noted by the person with a disorder, whereas a sign is a manifestation that is noted by an observer. A report of pain is a symptom, which is a subjective complaint. Temperature, pupil size, and lymph node enlargement are signs that can be observed by another person.
There are three fundamental types of prevention used in health care: primary, secondary, and tertiary. Which statement accurately describes secondary prevention? -Secondary prevention detects disease early, and most is done in clinical settings. -Secondary prevention goes beyond treating the problem with which the person presents. -Secondary prevention is often accomplished outside the health care system at the community level. -Secondary prevention takes place within health care systems and involves the services of a number of different types of health care professionals.
Secondary prevention detects disease early, and most is done in clinical settings. Secondary prevention detects disease early in its course when it is still asymptomatic and treatment measures can effect a cure or stop the disease from progressing. Most secondary prevention is undertaken in clinical settings. Tertiary prevention goes beyond treating the presenting problem. Tertiary prevention programs are located within health care systems and involve the services of a number of different types of health care professionals. Primary prevention is often accomplished outside the health care system at the community level.
A client has been admitted to the intensive care unit with a myocardial infarction. After the client recovers from the acute course of the event and ready for discharge, the nurse provides information about the beta adrenergic blocker, atenolol, that the client will take to prevent complications after the MI. What type of prevention is the nurse providing? -Primary prevention -Secondary prevention -Tertiary prevention -Initial prevention
Tertiary prevention Tertiary prevention is directed at clinical interventions that prevent further deterioration or reduce the complications of a disease once it has been diagnosed. An example is the use of beta adrenergic drugs to reduce the risk of death in people who have had a heart attack. The boundaries of tertiary prevention go beyond treating the problem with which the person presents.
Which statement is an example of a prognosis? -The client's chance of a full recovery is 50%. -The leading cause of death is cancer -Pressure ulcers occur in 2 percent of hospitalized clients -Folic acid during pregnancy may prevent neural tube defects
The client's chance of a full recovery is 50%. A prognosis refers to the probable outcome and prospect of recovery from disease as demonstrated by "The client's chance of a full recovery is 50%." Stating the ocurrence of a disease in a given population is the incidence. Statements that relate information about causes of death refer to mortality.
A client with risk factors associated with human immunodeficiency virus (HIV) has a positive enzyme-linked immunosorbent assay (ELISA) test followed by a negative Western blot test. Which interpretation of these results by the client indicates a need for more teaching? -The specificity for the Western blot lab is a true negative result. -The lab must have contaminated the specimen. -The positive ELISA result is likely false. -There is no need to worry about being infected with HIV.
The lab must have contaminated the specimen. A laboratory test such as the ELISA test for HIV is known to give some false positive results. Therefore, a positive ELISA test is followed with a Western blot test. If the Western blot shows negative, the specificity of the test indicates a true negative result. The client does not have HIV.
The nurse is performing an assessment on a newly admitted client with asthma and hears wheezes in the upper lobes of the lungs. When the nurse documents this finding, the nurse recognize this to be: -a sign -an objective symptom -a diagnosis -a complication
a sign A sign is a manifestation that is noted by the observer, in this case the nurse auscultating the breath sounds. A symptom is a subjective report by the client. A diagnosis is not formed by the nurse auscultating lung sounds, as wheezes can be a manifestation of other illnesses. A complication is a possible adverse extension of a disease or outcomes from treatment.
A client has died and the nurse is responsible for filling out the death certificate. In performing this task, the nurse is required to record the client's age, sex, and cause of death, among other factors. What is the purpose of reporting these statistics? -These statistics are recorded so pharmaceutical companies may compile the data to determine future need. -The government requires the statistics in order to calculate the crude mortality rate. -These statistics are useful in terms of anticipating health care needs, planning public-education programs, directing health research efforts, and allocating health care dollars. -These statistics are required by the hospital to inform the WHO for the coding of the cause of death.
These statistics are useful in terms of anticipating health care needs, planning public-education programs, directing health research efforts, and allocating health care dollars. Mortality statistics are very useful in predicting the needs of clients with similar symptoms, as well as planning future therapeutic interventions. Crude mortality rate does not require these factors. The International Classification of Diseases (ICD) by the WHO is used for coding the cause of death but is not required by the WHO.
When the nurse questions the blood glucose level obtained via a glucometer, a serum blood level is ordered. This protocol is directed toward ensuring which measure of standardization? -Validity -Standardization -Reliability -Predictability
Validity Validity refers to the extent to which a measurement tool measures what it is intended to measure, and is assessed by comparing a measurement method with the best possible method of measure that is available. Thus, the validity of a fingerstick method of testing blood glucose is compared with serum testing in the laboratory. Reliability refers to the extent to which an observation, if repeated, gives the same result. Predictive value is the extent to which an observation or test result is able to predict the presence of a given disease or condition. In the field of clinical laboratory measurements, standardization is aimed at increasing the accuracy and reliability of measured values.
Facility policies on wound dressing selection refer the nurse to a dressing algorithm. The nurse anticipates that the algorithm will include: -a step-by-step decision-making tree for dressing selection. -a pictorial representation of various dressings -standing orders for wound care -guidelines for staging pressure ulcers
a step-by-step decision-making tree for dressing selection. Algorithms are step-by-step methods for solving problems. An example would be a decision tree for selection of wound care dressings based on type of wound.
In 2014, an outbreak of Ebola virus disease began in West Africa in which there was a sharp increase in the number of people being diagnosed with this disease. At the same time, a very high proportion of those who were diagnosed died from the disease. The epidemiologic characteristics of this disease include: -increased incidence and high mortality. -high prevalence and increased incidence -high morbidity and mortality -increased morbidity and high prevalence
increased incidence and high mortality. Incidence is the rate of new cases of a disease and mortality is the death rate associated with it; Ebola is associated with high incidence and mortality. Morbidity consists of the functional effects of a disease and prevalence is the proportion of the population currently living with a disease.