Chapter 4 Health Promotion and Risk Reduction

17 of 23 A young couple is searching for a home in a new neighborhood. Which of the following neighborhoods would most likely promote a healthy lifestyle? a. One near a large active military base b. One with excellent health facilities nearby c. One with high walkability d. One with superb recreational facilities

One with high walkability One's environment is a significant factor. Those living in neighborhoods with high walkability engage in significantly more walking than those living in neighborhoods with low walkability. Having health and recreational facilities in the neighborhood can assist with health, but the family would need to be able to afford to purchase services at these businesses. Having a large active military base nearby would not play a major role related to the healthy lifestyle in the neighborhood.

19 of 23 A nurse is using Pender's model to explain what influences individuals to pursue health promotion activities. Which of the following factors would be examined? (Select all that apply.) a. A belief that one can change one's behaviors b. Environmental choices possible c. Fear of negative consequences if action is not taken d. The rewards one believes will result if action is taken e. The threat of an early death if behavior is not changed f. What one's family and peers believe should be done

a. A belief that one can change one's behaviors b. Environmental choices possible d. The rewards one believes will result if action is taken f. What one's family and peers believe should be done Fear and threat are not aspects of Pender's model. Although fear may cause an initial attempt at change, fear is not a long-term motivator for ongoing action. Pender does include perceived benefits, perceived self-efficacy, interpersonal influences, and available situational (environmental) options as factors that motivate persons to engage in health actions.

21 of 23 A nurse was becoming frustrated. It had been 2 weeks, and although the client had verbalized that the best time of day to take a 15-minute walk was early in the morning, the client had not begun to exercise. Which of the following principles of the Transtheoretical Model had the nurse forgotten? (Select all that apply.) a. A decision to act always occurs before action begins. b. Behavior change is difficult and takes time. c. Continuing to stress to the client how important exercise is will help the client decide to exercise. d. Discussing with the client why he or she is not yet exercising may help the client recognize his or her own resistance. e. The nurse should offer some reward if the person exercises for at least a week. f. Verbalizing compassion for how difficult it is to change is a crucial intervention.

a. A decision to act always occurs before action begins. b. Behavior change is difficult and takes time. The Transtheoretical Model is based on the assumption that behavior change takes place over time, progressing through a sequence of stages. The fact that the person had stated the best time to exercise demonstrates the client has moved through precontemplation and contemplation and is preparing to act. The nurse is being rather optimistic in thinking change will occur within 2 weeks. Although being compassionate is helpful, it is not a crucial step in the beginning of the process. Personal resistance to change is probably obvious and does not need further discussion as the patient has moved beyond the stage of analyzing pros and cons to the change.

of 23 Which of the following is the best definition of health? a. A goal and a resource for living b. A lack of disease or illness c. Complete state of well-being d. Freedom from pain or discomfort

a. A goal and a resource for living Health was originally defined as a lack of illness or disease. More recently, health has been defined as a state of complete physical, mental, and social well-being. Today, health's definition is based on the realization that health allows one to realize aspirations, to satisfy needs, and to change or cope with the environment. Health is a goal but also a resource for living.

18 of 23 Which of the following factors have a profound, if sometimes unrecognized, impact on one's health? (Select all that apply.) a. Adequate resources to allow easy access to health services b. Interpersonal relationships with family and friends c. Local, state, and national policies d. Number and quality of health care providers within transportation range e. Physical neighborhood where one works and lives f. Understanding the need for healthy lifestyle choices

a. Adequate resources to allow easy access to health services b. Interpersonal relationships with family and friends c. Local, state, and national policies e. Physical neighborhood where one works and lives Health is affected by biology. Behaviors, social environment, physical environment, policies, and access to quality health care are all factors that affect health. The number and quality of health care providers is not relevant if one does not have access to them because of lack of insurance or financial resources. Understanding the need for healthy lifestyle choices is important, but knowledge alone is not adequate to change behavior.

6 of 23 A nurse is using the theory of reasoned action when working with a client to exercise on a regular basis. Which of the following would be the easiest way for the nurse to determine if the client will engage in this activity? a. The client's intention to exercise regularly b. The client's perception of the threat of illness if he doesn't exercise regularly c. Society's emphasis on the importance of regular exercise d. The pros and cons of regular exercise

a. The client's intention to exercise regularly The theory of reasoned action attempts to predict a person's intention to perform or not perform a certain behavior based on the assumption that all behavior is determined by one's behavioral intention. The client's perception of the threat of illness, the opinion of society, and benefits of regular exercise are not major factors discussed using the theory of reasoned action.

8 of 23 Some people believe that the air within their workplace makes them ill. Which of the following premises support this belief? a. They consistently feel worse on workdays and weeks without holidays. b. There has been media coverage of "sick buildings" where there is very little air exchange with fresh air outside. c. Research has demonstrated that some buildings emit poisonous vapors that make anyone who works there ill. d. When a small group of persons begins to believe something, the others in the larger group begin to believe it as well.

a. They consistently feel worse on workdays and weeks without holidays. As the question discusses risk, the textbook states that the risk factor must precede the problem and that the problem would increase with exposure. Feeling ill only on workdays would imply that some factor in the workplace is responsible. The media coverage, research related to poisonous vapors, and "group think" responses do not address the fact that the repeated exposure to the risk factor may be what is making them ill.

9 of 23 It is rumored that there is something in the workplace that is causing persons employed there to feel ill. Which of the following actions would be most appropriate for the nurse to take? a. Ask researchers to set up a study to confirm the health hazard in the environment b. Assess the risk, including identifying any toxic substance c. Confirm the extent to which the illness resulted from intergroup agreement on the illness and cause d. Insist that the media not further spread stories of possible sick buildings until the truth of the situation can be studied

b. Assess the risk, including identifying any toxic substance The media report news; they do not create it without any basis. Researchers are not asked to confirm a preconceived conclusion but to seek what factors are active in a situation. "Group think" is a well-known phenomenon, but one would have to ask what led the communication leaders to believe originally that there was a hazard in the environment. Risk assessment in a questionable situation begins with identifying a possible hazard and describing the risk.

22 of 23 Which of the following actions have been effective in reducing problems related to alcohol use? (Select all that apply.) a. Abstinence education programs in elementary schools b. Enforcement of ban on sales of alcohol to minors c. Increased taxes on alcoholic beverages d. Media campaigns that show unpleasant behaviors such as vomiting after drinking e. Stringent laws on accurate labeling of alcoholic content in beverages f. Suggesting children be taught appropriate use of alcohol in the home

b. Enforcement of ban on sales of alcohol to minors c. Increased taxes on alcoholic beverages The prevalence of underage drinking declined significantly when states enacted the minimum legal drinking age of 21 years. The states with more stringent drinking laws have a lower prevalence of binge drinking. Enforcement of the legal drinking age, as well as enforcement of bans on sales of alcohol to minors, helps prevent underage drinking, as have increased excise taxes on alcoholic beverages.

10 of 23 Which of the following risk factors are least subject to modification? a. Choice of lifestyle behaviors b. Environmental exposure c. Nutritional options d. Recreational activities

b. Environmental exposure An individual may choose to control lifestyle behaviors, nutrition choices, and recreational options. An individual cannot alone control his or her neighborhood, employment setting, or other environmental exposures.

15 of 23 Which of the following best describes the reason why so many Americans are obese? a. Culture requires eating at celebrations and holidays. b. For many people, caloric intake is more than needed for their physical activity. c. Physical education is no longer a required subject in most elementary and secondary schools. d. The expected portion size in restaurants has vastly increased over time.

b. For many people, caloric intake is more than needed for their physical activity. Although many factors have led to obesity in American society—including cultural pressure, increased portion sizes in restaurants (portion distortion), offers of more food at a reduced price ("super-size"), and a perceived lack of time to cook nutritious inexpensive foods—the primary cause remains the consumption of more calories than needed for physical activity. With computers and television as recreational choices, Americans are as a group sedentary rather than physically active.

1 of 23 A nurse reviewed information before meeting with the community residents who were attending a program on healthful living. Which of the following best describes the action by the nurse? a. Disease prevention b. Health promotion c. Health improvement d. Specific protection

b. Health promotion Health promotion is any combination of health education and related support for health behaviors. It is not specific protection or disease prevention because no specific disease is being avoided. Although healthful living may indeed improve health, there is nothing to suggest the attendees were not currently healthy.

4 of 23 A nurse was becoming frustrated. She had given her client extensive information on his health problem, but the client continued to be noncompliant in making needed changes. Which of the following principles had the nurse forgotten? a. A person may have a higher priority than improving his or her health. b. Information, while necessary, will not motivate people to change. c. People need repetition over time to be able to absorb information. d. Physicians, not nurses, are perceived as experts in health.

b. Information, while necessary, will not motivate people to change. Information alone is rarely enough to motivate a person to act. Information is necessary to know what to do and how to do it before the person chooses to act, but other factors are primarily responsible for motivating people to change their behavior. Although other priorities may result in delay of change, the fact that the client has returned to the nurse demonstrates interest in changing. Repetition may be helpful, but apparently the nurse has given information on more than one occasion because she believes extensive information has been given.

14 of 23 During a health history, the client looked confused and said, "But everybody drinks, like at parties and such. How much drinking do you think is too much?" Which of the following would be most appropriate response by the nurse? a. "Alcohol should be used only in moderation." b. "It's okay as long as you don't binge, and you eat food with your drinks." c. "Per day, no more than one drink for women and two drinks for men." d. "Total abstinence is the only healthy choice."

c. "Per day, no more than one drink for women and two drinks for men." Because most Americans drink alcohol, it is probably not effective to teach total abstinence. Alcohol in moderation is not a specific answer to the client's question. The Dietary Guidelines for Americans suggest no more than one drink for women and two drinks for men per day, which is a specific response to the client's question.

20 of 23 A nurse is using the health belief model to help a client improve lifestyle choices. Which of the following interventions would the nurse most likely implement? (Select all that apply.) a. Conduct an ongoing public information campaign to motivate people to take action b. Emphasize how important it is to change behavior immediately c. Examine the individual's perceptions of his or her health in relation to current lifestyle behavior choices d. Review how lifestyle changes can reduce risk and improve the client's life e. Share statistics regarding the probability of health problems and their seriousness if action is not taken f. Use communication channels to send reminders of action currently needed

c. Examine the individual's perceptions of his or her health in relation to current lifestyle behavior choices d. Review how lifestyle changes can reduce risk and improve the client's life e. Share statistics regarding the probability of health problems and their seriousness if action is not taken f. Use communication channels to send reminders of action currently needed An effective way to evoke action begins with examining the individual's perceptions of his or her health and current lifestyle choices so education to change perceptions can occur. Sharing information regarding the probability of illness or perceived susceptibility and using communication channels to serve as cues to action may both be motivating. Similarly, reviewing how lifestyle changes can reduce risk and improve life may change the person's perception of the benefits of acting. Unfortunately, although people have to know what to do and how to do it before they can take action, information alone will not motivate people to act. Continued harassment, as in emphasizing how important it is for people to act, also is not motivating.

2 of 23 A 50-year-old woman comes to the clinic for her first mammogram. Which of the following best describes the action of this client? a. Disease prevention b. Health improvement c. Health protection d. Primary health promotion

c. Health protection Health protection is used to detect disease in its early state or maximize health within the constraints of disease. Unfortunately, screening will not prevent disease. Screenings are a secondary health promotion—not a primary health promotion.

23 of 23 A nurse asks a client how she has been sleeping. Which of the following best describes the rationale behind this question? (Select all that apply.) a. Accidents and injury may occur with the sleep-deprived client at fault. b. Interventions for sleep problems are primarily common sense. c. Many adults report sleep problems or occasional lack of sleep. d. Many important functions occur during sleep. e. Nurses can determine whether the patient has a sleep disorder. f. A sleep assessment is easy and inexpensive to complete.

c. Many adults report sleep problems or occasional lack of sleep. d. Many important functions occur during sleep. Almost three-fourths of all adults report having a sleep problem at least once a week, yet sleep is an essential component of chronic disease prevention and health promotion. Many important functions occur while we sleep, such as release of hormones, memory consolidation, and decrease in blood pressure.

7 of 23 A nurse is using the theory of planned behavior when working with a client to change her behavior and improve her health. Which of the following considerations should be made by the nurse? a. If environmental limitations may prevent the person from acting b. The availability of needed environmental supports for the client c. The client's belief about factors that may facilitate or impede the behavior d. If the suggested behavior is actually the most effective approach

c. The client's belief about factors that may facilitate or impede the behavior The theory of planned behavior stresses that perceived control is a major factor in whether or not the client performs the behavior. Thus, the nurse needs to understand the client's beliefs about factors that may facilitate or impede the behaviors. Using this theory, the environment is not considered as a major factor in client change, nor is the analysis as to if the behavior is the most effective approach.

11 of 23 Which of the following best describes why risk reduction is of such importance in the United States today? a. Families suffer when family members die from avoidable causes. b. Risk reduction activities will decrease insurance costs to individuals and their employers. c. The leading causes of death are all related to lifestyle choices. d. Risk reduction can decrease the ongoing rise in national health care expenditures.

c. The leading causes of death are all related to lifestyle choices. Approximately 50% of annual U.S. deaths occur as a result of modifiable lifestyle factors. The leading causes of death with the highest mortality are all related to lifestyle factors. A change in these factors will also reduce health care expenditures and insurance costs for those persons with insurance. However, unnecessary deaths are even more important.

16 of 23 Based on statistics, which of the following groups is probably more physically active? a. A group of adults living in the southern U.S. states b. A group of elderly mall walkers c. A group of high school graduates employed in blue collar occupations d. A group of highly paid college graduates

d. A group of highly paid college graduates Research has shown that those with higher levels of education and higher income enjoy physical activity more. Those of mature age, with less education, with less income, and/or living in the southern U.S. states engage in far less activity.

5 of 23 The nurse working with a client to change behavior to maximize health asked the client to bring his family to the next visit. Which of the following best describes why the nurse wants the family to come with the client? a. To analyze the family's beliefs about health b. To determine the family's support of the client c. To establish the family's communication patterns d. To evaluate the family's approval of the proposed changes

d. To evaluate the family's approval of the proposed changes Under the Theory of Reasoned Action, it is assumed that all behavior is determined by intentions, which are determined by attitude toward the behavior and the norms associated with the behavior. That in turn is determined by whether or not important persons approve or disapprove of the behavior. The family's beliefs about health, support of the client, and communication patterns are irrelevant if the family does not approve of the changes that have been proposed.

12 of 23 Which of the following is the cause of most preventable deaths in the United States? a. Alcohol b. Drug addictions c. Sexually transmitted diseases d. Tobacco

d. Tobacco Smoking is the leading cause of preventable deaths, accounting for about one out of every five deaths.

13 of 23 A nurse is completing a health history with a client. Which of the following questions would be most important to include? a. How many alcoholic drinks do you have in a day? b. How many sexual partners have you had in the past month? c. What nonprescription drugs do you take on a routine basis? d. What kinds of tobacco do you use daily?

d. What kinds of tobacco do you use daily? As smoking is the leading cause of preventable deaths, accounting for about one out of every five deaths, it is crucial that tobacco use be queried in each health history. After asking about tobacco use, the others should also be included in a health history.