Chapter 4: Health Promotion and Risk Reduction

Health People 2020 (HP 2020) is a guidepost for nurses and interdisciplinary teams in community and public health. New focal areas for HP 2020 include: (Select all that apply.) A. Adolescent health B. Diabetes C. Genomics D. Nutrition and weight status E. Social determinants of health

A. Adolescent health C. Genomics E. Social determinants of health Ten new focal areas were added to HP 2020, beyond those included in HP 2010. These include the following: adolescent health; blood disorders and blood safety; dementias, including Alzheimer disease; early and middle childhood; genomics; global health; healthcare-associated infections; health-related quality of life and well-being; lesbian, gay, bisexual, and transgender health; older adults; preparedness; sleep health; and social determinants of health. Diabetes and nutrition and weight status were focal areas that were already included in HP 2010.

A 34-year-old client is recovering from a below-the-knee amputation secondary to a motor vehicle accident. The nurse meets with the client to update his care plan, and client states that he knows that he will walk again. He asks for physical therapy schedules and timelines for prosthetics on the basis of his healing process. On the basis of knowledge of the theory of reasoned action, the client's behavior reflects: A. An enhanced ability to meet his goals on the basis of his intention and behaviors B. Goal setting that is unrealistic and irrational based on the client's diagnosis and behaviors C. A depression that will complicate the healing process D. Denial of the injury and part of the healing process

A. An enhanced ability to meet his goals on the basis of his intention and behaviors The theory of reasoned action states that a person's given behavior is primarily determined by his or her intention to perform that behavior (Fishbein & Ajzen, 1975). This intention is determined by the person's attitude toward the behavior (beliefs about the outcomes of the behavior and the value of these outcomes) and the influence of the person's societal environment or subjective norm (beliefs about what others think the person should do). The ability to perform the behavior (a belief that it can be done) is the critical aspect of the change process. The other answers do not reflect the theory of reasoned action.

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

A. Decreased cholesterol levels B. Delayed degenerative changes D. Improved overall muscle strength 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.

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.

A. Demonstrate a dressing change and allow the patient to practice. 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.

A 19-year-old client is diagnosed as HIV positive. Which behaviors might be indicators of noncompliance with her drug regimen and require further assessment? (Select all that apply.) A. Depression B. Indifference to self-advocacy in sexual relationships C. Goal-oriented attitude toward treatment plan D. Client's expression of concern for the health and well-being of her children E. Client's expression of concern regarding the ability to pay for her medications

A. Depression B. Indifference to self-advocacy in sexual relationships E. Client's expression of concern regarding the ability to pay for her medications In women, there is a relationship between poor self-image, depression, and lack of self-advocacy in sexual relationships (DeMarco, Johnsen, Fukuda, & Deffenbaugh, 2001). From a treatment perspective, depressive symptoms are underdiagnosed and are associated with lower medication adherence, risky behaviors, and poor health outcomes (Sanzero et al., 2005). Goal orientation toward the treatment plan and expressions of concern for her children would tend to indicate compliance, not noncompliance, with her drug regimen.

Absenteeism due to illness has increased recently in the local middle school. The increase is noted to be related to exacerbation of asthma symptoms in the student population. Which would be the most effective approach in decreasing absenteeism among this population? A. Develop an asthma education and surveillance program that addresses students, families, and faculty members. B. Develop a policy to exclude students with a diagnosis of asthma from admission to the school. C. Create an asthma prevention plan within the school environment, based in the school nurse's office. D. Create an education program for faculty related to the prevention of exacerbation of asthma systems.

A. Develop an asthma education and surveillance program that addresses students, families, and faculty members. Community health nurses are focused specifically on modifiable risks of acquiring disease. This requires nurses to analyze trends in risk surveillance data and consider the physical, emotional, and psychosocial challenges people face when confronting disease, physical stressors, and the possibility of premature death. Public health science uses in-depth processes of data collection across the natural history of disease to define trends, and in this way assists nurses and other public health officials in prioritizing the steps needed to minimize risk and improve the quality of care in populations. Only the development of a program that addresses students, families, and faculty members and that takes into account surveillance data is in-depth enough to be effective. The other options do not reflect public health science or approach the problem in a holistic manner.

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?

A. Do residents believe that they have ready access to health promotion resources? 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.

The nurse decided to use a learning model based on Skinner with a client with diabetes to improve compliance with dietary and blood glucose assessment requirements. Which would be the best way to implement this program? A. Give rewards for a lower blood sugar level and a food diary that reflects moderate dietary compliance. B. Eliminate the reward and punish the client when she fails to comply with dietary guidelines. C. Demonstrate positive reinforcement by decreasing dietary guidelines and blood sugar parameters. D. Institute a strict timeline to accomplish goals.

A. Give rewards for a lower blood sugar level and a food diary that reflects moderate dietary compliance. According to Skinner (1953), health behaviors are seen as incremental steps toward a final goal. In the learning model, the nurse establishes and reinforces a goal and rewards the client for partial accomplishment, if necessary. Incremental increases are then made as the pattern of behavior is shaped toward a specific goal. Reinforcement is used to motivate the client to either continue or discontinue a behavior. Giving rewards for a lower blood sugar level and a food diary that reflects moderate dietary compliance is the best example of implementing a learning model of behavior change. Punishment and enforcing a strict timeline do not provide positive reinforcement and thus are not good examples of the learning model. Lowering the requirements of the goal is also not a good example of this model, as the goal should not change.

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

A. Good nutrition 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 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

A. Health-promotion needs of the group 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.

Secondary HIV prevention or positive prevention is used when caring for African-American women living with HIV by addressing which behavioral risks? (Select all that apply.) A. Interpersonal mistrust B. Alcoholism C. Poor adherence to treatment D. Smoking E. Compromised self-advocacy in sexual relationships

A. Interpersonal mistrust C. Poor adherence to treatment E. Compromised self-advocacy in sexual relationships Advancing the scientific understanding of secondary HIV prevention (what is called positive prevention) in African-American women by exploring ways to address behavioral risk reduction prevents further transmission of HIV and the serious negative psychological consequences of living with HIV disease. African-American women experience disproportionate levels of (1) interpersonal mistrust and fear of disclosure related to perceived stigma, (2) poor adherence to treatment and other health promotion and disease prevention efforts, (3) delay in seeking care related to mental health comorbidities and addiction recovery issues, and (4) compromised self-advocacy in sexual relationships. Alcoholism and smoking are not behavioral risks associated with African-American women living with HIV.

The nurse works in a facility that provides hospice care for clients with cancer diagnoses. The nurse recognizes that the care provided in this facility is tertiary in nature. The nurse develops a plan for the clients that would include the tenets of tertiary prevention. The plan would include: (Select all that apply.) A. Palliative care B. Pain control C. Isolation D. Supportive spiritual development E. Diminished involvement of significant others

A. Palliative care B. Pain control D. Supportive spiritual development Tertiary prevention includes rehabilitation and palliative care. Nurses providing this level of care assess disease progression, watch for opportunistic infections, and control pain or other side effects of treatment. Care also includes supporting life choices that bring emotional comfort to clients such as family involvement, decreased isolation, supportive spiritual development, and organized help from communities. Isolation and diminished involvement of significant others do not enhance the client's health and well-being and are not examples of tertiary prevention.

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.

A. Prevention is emphasized as the link between personal behavior and health. 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.

The local clinic is dedicated to the well adult and child. It has evening hours and offers varied programs for the community. The programs include immunizations and classes on fire safety, health education, and car safety, to name a few. How would the nurse explain the level of prevention used in this setting to your colleagues? A. Primary B. Secondary C. Tertiary D. Quaternary

A. Primary When an individual person or a group is considered in good health and shows no signs or symptoms of disease or physical challenges, nurses in interdisciplinary teams and community partnerships are involved in primary prevention. Secondary prevention is a planned effort to minimize the impact of disease and injury once it is realized. Tertiary prevention is the long-term management and treatment of clients with chronic conditions. Quaternary prevention is fabricated.

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 hospital's diabetic educator. B. he patient sets aside a dessert brought in by a family member. C. The patient wants a family member to meet with the dietitian to discuss meals. D. The patient readily allows the nurse to measure his blood glucose level.

A. The patient requests a visit from the hospital's diabetic educator. 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 decides to use the health belief model for a wellness walking program for older adults. The walk is to begin each day at 8 PM. Each day a different participant is to start a chain of phone calls to other participants to remind all to attend. The nurse informs the clients in the clinic that walking will improve their overall health and well-being. Two older adults show up the first night and none the second. Which information should the nurse gather to explain the failure of the program? (Select all that apply.) A. The severity of the physical challenge related to the client population B. What stands in the way of taking action toward the goal of health promotion C. The presence or absence of cues needed for the program to achieve success D. The presence or absence of a strong team leader among the participants E. The need to increase persuasion when implementing the program

A. The severity of the physical challenge related to the client population B. What stands in the way of taking action toward the goal of health promotion C. The presence or absence of cues needed for the program to achieve success The health belief model, developed by Hochbaum (1956) and Rosenstock (1974), specifies that individual, family, or community health-related behavior depends on (1) the severity of the potential illness or physical challenge, (2) the level of conceivable susceptibility, (3) the benefits of taking preventive action, and (4) what stands in the way of taking action toward the goal of health promotion. This model uses cues as an important way to remind people of healthy behaviors and to promote these actions. A strong team leader and persuasion are not integral parts of the health belief model.

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.

A. The women demonstrate an understanding of the importance of a healthy diet. 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 woman arrives at the clinic for a routine appointment. She has been HIV positive for 3 years and states she is doing well. She currently is involved in a relationship with a man who is HIV positive. She states that she is not consistent with safe sex practices due to her significant other's preferences and feels uncomfortable asking him to wear a condom. Which is the nurse's best response to promote the client's health? A. "You won't become pregnant as long as you are taking your drug cocktail." B. "You will not be protected against other strains of HIV or sexually transmitted infections (STIs)." C. "You will both be safe because you both already have HIV." D. "Let's have you both tested for STIs."

B. "You will not be protected against other strains of HIV or sexually transmitted infections (STIs)." Although both the woman and her partner are already HIV positive, they can still transmit different strains of HIV to each other, as well as other STIs and can then go on to infect others. Thus, they are not "safe" and the woman should be encouraged to advocate for herself by insisting that her partner wear a condom. The client's drug cocktail will not prevent her from becoming pregnant from unprotected sex. Testing for STIs for the woman and her partner may be appropriate, but not until the client is made to understand the importance of protected sex.

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

B. A family planning clinic at a community center 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 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

B. A large, local workplace 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.

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

B. Costs of the prescribed regimen 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 27-year-old client comes from a background of physical and sexual abuse. Violence victimization continued with her partners until recently. She is currently in a support group for victims of abuse. The client's social background places her at risk for: (Select all that apply.) A. Increased safe sex behaviors B. Decreased safe sex behaviors C. Decreased risk for HIV/AIDS D. Increased risk for HIV/AIDS E. Increased risk of depression

B. Decreased safe sex behaviors D. Increased risk for HIV/AIDS E. Increased risk of depression Trauma such as child sexual abuse, intimate partner violence, adult sexual abuse, and victimization from exposure to violent environments contribute to behaviors associated with increased HIV risk and disease sequelae. Violence victimization increases depressive symptoms, decreases safe sex behaviors, increases the chance of becoming HIV seropositive, and increases the chances of acquiring and being treated for a sexually transmitted infection (STI) within a year's time (Laughon et al., 2007).

The nurse identifies the specific indicators and focal areas needed to establish immunization and well-child clinics in a low-income neighborhood. What actions are needed to meet the health outcomes of the project? A. Identify the need in the community for the clinic on the basis of subjective data. B. Develop a plan to meet the costs and promote the benefits of the project. C. Consider the identified neighborhood's need for healthcare compared with that of other low-income neighborhoods by interviewing the members of the neighborhood. D. Assume that the neighborhood will welcome the institution of a well-child and immunization clinic.

B. Develop a plan to meet the costs and promote the benefits of the project. Knowing how to address the need for change and the actual change at a personal, family, and community level must be based on science—evidence based on rigorous understanding of a problem. Specific actions that can best achieve positive health outcomes can then be determined. Consideration must be given to realistic viability of solutions, costs and benefits, and the degree to which individual people will accept these approaches. Developing a plan to meet the costs and promote the benefits of the project meets these criteria. The other answers are not evidence based.

An immigrant from Guatemala, age 47, is admitted to the coronary care unit with congestive heart failure. This is the fourth admission for this client, and the physician believes that the client's inability to adhere to his diet and medication regimen is the reason for his frequent admissions. The physician refers the client to the local community health nurse, on discharge from the hospital. Which would be most appropriate for the nurse to include in this client's plan of care? A. Insisting that the client adhere to his diet B. Developing culturally relevant and gender-sensitive interventions C. Teaching the family to adapt their cultural dietary plans to the client's diagnosis D. Assessing the client's financial needs and obtaining financial assistance as needed

B. Developing culturally relevant and gender-sensitive interventions The development of culturally relevant and gender-sensitive interventions that demonstrate positive outcomes in health and well-being is the focus of prevention efforts. Approaching individuals and groups about behavior change must incorporate knowledge of diverse client perspectives and include the use of counseling skills and motivational interviewing. To address behavior change using motivational interviewing, the motivation comes from the client and is not imposed by a clinician. The client needs to resolve ambivalence to change a behavior with autonomy. Persuasion on the part of the clinician only intensifies resistance. Thus, the nurse should not insist that the client adhere to his diet, which does not reflect the client's cultural needs as a Hispanic male. Teaching the family to adapt their cultural dietary plans to the client's diagnosis addresses only one of the client's needs. Assessing the client's financial needs and obtaining financial assistance is the role of the social worker, not the nurse.

The committee has established the need for a sick child clinic in an impoverished neighborhood. The demographic data have been collected, and the committee is ready to meet with a group of local businesspeople who are willing to support the project financially. The plan is for the committee and group to combine to facilitate the establishment of the clinic. Using a transtheoretical model, which level of readiness has the committee achieved? A. Contemplation B. Preparation C. Action D. Relapse

B. Preparation The stages in a transtheoretical model are as follows: precontemplation (no screening programs scheduled and no intention to schedule screening); contemplation (no screening programs scheduled but intent to start a program soon); preparation (no definite screening program but have taken steps to develop a program); action (developed a screening program and intent to sustain the program); maintenance (have had the program for some time and intend to continue); relapse (had a program, do not have a program currently, but intend to have one soon). The committees in this case are in the preparation stage, as they have taken steps to start the clinic but have not actually started it yet.

The nurse works at community clinic that provides various types of health screenings for members of the community. One day, the nurse provides tuberculin tests for a group of new hospital employees. Which type of screening procedure is this? A. Mass screening B. Selective screening C. Multiphasic screening D. Case finding

B. Selective screening Selective screening is performed for specific high-risk populations, such as tuberculin tests for hospital employees. Mass screening is performed on an entire population, such as blood lead level screening, Papanicolaou (Pap) smears, and phenylketonuria of newborns. Multiphasic screening involves a variety of screening tests applied to the same population on the same occasion, such as a series of tests performed on a single blood sample, periodic surveillance of drug therapy, and monitoring the stage of an illness. Case finding is a type of screening ordered by a clinician when searching for illness as part of a client's periodic health examination.

A nurse has planned a teaching-learning 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

B. Social and cultural patterns A patients social and cultural patterns must be appropriately incorporated into the teaching-learning interaction. Pretesting may or may not be used; patient awareness is a phrase that has many meanings, none of which make the teaching-learning interaction successful. Interventions are not measured; goals and outcomes are.

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.

B. Stress decreases immune function. 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.

Using the tenets of secondary prevention, the committee seeks to establish an HIV/AIDS clinic. The nurse states that it is important for the location of the clinic to be associated with the local hospital. The committee states that the cost of the clinic associated with the hospital is higher than one that is free standing. Which presents the best rationale for the nurse's suggestion? A. Third-party insurance will reimburse the clinic visits only if the clinic is attached to the hospital. B. The hospital can more easily implement programs of care for the clients. C. The hospital will cover the clients only if the clinic is approved by the hospital governance board. D. The hospital will have a vested interest in the success of the clinic.

B. The hospital can more easily implement programs of care for the clients. Clients diagnosed with HIV/AIDS need secondary prevention services. To screen effectively for the presence of this condition, a test should be backed by a healthcare infrastructure that can implement programs of care for people who have a verified risk of the disease or physical challenge. The other rationales for placement of the clinic are not based on the tenets of secondary prevention.

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

C. Determining the patients readiness to learn new information Assessment in the teaching learning process is directed toward the systematic collection of data about the person and family's 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.

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.

C. Directly observe the boy using his inhaler to give himself a dose. 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.

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

C. Discussing the importance of preventing sexually transmitted infections (STI) to a group of high school students 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.

The nurse conducts a class on the basics of nutrition to a group of obese adults. The nurse counsels the audience, telling them that they need to change their behaviors. By the end of the class, the nurse has lost the audience. To enhance audience participation and learning in the next class, the nurse should: A. Use consistent methods of persuasion B. Offer advice while the participants are passive C. Encourage the group to participate in the decision making D. Encourage the group to continue ambivalent behaviors

C. Encourage the group to participate in the decision making Motivational interviewing, which was developed by Rollnick and Miller (1995), is defined as a "directive, client-centered communication style for eliciting behavior change by helping clients/[groups] to explore and resolve ambivalence." To address behavior change using this method, the motivation comes from the client and is not imposed by a clinician. The client needs to resolve ambivalence to change a behavior with autonomy. Persuasion on the part of the clinician only intensifies resistance. The communication style is therefore one of directing the client to examine and resolve ambivalence. This method does not (1) argue with a group or community by insisting it has a problem that needs to change, (2) offer advice without actively encouraging group-identified choices, (3) give advice while the group is put in a passive role, (4) impose diagnostic labels, or (5) use coercive tactics.

Positive patient outcomes are the ultimate goal of nurse-patient interactions, regardless of the particular setting. Which of the following factors has the most direct influence on positive patient-care outcomes? A. Patient's age B. Patient's ethnic heritage C. Health education D. Outcome evaluation

C. Health education 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.

C. Health is a condition that enables people to function at their optimal potential. 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.

A 32-year-old African-American client is diagnosed with HIV. She is at her 6-month appointment following diagnosis and treatment. The client states that she has not revealed her diagnosis to her boyfriend because she is afraid that he will leave. She expresses feelings of anger because she must put her feelings and illness aside or be abandoned. The client's behaviors reflect: A. Denial of her disease process B. Noncompliance with her drug regimen C. Inability to advocate for herself D. Fear of financial insolvency

C. Inability to advocate for herself The concept of "silencing the self" has been used to explain how gender roles negatively influence self-advocacy behaviors in women. Women tend to silence their voice in relationships to maintain connections with others, even if that means they will subsequently suffer physically, psychologically, or socially. According to Jack (1991), women are reinforced culturally to (1) care for others' needs before their own, (2) abide by designated societal rules of behavior, (3) refrain from directly expressing their feelings and needs, and (4) outwardly maintain compliance, while feeling hostility inwardly, because of their silencing behaviors. Silencing the self is relevant to the proposed study because it is a concept that is identified and understood in the context of relationships with others, that is, a relational concept. There is no evidence that Carlene is denying her disease process, not complying with her drug regimen, or is fearful of financial insolvency.

Multiple family units in an underserved neighborhood have children who have not been vaccinated per health guidelines. The nurse researches the problem and establishes a well-child clinic within walking distance to the neighborhood. The clinic is poorly attended. Which would be the nurse's best action to revise the program and improve attendance to the clinic? A. Determine whether the location of the clinic is not conducive to attendance. B. Discuss the problem of attendance at the next community council meeting. C. Interview members of the neighborhood to determine why they do not use the clinic. D. Discuss the problem with the local minister and request him to discuss the clinic at the next prayer service.

C. Interview members of the neighborhood to determine why they do not use the clinic. Although the morbidity and mortality data reports are quantitative, it is important to understand that in most cases, perceptions of health or well-being on the part of individuals, families, and communities are subjective. The science of diagnosis and healthcare follow-up may be present, but it is the subjective perceptions of others that often determine a person's willingness to participate in health promotion initiatives. Interviewing members of the neighborhood to determine why they do not use the clinic is the only option that recognizes the need to perceive the subjective perceptions of the neighborhood.

A 43-year-old African-American client is HIV positive. She has a personal history of abuse, which ended when her husband died 2 years ago. When counseling the client about adherence to her treatment plan, the nurse finds her intelligent and goal oriented. In addition to her need for education and follow-up regarding her HIV diagnosis and treatment, which associated condition should the nurse most consider when caring for this client? A. Cardiac tamponade B. Chronic obstructive pulmonary disease C. Posttraumatic stress disorder D. Cirrhosis of the liver

C. Posttraumatic stress disorder When providing physical care to clients with HIV and working to decrease communicability using the ecological model, consider the client's mental health symptoms, severity/frequency of the effects from significant trauma, such as posttraumatic stress disorder, substance use and abuse, and addiction. Cardiac tamponade, chronic obstructive pulmonary disease, and cirrhosis of the liver are not typically associated with either HIV or a history of abuse.

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

D. A discussion and demonstration between the nurse and the patient 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 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

D. Before birth 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 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.

D. Make the information directly relevant to the patients condition. 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

D. Mrs. Griffin 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.

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.

D. Nurses have long-established credibility with the public. 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. Patient's expected lifespan B. Patient's gender C. Patient's occupation D. Patient's culture

D. Patient's culture 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.

A 47-year-old client and three members of his neighborhood have had their homes robbed and belongings scattered. The client contacts the police and, with their assistance, develops a neighborhood watch. The watch is organized and 24 families have been recruited to participate. The watch will be active throughout vacation months and as needed. This organization is representative of: A. Transtheoretical model B. Theory of reasoned action C. Social learning D. Relapse prevention model

D. Relapse prevention model The relapse prevention model has been used specifically with issues that relate to adherence. For example, communities interested in crime prevention may be aware that in certain months of the year there is an increase in violent crime. They would then create a community campaign to promote nonviolence by increasing law enforcement presence and improving faith-based support. Social learning/social cognitive theory is a behavior change approach affected by environmental influences, personal factors, and attributes of the behavior itself. The theory of reasoned action states that a person's given behavior is primarily determined by his or her intention to perform that behavior (Fishbein & Ajzen, 1975). The transtheoretical model, developed by Prochaska and DiClemente (1983), is a sequential approach to behavior change that involves timely readiness of the learner.

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

D. Risk for ineffective health maintenance related to nonadherence to therapeutic regimen 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.

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

D. Taking responsibility for oneself 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

D. To detect health problems at an early age so they can be treated promptly 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.

Which of the following statements best demonstrates a client's intention to start exercising on a regular basis? a. "I bought walking shoes and have scheduled a walk before breakfast each day." b. "I exercise when I can find someone to walk with." c. "I need to buy a treadmill or exercise bike so that I don't get fat." d. "I think exercising would reduce my stress and help my appearance."

a. "I bought walking shoes and have scheduled a walk before breakfast each day." The best indicator of whether a client is going to implement a health improvement plan is when the client has moved beyond contemplation and preparation or considering reasons they should engage in the behavior and actually takes action to initiate behavior change, such as buying exercise clothing and scheduling a time to engage in the action.

Which of the following services implemented by nurses would represent secondary prevention? a. A free diabetes screening held at the local shopping mall b. A post-heart attack exercise program at the local community college c. A "stay beautiful" program stressing safe exercises for pregnant moms d. An elementary school "don't smoke" campaign for students

a. A free diabetes screening held at the local shopping mall Screening, which is aimed at diagnosis and treatment of illness at an early stage, is secondary prevention. Secondary prevention establishes the earliest possible diagnosis and early treatment, even before symptoms are present, to prevent disease progression.

Which of the following has resulted from the Steps to a Healthier US program? (Select all that apply.) a. An increase in community-based chronic disease-prevention programs b. An increase in funding for health-promotion programs c. Improvements to include health and preventive practices in daily life d. Improvements in continuing education programs for health professionals e. An increase in availability of online interactive health risk appraisals f. An increase in tax deduction for participating in health-promotion programs

a. An increase in community-based chronic disease-prevention programs c. Improvements to include health and preventive practices in daily life The purpose of Steps to a Healthier US Initiative (2007) was to improve the lives of Americans through community-based chronic disease-prevention programs. Further progress has been made to weave health and preventive practices in all aspects of people's lives, including how they live, where they work, their ability to access clean water and safe food, and how they spend leisure time.

Models that assist clients, groups, and communities to redirect activities toward health and wellness: a. Behavior change models b. Ecologic model c. Health belief model d. Learning model

a. Behavior change models e.g., Social learning is behavior change model that considers environmental influences, personal factors, and behavior as key components to change; person must have self-efficacy.

Which of the following federal resources supply data that support the objectives and interventions described in Healthy People 2020? (Select all that apply.) a. Centers for Disease Control and Prevention (CDC) b. Dietary Guidelines for Americans c. National Health and Nutrition Examination Survey (NHANES) d. Healthfinder.gov e. National Health Care Survey (NHCS) f. U.S. Public Health Service Office of Disease Prevention and Health Promotion (ODPHP)

a. Centers for Disease Control and Prevention (CDC) c. National Health and Nutrition Examination Survey (NHANES) e. National Health Care Survey (NHCS) Numerous federal resources support the objectives and interventions related to Healthy People 2020 and are incorporated into each topic area. These data sources include the CDC, NHANES, and NHCS. The ODPHP coordinates the efforts of public and private sectors to reduce the risks of disease and promotes the nation's health. Links to various data sources can be found within the ODPHP website, but the role of the ODPHP is coordination of efforts to promote health, not data collection. The Dietary Guidelines for Americans and Healthfinder.gov provide information about interventions that can be used to address the Healthy People 2020 objectives.

A public health nurse was trying to persuade the largest employer in town to offer workplace health-promotion programs. Which arguments could the nurse offer as benefits of these programs? (Select all that apply.) a. Decreased absenteeism b. Decreased incidence of obesity c. Decreased use of insurance benefits d. Decreased accidents e. Decreased turnover f. Decreased commitment to self-improvement

a. Decreased absenteeism c. Decreased use of insurance benefits d. Decreased accidents e. Decreased turnover There are numerous positive outcomes for employer and employee participation in health-promotion activities. Incentives for employers include reduced rates of employee absenteeism because of improved health status, improved employee productivity, decreased use of medical insurance benefits and workers' compensation for illness and accidents, decreased employee turnover, fewer accidents, and decreased rates of premature morbidity and mortality. Workplace health-promotion programs may not decrease the incidence of obesity or decrease the commitment to self-improvement.

What efforts does the American Nurses Association (ANA) suggest all professional nurses should make? (Select all that apply.) a. Educate students that political options must conceptualize prevention as preferable to treatment in health care. b. Encourage partnerships with consumers and other professionals. c. Increase knowledge and skill in providing preventive services. d. Lobby for legislation to vastly increase sales tax on beer and liquor. e. Require health care providers to serve as role models of healthy lifestyles. f. Support requiring health insurance to pay for preventive health care.

a. Educate students that political options must conceptualize prevention as preferable to treatment in health care. b. Encourage partnerships with consumers and other professionals. c. Increase knowledge and skill in providing preventive services. f. Support requiring health insurance to pay for preventive health care. Box 18-1 lists various efforts that the ANA encourages. These include increasing nurses' knowledge and skill in providing preventive services, encouraging partnerships with consumers and other disciplines in promoting health, supporting health care legislation that holds health insurance plans accountable for preventive care, educating the public to promote the health of the population, and influencing local and national economic and political options toward reconceptualizing health care in preventive ways. The ANA does not support requiring specific actions by health care providers in their private life. Beer and liquor taxes are not discussed in the document.

A public health agency had enough funds to provide one more health-promotion program during the calendar year. In relation to nutrition and exercise, which of the following would be the best choice? a. Elementary school program for children to which parents are invited b. High school program for those who are involved in athletics c. Young adult programs provided at the YMCA d. Senior citizen programs offered during a free meal

a. Elementary school program for children to which parents are invited A healthy lifestyle is easier to maintain when healthful patterns of behavior are learned early in life. Therefore, learning healthy lifestyle behaviors at a young age yields more benefit in years of life.

According to the health-belief model, which factors influence whether a person will engage in a particular health-promoting behavior? a. Feeling susceptible to a severe disease b. Being told to do so by a significant other on a frequent basis c. Believing that high-income persons engage in such behavior d. Viewing posters emphasizing the behavior in an area that the person frequents

a. Feeling susceptible to a severe disease According to the health-belief model, people are motivated by the sense of personal susceptibility to a disease, as well as the perceived severity of a disease.

A quality, an ability to adapt to change, or a resource to help cope with challenges and processes of daily living: a. Health b. Reinforcement c. Modifiable risk d. Motivational interviewing

a. Health

Maximizing health and wellness through strategies that are set in place before illness or injury is present: a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Risk reduction

a. Primary prevention

A change model that is used primarily to assist people struggling with relapse and recovery from substance use: a. Relapse prevention model b. Transtheoretical model c. Behavior models d. Theory of reasoned action

a. Relapse prevention model Focuses on reducing barriers to promote healthy behaviors.

Which of the following is one of the goals of Healthy People 2020? a. Decreasing institutionalization and increasing community-based care services b. Achieving health equity, eliminating disparities, and improving the health of all groups c. Creating environments to improve the eating and exercise habits of all people d. Expanding the technology, resources, and medications used to treat chronic illness

b. Achieving health equity, eliminating disparities, and improving the health of all groups The goals of Healthy People 2020 are to achieve high-quality, longer lives free of preventable disease, disability, injury, and premature death; to achieve health equity, eliminate disparities, and improve the health of all groups; to create social and physical environments that promote good health for all people; and to promote quality of life, health development, and health behaviors across all life stages.

A nurse is planning a community-wide program about reducing the risk of developing cardiovascular disease. Which of the following actions should the nurse take first? a. Developing a public education campaign by using public service announcements b. Assessing the extent of the problem in the local community c. Forming partnerships and establishing support with community agencies d. Gathering resource materials and identifying funding sources

b. Assessing the extent of the problem in the local community Assessment is always the first step in the nursing process; it is needed to determine the focus of the community program.

A nurse used a lifestyle assessment to measure health-promoting lifestyle behaviors of participants at a meeting. Which of the following actions should the nurse take when reviewing the results with each individual? a. Arrange for the client to meet with a lifestyle coach. b. Collaborate with the client in choosing what changes to make. c. Explain ways that the client can engage in new behaviors. d. Tell the client what to do to improve his or her health.

b. Collaborate with the client in choosing what changes to make. A plan must involve both the nurse and the client to identify outcomes signifying success from the client's perspective. Only the client can decide what behaviors to attempt to change. The nurse collaborates as a partner to share information. Changing behavior is always the client's decision.

Which of the following are factors in the primary health care model? (Select all that apply.) a. Commitment to a plan of action b. Community participation c. Economics, politics, and environment d. Personal health care services e. Primary health care and personal health services f. Universal access to primary health care clinics

b. Community participation c. Economics, politics, and environment The primary health care model is not focused on primary care or personal health services, which address health care for individuals; instead, it emphasizes community involvement and environmental change.

Models that consider intrapersonal attributes, interpersonal dynamics, person/environment interactions, cultural beliefs, and attitudes: a. Behavior change models b. Ecologic model c. Health belief model d. Learning model

b. Ecologic model Belief that all processes occurring within individual people and their environment should be viewed as interdependent.

What is the primary goal of health promotion? a. Discovering people who are at risk and helping them obtain appropriate health care b. Enabling people to exercise control over their own well-being c. Preventing further physiologic damage by early intervention and education d. Reducing specific risks by early diagnosis and treatment

b. Enabling people to exercise control over their own well-being Health promotion is the process of helping people enhance their well-being and maximize their human potential by changing patterns to promote health rather than simply to avoid illness. The goal of health promotion is to enable people to exercise control over their well-being and ultimately improve their health.

Which of the following factors would most likely be motivating factors for setting up large community-wide group meetings instead of face-to-face counseling? (Select all that apply.) a. A more comfortable "party" atmosphere would result. b. It would effect more widespread change in the local social norms. c. Cost-effectiveness would be increased. d. The meeting would serve as an environmental cue. e. Most people would rather learn in a group setting. f. People would carpool to the meeting.

b. It would effect more widespread change in the local social norms. c. Cost-effectiveness would be increased. d. The meeting would serve as an environmental cue. Benefits of community-wide programs include cost efficiency, ability of the program to serve as an environmental cue, development of an environment of social support, increased ability to evaluate success, and opportunity to reach more people and effect widespread change in social norms.

When a nurse plans educational programs appropriate for a population being served, which of the following actions should the nurse take? a. Bill the employer for the actual cost of the health program. b. Provide feedback and follow-up information to attendees. c. Make handouts available to the audience. d. Incorporate the latest technology into the presentation.

b. Provide feedback and follow-up information to attendees. Although all of the actions should be taken, it is ethically required to provide feedback, education, and appropriate follow-up for identified risks.

Used as motivation to either continue or discontinue behavior: a. Health b. Reinforcement c. Modifiable risk d. Motivational interviewing

b. Reinforcement

Maximizing health and wellness through strategies set in place at the early and active chronic stages of illness and injury: a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Risk reduction

b. Secondary prevention i.e., Screening

Which of the following is the best example of a health-promotion program? a. The nurse collaborated with the local police department to prepare a public safety announcement about the benefits of using one's seat belt. b. The nurse appeared on the local public access television channel each Sunday afternoon to discuss nutrition and exercise options for families. c. The nurse worked with the local school parent-teacher organization to give free bicycle helmets to the students with bicycles. d. The nurse collaborated with the local motorcycle club to make sure all the cyclists who wanted one could obtain a free helmet.

b. The nurse appeared on the local public access television channel each Sunday afternoon to discuss nutrition and exercise options for families. Teaching good nutrition and encouraging exercise are excellent health-promotion activities. The other choices are all risk reduction or health protection programs.

Sequential approach to behavior change on the basis of process across stages and timely readiness of the learner: a. Relapse prevention model b. Transtheoretical model c. Behavior models d. Theory of reasoned action

b. Transtheoretical model

Considering the health-belief model, which statement suggests that the person is going to begin a new healthy habit? a. "If I could be asleep while they did the colonoscopy, it might be alright." b. "I did have a cousin who was treated for breast cancer." c. "Both my mother and father died of heart problems." d. "Because my employer was paying for the health screening, I thought I might go."

c. "Both my mother and father died of heart problems." The statement "Both my mother and father died of cardiac problems" suggests both susceptibility ("my parents") and severity ("died").

Which of the following services implemented by nurses would represent primary prevention? a. A nurse-managed hospital respiratory unit for patients with chronic obstructive pulmonary disease (COPD) and emphysema b. A quit-smoking-now clinic for adults who want to give up the habit c. A "don't smoke" campaign for elementary school students d. A "stay beautiful" campaign for high school female smokers that stresses that smokers have wrinkles about a decade earlier than their chronologic peers

c. A "don't smoke" campaign for elementary school students Only a "don't smoke" campaign for young children would represent action taken before they begin smoking, which is primary prevention. Primary prevention aims to prevent health problems and promote health.

Which of the following services implemented by nurses would represent tertiary prevention? a. A free high-cholesterol screening at the neighborhood grocery store b. A healthy lifestyle exercise and information program for all the employees of the city's largest employer, held at the worksite c. A posthospitalization social support program for persons with chronic severe mental illness and their families d. An exercise and parenting class for new first-time mothers

c. A posthospitalization social support program for persons with chronic severe mental illness and their families Only a social support program for ill persons and their families aims to prevent further disability in both the clients and their families. Tertiary prevention is rehabilitation and prevention of further disability and disease.

How was the concept of health defined originally? a. Balance and harmony b. Maximum self-actualization c. Absence of disease d. Total well-being

c. Absence of disease Historically, health and illness were viewed as extremes on a continuum; the absence of clinically recognizable disease was equated with the presence of health.

Include motivational interviewing and behavior-change models: a. Relapse prevention model b. Transtheoretical model c. Behavior models d. Theory of reasoned action

c. Behavior models

Care of the spirit, as well as promoting health of the body, is performed very effectively by which professional nursing specialty? a. Church-based nurses b. Community/public health nurses c. Faith community nurses d. Public health nurses

c. Faith community nurses Faith community nurses (formerly called parish nurses) intentionally focus on care of the spirit as part of the process of promoting holistic health and preventing illness in a faith community.

Which of the following is the most crucial environmental influence on health? a. Government in the local community b. Health care system in the local community c. Food, water, and exposure to toxic substances d. Religious and cultural beliefs and values

c. Food, water, and exposure to toxic substances An estimated 25% of the preventable illnesses worldwide can be attributed to poor environmental quality (e.g., poor water, sewage disposal, air quality). The government, the health care system, and the value/belief system are sociocultural aspects of the environment whose effects are harder to measure.

A public health nurse was asked by a town's community college to offer health education programs for its employees. How would the nurse most effectively determine which programs to offer? a. Asking the administrators which programs they would like b. Performing a complete physical examination on each employee during work time c. Having employees complete a health-risk appraisal form d. Planning a program on the basis of the broader community's demographic data

c. Having employees complete a health-risk appraisal form The most easy and effective way to determine current needs of the particular aggregate is by having each employee complete a paper-and-pencil form. Because the employer is a community college, literacy should not be a major problem. However, this is a subgroup, the wider community's data might be misleading.

A behavior change model that considers the severity of the potential illness or physical challenge, the level of conceivable susceptibility, the benefits of taking preventive action, and the challenges that may be faced in taking action toward the goal of health promotion: a. Behavior change models b. Ecologic model c. Health belief model d. Learning model

c. Health belief model

Because, in relation to physical activity, none of the Healthy People 2010 objectives was met, what does the United States need to do? a. Ensure more tax funding for education of physical education teachers. b. Encourage funding for an increased number of exercise centers. c. Increase programs for teaching and encouraging health-promoting lifestyle choices. d. Require health care providers to serve as role models of appropriate physical activity choices.

c. Increase programs for teaching and encouraging health-promoting lifestyle choices. The data highlight the importance of health-promotion programs and the need for individual and community commitment to health-promoting lifestyle changes, particularly in regard to nutrition and physical activity.

Why was the publication of Healthy People a landmark document? a. It was the first time that a national plan had been created with funding to implement it. b. It was the first time that evaluation measures based on outcomes to judge effectiveness were created. c. It was the first time that national goals for improving the health of Americans were established. d. It was the first time that universal agreement on federal government priorities was reached.

c. It was the first time that national goals for improving the health of Americans were established. Healthy People was instrumental in identifying major health problems and setting national goals for reducing death and disability. However, there were no funds or plans for implementing the goals.

Susceptibility to disease or injury that can be controlled by individual people, families, or communities: a. Health b. Reinforcement c. Modifiable risk d. Motivational interviewing

c. Modifiable risk

Which of the following would be a behavior-specific cognition and affect variable according to Pender's model? a. Commitment to a plan of action b. Competing demands (family or work) c. Perceived self-efficacy d. Personal realities such as demographics

c. Perceived self-efficacy Self-efficacy is a central concept in Pender's health-promotion model with regard to behavior-specific cognition and affect. Other such behavior-specific cognitions and affect variables are perceived benefits, perceived barriers, interpersonal influences, and situational influences.

Maximizing health and wellness through strategies that are set in place at the palliation and end stage of disease and injury trajectories: a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Risk reduction

c. Tertiary prevention i.e., Long term management and treatment of chronic diseases

With which of the following populations would collaboration be most important when a school nurse proposes that additional healthy options be added to the school lunch program? a. The staff and teachers b. The children and their parents c. The dietitians and nutritionists d. The school board and administration

c. The dietitians and nutritionists It is very important to develop partnerships with people who are most likely to be affected by the program and promote a sense of cooperation, collaboration, and teamwork in order to be successful.

Which of the following is the best example of a risk reduction program? a. At the senior citizens center, the nurse set up an exercise program for persons in wheelchairs. b. The nurse appeared on the local public access television channel each Sunday afternoon to discuss good parenting skills. c. The nurse worked with the local health maintenance organization (HMO) to make infant car seats available without charge to all first-time pregnant mothers. d. The nurse wrote a weekly local newspaper column on healthy lifestyle behaviors, such as the importance of exercise.

c. The nurse worked with the local health maintenance organization (HMO) to make infant car seats available without charge to all first-time pregnant mothers. Providing infant seats helps lower the risks of death or injury from car accidents. The other choices are all health-promotion behaviors.

The nurse gave each participant a health-risk appraisal tool to determine the health needs of the group as a whole. What other purpose may the tool serve? a. To assess the needs of the broader community b. To demonstrate the necessity of having health education programs c. To motivate participants to consider changing high-risk behaviors d. To provide data for future planning by the nurse's employer

c. To motivate participants to consider changing high-risk behaviors The health risk appraisal tool helps the nurse obtain data, which is statistically analyzed to determine health risks. However, it may stimulate the individual to engage in the necessary behavioral changes that reduce known health risks. Data about a subgroup should not be considered representative of a wider population.

Which of the following definitions of health is most typically used in nursing today? a. Ability to interact and adapt to the environment b. Ability to perform required social roles c. Ability to stay free from disease d. Ability to maximize human potential

d. Ability to maximize human potential Although all are accepted definitions, the most contemporary definition of health has emphasized the relationship between health and wellness. Wellness is the process of moving toward maximizing human potential.

After obtaining data from a health-risk appraisal tool, a nurse met with a client for follow-up. Which of the following actions should the nurse take first after summarizing the information? a. Create a reward system to reinforce healthful behaviors. b. Design a behavior change plan acceptable to the client. c. Establish an implementation time frame. d. Identify and reinforce client strengths.

d. Identify and reinforce client strengths. The process begins with summarizing information and then proceeds to identification and reinforcement of strengths. Then goals, outcome measures, a plan, reward system, and time frame are created. Good nursing practice always builds on client strengths rather than focusing just on weaknesses.

Which of the following would be the most effective mechanism to use when collaborating with others to have an extensive and lasting impact on health outcomes? a. Broadly disseminating health-related information to inform citizens b. Encouraging the creation of more health programs on client lifestyle modification c. Increasing funding to health agencies for more health education programs d. Influencing improved health policies and legislation for healthier communities

d. Influencing improved health policies and legislation for healthier communities The American Nurses Association (ANA) suggests that nursing's role in prevention includes supporting health care legislation and influencing local and national economic and political options (i.e., affecting health policies and legislation).

A behavior change model emphasizing reinforcement of social competence, problem-solving, autonomy, and sense of purpose: a. Behavior change models b. Ecologic model c. Health belief model d. Learning model

d. Learning model A goal is established and rewards are given for accomplishment on the flip side, behaviors often dissipate when rewards are taken away (e.g., Weight Watchers).

Client-centered communication style for eliciting behavior change by helping clients and groups explore and resolve ambivalence to change: a. Health b. Reinforcement c. Modifiable risk d. Motivational interviewing

d. Motivational interviewing Does not include arguing, offering advice, or coercing, but instead involves reflective listening, freedom of choice, acceptance, affirmation, and encouragement.

Decreasing the chance of developing an illness, experiencing an injury, or being faced with chronic consequences of both: a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Risk reduction

d. Risk reduction

In the United States, which of the following is the most crucial influence in the sociocultural environment? a. The community in which a person grows and develops b. Family's values and beliefs c. Health care provider from whom care is sought as needed d. Socioeconomic class, education, and occupation

d. Socioeconomic class, education, and occupation All of the options influence health and illness, as well as the individual's lifestyle. However, higher education and socioeconomic class are associated with greater participation in health-promotion activities and, therefore, better lifestyle choices overall.

The community/public health nurse charted the number of persons who came in to be taught breast self-examination. The nurse noted that during the past 3 days, there was a sudden increase in the number of women coming in. Which of the following is the most likely reason for the increase? a. The increased number is probably just a coincidence. b. The local nursing school hosted a women's health fair. c. The American Heart Association had just started its annual publicity campaign. d. The media had publicized a famous woman's diagnosis of breast cancer.

d. The media had publicized a famous woman's diagnosis of breast cancer. Even though the local nursing school hosted a health fair, some other factor (probably a new, one-time-only, external cue) had emphasized the importance of the behavior and made women aware of their susceptibility to and the severity of breast cancer. Only a very famous person's problems would be a current media event that would create enough attention to cause a sudden great increase. External cues to action influence decisions related to health care behavior. A publicity campaign by the American Heart Association may increase the public's cue to action in relation to heart disease, but it would not likely be a factor relevant to the risk for breast cancer.

A behavior model emphasizing that individual performance of a given behavior is primarily determined by a person's intention to perform that behavior: a. Relapse prevention model b. Transtheoretical model c. Behavior models d. Theory of reasoned action

d. Theory of reasoned action

The public health clinic was planning its once-a-month dental clinic in the community with a visiting volunteer dentist. Which of the following would be the most important task in preparation for this clinic? a. Plan to be there that day to assist with client flow. b. Sterilize all the dental equipment. c. Tell everyone to make an appointment to decrease waiting time. d. Use multiple strategies to publicize the clinic in the community.

d. Use multiple strategies to publicize the clinic in the community. Although planning, being present, and having necessary supplies are important, the crucial task is to inform community residents who might be interested. Establishing such a clinic means decreasing barriers to care (lack of access), and using every means to let people know about it is a cue to action.

A local employer was concerned about rapidly increasing health care costs. The nurse did an assessment and found that most of the employees smoked heavily. Which of the following suggestions should the nurse make to the employer as the most effective approach to decrease smoking among the employees? a. Lobby area legislators to increase the tax on cigarette sales. b. Offer a smoking cessation program at the workplace. c. Talk to the employees in small groups and ask them to quit smoking. d. Work with interested employees to create a "no tobacco products" environment.

d. Work with interested employees to create a "no tobacco products" environment. Although all of the actions could be performed and probably would be helpful, the most effective way to change behavior is to restructure the environment so that the behavior is not possible. Information alone is insufficient to effect large-scale, community-wide behavioral change, as the widespread dissemination of information on the health risks of obesity clearly demonstrates. Environmental restructuring makes it more difficult to engage in the high-risk behavior and improves and optimizes the healthful conditions (air) existing in the environment.