Fundamental of nursing Ch3: Health, illness, and disparities

A client tells the nurse that her doctor just told her that she had a "chronic condition." She asks the nurse what does "chronic condition" mean. What would be the nurse's best response?

"Chronic conditions usually come on slowly and may have periods of remission and exacerbation." Explanation: Chronic conditions usually come on slowly and may have periods of remission and exacerbation. Saying chronic diseases come and go is not the best answer. Chronic diseases are usually managed in the home environment.

The client is admitted with a gastrointestinal bleed (GI). The physician ordered a colonoscopy. Which level of care encompasses this procedure?

secondary Explanation: Secondary care delivery is when primary caregivers refer clients for consultation and additional testing. Therefore, this scenario portrays secondary level of care.

A client enjoys eating high-calorie carbohydrate meals, but understands her blood sugar can increase sharply, ultimately causing the feeling of butterflies in her stomach as her blood sugar decreases. This is considered

self-concept. Explanation: A person's self-concept is influenced by having knowledge and the ability to care for oneself, recognizing one's strengths and limitations.

A nurse working in the ICU understands that illnesses affect both the client as well as the family members. What are some things that often cause stress in family members due to a hospitalization of a family member? Select all that apply

Alterations in roles Economic problems Alterations in lifestyle Decrease in social interactions Explanation: A chronic illness can create stress for both client and family because of life long alterations in role or lifestyle, frequent hospitalizations, economic problems, and decreased social interactions among family members.

What is a misconception about chronic disease?

Chronic illnesses cannot be prevented. Explanation: A misconception regarding chronic disease is that chronic illnesses cannot be prevented. Almost half of chronic deaths occur prematurely in people under 70 years of age. Chronic illness typically does not result in sudden death. The major cause of chronic disease is known.

Explanation: To successfully adapt to a chronic illness, the person must learn to live as normally as possible and maintain a positive self-concept and sense of hope, despite symptoms and treatments.

It is important that the person maintain a feeling of being in control of his or her life, as well as in control of the prescribed treatments.

Nurses are aware that there is a current trend of an increase in the number of older adults resulting in an increase in the incidence of chronic illnesses. The nurse recognizes that some of the things that are necessary in order for a person to successfully adapt to a chronic illness include which of the following? Select all that apply.

One must maintain a positive self-concept. One must learn to live as normally as possible. One must maintain a sense of hope.

A client experiencing symptoms of cold is referred to the specialist for diagnosis and consultation. Consultation and diagnostic tests are included in which level of the health care system?

Secondary care

What is a state of complete physical, mental, and social well-being, not merely the absence of disease or infirmity?

Health Explanation: The World Health Organization defines health as "a state of complete physical, mental, and social well-being, not merely the absence of disease or infirmity."

A client states, "I must be in poor health because I am a senior citizen. That's what my neighbor says and she is older than I am." This statement is based on which of the following factors?

Peer influence Explanation: Peer influence, personality characteristics, ethnicity, and socioeconomic factors may affect a person's response to illness. Page 49

A 90-year-old woman has a staphylococcus infection in her decubitus ulcer. Staphylococcus is the:

Agent Explanation: The agent is any factor that leads to illness.

Explanation: To give holistic care the nurse must understand and respect each person's own definition of health and responses to illness, and should be familiar with models of health and illness.

Health is an active process in which a person moves toward his maximum potential.

A patient with a lump in her breast calls her primary care physician to schedule an appointment for an evaluation. Based upon the patient's actions, what stage of illness is the patient demonstrating?

Assuming the sick role Explanation: Seeking out a healthcare provider for diagnosis and treatment is an example of assuming the sick role. Experiencing the symptoms occurs when a person recognizes one or more symptoms. Assuming the dependent role is characterized by the patient's decision to accept the diagnosis and follow the prescribed treatment plan. Achieving recovery and rehabilitation is characterized by the patient giving up the dependent role and resuming normal activities and responsibilities.

A nurse observes that a patient who has pneumonia is in the recovery and rehabilitation stage of the illness. What statement describes the patient response that the nurse would expect at this stage of the illness?

The patient gives up the dependent role. Explanation: In the recovery and rehabilitation stage, known as Stage 4, the person gives up the dependent role and resumes normal activities and responsibilities. The client would not seek medical attention, assume a dependent role, or recognize symptoms of illness in this stage. Stage 1 is when the client would recognize symptoms of the illness. Stage 2 is when the client would seek medical attention. Stage 3 is when the client would assume a dependent role.

A nurse has chosen to characterize a new initiative as "wellness promotion" rather than "health promotion." Which statement best describes the difference between the concept of wellness and the concept of health?

Wellness is an active state, whereas health is a more passive state dependent on the absence of disease. Explanation: Good health is a passive state wherein the person is not ill. Wellness is a more active state, regardless of one's level of health. Wellness is not contingent on the resolution of disease or illness and it supersedes age. Both health and wellness can be influenced by nursing practice.

What have the models of health promotion and illness prevention been used for?

To help health care providers understand health-related behaviors.

Which of the following is an example of a characteristic of Stage 2 of illness? a. A person tells his family that he is sick and allows them to take care of him. b. A person experiences a headache and sore throat and takes an aspirin. c. A person visits a physician to receive treatment for symptoms of an infection. d. A person begins rehabilitation following a stroke that left him paralyzed on one side.

A person tells his family that he is sick and allows them to take care of him. Explanation: The person in Stage 2: assuming the sick role defines himself or herself as being sick, seeks validation of this experience from others, gives up normal activities, and assumes a "sick role." At this stage, most people focus on their symptoms and bodily functions.

Primary care delivery is provided by the first healthcare provider or agency a person contacts. Tertiary care is health services provided at hospitals or medical centers that have complex technology and specialists.

Quaternary care delivery is an extension of tertiary care, the types of care that might be considered to be quaternary would be experimental medicine and procedures, and highly uncommon, specialized surgeries.

The nurse is holding a cholesterol screening at a local pharmacy this Saturday morning. What level(s) of health promotion is this screening an example of?

Secondary Explanation: Screenings, such as those for blood pressure, cholesterol, glaucoma, HIV, and skin cancer, are considered nursing activities that fall under the category of secondary health promotion. Secondary health promotion and illness prevention focus on screening for early detection of disease, with prompt diagnosis and treatment of those found.

A nurse is caring for a patient who has breast cancer. The patient tells the nurse: "I don't know why this happened to me, but I'm ready to move on and do whatever I need to do to get healthy again." This patient is in which stage of acute illness?

Stage 3 Explanation: When a person becomes ill, certain illness behaviors may occur in identifiable stages (Suchman, 1965). These behaviors are how people cope with altered functioning caused by the disease. They are unique to the person and are influenced by age, gender, family values, economic status, culture, educational level, and mental status. By the statement the client made above, the client is in stage 3 of acute illness, assuming a dependent role. This stage is characterized by the client's decision to accept the diagnosis and follow the prescribed treatment plan. Stage 1 is experiencing symptoms. Stage 2 is assuming the sick role. Stage 4 is achieving recovery and rehabilitation.

The nurse recognizes that the client who makes the decision to accept a new diagnosis and follow the prescribed treatment plan is in which of the following stages of an illness?

Stage 3-Assuming a dependent role Explanation: Stage 3 is characterized by the client's decision to accept the diagnosis and follow the treatment plan. Stage 1 is the beginning of symptoms, while stage 2 is where a client describes him or herself as being sick and seeks validation from others. Stage 4 is recovery and rehabilitation and is the final stage of the illness.

Explanation: The education on lifestyle choices is part of health promotion activity, which focuses on protecting the person's health.

The goal of the prevention of illness is to detect and prevent the illness. High-level wellness focuses on maximizing the person's highest potential for functioning. Reversal of self-care deficits would involve therapeutic interventions that are directed at contributing factors.

Explanation: Consultation and diagnostic tests are included in the secondary level of health care. The first contact with a general physician is the primary care, and the reference to a highly specialized facility for desensitization is the tertiary care level.

The secondary and tertiary care facilities are equipped to provide highly specialized care. Extended care is care provided to clients who no longer require acute hospital care.

When providing holistic care to a client, the nurse recognizes that which of the following is necessary? Select all that apply.

Understand and respect each person's definition of health. Understand and respect each person's responses to illness.

A nurse is caring for a client with end-stage liver failure. Which healthcare agency should the nurse recommend for continuity of care?

extended care Explanation: Extended care services meet the needs of clients who no longer require acute hospital care, including rehabilitation, skilled nursing care in a person's home or nursing home, and hospice for dying clients. HMOs are corporations that provide health care for members in exchange for preset, fixed, or yearly fees. PPOs are agents for health insurance companies that control healthcare costs on the basis of competition.

A client is admitted to the mental health centre with attempted suicide. Which of the client's problems is priority for the nurse to manage?

freedom from harm Explanation: Safety and security is the priority for the client, so freeing the client from harm is what the nurse must address first. Lack of support, low self-esteem, and feelings of belonging, although still important to address, are not as critical as safety and security.

A community health nurse arranges for a dental checkup camp for the local children in the school district. Which of the following would most likely be the nurse's goal for this health camp?

health promotion

Primary health promotion and illness prevention is directed toward promoting good health and preventing the development of disease process or injury. Primary level activities include

immunization clinics, providing poison-control information, and education about seat belt and child-safety seat use.

The concept of holism is based on the belief that:

individuals cannot be seen apart from the environment. Explanation: Holism is based on the belief that people cannot be fully understood if examined solely in pieces apart from their environment.

The nurse is working in an acute care setting and performs primary, secondary, and tertiary prevention Which activity performed by the nurse is classified as tertiary prevention?

instructing a client how to use crutches Explanation: Tertiary care is used after an injury or sickness to decrease potential risk and further damage, such as instructing the client on how to use crutches. Promoting safety in the home, counseling a client about a low sodium diet, and assessing blood glucose are examples of primary care.

The nursing student who has diarrhea before every test and every clinical understands that this is not a healthy behavior. The student is aware that this negative effect can impact overall health. The nurse recognizes that this student needs to focus on which of the following dimensions of health?

Emotional dimension Explanation: This is an example of the emotional dimension. How the mind affects body functions and responds to body conditions also influences health. Long term stress affects body systems, and anxiety affects health habits.

An elderly patient has been recently diagnosed with vascular dementia. Because he lives alone and has poorly controlled hypertension, he has begun to receive home healthcare. This new aspect of his care is characteristic of which stage of illness?

Assuming a dependent role Explanation: The stage of assuming a dependent role often requires assistance in carrying out activities of daily living. As well, the patient often requires care, which may be provided in the home. Experiencing symptoms and assuming a sick role may precede (or accompany) this process. Recovery and rehabilitation are not evident in the patient's present circumstances.

A client has been admitted to the hospital for the treatment of diabetic ketoacidosis, a problem that was accompanied by a random blood glucose reading of 575 mg/dLm (31.91 mmol/L), vomiting, and shortness of breath. This client has experienced which phenomena?

Exacerbation Explanation: This client has experienced a significant exacerbation of his chronic disease (diabetes mellitus), which has manifested as an acute threat to their health. Morbidity is an epidemiological statistic of the frequency of a disease. The client's problem does not have an infectious etiology and while risk factors underlie their present condition, they are not the essence of their current state.

A patient has been admitted to the hospital for treatment of pancreatitis secondary to alcoholism. The patient states that he finds it nearly impossible to quit drinking because of the deep entrenchment of alcohol use in his circle of friends and line of work. As well, he claims that he thought limiting himself to beer and foregoing hard alcohol would prevent health problems. This patient is exhibiting health consequences rooted in which of the following human dimensions?

Sociocultural and intellectual Explanation: The fact that the patient is situated in a context that normalizes heavy alcohol use is an example of the sociocultural dimension. His ignorance of the health consequences of drinking beer rather than spirits is a component of the intellectual dimension.

Intellectual dimension encompasses cognitive abilities and past experiences, while the physical dimension includes things like genetics, sex, and race.

Sociocultural dimensions relate to a client's economic level, lifestyle, family, and culture.

The nurse is educating a client with diabetes on how to better control blood sugar levels and recognize the symptoms associated with both hyperglycemia and hypoglycemia. The client is frequently admitted to the hospital due to elevated blood sugars. This education is an example of which level of health promotion?

Tertiary Explanation: Tertiary health promotion and illness prevention begin after the illness is diagnosed and treated, with the goal of reducing disability and helping to rehabilitate to a maximum level of functioning. Educating a client with diabetes on how to recognize areas of risk for the disease is one such example of tertiary promotion.

Explanation: Several models of health promotion and illness prevention have been used to help health care providers understand health-related behaviors and adapt care to people from diverse economic and cultural backgrounds.

The models include the health belief model, the health promotion model, the health-illness continuum model, and the agent-host-environment model. These models do not define a medical framework in the care of the disabled; these models do not create a forum for improving rehabilitative care; and these models do not formulate care plans for use with the disabled.

When admitting an adolescent to the hospital, the nurse anticipates that the client will respond to questions about his health beliefs based primarily on his:

age and developmental stage. Explanation: Age and developmental stage are important considerations in the health belief model. Other factors are influential, but age and developmental stage are paramount.

Which nursing activity reflects care given on the tertiary level of healthcare delivery?

assisting with transplant surgery Explanation: Tertiary care is health services provided at hospitals or medical centers that have complex technology and specialists. Educating the client about safe habits, recommending regular exams, and teaching the client about exercise programs are examples of primary care.

While providing client care, a nurse determines that a client adheres to the health belief model. What would the nurse need to assess as a factor possibly affecting the client's response to illness?

personality characteristics Explanation: The health belief model provides insight into the connection between the way a person sees one's own state of health, and that person's response to health, illness, and treatment. According to the health belief model, personality characteristics affect the person's response to illness. Nutritional awareness, stress management, and environmental sensitivity are wellness behaviors that promote healthy functioning and help prevent illness.

The nurse is ccertified in providing Therapeutic Touch and is preparing to initiate this for a client. What activity should the nurse perform initially?

request the client's permission prior to touching the body Explanation: Prior to touching the client, the nurse should request permission and explain the process of therapeutic touch. All other interventions would be performed after this occurs.

Why is health promotion and illness prevention a key responsibility of nurses?

Chronic illnesses are the leading health problem in the world. Explanation: Because chronic illnesses are the leading health problem in the world, health promotion and illness prevention activities are vital to nursing care. It is true that treating chronic illnesses can be expensive, they do cause pain and suffering, and people do not like to be sick, but these are not the most important reason for promoting health and preventing illnesses.