Chapter 16: Health and Wellness
When a patient recognizes that a family history of a terminal disease predisposes him to illness, the nurse can identify this realization as which component of the Health Belief Model? a. Perception of susceptibility b. Likelihood of action c. Modification of factors d. Adherence to factors
ANS: A The first component of the Health Belief Model (HBM) is an individual's perception of susceptibility, that he or she can actually acquire a given disease. Risk for a disease is often due to a family history or a genetic trait. The second component of the HBM is the perception of the severity of the disease, and the third is the likelihood the individual will take action.
When a nurse approaches an overweight patient about lifestyle modifications that will reduce the risk for heart disease, the patient shows that he does not perceive susceptibility to disease when stating a. "I'm only a little overweight; there is no way I can have a heart attack." b. "I should lose a few pounds and try to exercise more often." c. "It would be helpful to speak to the nutritionist before I leave the hospital." d. "I will investigate the online Weight Watchers programs that helped me in the past."
ANS: A The patient does not perceive being overweight as a risk factor for cardiovascular disease. Education and nutrition counseling would be helpful in this patient's case. The other answers acknowledge the need to lose weight, on some level of understanding, but education is always helpful.
According to Maslow's hierarchy of needs, the nurse understands that which element(s) must be maintained before a patient can reach self-actualization? a. Self-esteem b. Safety c. Love and belonging d. Nutrition
ANS: D According to Maslow's hierarchy of needs, nutrition must be maintained before any of the higher-level needs can be met. Then safety, love and belonging, and self-esteem are necessary in a step-wise progression before self-actualization can occur.
A patient undergoing chemotherapy for bone cancer states that she uses guided imagery in conjunction with pain medications to tolerate bone marrow aspirations. The nurse recognizes guided imagery as a component of which health promotion model? a. The Health Function Model b. Lifestyle Fatality Model c. Model for Human Disease Progression d. Holistic Health Model
ANS: D Guided imagery, music therapy, reminiscence, and relaxation therapy are all examples of therapies used in holistic health models. Holistic health models do not discourage the use of biomedical drugs in conjunction with alternative therapies, but often view drugs and alternative therapies as enhancing one another.
The last concept to be added to the Health Belief Model (HBM) is defined as the confidence in one's ability to take action. What is this concept is called? a. Perceived benefits b. Cues to action c. Perceived severity d. Self-efficacy
ANS: D The final concept to be added to the Health Belief Model is self-efficacy, the belief in one's own ability to perform a task. Perceived benefits are defined as beliefs about the effectiveness of taking action to reduce risk or seriousness. Cues to action are the factors that activate readiness to make a change. Perceived severity is the belief about the seriousness of a condition and its consequences.
A 20-year-old patient is concerned that he may have the same illness (acute myeloid leukemia [AML]) as a 65-year-old male relative. Which influencing factor about which the nurse is aware may alleviate this patient's concern? a. Developmental level b. Environmental factors c. Lifestyle choices d. Age
ANS: D The nurse is aware that the disease the uncle has, acute myelogenous leukemia (AML), is highly uncommon in people less than 50 years of age. Although it does affect men more than women, it would be highly unlikely that a 20-year-old would have the disease. Developmental level is not a concern with this disease. The etiology is unknown, but environment and lifestyle factors are not believed to be triggers for AML.
Three weeks after delivery, a patient started a diet of 800 calories per day and started jogging 2 miles twice per day. The nurse recognizes the patient's behavior may be influenced by which motivating factor? a. Body image b. Family roles c. Illness behavior d. Chronic illness
Answer: a Body image is a self-ascribed attribute that influences a person's ability and desire to change, and it may be a motivating factor to maintain the change. Self-concept is a general and broader factor that motivates less specific responses. Family roles are not an influencing factor because this is a personal and possibly self-destructive behavior pattern for weight loss. Pregnancy is not a chronic illness.
Which activity best illustrates the use of the Health Promotion Model (HPM) by the nurse to increase the level of well-being for a patient immediately after surgery? a. Holding a pillow across his chest when coughing and deep breathing b. Encouraging the patient to eat his entire evening meal c. Changing his surgical dressing daily as ordered by the physician d. Asking his family to step out of the room during dressing changes
Answer: a The HPM describes an individual's interaction with his environment as he engages in behaviors that promote health. The patient using a pillow as a splint is interacting with his environment to prevent atelectasis and infection.
A nurse providing preventive care to an overweight patient with a family history of diabetes should engage in which priority care-planning activity for this patient? a. Calculating the patient's body mass index (BMI) and recommending a daily exercise routine b. Instructing the patient to perform blood glucose monitoring once daily c. Giving the patient a month's supply of insulin needles and syringes d. Participating in diabetes education classes offered at a local health facility
Answer: a The patient does not have diabetes but is overweight and at risk due to a family history of diabetes. The best way to prevent diabetes is to keep the BMI in the optimal range (<25). Beginning an exercise program with walking and progressing as tolerated increases muscle mass, improves depression, and strengthens the heart.
A 65-year-old male patient has been a one-pack-per-day smoker for 40 years. He was recently diagnosed with early-stage chronic obstructive pulmonary disease (COPD) and would like to attend a smoking cessation class. The nurse recognizes smoking cessation as which level of prevention for this patient? a. Primary prevention b. Secondary prevention c. Statutory prevention d. Tertiary prevention
Answer: b According to the stages for disease prevention, primary prevention is implemented for the absence of disease, secondary prevention applies to the early stages of disease or recently diagnosed risk factors, and tertiary preventive care is offered for permanent and irreversible disease.
A patient is seeking information about leading indicators that show the importance of health promotion and illness prevention in the United States. To which government-sponsored program would the nurse refer the patient for the best source of information? a. The American Cancer Society website b. The Healthy People 2020 website c. The Centers for Disease Control and Prevention (CDC) Morbidity and Mortality Weekly Report d. The American Association of Hospitals home page
Answer: b Healthy People 2020 is the most up-to-date site for health indicators in the United States, and it is presented in a client-friendly format. The CDC Morbidity and Mortality Weekly Report does not cover all of the indicators, and it may be overly technical for the client. The same holds true for the American Cancer Society website and the American Association of Hospitals home page.
An active, older patient has been frequently evaluated for minor problems at the clinic since the death of her husband 3 months earlier. During one of her visits, she states that she has no energy to get through the day and no desire to keep up with her Tuesday night bridge club. Which type of holistic health model intervention should the nurse employ to help the patient cope with the loss of her husband? a. Encouraging use as needed of a drug for anxiety ordered by her provider b. Teaching the value of music therapy to address anxiety about her loss c. Explaining that she will be over the loss of her husband in a few months d. Encouraging a gradual reentry into social interaction and activities with friends
Answer: b Teaching the patient to use music therapy when she feels anxious about her loss is the most appropriate intervention listed. This type of distraction is a holistic technique that works well in the form of music, painting, and expressive dance. Instructing the patient to use drugs is not part of the holistic approach. The patient may not be ready to re-engage in a full activity schedule, and it is unlikely that her feelings of loss will ever totally resolve.
The nurse enters a patient's room to deliver a dinner tray and notices that the patient has not been out of bed since the previous day. The patient states that his condition has made him bed-ridden, although the nurse knows that he is capable of independent ambulation. Which type of reaction is the patient exhibiting? a. Ambivalence to symptoms b. Illness behavior c. Diminished functional ability d. Overreaction to illness
Answer: b The patient is defining and interpreting his disease symptoms according to his beliefs about illness and how to respond to it. The patient's ability to ambulate is intact. Overreaction to illness is a subjective anomaly, and the patient is not ambivalent about his diagnosis.
An 8-year-old girl is newly diagnosed with type 1 diabetes. The nurse may expect fear and crying when teaching the child how to self-administer insulin injections due to which influencing factor? a. Self-concept b. Self-esteem c. Developmental level d. Hierarchy of needs
Answer: c Even when the child understands about having the disease, she is less likely to understand the need for insulin therapy due to her emotional and comprehension level of development. A child's self-concept is not well established at this point, and self-esteem is not a major factor. Hierarchy of needs is not yet fully developed because the child depends on her parents for the basic level of needs.
A patient diagnosed with an aggressive cancer is estimated to have 6 months to live. Two months later, the patient's wife calls the nurse's office because she is upset that her husband has taken up motorcycle racing and has already been injured twice. The nurse knows that the patient is experiencing a behavioral change in which factor due to the prognosis of his illness? a. Spirituality b. Physical attributes c. Self-concept d. Personal affect
Answer: c Self-concept is profoundly affected by the diagnosis of a terminal disease. The individual often tries to reinvent himself or herself and behaves in an uncharacteristic manner.
Which of the listed basic needs identified by Maslow must be addressed first when providing nursing care? a. Self-esteem b. Love and belonging c. Self-actualization d. Nutrition and elimination
Answer: d Nutrition and elimination must be addressed first before concerns about self-esteem, love and belonging, and self-actualization, according to Maslow's hierarchy of needs. According to Maslow, the lower-level needs must be fulfilled and maintained before the higher-level needs can be met.