Health Promotion 1125

Objectives

1. Explain the concept of Health Promotion (including definition, antecedents, and attributes). 2. Analyze situations which place patient care at risk when health promotion is neglected. 3. Identify when Health Promotion neglect is developing or has developed. 4. Discuss exemplars of Health Promotion. 5. Apply the nursing process (including collaborative interventions) for individuals experiencing Health Promotion neglect and Health Promotion. 6. Describe Healthy People 2020 objectives.

Key Points 1-2

1. Nurses have a significant responsibility for enhancing the health of individuals across the lifespan; this occurs in the context of a therapeutic relationship and requires skillful communication by the nurse. 2. Health promotion is a central focus of health care delivery that has been shown to add quality years of life and to decrease health care costs.

Key Points 3-4

3. Healthy People 2020 Goals include the following: a. Attain high-quality, longer lives free of preventable disease, disability, injury, and premature death. b. Achieve health equity, eliminate disparities, and improve the health of all groups. c. Create social and physical environments that promote good health for all. d. Promote quality of life, healthy development, and healthy behaviors across all life stages. Reference: Health People 2020, retrieved from: healthypeople.gov 4. Health policy to eliminate health disparities aims to increase accessible health services, requiring communities to increase involvement.

Exemplars

Injury prevention; Healthcare screening; Obesity Management

Variables

Internal - Developmental Stage - Intellectual background - Perception of functioning - Emotional factors - Spiritual factors EXTERNAL - Family practices - Socioeconomic factors

What is the nursing focus when the nurse performs a hearing test on a newborn infant?

Preventing developmental delays. Early detection of hearing loss can prevent developmental delay by allowing early intervention. The hearing test on a newborn evaluates the physical ability to respond, not the ability to perform language or communication skills. The test records the infant's ability to perceive sound but does not improve it. Older adults, not infants, are at risk for depression as a result of hearing loss.

Categories

Primary Prevention Secondary Prevention (Secondary) Tertiary Prevention (Restoration/Disease Management)

Exemplars (explained)

Primary Prevention: Injury Prevention Secondary Prevention: Healthcare Screening Tertiary Prevention: Obesity Management

Injury Prevention

Car seat safety Seat belts Gun safety Fall prevention

The nurse is instructing a group of women of childbearing age about human immunodeficiency virus (HIV) during pregnancy. What would be a priority recommendation in this setting?

Screening for HIV. No screening mandate has been put forth for HIV, but all pregnant women should be encouraged to undergo this test. Prophylactic treatment would be initiated only once the woman has been screened. Screening for STIs and ensuring proper nutrition are also part of health promotion for women in this age group, but they are of lower priority than identifying HIV-positive individuals.

Positive Outcomes

The nurse seeks to verify Positive Outcomes by the patient's improved level of well-being, alignment of resources affording the patient access to health promotion, and identifying health and wellness of the patient.

Tertiary Prevention

Those interventions aimed at optimizing function for individuals with disability or disease. Rehabilitation to increase efforts to improve compliance with prescribed treatment regimen Diet Exercise Lifestyle modifications Medication adherence Cardiac rehabilitation

An 11-year-old female child is at the pediatrician's office for a well-child check-up. Which health screening would the nurse anticipate that the child would undergo today?

scoliosis screening, Initial screening for scoliosis begins at age 10 to 11 years; the child is monitored into adolescence for development of scoliosis (or progression if scoliosis is already noted).

The American Academy of Pediatrics and the American Dietetic Association recommend breastfeeding exclusively for how long?

the first 6 months, Both the AAP and the ADA recommend breastfeeding exclusively for the first 6 months of life. After 6 months, breastfeeding does not need to be exclusive, but it should be continued until 12 months.

What is the most important consideration for the nurse when communicating with an adolescent about sexually transmitted infections (STI)?

use communication techniques that are direct and nonjudgmental, All of the answers are correct, but the most important consideration for a nurse communicating with an adolescent about STIs is to be direct and nonjudgmental. The style, content, and the message has to be aimed at the adolescent's developmental level. Any aids to help the adolescent learn should be used. The content should be designed to be delivered in the shortest amount of time because many clinics and health care provider offices are busy and do not lend themselves to long class times.

Which term describes a reddened, circumscribed lesion that ulcerates and becomes crusted and is a primary lesion of syphilis?

chancre, A chancre is a reddened circumscribed lesion that ulcerates and becomes crusted and is a primary lesion of syphilis. Lichen planus is a white papule at the intersection of a network of interlacing lesions. Actinic cheilitis is an irritation of the lips associated with a scaling, crusting fissure. Leukoplakias are white patches usually found in the buccal mucosa.

Which is not one of the general nursing measures employed when caring for the client with a fracture?

cranial nerve assessment, Cranial nerve assessment would only be carried out for head-related injuries or diseases. General nursing measures include administering analgesics, providing comfort measures, assisting with ADLs, preventing constipation, promoting physical mobility, preventing infection, maintaining skin integrity, and preparing client for self-care.

Prevention is better than

cure

A nurse in a clinic is caring for a female client who is of childbearing age. Which vitamins or minerals should the nurse recommend to prevent neural tube defects during pregnancy?

folic acid, Folic acid has significantly decreased the number of children born with neural tube defects. Vitamin C or ascorbic acid helps with wound healing. Vitamin E helps maintain strong immunity, healthy eyes, and skin. Vitamin D helps prevent osteoporosis by keeping bones strong.

Which skin condition is caused by staphylococci, streptococci, or multiple bacteria?

impetigo, Impetigo is seen at all ages but is particularly common among children living under poor hygienic conditions. Scabies is caused by the itch mite. Pediculosis capitis is caused by head lice. Poison ivy is a contact dermatitis caused by the oleoresin given off by a particular form of ivy.

An expectant mother has arranged for her massage therapist to provide gentle hand, arm, and neck massage for the client while she is in labor in the hospital. Which trend in today's health care environment is most related to this arrangement?

increasing use of alternative treatment modalities. There is a growing tendency for families to use alternative forms of therapy, such as acupuncture or therapeutic touch, in addition to (or instead of) traditional health care measures. Nurses have an increasing obligation to be aware of complementary or alternative therapies such as these as they have the potential to either enhance or detract from the effectiveness of traditional therapy. The other answers do not pertain to the arrangement the client has made to have her massage therapist present at her labor.

Risky behaviors are

overeating with no exercise and riding with toddler in lap while driving

The nurse is educating a client suffering from advanced emphysema on how to improve expiratory flow rates. Which breathing technique would the nurse describe as most effective?

pursed lip breathing, Pursed-lip breathing would be the most effective method for improving expiratory pressures and therefore expiratory flow rates. This breathing technique increases expiratory airway pressure and therefore enables an increased exhalation volume by keeping the alveoli open. The client must also slow respirations to do this technique, which will also support an increased volume of air with exhalation. The other three breathing techniques are used for relaxation.

The nurse is discussing hippotherapy with the parents of a special needs child. Which statements indicate an understanding of the information provided? Select all that apply.

"It promotes the development of balance and better muscle strength." "Children commonly feel more confident with this type of therapy." "Physical therapists often work closely with children during this therapy." The unique movement of the horses in this type of therapy promotes increased balance and muscle strength. Children may experience increased confidence with this type of therapy. Physical therapists or psychotherapists can work with the child during hippotherapy. During hippotherapy, children ride and interact with horses under careful supervision.

The nurse educates a 15-year-old female client on ways to prevent pregnancy. Which statement will the nurse include in the teaching?

"The use of a condom is a method often recommended to prevent pregnancy for people your age." The nurse would state condoms as the best option for preventing pregnancy for this age group. Oral contraceptives are also effective but must be taken daily at approximately the same time. The withdrawal method is not effective, regardless of the number of sexual partners because sperm can be released before ejaculation occurs. An intrauterine device could be removed if the client desired pregnancy in the upcoming years.

The clinic nurse is assessing a 12-year-old client. The client reports having dandruff and asks the nurse what can be done for it. Which response by the nurse is best?

"Wash your hair with a gentle shampoo daily." In the older child and adolescent, a gentle shampoo should be used daily to control scaling caused by dandruff. A medicated shampoo may be indicated if shampooing with a gentle formula shampoo does not provide relief. Washing hair vigorously twice a day is not recommended. Warm baby oil is recommended for infants with cradle cap (seborrhea).

Key Points 1-2

1. Nurses have a significant responsibility for enhancing the health of individuals across the lifespan; this occurs in the context of a therapeutic relationship and requires skillful communication by the nurse. 2. Health promotion is a central focus of health care delivery that has been shown to add quality years of life and to decrease health care costs. 4. Health policy to eliminate health disparities aims to increase accessible health services, requiring communities to increase involvement.

The community health nurse is talking with four clients. Who does the nurse identify that would most benefit from teaching about alcohol and drug use?

19-year-old male college student majoring in physics. Young adults, particularly those who just became emancipated from parental supervision, are at the highest risk for alcohol and drug use. Other clients may have other safety risk factors, but are not at a proportionately higher risk for alcohol and drug use.

Health People 2020 Goals

Attain high-quality, longer lives free of preventable disease, disability, injury and premature death. Achieve health equity, eliminate disparities, and improve the health of all groups. Create social and physical environments that promote good health for all. Promote quality of life, healthy development, and healthy behaviors across all life stages. Healthy People 2020, retrieved from: www.healthypeople.gov

Cystic fibrosis is a condition passed on through which type of inheritance?

Autosomal recessive, Cystic fibrosis is an autosomal recessive inherited condition. Huntington disease is an example of an autosomal dominant inherited condition. Hemophilia is an X-linked recessive inherited condition. Cleft lip is a multifactorial inherited condition.

A client has undergone a mastectomy for breast cancer. Which instruction should the nurse include in the postoperative client teaching plan?

Elevate the affected arm on a pillow. When providing care to the client, the nurse should instruct the client to elevate the affected arm on a pillow. As part of the respiratory care, the nurse should instruct the client to turn, cough, and breathe deeply every 2 hours; rapid breathing is not encouraged. Active range-of-motion and arm exercises are necessary. To counter any pain experienced by the client, analgesics are administered as needed; intake of medication is not restricted.

Antecedents pt.2

Knowledge of Importance of Health Promotion Knowledge of Available Services for Health Promotion Access to These Services Ability to Incorporate Health Promotion Activities Readiness to Learn Value Health

A client in her 29th week of gestation reports dizziness and clamminess when assuming a supine position. During the assessment, the nurse observes there is a marked decrease in the client's blood pressure. Which intervention should the nurse implement to help alleviate this client's condition?

Place the client in the left lateral position. The symptoms experienced by the client indicate supine hypotension syndrome. When the pregnant woman assumes a supine position, the expanding uterus exerts pressure on the inferior vena. The nurse should place the client in the left lateral position to correct this syndrome and optimize cardiac output and uterine perfusion. Elevating the client's legs, placing the client in an orthopneic position, or keeping the head of the bed elevated will not help alleviate the client's condition.

A 71-year-old male client with a history of myocardial infarction (MI) and peripheral vascular disease (PVD) has been advised by his family physician to begin taking 81 mg aspirin once daily. Which statement best captures an aspect of the underlying rationale for the physician's suggestion?

Platelet aggregation can be precluded through inhibition of prostaglandin production by aspirin. Aspirin prevents platelet plug formation by inhibiting synthesis of prostaglandins that mediate clot formation. Aspirin does not influence ADP, TXA2 synthesis, or fibrinogen conversion.

Attributes

Progression toward optimum health Incorporation/adaptation of Health Promotion practices into daily activities.

Negative Outcomes

The nurse would evaluate for Negative Outcomes including illness and disease, obesity, physical and psychological stress, and impairment. The nurse would also evaluate the economic impact of illness/disease. When Negative Outcomes occur, the nurse must re-evaluate the antecedents with the goal of identifying which antecedent was not as strong as need or not in place. This re-evaluation may indicate that an appropriate intervention must take place to correct this.

Primary Prevention defintion

Those strategies aimed at optimizing health and disease prevention. What types of activities promote health? Health education - Nutrition Exercise Immunizations Stress management Alcohol in moderation Avoid toxins No smoking Other drugs Injury prevention - Car seats - Seat belts - Gun safety - Fall prevention

Secondary prevention

Those strategies aimed at promoting early detection and treatment of illness. Healthcare Screening - Health exams throughout the lifespan Dental assessments Obesity: calculate Body Mass Index (BMI) Blood pressure monitoring Type 2 Diabetes monitoring Lipid disorders Tobacco use Cancer screening Breast Colon Hearing/Vision screening Mental health screening Depression

How are primary and tertiary prevention strategies similar?

WELLNESS - Physical - Social - Intellectual - Spiritual - Ocupational

A nurse is performing passive range of motion to a client's upper extremities. The nurse touches the client's thumb to each fingertip on the same hand. The nurse is performing which of the following?

opposition. Opposition involves touching the thumb to each fingertip on the same hand. Adduction would involve moving the arm away from the midline of the body. Pronation involves rotating the forearm so that the palm of the hand is down. Dorsiflexion involves movement that flexes or bends the hand back toward the body.

Obesity Management

Nutrition Exercise Interprofessional collaboration Alignment of resources

Risk factors for Promoting Health

Overeating Being overweight Insufficient exercise Tobacco use Risky behaviors

Components of Wellness

Physical Environmental Spiritual Emotional Social Intellectual Occupational

Health Promotion principles

Self-responsibility Nutrition Exercise Stress management

Choose the nursing statement that would best reflect the final component of the "Ask-Tell-Ask-Close" technique of communication and demonstration.

"Can you repeat for me the information I just reviewed about weighing food portions?" The last component to the "Ask-Tell-Ask-Close" communication technique is "Close the Loop." This component recommends asking the patient to restate the information as the patient understands it.

The nursing student asks the instructor to explain what a community is. Which statement by the instructor would be inappropriate?

"Communities have few effects on the health of the individuals that live there." The health of the residents of a community is affected by several factors, including the social support systems, the community health structure, environmental factors, and types of agencies providing assistance for those in need of shelter, housing, and food. The other three statements are true.

A parent is concerned about spoiling a 2-month-old child by picking up the child each time the child cries. Which suggestion should the nurse offer?

"Continue to pick up the crying baby because young infants need cuddling and holding to meet their needs." The nurse should advise the parent to continue to pick up the crying infant because a young infant needs to be cuddled and held when crying. Because the infant's cognitive development isn't advanced enough to associate crying with getting attention, it would be difficult to spoil the infant at this age. Even if the diaper is dry, a gentle touch may be necessary until the infant falls asleep. Crying for 10 minutes wears an infant out; ignoring crying can make the infant mistrust caregivers and the environment. Infants cry for many reasons, not just when hungry, so the parent shouldn't assume the infant is crying from hunger.

The community health nurse wants to identify clients who have lifestyle factors that may place them at risk for sensory disturbances. Which question will the nurse ask?

"Do you work around loud noises at work?" Clients may be at risk for sensory disturbances for different reasons. Lifestyle factors include work or leisure activities that are potentially harmful to the eyes and ears, such as loud noises. Physiologic factors, such as diabetes and use of medications (chemotherapy), place clients at risk for sensory disturbances as well. Social and environmental factors include human and environmental stimulation (living by oneself).

A nurse discusses sleep-promoting strategies with a client who reports insomnia. Which strategy would the nurse suggest?

"Get out of the bed. Do something else for a while, and then return to bed." It is important that the bed and bedroom be identified with sleep and not with reading, watching television, or working. People who cannot fall asleep should be instructed to turn on the light and do something else outside the bed, preferably in another room.

Which clients at the clinic should be encouraged to receive the pneumococcal vaccine to minimize the risk of developing pneumococcal pneumonia? Select all that apply.

A 65-year-old diagnosed with chronic asthma. A resident of a long-term care facility with a smoking history A young adult with human immunodeficiency virus (HIV) positive results A school-age adolescent who is a liver transplant recipient A teenager with a history of kidney disease resulting in mild renal failure The pneumococcal vaccine is recommended for people 65 years of age or older and persons aged 2 to 65 years with chronic illnesses (particularly cardiovascular and pulmonary diseases, diabetes mellitus, and alcoholism), who sustain increased morbidity with respiratory infections. Immunization also is recommended for immunocompromised people 2 years of age or older, including those with sickle cell disease, splenectomy, Hodgkin disease, multiple myeloma, renal failure, nephrotic syndrome, organ transplantation, and HIV infection. Immunization is also recommended for residents in special environments or social settings in which the risk for invasive pneumococcal disease is increased (e.g., Alaskan Natives, certain Native American/First Nation populations) and for residents of nursing homes and long-term care facilities.

Healthcare Screening

Blood pressure monitoring: Obesity: Type 2 Diabetes monitoring: Lipid disorders: Tobacco use: Cancer screening

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

Chronic illnesses are the leading health problem in the world. Because chronic illnesses are the leading health problems in the world, health promotion and illness prevention activities are vital to nursing care. By endorsing health promotion and illness prevention, the nurse can assist the client to achieve optimal health even with a chronic illness. 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 reasons for promoting health and preventing illnesses.

The nurse is working with a 40-year-old pregnant woman about to undergo amniocentesis. The nurse provides appropriate education by stating that amniocentesis is performed for a prenatal diagnosis of which condition?

Cystic fibrosis, Amniocentesis is used for prenatal diagnosis of chromosomal and some genetic disorders, such as Down syndrome, cystic fibrosis, and Tay-Sachs disease. Amniocentesis is not used to diagnose diabetes, thalassemia, or cleft palate.

What is the best nursing intervention to promote health in a client at risk for heart disease?

Emphasizing a client's strengths to encourage weight loss, Nurses promote health by identifying, analyzing, and maximizing each client's own individual strengths as components of preventing illness, restoring health, and facilitating coping with disability or death. Emphasizing the client's strengths to encourage weight loss is the most effective way to promote this client's health. Informing the client that the client must lose weight would not help the client use his or her strengths to accomplish the goal. Low-sodium diets can prevent heart disease. Taking the pulse daily would not prevent heart disease.

Health Promotion Theories

Health belief model (Stretcher and Rosenstock) Health promotion model (Pender) Transtheoretical Model for Health promotion(Prochaska and DiClemente)

What is a current trend in child health care?

Health promotion rather than health restoration is stressed.It is recognized that keeping individuals well is more cost effective for a system than helping ill individuals return to wellness.

Healthy People 2020 Goals

Healthy People 2020 Goals include the following: a. Attain high-quality, longer lives free of preventable disease, disability, injury, and premature death. b. Achieve health equity, eliminate disparities, and improve the health of all groups. c. Create social and physical environments that promote good health for all. d. Promote quality of life, healthy development, and healthy behaviors across all life stages. Reference: Health People 2020, retrieved from: healthypeople.gov

The nurse in an outpatient rehabilitation program is speaking with a group of clients who have recently recovered from alcohol abuse. Which issue should the nurse raise before the clients leave for the day?

Help them to identify appropriate diversional activities. Clients in recovery typically have devoted much time to their addiction. Substance use is integral to their existence and occupies most of their leisure time. In some cases, it also takes up work and family time. During treatment, clients may find themselves lonely, bored, idle, or conflicted about what to do with so much "free" time. They need to plan activities to minimize the temptation to revert to alcohol or drug use.

Nursing Diagnosis

Risk-Prone Health Behavior Health-Seeking Behaviors Deficient Knowledge Readiness for Enhanced Immunization Status Readiness for Enhanced Nutrition Readiness for Enhanced

Sub-Concepts

Sub-concepts offer guidelines which support the occurrence of Health Promotion. Primary, secondary, and tertiary prevention offer effective stages of prevention to meet the patient's needs. The sub-concept of health literacy must be considered to assure that the patient is able to receive the information needed.

A 27-year-old client is a regular smoker, has diabetes, and has been diagnosed with hypertension. The client says it is cumbersome and time consuming to visit the doctor regularly just for a blood pressure check. Which aspect of teaching would the nurse use with this client?

Suggest the client purchase a self-monitoring cuff. Because this client finds it time consuming to visit the health care provider just for a blood pressure reading, the nurse can suggest the client use an automatic cuff at a local pharmacy or purchase a self-monitoring cuff. Discussing methods for stress reduction, advising a smoking cessation, and applying glycemic control would constitute client education in managing hypertension.

Which of the following tests confirms the diagnosis of myasthenia gravis (MG)?

Tensilon test, Edrophonium chloride (Tensilon) is an acetylcholinesterase inhibitor that stops the breakdown of acetylcholine. The drug is used because it has a rapid onset of 30 seconds and a short duration of 5 minutes. Immediate improvement in muscle strength after administration of this agent represents a positive test and usually confirms the diagnosis. The presence of acetylcholine receptor antibodies is identified in serum. Repetitive nerve stimulation demonstrates a decrease in successive action potentials. The thymus gland may be enlarged in MG, and a T scan of the mediastinum is performed to detect thymoma or hyperplasia of the thymus.

Interrelated Concepts

To support success, the nurse utilizes interrelated concepts focusing on the individual patient. Interrelated concepts that may be utilized include patient education, nutrition, safety, mobility, and communication.

The nurse is planning a prevention program for infectious mononucleosis. The best target audience for the program is:

college students living in a dorm. The best target audience for the program is college students living in a dorm because in developed countries, infectious mononucleosis principally occurs in adolescents and young adults. It spreads from person to person primarily through contact with infected oral secretions; therefore, it spreads easily in crowded conditions where there is considerable sharing of oral secretions.

After completing a class for new parents, the nurse notes the session is successful when the class recognizes the newborn should be bathed how often?

two or three times per week. Bathing two or three times weekly is sufficient for the first year; more frequent bathing may dry the skin.

A client with chronic obstructive pulmonary disease (COPD) expresses a desire to quit smoking. The first appropriate response from the nurse is:

"Have you tried to quit smoking before?" All the options are appropriate statements; however, the nurse needs to assess the client's statement further. Assessment data include information about previous attempts to quit smoking.

During a physical assessment of a 6-year-old child, the nurse observes the child has lost a tooth. The nurse uses the opportunity to promote oral health care with the child and parents. Which comment should the nurse include in this discussion?

"Oral health can affect general health." The nurse will advise the parents that poor oral health can have significant negative effects on systemic health. Discussing fluoridation and community health may have little interest to the mother. Placing the hands in the mouth exposes the child to pathogens and is appropriate for personal hygiene promotion. Soft drink consumption is better covered during healthy diet promotion.

A client with osteoarthritis expresses concerns that the disease will prevent the ability to complete daily chores. Which suggestion should the nurse offer?

"Pace yourself and rest frequently, especially after activities." A client with osteoarthritis must adapt to this chronic and disabling disease, which causes deterioration of the joint cartilage. The most common symptom of the disease is deep, aching joint pain, particularly in the morning and after exercise and weight-bearing activities. Because rest usually relieves the pain, the nurse should instruct the client to rest frequently, especially after activities, and to pace oneself during daily activities. Telling the client to do chores in the morning is incorrect because the pain and stiffness of osteoarthritis are most pronounced in the morning. Telling the client to do all chores after performing morning exercises or in the evening is incorrect because the client should pace oneself and take frequent rests rather than doing all chores at once.

Antecedents

Antecedents found on the Health Promotion diagram address what must be present prior to health promotion taking place. These could be categorized as assessments of the patient including knowledge and readiness to learn plus assessing the value of health to the patient. The nurse must assess the patient's access to services supporting Health Promotion as well as the patient's ability to incorporate health promotion activities. If the antecedents are satisfactorily met, then Health Promotion can occur. This success is measured by the attributes found on the Health Promotion diagram. The nurse evaluates the patient's progress toward optimal health by incorporation/adaptation of Health Promotion practices into daily activities.

Health Promotion

Any activity undertaken for the purpose of achieving a high level of health and well-being. Any activity undertaken for the purpose of achieving a high level of health and well-being.

The nurse is developing a plan of care for a 65-year-old client who has significant hearing loss. The nurse will include which suggestions that can assist this older adult with hearing loss? Select all that apply.

Being evaluated for hearing aids/devices Investigating TV stations with closed captioning available Flashing alarms instead of high-frequency warning sounds The hearing loss associated with older adults is called presbycusis and is typically gradual, bilateral, and characterized by high-frequency hearing loss. It is further characterized by reduced hearing sensitivity and speech understanding in noisy environments, slowed central processing of acoustic information, and impaired localization of sound sources. High-frequency warning sounds, such as beepers, turn signals, and escaping steam, are not heard and localized, with potentially dangerous results. In mild to severe hearing loss, the most effective treatment is hearing amplification with hearing aids, lip reading, and assistive listening devices (e.g., hearing aids with the telephone, captioning on televised programs, flashing alarms). It is not necessary for round-the-clock home health care or for daily ear drops.

An elderly client reports fatigue without shortness of breath with walking 30 minutes five times each week. The nurse assesses the resting heart rate as 72 beats per minute; 10 minutes after walking, the client's heart rate is 92 beats per minute. What should the nurse instruct the client to do next?

Continue to walk at his current level. Elderly clients may report fatigue with increased activity as a result of a slower heart rate recovery, which may be a physiological response to aging. An appropriate nursing intervention is to educate the client to exercise regularly but also to pace activities. The nurse does not want to tell the client not to exercise, to walk faster, or to decrease frequency.

A 46-year-old obese client has been diagnosed with hypertension and type 2 diabetes. The client acknowledges the need to lose weight. The client recently visited a local fitness club, obtained a membership, and has signed up for their next water aerobics class. According to the Transtheoretical Model of Change, what stage of change is this client in related to her weight loss?

Preparation,This client is in the preparation stage, as the client is actively making changes to lose weight. During the precontemplation stage, the client is not even thinking about or considering making a change. During the contemplation stage, the client is considering making a change. During the preparation stage, the client has decided to make a change and is preparing for it. During the maintenance stage, the client attempts to maintain the change in lifestyle begun in an earlier stage.

The nurse will place a client who is to receive a hypertonic enema solution into which position for ease of administration?

Sims, Sims position is appropriate as it promotes gravity distribution of the solution. Other choices are incorrect positions.

A nurse is providing care to a client who has come to the outpatient clinic for chemotherapy. The client tells the nurse that to cope with the stress of chemotherapy, he uses a technique in which he "goes to my happy place, the beach, and I picture myself lying there under the warm sun, with the sound of the waves lapping at the shore." The nurse interprets this as which technique?

guided imagery, Guided imagery focuses on evoking pleasant images to replace negative or stressful feelings and to promote relaxation. It involves using all five senses to imagine an event or body process unfolding according to a plan. During a painful or stressful event, the client can "go to a favorite place" and imagine being there with all the pleasant experiences related to that space. Meditation refers to a group of techniques in which the person learns to focus attention. Tai chi is a martial art, mind-body practice that involves physical movement, mental focus, deep breathing and relaxation. Yoga is a mind-body practice that involves the combination of physical movements, breathing practices, and relaxation techniques.

Which would be an appropriate intervention to help a client regain, maintain, or improve psychological well-being?

Teach problem solving, stress reduction, coping, and proper interpersonal communication skills. A general intervention directed toward achieving the goals of psychiatric home care nursing includes: helping clients and family members or caregivers learn skills of problem solving, stress reduction, coping, and proper interpersonal communication; helping clients and family members or caregivers understand mental illness and how to monitor signs of relapse, medication effects, and medication side effects; providing respite and community resources to family members and caregivers; and coordinating and integrating clients' medical, social, spiritual, vocational, and other community-based services, as well as teaching clients and families to do so.