Chapter 3: Health, Wellness, and Health Disparities

A nurse is caring for a client who has COPD, a chronic illness of the lungs. The client is in remission. Which statement best describes a period of remission in a client with a chronic illness? A. Symptoms are not experienced. B. The symptoms of the illness reappear. C. New symptoms occur at this time. D. The disease is no longer present.

A. Symptoms are not experienced. Chronic illnesses usually have a slow onset and many have periods of remission (the disease is present but the client does not experience symptoms). Exacerbation is when the symptoms of the disease reappear. Chronic illnesses do not go away; the disease continues to be present.

Which model is most useful in examining the cause of disease in an individual, based upon external factors? A. The Health Belief Model B. The High-Level Wellness Model C. The Agent-Host-Environment Model D. The Health-Illness Continuum

C. The Agent-Host-Environment Model The Agent-Host-Environment Model is useful for examining the cause of disease in an individual. The agent, host, and environment interact in ways that create risk factors. The Health-Illness Continuum is a way to measure a person's level of health. The High-Level Wellness Model is characterized by functioning to one's maximum potential while maintaining balance and purposeful direction in the environment. The Health Belief Model is used to describe health behaviors.

The nurse is caring for a 46-year-old client recovering from a substance abuse disorder, who is admitted with suspected liver disease based on jaundiced skin and right upper quadrant tenderness. The laboratory results reveal the client is positive for hepatitis C. How would the client's current condition be classified? A. primary B. hereditary C. secondary D. idiopathic

C. secondary A secondary condition is a disorder that develops from a preexisting condition; in this case liver failure due to hepatitis C infection possibly related to the use of contaminated needles from the substance abuse disorder. A primary illness develops independently of any other disease. A hereditary disease is acquired from genetic codes of one or both parents, and an idiopathic illness is an illness of unknown cause.

The recognition of health as an ongoing process toward a person's highest potential of functioning is defined as: A. health belief model. B. illness. C. agent-host-environment. D. high-level wellness.

D. high-level wellness. High-level wellness is defined as recognizing health as an ongoing process toward a person's highest potential of functioning. The Health Belief Model focuses on how the client's beliefs about health influence the client's health and response to health and health care. Illness is a person's response to disease. the Agent-Host-Environment model explores the factors that contribute to infection in a client.

The nurse should identify the need for further teaching when the client with diabetes who is taking daily insulin and follows a strict diet makes which statement? A. "I cannot possibly ever be considered as healthy." B. "I can achieve a maximum level of functioning." C. "I can achieve a high quality of health and life." D. "I have an illness, but I can feel as if I am healthy."

A. "I cannot possibly ever be considered as healthy." The statement that describes the client as never being able to be considered healthy is incorrect. One who has an illness or injury can still achieve maximum functioning and consider oneself to be healthy. One who has a chronic illness can also achieve a quality of life that is acceptable as one works on achieving a satisfying health standard.

The nurse in a free clinic caring for clients uses the Health Belief Model, which is based on three components. What is the main focus for this model? A. What people believe to be true about their health B. Factors that predispose a person to infectious diseases C. How health is a constantly changing state D. How people interact with their environments

A. What people believe to be true about their health The Health Belief Model focuses on what people perceive or believe to be true about themselves in relation to their health. The Health Promotion Model focuses on how people interact with their environments, as they pursue health. The Health-Illness Continuum Model focuses on health as a constantly changing state, whereas The Agent-Host-Environment Model explains how certain factors place a person at risk for an infectious disease.

Which are factors that impact how a client defines health? Select all that apply. A. Community B. Culture C. Music D. Society E. Family

A, B, D, E. Each client defines health in terms of the client's own values and beliefs. The person's family, culture, community, and society also influence this personal perception of health. Music does not affect how a person defines health.

Which are characteristics of chronic conditions? (Select all that apply.) A. Have a prolonged course B. Resolve spontaneously C. Are rarely curable D. Require lifelong management E. Have a rapid onset

A, C, D. Chronic conditions typically have a slower onset and prolonged course, do not resolve spontaneously, are rarely curable, and require lifelong management. Acute conditions typically have a rapid onset and short course and resolve spontaneously or are curable.

Risk factors for illness are divided into six categories. Working with carcinogenic chemicals is an example of which type of risk factor? A. Environmental risk factor B. Lifestyle risk factor C. Physiologic risk factor D. Health habits risk factor

A. Environmental risk factor Working and living environments may contribute to disease. Working with cancer-causing chemicals is an example of an environmental risk factor for illness. Physiologic risk factors are those relating to an individual's body or biology. Lifestyle risk factors are habits or behaviors people choose to engage in. A health habit risk factor is any attribute, characteristic, or exposure of an individual that increases the likelihood of developing a disease or injury.

Which is an example of tertiary health promotion? A. Pap tests B. Water treatment C. Family counseling D. Rehabilitation

D. Rehabilitation Tertiary health promotion and disease prevention begin after an illness is diagnosed and treated to reduce disability and to help rehabilitate clients to a maximum level of functioning. Therefore, rehabilitation is an example of tertiary health promotion. Family counseling and Pap tests are examples of secondary health promotion. Water treatment is an example of primary health promotion.

A teenaged client reports having diarrhea before every test in school. The nurse recognizes that this client needs to focus on which dimension of health? A. Sociocultural dimension B. Intellectual dimension C. Physical dimension D. Emotional dimension

D. Emotional dimension This is an example of the emotional dimension. Long-term stress affects body systems, and anxiety affects health habits. The intellectual dimension encompasses cognitive abilities and past experiences, whereas the physical dimension includes factors such as genetics, gender, and race. The sociocultural dimension relates to a client's economic level, lifestyle, family, and culture.

A 48-year-old client was just diagnosed with type 2 diabetes mellitus. The client has a body mass index of 35 and leads a sedentary lifestyle. The nurse informs the client of risk factors for the diagnosis and the need to change diet and exercise behavior. Which client statement indicates a need for further teaching? A. "There is nothing that can be done anyway; chronic diseases cannot be prevented." B. "I need to start slow on an exercise program approved by my healthcare provider." C. "The major causes of chronic diseases are known." D. "Over 80% of cases of type 2 diabetes could be prevented if the risk factors were eliminated."

A. "There is nothing that can be done anyway; chronic diseases cannot be prevented." The major causes of chronic diseases are known, and if these risk factors were eliminated, over 80% of cases of heart disease, stroke, and type 2 diabetes would be prevented and over 40% of cases of cancer would be prevented. Of the ten leading causes of death in the United States, seven are chronic illnesses. The statement that the client should start slow on an exercise program approved by the client's healthcare provider is true.

Which definition of health is the best? A. Health is a state of complete well-being. B. Health is the absence of disease. C. Health is the lack of physical symptoms. D. Health is how people feel.

A. Health is a state of complete well-being. A classic definition of health is that health is a state of complete physical, mental, and social well-being, not merely the absence of disease or physical symptoms. Health encompasses a state of mind and not just how a client feels.

Chronic illness may be characterized by periods of remission. Remission is best defined as: A. the response of a person to a disease. B. the presence of a disease with the absence of symptoms. C. the reappearance of symptoms of a disease. D. a pathologic change in the structure of function of the body or mind.

B. the presence of a disease with the absence of symptoms. Remission is defined as the presence of a disease, but the person does not experience the symptoms. Exacerbation is the reappearance of symptoms of a disease. Disease is a pathologic change in the structure of function of the body or mind. Illness is the response of a person to a disease.

Which client growth needs are included in the love and belonging level of Maslow's hierarchy? (Select all that apply.) A. Self-respect B. Intimacy C. Friendships D. Status E. Family

B, C, E. Love and belonging includes the need for affection, belonging, and meaningful relations with others (family, intimacy, friendships). Self-esteem includes self-respect and status.

A hospital nurse assesses clients in various stages of illness. Which statements accurately describe client responses to illness based on Suchman's stages of illness? Select all that apply. A. In stage 2, most people focus on their symptoms and bodily functions. B. In stage 1, the person defines himself or herself as being sick, seeks validation of this experience from others, and gives up normal activities. C. Most clients complete the final stage of illness behavior in the hospital or a long-term care setting. D. In stage 1, pain is the most significant symptom indicating illness, although other symptoms, such as a rash, fever, bleeding, or cough, may be present. E. When a client decides to accept a diagnosis and follow a prescribed treatment plan, he or she is in stage 4, achieving recovery and rehabilitation. F. When help from a health care provider is sought, the person becomes a client and enters stage 3, assuming a dependent role.

A, D, F. 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. Stage 1 is experiencing symptoms, but the client does not define himself or herself sick until Stage 2. Stage 2 is assuming the sick role, focusing on the symptoms and bodily functions. Stage 3 is assuming the dependent role, accepting the diagnosis and following the prescribed treatment plan. Stage 4 is achieving recovery and rehabilitation. This can occur in a variety of health care settings, including the home setting.

A nurse is immunizing children against measles. This is an example of what level of preventive care? A. Primary B. Tertiary C. Chronic D. Secondary

A. Primary Primary health promotion and illness prevention are directed toward promoting health and preventing the development of disease processes or injury. Immunizations are an example of primary health promotion. Secondary health promotion and illness prevention focus on screening for early detection of disease, with prompt diagnosis and treatment of any found. Tertiary health promotion and illness prevention begin after an illness is diagnosed and treated, with the goal of reducing disability and helping rehabilitate clients to a maximum level of functioning. The term chronic is not related to health promotion.

The nurse's community outreach class is giving a presentation on seat belts and child safety seats at the local firehouse every weekend in October. Which level of health promotion is this an example of? A. Primary B. Medical C. Secondary D. Tertiary

A. Primary 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. Secondary-level activities include screening programs and early identification of disease. Tertiary-level prevention is concerned with returning the client to the optimal function after diagnosis. Medical is not a level of health promotion or illness prevention.

A client has had a total knee replacement and is receiving care that includes learning to walk with a walker. What level of prevention is most applicable to this client? A. Tertiary prevention B. Residual prevention C. Primary prevention D. Secondary prevention

A. Tertiary prevention Tertiary prevention in health care deals with rehabilitation of the client. Teaching the client to walk with a walker is tertiary prevention. Primary prevention refers to health promotion or illness prevention. Secondary prevention refers to screening and early detection of disease.

The nurse is addressing primary prevention with a group of college students. Which promotional statement by the nurse would be the best example of a developmentally appropriate discussion? A. Use of condoms can help prevent sexually transmitted infections and unwanted pregnancy. B. Annual Papanicolaou test can detect cancer earlier. C. Testicular examinations for male students can detect early stages of cancer. D. HIV screening should be done on an annual basis if you are sexually active.

A. Use of condoms can help prevent sexually transmitted infections and unwanted pregnancy. Safer sex practices, which include the use of condoms, are an example of primary prevention measures. HIV screening, annual Papanicolaou test, and testicular examinations are secondary prevention measures, which are usually screening measures. The nurse should discuss health practices that are most relevant to the developmental level of the audience, in this case college age students.

Which nursing intervention is an example of tertiary preventive care? A. Administration of immunizations to a 6-month-old child B. Assisting with speech therapy a client with a traumatic brain injury C. Blood pressure screenings at a senior center D. Teaching stress reduction classes at a wellness center

B. Assisting with speech therapy a client with a traumatic brain injury Tertiary prevention begins after the illness and is used to help rehabilitate clients. Speech therapy is an example of tertiary preventive care. The administration of immunizations and teaching stress reduction classes are examples of primary preventive care. Blood pressure screening is an example of secondary preventive care.

The nurse is preparing to talk to a local community group regarding chronic illness. The nurse informs the group that both external and internal factors influence a person's health. When discussing the fact that the male client has a higher chance of developing lung cancer due to his gender, which dimension is the nurse referring to? A. Environmental dimension B. Physical dimension C. Intellectual dimension D. Emotional dimension

B. Physical dimension The physical dimension includes genetic inheritance, age, developmental level, race, and gender. These components strongly influence the person's health status and health practices. Since lung cancer is more frequent in men, the male client is at a higher risk of developing lung cancer due to his gender. Emotional dimension refers to feelings. Intellectual dimension is cognitive ability. Environmental dimension is related to a client's environment, including work and school.

The client is admitted with a gastrointestinal bleed. The physician ordered a colonoscopy. Which level of care encompasses this procedure? A. Quaternary B. Secondary C. Primary D. Tertiary

B. Secondary Secondary care delivery is when primary caregivers refer clients for consultation and additional testing. Therefore, this scenario portrays secondary level of care. Primary care delivery is provided by the first healthcare provider or agency a person contacts. Quaternary care is an extension of tertiary care and includes experimental medicine and procedures and highly uncommon, specialized surgeries. Tertiary care is health services provided at hospitals or medical centers that have complex technology and specialists.

Consultation and diagnostic tests are included in which level of health care? A. Tertiary care B. Secondary care C. Extended care D. Primary care

B. Secondary care 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.

What have the models of health promotion and illness prevention been used for? A. To formulate care plans for the disabled population. B. To help health care providers understand health-related behaviors. C. To create a forum for improving rehabilitative care. D. To define a medical framework for the care of the disabled.

B. To help health care providers understand health-related behaviors. 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.

A pregnant client at 10 weeks' gestation is receiving education by the nurse about the importance of abstaining from alcohol while pregnant. What statement made by the client demonstrates an understanding of the education provided? A. "If I drink alcohol while pregnant, my child will have a hereditary disorder." B. "Alcohol use while pregnant will predispose my child to idiopathic illness." C."I should abstain from alcohol to prevent the development of a fetal alcohol spectrum disorder." D. "Abstaining from alcohol will prevent any type of congenital disorder."

C. "I should abstain from alcohol to prevent the development of a fetal alcohol spectrum disorder." Congenital disorders such as fetal alcohol spectrum disorders may be prevented by the client abstaining from alcohol while pregnant. Fetal alcohol spectrum disorders are congenital disorders caused by an undetermined amount of alcohol ingested by the mother which affects the fetus in the developmental stages of growth. Abstaining from alcohol will not prevent all types of congenital disorders, but clients should be educated about a variety of preventative measures in order to prevent interruption of the growth and development of the fetus. An idiopathic illness is one in which the cause is undetermined. A hereditary disorder is genetic and not altered by substance intake during pregnancy.

What is the definition of wellness? A. Being without disease B. A desire to be without disease C. An active state of being healthy D. Maximizing the state in which you live

C. An active state of being healthy Wellness, a reflection of health, is an active state of being healthy by living a lifestyle that promotes good physical, mental, and emotional health. It is not simply an absence of disease or a desire to be without disease, nor is it maximizing the state in which one lives.

A client has a Staphylococcus infection in a decubitus ulcer. In this case, Staphylococcus is the: A. disease. B. environment. C. agent. D. host.

C. agent. The agent is any factor that leads to illness. The client is the host of the infection. The environment is setting in which the infection occurs. The disease is a pathological process that can result from the infection.

When chronic illnesses and disabilities are present, individuals benefit most from activities that: A. help them eat well. B. accomplish financial stability. C. help them maintain independence. D. preserve their social interactions.

C. help them maintain independence. Although their chronic illnesses and disabilities cannot be eliminated, adults can benefit most from activities that help them maintain independence and achieve an optimal level of health. The other answers, while beneficial, are not as helpful.

A nurse refers an HIV-positive client to a local support group. This is an example of what level of preventive care? A. Secondary B. Primary C. Chronic D. Tertiary

D. Tertiary Tertiary health promotion and illness prevention begins after an illness is diagnosed and treated, with the goal of reducing disability and helping rehabilitate clients to a maximum level of functioning. Referring an HIV-positive client to a local support group would be an example of tertiary preventive care. Primary health promotion and illness prevention are directed toward promoting health and preventing the development of disease processes or injury. Secondary health promotion and illness prevention focus on screening for early detection of disease, with prompt diagnosis and treatment of any found. The term chronic is not related to health promotion.

A client comes to the emergency room complaining of abdominal pain, fever, chills, and nausea. Upon further examination the client is diagnosed with appendicitis. What type of illness does the nurse identify this client to have? A. Acute B. Chronic C. Contagious D. Tertiary

A. Acute Acute illness has a rapid onset and lasts only a short time. Chronic illness is a term that encompasses many different physical and mental alterations in health, and usually requires a long period of care and support. Appendicitis is not contagious. Tertiary is not a term used for illnesses.

Which needs are being met when a nurse recommends a senior citizen community center for an older client who is living alone? A. Intellectual needs B. Spiritual needs C. Sociocultural needs D. Emotional needs

C. Sociocultural needs Increased social interaction, as would be provided by visiting a senior citizen community center, would primarily address a client's sociocultural needs. Emotional needs address how the mind affects body functions and responds to body conditions. Long-term stress affects body systems, and anxiety affects health habits; conversely, calm acceptance and relaxation can actually change the body's responses to illness. The intellectual dimension encompasses cognitive abilities, educational background, and past experiences. Spiritual beliefs and values are assessed when addressing spiritual needs.

After passage of the Affordable Care Act (ACA) the nurse was able to suggest a new option for health insurance to the clients who were previously uninsured due to the high costs. Which option could the nurse now recommend to the clients? A. Medigap B. Medicare C. Tricare D. marketplace

D. marketplace Health insurance marketplaces are state organizations that provide a means for individuals or certain employers to purchase affordable private health insurance under ACA provisions. This insurance lowered premiums and out-of-pocket expenses for people with low or modest incomes by providing financial assistance subsidies. Tricare is a plan available for individuals in the military. Medigap is an additional plan to help with costs not covered by Medicare. Medicaid is a federally-funded, state-run insurance program for low-income individuals.

The nurse is caring for a client with a diagnosis of heart failure. This admission is the client's third admission within 90 days. The nurse educates the client with the goal of preventing readmission. Which nursing activity for this client would represent tertiary level prevention? A. Teaching about adhering to a low-sodium diet B. Screening for breast cancer every 5 years C. Screening for tuberculosis D. Assessing for risk factors for heart disease

A. Teaching about adhering to a low-sodium diet Tertiary health promotion and illness prevention begins after an illness is diagnosed and treated, with the goal of reducing disability and helping rehabilitate the client to a maximum level of functioning. Nursing activities on a tertiary level include teaching a client with heart failure the importance of adhering to a low-sodium diet. Primary prevention is directed toward promoting health and preventing the development of disease processes or injury. This client has a diagnosis. Secondary health promotion and illness prevention focus on screening for early detection of disease with prompt diagnosis and treatment of diseases found.

When providing care to a client, the nurse integrates knowledge that a client's beliefs and actions are related and influenced by the client's personal expectations in relation to health and illness. The nurse is demonstrating an understanding of which health model? A. High-level wellness model B. Holistic health model C. Health belief model D. Clinical model

C. Health belief model According to the health belief model, a client's beliefs and actions are related and influenced by the client's personal expectations in relation to health and illness. According to the clinical model, health is defined narrowly as the absence of signs and symptoms of disease or injury. The holistic model views individuals as ever-changing systems of energy, and the interaction of a person's mind, body, and spirit within the environment. The high-level wellness model is the recognition of health as an ongoing process toward a person's highest potential of functioning.

A nurse is planning a health fair in the community to highlight promotion and prevention of the leading cause of death in the United States. Which disease process should the nurse address? A. Emphysema B. Cerebrovascular accidents C. Lung cancer D. Coronary artery disease

D. Coronary artery disease Heart disease is the leading cause of death in the United States. Lung cancer, emphysema, and cerebrovascular accidents are not the leading causes of death in the United States.

The body's attempt to restore balance through self-regulatory mechanisms is termed: A. equilibration. B. biofeedback. C. self-conception. D. homeostasis.

D. Homeostasis Homeostasis is the organism's attempt to restore balance. Equilibration is a distractor for this question. Self-conception is related to the individual's feelings and attitudes about oneself. Biofeedback is a relaxation technique.

The nurse working in the community is assigned to the care of several clients. Which client(s) may require assistance to overcome barriers to accessing adequate care? Select all that apply. A. a student entering a local university B. a client who is a migrant and works on a farm C. an employed woman, pregnant for the second time D. a client who has been unemployed for 6 months E. an older adult client living independently

B, D, E. Everyone, regardless of age, gender, level of education, religion, sexual orientation, ethnic origin, social position, or wealth, is entitled to equal services for sustaining health. Disparities exist among various groups, including the poor, such as unemployed clients; racial and ethnic minorities, such as migrant farm workers; those affected by gender differences; older adults; and people with disabilities. Students entering a university and employed pregnant mothers are not categorically at risk for health disparities.

The nurse is caring for a client admitted to the hospital with pneumonia and associated pleuritic chest pain. Which would be a priority when creating the nursing care plan? A. Effective infection control measures. B. Monitoring airway clearance. C. Effective pain management. D. Monitoring fluid intake and output.

B. Monitoring airway clearance. Priority management, according to Maslow's hierarchy, starts at physiological needs, such as the need for oxygen, food, water, rest, and elimination. Therefore, difficulty breathing is the priority issue that the nurse must manage because it affects the ability of the client to get adequate oxygen. Symptoms such as pain, thirst, and needing to urinate, although important, are not a priority over difficulty breathing. Likewise, infection control is important but is not priority.

What are some examples of healthy self-care behaviors everyone should adopt? Select all that apply. A. Having a low self-esteem B. Exercising infrequently C. Maintaining an ideal body weight D. Eating regular healthy meals E. Sleeping 7 to 8 hours each night

C, D, E. Some self-care behaviors that everyone should adopt to promote health are: sleeping 7 to 8 hours regularly, eating regular and healthy meals, maintaining an ideal body weight, having a regular schedule of exercise, using alcohol in moderation if at all, not smoking, and maintaining a positive self-concept.

Why are health promotion and illness prevention a key responsibility of nurses? A. People do not like to be sick and feel bad. B. Chronic illnesses can cause pain and suffering. C. Chronic illnesses are the leading health problem in the world. D. Treatment of chronic illnesses is very expensive.

C. 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.

A client has been admitted to the hospital for the treatment of diabetic ketoacidosis, with a random blood glucose reading of 575 mg/dL (31.91 mmol/L), vomiting, and shortness of breath. This client has experienced which phenomenon? A. Infection B. Morbidity C. Exacerbation D. Risk factor

C. Exacerbation This client has experienced a significant exacerbation of a chronic disease (diabetes mellitus), which has manifested as an acute threat to the client's health. Morbidity is an epidemiological statistic of the frequency of a disease. The client's problem does not have an infectious etiology. A risk factor is any attribute, characteristic, or exposure of an individual that increases the likelihood of developing a disease or injury.

A client with chronic obstructive pulmonary disease (COPD) is admitted to the hospital for the second time in 2 months with wheezing, dyspnea, and use of accessory muscles when breathing. Which type of situation does the nurse identify is occurring with this client? A. This is the effect of a secondary illness. B. The client is experiencing remission of the COPD. C. The client is experiencing the effects of a terminal illness. D. The client is having an exacerbation of the COPD.

D. The client is having an exacerbation of the COPD. COPD is a chronic illness that has periods when the client goes from a chronic state to an acute state such as an acute onset of symptoms. The client will experience periods of exacerbation according to certain precipitating circumstances. Remission occurs in illnesses such as cancer when the symptoms or clinical manifestations disappear. A secondary illness is caused by complications from a primary illness. Clients with a terminal illness have no hope of recovery.