Chapter 3: Health, Wellness, and Health Disparities (Combined)
Which nursing activity reflects secondary prevention?
Making a referral for a mammogram Explanation: Secondary prevention involves screening for early detection of disease, such as a mammogram. Discussions about wearing helmets, using seat belts, and drugs and alcohol are all examples of primary prevention, which focuses on promoting health and preventing disease.
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?
Symptoms are not experienced. Explanation: 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.
The nurse is planning care for several clients in an outpatient clinic. Which client requires follow-up care due to a chronic condition?
A client with chronic obstructive pulmonary disease (COPD) who is wheezing and coughing Explanation: Chronic illnesses have expected symptoms, such as the client with COPD who has damage to the lungs that cannot be reversed. Symptoms of this chronic condition include shortness of breath, wheezing, and a chronic cough. The other clients all have new or recent injuries that are acute in nature and require immediate care rather than long-term follow-up (note that diabetes mellitus, although a chronic condition itself, can be associated with complications that are acute, such as an injury to the toes).
What level of prevention is represented by educating a group of clients on carseat safety?
Primary prevention Explanation: Primary prevention focuses on the health of a person with the goal of preventing disease or illness. Carseat safety education is primary prevention. Secondary prevention refers to screening and early detection of disease. Tertiary prevention refers to rehabilitation and prevention of complications after diagnosis with a disease. Educational is not a level of prevention.
The nurse is certified in providing Therapeutic Touch and is preparing to initiate this for a client. What activity should the nurse perform initially?
Requesting the client's permission to touch 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.
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?
"There is nothing that can be done anyway; chronic diseases cannot be prevented." Explanation: 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 behaviors are necessary for a person to successfully adapt to a chronic illness? Select all that apply. -Learn to live as normally as possible -Accept dependence and adjust to it -Maintain a positive self-concept -Maintain a sense of hope -Give up control of one's life
-Learn to live as normally as possible -Maintain a positive self-concept -Maintain a sense of hope 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. The client needs to maintain independence and not dependence on chronic illness outcomes.
Which are characteristics of chronic conditions? (Select all that apply.)
Are rarely curable Require lifelong management Have a prolonged course Explanation: 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.
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.
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.
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?
Coronary artery disease Explanation: 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.
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?
Emotional dimension Explanation: 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.
Which of these is not a factor in the Agent-Host-Environment Model of health and illness, as developed by Leavell and Clark (1965)?
Evil spirit Explanation: In the Agent-Host-Environment Model of health and illness as developed by Leavell and Clark (1965), an agent is an environmental factor or stressor that must be present or absent for an illness to occur. The factor may be bacteria, virus, chemical substance, or a form or radiation whose presence, excessive presence, or absence is necessary for an illness to take hold. Evil spirits do not play into this particular model of health and illness.
Which are factors that impact how a client defines health? Select all that apply.
Family Culture Community Society Explanation: 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.
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." Wellness is a dynamic and conscious process of making choices to achieve one's highest level of potential. Holism is care that addresses all dimensions of a person, including mind, body, and spirit. Host is the person who experiences an infection.
Which definition of health is the best?
Health is a state of complete well-being. Explanation: 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.
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?
Monitoring airway clearance. Explanation: 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.
A nurse is immunizing children against measles. This is an example of what level of preventive care?
Primary Explanation: 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.
Consultation and diagnostic tests are included in which level of health care?
Secondary care 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 referral 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 are some examples of healthy self-care behaviors everyone should adopt? Select all that apply.
Sleeping 7 to 8 hours each night Eating regular healthy meals Maintaining an ideal body weight Explanation: 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.
A nurse refers an HIV-positive client to a local support group. This is an example of what level of preventive care?
Tertiary Explanation: 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.
Which model is most useful in examining the cause of disease in an individual, based upon external factors?
The Agent-Host-Environment Model Explanation: 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 dir
What have the models of health promotion and illness prevention been used for?
To help health care providers understand health-related behaviors. 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.
The emergency department nurse is preparing a care plan for a young child who has suffered a fractured arm after a bicycle accident. Which factor should the nurse consider including in the care plan for this child to best address this issue?
applying for Children's Health Insurance Program (CHIP) Explanation: This child may be at risk of not being covered by medical insurance. CHIP is a government funded health care option which can help pay for these expenses as well as provide coverage for future health needs. Update immunizations and assessing nutritional needs would be handled after assuring the client is receiving appropriate care for the fracture. Visits from a home health nurse would not necessarily be a priority or necessity.
When chronic illnesses and disabilities are present, individuals benefit most from activities that:
help them maintain independence. Explanation: 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 is providing care for client who experienced a stroke. Which nursing intervention reflects the tertiary level of prevention?
provide care transition at discharge for speech therapy Explanation: Tertiary prevention minimizes the consequences of a disorder through aggressive rehabilitation or appropriate management of the disease. An example is speech therapy to help restore ability. Blood pressure and mental status exams are examples of secondary prevention associated with the acute stroke. Discussing family history is also secondary prevention in terms of assessing for further risk factors.
Chronic illness may be characterized by periods of remission. Remission is best defined as:
the presence of a disease with the absence of symptoms. Explanation: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 nursing intervention is an example of tertiary preventive care?
Assisting with speech therapy a client with a traumatic brain injury Explanation: 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.
Which is the most accurate definition of health?
Health is a state of complete physical, mental, and social well-being. Explanation: Health is viewed as a state of complete physical, mental, and social well-being, not merely the absence of disease or infirmity. The other options would not be the best definition of health.
A client is admitted to the mental health center with attempted suicide. Which of the client's problems is the priority for the nurse to manage?
Risk of self-harm Explanation: Safety and security are the priority for the client, so the risk of self-harm is what the nurse must address first. Lack of support, low self-esteem, and feelings of not belonging, although still important to address, are not as critical as safety and security.
The body's attempt to restore balance through self-regulatory mechanisms is termed:
homeostasis. Explanation: 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.
A community health nurse arranges for a dentist to teach local children in the school district how to properly brush their teeth. Which goal will the nurse set for this event?
health promotion Explanation: The education on lifestyle choices is part of health promotion activity, which focuses on protecting the person's health. Brushing one's teeth is a lifestyle choice. 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.
Which are characteristics of chronic conditions? (Select all that apply.) -Are rarely curable -Require lifelong management -Have a prolonged course
-Are rarely curable -Require lifelong management -Have a prolonged course Explanation: 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.
A group of nurses is participating in a community health fair and is engaged in primary prevention activities. Which activities would these nurses be leading? Select all that apply. -Family planning services -Accident prevention education -Heart-healthy nutrition services -Skin cancer screening -Rehabilitation for relief of low back pain
-Family planning services -Accident prevention education -Heart-healthy nutrition services Explanation: Primary health promotion and illness prevention are directed toward promoting health and preventing the development of disease processes or injury. Examples of primary-level activities are immunization clinics, family planning services, providing poison control information, and accident prevention education. Other nursing interventions include teaching about a healthy diet, the importance of regular exercise, safety in industry and farms, using seat belts, and safer sex practices. Screenings are a major activity in secondary health promotion. Rehabilitation is associated with tertiary health promotion.
The nurse is using Leavell and Clark's Agent-Host-Environment Health Model to help plan nursing interventions for clients in a hospital setting. Which examples of nursing actions to prevent hospital-acquired infections (HAIs) best illustrate the principles of this model? Select all that apply. -The nurse should assess the clients for risk factors for infection when planning nursing care. -The nurse should consider the client's family history and age when assessing risk factors for infection. -The nurse should examine environmental stressors in clients' lives to see how these stressors might affect their recovery and ability to ward off infection.
-The nurse should assess the clients for risk factors for infection when planning nursing care. -The nurse should consider the client's family history and age when assessing risk factors for infection. -The nurse should examine environmental stressors in clients' lives to see how these stressors might affect their recovery and ability to ward off infection. Explanation: The Agent-Host-Environment model of health and illness, developed by Leavell and Clark (1965), views the interaction between an external agent, a susceptible host, and the environment as causes of disease in a person. It is a traditional model that explains how certain factors place some people at risk for an infectious disease. These factors are constantly interacting, and a combination of factors may increase the risk of illness. The nurse assessing the clients for risk factors for infection when planning nursing care helps to illustrate this model. The nurse assessing the client's family history and age when assessing risk factors for infection helps to illustrate this model. The nurse assessing environmental stressors in clients' lives is another example to illustrate this model. The other options are not examples illustrating the Agent-Host-Environment health model.
Which scenario is an example of a characteristic of Stage 2 of illness?
A person tells his family that he is sick and allows family members 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. In stage 1, the client is aware that there is something wrong by any means: either someone significant mentions that the client looks unwell, or the client experiences some symptoms such as pain, rash, cough, fever, or bleeding. This example is the client taking an aspirin for a headache. In stage 3, the client now seeks for professional help either on his/her own initiative or at the urging of significant others. In stage 4, after accepting the illness and seeking treatment, the client becomes dependent on the professional. The client visiting the physician for an infection is an example of stage 4. In stage 5, the client is expected to give up the dependent role and resume former roles and responsibilities. This example is the client starting rehab after a stroke.
A client comes to the health center for a routine visit. During the visit, the client tells the nurse, "I'm motivated to do things now to make sure I'm the healthiest I can be." When planning this client's care, the nurse should focus on which area?
Health promotion Explanation: Health promotion is the behavior of a person who is motivated by a personal desire to increase well-being and health potential. In contrast, illness/disease prevention, also called health protection, is behavior motivated by a desire to avoid or detect disease or to maintain functioning within the constraints of an illness or disability. Self-concept incorporates both how people feel about themselves (self-esteem) and the way they perceive their physical self (body image). Diagnosis of disease involves a medical aspect such that a disease is traditionally diagnosed—and treatment is prescribed—by a physician or advanced practice nurse, whereas nurses focus on the person with an illness.
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?
Physical dimension Explanation: 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.
Which is an example of tertiary health promotion?
Rehabilitation Explanation: 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 nurse is caring for a client who has breast cancer. The client 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 client 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.
An older adult client who has been hospitalized due to a stroke is about to be discharged from a rehabilitation center where the client had to relearn how to perform activities of daily living, including feeding and dressing. The client has often voiced a desire to be as active as possible. The client now expresses a strong desire to go home. The nurse recognizes that these statements made by the client indicate that the client is:
giving up the dependent role. Explanation: By stating that the client wants to be as active as possible, as well as healthy, the client is reflecting a desire to give up a dependent role and become more independent. Therefore, when at home, the client wants to resume normal activities and responsibilities. The client seems hopeful and not hopeless.
The recognition of health as an ongoing process toward a person's highest potential of functioning is defined as:
high-level wellness. Explanation: 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.
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?
Tertiary prevention Explanation: 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?
Use of condoms can help prevent sexually transmitted infections and unwanted pregnancy. Explanation: 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.
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?
What people believe to be true about their health Explanation: 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.
An older adult patient has been recently diagnosed with vascular dementia. Because the client lives alone and has poorly controlled hypertension, the client has begun to receive home healthcare. This new aspect of the client's 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.
Why are 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 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 preparing a sterile field for a procedure. While the nurse is opening an instrument, the outer wrapper of the sterilized instrument touches the extreme edge of the field. What should the nurse do next?
Discard the sterile field and prepare a new one Explanation: Adhering to proper sterile technique can help eliminate breaks in sterile procedure, but if breaks in technique do occur, replace sterile equipment before resuming the procedure. Simply notifying the physician of the error is insufficient, as it is the nurse's responsibility to establish the sterile field. Avoiding the area touched by the package is not practical or safe.
An adolescent client reports having diarrhea before every test in school. The nurse recognizes that this client needs to focus on which dimension of health?
Emotional dimension Explanation: 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 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?
Exacerbation Explanation: 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.
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?
Primary Explanation: 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.
What are some examples of healthy self-care behaviors everyone should adopt? Select all that apply. -Sleeping 7 to 8 hours each night -Eating regular healthy meals -Maintaining an ideal body weight -Exercising infrequently -Having a low self-esteem
Sleeping 7 to 8 hours each night Eating regular healthy meals Maintaining an ideal body weight Explanation: 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.
Which lifestyle factor is associated with an increased risk for chronic diseases?
Smoking Explanation: Lifestyle factors, such as smoking, chronic stress, and sedentary lifestyle, increase the risk of chronic health problems, such as respiratory disease, hypertension, cardiovascular disease, and obesity. Exercise, eustress, and gastrointestinal disease have not been shown to be factors that have contributed to the increase in chronic conditions.
To be an effective change agent for wellness, the nurse must:
consume a healthy diet. Explanation: Nurses focused on wellness advocate the use of lifestyle modification skills that alleviate stress and promote a state less susceptible to disease, such as eating a healthy diet. Skipping breakfast, drinking caffeinated beverages, and being sedentary are not associated with improved health or wellness.
A client, who has just been diagnosed with a chronic condition, asks the nurse what a "chronic condition" means. 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, as they are long-term, permanent conditions. Chronic diseases are usually managed in the home environment, not in extended-care facilities. Chronic conditions are not always associated with disabilities nor do they always require hospitalization.
A mammogram represents which level of prevention?
Secondary prevention Explanation: Secondary prevention includes screening for those at risk to develop illness, or those who could be diagnosed early in the process, and thus receive prompt treatment. Primary prevention refers to health promotion and illness prevention. Tertiary prevention refers to rehabilitation or prevention of complications after diagnosis with a disease. Medical is not a level of prevention.
The nurse is counseling a newly pregnant woman who is concerned about developing infections during her pregnancy. The pregnant woman states, "I'm so afraid something will happen to my baby. My friend developed an infection while she was pregnant and the baby died." Which of the following responses by the nurse would be most appropriate?
"Early prenatal care like you are receiving is very beneficial in reducing chances of infection." Explanation: Informing the client that early prenatal care is important in decreasing the incidence of maternal infection is both accurate and reassuring to the client, addressing the client's fear. Telling the client that there is nothing to worry about is providing false hope, as there is no guarantee that the mother or baby will not experience some complication. The client's chances of developing an infection depend in part on measures the client takes to prevent infection, so the statement that the chances of developing an infection are very small is not completely accurate. The type and cause of the friend's infection are not relevant to the client's situation, and asking about them is more likely to upset or offend the client than reassure her.
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?
"I cannot possibly ever be considered as healthy." Explanation: 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.
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?
"I should abstain from alcohol to prevent the development of a fetal alcohol spectrum disorder." Explanation: 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?
An active state of being healthy Explanation: 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 nurse is caring for a client with chronic obstructive pulmonary disease (COPD). The nurse explains to the client that COPD is a chronic disease. Why is COPD considered a chronic disease?
It has a gradual onset and lasts for a long time. Explanation: Chronic illness has a gradual onset and lasts for a long time. It is usually seen in old age. It may or may not be due to acute illness. Chronic diseases are a major cause of morbidity in the population.
The nurse recognizes that the client who makes the decision to accept a new diagnosis and follow the prescribed treatment plan is in which stage 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. Stage 2 is where a client describes himself or herself as being sick and seeks validation from others. Stage 4 is recovery and rehabilitation and is the final stage of the illness.
When admitting an adolescent to the hospital, the nurse anticipates that the client will respond to questions about the client's health beliefs based primarily on the client's:
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.
When caring for a client who has just been diagnosed with a chronic illness, the nurse understands the importance of promoting health by highlighting which concept?
Focus on what is possible. Explanation: When a client has a chronic illness, the nurse needs to make every effort to promote health with a focus of care that emphasizes what is possible rather than what can no longer be. The focus should not be on the altered functioning or what can no longer be as this does not assist the client to move to promoting health in the current state. The basis for the change or why the client has an illness is not easy to determine.
As the staff reports for duty, each nurse and unlicensed assistive personnel (UAP) checks the assignment board (above) to see what he or she will be responsible for during that shift. Which method of nursing is this facility utilizing to provide care to the clients?
functional nursing Explanation: This method is referred to as functional nursing. Each member is assigned a specific task or function. The case method is a pattern in which one nurse manages all the care for a specific client(s) for a designated period of time. Team nursing involves a specific team of nurses working together to provide care for a specific group of clients. The team leader coordinates and delegates tasks to the various team members. Primary nursing occurs when the admitting nurse is responsible for planning client care and evaluating the client's progress. The nurse may delegate the client's care in his or her absence but remains responsible until the client is discharged.
The nurse instructor has completed a session detailing major factors differentiating exacerbations from remissions. The instructor determines the session is successful when the students point out which factor(s) can contribute to exacerbations? Select all that apply.
immune system is functioning poorly sleep has been disrupted due to family issues client is facing a potential eviction Explanation: Exacerbations of illnesses are often related to how poorly the immune system is functioning, the stressors the client is facing and overall health status (e.g., nutrition, sleep, hydration). Remission is the opposite and usually indicates how well the immune system is acting, how well the client is handling stressors, and his or her overall health status. Improving food choices and good hydration status are indications the individual is recovering and showing improvement in his or her health status.
The nurse is explaining the purpose of the Healthy People 2030 initiative to a client. Which goal(s) will the nurse point out as included? Select all that apply.
- increase the number of people with health insurance - decrease incidence of client with new cancer diagnosis - increase the number of various medical degrees among the underrepresented racial and ethnic groups - improve hearing and visual health with prevention education Explanation: Various goals of Healthy People 2030 include: increasing the number of people with health insurance; decreasing the incidence of client with new cancer diagnoses; increasing the number of various medical degrees among the underrepresented racial and ethnic groups; and improving hearing and visual health with prevention education. Another goal includes increasing the proportion of current health and wellness and treatment programs and facilities that provide full access for people with disabilities, not necessarily create new facilities
A nurse who is working in a long-term care facility is talking with a group of health care workers. One of the health care workers asks about current trends in health care. Which trend should the nurse mention?
An increase in the incidence of chronic illnesses Explanation: There is a current trend of an increase in the incidence of chronic illness primarily due to a growing number of older adults living today. People are living longer, not dying at an earlier age. Income and upper-class status are socioeconomic factors that are related to health care.
Which are characteristics of chronic conditions? (Select all that apply.) -Resolve spontaneously -Are rarely curable -Have a rapid onset -Require lifelong management -Have a prolonged course
Are rarely curable Require lifelong management Have a prolonged course Explanation: 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.
An exacerbation refers to the reactivation of a disease. Which condition is associated with exacerbation?
Chronic illness Explanation: Exacerbation is the increase in activity of a disease and aggravation of symptoms. This occurs periodically in clients with chronic diseases. It is often a result of physical, chemical, or emotional stress. Congenital illness (such as atrial septal defect), hereditary illness (such as cystic fibrosis), and acute illness (such as influenza) do not have exacerbation and remission stages.
Risk factors for illness are divided into six categories. Working with carcinogenic chemicals is an example of which type of risk factor?
Environmental risk factor Explanation: 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.
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 with end-stage liver failure would not require emergency care.
A group of nurses is participating in a community health fair and is engaged in primary prevention activities. Which activities would these nurses be leading? Select all that apply.
Family planning services Accident prevention education Heart-healthy nutrition services Explanation: Primary health promotion and illness prevention are directed toward promoting health and preventing the development of disease processes or injury. Examples of primary-level activities are immunization clinics, family planning services, providing poison control information, and accident prevention education. Other nursing interventions include teaching about a healthy diet, the importance of regular exercise, safety in industry and farms, using seat belts, and safer sex practices. Screenings are a major activity in secondary health promotion. Rehabilitation is associated with tertiary health promotion.
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?
Health belief model Explanation: 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 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.
In stage 2, most people focus on their symptoms and bodily functions. When help from a health care provider is sought, the person becomes a client and enters stage 3, assuming a dependent role 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. 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. 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
Which behaviors are necessary for a person to successfully adapt to a chronic illness?
Learn to live as normally as possible Maintain a positive self-concept Maintain a sense of hope 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. The client needs to maintain independence and not dependence on chronic illness outcomes.
A client has been admitted to the hospital for treatment of pancreatitis secondary to alcoholism. The client states that it is nearly impossible to quit drinking because of the deep entrenchment of alcohol use in the client's circle of friends and line of work. As well, the client claims to have thought that drinking only beer and foregoing hard alcohol would prevent health problems. This client is exhibiting health consequences rooted in which human dimensions?
Sociocultural and intellectual Explanation: That the patient is situated in a context that normalizes heavy alcohol use is an example of the sociocultural dimension. The client's ignorance of the health consequences of drinking beer rather than spirits is a component of the intellectual dimension.
Which needs are being met when a nurse recommends a senior citizen community center for an older client who is living alone?
Sociocultural needs Explanation: 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.
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?
Teaching about adhering to a low-sodium diet Explanation: 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.
A nurse who admitted a client and performed the necessary admission tasks, notes the comments from the night shift nurse and updates the client's nursing care plan. Which type of nursing care is this facility utilizing?
primary nursing Explanation: Primary nursing is the process in which the admitting nurse assumes responsibility for planning client care and evaluating the client's progress. The primary nurse may delegate the client's care to someone else in his or her absence but the primary nurse is consulted when new problems develop or the plan of care requires modifications. The primary nurse remains responsible and accountable for specific clients until they are discharged. Functional nursing is the process where each nurse on the shift is assigned a specific task, such as passing medications or performing wound care. Team nursing involves a team of nurses working together to provide care to a specific group of clients. One nurse is the team leader and responsible for delegating the care to the rest of the care unit and ensures the clients receive appropriate care. The case method is most often used in home health, public health and community mental health nursing. In this group one nurse manages all the care of a client or group of clients' needs for a designated period of time. Nurses involved in this type of care are often referred to as case managers.
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.
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?
Teaching about adhering to a low-sodium diet Explanation: 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 teaching is an important activity. However, before teaching can be initiated, it is essential that the nurse engage the client in a discussion about health risks and the implications of these risks. Secondary health promotion and illness prevention focus on screening for early detection of disease with prompt diagnosis and treatment of diseases found.
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. Primary promotion is focusing on educating the client to potential risks. Secondary promotion is screening. There is not a chronic promotion component.
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?
The client is having an exacerbation of the COPD. Explanation: 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.
