Exam 1 Health and Wellness

When teaching a patient with a family history of hypertension about health promotion, the nurse describes blood pressure screening as _____ prevention. a. illness b. primary c. secondary d. tertiary

ANS: C Blood pressure screening is considered secondary prevention. It is a measure designed to identify individuals in an early state of a disease process so that prompt treatment can be started. Illness prevention is considered primary prevention. Primary prevention measures are those strategies aimed at optimizing health and disease prevention in general and not linked to a single disease entity. Tertiary prevention measures are those that minimize the effects of disease and disability.

When describing patient education approaches, the nurse educator would explain that informal teaching is an approach that a. addresses group needs. b. follows formalized plans. c. has standardized content. d. often occurs one-to-one.

ANS: D Informal teaching is individualized one-on-one teaching which represents the majority of patient education done by nurses that occurs when an intervention is explained or a question is answered. Group needs are often the focus of formal patient education courses or classes. Informal teaching does not necessarily follow a specific formalized plan. It may be planned with specific content, but it is individualized responses to patient needs. Formal teaching involves the use of a curriculum/course plan with standardized content.

Health promotion efforts for a chronically ill client should include interventions related to primary prevention. What should this include? 1 Encouraging daily physical exercise 2 Performing yearly physical examinations 3 Providing hypertension screening programs 4 Teaching a person with diabetes how to prevent complication

1 Primary prevention activities are directed toward promoting a healthful lifestyle and increasing the level of well-being. Performing yearly physical examinations is a secondary prevention. Emphasis is on early detection of disease, prompt intervention, and health maintenance for those experiencing health problems. Providing hypertension screening programs is a secondary prevention. Emphasis is on early detection of disease, prompt intervention, and health maintenance for those experiencing health problems. Teaching a person with diabetes how to prevent complications is a tertiary prevention. Emphasis is on rehabilitating individuals and restoring them to an optimal level of functioning

A patient is being treated for tuberculosis (TB) with a standard four-drug regimen but continues to have positive sputum smears for acid-fast bacilli. Which actions should the nurse implement?

Ask the patient whether medications have been taken as directed. Provide the patient with all the educational materials about drug-resistant TB. Assist the patient with short-term goals and plan teaching according to these goals. Assist the patient with long-term goals and plan teaching according to these goals.

The school nurse incorporates seatbelt and helmet use in a high school class on health promotion as examples of which strategies? a.) primary prevention b.) rehabilitation c.) secondary prevention d.) tertiary prevention

a.) Primary prevention

The nurse is assessing learning needs for a patient who has coronary heart disease. The nurse finds that the patient has recently made dietary changes to decrease fat intake and has stopped smoking. The best initial response by the nurse at this time is 1. "You did an excellent job of changing your eating habits and quitting smoking. This is so important for your heart health. Nice work!'' 2. "Although the changes you made are important, it is essential that you make other changes, too." 3. "Which additional changes in your lifestyle would you like to implement at this time?" 4. "Are you having any difficulty in maintaining the changes you have already made?"

1 The perceived behavioral expectations (normative beliefs) of family, friends, coworkers, and health care providers influence an individual's motivation to comply with the perceived social pressures from these groups (subjective norm) to behave in a certain way. Responses 2, 3, and 4 are appropriate, but 1 is the best initial response.

A client is admitted to the coronary intensive care unit. Which is the first step the nurse should take when developing a discharge teaching plan for this client? 1 Identifying the client's needs 2 Formulating the client's desired outcomes 3 Exploring the client's community resources 4 Assessing the client's personal support system

1 For teaching to be meaningful, the client must have a need to learn; also, readiness to learn is part of this assessment. The nurse determines expected outcomes depending on mutually desired goals; also, this is not the first step when developing a discharge teaching plan. Exploring the client's community resources is not the initial step; assessment of learning needs comes first. Assessing the client's personal support system is not the initial intervention; the client's needs must be assessed first.

A client with severe breathing problems is brought to the emergency ward. Which level of Maslow's hierarchy of needs does the nurse need to follow? 1 First level 2 Second level 3 Third level 4 Fourth level

1 The first level of Maslow's hierarchy of needs includes physiological needs like air, water, and food. Since the client has difficulty breathing, sufficient air should be provided as the first step of nursing intervention. The second level is physiological security and safety needs. The third level includes social needs. The fourth level addresses the self-esteem and confidence of a client.

The nurse assesses that a patient has not been taking antihypertension medication as prescribed. How should the nurse proceed? Select all that apply. 1. Evaluate the teaching plan to determine if there is a need to reeducate the patient. 2. Assess the patient's perception and attitude towards the risks associated with missing doses of medication. 3. Review and reinforce the need to take the medication as prescribed. 4. Ask the provider to prescribe a different medication because the patient does not want to take this medication. 5. Emphasize the risk of stroke or heart attack if the patient does not adhere to the treatment plan.

1,2,3 The patient may need additional information. Assessing what the patient's perceptions are will provide the nurse with insight on how to proceed next. Reviewing and reinforcing will reaffirm the importance of taking the medication which leads to adherence. The nurse should first explore why the patient is not taking the medication before requesting a different medication order from the provider. Scare tactics may cause the patient to become defensive and may lead to nonadherence.

A nursing student lists examples of health promotion activities. Which examples are accurate? Select all that apply. 1 Good nutrition 2 Regular exercise 3 Weight reduction 4 Immunization against measles 5 Education about stress management

1,2,3 Health promotion activities enable clients to enhance or maintain their current health levels. Good nutrition, regular exercise, and weight reduction are examples of such activities. Immunization against measles is an example of an illness prevention activity. Education about stress management is an example of a wellness education activity.

A patient is admitted to the long-term care setting. The nurse notes that the patient does not read or write well. Which nursing actions are priority while developing a teaching plan to increase adherence? Select all that apply. 1. Determine the patient's motivation and readiness to learn. 2. Assess what the patient knows about their health issues. 3. Include the family in the orientation to the unit and include them in the teaching process. 4. Assess what grade level the patient can read and write and tailor teaching strategies accordingly. 5. Give the patient brochures with more pictures and explanations with short sentences.

1,2,3,4 It is most important to determine the level at which the patient will understand then the nurse can avoid teaching over the patient's level of understanding. Motivation is an important component to learning new information. Assessing what the patient does know will help determine what areas still need to be addressed. Including the family will aid in the teaching process. The patient may not be able to read even short sentences. The priority is to assess the patient's reading level first, then choose appropriate teaching tools.

In what ways can a nurse promote medication adherence in children? Select all that apply. 1 By mixing oral medications with food or juice 2 By communicating with parents to ensure active participation 3 By selecting a convenient route of dosage and dosing schedule 4 By measuring liquid formulations with a calibrated spoon or syringe 5 By refraining from readministering the drug if the child spills it or spits it out

1,2,3,4 Oral medications may be mixed with food or fruit juice to improve their palatability. Communication with parents helps to ensures conscientious and skilled participation. The most convenient dosage form and dosing schedule should be selected to help ensure easy administration. Liquid formulations should be measured with the use of a calibrated spoon or syringe to help prevent inappropriate dosing. If the child spits out or spills the drug, the amount of drug spilled should be readministered.

A patient is being treated for tuberculosis (TB) with a standard four-drug regimen but continues to have positive sputum smears for acid-fast bacilli. Which actions should the nurse implement? Select all that apply. 1. Assist the patient with short-term goals and plan teaching according to these goals. 2. Provide the patient with all the educational materials about drug-resistant TB. 3. Refer the patient to a pulmonary specialist, who can assist the patient with the treatment regimen. 4. Ask the patient about any barriers to obtaining medications. 5. Ask the patient whether medications have been taken as directed.

1,2,4,5 The first action should be to determine whether the patient has been compliant or encountered any barriers with completing the drug therapy regimen; because negative sputum smears would be expected if the TB bacillus is susceptible to the medications and if the medications have been taken correctly. Obtaining medications may be a factor in whether the client is taking medications as prescribed. Depending on whether the patient has been compliant or not, goals should be established and different medications or directly observed therapy may be indicated. The nurse is responsible and capable of providing education to patients regarding medication regimens and illness pathology. Referring the patient will not help with determining compliance.

A school nurse is planning a class on injury prevention for a group of high school students. What guidelines should the nurse include? Select all that apply. 1 Swim with a buddy. 2 Drink beer instead of wine. 3 Use well-traveled walkways. 4 Smoke only in designated areas. 5 Refuse to play "chicken" with others.

1,3,5 Developmentally, adolescents have a drive for independence, an inclination for risk-taking, and a feeling of indestructibility. These traits increase the risk for injury. If one develops problems in the water, the buddy can secure help. Using well-traveled walkways reduces the risk for being alone and overcome by an individual who wishes to do harm. Refusing to play "chicken" helps the student prevent dangerous situations from which the student cannot retreat. Beer is alcohol, and its intake, and that of all types of alcohol, should be discouraged; when one is under the influence of alcohol, reaction time and judgment decrease and the risk for injury increases. Smoking should be discouraged to decrease the risk for respiratory disease.

Health promotion efforts within the healthcare system should include efforts related to secondary prevention. Which activities reflect secondary prevention interventions in relation to health promotion? Select all that apply. 1 Encouraging regular dental checkups 2 Facilitating smoking cessation programs 3 Administering influenza vaccines to older adults 4 Teaching the procedure for breast self-examination

1,4 Encouraging regular dental checkups is a secondary prevention activity because it emphasizes early detection of health problems, such as dental caries and gingivitis. Teaching the procedure for breast self-examination is a secondary prevention activity because it emphasizes early detection of problems of the breast, such as cancer. Facilitating smoking cessation programs is a primary prevention activity because it emphasizes health protection against heart and respiratory diseases. Administering influenza vaccines to older adults is a primary prevention activity because it emphasizes health protection against influenza. Referring clients with a chronic illness to a support group is a tertiary prevention activity because it emphasizes care that is provided after illness already exists.

A nurse is assessing different situations on the basis of Maslow's hierarchy of needs. Which situation will the nurse address first on priority basis? 1 A client feels that he/she leads a completely worthless life. 2 A client has multiple fainting episodes due to lack of proper nutrition. 3 A client shows signs of lack of interest in carrying out social interactions. 4 A client conveys to the nurse that he/she is estranged from all family members.

2 According to Maslow's hierarchy of needs, the basic lower level needs of human beings need to be addressed first before moving on to the higher levels. A person's physiological needs should receive attention first on priority basis. If the client has fainting episodes due to lack of proper nutrition, his/her physiological needs should be addressed first. A client who feels that he/she leads a worthless life displays a lack of self-esteem. According to Maslow's hierarchy, self-esteem needs should be met after addressing physiological needs, safety and security needs, and needs related to love and belonging. A client who shows signs of impaired social interactions has a lack of love and belonging needs. According to Maslow's hierarchy, these needs should be met after addressing physiological needs and safety and security needs. Similarly, a client who is estranged from family members displays a lack of love and belonging needs.

A nurse is teaching a client about self-management techniques for smoking cessation. Which statement made by the client indicates the need for further teaching? 1 "I should list the reasons why I should stop smoking." 2 "I should visit all the places where I started smoking." 3 "I should remove all ashtrays and lighters." 4 "I should try replacing tobacco with sugarless mints and gum."

2 Clients may be tempted to smoke if they visit the places where they started smoking. Listing the reasons to stop smoking may help the client to prevent smoking. Removing ashtrays and lighters from the environment may help the client to prevent smoking. When the client is tempted to smoke, sugarless mints and gums may act as good substitutes for tobacco smoking.

The nurse is teaching a client self-management of skin cancer. Which statement made by the client indicates the need for further learning? 1 "I should use sunscreen when going out." 2 "I should limit sun exposure to between 7 am and 12 pm." 3 "I should wear a hat and opaque clothing when going out." 4 "I should go for a monthly examination of cancerous and precancerous lesions."

2 In the self-management of skin cancer, the client should not go out in the sun between 11 am and 3 pm. This is the time when the sunlight is strongest. Using sunscreen protects a client's skin from the sun's rays. The client should wear a hat and opaque clothing when going out. Going for monthly examination of cancerous and precancerous lesions is recommended.

A 42-year-old adult with a long history of alcohol abuse seeks help in one of the local hospitals. What does the nurse consider to be the major underlying factor for success in a client's alcohol treatment program? 1 Family 2 Motivation 3 Practitioner 4 Self-esteem

2 Motivation is necessary to help the client withstand the pain of giving up a defense; internal motivation is more influential in facilitating change than any external factor. Although having family support is important, internal motivation to change is the most important factor. The client's practitioner can be of assistance, but internal factors will have a greater effect on rehabilitation than external factors. Self-esteem will be useful if it precipitates abstinence behavior; however, people who are alcoholics commonly have low self-esteem.

A nursing student is recalling information about the primary level of prevention. Which statement accurately describes primary prevention? 1 Primary prevention is directed at rehabilitation rather than treatment. 2 Primary prevention is applied to clients who are physically and emotionally healthy. 3 Primary prevention includes screening techniques and the treatment of the early stages of a disease. 4 Primary prevention focuses on individuals who are ill and have a possibility for developing complications

2 Primary prevention is true prevention. This prevention is applied to clients who are considered to be physically and emotionally healthy. The tertiary level of prevention is directed at providing rehabilitative care to clients. Secondary prevention includes screening techniques and treatment of early stages of disease. Secondary prevention is focused on individuals who are ill and are at risk for further complications.

An older adult comes for an annual physical and tells the nurse, "I had three respiratory infections last year. How can I prevent this from happening again?" What is the nurse's best response? 1 "Stay away from preschool and school-aged children." 2 "Avoid putting your hands near your nose and mouth." 3 "Wear a sweater under your coat when going outside in cold weather." 4 "Take an aspirin when you think you may be coming down with a cold.

2 Transmission of microorganisms via the hands is one of the most common ways pathogens are transmitted from one person to another. Avoiding putting hands near the nose and mouth interrupts the chain of infection at the portal of entry phase. Staying away from preschool and school-aged children is unnecessary and could cause social isolation. However, exposure to these children when they have an active infection should be avoided if possible. Precautions can be taken when around children (e.g., washing the hands, avoiding exposure to nasal and oral secretions). Wearing a sweater under the coat when going outside in cold weather will not limit the exposure to pathogenic microorganisms. However, it may make the person more comfortable because older people have less subcutaneous fat and can be more sensitive to cold environmental temperatures. Colds are caused by viruses; an aspirin will not eliminate these microorganisms. In addition, it is not within the role of a nurse to prescribe medications, even if they are over-the-counter medications.

he community nurse is assessing an elderly client who lives alone at home. The nurse finds that the client refrains from physical activity for fear of falling when walking. Which interventions by the nurse are most beneficial to promote a healthy lifestyle? Select all that apply. 1 Instruct the client to apply bed side rails. 2 Encourage the client to wear nonskid shoes. 3 Suggest that the client use an assistive device. 4 Ask the client to install hand rails in the bathroom. 5 Help the client rearrange furniture in the house.

2,3,5 The nurse should encourage the client to wear nonskid shoes that will provide a firm grip while walking and help reduce the chance of falls. The nurse should suggest that the client use an assistive device such as a cane or walker for support while walking. The nurse should make environmental changes by helping the client rearrange the furniture in the house. This will help reduce the incidence of falls within the house. These interventions reduce the fear of falling and encourage the client to participate in physical activity indoors and outdoors. The bed side rails protect the client from falling from the bed. The hand rails in the bathroom assist provide support while using the bathroom.

A 15-year-old with type 1 diabetes has a history of noncompliance with the therapy regimen. What must the nurse consider about the teenager's developmental stage before starting a counseling program? 1 They usually deny their illness. 2 They have a need for attention. 3 The struggle for identity is typical. 4 Regression is associated with illness.

3 Striving to attain identity and independence are tasks of the adolescent, and rebellion against established norms may be exhibited. Although the adolescent may be using denial, denial is not developmentally related to adolescence. This behavior is not a bid for attention; adolescents want to be like their peers and not stand out. Nor is this behavior regression; regression is the use of patterns of coping associated with earlier stages of development.

Which of these is a part of health belief model? 1 Behavioral outcomes 2 Behavior-specific knowledge 3 Perception of susceptibility to an illness 4 Individual characteristics and experience

3 The health belief model is divided into three components. The first component is an individual's perception of susceptibility to an illness. The second component is an individual's perception of seriousness of an illness. The third component is the preventive actions taken by a person. The health promotion model focuses on behavioral outcomes, behavior-specific knowledge and affect, and individual characteristics and experience.

A nurse teaches an elderly client safety tip to prevent falls. Which physiologic change may have occurred in the client? 1 Slowed movement 2 Cartilage degeneration 3 Decreased bone density 4 Decreased range of motion (ROM)

3 teaching safety tips to prevent falls would best help a client with decreased bone density. If a client experiences slow movements, the nurse should not rush the client because the client may become frustrated if hurried. Providing a client with cartilage degeneration with a moist heat source such as a shower or a warm compress is beneficial because this action may increase blood flow to the area. A nurse should assess a client's ability to perform activities of daily living and mobility to help improve the self-care skills of clients with a decreased range of motion.

What kind of health service does the nurse offer in a health promotion or primary care program? 1 Home care 2 Immunization 3 Sports medicine 4 Nutrition counseling

4 Health promotion or primary care focuses on improved health outcomes for the entire population. It includes nutrition counseling and health education. Home care is the provision of enabling medically related professional and paraprofessional services and equipment to clients and their families at home. Preventive care is more disease oriented. It focuses on reducing and controlling risk factors for diseases through immunizations and occupational health programs. Sports medicine is a form of restorative care. The goal of this program is to help individuals regain maximum functional status through promotion of independence and self-care.

A nursing student is listing examples of active and passive health promotion strategies. Which strategy is an example of a passive health promotion strategy? 1 Weight-reduction program 2 Smoking-cessation program 3 Drug abuse prevention strategy 4 Fluoridation of municipal drinking water

4 Passive strategies of health promotion help people benefit from the activities of others without direct involvement. The fluoridation of municipal drinking water is an example of a passive health promotion strategy. Active strategies of health promotion require clients to adopt specific programs for improving health. Weight-reduction programs, smoking-cessation programs, and drug abuse prevention strategies are examples of active health promotion activities.

A registered nurse is educating a client about the three levels of prevention through different scenarios. Which scenario mentioned by the nurse is an example of secondary prevention? 1 "A nurse educates a young couple regarding sex and sexually transmitted infections." 2 "A nurse collaborates with a dietician to help prepare a healthy nutritional plan for a client." 3 "A nurse arranges for a client's rehabilitation to help in gaining maximum limb function after amputation." 4 "A nurse takes charge of screening every client upon suspecting a chicken pox outbreak in the healthcare facility.

4 Secondary level of prevention includes mass screening activities. Screening all the clients within the healthcare facility for chicken pox is an example of secondary prevention. Promoting health by providing education regarding sex and sexually transmitted infections is an example primary level prevention. Helping the client to follow healthy standards of nutrition is also an example of primary level of prevention. Rehabilitating a client to ensure maximum use of remaining capacity is an example of tertiary level of intervention.

A nurse caring for a pregnant client prioritizes nursing actions on the basis of Maslow's hierarchy of needs. Which statement of the client does the nurse consider to be a self-esteem need? 1 "I cannot contact my family as I eloped from home in order to get married." 2 "If I don't comply with my husband's demands, I might not have anywhere to live." 3 "My husband hurts me sometimes when I'm not able to live up to his expectations." 4 "I deserve ill treatment from my husband as I'm incapable of doing even simple things perfectly."

4 The client feels that she is incapable of performing simple tasks perfectly. This shows a lack of self-esteem. The nurse will consider this statement to be a self-esteem need. The client conveys to the nurse that she is not in touch with her family members. The nurse will consider this statement to be a love and belonging need as the client displays impaired social interaction. The client informs the nurse that she is in danger of losing her shelter. The nurse understands this statement to be an indication of a physiological need. The nurse notes that the client is in physical and psychological danger due to the husband's actions. The client displays the lack of safety and security need

Barriers to patient education the nurse considers in implementing a teaching plan include a. family resources. b. high school education. c. hunger and pain. d. need perceived by patient.

ANS: C A patient who is hungry or in pain has limited ability to concentrate or learn. Family resources would be considered in developing a plan of care and could be an asset or a barrier to patient education. The patient's educational level would be considered in planning teaching strategies but would not be a barrier to education. A need perceived by a patient would provide motivation for learning and would not be a barrier.

A nursing student is listing the steps that need to be followed to provide competent care for vulnerable populations. Which point listed by the nursing student is accurate? 1 "Refrain from giving priority to cultural practices and values of the vulnerable populations." 2 "Provide financial and legal advice to the vulnerable people as this may be more important to them." 3 "Evaluate client's beliefs and values about health in terms of the nurse's own culture, beliefs, and values." 4 "Understand the client's cultural beliefs, values, and practices to determine their specific needs and interventions."

4 The nurse should understand the client's cultural beliefs, values, and practices to determine their specific needs and interventions to provide competent care for vulnerable populations. The nurse should learn about the culture of the clients to understand cultural practices and values that influence their health care practices. The nurse should not provide financial and legal advice to the clients as clients should be connected with someone qualified to help them. The nurse should refrain from evaluating client's beliefs and values about health in terms of the nurse's own culture, beliefs, and values to provide competent care to vulnerable populations.

In order to implement primary prevention of STIs (sexually transmitted infections) a nurse is counseling an adolescent. What would be the priority nursing action? 1 Help the adolescent recognize the risk. 2 Educate the adolescent about proper preventive measures. 3 Provide complete information about STIs. 4 Assess the adolescent's sexual risk behaviors

4 The priority step for primary STI prevention is to assess the sexual risk behavior of the adolescent to identify the risk factors and provide appropriate counseling accordingly. With that information in mind, the nurse can then help the adolescent recognize the risk, encourage usage of preventive measures, and provide proper information about STIs.

Which healthcare factors create barriers that prevent older adults from participating in healthcare promotion and disease prevention? Select all that apply. 1 Finance 2 Activity level 3 Transportation 4 Personal motivation 5 Previous healthcare experience

4,5 Personal motivation and previous healthcare experience are factors that create barriers that prevent older adults from participating in healthcare promotion and disease prevention. Finances, activity levels, and transportation are non-health factors that create barriers for older adults.

When planning to evaluate a patient's satisfaction with a teaching activity, the most appropriate strategy would be to a. include a survey instrument. b. observe for level of skill mastery. c. present information more than one time. d. provide for a return demonstration.

ANS: A A survey or questionnaires can be used to measure affective behavior change as well as patient satisfaction with the teaching experience. Observing for level of skill mastery would evaluate achievement of a psychomotor goal rather than satisfaction with the experience. Repeating information more than one time or in more than one way may be appropriate strategies to include in the teaching plan but would provide no evaluation data. Providing for a return demonstration would help in evaluating achievement of a psychomotor goal, not satisfaction with the activity.

A patient has been newly diagnosed with hypertension. The nurse assesses the need to develop a collaborative plan of care that includes a goal of adhering to the prescribed regimen. When the nurse is planning teaching for the patient, which is the most important initial learning goal? a. The patient will select the type of learning materials they prefer. b. The patient will verbalize an understanding of the importance of following the regimen. c. The patient will demonstrate coping skills needed to manage hypertension. d. The patient will verbalize the side effects of treatment.

ANS: A Adults learn best when given information they can understand that is tailored to their learning styles and needs. Verbalizing an understanding is important; however, the nurse will first need to teach the patient

When there is evidence that supports a screening for an individual patient but not for the general population, the nurse would expect the United States Preventive Services Task Force Grading to be what? a. No recommendation for or against b. Recommends c. Recommends against d. Strongly recommends

ANS: A The United States Preventive Services Task Force Grading is an example of how evidence is used to make guidelines and determine priority. When there is evidence that supports a screening for an individual patient but not for the general population, there is no recommendation for or against screening the general population. Recommends is the grading when there is high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial. Recommends against is the grading when there is moderate or high certainty that the intervention has no net benefit or that the harms outweigh the benefits. Strongly recommends is the grading when there is high certainty that the net benefit is substantial.

The nurse is evaluating the need to refer a patient with osteoarthritis for a home care visit to be sure the patient can function in accomplishing daily activities independently. What is the nurse's first priority? a. Determine if the patient has had home visits before and if the experience was positive. b. Check the patient's ability to bathe without any assistance the next day. c. Have the patient demonstrate the learned skills at the end of the teaching session. d. Arrange a physical therapy visit before the patient is discharged from the hospital.

ANS: A To begin the assessment of adherence, it is first important to clarify with the patient (a) their beliefs and perceptions about their health risk status, (b) their existing knowledge about cardiovascular disease risk reduction, (c) any prior experience with health care professionals, and (d) their degree of confidence with controlling the disease. The other actions allow evaluation of the patient's short-term response to teaching.

The most appropriate resources to include when planning to provide patient education related to a goal in the psychomotor domain would be a. diagnosis-related support groups. b. Internet resources. c. manikin practice sessions. d. self-directed learning modules.

ANS: C A teaching goal in the psychomotor domain should be matched with teaching strategies in the psychomotor domain, such as demonstration, practice sessions with a manikin, and return demonstrations. Diagnosis-related support groups would be most effective with goals in the affective domain. Internet resources would be most effective for goals in the cognitive domain. Self-directed learning modules would be most effective for goals in the cognitive domain.

After the nurse implements a teaching plan for a newly diagnosed patient with hypertension, the patient can explain the information but fails to take the medications as prescribed. The nurse's next action would be to a. reeducate the patient, because learning did not occur because the patient's behavior did not change. b. assess the patient's perception and attitude towards the risks associated with not taking their anti-hypertensives. c. take full responsibility for helping the patient make dietary changes. d. ask the provider to prescribe a different medication, because the patient does not want to take this medication.

ANS: B Although the patient behavior has not changed, the patient's ability to explain the information indicates that learning has occurred. The nurse would need to ask what the patient's perceptions are of taking the medications to determine if the patient understands the ramifications of not taking the medication. The patient may be in the contemplation or preparation state (see Health Belief Model). The nurse should reinforce the need for change and continue to provide information and assistance with planning for change.

Strategies to include in a teaching plan for an adult who has repeatedly not followed the written discharge instructions would include a. individualized handout. b. instructional videos. c. Internet resources. d. self-help books.

ANS: B An instructional video would provide a visual/auditory approach for discharge instructions. Repeatedly not following written instructions is a clue that the patient may not be able to read or understand the information. While assessing the literacy level of an adult patient can be challenging, the information that they have not been able to follow previous written instructions would suggest that the nurse use an alternate strategy that does not require a high degree of literacy. An individualized handout would be written, very similar to previous instructions, and would not address a concern about literacy. Internet resources generally require an individual to be able to read, and although videos are available through the Internet, this is not the best response. Self-help books would be appropriate for an individual who reads. There is a question about whether this patient is literate, so these would not be the best choice.

A 73-year-old male patient is seen in the home setting for a routine physical. The nurse notes which behavior as the most reassuring sign that the patient has been following the treatment plan for the diagnoses of hypertension, diabetes, and hyperlipidemia? a. The patient has a list of glucose readings for the past 10 days. b. The patient has a list of medications along with newly refilled meds. c. The patient has a list of all foods and beverages for a 3-day period. d. The patient verbalizes the side effects of all his medications.

ANS: B Confirming how often a patient renews or refills his/her prescriptions is a measurement of the patient's persistence with continuation of the treatment. Having a list of glucose readings or verbalizing side effects does not necessarily mean that the patient is compliant unless the readings were all normal, which is not indicated. Listing foods may not indicate the patient is following the treatment plan.

The plan of care for a patient newly diagnosed with diabetes includes health promotion with the tertiary prevention measure of a. avoiding carcinogens. b. foot screening techniques. c. glaucoma screening. d. seat belt use.

ANS: B Foot screening is considered a tertiary prevention measure, one that minimizes the problems with foot ulcers, an effect of diabetic disease and disability. Avoiding carcinogens is considered primary prevention—those strategies aimed at optimizing health and disease prevention in general and not linked to a single disease entity. Glaucoma screening is considered secondary screening—measures designed to identify individuals in an early state of a disease process so that prompt treatment can be started. Seat belt use is considered primary prevention—those strategies aimed at optimizing health and disease prevention in general and not linked to a single disease entity.

At the well-child clinic, the nurse teaching a mother about health promotion activities describes immunizations as a. unique for children. b. primary prevention. c. secondary prevention. d. tertiary prevention.

ANS: B Immunizations/vaccinations are considered primary prevention measures, those strategies aimed at optimizing health and disease prevention in general. Immunizations/vaccinations are primary prevention measures for individuals across the life span, not just children. Secondary prevention measures are those designed to identify individuals in an early state of a disease process so that prompt treatment can be started. Tertiary prevention measures are those that minimize the effects of disease and disability.

A diabetic patient presents to the diabetes clinic with A1c levels of 7.5%. The nurse has met this patient for the first time. When applying principles of Theory of Planned Behavior (TPB), which teaching strategy by the nurse is most likely to be effective? a. Provide information on the importance of blood glucose control in maintenance of long-term health and evaluate how the patient has been following the prescribed regime. b. Establish a rapport with the patient by complimenting them on what they did correctly, and ask what strategies they have tried thus far. c. Refer the patient to a certified diabetic educator, because the educator is an expert on management of diabetes complications. d. Have the patient explain what medications they are on and what diet they should be following.

ANS: B Principles of a TPB indicate that the patient will need to establish a good rapport with the nurse in order to talk about nonadherence. If the patient finds it difficult to discuss their diabetes self-management and adherence with the nurse, the patient may not open up to the nurse. Although a referral to an educator is a good idea, it would be better to use this resource as a follow-up for this visit. Having the patient verbalize medications and diet is not part of the TPB method.

When assessing a 22-year-old male patient, the nurse learns that he smokes a pack of cigarettes daily. The patient tells the nurse, "I enjoy smoking and have no plans to quit." Which nursing diagnosis is most appropriate? a. Health Seeking Behaviors related to cigarette use b. Ineffective Health Maintenance related to tobacco use c. Readiness for Enhanced Self-Health Management related to smoking d. Deficient Knowledge related to long-term effects of cigarette smoking

ANS: B The patient's statement indicates that he is not considering smoking cessation. Ineffective Health Maintenance is defined as the inability to identify, manage, and/or seek out help to maintain health.

The nurse is developing a care plan for a patient who has low motivation and nonadherence with blood glucose monitoring. Which statement by the patient would indicate to the nurse that the patient is not motivated and will most likely not comply? a. "I do not like to test my sugar, but I do it because my wife nags me." b. "I forget to check my sugar once in a while." c. "I don't see or feel any different when I do keep my blood sugars under control." d. "I have no idea what the signs of low blood sugar are."

ANS: C If patients do not perceive any benefit from changing their behavior, sustaining the change becomes very difficult. Having someone remind the patient is more likely to reinforce compliance. Forgetting to check glucose occasionally may indicate the patient needs memory cues or joggers. The patient who doesn't know the signs of low glucose will need further teaching.

A patient with hypertension is prescribed a low-sodium diet. The patient's teaching plan includes this goal: "The patient will select a 2-gram sodium diet from the hospital menu for the next 3 days." Which intervention would be most effective at increasing the patient's compliance with the diet? a. Check the sodium content of the patient's menu choices over the next 3 days. b. Ask the patient to identify which foods on the hospital menus are high in sodium. c. Have the patient list favorite foods that are high in sodium and foods that could be substituted for these favorites. d. Compare the patient's sodium intake over the next 3 days with the sodium intake before the teaching was implemented.

ANS: C Including a patient's favorite foods will most likely increase compliance because the patient is not being deprived. Checking the sodium will be useful for teaching strategies but will not be the most effective means of increasing adherence.

Interrelated concepts to professional nursing a nurse manager would consider when addressing concerns about the quality of health promotion include a. culture. b. development. c. evidence. d. nutrition.

ANS: C The interrelated concepts to professional nursing include evidence, health care economics, health policy, and patient education. Culture is a patient attribute concept. Development is a patient attribute concept. Nutrition is a health and illness concept.

The nurse is assessing a newly diagnosed diabetic, and the patient's readiness to learn about glucose monitoring. Before planning teaching activities, which approach would be most effective? a. Assist the patient with long-term goals and plan teaching according to these goals. b. Provide the patient with all the latest research from the Internet on glucose monitoring. c. Refer the patient to the diabetic specialist who can assist the patient with the glucometer. d. Assist the patient in developing realistic short-term goals.

ANS: D Concordance reflects development of an alliance with patients based on realistic expectations. Providing the patient with the research will not help with the practical skill of using the glucometer. Long-term goals are useful; however, the goals need to be immediate with a newly diagnosed patient learning a new skill. Referring the patient would be useful if the patient has not been able to grasp the concept after several attempts.

The primary health care nurse would recommend screening based on known risk factors, because they can a. eliminate the possibility of developing a condition. b. identify appropriate treatment guidelines. c. initiate treatment of a condition or disease. d. make a substantial difference in morbidity and mortality.

ANS: D Screenings are typically indicated and recommended if the effort makes a substantial difference in morbidity and/or mortality of conditions, and they are safe, cost effective, and accurate. Ideally a screening measure will accurately differentiate individuals who have a condition from those who do not have a condition 100% of the time; however, there may be a false-negative result, or the patient may develop a condition after the screening was conducted. A screening does not specify treatment guidelines; the screen provides results, and the health care provider identifies the treatment. The goal of screening is to identify individuals in an early state of a disease so that prompt treatment can be initiated. The screening results are used for this purpose.

The nurse educator would identify a need for further teaching when the student lists the types of learning as a. affective. b. cognitive. c. psychomotor. d. self-directed.

ANS: D Self-directed is one approach to learning but is not considered a type or domain of learning. Self-directed would be a cognitive way of learning. Affective (feelings/attitude), cognitive (knowledge), and psychomotor (skills/performance) are the main domains of learning.

Interrelated concepts to the professional nursing role a nurse manager would consider when addressing concerns about the quality of patient education include a. adherence. b. developmental level. c. motivation. d. technology.

ANS: D The interrelated concepts to the professional role of a nurse include health promotion, leadership, technology/informatics, quality, collaboration, and communication. Adherence, culture, developmental level, family dynamics, and motivation are considered interrelated concepts to patient attributes and preference.

The nurse is doing discharge teaching on a patient who has peripheral vascular disease and has poor circulation to the feet. Which learning goal should the nurse include in the teaching plan? a. The nurse will demonstrate the proper technique for trimming toenails. b. The patient will understand the rationale for proper foot care after instruction. c. The nurse will instruct the patient on appropriate foot care before discharge. d. The patient will post reminder stickers on their calendar to check feet every day and record scheduled appointments with podiatrist.

ANS: D To improve the patient adherence to treatment, it will be important to help them develop reminder strategies that fit into their lifestyle. Options A and C describe actions that the nurse will take, rather than behaviors that indicate that patient learning has occurred. Option B is too vague and nonspecific to measure whether learning has occurred.

The nurse in a newly opened community health clinic is developing a program for the individuals considered at greatest risk for poor health outcomes. The group is considered the a. global community. b. sedentary society. c. unmotivated population. d. vulnerable populations.

ANS: D Vulnerable populations refers to groups of individuals who are at greatest risk for poor health outcomes. The entire world is the global community. Sedentary refers to the lifestyles of people worldwide who have epidemic rates of obesity and many other related chronic diseases. Unmotivated population refers to the individuals who have not demonstrated interest in changing.

What is the priority intervention when developing a teaching plan for a patient newly diagnosed with high blood pressure?

Ask the patient and caregiver to select important information from a list of hypertension teaching topics because adults learn best when they are given information that they view as being needed immediately

The nurse is discharging a hospitalized patient to the home care setting. Place the following actions in order of priority. a. Arrange a physical therapy visit before the patient is discharged from the hospital. b. Assess the patient's ability to perform activities of daily living before discharge. c. Have the patient demonstrate the learned skills at the end of the teaching session. d. Determine if the patient has had home visits before and if the experience was positive.

D, B, C, A To begin the assessment of adherence, it is first important to clarify with the patient their beliefs and perceptions about his health risk status, assessment of performing ADLs will assist in determining the number of visits needed or if the patient needs additional therapies. Demonstration of skills prior to discharge will ensure patient understands the teaching. Physical therapist can aid in evaluating the need for assistive devices in the home and also help the patient adhere to prescribed treatment plan

A patient is admitted to a long-term care facility. The nurse notes that the patient has a low literacy level. What is the priority intervention for this patient in regard to teaching?

Determine the literacy level of the patient and tailor the teaching strategies accordingly so that the nurse can avoid teaching information that would be beyond the patient's level of understanding.

A nurse is discharging a hospitalized patient to the home care setting. What is the priority intervention for increasing adherence to the plan of care?

Determine whether the patient has had home visits before and, if so, whether the experience was positive

The nurse finds that a patient has not been taking antihypertension medication as prescribed. How should the nurse proceed?

The patient may need additional information. Determining what the patient's perceptions are will provide the nurse with insight on how to proceed next. Reviewing and reinforcing the need to take the medication will reaffirm the importance of taking the medication and will lead to adherence. Scare tactics may cause the patient to become defensive and may lead to continued nonadherence.

Interrelated concepts regarding patient attributes that a nurse manager would consider when addressing concerns about the quality of health promotion include which type of attribute? a.) culture b.) evidence c.) health policy d.) nutrition

a.) Culture Culture, development, adherence, and motivation are patient attribute concepts. Interrelated concepts regarding professional nursing include evidence, health care economics, health policy, and patient education. Nutrition is a health and illness concept.

A primary health care provider has recommended a mammogram and a Papanicolaou (pap) smear for a 50-year-old female patient. In response to questions, the nurse teaches the patient about health promotion activities, describing the mammogram and pap smear as which forms of prevention? a.) Illness prevention b.)Primary prevention c.) secondary prevention d.) Tertiary prevention

b.) Secondary prevention

Which tertiary prevention measure is included in the plan of care for a patient newly diagnosed with asthma? a.) cholesterol screening b.) eliminating allergens c.) glaucoma screening d.) safe sex practice

b.) eliminating allergens

What is the process of enabling people to increase control over and improve their health? a.) community care b.) health promotion c.) high-level wellness d.) primary prevention

b.) health promotion