Exam 3

A nurse is reviewing an exercise prescription for a person. Which of the following aspects should be included? (select all that apply) a. Frequency of exercise b. Intensity level of exercise c. Time and duration of exercise d. Type of exercise

A,B,C,D a. Frequency of exercise b. Intensity level of exercise c. Time and duration of exercise d. Type of exercise

A nurse is providing an educational program addressing the importance of being physically active. The nurse states that individuals should engage in exercise for a minimum of 30 minutes of activity on most days of the week. For which of the following individuals is that recommendation appropriate? (select all that apply) a. A 54-year-old with hypercholesterolemia b. A 66-year-old with hypertension c. A 48-year-old with obesity d. A 58-year-old with Type 2 diabetes mellitus

A- A 54-year-old with hypercholesterolemia B- 66-year-old with hypertension D- A 58-year-old with Type 2 diabetes mellitus The risk of CHD decreases with an increase in physical activity. Exercise positively affects lipoprotein metabolism and is a common part of the treatment for hypertriglyceridemia. Regular exercise also decreases blood pressure in adults. Exercise improves glycemic control by increasing insulin sensitivity in people with Type 2 diabetes mellitus. The Physical Activity Guidelines for Americans advise adults to perform at least 150 minutes of moderate intensity or 75 minutes of vigorous activity per week. Exercise also has a positive effect on obesity. However, the American College of Sports Medicine recommends a minimum of 40 to 60 minutes of exercise 5 to 7 days a week for those with obesity.

A man states that he would like to change his dietary habits to decrease his risk of developing cancer in the future. Which of the following statements would be the best response for the nurse? a. "Consume at least cups of fruits and vegetables each day." b. "Dietary habits have minimal effect in reducing your risk of developing cancer." c. "A glass of red wine should be consumed daily." d. "Dietary supplements of specific nutrients will maximize the effects of dietary changes."

ANS: A- "Consume at least cups of fruits and vegetables each day." Eating at least cups of a variety of fruits and vegetables can help protect against cancers at many sites, particularly for cancers of the gastrointestinal and respiratory tracks. Following the dietary recommendations included in the 2010 Dietary guidelines for Americans and MyPlate are consistent with those recommended by the ACS. Food appears to have a protective effect by itself that dietary supplements do not provide.

A person asks the nurse if it is safe to use dietary supplements. Which of the following would be the best reply from the nurse? a. "It is important to be cautious when using any supplements." b. "All dietary supplements must be approved by the FDA before they can be sold and are safe." c. "No, dietary supplements have very limited regulations and should not be used." d. "Be sure to read the product label before using the supplement to see what health claims have been made by the product."

ANS: A- "It is important to be cautious when using any supplements." The desirable way for the general public to obtain recommended levels of nutrients is by eating a variety of foods. Low-dose supplements that contain the recommended intakes for micronutrients appear to be generally safe. Caution is advised when using supplements, as natural is not always better. Dietary supplements are unregulated by the FDA in the sense that they do not require premarket review or approval by the FDA.

Which of the following people is at greatest risk for a hip fracture secondary to osteoporosis? a. A 66-year-old White woman b. A 66-year-old African American woman c. A 66-year-old White man d. A 66-year-old African American man

ANS: A- A 66-year-old White woman White postmenopausal women have the greatest prevalence of osteoporosis and incidence of hip fracture by gender and race.

A nurse distributes a demographic questionnaire to attendees of a weight management program. Which step in the teaching-learning process is being implemented? a. Assessment b. Development c. Implementation d. Evaluation

ANS: A- Assessment The assessment step in the teaching-learning process is comprised of assessing the students' characteristics and needs. Obtaining demographic data from the attendees will help the nurse determine the characteristics of the students.

Which of the following illustrates that the objectives of health education and counseling have been met? a. Asthmatic who has a decrease in emergency department visits b. Asthmatic who has been prescribed an albuterol inhaler c. Asthmatic who attends an asthma education program d. Asthmatic who visits the emergency department with an exacerbation

ANS: A- Asthmatic who has a decrease in emergency department visits Health education encourages positive, informed changes in lifestyle behaviors that prevent acute and chronic disease, decrease disability, and enhance wellness. Two main objectives of health education and counseling are to change health behaviors and to improve health status. An asthmatic with a decrease in emergency department visits is an improvement in health status, which is a reflection of behavior changes used to prevent acute exacerbations of a chronic disease.

A nurse determined the interobserver reliability of a blood pressure reading. Which of the following describes the method that was used by the nurse? a. Blood pressure readings of 124/82 were obtained two days in a row by two different nurses. b. Three consecutive blood pressure readings of 124/82 were obtained by the same nurse. c. Blood pressure readings of 124/82 in the right arm and 124/82 in the left arm were obtained. d. A blood pressure reading of 124/82 was obtained immediately followed by another blood pressure reading of 147/92

ANS: A- Blood pressure readings of 124/82 were obtained two days in a row by two different nurses. Reliability is an assessment of the reproducibility of the test's results when different individuals with the same level of skill perform the test during different periods and under different conditions. If the same result emerges when two individuals perform the test, interobserver reliability is shown. Therefore, a client with a blood pressure reading of 124/82 two days in a row by two different nurses is an example of interobserver reliability

A 45-year-old man has been diagnosed with metabolic syndrome. Which of the following characteristics would this man exhibit? a. Blood pressure: 146/88 mm Hg b. Waist measurement: 36 inches c. HDL: 48 mg/dL d. Triglycerides: 140 mg/dL

ANS: A- Blood pressure: 146/88 mm Hg Metabolic syndrome is diagnosed when a person has three or more of these factors: excessive abdominal fat, as indicated by too large a waist measurement (greater than 40 inches in men); elevated blood pressure (higher than 130/85 mm Hg), low HDL level (lower than 40 mg/dL), and elevated triglyceride level (higher than 150 mg/dL).

A nurse is developing health education content for an educational session with adults about the prevention of cardiovascular disease. Which of the following domains should be considered when developing the teaching plan? (select all that apply) a. Cognitive b. Psychomotor c. Gross motor d. Affective

ANS: A- Cognitive, B- Psychomotor, D- Affective The three domains of health education are cognitive, affective, and psychomotor.

Which of the following causes of death is/are directly associated with diet? (select all that apply) a. Diabetes mellitus b. Cirrhosis of the liver c. Stroke d. Coronary heart disease (CHD)

ANS: A- Diabetes mellitus, C- Stroke, D- Coronary heart disease (CHD) Four leading causes of death directly associated with diet are coronary heart disease (CHD), some types of cancer, stroke, and diabetes mellitus. Four more major causes of death—accidents, cirrhosis of the liver, suicide, and homicide—are associated with excessive alcohol intake.

A nurse would like to assist Americans in improving their health. Which strategy would be most beneficial to improve the health of the American public? a. Encourage Americans to stop smoking. b. Lobby for state-of-the-art magnetic resonance imaging machines in all hospitals. c. Provide free medications for Americans. d. Offer free condoms to teenagers.

ANS: A- Encourage Americans to stop smoking The greatest opportunity to improve the health of the American people lies in addressing unhealthy, personal, behavioral risk factors. Intensive lifestyle changes can be effective not only in preventing chronic diseases, but also in reversing their progression and significantly reducing health care costs. Improvement of the public's health is more likely to come from behavior change than technology. Therefore, people deciding they are going to change their behavior and stop smoking are likely to lead to improvements in the health of the public.

During a screening, a test with a high specificity and low sensitivity is utilized. Which of the following issues could arise by using this test? a. Ethical issues b. Race issues c. Gender issues d. Cultural issues

ANS: A- Ethical issues Misinterpretation caused by screening instruments is of great ethical concern. A difficult ethical issue in screening is determining whether the benefits received by those who receive correct results are worth the problems experienced by those who receive incorrect results. In this case, the high specificity of the test would result in low false-positive rates and would correctly identify nondiseased individuals. However, the low sensitivity would result in a high false-negative rate and therefore would miss a large number of people who are actually positive, resulting in ethical issues.

A nurse is assessing a community and is trying to determine the appropriateness of conducting a Type 2 diabetes screening in the community. Which of the following questions would the nurse need to answer when making this decision? (select all that apply) a. Is Type 2 diabetes considered a community problem? b. What are the health benefits of screening for Type 2 diabetes? c. Can Type 2 diabetes be detected by screening? d. What is the cost-benefit ratio of implementing this screening?

ANS: A- Is Type 2 diabetes considered a community problem?, B- What are the health benefits of screening for Type 2 diabetes? C- Can Type 2 diabetes be detected by screening? The answers to the following three questions provide a basis for designating a disease as screenable or not screenable: Does the significance of the disorder warrant its consideration as a community problem? Can the disease by detected by screening? Should screening for the disease be done?

A nurse is planning to offer a depression screening at a local community center. Which of the following should be considered prior to implementation of the program? a. Limited referral sources in the community b. Limited support groups in the community c. Insufficient evidence that depression screening tools are cost effective d. Insufficient evidence mental health screening is appropriate

ANS: A- Limited referral sources in the community Constraints affecting the operation of a screening program include financial concerns, political issues, cultural constraints, follow-up and referral services, and accessible treatment facilities. An efficient referral system should link the follow-up resources to the screening program, providing continuity of care. A method must be devised to encourage the participant to take positive action on the referral. Depression screening for adults is a covered preventive service for adults.

Influenza occurs among Americans at a rate of 36 per 100 people annually. Which type of rate is this statement describing? a. Prevalence rate b. Incidence rate c. Morbidity rate d. Mortality rate

ANS: A- Prevalence rate Incidence rate is the rate of a new population problem and estimates the risk of an individual developing the specific disease or condition during a specific period or over a lifetime. Prevalence is the proportion of a given population with the disease or condition at any one point in time. Usually acute conditions are assessed by their incidence (rate of occurrence), whereas chronic conditions are measured by their prevalence (generally existing).

The goal for the educational session is to have the individual explain when he should check his blood sugar level. Which of the following teaching strategies would be most effective for the nurse to implement? a. Provide the individual with one-on-one education about blood sugar monitoring. b. Provide the individual with a scenario about blood sugar monitoring. c. Provide the individual with the opportunity to practice blood sugar monitoring. d. Provide the individual with a blood sugar monitor.

ANS: A- Provide the individual with one-on-one education about blood sugar monitoring. Teaching is directed toward one or more of the three learning domains. The goal of having the individual explain when to monitor blood sugar levels relates to the cognitive domain, and it is best achieved by using strategies such as lecture, one-on-one education, and discussion. This allows the educator to provide the individual with a large amount of information at one time.

Which of the following emphasizes that an individual's belief in being personally capable of performing the behavior is required to influence one's own health? a. Social cognitive theory b. Self-efficacy theory c. Health belief model d. Transtheoretical model

ANS: A- Social cognitive theory The model that emphasizes an individual's belief in being personally capable of performing the behavior required to influence one's own health is known as the social cognitive theory.

A nurse is providing health education about the importance of dental health to Latino residents in a community. Which of the following considerations should be made to promote health literacy within this program? a. Speak slowly and distinctly. b. Refer the client to an interpreter. c. Use photographs whenever possible. d. Consider methods to facilitate empowerment.

ANS: A- Speak slowly and distinctly. Strategies to promote health literacy include creating a shame-free environment (speaking slowly and distinctly), using clear and purposeful communication (being specific and concrete), communicating in a patient-centered manner (assess what is already known), and reinforcing the spoken word (using a variety of methods: photographs, audio, and drawings).

Which of the following statements about the current prevalence of obesity is accurate? a. The current generation of children may be less healthy and have a shorter life expectancy than their parents. b. The current incidence of obesity among American adults has stabilized. c. The current statistics show that greater than 75% of American adults are either overweight or obese. d. The current statistics report that about 50% of American children are either overweight or obese.

ANS: A- The current generation of children may be less healthy and have a shorter life expectancy than their parents. Because of the increasing rates of obesity, unhealthy eating habits, and physical inactivity, we may see the first generation that will be less healthy and have a shorter life expectancy than their parents. The current statistics show that two in three American adults and one in three children are either overweight or obese.

A school nurse is preparing to discuss food safety practices with high school students enrolled in a family and consumer science "foods" course. Which of the following information would be included in the presentation? a. Wash hands thoroughly with running warm water with soap for 30 seconds. b. Scrub firm services of all fruits and vegetables with a produce brush before eating. c. Pay close attention to assure that meat is cooked all of the way through. d. Refrigerate leftovers within 30 minutes of serving.

ANS: A- Wash hands thoroughly with running warm water with soap for 30 seconds. There are four principles at the cornerstones of Fight BAC!, a national food safety education campaign (Clean, Separate, Cook, and Chill). Clean—wash all parts of hands thoroughly with running warm water with soap and friction for about 20-30 seconds. Scrub firm surfaces like cantaloupe and cucumbers with a produce brush, other fresh fruits and vegetables can be rinsed under running water. A food thermometer should be used to make sure that food is cooked all the way through. Leftovers should be refrigerated within 2 hours or 1 hour in temperatures greater than 90° F.

A nurse is using a sweat test to screen people for cystic fibrosis. Which of the following results demonstrates poor sensitivity? a. When 6 out of every 10 sweat tests performed are negative, but the six individuals actually have cystic fibrosis b. When 6 out of every 10 sweat tests performed are positive, but the six individuals do not actually have cystic fibrosis c. When 6 out of every 10 sweat tests performed are negative, and the six individuals really do not have cystic fibrosis d. When 6 out of every 10 sweat tests performed are positive, and the six individuals really do have cystic fibrosis

ANS: A- When 6 out of every 10 sweat tests performed are negative, but the six individuals actually have cystic fibrosis Sensitivity refers to the proportion of people with a condition who correctly test positive when screened. A test with poor sensitivity will miss individuals with the condition, and there will be a large number of false-negative results; individuals actually have the condition but were told they were disease free. Thus when 6 out of every 10 sweat tests performed are negative but the six individuals actually have cystic fibrosis, it is an example of poor sensitivity.

Which of the following individuals would be at greatest risk to develop Type 2 diabetes? a. White, 50-year-old woman, obese, second child weighed 10 pounds at birth b. African American, 55-year-old man, hypertension, exercises regularly c. Hispanic, 22-year-old woman, healthy weight, family history of diabetes d. White, 75-year-old man, history of prostate cancer and high triglycerides

ANS: A- White, 50-year-old woman, obese, second child weighed 10 pounds at birth Risk factors for Type 2 diabetes include: having prediabetes (impaired glucose tolerance [IGT] and/or impaired fasting glucose [IFG]), age greater than 45, being overweight or obese, not exercising regularly, having a family history of diabetes, a personal history of gestational diabetes or a baby of at least 9 pounds at birth, other risk factors such as high blood pressure, a low HDL cholesterol or high triglycerides, and one's race and ethnicity. The White, 50-year-old woman who is obese and gave birth to a child weighing 10 pounds has the most risk factors of the clients described.

A nurse is creating a hypertension screening program. Which of the following methods would be the best way to design a successful program? a. Work with stakeholders to conduct a community assessment. b. Purchase state-of-the-art sphygmomanometers to measure blood pressures. c. Use the program developed at a previous place of employment. d. Contact a local church to see if the program can be implemented there.

ANS: A- Work with stakeholders to conduct a community assessment. Partnerships are essential to developing health programs and screening programs. The primary rule is to never assume that what is appropriate and effective for one community will be appropriate and effective for another community. A community assessment conducted as a partnership with key stakeholders provides information about the high-risk population, available health care resources, and the high-risk population's health needs. By conducting the assessment, the nurse can identify the necessary community resources and mobilize them to achieve maximal benefits and positive outcomes.

A nurse is counseling a teenager who smokes one pack of cigarettes a day. The teenager states he likes to smoke with his friends and does not recognize the connection between his smoking and his asthma. When planning an intervention for this person, the nurse must first recognize that the teenager is in the: a. precontemplation stage of change. b. preparation stage of change. c. action stage of change. d. maintenance stage of change.

ANS: A- precontemplation stage of change. A person in the precontemplation stage of change is not thinking about or considering quitting or adopting a behavior change within the next 6 months. Health education must be matched to the stage of change. This teenager does not see a connection between his smoking and his asthma. He likes to smoke and is therefore unlikely to make any changes at this time.

A nurse is developing an educational session for adolescents related to avoidance of risky behaviors. Which of the following steps of the teaching-learning process will need to be considered? (select all that apply) a. Assessment b. Diagnosis c. Development d. Implementation

ANS: A-Assessment, C-Development, D-Implementation Steps in the teaching-learning process include assessment, development of learning outcomes and teaching plan, implementation of the teaching plan, and evaluation of expected outcomes.

A nurse is providing a group presentation about the importance of healthy eating. Which of the following activities must be addressed to ensure an adequate learning climate? (select all that apply) a. Creating a sense of preparedness and organization b. Planning for alternative learning activities c. Assessing group needs d. Observing group interactions

ANS: A-Creating a sense of preparedness and organization, C-Assessing group needs, D-Observing group interactions Several activities need to be addressed in group presentations. They include creating a sense of preparedness and organization; anticipating group needs; assessing group needs; maintaining a high level of motivation and a sense of individualized attention and progression; and observing group interactions.

The proportion of people with a condition who correctly test positive when screened is known as: a. sensitivity. b. specificity. c. validity. d. efficacy.

ANS: A-sensitivity Sensitivity refers to the proportion of people with a condition who correctly test positive when screened.

A school nurse is discussing the income eligibility requirements for free and reduced-price school meals with a family who is new to the school district. Which of the following statements would the nurse most likely make? a. "If the employed member of your family earns less than $50,000 per year, your child will qualify for reduced-price meals." b. "If your family's income is less than 185% above the federal poverty level, your child will qualify for free or reduced-price meals." c. "If you have more than five members living in your household, your child will qualify for reduced-price meals." d. "If your family has an income above the federal poverty level, your child will not qualify for free or reduced-price meals."

ANS: B- "If your family's income is less than 185% above the federal poverty level, your child will qualify for free or reduced-price meals." Children from families with incomes greater than 130% to 185% of the federal poverty level are eligible for reduced-price school meals. Children from families with incomes at or less than 130% of the federal poverty level are eligible for free school meals. Consideration is given to both income level and number of members living in the household when interpreting the federal poverty guidelines.

A client who is taking Coumadin tells the nurse that she has started taking a vitamin E supplement as she has heard that this will help decrease the likelihood of her developing cancer. Which of the following would be the most appropriate response by the nurse? a. "Vitamin E supplements are unnecessary, so I don't recommend you use this supplement." b. "Vitamin E can interfere with the actions of vitamin K and enhance the effects of Coumadin ." c. "Vitamin E supplements can interfere with the absorption of iron and create additional health problems." d. "Vitamin E must be used cautiously, as it is easy to experience a toxicity of this nutrient."

ANS: B- "Vitamin E can interfere with the actions of vitamin K and enhance the effects of Coumadin ." High doses of vitamin E can interfere with vitamin K action and enhance the effect of Coumadin as one of the anticoagulant drugs. Because of this interaction, she should probably not be taking a supplement of vitamin E while taking the Coumadin. If she continues on the supplement, it may be necessary to adjust the dosage of Coumadin the woman is prescribed.

Which of the following women should be screened for breast cancer? a. A 35-year old woman with three children and no family history of breast cancer b. A 59-year-old woman with no children who still gets her period every month c. A 25-year-old woman with one child whom she gave birth to when she was a teenager d. A 17-year-old woman with one child who started menstruating at the age of 13

ANS: B- A 59-year-old woman with no children who still gets her period every month In the United States, the incidence of breast cancer increases with age. Breast cancer mammography screenings are recommended every 1 to 2 years for women over 40.

A nurse is conducting an initial nutritional assessment on a person who is HIV positive. Which of the following questions would be most important for the nurse to ask? a. What fresh fruits and vegetables do you like to eat? b. Are you taking a daily multivitamin? c. How often do you eat at restaurants? d. Do you have any questions about your current medications?

ANS: B- Are you taking a daily multivitamin? Evidence suggests that micronutrient deficiencies are common among those with HIV and that those not taking vitamin supplementation have increased morbidity and mortality. Thus, asking about use of a daily multivitamin is the most important information for the nurse to collect. A nutrient-dense, protein-rich, well-balanced diet should be stressed as well as vitamin and mineral supplementation. Because of an altered immune function, they get sicker when exposed to food-borne organisms, so discussion about how to avoid food-borne illness is also important.

A school nurse is using height and weight measurements to calculate the body mass index (BMI) of the students. How will the nurse use these data? a. BMI can be correlated to a specific percentage of body fat. b. BMI can be used to determine if a child is obese or underweight. c. BMI can be used to determine if a child will develop Type 2 diabetes. d. BMI can be compared with others of the same ethnic background.

ANS: B- BMI can be used to determine if a child is obese or underweight. Body mass index (BMI) is a helpful indicator of obesity and being underweight. Height and weight measurements are needed in the calculation to determine BMI. BMI is a good indicator of body fat, but it cannot be interpreted as a specific percentage of body fat. BMI is used to screen and monitor a population to detect the risk of health or nutritional disorders. In an individual, other data must be used to determine if a high BMI is associated with increased risk of disease; BMI alone is not diagnostic. The growth charts released in 2000 by the CDC more accurately reflect the nation's cultural and racial diversity, but there is not a different chart for each ethnic background.

A nurse is assessing a low-income population in a community. Which of the following would be most appropriate for this population? a. HIV screening b. Blood pressure screening c. Colorectal cancer screening d. Breast cancer mammography screening

ANS: B- Blood pressure screening According to a 2010 Gallup poll, 'Low-income Americans are more likely than their high-income counterparts to say they have been diagnosed with each of the chronic conditions . . . . the differences are largest for depression, high blood pressure, and diabetes . . . the high level of obesity among low-income Americans is likely a contributing factor in these differences.'

Which of the following analyses is used to determine the optimal use of resources to reach a predetermined constant end point or the desired health outcome? a. Cost-benefit ratio analysis b. Cost-effectiveness analysis c. Cost-efficiency analysis d. Cost-disease analysis

ANS: B- Cost-effectiveness analysis An analysis that determines the optimal use of resources to reach a predetermined, constant end-point or the desired health outcome is known as cost-effectiveness analysis

A community health nurse is preparing an educational brochure about improving the nutritional behaviors of Americans. Which of the following topics would most likely be included in the brochure? (select all that apply) a. Increasing daily intake of milk and dairy products b. Decreasing daily sodium intake c. Increasing daily intake of fruits and vegetables d. Decreasing daily intake of sugar-sweetened drinks

ANS: B- Decreasing daily sodium intake, C- Increasing daily intake of fruits and vegetables, D- Decreasing daily intake of sugar-sweetened drinks Fewer than 15% of adults and 10% of adolescents eat the recommended amounts of fruits and vegetables every day. Sixty-three percent of adults and 84% of adolescents consume at least one sugar-sweetened drink each day. Most American adults consume more than twice the recommended average daily sodium intake level.

A nurse plans to use lectures, handouts, and a video to teach a group of teenagers the importance of safe sex practices. Which step in the teaching-learning process is the nurse demonstrating? a. Assessment b. Development c. Implementation d. Evaluation

ANS: B- Development The development of a teaching plan component of the teaching-learning process is comprised of developing the course content, teaching strategies, and learning action. Lectures, handouts, and videos are all examples of teaching strategies.

A nurse is educating a 26-year-old, sexually active, female client about the screening tests that are now covered without a copayment or co-insurance because of the Affordable Care Act. Which of the following preventive services would the nurse include in this discussion? a. Tobacco use screening b. HIV screening c. Cervical cancer screening d. Breast cancer mammography screening

ANS: B- HIV screening One result of the Affordable Care Act that was passed in 2010 was the movement toward prevention and health promotion. One result is that preventive services are required to be covered by new health insurance plans or policies. When covered by a network provider, HIV screening must be provided by insurance plans without copayment or co-insurance.

A nurse is counseling a person who has recently started to receive treatment for alcohol abuse. Which factor would most negatively influence the person's decision to stop abusing alcohol? a. He is a Catholic. b. His wife recently died from breast cancer. c. Buying alcohol is expensive. d. He was educated on the dangers of excessive drinking.

ANS: B- His wife recently died from breast cancer. Effective health education requires an understanding of the influential factors affecting the individual's decision-making. These factors include values, beliefs, attitudes, life stresses, religion, previous experiences, and life goals. Although religion and education can influence a person's decision, the stressor of his wife's recent death is most likely to negatively influence his decision to stop abusing alcohol.

After the 2010 Dietary Guidelines were released, a community health nurse updated a nutrition presentation that was being used to educate various community groups about healthy eating habits. Which of the following information would have been added to the presentation? a. Consumption of increased amounts of carbohydrates b. Impact of the environment on the public's food, drink, and activity choices c. Revised guidelines for the use of MyPyramid d. Inclusion of physical activity standards

ANS: B- Impact of the environment on the public's food, drink, and activity choices For the first time, the 2010 Dietary Guidelines have an entire chapter devoted to addressing the impact of the broader food and physical environment on the public's food, drink, and activity choices using the Social-Ecological model. Physical activity standards were included in the 2005 guidelines. MyPyramid was replaced with MyPlate. There was a shift in food intake patterns emphasizing more vegetables, cooked dried beans, fruits, whole grains, nuts and seeds.

A teenager, who lives at home with her parents and school-aged brother, has been diagnosed with anorexia nervosa. Which of the following would be the most appropriate teaching goal for this family? a. Increased energy level b. Improved coping c. Enhanced self-esteem d. Facilitated family conversation

ANS: B- Improved coping The family plays an important role in health and illness. Understanding and intervening with the family is essential to promoting health and reducing risk. Health teaching includes all family members although the general teaching goal is the same for all, approaches and specific goals for each member will be different. An illness in one member of the family can alter the entire family's ability to cope. As a result, improved coping is the most appropriate goal.

A nurse is implementing a test that screens for hypercholesterolemia. Which of the following parameters should this test have? a. No cutoff point b. Low cutoff point c. Intermediate cutoff point d. High cutoff point

ANS: B- Low cutoff point The goal of a screening program, identifying an individual as high risk or not, depends on the numerical value of the screening instrument. When the parameter for this distinction is not clear, a cutoff point is set. Above this point, the person is considered disease positive; below this point, the individual is considered disease negative. Thus, if the disease were potentially life-threatening or if a disease is relatively benign in terms of stigmatization, anxiety, and problems with treatment, the lower cutoff would be preferred. High cholesterol, if left untreated, could contribute to life-threatening cardiac disease. Additionally, it is benign in terms of stigmatization. Therefore, a lower cutoff point should be set.

A woman has asked the nurse about the benefits and risks of using ginseng to control her hot flashes associated with menopause. Which of the following governmental offices would most likely serve as a resource to answer the woman's question? a. American Dietetic Association (ADA) b. National Center for Complementary and Alternative Medicine (NCCAM) c. Food and Drug Administration (FDA) d. United States Department of Agriculture (USDA)

ANS: B- National Center for Complementary and Alternative Medicine (NCCAM) The National Center for Complementary and Alternative Medicine (NCCAM) promotes and conducts the scientific study of the benefits and risks of dietary supplements, including medicinal herbs, in health maintenance and disease prevention.

Which of the following is an example of screening? (select all that apply) a. Asking if someone performs self-breast exam b. Performing a self-breast exam c. Obtaining a mammogram d. Undergoing a needle biopsy

ANS: B- Performing a self-breast exam, C- Obtaining a mammogram Screening is not considered a diagnostic measure. The ultimate goal could be curative, but more often, it is to prevent further development of the condition or disease. Screenings are done by oneself, or can be clinical, procedural, or lab based. Performing a self-breast exam and obtaining a mammogram are examples of screening. Asking if someone performs a self-breast exam may increase awareness but does not screen for disease. A needle biopsy would be diagnostic.

The goal is for the individual to verbalize the importance of checking blood sugar levels. Which of the following strategies would be best for the nurse to implement to achieve this goal? a. Provide one-on-one education about blood sugar monitoring. b. Provide the individual with a scenario about blood sugar monitoring. c. Provide the individual with the opportunity to practice blood sugar monitoring. d. Provide the individual with a blood sugar monitor.

ANS: B- Provide the individual with a scenario about blood sugar monitoring. Teaching is directed toward one or more of the three learning domains. The goals of having the individual verbalized the importance of checking blood sugar levels relates to the affective domain. Teaching strategies for this domain include role modeling and role playing. Such strategies allow the individual to formulate appropriate responses, attitudes, and feelings.

An occupational health nurse is planning a cholesterol screening with the employees at the factory. Which of the following would be an advantage of conducting this screening? a. Allows for the beginning of a multiple test screening process b. Provides an opportunity for health education c. Allows for preliminary diagnosis of coronary artery disease d. Provides the opportunity for a referral to a physician

ANS: B- Provides an opportunity for health education Screenings create an opportunity for providing health education to a group of individuals who may not otherwise receive it. This allows the nurse to take advantage of a teachable moment with the employees in the factory.

A nurse is using a health education component when teaching about smoking cessation. Which of the following actions is the nurse implementing? a. Setting a quit date for people in a smoking cessation class b. Providing education regarding the benefits of smoking cessation c. Allowing smokers to participate in a smoking cessation program only if they use the patch nicotine replacement system d. Encouraging attendees of a smoking cessation program to participate in a research study

ANS: B- Providing education regarding the benefits of smoking cessation Essential components of health education involve using teaching strategies, having learners maintain voluntary control over the decision to make changes in their actions, and focusing on behavior changes that have been found to improve heath. Providing smokers with the information regarding the benefits of smoking cessation allows them to make their own decision and provides them with information that is known to improve health.

The Denver Developmental Screening Test (DDST) has been said to have excellent test specificity. What does this statement mean? a. Rarely identifies children who have developmental delays b. Rarely identifies children who do not actually have developmental delays c. Has a large number of false positive results d. Has a large number of false negative results

ANS: B- Rarely identifies children who do not actually have developmental delays Specificity measures a test's ability to recognize negative reactions or nondiseased individuals. A test with excellent specificity will rarely be positive if the disease is not present.

A nurse is educating a group of adults who are attempting smoking cessation. Which intervention would be most effective for the nurse to implement? a. Give the group members a handout on the dangers of smoking. b. Set a quit date with the group and determine which pharmacological method is most suitable for group members. c. Provide a month's supply of nicotine replacement to use before the next visit. d. Have a guest speaker who has been diagnosed with lung cancer speak to the group.

ANS: B- Set a quit date with the group and determine which pharmacological method is most suitable for group members. Educators can increase a person's motivation and capabilities to change by involving the person in the planning and goal setting. By picking a quit date and developing an action plan with the person, the educator is positively influencing the person's motivation level. Education alone is not enough to influence change.

A nurse is developing learning objectives for an individual who has been placed on a low-fat, low-cholesterol diet. Which is an example of an appropriately written cognitive learning objective? a. The individual will understand the importance of a low-fat, low-cholesterol diet. b. The individual will correctly identify and purchase low-fat, low-cholesterol foods. c. The individual will believe that his heart will benefit from a low-fat, low-cholesterol diet. d. The individual will feel healthier if he follows a low-fat, low-cholesterol diet.

ANS: B- The individual will correctly identify and purchase low-fat, low-cholesterol foods. Cognitive learning refers to the development of new facts or concepts and builds on or applies knowledge to new situations. Objectives of this domain must incorporate action verbs that indicate observable learning. Identifying and purchasing low-fat, low-cholesterol foods demonstrates that the individual has learned which foods are low in fat and cholesterol.

A nurse is working with a family that is experiencing food insecurity. Which of the following statements best describes this family? a. Members of this family are susceptible to food-borne illness. b. This family's access to adequate food is limited by lack of money. c. This family is unable to purchase fresh fruits and vegetables. d. Members of this family are obese.

ANS: B- This family's access to adequate food is limited by lack of money. When a family experiences food insecurity it means that their access to adequate food is limited by a lack of money and other resources. Individuals and families may be more likely to be overweight or obese, potentially because the relatively lower cost of junk foods can promote overconsumption of calories.

A person has been diagnosed with salmonellosis. Which of the following symptoms would the person most likely exhibit? (select all that apply) a. Bloody diarrhea b. Vomiting c. Hypoactive bowel sounds d. Abdominal cramping

ANS: B- Vomiting, D- Abdominal cramping Symptoms of salmonellosis include abdominal cramping, mild to severe diarrhea, nausea, vomiting, and fever within 8 to 72 hours after infection. Bloody diarrhea is more likely seen with E. coli infection.

A nurse is examining the incidence, prevalence, and mortality rates of colon cancer in the community. Which of the following measures of life is being investigated? a. Quality adjusted life year (QALY) b. Quantity of life c. Disability adjusted life year (DALY) d. Satisfaction of life

ANS: B-Quantity of life Measures of quantity of life affected by a disease are more readily attainable than quality of life measures. Quantity of life can be measured by using incidence and prevalence rates as well as disease-specific mortality rates.

A nurse is reviewing the chart of a 15-year-old girl who has been sexually active since the age of 12. Which of the following findings would be of most concern? a. She does not perform self-breast exams. b. She has never had a Pap test. c. She had one HIV test performed at the age of 13. d. She does not use birth control pills.

ANS: B-She has never had a Pap test. Although self-breast exams are encouraged and considered an important aspect of breast health education, data regarding its efficacy is weak. Although she does not use birth control pills, there is no indication that she does not use other forms of birth control such as condoms that would also prevent against STDs. There is also no indication that she has had more than one sex partner and is at high risk for HIV infection. A cervical dysplasia screening is recommended for sexual active females. Therefore, the fact that she never had a Pap test to screen for cervical cancer and has been sexually active for the last 3 years is concerning.

To screen for colorectal cancer, colonoscopy should be conducted every 10 years beginning at age: a. 30. b. 40. c. 50. d. 60.

ANS: C- 50 It is recommended that men and women age 50 and older have a colonoscopy performed every 10 years to screen for colorectal cancer.

A nurse is providing education about safe driving with a group of newly licensed teenagers. Which factor would most likely influence a teenager's decision to drive within the speed limit? a. A speed limit sign b. Having his parents telling him not to speed c. A previous traffic violation for speeding d. Seeing someone get pulled over for speeding

ANS: C- A previous traffic violation for speeding Effective health education requires an understanding of the influential factors affecting the individual's decision making. These factors include values, beliefs, attitudes, life stresses, religion, previous experiences, and life goals. Having had a previous experience with receiving a speeding ticket may positively influence the teenager's decision to drive within the speed limit because (1) he knows he is vulnerable to being caught and ticketed again, and (2) further tickets may have an effect on his ability to drive at all (e.g., his parents may punish him by not allowing him to drive, his driving privileges with the department of motor vehicles may be affected, or his insurance premium may be affected). Although seeing someone get pulled over may influence a person's decision through modeling and observing others, teenagers believe they are invincible and therefore would probably not be effective in this age group.

A nurse is educating a group of community members about how hypertension screening is effective in reducing the rate of cardiovascular disease, thus reducing the expenses that are spent on management of this disease. Which of the following ratios is being described? a. Cost-disease analysis b. Cost-efficiency analysis c. Cost-benefit ratio analysis d. Cost-effectiveness analysis

ANS: C- Cost-benefit ratio analysis Cost-benefit ratio analysis allows the comparison of various outcomes in monetary terms. The cost of the screening versus the cost of chronic care management is considered.

An overweight woman is in the preparation stage of change. Which of the following interventions would be the most appropriate for the nurse to implement? a. Inform her of the health risks associated with being overweight. b. Prepare her for the setbacks. c. Develop a low-calorie/low-fat diet with her so she can follow it at home. d. Praise her for her recent successes.

ANS: C- Develop a low-calorie/low-fat diet with her so she can follow it at home. A person in the preparation stage of change has made a change or is seriously thinking about making a change in the next month. At this stage, people make small or sporadic changes. Health education must be matched to the stage of change. During this stage, it is the educator's role to provide the woman with the tools to move forward with her plan. Working on a diet together will decrease barriers to change by making it easier for the woman to follow a diet. Enlisting her cooperation achieves better results.

Which of the following illustrates that the objectives of health education and counseling are being met? a. Diabetic who attends a diabetes education program b. Diabetic who watches a video about self-administration of insulin c. Diabetic who starts taking his medications regularly d. Diabetic who is admitted in diabetic ketoacidosis

ANS: C- Diabetic who starts taking his medications regularly Health education encourages positive, informed changes in lifestyle behaviors that prevent acute and chronic disease, decrease disability, and enhance wellness. Two main objectives of health education and counseling are to change health behaviors and to improve health status. A diabetic who starts taking his medications regularly is an example of a behavior change intended to decrease disability.

A community health nurse is developing educational materials related to nutrition. Which of the following resources would be most appropriate for the nurse to use? (select all that apply) a. Recommended dietary allowances (RDAs) b. MyPyramid c. Dietary reference intakes (DRIs) d. MyPlate

ANS: C- Dietary reference intakes (DRIs), D- MyPlate The most current food and nutrition recommendations are found using the dietary reference intakes (DRIs) and MyPlate. These two resources replaced the previously issued recommended dietary allowances (RDAs) and MyPyramid.

1. Which is an example of asymptomatic pathogenesis? a. Blood pressure of 170/98 experiencing headaches b. Positive finding on colonoscopy and blood in his or her stool c. Elevated prostate-specific antigen (PSA) d. Elevated TSH who is always tired

ANS: C- Elevated prostate-specific antigen (PSA) The primary objective of screening is the detection of a disease in its early stages, to treat it and deter its progression. The screening process is based on the principle that disease is preceded by a period of asymptomatic pathogenesis when risk factors predisposing a person to the pathological condition are building momentum toward manifestation of the disease. Therefore, someone with an elevated PSA without any symptoms is an example of asymptomatic pathogenesis. The other three examples demonstrate manifestation of disease (headaches, blood in stool, and tiredness).

A teenager, who lives at home with her parents and school-aged brother, has been diagnosed with anorexia nervosa. Which of the following would be the most appropriate teaching goal for this teenager? a. Increased energy level b. Improved coping c. Enhanced self-esteem d. Accomplished activities of daily living

ANS: C- Enhanced self-esteem Health teaching includes all family members; although the general teaching goal is the same for all, approaches and specific goals for each member will be different. Teenagers with anorexia nervosa often have decreased self-esteem. As a result, an appropriate goal for this teenager would be enhanced self-esteem.

Which of the following is an example of a screenable population for hypertension? a. High school students b. Professional hockey players c. High-level business executives attending an annual conference d. Cardiac rehabilitation clients

ANS: C- High-level business executives attending an annual conference The objective of identifying a screenable population is to identify a high-risk group that, when tested, will yield a significant number of diseased individuals. The main criterion used to define an appropriate population is the definitive presence of risk factors related to the disorder. Most high-level business executives are middle-aged men with stressful jobs, placing them at high risk for heart disease. Thus, this would be the best example of a screenable population for hypertension.

A community health nurse is educating a community group about the 2010 Dietary Guidelines for Americans. Which of the following information would be included in this presentation? a. Limit consumption of dairy products. b. Purchase organic fruits and vegetables. c. Make at least half of your grains whole grains. d. Consume fish on a daily basis.

ANS: C- Make at least half of your grains whole grains. One of the principal messages for consumers is "make at least half of your grains whole grains." Other messages include "switch to fat-free or low-fat (1%) milk" and "make half your plate fruits and vegetables." There is not an essential message to consume fish on a daily basis.

For which of the following is Type 2 diabetes mellitus screening recommended? a. Overweight woman b. Teenager c. Man with hypertension d. Woman with a family history of Type 2 diabetes mellitus

ANS: C- Man with hypertension The risk of developing Type 2 diabetes mellitus increases with age, obesity, and lack of exercise. Although the woman with a family history of Type 2 diabetes mellitus is at risk of developing the disease, screening is only recommended for those with hypertension. Therefore, the man with hypertension should be screened for Type 2 diabetes mellitus.

A community health nurse is educating health care providers in a local clinic about steps to take to help their clients improve their health-related behaviors. Which of the following would be included as the nurse teaches about the acronym LEARN? a. Explain how small changes can affect health. b. Acknowledge that action needs to be taken. c. Negotiate an agreement. d. Refer to community resources.

ANS: C- Negotiate an agreement. LEARN refers to the steps nurses can take to help the person who needs to improve health-related behavior. L = Listen with sympathy and understanding to the person's perception of the problem, E = Explain personal perceptions of the problem, A = Acknowledge and discuss differences and similarities, R = Recommend treatment, N = Negotiate an agreement.

A nurse is planning a comprehensive health promotion activity to provide community members with a better opportunity to manage their own risk. Which of the following activities would be most appropriate for the nurse to perform? a. Obtaining blood pressures and cholesterol levels during a screening b. Obtaining blood pressures and family histories during a screening c. Obtaining blood pressures and discussing the importance of exercise during a screening d. Obtaining blood pressures, cholesterol levels, and glucose levels during a screening

ANS: C- Obtaining blood pressures and discussing the importance of exercise during a screening Providing health education during a screening falls under the Scope and Standards of Nursing Practice. Many chronic diseases are the result of health behaviors. The nurse's role as educator is essential in the screening process because nurses provide individuals with the information necessary for choices that are made regarding healthy behavioral changes. Awareness is the first step in prevention. If awareness is combined with health education and health-promotion tools, people will have a better opportunity to manage their own risks. Thus, obtaining a person's blood pressure while discussing the importance of exercise during a blood pressure screening is an example of a comprehensive health promotion activity.

A nurse is using the health belief model as a framework when developing a community action campaign to increase the percentage of the population who receives the influenza vaccine. Which of the following considerations will need to be made? a. How empowerment can be used to motivate community members b. How modeling can be used in the community to increase public awareness c. Perceived susceptibility in the community about getting influenza d. Perceived stage of behavior change that exists in the community

ANS: C- Perceived susceptibility in the community about getting influenza The components of the health belief model that need to be considered are: individual perceptions or readiness for change; the value of health to the individual compared with other aspects of living; perceived susceptibility to a health problem, disease, or complications; perceived seriousness of the disease level threatening the achievement of certain goals or aims; risk factors to a disease attributed to heredity, race or culture, medical history, or other causes; perceived benefits of health action; perceived barriers to promotion action

A nurse is investigating an outbreak of a food-borne illness occurring at a local school. Which of the following would contribute to a chemical contamination resulting in food-borne illness? a. Unintended allergen added to food b. Bacteria on the countertops c. Pesticide on the fresh fruit d. Metal shavings in the food from a dull can opener

ANS: C- Pesticide on the fresh fruit Food-borne illness is classified according to the source of its contamination. Food contaminants may be categorized as biological (bacteria), chemical (pesticides), or physical (metal shavings and unintended allergens).

The goal for the educational session is for the individual to correctly demonstrate proper technique for checking blood sugar levels. Which of the following teaching strategies would be most effective? a. Provide the individual with one-on-one education about blood sugar monitoring. b. Provide the individual with a scenario about blood sugar monitoring. c. Provide the individual with the opportunity to practice blood sugar monitoring. d. Provide the individual with a blood sugar monitor.

ANS: C- Provide the individual with the opportunity to practice blood sugar monitoring. Teaching is directed toward one or more of the three learning domains. The goal of having the individual demonstrate the proper technique for checking blood sugar levels relates to the psychomotor domain and is best achieved through demonstration and practice. These strategies allow the nurse to provide the individual with feedback and encouragement.

Which of the following individuals has a modifiable, nutrition-related risk factor for stroke? a. African American man, age 65, who has a low salt intake b. White woman, age 32, who follows the MyPlate recommendations c. Russian man, age 40, who drinks 3 oz of vodka daily d. Hispanic man, age 42, who exercises regularly

ANS: C- Russian man, age 40, who drinks 3 oz of vodka daily Modifiable risk factors are those that the person can control. Race, age, and gender are nonmodifiable risk factors. Habitual alcohol intake is a modifiable risk factor for stroke.

Which of the following statements about the Dietary Reference Intakes (DRI) is correct? a. The DRI is used to monitor deficiencies in nutritional intakes of obese populations. b. The DRI is used to establish minimal amounts of nutrients needed to protect against nutrient deficiency. c. The DRI is used to plan and assess diets of healthy people. d. The DRI is used to set minimal guidelines to reduce risk of adverse outcomes from inadequate consumption of nutrients.

ANS: C- The DRI is used to plan and assess diets of healthy people. The DRI are a set of values for the dietary nutrient intakes of healthy people in the United States and Canada. They are used for planning and assessing diets. The four sets of values included in the DRI are Recommended Daily Allowance (RDA), Adequate Intake, Estimated Average Requirement, and Tolerable Upper Intake Levels. The previous RDA, which existed before 1997, established minimal amounts of nutrients needed to protect against nutrient deficiency.

A nurse is developing learning objectives for an individual who is becoming more physically active. Which of the following is an example of an appropriately written affective learning objective? a. The individual will understand the importance of daily exercise. b. The individual will demonstrate the importance of daily exercise. c. The individual will verbalize the importance of daily exercise. d. The individual will believe in the importance of daily exercise.

ANS: C- The individual will verbalize the importance of daily exercise. Affective learning alludes to the recognition of values, religious and spiritual beliefs, family interaction patterns and relationships, and personal attitudes that affect decisions and the problem-solving process. Objectives of this domain must incorporate action verbs that indicate observable learning. Verbalizing the importance of daily exercise alludes to the recognition of the value of daily exercise to the individual.

A nurse is working at a women's health clinic and is asked by a client when she should return for her next Pap smear. Which of the following resources would the nurse use to find the most current recommendations? a. National Health Information Center b. Healthy People 2020 c. U.S. Preventive Services Task Force (USPSTF) website d. Centers for Disease Control and Prevention (CDC) website

ANS: C- U.S. Preventive Services Task Force (USPSTF) website The most current information about recommendations for screening tests can be found on the Agency for Healthcare Research and Quality (AHRQ) U.S. Preventive Services Task Force (USPSTF) website. These recommendations evolve as new scientific evidence becomes available.

Any combination of planned experiences based on sound theories that provide individuals, groups, and communities the opportunity to acquire the information and skills needed to make quality health decisions is known as health: a. promotion. b. counseling. c. education. d. knowledge.

ANS: C- education Any combination of planned experiences based on sound theories that provide individuals, groups, and communities the opportunity to acquire the information and skills needed to make quality health decisions is known as health education

The nurse is examining the ability of a phenylketonuria (PKU) screening test to distinguish correctly between newborns who have and who do not have the disease. Which of the following measures of accuracy of the instrument is being evaluated? a. Sensitivity b. Specificity c. Validity d. Efficacy

ANS: C-Validity Validity is defined as a test's ability to distinguish correctly between diseased and nondiseased individuals.

A nurse is counseling a person with heart disease. Which of the following statements made by the individual would require the nurse to provide additional education? a. "I drink skim milk on a regular basis." b. "I try not to eat foods that have added salt on the label." c. "I eat American cheese about once every 2 weeks." d. "I add salt to many of the food that I eat to enhance the flavor."

ANS: D- "I add salt to many of the food that I eat to enhance the flavor." The 2006 AHA diet and lifestyle recommendations include the suggestion to reduce salt intake by comparing the sodium content of similar products and choosing products with less salt or sodium; choosing versions of processed foods, including cereals and baked goods, that are reduced in salt or sodium; and limited condiments. Sodium ingestion leads to retention of fluids and may be harmful to the cardiovascular system of someone who has heart disease.

A 37-year-old woman asks the nurse if she should take a daily nutritional supplement. Which of the following would be the best reply by the nurse? a. "Postmenopausal women should take a calcium supplement to prevent osteoporosis." b. "Many people use supplements as drugs instead of as supplements." c. "Supplements can enhance the medications that you take." d. "The best way to obtain nutrients is by eating a variety of foods."

ANS: D- "The best way to obtain nutrients is by eating a variety of foods." The desirable way for the general public to obtain nutrients is by eating a variety of foods. Dietary supplements needs to be used cautiously so that excess amounts are not consumed, which could lead to possible adverse effects.

A nurse is speaking to a women's group in the community about the importance of completing mammography to screen for breast cancer. At which age should the nurse recommend that mammography begin? a. 18 b. 21 c. 35 d. 40

ANS: D- 40 It is recommended that all women age 40 and older have a mammography performed every 1 to 2 years to screen for breast cancer.

A nurse is counseling a person who was recently diagnosed with diabetes about how to prevent the complications of this disease. Which of the following interventions would be stressed the most by the nurse? a. Adjusting sliding scale insulin therapy as needed b. Taking oral hypoglycemic medication as prescribed c. Monitoring blood glucose daily d. Adhering to medical nutrition therapy

ANS: D- Adhering to medical nutrition therapy Medicine may be used to control blood glucose level, and measuring the blood glucose daily helps in controlling its level. But the key to maintaining diabetic control is individualized medical nutrition therapy, the purpose of which is to delay or prevent diabetic complications.

An overweight woman joins a support group to help her lose weight. During her first session, the nurse explains the components of a healthy diet and discusses with the woman how she can eat out and still maintain a healthy diet. She asks the woman what her goal is and emphasizes that she herself is the key to success. What is the nurse promoting through the use of this strategy? a. Communication b. Values c. Advanced planning d. Empowerment

ANS: D- Empowerment A goal of health education is empowerment. People who believe they can make a difference in their own health and who are included in decision making are more likely to make changes. By giving the woman the tools (education about a healthy diet) and involving her in the decision-making (set her own goal), the nurse empowers the woman to make a change in her eating habits.

A community health nurse is using the Dietary Reference Intakes (DRIs) as a guide while developing an education presentation about nutrition for a community group. How will the use of the DRIs be helpful in developing this presentation? a. It considers the unique differences among children, pregnant women, and elderly people. b. It contains well-researched data that are reviewed on an annual basis. c. It is prescriptive in the amount of nutrients that are needed on a daily basis. d. It serves as an overall guideline for the population.

ANS: D- It serves as an overall guideline for the population. Dietary Reference Intakes may be used for individuals; however, ideally they are guidelines for population groups and apply over time. It is the trend that matters not the amount on a certain day. The DRIs are created even when limited data are available as this is deemed better than no guidance at all. The DRIs are only updated when deemed necessary. There are limited data relating to genetic diversity in the population or specific groups such as children, pregnant women, and elderly people.

A person states to the nurse, "The guidelines for what we should eat as Americans is constantly changing, just when I got used to using MyPyramid they changed it to MyPlate. I wonder what will be next and if they really know what they are doing with all of this change." Which of the following would be the best response from the nurse? a. "The USDA is constantly making changes in order to decrease the alarming rates of obesity in our country." b. "MyPyramid was developed in 2005, so it was time for this graphic to be revised." c. "The creation of MyPlate has decreased the need for additional teaching resources for nutrition." d. "MyPlate serves as a better visual aid, reminding Americans what a healthy 'plate' looks like."

ANS: D- MyPlate serves as a better visual aid, reminding Americans what a healthy 'plate' looks like." MyPate was released in June 2011 providing Americans easy to understand and useful advice. MyPlate visually "reminds" consumers what a healthy "plate" looks like using a familiar place setting. It is not meant to stand alone as a teaching tool.

A community health nurse is working with a low-income family who is experiencing food insecurity. To assist the family in getting nutritious foods in their home, the family should be referred to which of the following programs? a. Nutrition Service Incentive Program (NSIP) b. Supplemental Nutrition for Women Infants and Children (WIC) c. National School Lunch Program (NSLP) d. Supplemental Nutrition Assistance Program (SNAP)

ANS: D- Supplemental Nutrition Assistance Program (SNAP) Supplemental Nutrition Assistance Program (SNAP) supplements the food-buying power of eligible low-income households and is the foundation of the Nations' nutrition safety net. The program is designed to help low-income families and individuals purchase nutritionally adequate foods.

A nurse is developing learning objectives for an individual who has been recently diagnosed with asthma. Which is an example of an appropriately written psychomotor learning objective? a. The individual will understand how to correctly use an inhaler. b. The individual will realize the importance of using an inhaler correctly. c. The individual will feel better when using the inhaler correctly. d. The individual will demonstrate proper use of the inhaler.

ANS: D- The individual will demonstrate proper use of the inhaler. Psychomotor learning involves developing physical skills from simple to complex. Objectives of this domain must incorporate action verbs that indicate observable learning. Demonstrating proper use indicates that the individual has developed the necessary skills to use an inhaler correctly.

A community health nurse is providing education about the "Dietary Approaches to Stop Hypertension" (DASH) eating plan to people attending cardiac rehabilitation. Which of the following recommendations would be included in this presentation? a. The use of this dietary plan has the same health effects as a daily exercise program. b. The use of this dietary plan will eliminate the need for medication to treat hypertension. c. This dietary plan is excludes the consumption of processed foods. d. This dietary plan includes eating greater amounts of fruits and vegetables.

ANS: D- This dietary plan includes eating greater amounts of fruits and vegetables. Clinical studies show that blood pressure can be lowered by following the DASH eating plan. The DASH eating plan includes abundant fruits and vegetables, more fat-free or low-fat milk and milk products, whole grains, fish, poultry, beans, seeds, and nuts. Depending on the severity of hypertension, the plan may allow for a reduction or elimination of medication.

Which represents a disadvantage of screening? a. Utilization of group screening methods b. Utilization of multiple test screening c. Utilization of a test with high specificity d. Utilization of a test with low sensitivity

ANS: D- Utilization of a test with low sensitivity Group screening and multiple test screening are advantages of screening programs. A disadvantage of screening occurs when the test is unable to distinguish those who probably have the disease from those who do not. Tests with low sensitivity produce a large number of false-negative tests and leave those screened with a false sense of a healthful state, resulting in them losing the opportunity to receive early treatments that could prevent irreversible damage.

The primary objective of social marketing is to: a. plan behavior b. analyze behavior c. limit behavior d. change behavior

ANS: D- change behavior The primary objective of social marketing is to change behavior

A nurse is developing a primary prevention strategy to address the problem of obesity. Which of the following interventions is being created? a. Encouraging an active lifestyle during childhood years b. Prescribing orlistat (Alli) c. Recommending the Jenny Craig program d. Recommending gastric banding surgery

a. Encouraging an active lifestyle during childhood years Exercise is an important component of primary prevention. Less active children increase their risk of sedentary lifestyles as adults. Sedentary lifestyles lead to obesity. Therefore, a primary prevention method for obesity is to encourage an active lifestyle during the childhood years.

A nurse is counseling a 19-year-old person who has recently been diagnosed with Type 1 diabetes mellitus. The person asks if there is anything specific that should be done before going to play tennis with a friend. Which of the following instructions should the nurse give the person to avoid hypoglycemia? a. Inject the insulin into the abdomen. b. Inject the insulin into the arm. c. Inject the insulin into the thigh. d. Skip taking any insulin before exercising.

a. Inject the insulin into the abdomen. When insulin is injected in a muscle that will be active, it will speed up the absorption of insulin and quickly decrease blood glucose. Because tennis involves a lot of leg and arm movement, insulin should be given in the abdomen. Additionally, not all insulins have the same onset or duration of action. Changes in insulin dosage schedules should not be made without knowing the onset or duration of action.

A nurse is educating a 35-year-old woman about the best exercises to engage in to prevent bone loss. Which of the following exercises would the nurse recommend? a. Walking b. Swimming c. Weight training d. Bike riding

a. Walking Weight-bearing activities have a positive effect on bone density, and walking is a weight-bearing activity. In young women, the goal is to increase bone mineral density; thus, walking is the best exercise to prevent osteoporosis in this woman.

Activity that uses large muscle groups in a repetitive, rhythmic fashion over an extended period to improve the efficiency of the oxidative energy producing system and improve cardiorespiratory endurance is known as: a. aerobic activity. b. anaerobic activity. c. flexibility. d. muscular fitness.

a. aerobic activity. Aerobic activity is defined as activity that uses large muscle groups in a repetitive, rhythmic fashion over an extended period to improve the efficiency of the oxidative energy producing system and improve cardiorespiratory endurance

A nurse is providing care for a 10-year-old child with a BMI at the 80th percentile. Which of the following best describes this child? a. Normal weight b. Overweight c. Obese d. Morbidly obese

a. normal weight A child or adolescent is categorized as being overweight if his or her BMI is greater than or equal to the 95th percentile of age- and gender-specific BMI growth charts. Thus, the 10-year-old child with a BMI at the 80th percentile is considered to be normal weight Children are considered normal if under 85th percentile. Children are considered abnormal (overweight/obese) if over 85th percentile.

According to the 2009-2010 National Health and Nutrition Examination Survey, what percentage of 6- to 11-year-old children are overweight? a. 14% b. 18% c. 24% d. 28%

b. 18% According to the 2009-2010 National Health and Nutrition Examination Survey conducted by the CDCs National Center for Health Statistics, 18% of 6- to 11-year-old children are overweight.

An occupational health nurse is trying to promote regular activity at her institution. Which of the following interventions would most likely be the most successful? a. Educate all employees regarding the benefits of exercise. b. Initiate a lunchtime walking group that employees can join. c. Provide all employees with an exercise prescription. d. Recommend that employees who do not exercise be terminated from their positions.

b. Initiate a lunchtime walking group that employees can join. Individuals are more likely to initiate and maintain physical activity if they feel competent doing the activity, feel safe doing it, perceive no negative financial or social cost, can access the activity easily on a regular basis, and can fit the activity into their regular schedule. Knowledge is not enough to sustain activity. Role models are helpful. Initiating a lunchtime walking group demonstrates enthusiasm on the part of the nurse, provides an activity that is easy and mastered by most and provides a social activity that can promote reinforcement by others who participate

A nurse is discussing exercise intensity with a client. Which of the following medications that the client is taking may limit the usefulness of heart rate as an indicator of exercise intensity? a. Ciprofloxacin (Cipro) b. Metoprolol (Toprol) c. Atorvastatin (Lipitor) d. Lansoprazole (Prevacid)

b. Metoprolol (Toprol) Beta-blockers may alter the relationship between heart rate and the rate of perceived exertion. Metoprolol is a beta-blocker and thus may limit the usefulness of heart rate as an indicator of exercise intensity.

A nurse is providing care to a person who has lower back pain. Which of the following exercises would the nurse recommend to assist with pain reduction? a. Walking b. Pilates c. Swimming d. Bike riding

b. Pilates Maintaining proper curves of lordosis and kyphosis in the vertebrae is important for sustaining the spring and shock absorption quality of the spine. Poor posture can increase stress on the back and lead to pain. Exercises that train the paraspinal muscles to improve posture (like Pilates) are effective for people with lower back pain. Aerobic activity is recommended to maintain endurance and prevent debilitation from inactivity.

During an office visit, a nurse meets with a woman who states she does not have time to exercise. Which of the following actions should the nurse take next? a. Do nothing because she has already made the decision to not exercise. b. Provide her with information on the benefits of exercising. c. Develop an exercise prescription with her. d. Schedule a follow-up in 2 months to see if she still feels the same way.

b. Provide her with information on the benefits of exercising. The woman is in the precontemplation state and thus should not be forced into a plan at this time. However, exercise has many benefits and it implementation should be encouraged. The nurse should continue to ask at each visit because when individuals are counseled by clinicians they are more likely to increase physical activity. As a result, providing the woman with information regarding the benefits of exercising and bringing up the topic of exercise is the best approach at this stage.

A nurse is working with a group of individuals to start an exercise program. Which of the following would require the most attention and assistance? a. White man who works 50 to 60 hours a week as a business executive b. Unemployed, obese Hispanic woman c. Employed White woman with hypertension d. White man with a high school diploma

b. Unemployed, obese Hispanic woman The number of adults with no leisure-time physical activity varies by race, ethnicity, gender, education level, geographic location, disability status, and age. Women are less active than men. Lower income and less educated people are not as physically active as those with higher socioeconomic and educational levels. In addition, African Americans and Hispanics are less active. The unemployed, obese Hispanic woman has three risk factors for inactivity: (1) she is unemployed and therefore likely has no or a low income level; (2) she is a woman, and (3) she is Hispanic. All of these factors place her at risk for inactivity

During a home visit, a nurse notes that a person with hypertension lives on the third floor of a subsidized housing project on a busy road with no sidewalks and few street lights. Which of the following would be the best recommendation for exercise for the nurse to make to the person? a. Do not exercise because you have high blood pressure. b. Use the stairs whenever you are entering or leaving the building. c. Go for short walks around the block during the daytime only. d. Purchase an exercise bike.

b. Use the stairs whenever you are entering or leaving the building. Exercise decreases blood pressure and thus should be encouraged in those with hypertension, especially aerobic activity. Participation in physical activity depends on the availability of facilities and a safe environment. Walking in the road is not safe, and it is also unlikely that this person, who lives in a subsidized housing project, has the funds to purchase an exercise bike. Therefore, using the stairs as much as possible would be a safe, inexpensive form of exercise for this person.

During an office visit, a nurse provides counseling to a 70-year-old woman with osteoporosis who is otherwise very healthy. Which of the following information should the nurse provide to the woman? a. Avoid all forms of exercise because of the risk of fractures. b. Walk with a partner at least 30 minutes a day 5 days a week. c. Use a wheelchair to get around so that she can prevent falls. d. Take a step aerobics class 5 days a week

b. Walk with a partner at least 30 minutes a day 5 days a week. Regular physical activity helps maintain functional independence and improve quality of life throughout the aging process. The benefits of exercise have been documented for both healthy and chronically ill older adults. Exercise improves bone mineral density, especially weight-bearing activities such as walking, aerobic, and dance. Women 30 to 40 years past menopause also need to consider decreasing the risk of fractures by preventing falls. Advanced age and osteoporosis should not exclude anyone from exercise. Therefore, walking with a partner provides the exercise that is needed as well as a companion to help prevent falls or notify someone if a fall occurs.

A nurse is monitoring the exercise of a 42-year-old woman. Which of the following would be the estimated maximum heart rate (MHR) for this woman? a. 126 b. 142 c. 178 d. 184

c. 178 A generic formula for determining MHR is 220 minus age: 220-42 = 178

A nurse is counseling a 40-year-old person who is going to start an exercise program. Which of the following heart rate ranges would the nurse encourage the person to maintain while exercising? a. 70 to 140 beats/min b. 80 to 143 beats/min c. 90 to 153 beats/min d. 100 to 180 beats/min

c. 90 to 153 beats/min The maximum heart rate for a 40-year-old is 180. Exercise should produce a heart rate that is 50% to 85% of maximum heart rate. This percentage corresponds to a rate of perceived exertion of 11 to 14: 50% of 180 = 90, 85% of 180 = 153. Thus, the range should be 90 to 153

A nurse is caring for a man who states he is ready to start exercising. Which of the following actions should the nurse take next? a. Do nothing because he has already made the decision to implement a change. b. Provide him with information on the benefits of exercising. c. Develop an exercise prescription with him. d. Schedule a follow-up in 2 months to see if he still feels the same way

c. Develop an exercise prescription with him. Working with a person to choose an activity that he likes will improve adherence. The person is displaying that he is in the action phase of change, and he should be given a prescription that promotes exercise and places him in the maintenance phase

A nurse is providing health education for a group of older adults about the risks of developing coronary heart disease. Which of the following group members is at highest risk? a. Takes a beta-blocker for hypertension b. Has a total cholesterol level of 201 c. Doesnt participate in any form of regular physical activity d. Has a family history of Type 2 diabetes mellitus

c. Doesnt participate in any form of regular physical activity Physical inactivity affects more people in the development of coronary heart disease than any other risk factor. At any level or combination of risk factors, sedentary individuals are at greater risk of developing coronary heart diseases. Exercise provides both primary and secondary prevention. Thus, the person who does not participate in any form of regular physical activity is at most risk of developing coronary heart disease.

The nurse is discussing an exercise prescription with a person. To help him determine the appropriate intensity, the nurse tells him that he should monitor his rate of perceived exertion. Which of the following should the nurse tell the man he should experience while exercising? a. Talking and singing without difficulty b. Feeling extremely fatigued c. Having mild musculoskeletal discomfort d. Being out of breath

c. Having mild musculoskeletal discomfort The rate of perceived exertion helps people determine a comfortable, beneficial level of exercise intensity. Being slightly short of breath, able to talk with difficulty, being pleasantly fatigued, and having mild musculoskeletal pain reflect a rate of perceived exertion that corresponds well with 50% to 85% of maximum heart rate, an appropriate target range for most individuals.

A nurse is providing care for a 40-year-old adult with a BMI of 32. Which of the following best describes this person? a. Normal weight b. Overweight c. Obese d. Morbidly obese

c. Obese An adult 20 years of age or older is considered overweight if his or her BMI is 25 to 29.9, obese if his or her BMI is 30 or higher, and morbidly obese if his or her BMI is 40 or higher. Thus, the 40-year-old adult with a BMI of 32 is considered obese.

An inborn set of physiological changes that offset those of the fight or flight response is known as: a. Self-efficacy b. Catecholamine surge c. Relaxation response d. Metabolism

c. Relaxation response

A nurse is developing an exercise program for a person with moderate osteoarthritis of the knees. Which of the following forms of exercise would the nurse include in this program? a. Step aerobics b. Running c. Water aerobics d. Bike riding

c. Water aerobics Water activities are good exercise alternatives for people with musculoskeletal limitations who need some weight relief with exercise. The water provides buoyancy while also providing resistance to the limbs as they move. Studies have also demonstrated that people who participate in aquatic exercise experienced greater pain reduction than those who participated in land activities. Thus, water aerobics would be the most appropriate form of exercise for this individual

A nurse is discussing resistance training with a 24-year-old woman. The woman is resistant to weight lifting because she does not want to get too muscular. She prefers a program that is strictly aerobic. Which of the following would be the most appropriate response from the nurse? a. Ok, just make sure you perform one hour of aerobics every day. b. Lifting weights is a necessary part of exercise. c. Weight lifting has many purposes and benefits; can we talk about them? d. Looking muscular at your age is attractive.

c. Weight lifting has many purposes and benefits; can we talk about them? Weight training helps develop healthy muscles that provide strength to perform activities of daily living (ADLs) without injury and it stimulates bone health. Additionally, the risk of injury outweighs the benefits of aerobic exercise more than 5 days a week. Not all weight lifting leads to a bodybuilder physique. Offering the patient the opportunity to discuss weight training will allow the patient the opportunity to open up and discuss fears and concerns. It also provides the nurse with the opportunity to discuss the risks and benefits

A 51-year-old woman has begun menopause. The nurse emphasizes the importance of a diet high in calcium and vitamin D as well as exercise for this woman. This recommendation is important because by the time the client is 56, she will have experienced another _____ bone loss. a. 3% b. 7% c. 10% d. 15%

d. 15% The rate of bone loss accelerates rapidly during the first 5 postmenopausal years, with annual losses of 3% to 5% being common. Thus, if at least 3 % is lost over 5 years, 3% 5 years (56 51) = 15%.

According to the physical activity and fitness section of the Healthy People 2020 report, what percentage of adults 18 years of age or older report no leisure-time physical activity? a. 16% b. 26% c. 36% d. 46%

d. 46% According to the physical activity and fitness section of the Healthy People 2020 report, 36% of adults 18 years of age or older report no leisure-time physical activity. pg 265

A woman is going for a 2-hour hike in the Grand Canyon and she asks the nurse how much fluid she should take along with her. Which of the following recommendations should be given by the nurse? a. Bring at least 24 ounces of water. b. Bring at least 72 ounces of water. c. Bring at least 24 ounces of sports drink. d. Bring at least 72 ounces of sports drink

d. Bring at least 72 ounces of sports drink If the weather is hot, 5 to 12 oz of fluid should be taken every 15 to 20 minutes during exercise. Additionally, if exercise lasts more than 1 hour, a drink that provides carbohydrates and electrolytes helps delay fatigue and improve performance

Which of the following statements about exercise is true? a. People who engage in high-intensity exercise are at lowest risk for illness. b. Aerobic exercise should be part of daily exercise routines. c. Regular exercise may cause people to experience fatigue and increased susceptibility to mental health disorders. d. Low-level physical activity may have a protective effect on gastric and pancreatic cancer.

d. Low-level physical activity may have a protective effect on gastric and pancreatic cancer. Low-level physical activity may have a protective effect on gastric and pancreatic cancer. People who engage in moderate-intensity activity are at lowest risk for illness, whereas those who engage in high-intensity activity are at higher risk for illness. Aerobic exercise is recommended at a frequency of three to five times per week. Every other day is a good frame of reference as it allows for recovery between training sessions. Cross-training is recommended as part of daily exercise routines. Regular exercise promotes positive well-being and decreased susceptibility to mental health disorders.