Mod 1: EAQ Chapter 16
A patient with diabetes mellitus had a lower leg amputation. Which patient statement indicates a problem with body image? "I just don't have any energy to get out of bed in the morning." "I've been attending church regularly with my wife since I discharged." "My wife has taken over paying the bills since I've been in the hospital." "I don't go out very much because everyone stares at me."
"I don't go out very much because everyone stares at me." The amputation resulted in a change in physical appearance that caused a change in body image. Reactions of patients and families to changes in body image depend on the type of changes (e.g., loss of a limb or an organ), their adaptive capacity, the rate at which changes take place, and the support services available. When a change in body image, such as one that results from a leg amputation, occurs, the patient generally adjusts in the following phases: shock, withdrawal, acknowledgment, acceptance, and rehabilitation. The patient's statement indicates he is in the stage of withdrawal. The other statements do not address altered body image or negative self-image. p. 227
Which activity represents secondary prevention? A home health care nurse visits a patient's home to change a wound dressing. A 50-year-old woman with no history of disease attends the local health fair and has her blood pressure checked. The school health nurse provides a program to the first-year students on healthy eating. The patient attends cardiac rehabilitation sessions weekly.
A home health care nurse visits a patient's home to change a wound dressing. Secondary prevention focuses on individuals who are experiencing health problems or illnesses and who are at risk for developing complications or worsening conditions. The home health nurse changing the wound dressing is an activity that is focused on preventing complications. Much of the nursing care related to secondary prevention is delivered in homes, hospitals, or skilled nursing facilities. Primary prevention is instituted before disease becomes established by removing the causes or increasing resistance. A 50-year-old woman with no history of disease attending a local health fair and having her blood pressure checked and a school nurse providing a program to the first-year students on healthy eating are examples of primary prevention. Tertiary prevention is aimed at reducing the number and impact of complications and disabilities resulting from a disease or medical condition. The patient attending a cardiac rehabilitation session weekly is an example of tertiary prevention. p. 221
Which intervention falls under an active strategy of health promotion? Fortification of milk with vitamin D Fluoridation of municipal drinking water A weight reduction program for obese people Fortification of cereals with vitamin A
A weight reduction program for obese people Active strategies of health promotion require a person to be actively involved in the measures taken to improve a condition and reduce the risk for disease. Therefore a weight reduction program for obese people is an active strategy. In passive strategies of health promotion, individuals gain from the activities of others without acting themselves. Therefore interventions such as fortification of milk with vitamin D, fluoridation of municipal drinking water, and fortification of cereals with vitamin A are classified as passive strategies. Test-Taking Tip: The patient takes action in active strategies. When asked for active strategies, examine each choice and decide whether the patient is taking the action. p. 219
Which nursing activity is part of a tertiary health care environment? Administering influenza immunizations at the senior independent-living facility Providing well-baby care in the clinic run by the local community health department Admitting a patient following open heart surgery to the cardiovascular intensive care unit Working the triage desk in the emergency department
Admitting a patient following open heart surgery to the cardiovascular intensive care unit Tertiary prevention, also known as the treatment or rehabilitation stage of preventive care, is implemented when a condition or illness is permanent and irreversible, as is the case when admitting a patient following open heart surgery to the cardiovascular intensive care unit. The aim of care is to reduce the number and impact of complications and disabilities resulting from a disease or medical condition. The goal for secondary prevention is early detection and diagnosis of health problems before patients exhibit symptoms of disease. Preventive and health-promotion activities are part of primary prevention. Immunizations, such as those for influenza, are also types of primary prevention. p. 221
When learning about preventive care, tertiary prevention includes which activity? Providing protection against occupational health hazards Taking measures to shorten a period of disability Providing services to limit disability and prevent death Aiding with rehabilitation for physically handicapped people
Aiding with rehabilitation for physically handicapped people Tertiary preventive measures are taken when permanent, irreversible damage has occurred as a result of a medical problem or accident. Therefore aiding with rehabilitation for physically handicapped people would be included within tertiary prevention. Providing protection against occupational health hazards is a primary preventive measure. Taking measures to shorten the period of disability comes under secondary prevention. Providing facilities to limit disability and prevent death would be a secondary preventive measure. Test-Taking Tip: Tertiary prevention occurs when it is Too late to prevent permanent damage. p. 216
Which component affects a family's access to adequate health care, opportunity for education, sound nutrition, and decreased stress? Development Family function Family structure Economic stability
Economic stability The ability of families to meet health care, education, and basic needs is often affected by the economic resources of the family. Family development, family function, and family structure are the basic framework for health promotion. p. 228
As part of a survey using the Behavioral Risk Factor Surveillance System(BRFSS), the nurse collects data on a group of patients. To which website would the nurse refer patients to view the results of the survey? National Institute of Health (NIH) Centers for Disease Control and Prevention (CDC) Health Maintenance Organization (HMO) U.S Department of Health and Human Services (DHHS)
Centers for Disease Control and Prevention (CDC) The BRFSS is an ongoing, state-based, random-digit-dialed telephone survey of the noninstitutionalized U.S. population over 18 years of age. The results are indirectly reported to the CDC. This system collects data on risky behaviors and preventive health measures. The results of this and other health risk behavior surveys are available online at the National Center for Health Statistics, which falls under the CDC. The NIH promotes biomedical research under an agency of the DHHS. An HMO acts as a liaison for primary health care providers and helps in the arrangement of medical services, self-health care benefit plans, and other entities. The government is primarily responsible for the biomedical and human-based research conducted by the DHHS. STUDY TIP: Spend a study session exploring the CDC website. It is a tremendous source of reliable information. Locate sections that you would use for patient education, and those for gathering updates on care. p. 225
When participating in an immunization awareness program within the community, which government website would the nurse recommend as the best source of immunization information for parents? National Institutes of Health (NIH) Centers for Disease Control and Prevention (CDC) Health Maintenance Organization (HMO) U.S Department of Health and Human Services (DHHS)
Centers for Disease Control and Prevention (CDC) The nurse should instruct parents about age-appropriate health checkups, screening examinations, and regular immunizations as per the schedule. The CDC recommends an immunization schedule that parents can use to access accurate information. This brings awareness and promotes parental motivation. The NIH promotes biomedical research under the U.S. DHHS. These organizations are primarily responsible for biomedical and human-related research. An HMO provides guidance for the management of health care, insurance, and self-health care benefit plans. It acts as a liaison with health care providers (hospitals, health care settings, individual practices).The DHHS provides links to health screening and disease prevention sites. STUDY TIP: Locate vaccination schedules on the CDC website: www.cdc.gov/vaccines.To check whether you are up to date on your vaccines, take the CDC's quiz about what vaccines are recommended for you. p. 220
During an older adult's routine physical examination, the medical history reveals that the patient is a smoker, has a milk allergy, and reports leg pain during activity. A Doppler study of the lower extremities confirms a diagnosis of peripheral vascular disease (PVD). The nurse counsels the patient regarding smoking cessation, provides information for a dairy-free, high-fiber diet, encourages exercising for 30 minutes 3days a week, and schedules a screening colonoscopy. Which intervention has a category of primary prevention? Select all that apply. One, some, or all responses may be correct. Counseling for smoking cessation Scheduling a screening colonoscopy Encouraging the patient to exercise regularly Advising the patient to avoid milk products Advising a high-fiber diet to prevent colon cancer
Counseling for smoking cessation Advising the patient to avoid milk products Advising a high-fiber diet to prevent colon cancer Measures taken before the occurrence of disease or dysfunction is categorized as primary prevention. In this case, activities for primary prevention include counseling for smoking cessation to reduce the incidence of lung and colon cancer and advising the patient to avoid milk products and to begin a high-fiber diet to reduce the risk for gastrointestinal (GI) disease. Screening colonoscopy would be a secondary level of prevention. Encouraging the patient with existing PVD to exercise is a tertiary prevention strategy aimed at reducing complications and disabilities related to the PVD. p. 221
A patient with cancer appears anxious and fearful and reports severe abdominal pain. Using the Holistic Health Model (HHM), which action would the nurse take to help the patient cope with these symptoms? Select all that apply. One, some, or all responses may be correct. Recommend that the patient practice yoga to relax. Address the patient's pain, and then focus on the anxiety. Explain the use of guided imagery to the patient. Use therapeutic communication with the patient. Encourage the patient to begin massage therapy.
Explain the use of guided imagery to the patient. Use therapeutic communication with the patient. The nurse uses the HHM while providing nursing care to patients. This model includes the use of natural healing remedies and complementary therapy to promote health. Guided imagery is a technique in which the patient uses imagination to promote relaxation. This technique may relieve stress, fear, and anxiety. The nurse establishes therapeutic communication to enhance the patient's participation in caregiving activities. Yoga is the practice of controlling the physical, mental, and social state of the body. This technique would not be helpful in relieving abdominal pain. Addressing physiological needs such as physical pain before higher-order psychological needs like fear and anxiety is characteristic of the basic human needs model rather than the HHM. Massage therapy may promote comfort but may not relieve abdominal pain. p. 218
When conducting a primary prevention program for school children less than 10 years of age, the nurse would include which intervention related to primary prevention? Explaining the importance of a nutritious diet Supplying a nutritious diet to children with malnutrition Teaching disabled children to use their capacities to the fullest Conducting health examinations to identify children with malnutrition
Explaining the importance of a nutritious diet Primary prevention interventions are done before the development of a disease or disorder. Interventions can be in the form of health education or nursing interventions such as immunizations. They also include a nutritious diet to maintain health and prevent illness. Conducting health examinations to identify children with malnutrition and supplying nutritious diets to the children with malnutrition would be considered secondary prevention because these measures are directed toward managing the disease which has manifested. Teaching disabled children to use their capacities to the fullest would be considered tertiary prevention, as disability has already occurred. STUDY TIP: Be sure to notice the differences between levels of prevention versus levels of care. p. 221
A 55-year-old patient, who is a wild life photographer, reports development of new moles of different sizes and variation in color and revealed the patient's father died of melanoma several years ago. Which risk factor would the nurse associate with melanoma? Select all that apply. One, some, or all responses may be correct. Age Exposure to sunlight Lifestyle Genetic factor Stressful workplace
Exposure to sunlight Genetic factor Excessive exposure to sun rays increases the likelihood of developing skin cancers like melanoma. Genetic factors are an important cause for cancer and make the patient susceptible to the disease. Age is not a risk factor for cancer. Lifestyle factors, such as stress in the workplace, do not predispose a person to cancer. p. 224
A patient diagnosed with major depressive disorder has a nursing diagnosis of chronic low self-esteem. Which cognitive intervention by the nurse would be the most effective? Promote active socialization with other patients. Role play to increase assertiveness skills. Focus on identifying strengths and accomplishments. Encourage journaling of underlying feelings.
Focus on identifying strengths and accomplishments. A humanistic approach to health care focuses on strengths of individuals rather than weaknesses or illness (e.g., physiologic disease or mental disorder). Focusing on strengths and accomplishments to minimize the emphasis on failures helps the patient alter distorted and negative thinking. The other interventions are important, but they are not designed to impact thoughts. p. 217
While obtaining a health history for a patient with a recent diagnosis of atherosclerosis and cardiovascular disease, the nurse determines that the patient's father also had a diagnosis of cardiac disease at the same age. Which risk factor would the nurse identify as significant in influencing the patient's health? Age Gender Lifestyle Genetics
Genetics Many factors influence an individual's health. Some diseases are passed on genetically from generation to generation. The individual's susceptibility to a disease may be genetically passed on from a parent to the off spring. Age is a strong indicator of susceptibility to a disease. For example, some diseases are more common in neonates and infants because of their immature immune system, whereas other diseases are found more in older adults. Gender may also influence susceptibility to an illness such as hemophilia, which is passed on to male children from the mother. Lifestyle may also influence susceptibility to an illness by affecting the risk factors. Lifestyle-related risk factors can include contracting hepatitis or human immunodeficiency virus. p.224,225
Which nursing action is representative of the "self-efficacy concept" of the Health Belief Model? Select all that apply. One, some, or all responses may be correct. Giving verbal reinforcement to make changes Using reminder systems to motivate people Specifying the consequences of noncompliance Explaining the potential positive results of change Receiving training and guidance in performing actions
Giving verbal reinforcement to make changes Receiving training and guidance in performing actions The self-efficacy concept describes confidence in one's ability to take action. The nurse helps the patient develop self-efficacy by providing verbal reinforcement. This action helps the patient repeat healthy behaviors and discontinue unhealthy ones. The patient goes through training on health-related practices such as how to make appointments and where to look for health-related information. Using a reminder system helps in providing cues to perform an action. Specifying consequences helps clarify the severity of the disease. The perceived-benefits concept helps explain the effectiveness of taking action to reduce risk and promote positive results. pp. 217,218
Which health model would the nurse follow to determine a patient's readiness and motivation to make changes? Health Belief Model (HBM) Holistic Health Model (HHM) Health Promotion Model (HPM) Basic Human Needs Model (BHNM)
Health Belief Model (HBM) The HBM explores the relationship between health behavior and factors that affect it, such as the patient's attitudes and beliefs. While preparing a nursing care plan, a nurse should determine a patient's readiness and motivation using HBM. The nurse follows the HHM to provide holistic health care, which includes natural remedies and complementary interventions. The nurse uses the HPM to provide primary preventive care to patients, including health promotion and specific protection. The nurse uses the BHNM to provide prioritized nursing care according to the patient's needs. p. 217
The nurse identifies a patient whose health status is affected by attitudes, values, and cultural practices. Which health model would identify the relationship between the patient's cultural practices and health status? Health Belief Model (HBM) Holistic Health Model (HHM) Health Promotion Model (HPM) Basic Human Needs Model (BHNM)
Health Belief Model (HBM) The HBM identifies the impact of the patient's attitudes and beliefs on the patient's susceptibility to illness, the severity of the illness, barriers to adopting a healthy lifestyle, and self-care during an illness. The nurse provides culturally competent and congruent care to the patient based on the HBM. The HHM deals with promotion of natural healing methods and collaborative care. The HPM deals with providing preventive care. The nurse follows the BHNM to categorize the areas of patient need. p. 218
During a visit to a family clinic, the nurse teaches a parent about immunizations, car seat use, and home safety for an infant and toddler. Which type of nursing interventions does the nurse implement? Health promotion activities Acute care activities Restorative care activities Growth and development-care activities
Health promotion activities Health promotion activities focus on interventions designed to maintain the physical, social, emotional, and spiritual health of the family unit. They can include information about specific health behaviors, family coping techniques, and growth and development. Acute care activities occur when a patient develops an acute illness. Restorative care activities occur when a patient has experienced a permanent and irreversible illness. Growth and development care activities depend on a person's ability to reason and learn from life experiences in predictable stages at age-appropriate intervals. pp. 219,220
Which action would the nurse take when recognizing that a patient is fasting for religious reasons? Administer intravenous fluids to compensate. Teach the patient about the ill effects of fasting on health. Instruct the patient to refrain from fasting. Incorporate religious practice into the care plan.
Incorporate religious practice into the care plan. The nurse should be aware of patients' religious and cultural practices while providing care. The care plan should incorporate the religious practices as best as possible to promote compliance with the treatment plan. The nurse cannot administer intravenous fluids without a prescription. In addition, the action may be against the patient's religious practices. The patient may be well aware of the effects of fasting on health, and reinforcing the teaching may not be appropriate. The nurse cannot tell the patient to refrain from fasting because the fasting is the patient's personal decision. Test-Taking Tip: Choose the response that supports the patient's cultural and religious practices. p. 224
When providing patient care, the nurse routinely asks whether the patient takes any vitamins or herbal medications, encourages family members to bring in music the patient likes to help the patient relax, and frequently prays with the patient when the patient requests it. The nurse is practicing which model? Holistic Health belief Transtheoretical Health promotion
Holistic The nurse is using a holistic model of care that considers emotional and spiritual well-being and other dimensions of an individual to be important aspects of physical wellness. The Holistic Health Model of nursing attempts to create conditions that promote optimal health. Nurses using the holistic nursing model recognize the natural healing abilities of the body and incorporate complementary and alternative interventions. These interventions may include music therapy, reminiscence, relaxation therapy, therapeutic touch, and guided imagery because they are effective, economical, noninvasive, nonpharmacological complements to traditional medical care. The Health Belief Model (HBM) explores how a patient's attitudes and beliefs predict health behavior. The HBM is used as a measure for determining the patient's readiness and motivation to act. The Transtheoretical Model seeks to include and integrate key constructs from other theories into a comprehensive theory of change that can be applied to a variety of behaviors, populations, and settings. The Health Promotion Model defines health as a positive, dynamic state of well-being rather than an absence of disease in a physiologic state. p. 218
An older adult, admitted to a facility for management of depression, asks a nurse for permission to meditate and perform breathing exercises for 15 minutes in the evening. The nurse grants permission for these activities. Which health model reflects the nurse's response? Health Promotion Model Health Belief Model Holistic Health Model Restoration and Rehabilitation Model
Holistic Health Model The Holistic Health Model emphasizes considering all the dimensions of an individual, including emotional and spiritual well-being dimensions, for the total wellness of an individual. Therefore, the approach used in this case comes under the Holistic Health Model. The Health Promotion Model focuses on individual characteristics and experiences, behavior-specific knowledge and affect, and behavioral outcomes. The Health Belief Model addresses the relationship between a person's beliefs and behavior. Restoration and rehabilitation fall under tertiary prevention. p. 216
Which step is first in health promotion, wellness education, and illness prevention? Identify risk factors. Identify vulnerable people. Help the patient improve health status. Emphasize wellness strategies.
Identify risk factors. When caring for a patient, the nurse has to identify the risk factors and discuss health issues following a comprehensive nursing assessment. Assessment is followed by identification of vulnerable groups. Following this, the nurse can help patients decide if they want to maintain or improve their health status by taking risk-reducing efforts. Based on the assessment and the patient's needs, the nurse can emphasize wellness strategies. pp. 219,220
When learning about health care settings and levels of services, which action would the nurse associate with preventive care? Select all that apply. One, some, or all responses may be correct. Intensive care Immunizations Family planning Cancer screening Mental health counseling
Immunizations Cancer screening Mental health counseling Immunizations vaccinate patients against specific illnesses and are performed under preventive health care. Cancer screening helps in early detection of cancer; hence this is a part of preventive care. Mental health counseling helps prevent mental disorders and is preventive care. A patient in intensive care needs immediate medical attention after the occurrence of medical illness, which is performed under tertiary care. Family planning is meant for the health of the family and is performed under health promotion. p. 221
When providing tertiary care for a patient with cancer, which intervention would the nurse include in a patient-centered care plan? Select all that apply. One, some, or all responses may be correct. Incorporate collaborative care for the patient. Involve family members in the patient's care. Encourage the patient to modify his or her lifestyle. Assist the patient in adjusting to treatments. Assess the patient to determine complications.
Incorporate collaborative care for the patient. Involve family members in the patient's care. Assist the patient in adjusting to treatments. Tertiary care includes treatment methods, restoration of function, or rehabilitation. The nurse provides tertiary care when an illness is permanent, terminal, and irreversible. Collaborating with health care professionals helps provide the best possible quality of life. Involving family members in patient care promotes psychosocial integrity. Helping the patient adjust to cancer treatments enhances the effectiveness of the treatment and keeps the patient motivated. At this stage, modifications in lifestyle may not reverse the disease; therefore this is not a tertiary care intervention. The nurse should try to prevent the complications from occurring rather than diagnosing them. p. 221
The nurse is teaching a 10-year-old patient the proper technique for using an inhaler. Based upon knowledge of the developmental tasks of Erikson's Industry versus Inferiority stage, which outcome is the nurse hoping to achieve? Increase in self-esteem with mastery of a new skill Acceptance of changes in appearance and physical endurance Successful role transitions and increased responsibility to share culture andvalues Appreciation of self as an individual after exploration of multiple roles
Increase in self-esteem with mastery of a new skill The developmental stage of industry versus inferiority (ages 6 to 12) is focused on incorporating feedback from peers and teachers, increasing self-esteem with mastering previously acquired skills, and promoting awareness of strengths and limitations. Acceptance of changes in appearance and physical endurance occurs during Integrity versus Despair (>55 years of age). Successful role transitions and increased responsibility to share culture and values, occurs within the 35- to 55-yearrange and includes the Generativity versus Stagnation stage. Appreciation of self as anindividual after exploration of multiple roles occurs during the Identity versus roleconfusion (12 to 18 years of age). STUDY TIP: Role play with your study group to memorize Erickson's stages. Pick an age group, but don't tell the group what it is. Then make statements consistent with the stage and have your study group guess the stage. For instance, if you were pretending to be an 8-year-old, you could say, "I had a great time playing with my friends today, and the teacher gave me a gold star when I finished my work!" pp. 235,236
Which component of the Health Belief Model addresses the relationship between a person's beliefs and behaviors? Select all that apply. One, some, or all responses may be correct. Individual's perception of susceptibility to an illness Individual's perception of duration of the illness Individual's perception of management of the illness Likelihood a person will take preventive action against a disease Individual's perception of the seriousness of the illness
Individual's perception of susceptibility to an illness Likelihood a person will take preventive action against a disease Individual's perception of the seriousness of the illness The first component of the Health Belief Model involves an individual's perception of susceptibility to an illness. Once individuals understand that they may be susceptible to a disease, they may be able to perceive the seriousness of the problem. The second component is an individual's perception of the seriousness of the illness. The third component is the likelihood that a person will take preventive action. Perception of duration and management of illness are not part of this model. p. 218
Which amount of physical activity would the nurse recommend for healthy adults? Vigorous physical activity for 30 minutes 5 or more days per week Vigorous physical activity for 60 minutes 5 or more days per week Moderate-intensity physical activity for 30 minutes 5 or more days per week Moderate-intensity physical activity for 30 minutes 3 or more days per week
Moderate-intensity physical activity for 30 minutes 5 or more days per week The nurse should instruct healthy adults to participate in moderate-intensity physical activity for at least 30 minutes 5 or more days per week. Engaging in physical activity helps reduce the risk for illness and promotes health. The exercise recommendation for obese and overweight people is to perform vigorous activity for 30 to 60 minutes 5or more days per week. Moderate-intensity activity for at least 30 minutes 3 or more days per week is recommended for older adults. STUDY TIP: A great way to recall this recommendation is to commit to it yourself for one month. Add a half hour of quick walking, tennis, dancing, bike-riding, or using an elliptical machine to your weekdays to see what level of a commitment you are asking of patients (if you do not already do so). p. 220
For a resident living in a long-term-care facility, which of the patient's needs would the nurse plan to meet first, according to Maslow's hierarchy? Love and belonging Safety and security Respect and self-esteem Nutrition and sleep
Nutrition and sleep Physiological needs are the basic requirements for sustaining life and include nutrition, sleep, elimination, and oxygen. People who are aged, disabled, and ill may need assistance in meeting these needs. Once the physiological needs are met, the nurse would address the safety and security needs. After safety and security needs are met, the nurse would work to improve the patient's perception of feeling loved and belonging. The nurse fulfills the respect and self-esteem needs to make the patient feelgood about himself or herself and to a promote sense of accomplishment. STUDY TIP: If you have to move while in school, pack your sheets on top with the phone number for pizza (or other favorite food) delivery. Why? (1) Because food/nutrition and sleep—two physiological needs—will be your top priorities after a hectic day moving; and (2) because this idea will help you recall that in Maslow's hierarchy, physiological needs must be met first! p. 217
Which desired outcome is congruent with the Health Promotion Model? Believing in one's ability to perform a task successfully Optimizing health status Modifying the personality of a person Improving the physical, mental, and social health of all age groups
Optimizing health status The concepts that define the Health Promotion Model are health promotion and health protection. Health promotion is motivated by the desire to increase well-being and optimize health status. A person's belief in one's ability to perform a task successfully is self-efficacy and part of the Health Belief Model. Modifying the personality of a person is not a goal of the Health Promotion Model. The Health Promotion Model acknowledges that people are different and each person is unique. Improving the physical, mental, and social health of all age groups is not included in the Health Promotion Model. These are activities included in the primary level of preventive care. p. 217
When reviewing the medical history of four patients in a health care setting, which patient would the nurse identify as being in stage III of illness? Patient 1 Patient 2 Patient 3 Patient 4
Patient 3 During stage III of illness, the patient may seek additional medical care, may accept medical diagnostic authority, and requests a plan of treatment. Patients 1 and 2 are in stage IV of the illness. These patients accept the illness and allow necessary medical and nursing interventions. Patient 4 is in stage V of the illness. This patient tries to resume his or her life roles and responsibilities to the greatest possible extent. pp. 222,223
The nurse is reviewing the electronic health records of four patients on a medical unit. Which patient has appropriate health promotion activities recommended? Patient 1 Patient 2 Patient 3 Patient 4
Patient 4 Health promotion is an act of motivating patients to obtain optimal health. The interventions for a patient of normal body weight include regular exercise, maintaining a stable body mass index, meeting nutritional requirements, and maintaining good sleep habits. Obesity is a risk factor for various diseases such as heart complications and diabetes mellitus. The interventions for an overweight patient would be a reduction of risk factors for conditions such as diabetes mellitus and hyperlipidemia. These interventions would help improve health and lower the likelihood of developing an illness. An underweight patient may be prone to malnutrition and other disorders such as anemia. The interventions for an underweight patient would be beginning a wellness activation process to gain weight. Such patients often participate in weekly wellness events like yoga, meditation, and fitness assessments. The interventions for a patient with cardiac disease would be to reduce complications such as myocardial infarction or cerebrovascular accident. They include maintaining a proper diet that contains omega-3-fatty acids and proper exercise. pp. 217,218
The nursing instructor discusses the various concepts of the Health Belief Model with student nurses. To which concept is the instructor referring when discussing patient's beliefs about the costs of being healthy? Perceived barriers Perceived benefits Perceived severity Perceived susceptibility
Perceived barriers The Health Belief Model proposes six constructs that influence a patient's decision making regarding disease prevention, screening, and control of illness. Perceived barriers are beliefs about the material and psychological costs of taking action related to health; these may pose a barrier during health promotion activities. Beliefs about the effectiveness of taking action to reduce the risk or severity of disease indicate perceived benefits. Perceived severity is the ability to comprehend the stage and the consequences of an illness. Perceived susceptibility is the risk of developing a disease. p. 217
Which term describes how individuals think about themselves? Self-awareness Self-concept Self-esteem Self-expression
Self-concept Self-concept is the way in which individuals perceive unchanging aspects of themselves. It is subjective and a mixture of conscious and unconscious thoughts, attitudes, and perceptions. Self-awareness is having knowledge about one's feelings, thoughts, and attitudes. Self-esteem is how individuals feel about themselves. Self-expression is expressing one's own character, feelings, thoughts, and mindsets. p.227
A patient at the community clinic asks the nurse about available health promotion activities because of a concern about developing diabetes mellitus because a grandfather and father have the disease. This inquiry reflects the patient is in which stage of the Health Belief Model? Perceived threat of the disease Likelihood of taking preventive health action Analysis of perceived benefits of preventive action Perceived susceptibility to the disease
Perceived susceptibility to the disease The Health Belief Model addresses the relationship between a person's beliefs and behaviors. It provides a way of understanding and predicting how patients will behave in relation to their health and how they will comply with health care therapies. In the perceived susceptibility to the disease phase, the patient recognizes the familial link to the disease. The third component, the probability/likelihood of taking preventive health action, involves lifestyle change and information gathering about a health topic that leads to a change in behavior. Taking action to reduce the susceptibility or severity of a condition is known as perceived benefit. p. 217
In planning nursing care for an older adult patient, which basic need must be met? Assurance of sexual intimacy Preservation of self-esteem Expanded socialization Increase in monthly income
Preservation of self-esteem Self-esteem is essential for physical and psychological health across the life span. Nurses should also consider that applying a fixed hierarchical order is not always the most accurate method for predicting patient behavior or actions concerning optimal health. Areas of need categorized above basic physiologic function, such as self-esteem and love, often override essential physiologic needs when a patient is confronted with certain circumstances. The nurse cannot guarantee the patient will attain sexual intimacy or expand their socialization. The nurse does not control the patient's monthly income. p. 217
Which level of prevention does the nurse use when administering a polio vaccine to an infant? Rehabilitation Tertiary prevention Primary prevention Secondary prevention
Primary prevention Primary prevention aims at health promotion and taking preventive steps before the disease or problem starts. Giving a vaccination to the infant is an example of primary prevention. Secondary prevention measures are taken by people who are experiencing diseases and are at risk for developing complications. Tertiary prevention includes measures taken to minimize the harmful effects of disease or disability. Rehabilitation is part of tertiary prevention. p.221
During an immunization program for physically challenged children in a rehabilitation center, the nurse administered pneumonia vaccines to the children as a part of the program. The scenario meets which level of prevention? Primary prevention Secondary prevention Tertiary prevention Early diagnosis
Primary prevention Primary prevention includes measures taken before the occurrence of a medical problem. For example, vaccinations are given to children or adults to prevent a disease from occurring, which comes under the realm of primary prevention. Secondary prevention includes early diagnosis, treatment, and disability limitation. Tertiary prevention is required when there is a permanent disability. Test-Taking Tip: Primary prevention occurs before disease. p. 221
At which level of prevention is the nurse practicing when administering influenza vaccines to senior citizen during a health fair at the local mall? Primary prevention Secondary prevention Tertiary prevention Quaternary prevention
Primary prevention Primary prevention is aimed at health promotion and includes health-education programs, immunizations, and physical and nutritional fitness activities. It can be provided to an individual and includes activities that focus on maintaining or improving the general health of individuals, families, and communities. It also includes specific protection such as immunization for influenza. Secondary prevention is undertaken in cases of latent disease. The goal of secondary prevention is early detection and diagnosis of health problems before patients exhibit symptoms of disease. Tertiary prevention is implemented when a condition or illness is permanent and irreversible. Quaternary prevention is a set of health activities to mitigate or avoid the consequences or unnecessary or excessive intervention of the health system. p. 221
Which type of care does the nurse promote when conducting health awareness training programs at a community center? Indirect care Tertiary prevention Primary prevention Secondary prevention
Primary prevention Primary prevention is instituted before the disease becomes established. The nurse is promoting health awareness before the symptoms of a disease appear. A health awareness workshop is an example of primary prevention. Indirect care is the care in which nurse and patient are not in direct contact. Tertiary prevention minimizes the ill effects of disease or disability. Secondary prevention includes treatment of disease and prevention of any complication. p. 221
Which activity represents the nurse participating in a primary prevention? Providing prenatal teaching on nutrition Working with patients in a cardiac rehabilitation program Assessing a patient at an emergent care facility Providing home wound care to a patient
Providing prenatal teaching on nutrition Primary prevention is focused on health promotion. Health-promotion programs, such as providing prenatal teaching on nutrition, contribute to quality health care by helping patients acquire healthier lifestyles. Health-promotion activities keep people healthy through exercise, good nutrition, rest, and adopting positive health attitudes. Working with patients in a cardiac rehabilitation program is an example of tertiary prevention. Assessing a patient at an emergent care facility and providing home wound care to a patient are examples of secondary prevention. Test-Taking Tip: Practicing a few relaxation techniques may prove helpful on the day of an examination. Relaxation techniques such as deep breathing, imagery, head rolling, shoulder shrugging, rotating and stretching of the neck, leg lifts, and heel lifts with feet flat on the floor can effectively reduce tension while causing little or no distraction to those around you. It is recommended that you practice one or two of these techniques intermittently to avoid becoming tense. p. 221
According to Maslow, which level of need does the nurse address when encouraging an older adult couple to remove several throw rugs and a low footstool, and to improve the lighting in the living room during a home assessment? Physiological Safety and security Love and belonging Self-actualization
Safety and security The teaching addresses the need for safety and security. The throw rugs, low lighting, and low stool are hazards that can cause falls in the elderly. Preventing falls is a priority safety issue for older adults. Physiological needs consist of food, water, warmth, and rest. Love and belonging is the third step of Maslow's hierarchy of needs. It consists of intimacy, friendship, family, and a sense of belonging. Self-actualization is the top tier of Maslow's hierarchy of needs. It consists of achieving one's full potential, including creative activities. pp. 216,217
A patient with diabetes was found to have high blood pressure at a health fair. At a 6 month reevaluation, the patient has followed there commended low-sodium diet, and an improvement in the patient's blood pressure was noted. Which level of prevention was implemented? Primary prevention Secondary prevention Tertiary prevention Specific protection
Secondary prevention Patients with health problems or who are at risk for developing complications need medical interventions. Early diagnosis and treatment helps in reducing further damage to help patients recover from the illness. In this patient, high blood pressure was diagnosed and a low-sodium diet was advised to control blood pressure. Therefore this intervention would be considered secondary prevention. Primary prevention occurs before development of a medical problem. Tertiary prevention is required for patients who need rehabilitation. Specific protection is a form of primary prevention. Test-Taking Tip: Secondary prevention happens second; diagnosis of a disorder occurs first. p. 221
A nurse, conducting a breast exam on a patient who reports familiar history of breast cancer, finds a lump in the right breast and recommends that the patient have a mammogram as soon as possible. Which level of preventive care does the nurse provide this patient? Primary prevention Secondary prevention Tertiary prevention Statutory prevention
Secondary prevention There are three levels of prevention: primary, secondary, and tertiary. Secondary prevention involves early diagnosis and prompt treatment. Because the patient is at risk for developing breast cancer because of family history, the nurse assesses for symptoms and does an examination to determine the condition. The nurse instructs the patient to undergo mammography to diagnose the disease. Primary prevention is aimed at reducing risk factors for or delaying the occurrence of an illness. This includes interventions for health promotion and specific protection. Tertiary prevention care is provided to severely ill or diseased patients to reduce the number and impact of complications. Statutory prevention is unrelated to breast cancer and is relevant to lifestyle-related habits such as smoking. STUDY TIP: Invent a way to recall the contents of each of the levels of prevention. Here's one example: Primary can be before disease; secondary is seeing symptoms, starting care; tertiary is too late to prevent, trying to control. Having a device like this one will help you answer questions about each level of prevention easily. p.221
The nurse identifies many risk factors after the admission interview of a young adult patient. Which factor may the patient modify? Select all that apply. One, some, or all responses may be correct. Age Gender Family history Sedentary lifestyle Nutrition and dietary intake
Sedentary lifestyle Nutrition and dietary intake The factors affecting an illness are either modifiable or nonmodifiable. Modifiable risk factors include a sedentary lifestyle and nutritional and dietary intake. Research shows that people who live a sedentary lifestyle have an increased risk for obesity and diabetes mellitus. Likewise, when people make better nutritional choices and improve their dietary intake, they also decrease their risk for obesity and diabetes mellitus. A patient can reduce the risk for diseases by modifying these factors. Age, gender, and family history of an illness are nonmodifiable risk factors. The patient cannot alter the age-related or genetic influence of an illness. STUDY TIP: Make a habit of noticing what risk factors are modifiable for each disease state. Then, if a patient is discouraged about nonmodifiable risk factors, you will be ready to review factors that are under his or her control. Think of this practice as defense against discouragement! It applies directly to studying: You cannot alter the requirement of passing nursing exams, but you can alter your study habits. pp. 225,226
As explained in the Health Belief Model (HBM), which concept provides a useful framework for implementing the nursing process? Select all that apply. One, some, or all responses may be correct. Self-efficacy Cues to action Perceived benefits Physical limitations Perceived susceptibility
Self-efficacy Cues to action Perceived benefits Perceived susceptibility The HBM suggests individuals are motivated to act if they have certain beliefs or experiences, as explained in the six concepts of the model. The first concept is self-efficacy, which is the individual's confidence in the ability to take action. The nurse provides training and guidance in performing action. Another concept is cues to action, which are factors that activate readiness to change. The nurse promotes awareness to bring about the change. The third concept is perceived benefits. The nurse explains how, where, and when to take action and describes the likely positive results. The nurse also has to determine the patient's perceived susceptibility. The nurse helps the individual identify the chances of acquiring a condition or disease. The patient's physical limitations are not included in the HBM. Instead, physical limitations impact their activities of daily living. p. 218
Which nursing goal supports the nurse teaching parents of toddlers about the use of seat belts and vehicle safety? Rehabilitation Early detection Health promotion Specific protection
Specific protection Specific protection activities help prevent a specific disease or a potential injury. Teaching safety measures to parents helps prevent injury and accidents in toddlers. Rehabilitation or restoration of health refers to attaining the highest possible level of recovery from the illness. Use of seat belts and safety measures do not help in rehabilitation. Diagnostic tests are performed to detect a disease at an early stage; however, teaching safety measures does not help in detection of diseases. Health promotion activities include general measures to prevent illness and promote health. They include activities such as lifestyle modifications, nutritional counseling, and modification of the environment. STUDY TIP: Injury prevention is grouped under health promotion. Consider that it becomes more difficult to promote health if one is injured; there is risk of infection and time lost in healing. That is why health promotion includes injury prevention. p. 221
The nurse identified that a patient, who recovered from an illness, has resumed personal responsibilities and performs usual tasks and roles. Using the stages of illness model, in which stage of illness would the nurse categorize this patient? Stage I Stage II Stage IV Stage V
Stage V Suchman categorized illness behavior into five stages. During stage V of illness, the patient abandons the sick role and begins to take on activities of daily living. During stage I of the illness, the patient accepts that something is wrong and seeks medical care. During stage II, the person feels sick, accepts the sick role, and is not involved in personal, social, or professional obligations. During stage IV illness, the patient is completely dependent on others, expresses fear and anxiety, and may reject treatment strategies. STUDY TIP: To recall that in stage V of the illness model, the patient begins to take on activities of daily living as best as possible, think "five alive!" In other words, if you were the patient, you could think, "I'm still alive, so I can still be doing my regular tasks. "You could also imagine the "V" of actiVities is like the Roman numeral five. p. 223
During a prevention of noncommunicable chronic disease workshop forthe community, which disease would the nurse educator emphasize? Select all that apply. One, some, or all responses may be correct. Flu Stroke Tuberculosis Childhood obesity Cardiovascular disease
Stroke Childhood obesity Cardiovascular disease Noncommunicable chronic diseases are diseases that cannot be transmitted from one person to another. These include stroke, childhood obesity, and cardiovascular disease. For the prevention and control of chronic diseases, the nurse should educate the community about preventive measures such as controlling blood pressure, maintaining a desirable weight, and including exercise in their lives. Influenza and tuberculosis are examples of communicable diseases. These diseases can be transmitted from one person to another. p. 221
Which level of prevention applies when a nurse works in collaboration with a physiotherapist to help a patient walk again after a motor vehicle accident? Indirect care Primary prevention Tertiary prevention Secondary prevention
Tertiary prevention Tertiary prevention involves minimizing the adverse effects of any disease or disability. This also includes rehabilitation. Indirect care is a process by which there is no direct contact between nurse and patient, but the nurse works for the benefit of the patient. Primary prevention aims at health promotion and taking preventive steps before the disease or problem starts. Secondary prevention refers to measures taken for people who are experiencing a disease or are at risk for developing complications. p. 221
A patient, who experienced a myocardial infarction 4 weeks ago, currently participates in daily cardiac rehabilitation sessions at the local fitness center. In which level of prevention is the patient participating? Primary prevention Secondary prevention Tertiary prevention Quaternary prevention
Tertiary prevention Tertiary prevention involves minimizing the effects of long-term disease or disability by interventions directed at preventing complications and deterioration following the myocardial infarction. Tertiary prevention activities are directed at rehabilitation rather than diagnosis and treatment. Care at this level aims to help patients achieve as high a level of functioning as possible, despite the limitations caused by illness or impairment. This level of care is called preventive care because it involves preventing further disability or reduced functioning. Primary prevention is instituted before disease becomes established by removing the causes or increasing resistance. Secondary prevention is undertaken in cases of latent disease. The goal for health interventions during this stage is early detection. Quaternary prevention is action taken to identify a patient or population at risk for over medicalization to protect them from invasive medical interventions and provide care that is medically accepted. p. 221
A nurse, learning about the Holistic Health Model of nursing, associates which statement to this model? Select all that apply. One, some, or all responses may be correct. The Holistic Health Model attempts to create conditions for optimal health. This model about holistic health recognizes the natural healing abilities of the body. The model incorporates complementary and alternative therapies into nursing care. The Holistic Health Model is used to understand the relationships of basichuman needs. Followers of the model believe that certain human needs are more basic than others.
The Holistic Health Model attempts to create conditions for optimal health. This model about holistic health recognizes the natural healing abilities of the body. The model incorporates complementary and alternative therapies into nursing care. The Holistic Health Model attempts to create conditions for optimal health. It believes that the human body possesses a natural healing ability. These abilities can be used in the patient's care by incorporating complementary and alternative therapies like music therapy and relaxation therapy. The Maslow's Hierarchy Model helps one understand the relationships of basic human needs. Maslow's Hierarchy Model also believes that certain human needs are more basic and need to be met before others. p. 217
Using the Health Belief Model to screen a patient at risk for cardiovascular disease, which intervention would the nurse implement to motivate the patient toward disease prevention and illness control? Select all that apply. One, some, or all responses may be correct. The nurse specifies the possible consequences of developing the illness. The nurse recommends an immediate intervention and lifestyle change. The nurse provides guidance in adopting necessary healing interventions. The nurse assesses the risk for illness based on the patient's behavior. The nurse helps the patient develop an accurate perception of illness.
The nurse assesses the risk for illness based on the patient's behavior. The nurse helps the patient develop an accurate perception of illness. The nurse determines the patient's health behaviors using the Health Belief Model. The patient's susceptibility to an illness should be determined on the basis of the patient's attitudes, beliefs, and cultural practices. After identifying the risks, the nurse makes the patient aware of the impact of risky behavior on the patient's health status. The nurse helps the patient develop an accurate perception of the illness by providing illness-related information. The nurse would describe the specific consequences of the illness only when the patient has an accurate perception of the illness. Immediate interventions are needed for patients who are already ill; immediate interventions would not be helpful for people who are at risk of developing an illness. Healing interventions would be beneficial for sick people; they would not be helpful for high-risk patients. p. 217
