Chapter 6 Health and Wellness

1. An argument for passing “universal health care” legislation is that it would help fulfill the Healthy People 2020 goal of

a.
Increasing quality of life in America.
b.
Prolonging healthy life in America.
c.
Eliminating health disparities in America.
d.
Promoting healthy behaviors.

ANS: C

Healthy People 2020 promotes a society in which all people live long, healthy lives. This program has four overarching goals: (1) attain high-quality, longer lives free of preventable disease, disability, injury, and premature death; (2) achieve health equity, eliminate disparities, and improve the health of all groups; (3) create social and physical environments that promote good health for all; and (4) promote quality of life, healthy development, and healthy behaviors across all life stages. Providing health care to all would eliminate disparities in health care by ensuring access. Perhaps the best way to increase quality and years of healthy life is to promote healthy behaviors. However, providing access to health care would not guarantee changes in behaviors, increased quality of life, or prolonged healthy life.

DIF: Understand REF: 66

OBJ: List two general Healthy People 2020 public health goals for Americans.

TOP: Evaluation MSC: Teaching/Learning

2. To increase quality and years of healthy life, Healthy People 2020 focuses on four areas. One of those areas is

a.
Allowing people to continue current behaviors to reduce the stress of change.
b.
Focusing only on individual health changes that will lead to better communities.
c.
Creating social and physical environments that promote good health.
d.
Focusing on illness treatment to provide fast recuperation.

ANS: C

Healthy People 2020 includes four goals, one of which is to create social and physical environments that promote good health for all. The other three include (1) attain high-quality, longer lives free of preventable disease, disability, injury, and premature death; (2) achieve health equity, eliminate disparities, and improve the health of all groups; and (3) promote quality of life, healthy development, and healthy behaviors across all life stages.

DIF: Understand REF: 66

OBJ: List two general Healthy People 2020 public health goals for Americans.

TOP: Evaluation MSC: Teaching/Learning

3. According to the World Health Organization, what is the best definition for “health”?

a.
Simply the absence of disease
b.
Involving the total person and environment
c.
Strictly personal in nature
d.
Status of pathological state

ANS: B

Nurses’ attitudes toward health and illness should consider the total person, as well as the environment in which the person lives. All people free of disease are not equally healthy. Views of health have broadened to include mental, social, and spiritual well-being, as well as a focus on health at family and community levels. Conditions of life, rather than pathological states, are what define health.

DIF: Knowledge REF: 66 OBJ: Discuss the definition of health.

TOP: Evaluation MSC: Teaching/Learning

4. The nurse is preparing a smoking cessation class and is amazed at how many people still smoke even with the information on lung cancer so readily available. She believes that her class will convert many smokers to nonsmokers once they get all the latest information. The nurse is a believer in which of the following health care models?

a.
Health Belief Model
b.
Health Promotion Model
c.
Basic Human Needs Model
d.
Holistic Health Model

ANS: A

The Health Belief Model addresses the relationship between a person’s beliefs and behaviors. The Health Promotion Model is more complex than the Health Belief Model in that it notes that each person has unique personal characteristics and experiences that affect subsequent actions. The Basic Human Needs Model is based on the theory that all people share basic human needs, and the extent to which basic needs are met is a major factor in determining a person’s level of health. The Holistic Health Model recognizes the natural healing abilities of the body and incorporates complementary and alternative interventions such as music therapy. Education is important but is not the sole determinant of change.

DIF: Apply REF: 66-68

OBJ: Discuss the Health Belief, Health Promotion, Basic Human Needs, and Holistic Health Models to understand the relationship between patients’ attitudes toward health and health practices.

TOP: Assessment MSC: Teaching/Learning

5. The health care model that utilizes Maslow’s hierarchy as its base is the _____ Model.

a.
Health Belief
b.
Health Promotion
c.
Basic Human Needs
d.
Holistic Health

ANS: C

The Basic Human Needs Model believes that the extent to which basic needs are met is a major factor in determining a person’s level of health. Maslow’s hierarchy of needs is a model that nurses use to understand the interrelationships of basic human needs. The Health Belief Model addresses the relationship between a person’s beliefs and behaviors. The Health Promotion Model notes that each person has unique personal characteristics and experiences that affect subsequent actions. The Holistic Health Model recognizes the natural healing abilities of the body and incorporates complementary and alternative interventions such as music therapy.

DIF: Understand REF: 66-68

OBJ: Discuss the Health Belief, Health Promotion, Basic Human Needs, and Holistic Health Models to understand the relationship between patients’ attitudes toward health and health practices.

TOP: Assessment MSC: Teaching/Learning

6. The patient is describing moderate incisional pain that was not relieved by the last dose of hydromorphone (Dilaudid) given 90 minutes earlier. The patient is not due for another dose of medication for another 2 1/2 hours. The nurse repositions the patient, asks what type of music she likes, and puts on the music channel on the television, setting it to play that type of music. The nurse is attempting to utilize which health care model?

a.
Health Belief Model
b.
Health Promotion Model
c.
Basic Human Needs Model
d.
Holistic Health Model

ANS: D

The Holistic Health Model recognizes the natural healing abilities of the body and incorporates complementary and alternative interventions such as music therapy. The Health Belief Model addresses the relationship between a person’s beliefs and behaviors. The Health Promotion Model notes that each person has unique personal characteristics and experiences that affect subsequent actions. The Basic Human Needs Model believes that the extent to which basic needs are met is a major factor in determining a person’s level of health. Maslow’s hierarchy of needs is a model that nurses use to understand the interrelationships of basic human needs.

DIF: Apply REF: 66-68

OBJ: Discuss the Health Belief, Health Promotion, Basic Human Needs, and Holistic Health Models to understand the relationship between patients’ attitudes toward health and health practices.

TOP: Implementation MSC: Nursing Process

7. Many variables influence a patient’s health beliefs and practices. Internal and external variables influence how a person thinks and acts. An example of an internal variable would be

a.
Perception of functioning.
b.
Family practices.
c.
Socioeconomic factors.
d.
Cultural background.

ANS: A

Internal variables include a person’s developmental stage, intellectual background, perception of functioning, and emotional and spiritual factors. External variables influencing a person’s health beliefs and practices include family practices, socioeconomic factors, and cultural background.

DIF: Remember REF: 68-70

OBJ: Describe variables influencing health beliefs and practices.

TOP: Assessment MSC: Nursing Process

8. The nurse is admitting a patient with uncontrolled diabetes mellitus. It is the fourth time the patient is being admitted in the last 6 months for high blood sugars. During the admission process, the nurse asks the patient about her employment status and displays a nonjudgmental attitude. Why does the nurse do this?

a.
Noncompliant patients thrive on the disapproval of authority figures.
b.
External variables have little effect on compliance.
c.
A person’s compliance is affected by economic status.
d.
Employment status is an internal variable that impacts compliance.

ANS: C

A person’s compliance with treatment is affected by economic status. A person tends to give a higher priority to food and shelter than to costly drugs or treatments. A person generally seeks approval and support from social networks, and this desire for approval affects health beliefs and practices. Internal and external variables influence how a person thinks and acts toward health care. Employment status is an external variable, not an internal variable.

DIF: Apply REF: 68-70

OBJ: Describe variables influencing health beliefs and practices.

TOP: Implementation MSC: Nursing Process

9. The nurse is working on a committee to evaluate the need for increasing the levels of fluoride in the drinking water of the community. In doing so, the nurse is fostering the concept of

a.
Illness prevention.
b.
Active health promotion.
c.
Wellness education.
d.
Passive health promotion.

ANS: D

Fluoridation of municipal drinking water and fortification of homogenized milk with vitamin D are examples of passive health promotion strategies. With active strategies of health promotion, individuals are motivated to adopt specific health programs such as weight reduction and smoking cessation programs. Illness prevention activities such as immunization programs protect patients from actual or potential threats to health. Wellness education teaches people how to care for themselves in a healthy way.

DIF: Apply REF: 71

OBJ: Describe health promotion, wellness, and illness prevention activities.

TOP: Implementation MSC: Nursing Process

10. The nurse is working in a clinic that is designed to provide health education and immunizations. As such, this clinic is designed to provide

a.
Primary prevention.
b.
Secondary prevention.
c.
Tertiary prevention.
d.
Diagnosis and prompt intervention.

ANS: A

Primary prevention precedes disease or dysfunction and is applied to people considered physically and emotionally healthy. Health promotion includes health education programs, immunizations, and physical and nutritional fitness activities. Secondary prevention focuses on individuals who are experiencing health problems or illnesses and who are at risk for developing complications or worsening conditions. Activities are directed at diagnosis and prompt intervention. Tertiary prevention occurs when a defect or disability is permanent and irreversible. It involves minimizing the effects of long-term disease or disability through interventions directed at preventing complications and deterioration.

DIF: Understand REF: 71 OBJ: Discuss the three levels of preventive care.

TOP: Implementation MSC: Nursing Process

11. The patient is admitted to the emergency department of the local hospital from home with reports of chest discomfort and shortness of breath. She is placed on oxygen, has labs and blood gases drawn, and is given an electrocardiogram and breathing treatments. What level of preventive care is this patient receiving?

a.
Primary prevention
b.
Secondary prevention
c.
Tertiary prevention
d.
Health promotion

ANS: B

Secondary prevention focuses on individuals who are experiencing health problems or illnesses and who are at risk for developing complications or worsening conditions. Activities are directed at diagnosis and prompt intervention. Primary prevention precedes disease or dysfunction and is applied to people considered physically and emotionally healthy. Health promotion includes health education programs, immunizations, and physical and nutritional fitness activities. Tertiary prevention occurs when a defect or disability is permanent and irreversible. It involves minimizing the effects of long-term disease or disability through interventions directed at preventing complications and deterioration.

DIF: Apply REF: 71 OBJ: Discuss the three levels of preventive care.

TOP: Implementation MSC: Nursing Process

12. A patient is admitted to a rehabilitation facility following a stroke. The patient has right-sided paralysis and is unable to speak. The patient will be receiving physical therapy and speech therapy. What are these examples of?

a.
Primary prevention
b.
Secondary prevention
c.
Tertiary prevention
d.
Health promotion

ANS: C

Tertiary prevention occurs when a defect or disability is permanent and irreversible. It involves minimizing the effects of long-term disease or disability through interventions directed at preventing complications and deterioration. Secondary prevention focuses on individuals who are experiencing health problems or illnesses, and who are at risk for developing complications or worsening conditions. Activities are directed at diagnosis and prompt intervention. Primary prevention precedes disease or dysfunction and is applied to people considered physically and emotionally healthy. Health promotion includes health education programs, immunizations, and physical and nutritional fitness activities.

DIF: Apply REF: 71 OBJ: Discuss the three levels of preventive care.

TOP: Implementation MSC: Nursing Process

13. Risk factors can be placed in the following interrelated categories: genetic and physiological factors, age, physical environment, and lifestyle. The presence of any of these risk factors means that

a.
A person with the risk factor will get the disease.
b.
The chances of getting the disease are increased.
c.
The disease is guaranteed not to develop if the risk factor is controlled.
d.
Risk modification will have no effect on disease prevention.

ANS: B

The presence of risk factors does not mean that a disease will develop, but risk factors increase the chances that the individual will experience a particular disease or dysfunction. Control of risk factors does not guarantee that a disease will not develop. However, risk factor identification assists patients in visualizing those areas in life that can be modified or even eliminated to promote wellness and prevent illness.

DIF: Knowledge REF: 72 OBJ: Describe four types of risk factors.

TOP: Assessment MSC: Nursing Process

14. The nurse is caring for a patient who has been trying to quit smoking. She has been smoke free for 2 weeks but had two cigarettes last night and at least two this morning. What should the nurse anticipate?

a.
The patient does not want to and never will quit smoking.
b.
The patient will return to the contemplation or precontemplation phase.
c.
The patient will need to adopt a new lifestyle for change to be effective.
d.
The patient must pick up her attempt right where she left off.

ANS: B

When relapse occurs, the person will return to the contemplation or precontemplation stage before attempting the change again. The patient cannot pick up her attempt where she left off.

It is believed that change involves movement through a series of stages. These stages range from no intention to change (precontemplation), to making small changes (preparation), to actively engaging in strategies to change behavior (action), to maintenance. The action phase indicates a desire to change and a potential to do so. Changes will be maintained over time only if they are integrated into an individual’s overall lifestyle.

DIF: Analyze REF: 73

OBJ: Discuss risk factor modification and changing health behaviors.

TOP: Evaluation MSC: Nursing Process

15. The nurse is working in a drug rehabilitation clinic and is in the process of admitting a patient who says that she wants to be “detoxified.” It is important for the nurse to

a.
Identify the patient’s stage of change.
b.
Realize that the patient is ready to change.
c.
Instruct the patient that she will have to change her lifestyle.
d.
Instruct the patient that relapses are not tolerated.

ANS: A

Processes of change, or nursing interventions, should be appropriately chosen to match the stage of change. Most behavior change programs are designed for those people who are ready to take action regarding their health behavior problems. Only a minority of people are actually in this action stage. Changes will be maintained over time only if they are integrated into an individual’s overall lifestyle. As individuals attempt a change in behavior, relapse followed by recycling through the stages occurs frequently.

DIF: Apply REF: 73

OBJ: Discuss risk factor modification and changing health behaviors.

TOP: Implementation MSC: Caring

16. The patient has been overweight for most of her life. She has tried dieting in the past and has lost weight, only to regain it when she stopped dieting. She is visiting the weight loss clinic/health club because she has decided to do it. She states that she will join right after the holidays, in 3 months. The nurse recognizes that the patient is in which stage of the change process?

a.
Precontemplation
b.
Contemplation
c.
Preparation
d.
Action

ANS: B

These stages range from no intention to change (precontemplation), to considering a change within the next 6 months (contemplation), to making small changes (preparation), to actively engaging in strategies to change behavior (action), to maintaining a changed behavior (maintenance). This patient is planning to make the change within the next 6 months and is in the contemplation stage.

DIF: Analyze REF: 73

OBJ: Discuss risk factor modification and changing health behaviors.

TOP: Evaluation MSC: Nursing Process

17. The patient has quit smoking and has been smoke free for the past 2 years. Of the following stages, which best fits her current stage of change?

a.
Contemplation
b.
Preparation
c.
Action
d.
Maintenance

ANS: D

These stages range from no intention to change (precontemplation), to considering a change within the next 6 months (contemplation), to making small changes (preparation), to actively engaging in strategies to change behavior (action), to maintaining a changed behavior (maintenance). Because she has been smoke free for 2 years, she is in the maintenance stage.

DIF: Analyze REF: 73

OBJ: Discuss risk factor modification and changing health behaviors.

TOP: Evaluation MSC: Nursing Process

18. The patient had a colostomy placed 1 week ago. When approached by the nurse, the patient and his wife refuse to talk about it and refuse to be taught about how to care for it. The nurse realizes that the patient and his wife are in which stage of adjustment?

a.
Shock
b.
Withdrawal
c.
Acceptance
d.
Rehabilitation

ANS: B

As the patient and family recognize the reality of a change, they become anxious and may withdraw, refusing to discuss it. This is an adaptive coping mechanism that assists the patient in making the adjustment. Initially, the patient may be shocked by the change. This is followed by withdrawal, acknowledgment when they accept the loss, and rehabilitation when the patient is ready to learn how to adapt.

DIF: Analyze REF: 75

OBJ: Describe the impact of illness on the patient and family. TOP: Evaluation

MSC: Nursing Process

19. A 62-year-old male patient has had chronic obstructive pulmonary disease (COPD) for many years but has been unable to quit smoking. When approached by the nurse, he states that he would be “better off dead.” He states that he has always supported his family, and now the doctor says he can no longer work because of his condition and oxygen dependency. His wife will now have to go to work, and he is sure that she will not make enough money to pay the bills. In preparing the patient for discharge, the nurse should

a.
Develop a plan of care for the family.
b.
Contact psychiatric services.
c.
Assure the patient that things will work out.
d.
Focus the plan of care on maximizing patient function.

ANS: A

Because of the effects of illness, family dynamics often change. The nurse must view the whole family as a patient under stress, planning care to help the family regain its maximal level of functioning and well-being. Psychiatric services may be a part of that plan but do not represent the entire plan. Offering false assurance is never acceptable.

DIF: Apply REF: 76

OBJ: Describe the impact of illness on the patient and family. TOP: Implementation

MSC: Nursing Process

MULTIPLE RESPONSE

1. Just as health and health behavior are affected by internal and external variables, so are illness and illness behavior. Which external variables can affect illness and behavior? (Select all that apply.)

a.
Perception of the seriousness of the illness
b.
Patient’s coping skills
c.
Cultural background
d.
Social support
e.
Socioeconomic status

ANS: C, D, E

External variables influencing a patient’s illness behavior include the visibility of symptoms, social group, cultural background, economic variables, accessibility of the health care system, and social support. Internal variables include the patient’s perceptions of symptoms and the nature of the illness, as well as the patient’s coping skills and locus of control.

DIF: Understand REF: 75 OBJ: Describe variables influencing illness behavior.

TOP: Assessment MSC: Nursing Process

2. Models of health offer a perspective by which to understand the relationships between the concepts of health, wellness, and illness. Nurses are in a unique position to assist patients in achieving and maintaining optimal levels of health because nurses (Select all that apply.)

a.
Understand the challenges of today’s health care system.
b.
Identify actual and potential risk factors.
c.
Have coined the term “illness behavior.”
d.
Can minimize the effects of illness and assist to the return of optimal health

ANS: A, B, D

Nurses are in a unique position to assist patients in achieving and maintaining optimal levels of health. Nurses understand the challenges of today’s health care system and embrace the opportunity to use wellness activities to promote health and wellness and to prevent illness. Nurses can identify actual and potential risk factors that predispose a person or group to illness. Nurses who understand how patients react to illness can minimize the effects of illness and assist patients and their families in maintaining or returning to the highest level of functioning. Medical sociologists call the reaction to illness “illness behavior.”

DIF: Understand REF: 65 OBJ: Discuss the nurse’s role in health and illness.

TOP: Assessment MSC: Nursing Process