Experiencing Health & Illness

Identify the choice that best completes the statement or answers the question.

____ 1. In an effort to promote health, the home health nurse opens the client’s bedroom windows to let in fresh air and sunlight, washes her hands often, and teaches the patient and family about the importance of hygiene and cleanliness. This most closely illustrates the ideas of which of the following people?

1)
Jean Watson
2)
Jurgen Moltmann
3)
Florence Nightingale
4)
Robert Louis Stevenson

____ 2. Which of the following is known to be a healthy strategy for coping with stress?

1)
Performing meaningful work
2)
Consuming simple carbohydrates
3)
Drinking three glasses of red wine each day
4)
Weight training

____ 3. Which family would most likely be helpful in encouraging the client to experience a high level of wellness? A family who:

1)
Controls feelings in order to avoid conflict.
2)
Teaches negotiation skills and independence.
3)
Encourages risk-taking and adventure.
4)
Views themselves as helpless victims.

____ 4. The client is a 76-year-old man who is experiencing chronic illness. He has a genetic-linked anemia. He says he does not eat a balanced diet, as he prefers sweets to meat and vegetables. Which of the following dimensions of health can the nurse most likely influence by teaching and counseling him?

1)
Age-related changes
2)
Genetic anemia
3)
Eating habits
4)
Gender-related issues

____ 5. What type of loss is most common among patients who are hospitalized for complex health conditions?

1)
Privacy
2)
Dignity
3)
Functional
4)
Identity

____ 6. A 62-year-old patient is admitted to the hospital with hypertension. Which question by the nurse is most important when performing the initial assessment interview?

1)
“What medications do you take at home?”
2)
“Do you have any environmental, food, or drug allergies?”
3)
“Do you have an advance directive?”
4)
“What is the greatest concern you are dealing with today?”

____ 7. When developing goals, which guideline should the nurse keep in mind? Goals should be:

1)
Realistic so that progress is recognized by the patient
2)
Developed solely by the healthcare team
3)
Developed without family input, to maintain confidentiality
4)
Valued by the multidisciplinary care providers

____ 8. Which one of the following important nursing actions is a hospitalized patient likely to experience on an emotional level and remember long after this hospitalization has ended?

1)
Administering her medications according to schedule
2)
Allowing flexible visitation by her family and friends
3)
Explaining treatment options in terms she can understand
4)
Providing a healing presence by listening and being attentive

____ 9. Which statement best describes the health–illness continuum?

1)
Health is the absence of disease; illness is the presence of disease.
2)
Health and illness are along a continuum that cannot be divided.
3)
Health is remission of disease; illness is exacerbation of disease.
4)
Health is not having illness; illness is not having health.

____ 10. Which of the following helps the body release growth hormone (growth hormone assists in tissue regeneration, synthesis of bone, and formation of red blood cells)?

1)
A healthy diet
2)
Physical activity
3)
Restful sleep
4)
Comfortable room temperature

____ 11. A client has been hospitalized for 6 weeks. All of the following interventions are good ones; but which intervention is specifically focused on helping the patient cope with the emotional responses to prolonged hospitalization?

1)
Providing skin care every shift to prevent skin breakdown
2)
Encouraging the patient to get up in a chair to eat meals
3)
Assisting the patient to ambulate in the hallway for several minutes each day
4)
Designating a corner of the patient’s room to display personal mementos

____ 12. Which of the following is particularly valuable in helping a patient with a terminal illness maintain a sense of self?

1)
Family relationships
2)
Spirituality
3)
Nutrition
4)
Sleep and rest

____ 13. A client with a history of schizophrenia is diagnosed with a urinary tract infection. What is probably the most significant barrier this patient faces?

1)
Chronic urinary incontinence
2)
Stigma associated with mental illness
3)
Risk for recurring infections
4)
Auditory hallucinations (“hearing things”)

____ 14. A 76-year-old patient is admitted with an acute myocardial infarction (heart attack). The doctor tells the patient that an angioplasty is necessary. The patient agrees and signs the informed consent. This patient is experiencing which stage of illness behavior?

1)
Sick-role behavior
2)
Seeking professional care
3)
Experiencing symptoms
4)
Dependence on others

____ 15. Many health providers define illness as pathology; however, people experience, rather than define, illness. Which of the following is how most people experience illness?

1)
“Feeling lousy,” a true sense of not being all right
2)
A change in the way they feel or a disruption in their typical life
3)
Something to be dreaded and avoided if at all possible
4)
An experience that offers the potential for learning and spiritual growth

____ 16. Dunn believes that an individual’s state of health should be evaluated in the context of the person’s environment. This approach illustrates that:

1)
An unhealthy physical environment, characterized by poor living conditions, always has a negative effect on an individual’s health.
2)
Adequate income, food, and shelter create a healthful environment and always improve physical health status.
3)
Physical environment, family, and social support may help or hinder the health status of an individual.
4)
The environment that should always be assessed is the client’s immediate surroundings; extended boundaries do not apply in an ill state.

____ 17. Some people readily become ill when under stress. Others are able to deal with tremendous stress and remain physically and mentally healthy. This disparity is affected by a person’s level of hardiness. How can you apply this knowledge to your nursing care?

1)
You cannot use this information at all. People are innately hardy or not. This is something that you must merely recognize.
2)
You should encourage all people to develop some level of hardiness in order to get through difficult physical and emotional times.
3)
You should assess for your own level of hardiness: if you are hardy, you will be a better nurse; if you are not, you can learn more about hardiness.
4)
You can assess for hardiness in patients; you can encourage hardy patients to learn about their illness as a means for them to be more comfortable.

____ 18. When preparing a room to receive a newly admitted patient, which of the following should the nursing assistive personnel (NAP) do?

1)
Mop the floor with an approved disinfecting solution.
2)
Fold the top bed linens back to “open” the bed.
3)
Hook up the suction machine and check to see that it is working.
4)
Position the bed in its lowest position.

____ 19. When transferring a patient from a hospital to a long-term care facility, which of the following is most helpful in facilitating the patient’s planning and emotional adjustment?

1)
Notify the patient and family as much in advance of the transfer as possible.
2)
Send a complete copy of the patient’s medical records to the new facility.
3)
Carefully coordinate the transfer with the long-term facility to keep it smooth.
4)
Help arrange for transportation and accompany the patient to the transport vehicle.

____ 20. A 36-year-old mother of three small children has had nausea, vomiting, and extreme fatigue for the past 2 days. She calls her mother and tells her she is ill and asks if her mother can care for the children. Which stage of illness behavior is she experiencing? Choose all that apply.

1)
Sick-role behavior
2)
Dependence on others
3)
Seeking professional care
4)
Experiencing symptoms

Chapter 10. Experiencing Health & Illness

Answer Section

MULTIPLE CHOICE

1. ANS: 3

Florence Nightingale believed that health was prevention of disease through the use of fresh air, pure water, efficient drainage, cleanliness, and light. Jean Watson believes that health has three elements: a high level of overall physical, mental, and social functioning; a general adaptive-maintenance level of daily functioning; and the absence of illness (or the presence of efforts that lead to its absence). Jurgen Moltmann believes that true health is the strength to live, the strength to suffer, and the strength to die. He also stated that health is not a condition of my body; it is the power of my soul to cope with the varying condition of that body. Robert Louis Stevenson wrote that health is not a matter of holding good cards; it is playing a poor hand well.

PTS: 1 DIF: Easy REF: V1, p. 168

KEY: Client need: HPM | Cognitive level: Recall

2. ANS: 1

Many individuals find that meaningful work is a healthy way to cope with stressors. Consuming simple carbohydrates is not a healthy way to cope with stress. Drinking more than one glass of red wine each day is considered unhealthy. Weight training has been shown to increase bone density and reduce the risk of osteoporosis and heart disease but not necessarily to reduce stress.

PTS: 1 DIF: Moderate REF: V1, pp. 169-170

KEY: Client need: PSI | Cognitive level: Application

3. ANS: 2

Families who promote independence and teach good negotiation skills enable family members to experience a high level of wellness by thinking for themselves. In contrast, families who tend to squelch personal feelings to avoid conflict may not allow a high level of wellness. Families who emphasize caution in new situations are more beneficial than those who encourage risk-taking. Families who view themselves as capable and successful are more advantageous than those who view themselves as helpless victims.

PTS: 1 DIF: Easy REF: V1, p. 170

KEY: Client need: PSI | Cognitive level: Recall

4. ANS: 3

The nurse is most likely to influence the patient’s eating habits because those are the dimension over which he has the most control and, therefore, has the most potential for changing. Although people consider biological factors when they describe themselves as well or ill, they are not entirely within our control. Biological factors include age and developmental stage, genetic makeup, and gender.

PTS: 1 DIF: Easy REF: V1, pp. 168-169

KEY: Nursing process: Planning | Client need: HPM | Cognitive level: Application

5. ANS: 2

Hospitalized patients commonly experience the loss of dignity. Wearing a hospital gown, having their body exposed, invasive procedures, loss of control over body functions—all of these contribute to loss of dignity, and all are very common among hospitalized patients. Healthcare providers have a duty to protect privacy and confidentiality of patients, even though it is certainly threatened by some situations during hospitalization. Some patients lose functioning and identity during hospitalization, but they are not common occurrences.

PTS: 1 DIF: Moderate REF: V1, pp. 172-173

KEY: Nursing process: Assessment | Client need: PSI | Cognitive level: Comprehension

6. ANS: 4

It is most important for the nurse to ask the patient about his greatest concern. His concern can then be incorporated into the plan of care, making sure that his needs are met. Asking about medications, allergies, and an advance directive is also important but does not take priority over asking about the patient’s greatest concern.

PTS: 1 DIF: Moderate REF: V1, p. 178

KEY: Nursing process: Assessment | Client need: PSI | Cognitive level: Analysis

7. ANS: 1

Goals should be realistic so that progress is recognized by the patient. They should be valued by both the patient and family. The nurse should develop goals with input from the patient and his family.

PTS: 1 DIF: Moderate REF: V1, p. 178

KEY: Nursing process: Planning | Client need: SECE | Cognitive level: Comprehension

8. ANS: 4

The nurse can contribute meaningfully to the patient’s hospitalization by providing a healing presence. The nurse can do this by listening to the patient and being attentive. Administering medications according to schedule, allowing flexible visitation, and explaining treatment options are important contributions that the nurse can make, but they will not be most meaningful to the patient. Patients may be impressed, even amazed, by the healthcare technology used to diagnose and treat their illness. However, often what they remember, perhaps through the rest of their lives, is the person who connected with them in a personal way.

PTS: 1 DIF: Moderate REF: V1, pp. 179-180

KEY: Nursing process: Interventions | Client need: PSI | Cognitive level: Comprehension

9. ANS: 2

The health–illness continuum is best described as a graduated spectrum that cannot be divided.

PTS: 1 DIF: Moderate REF: V1, p. 167

KEY: Client need: HPM | Cognitive level: Comprehension

10. ANS: 3

During sleep, our bodies release the majority of our growth hormone, which assists in tissue regeneration, synthesis of bone, and formation of red blood cells. Consuming healthy foods helps prevent disease. Physical activity reduces the risk of chronic disease and promotes longevity. Keeping the body at a comfortable temperature helps maintain health but not release of growth hormone.

PTS: 1 DIF: Moderate REF: V1, p. 169

KEY: Client need: PHSI | Cognitive level: Recall

11. ANS: 4

The patient’s environment can help nourish wellness. Helping the patient designate a corner of the room to display personal mementos can be healing and help the patient cope with the prolonged hospitalization. The other interventions might be helpful to the patient but are not as helpful in specifically dealing with “hospitalization” as is designating a portion of the room that is uniquely hers.

PTS: 1 DIF: Moderate REF: V1, p. 171

KEY: Nursing process: Implementation | Client need: PSI | Cognitive level: Application

12. ANS: 2

When patients are faced with a terminal illness, spirituality can help the patient maintain his sense of self. Family relationships can provide a loving, supportive source of comfort and reassurance, but sometimes cause the patient pain and a feeling of loneliness when faced with a terminal illness. Nutrition, sleep, and rest are healing but usually not as helpful to a patient with terminal illness as is spirituality.

PTS: 1 DIF: Difficult REF: V1, p. 171

KEY: Client need: PSI | Cognitive level: Recall

13. ANS: 2

Mental illness is associated with a stigma that is usually a barrier, and even considered a debilitating handicap. Chronic urinary incontinence is not commonly associated with urinary tract infection, and nothing in the scenario suggests that the patient is incontinent. The patient is at risk for recurring urinary tract infections, but this is not considered a debilitating handicap. Auditory hallucinations are associated with schizophrenia but have not been described as the most debilitating handicap.

PTS: 1 DIF: Moderate REF: V1, p. 172

KEY: Client need: PSI | Cognitive level: Application

14. ANS: 4

This patient is experiencing the dependence-on-others stage of illness behavior; he has accepted the diagnosis and treatment of the healthcare provider. The patient entered the experiencing illness stage when he began having chest pain at home. He entered the sick-role behavior phase when he admitted to family that he was experiencing chest pain. When he decided to go to the emergency department for health care intervention, he entered the seeking-professional-care stage of illness.

PTS: 1 DIF: Moderate REF: V1, pp. 174-175

KEY: Nursing process: Assessment | Client need: PSI | Cognitive level: Analysis

15. ANS: 2

People typically describe their illness in terms of how it makes them feel or the effect it has on day-to-day life. “Feeling lousy” is inappropriate as many people do not feel “lousy” when they are ill. For example, hypertension is an illness that may have no symptoms. Similarly, patients may have chronic disease that is well managed and therefore does not make them feel ill. “Something to be dreaded and avoided . . .” is also not accurate. If a person has an external locus of control, he may view illness as a consequence of actions taken. From this viewpoint, he may have little control over whether he can avoid illness. Finally, although some people do grow and learn in the face of illness, most people do not hold such a positive view about illness—and the question asks how people experience illness.

PTS: 1 DIF: Moderate REF: V1, p. 167

KEY: Client need: PSI | Cognitive level: Recall

16. ANS: 3

The home environment, community, family, friends, and support system all influence health status. The balance among these variables has a net positive or negative effect on a client’s health status. The effect of poor living conditions may be offset by the presence of loving family and friends. Poverty does not always have a negative effect on health. Similarly, the presence of food, shelter, and clothing does not always convey protective health, as loneliness and hopelessness may counteract these positive influences. When examining the client’s environment, extended boundaries must be considered, especially when providing community-based care.

PTS: 1 DIF: Difficult REF: V1, p. 168

KEY: Nursing process: Assessment | Client need: HPM | Cognitive level: Application

17. ANS: 4

Hardiness is a personality trait that helps many cope with stress and illness. As a personality trait, it is unlikely that you can teach or otherwise encourage this trait. Awareness of your own level of hardiness will help you understand your response to stress, but hardiness does not necessarily make you a better nurse.

PTS: 1 DIF: Difficult REF: V1, pp. 175-176

KEY: Nursing process: Interventions | Client need: PSI | Cognitive level: Application

18. ANS: 2

The NAP should create an “open” bed. The housekeeping department is almost always responsible for cleaning the room between patients. The nurse is responsible for hooking up and checking special equipment such as suction. The nurse would need to tell the NAP whether the patient is to be admitted ambulatory, by wheelchair, or by stretcher in order to know whether to position the bed high or low.

PTS: 1 DIF: Moderate REF: V2, p. 100

KEY: Nursing process: Interventions | Client need: SECE | Cognitive level: Application

19. ANS: 1

Notifying the patient and family well in advance of the transfer allows them time to adjust emotionally and to make any necessary plans. A copy of the records is usually sent, and the nurse does coordinate the transfer with the receiving facility; however, that does very little to assist with the patient’s emotional status or planning. Someone from the hospital may accompany the patient to the car; or if the transfer is by ambulance, perhaps not. Either way, that will not help the patient and family to do the necessary planning for the transfer.

PTS: 1 DIF: Moderate REF: V1, p. 181 | V2, p. 94

KEY: Nursing process: Interventions | Client need: PSI | Cognitive level: Application

20. ANS: 1

D

The 36-year-old mother is assuming sick-role behavior because she is identifying herself as ill. She is also in the stage of experiencing symptoms; she is experiencing symptoms and realizes that illness is starting, even though she has not yet entered the stages of dependence and seeking professional care. By telling her mother of the illness, she is relieved of her normal duties, caring for her children. Dependence on others occurs when the client accepts a diagnosis and treatment from the health care provider. Seeking professional care occurs after the sick-role behavior stage. During this stage, the client makes the decision that she is ill and that professional healthcare is needed.

PTS: 1 DIF: Moderate REF: V1, pp. 174-175

KEY: Client need: PSI | Cognitive level: Application