Chapter 6: Health and Wellness

1. When formulating a definition of “health,” the nurse should consider that health, within its current definition, is:

1.
The absence of disease
2.
A function of the physiological state
3.
The ability to pursue activities of daily living
4.
A state of well-being involving the whole person

ANS: 4

When formulating a definition of “health,” a person should consider the total person, as well as the environment in which the person lives. Health generally implies a state of well-being that is ultimately defined in terms of the individual.

Health is considered to be more than merely the absence of disease.

The definition of health has broadened beyond the physiological state to include mental, social, and spiritual well-being.

An individual who has the ability to pursue activities of daily living may not define himself or herself as being healthy. Life conditions such as environment, diet, and lifestyle practices may negatively impact one’s health long before the person is unable to perform activities of daily living.

DIF: A REF: 69 OBJ: Comprehension

TOP: Nursing Process: Assessment

MSC: NCLEX® test plan designation: Health Promotion and Maintenance

2. Which one of the following is the main, overarching goal for Healthy People 2010?

1.
Reduction of health care costs
2.
Elimination of health disparities
3.
Investigation of substance abuse
4.
Determination of acceptable morbidity rates

ANS: 2

Two overarching goals for Healthy People 2010 are (1) to increase quality and years of healthy life and (2) to eliminate health disparities.

Reducing health care costs was not a goal for Healthy People 2010.

Investigation of substance abuse was not one of the main, overarching goals for Healthy People 2010.

Determining acceptable morbidity rates was not one of the main, overarching goals for Healthy People 2010.

DIF: A REF: 69 OBJ: Comprehension

TOP: Nursing Process: Assessment

MSC: NCLEX® test plan designation: Health Promotion and Maintenance

3. A nurse is using a holistic approach when caring for a client. To incorporate all of the factors that may influence the client, which of the following nursing responses is most therapeutic?

1.
“I would like you to perform this exercise once a day.”
2.
“Your physician has left orders that you are to follow.”
3.
“The laboratory tests reveal the need to reduce your daily percentage of fat intake.”
4.
“Adapting to a low-fat diet and increasing your activity will help lower your blood glucose levels.”

ANS: 4

Using a holistic approach involves consideration of all factors that may impact a client’s level of well-being in all dimensions, not just physical health. Factors such as diet and exercise can influence one’s level of health.

Directing the client to exercise does not address the many factors that may impact one’s level of health. This response does not facilitate the client in seeing the connection between lifestyle choices and well-being.

Directing the client to follow physician’s orders, though important, does not describe a holistic approach of nursing care. A holistic approach may include a discussion of diet and exercise and the effect these factors have on blood glucose level. The aim is for the client to take responsibility for their health and choices that may impact their health.

Viewing laboratory test results is a part of the nursing assessment. To approach the client holistically, the nurse would need to also assess the client’s diet and activity level.

DIF: C REF: 72 OBJ: Analysis

TOP: Nursing Process: Implementation

MSC: NCLEX® test plan designation: Health Promotion and Maintenance

4. The client states, “Heart disease runs in our family. My blood pressure has always been high.” The nurse determines that this is an example of the client’s:

1.
Risk factors
2.
Active strategy
3.
Health beliefs
4.
Negative health behavior

ANS: 1

Risk factors are anything that increases the vulnerability of an individual or group to an illness or accident. This client is identifying the physical risk factor of genetic predisposition to heart disease.

An example of an active strategy would be weight reduction or smoking cessation, where the client is actively involved in measures to improve their present and future levels of wellness.

Health beliefs are a person’s ideas, convictions, and attitudes about health and illness. An example of a health belief would be if the client stated, “Heart disease runs in our family. I know I will have heart disease anyway, so why exercise?”

A negative health behavior is a behavior that may negatively impact one’s health. An example of a negative health behavior would be consistently drinking alcohol in excess.

DIF: A REF: 77 OBJ: Comprehension

TOP: Nursing Process: Assessment

MSC: NCLEX® test plan designation: Health Promotion and Maintenance

5. A client is discharged following a heart attack. In using the Stages of Health Behavior Change as a guide, the nurse recognizes that the client is most likely to begin to accept information on diet changes and an exercise program during which stage?

1.
Action
2.
Preparation
3.
Maintenance
4.
Contemplation

ANS: 4

During the contemplation stage, the client is considering a change within the next 6 months. The client may be ambivalent initially, but will more likely accept information as he or she develops more belief in the value of change.

During the action stage, the client is actively engaged in strategies to change behavior.

During the preparation stage, the client is making small changes in preparation for a change in the next month. At this point, the client believes advantages outweigh disadvantages in behavior change.

During the maintenance stage, the client has sustained change over time.

DIF: A REF: 78 OBJ: Knowledge

TOP: Nursing Process: Planning

MSC: NCLEX® test plan designation: Health Promotion and Maintenance

6. When assessing the external variables that influence a client’s health beliefs and practices, the nurse must consider his:

1.
Income status
2.
Religious practices
3.
Educational background
4.
Reaction to the heart disease

ANS: 1

External variables influencing a person’s health beliefs and practices include family practices, cultural background, and socioeconomic factors, such as income. Economic variables may affect a client’s level of health by increasing the risk for disease and influencing how or at what point the client enters the health care system. A person’s compliance with the treatment to maintain or improve health is also affected by economic status.

Religious practices are one way that people exercise spirituality. Spirituality is considered to be an internal variable.

Educational background is an internal variable that can influence the health beliefs and practices of a client.

An example of an internal variable that can influence health beliefs and practices of a client includes emotional factors, such as the reaction to heart disease.

DIF: A REF: 74 OBJ: Comprehension

TOP: Nursing Process: Assessment

MSC: NCLEX® test plan designation: Health Promotion and Maintenance

7. A paraplegic client is admitted for an electrolyte imbalance. Based on the levels of prevention, the client is receiving care at the level of:

1.
Health promotion
2.
Primary prevention
3.
Tertiary prevention
4.
Secondary prevention

ANS: 4

The secondary prevention level focuses on early diagnosis and prompt treatment as well as disability limitations. Adequate treatment for the electrolyte imbalance is sought to prevent further complications.

Health promotion is a focus of the primary prevention level.

The primary prevention level focuses on health promotion and specific protection measures such as immunizations and personal hygiene.

The tertiary prevention level focuses on restoration and rehabilitation.

DIF: A REF: 75 OBJ: Comprehension

TOP: Nursing Process: Planning

MSC: NCLEX® test plan designation: Health Promotion and Maintenance

8. Which of the following nursing activities is an example of tertiary level caregiving?

1.
Teaching a client how to irrigate a new colostomy
2.
Providing a class on hygiene for an elementary school class
3.
Informing a client that her infant can be immunized at the health department
4.
Arranging for a hospice nurse to visit with the family of a client with lung cancer

ANS: 4

Tertiary prevention occurs when a defect or disability is permanent and irreversible. Care of the hospice nurse at this level aims to help the client and the client’s family achieve as high a level of functioning as possible despite the limitations caused by the cancer.

Teaching a client how to irrigate a new colostomy would be an example of secondary prevention. If the colostomy is to be permanent, care may later move to the tertiary level of prevention.

Providing a class on hygiene for an elementary school class would be an example of the primary level of prevention.

Informing a client about available immunizations would be an example of primary prevention.

DIF: A REF: 75-76 OBJ: Comprehension

TOP: Nursing Process: Planning/Implementation

MSC: NCLEX® test plan designation: Health Promotion and Maintenance

9. Which one of the following client assessment findings indicates a lifestyle risk factor to the nurse?

1.
Obesity
2.
Sunbathing
3.
Overcrowded housing
4.
Industrial-based occupation

ANS: 2

Excessive sunbathing is a lifestyle risk factor for skin cancer.

Obesity is a physiological risk factor.

Overcrowded housing is an environmental risk factor.

An industrial-based occupation is an environmental risk factor.

DIF: A REF: 77-78 OBJ: Comprehension

TOP: Nursing Process: Assessment

MSC: NCLEX® test plan designation: Health Promotion and Maintenance

10. In the Health Belief Model, the nurse recognizes that the focus is placed on the:

1.
Basic human needs for survival
2.
Functioning of the individual in all dimensions
3.
Relationship of perceptions and compliance with therapy
4.
Multidimensional nature of clients and their interaction with the environment

ANS: 3

In the Health Belief Model, the nurse focuses on the relationship between a person’s beliefs and health behaviors. By focusing on the client’s perceptions of health, the nurse is better able to understand and predict how a client will comply with health care therapies.

Basic human needs for survival is a component of Maslow’s hierarchy of needs model.

The nurse who focuses on the functioning of the individual in all dimensions is following a holistic health model.

In the health promotion model, the nurse focuses on the multidimensional nature of clients and their interaction with the environment.

DIF: A REF: 70 OBJ: Comprehension

TOP: Nursing Process: Assessment

MSC: NCLEX® test plan designation: Health Promotion and Maintenance

11. The client who recently received a kidney transplant is worried about her husband since he has taken over the physical tasks of running their home. The client is in the process of adapting to a change in:

1.
Body image
2.
Self-concept
3.
Illness behavior
4.
Family dynamics

ANS: 4

The effects of illness on the client and family have created a change in family dynamics. Family dynamics is the process by which the family functions, makes decisions, gives support to individual members, and copes with everyday changes and challenges.

Body image is the subjective concept of physical appearance. The client did not express concerns regarding body image.

Self-concept is a mental self-image of strengths and weaknesses in all aspects of personality. The client did not express a change in self-concept.

Illness behavior refers to how people monitor their bodies, define and interpret their symptoms, take remedial actions, and use the health care system. The client did not express change in illness behavior.

DIF: A REF: 81 OBJ: Comprehension

TOP: Nursing Process: Assessment

MSC: NCLEX® test plan designation: Health Promotion and Maintenance

12. Client assessment provides the nurse with necessary information for the development of an effective plan of care. When determining the influence of an internal variable on the client’s health status, the nurse will specifically look for:

1.
Anxiety level present
2.
Family remedies used
3.
Location and type of occupation
4.
Available health insurance coverage

ANS: 1

Emotional factors, such as the client’s degree of anxiety, is an internal variable that can influence the client’s health status.

An example of an external variable that can influence the client’s health status is the use of family remedies.

Socioeconomic factors, such as location and type of occupation, are external variables that can influence the client’s health status.

Available health insurance coverage is an example of an external socioeconomic factor that can influence the client’s health status.

DIF: C REF: 73-74 OBJ: Analysis

TOP: Nursing Process: Assessment

MSC: NCLEX® test plan designation: Health Promotion and Maintenance

13. A nurse understands that illness behavior means:

1.
Each distinct illness will cause the client to behave in a specific manner
2.
Nursing care provides interventions that are behavior oriented
3.
The client’s behaviors will have a direct impact on his illness
4.
When ill, a client’s perception of illness will result in unique behaviors

ANS: 4

Medical sociologists call the reaction to illness, illness behavior. Nurses who understand how clients react to illness can minimize the effects of illness and assist clients and their families in maintaining or returning to the highest level of functioning.

While the other options may be true, they do not define illness behavior.

DIF: A REF: 79 OBJ: Comprehension

TOP: Nursing Process: Assessment

MSC: NCLEX® test plan designation: Health Promotion and Maintenance

14. A client tells the nurse that his illness is a result of his failure to “live a good life.” The nurse recognizes this statement as an example of the client’s:

1.
Risk factor
2.
Health belief
3.
Illness behavior
4.
Negative health behavior

ANS: 2

Health beliefs are a person’s ideas, convictions, and attitudes about health and illness.

A risk factor is any situation, habit, social or environmental condition, physiological or psychological condition, developmental or intellectual condition, or spiritual or other variable that increases the vulnerability of an individual or group to an illness or accident.

Illness behavior is the unique manner in which a client reacts to illness.

Negative health behaviors include practices actually or potentially harmful to health, such as smoking, drug or alcohol abuse, poor diet, and refusal to take necessary medications.

DIF: A REF: 70 OBJ: Comprehension

TOP: Nursing Process: Assessment

MSC: NCLEX® test plan designation: Health Promotion and Maintenance

15. Which of the following client statements best relates to the third component of the Health Belief Model?

1.
“My blood cholesterol is only a little high.”
2.
“No one in my family is susceptible to the flu.”
3.
“I’ll just avoid the food that causes the problem.”
4.
”By losing weight my blood pressure may come down.”

ANS: 4

The third component—the likelihood that a person will take preventive action—results from the person’s perception of the benefits of and barriers to taking action. Preventive action may include lifestyle changes, increased adherence to medical therapies, or a search for medical advice or treatment.

The second component is the individual’s perception of the seriousness of the illness.

The first component of this model involves the individual’s perception of susceptibility to an illness.

Increased incidence of chronic disease processes.

DIF: C REF: 70 OBJ: Analysis

TOP: Nursing Process: Assessment

MSC: NCLEX® test plan designation: Health Promotion and Maintenance

16. The goal of Pender’s Health Promotion theory is best reflected in which of the following nursing interventions?

1.
Suggesting the client experience a variety of exercise routines before settling on the one to adapt
2.
Arranging for a client to attend a support group for individuals who also have severe burn scars
3.
Playing soft, classical music when a client diagnosed with Alzheimer’s becomes physically agitated
4.
Providing a client with a history of stress-induced respiratory problems with detailed explanations regarding her care

ANS: 1

Health-promoting behaviors should result in improved health, enhanced functional ability, and better quality of life.

According to the Basic Human Needs model, certain human needs are more basic than others; that is, some needs must be met before other needs (i.e., fulfilling the physiological needs before the needs of love and belonging). Self-actualization is the highest expression of one’s individual potential and allows for continual discovery of self. Maslow’s model takes into account individual experiences, always unique to the individual.

Nurses using the holistic nursing model recognize the natural healing abilities of the body and incorporate complementary and alternative interventions, such as music therapy, reminiscence, relaxation therapy, therapeutic touch, and guided imagery, because they are effective, economical, noninvasive, nonpharmacological complements to traditional medical care.

The holistic nursing model considers the emotional and spiritual well-being, as well as other dimensions of an individual, as important aspects of physical wellness.

DIF: C REF: 71 OBJ: Analysis

TOP: Nursing Process: Assessment

MSC: NCLEX® test plan designation: Health Promotion and Maintenance

17. The nurse knows that the greatest internal factor to consider when educating an adult client concerning health promotion activities is the client’s:

1.
Emotional wellness
2.
Developmental stage
3.
Professed spirituality
4.
Intellectual background

ANS: 4

A person’s beliefs about health are shaped in part by the person’s knowledge, lack of knowledge, or incorrect information about body functions and illnesses; educational background; and past experiences. These variables influence how a client thinks about health. In addition, cognitive abilities shape the way a person thinks, including the ability to understand factors involved in illness and to apply knowledge of health and illness to personal health practices. The client’s ability to understand and accept the importance of the teaching is the primary nursing consideration.

The client’s degree of stress, depression, or fear, for example, can influence health beliefs and practices. The manner in which a person handles stress throughout each phase of life will influence the way the person reacts to illness, but this option is not the best choice available.

A person’s thought and behavior patterns change throughout life. The nurse must consider the client’s level of growth and development when using his or her health beliefs and practices as a basis for planning care, but the client has been identified as being adult and so the developmental stage has been determined.

Spirituality is reflected in how a person lives his or her life, including the values and beliefs exercised, the relationships established with family and friends, and the ability to find hope and meaning in life. However, this is not the best option available.

DIF: C REF: 23 OBJ: Analysis

TOP: Nursing Process: Assessment

MSC: NCLEX® test plan designation: Health Promotion and Maintenance

18. The nurse is caring for a terminally ill client who recently immigrated to the United States. To provide quality end-of-life care, the nurse must initially:

1.
Make every effort to involve the client and his family in the end-of-life care
2.
Understand the client’s personal and cultural views regarding death and dying
3.
Arrange for end-of-life care to be provided by personnel familiar with the client’s culture
4.
Share the client’s concerns regarding the dying process with his interdisciplinary care team

ANS: 2

Differences in beliefs, values, and traditional health care practices are relevant when planning end-of-life care. It is the nurse’s responsibility to become familiar with the client’s personal and cultural views so as to provide the most effective and appropriate end-of-life care.

While this is important, it is not the best available option because understanding the client’s cultural and personal views will facilitate all other offered options.

This may not be either practical or possible.

While this is important, it is not the best available option because understanding the client’s cultural and personal views will facilitate all other offered options.

DIF: C REF: 74 OBJ: Analysis

TOP: Nursing Process: Planning

MSC: NCLEX® test plan designation: Health Promotion and Maintenance

19. Which of the following nursing interventions is the best example of a primary care prevention strategy regarding the flu?

1.
Staffing a flu immunization clinic at a senior citizen’s center
2.
Providing flu prevention literature for distribution to visitors
3.
Reminding client care personnel of the importance of the flu shot
4.
Getting a drug manufacturer to donate flu vaccine for the homeless

ANS: 4

Primary prevention is true prevention; it precedes disease or dysfunction and is applied to clients considered physically and emotionally healthy. Primary prevention aimed at health promotion includes health education programs, immunizations, and physical and nutritional fitness activities. This option is the best example because it facilitates the availability of a service to clients to whom it might otherwise be unavailable.

This is a good example of primary care, but it is not the best one available because it facilitates a service that is already available.

While this is an example of primary care, it is not the best because it does not ensure the facilitation of the needed service.

DIF: C REF: 75 OBJ: Analysis

TOP: Nursing Process: Planning

MSC: NCLEX® test plan designation: Health Promotion and Maintenance

20. The nurse can best discuss the impact of a known risk factor on a client’s health by stating:

1.
“It doesn’t mean you’ll get the disease just that the odds are greater for you.”
2.
“Now you know that the possibility is there, you can take steps to prevent it.”
3.
“The risk factor can be managed by making a change in your lifestyle.”
4.
“You’re lucky because you have the benefit of being able to do something about it.”

ANS: 1

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.

While this response is not incorrect, it does not address the impact of a risk factor on the client’s health.

This is not always true, and so it is not the best option.

This option minimizes the client’s concern and does not address the impact of a risk factor on the client’s health.

DIF: C REF: 77 OBJ: Analysis

TOP: Nursing Process: Planning

MSC: NCLEX® test plan designation: Health Promotion and Maintenance

21. When caring for a client with a spouse and two adolescent children, the nurse knows that the family unit must first:

1.
Be viewed as a client
2.
Change traditional roles
3.
Provide support for the ailing mother
4.
Seek help to fulfill day-to-day needs

ANS: 1

The nurse must view the whole family as a client under stress, planning care to help the family regain the maximal level of functioning and well-being.

While the illness of a family member requires role reassignment in order for the family to continue to function, the initial focus is to be viewed as a unit in need of care.

While the family should provide support to the ailing member, the initial focus is to be viewed as a unit in need of care.

This may become necessary in order to ensure the continued functioning of the family, but the initial focus is to be viewed as a unit in need of care.

DIF: C REF: 81 OBJ: Analysis

TOP: Nursing Process: Assessment

MSC: NCLEX® test plan designation: Health Promotion and Maintenance

22. The nurse observes signs of depression in a client who has been hospitalized for several weeks because of injuries sustained in an automobile accident. The client confirms his fears of never, “Being able to work and support my family as I did before.” The nurse’s initial intervention is to:

1.
Offer to arrange for him to speak with the facility’s chaplain
2.
Assure the client that physical therapy will help him tremendously
3.
Revise his care plan to include interventions to assist him with coping
4.
Tell his health care provider of his need for antidepressant medication

ANS: 3

In the course of providing care, a nurse is able to observe changes in the client’s self-concept (or in the self-concepts of family members) and develop a care plan to help them adjust to the changes resulting from the illness.

This option is appropriate only when the client shows an interest in such a referral. The initial most therapeutic intervention is to revise his care plan to address the issue of depression and grieving over his current situation.

Although this may be appropriate in some cases, the nurse should not offer false or unrealistic hope to the client. The initial most therapeutic intervention is to revise his care plan to address the issue of depression and grieving over his current situation.

Although the health care provider should be informed of the client’s signs, the initial intervention is to revise his care plan to address the issue of depression and grieving over his current situation.

DIF: C REF: 81 OBJ: Analysis

TOP: Nursing Process: Planning

MSC: NCLEX® test plan designation: Health Promotion and Maintenance

23. While discussing discharge plans for a client who recently experienced a stroke that resulted in right-sided weakness and communication problems, the daughter shares with the nurse that she has concerns regarding her role as caregiver. The most therapeutic response by the nurse is to:

1.
Agree that her concerns are well-founded
2.
Suggest that she consider home health aides
3.
Offer to arrange for her to see the facility’s grief counselor
4.
Provide her with information about a caregiver support group

ANS: 3

The client and family often require specific counseling and guidance to assist them in coping with the role changes.

Although the nurse may agree that the daughter’s concerns are legitimate, the counselor is best suited to help the daughter cope with these changes.

While assistance with providing the care may help, the counselor is best suited to help the daughter cope with these changes.

Although actively participating in a support care could prove helpful, the counselor is best suited to help the daughter cope with these changes.

DIF: C REF: 81 OBJ: Analysis

TOP: Nursing Process: Planning

MSC: NCLEX® test plan designation: Health Promotion and Maintenance

MULTIPLE RESPONSE

1. Which of the following would be considered positive health behaviors for a 40-year-old client? (Select all that apply.)

1.
Eating a low-fat, low-salt diet
2.
Getting 6 to 8 hours of sleep nightly
3.
Spending quality time with his children
4.
Limiting his smoking to 3 cigarettes daily
5.
Having his blood pressure checked regularly
6.
Walking for 30 minutes several times a week

ANS: 1, 2, 5, 6

Positive health behaviors are activities related to maintaining, attaining, or regaining good health and preventing illness.

Although spending quality time with his children is an admirable behavior and will certainly positively affect the parent-child relationship, it is not considered a positive health behavior.

While limiting nicotine intake to 3 cigarettes daily is a great first step, it would require smoking cessation to be considered a positive health behavior.

DIF: A REF: 78 OBJ: Comprehension

TOP: Nursing Process: Assessment

MSC: NCLEX® test plan designation: Health Promotion and Maintenance

2. Which of the following client behaviors are examples of active strategies of health promotion? (Select all that apply.)

1.
Losing 10 pounds
2.
Walking 1 mile each evening
3.
Drinking vitamin D fortified milk
4.
Driving a car equipped with airbags
5.
Having regular blood pressure checks
6.
Having a company-required hearing exam

ANS: 1, 2, 5

With active strategies of health promotion, individuals are motivated to adopt specific health programs. The individual plays an active role in performing tasks or adapting behaviors that impact their health in a positive manner.

With passive strategies of health promotion, individuals gain from the activities of others without acting themselves. The fluoridation of municipal drinking water and the fortification of homogenized milk with vitamin D are examples of passive health promotion strategies as are driving a car with a manufacturer’s installed airbag and accepting a hearing test that is a job requirement.

DIF: C REF: 78 OBJ: Analysis

TOP: Nursing Process: Assessment

MSC: NCLEX® test plan designation: Health Promotion and Maintenance