Professional Nursing Practice: Concepts and Perspectives, 7e

Professional Nursing Practice: Concepts and
Perspectives, 7e
Chapter 7: The Nurse as Health Promoter and Care Provider
Question 1
The nurse is involved in an organization whose goal is to help children make the decision
not use tobacco. Which type of health organization does this represent?
1. Health protection
2. Health restoration
3. Preventive health services
4. Health promotion
Correct Answer: 4
Rationale: Health promotion includes individual and community activities to promote a
healthful lifestyle. Examples of these health-promotion activities include improving
nutrition, preventing alcohol and drug misuse, restricting smoking, maintaining fitness,
and exercising. Health protection includes actions by government and industry to
minimize environmental health threats. Preventative health services include actions that
healthcare providers take to prevent health problems. Health restoration is restoring
clients to optimal health once disease has occurred.
Cognitive Level: Analyzing
Client Need: Health Promotion and Maintenance
Client Need Sub:
QSEN Competencies: I.A.6. Describe strategies to empower patients or families in all
aspects of the health care process.
AACN Essential Competencies: VII.7. Collaborate with other healthcare professionals
and patients to provide spiritually and culturally appropriate health promotion, and
disease and injury prevention interventions.
NLN Competencies: Context and Environment; Knowledge; Health promotion/disease
prevention.
Nursing/Integrated Concepts: Assessment; Nursing Process
Learning Outcome: 1. Differentiate between health prevention or protective care and
health promotion.
Page Number: p. 122
Question 2
The government has authorized a series of influenza immunization clinics that will be
provided free of cost to citizens. Which type of health organization does this represent?
4. Health promotion
Correct Answer: 1
Rationale: Health protection includes actions by government and industry to minimize
environmental health threats. Examples of these health protection activities include
maintaining occupational safety, controlling radiation and toxic agents, and preventing
infectious diseases and accidents. Health restoration is restoring clients to optimal health
once disease has occurred. Preventative health services include actions that healthcare
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providers take to prevent health problems. Health promotion includes individual and
community activities to promote a healthful lifestyle.
Client Need Sub:
prevention.
health promotion.
Page Number: p. 138
Question 3
A nurse has accepted a job position in a clinic whose focus is on health care during
pregnancy and infancy. Which type of health organization does this represent?
4. Health promotion
Correct Answer: 3
Rationale: Preventive health services include actions that healthcare providers take to
prevent health problems. Examples of these health preventive services include control of
high blood pressure, control of sexually transmitted diseases, immunization, family
planning, and health care during pregnancy and infancy. Health protection includes
actions by government and industry to minimize environmental health threats. Health
restoration is restoring clients to optimal health once disease has occurred. Health
promotion includes individual and community activities to promote a healthful lifestyle.
Client Need Sub:
prevention.
health promotion.
Page Number: p. 122
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Question 4
Which level of prevention as defined by Leavell and Clark most closely reflects health
promotion?
1. Primary
2. Secondary
3. Tertiary
4. None of the levels is related to health promotion
Correct Answer: 1
Rationale: In the model used by Leavell and Clark, primary prevention precedes any
disease symptoms and encourages optimal health and increases the person’s resistance to
illness. Secondary prevention presumes the presence of a disease or illness. Tertiary
prevention relates to situations in which a disability is already present.
Client Need Sub:
prevention.
Learning Outcome: 2. Discuss essential components of health promotion.
Page Number: p. 122
Question 5
According to Pender, Murdaugh, and Parsons, what is the definition of health promotion?
1. Behavior designed to avoid illness.
2. Behavior to increase early detection.
3. Behavior to help maintain function within constraints of illness.
4. Behavior motivated by a desire to increase well-being.
Correct Answer: 4
Rationale: Health promotion is considered to be an approach that is motivated by a
desire to increase well-being and is not disease oriented. Illness avoidance, early
detection of illness, and behavior motivated by a desire to increase well-being are all
components of health protection.
Cognitive Level: Understanding
Client Need Sub:
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prevention.
Learning Outcome: 2. Discuss essential components of health promotion.
Page Number: p. 122
Question 6
What is a mission of Healthy People 2020?
1. Encourage all people to change behavior.
2. Identify nationwide health improvement priorities.
3. Increase the number of health-related research studies.
4. Increase the number of healthcare professionals.
Correct Answer: 2
Rationale: The mission of Healthy People 2020 is to identify nationwide health
improvement priorities. Healthy People 2020 does not have as a mission to encourage all
people to change behavior, increase the number of health-related research studies, or to
increase the number of healthcare professionals.
Cognitive Level: Remembering
Client Need Sub:
prevention.
Learning Outcome: 3. Discuss the overarching goals, foundation health measures,
topics, and objectives of Healthy People 2020.
Page Number: p. 123
Question 7
What is a goal of Healthy People 2020?
1. Elimination of health disparities.
2. Improvement of personal sense of well-being.
3. Identifying differences between health promotion and health protection.
4. Increasing people’s involvement in health-promotion activities.
Correct Answer: 1
Rationale: A goal of Healthy People 2020 is to achieve health equity, eliminate
disparities, and improve the health of all groups. The other options are not Healthy
People 2020 goals.
Cognitive Level: Remembering
Client Need Sub:
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prevention.
Page Number: p. 123
Question 8
What do the leading health indicators developed as a part of Healthy People 2020 have in
common?
1. They are all focused on young people.
2. They all can be measured by objective data.
3. They are passive and do not require client motivation.
4. They eliminate health disparities.
Correct Answer: 2
Rationale: These indicators have the ability to motivate action, can be measured by
objective data, and are relevant to broad public health issues. They consider all age
groups. They will not eliminate health disparities, but may serve to narrow this problem.
Client Need Sub:
prevention.
Page Number: p. 124
Question 9
What is the purpose of a risk appraisal program?
1. To inform the public about the risks of particular lifestyle choices.
2. To improve the quality of risky environmental situations.
3. To enhance the quality of life and extend the life span.
4. To apprise individuals of the risk factors that are inherent in their lives.
Correct Answer: 4
Rationale: Health risk appraisal/wellness assessment programs are used to apprise
individuals of the risk factors that are inherent in their lives in order to motivate them to
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reduce specific risks and develop positive health habits. Environmental control programs
have been developed in response to environmental hazards. Information dissemination
makes use of a variety of media to offer information to the public about the risk of
particular lifestyle choices. Lifestyle- and behavior-change programs require the
participation of the individual and are geared toward enhancing the quality of life and
extending the life span.
Client Need Sub:
prevention.
Learning Outcome: 4. Identify various types of and sites for health promotion programs.
Page Number: p. 127
Question 10
A small school district cannot afford to employ registered nurses at each of its individual
school campuses. Can this school offer health-promotion activities?
1. No; there must be a healthcare professional present for these activities.
2. It can only do so if the district employs a nurse consultant to plan the curriculum.
3. It can only do so if the district has access to preprinted curriculum approved by the
state.
4. Yes; many professionals such as teachers can teach health-related topics.
Correct Answer: 4
Rationale: Classroom teachers may include health-related topics in their lesson plans, for
example, the way the normal heart functions or the need for clean air and water in the
environment. Although a full-time health professional would be optimal for this district,
others can also teach some content. Health based curriculums are available commercially,
so there is no requirement that the school district employ a nurse consultant to write the
curriculum. The school district can choose curriculum; it does not have to be approved by
the state.
Cognitive Level: Applying
Client Need Sub:
prevention.
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Nursing/Integrated Concepts: Planning; Nursing Process
Page Number: p. 128
Question 11
What is the outcome of a work-site health-promotion program for the company offering
these classes to employees?
1. There is no benefit documented.
2. Employees report feeling coerced to attend.
3. Morale among employees often increases.
4. Absenteeism increases during classes.
Correct Answer: 3
Rationale: Companies that offer these programs report benefits such as an increase in
employee motivation and productivity, an increase in employee morale, a decrease in
absenteeism, and a lower rate of employee turnover. There is no information in the text
that supports that employees feel coerced to attend these sessions.
Client Need Sub:
AACN Essential Competencies: VII. 7. Collaborate with other healthcare professionals
prevention.
Nursing/Integrated Concepts: Evaluation; Nursing Process
Page Number: p. 129
Question 12
A client asks the nurse about a new treatment for Alzheimer disease that the client found
during a search of the Internet. The treatment is based upon alternative medicine
strategies. How should the nurse respond to questions about this treatment?
1. Since the treatment was discovered on the Internet, it is probably not valid.
2. Because the treatment is based upon alternative medicine strategies, it is probably not
valid.
3. The treatment must be researched and found to be valid before it can be added to the
Internet.
4. The treatment may be valid, but further investigation should be done before it is
trusted.
Correct Answer: 4
Rationale: Just because the treatment was found on the Internet and/or it is based upon
alternative medicine strategies, it is not necessarily invalid. The treatment may be based
in science, but further investigation should be done into its validity before trusting the
treatment modality. There is no requirement that information has to be researched or
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validated prior to adding it to the Internet.
Client Need Sub:
prevention.
Page Number: p. 129
Question 13
The nurse working to promote a client’s health identifies that the client did not finish
high school. Using Pender’s Health-Promotion Model, the nurse classifies this
information as which personal factor?
1. Biologic
2. Psychologic
3. Sociocultural
4. Affect
Correct Answer: 3
Rationale: Personal factors in Pender’s model include biologic, psychologic,
sociocultural, cognitions, affect, and health behaviors. Education level is described as
sociocultural. Biologic factors include such factors as age, gender, and familial disease
risk. Psychologic factors include such characteristics as self-esteem, self-motivation, and
perceptions of health status. Affect is also a psychologic factor.
Client Need Sub:
prevention.
Learning Outcome: 6. Compare and contrast Pender’s Health Promotion Model (HPM)
and the Neuman Systems Model as they relate to health-promotion decision making.
Page Number: p. 132
Question 14
The client has a strong belief that he can successfully change his eating and exercise
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pattern in order to lose weight. Using Pender’s Health-Promotion Model, how would the
nurse document this belief?
1. As a positive activity-related affect.
2. As a perceived barrier to action.
3. As positive self-efficacy.
4. As good interpersonal influence.
Correct Answer: 3
Rationale: When a client has a strong belief that he or she can successfully carry out the
behavior necessary to achieve a desired outcome, it is termed positive self-efficacy.
Positive activity-related affect occurs when the person has had a previous positive
experience with a health-promoting behavior. Perceived barriers to action are negative in
that they give a reason why the health-promoting behavior will not succeed. Good
interpersonal influences have to do with the perceptions of others.
Client Need Sub:
prevention.
Page Number: p. 132
Question 15
A client tells the nurse that a group of friends have all decided to stop smoking. The
group has planned a party at which they will each smoke their last cigarette. According to
Pender’s model, how does the nurse interpret this information?
1. This group’s plan sounds too frivolous to be successful.
2. Group actions generally are not as successful as individual efforts.
3. This party demonstrates a plan of action and is positive.
4. There is no connection between successful outcomes and planning.
Correct Answer: 3
Rationale: Commitment to a plan of action is essential to success in behavioral change.
This group has a plan that will elicit a commitment from each group member. Group
actions are often more successful since there is support among the group members. This
plan is not frivolous if it elicits commitment from the group. Attendance at this party and
participation in the ritual of a last cigarette may serve to bond the group so that they can
support each other through smoking cessation.
Cognitive Level: Analzying
Client Need Sub:
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prevention.
Nursing/Integrated Concepts: Evaluation; Nursing Process
Page Number: p. 133
Question 16
After being provided with smoking cessation information the client responds, “I’m not
interested. I enjoy smoking and don’t want to quit.” According to Prochaska and
DiClemente, in which stage of change is this client?
1. Preparation
2. Precontemplation
3. Action
4. Contemplation
Correct Answer: 2
Rationale: This response reflects precontemplation, in which the patient neither thinks
about changing behavior nor is interested in information about the behavior. In
contemplation, the patient seriously considers changing a specific behavior, actively
gathers information, and verbalizes plans to make the change in the near future. The
preparation stage occurs when the person undertakes cognitive and behavioral activities
that prepare the person for change. The action stage occurs when the person actively
implements behavioral and cognitive strategies to interrupt previous behavior patterns
and adopt new ones.
Client Need Sub:
prevention.
Learning Outcome: 7. Discuss Prochaska and DiClemente’s five-stage model of
behavior change.
Page Number: p. 134
Question 17
After receiving information about smoking cessation the client responds, “OK. I’ve been
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thinking about quitting.” According to Prochaska and DiClemente, in which stage of
change is this client?
1. Preparation
2. Precontemplation
3. Action
4. Contemplation
Correct Answer: 4
Rationale: This response reflects contemplation, when the patient seriously considers
changing a specific behavior, actively gathers information, and verbalizes plans to make
the change in the near future. In precontemplation the patient neither thinks about
changing behavior nor is interested in information about the behavior. The preparation
stage occurs when the person undertakes cognitive and behavioral activities that prepare
the person for change. The action stage occurs when the person actively implements
behavioral and cognitive strategies to interrupt previous behavior patterns and adopt new
ones.
Client Need Sub:
prevention.
behavior change.
Page Number: p. 134
Question 18
During a health visit a client who has been reviewing smoking cessation material states
“I’ve already cut back from a pack a day to half a pack.” According to Prochaska and
DiClemente, in which stage of change is this client?
1. Preparation
2. Precontemplation
3. Action
4. Contemplation
Correct Answer: 1
Rationale: This response reflects the preparation stage when the person undertakes
cognitive and behavioral activities that prepare the person for change and may have
already changed some small aspect of the behavior. Contemplation is when the patient
seriously considers changing a specific behavior, actively gathers information, and
verbalizes plans to make the change in the near future. In precontemplation the patient
neither thinks about changing behavior nor is interested in information about the
behavior. The action stage occurs when the person actively implements behavioral and
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cognitive strategies to interrupt previous behavior patterns and adopt new ones.
Client Need Sub:
prevention.
behavior change.
Page Number: pp. 134–135
Question 19
A client who has been considering smoking cessation says “I’ve already quit. I haven’t
had a cigarette for 6 weeks.” According to Prochaska and DiClemente, in which stage of
change is this client?
1. Preparation
2. Precontemplation
3. Action
4. Contemplation
Correct Answer: 3
Rationale: This response reflects the action stage when the person actively implements
behavioral and cognitive strategies to interrupt previous behavior patterns and adopt new
ones. This stage may need to continue for several weeks or months. The preparation stage
occurs when the person undertakes cognitive and behavioral activities that prepare the
person for change and may have already changed some small aspect of the behavior.
Contemplation is when the patient seriously considers changing a specific behavior,
actively gathers information, and verbalizes plans to make the change in the near future.
In precontemplation the patient neither thinks about changing behavior nor is interested
in information about the behavior.
Client Need Sub:
prevention.
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behavior change.
Page Number: p. 135
Question 20
What is the primary role in which the nurse works when leading a health-promotion
group?
1. Provider of care
2. Manager of care
3. Facilitator of the process
4. Member of the discipline of nursing
Correct Answer: 3
Rationale: Whereas all of these roles are inherent in health-promotion work, the nurse’s
primary role is as facilitator of the process. The nurse works with the client, not for the
client, and not as director of the client’s health.
Client Need Sub:
prevention.
Nursing/Integrated Concepts: Implementation; Nursing Process
Learning Outcome: 8. Analyze the nurse’s role in health promotion.
Page Number: p. 137
Question 21
Which model does the nurse employ while working in the role of health promoter?
1. Nursing process
2. Medical model
3. Scientific method
4. Problem-solving model
Correct Answer: 1
Rationale: The nurse’s practice is always based upon nursing process. Although some
aspects of the other options may be considered in care planning, the model for nursing
care is nursing process.
Client Need Sub:
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prevention.
Nursing/Integrated Concepts: Implementation; Nursing Process
Page Number: p. 137
Question 22
The nurse has been asked to provide a health-promotion session for a group of preschool
children. Can the nurse work in this capacity?
1. No; health-promotion activities are limited to individual sessions.
2. The nurse may do so only if there is a medical order for the session.
3. No; health promotion is effective only with adult clients.
4. Yes; the nurse can work with groups or individuals of all ages.
Correct Answer: 4
Rationale: In the health-promotion role, the nurse may work with individuals of all age
groups and with individuals or with groups. There is no need for a medical order for these
sessions; however, there may be need for parental permission, depending upon the
content of the session. The activities may be limited to one session or may continue
through several days or weeks.
Client Need Sub:
prevention.
Nursing/Integrated Concepts: Planning; Nursing Process
Page Number: p. 137
Question 23
The nurse is reviewing data within a client’s medical record:
Current Problem: Right hip pain
Explaining Factors: “It started when I rode the stationary bike at home. It’s that bike’s
fault I have pain now and I’m not going to do any exercise anymore.”
Efforts take to relieve pain: “I take over-the-counter pills, but I figure if I’m supposed
to get over this I will. Something will come up that will help with the pain.”
Based upon this information, which health belief model should the nurse identify that the
client follows?
1. Internal locus of control
2. External local of control
3. Rosenstock’s health belief model
4. Pender’s health promotion model
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Correct Answer: 2
Rationale: People who believe their health is largely controlled by outside forces and is
beyond their control have an external locus of control and may need assistance to become
more internally controlled if behavior changes are to be successful. People who believe
that they have a major influence on their own health status are internally controlled; that
is, they have an internal locus of control. The health belief model (HBM), developed by
Rosenstock provides a framework for understanding why people do not adopt disease
prevention strategies or participate in screening tests for the early detection of disease.
Pender’s health promotion model focuses on health-promoting behaviors rather than
health-protecting or preventive behaviors.
Client Need Sub:
AACN Essential Competencies: VII. 7. Collaborate with other healthcare professionals
prevention.
Learning Outcome: 5. Compare and contrast the locus-of-control and health belief
models as they relate to healthcare decision making.
Page Number: p. 129
Question 24
A client comes into the community clinic for a wellness check-up. During the interview
the nurse collects the following information:
Reason for visit: “Just wanted to get a quick check-up. I know I’m not sick and will
not get anything serious. And even if I do, what can be done? You people will tell me to
take some pills, change my diet, get more exercise … the list goes on and on and why? If
I’m meant to live long I will and if I’m meant to die early, then I will do that too.”
Which health belief model should the nurse consider as the guiding principle for this
client?
1. Internal locus of control
2. Neuman systems model
3. Rosenstock’s health belief model
4. Pender’s health promotion model
Correct Answer: 3
Rationale: The health belief model (HBM), developed by Rosenstock provides a
framework for understanding why people do not adopt disease prevention strategies or
participate in screening tests for the early detection of disease. As the model evolved,
individual responses to symptoms and compliance with medical treatments were
examined. Initially the model was used to explain why people do not take action to
prevent disease/injury. While mostly associated with disease/injury prevention, the model
may also be used to explain why people do or do not participate in health promotion
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behaviors. People who believe that they have a major influence on their own health status
are internally controlled; that is, they have an internal locus of control. The Neuman
Systems Model is wellness oriented and views health promotion as an intervention
component of primary prevention. Pender’s health promotion model focuses on health-
promoting behaviors rather than health-protecting or preventive behaviors.
Client Need Sub:
prevention.
Learning Outcome: 5. Compare and contrast the locus-of-control and health belief
models as they relate to healthcare decision making.
Page Number: p. 130
Question 25
The nurse is creating a weight-reduction teaching plan for a client who has a BMI of 42
and type 2 diabetes mellitus. In which order should the nurse implement the contents of
this plan?
1. Set realistic goals.
2. Raise awareness of healthy behaviors.
3. Explain relapse as an opportunity to try again.
4. Identify strategies that support healthy behavior.
5. Further clarify values in relation to the health behavior.
6. Identify unhealthy behavior triggers and ways to reduce them.
Correct Answer: 2, 5, 6, 1, 4, 3
Rationale: In the first stage of precontemplation (1) the nurse raises the client’s
awareness of healthy behaviors. In the contemplation stage (2) the nurse helps the client
further clarify his or her values in relation to the health behavior. In the preparation stage
(3) the nurse helps the client identify stimuli that trigger unhealthy behavior and consider
ways to remove or minimize those stimuli. In the action stage (4) the nurse helps the
client set realistic goals. In the maintenance stage (5) the nurse identifies and encourages
strategies that support healthy behavior. In the termination stage (6) the nurse should
review the role of relapse as an opportunity to try again.
Client Need Sub:
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prevention
Nursing/Integrated Concepts: Implementation; Teaching/Learning
behavior change.
Page Number: p. 136
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