Chapter 08: Health Promotion and Illness/Disability Prevention My Nursing Test Banks

Chapter 08: Health Promotion and Illness/Disability Prevention

Meiner: Gerontologic Nursing, 5th Edition

MULTIPLE CHOICE

1. When the home health nurse assists the older adult patient with rearranging furniture within the home to prevent the patient from falling, the nurse is demonstrating:

a.

health promotion.

b.

health protection.

c.

health prevention.

d.

disease prevention.

ANS: B

The overarching goals are to attain high-quality, long lives free of preventable disease, disability, and injury; to eliminate disparities; create social and physical environments that promote health; and optimize quality of life across the life span. Health protection targets five areas including unintentional injury. Rearranging furniture to prevent falls is a health protection activity.

DIF: Applying (Application) REF: N/A OBJ: 8-1

TOP: Nursing Process: Implementation MSC: Safe Effective Care Environment

2. The primary focus of the health belief model of health promotion is addressed when the nurse:

a.

accompanies the assisted living residents on a walk before dinner.

b.

asks a senior citizens group what health screening they want to have.

c.

plans a program on cooking diabetic-friendly meals in cooperation with a dietician.

d.

asks the patient if he believes smoking puts him at risk for lung cancer.

ANS: D

The health belief model, which was developed to determine the likelihood of an individuals participation in health promotion, health protection, and disease prevention services, includes assessing an individuals perception of his or her susceptibility to developing an illness. Asking the patient about beliefs related to tobacco use and health is an activity that falls within this model. The other activities do not.

DIF: Understanding (Comprehension) REF: Page 141 OBJ: 8-2

TOP: Nursing Process: Assessment MSC: Health Promotion

3. Financial considerations are a major barrier to the older adults participation in health promotion because:

a.

most older adults have accepted poor health as a part of growing older.

b.

Medicare often does not cover the cost of preventive services.

c.

many already have been diagnosed with chronic illnesses.

d.

they generally place more value on saving their disposable income.

ANS: B

Older adults must incur the cost of many preventive services because Medicare does not cover them all. This can be hard on the fixed, limited income of many older adults. It is not true that older adults accept poor health as inevitable. Health promotion activities can occur in the presence of chronic illnesses. Some older adults do place high value on saving money, but not all older adults are influenced by this desire.

DIF: Understanding (Comprehension) REF: Page 148 OBJ: 8-4

TOP: Nursing Process: Assessment MSC: Health Promotion

4. To engage the older adults who frequently attend a senior citizens center in primary disease prevention, the nurse:

a.

immunizes those attending a weekly luncheon against the H1N1 virus.

b.

arranges for a colorectal cancer screening at the center.

c.

schedules a speaker to discuss cooking for diabetic patients.

d.

surveys the members to identify health issues of interest to them.

ANS: A

Primary prevention refers to specific action taken to optimize the health of the older individual by helping him or her to become more resistant to disease or to ensure that the environment will be less harmful. Providing immunizations would be included in this level of prevention. Colorectal cancer screening is secondary prevention. Cooking for diabetic patients is tertiary prevention. Surveying patients does not fall into any level of prevention.

DIF: Applying (Application) REF: N/A OBJ: 8-5

TOP: Nursing Process: Implementation MSC: Health Promotion

5. The nurse has the greatest impact on a patients health promotion when:

a.

evaluating a diabetic patients ability to administer his insulin injections.

b.

encouraging an obese patient to limit both fat and carbohydrate intake.

c.

volunteering to take blood pressures at a community health fair.

d.

educating the patient about vitamin D and calcium to prevent bone loss.

ANS: D

Health promotion includes interventions that help prevent disease and disability in a patient. Education regarding health promotion issues has the greatest impact on the health of a patient. The other patients already have established diseases.

DIF: Applying (Application) REF: N/A OBJ: 8-1

TOP: Teaching-Learning MSC: Health Promotion

6. A nurse is assessing a patients ability to manage existing health problems. What question by the nurse is most helpful?

a.

Can you tell me why its important to test your blood glucose level at least daily?

b.

What were the results of your most recent A1C blood test?

c.

Which pharmacy do you use when your prescription needs to be refilled?

d.

Have you been experiencing pain in your feet?

ANS: B

The results of a laboratory test used to monitor glucose control will show how well the patient has been managing the various aspects of his or her treatment plan. This information is collected in the health perception/health management functional health pattern. The other questions do not demonstrate the patients knowledge level.

DIF: Applying (Application) REF: N/A OBJ: 8-5

TOP: Nursing Process: Assessment MSC: Health Promotion

7. During a home visit, a nurse is assessing the nutritional awareness of an older adult patient who lives alone. The nurse is most effective in obtaining objective information when:

a.

asking to see what types of foods the patient keeps readily available.

b.

reviewing the components of a healthy diet with the patient.

c.

asking the patient to describe what he or she ate for all three meals yesterday.

d.

observing the patient eat a meal that he or she has prepared.

ANS: D

Objective information is best obtained when observing general appearance and various body system indicators of nutritional status. Note height, weight, and fit of clothes. If possible, observe the older adult eating a meal. Food available in the home does not indicate the patients knowledge, as someone else may have bought the food. Asking the patient for information is requesting subjective data. Reviewing a healthy diet does not allow the patient to demonstrate knowledge.

DIF: Applying (Application) REF: N/A OBJ: 8-5

TOP: Nursing Process: Assessment MSC: Physiologic Integrity

8. The nurse is discussing an older adults past marital history during the admission assessment. The nurse can best determine that the patient has a healthy ability to cope with emotional stressors when the patient states:

a.

After my husband died, I managed to raise and educate our two children by myself.

b.

Since my husbands death, Ive grown even closer to my sisters.

c.

Its been hard since my husband died, but you manage to go on somehow.

d.

After my husband died, I married a good man who was there for me and my children.

ANS: A

This pattern encompasses the patients reserve and capacity to resist challenges to self-integrity and his or her ability to manage difficult situations. The ability to view herself as a success in fulfilling her responsibilities as a mother is evidence of healthy stress coping skills.

DIF: Evaluating (Evaluation) REF: N/A OBJ: 8-5

TOP: Nursing Process: Evaluation MSC: Psychosocial Integrity

9. An older adult patient has recently experienced some difficulty sustaining an erection as a result of medication he has been prescribed. The nurse best assesses the patients perception of his own sexuality by asking:

a.

How are you and your wife coping with your sexual dysfunction?

b.

What problems has your sexual dysfunction caused between you and your wife?

c.

What impact has this dysfunction had on your ability to be intimate with your wife?

d.

Are you and your wife prepared to deal with this dysfunction over the long term?

ANS: C

Asking about the impact of the dysfunction directly assesses the patients satisfaction or dissatisfaction with current circumstances related to sexual function and intimacy, thus providing the best evaluation of his self-perception of the issue.

DIF: Applying (Application) REF: N/A OBJ: 8-5

TOP: Nursing Process: Assessment MSC: Psychosocial Integrity

10. The nurse admitting an 89-year-old patient to an assisted living facility notes that the patient is currently taking numerous prescribed and over-the-counter medications. The nurses initial intervention is to:

a.

confirm with the physician that all the medications are required.

b.

evaluate the patients understanding of why he is taking each medication.

c.

explain to the patient the dangers of taking so many different medications.

d.

review the listed medications for possible interactions.

ANS: D

The first nursing action is to determine if the patients health is at risk from possible drug interactions. The other actions might be warranted, but patient safety comes first.

DIF: Understanding (Comprehension) REF: Page 143 OBJ: 8-6

TOP: Nursing Process: Assessment MSC: Physiologic Integrity

11. When assessing the older adult for bowel health, the nurse is most effective in obtaining subjective data when asking:

a.

Would you describe your bowel movements as usually normal?

b.

Do you have a problem with constipation?

c.

How often do you usually have a bowel movement?

d.

Have your bowel movements changed recently?

ANS: C

Subjective data can be obtained through the health history. Asking the patient to identify how often the bowels move would establish the fundamental baseline of the patients elimination patterns. Normal is a vague term that should not be used. Asking if there are problems with constipation or if bowel habits have changed are yes/no questions, which are generally avoided.

DIF: Applying (Application) REF: N/A OBJ: 8-5

TOP: Nursing Process: Assessment MSC: Physiologic Integrity

12. Using social cognitive theory, which action by the nurse will have the most impact on older adults participation in health promotion behaviors?

a.

Creating a walking club in the community

b.

Offering private nutritional counseling

c.

Providing meals at the senior center

d.

Handing out educational materials

ANS: A

According to this theory, self-efficacy and outcome expectations are influenced by successful performance of the behavior, verbal encouragement, seeing similar people do the behavior, decreasing unpleasant aspects of the behavior, caring approaches to facilitate the behavior, and education about benefits. A local walking club with other seniors fulfills many of these criteria. Private nutritional counseling does not allow the participant to see others engaged in this activity. Meals may or may not be healthy or palatable. Educational materials on their own may not have great benefit.

DIF: Applying (Application) REF: N/A OBJ: 8-2

TOP: Nursing Process: Implementation MSC: Health Promotion

13. The nurse wishes to participate in a community secondary prevention activity. Which activity does the nurse choose?

a.

Administering blood pressure screening at a mall

b.

Dispensing free flu vaccinations at a clinic

c.

Fitting impoverished older adults with glasses

d.

Teaching about the risks of sun exposure

ANS: A

Secondary prevention is screening and early diagnosis. It aims to find people with clinical conditions that have not yet become apparent to them. Blood pressure screening would fit this description. Flu vaccinations and teaching about sun exposure are examples of primary prevention. Fitting older adults with glasses is a tertiary prevention.

DIF: Applying (Application) REF: N/A OBJ: 8-5

TOP: Nursing Process: Implementation MSC: Health Promotion

14. A patient who is homeless has not followed through with getting an influenza vaccination. What response by the nurse to a student is most appropriate?

a.

Its hard to be proactive when you are hungry.

b.

If the patient would just come in, we have the shot.

c.

These patients never follow through on directions.

d.

Too bad we cant take the shot to him where he is.

ANS: A

Competing priorities often cause patients to seem uninterested or noncompliant with health recommendations. According to Maslow, basic needs such as food, water, shelter, and safety take priority over other matters. Perhaps it is a good idea to take shots into the community, but that is not the best response by the nurse, as it does not help the student understand the situation. The other two statements are biased and show disregard for the patients circumstances.

DIF: Applying (Application) REF: N/A OBJ: 8-4

TOP: Communication and Documentation MSC: Health Promotion

15. The nurse is seeing a 68-year old woman for a physical exam in the family practice clinic. The woman complains about having another pelvic exam. What response by the nurse is best?

a.

I know its uncomfortable, but its important to do it.

b.

You are past the age where this exam is recommended.

c.

Why dont you want to have your pelvic exam?

d.

This will be the last time you need this exam.

ANS: B

According to the U.S. Preventative Task Force, pelvic exams and pap smears can be discontinued after age 65 if prior testing was normal and the patient is not at high risk for cervical cancer. The other statements are incorrect.

DIF: Understanding (Comprehension) REF: Page 143 OBJ: 8-5

TOP: Teaching-Learning MSC: Health Promotion

16. A male patient complains about the digital rectal prostate exam and blood work for prostate-specific antigen (PSA) and asks, How long am I expected to do this? What response by the nurse is best?

a.

Every year for the rest of your life.

b.

Until you turn 75 years of age.

c.

You can quit when you turn 80.

d.

There are no guidelines on this.

ANS: B

According to the U.S. Preventative Task Force, there is no evidence that continuing routine PSA screening past the age of 75 has any benefit, so the patient can forgo the blood test after he turns 75.

DIF: Understanding (Comprehension) REF: Page 143 OBJ: 8-5

TOP: Teaching-Learning MSC: Health Promotion

17. A nurse routinely assesses patients for alcohol use. What principle guides this assessment?

a.

The older adult must balance risks to benefits of use.

b.

Alcohol causes older adults to fall and should not be consumed.

c.

There are no data on risks or benefits after the age of 75.

d.

Alcohol-related diseases are more severe in older people.

ANS: A

There are both benefits and risks to drinking alcohol. The nurse must help the older patient determine which predominates when assessing and possibly counseling patients on their alcohol use.

DIF: Applying (Application) REF: N/A OBJ: 8-6

TOP: Nursing Process: Assessment MSC: Safe Effective Care Environment

18. An 80-year-old woman has found a lump in her breast and is in the clinic. What question by the nurse is most appropriate?

a.

How long have you had this lump?

b.

If its cancer, are you willing to treat it?

c.

Do you have cancer in your family?

d.

Are you having any pain right now?

ANS: B

All questions are appropriate; however, for a woman this age, further testing is not recommended unless the patient is willing to go through with treatment for cancer. Tumors in older women tend to be slow growing and quality of life is a bigger priority.

DIF: Applying (Application) REF: N/A OBJ: 8-6

TOP: Nursing Process: Assessment MSC: Physiologic Integrity

19. A nurse wishes to volunteer in a tertiary health care activity. What activity would the nurse choose?

a.

Teaching about safer sexual behaviors

b.

Greeting women at an emergency pregnancy clinic

c.

Assisting women who are having radiation therapy

d.

Finding home health safety resources

ANS: C

Tertiary prevention aims to care for established disease. Helping women having radiation therapy for cancer would fall into this realm. Teaching is primary prevention. The emergency pregnancy clinic is secondary prevention. Home safety is primary prevention.

DIF: Applying (Application) REF: N/A OBJ: 8-5

TOP: Nursing Process: Implementation MSC: Health Promotion

20. A nurse is working with a woman who has been reluctant to start a walking program for her osteoporosis. What assessment by the nurse is most important?

a.

Fear of falling

b.

Lack of time

c.

Lack of energy

d.

Pain with movement

ANS: A

Fear of falling is a common fear in older adults and has special significance to those with osteoporosis. The nurse should first assess for this factor. All other factors can be possible contributors, but people usually attend to safety first.

DIF: Applying (Application) REF: N/A OBJ: 8-4

TOP: Nursing Process: Assessment MSC: Psychosocial Integrity

MULTIPLE RESPONSE

1. A nurse planning primary disease prevention interventions for a 64-year-old patient includes which of the following? (Select all that apply.)

a.

Giving an influenza vaccination in early autumn of each year.

b.

Suggesting the patient attend Cooking to Manage Hypertension classes taught by a registered dietician.

c.

Giving a pneumococcal vaccination to celebrate the patients 65th birthday.

d.

Identifying several local smoking cessation support groups.

e.

Providing the patient with a take-home occult stool screening kit.

ANS: A, C, D

Primary prevention refers to specific action taken to optimize the health of the older individual by helping him or her become more resistant to disease or to ensure that the environment will be less harmful.

DIF: Application (Apply) REF: N/A TOP: Nursing Process: Planning

MSC: Health Promotion and Maintenance

2. A patient has not followed up with recommendations made by the nurse to participate in cardiac rehabilitation after a myocardial infarction. What factors are most important for the nurse to assess in determining the cause of this behavior? (Select all that apply.)

a.

Out-of-pocket costs

b.

Transportation problems

c.

Beliefs about the benefits

d.

Location of the clinic

e.

Ethnicity of providers

ANS: A, B, C, D

Many factors affect the ability and willingness of patients to engage in health promotion behaviors, including cost, transportation, beliefs, and location of the services. Ethnicity of the providers may be a consideration for some, but that is not a high priority for assessment in most patients.

DIF: Applying (Application) REF: N/A OBJ: 8-2

TOP: Nursing Process: Assessment MSC: Health Promotion

3. The student learns the Medicare guidelines for preventive health and reimbursement policies. Which statement follows the guidelines? (Select all that apply.)

a.

Medicare pays for an annual pneumococcal vaccination.

b.

Medicare covers annual influenza vaccinations.

c.

Pap smears and pelvic exams are covered once every 2 years.

d.

Annual fecal occult blood tests are covered for those who are from 50 to 85 years of age.

e.

A bone density scan is covered every 2 years (a co-payment is required).

ANS: B, D, E

Medicare guidelines provide reimbursement for pneumococcal vaccination once and every 5 years as recommended, an annual flu vaccination, pap smears and pelvic exams every 3 years, an annual fecal occult blood test for those who are from 50 to 85 years of age, and a bone density scan every 2 years (however, a co-payment is required)

DIF: Remembering (Knowledge) REF: Page 142 OBJ: 8-6

TOP: Teaching-Learning MSC: Health Promotion

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