Chapter 17: Promoting Healthful Living in the Primary Care Setting My Nursing Test Banks

Chapter 17: Promoting Healthful Living in the Primary Care Setting

Test Bank

MULTIPLE CHOICE

1. A patient admitted with chest pain who is a one pack-a-day smoker tells the nurse, I am just not ready to quit smoking yet. The most appropriate response by the nurse is:

a.

This would be a really good time to quit.

b.

Are you familiar with the nicotine patch?

c.

Your smoking is the cause of your chest pain.

d.

What do you think keeps you from quitting?

ANS: D

Pender and Pender discuss the relationship of situational influences with regard to health promotion. The nurses role is to assist the patient in identifying motivators to quitting. In addition, the nurse may also ask the patient about roadblocks to quitting. The responses about this being a good time to quit and naming smoking as the cause of the chest pain express judgmental feelings by the nurse and are not likely to motivate the patient. Suggesting the use of medication would be appropriate for the patient only if the patient expressed a desire to quit smoking.

DIF: Cognitive Level: Application REF: Page 270

OBJ: Analyze the RNs role in health promotion. TOP: Health Promotion

MSC: NCLEX: Health Promotion and Maintenance

2. A nurse is caring for a nonEnglish-speaking Asian patient whose cultural practices are not familiar to the nurse. The nurse is curious about practices regarding communication and eye contact. The nurse should:

a.

tell the patient that it is cultural practice in the United States to maintain good eye contact when communicating with someone.

b.

observe the behaviors and interactions between the patient and other members of the culture.

c.

avoid all eye contact unless the patient establishes eye contact.

d.

use eye contact and communication techniques that are most comfortable for the nurse.

ANS: B

Telling the patient what U.S. practices are will not be helpful in assessing the patients cultural values regarding eye contact. Avoiding eye contact may not be appropriate for interactions with some patients. The nurse should attempt to adapt communication to the patients communication style.

DIF: Cognitive Level: Application REF: Page 271

OBJ: Describe the theoretical basis of self-care. TOP: Self-Care

MSC: NCLEX: Health Promotion and Maintenance

3. After the nurse implements diet instruction with a patient with heart disease, the patient can explain the information but fails to make the recommended dietary changes. The nurses evaluation is that:

a.

learning did not occur because the patients behavior did not change.

b.

the nursing responsibility for helping the patient make dietary changes has been fulfilled.

c.

choosing not to follow the diet is the behavior that resulted from the learning.

d.

the teaching methods were ineffective in helping the patient learn the dietary information.

ANS: C

Orem assumes that the responsibility of primary health promotion lies with the individual. Although the patients behavior has not changed, the patients ability to explain the information indicates that learning has occurred and the patient is choosing at this time to continue with the previous diet. The patient may be contemplating or preparing to transition his behavior. The nurse should reinforce the need for change and continue to provide information and assistance with planning for change.

DIF: Cognitive Level: Application REF: Page 271

OBJ: Describe the theoretical basis of self-care. TOP: Self-Care

MSC: NCLEX: Health Promotion and Maintenance

4. A patient is admitted to the hospital with a new diagnosis of diabetes mellitus type 1 and is scheduled for discharge on the second day after admission. In view of the patients 2-day inpatient stay, the nurse should set realistic goals by planning to:

a.

teach the patient how to monitor glucose and self-administer insulin.

b.

include detailed information about diet and medication use in patient teaching.

c.

use every interaction to teach the patient about the details of glucose control.

d.

focus on teaching the family instead of the patient about diabetic management.

ANS: A

When time is limited, the nurse should set realistic goals with the patient that will meet immediate needs. The patient and family will need further teaching about the role of diet, exercise, medications, and so forth, in controlling glucose, but these topics can be addressed through planning for appropriate referrals.

DIF: Cognitive Level: Application REF: Page 271

OBJ: Describe the theoretical basis of self-care. TOP: Self-Care

MSC: NCLEX: Health Promotion and Maintenance

5. A nurse recognizes that a homeless patient must walk great distances to obtain food. What kind of need does this patient demonstrate?

a.

Health-deviation need

b.

Developmental need

c.

Universal need

d.

Health continuum need

ANS: C

A universal need is an essential requirement for everyone: food, shelter, air, water, and other basic needs. A developmental need, such as trust, love, and belonging, changes as a person moves through each life-cycle period. A health-deviation need is based on an individuals genetic or constitutional deviations from normal. A health continuum need is not a true term.

DIF: Cognitive Level: Application REF: Page 273

OBJ: Describe the theoretical basis of self-care. TOP: Self-Care

MSC: NCLEX: Health Promotion and Maintenance

6. A patient has had no visitors for the 2 weeks he has been on your unit. The patient seems dejected and insists on having his few belongings in sight at all times. The nurse realizes that he may be experiencing what kind of need?

a.

Health-deviation need

b.

Developmental need

c.

Universal need

d.

Health continuum need

ANS: B

Orem considers self-care as meeting ones own basic needs, including the self-care requisites of universal, developmental, and health-deviation needs. A developmental need, such as trust, love, and belonging, changes as a person moves through each life-cycle period. A health-deviation need is based on an individuals genetic or constitutional deviations from normal. A universal need is an essential requirement for everyone: food, shelter, air, water, and other basic needs. A health continuum need is not a true term.

DIF: Cognitive Level: Analysis REF: Page 273

OBJ: Describe the theoretical basis of self-care. TOP: Self-Care

MSC: NCLEX: Health Promotion and Maintenance

7. The priority health promotion nursing diagnoses for an overweight, but not yet obese, patient who is learning about weight reduction may include:

a.

the potential for obesity.

b.

the potential for impaired mobility.

c.

alteration in nutrition.

d.

health-seeking behaviors or knowledge deficit.

ANS: D

The priority of care for health promotion is to help a patient regain control over his or her health. The priority nursing diagnoses include health-seeking behaviors or knowledge deficit. The potential for obesity, the potential for impaired mobility, and alteration in nutrition do not address the health promotion intervention of teaching.

DIF: Cognitive Level: Analysis REF: Pages 274-275

OBJ: Describe the theoretical basis of self-care. TOP: Self-Care

MSC: NCLEX: Health Promotion and Maintenance

8. Negative dietary influences on the health of Asian immigrants to the United States are most likely considered to be which type of environmental factor affecting health promotion?

a.

Spiritual

b.

Cultural

c.

Developmental

d.

Economic

ANS: B

Cultural influences on health are most obviously observed in the form of dietary habits. For example, as a whole, Americans consume a higher degree of fat and empty calories in their diets than other cultures. The result is that a large percentage of the American population will develop negative health consequences, such as peripheral vascular disease, coronary artery disease, hypertension, obesity, and diabetes. Dietary habits have nothing to do with spiritual, developmental, and economic components of the environmental influences on health promotion.

DIF: Cognitive Level: Analysis REF: Page 277

OBJ: Explain environmental influences on health promotion.

TOP: Environmental Influences on Health

MSC: NCLEX: Health Promotion and Maintenance

9. A nurse is developing a health promotion care plan for an otherwise healthy man who is married with four children and has a career as a public school teacher. Which of the following environmental factors could have a major effect on the patients health promotion activities?

a.

Developmental

b.

Spiritual

c.

None of the above

d.

Both a and b

ANS: A

Developmental factors describe positive or negative influences on health-seeking behaviors or compliance with a health promotion plan of care. Health promotion may be on the mans mind, but he may be caught up in self-imposed time constraints providing for his family and planning for retirement that may make it difficult to maintain a healthy lifestyle. The man may not perceive the task of self-health promotion as a priority. The spiritual environment includes a persons perception of help from a higher power and is not relevant in this scenario.

DIF: Cognitive Level: Analysis REF: Page 279

OBJ: Explain environmental influences on health promotion.

TOP: Environmental Influences on Health

MSC: NCLEX: Health Promotion and Maintenance

10. While obtaining a health history of a patient who has a large infected wound on the foot, the nurse learns that the patient has taken goldenseal to boost immune function rather than taking antibiotics for the infection. Which action by the nurse is initially most appropriate?

a.

Instruct the patient about the reasons for antibiotic use with infection.

b.

Ask the patient, How do you feel about using both antibiotics and natural remedies?

c.

Tell the patient that the doctor is likely to prescribe antibiotics.

d.

Tell the patient that studies of goldenseal show that it is not effective in treating infection.

ANS: B

Further assessment of the patients feelings about using Western and natural therapies is needed before further action should be taken. The patient may need instruction about antibiotics if further assessment indicates that the patient is receptive to antibiotic use. It is inappropriate for the nurse to tell the patient what another health care provider will do, and it is disrespectful to the patients values system. Studies of goldenseal are unclear about benefit as an immune stimulant.

DIF: Cognitive Level: Application REF: Page 271

OBJ: Define health-illness continuum. TOP: Health-Illness Continuum

MSC: NCLEX: Health Promotion and Maintenance

11. Several family members of a patient who has just been admitted to the intensive care unit (ICU) with multiple traumatic injuries have just arrived in the ICU waiting room. Which action should the nurse take first?

a.

Take the family members to the patients room.

b.

Discuss ICU visitation policies and encourage family visits.

c.

With the patients approval, describe the patients injuries and the care that is being provided.

d.

Invite the family to participate in a multidisciplinary care conference.

ANS: C

Lack of information is a major source of anxiety for family members and should be addressed first. Family members should be prepared for the patients appearance and the ICU environment before visiting the patient for the first time. ICU visiting should be individualized to each patient and family, rather than being dictated by rigid visitation policies. Inviting the family to participate in a multidisciplinary conference is appropriate but should not be the initial action by the nurse.

DIF: Cognitive Level: Application REF: Page 271

OBJ: Describe the theoretical basis of self-care. TOP: Self-Care

MSC: NCLEX: Health Promotion and Maintenance

12. A homeless patient with severe anorexia, fatigue, jaundice, and hepatomegaly is diagnosed with viral hepatitis and has just been admitted to the hospital. In planning care of the patient, the nurse assigns the highest priority to the patient outcome of:

a.

establishing a stable home environment.

b.

maintaining adequate nutrition.

c.

increasing activity level.

d.

identifying the source of exposure to hepatitis.

ANS: B

The highest priority outcome is to maintain nutrition because adequate nutrition is needed for hepatocyte regeneration. Finding a home for the patient and identifying the source of the infection would be appropriate activities, but they do not have as high a priority as adequate nutrition. Although the patients activity level will be gradually increased, rest is indicated during the acute phase of hepatitis.

DIF: Cognitive Level: Application REF: Page 275

OBJ: Explain environmental influences on health promotion.

TOP: Environmental Influences on Health

MSC: NCLEX: Health Promotion and Maintenance

13. When developing strategies to decrease health care disparities, the nurse working in a hospital located in a neighborhood with many Vietnamese individuals will include:

a.

educating the staff about Vietnamese health beliefs.

b.

improving public transportation.

c.

obtaining low-cost medications.

d.

updating equipment and supplies for the clinic.

ANS: A

Health care disparities result from stereotyping, biases, and prejudices of health care providers. The nurse can decrease these disparities through staff education. The other strategies also may be addressed by the nurse but will not impact health disparities.

DIF: Cognitive Level: Application REF: Page 278

OBJ: Explain environmental influences on health promotion.

TOP: Environmental Influences on Health

MSC: NCLEX: Health Promotion and Maintenance

14. Which family would the nurse consider healthy?

a.

A family in which the parents do not allow their 10-year-old child to make basic decisions.

b.

A family that encourages independence while supporting each other.

c.

A family that does not require a specific curfew for their 16-year-old son.

d.

A family that does not allow their 15-year-old child to be an individual.

ANS: B

Inductive reasoning explains how a family that encourages independence while supporting each other and is considered to have healthy family functioning In terms of health promotion, the nurses role is working with people with generally good health but who are experiencing life or development changes. Health promotion efforts by nurses are educational efforts to help the individual remain an independent self-care agent.

DIF: Cognitive Level: Application REF: Page 271

OBJ: Describe the theoretical basis of self-care. TOP: Self-Care

MSC: NCLEX: Health Promotion and Maintenance

15. A home health nurse is going to visit a new patient for admission to the nurses care. At the first meeting the nurse is able to meet the entire family. The nurse recognizes some unhealthy characteristics. Which statement made by the patient would lead the nurse to this conclusion?

a.

We all have specific chores that we are responsible for on a daily basis.

b.

We allow our 14-year-old to make all of her own decisions.

c.

We like to go camping together as a family in the summertime.

d.

Our children are actively involved in school-sponsored sports.

ANS: B

Allowing a 14-year-old child to make her own decisions led to the nurses conclusion that unhealthy characteristics existed within this family. The nurse should engage in health protective behaviors as well as health promotion behaviors. Health protective behaviors take a person away from a dangerous situation or from a dangerous habit. Health promotion behaviors move an individual to a higher level of health, greater vigor, or energy to do more than he or she is currently capable of doing. All the other statements imply a strong and healthy family unit.

DIF: Cognitive Level: Application REF: Page 272

OBJ: Describe the theoretical basis of self-care. TOP: Self-Care

MSC: NCLEX: Health Promotion and Maintenance

16. A patient has chosen to see a Family Nurse Practitioner (FNP) to assist with health promoting activities. Which of the following services provided by the FNP is the best example of a health promotion activity?

a.

Teaching about a low-fat diet for a patient with a blood pressure of 136/82

b.

Prescribing a cholesterol-lowering medication

c.

Scheduling a cardiac stress test

d.

Prescribing an anticoagulant for a patient with atrial fibrillation

ANS: A

A nurse practitioner is more likely to treat the patient from a holistic perspective and provide teaching to prevent illness or promote wellness. Although health promotion is a portion of the nurses role, many other organizations and individuals provide primary health care. The FNP is a primary health care provider. Patients seek out FNPs and trust that their counsel will help keep them well. Writing prescriptions and scheduling stress tests are functions of an FNP and are also good health promoting activities but are not the best in terms of motivating lifestyle changes.

DIF: Cognitive Level: Application REF: Page 275

OBJ: Analyze the RNs role in health promotion.

TOP: Primary Health Care Systems MSC: NCLEX: Health Promotion and Maintenance

17. A program designed to increase exercise, reduce fat in a diet, and teach low-fat cooking methods to improve the health of a large population could be best described as:

a.

supportive care.

b.

rehabilitation.

c.

diagnosis and treatment.

d.

health promotion and health protective.

ANS: D

Exercise and a low-fat diet promote health and prevent illness. The nurse should engage in health protective behaviors as well as health promotion behaviors. Health protective behaviors take a person away from a dangerous situation or from a dangerous habit. Health promotion behaviors move an individual to a higher level of health, greater vigor, or energy to do more than he or she is currently capable of doing.

DIF: Cognitive Level: Application REF: Page 273

OBJ: Describe the theoretical basis of self-care. TOP: Self-Care

MSC: NCLEX: Health Promotion and Maintenance

18. Healthy People 2020 is a:

a.

new global action plan to prevent and treat disease.

b.

prevention agenda for the nation.

c.

national effort to improve lives of U.S. citizens.

d.

set of national health mandates.

ANS: C

Healthy People 2020 is an example of a national effort to improve the lives and health of all Americans. For 30 years, the government has encouraged informed decisions about healthful living through collaboration across all communities of interest. Topical objectives can be found at www.healthypeople.gov. It is expected that through the help of governmental partners and their resources, states, cities, communities, and individual people will be able to achieve the objectives in each of the topic categories by 2020. The other answer choices are incorrect.

DIF: Cognitive Level: Application REF: Pages 281-282

OBJ: Describe the theoretical basis of self-care. TOP: Self-Care

MSC: NCLEX: Health Promotion and Maintenance

19. To help prevent drug-drug interactions in an older adult patient taking many medications, the most appropriate instruction by the nurse is:

a.

Do not take any over-the-counter (OTC) drugs with your prescription drugs.

b.

Bring a list or all of your medications, supplements, and herbs that you use to every health care appointment and/or the hospital.

c.

Be sure to have all your prescriptions filled at the same pharmacy.

d.

Use a medication reminder system so that you wont forget to take your medications as scheduled.

ANS: B

The information about drug use and possible interactions is obtained when the patient brings all prescribed medications, OTC medications, and supplements to every health care appointment. The patient should discuss the use of any OTC medications with the health care provider and obtain all prescribed medications from the same pharmacy, but these interventions alone will not prevent drug-drug interactions among prescribed drugs, OTC drugs, and any herbal supplements. Use of a medication reminder system will help the patient take medications as scheduled but will not prevent drug-drug interactions.

DIF: Cognitive Level: Application REF: Page 275

OBJ: Analyze the RNs role in health promotion.

TOP: RNs Role in Health Promotion MSC: NCLEX: Health Promotion and Maintenance

MULTIPLE RESPONSE

1. Before discharging a patient with osteoarthritis (OA) of the left hip and lower lumbar vertebrae, the nurse teaches her about management of the condition. Which replies by the patient demonstrate proper understanding of how to manage her condition? (Select all that apply.)

a.

I should try and stay active all the day to keep my joints from becoming stiff.

b.

I can use a cane if I find it helpful in relieving the pressure on my back and hips.

c.

A warm shower in the morning will help relieve the stiffness I have when I get up.

d.

I should take no more than 1 gram of acetaminophen four times a day to control the pain.

e.

Exercising daily on a stationary recumbent bicycle will lessen joint stress.

ANS: B, C, D

Protection and avoidance of joint stressors are recommended for patients with OA, so this patient should use a cane to ambulate more comfortably, take warm showers to lessen joint stiffness, and should use nonsteroidal anti-inflammatory medication as directed. Staying active all day or exercising daily will likely exacerbate joint swelling and pain.

DIF: Cognitive Level: Application REF: Page 275

OBJ: Explain environmental influences on health promotion.

TOP: Environmental Influences on Health

MSC: NCLEX: Health Promotion and Maintenance

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