1. A nurse is teaching about the goals of Healthy People 2020. Which information should the
nurse include in the teaching session?
~ The nurse should include eliminating health disparities in America. Healthy People 2020
promotes a society in which all people live long, healthy lives. There are four overarching
goals: (1) attain high-quality, longer lives free of preventable disease, disability, injury, and
premature death; (2) achieve health equity, eliminate disparities, and improve the health of all
groups; (3) create social and physical environments that promote good health for all; and (4)
promote quality of life, healthy development, and healthy behaviors across all life stages.
DIF: Understand (comprehension)
OBJ: List the four general Healthy People 2020 public health goals for Americans.
TOP: Teaching/Learning
MSC: Health Promotion and Maintenance
*a.
b.
c.
d.
Eliminate health disparities in America.
Eliminate health behaviors in America.
Eliminate quality of life in America.
Eliminate healthy life in America.
2. A nurse is following the goals of Healthy People 2020 to provide care. Which action should
the nurse take?
~ Healthy People 2020 includes four goals, one of which is to create social and physical
environments that promote good health for all. The goals do not include continuing current
behaviors to reduce stress, focusing only on health changes for communities, or focusing on
fast recuperation.
DIF: Apply (application)
OBJ: List the four general Healthy People 2020 public health goals for Americans.
TOP: Implementation
MSC: Health Promotion and Maintenance
a.
b.
*c.
d.
Allow people to continue current behaviors to reduce the stress of change.
Focus only on health changes that will lead to better local communities.
Create social and physical environments that promote good health.
Focus on illness treatment to provide fast recuperation.
3. A nurse is using the World Health Organization definition of health to provide care. Which
area will the nurse focus on while providing care?
~ The World Health Organization (WHO) defines health as a “state of complete physical,
mental, and social well-being, not merely the absence of disease or infirmity.” Therefore,
nurses’ attitudes toward health and illness should consider the total person, as well as the
environment in which the person lives. All people free of disease are not necessarily healthy.
Strictly personal and a focus only on pathological states do not correlate to WHO’s definition.
DIF: Apply (application)
OBJ: Discuss the definition of health.
TOP: Implementation
MSC: Management of Care
a.
*b.
c.
d.
Focusing on helping patients be disease free
Providing care that involves the whole person
Assuring that care is strictly personal in nature
Directing focus only on the pathological state
4. The nurse is preparing a smoking cessation class for family members of patients with lung
cancer. The nurse believes that the class will convert many smokers to nonsmokers once they
realize the benefits of not smoking. Which health care model is the nurse following?
~ The health belief model addresses the relationship between a person’s beliefs and behaviors.
The holistic health model recognizes the natural healing abilities of the body and incorporates
complementary and alternative interventions such as music therapy. The health promotion
model focuses on the following three areas: (1) individual characteristics and experiences, (2)
behavior-specific knowledge and affect, and (3) behavioral outcomes, in which the patient
commits to or changes a behavior. Maslow’s’ hierarchy of needs is based on the theory that all
people share basic human needs, and the extent to which basic needs are met is a major factor
in determining a person’s level of health.
DIF: Analyze (analysis)
OBJ: Discuss the health belief, health promotion, basic human needs, and holistic health
models to understand the relationship between patients’ attitudes toward health and health
practices.
TOP: Implementation
MSC: Health Promotion and Maintenance
*a.
b.
c.
d.
Health belief model
Holistic health model
Health promotion model
Maslow’s hierarchy of needs
5. A nurse is using Maslow’s hierarchy to prioritize care for an anxious patient that is not
eating and will not see family members. Which area should the nurse address first?
~ According to Maslow, in all cases an emergent physiological need takes precedence over a
higher-level need. Nutrition is a physiological need and should be addressed first. Anxiety,
mental health, and not seeing family members are all higher-level needs.
DIF: Analyze (analysis)
OBJ: Discuss the health belief, health promotion, basic human needs, and holistic health
models to understand the relationship between patients’ attitudes toward health and health
practices.
TOP: Implementation
MSC: Management of Care
a.
*b.
c.
d.
Anxiety
Not eating
Mental health
Not seeing family members
6. The patient is reporting moderate incisional pain that was not relieved by the last dose of
pain medication. The patient is not due for another dose of medication for another 2 1/2 hours.
The nurse repositions the patient, asks what type of music the patient likes, and sets the
television to the channel playing that type of music. Which health care model is the nurse
using?
~ The holistic health model recognizes the natural healing abilities of the body and
incorporates complementary and alternative interventions such as music therapy. The health
belief model addresses the relationship between a person’s beliefs and behaviors. The health
promotion model notes that each person has unique personal characteristics and experiences
that affect subsequent actions. The basic human needs model believes that the extent to which
basic needs are met is a major factor in determining a person’s level of health. Maslow’s
hierarchy of needs is a model that nurses use to understand the interrelationships of basic
human needs.
DIF: Apply (application)
OBJ: Discuss the health belief, health promotion, basic human needs, and holistic health
models to understand the relationship between patients’ attitudes toward health and health
practices.
TOP: Implementation
MSC: Management of Care
a.
*b.
c.
d.
Health belief model
Holistic health model
Health promotion model
Maslow’s hierarchy of needs
7. A nurse is assessing internal variables that are affecting the patient’s health status. Which
area should the nurse assess?
~ Internal variables include a person’s developmental stage, intellectual background,
perception of functioning, and emotional and spiritual factors. External variables influencing a
person’s health beliefs and practices include family practices, socioeconomic factors, and
cultural background.
DIF: Apply (application)
OBJ: Describe variables influencing health beliefs and practices.
TOP: Assessment
MSC: Health Promotion and Maintenance
*a.
b.
c.
d.
Perception of functioning
Socioeconomic factors
Cultural background
Family practices
8. The nurse is admitting a patient with uncontrolled diabetes mellitus. It is the fourth time the
patient is being admitted in the last 6 months for high blood glucose levels. During the
admission process, the nurse asks the patient about employment status and displays a
nonjudgmental attitude. What is the rationale for the nurse’s actions?
~ A person’s compliance with treatment is affected by economic status. A person tends to give
a higher priority to food and shelter than to costly drugs or treatments. External variables can
have a major impact on compliance. Employment status is an external variable, not an internal
variable. A person generally seeks approval and support from social networks, and this desire
for approval affects health beliefs and practices; noncompliance does not occur from thriving
on disapproval of authority figures.
DIF: Apply (application)
OBJ: Describe variables influencing health beliefs and practices.
TOP: Implementation
MSC: Health Promotion and Maintenance
a.
*b.
c.
d.
External variables have little effect on compliance.
A person’s compliance is affected by economic status.
Employment status is an internal variable that impacts compliance.
Noncompliant patients thrive on the disapproval of authority figures.
9. The nurse is working on a committee to evaluate the need for increasing the levels of
fluoride in the drinking water of the community. Which concept is the nurse fostering?
~ Fluoridation of municipal drinking water and fortification of homogenized milk with
vitamin D are examples of passive health promotion strategies. With active strategies of
health promotion, individuals are motivated to adopt specific health programs such as weight
reduction and smoking cessation programs. Illness prevention activities such as immunization
programs protect patients from actual or potential threats to health. Wellness education
teaches people how to care for themselves in a healthy way.
DIF: Understand (comprehension)
OBJ: Describe health promotion, wellness, and illness prevention activities.
TOP: Implementation
MSC: Health Promotion and Maintenance
a.
b.
c.
*d.
Illness prevention
Wellness education
Active health promotion
Passive health promotion
10. The nurse is working in a clinic that is designed to provide health education and
immunizations. Which type of preventive care is the nurse providing?
~ Primary prevention precedes disease or dysfunction and is applied to people considered
physically and emotionally healthy. Primary prevention includes health education programs,
immunizations, and physical and nutritional fitness activities. Secondary prevention focuses
on individuals who are experiencing health problems or illnesses and who are at risk for
developing complications or worsening conditions. Activities are directed at diagnosis and
prompt intervention. Tertiary prevention occurs when a defect or disability is permanent and
irreversible. It involves minimizing the effects of long-term disease or disability through
interventions directed at preventing complications and deterioration. While risk factor
modification is an integral component of health promotion, it is not a type of preventive care.
DIF: Understand (comprehension)
OBJ: Discuss the three levels of preventive care.
TOP: Implementation
MSC: Health Promotion and Maintenance
*a.
b.
c.
d.
Primary prevention
Secondary prevention
Tertiary prevention
Risk factor prevention
11. The patient is admitted to the emergency department of the local hospital from home with
reports of chest discomfort and shortness of breath. The patient is placed on oxygen, has labs
and blood gases drawn, and is given an electrocardiogram and breathing treatments. Which
level of preventive care is this patient receiving?
~ Secondary prevention focuses on individuals who are experiencing health problems or
illnesses and who are at risk for developing complications or worsening conditions. Activities
are directed at diagnosis and prompt intervention. Primary prevention precedes disease or
dysfunction and is applied to people considered physically and emotionally healthy. Health
promotion includes health education programs, immunizations, and physical and nutritional
fitness activities for healthy people. Tertiary prevention occurs when a defect or disability is
permanent and irreversible. It involves minimizing the effects of long-term disease or
disability through interventions directed at preventing complications and deterioration.
DIF: Apply (application)
OBJ: Discuss the three levels of preventive care.
TOP: Evaluation
MSC: Management of Care
a.
*b.
c.
d.
Primary prevention
Secondary prevention
Tertiary prevention
Health promotion
12. A patient is admitted to a rehabilitation facility following a stroke. The patient has
right-sided paralysis and is unable to speak. The patient will be receiving physical therapy and
speech therapy. Which level of preventive care is the patient receiving?
~ Tertiary prevention occurs when a defect or disability is permanent and irreversible. It
involves minimizing the effects of long-term disease or disability through interventions
directed at preventing complications and deterioration. Secondary prevention focuses on
individuals who are experiencing health problems or illnesses and who are at risk for
developing complications or worsening conditions. Activities are directed at diagnosis and
prompt intervention. Primary prevention precedes disease or dysfunction and is applied to
people considered physically and emotionally healthy. Health promotion includes health
education programs, immunizations, and physical and nutritional fitness activities.
DIF: Apply (application)
OBJ: Discuss the three levels of preventive care.
TOP: Evaluation
MSC: Management of Care
a.
b.
*c.
d.
Primary prevention
Secondary prevention
Tertiary prevention
Health promotion
13. Upon completing a history, the nurse finds that a patient has risk factors for developing
lung disease. How should the nurse interpret this finding?
~ 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.
Control of risk factors does not guarantee that a disease will not develop. However, risk factor
modification can assist patients in adopting activities to promote health and decrease risks of
illness.
DIF: Understand (comprehension)
OBJ: Describe four types of risk factors affecting health.
TOP: Assessment
MSC: Health Promotion and Maintenance
a.
*b.
c.
d.
A person with the risk factor will get the disease.
The chances of getting the disease are increased.
Risk modification will have no effect on disease prevention.
The disease is guaranteed not to develop if the risk factor is controlled.
14. The nurse is caring for a patient who has been trying to quit smoking. The patient has been
smoke free for 2 weeks but had two cigarettes last night and at least two this morning. What
should the nurse anticipate?
~ When relapse occurs, the person will return to the contemplation or precontemplation stage
before attempting the change again. The patient cannot pick up the attempt where left off. It is
believed that change involves movement through a series of stages (precontemplation,
contemplation, preparation, action, and maintenance). Anticipating that the patient does not
want to and will never quit is premature. While the patient will need to adopt a new lifestyle
for change to be effective, it does not correlate to this scenario since the patient relapsed.
DIF: Understand (comprehension)
OBJ: Discuss risk factor modification and changing health behaviors.
TOP: Planning
MSC: Health Promotion and Maintenance
a.
b.
*c.
d.
The patient does not want to and will never quit smoking.
The patient must pick up the attempt right where the patient left off.
The patient will return to the contemplation or precontemplation phase.
The patient will need to adopt a new lifestyle for change to be effective.
15. The nurse is working in a drug rehabilitation clinic and is in the process of admitting a
patient for “detox.” What should the nurse do next?
~ The nurse should identify the stage of change and assess where the patient is currently in
this situation. To be most effective, nursing interventions should match the stage of change.
The nurse cannot realize the patient is ready for change because only a minority of people are
actually in the action stage of changing. While teaching that choices will have to change, it
will follow later after the nurse has determined which stage the person is in. As individuals
attempt a change in behavior, relapse followed by recycling through the stages occurs
frequently.
DIF: Analyze (analysis)
OBJ: Discuss risk factor modification and changing health behaviors.
TOP: Implementation
MSC: Management of Care
*a.
b.
c.
d.
Identify the patient’s stage of change.
Realize that the patient is ready to change.
Teach the patient that choices will have to change.
Instruct the patient that relapses will not be tolerated.
16. A female patient has been overweight for most of her life. She has tried dieting in the past
and has lost weight, only to regain it when she stopped dieting. The patient is visiting the
weight loss clinic/health club because she has decided to do it. She states that she will join
right after the holidays, in 3 months. Which stage is the patient displaying?
~ This patient is planning to make the change within the next 6 months and is in the
contemplation stage. These stages range from no intention to change (precontemplation), to
considering a change within the next 6 months (contemplation), to making small changes
(preparation), to actively engaging in strategies to change behavior (action), to maintaining a
changed behavior (maintenance).
DIF: Apply (application)
OBJ: Discuss risk factor modification and changing health behaviors.
TOP: Evaluation
MSC: Health Promotion and Maintenance
a.
*b.
c.
d.
Precontemplation
Contemplation
Preparation
Action
17. Upon completion of the assessment, the nurse finds that the patient has quit drinking and
has been alcohol free for the past 2 years. Which stage best describes the nurse’s assessment
finding?
~ Because the patient has been alcohol free for 2 years, the patient is in the maintenance stage.
These stages range from no intention to change (precontemplation), to considering a change
within the next 6 months (contemplation), to making small changes (preparation), to actively
engaging in strategies to change behavior (action), to maintaining a changed behavior
(maintenance).
DIF: Apply (application)
OBJ: Discuss risk factor modification and changing health behaviors.
TOP: Evaluation
MSC: Health Promotion and Maintenance
a.
*b.
c.
d.
Contemplation
Maintenance
Preparation
Action
18. The patient had a colostomy placed 1 week ago. When approached by the nurse, the
patient and their spouse refuse to talk about it and reject the opportunity to be taught about
how to care for it. How will the nurse evaluate this couple’s stage of adjustment?
~ As the patient and family recognize the reality of a change, they become anxious and may
withdraw, refusing to discuss it. This is an adaptive coping mechanism that assists the patient
in making the adjustment. Initially, the patient may be shocked by the change. This is
followed by withdrawal, acknowledgment, acceptance, and rehabilitation (ready to adapt to
the change through use of colostomy bag).
DIF: Analyze (analysis)
OBJ: Describe the effect of illness on patients and families.
TOP: Evaluation
MSC: Psychosocial Integrity
a.
*b.
c.
d.
Shock
Withdrawal
Acceptance
Rehabilitation
19. A patient diagnosed with chronic emphysema (lung disease) states “I would be better off
dead.” The nurse learns that the patient, has recently become unemployed because of oxygen
dependency. The patient’s spouse will have to go to work to support the family. Which action
should the nurse take?
~ Because of the effects of chronic illness, family dynamics often change. The nurse must
view the whole family as a patient under stress, planning care to help the family regain its
maximal level of functioning and well-being. Psychiatric services may be a part of that plan
but do not represent the entire plan. Offering false assurance is never acceptable. Focusing
only on the patient will not help the family adjust.
DIF: Apply (application)
OBJ: Describe the effect of illness on patients and families.
TOP: Implementation
MSC: Psychosocial Integrity
*a.
b.
c.
d.
Develop a plan of care for the family.
Contact psychiatric services for a referral.
Assure the patient that things will work out.
Focus the plan of care solely on maximizing patient function.
20. A nurse is teaching about the transtheoretical model of change. In which order will the
nurse place the progression of the stages from beginning to end?
1. Action
2. Preparation
3. Maintenance
4. Contemplation
5. Precontemplation
~ The stages of change in the transtheoretical model of change include five stages. These
stages range from no intention to change (precontemplation), considering a change within the
next 6 months (contemplation), making small changes (preparation), and actively engaging in
strategies to change behavior (action), to maintaining a changed behavior (maintenance stage).
DIF: Understand (comprehension)
OBJ: Describe variables influencing health beliefs and practices.
TOP: Teaching/Learning
MSC: Health Promotion and Maintenance
*a.
b.
c.
d.
5, 4, 2, 1, 3
2, 5, 4, 3, 1
4, 5, 3, 1, 2
1, 5, 2, 3, 4
Type: MA 1. Which areas should the nurse assess to determine the effects of external
variables on a patient’s illness? (Select all that apply.)
~ External variables influencing a patient’s illness behavior include the visibility of
symptoms, social group, cultural background, economic variables, accessibility of the health
care system, and social support. Internal variables include the patient’s perceptions of
symptoms and the nature of the illness, as well as the patient’s coping skills and locus of
control.
DIF: Understand (comprehension)
OBJ: Describe variables influencing illness behavior.
TOP: Assessment
MSC: Psychosocial Integrity
a.
b.
*c.
*d.
*e.
Patient’s perception of the illness
Patient’s coping skills
Socioeconomic status
Cultural background
Social support
Type: MA 2. A nurse meets the following goals: helps a patient maintain health and helps a
patient with an illness. Which factors assist the nurse in achieving these goals? (Select all that
apply.)
~ Nurses are in a unique position to assist patients in achieving and maintaining optimal levels
of health. Nurses understand the challenges of today’s health care system. Nurses can identify
actual and potential risk factors that predispose a person or group to illness. Nurses who
understand how patients react to illness can minimize the effects of illness and assist patients
and their families in maintaining or returning to the highest level of functioning. Nurses did
not coin the phrase “illness behavior.” While nurses can experience compassion fatigue, it
does not help in meeting patient goals.
DIF: Understand (comprehension)
OBJ: Discuss a nurse’s role in health and illness.
TOP: Implementation
MSC: Health Promotion and Maintenance
*a.
*b.
c.
*d.
Understands the challenges of today’s health care system.
Identifies actual and potential risk factors.
Has coined the term “illness behavior.”
Minimizes the effects of illnesses.
e. Experiences compassion fatigue.