Chapter 3, Health, Illness, and Disparities

1.

The nurse is preparing a care plan for an African American man age 68 years who was recently diagnosed with hypertension. Age, race, gender, and genetic inheritance are examples of what human dimension?

A)

Physical

B)

Emotional

C)

Environmental

D)

Sociocultural

Ans:

A

Feedback:

The physical dimension includes genetic inheritance, age, developmental level, race, and gender. These components strongly influence a person’s health status and health practices. The emotional dimension focuses on how the mind affects body function and responds to body conditions. The environmental dimension includes influences such as housing, sanitation, climate, and pollution of food, air, and water. Sociocultural dimensions are health practices and beliefs strongly influenced by economic status, lifestyle, family, and culture.

2.

The mother of a toddler with asthma seeks support from the parents of other children with asthma. The nurse recognizes that seeking and utilizing support systems is an example of which human dimension?

A)

Sociocultural dimension

B)

Physical dimension

C)

Environmental dimension

D)

Intellectual and spiritual dimension

Ans:

A

Feedback:

Communicating with others and the use of support systems relate to the sociocultural dimension. An individual’s relationship with others, being connected to a community, and feeling accepted and loved by others are also related to the sociocultural dimension.

3.

A nurse educator uses models of health and illness when teaching. Which model of health and illness places high-level health and death on opposite ends of a graduated scale?

A)

Health-Illness Continuum

B)

Agent-Host-Environment Model

C)

Health Belief Model

D)

Health Promotion Model

Ans:

A

Feedback:

The Health-Illness Continuum views health as a constantly changing state, with high-level wellness and death being on opposite ends of a graduated scale. The Agent-Host-Environment Model is useful in examining the causes of disease in an individual. The Health Belief Model describes health behaviors. The Health Promotion Model incorporates individual characteristics and experiences, as well as behavior-specific knowledge and beliefs, to motivate healthy behavior.

4.

A homeless client has been brought to the emergency department (ED) by ambulance after being found unresponsive outside a mall. The client is known to the ED staff as having bipolar disorder, and assessment reveals likely cellulitis on his left ankle. He is febrile with a productive cough, and the care team suspects pneumonia. A sputum culture for tuberculosis has been obtained and sent to the laboratory. Which of the following aspects of the client’s medical condition would be considered a chronic condition?

A)

Bipolar disorder

B)

Pneumonia

C)

Cellulitis

D)

Tuberculosis

Ans:

A

Feedback:

Bipolar disorder is a long-standing diagnosis that requires the lifelong education and treatment associated with chronic conditions. Pneumonia, tuberculosis, and cellulitis are all acute, infectious diseases that may be treated with antibiotic regimens of varying length.

5.

Which of the following activities related to respiratory health is an example of tertiary health promotion and illness prevention?

A)

Administering a nebulized bronchodilator to a client who is short of breath

B)

Assisting with lung function testing of a client to help determine a diagnosis

C)

Teaching a client that “light” cigarettes do not prevent lung disease

D)

Advocating politically for more explicit warning labels on cigarette packages

Ans:

A

Feedback:

The use of medications is characteristic of tertiary health promotion and illness prevention. Testing and screening are examples of secondary health promotion and illness prevention, while client education and political advocacy are associated with primary prevention.

6.

An elderly resident of a long-term care facility has developed diarrhea and dehydration as a result of exposure to clostridium difficile during a recent outbreak. The resident’s primary care provider has consequently prescribed the antibiotic metronidazole (Flagyl). Which model of health promotion and illness prevention is most clearly evident in these events?

A)

The Agent-Host-Environment Model

B)

The Health-Illness Continuum

C)

The Health Promotion Model

D)

The Health Belief Model

Ans:

A

Feedback:

The presence of an infectious microorganism and the act of treating that agent are associated with the Agent-Host-Environment Model of health promotion and illness prevention. The client’s beliefs about health are not central in this scenario, and health promotion and the pursuit of health are not the most important priorities during this active treatment of illness. This client is not being characterized as existing on a point on a health continuum.

7.

The nurse is performing a routine assessment of a male client who has an artificial arm as a result of a small plane crash many years earlier. How should the nurse best understand this client’s health?

A)

Despite the loss of his limb, the client may consider himself to be healthy.

B)

The client may be well, but his loss of limb means that he is unhealthy.

C)

The loss of his limb prevents the client from achieving wellness, though he may be healthy.

D)

Because the client’s injury is far in the past, it does not have a bearing on his health or wellness.

Ans:

A

Feedback:

Individuals who live with chronic conditions, such as the loss of a limb, may accommodate their condition fully and consider themselves to be healthy and well. This is not a certainty, however, and the passage of time does not guarantee such acceptance.

8.

What phrase best describes health?

A)

Individually defined by each person

B)

Experienced by each person in exactly the same way

C)

The opposite of illness

D)

The absence of disease

Ans:

A

Feedback:

Health is individually defined by each person and is affected by many factors. The most widely accepted definition of health is that it is a state of complete physical, mental, and social well-being—not the absence of disease or infirmity. Health is experienced differently by each person; it is not the opposite of illness, and does not indicate the absence of disease.

9.

Which of the following most accurately defines “illness”?

A)

The inability to carry out normal activities of living

B)

A pathologic change in mind or body structure or function

C)

The response of a person to a disease

D)

Achieving maximum potential and quality of life

Ans:

C

Feedback:

Illness is the response of a person to a disease, an abnormal process in which one’s level of function is changed when compared with the previous level. A disease (a medical term) means there is a pathologic change in the structure or function of the body or mind. Wellness is a term used to describe a person achieving maximum potential and quality of life despite disease or illness.

10.

Which of the following statements accurately describes the concepts of disease and illness?

A)

A disease is traditionally diagnosed and treated by a nurse.

B)

The focus of nurses is the person with an illness.

C)

A person with an illness cannot be considered healthy.

D)

Illness is a normal process that affects level of functioning.

Ans:

B

Feedback:

A disease is traditionally diagnosed and treated by a physician (although nurses with advanced educations are increasingly doing so), while nurses focus on the person with an illness. A person may have an illness or injury but still achieves maximum functioning and quality of life, and considers himself or herself to be healthy. Illness is the response of the person to a disease; it is an abnormal process in which the person’s level of functioning is changed when compared with a previous level.

11.

A nurse calls in to his unit to report he has the flu and will not be at work. What stage of illness behavior is he exhibiting?

A)

Experiencing symptoms

B)

Assuming the sick role

C)

Assuming a dependent role

D)

Achieving recovery and rehabilitation

Ans:

B

Feedback:

When assuming the sick role, the person defines himself or herself as sick, seeks validation from others, and gives up normal activities such as going to work. Although the other choices are stages of illness, they are not defined by the behavior presented.

12.

A cleint accepts the fact that he needs bypass surgery for a blocked artery and is admitted into the hospital. Which one of the following stages of illness is this client experiencing?

A)

Stage 1

B)

Stage 2

C)

Stage 3

D)

Stage 4

Ans:

C

Feedback:

In Stage 3, assuming a dependent role, the patient decides to accept the diagnosis and follow the prescribed treatment plan. The person conforms to the opinions of others, often requires assistance in carrying out activities of daily living, and needs emotional support through acceptance, approval, physical closeness, and protection.

13.

A child age 4 years has leukemia but is now in remission. What does it mean to be in remission when one has a chronic illness?

A)

The chronic disease has been cured.

B)

Nothing further can be done in terms of treatment.

C)

Severe symptoms of the chronic illness have reappeared.

D)

The disease is present, but symptoms are not experienced.

Ans:

D

Feedback:

Many chronic illnesses have periods of remission and exacerbation. During remission, the disease is present but the person does not experience symptoms. During exacerbation, the symptoms of the illness reappear.

14.

What may happen to the family when one of the family members suffers an illness?

A)

Alterations in values and religious beliefs

B)

More public displays of affection

C)

Changes in roles for the client and family

D)

Increased resistance to stress

Ans:

C

Feedback:

When an illness occurs, roles change for both the client and the family. Chronic illnesses often result in increased stress for the family, but responses by all members are individualized.

15.

A baby is born with Down syndrome, which influences his health–illness status. This is an example of which of the following human dimensions?

A)

Physical

B)

Emotional

C)

Environmental

D)

Sociocultural

Ans:

A

Feedback:

The physical dimension includes genetic inheritance, age, developmental level, race, and gender. These components strongly influence the person’s health status and health practices.

16.

Which of the following statements illustrates the effect of the sociocultural dimension on health and illness?

A)

“Why shouldn’t I drink and drive? Everyone else does.”

B)

“My mother has sickle cell anemia, and so do I.”

C)

“I know I have heart problems, so I have changed my diet.”

D)

“I used biofeedback to lower my blood pressure.”

Ans:

A

Feedback:

Health practices and beliefs are strongly influenced by one’s sociocultural dimension, including lifestyle, family, and culture. These factors are involved in patterns of living (such as drinking and driving) and values about health and illness. Sickle cell anemia involves the physical dimension; changing one’s diet involves the intellectual dimension; and biofeedback involves the emotional dimension.

17.

A middle-aged woman is 40 pounds over her ideal weight. Which of the following statements best illustrates the effect of her self-concept on health and illness?

A)

“I am just too busy with my kids to bother about a diet.”

B)

“Why should I lose weight? I’ll still be fat.”

C)

“My sister is thin, but I don’t think she looks that good.”

D)

“My husband loves me this way.”

Ans:

B

Feedback:

Self-concept is an important variable affecting health and illness. People who are overweight may believe that nothing can change the way they look and refuse to follow a diet and exercise program.

18.

A camp nurse is teaching a group of adolescent girls about the importance of monthly breast self-examination. What level of preventive care does this activity represent?

A)

Primary

B)

Secondary

C)

Tertiary

D)

Restorative

Ans:

A

Feedback:

Primary preventive care activities are directed toward promoting health and preventing the development of disease. Teaching breast self-examination is an example of a primary preventive care activity.

19.

Which of the following models of health promotion and illness prevention was developed to illustrate how people interact with their environment as they pursue health?

A)

The health promotion model

B)

The health belief model

C)

The health–illness continuum

D)

The agent–host–environment model

Ans:

A

Feedback:

The health promotion model (Pender, Murdaugh, & Parsons, 2006) was developed to illustrate how people interact with their environment as they pursue health. The model incorporates individual characteristics and experiences and behavior-specific knowledge and beliefs, to motivate healthy behavior.

20.

A nurse is caring for a client who is in the remission state of leukemia. The client expresses anxiety about the recurrence of leukemia. The client feels depressed when thinking about the outcome of leukemia. Which aspect of health is the client talking about?

A)

Physical health

B)

Emotional health

C)

Social health

D)

Spiritual health

Ans:

B

Feedback:

Anxiety and depression are components of emotional health. The client is not feeling emotionally well because of worry about the disease outcomes. Currently the client is in remission and thus is physically healthy. The client does not mention anything about social interactions and spiritual health.

21.

A nurse is educating women on the need for calcium to prevent bone loss. What level of prevention does this represent?

A)

Primary prevention

B)

Secondary prevention

C)

Tertiary prevention

D)

Residual prevention

Ans:

A

Feedback:

Primary prevention or primary health care involves the education of clients in the prevention of disease.

22.

A client states, “I must be in poor health because I am a senior citizen. That’s what my neighbor says and she is older than I am.” This statement is based on which of the following factors?

A)

Age

B)

Gender

C)

Peer influence

D)

Illness factors

Ans:

C

Feedback:

Peer influence, personality characteristics, ethnicity, and socioeconomic factors may affect a person’s response to illness.

23.

An woman 80 years of age has had a cerebrovascular accident. She has flaccidity of her right side with aphasia. For this client, which of the following activities constitutes tertiary prevention?

A)

Assessment of her blood pressure

B)

Daily bleeding and clotting times

C)

Gait training and speech therapy

D)

Education on the symptoms of a CVA

Ans:

C

Feedback:

Tertiary prevention occurs when a person already has been diagnosed with a long-term disease or disability.

24.

Which of the following statements accurately describes how risk factors may increase a person’s chances for illness or injury? Select all that apply.

A)

Risk factors are unrelated to the person or event.

B)

All risk factors are modifiable.

C)

An increase in risk factors increases the possibility of illness.

D)

A family history of breast cancer is not a modifiable risk factor.

E)

School-aged children are at high risk for communicable diseases.

Ans:

C, D, E

Feedback:

A risk factor is something that increases a person’s chances for illness or injury. Like other components of health and illness, risk factors are often interrelated. Risk factors may be further defined as modifiable (able to be changed, such as quitting smoking) or nonmodifiable (unable to be changed, such as a family history of cancer). As the number of risk factors increases, so does the possibility of illness. School-aged children are at high risk for communicable diseases. Multiple sexual relationships increase the risk for sexually transmitted diseases (e.g., gonorrhea or acquired immunodeficiency syndrome AIDS).

25.

Which of the following statements explains why models of health promotion and illness prevention are useful when planning health care? Select all that apply.

A)

They help health care providers understand health-related behaviors.

B)

They are useful for adapting care to people from diverse backgrounds.

C)

They help overcome barriers related to increased number of people without health care.

D)

They overcome barriers to care for the predicted downward trend in minority populations.

E)

They overcome barriers to care for low-income and rural populations.

Ans:

A, B, C, E

Feedback:

Models of why and how individuals carry out behaviors to promote health and prevent illness are useful in helping health care providers understand health-related behaviors, and adapt care to people from diverse economic and cultural backgrounds. This knowledge can be used to overcome barriers to health from disparities in care resulting from such factors as the increasing number of people without health insurance; a predicted upward trend in minority populations; and a lack of accessible and essential health care services for low-income and rural populations. Many people do not take advantage of low-cost screens and health care information.

26.

On which of the following components is Rosenstock’s health belief model based? Select all that apply.

A)

Perceived susceptibility to a disease

B)

Perceived consequences of treating disease

C)

Perceived seriousness of a disease

D)

Perceived benefits of action

E)

Perceived immunity to disease

Ans:

A, C, D

Feedback:

The health belief model (Rosenstock, 1974) is concerned with what people perceive, or believe, to be true about themselves in relation to their health. This model is based on three components of individual perceptions of threat of a disease: (1) perceived susceptibility to a disease, (2) perceived seriousness of a disease, and (3) perceived benefits of action.

27.

Which of the following nursing interventions is an example of health promotion and preventive care on the primary level? Select all that apply.

A)

A nurse counsels a teenager to stop smoking.

B)

A nurse conducts a health fair for high blood pressure screening.

C)

A nurse counsels the family of a client diagnosed with lung cancer.

D)

A home health care nurse arranges for rehabilitation services for a patient.

E)

A school nurse arranges for a career seminar for graduating seniors.

Ans:

A

Feedback:

Primary health promotion and illness prevention are directed toward promoting health and preventing the development of disease processes or injury. Nursing activities at the primary level may focus on individuals or groups. Examples are immunization clinics, family planning services, providing poison-control information, counseling about obesity and smoking cessation, and accident-prevention education. Conducting a high blood pressure screening and providing family counseling are secondary level preventive measures. Rehabilitation and career counseling fall under the tertiary level of preventive care.

28.

The nursing instructor has given an assignment to a group of nurse practitioner students. They are to break into groups of four and complete a health-promotion teaching project, then present a report back to their fellow students. What project is the best example of health-promotion teaching?

A)

Demonstrating an injection technique to a client for anticoagulant therapy

B)

Explaining the side effects of a medication to an adult client

C)

Discussing the importance of preventing sexually transmitted disease to a group of 12th-grade students

D)

Instructing an adolescent client about safe food preparation

Ans:

C

Feedback:

Health promotion encourages people to live a healthy lifestyle and to achieve a high level of wellness. Discussing the importance of STD prevention to a group of 12th-grade students is the best example of a health-promotion teaching project. This makes the other options incorrect.

29.

A nurse is providing an educational event to a local group of disabled citizens. What would be important for the nurse to be aware of when planning this event?

A)

The health promotion needs of the group the nurse is speaking to

B)

What the disability of each person is

C)

Wellness needs of each individual person

D)

What the families want you to talk about

Ans:

A

Feedback:

The nurse must be aware of the health promotion needs when teaching specific groups of people. The other options are incorrect because the nurse doesn ‘t need to aware of them when planning the event.

30.

Which of the following is not one of the six general types of risk factors in regard to increasing an individual ‘s chances for illness and injury?

A)

Gender

B)

Age

C)

Environment

D)

Lifestyle

Ans:

A

Feedback:

The six general types of risk factors are age, genetics, physiologic factors, health habits, lifestyle, and environment. Gender is not a risk factor per se, but certain conditions, such as pregnancy, can contribute to risk.

31.

After teaching the students about health and wellness, the nursing instructor identifies a need for further instruction when one of the students makes which of the following statements?

A)

“Health is more than just the absence of illness.”

B)

“Health is an active process.”

C)

“Health means the same to every person.”

D)

“Health is dynamic and ever-changing.”

Ans:

C

Feedback:

Health is more than just the absence of illness; it is an active process in which a person moves toward his or her maximum potential. It also has different definitions for different people. It is not stagnant, but changes frequently.

32.

A client is admitted to the hospital with abrupt symptoms of increasing shortness of breath, fever, and a productive cough with green sputum. Upon further exam the client is diagnosed with chronic obstructive pulmonary disease (COPD) exacerbation. The nurse identifies this as which type of illness?

A)

Acute

B)

Chronic

C)

Terminal

D)

Contagious

Ans:

B

Feedback:

Chronic illness encompasses many different physical and mental alterations in health. Chronic illnesses usually have a slow onset and many periods of remission (disease is present, but there are no symptoms) and exacerbation (symptoms of the disease reappear). COPD is not terminal (although there is no cure) and it is not contagious.

33.

A nurse is giving a talk to a local community group on the importance of proper diet and regular exercise. This is an example of which type of health promotion?

A)

Primary health promotion

B)

Secondary health promotion

C)

Tertiary health promotion

D)

Chronic health promotion

Ans:

A

Feedback:

Primary health promotion is aimed at promoting health and preventing the development of a disease. Examples of primary promotion are immunizations, family planning, the teaching of healthy diet, regular exercise, safety, and safe sex. Secondary health promotion is aimed at early detection of the disease and treatment. Tertiary promotion begins after the disease is diagnosed and treated, with the goal of reducing disability and helping in rehab. The term chronic is not related to health promotion.

34.

An older adult male client is admitted to the cardiac ICU after suffering a heart attack. Upon taking a history after the client is stable, the nurse charts that he weighs over 275 pounds, has a history of heart disease in his family, suffers frequent stress at work, drinks alcohol daily, and smokes two packs of cigarettes daily. What are some modifiable risks factors for this client that has attributed to his heart attack? Select all that apply.

A)

Alcohol intake

B)

Smoking

C)

Stress

D)

Age

E)

Family history

F)

Sex

Ans:

A, B, C

Feedback:

The modifiable risk factors related to this client’s heart attack include stress, alcohol intake, and smoking. These are things that a person can change. The others are nonmodifiable, as the client cannot change his age, family history, or sex.

35.

A nurse is giving a talk to a local community group on health promotion and illness prevention. The nurse explains the different levels of promotion. Which of the following does the nurse include when talking about primary promotion? Select all that apply.

A)

Immunization clinics

B)

Poison control information

C)

Screenings for blood pressure

D)

Recommending mammograms for women

E)

Teaching about a healthy diet

Ans:

A, B, E

Feedback:

Primary health promotion is directed toward promoting good health and preventing disease. Examples include immunization clinics, providing poison control information, and accident prevention. Teaching about a healthy diet, regular exercise, and using seat belts are other examples. Secondary health promotion focuses on screening for early detection of diseases with prompt diagnosis. Things included are screenings for blood pressure and cholesterol, recommending gynecologic exams, and recommending mammograms for women at appropriate ages.