Health & Physical Assessment In Nursing 3rd Edition by Donita T D’Amico – Test Bank

 

 

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Sample Test

D’Amico/Barbarito Health & Physical Assessment in Nursing, 3/e

Chapter 3

 

Question 1

Type: MCSA

The nurse held a smoking cessation class prior to the upcoming Great American Smokeout, hoping to motivate many individuals to stop smoking by promoting self-efficacy. Which statement made by a participant indicates the highest level of positive self-efficacy according to the Health Belief Model?

1.    “I think this time will be different.”

2.    “I am going to do the best that I can, so that I won’t get lung cancer.”

3.    “I am afraid of getting lung cancer like my father.”

4.    “I know that this time I will quit smoking permanently.”

Correct Answer: 4

Rationale 1: Stating that this attempt at quitting smoking will be different shows a low level of commitment to the action.

Rationale 2: Stating fear of getting lung cancer represents an internal cue to action, based on the Health Belief Model.

Rationale 3: Referring to a family member with the disease represents an internal cue to action, based on the Health Belief Model.

Rationale 4: Based on the Health Belief Model, self-efficacy refers to the level of confidence an individual has about the ability to perform the activity. The client’s statement, “I know that this time I will quit smoking permanently,” shows the highest-level determination and motivation.

Global Rationale: Based on the Health Belief Model, self-efficacy refers to the level of confidence an individual has about the ability to perform the activity. The client’s statement that he/she intends to make a permanent change shows the highest-level determination and motivation. Stating that this attempt at quitting smoking will be different shows a low level of commitment to the action. Stating fear of getting lung cancer and referring to a family member with the disease represents internal cues to action, based on the Health Belief Model.

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

QSEN Competencies: III.B.3. Base individualized care plan on patient values, clinical expertise, and evidence.

AACN Essentials Competencies: I.1. Integrate theories and concepts from liberal education into nursing practice.

NLN Competencies: Context and Environment: Health promotion/disease prevention.

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 3.3: Relate perspectives of health promotion to the individual, family, and community.

MNL Learning Outcome:

Page Number: p. 49

 

Question 2

Type: MCSA

A couple seeks genetic counseling as both have a positive family history of sickle cell anemia, and are concerned about the potential of having a child with this disease. Which statement indicates that the couple wishes to participate in primary prevention?

1.    “We need to both be treated for sickle cell anemia before we can have a baby.”

2.    “We will have blood tests to determine if we are carriers.”

3.    “We need to see a genetics counselor to discuss the potential for having a child with sickle cell disease.”

4.    “Neither one of us has sickle cell disease, so any baby we have will be safe from the disease as well.”

Correct Answer: 3

Rationale 1: Indicating a need for treatment would be considered secondary or tertiary prevention.

Rationale 2: Both individuals being tested for carrier status would be considered secondary prevention, as it deals with early diagnosis of health problems.

Rationale 3: Primary prevention implies health and a high level of wellness for the individual. Seeking out a genetics counselor to discuss the potential for having a child with sickle cell disease is considered primary prevention.

Rationale 4: Stating that neither has the disease, thus a child would not inherit the disease, indicates no level of prevention.

Global Rationale: Primary prevention implies health and a high level of wellness for the individual. Seeking out a genetics counselor is considered primary prevention. Indicating a need for treatment would be considered secondary or tertiary prevention. Both individuals being tested for carrier status would be considered secondary prevention, as it deals with early diagnosis of health problems. Stating that neither has the disease, thus a child would not inherit the disease, indicates no level of prevention.

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

QSEN Competencies: III.A.1. Demonstrate knowledge of basic scientific methods and processes.

AACN Essentials Competencies: I.1. Integrate theories and concepts from liberal education into nursing practice.

NLN Competencies: Context and Environment: Health promotion/disease prevention.

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 3.2: Compare and contrast selected theories of wellness.

MNL Learning Outcome:

Page Number: p. 48

 

Question 3

Type: MCSA

The nurse is interviewing a client who has experienced a 15-pound weight gain during the last year. The nurse obtains a 24-hour dietary recall, as well as determining the client’s exercise habits and feelings regarding plans to take off the excess weight. Which type of approach is the nurse using to enhance the client’s health?

1.    Psychosocial perspective.

2.    Illness perspective.

3.    Physiologic perspective.

4.    Wellness perspective.

Correct Answer: 4

Rationale 1: A psychosocial perspective would not take into account the physiologic alteration necessary for a successful weight loss program.

Rationale 2: An illness perspective does not include the positive attributes, such as motivation, that the client possesses to address the 15-pound weight gain during the past year; rather, it focuses on the illnesses, such as hypertension, that can result from the weight gain.

Rationale 3: A physiologic perspective could also be considered an illness perspective.

Rationale 4: When using a wellness perspective, the nurse focuses on the client’s personal strengths and abilities to enhance health.

Global Rationale: When using a wellness perspective, the nurse focuses on the client’s personal strengths and abilities to enhance health. An illness perspective does not include the positive attributes that the client possesses to address the problem. A physiologic perspective could also be considered an illness perspective. A psychosocial perspective would not take into account the physiologic alteration necessary for a successful weight loss program.

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

QSEN Competencies: III.A.1. Demonstrate knowledge of basic scientific methods and processes.

AACN Essentials Competencies: I.1. Integrate theories and concepts from liberal education into nursing practice.

NLN Competencies: Context and Environment: Health promotion/disease prevention.

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 3.2: Compare and contrast selected theories of wellness.

MNL Learning Outcome:

Page Number: pp. 48–49

 

Question 4

Type: MCSA

The nurse is discharging a client who was hospitalized for a cerebral vascular accident (CVA). The client will be cared for at home by family members. Which statement made by the family indicates understanding of the client’s primary prevention needs after discharge?

1.    “She will need instruction on using her walker.”

2.    “She will need to have her flu shot this year.”

3.    “She must take her blood pressure medications regularly.”

4.    “She needs to have her cholesterol checked every 2 months.”

Correct Answer: 2

Rationale 1: Tertiary prevention involves strategies for rehabilitation; instructing the client on proper use of a walker is an example of tertiary prevention.

Rationale 2: Having a flu shot is a primary prevention strategy.

Rationale 3: Taking blood pressure medication is secondary prevention since the treatment is aimed at maintaining normal blood pressure and preventing complications from the condition.

Rationale 4: Having a cholesterol screening is an example of secondary prevention.

Global Rationale: Having a flu shot is a primary prevention strategy. Taking blood pressure medication is secondary prevention since the treatment is aimed at maintaining normal blood pressure and preventing complications from the condition. Having a cholesterol screening is also an example of secondary prevention. Tertiary prevention involves strategies for rehabilitation, such as using a walker to aid ambulation.

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Reduction of Risk Potential

QSEN Competencies: III.A.1. Demonstrate knowledge of basic scientific methods and processes.

AACN Essentials Competencies: I.1. Integrate theories and concepts from liberal education into nursing practice.

NLN Competencies: Context and Environment: Health promotion/disease prevention.

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 3.2: Compare and contrast selected theories of wellness.

MNL Learning Outcome:

Page Number: pp. 48–49

 

Question 5

Type: MCMA

The nurse is planning a weight reduction class and wants to use the Health Belief Model to motivate the clients in losing weight. Which are mediating factors in the Health Belief Model?

Standard Text: Select all that apply.

1.    Likelihood of the individuals developing complications from being overweight.

2.    The clients’ perception of the severity of an illness that could develop from being overweight.

3.    The cost of the class that will be the client’s responsibility.

4.    The amount of time commitment for the individuals taking the class.

5.    The religion of the clients who will be taking the class.

Correct Answer: 1, 2, 3, 4

Rationale 1: Susceptibility refers to how likely an individual is to develop an illness or condition and it is one of the mediating factors according to the Health Belief Model; the likelihood of the individuals developing complications from being overweight is an example.

Rationale 2: The perceived severity of an illness is the second mediating factor that determines the motivation to participating in health-promotion behaviors. The clients’ perception of the severity of an illness that could develop from being overweight is an example.

Rationale 3: The actual cost of the class would be considered the physical cost of the health-promoting activity versus continuing the unhealthy behavior. Physical and psychologic perceived cost is the fourth mediating variable.

Rationale 4: Time commitment necessary for the class would be considered a psychologic cost of the health promoting activity versus continuing the unhealthy behavior. Physical and psychologic perceived cost is the fourth mediating variable.

Rationale 5: Religion is not identified as one of the mediating variable according to the Health Belief Model.

Global Rationale: Mediating factors affect the health-promoting behaviors by influencing the perception of susceptibility, severity, effectiveness, and cost (physical and psychologic). Religion is not one of the identified mediating factors according to the Health Belief Model.

Cognitive Level: Understanding

Client Need: Health Promotion and Maintenance

Client Need Sub:

QSEN Competencies: III.B.3. Base individualized care plan on patient values, clinical expertise, and evidence.

AACN Essentials Competencies: I.1. Integrate theories and concepts from liberal education into nursing practice.

NLN Competencies: Context and Environment: Health promotion/disease prevention.

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 3.3: Relate perspectives of health promotion to the individual, family, and community.

MNL Learning Outcome:

Page Number: p. 49

 

Question 6

Type: MCSA

A staff nurse is participating on a committee examining ways to most effectively meet the goals of Healthy People 2020. Which client would be the nurse’s highest priority based on the goals of Healthy People 2020?

1.    An adolescent female with her first pregnancy.

2.    A diabetic client who maintains optimal visual intactness.

3.    An IV drug abuser who converts to methadone use.

4.    Several obese school-age children.

Correct Answer: 2

Rationale 1: A 16 year old with a pregnancy does not indicate healthy behavior across the life span.

Rationale 2: The diabetic client maintaining visual intactness demonstrates the overall goal of Healthy People 2020 through practicing healthy behavior in regards to controlling his diabetes and improved long-term quality of life.

Rationale 3: An IV drug user still using a drug does not demonstrate healthy behavior, nor improved quality of life or elimination of health inequities.

Rationale 4: Obesity levels in the school-aged population do not demonstrate healthy behavior across the life span.

Global Rationale: The overriding goals for Healthy People 2020 are to eliminate preventable diseases and health inequities, as well as promotion of healthy behavior across the entire life span of an individual. The diabetic client maintaining visual intactness demonstrates healthy behavior in regards to controlling his diabetes and improved long-term quality of life. A 16 year old with a pregnancy does not indicate healthy behavior across the life span. An IV drug user still using a drug does not demonstrate healthy behavior, nor improved quality of life or elimination of health inequities. Obesity levels in the school-aged population do not demonstrate healthy behavior across the life span.

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

QSEN Competencies: III.B.3. Base individualized care plan on patient values, clinical expertise, and evidence.

AACN Essentials Competencies: VII.11. Participate in clinical prevention and population-focused interventions with attention to effectiveness, efficiency, cost-effectiveness, and equity.

NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; Apply health policy.

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 3.4: Apply the goals and objectives for each topic area in Healthy People 2020 to nursing practice.

MNL Learning Outcome:

Page Number: pp. 54–66

 

Question 7

Type: MCMA

The nurse is planning an exercise class for a group of young adults. When promoting the benefits of regular exercise, which topics will the nurse include?

Standard Text: Select all that apply.

1.    Reducing risk of cardiovascular disease.

2.    Reducing risk of skin cancer.

3.    Reducing risk of colon cancer.

4.    Reducing risk of renal disease.

5.    Reduced risk of hypertension.

Correct Answer: 1, 3, 5

Rationale 1: Regular physical activity has been found to decrease the risk of developing or dying from cardiovascular disease.

Rationale 2: The development of skin cancer is not related to physical activity.

Rationale 3: Regular physical activity has been found to decrease the risk of developing or dying from colon cancer.

Rationale 4: The development of renal disease is not related to physical activity.

Rationale 5: Regular physical activity has been found to decrease the risk of developing or dying from hypertension.

Global Rationale: According to Healthy People 2020, regular physical activity results in a decreased risk of cardiovascular disease, colon cancer, and hypertension. It does not result in decreasing the risk of skin cancer or renal disease.

Cognitive Level: Remembering

Client Need: Health Promotion and Maintenance

Client Need Sub:

QSEN Competencies: III.B.3. Base individualized care plan on patient values, clinical expertise, and evidence.

AACN Essentials Competencies: VII.11. Participate in clinical prevention and population-focused interventions with attention to effectiveness, efficiency, cost-effectiveness, and equity.

NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; Apply health policy.

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 3.4: Apply the goals and objectives for each topic area in Healthy People 2020 to nursing practice.

MNL Learning Outcome:

Page Number: pp. 54–66

 

Question 8

Type: MCSA

The school nurse is working with several adolescents during gym class. Which adolescent is meeting the age-appropriate recommendations for physical activity developed by the Centers for Disease Control (CDC)?

1.    A 17 year old who runs at a fast pace for 30 minutes five times per week and practices yoga for 30 minutes two times per week.

2.    A 16 year old who swims for 60 minutes 5 times per week and jogs for 60 minutes the other 2 days per week.

3.    A 15 year old who lifts moderately heavy weights 15 minutes three times per week.

4.    A 13 year old who speed-walks 60 minutes five times per week.

Correct Answer: 2

Rationale 1: Running for 30 minutes five times per week and practicing yoga for 30 minutes two times per week does not meet the CDC recommendation of 1 hour of moderate to vigorous exercise daily for children and adolescents ages 6 to 17.

Rationale 2: Swimming for 60 minutes five times per week and jogging for 60 minutes the remaining 2 days per week meets the CDC recommendation of 1 hour of moderate to vigorous exercise daily for children and adolescents ages 6 to 17.

Rationale 3: Lifting weights for 15 minutes three times per week does not meet the CDC recommendation of 1 hour of moderate to vigorous exercise daily for children and adolescents ages 6 to 17.

Rationale 4: Speed walking for 60 minutes five times per week does not meet the CDC recommendation of 1 hour of moderate to vigorous exercise daily for children and adolescents ages 6 to 17.

Global Rationale: The CDC recommendation for physical activity for children and adolescents, ages 6 to 17, are: 1 hour or more of physical activity every day with most of the hour consisting of moderate- or vigorous-intensity aerobic activity. The CDC also recommends that during the daily hour of physical activity, muscle- and bone-strengthening activity should each be included at least 3 days per week. Therefore, the 16 year old who swims for 1 hour 5 days per week and jogs for 60 minutes the remaining 2 days per week meets the CDC recommendations. The swimming would also be considered a muscle-strengthening activity and the jogging would be considered a bone-strengthening activity. The other options do not meet CDC recommendations.

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

QSEN Competencies: III.B.3. Base individualized care plan on patient values, clinical expertise, and evidence.

AACN Essentials Competencies: VII.11. Participate in clinical prevention and population-focused interventions with attention to effectiveness, efficiency, cost-effectiveness, and equity.

NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; Apply health policy.

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 3.4: Apply the goals and objectives for each topic area in Healthy People 2020 to nursing practice.

MNL Learning Outcome:

Page Number: pp. 54–66

 

Question 9

Type: MCSA

The school nurse is working with several school-aged children in health class. Which child is meeting age-appropriate recommendations for physical activity developed by the Centers for Disease Control (CDC)?

1.    A 12-year-old who plays soccer 4 days per week at the neighborhood playground and 3 days per week for a soccer team.

2.    A 10-year-old who runs wind sprints for 15 minutes for PE class 1 day per week.

3.    An 8-year-old who plays on the monkey bars at both 30-minute recess periods three times per week.

4.    A 9-year-old who plays kickball at one 20-minute recess daily five times per week and plays basketball for a team 2 days per week.

Correct Answer: 1

Rationale 1: The 12-year-old who plays soccer 4 days per week at the neighborhood playground and 3 days per week for a soccer team is meeting the recommended 60 minutes per day of moderate- to vigorous-intensity aerobic activity.

Rationale 2: The 10-year-old who runs wind sprints for 15 minutes for PE class 1 day per week is not meeting the recommended 60 minutes per day of moderate- to vigorous-intensity aerobic activity.

Rationale 3: The 8-year-old who plays on the monkey bars at both 30-minute recess periods three times per week is not meeting the recommended 60 minutes per day of moderate- to vigorous-intensity aerobic activity.

Rationale 4: The 9-year-old who plays kickball at one 20-minute recess daily five times per week and plays basketball for a team 2 days per week is not meeting the recommended 60 minutes per day of moderate- to vigorous-intensity aerobic activity.

Global Rationale: The CDC recommendation for physical activity for children and adolescents, ages 6 to 17, are: 1 hour or more of physical activity every day with most of the hour consisting of moderate- or vigorous-intensity aerobic activity. The CDC also recommends that during the daily hour of physical activity, muscle- and bone-strengthening activity should each be included at least 3 days per week. Only the child who plays soccer each day meets the recommended activity levels for age. The 10-year-old is exercising only 15 minutes once per week. The 8-year-old is exercising 60 minutes per day, but only three times per week, which does not meet the criteria for 60 minutes of daily exercise. The 9-year-old is only exercising for 20 minutes 5 days while playing kickball and 2 days of basketball, which does not meet the minimum criteria.

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

QSEN Competencies: III.B.3. Base individualized care plan on patient values, clinical expertise, and evidence.

AACN Essentials Competencies: VII.11. Participate in clinical prevention and population-focused interventions with attention to effectiveness, efficiency, cost-effectiveness, and equity.

NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; Apply health policy.

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 3.4: Apply the goals and objectives for each topic area in Healthy People 2020 to nursing practice.

MNL Learning Outcome:

Page Number: pp.54–66

 

Question 10

Type: MCSA

A nurse teaching a smoking cessation class includes the following statements in the presentation: “Everyone here tonight has the ability to control the urge to smoke. You are all rational people who understand that smoking is the cause of many significant health problems, and that it is a voluntary event that you are going to learn to do without. Regardless of your motivation, you will get help here to understand your triggers to smoke, and how to control them.” Which theory or model is the nurse using to promote smoking cessation?

1.    The Self-Efficacy Model.

2.    The Theory of Reasoned Action.

3.    The Health Promotion Model.

4.    The Health Belief Model.

Correct Answer: 2

Rationale 1: Self-efficacy is part of the Health Belief Model, and not its own theory. Self-efficacy refers to how confident individuals are in their own ability to perform a behavior.

Rationale 2: The Theory of Reasoned Action/Planned Behavior is a prediction theory based on the assumptions that behavior is under volitional control and that people are rational beings. The theory also suggests that individuals are more likely to participate in healthy behaviors if they believe the benefit outweighs the cost of the behavior. The statement by the nurse indicates these principles.

Rationale 3: The Health Promotion Model depicts people as multidimensional in interactions with their environments, and focuses on variables that impact behavior. Variables that impact behavior include personal factors such as age, strength, and agility; cognitive factors such as an individual’s perceived benefit of a health promoting action; and intrapersonal influences such as the influence of family members, friends, or a health care provider. The statement by the nurse does not depict this model.

Rationale 4: The Health Belief Model relates to cues to action for a change in behavior. The cues to action in this model refer to internal and external stimuli that motivate a person to participate in health promoting behavior. An example of a cue to action is a female getting yearly mammograms due to a family member having breast cancer. The statement by the nurse does not depict this model.

Global Rationale: The Theory of Reasoned Action/Planned Behavior is a prediction theory based on the assumptions that behavior is under volitional control and that people are rational beings. The theory also suggests that individuals are more likely to participate in healthy behaviors if they believe the benefit outweighs the cost of the behavior. Self-efficacy refers to how confident individuals are in their own ability to perform a behavior, and is part of the Health Belief Model, not its own theory. The Health Promotion Model depicts people as multidimensional in interactions with their environments, and focuses on variables that impact behavior. Variables that impact behavior include personal factors such as age, strength, and agility; cognitive factors such as an individual’s perceived benefit of a health-promoting action; and intrapersonal influences such as the influence of family members, friends, or a health care provider. The Health Belief Model relates to cues to action. The cues to action in this model refer to internal and external stimuli that motivate a person to participate in health-promoting behavior. An example of a cue to action is a female getting yearly mammograms due to a family member having breast cancer.

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

QSEN Competencies: III.B.3. Base individualized care plan on patient values, clinical expertise, and evidence.

AACN Essentials Competencies: I.1. Integrate theories and concepts from liberal education into nursing practice.

NLN Competencies: Context and Environment: Health promotion/disease prevention.

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 3.3: Relate perspectives of health promotion to the individual, family, and community.

MNL Learning Outcome:

Page Number: pp. 48–54

 

Question 11

Type: MCSA

The nurse is working with several clients in a fitness setting. Which client is meeting the age-appropriate recommendations for physical activity developed by the Centers for Disease Control (CDC)?

1.    A 37-year-old who lifts weights for one hour twice per week.

2.    A 42-year-old who walks at a slow pace for 60 minutes 4 days per week.

3.    A 45-year-old who walks briskly for 30 minutes 6 days per week.

4.    A 57-year-old who swims for 20 minutes twice per week.

Correct Answer: 3

Rationale 1: The weight lifter is not exercising the minimum number of hours per week of the recommended moderate-intensity physical activities, for at least 2 hours and 30 minutes per week or 1 hour and 15 minutes of vigorous-intensity aerobic physical activity per week; or an equivalent combination of moderate- and vigorous-intensity aerobic activity.

Rationale 2: The 42-year-old who is walking at a slow pace is not meeting the minimum criteria for moderate exercise.

Rationale 3: The adult who walks briskly for 30 minutes 6 days per week is meeting the criteria of moderate-intensity physical activities for at least 2 hours and 30 minutes per week or 1 hour and 15 minutes of vigorous-intensity aerobic physical activity per week; or an equivalent combination of moderate- and vigorous-intensity aerobic activity, as well as the suggested aerobic activity occurring for at least 10 minute episodes throughout the week.

Rationale 4: The swimmer is only exercising twice per week for a total of 40 minutes, which does not meet the minimum requirements for moderate physical activity.

Global Rationale: The recommendations for physical activity for adults are: moderate-intensity physical activities for at least 2 hours and 30 minutes per week or 1 hour and 15 minutes of vigorous-intensity aerobic physical activity per week, or an equivalent combination of moderate- and vigorous-intensity aerobic activity. Aerobic activity should occur for at least 10-minute episodes throughout the week. Only the adult who walks briskly is meeting the criteria of moderate-intensity physical activities for at least 2 hours and 30 minutes per week or 1 hour and 15 minutes of vigorous-intensity aerobic physical activity per week, or an equivalent combination of moderate- and vigorous-intensity aerobic activity. The weight lifter is not exercising the minimum number of hours per week. The 42-year-old who is walking at a slow pace is not meeting the minimum criteria for moderate exercise. The swimmer is only exercising twice per week for a total of 40 minutes.

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

QSEN Competencies: III.B.3. Base individualized care plan on patient values, clinical expertise, and evidence.

AACN Essentials Competencies: VII.11. Participate in clinical prevention and population-focused interventions with attention to effectiveness, efficiency, cost-effectiveness, and equity.

NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; Apply health policy.

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 3.4: Apply the goals and objectives for each topic area in Healthy People 2020 to nursing practice.

MNL Learning Outcome:

Page Number: pp. 54–66

 

Question 12

Type: MCSA

The nurse is working with a 60-year-old female client in a fitness setting. Which is the correct maximum desired heart rate target zone for both moderate- and vigorous-intensity workouts for this client?

1.    66–80, and 112–124.

2.    60–85, and 85–110.

3.    80–110, and 120–130.

4.    80–112, and 112–136.

Correct Answer: 4

Rationale 1: Utilizing the proper calculation method, 66–80, and 112–124 beats per minute are not the desired heart rate target zones for moderate- and vigorous-intensity workouts for a 60 year old.

Rationale 2: Utilizing the proper calculation method, 60–85, and 85–110 beats per minute are not the desired heart rate target zones for moderate- and vigorous-intensity workouts for a 60 year old.

Rationale 3: Utilizing the proper calculation method, 80–110, and 120–130 beats per minute are not the desired heart rate target zones for moderate- and vigorous-intensity workouts for a 60 year old.

Rationale 4: Utilizing the proper calculation method, 80–112, and 112–136 beats per minute are the desired heart rate target zones for moderate- and vigorous-intensity workouts for a 60 year old.

Global Rationale: Moderate intensity exercise should raise the heart rate 50–70%. Vigorous intensity exercise should raise the heart rate 70–85%. To calculate the minimum and maximum targets zones from each type of activity, you must first determine the maximum heart rate. This is done by subtracting the individual’s age from 220. Therefore, 220 – 60 = 160. 160 × 0.5 (50%) = 80; 160 × 0.7 (70%) = 112. For vigorous activity, 160 × 0.7 = 112; 160 × 0.85 (85%) = 136. Therefore, 80–112, and 112–136 is the correct answer.

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

QSEN Competencies: III.B.3. Base individualized care plan on patient values, clinical expertise, and evidence.

AACN Essentials Competencies: VII.11. Participate in clinical prevention and population-focused interventions with attention to effectiveness, efficiency, cost-effectiveness, and equity.

NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; Apply health policy.

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 3.4: Apply the goals and objectives for each topic area in Healthy People 2020 to nursing practice.

MNL Learning Outcome:

Page Number: pp. 54–66

 

Question 13

Type: MCMA

The client inquires about isotonic exercises that will increase muscle tone. Which activities will the nurse recommend to the client?

Standard Text: Select all that apply.

1.    Running.

2.    Weight lifting.

3.    Walking.

4.    Pushing against a wall.

5.    Cycling.

Correct Answer: 1, 3, 5

Rationale 1: Running is an example of isotonic exercise which increases muscle tone.

Rationale 2: Resistive exercises do not increase muscle tone. An example of resistive exercise includes weight lifting.

Rationale 3: Walking is an example of isotonic exercise which increases muscle tone.

Rationale 4: Isometric exercises include those that affect muscle tension but do not result in muscle or joint movement. Isometric exercises are useful for strengthening abdominal, gluteal, and quadriceps muscles, for maintaining strength of immobilized muscles, and for endurance training. Examples of isometric exercise would include tensing of thigh muscles and extending the arms and pushing against a wall.

Rationale 5: Cycling is an example of isotonic exercise which increases muscle tone.

Global Rationale: Isotonic exercises increase tone, and involve activities such as running, walking, and cycling. Resistive exercises such as weight lifting do not increase muscle tone. Isometric exercises include those that affect muscle tension but do not result in muscle or joint movement. Isometric exercises are useful for strengthening abdominal, gluteal, and quadriceps muscles, for maintaining strength of immobilized muscles, and for endurance training. Examples of isometric exercise would include tensing of thigh muscles and extending the arms and pushing against a wall. Cycling is an example of isotonic exercise which increases muscle tone.

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

QSEN Competencies: III.B.3. Base individualized care plan on patient values, clinical expertise, and evidence.

AACN Essentials Competencies: VII.11. Participate in clinical prevention and population-focused interventions with attention to effectiveness, efficiency, cost-effectiveness, and equity.

NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; Apply health policy.

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 3.4: Apply the goals and objectives for each topic area in Healthy People 2020 to nursing practice.

MNL Learning Outcome:

Page Number: pp. 63–64

 

Question 14

Type: MCSA

The nurse is preparing a seminar presentation regarding causes of death in the United States. Which cause of death with the nurse include as being responsible for more deaths in the United States than all of the others combined?

1.    HIV and AIDS.

2.    Cigarette smoking.

3.    Automobile crashes.

4.    Drug abuse.

Correct Answer: 2

Rationale 1: HIV and AIDS are not responsible for the most deaths in the United States.

Rationale 2: Cigarette smoking is responsible for more deaths in the United States than death from HIV/AIDS, drug abuse, homicide, suicide, automobile crashes, and fire combined.

Rationale 3: Automobile crashes are not responsible for the most deaths in the United States.

Rationale 4: Drug abuse is not responsible for the most deaths in the United States.

Global Rationale: Cigarette smoking is responsible for more deaths in the United States than death from HIV/AIDS, drug abuse, homicide, suicide, automobile crashes, and fire combined. Smoking is a risk factor for heart disease, breathing disorders, and lung cancer. Secondary smoke increases the incidence of asthma and bronchitis in children, and heart and lung diseases in adults.

Cognitive Level: Remembering

Client Need: Health Promotion and Maintenance

Client Need Sub:

QSEN Competencies: III.B.3. Base individualized care plan on patient values, clinical expertise, and evidence.

AACN Essentials Competencies: VII.11. Participate in clinical prevention and population-focused interventions with attention to effectiveness, efficiency, cost-effectiveness, and equity.

NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; Apply health policy.

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 3.4: Apply the goals and objectives for each topic area in Healthy People 2020 to nursing practice.

MNL Learning Outcome:

Page Number: pp. 54–66

 

Question 15

Type: MCSA

A nursing student is preparing an educational program concerning breast cancer. The focus of the program is secondary prevention. Which topic would be most appropriate?

1.    A dietary discussion concerning the connection between breast cancer and dietary intake.

2.    Techniques for performing self-breast examination.

3.    Radical mastectomy.

4.    Chemotherapy and radiation treatments.

Correct Answer: 2

Rationale 1: Primary prevention implies that an individual is healthy and focuses on health promotion and disease prevention. Primary prevention is demonstrated by the discussion of dietary recommendations for prevention of breast cancer.

Rationale 2: Secondary prevention emphasizes early diagnosis and treatment of health problems, and includes screenings such as teaching clients about self-breast examination.

Rationale 3: Tertiary prevention is aimed toward treatment of a condition and restoration of health to the highest level of wellness possible. Treatment options for breast cancer, such as a radical mastectomy, would be considered a form of tertiary prevention.

Rationale 4: Tertiary prevention is aimed toward treatment of a condition and restoration of health to the highest level of wellness possible. Treatment options for breast cancer, such as chemotherapy and radiation, would be considered a form of tertiary prevention.

Global Rationale: Secondary prevention emphasizes early diagnosis and treatment of health problems, and includes screenings such as teaching clients about self-breast examination and mammography. Primary prevention has a focus geared toward health promotion and disease prevention, which is demonstrated by the discussion of dietary recommendations. Tertiary prevention is aimed toward treatment of a condition and restoration of health to the highest level of wellness possible. Treatment options for breast cancer such as a radical mastectomy, chemotherapy, and radiation would be considered forms of tertiary prevention.

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

QSEN Competencies: III.A.1. Demonstrate knowledge of basic scientific methods and processes.

AACN Essentials Competencies: I.1. Integrate theories and concepts from liberal education into nursing practice.

NLN Competencies: Context and Environment: Health promotion/disease prevention.

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 3.2: Compare and contrast selected theories of wellness.

MNL Learning Outcome:

Page Number: p. 48

 

Question 16

Type: MCSA

During a routine health examination, a client reports concern about her potential for the development of heart disease. During the assessment, the nurse reviews the client’s risk factors. Which of the client’s risk factors are considered modifiable?

1.    Age, heredity, and weight.

2.    Family history, self-history of diabetes mellitus type 1, and age

3.    Weight, dietary intake, and environmental risks.

4.    Biological characteristics, lifestyle factors, and family history.

Correct Answer: 3

Rationale 1: Age and heredity are non-modifiable risk factors (cannot be changed by the client’s actions); while weight is a modifiable risk factor (can be changed by the client’s actions).

Rationale 2: Family history, self-history of diabetes mellitus type 1, and age are all non-modifiable risk factors (cannot be changed by the client’s actions).

Rationale 3: Weight, dietary intake, and environmental risks are all modifiable risk factor (can be changed by the client’s actions).

Rationale 4: Biological characteristics and family history are non-modifiable risk factors (cannot be changed by the client’s actions); while lifestyle factors are modifiable risk factors (can be changed by the client’s actions).

Global Rationale: Risk factors that can be controlled by client action are termed modifiable. Those risk factors which cannot be changed by the client, such as age, heredity, genetic factors, certain health conditions, and biological characteristics, are called non-modifiable factors.

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Reduction of Risk Potential

QSEN Competencies: III.B.3. Base individualized care plan on patient values, clinical expertise, and evidence.

AACN Essentials Competencies: I.1. Integrate theories and concepts from liberal education into nursing practice.

NLN Competencies: Context and Environment: Health promotion/disease prevention.

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 3.3: Relate perspectives of health promotion to the individual, family, and community.

MNL Learning Outcome:

Page Number: p. 66

 

Question 17

Type: MCSA

The Health Promotion Model is being used by a nurse to analyze the potential impact of the importance of regular exercise. According to the model, which participant is most likely to initiate and consistently participate in a successful program of exercise after attending the session?

1.    An overweight female who has never participated in an exercise program.

2.    A 30-year-old male who admits frequently joining and quitting exercise groups.

3.    A teenaged male who has low self-esteem.

4.    A 24-year-old female who reports she is anxious to begin exercising with her husband.

Correct Answer: 4

Rationale 1: The overweight female who has never participated in an exercise program would most likely have less motivation to initiate and consistently participate in a successful exercise program than the 24-year-old female who is anxious to begin exercise with her husband, who would be a source of support, according to the Health Promotion Model.

Rationale 2: A 30-year-old male who frequently joins and quits exercise groups is less likely to initiate and consistently participate in a successful exercise program than the 24-year-old female who is anxious to begin exercise with her husband, who would be a source of support, according to the Health Promotion Model.

Rationale 3: A teenaged male with low self-esteem is less likely to initiate and consistently participate in a successful exercise program than the 24-year-old female who is anxious to begin exercise with her husband, who would be a source of support, according to the Health Promotion Model.

Rationale 4: The 24-year-old female who reports she is anxious to begin exercising with her husband displays the motivational characteristics of the Health Promotion Model to most likely initiate and consistently participate in a successful exercise program.

Global Rationale: The Health Promotion Model views persons as “multidimensional and in interaction with interpersonal and physical environments as they pursue health.” The model can be used to make inferences about people’s motivational and behavioral outcomes. The female who has a strong motivation and social support demonstrates the strongest likelihood of following through with the program. Variables such as low self-esteem, prior negative outcomes, and a lack of experience can reduce the individual’s willingness to engage in the health-promoting activities.

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

QSEN Competencies: III.B.3. Base individualized care plan on patient values, clinical expertise, and evidence.

AACN Essentials Competencies: VII.5. Use evidence-based practices to guide health teaching, health counseling, screening, outreach, disease and outbreak investigation, referral, and follow-up throughout the lifespan.

NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; Apply health policy.

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 3.5: Demonstrate how to use the nursing process to encourage health promotion.

MNL Learning Outcome:

Page Number: pp. 66–67

 

Question 18

Type: MCMA

The nurse is planning a presentation to a group of middle-school students regarding health promotion and wellness. Which concepts will the nurse plan to include in the presentation?

Standard Text: Select all that apply.

1.    Individuals are more knowledgeable in today’s society in regard to health care issues.

2.    Consumers of health care in today’s society demonstrate less decision-making capabilities concerning their health care than in the past.

3.    The focus of Healthy People 2020 is on the early treatment of disease and pathologic conditions.

4.    The roles of health care providers in today’s society have expanded.

5.    Individuals, in general, are proactive regarding health care practices and desire care that promotes health and prevents disease.

Correct Answer: 1, 4, 5

Rationale 1: Individuals in today’s society are more knowledgeable regarding health care issues than in the past.

Rationale 2: Clients are actively involved in the decision-making process related to their health care.

Rationale 3: The focus of Healthy People 2020 is on health promotion and disease prevention rather than early treatment of disease and pathologic conditions.

Rationale 4: Due to the complexity of the health care system of today, the role of health care providers has changed and expanded.

Rationale 5: Individuals in today’s society are proactive in regard to their health care needs and an emphasis is placed on health promotion and disease prevention.

Global Rationale: Individuals in today’s society are more knowledgeable in regard to health care issues; thus, individuals demonstrate control in decision-making capabilities concerning their health care. Healthy People 2020 focuses on health and wellness, rather than early treatment of disease and pathologic conditions. Due to the complexity of today’s health care system, the role of health care providers has changed and expanded. Lastly, individuals are more proactive in regard to health care practices of today and desire care that emphasizes health promotion.

Cognitive Level: Remembering

Client Need: Health Promotion and Maintenance

Client Need Sub:

QSEN Competencies: III.A.1. Demonstrate knowledge of basic scientific methods and processes.

AACN Essentials Competencies: I.1. Integrate theories and concepts from liberal education into nursing practice.

NLN Competencies: Context and Environment: Health promotion/disease prevention.

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 3.1: Distinguish between concepts of wellness and health promotion.

MNL Learning Outcome:

Page Number: pp. 48–49

 

Question 19

Type: MCSA

A client who has recently experienced a fracture is concerned about maintaining muscle strength during recuperation. Which type of exercise will the nurse recommend for this client?

1.    Isometric exercise.

2.    Isotonic exercise.

3.    Resistive exercise.

4.    Anaerobic exercise.

Correct Answer: 1

Rationale 1: Isometric exercises affect muscle tension. Joint movement does not occur during isometric exercises. This type of exercise can be used for strength maintenance for immobilized clients and can be achieved with tensing the muscles in the affected arm or extending the arm.

Rationale 2: Isotonic exercises increase tone and involve activities such as running, walking, and cycling. These types of activities may be contraindicated by clients having a fracture.

Rationale 3: Resistive exercises use resistance. An example of resistive exercise includes weight lifting. This activity may be contraindicated by a client with a fracture.

Rationale 4: Anaerobic exercises are activities used to promote endurance training by participating in short periods of vigorous activity. This type of activity would not be indicated for a client with a fracture.

Global Rationale: Isometric exercises affect muscle tension. Joint movement does not occur during isometric exercises. Examples of isometric exercise would include tensing of thigh muscles, extending the arms, and pushing against a wall. For this client, the best isometric exercise would be tensing the muscles in the affected arm or extending the arm. This type of exercise can be used for strength maintenance for immobilized clients. Isotonic exercises increase tone and involve activities such as running, walking, and cycling. These types of activities may be contraindicated by clients having a fracture. Resistive exercises use resistance. An example of resistive exercise includes weight lifting. Anaerobic exercises are activities used to promote endurance.

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

QSEN Competencies: III.B.3. Base individualized care plan on patient values, clinical expertise, and evidence.

AACN Essentials Competencies: VII.5. Use evidence-based practices to guide health teaching, health counseling, screening, outreach, disease and outbreak investigation, referral, and follow-up throughout the lifespan.

NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; Apply health policy.

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 3.5: Demonstrate how to use the nursing process to encourage health promotion.

MNL Learning Outcome:

Page Number: pp. 63–64

 

Question 20

Type: MCMA

The client who reports having difficulty sleeping at night asks the nurse for suggestions to enhance getting a good night’s sleep. Which recommendations may be beneficial to this client?

Standard Text: Select all that apply.

1.    Performing 30 minutes of exercise prior to going bedtime.

2.    Setting a regular bedtime.

3.    Establishing a relaxation routine at bedtime.

4.    Avoiding alcohol.

5.    Watching television to assist in falling asleep.

Correct Answer: 2, 3, 4

Rationale 1: Performing exercises 30 minutes prior to going to bed will most likely stimulate the individual rather than promote sleep.

Rationale 2: Setting a regular bedtime, as well as a regular waking time, promotes a more restful sleep.

Rationale 3: A relaxation routine prior to bedtime promotes sleep.

Rationale 4: Avoiding alcohol will promote restful sleep since alcohol interferes with a normal sleep pattern.

Rationale 5: Watching television prior to attempting to fall asleep will most likely stimulate the individual rather than promote sleep.

Global Rationale: Establishing a routine including a regular bedtime and relaxation promote a restful sleep. Alcohol may be associated with altered sleep patterns. Performing exercises prior to going to bed and watching television will stimulate the individual rather than promote sleep.

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Basic Care and Comfort

QSEN Competencies: III.B.3. Base individualized care plan on patient values, clinical expertise, and evidence.

AACN Essentials Competencies: VII.5. Use evidence-based practices to guide health teaching, health counseling, screening, outreach, disease and outbreak investigation, referral, and follow-up throughout the lifespan.

NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; Apply health policy.

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 3.5: Demonstrate how to use the nursing process to encourage health promotion.

MNL Learning Outcome:

Page Number: pp. 64–65

 

Question 21

Type: MCSA

During a routine pediatric health maintenance appointment, the parents of a newborn report being concerned their baby is sleeping too much. The nursing assessment reveals the newborn sleeps 16 hours each day. Which response by the nurse is the most appropriate?

1.    “The recommendation for a newborn is 16 to 18 hours of sleep per day.”

2.    “Your newborn is sleeping too much.”

3.    “Do not allow your newborn to nap as often.”

4.    “I would recommend putting your baby to sleep later in the evening.”

 

 

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