Chapter 04: Health Promotion and Risk Reduction Nies: Community/Public Health Nursing, 8th Edition

1. A nurse reviewed information before meeting with the community residents who were attending a program on healthful living. Which best describes the action by the nurse?

a. Disease prevention

b. Health promotion

c. Health improvement

d. Specific protection

ANS: B Health promotion is any combination of health education and related support for health behaviors. It is not specific protection or disease prevention because no specific disease is being avoided. Although healthful living may indeed improve health, there is nothing to suggest the attendees were not currently healthy.

2. A 50-year-old woman comes to the clinic for her first mammogram. Which best describes the action of this client?

a. Disease prevention

b. Health improvement

c. Health protection

d. Primary health promotion

ANS: C Health protection is used to detect disease in its early state or maximize health within the constraints of disease. Unfortunately, screening will not prevent disease. Screenings are a secondary health promotion—not a primary health promotion.

3. Which is the best definition of health?

a. A goal and a resource for living

b. A lack of disease or illness

c. Complete state of well-being d. Freedom from pain or discomfort

ANS: C Health was originally defined as a lack of illness or disease. More recently, health has been defined as a state of complete physical, mental, and social well-being. Today, health's definition is based on the realization that health allows one to realize aspirations, to satisfy needs, and to change or cope with the environment. Health is a goal but also a resource for living.

4. A nurse was becoming frustrated. She had given her client extensive information on his health problem, but the client continued to be noncompliant in making needed changes. Which principle had the nurse forgotten?

a. A person may have a higher priority than improving his or her health.

b. Information, while necessary, will not motivate people to change.

c. People need repetition over time to be able to absorb information.

d. Physicians, not nurses, are perceived as experts in health.

ANS: B Information alone is rarely enough to motivate a person to act. Information is necessary to know what to do and how to do it before the person chooses to act, but other factors are primarily responsible for motivating people to change their behavior. Although other priorities may result in delay of change, the fact that the client has returned to the nurse demonstrates interest in changing. Repetition may be helpful, but apparently the nurse has given information on more than one occasion because she believes extensive information has been given.

5. The nurse working with a client to change behavior to maximize health asked the client to bring his family to the next visit. Which best describes why the nurse wants the family to come with the client?

a. To analyze the family's beliefs about health

b. To determine the family's support of the client

c. To establish the family's communication patterns

d. To evaluate the family's approval of the proposed changes

ANS: D

Under the Theory of Reasoned Action, it is assumed that all behavior is determined by intentions, which are determined by attitude toward the behavior and the norms associated with the behavior. That in turn is determined by whether or not important persons approve or disapprove of the behavior. The family's beliefs about health, support of the client, and communication patterns are irrelevant if the family does not approve of the changes that have been proposed.

6. A nurse is using the theory of reasoned action when working with a client to exercise on a regular basis. Which would be the easiest way for the nurse to determine if the client will engage in this activity?

a. The client's intention to exercise regularly

b. The client's perception of the threat of illness if he doesn't exercise regularly

c. Society's emphasis on the importance of regular exercise d. The pros and cons of regular exercise

ANS: A The theory of reasoned action attempts to predict a person's intention to perform or not perform a certain behavior based on the assumption that all behavior is determined by one's behavioral intention. The client's perception of the threat of illness, the opinion of society, and benefits of regular exercise are not major factors discussed using the theory of reasoned action.

7. A nurse is using the theory of planned behavior when working with a client to change her behavior and improve her health. Which consideration should be made by the nurse?

a. If environmental limitations may prevent the person from acting

b. The availability of needed environmental supports for the client

c. The client's belief about factors that may facilitate or impede the behavior

d. If the suggested behavior is actually the most effective approach

ANS: C The theory of planned behavior stresses that perceived control is a major factor in whether or not the client performs the behavior. Thus, the nurse needs to understand the client's beliefs about factors that may facilitate or impede the behaviors. Using this theory, the environment is not considered as a major factor in client change, nor is the analysis as to if the behavior is the most effective approach.

8. Some people believe that the air within their workplace makes them ill. Which premises support this belief?

a. They consistently feel worse on workdays and weeks without holidays.

b. There has been media coverage of "sick buildings" where there is very little air exchange with fresh air outside. c. Research has demonstrated that some buildings emit poisonous vapors that make anyone who works there ill.

d. When a small group of persons begins to believe something, the others in the larger group begin to believe it as well.

ANS: A

As the question discusses risk, the textbook states that the risk factor must precede the problem and that the problem would increase with exposure. Feeling ill only on workdays would imply that some factor in the workplace is responsible. The media coverage, research related to poisonous vapors, and "group think" responses do not address the fact that the repeated exposure to the risk factor may be what is making them ill.

9. It is rumored that there is something in the workplace that is causing persons employed there to feel ill. Which action would be most appropriate for the nurse to take?

a. Ask researchers to set up a study to confirm the health hazard in the environment.

b. Assess the risk, including identifying any toxic substance. c. Confirm the extent to which the illness resulted from intergroup agreement on the illness and cause.

d. Insist that the media not further spread stories of possible sick buildings until the truth of the situation can be studied.

ANS: B The media report news; they do not create it without any basis. Researchers are not asked to confirm a preconceived conclusion but to seek what factors are active in a situation. "Group think" is a well-known phenomenon, but one would have to ask what led the communication leaders to believe originally that there was a hazard in the environment. Risk assessment in a questionable situation begins with identifying a possible hazard and describing the risk.

10. Which risk factors are least subject to modification?

a. Choice of lifestyle behaviors b. Environmental exposure

c. Nutritional options

d. Recreational activities

ANS: B An individual may choose to control lifestyle behaviors, nutrition choices, and recreational options. An individual cannot alone control his or her neighborhood, employment setting, or other environmental exposures.

11. Which best describes why risk reduction is of such importance in the United States today?

a. Families suffer when family members die from avoidable causes.

b. Risk reduction activities will decrease insurance costs to individuals and their employers. c. The leading causes of death are all related to lifestyle choices.

d. Risk reduction can decrease the ongoing rise in national health care expenditures.

ANS: C

Approximately 50% of annual U.S. deaths occur as a result of modifiable lifestyle factors. The leading causes of death with the highest mortality are all related to lifestyle factors. A change in these factors will also reduce health care expenditures and insurance costs for those persons with insurance. However, unnecessary deaths are even more important.

12. Which is the cause of most preventable deaths in the United States?

a. Alcohol

b. Drug addictions

c. Sexually transmitted diseases d. Tobacco

ANS: D Smoking is the leading cause of preventable deaths, accounting for about one out of every five deaths.

13. A nurse is completing a health history with a client. Which question would be most important to include?

a. How many alcoholic drinks do you have in a day?

b. How many sexual partners have you had in the past month? c. What nonprescription drugs do you take on a routine basis? d. What kinds of tobacco do you use daily?

ANS: D As smoking is the leading cause of preventable deaths, accounting for about one out of every five deaths, it is crucial that tobacco use be queried in each health history. After asking about tobacco use, the others should also be included in a health history.

14. During a health history, the client looked confused and said, "But everybody drinks, like at parties and such. How much drinking do you think is too much?" Which would be most appropriate response by the nurse?

a. "Alcohol should be used only in moderation."

b. "It's okay as long as you don't binge, and you eat food with your drinks."

c. "Per day, no more than one drink for women and two drinks for men."

d. "Total abstinence is the only healthy choice."

ANS: C Because most Americans drink alcohol, it is probably not effective to teach total abstinence. Alcohol in moderation is not a specific answer to the client's question. The Dietary Guidelines for Americans suggest no more than one drink for women and two drinks for men per day, which is a specific response to the client's question.

15. Which best describes the reason why so many Americans are obese?

a. Culture requires eating at celebrations and holidays.

b. For many people, caloric intake is more than needed for their physical activity.

c. Physical education is no longer a required subject in most elementary and secondary schools.

d. The expected portion size in restaurants has vastly increased over time.

ANS: B Although many factors have led to obesity in American society—including cultural pressure, increased portion sizes in restaurants (portion distortion), offers of more food at a reduced price ("super-size"), and a perceived lack of time to cook nutritious inexpensive foods—the primary cause remains the consumption of more calories than needed for physical activity. With computers and television as recreational choices, Americans are as a group sedentary rather than physically active.

16. Based on statistics, which group is probably more physically active?

a. A group of adults living in the southern U.S. states

b. A group of elderly mall walkers

c. A group of high school graduates employed in blue collar occupations

d. A group of highly paid college graduates

ANS: D Research has shown that those with higher levels of education and higher income enjoy physical activity more. Those of mature age, with less education, with less income, and/or living in the southern U.S. states engage in far less activity.

17. A young couple is searching for a home in a new neighborhood. Which neighborhood would most likely promote a healthy lifestyle?

a. One near a large active military base

b. One with excellent health facilities nearby

c. One with high walkability

d. One with superb recreational facilities

ANS: C One's environment is a significant factor. Those living in neighborhoods with high walkability engage in significantly more walking than those living in neighborhoods with low walkability. Having health and recreational facilities in the neighborhood can assist with health, but the family would need to be able to afford to purchase services at these businesses. Having a large active military base nearby would not play a major role related to the healthy lifestyle in the neighborhood.

Receiving immunizations, regular health screenings, and physical examinations is an example of

health promotion.

health protection.

secondary prevention.

health maintenance.

health protection

Which "determinants of health" refers to factors that are experienced with the senses-things that can be seen, touched, heard, and smelled?

Biology

Behaviors

Social environment

Physical environment

Physical environment

Which "determinants of health" would include predisposition to prostate cancer and a history of depression?

Biology

Behaviors

Social environment

Physical environment

Biology

According to the Health Belief Model, the inconvenience of driving to a gym to exercise is an example of a

perceived susceptibility.

perceived barrier.

perceived benefit.

cue to action.

perceived barrier.

A man has been smoking for 20 of his 40 years. He smokes a pack of cigarettes daily and states, "My dad smoked two packs a day and lived to be almost 90. Besides, I'm going to die from something anyway, so why quit?" He is in which "stage of change" in the transtheoretical model?

Contemplation

Maintenance

Precontemplation

Preparation

Precontemplation

A smoking cessation class stresses increased lung function, money saved that is not spent on cigarettes, and smelling clean as benefits to quitting smoking. These support which concept?

Perceived barriers

Decisional balance

Precontemplation

Contemplation

Decisional balance

A risk factor refers to a(n)

probability that a specific event will occur in a given time frame.

exposure that is associated with a disease.

systematic way of distinguishing the risks posed by potentially harmful exposures.

proactive process in which individuals participate in behaviors that enable them to react to actual or potential threats to their health.

exposure that is associated with a disease.

What is the most common chemical dependence in the United States?

Alcohol

Cocaine

Marijuana

Nicotine

Nicotine

A 22-year-old college student explains to the nurse at the health clinic that she drinks five beers when she goes out with friends on Saturday nights. Otherwise, she rarely drinks during the week because of her classes, studying, and part-time job. This would be considered

age- and circumstance-appropriate behavior.

alcoholism.

binge drinking.

excessive drinking.

binge drinking.