Chapter - 001 Health Promotion in Middle-Aged Adults

Black & Hawks: Medical-Surgical Nursing: Clinical Management for
Positive Outcomes, 7th Edition
Chapter 1: Health Promotion in Middle-Aged Adults
MULTIPLE CHOICE
1. The nurse explains that the belief advancing the idea that disease is a result of an
organic caused disorder is the
a. biomedical model.
b. biopsychosocial theory.
c. Travis’ health model.
d. Dunn’s High Level Wellness model.
ANS: a
The biomedical model describes disease as an organically caused disorder with consistent
clinical manifestations.
DIF: Cognitive Level: Knowledge REF: Text Reference: 5

TOP: Nursing Process Step: Intervention
MSC: NCLEX: Health Promotion and Maintenance
2. The nurse explains that the client’s ability to cope with stress dynamically will play a
significant role in the client attaining maximum potential. This approach is most
consistent with the model of
a. King.
b. Leninger.
c. Levine.
d. Neuman.
ANS: a
King’s theory suggests that continuous adjustment to stressors, both internal and external,
with the use of one’s resources allow the person to attain maximum potential.
DIF: Cognitive Level: Comprehension REF: Text Reference: 4, Table 1-1;

3. When the nurse encourages a Native American to seek health counsel from the tribe’s
shaman, the nurse is following the tenets of
a. King.
b. Pender.
c. Rogers.
d. Leninger.
ANS: d
Elsevier items and derived items 2005 by Elsevier Inc.

Chapter 1: Health Promotion in Middle-Aged Adults 2
Leninger postulates that health refers to culturally known and utilized practices that
maintain personal and group well being.
DIF: Cognitive Level: Application REF: Text Reference: 4, Table 1-1;

4. While the nurse is doing an intake interview with a new client, it becomes clear
that
the client seems to be having many problems with her health, family, finances, and
significant relationships. The nurse recognizes that these problems comprise an
allostatic load that
a. is not related to major life events and probably is not significant.
b. represents the same emotional significance to all people.
c. can lead to impaired immune responses if not coped with adequately.
d. helps strengthen the client’s stress management ability.
ANS: c
Persons who cope poorly with stress have significantly impaired immune responses, as
shown by diminished leukocyte activity levels.
DIF: Cognitive Level: Application REF: Text Reference: 21

5. The nurse using the World Health Organization (WHO) description of health bases
care on the premise that health is
a. a gift from a higher being.
b. any disease-free condition.
c. complete mental, physical, and social well being.
d. a highly personal concept of attaining self-actualization.
ANS: c
The most widely accepted definition is the classic 1947 WHO description of health as “ a
state of complete physical, mental and social well being and not merely the absence of
disease or infirmity.”

6. The nurse who is planning a health promotion program with clients in the community
will have the least focus on
a. assisting the clients to make informed decisions.
b. organizing methods to achieve optimal mental health.
c. reducing genetic risk factors for illness.

d. providing information and skills to maintain lifestyle changes.

ANS: c
Health promotion programs are designed to improve the health and well being of
individuals and communities by providing people with information, skills, services, and
support they need to undertake and maintain positive lifestyle changes.
DIF: Cognitive Level: Comprehension REF: Text Reference: 6

7. A holistic belief system by the nurse would be most evident if the nurse
a. incorporates client perceptions of health when planning care.
b. encourages behavior modification programs.
c. supports goal-directed learning to improve health.
d. accepts death as an outcome of life.
ANS: a
The theories of Orem, Rogers, and Roy focus on the holistic view, which takes the client
and the client’s beliefs, values, and culture as necessary considerations to comprehensive
care.

8. Dunn discussed the feeling of being “alive to the tips of the fingers, with energy to
burn, tingling with vitality.” The nurse recognizes this concept as
a. euphoria.
b. high-level wellness.
c. self-actualization.
d. achieving maximum potential.
ANS: b
Dunn’s theory is that of high-level wellness.

TOP: Nursing Process Step: N/A MSC: NCLEX: N/A
9. The nurse is searching for a report released by the U.S. Surgeon General’s Office that
discusses the relationship between health and the environment. This report is
a. the Goldmark Report.
b. Healthy People.
c. Social Security amendments.
d. Nursing’s Agenda for Healthcare.
ANS: b

Healthy People and the Lalonde Report both brought to public scrutiny the
interrelationship between health and the environment.

TOP: Nursing Process Step: N/A MSC: NCLEX: N/A
10. The nurse points out that the activity that could reflect primary prevention is
a. collaboration with a physical therapist.
b. tuberculosis screening.
c. physician-prescribed exercise after a heart attack.
d. a self-initiated walking regimen.
ANS: d
Primary prevention is an activity that is done before any illness, but as a preventive effort
to avoid illness.
DIF: Cognitive Level: Analysis REF: Text Reference: 15

11. The nurse is planning a teaching program at a local swim club to discuss the correct
diving technique to prevent spinal cord injury. This type of program is best classified
as
a. primary prevention.
b. secondary prevention.
c. tertiary prevention.
d. epidemiologic prevention.
ANS: a
Primary prevention is concerned with health promotion activities that prevent the actual
occurrence of a specific disease or disability.

12. The nurse is developing a teaching plan for a 60-year-old man who experienced a
cerebrovascular accident (CVA) 1 year ago. The nurse works with the client to
prevent aspiration when eating. This is an example of
a. primary prevention.
b. secondary prevention.
c. tertiary prevention.
d. epidemiologic prevention.
ANS: c
Tertiary prevention is directed toward rehabilitation after a disorder already exists. The
interventions are directed toward minimizing disability and improving quality of life.


13. The nurse is counseling an overweight young man on entry into a weight reduction
program. The nurse is aware that the client is most likely to begin and maintain the
program if he
a. is aware of being overweight.
b. has read about the program.
c. feels competent about making the change.
d. can envision himself as thinner.
ANS: c
Clients are more likely to be motivated to change if they feel competent to do it and can
be lead to believe that the problem is solvable.

14. Which statement by the nurse indicates that the nurse needs more instruction in
promoting healthy behaviors?
a. My client needs more than the usual amount of support to cope with his asthma
because of his depression.
b. I gave my client a book on diabetes. It is comprehensive and should help her.
c. I want my client to inject his own insulin, even though his daughter has
volunteered.
d. My client needs a cheerleader to inspire her to do wound care.
ANS: b
Both practice and research have demonstrated that giving information to clients does not,
in itself, bring about healthy behaviors.

15. The nursing intervention that is least likely to motivate clients to change health
behaviors is
a. encouraging clients to see problems as solvable.
b. inspiring clients to believe in themselves and their ability to cope.
c. providing clients positive feedback when they show interest in change.
d. convincing clients to accept solutions that are unattractive to them.
ANS: d
Clients must see the problem as solvable and the solution as attractive and must believe
they have the ability to perform the intervention successfully. Positive feedback
reinforces all these tenets.


16. A nurse desiring to design a nursing approach based on human caring will be
following the theory of
a. Roy.
b. Neuman.
c. Rogers.
d. Watson.
ANS: d
Watson’s model focuses on caring, not curing.
DIF: Cognitive Level: Comprehension REF: Text Reference: 4, Table 1-1;

17. The nurse is caring for a 35-year-old client at risk for cardiovascular disease. The
client states that he is aware that he must “maintain a low-fat diet.” Using the
Transtheoretical Model and Stage of Change, the nurse assesses that this client is at
the stage of
a. precontemplation.
b. contemplation.
c. action.
d. maintenance.
ANS: b
The contemplation phase describes the client as seriously thinking about a change.

18. The nurse who is using social resources to help a client adjust to a recent below-the-
knee amputation would
a. introduce the client to an individual who has successfully adjusted to a similar
amputation.
b. explore feelings related to amputation in the social context of a group.
c. encourage the client to maintain social contacts and activities.
d. make a referral to a qualified social worker.
ANS: a
Social support may help a client adhere to medical treatment. Social resources that can
influence adaptation to chronic illness include interaction with people with the same
illness, money, and community services.


19. A client who has had multiple sclerosis (MS) for 10 years informs his home health
nurse that he has set a goal of running in a marathon. The nurse’s best response to
this statement would be
a. “It is important to set goals to maintain mobility. Generally, persons with MS do
not compete in marathons.”
b. “I think you should compete in shorter races before trying to run an official full-
length marathon.”
c. “What does your doctor have to say about you planning to run in a full-length
marathon?”
d. “It is not good for you to set unrealistic goals for yourself, like running in a full-
length marathon.”
ANS: a
When clients and families idenify goals that seem unrealistic, the home health nurse
should tell them that although the nurse cannot say for sure that they will not achieve the
goals, persons with similar conditions have not done so.

20. The nurse can “empower” a client in adjusting to the changes associated with the
chronic effects of non-insulin-dependent diabetes mellitus by
a. informing the client about the different types of insulin.
b. explaining that concerns about vision changes are premature at this point.
c. teaching the client how to minimize complications.
d. expaining the pathophysiology of the disease.
ANS: c
Empowering gives the client information, skills, and contact with services available to
deal with the client’s disease.

21. Using the theory of high-level wellness, the nurse assesses four clients and
determines that the client exhibiting high-level wellness is
a. the 20-year-old athlete who eats a healthy diet and smokes a pack of cigarettes a
day.
b. the 30-year-old obese housewife who has lost 20 pounds, exercises 1 hour a day,
and eats 10 cookies a day.
c. the 50-year old frail client with rheumatoid arthritis who swims 1 hour a day, sits

and reads for 5 hours a day, and sleeps for at least 10 hours a day.
d. the 70-year-old robust retiree who plays 18 holes of golf a day, eats a healthy diet,
and drinks two glasses of red wine each evening.
ANS: d
There are degrees of health and illness. High-level wellness maximizes one’s potential
capacity and is a component of the highest level of health.

TOP: Nursing Process Step: Assessment
22. The nurse who is doing an epidemiologic study in a local high school would
a. determine the source of an epidemic of scabies.
b. identify processes to make halls and stairways more safe against falls.
c. design methods to increase physical fitness for the entire school population.
d. identify teenagers at risk for pregancy.
ANS: d
Epidemiology is the study of health patterns and disease, identification of subgroups at
risk for acquiring a disability, and interventions to lower the risk.

23. The nurse who uses Bandura’s Social Cognitive Theory to effect change in a group
of obese junior high students leads them in this cheer every morning,” Hey! Hey! I
am round, but I’m not meek! I’m gonna loose one pound this week!” This is an
example of providing
a. performance attainment.
b. vicarious experience.
c. identification of physiologic states.
d. verbal persuasion.
ANS: d
Verbal persuasion help convince clients of their capability to attain or execute a specific
behavior.

24. The nurse caring for a client who is despondent about his decreasing vision related to
macular degeneration introduces the possibility of a treatment option of
angiogenesis, which is an evolving
a. gene therapy that stimulates growth of new blood vessels.
b. behavior relaxation technique that causes vasodilation.

c. technique using an intravenous gene-enhancing drug that stimulates the optic

nerve.
d. treatment approach using deep heat, which causes vasodilation.
ANS: a
Angiogenesis is a gene therapy that stimulates new blood vessels.

25. Suggestions that a home health nurse could make to an elderly client with cataracts
to reduce the risk of falls in his home would include
a. using lower-illumination bulbs to prevent eyestrain.
b. arranging scatter rugs to prevent slipping on the hardwood floor.
c. using night-lights in every room.
d. wearing soft-soled house shoes indoors.
ANS: c
The visual impairment requires increased illumination and an uncluttered environment.
Soft-soled shoes enhance the fall potential.

MSC: NCLEX: Safe, Effective Care Environment;
26. As the school nurse is examining the health records of a group of 14-year-old junior
high school students, he recognizes a potential race-related health problem when he
observes
a. a Japanese boy who wears glasses.
b. an Hispanic girl who is 30 pounds overweight.
c. a Native American boy who is 15 pounds underweight.
d. a black girl who brought a can of beer to school in her lunch.
ANS: b
Hispanics and blacks are prone to diabetes. Excessive weight can hasten the onset.

27. The school nurse explains to a tanned, blond high school senior that she is at risk for
skin cancer because
a. tanned skin is in reality “dead” skin.
b. DNA is damaged by ultraviolet exposure.
c. repeated exposure to the sun weakens the squamous cells.
d. the dermal layer becomes thickened from repeated ultraviolet exposure.

ANS: b
The chief cause of skin cancer is damage to DNA from ultraviolet (UV) light.

28. The school nurse reviewing records of 300 high school students notes that 29 are
“seriously” overweight. The nurse interprets this to mean that these students are
a. 100 pounds overweight.
b. physically impaired by their excess weight.
c. no more than 50 pounds overweight.
d. already exhibiting clinical manifestations of hypertension or diabetes.
ANS: a
Many Americans are seriously overweight, meaning 100 pounds overweight or double
the average weight.

TOP: Nursing Process Step: Diagnosis
29. The nurse explains to the anxious client that mind-body techniques can have many
positive outcomes, with the most significant being that the technique
a. is easy to do.
b. is inexpensive.
c. is beneficial to the immune system.
d. enhances life experience.
ANS: c
Mind-body therapies can influence the immune system, help manage pain, and reduce
stress.


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Black & Hawks: Medical-Surgical Nursing: Clinical Management for

Positive Outcomes, 7th Edition

Chapter 1: Health Promotion in Middle-Aged Adults

DIF: Cognitive Level: Knowledge REF: Text Reference: 5

DIF: Cognitive Level: Comprehension REF: Text Reference: 4, Table 1-1;

Elsevier items and derived items 2005 by Elsevier Inc.

DIF: Cognitive Level: Application REF: Text Reference: 4, Table 1-1;

DIF: Cognitive Level: Application REF: Text Reference: 21

DIF: Cognitive Level: Knowledge REF: Text Reference: 3

Elsevier items and derived items 2005 by Elsevier Inc.

d. providing information and skills to maintain lifestyle changes.

DIF: Cognitive Level: Comprehension REF: Text Reference: 6

DIF: Cognitive Level: Application REF: Text Reference: 4, Table 1-1;

DIF: Cognitive Level: Knowledge REF: Text Reference: 4

Elsevier items and derived items 2005 by Elsevier Inc.

DIF: Cognitive Level: Knowledge REF: Text Reference: 6

DIF: Cognitive Level: Analysis REF: Text Reference: 15

DIF: Cognitive Level: Application REF: Text Reference: 15

Elsevier items and derived items 2005 by Elsevier Inc.

DIF: Cognitive Level: Application REF: Text Reference: 16

DIF: Cognitive Level: Analysis REF: Text Reference: 18

DIF: Cognitive Level: Analysis REF: Text Reference: 18

Elsevier items and derived items 2005 by Elsevier Inc.

DIF: Cognitive Level: Application REF: Text Reference: 18

DIF: Cognitive Level: Comprehension REF: Text Reference: 4, Table 1-1;

DIF: Cognitive Level: Analysis REF: Text Reference: 17

Elsevier items and derived items 2005 by Elsevier Inc.

DIF: Cognitive Level: Application REF: Text Reference: 24

DIF: Cognitive Level: Application REF: Text Reference: 24

DIF: Cognitive Level: Analysis REF: Text Reference: 5

Elsevier items and derived items 2005 by Elsevier Inc.

DIF: Cognitive Level: Analysis REF: Text Reference: 5

DIF: Cognitive Level: Analysis REF: Text Reference: 6

DIF: Cognitive Level: Application REF: Text Reference: 16

Elsevier items and derived items 2005 by Elsevier Inc.

c. technique using an intravenous gene-enhancing drug that stimulates the optic

DIF: Cognitive Level: Knowledge REF: Text Reference: 19

DIF: Cognitive Level: Application REF: Text Reference: 8, Table 1-2;

DIF: Cognitive Level: Application REF: Text Reference: 7, Table 1-2;

Elsevier items and derived items 2005 by Elsevier Inc.

DIF: Cognitive Level: Comprehension REF: Text Reference: 21

DIF: Cognitive Level: Comprehension REF: Text Reference: 22

DIF: Cognitive Level: Knowledge REF: Text Reference: 25

Elsevier items and derived items 2005 by Elsevier Inc.

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