Chapter 06: Health and Wellness

MULTIPLE CHOICE

1. A nurse is teaching about the goals of Healthy People 2020. Which information
should the nurse include in the teaching session?
a. Eliminate health disparities in America.
b. Eliminate health behaviors in America.
c. Eliminate quality of life in America.
d. Eliminate healthy life in America.

ANS: A

The nurse should include eliminating health disparities in America. Healthy People
2020 promotes a society in which all people live long, healthy lives. There are four
overarching goals: (1) attain high-quality, longer lives free of preventable disease,
disability, injury, and premature death; (2) achieve health equity, eliminate disparities,
and improve the health of all groups; (3) create social and physical environments that
promote good health for all; and (4) promote quality of life, healthy development, and
healthy behaviors across all life stages.

DIF: Understand (comprehension) REF: 66

OBJ: List the four general Healthy People 2020 public health goals for Americans.

TOP: Teaching/Learning MSC: Health Promotion and Maintenance

2. A nurse is following the goals of Healthy People 2020 to provide care. Which
action should the nurse take?
a. Allow people to continue current behaviors to reduce the stress of change.
b. Focus only on health changes that will lead to better local communities.
c. Create social and physical environments that promote good health.
d. Focus on illness treatment to provide fast recuperation.
ANS: C

Healthy People 2020 includes four goals, one of which is to create social and physical
environments that promote good health for all. The goals do not include continuing
current behaviors to reduce stress, focusing only on health changes for communities, or
focusing on fast recuperation.

DIF: Apply (application) REF: 66

OBJ: List the four general Healthy People 2020 public health goals for Americans.

TOP: Implementation MSC: Health Promotion and Maintenance

3. A nurse is using the World Health Organization definition of health to provide

care. Which area will the nurse focus on while providing care?
a. Making sure the patients are disease free
b. Making sure to involve the whole person
c. Making sure care is strictly personal in nature
d. Making sure to focus only on the pathological state

ANS: B

The World Health Organization (WHO) defines health as a “state of complete physical,
mental, and social well-being, not merely the absence of disease or infirmity.”
Therefore, nurses’ attitudes toward health and illness should consider the total person,
as well as the environment in which the person lives. All people free of disease are not
necessarily healthy. Strictly personal and a focus only on pathological states do not
correlate to WHO’s definition.

DIF: Apply (application) REF: 66

OBJ: Discuss the definition of health. TOP: Implementation

MSC: Management of Care

4. The nurse is preparing a smoking cessation class for family members of patients
with lung cancer. The nurse believes that the class will convert many smokers to
nonsmokers once they realize the benefits of not smoking. Which health care
model is the nurse following?
a. Health belief model
b. Holistic health model
c. Health promotion model
d. Maslow’s hierarchy of needs

ANS: A

The health belief model addresses the relationship between a person’s beliefs and
behaviors. The holistic health model recognizes the natural healing abilities of the body
and incorporates complementary and alternative interventions such as music therapy.
The health promotion model focuses on the following three areas: (1) individual
characteristics and experiences, (2) behavior-specific knowledge and affect, and (3)
behavioral outcomes, in which the patient commits to or changes a behavior. Maslow’s’
hierarchy of needs is based on the theory that all people share basic human needs, and
the extent to which basic needs are met is a major factor in determining a person’s level
of health.

DIF: Analyze (analysis) REF: 66

OBJ: Discuss the health belief, health promotion, basic human needs, and holistic
health models to understand the relationship between patients’ attitudes toward health
and health practices.

TOP: Implementation MSC: Health Promotion and Maintenance

5. A nurse is using Maslow’s hierarchy to prioritize care for an anxious patient that
is not eating and will not see family members. Which area should the nurse
address first?
a. Anxiety
b. Not eating
c. Mental health
d. Not seeing family members

ANS: B

According to Maslow, in all cases an emergent physiological need takes precedence

over a higher-level need. Nutrition is a physiological need and should be addressed
first. Anxiety, mental health, and not seeing family members are all higher-level needs.

DIF: Analyze (analysis) REF: 67-68

OBJ: Discuss the health belief, health promotion, basic human needs, and holistic
health models to understand the relationship between patients’ attitudes toward health
and health practices.

TOP: Implementation MSC: Management of Care

6. The patient is reporting moderate incisional pain that was not relieved by the last
dose of pain medication. The patient is not due for another dose of medication for
another 2 1/2 hours. The nurse repositions the patient, asks what type of music
the patient likes, and sets the television to the channel playing that type of music.
Which health care model is the nurse using?
a. Health belief model
b. Holistic health model
c. Health promotion model
d. Maslow’s hierarchy of needs

ANS: B

The holistic health model recognizes the natural healing abilities of the body and
incorporates complementary and alternative interventions such as music therapy. The
health belief model addresses the relationship between a person’s beliefs and
behaviors. The health promotion model notes that each person has unique personal
characteristics and experiences that affect subsequent actions. The basic human needs
model believes that the extent to which basic needs are met is a major factor in
determining a person’s level of health. Maslow’s hierarchy of needs is a model that
nurses use to understand the interrelationships of basic human needs.

DIF: Apply (application) REF: 68-69

OBJ: Discuss the health belief, health promotion, basic human needs, and holistic
health models to understand the relationship between patients’ attitudes toward health
and health practices.

TOP: Implementation MSC: Management of Care

7. A nurse is assessing internal variables that are affecting the patient’s health
status. Which area should the nurse assess?
a. Perception of functioning
b. Socioeconomic factors
c. Cultural background
d. Family practices

ANS: A

Internal variables include a person’s developmental stage, intellectual background,

perception of functioning, and emotional and spiritual factors. External variables
influencing a person’s health beliefs and practices include family practices,
socioeconomic factors, and cultural background.

DIF: Apply (application) REF: 69 | 74

OBJ: Describe variables influencing health beliefs and practices.

TOP: Assessment MSC: Health Promotion and Maintenance

8. The nurse is admitting a patient with uncontrolled diabetes mellitus. It is the

fourth time the patient is being admitted in the last 6 months for high blood
 sugars. During the admission process, the nurse asks the patient about
employment status and displays a nonjudgmental attitude. What is the rationale
for the nurse’s actions?
a. External variables have little effect on compliance.
b. A person’s compliance is affected by economic status.
c. Employment status is an internal variable that impacts compliance.
d. Noncompliant patients thrive on the disapproval of authority figures.

ANS: B

A person’s compliance with treatment is affected by economic status. A person tends to

give a higher priority to food and shelter than to costly drugs or treatments. External
variables can have a major impact on compliance. Employment status is an external
variable, not an internal variable. A person generally seeks approval and support from
social networks, and this desire for approval affects health beliefs and practices;
noncompliance does not occur from thriving on disapproval of authority figures.

DIF: Apply (application) REF: 69-70 | 74

OBJ: Describe variables influencing health beliefs and practices.

TOP: Implementation MSC: Health Promotion and Maintenance

9. The nurse is working on a committee to evaluate the need for increasing the
levels of fluoride in the drinking water of the community. Which concept is the
nurse fostering?
a. Illness prevention
b. Wellness education
c. Active health promotion
d. Passive health promotion

ANS: D
Fluoridation of municipal drinking water and fortification of homogenized milk with
vitamin D are examples of passive health promotion strategies. With active strategies of
health promotion, individuals are motivated to adopt specific health programs such as
weight reduction and smoking cessation programs. Illness prevention activities such as
immunization programs protect patients from actual or potential threats to health.
Wellness education teaches people how to care for themselves in a healthy way.

DIF: Understand (comprehension) REF: 71

OBJ: Describe health promotion, wellness, and illness prevention activities.

TOP: Implementation MSC: Health Promotion and Maintenance

10. The nurse is working in a clinic that is designed to provide health education and
immunizations. Which type of preventive care is the nurse providing?
a. Primary prevention
b. Secondary prevention
c. Tertiary prevention
d. Risk factor prevention

ANS: A

Primary prevention precedes disease or dysfunction and is applied to people

considered physically and emotionally healthy. Primary prevention includes health
education programs, immunizations, and physical and nutritional fitness activities.
Secondary prevention focuses on individuals who are experiencing health problems or
illnesses and who are at risk for developing complications or worsening conditions.
Activities are directed at diagnosis and prompt intervention. Tertiary prevention occurs
when a defect or disability is permanent and irreversible. It involves minimizing the
effects of long-term disease or disability through interventions directed at preventing
complications and deterioration. While risk factor modification is an integral component
of health promotion, it is not a type of preventive care.

DIF: Understand (comprehension) REF: 71

OBJ: Discuss the three levels of preventive care. TOP: Implementation

MSC: Health Promotion and Maintenance

11. The patient is admitted to the emergency department of the local hospital from
home with reports of chest discomfort and shortness of breath. The patient is
placed on oxygen, has labs and blood gases drawn, and is given an
electrocardiogram and breathing treatments. Which level of preventive care is
this patient receiving?
a. Primary prevention
b. Secondary prevention
c. Tertiary prevention
d. Health promotion

ANS: B

Secondary prevention focuses on individuals who are experiencing health problems or

illnesses and who are at risk for developing complications or worsening conditions.
Activities are directed at diagnosis and prompt intervention. Primary prevention
precedes disease or dysfunction and is applied to people considered physically and
emotionally healthy. Health promotion includes health education programs,
immunizations, and physical and nutritional fitness activities for healthy people. Tertiary
prevention occurs when a defect or disability is permanent and irreversible. It involves
minimizing the effects of long-term disease or disability through interventions directed at
preventing complications and deterioration.

DIF: Apply (application) REF: 71

OBJ: Discuss the three levels of preventive care. TOP: Evaluation

MSC: Management of Care

12. A patient is admitted to a rehabilitation facility following a stroke. The patient has
right-sided paralysis and is unable to speak. The patient will be receiving physical
therapy and speech therapy. Which level of preventive care is the patient
receiving?
a. Primary prevention
b. Secondary prevention
c. Tertiary prevention
d. Health promotion

ANS: C

Tertiary prevention occurs when a defect or disability is permanent and irreversible. It

involves minimizing the effects of long-term disease or disability through interventions
directed at preventing complications and deterioration. Secondary prevention focuses
on individuals who are experiencing health problems or illnesses and who are at risk for
developing complications or worsening conditions. Activities are directed at diagnosis
and prompt intervention. Primary prevention precedes disease or dysfunction and is
applied to people considered physically and emotionally healthy. Health promotion
includes health education programs, immunizations, and physical and nutritional fitness
activities.

DIF: Apply (application) REF: 72

OBJ: Discuss the three levels of preventive care. TOP: Evaluation

MSC: Management of Care

13. Upon completing a history, the nurse finds that a patient has risk factors for lung
disease. How should the nurse interpret this finding?
a. A person with the risk factor will get the disease.
b. The chances of getting the disease are increased.
c. Risk modification will have no effect on disease prevention.
d. The disease is guaranteed not to develop if the risk factor is controlled.

ANS: B

The presence of risk factors does not mean that a disease will develop, but risk factors
increase the chances that the individual will experience a particular disease or
dysfunction. Control of risk factors does not guarantee that a disease will not develop.
However, risk factor modification can assist patients in adopting activities to promote
health and decrease risks of illness.

DIF: Understand (comprehension) REF: 72

OBJ: Describe four types of risk factors affecting health. TOP: Assessment

MSC: Health Promotion and Maintenance

14. The nurse is caring for a patient who has been trying to quit smoking. The patient
has been smoke free for 2 weeks but had two cigarettes last night and at least
two this morning. What should the nurse anticipate?
a. The patient does not want to and will never quit smoking.
b. The patient must pick up the attempt right where the patient left off.
c. The patient will return to the contemplation or precontemplation phase.
d. The patient will need to adopt a new lifestyle for change to be effective.

ANS: C

When relapse occurs, the person will return to the contemplation or precontemplation
stage before attempting the change again. The patient cannot pick up the attempt
where left off. It is believed that change involves movement through a series of stages
(precontemplation, contemplation, preparation, action, and maintenance). Anticipating
that the patient does not want to and will never quit is premature. While the patient will
need to adopt a new lifestyle for change to be effective, it does not correlate to this
scenario since the patient relapsed.

DIF: Analyze (analysis) REF: 73

OBJ: Discuss risk factor modification and changing health behaviors.

TOP: Planning MSC: Health Promotion and Maintenance

 15. The nurse is working in a drug rehabilitation clinic and is in the process of
admitting a patient for “detox.” What should the nurse do next?
a. Identify the patient’s stage of change.
b. Realize that the patient is ready to change.
c. Teach the patient that choices will have to change.
d. Instruct the patient that relapses will not be tolerated.

ANS: A

The nurse should identify the stage of change and assess where the patient is currently
in this situation. To be most effective, nursing interventions should match the stage of
change. The nurse cannot realize the patient is ready for change because only a
minority of people are actually in the action stage of changing. While teaching that
choices will have to change, it will follow later after the nurse has determined which
stage the person is in. As individuals attempt a change in behavior, relapse followed by
recycling through the stages occurs frequently.

DIF: Analyze (analysis) REF: 73

OBJ: Discuss risk factor modification and changing health behaviors.

TOP: Implementation MSC: Management of Care

16. A female patient has been overweight for most of her life. She has tried dieting in
the past and has lost weight, only to regain it when she stopped dieting. The
patient is visiting the weight loss clinic/health club because she has decided to do
it. She states that she will join right after the holidays, in 3 months. Which stage
is the patient displaying?
a. Precontemplation
b. Contemplation
c. Preparation
d. Action

ANS: B
This patient is planning to make the change within the next 6 months and is in the
contemplation stage. These stages range from no intention to change
(precontemplation), to considering a change within the next 6 months (contemplation),
to making small changes (preparation), to actively engaging in strategies to change
behavior (action), to maintaining a changed behavior (maintenance).

DIF: Apply (application) REF: 73

OBJ: Discuss risk factor modification and changing health behaviors.

TOP: Evaluation MSC: Health Promotion and Maintenance

17. Upon completion of the assessment, the nurse finds that the patient has quit
drinking and has been alcohol free for the past 2 years. Which
stage best describes the nurse’s assessment finding?
a. Contemplation
b. Maintenance
c. Preparation
d. Action

ANS: B

Because the patient has been alcohol free for 2 years, the patient is in the maintenance
stage. These stages range from no intention to change (precontemplation), to
considering a change within the next 6 months (contemplation), to making small
changes (preparation), to actively engaging in strategies to change behavior (action), to
maintaining a changed behavior (maintenance).

DIF: Apply (application) REF: 73

OBJ: Discuss risk factor modification and changing health behaviors.

TOP: Evaluation MSC: Health Promotion and Maintenance

 18. The patient had a colostomy placed 1 week ago. When approached by the nurse,
the patient and spouse refuse to talk about it and refuse to be taught about how
to care for it. How will the nurse evaluate this couple’s stage of adjustment?
a. Shock
b. Withdrawal
c. Acceptance
d. Rehabilitation

ANS: B

As the patient and family recognize the reality of a change, they become anxious and
may withdraw, refusing to discuss it. This is an adaptive coping mechanism that assists
the patient in making the adjustment. Initially, the patient may be shocked by the
change. This is followed by withdrawal, acknowledgment, acceptance, and rehabilitation
(ready to adapt to the change through use of colostomy bag).

DIF: Analyze (analysis) REF: 75

OBJ: Describe the effect of illness on patients and families. TOP: Evaluation

MSC: Psychosocial Integrity

19. A patient has had emphysema (lung disease) for many years. When approached
by the nurse, the patient states “I would be better off dead.” The patient supports
the family, and now because of oxygen dependency the patient must quit work.
The patient’s spouse will have to go to work. Which action should the nurse
take?
a. Develop a plan of care for the family.
b. Contact psychiatric services for a referral.
c. Assure the patient that things will work out.
d. Focus the plan of care solely on maximizing patient function.

ANS: A
Because of the effects of chronic illness, family dynamics often change. The nurse must
view the whole family as a patient under stress, planning care to help the family regain
its maximal level of functioning and well-being. Psychiatric services may be a part of
that plan but do not represent the entire plan. Offering false assurance is never
acceptable. Focusing only on the patient will not help the family adjust.

DIF: Apply (application) REF: 75

OBJ: Describe the effect of illness on patients and families. TOP: Implementation

MSC: Psychosocial Integrity

20. A nurse is teaching about the transtheoretical model of change. In which order
will the nurse place the progression of the stages from beginning to end?
21. Action
22. Preparation
23. Maintenance
24. Contemplation
25. Precontemplation
a. 5, 4, 2, 1, 3
b. 2, 5, 4, 3, 1
c. 4, 5, 3, 1, 2
d. 1, 5, 2, 3, 4

ANS: A

The stages of change in the transtheoretical model of change include five stages. These
stages range from no intention to change (precontemplation), considering a change
within the next 6 months (contemplation), making small changes (preparation), and
actively engaging in strategies to change behavior (action), to maintaining a changed
behavior (maintenance stage).

DIF: Understand (comprehension) REF: 73

OBJ: Describe variables influencing health beliefs and practices.

TOP: Teaching/Learning MSC: Health Promotion and Maintenance

MULTIPLE RESPONSE

1. Which areas should the nurse assess to determine the effects of external
variables on a patient’s illness? (Select all that apply.)
a. Patient’s perception of the illness
b. Patient’s coping skills
c. Socioeconomic status
d. Cultural background
e. Social support

ANS: C, D, E

External variables influencing a patient’s illness behavior include the visibility of

symptoms, social group, cultural background, economic variables, accessibility of the
health care system, and social support. Internal variables include the patient’s
perceptions of symptoms and the nature of the illness, as well as the patient’s coping
skills and locus of control.

DIF: Understand (comprehension) REF: 69 | 74

OBJ: Describe variables influencing illness behavior. TOP: Assessment

MSC: Psychosocial Integrity

2. A nurse meets the following goals: helps a patient maintain health and helps a
patient with an illness. Which factors assist the nurse in achieving these goals?
(Select all that apply.)
a. Understands the challenges of today’s health care system
b. Identifies actual and potential risk factors
c. Has coined the term “illness behavior”
d. Minimizes the effects of illnesses
e. Experiences compassion fatigue
ANS: A, B, D

Nurses are in a unique position to assist patients in achieving and maintaining optimal
levels of health. Nurses understand the challenges of today’s health care system.
Nurses can identify actual and potential risk factors that predispose a person or group to
illness. Nurses who understand how patients react to illness can minimize the effects of
illness and assist patients and their families in maintaining or returning to the highest
level of functioning. Nurses did not coin the phrase “illness behavior.” While nurses can
experience compassion fatigue, it does not help in meeting patient goals.