Chapter 01: Health Defined: Objectives for Promotion and Prevention
Edelman: Health Promotion Throughout the Life Span, 9th Edition

MULTIPLE CHOICE

	1.	Which model of health is most likely used by a person who does not believe in preventive health care?
a.	Clinical model	
b.	Role performance model	
c.	Adaptive model	
d.	Eudaimonistic model	

ANS:	A
The clinical model of health views the absence of signs and symptoms of disease as indicative of health. People who use this model wait until they are very sick to seek care.

DIF:	Cognitive Level: Remember (Knowledge)		REF:	p. 3.

	2.	A person with chronic back pain is cared for by her primary care provider, as well as receives acupuncture. Which model of health does this person likely favor?
a.	Clinical model	
b.	Role performance model	
c.	Adaptive model	
d.	Eudaimonistic model	

ANS:	D
The eudaimonistic model embodies the interaction and interrelationships among physical, social, psychological, and spiritual aspects of life and the environment in goal attainment and creating meaning in life. Practitioners who practice the clinical model may not be enough for someone who believes in the eudaimonistic model. Those who believe in the eudaimonistic model often look for alternative providers of care.

DIF:	Cognitive Level: Apply (Application)		REF:	p. 3

	3.	Halbert Dunn (1961) introduced the concept of high level wellness, a health-illness continuum which factored in the individual’s environment when determining a level of health. Which of the following statements is correct concerning his model?
a.	Care recipients who are terminal or dying could not be classified as having high-level wellness.	
b.	The focus is on environment and the ability to achieve health on a personal and societal level.	
c.	It provides a view of health which is in opposition to the eudaimonistic model of health.	
d.	It is most closely aligned with a clinical model of health.	

ANS:	B
Dunn’s construct of high level wellness assesses a person’s wellness not only from the perspective of his relative health but also factors in his environment—favorable or unfavorable—to arrive at a more comprehensive determination of relative wellness. With this concept in mind, a person who is dying can be said to have achieved high-level wellness via emotionally preparing for death and/or supporting others toward this end. His concept defines health on both personal and societal levels. This model is similar to the eudaimonistic model of health which factors in physical, social, psychological, and spiritual aspects as well as influences from the environment in defining health. For these reasons, choices A, C, and D would all be incorrect.

DIF:	Cognitive Level: Apply (Application)		REF:	p. 4

	4.	A state of physical, mental, spiritual, and social functioning that realizes a person’s potential and is experienced within a developmental context is known as
a.	growth and development.	
b.	health.	
c.	functioning.	
d.	high-level wellness.	

ANS:	B
Health is defined as a state of physical, mental, spiritual, and social functioning that realizes a person’s potential and is experienced within a developmental context.

DIF:	Cognitive Level: Remember (Knowledge)		REF:	p. 5

	5.	Which of the following best describes a care recipient who has an illness?
a.	Someone who has well-controlled diabetes	
b.	Someone with hypercholesterolemia	
c.	Someone with a headache	
d.	Someone with coronary artery disease without angina	

ANS:	C
Someone with a headache represents a person with an illness. An illness is made up of the subjective experience of the individual and the physical manifestation of disease. It can be described as a response characterized by a mismatch between a person’s needs and the resources available to meet those needs. A person can have a disease without feeling ill. The other choices represent disease.

DIF:	Cognitive Level: Analyze (Analysis)			REF:	p. 6

	6.	Which US report is considered a landmark document in creating a global approach to health?
a.	The 1990 Health Objectives for the Nation: A Midcourse Review	
b.	Healthy People 2020	
c.	Healthy People 2000	
d.	The US Surgeon General Report	

ANS:	C
Healthy People 2000 and its Midcourse Review and 1995 Revisions were landmark documents in which a consortium of people representing national organizations worked with US Public Health Service officials to create a more global approach to health.

DIF:	Cognitive Level: Remember (Knowledge)		REF:	p. 6

	7.	Which of the following is one of the four overreaching goals for Healthy People 2020 (US Department of Health and Human Services)?
a.	Decreased tobacco use in youth throughout the nation	
b.	Achieve health equality and eliminate disparity for all groups	
c.	Increased public funding for health insurance	
d.	Decreased hospital re-admission rates	

ANS:	B
Healthy people 2020 has four overarching goals to include the following: 1. attain high quality, longer lives free of preventable disease, disability, injury, and premature death. 2. Achieve health equality, eliminate disparities, and improve the health of all groups. 3. Create social and physical environments that promote good health for all. 4. Promote quality of life, healthy development, and healthy behaviors across all life stages. Choices A, C, and D are possible strategies to achieve the state goals but they do not reflect the actual published overarching goals.

DIF:	Cognitive Level: Remember (Knowledge)		REF:	p. 7

	8.	Which of the following statements accurately reflect primordial prevention?
a.	It concerns interventions directed at the fetus while in utero to assure lifelong health.	
b.	It is a more modern term used interchangeably with primary prevention.	
c.	It is a health-promotion strategy which reflects policy-level interventions.	
d.	It refers administering vaccines to prevent individuals from developing the disease.	

ANS:	C
Primordial prevention is a fairly new concept which has been added to the more traditional modalities of primary, secondary, and tertiary prevention. Primordial refers to the time frame before a risk factor develops and before disease occurs. Primordial prevention reflects policy-level interventions which will serve to prevent disease. Such prevention is typically implemented at the “national, state, or community” levels. Examples of primordial prevention would be state regulations which mandate healthy food for school-based lunch programs or regulations which call for the elimination of trans fats in commercial foods. By contrast, primary prevention are those interventions which are directed at the individual in the interest of preventing disease. Vaccinating an individual against disease would be an example of primary prevention as would be education and interventions (exercise, low fat, avoiding excess salt) aimed at preventing cardiovascular disease before it occurs.

DIF:	Cognitive Level: Remember (Knowledge)		REF:	p. 9

	9.	Which of the following represents a method of primary prevention?
a.	Informational session about healthy lifestyles	
b.	Blood pressure screening	
c.	Interventional cardiac catheterization	
d.	Diagnostic cardiac catheterization	

ANS:	A
Primary prevention precedes disease or dysfunction. It includes health promotion and specific protection and encourages increased awareness; thus, education about healthy lifestyles fits this definition. Blood pressure screening does not prevent disease, but instead identifies it.

DIF:	Cognitive Level: Apply (Application)		REF:	p. 11

	10.	Which of the following represents a method of secondary prevention?
a.	Self-breast examination education	
b.	Yearly mammograms	
c.	Chemotherapy for advanced breast cancer	
d.	Complete mastectomy for breast cancer	

ANS:	B
Screening is secondary prevention because the principal goal of screenings is to identify individuals in an early, detectable stage of the disease process. A mammogram is a screening tool for breast cancer and thus is considered a method of secondary prevention.

DIF:	Cognitive Level: Apply (Application)		REF:	p. 13

	11.	Which of the following represents a method of tertiary prevention?
a.	Drunk driving campaign	
b.	Road blocks for drunk driving	
c.	Emergency surgery for head trauma after a motor vehicle accident	
d.	Physical and occupational therapy after a motor vehicle accident with head trauma	

ANS:	D
Physical therapy and occupational therapy are considered tertiary prevention. Tertiary prevention occurs when a defect or disability is permanent and irreversible. It involves minimizing the effect of disease and disability. The objective of tertiary prevention is to maximize remaining capacities.

DIF:	Cognitive Level: Apply (Application)		REF:	p. 13

	12.	In reviewing a person’s medical claims, a nurse realizes that the individual with moderate persistent asthma has had several emergency department visits and is not on inhaled steroids as recommended by the NHLBI asthma management guidelines. The nurse discusses this with the person’s primary care provider. In this scenario, the nurse is acting as a(n)
a.	advocate.	
b.	care manager.	
c.	consultant.	
d.	educator.	

ANS:	B
Care managers act to prevent duplication of service and reduce cost. Care managers base recommendation on reliable data sources such as evidence-based practices and protocols.

DIF:	Cognitive Level: Apply (Application)		REF:	p. 14

	13.	During a home visit, a nurse assists an individual to complete an application for disability services. The nurse is acting as a(n)
a.	advocate.	
b.	care manager.	
c.	consultant.	
d.	educator.	

ANS:	A
The advocacy role of the nurse helps individuals obtain what they are entitled to receive from the health care system, tries to make the system more responsive to individuals’ community needs, and assists individuals in developing skills to advocate for themselves.

DIF:	Cognitive Level: Apply (Application)		REF:	p. 13

	14.	During a home visit, a nurse discusses the dangers of smoking with an individual. In this scenario the nurse is acting as a(n)
a.	advocate.	
b.	care manager.	
c.	consultant.	
d.	educator.	

ANS:	D
Health education is a primary prevention technique available to avoid major causes of disease. Teaching can range from a chance remark to a planned lesson.

DIF:	Cognitive Level: Apply (Application)		REF:	p. 14

	15.	A nurse is asked to provide an expert opinion about the development of an education program for newly diagnosed diabetics. In this scenario, the nurse is acting as a(n)
a.	advocate.	
b.	care manager.	
c.	consultant.	
d.	educator.	

ANS:	C
Nurses with a specialized area of expertise provide education about health promotion and disease prevention to individuals and groups as consultants.

DIF:	Cognitive Level: Apply (Application)		REF:	p. 14

	16.	A nurse is planning to deliver an educational program to individuals with diabetes. Which of the following should be the initial action taken by the nurse to ensure the success of the program?
a.	Assess the motivation level of the individuals	
b.	Assess the knowledge level of the individuals	
c.	Establish teacher–learner goals with the individuals	
d.	Establish multiple teaching sessions with the individuals	

ANS:	C
Selection of the methods most likely to succeed involves the establishment of teacher–learner goals. Thus, the first step by the nurse should be establishment of goals.

DIF:	Cognitive Level: Analyze (Analysis)			REF:	p. 14

	17.	The conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individuals is known as
a.	health-related quality of life.	
b.	evidence-based practice.	
c.	a Healthy People 2020 goal.	
d.	the ecological model of health.	

ANS:	B
Evidence-based practice is defined as the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individuals.

DIF:	Cognitive Level: Remember (Knowledge)		REF:	p. 14

	18.	Which research methodology should be used to address the question, “What is the difference in the infection rates between individuals who receive twice-a-day dressing changes versus once-a-day dressing changes?”
a.	Evidence-based practice research	
b.	Qualitative research	
c.	Quantitative research	
d.	Clinical judgment research	

ANS:	C
Quantitative research studies describe situations, correlate different variables related to care, or test causal relationships among variables related to care. Evidence-based practice research and clinical judgment research are not research methodologies; they are used to answer clinical questions.

DIF:	Cognitive Level: Apply (Application)		REF:	p. 15

	19.	The question, “What is the experience of teenagers who lose a sibling to cancer?” can best be answered by using which research methodology?
a.	Evidence-based practice research	
b.	Qualitative research	
c.	Quantitative research	
d.	Clinical judgment research	

ANS:	B
Qualitative research studies describe phenomena or define the historical nature, cultural relevance, or philosophical basis of aspects of nursing care. Evidence-based practice research and clinical judgment research are not research methodologies; they are used to answer clinical questions.

DIF:	Cognitive Level: Apply (Application)		REF:	p. 15

	20.	A nurse who uses findings from a randomized, controlled trial on the care of Foley catheters to change practice at an institution is practicing
a.	evidence-based medicine.	
b.	qualitative research.	
c.	quantitative research.	
d.	clinical judgment.	

ANS:	A
The practice of evidence-based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research.

DIF:	Cognitive Level: Apply (Application)		REF:	p. 14

	21.	Which of the following is most influenced by the social and economic environment of a community?
a.	Social health policies	
b.	Quality of care	
c.	Evidence-based practice	
d.	Practice guidelines	

ANS:	A
Social policies concerning health are influenced by the social and economic environment of a population. Analysis of population trends and projections is necessary to help health professionals determine changing needs.

DIF:	Cognitive Level: Remember (Knowledge)		REF:	p. 15

	22.	A major cause of death in the early twentieth century was
a.	cancer.	
b.	cerebrovascular disease.	
c.	heart disease.	
d.	infections.	

ANS:	D
Infections and acute disease were the major causes of death in the early part of the twentieth century.

DIF:	Cognitive Level: Remember (Knowledge)		REF:	p. 16

	23.	Which of the following groups of people are likely to show an increase in numbers between the years 2010 to 2030?
a.	Persons age 65 and older	
b.	Persons of White European descent	
c.	Infants due to rising birth rates	
d.	Population growth and character are unpredictable	

ANS:	A
By the year 2050, it is predicted that the majority of people in the United States will not be of White European descent (US Census Bureau, 2010a). ……. addition to changes in the ethnic and racial distribution within the population, the projected changes in age distribution will affect health-promotion practice. Considerable growth is expected in the proportion of the population that is 25 years of age and older. For example, the post-World War II baby boom will increase the number of persons in the 65-and-older age group between the years 2010 and 2030 (US Census Bureau, 2010b). …. there was a drop in births after 1960.

DIF:	Cognitive Level: Apply (Application)		REF:	p. 15

	24.	Which of the following demonstrates a nurse taking action to promote health and prevent disease?
a.	Making a home visit to a person who is recovering from a heart attack	
b.	Administering medications to a cardiac care recipient in the hospital	
c.	Providing cardiopulmonary resuscitation during a heart attack	
d.	Educating a person about the advantages of a heart-healthy diet during a home visit	

ANS:	D
Solutions for health promotion are focused on individual and government involvement. To promote health and wellness, an emphasis must be placed on primary prevention. This is often related to actions such as education that influence lifestyle choices. In the preceding example, educating a person about the advantages of a heart-healthy diet during a home visit serves to influence lifestyle choices.

DIF:	Cognitive Level: Apply (Application)		REF:	p. 16

	25.	Which factor may have the most influence in changing the health behavior of a single, adult woman who smokes and is the care provider for her mother, her own children, and granddaughter?
a.	Education regarding effects of smoking on her health	
b.	The satisfaction that she will not contribute to secondhand smoke	
c.	The availability of a weekly support group	
d.	A gift card for $10 to a local grocery store for every week she is smoke free	

ANS:	D
Motivational factors play a role in influencing attitudinal changes. A financial incentive is an example of a motivating factor. For this woman, who is financially responsible for the health and well-being of other individuals, finances will likely play a significant role in motivating her actions. Remember that education regarding the benefits of not smoking is not enough. Thus, the $10 gift card may have the most influence in changing her health behavior.

DIF:	Cognitive Level: Analyze (Analysis)			REF:	p. 16

MULTIPLE RESPONSE

	1.	Which of the following “investment” themes has been identified by the National Institute of Nursing Research? (Select all that apply.)
a.	Interprofessional collaboration	
b.	Improving quality of life	
c.	End-of-life care	
d.	Increasing physical activity among Americans	

ANS:	B, C
The National Institute of Nursing Research has identified five themes that promote health and prevent disease, improve quality of life through symptom management, and support palliative and end-of-life care, innovation, and nurse scientists.

DIF:	Cognitive Level: Remember (Knowledge)		REF:	p. 14

	2.	Which interventions address both the National Institute of Nursing Research themes and the overall goals of the Healthy People 2020 leading health indicators? (Select all that apply.)
a.	Establishing a new park with a well-lit track	
b.	Establishing a smoking cessation campaign	
c.	Providing reduced-cost transportation passes to senior citizens	
d.	Providing free condoms at all federally funded health clinics	

ANS:	A, B, D
Establishing a new park with a well-lit track, establishing a smoking cessation campaign, and providing free condoms at all federally funded health clinics all address the National Institute of Nursing Research themes and the Healthy People 2020 leading health indicators. A park, smoking cessation campaign, and free condoms address the themes of promoting health and preventing disease and the goal of increasing quality and years of healthy life. Providing reduced-cost transportation passes to senior citizens may indirectly affect the health of this population; however, it is not directly related to the themes of the National Institute of Research (promote health and prevent disease, improve quality of life through symptom management, and support palliative and end-of-life care, innovation, and nurse scientists) or the overall goals of Healthy People 2020 (increase quality and years of healthy life and eliminate health disparities).

DIF:	Cognitive Level: Analyze (Analysis)			REF:	p. 14