Chapter 1 MULTIPLE CHOICE. Choose the one alternative that best completes the statement or answers the question. 1) A nurse is obtaining a health history from a client who reports that he is healthy and has no health concerns. As part of the health history, the nurse documents that the client reported that he has high blood pressure and suffers from a leg ulcer that remains unhealed after 6 months. What is the most appropriate response by the nurse at this point in the interview? 1) “I feel that you may be in denial about your health status.” 2) “Tell me about your definition of being healthy.” 3) “Do you understand what hypertension is?” 4) “Is there anything else you are not telling me?” 1) 2 Explanation: 1. More information is needed before the nurse could describe the client’s viewpoint as denial. 2. A client will have his or her own definition of health, illness, and wellness that is influenced by many factors including age, gender, race, family, culture, religion, socioeconomic conditions, environment, previous experiences, and self-expectations. It is important for the nurse to understand the client’s perspective on health. 3. More information is needed before the nurse can determine that the client has a lack of knowledge. 4. There is not enough information to determine that the client is withholding information from the nurse. Also this statement could come across as the nurse accusing the client. Assessment Analysis Objective 1 Page 4 Difficulty - 1 2) What is the best description of the assessment component of SOAP charting? 1) Objective data obtained from the physical assessment 2) The client’s chief complaint 3) Subjective statements the client makes regarding feelings 4) Conclusions drawn from the data obtained 2) 4 Explanation: 1. Objective data obtained from the physical assessment is an example of the “O” component of SOAP charting 2. The client’s chief complaint is an example of subjective data, the “S” component of SOAP charting.
3. This is another example of subjective data, the “S” component of SOAP charting, because it is information reported by the client. 4. The “A” component of SOAP charting refers to conclusions drawn from the subjective and objective data obtained. Assessment Knowledge Objective 7 Page 7 Difficulty -1 3) A nurse is reviewing a client’s medical record. Which is an example of a constant piece of data? 1) The client has B negative blood type. 2) The blood pressure at 0900 was 110/74 mmHg. 3) The sodium level is 145 mmol/L. 4) The client is 64 years of age. 3)1 Explanation: 1. Constant data are things that do not typically change over time such as race, gender, or blood type. 2. Variable data may change within minutes, hours, or days and includes things like blood pressure, pulse rate, blood counts, and age. 3. Variable data may change within minutes, hours, or days and includes things like blood pressure, pulse rate, blood counts, and age. 4. Variable data may change within minutes, hours, or days and includes things like blood pressure, pulse rate, blood counts, and age. Assessment Application Objective 4 Page - 5 Difficulty - 2 4) A nurse is developing a handout for clients in a physician’s office. What content areas would be included in this handout to emphasize current changes in the healthcare delivery system? 1) Symptom management, environmental control 2) Management of outbreaks of disease, eradicating the use of toxins 3) Illness care, pain management, prevention of complications 4) Wellness, health maintenance, health promotion, prevention of disease 4) 4 Explanation: 1. Historically the Canadian healthcare system focused on illness and symptom control but this has changed to include a broader focus with an emphasis on wellness, prevention of disease, health maintenance, and health promotion. 2. Management of outbreaks of disease is a function of governmental organizations and health care providers in the community, but is not a focus of individual care. 3. Illness care, pain management, and prevention of complications are addressed by the health care delivery system, but are no longer the primary focus of client care. There is now an emphasis on wellness, health maintenance, and health promotion. 4. The focus of healthcare in the Canada is now on wellness, prevention of disease, health promotion and health maintenance. Assessment Health Promotion and Management
Knowledge Objective 1 Page 3 Difficulty -1
5) What is the best method for the nurse to obtain subjective data during a health assessment?
1) Interviewing a primary source 2) Reviewing an indirect source like health records 3) Completing a physical assessment 4) Obtaining information from a family member 5)1 Explanation: 1. During a health assessment interview, subjective data is best gathered directly from the client, the primary source. 2. Although subjective data can be obtained through secondary or indirect sources such as the family, caregivers, other members of the health care team, or medical records, it is best to obtain such information directly from the client. If secondary sources are used, the nurse must validate subjective data from other sources to ensure the accuracy of the information. 3. Objective data is obtained during the physical assessment. 4. A family member can report subjective data based on perceptions the client has shared with them but it is always best to obtain the subjective data directly from the client when possible. Health Knowledge Objective 4 Page 5 Difficulty - 2 6) A nurse is reviewing a client’s medical records and notes various forms of information. What piece of information is an example of subjective data? 1) Symptoms described by the client 2) Physical examination results 3) Results of radiographic studies 4) Laboratory analysis reports 6) 1 Explanation: 1. Clients can describe feelings or symptoms that cannot be observed by others. This is an example of subjective data. 2. Physical examination results are an example of objective data. 3. Results of radiographic studies are an example of objective data. 4. Laboratory analysis reports are an example of objective data.
Assessment Knowledge Objective 4 Page 5 Difficulty-1
7) A nurse is reviewing a client’s medical records. What is an example of objective data? 1) “I hurt my head.” 2) “I am six-years-old and I’m here because I fell.” 3) Six-year-old Hispanic female sitting on examination table holding a towel to her forehead. 4) Client states that she fell at the playground. 7) 3 Explanation: 1. “I hurt my head” is a statement made by the client and is an example of subjective data. Subjective data are things the client experiences and communicates to the nurse. 2. The nurse did not observe the child’s fall, therefore this information was communicated by the client to the nurse which is an example of subjective data. 3. Objective data is data that can be observed or measured by the nurse. The nurse can see the child holding the towel to her head and can use her birth date to determine her age. 4. Statements the client makes are subjective data. Assessment Knowledge Objective 4 Page 5 Difficulty - 3 8) A nurse is evaluating the plan of care and notes that none of the goals have been met for the client. What should the nurse do next in this situation? 1) Report the lack of achievement of the goals to the physician 2) Review the data and modify the plan 3) Re-formulate the nursing diagnosis to a more realistic one 4) Nothing as long as the client is stable 8) 2 Explanation: 1. Reporting the lack of achievement of the goals to the physician is not appropriate, though, reporting undesirable client physiologic responses may be. 2. The plan of care should be evaluated periodically, at the established time frames, to determine achievement of the goals. If goals are not achieved, then the data need to be further assessed and the plan modified. 3. Re-formulating the nursing diagnosis to a more realistic one is not the best course of action as the diagnosis established came from subjective and objective data specific to that diagnosis. 4. Client achievement of goals is needed regardless of status. Evaluation Application Objective 5 Page 14 Difficulty - 2
9) A nurse is obtaining a health history from the client. What phase of the nursing process is the nurse using? 1) Planning 2) Assessment 3) Diagnosis 4) Interviewing 9) 2 Explanation: 1. Planning is the third phase of the nursing process and can only occur after the completion of the assessment and diagnosis. Obtaining a health history is a component of the assessment phase of the nursing process. 2. Obtaining the health history is a component of the assessment phase of the nursing process. The nurse cannot determine an accurate nursing diagnosis or plan of care without assessment data. 3. Formulating a diagnosis is the second phase of the nursing process and occurs after the completion of the assessment phase. Obtaining the health history is a component of the assessment phase of the nursing process. 4. Interviewing is the technique used by the nurse to obtain a health history from the client. Interviewing is not one of the four phases of the nursing process. Assessment Knowledge Objective 5 Page 11, 12 Difficulty - 2 10) A nurse is developing a plan of care for a client. What types of data must the nurses consider when developing nursing diagnoses? 1) Assessment, planning, and evaluation 2) Subjective and objective 3) Family history, laboratory results 4) Standard and normative 10) 2 Explanation: 1. Assessment involves the collection of subjective and objective data in order to plan and provide care for the client. Planning is the process that occurs after the assessment data has been collected and interpreted. Evaluation is the process of examining the goal to see achievement. 2. The nurse must consider all subjective and objective data collected. The nurse will make a judgment after analysis and synthesis of the collected data. 3. Family history and laboratory data are components of assessment data but the nurse must consider all the objective and subjective data collected not just these two elements of data. 4. Standard and normative data are found on charts (for example, growth charts) or in results of studies to achieve the goal of establishing norms for groups of people. Data collected during the assessment are compared to normative values and standards but the nurse must consider a broader range of data in the process of formulating a nursing diagnosis. Assessment
Knowledge Objective 5 Page 12 Difficulty - 2 11) A nurse is interpreting the findings from a health assessment she completed on a college student with influenza. The student was sent home because the student dormitory was closed due to an influenza outbreak. What determinant of health is present in this situation? 1) Ethnocultural 2) Family 3) Environmental 4) Psychological 11) 3 Explanation: 1. Enthocultural factors are an example of a determinant of health; however, there is no information provided in the scenario that indicates a cultural factor is influencing the student’s health. 2. Family factors are another example of a determinant of health; however, there is no information provided in the scenario that indicates that a family factor is influencing the student’s health. 3. Environmental factors can affect health. Influenza is spread from person to person through coughing and sneezing, particularly in places where people live in close quarters like student housing. There is evidence in this scenario to support an environmental determinant of health has affected this student. 4. Psychological factors are another example of a determinant of health; however, there is not information provided in this scenario to support that a psychological factor is affecting this student’s health status. Health Knowledge Objective 2 Page 4, 10, 11 Difficulty - 2 12) What statement most accurately describes the World Health Organization (WHO) definition of health? 1) Health is the absence of illness, disease, and symptoms. 2) Health is a state of well-being and the use of every power the person possesses to the fullest extent. 3) Health is a culturally defined, valued, and practiced state of well-being 4) Health is a state of complete physical, mental, and social well-being. 12) 4 Explanation: 1. The traditional view of health was the absence of illness and disease but the WHO definition is broader and includes the ideas of complete physical, mental, and social well-being. 2. This statement is a definition of health by the nursing theorist Nightingale and is not the WHO definition of health (Nightingale, 1860/1969).
3. This statement is from Leininger’s model of health and is not the WHO definition of health (Leininger, 1991). 4. This is the WHO definition of health (WHO, 1947). Assessment Comprehension Objective 1 Page 4 Difficulty - 1 13) A nurse is developing a plan of care for a client with surgical incision pain. What is the most appropriate goal statement for this client? 1) The client will verbalize pain relief using an intensity rating in 4 hours. 2) The client will state that they feel fine. 3) The client will state understanding of the cause of pain in 3 days. 4) The client will verbalize no pain. 13) 1 Explanation: 1. “The client will verbalize pain relief" is a goal statement directly related to the nursing diagnosis, it is stated in a positive fashion, and has measurable criteria. 2. “The client will state they feel fine" is not directly related to the surgical pain and is not measurable. 3. Understanding the cause of surgical pain does not measure whether the pain has been reduced. 4. It is unrealistic to expect a client will feel no pain following surgery. The goal statement should be realistic and measurable. Planning Knowledge Objective 5 Page – 13 Difficulty Level - 2 14) A nurse is developing the plan of care and needs to develop interventions to achieve a specific goal. What source should the nurse use to determine interventions? 1) Nursing diagnosis 2) Defining characteristics of the nursing diagnosis 3) Etiology of the nursing diagnosis 4) Client’s stated wishes 14) 3 Explanation: 1. The interventions are derived from the cause of the diagnosis. 2. The defining characteristics provide the background support for the diagnosis. 3. The etiology of the diagnosis is used to determine the interventions. 4. The client’s stated wishes are an important component of planning, and may be included in the list of interventions as appropriate but the primary source of interventions will be related to the etiology of the diagnosis. Planning Knowledge Objective - 5 Page – 13 Difficulty Level - 2
15) Ms. Benoit, 38 years old, is admitted with chest pain. What is an example of a holistic approach to nursing care? 1) Considering all the factors that impact Ms. Benoit’s well-being 2) Completing a thorough chest assessment 3) Reviewing Ms. Benoit’s life style 4) Obtaining a detailed family history 15) 1 Explanation: 1. Holism includes all factors that impact the client’s physical and emotional well-being, including physiological, developmental, psychological, emotional, family, cultural, and environmental factors. 2. The holistic approach should not look at just the physical problem the client is experiencing. 3. A review of lifestyle is important but does not provide a holistic approach. 4. The family history is important but does not include other aspects that may impact physical and emotional well-being. Assessment Application Objective - 4 Page 10 Difficulty - 2 16) A nurse is evaluating the client’s progress toward meeting the following objective of a teaching plan, “The client will list signs of hypoglycemia before discharge.” What missing factor will make it difficult for the nurse to evaluate whether the client has met this objective? 1) Time frame 2) Specific criteria to be met 3) Method of evaluation 4) How the information was taught 16) 2 Explanation: 1. Time frame has been included in the objective. 2. The criteria is too general; the objective needs to be more specific (e.g., list 5 signs). 3. The method of evaluation is not part of the objective. 4. The teaching strategy is not part of the objective. Evaluation Knowledge Objective – 8 Page – 13, 18, 19 Difficulty - 3 17) A nurse is required to teach Mr. Hammond how to administer his insulin injection. What is an appropriate teaching strategy for the nurse to use? 1) Discussion 2) Demonstration 3) Printed directions 4) Role play
17) 2 Explanation: 1. Discussion is best used with cognitive learning. 2. Demonstration and practice are effective strategies for teaching psychomotor skills. 3. Printed material is not effective in teaching a psychomotor skill. 4. Role play will allow an understanding of others point of view but is not effective in teaching a psychomotor skill. Evaluation Knowledge Objective – 8 Page – 19 (Table 1.2) Difficulty - 2 18) A nurse is caring for a newly admitted patient with Methicillin-resistant Staphylococcus Aureus (MRSA). What is the primary goal of the initial health assessment? 1) Determine the client’s current state of health 2) Assess the client’s knowledge about MRSA 3) To determine client allergies 4) Determine how frequently the client is able to change positions 18) 1 Explanation: 1. Health assessment goals are to determine the client’s current state of health and ongoing healthpromotion activities, predict risks to health, and identify health promoting activities. 2. Assessment of the client’s knowledge is important, but is not the primary goal of doing a health assessment. 3. Determining the client’s allergies is important, but the goal of a health assessment is broader. 4. It is important to determine what limitations the client has, but it is not the primary goal of a health assessment. Application Comprehension Objective - 3 Page – 5 Difficulty Level - 3
19) While the nurse assesses a client who is hospitalized for an acute exacerbation of chronic obstructive pulmonary disease, the client becomes short of breath. The nurse recognizes the need to stop the assessment to initiate respiratory support interventions. This is an example of which phase of critical thinking? 1) Collection of information 2) Evaluation 3) Generation of alternatives 4) Analysis of the situation 19) 4 Explanation: 1. The nurse has collected data and has analyzed the situation. 2. Evaluation looks at whether there are omissions in the critical thinking process and whether outcomes have been achieved.
3. This step looks at steps to follow to resolve a problem. 4. The nurses has analyzed the data and drawn valid conclusions. Planning Analysis Objective - 6 Page – 15 Difficulty Level - 2
20) What is an example of subjective data? 1) The bowel sounds are hyperactive in all four quadrants. 2) The client states, “I have pain in my belly that is 7 out of 10.” 3) Abdominal assessment reveals a firm, hard abdomen. 4) The client is weak and looks very pale. 20) 2 Explanation: 1. Bowel sounds are objective data. 2. Subjective data is information the client experiences and communicates to the nurse. 3. This is objective data as it can be seen /felt by the nurse. 4. This is an objective assessment made by the nurse. Assessment Application Objective –4 Page – 5 Difficulty Level - 1 21) A client with hepatitis B is admitted to the hospital. What should the nurse keep in mind regarding client confidentiality? 1) Information sharing is limited to those directly involved in the client’s care. 2) All members of the health care team should be aware of this information. 3) This information should not be included in the client’s chart. 4) The medical records are open to any hospital employee, including administration. 21) 1 Explanation: 1. Confidentiality means that information sharing is limited to those directly involved in the client’s care. 2. Not all members of the health care team have access to the chart, only those who are directly caring for the client. 3. This information should be available to those health care professionals directly involved in the client’s care. 4. Hospital records are only open to those directly related to the care of the client. Assessment Application Objective – 4 Page – 6 Difficulty Level - 3 22) What is included in the planning step of the nursing process?
1) 2) 3) 4)
Setting priorities Teaching the client Making a referral Analyzing the assessment data
22) 1 Explanation: 1. Priority setting, stating goals, and listing strategies to meet the goals are all part of the planning process. 2. Teaching is an intervention. 3. Making a referral is an intervention. 4. Analysis of data is part of determining the nursing diagnosis. Implementation Knowledge Objective – 5 Page – 13 Difficulty Level - 2
23) Mr. James, 59 years old, is hospitalized with end stage liver failure secondary to years of alcoholism. What is the nurse’s first step when using a critical thinking approach to collect information about this client? 1) Organizing the approach to use 2) Identifying assumptions 3) Identifying missing information 4) Identifying any inconsistencies 23) 2 Explanation: 1. Before developing an organized approach to collect information the nurse needs to identify assumptions that may impact the assessment. 2. The nurse needs to identify assumptions that may misguide or misdirect assessment. 3. Identifying gaps in information is important, but the nurse needs to identify assumptions made about the client. 4. It is important to identify and follow-up on inconsistencies in the information, but it is not the first step. Application Comprehension Objective – 6 Page – 14 Difficulty Level - 2
24) In the nurse’s teaching plan, what objective addresses the psychomotor domain? 1) The client will discuss three interventions for low blood sugar. 2) The client will describe four symptoms of low blood sugar. 3) The client will demonstrate how to draw up the correct dose of insulin. 4) The client will define diabetes mellitus. 24) 3
Explanation: 1. This goal is in the cognitive domain. 2. This goal is in the affective domain. 3. This goal is in the psychomotor domain. 4. This goal is in the cognitive domain. Evaluation Comprehension Objective – 8 Page – 18 (Table 1.1), 19(Table 1.2) Difficulty Level - 2 25) Which statement best describes the active role of the nurse as an educator? 1) Nurses must consider learning needs, goals, objectives, content, teaching methods, and evaluation when carrying out client education. 2) Teaching plans are developed for informal teaching when distinct needs are identified or when common needs are recognized. 3) The nurse should refer the client to other health care providers who specialize in the area of need. 4) Teaching is to be delegated to the advanced practice nurse specialist or the nurse educator. 25) 1 Explanation: 1. These are the aspects of client teaching the nurse needs to consider. 2. Informal teaching does not involve teaching plans. 3. The nurse at the bedside has a role in teaching clients and cannot be delegated to others. 4. Teaching can be done in collaboration, but the nurse at the bedside has a role as an educator. Planning Comprehension Objective – 8 Page – 17 Difficulty - 2
SHORT ANSWER. Write the word or phrase that best completes each statement or answers the question. 26) A nurse is admitting a client and notes a place for subjective data on the history form. What method will the nurse use to gather the required subjective data? 26) interview Explanation: Subjective data is gathered from the interviews of primary and secondary sources. The interview includes the health history and focused interview. Assessment Knowledge Objective 4 Page 5 Difficulty - 2
Chapter 2 MULTIPLE CHOICE. Choose the one alternative that best completes the statement or answers the question. 1) What statement most accurately describes the concept of health promotion? 1) A psychological model that attempts to explain and predict health behaviours 2) A process of enabling people to increase control over their health and its determinants 3) The economic and social conditions that influence the health of individuals and their communities 4) Understanding the psychosocial and physical processes of disease in order to promote good health 1) 2 Explanation: 1. This statement describes the Health Belief Model. 2. This statement describes the basis of health promotion. 3. This is a description of the social determinants of health. 4. The medical model fits this description. Assessment Knowledge Objective 1 Page 23 Difficulty 2 2) A couple who both have a positive family history of sickle cell anemia are concerned about the potential of having a child with sickle cell disease. Which statement indicates that the couple wishes to participate in primary prevention? 1) “We both need to 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 counsellor 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 had would be safe from the disease as well.” 2) 3 Explanation: 1. It is not stated that either partner has sickle cell disease, so there is no need for treatment prior to pregnancy. 2. Both individuals being tested for carrier status would be considered secondary prevention, as it deals with early detection of health problems. 3. Primary prevention focus is to improve or maintain health for the individual. Seeking out a genetics counselor is considered primary prevention. 4. Despite the fact that neither the man nor woman has sickle cell disease, there is still a possibility that a child could be born with the disease, depending on the carrier state of the parents. Diagnosis Application Objective 1 Page 30 and 31 Difficulty = 2 3) A nurse is working to develop a community garden to provide food security for people living in an impoverished area of the city. What social determinant of health is present in this situation? 1) Income and social status 2) Culture
3) Social environment 4) Physical environment 3) 1 Explanation: 1. Food insecurity is largely the result of low income and financial insecurity. The community garden provides impoverished people access to affordable healthy food. 2. The community garden may be helping many marginalized people access healthy food, but it is not changing the underlying factors leading to marginalization. 3. A community garden may bring people together to form a sense of community, but the main determinant of health addressed through a community garden is food security for low income people. 4. Physical environment is generally about clean air, water, and soil. Planning Application Objective 2 Page 23 Difficulty 2 4) A nurse is discharging a client who had a cerebral vascular accident (CVA) and will be cared for at home by her husband. The nurse knows that the client’s husband understands the need for tertiary prevention when he makes which statement? 1) “She will need instruction on using her walker.” 2) “She will need to have her flu shot this year.” 3) “She must have coagulation studies completed weekly.” 4) “She needs to have her cholesterol checked every 2 months.” 4) 1 Explanation: 1. Tertiary prevention focuses on reducing loss of function, maximizing health, and minimizing disability. Learning to use a walker to aid ambulation is an example of tertiary prevention to reduce the loss of function. 2. Having a yearly flu shot is an example of primary prevention. 3. Having blood work taken weekly to review clotting times is a screening procedure and is an example of secondary prevention. 4. Having a cholesterol screening is an example of secondary prevention. Evaluation Application Objective 1 Page 30 and 31 Difficulty 2
5) A nurse works in a large urban hospital using telehealth to provide cardiac consultations to clients in rural settings. What principle of primary health care is evident in this scenario? 1) Public participation 2) Intersectoral cooperation 3) Activism 4) Accessibility
5)4 Explanation: 1. Public participation means that the public is fully involved in decision-making about personal health care and health system issues. This is not the focus in this scenario. 2. Intersectoral collaboration means that there is integration with other sectors that impact health such as education, social services, and justice. 3. Activism is the direct action (for example, political lobbying) taken to support a health goal. Activism is not one of the principles of primary healthcare. 4. Equitable access to health and health services is one of the guiding principles of primary health care that is illustrated in the scenario where a rural population is able to access specialized healthcare through technology. Implement Application Objective 1 Page 24 and 25 Difficulty 2 6) A mother calls the provincial 'Nurse Hotline' concerned about her toddler's flu symptoms. What principle of primary healthcare is evident in this situation? 1) Public participation 2) Intersectoral collaboration 3) Appropriate technology 4) Advocacy 6) 3 Explanation: 1. Public participation means that the public is fully involved in decision-making about personal health care and health system issues. This is not the focus in the scenario. 2. Intersectoral collaboration means that there is integration with other sectors that impact health such as education, social services, and justice. 3. A telephone triage system is an example of an effective and affordable technology used to benefit health and reduce the reliance on emergency departments. 4. Advocacy is not one of the principles of primary healthcare. Implementation Application Objective 1 Page 24 and 25 Difficulty 2
7) A nurse working in a remote northern community has noticed a sharp increase in the number of teens coming to the clinic with sexually transmitted infections (STIs). What strategy is an example of an upstream approach to the problem? 1) Have a condom machine installed in the washrooms at the high school 2) Schedule more nurses to work at the clinic to handle the increased case load 3) Hold an educational session with the students on STIs 4) Provide free condoms at the health clinic 7) 3 Explanation:
1. Upstream approaches address the root cause of the problem. Installing a condom machine will not address the problem if the students don’t use the condoms. The teens need to understand how STIs are transmitted and how to prevent transmission. 2. Having more nurses work at the clinic is a downstream approach because this strategy focuses on treatment rather than the cause of the problem. 3. An educational session is an upstream approach because it provides the nurse with an opportunity to address the cause of the problem such as a lack of understanding about transmission of sexual infections. 4. This strategy does not address the cause of the problem. Providing free condoms will not decrease the incidence of STIs if the condoms are not used or are used incorrectly. Planning Analysis Objective 1 Page 29 and 30 Difficulty 2 8) A group of nursing students are organizing a health fair at the university. What activity is an example of secondary prevention? 1) Provide free condoms at the health booth 2) Have participants complete a screening tool to determine mental health wellness 3) Develop a handout on the adverse effects of alcohol abuse 4) Supply a pamphlet on Canada's Food Guide with a sample meal plan 8) 2 Explanation: 1. This is a primary prevention activity. 2. Secondary prevention focuses on early detection of diseases or conditions in a particular population. Screening tests are an effective method of achieving this goal. 3. A handout on alcohol abuse is aimed at preventing or reducing disease/injury from occurring, which is a primary prevention activity. 4. Providing information on a well-balanced diet is an example of an educational strategy, which is a primary prevention activity. Implementation Analysis Objective 1 Page 30 and 31 Difficulty 2
9) Mr. Smith has been living in a one bedroom apartment with six other people. He has recently been diagnosed with drug resistant tuberculosis (XDR-TB). What nursing action is consistent with the goals of tertiary prevention? 1) Complete TB skin testing on Mr. Smith's roommates 2) Start prophylactic TB medications with each roommate 3) Schedule a daily appointment for the client to be given his TB medication 4) Have the client wear a surgical mask 9) 3 Explanation: 1. Skin testing for TB is a screening procedure; therefore, this is an example of secondary prevention.
2. Providing prophylaxis medications to prevent illness after exposure to a communicable disease is an example of secondary prevention. 3. Having the nurse give the client his medication, known as direct observation and treatment (DOTS), is a tertiary prevention method that involves monitoring medication compliance to treat diseases. 4. The strategy of wearing a mask will prevent or reduce the risk of disease transmission from occurring; this is an example of primary prevention. Implementation Application Objective 1 Page 30 and 31 Difficulty 3 10) Mrs. Singh, 70 years old and a widow of two years, is at the clinic for a follow-up health assessment. Mrs. Singh was diagnosed with hypertension 6 months ago and was started on health plan that includes two different antihypertensive medications, an exercise program, and dietary changes. Mrs. Singh reports that she has not attended the exercise program at the community centre and did not renew her prescription. What question should the nurse ask to better understand the client’s situation? 1) "What social supports do you have at home and in the community?" 2) "What cultural barriers are preventing you from following the health plan?" 3) "What is your financial status?" 4) "What challenges are you experiencing with following the health plan?" 10) 4 Explanation: 1. It is important for the nurse to assess the social determinants of health that may be impacting the client's ability to follow the health plan. The client may or may not lack an adequate social network; therefore, a question that is broader in scope would be of more value to ask at this juncture. 2. It is inappropriate to assume that the client is experiencing cultural barriers. The nurse needs to ask a broader and a more culturally sensitive question. 3. This is a rather abrupt question to initiate a discussion with the client. 4. This question is broad and will allow the client to identify issues she may be having in following the health plan. This question will allow the nurse to assess a wider range of social determinants that may be impacting this client. Assessment Application Objective 3 Page 23 Difficulty 2 CASE 1 A nurse is working with a student council at a local high school to develop a health promotion project that will benefit the entire school. The students identified a need to address bullying within the school. QUESTIONS 11 to 13 refer to this case. 11) The students want to develop anti-bullying policies at the school and have arranged a meeting with the parent advisory committee, teachers, administrators, and other students. What principle of primary health care is evident? 1) Public participation 2) Advocacy 3) Intersectoral collaboration
4) Social justice 11) 1 Explanation: 1. Public participation means that the public is fully involved in decision-making about personal health care and health system issues. All the key stakeholders have been included in the anti-bullying discussions. 2. Although advocacy is an important concept in the Population Health Promotion model it is not a principle of primary health care. 3. Intersectoral collaboration means that there is integration with other sectors that impact health such as education, social services, and justice. This is not case in this scenario. 4. Social justice is an important concept in the Population Health Promotion model; it is not a principle of primary health care. Implementation Application Objective 1 Page 24 and 25 Difficulty 1 12) The nurse is aware of the need for evidence-based decisions to strengthen the development of the antibullying health promotion activities that the student council wants to pursue. What would be a credible source to consult? 1) Bullying sites on the internet 2) A needs assessment completed at the school 3) Another high school's anti-bullying program 4) Peer-reviewed research studies 12) 4 Explanation: 1. There are some wonderful resources available on the internet, but the sites need to be from a credible agency or source. This statement does not indicate the reliability of the internet source. 2. A needs assessment will be an important step in the process of developing a program that meets the unique needs of the school, but this is not an evidence-based source. 3. The evaluation of another school’s policy would be acceptable, but the council needs to make sure that the other school's program was based on credible sources of information tnd address whether the program focused on the right issues, took effective action, and produced sound results. 4. Peer-reviewed research studies that focus on the issue of bullying is the most credible source to use. Implementation Knowledge Objective 4 Page 27 Difficulty 1 13) The student council, in collaboration with the nurse, developed an anti-bullying school program that includes a social marketing campaign, educational sessions, and a safe reporting mechanism. What would be the most effective approach for delivering the educational session? 1) Use an expert like the nurse to deliver the session at a school-wide assembly 2) Have peers deliver the session to each grade 3) Develop a handout that can be distributed throughout the school 4) Make and post a YouTube video.
13) 2 Explanation: 1. Although the nurse would certainly have credibility, peer-led programs are most effective with this age group. Also, a large group is not as effective when it comes to discussion and answering student questions. 2. Peer-led educational programs are effective and smaller groups are more conducive to discussion. 3. Although a handout may be one strategy used as part of a larger educational program, they should not be the only strategy used because it may not reach all of the student body. 4. YouTube videos certainly appeal to this population but it is not the most effective approach to deliver the school-based educational program. This may be one tool used to support the antibullying program. Implementation Analysis Objective 3 Page 33 Difficulty 2 END OF CASE 1 14) What statement best defines the concept of social justice? 1) Entails direct action taken to support a health goal 2) All people have an equal entitlement to health 3) The practice of supporting something or someone 4) Fair distribution of society's benefits, responsibilities, and consequences 14) 4 Explanation: 1. This statement defines the term activism. 2. This is the definition of health equity. 3. This statement describes the term advocacy. 4. This is a definition of social justice. Assessment Knowledge Objective 1 Page 25 and 26 Difficulty 1 15) A nursing student is preparing an educational program concerning breast cancer. The focus of the program is primary prevention. What topic would meet the goal of a primary prevention strategy? 1) A dietary discussion concerning the connection between breast cancer and dietary intake 2) Yearly clinical breast examination 3) Canadian Cancer Society recommendations for mammography 4) Treatment options available for breast cancer clients 15) 1 Explanation: 1. Primary prevention has a focus geared toward health promotion and disease prevention. 2. Yearly clinical breast examination is an example of a secondary level of prevention. 3. The goal of mammography is to screen for early identification of illness which is the focus of secondary prevention. 4. Treatment options are a form of tertiary prevention.
Planning Application Objective 1 Page 30 Difficulty 2 16) A nurse is performing a health assessment. What question will provide the most information about a client’s social support network? 1) “Do you live alone?” 2) “Did you graduate from high school?” 3) “Are you involved in any type of exercise programs?” 4) “Who will assist in your care after discharge?” 16) 4 Explanation: 1. A closed-ended question will not elicit the information required to assess social support networks. 2. This closed-ended question would provide information on educational level but not social support networks. 3. Determining participation in exercise programs will not provide information concerning social structure. 4. An open-ended question will solicit the greatest amount of information and this question will begin a discussion on social support. Assessment Application Objective 2 Page 23 Difficulty 2
17) A nurse is working with an elementary school to develop a healthier school environment. The teachers are particularly concerned about the numbers of overweight children they see in their classrooms. The school is on a tight budget. What would be the most appropriate health promotion strategy to implement at this school? 1) Initiate a lunch hour walking program 2) Implement a quality school meals program 3) Start a course in health education 4) Work with the vending machine company to provide healthier drink and food options 17) 1 Explanation: 1. Increasing the physical activity of the children will help them to maintain a healthy weight. A lunch hour walking program would not cost any money and would be a relatively easy strategy to initiate. 2. Improving the access to health food through a meals program would be a worthwhile initiative; however, it would take some time to implement and there is the potential to impact the school budget in a negative way. 3. This is another worthwhile initiative that would take time and money to implement and would not address the school budget issue. 4. This strategy is workable and would not cost the school anything. The down side of this strategy is that it only targets the students who use the vending machine and would not be applicable to all the students. Implementation
Application Objective 3 Page 32 and 33 Difficulty 2 18) Mr. Walters, 54 years old, had emergency abdominal surgery last night for a perforated bowel. He also has a history of hypertension, type 2 diabetes, and glaucoma. The nurse is administering his morning medications. Which drug classification is a secondary prevention initiative? 1) Enalapril, antihypertensive 2) Metformin, oral anti-diabetic agent 3) Pilocarpine, miotic 4) Enoxaparin, low molecular weight heparin 18) 4 Explanation: 1. Enalapril treats hypertension and is an example of tertiary prevention. 2. Metformin treats hyperglycemia brought on by the type 2 diabetes and is an example of tertiary prevention. 3. Pilocarpine is used to decrease intraocular pressure associated with glaucoma and is tertiary level prevention. 4. Enoxaparin is used to prevent the formation of a deep vein thrombosis in the post-operative period and is an example of secondary prevention. This is an example of using a medication prophylactically to prevent illness. Assessment Analysis Objective 4 Page 30 and 31 Difficulty 3 19) A nurse working in a remote northern community wants to improve the health of the community by decreasing the number of low-birth-weight infants in the community. What strategy would be best to achieve this goal? 1) Establish a public education program on the benefits of eliminating tobacco use during pregnancy 2) Speak about the importance of daily folic acid supplementation in prenatal classes 3) Develop a pamphlet on the benefits of breastfeeding 4) Ask physicians to spend more time discussing nutritional needs during pregnancy 19) 1 Explanation: 1. Smoking during pregnancy doubles the risk of having a low-birth-weight infant. Smoking cessation programs that focus on the benefits of eliminating tobacco use are more successful than those programs that focus on the harmful effects of smoking during pregnancy. 2. Folic acid supplementation is important for fetal neural development but this health strategy does not influence infant birth weight. 3. Breastfeeding provides the infant with important health benefits but this is a post-partum strategy and will not influence the number of low-birth-weight infants in the community. 4. Nutrition is an important factor in a healthy pregnancy but smoking during pregnancy is the single most important determinant in low-birth-weight infants. Planning Application Objective 3
Page 32 Difficulty 3 20) Mr. Bob, 30 years old, is in hospital recovering from injuries sustained in a motor vehicle accident. The nurse notes on the admission history that Mr. Bob is a smoker. The nurse approaches Mr. Bob to assess whether he is interested in strategies to help him quit smoking. What process is the nurse engaging in? 1) Primary prevention 2) Tertiary prevention 3) Health belief modification 4) Health promotion 20) 4 Explanation: 1. The nurse is incorporating health promotion activities within the acute care environment. If the client decided to set the goal to quit smoking that would be primary prevention but at this point the nurse is just exploring the idea with the client. 2. This is not a tertiary prevention activity. 3. The client is not doing anything to change his health behaviours at this point. 4. The nurse is engaging in the process of health promotion by exploring with the client whether he wants to improve his own health. Assessment Application Objective 3 Page 34 Difficulty 2 21) A family has contacted the public health nurse wanting to know more about how to promote their cardiovascular health because they are overweight and sedentary. During the family health assessment the nurse learns that many of the first degree relatives have hypertension and angina. What determinant of health is present in this family? 1) Education 2) Genetic 3) Gender 4) Physical environment 21) 2 Explanation: 1. There is no information about the education level of the family. 2. There is a strong genetic risk factor for cardiovascular disease. 3. Gender can be a risk factor for certain diseases but in this scenario the genetic determinant of health is the dominant influence. 4. Physical environment is generally about clean air, water, and soil. Assessment Knowledge Objective 1 Page 23 Difficulty 1 22) What is an example of an upstream policy that benefits the whole community? 1) Establish a free needle exchange program 2) Develop a campaign on the daily folic acid supplementation for women in childbearing years
3) Seat belt laws for all motorized vehicles 4) Launch HPV vaccination program for girls aged 9 to 13 years 22) 3 Explanation: 1. This initiative would be an upstream strategy to reduce the transmission of HIV and Hepatitis C but it only benefits a small subsection of the general population. 2. This upstream initiative benefits a subpopulation of the community. 3. This upstream approach keeps all members of the community safe. 4. This upstream activity will benefit a small subgroup in the community. Assessment Knowledge Objective 1 Page 29 and 30 Difficulty 3
23) A nurse has been contracted to complete annual spirometry testing for the city's firefighters. What level of prevention is this activity? 1) Primary 2) Secondary 3) Tertiary 4) This is not a prevention activity. 23) 2 Explanation: 1. Primary prevention strategies are designed to prevent or reduce the risk of disease from occurring by improving or maintaining general health, boosting the immune system, or preventing injury. 2. Spiromtery is a screening tool to assess lung health. Secondary prevention focuses on early detection of disease or conditions in a particular population. 3. Tertiary prevention focuses on reducing loss of function, maximizing health, and minimizing disability. 4. Spirometry is an example of a secondary prevention initiative. Planning Knowledge Objective 1 Page 31 Difficulty 1 24) The union at a large industrial company has contacted the occupational health nurse to discuss ways to decrease employee stress. What would be an appropriate stress relieving strategy? 1) Organize a monthly after work social at the bar 2) Arrange for a noon hour yoga class 3) Hold a focus group with the employees 4) Offer one-to-one counselling sessions 24) 3 Explanation:
1. Stress is a determinant of health and the employees need a healthy outlet for their stress. Socializing can be a great way to manage stress, but it would be better if this activity wasn’t linked to alcohol. 2. Yoga may a great way to relieve stress, but a noon hour class will only be available to the employees that work the day shift. 3. It is important to understand the root cause of the stress so that more specific stress reduction strategies can be developed. Holding a focus group with the employees will provide the nurse with the information needed to assist the employees in a meaningful way. 4. Some employees may benefit from one-to-one counseling, but this not an effective method for addressing the company-wide issue of stress. Implementation Application Objective 3 Page 24, 33, and 34 Difficulty 2
25) Mrs. Langois, 48 years old, lives alone in an apartment. She is taking medications to lower her blood pressure. What secondary prevention strategy should the nurse advocate? 1) Get annual flu vaccination 2) Have an annual Papanicolau test 3) Have blood pressure checked monthly 4) Exercise at least three times a week 25) 2 Explanation 1. This is a primary prevention strategy, as it will prevent disease. 2. This is a secondary prevention strategy, as it focuses on early detection. 3. This is a tertiary prevention strategy, as the nurse is monitoring the success of treatment and preventing complications. 4. This is a primary prevention strategy, as it aims to improve or maintain health. Planning Analysis Objective 1 Page 30, 31 Difficulty 2
SHORT ANSWER. Write the word or phrase that best completes each statement or answers the question. 26) What were the original principles of primary health care as established by the World Health Organization in 1978? (select all that apply) 1) Equitable access to health and health services 2) Public participation 3) Appropriate technology 4) Intersectoral collaboration 5) Reorientation of the health system 6) Promotion of health and prevention of disease and injury 26) 1, 2, 3, 4, and 6 Explanation:
The declaration of Alma-Ata emphasized the need for health providers to work with people to assist them in making decisions about their health and help them understand how to meet health challenges in ways that are affordable, acceptable, and sustainable over the long term. Primary healthcare was developed to guide effective healthcare delivery and incorporates all levels of prevention (primary, secondary, and tertiary) and includes the concepts of accessibility, public participation, health promotion, appropriate technology, and intersectoral cooperation (WHO, 1978). Assessment Knowledge Objective 1 Page 24 and 25 Difficulty 1
Chapter 3 MULTIPLE CHOICE. Choose the one alternative that best completes the statement or answers the question. 1) The mother of a two-year-old tells the nurse that she is concerned about her child’s lower back curving in and the child’s belly sticking out. How should the nurse respond? 1) Ask the mother to buy the child bigger clothes 2) Give the mother the first available appointment to see the physician 3) Obtain a referral to the pediatric orthopedic clinic 4) Reassure the mother that this is normal for a toddler 1) 4 Explanation: 1. This does not address the mother concerns. 2. There is no need to see a physician as the lordosis and protruding abdomen are normal in toddlers. 3. There is need to make a referral as the lordosis and protruding abdomen are normal in a toddler. 4. Young toddlers have pronounced lordosis, which makes their abdomens protrude. This is a normal finding, and the mother should be assured of this. Intervention Application Objective – 4 Page – 43 Difficulty – 2 2) A nurse is teaching parents of a child in Piaget’s sensorimotor stage of development. What would be an appropriate activity to help the child accomplish developmental tasks of this stage? 1) Buying more colourful toys 2) Playing with water toys in the bathtub 3) Buying some blocks with numbers 4) Playing peek-a-boo 2) 4 Explanation: 1. This stage deals with helping the child learn that objects continue to exist even when not seen. 2. This stage is from birth to 2 years and playing with toys in the tub would not be appropriate. 3. Buying blocks will help with coordination, but not with learning that things still exist when not seen 4. In the sensorimotor stage (birth to 2 years) the infant attains a sense of object permanence, which is the knowledge that objects continue to exist when not seen. Playing peek-a-boo helps the child know that someone is there even when not seen. Evaluation Analysis Objective – 2 Page – 39, 44 Difficulty – 2
3) A nurse is writing a care plan for a pediatric client who is working on Erickson's developmental Stage 4. What would be an appropriate goal for a child in this stage? 1) Stating that the sense of shame and self-doubt has become less intense 2) Helping the child develop a sense of identify and exploring attitudes and beliefs 3) Completing school homework and have passing grades within one month 4) Volunteering to help with one or more community projects each week 3) 3 Explanation: 1. Shame and self-doubt may occur in toddlers if they do not learn independence. 2. This would be a task for the child in Stage 5, Identity vs. Role Confusion. 3. Stage 4 (6–11 years) is the crisis of industry versus inferiority. Industry results in the development of competency, creativity, and perseverance. Inferiority creates feelings of hopelessness, and a sense of being mediocre or incompetent, and withdrawal from school and peers may result. Reaching a goal of completing school homework and having passing grades within one month would help develop a sense of competency and creativity and would require perseverance to accomplish this goal. 4. Community involvement is seen in later years to prevent isolation and stagnation. Planning Application Objective – 2 Page – 40, 48 Difficulty – 2
4) A nurse is working at a Senior Centre and has just counselled a client experiencing a crisis in Erickson’s Integrity vs. Despair developmental stage. What suggestion would be the most appropriate? 1) Buying a bigger house to house a divorced adult child 2) Getting a pet 3) Cataloguing family pictures 4) Playing sports 4) 3 Explanation: 1. Having an adult child move back in the home may cause the senior to feel like a failure as a parent. 2. A pet can be good company for a senior, but does not address the need for the senior to feel a sense of satisfaction in his/her life at this stage. 3. During the stage of Integrity vs. Despair an individual will either feel contentment and satisfaction with their place in life or feel sadness and a sense of loss. Cataloguing family pictures may bring a sense of satisfaction to the individual. 4. Playing sports may be healthy but does not help the senior reflect on his life and feel a sense of satisfaction. Intervention Application Objective – 2 Page – 40, 53 Difficulty – 2
5) A nurse is interviewing the mother of a toddler who complains that her child continues to hide and have bowel movements in the diaper, but will use the toilet to void. The nurse would correctly tell the mother that the child is in which of the following Freudian phases of psychological development? 1) Genital 2) Phallic 3) Anal 4) Latency 5) 3 Explanation: 1. The genital stage is when sexual urges awake. 2. During this stage the child discovers that the genitals can be a source of pleasure. It is a time of exploration and identifying with the same-sex parent. 3. Freud’s anal phase follows the oral phase and continues through age 3. The anus becomes the focus for gratification and the child experiences conflict when expectations about toileting are presented. 4. The latency phase occurs during years 5 to 6; sexual urges are repressed and the child focuses on the educational and social world. Assessment Application Objective – 2 Page – 39, 45 Difficulty – 1
6) The mother of a 5-month-old infant calls the health unit to report to the nurse that she has noticed that her infant still has tremors of the extremities and chin at times. How should the nurse respond? 1) Reassure the mother that these tremors are a normal part of the infant’s development 2) Give the mother the first available appointment to see the physician 3) Contact the pediatrician to see if he/she wants an EEG to be completed 4) Ask the mother to document the time of day of tremors and come in next week 6) 1 Explanation: 1. Tremors of the extremities or chin of an infant are normal and reflect immature myelinization and will disappear by one year when the myelinization of the efferent pathways matures. 2. The tremors are normal and a referral is not necessary. 3. The need to have an EEG is not indicated. 4. This is a normal behaviour in a 5-month-old infant and it is not necessary to determine a pattern. Intervention Application Objective – 3 Page - 40 Difficulty – 2 7) A nurse is counselling a middle-aged couple. The husband has been told by his wife that both men and women experience decreasing hormonal production during middle adulthood, and he asks the nurse if this is true. How should the nurse respond? 1) “Your wife has obtained some incorrect data.” 2) “Why do you ask?” 3) “Your hormonal levels increase, not decrease with age.” 4) “Your wife is correct. Men do have a decrease in hormone production with aging.”