Chapter 5 Frameworks for Health Promotion, Disease Prevention, and Risk Reduction

1. Health People 2020 (HP 2020) is a guidepost for nurses and interdisciplinary teams in community and public health. New focal areas for HP 2020 include: (Select all that apply.)
A) Adolescent health
B) Diabetes
C) Genomics
D) Nutrition and weight status

Ans: A, C, E
Feedback: Ten new focal areas were added to HP 2020, beyond those included in HP 2010. These include the following: adolescent health; blood disorders and blood safety; dementias, including Alzheimer disease; early and middle childhood; genom

2. The nurse identifies the specific indicators and focal areas needed to establish immunization and well-child clinics in a low-income neighborhood. What actions are needed to meet the health outcomes of the project?
A) Identify the need in the community

Ans: B
Feedback: Knowing how to address the need for change and the actual change at a personal, family, and community level must be based on science�evidence based on rigorous understanding of a problem. Specific actions that can best achieve positive he

3. Absenteeism due to illness has increased recently in the local middle school. The increase is noted to be related to exacerbation of asthma symptoms in the student population. Which would be the most effective approach in decreasing absenteeism among t

Ans: A
Feedback: Community health nurses are focused specifically on modifiable risks of acquiring disease. This requires nurses to analyze trends in risk surveillance data and consider the physical, emotional, and psychosocial challenges people face when

4. Multiple family units in an underserved neighborhood have children who have not been vaccinated per health guidelines. The nurse researches the problem and establishes a well-child clinic within walking distance to the neighborhood. The clinic is poorl

Ans: C
Feedback: Although the morbidity and mortality data reports are quantitative, it is important to understand that in most cases, perceptions of health or well-being on the part of individuals, families, and communities are subjective. The science of

5. The local clinic is dedicated to the well adult and child. It has evening hours and offers varied programs for the community. The programs include immunizations and classes on fire safety, health education, and car safety, to name a few. How would the

Ans: A
Feedback: When an individual person or a group is considered in good health and shows no signs or symptoms of disease or physical challenges, nurses in interdisciplinary teams and community partnerships are involved in primary prevention. Secondary

6. Using the tenets of secondary prevention, the committee seeks to establish an HIV/AIDS clinic. The nurse states that it is important for the location of the clinic to be associated with the local hospital. The committee states that the cost of the clin

Ans: B
Feedback: Clients diagnosed with HIV/AIDS need secondary prevention services. To screen effectively for the presence of this condition, a test should be backed by a healthcare infrastructure that can implement programs of care for people who have a

7. The nurse works in a facility that provides hospice care for clients with cancer diagnoses. The nurse recognizes that the care provided in this facility is tertiary in nature. The nurse develops a plan for the clients that would include the tenets of t

Ans: A, B, D
Feedback: Tertiary prevention includes rehabilitation and palliative care. Nurses providing this level of care assess disease progression, watch for opportunistic infections, and control pain or other side effects of treatment. Care also incl

8. An immigrant from Guatemala, age 47, is admitted to the coronary care unit with congestive heart failure. This is the fourth admission for this client, and the physician believes that the client's inability to adhere to his diet and medication regimen

Ans:B
Feedback:The development of culturally relevant and gender-sensitive interventions that demonstrate positive outcomes in health and well-being is the focus of prevention efforts. Approaching individuals and groups about behavior change must incorpor

9. The nurse conducts a class on the basics of nutrition to a group of obese adults. The nurse counsels the audience, telling them that they need to change their behaviors. By the end of the class, the nurse has lost the audience. To enhance audience part

Ans: C
Feedback: Motivational interviewing, which was developed by Rollnick and Miller (1995), is defined as a "directive, client-centered communication style for eliciting behavior change by helping clients/[groups] to explore and resolve ambivalence." T

10. The nurse decided to use a learning model based on Skinner with a client with diabetes to improve compliance with dietary and blood glucose assessment requirements. Which would be the best way to implement this program?
A) Give rewards for a lower blo

Ans: A
Feedback: According to Skinner (1953), health behaviors are seen as incremental steps toward a final goal. In the learning model, the nurse establishes and reinforces a goal and rewards the client for partial accomplishment, if necessary. Increment

11. The nurse decides to use the health belief model for a wellness walking program for older adults. The walk is to begin each day at 8 PM. Each day a different participant is to start a chain of phone calls to other participants to remind all to attend.

Ans: A, B, C
Feedback: The health belief model, developed by Hochbaum (1956) and Rosenstock (1974), specifies that individual, family, or community health-related behavior depends on (1) the severity of the potential illness or physical challenge, (2) the

12. The committee has established the need for a sick child clinic in an impoverished neighborhood. The demographic data have been collected, and the committee is ready to meet with a group of local businesspeople who are willing to support the project fi

Ans: B
Feedback: The stages in a transtheoretical model are as follows: precontemplation (no screening programs scheduled and no intention to schedule screening); contemplation (no screening programs scheduled but intent to start a program soon); preparat

13. A 34-year-old client is recovering from a below-the-knee amputation secondary to a motor vehicle accident. The nurse meets with the client to update his care plan, and client states that he knows that he will walk again. He asks for physical therapy s

Ans: A
Feedback: The theory of reasoned action states that a person's given behavior is primarily determined by his or her intention to perform that behavior (Fishbein & Ajzen, 1975). This intention is determined by the person's attitude toward the behavi

14. A 47-year-old client and three members of his neighborhood have had their homes robbed and belongings scattered. The client contacts the police and, with their assistance, develops a neighborhood watch. The watch is organized and 24 families have been

Ans: D
Feedback: The relapse prevention model has been used specifically with issues that relate to adherence. For example, communities interested in crime prevention may be aware that in certain months of the year there is an increase in violent crime. T

15. A 27-year-old client comes from a background of physical and sexual abuse. Violence victimization continued with her partners until recently. She is currently in a support group for victims of abuse. The client's social background places her at risk f

Ans: B, D, E
Feedback: Trauma such as child sexual abuse, intimate partner violence, adult sexual abuse, and victimization from exposure to violent environments contribute to behaviors associated with increased HIV risk and disease sequelae. Violence vict

16. A 19-year-old client is diagnosed as HIV positive. Which behaviors might be indicators of noncompliance with her drug regimen and require further assessment? (Select all that apply.)
A) Depression
B) Indifference to self-advocacy in sexual relationshi

Ans: A, B, E
Feedback: In women, there is a relationship between poor self-image, depression, and lack of self-advocacy in sexual relationships (DeMarco, Johnsen, Fukuda, & Deffenbaugh, 2001). From a treatment perspective, depressive symptoms are underdia

17. A 32-year-old African-American client is diagnosed with HIV. She is at her 6-month appointment following diagnosis and treatment. The client states that she has not revealed her diagnosis to her boyfriend because she is afraid that he will leave. She

Ans: C
Feedback: The concept of "silencing the self" has been used to explain how gender roles negatively influence self-advocacy behaviors in women. Women tend to silence their voice in relationships to maintain connections with others, even if that mean

18. A woman arrives at the clinic for a routine appointment. She has been HIV positive for 3 years and states she is doing well. She currently is involved in a relationship with a man who is HIV positive. She states that she is not consistent with safe se

Ans: B
Feedback: Although both the woman and her partner are already HIV positive, they can still transmit different strains of HIV to each other, as well as other STIs and can then go on to infect others. Thus, they are not "safe" and the woman should be

19. Secondary HIV prevention or positive prevention is used when caring for African-American women living with HIV by addressing which behavioral risks? (Select all that apply.)
A) Interpersonal mistrust
B) Alcoholism
C) Poor adherence to treatment
D) Smo

Ans: A, C, E
Feedback: Advancing the scientific understanding of secondary HIV prevention (what is called positive prevention) in African-American women by exploring ways to address behavioral risk reduction prevents further transmission of HIV and the se

20. A 43-year-old African-American client is HIV positive. She has a personal history of abuse, which ended when her husband died 2 years ago. When counseling the client about adherence to her treatment plan, the nurse finds her intelligent and goal orien

Ans: C
Feedback: When providing physical care to clients with HIV and working to decrease communicability using the ecological model, consider the client's mental health symptoms, severity/frequency of the effects from significant trauma, such as posttrau

21. The nurse works at community clinic that provides various types of health screenings for members of the community. One day, the nurse provides tuberculin tests for a group of new hospital employees. Which type of screening procedure is this?
A) Mass s

Ans: B
Feedback: Selective screening is performed for specific high-risk populations, such as tuberculin tests for hospital employees. Mass screening is performed on an entire population, such as blood lead level screening, Papanicolaou (Pap) smears, and