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Shop What's New Sign inTest Bank for LeMone and Burkes Medical-Surgical Nursing: Clinical Reasoning in Patient Care, 7th Edition
Preview Extract
LeMone & Burke’s Medical-Surgical Nursing, 7e (Bauldoff/Gubrud/Carno)
Chapter 2 Health and Illness Care of Adults
1) The nurse is caring for a patient with heart failure. What should the nurse include when
planning holistic care for this patient?
1. Spiritual needs
2. Measuring intake and output
3. Daily weights
4. Ambulating with assistance
Answer: 1
Explanation: 1. Holistic healthcare considers all aspects of an individual (physical, psychosocial,
cultural, spiritual, and intellectual) as essential components of individualized care.
2. Measuring intake and output meets the patient’s physical needs and would not address
holistic needs.
3. Daily weights focus solely on the patient’s physical needs and would not address holistic
needs.
4. Ambulating with assistance focuses solely on the patient’s physical needs and would not
address holistic needs.
Page Ref: 25
Cognitive Level: Applying
Client Need & Sub: Psychosocial Integrity: Religious and Spiritual Influences on Health
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of
patient-centered care | AACN Essentials Competencies: IX.3. Implement holistic, patientcentered care that reflects an understanding of human growth and development,
pathophysiology, pharmacology, medical management and nursing management across the
health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies:
Relationship-Centered Care; Knowledge; Factors that contribute to or threaten health |
Nursing/Integrated Concepts: Nursing Process: Planning
Learning Outcome: 2.1 Define health and the health-illness continuum, and discuss factors
affecting the health of individuals, families, communities, and special populations.
MNL Learning Outcome: 1. Consider the impact of health, wellness, illness, and injury to
patients and their families.
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2) A patient reports never experiencing major illnesses and has enjoyed good health without
much effort. How should the nurse identify this patient’s definition of health?
1. Absence of disease
2. Effortless
3. Fortunate
4. Integrated method of functioning
Answer: 1
Explanation: 1. The patient is defining health as being the absence of disease because of not
experiencing any major illnesses and not expending much effort to do so.
2. The nurse has no way of knowing if the patient believes health is effortless.
3. The nurse has no way of knowing if the patient believes health is fortunate.
4. An integrated method of functioning is the definition of wellness which the patient is not
describing.
Page Ref: 25
Cognitive Level: Analyzing
Client Need & Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of
patient-centered care | AACN Essentials Competencies: IX.3. Implement holistic, patientcentered care that reflects an understanding of human growth and development,
pathophysiology, pharmacology, medical management, and nursing management across the
health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies:
Relationship-Centered Care; Knowledge; Factors that contribute to or threaten health |
Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 2.1 Define health and the health-illness continuum, and discuss factors
affecting the health of individuals, families, communities, and special populations.
MNL Learning Outcome: 1. Consider the impact of health, wellness, illness, and injury to
patients and their families.
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3) During an assessment, the nurse learns that a patient has a genetic predisposition to the
development of several disease processes. Which illness should the nurse realize is associated
with genetic makeup?
1. Cancer
2. Hypertension
3. Osteoporosis
4. Myocardial infarction
Answer: 1
Explanation: 1. Chronic illnesses that are associated with genetic makeup include sickle cell
disease, hemophilia, diabetes mellitus, and cancer.
2. Hypertension is associated with a cultural group.
3. Osteoporosis is associated with a cultural group.
4. Myocardial infarction is associated with age and lifestyle factors.
Page Ref: 25
Cognitive Level: Analyzing
Client Need & Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of
patient-centered care | AACN Essentials Competencies: VII.2. Conduct a health history,
including environmental exposure and a family history that recognizes genetic risks, to identify
current and future health problems | NLN Competencies: Relationship-Centered Care;
Knowledge; Factors that contribute to or threaten health | Nursing/Integrated Concepts:
Nursing Process: Assessment
Learning Outcome: 2.1 Define health and the health-illness continuum, and discuss factors
affecting the health of individuals, families, communities, and special populations.
MNL Learning Outcome: 1. Consider the impact of health, wellness, illness, and injury to
patients and their families.
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4) The nurse is assessing a patient who is a Native American. For which health problem should
the nurse assess the patient?
1. Diabetes mellitus
2. Eye disorders
3. Hypertension
4. Osteoporosis
Answer: 1
Explanation: 1. Diabetes mellitus is among the leading causes of illness in Native Americans.
This is what the nurse should include in the assessment of this patient.
2. Eye disorders are more common in Chinese Americans.
3. Hypertension is more common in African Americans.
4. Osteoporosis is more common in Caucasian women of small stature and Scandinavian
heritage.
Page Ref: 26
Cognitive Level: Applying
Client Need & Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of
patient-centered care | AACN Essentials Competencies: VII.2. Conduct a health history,
including environmental exposure and a family history that recognizes genetic risks, to identify
current and future health problems | NLN Competencies: Relationship-Centered Care;
Knowledge; Factors that contribute to or threaten health | Nursing/Integrated Concepts:
Nursing Process: Assessment
Learning Outcome: 2.1 Define health and the health-illness continuum, and discuss factors
affecting the health of individuals, families, communities, and special populations.
MNL Learning Outcome: 1. Consider the impact of health, wellness, illness, and injury to
patients and their families.
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5) During an assessment, a patient reports being lactose intolerant. Within which cultural group
is this food intolerance common?
1. Mexican Americans
2. Scandinavian Americans
3. Indian Americans
4. Mediterranean Americans
Answer: 1
Explanation: 1. Mexican Americans, African Americans, Native Americans, and Asians may be
lactose intolerant.
2. Lactose intolerance is not common in Scandinavian Americans.
3. Lactose intolerance is not common in Indian Americans.
4. Lactose intolerance is not common in Mediterranean Americans.
Page Ref: 26
Cognitive Level: Analyzing
Client Need & Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of
patient-centered care | AACN Essentials Competencies: VII.2. Conduct a health history,
including environmental exposure and a family history that recognizes genetic risks, to identify
current and future health problems | NLN Competencies: Relationship-Centered Care;
Knowledge; Factors that contribute to or threaten health | Nursing/Integrated Concepts:
Nursing Process: Assessment
Learning Outcome: 2.1 Define health and the health-illness continuum, and discuss factors
affecting the health of individuals, families, communities, and special populations.
MNL Learning Outcome: 1. Consider the impact of health, wellness, illness, and injury to
patients and their families.
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6) A patient with a respiratory illness is a factory worker and uses public transportation to get
to work. Which will be impacted by the patient’s socioeconomic status?
1. Lifestyle
2. Cognitive abilities
3. Education level
4. Developmental level
Answer: 1
Explanation: 1. Lifestyle and environmental influences are affected by one’s income level.
2. Cognitive development affects whether people view themselves as healthy or ill and may
affect their health practices.
3. Educational level affects the ability to understand and follow guidelines for health.
4. Developmental level is not related to socioeconomic status.
Page Ref: 26
Cognitive Level: Analyzing
Client Need & Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of
patient-centered care | AACN Essentials Competencies: VII.2. Conduct a health history,
including environmental exposure and a family history that recognizes genetic risks, to identify
current and future health problems | NLN Competencies: Relationship-Centered Care;
Knowledge; Factors that contribute to or threaten health | Nursing/Integrated Concepts:
Nursing Process: Assessment
Learning Outcome: 2.1 Define health and the health-illness continuum, and discuss factors
affecting the health of individuals, families, communities, and special populations.
MNL Learning Outcome: 1. Consider the impact of health, wellness, illness, and injury to
patients and their families.
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7) The nurse is reviewing the goals for Healthy People 2020 with a group of patients in an
outpatient clinic. What should the nurse include in this presentation? Select all that apply.
1. Attain high-quality, longer lives free of preventable disease, disability, injury, and premature
death.
2. Achieving health equity, eliminating disparities, and improving the health of all groups.
3. Creating social and physical environments that promote good health for all.
4. Promoting healthy development and healthy behaviors across every stage of life.
5. Achieving a body weight 20% less than recommended in current standardized height/weight
charts.
Answer: 1, 2, 3, 4
Explanation: 1. Attaining high-quality, longer lives free of preventable disease, disability, injury,
and premature death is one of the Healthy People 2020 goals and should be included in the
presentation.
2. Achieving health equity, eliminating disparities, and improving the health of all groups is one
of the Healthy People 2020 goals and should be included in the presentation.
3. Creating social and physical environments that promote good health for all is one of the
Healthy People 2020 goals and should be included in the presentation.
4. Promoting healthy development and healthy behaviors across every stage of life is one of the
Healthy People 2020 goals and should be included in the presentation.
5. Achieving a body weight 20% less than recommended in current standardized height/weight
charts is not a Healthy People 2020 goal and might be considered dangerous.
Page Ref: 35
Cognitive Level: Applying
Client Need & Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of
patient-centered care | AACN Essentials Competencies: VII.5. Use evidence-based practices to
guide health teaching, health counseling, screening, outreach, disease and outbreak
investigation, referral and follow-up throughout the lifespan | NLN Competencies: Context and
Environment; Knowledge; health promotion/disease prevention; chronic disease management
| Nursing/Integrated Concepts: Nursing Process: Implementation/Teaching/Learning
Learning Outcome: 2.2 Compare and contrast health risks, assessment, and health promotion
for the young adult, middle adult, and older adult.
MNL Learning Outcome: 2. Recognize the health risks of individuals across the lifespan,
families, and communities and the role of nursing in health promotion and maintenance.
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8) The nurse is instructing a patient on nutritional needs by using MyPlate. What should the
nurse emphasize when using this food guide?
1. Consuming nutrient-dense foods and beverages.
2. Ways to limit exposure to carcinogens
3. Activities to reduce the onset of diabetes mellitus
4. Avoiding overuse of aerobic exercise
Answer: 1
Explanation: 1. The U.S. Department of Agriculture provides a general guideline for what to eat
each day, illustrated in MyPlate. One overarching concept for this guide is to focus on
consuming nutrient-dense foods and beverages.
2. MyPlate was not created to instruct patients on ways to limit exposure to carcinogens.
3. MyPlate was not created to reduce the onset of diabetes mellitus.
4. MyPlate was not created to avoid the overuse of aerobic exercise.
Page Ref: 36
Cognitive Level: Applying
Client Need & Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of
patient-centered care | AACN Essentials Competencies: VII.5. Use evidence-based practices to
guide health teaching, health counseling, screening, outreach, disease and outbreak
investigation, referral and follow-up throughout the lifespan | NLN Competencies: Context and
Environment; Knowledge; health promotion/disease prevention; chronic disease management
| Nursing/Integrated Concepts: Nursing Process: Implementation/Teaching/Learning
Learning Outcome: 2.2 Compare and contrast health risks, assessment, and health promotion
for the young adult, middle adult, and older adult.
MNL Learning Outcome: 2. Recognize the health risks of individuals across the lifespan,
families, and communities and the role of nursing in health promotion and maintenance.
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9) A patient asks for suggestions to help improve current health status. What should the nurse
instruct this patient?
1. Participate in a continuous physical activity for 30 minutes, 5 or more days each week.
2. Obtain sun exposure every day.
3. Reduce tobacco use.
4. Sleep at least 6 hours each night.
Answer: 1
Explanation: 1. Practices for healthy living include participating in a continuous physical activity
for 30 minutes 5 or more days each week.
2. Sun exposure should be limited and should always involve application of a sunscreen.
3. Smoking and the use of tobacco products should be eliminated, not just reduced.
4. The patient should be instructed to sleep 7 to 8 hours each day.
Page Ref: 36
Cognitive Level: Applying
Client Need & Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of
patient-centered care | AACN Essentials Competencies: VII.5. Use evidence-based practices to
guide health teaching, health counseling, screening, outreach, disease and outbreak
investigation, referral and follow-up throughout the lifespan | NLN Competencies: Context and
Environment; Knowledge; apply health promotion/disease prevention strategies; apply health
policy | Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 2.2 Compare and contrast health risks, assessment, and health promotion
for the young adult, middle adult, and older adult.
MNL Learning Outcome: 2. Recognize the health risks of individuals across the lifespan,
families, and communities and the role of nursing in health promotion and maintenance.
9
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10) A patient reports drinking four alcoholic beverages every day and smoking one pack of
cigarettes. Which is this patient predisposed to develop?
1. Disease
2. Illness
3. Injury
4. Infection
Answer: 1
Explanation: 1. The term disease describes an alteration in structure and function of the body
or mind. One cause of disease is exposure to chemicals such as alcohol and tobacco. Ingesting
four alcoholic beverages and smoking one pack of cigarettes per day exposes the body to
chemicals that can lead to the development of a disease.
2. An illness is a person’s response to a disease and is highly individualized.
3. There is not enough information to determine if the alcohol and cigarettes will cause the
patient to develop an injury.
4. There is not enough information to determine if the alcohol and cigarettes will cause the
patient to develop an infection.
Page Ref: 36
Cognitive Level: Analyzing
Client Need & Sub: Health Promotion and Maintenance: High Risk Behaviors
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of
patient-centered care | AACN Essentials Competencies: VII.5. Use evidence-based practices to
guide health teaching, health counseling, screening, outreach, disease and outbreak
investigation, referral and follow-up throughout the lifespan | NLN Competencies: Context and
Environment; Knowledge; health promotion/disease prevention, chronic disease management
| Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 2.3 Differentiate between disease, illness, and injury, and describe illness
behaviors and needs of the patient with acute, critical, and chronic illness.
MNL Learning Outcome: 3. Consider the differences between disease, illness, and injury and
the behaviors and needs of the patient with various levels of illness.
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11) A patient reports a new onset of a health problem. Which is the primary reason for a
patient to seek medical attention?
1. Pain
2. Bleeding
3. Vomiting
4. Fatigue
Answer: 1
Explanation: 1. The subjective symptom of pain is the primary reason people seek healthcare.
2. Bleeding is an objective symptom that varies with the disease process.
3. Vomiting is an objective symptom that varies with the disease process.
4. Fatigue is a subjective symptom that varies with the disease process.
Page Ref: 36
Cognitive Level: Analyzing
Client Need & Sub: Physiological Integrity: Reduction of Risk Potential
Standards: QSEN Competencies: I.C.9. Recognize that patient expectations influence outcomes
in management of pain or suffering | AACN Essentials Competencies: IX.8. Implement evidencebased nursing interventions as appropriate for managing the acute and chronic care of patients
and promoting health across the lifespan | NLN Competencies: Quality and Safety; Knowledge;
Current best practices | Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 2.3 Differentiate between disease, illness, and injury, and describe illness
behaviors and needs of the patient with acute, critical, and chronic illness.
MNL Learning Outcome: 3. Consider the differences between disease, illness, and injury and
the behaviors and needs of the patient with various levels of illness.
12) While being treated for one disease process, a patient begins demonstrating manifestations
of another disease process. Which type of disease is the patient experiencing?
1. Iatrogenic
2. Communicable
3. Congenital
4. Degenerative
Answer: 1
Explanation: 1. An iatrogenic disease is caused by medical therapy.
2. A communicable disease spreads from one person to another.
3. A congenital disease exists at or before birth.
4. A degenerative disease results from the deterioration or impairment of organs or tissues.
Page Ref: 37
Cognitive Level: Analyzing
Client Need & Sub: Physiological Integrity: Reduction of Risk Potential
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of
patient-centered care | AACN Essentials Competencies: IX.8. Implement evidence-based
nursing interventions as appropriate for managing the acute and chronic care of patients and
promoting health across the lifespan | NLN Competencies: Quality and Safety; Knowledge;
Current best practices | Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 2.3 Differentiate between disease, illness, and injury, and describe illness
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behaviors and needs of the patient with acute, critical, and chronic illness.
MNL Learning Outcome: 3. Consider the differences between disease, illness, and injury and
the behaviors and needs of the patient with various levels of illness.
13) A patient reports feeling fine even after being diagnosed with chronic kidney failure. What
is the patient likely to manifest?
1. Signs of an illness
2. An iatrogenic disease
3. A psychosomatic illness
4. An idiopathic disorder
Answer: 1
Explanation: 1. An illness is a person’s response to a disease. The person responds to personal
perception of the disease and to the perception of others. Because the patient is diagnosed
with chronic kidney failure, signs of an illness are likely to manifest.
2. An iatrogenic disease is caused by medical therapy.
3. Psychosomatic illnesses are characterized by physiologic symptoms caused by mental or
emotional disturbance.
4. An idiopathic disorder has no known cause.
Page Ref: 36
Cognitive Level: Analyzing
Client Need & Sub: Physiological Integrity: Reduction of Risk Potential
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of
patient-centered care | AACN Essentials Competencies: IX.8. Implement evidence-based
nursing interventions as appropriate for managing the acute and chronic care of patients and
promoting health across the lifespan | NLN Competencies: Quality and Safety; Knowledge;
Current best practices | Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 2.3 Differentiate between disease, illness, and injury, and describe illness
behaviors and needs of the patient with acute, critical, and chronic illness.
MNL Learning Outcome: 3. Consider the differences between disease, illness, and injury and
the behaviors and needs of the patient with various levels of illness.
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14) A patient reports not feeling well for a few days and has been using an over-the-counter
medication without improvement. Which illness behavior is this patient demonstrating?
1. Seeking medical care
2. Experiencing symptoms
3. Assuming the sick role
4. Assuming a dependent role
Answer: 1
Explanation: 1. The patient is reporting not feeling well, which describes the behavior of
seeking medical care.
2. Experiencing symptoms occurs when the patient realizes feelings of being unwell.
3. Assuming the sick role occurs after seeking medical care.
4. Assuming a dependent role occurs upon hospitalization.
Page Ref: 38
Cognitive Level: Analyzing
Client Need & Sub: Physiological Integrity: Reduction of Risk Potential
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of
patient-centered care | AACN Essentials Competencies: IX.8. Implement evidence-based
nursing interventions as appropriate for managing the acute and chronic care of patients and
promoting health across the lifespan | NLN Competencies: Quality and Safety; Knowledge;
Current best practices | Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 2.3 Differentiate between disease, illness, and injury, and describe illness
behaviors and needs of the patient with acute, critical, and chronic illness.
MNL Learning Outcome: 3. Consider the differences between disease, illness, and injury and
the behaviors and needs of the patient with various levels of illness.
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15) A patient wants to be discharged to home and resume normal activities of daily living. In
which stage of illness behavior is the patient entering?
1. Achieving recovery and rehabilitation
2. Seeking medical care
3. Assuming a dependent role
4. Experiencing symptoms
Answer: 1
Explanation: 1. Achieving recovery and rehabilitation is the final stage of an acute illness and
occurs when the patient gives up the dependent role and resumes normal activities and
responsibilities.
2. Seeking medical care occurs when the patient sees a healthcare provider for diagnosis of an
illness.
3. The patient assumes a dependent role when entering the hospital for care.
4. Experiencing symptoms is the first stage of an acute illness.
Page Ref: 38
Cognitive Level: Analyzing
Client Need & Sub: Physiological Integrity: Physiological Adaptation
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of
patient-centered care | AACN Essentials Competencies: IX.8. Implement evidence-based
nursing interventions as appropriate for managing the acute and chronic care of patients and
promoting health across the lifespan | NLN Competencies: Quality and Safety; Knowledge;
Current best practices | Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 2.3 Differentiate between disease, illness, and injury, and describe illness
behaviors and needs of the patient with acute, critical, and chronic illness.
MNL Learning Outcome: 3. Consider the differences between disease, illness, and injury and
the behaviors and needs of the patient with various levels of illness.
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16) A patient with a chronic illness is not currently experiencing any symptoms and plans to
stop following the identified course of care because the disease is cured. How should the nurse
respond to this patient?
1. “The treatment plan is the reason you are not experiencing symptoms, so it would be best if
you did not stop the plan.”
2. “That does sound like a good idea.”
3. “You can always resume the plan if the symptoms return.”
4. “Plan to wean yourself off the treatment plan and not discontinue it all at once.”
Answer: 1
Explanation: 1. Patients with a chronic illness need to learn how to manage an ongoing
treatment plan even in periods of remission. The treatment plan is the reason the patient is not
experiencing any symptoms and the patient should be encouraged to follow the plan.
2. The nurse should not encourage the patient to stop the treatment plan by agreeing that it is
a good idea.
3. The nurse should not say that the plan can always be resumed if the symptoms return.
4. The nurse should not suggest that the patient make any alterations in the treatment plan
such as weaning off the plan.
Page Ref: 39
Cognitive Level: Applying
Client Need & Sub: Health Promotion and Maintenance: Self-Care
Standards: QSEN Competencies: I.C.1. Value seeing healthcare situations “through patients’
eyes” | AACN Essentials Competencies: IX.8. Implement evidence-based nursing interventions
as appropriate for managing the acute and chronic care of patients and promoting health
across the lifespan | NLN Competencies: Quality and Safety; Knowledge; Current best practices
| Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 2.3 Differentiate between disease, illness, and injury, and describe illness
behaviors and needs of the patient with acute, critical, and chronic illness.
MNL Learning Outcome: 3. Consider the differences between disease, illness, and injury and
the behaviors and needs of the patient with various levels of illness.
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17) The nurse is planning care for a patient with a chronic illness. What intervention should the
nurse include in the plan of care?
1. Instruct on ways to minimize the impact of the chronic illness.
2. Encourage to seek medical care weekly.
3. Limit activities until symptoms subside.
4. Suggest lifestyle alterations to prepare for more challenging symptom management in the
future.
Answer: 1
Explanation: 1. Nursing interventions for the person with a chronic illness include modifying
lifestyle to adapt to and minimize the impact of the disease.
2. Encouraging the patient to seek medical care weekly does not support effective interaction
with the healthcare system on an ongoing basis.
3. Limiting activities until symptoms subside does not improve well-being and quality of life.
4. Suggesting lifestyle alterations to prepare for more challenging symptom management in the
future does not improve well-being or quality of life.
Page Ref: 39
Cognitive Level: Applying
Client Need & Sub: Health Promotion and Maintenance: Self-Care
Standards: QSEN Competencies: I.C.1. Value seeing healthcare situations “through patients’
eyes” | AACN Essentials Competencies: IX.8. Implement evidence-based nursing interventions
as appropriate for managing the acute and chronic care of patients and promoting health
across the lifespan | NLN Competencies: Quality and Safety; Knowledge; Current best practices
| Nursing/Integrated Concepts: Nursing Process: Planning
Learning Outcome: 2.3 Differentiate between disease, illness, and injury, and describe illness
behaviors and needs of the patient with acute, critical, and chronic illness.
MNL Learning Outcome: 3. Consider the differences between disease, illness, and injury and
the behaviors and needs of the patient with various levels of illness.
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18) The nurse is planning an education session to discuss primary levels of disease prevention.
Which topics should the nurse include in this presentation?
1. Elimination of smoking and alcohol use
2. Locations for diabetes screening
3. Schedule colonoscopy examinations as prescribed
4. Use of available community rehabilitation facilities
Answer: 1
Explanation: 1. Primary prevention involves activities to prevent illness and disease and
includes smoking cessation and abstinence from alcohol.
2. Screening activities such as glucose testing are a form of secondary prevention.
3. Screening activities such as colonoscopy examinations are a form of secondary prevention.
4. Rehabilitation activities are considered a tertiary level of prevention.
Page Ref: 40
Cognitive Level: Applying
Client Need & Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of
patient-centered care | AACN Essentials Competencies: VII.5. Use evidence-based practices to
guide health teaching, health counseling, screening, outreach, disease and outbreak
investigation, referral and follow-up throughout the lifespan | NLN Competencies: Context and
Environment; Knowledge; health promotion/disease prevention | Nursing/Integrated Concepts:
Nursing Process: Planning
Learning Outcome: 2.3 Differentiate between disease, illness, and injury, and describe illness
behaviors and needs of the patient with acute, critical, and chronic illness.
MNL Learning Outcome: 3. Consider the differences between disease, illness, and injury and
the behaviors and needs of the patient with various levels of illness.
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19) The nurse is planning interventions to meet a patient’s tertiary care needs. Which would be
applicable for the patient?
1. Providing preoperative instructions
2. Instruction in self-examination of breasts
3. Screening for glaucoma
4. Counseling on healthy nutrition
Answer: 1
Explanation: 1. The tertiary level of care focuses on stopping the disease process and returning
the individual to a useful place in society. Providing preoperative instructions is a tertiary-level
intervention.
2. Instructing in self-examination of the breasts is a secondary-level intervention.
3. Screening for glaucoma is a secondary-level intervention.
4. Counseling on healthy nutrition is a primary-level intervention.
Page Ref: 40
Cognitive Level: Applying
Client Need & Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of
patient-centered care | AACN Essentials Competencies: VII.5. Use evidence-based practices to
guide health teaching, health counseling, screening, outreach, disease and outbreak
investigation, referral and follow-up throughout the lifespan | NLN Competencies: Context and
Environment; Knowledge; health promotion/disease prevention | Nursing/Integrated Concepts:
Nursing Process: Planning
Learning Outcome: 2.3 Differentiate between disease, illness, and injury, and describe illness
behaviors and needs of the patient with acute, critical, and chronic illness.
MNL Learning Outcome: 3. Consider the differences between disease, illness, and injury and
the behaviors and needs of the patient with various levels of illness.
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20) A patient is diagnosed with an ear infection and has been prescribed antibiotics. Which
level of intervention has the patient received?
1. Secondary
2. Primary
3. Tertiary
4. Acute
Answer: 1
Explanation: 1. The secondary level involves activities that emphasize early diagnosis and
treatment of an illness to stop the pathologic process and enable the person to return to a
former state of health as soon as possible. This includes receiving treatment such as antibiotic
therapy for an infection.
2. Primary activities promote health and delay the occurrence of disease.
3. Tertiary interventions focus on stopping the disease process and returning the individual to
society within the constraints of a disability.
4. There is no acute level of intervention.
Page Ref: 40
Cognitive Level: Analyzing
Client Need & Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of
patient-centered care | AACN Essentials Competencies: VII.5. Use evidence-based practices to
guide health teaching, health counseling, screening, outreach, disease and outbreak
investigation, referral and follow-up throughout the lifespan | NLN Competencies: Context and
Environment; Knowledge; health promotion/disease prevention | Nursing/Integrated Concepts:
Nursing Process: Implementation
Learning Outcome: 2.3 Differentiate between disease, illness, and injury, and describe illness
behaviors and needs of the patient with acute, critical, and chronic illness.
MNL Learning Outcome: 3. Consider the differences between disease, illness, and injury and
the behaviors and needs of the patient with various levels of illness.
19
Copyright ยฉ 2020 Pearson Education, Inc.
21) A middle-aged patient voices concerns about gaining 12 pounds over the past 2 years
without changing any dietary habits. Which response by the nurse is most appropriate?
1. “Age-related weight gain can occur because of consistent dietary intake and less physical
activity.”
2. “Are you exercising?”
3. “You might be eating more than you think.”
4. “You are getting older.”
Answer: 1
Explanation: 1. Weight gain is common in middle adulthood, usually the result of continuing to
consume the same number of calories while decreasing physical activity.
2. Asking the patient about exercise fails to provide the needed information and assumes the
patient is sedentary.
3. Implying the patient is overeating is judgmental and will do little to establish therapeutic
rapport.
4. The patient is aware of aging, and pointing this out does little to meet the patient’s obvious
interest in more information.
Page Ref: 28
Cognitive Level: Applying
Client Need & Sub: Health Promotion and Maintenance: Aging Process
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of
patient-centered care | AACN Essentials Competencies: VII.5. Use evidence-based practices to
guide health teaching, health counseling, screening, outreach, disease and outbreak
investigation, referral and follow-up throughout the lifespan | NLN Competencies: Context and
Environment; Knowledge; health promotion/disease prevention | Nursing/Integrated Concepts:
Nursing Process: Implementation
Learning Outcome: 2.1 Define health and the health-illness continuum, and discuss factors
affecting the health of individuals, families, communities, and special populations.
MNL Learning Outcome: 1. Consider the impact of health, wellness, illness, and injury to
patients and their families.
20
Copyright ยฉ 2020 Pearson Education, Inc.
22) The nurse is assisting an adolescent female patient to strategize ways to avoid the onset of
disease with aging. What should the nurse include in this plan? Select all that apply.
1. Maintain a healthy weight.
2. Avoid smoking.
3. Avoid substance abuse.
4. Schedule an annual mammogram.
5. Plan for a colonoscopy every 2 years.
Answer: 1, 2, 3
Explanation: 1. Healthy behaviors that are known to promote health and wellness include
eating a balanced diet, maintaining a calorie balance over time to achieve and sustain a healthy
weight; and focus on consuming nutrient-dense foods and beverages.
2. Healthy behaviors that are known to promote health and wellness include eliminating
smoking and use of other tobacco products such as smokeless tobacco.
3. Substance abuse is a major cause for concern in the young adult population.
4. Annual mammograms would not apply until the patient reaches the age of 40.
5. Colonoscopies would not apply until the patient reaches the age of 50.
Page Ref: 28, 36
Cognitive Level: Applying
Client Need & Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of
patient-centered care | AACN Essentials Competencies: VII.5. Use evidence-based practices to
guide health teaching, health counseling, screening, outreach, disease and outbreak
investigation, referral and follow-up throughout the lifespan | NLN Competencies: Context and
Environment; Knowledge; health promotion/disease prevention | Nursing/Integrated Concepts:
Nursing Process: Planning
Learning Outcome: 2.2 Compare and contrast health risks, assessment, and health promotion
for the young adult, middle adult, and older adult.
MNL Learning Outcome: 2. Recognize the health risks of individuals across the lifespan,
families, and communities and the role of nursing in health promotion and maintenance.
21
Copyright ยฉ 2020 Pearson Education, Inc.
23) A middle-aged female patient is having a routine examination and has no significant
personal or family medical history. What information concerning health-promotion behaviors
should the nurse provide to this patient?
1. Have bone density evaluated.
2. Plan to have a mammogram every other year.
3. Measure blood pressure every 3 years.
4. Exercise for at least 15 minutes a day 3 days each week.
Answer: 1
Explanation: 1. During the middle adult years, postmenopausal female patients may develop
low bone density or osteoporosis. Bone density should be evaluated.
2. Female patients should begin having annual mammograms by age 40.
3. Blood pressure should be measured annually and more frequently if elevated.
4. Exercise recommendations are for 30 minutes 5 or more days each week.
Page Ref: 28
Cognitive Level: Applying
Client Need & Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of
patient-centered care | AACN Essentials Competencies: VII.5. Use evidence-based practices to
guide health teaching, health counseling, screening, outreach, disease and outbreak
investigation, referral and follow-up throughout the lifespan | NLN Competencies: Context and
Environment; Knowledge; health promotion/disease prevention | Nursing/Integrated Concepts:
Nursing Process: Implementation
Learning Outcome: 2.1 Define health and the health-illness continuum, and discuss factors
affecting the health of individuals, families, communities, and special populations.
MNL Learning Outcome: 1. Consider the impact of health, wellness, illness, and injury to
patients and their families.
22
Copyright ยฉ 2020 Pearson Education, Inc.
24) An older patient experiences extreme drowsiness after taking an over-the-counter cold
medication at the prescribed dose. What should this information suggest to the nurse?
1. Older age is influencing the patient’s response to the medication.
2. More medication was taken than was reported.
3. A reaction between the cold medication and other routine medications has occurred.
4. An allergic reaction to the cold medication occurred.
Answer: 1
Explanation: 1. Older patients often experience altered responses to medications because of
age-related changes in the kidneys and liver.
2. There is no evidence the patient has taken too much medication.
3. There is no information provided to indicate the patient is taking other medications.
4. Allergic reactions usually cause integumentary- or respiratory-related symptoms.
Page Ref: 32
Cognitive Level: Analyzing
Client Need & Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of
patient-centered care | AACN Essentials Competencies: VII.5. Use evidence-based practices to
guide health teaching, health counseling, screening, outreach, disease and outbreak
investigation, referral and follow-up throughout the lifespan | NLN Competencies: Context and
Environment; Knowledge; health promotion/disease prevention; | Nursing/Integrated
Concepts: Nursing Process: Assessment
Learning Outcome: 2.1 Define health and the health-illness continuum, and discuss factors
affecting the health of individuals, families, communities, and special populations.
MNL Learning Outcome: 1. Consider the impact of health, wellness, illness, and injury to
patients and their families.
23
Copyright ยฉ 2020 Pearson Education, Inc.
25) The nurse is preparing discharge instructions for an African American patient recovering
from a same-day surgical procedure. What genetic, racial, ethnic, and cultural factors affecting
health and well-being should the nurse consider prior to giving discharge instructions? Select all
that apply.
1. Hypertension
2. Sickle cell anemia
3. Lactose intolerance
4. Diabetes
5. Osteoporosis
Answer: 1, 2, 3, 4
Explanation: 1. Certain diseases occur at a higher rate of incidence in some races and ethnic
and cultural groups. Examples of illnesses that are associated with genetic makeup include
hypertension among African Americans.
2. Certain diseases occur at a higher rate of incidence in some races and ethnic and cultural
groups. Examples of illnesses that are associated with genetic makeup include sickle cell anemia
among African Americans.
3. Certain diseases occur at a higher rate of incidence in some races and ethnic and cultural
groups. Examples of illnesses that are associated with genetic makeup include lactose
intolerance among African Americans.
4. Certain diseases occur at a higher rate of incidence in some races and ethnic and cultural
groups. Examples of illnesses that are associated with genetic makeup include diabetes among
African Americans.
5. Caucasian women of small stature and of Scandinavian heritage have a higher risk of
developing osteoporosis.
Page Ref: 26
Cognitive Level: Applying
Client Need & Sub: Psychosocial Integrity: Cultural Awareness/Cultural Influences on Health
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of
patient-centered care | AACN Essentials Competencies: VII.5. Use evidence-based practices to
guide health teaching, health counseling, screening, outreach, disease and outbreak
investigation, referral and follow-up throughout the lifespan | NLN Competencies: Context and
Environment; Knowledge; health promotion/disease prevention | Nursing/Integrated Concepts:
Nursing Process: Planning/Teaching/Learning
Learning Outcome: 2.1 Define health and the health-illness continuum, and discuss factors
affecting the health of individuals, families, communities, and special populations.
MNL Learning Outcome: 1. Consider the impact of health, wellness, illness, and injury to
patients and their families.
24
Copyright ยฉ 2020 Pearson Education, Inc.
26) The nurse is reviewing the health history with a young adult patient. For which vaccination
should the nurse assess this patient? Select all that apply.
1. Measles, mumps, rubella (MMR)
2. Hepatitis B
3. HPV
4. Influenza
5. Tetanus, diphtheria, pertussis every 10 years
Answer: 2, 3, 4, 5
Explanation: 1. MMR is not recommended for a young adult.
2. Hepatitis B is recommended for a young adult.
3. HPV is recommended for a young adult.
4. Influenza vaccination is recommended annually for all adults.
5. Tetanus-diphtheria boosters are recommended every 10 years. .
Page Ref: 37
Cognitive Level: Applying
Client Need & Sub: Physiological Integrity: Reduction of Risk Potential
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of
patient-centered care | AACN Essentials Competencies: VII.5. Use evidence-based practices to
guide health teaching, health counseling, screening, outreach, disease and outbreak
investigation, referral and follow-up throughout the lifespan | NLN Competencies: Context and
Environment; Knowledge; health promotion/disease prevention; chronic disease management
| Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 2.2 Compare and contrast health risks, assessment, and health promotion
for the young adult, middle adult, and older adult.
MNL Learning Outcome: 2. Recognize the health risks of individuals across the lifespan,
families, and communities and the role of nursing in health promotion and maintenance.
25
Copyright ยฉ 2020 Pearson Education, Inc.
27) A patient is diagnosed with an acute onset of pulmonary embolism. Rank the illness
behaviors that this patient may demonstrate in the commonly recognized sequence. Place the
five behaviors in the correct order.
Choice 1. Experiencing symptoms
Choice 2. Assuming a dependent role
Choice 3. Seeking medical care
Choice 4. Assuming the sick role
Choice 5. Recovery and rehabilitation
Answer: 1, 4, 3, 2, 5
Explanation: Choice 1. Illness behaviors are the way people cope with the alterations in health
and function caused by a disease. In the commonly recognized sequence of illness behaviors,
the first is experiencing symptoms.
Choice 2. In the commonly recognized sequence of illness behaviors, assuming a dependent
role is the fourth.
Choice 3. In the commonly recognized sequence of illness behaviors, seeking medical care is the
third.
Choice 4. In the commonly recognized sequence of illness behaviors, assuming the sick role is
the second.
Choice 5. In the commonly recognized sequence of illness behaviors, recovery and
rehabilitation are the fifth.
Page Ref: 38
Cognitive Level: Applying
Client Need & Sub: Physiological Integrity: Physiological Adaptation
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of
patient-centered care | AACN Essentials Competencies: IX.3. Implement holistic, patientcentered care that reflects an understanding of human growth and development,
pathophysiology, pharmacology, medical management and nursing management across the
health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies:
Context and Environment; Knowledge; health promotion/disease prevention |
Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 2.3 Differentiate between disease, illness, and injury, and describe illness
behaviors and needs of the patient with acute, critical, and chronic illness.
MNL Learning Outcome: 3. Consider the differences between disease, illness, and injury and
the behaviors and needs of the patient with various levels of illness.
26
Copyright ยฉ 2020 Pearson Education, Inc.
28) The overall mission of Healthy People 2020 is to improve the nation’s health. What topic is
addressed to achieve this goal? Select all that apply.
1. Access to health services
2. Nutrition and weight status
3. Reproductive health
4. Injury and violence
5. Outpatient surgery
Answer: 1, 2, 3, 4
Explanation: 1. Access to health services is a health indicator used in Healthy People 2020.
2. Nutrition and weight status are health indicators used in Healthy People 2020.
3. Reproductive health is a health indicator used in Healthy People 2020.
4. Injury and violence are health indicators used in Healthy People 2020.
5. Outpatient surgery is not a health indicator in Healthy People 2020.
Page Ref: 35
Cognitive Level: Applying
Client Need & Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of
patient-centered care | AACN Essentials Competencies: VII.5. Use evidence-based practices to
guide health teaching, health counseling, screening, outreach, disease and outbreak
investigation, referral and follow-up throughout the lifespan | NLN Competencies: Context and
Environment; Knowledge; health promotion/disease prevention | Nursing/Integrated Concepts:
Nursing Process: Assessment
Learning Outcome: 2.2 Compare and contrast health risks, assessment, and health promotion
for the young adult, middle adult, and older adult.
MNL Learning Outcome: 2. Recognize the health risks of individuals across the lifespan,
families, and communities and the role of nursing in health promotion and maintenance.
27
Copyright ยฉ 2020 Pearson Education, Inc.
29) A patient with seizures is being monitored to determine if the seizure activity was present
at birth or has been slowly developing. For which classifications of diseases is this patient’s
seizure activity being evaluated?
1. Congenital versus chronic
2. Acute versus chronic
3. Communicable versus functional
4. Idiopathic versus iatrogenic
Answer: 1
Explanation: 1. A congenital disease or disorder exists at or before birth; a chronic disease is
one that requires continuing management over a long period.
2. An acute disease has a rapid onset; a chronic disease requires continuing management over a
long period.
3. A communicable disease can be spread from one person to another; a functional disease
affects function but does not have organic causes.
4. An idiopathic disease has an unknown cause; an iatrogenic disease is caused by medical
therapy.
Page Ref: 37
Cognitive Level: Applying
Client Need & Sub: Physiological Integrity: Physiological Adaptation
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of
patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and
focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental
assessments of health and illness parameters in patients, using developmentally and culturally
appropriate approaches | NLN Competencies: Context and Environment; Knowledge; chronic
disease management | Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 2.3 Differentiate between disease, illness, and injury, and describe illness
behaviors and needs of the patient with acute, critical, and chronic illness.
MNL Learning Outcome: 3. Consider the differences between disease, illness, and injury and
the behaviors and needs of the patient with various levels of illness.
28
Copyright ยฉ 2020 Pearson Education, Inc.
30) A patient with a family history of breast cancer is participating in activities to prevent
illness. Which primary prevention action is the patient performing?
1. Genetic testing to determine genetic predisposition
2. Obtaining a mammogram and performing monthly breast self-examinations
3. Taking lipid-reducing agent to reduce cholesterol levels
4. Supporting breast cancer research by running in a half marathon
Answer: 1
Explanation: 1. Genetic testing is primary prevention in that it determines genetically linked
diseases before they develop.
2. Mammograms and self-examinations of the breasts are examples of secondary prevention.
3. Taking lipid reducing agents to treat a specific disease is secondary prevention.
4. Supporting research is tertiary level prevention that helps in stopping the disease through
research efforts.
Page Ref: 40
Cognitive Level: Analyzing
Client Need & Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of
patient-centered care | AACN Essentials Competencies: VII.5. Use evidence-based practices to
guide health teaching, health counseling, screening, outreach, disease and outbreak
investigation, referral and follow-up throughout the lifespan | NLN Competencies: Context and
Environment; Knowledge; health promotion/disease prevention | Nursing/Integrated Concepts:
Nursing Process: Assessment
Learning Outcome: 2.3 Differentiate between disease, illness, and injury, and describe illness
behaviors and needs of the patient with acute, critical, and chronic illness.
MNL Learning Outcome: 3. Consider the differences between disease, illness, and injury and
the behaviors and needs of the patient with various levels of illness.
29
Copyright ยฉ 2020 Pearson Education, Inc.
31) A middle-aged female is having a routine wellness evaluation. Which statement reflects the
changes that occur in middle adulthood? Select all that apply.
1. “I am embarrassed by the amount of weight I have gained each year.”
2. “I have recently been put on a lipid-lowering agent for an increase in my cholesterol levels.”
3. “I worry about getting breast cancer like my friend who is the same age.”
4. “I have been lonely since my children all married and moved far away.”
5. “I am concerned about coping with an unplanned pregnancy.”
Answer: 1, 2, 3, 4
Explanation: 1. This statement reflects the changes and concerns that arise in the middle adult
years.
2. This statement reflects the changes and concerns that arise in the middle adult years.
3. This statement reflects the changes and concerns that arise in the middle adult years.
4. This statement reflects the changes and concerns that arise in the middle adult years.
5. While unplanned pregnancy can be a concern for perimenopausal women, this statement is
more likely to come from a young adult.
Page Ref: 28-29
Cognitive Level: Analyzing
Client Need & Sub: Psychosocial Integrity: Coping Mechanisms
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of
patient-centered care | AACN Essentials Competencies: VII.5. Use evidence-based practices to
guide health teaching, health counseling, screening, outreach, disease and outbreak
investigation, referral and follow-up throughout the lifespan | NLN Competencies: Context and
Environment; Knowledge; health promotion/disease prevention | Nursing/Integrated Concepts:
Nursing Process: Assessment
Learning Outcome: 2.1 Define health and the health-illness continuum, and discuss factors
affecting the health of individuals, families, communities, and special populations.
MNL Learning Outcome: 1. Consider the impact of health, wellness, illness, and injury to
patients and their families.
30
Copyright ยฉ 2020 Pearson Education, Inc.
32) An older patient is experiencing confusion and lethargy after taking routine doses of
medication. Which age-related change should the nurse identify that could predispose this
patient to toxic drug effects? Select all that apply.
1. Changes in tissue and organ structure
2. Decrease in liver function
3. Taking several drugs at once
4. Decrease in renal function
5. Decrease in taste sensation
Answer: 1, 2, 3, 4
Explanation: 1. Changes in tissue and organ structure contribute to a predisposition to toxic
drug effects.
2. Reduced liver function contributes to a predisposition to toxic drug effects.
3. Taking several drugs at once contributes to a predisposition to toxic drug effects.
4. Reduced renal function contributes to a predisposition to toxic drug effects.
5. A decrease in taste sensation is an age-related change but it does not contribute to toxic drug
effects.
Page Ref: 32
Cognitive Level: Analyzing
Client Need & Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of
patient-centered care | AACN Essentials Competencies: IX.8. Implement evidence-based
nursing interventions as appropriate for managing the acute and chronic care of patients and
promoting health across the lifespan | NLN Competencies: Context and Environment;
Knowledge; chronic disease management | Nursing/Integrated Concepts: Nursing Process:
Assessment
Learning Outcome: 2.1 Define health and the health-illness continuum, and discuss factors
affecting the health of individuals, families, communities, and special populations.
MNL Learning Outcome: 1. Consider the impact of health, wellness, illness, and injury to
patients and their families.
31
Copyright ยฉ 2020 Pearson Education, Inc.
33) In a healthcare provider’s office, the nurse case manager approaches a patient with type 2
diabetes mellitus to review the patient-centered medical home (PCMH) approach to care. What
benefits of this approach should the case manager include in this discussion? Select all that
apply.
1. Prevents acute disease crises
2. Encourages preventive services
3. Eliminates health insurance billing
4. Comprehensive and coordinated care
5. Focus on all levels of illness prevention
Answer: 1, 2, 4, 5
Explanation: 1. For people with chronic illnesses, the goal of the PCMH is to provide
comprehensive care with a focus on preventing acute disease crises.
2. One facet of the PCMH is increased preventive services.
3. Health insurance billing is not a facet of this care delivery model.
4. PCMH is designed to provide comprehensive and coordinated patient and family care.
5. The PCMH is a primary care model that focuses on all levels of illness prevention.
Page Ref: 42
Cognitive Level: Applying
Client Need & Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of
patient-centered care | AACN Essentials Competencies: VII.5. Use evidence-based practices to
guide health teaching, health counseling, screening, outreach, disease and outbreak
investigation, referral and follow-up throughout the lifespan | NLN Competencies: Context and
Environment; Knowledge; health promotion/disease prevention | Nursing/Integrated Concepts:
Nursing Process: Implementation
Learning Outcome: 2.4 Describe essential elements and goals of coordinated primary care
models; the services, settings, and essential components of community-based care and home
healthcare; and nursing interventions to deliver safe, effective, and competent care to patients
in their homes.
MNL Learning Outcome: 4. Recognize the various care approaches and settings for nursing
care.
32
Copyright ยฉ 2020 Pearson Education, Inc.
34) The nurse is preparing to provide disease management care to a patient with heart failure.
On what should the nurse focus when caring for this patient? Select all that apply.
1. Disease process
2. Daily monitoring
3. Medication management
4. Transfer to long-term care
5. Frequency of hospitalization
Answer: 1, 2, 3
Explanation: 1. In the disease management model, the focus is on education about the disease.
2. In the disease management model, the focus is on self-monitoring.
3. In the disease management model, the focus is on management.
4. Transferring to long-term care is not a focus in the disease management model.
5. The goal is to avoid hospitalization in the disease management model.
Page Ref: 42
Cognitive Level: Applying
Client Need & Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of
patient-centered care | AACN Essentials Competencies: VII.5. Use evidence-based practices to
guide health teaching, health counseling, screening, outreach, disease and outbreak
investigation, referral and follow-up throughout the lifespan | NLN Competencies: Context and
Environment; Knowledge; health promotion/disease prevention | Nursing/Integrated Concepts:
Nursing Process: Implementation
Learning Outcome: 2.4 Describe essential elements and goals of coordinated primary care
models; the services, settings, and essential components of community-based care and home
healthcare; and nursing interventions to deliver safe, effective, and competent care to patients
in their homes.
MNL Learning Outcome: 4. Recognize the various care approaches and settings for nursing
care.
33
Copyright ยฉ 2020 Pearson Education, Inc.
35) The nurse is preparing to transition a patient with chronic obstructive pulmonary disease
from a rehabilitation facility back to home. What preparations has the nurse made to support
this patient’s transition? Select all that apply.
1. Instructing on symptoms to report
2. Scheduling healthcare provider visits
3. Submitting facility charges to Medicare
4. Creating an evidence-based plan of care
5. Reviewing health insurance coverage plans
Answer: 1, 2, 4
Explanation: 1. Interventions include an emphasis on early identification of and response to
risks and symptoms to avoid adverse events.
2. Interventions include ongoing support and an emphasis on early identification of and
response to risks and symptoms to avoid adverse events.
3. It is not the nurse’s responsibility to bill Medicare for the patient’s charges.
4. Interventions include development of an evidence-based plan of care.
5. It is not the nurse’s responsibility to review health insurance coverage plans.
Page Ref: 42
Cognitive Level: Analyzing
Client Need & Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of
patient-centered care | AACN Essentials Competencies: VII.5. Use evidence-based practices to
guide health teaching, health counseling, screening, outreach, disease and outbreak
investigation, referral and follow-up throughout the lifespan | NLN Competencies: Context and
Environment; Knowledge; health promotion/disease prevention | Nursing/Integrated Concepts:
Nursing Process: Evaluation
Learning Outcome: 2.4 Describe essential elements and goals of coordinated primary care
models; the services, settings, and essential components of community-based care and home
healthcare; and nursing interventions to deliver safe, effective, and competent care to patients
in their homes.
MNL Learning Outcome: 4. Recognize the various care approaches and settings for nursing
care.
34
Copyright ยฉ 2020 Pearson Education, Inc.
36) The nurse notes that a patient with osteoarthritis receiving transition care has achieved the
goals for this care delivery approach. What did the nurse observe to come to this conclusion?
Select all that apply.
1. Safety bars installed in the bathroom
2. Oldest daughter moved out of the patient’s home
3. Monthly pension from previous employer reduced
4. Adhering to exercise, pain medication, and dietary plans
5. Last hospitalization for treatment from a fall 9 months ago
Answer: 1, 4, 5
Explanation: 1. The goal of transitional care is to improve the care and outcomes of chronically
ill patients by streamlining plans of care, improving the ability of patients and caregivers to
manage care needs, and interrupting patterns of frequent acute health crises. Installing safety
bars in the bathroom is evidence that this goal has been achieved.
2. The goal of transitional care is to improve the care and outcomes of chronically ill patients by
streamlining plans of care, improving the ability of patients and caregivers to manage care
needs, and interrupting patterns of frequent acute health crises. The oldest daughter moving
out of the home could create a care crisis if the daughter provided care to the patient.
3. The goal of transitional care is to improve the care and outcomes of chronically ill patients by
streamlining plans of care, improving the ability of patients and caregivers to manage care
needs, and interrupting patterns of frequent acute health crises. A reduced income could cause
a crisis because it could impact resources for healthcare, medication, food, or shelter.
4. The goal of transitional care is to improve the care and outcomes of chronically ill patients by
streamlining plans of care, improving the ability of patients and caregivers to manage care
needs, and interrupting patterns of frequent acute health crises. Adhering to exercise, pain
medication, and dietary plans indicates the ability to manage care needs.
5. The goal of transitional care is to improve the care and outcomes of chronically ill patients by
streamlining plans of care, improving the ability of patients and caregivers to manage care
needs, and interrupting patterns of frequent acute health crises. Being hospitalized 9 months
ago indicates an interruption in the pattern of frequent acute health crises.
Page Ref: 42
Cognitive Level: Analyzing
Client Need & Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of
patient-centered care | AACN Essentials Competencies: VII.5. Use evidence-based practices to
guide health teaching, health counseling, screening, outreach, disease and outbreak
investigation, referral and follow-up throughout the lifespan | NLN Competencies: Context and
Environment; Knowledge; health promotion/disease prevention | Nursing/Integrated Concepts:
Nursing Process: Evaluation
Learning Outcome: 2.4 Describe essential elements and goals of coordinated primary care
models; the services, settings, and essential components of community-based care and home
healthcare; and nursing interventions to deliver safe, effective, and competent care to patients
in their homes.
MNL Learning Outcome: 4. Recognize the various care approaches and settings for nursing
care.
35
Copyright ยฉ 2020 Pearson Education, Inc.
36
Copyright ยฉ 2020 Pearson Education, Inc.
37) The nurse working in an acute care hospital is considering a position working with patients
in the community. What care settings should the nurse consider before making a final decision?
Select all that apply.
1. Parish nursing
2. Homeless shelters
3. Adoption agencies
4. County health department
5. Ambulatory surgical center
Answer: 1, 2, 4, 5
Explanation: 1. Community-based nursing care settings include parish nursing.
2. Community-based nursing care settings include homeless shelters.
3. Community-based nursing care settings do not include adoption agencies.
4. Community-based nursing care settings include county health departments.
5. Community-based nursing care settings include ambulatory surgical centers.
Page Ref: 42
Cognitive Level: Applying
Client Need & Sub: Safe and Effective Care Environment: Management of Care
Standards: QSEN Competencies: I.C.4. Seek learning opportunities with patients who represent
all aspects of human diversity | AACN Essentials Competencies: II.1. Apply leadership concepts,
skills and decision making in the provision of high quality nursing care, healthcare team
coordination and the oversight and accountability for care delivery in a variety of settings | NLN
Competencies: Context and Environment; Knowledge; health promotion/disease prevention |
Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 2.4 Describe essential elements and goals of coordinated primary care
models; the services, settings, and essential components of community-based care and home
healthcare; and nursing interventions to deliver safe, effective, and competent care to patients
in their homes.
MNL Learning Outcome: 4. Recognize the various care approaches and settings for nursing
care.
37
Copyright ยฉ 2020 Pearson Education, Inc.
38) A patient recovering from total hip replacement surgery is being transferred to a
rehabilitation facility. When discussing this facility with the patient, what should the nurse
include? Select all that apply.
1. An assessment of functional abilities will be completed.
2. The patient should expect to provide all self-care.
3. A team of therapists and nurses will be working with the patient.
4. The focus will include interpersonal relationships and family support.
5. Plans will be made to transition the patient to a long-term care facility.
Answer: 1, 3, 4
Explanation: 1. Assessment in a rehabilitation facility includes functional health level and selfcare abilities.
2. There is no expectation that the patient will provide all self-care.
3. Rehabilitation promotes reintegration into the patient’s family and community through a
team approach.
4. Many different aspects of the patient’s life are addressed in the plan of care, including
interpersonal relationships and family support.
5. Patients who receive care in a rehabilitation facility are not transferred to a long-term care
facility.
Page Ref: 43
Cognitive Level: Applying
Client Need & Sub: Safe and Effective Care Environment: Management of Care
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of
patient-centered care | AACN Essentials Competencies: IX.3. Implement holistic, patientcentered care that reflects an understanding of human growth and development,
pathophysiology, pharmacology, medical management and nursing management across the
health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies:
Knowledge and Science; Knowledge; Integration of knowledge from nursing and other
disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 2.4 Describe essential elements and goals of coordinated primary care
models; the services, settings, and essential components of community-based care and home
healthcare; and nursing interventions to deliver safe, effective, and competent care to patients
in their homes.
MNL Learning Outcome: 4. Recognize the various care approaches and settings for nursing
care.
38
Copyright ยฉ 2020 Pearson Education, Inc.
39) The nurse is determining if a patient recovering from abdominal surgery is a candidate for
home care. Which information should the nurse use to help make this decision? Select all that
apply.
1. The patient needs intermittent skilled nursing care.
2. The patient prefers to use an agency that is Medicare certified.
3. The patient plans to attend the upcoming senior citizen bingo night.
4. The patient can walk to a shopping mall to do banking and purchase groceries.
5. The patient is unable to change the abdominal wound dressing because of limited upperextremity mobility.
Answer: 1, 2, 5
Explanation: 1. To receive healthcare coverage for home care, the patient must need
intermittent skilled nursing care.
2. To receive healthcare coverage for home care, the patient must use an agency that is
Medicare certified.
3. To receive healthcare coverage for home care, the patient must be homebound and limited
to leaving the home for healthcare visits or religious services. Being able to attend bingo night
indicates the patient is not homebound.
4. To receive healthcare coverage for home care, the patient must be homebound and limited
to leaving the home for healthcare visits or religious services. Being able to shop and bank
independently means the patient is not homebound.
5. To receive healthcare coverage for home care, the patient must need intermittent skilled
nursing care. Needing someone to change the wound dressing means requiring intermittent
skilled nursing care.
Page Ref: 44
Cognitive Level: Applying
Client Need & Sub: Safe and Effective Care Environment: Management of Care
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of
patient-centered care | AACN Essentials Competencies: IX.3. Implement holistic, patientcentered care that reflects an understanding of human growth and development,
pathophysiology, pharmacology, medical management and nursing management across the
health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies:
Context and Environment; Knowledge; healthcare systems | Nursing/Integrated Concepts:
Nursing Process: Implementation
Learning Outcome: 2.4 Describe essential elements and goals of coordinated primary care
models; the services, settings, and essential components of community-based care and home
healthcare; and nursing interventions to deliver safe, effective, and competent care to patients
in their homes.
MNL Learning Outcome: 4. Recognize the various care approaches and settings for nursing
care.
39
Copyright ยฉ 2020 Pearson Education, Inc.
40) The primary caregiver for a patient with Alzheimer disease receiving care in the home wants
to attend a granddaughter’s high school graduation in a city 50 miles from the patient’s home.
What should the home care nurse suggest so that the caregiver can attend this event?
1. Admit the patient to hospice.
2. Schedule respite care for the caregiver.
3. Admit the patient to an inpatient facility.
4. Transport the patient with the caregiver to the graduation.
Answer: 2
Explanation: 1. Hospice care is a special component of home care, designed to provide medical,
nursing, social, psychologic, and spiritual care for terminally ill patients and their families. The
patient has not been diagnosed with a terminal illness.
2. Respite care provides short-term or intermittent home care, often using volunteers. These
services exist primarily to give the family member or friend who is the primary caregiver some
time away from care.
3. There is no medical reason for the patient to be admitted to an inpatient facility.
4. The caregiver will not be able to drive and safely care for the patient at the same time.
Page Ref: 47
Cognitive Level: Applying
Client Need & Sub: Psychosocial Integrity: Support Systems
Standards: QSEN Competencies: I.A.6. Describe strategies to empower patients or families in
all aspects of the healthcare process | AACN Essentials Competencies: IX.5. Deliver
compassionate, patient-centered, evidence-based care that respects patient and family
preferences | NLN Competencies: Context and Environment; Knowledge; family dynamics |
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 2.4 Describe essential elements and goals of coordinated primary care
models; the services, settings, and essential components of community-based care and home
healthcare; and nursing interventions to deliver safe, effective, and competent care to patients
in their homes.
MNL Learning Outcome: 4. Recognize the various care approaches and settings for nursing
care.
40
Copyright ยฉ 2020 Pearson Education, Inc.
41) The nurse is visiting the home of a patient recovering from an acute gastrointestinal bleed.
Which action should the nurse take to limit distractions during this home visit? Select all that
apply.
1. Establishing short- and long-term goals
2. Explaining the primary goal of home care
3. Exploring the patient’s and family’s expectations of home care
4. Asking the patient if the television could be turned off during the visit
5. Asking the patient if the visit could be conducted in the bedroom away from small children
and pets
Answer: 4, 5
Explanation: 1. Establishing short- and long-term goals is setting priorities with the patient.
2. Explaining the primary goal of home care is setting goals and priorities.
3. Exploring the patient’s and family’s expectation of home care is setting goals and priorities.
4. Asking to turn off the television is limiting a distraction.
5. Asking to conduct the visit in a room away from children and pets is limiting a distraction.
Page Ref: 45
Cognitive Level: Applying
Client Need & Sub: Safe and Effective Care Environment: Management of Care
Standards: QSEN Competencies: I.A.6. Describe strategies to empower patients or families in
all aspects of the healthcare process | AACN Essentials Competencies: IX.5. Deliver
compassionate, patient-centered, evidence-based care that respects patient and family
preferences | NLN Competencies: Context and Environment; Knowledge; family dynamics |
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 2.4 Describe essential elements and goals of coordinated primary care
models; the services, settings, and essential components of community-based care and home
healthcare; and nursing interventions to deliver safe, effective, and competent care to patients
in their homes.
MNL Learning Outcome: 4. Recognize the various care approaches and settings for nursing
care.
41
Copyright ยฉ 2020 Pearson Education, Inc.
42) After completing a home assessment, the nurse determines that safety hazards exist in a
patient’s bathroom. What did the nurse assess to come to this conclusion? Select all that apply.
1. Water temperature of 150ยฐF
2. Grab bars around the toilet only
3. Scatter rug outside the shower stall
4. Smoke detector battery with a low reading
5. Electrical outlet on the wall near the shower door
Answer: 1, 2, 3, 5
Explanation: 1. A water temperature of 150ยฐF is too high. This could burn the patient.
2. Grab bars need to be within the bathtub or shower area in addition to near the commode.
3. Nonstick rugs should be used. Scatter rugs should be avoided or removed.
4. Smoke detectors are not routinely mounted near bathrooms.
5. Electrical outlets should not be near areas of water.
Page Ref: 46
Cognitive Level: Analyzing
Client Need & Sub: Safe and Effective Care Environment: Safety and Infection Control
Standards: QSEN Competencies: V.B.4. Communicate observations or concerns related to
hazards and errors to patients, families and the healthcare team | AACN Essentials
Competencies: II.7. Promote factors that create a culture of safety and caring | NLN
Competencies: Quality and Safety; Practice-Know-How; Communicate potential risk factors and
actual errors | Nursing/Integrated Concepts: Nursing Process: Evaluation
Learning Outcome: 2.4 Describe essential elements and goals of coordinated primary care
models; the services, settings, and essential components of community-based care and home
healthcare; and nursing interventions to deliver safe, effective, and competent care to patients
in their homes.
MNL Learning Outcome: 4. Recognize the various care approaches and settings for nursing
care.
42
Copyright ยฉ 2020 Pearson Education, Inc.
43) While making a home visit, the nurse learns that a patient self-administering insulin
injections is placing the used needles and syringes in the family’s trash can. What action should
the nurse take?
1. Instruct the patient to place the needles and syringes in a separate plastic bag.
2. Nothing, because these needles and syringes are harmless to the general population.
3. Ask the patient to save all used syringes and needles after use for the nurse to dispose of.
4. Teach the patient to place all used syringes and needles into the red biohazard sharps box.
Answer: 4
Explanation: 1. Used needles and syringes should not be placed in a plastic bag. They could
puncture the bag and cause someone harm.
2. Doing nothing would be considered negligence on the part of the nurse.
3. The nurse is not responsible for disposing of a patient’s used needles and syringes.
4. The disposal of sharp objects such as needles used for injections is a safety issue in the home.
The nurse must address this with the patient, demonstrate safe disposal, and provide the
necessary equipment for safe disposal.
Page Ref: 46
Cognitive Level: Applying
Client Need & Sub: Safe and Effective Care Environment: Safety and Infection Control
Standards: QSEN Competencies: V.B.4. Communicate observations or concerns related to
hazards and errors to patients, families and the healthcare team | AACN Essentials
Competencies: II.7. Promote factors that create a culture of safety and caring | NLN
Competencies: Quality and Safety; Practice-Know-How; Communicate potential risk factors and
actual errors | Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 2.4 Describe essential elements and goals of coordinated primary care
models; the services, settings, and essential components of community-based care and home
healthcare; and nursing interventions to deliver safe, effective, and competent care to patients
in their homes.
MNL Learning Outcome: 4. Recognize the various care approaches and settings for nursing
care.
43
Copyright ยฉ 2020 Pearson Education, Inc.
44) During a home visit, the nurse notes that the caregiver does not apply clean gloves before
removing the patient’s leg wound dressings. What should the nurse do to encourage infection
control practices in this home?
1. Place the box of gloves next to the sink in the bathroom.
2. Remind the caregiver to wash hands after completing wound care.
3. Place the box of gloves next to the bag used to discard soiled dressings.
4. Encourage the caregiver to touch only the edges of the soiled dressings.
Answer: 3
Explanation: 1. Placing the box of gloves next to the sink in the bathroom might not be
convenient enough to encourage consistent use.
2. Hand washing should occur before and after wound care.
3. If the box of gloves is next to the bag used to discard soiled dressings, the caregiver will be
reminded to put on a pair of gloves before removing the dressing.
4. Touching the edges of the soiled dressing will not prevent the spread of infection.
Page Ref: 46
Cognitive Level: Applying
Client Need & Sub: Safe and Effective Care Environment: Safety and Infection Control
Standards: QSEN Competencies: V.B.4. Communicate observations or concerns related to
hazards and errors to patients, families and the healthcare team | AACN Essentials
Competencies: II.7. Promote factors that create a culture of safety and caring | NLN
Competencies: Quality and Safety; Practice-Know-How; Communicate potential risk factors and
actual errors | Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 2.4 Describe essential elements and goals of coordinated primary care
models; the services, settings, and essential components of community-based care and home
healthcare; and nursing interventions to deliver safe, effective, and competent care to patients
in their homes.
MNL Learning Outcome: 4. Recognize the various care approaches and settings for nursing
care.
44
Copyright ยฉ 2020 Pearson Education, Inc.
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