Chapter 01: Health Defined: Health Promotion, Protection and Prevention
Edelman: Health Promotion Throughout the Life Span, 10th Edition

MULTIPLE CHOICE

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

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

DIF:	Cognitive Level: Remember (Knowledge)	

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

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

DIF:	Cognitive Level: Apply (Application)	

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

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

DIF:	Cognitive Level: Apply (Application)	

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

ANS:	B
Health, as defined in this text, is a state of physical, mental, spiritual, and social functioning that realizes a person’s potential and is experienced within a developmental context. Although health is, in part, an individual’s responsibility, health also requires collective action to ensure a society and an environment in which people can act responsibly to support health. The culture and beliefs of people can also influence health action.

DIF:	Cognitive Level: Remember (Knowledge)	

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

ANS:	C
Illness is composed of the subjective experience of the individual and the physical manifestation of disease (Hollingsworth & Didelot, 2005). Both are social constructs in which people are in an imbalanced, unsustainable relationship with their environment and are failing in their ability to survive and create a higher quality of life. Illness can be described as a response characterized by a mismatch between a person’s needs and the resources available to meet those needs. Someone with a headache represents a person with an illness. A person can have a disease without feeling ill. The other choices represent disease.

DIF:	Cognitive Level: Analyze (Analysis)		

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

ANS:	C
Healthy People 2000 (USDHHS, Public Health Service, 1990) and Healthy People 2000 Midcourse Review and 1995 Revisions (USDHHS, Public Health Service, 1996) were landmark documents in that a consortium of people representing national organizations worked with US Public Health Service officials to create a more global approach to health. Additionally, a management-by-objectives approach was used to address each problem area. These two documents became the blueprints for each state as funding for federal programs became linked to meeting these national health objectives.

DIF:	Cognitive Level: Remember (Knowledge)	

	7.	Healthy people 2030 will be built upon the goals of Healthy people 2020 and is currently underway. Which of the following is one of the four overreaching goals for Healthy People 2020/2030 (US Department of Health and Human Services)?
a.	Decreased tobacco use in youth throughout the nation	
b.	Achieve health equality and eliminate disparity for all groups	
c.	Increased public funding for health insurance	
d.	Decreased hospital re-admission rates	

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

DIF:	Cognitive Level: Remember (Knowledge)	

	8.	The current process of updating Healthy People 2020 to Healthy people 2030 is underway. Five overarching goals have been identified. Which of the following overarching goals represents a new concept, not previously identified in the former Healthy People projects?
a.	Engage leadership, key constituents and the public to take action and design projects	
b.	Promote healthy development and healthy behavior across the lifespan	
c.	Eliminate health disparities and achieve health equity	
d.	Attain longer lives free of preventable disease	

ANS:	A
Healthy People 2030 will be the first time a goal to engage leadership, constituents and the public has been identified. Previously these parties and sectors have not been consulted in formulating policies to foster health and well-being. The other choices, B, C and D, all represent goals or components which have been addressed previously in one form or another in terms of overarching goals.

DIF:	Cognitive Level: Remember (Knowledge)	

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

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

DIF:	Cognitive Level: Remember (Knowledge)	

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

ANS:	A
Primary prevention precedes disease or dysfunction. It includes health promotion and specific protection and encourages increased awareness; thus, education about healthy lifestyles fits this definition. Blood pressure screening does not prevent disease, but instead identifies it. Cardiac catheterization – either interventional or diagnostic – is an invasive procedure to either diagnose or treat cardiac or coronary artery disease.

DIF:	Cognitive Level: Apply (Application)	

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

ANS:	B
Screening is secondary prevention because the principal goal of screenings is to identify individuals in an early, detectable stage of the disease process. A mammogram is a screening tool for breast cancer and thus is considered a method of secondary prevention. Self-breast exams are no longer recommended due to low yield in detecting breast tumors.

DIF:	Cognitive Level: Apply (Application)	

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

ANS:	D
Physical therapy and occupational therapy are considered tertiary prevention. Tertiary prevention occurs when a defect or disability is permanent and irreversible. It involves minimizing the effect of disease and disability. The objective of tertiary prevention is to maximize remaining capacities. A drunk driving campaign would be primary prevention as it seeks to prevent drunk driving. Road blocks would fit into the realm of early detection before the person has caused injury to themselves or others. Emergency surgery is a life-saving procedure versus an intervention directed at prevention.

DIF:	Cognitive Level: Apply (Application)	

	13.	Which of the following would NOT be an appropriate focus of public health concerns?
a.	Patients with heart failure	
b.	Employees	
c.	Prisoners	
d.	Disabled persons	

ANS:	A
Public health is population-based focusing on the determinants of health for defined populations. It is also grounded in social justice, focused on health promotion and disease prevention, driven by the science of epidemiology, and organizes community services (Keller et al., 2016). Population health is the outcomes (i.e., length of life, health-related quality of life, function) of a population that are influenced by patterns of health determinants, policies, and interventions (Kindig & Stoddart, 2015). Population is a group defined by a geographic area, or employees, ethnic groups, prisoners, or disabled people. It is not defined as a clinical patient group like patients with heart failure.

DIF:	Cognitive Level: Apply (Application)	

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

ANS:	B
Primary roles of the care manager include preventing duplication of services, maintaining quality and safety, providing education and advocacy, facilitating self-management, and reducing costs. Care managers base recommendation on reliable data sources such as evidence-based practices and protocols. The nurse acts as a care manager to assist the individual in navigating the complexities of health care and health decision-making.

DIF:	Cognitive Level: Apply (Application)	

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

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

DIF:	Cognitive Level: Apply (Application)	

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

ANS:	D
Health education is a primary prevention technique available to avoid major causes of disease. Teaching can range from a chance remark to a planned lesson. Teaching may range from a chance remark by the nurse, based on a perception of desirable individual behavior, to structurally planned teaching according to individual needs. Selection of the methods most likely to succeed involves the establishment of teacher-learner goals.

DIF:	Cognitive Level: Apply (Application)	

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

ANS:	C
Nurses with a specialized area of expertise provide education about health promotion and disease prevention to individuals and groups as consultants. Some nurses have specialized areas of expertise or advanced practice, such as in gerontology, women’s health, or community/public health, and they are equipped to provide information as consultants in these areas of specialization.

DIF:	Cognitive Level: Apply (Application)	

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

ANS:	B
When nurses or other clinicians use research findings and the best evidence possible to make decisions, the outcome is termed evidence-based practice. Evidence-based practice is defined as the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individuals. The practice of evidence-based nursing means integrating individual clinical expertise with the best available external clinical evidence from systematic research.

DIF:	Cognitive Level: Remember (Knowledge)	

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

ANS:	C
Quantitative research studies describe situations, correlate different variables related to care, or test causal relationships among variables related to care. Evidence-based practice research and clinical judgment research are not research methodologies; they are strategies used to answer clinical questions. Qualitative studies describe phenomenon or define the historical nature, cultural relevance or philosophical basis of aspects of nursing care.

DIF:	Cognitive Level: Apply (Application)	

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

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

DIF:	Cognitive Level: Apply (Application)	

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

ANS:	A
When nurses or other clinicians use research findings and the best evidence possible to make decisions, the outcome is termed evidence-based practice. Evidence-based practice is defined as the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individuals. The practice of evidence-based nursing means integrating individual clinical expertise with the best available external clinical evidence from systematic research.

DIF:	Cognitive Level: Apply (Application)	

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

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

DIF:	Cognitive Level: Remember (Knowledge)	

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

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

DIF:	Cognitive Level: Remember (Knowledge)	

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

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

DIF:	Cognitive Level: Apply (Application)	

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

ANS:	D
Health promotion and disease prevention commonly involves lifestyle choices across the life span. Educating a person about the advantages of a heart-healthy diet during a home visit serves to influence lifestyle choices. To promote health and wellness, an emphasis must be placed on primary prevention. This is often related to actions such as education that influence lifestyle choices. The nurse educating a patient regarding a heart-healthy diet is engaging in primary prevention so as to prevent disease from occurring. Choices A, B, and C all involve interventions occurring after a disease has manifested.

DIF:	Cognitive Level: Apply (Application)	

	26.	Which factor may have the most influence in changing the health behavior of a single, adult woman who smokes and is the care provider for her mother, her own children, and granddaughter?
a.	Education regarding effects of smoking on her health	
b.	The satisfaction that she will not contribute to secondhand smoke	
c.	The availability of a weekly support group	
d.	Financial incentives rooted in a non-smoking lifestyle	

ANS:	D
Motivational factors play a large role in influencing attitudinal change. Programs for health promotion and health education are only part of the answer. Financial incentives for prevention may be another motivating factor, and health advocacy by professionals in the health field is critical. For this woman, who is financially responsible for the health and well-being of other individuals, finances will likely play a significant role in motivating her actions. Financial considerations might include reduced insurance rates, occupational bonus programs, money saved from not buying cigarettes, etc. The text states numerous times that education regarding the benefits of not smoking is not enough.

DIF:	Cognitive Level: Analyze (Analysis)		

MULTIPLE RESPONSE

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

ANS:	B, C
The National Institute of Nursing Research (NINR) serves as the focal point in developing research themes for the future of the profession. NINR supports research to establish a scientific base for the care of individuals throughout the life span; from the management of individuals during illness and recovery to the reduction of the risks of disease and disability. The four “investment” themes NINR has identified are promoting personalized health strategies using symptom science, promoting health and preventing disease, improving the quality of life for individuals with chronic disease through self-management, and end-of life and palliative care through compassion (NINR, 2016). In fact, the Healthy People 2020 and Healthy People 2030 objectives match many of these themes.

DIF:	Cognitive Level: Remember (Knowledge)	

	2.	Which interventions address both the National Institute of Nursing Research themes and the overall goals of the Healthy People 2020 and Healthy People 2030 as it pertains to leading health indicators? (Select all that apply.)
a.	Establishing a new park with a well-lit track	
b.	Establishing a smoking cessation campaign	
c.	Providing reduced-cost transportation passes to senior citizens	
d.	Providing free condoms at all federally funded health clinics	

ANS:	A, B, D
Establishing a new park with a well-lit track, establishing a smoking cessation campaign, and providing free condoms at all federally funded health clinics all address the National Institute of Nursing Research themes and the Healthy People 2020 and Healthy People 2030 with respect to leading health indicators. A park, smoking cessation campaign, and free condoms all address the themes of promoting health and preventing disease as well as the goal of increasing quality and years of healthy life.
While, providing reduced-cost transportation passes to senior citizens may indirectly affect the health of this population, this measure does not directly related to the themes of the National Institute of Nursing Research. The NINR strives to promote health and prevent disease, improve quality of life through symptom management, and support palliative and end-of-life care, innovation, and nurse scientists. Similarly, the stated overall goals of Healthy People 2020 and Healthy People 2030 is to increase quality and years of healthy life and eliminate health disparities.

DIF:	Cognitive Level: Analyze (Analysis)