Health/Illness
The nurse is aware that any description of health would include the concept that:
a. Health is the absence of illness, and illness is the presence of chronic disease.
b. Lifestyle factors are the major determinants of health or illness.
c. Culture, education, and socioeconomic status influence one’s definition of health or illness.
d. Illness is a biological malfunction, and health is biological soundness.
Correct Answer: c-Culture, education, and socioeconomic status influence one’s definition of health or illness
Rationale: Health is a multidimensional concept influenced by cultural background, education, and socioeconomic status. These factors shape how individuals perceive both health and illness.
Included in Maslow’s hierarchy, physiological needs are those that:
a. Nurture intimacy.
b. Foster independence.
c. Encourage social interaction.
d. Protect from harm.
Correct Answer: d-Protect from harm.
Rationale: Physiological needs include essentials such as oxygen, food, water, and safety—protecting from harm is foundational.
According to Selye’s General Adaptation Syndrome, prolonged stress may result in:
a. Resistance to biological treatment.
b. Development of illness like arthritis or asthma.
c. Treatment for imagined illnesses.
d. Hospitalization during the alarm stage.
Correct Answer: b-Development of illness like arthritis or asthma
Rationale: Chronic stress can weaken the immune system and contribute to or worsen conditions like asthma and arthritis.
True or False: Physical therapy falls under primary prevention strategies.
False
Microorganisms that do not harm their host are known as:
a) Normal flora
b) Parasites
c) Nosocomial
d) Monoclonal
Correct Answer: a) Normal flora
Rationale: Normal flora are non-pathogenic microorganisms that live on or in the body and protect against harmful microbes. They play a beneficial role in maintaining health
The nurse takes into consideration that the patient with an admitting diagnosis of Type 2 diabetes mellitus and influenza is described as having:
a. One chronic and one acute illness.
b. One acute and one infectious illness.
c. Two acute illnesses.
d. Two chronic illnesses.
Correct Answer: a- One chronic and one acute illness
Rationale: Type 2 diabetes is a chronic condition, while influenza is an acute illness. The combination indicates the presence of both types.
Teaching a patient to give insulin and monitor blood glucose improves the patient’s:
a. Physiological well-being.
b. Self-actualization.
c. Security.
d. Self-esteem.
Correct Answer: d-. Self-esteem.
Rationale: Teaching enhances independence and promotes self-esteem through skill-building and empowerment.
According to Selye’s GAS, prolonged, strong stress leads to the stage of:
a. Transition
b. Convalescence
c. Alarm
d. Exhaustion
Correct Answer: d
Rationale: The exhaustion stage occurs when adaptive mechanisms are depleted, increasing the risk of illness or death.
Which of the following is an example of primary prevention?
A. Cardiac rehabilitation after a heart attack
B. Monthly breast self-exams
C. Wearing a helmet while riding a bike
D. Having a colonoscopy
C. Wearing a helmet while riding a bike
Rationale- Primary prevention: This prevents injury before it occurs, which is the hallmark of primary prevention
In the normal response to an infection, the white blood cell count will:
a) Decrease
b) Stay the same
c) Match red blood cell count
d) Increase
Correct Answer: d) Increase
Rationale: In response to infection, the body increases white blood cell production to fight off pathogens. This rise in WBC count (leukocytosis) is a hallmark of infection.
The nurse explains that an idiopathic disease is one that:
a. Has an unknown cause.
b. Results from injury during labor or delivery.
c. Is caused by inherited characteristics.
d. Develops suddenly, related to new viruses.
Correct Answer: a- Has an unknown cause
Rationale: "Idiopathic" refers to a condition that arises without a known cause.
A nurse is caring for a patient who is post-op day 1 from abdominal surgery. The patient reports pain of 7/10 is refusing to eat and appears anxious about their prognosis. Which nursing intervention is the priority?
A. Offer emotional support regarding the patient’s anxiety
B. Encourage nutritional intake to promote healing
C. Administer prescribed pain medication
D. Discuss the surgical outcome and recovery plan with the patient
Correct Answer: C. Administer prescribed pain medication
Rationale: According to Maslow’s hierarchy, relief from pain (a physiologic need) takes priority over psychological or emotional concerns.
When a hospitalized man worries about his family and finances, the nurse should:
a. Encourage family visits.
b. Reassure him about his healing leg.
c. Actively listen to his concerns.
d. Distract him with socialization.
Correct Answer: c- Actively listen to his concerns
Rationale: Active listening helps patients feel heard, understood, and secure in a stressful environment.
Secondary prevention focuses on:
A. Preventing the initial occurrence of a disease
B. Limiting long-term disability after disease diagnosis
C. Early detection and prompt treatment of disease
D. Promoting wellness in healthy populations
C. Early detection and prompt treatment of disease
Rationale: Secondary prevention (e.g., screening tests like mammograms)
Infections spread most easily to others from body secretions found on or in:
a) Patient clothing
b) Hospital magazines and books
c) Hospital linens that are not washed in hot water
d) Nasal secretions, coughing, and contaminated blood
Correct Answer: d) Nasal secretions, coughing, and contaminated blood
Rationale: Body fluids such as respiratory droplets and blood are common sources of infection transmission, making them high-risk for spreading disease.
The nurse assesses a terminal illness in:
a. A 76-year-old admitted to a nursing home with Alzheimer disease who is pacing and asking to go home.
b. A 2-year-old child who burned her esophagus by drinking drain cleaner and who is being fed by a tube.
c. A 52-year-old diagnosed with lung cancer who had part of one lung removed and has a closed chest drainage device in place.
d. A 43-year-old with Lou Gehrig’s disease who is refusing food and fluid.
Correct Answer: d
Rationale: Terminal illness refers to a condition expected to result in death within a short time frame. ALS (Lou Gehrig’s disease) is terminal, and refusing food and fluids indicates impending death.
True/False
According to Maslow’s hierarchy of needs, a patient’s need for safety and security must be met before addressing needs related to love, belonging, or self-esteem.
Correct Answer: True Rationale: Maslow emphasizes fulfilling lower-level needs (physiologic and safety) before progressing to higher-level needs like love/belonging or self-esteem.
Responses during the alarm stage of GAS include: (Select all that apply)
a. Slight increase in body temperature
b. Substantial increase in energy
c. Decreased appetite
d. Hormones released for defense
e. Overreacting adaptation abilities
Correct answers
a. Slight increase in body temperature
c. Decreased appetite
d. Hormones released for defense
Rationale: Alarm stage activates physiological changes like mild temperature rise, appetite loss, and hormone release to initiate coping responses.
A patient attending physical therapy for arthritis is participating in:
A. Primary prevention
B. Secondary prevention
C. Tertiary prevention
D. None of the above
C. Tertiary prevention
Rationale-Focuses on managing an existing disease (arthritis) to improve function and reduce complications or disability
A common means of preventing the spread of infections in the hospital and home is:
a) Handwashing, use of disposable gloves and equipment, and proper disposal of contaminated items
b) Limiting the physical activity of an infected patient with a fever
c) Early discharge of infected patients
d) Disinfecting the room air with an electronic breeze machine
Correct Answer: a) Handwashing, use of disposable gloves and equipment, and proper disposal of contaminated items
Rationale: Hand hygiene and standard precautions are the most effective ways to prevent infection spread in both healthcare and home environments.
A patient has been advised to take medication for high cholesterol and follow dietary changes but refuses. The nurse’s best initial response is to:
a. Emphasize to the patient how important it is to follow the doctor’s advice.
b. Determine whether any cultural, socioeconomic, or religious values conflict, thus interfering with compliance.
c. Inform the provider that the patient is unable to understand the instructions.
d. Explain that without diet and medication the condition will worsen.
Correct Answer: b-Determine whether any cultural, socioeconomic, or religious values conflict, thus interfering with compliance.
Rationale: Understanding the patient's values and beliefs allows the nurse to address potential barriers to adherence effectively.
Mr. J., a 72-year-old male with COPD, is admitted with shortness of breath, increased sputum production, and fatigue. His oxygen saturation is 87% on room air. He also shares that since his wife passed away last year, he feels isolated and "has no one left." He is not eating well and seems withdrawn.
Based on Maslow’s hierarchy, what is the priority nursing intervention? __________________
Which of Mr. J’s needs would be addressed after physiologic stabilization? ________________
What community resources could support his higher-level needs (love/belonging or self-esteem)? _________
Expected Student Answers:
Apply oxygen and improve airway clearance (address oxygenation).
Address his emotional needs such as social isolation and grief (belonging and love).
Refer to a social worker, bereavement group, or senior community center to foster belonging.
When the brain perceives a threat, the sympathetic nervous system stimulates: (Select all that apply)
a. Dilation of the bronchial tubes
b. Constriction of the pupils
c. Decreased heart rate
d. Dilation of the pupils
Answers: a. Dilation of the bronchial tubes & d- dilation of pupils
Rationale: The sympathetic response includes increased heart rate, pupil dilation, and bronchial dilation to prepare the body for “fight or flight.”
A patient who experienced a traumatic event in childhood is unaware of the event because the memory has been pushed into the unconscious mind. This is an example of the defense mechanism known as repression.
Which level of prevention is most appropriate in helping this patient address and manage the long-term effects of the repressed trauma?
a) Primary prevention – Providing education to prevent trauma before it occurs
b) Secondary prevention – Screening the patient for signs of emotional distress
c) Tertiary prevention – Providing therapy to help the patient process and heal from repressed trauma
d) Primary prevention – Administering vaccines to reduce infection risk
c) Tertiary prevention – Providing therapy to help the patient process and heal from repressed trauma
Rationale:
Repression is a defense mechanism in which distressing thoughts are unconsciously blocked.
Tertiary prevention focuses on treatment and rehabilitation after a condition or problem has been identified—in this case, helping the patient heal from unresolved trauma through therapy or counseling.
Options a and d refer to primary prevention, which aims to stop problems before they start.
Option b, secondary prevention, is about early detection, such as screening for depression or anxiety.
The body has natural defenses against pathogen invasion. As part of the third line of defense, specific immune mechanisms are activated. Which of the following occur during this immune response?
(Select all that apply)
a) Antigens are identified on foreign cells
b) Antibodies are produced to target specific pathogens
c) White blood cells engulf bacteria through phagocytosis
d) Memory cells are created for future protection
e) Skin and mucous membranes prevent pathogen entry
Correct Answers:
✅ a) Antigens are identified on foreign cells
✅ b) Antibodies are produced to target specific pathogens
✅ d) Memory cells are created for future protection
Rationale:
a) True – The immune system recognizes antigens (foreign markers) on pathogens during the third line of defense.
b) True – B lymphocytes produce antibodies that specifically target those antigens.
c) False – Phagocytosis is part of the second line of defense, a non-specific immune response.
d) True – The immune system forms memory cells that remember the pathogen and respond more quickly in future exposures.
e) False – Skin and mucous membranes are part of the first line of defense, which is physical and chemical protection.