A home health nurse is caring for an elderly client who has heart failure. Which of the following interventions on the tertiary level of prevention could be included in the care?
Reinforce past teachings on how to read food labels.
Review the daily weights the client has collected since the last home visit.
Remind the client to ask for the pneumococcal vaccine during their next provider appointment.
Auscultate the lungs and assess for edema.
The Correct Answer is B
Choice A Reason:
Reinforcing past teachings on how to read food labels is an important educational intervention. It helps the client make informed dietary choices, which can be crucial in managing heart failure. However, this intervention is more aligned with secondary prevention, which focuses on early detection and management of disease risk factors to prevent progression. Tertiary prevention, on the other hand, aims to manage and mitigate complications of an already established disease.
Choice B Reason:
Tertiary prevention focuses on managing and mitigating the effects of an existing disease to prevent complications and improve quality of life. In the context of heart failure, this involves monitoring and managing symptoms to prevent disease progression and hospitalizations. Reviewing the client's daily weights helps detect early signs of fluid retention, a common issue in heart failure, allowing for timely interventions.
Choice C Reason:
Reminding the client to ask for the pneumococcal vaccine during their next provider appointment is a preventive measure aimed at reducing the risk of infections, which can exacerbate heart failure. This intervention falls under primary prevention, as it aims to prevent the occurrence of a new health issue (pneumonia) rather than managing an existing condition.
Choice D Reason:
While assessing for edema is important in managing heart failure, it is more of a diagnostic activity rather than an intervention. Tertiary prevention involves interventions to manage and mitigate the effects of an existing disease.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A: "I Think That I Missed Two Math Tutoring Classes Last Week, But I Can Still Catch Up."
This statement indicates that the client is aware of their academic responsibilities and is optimistic about catching up. Missing a couple of classes is not uncommon, and the client's positive attitude towards catching up is a good sign. This statement does not indicate an immediate need for intervention regarding their mental health.
Choice B: "I Have Not Used Drugs in 6 Weeks."
This statement is positive and indicates progress in the client's efforts to stay away from substance use. It shows that the client is making strides towards healthier behaviors, which is a crucial aspect of their overall well-being. This statement does not require immediate intervention but should be acknowledged and supported.
Choice C: "I Don't Have Anyone I Can Talk to About My Problems."
This statement is concerning and indicates a lack of social support, which is critical for someone with a history of depression and suicidal ideation. Feeling isolated and having no one to talk to can exacerbate feelings of depression and increase the risk of suicidal thoughts. This statement requires immediate intervention to ensure the client receives the necessary support and resources to address their feelings of isolation.
Choice D: "I Have Been Participating in My Local YMCA After-School Dance Program Again."
This statement is positive and indicates that the client is engaging in social and physical activities, which can be beneficial for their mental health. Participation in such programs can provide a sense of community, improve mood, and reduce feelings of isolation. This statement does not require immediate intervention but should be encouraged and supported.
Correct Answer is D
Explanation
Choice A Reason:
Considering the individual characteristics first focuses on personal attributes such as age, gender, genetics, and personal health behaviors. While these factors are important, the ecological model emphasizes the broader context in which individuals live. Starting with individual characteristics may overlook the larger environmental and social influences that significantly impact health outcomes.
Choice B Reason:
Close social circles, including family, friends, and immediate social networks, play a crucial role in shaping health behaviors and providing support. These relationships can influence lifestyle choices, stress levels, and access to resources. However, focusing on close social circles first may not capture the broader environmental and societal factors that also affect health.
Choice C Reason:
Social and cultural factors encompass the norms, values, and practices of the community. These factors influence health behaviors, access to healthcare, and overall well-being. While social and cultural factors are vital, they are part of a larger context that includes the physical environment. Addressing these factors without considering the environment may provide an incomplete picture of the community's health.
Choice D Reason:
The environment includes the physical, social, and economic conditions in which people live. This encompasses factors such as housing quality, access to green spaces, pollution levels, and availability of healthcare services. The environment sets the stage for individual and community health by influencing exposure to risks and access to resources. Starting with the environment provides a comprehensive understanding of the context in which individuals and communities operate, making it the most appropriate starting point for an ecological assessment.
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