A. Wear Your Slippers at All Times, and Don T Walkbarefoot

Health CounselingChapters6December 21, 2014

6-1 Elyssa, age 69, lives alone. When talkingabout personal safety activities, you tell her,

A. “Wear your slippers at all times, and don’t walkbarefoot.”

B. “Wear your reading glasses when walkingaround so you’ll have them when you needthem.”

C. “When smoking in bed, be sure to turn on thelight to keep you awake.”

D. “Wear wide-base, low-heel shoes with corrugated soles to help prevent slips and falls.”

6-1 Answer D: For the promotion of personal safety, advise clientsto wear wide-base, low-heel shoes with corrugatedsoles to help prevent slips and falls. Slippers or flimsyor slippery-soled shoes should not be worn. No oneshould walk around with glasses that are meant onlyfor reading; they should be taken off before moving.Smoking should never take place in bed.

6-2 Shelley, 65 years old, sees you for the firsttime. She has demonstrated osteopenia on abone density test, and you have prescribed theappropriate medication for her. What additionallifestyle changes should you counsel for this client?

A. She should begin a rigorous swimming program toactively build bone.

B. She should cut down on coffee, but tea is OK.

C. She needs to take a multivitamin every day.

D. She should begin weight training.

6-2 Answer D: Swimming greatly benefits the heart and lungs butdoes not help osteoporosis. All caffeine is a riskfactor for osteoporosis. Cutting down on coffee is agood first step, but black (regular) tea also containscaffeine. Herbal tea or decaffeinated coffee arebetter recommendations. Shelley needs an adequatecalcium intake, not just a multivitamin. Regularexercise, especially weight-bearing exercise thatincludes walking and running, is recommended.This is because these types of exercises put thebody’s weight on the bones, pressing calcium intothe bone matrix. Additionally, strengthening theleg muscles helps prevent falls; therefore, simplystanding is more beneficial than sitting.

6-3 Ralph, age 66, comes to your office withconcerns regarding declining sexual function.He states that it takes him much longer to getan erection and sometimes he cannot get ormaintain an erection. He has also noticed adiminished desire for sexual activity. He deniesany change in his relationship with his wife of35 years, with whom he has always enjoyed asatisfying sexual relationship. What do you do?

A. Explain that you must investigate possible underlying causes of his problem, some of which are reversible and some of which are not.

B. Explain that diminished sexual desire andfunction are natural sequelae of aging.

C. Advise sexual counseling and prescribe Viagra.

D. Suggest that Ralph may be suffering from a low-gradedepression and prescribe an antidepressant.

6-3 Answer A:You must investigate the underlying causes of thisnew change in sexual function and desire. Althoughtestosterone deficiency is a common cause oflow desire and is more common in older adults,this change in sexual function is not a naturalconsequence of aging and should not be treated assuch. It is too soon to send this client for sexualcounseling, as you must first attempt to ascertainthe underlying reason behind the problem. Youdo not have enough data to presume depression,although depression is a common component of lowsexual desire. Also, prescribing serotonin reuptakeinhibitors (SSRIs), a type of antidepressant, maycreate other forms of sexual dysfunction, typicallydelayed or absent orgasm. You may end up sendingthis client for counseling and/or prescribing Viagra,but more investigation should be completed first.

6-4 Your 75-year-old client with osteoarthritis ofthe knee will be starting on a course of NSAIDs forpain management. The most important teachingpoint for your patient at this time is:

A. You should start with a high dose first and taperdown the dose as needed.

B. You should continue to take your Coumadin asyou have been.

C. Report any excessive stomach upset or if younotice that your stools become dark or bloody.

D. At this point, it will not be helpful to loseweight.

6-4 Answer C: When clients are taking NSAIDs, there is alwaysa risk of gastrointestinal tract bleeding, so theclients should be advised to look for signs of thiscomplication. The American Academy of FamilyPhysicians (AAFP) recommends that the smallestpossible doses of NSAIDs for the shortest possibleduration are best to minimize the incidence of sideeffects. The AAFP cautions to avoid using NSAIDsin clients taking anticoagulant such as Coumadin,as there may be an additive effect and increased riskof bleeding. Obesity is one of the major contributorsto the development of osteoarthritis of the knee.Any weight loss that can occur will remove stressfrom the client’s joints and may improve overallcardiovascular health.

6-5 Jake, age 10, comes to your primary careoffice with his mother. You are in a rural area.What is a priority area for health counseling?

A. Assessing the physical education programprovided in Jake’s school

B. Finding out whether the family has any pets

C. Determining whether Jake is able to swim

D. Asking about the occupation of the family,and if it is farming, providing adequate healthcounseling

6-5 Answer D: Agriculture continues to rank as the most dangerousindustry in the United States. It is important forthe health-care provider to provide anticipatoryguidance related to farm safety. Various groupssuch as the National Committee for ChildhoodAgricultural Injury Prevention (NCAIP) and FarmSafety 4 Just Kids provide resources for farm safetyinformation, including age-appropriate publicationssuch as storybooks and coloring books, as well asa rural health and safety kit that includes games,puzzles, and brochures. Still, farm-related injuries and fatalities continue to occur. Contributing factors include lack of parental supervision, operator fatigue, and children performing tasks inappropriate for age. Education and health counseling is a highpriority for all members of the farming family.

6-6 A new mother is refusing to vaccinate herinfant because she is concerned about mercury invaccines. What do you advise her?

A. The risk of dying from childhood disease isgreater than the health risks of thimerosal.

B. If thimerosal were dangerous, there would be anFDA warning on the label.

C. Thimerosal is not used as a preservative inroutinely recommended childhood vaccinesexcept for some forms of the influenza vaccine.

D. She should not be concerned about this.

6-6 Answer C: Thimerosal is a preservative that contains ethylmercury 50% by weight. Though the risk of dyingfrom childhood disease is greater than any potentialhealth risks associated with thimerosal, this firstanswer does not address the parent’s concernabout thimerosal specifically. The U.S. Food andDrug Administration (FDA) can and does issuedirectives to drug manufacturers concerning labelwarnings; however, to date, the FDA has notissued such a directive about thimerosal becauseit has not been adequately demonstrated thatthimerosal contributes to or causes autism or anyother neurodevelopmental disorder. Concernedparents should ensure that all currently usedvaccine is thimerosal free, as there may be oldstock still in circulation. In the United States, thimerosal is no longer added as a preservative to routinely recommended childhood vaccines, except inactivated influenza vaccine. Concerned parents can request thimerosal-free vaccines. Always addressparents’ concerns.

6-7 Ilene brings in her 14-year-old daughter,Tracie, because she fears that Tracie may besexually active. What do you do?

A. Start her on medroxyprogesterone acetate(Depo-Provera) immediately.

B. Perform a vaginal exam.

C. Ascertain in private from Tracie if she iscontemplating becoming or is sexually active.

D. Call child protective services.

6-7 Answer C:If a mother brings in her daughter because shethinks her daughter is sexually active, you shouldnot take as fact the mother’s belief. You shouldfind out directly from the daughter. If the daughteradmits to being sexually active, you may want to doa vaginal examination and discuss contraceptionmethods or counseling. Notification of a childprotective services agency may be warranted ifthe daughter admits to, or if you suspect, sexualabuse or an incestuous relationship with her father,stepfather, or other male relative given the age ofthe child and state law on statutory rape, even ifsexual activity is consensual and nonfamilial.

6-8 Nathan, a long-distance runner, says heheard that a high-protein diet would increase hisendurance. When you counsel him, which typeof diet do you tell him will increase an athlete’sendurance?

A. A fat-and-protein diet

B. A normal mixed diet with fat, protein, andcarbohydrates

C. A high-carbohydrate diet

D. A fruit-and-vegetable diet

6-8 Answer C: A high-carbohydrate diet will increase an athlete’sendurance. A fat-and-protein diet provides 95% oftotal calories from fat and 5% from protein; a normalmixed diet with fat, protein, and carbohydratesprovides 55% of total calories from carbohydrates; anda high-carbohydrate diet provides 83% of total caloriesfrom carbohydrates. Although fruits and vegetablesshould be a component of all diets, they should notmake up the entire diet. A fruit-and-vegetable dietwould not maximize an athlete’s endurance time.In a study related to these diets and an athlete’smaximum endurance time, a fat-and-protein diet gave57 minutes of maximum endurance, a normal mixeddiet gave 114 minutes, and a high-carbohydrate dietgave 167 minutes.

6-9 Jane comes to your office shortly after thedeath of her husband of 40 years. You should beconcerned if she expresses complaints of

A. waves or periods of depression.

B. loss of appetite.

C. crying when she talks with friends.

D. extreme guilt.

6-9 Answer D:Grief reactions vary from person to person, andeveryone deals differently with their grief. It is notnormal, however, to experience extreme feelings ofguilt or responsibility for the loved one’s loss. If yourclient is experiencing this or symptoms of prolongedor functional impairment, it may signal that sheis experiencing a complicated grief reaction thatmay require a consultation or further evaluation.It is quite normal for clients to experience waves ofdepression as well as crying and some loss of appetite.

6-10The most effective interventions availableto health-care providers for reducing the incidenceand severity of the leading causes of disease anddisability in the United States are

A. screening tests.

B. immunizations.

C. counseling interventions that address thepersonal health practices of clients.

D. chemoprophylaxes such as the use of drugs andnutritional and mineral supplements.

6-10 Answer C:The most effective interventions available tohealth-care providers for reducing the incidenceand severity of the leading causes of disease anddisability in the United States are those counselinginterventions that address the personal healthpractices of clients. This is the first type of clinicalpreventive service that providers should use,according to the U.S. Preventive Services TaskForce. These counseling interventions address use of tobacco, diet, physical activity, sexual practices, and injury prevention. Other interventions that shouldbe used include screening tests, immunizations, and chemoprophylaxis.

6-11 Mike was given three stool cards at the laband told how to do a fecal occult blood test at home,but he was not counseled as to what foods or drugsto eat or avoid. What do you tell him to do?

A. Do not take aspirin for 7 days before and duringthe collection period, and avoid red or processedmeat for 3 days before and during the collectionperiod.

B. Avoid eating clams and other shellfish.

C. Do not engage in vigorous physical exercise for5 days prior to the test.

D. Avoid fruit juices.

6-11 Answer A:To get an accurate result when collecting fecaloccult blood samples, the following should beavoided: aspirin or aspirin-containing drugs for 7 days before and during the collection period; red or processed meat and raw fruits and vegetables for 3 days before and during the collection period; and vitamin C or multivitamins containing more than 250 mg of vitamin C per day during the collection period. Clients may have fruit juices and otherbeverages they normally drink, cooked vegetablesor fruits, breads, cereal, fish, chicken, pork, andpopcorn. They do not need to avoid shellfish, nordo they need to avoid vigorous exercise.

6-12You are teaching a client about his gout. Whichof the following should you include in your teaching?

A. Once gout is treated, there is no danger ofpermanent damage.

B. Diet and alcohol may remain the same.

C. He should drink at least 1 quart of fluid per day.

D. Kidney stones and kidney damage may result ifgout is not adequately managed.

6-12 Answer D:When teaching clients about gout, include thefollowing information: Although the initial attackof gout causes no permanent damage, recurrentattacks may lead to permanent damage and jointdestruction. Kidney stones and kidney damage mayresult if the gout is not managed adequately. Clientsshould drink at least 3 quarts of fluid per day to helpprevent kidney stones and damage to the kidneysfrom hyperuricemia, and they should avoid alcohol.Other potential effects of continued hyperuricemiainclude tophaceous deposits in subcutaneous andother connective tissues.

6-13Which of the following healthy lifestylechoices has been shown to improve the functioningpower of a man’s heart?

A. Improving diet

B. Taking vitamins

C. Doing aerobic exercise

D. Having a restful sleep at night

6-13 Answer C: Researchers in a study on the strength of heartsin men and women found that men’s hearts lose20% – 25% of their power from ages 20 – 70,whereas the power of women’s hearts essentiallyremains unchanged. These researchers found that70-year-old men who did regular aerobic exercisehad the same functioning power of the heart as20-year-old men. The study helps to illustrate thefact that although men’s hearts can, with aging,lose some of their power or strength, aerobicexercise can help to prevent this loss. This isanother example of how encouragement of healthylifestyle choices (e.g., regular aerobic exercise)can enhance or preserve health. Certainly dietand good sleep habits are important, but not asimportant as exercise for improving overall heartfunctioning.

6-14It is important to counsel your clients of allages regarding prevention strategies for cancers ofthe colon and rectum. These strategies include

A. fecal occult blood testing on an annual basis afterage 50.

B. emphasizing the importance of regular physicalexercise and colonoscopy after age 50.

C. stressing the importance of regular physicalexercise; a diet rich in vegetables, fruit, and fiber;and regular use of aspirin.

D. weight loss, smoking cessation, and a diet rich infiber.

6-14 Answer C:Colonoscopy is not a preventive strategy butrather a form of secondary (screening) prevention,as is routine annual testing for fecal occultblood after age 50. Obesity is a weak risk factorfor colon and rectal cancer, so weight loss isnot the most valuable preventive strategy. Nocorrelation between cigarette smoking and colonand rectal cancer has been discovered. However,the preventive power of regular physical exercisehas been established as a protective factor againstcolon cancer and also against rectal cancer, butto a lesser degree. Likewise, a healthy diet rich invegetables, fruits, and fiber has been shown to haveprotective effects against colon and rectal cancer.The effect of regular aspirin use as a protectoragainst colon cancers has been replicated in severalstudies. Aspirin inhibits the growth of colonicand rectal polyps, perhaps by means of inhibitingprostaglandin synthesis.

6-15 Sylvia has scleroderma and asks forcounseling related to measures to help manage itseffects. You tell Sylvia to

A. avoid becoming chilled.

B. cut down on smoking.

C. wear tightly layered clothing to keep the skinwarm in winter.

D. begin physical therapy at the first signs of jointstiffness.

6-15 Answer A:To help manage the effects of scleroderma, adviseclients to avoid becoming chilled, which couldtrigger episodes of Raynaud’s phenomenon;maintain good skin care; perform physical therapy,particularly of the hands and face, to help maintainmobility; wear loose, warm clothing, gloves, andwarm stockings in the winter; and stop smokingaltogether (because of the vasoconstrictive effectof nicotine, as well as the respiratory effects of thedisease).

6-16 Melinda brings in her daughter Shirley,age 2, with an ear infection. She asks why

Shirley gets such frequent infections. Yourespond that

A. Shirley must be putting something in her ear.

B. a high-fat diet results in higher cerumenproduction; the cerumen traps bacteria, causingthe infection.

C. her eustachian tubes are horizontal, which doesnot allow drainage.

D. Melinda must dry Shirley’s ears more thoroughlyafter bathing.

6-16 Answer C: Children younger than the age of 7 years oftenexperience frequent ear infections. The Eustachian tubes of children this age are horizontal and do notallow the drainage of infecting organisms — viralor bacterial. An infection in the nasopharynx may ascend to a child’s horizontal eustachian tube and theninto the middle ear by impairing local host defensesor by eustachian tube dysfunction. By age 7, 35% ofchildren experience six or more episodes of acute otitismedia. As the child grows, the eustachian tube anglesmore and is no longer horizontal. If Shirley inserteda foreign body into her ear and it remained in place,occluding the canal, she could develop an infection,but the mother is asking about frequent infections,which are more common than infections induced byforeign bodies. A high-fat diet will not affect cerumen production. The mother cannot be expected to dryher daughter’s ears completely after bathing. Sheshould be drying the external canal with a cloth ortissue, nothing smaller.

6-17 Joanne is a second-grade teacher and isfrustrated that her students do not seem to begetting any physical exercise at home. She asks youfor advice. What do you recommend?

A. “Advise parents to play outside with theirchildren after dinner.”

B. “Tell parents to let their children play outside after school.”

C. “Assign homework to students that must bedone with their parents and involves physicalactivity.”

D. “Advise parents to turn the TV off for a weekto get the children used to doing somethingelse.”

6-17 Answer C:To encourage physical activity along with parentalinvolvement, advise teachers to assign homeworkto the students that must be done with their parentsand involves physical activity, such as havingthe parents count how many times in 2 minutesthe child can hop on one foot. Recommendingplay outside may not be safe, depending on theneighborhood. Turning off the TV is a good idea,but children may then substitute some othersedentary method of play, such as computer games.

6-18You must tell Joe, age 66, that the biopsyresults from his lung tumor were positive for lungcancer and that his prognosis is poor. Whichof the following is the best way to deliver thismessage?