Health PromotionChapter 3December 12, 2014
3-1Herbert, a 69-year-old man, comes to youroffice complaining of nocturia. On questioningHerbert, you find that for the past 3 months hehas been getting up at least five times a night tovoid. He came in to seek help today because of hiswife’s insistence that he be checked out. Whenyou perform the digital rectal exam, you find thathis prostate protrudes 3–4 cm into the rectum.What grade would you assign to Herbert’s prostateenlargement?
A. Grade 1
B. Grade 2
C. Grade 3
D. Grade 4
3-1 Answer C: The degree of prostate enlargement is based onthe amount of projection of the prostate into therectum. The normal prostate protrudes less than1 cm into the rectum. Grade 1 enlargement is aprotrusion of 1–2 cm, grade 2 is 2–3 cm, grade 3 is3-4 cm, and grade 4 is greater than 4 cm.
3-2 Screening is considered a form of
A. health counseling.
B. primary prevention.
C. secondary prevention.
D. tertiary intervention.
3-2 Answer C: Screening is considered a form of secondary preventionbecause it seeks to identify the presence of diseases,such as high blood pressure, glaucoma, and diabetes, atearly stages when treatment would be most effective.
3-3 Which industry is responsible for the mostinjuries?
A. Mining
B. Construction
C. Transportation and utilities
D. Manufacturing
3-3 Answer B: The construction industry is responsible for the mostinjuries (15 injuries per 100 full-time workers peryear). Next in line are the agriculture, fishing, andforestry industries, followed by the manufacturing,transportation and utilities, and mining industries.
3-4Which immunization may prevent meningitis?
A. Hepatitis B
B. Haemophilusinfluenzae type B (Hib)
C. Measles, mumps, and rubella (MMR)
D. Varicella
3-4 Answer B: Meningitis is one of the most severe manifestationsof Haemophilusinfluenzae infection, and the H. influenzae type B (HiB) immunization mayhelp prevent its occurrence. The HiB vaccination is especially important for children age 5 years and younger. It should be given at ages 2 months, 4 months, and 6 months, with the fourth dose given between ages 12 and 18 months. Hepatitis B vaccination is important for all infants to helpprevent liver disease as adults. A measles, mumps, and rubella (MMR) vaccination protects againstmeasles, mumps, and rubella (German measles), andvaricella vaccination protects against chickenpox.
3-5 When should a woman start getting Pap tests?
A. When she becomes sexually active
B. At age 21
C. During her first pregnancy
D. Before birth control is prescribed
3-5 Answer B: Women are advised to begin Pap testing either3 years after the onset of vaginal intercourse or atthe age of 21, whichever comes first. For a youngteenager, birth control may be prescribed withoutfirst performing a pelvic exam.
3-6 Susie, age 5, comes to the clinic for a well-childvisit. She has not been in since she was 2. Herimmunizations are up to date. What immunizationswould you give her today?
A. None; wait until she is 6 years old to give herbooster shots
B. Diphtheria, tetanus, and pertussis (DTaP);Haemophilusinfluenzae type B (Hib); and measles,mumps, and rubella (MMR)
C. DTaP and IPV
D. DTaP, IPV, and MMR
3-6 Answer D: Because Susie has not been in for several years, onecannot assume that she will come in next year to getthe immunizations that are due between the agesof 4 and 6; therefore, this opportunity to give herimmunizations cannot be missed. Between the agesof 4 and 6, a child is due for diphtheria, tetanus, andpertussis (DTP); polio; and measles, mumps, and rubella(MMR) if all other immunizations are up to date.
3-7Which tumor marker is specifically elevatedin prostate cancer?
A. Prostate cancer tumor marker (PCTM)
B. Cancer antigen (CA) 125
C. Carcinoembryonic antigen (CEA)
D. Prostate-specific antigen (PSA)
3-7 Answer D: The tumor marker that is elevated in prostate canceris prostate-specific antigen (PSA). Determined by asimple blood test, PSA is a tumor marker whose levelin the bloodstream becomes elevated with prostatecancer, although it may also become elevated withbenign prostatic hypertrophy (BPH). There is noprostate cancer tumor marker (PCTM). Levelsof cancer antigen (CA) 125are increased in thefollowing cancers: epithelial ovarian, fallopian tube, endometrial, endocervical, hepatic, and pancreatic.It is also used to monitor for persistent or recurrentserous carcinoma of the ovary in the postoperativeperiod or during chemotherapy. Measurement of thelevel of carcinoembryonic antigen (CEA) is usedprimarily for monitoring persistent, metastatic, or recurrent cancer of the colon after surgery and lessfrequently for breast or other cancers.
3-8 Gerald, a 67-year-old male retiredmaintenance worker, comes to your office fora physical. On reviewing Gerald’s history, youdiscover that he has had pneumonia twice inthe past 5 years. When you question Geraldabout his immunization history, he revealsthat his last tetanus and diphtheria (Td)immunization was 6 years ago, and his lastflu shot was 8 months ago during the last fluseason. He denies ever having had a pneumoniavaccination. Which immunizations should youoffer to Gerald today?
A. Td
B. Pneumococcal vaccine
C. Influenza
D. Td and pneumococcal vaccine
3-8 Answer B: Prevention of pneumococcal disease in olderpeople is one of the health initiatives of the U.S.government report Healthy People 2020, NationalHealth Promotion and Disease Prevention Objectives.The goal for health-care providers is to have 90%of all clients older than 65 years immunized againstpneumococcal disease by the year 2020. Thepneumococcal vaccine is a one-time injection thatmay need to be repeated in 8 years. Gerald does not need a Td booster because his last injection was only 6 years ago, and the Centers for Disease Control and Prevention recommends a Td booster every 10 years. The influenza injection would notbe appropriate at this time. Influenza vaccine isadjusted yearly to address the type of influenza thatis thought to be prevalent in that year. Also, theinfluenza vaccine is given just before flu season.
3-9 When should glaucoma screening be instituted?
A. When the client is age 65
B. When the client exhibits vision problems
C. At the client’s annual exam
D. Starting at age 40
3-9 Answer D: While the USPSTF found insufficient evidenceto recommend for or against screening adultsfor glaucoma, the American Academy ofOphthalmology recommends screening for glaucomaas part of the comprehensive adult medicaleye evaluation, starting at the age of 20, with afrequency depending on an individual’s age andother risk factors for glaucoma. The Departmentof Veterans Affairs recommends that every veteranover the age of 40 be screened for glaucoma in aprimary care setting with a frequency depending onage, ethnicity, and family history. Glaucoma is an elevated intraocular pressure that is measured with the use of a tonometer.Looking at all guidelines, answer D is the bestchoice. Waiting until the client exhibits visionproblems may be too late.
3-10 The U.S. government report, Healthy People2020, National Health Promotion and DiseasePrevention Objectives, lists which of the followingas leading health indicators?
A. Obesity, substance abuse, and immunizations
B. Obesity, responsible sexual behavior, and drivereducation
C. Obesity, substance abuse, and driver education
D. Obesity, immunizations, and driver education
3-10 Answer A: The U.S. government report Healthy People 2020,National Health Promotion and Disease PreventionObjectives cites obesity, substance abuse, andimmunizations as leading health indicators. Drivereducation is not considered a leading health-careindicator. The fourth-generation plan, HealthyPeople 2020, builds on past achievements, reaffirmsthe two overarching goals from the past decade,and adds two more: promoting quality of life,healthy development, and healthy behaviorsacross life stages; and creating social and physicalenvironments that promote good health.
3-11 Mimi, age 52, asks why she should performa monthly breast self-examination (BSE) when shehas an annual exam by the physician, as well as ayearly mammogram. You respond,
A. “If you are faithful about your annual exams andmammograms, that is enough.”
B. “More breast abnormalities are picked up bymammograms than by clinical exams or BSE.”
C. “More than 90% of all breast abnormalities arefirst detected by self-examination.”
D. “Self-examinations need to be performed onlyevery other month.”
3-11 Answer C: More than 90% of all breast abnormalities are firstdetected by self-examination. All women olderthan age 20 should examine their breasts monthly,a week after their period. After menopause, womenshould examine their breasts at the same time eachmonth.
3-12 Alcohol, especially when used with tobacco,is a dietary factor in which type of cancer?
A. Liver
B. Esophagus
C. Bladder
D. Breast
3-12 Answer B: Alcohol, especially when used with tobacco, is adietary factor in cancer of the esophagus. Alcohol isalso a factor in liver cancer. Dietary factors relatedto bladder cancer are unknown. A high-calorie diet (with high fat and low fiber) is a factor in breast cancer.
3-13When performing a sports physical exam onKevin, a 16-year-old healthy boy, which questionin the history is important to ask Kevin or hisguardian?
A. Did anyone in your family ever have suddencardiac death?
B. Does anyone in your family have elevatedcholesterol levels?
C. Did you ever have any injury requiring stitches?
D. Does anyone in your family have a history of asthma?
3-13 Answer A: The risk of sudden death during sports activitiesfrom hypertrophic cardiomyopathy may be greatlyreduced with a thorough cardiac history andexamination. If a child has a relative who diedof sudden cardiac disease before age 55, that childcould possibly have hypertrophic cardiomyopathy.Family history of asthma is not relevant to this examquestion.
3-14 Joseph, a 55-year-old man with diabetes,is at your office for his diabetes follow-up. Onexamining his feet with monofilament (fishing line), you discoverthat he has developed decreased sensation in bothfeet. There are no open areas or signs of infectionon his feet. What health teaching should Josephreceive today regarding the care of his feet?
A. Wash your feet with cold water only.
B. See a podiatrist every 2 years, inspect your ownfeet monthly, and apply lotion to your feet daily.
C. Go to a spa and have a pedicure monthly.
D. See a podiatrist yearly; wash your feet daily withwarm, soapy water and towel dry between thetoes; inspect your feet daily for any lesions; andapply lotion to any dry areas.
3-14 Answer D: The American Diabetes Association recommendscareful inspection of a diabetic client’s feet forcorns, calluses, and open lesions to preventfurther deterioration into diabetic foot ulcers.The client should wash his or her feet daily with warm soapy water and towel dry them, especially between the toes, to prevent fungal infections.Diabetic clients should see a podiatrist yearly.Encourage patients to use a mirror to inspect thebottom of their feet.
3-15 Harvey, age 55, comes to the office with ablood pressure of 144/96 mm Hg. He states that hedid not know if it was ever elevated before. Whenyou retake his blood pressure at the end of theexamination, it remains at 144/96. What shouldyour next action be?
A. Start him on an ACE inhibitor.
B. Start him on a diuretic.
C. Have him monitor his blood pressure at home.
D. Try non-pharmacological methods and have himmonitor his blood pressure at home.
3-15 Answer D: Before drug therapy for hypertension is instituted,lifestyle modification and non-pharmacologicalmethods such as salt restriction, weight reduction,biofeedback, and exercise should be considered.Aggressive treatment of all clients with a systolicpressure greater than 140 mm Hg and/or a diastolicpressure greater than 90 mm Hg is essential. Theclient should monitor his or her blood pressureat home and call the health-care provider if itexceeds the parameters discussed. In this case,Harvey should try non-pharmacological methods andmonitor his blood pressure at home and then returnin 1–2 weeks for follow-up. If his diastolic pressure is still 96 mm Hg after 2 weeks, a diuretic or an ACE inhibitor would be indicated.
3-16 Sally, age 25, is of normal weight. Shefollows a diet of 70% carbohydrates, 10% fat, and20% proteins. How do you respond when she asksyou if this is a good diet?
A. “Yes, this is a good diet.”
B. “No, you should eat more proteins.”
C. “You should be eating only about 55%carbohydrates.”
D. “Make sure your fats are divided among saturated,polyunsaturated, and monounsaturated fats.”
3-16 Answer C: The National Cholesterol Education Programrecommends that carbohydrates comprise about55% of total calories, fat no more than 30% oftotal calories, and proteins about 15%–20% of totalcalories.
3-17What is the most common type ofoccupational (nonfatal) illness in the United States?
A. Poisoning
B. Respiratory conditions caused by toxic agents
C. Repetitive stress injury
D. Skin disorders
3-17 Answer C: Occupational repetitive stress injuries result fromwear and tear on the body over a period of time.Repetitive stress injuries are one of the fastestgrowing workplace injuries and can happen anytime there is a discrepancy between the physicalrequirements of a job and the physical capacity ofthe worker’s body. Risk factors include repetitive motion, force, awkward posture, heavy lifting, or some combination of these factors. Teaching properbody mechanics is a good form of prevention.Skin disorders represent up to 20% of alloccupational illnesses. Many incidences ofworkplace skin disease go unreported, and the truerate of occupational skin disease is probably muchhigher. The most common occupational skin diseaseis contact dermatitis, which may be classified asacute (weepy, edematous, vesicular, blistered) orchronic (dry, cracked, scaly, thickened). This isfollowed by respiratory conditions, then poisoning.
3-18The primary objective of screening is to
A. prevent a disease.
B. detect a disease.
C. determine the treatment options.
D. promote genetic testing to prevent passing on thedisease.
3-18 Answer B: The primary objective of screening is to detect adisease in its early stages to be able to treat it andchange its progression. Treating a disease at theearly asymptomatic period can significantly alter thecourse of the disease.
3-19 Tuberculin skin testing using the Mantouxtest should be considered for
A. high-risk adolescents, recent immigrants, andhomeless individuals.
B. all clients every 2 years.
C. all clients at their annual physical.
D. all children before entrance into first grade.
3-19 Answer A: Tuberculin skin testing using the Mantoux test shouldbe considered in high-risk adolescents as well as recentimmigrants and homeless individuals. For high-riskindividuals, an induration of 10 mm or greaterwhenread at 48–72 hours is considered positive.
3-20 Josephine, a 60-year-old woman,presents to your office with a history of elevatedtotal cholesterol, triglycerides, and low-densitylipoprotein (LDL) cholesterol. She was started ona statin medication 4 weeks ago and is concernedabout some muscle pains she has been experiencing.On questioning Josephine, you discover that she hashad pain in both her thighs for the past 2 weeks.What possible complication of statin therapy are youconcerned that Josephine might be experiencing?
A. Liver failure
B. Renal failure
C. Rhabdomyolysis
D. Rheumatoid arthritis
3-20 Answer C: Rhabdomyolysis is a syndrome that results fromdestruction of skeletal muscle. It is usually diagnosedfrom laboratory findings that are characteristicof myonecrosis. Although there are no standardcreatinekinase values that establish the diagnosisof rhabdomyolysis, elevations above 10,000 IU/Lare usually indicative of clinically significantrhabdomyolysis. The syndrome usually affectsmuscles used in exercise, but it may present asgeneralized muscle weakness. It usually resolves on stopping the statin medication, but severe cases may lead to renal failure and death.
3-21One of the major criteria for diagnosingchronic fatigue syndrome is
A. generalized headaches.
B. unexplained, generalized muscle weakness.
C. sleep disturbance.
D. fatigue for more than 6 months.
3-21 Answer D: Fatigue for more than 6 months and absence of otherclinical conditions that may explain such fatigue arethe two major criteria the client must demonstrateto be diagnosed with chronic fatigue syndrome.Other minor criteria include generalized headaches,unexplained generalized muscle weakness, sleepdisturbances, sore throat, mild fever or chills, andmigratory arthralgias without swelling or redness.
3-22Margaret, age 29, is of medium build and5 ft 4 in. tall. You estimate that she should weighabout
A. 105 lb.
B. 110 lb.
C. 120 lb.
D. 130 lb.
3-22 Answer C: To estimate a client’s ideal weight, use the followingformula: For women older than age 25, allow 100 lb for the first 5 ft, then add 5 lb for each inch thereafter. For men, allow 106 lb for the first 5 ft,then 6 lb for each inch thereafter. Multiply the number by 110% for a client with a large frame and 90% for a client with a small frame.
3-23 A heart-healthy diet should be recommendedto clients
A. with a low-density lipoprotein (LDL) cholesterollevel greater than 160 mg/dL.
B. with a total cholesterol level greater than 200 mg/dL.
C. with a high-density lipoprotein (HDL)cholesterol level below 35 mg/dL.
D. regardless of age or risk.
3-23 Answer D: A heart-healthy diet should be recommended forall clients regardless of age or risk. It is especially important that children learn healthy eating habits early in life. A heart-healthy diet follows the Dietary Guidelines for Americans developed by the U.S. Departments of Agriculture and Health and Human Services. It is designed for healthy people older than age 2 to maintain their health. The guidelinesinclude eating a variety of foods; balancing thefood you eat with physical activity; maintaining orimproving your weight; choosing a diet with plentyof grain products, vegetables, and fruits; choosinga diet low in fat, saturated fat, and cholesterol;choosing a diet moderate in sugars; choosing adiet moderate in salt and sodium; and, if you drinkalcoholic beverages, doing so in moderation.
3-24 Dennis, age 62, has benign prostatichyperplasia (BPH). He tells you that he voids atleast four times per night and that he has read abouta preventive drug called terazosin hydrochloride(Hytrin) that might help him. What do you tell him?
A. “It’s not a preventive drug, but it relaxes smoothmuscle in the prostate and bladder neck.”
B. “It changes the pH of the urine and preventsinfections caused by urinary stasis.”
C. “It relaxes the urethra.”
D. “It shrinks the prostate tissue.”
3-24 Answer A: Terazosin (Hytrin) is an alpha-1 adrenergic blocker.It is not a preventive drug, but it does relax smoothmuscle in the prostate and bladder neck and allowscomplete emptying of the bladder, relieving frequentnocturnal urination. Terazosin is begun at 1 mg atbedtime initially and then titrated upward to 10 mgonce a day. Doxazosin (Cardura) is also effective asan alpha-1 adrenergic blocker. It is begun initially at1 mg at bedtime, with the dosage doubled every1–2 weeks to a maximum of 8 mg per day.Finasteride (Proscar), a 5-alpha reductase inhibitor,decreases the volume of the prostate within about3 months. At 12 months, it seems to have reachedits peak effectiveness. Finasteride is given 5 mg dailyfor at least 6 months; then the client is reevaluated.
3-25 Julia, age 18, asks you how many calories of fatshe is eating when one serving has 3 g of fat. You tell her