Chapter 1: Health Defined: Health Promotion, Prevention, and Protection
Dames, Luctkar-Flude and Tyerman: Edelman and Kudzma’s Canadian Health Promotion Throughout the Life Span, 1st Edition

MULTIPLE CHOICE

	1.	How is disease defined?
a.	The failure of a person’s adaptive mechanisms to counteract stimuli and stresses adequately, resulting in functional or structural disturbances	
b.	Disease and illness are components of a struggle for balance in the bodily systems	
c.	The failure of a person’s bodily systems in responding to stresses, resulting in a hormonal imbalance	
d.	The assault by stimuli and stress on the body’s core defence systems	

ANS:	A
Disease may be defined as the failure of a person’s adaptive mechanisms to counteract stimuli and stresses adequately, resulting in functional or structural disturbances. This definition is an ecological concept of disease, which uses multiple factors to determine the cause of disease, rather than describing a single cause. Disease and illness are not synonymous.

DIF:	Cognitive Level: Remember (Knowledge)		REF:	Disease, Illness, and Health
OBJ:	1	TOP:	Assessment	MSC:	Health Promotion and Maintenance

	2.	How can health be defined?
a.	As the absence of disease and illness	
b.	As the person’s philosophy for living in harmony with their environment	
c.	A state of physical, mental, and spiritual well-being	
d.	A state of physical, mental, spiritual, and social functioning that realizes a person’s potential and is experienced within a developmental context.	

ANS:	D
Definitions of health have evolved as the nature of health and illness becomes better understood. Health is much more than the absence of disease and illness. It is a state of physical, mental, spiritual, and social functioning that realizes a person’s potential and is experienced within a developmental context.

DIF:	Cognitive Level: Apply (Application)		REF:	Health and Wellness
OBJ:	1	TOP:	Assessment	MSC:	Health Promotion and Maintenance

	3.	The 1986 Ottawa Charter for Health Promotion document provides a blueprint for health promotion in Canada. Which of the following statements is correct concerning this model?
a.	The focus is on environment and the ability to achieve health on a personal and societal level.	
b.	It depicts health promotion as the process of enabling people to increase control over and improve their health.	
c.	It provides a view of health promotion that is focused on people taking control of their own health.	
d.	It is most closely aligned with a clinical model of health.	

ANS:	B
The Ottawa Charter for Health Promotion provides a blueprint for health promotion in Canada. Within this model, health promotion is depicted as the process of enabling people to increase control over and improve their health.

DIF:	Cognitive Level: Apply (Application)		REF:	Health Promotion
OBJ:	2	TOP:	Assessment	MSC:	Health Promotion and Maintenance

	4.	Which of the following is a tool used to measure quality of life?
a.	CDCQOL-BREF (from the Centers for Disease Control)	
b.	McGowan Quality of Life Questionnaire	
c.	WHOQOL-BREF (World Health Organization)	
d.	Ottawa Charter for Health Promotion	

ANS:	C
Multiple tools are available for measuring quality of life, including a general measure established by the World Health Organization Quality of Life, WHOQOL-BREF and the McGill Quality of Life Questionnaire for use at the end of life. The Ottawa Charter for Health Promotion provides a framework for health promotion, rather than measuring quality of life.

DIF:	Cognitive Level: Understand (Comprehension)	REF:	Health Promotion
OBJ:	2	TOP:	Assessment	MSC:	Health Promotion and Maintenance

	5.	Which of the following best describes a care recipient 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
Someone with a headache represents a person with an illness. An illness is made up of the subjective experience of the individual and the physical manifestation of disease. It can be described as a response characterized by a mismatch between a person’s needs and the resources available to meet those needs. A person can have a disease without feeling ill. The other choices represent disease.

DIF:	Cognitive Level: Analyze (Analysis)			REF:	Disease, Illness, and Health
OBJ:	4	TOP:	Assessment	MSC:	Health Promotion and Maintenance

	6.	Which Canadian report is considered to be a landmark document in creating a global approach to health?
a.	Population Health Promotion Model	
b.	Healthy People 2020	
c.	Framework for Health Promotion in Canada	
d.	World Health Organization Quality of Life	

ANS:	C
By the mid-1980s, Canada became a world leader in the formulation of health-promotion ideals and strategies, particularly with the unveiling of the Framework for Health Promotion in Canada at the first World Health Organization (WHO) conference on health promotion in Ottawa. The overall goal of “achieving health for all” in this report identifies three health challenges: reducing inequities, increasing prevention, and enhancing coping. The three health-promotion mechanisms to address these challenges are self-care, mutual aid, and healthy environments. The final component of the framework consists of three implementation strategies: fostering public participation, strengthening community health services; and coordinating health public policy.
Healthy People 2020 is a US-based document to guide planning for health care. The WHO Quality of Life tool is a quality of life measurement tool used by health care workers. The Population Health Promotion Model was developed to provide an overall framework to guide health promotion by blending both health promotion and population health concepts.

DIF:	Cognitive Level: Remember (Knowledge)		
REF:	The Evolution of Health Promotion in Canada	OBJ:	3
TOP:	Planning	MSC:	Health Promotion and Maintenance		

	7.	Which of the following is one of the three programs that the Public Health Agency of Canada (PHAC) is focused on for improving the health of Canadians?
a.	Decreased tobacco use in youth throughout the country	
b.	Health promotion and disease prevention	
c.	Increased public funding for health insurance	
d.	Decreased hospital re-admission rates	

ANS:	B
The aim of the Public Health Agency of Canada (PHAC) is to promote and protect the health of Canadians through leadership, partnership, innovation, and action in public health. Among the agency’s recent plans are three programs: public health infrastructure; health promotion and disease prevention; and health security. Choices A, C, and D are possible strategies to achieve the goals of this program.

DIF:	Cognitive Level: Remember (Knowledge)		
REF:	The Role of the Public Health Agency of Canada in Health Promotion, Prevention, and Protection	OBJ:	3	TOP:	Planning	
MSC:	Health Promotion and Maintenance		

	8.	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.

DIF:	Cognitive Level: Apply (Application)		REF:	Levels of Prevention
OBJ:	5	TOP:	Planning	MSC:	Health Promotion and Maintenance

	9.	Which of the following represents a method of secondary prevention?
a.	Education about breast self-examination	
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.

DIF:	Cognitive Level: Apply (Application)		REF:	Levels of Prevention
OBJ:	5	TOP:	Planning	MSC:	Health Promotion and Maintenance

	10.	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.	Physiotherapy and occupational therapy after a motor vehicle accident with head trauma	

ANS:	D
Physiotherapy 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.

DIF:	Cognitive Level: Apply (Application)		REF:	Levels of Prevention
OBJ:	5	TOP:	Planning	MSC:	Health Promotion and Maintenance

	11.	In reviewing a person’s medical history, 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 best practice guidelines for asthma management. 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 coordinator.	
c.	Consultant or collaborator.	
d.	Educator.	

ANS:	B
Care coordinators act to prevent duplication of services, maintain quality and safety, and reduce costs. Care coordinators base recommendations on reliable data sources such as evidence-informed practices and protocols.

DIF:	Cognitive Level: Apply (Application)		
REF:	Nursing Roles in Health Promotion, Prevention, and Protection	
OBJ:	6	TOP:	Assessment	MSC:	Health Promotion and Maintenance

	12.	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 coordinator.	
c.	Consultant or collaborator.	
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)		REF:	The Nurse's Role
OBJ:	6	TOP:	Implementation		
MSC:	Health Promotion and Maintenance		

	13.	During a home visit with an individual, a nurse discusses the dangers of smoking. In this scenario the nurse is acting as a(n):
a.	Advocate.	
b.	Care coordinator.	
c.	Consultant or collaborator.	
d.	Educator.	

ANS:	D
Teaching may range from a chance remark by the nurse, based on a perception of desirable individual behaviour, to structurally planned teaching according to individual needs. Selection of the methods most likely to succeed involves the establishment of teacher–learner goals. Health promotion and protection rely heavily on the individual’s ability to use appropriate knowledge. Health education is one of the primary prevention techniques available to avoid the major causes of disability and death today, and is a critical role for nurses.

DIF:	Cognitive Level: Apply (Application)		REF:	The Nurse's Role
OBJ:	6	TOP:	Implementation		
MSC:	Health Promotion and Maintenance		

	14.	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 coordinator.	
c.	Consultant or collaborator.	
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 or public health, and they are equipped to provide information as consultants in these areas of specialization.

DIF:	Cognitive Level: Apply (Application)		REF:	The Nurse's Role
OBJ:	6	TOP:	Planning	MSC:	Health Promotion and Maintenance

	15.	In which of the following scenarios is the nurse functioning as a care coordinator?
a.	A nurse is working with a family to coordinate care for a child with multiple previous hospital admissions due to exacerbation of asthma.	
b.	A nurse is providing asthma education in an office setting to a child with moderate, persistent asthma.	
c.	A nurse is administering the appropriate anti-inflammatory medication to a child hospitalized for exacerbation of asthma.	
d.	A nurse is making a home visit to perform a respiratory assessment on a child discharged from the hospital following an admission for an asthma exacerbation.	

ANS:	A
Care coordinators help determine what medical care is necessary, monitor care, and arrange for individuals to receive the most cost-effective care in the most appropriate settings. They must collaborate with care providers and with the care recipient/family. Care coordinators are especially helpful in following a care recipient after discharge and assisting care recipients with complex needs. A nurse working with a family to coordinate service after a hospitalization is a good example of services provided by a care coordinator.

DIF:	Cognitive Level: Apply (Application)		REF:	The Nurse's Role
OBJ:	6	TOP:	Planning	MSC:	Health Promotion and Maintenance

	16.	A nurse is planning to deliver an educational program to individuals with diabetes. Which of the following should be the initial action taken by the nurse to ensure the success of the program?
a.	Assess the motivation level of the individuals	
b.	Assess the knowledge level of the individuals	
c.	Establish teacher–learner goals with the individuals	
d.	Establish multiple teaching sessions with the individuals	

ANS:	C
Selection of the methods most likely to succeed involves the establishment of teacher–learner goals. Thus, the first step by the nurse should be establishment of goals.

DIF:	Cognitive Level: Analyze (Analysis)			REF:	The Nurse's Role
OBJ:	6	TOP:	Planning	MSC:	Health Promotion and Maintenance

	17.	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-informed practice.	
c.	A goal of the Canada Health Act.	
d.	The ecological model of health.	

ANS:	B
Evidence-informed 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-informed nursing decision-making means integrating individual clinical expertise with the best available external clinical evidence from systematic research.

DIF:	Cognitive Level: Remember (Knowledge)		REF:	The Nurse's Role
OBJ:	6	TOP:	Planning	MSC:	Health Promotion and Maintenance

	18.	In order to promote health and prevent illness, disease, and disabilities, various levels of prevention are used in nursing practice. Health promotion fits as a strategy under the umbrella of primary prevention. Which of the following is an example of primary prevention?
a.	Teaching how to give insulin	
b.	Screening mammogram	
c.	Immunization against hepatitis B	
d.	Rehabilitation for a stroke	

ANS:	C
Primary prevention refers to the timeline before disease occurs. Examples include healthy eating and activity-based school programs, reduction of sodium in the food supply, and specific protection from diseases by immunization such as hepatitis B. Teaching how to give insulin and encouraging women to have mammograms are examples of secondary prevention. Rehabilitation for a stroke is an example of tertiary prevention.

DIF:	Cognitive Level: Apply (Application)		
REF:	Prevention, Primary Prevention	OBJ:	5	TOP:	Planning
MSC:	Health Promotion and Maintenance		

	19.	Secondary prevention is focused on averting or delaying the consequences of advanced disease. Which of the following is an example of secondary prevention?
a.	Immunization for human papillomavirus (HPV)	
b.	Screening for colorectal cancer	
c.	School presentation on bicycle safety	
d.	Physiotherapy after hip replacement surgery	

ANS:	B
Secondary prevention ranges from providing screening activities and treating early stages of disease to limiting disability by averting or delaying the consequences of advanced disease. Screening is secondary prevention because the principal goal is to identify individuals in an early, detectable stage of the disease process.

DIF:	Cognitive Level: Apply (Application)		
REF:	Prevention, Secondary Prevention	OBJ:	5	TOP:	Planning
MSC:	Health Promotion and Maintenance		

	20.	Tertiary prevention activities are focused on helping people to attain and retain an optimal level of functioning. Which of the following is an example of tertiary prevention activities?
a.	Rehabilitation after a stroke	
b.	Chest X-ray to screen for tuberculosis	
c.	Screening for prostate specific antigen (PSA)	
d.	Childhood immunization for measles and varicella	

ANS:	A
Tertiary prevention occurs when a defect or disability is permanent or irreversible. The process involves minimizing the effects of disease and disability by surveillance and maintenance activities that are aimed at preventing complications and deterioration. Tertiary prevention focuses on rehabilitation to help people attain and retain an optimal level of functioning, regardless of their disabling condition.

DIF:	Cognitive Level: Apply (Application)		
REF:	Prevention, Tertiary Prevention	OBJ:	5	TOP:	Planning
MSC:	Health Promotion and Maintenance		

	21.	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-informed practice	
d.	Practice guidelines	

ANS:	A
Cultural and socioeconomic changes within the population unequivocally influence lay concepts of health and health promotion. Health-promotion efforts, unlike those efforts directed at specific protection from certain diseases, focus on maintaining or improving the general health of individuals, families, and communities. These activities are conducted at the public level (e.g., government programs promoting adequate housing or reducing pollutants in the air), at the community level, and at the personal level. 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 care providers determine changing care needs.

DIF:	Cognitive Level: Remember (Knowledge)		
REF:	Improving Prospects for Health, Population Effects	OBJ:	6
TOP:	Planning	MSC:	Health Promotion and Maintenance		

	22.	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)		REF:	Shifting Problems
OBJ:	6	TOP:	Planning	MSC:	Health Promotion and Maintenance

	23.	Which of the following groups of people is likely to show an increase in population numbers between the years 2036 to 2063?
a.	Persons aged 65 and older	
b.	Persons of European descent	
c.	Persons belonging to a visible minority group	
d.	Infants, due to rising birth rates	

ANS:	C
By the year 2036, among working-age (15 to 64 years) Canadians, between 35% and 40% are projected to belong to a visible minority group. In addition to changes in the ethnic distribution within the population, the projected changes in age distribution will affect health-promotion practice. Considerable growth is also expected in the proportion of the population that is 25 years of age and older. For example, it is projected that by 2063 the number of older people will more than double and potentially comprise between 24% and 28% of the overall Canadian population. Although there was a drop in births after 1960, this decrease has been offset by an increase in immigration.

DIF:	Cognitive Level: Apply (Application)		
REF:	Improving Prospects for Health, Population Effects	OBJ:	6
TOP:	Planning	MSC:	Health Promotion and Maintenance		

	24.	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
Solutions for health promotion are focused on individual and government involvement. 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. Educating a person about the advantages of a heart-healthy diet during a home visit serves to influence lifestyle choices.

DIF:	Cognitive Level: Apply (Application)		
REF:	Prevention, Primary Prevention	OBJ:	5	TOP:	Implementation
MSC:	Health Promotion and Maintenance		

	25.	Which factor is likely to have the most influence in changing the health behaviour of a single, adult woman who smokes and is the care provider for her mother, her own children, and her 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.	A gift card for $10 to a local grocery store for every week she is smoke-free	

ANS:	D
Motivational factors play a role in influencing attitudinal changes. A financial incentive is an example of a motivating factor. 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. Remember that education regarding the benefits of not smoking is not enough. Thus, the $10 gift card may have the most influence in changing her health behaviour.

DIF:	Cognitive Level: Analyze (Analysis)			REF:	Moving Toward Solutions
OBJ:	5	TOP:	Implementation		
MSC:	Health Promotion and Maintenance		

MULTIPLE RESPONSE

	1.	Which of the following are solution-focused directions when using the population health promotion model (PHPM)? (Select all that apply.)
a.	Working to promote interprofessional collaboration	
b.	Working with individuals and families	
c.	Working at the community and governmental levels	
d.	Working to improve quality of life	

ANS:	B, C
The population health promotion model (PHPM) assists in identifying the socioenvironmental “who, what, how, and why” of a health-promotion activity. Specifically, one must determine at which level of society to take action (the “who” of the PHPM), the social determinants of health to act upon (the “what”), the appropriate Ottawa Charter action area (the “how”), and the best available evidence to make decisions (the “why”). Using the model results in a more all-encompassing view of the problem and leads to better solutions. Such an approach promotes upstream thinking that focuses on strategies to address economic and social factors by removing barriers and improving supports to allow people to reach their full potential. Solutions can be focused in two main directions: with individuals and families, or at community and governmental levels of involvement.

DIF:	Cognitive Level: Remember (Knowledge)		REF:	Moving Toward Solutions
OBJ:	3	TOP:	Implementation		
MSC:	Health Promotion and Maintenance		

	2.	Which of the following interventions address both the population health promotion model (PHPM) indicators and the overall goals of the Ottawa Charter for Health Promotion? (Select all that apply.)
a.	Establishing a new park with a well-lit walking 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 walking track, establishing a smoking cessation campaign, and providing free condoms at all federally funded health clinics address the population health promotion model (PHPM) indicators as well as the overall goals of the Ottawa Charter for Health Promotion. A park, smoking cessation campaign, and free condoms address the themes of promoting health and preventing disease and the goal of increasing quality and years of healthy life.
Providing reduced-cost transportation passes to senior citizens may indirectly affect the health of this population; however, it is not directly related to the population health promotion model (PHPM) indicators and the overall goals of the Ottawa Charter for Health Promotion.

DIF:	Cognitive Level: Analyze (Analysis)			REF:	Moving Toward Solutions
OBJ:	3	TOP:	Planning	MSC:	Health Promotion and Maintenance