Health Promotion and Disease Prevention Flashcards

A practical nurse is reviewing immunization records for a 65-year-old client with a documented egg allergy who requires annual influenza vaccination. Which action is MOST appropriate?

Answer: Administer the vaccine in a controlled clinical setting with a 30-minute observation period, as current evidence supports administration regardless of egg allergy severity

Current Canadian immunization guidelines (NACI) indicate that influenza vaccines may be administered to individuals with egg allergy, including those with anaphylaxis history, in a setting equipped to manage allergic reactions with a 30-minute post-vaccination observation. The old practice of withholding vaccines or mandatory allergist referral for egg allergy has been superseded by evidence showing the egg protein content in modern vaccines is too low to trigger systemic reactions in most cases. The live-attenuated intranasal form is actually contraindicated in adults 65+ and in those with certain immunocompromising conditions.

Using the Precaution Adoption Process Model (PAPM), a PN is counselling a client who says, 'I know I should quit smoking but I've decided it's just not worth trying — I've failed too many times.' Which stage does this client occupy, and what is the BEST intervention?

Answer: Stage 4 (decided not to act); explore and address the specific barriers and past failure experiences without immediately pushing action

In PAPM, Stage 4 is 'decided not to act' — the client is aware of the issue and has made a conscious decision against change, often based on past failure or perceived futility. This differs from Stage 3 (undecided/ambivalent) where the client has not yet formed a decision. The most therapeutic approach in Stage 4 is not to immediately push action or bombard with information, but to explore the client's specific barriers, validate past difficulty, and gently reframe previous attempts as learning experiences. Jumping to action-stage interventions (like relapse prevention) or awareness campaigns is mismatched to this stage.

A PN working in a remote First Nations community is implementing a cervical cancer screening program. The community's Elder council has expressed concern that the program disregards cultural protocols around women's health. Which principle of the Ottawa Charter for Health Promotion MOST directly guides the PN's next step?

Answer: Strengthen community action by supporting the community's own ability to define priorities and strategies for the program

The Ottawa Charter's principle of 'Strengthen Community Action' is most directly applicable here. It emphasizes empowering communities to own their health priorities and strategies — not having external health providers impose solutions. In Indigenous contexts, meaningful community action requires genuine partnership with leadership structures such as Elder councils. While reorienting health services, building healthy public policy, and creating supportive environments are all valid Ottawa Charter principles, they do not address the immediate need to respect and integrate the community's decision-making authority, which is the core issue raised by the Elder council.

A PN is screening clients using the AUDIT-C tool at a primary care clinic. A 52-year-old male client scores 6/12. The PN knows his physician plans to prescribe metronidazole for H. pylori eradication. Which secondary prevention action is MOST clinically urgent?

Answer: Advise the client to abstain from alcohol during metronidazole therapy due to a disulfiram-like reaction risk, and document the counselling

An AUDIT-C score of 6 in a male indicates hazardous alcohol use, raising clinically significant risk for a disulfiram-like reaction (flushing, nausea, vomiting, tachycardia) if the client consumes alcohol while taking metronidazole. The most urgent secondary prevention action is clear, documented counselling to abstain from alcohol for the duration of therapy plus 48 hours after the last dose. Delaying H. pylori treatment is not supported — the infection itself poses GI disease risk. Substituting clarithromycin is a prescriber decision and not within the PN's scope, and AA referral, while appropriate as a longer-term intervention, does not address the immediate pharmacological risk.

During a community health fair, a PN applies the concept of 'proportionate universalism' when planning health promotion activities. Which approach BEST reflects this concept?

Answer: Delivering universal services scaled in intensity and reach according to the degree of disadvantage experienced by different population groups

Proportionate universalism, a concept articulated by Sir Michael Marmot, refers to delivering universal programs with a scale and intensity proportionate to the level of disadvantage. Unlike pure targeting (which can stigmatize and miss those in the middle of the socioeconomic gradient) or pure universalism (which fails to close health inequity gaps), proportionate universalism acknowledges that those with greater disadvantage require more intensive support while ensuring all groups receive some level of service. Prioritizing only 'ready' participants contradicts health equity principles by selecting out those with fewer resources.

A PN is reviewing a 58-year-old post-menopausal female client's chart. She has a BMI of 22, is a non-smoker, drinks 2 glasses of wine nightly, has a maternal history of hip fracture, and takes a proton pump inhibitor (PPI) long-term. Using FRAX-informed clinical reasoning, which factor MOST significantly elevates her fracture risk beyond what BMI alone would suggest?

Answer: Maternal history of hip fracture, which contributes to FRAX score independently of bone mineral density measurement

The FRAX tool explicitly incorporates parental history of hip fracture as an independent risk factor for major osteoporotic fracture, separate from BMI or bone mineral density (BMD). This is a clinically important distinction because clients may have normal BMD yet carry significant familial fracture risk. While long-term PPI use does impair calcium absorption and alcohol intake reduces BMD, and while post-menopausal status is a foundational risk, FRAX specifically captures parental hip fracture as a discrete variable that elevates calculated risk in a way that standard BMD testing alone would not detect. BMI of 22, though on the lower end, is not itself a flagged FRAX risk factor — the tool uses BMI <19 as a threshold.