Betty Neuman – Systems Model Summary
🎯 Focus: Understanding patients as open systems constantly reacting to
stressors and seeking balance (stability).
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🧠 Who is Betty Neuman?
American nurse theorist
Created the Neuman Systems Model (NSM) in 1970
Integrates concepts from systems theory, stress theory, and nursing
theory
Focus: Holistic care, prevention, and patient response to stress
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🌐 Core Concept: Client as an Open System
> The client is a system (person, family, group, or community) that
responds to stressors from the environment.
The goal of nursing is to maintain or restore system stability.
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🧩 Major Concepts in Neuman’s Model
1. Client System
Can be an individual, family, or group
Interacts with:
•Internal environment (within the person)
•External environment (outside influences)
•Created environment (developed by the client)
2. Stressors
Types and Examples
Intrapersonal
Ex. Inside the person (e.g., pain, anxiety)
Interpersonal
Ex. Between people (e.g., conflict, role changes)
Extrapersonal
Ex. External (e.g., financial issues, environment)
3. Lines of Defense and Resistance
Line and Function
•Flexible Line of Defense
☆First line — temporary buffer (e.g., rest, coping)
•Normal Line of Defense
☆Usual level of health/stability (baseline health)
•Lines of Resistance
☆Activate when stressor breaks through defenses (e.g., immune response,
inflammation)
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4. Nursing Interventions (Three Levels of Prevention)
Level, Goal, and Example
Primary
-Prevent stressor from penetrating defenses
Ex. Health education, immunizations
Secondary
-Treat symptoms after stressor invades
Ex. Screening, early treatment
Tertiary
-Support after treatment to restore health
Ex. Rehab, follow-up care
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💡 Key Nursing Focus in Neuman's Model
□Identify the stressors
□Strengthen the lines of defense
□Provide interventions at all three prevention levels
□Consider all dimensions of the client: physiological, psychological,
sociocultural, developmental, and spiritual
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📝 NCLEX-Style Sample Questions – Betty Neuman
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1. According to Neuman’s model, what is the nurse’s primary goal?
A. Cure the disease
B. Control medication
C. Maintain or restore client system stability
D. Diagnose mental illness
✅ Answer: C
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2. Which of the following is an example of an intrapersonal stressor?
A. Argument with spouse
B. Death of a family member
C. Anxiety before surgery
D. Job loss
✅ Answer: C
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3. A nurse educates teens on healthy eating to prevent obesity. Which
level of prevention is this?
A. Primary
B. Secondary
C. Tertiary
D. Crisis
✅ Answer: A
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4. What is the “normal line of defense” in Neuman’s model?
A. The strongest barrier to illness
B. Usual level of wellness and stability
C. Physical boundary like the skin
D. Emergency stress response
✅ Answer: B
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5. The nurse gives rehab exercises after a stroke. What type of
intervention is this?
A. Primary
B. Secondary
C. Tertiary
D. Acute
✅ Answer: C
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6. The patient experiences stress due to unemployment. This is what kind
of stressor?
A. Intrapersonal
B. Interpersonal
C. Extrapersonal
D. Personal
✅ Answer: C
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7. What happens when a stressor breaks through the lines of defense?
A. The patient heals immediately
B. The nurse applies only tertiary prevention
C. The lines of resistance attempt to restore stability
D. The client system stops functioning
✅ Answer: C
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🩺 In Practice Example:
•A 45-year-old client experiences work-related stress (extrapersonal
stressor).
•Nurse promotes stress management education (primary prevention)
•Monitors for signs of anxiety (secondary prevention)
•Refers to counseling after burnout (tertiary prevention)
Absolutely! Here are 20 more NCLEX-style practice questions based on
Betty Neuman’s Systems Model, complete with answers and rationales —
perfect for your nursing exam review.
🧠 Betty Neuman Systems Model – NCLEX-Style Questions (Set 2)
1. A nurse teaches stress management to prevent anxiety before it starts.
What type of prevention is this?
A. Secondary
B. Tertiary
C. Primary
D. Curative
✅ Answer: C
Rationale: Primary prevention aims to prevent stressors from impacting
the client system.
2. Which of the following is a key concept in Neuman’s model?
A. Self-care agency
B. Stressors and lines of defense
C. Transpersonal caring
D. Developmental task resolution
✅ Answer: B
3. Which is an example of an interpersonal stressor?
A. Elevated blood pressure
B. Death of a spouse
C. Argument with a roommate
D. Noise in the hospital
✅ Answer: C
4. A nurse screens a population for hypertension. What level of prevention
is this?
A. Primary
B. Secondary
C. Tertiary
D. Preventive
✅ Answer: B
5. What is the flexible line of defense in Neuman’s model?
A. Permanent immunity
B. Short-term buffer to stress
C. Normal health state
D. Hospital policy guideline
✅ Answer: B
6. Which situation reflects tertiary prevention?
A. A flu vaccine
B. Blood sugar screening
C. Physical therapy post-stroke
D. Teaching CPR in schools
✅ Answer: C
7. The normal line of defense is best described as:
A. Temporary mental defense
B. Patient’s baseline state of wellness
C. Medical orders
D. Emergency plan
✅ Answer: B
8. When does the nurse apply the lines of resistance in Neuman’s model?
A. Before illness
B. When primary prevention fails and illness occurs
C. When patient is stable
D. During vaccination
✅ Answer: B
9. A patient is overwhelmed with family expectations and feels anxious.
What stressor is this?
A. Intrapersonal
B. Interpersonal
C. Extrapersonal
D. Psychospiritual
✅ Answer: B
10. Which concept represents a client-created environment?
A. Blood pressure monitoring
B. Meditation room set up by the client
C. Nurse-written care plan
D. Physician orders
✅ Answer: B
11. What is the primary focus of Neuman’s theory in nursing?
A. Disease cure
B. Patient independence
C. Stressor management and system stability
D. Surgical intervention
✅ Answer: C
12. A nurse counsels a patient after a major loss. Which line of defense is
involved?
A. Normal line
B. Tertiary line
C. Line of resistance
D. Primary barrier
✅ Answer: C
13. In Neuman’s model, a patient with strong coping skills is protected by
the:
A. Line of resistance
B. Normal line of defense
C. Flexible line of defense
D. External barrier
✅ Answer: C
14. A nurse observes high stress levels and refers the patient to
counseling. This is an example of:
A. Primary prevention
B. Secondary prevention
C. Rehabilitation
D. Disease management
✅ Answer: B
15. A patient receiving chemotherapy develops severe fatigue. This is
considered what type of stressor?
A. Intrapersonal
B. Interpersonal
C. Extrapersonal
D. Immunologic
✅ Answer: A
16. Which Neuman system concept is best associated with resilience and
recovery?
A. Prevention
B. Resistance lines
C. Role modeling
D. Self-efficacy
✅ Answer: B
17. A patient has low immunity due to chronic stress. The compromised
flexible line of defense indicates the need for:
A. Medication
B. Immediate tertiary care
C. Reinforced primary prevention
D. Patient isolation
✅ Answer: C
18. What is the main goal of the nurse when using Neuman’s model?
A. Diagnose disease
B. Stabilize the client system by managing stressors
C. Increase medication adherence
D. Promote dependence on care
✅ Answer: B
19. The holistic view in Neuman’s model means the nurse considers:
A. Physical needs only
B. Physician’s orders
C. Physiological, psychological, sociocultural, developmental, and spiritual
factors
D. Vital signs exclusively
✅ Answer: C
20. A nurse promotes smoking cessation to prevent lung disease. What
type of prevention is this?
A. Secondary
B. Tertiary
C. Primary
D. Curative
✅ Answer: C
