Brunner And Suddarth’s Medical Surgical Nursing 12Th Ed by Suzanne C. Smeltzer – Test Bank

Complete Test Bank With Answers

 

 

 

Sample Questions Posted Below

 

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Chapter: Chapter 05: Adult Health and Nutritional Assessment

Multiple Choice

1.  A school nurse is teaching an adolescent girl of normal weight some of the key factors necessary to maintain good nutrition in her teen years. What would the nurse be correct to focus on?

A)  Decreasing her calories and encouraging her to maintain her weight to avoid obesity

B)  Increasing BMI to at least 35, taking a multivitamin, and discussing body image

C)  Increasing milk intake, eating a balanced diet, and discussing eating disorders

D)  Obtaining a food diary along with providing close monitoring for anorexia

Ans:  C

Chapter:  5

Client Needs:  A-2

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Nursing Process

Objective:  9

Page and Header:  68, Nutritional Assessment

Feedback:  Adolescent girls are considered to be at high risk for nutritional disorders. Increasing milk intake provides increased calcium and a balanced diet will provide the necessary vitamins and minerals. If adolescents are diagnosed with eating disorders early, the recovery chances are increased. Option A is incorrect; the question presents no information that indicates a need for decreasing her calories. Option B is incorrect; a person with a BMI of 35 would be obese. Option D is incorrect; a food diary is used for assessing eating habits, but the question asks for teaching factors related to good nutrition.

2.  During a health assessment the patient asks the nurse, “Why do you need all this health information and who is going to see it?” What is the nurse’s best response?

A)  Please do not worry. It is safe and will be used only to help us with your care. It allows access to a wide variety of people who need to know your health information.

B)  It is good you asked and you have a right to know; your information helps us to provide you with the best possible care, and your records are in a secure place.

C)  Your health information is placed on Web sites to provide easy access to anyone wishing to see your medical records, which is a great way to offer other people your information.

D)  Health information becomes the property of the hospital and we will make sure that no one sees it. Then, in 2 years, we destroy all records and the process starts over.

Ans:  B

Chapter:  5

Client Needs:  A-2

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Teaching/Learning

Objective:  1

Page and Header:  56, Considerations for Conducting a Health History and Physical Assessment

Feedback:  Whenever information is elicited from a person through a health history or physical examination, the person has the right to know why the information is sought and how it will be used. For this reason, it is important to explain what the history and physical examination are, how the information will be obtained, and how it will be used. Medical records allow access to health care providers who need the information to provide patients with the best possible care, and the records are always held in a secure environment. Option A is incorrect because telling the patient “not to worry” minimizes the patient’s concern regarding the safety of his health information and “a wide variety of people” should not have access to patients’ health information. Option C is incorrect; health information should not be placed on Web sites. Option D is incorrect; health records are not destroyed every 2 years.

3.  The nurse is performing an admission assessment on a 72-year-old female patient who speaks Spanish and broken English. How might the nurse best collect the data?

A)  Have a family member provide the data

B)  Obtain the data from the old chart and physician’s assessment

C)  Obtain the data only from the patient

D)  Collect the data from the patient and have the family provide any missing details

Ans:  D

Chapter:  5

Client Needs:  A-1

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Communication and Documentation

Objective:  3

Page and Header:  57, Health History

Feedback:  The informant, or the person providing the information, may not always be the patient. The nurse can gain information from the patient and have the family provide any missing details. Options A and B are incorrect because you always obtain as much information as possible directly from the patient; option C is incorrect because you may not be able to get all the information you need only from the patient.

4.  You are the nurse assessing an 18-year-old woman. You note bruising to the patient’s upper arm that appears as fingerprints as well as yellow bruising to the lower eye. The patient makes minimal eye contact during the assessment. How might you best inquire about the bruising?

A)  “Is anyone physically hurting you?”

B)  “Tell me about your relationships.”

C)  “Do you want to see a social worker?”

D)  “Is there something you want to tell me?”

Ans:  A

Chapter:  5

Client Needs:  C

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Communication and Documentation

Objective:  5

Page and Header:  64, Health History

Feedback:  Few patients will discuss the topic of abuse unless they are directly asked. Therefore, it is important to ask direct questions, such as, “Is anyone physically hurting you?” The other options are incorrect because they are not the best way to illicit information about possible abuse.

5.  You are the nurse taking a detailed assessment of a middle-aged male patient. The man states, “The doctor has already asked me all these questions. Why are you repeating them?” What is your best response?

A)  “Taking this history allows us to determine what your needs may be for nursing care.”

B)  “You are right; this may seem redundant.”

C)  “I want to make sure your doctor has covered everything.”

D)  “I am a member of your health care team.”

Ans:  A

Chapter:  5

Client Needs:  D-1

Cognitive Level:  Application

Difficulty:  Difficult

Integrated Process:  Communication and Documentation

Objective:  2

Page and Header:  57, Health History

Feedback:  Regardless of the assessment format used, the focus of nurses during data collection is different from that of physicians and other health team members. Explaining to the patient the purpose of the nursing assessment creates a better understanding of what the nurse does. It also gives the patient an opportunity to add his or her own input into the patient’s care plan. Option B and D do not address the patient’s question. Option C casts doubt on the thoroughness of the physician.

6.  You are taking a health history on a new patient. While performing your assessment, the patient informs you that her mother has type 1 diabetes. What is the significance of this information to the health history?

A)  The patient may be at risk for developing diabetes.

B)  The patient may need teaching on preventing diabetes.

C)  The patient may need to attend a support group for diabetes.

D)  This may affect the patient’s diet during hospitalization.

Ans:  A

Chapter:  5

Client Needs:  D-1

Cognitive Level:  Analysis

Difficulty:  Difficult

Integrated Process:  Communication and Documentation

Objective:  4

Page and Header:  59, Health History

Feedback:  Nurses incorporate a genetics focus into the health assessments of family history to assess for genetics-related risk factors. The information aids the nurse in determining if the patient may be predisposed to diseases that are genetic in origin.

7.  A staff nurse is admitting a patient to her unit. During the nursing assessment, the nurse asks the patient questions related to his spirituality. What is the most important reason to assess a patient’s spiritual environment?

A)  A patient’s spiritual environment can affect his physical activity.

B)  A patient’s spiritual environment can affect his ability to communicate.

C)  A patient’s spiritual environment can affect his quality of sexual relationships.

D)  A patient’s spiritual environment can affect his responses to illness.

Ans:  D

Chapter:  5

Client Needs:  C

Cognitive Level:  Analysis

Difficulty:  Difficult

Integrated Process:  Nursing Process

Objective:  2

Page and Header:  61, Health History

Feedback:  Illness may cause a spiritual crisis and can place considerable stresses on a person’s internal resources. The term spiritual environment refers to the degree to which a person has contemplated his or her own existence. Options A, B, and C may be right, but they are not the most important reason for a nurse to assess a patient’s spiritual environment.

8.  While admitting your new patient, you do a spiritual assessment. At this time the patient indicates that he or she does not eat meat. What would this be considered?

A)  A personal choice

B)  A religious practice

C)  A risk for malnutrition

D)  A lifestyle choice

Ans:  B

Chapter:  5

Client Needs:  A-1

Cognitive Level:  Analysis

Difficulty:  Moderate

Integrated Process:  Nursing Process

Objective:  2

Page and Header:  61, Health History

Feedback:  The nurse has collected the dietary preferences during the spiritual assessment, so the patient holds a religious belief that forbids the intake of meat. A spiritual assessment may involve asking, is religion or God important to you?, or are there any religious practices that are important to you? The other options are incorrect because the dietary practice of the patient, when told to the nurse during the spiritual assessment, is not a personal or lifestyle choice and it is not a risk for malnutrition.

9.  You are performing a shift assessment as you begin caring for one of your patients. What is the most effective assessment technique for the lymph nodes of the neck?

A)  Inspection

B)  Ausculation

C)  Palpation

D)  Percussion

Ans:  C

Chapter:  5

Client Needs:  D-1

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Nursing Process

Objective:  5

Page and Header:  67, Physical Assessment

Feedback:  Palpation is a part of the assessment that allows the nurse to assess a body part through touch. Many structures of the body (superficial blood vessels, lymph nodes, thyroid gland, organs of the abdomen, pelvis, and rectum), although not visible, may be assessed through the techniques of light and deep palpation. The other options are incorrect because lymph nodes are not assessed through inspection, auscultation, or percussion.

10.  You are the clinic nurse assessing a new patient that has come in to see a physician. The assessment data that you collect reveals that the patient is a 23-year-old female weighing 175 pounds with a height of 5 feet 3 inches. Her body mass index is 31. What would she be considered?

A)  Average weight

B)  Obese

C)  Overweight

D)  Underweight

Ans:  B

Chapter:  5

Client Needs:  D-4

Cognitive Level:  Analysis

Difficulty:  Moderate

Integrated Process:  Nursing Process

Objective:  7

Page and Header:  68, Nutritional Assessment

Feedback:  A body mass index of 31 is considered clinically obese. People who have a BMI lower than 24 (or who are 80% or less of their desirable body weight for height) are at increased risk for problems associated with poor nutritional status. Those who have a BMI of 25 to 29 are considered overweight; those with a BMI of 30 to 39, obese; and those with a BMI greater than 40, extremely obese.

11.  You are completing a health assessment on a new patient. You note that the patient has dry, dull, brittle hair and dry, flaky skin with poor turgor. What might this indicate?

A)  Excessive physical activity

B)  Poor personal hygiene

C)  Poor nutritional status

D)  Damage from an environmental cause

Ans:  C

Chapter:  5

Client Needs:  D-1

Cognitive Level:  Analysis

Difficulty:  Moderate

Integrated Process:  Nursing Process

Objective:  7

Page and Header:  73, Nutritional Assessment

Feedback:  Signs of poor nutrition include dry, dull, brittle hair and dry, flaky skin with poor turgor. These findings do not indicate excessive physical activity, poor personal hygiene, or damage from an environmental cause; therefore, these options are incorrect.

12.  A home care nurse is teaching a patient’s daughter meal planning for her mother who is recovering from a hip replacement surgery. Which of the following meals indicates that the daughter understands the concept of a nutritionally complete choice based upon the Food Guide Pyramid?

A)  Cheeseburger, carrot sticks and mushroom soup with crackers

B)  Spaghetti and meat sauce with a salad

C)  Chicken and pepper stir fry and basmati rice

D)  Ham sandwich with tomato on rye bread with peaches and yogurt

Ans:  D

Chapter:  5

Client Needs:  B

Cognitive Level:  Analysis

Difficulty:  Moderate

Integrated Process:  Teaching/Learning

Objective:  9

Page and Header:  71, Nutritional Assessment

Feedback:  The menu has a choice from each of the food groups from the Food Guide Pyramid. The other selections are incomplete choices.

13.  You are assessing a new clinic patient who has come in because of an unintended weight loss of 10 pounds. During the assessment, you learn that the patient has ill-fitting dentures and a limited intake of high-fiber foods. You would be aware that the patient is at risk for what problem?

A)  Constipation

B)  Dehydration

C)  Malabsorption of nutrients

D)  Inadequate caloric intake

Ans:  A

Chapter:  5

Client Needs:  D-3

Cognitive Level:  Analysis

Difficulty:  Moderate

Integrated Process:  Nursing Process

Objective:  8

Page and Header:  73, Nutritional Assessment

Feedback:  Patients with ill-fitting dentures are at a potential risk for an inadequate intake of high-fiber foods. The elderly are already at an increased risk for constipation because of other developmental factors and the potential for a decreased activity level. Ill-fitting dentures do not put a patient at risk for dehydration, malabsorption of nutrients, or an inadequate caloric intake.

14.  You are teaching a nutrition education class held for a group of older adults at a senior center. You would be sure to teach the group that older adults have an increased need for nutrients and what?

A)  A decreased need for calcium

B)  An increased need for glucose

C)  An increased need for sodium

D)  A decreased need for calories

Ans:  D

Chapter:  5

Client Needs:  B

Cognitive Level:  Analysis

Difficulty:  Moderate

Integrated Process:  Teaching/Learning

Objective:  9

Page and Header:  68, Nutritional Assessment

Feedback:  The older adult has a decreased metabolism, and absorption of nutrients has decreased. The older adult has an increased need for nutrition and a decreased need for calories. The other options are incorrect because there is no decreased need for calcium and no increased need for either glucose or sodium.

15.  You are the nurse obtaining a health history from a patient who has come to the local health clinic and is having abdominal pain. You know the best question to elicit the probable reason for the visit and identify the chief complaint is what?

A)  “Why do you think your abdomen is painful?”

B)  “Where is your abdominal pain and when did it start?”

C)  “What brings you to the clinic today?”

D)  “What is the problem today?”

Ans:  C

Chapter:  5

Client Needs:  A-1

Cognitive Level:  Application

Difficulty:  Difficult

Integrated Process:  Nursing Process

Objective:  2

Page and Header:  57, Health History

Feedback:  The chief complaint should clearly address what has brought the patient to see the health care provider; an open-ended question best serves this purpose. The question what brings you to the clinic? allows the client sufficient latitude to provide an answer that expresses the priority issue. Options A and B are incorrect; both of those questions would be too specific to serve as the first question regarding the chief complaint but would be good follow-up questions. Option D is incorrect; what is the problem today? is an open-ended question but still directs the patient toward the fact that there is a problem.

16.  You are the nurse caring for a patient who is Native American who arrives at the clinic for treatment related to type II diabetes. Which question would best provide you with information about the role food plays in the patient’s cultural practice and identify how the patient’s food preferences could be related to the patient’s problem?

A)  “Do you feel any of your cultural practices have a negative impact on your disease process?”

B)  “What types of foods are served as a part of your cultural practices, and how they are prepared?”

C)  “As a nonnative, I am unaware of your cultural practices. Could you teach me a few practices that may affect your care?”

D)  “Tell me about foods that are important to your cultural practices and how you feel they relate to your diabetes.”

Ans:  D

Chapter:  5

Client Needs:  A-1

Cognitive Level:  Application

Difficulty:  Difficult

Integrated Process:  Nursing Process

Objective:  3

Page and Header:  61, Health History

Feedback:  The beliefs and practices that have been shared from generation to generation are known as cultural or ethnic patterns. They are expressed through language, dress, dietary choices, and role behaviors; in perceptions of health and illness; and in health-related behaviors. Food plays a significant role in both cultural practices and type II diabetes. By asking the question, tell me about the foods that are important to your cultural practices and how you feel they relate to your diabetes, the nurse demonstrates a cultural awareness to the client and allows an open-ended discussion of the disease process and its relationship to cultural practice. Option A is incorrect; it assuming that the patient knows diabetes is dangerous, and the answer is stated in a threatening and negative way. Option B is incorrect; it only assesses the types and preparation of foods specific to cultural practices without relating it to diabetes. Option C is a good answer but focuses on “care” and fails to address the significance of food in cultural practice or diabetes.

17.  An 89-year-old male patient is wheelchair bound. He has been living in a nursing home since leaving the hospital. He returns to the local primary care clinic by wheelchair for follow-up hypertension treatment. The nurse would modify his health history to include which question?

A)  “Tell me about your medications: how they are administered and do you take them on a regular basis?”

B)  “Tell me about where you live: do you feel your needs are being met, and do you feel safe?”

C)  “Your wheelchair would seem to limit your ability to move around. How do you deal with that?”

D)  “What limitations are you dealing with related to your hypertension and being in a wheelchair?”

Ans:  B

Chapter:  5

Client Needs:  A-2

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Nursing Process

Objective:  5

Page and Header:  73, Assessment in the Home and Community

Feedback:  The question, tell me about where you live: do you feel your needs are being met and do you feel safe? seeks to explore the specific issue of the safety in the home environment. People who are older, have a disability, and live in the community setting are at a greater risk for abuse. Options A, C, and D would not require modification of the health history.

18.  A 30-year-old man is in the clinic for a yearly physical. He states “all my uncles had heart attacks when they were young.” This alerts the nurse to complete a genetic-specific assessment. The nurse is aware that it is important to include what as a part of a genetic-specific assessment?

A)  A complete health history including genogram along with any history of cholesterol testing or screening and a complete physical exam

B)  A limited health history along with a complete physical assessment with an emphasis on genetic abnormalities

C)  A limited health history and focused physical exam followed by safety-related education

D)  A family history focused on the paternal family with focused physical exam and genetic profile

Ans:  A

Chapter:  5

Client Needs:  B

Cognitive Level:  Application

Difficulty:  Difficult

Integrated Process:  Nursing Process

Objective:  4

Page and Header:  59, Health History

Feedback:  A genetic-specific exam in this case would include a complete health history, genogram, a history of cholesterol testing or screening, and a complete physical exam. Options B and D are incorrect; they do not provide enough information to complete a genogram or provide a holistic view of the patient. Option C is incorrect; it offers a focused exam when a complete physical exam is more appropriate, and safety-related education is unwarranted in this case.

19.  Your patient has a newly diagnosed heart murmur. He asks you if he can listen to it. What would be your best response?

A)  Listening is called auscultation, is done with the diaphragm, and requires a trained ear to hear a murmur.

B)  Listening is called palpation, and I would be glad to help you to palpate your murmur.

C)  Heart murmurs are pathologic and may require surgery. If you would like to listen to your murmur, I can provide you with instruction.

D)  Listening is called auscultation and should be done with both the bell and diaphragm. If you would like to listen to your murmur, I would be glad to help you.

Ans:  D

Chapter:  5

Client Needs:  A-1

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Teaching/Learning

Objective:  5

Page and Header:  67, Physical Assessment

Feedback:  Listening with a stethoscope is auscultation and is done with both the bell and diaphragm. The diaphragm is used to assess high-frequency sounds such as systolic heart murmurs while the bell is used to assess low frequency sounds such as diastolic heart murmurs. It is also important to provide education whenever possible and actively include the patient in the plan of care. Option A is incorrect; teaching an interested patient how to listen to a murmur should be encouraged. Option B is incorrect; listening is not called palpation. Option C is incorrect; most heart murmurs are benign and do not require surgery.

20.  You are performing sports physicals on healthy adolescent girls. When it comes time to listen to the heart and lungs, you decide to what?

A)  Perform auscultation with the stethoscope placed firmly over her clothing to protect her privacy

B)  Perform auscultation by holding the diaphragm lightly on her clothing to eliminate the “scratchy noise”

C)  Perform auscultation with the diaphragm placed firmly on her skin to minimize extra noise

D)  Defer the exam because she is healthy and it may agitate the girl

Ans:  C

Chapter:  5

Client Needs:  A-1

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Nursing Process

Objective:  6

Page and Header:  67, Physical Assessment

Feedback:  Auscultation should always be performed with the diaphragm placed firmly on the skin to minimize extra noise and with the bell lightly placed on the skin to reduce distortion caused by vibration. Options A and B are incorrect; placing a stethoscope over clothing limits the conduction of sound. Option D is incorrect; performing auscultation is an important part of a sports physical and should never be deferred.

21.  The nurse in a bariatric clinic is providing education to a patient who wishes to lose weight. The nurse informs the patient that she has a body mass index of 45. What does this indicate?

A)  The patient is a normal weight.

B)  The patient is extremely obese.

C)  The patient is overweight.

D)  The patient is mildly obese.

Ans:  B

Chapter:  5

Client Needs:  B

Cognitive Level:  Application

Difficulty:  Easy

Integrated Process:  Teaching/Learning

Objective:  7

Page and Header:  68, Nutritional Assessment

Feedback:  Body mass index is a ratio based on body weight and height. A BMI of 25 to 29 is considered overweight, a BMI of 30 to 39 is obese, and a BMI greater than 40 is extremely obese. Options A, C, and D are incorrect; they are not in the appropriate range on the BMI scale.

22.  A nurse is conducting a home visit as part of the community health assessment of the patient. The nurse will focus special attention on

A)  availability of home health care, current Medicare rules, and family support.

B)  the community and home environment, support systems or family care, and the availability of needed resources.

C)  the future health status of the individual, and community and hospital resources.

D)  special assessment is not required; the community and acute-care health assessments are very similar and have few distinctions.

Ans:  B

Chapter:  5

Client Needs:  A-1

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Nursing Process

Objective:  9

Page and Header:  73, Assessment in the Home and Community

Feedback:  The community or home environment, support systems or family care, and the availability of needed resources are the key factors that distinguish community assessment from assessments in the acute-care setting. Options A and C are incorrect; they fail to address either the community or home environment. Option D is incorrect; community and acute-care health assessments are fundamentally different.

23.  You are taking a new patient’s health history when the patient asks who will have access to their information. What would be your best response?

A)  “Your information is maintained in a secure place and only those health care professionals directly involved in your care can see it.”

B)  “Your information is available to anyone who works here in the clinic.”

C)  “Your information is kept in computer files and anyone who gets permission from you can see it.”

D)  “Your information is available to anyone who cares for you, plus your insurance company.”

Ans:  A

Chapter:  5

Client Needs:  A-2

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Teaching/Learning

Objective:  1

Page and Header:  56, Considerations for Conducting a Health History and Physical Assessment

Feedback:  This written record of the patient’s history and physical examination findings is then maintained in a secure place and made available only to those health professionals directly involved in the care of the patient. Options B, C, and D are incorrect because only those caring for the patient have access to the health record. Insurance companies have the right to know the patient’s coded diagnosess so that bills may be paid.

24.  You are admitting an elderly woman to your unit. Her husband is with her. The husband wants to know where the information you are obtaining is going to be kept. You explain to the husband that while his wife is in the hospital all of her information will be kept on the computer. The husband states, “I sure am not comfortable with that. It is too easy for someone to break into computer records these days.” What is your best response?

A)  “The Institute of Medicine has called for the implementation of the computerized health record so all hospitals are doing it.”

B)  “Don’t worry, our records are very safe.”

C)  “This hospital is as concerned as you are about keeping our patients’ records private. So we take special precautions and we have set up special safeguards so no one can break into our patients’ medical records.”

D)  “We have only had one time a patient’s records were broken into in the past 5 years so we have a pretty good record.”

Ans:  C

Chapter:  5

Client Needs:  A-1

Cognitive Level:  Analysis

Difficulty:  Moderate

Integrated Process:  Nursing Process

Objective:  1

Page and Header:  56, Considerations for Conducting a Health History and Physical Assessment

Feedback:  Nurses must be sensitive to the needs of the older adults and others who may not be comfortable with computer technology. Options A, B, and C may be the truth, but they are not the correct answers as they are not the best way to alleviate the husband’s concern about his wife’s medical records.

25.  A family that is Amish is admitting their grandfather to your unit. They voice concerns about the fact that you are recording the admission data on a laptop computer. What would be your best response to their concerns?

A)  “We use computers to record and store our patient information because research has shown that this helps to improve the quality of our patients’ care and reduce their health care costs.”

B)  “We have found that it is easier to keep track or our patients’ information this way.”

C)  “All the hospitals are doing this now.”

D)  “The government is telling us we have to do this.”

Ans:  A

Chapter:  5

Client Needs:  A-1

Cognitive Level:  Analysis

Difficulty:  Moderate

Integrated Process:  Teaching/Learning

Objective:  1

Page and Header:  56, Considerations for Conducting a Health History and Physical Assessment

Feedback:  Electronic health records are thought to improve the quality of care, reduce medical errors, and help reduce health care costs; therefore, their implementation is moving forward on a global scale. Options B, C, and D are correct but are not the best answer for this family.

26.  You are doing a dietary assessment with your new patient. The patient asks you why the hospital wants to know all this information about the way he eats. He specifically asks you, are you asking all these questions because I am Middle Eastern? What would be the most correct response you could give this patient?

A)  “We always try to abide by our patients’ dietary preferences.”

B)  “We know that culture and religious practices often determine dietary prohibitions, and we do not want to offend any of our patients.”

C)  “We wouldn’t want to feed you anything you only eat on certain holidays.”

D)  “We know that in some cultures certain foods are only eaten at specific family gatherings.”

Ans:  B

Chapter:  5

Client Needs:  A-1

Cognitive Level:  Analysis

Difficulty:  Difficult

Integrated Process:  Caring

Objective:  3

Page and Header:  71, Nutritional Assessment

Feedback:  Culture and religious practices together often determine whether certain foods are prohibited and whether certain foods and spices are eaten on certain holidays or at specific family gatherings. Options A, C, and D are correct answers, but they are not the best answer for this patient.

27.  You are orienting a new nurse to your unit. The new nurse has been assisting an elderly woman who is Greek to fill out her menu for the next day. Where would be a good place for you to send this new nurse to obtain appropriate dietary recommendations for this patient?

A)  The food pyramid

B)  Nursing resource books

C)  Culturally sensitive materials such as the Mediterranean Pyramid

D)  The food pagoda

Ans:  C

Chapter:  5

Client Needs:  A-1

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Teaching/Learning

Objective:  3

Page and Header:  71, Nutritional Assessment

Feedback:  Culturally sensitive materials, such as the food pagoda and the Mediterranean Pyramid, are available for making appropriate dietary recommendations. Option A is incorrect because the regular food pyramid is not culturally sensitive; option B is incorrect because nursing resource books do not usually have culturally sensitive dietary specific material; option D is incorrect because the food pagoda would not pertain to someone of Greek ancestry.

28.  When performing an admission assessment, the nurse knows to ask about both first- and second-order relatives. Why does the nurse do this?

A)  To see how many living relatives the patient has

B)  To identify the cause of death of any aunts or uncles

C)  To identify the ages of great-grandparents

D)  To identify diseases that may be genetic

Ans:  D

Chapter:  5

Client Needs:  A-1

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Nursing Process

Objective:  4

Page and Header:  59, Health History

Feedback:  To identify diseases that may be genetic, communicable, or possibly environmental in origin, the interviewer asks about the age and health status, or the age and cause of death, of first-order relatives (parents, siblings, spouse, children) and second-order relatives (grandparents, cousins). Options A, B, and C are incorrect because it is not necessary to count how many living relatives the patient has and information on aunts, uncles, and great-grandparents is not included in the assessment being performed.

Multiple Selection

29.  The nurse is completing a family history for a newly admitted patient. Questions about what conditions would be included in this assessment? (Mark all that apply.)

A)  Allergies

B)  Alcoholism

C)  Psoriasis

D)  Hypervitaminosis

E)  Obesity

Ans:  A, B, E

Chapter:  5

Client Needs:  D-3

Cognitive Level:  Analysis

Difficulty:  Moderate

Integrated Process:  Nursing Process

Objective:  4

Page and Header:  59, Health History

Feedback:  In general the following conditions are included in a family history: cancer, hypertension, heart disease, diabetes, epilepsy, mental illness, tuberculosis, kidney disease, arthritis, allergies, asthma, alcoholism, and obesity. Options C and D are incorrect because they are not genetic or familial in origin.

Multiple Choice

30.  The admitting nurse has just met a new patient. As the nurse introduces himself, he begins the process of inspection on this patient. What does the admitting nurse know it is important to do while observing during the process of inspection?

A)  Gather as much general information as possible

B)  Pay attention to the details while observing

C)  Write down as many details as possible during the observation

D)  Not to let the patient know he is being observed

Ans:  B

Chapter:  5

Client Needs:  C

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Nursing Process

Objective:  6

Page and Header:  65, Physical Assessment

Feedback:  It is essential to pay attention to the details in observation. Vague, general statements are not a substitute for specific descriptions based on careful observation. Option A is incorrect because it is specific information, not general information, that is being gathered; option C is incorrect because writing while observing can be a conflict for the nurse; option D is incorrect because it is not important to keep the patient from knowing he is being observed.

31.  Palpation is a necessary skill in nursing. Many of the body’s structures, even though they are not visible, can be assessed through palpation. Which structures would be included in assessment by palpation?

A)  Intestines

B)  Muscles

C)  Thyroid gland

D)  Pancreas

Ans:  C

Chapter:  5

Client Needs:  D-4

Cognitive Level:  Knowledge

Difficulty:  Easy

Integrated Process:  Nursing Process

Objective:  6

Page and Header:  67, Physical Assessment

Feedback:  Many structures of the body, although not visible, may be assessed through the techniques of light and deep palpation. Examples include the superficial blood vessels, lymph nodes, thyroid gland, organs of the abdomen and pelvis, and rectum. The intestines, muscles, and pancreas cannot be assessed through palpation.

32.  What is the principle of percussion?

A)  To assess the sound created by the body

B)  To strike the abdominal wall with a soft object

C)  To create sound over dead spaces in the body

D)  To create vibration in a body wall

Ans:  D

Chapter:  5

Client Needs:  D-4

Cognitive Level:  Comprehension

Difficulty:  Easy

Integrated Process:  Nursing Process

Objective:  6

Page and Header:  67, Physical Assessment

Feedback:  The principle of percussion is to set the chest wall or abdominal wall into vibration by striking it with a firm object. Options A, B, and C are incorrect because they are not considered the principle of percussion.

33.  What can be assessed using percussion?

A)  Borders of the heart

B)  Movement of the diaphragm during expiration

C)  Borders of the liver

D)  Rectal distension

Ans:  A

Chapter:  5

Client Needs:  D-4

Cognitive Level:  Comprehension

Difficulty:  Easy

Integrated Process:  Nursing Process

Objective:  6

Page and Header:  67, Physical Assessment

Feedback:  Percussion allows the examiner to assess such normal anatomic details as the borders of the heart and the movement of the diaphragm during inspiration. Options B, C, and D are incorrect because they cannot be assessed by percussion.

34.  Where would a biochemical assessment of transferring be made?

A)  Urine

B)  Serum

C)  Sputum

D)  Joint fluid

Ans:  B

Chapter:  5

Client Needs:  D-4

Cognitive Level:  Knowledge

Difficulty:  Easy

Integrated Process:  Teaching/Learning

Objective:  7

Page and Header:  69, Nutritional Assessment

Feedback:  These determinations are made from studies of serum (albumin, transferrin, retinol-binding protein, electrolytes, hemoglobin, vitamin A, carotene, vitamin C, and total lymphocyte count) and studies of urine (creatinine, thiamine, riboflavin, niacin, and iodine). Options A, C, and D are incorrect because transferring is found in serum.

35.  What makes biochemical assessment such an important aspect of a person’s nutritional status?

A)  It identifies abnormalities in the utilization of nutrients.

B)  It predicts abnormal utilization of nutrients.

C)  It reflects the tissue level of a given nutrient.

D)  It predicts metabolic abnormalities in nutritional intake.

Ans:  C

Chapter:  5

Client Needs:  D-4

Cognitive Level:  Comprehension

Difficulty:  Moderate

Integrated Process:  Nursing Process

Objective:  7

Page and Header:  69, Nutritional Assessment

Feedback:  Biochemical assessment reflects both the tissue level of a given nutrient and any abnormality of metabolism in the utilization of nutrients. Option A is incorrect because biochemical assessment identifies abnormalities of metabolism when utilizing nutrients; options B and D are incorrect because biochemical assessment is not predictive.

36.  What is a major factor in the nutritional risk of adolescent girls?

A)  Protein intake in this age group falls below recommended levels.

B)  They are more physically active then at other ages.

C)  Calcium intake is above the recommended levels.

D)  Folate intake is below the recommended levels in this age group.

Ans:  D

Chapter:  5

Client Needs:  D-3

Cognitive Level:  Knowledge

Difficulty:  Easy

Integrated Process:  Nursing Process

Objective:  8

Page and Header:  68, Nutritional Assessment

Feedback:  Adolescent girls are at particular nutritional risk, because iron, folate, and calcium intakes are below recommended levels, and they are a less physically active group compared to adolescent males. Therefore, options A, B, and C are incorrect.

37.  The teen years are not only a time of critical growth. This makes nutritional assessment and intervention so important. What else occurs during the teen years?

A)  Lifelong eating habits are acquired.

B)  Peer pressure influences growth and development.

C)  Obesity develops.

D)  Cultural influences become very important.

Ans:  A

Chapter:  5

Client Needs:  D-3

Cognitive Level:  Comprehension

Difficulty:  Easy

Integrated Process:  Nursing Process

Objective:  8

Page and Header:  68, Nutritional Assessment

Feedback:  Adolescence is a time of critical growth and acquisition of lifelong eating habits, and, therefore, nutritional assessment, analysis, and intervention are critical. Peer pressure does not influence growth and development. Obesity can develop at any age. Cultural influences tend to become less important during the teen years.

Multiple Selection

38.  What assessment parameters are included when assessing a patients’ nutritional status? (Mark all that apply.)

A)  Ethnic mores

B)  Body mass index

C)  Clinical examination findings

D)  Wrist circumference

E)  Dietary data

Ans:  B, C, E

Chapter:  5

Client Needs:  D-3

Cognitive Level:  Knowledge

Difficulty:  Easy

Integrated Process:  Nursing Process

Objective:  8

Page and Header:  68, Nutritional Assessment

Feedback:  The sequence of assessment of parameters may vary, but evaluation of nutritional status includes one or more of the following methods: measurement of body mass index and waist circumference, biochemical measurements, clinical examination findings, and dietary data. Ethnic mores and wrist circumference are not assessment parameters for nutritional status.

Multiple Choice

39.  The segment of the population who has a BMI lower than 24 have been found to be at increased risk for poor nutritional status and its resultant problems. What else is a low BMI associated with in the community-dwelling elderly?

A)  High risk of diabetes

B)  Poor outcomes in wound healing

C)  Higher mortality rate

D)  Low risk of chronic disease

Ans:  C

Chapter:  5

Client Needs:  D-3

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Nursing Process

Objective:  8

Page and Header:  68, Nutritional Assessment

Feedback:  People who have a BMI lower than 24 (or who are 80% or less of their desirable body weight for height) are at increased risk for problems associated with poor nutritional status. In addition, a low BMI is associated with a higher mortality rate among hospitalized patients and community-dwelling elderly.

40.  Malnutrition can be too much or too little nutrition. What can malnutrition do in the human body?

A)  Decrease risk of disease complications

B)  Decrease wound healing time

C)  Contribute to shorter hospital stays

D)  Prolong confinement to bed

Ans:  D

Chapter:  5

Client Needs:  D-3

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Nursing Process

Objective:  9

Page and Header:  72, Nutritional Assessment

Feedback:  Malnutrition interferes with wound healing, increases susceptibility to infection, and contributes to an increased incidence of complications, longer hospital stays, and prolonged confinement of patients to bed. Therefore options A, B, and C are incorrect.

41.  How does a physical assessment in the community vary in technique from the physical assessment in the hospital?

A)  A physical assessment in the community consists of the same techniques used in the hospital.

B)  A physical assessment made in the community does not require the privacy that a physical assessment made in the hospital setting requires.

C)  A physical assessment made in the community requires that the patient be made more comfortable than would be necessary in the hospital setting.

D)  A physical assessment made in the community varies in technique from that conducted in the hospital setting by being less structured.

Ans:  A

Chapter:  5

Client Needs:  D-3

Cognitive Level:  Comprehension

Difficulty:  Easy

Integrated Process:  Nursing Process

Objective:  9

Page and Header:  73, Assessment in the Home and Community

Feedback:  The physical assessment in the community and home consists of the same techniques used in the hospital, outpatient clinic, or office setting. Privacy is provided, and the person is made as comfortable as possible. This makes options B, C, and D incorrect.

42.  You are conducting an assessment of a patient in her home setting. Your patient is a 91-year-old female who lives alone and has no family members living close by. What would you need to be aware of to aid in providing care to this patient?

A)  Where the closest relative lives

B)  How to obtain Meals-on-Wheels for this patient

C)  What the patient’s financial status is

D)  How many children this patient has

Ans:  B

Chapter:  5

Client Needs:  D-3

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Caring

Objective:  9

Page and Header:  73, Assessment in the Home and Community

Feedback:  The patient may not have family members available to assist her and may live alone in substandard housing or in a shelter for the homeless. Therefore, the nurse must be aware of resources available in the community and methods of obtaining those resources for the patient. Options A, C, and D would be nice to know, but are not pre-requisite to aid in providing care to this patient.