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Chapter 4 Adult Health and Physical, Nutritional, and Cultural Assessment. $5.49   Add to cart
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Chapter 4 Adult Health and Physical, Nutritional, and Cultural Assessment.

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  • Course
  • Nursing
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  • Chamberlain College Of Nursng

Chapter 4 Adult Health and Physical, Nutritional, and Cultural Assessment. 1. A school nurse is teaching a 14-year-old girl of normal weight some of the key factors necessary to maintain good nutrition in this stage of her growth and development. What interventions should the nurse most likely pri...

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  • March 5, 2022
  • 35
  • 2021/2022
  • Exam (elaborations)
  • Questions & answers

Subjects

  • nutritional
  • chapter 4 adult health and physical
  • and cultural assessment

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  • Chamberlain College Of Nursng
  • Nursing
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1. A school nurse is teaching a 14-year-old girl of normal weight some of the key factors
necessary to maintain good nutrition in this stage of her growth and development. What
interventions should the nurse most likely prioritize?
A) Decreasing her calorie intake and encouraging her to maintain her weight to
avoid obesity
B) Increasing her BMI, taking a multivitamin, and discussing body image
C) Increasing calcium intake, eating a balanced diet, and discussing eating disorders
D) Obtaining a food diary along with providing close monitoring for anorexia
Ans: C
Feedback:
Adolescent girls are considered to be at high risk for nutritional disorders. Increasing calcium
intake and promoting a balanced diet will provide the necessary vitamins and minerals. If
adolescents are diagnosed with eating disorders early, the recovery chances are increased.
The question presents no information that indicates a need for decreasing her calories. There
is no apparent need for an increase in BMI. A food diary is used for assessing eating habits, but
the question asks for teaching factors related to good nutrition.


2. A nurse is conducting a health assessment of an adult patient when the patient asks, ìWhy do
you need all this health information and who is going to see it?î 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's accessible
to a wide variety of people who are invested in your health.
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 secure Web sites to provide easy access to anyone
wishing to see your medical records. This ensures continuity of care.
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
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. Telling the patient ìnot to worryî minimizes the patient's concern regarding the
safety of his or her health information and ìa wide variety of peopleî
should not have access to patients' health information. Health information should not be
placed on Web sites and health records are not destroyed every 2 years.

, 3. The nurse is performing an admission assessment of a 72-year-old female patient who
understands minimal English. An interpreter who speaks the patient's language is unavailable
and no members of the care team speak the language. How should the nurse best perform
data collection?
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, prioritizing aspects that the patient understands.
D) Collect all possible data from the patient and have the family supplement missing details.
Ans: D
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.
The nurse should always obtain as much information as possible directly from the patient. In
this case, it is not likely possible to get all the information needed only from the patient.


4. You are the nurse assessing a 28-year-old woman who has presented to the emergency
department with vague complaints of malaise. You note bruising to the patient's upper arm
that correspond to the outline of fingers as well as yellow bruising around her left eye. The
patient makes minimal eye contact during the assessment. How might you best inquire about
the bruising?
A) ìIs anyone physically hurting you?î
B) ìTell me about your relationships.î
C) ìDo you want to see a social worker?î
D) ìIs there something you want to tell me?î
Ans: A
Feedback:
Few patients will discuss the topic of abuse unless they are directly asked. Therefore, it is
important to ask direct questions, such as, ìIs anyone physically hurting you?î The other

, options are incorrect because they are not the best way to illicit information about possible
abuse in a direct and appropriate manner.


5. You are the nurse performing a health assessment of an adult male patient. The man
states, ìThe doctor has already asked me all these questions. Why are you asking them all over
again?î What is your best response?
A) ìThis history helps us determine what your needs may be for nursing care.î
B) ìYou are right; this may seem redundant and I'm sure that it's frustrating for you.î
C) ìI want to make sure your doctor has covered everything that's important for your
treatment.î
D) ìI am a member of your health care team and we want to make sure that nothing
falls through the cracks.î
Ans: A
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. The nurse should address the patient's concerns directly and avoid casting doubt on the
thoroughness of the physician.


6. You are taking a health history on an adult patient who is new to the clinic. While performing
your assessment, the patient informs you that her mother has type 1 diabetes. What is the
primary 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 the effects of diabetes.
C) The patient may need to attend a support group for individuals with diabetes. D) The
patient may benefit from a dietary regimen that tracks glucose intake. Ans: A

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