chapter 12 - Jarvis 3rd edition- test bank - for final exam PDF

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Physical Examination and Health Assessment CANADIAN 3rd Edition Jarvis Test Bank

Chapter 12: Nutritional Assessment Jarvis: Physical Examination & Health Assessment, 3rd Canadian edition MULTIPLE CHOICE 1. The nurse is working with some of the city’s homeless population. When assessing the

2-day-old surgical wound of one of the patients, the nurse is most concerned about: Undernutrition leading to delayed wound healing. Excess weight gain from overconsumption of nutrients. Adequate nutritional intake for athletic performance. Lowered resistance to infection resulting from overnutrition.

a. b. c. d.

ANS: A

Vulnerable groups for undernutrition are infants, children, pregnant women, recent immigrants, persons with low incomes, hospitalized people, and aging adults. Undernutrition increases the risk for impaired growth and development, lowered resistance to infection and disease, delayed wound healing, longer hospital stays, and higher health-related expenses. DIF: Cognitive Level: Understanding (Comprehension) MSC: Client Needs: Health Promotion and Maintenance: Reduction of Risk Potential 2. When providing patient education on nutrition the nurse explains optimal nutritional status as: a. Consuming food in excess of daily body requirements. b. Consuming energy-dense foods to meet the minimum body needs. c. Food intake to meet daily body requirements but not to support increased

metabolic demands. d. Consuming nutrients to meet daily body requirements and support increased

metabolic demands. ANS: D

Optimal nutritional status is achieved when sufficient nutrients are consumed to support day-to-day body needs and any increased metabolic demands resulting from growth, pregnancy, or illness. DIF: Cognitive Level: Remembering (Knowledge) MSC: Client Needs: Health Promotion and Maintenance 3. The nurse is providing nutrition information to the mother of a 1-year-old child. Which of

these statements represents accurate information for this age group? a. Maintaining adequate fat and caloric intake is important for a child in this age group. b. The recommended dietary allowances for an infant are the same as for an adolescent. c. The baby’s growth is minimal at this age; therefore, caloric requirements are decreased. d. The baby should be placed on skim milk to decrease the risk for coronary artery disease at a later age. ANS: A

Physical Examination and Health Assessment CANADIAN 3rd Edition Jarvis Test Bank Because of rapid growth, especially of the brain, both infants and children younger than 2 years of age should not drink skim or low-fat milk or be placed on low-fat diets. Fats (calories and essential fatty acids) are required for proper growth and central nervous system development. DIF: Cognitive Level: Applying (Application) MSC: Client Needs: Health Promotion and Maintenance 4. A pregnant woman is interested in breastfeeding her baby and asks several questions about it.

Which information is appropriate for the nurse to share with her? a. Breastfeeding is best when also supplemented with bottle feedings. b. Babies who are breastfed often require supplemental vitamins. c. Breastfeeding is recommended for infants for the first 2 years of life. d. Breast milk provides the nutrients necessary for growth and natural immunity. ANS: D

Breastfeeding is recommended for full-term infants for the first year of life because breast milk is ideally formulated to promote normal infant growth and development and natural immunity. The other statements are not correct. DIF: Cognitive Level: Applying (Application) MSC: Client Needs: Health Promotion and Maintenance 5. A mother and her 13-year-old daughter express concern related to the daughter’s recent

weight gain and her increase in appetite. Which of these statements represents information the nurse should discuss with them? a. Dieting and exercising are necessary at this age. b. Snacks should be high in protein, iron, and calcium. c. Teenagers who have a weight problem should not be allowed to snack. d. A low-calorie diet is important to prevent the accumulation of fat. ANS: B

After a period of slow growth in late childhood, adolescence is characterized by rapid physical growth and endocrine and hormonal changes. Caloric and protein requirements increase to meet this demand. Because of bone growth and increasing muscle mass (and, in girls, the onset of menarche), calcium and iron requirements also increase. DIF: Cognitive Level: Applying (Application) MSC: Client Needs: Health Promotion and Maintenance 6. The nurse is assessing a 30-year-old immigrant from Nigeria who has been in Canada for 1

month and is unemployed. Which of these potential problems might the nurse expect to find as related to nutritional status? a. Obesity b. Hypotension c. Osteomalacia (softening of the bones) d. Coronary artery disease ANS: C

General undernutrition, hypertension, diarrhea, lactose intolerance, osteomalacia, scurvy, and dental caries are among the more common nutrition-related problems of new immigrants from developing countries.

Physical Examination and Health Assessment CANADIAN 3rd Edition Jarvis Test Bank

DIF: Cognitive Level: Applying (Application) MSC: Client Needs: Health Promotion and Maintenance 7. The nurse is meeting a patient who has no history of nutrition-related problems for the first

clinic visit. The initial nutritional screening should include which activity? Calorie count of nutrients Anthropometric measures Complete physical examination Measurement of weight and weight history

a. b. c. d.

ANS: D

The parameters used for nutrition screening typically include weight and weight history, conditions associated with increased nutritional risk, diet information, and routine laboratory data. The other responses reflect a more in-depth assessment, rather than screening. DIF: Cognitive Level: Applying (Application) MSC: Client Needs: Health Promotion and Maintenance 8. A patient is asked to indicate on a form how many times he eats a specific food. Which

method is the nurse using to assess nutritional intake? a. Food diary b. Calorie count c. 24-hour recall d. Food-frequency questionnaire ANS: D

With this tool, information is collected on how many times per day, week, or month the individual eats particular foods, which provides an estimate of usual intake. DIF: Cognitive Level: Remembering (Knowledge) MSC: Client Needs: Health Promotion and Maintenance 9. The nurse is providing care for a 68-year-old woman who is complaining of constipation.

What concern exists regarding her nutritional status? a. Absorption of nutrients may be impaired. b. Constipation may represent a food allergy. c. The patient may need emergency surgery to correct the problem. d. Gastrointestinal problems will increase her caloric demand. ANS: A

Gastrointestinal symptoms, such as vomiting, diarrhea, or constipation, may interfere with nutrient intake or absorption. The other responses are not correct. DIF: Cognitive Level: Applying (Application) MSC: Client Needs: Health Promotion and Maintenance 10. During a nutritional assessment, why is it important for the nurse to ask a patient what

medications he or she is taking? a. Certain medications can affect the metabolism of nutrients. b. The nurse needs to assess the patient for allergic reactions. c. Medications need to be documented in the record for the physician’s review.

Physical Examination and Health Assessment CANADIAN 3rd Edition Jarvis Test Bank d. Medications can affect memory and ability to identify food eaten in the last 24

hours. ANS: A

Analgesics, antacids, anticonvulsants, antibiotics, diuretics, laxatives, antineoplastic drugs, steroids, and oral contraceptives are medications that can interact with nutrients, impairing their digestion, absorption, metabolism, or use. The other responses are not correct. DIF: Cognitive Level: Understanding (Comprehension) MSC: Client Needs: Health Promotion and Maintenance 11. A patient tells the nurse that he simply does not find any food tasty anymore. The best

response by the nurse would be: a. “That must be really frustrating.” b. “When did you first notice this change?” c. “My food doesn’t always have a lot of taste either.” d. “Sometimes that happens, but your taste will come back.” ANS: B

With changes in appetite, taste, smell, or chewing and swallowing, the examiner should ask about the type of change and when the change occurred. These problems interfere with adequate nutrient intake. The other responses are not correct. DIF: Cognitive Level: Understanding (Comprehension) MSC: Client Needs: Health Promotion and Maintenance 12. The nurse is performing a nutritional assessment on a 15-year-old girl, who tells the nurse that

she is “so fat.” Assessment reveals that she is 1.6 m tall and weighs 50 kg. An appropriate response from the nurse would be: a. “How much do you think you should weigh?” b. “Don’t worry about it; you’re not that overweight.” c. “The best thing for you would be to go on a diet.” d. “I used to always think I was fat when I was your age.” ANS: A

Adolescents’ increased body awareness and self-consciousness may cause eating disorders, such as anorexia nervosa or bulimia, conditions in which the real or perceived body image does not compare favourably with an ideal image. The nurse should not belittle the adolescent’s feelings, provide unsolicited advice, or agree with her. DIF: Cognitive Level: Applying (Application) MSC: Client Needs: Health Promotion and Maintenance 13. The nurse is discussing appropriate foods with the mother of a 3-year-old child. Which of

these foods are recommended? a. Foods that the child will eat, no matter what they are b. Foods easy to hold such as hot dogs, nuts, and grapes c. Any foods, as long as the rest of the family is also eating them d. Finger foods and nutritious snacks that cannot cause choking ANS: D

Physical Examination and Health Assessment CANADIAN 3rd Edition Jarvis Test Bank Small portions, finger foods, simple meals, and nutritious snacks help improve the dietary intake of young children. Foods likely to be aspirated should be avoided (e.g., hot dogs, nuts, grapes, round candies, popcorn). DIF: Cognitive Level: Applying (Application) MSC: Client Needs: Health Promotion and Maintenance 14. The nurse is reviewing the nutritional assessment of an 82-year-old patient. Which of these

factors will most likely affect the nutritional status of an older adult? a. Increase in taste and smell b. Living alone on a fixed income c. Change in cardiovascular status d. Increase in gastrointestinal motility and absorption ANS: B

Socioeconomic conditions frequently affect the nutritional status of the aging adult; these factors should be closely evaluated. Physical limitations, income, and social isolation are frequent problems that interfere with the acquisition of a balanced diet. A decrease in taste and smell and decreased gastrointestinal motility and absorption occur with aging. Cardiovascular status is not a factor that affects an older adult’s nutritional status. DIF: Cognitive Level: Understanding (Comprehension) MSC: Client Needs: Health Promotion and Maintenance 15. The nurse is obtaining the objective data for the nutritional assessment. Which of the

following would the nurse measure as common anthropometric elements? a. Height and weight b. Leg circumference c. Skinfold thickness of the biceps d. Arm length ANS: A

The most commonly used anthropometric measures are height, weight, waist-to-hip ratio, and waist circumference. DIF: Cognitive Level: Remembering (Knowledge) MSC: Client Needs: Health Promotion and Maintenance 16. The nurse is assessing a 29-year-old woman and records her weight as 70 kg and height as 1.6

m. The nurse calculates the body mass index (BMI) and identifies the patient as being: a. Obese b. Overweight c. Suffering from malnutrition d. Normal weight ANS: B

BMI is a practical marker of optimal weight for height and an indicator of obesity. It is calculated as follows:

The patient’s BMI is 27.3, which indicates overweight.

Physical Examination and Health Assessment CANADIAN 3rd Edition Jarvis Test Bank 40

Underweight Normal weight Overweight Obesity Extreme obesity

DIF: Cognitive Level: Applying (Application) MSC: Client Needs: Health Promotion and Maintenance 17. During assessment, the nurse measures the patient’s waist to be 76 cm and hips circumference

to be 86 cm. Calculating the waist-hip ratio, the nurse determines the patient to be: Underweight. At increased risk for early mortality. Gynoid obese. At risk for metabolic diseases.

a. b. c. d.

ANS: B

The waist-to-hip ratio reflects body fat distribution as an indicator of health risk. Obese individuals with a greater proportion of fat in the upper body, especially in the abdomen, have android obesity; obese individuals with most of their fat in the hips and thighs have gynoid obesity. Waist-to-hip ratio is calculated as follows:

The patient’s waist-to-hip ratio = 76/86 = 0.88 A waist-to-hip ratio of 1.0 or more in men or 0.8 or more in women is indicative of android (upper body obesity) and increasing risk for obesity-related diseases and early mortality. A waist circumference exceeding 89 cm (35 inches) in women and exceeding 102 cm (40 inches) in men increases risk for cardiovascular and metabolic diseases. DIF: Cognitive Level: Understanding (Comprehension) MSC: Client Needs: Health Promotion and Maintenance 18. To gather the anthropometric waist measurement of the patient to calculate the waist-hip ratio,

the nurse will: Measure below the umbilicus and above the thighs. Measure at the level of the rib cage. Measure at the largest circumference of the buttocks. Measure at the smallest circumference below the rib cage and above the umbilicus.

a. b. c. d.

ANS: D

Waist circumference is measured either in inches or centimeters at the smallest circumference below the rib cage and above the umbilicus, and hip circumference is measured in the same units at the largest circumference of the buttocks. DIF: Cognitive Level: Understanding (Comprehension) MSC: Client Needs: Health Promotion and Maintenance 19. In teaching a patient how to determine best weight for the patient’s height, the nurse includes

instructions to obtain measurements of:

Physical Examination and Health Assessment CANADIAN 3rd Edition Jarvis Test Bank a. b. c. d.

Height and weight. Frame size and weight. Waist and hip circumferences. Mid-upper arm circumference and arm span.

ANS: A

BMI, calculated by using height and weight measurements, is a practical marker of optimal weight for height and an indicator of obesity. The other options are not correct. DIF: Cognitive Level: Understanding (Comprehension) MSC: Client Needs: Health Promotion and Maintenance 20. The nurse is evaluating patients for obesity-related diseases by calculating the waist-to-hip

ratios. Which one of these patients would be at increased risk? a. A 29-year-old woman whose waist measures 33 inches (83cm) and hips measure

36 inches (91 cm) b. A 32-year-old man whose waist measures 34 inches (86 cm) and hips measure 36

inches (91 cm) c. A 38-year-old man whose waist measures 35 inches (89 cm) and hips measure 38

inches (96 cm) d. A 46-year-old woman whose waist measures 30 inches (76 cm) and hips measure

38 inches (96 cm) ANS: A

The waist-to-hip ratio assesses body fat distribution as an indicator of health risk. A waist-to-hip ratio of 1.0 or greater in men or 0.8 or greater in women is indicative of android (upper body obesity) and increasing risk for obesity-related disease and early death. The 29-year-old woman has a waist-to-hip ratio of 0.92, which is greater than 0.8. The 32-year-old man has a waist-to-hip ratio of 0.94; the 38-year-old man has a waist-to-hip ratio of 0.92; the 46-year-old woman has a waist-to-hip ratio of 0.78. DIF: Cognitive Level: Analyzing (Analysis) MSC: Client Needs: Health Promotion and Maintenance 21. After completing a diet assessment on a 30-year-old woman, the nurse suspects that she may

be deficient in iron. The nurse can verify by using laboratory values of: a. Hemoglobin and hematocrit. b. Cholesterol and triglycerides. c. Urinalysis. d. Serum albumin. ANS: A

The hemoglobin determination is used to detect iron-deficiency anemia. Hematocrit, a measure of cell volume, is also an indicator of iron status. Cholesterol and triglyceride levels are tested for hyperlipidemia, and serum albumin levels indicate visceral protein status. Urinalysis is a measure of renal function and does not reflect iron-deficiency anemia. DIF: Cognitive Level: Applying (Application) MSC: Client Needs: Health Promotion and Maintenance 22. A 50-year-old woman with elevated total cholesterol and triglyceride levels is visiting the

clinic to discuss the laboratory results. The nurse will include patient education on:

Physical Examination and Health Assessment CANADIAN 3rd Edition Jarvis Test Bank a. b. c. d.

The risks of undernutrition. Methods to reduce stress in her life. Information to include a diet low in saturated fat. The condition being hereditary and why nothing she can do can change the levels.

ANS: C

The patient with elevated cholesterol and triglyceride levels should be taught about eating a healthy diet that limits the intake of foods high in saturated fats or trans fats. Reducing dietary fats is part of the treatment for this condition. The other responses are not pertinent to her condition. DIF: Cognitive Level: Applying (Application) MSC: Client Needs: Health Promotion and Maintenance 23. During assessment of a 78-year-old patient taking multiple medications for various chronic

conditions, the nurse is concerned that the patient is experiencing: Increase in hair growth. Inadequate nutrient food intake. Extreme weight gain. Increase in abdominal fat.

a. b. c. d.

ANS: B

Older adults are prescribed multiple medications that may interact with nutrients, vitamin supplements, and other prescription medications. DIF: Cognitive Level: Applying (Application) MSC: Client Needs: Health Promotion and Maintenance 24. A 21-year-old woman with extensive weight gain over the past 12 months, has a BMI of 38,

indicating obesity. The nurse is concerned that she is at increased risk for: a. Polypharmacy. b. Diabetes. c. Optimal nutrition. d. Low mortality. ANS: B

Excess body weight is associated with numerous chronic conditions, including type 2 diabetes, hypertension, cardiovascular disease, gallbladder disease, and certain types of cancer. DIF: Cognitive Level: Analyzing (Analysis) MSC: Client Needs: Health Promotion and Maintenance 25. The nurse is performing a nutritional assessment on an 80-year-old patient. The nurse knows

that physiological changes can directly affect the nutritional status of the older adult and include: a. Slowed gastrointestinal motility. b. Hyperstimulation of the salivary glands. c. Increased sensitivity to spicy and aromatic foods. d. Decreased gastrointestinal absorption causing esophageal reflux. ANS: A

Physical Examination and Health Assessment CANADIAN 3rd Edition Jarvis Test Bank Normal physiological changes in aging adults that affect nutritional status include slowed gastrointestinal motility, decreased gastrointestinal absorption, diminished olfactory and taste sensitivity, decreased saliva production, decreased visual acuity, and poor dentition. DIF: Cognitive Level: Remembering (Knowledge) MSC: Client Needs: Health Promotion and Maintenance 26. Whic...