Reference no: EM133842587
Questions
1. The nurse is completing a diet health history for a client recently admitted to the hospital. Which data is most important to collect to assess the client's nutritional needs? Select all that apply.
a. Allergies
b. Height and weight
c. Medications
d. Swallowing
2. The nurse suspects the client may have dysphagia (difficulty when swallowing). What are the warning signs for dysphagia? Select all that apply.
a. Abnormal gag reflex.
b. Coughing during eating.
c. Pain in the abdomen.
d. Persistent wheezing.
e. Weakness and fatigue.
3. A client is receiving tube feeding due to the inability to swallow foods. The nurse suspects the client has aspirated. What is the nurse's next step?
a. Administer oxygen by nasal cannula.
b. Elevate the head of the bed.
c. Stop feedings immediately.
d. Turn the client on the side.
4. When completing a physical assessment on a client the nurse notes which signs and symptoms indicate poor nutritional status? Select all that apply.
a. Bright clear eyes.
b. Confusion.
c. Dry, thin, sparse hair.
d. Falls asleep easily.
e. Pink nail beds.
f. Rough dry scaly skin
5. After completing the assessment of a client with difficulty swallowing, which nursing problem would be a priority nursing diagnosis for this client?
a. Feeding self-care deficit.
b. Fatigue
c. Imbalanced nutrition.
d. Risk for aspiration.
6. Which intervention is most appropriate for the client with a nursing diagnosis of poor nutritional intake related to impaired social interaction?
a. Ask a family member to cook for the client.
b. Encourage the client to eat with friends three times a week.
c. Encourage the client to take daily walks in the park.
d. Teach the client to cook smaller meals.
7. The nurse is planning the care for a client with imbalanced nutrition: less than body requirements, related to lack of interest in food, evidenced by pain in the mouth preventing the client from eating. Which nursing intervention will be a priority for this client?
a. Ask a family member to cook for the client.
b. Determine the cause of the pain in the mouth.
c. Encourage the client to add seasonings to the food.
d. Suggest the client eat soups until the pain is resolved.
8. The nurse understands a health care provider's order for enteral feeding may be a result of:
a. a client needing additional calories.
b. surgical intervention with the stomach.
c. the client's inability to purchase food.
d. the client's inability to swallow.
9. A client is scheduled for parenteral nutrition. Which statement by the nurse best explains this therapy?
a. "Parenteral nutritional therapy is administered directly in the stomach."
b. "Parenteral nutrition is a form of nutrition where nutrients are provided intravenously."
c. "This nutritional therapy is permanent and will be used to replace oral feeding."
d. "When you are unable to eat, parenteral nutrition is the best therapy to replace nutrients."
10. The nurse completes an assessment on a client diagnosed with anemia and notices the following symptoms: tachycardia, fatigue, and agitation. The nurse understands anemia, as a result of decreased hemoglobin levels, will result in:
a. Hyperventilation.
b. Hypovolemia.
c. Hypoxia.
d. Impaired ventilation.
11. A client admitted with the diagnosis of severe left- sided heart failure and fluid overload in the lungs. The nurse expects to auscultate which adventitious lung sounds?
a. Crackles.
b. Pleural friction rub.
c. Rhonchi.
d. Wheezing.
12. The nurse recognizes a client is anxious, respiratory rate is 30 breaths per minute, and ABG labs show pH 7.47, CO2 30, HCO3 24. Which disorder is the client experiencing?
a. Hyperventilation
b. Hypoventilation
c. hypovolemia
d. Hypoxia
13. The client is experiencing an abnormal cardiac rhythm. The nurse reviews the tele-monitor and recognizes ________________as a dysrhythmia that is common in older adults.
a. Atrial fibrillation
b. Bradycardia
c. Normal Sinus Rhythm
d. Tachycardia
14. The client complains of squeezing chest pain that does not goes away with rest. The nurse understands the client is experiencing which disorder?
a. Angina pectoris
b. Heart failure
c. Myocardial ischemia
d. Myocardial infarction
15. After completing a respiratory assessment, the nurse determines an adult client is experiencing dyspnea associated with hypoxia as a result of which clinical signs and symptoms?
a. Anxiety
b. Cyanosis
c. Dyspnea
d. Nasal flaring
e. Respiratory rate 32
f. pH level 7.35
g. Tachycardia