ASSESSMENT EXAM QUESTIONS AND
CORRECT DETAILED ANSWERS WITH
RATIONALES (VERIFIED ANSWERS)
A nurse is completing a nutritional assessment on a client and measures body mass
index (BMI). Which of the following readings correlates with a BMI of an overweight
client?
A. 18.5
B. 24.9
C. 25
D. 32 - CORRECT ANSWER - C. 25
Rationale: Healthy weight is indicates by a BMI of 18.5-24.9. Overweight is defined as
an increased body weight in relation to height. It is indicated by a BMI of 25-29.9.
Obesity is an excess amount of body fat. It is indicated by a BMI greater than or equal
to 30.
Underweight- less than 18.5
A nurse should teach which of the following clients requiring crutches about how to use
a three-point gait?
A. A client who is able to bear full weight on both lower extremities.
B. A client who has bilateral leg braces due to paralysis of the lower extremities.
C. A client who has a right femur fracture with no weight bearing on the affected leg.
D. A client who has bilateral knee-replacements with partial weight bearing on both legs.
- CORRECT ANSWER - C. A client who has a right femur fracture with no weight
bearing on the affected leg.
Rationale: A three-point gait requires the client to bear all of his weight on one foot. With
a three-point gait, the client bears weight on both crutches and then on the uninvolved
leg, repeating the sequence. The affected leg does not touch the ground.
, A nurse is caring for a client who has been prescribed furosemide. Which of the
following foods should the nurse encourage to include in his diet?
A. Table salt
B. Egg yolks
C. White wine
D. Oranges - CORRECT ANSWER - D. Oranges
Rationale: Client prescribed potassium-wasting diuretics should be encouraged to eat
foods high in potassium. Oranges, dried fruits, tomatoes, avocados, dried peas, meats,
broccoli, and bananas are all good sources of potassium. Table salt is not a good
source of potassium.
A menopausal client is having difficulty getting to sleep and asks what actions she
should incorporate in her daily routine to promote sleep. The nurse would encourage
which of the below measures to promote sleep?
A. Consume a warm drink at bedtime.
B. Take an evening walk before bedtime.
C. Take an afternoon nap.
D. Limit alcohol and nicotine prior to bedtime. - CORRECT ANSWER - D. Limit alcohol
and nicotine prior to bedtime.
Rationale: Limit alcohol, caffeine (stimulant), and nicotine (stimulant) at least 4 hr before
bedtime. Exercise regularly; limit exercise at least 2 hr before bedtime. Limit fluids 2 to 4
hr before bedtime.
A nurse is caring for a client with heart failure who has evidence of dyspnea, bibasilar
crackles and frothy sputum. What dietary recommendations should be provided to this
client in management of their heart failure?
A. Decrease protein intake.
B. Reduce sodium intake.
C. Increase fluid intake.
D. Decrease calcium intake. - CORRECT ANSWER - B. Reduce sodium intake.