n3320 exam 3
assessment of a client reveals a history of insulin-dependent diabetes mellitus,
weight loss, polyuria, poor skin turgor, nausea, loss of appetite, and a blood glucose
level measured by finger stick of 348 mg/dL. Which of the following nursing
diagnoses would be the nurses priority.
- ✅✅-risk for imbalanced fluid volume related to inadequate oral intake and
frequent urination
the nurse's assessment reveals that a client is in a low percentile for midarm muscle
circumference (MAMC) and a high percentile for triceps skin fold (TSF) thickness.
Which of the following would be appropriate? - ✅✅-teaching the client muscle-
building exercises
an adult client weighs 175 pounds and is 5 feet 6 inches tall. The nurse determines
that the client's body mass index is which of the following?
(weight)/(height)(height) x 703 - ✅✅-28
a client weighs 106 pounds and is 5 feet 5 inches tall. As a result, her ideal body
weight is 120 pounds. After determining the client's percentage of ideal body
weight, which of the following should the nurse conclude? - ✅✅-client is mildly
malnourished
a nurse is reviewing the laboratory test results of an adult client who has numerous
chronic health challenges. which assessment result would alert the nurse to
potential malnutrition? -
✅✅-serum albumin of 2.6 g/dL
the nurse should prioritize assessments related to overhydration for a client
experiencing which of the following health problems - ✅✅-early congestive heart
failure
the nurse is assessing a client who has been admitted with signs and symptoms that
are consistent with malnutrition. Which of the following physiological phenomena
should the nurse recognize as an early indicator of malnutrition? - ✅✅-protein
stores are lower than normal
a client is receiving an intradermal injection to evaluate general immunity during a
nutritional assessment. Which of the following conclusions is suggested if the client
has no reaction? -
✅✅-it may be immunosuppression resulting from undernourishment
the nurse is preparing to preform a nutritional assessment of a newly admitted
client. which of the following questions would be most appropriate to use when
initiating the assessment? -
✅✅-can you tell me what you've eaten in the last 24 hours?
a nurse is assessing a client's skeletal muscle mass in the context of a
comprehensive nutritional assessment. Which measurement would yield the most
valid and reliable data? -
✅✅-mid-arm circumference
,desire and request to alter amount of food intake.
the nurse is collecting data from a client about his nutrition. Which of the following
would the nurse document as objective data. - ✅✅-tenting of client's skin
observed upon skin pinch
, a nurse in the intensive care unit is calculating an acutely ill client's 24-hour fluid
balance. The nurse should include insensible fluid losses of what volume when
performing this assessment -
✅✅-800 to 1000 mL
a nurse is assessing a client for possible fluid overload. Which of the following
assessment findings is most consistent with this diagnosis? - ✅✅-distended neck
veins with head elevated at 45 degrees
during a nutritional assessment, the client asks the nurse for suggestions to
improve her diet. the nurse identifies a nursing diagnosis of health-seeking
behaviors related to desire to improve diet. Which of the following suggestions
would be most appropriate? - ✅✅-choose low-fat versions of milk products such
as yogurt
a group of students is reviewing information about general assessment indicators of
nutritional status. The students demonstrate a need for additional review when they
identify which of the following as indicator of adequate nutritional status? - ✅✅-
brittle hair
when obtaining the nutritional health history from a female client, which of the
nurse's questions would best elicit information about the client's knowledge of her
own health status? - ✅✅-what are your height and usual weight
the nurse needs to obtain the height of a client who is unable to stand. Which of the
following would the nurse do? - ✅✅-measure from client's arm span using one of
his arms outstretched.
an older adult client has presented to the ED with s&s of dehydration. when
assessing the client for risk factors that may have contributed to this condition,
what question should the nurse prioritize? - ✅✅-are you currently taking any
diuretic medications?
an older adult client has a body mass index of 15.5 and is consequently considered
to be underweight. the client lives alone and states she has never been a heavy
eater. how can the nurse most accurately assess the client's nutritional habits? -
✅✅-elicit the client's 24-hour food recall
During a new client's nutritional assessment, the nurse asks the client's height and
usual weight. The client states that he has no idea how much he weighs. How
should the nurse respond? -
✅✅-do you feel like your weight has increase, decrease, or stayed the same lately
a hospital nurse is performing a nutritional assessment of a 39-year-old obese client
who has recently diagnosed with type 2 diabetes. the nurse has completed the
collection of subjective data and is preparing to proceed with objective data
collection. Which principle should guide the nurse's subsequent actions. - ✅✅-the
nurse should be aware that the client may find assessment embarrassing
during an initial prenatal visit, the nurse is performing a nutritional assessment of
a woman who has just learned that she is pregnant for the first time. the nurse has
determined that the client has an average stature and is 5 feet, 3 inches tall. What
is the ideal body weight? - ✅✅-115 lbs
assessment of a client reveals a history of insulin-dependent diabetes mellitus,
weight loss, polyuria, poor skin turgor, nausea, loss of appetite, and a blood glucose
level measured by finger stick of 348 mg/dL. Which of the following nursing
diagnoses would be the nurses priority.
- ✅✅-risk for imbalanced fluid volume related to inadequate oral intake and
frequent urination
the nurse's assessment reveals that a client is in a low percentile for midarm muscle
circumference (MAMC) and a high percentile for triceps skin fold (TSF) thickness.
Which of the following would be appropriate? - ✅✅-teaching the client muscle-
building exercises
an adult client weighs 175 pounds and is 5 feet 6 inches tall. The nurse determines
that the client's body mass index is which of the following?
(weight)/(height)(height) x 703 - ✅✅-28
a client weighs 106 pounds and is 5 feet 5 inches tall. As a result, her ideal body
weight is 120 pounds. After determining the client's percentage of ideal body
weight, which of the following should the nurse conclude? - ✅✅-client is mildly
malnourished
a nurse is reviewing the laboratory test results of an adult client who has numerous
chronic health challenges. which assessment result would alert the nurse to
potential malnutrition? -
✅✅-serum albumin of 2.6 g/dL
the nurse should prioritize assessments related to overhydration for a client
experiencing which of the following health problems - ✅✅-early congestive heart
failure
the nurse is assessing a client who has been admitted with signs and symptoms that
are consistent with malnutrition. Which of the following physiological phenomena
should the nurse recognize as an early indicator of malnutrition? - ✅✅-protein
stores are lower than normal
a client is receiving an intradermal injection to evaluate general immunity during a
nutritional assessment. Which of the following conclusions is suggested if the client
has no reaction? -
✅✅-it may be immunosuppression resulting from undernourishment
the nurse is preparing to preform a nutritional assessment of a newly admitted
client. which of the following questions would be most appropriate to use when
initiating the assessment? -
✅✅-can you tell me what you've eaten in the last 24 hours?
a nurse is assessing a client's skeletal muscle mass in the context of a
comprehensive nutritional assessment. Which measurement would yield the most
valid and reliable data? -
✅✅-mid-arm circumference
,desire and request to alter amount of food intake.
the nurse is collecting data from a client about his nutrition. Which of the following
would the nurse document as objective data. - ✅✅-tenting of client's skin
observed upon skin pinch
, a nurse in the intensive care unit is calculating an acutely ill client's 24-hour fluid
balance. The nurse should include insensible fluid losses of what volume when
performing this assessment -
✅✅-800 to 1000 mL
a nurse is assessing a client for possible fluid overload. Which of the following
assessment findings is most consistent with this diagnosis? - ✅✅-distended neck
veins with head elevated at 45 degrees
during a nutritional assessment, the client asks the nurse for suggestions to
improve her diet. the nurse identifies a nursing diagnosis of health-seeking
behaviors related to desire to improve diet. Which of the following suggestions
would be most appropriate? - ✅✅-choose low-fat versions of milk products such
as yogurt
a group of students is reviewing information about general assessment indicators of
nutritional status. The students demonstrate a need for additional review when they
identify which of the following as indicator of adequate nutritional status? - ✅✅-
brittle hair
when obtaining the nutritional health history from a female client, which of the
nurse's questions would best elicit information about the client's knowledge of her
own health status? - ✅✅-what are your height and usual weight
the nurse needs to obtain the height of a client who is unable to stand. Which of the
following would the nurse do? - ✅✅-measure from client's arm span using one of
his arms outstretched.
an older adult client has presented to the ED with s&s of dehydration. when
assessing the client for risk factors that may have contributed to this condition,
what question should the nurse prioritize? - ✅✅-are you currently taking any
diuretic medications?
an older adult client has a body mass index of 15.5 and is consequently considered
to be underweight. the client lives alone and states she has never been a heavy
eater. how can the nurse most accurately assess the client's nutritional habits? -
✅✅-elicit the client's 24-hour food recall
During a new client's nutritional assessment, the nurse asks the client's height and
usual weight. The client states that he has no idea how much he weighs. How
should the nurse respond? -
✅✅-do you feel like your weight has increase, decrease, or stayed the same lately
a hospital nurse is performing a nutritional assessment of a 39-year-old obese client
who has recently diagnosed with type 2 diabetes. the nurse has completed the
collection of subjective data and is preparing to proceed with objective data
collection. Which principle should guide the nurse's subsequent actions. - ✅✅-the
nurse should be aware that the client may find assessment embarrassing
during an initial prenatal visit, the nurse is performing a nutritional assessment of
a woman who has just learned that she is pregnant for the first time. the nurse has
determined that the client has an average stature and is 5 feet, 3 inches tall. What
is the ideal body weight? - ✅✅-115 lbs
