Chapter 28: Assessment of Nutrition and the Digestive System Nursing School Test Banks

Black & Hawks: Medical-Surgical Nursing, 8th Edition

Test Bank

Chapter 28: Assessment of Nutrition and the Digestive System

MULTIPLE CHOICE

1. The nurse is assessing a client who describes stomach discomfort. The most appropriate sequence for conducting the physical examination of the abdomen is

a.

auscultation, percussion, palpation, inspection.

b.

inspection, auscultation, percussion, palpation.

c.

inspection, palpation, percussion, auscultation.

d.

palpation, percussion, auscultation, inspection.

ANS: B

Assess the abdomen in the following sequence: inspection, auscultation, percussion, and palpation.

DIF: Application/Applying REF: p. 566 OBJ: Assessment

MSC: Health Promotion and Maintenance Prevention and/or Early Detection of Health Problems-Techniques of Physical Assessment

2. The nurse is assessing the abdomen of an obese 67-year-old client who is admitted to the emergency department. The finding noted during the abdominal examination that requires further assessment is

a.

flat appearance below the umbilicus.

b.

rounded abdominal contour.

c.

umbilicus that is concave.

d.

visible peristalsis.

ANS: D

Normally, peristaltic movements are not visible, although abdominal pulsations may be observed in a very thin client.

DIF: Application/Applying REF: p. 566 OBJ: Assessment

MSC: Physiological Integrity Reduction of Risk Potential-System Specific Assessments

3. Before determining the absence of bowel sounds, the nurse must auscultate the abdomen for

a.

1 minute.

b.

5 minutes.

c.

10 minutes.

d.

20 minutes.

ANS: B

To determine the absence of bowel sounds, the nurse must listen a total of 5 minutes, or at least 1 minute per abdominal quadrant.

DIF: Application/Applying REF: p. 566 OBJ: Assessment

MSC: Health Promotion and Maintenance Prevention and/or Early Detection of Health Problems-Techniques of Physical Assessment

4. When the nurse measures waist-to-hip ratio and calculates the midarm muscle circumference (MAMC), the nurse is assessing

a.

overall muscle strength and density compared to fat stores.

b.

proportion and distribution of muscle mass and body fat.

c.

reserves of protein and calories stores in the muscle.

d.

the size of the body frame related to body weight.

ANS: B

These two anthropometric measures are used to assess the proportion and distribution of muscle mass and body fat.

DIF: Application/Applying REF: p. 564 OBJ: Assessment

MSC: Physiological Integrity Reduction of Risk Potential-System Specific Assessments

5. For a client having all the following GI tests, which test should the nurse schedule last?

a.

Barium swallow

b.

Computed tomography scan

c.

Flat plate of abdomen

d.

Ultrasound

ANS: A

Ultrasound, abdominal scan, and colonoscopy, if indicated, should be performed first, because the barium interferes with these tests.

DIF: Application/Applying REF: p. 568 OBJ: Intervention

MSC: Physiological Integrity Reduction of Risk Potential-Diagnostic Tests

6. A client who had a barium swallow 4 days earlier calls the nurse in the GI clinic to ask, Is there anything I can do about my constipation? I have not had a bowel movement since the x-ray, and my stomach is so big that I look pregnant. The most appropriate response for the nurse to make is

a.

Do you normally have more frequent bowel movements?

b.

Increase fluids in your diet to 10 glasses of water a day.

c.

Take a strong laxative immediately.

d.

You need to be examined in the clinic today.

ANS: D

To prevent impactions with barium, the client takes a laxative after the barium test. This client shows manifestations of a barium impaction and needs to be evaluated as soon as possible.

DIF: Analysis/Analyzing REF: p. 568 OBJ: Intervention

MSC: Physiological Integrity Reduction of Risk Potential-Diagnostic Tests

7. The nurse administers an anticholinergic drug to a client scheduled for an endoscopy in order to provide

a.

decreased secretions.

b.

increased peristalsis.

c.

muscle relaxation.

d.

sedation.

ANS: A

Anticholinergic medications may be given to decrease oropharyngeal secretions. They may also help prevent reflex bradycardia.

DIF: Application/Applying REF: p. 569 OBJ: Intervention

MSC: Physiological Integrity Pharmacological and Parenteral Therapies-Pharmacological Agents/Actions

8. When preparing a client for gastric analysis, the nurse should plan for

a.

antacid administration.

b.

fluoroscopic examination.

c.

frequent expectoration for samples.

d.

nasogastric tube insertion.

ANS: A

Gastric analysis is performed to measure secretions of hydrochloric acid and pepsin in the stomach. There are two kinds of gastric analysis: basal cell secretion test and the gastric acid stimulation test. Both examinations require insertion of an NG tube through which samples of gastric secretions can be withdrawn.

DIF: Knowledge/Remembering REF: p. 569 OBJ: Intervention

MSC: Physiological Integrity Reduction of Risk Potential-System Specific Assessments

9. The nurse conducting a physical assessment on a client with ascorbic acid (vitamin C) deficiency would assess that the clinical manifestation associated with this problem is

a.

bumpy or scaly skin.

b.

ecchymotic skin lesions.

c.

extremity edema.

d.

muscle tetany.

ANS: B

Evidence of vitamin C (ascorbic acid) deficit includes gingivitis, dry mouth, alopecia, pruritus, and ecchymotic lesions on the skin.

DIF: Application/Applying REF: p. 557 OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation-Alteration in Body Systems

10. The amount of calories and protein that a client weighing 185 pounds would require is at least

a.

1575 calories and 53 g of protein.

b.

2394 calories and 62 g of protein.

c.

2520 calories and 67 g of protein.

d.

2743 calories and 73 g of protein.

ANS: C

The client weighs 84 kg ; calories: ; protein: .

DIF: Analysis/Analyzing REF: p. 558 OBJ: Assessment

MSC: Health Promotion and Maintenance Prevention and/or Early Detection of Health Problems-Health and Wellness

11. For a client taking a histamine H2 blocker to reduce clinical manifestations of gastritis, the nurse would clarify that the client is at risk for a possible deficiency of vitamin

a.

A.

b.

B12.

c.

C.

d.

D.

ANS: B

In a possible nutrient interaction, histamine H2 blockers may cause decreased vitamin B12 absorption. Anti-tuberculosis drugs can also cause interference in the metabolism of vitamin B12.

DIF: Comprehension/Understanding REF: p. 563 OBJ: Intervention

MSC: Physiological Integrity Pharmacological and Parenteral Therapies-Adverse Effects/Contraindications

12. A client has been admitted with a diagnosis of primary starvation. The nurse explains to the family that this means the client

a.

has a possible problem with the GI tract.

b.

has not been eating enough calories and other nutrients.

c.

is not eating, absorbing, or using micronutrients.

d.

is over-excreting specific nutrients.

ANS: B

Primary starvation occurs when adequate nutrition is not delivered to the GI tract because of decreased eating. Secondary starvation is when the GI tract receives enough nutrients, but does not absorb, metabolize, or use them because of a problem with the GI tract itself. Micronutrient malnutrition is what is occurring in option c. Increased excretion of nutrients would be another example of secondary starvation.

DIF: Comprehension/Understanding REF: p. 558 OBJ: Intervention

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

13. In collecting a 24-hour urine specimen to determine nitrogen balance for a client, the nurse would

a.

conduct the urine collection before a 24-hour food record.

b.

correct the results by multiplying by 0.13 for clients with renal disease.

c.

instruct the client on foods to eat containing specified amounts of protein.

d.

start the urine collection at the same time a 24-hour food record starts.

ANS: D

To determine nitrogen balance, the nurse will simultaneously record the amount and type of food consumed in a 24-hour period and obtain and 24- hour urine collection for urine urea nitrogen measurement. The start and stop times for the food record and urine collection must be the same. The amount of protein the client eats is not restricted or predetermined. The results are not corrected for clients with renal disease, and analyzing results is not related to the collection procedure.

DIF: Application/Applying REF: p. 571 OBJ: Intervention

MSC: Health Promotion and Maintenance

14. A nurse is assessing a client who complains of aching abdominal pain. To correctly assess this client, the nurse would

a.

defer palpation altogether.

b.

give pain medication before starting.

c.

palpate the nonpainful areas first.

d.

percuss the abdomen before ausculating.

ANS: C

The correct sequence of assessments when evaluating a clients abdomen is inspection, auscultation, percussion, and palpation. When palpating, start in any nonpainful areas first. Use light palpation and then move to deeper palpation, being cautious over any painful areas. Giving pain medication may hinder accurate assessments.

DIF: Application/Applying REF: p. 567 OBJ: Intervention

MSC: Health Promotion and Maintenance Prevention and/or Early Detection of Health Problems-Techniques of Physical Assessment

15. A client is having an abdominal ultrasound and wonders why the physician did not order a CT scan or MRI. The nurses best explanation for the choice of procedure is

a.

An ultrasound is far less expensive than CT or MRI.

b.

There is less need for dye contrast and fewer complications.

c.

Ultrasounds can be done more quickly and are best for screening.

d.

You can correlate physical and ultrasound findings during the exam.

ANS: D

Ultrasound can enhance physical examination because findings can be correlated with physical structures while the client is on the examining table. Ultrasound is faster and cheaper than CT or MRI, but each test has its own benefits and indications. Ultrasound is not used primarily for screening.

DIF: Comprehension/Understanding REF: p. 568 OBJ: Intervention

MSC: Physiological Integrity Reduction of Risk Potential-Diagnostic Tests

16. A hospitalized client has lost several pounds in the last week. The nurse reviews the clients lab results understanding that which test is the best indicator of acute nutritional changes?

a.

Albumin level

b.

Pre-albumin level

c.

RBC count

d.

Total protein level

ANS: B

Serum proteins give accurate nutritional information and include albumin, pre-albumin, retinal-binding protein, and transferrin. Serum proteins with long half-lives (albumin) tend to be global indicators of nutritional status, and proteins with shorter half-lives like pre-albumin and transferrin provide information on acute nutritional status changes.

DIF: Analysis/Analyzing REF: p. 570 OBJ: Assessment

MSC: Physiological Integrity Reduction of Risk Potential-Diagnostic Tests

17. A client has the following lab results. Which would alert the nurse to a possible nutrition problem?

a.

Albumin 5.0 g/dl

b.

Pre-albumin 12 mg/dl

c.

Retinol-binding protein 5 mg/dl

d.

Transferrin 200 mg/dl

ANS: B

Normal pre-albumin levels are 20-40 mg/dl. Even though the other values are normal, since pre-albumin reflects acute changes because of its half-life, the nurse should be concerned that the client is at nutritional risk. The clients transferrin level is at the low end of normal. Transferrin, the other serum protein with a short half-life, would also change rapidly with nutritional changes and its low-normal value in conjunction with the abnormal pre-albumin should confirm the nurses suspicions.

DIF: Analysis/Analyzing REF: p. 570 OBJ: Assessment

MSC: Physiological Integrity Reduction of Risk Potential-Diagnostic Tests

MULTIPLE RESPONSE

1. The nurse assessing clients for nutritional status is aware that a client would need a more in-depth analysis when the client complains of frequent nutrition-related manifestations, including (Select all that apply)

a.

abdominal pain.

b.

changes in weight or appetite.

c.

diarrhea.

d.

indigestion.

e.

nausea and vomiting.

ANS: A, B, C, D, E

These manifestations are frequent complaints that relate to GI function and nutrition and should spur the nurse to conducting a more thorough assessment of GI and nutritional status.

DIF: Knowledge/Remembering REF: p. 559 OBJ: Assessment

MSC: Physiological Integrity Reduction of Risk Potential-System Specific Assessments

Elsevier items and derived items 2009 by Saunders, an imprint of Elsevier Inc.

Some material was previously published.

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