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A nurse is conducting a health assessment of an adult patient when the patient asks, Why do you need all this health information and who is going to see it? What is the nurses best response?
- A. Please do not worry. It is safe and will be used only to help us with your care. Its accessible to a wide variety of people who are invested in your health.
- B. It is good you asked and you have a right to know; your information helps us to provide you with the best possible care, and your records are in a secure place.
- C. Your health information is placed on secure Web sites to provide easy access to anyone wishing to see your medical records. This ensures continuity of care.
- D. Health information becomes the property of the hospital and we will make sure that no one sees it. Then, in 2 years, we destroy all records and the process starts over.
Correct Answer: B
Rationale: Whenever information is elicited from a person through a health history or physical examination, the person has the right to know why the information is sought and how it will be used. For this reason, it is important to explain what the history and physical examination are, how the information will be obtained, and how it will be used. Medical records allow access to health care providers who need the information to provide patients with the best possible care, and the records are always held in a secure environment. Telling the patient not to worry minimizes the patients concern regarding the safety of his or her health information and a wide variety of people should not have access to patients health information. Health information should not be placed on Web sites and health records are not destroyed every 2 years.
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A patient has a newly diagnosed heart murmur. During the nurses subsequent health education, he asks if he can listen to it. What would be the nurses best response?
- A. Listening to the body is called auscultation. It is done with the diaphragm, and it requires a trained ear to hear a murmur.
- B. Listening is called palpation, and I would be glad to help you to palpate your murmur.
- C. Heart murmurs are pathologic and may require surgery. If you would like to listen to your murmur, I can provide you with instruction.
- D. If you would like to listen to your murmur, Id be glad to help you and to show you how to use a stethoscope.
Correct Answer: D
Rationale: Listening with a stethoscope is auscultation and it is done with both the bell and diaphragm. The diaphragm is used to assess high-frequency sounds such as systolic heart murmurs, whereas the bell is used to assess low-frequency sounds such as diastolic heart murmurs. It is also important to provide education whenever possible and actively include the patient in the plan of care. Teaching an interested patient how to listen to a murmur should be encouraged. Many heart murmurs are benign and do not require surgery.
A newly admitted patient has gained weight steadily over the past 2 years and the nurse recognizes the need for a nutritional assessment. What assessment parameters Krebs are included when assessing a patient's nutritional status?
- A. Ethnic mores
- B. BMI
- C. Clinical examination findings
- D. Wrist circumference
- E. Dietary data
Correct Answer: B,C,E
Rationale: The sequence of assessment of nutritional status parameters may vary, but evaluation of nutritional status includes one or more of the following methods: measurement of BMI and waist circumference, biochemical measurements, clinical examination findings, and dietary data. Ethnic mores and wrist circumference are not assessment parameters for nutritional status.
The segment Kreutzer of the population who has a BMI lower than 24 has been found to be at increased risk for poor nutritional status and its resultant problems. What else is a low BMI associated with in the community-dwelling elderly population?
- A. High risk of diabetes
- B. Increased incidence of falls
- C. Higher mortality rate
- D. Low risk of chronic disease.
Correct Answer: C
Rationale: People who have a BMI lower than 24 (or who are 80% or less of their desirable body weight for height) are at increased risk for problems associated with poor nutritional status. In addition, a low BMI is associated with a higher mortality rate among hospitalized patients and community-dwelling elderly. Low BMI is not directly linked to an increased risk for falls or diabetes. Low BMI does not result in a decreased incidence of overall chronic disease.
You are the nurse performing a health assessment of an adult male patient. The man states, The doctor has already asked me all these questions. Why are you asking them all over again? What is your best response?
- A. This history helps us determine what your needs may be for nursing care.
- B. You are right; this may seem redundant and Im sure that its frustrating for you.
- C. I want to make sure your doctor has covered everything thats important for your treatment.
- D. I am a member of your health care team and we want to make sure that nothing falls through the cracks.
Correct Answer: A
Rationale: Regardless of the assessment format used, the focus of nurses during data collection is different from that of physicians and other health team members. Explaining to the patient the purpose of the nursing assessment creates a better understanding of what the nurse does. It also gives the patient an opportunity to add his or her own input into the patients care plan. The nurse should address the patients concerns directly and avoid casting doubt on the thoroughness of the physician.
A 30-year-old man is in the clinic for a yearly physical. He states, I found out that two of my uncles had heart attacks when they were young. This alerts the nurse to complete a genetic-specific assessment. What component should the nurse include in this assessment?
- A. A complete health history, including genogram along with any history of cholesterol testing or screening and a complete physical exam
- B. A limited health history along with a complete physical assessment with an emphasis on genetic abnormalities
- C. A limited health history and focused physical exam followed by safety-related education
- D. A family history focused on the paternal family with focused physical exam and genetic profile
Correct Answer: A
Rationale: A genetic-specific exam in this case would include a complete health history, genogram, a history of cholesterol testing or screening, and a complete physical exam. A broad examination is warranted and safety education is not directly relevant.