Chamberlain University W8 NR302 Health Assessment I Exam 3 .
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Free Chamberlain University W8 NR302 Health Assessment I Exam 3 . Questions
A nurse is planning care for a client with poorly controlled asthma who frequently misses doses of their inhaled corticosteroid. The client reports forgetting to take the medication due to a busy schedule. Which strategy should the nurse use in the client's care plan to improve medication adherence?
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Ask to switch the client to an oral corticosteroid for easier administration
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Arrange follow-up visits to provide support and feedback
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Instruct the client to take the medication only when symptoms occur
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Provide written instructions on proper inhaler technique
Explanation
Correct Answer: B) Arrange follow-up visits to provide support and feedback
Since the client's non-adherence is due to a busy schedule and forgetfulness, arranging regular follow-up visits provides accountability, ongoing support, and the opportunity to address barriers to adherence. Follow-up also allows the nurse to reinforce education and adjust strategies as needed.
Switching to an oral corticosteroid is a clinical decision outside the nurse's independent scope and is not indicated solely for convenience. Inhaled corticosteroids are controller medications that must be taken regularly, not only when symptoms occur. Written instructions on inhaler technique address a different barrier than forgetfulness.
The nurse is evaluating the client's understanding of non-modifiable risk factors for cardiovascular disease. Which statement by the client indicates an understanding of non-modifiable risk factors?
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"I will ask my mother about our family history."
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"I will make an appointment with a dietician."
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"I will limit my daily alcohol intake."
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"I will start a regular walking schedule."
Explanation
Correct Answer: A) "I will ask my mother about our family history."
Non-modifiable risk factors are those that cannot be changed, such as age, gender, race, and family history of cardiovascular disease. By asking about family history, the client demonstrates understanding that genetic predisposition is a risk factor they cannot change but should be aware of. Making a dietician appointment, limiting alcohol, and starting a walking schedule all reflect modifiable risk factors, meaning they are lifestyle changes within the client's control.
Which monitoring action(s) should the nurse include in the plan of care for an older adult with age-related cardiovascular changes? (Select All that Apply.)
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Monitor for new onset of dysrhythmias
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Encourage sudden increases in exercise
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Take medications only when feeling symptoms
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Assess for the development of peripheral edema
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Regularly check for orthostatic hypotension
Explanation
Correct Answer: (A) Monitor for new onset of dysrhythmias, (D) Assess for the development of peripheral edema, (E) Regularly check for orthostatic hypotension
Age-related cardiovascular changes include decreased cardiac conduction efficiency, which increases the risk of dysrhythmias and warrants ongoing monitoring. Reduced venous tone and decreased cardiac output in older adults contribute to dependent fluid accumulation, making peripheral edema assessment an important component of ongoing care. Orthostatic hypotension is common in older adults due to impaired baroreceptor sensitivity and decreased vascular compliance, placing them at high risk for falls and syncope, so regular positional blood pressure checks are essential.
Why Other Options are Incorrect:
B. Encourage sudden increases in exercise Sudden increases in exercise intensity are dangerous for older adults with age-related cardiovascular changes and can precipitate arrhythmias, myocardial ischemia, or injury. Exercise should be introduced gradually and progressively under appropriate guidance.
C. Take medications only when feeling symptoms Many cardiovascular medications such as antihypertensives, anticoagulants, and antiarrhythmics must be taken consistently on a scheduled basis regardless of symptoms to maintain therapeutic levels and prevent serious complications. Symptom-based dosing is unsafe and contradicts standard medication management principles.
The nurse is caring for a client who presents with dermatitis. When performing a complete skin assessment, which action should the nurse implement?
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Inspect mainly exposed areas of the skin for signs of irritation
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Ask the client to describe the rash to determine the spread of the condition
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Fully inspect the skin, including under skin folds and under breasts
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Focus the skin assessment on areas where the client reports itching
Explanation
A complete skin assessment requires full-body inspection, including hidden and occluded areas such as skin folds, under the breasts, the groin, and between the toes. Dermatitis frequently develops in moist, occluded areas that may not be visible without a thorough examination, and limiting the assessment would risk missing significant findings.
Why the other options are incorrect:
A. Inspect mainly exposed areas of the skin for signs of irritation — Limiting assessment to exposed areas is incomplete and would miss dermatitis in concealed locations where it commonly occurs.
B. Ask the client to describe the rash to determine the spread — While subjective history is valuable, it cannot replace direct visual inspection for an accurate and complete skin assessment.
D. Focus the skin assessment on areas where the client reports itching — Restricting assessment to symptomatic areas is insufficient, as dermatitis can be present in areas that are not yet symptomatic.
The nurse is providing education to a client newly diagnosed with familial hypercholesterolemia (FH). The client asks, "Should my children be tested too?" How should the nurse respond?
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"Yes, your children have a 50% chance of having it."
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"No, children are too young to worry about cholesterol."
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"That's something your healthcare provider will decide."
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"Only if your children start showing symptoms."
Explanation
Correct Answer: (A) "Yes, your children have a 50% chance of having it"
Familial hypercholesterolemia is an autosomal dominant genetic disorder, meaning each first-degree relative of an affected individual, including children, has a 50% chance of inheriting the condition. Early identification is critical because FH leads to significantly elevated LDL cholesterol from birth, dramatically increasing the lifelong risk of premature cardiovascular disease. Current guidelines recommend that children of affected parents be screened beginning as early as age 2, making early testing both appropriate and clinically urgent.
Why the other options are incorrect:
B. "No, children are too young to worry about cholesterol." This is factually incorrect and potentially harmful. FH is a genetic condition present from birth, and early cholesterol screening and lifestyle intervention in children are strongly recommended to prevent premature cardiovascular disease.
C. "That's something your healthcare provider will decide." While providers make final clinical decisions, the nurse has the knowledge and responsibility to provide accurate health education. Deflecting this evidence-based information is not appropriate therapeutic communication.
D. "Only if your children start showing symptoms." FH is largely asymptomatic in childhood despite dangerously elevated cholesterol levels. Waiting for symptoms to appear defeats the purpose of early detection and prevention.
What is the purpose of inspection during the cardiac assessment?
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To assess for abnormal valve closure and murmurs
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To visualize abnormalities such as bruising or wounds
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To assess the size and location of the heart
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To feel for structural abnormalities and assess pulsations
Explanation
Correct Answer: (B) To visualize abnormalities such as bruising or wounds
Inspection is the first step of physical assessment and involves using the sense of sight to observe the patient. During a cardiac assessment, inspection is used to visualize the chest wall for abnormalities such as bruising, wounds, scars, visible pulsations, or chest deformities. It provides initial visual data before proceeding to auscultation, palpation, and percussion.
Why the other options are incorrect:
A. To assess for abnormal valve closure and murmurs Assessing for murmurs and valve sounds is accomplished through auscultation using a stethoscope, not through visual inspection.
C. To assess the size and location of the heart Determining heart size and position is achieved through percussion, which involves tapping the chest wall to detect changes in sound, not through inspection.
D. To feel for structural abnormalities and assess pulsations Palpation involves using the hands to feel for abnormalities, thrills, and pulsations. This is a distinct assessment technique separate from inspection.
The nurse is assessing a client with coronary artery disease. Which question should the nurse ask to assess for angina?
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Do you experience palpitations while at rest?
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Do you feel short of breath when laying down?
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Do you experience chest pain when you exercise?
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Do you feel short of breath when walking up stairs?
Explanation
Correct Answer: C) Do you experience chest pain when you exercise?
Angina pectoris is chest pain or discomfort caused by reduced blood flow to the heart muscle, most commonly triggered by physical exertion or emotional stress in clients with coronary artery disease. During exercise, myocardial oxygen demand increases, and in the presence of coronary artery narrowing, the supply cannot meet the demand, resulting in ischemic chest pain.
Asking specifically about chest pain with exertion is the most direct question to assess for classic stable angina. Palpitations at rest suggest dysrhythmia. Shortness of breath when lying down describes orthopnea, a hallmark of heart failure. Shortness of breath on exertion may suggest heart failure or pulmonary disease but does not specifically assess for angina.
Which should be included in the health history assessment for the eyes?
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Sexual history
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History of smoking
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Mood changes
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Dietary preferences
Explanation
Correct Answer: (B) History of smoking
Smoking is a well-documented risk factor for several serious eye conditions including cataracts, macular degeneration, and optic nerve damage. Including smoking history in an eye health assessment is clinically relevant and directly impacts ocular health outcomes.
Why the other options are incorrect:
A. Sexual history — Sexual history is not a standard component of an eye health assessment unless a specific sexually transmitted infection with ocular manifestations is being investigated.
C. Mood changes — Mood changes are relevant to mental health assessments and neurological evaluations but are not a standard part of an ocular health history.
D. Dietary preferences — While certain nutritional deficiencies can affect eye health, dietary preferences are not a priority component of a standard ocular health history compared to smoking history.
The nurse received shift report on several clients. Which client should the nurse assess first?
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A client with post-operative atelectasis who becomes suddenly short of breath
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A client with lung cancer who has fatigue, nausea, weight loss, and mild cough
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A client with pneumonia is being discharged and needs an influenza vaccination
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A client with chronic obstructive pulmonary disease (COPD) with a barrel chest
Explanation
Correct Answer: A) A client with post-operative atelectasis who becomes suddenly short of breath
A sudden onset of shortness of breath in a post-operative client with atelectasis represents an acute change in respiratory status that requires immediate assessment, as it may indicate progression to a more serious condition such as pulmonary embolism, pneumothorax, or severe hypoxia.
Sudden changes in a client's condition always take priority over chronic or stable findings. The lung cancer client's symptoms are chronic and expected. The discharge client's vaccination is a non-urgent administrative task. The COPD client's barrel chest is a chronic, expected finding that does not require immediate intervention.
A nurse auscultates the heart at the fifth intercostal space at the left midclavicular line. What area is the nurse assessing?
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Aortic valve
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Tricuspid valve
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Mitral valve
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Pulmonic valve
Explanation
Correct Answer: (C) Mitral valve
The mitral valve, also known as the bicuspid valve, is best auscultated at the fifth intercostal space at the left midclavicular line, which corresponds to the cardiac apex and the point of maximum impulse (PMI). This is where S1 is most prominently heard and where mitral valve abnormalities such as mitral stenosis or mitral regurgitation murmurs are best detected.
Why Other Options are Incorrect:
A. Aortic valve The aortic valve is auscultated at the right second intercostal space along the right sternal border. This is one of the base locations of the heart.
B. Tricuspid valve The tricuspid valve is best heard at the left lower sternal border, typically at the fourth or fifth intercostal space near the sternum, not at the midclavicular line.
D. Pulmonic valve The pulmonic valve is auscultated at the left second intercostal space along the left sternal border, at the base of the heart on the left side.
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