Describe four components of health promotion.
QUESTION 5: Chapter 5, Adult Health and Nutritional Assessment
The registered nurse prepares to conduct a nutritional assessment on Mrs. Varner, a 52-year-old Caucasian female who describes herself as “overweight most of my adult life.” The client states that her health is good. She works part time as a receptionist and volunteers about 10 hours per week in her church. The nurse obtains Mrs. Varner’s height as 64 inches and her weight as 165 pounds. (Learning Objective 8)
a. What is the rationale for computing body mass index? What is Mrs. Varner’s BMI?
b. Calculate her ideal body weight. What is your assessment of her BMI and weight?
c. Based on Mrs. Varner’s BMI and weight, the nurse measures her waist circumference. Describe the proper procedure for this assessment.
d. Mrs. Varner’s waist circumference is 38 inches. What is your assessment?
e. What laboratory values would the nurse review to evaluate Mrs. Varner’s protein levels?
QUESTION 6: Chapter 6, Individual and Family Homeostasis, Stress, and Adaptation
Mary Turner stepped on a nail 5 days ago and sustained a puncture about 1 inch deep. She immediately cleaned the area with soap and water and hydrogen peroxide, and applied triple antibiotic ointment to the site. Today she comes to the clinic with complaints of increased pain and swelling in her foot. On assessment, the nurse notes that the puncture site is red and edematous, and has a moderate amount of yellowish drainage. (Learning Objective 9)
a. Describe the sequence of events that caused the local inflammation seen in Mary’s foot.
b. What is the role of histamine and kinins in the inflammatory process?
c. Which of the five cardinal signs of inflammation does Mary exhibit?
d. Because Mary’s injury occurred 5 days ago, the nurse should assess for what systemic effects?
Chapter 7, Overview of Transcultural Nursing
The nurse manager of an ambulatory care clinic has noted an increased number of visits by patients from different countries and cultures, including patients from Mexico and other Latin American countries. Concerned about meeting the needs of this culturally diverse population, the nurse manager convenes a staff meeting to discuss this change in patient demographics, and to query the staff about any learning needs they have related to the care of these patients. (Learning Objective 3)
a. What strategy to avoid stereotyping clients from other cultures should the nurse include in this meeting?
b. Identify culturally sensitive issues to be discussed in the staff meeting.
c. One technician on the staff complains that some patients never make eye contact, and this makes it difficult for him to complete his work. How should the nurse respond?
QUESTION 8: Chapter 8, Overview of Genetics and Genomics in Nursing
Mr. Wayne is a 38-year-old man with a significant family history of elevated cholesterol levels. His father died at age 42 from a massive heart attack secondary to elevated cholesterol and triglycerides, and two of his older siblings are currently taking medications to lower their cholesterol levels. Mr. Wayne makes an appointment to discuss his risk for hypercholesterolemia. The nurse recognizes that Mr. Wayne is at risk for familial hypercholesterolemia because this is an autosomal dominant inherited condition. (Learning Objective 2)
a. Describe the pattern of autosomal dominant inheritance.
b. Mr. Wayne asks what chance his children have of developing familial hypercholesterolemia. How should the nurse respond?
c. Explain the phenomenon of penetrance observed in autosomal dominant inheritance.
QUESTION 9: Chapter 9, Chronic Illness and Disability
Mr. Edwards is 20-year-old male patient who is admitted for treatment of recurring pyelonephritis (kidney infection) and surgical treatment of a urinary stricture, which has decreased the urinary stream. Mr. Edwards has paraplegia; he is paralyzed from the waist down secondary to an automobile accident when he was 16. He came by ambulance to the hospital, leaving his wheelchair and wheelchair pressure-relieving cushion at home. According to the nursing history, the patient is a nonsmoker and he does not drink alcohol or take any illegal drugs. (Learning Objective 5)
a. What nursing considerations should be made for Mr. Edwards related to his disability?
b. What health promotion and prevention education does Mr. Edwards need?
QUESTION 10: Chapter 10, Principles and Practices of Rehabilitation
You are assigned to care for David Ramsey, a 22-year-old male patient who sustained a back injury secondary to being thrown from a motorcycle. He did not damage the spinal cord, but the computed tomography revealed a compression fracture at L-2 (lumbar area). David complains of severe lower back pain with numbness and tingling in the lower extremities. You identify the following nursing diagnosis: Impaired Physical Mobility.
(Learning Objective 4)
a. What assessments are indicated based on this nursing diagnosis?
b. List other major nursing diagnoses based on David’s clinical presentation.
Chapter 11, Health Care of the Older Adult
The nurse working at the senior center notices Mrs. Jones, a 78-year-old, crying. The nurse approaches Mrs. Jones and asks if she needs help. Mrs. Jones states “I am so embarrassed. I had another accident and my pants are all wet. It’s like I’m a baby. I never should have come to the senior center.” (Learning Objectives 3 and 4)
a. What factors may be contributing to the urinary incontinence?
b. How should the nurse respond to Mrs. Jones?
Chapter 12, Pain Management
Mr. Rogers is 2 days postoperative of a thoracotomy for removal of a malignant mass in his left chest. His pain is being managed via an epidural catheter with morphine (an opioid analgesic). As the nurse assumes care of Mr. Rogers, he is alert and fully oriented, and states that his current pain is 2 on a 1-to-10 scale. His vital signs are 37.8 – 92 – 12, 138/82. (Learning Objective 6)
What are benefits of epidural versus systemic administration of opioids?
b. The nurse monitors Mr. Rogers’ respiratory status and vital signs every 2 hours. What is the rationale for these frequent assessments?
c. The nurse monitors Mr. Rogers for what other complications of epidural analgesia?
d. Mr. Rogers complains of a severe headache. What should the nurse do?
e. Mr. Rogers’ epidural morphine and decreased mobility increase his chances of constipation. What interventions should be included in his plan of care to minimize constipation?
Chapter 13, Fluid and Electrolytes: Balance and Disturbance
Mrs. Dean is 75-year-old woman admitted to the hospital for a small bowel obstruction. Her medical history includes hypertension. Mrs. Dean is NPO. She has a nasogastric (NG) tube to low continuous suction. She has an IV of 0.9% NS at 83 mL/hr. Current medications include furosemide 20 mg daily and hydromorphone 0.2 mg every 4 hours, as needed for pain. The morning electrolytes reveal serum potassium of 3.2 mEq/L. (Learning Objective 4)
a. What are possible causes of a low potassium level?
b. What action should the nurse take in relation to the serum potassium level?
c. What clinical manifestations might the nurse assess in Mrs. Dean?