Practice Quiz Answers
Unit 10
Question 1
The single best indicator of fluid status is the nurse’s assessment of the client’s:
A) Skin turgor
B) Intake and output
C) Serum electrolyte levels
D) Daily body weight.
Correct Answer: D
Explanation: Daily weights are the single most important indicator of fluid status.
A. Skin turgor is a measure of hydration, but it is not the single best indicator of a client’s fluid
status.
B. Intake and output measurements are an important nursing intervention for monitoring fluid
status; however, daily weights are the best indicator.
C. Serum electrolytes help monitor fluid status. Daily weights are the single best indicator of a
client’s fluid status.
Question 2
The client is assessed by the nurse as having a high risk for aspiration. The nursing diagnosis
identified for the client is “Self-care deficit, feeding related to unilateral weakness”. An appropriate
technique for the nurse to use when assisting the client with feeding is to:
A) Place food to the unaffected side of the mouth
B) Place the client in semi-Fowler’s position
C) Have the client use a straw
D) Use thinner liquids
Correct Answer: A
Explanation: If the client has unilateral weakness, the nurse should place food in the stronger
side of the mouth.
B. The client should be positioned in an upright, seated position to prevent aspiration.
C. Clients with unilateral weakness often have difficulty using a straw.
D. Thickened liquids are often tolerated better and will help prevent aspiration, as clients with
impaired swallowing often choke more with thin liquids.
Question 3
A school nurse in a high school is reviewing the nutritional needs of adolescents. The nurse is
aware that in this age group:
A) Vitamin A needs are increased
B) Calcium needs are increased
C) Vitamin B needs are decreased
D) Energy and caloric needs are decreased
Correct Answer: B
Explanation: Adolescents require an increase in calcium for bone formation and decrease the
risk for osteoporosis later in life.
A. Daily requirements for vitamin A are not increased during adolescence.
C. B-complex vitamins are needed to support heightened metabolic activity. The need for Vitamin
B is not decreased during the adolescent period.
D. Energy and caloric needs are increased to meet greater metabolic demands of growth during
the adolescent period.
Question 4
A client is suspected of having a fat-soluble vitamin deficiency. To assist the client with this
deficiency, the nurse informs the client:
A) “More exposure to sunlight and drinking milk could solve your nutritional problem.”
B) “Eating more pork, fish, eggs, and poultry will increase your vitamin B complex intake.”
C) “Increasing your protein intake will increase your negative nitrogen imbalance.”
D) “Decreasing your triglyceride levels by eating less saturated fats would be a good health
intervention for you.”
Correct Answer: A
Explanation: The fat-soluble vitamins are A, D, E, and K. With the exception of vitamin D, which
can be obtained through exposure to sunlight, these vitamins are provided through dietary intake,
including fortified milk.
B. The B vitamins are not fat soluble; they are water-soluble vitamins.
C. Increasing protein intake will improve (decrease) a negative nitrogen imbalance, not increase
it. Furthermore, increasing protein intake does not address the problem of a fat-soluble vitamin
deficiency.
D. Although this is a true statement, it does not address the problem of a fat-soluble vitamin
deficiency.
Question 5
According to the Food Guide, vegetables should be included in the average adult’s diet as:
A) 1 to 3 servings per day
B) 2 to 4 servings per day
C) 3 to 5 servings per day
D) 6 to 11 servings per day
Correct Answer: C
Explanation: According to the Food Guide Pyramid, the average adult’s diet should include three
to five servings of vegetables per day.
A. This is not the recommended number of servings per day for vegetables.
B. According to the Food Guide Pyramid, the average adult’s diet should include two to four
servings per day of fruit.
D. According to the Food Guide Pyramid, the average adult’s diet should include 6-11 servings
per day of grains.
Question 6
After a surgical procedure, the client is advanced to a full liquid diet. The nurse is able to
recommend which one of the following foods for this client?
A) Custard
B) Pureed meats
C) Soft fresh fruit
D) Canned soup
Correct Answer: A
Explanation: Custard is included in a full liquid diet.
B. Pureed meats are allowed in a pureed diet, not a full liquid diet.
C. Soft fresh fruit is not included in a full liquid diet. Fresh fruit is often part of a high-fiber diet.
Cooked or canned fruits are allowed on a mechanical soft diet.
D. Canned soup is not part of full liquid diet, as it may contain noodles or rice or vegetables.
Soups are allowed on a mechanical soft diet.
Question 7
For a client with a nursing diagnosis of “Fluid volume excess”, the nurse is alert to which one of
the following signs and symptoms?
A) Weak, thready pulse
B) Hypertension
C) Dry mucous membranes
D) Flushed skin
Correct Answer: B
Explanation: Hypertension is a symptom of fluid volume excess.
A. A weak, thready pulse is associated with fluid volume deficit. A bounding pulse is a symptom
of fluid volume excess.
C. Dry mucous membranes are symptomatic of fluid volume deficit, not excess.
D. Flushed skin is a symptom of fluid volume deficit.
Question 8
Of all of the following clients, the nurse recognizes that the individual who is most at risk for a fluid
volume deficit is:
A) A 6-month-old learning to drink from a cup
B) A 12-year-old who is moderately active in 80° F weather
C) A 42-year-old with severe diarrhea
D) A 90-year-old with frequent headaches
Correct Answer: C
Explanation: The client at greatest risk for a fluid volume deficit is the client who has severe
diarrhea. Any condition that results in the loss of GI fluids predisposes the client to dehydration
and a variety of electrolyte disturbances.
A. The very young are at risk for a fluid volume deficit because their body-water loss is
proportionately greater per kilogram of weight. However, the very young client is not the individual
at most risk for fluid volume deficit.
B. A 12-year-old who is moderately active in warm weather will lose body water through sweating,
but is not the individual at greatest risk for a fluid volume deficit.
D. The very old are at increased risk for fluid volume deficit as they have a decreased thirst
sensation and a decreased number of filtering nephrons. However, this older adult client is not
the individual at greatest risk for a fluid volume deficit.
Question 9
The nurse anticipates that the client with a fluid volume deficit will manifest a(n):
A) Increased blood pressure
B) Increased body weight
C) Increased urine specific gravity
D) Increased pulse strength
Correct Answer: C
Explanation: The nurse would anticipate an increased urine specific gravity with fluid volume
deficit.
A. Hypertension is manifested with fluid volume excess.
B. The nurse would anticipate a decrease, not an increase, in body weight with fluid volume
deficit.
D. The nurse would anticipate a decrease, not an increase, in pulse strength, in fluid volume
deficit.
Question 10
While doing a nutritional assessment of a low-income family, the community health nurse
determines that the family’s diet is inadequate in protein content. The nurse suggests which of the
following foods to increase protein content with little increase in food expenditure?
A) Oranges and potatoes
B) Potatoes and rice
C) Rice and macaroni
D) Peas and beans
Correct Answer: D
Explanation: For families on limited budgets, substitutes can be used. For example, bean or
cheese dishes can often replace meat in a meal. Peas and lentils also are inexpensive food
sources of protein.
A. Oranges and potatoes are not high in protein content.
B. Potatoes and rice are sources of carbohydrates, not protein.
C. Rice and macaroni are carbohydrates and are not high in protein.
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