(HA Ch 4) PrepU - Health History

During a health history, a client asks why family information is requested. Which response should the nurse make to the client? a) "It can help identify any illnesses that you might be at risk for developing." b) "It is used to predict your longevity." c) "It helps determine your response to prescribed medications." d) "It helps determine what health problems you might be experiencing now."

a) "It can help identify any illnesses that you might be at risk for developing." The family history is an important part of the patient history. An accurate family history can identify diseases, which the patient is at increased risk of developing. A family history is not used to predict longevity, determine response to medications, or help determine the health problems the client may be currently experiencing.

While completing a history of present illness the nurse asks the client about risk factors. In which way should the nurse use this information? a) Analyze as a contributing factor to the current problem b) Speculate a genetic reason for the health problem c) Determine if a family history of the problem exists d) Use to determine health teaching to prepare

a) Analyze as a contributing factor to the current problem Risk factors or other pertinent information related to the symptom is frequently relevant, such as risk factors for health problem or a current medication that may have side effects similar to the complaint. Risk factors are not used to determine health teaching, identify a genetic cause, or determine if a family history of the problem exists.

During the comprehensive health assessment, the nurse asks several questions relating to the client's family history of illnesses, such as diabetes and cancer. Why does the nurse do this? Select all that apply. a) To help identify those diseases for which the client may be at risk b) To identify genetic family trends for which the client is at risk c) To elicit negative family history d) To help the client feel at ease and not worry about being sick e) To provide counseling and health teaching in high-risk areas

a) To help identify those diseases for which the client may be at risk e) To provide counseling and health teaching in high-risk areas b) To identify genetic family trends for which the client is at risk The nurse asks the client about the health of close family members (ie, parents, grandparents, siblings) to help identify those diseases for which the client may be at risk and to provide counseling and health teaching. Information concerning client and family history may be elicited to identify genetic family trends. The primary reasons are not to identify a negative family history or help the client feel at ease and not worry about being sick.

A client says that food is not important and meals are not enjoyable. Where should the nurse document this information? a) nutrition health pattern b) gastrointestinal review of systems c) history of present illness d) past medical history

a) nutrition health pattern Information about diet and intake should be documented within the nutrition health pattern. There is no evidence to support that this is the a past or present health problem for the client. It would not be appropriate to document this information within the gastrointestinal review of systems.

A patient comes to the emergency department with severe abdominal pain. When performing a complete assessment, the nurse would focus on which of the following areas when covering past health history? a) previous medical and surgical problems b) aggravating factors of the pain c) intensity of the pain d) duration of the pain

a) previous medical and surgical problems The past health history includes asking about previous medical and surgical problems along with their dates. Aggravating factors, duration, and intensity of the pain are all part of the history of present illness.

A client reports feeling depressed for several months since being fired from a long-term job. Which question should the nurse include when assessing this client? a) "Have you considered a job placement agency?" b) "Have you thought of hurting yourself?" c) "Are you looking for a new job?" d) "How are you managing financially?

b) "Have you thought of hurting yourself?" If the client seems depressed, ask about thoughts of suicide: "Have you ever thought about hurting yourself or ending your life?" The severity of the depression needs to be assessed since it could be lethal. Asking about a job search or finances are not appropriate questions when a client is depressed.

Which observation would cause the nurse to suspect an abusive situation? Select all that apply. a) A parent allows the adolescent to speak privately with the nurse. b) A child is persistent in trying to please a parent. c) A pre-schooler rubs her perineum and complains of it hurting. d) A caregiver of a cognitively intact older adult dominates the interview. e) The explanation of an injury seems appropriate.

b) A child is persistent in trying to please a parent. d) A caregiver of a cognitively intact older adult dominates the interview. c) A pre-schooler rubs her perineum and complains of it hurting. Observations suggestive of possible abuse include a caregiver of a cognitively intact older adult dominating the interview, a child being persistent in trying to please a parent, and a pre-schooler rubbing her perineum and complaining of it hurting. Observations not suggestive of abuse include a parent allowing an adolescent to speak privately with the nurse and an explanation that is appropriate for an injury.

The nurse is assessing a client's lifestyle and habits. At which time should the nurse assess the client for alcohol use? a) Before assessing for vaccinations b) After assessing for cigarette use c) During the review of systems d) While completing the family history

b) After assessing for cigarette use Questions about alcohol and other drugs follow naturally after questions about cigarettes. Questions about alcohol intake occurs before the review of systems. Alcohol intake is a risk factor that is assessed after vaccinations. Alcohol use is assessed before completing the family history.

A patient arrives at the Emergency Department reporting shortness of breath. She is cyanotic with bilateral wheezing. The patient begins to gasp for air and cannot speak. The nurse begins to gather information so that interventions can resolve the immediate breathing problem. Her assessment and interventions are concurrent. The nurse is performing what type of health history? a) Comprehensive b) Emergency c) Primary d) Focused

b) Emergency The nurse is performing an emergency health history, the purpose of which is to collect the most important information and defer obtaining details until the patient is stable. The focused health history involves questions that relate to the current situation. The comprehensive health history takes place during an annual physical examination. There is not a primary health history for patients.

During the interview process, the nurse obtains what type of data from the client? a) Oral b) Primary c) Secondary d) Objective

b) Primary Nurses collect primary data from clients themselves. Secondary data come from family and medical records. Objective data are data observed. Oral data is a form of data obtained through conversation.

A nurse draws a genogram to help organize and illustrate a client's family history. Which shape is a standard format for representing a deceased female relative? a) Simple circle b) Simple square c) Circle with a cross d) Square with a cross

c) Circle with a cross The standard format for representing a deceased female relative in a genogram is using a circle with a cross. A simple circle indicates a living female relative. A simple square indicates a living male relative. A square with a cross indicates a deceased male relative.

The patient is being interviewed upon arrival in the Emergency Department. When collecting subjective data from the patient, the nurse is obtaining what other type of data from the patient? a) Objective b) Tertiary c) Primary d) Secondary

c) Primary Subjective data given by the patient are considered primary data. Charts and family are sources of secondary data, while objective data are based upon tests, vital signs, and examinations. At present, no data are called tertiary.

As a nursing student you learn that mastering all the components of the comprehensive history provides what? a) Authority b) Empathy c) Proficiency d) Advocacy

c) Proficiency Mastery of all the components of the comprehensive history provides proficiency and the ability to select the elements most pertinent to the patient encounter.

The nurse is assessing an older adult client a hospice unit. The client cannot speak or communicate, but the client's daughter is there and answers all the questions as best as she can. What type of data source is the daughter? a) Primary b) Tertiary c) Secondary d) Subjective

c) Secondary Charts and family members are considered secondary data sources. Primary data would be directly from the client. Subjective data are based on the signs and symptoms that the patient reports; they may not be perceived by observers.

A client comes to the office for evaluation of fatigue. He has come to the office many times in the past with various injuries, and the nurse suspects that the client has a problem with alcohol. Which of the following questions will be most helpful in diagnosing this problem? a) Do you drink 2 to 3 beers every weekend? b) You are an alcoholic, aren't you? c) When was your last drink? d) Do you drink alcohol when you are supposed to be working?

c) When was your last drink? "When was your last drink?" is a good opening question that is general and neutral in tone; depending on the timing, the nurse will be able to ask for more specific information related to the client's last drink. The other questions may close the conversation down because they are close-ended. Asking "Do you drink alcohol when you are supposed to be working?" implies negative behavior and may also keep the person from sharing freely.

During a health history, a client reports drinking bloody Mary's several mornings a week before going to work. In which part of the CAGE questionnaire should the nurse document this information? a) Guilty feelings b) Annoyance c) Cutting down d) Eye-openers

d) Eye-openers The client drinking alcohol in the morning would be applicable to the area on eye-openers specifically the question "Have you ever taken a drink first thing in the morning (Eye-opener) to steady your nerves or get rid of a hangover? This information is not applicable to the other areas of the CAGE questionnaire, specifically, annoyance, cutting down, or guilty feelings.

During the review of systems, a client reports dizziness, tingling, and mood changes. In which area should the nurse document this information? a) Cardiovascular b) Fluid and electrolytes c) Psychiatric d) Neurologic

d) Neurologic Dizziness, tingling, and mood changes would be documented under neurologic. Nervousness, tension, depression, memory change, and suicide attempts should be documented under psychiatric. This information is not appropriate to document under cardiovascular or fluid and electrolytes.

A comprehensive health history includes which components? Select all that apply. a) Income b) History of present illness c) Past health history d) Reason for seeking care e) Employment history

d) Reason for seeking care b) History of present illness c) Past health history Usually the nurse collects demographical data first and then elicits from clients a complete description of their reason for seeking care, because that information usually is most important. The nurse collects information about the present illness by beginning with open-ended questions and having clients explain symptoms. A complete description of the present illness is essential to an accurate diagnosis.