Nursing Elites

1. When assessing for criteria that signify malnutrition risk, which element would most likely be included as part of the functional assessment data?

• A. severity of illness
• B. presence of pressure sores
• C. localized edema
• D. generalized weakness

Correct answer: D

Rationale: Generalized weakness is a key indicator of malnutrition and is often assessed as part of functional status, reflecting muscle wasting and reduced physical function. The other choices, such as severity of illness, presence of pressure sores, and localized edema, are important factors to consider in a clinical assessment but are not primarily indicative of malnutrition risk. Generalized weakness directly relates to the functional impact of malnutrition on physical performance.

2. This flip-over card is usually kept in a portable file at the Nurse’s Station. It has 2-parts: the activity and treatment section and a nursing care plan section. This carries information about basic demographic data, primary medical diagnosis, current orders of the physician to be carried out by the nurse, written nursing care plan, nursing orders, scheduled tests and procedures, safety precautions in patient care and factors related to daily living activities. This record is used in the charge-of-shift reports or during the bedside rounds or walking rounds. What record is this?

• A. Discharge Summary
• B. Medicine and Treatment Record
• C. Nursing Health History and Assessment Worksheet
• D. Nursing Kardex

Correct answer: C

Rationale: Effective nursing care involves comprehensive assessments that address all aspects of a patient's condition, ensuring that interventions are appropriately targeted and outcomes are optimized.

3. In PEM, which condition is characterized by symptoms such as muscle weakness, hanging skin, delayed tooth eruption, and changes in saliva?

• A. Marasmus
• B. Kwashiorkor
• C. Anemia
• D. Noma

Correct answer: A

Rationale: The correct answer is Marasmus. Marasmus is a severe form of protein-energy malnutrition (PEM) that leads to muscle wasting, hanging skin, delayed growth, and changes in saliva. These symptoms are commonly seen in vulnerable populations such as children, homeless individuals, older adults, and substance abusers. Kwashiorkor, on the other hand, is characterized by edema, a distended belly, and skin lesions. Anemia is a condition characterized by a low red blood cell count, leading to fatigue and weakness. Noma is a severe infection affecting the face, particularly the mouth and jaw area.

4. The nurse understands that malnutrition is a prevalent issue among hospitalized individuals. What is it commonly associated with?

• A. Decreased health care expenses
• B. Elevated blood pressure
• C. Decreased mortality rates
• D. A compromised immune system

Correct answer: D

Rationale: Malnutrition is often associated with a weakened immune system. This is because when the body is not sufficiently nourished, it lacks the necessary nutrients to maintain a well-functioning immune system, making patients more vulnerable to infections and other health complications. This can potentially increase mortality rates and prolong hospital stays, contrary to choice C. Choices A and B are incorrect as malnutrition does not lead to decreased health care costs or high blood pressure. In fact, it may increase health care costs due to the potential for increased complications and extended hospital stays.

5. The nurse understands that one of these factors contributes to constipation:

• A. excessive exercise
• B. high fiber diet
• C. no regular time for defecation daily
• D. prolonged use of laxatives

Correct answer: A

Rationale: Patient safety and efficacy of care depend on actions rooted in established nursing protocols that consider both the immediate and long-term needs of the patient.

Similar Questions