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. After a vaginal examination, the nurse determines that the client’s fetus is in an occiput posterior position. The nurse would anticipate that the client will have:

• A. A precipitous birth
• B. Intense back pain
• C. Frequent leg cramps
• D. Nausea and vomiting

Correct answer: D

Rationale: Understanding the underlying pathology and therapeutic techniques ensures that nursing care is not only reactive but also preventative, reducing the risk of complications.

3. What is the absorbable unit of a protein?

• A. Amino acid
• B. Pepsin
• C. Glucose
• D. Sucrose

Correct answer: A

Rationale: Amino acids are the correct answer because they are the building blocks of proteins that the body absorbs after digestion. Pepsin, choice B, is incorrect as it is an enzyme that aids in the digestion of proteins, not the absorbable unit of them. Choices C and D, glucose and sucrose, are wrong because they are types of sugars, not proteins.

4. A client who is 2 days postoperative following abdominal surgery is about to progress from a clear liquid diet to full liquids. Which of the following items should the nurse tell the client he may now request to have on his meal tray?

• A. Cranberry juice
• B. Flavored gelatin
• C. Skim milk
• D. Chicken broth

Correct answer: A

Rationale: Cranberry juice is an appropriate choice for a client transitioning from a clear liquid diet to full liquids post abdominal surgery. It provides hydration and some essential nutrients. Flavored gelatin is usually allowed on a clear liquid diet and may not be suitable for a full liquids phase. Skim milk and chicken broth are typically introduced in a later stage of the diet progression, closer to a soft diet, due to their higher protein and fat content.

5. A factor contributing to the risk for dehydration in the older adult is that _____.

• A. drinking fluids causes loss of bladder control
• B. older adults do not seem to notice mouth dryness as readily as younger people
• C. increased fluid intake will decrease the intake of nutrient-dense foods
• D. changes in intestinal motility contribute to excess fluid loss

Correct answer: C

Rationale: Older adults may not notice mouth dryness as readily as younger individuals, increasing their risk for dehydration, especially if they do not consciously increase fluid intake.

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