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. A nurse is caring for an older adult client who reports difficulty chewing due to ill-fitting dentures. Which of the following foods should the nurse recommend for the client?

• A. Dried fruit
• B. Roast beef
• C. Tuna fish
• D. Apple slices

Correct answer: C

Rationale: The correct answer is C: Tuna fish. Tuna fish is a soft and easy-to-chew option, suitable for clients with ill-fitting dentures. Dried fruit (choice A) can be tough to chew and may stick to the dentures, causing discomfort. Roast beef (choice B) requires significant chewing effort and may not be suitable for someone with difficulty chewing. Apple slices (choice D) are crunchy and hard, which can be challenging for individuals with ill-fitting dentures.

3. In monitoring the patient in PACU, the nurse correctly identifies that checking the patient's vital signs is done every:

• A. 1 hour
• B. 5 minutes
• C. 15 minutes
• D. 30 minutes

Correct answer: A

Rationale: Correct Answer: A - Vital signs monitoring in the PACU (Post-Anesthesia Care Unit) is typically done every hour to closely monitor the patient's condition during the immediate postoperative period. This frequency allows the nurse to promptly identify any changes in the patient's vital signs and intervene as necessary. Choice B (5 minutes) is too frequent for routine vital signs monitoring in the PACU and may not allow for a comprehensive assessment of the patient's stability. Choice C (15 minutes) and Choice D (30 minutes) are also not in line with the standard practice of vital signs monitoring in the PACU, which is typically hourly.

4. A nurse is teaching a client about complete and incomplete proteins. Which of the following foods should the nurse include in the teaching as an incomplete protein?

• A. 4 oz chickpeas
• B. 2 poached eggs
• C. 2 oz cheddar cheese
• D. 4 oz salmon fillet

Correct answer: A

Rationale: The correct answer is A: 4 oz chickpeas. Chickpeas are considered an incomplete protein because they lack one or more essential amino acids required by the body. Incomplete proteins do not provide all essential amino acids in sufficient quantities. Choice B, 2 poached eggs, is a complete protein source because eggs contain all essential amino acids. Choice C, 2 oz cheddar cheese, is also a complete protein as it contains all essential amino acids. Choice D, 4 oz salmon fillet, is another complete protein source as fish typically provide all essential amino acids needed by the body.

5. Toilet training occurs in the anal stage of Freud’s psychosexual development. This is equivalent to Erikson’s:

• A. Trust vs. Mistrust
• B. Autonomy vs. Shame and Doubt
• C. Initiative vs. Guilt
• D. Industry vs. Inferiority

Correct answer: A

Rationale: The correct answer is A: Trust vs. Mistrust. In Freud's psychosexual development theory, the anal stage is where toilet training occurs, focusing on issues of control and independence. This stage is parallel to Erikson's Trust vs. Mistrust stage, where infants learn to trust or mistrust their caregivers based on the consistency of care they receive. Choices B, C, and D are incorrect as they correspond to different stages in Erikson's psychosocial development theory, not related to toilet training or the anal stage of Freud's theory.

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