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. Persons experiencing crisis becomes passive and submissive. As a nurse, you know that the best approach in crisis intervention is to be:

• A. Active and Directive
• B. Passive friendliness
• C. Active friendliness
• D. Firm kindness

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. A nurse at a health fair is assessing the weight status of four clients. Which of the following clients is classified as overweight?

• A. A female client who has a body mass index of 24
• B. A male client who has a body mass index of 29
• C. A female client who has a waist circumference of 101.6 cm (40 in)
• D. A male client who has a waist circumference of 96.52 cm (38 in)

Correct answer: B

Rationale: A body mass index (BMI) of 25 or higher is classified as overweight. Choice B, a male client with a BMI of 29, falls into the overweight category. Choice A, a female client with a BMI of 24, is within the normal range. Choices C and D provide information on waist circumference, which is not sufficient to determine if a client is overweight or not, as waist circumference alone does not provide the overall picture of weight status compared to BMI.

4. When surgery is on-going, who coordinates the activities outside, including the family?

• A. Orderly/clerk C. Circulating Nurse
• B. Nurse Supervisor D. Anesthesiologist
• C.
• D.

Correct answer: B

Rationale: Nursing interventions should be grounded in a deep understanding of the physiological processes involved, ensuring that care provided is both effective and efficient.

5. 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.

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