Nursing Elites

1. When conducting assessments for malnutrition, which risk factors should the nurse consider? (SATA)

• A. Dental problems
• B. Depression
• C. Ability to read and write
• D. All of the above

Correct answer: D

Rationale: When assessing for malnutrition, nurses should consider multiple risk factors. Dental problems and depression can impact a person's ability to eat and maintain proper nutrition. The ability to read and write may not directly relate to malnutrition risk. The correct answer is 'All of the above' because dental problems and depression are indeed risk factors, along with other factors like the inability to prepare meals and the loss of a spouse.

2. Which of the following actions would be of highest priority with regards to the external shunt?

• A. Avoid taking blood pressure or blood sample from the arm with the shunt
• B. Instruct the patient not to exercise the arm with the shunt
• C. Heparinize the shunt daily
• D. Change the dressing of the shunt daily

Correct answer: C

Rationale: Heparinizing the shunt daily (choice C) is the highest priority action as it prevents the formation of blood clots that can occlude the shunt, leading to potential complications such as thrombosis. Avoiding taking blood pressure or blood samples from the arm with the shunt (choice A) is also important, but secondary to heparinizing the shunt. Similarly, instructing the patient not to exercise the arm with the shunt (choice B) can help prevent unnecessary strain on the shunt, but it is not as critical as preventing clot formation. Changing the dressing of the shunt daily (choice D) is a standard nursing care practice to prevent infection, but again, it is not as critical as ensuring the shunt remains patent through daily heparinization.

3. Which suggestion is most appropriate to increase calorie intake for a patient with stomach cancer, aiming to prevent weight loss and wasting?

• A. Replace whole fat milk with skim milk or water
• B. Avoid peanut butter and other nuts
• C. Choose high-fat meat instead of lean meat
• D. Limit alcohol intake to two drinks per day

Correct answer: C

Rationale: The correct answer is C: Choose high-fat meat instead of lean meat. High-fat meats are more calorie-dense than lean meats, which makes them a good choice for increasing calorie intake. This is crucial for patients with stomach cancer who want to avoid weight loss and wasting. Choice A is incorrect because skim milk or water contains fewer calories than whole fat milk. Choice B is also incorrect because peanut butter and nuts are high in calories and therefore should not be avoided when trying to increase calorie intake. Finally, choice D is not a good suggestion to increase calorie intake as alcohol does not provide the necessary nutrients needed for a balanced diet. In fact, excessive alcohol can harm the liver and other organs, and it's not a reliable source of calories.

4. A nurse is caring for four clients. The nurse should plan to administer total parenteral nutrition for which of the following clients?

• A. A client who is postoperative following a laminectomy and is receiving IV PCA
• B. A client who has dysphagia and does not recognize his family
• C. A client who has COPD and is going home with oxygen
• D. A client who has colon cancer and will undergo a hemicolectomy

Correct answer: D

Rationale: Total parenteral nutrition (TPN) is essential for clients undergoing significant surgical procedures like a hemicolectomy to ensure they receive adequate nutrition when oral intake is not possible. Choices A, B, and C do not typically require TPN. Choice A is managing postoperative pain with IV PCA, choice B is likely to need alternative feeding methods due to dysphagia, and choice C is going home with oxygen for COPD management, which does not directly relate to the need for TPN.

5. The purpose of the health history is to identify health-related considerations and medications that may cause nutritional risk. Many medications, such as prednisone, have drug-nutrient interactions that can influence nutrient needs.

• A. Both statements are true
• B. Both statements are false
• C. The first statement is true; the second is false
• D. The first statement is false; the second is true

Correct answer: A

Rationale: Both statements are true. The health history aims to uncover health-related factors that could pose nutritional risks, including medications like prednisone that may have interactions affecting nutrient requirements. Choice B is incorrect as both statements are accurate, emphasizing the significance of health history in assessing nutritional concerns.

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