Free NSC Clinical Knowledge Questions and Answers — Questions and Answers

Question 1: Which of the following clinical factors in an acute care hospital is LEAST likely to be a sign of a patient who is nutritionally at risk?

Extensive resection of the colon due to cancer
5% unplanned weight loss in a 1-month period
Inadequate nutrition for 10 days
Intentional weight loss of 15% over a 6-month period in an obese individual (Correct answer)

Correct answer: Intentional weight loss of 15% over a 6-month period in an obese individual

Intentional weight loss in an obese individual, especially when medically supervised, is often a positive health intervention aimed at improving health outcomes. In contrast, unplanned weight loss, extensive surgical resections, or prolonged inadequate nutrition are strong indicators of nutritional risk due to underlying disease, malabsorption, or insufficient intake, making them more concerning in an acute care setting.

Question 2: In an ICU situation, which of the following anthropometric techniques is LEAST helpful for assessing nutrition?

Comparing actual weight to either ideal weight or usual weight
Triceps skinfold (Correct answer)
Body mass index
Estimating idea body weight using height and Hamwi equation

Correct answer: Triceps skinfold

In an ICU setting, triceps skinfold measurements are often unreliable for assessing nutrition due to significant fluid shifts (edema) and the difficulty in obtaining accurate, consistent measurements on critically ill patients. These factors can lead to misleading results, making other anthropometric techniques or clinical assessments more practical and helpful in this acute care environment.

Question 3: Scaly, dry skin may be an indicator of malnutrition when conducting a physical examination that focuses on nutrition.

Essential fatty acid deficiency (Correct answer)
Vitamin A toxicity
Protein deficiency
Cholesterol deficieny

Correct answer: Essential fatty acid deficiency

Essential fatty acids (EFAs) are crucial for maintaining the integrity and function of skin cell membranes and the skin's barrier function. A deficiency in EFAs, particularly linoleic acid, can lead to impaired skin health, manifesting as characteristic symptoms like scaly, dry, and flaky skin, often accompanied by dermatitis.

Question 4: Which of the following drugs has the lowest potential to make you gain weight?

Elavil
Paxil
Prozaac
Wellbutrin (Correct answer)

Correct answer: Wellbutrin

Wellbutrin (bupropion) is an antidepressant that is generally associated with weight loss or weight neutrality, unlike many other antidepressants which can cause weight gain. Its mechanism of action, involving norepinephrine and dopamine reuptake inhibition, contributes to this different side effect profile regarding weight. Therefore, it has the lowest potential to cause weight gain among the listed options.

Question 5: The LEAST reliable marker to utilize when determining malnutrition in a critically unwell patient would be

Serum albumin of 2.5 g/dL (Correct answer)
Unplanned weight loss of 8% in a 4-month period
Body mass index of 16 kg/m2
Poor wound healing

Correct answer: Serum albumin of 2.5 g/dL

While a low serum albumin level (e.g., 2.5 g/dL) can be associated with malnutrition, it is also significantly affected by inflammation, hydration status, and liver disease, especially in critically ill patients. Therefore, it is considered a poor and unreliable indicator of acute malnutrition in this population. Other factors like significant unplanned weight loss, very low BMI, and poor wound healing are more reliable markers of nutritional compromise.

Question 6: Which of the following instruments is most useful for evaluating a patient who has both ascites and chronic liver disease?

Nitrogen Balance
Weight for height
Subjective Global Assessment (Correct answer)
Albumin and Prealbumin

Correct answer: Subjective Global Assessment

For patients with ascites and chronic liver disease, traditional anthropometric measures like weight for height are unreliable due to fluid retention masking actual body weight changes. Albumin and prealbumin levels are also confounded by liver dysfunction and inflammation. Subjective Global Assessment (SGA) is most useful as it relies on clinical judgment, patient history (weight changes, dietary intake), and physical examination (muscle wasting, fat loss, presence of edema/ascites) to assess nutritional status, making it less affected by fluid shifts.

Question 7: What weight should an obese patient with chronic renal disease use when performing calculations?

Adjusted dry weight (Correct answer)
Dry weight
Actual weight
Ideal weight

Correct answer: Adjusted dry weight

For obese patients with chronic renal disease, especially those with fluid retention, using actual weight can overestimate energy and protein needs due to excess adipose tissue and fluid. Ideal weight may underestimate needs. Adjusted dry weight accounts for excess body fat while considering the patient's fluid status, providing a more accurate basis for calculating nutritional requirements in this complex patient population.

Question 8: The patient is taking Zerit, an anti-HIV medication. This medication could lead to

AIDS wasting syndrome
Malnutrition
Metabolic syndrome
Lipodystrophy (Correct answer)

Correct answer: Lipodystrophy

Zerit (stavudine) is an anti-HIV medication, specifically a nucleoside reverse transcriptase inhibitor (NRTI). A well-known side effect associated with long-term use of stavudine is lipodystrophy, which involves abnormal fat redistribution, such as fat loss in the face and limbs (lipoatrophy) and fat accumulation in the abdomen and neck (lipohypertrophy). This can lead to significant body image issues and metabolic complications.

Question 9: Which of the following best sums up when an enteral feeding regimen should be started for a patient who has had a traumatic brain injury?

Within 48 hours
Within 24 hours (Correct answer)
Once bowel sounds are distinctly heard
As soon as a nasogastric tube cab be placed

Correct answer: Within 24 hours

Current clinical guidelines recommend initiating enteral nutrition within 24-48 hours for critically ill patients, including those with traumatic brain injury (TBI). Early enteral feeding helps to support metabolic needs, preserve gut integrity, and has been shown to improve patient outcomes by reducing infection rates and preventing catabolism. Waiting for bowel sounds is an outdated practice.

Question 10: In the early postburn phase, what is a tolerable protein level for a patient with a 50% TBSA?

2.0-2.5 grams per kg (Correct answer)
1.0-1.2 grams per kg
1.2-1.5 grams per kg
1.5-2.0 grams per kg

Correct answer: 2.0-2.5 grams per kg

Patients with severe burns, such as a 50% TBSA, experience a profound hypermetabolic and hypercatabolic response, leading to significant protein breakdown and increased nitrogen losses. To counteract this catabolism, support wound healing, and maintain immune function, very high protein intakes, typically in the range of 2.0-2.5 grams per kg of body weight, are required in the early postburn phase.

Question 11: With the intention of weaning in the next days, a COPD patient who is experiencing respiratory failure is presently receiving mechanical ventilation. At 95% of his typical body weight, he is 85% of his optimum weight. Which weight would be most appropriate to use when figuring out how much energy is needed?

Adjusted weight
Ideal weight
Usual weight
Actual weight (Correct answer)

Correct answer: Actual weight

For a COPD patient who is 95% of his usual body weight and 85% of his optimum weight, his actual weight is the most appropriate to use for energy calculations. While he is below optimum, he is not severely underweight, and using actual weight ensures that current metabolic needs are met without overfeeding or underfeeding based on theoretical or adjusted weights that may not reflect his current physiological state.

Free NSC Clinical Knowledge Questions and Answers

Which of the following clinical factors in an acute care hospital is LEAST likely to be a sign of a patient who is nutritionally at risk?