The nurse examines a patient who has asthma and chronic hypoxemia. The nurse would expect to find which condition of the nails?

Clubbing

Onychomycosis

Spooning

Paronychia

Answer and Explanation

The Correct Answer is A

Choice A reason: Clubbing, characterized by bulbous nail bed enlargement, is associated with chronic hypoxemia from conditions like asthma or COPD. It results from long-term low oxygen levels, making it the expected finding in this patient with chronic respiratory issues.

Choice B reason: Onychomycosis is a fungal nail infection unrelated to hypoxemia or asthma. Clubbing is directly linked to chronic oxygen deficiency, so this is not the expected nail condition in this patient’s context.

Choice C reason: Spooning (koilonychia) is associated with iron deficiency anemia, not hypoxemia or asthma. Clubbing is the nail abnormality seen in chronic respiratory conditions, so this is incorrect for the patient’s condition.

Choice D reason: Paronychia is an infection around the nail, typically from trauma or bacteria, not hypoxemia. Clubbing is the hallmark nail change in chronic asthma with low oxygen, so this is not the expected finding.

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Correct Answer is B

Explanation

Choice A reason: A complete physical exam is comprehensive but not specific to initial nutritional screening. Height and weight history provide BMI, a quick nutritional indicator, so this is not the first assessment.

Choice B reason: Height and weight history are critical for initial nutritional screening, enabling BMI calculation to assess undernutrition or obesity. This is a standard, quick method, making it the correct first step.

Choice C reason: Calorie counting is detailed and time-consuming, unsuitable for initial screening. Height and weight offer a rapid baseline for nutritional status, so this is incorrect for the first step.

Choice D reason: Leg circumference may assess muscle mass but is not standard for initial nutritional screening. Height and weight are primary for BMI, so this is incorrect for the initial assessment.

A. Intelligence B. Cerebral cortex function C. Reflexes D. Cranial nerves

Correct Answer is C

Explanation

Choice A reason: Intelligence cannot be assessed in a 3-month-old, as cognitive abilities are not yet developed enough for evaluation. Sucking and grasping are innate behaviors driven by reflexes, not conscious thought, making this an incorrect assessment focus.

Choice B reason: Cerebral cortex function is immature in a 3-month-old, and sucking and grasping are primarily brainstem-mediated reflexes. These actions do not directly assess higher cortical functions like memory or reasoning, making this an incorrect choice.

Choice C reason: Sucking and grasping in a 3-month-old are primitive reflexes (sucking reflex and palmar grasp reflex), mediated by the brainstem. Assessing these evaluates normal neurological development, making this the correct focus of the nurse’s inquiry.

Choice D reason: While sucking involves Cranial Nerves V, VII, IX, and XII, and grasping involves spinal reflexes, the nurse is assessing the presence of these reflexes, not the cranial nerves directly. Reflex assessment is the primary focus, making this less precise.

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The nurse examines a patient who has asthma and chronic hypoxemia. The nurse would expect to find which condition of the nails?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

What is one of the first assessments that a nurse should include when performing an initial nutritional screening on a new patient?

Correct Answer is B

Explanation

While obtaining a health history of a 3-month-old infant from the mother, the nurse asks about the infant’s ability to suck and grasp the mother’s finger. What is the nurse assessing?

Correct Answer is C

Explanation

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