Unit 4.2: Nutrition, Hydration and Elimination

• Topic 01

  Malnutrition Universal Screening Tool (MUST)

  45 questions
• Topic 02

  Enteral Feeding

  45 questions
• Topic 03

  IV Fluid Therapy

  36 questions
• Topic 04

  Catheterisation, Urinary Output, and Urinalysis

  42 questions

A few questions from this unit, with the answer and a full explanation. The complete bank is available when you start practising.

1. What is the sodium concentration of 0.9% sodium chloride, and what metabolic complication can large volumes cause?

   • A
     0.9% NaCl contains 154 mmol/L sodium and 154 mmol/L chloride; large volumes cause metabolic alkalosis.
   • B
     0.9% NaCl contains 154 mmol/L of both sodium and chloride; large volumes cause hyperchloraemic metabolic acidosis due to the supraphysiological chloride load.
     Correct answer
   • C
     0.9% NaCl contains 131 mmol/L sodium and 111 mmol/L chloride; large volumes cause hyponatraemia.
   • D
     0.9% NaCl contains 154 mmol/L sodium only; it contains no chloride and the main complication is hypernatraemia.
   Explanation

   0.9% sodium chloride (often called 'normal saline') contains 154 mmol/L of both sodium and chloride. Plasma chloride levels are approximately 100 mmol/L. When large volumes (>2 litres) of 0.9% NaCl are administered, the excess chloride causes hyperchloraemic metabolic (non-anion gap) acidosis. This can impair renal tubular function and contribute to acute kidney injury. This is why balanced crystalloids (Hartmann's, Plasmalyte) are preferred for large-volume resuscitation and maintenance.

2. A patient with a MUST score of 4 is on a ward where the dietitian has a 3-day waiting list. A nurse asks: 'Can I implement nutritional support strategies myself, or must I wait for the dietitian?' Which answer is MOST appropriate?

   • A
     The nurse should implement basic nutritional strategies immediately (offering fortified foods, ensuring meals are offered, considering oral supplements per local formulary) and ensure the dietitian referral is made urgently; waiting 3 days before acting is not acceptable for a high-risk patient.
     Correct answer
   • B
     A MUST score of 4 requires intravenous nutritional support; the nurse cannot commence this without a medical prescription and dietitian involvement.
   • C
     The nurse must wait for the dietitian because implementing nutritional strategies without a dietitian's prescription is outside nursing scope of practice.
   • D
     The nurse should document the 3-day waiting list as the reason for the delay and continue routine care until the dietitian is available.
   Explanation

   MUST high risk management directs nurses to act immediately — 'treat' and refer. Nurses are expected to implement initial nutritional strategies proactively: offering fortified/enriched foods, ensuring meals are available and accessible, assisting with eating, and considering oral nutritional supplements available under local policy or formulary. These actions do not require a dietitian prescription. The dietitian referral should be made urgently and the nurse should escalate if the waiting time creates unacceptable clinical risk. Waiting passively is not acceptable.

3. A patient has a BMI of 22 kg/m². What is their MUST Step 1 score?

   • A
     0
     Correct answer
   • B
     1
   • C
     The patient's BMI indicates obesity risk and scores 1
   • D
     3
   Explanation

   MUST Step 1: BMI > 20 scores 0. A BMI of 22 is above the 20 threshold, so the score is 0 for Step 1. The patient may still score on Steps 2 or 3, so a score of 0 on Step 1 does not automatically mean the patient is low risk overall.