NCLEX-PN FINAL 2024-2025 ACTUAL EXAM (VERSION A) REAL EXAM WITH 300+ QUESTIONS AND CORREC, Exams of Nursing

Download NCLEX-PN FINAL 2024-2025 ACTUAL EXAM (VERSION A) REAL EXAM WITH 300+ QUESTIONS AND CORREC and more Exams Nursing in PDF only on Docsity!

NCLEX-PN FINAL

2024 - 2025 ACTUAL

EXAM (VERSION A)

REAL EXAM WITH

300+ QUESTIONS

AND CORRECT

ANSWER S

(VERIFIED

ANSWERS)

|ALREADY GRADED

A+

CORRECT ANSWERS (VERIFIED ANSWERS) |ALREADY GRADED A+ A nurse is caring for a client with systemic lupus erythematosus (SLE). The client begins to cry and tells the nurse that she is afraid that her skin will be disfigured with lesions. Which intervention does the nurse plan to teach this client to minimize skin infections associated with SLE? Select all that apply. A) Use sunscreen with an SPF of 15 or greater. B) Remain indoors on sunny days. C) Avoid swimming in a pool or the ocean. D) Avoid sun exposure between 10:00 a.m. and 3:00 p.m. E) Decrease sun exposure between 3:00 p.m. and 5:00 p.m. - correct answer Answer: A, D The nurse teaches the client to live a normal life with a few extra precautions. There is a relationship between sun exposure and infection, so the client is taught to use sunscreen with an SPF of at least 15 and to avoid the sun between 10:00 a.m. and 3:00 p.m. The client may swim but should reapply sunscreen after swimming. The client does not need to stay indoors on sunny days or to decrease sun exposure between 3:00 p.m. and 5:00 p.m. A patient on a medical unit has a potassium level of 6.8 mEq/L. What is the priority action that the nurse should take? a. Place the patient on a cardiac monitor. b. Check the patient's BP. c. Instruct the patient to avoid high-potassium foods. d. Call the lab and request a redraw of the lab to verify results. - correct answer a. Dysrhythmias may occur with an elevated potassium level and are potentially lethal. Monitor the rhythm while contacting physician or calling the rapid response team. A patient is admitted to the hospital with CKD. You understand that this condition is characterized by A. Progressive irreversible destruction of the kidneys B. A rapid decrease in urinary output with an elevated BUN level

CORRECT ANSWERS (VERIFIED ANSWERS) |ALREADY GRADED A+ C. Increasing creatinine clearance with a decrease in urinary output D. Prostration, somnolence, and confusion with coma and imminent death - correct answer A. Progressive irreversible destruction of the kidneys CKD involves progressive, irreversible loss of kidney function. Measures indicated in the conservative therapy of CKD include A. decreased fluid intake, carbohydrate intake, and protein intake. B. increased fluid intake; decreased carbohydrate intake and protein intake. C. decreased fluid intake and protein intake; increased carbohydrate intake. D. decreased fluid intake and carbohydrate intake; increased protein intake. - correct answer C. decreased fluid intake and protein intake; increased carbohydrate intake. Water and any other fluids are not routinely restricted in the pre-end-stage renal disease (ESRD) stages. Patients on hemodialysis have a more restricted diet than patients receiving peritoneal dialysis. For those receiving hemodialysis, as their urinary output diminishes, fluid restrictions are enhanced. Intake depends on the daily urine output. Generally, 600 mL (from insensible loss) plus an amount equal to the previous day's urine output is allowed for a patient receiving hemodialysis. Patients are advised to limit fluid intake so that weight gains are no more than 1 to 3 kg between dialyses (interdialytic weight gain). For the patient who is undergoing dialysis, protein is not routinely restricted. The beneficial role of protein restriction in CKD stages 1 through 4 as a means to reduce the decline in kidney function is being studied. Historically, dietary counseling often encouraged restriction of protein for CKD patients. Although there is some evidence that protein restriction has benefits, many patients find these diets difficult to adhere to. For CKD stages 1 through 4, many clinicians encourage a diet with normal protein intake. However, you should teach patients to avoid high-protein diets and supplements because they may overstress the diseased kidneys. Nurses need to educate patients at risk for CKD. Which individuals are considered to be at increased risk (select all that apply)? A. Older African Americans B. Individuals older than 60 years

CORRECT ANSWERS (VERIFIED ANSWERS) |ALREADY GRADED A+ C. Those with a history of pancreatitis D. Those with a history of hypertension E. Those with a history of type 2 diabetes - correct answer A. Older African Americans B. Individuals older than 60 years D. Those with a history of hypertension E. Those with a history of type 2 diabetes Risk factors for CKD include diabetes mellitus, hypertension, age older than 60 years, cardiovascular disease, family history of CKD, exposure to nephrotoxic drugs, and ethnic minorities (e.g., African American, Native American). Which statement regarding continuous ambulatory peritoneal dialysis (CAPD) is of highest priority when teaching a patient new to this procedure? A. "It is essential that you maintain aseptic technique to prevent peritonitis." B. "You will be allowed a more liberal protein diet after you complete CAPD." C. "It is important for you to maintain a daily written record of blood pressure and weight." D. "You must continue regular medical and nursing follow-up visits while performing CAPD." - correct answer A. "It is essential that you maintain aseptic technique to prevent peritonitis." Peritonitis is a potentially fatal complication of peritoneal dialysis, and it is imperative to teach the patient methods to prevent it from occurring. Although the other teaching statements are accurate, they do not address the potential for mortality by peritonitis, making that nursing action the highest priority. How should you assess the patency of a newly placed arteriovenous graft for dialysis? A. Irrigate the graft daily with low-dose heparin.

CORRECT ANSWERS (VERIFIED ANSWERS) |ALREADY GRADED A+ B. Monitor for any increase in blood pressure in the affected arm. C. Listen with a stethoscope over the graft for presence of a bruit. D. Frequently monitor the pulses and neurovascular status distal to the graft. - correct answer C. Listen with a stethoscope over the graft for presence of a bruit. A thrill can be felt by palpating the area of anastomosis of the arteriovenous graft, and a bruit can be heard with a stethoscope. The bruit and thrill are created by arterial blood rushing into the vein. What are the main advantages of peritoneal dialysis compared to hemodialysis? A. No medications are required because of the enhanced efficiency of the peritoneal membrane in removing toxins. B. The diet is less restricted and dialysis can be performed at home. C. The dialysate is biocompatible and causes no long-term consequences. D. High glucose concentrations of the dialysate cause a reduction in appetite, promoting weight loss. - correct answer B. The diet is less restricted and dialysis can be performed at home. Advantages of peritoneal dialysis include fewer dietary restrictions and home dialysis is possible. The nurse teaches a client who is recovering from acute kidney disease to avoid which type of medication? A Nonsteroidal anti-inflammatory drugs (NSAIDs) B Angiotensin-converting enzyme (ACE) inhibitors C Opiates D Calcium channel blockers filtration rate and blood flow within the kidney. - correct answer A Nonsteroidal anti-inflammatory drugs (NSAIDs)

CORRECT ANSWERS (VERIFIED ANSWERS) |ALREADY GRADED A+ NSAIDs may be nephrotoxic to a client with acute kidney disease, and should be avoided. ACE inhibitors are used for treatment of hypertension and to protect the kidneys, especially in the diabetic client, from progression of kidney disease. Opiates may be used by clients with kidney disease if severe pain is present; however, excretion may be delayed. Calcium channel blockers can improve the glomerular A client with end-stage kidney disease has been put on fluid restrictions. Which assessment finding indicates that the client has not adhered to this restriction? A Blood pressure of 118/78 mm Hg B Weight loss of 3 pounds during hospitalization C Dyspnea and anxiety at rest D Central venous pressure (CVP) of 6 mm Hg - correct answer C Dyspnea and anxiety at rest Dyspnea is a sign of fluid overload and possible pulmonary edema; the nurse should assist the client in correlating symptoms of fluid overload with nonadherence to fluid restriction. Nonadherence to fluid restriction results in fluid volume excess and higher blood pressures; 118/78 mm Hg is a normal blood pressure. Excess fluid intake and fluid retention are manifested by an elevated CVP (>8 mm Hg) and weight gain, not weight loss. Which assessment finding represents a positive response to erythropoietin (Epogen, Procrit) therapy? A Hematocrit of 26.7% B Potassium within normal range C Absence of spontaneous fractures D Less fatigue - correct answer D Less fatigue Treatment of anemia with erythropoietin will result in increased hemoglobin and hematocrit (H&H) and decreased shortness of breath and fatigue. A hematocrit value of 26.7% is low; erythropoietin should restore the hematocrit to at least 36% to be effective. Erythropoietin causes more red blood cells to be produced, increasing H&H, not potassium. Calcium

CORRECT ANSWERS (VERIFIED ANSWERS) |ALREADY GRADED A+ supplements and phosphate binders prevent renal osteodystrophy; erythropoietin treats anemia. When caring for a client who receives peritoneal dialysis (PD), which finding does the nurse report to the provider immediately? A Pulse oximetry reading of 95% B Sinus bradycardia, rate of 58 beats/min C Blood pressure of 148/90 mm Hg D Temperature of 101.2° F (38.4° C) - correct answer D Temperature of 101.2° F (38.4° C) Peritonitis is the major complication of PD, caused by intra-abdominal catheter site contamination; meticulous aseptic technique must be used when caring for PD equipment. A pulse oximetry reading of 95% is a normal saturation. Although a heart rate of 58 beats/min is slightly bradycardic, the provider can be informed upon visiting the client. Clients with kidney failure tend to have slightly higher blood pressures due to fluid retention; this is not as serious as a fever. Which clinical manifestation indicates the need for increased fluids in a client with kidney failure? A Increased blood urea nitrogen (BUN) B Increased creatinine level C Pale-colored urine D Decreased sodium level - correct answer A Increased blood urea nitrogen (BUN An increase in BUN can be an indication of dehydration, and an increase in fluids is needed. Increased creatinine indicates kidney impairment. Urine that is pale in color is diluted; an increase in fluids is not necessary. Sodium is increased, not decreased, with dehydration. A client with acute kidney injury is receiving a fluid challenge of 500 mL of normal saline over 1 hour. With a drop factor of 20 drops/mL, how many drops per minute does the nurse infuse? - correct answer 167 drops/min

CORRECT ANSWERS (VERIFIED ANSWERS) |ALREADY GRADED A+ 20 gtt × 500 mL = 10,000/60 min = 167 drops/min Which clients are at risk for acute kidney injury (AKI)? (Select all that apply.) A Football player in preseason practice Correct B Client who underwent contrast dye radiology Correct C Accident victim recovering from a severe hemorrhage Correct D Accountant with diabetes E Client in the intensive care unit on high doses of antibiotics Correct F Client recovering from gastrointestinal influenza - correct answer A Football player in preseason practice B Client who underwent contrast dye radiology C Accident victim recovering from a severe hemorrhage E Client in the intensive care unit on high doses of antibiotics F Client recovering from gastrointestinal influenza To prevent AKI, all people should be urged to avoid dehydration by drinking at least 2 to 3 liters of fluids daily, especially during strenuous exercise or work associated with diaphoresis, or when recovering from an illness that reduces kidney blood flow, such as influenza. Contrast media may cause acute renal failure, especially in older clients with reduced kidney function. Recent surgery or trauma, transfusions, or other factors that might lead to reduced kidney blood flow may cause AKI. Certain antibiotics may cause nephrotoxicity. Diabetes may cause acute kidney failure superimposed on chronic kidney failure. The nurse assists a client with acute kidney injury (AKI) to modify the diet in which ways? (Select all that apply.) A Restricted protein B Liberal sodium C Restricted fluids D Low potassium E Low fat - correct answer A Restricted protein

CORRECT ANSWERS (VERIFIED ANSWERS) |ALREADY GRADED A+ C Restricted fluids D Low potassium Breakdown of protein leads to azotemia and increased blood urea nitrogen. Fluid is restricted during the oliguric stage. Potassium intoxication may occur, so dietary potassium is also restricted. Sodium is restricted during AKI because oliguria causes fluid retention. Fats may be used for needed calories when proteins are restricted. When caring for a client with a left forearm arteriovenous fistula created for hemodialysis, which actions must the nurse take? (Select all that apply.) A Check brachial pulses daily. B Auscultate for a bruit every 8 hours. Correct C Teach the client to palpate for a thrill over the site. Correct D Elevate the arm above heart level. E Ensure that no blood pressures are taken in that arm. - correct answer B Auscultate for a bruit every 8 hours. C Teach the client to palpate for a thrill over the site. E Ensure that no blood pressures are taken in that arm. A bruit or swishing sound, and a thrill or buzzing sensation upon palpation should be present in this client, indicating patency of the fistula. No blood pressure, venipuncture, or compression, such as lying on the fistula, should occur. Distal pulses and capillary refill should be checked, and for a forearm fistula, the radial pulse is checked—the brachial pulse is proximal. Elevating the arm increases venous return, possibly collapsing the fistula. While managing care for a client with chronic kidney disease, which actions does the registered nurse (RN) plan to delegate to unlicensed assistive personnel (UAP)? (Select all that apply.) A Obtain the client's pre-hemodialysis weight. ] B Check the arteriovenous (AV) fistula for a thrill and bruit. C Document the amount the client drinks throughout the shift.

CORRECT ANSWERS (VERIFIED ANSWERS) |ALREADY GRADED A+ D Auscultate the client's lung sounds every 4 hours. E Explain the components of a low-sodium diet. - correct answer A Obtain the client's pre- hemodialysis weight. C Document the amount the client drinks throughout the shift. Obtaining the client's weight and documenting oral fluid intake are routine tasks that can be performed by UAP. Assessment skills (checking the AV fistula and auscultating lung sounds) and client education (explaining special diet) require more education and are in the legal scope of practice of the RN. The LPN/LVN should understand that invasive procedures are postponed for 4 to 6 hours after hemodialysis for which reason? A. The procedure is very tiring. B. Heparin is used during the procedure. C. The patient is disoriented immediately after the procedure. D. The chance of infection is heightened immediately after the procedure. - correct answer B. Heparin is used during the procedure. Invasive procedures are postponed for 4 to 6 hours after dialysis because the clotting time is extended from the heparin used during dialysis and prolonged bleeding could occur. Disorientation of the patient after the procedure is not anticipated. Although the patient may be fatigued after the procedure, this is not the most important reason for avoiding invasive procedures in the period of time immediately after hemodialysis. Infection risk is not increased after dialysis. A patient who has undergone transurethral resection of the prostate (TURP) surgery asks why he needs to have the continuous bladder irrigation (CBI) because it seems to increase his pain. Which explanation would be the best? A. "Normal urine production is maintained until healing can occur." B. "Antibiotics are being instilled into the bladder to prevent infection." C. "The bladder irrigation is necessary to stop the bleeding in the bladder."

CORRECT ANSWERS (VERIFIED ANSWERS) |ALREADY GRADED A+ D. "The irrigation is needed to keep the catheter from becoming occluded by blood clots." - correct answer D. "The irrigation is needed to keep the catheter from becoming occluded by blood clots." The continuous irrigation acts to flush small to moderate clots from the GU tract, keeping it patent. CBIs are not used to maintain normal urine production, instill antibiotics into the bladder, or stop bleeding in the bladder. Which statement(s) is/are most accurate regarding transmission of human immunodeficiency virus (HIV) and development of acquired immune deficiency syndrome (AIDS)? (Select all that apply.) A. It is treatable. B. Poor personal hygiene is a factor in its transmission. C. It cannot be transmitted if safer sexual practices are used. D. It enters the bloodstream through breaks in mucous membrane. E. It is a blood-borne pathogen and can be transmitted by contaminated intravenous (IV) drug use supplies. - correct answer A. It is treatable. D. It enters the bloodstream through breaks in mucous membrane. E. It is a blood-borne pathogen and can be transmitted by contaminated intravenous (IV) drug use supplies. HIV/AIDS is a treatable viral infection that enters the body through breaks in mucous membranes (e.g., oral, vaginal, rectal mucosa). Although HIV is a blood-borne pathogen, use of contaminated IV drug use supplies is one of many ways it is transmitted. IV drug use significantly increases the risk of HIV infection. Although risk of infection is considerably lessened by use of safer sex practices, intimate sexual contact involving any mucous membrane will pose a risk of transmission. Personal hygiene has no effect on susceptibility to or transmission of HIV. How is the effectiveness of antiviral drugs administered to treat HIV infection assessed and evaluated? A. Viral load

CORRECT ANSWERS (VERIFIED ANSWERS) |ALREADY GRADED A+ B. Megakaryocytes C. Lymphocyte counts D. Red blood cell counts - correct answer A. Viral load All antiretroviral drugs work to reduce the viral load, which is the number of viral RNA copies per milliliter of blood. Which client statement regarding his or her diagnosis of HIV infection indicates a need that further teaching is necessary? A. "I must take these medications exactly as prescribed for the rest of my life." B. "I don't need to use condoms as long as I take my medication as prescribed." C. "I will notify my health care provider immediately if I bruise or bleed more easily than normal." D. "I should remain upright for 30 minutes after taking my zidovudine to prevent esophageal ulceration." - correct answer B. "I don't need to use condoms as long as I take my medication as prescribed." Antiretroviral drugs do not stop the transmission of HIV, and clients need to continue standard precautions and safe sex practice, including condom use. Potential serious adverse effects of zidovudine are bone marrow suppression and esophageal ulceration. A patient known to be positive for HIV is admitted with oral thrush, recurrent vaginal yeast infections, and skin infections. What do these signs indicate?

1. Opportunistic infection
2. Antimicrobial resistance
3. Resistant strain of HIV
4. Sentinel infection - correct answer correct answer : 1

CORRECT ANSWERS (VERIFIED ANSWERS) |ALREADY GRADED A+ Candidiasis is a common opportunistic infection (OI) in the HIV-positive patient. (2) Antimicrobial resistance can be determined only via microbiologic culture accompanied by the antibiogram (test that shows drug sensitivities). (3) Resistant strains of HIV are mutations of the virus that do not respond well to chemotherapy. (4) Sentinel infections are seen in AIDS- defining infections and where the candidiasis is currently located is not indicative of this type of infection Which instructions should be given to a patient regarding preventing the spread of hepatitis A? (Select all that apply.)

1. Bleach solutions must be used to clean the bathroom.
2. Somebody else should be doing the cooking right now.
3. No vaccination is available for hepatitis A.
4. Good hand hygiene prevents the likelihood of passing the virus. - correct answer correct answer s: 1, 2, 4 Hepatitis A vaccination is available and recommended. The other statements indicate an understanding of the information (see the Home Care Considerations box, Preventing the Spread of Hepatitis Virus, for additional information). What is included in the nursing care of a patient undergoing peritoneal dialysis? (Select all that apply.)
5. Maintain aseptic technique when accessing a peritoneal catheter.
6. Instruct the patient to remain supine until the dialysate is drained.
7. Weigh the patient before and after dialysis.

CORRECT ANSWERS (VERIFIED ANSWERS) |ALREADY GRADED A+

4. Monitor vital signs.
5. Check color and volume of effluent. - correct answer correct answer s: 1, 3, 4, 5 (2) Patient can get up and ambulate after dialysate is instilled. (Dwell time varies from 4 to 8 hours. Others may have the dwell time at night or have continuous ambulatory peritoneal dialysis [CAPD], which goes on for 24 hours a day. (1, 3, 4, 5) All other answers are correct. A nurse is sending a patient to the dialysis clinic. What predialysis nursing intervention should be included? (Select all that apply.)
6. Withholding anticoagulants
7. Administering antihypertensive
8. Assessing dialysis access site
9. Checking vital signs
10. Monitoring laboratory values - correct answer correct answer s: 1, 3, 4, 5 (2) Antihypertensive medications are held because they can cause hypotension during the treatment. Nitroglycerin (NTG) patches, digitalis, and anticoagulants also are held. (1, 3-5) Physical assessment, checking for bruit and thrill at the access site, vital signs, weight and laboratory results are done and compared with post-treatment results. A patient who had TURP complains of increasing bladder spasms. Which is an appropriate initial nursing action?
11. Medicate with a B&O suppository.

CORRECT ANSWERS (VERIFIED ANSWERS) |ALREADY GRADED A+

2. Check the urinary catheter tubing for kinks and obstruction.
3. Teach relaxation exercises.
4. Encourage use of patient-controlled analgesia. - correct answer correct answer : 2 Before giving medication, the nurse (2) checks to see that the tubing is not kinked and the catheter is draining well, as obstruction can cause bladder spasm. (1) This is not an initial action. Abdominal distention may be a sign of catheter obstruction as well. (3) Relaxation is not effective to eliminate spasms. (4) The patient who has had a radical procedure may have a patient-controlled analgesia pump to control pain. After giving an injection to a patient with HIV infection, the nurse accidentally receives a needlestick from a too-full needle disposal box. Recommendations for occupational HIV exposure may include the use of which drug(s)? a. didanosine b. lamivudine and enfuvirtide c. emtricitabine and tenofovir d. acyclovir - correct answer C The nurse is reviewing the use of multidrug therapy for HIV with a patient. Which statements are correct regarding the reason for using multiple drugs to treat HIV? (Select all that apply.) a. The combination of drugs has fewer associated toxicities. b. The use of multiple drugs is more effective against resistant strains of HIV.

CORRECT ANSWERS (VERIFIED ANSWERS) |ALREADY GRADED A+ c. Effective treatment results in reduced T-cell counts. d. The goal of this treatment is to reduce the viral load. e. This type of therapy reduces the incidence of opportunistic infections. - correct answer B, D, E The order for a patient who has a severe case of shingles is for acyclovir (Zovirax) 10 mg/kg IV every 8 hours for 7 days. The patient weighs 165 pounds. How much is each dose? - correct answer 750 mg per dose A patient with acute renal injury has a GFR (glomerular filtration rate) of 40 mL/min. Which signs and symptoms below may this patient present with? Select all that apply: A. Hypervolemia B. Hypokalemia C. Increased BUN level D. Decreased Creatinine level - correct answer The answers are A and C. The glomerular filtration rate indicates how well the glomerulus is filtering the blood. A normal GFR tends to be 90 mL/min or higher. A GFR of 40 mL/min indicates that the kidney's ability to filter the blood is decreased. Therefore, the kidneys will be unable to remove waste and excessive water from the blood...hence hypervolemia and an increased BUN level will present in this patient. The patient will experience HYPERkalemia (not hypo) because the kidneys are unable to remove potassium from the blood. In addition, an INCREASED creatinine level (not decreased) will present because the kidneys cannot remove excessive waste products, such as creatinine. You're assessing morning lab values on a female patient who is recovering from a myocardial infraction. Which lab value below requires you to notify the physician? A. Potassium level 4.2 mEq/L B. Creatinine clearance 35 mL/min

CORRECT ANSWERS (VERIFIED ANSWERS) |ALREADY GRADED A+ C. BUN 20 mg/dL D. Blood pH 7.40 - correct answer The answer is B. A normal creatinine clearance level in a female should be 85-125 mL/min (95-140 mL/min males). A creatinine clearance level indicates the amount of blood the kidneys can make per minute that contain no amounts of creatinine in it. Remember creatinine is a waste product of muscle breakdown. Therefore, the kidneys should be able to remove excessive amounts of it from the bloodstream. A patient who has experienced a myocardial infraction is at risk for pre- renal acute injury due to decreased cardiac output to the kidneys from a damaged heart muscle (the heart isn't able to pump as efficiently because of ischemia). All the other labs values are normal. A 55 year old male patient is admitted with a massive GI bleed. The patient is at risk for what type of acute kidney injury? A. Post-renal B. Intra-renal C. Pre-renal D. Intrinsic renal - correct answer The answer is C. Pre-renal injury is due to decreased perfusion to the kidneys secondary to a cause (massive GI bleeding...patient is losing blood volume). This leads to a major decrease in kidney function because the kidneys are deprived of nutrients to function and the amount of blood it can filter. Pre-renal injury can eventually lead to intrarenal damage where the nephrons become damaged. Select all the patients below that are at risk for acute intra-renal injury? A. A 45 year old male with a renal calculus. B. A 65 year old male with benign prostatic hyperplasia. C. A 25 year old female receiving chemotherapy. D. A 36 year old female with renal artery stenosis. E. A 6 year old male with acute glomerulonephritis.

CORRECT ANSWERS (VERIFIED ANSWERS) |ALREADY GRADED A+ F. An 87 year old male who is taking an aminoglycoside medication for an infection. - correct answer The answers are: C, E, and F. These patients are at risk for an intra-renal injury, which is where there is damage to the nephrons of kidney. The patients in options A and B are at risk for POST-RENAL injury because there is an obstruction that can cause back flow of urine into the kidney, which can lead to decreased function of the kidney. The patient in option D is at risk for PRE-RENAL injury because there is an issue with perfusion to the kidney. A 36 year old male patient is diagnosed with acute kidney injury. The patient is voiding 4 L/day of urine. What complication can arise based on the stage of AKI this patient is in? Select all that apply: A. Water intoxication B. Hypotension C. Low urine specific gravity D. Hypokalemia E. Normal GFR - correct answer The answers are: B, C, and D. This patient is in the DIURESIS stage of AKI. The nephrons are now starting to filter out waste but cannot concentrate the urine. There is now a high amount of urea in the filtrate (because the nephrons can filter the urea out of the blood) and this causes osmotic diuresis. Urinary output will be excessive (3 to 6 L/day). Therefore, the patient is at risk for hypotension, diluted urine (low urine specific gravity), and hypokalemia (waste potassium in the urine). The patient is not at risk for water intoxication and will not have a normal GFR until the recovery stage. Which patient below with acute kidney injury is in the oliguric stage of AKI: A. A 56 year old male who has metabolic acidosis, decreased GFR, increased BUN/Creatinine, hyperkalemia, edema, and urinary output 350 mL/day. B. A 45 year old female with metabolic alkalosis, hypokalemia, normal GFR, increased BUN/creatinine, edema, and urinary output 600 mL/day.

CORRECT ANSWERS (VERIFIED ANSWERS) |ALREADY GRADED A+ C. A 39 year old male with metabolic acidosis, hyperkalemia, improving GFR, resolving edema, and urinary output 4 L/day. D. A 78 year old female with respiratory acidosis, increased GFR, decreased BUN/creatinine, hypokalemia, and urinary output 550 mL/day. - correct answer The answer is A. During the oliguric stage of AKI the patient will have a urinary output of 400 mL/day or LESS. This is due to a decreased GRF (glomerular filtration rate), which will lead to increased amounts of waste in the blood (increased BUN/Creatinine), metabolic acidosis (decreased excretion of hydrogen ions), hyperkalemia, hypervolemia (edema/hypertension), and urinary output of < mL/day. A patient with AKI has a urinary output of 350 mL/day. In addition, morning labs showed an increased BUN and creatinine level along with potassium level of 6 mEq/L. What type of diet ordered by the physician is most appropriate for this patient? A. Low-sodium, high-protein, and low-potassium B. High-protein, low-potassium, and low-sodium C. Low-protein, low-potassium, and low-sodium D. High-protein and high-potassium - correct answer The answer is C. The patient with AKI, especially in the oliguric stage of AKI, should eat a low-protein, low- potassium, and low-sodium diet. This is because the kidneys are unable to filter out waste products, excessive water, and maintain electrolyte balance. The patient will have a buildup of waste (BUN and creatinine). Remember these waste products are the byproduct of protein (urea) and muscle breakdown (creatinine). So the patient should avoid high-protein foods. In addition, the patient is at risk for hyperkalemia and fluid overload (needs low-potassium and sodium foods). A patient with CKD has a low erythropoietin (EPO) level. The patient is at risk for? A. Hypercalcemia B. Anemia C. Blood clots

CORRECT ANSWERS (VERIFIED ANSWERS) |ALREADY GRADED A+ D. Hyperkalemia - correct answer The answer is B. EPO (erythropoietin) helps create red blood cells in the bone marrow. The kidneys produce EPO and when the kidneys are damaged in CKD they can decrease in the production of EPO. Therefore, the patient is at risk for anemia. A 65 year old male patient has a glomerular filtration rate of 55 mL/min. The patient has a history of uncontrolled hypertension and coronary artery disease. You're assessing the new medication orders received for this patient. Which medication ordered by the physician will help treat the patient's hypertension along with providing a protective mechanism to the kidneys? A. Lisinopril B. Metoprolol C. Amlodipine D. Verapamil - correct answer The answer is A. There are two types of drugs that can be used to treat hypertension and protect the kidneys in patients with CKD. These drugs include angiotensin converting enzyme inhibitors (ACE inhibitors) and angiotensin receptor blockers (ARBs). The only drug listed here that is correct is Lisinopril. This drug is known as an ACE inhibitor. Metoprolol is a BETA BLOCKER. Amlodipine and Verapamil are calcium channel blockers. A patient with Stage 5 CKD is experiencing extreme pruritus and has several areas of crystallized white deposits on the skin. As the nurse, you know this is due to excessive amounts of what substance found in the blood? A. Calcium B. Urea C. Phosphate D. Erythropoietin - correct answer The answer is B.

CORRECT ANSWERS (VERIFIED ANSWERS) |ALREADY GRADED A+ This patient is experiencing uremic frost that occurs in severe chronic kidney disease. This is due to high amounts of urea in the blood being secreted via the sweat glands onto the skin, which will appear as white deposits on the skin. The patient will experience itching with this as well. Your patient with chronic kidney disease is scheduled for dialysis in the morning. While examining the patient's telemetry strip, you note tall peaked T-waves. You notify the physician who orders a STAT basic metabolic panel (BMP). What result from the BMP confirms the EKG abnormality? A. Phosphate 3.2 mg/dL B. Calcium 9.3 mg/dL C. Magnesium 2.2 mg/dL D. Potassium 7.1 mEq/L - correct answer The answer is D. The patient's potassium level is extremely elevated. A normal potassium level is 3.5-5.1 mEq/L. This patient is experiencing hyperkalemia, which can cause tall peak T-waves. Remember in CKD (especially prior to dialysis), the patient will experience electrolyte imbalances, especially hyperkalemia. A patient with stage 4 chronic kidney disease asks what type of diet they should follow. You explain the patient should follow a: A. Low protein, low sodium, low potassium, low phosphate diet B. High protein, low sodium, low potassium, high phosphate diet C. Low protein, high sodium, high potassium, high phosphate diet D. Low protein, low sodium, low potassium, high phosphate diet - correct answer The answer is A. The patient should follow this type of diet because protein breaks down into urea (remember patients will have increased urea levels), low sodium to prevent fluid retention, low potassium to prevent hyperkalemia (remember glomerulus isn't filtering out potassium/phosphate as it should), and low phosphate to prevent hyperphosphatemia. The kidneys are responsible for performing all the following functions EXCEPT?

CORRECT ANSWERS (VERIFIED ANSWERS) |ALREADY GRADED A+ A. Activating Vitamin D B. Secreting Renin C. Secreting Erythropoietin D. Maintaining cortisol production - correct answer The answer is D. The adrenal glands are responsible for maintaining cortisol production not the kidneys. You're providing an in-service to a group of nurses about the different types of kidney stones. You explain to the attendees that the most common type of kidney stone is made up of: A. Cholesterol B. Calcium and oxalate C. Calcium and phosphate D. Uric acid - correct answer The answer is B. The most common type of kidney stone composite is calcium and oxalate. Which patient below is at MOST risk for developing uric acid type kidney stones? A. A 53 year old female with recurrent urinary tract infections. B. A 6 year old male with cystinuria. C. A 63 year male with gout. D. A 25 year old female that follows a vegan diet and report eating high amounts of spinach and strawberries on a regular basis. - correct answer The answer is C. Patients with gout experience high uric acid levels which can lead to the development of uric acid kidney stones. In option A, the patient is at risk for struvite kidney stones. In option B, the patient is at risk for cystine kidney stones, and in option C, the patient is at a small risk for calcium oxalate stones due to the high consumption of foods with oxalates. You're providing care to a patient with a uric acid kidney stone that is 2 mm in size per diagnostic imaging. The patient is having severe pain and rates their pain 10 on 1-10 scale. The

CORRECT ANSWERS (VERIFIED ANSWERS) |ALREADY GRADED A+ physician has ordered a treatment plan to assist the patient in passing the kidney stone. What nursing intervention is PRIORITY for this patient based on the scenario? A. Administer pain medication B. Encourage fluid intake of 2-4 liters per day C. Massage the costovertebral area D. Implement a high protein diet - correct answer The answer is A. Controlling the patient's pain is priority. Option B is another important part of the patient's plan of care to help assist the passage of the kidney stone, but it is not priority at the moment until the patient's pain is controlled. Option C and D are not recommended for the treatment of uric acid kidney stones. You would never massage the costovertebral area, and a high protein diet will further increase uric acid levels, therefore, should be avoided. You're developing a nursing care plan for a patient with a kidney stone. Which of the following nursing interventions will you include in the patient's plan of care? A. Restrict calcium intake B. Strain urine with every void C. Keep patient in supine position to alleviate pain D. Maintain fluid restriction of 1-2 Liter per day - correct answer The answer is B. It is vital the nurse strains every void and assesses the urine very closely for stones. This is crucial so it can be determined what type of kidney stone is causing the problem, therefore, appropriate treatment can be ordered. Restricting calcium intake is no longer recommended unless the patient has a metabolic or renal tubule problem. It is important to avoid placing the patient in the supine position for long periods because this impedes the flow of urine and the patient's ability to pass the stone. Fluid should not be restricted (unless the patient has a condition that requires it like heart failure etc.) because this concentrates the urine...hence increases the chances of another stone developing. You are providing pre-op teaching to a patient scheduled for a percutaneous nephrolithotomy. Which statement by the patient demonstrates the patient understood the pre-op teaching?

CORRECT ANSWERS (VERIFIED ANSWERS) |ALREADY GRADED A+ A. "During the procedure the surgeon will move the stone down the ureter, so I can pass the stone in the urine. B. "I may have a nephrostomy tube after the procedure." C. "A scope is inserted through the urinary system from the urethra to the kidneys to assess the kidney stone." D. "This procedure is noninvasive and no incision is required." - correct answer The answer is B. A percutaneous nephrolithotomy is an INVASIVE procedure that can be used to remove large kidney stones. An incision is made on the back where the kidney is located. A nephroscope is then insert through the incision and used to remove the stone. Generally, the surgeon is able to remove the stone or break it up, therefore, the patient doesn't have to pass it naturally as with other procedures. A nephrostomy tube is sometimes placed after the procedure to drain urine and fragments of the stone out of the kidney. The client is scheduled to have a kidney, ureter, and bladder (KUB) radiograph. To prepare the client for this procedure, the nurse should explain to the client that:

1. Fluid and food will be withheld the morning of the examination.
2. A tranquilizer will be given before the examination.
3. An enema will be given before the examination.
4. No special preparation is required for the examination. - correct answer 4. A KUB radiographic examination ordinarily requires no preparation. It is usually done while the client lies supine and does not involve the use of radiopaque substances. A client with a history of renal calculi formation is being discharged after surgery to remove the calculus. What instructions should the nurse include in the client's discharge teaching plan?
5. Increase daily fluid intake to at least 3 to 4 L.

CORRECT ANSWERS (VERIFIED ANSWERS) |ALREADY GRADED A+

2. Strain urine at home regularly.
3. Eliminate dairy products from the diet.
4. Follow measures to alkalinize the urine. - correct answer 1. A high daily fluid intake is essential for all clients who are at risk for calculi formation because it prevents urinary stasis and concentration, which can cause crystallization. Depending on the composition of the stone, the client also may be instructed to institute specific dietary measures aimed at preventing stone formation. Clients may need to limit purine, calcium, or oxalate. Urine may need to be either alkaline or acid. There is no need to strain urine regularly. During hemodialysis, the patient develops light-headedness and nausea. What should the nurse do first? a. Administer hypertonic saline. b. Administer a blood transfusion. c. Decrease the rate of fluid removal. d. Administer antiemetic medications. - correct answer c. Decrease the rate of fluid removal. The patient is experiencing hypotension from a rapid removal of vascular volume. The rate and volume of fluid removal will be decreased, and 0.9% saline solution may be infused. Hypertonic saline is not used because of the high sodium load. A blood transfusion is not indicated. Antiemetic medications may help the nausea but would not help the hypovolemia. The patient has rapidly progressing glomerular inflammation. Weight has increased and urine output is steadily declining. What is the priority nursing intervention? a. Monitor the patient's cardiac status. b. Teach the patient about hand washing. c. Obtain a serum specimen for electrolytes. d. Increase direct observation of the patient. - correct answer a. Monitor the patient's cardiac status.