NCLEX Questions and Answers with Rationales: Nursing Practice Exam, Exams of Nursing

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N342 NCLEX Questions and Answers

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A patient has been receiving chemotherapy and radiation for a diagnosis of non-Hodgkin's lymphoma. In your morning assessment, you notice the patient has new onset facial edema, distention of head and neck veins, and dyspnea. Which oncologic emergency would be suspected? a. Hypercalcemia b. Spinal Cord Compression c. Superior Vena Cava Syndrome (SVCS) d. Tumor Lysis Syndrome (TLS) - Correct answer C. Superior Vena Cava Syndrome (SVCS) The manifestations in the patient are all seen in SVCS in addition to headache, seizures, and often a mediastinal mass found on a chest x-ray. This complication is common with lung cancer, metastatic breast cancer, and non-Hodgkin's lymphoma When providing education to a patient newly diagnosed with cirrhosis, what information should be included? (select all that apply) a. Inform the patient that cirrhosis is an acute condition that can be alleviated with the correct drug regimen b. Avoid aspirin and NSAIDs to prevent hemorrhage c. Limit alcohol consumption to one drink per week d. Teach symptoms of complications and when to seek medical attention e. Avoid hepatotoxic over-the-counter (OTC) drugs - Correct answer B, D, E B. In patients with cirrhosis, especially if they have esophageal or gastric varices as a comorbidity, use of aspirin and NSAIDs is discouraged. The damage cirrhosis causes to the liver lowers its ability to assist in clotting and taking aspirin and NSAIDs, which also have anticoagulant properties, can increase the risk of hemorrhage

D. Patient should be informed of signs and symptoms to look for that may indicate worsening of their condition. These can include peripheral edema (swelling in extremities), signs of bleeding, ascites (build-up of fluid in peritoneal cavity), alterations in mental status, asterixis (flapping tremors), etc. If any of these symptoms occur, the patient should seek medical attention right away E. OTC drugs that may be toxic to the liver (ex: acetaminophen in high doses) should be avoided because the damage that cirrhosis causes to the liver makes it unable to metabolize those drugs A nurse is teaching a patient about prevention of a second UTI. Which of the statements made by the patient requires further intervention? a. "I will stop taking my antibiotic once the symptoms are gone." b. "I should consider drinking unsweetened cranberry juice in my diet." c. "I will urinate regularly approximately every 3-4 hours" d. "I will remember to drink fluids adequately." - Correct answer A. "I will stop taking my antibiotic once the symptoms are gone." It is important to take all antibiotics as prescribed. Symptoms may improve 1-2 days after therapy, but organisms maybe still present. A nursing student is teaching a patient about management of constipation. The nursing instructor would intervene if the student made which statement? (Select all that apply) a. The use of laxatives and enemas will help free up blockage. b. Eat foods with high fiber like raw vegetables and beans c. Drink about 3 quarts of fluid including coffee and energy drinks. d. Establish a regular time to defecate. e. Exercise about 3 times a week. - Correct answer A, C A. Do not overuse laxatives and enemas because they cause dependence. People who overuse them are unable to have a bowel movement without them. C. Fluid soften hard stools. Drink 2 L per day. Drink water or fruit juices. Avoid caffeinated coffee, tea, and cola. Caffeine stimulate fluid loss through urination.

A nurse is reviewing lab values for a patient admitted to the hospital for acute pancreatitis, what lab values would the nurse expect to see? (Select all that apply.) a. Elevated Serum Amylase b. Decreased Phosphorus c. Decreased Calcium d. Elevated Serum Lipase - Correct answer A, C, D The primary diagnostic tests for acute pancreatitis are serum amylase and lipase. The serum amylase level is usually elevated early and remains elevated for 24 to 72 hours. The nurse knows, which of the following patients is most at risk of having another flair up of their chronic pancreatitis? a. A 72-year-old female, who enjoys eating fried foods regularly and states she prefers to eat late dinners just before bedtime. b. A 23-year-old male, who was hospitalized with spleen injury after a MVA, who states he drinks several times a week with his friends, and takes NSAIDs to treat abdominal pain from his accident. c. A 56-year-old male, who prefers drinking milk instead of water with meals, and states his diet consists of mostly legumes and fish. d. A 28-year-old female, with poly cystic ovarian syndrome and a BMI of 31, who states she binges on sweets when she is feeling stressed from work and school. - Correct answer B. A 23-year-old male, who was hospitalized with spleen injury after a MVA, who states he drinks several times a week with his friends, and takes NSAIDs to treat abdominal pain from his accident. This patient is most at risk for aggravating his chronic pancreatitis he drinks heavily and sustained abdominal trauma recently which puts him at higher risk. Encourage the patient to eliminate alcohol intake, especially if he or she has had any previous episodes of pancreatitis. Recurrent attacks of pancreatitis may become milder or disappear with the discontinuance of alcohol use.

A 43 year old woman is diagnosed with gastroesophageal reflux disease (GERD). What guidelines can the nurse provide to her for managing her symptoms? SELECT ALL THAT APPLY. a. Lie down after eating to relieve pressure b. Having peppermint or tea after eating can soothe any discomfort c. Avoid late night snacking d. Eating small, more frequent meals is better than eating a few large meals per day e. Drinking fluids between meals and not with meals can help prevent reflux

• Correct answer C, D, E C. Eating before bedtime should be avoided to prevent food from traveling back up the esophagus. It is recommended that patients with GERD avoid eating within 3 hours of bedtime. D. Eating small, frequent meals can help prevent over distention of the stomach. This reduces symptoms of GERD. E. Drinking fluids between meals, but not with meals will help prevent over distention of the stomach. This reduces symptoms of GERD A 26 year old male presents to the Emergency Department with 2 days of bloody stools, abdominal cramping, and watery diarrhea. He is diagnosed with E. coli poisoning. When explaining what he ate the past few days, which items might you suspect as the E. coli carrying culprit? a. A bowl of oatmeal with brown sugar and raisins b. Vegetable soup c. A chocolate brownie d. A cheeseburger and fries - Correct answer D. A cheeseburger and fries Contaminated beef, pork, milk, cheese, and cookie dough are the most common sources of E. coli food poisoning Which of the following are considered nursing interventions for patients going through radiation or chemotherapy? (Select all that apply) a. Monitor BUN and creatinine levels b. Teach patient to avoid large crowds

c. Encourage patient to get at least 60 min of direct sunlight per day d. Monitor platelet counts e. High fiber diet to prevent constipation - Correct answer A, B, D A. Direct renal damage from exposure to nephrotoxic agents such as cisplatin and high dose-methotrexate can be a complication from treatment. Therefore, labs for BUN and creatinine levels must be continuously monitored. B. Infection is a major cause of death in cancer patients because of low WBC's, especially neutrophils. It is recommended that because of immune suppression while undergoing treatment, it is best to avoid large crowds. D. Because spontaneous bleeding can occur with platelet counts <20,000, it is important that the nurse must monitor platelet counts. Lifestyle modifications are crucial for the management and prevention of gastroesophageal reflux disease (GERD). Which of the following is a strategy for good management to teach a patient who was recently diagnosed? a. Eat a small meal close to bedtime to ease the onset of GERD b. Avoid alcohol and caffeinated beverages c. Avoid taking sucralfate (Carafate) d. If a PPI is being taken, it is best to take it right before bedtime - Correct answer B. Avoid alcohol and caffeinated beverages Caffeinated beverages, as well as alcohol, cause an almost immediate, marked decrease in lower esophageal sphincter pressure. Because of this, alcohol and caffeinated beverages should be avoided. When providing education about diet for a patient who has had a history of gout and urinary calculi, the nurse should tell the patient to avoid or limit which of the following food selections (SELECT ALL THAT APPLY) a. Liver b. Corn c. Mussels d. Salmon e. Tomatoes - Correct answer A, C, D

The treatment for a patient with a history of uric acid urinary calculi is reduce urinary concentration of uric acid. Alkalinize urine with potassium citrate. Administer allopurinol. Reduce dietary purines. Also, foods high in purine include sardines, herring, mussels, liver, kidney, goose, goose, venison, meat soups, sweet breads. Foods moderate in purine; chicken, salmon, crab, veal, mutton, bacon, pork, beef, ham. A 12-year-old patient presents with poor skin turgor, dry mucus membranes, tachycardia, orthostatic hypotension, lethargy, weakness, and has rapid deep respirations with a sweet fruity odor. The nurse suspects this patient is suffering from: a. Hyperosmolar hyperglycemic syndrome b. Diabetic Ketoacidosis c. Insulin excess d. Dehydration - Correct answer B. Diabetic Ketoacidosis Diabetic Ketoacidosis is seen mostly in type 1 diabetes. It is a profound deficiency in insulin is characterized by hyperglycemia, ketosis, acidosis, and dehydration. The body has begun to break down fats and proteins for energy from the lack for glucose entering the cell. This caused all the above signs and symptoms. Acidosis causes Kussmaul respirations too in an attempt to compensate for acidotic state. Increased acetone can cause a sweet fruity odor on the breath A 65-year-old patient is receiving hemodialysis. They are on Norco for post- surgical pain, and Benazepril for hypertension. The patient starts to unexpectedly bleed out from his surgical incision. What would you do and why? (Select all that apply) a. Give Vitamin K to help the blood clot b. Give protamine sulfate to stem the excessive bleeding c. Stop hemodialysis to focus on the bleeding d. Put pressure on the surgical site to slow the bleeding - Correct answer B, C B. Protamine sulfate would be used in this situation as the unexpected bleeding is likely caused by the Heparin in the hemodialysis machine.

C. Stopping hemodialysis would stop the influx of heparin from the machine. Heparin is used to prevent clotting in the machine. A student nurse is explaining the probable sites for an arteriovenous fistula to the patient. Which statement does the preceptor know suggests understanding of placement on the part of the student nurse? a. Brachial and antecubital area b. Cephalic or basilic vein with radial artery c. Femoral vein d. Internal jugular - Correct answer B. Cephalic or basilic vein with radial artery The brachial or basilic vein with the radial artery are used with an arteriovenous fistula The nurse is doing discharge teaching for a patient with a new diagnosis of thrombocytopenia. Which statement, if made by the patient, would indicate that the patient understands the teaching? (SELECT ALL THAT APPLY) a. "I can't wait to get back to my weights class at the gym!" b. "I will talk with my Dr. before my pedicure appointment next week." c. "I will stop taking my herbal supplements and over the counter medications until I speak with my Dr." d. "I will replace my toothbrush with one with medium bristles." e. "I will contact my Dr. if I get a headache, or my vision changes." - Correct answer B, C, E B. Talk with your HCP before you have any invasive procedures done, such as pedicures, manicures, or dental cleanings. C. Any medications or herbal supplements that prolong bleeding, such as aspirin, should be avoided. E. Headache and/or vision changes are a manifestation of bleeding. A patient's arterial blood gas (ABG) results are: PH; 7.31, PaCO2; 54 mmHg, HCO3; 25 mEq/L. What kind of acid-base imbalance is this? a. Metabolic acidosis, uncompensated

b. Respiratory alkalosis, compensated c. Respiratory acidosis, uncompensated d. Metabolic alkalosis, uncompensated e. Respiratory acidosis, compensated - Correct answer C.. Respiratory acidosis, uncompensated Respiratory acidosis occurs whenever the person hypoventilates. [This] leads to a buildup of CO2, resulting in an accumulation of carbonic acid in the blood. Renal compensatory mechanisms begin to operate within 24 hours. The kidneys conserve HCO3 (bicarbonate) and secrete increased concentrations of H+ (hydrogen) into the urine. Until the renal mechanisms have an effect, the serum HCO3 level will usually be normal, and then it will increase. A patient diagnosed with chronic kidney disease questions the nurse on his possibility of a kidney transplant. The nurse knows that which of the following factors would cause the patient to be unable to receive a kidney transplant (select all that apply): a. Unmanaged Bipolar II disorder b. Being over age 70 c. Having no familial relatives with a viable kidney to donate d. Disseminated lung cancer e. Being HIV positive f. Chronic respiratory failure - Correct answer A, D, F A. Contraindications to transplantation include disseminated malignancies, refractory or untreated cardiac disease, chronic respiratory failure, extensive vascular disease, chronic infection, and unresolved psychosocial disorders. D. Contraindications to transplantation include disseminated malignancies, refractory or untreated cardiac disease, chronic respiratory failure, extensive vascular disease, chronic infection, and unresolved psychosocial disorders. F. Contraindications to transplantation include disseminated malignancies, refractory or untreated cardiac disease, chronic respiratory failure, extensive vascular disease, chronic infection, and unresolved psychosocial disorders.

A student nurse is discussing risk factors for renal cell carcinoma with an experienced nurse. The experienced nurse should intervene if the student describes which of the following as a risk factor for developing this type of cancer? a. Smoking one pack of cigarettes per day b. A blood pressure of 110/ c. A body mass index of 31 kg/m d. Workplace exposure to asbestos and gasoline - Correct answer B. A blood pressure of 110/ Risk factors include obesity; hypertension; and exposure to asbestos, cadmium, and gasoline. A blood pressure of 110/76 is within normal limits and does not indicate hypertension. A patient comes into the hospital and based on the complete history and physical examination he/she is diagnosed with Acute Poststreptococcal Glomerulonephritis. What are the clinical manifestations that the health care provider is going to see? (Select all that apply) a. Proteinuria b. Hematuria with smoky appearance c. Hyperlipidemia d. Periorbital edema e. Flu-like symptoms - Correct answer A, B, D A. Depending on the severity of Acute Poststreptococcal Glomerulonephritis, the degree of proteinuria will differ but there will be some no matter what. The dietary protein restriction also varies but the patient will be on a low protein, low sodium, fluid restricted diet. B. Smoky urine in a patient with Acute Poststreptococcal Glomerulonephritis indicates bleeding in the upper urinary tract. The smoky appearance is what distinctly distinguishes Acute Poststreptococcal Glomerulonephritis from another diagnosis. D. Initially edema appears in low pressure tissues, such as those around the eyes (periorbital edema), but later it progresses to involve the total body

as ascites or peripheral edema in the legs. The edema is treated by restricting sodium and fluid intake by administering diuretics. After a patient comes into the hospital for an AKI and you notice that he/she is experiencing severe dehydration, and oliguria. The patient does not encompass any damage to the kidney tissue but is experiencing decreased circulating blood volume, which stage of AKI would this patient be in? a. Acute tubular necrosis b. Intrarenal c. Prerenal d. Postrenal - Correct answer C. Prerenal The patient would be in the prerenal stage because this stage of an acute kidney injury has oliguria but does not have any damage to the kidney tissue and can be reversed with adequate treatment. The oliguria in this stage can be caused by severe dehydration, heart failure, and decreased cardiac output. A nurse is educating a female patient about to be discharged from the hospital after being treated for a urinary tract infection (UTI). The nurse recognizes the patient correctly understands the education material when they make the following statements, EXCEPT? (SELECT ALL THAT APPLY) a. I should urinate approximately every 3-4 hours throughout the day b. I should take bubble bathes as a way to get everything clean down there c. I should be emptying my bladder before and after sexual intercourse d. I should be wiping from front to back after urinating e. I should stop taking my antibiotics once the symptoms of my urinary tract infection (UTI) are gone - Correct answer B, E B. Avoid vaginal douches and harsh soaps, bubble baths, powders, and sprays in the perineal area. E. Emphasize the importance of taking the full course of antibiotics. Often patients stop antibiotic therapy once symptoms disappear. This can lead to inadequate treatment and recurrence of infection or bacterial resistance to antibiotics

A patient is presenting to the emergency department with confirmed anaphylactic shock after eating peanuts. Which order by the doctor would the nurse question in regard to the treatment of this patient? a. Epinephrine IM b. Albuterol c. Nitroglycerin d. Diphenhydramine - Correct answer C. Nitroglycerin Hypotension results from leakage of fluid out of the intravascular space into the interstitial space as a result of increased vascular permeability and vasodilation. Vasodilators, such as nitroglycerin, would be contraindicated Which statement(s) is/are correct about Acute Kidney Injury (AKI)? Select all that apply. a. The most common intrarenal cause is acute tubular necrosis. b. The onset is gradual and often over many years. c. Prerenal and postrenal AKI usually resolves quickly with treatment. d. The RIFLE classification is used to describe the stages of AKI. e. Diagnostic criteria of AKI are acute reduction in urine output and /or elevation in serum creatinine. - Correct answer A, C, D, E A. Acute tubular necrosis (ATN) is the most common intrarenal cause of AKI and is primarily the result of ischemia, nephrotoxins, or sepsis. C. Prerenal and postrenal AKI that has not caused intrarenal damage usually resolves quickly with treatment. When parenchymal damage occurs due to either prerenal or postrenal causes, or when parenchymal damage occurs directly as with intrarenal causes, AKI has a prolonged course. D. The RIFLE classification is used to describe the stages of AKI. Risk, Injury, Failure, Loss, and End-stage renal disease. E. Although changes in urine output and serum creatinine occur relatively late in the course of AKI, they are known diagnostic indicators. The rate of increase in serum creatinine is also important as a diagnostic indicator in determining the severity of injury.

What is Inflammatory bowel disease (IBD)? a. Inflammation of the mucosa of the stomach and small intestine with sudden diarrhea, nausea, vomiting, fever, and abdominal cramping. b. Disorder characterized by chronic abdominal pain or discomfort and alteration of bowel patterns between diarrhea and constipation. c. Chronic symptom of mucosal damage caused by reflux of stomach acid into the lower esophagus. d. Chronic inflammation of the GI tract characterized by periods of remission interspersed with periods of exacerbation. e. Syndrome defined by difficult or infrequent stools; hard, dry stools that are difficult to pass; or a feeling of incomplete evacuation. - Correct answer D. Chronic inflammation of the GI tract characterized by periods of remission interspersed with periods of exacerbation. IBD is a chronic inflammation of the GI tract characterized by periods of remission interspersed with periods of exacerbation A patient is admitted to the hospital with a ventricular septal rupture. He is experiencing tachycardia, tachypnea, crackles, and a narrowing pulse pressure. The patient is suspected to be in cardiogenic shock. The nurse would question which medication ordered? a. Nitroglycerin b. Dobutamine c. Furosemide d. Norepinephrine e. Dopamine - Correct answer D. Norepinephrine The nurse would question the order for norepinephrine because it is a sympathomimetic drug that increases SVR. An increase in SVR increases the workload of the heart and can cause further myocardial damage to a patient in cardiogenic shock. The nurse is providing discharge teaching to a patient who has a new diagnosis of Type 1 Diabetes Mellitus. The nurse understands teaching has been effective when the patient makes which statements? Select all that apply. a. I have an autoimmune disorder

b. I will be able to control my disease with diet and exercise only c. My A1C goal is less than 7% d. I will only require a once daily injection of Lantus e. I will carry cookies with me in case my blood glucose drops below 70 - Correct answer A, C A. Type 1 Diabetes Mellitus is an autoimmune disorder in which the body develops antibodies against insulin or the beta pancreatic cells. This results in an 80-90% reduction in islet cells. The person can no longer produce enough insulin to survive. C. A goal of an A1C <7% is the recommended guideline from the ADA. This level decreases the risk for micro and macrovascular damage. A student nurse is providing health promotion activities to a patient and caregiver to prevent the recurrence of a Urinary Tract Infection. Which statement by the student would require correction from the nurse? a. When providing appropriate hygiene wipe from back to front after urinating b. Maintain adequate fluid intake c. Report to the HCP symptoms or signs of recurrent UTI d. Consider drinking unsweetened cranberry juice or taking cranberry extract tablets 300-400 mg/day - Correct answer A. When providing appropriate hygiene wipe from back to front after urinating Health promotion activities can help decrease the frequency of infections and provide early detection of infection. Health promotion activities include teaching preventative measures such as 1) emptying the bladder regularly and completely, 2) evacuating the bowel regularly, 3) wiping the perineal area from front to back after urination and defecation, and 4) drinking an adequate amount of liquid each day. What clinical manifestations would you expect to find in a patient diagnosed with Irritable Bowel Disease presenting with hypomagnesemia? (Select all that apply) a. Trousseau's sign b. Diminished deep tendon reflexes c. Vertigo

d. Muscle cramps e. Urinary retention f. Confusion - Correct answer A, C, D, F Clinically, hypomagnesemia resembles hypocalcemia. Neuromuscular manifestations are common such as muscle cramps, tremors, hyperactive deep tendon reflexes, Chvostek's sign, and Trousseau's sign. Neurologic manifestations include confusion, vertigo, and seizures. A patient's morning lab has hemoglobin level of 5 g/dL, the integumentary changes. The nurse will notice in this patient include the following? (Select all that apply). a. Pallor b. Jaundice c. Anorexia d. Pruritus e. Increased pulse pressure - Correct answer A, B, D The clinical manifestations of anemia are caused by the body's response to tissue hypoxia. Specific manifestations vary depending on the rate at which the anemia has evolved, its severity, and any coexisting disease. Hemoglobin levels are often used to determine the severity of anemia. The integumentary changes include pallor, jaundice, and pruritus, and in addition to the skin, the sclera of the eyes and mucous membrane are evaluated for jaundice because they reflect the integumentary changes more accurately A critically ill patient is diagnosed with severe hypokalemia. Appropriate treatment modalities for the management of severe hypokalemia include (select all that apply) a. Set up continuous electrocardiogram monitoring b. Administer a bolus of intravenous potassium chloride c. Frequently assess the intravenous site for phlebitis and infiltration d. Monitor urine output - Correct answer A, C, D A. Patients who are critically ill should have continuous electrocardiogram monitoring to detect cardiac changes.

C. Intravenous sites used to administer potassium chloride should be assessed for phlebitis and infiltration at least hourly because it is irritating to the vein. Necrosis and sloughing of the surrounding tissue can result from infiltration. D. Potassium chloride is typically only given if urine output meets the parameter of at least 0.5 mL/kg of body weight per hour. Urine output should be monitored appropriately. A client diagnosed with chronic kidney has the following ABG results; pH 7.26, PaCO2 30 mm Hg, HCO3 16 mEq/L, PaO2 90 mm Hg, and O saturation of 96%. As the nurse, you will interpret these results as a. Respiratory Acidosis b. Metabolic Acidosis c. Respiratory Alkalosis d. Metabolic Alkalosis - Correct answer B. Metabolic Acidosis Metabolic Acidosis occurs when an acid other than carbonic acid accumulates in the body or when bicarbonate is lost from body fluids. The compensatory response to metabolic acidosis is to increase CO2 excretion by the lungs. The patient often develops kussmaul respiration, and in addition, the kidneys attempt to excrete addition acid. During an hourly neurological assessment of a patient suffering from neurogenic shock, which of the following signs or symptoms would the nurse find most concerning? a. Delirium b. Restlessness c. Decreased responsiveness to stimuli d. Pupils nonreactive and dilated - Correct answer D. Pupils nonreactive and dilated Pupils nonreactive and dilated indicate progression into the final stage of shock. The refractory stage of neurogenic shock is characterized by unresponsiveness, loss of reflexes, and nonreactive and dilated pupils. You are caring for a patient diagnosed with Acute Kidney injury. In educating the patient about this disease, you describe the different types of

AKI as prerenal, intrarenal, and postrenal. Which of the following are potential causes of prerenal AKI? Select all that apply. a. Severe dehydration b. Heart failure c. Damage to kidney tissue d. Decreased cardiac output e. Nephrotoxins - Correct answer A, B, D A. Severe dehydration decreases systemic circulation. The decreased systemic circulation causes a reduction in renal blood flow. The decrease in blood flow leads to decreased glomerular perfusion and filtration of the kidneys. B. Heart failure decreases systemic circulation because the heart is not able to pump effectively. In turn, this failure of the heart to pump is causing circulation issues. The decrease in blood flow leads to decreased glomerular perfusion and filtration of the kidneys. D. Normal adults have cardiac output of 4.7 liters a minute. When CO falls below this amount, there is decreased circulation. The decreased circulation to the kidneys decreases glomerular perfusion and filtration of the kidney. A patient is diagnosed with Grave's disease. They are scheduled to have a complete thyroidectomy. What post-op complication should the nurse educate the patient on that involves an excessive amount of thyroid hormone being released into circulation and is considered a medical emergency if left untreated? a. Thyroid Storm b. Exophthalmos c. Goiter d. Hyperthyroidism e. Decreased basal metabolic rate - Correct answer A. Thyroid Storm Thyroid storm also known as thyrotoxic crisis is an acute, severe, and rare condition that occurs when excessive amounts of thyroid hormones are released into circulation. This is a life-threatening emergency if left untreated. Thyroid storm happens as a result of manipulation of the

hyperactive thyroid gland which causes an increase in hormones released all at once. After providing education to a patient with Chronic Kidney Disease (CKD) receiving bi-weekly Peritoneal Dialysis, which of the following statements indicates that dietary coaching has been effective? a. "I can drink as much water as I want as long as my weight and blood pressure are controlled." b. "My daily protein intake should be 2.1 g/kg of my ideal body weight." c. "My nutritional energy sources should come primarily from carbohydrate and fat sources." d. "I will not require supplements to balance my nutritional needs if I'm receiving erythropoietin." - Correct answer A. "I can drink as much water as I want as long as my weight and blood pressure are controlled." Patients undergoing Peritoneal Dialysis have an unrestricted fluid allowance if weight and blood pressure are controlled. Which of the following are risk factors for developing Chronic Kidney Disease? (Select all that apply) a. Diabetes Mellitus b. Hypertension c. Minority population status d. Burns - Correct answer A, B, C Chronic kidney disease has a high in minority populations, especially African Americans and Native Americans. Although Chronic kidney disease has many different causes, the leading causes are diabetes (about 50%) and hypertension (about 25%). A patient asks the student nurse to explain common symptoms of a lower urinary tract infection. The student nurse would be correct if they gave all the symptoms except which of the following? a. Dysuria b. Suprapubic discomfort c. Flank pain d. Urgency - Correct answer C. Flank pain

Flank pain, chills, and fever indicate an infection involving the upper urinary tract (pyelonephritis). When hemodialysis is performed, the nurse will want to closely observe the patient for a decrease in blood pressure that will manifest itself in which way(s). (Select all that apply.) a. vision changes b. increases cardiovascular disease c. seizure activity d. nausea/vomiting - Correct answer A, C, D The drop in blood pressure during dialysis may precipitate light- headedness, nausea, vomiting, seizures, vision changes, and chest pain from cardiac ischemia. A male patient has undergone a hemopoietic stem cell transplant for acute lymphoblastic leukemia (ALL) a couple months ago. From the patient's most recent lab draw, which lab values would be most concerning to the nurse? Select all that applies a. Sodium level of 136 b. Hematocrit of 25% c. Hemoglobin of 8.2 g/dL d. Platelet count of 350,000/μL e. Red blood cell count of 5.0×10^6/μL - Correct answer B, C This is a pertinent lab to be concerned about because a normal hematocrit level is 39%-50% for males, and this one is on the low end which is also a typical lab value in ALL A nurse is administering parenteral nutrition to their patient. What action by the nurse would require the charge nurse to intervene? a. The nurse verifies the parenteral nutrition rate and dose before administration. b. The nurse realizes the feeding is behind schedule and speeds it up. c. The feeding finishes sooner than expected so the nurse starts a 10% dextrose solution.

d. The nurse attaches feeding tubing to the patient's peripherally inserted central catheter. - Correct answer B. The nurse realizes the feeding is behind schedule and speeds it up. The nurse would not speed up the feeding even though it was behind. This could cause an electrolyte imbalance in the patient or cause refeeding syndrome. The proper action would be to correct the speed of the feeding to what it should be and ensure that it is feeding the proper rate after the change. A nurse is administering IV antibiotics for an adult patient recently diagnosed with PKD (Polycystic kidney disease). The patient states, "I can't wait to finish this round of antibiotics so this condition will go away." The nurse plans to re-educate the patient on their diagnosis and includes which of the following (select all that apply): a. This antibiotic is being used to treat your Urinary Tract Infection, not your PKD. b. Treatment of PKD includes antibiotics to prevent UTI infections that can cause additional harm and pain to your kidneys. c. PKD is a life-long condition that will eventually lead to ESRD. d. Kidney transplants are not recommended for patients with PKD. - Correct answer A, B, C A. PKD does not have a specific rout of treatment. One goal of treatment is the prevention infection of urinary tract, which would be treated with antibiotics. The remaining treatments for PKD are to treat symptoms, like pain, and then begin specific treatments for end-stage renal disease that include nephrectomy, dialysis, and kidney transplant once the disease has progressed. B. The major goal of treating patients with PKD is to prevent urinary tract infections. UTI's can cause additional pain and inflammation. C. PKD usually progresses to ESRD with loss of kidney function. This occurs by the age of 60 in 50% of the population diagnosed with PKD. You are planning discharge education for a patient who was diagnosed with acute diverticulitis. Included in the patients dietary education would be:

a. Eat a diet high in carbohydrates and avoid nuts and seeds. b. Eat a diet high in fiber, mainly from fruits and vegetables. c. Increase the amount of red meat and fat in diet to promote protein absorption. d. Diet modifications are not necessary. Continue with your current diet, but add a dietary fiber supplement and stool softeners to your daily routine. - Correct answer B. Eat a diet high in fiber, mainly from fruits and vegetables. It is recommended that the patient has a diet high in fiber and most of that fiber coming from fruits and vegetables. Decreasing the level of red meat and fat are also recommended to prevent diverticulitis. Sue is a 34 year old patient who has just been diagnosed with adrenocortical insufficiency. What discharge instructions should be included to manage her corticosteroid therapy? (Select all that apply) a. Diet high in potassium b. Diet high in carbohydrates c. Limit amount exercise to prevent fractures. d. Monitor glucose levels - Correct answer A, D A. Hypokalemia may develop when taking corticosteroids. A diet high in potassium, protein, and calcium is important. Diet should also be low in fat, and simple carbohydrates. D. Corticosteroids can cause glucose intolerance thus affecting blood glucose levels. It is important to monitor blood glucose levels and educate patient on signs and symptoms of hyperglycemia. A 31 year old homeless patient whom has been living under a bridge next to a sewage deposit presents to the emergency department with a temperature of 100.2 degrees and has noticed a yellowish tint to his eyes. The nurse would suspect the patient has contracted what hepatic condition? a. Hepatitis C b. Hepatitis A c. Ascites d. Jaundice - Correct answer B. Hepatitis A

Hepatitis A can be contracted from crowded conditions, poor personal hygiene, sexual contact, IV drug users, poor sanitation, contaminated food and water (like a sewage deposit). Infection presents with mild flu-like illness and jaundice which is a yellowish discoloration of body tissues which can be seen in the eyes sometimes. The nurse is providing care to a patient diagnosed with a proximal small intestine obstruction. The nurse is monitoring for common manifestations of a proximal small intestine obstruction and knows they include all of the following except: a. Frequent and copious vomiting b. Increased abdominal distention c. Frequent cramping d. Rapid onset of pain e. Rapid dehydration - Correct answer B. Increased abdominal distention The signs of colonic obstruction include abdominal distention, either absolute constipation or a marked change in bowel function, and lack of flatus. Vomiting is rare. The nurse is providing care for a patient with acute kidney infection, the nurse knows that this patient has an increased risk for which potential complications? (Select all that apply) a. Hyperkalemia b. Neurologic disorders c. Metabolic acidosis d. Respiratory infection - Correct answer A, B, C, D A. In acute kidney infection, the serum potassium level increases because the kidney's normal ability to excrete potassium is impaired. Hyperkalemia is the serious complication of acute kidney infection because it can cause life-threatening cardiac dysrhythmias. B. Neurologic changes can occur as the nitrogenous waste products accumulate in the

brain and other nervous tissues. The manifestations can be as mild as fatigue and difficulty concentrating, and escalate to seizures, stupor, and coma. C. The impaired kidneys cannot excrete hydrogen ions or the acid products of metabolism. A patient with severe metabolic acidosis may develop Kussmaul respirations in an effort to compensate by increasing the exhalation of CO2. D. Leukocytosis is often present with acute kidney infection. The most common cause of death in acute kidney infection is infection. The most common sites of infection are the urinary and respiratory systems. The nurse is getting report on a patient that is in the hospital awaiting laser lithotripsy for their kidney stone. What assessment data do you expect to see in your patient? (Select all that apply) a. Back pain. b. High urine output. c. Cool moist skin. d. Patient frequently changing positions; sitting, standing, walking, laying down. - Correct answer A, C, D A. The kidney stone pain normally presents as a sharp pain in the flank/back area. C. The patient may be in mild shock with cool, moist skin. D. Patients with renal colic have a hard time staying still because they cannot get comfortable, a common name for this is the kidney stone dance. A patient is traveling to Malaysia and is at his primary care provider to get vaccinated for the diseases he might be exposed to during his trip. Which vaccine would you expect him to get? a. Hepatitis A vaccine. b. Hepatitis B vaccine. c. Hepatitis C vaccine. d. Hepatitis D vaccine. - Correct answer A. Hepatitis A vaccine.

Hepatitis A is commonly found in developing countries and is spread through the fecal/oral route. There is a vaccine for hepatitis A and it is recommended that people traveling to developing countries get the vaccine. When educating the patient, caregiver, and family about incontinent urinary diversion surgery, the nurse understands it is important to include (SELECT ALL THAT APPLY) a. small bowel obstruction is a potential complication after pelvic surgery. b. an assessment of the patient's ability and readiness to learn before beginning. c. observations of mucus in the urine from an ileal conduit should be reported to the healthcare provider as soon as possible. d. the skin around the stoma must be cared for meticulously to prevent dermatitis and yeast infections. e. in this procedure, a patient does not leak involuntarily; there will be no need for an external collecting device. - Correct answer A, B, D A. After pelvic surgery, there is an increased incidence of thrombophlebitis, small bowel obstruction, and UTI. B. It is important to assess the patient's ability and readiness to learn before initiating a teaching program. Anxiety and fear may interfere with learning. D. Alkaline encrustations with dermatitis may occur when alkaline urine comes in contact with the skin around the stoma; other common problems include yeast infections, product allergies, and shearing-effect excoriations. When assessing a patient with the diagnosis of Grave's disease, the nurse anticipates the following manifestations EXCEPT: a. exophthalmos b. thick, brittle nails c. laboratory results showing low thyroid stimulating hormone (TSH) and elevated thyroxine (T 4 )

d. intolerance to heat - Correct answer B. thick, brittle nails Thin, brittle nails detached from nail bed (onycholysis) are a symptom of hyperthyroidism whereas thick, brittle nails are found in hypofunction of the thyroid. A client comes into the clinic complaining of dysuria, frequent urination, urgency, and cloudy urine. For which client would it be expected for the health care provider to order 3 days of trimethropim/sulfamethoxazole (Bactrim)? a. A 22 year old female who tends to drink 4-5 alcoholic beverages on Friday nights. b. A 24 year old male who exercises regularly. c. A 30 year old female with type 2 diabetes. d. A 70 year old male patient who lives in a nursing home and has a foley catheter. e. A 45 year old female who is complaining of costovertebral angle (CVA) tenderness. - Correct answer A. A 22 year old female who tends to drink 4-5 alcoholic beverages on Friday nights. This is a 22 year old female patient who is presenting signs of a lower urinary tract infection (UTI). It is likely she has uncomplicated cystitis and it can be treated with a 3 day course of antibiotics. Trimethropim/sulfamethoxazole (Bactrim) is a common antibiotic HCP's prescribe for this diagnosis. The fact that she drinks 4-5 drinks on Friday nights is not relevant to this scenario. The nurse is caring for a patient who had strep throat 8 days ago and is now complaining of flank pain, periorbital edema and said their urine is a rusty color. What lab findings will the nurse expect to see? Select all that apply. a. Proteinuria b. RBCs c. WBSc d. Casts e. Glucose - Correct answer A, B, D

The nurse will suspect that the patient has acute poststreptococcal glomerulonephritis. For this diagnosis, a dipstick urinalysis and urine sediment microscopy would show a significant amount of RBCs, proteinuria that ranges from mild to severe, and erythrocyte casts which are highly indicative of acute poststreptococcal glomerulonephritis. The nurse would also look at the blood tests to see if the blood urea nitrogen (BUN) and serum creatinine were elevated to assess if any renal impairment has occurred. A 59-year-old male is admitted to the ER with a distended abdomen thought to be ascites. Ascites is a common manifestation of cirrhosis. What are three mechanisms that lead to ascites? (Select all that apply) a. Hyperaldosteronism b. Inflammation of the sphincter of Oddi associated with cholelithiasis c. Portal hypertension d. Hypoalbuminemia e. Pancreatic abscess - Correct answer A, C, D A. Hyperaldosteronism, occurs when the hormone aldosterone is metabolized by damaged hepatocytes. The increased level of aldosterone causes increased sodium reabsorption by the renal tubules. This retention of sodium, combined with an increase in antidiuretic hormone in blood, leads to additional water retention. C. Portal hypertension which causes proteins to shift from the blood vessels into the lymph space. When the lymphatic system is unable to carry off the excess proteins and water, they leak into the peritoneal cavity. D. Hypoalbuminemia resulting from the liver's decreased ability to synthesize albumin. The hypoalbuminemia results in decreased colloidal oncotic pressure. Central Venous Access Devices (CVADs) have several potential complications. Careful monitoring and assessment may assist in early identification of potential complications. What is a manifestation of a pneumothorax, if it would occur? a. Sluggish infusion or aspiration b. Dysrhythmias