NUR 141 Exam 2 fall
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Free NUR 141 Exam 2 fall Questions
The nurse is teaching a client with chronic kidney disease (CKD) about the sodium restriction needed in the diet to prevent edema and hypertension. Which statement by the client indicates that more teaching is needed?
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"I will probably lose weight by cutting out potato chips."
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"My cooking style will change by not adding salt."
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"I will cut out bacon with my eggs every morning."
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"I am thrilled that I can continue to eat fast food."
Explanation
Correct Answer: D) "I am thrilled that I can continue to eat fast food."
This statement reveals a critical misunderstanding about sodium restriction. Fast food is one of the highest sources of dietary sodium available, with single meals often containing well over 1,000–2,000 mg of sodium. For a CKD patient on sodium restriction, continuing to eat fast food regularly would directly undermine the goal of preventing fluid retention, edema, and worsening hypertension. This response clearly indicates the client has not understood the teaching and requires further education about hidden sodium sources in processed and restaurant foods.
A nurse is caring for a client who underwent ileostomy surgery 3 days ago for treatment of bowel disease. During the postoperative assessment, the nurse notes that the stoma is moist, bright red, and slightly edematous with a small amount of bleeding noted on the stoma surface during cleaning. The client reports no pain at the site and vital signs are stable. Which nursing action is most appropriate at this time?
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Apply firm pressure and a sterile dressing over the stoma to control bleeding and prevent further irritation.
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Prepare the client for diagnostic evaluation because the findings suggest impaired stoma perfusion.
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Notify the healthcare provider because bleeding from a stoma indicates postoperative hemorrhage.
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Document the findings as expected postoperative assessment findings and continue monitoring the stoma.
Explanation
Correct Answer: D) Document the findings as expected postoperative assessment findings and continue monitoring the stoma.
A healthy stoma in the early postoperative period should be moist, bright red, and slightly edematous — these are all normal findings. Minor surface bleeding during cleaning is also expected due to the stoma's rich blood supply and fragile mucosa. Since the client has no pain and vital signs are stable, there is no cause for alarm. The appropriate action is to document these normal findings and continue routine monitoring.
A client with end-stage kidney disease is scheduled to begin hemodialysis. The nurse is working with the client to adapt the client's diet to maximize the therapeutic effect and minimize the risks of complications. The client's diet should include which of the following modifications? Select all that apply.
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Fluid restriction
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Decreased protein intake
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Increased potassium intake
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Vitamin D supplementation
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Decreased sodium intake
Explanation
Correct Answers: A) Fluid restriction, D) Vitamin D supplementation, E) Decreased sodium intake
Fluid restriction is essential in end-stage kidney disease because the failing kidneys can no longer excrete excess fluid, leading to dangerous fluid overload, pulmonary edema, and hypertension. Between hemodialysis sessions, strict fluid intake limits prevent life-threatening fluid accumulation.
Vitamin D supplementation is necessary because the kidneys are responsible for activating vitamin D. In end-stage kidney disease, this activation is impaired, leading to deficiency, poor calcium absorption, and renal osteodystrophy. Supplementation with activated vitamin D (calcitriol) corrects this deficiency.
Decreased sodium intake is required to prevent fluid retention, hypertension, and thirst — all of which worsen fluid overload between dialysis sessions. Sodium restriction also helps maintain blood pressure control.
Protein intake in hemodialysis patients is actually increased, not decreased, because dialysis removes amino acids during treatment and patients are at risk for malnutrition. Potassium intake must be restricted, not increased, as impaired kidneys cannot excrete potassium, leading to dangerous hyperkalemia and potentially fatal cardiac arrhythmias.
A client with diabetic nephropathy has end-stage renal disease and is starting dialysis. What should the nurse teach the client about hemodialysis?
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"Hemodialysis is a program that will require you to commit to daily treatment."
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"This will require you to have surgery and a catheter will need to be inserted into your abdomen."
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"Hemodialysis is a treatment option that is usually required three times a week."
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"Hemodialysis is a treatment that is used for a few months until your kidney heals and starts to produce urine again."
Explanation
Correct Answer: C) "Hemodialysis is a treatment option that is usually required three times a week."
Standard hemodialysis is typically performed three times per week, with each session lasting approximately 3–5 hours. This is accurate patient education for someone beginning hemodialysis for end-stage renal disease (ESRD).
Daily treatment describes intensive hemodialysis schedules, which are not the standard regimen. Abdominal surgery and catheter insertion describe peritoneal dialysis, not hemodialysis. ESRD is irreversible — kidneys do not heal and resume function, so telling the patient dialysis is temporary is inaccurate and potentially harmful.
The nurse administers epoetin alfa to a client who has chronic kidney disease (CKD). Which laboratory test value would the nurse monitor to determine this drug's effectiveness?
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Hemoglobin
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Sodium
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Potassium
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Renin
Explanation
Correct Answer: A) Hemoglobin
Epoetin alfa is a synthetic form of erythropoietin used to treat anemia in CKD, as damaged kidneys produce insufficient erythropoietin to stimulate red blood cell production. Its effectiveness is directly measured by monitoring hemoglobin levels — a rising hemoglobin indicates the drug is successfully stimulating red blood cell production and correcting anemia.
A 24-year-old woman with Crohn's disease develops a fever and symptoms of a urinary tract infection (UTI) with tan, fecal-smelling urine. What information will the nurse add to a general teaching plan about UTIs in order to individualize the teaching for this patient?
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Empty the bladder before and after sexual intercourse.
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Drink adequate fluids to maintain normal hydration.
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Bacteria in the perianal area can enter the urethra.
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Fistulas can form between the bowel and bladder.
Explanation
Correct Answer: D) Fistulas can form between the bowel and bladder.
The key clinical clue here is the tan, fecal-smelling urine — this is characteristic of a enterovesical (colovesical) fistula, an abnormal connection between the bowel and bladder that can occur as a complication of Crohn's disease.
Bowel contents, including bacteria and fecal matter, enter the bladder through this fistula, causing recurrent, difficult-to-treat UTIs. This is specific information that individualizes the teaching for a Crohn's patient and explains her unique presentation.
Emptying the bladder before and after intercourse and drinking adequate fluids are general UTI prevention strategies applicable to all patients, not specific to Crohn's disease. Perianal bacteria entering the urethra is also general UTI education, not Crohn's-specific.
The nurse is caring for a client in acute kidney injury (AKI). Which complication would most clearly warrant the administration of polystyrene sulfonate?
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Hypernatremia
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Hyperkalemia
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Hypercalcemia
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Hypomagnesemia
Explanation
Correct Answer: B) Hyperkalemia
Polystyrene sulfonate (e.g., Kayexalate) is a cation-exchange resin that binds potassium in the gastrointestinal tract and promotes its excretion through the stool. In AKI, the kidneys lose their ability to excrete potassium, leading to dangerous hyperkalemia — which can cause life-threatening cardiac arrhythmias. Polystyrene sulfonate is specifically indicated to lower elevated serum potassium levels.
Hypernatremia involves excess sodium and is managed with fluid replacement, not polystyrene sulfonate. Hypercalcemia involves excess calcium and is treated with hydration and bisphosphonates. Hypomagnesemia is a deficiency of magnesium and would require magnesium replacement, not a potassium-binding resin.
A client has a glomerular filtration rate (GFR) of 43 mL/min/1.73 m². Based on this GFR, the nurse interprets that the client's chronic kidney disease is at what stage?
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Stage 3
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Stage 1
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Stage 4
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Stage 2
Explanation
Correct Answer: A) Stage 3
CKD is staged based on GFR values. Stage 3 is defined by a GFR of 30–59 mL/min/1.73 m², indicating moderately decreased kidney function. A GFR of 43 falls squarely within this range. At this stage, patients begin to experience complications such as anemia, bone disease, and fluid imbalances, and require closer monitoring and management to slow disease progression.
A 62-year-old client with a history of colorectal cancer presents to the clinic reporting increasing fatigue, shortness of breath on exertion, and intermittent dizziness over the past several weeks. The client also states that bowel movements have become darker in color recently. Laboratory results reveal hemoglobin of 8.9 g/dL and hematocrit of 27%. Which interpretation by the nurse is most appropriate?
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The symptoms are expected effects of aging and reduced physical activity.
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The findings most likely indicate chronic gastrointestinal bleeding related to the tumor.
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The laboratory findings suggest dehydration secondary to decreased fluid intake.
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The client is likely experiencing acute intestinal obstruction caused by tumor growth.
Explanation
Correct Answer: B) The findings most likely indicate chronic gastrointestinal bleeding related to the tumor.
The combination of fatigue, exertional dyspnea, dizziness, dark stools, low hemoglobin of 8.9 g/dL, and hematocrit of 27% in a patient with colorectal cancer is a classic presentation of chronic occult gastrointestinal bleeding. Colorectal tumors commonly bleed slowly over time, causing gradual iron-deficiency or blood-loss anemia. The dark stool color indicates the presence of digested blood in the gastrointestinal tract. These findings together paint a clear clinical picture of tumor-related chronic blood loss rather than dehydration, obstruction, or normal aging.
A patient being admitted with an acute exacerbation of ulcerative colitis reports crampy abdominal pain and passing 15 or more bloody stools a day. The nurse will plan to:
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Administer cobalamin (vitamin B₁₂) injections.
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Administer IV metoclopramide (Reglan).
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Discontinue the patient's oral food intake.
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Teach the patient about total colectomy surgery.
Explanation
Correct Answer: C) Discontinue the patient's oral food intake.
In a severe acute exacerbation of ulcerative colitis — evidenced by 15 or more bloody stools per day and significant abdominal cramping — the bowel requires rest. Placing the patient on NPO (nothing by mouth) status reduces GI stimulation, decreases stool frequency, allows mucosal healing, and is a standard intervention in acute severe UC management. The patient would typically receive IV fluids and nutritional support parenterally.
Vitamin B₁₂ injections are indicated in Crohn's disease with terminal ileum involvement, not ulcerative colitis. IV metoclopramide promotes gastric motility, which would worsen symptoms. Teaching about total colectomy may eventually be appropriate but is not the immediate nursing priority during acute management.
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