NUR 141 Exam 2 fall
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Free NUR 141 Exam 2 fall Questions
The nurse is caring for a client receiving hemodialysis three times weekly. The client has had surgery to form an arteriovenous fistula. What is most important for the nurse to be aware of when providing care for this client?
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Using a stethoscope for auscultating the fistula is contraindicated
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Taking a BP reading on the affected arm can damage the fistula
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The client feels best immediately after the dialysis treatment
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The client should not feel pain during initiation of dialysis
Explanation
Correct Answer: B) Taking a BP reading on the affected arm can damage the fistula.
An arteriovenous fistula is a surgically created connection between an artery and vein, typically in the forearm, used for hemodialysis access. Any compression of the affected arm — including blood pressure measurement, venipuncture, or IV insertion — can damage the fistula, cause clotting, or compromise blood flow. Protecting the fistula arm from all forms of compression is a critical nursing responsibility.
A client's screening colonoscopy revealed the presence of numerous polyps in the large bowel. What principle should guide the subsequent treatment of this client's health problem?
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The client's polyps constitute a risk factor for cancer.
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The client should be assured that this is a normal, age-related physiologic change.
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The presence of polyps is associated with an increased risk of bowel obstruction.
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Adherence to a high-fiber diet will help the polyps resolve.
Explanation
Correct Answer: A) The client's polyps constitute a risk factor for cancer.
Colorectal polyps, particularly adenomatous polyps, are well-established precursors to colorectal cancer. The presence of numerous polyps significantly elevates the client's cancer risk, as polyps can undergo malignant transformation over time if left untreated.
This principle guides subsequent treatment, which includes polypectomy during colonoscopy, histological examination of removed polyps, and a more frequent surveillance colonoscopy schedule to detect and remove new polyps before they progress to cancer.
Colonic polyps are not a normal age-related change, do not typically cause bowel obstruction, and cannot be resolved through dietary modifications alone.
A client with end-stage renal disease receives continuous ambulatory peritoneal dialysis. The nurse observes that the dialysate drainage fluid is cloudy. What is the nurse's most appropriate action?
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Inform the health care provider and assess the client for signs of infection.
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Administer a bolus of IV normal saline as prescribed.
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Remove the catheter promptly and have the catheter tip cultured.
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Flush the peritoneal catheter with normal saline.
Explanation
Correct Answer: A) Inform the health care provider and assess the client for signs of infection.
Cloudy dialysate drainage is the earliest and most classic warning sign of peritonitis — a serious infection of the peritoneal cavity that is the most feared complication of peritoneal dialysis. Normal dialysate drainage should be clear and pale yellow. Cloudiness indicates the presence of white blood cells and bacteria in the fluid. The nurse must immediately notify the provider and assess the client for fever, abdominal pain, and rebound tenderness, as peritonitis requires prompt antibiotic treatment to prevent sepsis and loss of the peritoneal membrane as a dialysis access site.
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 with acute kidney injury (AKI) has a blood pressure of 76/55 mm Hg. The primary health care provider prescribed 1000 mL of normal saline to be infused over 1 hour to maintain perfusion. The client starts to develop shortness of breath. What is the nurse's priority action?
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Decrease the rate of the IV infusion.
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Calculate the mean arterial pressure (MAP).
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Take the client's pulse.
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Ask for insertion of a pulmonary artery catheter.
Explanation
Correct Answer: A) Decrease the rate of the IV infusion.
The client is showing signs of fluid overload — shortness of breath during rapid IV fluid administration indicates fluid is accumulating in the lungs. Despite the low blood pressure requiring fluid resuscitation, the developing respiratory compromise takes priority. Decreasing the IV rate is the most immediate nursing action to prevent further pulmonary fluid accumulation while the provider is notified to reassess the treatment plan.
A client is admitted with acute kidney injury (AKI) and a urine output of 2000 mL/day. What is the major concern of the nurse regarding this patient's care?
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Cardiac and respiratory status
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Mental health status
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Edema and pain
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Electrolyte and fluid imbalance
Explanation
Correct Answer: D) Electrolyte and fluid imbalance
Electrolyte and fluid imbalance is the major concern in AKI because the kidneys are responsible for regulating the body's fluid volume and electrolyte composition. When kidney function is impaired, dangerous imbalances rapidly develop — particularly hyperkalemia, which can cause life-threatening cardiac arrhythmias, hypernatremia causing fluid shifts, and metabolic acidosis from the inability to excrete hydrogen ions. A urine output of 2000 mL/day places the client in the polyuric phase of AKI, during which massive electrolyte losses occur and must be carefully monitored and replaced to prevent fatal complications.
A nurse is presenting an educational event to a local community group. When speaking about colorectal cancer, what risk factor should the nurse cite?
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History of bowel obstruction
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Longstanding psychosocial stress
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History of diverticulitis
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High levels of alcohol consumption
Explanation
Correct Answer: D) High levels of alcohol consumption
High alcohol consumption is a well-established modifiable risk factor for colorectal cancer. Alcohol is metabolized into acetaldehyde, a toxic compound that damages DNA in colon cells and promotes tumor development. Other recognized risk factors include a high-fat, low-fiber diet, obesity, smoking, and a sedentary lifestyle. Bowel obstruction, psychosocial stress, and diverticulitis are not recognized risk factors for colorectal cancer development.
A client with chronic kidney disease (CKD) has an elevated serum phosphorus level. What drug would the nurse anticipate to be prescribed for this client?
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Calcium acetate
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Doxycycline
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Lisinopril
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Magnesium sulfate
Explanation
Correct Answer: A) Calcium acetate
In CKD, the kidneys cannot excrete phosphorus adequately, leading to hyperphosphatemia. Calcium acetate is a phosphate binder that works in the gastrointestinal tract by binding dietary phosphorus before it can be absorbed into the bloodstream, allowing it to be excreted through the stool. It is a first-line pharmacological treatment for elevated phosphorus levels in CKD patients and must be taken with meals to be effective.
A client with chronic kidney disease (CKD) is refusing to take his medication and has missed two hemodialysis appointments. What is the best initial action for the nurse?
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Reschedule the appointments to another date and time.
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Refer the client to a mental health nurse practitioner.
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Discuss the option of peritoneal dialysis.
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Discuss what the treatment regimen means to the client.
Explanation
Correct Answer: D) Discuss what the treatment regimen means to the client.
Before taking any other action, the nurse must first understand why the client is non-compliant. Engaging in open, non-judgmental dialogue allows the nurse to identify underlying barriers such as fear, depression, financial concerns, or misunderstanding about the disease. This patient-centered approach is the foundation of therapeutic communication and is always the appropriate first step before escalating to referrals or alternative treatment options.
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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