NUR 141 Exam 2 fall
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Free NUR 141 Exam 2 fall Questions
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?
- Empty the bladder before and after sexual intercourse.
- Drink adequate fluids to maintain normal hydration.
- Bacteria in the perianal area can enter the urethra.
- 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.
A nurse assesses clients at a community health center. Which client is at highest risk for developing colorectal cancer?
- A 60-year-old lawyer who works 65 hours per week.
- A 72-year-old who eats fast food frequently.
- A 37-year-old who drinks eight cups of coffee daily.
- A 44-year-old with irritable bowel syndrome (IBS).
Explanation
Correct Answer: B) A 72-year-old who eats fast food frequently.
The 72-year-old carries two major independent risk factors for colorectal cancer. Age over 50 is the single strongest risk factor for colorectal cancer, as the risk increases significantly with each decade of life. Additionally, a diet high in processed and fast foods — which is typically high in saturated fat, red meat, and low in fiber — is strongly associated with increased colorectal cancer risk. The combination of advanced age and a high-risk diet makes this client the most vulnerable among those listed.
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?
- Apply firm pressure and a sterile dressing over the stoma to control bleeding and prevent further irritation.
- Prepare the client for diagnostic evaluation because the findings suggest impaired stoma perfusion.
- Notify the healthcare provider because bleeding from a stoma indicates postoperative hemorrhage.
- 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 nurse reviews the electronic health record of a client who has Crohn disease and a draining fistula. Which documentation would alert the nurse to urgently contact the primary health care provider for additional prescriptions?
- Client ate 20% of breakfast meal
- Client's weight decreased by 3 lb (1.4 kg)
- White blood cell count of 8200/mm³ (8.2 × 10⁹/L)
- Serum potassium of 2.6 mEq/L (2.6 mmol/L)
Explanation
Correct Answer: D) Serum potassium of 2.6 mEq/L (2.6 mmol/L)
A potassium level of 2.6 mEq/L is critically below the normal range of 3.5–5.0 mEq/L, placing the client at immediate risk for life-threatening cardiac arrhythmias and respiratory muscle paralysis. In Crohn's disease with a draining fistula, continuous electrolyte losses make this even more dangerous. The nurse must urgently contact the provider for potassium replacement and initiate cardiac monitoring immediately.
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?
- The client's polyps constitute a risk factor for cancer.
- The client should be assured that this is a normal, age-related physiologic change.
- The presence of polyps is associated with an increased risk of bowel obstruction.
- 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.
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?
- "I will probably lose weight by cutting out potato chips."
- "My cooking style will change by not adding salt."
- "I will cut out bacon with my eggs every morning."
- "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 assesses a client who has ulcerative colitis and severe diarrhea. Which assessment would the nurse complete first?
- Percussion of abdomen
- Heart rate and rhythm
- Inspection of oral mucosa
- Recent dietary intake
Explanation
Correct Answer: B) Heart rate and rhythm
Severe diarrhea in ulcerative colitis causes significant fluid and electrolyte losses, most critically potassium. Hypokalemia and hypovolemia directly affect cardiac function and can precipitate life-threatening arrhythmias. Assessing heart rate and rhythm first follows the ABCs of priority nursing assessment — cardiovascular stability is the most immediately life-threatening concern in a client with severe diarrhea and must be evaluated before other assessments.
The nurse is assessing a client with a diagnosis of prerenal acute kidney injury (AKI). Which condition would the nurse expect to find in the patient's recent history?
- Bladder cancer
- Pyelonephritis
- Kidney stones
- Dehydration
Explanation
Correct Answer: D) Dehydration
Prerenal AKI occurs when severely reduced blood flow to the kidneys impairs their ability to filter, without direct damage to kidney tissue itself. Dehydration is one of the most common prerenal causes because significant fluid loss reduces circulating blood volume, dropping renal perfusion pressure below the threshold needed for adequate filtration. The kidneys respond by reducing urine output in an attempt to conserve fluid, but if perfusion is not restored promptly, ischemic injury can progress to intrinsic renal damage.
A nurse cares for a client who had a colostomy placed in the ascending colon 2 weeks ago. The client states, "The stool in my pouch is still liquid." How would the nurse respond?
- "Eating additional fiber will bulk up your stool and decrease diarrhea."
- "This is abnormal. I will contact your primary health care provider."
- "Your stool will become firmer over the next couple of weeks."
- "The stool will always be liquid with this type of colostomy."
Explanation
Correct Answer: D) "The stool will always be liquid with this type of colostomy."
An ascending colostomy is located in the early part of the large intestine, before significant water absorption has occurred. As a result, stool that exits through an ascending colostomy will permanently remain liquid in consistency, regardless of dietary modifications. This is an expected and permanent characteristic of this type of colostomy, and the client requires education to understand and manage this normal finding.
The nurse is planning client teaching for a client with end-stage kidney disease who is scheduled for the creation of a fistula. The nurse should teach the client what information about the fistula?
- "The arm should be immobilized for 4 to 6 days."
- "A vein and an artery in your arm will be attached surgically."
- "One needle will be inserted into the fistula for each dialysis treatment."
- "The fistula can be used 5 to 7 days after the surgery for dialysis treatment."
Explanation
Correct Answer: B) "A vein and an artery in your arm will be attached surgically."
An arteriovenous (AV) fistula is created by surgically connecting an artery directly to a vein, most commonly in the forearm. This connection causes arterial blood to flow into the vein, causing it to enlarge and develop thickened walls — a process called maturation — which makes the vessel strong enough to withstand repeated needle insertions for hemodialysis.
The fistula is the preferred vascular access for hemodialysis due to its durability, lower infection risk, and longer lifespan compared to grafts or catheters. Importantly, the fistula requires 4 to 6 weeks to mature before it can be used, not 5 to 7 days.
Two needles are inserted for each dialysis session — one to carry blood to the dialyzer and one to return it. The arm does not need to be immobilized for 4 to 6 days following surgery.
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