PN1 FINAL EXAM-NCLEX EXAM 2 ELIMINATION/ETHICS/SURGERY 2023/2024 WITH RATIONALES AND EXPERT VERIFIED ANSWERS GUARANTEED PASS

PN1 FINAL EXAM -NCLEX EXAM 2 ELIMINATION/ETHICS/SURGERY 2023/2024 WITH RATIONALES AND EXPERT VERIFIED ANSWERS GUARANTEED PASS Which statement made by a client with chronic renal failure and who is on hemodialysis indicates the need for further teaching? 1. "I will report any increase in my weight of 5 pounds in a 2 -day period." 2. "I take my prescribed antihypertensive drugs daily ." 3. "I am careful to take precautions in the arm with the AV fistula." 4. "I comply with salt restrictions in my diet by using salt substitutes." Answer: 4 Rationale: Many salt substitutes use potassium chloride. Potassium intake is carefully regulated i n clients with renal failure, and the use of salt substitutes will worsen hyperkalemia. Increases in weight do need to be reported to the health care provider as a possible indication of fluid volume excess. The control of hypertension is essential in the management of a client with renal failure. An AV fistula does need to be protected from injury that could be caused by constricting clothing, venipunctures, and other items What type of renal failure would the nurse expect to see in a client who overdosed accidentally on tobramycin (Nebcin)? 1. Prerenal failure 2. Postrenal failure 3. Extrarenal failure 4. Intrarenal failure Answer: 4 Rationale: Nephrotoxic drugs, such as aminoglycoside antibiotics (tobramycin), can damage the nephrons and cause intrarenal (within the kidneys) failure. Prerenal causes of renal failure include any condition that reduces the blood flow to the kidney, such as heart failure, shock, and other conditions. Postrenal failure can be caused by conditions that obstruct urine outflow in the lower urinary system. There is no condition called extrarenal failure. A client with urinary tract infection (UTI) is prescribed phenazopyridine (Pyridium). Which instruction would the nurse give the client? 1. "This drug will take care of the infecti on causing your symptoms." 2. "Your urine may turn reddish orange and may cause staining of your clothes." 3. "Take the drug before meals to minimize GI symptoms." 4. "Always keep this drug and use it at the first symptom of a UTI." Answer: 2 Rationale: Th e drug makes the urine reddish orange in color, and the client should be advised that this might stain the underwear and other clothing. The client should also be reassured that it should not be confused with blood in the urine. Phenazopyridine does not ta rget the cause of the infection. Taking the drug after meals minimizes GI symptoms associated with the use of this drug. Indiscriminate use of a urinary analgesic can mask symptoms and delay initiation of treatment. A client with a urinary diversion device has the nursing diagnosis Risk for Impaired Skin Integrity. Which interventions will the nurse use with this client? Select all that apply. 1. Change urine collection device every other day. 2. Teach self -catheteriz ation technique. 3. Empty the bag reservoir every 2 hours. 4. Monitor for foul -smelling urine. 5. Ensure appliance wafer is not more than 1/8 inch larger than stoma. Answer: 3, 5 Rationale: Emptying the reservoir bag every 2 hours prevents overfilling and possible leakage of urine into the skin surface. Ensuring that opening is not more than 1/8 inch larger than stoma reduces the risk of skin irritation and breakdown from urine on the skin. The urine collection device should be changed as needed to maintain integrity of the system. Self - catheterization is not appropriate for this nursing diagnosis. Monitoring for foul -smelling urine and monitoring for signs of infection are more appropriate interventions for the diagnosis risk for infection. A client with r enal calculi is advised to restrict calcium in the diet. The nurse determines that the client understands the restriction when the client states to avoid which types of foods? 1. Chicken, beef, and salmon 2. Green vegetables, fruit, and legumes 3. Chocolat e, smoked fish, and low -fat milk 4. Eggs, meat, and poultry Answer: 3 Rationale: Chocolate, smoked fish, milk products, beans, lentils, and dried fruits are high in calcium. In calcium phosphate and calcium oxalate calculi, dietary management includes an acid-ash diet and limiting foods high in calcium and oxalate. The other foods listed may be consumed as desired. In conducting client teaching with a client who will undergo peritoneal dialysis at home, the nurse includes discussion of what common and signi ficant complication of peritoneal dialysis? 1. Pulmonary embolism 2. Hypotension 3. Dyspnea 4. Peritonitis Answer: 4 Rationale: Peritonitis is a grave complication of peritoneal dialysis, caused by bacteria that may enter through the catheter or dialysate solution. Hypotension is a common complication of hemodialysis but not peritoneal dialysis. Pulmonary embol ism and dyspnea are not common complications of peritoneal dialysis. The nurse is preparing to admit a client with urge incontinence. In writing the nursing care plan, the nurse writes interventions that target which manifestation? 1. Involuntary loss of u rine without warning or stimulus 2. Loss of urine when coughing or sneezing 3. Inability to empty bladder 4. Inability to inhibit urine flow long enough to reach the toilet Answer: 4 Rationale: Urge incontinence is the unpredictable passage of urine soon a fter a strong urge to void is felt. Total incontinence is involuntary loss of urine without warning or stimulus. Stress incontinence is loss of urine when intra -abdominal pressure rises, such as with coughing or sneezing. Urinary retention is an inability to empty the bladder. A male client who presents to the emergency department with coffee -colored urine and edema states he had a bad sore throat a few weeks ago. His blood pressure is elevated, and urinalysis shows blood and protein in the urine. The nurse interprets that this clinical picture is consistent with which developing health problem? 1. Urinary tract infection 2. Urinary calculi 3. Acute glomerulonephritis 4. Acute prostatitis Answer: 3 Rationale: The symptoms are typical of acute glomerulonephri tis. Hematuria and proteinuria are caused by a damaged glomerular capillary membrane, which allows blood cells and proteins to escape into the renal filtrate. A urinary tract infection usually manifests with signs of infection including fever, malodorous u rine, frequency, and urgency. Clients with urinary calculi usually present with renal colic. Prostatitis, or inflammation of the prostate gland, has presenting symptoms similar to a urinary tract infection. A client in the intensive care unit develops prer enal failure following surgery. Which of the following causes should the nurse suspect? 1. Vascular disease 2. Urethral obstruction 3. Hypovolemia 4. Glomerulonephritis Answer: 3 Rationale: Prerenal failure is caused by factors such as hypovolemia and decr eased cardiac output that reduce renal blood flow and perfusion. Vascular disease may be a factor in the development of intrarenal failure. Urethral obstruction can cause postrenal failure. Glomerulonephritis may be a factor in the development of intrarena l failure Which discharge instructions would the nurse give to a client who will receive an aminoglycoside antibiotic at home to address the risk of nephrotoxicity? Select all that apply. 1. Increase fluid intake to 2000 -2500 mL fluid daily. 2. Report sudd en weight gain or puffy eyes. 3. Don't be concerned with edema as a normal side effect. 4. Elevated blood pressure is an expected drug effect. 5. Eat a low protein diet while taking this antibiotic. Answer: 1, 2 Rationale: The client should maintain a flui d intake of 2000 to 2500 mL per day to reduce the risk of nephrotoxicity. To detect nephrotoxicity early, the client should report signs of edema. Edema is not a normal side effect of the medication. To reduce the risk of nephrotoxicity, the client should report hypertension. It is unnecessary to eat a low protein diet while taking an aminoglycoside antibiotic. The nurse caring for a client undergoing a hemodialysis procedure places high priority on evaluating the client frequently for what common complicat ion during the treatment? 1. Hyperglycemia 2. Infection and fever 3. Dialysis dementia 4. Hypotension Answer: 4 Rationale: Hypotension is the most common complication during hemodialysis and is related to several factors, including changes in serum osmolal ity and rapid removal of fluid from the intravascular compartment. Hyperglycemia could occur in peritoneal dialysis because of the glucose composition of the dialysate. Infection and fever should be an ongoing assessment, not just when the client is underg oing hemodialysis. Dialysis dementia is a progressive, long -term complication. The nurse is explaining the process of peritoneal dialysis to a client who recently developed renal failure. Which statement would the nurse include in a discussion with the cli ent? 1. "The solutes in the dialysate will enter the bloodstream through the peritoneum." 2. "The peritoneum is more permeable because of the presence of excess metabolites." 3. "The peritoneum acts as a semipermeable membrane through which wastes move by diffusion and osmosis." 4. "The metabolites will move from the interstitial space to the bloodstream mainly through diffusion and ultrafiltration." Answer: 3 Rationale: The peritoneum acts as a semipermeable membrane, allowing substances to move from an ar ea of high concentration (the blood) to an area of lower concentration (the dialysate). Metabolic waste products and excess water can be eliminated through osmosis and diffusion utilizing the peritoneum as the semipermeable membrane. Which laboratory data is the most accurate indicator that a client with acute renal failure has met the expected outcomes? 1. Decreasing blood urea nitrogen (BUN) levels 2. Decreasing serum creatinine 3. Decreasing neutrophil count 4. Decreasing lymphocyte count Answer: 2 Rationale: Creatinine is the metabolic end product of creatine phosphate and is excreted via the kidneys in relatively constant amounts. BUN, a measurement of the nitrogen