DOH Nursing Adult Health Nursing 3 — Questions and Answers
Question 1: A patient is diagnosed with chronic kidney disease Stage 4 (GFR 15–29 mL/min). Which dietary modification is most important?
- Restrict dietary potassium, phosphorus, and protein intake (Correct answer)
- Increase protein intake to compensate for proteinuria
- Encourage a high-sodium diet to maintain blood pressure
- Restrict fluid intake to 4 liters per day
Correct answer: Restrict dietary potassium, phosphorus, and protein intake
In advanced CKD, the kidneys cannot excrete potassium, phosphorus, or protein metabolic waste. Restriction prevents hyperkalemia (cardiac arrhythmias), hyperphosphatemia (bone disease), and uremia. Dietitian collaboration is essential.
Question 2: Which sign or symptom indicates increased intracranial pressure (ICP)?
- Cushing's triad: bradycardia, hypertension, irregular respirations (Correct answer)
- Tachycardia, hypotension, and fever
- Pinpoint pupils bilaterally with normal consciousness
- Diplopia alone without headache
Correct answer: Cushing's triad: bradycardia, hypertension, irregular respirations
Cushing's triad (bradycardia, widened pulse pressure/hypertension, and irregular respirations) is a late, ominous sign of severely raised ICP indicating brainstem compression. Early signs include headache, vomiting, and papilledema.
Question 3: A nurse is caring for a patient with liver cirrhosis who develops asterixis. What condition does this finding suggest?
- Hepatic encephalopathy (Correct answer)
- Portal hypertension alone
- Alcohol withdrawal seizures
- Spontaneous bacterial peritonitis
Correct answer: Hepatic encephalopathy
Asterixis ('flapping tremor') is a characteristic sign of hepatic encephalopathy caused by ammonia accumulation when the failing liver cannot convert ammonia to urea. It is elicited by asking the patient to hold their wrists extended.
Question 4: Which finding in a patient with heart failure indicates worsening fluid retention?
- Weight gain of 2 kg in 24 hours (Correct answer)
- Serum sodium of 138 mEq/L
- Clear lung sounds bilaterally
- Urine output of 60 mL/hr
Correct answer: Weight gain of 2 kg in 24 hours
Daily weight is the most sensitive indicator of fluid retention in heart failure. A weight gain of 1 kg = approximately 1 L of retained fluid. A gain of 2 kg in 24 hours indicates significant fluid accumulation and requires physician notification.
Question 5: A patient with a fractured femur develops sudden respiratory distress, petechiae on the chest, and confusion 24 hours post-injury. What complication has occurred?
- Fat embolism syndrome (Correct answer)
- Pulmonary embolism from DVT
- Compartment syndrome
- Hypovolemic shock
Correct answer: Fat embolism syndrome
Fat embolism syndrome classically presents 24–72 hours after a long bone fracture with the triad of respiratory distress, neurological changes, and petechiae (fat droplets occlude capillaries). It is differentiated from DVT-related PE by the petechiae and timing.
Question 6: Which intervention prevents dumping syndrome in a post-gastrectomy patient?
- Eat small, frequent meals low in simple sugars and avoid fluids with meals (Correct answer)
- Eat large meals three times a day with plenty of water
- Increase dietary fiber and eat slowly
- Lie down immediately after eating to slow gastric emptying
Correct answer: Eat small, frequent meals low in simple sugars and avoid fluids with meals
Dumping syndrome occurs when gastric contents rapidly enter the small intestine. Small meals low in simple carbohydrates reduce osmotic load; separating fluids from solids slows gastric transit. Lying down after eating is actually helpful to slow transit.
DOH Nursing Adult Health Nursing 3
A patient is diagnosed with chronic kidney disease Stage 4 (GFR 15–29 mL/min).
Which dietary modification is most important?