DOH Nursing Adult Health Nursing 3

Question 1

A patient is diagnosed with chronic kidney disease Stage 4 (GFR 15–29 mL/min). Which dietary modification is most important?

Accepted Answer

Restrict dietary potassium, phosphorus, and protein intake

Answer

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)?

Accepted Answer

Cushing's triad: bradycardia, hypertension, irregular respirations

Answer

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?

Accepted Answer

Hepatic encephalopathy

Answer

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?

Accepted Answer

Weight gain of 2 kg in 24 hours

Answer

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?

Accepted Answer

Fat embolism syndrome

Answer

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.

DOH Nursing Practice Test

DOH Nursing Practice Test

DOH Nursing Adult Health Nursing 3