NCLEX-PN Test #3 3 — Questions and Answers
Question 1: A client in acute renal failure has a serum potassium of 6.8 mEq/L. Which dietary restriction is most important to reinforce?
- Limit sodium to 2 g/day
- Avoid high-potassium foods such as bananas, oranges, and potatoes (Correct answer)
- Restrict fluid intake to 1,000 mL/day
- Limit protein to 0.8 g/kg/day
Correct answer: Avoid high-potassium foods such as bananas, oranges, and potatoes
Hyperkalemia (K+ ≥6.5 mEq/L) is life-threatening and can cause fatal cardiac dysrhythmias. In acute renal failure, the kidneys cannot excrete potassium. Restricting high-potassium foods is the most immediate dietary intervention. Cardiac monitoring and emergency treatment (kayexalate, calcium gluconate, insulin+glucose) are also required.
Question 2: A client with Cushing's syndrome is admitted for surgical management. Which assessment finding is expected?
- Moon face, buffalo hump, and purple striae (Correct answer)
- Exophthalmos, heat intolerance, and weight loss
- Periorbital edema, cold intolerance, and constipation
- Bronze skin discoloration and hypotension
Correct answer: Moon face, buffalo hump, and purple striae
Cushing's syndrome results from excess cortisol causing classic findings: central obesity, moon face, buffalo hump (fat redistribution), purple abdominal striae, hypertension, hyperglycemia, and muscle weakness. Exophthalmos is seen in hyperthyroidism; cold intolerance in hypothyroidism; bronze skin in Addison's disease.
Question 3: A client with peptic ulcer disease reports sudden onset of severe, rigid abdominal pain that radiates to the shoulder. What complication does the nurse suspect?
- Hemorrhage
- Gastric outlet obstruction
- Perforation (Correct answer)
- Stress ulcer formation
Correct answer: Perforation
Sudden onset of severe, board-like abdominal rigidity with referred shoulder pain (due to diaphragmatic irritation from free air) indicates peptic ulcer perforation. This is a surgical emergency. Hemorrhage presents with hematemesis/melena; obstruction with persistent vomiting and distension.
Question 4: A client post-kidney transplant is prescribed tacrolimus. Which finding requires immediate notification of the provider?
- Blood pressure 130/85 mmHg
- Serum creatinine rising from 1.0 to 2.5 mg/dL over 48 hours (Correct answer)
- Mild hand tremors
- Blood glucose of 130 mg/dL
Correct answer: Serum creatinine rising from 1.0 to 2.5 mg/dL over 48 hours
A rising serum creatinine after kidney transplant indicates possible acute rejection. Tacrolimus is an immunosuppressant used to prevent rejection; however, its therapeutic window is narrow and nephrotoxicity is a known side effect. A creatinine that doubles in 48 hours requires urgent evaluation for rejection vs. drug toxicity.
Question 5: The PN is caring for a client with type 2 diabetes who is prescribed metformin. Which condition is a contraindication to this medication?
- Obesity (BMI > 30)
- Chronic kidney disease with GFR < 30 mL/min (Correct answer)
- Elevated HbA1c > 8%
- Hypertension controlled with ACE inhibitors
Correct answer: Chronic kidney disease with GFR < 30 mL/min
Metformin is contraindicated in clients with significant renal impairment (GFR < 30 mL/min) due to the risk of lactic acidosis. The kidneys excrete metformin, and impaired clearance leads to dangerous drug accumulation. It is also held before contrast studies and surgery.
Question 6: A client with Crohn's disease is at risk for deficiency of which vitamin due to terminal ileum involvement?
- Vitamin C
- Vitamin B12 (Correct answer)
- Vitamin D
- Vitamin K
Correct answer: Vitamin B12
Vitamin B12 (cobalamin) is absorbed exclusively in the terminal ileum. Crohn's disease commonly involves the terminal ileum, leading to impaired B12 absorption and megaloblastic anemia. Clients with extensive terminal ileum disease or surgical resection require parenteral B12 supplementation.
NCLEX-PN Test #3 3
A client in acute renal failure has a serum potassium of 6.8 mEq/L.
Which dietary restriction is most important to reinforce?