NCLEX-PN Test #3 3

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?

Accepted Answer

Avoid high-potassium foods such as bananas, oranges, and potatoes

Answer

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?

Accepted Answer

Moon face, buffalo hump, and purple striae

Answer

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?

Accepted Answer

Perforation

Answer

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?

Accepted Answer

Serum creatinine rising from 1.0 to 2.5 mg/dL over 48 hours

Answer

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?

Accepted Answer

Chronic kidney disease with GFR < 30 mL/min

Answer

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.

NCLEX Practice Test

NCLEX Practice Test

NCLEX-PN Test #3 3