ADN 120 Final Exam – Questions & Solutions
The nurse notes documentation in a client's medical record that the client is experiencing anuria. Based on this notation, what determination should the nurse make? A. The client is unable to produce urine.
B. The client has a diminished capacity to form urine.
C. The client has difficulty having a bowel movement.
D. The client has episodes of alternating constipation and diarrhea. Correct Ans - A. The client is unable to produce urine.
The nurse is caring for a client who has a fever and is diaphoretic. The nurse monitors the client's intake and output and expects which finding?
A. The client's urine is diluted.
B. The client's output is decreased.
C. The client's urine production is increased.
D. The majority of the client's fluid is excreted through the skin. Correct Ans - B. The client's output is decreased.
The nurse instructs a client taking a potassium-retaining diuretic about foods high in potassium that need to be avoided. The nurse determines that the client needs further instruction if the client states that which food is high in potassium?
A. Kiwi B. Celery
C. Oranges D. Dried fruit Correct Ans - B. Celery
A clear liquid diet has been prescribed for a client. The nurse should offer which item to the client?
A. Apple juice
B. Orange juice
C. Tomato juice
D. Ice cream without nuts Correct Ans - A. Apple juice The nurse caring for a client following a bowel resection notes that the client is restless. The nurse takes the client's vital signs and notes that the client's pulse rate has increased and that the blood pressure has dropped significantly
since the previous readings. The nurse suspects that the client is going into shock and should take which immediate action?
A. Check the client's oxygen saturation level.
B. Recheck the vital signs to verify the findings.
C. Raise the client's legs above the level of the heart.
D. Slow the rate of the intravenous (IV) fluid infusing. Correct Ans - C. Raise the client's legs above the level of the heart.
The client has been diagnosed with polycystic kidney disease. The nurse should assess the client for which manifestation that is most common for this disorder?
A. Headache B. Hypotension
C. Flank pain and hematuria
D. Complaints of low pelvic pain Correct Ans - C. Flank pain and hematuria
A client with chronic kidney disease returns to the nursing unit after receiving
his second hemodialysis treatment; the nurse is monitoring the client closely for signs of disequilibrium syndrome. What is a sign of this syndrome?
A. Irritability
B. Tachycardia C. Hypothermia D. Mental confusion Correct Ans - D. Mental confusion
A hospitalized client with chronic kidney disease has returned to the nursing unit after a hemodialysis treatment. The nurse should check predialysis and postdialysis documentation of which parameters to determine the effectiveness of the procedure?
A. Blood pressure and weight
B. Weight and blood urea nitrogen C. Potassium level and creatinine levels
D. Blood urea nitrogen and creatinine levels Correct Ans - A. Blood pressure and weight
The nurse notes that a child with Hirschsprung disease who is scheduled for surgery has inadequate fluid volume. The nurse should plan to implement which intervention to stabilize the child's hydration status before surgery?
A. Monitor daily weight.
B. Monitor intake and output.
C. Administer tap water enemas.
D. Administer intravenous fluids and electrolytes. Correct Ans - D. Administer intravenous fluids and electrolytes
The nurse is preparing to care for a pediatric client with an intravenous solution infusing. The nurse should ensure that which item is in place to prevent fluid overload in this client?
A. Armboard
B. Infusion pump
C. Macrodrip infusion set
D. Large-bore intravenous catheter Correct Ans - B. Infusion pump
A client is taking amiloride hydrochloride daily. The nurse should tell the client to take the dose at what time?
A. At bedtime
B. On an empty stomach
C. Between lunch and dinner
D. In the morning with breakfast Correct Ans - D. In the morning with breakfast
A client with acute kidney injury has been treated with sodium polystyrene sulfonate by mouth. The nurse should evaluate this therapy as most effective if which value was noted on follow-up laboratory testing?
A. Calcium 9.8 mg/dL (2.5 mmol/L))
B. Sodium 142 mEq/L (142 mmol/L)
C. Potassium 4.9 mEq/L (4.9 mmol/L) D. Phosphorus 3.9 mg/dL (1.26 mmol/L) Correct Ans - C. Potassium 4.9 mEq/L (4.9 mmol/L)
The nurse is caring for a client who is receiving a potassium-retaining diuretic.
The nurse should monitor for which side effect of the medication?
A. Dry skin
B. Constipation
C. Hyperkalemia
D. Hypernatremia Correct Ans - C. Hyperkalemia
During the administration of a blood transfusion to a client, the nurse notes the presence of crackles in the client's lung bases. On further data collection, the nurse notes that the client has distended neck veins and an increase in blood pressure. The nurse suspects that the client is experiencing what complication of the blood transfusion?
A. Sepsis B. Allergic reaction
C. Circulatory overload
D. Transfusion reaction Correct Ans - C. Circulatory overload
The nurse is reviewing the laboratory results of a client and notes that the client has a magnesium level of 1.3 mg/dL (0.5 mmol/L). What is the most appropriate nursing action?
A. Monitor the client for dysrhythmias.
B. Encourage increased intake of phosphorus antacids.
C. Instruct the client to increase the consumption of foods low in magnesium.
D. Consult with the health care provider about the need to discontinue magnesium intake. Correct Ans - A. Monitor the client for dysrhythmias.
A client with severe hyponatremia is being treated with intravenous hypertonic saline (3%). The nurse determines that the treatment is effective when the laboratory results reveal which sodium level?
A. 120 mEq/L (120 mmol/L)
B. 130 mEq/L (130 mmol/L)
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