Published - Thu, 23 Feb 2023

NCLEX-RN Exam Questions - Part 161

1. A client with cirrhosis of the liver becomes comatose and is started on neomycin 300 mg q6h via nasogastric tube. The rationale for this therapy is to:

A) Prevent systemic infection
B) Promote diuresis
C) Decrease ammonia formation
D) Acidify the small bowel

2. The following nursing diagnosis is written for a comatose client with cirrhosis of the liver and secondary splenomegalyHigh risk for injury: Increased susceptibility to bleeding related to:

A) Increased absorption of vitamin K
B) Thrombocytopenia due to hypersplenism
C) Diminished function of the Kupffer cells
D) Increased synthesis of the clotting factors

3. A 52-year-old female client is admitted to the hospital in acute renal failure. She has been on hemodialysis for the past 2 years. Stat arterial blood gases are drawn on the client yielding the following results: pH 7.30, PCO2 51 mm Hg, HCO3, 18 mEq/L, PaO2, 84 mm Hg. The nurse would interpret these results as:

A) Compensated metabolic alkalosis
B) Respiratory acidosis
C) Partially compensated metabolic alkalosis
D) Combined respiratory and metabolic acidosis

4. The nurse writes the following nursing diagnosis for a client in acute renal failure - Impaired gas exchange related to:

A) Decreased red blood cell production
B) Increased levels of vitamin D
C) Increased red blood cell production
D) Decreased production of renin

5. A 6-year-old child returned to the surgical floor 20 hours ago after an appendectomy for a gangrenous appendix. His mother tells the nurse that he is becoming more restless and is anxious. Assessment findings indicate that the child has atelectasis. Appropriate nursing actions would include:

A) Allowing the child to remain in the position of comfort, preferably semi-or high-Fowler position
B) Administering analgesics as ordered
C) Having the child turn, cough, and deep breathe every 1 - 2 hours
D) Remaining with the child and keeping as calm and quiet as possible

1. Right Answer: C
Explanation: (A) Neomycin is an antibiotic, but this is not the Rationale for administering it to a client in hepatic coma. (B) Diuretics and salt-free albumin are used to promote diuresis in clients with cirrhosis of the liver. (C) Neomycin destroys the bacteria in the intestines. It is the bacteria in the bowel that break down protein into ammonia. (D) Lactulose is administered to create an acid environment in the bowel. Ammonia leaves the blood and migrates to this acidic environment where it is trapped and excreted.

2. Right Answer: B
Explanation: (A) There is a decreased absorption of vitamin K with cirrhosis of the liver. This decrease impairs blood coagulation and the formation of prothrombin. (B)Thrombocytopenia, an increased destruction of platelets, occurs secondary to hypersplenism. (C) A diminished function of the Kupffer cells occurs with cirrhosis of the liver, causing the client to become more susceptible to infections. (D) A decrease in the synthesis of fibrinogen and clotting factors VII, IX, and X occurs with cirrhosis of the liver and increases the susceptibility to bleeding.

3. Right Answer: D
Explanation: (A) Compensated metabolic alkalosis would be reflected by the following: pH within normal limit (7.357.45), PCO2 > 45 mm Hg, HCO3 >26 mEq/L. (B)Respiratory acidosis would be reflected by the following: pH < 7.35, PCO2 > 45 mm Hg, HCO3 within normal limits (2226 mEq/L). (C) Partially compensated metabolic alkalosis would be reflected by the following: pH > 7.45, PCO2 > 45 mm Hg, HCO3 > 26 mEq/L. (D) Combined respiratory and metabolicacidosis would be reflected by the following: pH < 7.35, PCO2 > 45 mm Hg, HCO3 < 22 mEq/L.

4. Right Answer: A
Explanation: (A) Red blood cell production is impaired in renal failure owing to impaired erythropoietin production. This causes a decrease in the delivery of oxygen to the tissue and impairs gas exchange. (B) The conversion of vitamin D to its physiologically active form is impaired in renal failure. (C) In renal failure, a decrease in red blood cell production occurs owing to an impaired production of erythropoietin, leading to impaired gas exchange at the cellular level. (D) The decreased production of renin in renal failure causes an increased production of aldosterone causing sodium and water retention.

5. Right Answer: C
Explanation: (A) Allowing the client to remain in the position of comfort will not resolve the atelectasis. This position, if left unchanged, over time may actually increase the atelectasis. (B) Analgesics will not resolve the atelectasis and may contribute to it if proper nursing actions are not taken to help resolve the atelectasis. (C) Having the client turn, cough, and deep breathe every 12 hours will aid in resolving the atelectasis. Surgery clients are at risk for postoperative respiratory complications because pulmonary function is reduced as a result of anesthesia and surgery. (D) Remaining with the client and keeping him calm and quiet will not affect the clients anxiety, restlessness, or help to resolve the atelectasis. The cause (atelectasis) needs to be treated, not the symptoms (anxiety and restlessness).

80% DISCOUNT: NCLEX-RN PRACTICE EXAMS