NCLEX Daily Ten Question Practical Exercise 12

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6. A 55-year-old male patient is admitted with acute renal failure and is under the care of a nurse. The patient’s recent blood work shows a significantly elevated potassium level, which is a common complication in acute renal failure. The nurse is preparing for the prescribed treatment to address this electrolyte imbalance. Given the patient’s condition and laboratory results, for which of the following conditions should the nurse expect hypertonic glucose, insulin infusions, and sodium bicarbonate to be used?

A. Hypernatremia.

B. Hypokalemia.

C. Hyperkalemia.

D. Hypercalcemia.

Correct Answer: C

Answer Explanation:

Hyperkalemia is a common complication of acute renal failure. It’s life-threatening if immediate action isn’t taken to reverse it. The administration of glucose and regular insulin, with sodium bicarbonate, if necessary, can temporarily prevent cardiac arrest by moving potassium into the cells and temporarily reducing serum potassium levels.

Option A: Hypernatremia is believed to be due to post-acute kidney injury diuresis in the face of inability to maximally concentrate the urine because of renal failure. The diuresis caused a disproportionate loss of water in excess of that of sodium in the absence of replenishment of the water loss.
Option B: Hypokalemia is related to increased use of diuretics, decreased use of RAS blockade, and malnutrition, all of which may impose additive deleterious effects on renal outcomes.
Option D: Hypocalcemia is a frequent accompaniment of acute renal failure, but paradoxically hypercalcemia also has been described in association with acute renal failure. This may be caused by dissolution of dystrophic calcifications in traumatized muscle and may lead to severe metastatic calcifications.

7. A 32-year-old female presents to the clinic with a recent diagnosis of condylomata acuminata (genital warts). She is concerned about the implications of her diagnosis and future health risks. Which of the following statements by the nurse is most appropriate?

A. “This condition increases your risk for cervical cancer. It’s important to have a Papanicolaou (Pap) smear annually.”

B. “The usual treatment for this is metronidazole (Flagyl), which typically resolves the issue within 7 to 10 days.”

C. “Using condoms every time during sexual intercourse significantly reduces, but does not completely eliminate, the risk of transmitting the virus to your partner.”

D. “The human papillomavirus (HPV), responsible for your condition, can still be transmitted during oral sex.”

Correct Answer: A

Answer Explanation:

Women with condylomata acuminata are at risk for cancer of the cervix and vulva. Yearly Pap smears are very important for early detection. Because condylomata acuminata is a virus, there is no permanent cure.

Option B: Genital warts may be treated with imiquimod, podophyllin and podofilox, trichloroacetic acid, and sinecatechins. These are all topical treatments that the physician or even the client may apply.
Option C: Because condylomata acuminata can occur on the vulva, a condom won’t protect sexual partners.
Option D: HPV can be transmitted to other parts of the body, such as the mouth, oropharynx, and larynx.

8. A 45-year-old individual presents to the emergency department with flank pain and a recent diagnosis of a genitourinary problem. The nurse prepares to palpate the patient’s kidneys, keeping in mind relevant anatomical facts. Which statement is correct regarding the location and size of kidneys?

A. The left kidney usually is slightly higher than the right one.

B. The kidneys are situated just above the adrenal glands.

C. The average kidney is approximately 5 cm (2 inches) long and 2 to 3 cm 3/4 inch to 1 1/8 inch) wide.

D. The kidneys lie between the 10th and 12th thoracic vertebrae.

Correct Answer: A

Answer Explanation:

The left kidney usually is slightly higher than the right one. An adrenal gland lies atop each kidney.

Option C: The average kidney measures approximately 11 cm (4-3/8″) long, 5 to 5.8 cm (2″ to 2 1/4”) wide, and 2.5 cm (1″) thick.
Option B: The kidneys are located retroperitoneally, in the posterior aspect of the abdomen, on either side of the vertebral column.
Option D: They lie between the 12th thoracic and 3rd lumbar vertebrae.

9. A 60-year-old male with a history of hypertension and diabetes is admitted to the urology unit with symptoms of fatigue, decreased urine output, and nausea. He has a known diagnosis of chronic renal failure (CRF). The nurse reviews his recent laboratory test results. Which result is most consistent with a diagnosis of CRF?

A. Increased pH with decreased hydrogen ions.

B. Increased serum levels of potassium, magnesium, and calcium.

C. Blood urea nitrogen (BUN) 100 mg/dl and serum creatinine 6.5 mg/ dl.

D. Uric acid analysis 3.5 mg/dl and phenolsulfonphthalein (PSP) excretion 75%.

Correct Answer: C

Answer Explanation:

The normal BUN level ranges 8 to 23 mg/dl; the normal serum creatinine level ranges from 0.7 to 1.5 mg/dl. The test results in option C are abnormally elevated, reflecting CRF and the kidneys’ decreased ability to remove nonprotein nitrogen waste from the blood.

Option A: CRF causes decreased pH and increased hydrogen ions — not vice versa.
Option B: CRF also increases serum levels of potassium, magnesium, and phosphorus, and decreases serum levels of calcium.
Option D: A uric acid analysis of 3.5 mg/dl falls within the normal range of 2.7 to 7.7 mg/dl; PSP excretion of 75% also falls with the normal range of 60% to 75%.

10. A 35-year-old female patient, presenting with a history of irregular menstrual cycles and recent abnormal vaginal discharge, receives an abnormal result on a Papanicolaou (Pap) smear test. After unintentionally viewing her chart, the patient inquires about the meaning of ‘dysplasia’ noted in her results. The nurse should provide which definition of dysplasia?

A. Presence of completely undifferentiated tumor cells that don’t resemble cells of the tissues of their origin.

B. Increase in the number of normal cells in a normal arrangement in a tissue or an organ.

C. Replacement of one type of fully differentiated cell by another in tissues where the second type normally isn’t found.

D. Alteration in the size, shape, and organization of differentiated cells.

Correct Answer: D

Answer Explanation:

Dysplasia refers to an alteration in the size, shape, and organization of differentiated cells.

Option A: The presence of completely undifferentiated tumor cells that don’t resemble cells of the tissues of their origin is called anaplasia.
Option B: An increase in the number of normal cells in a normal arrangement in a tissue or an organ is called hyperplasia.
Option C: Replacement of one type of fully differentiated cell by another in tissues where the second type normally isn’t found is called metaplasia.

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