Physiological Adaptation NCLEX

Extract:

Question 1 of 5

A 28 year-old male has a diagnosis of AIDS. The patient has had a two year history of AIDS. The most likely cognitive deficits include which of the following?

Correct Answer: A

Rationale: Cognitive changes may include confusion and disorientation.

Question 2 of 5

A 64 year-old Alzheimer's patient has exhibited excessive cognitive decline resulting in harmful behaviors. The physician orders restraints to be placed on the patient. Which of the following is the appropriate procedure?

A. Secure the restraints to the bed rails on all extremities. B. Notify the physician that restraints have been placed properly. C. Communicate with the patient and family the need for restraints. D. Position the head of the bed at a 45 degree angle.

Correct Answer: C

Rationale: Both the family and the patient should have the need for restraints explained to them.

Question 3 of 5

A client is admitted with a diagnosis of Multiple Drug Use. The nurse should plan care based on knowledge that:

A. Multiple drug use is very uncommon B. People might use more than one drug to enhance the effect or relieve withdrawal symptoms C. Alcohol and barbiturates used together are not dangerous because one is a stimulant and the other is a depressant D. Assessment and intervention are easier with multiple drug use because of the synergistic effect

Correct Answer: B

Rationale: Multiple drug use is common to enhance effects or relieve withdrawal symptoms, complicating assessment and intervention due to varied drug interactions.

Question 4 of 5

What are the implications for a client with renal insufficiency who wants to start a low-carbohydrate (CHO) diet?

A. As long as the client eats a minimum of 30 g of CHO/day, there should be no problem. B. The client's clinical condition is a contraindication to starting a low CHO diet. C. Calcium supplements should be utilized to prevent the development of osteoporosis while on a low CHO diet. D. As long as the client eats foods that are high biologic protein sources, a low CHO diet can be followed.

Correct Answer: B

Rationale: A client with renal insufficiency should not start a low CHO diet because it could result in an increased renal solute load. Clients who have renal disease (renal failure, endstage renal disease [ESRD], dialysis, and transplant) or liver disease (liver failure, hepatic encephalopathy, cirrhosis, transplant, and hepatitis) require some form of protein control in dietary patterns to prevent complications from an inability to handle protein solute load. Proteins used in the diet must be of high biologic value, and protein intake is usually weight based, starting at 0.8 g/kg of dry weight, depending on the client's underlying clinical condition. Protein levels may be increased as necessary to account for metabolic response to dialysis and regeneration of liver tissue (1.5-2.0 g/kg/day). A minimum level of CHOs are needed in the diet (50-100 g/day) to spare protein. Vitamin and mineral supplements might be indicated with clients who have liver failure. The dietician is instrumental in calculating specific nutrient requirements for these clients and reviewing fluid intake and output, medication profile, and daily weight to monitor client outcomes in conjunction with dialysis technicians and nurses.

Question 5 of 5

If a client is suffering from thyroid storm, the PN can expect to find on assessment:

A. tachycardia and hyperthermia. B. bradycardia and hypothermia. C. a large goiter. D. a calm, quiet client.

Correct Answer: A

Rationale: In thyroid storm, excessive thyroxine causes increased metabolic rate, leading to tachycardia, hyperthermia, and other signs of hyperthyroidism such as atrial fibrillation.

Physiological Adaptation NCLEX | Nurselytic

Nurselytic

NCLEX-PN

NCLEX-PN