NCLEX-RN
Urinary NCLEX RN Questions Questions
Extract:
The nurse in the emergency department (ED) is caring for a 57-year-old male client.
Item 4 of 6
History and Physical
A 57-year-old male client with stage three small cell lung cancer. The client had suddenly become disoriented and did not recognize his family members and relatives. He reports severe lower extremity weakness and has had three episodes of diarrhea in the past four hours. The client is undergoing 6 cycles of chemotherapy with cisplatin and etoposide. He is currently taking a 14-day course of 15 mg of prednisone. He is on his third day of steroid treatment. He has a medical history of dyslipidemia and advanced chronic obstructive pulmonary disease.
Laboratory Results
• Hemoglobin 14 g/dL [14-18 g/dL (140–180 g/L)]
• Hematocrit 42% (0.42) [42-52% (0.42-0.52)]
• White Blood Cell 11,000 mm3 [5-10 mm3]
• Platelet Count 140,000 mm3 [150-400 mm3 (150–400 × 109/L)]
• Glucose 139 mg/dL (7.72 mmol/L) [70–110 mg/dL (4-6 mmol/L)]
• Sodium 116 mEq/L [136–145 mEq/L (mmol/L)]
• Potassium 3.3 mEq/L [3.5–5.0 mEq/L (mmol/L)]
• Creatinine 0.7 mg/dL (61.88 mmol/L) [0.6–1.2 mg/dL (53–106 mmol/L)]
• Blood Urea Nitrogen 8 mg/dL (2.86 mmol/L) [10–20 mg/dL (3.6–7.1 mmol/L)]
• Serum Osmolality 277 mOsm/kg [285-295 mOsm/kg (285–295 mmol/kg)]
Nurses' Notes
0759: Client is completely disoriented and required maximum assistance to the stretcher because of unsteady gait. Lung sounds clear bilaterally. Alopecia noted. Skin is warm and dry and normal for ethnicity. Peripheral pulses 2+. No skin tenting. Hyperactive bowel sounds in all quadrants. 20-gauge peripheral vascular access device placed in the left antecubital space. T 97.8° F (36.6° C) P 88 RR 21 BP 123/68 Pulse oximetry reading 91% on room air.
0850: Verbal order was received from physician to insert indwelling urethral catheter.
0910: Urinary catheter inserted with sterile technique. 40 mL of dark yellow urine returned.
Question 1 of 5
The physician diagnoses the client with syndrome of inappropriate antidiuretic hormone. The nurse updates the nurses' notes. For each potential order, click to specify whether the potential order is indicated or not indicated for the client.
| potential order | indicated | not indicated |
|---|---|---|
| thiazide diuretic | ||
| continuous cardiac monitoring | ||
| seizure precautions | ||
| intravenous hypotonic fluids | ||
| urology consultation | ||
| desmopressin {DDAVP} |
Correct Answer: A: Not indicated, B: Indicated, C: Indicated, D: Not indicated, E: Not indicated, F: Not indicated
Rationale: Thiazide diuretics, hypotonic fluids, and desmopressin worsen SIADH. Cardiac monitoring and seizure precautions are indicated due to hyponatremia risks.
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Question 2 of 5
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Question 3 of 5
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Question 4 of 5
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Question 5 of 5
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