Published - Thu, 23 Feb 2023

NCLEX-RN Exam Questions - Part 131

1. Due to his prolonged history of alcohol abuse, an alcoholic client will most likely have deficiencies of which of the following nutrients?

A) Vitamin C and zinc
B) Folic acid and niacin
C) Vitamin A and biotin
D) Thiamine and pyroxidine

2. The physician of an alcoholic client places him on a low-protein, high-carbohydrate diet. When choosing his menu, the clients best choice from the items below would be:

A) Liver and onions, macaroni and cheese, tea with sugar
B) Baked chicken, baked potato with bacon bits, milk
C) Waffles with butter and honey, orange juice
D) Cheese omelette with ham and mushrooms, milk

3. A chronic alcoholic clients condition deteriorates, and he begins to exhibit signs of hepatic coma. Which of the following is an early sign of impending hepatic coma?

A) Hiccups
B) Anorexia
C) Mental confusion
D) Fetor hepaticus

4. The physician of a client diagnosed with alcoholism orders neomycin 0.5 g q6h to prevent hepatic coma. Neomycin decreases serum ammonia levels by:

A) Decreasing nitrogen-forming bacteria in the intestines
B) Acidifying colon contents by causing ammonia retention in the colon
C) Decreasing the uptake of vitamin D, thereby drawing more water into the colon
D) Irritating the bowel and promoting evacuation of stool

5. A client with IDDM is given IV insulin for a blood glucose level of 520 mg/dL. Life-threatening complications may occur initially, so the nurse will monitor him closely for serum:

A) Chloride level of 99 mEq/L
B) Sodium level of 136 mEq/L
C) Potassium level of 3.1 mEq/L
D) Potassium level of 6.3 mEq/L

1. Right Answer: D
Explanation: (A) Chronic alcoholism can lead to deficiencies of B complex vitamins including thiamine and pyroxidine. (B) Chronic alcoholism can lead to deficiencies of vitamins A, D, K, and B complex. (C) Chronic alcoholism can lead to deficiencies of vitamins A, D, K, and B complex. (D) Vitamins A, D, K, and B require bile salts to be absorbed from the gastrointestinal tract. A damaged liver does not form bile salts.

2. Right Answer: C
Explanation: (A, B, D) These foods are high in protein, which needs to be restricted. (C) Serum ammonia levels can be decreased by restricting dietary protein intake. Waffles, honey, and orange juice are high in carbohydrate and low or completely lacking in protein. Butter, a concentrated fat, will provide extra calories.

3. Right Answer: C
Explanation: (A) Hiccups are not a sign of impending hepatic coma. (B) Anorexia is not a sign of impending hepatic coma. (C) One of the earliest symptoms of hepatic coma is mental confusion. Asterixis, a flapping tremor of the hand, may also be seen. (D) This sign is associated with the later stages of hepatic coma. Fetor hepaticus, a characteristic odor on the breath that smells like acetone, may sometimes be noted when the liver fails.

4. Right Answer: A
Explanation: (A) Neomycin interferes with protein synthesis in the bacterial cell, causing bacterial death. Neomycin reduces the growth of the ammonia-producing bacteria in the intestines and is used for the treatment of hepatic coma. (B) This choice describes the action of lactulose, another drug commonly used to decrease systemic ammonia levels. (C) Neomycins action doesnotdecrease uptake of vitamin D to reduce serum ammonia levels. (D) Bowel irritation with diarrhea is more likely to occur with administration of lactulose rather than of neomycin. Besides, diarrhea is a side effect of a drug, not the action of the drug.

5. Right Answer: D
Explanation: (A) The chloride level is within acceptable limits. (B) The sodium level is within acceptable limits. (C) This value indicates hypokalemia, rather than the hyperkalemia that occurs during diabetic ketoacidosis. (D) When diabetic ketoacidosis exists, intracellular dehydration occurs and potassium leaves the cells and enters the vascular system, thus increasing the serum level beyond an acceptable range. When insulin and fluids are administered, cell walls are repaired and potassium is transported back into the cells. Normal serum potassium levels range from 3.55.0 mEq/L.

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