N261 Exam 2 Actual Exam V1 | N261 Nursing (N261 Exam 2) |
University of California, Los Angeles
1. A patient with Acute Kidney Injury (AKI) has a urine output of 350 mL over 24 hours. The
nurse notes a rise in serum creatinine and blood urea nitrogen (BUN). Which phase of AKI is
this patient currently experiencing?
A. Initiation phase
B. Diuretic phase
C. Oliguric phase
D. Recovery phase
Answer: C
Rationale: The oliguric phase is characterized by a urine output of less than 400 mL/day
and typically lasts 10 to 14 days. During this period, the patient develops fluid volume
excess, metabolic acidosis, and electrolyte imbalances such as hyperkalemia. The nurse
must monitor for signs of uremia and neurological changes as waste products accumulate
in the bloodstream.
2. A patient with cirrhosis and esophageal varices is prescribed propranolol. Which of the
following best describes the rationale for this medication?
A. To increase systemic blood pressure to improve renal perfusion.
B. To promote the excretion of ammonia through the bowel.
C. To reduce portal venous pressure and decrease the risk of bleeding.
D. To treat underlying tachycardia associated with hepatic failure.
Answer: C
Rationale: Nonselective beta-blockers like propranolol are used in cirrhosis patients to
reduce the risk of variceal hemorrhage. By decreasing cardiac output and causing
splanchnic vasoconstriction, these medications effectively lower portal venous pressure.
This is a crucial preventative measure because esophageal varices are fragile and high
pressure can lead to life-threatening bleeding.
3. A patient is admitted with acute pancreatitis. Which laboratory finding would the nurse
expect to be most specific for this diagnosis?
A. Elevated serum lipase
B. Elevated serum amylase
C. Decreased serum calcium
,D. Increased white blood cell count
Answer: A
Rationale: Serum lipase is more specific than amylase for diagnosing acute pancreatitis
because it stays elevated for a longer period. Amylase levels usually return to normal
within 48 to 72 hours, while lipase remains high for up to 14 days. Assessing these
enzymes alongside clinical symptoms like epigastric pain helps confirm the inflammatory
process within the pancreas.
4. A nurse is caring for a patient with Chronic Kidney Disease (CKD) who has a serum
potassium level of 6.8 mEq/L and EKG changes showing peaked T waves. Which intervention
is the highest priority?
A. Administering IV Calcium Gluconate.
B. Preparing the patient for emergent hemodialysis.
C. Administering oral Sodium Polystyrene Sulfonate (Kayexalate).
D. Providing a low-potassium diet meal tray.
Answer: A
Rationale: IV Calcium Gluconate is the priority intervention because it stabilizes the
cardiac muscle cell membrane against the effects of high potassium. While it does not lower
the potassium level itself, it prevents lethal arrhythmias like ventricular fibrillation. The
nurse would then follow up with medications like insulin/dextrose or dialysis to actually
remove potassium from the body.
5. A patient with Type 1 Diabetes Mellitus presents to the ED with a blood glucose of 550
mg/dL, fruity breath, and Kussmaul respirations. What is the nurse’s first action?
A. Start a rapid infusion of 0.9% Normal Saline.
B. Administer an IV bolus of Regular Insulin.
C. Obtain an arterial blood gas (ABG) sample.
D. Administer Sodium Bicarbonate for metabolic acidosis.
Answer: A
Rationale: In Diabetic Ketoacidosis (DKA), the priority is fluid resuscitation to correct
dehydration and restore circulatory volume. Dehydration in DKA is severe due to osmotic
diuresis caused by hyperglycemia. Insulin therapy is typically started only after fluid
volume is being replaced to avoid a sudden shift of water into cells, which could worsen
vascular collapse.
, 6. A patient with cirrhosis has developed hepatic encephalopathy. The nurse administers
lactulose and notes the patient is having 3-4 soft stools per day. How should the nurse
interpret this finding?
A. The medication is ineffective and the dose needs to be increased.
B. The medication is working as intended to lower ammonia levels.
C. The patient is developing diarrhea and the medication should be held.
D. The patient is experiencing a side effect that requires a physician notification.
Answer: B
Rationale: The goal of lactulose therapy in hepatic encephalopathy is to produce 2 to 3 soft
stools per day to facilitate the excretion of ammonia. Lactulose works by trapping ammonia
in the gut and acting as an osmotic laxative to clear it from the system. If the patient has the
desired number of stools and improved mental status, the treatment plan is considered
successful.
7. Which arterial blood gas (ABG) result would the nurse expect to see in a patient with a
severe exacerbation of COPD who is retaining CO2?
A. pH 7.30, PaCO2 55, HCO3 28
B. pH 7.50, PaCO2 30, HCO3 24
C. pH 7.32, PaCO2 35, HCO3 18
D. pH 7.45, PaCO2 40, HCO3 25
Answer: A
Rationale: Patients with COPD often experience respiratory acidosis due to
hypoventilation and air trapping, leading to high CO2 levels. A pH below 7.35 and a PaCO2
above 45 mmHg characterize this state. The elevated bicarbonate (HCO3 28) represents
the body’s attempt at renal compensation over time.
8. A nurse is assessing a patient undergoing peritoneal dialysis. The nurse notes the outflow
(effluent) is cloudy. What is the nurse’s priority action?
A. Reposition the patient to improve drainage.
B. Flush the catheter with heparinized saline.
C. Obtain a sample of the effluent for culture and sensitivity.
D. Warm the next dialysate bag to body temperature.
Answer: C
Rationale: Cloudy dialysate outflow is the primary sign of peritonitis, a serious
complication of peritoneal dialysis. The nurse must immediately notify the provider and
University of California, Los Angeles
1. A patient with Acute Kidney Injury (AKI) has a urine output of 350 mL over 24 hours. The
nurse notes a rise in serum creatinine and blood urea nitrogen (BUN). Which phase of AKI is
this patient currently experiencing?
A. Initiation phase
B. Diuretic phase
C. Oliguric phase
D. Recovery phase
Answer: C
Rationale: The oliguric phase is characterized by a urine output of less than 400 mL/day
and typically lasts 10 to 14 days. During this period, the patient develops fluid volume
excess, metabolic acidosis, and electrolyte imbalances such as hyperkalemia. The nurse
must monitor for signs of uremia and neurological changes as waste products accumulate
in the bloodstream.
2. A patient with cirrhosis and esophageal varices is prescribed propranolol. Which of the
following best describes the rationale for this medication?
A. To increase systemic blood pressure to improve renal perfusion.
B. To promote the excretion of ammonia through the bowel.
C. To reduce portal venous pressure and decrease the risk of bleeding.
D. To treat underlying tachycardia associated with hepatic failure.
Answer: C
Rationale: Nonselective beta-blockers like propranolol are used in cirrhosis patients to
reduce the risk of variceal hemorrhage. By decreasing cardiac output and causing
splanchnic vasoconstriction, these medications effectively lower portal venous pressure.
This is a crucial preventative measure because esophageal varices are fragile and high
pressure can lead to life-threatening bleeding.
3. A patient is admitted with acute pancreatitis. Which laboratory finding would the nurse
expect to be most specific for this diagnosis?
A. Elevated serum lipase
B. Elevated serum amylase
C. Decreased serum calcium
,D. Increased white blood cell count
Answer: A
Rationale: Serum lipase is more specific than amylase for diagnosing acute pancreatitis
because it stays elevated for a longer period. Amylase levels usually return to normal
within 48 to 72 hours, while lipase remains high for up to 14 days. Assessing these
enzymes alongside clinical symptoms like epigastric pain helps confirm the inflammatory
process within the pancreas.
4. A nurse is caring for a patient with Chronic Kidney Disease (CKD) who has a serum
potassium level of 6.8 mEq/L and EKG changes showing peaked T waves. Which intervention
is the highest priority?
A. Administering IV Calcium Gluconate.
B. Preparing the patient for emergent hemodialysis.
C. Administering oral Sodium Polystyrene Sulfonate (Kayexalate).
D. Providing a low-potassium diet meal tray.
Answer: A
Rationale: IV Calcium Gluconate is the priority intervention because it stabilizes the
cardiac muscle cell membrane against the effects of high potassium. While it does not lower
the potassium level itself, it prevents lethal arrhythmias like ventricular fibrillation. The
nurse would then follow up with medications like insulin/dextrose or dialysis to actually
remove potassium from the body.
5. A patient with Type 1 Diabetes Mellitus presents to the ED with a blood glucose of 550
mg/dL, fruity breath, and Kussmaul respirations. What is the nurse’s first action?
A. Start a rapid infusion of 0.9% Normal Saline.
B. Administer an IV bolus of Regular Insulin.
C. Obtain an arterial blood gas (ABG) sample.
D. Administer Sodium Bicarbonate for metabolic acidosis.
Answer: A
Rationale: In Diabetic Ketoacidosis (DKA), the priority is fluid resuscitation to correct
dehydration and restore circulatory volume. Dehydration in DKA is severe due to osmotic
diuresis caused by hyperglycemia. Insulin therapy is typically started only after fluid
volume is being replaced to avoid a sudden shift of water into cells, which could worsen
vascular collapse.
, 6. A patient with cirrhosis has developed hepatic encephalopathy. The nurse administers
lactulose and notes the patient is having 3-4 soft stools per day. How should the nurse
interpret this finding?
A. The medication is ineffective and the dose needs to be increased.
B. The medication is working as intended to lower ammonia levels.
C. The patient is developing diarrhea and the medication should be held.
D. The patient is experiencing a side effect that requires a physician notification.
Answer: B
Rationale: The goal of lactulose therapy in hepatic encephalopathy is to produce 2 to 3 soft
stools per day to facilitate the excretion of ammonia. Lactulose works by trapping ammonia
in the gut and acting as an osmotic laxative to clear it from the system. If the patient has the
desired number of stools and improved mental status, the treatment plan is considered
successful.
7. Which arterial blood gas (ABG) result would the nurse expect to see in a patient with a
severe exacerbation of COPD who is retaining CO2?
A. pH 7.30, PaCO2 55, HCO3 28
B. pH 7.50, PaCO2 30, HCO3 24
C. pH 7.32, PaCO2 35, HCO3 18
D. pH 7.45, PaCO2 40, HCO3 25
Answer: A
Rationale: Patients with COPD often experience respiratory acidosis due to
hypoventilation and air trapping, leading to high CO2 levels. A pH below 7.35 and a PaCO2
above 45 mmHg characterize this state. The elevated bicarbonate (HCO3 28) represents
the body’s attempt at renal compensation over time.
8. A nurse is assessing a patient undergoing peritoneal dialysis. The nurse notes the outflow
(effluent) is cloudy. What is the nurse’s priority action?
A. Reposition the patient to improve drainage.
B. Flush the catheter with heparinized saline.
C. Obtain a sample of the effluent for culture and sensitivity.
D. Warm the next dialysate bag to body temperature.
Answer: C
Rationale: Cloudy dialysate outflow is the primary sign of peritonitis, a serious
complication of peritoneal dialysis. The nurse must immediately notify the provider and
