Physiological Adaptation NCLEX

Physiological Adaptation NCLEX Related

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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.

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The three universal spiritual needs include all of the following except:

  • A. meaning and purpose.
  • B. love and relatedness.
  • C. forgiveness.
  • D. God's permission.
Correct Answer: D

Rationale: Religious teachings help to present a meaningful philosophy and system of practices within a system of social controls having specific values, norms, and ethics. God is the center of many religions (major), but not all.

A client is having psychological counseling for problems communicating with his mother. Which model of stress is the most useful in reference to this stressor?

  • A. Adaptation Model
  • B. Stimulus-Based Model
  • C. Transaction-Based Model
  • D. Selye's Model of Stress
Correct Answer: C

Rationale: The Transaction-Based Model is, according to R.S. Lazarus, a state that Stimulus theory and Response theory do not consider individual differences. He takes into account cognitive processes that intervene between the encounter and the reaction and the factors that affect the nature of this process. He includes mental and psychological components or responses as part of his concept of stress (Person-Environment Transactions).

When discussing possible complications of pregnancy with a client, the nurse should explain that all of the following are symptoms of urinary tract infection (UTI). Which of the following is least indicative of UTI during pregnancy?

  • A. low-back pain
  • B. urinary frequency
  • C. GI distress
  • D. malaise
Correct Answer: B

Rationale: Urinary frequency is least indicative of UTI during pregnancy because it is a common minor discomfort of pregnancy and is caused by pressure of the growing uterus on the bladder. As the uterus rises in the second trimester, there are no problems. Frequency returns in the third trimester when the uterus drops into the pelvic cavity. A UTI has the symptoms of frequency, back pain, supra pubic discomfort, and malaise and is diagnosed by laboratory findings.

A client is taking hydrocodone (Vicodin) for chronic back pain. The client has required an increase in the dose and asks whether this means he is addicted to Vicodin. The nurse should base her reply on the knowledge that:

  • A. the client's body has developed tolerance, requiring more drug to produce the same effect.
  • B. the client is preoccupied with getting the drug and is experiencing loss of control, indicating drug dependence.
  • C. addiction is the term used to describe physical dependence with withdrawal symptoms and tolerance.
  • D. the client has a dual diagnosis of substance abuse and chronic back pain.
Correct Answer: A

Rationale: Drug tolerance is characterized by the ability to ingest a larger dose without adverse effect and decreased sensitivity to the substance. Substance dependence is a severe condition indicating physical problems and disruption of the person's social, family, and work life. The psychological behaviors related to substance use are termed addiction. Dual diagnosis is the coexistence of substance abuse and psychiatric disorders.

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?

  • A. Disorientation
  • B. Sensory changes
  • C. Inability to produce sound
  • D. Hearing deficits
Correct Answer: A

Rationale: Cognitive changes may include confusion and disorientation.

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