Renal NCLEX Style questions

Number the following in the order of the phases of exchange in PD. Begin with 1 and end with 3. a. Drain b. Dwell c. Inflow

1.) Inflow 2.) Dwell 3.) Drain (outflow)

A client being hemodialysed suddenly becomes SOB and complains of CP. The client is tachycardia, pale, and anxious. The nurse suspects air embolism. What are the PRIORITY nursing actions? SATA A.) Administer oxygen to the client B.) Continue dialysis at a slower rate after checking the lines for air C.) Notify HCP and rapid response team D.) Stop dialysis, turn the client on the left side with head lower than the feet E.) Bolus the client with 500ml of NS to break up the air embolism

A.) Adminsiter oxygen to the client C.) Notify HCP and rapid response team D.) Stop dialysis and turn client on their left side with head lower than feet

Which intervention is most important for the nurse to implement for the client with a left nephrectomy? A.) Assess the intravenous fluids for rate and volume B.) Change surgical dressing every day at the same time C.) Monitor the client's PT/PTT/INR level daily D.) Monitor the percentage of each meal risen

A.) Assess the intravenous fluids for rate and volume

The client performs self PD. Which should the nurse teach the client about preventing peritonitis? SATA A.) Broad-spectrum antibiotics may be administered to prevent infection B.) Antibiotics may be added to the dialysate to prevent infection C.) Clean technique is permissible for prevention of peritonitis D.) Peritonitis is characterized by cloudy dialysate drainage and abdominal discomfort E.) Peritonitis is the most common and serious complication of peritoneal dialysis

A.) Broad-spectrum antibiotics may be administered to prevent infection B.) Antibiotics may be added to the dialysate to prevent infection D.) Peritonitis is characterized by cloudy dialysate drainage and abdominal discomfort E.) Peritonitis is the most common and serious complicationof peritoneal dialysis

A nurse is planning post-procedure care for a client who received hemodialysis. Which of the following should the nurse include in the plan of care? SATA A.) Check BUN and creatinine B.) Administer medications held prior to dialysis C.) Observe for signs of hypovolemia D.) Assess the access site for bleeding E.) Evaluate blood pressure on the site of AV access

A.) Check BUN and creatinine B.) Administer medications held prior to dialysis C.) Observe for signs of hypovolemia D.) Assess the access site for bleeding

The nurse monitoring a client receiving PD nothes that the client's outflow is less than the inflow. Which actions should the nurse take? SATA A.) Check the level of the drainage bag B.) Reposition the client to her side C.) Contact the health care provider D.) Place the client in good body alignment E.) Check the peritoneal dialysis system for kinks F.) Increase the flow rate of the peritoneal dialysis solution

A.) Check the level of the drainage bag B.) Reposition the patient to her side D.) Place the client in good body alignment E.) Check the peritoneal dialysis system for kinks

The client is receiving continous ambulatory peritoneal dialysis. The nurse should assess the client for which sign of peritoneal infection? A.) Cloudy dialysate fluid B.) Swelling in the legs C.) Poor drainage of the dialysate fluid D.) Redness at the catheter insertion site

A.) Cloudy dialysate fluid

A man with ESRD is scheduled for HD following healing of an arteriovenous fistula (AVF). What should the nurse explain to him that will occur during dialysis? A.) He will be able to visit, read, sleep, or watch TV while reclining in a chair B.) He will be placed on a cardiac monitor to detect any adverse effects that may occur C.) The dialyzer will remove and hold part of his blood for 20 to 30 minutes to remove the waste products D.) A large catheter with 2 lumens will be inserted into the fistula to send blood and return it from the dialyzer

A.) He will be able to visit, read, sleep, or watch TV while reclining in a chair

A nurse is planning for a client who is having peritoneal dialysis. Which of the following are appropriate nursing actions? SATA A.) Monitor serum glucose levels B.) Report cloudy dialysate return C.) Warm the dialysate in a microwave D.) Assess for SOB E.) Check the access site dressing for wetness F.) Maintain medical asepsis when accessing the Catheter

A.) Monitor serum glucose levels B.) Report cloudy dialysate return D.) Assess for SOB E.) Check the access site dressing for wetness

A 39 yo client has been diagnosed with ESRD and is on the transplant waiting list. The client has been receiving dialysis through a subclavin central vein catheter while an AV fistula is maturing. Besides dialysis access, the nurse can utilize this subclavin central vein catheter for which of the following? A.) Nothing B.) Blood draws only C.) Infusion of NS and obtaining blood draws D.) Infusion of medications, all IV fluids, and maintaining blood draws

A.) Nothing

The nurse is assessing the patency of a client's left arm AV fistula prior to initiating hemodialysis. Which finding indicates that the fistula is patent? A.) Palpation of a thrill over the fistula B.) Presence of radial pulse in the left wrist C.) Visualization of enlarged blood vessels at the fistula site D.) Capillary refill less than 3 seconds in the nail bed of the fingers on the left hand

A.) Palpation of a thrill over the fistula

The client receiving dialysis is complaining of being dizzy and light-headed. Which action should the nurse implement first? A.) Place the clinet in the Trendelenburg position B.) Turn off the dialysis machine immediately C.) Bolus the client with 500ml of normal saline D.) Notify the health-care provider as soon as possible

A.) Place client in the Trendelenburg position

Priority Decision: During the immediate postoperative care of a recipient of a kidney transplant, what is the priority for the nurse to do? A.) Regulate fluid intake hourly based on urine output B.) Monitor urine-tinged drainage on abdominal dressing C.) Medicate the patient frequently for incisional flank pain D.) Remove the urinry catheter to evaluate the ureteral implant

A.) Regulate fluid intake hourly based on urine output (strict intake & output required)

A nurse is preparing to initiate hemodialysis for a client who has AKI and has been hospitalized. Which of the following are appropriate nursing actions? SATA A.) Review the client's current medicaton history B.) Assess the client's arteriovenous fistula for a bruit C.) Calculate the client's total urine output during the shift D.) Obtain the client's weight E.) Check the client's serum electrolytes F.) Use the client's access site area for venipuncture

A.) Review the client's current medicaiton history B.) Assess the client's arteriovenous fistula for a bruit D.) Obtain the client's weight E.) Check the client's serum electrolytes

The client diagnosed with CKD has a new AV fistula in the left forearm. Which intervention should the nurse implement? A.) Tech the client to carry heavy objects with the right arm B.) Perform all lab blood tests on the left arm C.) Instruct the client to lie on the left arm during the night D.) Discuss the importance of not performing any hand exercises

A.) Teach the client to carry heavy objects with the right arm

The client in acute renal failure has an external cannula inserted in the forearm for hemodialysis. Which nursing measure is appropriate for the care of this client? A.) Use the unffected arm for BP measurements B.) Draw blood from the cannula for routine lab work C.) Percuss the cannula for bruits each shift D.) Inject heparin into the cannula each shift

A.) Use the unaffected arm for blood pressure measurements

The nurse is discussing kidney transplant with clients at a dialysis center. Which population is less likely to participate in organ donation? A.) Caucasian B.) African American C.) Asian D.) Hispanic

B.) African American

A client with chronic renal failure has asked to be evaluated for a home continous ambulatory peritoneal dialysis (CAPD) program. The nurse should explain that the major advantage of this approach is that it: A.) Is relatively low in cost B.) Allows the client to be more independent C.) Is faster and more efficient than standard peritoneal dialysis D.) Has fewer potential complications than standard peritoneal dialysis

B.) Allows the client to be more independent

What is the primary way that a nurse will evaluate the latency of an AVF? A.) Palpate the pulses distal to the graft site B.) Auscultate for the presence of a bruit at the site C.) Evaluate the color and temperature of the extrimity D.) Assess for the presence of a numbness and tingling distal to the site

B.) Auscultate for the presence of a bruit at the site (Can palpate for thrill as well)

In which type of dialysis does the patient dialyse during sleep and leave the fluid in the abdomen during the day? A.) Long nocturnal HD B.) Automated peritonela dialysis (APD) C.) Continous venovenous hemofiltrations (CVVH) D.) Continous ambulatory peritoneal dialysis (CAPD)

B.) Automated peritoneal dialysis (APD)

A client with ESRF has an internal AV fistula in the left arm for vascular access during hemodialysis. What should the nurse instruct the client to do? A.) Remind HCP to draw blood from veins on the left side B.) Avoid sleeping on the left arm C.) Wear wristwatch on the right arm D.) Assess fingers on the left arm for warmth E.) Obtain BP on the left arm

B.) Avoid sleeping on the left arm C.) Wear wristwatch on the right arm D.) Assess fingers on the left arm for warmth

A client with chronic renal failure who receives hemodialysis three times a week is experiencing severe nausea. What should the nurse advise the client to do to manage the nausea? A.) Drink fluids before eating solid foods B.) Have limited amounts of fluids only when thirsty C.) Limit activity D.) Keep all dialysis appointments E.) Eat smaller, more frequent meals

B.) Have limited amounts of fluids only when thirsty D.) Keep all dialysis appointments E.) Eat smaller, more frequent meals

The nurse is instructing a client with diabetes mellitus about PD. The nurse tells the client that is important to maintain the prescribed dwell time for the dialysis because of the rick of which complication? A.) Peritonitis B.) Hyperglycemia C.) Hyperphosphatemia D.) Disequilibrim syndrome

B.) Hyperglycemia

The nurse is preparing the discharge teaching plan for the male client with a left-sided nephrectomy. Which statement indicates the teaching is effective? A.) I can't wait to start back to work each week, I really need the money B.) I will take my temp and if it is above 101 I will call my doctor C.) I am glad I won't have to keep tract of how much I urinate in the day D.) I am happt I will be able to eat what I usually eat I don't like this food

B.) I will take my temp and if it is above 101 I will call my doctor

During PD, the nurse observes that the solution draining from the client's abdomen is constantly blood tinged. The client has a permanent peritoneal catheter in place. The nurse should recognize that the bleeding: A.) Is expected with permanent peritoneal catheter B.) Indicates abdominal blood vessel damage C.) Can indicate kidney damage D.) Is caused by too-rapid infusion of the dialysis

B.) Indicates abdominal blood vessel damage

Patient-Centered care: A patient received a kidney transplant last month. Because of the effects of immunosuppressive drugs and CKD, what complication of transplantation should the nurse be assessing the patient for to decrease the risk of mortality? A.) Cancer B.) Infection C.) Rejection D.) Cardiovascular disease

B.) Infection

Which should be included in the client's plan of care during dialysis therapy? A.) Limit the client's visitors B.) Monitor the client's blood pressure C.) Pad the side rails of the bed D.) Keep the client on NPO status

B.) Monitor the client's BP

A nurse is providing information to a client who has chronic rejection of a transplanted kidney. Which of the following statements should the nurse include? A.) Immediate removal of the donor kidney is planned B.) Monitoring electrolytes frequently determines kidney status C.) Scheduled kidney biopsies determine kidney status D.) Restarting dialysis depends on marked azotemia E.) Plan to have the immunosuppressive medication increased

B.) Monitoring electrolytes frequently determines kidney status C.) Scheduled kidney biopsies determine kidney status D.) Restarting dialysis depends on marked azotemia E.) Plan to have the immunosuppressive medication increased

A client with CKD returns to the nursing unit following a hemodialysis tx. On assessment, the nurse notes that the client's temp is 101.2. Which nursing action is MOST appropriate? A.) Encourage fluid intake B.) Notify HCP C.) Continue to monitor D.) Monitor the site of the shunt for infection

B.) Notify HCP (This is rarely the best answer on NCLEX, but note that the nurse had already done the assessment)

A client is receiving peritoneal dialysis. While the dialysis solution is dwelling in the client's abdomen, the nurs should: A.) Assess the urticaria B.) Observe respiratory status C.) Check capillary refill time D.) Monitor electrolyte status

B.) Observe respiratory status

A client with chronic renal failure is receiving hemodialysis three times a week. In order to protect the fistula, the nurse should: A.) Take the BP in the arm with the fistula B.) Report the loss of a thrill or bruit on the arm with the fistula C.) Maintain a pressure dressing on the shunt D.) Start a second IV in the arm with the fistula

B.) Report the loss of a thrill or bruit on the arm with the fistula

During dialysis, the client has disequilibrium syndrome. The nurse should first: A.) Administer oxygen per nasal cannula B.) Slow the rate of dialysis C.) Reassure the client that the symptoms are normal D.) Place the client in Trendelenburg's position

B.) Slow the rate of dialysis

The nurse in the dialysis center is initiating the morning dialysis run. Which client should the nurse assess first? A.) The client who has a hgb of 9.8 and hct of 30% B.) The client who does not have a palpable thrill or auscultated bruit C.) The client who is complaining of being exhausted and is sleeping D.) The client who did not take antihypertensive medication this morning

B.) The client who does not have a palpable thrill or auscultated bruit

The home care nurse visits a 34-year-old wiman receiving PD. Which statement made by the patient indicated immediate follow-up by the nurse? A.) Drain time is faster if I rub my abdomen B.) The fluid draining from the catheter is cloudy C.) The drainage is bloody when I have my period D.) I wash around the catheter with soap and water

B.) The fluid draining from the catheter is cloudy

During PD, the nurse observes that the flow of dialysate stops before all the solution has drained out. The nurse should: A.) Have the client sit in a chair B.) Turn the client from side to side C.) Reposition the peritoneal catheter D.) Have the client walk

B.) Turn the client from side to side

To prevent the most common complication of PD, what is important for the nurse to do? A.) Infuse the dialysate slowly B.) Use strict aseptic technique in the dialysis procedure C.) Have the patient empty the bowel before the inflow phase D.) Reposition the patient frequently and promote deep breathing

B.) Use strict aseptic technique in the dialysis procedures

After completion of peritoneal dialysis, the nurse should assess the client for: A.) Hematuria B.) Weight loss 3.) Hypertension 4.) Increased urine output

B.) Weight loss

The client is notified he will not be placed on the kidney transplant list. The client tells the nurse he will not be back for any more dialysis. Which response is the MOST therapeutic? A.) You cannot just quit your dialysis. This is not an option. B.) You're angry at not being on the list, and you want to quit your dialysis? C.) I will call your nephrologist right now so you can talk D.) Make your funeral arrangements because you are going to die

B.) You're angry at not being on the list, and you want to quit dialysis

A nurse is caring for a client who is receiving HD and develops disequilibrium syndrome. Which of the following is an appropriate action by the nurse? A.) Administer an opiod medication B.) Monitor for hypertension C.) Assess level of consciousness D.) Increase the dialysis exchange rate

C.) Assess level of consciousness

Which abnormal blood value would NOT be improved by dialysis treatment? A.) Elevated serum creatinine level B.) Hyperkalemia C.) Decreased hemoglobin concentration D.) Hypernatremia

C.) Decreased hemoglobin concentration

What does the dialysate for PD routinely contain? A.) Calcium in a lower concentratoin than in blood B.) Sodium in a higher concentration than the blood C.) Dextrose in a higher concentration than in blood D.) Electrolytes in an equla concentration to that of the blood

C.) Dextrose in a higher concentration than in the blood

The client asks about diet changes when using continous ambulatory PD. Which response by the nurse is best? A.) Diet restrictions are more rigid with CAPD because standard peritoneal dialysis is a more effective technique B.) Diet restrictions are the same for both CAPD and standard peritoneal dialysis C.) Diet restrictions with CAPD are fewer than with standard peritoneal because dialysis is constant D.) Diet restrictions with CAPD are fewer than with standard peritoneal dialysis because CAPD works more quickly

C.) Diet restrictions with CAPD are fewer than with standard peritoneal dialysis because dialysis is constant

A patient with AKI is a candidate for continous renal replacement therapy (CRRT). What is the MOST common indication for use? A.) Pericarditis B.) Hyperkalemia C.) Fluid overload D.) Hypernatremia

C.) Fluid overload

The client receiving hemodialysis being discharges home from the dialysis center. Which instruction should the nurse teach the client? A.) Notify the HCP if oral temp is 102 or greater B.) Apply ice to the access site if it starts bleeding at home C.) Keep fingernails short and try not to scratch the skin D.) Encourage the significant other to make decisions for the client

C.) Keep fingernails short and try not to scratch the skin

The patient with CKD is considering whether to use peritoneal dialysis (PD) or hemodialysis (HD). What are the advantages of PD compared to HD? SATA A.) Less protein loss B.) Rapid fluid removal C.) Less cardiovascular stress D.) Decreased hyperlipidemia E.) Requires fewer dietary restrictions

C.) Less cardiovascular stress E.) Requires fewer dietary restrictions

A patient on HD develops a thrombus of a subcutaneous AVG, requiring its removal. While waiting for a replacement graft or fistula, the patient is most likely to have what done for treatment? A.) PD B.) Peripheral vascular access using radial artery C.) Long-term cuffed catheter tunnedled subcutaneously to the jugular vein D.) Peripherally inserted central catheter (PICC) line inserted into subclavian vein

C.) Long-term cuffed catheter tunneled subcutaneously to the jugular vein

Whic is the MOST accurate method of determining the extent of a client's fluid loss? A.) Measuting intake and output B.) Assessing vital signs C.) Weighing the client D.) Assessing skin turgor

C.) Weighing the client

The client undergoing long-term PD at home is currently experiencing a reduced outflow from the dialysis catheter. To determine if the catheter is obstructed, the nurse should inquire whether the client has: A.) Diarrhea B.) Vomiting C.) Flatulence D.) Constipation

D.) Constipation (peristalsis in part contributes to outflow)

A patient rapidly progressing toward ESRD asks about the possibility of a kidney transplant. In responding to the patient, the nurse knows that what is a contraindication to kidney transplantation? A.) Hepatitis C infection B.) Coronary artery disease C.) Refractory hypertension D.) Extensive vascular disease

D.) Extensive vascular disease

The client newly diagnosed with CKD recently has begun hemodialysis. Knowing that the client is at risk for disequilibrium syndrome, the nurse should assess the client during dialysis for whihc associated manifestation? A.) Hypertension, tachycardia, and fever B.) Hypotension, bradycardia, and fever C.) Restlessness, irritability, and generalized weakness D.) Headache, deteriorating LOC, and twitching

D.) Headache, deteriorating LOC, and twitching

A nurse is providing teaching to a client who has chronic kidney disease and is to start hemodialysis. Which of the following information should the nurse include in the teaching? A.) Hemodialysis restores renal function B.) Hemodialysis replaces hormonal funciton of the renal system C.) Hemodialysis allows an unrestricted diet D.) Hemodialysis returns balance to serum electrolytes

D.) Hemodialysis returns a balance to serum electrolytes

A week after kidney transplantation, a client develops a temperature of 101F, the BP is elevated and there is tenderness over the transplanted kidney. The serum creatinine is rising and urine output is decreased. The x-ray indicates that the transplantes kidney is enlarged. Based on these assessment findings, the nurse anticipates which treatment? A.) Antibiotic therapy B.) Peritoneal dialysis C.) Removal of the transplanted kidney D.) Increased immunosuppression therapy

D.) Increased immunosuppression therapy

The nurse is performing an assessment on a client who has returned from the dialysis until following hemodialysis. The client is complaining of headache and nausea and is extremely restless. Whish is the priority nursing action? A.) Monitor the client B.) Elevate the head of the bed C.) Assess the fistula sire and dressing D.) Notify the health care provider (HCP)

D.) Notify the healthcare provider (HCP)

A hemodialysis client with a left arm fistul is at risk for arterial stenosis syndrome. The nurse should assess for which manifestations of this complication? A.) Warmth, redness, and pain in the left hand B.) Ecchymosis and audible bruit over the fistula C.) Edema and reddish discoloration of the left arm D.) Pallor, diminished pulse, and pain in left hand

D.) Pallor, diminished pulse, and pain in the left hand (Steal syndrome results from vascular insufficiency after creation of a fistula)

The nurse teaches the client how to recognize infection in the shunt by telling the client to assess the shunt each day for: A.) Absence of a bruit B.) Sluggish capillary refill time C.) Coolness of the involved extrimity D.) Swelling at the shunt site

D.) Swelling at the shunt site

The client diagnosed with CKD is receiving peritoneal dialysis. Which assessment data warrant immediate interventino by the nurse? A.) Inability to auscultate a bruit over the fistula B.) The client's abdomen is soft, nontender, and has bowel sounds C.) The dialysate is being removed from the client's abdomen in clear D.) The dialysate instilled was 1,500ml and removed was 1,500ml

D.) The dialysate instilled was 1,500ml and removed was 1,500ml

A client is to receive PD. To prepare for the procedure the nurse should: A.) Assess the dialysis access for a bruit and thrill B.) Insert an indwelling urinary catheter and drain all urine from the bladder C.) Ask the client to turn toward the left side D.) Warm the dialysis solution in the warmer

D.) Warm the dialysis solution in the warmer

The medical floor nurse receives report from the ED on a 42 yo client who is admitted to the hospital for hyperphosphatemia related to ESRD. The client receives continous ambulatory peritoneal dialysis (CAPD), and the physican has ordered continuation of tx during hospitalization. The nurse should do what? A.) Maintain a permanent peritoneal catheter with flushes of NS q 4-6hrs B.) Obtain a pump in preparation for dialysate infusion C.) Ensure the dialysate is refrigerated until ready to infuse, and obtain a warming pad or a warming machine to warm the dialysate to body temp prior to exchange D.) Weigh the client at the same time every day, and use sterile technique while working with a permanent catheter

D.) Weigh the client at the same time every day, and use sterile technique while working with a permanent peritoneal catheter

The dialysis solution is wawrmed before use in PD primarily to A.) Encourage the rmoval of serum urea B.) Force potassium back into the cells C.) Add extra warmth to the body D.) Promote abdominal muscle relaxation

a.) Encourage the removal of serum urea