NCLEX Questions for Renal Disorders

What is the appropriate infusion time for the dialysate in your 38 y/o patient with chronic renal failure? A. 15 min B. 30 min C. 1 hr D. 2 to 3 hrs

A. 15 min Rationale: Dialysate should be infused quickly. The dailysate should be infused over 15 min or less when performing peritoneal dialysis. The fluid exchange takes place over a period ranging from 30 min to several hours.

A patient with ESRD has an arteriovenous fistula in the left arm for hemodialysis. Which intervention do you include in his plan of care? A. Apply pressure to the needle site upon discontinuing hemodialysis B. Keep HOB elevated 45 degrees C. Place the left arm on an arm board for at least 30 min D. Keep the left arm dry

A. Apply pressure to the needle site upon discontinuing hemodialysis Rationale: Apply pressure when discontinuing hemodialysis and after removing the venipuncture needle until all the bleeding has stopped. Bleeding may continue for 10 min in some patients.

You have a patient that is receiving peritoneal dialysis. What should you do when you notice the return fluid is slowly draining? A. Check for kinks in the outflow tubing B. Raise the drainage bag above the level of the abdomen C. Place the patient in a reverse Trendelenburg position D. Ask the patient to cough

A. Check for kinks in the outflow tubing Rationale: Tubing problems are a common cause of outflow difficulties, check the tubing for kinks and ensure that all clamps are open. Other measures include having the patient change positions (moving side to side or sitting up), applying gentle pressure over the abdomen, or having a bowel movement

Which sign indicates the second phase of acute renal failure? A. Daily doubling of urine output (4 to 5 L/day) B. Urine output less than 400 mL/day C. Urine output less than 100 mL/day D. Stabilization of renal function

A. Daily doubling of urine output (4 to 5 L/day) Rationale: Daily doubling of the urine output indicates that the nephrons are healing. This means the patient is passing into the second phase (diuresis) of acute renal failure.

What change indicates recovery in a patient with nephrotic syndrome? A. Disappearance of protein from the urine B. decrease in BP to normal C. Increase in serum lipid levels D. Gain in body weight

A. Disappearance of protein from the urine Rationale: With nephrotic syndrome, the glomerular basement membrane of the kidney becomes more porous, leading to loss of protein in the urine. As the patient recovers, less protein is found in the urine.

You have a paraplegic patient with renal calculi. Which factor contributes to the development of calculi? A. Increased calcium loss from the bones B. Decreased kidney function C. Decreased calcium intake D. High fluid intake

A. Increased calcium loss from the bones Rationale: Bones lose calcium when a patient can no longer bear weight. The calcium lost from bones form calculi, a concentration of mineral salts also known as a stone, in the renal system.

Which drug is indicated for pain r/t acute renal calculi? A. Narcotic analgesics B. NSAIDs C. Muscle relaxants D. Salicylates

A. Narcotic analgesics Rationale: Narcotic analgesics are usually needed to relieve the severe pain of renal calculi. Muscle relaxants are typically used to treat skeletal muscle spasms. NSAIDs and salicylate are used for their anti-inflammatory and anti-pyretic properties and to treat less severe pain.

You're developing a care plan with the nursing diagnosis risk for infection for your patient that received a kidney transplant. A goal for this patient is to: A. Remain afebrile and have negative cultures B. Resume normal fluid intake within 2 to 3 days C. Resume the patient's normal job within 2 to 3 weeks D. Try to discontinue cyclosporine (Neural) as quickly as possible

A. Remain afebrile and have negative cultures Rationale: The immunosuppressive activity of cyclosporine places the patient at risk for infection, and steroids can mask the signs of infection. The patient may not be able to resume normal fluid intake or return to work for an extended period of time and the patient may need cyclosporine therapy for life.

Which criterion is required before a patient can be considered for continuous peritoneal dialysis? A. The patient must be hemodynamically stable B. The vascular access must have healed C. The patient must be in a home setting D. Hemodialysis must have failed

A. The patient must be hemodynamically stable Rationale: Hemodynamic stability must be established before continuous peritoneal dialysis can be started.

Your 60 y/o patient with pyelonephritis and possible septicemia has had five UTIs over the past 2 years. She is fatigued from lack of sleep, has lost weight, and urinates frequently even in the night. Her labs show: Sodium 154 mEq/L, osmolarity 340 most/L, glucose 127 mg/dl, and potassium 3.9 mEq/L. Which nursing diagnosis is priority? A. Fluid volume deficit r/t osmotic diuresis induced by hyponatremia B. Fluid volume deficit r/t inability to conserve water C. Altered nutrition: Less than body requirements r/t hyper metabolic state D. Altered nutrition: Less than body requirements r/t catabolic effects of insulin deficiency

B Fluid volume deficit r/t inability to conserve water

You have a patient that might have a urinary tract infection (UTI). Which statement by the patient suggests that a UTI is likely? A. "I pee a lot." B. "It burns when I pee." C. "I go hours without the urge to pee." D. "My pee smells sweet."

B. "It burns when I pee." Rationale: A common symptom of a UTI is dysuria. A patient with a UTI often reports frequent voiding of small amounts and the urgency to void. Urine that smells sweet is often associated with DKA.

You expect a patient in the oliguric phase of renal failure to have a 24 hour urine output less than: A. 200 mL B. 400 mL C. 800 mL D. 1000 mL

B. 400 mL Rationale: Oliguria is defined as output of less than 400 mL/24 hours

A 30 y/o female patient is undergoing hemodialysis with an internal arteriovenous fistula in place. What do you do to prevent complications associated with this device? A. Insert IV lines above fistula B. Avoid taking BPs in the arm with the fistula C. Palpate pulses above the fistula D. Report a bruit or thrill over the fistula to the doctor

B. Avoid taking BPs in the arm with the fistula Rationale: Because the compression could damage the fistula. IV lines shouldn't be inserted in the arm used for hemodialysis. Palpate pulses below the fistula. Lack of bruit or thrill should be reported to the doctor.

Your patient becomes restless and tells you she has a headache and feels nauseous during hemodialysis. Which complication do you suspect? A. Infection B. Disequilibrium syndrome C. Air embolus D. Acute hemolysis

B. Disequilibrium syndrome Rationale: Disequilibrium syndrome is caused by a rapid reduction in urea, sodium, and other solutes from the blood. This can lead to cerebral edema and increased ICP. S/S include headache, nausea, restlessness, vomiting, confusion, twitching, and seizures.

The most common early sign of kidney disease is: A. Sodium retention B. Elevated BUN level C. Development of metabolic acidosis D. Inability to dilute or concentrate urine

B. Elevated BUN level Rationale: Increased BUN is usually an early indicator of decreased renal function.

A patient returns from surgery with an indwelling urinary catheter in place and empty. Six hours later, the volume is 120 mL. The drainage system has no obstructions. Which intervention has priority? A. Give a 500 mL bolus of isotonic saline B. Evaluate the patient's circulation and VS C. Flush the urinary catheter with sterile water or saline D. Place the patient in the shock position, and notify the surgeon

B. Evaluate the patient's circulation and VS Rationale: A total UO of 120 mL is too low. Assess the patient's circulation and hemodynamic stability for signs of hypovolemia. A fluid bolus may be required, but only after further nursing assessment and a doctor's order.

What is the priority nursing diagnosis with your patient diagnosed with ESRD? A. Activity intolerance B. Fluid volume excess C. Knowledge deficit D. Pain

B. Fluid volume excess Rationale: Fluid volume excess because the kidneys aren't removing fluid and waste. The other diagnoses may apply, but they don't take priority.

What is the most important nursing diagnosis for a patient in ESRD? A. Risk for injury B. Fluid volume excess C. Altered nutrition: less than body requirements D. Activity intolerance

B. Fluid volume excess Rationale: Kidneys are unable to rid the body of excess fluids which results in fluid volume excess during ESRD.

Immediately post-op after a prostatectomy, which complication requires priority assessment of your patient? A. Pneumonia B. Hemorrhage C. Urine retention D. DVT

B. Hemorrhage Rationale: Hemorrhage is a potential complication. Urine retention isn't a problem soon after surgery because a catheter is in place. Pneumonia may occur if the patient doesn't cough and deep breathe. Thrombosis may occur later if the patient doesn't ambulate.

Which cause of HTN is the most common in acute renal failure? A. Pulmonary edema B. Hypervolemia C. Hypovolemia D. Anemia

B. Hypervolemia Rationale: Acute renal failure causes hypervolemia as a result of over expansion of extracellular fluid and plasma volume with the hyper secretion of renin. Therefore, hypervolemia causes HTN.

Your patient is complaining of muscle cramps while undergoing hemodialysis. Which intervention is effective in relieving muscle cramps? A. Increase the rate of dialysis B. Infuse normal saline solution C. Administer a 5% dextrose solution D. Encourage active ROM exercises

B. Infuse normal saline solution Rationale: Tx includes administering normal saline or hypertonic normal saline solution because muscle cramps can occur when the sodium and water are removed too quickly during dialysis. Reducing the rate of dialysis, not increasing it, may alleviate muscle cramps.

A patient with DM and renal failure begins hemodialysis. Which diet is best on days between dialysis treatments? A. Low-protein diet with unlimited amounts of water B. Low-protein diet with a prescribed amount of water C. No protein in the diet and use of a salt substitute D. No restrictions

B. Low-protein diet with a prescribed amount of water Rationale: Patient requires some protein to meet metabolic needs. Salt substitutes shouldn't be used w/o a Dr's order b/c it may contain potassium, which could make the patient hyperkalemic. Fluid and protein restrictions are needed.

Which action is most important during bladder training in a patient with a neurogenic bladder? A. Encourage the use of an indwelling urinary catheter B. Set up specific times to empty the bladder C. Encourage Kegel exercises D. Force fluids

B. Set up specific times to empty the bladder Rationale: Instruct the patient with neurogenic bladder to write down his voiding pattern and empty the bladder at the same times each day.

Polystyrene sulfonate (Kayexalate) is used in renal failure to: A. Correct acidosis B. Reduce serum phosphate level C. Exchange potassium for sodium D. Prevent constipation from sorbitol use

C. Exchange potassium for sodium Rationale: In renal failure, patients become hyperkalemic because they can't excrete potassium in the urine. Polystyrene sulfonate acts to excrete potassium by pulling potassium into the bowels and exchanging it for sodium

You suspect kidney transplant rejection when the patient shows which symptoms? A. Pain in the incision, general malaise, and hypotension B. Pain in the incision, general malaise, and depression C. Fever, weight gain, and diminished urine output D. Diminished urine output and hypotension

C. Fever, weight gain, and diminished urine output Rationale: Symptoms of rejection include fever, rapid weight gain, HTN, pain over the graft site, peripheral edema, and diminished urine output.

Which finding leads you to suspect acute glomerulonephritis in your 32 y/o patient? A. Dysuria, frequency, and urgency B. Back pain, N/V C. HTN, oliguria, and fatigue D. Fever, chills, and right upper quadrant pain radiating to the back

C. HTN, oliguria, and fatigue Rationale: Mild to moderate HTN may result from sodium or water retention and inappropriate renin release from the kidneys. Oliguria and fatigue also may be seen. Other signs are proteinuria and azotemia.

Clinical manifestations of acute glomerulonephritis include which of the following? A. Chills and flank pain B. Oliguria and generalized edema C. Hematuria and proteinuria D. Dysuria and hypotension

C. Hematuria and proteinuria Rationale: Hematuria and proteinuria indicate acute glomerulonephritis. These findings result from increased permeability of the glomerular membrane due to the antigen-antibody reaction. Generalized edema is seen most often in nephrosis.

Which of the following causes the majority of UTI's in hospitalized patients? A. Lack of fluid intake B. Inadequate perineal care C. Invasive procedures D. Immunosuppression

C. Invasive procedures. Rationale: Invasive procedures such as catheterization can introduce bacteria into the urinary tract. A lack of fluid intake could cause concentration of urine, but wouldn't necessarily cause infection.

Your patient returns from the operating room after abdominal aortic aneurysm repair. Which symptom is a sign of acute renal failure? A. Anuria B. Diarrhea C. Oliguria D. Vomiting

C. Oliguria Rationale: Urine output less than 50 mL in 24 hrs signifies oliguria, an early sign of renal failure. Anuria is uncommon except in obstructive renal disorders.

A patient with diabetes has had many renal calculi over the past 20 years and now has chronic renal failure. Which substance must be reduced in this patient's diet? A. Carbohydrates B. Fats C. Protein D. Vitamin C

C. Protein Rationale: Because of damage to the nephrons, the kidney can't excrete all the metabolic wastes of protein, so this patient's protein intake must be restricted. A higher intake of carbs, fats, and vitamin supplements is needed to ensure the growth and maintenance of the patient's tissues.

An 18 y/o student is admitted with dark urine, fever, and flank pain and is diagnosed with acute glomerulonephritis. Which would most likely be in this student's health history? A. Renal calculi B. Renal trauma C. Recent sore throat D. Family hx of acute glomerulonephritis

C. Recent sore throat Rationale: The most common form of acute glomerulonephritis is caused by group A beta-hemolytic streptococcal infection elsewhere in the body

Which statement correctly distinguishes renal failure from prerenal failure? A. With prerenal failure, vasoactive substances such as dopamine (Intropin) increase BP B. With prerenal failure, there is less response to such diuretics as furosemide (Lasix) C. With prerenal failure, an IV isotonic saline infusion increases urine output D. With prerenal failure, hemodialysis reduces the BUN level

C. With prerenal failure, an IV isotonic saline infusion increases urine output Rationale: Prerenal failure is caused by such conditions as hypovolemia that impairs kidney perfusion; giving isotonic fluids improves urine output. Vasoactive substances can increase BP in both conditions.

A 22 y/o patient with diabetic nephropathy says, "I have two kidneys and I'm still young. If I stick to my insulin schedule, I don't have to worry about kidney damage, right?" Which of the following statements is the best response? A. "You have little to worry about as long as your kidneys keep making urine." B. "You should talk to your doctor because statistics show that you're being unrealistic." C. "You would be correct if your diabetes could be managed with insulin." D. "Even with insulin, kidney damage is still a concern."

D. "Even with insulin, kidney damage is still a concern." Rationale: Microvascular changes occur in both of the patient's kidneys as a complication of the diabetes. Diabetic nephropathy is the leading cause of ESRD. The kidneys continue to produce urine until the end stage. Nephropathy occurs even with insulin management.

Frequent PVCs are noted on the cardiac monitor of a patient with end-stage renal disease. The priority intervention is: A. Call the doctor immediately B. Give the patient IV lidocaine (Xylocaine) C. Prepare to defibrillate the patient D. Check the patient's latest potassium level

D. Check the patient's latest potassium level Rationale: The patient with ESRD may develop arrhythmias caused by hypokalemia. Call the doctor after checking the patient's potassium values. Lidocaine may be ordered if the PVCs are frequent and the patient is symptomatic.

Your patient has complaints of severe right-sided flank pain, N/V, and restlessness. He appears slightly pale and is diaphoretic. VS are BP 140/90 mmHg, P 118 bp, RR 33 breaths/min, and T 98.0F. Which subjective data supports a diagnosis of renal calculi? A. Pain radiating to the right upper quadrant B. Hx of mild flu symptoms last week C. Dark-colored coffee-ground emesis D. Dark, scanty urine output

D. Dark, scanty urine output Rationale: Patients with renal calculi commonly have blood in the urine caused by the stone's passage through the urinary tract. The urine appears dark, tests positive for blood, and is typically scant.

You're preparing for urinary catheterization of a trauma patient and you observe bleeding at the urethral meatus. Which action has priority? A. Irrigate and clean the meatus before catheterization. B. Check the discharge for occult blood before catheterization. C. Heavily lubricate the catheter before insertion. D. Delay catheterization and notify the doctor.

D. Delay catheterization and notify the doctor. Rationale: Bleeding at the urethral meatus is evidence that the urethra is injured. Because catheterization can cause further harm, consult with the doctor.

Your patient with chronic renal failure reports pruritus. Which instruction should you include in this patient's teaching plan? A. Rub the skin vigorously with a towel B. Take frequent baths C. Apply alcohol-based emollients to the skin D. Keep fingernails short and clean

D. Keep fingernails short and clean Rationale: Calcium-phosphate deposits in the skin may cause pruritus. Scratching leads to excoriation and breaks in the skin that increase the patient's risk of infection. Keeping the fingernails short and clean helps reduce the risk of infection.

What is the best way to check for patency of the arteriovenous fistula for hemodialysis? A. Pinch the fistula and note the speed of filling on release B. Use a needle and syringe to aspirate blood from the fistula C. Check for capillary refill of the nail beds on that extremity D. Palpate the fistula throughout its length to assess for a thrill

D. Palpate the fistula throughout its length to assess for a thrill Rationale: The vibration or thrill felt during palpation ensures that the fistula has the desired turbulent blood flow. Pinching the fistula could cause damage. Aspirating blood is a needless invasive procedure.

Which intervention do you plan to include with a patient who has renal calculi? A. Maintain bed rest B. Increase dietary purines C. Restrict fluids D. Strain all urine

D. Strain all urine Rationale: All urine should be strained through gauze or a urine strainer to catch stones that are passed. The stones are then analyzed for composition. Ambulation may help the movement of the stone down the urinary tract. Encourage fluid to help flush the stones out.

Your patient had surgery to form an arteriovenous fistula for hemodialysis. Which information is important for providing care for the patient? A. The patient shouldn't feel pain during initiation of dialysis. B. The patient feels best immediately after the dialysis tx. C. Using a stethoscope for auscultating the fistula is contraindicated. D. Taking a BP reading on the affected arm can cause clotting of the fistula.

D. Taking a BP reading on the affected arm can cause clotting of the fistula. Rationale: Pressure on the fistula or the extremity can decrease blood flow and precipitate clotting, so avoid taking BP on the affected arm.