Renal NCLEX Questions
A nurse is analyzing the laboratory results of a client with chronic renal failure who is receiving epoetin alfa (Epogen). The nurse interprets that the medication is having the expected effect if the results indicate an increase in which of the following levels? a) red blood cells b) potassium c) creatinine d) phosphorus
A - Epoetin alfa is erythropoietin that has been manufactured through the use of recombinant DNA technology. It is used to treat anemia in the client with chronic renal failure. The other levels rise as a result of the pathology of renal failure and have nothing to do with the effects of this medication.
A nurse is caring for a client who has just returned to the nursing unit after an intravenous pyelogram (IVP). The nurse determines that which of the following is important in the postprocedure care of this client? a) encouraging increased intake of oral fluids b) ambulating the client in the hallway c) encouraging the client to try to avoid frequently d) maintaining the client on bedrest
A - Following an IVP, the client should take in increased fluids to aid in the clearance of the dye used for the procedure. It is unnecessary to void frequently after the procedure. The client is usually allowed activity as tolerated without any specific activity guidelines.
A client diagnosed with cancer of the bladder has a nursing diagnosis of fear related to the uncertain outcome of upcoming cystectomy and urinary diversion. The nurse determines that this diagnosis is appropriate if the client makes which statement? a) I'm so afraid I won't live through all this b) what if I have no help at home after going through this awful surgery c) I'll never feel like myself once I can't go to the bathroom normally d) I wish I'd never gone to the doctor at all
A - In order for fear to be an actual diagnosis, the client must be able to identify the object of fear. In this question, the client is expressing a fear of the outcome related to surgery. The statement in option B relates to a nursing diagnosis of impaired home maintenance. Option C relates to a nursing diagnosis of disturbed body image. Option D is vague and nonspecific, and further assessment is needed to associate this statement with a nursing diagnosis.
A nurse has provided instructions to a female client with cystitis about measures to prevent recurrence. The nurse determines that the client needs further instruction if the client verbalizes to: a) take bubble baths for more effective hygiene b) wear underwater made of cotton or with cotton panels c) drink a glass of water and void after intercourse d) avoid wearing pantyhose while wearing socks
A - Measures to prevent cystitis include increasing fluid intake to 3 L per day; consuming an acid-ash diet; wiping front to back after urination; using showers instead of tub baths; drinking water and voiding after intercourse; avoiding bubble baths, feminine hygiene sprays, or perfumed toilet tissue or sanitary pads; and wearing clothes that "breathe" (cotton pants, no tight jeans, no pantyhose under slacks). Other measures include teaching pregnant women to void every 2 hours, and teaching menopausal women to use estrogen vaginal creams to restore vaginal pH.
A client with renal malignancy is admitted to the hospital for a diagnostic workup and probable surgery. During the admission assessment the nurse inquires about the presence of which common symptom related to this problem? a) flank pain and intermittent hematuria b) suprapubic pain and constant slight hematuria c) flank pain and foul-smelling urine d) abdominal pain and decreased urine output
A - Renal cancer is commonly manifested by hematuria and flank pain (not abdominal or suprapubic), and a palpable mass may be palpated on physical examination. Because the hematuria is gross but intermittent, the client may delay seeking medical treatment. Foul-smelling urine could indicate infection. Decreased urine output could indicate renal insufficiency.
A client with glomerulonephritis is at risk of developing acute renal failure. The nurse monitors the client for which sign of this complication? a) bradycardia b) hypertension c) decreased cardiac output d) decreased central venous pressure
B - Acute renal failure caused by glomerulonephritis is classified as intrinsic or intrarenal failure. This form of acute renal failure is commonly manifested by hypertension, tachycardia, oliguria, lethargy, edema, and other signs of fluid overload. Acute renal failure from prerenal causes is characterized by decreased blood pressure or a recent history of the same, tachycardia, and decreased cardiac output and central venous pressure. Bradycardia is not part of the clinical picture for renal failure.
A nurse is caring for a client receiving hemodialysis who has an internal arteriovenous (AV) fistula. Which assessment finding would indicate to the nurse that the fistula is patent? a) white fibrin specks noted in the fistula b) palpation of a thrill over the site of the fistula c) lack of bruit over the site of the fistula d) a feeling of warmth at the site of the fistula
B - An internal AV fistula is created through a surgical procedure in which an artery in the arm is anastomosed to a vein. To assess patency, the nurse palpates over the fistula for a thrill and auscultates for a bruit. With an internal AV fistula, the nurse would not note white fibrin specks. A feeling of warmth at the site of the fistula may indicate an inflammatory process.
A nurse has collected nutritional data from a client with a diagnosis of cystitis. The nurse determines that which beverage needs to be eliminated from the client's diet to minimize the recurrence of cystitis? a) fruit juice b) tea c) water d) lemonade
B - Caffeine and alcohol can irritate the bladder. Therefore, alcohol and caffeine-containing beverages such as coffee, tea, and cocoa are avoided to minimize the risk. Water helps flush bacteria out of the bladder, and an intake of six to eight glasses per day is encouraged. Lemonade and fruit juice are acceptable items to drink.
A nurse is giving a client with polycystic kidney disease instructions in replacing elements lost in the urine as a result of impaired kidney function. The nurse instructs the client to increase intake of which of the following in the client? a) sodium and potassium b) sodium and water c) water and phosphorus d) calcium and phosphorus
B - Clients with polycystic kidney disease waste sodium rather than retain it and therefore need an increase in sodium and water in the diet. Potassium, calcium, and phosphorus do not need to be increased in this condition.
A nurse is caring for a client newly diagnosed with chronic renal failure who has recently begun hemodialysis. The nurse determines that the client has not tolerated the procedure optimally if the client experiences which symptoms that represent disequilibrium syndrome? a) restlessness, irritability, and generalized weakness b) headache, deteriorating level of consciousness, and seizures c) hypertension, tachycardia, and fever d) hypotension, bradycardia, and hypothermia
B - Disequilibrium syndrome is characterized by headache, mental confusion, decreasing level of consciousness, nausea, vomiting, twitching, and possible seizure activity. It results from the rapid removal of solutes from the body during hemodialysis. The blood-brain barrier interferes with equally efficient removal of wastes from brain tissue. As a result, water goes into cerebral cells because of the osmotic gradient, causing brain swelling and onset of symptoms. It most often occurs in clients who are new to dialysis, and is prevented by dialyzing for shorter times or at reduced blood flow rates.
A client with chronic renal failure has completed a hemodialysis treatment. The nurse measures which parameters at the completion of the hemodialysis procedure to monitor for hemodynamic stability and to determine effectiveness of fluid extraction? a) vital signs and blood urea nitrogen (BUN) b) vital signs and weight c) sodium and potassium levels d) BUN and creatinine levels
B - Following dialysis, the client's vital signs are monitored to determine whether the client is remaining hemodynamically stable. Weight is measured and compared with the client's "dry weight" to determine effectiveness of fluid extraction. Laboratory studies are done as per protocol, but are not necessarily done after the hemodialysis treatment has been ended.
A client with nephrolithiasis arrives at a clinic for a follow-up visit. The laboratory analysis of the stone that the client passed 1 week ago indicates that the stone is composed of calcium oxalate. The nurse tells the client to avoid consuming which food item? a) lentils b) strawberries c) lettuce d) pasta
B - Foods that raise urinary oxalate excretion include spinach, rhubarb, strawberries, chocolate, wheat bran, nuts, beets, and tea. Of the options provided, the client will be instructed to avoid strawberries.
A nurse is working with a client newly diagnosed with chronic renal failure to set up schedule for hemodialysis. The client states, "This is so unfair I wouldn't have to do this for the rest of my life if you people had caught this disease in time!" The nurse interprets that the client is exhibiting: a) anger b) projection c) withdrawal d) depression
B - Psychosocial reactions to chronic renal failure and hemodialysis are varied and may include personality changes, emotional lability, withdrawal, depression, and anger. The individual client response may vary depending on the client's personality and support systems. The client in this question is exhibiting projection. The client is blaming the nurse and other health care personnel for the client's situation.
A nurse has provided instructions to a client with a nephrotostomy tube regarding home care after hospital discharge. The nurse determines that the client understands the instructions if the client verbalizes to drink approximately how many 8-ounce glasses of water per day? a) 2 b) 8 c) 16 d) 20
B - The client with a nephrostomy tube needs to have adequate fluid intake to dilute urinary particles that could cause calculus and to provide mechanical flushing of the kidney and tube. The nurse encourages the client to take in 2000 mL of fluid per day, which is roughly equivalent to eight 8-ounce glasses of water. Option A identifies a fluid intake volume that is too low and would not provide mechanical flushing of the kidney and tube. Options C and D identify very large volumes of fluid intake; these volumes are unnecessary and could possibly place undo distention on the renal pelvis.
A client undergoing hemodialysis becomes hypotensive. The nurse immediately prepares to take which action? a) administer 1000 ml 5% dextrose in water b) administer a 250 ml normal saline bolus c) increase the blood flow into the dialyzer d) lower the client's legs and feet
B - To treat hypotension during hemodialysis, a normal saline bolus of up to 500 mL may be given. The client's feet and legs are raised to enhance cardiac return. Albumin may be given as per protocol to increase colloid oncotic pressure. The blood flow rate into the dialyzer may be decreased. All of these measures should improve the circulating volume and blood pressure. Five percent dextrose in water is not prescribed because it is less likely to improve the circulating volume and blood pressure.
A nurse is developing a plan of care for a client with nephrotic syndrome. The nurse documents that which important parameter needs to be assessed on a daily basis? a) total protein levels b) weight c) blood urea nitrogen (BUN) d) activity tolerance
B The client with nephrotic syndrome typically presents with edema, hypoalbuminemia, and proteinuria. The nurse carefully assesses the fluid balance of the client, which includes daily monitoring of weight, intake and output, edema, and girth measurements. Albumin levels are monitored as they are ordered, as are the BUN and creatinine levels. The client's activity level is adjusted according to the amount of edema and water retention. As edema increases, the client's activity level should be restricted.
A nurse is caring for a client following a cystoscopy. Which assessment finding requires physician notification? a) bladder spasm b) complaints of fullness and burning in the bladder c) clots in the urine d) back pain
C - Back pain, bladder spasms, and feelings of fullness and burning in the bladder may be experienced by the client following a cystoscopy. Warm tub baths, mild analgesics, and antispasmodics will provide relief. Pink-tinged urine is common but any bright red bleeding or clots in the urine should be reported to the physician.
A client with chronic renal failure has a new medication order for epoetin alfa (Epogen). The nurse plans to give this medication in which of the following ways? a) with a full glass of water b) diluted in juice to enhance taste c) subcutaneously d) with an antacid
C - Epoetin alfa is erythropoietin that has been manufactured through the use of recombinant DNA technology. It is used to treat anemia in the client with chronic renal failure. The medication may be administered subcutaneously or intravenously.
A client has undergone urinary diversion after cystectomy for bladder cancer. The nurse assesses the urostomy stoma to ensure that it is: a) pale and pink b) pink and dry c) red and moist d) dusky to beefy colored
C - Following urostomy, the stoma should be red and moist. It may be edematous, but this will decrease after the first few days. A dusky or cyanotic color indicates insufficient circulation with impending necrosis and warrants notification of the surgeon immediately.
A client is undergoing hemodialysis and receives heparin during the dialysis procedure. The nurse monitors the results of which of the following laboratory tests during the dialysis procedure? a) thrombin time b) bleeding time c) partial thromboplastin time (PTT) d) prothrombin time (PT)
C - Heparin is used as an anticoagulant during hemodialysis. The hemodialysis nurse monitors the extent of anticoagulation by measuring the PTT, which measures heparin effect. The PT is measured to monitor the effect of warfarin (Coumadin) therapy. Thrombin and bleeding times are not used to measure the effect of heparin therapy, although they are useful in the diagnosis of other clotting abnormalities.
A nurse is developing a teaching plan for a client with chronic renal failure who has been started on hemodialysis. The nurse would plan to include which of the following pieces of information in discussions with the client? a) it's unnecessary to stay within the fluid restriction on the day before hemodialysis b) it's all right to eat unlimited protein on the day before hemodialysis c) daily medications should be taken after hemodialysis, not before d) daily medications should be double-dosed if going for hemodialysis that day
C - Many medications are dialyzable, which means they are removed from the bloodstream during dialysis. Because of this, many medications are withheld on the day of dialysis until after the procedure. It is not typical for medications to be "double-dosed" because there is no way to be certain how much of each medication is cleared by dialysis. Clients receiving hemodialysis are not routinely taught that it is acceptable to disregard dietary and fluid restrictions.
A nurse provides home care instructions to a client hospitalized for a transurethral resection of the prostate (TURP). Which statement by the client indicates a need for further instructions? a) I need to avoid strenuous activity for 4 to 6 weeks b) I need to maintain a daily intake of 6 to 8 glasses of water daily c) I need to avoid lifting items greater than 30 pounds d) I need to include prune juice in my diet
C - The client needs to be advised to avoid strenuous activity for 4 to 6 weeks and to avoid lifting items weighing greater than 20 pounds. The client needs to consume an intake of at least 6 to 8 glasses daily of nonalcoholic fluids to minimize clot formation. Straining during defecation for at least 6 weeks after surgery is avoided to prevent bleeding. Prune juice is a satisfactory bowel stimulant.
A client with pyelonephritis is being discharged from the hospital, and the nurse provides instructions to the client to prevent recurrence. The nurse determines that the cleint understands the information that was given if hte client states an intention to: a) increase fluids for 2 days if signs and symptoms of a urinary tract infection develop b) take the prescribed antibiotics until all symptoms subside c) return to the physician's office for scheduled follow-up urine cultures d) decrease fluid intake if frequent urination occurs
C - The client with pyelonephritis should take the full course of antibiotic therapy that has been prescribed and return to the physician's office for follow-up urine cultures if so instructed. The client should learn the signs and symptoms of a urinary tract infection, and report them immediately if they occur. The client should also drink 3 L of fluid per day.
A client with chronic renal failure is on a fluid restriction and receives aluminum hydroxide gel (ALternaGEL) as a phosphate binder. The nurse determines that the client is at risk for which problem (nursing diagnosis) because of these treatment measures? a) fatigue b) deficient fluid volume c) constipation d) ineffective coping
C - The client with renal failure is almost certain to have a problem with constipation due to factors such as fluid restriction and dietary restrictions of most high-fiber foods (which have high potassium content). In addition, aluminum-based antacids such as aluminum hydroxide gel cause constipation as a side effect. There is no information in the question to support any of the other options, although the client with renal failure is commonly fatigued.
A nurse is explaining the concept of fluid restriction to a client with chronic renal failure who has started hemodialysis. The nurse tells the client that the fluid restriction is planned by adding the amount of the daily urine output (if any) and: a) 1800 to 2000 ml b) 1200 to 1500 ml c) 500 to 700 ml d) 200 to 300 ml
C - The usual allowable daily fluid intake of the hemodialysis client is the total of the daily urine output plus 500 to 700 mL. Options 1 and 2 identify high volumes of fluid intake, and option 4 identifies an insufficient volume.
A client with chronic renal failure has been on dialysis for 4 years and has been taking aluminum hydroxide (Amphojel tablets) as prescribed as part of the medication regimen. The client develops confusion and dementia, and complains of bone pain. The nurse interprets that this client is at risk for developing: a) advancing uremia b) folic acid defieciency c) phosphate overdose d) aluminum intoxication
D - Aluminum intoxication can occur when there is accumulation of aluminum, an ingredient in many phosphate-binding antacids. Symptoms include mental cloudiness, dementia, and bone pain from infiltration of the bone with aluminum. This complication is treated with aluminum chelating agents, which make aluminum available to be dialyzed from the body. It is prevented by avoiding or limiting the use of phosphate-binding agents that contain aluminum.
A client with chronic renal failure has undergone insertion of an indwelling catheter in the abdomen for peritoneal dialysis. The nurse teaches the client to do which of the following if the peritoneal catheter dressing gets wet? a) flush the peritoneal dialysis catheter b) scrub the catheter with povidone-iodine c) reinforce the dressing d) change the dressing
D - Clients with peritoneal dialysis catheters are at high risk for infection. A dressing that is wet is a conduit for bacteria to reach the catheter insertion site. The nurse teaches the client to keep the dressing dry at all times. Reinforcing the dressing is not a safe practice to prevent infection. Flushing the catheter is not indicated. Scrubbing the catheter with povidone-iodine is done at the time of connection or disconnection of peritoneal dialysis.
a nurse has formulated a nursing diagnosis of Risk for Infection for a hemodialysis client with an arteriovenous (AV) fistula in the right arm. The nurse determines that the client has best met the outcome criteria for this nursing diagnosis if which of the following observations is made? a) the client states her or she should do careful handwashing once a day b) the client states her or she should avoid blood pressure measurement in the right arm c) the client's temperature does not exceed 100.6F d) the client's white blood cell (WBC) count is 7500/mm3
D - General indicators that the client is not experiencing infection include a normal temperature and a normal WBC count. Option C is incorrect because the temperature is elevated above normal. The client should also use proper handwashing technique as a general preventive measure; however, handwashing once per day is insufficient, and is therefore incorrect. It is true that the client should avoid blood pressure measurement in the affected arm; however, this would relate more closely to the nursing diagnosis Risk for injury.
A hemodialysis client has a newly created left arm fistula. The nurse monitors the affected extremity for which signs and symptoms that indicate a complication related to steal syndrome? a) edema and purplish discoloration b) aching pain, pallor, and edema c) warmth, redness, and pain d) pallor, diminished pulse. and pain
D - Steal syndrome results from vascular insufficiency after creation of a fistula. The client exhibits pallor and diminished pulse distal to the fistula and complains of pain distal to the fistula from tissue ischemia. Warmth, redness, and pain would more likely characterize a problem with infection. The patterns described in options A and B are not usually observed because they do not relate to a complication following fistula creation.
A nurse is giving suggestions to a client with chronic renal failure about ways to reduce pruritus from uremia. The nurse tells the client to avoid which type of skin care product? a) lanolin-based lotion b) bath oil c) mild soap d) astringent cleansing pads
D - The client with chronic renal failure often has dry skin, accompanied by itching (pruritus) from uremia. The client should use mild soaps, lotions, and bath water oils to reduce dryness without increasing skin irritation. Products that contain perfumes or alcohol increase dryness and pruritus, and should be avoided.