NCLEX-Style Practice Questions: Acute Renal Failure

1. 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

1) 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.

13. For a male client in the oliguric phase of acute renal failure (ARF), which nursing intervention is most important? a. Encouraging coughing and deep breathing b. Promoting carbohydrate intake c. Limiting fluid intake d. Providing pain-relief measures

13. Answer C. During the oliguric phase of ARF, urine output decreases markedly, possibly leading to fluid overload. Limiting oral and I.V. fluid intake can prevent fluid overload and its complications, such as heart failure and pulmonary edema. Encouraging coughing and deep breathing is important for clients with various respiratory disorders. Promoting carbohydrate intake may be helpful in ARF but doesn't take precedence over fluid limitation. Controlling pain isn't important because ARF rarely causes pain.

3. 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

3) 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.

41. Your patient returns from the operating room after abdominal aortic aneurysm repair. Which symptom is a sign of acute renal failure? 1. Anuria 2. Diarrhea 3. Oliguria 4. Vomiting

41. Answer: 3. Oliguria Urine output less than 50ml in 24 hours signifies oliguria, an early sign of renal failure. Anuria is uncommon except in obstructive renal disorders.

What nursing measure would be included in the plan of care for a client with acute renal failure? 1) Observe for signs of a secondary infection 2) Provide a high protein, low carbohydrate diet 3) In and out catheterization for residual urine 4) Encourage fluids to 2000 mL in 24 hours

1: Secondary infections are the cause of death in 50-90% of clients with acute renal failure. A low protein diet is most often offered. Catheterizations are avoided. Fluids may be limited if the client is in ARF.

2. 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

2) 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.

28. Which sign indicated the second phase of acute renal failure? 1. Daily doubling of urine output (4 to 5 L/day) 2. Urine output less than 400 ml/day 3. Urine output less than 100 ml/day 4. Stabilization of renal function

28. Answer: 1. Daily doubling of urine output (4 to 5 L/day) Daily doubling of the urine output indicates that the nephrons are healing. This means the patient is passing into the second phase (dieresis) of acute renal failure.

42. Which cause of hypertension is the most common in acute renal failure? 1. Pulmonary edema 2. Hypervolemia 3. Hypovolemia 4. Anemia

42. Answer: 2. Hypervolemia Acute renal failure causes hypervolemia as a result of overexpansion of extracellular fluid and plasma volume with the hypersecretion of renin. Therefore, hypervolemia causes hypertension.

5. 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

5) 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.

Acute renal failure is potentially reversible in the: A. convalescent phase. B. initiation phase. C. maintenance phase. D. recovery phase.

B, initiation phase

Signs and symptoms of acute renal failure include: A. bradycardia, with decreased respiration, low serum bicarbonate, and elevated pH. B. lethargy, tachypnea, and elevated serum bicarbonate. C. slowed respirations and low pH. D. tachypnea, low pH, and low serum bicarbonate.

D. tachypnea, low pH, and low serum bicarbonate.

A client with acute renal failure develops sever hyperkalemia. What would the nurse anticipate to be used to treat this imbalance? 1) Furosemide (Lasix) 2) Amphojel (aluminum hydroxide) 3) 50% glucose and regular insulin 4) Epoetin (Procrit)

3: Hyperkalemia can develop into an emergency situation (Cardia Arrest). It is important to quickly move the potassium back into the cells by administering 50% glucose and regular insulin, usually in conjunction with some type of base to correct the acidosis, such as sodium bicarbonate or calcium gluconate given IV. Insulin assists in the movement of potassium into the cells and helps to reduce the serum potassium level. Amphojel is used for the treatment of hyperphosphatemia that occurs with ARF. Procrit is used for the treatment of anemia caused by a decrease in erythropoietin production by the kidneys. A diuretic, such as Lasix, may lead to a loss of potassium, but the rate is too slow.

4. 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

4) 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.