Renal system NCLEX Type Questions

Acute renal failure is generally identified by oliguria (urine output <_____ mL/day).

400mL/day

True or false? Creatinine, phosphate, sulfates, and uric acid should not be present in urine because they signify renal failure.

false Explanation Creatinine, phosphate, sulfates, and uric acid should be found in urine.

What could a decrease in BUN/Creatinine ratio indicate?

fluid volume excess or malnutrition

Clients with chronic renal failure should notify the physician of any weight: A. loss of 2 pounds over a 5 day period B. gain of 2 pounds over a 2 day period C. loss of 5 pounds over a 5 day period D. gain of 5 pounds over a 2 day period

gain of 5 pounds over a 2 day period

The most serious electrolyte disorder associated with kidney disease is A. hypermagnesemia B. hyponatremia C. hyperkalemia D. metabolic acidosis

hyperkalemia

Nurse Tristan is caring for a male client in acute renal failure. The nurse should expect hypertonic glucose, insulin infusions, and sodium bicarbonate to be used to treat: A. hypokalemia. B. hypernatremia. C. hypercalcemia. D. hyperkalemia.

hyperkalemia Explanation Hyperkalemia is a common complication of acute renal failure. It's life-threatening if immediate action isn't taken to reverse it. The administration of glucose and regular insulin, with sodium bicarbonate if necessary, can temporarily prevent cardiac arrest by moving potassium into the cells and temporarily reducing serum potassium levels. Hypernatremia, hypokalemia, and hypercalcemia don't usually occur with acute renal failure and aren't treated with glucose, insulin, or sodium bicarbonate.

_________ is the most frequent complication during hemodialysis.

hypertension

normal GFR

125mL/min

End-stage renal disease is defined as GFR less than ________________ ml/min per 1.73m2. A. 45 B. 30 C. 15 D. 10 E. 5

15

Whici is a normal value of Blood Urea Nitrogen (BUN)? A. 0.5-1.1 mg/dL B. 5-20 mg/dL C. 40-70 mg/dL D. 250-500 mg/dL

5-20 mg/dL

The K/DOQI guidelines consider a chronic estimated GFR (eGFR) less than ______________ ml/min per 1.73 m2 as a definition of chronic kidney disease. A. 90 B. 75 C. 60 D. 45 E. 30

60

4. Which patient is at greatest risk for developing a urinary tract infection (UTI)? 1. A 35 y.o. woman with a fractured wrist 2. A 20 y.o. woman with asthma 3. A 50 y.o. postmenopausal woman 4. A 28 y.o. with angina

A 50 y.o. postmenopausal woman Women are more prone to UTI's after menopause due to reduced estrogen levels. Reduced estrogen levels lead to reduced levels of vaginal Lactobacilli bacteria, which protect against infection. Angina, asthma and fractures don't increase the risk of UTI.

Which of the followings are manifestations of the uremic state? A. Anorexia B. Nausea and vomiting C. Palpitations D. Peripheral neuropathy E. Central nervous system abnormalities F. Pericarditis

A. Anorexia B. Nausea and vomiting D. Peripheral neuropathy E. Central nervous system abnormalities F. Pericarditis

What controls the amount of water reabsorbtion?

ADH and Vasopressin

sudden onset with 50% of nephrons involved, duration in 2-4 weeks < 3 months with good prognosis for return of renal function.

ARF

A history of infection specifically caused by group A beta-hemolytic streptococci is associated with which of the following disorders? A. Nephrotic syndrome B. Acute glomerulonephritis C. Acute renal failure D. Chronic renal failure

Acute glomerulonephritis Explanation Acute glomerulonephritis is also associated with varicella zoster virus, hepatitis B, and Epstein-Barr virus. Acute renal failure is associated with hypoperfusion to the kidney, parenchymal damage to the glomeruli or tubules, and obstruction at a point distal to the kidney. Chronic renal failure may be caused by systemic disease, hereditary lesions, medications, toxic agents, infections, and medications. Nephrotic syndrome is caused by disorders such as chronic glomerulonephritis, systemic lupus erythematosus, multiple myeloma, and renal vein thrombosis.

3. Which instructions do you include in the teaching care plan for a patient with cystitis receiving phenazopyridine (Pyridium). 1. If the urine turns orange-red, call the doctor. 2. Take phenazopyridine just before urination to relieve pain. 3. Once painful urination is relieved, discontinue prescribed antibiotics. 4. After painful urination is relieved, stop taking phenazopyridine.

After painful urination is relieved, stop taking phenazopyridine. Pyridium is taken to relieve dysuria because is provides an analgesic and anesthetic effect on the urinary tract mucosa. The patient can stop taking it after the dysuria is relieved. The urine may temporarily turn red or orange due to the dye in the drug. The drug isn't taken before voiding, and is usually taken 3 times a day for 2 days.

38. A patient who received a kidney transplant returns for a follow-up visit to the outpatient clinic and reports a lump in her breast. Transplant recipients are: 1. At increased risk for cancer due to immunosuppression caused by cyclosporine (Neoral) 2. Consumed with fear after the life-threatening experience of having a transplant 3. At increased risk for tumors because of the kidney transplant 4. At decreased risk for cancer, so the lump is most likely benign

At increased risk for cancer due to immunosuppression caused by cyclosporine (Neoral). Cyclosporine suppresses the immune response to prevent rejection of the transplanted kidney. The use of cyclosporine places the patient at risk for tumors.

Anti-hypertensive therapy in patients with chronic renal disease is for? A. Renal protection B. Cardiovascular protection C. Both renal and cardiovascular protection D. None of the above

Both renal and cardiovascular protection

gradual onset with 90-95% nephrons involved, with permanet damage and fatal without renal replacement therapy.

CKD

________ renal failure is a slow, insidious process of kidney destruction. It may go unrecognized for years as nephrons are destroyed and renal mass is reduced.

Chronic

22. A patient diagnosed with sepsis from a UTI is being discharged. What do you plan to include in her discharge teaching? 1. Take cool baths 2. Avoid tampon use 3. Avoid sexual activity 4. Drink 8 to 10 eight-oz glasses of water daily

Drink 8 to 10 eight-oz glasses of water daily. Drinking 2-3L of water daily inhibits bacterial growth in the bladder and helps flush the bacteria from the bladder. The patient should be instructed to void after sexual activity.

1. Which of the following symptoms do you expect to see in a patient diagnosed with acute pyelonephritis? 1. Jaundice and flank pain 2. Costovertebral angle tenderness and chills 3. Burning sensation on urination 4. Polyuria and nocturia

Costovertebral angle tenderness, flank pain, and chills are symptoms of acute pyelonephritis. Jaundice indicates gallbladder or liver obstruction. A burning sensation on urination is a sign of lower urinary tract infection.

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

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.

49. Your patient has complaints of severe right-sided flank pain, nausea, vomiting and restlessness. He appears slightly pale and is diaphoretic. Vital signs are BP 140/90 mmHg, Pulse 118 beats/min., respirations 33 breaths/minute, and temperature, 98.0F. Which subjective data supports a diagnosis of renal calculi? 1. Pain radiating to the right upper quadrant 2. History of mild flu symptoms last week 3. Dark-colored coffee-ground emesis 4. Dark, scanty urine output

Dark-colored coffee-ground emesis. 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.

44. You're preparing for urinary catheterization of a trauma patient and you observe bleeding at the urethral meatus. Which action has priority? 1. Irrigate and clean the meatus before catheterization 2. Check the discharge for occult blood before catheterization 3. Heavily lubricate the catheter before insertion 4. Delay catheterization and notify the doctor

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

45. What change indicates recovery in a patient with nephritic syndrome? 1. Disappearance of protein from the urine 2. Decrease in blood pressure to normal 3. Increase in serum lipid levels 4. Gain in body weight

Disappearance of protein from the urine. 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.

17. The most common early sign of kidney disease is: 1. Sodium retention 2. Elevated BUN level 3. Development of metabolic acidosis 4. Inability to dilute or concentrate urine

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

When the kidneys have too few nephrons to excrete metabolic wastes and regulate fluid and electrolyte balance adequately, the client is said to have ____________, the final stage of Chronic Renal Failure. A. End-stage renal disease (ESRD) B. renal insufficiency C. acute tubular necrosis D. dialysis

End-stage renal disease (ESRD)

43. A patient returns from surgery with an indwelling urinary catheter in place and empty. Six hours later, the volume is 120ml. The drainage system has no obstructions. Which intervention has priority? 1. Give a 500 ml bolus of isotonic saline 2. Evaluate the patient's circulation and vital signs 3. Flush the urinary catheter with sterile water or saline 4. Place the patient in the shock position, and notify the surgeon

Evaluate the patient's circulation and vital signs. A total UO of 120ml 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.

21. 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? 1. "You have little to worry about as long as your kidneys keep making urine." 2. "You should talk to your doctor because statistics show that you're being unrealistic." 3. "You would be correct if your diabetes could be managed with insulin." 4. "Even with insulin, kidney damage is still a concern."

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

48. Polystyrene sulfonate (Kayexalate) is used in renal failure to: 1. Correct acidosis 2. Reduce serum phosphate levels 3. Exchange potassium for sodium 4. Prevent constipation from sorbitol use

Exchange potassium for sodium. 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.

What tests and results prove the presence of dilute urine? A. GFR (100 ml/min), and/or Specific Gravity (1.030) B. Fixed Specific Gravity (1.010), and/or Fixed osmolality (300 mOsm/l) C. Serum Creatinine (1.5 mg/dl)

Fixed Specific Gravity (1.010), and/or Fixed osmolality (300 mOsm/l)

27. Your 60 y.o. patient with pyelonephritis and possible septicemia has had five UTIs over the past two 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 mOsm/L; glucose, 127 mg/dl; and potassium, 3.9 mEq/L. Which nursing diagnosis is priority? 1. Fluid volume deficit related to osmotic diuresis induced by hyponatremia 2. Fluid volume deficit related to inability to conserve water 3. Altered nutrition: Less than body requirements related to hypermetabolic state 4. Altered nutrition: Less than body requirements related to catabolic effects of insulin deficiency

Fluid volume deficit related to inability to conserve water

25. What is the priority nursing diagnosis with your patient diagnosed with end-stage renal disease? 1. Activity intolerance 2. Fluid volume excess 3. Knowledge deficit 4. Pain

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

36. What is the most important nursing diagnosis for a patient in end-stage renal disease? 1. Risk for injury 2. Fluid volume excess 3. Altered nutrition: less than body requirements 4. Activity intolerance

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

what are the risk factors for the development of CKD/ESRD?

HTN, DM, age over 60, CVD, family history of CKD, exposure to nephrotoxic drugs, ethnic group, being African american

15. Clinical manifestations of acute glomerulonephritis include which of the following? 1. Chills and flank pain 2. Oliguria and generalized edema 3. Hematuria and proteinuria 4. Dysuria and hypotension

Hematuria and proteinuria.

19. Immediately post-op after a prostatectomy, which complications requires priority assessment of your patient? 1. Pneumonia 2. Hemorrhage 3. Urine retention 4. Deep vein thrombosis

Hemorrhage. 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.

24. Which finding leads you to suspect acute glomerulonephritis in your 32 y.o. patient? 1. Dysuria, frequency, and urgency 2. Back pain, nausea, and vomiting 3. Hypertension, oliguria, and fatigue 4. Fever, chills, and right upper quadrant pain radiating to the back

Hypertension, oliguria, and fatigue. 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.

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

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.

14. Which of the following causes the majority of UTI's in hospitalized patients? 1. Lack of fluid intake 2. Inadequate perineal care 3. Invasive procedures 4. Immunosuppression

IInvasive procedures. nvasive 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.

35. You have a paraplegic patient with renal calculi. Which factor contributes to the development of calculi? 1. Increased calcium loss from the bones 2. Decreased kidney function 3. Decreased calcium intake 4. High fluid intake

Increased calcium loss from the bones. 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.

2. You have a patient that might have a urinary tract infection (UTI). Which statement by the patient suggests that a UTI is likely? 1. "I pee a lot." 2. "It burns when I pee." 3. "I go hours without the urge to pee." 4. "My pee smells sweet."

It burns when I pee." 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 diabetic ketoacidosis.

10. Your patient with chronic renal failure reports pruritus. Which instruction should you include in this patient's teaching plan? 1. Rub the skin vigorously with a towel 2. Take frequent baths 3. Apply alcohol-based emollients to the skin 4. Keep fingernails short and clean

Keep fingernails short and clean. 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 fingernails short and clean helps reduce the risk of infection

Which is the treatment of choice for many clients with end-stage renal disease? A. Hemodialysis B. Kidney transplant C. Continuous Renal Replacement Therapy (CRRT) D. Peritoneal dialysis

Kidney transplant

Which of these drugs is nephrotoxic? A. Diuretics B. ACE inhibitors C. NSAIDs D. Sodium bicarbonate/ Potassium bicarbonate

NSAIDs

13. Which drug is indicated for pain related to acute renal calculi? 1. Narcotic analgesics 2. Nonsteroidal anti-inflammatory drugs (NSAIDS) 3. Muscle relaxants 4. Salicylates

Narcotic analgesics. 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 salicylates are used for their anti-inflammatory and antipyretic properties and to treat less severe pain.

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

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.

16. You expect a patient in the oliguric phase of renal failure to have a 24 hour urine output less than: 1. 200ml 2. 400ml 3. 800ml 4. 1000ml

Oliguria is defined as urine output of less than 400ml/24hours.

20. The most indicative test for prostate cancer is: 1. A thorough digital rectal examination 2. Magnetic resonance imaging (MRI) 3. Excretory urography 4. Prostate-specific antigen

Prostate-specific antigen. An elevated prostate-specific antigen level indicates prostate cancer, but it can be falsely elevated if done after the prostate gland is manipulated. A digital rectal examination should be done as part of the yearly screening, and then the antigen test is done if the digital exam suggests cancer. MRI is used in staging the cancer.

33. 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? 1. Carbohydrates 2. Fats 3. Protein 4. Vitamin C

Protein. 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.

12. 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? 1. Renal calculi 2. Renal trauma 3. Recent sore throat 4. Family history of acute glomerulonephritis

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

The nurse is reviewing laboratory results on a client with acute renal failure. Which one of the following should be reported IMMEDIATELY? A. Blood urea nitrogen 50 mg/dl B. Venous blood pH 7.30 C. Serum potassium 6 mEq/L D. Hemoglobin of 10.3 mg/dl

Serum potassium 6 mEq/L Although all of these findings are abnormal, the elevated potassium is a life threatening finding and must be reported immediately.

11. Which intervention do you plan to include with a patient who has renal calculi? 1. Maintain bed rest 2. Increase dietary purines 3. Restrict fluids 4. Strain all urine

Strain all urine. 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.

18. A patient is experiencing which type of incontinence if she experiences leaking urine when she coughs, sneezes, or lifts heavy objects? 1. Overflow 2. Reflex 3. Stress 4. Urge

Stress. Stress incontinence is an involuntary loss of a small amount of urine due to sudden increased intra-abdominal pressure, such as with coughing or sneezing.

A patient rapidly progressing toward ESRD asks about the possibility of a kidney transplant. In responding to the patient, the nurse knows that contraindications to kidney transplantation include A. hepatitis C infection B. extensive vascular disease C. coronary artery disease D. refractory hypertension

extensive vascular disease

stones (calculi) in the urinary tract.

Urolithiasis

46. Which statement correctly distinguishes renal failure from prerenal failure? 1. With prerenal failure, vasoactive substances such as dopamine (Intropin) increase blood pressure 2. With prerenal failure, there is less response to such diuretics as furosemide (Lasix) 3. With prerenal failure, an IV isotonic saline infusion increases urine output 4. With prerenal failure, hemodialysis reduces the BUN level

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

23. You're planning your medication teaching for your patient with a UTI prescribed phenazopyridine (Pyridium). What do you include? 1. "Your urine might turn bright orange." 2. "You need to take this antibiotic for 7 days." 3. "Take this drug between meals and at bedtime." 4. "Don't take this drug if you're allergic to penicillin."

Your urine might turn bright orange." The drug turns the urine orange. It may be prescribed for longer than 7 days and is usually ordered three times a day after meals. Phenazopyridine is an azo (nitrogenous) analgesic; not an antibiotic.

_________ renal Failure is a rapid decline in renal function with an abrupt onset

acute

The risk for __________________ is particularly high when ischemia and exposure to a nephrotoxin occur at the same time.

acute tubular necrosis tubular necrosis

The client with renal failure should be on which type of diet? A. high protein, high carbohydrate, low calorie B. adequate calorie intake, high carbohydrate, limited protein C. Limited protein, low carbohydrate, adequate calorie intake D. Low calorie, limited protein, low carbohydrate

adequate calorie intake, high carbohydrate, limited protein

What electrolytes are in urine? A. HCO3- B. K C. Cl D. Na E. All of the above

all of the above

Which diagnostic test would be monitored to evaluate glomerulat filtration rateand renal function? A. Sreum creatinine and BUN B. Urinalysis C. Kidney biopsy D. creatinine clearance

creatinine clearance

The leading cause of ESRD is the client with a history of A. hypotension B. anemia C. prostate cancer D. diabetes Mellitus

diabetes mellitus

nursing diagnosis for CKD?

excess fluid volume, risk for electrolyte imbalance, imbalanced nutrition: less than body requirements.

A female client is admitted with a diagnosis of acute renal failure. She is awake, alert, oriented, and complaining of severe back pain, nausea and vomiting and abdominal cramps. Her vital signs are blood pressure 100/70 mm Hg, pulse 110, respirations 30, and oral temperature 100.4°F (38°C). Her electrolytes are sodium 120 mEq/L, potassium 5.2 mEq/L; her urinary output for the first 8 hours is 50 ml. The client is displaying signs of which electrolyte imbalance? A. Hyperkalemia B. Hypercalcemia C. Hyperphosphatemia D. Hyponatremia

hyponatremia The normal serum sodium level is 135 - 145 mEq/L. The client's serum sodium is below normal. Hyponatremia also manifests itself with abdominal

After 1 week a client with acute renal failure moves, into the diuretic phase. During this phase the client must be carefully assessed for signs of: A. Chronic renal failure B. Hyperkalemia C. Hypovolemia D. Metabolic acidosis

hypovolemia

________ failure is caused by Acute damage to renal tissue and nephrons or acute tubular necrosis: abrupt decline in tubular and glomerular function due to either prolonged ischemia and/or exposure to nephrotoxins. (Acute glomerulonephritis, malignant hypertension, ischemia; nephrotoxic drugs or substances; red blood cell destruction; muscle tissur breakdown due to trauma, heatstroke) A. Prerenal B. Intrarenal C. Postrenal D. Perirenal

intrarenal

When the kidneys cannot effectively regulate fluid and electrolyte balance and eliminate metabolic waste products, intake of these substances must be regulated. Fluid and Sodium intahe are ________. A. encouraged B. limited C. restricted

limited

Agents that damage the kidney tissue are called: A. nephrons B. nephrotoxins C. antibodies D. enterotoxins

nephrotoxins

__________ failure is caused by obstruction of urine flow. (urethral obstruction by enlarged prostate or tumor; ureteral or kidney pelvis obstruction by calculi) A. prerenal B. intrarenal C. postrenal D. perirenal

postrenal

The cause of ___________ failure is impaired blood supply to the kidney (Fluid Volume Deficit, hemorrhage, heart failure, shock) A. prerenal B. Intrarenal C. Postrenal D. perirenal

prerenal

What are the functions of the kidney?

regulates fluid and electrolyte balance by filtration, secretion and reabsorption, it activates both erythropoeitin and vitamin-D, It also produces renin to regulate blood pressure

Impaired metabolic processes such as Hyperkalemia, Acidosis, Hyperlipidemia, Hyperuricemia, and malnutrition are some effects of ___________. A. hematuria B. oliguria C. uremia D. nephrotoxins

uremia

"urine in the blood"

uremia or hematuria

what assessment data should the nurse collect for CKD patient?

weight, age, gender, hx. of renal problems, long term health problems, drug use, family hx., dietary habits, energy levels, recent injury to kidneys.