RENAL NCLEX QUESTIONS – Flashcards
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A client who has a renal mass asks the nurse why an ultrasound has been scheduled, as opposed to other diagnostic tests that may be ordered. The nurse formulates a response based on the understanding that: a) all other tests are more invasive than an ultrasound b) all other tests require more elaborate postprocedure care c) an ultrasound can differentiate a solid mass from a fluid-filled cyst d) an ultrasound is much more cost effective than other diagnostic tests
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c) an ultrasound can differentiate a solid mass from a fluid-filled cyst
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A client has been admitted to the hospital with a diagnosis of acute glomerulonephritis. During history-taking the nurse first asks the client about a recent history of: a) bleeding ulcer b) deep vein thrombosis c) myocardial infarction d) streptococcal infection
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d) streptococcal infection
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A nurse is assigned to care for a client with nephrotic syndrome. The nurse assesses which important parameter on a daily basis? a) weight b) albumin levels c) activity tolerance d) blood urea nitrogen (BUN) level
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a) weight
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A client is being admitted to the hospital with a diagnosis of urolithiasis and ureteral colic. The nurse assesses the client for pain that is: a) dull and aching in the costovetebal area b) aching and camplike thoughout the abdomen c) sharp and radiating posteriorly to the spinal column d) excruciating, wavelike, and radiating toward the genitalia
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d) excruciating, wavelike, and radiating toward the genitalia
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A client with renal failure is receiving epoetin alfa (Epogen) to support erythropoiesis. The nurse questions the client about compliance with taking which of the following medications that supports red blood cell (RBC) production? a) iron supplement b) zinc supplement c) calcium supplement d) magnesium supplement
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a) iron supplement
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A client has an arteriovenous (AV) fistula in place in the right upper extremity for hemodialysis treatments. When planning care for this client, which of the following measures should the nurse implement to promote client safely? a) take blood pressures only on the right arm to ensure accuracy b) use the fistula for all venipunctures and intravenous infusions c) ensure that small clamps are attached to the AV fistula dressing d) assess the fistula for the presence of a bruit and thrill every 4 hours
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d) assess the fistula for the presence of a bruit and thrill every 4 hours
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A nurse is assessing a client who is diagnosed with cystitis. Which assessment finding is inconsistent with the typical clinical manifestations noted in this disorder? a) hematuria b) low back pain c) urinary retention d) burning on urination
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c) urinary retention
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The home care nurse is making follow-up visits to a client following renal transplant. The nurse assesses the client for which signs of acute graft rejection? a) hypotension, graft tenderness, and anemia b) hypertension, oliguria, thirst, and hypothermia c) fever, hypertension, graft tenderness, and malaise d) fever, vomiting, hypotension, and copious amounts of dilute urine
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c) fever, hypertension, graft tenderness, and malaise
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A client is scheduled for computed tomography (CT) of the kidneys to rule out renal disease. As an essential preprocedure component of the nursing assessment, the nurse plans to ask the client about a history of: a) familial renal disease b) frequent antibiotic use c) long-term diuretic therapy d) allergy to shellfish or iodine
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d) allergy to shellfish or iodine
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The client with an external arteriovenous shunt in place for hemodialysis is at risk for bleeding. The priority nurse action would be to: a) check the shunt for the presence of bruit and thrill b) observe the site once as time permits during the shift c) check the results of the prothrombin time as they are determined d) ensure that small clamps are attached to the arteriovenous shunt dressing
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d) ensure that small clamps are attached to the arteriovenous shunt dressing - An arteriovenous shunt is a less common form of access site but carries a risk for bleeding when it is used because two ends of an external cannula are tunneled subcutaneously into an artery and a vein, and the ends of the cannula are joined. If accidental disconnection occurs, the client could lose blood rapidly. For this reason, small clamps are attached to the dressing that covers the insertion site for use if needed. The shunt site also should be assessed at least every 4 hours.
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The nurse develops a post-procedure plan of care for a client who had a renal biopsy. The nurse avoids documenting which intervention in the plan? a) administering analgesics as needed b) encouraging fluids to at least 3L in the first 24 hours c) testing serial urine samples with dipstick for occult blood d) ambulating the client in the room and hall for short distances
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d) ambulating the client in the room and hall for short distances
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The client arrives at the emergency department with complaints of low abdominal pain and hematuria. The client is afebrile. The nurse next assesses the client to determine a history of: a) pyelonephritis b) glomerulonephritis c) trauma to the bladder or abdomen d) renal cancer in the client's family
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c) trauma to the bladder or abdomen Use the process of elimination. Eliminate options A and B, knowing that any inflammatory disease or infection is accompanied by fever. Because this client is afebrile, these are not possible options. Use knowledge of anatomy and pain assessment to select option C. Pain from renal cancer is a later finding and is localized in the flank area.
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The client who has a history of gout also is diagnosed with urolithisis and the stones are determined to be of uric acid type. The nurse gives the client instructions in which foods to limit, including: a) milk b) liver c) apples d) carrots
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b) liver
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The client with acute renal failure has a serum potassium of 6.0 mEq/L. The nurse would plan which of the following as a priority action? a) check the sodium level b) place the client on a cardiac monitor c) encourage increased vegetables in the diet d) allow an extra 500 ml of fluid intake to dilute the electrolyte concentration
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b) place the client on a cardiac monitor
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The client with chronic renal failure who is scheduled for hemodialysis this morning is due to receive a daily dose of enalapril (Vasotec). The nurse should plan to administer this medication: a) during dialysis b) just before dialysis c) the day after dialysis d) on return form dialysis
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d) on return form dialysis
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The client with chronic renal failure has an indwelling abdominal catheter for peritoneal dialysis. The client spills water on the catheter dressing while bathing. The nurse should immediately: a) change the dressing b) reinforce the dressing c) flush the peritoneal dialysis catheter d) scrub the catheter with povidine-iodine
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a) change the dressing - Clients with peritoneal dialysis catheters are at high risk for infection. A wet dressing is a conduit for bacteria to reach the catheter insertion site. The nurse ensures that the dressing is kept dry at all times. Reinforcing the dressing is not a safe practice to prevent infection in this circumstance. Flushing the catheter is not indicated. Scrubbing the catheter with povidone-iodine is done at the time of connection or disconnection of peritoneal dialysis.
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The client hemodialyzed suddenly becomes short of breath and complains of chest pain. The client is tachycardic, pale and anxious. The nurse suspects air embolism. The priority action for the nurse is to: a) discontinue dialysis and notify the physician b) monitor vital signs every 15 minutes for the next hour c) continue dialysis at a slower rate after checking the lines for air d) bolus the client with 500 ml of normal saline to break up the air embolus
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a) discontinue dialysis and notify the physician
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The nurse has completed client teaching with the hemodialysis client about self-monitoring between hemodialysis treatments. The nurse determines that the best understands the information if the client states to record daily the: a) amount of activity b) pulse and respiratory rate c) intake and output and weight d) blood urea nitrogen and creatinine levels
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c) intake and output and weight
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Which of the following should be considered in the diet of the client with end-stage-renal-disease (ESRD)? a) limit fluid intake during anuric phase b) limit phosphorus and vitamin D-rich food c) limit calcium-rich food d) limit carbohydrates
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a) limit fluid intake during anuric phase during ESRD, fluid intake of the client should be limited during anuric phase to prevent fluid overload. Fluid overload increases renal workload, pulmonary edema, and congestive heart failure.
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A client has been admitted to the hospital for urinary tract infection and dehydration. The nurse determines that the client has received adequate volume replacement if the blood urea nitrogen level drops to: a) 3 mg/dL b) 15 mg/dL c) 29 mg/dL d) 35 mg/dL
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b) 15 mg/dL the normal blood urea nitrogen level is 8 to 25 mg/dL
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A adult client has had laboratory work done as part of a routine physical examination. The nurse interprets that the client may have a mild degree of renal insufficiency if which of the following serum creatinine levels is noted? a) 0.2 mg/dlL b) 0.5 mg/dL c) 1.9 mg/dL d) 3.5 mg/dL
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c) 1.9 mg/dL the normal serum creatinine level foadults is 0.6 to 1.3 mg/dL. The client with a mild degree of renal insufficiency would have a slight elevated level. A creatinie level of 0.2 mg/dL is low, and a level of 0.5 mg/dL is just below normal. A creeatinie level of 3.5 mg/dL may be associated with acute or chronic renal failure.
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The nurse instructs a client with renal failure who is receiving hemodialysis about dietary modifications. The nurse determines that the client understands these dietary modifications if the client selects which items from the dietary menu? a) cream of wheat, blueberries, coffee b) sausage and eggs, banana, orange juice c) bacon, cantaloupe melon, tomato juice d) cured pork, strawberries, orange juice
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a) cream of wheat, blueberries, coffee - the diet for a client with renal failure who is receiving hemodialysis should include controlled amounts of sodium, phosphorus, calcium, potassium, and fluids. Option B, C, and D are high in sodium, phosphorus, and potassium.
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The client with continuous ambulatory peritoneal dialysis (CAPD) has cloudy dialysate. Which of the following is the best initial nursing action? a) send fluid to the laboratory for culture b) administer antibiotic c) do nothing, this is expected d) stop drainage of fluid
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a) send fluid to the laboratory for culture cloudy diasylate indicates infection (peritonitis). Culture of the fluid must be done to determine the microorganism present.
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Which of the following may be included in the diet of the client with chronic renal failure? a) orange slices b) watermelon slices c) cantaloupe slices d) apple slices
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d) apple slices the client with renal failure should be given low potassium diet because of hyperkalemia. Apple contains very little potassium. So, it can be given to the client.
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The client with chronic renal failure is on chronic hemodialysis. Which of the following indicate improvement of the client's condition due to hemodialysis? Select all that apply a) the client's BP is 130/90 b) the client's serum potassium is 4.8 mEq/L c) the client's hemoglobin level is 10 g/dL d) the client's serum calcium is 7.7 mg/dL e) the client's serum sodium is 140 mEg/L f) the client's serum magnesium is 4 mEq/L g) the client's weight has increased from 60 kg to 63 kg
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a) the client's BP is 130/90 b) the client's serum potassium is 4.8 mEq/L e) the client's serum sodium is 140 mEg/L
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The client is in end-stage renal failure (ESRD). Which of the following foods may be allowed for the client? a) banana b) apple c) carrot cake d) cantaloupe
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b) apple APPLES ARE LOW IN POTASSIUM
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The client has end-stage renal disease. He had undergone kidney transplant 5 days ago. Which of the following is the most important intervention for the client to prevent infection? a) observe asepsis b) increase fluid intake c) avoid clients with flu d) avoid crowded places
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a) observe asepsis
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Which of the following should the nurse include in the nursing care plan of the client who is diagnosed to have renal failure, whose BUN is 32 mg/dl, serum creatinine is 4 mg/dl, hematocrit is 38%. He is complaining of fatigue and edema. a) low protein diet and fluid restriction b) high protein diet and fluid restriction c) low protein diet and increase in fiber d) high protein diet and potassium restriction
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a) low protein diet and fluid restriction
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The client in end-stage of renal failure had undergone kidney transplant. Which of the following assessment findings indicate kidney transplant rejection? a) increased urinary output, BUN = 15 mg/dL b) HCT = 50%, Hgb = 17 g/dl c) decreased urinary output, sudden weight gain d) decreased urinary output, sudden weight loss
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c) decreased urinary output, sudden weight gain
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Which of the following anti-hypertensive medications is contraindicated for clients with renal insufficiency? a) beta-adrenergic blockers b) calcium-channel blockers c) direct-acting vasodilators d) angiotensin-converting enzyme inhibitors
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d) angiotensin-converting enzyme inhibitors
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The client has been diagnosed to have glomerulonephritis. What should the nurse observe in the urine? a) blood b) pus c) white blood cells d) glucose
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a) blood
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A client has been diagnosed to have chronic renal failure. Sodium polysterene sulfonate (exchange resin kayexalate) is prescribed. The action of the medication is that it releases a) bicarbonate in exchange for primarily sodium ions b) sodium ions in exchange for primarily bicarbonate ions c) sodium ions in exchange for primarily potassium ions d) potassium ions in exchange for primarily sodium ions
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c) sodium ions in exchange for primarily potassium ions
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Which of the following problems is expected in a client who is in end-stage renal failure? a) anemia b) thalassemia c) renal calculi d) hypotension
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a) anemia
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Which of the following client responses shows a correct understanding of continuous ambulatory peritoneal dialysis (CAPD)? a) I am expected to perform the procedure at home b) the procedure lasts for one hour c) I have to sit and raise my legs during the procedure d) I have to go to the hospital for this procedure
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a) I am expected to perform the procedure at home
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The client with chronic renal failure is undergoing peritoneal dialysis. He asks why the nurse monitors his blood glucose levels. Which of the following will be the most appropriate response by the nurse? a) I have to check if you have diabetes mellitus b) the dialysate contains glucose c) the procedure may lower your blood glucose levels d) it is a routine procedure for every client who undergoes the treatment
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b) the dialysate contains glucose
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Which of the following is an expected finding in the client with chronic renal failure? a) anemia b) polyuria c) increased creatinine clearance d) increased serum calcium levels
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a) anemia
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In the oliguric phase of renal failure, what is the most appropriate nursing diagnosis? a) fluid volume deficit b) activity intolerance c) ineffective breathing pattern d) fluid volume excess
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d) fluid volume excess
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Which of the following complaints is common in a client with pyelonephritis? a) right upper quadrant pain b) left upper quadrant pain c) pain at the costovertebral region d) pain at the suprapubic region
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c) pain at the costovertebral region
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The client had been diagnosed to have chronic renal failure. He had undergone hemodialysis for the first time. What signs and symptoms when experienced by the client suggest that he is experiencing disequilibrium syndrome? a) restlessness, hypotension, headache b) nausea and vomiting, hypertension, dizziness c) lethargy, hypotension, dizziness d) thachycardia, hypotension, headache
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b) nausea and vomiting, hypertension, dizziness disequilibrium syndrome is caused by more rapid removal of waste products from the blood from the brain. This is due to the presence of blood-brain barrier. This causes increased intracranial pressure.
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Situation: Three year old Carlo has been admitted to the pediatric unit with a tentative diagnosis of nephrotic syndrome. The diagnosis of Idiopathic Nephrotic Syndrome has been confirmed. Which unexpected finding would the nurse report? a) proteinuria b) distended abdomen c) blood in the urine d) elevated serum lipid levels
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c) blood in the urine hematuria is rare in nephrotic syndrome but it is profuse is acute glomerulonephritis The manifestations of nephrotic syndrome are: Proteinuria - nephrosis is believed to be due to immunologic response that results in increased permeability of glomerular membrane to proteins resulting in massive protein losses in the urine -- proteinuria and albuminuria (+3 +4), the child losses 50-100 mg/kg weight/day from proteinuria. Hypoalbuminemia - loss of protein in blood results in hypoalbumenimia Edema - cardinal sign and appears first in the periorbital region followed by dependent edema and accompanied by pallor, fatigue and lethargy. Hypoalbuminemia leads to decreased oncotic pressure resulting in fluid shift from intravascular to interstitial causing generalized edema or anasarca.The child has lost appetite but gained weight -- puffiness of the eyes on awakening decreases during the day but appears on the legs and abdomen. Fluid shift causes decreased blood volume that leads to decreased blood supply to kidney. Decreased blood supply to kidney initiates release of aldosterone. Aldosterone causes sodium retention (in interstitial spaces so child will have hyponatremia) and water retention contributing to edema. Hypocholesteronemia and hyperlipidemia - triglycerides and fats are released by the liver in the blood to make up for the protein loss
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Three year old Carlo has been admitted to the pediatric unit with a tentative diagnosis of nephrotic syndrome. Carlo's potential for impairment of skin integrity is related to: a) joint inflammation b) drug therapy c) edema d) generalized body rash
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c) edema - management: reduce protein excretion Prevention of Skin Breakdown from Edema frequent turning keep nails short to prevent scratching meticulous skin care to dependent and edematous areas - sacrum, scrotum, labia, abdomen, legs loose clothing Monitor Edema weigh daily and monitor I and O check for pulmonary edema manifested by crackles on auscultation ascites - measure abdominal girth Prevention of Infection - pulmonary edema predisposes to respiratory infection and generalized edema predisposes to skin breakdown. Avoid contact with persons who have infection. Diet - usually anorexic because of GI edema high protein diet sodium restriction if with severe edema fluid intake equal to output and insensible loss vitamin and iron supplements small feedings, give favorite foods
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Three year old Carlo has been admitted to the pediatric unit with a tentative diagnosis of nephrotic syndrome Prednisone is prescribed for Carlo. The nurse evaluate its effectiveness by a) checking his BP every 4 hours b) checking his urine for protein c) weighing him each morning before breakfast d) observing him for behavioral changes
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b) checking his urine for protein Monitor side effect of prolonged steroid therapy Hyperglycemia - test urine monitor growth of child by checking height because steroid has growth suppressing effect by preventing calcium deposition in the bones Gastric Irritation - give milk or meals, test for occult blood, administer with antacids Avoid exposure to infection because child is immunosuppressed
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Three year old Carlo has been admitted to the pediatric unit with a tentative diagnosis of nephrotic syndrome: At Carlo's last check-up when he was 2 1/2 years old, his BP was 95/60, PR was 110/min and weight was 15 kg. Which unexpected assessment today would the nurse report to help the diagnosis? a) BP: 95/60 b) weight: 20 kg c) PR: 110 d) temp: 37 C
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b) weight: 20 kg during the toddler period, the child gains 2.5 kg a year. Carlo has gained 5 kg in only 6 months. In nephrotic syndrome, this excessive weight gain is due to edema.
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The physician orders a combination of Sulfamethoxazole and Phenazopyridine hydrochloride (Azogantrisol) for a patient. Which therapeutic effect should this combination drug have: a) plain relief and a decreased WBC count b) equal fluid intake and output c) polyuria with reddish stain d) increased complaints of bladder spasm after 20 minutes
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a) plain relief and a decreased WBC count
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Diagnosis of acute pyelonephritis has been established your nursing intervention includes the following except: a) provide health teaching and discharge planning b) administer antibiotic c) measure I and O d) provide adequate comfort and rest
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c) measure I and O
