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NCLEX Practice Exam for Renal Disorders 1 (PM)
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Question 1
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?
A
Fluid volume deficit related to osmotic diuresis induced by hyponatremia
B
Fluid volume deficit related to inability to conserve water
C
Altered nutrition: Less than body requirements related to catabolic effects of insulin deficiency
D
Altered nutrition: Less than body requirements related to hypermetabolic state
Question 2
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?
A
Dark-colored coffee-ground emesis
B
Pain radiating to the right upper quadrant
C
History of mild flu symptoms last week
D
Dark, scant urine output
Question 2 Explanation:
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.
Question 3
Polystyrene sulfonate (Kayexalate) is used in renal failure to:
A
Reduce serum phosphate levels
B
Exchange potassium for sodium
C
Correct acidosis
D
Prevent constipation from sorbitol use
Question 3 Explanation:
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.
Question 4
Immunosuppression following Kidney transplantation is continued:
A
24 hours after transplantation
B
Until the kidney is not anymore rejected
C
For life
D
A week after transplantation
Question 5
Your patient with chronic renal failure reports pruritus. Which instruction should you include in this patient’s teaching plan?
A
Apply alcohol-based emollients to the skin
B
Take frequent baths
C
Keep fingernails short and clean
D
Rub the skin vigorously with a towel
Question 5 Explanation:
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.
Question 6
You have a paraplegic patient with renal calculi. Which factor contributes to the development of calculi?
A
Decreased calcium intake
B
Decreased kidney function
C
Increased calcium loss from the bones
D
High fluid intake
Question 6 Explanation:
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.
Question 7
What is the appropriate infusion time for the dialysate in your 38 y.o. patient with chronic renal failure?
A
1 hour
B
15 minutes
C
2 to 3 hours
D
30 minutes
Question 7 Explanation:
Dialysate should be infused quickly. The dialysate should be infused over 15 minutes or less when performing peritoneal dialysis. The fluid exchange takes place over a period ranging from 30 minutes to several hours.
Question 8
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
Protein
C
Fats
D
Vitamin C
Question 8 Explanation:
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.
Question 9
Clinical manifestations of acute glomerulonephritis include which of the following?
A
Dysuria and hypotension
B
Hematuria and proteinuria
C
Chills and flank pain
D
Oliguria and generalized edema
Question 9 Explanation:
Hematuria and proteinuria indicate acute glomerulonephritis. These finding result from increased permeability of the glomerular membrane due to the antigen-antibody reaction. Generalized edema is seen most often in nephrosis.
Question 10
Which of the following symptoms do you expect to see in a patient diagnosed with acute pyelonephritis?
A
Burning sensation on urination
B
Jaundice and flank pain
C
Costovertebral angle tenderness and chills
D
Polyuria and nocturia
Question 10 Explanation:
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.
Question 11
Which drug is indicated for pain related to acute renal calculi?
A
Salicylates
B
Nonsteroidal anti-inflammatory drugs (NSAIDS)
C
Muscle relaxants
D
Narcotic analgesics
Question 11 Explanation:
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.
Question 12
Which sign indicated the second phase of acute renal failure?
A
Urine output less than 100 ml/day
B
Stabilization of renal function
C
Daily doubling of urine output (4 to 5 L/day)
D
Urine output less than 400 ml/day
Question 12 Explanation:
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.
Question 13
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
Question 13 Explanation:
Symptoms of rejection include fever, rapid weight gain, hypertension, pain over the graft site, peripheral edema, and diminished urine output.
Question 14
Your patient is complaining of muscle cramps while undergoing hemodialysis. Which intervention is effective in relieving muscle cramps?
A
Encourage active ROM exercises
B
Infuse normal saline solution
C
Increase the rate of dialysis
D
Administer a 5% dextrose solution
Question 14 Explanation:
Treatment includes administering normal saline or hypertonic normal saline solution because muscle cramps can occur when the sodium and water are removed to quickly during dialysis. Reducing the rate of dialysis, not increasing it, may alleviate muscle cramps.
Question 15
A patient diagnosed with sepsis from a UTI is being discharged. What do you plan to include in her discharge teaching?
A
Take cool baths
B
Drink 8 to 10 eight-oz glasses of water daily
C
Avoid sexual activity
D
Avoid tampon use
Question 15 Explanation:
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.
Question 16
Your patient returns from the operating room after abdominal aortic aneurysm repair. Which symptom is a sign of acute renal failure?
A
Diarrhea
B
Anuria
C
Oliguria
D
Vomiting
Question 16 Explanation:
Urine output less than 50ml in 24 hours signifies oliguria, an early sign of renal failure. Anuria is uncommon except in obstructive renal disorders.
Question 17
Immediately post-op after a prostatectomy, which complications requires priority assessment of your patient?
A
Pneumonia
B
Hemorrhage
C
Urine retention
D
Deep vein thrombosis
Question 17 Explanation:
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.
Question 18
Which finding leads you to suspect acute glomerulonephritis in your 32 y.o. patient?
A
Back pain, nausea, and vomiting
B
Dysuria, frequency, and urgency
C
Fever, chills, and right upper quadrant pain radiating to the back
D
Hypertension, oliguria, and fatigue
Question 18 Explanation:
Mild to moderate HTN may result from sodium or water retention and inappropriate rennin release from the kidneys. Oliguria and fatigue also may be seen. Other signs are proteinuria and azotemia.
Question 19
Which of the following causes the majority of UTI’s in hospitalized patients?
A
Lack of fluid intake
B
Invasive procedures
C
Immunosuppression
D
Inadequate perineal care
Question 19 Explanation:
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.
Question 20
What is the most important nursing diagnosis for a patient in end-stage renal disease?
A
Altered nutrition: less than body requirements
B
Activity intolerance
C
Fluid volume excess
D
Risk for injury
Question 20 Explanation:
Kidneys are unable to rid the body of excess fluids which results in fluid volume excess during ESRD.
Question 21
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?
A
Flush the urinary catheter with sterile water or saline
B
Place the patient in the shock position, and notify the surgeon
C
Evaluate the patient’s circulation and vital signs
D
Give a 500ml bolus of isotonic saline
Question 21 Explanation:
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.
Question 22
You have a patient that is receiving peritoneal dialysis. What should you do when you notice the return fluid is slowly draining?
A
Place the patient in a reverse Trendelenburg position.
B
Ask the patient to cough.
C
Check for kinks in the outflow tubing.
D
Raise the drainage bag above the level of the abdomen.
Question 22 Explanation:
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.
Question 23
Frequent PVCs are noted on the cardiac monitor of a patient with end-stage renal disease. The priority intervention is:
A
Give the patient IV lidocaine (Xylocaine)
B
Prepare to defibrillate the patient
C
Check the patient’s latest potassium level
D
Call the doctor immediately
Question 23 Explanation:
The patient with ESRD may develop arrhythmias caused by hypokalemi. Call the doctor after checking the patient’s potassium values. Lidocaine may be ordered if the PVCs are frequent and the patient is symptomatic.
Question 24
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 I.V. lines above the fistula.
B
Palpate pulses above the fistula.
C
Report a bruit or thrill over the fistula to the doctor.
D
Avoid taking blood pressures in the arm with the fistula.
Question 24 Explanation:
Don’t take blood pressure readings in the arm with the fistula 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.
Question 25
A patient is experiencing which type of incontinence if she experiences leaking urine when she coughs, sneezes, or lifts heavy objects?
A
Overflow
B
Stress
C
Reflex
D
Urge
Question 25 Explanation:
Stress incontinence is an involuntary loss of a small amount of urine due to sudden increased intra-abdominal pressuer, such as with coughing or sneezing.
Question 26
Which intervention do you plan to include with a patient who has renal calculi?
A
Increase dietary purines
B
Strain all urine
C
Maintain bed rest
D
Restrict fluids
Question 26 Explanation:
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.
Question 27
You expect a patient in the oliguric phase of renal failure to have a 24 hour urine output less than:
A
200ml
B
400ml
C
1000ml
D
800ml
Question 27 Explanation:
Oliguria is defined as urine output of less than 400ml/24hours.
Question 28
Which cause of hypertension is the most common in acute renal failure?
A
Hypovolemia
B
Anemia
C
Pulmonary edema
D
Hypervolemia
Question 28 Explanation:
Acute renal failure causes hypervolemia as a result of overexpansion of extracellular fluid and plasma volume with the hypersecretion of rennin. Therefore, hypervolemia causes hypertension.
Question 29
Your patient had surgery to form an arteriovenous fistula for hemodialysis. Which information is important for providing care for the patient?
A
Using a stethoscope for auscultating the fistula is contraindicated
B
The patient feels best immediately after the dialysis treatment
C
The patient shouldn’t feel pain during initiation of dialysis
D
Taking a blood pressure reading on the affected arm can cause clotting of the fistula
Question 29 Explanation:
Pressure on the fistula or the extremity can decrease blood flow and precipitate clotting, so avoid taking blood pressure on the affected arm.
Question 30
The most common early sign of kidney disease is:
A
Elevated BUN level
B
Development of metabolic acidosis
C
Inability to dilute or concentrate urine
D
Sodium retention
Question 30 Explanation:
Increased BUN is usually an early indicator of decreased renal function.
Question 31
Which instructions do you include in the teaching care plan for a patient with cystitis receiving phenazopyridine (Pyridium).
A
After painful urination is relieved, stop taking phenazopyridine.
B
Take phenazopyridine just before urination to relieve pain.
C
If the urine turns orange-red, call the doctor.
D
Once painful urination is relieved, discontinue prescribed antibiotics.
Question 31 Explanation:
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.
Question 32
What is the best way to check for patency of the arteriovenous fistula for hemodialysis?
A
Use a needle and syringe to aspirate blood from the fistula
B
Palpate the fistula throughout its length to assess for a thrill
C
Check for capillary refill of the nail beds on that extremity
D
Pinch the fistula and note the speed of filling on release
Question 32 Explanation:
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.
Question 33
Your patient becomes restless and tells you she has a headache and feels nauseous during hemodialysis. Which complication do you suspect?
A
Disequilibrium syndrome
B
Acute hemolysis
C
Infection
D
Air embolus
Question 33 Explanation:
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 intracranial pressure (ICP). Signs and symptoms include headache, nausea, restlessness, vomiting, confusion, twitching, and seizures.
Question 34
Which criterion is required before a patient can be considered for continuous peritoneal dialysis?
A
Hemodialysis must have failed
B
The patient must be hemodynamically stable
C
The patient must be in a home setting
D
The vascular access must have healed
Question 34 Explanation:
Hemodynamic stability must be established before continuous peritoneal dialysis can be started.
Question 35
A patient with diabetes mellitus and renal failure begins hemodialysis. Which diet is best on days between dialysis treatments?
A
No restrictions
B
Low-protein diet with unlimited amounts of water
C
No protein in the diet and use of a salt substitute
D
Low-protein diet with a prescribed amount of water
Question 35 Explanation:
The patient should follow a low-protein diet with a prescribed amount of water. The patient requires some protein to meet metabolic needs. Salt substitutes shouldn’t be used without a doctor’s order because it may contain potassium, which could make the patient hyperkalemic. Fluid and protein restrictions are needed.
Question 36
You’re preparing for urinary catheterization of a trauma patient and you observe bleeding at the urethral meatus. Which action has priority?
A
Heavily lubricate the catheter before insertion
B
Check the discharge for occult blood before catheterization
C
Irrigate and clean the meatus before catheterization
D
Delay catheterization and notify the doctor
Question 36 Explanation:
Bleeding at the urethral meatus is evidence that the urethra is injured. Because catheterization can cause further harm, consult with the doctor.
Question 37
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
Recent sore throat
B
Family history of acute glomerulonephritis
C
Renal calculi
D
Renal trauma
Question 37 Explanation:
The most common form of acute glomerulonephritis is caused by goup A beta-hemolytic streptococcal infection elsewhere in the body.
Question 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:
A
Consumed with fear after the life-threatening experience of having a transplant
B
At decreased risk for cancer, so the lump is most likely benign
C
At increased risk for cancer due to immunosuppression caused by cyclosporine (Neoral)
D
At increased risk for tumors because of the kidney transplant
Question 38 Explanation:
Cyclosporine suppresses the immune response to prevent rejection of the transplanted kidney. The use of cyclosporine places the patient at risk for tumors.
Question 39
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 would be correct if your diabetes could be managed with insulin.”
C
“You should talk to your doctor because statistics show that you’re being unrealistic.”
D
“Even with insulin, kidney damage is still a concern.”
Question 39 Explanation:
Kidney damage is still a concern. Microavascular 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.
Question 40
You’re planning your medication teaching for your patient with a UTI prescribed phenazopyridine (Pyridium). What do you include?
A
“Take this drug between meals and at bedtime.”
B
“Don’t take this drug if you’re allergic to penicillin.”
C
“You need to take this antibiotic for 7 days.”
D
“Your urine might turn bright orange.”
Question 40 Explanation:
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.
Question 41
You have a patient that might have a urinary tract infection (UTI). Which statement by the patient suggests that a UTI is likely?
A
“My pee smells sweet.”
B
“I go hours without the urge to pee.”
C
“It burns when I pee.”
D
“I pee a lot.”
Question 41 Explanation:
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 diabetic ketoacidosis.
Question 42
What change indicates recovery in a patient with nephritic syndrome?
A
Increase in serum lipid levels
B
Decrease in blood pressure to normal
C
Disappearance of protein from the urine
D
Gain in body weight
Question 42 Explanation:
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.
Question 43
After the first hemodialysis treatment, your patient develops a headache, hypertension, restlessness, mental confusion, nausea, and vomiting. Which condition is indicated?
A
Disequilibrium syndrome
B
Peritonitis
C
Respiratory distress
D
Hypervolemia
Question 43 Explanation:
Disequilibrium occurs when excess solutes are cleared from the blood more rapidly than they can diffuse from the body’s cells into the vascular system.
Question 44
Which statement correctly distinguishes renal failure from prerenal failure?
A
With prerenal failure, an IV isotonic saline infusion increases urine output
B
With prerenal failure, vasoactive substances such as dopamine (Intropin) increase blood pressure
C
With prerenal failure, hemodialysis reduces the BUN level
D
With prerenal failure, there is less response to such diuretics as furosemide (Lasix)
Question 44 Explanation:
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.
Question 45
Which patient is at greatest risk for developing a urinary tract infection (UTI)?
A
A 35 y.o. woman with a fractured wrist
B
A 50 y.o. postmenopausal woman
C
A 28 y.o. with angina
D
A 20 y.o. woman with asthma
Question 45 Explanation:
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.
Question 46
The most indicative test for prostate cancer is:
A
Prostate-specific antigen
B
A thorough digital rectal examination
C
Excretory urography
D
Magnetic resonance imaging (MRI)
Question 46 Explanation:
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.
Question 47
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
Try to discontinue cyclosporine (Neoral) as quickly as possible
C
Resume normal fluid intake within 2 to 3 days
D
Resume the patient’s normal job within 2 to 3 weeks
Question 47 Explanation:
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.
Question 48
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
Question 48 Explanation:
Instruct the patient with neurogenic bladder to write down his voiding pattern and empty the bladder at the same times each day.
Question 49
What is the priority nursing diagnosis with your patient diagnosed with end-stage renal disease?
A
Knowledge deficit
B
Pain
C
Fluid volume excess
D
Activity intolerance
Question 49 Explanation:
Fluid volume excess because the kidneys aren’t removing fluid and wastes. The other diagnoses may apply, but they don’t take priority.
Question 50
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
Keep the head of the bed elevated 45 degrees
B
Apply pressure to the needle site upon discontinuing hemodialysis
C
Keep the left arm dry
D
Place the left arm on an arm board for at least 30 minutes
Question 50 Explanation:
Apply pressure when discontinuing hemodialysis and after removing the venipuncture needle until all the bleeding has stopped. Bleeding may continue for 10 minutes in some patients.
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NCLEX Practice Exam for Renal Disorders 1 (EM)
Choose the letter of the correct answer. You have 50 mins to finish this exam. Good luck!
Start
Congratulations - you have completed NCLEX Practice Exam for Renal Disorders 1 (EM).
You scored %%SCORE%% out of %%TOTAL%%.
Your performance has been rated as %%RATING%%
Your answers are highlighted below.
Question 1
Which of the following symptoms do you expect to see in a patient diagnosed with acute pyelonephritis?
A
Polyuria and nocturia
B
Burning sensation on urination
C
Costovertebral angle tenderness and chills
D
Jaundice and flank pain
Question 1 Explanation:
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.
Question 2
Which criterion is required before a patient can be considered for continuous peritoneal dialysis?
A
The patient must be hemodynamically stable
B
Hemodialysis must have failed
C
The vascular access must have healed
D
The patient must be in a home setting
Question 2 Explanation:
Hemodynamic stability must be established before continuous peritoneal dialysis can be started.
Question 3
The most common early sign of kidney disease is:
A
Development of metabolic acidosis
B
Inability to dilute or concentrate urine
C
Elevated BUN level
D
Sodium retention
Question 3 Explanation:
Increased BUN is usually an early indicator of decreased renal function.
Question 4
Clinical manifestations of acute glomerulonephritis include which of the following?
A
Oliguria and generalized edema
B
Hematuria and proteinuria
C
Dysuria and hypotension
D
Chills and flank pain
Question 4 Explanation:
Hematuria and proteinuria indicate acute glomerulonephritis. These finding result from increased permeability of the glomerular membrane due to the antigen-antibody reaction. Generalized edema is seen most often in nephrosis.
Question 5
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
Apply alcohol-based emollients to the skin
C
Take frequent baths
D
Keep fingernails short and clean
Question 5 Explanation:
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.
Question 6
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
Vitamin C
B
Protein
C
Carbohydrates
D
Fats
Question 6 Explanation:
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.
Question 7
A patient diagnosed with sepsis from a UTI is being discharged. What do you plan to include in her discharge teaching?
A
Take cool baths
B
Avoid sexual activity
C
Drink 8 to 10 eight-oz glasses of water daily
D
Avoid tampon use
Question 7 Explanation:
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.
Question 8
You’re planning your medication teaching for your patient with a UTI prescribed phenazopyridine (Pyridium). What do you include?
A
“Take this drug between meals and at bedtime.”
B
“Don’t take this drug if you’re allergic to penicillin.”
C
“Your urine might turn bright orange.”
D
“You need to take this antibiotic for 7 days.”
Question 8 Explanation:
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.
Question 9
What is the appropriate infusion time for the dialysate in your 38 y.o. patient with chronic renal failure?
A
1 hour
B
2 to 3 hours
C
15 minutes
D
30 minutes
Question 9 Explanation:
Dialysate should be infused quickly. The dialysate should be infused over 15 minutes or less when performing peritoneal dialysis. The fluid exchange takes place over a period ranging from 30 minutes to several hours.
Question 10
Immediately post-op after a prostatectomy, which complications requires priority assessment of your patient?
A
Pneumonia
B
Hemorrhage
C
Deep vein thrombosis
D
Urine retention
Question 10 Explanation:
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.
Question 11
Which patient is at greatest risk for developing a urinary tract infection (UTI)?
A
A 20 y.o. woman with asthma
B
A 28 y.o. with angina
C
A 35 y.o. woman with a fractured wrist
D
A 50 y.o. postmenopausal woman
Question 11 Explanation:
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.
Question 12
A patient is experiencing which type of incontinence if she experiences leaking urine when she coughs, sneezes, or lifts heavy objects?
A
Overflow
B
Stress
C
Reflex
D
Urge
Question 12 Explanation:
Stress incontinence is an involuntary loss of a small amount of urine due to sudden increased intra-abdominal pressuer, such as with coughing or sneezing.
Question 13
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
Palpate pulses above the fistula.
B
Insert I.V. lines above the fistula.
C
Avoid taking blood pressures in the arm with the fistula.
D
Report a bruit or thrill over the fistula to the doctor.
Question 13 Explanation:
Don’t take blood pressure readings in the arm with the fistula 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.
Question 14
You have a paraplegic patient with renal calculi. Which factor contributes to the development of calculi?
A
Decreased kidney function
B
Decreased calcium intake
C
High fluid intake
D
Increased calcium loss from the bones
Question 14 Explanation:
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.
Question 15
The most indicative test for prostate cancer is:
A
Excretory urography
B
A thorough digital rectal examination
C
Magnetic resonance imaging (MRI)
D
Prostate-specific antigen
Question 15 Explanation:
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.
Question 16
Immunosuppression following Kidney transplantation is continued:
A
For life
B
Until the kidney is not anymore rejected
C
A week after transplantation
D
24 hours after transplantation
Question 17
Your patient had surgery to form an arteriovenous fistula for hemodialysis. Which information is important for providing care for the patient?
A
Taking a blood pressure reading on the affected arm can cause clotting of the fistula
B
The patient shouldn’t feel pain during initiation of dialysis
C
Using a stethoscope for auscultating the fistula is contraindicated
D
The patient feels best immediately after the dialysis treatment
Question 17 Explanation:
Pressure on the fistula or the extremity can decrease blood flow and precipitate clotting, so avoid taking blood pressure on the affected arm.
Question 18
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
Keep the head of the bed elevated 45 degrees
B
Keep the left arm dry
C
Apply pressure to the needle site upon discontinuing hemodialysis
D
Place the left arm on an arm board for at least 30 minutes
Question 18 Explanation:
Apply pressure when discontinuing hemodialysis and after removing the venipuncture needle until all the bleeding has stopped. Bleeding may continue for 10 minutes in some patients.
Question 19
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?
A
Dark, scant urine output
B
History of mild flu symptoms last week
C
Pain radiating to the right upper quadrant
D
Dark-colored coffee-ground emesis
Question 19 Explanation:
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.
Question 20
Which statement correctly distinguishes renal failure from prerenal failure?
A
With prerenal failure, an IV isotonic saline infusion increases urine output
B
With prerenal failure, hemodialysis reduces the BUN level
C
With prerenal failure, there is less response to such diuretics as furosemide (Lasix)
D
With prerenal failure, vasoactive substances such as dopamine (Intropin) increase blood pressure
Question 20 Explanation:
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.
Question 21
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:
A
At increased risk for tumors because of the kidney transplant
B
At increased risk for cancer due to immunosuppression caused by cyclosporine (Neoral)
C
At decreased risk for cancer, so the lump is most likely benign
D
Consumed with fear after the life-threatening experience of having a transplant
Question 21 Explanation:
Cyclosporine suppresses the immune response to prevent rejection of the transplanted kidney. The use of cyclosporine places the patient at risk for tumors.
Question 22
Frequent PVCs are noted on the cardiac monitor of a patient with end-stage renal disease. The priority intervention is:
A
Prepare to defibrillate the patient
B
Give the patient IV lidocaine (Xylocaine)
C
Call the doctor immediately
D
Check the patient’s latest potassium level
Question 22 Explanation:
The patient with ESRD may develop arrhythmias caused by hypokalemi. Call the doctor after checking the patient’s potassium values. Lidocaine may be ordered if the PVCs are frequent and the patient is symptomatic.
Question 23
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.”
Question 23 Explanation:
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 diabetic ketoacidosis.
Question 24
Which instructions do you include in the teaching care plan for a patient with cystitis receiving phenazopyridine (Pyridium).
A
Take phenazopyridine just before urination to relieve pain.
B
Once painful urination is relieved, discontinue prescribed antibiotics.
C
After painful urination is relieved, stop taking phenazopyridine.
D
If the urine turns orange-red, call the doctor.
Question 24 Explanation:
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.
Question 25
Which of the following causes the majority of UTI’s in hospitalized patients?
A
Lack of fluid intake
B
Immunosuppression
C
Inadequate perineal care
D
Invasive procedures
Question 25 Explanation:
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.
Question 26
Which drug is indicated for pain related to acute renal calculi?
A
Muscle relaxants
B
Salicylates
C
Narcotic analgesics
D
Nonsteroidal anti-inflammatory drugs (NSAIDS)
Question 26 Explanation:
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.
Question 27
You have a patient that is receiving peritoneal dialysis. What should you do when you notice the return fluid is slowly draining?
A
Place the patient in a reverse Trendelenburg position.
B
Check for kinks in the outflow tubing.
C
Raise the drainage bag above the level of the abdomen.
D
Ask the patient to cough.
Question 27 Explanation:
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.
Question 28
You expect a patient in the oliguric phase of renal failure to have a 24 hour urine output less than:
A
200ml
B
800ml
C
400ml
D
1000ml
Question 28 Explanation:
Oliguria is defined as urine output of less than 400ml/24hours.
Question 29
Which finding leads you to suspect acute glomerulonephritis in your 32 y.o. patient?
A
Hypertension, oliguria, and fatigue
B
Dysuria, frequency, and urgency
C
Back pain, nausea, and vomiting
D
Fever, chills, and right upper quadrant pain radiating to the back
Question 29 Explanation:
Mild to moderate HTN may result from sodium or water retention and inappropriate rennin release from the kidneys. Oliguria and fatigue also may be seen. Other signs are proteinuria and azotemia.
Question 30
Which sign indicated the second phase of acute renal failure?
A
Urine output less than 400 ml/day
B
Urine output less than 100 ml/day
C
Stabilization of renal function
D
Daily doubling of urine output (4 to 5 L/day)
Question 30 Explanation:
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.
Question 31
What is the priority nursing diagnosis with your patient diagnosed with end-stage renal disease?
A
Activity intolerance
B
Knowledge deficit
C
Fluid volume excess
D
Pain
Question 31 Explanation:
Fluid volume excess because the kidneys aren’t removing fluid and wastes. The other diagnoses may apply, but they don’t take priority.
Question 32
What is the most important nursing diagnosis for a patient in end-stage renal disease?
A
Risk for injury
B
Fluid volume excess
C
Activity intolerance
D
Altered nutrition: less than body requirements
Question 32 Explanation:
Kidneys are unable to rid the body of excess fluids which results in fluid volume excess during ESRD.
Question 33
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
Delay catheterization and notify the doctor
C
Check the discharge for occult blood before catheterization
D
Heavily lubricate the catheter before insertion
Question 33 Explanation:
Bleeding at the urethral meatus is evidence that the urethra is injured. Because catheterization can cause further harm, consult with the doctor.
Question 34
What change indicates recovery in a patient with nephritic syndrome?
A
Disappearance of protein from the urine
B
Gain in body weight
C
Decrease in blood pressure to normal
D
Increase in serum lipid levels
Question 34 Explanation:
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.
Question 35
Your patient becomes restless and tells you she has a headache and feels nauseous during hemodialysis. Which complication do you suspect?
A
Air embolus
B
Infection
C
Disequilibrium syndrome
D
Acute hemolysis
Question 35 Explanation:
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 intracranial pressure (ICP). Signs and symptoms include headache, nausea, restlessness, vomiting, confusion, twitching, and seizures.
Question 36
After the first hemodialysis treatment, your patient develops a headache, hypertension, restlessness, mental confusion, nausea, and vomiting. Which condition is indicated?
A
Disequilibrium syndrome
B
Hypervolemia
C
Peritonitis
D
Respiratory distress
Question 36 Explanation:
Disequilibrium occurs when excess solutes are cleared from the blood more rapidly than they can diffuse from the body’s cells into the vascular system.
Question 37
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 should talk to your doctor because statistics show that you’re being unrealistic.”
B
“Even with insulin, kidney damage is still a concern.”
C
“You would be correct if your diabetes could be managed with insulin.”
D
“You have little to worry about as long as your kidneys keep making urine.”
Question 37 Explanation:
Kidney damage is still a concern. Microavascular 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.
Question 38
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
Family history of acute glomerulonephritis
C
Recent sore throat
D
Renal trauma
Question 38 Explanation:
The most common form of acute glomerulonephritis is caused by goup A beta-hemolytic streptococcal infection elsewhere in the body.
Question 39
Which intervention do you plan to include with a patient who has renal calculi?
A
Restrict fluids
B
Increase dietary purines
C
Strain all urine
D
Maintain bed rest
Question 39 Explanation:
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.
Question 40
Your patient is complaining of muscle cramps while undergoing hemodialysis. Which intervention is effective in relieving muscle cramps?
A
Administer a 5% dextrose solution
B
Increase the rate of dialysis
C
Infuse normal saline solution
D
Encourage active ROM exercises
Question 40 Explanation:
Treatment includes administering normal saline or hypertonic normal saline solution because muscle cramps can occur when the sodium and water are removed to quickly during dialysis. Reducing the rate of dialysis, not increasing it, may alleviate muscle cramps.
Question 41
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 the patient’s normal job within 2 to 3 weeks
C
Try to discontinue cyclosporine (Neoral) as quickly as possible
D
Resume normal fluid intake within 2 to 3 days
Question 41 Explanation:
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.
Question 42
Which action is most important during bladder training in a patient with a neurogenic bladder?
A
Encourage Kegel exercises
B
Encourage the use of an indwelling urinary catheter
C
Set up specific times to empty the bladder
D
Force fluids
Question 42 Explanation:
Instruct the patient with neurogenic bladder to write down his voiding pattern and empty the bladder at the same times each day.
Question 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?
A
Flush the urinary catheter with sterile water or saline
B
Evaluate the patient’s circulation and vital signs
C
Give a 500ml bolus of isotonic saline
D
Place the patient in the shock position, and notify the surgeon
Question 43 Explanation:
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.
Question 44
Polystyrene sulfonate (Kayexalate) is used in renal failure to:
A
Prevent constipation from sorbitol use
B
Reduce serum phosphate levels
C
Correct acidosis
D
Exchange potassium for sodium
Question 44 Explanation:
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.
Question 45
You suspect kidney transplant rejection when the patient shows which symptoms?
A
Diminished urine output and hypotension
B
Pain in the incision, general malaise, and hypotension
C
Fever, weight gain, and diminished urine output
D
Pain in the incision, general malaise, and depression
Question 45 Explanation:
Symptoms of rejection include fever, rapid weight gain, hypertension, pain over the graft site, peripheral edema, and diminished urine output.
Question 46
What is the best way to check for patency of the arteriovenous fistula for hemodialysis?
A
Use a needle and syringe to aspirate blood from the fistula
B
Pinch the fistula and note the speed of filling on release
C
Check for capillary refill of the nail beds on that extremity
D
Palpate the fistula throughout its length to assess for a thrill
Question 46 Explanation:
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.
Question 47
Your patient returns from the operating room after abdominal aortic aneurysm repair. Which symptom is a sign of acute renal failure?
A
Diarrhea
B
Anuria
C
Vomiting
D
Oliguria
Question 47 Explanation:
Urine output less than 50ml in 24 hours signifies oliguria, an early sign of renal failure. Anuria is uncommon except in obstructive renal disorders.
Question 48
Which cause of hypertension is the most common in acute renal failure?
A
Pulmonary edema
B
Hypovolemia
C
Anemia
D
Hypervolemia
Question 48 Explanation:
Acute renal failure causes hypervolemia as a result of overexpansion of extracellular fluid and plasma volume with the hypersecretion of rennin. Therefore, hypervolemia causes hypertension.
Question 49
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?
A
Fluid volume deficit related to inability to conserve water
B
Altered nutrition: Less than body requirements related to hypermetabolic state
C
Fluid volume deficit related to osmotic diuresis induced by hyponatremia
D
Altered nutrition: Less than body requirements related to catabolic effects of insulin deficiency
Question 50
A patient with diabetes mellitus and renal failure begins hemodialysis. Which diet is best on days between dialysis treatments?
A
No protein in the diet and use of a salt substitute
B
Low-protein diet with a prescribed amount of water
C
No restrictions
D
Low-protein diet with unlimited amounts of water
Question 50 Explanation:
The patient should follow a low-protein diet with a prescribed amount of water. The patient requires some protein to meet metabolic needs. Salt substitutes shouldn’t be used without a doctor’s order because it may contain potassium, which could make the patient hyperkalemic. Fluid and protein restrictions are needed.
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1. Which of the following symptoms do you expect to see in a patient diagnosed with acute pyelonephritis?
Jaundice and flank pain
Costovertebral angle tenderness and chills
Burning sensation on urination
Polyuria and nocturia
2. You have a patient that might have a urinary tract infection (UTI). Which statement by the patient suggests that a UTI is likely?
“I pee a lot.”
“It burns when I pee.”
“I go hours without the urge to pee.”
“My pee smells sweet.”
3. Which instructions do you include in the teaching care plan for a patient with cystitis receiving phenazopyridine (Pyridium).
If the urine turns orange-red, call the doctor.
Take phenazopyridine just before urination to relieve pain.
Once painful urination is relieved, discontinue prescribed antibiotics.
After painful urination is relieved, stop taking phenazopyridine.
4. Which patient is at greatest risk for developing a urinary tract infection (UTI)?
A 35 y.o. woman with a fractured wrist
A 20 y.o. woman with asthma
A 50 y.o. postmenopausal woman
A 28 y.o. with angina
5. You have a patient that is receiving peritoneal dialysis. What should you do when you notice the return fluid is slowly draining?
Check for kinks in the outflow tubing.
Raise the drainage bag above the level of the abdomen.
Place the patient in a reverse Trendelenburg position.
Ask the patient to cough.
6. What is the appropriate infusion time for the dialysate in your 38 y.o. patient with chronic renal failure?
15 minutes
30 minutes
1 hour
2 to 3 hours
7. 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?
Insert I.V. lines above the fistula.
Avoid taking blood pressures in the arm with the fistula.
Palpate pulses above the fistula.
Report a bruit or thrill over the fistula to the doctor.
8. Your patient becomes restless and tells you she has a headache and feels nauseous during hemodialysis. Which complication do you suspect?
Infection
Disequilibrium syndrome
Air embolus
Acute hemolysis
9. Your patient is complaining of muscle cramps while undergoing hemodialysis. Which intervention is effective in relieving muscle cramps?
Increase the rate of dialysis
Infuse normal saline solution
Administer a 5% dextrose solution
Encourage active ROM exercises
10. Your patient with chronic renal failure reports pruritus. Which instruction should you include in this patient’s teaching plan?
Rub the skin vigorously with a towel
Take frequent baths
Apply alcohol-based emollients to the skin
Keep fingernails short and clean
11. Which intervention do you plan to include with a patient who has renal calculi?
Maintain bed rest
Increase dietary purines
Restrict fluids
Strain all urine
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?
Renal calculi
Renal trauma
Recent sore throat
Family history of acute glomerulonephritis
13. Which drug is indicated for pain related to acute renal calculi?
Narcotic analgesics
Nonsteroidal anti-inflammatory drugs (NSAIDS)
Muscle relaxants
Salicylates
14. Which of the following causes the majority of UTI’s in hospitalized patients?
Lack of fluid intake
Inadequate perineal care
Invasive procedures
Immunosuppression
15. Clinical manifestations of acute glomerulonephritis include which of the following?
Chills and flank pain
Oliguria and generalized edema
Hematuria and proteinuria
Dysuria and hypotension
16. You expect a patient in the oliguric phase of renal failure to have a 24 hour urine output less than:
200ml
400ml
800ml
1000ml
17. The most common early sign of kidney disease is:
Sodium retention
Elevated BUN level
Development of metabolic acidosis
Inability to dilute or concentrate urine
18. A patient is experiencing which type of incontinence if she experiences leaking urine when she coughs, sneezes, or lifts heavy objects?
Overflow
Reflex
Stress
Urge
19. Immediately post-op after a prostatectomy, which complications requires priority assessment of your patient?
Pneumonia
Hemorrhage
Urine retention
Deep vein thrombosis
20. The most indicative test for prostate cancer is:
A thorough digital rectal examination
Magnetic resonance imaging (MRI)
Excretory urography
Prostate-specific antigen
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?
“You have little to worry about as long as your kidneys keep making urine.”
“You should talk to your doctor because statistics show that you’re being unrealistic.”
“You would be correct if your diabetes could be managed with insulin.”
“Even with insulin, kidney damage is still a concern.”
22. A patient diagnosed with sepsis from a UTI is being discharged. What do you plan to include in her discharge teaching?
Take cool baths
Avoid tampon use
Avoid sexual activity
Drink 8 to 10 eight-oz glasses of water daily
23. You’re planning your medication teaching for your patient with a UTI prescribed phenazopyridine (Pyridium). What do you include?
“Your urine might turn bright orange.”
“You need to take this antibiotic for 7 days.”
“Take this drug between meals and at bedtime.”
“Don’t take this drug if you’re allergic to penicillin.”
24. Which finding leads you to suspect acute glomerulonephritis in your 32 y.o. patient?
Dysuria, frequency, and urgency
Back pain, nausea, and vomiting
Hypertension, oliguria, and fatigue
Fever, chills, and right upper quadrant pain radiating to the back
25. What is the priority nursing diagnosis with your patient diagnosed with end-stage renal disease?
Activity intolerance
Fluid volume excess
Knowledge deficit
Pain
26. A patient with ESRD has an arteriovenous fistula in the left arm for hemodialysis. Which intervention do you include in his plan of care?
Apply pressure to the needle site upon discontinuing hemodialysis
Keep the ehad of the bed elevated 45 degrees
Place the left arm on an arm board for at least 30 minutes
Keep the left arm dry
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?
Fluid volume deficit related to osmotic diuresis induced by hyponatremia
Fluid volume deficit related to inability to conserve water
Altered nutrition: Less than body requirements related to hypermetabolic state
Altered nutrition: Less than body requirements related to catabolic effects of insulin deficiency
28. Which sign indicated the second phase of acute renal failure?
Daily doubling of urine output (4 to 5 L/day)
Urine output less than 400 ml/day
Urine output less than 100 ml/day
Stabilization of renal function
29. Your patient had surgery to form an arteriovenous fistula for hemodialysis. Which information is important for providing care for the patient?
The patient shouldn’t feel pain during initiation of dialysis
The patient feels best immediately after the dialysis treatment
Using a stethoscope for auscultating the fistula is contraindicated
Taking a blood pressure reading on the affected arm can cause clotting of the fistula
30. A patient with diabetes mellitus and renal failure begins hemodialysis. Which diet is best on days between dialysis treatments?
Low-protein diet with unlimited amounts of water
Low-protein diet with a prescribed amount of water
No protein in the diet and use of a salt substitute
No restrictions
31. After the first hemodialysis treatment, your patient develops a headache, hypertension, restlessness, mental confusion, nausea, and vomiting. Which condition is indicated?
Disequilibrium syndrome
Respiratory distress
Hypervolemia
Peritonitis
32. Which action is most important during bladder training in a patient with a neurogenic bladder?
Encourage the use of an indwelling urinary catheter
Set up specific times to empty the bladder
Encourage Kegel exercises
Force fluids
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?
Carbohydrates
Fats
Protein
Vitamin C
34. What is the best way to check for patency of the arteriovenous fistula for hemodialysis?
Pinch the fistula and note the speed of filling on release
Use a needle and syringe to aspirate blood from the fistula
Check for capillary refill of the nail beds on that extremity
Palpate the fistula throughout its length to assess for a thrill
35. You have a paraplegic patient with renal calculi. Which factor contributes to the development of calculi?
Increased calcium loss from the bones
Decreased kidney function
Decreased calcium intake
High fluid intake
36. What is the most important nursing diagnosis for a patient in end-stage renal disease?
Risk for injury
Fluid volume excess
Altered nutrition: less than body requirements
Activity intolerance
37. Frequent PVCs are noted on the cardiac monitor of a patient with end-stage renal disease. The priority intervention is:
Call the doctor immediately
Give the patient IV lidocaine (Xylocaine)
Prepare to defibrillate the patient
Check the patient’s latest potassium level
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:
At increased risk for cancer due to immunosuppression caused by cyclosporine (Neoral)
Consumed with fear after the life-threatening experience of having a transplant
At increased risk for tumors because of the kidney transplant
At decreased risk for cancer, so the lump is most likely benign
39. 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:
Remain afebrile and have negative cultures
Resume normal fluid intake within 2 to 3 days
Resume the patient’s normal job within 2 to 3 weeks
Try to discontinue cyclosporine (Neoral) as quickly as possible
40. You suspect kidney transplant rejection when the patient shows which symptoms?
Pain in the incision, general malaise, and hypotension
Pain in the incision, general malaise, and depression
Fever, weight gain, and diminished urine output
Diminished urine output and hypotension
41. Your patient returns from the operating room after abdominal aortic aneurysm repair. Which symptom is a sign of acute renal failure?
Anuria
Diarrhea
Oliguria
Vomiting
42. Which cause of hypertension is the most common in acute renal failure?
Pulmonary edema
Hypervolemia
Hypovolemia
Anemia
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?
Give a 500ml bolus of isotonic saline
Evaluate the patient’s circulation and vital signs
Flush the urinary catheter with sterile water or saline
Place the patient in the shock position, and notify the surgeon
44. You’re preparing for urinary catheterization of a trauma patient and you observe bleeding at the urethral meatus. Which action has priority?
Irrigate and clean the meatus before catheterization
Check the discharge for occult blood before catheterization
Heavily lubricate the catheter before insertion
Delay catheterization and notify the doctor
45. What change indicates recovery in a patient with nephritic syndrome?
Disappearance of protein from the urine
Decrease in blood pressure to normal
Increase in serum lipid levels
Gain in body weight
46. Which statement correctly distinguishes renal failure from prerenal failure?
With prerenal failure, vasoactive substances such as dopamine (Intropin) increase blood pressure
With prerenal failure, there is less response to such diuretics as furosemide (Lasix)
With prerenal failure, an IV isotonic saline infusion increases urine output
With prerenal failure, hemodialysis reduces the BUN level
47. Which criterion is required before a patient can be considered for continuous peritoneal dialysis?
The patient must be hemodynamically stable
The vascular access must have healed
The patient must be in a home setting
Hemodialysis must have failed
48. Polystyrene sulfonate (Kayexalate) is used in renal failure to:
Correct acidosis
Reduce serum phosphate levels
Exchange potassium for sodium
Prevent constipation from sorbitol use
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?
Pain radiating to the right upper quadrant
History of mild flu symptoms last week
Dark-colored coffee-ground emesis
Dark, scant urine output
50. Immunosuppression following Kidney transplantation is continued:
For life
24 hours after transplantation
A week after transplantation
Until the kidney is not anymore rejected
Answers and Rationales
B. 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.
B. 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 diabetic ketoacidosis.
D. 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.
C. 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.
A. 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.
A. Dialysate should be infused quickly. The dialysate should be infused over 15 minutes or less when performing peritoneal dialysis. The fluid exchange takes place over a period ranging from 30 minutes to several hours.
B. Don’t take blood pressure readings in the arm with the fistula 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.
B. 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 intracranial pressure (ICP). Signs and symptoms include headache, nausea, restlessness, vomiting, confusion, twitching, and seizures.
B. Treatment includes administering normal saline or hypertonic normal saline solution because muscle cramps can occur when the sodium and water are removed to quickly during dialysis. Reducing the rate of dialysis, not increasing it, may alleviate muscle cramps.
D. 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.
D. 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.
C. The most common form of acute glomerulonephritis is caused by goup A beta-hemolytic streptococcal infection elsewhere in the body.
A. 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.
C. 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.
C. Hematuria and proteinuria indicate acute glomerulonephritis. These finding result from increased permeability of the glomerular membrane due to the antigen-antibody reaction. Generalized edema is seen most often in nephrosis.
B. Oliguria is defined as urine output of less than 400ml/24hours.
B. Increased BUN is usually an early indicator of decreased renal function.
C. Stress incontinence is an involuntary loss of a small amount of urine due to sudden increased intra-abdominal pressuer, such as with coughing or sneezing.
B. 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.
D. 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.
D. Kidney damage is still a concern. Microavascular 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.
D. 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.
A. 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.
C. Mild to moderate HTN may result from sodium or water retention and inappropriate rennin release from the kidneys. Oliguria and fatigue also may be seen. Other signs are proteinuria and azotemia.
B. Fluid volume excess because the kidneys aren’t removing fluid and wastes. The other diagnoses may apply, but they don’t take priority.
A. Apply pressure when discontinuing hemodialysis and after removing the venipuncture needle until all the bleeding has stopped. Bleeding may continue for 10 minutes in some patients.
B.
A. 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.
D. Pressure on the fistula or the extremity can decrease blood flow and precipitate clotting, so avoid taking blood pressure on the affected arm.
B. The patient should follow a low-protein diet with a prescribed amount of water. The patient requires some protein to meet metabolic needs. Salt substitutes shouldn’t be used without a doctor’s order because it may contain potassium, which could make the patient hyperkalemic. Fluid and protein restrictions are needed.
A. Disequilibrium occurs when excess solutes are cleared from the blood more rapidly than they can diffuse from the body’s cells into the vascular system.
B. Instruct the patient with neurogenic bladder to write down his voiding pattern and empty the bladder at the same times each day.
C. 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.
D. 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.
A. 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.
B. Kidneys are unable to rid the body of excess fluids which results in fluid volume excess during ESRD.
D. The patient with ESRD may develop arrhythmias caused by hypokalemi. Call the doctor after checking the patient’s potassium values. Lidocaine may be ordered if the PVCs are frequent and the patient is symptomatic.
A. Cyclosporine suppresses the immune response to prevent rejection of the transplanted kidney. The use of cyclosporine places the patient at risk for tumors.
A. 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.
C. Symptoms of rejection include fever, rapid weight gain, hypertension, pain over the graft site, peripheral edema, and diminished urine output.
C. Urine output less than 50ml in 24 hours signifies oliguria, an early sign of renal failure. Anuria is uncommon except in obstructive renal disorders.
B. Acute renal failure causes hypervolemia as a result of overexpansion of extracellular fluid and plasma volume with the hypersecretion of rennin. Therefore, hypervolemia causes hypertension.
B. 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.
D. Bleeding at the urethral meatus is evidence that the urethra is injured. Because catheterization can cause further harm, consult with the doctor.
A. 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.
C. 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.
A. Hemodynamic stability must be established before continuous peritoneal dialysis can be started.
C. 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.
D. 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.