Nursing Practice Test - Genito-Urinary Sample Exam (1-20)1. Which of the following solutions will be useful to help control odor in the urine collection bag after it has been cleaned?

a) salt waterb) vinegarc) ammoniad) bleach

2. A female client who has a urinary diversion tells the nurse, "This urinary pouch is embarrassing. Everyone will know that I'm not normal. I don't see how I can go out in public anymore." The most appropriate nursing diagnosis for this client is:

a) anxiety related to the presence of urinary diversionb) deficient knowledge about how to care for the urinary diversionc) low self-esteem related to feelings of worthlessnessd) disturbed body image related to creation of a urinary diversion

3. Which of the following urinary symptoms is the most common initial manifestation of acute renal failure?

a) dysuriab) anuriac) hematuriad) oliguria

4. The client's blood urea nitrogen (BUN) concentration is elevated in acute renal failure. What is the likely cause of this finding?

a) fluid retentionb) hemolysis of red blood cellsc) below normal metabolic rated) reduced renal blood flow

5. The client's serum potassium is elevated in acute renal failure, and the nurse administers sodium polystyrene sulfonate (Kayexalate). This drug acts to:

a) increase potassium excretion from the colonb) release hydrogen ions for sodium ionsc) increase calcium absorption in the colond) exchange sodium for potassium ions in the colon

6. If the client's serum potassium continues to rise in acute renal failure, the nurse should be prepared for which of the following emergency situations?

a) cardiac arrestb) pulmonary edemac) circulatory collapsed) hemorrhage

7. A high-carbohydrate, low protein diet is prescribed for the client with acute renal failure. The rationale for the high-carbohydrate will:

a) act as a diureticb) reduce demands on the liverc) help maintain urine acidityd) prevent the development of ketosis

8. In the oliguric phase of acute renal failure, the nurse should anticipate the development of which of the following complications?

a) pulmonary edemab) metabolic alkalosisc) hypotensiond) hypokalemia

9. Which of the following abnormal blood values would not be improved by dialysis treatment?

a) elevated serum creatinineb) hyperkalemiac) decreased hemoglobind) nypernatremia

10. The client asks the nurse, :How did I get this urinary tract infection?" the nurse should explain that in most instances, cystitis is caused by:

a) congenital strictures in the urethrab) an infection elsewhere in the bodyc) urine stasis in the urinary bladderd) an ascending infection from the urethra

11. Which of the following statements by the client would indicate that she is at high risk for a recurrence of cystitis?

a) I can usually go to 8 to 10 hours without needing to empty my bladderb) I take a tub bath every eveningc) I wipe from front to back after voidingd) I drink a lot of water during the day

12. To prevent recurrence of cystitis, the nurse should plan to encourage the client to include which of the following measures in her daily routine?

a) wearing cotton underpantsb) increasing citrus juice intakec) douching regularly with 0.25% acetic acidd) using vaginal sprays

13. Which of the following symptoms would most likely indicate pyelonephritis?

a) ascitesb) costovertebral angle(CVA) tendernessc) polyuriad) nausea and vomiting

14. Which of the following factors would put the client at increased risk for pyelonephritis?

a) history of hypertensionb) intake of large quantities of cranberry juicec) fluid intake of 2000 ml/dayd) history of diabetes mellitus

15. Which of the following groups of laboratory tests is most important for assessing the client's renal status?

a) serum sodium and potassium levelsb) arterial blood gases and hemoglobinc) serum blood urea (BUN) and creatinine levelsd) urinalysis and urine culture

16. The client with pyelonephritis asks the nurse, :How will I know whether the antibiotics are effectively treating my infection?" the nurse's most appropriate response would be which of the following?

a) after you take the antibiotics for 2 weeks, you'll be curedb) the doctor can tell by the color and odor of your urinec) the doctor can determine your progress through urine culturesd) when your symptoms disappear you'll know that your infection is gone

17. The nurse assesses the client who has chronic renal failure and notes the following: crackles in the lung bases, elevated blood pressure, and weight gain of 2 pounds in 1 day. Based on these data, which of the following nursing diagnoses is appropriate?

a) excess fluid volume related to the kidney's inability to maintain fluid balanceb) increased cardiac output related to fluid overloadc) ineffective tissue perfusion related to interrupted arterial; blood flowd) ineffective therapeutic regimen management related to lack of knowledge about therapy

18. What is the primary disadvantage of using peritoneal dialysis for long-term management of chronic renal failure?

a) the danger of hemorrhage is highb) it cannot correct severe imbalancesc) it is a time-consuming method of treatmentd) the risk of contracting hepatitis is high

19. The client with chronic renal failure complains of feeling nauseated at least part of every day. The nurse should explain that the nausea is the result of:

a) acidosis caused by the medicationsb) accumulation of waste products in the bloodc) chronic anemia and fatigued) excess fluid load

20. During dialysis, the nurse observes that the flow of dialysate stops before all the solution has drained out. The nurse should:

a) have the client sit in a chairb) turn the client from side to sidec) reposition the peritoneal catheterd) have the client walkANSWERS

1) b ..... 2) d ..... 3) d ..... 4) d ..... 5) d

6) a ..... 7) d ..... 8) a ..... 9) c ..... 10) d

11) a .... 12) a .... 13) b .... 14) d .... 15) c

16) c .... 17) a .... 18) c .... 19) b .... 20) b

1. A client with nephrotic syndrome asks the nurse, "Why should I even bother trying to control my diet and the edema? It doesn't really matter what I do if I can never get rid of this kidney problem, anyway!"

The nurse selects which of the following as the most appropriate nursing diagnosis for this client?

a) anxietyb) powerlessnessc) ineffective copingd) disturbed body image

2. A client with acute renal failure is having trouble remembering information and instructions as a result of altered laboratory values. The nurse avoids doing which of the following when communicating with this client?

a) giving simple, clear directionsb) including the family in discussions related to carec) explaining treatments using understandable languaged) giving thorough and complete explanations of treatment options

3. A client who has never been hospitalized before is having trouble initiating the stream of urine. Knowing that there is no pathological reason for this difficulty, the nurse avoids which of the following because it is the least helpful method of assisting the client?

a) running tap water in the sinkb) assisting the client to a commode behind a closed curtainc) instructing the client to pour warm water over the perineumd) closing the bathroom door and instructing the client to pull the call bell when done

4. The nurse provide home-care instructions to a client who has been hospitalized for a transurethral resection of the prostate (TURP). Which statement by the client indicates the need for further instructions?

a) I need to include prune juice in my dietb) I need to avoid strenuous activity for 4 to 6 weeksc) I can lift and push objects up to 30 pounds in weightd) I need to maintain a daily intake of 6 to 8 glasses of water

5. The nurse has given instructions about site care to a hemodialysis client who had an implantation of arteriovenous (AV) fistula in the right arm. The nurse determines that the client needs further instructions if the client states the need to:

a) sleep on the right sideb) avoid carrying heavy objects with the right armc) perform range-of-motion exercises routinely on the right armd) report an increased temperature, redness, or drainage at the site

Renal Failure NCLEX QuestionsAnswers and Rationale

1) B- Powerlessness is present when the client believes that personal actions will not affect an outcome in any significant way. Because nephrotic syndrome is progressive, the client may feel that personal actions may not affect the disease process. Anxiety is diagnosed when the client has a feeling of unease with a vague or undefined source. Ineffective coping occurs when the client has impaired adaptive abilities or behaviors with regard to meeting expected demands or roles. Disturbed body image occurs when there is

an alteration in the way that the client perceives his or her body image.

2) D- The client with acute renal failure may have difficulty remembering information and instructions because of anxiety and altered laboratory values. Communications should be clear, simple, and understandable. The family is included whenever possible. Information about treatment should be explained using understandable language.

3) B- A lack of privacy is a key issue that may inhibit the ability of the client to void in the absence of known pathology. Using a commode behind a curtain may inhibit voiding in some people. The use of a bathroom is preferable, and this may be supplemented with the use of running water or pouring water over the perineum, as needed.

4) C- The client needs to be advised to avoid strenuous activity for 4 to 6 weeks and to avoid lifting items that weigh more than 20 pounds. Straining during defecation is avoided to prevent bleeding. Prune juice is a satisfactory bowel stimulant. The client needs to consume a daily intake of at least 6 to 8 glasses of nonalcoholic fluids to minimize clot formation.

5) A- Routine instructions to the client with an AV fistula, graft, or shunt include reporting signs and symptoms of infection, performing routine range-of-motion exercises of the affected extremity, avoiding sleeping with the body weight on the extremity with the access site, and avoiding carrying heavy objects or compressing the extremity that has the access site.

6. The nurse is caring for a client who has just returned to the nursing unit after an intravenous pyelogram (IVP). The nurse determines that which of the following is the priority for the postprocedure care of this client?

a) maintaining the client on bedrestb) ambulating the client in the hallwayc) encouraging the increased intake of oral fluidsd) encouraging the client to try to void frequently

7. The nurse is evaluating the effects of care for the client with nephrotic syndrome. The nurse determines that the client showed the least amount of improvement if which of the following information was obtained serially over 2 days of care?

a)  serum albumin 1.9g/dL, up to 2.0g/dLb) initial weight 208 pounds, down to 203 poundsc) blood pressure 160/90mm Hg, down to 130/78mm Hgd) daily intake and output of 2100 ml intake and 1900 ml output 2000 ml intake and 2900 ml output

8. A client is being discharged to home while recovering from acute renal failure (ARF). The client indicates an understanding of the therapeutic dietary regimen if the client states the need to eat foods that are lower in:

a) fatsb) vitaminsc) potassiumd) carbohydrates

9. The nurse is caring for a client who has returned from the postanesthesia care unit after prostatectomy. The client has a three-way Foley catheter with an infusion of continuous bladder irrigation (CBI). The

nurse determines that the flow rate is adequate if the color of the urinary drainage is:

a)  dark cherryb) clear as waterc) pale yellow or slightly pinkd) concentrated yellow with small clots

10. A client with chronic renal failure has a protein restriction in the diet. The nurse should include in a teaching plan to avoid which of the following sources of incomplete protein in the diet?

a) nutsb) eggsc) milkd) fish

Renal Failure NCLEX QuestionsAnswers and Rationale

6) C- After IVP, the client should take in increased fluids to aid in the clearance of the dye used for the procedure. It is unnecessary to void frequently after the procedure. The client is usually allowed activity as tolerated, without any specific activity guidelines.

7) A- The goal of therapy in nephrotic syndrome is to heal the leaking glomerular membrane. This would then control edema by stopping the loss of protein in the urine. Fluid balance and albumin levels are monitored to determine the effectiveness of therapy. Option B represents a loss of fluid that slightly exceeds 2 L and that represents a significant improvement. Option C shows improvement, because both systolic and diastolic blood pressures are lower. Option D represents a total fluid loss of 700 mL over the 2 days, which is also helpful. The least amount of improvement is in the serum albumin level, because the normal albumin level is 3.5 to 5.0 g/dL.

8) C- Most of the excretion of potassium and the control of potassium balance are normal functions of the kidneys. In the client with renal failure, potassium intake must be restricted as much as possible (30 to 50 mEq/day). The primary mechanism of potassium removal during ARF is dialysis. Options A, B, and D are not normally restricted in the client with ARF unless a secondary health problem warrants the need to do so.

9) C- The infusion of bladder irrigant is not at a preset rate; rather, it is increased or decreased to maintain urine that is a clear, pale yellow color or that has just a slight pink tinge. The infusion rate should be increased if the drainage is cherry colored or if clots are seen. Alternatively, the rate can be slowed down slightly if the returns are as clear as water.

10) A- The client whose diet has a protein restriction should be careful to ensure that the proteins eaten are complete proteins with the highest biological value. Foods such as meat, fish, milk, and eggs are complete proteins, which are optimal for the client with chronic renal failure.

11. A client with acute renal failure has an elevated blood urea nitrogen (BUN). The client is experiencing difficulty remembering information due to uremia. The nurse avoids which of the following when

communicating with this client?

a) giving simple, clear directionsb) including the family in discussions related to carec) giving thorough, lengthy explanations of proceduresd) explaining treatments using understandable language

12. At the beginning of the work shift. the nurse is checking a client who has returned from the post-anesthesia care unit following transurethral resection of the prostate (TURP). The client has bladder irrigation running via a three-way Foley catheter. The nurse should notify the physician if which color if urine is noted in the urinary drainage bag?

a) pale pinkb) dark pinkc) bright redd) tea-colored

13. The nurse is assisting in participating in a prostate screening clinic for men. The nurse questions each client about which sign of prostatism?

a) ability to stop voiding quicklyb) absence of postvoid dribblingc) excessive force in urinary systemd) hesitancy when initiating urinary stream

14. An adult with renal insufficiency has been placed on a fluid restriction of 1200 mL per day. The nurse discusses the fluid restriction with the dietitian and then plans to allow the client to have how many milliliters of fluid from 7:00 AM to 3:00 PM?

a) 400b) 600c) 800d) 1000

15. A client with chronic renal failure has learned about managing diet and fluid restriction between dialysis treatments. The nurse determines that the client is compliant with the therapeutic regimen of the client gains no more than how much weight between hemodialysis treatments?

a) 2 to 4kgb) 5 to 6kgc) 0.5 to 1kgd) 1 to 1.5kg

Renal Failure NCLEX QuestionsAnswers and Rationale

11) C- the client with acute renal failure nay have difficulty remembering information and instructions because of anxiety and the increased level of the BUN. The nurse should avoid giving  lengthy explanations about procedures because this information may not be remembered by the client and could increase client

anxiety.

12) C- Bright red bleeding should be reported, because it could indicate complications related to active bleeding. If the bladder irrigation is infusing at a sufficient rate, the urinary drainage will be pale pink. A dark pink color (sometimes referred to as punch-colored) indicates that the speed of the irrigation should be increased. Tea-colored urine is not seen after TURP, but may be noted in the client with renal failure or other renal disorders.

13) D- Signs of prostatism that may be reported to the nurse are reduced force and size of urinary stream, intermittent stream, hesitancy in beginning the flow of urine, inability to stop urinating quickly, a sensation of incomplete bladder emptying after voiding, and an increase in episodes of nocturia. These symptoms are the result of pressure of the enlarging prostate on the client's urethra.

14) B- When a client is on a fluid restriction, the nurse informs the dietary department and discusses the allotment of fluid per shift with the dietitian. When calculating how to distribute a fluid restriction, the nurse usually allows half of the daily allotment (600 mL) during the day shift, when the client eats two meals and takes most medications. Another two-fifths (480 mL) is allotted to the evening shift, with the balance (120 mL) allowed during the nighttime.

15) D- A limit of 1 to 1.5 kg of weight gain between dialysis treatments helps prevent hypotension that tends to occur during dialysis with the removal of larger fluid loads. The nurse determines that the client is compliant with fluid restriction if this weight gain is not exceeded.

16. The nurse is administering epoetin alfa (Epogen) to a client with chronic renal failure. The nurse monitors the client for which adverse effect of this therapy?

a) anemiab) hypertensionc) iron intoxicationd) bleeding tendencies

17. The client scheduled for transurethral prostatectomy (TURP) has listened to the surgeon's explanation of the surgery. The client later asks the nurse to explain again how the prostate is going to be removed. The nurse tells the client that the prostate will be removed through:

a) the urethrab) a lower abdominal incisionc) an upper abdominal incisiond) an incision made in the perineal area

18. The nurse is reviewing a urinalysis report for a client with acute renal failure and notes that the results are highly positive for proteinuria. The nurse interprets that this client has which type of renal failure?

a) prerenal failureb) postrenal failurec) intrinsic renal failured) atypical renal failure

19. The nurse caring for a client immediately following transurethral resection of the prostate (TURP) notices that the client has suddenly become confused and disoriented. The nurse determines that this may be a result of which potential complication of this surgical procedure?

a) hyponatremia

b) hypernatremiac) hyperchloremiad) hypochloremia

20. A client with chronic renal failure has received dietary counseling about potassium restriction in the diet. The nurse determines that the client has learned the information correctly if the client states to do which of the following for preparation of vegetables?

a) eat only fresh vegetablesb) boil them and discard the waterc) use salt substitute on them liberallyd) buy frozen vegetables whenever possible

NCLEX Renal Failure Questions Answers and Rationale

16) B- The client taking epoetin alfa is at risk of hypertension and seizure activity as the most serious adverse effects of therapy. This medication is used to treat anemia. The medication does not cause iron intoxication. Bleeding tendencies is not an adverse effect of this medication.

17) A- A TURP is done through the urethra. An instrument called a resectoscope is used to remove the tissue using high-frequency current. An incision between the scrotum and anus is made when a perineal prostatectomy is performed. A lower abdominal incision is used for suprapubic or retropubic prostatectomy. An upper abdominal incision is not used.

18) C- With intrinsic renal failure, there is a fixed specific gravity and the urine tests positive for proteinuria. In prerenal failure, the specific gravity is high, and there is very little or no proteinuria. In postrenal failure, there is a fixed specific gravity and little or no proteinuria. There is no such classification as atypical renal failure.

19) A- The client who suddenly becomes disoriented and confused following TURP could be experiencing early signs of hyponatremia. This may occur because the flushing solution used during the operative procedure is hypotonic. If enough solution is absorbed through the prostate veins during surgery, the client experiences increased circulating volume and dilutional hyponatremia. The nurse needs to report these symptoms.

20) B- The potassium content of vegetables can be reduced by boiling them and discarding the cooking water. Options 1 and 4 are incorrect. Clients with renal failure should avoid the use of salt substitutes altogether, because they tend to be high in potassium content.

21. A client with chronic renal failure has started receiving epoetin alfa (Epogen). The nurse reminds the client about the importance of taking which prescribed medication to enhance the effects of this therapy?

a) ferrous gluconateb) aluminum carbonatec) aluminum hydroxide gel

d) calcium carbonate (Tums)

22. The nurse is planning to do preoperative teaching with a client scheduled for a transurethral resection of the prostate (TURP). The nurse plans to include in the discussion that the most frequent cause of postoperative pain will be:

a) bladder spasmsb) bleeding within the bladderc) the lower abdominal incisiond) tension on the Foley catheter

23. A client is being discharged to home after undergoing a transurethral resection of the prostate (TURP). The nurse teaches the client to expect which variation in normal urine color for several days following the procedure?

a) dark redb) pink-tingedc) clear yellowd) cloudy amber

24. A client with nephrotic syndrome states to the nurse: "Why should I even bother trying to control my diet and the edema? It doesn't really matter what I do, if I can never get rid of this kidney problem anyway!" Based on the client's statement, the nurse addresses which potential client problem?

a) anxietyb) powerlessnessc) ineffective copingd) disturbed body image

25. A client has just been diagnosed with acute renal failure. The laboratory calls the nurse to report a serum potassium level of 6.1 mEq/L on the client. The nurse takes which immediate action?

a) calls the physicianb) checks the sodium levelc) encourages an extra 500ml of fluid intaked) teaches the client about foods low in potassium

NCLEX Renal Failure QuestionsAnswers and Rationale

21) A- In order to form healthy red blood cells, which is the purpose of epoetin alfa, the body needs adequate stores of iron, folic acid, and vitamin B12. The client should take these supplements regularly to enhance the hematocrit-raising benefit of this medication. The other options are incorrect.

22) A

- Bladder spasms can occur after this surgery because of postoperative bladder distention or irritation from the balloon on the indwelling urinary catheter. The nurse administers antispasmodic medications, such as belladonna and opium, to treat this type of pain. There is no incision with a TURP (option C). Options B and D are not frequent causes of pain. Some surgeons purposefully apply tension to the catheter for a few hours postoperatively to control bleeding.

23) B- The client should expect that the urine will be pink-tinged for several days following this procedure. Dark red urine may be present initially, especially with inadequate bladder irrigation, and if it occurs, it must be corrected. Options C and D are incorrect because urine of these colors is not generally expected for several days following surgery.

24) B- Powerlessness is a problem when the client believes that personal actions will not affect an outcome in any significant way. Anxiety occurs when the client has a feeling of unease with a vague or undefined source. Ineffective coping indicates that the client has impaired adaptive abilities or behaviors in meeting the demands or roles expected from the individual. Disturbed body image occurs when the way the client perceives body image is altered.

25) A- The client with hyperkalemia is at risk of developing cardiac dysrhythmias and resultant cardiac arrest. Because of this, the physician must be notified at once so that the client may receive definitive treatment. Fluid intake would not be increased because it would contribute to fluid overload and wouldn't effectively lower the serum potassium level. Dietary teaching may be necessary at some point, but this action is not the priority. The nurse might also check the result of a serum sodium level, but this is not a priority action of the nurse.

26. A nurse is assessing the renal function of a client. The nurse checks which item as the best indirect indicator of renal status?

a) bladder distentionb) level of conciousnessc) pulse rated) blood pressure

27. A nurse is caring for a hospitalized client with polycystic kidney disease who has intravenous pyelography (IVP). The nurse monitors which specific item in the postprocedure period?

a) lung soundsb) groin areac) carotid pulse rated) intake and output

28. A client has been diagnosed with urolothiasis in the right ureter. The nurse would expect the client to describe the pain (renal colic) as:

a)  located in the upper right epigastric area, radiating to the shoulder or backb) occurring 2 to 3 hours after mealc) intermittent in the right upper abdominal quadrant, radiating to the groind) worsening with the ingestion of food

29. A female client with a history of chronic urinary tract infection complains of burning and urinary frequency. To determine whether the current problem is of renal (kidney) origin, the nurse would assess whether the client has pain or discomfort in the:

a) suprapubic areab) right or left costovertebral anglec) urinary meatusd) labium

30. A client has been diagnosed with acute pyelonephritis. The nurse assesses the client for which manifestation of this disorder?

a)  low-grade feverb) flank pain on the unaffected sidec) chills and nausead) pale, dilute urine

NCLEX Renal Failure Questions Answers and Rationale

26) D- The kidneys normally receive 20% to 25% of the cardiac output, even under conditions of rest. In order for kidney function to be optimal, adequate renal perfusion is necessary. Perfusion can best be estimated by the blood pressure, which is an indirect reflection of the adequacy of cardiac output. The pulse rate affects the cardiac output, but can be altered by factors unrelated to kidney function. Bladder distention reflects a problem or obstruction that is most often distal to the kidneys. Level of consciousness is an unrelated item.

27) D- IVP is used to visualize the kidneys, ureters, and bladder for evaluation of structure and excretory function. Contrast medium is injected intravenously (usually in a vein located in the antecubital area) to visualize the renal parenchyma, collecting system, ureter, and bladder, using multiple x-ray films. This diagnostic test detects renal masses and cysts, ureteral obstruction, retroperitoneal tumors, renal trauma, and other urinary tract abnormalities. The nurse monitors urinary output and renal function for 24 to 48 hours after the test in order to recognize a nephrotoxic response to the contrast medium. Options A, B, and C are unrelated to this procedure.

28) C- Renal colic is generally associated with acute obstruction of a ureter and resulting ureteral spasm. As the stone moves along the ureter, the pain can be excruciating, is intermittent in character, and is located in the flank and upper abdominal quadrant of the affected side. It is caused by the spasm of the ureter and anoxia of the ureter wall from the pressure of the stone. The pain follows the anterior course of the ureter down to the suprapubic area and radiates to the external genitalia (groin). Options A, B, and D describe pain characteristic of gastrointestinal problems (cholecystitis, duodenal and gastric ulcers, respectively).

29) B- Pain or discomfort from a problem that originates in the kidney is felt at the costovertebral angle on the affected side. Ureteral pain is felt in the ipsilateral labium in the female client, or the ipsilateral scrotum in the male client. Bladder infection is often accompanied by suprapubic pain and pain or burning at the urinary meatus when voiding.

30) C- Typical manifestations of acute pyelonephritis include high fever, chills, nausea and vomiting, flank pain on the affected side with costovertebral angle tenderness, general weakness, and headache. The client often exhibits the typical signs and symptoms of cystitis, with production of urine that is foul smelling and cloudy or bloody, and with an increased urinary white blood cell count.

31. A nurse is caring for a client receiving peritoneal dialysis and notes a brownish tinge to the dialysate output. The nurse interprets that this finding could be a result of:

a) early infectionb) insufficient fluid instillationc) bladder perforationd) bowel perforation

32. While reading the product literature regarding ofloxacin (Floxin), the nurse notes that the medication could cause crystalluria. The nurse decides to tell the client taking the medication to do which of the following to decrease the likelihood of this adverse effect?

a) avoid beverages that contain salts, such as mineral waterb) avoid carbonated soft-drink beveragesc) drink at least 1500 to 2000 ml of fluid per dayd) drink at least three glasses of milk per day

33. A nurse is caring for a client who has begun using peritoneal dialysis. The nurse determines that which manifestation indicates the onset of peritonitis?

a)  oral temperature of 100Fb) history of gastrointestinal (GI) upset 1 week agoc) clear dialysate outputd) presence of crystals in dialysate output

34. A nurse is working on a renal unit in a local hospital. The nurse interprets that which client with renal failure is best suited for peritoneal dialysis as a treatment option?

a)  a client with severe congestive heart failureb) a client with a history of ruptured diverticulic) a client with a history of herniated lumbar diskd) a client with a history of three previous abdominal surgeries

35. A client undergoing long-term peritoneal dialysis is experiencing a problem with reduced outflow from the dialysis catheter. The nurse assessing the client would inquire whether the client has had a recent problem with:

a)  vomitingb) diarrhea

c) constipationd) flatulence

NCLEX Questions on Renal FailureAnswers and Rationale

31) D- Brown-tinged or bloody drainage could indicate perforation of the bowel by the peritoneal dialysis catheter. If noted, this must be reported to the physician immediately. Early signs of infection include cloudy dialysate output or fever and, most likely, abdominal discomfort. Bladder perforation could yield yellow or bloody drainage. Insufficient fluid instillation is an incorrect option. The client would have no signs as a result of insufficient fluid instillation except outflow of smaller amounts of dialysate.

32) C- To prevent crystalluria, the client should drink at least 1500 to 2000 mL of fluid per day. Milk interferes with the absorption of the medication and should be avoided. Consumption of carbonated beverages or mineral water is not harmful.

33) A- Typical symptoms of peritonitis include fever, nausea, malaise, rebound abdominal tenderness, and cloudy dialysate output. The complaint of GI upset is too vague to be correct. Peritonitis would cause cloudy dialysate but would not cause crystals to appear in the dialysate.

34) A- Peritoneal dialysis may be the treatment option of choice for clients with severe cardiovascular disease, which would be worsened by the rapid shifts in fluid, electrolytes, urea, and glucose that occur with hemodialysis. Contraindications to peritoneal dialysis include diseases of the abdomen, such as ruptured diverticuli or malignancies, extensive abdominal surgeries, history of peritonitis, obesity, and history of back problems, which could be aggravated by the fluid weight of the dialysate. Severe disease of the vascular system also may be a contraindication.

35) C- Reduced outflow may be caused by catheter position and adherence to the omentum, infection, or constipation. Constipation may contribute to reduced outflow in part because peristalsis seems to aid in drainage. For this reason, bisacodyl suppositories are sometimes used prophylactically, even without a history of constipation. The other options are unrelated to impaired catheter drainage.

36. A nurse is reviewing the health care record of a client with a diagnosis of benign prostatic hyperplasia. The nurse that which sign exhibited by the client occurs late in the disorder?

a) nocturiab) decreased force of urine streamc) difficulty initiating urine streamd) hematuria

37. A nurse is caring for a client at risk for acute renal tubular necrosis following a crush injury to the leg.

The nurse implements which measure to minimize this particular risk for the client?

a) use of sheepskin and bed cradleb) frequent position changes in bedc) administration of antibiotics in a timely fashiond) careful monitoring of intravenous fluids to ensure sufficient intake

38. A clinic nurse is reviewing the laboratory results of an adult client seen in the health care clinic. The nurse determines that the blood urea nitrogen (BUN) level is normal if which of the following is noted on the laboratory results? 

a) 35 mg/dLb) 29 mg/dLc) 15 mg/dLd) 3 mg/dL

39. A nurse is caring for a client who is receiving immunosuppressant therapy including corticosteroids following a renal transplant. The nurse would plan to carefully monitor which laboratory result for this client?

a) serum albuminb) blood glucosec) magnesiumd) potassium

40. A client who has been diagnosed with chronic renal failure has been told that hemodialysis will be required. The client becomes angry and withdrawn, and states, "I'll never be the same now." The nurse formulates which of the following nursing diagnoses for this client?

a)  disturbed thought processesb) disturbed body imagec) anxietyd) noncompliance

NCLEX Questions on Renal FailureAnswers and Rationale

36) D- Nocturia, decreased force, and difficulty initiating urine stream are all early signs of benign prostatic hypertrophy. Hematuria may occur as a later sign.

37) D- After a crush injury, myoglobin released from damaged muscle cells circulates in the bloodstream and can clog renal tubules. It is important to maintain an increased fluid intake to "flush" the kidneys and minimize this occurrence. The other options may be part of the management of this client but do not specifically relate to this potential complication.

38) CThe normal BUN ranges from 5 to 25 mg/dL. Options A and B reflect elevated values, which may indicate renal abnormalities or dehydration. Option D reflects a lower than normal value, which may not be clinically significant.

39) B- Corticosteroid therapy can result in glucose intolerance, leading to elevated blood glucose levels. The nurse monitors these levels to detect this side effect of therapy. With successful transplant, the client's serum electrolyte levels should be better regulated, although corticosteroids could also cause sodium retention.

40) B- The client with any renal disorder, such as renal failure, may become angry and depressed because of the permanence of the alteration. Because of the physical change and the change in lifestyle that may be required to manage a severe renal condition, the client may experience Disturbed body image. Options A, C, and D are unrelated to the client's statement.

41. A nurse is caring for a client who has been diagnosed as having a kidney mass. The client asks the nurse the reason for renal biopsy when other tests such as computed tomography (CT) scan and ultrasound are available. In formulating a response, the nurse incorporates the knowledge that renal biopsy :

a) helps differentiate between a solid mass and a fluid-filled cystb) provides an outline of the renal vascular systemc) gives specific cytological information about the lesiond) determines if the mass is growing rapidly or slowly

42. A nurse is providing discharge instructions to a client after a hydrocelectomy. Which statement by the client would indicate a need for further instructions?

a) I should apply ice packs to the scrotumb) I should keep the scrotum elevated until the swelling has gone awayc) the sutures will be removed by the doctor in a few daysd) I need to avoid sexual intercourse at this time

43. A client hospitalized with urolithiasis has a sudden significant decrease in urine output. The nurse would immediately:

a)  call the physicianb) replace the foley catheter with a new onec) tell the client to drink increased fluidsd) obtain a urine specific gravity

44. A nurse is caring for a client undergoing peritoneal dialysis. The nurse checks the client and notes that the drainage from the outflow catheter is cloudy. The nurse should take which action?

a) stop the peritoneal dialysisb) obtain a culture and sensitivity of the drainagec) institute hemodialysis temporarilyd) add antibiotics to the next several dialysis bags

45. A nurse is urging a client to cough and deep breathe after nephrectomy. The client tells the nurse, "That's easy for you to say! You don't have to do this." The nurse interprets that the client's statement is likely a result of:

a)  a stress response to the ordeal of surgeryb) a latent fear of needing dialysis if the surgery is unsuccessfulc) effects of circulating metabolites that have not been excreted by the remaining kidneyd) pain that is intensified because the location of the incision is near the diaphragm

Renal NCLEX Questions  Answers and Rationale

41) C- Renal biopsy is a definitive test that gives specific information about whether the lesion is benign or malignant. An ultrasound discriminates between a fluid-filled cyst and a solid mass. Renal arteriography outlines the renal vascular system. Although some types of cancer grow more quickly than others, it is not possible to determine this by biopsy.

42) C- A hydrocele is an abnormal collection of fluid within the layers of the tunica vaginalis that surrounds the testis. It may be unilateral or bilateral and can occur in an infant or adult. Hydrocelectomy is the excision of the fluid filled sac in the tunica vaginalis. The client needs to be instructed that the sutures used during the hydrocelectomy are absorbable. The other options are correct.

43) A- A sudden significant decrease in urine output, to either oliguria or anuria, represents obstruction of the urinary tract, usually at the bladder neck or urethra. This represents a medical emergency, requiring prompt treatment to preserve kidney function. In this instance, the nurse would call the physician to report the findings immediately. There are no data in the question to indicate that a Foley catheter is present. Obtaining a urine specific gravity will not relieve the obstruction. Telling the client to increase fluid intake is incorrect. Additionally, if an obstruction is present, increasing fluids can cause hydronephrosis.

44) B- When the drainage becomes cloudy, peritonitis is suspected. A culture and sensitivity is obtained, and broad-spectrum antibiotics are added to the dialysis solution, pending culture and sensitivity results. The dialysis solution may also be heparinized to prevent catheter occlusion. Some clients must switch to hemodialysis if peritonitis is severe or recurring, but the nurse does not make this decision. The peritoneal dialysis is not stopped.

45) DAfter nephrectomy the client may be in considerable pain. This is a result of the size of the incision and its location near the diaphragm, which makes coughing and deep breathing so uncomfortable. For this reason, opioids are used liberally, and may be most effective when provided as patient-controlled analgesia, or through epidural analgesia. Options A, B, and C are not specifically related to this client's situation.

46. A nurse is admitting a client with chronic renal failure to the nursing unit. The nurse anticipates that the client will exhibit which frequent cardiovascular sign associated with chronic renal failure?

a) pulse 110 beats per minuteb) pulse 56 beats per minutec) blood pressure 168/94 mm Hgd) blood pressure 96/64 mm Hg

47. A nurse is preparing to teach a client who is newly diagnosed with chronic renal failure about the disease and its management. The client has a diminished ability to learn because of uremia and anxiety. The nurse makes it a priority to include which of the following when conducting teaching sessions with this client?

a) family membersb) charts and diagramsc) research articlesd) lengthy printed materials

48. A client who is newly diagnosed with chronic renal failure is scheduled for hemodialysis this morning and asks he nurse why the daily dose of enalapril (Vasotec) has not been given. The nurse tells the client that this medication will be given:

a) just before going to hemodialysisb) during the hemodialysisc) when dialysis is completedd) at bedtime

49. A nurse is teaching a client with chronic renal failure about fluid restriction. The nurse tells the client which of the following dessert items from the dietary menu represents the best choice? 

a) ice creamb) sherbetc) angel food caked) jell-O

50. A client who is newly diagnosed with chronic renal failure is scheduled to begin hemodialysis. The nurse interprets which of the following neurological or psychological findings exhibited by the client to be atypical?

a) euphoriab) labile emotionsc) withdrawald) depression

Renal NCLEX Questions Answers and Rationale

46) C- Hypertension is commonly associated with chronic renal failure. This results from a number of mechanisms, including volume overload, renin-angiotensin system stimulation, vasoconstriction from sympathetic stimulation, and the absence of prostaglandins. Hypertension may also be the cause of the renal failure. It is an important item to assess because hypertension can lead to heart failure in the chronic renal failure client as a result of increased cardiac workload in conjunction with fluid overload. Options A, B, and D are not specifically associated with chronic renal failure. 

47) A- The client with chronic renal failure may have several barriers to learning, including anxiety and the effects of uremia, such as short attention span and memory deficits. Uremic effects usually improve once hemodialysis has begun. The presence of family is helpful because the family needs to understand the disease and treatment and may help reinforce information with the client after the formal teaching session is over. Information should also be simple, direct, and at the educational level of the client to be most effective. Charts and diagrams may be helpful but are not the priority. Research articles will not be helpful.

48) C- Antihypertensive medications such as enalapril are given to the client after hemodialysis. This prevents the client from becoming hypotensive during dialysis, and prevents the medication from being removed from the bloodstream during dialysis. There is no rationale to wait until bedtime to resume the medication. Erratic dosing could lead to ineffective blood pressure control.

49) C- Dietary fluid includes anything that is liquid at room temperature. This includes items such as ice cream, sherbet, and Jell-O. With clients on a fluid restricted diet, it is helpful to avoid "hidden" fluids to whatever extent is possible. This allows the client more fluid for drinking, which can help alleviate thirst.

50) A- The client with chronic renal failure often experiences a variety of psychosocial changes. These are related to uremia as well as the stress experienced by the client with a chronic, life-threatening disease. These clients may have labile emotions or personality changes, and may exhibit withdrawal, depression, or agitation. Delusions and psychosis also can occur. Euphoria is not part of the clinical picture for the client in renal failure.