Renal NCLEX questions:

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1

A nurse reviews laboratory results for a client who was admitted for a myocardial infarction and cardiogenic shock 2 days ago. Which laboratory test result should the nurse expect to find?
a. Blood urea nitrogen (BUN) of 52 mg/dL
b. Creatinine of 2.3 mg/dL
c. BUN of 10 mg/dL
d. BUN/creatinine ratio of 8:1

ANS: A
Shock leads to decreased renal perfusion. An elevated BUN accompanies this condition. The creatinine should be normal because no kidney damage occurred. A low BUN signifies overhydration, malnutrition, or liver damage. A low BUN/creatinine ratio indicates fluid volume excess or acute renal tubular acidosis.

2

A high BUN level indicates?

dehydration

3

A low BUN level indiactes?

over hydration, malnutrition or liver damage

4

A nurse cares for a client with a urine specific gravity of 1.018. Which action should the nurse take?
a. Evaluate the client's intake and output for the past 24 hours.
b. Document the finding in the chart and continue to monitor.
c. Obtain a specimen for a urine culture and sensitivity.
d. Encourage the client to drink more fluids, especially water.

ANS: B
This specific gravity is within the normal range for urine. There is no need to evaluate the client's intake and output, obtain a urine specimen, or increase fluid intake.

5

A nurse cares for a client who has elevated levels of antidiuretic hormone (ADH). Which disorder should the nurse identify as a trigger for the release of this hormone?
a. Pneumonia
b. Dehydration
c. Renal failure
d. Edema

ANS: B
ADH increases tubular permeability to water, leading to absorption of more water into the capillaries. ADH is triggered by a rising extracellular fluid osmolarity, as occurs in dehydration. Pneumonia, renal failure, and edema would not trigger the release of ADH.

6

A nurse reviews a female client's laboratory results. Which results from the client's urinalysis should the nurse recognize as abnormal?
a. pH 5.6
b. Ketone bodies present
c. Specific gravity of 1.020
d. Clear and yellow color

ANS: B
Ketone bodies are by-products of incomplete metabolism of fatty acids. Normally no ketones are present in urine. Ketone bodies are produced when fat sources are used instead of glucose to provide cellular energy. A pH between 4.6 and 8, specific gravity between 1.005 and 1.030, and clear yellow urine are normal findings for a female client's urinalysis.

7

The client newly diagnosed with chronic kidney disease recently has begun hemodialysis. Knowing that the client is at risk for disequilibrium syndrome, the nurse should assess the client during dialysis for which associated manifestations?
A. Hypertension, tachycardia, and fever

B. Hypotension, bradycardia, and hypothermia

C. Restlessness, irritability, and generalized weakness

D. Headache, deteriorating level of consciousness, and twitching

D. Headache, deteriorating level of consciousness, and twitching
Disequilibrium syndrome is characterized by headache, mental confusion, decreasing level of consciousness, nausea, vomiting, twitching, and possible seizure activity. Disequilibrium syndrome is caused by rapid removal of solutes from the body during hemodialysis. At the same time, the blood-brain barrier interferes with the efficient removal of wastes from brain tissue. As a result, water goes into cerebral cells because of the osmotic gradient, causing increased intracranial pressure and onset of symptoms. The syndrome most often occurs in clients who are new to dialysis and is prevented by dialyzing for shorter times or at reduced blood flow rates.

8

A client has developed acute kidney injury (AKI) as a complication of glomerulonephritis. The nurse should assess the client for which expected manifestation of AKI?
A. Bradycardia

B. Hypertension

C. Decreased cardiac output

D. Decreased central venous pressure

B. Hypertension
AKI caused by glomerulonephritis is classified as intrinsic or intrarenal failure. This form of AKI commonly manifests with hypertension, tachycardia, oliguria, lethargy, edema, and other signs of fluid overload. AKI from prerenal causes is characterized by decreased blood pressure or a recent history of the same, tachycardia, and decreased cardiac output and central venous pressure. Bradycardia is not part of the clinical picture for any form of renal failure.

9

The nurse is analyzing the post-hemodialysis laboratory test results for a client with chronic kidney disease. The nurse interprets that the dialysis is having an expected but nontherapeutic effect if which value is decreased?
A. Potassium

B. Creatinine

C. Phosphorus

D. Red blood cell (RBC) count

D. Red blood cell (RBC) count
Hemodialysis typically lowers the amounts of fluid, sodium, potassium, urea nitrogen, creatinine, uric acid, magnesium, and phosphate levels in the blood. Hemodialysis also worsens anemia because RBCs are lost during dialysis from blood sampling and anticoagulation and from residual blood left in the dialyzer. Although all of these results are expected, only the lowered RBC count is nontherapeutic and worsens the anemia already caused by the disease process.

10

A client with an arteriovenous fistula in the left arm and who is undergoing hemodialysis is at risk for infection. Which should the nurse formulate as the best outcome goal for this client problem?
A. The client washes hands at least once per day.

B. The client's temperature remains lower than 101° F.

C. The client avoids blood pressure (BP) measurement in the left arm.

D. The client's white blood cell (WBC) count remains within normal limits.

D. The client's white blood cell (WBC) count remains within normal limits.
General indicators that the client is not experiencing infection include a temperature and WBC count within normal limits. The client also should use proper hand washing technique as a general preventive measure. Hand washing once per day is insufficient. It is true that the client should avoid BP measurement in the affected arm; however, this would relate more closely to the problem of risk for injury.

11

The nurse is giving general instructions to a client receiving hemodialysis. Which statement would be most appropriate for the nurse to include?
A. "It is acceptable to eat whatever you want on the day before hemodialysis."

B. "It is acceptable to exceed the fluid restriction on the day before hemodialysis."

C. "Medications should be double-dosed on the morning of hemodialysis because of potential loss."

D. "Several types of medications should be withheld on the day of dialysis until after the procedure."

D. "Several types of medications should be withheld on the day of dialysis until after the procedure."
Many medications are dialyzable, which means that they are extracted from the bloodstream during dialysis. Therefore many medications may be withheld on the day of dialysis until after the procedure. It is not typical for medications to be double-dosed, because there is no way to be certain how much of each medication is cleared by dialysis. Clients receiving hemodialysis are not routinely taught that it is acceptable to disregard dietary and fluid restrictions

12

A client undergoing hemodialysis is at risk for bleeding from the heparin used during the hemodialysis treatment. The nurse assesses for this occurrence by periodically checking the results of which laboratory test?
A. Bleeding time

B. Thrombin time

C. Prothrombin time (PT)

D. Partial thromboplastin time (PTT)

D. Partial thromboplastin time (PTT)
Heparin is the anticoagulant used most often during hemodialysis. The hemodialysis nurse monitors the extent of anticoagulation by checking the PTT, which is the appropriate measure of heparin effect. Thrombin and bleeding times are not used to measure the effect of heparin therapy, although they are useful in the diagnosis of other clotting abnormalities. The PT is one test used to monitor the effect of warfarin (Coumadin) therapy

13

The nurse is monitoring the fluid balance of an assigned client. The nurse determines that the client has proper fluid balance if which 24-hour intake and output totals are noted?

A. Intake 1500 mL, output 800 mL

B. Intake 3000 mL, output 2000 mL

C. Intake 2400 mL, output 2900 mL

D. Intake 1800 mL, output 1750 mL

D. Intake 1800 mL, output 1750 mL
For the client taking a normal diet, the normal fluid intake is approximately 1200 to 1800 mL of measurable fluids per day. The client's output in the same period should be about the same and does not include insensible losses, which are extra. Insensible losses are offset by the fluid in solid foods, which also is not measured.

14

The registered nurse is instructing a new nursing graduate about hemodialysis. Which statement, if made by the new nursing graduate, would indicate an understanding of the procedure for hemodialysis? Select all that apply.

A. "Sterile dialysate must be used."

B. "Dialysate contains metabolic waste products."

C. "Heparin sodium is administered during dialysis."

D. "Dialysis cleanses the blood of accumulated waste products."

E. "Warming the dialysate increases the efficiency of diffusion."

C. "Heparin sodium is administered during dialysis."
D. "Dialysis cleanses the blood of accumulated waste products."
E. "Warming the dialysate increases the efficiency of diffusion."
Heparin sodium is used during dialysis, and it inhibits the tendency of blood to clot when it comes in contact with foreign substances. Option 4 is the purpose of dialysis. The dialysate is warmed to approximately 100° F to increase the efficiency of diffusion and to prevent a decrease in the client's blood temperature. Dialysate is made from clear water and chemicals and is free from any metabolic waste products or medications. Bacteria and other microorganisms are too large to pass through the membrane; therefore the dialysate does not need to be sterile.

15

The nurse is caring for a client with acute kidney injury (AKI). When performing an assessment, the nurse would expect to note which breathing pattern?

A. Apnea

B. Kussmaul's respirations

C. Decreased respirations

D. Cheyne-Stokes respirations

B. Kussmaul's respirations
Clinical manifestations associated with AKI occur as a result of metabolic acidosis. The nurse would expect to note Kussmaul's respirations as a result of the metabolic acidosis because the bodily response is to exhale excess carbon dioxide. The breathing patterns noted in options 1, 3, and 4 are not characteristic of AKI.

16

The nursing student is assigned to care for a client with a diagnosis of acute kidney injury (AKI), diuretic phase. The nursing instructor asks the student about the primary goal of the treatment plan for this client. Which goal, if stated by the nursing student, would indicate an adequate understanding of the treatment plan for this client?

A. Prevent fluid overload.

B. Prevent loss of electrolytes.

C. Promote the excretion of wastes.

D. Reduce the urine specific gravity.

B. Prevent loss of electrolytes.
In the diuretic phase, fluids and electrolytes are lost in the urine. As a result, the plan of care focuses on fluid and electrolyte replacement and monitoring. Options 1, 3, and 4 are not the primary concerns in this phase of acute kidney injury.

17

The nurse instructs a client about continuous ambulatory peritoneal dialysis (CAPD). Which statement, if made by the client, indicates an accurate understanding of CAPD?

A. "No machinery is involved, and I can pursue my usual activities."

B. "A cycling machine is used, so the risk for infection is minimized."

C. "The drainage system can be used once during the day and a cycling machine for three cycles at night."

D. "A portable hemodialysis machine is used so that I will be able to ambulate during the treatment."

A. "No machinery is involved, and I can pursue my usual activities."
CAPD closely approximates normal renal function, and the client will need to infuse and drain the dialysis solution several times a day. No machinery is used, and CAPD is a manual procedure.

18

The nurse tests the urine of a client with acute kidney injury (AKI) with a multitest reagent strip. The strip tests highly positive for proteinuria. The nurse plans care, knowing that this result is consistent with which type of AKI?

A. Prerenal

B. Postrenal

C. Intrinsic

D. Atypical

C. Intrinsic
With intrinsic 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 disorder known as atypical renal failure.

19

A client with chronic kidney disease (CKD) is about to begin hemodialysis therapy. The client asks the nurse about the frequency and scheduling of hemodialysis treatments. The nurse's response is based on an understanding that which represents the typical schedule?

A. 5 hours of treatment 2 days per week

B. 2 hours of treatment 6 days per week

C. 3 to 4 hours of treatment 3 days per week

D. 2 to 3 hours of treatment 5 days per week

C. 3 to 4 hours of treatment 3 days per week
The typical schedule for hemodialysis is 3 to 4 hours of treatment 3 days per week. Individual adjustments are made according to variables such as the size of the client, type of dialyzer, rate of blood flow, personal client preferences, and other factors.

20

A client is about to begin hemodialysis. Which measure(s) should the nurse employ in the care of the client? Select all that apply.

A. Using sterile technique for needle insertion

B. Using standard precautions in the care of the client

C. Giving the client a mask to wear during connection to the machine

D. Wearing full protective clothing such as goggles, mask, gloves, and apron

E. Covering the connection site with a bath blanket to enhance extremity warmth

A. Using sterile technique for needle insertion
B. Using standard precautions in the care of the client
C. Giving the client a mask to wear during connection to the machine
D. Wearing full protective clothing such as goggles, mask, gloves, and apron
Infection is a major concern with hemodialysis. For that reason, the use of sterile technique and the application of a face mask for both nurse and client are extremely important. It also is imperative that standard precautions be followed, which includes the use of goggles, mask, gloves, and an apron. The connection site should not be covered; it should be visible so that the nurse can assess for bleeding, ischemia, and infection at the site during the hemodialysis procedure.

21

List the Complications of Hemodialysis:

Major complication: cardiovascular

Anemia, Air embolism

Chest pain, Calcification of blood vessels

Dysrhythmias, Dialysis Disequilibrium

Exsanguination

Hypertriglycerdies, Hypotension

Naseau/vomitting

Painful muscles

sleep problems, SOB

22

Dialysis Disequilibrium is:

complication of HD results from cerebral shifts (head injury from dialysis)

23

S/S of dialysis disequilibrium:

headache, N/V, restlessness, decreased LOC, seizures

24

When does dialysis disequilibrium most often occur?

in AKI when BUN levels are super high reaching above 150

check for this when your patient comes back from dialysis

25

The nurse is working on a medical-surgical nursing unit and is caring for several clients with chronic kidney disease. The nurse interprets that which client is best suited for peritoneal dialysis as a treatment option?

A. A client with severe heart failure

B. A client with a history of ruptured diverticula

C. A client with a history of herniated lumbar disk

D. A client with a history of three previous abdominal surgeries

A. A client with severe heart failure
Peritoneal dialysis may be the treatment option of choice for clients with severe cardiovascular disease. Severe cardiac disease can be worsened by the rapid shifts in fluid, electrolytes, urea, and glucose that occur with hemodialysis. For the same reason, peritoneal dialysis may be indicated for the client with diabetes mellitus. Contraindications to peritoneal dialysis include diseases of the abdomen such as ruptured diverticula or malignancies; extensive abdominal surgeries; history of peritonitis; obesity; and a 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 relative contraindication.

26

A client is being discharged to home while recovering from acute kidney injury (AKI). A reduction in which substance indicates to the nurse that the client understands the dietary teaching?

A. Fats

B. Vitamins

C. Potassium

D. Carbohydrates

C. Potassium
The excretion of potassium and maintenance of potassium balance are normal functions of the kidneys. In the client with acute kidney injury or chronic kidney disease, potassium intake must be restricted as much as possible (to 60 to 70 mEq/day). The primary mechanism of potassium removal during AKI is dialysis. Vitamins, carbohydrates, and fats are not normally restricted in the client with AKI unless a secondary health problem warrants the need to do so. The amount of fluid permitted is generally calculated to be equal to the urine volume plus the insensible loss volume of 500 mL.

27

Before providing care for a client in the late stages of chronic kidney disease (CKD), the nurse should review the results of which most relevant laboratory study?

A. Urinalysis, hematocrit, hemoglobin

B. Culture and sensitivity testing, serum sodium

C. Urine specific gravity, intravenous pyelogram

D. Fasting blood glucose, serum potassium, serum calcium

D. Fasting blood glucose, serum potassium, serum calcium
Because of the potentially life-threatening outcomes associated with hyperglycemia, hyperkalemia, and hypocalcemia, they are the most relevant to nursing management of the client with CKD. The diagnostic tests in the remaining options may be helpful in diagnosing CKD or in monitoring treatment but are not the most relevant. Additionally, decreased hematocrit and hemoglobin occur in CKD because of the decreased level of erythropoietin. However, a decrease in hematocrit and hemoglobin may be reflective of various health alterations.

28

In performing a physical assessment of a client with chronic kidney disease (CKD), which finding should the nurse anticipate to note?

A. Glycosuria

B. Polyphagia

C. Crackles auscultated in lungs

D. Blood pressure 98/58 mm Hg

C. Crackles auscultated in lungs
Chronic kidney disease is a condition in which the kidneys have progressive problems in clearing nitrogenous waste products and controlling fluid and electrolyte balance within the body. Cardiovascular symptoms of heart failure and hypertension are caused by the fluid volume overload resulting from the kidney's inability to excrete water. Signs and symptoms of heart failure include jugular venous distention, S3 heart sound, pedal edema, increased weight, shortness of breath, and crackles auscultated in the lungs. The typical signs and symptoms of CKD include proteinuria or hematuria, not glycosuria. The nurse would observe anorexia and nausea in this client, not polyphagia.