N321: Exam 2 - NCLEX-Style Questions (Renal/GU)
With Complete Solutions
A diabetic patient is admitted for evaluation of renal function because of recent fatigue,
weakness, and elevated BUN and serum creatinine levels. While obtaining a nursing
history, the nurse identifies an early symptom of renal insufficiency when the patient
states,
a. "I get up several times every night to urinate."
b. "I wake up in the night feeling short of breath."
c. "My memory is not as good as it used to be."
d. "My mouth and throat are always dry and sore." - ANSWER a. "I get up several times
every night to urinate."
R: Polyuria occurs early in chronic kidney disease (CKD) as a result of the inability of the
kidneys to concentrate urine. The other symptoms would be expected later in the
progression of CKD.
A patient is diagnosed with stage 3 CKD. The patient is treated with conservative
management, including erythropoietin injections. After teaching the patient about
management of CKD, the nurse determines teaching has been effective when the
patient states,
a. "I will measure my urinary output each day to help calculate the amount I can drink."
b. "I need to take the erythropoietin to boost my immune system and help prevent
infection."
c. "I need to try to get more protein from dairy products."
d. "I will try to increase my intake of fruits and vegetables." - ANSWER a. "I will measure
my urinary output each day to help calculate the amount I can drink."
R: The patient with CKD who is not receiving dialysis is generally taught to restrict
fluids. The patient would need to measure urine output and then add 600 ml for
insensible losses to calculate an appropriate oral intake. Erythropoietin is given to
increase red blood cell count and will not offer any benefit for immune function. Dairy
products are restricted because of the high phosphate level. Many fruits and vegetables
,are high in potassium and should be restricted in the patient with CKD.
A patient with CKD has a nursing diagnosis of disturbed sensory perception related to
central nervous system changes induced by uremic toxins. An appropriate nursing
intervention for this problem is to
a. convey a caring attitude and foster the nurse-patient relationship.
b. keep the patient on bed rest to avoid possible falls or other injuries.
c. ensure restricted protein intake to prevent nitrogenous product accumulation.
d. provide an opportunity for the patient to discuss concerns about the condition. -
ANSWER c. ensure restricted protein intake to prevent nitrogenous product
accumulation.
R: Uremia is caused by the products of protein breakdown, and protein restriction is
used to decrease uremia. Because the primary cause of the patient's disturbed sensory
perception is the uremia, conveying a caring attitude and providing opportunities for the
patient to discuss concerns will not be as helpful as protein restriction. Although safety
is a concern for the patient, bed rest is likely to promote weakness. The patient should
be supervised when out of bed.
As the nurse reviews a diet plan with a patient with diabetes and renal insufficiency, the
patient states that with diabetes and kidney failure there is nothing that is good to eat.
The patient says, "I am going to eat what I want; I'm going to die anyway!" The best
nursing diagnosis for this patient is
a. imbalanced nutrition: more than required related to knowledge deficit about
appropriate diet.
b. risk for noncompliance related to feelings of anger.
c. grieving related to actual and perceived losses.
d. risk for ineffective health maintenance related to complexity of therapeutic regimen. -
ANSWER c. grieving related to actual and perceived losses.
R: The patient's statements that there is nothing that is good to eat and that death is
unavoidable indicate grieving about the losses being experienced as a result of the
diabetes and chronic kidney disease (CKD). The patient data do not indicate knowledge
deficit, anger, or the complexity of the therapeutic program as being issues for this
, patient.
Before administering sodium polystyrene sulfonate (Kayexalate) to a patient with
hyperkalemia, the nurse should assess
a. the BUN and creatinine.
b. the blood glucose level.
c. the patient's bowel sounds.
d. the level of consciousness (LOC). - ANSWER c. the patient's bowel sounds.
R: Sodium polystyrene sulfonate (Kayexalate) should not be given to a patient with a
paralytic ileus (as indicated by absent bowel sounds) because bowel necrosis can
occur. The BUN and creatinine, blood glucose, and LOC would not impact on the nurse's
decision to give the medication.
The nurse has instructed a patient who is receiving hemodialysis about dietary
management. Which diet choices by the patient indicate that the teaching has been
successful?
a. Scrambled eggs, English muffin, and apple juice
b. Cheese sandwich, tomato soup, and cranberry juice
c. Split-pea soup, whole-wheat toast, and nonfat milk
d. Oatmeal with cream, half a banana, and herbal tea - ANSWER a. Scrambled eggs,
English muffin, and apple juice
R: Scrambled eggs would provide high-quality protein, and apple juice is low in
potassium. Cheese is high in salt and phosphate, and tomato soup would be high in
potassium. Split-pea soup is high in potassium, and dairy products are high in
phosphate. Bananas are high in potassium, and the cream would be high in phosphate.
To determine glomerular filtration rate (GFR) for a patient with chronic kidney disease,
the nurse will plan to
a. schedule frequent blood urea nitrogen (BUN) tests.
With Complete Solutions
A diabetic patient is admitted for evaluation of renal function because of recent fatigue,
weakness, and elevated BUN and serum creatinine levels. While obtaining a nursing
history, the nurse identifies an early symptom of renal insufficiency when the patient
states,
a. "I get up several times every night to urinate."
b. "I wake up in the night feeling short of breath."
c. "My memory is not as good as it used to be."
d. "My mouth and throat are always dry and sore." - ANSWER a. "I get up several times
every night to urinate."
R: Polyuria occurs early in chronic kidney disease (CKD) as a result of the inability of the
kidneys to concentrate urine. The other symptoms would be expected later in the
progression of CKD.
A patient is diagnosed with stage 3 CKD. The patient is treated with conservative
management, including erythropoietin injections. After teaching the patient about
management of CKD, the nurse determines teaching has been effective when the
patient states,
a. "I will measure my urinary output each day to help calculate the amount I can drink."
b. "I need to take the erythropoietin to boost my immune system and help prevent
infection."
c. "I need to try to get more protein from dairy products."
d. "I will try to increase my intake of fruits and vegetables." - ANSWER a. "I will measure
my urinary output each day to help calculate the amount I can drink."
R: The patient with CKD who is not receiving dialysis is generally taught to restrict
fluids. The patient would need to measure urine output and then add 600 ml for
insensible losses to calculate an appropriate oral intake. Erythropoietin is given to
increase red blood cell count and will not offer any benefit for immune function. Dairy
products are restricted because of the high phosphate level. Many fruits and vegetables
,are high in potassium and should be restricted in the patient with CKD.
A patient with CKD has a nursing diagnosis of disturbed sensory perception related to
central nervous system changes induced by uremic toxins. An appropriate nursing
intervention for this problem is to
a. convey a caring attitude and foster the nurse-patient relationship.
b. keep the patient on bed rest to avoid possible falls or other injuries.
c. ensure restricted protein intake to prevent nitrogenous product accumulation.
d. provide an opportunity for the patient to discuss concerns about the condition. -
ANSWER c. ensure restricted protein intake to prevent nitrogenous product
accumulation.
R: Uremia is caused by the products of protein breakdown, and protein restriction is
used to decrease uremia. Because the primary cause of the patient's disturbed sensory
perception is the uremia, conveying a caring attitude and providing opportunities for the
patient to discuss concerns will not be as helpful as protein restriction. Although safety
is a concern for the patient, bed rest is likely to promote weakness. The patient should
be supervised when out of bed.
As the nurse reviews a diet plan with a patient with diabetes and renal insufficiency, the
patient states that with diabetes and kidney failure there is nothing that is good to eat.
The patient says, "I am going to eat what I want; I'm going to die anyway!" The best
nursing diagnosis for this patient is
a. imbalanced nutrition: more than required related to knowledge deficit about
appropriate diet.
b. risk for noncompliance related to feelings of anger.
c. grieving related to actual and perceived losses.
d. risk for ineffective health maintenance related to complexity of therapeutic regimen. -
ANSWER c. grieving related to actual and perceived losses.
R: The patient's statements that there is nothing that is good to eat and that death is
unavoidable indicate grieving about the losses being experienced as a result of the
diabetes and chronic kidney disease (CKD). The patient data do not indicate knowledge
deficit, anger, or the complexity of the therapeutic program as being issues for this
, patient.
Before administering sodium polystyrene sulfonate (Kayexalate) to a patient with
hyperkalemia, the nurse should assess
a. the BUN and creatinine.
b. the blood glucose level.
c. the patient's bowel sounds.
d. the level of consciousness (LOC). - ANSWER c. the patient's bowel sounds.
R: Sodium polystyrene sulfonate (Kayexalate) should not be given to a patient with a
paralytic ileus (as indicated by absent bowel sounds) because bowel necrosis can
occur. The BUN and creatinine, blood glucose, and LOC would not impact on the nurse's
decision to give the medication.
The nurse has instructed a patient who is receiving hemodialysis about dietary
management. Which diet choices by the patient indicate that the teaching has been
successful?
a. Scrambled eggs, English muffin, and apple juice
b. Cheese sandwich, tomato soup, and cranberry juice
c. Split-pea soup, whole-wheat toast, and nonfat milk
d. Oatmeal with cream, half a banana, and herbal tea - ANSWER a. Scrambled eggs,
English muffin, and apple juice
R: Scrambled eggs would provide high-quality protein, and apple juice is low in
potassium. Cheese is high in salt and phosphate, and tomato soup would be high in
potassium. Split-pea soup is high in potassium, and dairy products are high in
phosphate. Bananas are high in potassium, and the cream would be high in phosphate.
To determine glomerular filtration rate (GFR) for a patient with chronic kidney disease,
the nurse will plan to
a. schedule frequent blood urea nitrogen (BUN) tests.
