NCLEX Renal questions and answers well illustrated.

NCLEX Renal questions and answers well illustrated. A client has been admitted to the hospital for urinary tract infection an dehydration. The nurse determines that the client has received adequate volume replacement if the BUN drops to: 1. 3 mg/dL 2. 15 mg/dL 3. 29 mg/dL 4. 35 mg/dL - correct answers.2. The normal blood urea nitrogen level is 8 to 25 mg/dL. Values such as those in options 3 and 4 reflect continued dehydration. Option 1 reflects a lower than normal value, which may occur with fluid volume overload, among other conditions. An adult client has had lab work done as part of a routine physical exam. The nurse interprets that the client may have a mild degree of renal insufficiency if which of the following serum creatinine levels is noted? 1. 0.2 mg/dL 2. 0.5 mg/dL 3. 1.9 mg/dL 4. 3.5 mg/dL - correct answers.3. The normal serum creatinine level for adults is 0.6 to 1.3 mg/dL. The client with a mild degree of renal insufficiency would have a slightly elevated level. A creatinine level of 0.2 mg/dL is low, and a level of 0.5 mg/dL is just below normal. A creatinine level of 3.5 mg/dL may be associated with acute or chronic renal failure. The nurse instructs a client with renal failure who is receiving hemodialysis about dietary modifications. The nurse determines that the client understands these dietary modifications if the client selects which items from the menu? 1. Cream of wheat, blueberries, coffee 2. Sausage and eggs, banana, orange juice. 3. Bacon, cantaloupe melon, tomato juice. 4. Cured pork, grits, strawberries, orange juice. - correct answers.1. The diet for a client with renal failure who is receiving hemodialysis should include controlled amounts of sodium, phosphorus, calcium, potassium, and fluids. Options 2, 3, and 4 are high in sodium, phosphorus and potassium. The client with acute renal failure has a serum potassium level of 6.0 mEq/L. The nurse would plan which of the following as a priority action? 1. Check the sodium level. 2. Place the client on a cardiac monitor. 3. Encourage increased vegetables in the diet. 4. Allow an extra 500 mL of fluid intake to dilute the electrolyte concentration. - correct answers.2. The client with hyperkalemia is at risk of developing cardiac dysrhythmias and cardiac arrest. Because of this, the client should be placed on a cardiac monitor. Fluid intake is not increased because it contributes to fluid overload and would not affect the serum potassium level significantly. Vegetables are a natural source of potassium in the diet, and their use would not be increased. The nurse also may assess the sodium level because sodium is another electrolyte commonly measured with the potassium level. However, this is not a priority action of the nurse. The client with chronic renal failure is scheduled for hemodialysis this morning is due to receive a daily dose of enalapril (Vasotec). The nurse should plan to administer this medication: 1. During dialysis. 2. Just before dialysis. 3. The day after dialysis. 4. On return from dialysis. - correct answers.4. Antihypertensive medications such as enalapril are given to the client following hemodialysis. This prevents the client from becoming hypotensive during dialysis and also from having the medication removed from the bloodstream by dialysis. No rationale exists for waiting an entire day to resume the medication. This would lead to ineffective control of the blood pressure. The client with chronic renal failure has an indwelling abdominal catheter for peritoneal dialysis. The client spills water on the catheter dressing while bathing. The nurse should immediately: 1. Change the dressing. 2. Reinforce the dressing. 3. Flush the peritoneal dialysis catheter. 4. Scrub the catheter with providone-iodine. - correct answers.1. Clients with peritoneal dialysis catheters are at high risk for infection. A wet dressing is a conduit for bacteria to reach the catheter insertion site. The nurse ensures that the dressing is kept dry at all times. Reinforcing the dressing is not a safe practice to prevent infection in this circumstance. Flushing the catheter is not indicated. Scrubbing the catheter with povidone-iodine is done at the time of connection or disconnection of peritoneal dialysis. The client being hemodialyzed suddenly becomes short of breath and complains of chest pain. The client is tachycardic, pale, and anxious. The nurse suspects air embolism. The priority action for the nurse is to: 1. Discontinue dialysis and notify the physician. 2. Monitor vital signs every 15 minutes for the next hour. 3. Continue dialysis at a slower rate after checking the lines for air. 4. Bolus the client with 500 mL of normal saline to break up the embolus. - correct answers.1. If the client experiences air embolus during hemodialysis, the nurse should terminate dialysis immediately, notify the physician, and administer oxygen as needed. Options 2, 3, and 4 are incorrect. The nurse has completed client teaching with the hemodialysis client about self-monitoring between hemodialysis treatments. The nurse determines that the client best understands the information if the client states to record daily the: 1. Amount of activity. 2. Pulse and respiratory rate. 3. Intake and output and weight. 4. Blood urea nitrogen and creatinine levels. - correct answers.3. The client on hemodialysis should monitor fluid status between hemodialysis treatments by recording intake and output and measuring weight daily. Ideally, the hemodialysis client should not gain more than 0.5 kg of weight/day. The client with an external arteriovenous shunt in place for hemodialysis is at risk for bleeding. The priority nurse action would be to: 1. Check the shunt for the presence of bruit and thrill. 2. Observe the site once as time permits during the shift. 3. Check the results of the prothrombin times as they are determined. 4. Ensure that small clamps are attached to the arteriovenous shunt dressing. - correct answers.4. An arteriovenous shunt is a less common form of access site but carries a risk for bleeding when it is used because two ends of an external cannula are tunneled subcutaneously into an artery and a vein, and the ends of the cannula are joined. If accidental disconnection occurs, the client could lose blood rapidly. For this reason, small clamps are attached to the dressing that covers the insertion site for use if needed. The shunt site also should be assessed at least every 4 hours. The nurse develops a postprocedure plan of care for a client who had a renal biopsy. The nurse avoids documenting which intervention in the plan? 1. Administering analgesics as needed. 2. Encouraging fluids to at least 3 L in the first 24 hours. 3. Testing serial urine samples with dipsticks for occult blood. 4. Ambulating the client in the room and hall for short distances. - correct answers.4. Following renal biopsy, the nurse ensures that the client remains in bed for at least 24 hours. Vital signs and puncture site assessments are done frequently during this time. Encouraging fluids is done to reduce possible clot formation at the biopsy site. Serial urine samples are assayed by Hematest with urine dipsticks to evaluate bleeding. Analgesics often are needed to manage the renal colic pain that some clients feel after this procedure. The client with urolithiasis has a history of chronic urinary tract infections. The nurse plans teaching the client to avoid which of the following? 1. Long-term use of antibiotics. 2. Wearing synthetic underwear and pantyhose. 3. High--phosphate foods, such as dairy products. 4. Foods that make the urine more acidic, such as cranberries. - correct answers.2. Urolithiasis (struvite stones) can result from chronic infections. They form in urine that is alkaline and rich in ammonia, such as with a urinary tract infection. Teaching should focus on prevention of infections and ingesting foods to make the urine more acidic. The client should wear cotton (not synthetic) underclothing to prevent the accumulation of moisture and to prevent irritation of the perineal area, which can lead to infection. The client who has a history of gout also is diagnosed with urolithiasis and the stones are determined to be of uric acid type. The nurse gives the client instructions in which foods to limit, including: 1. Milk 2. Liver 3. Apples 4. Carrots - correct answers.2. The client with uric acid stones should avoid foods containing high amounts of purines. This includes limiting or avoiding organ meats such as liver, brain, heart, kidney, and sweetbreads. Other foods to avoid include herring, sardines, anchovies, meat extracts, consommés, and gravies. Foods that are low in purines include all fruits, many vegetables, milk, cheese, eggs, refined cereals, sugars and sweets, coffee, tea, chocolate, and carbonated beverages. The client arrives at the emergency department with complaints of low abdominal pain and hematuria. The client is afebrile. The nurse next assesses the client to determine a history of: 1. Pyelonephritits 2. Glomerulonephritis 3. Trauma to the bladder or abdomen 4. Renal cancer in the client's family - correct answers.3. Bladder trauma or injury should be considered or suspected in the client with low abdominal pain and hematuria. Glomerulonephritis and pyelonephritis would be accompanied by fever and are thus not applicable to the client in this question. Renal cancer would not cause pain that is felt in the low abdomen; rather pain would be in the flank area. The client is admitted to the emergency department following a motor vehicle accident. The client was wearing a lap seat belt when the accident occurred and now the client has hematuria and lower abdominal pain. To assess further whether the pain is caused by bladder trauma, the nurse asks the client if the pain is referred to which of the following area? 1. Hip 2. Shoulder 3. Umbilicus 4. Costovertebral angle - correct answers.2. Bladder trauma or injury is characterized by lower abdominal pain that may radiate to one of the shoulders. Bladder injury pain does not radiate to the umbilicus, costovertebral angle, or hip. A nurse is assessing the patency of a client's left arm arteriovenous fistula prior to initiating hemodialysis. Which finding indicates that the fistula is patent? 1. Palpation of a thrill over the fistula. 2. Presence of a radial pulse in the left wrist. 3. Absence of a bruit on auscultation of the fistula. 4. Capillary refill less than 3 seconds in the nail beds of the fingers of the left hand. - correct answers.1. The nurse assesses the patency of the fistula by palpating for the presence of a thrill or auscultating for a bruit. The presence of a thrill and bruit indicate patency of the fistula. Although the presence of a radial pulse in the left wrist and capillary refill shorter than 3 seconds in the nail beds of the fingers on the left hand are normal findings, they do not assess fistula patency.