NCLEXz Renalz andz Urinary
(#1)z Az clientz withz acutez kidneyz injuryz hasz az serumz potassiumz levelz ofz
7.0z mEq/Lz (7.0z mmol/L).z Thez nursez shouldz planz whichz actionsz asz az
priority?z Selectz allz thatz apply.
1.z Placez thez clientz onz az cardiacz monitor.
2.z Notifyz thez healthz carez providerz (HCP).
3.z Putz thez clientz onz NPOz (nothingz byz mouth)z statusz exceptz forz icez
chips.
4.z Reviewz thez client'sz medicationsz toz determinez ifz anyz containz orz retainz
potassium.
5.z Allowz anz extraz 500z mLz ofz intravenousz fluidz intakez toz dilutez thez
electrolytez concentration.z -z
z z z z z z z z z z z z z z 1,z 2,z 4
R:z NPOz isz unnecessary.z Addingz extraz fluidz mayz worsenz thez situationz
andz leadz toz fluidz overload.z Excessz Kz canz causez heartz dysrhythmias,z soz
1&4z arez appropriate.z Callingz thez HCPz isz alsoz necessaryz forz furtherz
orders.
(#2)z Az clientz arrivesz atz thez emergencyz departmentz withz complaintsz ofz
lowz abdominalz painz andz hematuria.z Thez clientz isz afebrile.z Thez nursez
nextz assessesz thez clientz toz determinez az historyz ofz whichz condition?
1.z Pyelonephritis
2.z Glomerulonephritis
3.z Traumaz toz thez bladderz orz abdomen
4.z Renalz cancerz inz thez client'sz familyz -z
z z z z z z z z z z z z z z 3
R:z 1&z 2z arez similar/alike,z andz theyz wouldz involvez az fever.z 4z wouldz
havez flankz painz insteadz ofz lowz abdz pain.
(#z 3)z Thez nursez discussesz plansz forz futurez treatmentz optionsz withz az
clientz withz symptomaticz polycysticz kidneyz disease.z Whichz treatmentz shouldz
bez includedz inz thisz discussion?z Selectz allz thatz apply.
1.z Hemodialysis
2.z Peritonealz dialysis
3.z Kidneyz transplant
4.z Bilateralz nephrectomy
5.z Intensez immunosuppressionz therapyz -z
z z z z z z z z z z z z z z 1,3,4
R:z Polycysticz KDz involvesz cystsz thatz eventuallyz rupturez andz damagez thez
kidneys,z leadingz toz end-stagez renalz disease.z Thisz requiresz optionsz 1,z 3,z
orz 4.z 2z isz contraindicatedz r/tz infection.z 5z won'tz helpz thez pt'sz condition.
1z |z P a g e
,Az clientz isz admittedz toz thez emergencyz departmentz followingz az fallz fromz
az horsez andz thez healthz carez providerz (HCP)z prescribesz insertionz ofz az
urinaryz catheter.z Whilez preparingz forz thez procedure,z thez nursez notesz bloodz
atz thez urinaryz meatus.z Thez nursez shouldz takez whichz action?
1.z Notifyz thez HCPz beforez performingz thez catheterization.
2.z Usez az small-sizedz catheterz andz anz anestheticz gelz asz az lubricant.
3.z Administerz parenteralz painz medicationz beforez insertingz thez catheter.
4.z Cleanz thez meatusz withz soapz andz waterz beforez openingz thez
catheterizationz kit.z -z
z z z z z z z z z z z z z z 1
R:z bloodz mayz =z urethralz trauma,z soz youz needz toz notifyz thez HCPz firstz
soz youz canz identifyz thez truez causez ofz bloodz beforez catheterization.
Sincez there'sz bloodz fromz anz unknownz cause,z youz needz toz assessz firstz
beforez doingz anythingz thatz canz worsenz it.
Thez nursez isz assessingz thez patencyz ofz az client'sz leftz armz arteriovenousz
fistulaz priorz toz initiatingz hemodialysis.z Whichz findingz indicatesz thatz thez
fistulaz isz patent?
1.z Palpationz ofz az thrillz overz thez fistula
2.z Presencez ofz az radialz pulsez inz thez leftz wrist
3.z Visualizationz ofz enlargedz bloodz vesselsz atz thez fistulaz site
4.z Capillaryz refillz lessz thanz 3z secondsz inz thez nailz bedsz ofz thez fingersz
onz thez leftz handz -z
z z z z z z z z z z z z z z 1.
R:z listenz forz az thrillz orz bruitz overz AVz fistulaz site.z Allz otherz optionsz
don'tz REALLYz showz ifz thez AVz fistulaz isz patent,z justz thatz there'sz
perfusionz toz thez hand.
Az malez clientz hasz az tentativez diagnosisz ofz urethritis.z Thez nursez shouldz
assessz thez clientz forz whichz manifestationz ofz thez disorder?
1.z Hematuriaz andz pyuria
2.z Dysuriaz andz proteinuria
3.z Hematuriaz andz urgency
4.z Dysuriaz andz penilez dischargez -z
z z z z z z z z z z z z z z 4.
R:z Urethritisz usuallyz involvesz dysuria,z soz 1&3z arez incorrect.z Proteinuriaz isz
r/tz kidneyz dysfunction,z soz optionz 2z isz alsoz incorrect.z Urethritisz isz alsoz
associatedz withz chlamydia,z soz dischargez isz expected.z Hematuriaz isz notz
assoc.z withz urethritis.
Thez nursez isz assessingz az clientz withz epididymitis.z Thez nursez anticipatesz
whichz findingsz onz physicalz examination?
2z |z P a g e
,1.z Fever,z diarrhea,z groinz pain,z andz ecchymosis
2.z Nausea,z painfulz scrotalz edema,z andz ecchymosis
3.z Fever,z nausea,z vomiting,z andz painfulz scrotalz edema
4.z Diarrhea,z groinz pain,z testicularz torsion,z andz scrotalz edemaz -z
z z z z z z z z z z z z z z 3
R:z -itisz isz associatedz w/z fever,z soz youz canz narrowz itz downz toz 1&3.z
Epididymitisz doesz notz involvez bleedingz soz ecchymosisz (optionz 1)z isz
irrelevant.
Typicalz signsz andz symptomsz ofz epididymitisz includez scrotalz painz andz
edema,z whichz oftenz arez accompaniedz byz fever,z nauseaz andz vomiting,z andz
chills.
Az clientz complainsz ofz fever,z perinealz pain,z andz urinaryz urgency,z
frequency,z andz dysuria.z Toz assessz whetherz thez client'sz problemz isz relatedz
toz bacterialz prostatitis,z thez nursez reviewsz thez resultsz ofz thez prostatez
examinationz forz whichz characteristicz ofz thisz disorder?
1.z Softz andz swollenz prostatez gland
2.z Swollen,z andz boggyz prostatez gland
3.z Tenderz andz edematousz prostatez gland
4.z Tender,z induratedz prostatez glandz thatz isz warmz toz thez touchz -z
z z z z z z z z z z z z z z 4
R:z Thez clientz withz bacterialz prostatitisz hasz az swollenz andz tenderz prostatez
glandz thatz isz alsoz warmz toz thez touch,z firm,z andz indurated.z Systemicz
symptomsz includez feverz withz chills,z perinealz andz lowz backz pain,z andz
signsz ofz urinaryz tractz infection,z whichz oftenz accompanyz thez disorder.
*Remember,z -itis=z inflammation/infection,z soz tendernessz andz localz warmthz isz
expected.z soz optionz 4z isz mostz correct.
Thez nursez isz collectingz dataz fromz az client.z Whichz symptomz describedz byz
thez clientz isz characteristicz ofz anz earlyz symptomz ofz benignz prostaticz
hyperplasia?
1.z Nocturia
2.z Scrotalz edema
3.z Occasionalz constipation
4.z Decreasedz forcez inz thez streamz ofz urinez -z
z z z z z z z z z z z z z z 4
R:z Optionz 1z isz az laterz sign.z 2&3z arez irrelevantz toz BPH.
Thez nursez monitoringz az clientz receivingz peritonealz dialysisz notesz thatz thez
client'sz outflowz isz lessz thanz thez inflow.z Whichz actionsz shouldz thez nursez
take?z Selectz allz thatz apply.
1.z Checkz thez levelz ofz thez drainagez bag.
2.z Repositionz thez clientz toz hisz orz herz side.
3.z Contactz thez healthz carez providerz (HCP).
3z |z P a g e
, 4.z Placez thez clientz inz goodz bodyz alignment.
5.z Checkz thez peritonealz dialysisz systemz forz kinks.
6.z Increasez thez flowz ratez ofz thez peritonealz dialysisz solution.z -z
z z z z z z z z z z z z z z 1,2,4,5
R:z Tryz toz fixz thez flowz yourselfz beforez callingz thez HCPz orz messingz
withz thez flowz rate.z Imbalancez mayz bez r/tz az kinkz orz improperz
positioningz soz fixz thosez first.
Az hemodialysisz clientz withz az leftz armz fistulaz isz atz riskz forz arterialz
stealz syndrome.z Thez nursez shouldz assessz forz whichz manifestationsz ofz thisz
complication?
1.z Warmth,z redness,z andz painz inz thez leftz hand
2.z Ecchymosisz andz audiblez bruitz overz thez fistula
3.z Edemaz andz reddishz discolorationz ofz thez leftz arm
4.z Pallor,z diminishedz pulse,z andz painz inz thez leftz handz -z
z z z z z z z z z z z z z z 4
R:z Arterialz STEALz syndromez involvesz vascularz insufficiencyz (literallyz
stealingz thez bloodz thatz thez hand'sz tissuez needs!).z Soz you'dz seez pallorz
andz otherz signsz ofz decr.z perfusion.
1&3z soundz morez likez anz infectionz soz they'rez incorrect.z Optionz 2z isz az
normalz findingz forz az fistula.
Thez nursez isz reviewingz az client'sz recordz andz notesz thatz thez healthz carez
providerz hasz documentedz thatz thez clientz hasz chronicz renalz disease.z Onz
reviewz ofz thez laboratoryz results,z thez nursez mostz likelyz wouldz expectz toz
notez whichz finding?
1.z Elevatedz creatininez level
2.z Decreasedz hemoglobinz level
3.z Decreasedz redz bloodz cellz count
4.z Increasedz numberz ofz whitez bloodz cellsz inz thez urinez -z
z z z z z z z z z z z z z z 1
R:z Creatz isz increasedz onlyz byz kidneyz dysfunctionz ofz atz leastz 50%z loss.z
2&3z arez irrelevant.z 4z isz morez involvedz w/z UTIs.
Az clientz withz chronicz kidneyz diseasez returnsz toz thez nursingz unitz
followingz az hemodialysisz treatment.z Onz assessment,z thez nursez notesz thatz
thez client'sz temperaturez isz 38.5°Cz (101.2°F).z Whichz nursingz actionz isz mostz
appropriate?
1.z Encouragez fluidz intake.
2.z Notifyz thez healthz carez provider.
3.z Continuez toz monitorz vitalz signs.
4.z Monitorz thez sitez ofz thez shuntz forz infection.z -z
z z z z z z z z z z z z z z 2
4z |z P a g e
(#1)z Az clientz withz acutez kidneyz injuryz hasz az serumz potassiumz levelz ofz
7.0z mEq/Lz (7.0z mmol/L).z Thez nursez shouldz planz whichz actionsz asz az
priority?z Selectz allz thatz apply.
1.z Placez thez clientz onz az cardiacz monitor.
2.z Notifyz thez healthz carez providerz (HCP).
3.z Putz thez clientz onz NPOz (nothingz byz mouth)z statusz exceptz forz icez
chips.
4.z Reviewz thez client'sz medicationsz toz determinez ifz anyz containz orz retainz
potassium.
5.z Allowz anz extraz 500z mLz ofz intravenousz fluidz intakez toz dilutez thez
electrolytez concentration.z -z
z z z z z z z z z z z z z z 1,z 2,z 4
R:z NPOz isz unnecessary.z Addingz extraz fluidz mayz worsenz thez situationz
andz leadz toz fluidz overload.z Excessz Kz canz causez heartz dysrhythmias,z soz
1&4z arez appropriate.z Callingz thez HCPz isz alsoz necessaryz forz furtherz
orders.
(#2)z Az clientz arrivesz atz thez emergencyz departmentz withz complaintsz ofz
lowz abdominalz painz andz hematuria.z Thez clientz isz afebrile.z Thez nursez
nextz assessesz thez clientz toz determinez az historyz ofz whichz condition?
1.z Pyelonephritis
2.z Glomerulonephritis
3.z Traumaz toz thez bladderz orz abdomen
4.z Renalz cancerz inz thez client'sz familyz -z
z z z z z z z z z z z z z z 3
R:z 1&z 2z arez similar/alike,z andz theyz wouldz involvez az fever.z 4z wouldz
havez flankz painz insteadz ofz lowz abdz pain.
(#z 3)z Thez nursez discussesz plansz forz futurez treatmentz optionsz withz az
clientz withz symptomaticz polycysticz kidneyz disease.z Whichz treatmentz shouldz
bez includedz inz thisz discussion?z Selectz allz thatz apply.
1.z Hemodialysis
2.z Peritonealz dialysis
3.z Kidneyz transplant
4.z Bilateralz nephrectomy
5.z Intensez immunosuppressionz therapyz -z
z z z z z z z z z z z z z z 1,3,4
R:z Polycysticz KDz involvesz cystsz thatz eventuallyz rupturez andz damagez thez
kidneys,z leadingz toz end-stagez renalz disease.z Thisz requiresz optionsz 1,z 3,z
orz 4.z 2z isz contraindicatedz r/tz infection.z 5z won'tz helpz thez pt'sz condition.
1z |z P a g e
,Az clientz isz admittedz toz thez emergencyz departmentz followingz az fallz fromz
az horsez andz thez healthz carez providerz (HCP)z prescribesz insertionz ofz az
urinaryz catheter.z Whilez preparingz forz thez procedure,z thez nursez notesz bloodz
atz thez urinaryz meatus.z Thez nursez shouldz takez whichz action?
1.z Notifyz thez HCPz beforez performingz thez catheterization.
2.z Usez az small-sizedz catheterz andz anz anestheticz gelz asz az lubricant.
3.z Administerz parenteralz painz medicationz beforez insertingz thez catheter.
4.z Cleanz thez meatusz withz soapz andz waterz beforez openingz thez
catheterizationz kit.z -z
z z z z z z z z z z z z z z 1
R:z bloodz mayz =z urethralz trauma,z soz youz needz toz notifyz thez HCPz firstz
soz youz canz identifyz thez truez causez ofz bloodz beforez catheterization.
Sincez there'sz bloodz fromz anz unknownz cause,z youz needz toz assessz firstz
beforez doingz anythingz thatz canz worsenz it.
Thez nursez isz assessingz thez patencyz ofz az client'sz leftz armz arteriovenousz
fistulaz priorz toz initiatingz hemodialysis.z Whichz findingz indicatesz thatz thez
fistulaz isz patent?
1.z Palpationz ofz az thrillz overz thez fistula
2.z Presencez ofz az radialz pulsez inz thez leftz wrist
3.z Visualizationz ofz enlargedz bloodz vesselsz atz thez fistulaz site
4.z Capillaryz refillz lessz thanz 3z secondsz inz thez nailz bedsz ofz thez fingersz
onz thez leftz handz -z
z z z z z z z z z z z z z z 1.
R:z listenz forz az thrillz orz bruitz overz AVz fistulaz site.z Allz otherz optionsz
don'tz REALLYz showz ifz thez AVz fistulaz isz patent,z justz thatz there'sz
perfusionz toz thez hand.
Az malez clientz hasz az tentativez diagnosisz ofz urethritis.z Thez nursez shouldz
assessz thez clientz forz whichz manifestationz ofz thez disorder?
1.z Hematuriaz andz pyuria
2.z Dysuriaz andz proteinuria
3.z Hematuriaz andz urgency
4.z Dysuriaz andz penilez dischargez -z
z z z z z z z z z z z z z z 4.
R:z Urethritisz usuallyz involvesz dysuria,z soz 1&3z arez incorrect.z Proteinuriaz isz
r/tz kidneyz dysfunction,z soz optionz 2z isz alsoz incorrect.z Urethritisz isz alsoz
associatedz withz chlamydia,z soz dischargez isz expected.z Hematuriaz isz notz
assoc.z withz urethritis.
Thez nursez isz assessingz az clientz withz epididymitis.z Thez nursez anticipatesz
whichz findingsz onz physicalz examination?
2z |z P a g e
,1.z Fever,z diarrhea,z groinz pain,z andz ecchymosis
2.z Nausea,z painfulz scrotalz edema,z andz ecchymosis
3.z Fever,z nausea,z vomiting,z andz painfulz scrotalz edema
4.z Diarrhea,z groinz pain,z testicularz torsion,z andz scrotalz edemaz -z
z z z z z z z z z z z z z z 3
R:z -itisz isz associatedz w/z fever,z soz youz canz narrowz itz downz toz 1&3.z
Epididymitisz doesz notz involvez bleedingz soz ecchymosisz (optionz 1)z isz
irrelevant.
Typicalz signsz andz symptomsz ofz epididymitisz includez scrotalz painz andz
edema,z whichz oftenz arez accompaniedz byz fever,z nauseaz andz vomiting,z andz
chills.
Az clientz complainsz ofz fever,z perinealz pain,z andz urinaryz urgency,z
frequency,z andz dysuria.z Toz assessz whetherz thez client'sz problemz isz relatedz
toz bacterialz prostatitis,z thez nursez reviewsz thez resultsz ofz thez prostatez
examinationz forz whichz characteristicz ofz thisz disorder?
1.z Softz andz swollenz prostatez gland
2.z Swollen,z andz boggyz prostatez gland
3.z Tenderz andz edematousz prostatez gland
4.z Tender,z induratedz prostatez glandz thatz isz warmz toz thez touchz -z
z z z z z z z z z z z z z z 4
R:z Thez clientz withz bacterialz prostatitisz hasz az swollenz andz tenderz prostatez
glandz thatz isz alsoz warmz toz thez touch,z firm,z andz indurated.z Systemicz
symptomsz includez feverz withz chills,z perinealz andz lowz backz pain,z andz
signsz ofz urinaryz tractz infection,z whichz oftenz accompanyz thez disorder.
*Remember,z -itis=z inflammation/infection,z soz tendernessz andz localz warmthz isz
expected.z soz optionz 4z isz mostz correct.
Thez nursez isz collectingz dataz fromz az client.z Whichz symptomz describedz byz
thez clientz isz characteristicz ofz anz earlyz symptomz ofz benignz prostaticz
hyperplasia?
1.z Nocturia
2.z Scrotalz edema
3.z Occasionalz constipation
4.z Decreasedz forcez inz thez streamz ofz urinez -z
z z z z z z z z z z z z z z 4
R:z Optionz 1z isz az laterz sign.z 2&3z arez irrelevantz toz BPH.
Thez nursez monitoringz az clientz receivingz peritonealz dialysisz notesz thatz thez
client'sz outflowz isz lessz thanz thez inflow.z Whichz actionsz shouldz thez nursez
take?z Selectz allz thatz apply.
1.z Checkz thez levelz ofz thez drainagez bag.
2.z Repositionz thez clientz toz hisz orz herz side.
3.z Contactz thez healthz carez providerz (HCP).
3z |z P a g e
, 4.z Placez thez clientz inz goodz bodyz alignment.
5.z Checkz thez peritonealz dialysisz systemz forz kinks.
6.z Increasez thez flowz ratez ofz thez peritonealz dialysisz solution.z -z
z z z z z z z z z z z z z z 1,2,4,5
R:z Tryz toz fixz thez flowz yourselfz beforez callingz thez HCPz orz messingz
withz thez flowz rate.z Imbalancez mayz bez r/tz az kinkz orz improperz
positioningz soz fixz thosez first.
Az hemodialysisz clientz withz az leftz armz fistulaz isz atz riskz forz arterialz
stealz syndrome.z Thez nursez shouldz assessz forz whichz manifestationsz ofz thisz
complication?
1.z Warmth,z redness,z andz painz inz thez leftz hand
2.z Ecchymosisz andz audiblez bruitz overz thez fistula
3.z Edemaz andz reddishz discolorationz ofz thez leftz arm
4.z Pallor,z diminishedz pulse,z andz painz inz thez leftz handz -z
z z z z z z z z z z z z z z 4
R:z Arterialz STEALz syndromez involvesz vascularz insufficiencyz (literallyz
stealingz thez bloodz thatz thez hand'sz tissuez needs!).z Soz you'dz seez pallorz
andz otherz signsz ofz decr.z perfusion.
1&3z soundz morez likez anz infectionz soz they'rez incorrect.z Optionz 2z isz az
normalz findingz forz az fistula.
Thez nursez isz reviewingz az client'sz recordz andz notesz thatz thez healthz carez
providerz hasz documentedz thatz thez clientz hasz chronicz renalz disease.z Onz
reviewz ofz thez laboratoryz results,z thez nursez mostz likelyz wouldz expectz toz
notez whichz finding?
1.z Elevatedz creatininez level
2.z Decreasedz hemoglobinz level
3.z Decreasedz redz bloodz cellz count
4.z Increasedz numberz ofz whitez bloodz cellsz inz thez urinez -z
z z z z z z z z z z z z z z 1
R:z Creatz isz increasedz onlyz byz kidneyz dysfunctionz ofz atz leastz 50%z loss.z
2&3z arez irrelevant.z 4z isz morez involvedz w/z UTIs.
Az clientz withz chronicz kidneyz diseasez returnsz toz thez nursingz unitz
followingz az hemodialysisz treatment.z Onz assessment,z thez nursez notesz thatz
thez client'sz temperaturez isz 38.5°Cz (101.2°F).z Whichz nursingz actionz isz mostz
appropriate?
1.z Encouragez fluidz intake.
2.z Notifyz thez healthz carez provider.
3.z Continuez toz monitorz vitalz signs.
4.z Monitorz thez sitez ofz thez shuntz forz infection.z -z
z z z z z z z z z z z z z z 2
4z |z P a g e
