Hepatic- Renal NCLEX Q's
A client who is diagnosed with viral hepatitis is complaining of "no appetite" and "losing my taste
for food." What instruction should the nurse give the client to guide adequate nutrition?
1. Select foods high in fat.
2. Increase intake of fluids, including juices.
3. Eat a good supper when anorexia is not as severe.
4. Eat less often, preferably only three large meals daily. -
✅ANSWER: 2
Rationale: Although no special diet is required to treat viral hepatitis, it is generally recommended
that clients consume a low-fat diet, as fat may be tolerated poorly because of decreased bile
production. Small, frequent meals are preferable and may even prevent nausea. Frequently, appetite
is better in the morning, so it is easier to eat a good breakfast. An adequate fluid intake of 2 500 to 3
000 mL/day that includes nutritional juices is also important.
A client has developed hepatitis A after eating contaminated oysters. The nurse assesses the client
for which expected assessment finding?
1. Malaise
2. Dark stools
3. Weight gain
4. Left upper quadrant discomfort -
✅ANSWER: 1
Rationale: Hepatitis causes gastrointestinal symptoms such as anorexia, nausea, right upper
quadrant discomfort, and weight loss. Fatigue and malaise are common. Stools will be light- or
clay-coloured if conjugated bilirubin is unable to flow out of the liver because of inflammation or
obstruction of the bile ducts.
The health care provider has determined that a client has contracted hepatitis A, based on flulike
symptoms and jaundice. Which statement made by the client supports this medical diagnosis?
1. "I have had unprotected sex with multiple partners."
2. "I ate shellfish about 2 weeks ago at a local restaurant."
3. "I was an intravenous drug abuser in the past and shared needles."
4. "I had a blood transfusion 30 years ago after major abdominal surgery." -
✅ANSWER: 2
Rationale: Hepatitis A is transmitted by the fecal-oral route via contaminated water or food
(improperly cooked shellfish) or infected food handlers. Hepatitis B, C, and D are transmitted most
commonly via infected blood or body fluids, such as with intravenous drug abuse, history of blood
transfusion, or unprotected sex with multiple partners.
The nurse is reviewing laboratory results for a client with cirrhosis and notes that the ammonia level
is 51 mcmol/L (85 mcg/dL). Which dietary selection does the nurse suggest to the client?
1. Roast pork
2. Cheese omelet
3. Pasta with sauce
4. Tuna fish sandwich -
✅ANSWER: 3
Rationale: Cirrhosis is a chronic, progressive disease of the liver characterized by diffuse
degeneration and destruction of hepatocytes. The serum ammonia level assesses the ability of the
liver to deaminate protein byproducts. Normal reference interval is 6 to 47 mcmol/L (10 to 80
mcg/dL). Most of the ammonia in the body is found in the gastrointestinal tract. Protein provided by
1
,the diet is transported to the liver by the portal vein. The liver breaks down protein, which results in
formation of ammonia. Foods high in protein should be avoided since the client's ammonia level is
elevated above the normal range; therefore, pasta with sauce would be the best selection.
A client with acute kidney injury has a serum potassium level of 7.0 mmol/L (7.0 mEq/L). The
nurse should plan which immediate actions? Select all that apply.
1. Place the client on a cardiac monitor.
2. Notify the primary health care provider (PHCP).
3. Put the client on NPO (nothing by mouth) status except for ice chips.
4. Review the client's medications to determine if any contain or retain potassium.
5. Allow an extra 500 mL of intravenous fluid intake to dilute the electrolyte concentration. -
✅ANSWER: 1, 2, 4
Rationale: The normal potassium level is 3.5-5.0 mmol/L (3.5-5.0 mEq/L). A potassium level of 7.0
is elevated. 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. The nurse should notify the
PHCP and also review medications to determine if any contain potassium or are potassium
retaining. The client does not need to be put on NPO status. Fluid intake is not increased because it
contributes to fluid overload and would not affect the serum potassium level significantly.
A client with chronic kidney disease undergoing hemodialysis suddenly becomes short of breath
and reports chest pain and anxiety. The client is tachycardic and pale, and the nurse suspects air
embolism. What are the priority nursing actions? Select all that apply.
1. Administer oxygen to the client.
2. Continue dialysis at a slower rate after checking the lines for air.
3. Notify the primary health care provider (PHCP) and Rapid Response Team.
4. Stop dialysis, and turn the client on their left side with head lower than feet.
5. Bolus the client with 500 mL of normal saline to break up the air embolus. -
✅ANSWER: 1, 3, 4
Rationale: If the client experiences air embolus during hemodialysis, the nurse should terminate
dialysis immediately, position the client so the air embolus is on the right side of the heart, notify
the PHCP and Rapid Response Team, and administer oxygen as needed. Slowing the dialysis
treatment or giving an intravenous bolus will not correct the air embolism or prevent complications.
A client arrives at the emergency department with low abdominal pain and hematuria. The client is
afebrile. What is the most likely cause associated with this presentation?
1. Pyelonephritis
2. Glomerulonephritis
3. Trauma to the bladder or abdomen
4. Renal cancer in the client's family -
✅ANSWER: 3
Rationale: 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 described in this question. Renal cancer would not
cause pain that is felt in the low abdomen; rather, the pain would be in the flank area.
A client is admitted to the emergency department following a fall from a horse and is prescribed
insertion of a urinary catheter. While preparing for the procedure, the nurse notes blood at the
urinary meatus. The nurse should take which action next?
1. Notify the PHCP before performing the catheterization.
2. Use a small-sized catheter and an anaesthetic gel as a lubricant.
3. Administer parenteral pain medication before inserting the catheter.
4. Clean the meatus with soap and water before opening the catheterization kit. -
2
, ✅ANSWER: 1
Rationale: The presence of blood at the urinary meatus may indicate urethral trauma or disruption.
The nurse should notify the PHCP, knowing that the client should not be catheterized until the cause
of the bleeding is determined by diagnostic testing. The other options include performing the
catheterization procedure and therefore are incorrect.
What laboratory result would the nurse most likely expect to find for a client diagnosed with
chronic renal disease?
1. Elevated creatinine level
2. Decreased hemoglobin level
3. Decreased red blood cell count
4. Increased number of white blood cells in the urine -
✅ANSWER: 1
Rationale: The creatinine level is the most specific laboratory test used to determine renal function.
The creatinine level increases when at least 50% of renal function is lost. A decreased hemoglobin
level and red blood cell count are associated with anemia or blood loss and not specifically with
decreased renal function. Increased white blood cells in the urine are noted with urinary tract
infection.
A client with chronic kidney disease returns to the nursing unit following hemodialysis treatment.
On assessment, the nurse notes that the client's temperature is 38.5°C. Which nursing action is most
appropriate?
1. Encourage fluid intake.
2. Continue to monitor vital signs.
3. Notify the primary health care provider.
4. Monitor the site of the shunt for infection. -
✅ANSWER: 3
Rationale: A temperature of 38.5°C is significantly elevated and may indicate infection as a
complication of this ongoing treatment. The nurse should notify the primary health care provider
(PHCP). Dialysis clients cannot have fluid intake encouraged. Vital signs and the shunt site should
be monitored, but the PHCP should be notified first, as sepsis is a risk.
A client with chronic kidney disease is receiving epoetin alfa. Which laboratory result would
indicate a therapeutic effect of the medication?
1. Hematocrit of 0.33 (33%)
2. Platelet count of 400 × 109/L (400 000 mm3)
3. White blood cell count of 6.0 × 109/L (6 000 mm3)
4. Blood urea nitrogen level of 5.25 mmol/L (15 mg/dL) -
✅ANSWER: 1
Rationale: Epoetin alfa is synthetic erythropoietin, which the kidneys produce to stimulate red
blood cell production in the bone marrow. It is used to treat anemia associated with chronic kidney
disease. The normal hematocrit level for males is 0.42 to 0.52 (42 to 52%) and for females, 0.37 to
0.47 (37 to 47%). Therapeutic effect is seen when the hematocrit reaches between 0.30 and 0.33 (30
and 33%). The normal platelet count is 150 to 400 × 109/L (150 000 to 400 000 mm3). The normal
blood urea nitrogen level is 3.6 to 7.1 mmol/L (10 to 20 mg/dL). The normal white blood cell count
is 5 to 10 × 109/L (5 000 to 10 000 mm3). Platelet production, white blood cell production, and
blood urea nitrogen do not respond to erythropoietin.
______________ is solely filtered from the bloodstream via the glomerulus and is NOT reabsorbed
back into the bloodstream but is excreted through the urine.
A. Urea
B. Creatinine
3
A client who is diagnosed with viral hepatitis is complaining of "no appetite" and "losing my taste
for food." What instruction should the nurse give the client to guide adequate nutrition?
1. Select foods high in fat.
2. Increase intake of fluids, including juices.
3. Eat a good supper when anorexia is not as severe.
4. Eat less often, preferably only three large meals daily. -
✅ANSWER: 2
Rationale: Although no special diet is required to treat viral hepatitis, it is generally recommended
that clients consume a low-fat diet, as fat may be tolerated poorly because of decreased bile
production. Small, frequent meals are preferable and may even prevent nausea. Frequently, appetite
is better in the morning, so it is easier to eat a good breakfast. An adequate fluid intake of 2 500 to 3
000 mL/day that includes nutritional juices is also important.
A client has developed hepatitis A after eating contaminated oysters. The nurse assesses the client
for which expected assessment finding?
1. Malaise
2. Dark stools
3. Weight gain
4. Left upper quadrant discomfort -
✅ANSWER: 1
Rationale: Hepatitis causes gastrointestinal symptoms such as anorexia, nausea, right upper
quadrant discomfort, and weight loss. Fatigue and malaise are common. Stools will be light- or
clay-coloured if conjugated bilirubin is unable to flow out of the liver because of inflammation or
obstruction of the bile ducts.
The health care provider has determined that a client has contracted hepatitis A, based on flulike
symptoms and jaundice. Which statement made by the client supports this medical diagnosis?
1. "I have had unprotected sex with multiple partners."
2. "I ate shellfish about 2 weeks ago at a local restaurant."
3. "I was an intravenous drug abuser in the past and shared needles."
4. "I had a blood transfusion 30 years ago after major abdominal surgery." -
✅ANSWER: 2
Rationale: Hepatitis A is transmitted by the fecal-oral route via contaminated water or food
(improperly cooked shellfish) or infected food handlers. Hepatitis B, C, and D are transmitted most
commonly via infected blood or body fluids, such as with intravenous drug abuse, history of blood
transfusion, or unprotected sex with multiple partners.
The nurse is reviewing laboratory results for a client with cirrhosis and notes that the ammonia level
is 51 mcmol/L (85 mcg/dL). Which dietary selection does the nurse suggest to the client?
1. Roast pork
2. Cheese omelet
3. Pasta with sauce
4. Tuna fish sandwich -
✅ANSWER: 3
Rationale: Cirrhosis is a chronic, progressive disease of the liver characterized by diffuse
degeneration and destruction of hepatocytes. The serum ammonia level assesses the ability of the
liver to deaminate protein byproducts. Normal reference interval is 6 to 47 mcmol/L (10 to 80
mcg/dL). Most of the ammonia in the body is found in the gastrointestinal tract. Protein provided by
1
,the diet is transported to the liver by the portal vein. The liver breaks down protein, which results in
formation of ammonia. Foods high in protein should be avoided since the client's ammonia level is
elevated above the normal range; therefore, pasta with sauce would be the best selection.
A client with acute kidney injury has a serum potassium level of 7.0 mmol/L (7.0 mEq/L). The
nurse should plan which immediate actions? Select all that apply.
1. Place the client on a cardiac monitor.
2. Notify the primary health care provider (PHCP).
3. Put the client on NPO (nothing by mouth) status except for ice chips.
4. Review the client's medications to determine if any contain or retain potassium.
5. Allow an extra 500 mL of intravenous fluid intake to dilute the electrolyte concentration. -
✅ANSWER: 1, 2, 4
Rationale: The normal potassium level is 3.5-5.0 mmol/L (3.5-5.0 mEq/L). A potassium level of 7.0
is elevated. 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. The nurse should notify the
PHCP and also review medications to determine if any contain potassium or are potassium
retaining. The client does not need to be put on NPO status. Fluid intake is not increased because it
contributes to fluid overload and would not affect the serum potassium level significantly.
A client with chronic kidney disease undergoing hemodialysis suddenly becomes short of breath
and reports chest pain and anxiety. The client is tachycardic and pale, and the nurse suspects air
embolism. What are the priority nursing actions? Select all that apply.
1. Administer oxygen to the client.
2. Continue dialysis at a slower rate after checking the lines for air.
3. Notify the primary health care provider (PHCP) and Rapid Response Team.
4. Stop dialysis, and turn the client on their left side with head lower than feet.
5. Bolus the client with 500 mL of normal saline to break up the air embolus. -
✅ANSWER: 1, 3, 4
Rationale: If the client experiences air embolus during hemodialysis, the nurse should terminate
dialysis immediately, position the client so the air embolus is on the right side of the heart, notify
the PHCP and Rapid Response Team, and administer oxygen as needed. Slowing the dialysis
treatment or giving an intravenous bolus will not correct the air embolism or prevent complications.
A client arrives at the emergency department with low abdominal pain and hematuria. The client is
afebrile. What is the most likely cause associated with this presentation?
1. Pyelonephritis
2. Glomerulonephritis
3. Trauma to the bladder or abdomen
4. Renal cancer in the client's family -
✅ANSWER: 3
Rationale: 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 described in this question. Renal cancer would not
cause pain that is felt in the low abdomen; rather, the pain would be in the flank area.
A client is admitted to the emergency department following a fall from a horse and is prescribed
insertion of a urinary catheter. While preparing for the procedure, the nurse notes blood at the
urinary meatus. The nurse should take which action next?
1. Notify the PHCP before performing the catheterization.
2. Use a small-sized catheter and an anaesthetic gel as a lubricant.
3. Administer parenteral pain medication before inserting the catheter.
4. Clean the meatus with soap and water before opening the catheterization kit. -
2
, ✅ANSWER: 1
Rationale: The presence of blood at the urinary meatus may indicate urethral trauma or disruption.
The nurse should notify the PHCP, knowing that the client should not be catheterized until the cause
of the bleeding is determined by diagnostic testing. The other options include performing the
catheterization procedure and therefore are incorrect.
What laboratory result would the nurse most likely expect to find for a client diagnosed with
chronic renal disease?
1. Elevated creatinine level
2. Decreased hemoglobin level
3. Decreased red blood cell count
4. Increased number of white blood cells in the urine -
✅ANSWER: 1
Rationale: The creatinine level is the most specific laboratory test used to determine renal function.
The creatinine level increases when at least 50% of renal function is lost. A decreased hemoglobin
level and red blood cell count are associated with anemia or blood loss and not specifically with
decreased renal function. Increased white blood cells in the urine are noted with urinary tract
infection.
A client with chronic kidney disease returns to the nursing unit following hemodialysis treatment.
On assessment, the nurse notes that the client's temperature is 38.5°C. Which nursing action is most
appropriate?
1. Encourage fluid intake.
2. Continue to monitor vital signs.
3. Notify the primary health care provider.
4. Monitor the site of the shunt for infection. -
✅ANSWER: 3
Rationale: A temperature of 38.5°C is significantly elevated and may indicate infection as a
complication of this ongoing treatment. The nurse should notify the primary health care provider
(PHCP). Dialysis clients cannot have fluid intake encouraged. Vital signs and the shunt site should
be monitored, but the PHCP should be notified first, as sepsis is a risk.
A client with chronic kidney disease is receiving epoetin alfa. Which laboratory result would
indicate a therapeutic effect of the medication?
1. Hematocrit of 0.33 (33%)
2. Platelet count of 400 × 109/L (400 000 mm3)
3. White blood cell count of 6.0 × 109/L (6 000 mm3)
4. Blood urea nitrogen level of 5.25 mmol/L (15 mg/dL) -
✅ANSWER: 1
Rationale: Epoetin alfa is synthetic erythropoietin, which the kidneys produce to stimulate red
blood cell production in the bone marrow. It is used to treat anemia associated with chronic kidney
disease. The normal hematocrit level for males is 0.42 to 0.52 (42 to 52%) and for females, 0.37 to
0.47 (37 to 47%). Therapeutic effect is seen when the hematocrit reaches between 0.30 and 0.33 (30
and 33%). The normal platelet count is 150 to 400 × 109/L (150 000 to 400 000 mm3). The normal
blood urea nitrogen level is 3.6 to 7.1 mmol/L (10 to 20 mg/dL). The normal white blood cell count
is 5 to 10 × 109/L (5 000 to 10 000 mm3). Platelet production, white blood cell production, and
blood urea nitrogen do not respond to erythropoietin.
______________ is solely filtered from the bloodstream via the glomerulus and is NOT reabsorbed
back into the bloodstream but is excreted through the urine.
A. Urea
B. Creatinine
3
