Renal Disorders/Dialysis & Peritoneal
Dialysis NCLEX Questions and Answers
Updated 2026
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?
a. Cream of wheat, blueberries, coffee
b. Sausage and eggs, banana, orange juice.
c. Bacon, cantaloupe melon, tomato juice.
d. Cured pork, grits, strawberries, orange juice. - AnswerA
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 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:
a. During dialysis.
b. Just before dialysis.
c. The day after dialysis.
d. On return from dialysis. - AnswerD
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 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:
a. Discontinue dialysis and notify the physician.
b. Monitor vital signs every 15 minutes for the next hour.
c. Continue dialysis at a slower rate after checking the lines for air.
d. Bolus the client with 500 mL of normal saline to break up the embolus. - AnswerA
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:
a. Amount of activity.
b. Pulse and respiratory rate.
c. Intake and output and weight.
d. Blood urea nitrogen and creatinine levels. - AnswerC
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:
a. Check the shunt for the presence of bruit and thrill.
b. Observe the site once as time permits during the shift.
c. Check the results of the prothrombin times as they are determined.
d. Ensure that small clamps are attached to the arteriovenous shunt dressing. - AnswerD
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.
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?
a. Palpation of a thrill over the fistula.
b. Presence of a radial pulse in the left wrist.
c. Absence of a bruit on auscultation of the fistula.
d. Capillary refill less than 3 seconds in the nail beds of the fingers of the left hand. - AnswerA
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.
,The client newly diagnosed with chronic renal failure recently has begun hemodialysis. Knowing that
the client is at risk for disequilibrium syndrome, the nurse assesses the client during dialysis for:
a. Hypertension, tachycardia, and fever.
b. Hypotension, bradycardia, and hypothermia.
c. Restlessness, irritability, and generalized weakness.
d. Headache, deteriorating level of consciousness, and twitching. - AnswerD
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 brain swelling 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.
A client with chronic renal failure has completed a hemodialysis treatment. The nurse would use
which of the following standard indicators to evaluate the client's status after dialysis?
a. Vital signs and weight.
b. Potassium level and weight.
c. Vital signs and BUN.
d. BUN and creatinine levels. - AnswerA
Following dialysis, the client's vital signs are monitored to determine whether the client is remaining
hemodynamically stable. Weight is measured and compared with the client's predialysis weight to
determine effectiveness of fluid extraction. Laboratory studies are done as per protocol but are not
necessarily done after the hemodialysis treatment has ended.
The hemodialysis client with a left arm fistula is at risk for arterial steal syndrome. The nurse assesses
this client for which of the following manifestations?
a. Warmth, redness, and pain in the left hand.
b. Pallor, diminished pulse, and pain in the left hand.
c. Edema and reddish discoloration of the left arm.
d. Aching pain, pallor, and edema of the left arm. - AnswerB
Steal syndrome results from vascular insufficiency after creation of a fistula. The client exhibits pallor
and a diminished pulse distal to the fistula. The client also complains of pain distal to the fistula,
caused by tissue ischemia. Warmth, redness, and pain probably would characterize a problem with
infection. The manifestations described in options 3 and 4 are incorrect.
, The client with chronic renal failure returns to the nursing unit following a hemodialysis treatment.
On assessment, the nurse notes that the client's temperature is 100.2F. Which of the following is the
appropriate nursing action?
a. Encourage fluids.
b. Notify the physician.
c. Continue to monitor vital signs.
d. Monitor the site of the shunt for infection. - AnswerC
The client may have an elevated temperature following dialysis because the dialysis machine warms
the blood slightly. If the temperature is elevated excessively and remains elevated, sepsis would be
suspected and a blood sample would be obtained as prescribed for culture and sensitivity
determinations.
The nurse is performing an assessment on a client who has returned from the dialysis unit following
hemodialysis. The client is complaining of headache and nausea and is extremely restless. Which of
the following is the most appropriate nursing action?
a. Monitor the client.
b. Notify the physician.
c. Elevate the head of the bed.
d. Medicate the client for nausea. - AnswerB
Disequilibrium syndrome may be caused by the rapid decreases in the blood urea nitrogen level
during hemodialysis. These changes can cause cerebral edema that leads to increased intracranial
pressure. The client is exhibiting early signs of disequilibrium syndrome and appropriate treatments
with anticonvulsive medications and barbiturates may be necessary to prevent a life-threatening
situation. The physician must be notified.
A nurse is analyzing the posthemodialysis lab test results for a client with chronic renal failure (CRF).
The nurse interprets that the dialysis is having an expected but nontherapeutic effect if the results
indicate a decreased:
a. Phosphorus.
b. Creatinine.
c. Potassium.
d. Red blood cell count - AnswerD
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 in dialysis from blood sampling and anticoagulation during the procedure, and from
residual blood that is 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.
Dialysis NCLEX Questions and Answers
Updated 2026
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?
a. Cream of wheat, blueberries, coffee
b. Sausage and eggs, banana, orange juice.
c. Bacon, cantaloupe melon, tomato juice.
d. Cured pork, grits, strawberries, orange juice. - AnswerA
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 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:
a. During dialysis.
b. Just before dialysis.
c. The day after dialysis.
d. On return from dialysis. - AnswerD
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 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:
a. Discontinue dialysis and notify the physician.
b. Monitor vital signs every 15 minutes for the next hour.
c. Continue dialysis at a slower rate after checking the lines for air.
d. Bolus the client with 500 mL of normal saline to break up the embolus. - AnswerA
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:
a. Amount of activity.
b. Pulse and respiratory rate.
c. Intake and output and weight.
d. Blood urea nitrogen and creatinine levels. - AnswerC
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:
a. Check the shunt for the presence of bruit and thrill.
b. Observe the site once as time permits during the shift.
c. Check the results of the prothrombin times as they are determined.
d. Ensure that small clamps are attached to the arteriovenous shunt dressing. - AnswerD
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.
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?
a. Palpation of a thrill over the fistula.
b. Presence of a radial pulse in the left wrist.
c. Absence of a bruit on auscultation of the fistula.
d. Capillary refill less than 3 seconds in the nail beds of the fingers of the left hand. - AnswerA
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.
,The client newly diagnosed with chronic renal failure recently has begun hemodialysis. Knowing that
the client is at risk for disequilibrium syndrome, the nurse assesses the client during dialysis for:
a. Hypertension, tachycardia, and fever.
b. Hypotension, bradycardia, and hypothermia.
c. Restlessness, irritability, and generalized weakness.
d. Headache, deteriorating level of consciousness, and twitching. - AnswerD
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 brain swelling 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.
A client with chronic renal failure has completed a hemodialysis treatment. The nurse would use
which of the following standard indicators to evaluate the client's status after dialysis?
a. Vital signs and weight.
b. Potassium level and weight.
c. Vital signs and BUN.
d. BUN and creatinine levels. - AnswerA
Following dialysis, the client's vital signs are monitored to determine whether the client is remaining
hemodynamically stable. Weight is measured and compared with the client's predialysis weight to
determine effectiveness of fluid extraction. Laboratory studies are done as per protocol but are not
necessarily done after the hemodialysis treatment has ended.
The hemodialysis client with a left arm fistula is at risk for arterial steal syndrome. The nurse assesses
this client for which of the following manifestations?
a. Warmth, redness, and pain in the left hand.
b. Pallor, diminished pulse, and pain in the left hand.
c. Edema and reddish discoloration of the left arm.
d. Aching pain, pallor, and edema of the left arm. - AnswerB
Steal syndrome results from vascular insufficiency after creation of a fistula. The client exhibits pallor
and a diminished pulse distal to the fistula. The client also complains of pain distal to the fistula,
caused by tissue ischemia. Warmth, redness, and pain probably would characterize a problem with
infection. The manifestations described in options 3 and 4 are incorrect.
, The client with chronic renal failure returns to the nursing unit following a hemodialysis treatment.
On assessment, the nurse notes that the client's temperature is 100.2F. Which of the following is the
appropriate nursing action?
a. Encourage fluids.
b. Notify the physician.
c. Continue to monitor vital signs.
d. Monitor the site of the shunt for infection. - AnswerC
The client may have an elevated temperature following dialysis because the dialysis machine warms
the blood slightly. If the temperature is elevated excessively and remains elevated, sepsis would be
suspected and a blood sample would be obtained as prescribed for culture and sensitivity
determinations.
The nurse is performing an assessment on a client who has returned from the dialysis unit following
hemodialysis. The client is complaining of headache and nausea and is extremely restless. Which of
the following is the most appropriate nursing action?
a. Monitor the client.
b. Notify the physician.
c. Elevate the head of the bed.
d. Medicate the client for nausea. - AnswerB
Disequilibrium syndrome may be caused by the rapid decreases in the blood urea nitrogen level
during hemodialysis. These changes can cause cerebral edema that leads to increased intracranial
pressure. The client is exhibiting early signs of disequilibrium syndrome and appropriate treatments
with anticonvulsive medications and barbiturates may be necessary to prevent a life-threatening
situation. The physician must be notified.
A nurse is analyzing the posthemodialysis lab test results for a client with chronic renal failure (CRF).
The nurse interprets that the dialysis is having an expected but nontherapeutic effect if the results
indicate a decreased:
a. Phosphorus.
b. Creatinine.
c. Potassium.
d. Red blood cell count - AnswerD
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 in dialysis from blood sampling and anticoagulation during the procedure, and from
residual blood that is 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.
