NCLEX Renal Exam - Questions And Verified
Answers
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 ✔️Ans - 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 ✔️Ans - 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. ✔️Ans - 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. ✔️Ans - 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. ✔️Ans - 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. ✔️Ans - 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.
✔️Ans - 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. ✔️Ans - 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. ✔️Ans - 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
Answers
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 ✔️Ans - 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 ✔️Ans - 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. ✔️Ans - 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. ✔️Ans - 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. ✔️Ans - 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. ✔️Ans - 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.
✔️Ans - 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. ✔️Ans - 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. ✔️Ans - 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
