Combo NCLEX Renal Exam – Questions / Answers
A client admitted for acute pyelonephritis is about to start antibiotic
therapy. Which symptom would be expected in this client?
1) Hypertension
2) Flank pain on the affected side
3) Pain that radiates toward the unaffected side
4) No tenderness with deep palpation over the
CVA ✔️Ans - RATIONAL: 2) The client may complain of pain on the
affected side because the kidney is enlarged and might have formed an
abscess.
Hypertension is associated with chronic pyelonephritis. Pain may radiate
down the ureters or to the epigastrium. The client would have tenderness
with deep palpation over the CVA.
Discharge instructions for a client treated for acute pyelonephritis should
include which statement?
- 1. Avoid taking any dairy products.
- 2. Return for follow-up urine cultures.
- 3. Stop taking the prescribed antibiotics when the symptoms subside.
- 4. Recurrence is unlikely because you've been treated with
antibiotics. ✔️Ans - RATIONALE: 2) The client needs to return for
follow-up urine cultures because bacteriuria may be present but
asymptomatic. Intake of dairy products won't contribute to pyelonephritis.
Antibiotics need to be taken for the full course of therapy regardless of the
symptoms. Pyelonephritis typically recurs as a relapse or new infection and
frequently recurs within 2 weeks of completing therapy.
A client is complaining of severe flank and abdominal pain. A flat plate of
the abdomen shows urolithiasis. Which intervention is important?
- 1. Strain all urine
- 2. Limit fluid intake
- 3. Enforce strict bed rest.
- 4. Encourage a high-calcium diet ✔️Ans - RATIONALE: 1) Urine
should be strained for calculi and sent to the laboratory for analysis. Fluid
intake of 3 to 4 qt. 3 to 4 L/day is encouraged to flush the urinary tract and
prevent further calculi formation. Ambulation is encouraged to help pass
the calculi through gravity. A low-calcium formation of calcium calculi.
,A client is diagnosed with cystitis. Client teaching aimed at preventing a
recurrence should include which instruction?
- 1. Bathe in a tub.
- 2. Wear cotton underwear.
- 3. Use a feminine hygiene spray.
- 4. Limit your intake of cranberry juice. ✔️Ans - RATIONALE: 2)
Cotton underwear prevents infection because it allows for air to flow to the
perineum. Women should shower instead of taking a tub bath to prevent
infection. Feminine hygiene spray can act as an irritant. Cranberry juice
helps prevent cystitis because it increases urine acidity; alkaline urine
supports bacterial growth, so cranberry juice intake should be increased,
not limited.
When performing a physical assessment, the nurse discovers a
client's urinary drainage bag lying next to him. Based on this
finding, the nurse identifies which priority nursing diagnosis?
- 1. Risk for infection
- 2. Reflex urinary incontinence
- 3. Impaired comfort
- 4. Risk for compromised human dignity ✔️Ans - RATIONALE: 1) The
drainage bag shouldn't be placed alongside the client or on the floor
because of the increased risk of infection caused by microorganisms. It
should hang on the bed in a dependent position. The other nursing
diagnoses are not appropriate for this assessment finding.
A client with renal insufficiency is admitted with a diagnosis of pneumonia.
He's being treated with IV antibiotics, which can be nephrotoxic.
Which laboratory value(s) should be monitored closely?
- 1. Blood Urea Nitrogen (BUN) and creatinine levels.
- 2. Arterial Blood Gas (ABG) levels
- 3. Platelet count
- 4. Potassium level ✔️Ans - RATIONALE: 1) BUN and creatinine levels
should be monitored closely to detect elevations due to nephrotoxicity. ABG
determinations are inappropriate for this situation. Platelets and
potassium levels should be monitored according to routine.
During a health history, which statement by a client indicates a risk of renal
calculi?
, - 1. "I've been drinking a lot of cola soft drinks lately."
- 2. "I've been jogging more than usual."
- 3. "I've had more stress since we adopted a child last
year."
- 4. "I'm a vegetarian and eat cheese two or three times each
day." ✔️Ans - RATIONALE: 4) Renal calculi are commonly
composed of calcium. Diets high in calcium may predispose a person to
renal calculi. Milk and milk products are high in calcium. Cola soft drinks
don't contain ingredients that would increase the risk of renal calculi.
Jogging and increased stress aren't considered risk factors for renal calculi
formation.
The nurse is assessing a client who reports painful urination during and
after voiding. The nurse suspects the client may have a problem with which
area of the client's urinary system?
- 1. Bladder
- 2. Kidneys
- 3. Ureters
- 4. Urethra ✔️Ans - RATIONALE: 1) Pain during or after voiding
indicates a bladder problems, usually infection. Kidney and ureter pain
would be in the flank area, and problems or the urethra would cause pain
at the external orifice that's commonly felt at the start of voiding.
A nurse is instructing a client with oxalate renal calculi. What foods should
the nurse urge the client to eliminate from his diet?
1) Citrus fruits, molasses, and dried apricots
2) Milk, cheese, and ice cream
3) Sardines, liver and kidney
4) Spinach rhubarb and asparagus ✔️Ans - RATIONALE: 4) To reduce
the formation of oxalate calculi, urge the client to avoid foods high in
oxalate, such as spinach, rhubarb, and asparagus. Other oxalate- rich foods
to avoid include tomatoes, beets, chocolate, cocoa, celery, and parsley.
Citrus fruits, molasses, dried apricots, milk, cheese, ice cream, sardines and
organ meats do NOT produce oxalate and do NOT need to be omitted from
the client's diet.
A nurse is assessing a client diagnosed with acute pyelonephritis. Which of
the following symptoms does the nurse expect to see?
1) Jaundice and flank pain
A client admitted for acute pyelonephritis is about to start antibiotic
therapy. Which symptom would be expected in this client?
1) Hypertension
2) Flank pain on the affected side
3) Pain that radiates toward the unaffected side
4) No tenderness with deep palpation over the
CVA ✔️Ans - RATIONAL: 2) The client may complain of pain on the
affected side because the kidney is enlarged and might have formed an
abscess.
Hypertension is associated with chronic pyelonephritis. Pain may radiate
down the ureters or to the epigastrium. The client would have tenderness
with deep palpation over the CVA.
Discharge instructions for a client treated for acute pyelonephritis should
include which statement?
- 1. Avoid taking any dairy products.
- 2. Return for follow-up urine cultures.
- 3. Stop taking the prescribed antibiotics when the symptoms subside.
- 4. Recurrence is unlikely because you've been treated with
antibiotics. ✔️Ans - RATIONALE: 2) The client needs to return for
follow-up urine cultures because bacteriuria may be present but
asymptomatic. Intake of dairy products won't contribute to pyelonephritis.
Antibiotics need to be taken for the full course of therapy regardless of the
symptoms. Pyelonephritis typically recurs as a relapse or new infection and
frequently recurs within 2 weeks of completing therapy.
A client is complaining of severe flank and abdominal pain. A flat plate of
the abdomen shows urolithiasis. Which intervention is important?
- 1. Strain all urine
- 2. Limit fluid intake
- 3. Enforce strict bed rest.
- 4. Encourage a high-calcium diet ✔️Ans - RATIONALE: 1) Urine
should be strained for calculi and sent to the laboratory for analysis. Fluid
intake of 3 to 4 qt. 3 to 4 L/day is encouraged to flush the urinary tract and
prevent further calculi formation. Ambulation is encouraged to help pass
the calculi through gravity. A low-calcium formation of calcium calculi.
,A client is diagnosed with cystitis. Client teaching aimed at preventing a
recurrence should include which instruction?
- 1. Bathe in a tub.
- 2. Wear cotton underwear.
- 3. Use a feminine hygiene spray.
- 4. Limit your intake of cranberry juice. ✔️Ans - RATIONALE: 2)
Cotton underwear prevents infection because it allows for air to flow to the
perineum. Women should shower instead of taking a tub bath to prevent
infection. Feminine hygiene spray can act as an irritant. Cranberry juice
helps prevent cystitis because it increases urine acidity; alkaline urine
supports bacterial growth, so cranberry juice intake should be increased,
not limited.
When performing a physical assessment, the nurse discovers a
client's urinary drainage bag lying next to him. Based on this
finding, the nurse identifies which priority nursing diagnosis?
- 1. Risk for infection
- 2. Reflex urinary incontinence
- 3. Impaired comfort
- 4. Risk for compromised human dignity ✔️Ans - RATIONALE: 1) The
drainage bag shouldn't be placed alongside the client or on the floor
because of the increased risk of infection caused by microorganisms. It
should hang on the bed in a dependent position. The other nursing
diagnoses are not appropriate for this assessment finding.
A client with renal insufficiency is admitted with a diagnosis of pneumonia.
He's being treated with IV antibiotics, which can be nephrotoxic.
Which laboratory value(s) should be monitored closely?
- 1. Blood Urea Nitrogen (BUN) and creatinine levels.
- 2. Arterial Blood Gas (ABG) levels
- 3. Platelet count
- 4. Potassium level ✔️Ans - RATIONALE: 1) BUN and creatinine levels
should be monitored closely to detect elevations due to nephrotoxicity. ABG
determinations are inappropriate for this situation. Platelets and
potassium levels should be monitored according to routine.
During a health history, which statement by a client indicates a risk of renal
calculi?
, - 1. "I've been drinking a lot of cola soft drinks lately."
- 2. "I've been jogging more than usual."
- 3. "I've had more stress since we adopted a child last
year."
- 4. "I'm a vegetarian and eat cheese two or three times each
day." ✔️Ans - RATIONALE: 4) Renal calculi are commonly
composed of calcium. Diets high in calcium may predispose a person to
renal calculi. Milk and milk products are high in calcium. Cola soft drinks
don't contain ingredients that would increase the risk of renal calculi.
Jogging and increased stress aren't considered risk factors for renal calculi
formation.
The nurse is assessing a client who reports painful urination during and
after voiding. The nurse suspects the client may have a problem with which
area of the client's urinary system?
- 1. Bladder
- 2. Kidneys
- 3. Ureters
- 4. Urethra ✔️Ans - RATIONALE: 1) Pain during or after voiding
indicates a bladder problems, usually infection. Kidney and ureter pain
would be in the flank area, and problems or the urethra would cause pain
at the external orifice that's commonly felt at the start of voiding.
A nurse is instructing a client with oxalate renal calculi. What foods should
the nurse urge the client to eliminate from his diet?
1) Citrus fruits, molasses, and dried apricots
2) Milk, cheese, and ice cream
3) Sardines, liver and kidney
4) Spinach rhubarb and asparagus ✔️Ans - RATIONALE: 4) To reduce
the formation of oxalate calculi, urge the client to avoid foods high in
oxalate, such as spinach, rhubarb, and asparagus. Other oxalate- rich foods
to avoid include tomatoes, beets, chocolate, cocoa, celery, and parsley.
Citrus fruits, molasses, dried apricots, milk, cheese, ice cream, sardines and
organ meats do NOT produce oxalate and do NOT need to be omitted from
the client's diet.
A nurse is assessing a client diagnosed with acute pyelonephritis. Which of
the following symptoms does the nurse expect to see?
1) Jaundice and flank pain
