NCLEX Urinary/Renal Function/Disorder
and Electrolyte Imbalance
A client is admitted for treatment of chronic renal failure (CRF). The nurse knows that this
disorder increases the client's risk of:
a) a decreased serum phosphate level secondary to kidney failure.
b) an increased serum calcium level secondary to kidney failure.
c) water and sodium retention secondary to a severe decrease in the glomerular filtration rate.
d) metabolic alkalosis secondary to retention of hydrogen ions. -
C) water and sodium retention secondary to a severe decrease in the glomerular
filtration rate.
Explanation: The client with CRF is at risk for fluid imbalance — dehydration if the kidneys
fail to concentrate urine, or fluid retention if the kidneys fail to produce urine. Electrolyte
imbalances associated with this disorder result from the kidneys' inability to excrete
phosphorus; such imbalances may lead to hyperphosphatemia with reciprocal hypocalcemia.
CRF may cause metabolic acidosis, not metabolic alkalosis, secondary to inability of the
kidneys to excrete hydrogen ions.
Which is the correct term for the ability of the kidneys to clear solutes from the plasma?
a) Glomerular filtration rate (GFR)
b) Renal clearance
c) Specific gravity
d) Tubular secretion -
B) Renal Clearance
Explanation: Renal clearance refers to the ability of the kidneys to clear solutes from the
plasma. GFR is the volume of plasma filtered at the glomerulus into the kidney tubules each
minute. Specific gravity reflects the weight of particles dissolved in the urine. Tubular
secretion is the movement of a substance from the kidney tubule into the blood in the
peritubular capillaries or vasa recta.
A client is admitted with nausea, vomiting, and diarrhea. His blood pressure on admission is
74/30 mm Hg. The client is oliguric and his blood urea nitrogen (BUN) and creatinine levels
are elevated. The physician will most likely write an order for which treatment?
a) Start I.V. fluids with a normal saline solution bolus followed by a maintenance dose.
b) Administer furosemide (Lasix) 20 mg I.V.
c) Encourage oral fluids.
d) Start hemodialysis after a temporary access is obtained. -
A) Start IV fluids with normal saline solution bolus followed by a maintenance
dose.
Explanation: The client is in prerenal failure caused by hypovolemia. I.V. fluids should be
given with a bolus of normal saline solution followed by maintenance I.V. therapy. This
treatment should rehydrate the client, causing his blood pressure to rise, his urine output to
increase, and the BUN and creatinine levels to normalize. The client wouldn't be able to
tolerate oral fluids because of the nausea, vomiting, and diarrhea. The client isn't fluid-
overloaded so his urine output won't increase with furosemide, which would actually worsen
the client's condition. The client doesn't require dialysis because the oliguria and elevated
BUN and creatinine levels are caused by dehydration.
1|Page
,Which of the following would the nurse expect to find when reviewing the laboratory test
results of a client with renal failure?
a) Increased red blood cell count
b) Decreased serum potassium level
c) Increased serum calcium level
d) Increased serum creatinine level -
D) Increased serum creatinine level
Explanation: In renal failure, laboratory blood tests reveal elevations in BUN, creatinine,
potassium, magnesium, and phosphorus. Calcium levels are low. The RBC count, hematocrit,
and hemoglobin are decreased.
A nurse assesses a client shortly after living donor kidney transplant surgery. Which
postoperative finding must the nurse report to the physician immediately?
a) Serum sodium level of 135 mEq/L
b) Serum potassium level of 4.9 mEq/L
c) Temperature of 99.2° F (37.3° C)
d) Urine output of 20 ml/hour -
D) Urine output of 20 ml/hour
Explanation: Because kidney transplantation carries the risk of transplant rejection, infection,
and other serious complications, the nurse should monitor the client's urinary function
closely. A decrease from the normal urine output of 30 ml/hour is significant and warrants
immediate physician notification. A serum potassium level of 4.9 mEq/L, a serum sodium
level of 135 mEq/L, and a temperature of 99.2° F are normal assessment findings.
After teaching a group of students about how to perform peritoneal dialysis, which statement
would indicate to the instructor that the students need additional teaching?
a) "The effluent should be allowed to drain by gravity."
b) "It is important to use strict aseptic technique."
c) "The infusion clamp should be open during infusion."
d) "It is appropriate to warm the dialysate in a microwave." -
D) It is appropriate to warm the dialysate in a microwave
Explanation: The dialysate should be warmed in a commercial warmer and never in a
microwave oven. Strict aseptic technique is essential. The infusion clamp is opened during
the infusion and clamped after the infusion. When the dwell time is done, the drain clamp is
opened and the fluid is allowed to drain by gravity into the drainage bag.
A nurse is reviewing the history of a client who is suspected of having glomerulonephritis.
Which of the following would the nurse consider significant?
a) History of hyperparathyroidism
b) History of osteoporosis
c) Recent history of streptococcal infection
d) Previous episode of acute pyelonephritis -
C) Recent hx of streptococcal infection
Explanation: Glomerulonephritis can occur as a result of infections from group A beta-
hemolytic streptococcal infections, bacterial endocarditis, or viral infections such as hepatitis
B or C or human immunodeficiency virus (HIV). A history of hyperparathyroidism or
osteoporosis would place the client at risk for developing renal calculi. A history of
pyelonephritis would increase the client's risk for chronic pyelonephritis.
2|Page
, A client presents at the testing center for an intravenous pyelogram. What question should the
nurse ask to ensure the safety of the client?
a) "Have you any artificial joints?"
b) "Do you have a pacemaker?"
c) "Do you have any allergies?"
d) "Who has come with you today?" -
C) Do you have any allergies?
Explanation: Many contrast dyes contain iodine. Therefore, it is essential for the nurse to
determine whether the client has any allergies, especially to iodine, shellfish, and other
seafood.
The client asks the nurse about the functions of the kidney. Which should the nurse include
when responding to the client? Select all that apply.
a) Vitamin D synthesis
b) Secretion of prostaglandins
c) Vitamin B production
d) Secretion of insulin
e) Regulation of blood pressure -
A) Vitamin D synthesis
B) Secretion of prostaglandins
E) Regulation of blood pressure
Explanation: Functions of the kidney include secretion of prostaglandins, regulation of blood
pressure, and synthesis of aldosterone and vitamin D. The pancreas secretes insulin. The body
does not produce Vitamin B.
A client is scheduled for a creatinine clearance test. The nurse should explain that this test is
done to assess the kidneys' ability to remove a substance from the plasma in:
a) 1 hour.
b) 24 hours.
c) 1 minute.
d) 30 minutes. -
C) 1 minute
Explanation: The creatinine clearance test determines the kidneys' ability to remove a
substance from the plasma in 1 minute. It doesn't measure the kidneys' ability to remove a
substance over a longer period.
A client with renal failure is undergoing continuous ambulatory peritoneal dialysis. Which
nursing diagnosis is the most appropriate for this client?
a) Impaired urinary elimination
b) Toileting self-care deficit
c) Risk for infection
d) Activity intolerance -
C) Risk for infection
Explanation: The peritoneal dialysis catheter and regular exchanges of the dialysis bag
provide a direct portal for bacteria to enter the body. If the client experiences repeated
peritoneal infections, continuous ambulatory peritoneal dialysis may no longer be effective in
clearing waste products. Impaired urinary elimination, Toileting self-care deficit, and
Activity intolerance may be pertinent but are secondary to the risk of infection.
3|Page
and Electrolyte Imbalance
A client is admitted for treatment of chronic renal failure (CRF). The nurse knows that this
disorder increases the client's risk of:
a) a decreased serum phosphate level secondary to kidney failure.
b) an increased serum calcium level secondary to kidney failure.
c) water and sodium retention secondary to a severe decrease in the glomerular filtration rate.
d) metabolic alkalosis secondary to retention of hydrogen ions. -
C) water and sodium retention secondary to a severe decrease in the glomerular
filtration rate.
Explanation: The client with CRF is at risk for fluid imbalance — dehydration if the kidneys
fail to concentrate urine, or fluid retention if the kidneys fail to produce urine. Electrolyte
imbalances associated with this disorder result from the kidneys' inability to excrete
phosphorus; such imbalances may lead to hyperphosphatemia with reciprocal hypocalcemia.
CRF may cause metabolic acidosis, not metabolic alkalosis, secondary to inability of the
kidneys to excrete hydrogen ions.
Which is the correct term for the ability of the kidneys to clear solutes from the plasma?
a) Glomerular filtration rate (GFR)
b) Renal clearance
c) Specific gravity
d) Tubular secretion -
B) Renal Clearance
Explanation: Renal clearance refers to the ability of the kidneys to clear solutes from the
plasma. GFR is the volume of plasma filtered at the glomerulus into the kidney tubules each
minute. Specific gravity reflects the weight of particles dissolved in the urine. Tubular
secretion is the movement of a substance from the kidney tubule into the blood in the
peritubular capillaries or vasa recta.
A client is admitted with nausea, vomiting, and diarrhea. His blood pressure on admission is
74/30 mm Hg. The client is oliguric and his blood urea nitrogen (BUN) and creatinine levels
are elevated. The physician will most likely write an order for which treatment?
a) Start I.V. fluids with a normal saline solution bolus followed by a maintenance dose.
b) Administer furosemide (Lasix) 20 mg I.V.
c) Encourage oral fluids.
d) Start hemodialysis after a temporary access is obtained. -
A) Start IV fluids with normal saline solution bolus followed by a maintenance
dose.
Explanation: The client is in prerenal failure caused by hypovolemia. I.V. fluids should be
given with a bolus of normal saline solution followed by maintenance I.V. therapy. This
treatment should rehydrate the client, causing his blood pressure to rise, his urine output to
increase, and the BUN and creatinine levels to normalize. The client wouldn't be able to
tolerate oral fluids because of the nausea, vomiting, and diarrhea. The client isn't fluid-
overloaded so his urine output won't increase with furosemide, which would actually worsen
the client's condition. The client doesn't require dialysis because the oliguria and elevated
BUN and creatinine levels are caused by dehydration.
1|Page
,Which of the following would the nurse expect to find when reviewing the laboratory test
results of a client with renal failure?
a) Increased red blood cell count
b) Decreased serum potassium level
c) Increased serum calcium level
d) Increased serum creatinine level -
D) Increased serum creatinine level
Explanation: In renal failure, laboratory blood tests reveal elevations in BUN, creatinine,
potassium, magnesium, and phosphorus. Calcium levels are low. The RBC count, hematocrit,
and hemoglobin are decreased.
A nurse assesses a client shortly after living donor kidney transplant surgery. Which
postoperative finding must the nurse report to the physician immediately?
a) Serum sodium level of 135 mEq/L
b) Serum potassium level of 4.9 mEq/L
c) Temperature of 99.2° F (37.3° C)
d) Urine output of 20 ml/hour -
D) Urine output of 20 ml/hour
Explanation: Because kidney transplantation carries the risk of transplant rejection, infection,
and other serious complications, the nurse should monitor the client's urinary function
closely. A decrease from the normal urine output of 30 ml/hour is significant and warrants
immediate physician notification. A serum potassium level of 4.9 mEq/L, a serum sodium
level of 135 mEq/L, and a temperature of 99.2° F are normal assessment findings.
After teaching a group of students about how to perform peritoneal dialysis, which statement
would indicate to the instructor that the students need additional teaching?
a) "The effluent should be allowed to drain by gravity."
b) "It is important to use strict aseptic technique."
c) "The infusion clamp should be open during infusion."
d) "It is appropriate to warm the dialysate in a microwave." -
D) It is appropriate to warm the dialysate in a microwave
Explanation: The dialysate should be warmed in a commercial warmer and never in a
microwave oven. Strict aseptic technique is essential. The infusion clamp is opened during
the infusion and clamped after the infusion. When the dwell time is done, the drain clamp is
opened and the fluid is allowed to drain by gravity into the drainage bag.
A nurse is reviewing the history of a client who is suspected of having glomerulonephritis.
Which of the following would the nurse consider significant?
a) History of hyperparathyroidism
b) History of osteoporosis
c) Recent history of streptococcal infection
d) Previous episode of acute pyelonephritis -
C) Recent hx of streptococcal infection
Explanation: Glomerulonephritis can occur as a result of infections from group A beta-
hemolytic streptococcal infections, bacterial endocarditis, or viral infections such as hepatitis
B or C or human immunodeficiency virus (HIV). A history of hyperparathyroidism or
osteoporosis would place the client at risk for developing renal calculi. A history of
pyelonephritis would increase the client's risk for chronic pyelonephritis.
2|Page
, A client presents at the testing center for an intravenous pyelogram. What question should the
nurse ask to ensure the safety of the client?
a) "Have you any artificial joints?"
b) "Do you have a pacemaker?"
c) "Do you have any allergies?"
d) "Who has come with you today?" -
C) Do you have any allergies?
Explanation: Many contrast dyes contain iodine. Therefore, it is essential for the nurse to
determine whether the client has any allergies, especially to iodine, shellfish, and other
seafood.
The client asks the nurse about the functions of the kidney. Which should the nurse include
when responding to the client? Select all that apply.
a) Vitamin D synthesis
b) Secretion of prostaglandins
c) Vitamin B production
d) Secretion of insulin
e) Regulation of blood pressure -
A) Vitamin D synthesis
B) Secretion of prostaglandins
E) Regulation of blood pressure
Explanation: Functions of the kidney include secretion of prostaglandins, regulation of blood
pressure, and synthesis of aldosterone and vitamin D. The pancreas secretes insulin. The body
does not produce Vitamin B.
A client is scheduled for a creatinine clearance test. The nurse should explain that this test is
done to assess the kidneys' ability to remove a substance from the plasma in:
a) 1 hour.
b) 24 hours.
c) 1 minute.
d) 30 minutes. -
C) 1 minute
Explanation: The creatinine clearance test determines the kidneys' ability to remove a
substance from the plasma in 1 minute. It doesn't measure the kidneys' ability to remove a
substance over a longer period.
A client with renal failure is undergoing continuous ambulatory peritoneal dialysis. Which
nursing diagnosis is the most appropriate for this client?
a) Impaired urinary elimination
b) Toileting self-care deficit
c) Risk for infection
d) Activity intolerance -
C) Risk for infection
Explanation: The peritoneal dialysis catheter and regular exchanges of the dialysis bag
provide a direct portal for bacteria to enter the body. If the client experiences repeated
peritoneal infections, continuous ambulatory peritoneal dialysis may no longer be effective in
clearing waste products. Impaired urinary elimination, Toileting self-care deficit, and
Activity intolerance may be pertinent but are secondary to the risk of infection.
3|Page
