Renal NCLEX Questions and Answers 100% CORRECT

Renal NCLEX Questions and Answers 1. Which of the following symptoms do you expect to see in a patient diagnosed with acute pyelonephritis? 1. Jaundice and flank pain 2. Costovertebral angle tenderness and chills 3. Burning sensation on urination 4. Polyuria and nocturia Correct answer- Answer: 2. Costovertebral angle tenderness, flank pain, and chills are symptoms of acute pyelonephritis. Jaundice indicates gallbladder or liver obstruction. A burning sensation on urination is a sign of lower urinary tract infection. 2. You have a patient that might have a urinary tract infection (UTI). Which statement by the patient suggests that a UTI is likely? 1. "I pee a lot." 2. "It burns when I pee." 3. "I go hours without the urge to pee." 4. "My pee smells sweet." Correct answer- Answer: 2. A common symptom of a UTI is dysuria. A patient with a UTI often reports frequent voiding of small amounts and the urgency to void. Urine that smells sweet is often associated with diabetic ketoacidosis. 3. Which instructions do you include in the teaching care plan for a patient with cystitis receiving phenazopyridine (Pyridium). 1. If the urine turns orange-red, call the doctor. 2. Take phenazopyridine just before urination to relieve pain. 3. Once painful urination is relieved, discontinue prescribed antibiotics. 4. After painful urination is relieved, stop taking phenazopyridine. Correct answer- Answer: 4. Pyridium is taken to relieve dysuria because is provides an analgesic and anesthetic effect on the urinary tract mucosa. The patient can stop taking it after the dysuria is relieved. The urine may temporarily turn red or orange due to the dye in the drug. The drug isn't taken before voiding, and is usually taken 3 times a day for 2 days. 4. Which patient is at greatest risk for developing a urinary tract infection (UTI)? 1. A 35 y.o. woman with a fractured wrist 2. A 20 y.o. woman with asthma 3. A 50 y.o. postmenopausal woman 4. A 28 y.o. with angina Correct answer- Answer: 3. Women are more prone to UTI's after menopause due to reduced estrogen levels. Reduced estrogen levels lead to reduced levels of vaginal Lactobacilli bacteria, which protect against infection. Angina, asthma and fractures don't increase the risk of UTI. 5. You have a patient that is receiving peritoneal dialysis. What should you do when you notice the return fluid is slowly draining? 1. Check for kinks in the outflow tubing. 2. Raise the drainage bag above the level of the abdomen. 3. Place the patient in a reverse Trendelenburg position. 4. Ask the patient to cough. Correct answer- Answer: 1. Tubing problems are a common cause of outflow difficulties, check the tubing for kinks and ensure that all clamps are open. Other measures include having the patient change positions (moving side to side or sitting up), applying gentle pressure over the abdomen, or having a bowel movement. 6. What is the appropriate infusion time for the dialysate in your 38 y.o. patient with chronic renal failure? 1. 15 minutes 2. 30 minutes 3. 1 hour 4. 2 to 3 hours Correct answer- Answer: 1. Dialysate should be infused quickly. The dialysate should be infused over 15 minutes or less when performing peritoneal dialysis. The fluid exchange takes place over a period ranging from 30 minutes to several hours. 7. A 30 y.o. female patient is undergoing hemodialysis with an internal arteriovenous fistula in place. What do you do to prevent complications associated with this device? 1. Insert I.V. lines above the fistula. 2. Avoid taking blood pressures in the arm with the fistula. 3. Palpate pulses above the fistula. 4. Report a bruit or thrill over the fistula to the doctor. Correct answer- Answer: 2. Don't take blood pressure readings in the arm with the fistula because the compression could damage the fistula. IV lines shouldn't be inserted in the arm used for hemodialysis. Palpate pulses below the fistula. Lack of bruit or thrill should be reported to the doctor. 8. Your patient becomes restless and tells you she has a headache and feels nauseous during hemodialysis. Which complication do you suspect? 1. Infection 2. Disequilibrium syndrome 3. Air embolus 4. Acute hemolysis Correct answer- Answer: 2. Disequilibrium syndrome is caused by a rapid reduction in urea, sodium, and other solutes from the blood. This can lead to cerebral edema and increased intracranial pressure (ICP). Signs and symptoms include headache, nausea, restlessness, vomiting, confusion, twitching, and seizures. 9. Your patient is complaining of muscle cramps while undergoing hemodialysis. Which intervention is effective in relieving muscle cramps? 1. Increase the rate of dialysis 2. Infuse normal saline solution 3. Administer a 5% dextrose solution 4. Encourage active ROM exercises Correct answer- Answer: 2. Treatment includes administering normal saline or hypertonic normal saline solution because muscle cramps can occur when the sodium and water are removed to quickly during dialysis. Reducing the rate of dialysis, not increasing it, may alleviate muscle cramps. 10. Your patient with chronic renal failure reports pruritus. Which instruction should you include in this patient's teaching plan? 1. Rub the skin vigorously with a towel 2. Take frequent baths 3. Apply alcohol-based emollients to the skin 4. Keep fingernails short and clean Correct answer- Answer: 4. Calcium-phosphate deposits in the skin may cause pruritus. Scratching leads to excoriation and breaks in the skin that increase the patient's risk of infection. Keeping fingernails short and clean helps reduce the risk of infection. 11. Which intervention do you plan to include with a patient who has renal calculi? 1. Maintain bed rest 2. Increase dietary purines 3. Restrict fluids 4. Strain all urine Correct answer- Answer: 4. All urine should be strained through gauze or a urine strainer to catch stones that are passed. The stones are then analyzed for composition. Ambulation may help the movement of the stone down the urinary tract. Encourage fluid to help flush the stones out. 12. An 18 y.o. student is admitted with dark urine, fever, and flank pain and is diagnosed with acute glomerulonephritis. Which would most likely be in this student's health history? 1. Renal calculi 2. Renal trauma 3. Recent sore throat 4. Family history of acute glomerulonephritis Correct answer- Answer: 3. The most common form of acute glomerulonephritis is caused by group A beta-hemolytic streptococcal infection elsewhere in the body. 13. Which drug is indicated for pain related to acute renal calculi? 1. Narcotic analgesics 2. Nonsteroidal anti-inflammatory drugs (NSAIDS) 3. Muscle relaxants 4. Salicylates Correct answer- Answer: 1. Narcotic analgesics are usually needed to relieve the severe pain of renal calculi. Muscle relaxants are typically used to treat skeletal muscle spasms. NSAIDS and salicylates are used for their anti-inflammatory and antipyretic properties and to treat less severe pain. 14. Which of the following causes the majority of UTI's in hospitalized patients? 1. Lack of fluid intake 2. Inadequate perineal care 3. Invasive procedures 4. Immunosuppression Correct answer- Answer: 3. Invasive procedures such as catheterization can introduce bacteria into the urinary tract. A lack of fluid intake could cause concentration of urine, but wouldn't necessarily cause infection. 15. Clinical manifestations of acute glomerulonephritis include which of the following? 1. Chills and flank pain 2. Oliguria and generalized edema 3. Hematuria and proteinuria 4. Dysuria and hypotension Correct answer- Answer: 3. Hematuria and proteinuria indicate acute glomerulonephritis. These finding result from increased permeability of the glomerular membrane due to the antigen-antibody reaction. Generalized edema is seen most often in nephrosis. 16. You expect a patient in the oliguric phase of renal failure to have a 24 hour urine output less than: 1. 200ml 2. 400ml 3. 800ml 4. 1000ml Correct answer- Answer: 2. Oliguria is defined as urine output of less than 400ml/24hours. 17. The most common early sign of kidney disease is: 1. Sodium retention 2. Elevated BUN level 3. Development of metabolic acidosis 4. Inability to dilute or concentrate urine Correct answer- Answer: 2. Increased BUN is usually an early indicator of decreased renal function. 18. A patient is experiencing which type of incontinence if she experiences leaking urine when she coughs, sneezes, or lifts heavy objects? 1. Overflow 2. Reflex 3. Stress 4. Urge Correct answer- Answer: 3. Stress incontinence is an involuntary loss of a small amount of urine due to sudden increased intra-abdominal pressure, such as with coughing or sneezing. 19. Immediately post-op after a prostatectomy, which complications requires priority assessment of your patient? 1. Pneumonia 2. Hemorrhage 3. Urine retention 4. Deep vein thrombosis Correct answer- Answer: 2. Hemorrhage is a potential complication. Urine retention isn't a problem soon after surgery because a catheter is in place. Pneumonia may occur if the patient doesn't cough and deep breathe. Thrombosis may occur later if the patient doesn't ambulate. 20. The most indicative test for prostate cancer is: 1. A thorough digital rectal examination 2. Magnetic resonance imaging (MRI) 3. Excretory urography 4. Prostate-specific antigen Correct answer- Answer: 4. An elevated prostate-specific antigen level indicates prostate cancer, but it can be falsely elevated if done after the prostate gland is manipulated. A digital rectal examination should be done as part of the yearly screening, and then the antigen test is done if the digital exam suggests cancer. MRI is used in staging the cancer. 21. A 22 y.o. patient with diabetic nephropathy says, "I have two kidneys and I'm still young. If I stick to my insulin schedule, I don't have to worry about kidney damage, right?" Which of the following statements is the best response? 1. "You have little to worry about as long as your kidneys keep making urine." 2. "You should talk to your doctor because statistics show that you're being unrealistic." 3. "You would be correct if your diabetes could be managed with insulin." 4. "Even with insulin, kidney damage is still a concern." Correct answer- Answer: 4. Kidney damage is still a concern. Microvascular changes occur in both of the patient's kidneys as a complication of the diabetes. Diabetic nephropathy is the leading cause of end-stage renal disease. The kidneys continue to produce urine until the end stage. Nephropathy occurs even with insulin management. 22. A patient diagnosed with sepsis from a UTI is being discharged. What do you plan to include in her discharge teaching? 1. Take cool baths 2. Avoid tampon use 3. Avoid sexual activity 4. Drink 8 to 10 eight-oz glasses of water daily Correct answer- Answer: 4. Drinking 2-3L of water daily inhibits bacterial growth in the bladder and helps flush the bacteria from the bladder. The patient should be instructed to void after sexual activity. 23. You're planning your medication teaching for your patient with a UTI prescribed phenazopyridine (Pyridium). What do you include? 1. "Your urine might turn bright orange." 2. "You need to take this antibiotic for 7 days." 3. "Take this drug between meals and at bedtime." 4. "Don't take this drug if you're allergic to penicillin." Correct answer- Answer: 1. The drug turns the urine orange. It may be prescribed for longer than 7 days and is usually ordered three times a day after meals. Phenazopyridine is an azo (nitrogenous) analgesic; not an antibiotic. 24. Which finding leads you to suspect acute glomerulonephritis in your 32 y.o. patient? 1. Dysuria, frequency, and urgency 2. Back pain, nausea, and vomiting 3. Hypertension, oliguria, and fatigue 4. Fever, chills, and right upper quadrant pain radiating to the back Correct answer- Answer: 3. Mild to moderate HTN may result from sodium or water retention and inappropriate renin release from the kidneys. Oliguria and fatigue also may be seen. Other signs are proteinuria and azotemia. 25. What is the priority nursing diagnosis with your patient diagnosed with end-stage renal disease? 1. Activity intolerance 2. Fluid volume excess 3. Knowledge deficit 4. Pain Correct answer- Answer: 2. Fluid volume excess because the kidneys aren't removing fluid and wastes. The other diagnoses may apply, but they don't take priority.