NCLEX Renal Exam – Questions & Answers
A nurse is inserting an indwelling urinary catheter into a male client. As the
catheter is inserted into the urethra, urine begins to flow into the tubing. At
this point, the nurse:
1. Immediately inflates the balloon
2. Inserts the catheter 2.5 to 5 cm and inflates the balloon
3. Inserts the catheter until resistance is met and inflates the balloon
4. Withdraws the catheter approximately 1 inch and inflates the balloon
✔️Ans - 2. Inserts the catheter 2.5 to 5 cm and inflates the balloon
Rationale:
The catheter's balloon is behind the opening at the insertion tip. The
catheter is inserted 2.5 to 5 cm after urine begins to flow to provide
sufficient space to inflate the balloon. Inserting the catheter the extra
distance will ensure that the balloon is inflated inside the bladder and not
in the urethra, which could produce trauma.
A nurse is caring for the client with epididymitis. The nurse understands
that which treatment modality could increase swelling in the affected area?
1. Bedrest
2. Sitz bath
3. Heating pad
4. Scrotal elevation ✔️Ans - 3. Heating pad
Rationale:
Common interventions used in the treatment of epididymitis include
bedrest, elevation of the scrotum, ice packs, sitz baths, analgesics, and
antibiotics. A heating pad would not be used because direct application of
heat could increase blood flow to the area and increase the swelling.
,A client has epididymitis as a complication of urinary tract infection (UTI).
The nurse is giving the client instructions to prevent a recurrence. The
nurse determines that the client needs further instruction if the client
states the intention to:
1. Drink increased amounts of fluids.
2. Limit the force of the stream during voiding.
3. Continue to take antibiotics until all symptoms are gone.
4. Use condoms to eliminate risk from chlamydia and gonorrhea.
✔️Ans - 3. Continue to take antibiotics until all symptoms are gone.
Rationale:
The client who experiences epididymitis from UTI should increase intake of
fluids to flush the urinary system. Because organisms can be forced into the
vas deferens and epididymis from strain or pressure during voiding, the
client should limit the force of the stream. Condom use can help prevent
urethritis and epididymitis from sexually transmitted infections.
Antibiotics are always taken until the full course of therapy is completed.
A nurse is collecting data from a client who has had benign prostatic
hyperplasia (BPH) in the past. To determine if the client is currently
experiencing exacerbation of BPH, the nurse asks the client about the
presence of which early symptom?
1. Nocturia
2. Urinary retention
3. Urge incontinence
4. Decreased force in the stream of urine ✔️Ans - 4. Decreased force
in the stream of urine
Rationale:
Decreased force in the stream of urine is an early sign of BPH. The stream
later becomes weak and dribbling. The client may then develop hematuria,
,frequency, urgency, urge incontinence, and nocturia. If untreated, complete
obstruction and urinary retention can occur.
A client newly diagnosed with chronic renal failure has recently begun
hemodialysis. Knowing that the client is at risk for disequilibrium
syndrome, the nurse monitors the client during dialysis for:
1. Hypertension, tachycardia, and fever
2. Hypotension, bradycardia, and hypothermia
3. Restlessness, irritability, and generalized weakness
4. Headache, deteriorating level of consciousness, and twitching
✔️Ans - 4. Headache, deteriorating level of consciousness, and twitching
Rationale:
Disequilibrium syndrome is characterized by headache, mental confusion,
decreasing level of consciousness, nausea and vomiting, twitching, and
possible seizure activity. It 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. It 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 been on dialysis for 3 years. The
client is receiving the usual combination of medications for the disease,
including aluminum hydroxide as a phosphate-binding agent. The client
now has mental cloudiness, dementia, and complaints of bone pain. The
nurse interprets that these data are compatible with:
1. Advancing uremia
2. Phosphate overdose
3. Folic acid deficiency
, 4. Aluminum intoxication ✔️Ans - 4. Aluminum intoxication
Rationale:
Aluminum intoxication may occur when there is accumulation of
aluminum, an ingredient in many phosphate-binding antacids. It results in
mental cloudiness, dementia, and bone pain from infiltration of the bone
with aluminum. This condition was formerly known as dialysis dementia. It
may be treated with aluminum-chelating agents, which make aluminum
available to be dialyzed from the body. It can be prevented by avoiding or
limiting the use of phosphate-binding agents that contain aluminum.
A hemodialysis client with a left arm fistula is at risk for arterial steal
syndrome. The nurse monitors this client for which manifestation of this
disorder?
1. Warmth, redness, and pain in the left hand
2. Aching pain, pallor, and edema of the left arm
3. Edema and purpura of the left arm
4. Pallor, diminished pulse, and pain in the left hand ✔️Ans - 4.
Pallor, diminished pulse, and pain in the left hand
Rationale:
Arterial steal syndrome results from vascular insufficiency after creation of
a fistula. The client exhibits pallor and diminished pulse distal to the fistula
and complains of pain distal to the fistula, which is caused by tissue
ischemia. Warmth, redness, and pain would more likely characterize a
problem with infection. Options 2 and 3 are not characteristics of steal
syndrome.
A nurse is reviewing the medical record of a client with a diagnosis of
pyelonephritis. Which disorder, if noted on the client's record, would the
nurse identify as a risk factor for this disorder?
1. Hypoglycemia
2. Diabetes mellitus
A nurse is inserting an indwelling urinary catheter into a male client. As the
catheter is inserted into the urethra, urine begins to flow into the tubing. At
this point, the nurse:
1. Immediately inflates the balloon
2. Inserts the catheter 2.5 to 5 cm and inflates the balloon
3. Inserts the catheter until resistance is met and inflates the balloon
4. Withdraws the catheter approximately 1 inch and inflates the balloon
✔️Ans - 2. Inserts the catheter 2.5 to 5 cm and inflates the balloon
Rationale:
The catheter's balloon is behind the opening at the insertion tip. The
catheter is inserted 2.5 to 5 cm after urine begins to flow to provide
sufficient space to inflate the balloon. Inserting the catheter the extra
distance will ensure that the balloon is inflated inside the bladder and not
in the urethra, which could produce trauma.
A nurse is caring for the client with epididymitis. The nurse understands
that which treatment modality could increase swelling in the affected area?
1. Bedrest
2. Sitz bath
3. Heating pad
4. Scrotal elevation ✔️Ans - 3. Heating pad
Rationale:
Common interventions used in the treatment of epididymitis include
bedrest, elevation of the scrotum, ice packs, sitz baths, analgesics, and
antibiotics. A heating pad would not be used because direct application of
heat could increase blood flow to the area and increase the swelling.
,A client has epididymitis as a complication of urinary tract infection (UTI).
The nurse is giving the client instructions to prevent a recurrence. The
nurse determines that the client needs further instruction if the client
states the intention to:
1. Drink increased amounts of fluids.
2. Limit the force of the stream during voiding.
3. Continue to take antibiotics until all symptoms are gone.
4. Use condoms to eliminate risk from chlamydia and gonorrhea.
✔️Ans - 3. Continue to take antibiotics until all symptoms are gone.
Rationale:
The client who experiences epididymitis from UTI should increase intake of
fluids to flush the urinary system. Because organisms can be forced into the
vas deferens and epididymis from strain or pressure during voiding, the
client should limit the force of the stream. Condom use can help prevent
urethritis and epididymitis from sexually transmitted infections.
Antibiotics are always taken until the full course of therapy is completed.
A nurse is collecting data from a client who has had benign prostatic
hyperplasia (BPH) in the past. To determine if the client is currently
experiencing exacerbation of BPH, the nurse asks the client about the
presence of which early symptom?
1. Nocturia
2. Urinary retention
3. Urge incontinence
4. Decreased force in the stream of urine ✔️Ans - 4. Decreased force
in the stream of urine
Rationale:
Decreased force in the stream of urine is an early sign of BPH. The stream
later becomes weak and dribbling. The client may then develop hematuria,
,frequency, urgency, urge incontinence, and nocturia. If untreated, complete
obstruction and urinary retention can occur.
A client newly diagnosed with chronic renal failure has recently begun
hemodialysis. Knowing that the client is at risk for disequilibrium
syndrome, the nurse monitors the client during dialysis for:
1. Hypertension, tachycardia, and fever
2. Hypotension, bradycardia, and hypothermia
3. Restlessness, irritability, and generalized weakness
4. Headache, deteriorating level of consciousness, and twitching
✔️Ans - 4. Headache, deteriorating level of consciousness, and twitching
Rationale:
Disequilibrium syndrome is characterized by headache, mental confusion,
decreasing level of consciousness, nausea and vomiting, twitching, and
possible seizure activity. It 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. It 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 been on dialysis for 3 years. The
client is receiving the usual combination of medications for the disease,
including aluminum hydroxide as a phosphate-binding agent. The client
now has mental cloudiness, dementia, and complaints of bone pain. The
nurse interprets that these data are compatible with:
1. Advancing uremia
2. Phosphate overdose
3. Folic acid deficiency
, 4. Aluminum intoxication ✔️Ans - 4. Aluminum intoxication
Rationale:
Aluminum intoxication may occur when there is accumulation of
aluminum, an ingredient in many phosphate-binding antacids. It results in
mental cloudiness, dementia, and bone pain from infiltration of the bone
with aluminum. This condition was formerly known as dialysis dementia. It
may be treated with aluminum-chelating agents, which make aluminum
available to be dialyzed from the body. It can be prevented by avoiding or
limiting the use of phosphate-binding agents that contain aluminum.
A hemodialysis client with a left arm fistula is at risk for arterial steal
syndrome. The nurse monitors this client for which manifestation of this
disorder?
1. Warmth, redness, and pain in the left hand
2. Aching pain, pallor, and edema of the left arm
3. Edema and purpura of the left arm
4. Pallor, diminished pulse, and pain in the left hand ✔️Ans - 4.
Pallor, diminished pulse, and pain in the left hand
Rationale:
Arterial steal syndrome results from vascular insufficiency after creation of
a fistula. The client exhibits pallor and diminished pulse distal to the fistula
and complains of pain distal to the fistula, which is caused by tissue
ischemia. Warmth, redness, and pain would more likely characterize a
problem with infection. Options 2 and 3 are not characteristics of steal
syndrome.
A nurse is reviewing the medical record of a client with a diagnosis of
pyelonephritis. Which disorder, if noted on the client's record, would the
nurse identify as a risk factor for this disorder?
1. Hypoglycemia
2. Diabetes mellitus
