Lewis chapter 45, 46, 47 Renal NCLEX
questions
To assess whether there is any improvement in a patient's dysuria, which question will the nurse
ask?
a. "Do you have to urinate at night?"
b. "Do you have blood in your urine?"
c. "Do you have to urinate frequently?"
d. "Do you have pain when you urinate?" -
✅ANS: D
Dysuria is painful urination. The alternate responses are used to assess other urinary tract
symptoms: hematuria, nocturia, and frequency.
DIF: Cognitive Level: Apply (application) REF: 1056
TOP: Nursing Process: Assessment MSC: NCLEX: Physiological
When a patient's urine dipstick test indicates a small amount of protein, the nurse's next action
should be to
a. send a urine specimen to the laboratory to test for ketones.
b. obtain a clean-catch urine for culture and sensitivity testing.
c. inquire about which medications the patient is currently taking.
d. ask the patient about any family history of chronic renal failure. -
✅ANS: C
Normally the urinalysis will show zero to trace amounts of protein, but some medications may give
false-positive readings. The other actions by the nurse may be appropriate, but checking for
medications that may affect the dipstick accuracy should be done first.
DIF: Cognitive Level: Apply (application) REF: 1057
TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity
A hospitalized patient with possible renal insufficiency after coronary artery bypass surgery is
scheduled for a creatinine clearance test. Which equipment will the nurse need to obtain?
a. Urinary catheter
b. Cleaning towelettes
c. Large container for urine
d. Sterile urine specimen cup -
✅ANS: C
Because creatinine clearance testing involves a 24-hour urine specimen, the nurse should obtain a
large container for the urine collection. Catheterization, cleaning of the perineum with antiseptic
towelettes, and a sterile specimen cup are not needed for this test.
DIF: Cognitive Level: Apply (application) REF: 1056
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity
A 32-year-old patient who is employed as a hairdresser and has a 15 pack-year history of cigarette
smoking is scheduled for an annual physical examination. The nurse will plan to teach the patient
about the increased risk for
a. renal failure.
b. kidney stones.
1
,c. pyelonephritis.
d. bladder cancer. -
✅ANS: D
Exposure to the chemicals involved with working as a hairdresser and in smoking both increase the
risk of bladder cancer, and the nurse should assess whether the patient understands this risk. The
patient is not at increased risk for renal failure, pyelonephritis, or kidney stones.
DIF: Cognitive Level: Apply (application) REF: 1053
TOP: Nursing Process: Planning MSC: NCLEX: Health Promotion and Maintenance
Which medication taken at home by a 47-year-old patient with decreased renal function will be of
most concern to the nurse?
a. ibuprofen (Motrin)
b. warfarin (Coumadin)
c. folic acid (vitamin B9)
d. penicillin (Bicillin LA) -
✅ANS: A
The nonsteroidal antiinflammatory medications (NSAIDs) are nephrotoxic and should be avoided in
patients with impaired renal function. The nurse also should ask about reasons the patient is taking
the other medications, but the medication of most concern is the ibuprofen.
DIF: Cognitive Level: Apply (application) REF: 1052
TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity
A 79-year-old man has been admitted with benign prostatic hyperplasia. What is most appropriate to
include in the nursing plan of care?
a. Limit fluid intake to no more than 1000 mL/day.
b. Leave a light on in the bathroom during the night.
c. Ask the patient to use a urinal so that urine can be measured.
d. Pad the patient's bed to accommodate overflow incontinence. -
✅ANS: B
The patient's age and diagnosis indicate a likelihood of nocturia, so leaving the light on in the
bathroom is appropriate. Fluids should be encouraged because dehydration is more common in
older patients. The information in the question does not indicate that measurement of the patient's
output is necessary or that the patient has overflow incontinence.
DIF: Cognitive Level: Apply (application) REF: 1050-1051
TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity
The nurse completing a physical assessment for a newly admitted male patient is unable to feel
either kidney on palpation. Which action should the nurse take next?
a. Obtain a urine specimen to check for hematuria.
b. Document the information on the assessment form.
c. Ask the patient about any history of recent sore throat.
d. Ask the health care provider about scheduling a renal ultrasound. -
✅ANS: B
The kidneys are protected by the abdominal organs, ribs, and muscles of the back, and may not be
palpable under normal circumstances, so no action except to document the assessment information
is needed. Asking about a recent sore throat, checking for hematuria, or obtaining a renal ultrasound
may be appropriate when assessing for renal problems for some patients, but there is nothing in the
question stem to indicate that they are appropriate for this patient.
2
, DIF: Cognitive Level: Apply (application) REF: 1055
TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity
How will the nurse assess for flank tenderness in a 30-year-old female patient with suspected
pyelonephritis?
a. Palpate along both sides of the lumbar vertebral column.
b. Strike a flat hand covering the costovertebral angle (CVA).
c. Push fingers upward into the two lowest intercostal spaces.
d. Percuss between the iliac crest and ribs along the midaxillary line. -
✅ANS: B
Checking for flank pain is best performed by percussion of the CVA and asking about pain. The
other techniques would not assess for flank pain.
DIF: Cognitive Level: Understand (comprehension) REF: 1055
TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity
What glomerular filtration rate (GFR) would the nurse estimate for a 30-year-old patient with a
creatinine clearance result of 60 mL/min?
a. 60 mL/min
b. 90 mL/min
c. 120 mL/min
d. 180 mL/min -
✅ANS: A
The creatinine clearance approximates the GFR. The other responses are not accurate.
DIF: Cognitive Level: Understand (comprehension) REF: 1056
TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity
The nurse assessing the urinary system of a 45-year-old female would use auscultation to
a. determine kidney position.
b. identify renal artery bruits.
c. check for ureteral peristalsis.
d. assess for bladder distention. -
✅ANS: B
The presence of a bruit may indicate problems such as renal artery tortuosity or abdominal aortic
aneurysm. Auscultation would not be helpful in assessing for the other listed urinary tract
information.
DIF: Cognitive Level: Understand (comprehension) REF: 1055
TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity
A patient gives the nurse health information before a scheduled intravenous pyelogram (IVP).
Which item has the most immediate implications for the patient's care?
a. The patient has not had food or drink for 8 hours.
b. The patient lists allergies to shellfish and penicillin.
c. The patient complains of costovertebral angle (CVA) tenderness.
d. The patient used a bisacodyl (Dulcolax) tablet the previous night. -
✅ANS: B
Iodine-based contrast dye is used during IVP and for many computed tomography (CT) scans. The
nurse will need to notify the health care provider before the procedures so that the patient can
receive medications such as antihistamines or corticosteroids before the procedures are started. The
3
questions
To assess whether there is any improvement in a patient's dysuria, which question will the nurse
ask?
a. "Do you have to urinate at night?"
b. "Do you have blood in your urine?"
c. "Do you have to urinate frequently?"
d. "Do you have pain when you urinate?" -
✅ANS: D
Dysuria is painful urination. The alternate responses are used to assess other urinary tract
symptoms: hematuria, nocturia, and frequency.
DIF: Cognitive Level: Apply (application) REF: 1056
TOP: Nursing Process: Assessment MSC: NCLEX: Physiological
When a patient's urine dipstick test indicates a small amount of protein, the nurse's next action
should be to
a. send a urine specimen to the laboratory to test for ketones.
b. obtain a clean-catch urine for culture and sensitivity testing.
c. inquire about which medications the patient is currently taking.
d. ask the patient about any family history of chronic renal failure. -
✅ANS: C
Normally the urinalysis will show zero to trace amounts of protein, but some medications may give
false-positive readings. The other actions by the nurse may be appropriate, but checking for
medications that may affect the dipstick accuracy should be done first.
DIF: Cognitive Level: Apply (application) REF: 1057
TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity
A hospitalized patient with possible renal insufficiency after coronary artery bypass surgery is
scheduled for a creatinine clearance test. Which equipment will the nurse need to obtain?
a. Urinary catheter
b. Cleaning towelettes
c. Large container for urine
d. Sterile urine specimen cup -
✅ANS: C
Because creatinine clearance testing involves a 24-hour urine specimen, the nurse should obtain a
large container for the urine collection. Catheterization, cleaning of the perineum with antiseptic
towelettes, and a sterile specimen cup are not needed for this test.
DIF: Cognitive Level: Apply (application) REF: 1056
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity
A 32-year-old patient who is employed as a hairdresser and has a 15 pack-year history of cigarette
smoking is scheduled for an annual physical examination. The nurse will plan to teach the patient
about the increased risk for
a. renal failure.
b. kidney stones.
1
,c. pyelonephritis.
d. bladder cancer. -
✅ANS: D
Exposure to the chemicals involved with working as a hairdresser and in smoking both increase the
risk of bladder cancer, and the nurse should assess whether the patient understands this risk. The
patient is not at increased risk for renal failure, pyelonephritis, or kidney stones.
DIF: Cognitive Level: Apply (application) REF: 1053
TOP: Nursing Process: Planning MSC: NCLEX: Health Promotion and Maintenance
Which medication taken at home by a 47-year-old patient with decreased renal function will be of
most concern to the nurse?
a. ibuprofen (Motrin)
b. warfarin (Coumadin)
c. folic acid (vitamin B9)
d. penicillin (Bicillin LA) -
✅ANS: A
The nonsteroidal antiinflammatory medications (NSAIDs) are nephrotoxic and should be avoided in
patients with impaired renal function. The nurse also should ask about reasons the patient is taking
the other medications, but the medication of most concern is the ibuprofen.
DIF: Cognitive Level: Apply (application) REF: 1052
TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity
A 79-year-old man has been admitted with benign prostatic hyperplasia. What is most appropriate to
include in the nursing plan of care?
a. Limit fluid intake to no more than 1000 mL/day.
b. Leave a light on in the bathroom during the night.
c. Ask the patient to use a urinal so that urine can be measured.
d. Pad the patient's bed to accommodate overflow incontinence. -
✅ANS: B
The patient's age and diagnosis indicate a likelihood of nocturia, so leaving the light on in the
bathroom is appropriate. Fluids should be encouraged because dehydration is more common in
older patients. The information in the question does not indicate that measurement of the patient's
output is necessary or that the patient has overflow incontinence.
DIF: Cognitive Level: Apply (application) REF: 1050-1051
TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity
The nurse completing a physical assessment for a newly admitted male patient is unable to feel
either kidney on palpation. Which action should the nurse take next?
a. Obtain a urine specimen to check for hematuria.
b. Document the information on the assessment form.
c. Ask the patient about any history of recent sore throat.
d. Ask the health care provider about scheduling a renal ultrasound. -
✅ANS: B
The kidneys are protected by the abdominal organs, ribs, and muscles of the back, and may not be
palpable under normal circumstances, so no action except to document the assessment information
is needed. Asking about a recent sore throat, checking for hematuria, or obtaining a renal ultrasound
may be appropriate when assessing for renal problems for some patients, but there is nothing in the
question stem to indicate that they are appropriate for this patient.
2
, DIF: Cognitive Level: Apply (application) REF: 1055
TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity
How will the nurse assess for flank tenderness in a 30-year-old female patient with suspected
pyelonephritis?
a. Palpate along both sides of the lumbar vertebral column.
b. Strike a flat hand covering the costovertebral angle (CVA).
c. Push fingers upward into the two lowest intercostal spaces.
d. Percuss between the iliac crest and ribs along the midaxillary line. -
✅ANS: B
Checking for flank pain is best performed by percussion of the CVA and asking about pain. The
other techniques would not assess for flank pain.
DIF: Cognitive Level: Understand (comprehension) REF: 1055
TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity
What glomerular filtration rate (GFR) would the nurse estimate for a 30-year-old patient with a
creatinine clearance result of 60 mL/min?
a. 60 mL/min
b. 90 mL/min
c. 120 mL/min
d. 180 mL/min -
✅ANS: A
The creatinine clearance approximates the GFR. The other responses are not accurate.
DIF: Cognitive Level: Understand (comprehension) REF: 1056
TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity
The nurse assessing the urinary system of a 45-year-old female would use auscultation to
a. determine kidney position.
b. identify renal artery bruits.
c. check for ureteral peristalsis.
d. assess for bladder distention. -
✅ANS: B
The presence of a bruit may indicate problems such as renal artery tortuosity or abdominal aortic
aneurysm. Auscultation would not be helpful in assessing for the other listed urinary tract
information.
DIF: Cognitive Level: Understand (comprehension) REF: 1055
TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity
A patient gives the nurse health information before a scheduled intravenous pyelogram (IVP).
Which item has the most immediate implications for the patient's care?
a. The patient has not had food or drink for 8 hours.
b. The patient lists allergies to shellfish and penicillin.
c. The patient complains of costovertebral angle (CVA) tenderness.
d. The patient used a bisacodyl (Dulcolax) tablet the previous night. -
✅ANS: B
Iodine-based contrast dye is used during IVP and for many computed tomography (CT) scans. The
nurse will need to notify the health care provider before the procedures so that the patient can
receive medications such as antihistamines or corticosteroids before the procedures are started. The
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