Urinary Disorders NCLEX Practice Exam
(Quiz #5: 20 Questions) and Rationales
(All Answered) and Categories Covered
1. 1. Question
The client newly diagnosed with chronic renal failure recently has begun
hemodialysis. Knowing that the client is at risk for disequilibrium syndrome,
the nurse assesses the client during dialysis for:
o A. Hypertension, tachycardia, and fever.
o B. Hypotension, bradycardia, and hypothermia.
o C. Restlessness, irritability, and generalized weakness.
o D. Headache, deteriorating level of consciousness, and twitching.
Correct
Correct Answer: D. Headache, deteriorating level of consciousness, and
twitching.
Disequilibrium syndrome is characterized by headache, mental confusion,
decreasing level of consciousness, nausea, and vomiting, twitching, and
possible seizure activity. Disequilibrium syndrome is caused by the 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 the onset of symptoms. The syndrome
most often occurs in clients who are new to dialysis and is prevented by
dialyzing for shorter times or at reduced blood flow rates.
• Option A: Symptoms are commonly seen in patients with high blood urea
nitrogen levels, in patients with chronic kidney disease (CKD) versus acute
kidney injury, and with aggressive urea removal after initial dialysis
treatment. In severe cases, symptoms can progress to seizure, somnolence,
stupor, or coma leading to mortality.
• Option B: Some symptoms, such as dizziness and muscle cramps that occur
towards the latter part of dialysis, are also considered to be part of DDS.
Rarely, DDS can present as increased intraocular pressure. Dialysis
disequilibrium syndrome is usually self-limited, with symptoms resolving in
, a short interval. The prognosis is generally favorable, and dialysis does not
need to be stopped in the majority of cases.
• Option C: Most cases of DDS can be mild and self-limited, with patients
reporting headache, nausea, or blurred vision as well as other CNS
symptoms such as restlessness and confusion. These symptoms usually
begin soon after the initiation of dialysis and resolve within hours in most
cases. The complications of dialysis disequilibrium syndrome include
consequences from delay in recognition of the condition and delay in
implementing prevention strategies.
2. 2. Question
A client with chronic renal failure has completed a hemodialysis treatment. The
nurse would use which of the following standard indicators to evaluate the
client’s status after dialysis?
• A. Potassium level and weight.
• B. BUN and creatinine levels.
• C. VS and BUN.
• D. VS and weight.
Correct
Correct Answer: D. VS and weight.
Following dialysis, the client’s vital signs are monitored to determine whether
the client is remaining hemodynamically stable. Weight is measured and
compared with the client’s predialysis weight to determine the effectiveness of
fluid extraction.
• Option A: Monitor serum electrolytes, blood urea nitrogen, creatinine, and
hemoglobin and hematocrit levels before and after dialysis. Monitor fluid
status. Monitor coagulation studies because heparin is used to prevent
clotting during dialysis.
• Option B: The blood urea concentration is artificially low immediately
following high-efficiency dialysis. Post-dialysis urea rebound correlates with
hemodialysis efficiency and is inversely correlated with dialysis treatment
time. Post-dialysis urea rebound varies among patients but should remain
relatively constant in a given patient with stable hemodynamic parameters.
• Option C: Laboratory studies are done as per protocol but are not
necessarily done after the hemodialysis treatment has ended. After dialysis,
assess the vascular access for any bleeding or hemorrhage. When you move
, the patient or help with ambulation, avoid trauma to or excessive pressure
on the affected arm.
3. 3. Question
The hemodialysis client with a left-arm fistula is at risk for steal syndrome. The
nurse assesses this client for which of the following clinical manifestations?
• A. Warmth, redness, and pain in the left hand.
• B. Pallor, diminished pulse, and pain in the left hand.
• C. Edema and reddish discoloration of the left arm.
• D. Aching pain, pallor, and edema in the left arm.
Correct
Correct Answer: B. Pallor, diminished pulse, and pain in the left hand.
Steal syndrome results from vascular insufficiency after the creation of a
fistula. The client exhibits pallor and a diminished pulse distal to the fistula.
The client also complains of pain distal to the fistula, which is due to tissue
ischemia. Ischemic steal syndrome (ISS) is a complication that can occur after
the construction of a vascular access for hemodialysis. It is characterized by
ischemia of the hand caused by marked reduction or reversal of flow through
the arterial segment distal to the arteriovenous fistula (AVF).
• Option A: Warmth, redness, and pain more likely would characterize a
problem with infection. The diagnosis of hand ischemia is based on physical
examination, but imaging studies are very useful for detecting the true
cause of ischemia and for selecting an appropriate therapeutic strategy. The
distal ischemic steal syndrome (ISS) is a possible complication following the
construction of an arteriovenous (AV) access for hemodialysis.
• Option C: ISS is caused by a substantial decrease or even reversal of blood
flow (“steal”) through the arterial segment distal to the vascular access.
These changes are due to the presence of low resistance in the AV access or
to hypoperfusion secondary to distal arteriopathy. Both of these factors
frequently contribute to symptomatic ischemia.
• Option D: It occurs in approximately 1–20 percent of patients with an
upper extremity access, and its clinical manifestations can include various
signs and symptoms, ranging from coolness, pallor, mild paresthesia, and
pain during dialysis to severe symptoms, such as pain at rest, paralysis,
ulceration, tissue necrosis, and loss of one or more fingers or the entire
hand.
(Quiz #5: 20 Questions) and Rationales
(All Answered) and Categories Covered
1. 1. Question
The client newly diagnosed with chronic renal failure recently has begun
hemodialysis. Knowing that the client is at risk for disequilibrium syndrome,
the nurse assesses the client during dialysis for:
o A. Hypertension, tachycardia, and fever.
o B. Hypotension, bradycardia, and hypothermia.
o C. Restlessness, irritability, and generalized weakness.
o D. Headache, deteriorating level of consciousness, and twitching.
Correct
Correct Answer: D. Headache, deteriorating level of consciousness, and
twitching.
Disequilibrium syndrome is characterized by headache, mental confusion,
decreasing level of consciousness, nausea, and vomiting, twitching, and
possible seizure activity. Disequilibrium syndrome is caused by the 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 the onset of symptoms. The syndrome
most often occurs in clients who are new to dialysis and is prevented by
dialyzing for shorter times or at reduced blood flow rates.
• Option A: Symptoms are commonly seen in patients with high blood urea
nitrogen levels, in patients with chronic kidney disease (CKD) versus acute
kidney injury, and with aggressive urea removal after initial dialysis
treatment. In severe cases, symptoms can progress to seizure, somnolence,
stupor, or coma leading to mortality.
• Option B: Some symptoms, such as dizziness and muscle cramps that occur
towards the latter part of dialysis, are also considered to be part of DDS.
Rarely, DDS can present as increased intraocular pressure. Dialysis
disequilibrium syndrome is usually self-limited, with symptoms resolving in
, a short interval. The prognosis is generally favorable, and dialysis does not
need to be stopped in the majority of cases.
• Option C: Most cases of DDS can be mild and self-limited, with patients
reporting headache, nausea, or blurred vision as well as other CNS
symptoms such as restlessness and confusion. These symptoms usually
begin soon after the initiation of dialysis and resolve within hours in most
cases. The complications of dialysis disequilibrium syndrome include
consequences from delay in recognition of the condition and delay in
implementing prevention strategies.
2. 2. Question
A client with chronic renal failure has completed a hemodialysis treatment. The
nurse would use which of the following standard indicators to evaluate the
client’s status after dialysis?
• A. Potassium level and weight.
• B. BUN and creatinine levels.
• C. VS and BUN.
• D. VS and weight.
Correct
Correct Answer: D. VS and weight.
Following dialysis, the client’s vital signs are monitored to determine whether
the client is remaining hemodynamically stable. Weight is measured and
compared with the client’s predialysis weight to determine the effectiveness of
fluid extraction.
• Option A: Monitor serum electrolytes, blood urea nitrogen, creatinine, and
hemoglobin and hematocrit levels before and after dialysis. Monitor fluid
status. Monitor coagulation studies because heparin is used to prevent
clotting during dialysis.
• Option B: The blood urea concentration is artificially low immediately
following high-efficiency dialysis. Post-dialysis urea rebound correlates with
hemodialysis efficiency and is inversely correlated with dialysis treatment
time. Post-dialysis urea rebound varies among patients but should remain
relatively constant in a given patient with stable hemodynamic parameters.
• Option C: Laboratory studies are done as per protocol but are not
necessarily done after the hemodialysis treatment has ended. After dialysis,
assess the vascular access for any bleeding or hemorrhage. When you move
, the patient or help with ambulation, avoid trauma to or excessive pressure
on the affected arm.
3. 3. Question
The hemodialysis client with a left-arm fistula is at risk for steal syndrome. The
nurse assesses this client for which of the following clinical manifestations?
• A. Warmth, redness, and pain in the left hand.
• B. Pallor, diminished pulse, and pain in the left hand.
• C. Edema and reddish discoloration of the left arm.
• D. Aching pain, pallor, and edema in the left arm.
Correct
Correct Answer: B. Pallor, diminished pulse, and pain in the left hand.
Steal syndrome results from vascular insufficiency after the creation of a
fistula. The client exhibits pallor and a diminished pulse distal to the fistula.
The client also complains of pain distal to the fistula, which is due to tissue
ischemia. Ischemic steal syndrome (ISS) is a complication that can occur after
the construction of a vascular access for hemodialysis. It is characterized by
ischemia of the hand caused by marked reduction or reversal of flow through
the arterial segment distal to the arteriovenous fistula (AVF).
• Option A: Warmth, redness, and pain more likely would characterize a
problem with infection. The diagnosis of hand ischemia is based on physical
examination, but imaging studies are very useful for detecting the true
cause of ischemia and for selecting an appropriate therapeutic strategy. The
distal ischemic steal syndrome (ISS) is a possible complication following the
construction of an arteriovenous (AV) access for hemodialysis.
• Option C: ISS is caused by a substantial decrease or even reversal of blood
flow (“steal”) through the arterial segment distal to the vascular access.
These changes are due to the presence of low resistance in the AV access or
to hypoperfusion secondary to distal arteriopathy. Both of these factors
frequently contribute to symptomatic ischemia.
• Option D: It occurs in approximately 1–20 percent of patients with an
upper extremity access, and its clinical manifestations can include various
signs and symptoms, ranging from coolness, pallor, mild paresthesia, and
pain during dialysis to severe symptoms, such as pain at rest, paralysis,
ulceration, tissue necrosis, and loss of one or more fingers or the entire
hand.
