Renal NCLEX Exam – Questions & Solutions
Which instructions do you include in the teaching care plan for a patient
with cystitis receiving phenazopyridine (Pyridium).
A. If the urine turns orange-red, call the doctor.
B. Take phenazopyridine just before urination to relieve pain.
C. Once painful urination is relieved, discontinue prescribed antibiotics.
D. After painful urination is relieved, stop taking phenazopyridine ✔️Ans -
D
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.
You have a patient that is receiving peritoneal dialysis. What should you do
when you notice the return fluid is slowly draining?
A. Check for kinks in the outflow tubing
B. Raise the drainage bag above the level of the abdomen
C. Place the patient in a reverse Trendelenburg position
D. Ask the patient to cough ✔️Ans - A
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.
What is the appropriate infusion time for the dialysate in your 38 y.o.
patient with chronic renal failure?
A. 15 minutes
B. 30 minutes
C. 1 hour
D. 2 to 3 hours ✔️Ans - A
, 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.
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?
A. Insert I.V. lines above the fistula.
B. Avoid taking blood pressures in the arm with the fistula
C. Palpate pulses above the fistula
D. Report a bruit or thrill over the fistula to the doctor ✔️Ans - B
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.
Your patient becomes restless and tells you she has a headache and feels
nauseous during hemodialysis. Which complication do you suspect?
A. Infection
B. Disequilibrium syndrome
C. Air embolus
D. Acute hemolysis ✔️Ans - B
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.
Your patient is complaining of muscle cramps while undergoing
hemodialysis. Which intervention is effective in relieving muscle cramps?
A. Increase the rate of dialysis
B. Infuse normal saline solution
C. Administer a 5% dextrose solution
D. Encourage active ROM exercises ✔️Ans - B
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.
Your patient with chronic renal failure reports pruritus. Which instruction
should you include in this patient's teaching plan?
A. Rub the skin vigorously with a towel
B. Take frequent baths
C. Apply alcohol-based emollients to the skin
D. Keep fingernails short and clean ✔️Ans - D
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.
Which intervention do you plan to include with a patient who has renal
calculi?
A. Maintain bed rest
B. Increase dietary purines
C. Restrict fluids
D. Strain all urine ✔️Ans - D
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.
Which drug is indicated for pain related to acute renal calculi?
A. Narcotic analgesics
B. Nonsteroidal anti-inflammatory drugs (NSAIDS)
C. Muscle relaxants
D. Salicylates ✔️Ans - A
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.
, You expect a patient in the oliguric phase of renal failure to have a 24 hour
urine output less than:
A. 200ml
B. 400ml
C. 800ml
D. 1000ml ✔️Ans - B
Oliguria is defined as urine output of less than 400ml/24hours.
The most common early sign of kidney disease is:
A. Sodium retention
B. Elevated BUN level
C. Development of metabolic acidosis
D. Inability to dilute or concentrate urine ✔️Ans - B
Increased BUN is usually an early indicator of decreased renal function.
A patient is experiencing which type of incontinence if she experiences
leaking urine when she coughs, sneezes, or lifts heavy objects?
A. Overflow
B. Reflex
C. Stress
D. Urge ✔️Ans - C
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.
What is the priority nursing diagnosis with your patient diagnosed with
end-stage renal disease?
A. Activity intolerance
B. Fluid volume excess
C. Knowledge deficit
D. Pain ✔️Ans - B
Fluid volume excess because the kidneys aren't removing fluid and wastes.
The other diagnoses may apply, but they don't take priority.
Which instructions do you include in the teaching care plan for a patient
with cystitis receiving phenazopyridine (Pyridium).
A. If the urine turns orange-red, call the doctor.
B. Take phenazopyridine just before urination to relieve pain.
C. Once painful urination is relieved, discontinue prescribed antibiotics.
D. After painful urination is relieved, stop taking phenazopyridine ✔️Ans -
D
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.
You have a patient that is receiving peritoneal dialysis. What should you do
when you notice the return fluid is slowly draining?
A. Check for kinks in the outflow tubing
B. Raise the drainage bag above the level of the abdomen
C. Place the patient in a reverse Trendelenburg position
D. Ask the patient to cough ✔️Ans - A
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.
What is the appropriate infusion time for the dialysate in your 38 y.o.
patient with chronic renal failure?
A. 15 minutes
B. 30 minutes
C. 1 hour
D. 2 to 3 hours ✔️Ans - A
, 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.
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?
A. Insert I.V. lines above the fistula.
B. Avoid taking blood pressures in the arm with the fistula
C. Palpate pulses above the fistula
D. Report a bruit or thrill over the fistula to the doctor ✔️Ans - B
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.
Your patient becomes restless and tells you she has a headache and feels
nauseous during hemodialysis. Which complication do you suspect?
A. Infection
B. Disequilibrium syndrome
C. Air embolus
D. Acute hemolysis ✔️Ans - B
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.
Your patient is complaining of muscle cramps while undergoing
hemodialysis. Which intervention is effective in relieving muscle cramps?
A. Increase the rate of dialysis
B. Infuse normal saline solution
C. Administer a 5% dextrose solution
D. Encourage active ROM exercises ✔️Ans - B
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.
Your patient with chronic renal failure reports pruritus. Which instruction
should you include in this patient's teaching plan?
A. Rub the skin vigorously with a towel
B. Take frequent baths
C. Apply alcohol-based emollients to the skin
D. Keep fingernails short and clean ✔️Ans - D
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.
Which intervention do you plan to include with a patient who has renal
calculi?
A. Maintain bed rest
B. Increase dietary purines
C. Restrict fluids
D. Strain all urine ✔️Ans - D
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.
Which drug is indicated for pain related to acute renal calculi?
A. Narcotic analgesics
B. Nonsteroidal anti-inflammatory drugs (NSAIDS)
C. Muscle relaxants
D. Salicylates ✔️Ans - A
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.
, You expect a patient in the oliguric phase of renal failure to have a 24 hour
urine output less than:
A. 200ml
B. 400ml
C. 800ml
D. 1000ml ✔️Ans - B
Oliguria is defined as urine output of less than 400ml/24hours.
The most common early sign of kidney disease is:
A. Sodium retention
B. Elevated BUN level
C. Development of metabolic acidosis
D. Inability to dilute or concentrate urine ✔️Ans - B
Increased BUN is usually an early indicator of decreased renal function.
A patient is experiencing which type of incontinence if she experiences
leaking urine when she coughs, sneezes, or lifts heavy objects?
A. Overflow
B. Reflex
C. Stress
D. Urge ✔️Ans - C
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.
What is the priority nursing diagnosis with your patient diagnosed with
end-stage renal disease?
A. Activity intolerance
B. Fluid volume excess
C. Knowledge deficit
D. Pain ✔️Ans - B
Fluid volume excess because the kidneys aren't removing fluid and wastes.
The other diagnoses may apply, but they don't take priority.
