Nursing Q And A (volume 2)- Answers

NCLEX-RN Test II Renal:

1. The most important diagnostic test used to assess kidney functions include: a. Serum BUN b. Serum creatinine c. IVP d. Specific gravity B- serum creatinine is a waste product accumulated in the blood and completely excreted by the kidneys. 2. The patient is scheduled for intravenous pyelography (IVP) to assess kidney function. Priority goal for the patient immediately after the procedure would include: a. Immobility b. Blood pressure control. c. Preventing fluid volume deficit. d. Monitoring vital signs. C—fluids flush the dye through the kidneys. Retention of the dye in the blood will result to renal failure. 3. When developing the discharged teaching plan for the patient with chronic renal failure, the nurse would emphasize restriction of which of the following nutrients? a. Ascorbic acid b. Calcium c. Magnesium d. Phosphate D—phosphate is already elevated in renal failure. 4. Which of the following diet plans would be appropriate for the nurse to discuss with the patient with acute renal failure? a. High carbohydrate, high protein-diet. b. High fat and carbohydrate. c. Low fat and low protein. d. Low in carbohydrate and fat. C—Protein liberalizes ammonia, which is converted by the liver into urea. Urea is excreted as waste product by the kidneys. In renal failure, urea is not properly excreted. 5. A patient developed shock after a severe myocardial infarction and has now developed acute renal failure. The patient’s family asks the nurse why the patient has developed acute renal failure. The nurse should base the response on the knowledge that there was a. A decrease in the blood flow in the kidneys. b. An obstruction of urine flow from the kidneys. c. A blood clot formed in the kidney. d. Structural damage to the kidney resulting in acute tubular necrosis. A—renal hypoperfusion is one of the causes of renal failure. 6. The patient’s blood urea nitrogen (BUN) concentration is elevated in acute renal failure. What is the likely cause of this finding? a. Fluid retention. b. Hemolysis of RBC. c. Subnormal metabolic rate. d. Reduced renal blood flow.

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D—adequate amount of fluids is needed to eliminate BUN through urination. 7. Which of the following snack will be appropriate for the patient with renal failure? a. Jell-O b. Yogurt c. Orange d. Peanut butter A- Jell-O does not contain potassium or protein. There’s hyperkalemia and increased BUN in renal failure. 8. After the completion of PD, the nurse would expect the patient to exhibit which the following characteristics? a. Hematuria b. Weight loss c. Hypertension d. Increased urine output B—excess fluids is removed during dialysis. Weight loss following dialysis is expected. 9. In planning teaching strategies for the patient with chronic renal failure, the nurse must keep in mind the neurologic impact of uremia. Which teaching strategy would be most appropriate? a. Providing all needed teaching in one extended session. b. Validating frequently the patient understanding of the material. c. Conducting a one-on-one session with the patient. d. Using videotapes to reinforce the material as needed. B—confusion and forgetfulness are seen uremia. Ensures that the patient understands and remembers the teaching plan. 10. The nurse is developing a teaching plan for the patient with stress incontinence. Which of the following instructions should be included? a. Avoid activities that are stressful & upsetting. b. Avoid caffeine & alcohol. c. Do not wear constricting clothing especially in the abdomen. d. Limit physical exertion. B—caffeine & alcohol are favor diuresis. Mr. Joseph Cohen, 74 years old, is presently living with his wife in a small apartment. He is completely independent. He cares for his wife and takes care of their apartment, does the cooking, and shops at the local stores. He is socially active with church work and a senior citizen group. His only child lives over 300 miles away, but they keep in touch through visits, phone calls, and letters. The Cohen lives with their annuity, and receives social security payments. Mr. Cohen rarely sees his doctor. Today, he is scheduled to visit his doctor due to his urinary problem. The community volunteer driver provides him transportation. 11. Following cystoscopy, a diagnosis of Benign Prostatic Hypertrophy was confirmed. Mr. Cohen is scheduled for transurethral resection of the prostate (TURP). Which of the following goals post TURP is most critical on Mr. Cohen? a. Prevention of embolus formation. b. Prevention of pulmonary complications. c. Prevention of urinary complications. d. Prevention of bladder distention.

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D—Bladder distention is a sign of hemorrhage post TURP. Blood clots accumulating in the bladder will eventually obstruct the flow of the foley catheter causing bladder distention. 12. While assessing the client post TURP, the nurse notifies the physician for which of the following findings? a. The foley output is reddish pink with clots. b. The client complains of bladder fullness and spasms. c. The client complains of “urge to void”. d. The client’s BP went up to 160/100 and complaining of severe pain. B—bladder fullness and spasms are signs of bleeding post TURP. 13. Post TURP, important discharge instruction should include: a. Sex can be resumed as long as the client feels comfortable doing it. b. Notify the physician if dribbling is experienced. c. Take Colace on a regular basis. d. Notify the physician if urine appears cloudy during the first few weeks post TURP. C—post TURP the patient is not allowed to bear which can lead to bleeding. 14. A client with history of chronic renal failure complains of fatigue. Blood test reveals anemia secondary to failure of the kidneys to secrete erythropoetin. Which of the following nursing interventions is appropriate for this client? a. Implement bleeding precaution. b. Implement infection precaution. c. Provide a quiet and restful environment. d. Implement reverse isolation. C—lack of erythorpoetin leads to anemia, which results to decreased oxygenation due to lack of RBCs. Rest promotes less oxygen consumption. 15. A client who has had a prostatectomy is receiving continuous bladder irrigation. The nurse should assessed for the development of: a. Hematuria b. Pulmonary congestion c. Water intoxication d. Pulmonary embolus C—NS irrigation can lead to retention of fluids. 16. Susan Ramos, 24 years old, is in acute renal failure following a large amount of blood loss from injuries she received in a car accident. Her 24-hour urine output is 275 ml. Her serum BUN is 90 mg/dl and her serum creatinine is 7.2 mg/dl. During her oliguric phase, which of the following would be an appropriate nursing intervention? a. Increase her fluid intake to promote urination. b. Weigh client 3X/week. c. Provide high protein, high CHO diet. d. Implement safety precaution. D—elevated creatinine & BUN levels affect the CNS causing confusion, irritability, ect. Safety precaution is important to prevent accident. 17. The client with chronic renal failure (CRF) goes for hemodialysis. Nursing assessment of the AV fistula would include:

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a. Check the blood pressure Q 2H on the affected arm to ensure good circulation. b. Palpate the access site for a thrill to assess circulation. c. Check the skin temperature and pulses proximal to the fistula to assess circulation. d. Monitor the pulse rate Q 2H on the cannulated arm to check for circulation. B—the presence of thrill ensures patent AV fistula. 18. The client with ARF is maintained on peritoneal dialysis while waiting for the AV fistula to mature. During peritoneal dialysis, the nurse notes retention of 600 ml of dialysate after draining the peritoneal cavity. The initial response of the nurse would be to: a. Infuse more dialysate until the outflow increases. b. Have the client turn from side to side to help localize the fluid to promote drainage. c. Monitor vital signs and assess client for possible hypovolemia. d. Notify the physician immediately. B—asking the patient to turn from side to side removes the obstruction (fibrin clot) in the catheter which promotes drainage of dialysate. 19. The physician ordered specific gravity to be monitored on a client with ARF for which of the following rationale: a. To check urinary pH. b. To check the ability of the kidneys to concentrate urine. c. The check the ability of the kidneys to excrete electrolytes. d. To detect any acid-base imbalance. B—SG measures the ability of the kidney tubules (distal and collecting duct) to concentrate urine. 20. Which of the following mechanism of actions of aluminum hydroxide gel is useful on a client with CRF? a. Prevent leg cramps. b. Prevent hypercalcemia. c. Promotes increase calcium level. d. Protects the stomach to prevent gastritis. C—Aluminum hydroxide is a phosphate binder. Bound phosphate can no longer be used by the body, thus, causes calcium to go up. 21. Mr. Tan has CRF. His phosphate level is 6.5 mg/dl. He will most likely exhibit which of the following? a. Kernig`s b. Babinski`s c. Chvostec`s d. Brudzinki`s C—elevated phosphate level reflects low calcium level. Chvoteck’s is a sign of low calcium level. 22. Eva Collins is a 54 year-old female who is admitted with a diagnosis of endstage irreversible CRF. She has a history of using illicit drugs. The nurse notices a specific gravity of 1.010. Which of the following would indicate that the nurse understands the pathology of renal failure? a. Severe damage to the kidney tubules has occurred. b. The glomerulus` ability to filter has been severely impaired. c. The ability of the tubules to concentrate urine is within normal limits.

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d. The kidney nephrons are hypertrophied. A— An SG that is fixed and within the normal range means irreversible tubular damage such as in irreversible renal disease. 23. The nursing care plan states to observe for hyperkalemia. The nurse should recognize that the greatest danger of hyperkalemia is: a. Cardiac arrest b. Tetany c. Acid-base imbalance d. Fluid overload A—elevated potassium prevents the myocytes (cells in the ehart) to become depolarize (paralysis) causing cardiac arrest. 24. The physician orders regular insulin, 8U added to IV fluid on Eva. The nurse understands that this therapy is indicated for which of the following reasons? a. The client has diabetes. b. Insulin will decrease the high K⁺ level of the client. c. To lower the client’s high blood sugar. d. To prevent metabolic acidosis. B—insulin transports glucose, hydrogen ions, and potassium back to the cells.

25. To prevent abdominal discomfort during the peritoneal dialysis exchange, the nurse should: a. Instruct the client to keep from moving during the infusion period b. Infuse the dialysate slowly. c. Infuse the dialysate at body temperature. d. Drain the client as soon as the dialysate has been infused. C—warm dialysate promotes vasodilation, which promotes patient comfort. 26. Mr. John McLean, 34 years old, presents to the health clinic complaining of urinary burning and urgency, hematuria, fever and chills. Laboratory tests on a clean catch urine reveals RBC’s and WBC’s too many to count, bacteria greater than 100,000/ml. A physical examination reveals extreme tenderness on the costovertebral angle. Mr. McLean is diagnosed as having urethritis and he is admitted to the hospital. An intravenous pyelography (IVP) is ordered on Mr. McLean. Which of the following would be most important for the nurse to perform the night before the IVP? a. Give a cleansing enema. b. Keep the client NPO 8 hours before the test. c. Assess the client for allergic reaction to iodine. d. Obtain consent for IVP. C—a patient with pneumonia is expected to receive antibiotic therapy. Some people have allergic reaction to certain antibiotics. 27. A female client complains of pain when the balloon of the catheter is being inflated. The nurse who is inserting the catheter will take which of the following nursing actions? a. Deflate the balloon and advance the catheter. b. Pull back or withdraw the catheter. c. Remove the catheter and insert a new one. d. Ask the client to hold her breath while advancing the catheter. A—if the catheter is not properly advanced in the bladder, inflation of the balloon will cause pain.

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28. Following a prostatectomy the foley catheter of the patient was pulled taut and taped to the thigh. The client complains that the catheter was pulled to tight. The nurse’s best initial action would be to a. adjust the tension on the catheter to relieve pressure. b. untape the foley catheter and retape it closer to the urinary meatus. c. assess the degree of tension on the catheter and call the physician. d. explain to the client that the traction in the catheter is required to control bleeding. D- foley traction is essential to prevent bleeding post TURP. 29. The most important test use to assess if the newly transplanted kidney is working is e. renal scan. f. serum creatinine. g. 24-hour urine collection. h. white blood count. B- serum creatinine is a waste product excreted by the kidneys. It requires adequate renal perfusion to promote excretion of creatinine through urination. 30. A 30-year-old mill worker who has had urinary frequency and dysuria for 3 days comes to the urology clinic. The nurse can obtain the best history related to the client’s urinary function by stating: a. “Relax and just tell me everything about yourself.” b. “Tell me about your dysuria and urinary frequency.” c. “I know you’re embarrassed but I heard it all before.” d. “Describe your urinary pattern with as much detail as possible.” D—the issue is urinary function and this option allows the nurse to properly assess the patient’s urinary function. 31. A male client who is to have a kidney transplant asks the nurse how long he will be taking Azathioprine (Imuran), Cyclosporine, and Prednisone. The nurse recognizes that the client understood the teaching when he states, “I must take these medications a. for the rest of my life.” b. until the surgery is over.” c. until the anastomosis heals.” d. during the preoperative period.” A- anti-rejection drugs are taken lifetime following kidney transplant. 32. After a kidney transplant the nurse must observe the client for symptoms of rejection, which include: a. Polyuria and jaundice. b. Fever and weight gain. c. Hematuria and seizures. d. Moon face and muscle atrophy. B—fever and weight gain are signs of rejection. 33. An elderly client is incontinent of urine. The nurse is aware that the most satisfactory initial approach to managing this incontinence would be to a. offer the urinal regularly.

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b. apply incontinence pants. c. insert an indwelling catheter. d. restrict the client’s fluid intake. A—initially offering the urinal on a regular basis helps the patient who has incontinence. 34. A client is in the oliguric phase of acute tubular necrosis and is experiencing fluid and electrolyte imbalances. The client is somewhat confused and complains of nausea and muscle weakness. As part of the prescribed therapy to correct this electrolyte imbalance, the nurse would expect to: a. administer Kayexalate. b. restrict foods high in protein. c. increase in oral intake of cheese and milk. d. administer large amounts of normal saline IV. B—kayexalate promotes elimination of potassium. The patient’s manifestations are signs of hyperkalemia.

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