NCLEX Questions for Renal Disorders

NCLEX Questions for Renal Disorders mdunlap5920 Save Renal NCLEX Questions 30 terms lilnurseangelPreview Med Surg Gastrointestinal NCLEX Q...86 terms Jasmine_Lawson4 Preview Renal Disorders/Dialysis & Peritone...132 terms rnin2018Preview Fluid a 33 terms Ale You're preparing for urinary catheterization of a trauma patient and you observe bleeding at the urethral meatus. Which action has priority?

• Irrigate and clean the meatus before catheterization.
• Check the discharge for occult blood before catheterization.
• Heavily lubricate the catheter before insertion.
• Delay catheterization and notify the doctor.
• Delay catheterization and notify the doctor.

Rationale:

Bleeding at the urethral meatus is evidence that the urethra is injured. Because catheterization can cause further harm, consult with the doctor.Which of the following causes the majority of UTI's in hospitalized patients?

• Lack of fluid intake
• Inadequate perineal care
• Invasive procedures
• Immunosuppression
• Invasive procedures.

Rationale: Invasive procedures such as catheterization can introduce bacteria into the urinary tract. A lack of fluid intake could cause concentration of urine, but wouldn't necessarily cause infection.A patient with diabetes has had many renal calculi over the past 20 years and now has chronic renal failure. Which substance must be reduced in this patient's diet?

• Carbohydrates
• Fats
• Protein
• Vitamin C
• Protein

Rationale: Because of damage to the nephrons, the kidney can't excrete all the metabolic wastes of protein, so this patient's protein intake must be restricted. A higher intake of carbs, fats, and vitamin supplements is needed to ensure the growth and maintenance of the patient's tissues.

You're developing a care plan with the nursing diagnosis risk for infection for your patient that received a kidney transplant. A goal for this

patient is to:

• Remain afebrile and have negative cultures
• Resume normal fluid intake within 2 to 3 days
• Resume the patient's normal job within 2 to 3 weeks
• Try to discontinue cyclosporine (Neural) as quickly as possible
• Remain afebrile and have negative cultures

Rationale: The immunosuppressive activity of cyclosporine places the patient at risk for infection, and steroids can mask the signs of infection.The patient may not be able to resume normal fluid intake or return to work for an extended period of time and the patient may need cyclosporine therapy for life.Which criterion is required before a patient can be considered for continuous peritoneal dialysis?

• The patient must be hemodynamically stable
• The vascular access must have healed
• The patient must be in a home setting
• Hemodialysis must have failed
• The patient must be hemodynamically stable

Rationale: Hemodynamic stability must be established before continuous peritoneal dialysis can be started.You have a patient that is receiving peritoneal dialysis. What should you do when you notice the return fluid is slowly draining?

• Check for kinks in the outflow tubing
• Raise the drainage bag above the level of the abdomen
• Place the patient in a reverse Trendelenburg position
• Ask the patient to cough
• Check for kinks in the outflow tubing

Rationale: 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 You suspect kidney transplant rejection when the patient shows which symptoms?

• Pain in the incision, general malaise, and hypotension
• Pain in the incision, general malaise, and depression
• Fever, weight gain, and diminished urine output
• Diminished urine output and hypotension
• Fever, weight gain, and diminished urine output

Rationale: Symptoms of rejection include fever, rapid weight gain, HTN, pain over the graft site, peripheral edema, and diminished urine output.Which cause of HTN is the most common in acute renal failure?

• Pulmonary edema
• Hypervolemia
• Hypovolemia
• Anemia
• Hypervolemia

Rationale: Acute renal failure causes hypervolemia as a result of over expansion of extracellular fluid and plasma volume with the hyper secretion of renin. Therefore, hypervolemia causes HTN.

The most common early sign of kidney disease is:

• Sodium retention
• Elevated BUN level
• Development of metabolic acidosis
• Inability to dilute or concentrate urine
• Elevated BUN level

Rationale: Increased BUN is usually an early indicator of decreased renal function.Frequent PVCs are noted on the cardiac monitor of a patient with end-stage renal disease. The priority intervention is:

• Call the doctor immediately
• Give the patient IV lidocaine (Xylocaine)
• Prepare to defibrillate the patient
• Check the patient's latest potassium level
• Check the patient's latest potassium level

Rationale: The patient with ESRD may develop arrhythmias caused by hypokalemia. Call the doctor after checking the patient's potassium values.Lidocaine may be ordered if the PVCs are frequent and the patient is symptomatic.Your patient has complaints of severe right-sided flank pain, N/V, and restlessness. He appears slightly pale and is diaphoretic. VS are BP 140/90 mmHg, P 118 bp, RR 33 breaths/min, and T 98.0F. Which subjective data supports a diagnosis of renal calculi?

• Pain radiating to the right upper quadrant
• Hx of mild flu symptoms last week
• Dark-colored coffee-ground emesis
• Dark, scanty urine output
• Dark, scanty urine output

Rationale: Patients with renal calculi commonly have blood in the urine caused by the stone's passage through the urinary tract. The urine appears dark, tests positive for blood, and is typically scant.What change indicates recovery in a patient with nephrotic syndrome?

• Disappearance of protein from the urine
• decrease in BP to normal
• Increase in serum lipid levels
• Gain in body weight
• Disappearance of protein from the urine

Rationale: With nephrotic syndrome, the glomerular basement membrane of the kidney becomes more porous, leading to loss of protein in the urine. As the patient recovers, less protein is found in the urine.Your 60 y/o patient with pyelonephritis and possible septicemia has had five UTIs over the past 2 years. She is fatigued from lack of sleep, has lost weight, and urinates frequently even in the night. Her labs show: Sodium 154 mEq/L, osmolarity 340 most/L, glucose 127 mg/dl, and potassium 3.9 mEq/L. Which nursing diagnosis is priority?

• Fluid volume deficit r/t osmotic diuresis induced by hyponatremia
• Fluid volume deficit r/t inability to conserve water

C. Altered nutrition: Less than body requirements r/t hyper metabolic state

• Altered nutrition: Less than body requirements r/t catabolic effects of insulin deficiency

B Fluid volume deficit r/t inability to conserve water

Immediately post-op after a prostatectomy, which complication requires priority assessment of your patient?

• Pneumonia
• Hemorrhage
• Urine retention

D. DVT

• Hemorrhage

Rationale: Hemorrhage is a potential complication. Urine retention isn't a problem soon after surgery because a catheter is in place. Pneumonia may occur if the patient doesn't cough and deep breathe. Thrombosis may occur later if the patient doesn't ambulate.Which sign indicates the second phase of acute renal failure?

• Daily doubling of urine output (4 to 5 L/day)
• Urine output less than 400 mL/day
• Urine output less than 100 mL/day
• Stabilization of renal function
• Daily doubling of urine output (4 to 5 L/day)

Rationale: Daily doubling of the urine output indicates that the nephrons are healing. This means the patient is passing into the second phase (diuresis) of acute renal failure.Which drug is indicated for pain r/t acute renal calculi?

• Narcotic analgesics
• NSAIDs
• Muscle relaxants
• Salicylates
• Narcotic analgesics

Rationale: 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 salicylate are used for their anti-inflammatory and anti-pyretic properties and to treat less severe pain.What is the appropriate infusion time for the dialysate in your 38 y/o patient with chronic renal failure?

• 15 min
• 30 min
• 1 hr
• 2 to 3 hrs
• 15 min

Rationale: Dialysate should be infused quickly. The dailysate should be infused over 15 min or less when performing peritoneal dialysis. The fluid exchange takes place over a period ranging from 30 min to several hours.A patient with ESRD has an arteriovenous fistula in the left arm for hemodialysis. Which intervention do you include in his plan of care?

• Apply pressure to the needle site upon discontinuing hemodialysis
• Keep HOB elevated 45 degrees
• Place the left arm on an arm board for at least 30 min
• Keep the left arm dry
• Apply pressure to the needle site upon discontinuing hemodialysis

Rationale: Apply pressure when discontinuing hemodialysis and after removing the venipuncture needle until all the bleeding has stopped.Bleeding may continue for 10 min in some patients.