Renal NCLEX questions Chapter 45 46 Renal and Urologic Problems

Renal NCLEX questions Chapter 45 & 46 Renal and Urologic Problems ScienceMedicineNursing xvjessn Save Renal NCLEX Questions 30 terms lilnurseangelPreview NCLEX Questions for Renal Disorder...40 terms mdunlap5920Preview Renal Calculi NCLEX style questions...35 terms sputumgirlPreview

EXAM 2

36 terms Bts The nurse has admitted a client with uremia. The nurse questions the client about a history of which health problem?

• Polycystic kidney disease
• End-stage renal failure
• Pyelonephritis
• Cystitis

ANS:B

A client receiving peritoneal dialysis has outflow that is 200 ml less than the inflow for 2 consecutive exchanges. Which actions would be appropriate for the nurse to take at this time? Select all that apply.

• Examine the abd dressing
• Change clients position
• Lower the drainage bag
• Continue to monitor the outflow in future exchanges
• Irrigate the peritoneal dialysis catheter

ANS: A, B, C

The nurse is planning to teach the client with acute glomerulonephritis about necessary dietary restrictions. Which dietary changes should the nurse include in the plan?

• Limit fluid intake to 500 ml perday
• Restrict protein intake by limiting meats and other high protein foods
• Increase intake of high fiber foods, such as bran cereal.
• Increase intake of potassium-rich foods such as bananas or canteloupe

ANS: B

A client develops a renal disorder after taking an antibiotic that is known to have nephrotoxic effects. The nurse adds a standardized care plan to the client's medical record for which disorder?

• Polycystic kidney disease
• Glomerulonephritis
• Acute renal failure
• Chronic renal failure

ANS: C

The nurse is teaching the client to perform peritoneal dialysis. The nurse reviews which essential action that will help to prevent the major complication of peritoneal dialysis?

• Monitor postvoid residuals
• Maintain strict aseptic technique during connection and disconnection
• Add heparin to dialysate at least once per day
• Change catheter site dressing twice daily

ANS: B

The nurse is reviewing health care provider prescriptions for a client diagnosed with end-stage renal failure. Which diet should the nurse expect the provider to prescribe for this client?

• Increased protein, decreased CHO
• Restricted protein, increased CHO
• Increased potassium and sodium
• Increased phosphorus and magnesium

ANS: B

Which nursing action is most appropriate when caring for a client with a nursing dx of excess fluid volume r/t renal insufficiency?

• Teaching clients about sodium content of foods
• Administering vitamin D supplements
• Assessing and documenting clients energy level
• Observing for signs of hypocalcemia

ANS: A

The nurse is reviewing the past medical history of a client diagnosed with chronic renal failure. Which conditions in the client's history most likely contributed to the client's renal failure? Select all that apply.

• DM type 1

B) HTN

C) SLE

• Hypothyroidism
• Hiatal hernia

ANS: A, B, C

The nurse is conducting discharge teaching with a client following insertion of a new AV fistula in the L arm for hemodialysis. The nurse will be sure to include which topics in discussions with this client? Select all that apply.

• Avoid carrying items with the left arm
• Assess the fistula daily for redness or drainage
• BP should be taken in the right arm only
• Sleep on the left side
• It is expected to have some bleeding at the access site after a dialysis treatment

ANS: A, B, C

A nurse will teach a patient who is scheduled to complete a 24-hour urine collection for 17-ketosteroids to

• Insert and maintain a retention catheter.
• Keep the specimen refrigerated or on ice.
• Drink at least 3 L of fluid during the 24 hours.
• Void and save that specimen to start the collection.

B - The specimen must be kept on ice or refrigerated until the collection is finished. Voided or catheterized specimens are acceptable for the test. The initial voided specimen is discarded. There is no fluid intake requirement for the 24-hour collection.

• A 46-year-old female patient returns to the clinic with recurrent dysuria after being treated with trimethoprim and sulfamethoxazole (Bactrim)

for 3 days. Which action will the nurse plan to take?a.Teach the patient to take the prescribed Bactrim for 3 more days.b.Remind the patient about the need to drink 1000 mL of fluids daily.c.Obtain a midstream urine specimen for culture and sensitivity testing.d.Suggest that the patient use acetaminophen (Tylenol) to treat the symptoms.

ANS: C

Because uncomplicated urinary tract infections (UTIs) are usually successfully treated with 3 days of antibiotic therapy, this patient will need a urine culture and sensitivity to determine appropriate antibiotic therapy. Acetaminophen would not be as effective as other over-the-counter (OTC) medications such as phenazopyridine (Pyridium) in treating dysuria. The fluid intake should be increased to at least 1800 mL/day. Because the UTI has persisted after treatment with Bactrim, the patient is likely to need a different antibiotic.

• It is most important that the nurse ask a patient admitted with acute glomerulonephritis about

a.history of kidney stones.b.recent sore throat and fever.c.history of high blood pressure.d.frequency of bladder infections.

ANS: B

Acute glomerulonephritis frequently occurs after a streptococcal infection such as strep throat. It is not caused by kidney stones, hypertension, or urinary tract infection (UTI).

• Which finding for a patient admitted with glomerulonephritis indicates to the nurse that treatment has been effective?

a.The patient denies pain with voiding.b.The urine dipstick is negative for nitrites.c.The antistreptolysin-O (ASO) titer is decreased.d.The periorbital and peripheral edema is resolved.

ANS: D

Because edema is a common clinical manifestation of glomerulonephritis, resolution of the edema indicates that the prescribed therapies have been effective. Nitrites will be negative and the patient will not experience dysuria because the patient does not have a urinary tract infection.Antibodies to streptococcus will persist after a streptococcal infection.

• A 58-year-old male patient who weighs 242 lb (110 kg) undergoes a nephrectomy for massive kidney trauma due to a motor vehicle crash.

Which postoperative assessment finding is most important to communicate to the surgeon?a.Blood pressure is 102/58.b.Urine output is 20 mL/hr for 2 hours.c.Incisional pain level is reported as 9/10.d.Crackles are heard at bilateral lung bases.

ANS: B

Because the urine output should be at least 0.5 mL/kg/hr, a 40 mL output for 2 hours indicates that the patient may have decreased renal perfusion because of bleeding, inadequate fluid intake, or obstruction at the suture site. The blood pressure requires ongoing monitoring but does not indicate inadequate perfusion at this time. The patient should cough and deep breathe, but the crackles do not indicate a need for an immediate change in therapy. The incisional pain should be addressed, but this is not as potentially life threatening as decreased renal perfusion.In addition, the nurse can medicate the patient for pain.

• Which information about a patient with Goodpasture syndrome requires the most rapid action by the nurse?

a.Blood urea nitrogen level is 70 mg/dL.b.Urine output over the last 2 hours is 30 mL.c.Audible crackles bilaterally over the posterior chest to the midscapular level.d.Elevated level of antiglomerular basement membrane (anti-GBM) antibodies.

ANS: C

Crackles heard to a high level indicate a need for rapid actions such as assessment of oxygen saturation, reporting the findings to the health care provider, initiating oxygen therapy, and dialysis. The other findings will also be reported, but are typical of Goodpasture syndrome and do not require immediate nursing action.