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

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.

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

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.

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.

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.

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

8. After the completion of PD, the nurse would expect the patient to exhibit
which the following characteristics?

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 a. Hematuria
b. Weight loss
c. Hypertension
d. Increased urine output

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.

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.

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.

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.

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.

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.

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 b. Implement infection precaution.
c. Provide a quiet and restful environment.
d. Implement reverse isolation.

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

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.

17. The client with chronic renal failure (CRF) goes for hemodialysis. Nursing
assessment of the AV fistula would include:
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.

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.

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.

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.

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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

22. Eva Collins is a 54 year-old female who is admitted with a diagnosis of end-
stage 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.
d. The kidney nephrons are hypertrophied.

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

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.

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.

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.

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.

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 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.

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.

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.

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.”

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.”

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.

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.
b. apply incontinence pants.
c. insert an indwelling catheter.
d. restrict the client’s fluid intake.

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

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 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.

35. Give the rationale of elevated BUN and elevated creatinine level in pancreatitis.

36. Give 2 reasons for hyperkalemia in Renal Failure?

a.

b.

37. ________ described as painful urination.

38. 5 Clinical manifestations of the first phase of Acute Renal Failure:

a.
b.
c.
d.
e.

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