Renal System Disorders

NCLEX-RN Examination Practice Questions

Medical Surgical Nursing
Prepared by: Jeffrey Viernes
Name:

Score:

/100

Success is not to be measured by the position someone has reached in life,

but the obstacles he has overcome while trying to succeed.Booker T.
Washington
1. A married female patient has a history of repeated urinary tract infections (UTIs). Which of the
following should the nurse include while assessing this patient?
1. preferred method of birth control
2. employment status
3. height and weight
4. activity status
2. A male patient has a history of calcium calculi. Which of the following medications can be
prescribed to help this patient?
1. NSAIDs
2. penicillin (Pentids)
3. allopurinol (Alloprim)
4. furosemide (Lasix)
3. A male patient with a urinary stoma says, I looked at it while you were out of the room. Its
not so bad. The nurse realizes that this patient is demonstrating which of the following?
1. grief
2. denial
3. coping
4. anger
4.A middle-aged

male patient comes into the clinic for frequency and voiding small amounts
of urine at a time. The nurse realizes that this patient might be experiencing symptoms of which
of the following?
1. cystitis
2. benign prostatic hypertrophy (BPH)
3. renal calculi
4. bladder cancer
5. A female patient is admitted with an overdistended bladder. Which of the following diagnostic
tests can be done to confirm the diagnosis of urine retention?
1. intravenous pyelography (IVP)
2. renal scan
3. bladder scan
4. MRI

6. While being catheterized for urinary retention, the patient becomes diaphoretic and pale.
Which of the following can be done to help this patient?
1. Clamp the catheter after draining 500 mL of urine.
2. No action is needed, as this situation is transient.
3. Remove the urinary catheter.
4. Provide the patient with fluids.
7. A male patient needs to increase the acidity of his urine. Which foods should this patient
increase in his diet?
1. cranberries, grapes, and tomatoes
2. sardines and herring
3. green vegetables and oranges
4. beans, chocolate, and dairy products
8. A patient is scheduled for a lithotripsy for renal calculi. The purpose of a bowel preparation
prior to this procedure is to do which of the following?
1. Increase comfort.
2. Ensure that there is no evidence of constipation prior to the procedure.
3. Ensure maximum visualization of the kidney and the stones.
4. Reduce postoperative pain.
9. A patient is participating in bladder retraining activities. Of the following, select the toileting
activities that can reduce episodes of incontinence. Standard Text: Select all that apply.
1. scheduled toileting
2. habit training
3. intermittent straight catheterization
4. external catheter placement at bedtime
5. use of adult incontinence protection devices
10. A patient is being instructed on how to perform Kegel exercises. Which of the following
should be included in these instructions? Select all that apply.
Standard Text: Select all that apply.
1. While voiding, stop the flow of urine and hold for a few minutes.
2. Tighten the muscles around the anus to resist defecation.
3. Take a deep breath and hold while performing the exercise.
4. These should be performed at least once per day.
5. These should be performed for at least several months.
11. A patient diagnosed with a symptomatic urinary tract infection (UTI), is prescribed
phenazopyridine (Pyridium). The patient should be instructed that urine will
1. become orange or red.
2. have a green tint.
3. turn brown in color.
4. become clearer and pale yellow.
12. The nurse is to collect a urine culture specimen from a catheterized patient. Which of the
following statements describes the correct technique?

1. A small volume of urine is emptied from the urine collection bag into a sterile specimen cup.
2. The nurse disconnects the catheter from the drainage tubing and allows 1-3 mL of urine to
drain into a sterile specimen container.
3. With a sterile syringe and needle, the nurse aspirates 50 mL of urine from the catheter above
where it is connected to the drainage tubing.
4. With a sterile syringe, the nurse aspirates several mL of urine from the sampling port after
swabbing it with alcohol. A small volume of urine is emptied from the urine collection bag into a
sterile specimen cup.
13. Which of the following statements by a female patient indicates that teaching was effective
about ways to prevent urinary tract infection (UTI)?
1. I should only wear nylon underpants.
2. I should limit intake of water so I wont need to urinate so often.
3. I should drink 2000 mL of fluids per day.
4. I should void every six hours while I am awake.
14. Which of the following statements by a patient with uric acid stones indicates that teaching
was effective about prevention of lithiasis?
1. I should avoid organ meats and sardines in my diet.
2. I will increase purine-rich foods in my diet.
3. I know to avoid eating vitamin D-enriched foods.
4. I will have to make my urine more acidic by eating cheese, cranberries, grapes, and
tomatoes.
15. The nurse observes no change in urine output and a distended bladder in a patient with an
indwelling urinary catheter and drainage system. The immediate nursing intervention is to do
which of the following?
1. Assess the catheter tubing for kinks and position so drainage is maintained by gravity.
2. Notify the physician.
3. Flush the catheter with sterile saline using a large syringe.
4. Change the catheter.
16. A patient with struvite-type kidney stones may be managed by what two interventions?
1. a sodium restricted diet; taking penicillamine
2. limiting foods high in calcium; taking thiazide diuretics
3. surgical intervention; antibiotic therapy
4. a low-purine diet; taking potassium citrate
17. During the health history interview of a patient diagnosed with postoperative urinary
retention, the nurse asks if the patient is taking what medication to stimulate micturition?
1. tolterodine (Detrol)
2. bethanechol (Urecholine)
3. propantheline bromide (Pro-Banthine)
4. nitrofurantoin (Macrobid)
18. The nurse reviews the data presented (see below) and recognizes these symptoms as being
compatible with a diagnosis of which of the following?

1. cystitis
2. nephrolithiasis
3. hydronephrosis
4. pyelonephritis
19. An elderly patient is admitted to the hospital with cardiac complications associated with
diabetes. What should be of concern to the nurse regarding this patients medications?
1. what vitamins and supplements this patient is taking
2. if the patient taking the prescribed dosages
3. the type and amount of medications in relation to the patients renal function
4. the costs of the patients medications
20. A patient is diagnosed with hypertension caused by polycystic kidney disease. Which of the
following might be helpful to control this patients blood pressure?
1. dialysis
2. kidney transplant
3. ACE inhibitors
4. peritoneal dialysis
21. Three weeks after being treated for strep throat, a patient comes into the clinic with signs of
acute glomerulonephritis. Which of the following symptoms will the nurse most likely find upon
assessment of this patient?
1. periorbital edema
2. hunger
3. polyuria
4. polyphagia
22. The nurse is planning the care of a patient with chronic glomerulonephritis. The goal of
treatment for this patient should include which of the following?
1. achieving maximum independence
2. maintaining renal function
3. returning to work as soon as possible
4. lifestyle changes

23. Which of the following interventions would be appropriate for a patient with Fluid Volume
Excess related to chronic glomerulonephritis?
1. Schedule activities to conserve energy.
2. Document energy level.
3. Weigh daily on the same scale.
4. Assess for signs of infection.
24. An elderly patient is scheduled for a CT scan with and without contrast dye. Which of the
following should be done prior to this CT scan?
1. Keep the patient n.p.o.
2. Assess for level of responsiveness.
3. Assess vital signs.
4. Monitor renal function.
25. A patient with acute renal failure (ARF) is prescribed furosemide (Lasix). The nurse realizes
that this medication will be helpful to the patient because it will do which of the following?
1. preserve protein
2. keep sodium in the body
3. reduce edema
4. be the gentlest diuretic to use
26. A patient is scheduled to have an arteriovenous (AV) fistula created for hemodialysis. Which
of the following statements are appropriate for this patient? Standard Text: Select all that apply.
1. Always use the dominant hand and arm for blood pressure readings.
2. A functioning fistula has a palpable pulse and bruit.
3. Ensure the use of the dominant hand and arm for placement.
4. The fistula can be used immediately after its creation.
5. Venipunctures should be performed on the arm with the fistula.
27. A patient who is recovering from acute renal failure is being discharged. Which of the
following should the nurse include in this patients instructions?
1. Avoid alcohol consumption.
2. Use over-the-counter medications as needed.
3. Instruct to weigh self at least once a week.
4. Resume a normal diet.
28. A patient is admitted with signs of chronic renal failure. Which of the following is indicative
of metabolic acidosis?
1. diarrhea
2. low urine output
3. muscle cramps
4. Kussmauls respirations
29. A patient with diabetes and heart disease is diagnosed with chronic renal failure. The nurse
realizes that this patient should NOT be prescribed which of the following classifications of
medications?

1. calcium channel blockers

2. beta-blockers
3. oral antihyperglycemic agents
4. analgesics
30. A patient with chronic renal failure is trying to decide between hemodialysis and peritoneal
dialysis. Which of the following are advantages of peritoneal dialysis for this patient?
Standard Text: Select all that apply.
1. minimal vascular complications
2. liberal intake of fluids
3. better self-management
4. better metabolite elimination
5. lower risk of infection
31. A patient who received a kidney transplant seven years ago is seen for increasing blood
pressure and proteinuria. The nurse realizes that this patient is demonstrating signs of which of
the following?
1. chronic kidney rejection
2. acute kidney rejection
3. renal artery stenosis
4. pyelonephritis
32. Which of the following interventions would be appropriate for a patient in renal failure with
the diagnosis of Imbalanced Nutrition: Less than Body Requirements?
1. Schedule meals for three times each day.
2. Provide mouth care before meals.
3. Provide antiemetics after meals.
4. Weigh once per week.
33. A patient is diagnosed with postrenal acute renal failure. The nurse realizes that this type of
renal failure can be caused by which of the following?
1. sepsis
2. hypovolemia
3. an enlarged prostate
4. drug toxicity
34. A patient with polycystic kidney disease is planning to be married and asks the nurse if his
children could inherit this disorder. What is the nurses best response?
1. You should ask your fiance to come with you to your next office visit so we can discuss
this.
2. Yes, but this condition is so rare that you shouldnt worry about it.
3. No, polycystic kidney disease occurs because of spontaneous mutations.
4. Yes, this condition can be inherited.
35. In reviewing the report of laboratory results (see diagram) for a newly admitted patient, the
nurse can anticipate that

1. the patient will probably need to undergo additional testing to validate a diagnosis of acute
proliferative glomerulonephritis.
2. no further testing will be needed.
3. the patient probably has prerenal acute renal failure (ARF).
4. the patient will be classified as being in end stage renal disease.
36. The nurse is completing the instructions to a patient who underwent a cadaver kidney
transplant and is ready for discharge from the hospital. Which of the following statements by the
patient would indicate that further teaching is needed?
1. I know to check my weight on a regular basis.
2. Im glad I wont have to take immunosuppressants any longer.
3. Ill call my doctor if I notice any decrease in my urine output.
4. Ill tell my friends to stay away from if they have colds or the flu.
37. Which of the following indicates that a patient with chronic renal failure understands the
dietary regimen?
1. The patient had an apple and oatmeal for breakfast, peanut butter sandwich for lunch, and
pasta with fish for dinner.
2. Breakfast included bacon and eggs; lunch was a hot dog with sauerkraut; dinner consisted of
baked canned ham with green peas.
3. The patient reported eating two bananas for breakfast, rice and beans for lunch, and fruit salad,
green beans and an 8-ounce steak for dinner.
4. The patient related eating half a cantaloupe and three eggs for breakfast, a baked potato with
processed cheese spread and broccoli for lunch, and chicken, pinto beans, squash, and pecan pie
for dinner.
38. The nurse is caring for a patient receiving peritoneal dialysis. After completing the exchange
and draining the dialysate, the nurse observes the dialysate is cloudy. The nurse interprets this
finding as which of the following?
1. the normal appearance of dialysate
2. a sign of vascular access occlusion

3. a sign of infection
4. a sign of possible bowel perforation
39. The nurse, teaching a patient about the concept of hemodialysis, would include that dialysis
is a process that
1. will add electrolytes and water to the blood when passing through a semipermeable membrane
to correct electrolyte imbalances.
2. allows a choice of either diffusion osmosis or ultrafiltration to remove excess water from the
body.
3. increases potassium and calcium to the blood when passing through the dialyzer and works on
the principle of diffusion.
4. moves blood through a semipermeable membrane into a dialyzer that is used to remove waste
products as well as correct fluid and electrolyte imbalances.
40. The patient with chronic renal failure who is scheduled for dialysis this morning is due to
receive a daily dose of enalapril (Vasotec). The nurse should plan to administer this medication
1. just before dialysis.
2. during dialysis.
3. on return from dialysis.
4. the day after dialysis.
41. The nurse, administering epoetin alfa (Epogen) to a patient on dialysis, understands the
therapeutic outcome of this medication is to do which of the following?
1. treat the anemia seen in chronic renal failure patients on dialysis
2. combat the effects of dialysis on bone marrow
3. promote elimination of nephrotoxic drugs from the body
4. enhance absorption of iron and folate in the intestinal tract
42. The nurse instructs a patient in acute renal failure that the expected result of taking sodium
polystyrene sulfonate (Kayexalate) is which of the following?
1. replacing sodium
2. removing excess potassium
3. replacement of magnesium
4. exchanging calcium for sodium
43. Nursing responsibilities when giving osmotic diuretics include which of the following?
Standard Text: Select all that apply.
1. Check mannitol (Osmitrol) solution for crystallization prior to IV administration.
2. Evaluate urine output after test dose is given.
3. Assess for signs of worsening heart failure
4. Assess for orthostatic hypertension.
5. Monitor patient for signs of ototoxicity.
44. The nurse reviews the patients clinical record. Based on the above data, what is the correct
interpretation of this information?

1. kidney trauma
2. azotemia
3. azotemia acute renal failure
4. acute proliferative glomerulonephritis
45. The nurse assesses the patients arm for the presence of which of the following?

1. a thrill upon auscultation

2. a bruit upon auscultation
3. a bruit upon palpation
4. a thrill upon inspection

46.Whenwhichassessmentfindingisnoted,foraclientwithpolycystickidneydisease(PKD),
shouldanursesuspectthatacysthasruptured?
1.Reportsadecreaseinpain
2.Voidscolacoloredurine
3.Passesbloodystools
4.Hasdecreasedserumcreatininelevels
47.Afteradiagnosisofchronicrenalfailure,aclientwasstartedonepoetinalfa(Epogen).
Whichfindingshouldanurseexpectwhenevaluatingthedesiredtherapeuticeffectivenessofthe
medication?
1.Decreaseinserumcreatininelevels(SCr)
2.Increaseinwhitebloodcells(WBCs)
3.Increaseinserumhematocrit(Hct)

4.Decreaseinbloodpressure(BP)
48.Whichnursingassessmentismostaccurateindeterminingthepatencyofaclientsnewly
placedleftforearminternalarteriovenous(AV)fistulaforhemodialysis?
1.Feelingforabruitontheleftforearm
2.Palpatingforathrilloverthefistula
3.Aspiratingbloodfromthefistulaevery8hours
4.Checkingtheclientsdistalpulsesandcirculation
49.A3yearoldclientpresentswithvomitinganddiarrheafor24hours.Onroutineurinalysis,
whichfindingshouldindicatetoanursethatthechildisdehydrated?
1.Specificgravity1.000.
2.Specificgravity1.010.
3.Specificgravity1.020.
4.Specificgravity1.030.
50.Whichclientwouldbemostappropriateforanursetoinstructontheuseofintermittentself
urinarycatheterization?
1.A15yearoldfemalepreparingtohaveacesariansection
2.A18yearoldfemalenewlydiagnosedwithmultiplesclerosis(MS)
3.A13yearoldmalewithspinalcordinjuryandnoawarenessofurgetovoid
4.A16yearoldfemalewhois8monthspregnantandreportsdribbling