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4000+ Free NCLEX QUESTIONS. Go to QBankProAcademy.com FREE Qbank questions for NCLEX RN, PN, HESI Exit, Med Surg, AANP, ANCC, and HesiA2. Practice questions, quizzes, and listen to the Free Podcast. In this video, we review a question on a LOOP DIURETIC, FUROSEMIDE in Nursing Care. At QbankproAcademy.com our mission is to provide free QBanks, videos, and the most up to date test prep information for nurses. If you find our website helpful, please tell other aspiring nurses, nursing students, and professors. Please link to our site from your blogs, videos, and college websites, or share us on your favorite social media sites. Thank you for your support! Free nursing NCLEX 60-DAY CHALLENGE https://qbankpro.thinkific.com/courses/qbankpro-academy nclex Nurses Nursing aanp qbank ancc hesi medsurg qbank

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Question A patient is admitted with acute kidney injury (AKI) secondary to dehydration. Which of the following laboratory findings would the nurse expect to be elevated initially?
A. Serum sodium
B. Serum potassium
C. Urine specific gravity
D. Serum calcium
E. Blood urea nitrogen (BUN)

Show the answer: The correct answer is E Rationale: In AKI, the kidneys’ ability to filter blood is compromised, leading to an accumulation of waste products such as urea in the blood, resulting in elevated BUN levels. Dehydration further exacerbates this condition by reducing the volume of blood flowing through the kidneys, leading to higher concentrations of waste products. Elevated BUN levels are one of the earliest indicators of renal impairment before changes in serum creatinine levels become apparent. This finding is critical for early intervention and management of AKI to prevent further renal damage. Topic: Acute Kidney Injury (AKI) 

Question Which dietary modification should be recommended for a patient with chronic kidney disease (CKD) to prevent progression and complications?
A. High protein diet
B. Low sodium diet
C. High potassium diet
D. Low fat diet
E. High calcium diet

Show the answer: The correct answer is B Rationale: A low sodium diet is essential for patients with CKD to manage blood pressure and reduce fluid retention, which are common complications of reduced kidney function. High blood pressure can further damage the kidneys, accelerating the progression of CKD. Reducing sodium intake helps in controlling hypertension and decreases the risk of edema by minimizing fluid overload. This dietary modification is a key component of the comprehensive management plan for CKD to slow the progression of kidney damage. Topic: Chronic Kidney Disease (CKD)

Question A patient diagnosed with acute glomerulonephritis is exhibiting hematuria, hypertension, and oliguria. Which of the following interventions should the nurse prioritize?
A. Administration of a loop diuretic
B. Strict fluid restriction
C. High protein diet
D. Blood pressure monitoring and control
E. Initiation of anticoagulant therapy

Show the answer: The correct answer is D Rationale: In acute glomerulonephritis, inflammation of the glomeruli can lead to hypertension due to the reduction in the kidneys’ ability to regulate fluid and sodium balance. Controlling blood pressure is crucial to prevent further kidney damage and complications such as heart failure. Antihypertensive medications, along with monitoring for signs of fluid overload and adjusting treatment as necessary, are key interventions. This approach helps mitigate the risk of chronic kidney disease and ensures stabilization of the patient’s condition. Topic: Glomerulonephritis

Question Which genetic pattern is MOST commonly associated with autosomal dominant polycystic kidney disease (ADPKD)?
A. Autosomal recessive inheritance
B. X-linked recessive inheritance
C. Autosomal dominant inheritance
D. Mitochondrial inheritance
E. X-linked dominant inheritance

Show the answer: The correct answer is C Rationale: ADPKD is typically inherited in an autosomal dominant pattern, meaning only one copy of the altered gene in each cell is sufficient to cause the disorder. This mode of inheritance explains why ADPKD can be passed down from one affected parent to their child with a 50% chance of inheriting the condition. The presence of numerous cysts in the kidneys characterizes ADPKD, leading to increased kidney size and progressive loss of kidney function. Understanding the genetic basis of ADPKD is crucial for genetic counseling and management of the disease. Topic: Polycystic Kidney Disease (PKD)

Question A patient with a history of calcium oxalate kidney stones is seeking advice on prevention. Which of the following should the nurse recommend?
A. Increase intake of oxalate-rich foods
B. Decrease fluid intake to concentrate urine C
. Increase intake of dairy products
D. Limit sodium intake
E. Limit calcium intake

Show the answer: The correct answer is D Rationale: Limiting sodium intake is vital in preventing calcium oxalate kidney stones. High sodium levels in the diet can increase calcium concentration in urine, promoting the formation of calcium oxalate stones. Encouraging adequate hydration to dilute urine and decrease urinary concentration of calcium and oxalate can also prevent stone formation. Dietary modifications, including reducing sodium intake, play a significant role in the prevention and management of renal calculi. Topic: Renal Calculi

Question In a patient with nephrotic syndrome, which clinical manifestation would the nurse expect to find?
A. Hypotension
B. Hematuria
C. Proteinuria
D. Hyperkalemia
E. Anuria

Show the answer: The correct answer is C Rationale: Nephrotic syndrome is characterized by a significant loss of protein in the urine (proteinuria) due to increased permeability of the glomerular basement membrane. This condition leads to low plasma albumin levels and subsequent edema. Proteinuria, along with hypoalbuminemia, edema, and hyperlipidemia, forms the primary clinical manifestations of nephrotic syndrome. Recognizing proteinuria as a key symptom allows for early diagnosis and management of the syndrome to prevent complications. Topic: Nephrotic Syndrome

Question What is the PRIMARY purpose of using an arteriovenous fistula (AVF) in a patient requiring hemodialysis?
A. To reduce the risk of infection
B. To provide a high-flow vascular access
C. To monitor blood pressure
D. To administer intravenous medications
E. To draw blood samples

Show the answer: The correct answer is B Rationale: An arteriovenous fistula (AVF) is created surgically to provide a durable and high-flow vascular access for hemodialysis. It connects an artery directly to a vein, facilitating the high volume of blood flow needed for effective dialysis treatments. AVFs are preferred over other types of access because they have a lower risk of complications, such as infections and clotting, and tend to last longer. Ensuring adequate blood flow is essential for the efficient removal of waste products and excess fluid from the blood during dialysis. Topic: Hemodialysis

Question Post-renal transplant, which medication would the nurse anticipate administering to prevent organ rejection?
A. Antibiotics
B. Diuretics
C. Antihypertensives
D. Immunosuppressants
E. Anticoagulants

Show the answer: The correct answer is D Rationale: Immunosuppressants are crucial in the post-renal transplant period to prevent the recipient’s immune system from rejecting the new kidney. These medications work by suppressing the immune response that could lead to organ rejection. While managing side effects and ensuring compliance with the medication regimen can be challenging, immunosuppressants are essential for the long-term success of the transplant. The nurse plays a vital role in educating the patient about the importance of adherence to these medications to maintain graft function. Topic: Renal Transplantation

Question Which electrolyte imbalance is MOST commonly associated with chronic renal failure?
A. Hyponatremia
B. Hypercalcemia
C. Hypokalemia
D. Hyperkalemia
E. Hypocalcemia

Show the answer: The correct answer is D Rationale: In chronic renal failure, the kidneys lose their ability to excrete potassium effectively, leading to hyperkalemia, or elevated blood potassium levels. Hyperkalemia is a dangerous condition that can lead to cardiac arrhythmias and cardiac arrest if not managed promptly. Management strategies include dietary potassium restriction, medications to bind potassium in the gastrointestinal tract, and dialysis in severe cases. Recognizing and managing hyperkalemia is critical in patients with chronic renal failure to prevent life-threatening complications. Topic: Electrolyte Imbalance in Renal Failure

Question A patient with acute renal failure (ARF) is experiencing metabolic acidosis. Which intervention should the nurse anticipate?
A. Administration of sodium bicarbonate
B. Restriction of protein intake
C. Increase in dietary potassium
D. Fluid restriction
E. High carbohydrate diet

Show the answer: The correct answer is A Rationale: Metabolic acidosis is a common complication of ARF due to the kidneys’ reduced ability to excrete acid and reabsorb bicarbonate. Administering sodium bicarbonate can help correct the acid-base balance by providing a bicarbonate source for buffering the excess acid in the blood. This intervention is part of the management strategies to treat metabolic acidosis in patients with ARF. Monitoring and correcting electrolyte imbalances and acid-base disturbances are crucial in the care of patients with ARF to improve outcomes. Topic: Acute Renal Failure (ARF)

 

Renal Failure Nursing Diagnosis

Blood and urine tests give you an idea of kidney function fluid status: BUN, creatinine, serum chemistry, and 24-hour urine collection. In addition a urinalysis or U.A. provides information about the infection, hematuria, proteinuria and specific gravity. Culture and sensitivity provide additional information. A urinalysis and culture provide information about the bacteria present in the urine specimen. Sensitivity provides information about the antibiotic coverage.

Advanced Studies that Assess Kidney Function

The imaging studies include a KUB x-ray, or kidney urine bladder x-ray, an ultrasound of the kidneys and the bladder, or an intravenous pyelogram (IVP). The IVP study uses dye and allows us to look at the urinary tract. It is an excellent study very good for identifying stones. We can do a CT scan or a more invasive test such as cystoscopy which involves looking in the bladder with a lighted scope. Cystoscopy provides direct visualization and one can obtain biopsies. On the licensing exam, you may be asked about obtaining the patient’s consent, pretest creatinine level, or assessing the patient for allergies to the dye or contrast used for the study. Recall that a KUB is a plain x-ray that doesn’t require preparation or dye.

Acute renal injury

This is normally recognized during hospitalization by a change in renal function. Usually, we note a decrease in urine output or an increase in creatinine that may signify this acute renal injury. Acute renal injury is typically but not always temporary. Some of these patients may require dialysis during hospitalization. The patient may get a catheter hemodialysis catheter placed that can be used temporarily. The causes of.reversible acute renal failure may be drugs, infection, hypertension, or low blood pressure when there is a decrease in blood flow to the kidney for a period of time that affects kidney function.

chronic renal injury

The other presentation that you may be asked about is chronic kidney disease. These are patients where the disease is slow. Typically the course of the disease is longer with a longer course of illness as the disease progresses. Often the disease is not reversible and these patients will end up with long-term dialysis or getting a kidney transplant. The causes of chronic kidney disease include diabetes, autoimmune disease, chronic obstruction, and hypertension.

Acute renal Failure nursing care plan

In patients with these conditions that are the cause of chronic kidney disease, we try to control and slow down and reverse kidney disease. Patients who have chronic kidney disease will have certain things we will have to monitor because these are the patients who will live with anemia, easy bruising, increased risk of infection. These patients are at risk for gastrointestinal bleeding, thrombocytopenia, hyperkalemia, calcium abnormalities, fluid excess and cardiac congestive heart failure.

renal failure nursing diagnosis

You can expect questions on dialysis. There are different types of dialysis, the board expects you to know the difference between hemodialysis and peritoneal dialysis. The latter may be done at home. Because they don’t have to go to the renal center, there is an advantage. The patient doesn’t have to be transported to the dialysis center. Peritoneal dialysis involves warming the dialysate. The fluid is infused into the peritoneal cavity for dialysis. After some time, usually 45 minutes to an hour, it is allowed to drain. Patients do this as an alternative to hemodialysis.

Dialysis Nursing

Renal Failure Nursing Diagnosis

Some patients prefer to go to the dialysis center, typically three times a week. Upon arrival at the dialysis center they are connected to a dialysis machine using a surgical shunt or fistula for hemodialysis. Recall that we said patients can be dialyzed temporarily with a hemodialysis catheter. If dialysis is needed long-term a shunt or fistula will be done. This procedure is done in the operating room by a surgeon who specializes in providing vascular access.

Hemodialysis Shunts

Soft cannulas are inserted and connected to an artery and vein in the forearm or leg. This allows the patient’s blood to flow through the shunt from the artery to the vein. During dialysis, a needle is inserted into the shunt. The blood flows to the dialyzer and then is returned to the patient. The shunt can be used immediately after it is created. However, the shunt can become infected or clot. Patients should be taught that the shunt extremity should not be used for blood draws, intravenous lines, or blood pressure monitoring. Monitor the shunt regularly by auscultating (listening) for a bruit or palpating a thrill (vibration). Contact the health care provider if you detect signs of a clot, infection, or bleeding.

Arteriovenous Fistula

Creating an arteriovenous fistula involves surgically connecting an artery and a vein in the arm or leg. The blood flow from the artery to the vein is the site for the insertion of the dialysis catheter. The fistula cannot be used immediately. It requires 4-6 weeks for the site to mature. However, there is less risk of infection with a fistula as compared to a graft. Like patients with a hemodialysis tube graft, these patients should be taught that the fistula extremity should not be used for blood draws, intravenous lines, or blood pressure monitoring.

Peritoneal dialysis nursing interventions

Peritoneal dialysis is administered through a catheter that is surgically placed in the peritoneal cavity just below the umbilicus. The solution that is put inside the peritoneal cavity is sterile. To begin, fill the peritoneal cavity by gravity with 1-2 liters of dialysate. This takes about 30 minutes. The dialysate remains in the peritoneal cavity for a period of time also known as the dwell time. The physician prescribes the dwell time. After the dwell time, the fluid is drained by gravity into a drainage bag.

Monitoring during peritoneal dialysis

Renal Failure Nursing Diagnosis

Monitor the vital signs and breathing during peritoneal dialysis. As the dialysate is added to the peritoneal cavity, the patient may show signs of respiratory distress and pain. Monitor for nausea and gastrointestinal upset. The prescribed dwell time should not be exceeded. Carefully assess the character of the dialysate return for color and clarity. Cloudy or malodorous drainage may indicate infection. If this is not contact the health care provider. Gross blood in the dialysate should also be reported to the health care provider.

Infections of the Urinary Tract

The other thing you have to know about is some of these renal conditions and infections. UTI can come up in your NCLEX question. We can have lower urinary tract infections and then we can have upper UTI. Pyelonephritis is upper urinary tract; the lower urinary tract will be, for example, urethritis or cystitis. Urethritis is not uncommon and typically resolves with antibiotics, but the ascending infection can be much more serious. You can have acute and chronic pyelonephritis. Pyelonephritis can result in bacteremia and that’s why patients get very sick. Patients present with fever and chills. Mental status changes, confusion and delirium occur in the elderly.

Urethritis

Urethritis is commonly caused by a bacterial infection. This results in inflammation of the urethra. Patients present with complaints of pain with urination, discharge, frequent urination, and burning. The treatment is usually an antibiotic or if the infection is caused by yeast, an antifungal medication.

Cystitis

Cystitis may be caused by a bacterial infection and results in inflammation of the bladder. Patients present with complaints of pain with urination, discharge, frequent urination, and burning, lower abdominal pain and bladder spasms.

Pyelonephritis

Pyelonephritis is inflammation of the kidney or renal pelvis, most commonly caused by a bacterial infection. The condition my be acute or chronic. This infection is more serious and may result in bacteremia and sepsis. Patients present with chills, fever, vomiting, nausea, back and flank pain, frequent urination, cloudy urine, and malaise. The treatment is antibiotics and includes close monitoring. Adequate rest will be needed, fluid hydration to prevent dehydration, antipyretics, analgesics and antibiotics. Patients with serious in infections and sepsis will be admitted.

Kidney Stones

It is important to understand the management of kidney stones. On your exam kidney stones may be referred to as renal calculi. The primary focus is pain management pain and the best practices for treatment of pain that is important. The treatment of kidney stones includes cystoscopy and the placement of ureteral catheters to drain the urine if obstruction is present. Lithotripsy is used to break up stones. After lithotripsy, the stones are passed in the urine within a few days. Open surgical procedures are also used to remove the stone in some cases.

Nephrectomy

The other procedure, unrelated to stones, is nephrectomy. Nephrectomy is removal of the kidney. The reasons for removing kidneys are for example cancer and trauma – a crushed or shattered kidney. A total nephrectomy means the entire kidney is removed.  A partial nephrectomy means a portion of the kidney is removed. “Ectomy” indicates surgery to remove an organ or part of the body. “Nephro” means relating to the kidney. Renal cancer typically presents with painless hematuria. Hematuria is a term indicating blood in the urine. This could either be “gross” hematuria, where we see the blood in the urine or it could be an microscopic hematuria, where we don’t see the blood, but if we test the urine, we will detect blood in the urine. So here, the terminology is important.

What are some findings in patients following cystoscopy?

Bladder spasm is not unexpected. Patients may be sleepy from the anesthesia. We are inserting a scope and biopsies may be done. As a result, mild hematuria may be seen after the procedure. We don’t expect these patients to have signs of infection, chills or fever. The later may indicate the possibility of a perforation or complication. Bladder spasm it not an infrequent complication after cystoscopy and sitz baths can relieve that bladder spasm.

What are some factors affecting ileal conduit management?

An ileal conduit is created by a surgeon. It may be used to divert urine to the surface of the abdomen after the bladder is removed (cystectomy). Sometimes you will be asked a question about the odor. Changing the ostomy bag on schedule, avoiding leakage, and avoiding certain foods an affect the odor.

Encourage normal return of bowel function after cystectomy

Postoperative paralytic ileus is normal after abdominal surgery. What does it mean to be paralyzed? It means “not moving”, so how can we get the bowels to wake up? You will notice after surgery orders include encouraging the patient to get the patient out of bed the next morning, sit in the chair at bedside or ambulate the patient every shift in the hallways. This is because we are trying to expedite the return of normal bowel function. An excellent way to accomplish this is ambulation. We don’t recommend and we not give stool softeners or laxatives. Increasing the patient’s activity helps. As bowel peristalsis returns, the patient will have flatus and normal bowel sounds.

More Renal NCLEX Questions

Renal Failure Nursing Diagnosis

NCLEX QUESTION: 1. The nurse is taking care of a 56-year-old diabetic female receiving dialysis three days a week. What are some additional risk factors associated with chronic kidney disease (select all that apply)
A. bleeding
B. neurological symptoms
C. hypomagnesemia
D. hypokalemia

Cystoscopy

NCLEX QUESTION: 2. The nurse’s patient returns to the ward after cystoscopy. What are appropriate nursing interventions (select all that apply)
A. Assess the patient’s vital signs
B. Restrict fluid intake
C. Keep the patient NPO until return of bowel function
D. Monitor urine for bleeding

Hemodialysis

NCLEX QUESTION: 3. All the following statements are true about access for hemodialysis, (select all that apply)
A. Hemodialysis arteriovenous fistulas are assessed by the nursing staff by palpating a “thrill” over the skin of the fistula site
B. Peritoneal dialysis is accomplished by placing a small access catheter into the subclavian or femoral vein
C. A complication of peritoneal dialysis is bacterial peritonitis
D. Hemodialysis catheters are placed in the subclavian or femoral vein

GI Bleeding in Renal Failure Patients

NCLEX QUESTION: 4. Preventing or decreasing the risk of gastrointestinal bleeding includes all the following, (select all that apply)
A. Avoid administering aspirin
B. Monitor PT, APTT
C. Avoid administration of NSAIDs
D. Avoid administration of Vitamin K

BUN/Creatinine Ratio in ICU Patients

NCLEX QUESTION: 5. A 53-year-old male with sepsis and pneumonia is in the ICU. His decreased BUN/creatinine ratio may indicate, (select all that apply)
A. An anabolic state
B. An increase in creatinine only
C. A catabolic state
D. Dehydration

Diagnostic Testing for Kidney Function

NCLEX QUESTION: 6. The nurse is caring for a post-op patient. Which statements are true about diagnostic testing for kidney dysfunction? (select all that apply)
A. Creatinine is a laboratory test that assesses the rate of hemolysis (red blood cell breakdown)
B. Creatinine is a laboratory test that indicates glomerular filtration.
C. BUN/Creatinine ratio is the creatinine level divided by the BUN level to determine the ratio
D. BUN is a laboratory test that indicates the amount of urea in the blood, a by product of protein metabolism

Obtaining a Urine Specimen for Urinalysis

NCLEX QUESTION: 7. Obtaining a urine specimen for urinalysis in a 23-year-old female patient who may have a urinary tract infection includes, (select all that apply)
A. Drinking 16 ounces of water prior to providing a specimen
B. Washing the perineal area prior to voiding
C. Obtain the first morning void if possible
D. Document menstruation on the requisition if present

More NCLEX Questions

Answers to NCLEX Questions

Renal Failure Nursing Diagnosis

1. A and B
GI bleeding may occur in these patients because the increased urea leads to an increase in ammonia. Ammonia irritates the gastrointestinal mucosa resulting in bleeding. Elevated magnesium and potassium are more common. Confusion and decreased level of consciousness may occur.
2. A and D
As usual, when a patient returns from an invasive procedure, assess and document the vital signs. The exam would expect you to know that cystoscopy involves an endoscopic examination of the bladder, and the nurse will monitor for bleeding. Fluids are encouraged post cystoscopy.
3. A, C and D
Hemodialysis (HD) involves removal of the blood out of the body. The blood is cleansed by a machine. Peritoneal dialysis (PD) uses the peritoneal lining of the abdominal cavity to act as the filter. HD “access” refers to how the blood is removed from the body.
4. A, B, C
Two medications associated with an increase in bleeding are aspirin and NSAIDS. For this reason, these medications should be avoided in patients with kidney disease. Assessing PT/APTT is a valuable indicator of coagulopathy.
5. C and D
Note, in this question you are asked about the ratio (BUN/creatinine). Decreased BUN/creatinine ratio may indicate a high protein diet, increased catabolism or dehydration. Critically ill patients with prolonged illness are in a catabolic state that leads to weight loss and loss of muscle mass
6. B and D
When the BUN and creatinine levels increase, this may be an indication of renal dysfunction. The BUN level divided by the creatinine is the BUN/creatinine ratio.
7. B, C and D
Instructing patients about the correct steps for obtaining a urinalysis sample is important. Cleansing the perineal area helps limit contamination. Red blood cells (RBC’s) may be present in the sample during menstruation.