Nursing Practice Test - Genito-Urinary Sample Exam (1-20)

1. Which of the following solutions will be useful to help control odor in the urine collection bag after it has
been cleaned?
a) salt water
b) vinegar
c) ammonia
d) bleach
2. A female client who has a urinary diversion tells the nurse, "This urinary pouch is embarrassing.
Everyone will know that I'm not normal. I don't see how I can go out in public anymore." The most
appropriate nursing diagnosis for this client is:
a) anxiety related to the presence of urinary diversion
b) deficient knowledge about how to care for the urinary diversion
c) low self-esteem related to feelings of worthlessness
d) disturbed body image related to creation of a urinary diversion
3. Which of the following urinary symptoms is the most common initial manifestation of acute renal
failure?
a) dysuria
b) anuria
c) hematuria
d) oliguria
4. The client'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 red blood cells
c) below normal metabolic rate
d) reduced renal blood flow
5. The client's serum potassium is elevated in acute renal failure, and the nurse administers sodium
polystyrene sulfonate (Kayexalate). This drug acts to:
a) increase potassium excretion from the colon
b) release hydrogen ions for sodium ions
c) increase calcium absorption in the colon
d) exchange sodium for potassium ions in the colon
6. If the client's serum potassium continues to rise in acute renal failure, the nurse should be prepared for
which of the following emergency situations?
a) cardiac arrest
b) pulmonary edema
c) circulatory collapse
d) hemorrhage
7. A high-carbohydrate, low protein diet is prescribed for the client with acute renal failure. The rationale
for the high-carbohydrate will:
a) act as a diuretic
b) reduce demands on the liver
c) help maintain urine acidity
d) prevent the development of ketosis

8. In the oliguric phase of acute renal failure, the nurse should anticipate the development of which of the
following complications?
a) pulmonary edema
b) metabolic alkalosis
c) hypotension
d) hypokalemia
9. Which of the following abnormal blood values would not be improved by dialysis treatment?
a) elevated serum creatinine
b) hyperkalemia
c) decreased hemoglobin
d) nypernatremia
10. The client asks the nurse, :How did I get this urinary tract infection?" the nurse should explain that in
most instances, cystitis is caused by:
a) congenital strictures in the urethra
b) an infection elsewhere in the body
c) urine stasis in the urinary bladder
d) an ascending infection from the urethra
11. Which of the following statements by the client would indicate that she is at high risk for a recurrence
of cystitis?
a) I can usually go to 8 to 10 hours without needing to empty my bladder
b) I take a tub bath every evening
c) I wipe from front to back after voiding
d) I drink a lot of water during the day
12. To prevent recurrence of cystitis, the nurse should plan to encourage the client to include which of the
following measures in her daily routine?
a) wearing cotton underpants
b) increasing citrus juice intake
c) douching regularly with 0.25% acetic acid
d) using vaginal sprays
13. Which of the following symptoms would most likely indicate pyelonephritis?
a) ascites
b) costovertebral angle(CVA) tenderness
c) polyuria
d) nausea and vomiting
14. Which of the following factors would put the client at increased risk for pyelonephritis?
a) history of hypertension
b) intake of large quantities of cranberry juice
c) fluid intake of 2000 ml/day
d) history of diabetes mellitus

15. Which of the following groups of laboratory tests is most important for assessing the client's renal
status?

a) serum sodium and potassium levels

b) arterial blood gases and hemoglobin
c) serum blood urea (BUN) and creatinine levels
d) urinalysis and urine culture
16. The client with pyelonephritis asks the nurse, :How will I know whether the antibiotics are effectively
treating my infection?" the nurse's most appropriate response would be which of the following?
a) after you take the antibiotics for 2 weeks, you'll be cured
b) the doctor can tell by the color and odor of your urine
c) the doctor can determine your progress through urine cultures
d) when your symptoms disappear you'll know that your infection is gone
17. The nurse assesses the client who has chronic renal failure and notes the following: crackles in the
lung bases, elevated blood pressure, and weight gain of 2 pounds in 1 day. Based on these data, which of
the following nursing diagnoses is appropriate?
a) excess fluid volume related to the kidney's inability to maintain fluid balance
b) increased cardiac output related to fluid overload
c) ineffective tissue perfusion related to interrupted arterial; blood flow
d) ineffective therapeutic regimen management related to lack of knowledge about therapy
18. What is the primary disadvantage of using peritoneal dialysis for long-term management of chronic
renal failure?
a) the danger of hemorrhage is high
b) it cannot correct severe imbalances
c) it is a time-consuming method of treatment
d) the risk of contracting hepatitis is high
19. The client with chronic renal failure complains of feeling nauseated at least part of every day. The
nurse should explain that the nausea is the result of:
a) acidosis caused by the medications
b) accumulation of waste products in the blood
c) chronic anemia and fatigue
d) excess fluid load
20. During dialysis, the nurse observes that the flow of dialysate stops before all the solution has drained
out. The nurse should:
a) have the client sit in a chair
b) turn the client from side to side
c) reposition the peritoneal catheter
d) have the client walk
ANSWERS
1) b ..... 2) d ..... 3) d ..... 4) d ..... 5) d
6) a ..... 7) d ..... 8) a ..... 9) c ..... 10) d
11) a .... 12) a .... 13) b .... 14) d .... 15) c
16) c .... 17) a .... 18) c .... 19) b .... 20) b
1. A client with nephrotic syndrome asks the nurse, "Why should I even bother trying to control my diet
and the edema? It doesn't really matter what I do if I can never get rid of this kidney problem, anyway!"

The nurse selects which of the following as the most appropriate nursing diagnosis for this client?
a) anxiety
b) powerlessness
c) ineffective coping
d) disturbed body image
2. A client with acute renal failure is having trouble remembering information and instructions as a result
of altered laboratory values. The nurse avoids doing which of the following when communicating with this
client?
a) giving simple, clear directions
b) including the family in discussions related to care
c) explaining treatments using understandable language
d) giving thorough and complete explanations of treatment options
3. A client who has never been hospitalized before is having trouble initiating the stream of urine. Knowing
that there is no pathological reason for this difficulty, the nurse avoids which of the following because it is
the least helpful method of assisting the client?
a) running tap water in the sink
b) assisting the client to a commode behind a closed curtain
c) instructing the client to pour warm water over the perineum
d) closing the bathroom door and instructing the client to pull the call bell when done
4. The nurse provide home-care instructions to a client who has been hospitalized for a transurethral
resection of the prostate (TURP). Which statement by the client indicates the need for further
instructions?
a) I need to include prune juice in my diet
b) I need to avoid strenuous activity for 4 to 6 weeks
c) I can lift and push objects up to 30 pounds in weight
d) I need to maintain a daily intake of 6 to 8 glasses of water
5. The nurse has given instructions about site care to a hemodialysis client who had an implantation of
arteriovenous (AV) fistula in the right arm. The nurse determines that the client needs further instructions
if the client states the need to:
a) sleep on the right side
b) avoid carrying heavy objects with the right arm
c) perform range-of-motion exercises routinely on the right arm
d) report an increased temperature, redness, or drainage at the site

Renal Failure NCLEX Questions

Answers and Rationale
1) B
- Powerlessness is present when the client believes that personal actions will not affect an outcome in
any significant way. Because nephrotic syndrome is progressive, the client may feel that personal actions
may not affect the disease process. Anxiety is diagnosed when the client has a feeling of unease with a
vague or undefined source. Ineffective coping occurs when the client has impaired adaptive abilities or
behaviors with regard to meeting expected demands or roles. Disturbed body image occurs when there is

an alteration in the way that the client perceives his or her body image.
2) D
- The client with acute renal failure may have difficulty remembering information and instructions because
of anxiety and altered laboratory values. Communications should be clear, simple, and understandable.
The family is included whenever possible. Information about treatment should be explained using
understandable language.
3) B
- A lack of privacy is a key issue that may inhibit the ability of the client to void in the absence of known
pathology. Using a commode behind a curtain may inhibit voiding in some people. The use of a bathroom
is preferable, and this may be supplemented with the use of running water or pouring water over the
perineum, as needed.
4) C
- The client needs to be advised to avoid strenuous activity for 4 to 6 weeks and to avoid lifting items that
weigh more than 20 pounds. Straining during defecation is avoided to prevent bleeding. Prune juice is a
satisfactory bowel stimulant. The client needs to consume a daily intake of at least 6 to 8 glasses of
nonalcoholic fluids to minimize clot formation.
5) A
- Routine instructions to the client with an AV fistula, graft, or shunt include reporting signs and symptoms
of infection, performing routine range-of-motion exercises of the affected extremity, avoiding sleeping with
the body weight on the extremity with the access site, and avoiding carrying heavy objects or
compressing the extremity that has the access site.

6. The nurse is caring for a client who has just returned to the nursing unit after an intravenous pyelogram
(IVP). The nurse determines that which of the following is the priority for the postprocedure care of this
client?
a) maintaining the client on bedrest
b) ambulating the client in the hallway
c) encouraging the increased intake of oral fluids
d) encouraging the client to try to void frequently
7. The nurse is evaluating the effects of care for the client with nephrotic syndrome. The nurse determines
that the client showed the least amount of improvement if which of the following information was obtained
serially over 2 days of care?
a) serum albumin 1.9g/dL, up to 2.0g/dL
b) initial weight 208 pounds, down to 203 pounds
c) blood pressure 160/90mm Hg, down to 130/78mm Hg
d) daily intake and output of 2100 ml intake and 1900 ml output 2000 ml intake and 2900 ml output
8. A client is being discharged to home while recovering from acute renal failure (ARF). The client
indicates an understanding of the therapeutic dietary regimen if the client states the need to eat foods that
are lower in:
a) fats
b) vitamins
c) potassium
d) carbohydrates
9. The nurse is caring for a client who has returned from the postanesthesia care unit after prostatectomy.
The client has a three-way Foley catheter with an infusion of continuous bladder irrigation (CBI). The

nurse determines that the flow rate is adequate if the color of the urinary drainage is:
a) dark cherry
b) clear as water
c) pale yellow or slightly pink
d) concentrated yellow with small clots
10. A client with chronic renal failure has a protein restriction in the diet. The nurse should include in a
teaching plan to avoid which of the following sources of incomplete protein in the diet?
a) nuts
b) eggs
c) milk
d) fish

Renal Failure NCLEX Questions

Answers and Rationale
6) C
- After IVP, the client should take in increased fluids to aid in the clearance of the dye used for the
procedure. It is unnecessary to void frequently after the procedure. The client is usually allowed activity as
tolerated, without any specific activity guidelines.
7) A
- The goal of therapy in nephrotic syndrome is to heal the leaking glomerular membrane. This would then
control edema by stopping the loss of protein in the urine. Fluid balance and albumin levels are monitored
to determine the effectiveness of therapy. Option B represents a loss of fluid that slightly exceeds 2 L and
that represents a significant improvement. Option C shows improvement, because both systolic and
diastolic blood pressures are lower. Option D represents a total fluid loss of 700 mL over the 2 days,
which is also helpful. The least amount of improvement is in the serum albumin level, because the normal
albumin level is 3.5 to 5.0 g/dL.
8) C
- Most of the excretion of potassium and the control of potassium balance are normal functions of the
kidneys. In the client with renal failure, potassium intake must be restricted as much as possible (30 to 50
mEq/day). The primary mechanism of potassium removal during ARF is dialysis. Options A, B, and D are
not normally restricted in the client with ARF unless a secondary health problem warrants the need to do
so.
9) C
- The infusion of bladder irrigant is not at a preset rate; rather, it is increased or decreased to maintain
urine that is a clear, pale yellow color or that has just a slight pink tinge. The infusion rate should be
increased if the drainage is cherry colored or if clots are seen. Alternatively, the rate can be slowed down
slightly if the returns are as clear as water.
10) A
- The client whose diet has a protein restriction should be careful to ensure that the proteins eaten are
complete proteins with the highest biological value. Foods such as meat, fish, milk, and eggs are
complete proteins, which are optimal for the client with chronic renal failure.
11. A client with acute renal failure has an elevated blood urea nitrogen (BUN). The client is experiencing
difficulty remembering information due to uremia. The nurse avoids which of the following when
communicating with this client?

a) giving simple, clear directions

b) including the family in discussions related to care
c) giving thorough, lengthy explanations of procedures
d) explaining treatments using understandable language
12. At the beginning of the work shift. the nurse is checking a client who has returned from the postanesthesia care unit following transurethral resection of the prostate (TURP). The client has bladder
irrigation running via a three-way Foley catheter. The nurse should notify the physician if which color if
urine is noted in the urinary drainage bag?
a) pale pink
b) dark pink
c) bright red
d) tea-colored
13. The nurse is assisting in participating in a prostate screening clinic for men. The nurse questions each
client about which sign of prostatism?
a) ability to stop voiding quickly
b) absence of postvoid dribbling
c) excessive force in urinary system
d) hesitancy when initiating urinary stream
14. An adult with renal insufficiency has been placed on a fluid restriction of 1200 mL per day. The nurse
discusses the fluid restriction with the dietitian and then plans to allow the client to have how many
milliliters of fluid from 7:00 AM to 3:00 PM?
a) 400
b) 600
c) 800
d) 1000
15. A client with chronic renal failure has learned about managing diet and fluid restriction between
dialysis treatments. The nurse determines that the client is compliant with the therapeutic regimen of the
client gains no more than how much weight between hemodialysis treatments?
a) 2 to 4kg
b) 5 to 6kg
c) 0.5 to 1kg
d) 1 to 1.5kg

Renal Failure NCLEX Questions

Answers and Rationale
11) C
- the client with acute renal failure nay have difficulty remembering information and instructions because
of anxiety and the increased level of the BUN. The nurse should avoid giving lengthy explanations about
procedures because this information may not be remembered by the client and could increase client
anxiety.

12) C
- Bright red bleeding should be reported, because it could indicate complications related to active
bleeding. If the bladder irrigation is infusing at a sufficient rate, the urinary drainage will be pale pink. A
dark pink color (sometimes referred to as punch-colored) indicates that the speed of the irrigation should
be increased. Tea-colored urine is not seen after TURP, but may be noted in the client with renal failure or
other renal disorders.
13) D
- Signs of prostatism that may be reported to the nurse are reduced force and size of urinary stream,
intermittent stream, hesitancy in beginning the flow of urine, inability to stop urinating quickly, a sensation
of incomplete bladder emptying after voiding, and an increase in episodes of nocturia. These symptoms
are the result of pressure of the enlarging prostate on the client's urethra.
14) B
- When a client is on a fluid restriction, the nurse informs the dietary department and discusses the
allotment of fluid per shift with the dietitian. When calculating how to distribute a fluid restriction, the nurse
usually allows half of the daily allotment (600 mL) during the day shift, when the client eats two meals and
takes most medications. Another two-fifths (480 mL) is allotted to the evening shift, with the balance (120
mL) allowed during the nighttime.
15) D
- A limit of 1 to 1.5 kg of weight gain between dialysis treatments helps prevent hypotension that tends to
occur during dialysis with the removal of larger fluid loads. The nurse determines that the client is
compliant with fluid restriction if this weight gain is not exceeded.
16. The nurse is administering epoetin alfa (Epogen) to a client with chronic renal failure. The nurse
monitors the client for which adverse effect of this therapy?
a) anemia
b) hypertension
c) iron intoxication
d) bleeding tendencies
17. The client scheduled for transurethral prostatectomy (TURP) has listened to the surgeon's explanation
of the surgery. The client later asks the nurse to explain again how the prostate is going to be removed.
The nurse tells the client that the prostate will be removed through:
a) the urethra
b) a lower abdominal incision
c) an upper abdominal incision
d) an incision made in the perineal area
18. The nurse is reviewing a urinalysis report for a client with acute renal failure and notes that the results
are highly positive for proteinuria. The nurse interprets that this client has which type of renal failure?
a) prerenal failure
b) postrenal failure
c) intrinsic renal failure
d) atypical renal failure
19. The nurse caring for a client immediately following transurethral resection of the prostate (TURP)
notices that the client has suddenly become confused and disoriented. The nurse determines that this
may be a result of which potential complication of this surgical procedure?
a) hyponatremia
b) hypernatremia
c) hyperchloremia

d) hypochloremia
20. A client with chronic renal failure has received dietary counseling about potassium restriction in the
diet. The nurse determines that the client has learned the information correctly if the client states to do
which of the following for preparation of vegetables?
a) eat only fresh vegetables
b) boil them and discard the water
c) use salt substitute on them liberally
d) buy frozen vegetables whenever possible

NCLEX Renal Failure Questions

Answers and Rationale
16) B
- The client taking epoetin alfa is at risk of hypertension and seizure activity as the most serious adverse
effects of therapy. This medication is used to treat anemia. The medication does not cause iron
intoxication. Bleeding tendencies is not an adverse effect of this medication.
17) A
- A TURP is done through the urethra. An instrument called a resectoscope is used to remove the tissue
using high-frequency current. An incision between the scrotum and anus is made when a perineal
prostatectomy is performed. A lower abdominal incision is used for suprapubic or retropubic
prostatectomy. An upper abdominal incision is not used.
18) C
- With intrinsic renal failure, there is a fixed specific gravity and the urine tests positive for proteinuria. In
prerenal failure, the specific gravity is high, and there is very little or no proteinuria. In postrenal failure,
there is a fixed specific gravity and little or no proteinuria. There is no such classification as atypical renal
failure.
19) A
- The client who suddenly becomes disoriented and confused following TURP could be experiencing early
signs of hyponatremia. This may occur because the flushing solution used during the operative procedure
is hypotonic. If enough solution is absorbed through the prostate veins during surgery, the client
experiences increased circulating volume and dilutional hyponatremia. The nurse needs to report these
symptoms.
20) B
- The potassium content of vegetables can be reduced by boiling them and discarding the cooking water.
Options 1 and 4 are incorrect. Clients with renal failure should avoid the use of salt substitutes altogether,
because they tend to be high in potassium content.
21. A client with chronic renal failure has started receiving epoetin alfa (Epogen). The nurse reminds the
client about the importance of taking which prescribed medication to enhance the effects of this therapy?
a) ferrous gluconate
b) aluminum carbonate
c) aluminum hydroxide gel
d) calcium carbonate (Tums)

22. The nurse is planning to do preoperative teaching with a client scheduled for a transurethral resection
of the prostate (TURP). The nurse plans to include in the discussion that the most frequent cause of
postoperative pain will be:
a) bladder spasms
b) bleeding within the bladder
c) the lower abdominal incision
d) tension on the Foley catheter
23. A client is being discharged to home after undergoing a transurethral resection of the prostate
(TURP). The nurse teaches the client to expect which variation in normal urine color for several days
following the procedure?
a) dark red
b) pink-tinged
c) clear yellow
d) cloudy amber
24. A client with nephrotic syndrome states to the nurse: "Why should I even bother trying to control my
diet and the edema? It doesn't really matter what I do, if I can never get rid of this kidney problem
anyway!" Based on the client's statement, the nurse addresses which potential client problem?
a) anxiety
b) powerlessness
c) ineffective coping
d) disturbed body image
25. A client has just been diagnosed with acute renal failure. The laboratory calls the nurse to report a
serum potassium level of 6.1 mEq/L on the client. The nurse takes which immediate action?
a) calls the physician
b) checks the sodium level
c) encourages an extra 500ml of fluid intake
d) teaches the client about foods low in potassium

NCLEX Renal Failure Questions

Answers and Rationale
21) A
- In order to form healthy red blood cells, which is the purpose of epoetin alfa, the body needs adequate
stores of iron, folic acid, and vitamin B12. The client should take these supplements regularly to enhance
the hematocrit-raising benefit of this medication. The other options are incorrect.
22) A
- Bladder spasms can occur after this surgery because of postoperative bladder distention or irritation
from the balloon on the indwelling urinary catheter. The nurse administers antispasmodic medications,

such as belladonna and opium, to treat this type of pain. There is no incision with a TURP (option C).
Options B and D are not frequent causes of pain. Some surgeons purposefully apply tension to the
catheter for a few hours postoperatively to control bleeding.
23) B
- The client should expect that the urine will be pink-tinged for several days following this procedure. Dark
red urine may be present initially, especially with inadequate bladder irrigation, and if it occurs, it must be
corrected. Options C and D are incorrect because urine of these colors is not generally expected for
several days following surgery.
24) B
- Powerlessness is a problem when the client believes that personal actions will not affect an outcome in
any significant way. Anxiety occurs when the client has a feeling of unease with a vague or undefined
source. Ineffective coping indicates that the client has impaired adaptive abilities or behaviors in meeting
the demands or roles expected from the individual. Disturbed body image occurs when the way the client
perceives body image is altered.
25) A
- The client with hyperkalemia is at risk of developing cardiac dysrhythmias and resultant cardiac arrest.
Because of this, the physician must be notified at once so that the client may receive definitive treatment.
Fluid intake would not be increased because it would contribute to fluid overload and wouldn't effectively
lower the serum potassium level. Dietary teaching may be necessary at some point, but this action is not
the priority. The nurse might also check the result of a serum sodium level, but this is not a priority action
of the nurse.
26. A nurse is assessing the renal function of a client. The nurse checks which item as the best indirect
indicator of renal status?
a) bladder distention
b) level of conciousness
c) pulse rate
d) blood pressure
27. A nurse is caring for a hospitalized client with polycystic kidney disease who has intravenous
pyelography (IVP). The nurse monitors which specific item in the postprocedure period?
a) lung sounds
b) groin area
c) carotid pulse rate
d) intake and output
28. A client has been diagnosed with urolothiasis in the right ureter. The nurse would expect the client to
describe the pain (renal colic) as:
a) located in the upper right epigastric area, radiating to the shoulder or back
b) occurring 2 to 3 hours after meal
c) intermittent in the right upper abdominal quadrant, radiating to the groin
d) worsening with the ingestion of food
29. A female client with a history of chronic urinary tract infection complains of burning and urinary
frequency. To determine whether the current problem is of renal (kidney) origin, the nurse would assess

whether the client has pain or discomfort in the:

a) suprapubic area
b) right or left costovertebral angle
c) urinary meatus
d) labium
30. A client has been diagnosed with acute pyelonephritis. The nurse assesses the client for which
manifestation of this disorder?
a) low-grade fever
b) flank pain on the unaffected side
c) chills and nausea
d) pale, dilute urine

NCLEX Renal Failure Questions

Answers and Rationale
26) D
- The kidneys normally receive 20% to 25% of the cardiac output, even under conditions of rest. In order
for kidney function to be optimal, adequate renal perfusion is necessary. Perfusion can best be estimated
by the blood pressure, which is an indirect reflection of the adequacy of cardiac output. The pulse rate
affects the cardiac output, but can be altered by factors unrelated to kidney function. Bladder distention
reflects a problem or obstruction that is most often distal to the kidneys. Level of consciousness is an
unrelated item.
27) D
- IVP is used to visualize the kidneys, ureters, and bladder for evaluation of structure and excretory
function. Contrast medium is injected intravenously (usually in a vein located in the antecubital area) to
visualize the renal parenchyma, collecting system, ureter, and bladder, using multiple x-ray films. This
diagnostic test detects renal masses and cysts, ureteral obstruction, retroperitoneal tumors, renal trauma,
and other urinary tract abnormalities. The nurse monitors urinary output and renal function for 24 to 48
hours after the test in order to recognize a nephrotoxic response to the contrast medium. Options A, B,
and C are unrelated to this procedure.
28) C
- Renal colic is generally associated with acute obstruction of a ureter and resulting ureteral spasm. As
the stone moves along the ureter, the pain can be excruciating, is intermittent in character, and is located
in the flank and upper abdominal quadrant of the affected side. It is caused by the spasm of the ureter
and anoxia of the ureter wall from the pressure of the stone. The pain follows the anterior course of the
ureter down to the suprapubic area and radiates to the external genitalia (groin). Options A, B, and D
describe pain characteristic of gastrointestinal problems (cholecystitis, duodenal and gastric ulcers,
respectively).
29) B
- Pain or discomfort from a problem that originates in the kidney is felt at the costovertebral angle on the

affected side. Ureteral pain is felt in the ipsilateral labium in the female client, or the ipsilateral scrotum in
the male client. Bladder infection is often accompanied by suprapubic pain and pain or burning at the
urinary meatus when voiding.
30) C
- Typical manifestations of acute pyelonephritis include high fever, chills, nausea and vomiting, flank pain
on the affected side with costovertebral angle tenderness, general weakness, and headache. The client
often exhibits the typical signs and symptoms of cystitis, with production of urine that is foul smelling and
cloudy or bloody, and with an increased urinary white blood cell count.
31. A nurse is caring for a client receiving peritoneal dialysis and notes a brownish tinge to the dialysate
output. The nurse interprets that this finding could be a result of:
a) early infection
b) insufficient fluid instillation
c) bladder perforation
d) bowel perforation
32. While reading the product literature regarding ofloxacin (Floxin), the nurse notes that the medication
could cause crystalluria. The nurse decides to tell the client taking the medication to do which of the
following to decrease the likelihood of this adverse effect?
a) avoid beverages that contain salts, such as mineral water
b) avoid carbonated soft-drink beverages
c) drink at least 1500 to 2000 ml of fluid per day
d) drink at least three glasses of milk per day
33. A nurse is caring for a client who has begun using peritoneal dialysis. The nurse determines that
which manifestation indicates the onset of peritonitis?
a) oral temperature of 100F
b) history of gastrointestinal (GI) upset 1 week ago
c) clear dialysate output
d) presence of crystals in dialysate output
34. A nurse is working on a renal unit in a local hospital. The nurse interprets that which client with renal
failure is best suited for peritoneal dialysis as a treatment option?
a) a client with severe congestive heart failure
b) a client with a history of ruptured diverticuli
c) a client with a history of herniated lumbar disk
d) a client with a history of three previous abdominal surgeries
35. A client undergoing long-term peritoneal dialysis is experiencing a problem with reduced outflow from
the dialysis catheter. The nurse assessing the client would inquire whether the client has had a recent
problem with:
a) vomiting
b) diarrhea
c) constipation
d) flatulence

NCLEX Questions on Renal Failure

Answers and Rationale
31) D
- Brown-tinged or bloody drainage could indicate perforation of the bowel by the peritoneal dialysis
catheter. If noted, this must be reported to the physician immediately. Early signs of infection include
cloudy dialysate output or fever and, most likely, abdominal discomfort. Bladder perforation could yield
yellow or bloody drainage. Insufficient fluid instillation is an incorrect option. The client would have no
signs as a result of insufficient fluid instillation except outflow of smaller amounts of dialysate.
32) C
- To prevent crystalluria, the client should drink at least 1500 to 2000 mL of fluid per day. Milk interferes
with the absorption of the medication and should be avoided. Consumption of carbonated beverages or
mineral water is not harmful.
33) A
- Typical symptoms of peritonitis include fever, nausea, malaise, rebound abdominal tenderness, and
cloudy dialysate output. The complaint of GI upset is too vague to be correct. Peritonitis would cause
cloudy dialysate but would not cause crystals to appear in the dialysate.
34) A
- Peritoneal dialysis may be the treatment option of choice for clients with severe cardiovascular disease,
which would be worsened by the rapid shifts in fluid, electrolytes, urea, and glucose that occur with
hemodialysis. Contraindications to peritoneal dialysis include diseases of the abdomen, such as ruptured
diverticuli or malignancies, extensive abdominal surgeries, history of peritonitis, obesity, and history of
back problems, which could be aggravated by the fluid weight of the dialysate. Severe disease of the
vascular system also may be a contraindication.
35) C
- Reduced outflow may be caused by catheter position and adherence to the omentum, infection, or
constipation. Constipation may contribute to reduced outflow in part because peristalsis seems to aid in
drainage. For this reason, bisacodyl suppositories are sometimes used prophylactically, even without a
history of constipation. The other options are unrelated to impaired catheter drainage.
36. A nurse is reviewing the health care record of a client with a diagnosis of benign prostatic hyperplasia.
The nurse that which sign exhibited by the client occurs late in the disorder?
a) nocturia
b) decreased force of urine stream
c) difficulty initiating urine stream
d) hematuria
37. A nurse is caring for a client at risk for acute renal tubular necrosis following a crush injury to the leg.
The nurse implements which measure to minimize this particular risk for the client?

a) use of sheepskin and bed cradle

b) frequent position changes in bed
c) administration of antibiotics in a timely fashion
d) careful monitoring of intravenous fluids to ensure sufficient intake
38. A clinic nurse is reviewing the laboratory results of an adult client seen in the health care clinic. The
nurse determines that the blood urea nitrogen (BUN) level is normal if which of the following is noted on
the laboratory results?
a) 35 mg/dL
b) 29 mg/dL
c) 15 mg/dL
d) 3 mg/dL
39. A nurse is caring for a client who is receiving immunosuppressant therapy including corticosteroids
following a renal transplant. The nurse would plan to carefully monitor which laboratory result for this
client?
a) serum albumin
b) blood glucose
c) magnesium
d) potassium
40. A client who has been diagnosed with chronic renal failure has been told that hemodialysis will be
required. The client becomes angry and withdrawn, and states, "I'll never be the same now." The nurse
formulates which of the following nursing diagnoses for this client?
a) disturbed thought processes
b) disturbed body image
c) anxiety
d) noncompliance

NCLEX Questions on Renal Failure

Answers and Rationale
36) D
- Nocturia, decreased force, and difficulty initiating urine stream are all early signs of benign prostatic
hypertrophy. Hematuria may occur as a later sign.
37) D
- After a crush injury, myoglobin released from damaged muscle cells circulates in the bloodstream and
can clog renal tubules. It is important to maintain an increased fluid intake to "flush" the kidneys and
minimize this occurrence. The other options may be part of the management of this client but do not
specifically relate to this potential complication.
38) C
The normal BUN ranges from 5 to 25 mg/dL. Options A and B reflect elevated values, which may indicate

renal abnormalities or dehydration. Option D reflects a lower than normal value, which may not be
clinically significant.
39) B
- Corticosteroid therapy can result in glucose intolerance, leading to elevated blood glucose levels. The
nurse monitors these levels to detect this side effect of therapy. With successful transplant, the client's
serum electrolyte levels should be better regulated, although corticosteroids could also cause sodium
retention.
40) B
- The client with any renal disorder, such as renal failure, may become angry and depressed because of
the permanence of the alteration. Because of the physical change and the change in lifestyle that may be
required to manage a severe renal condition, the client may experience Disturbed body image. Options A,
C, and D are unrelated to the client's statement.

41. A nurse is caring for a client who has been diagnosed as having a kidney mass. The client asks the
nurse the reason for renal biopsy when other tests such as computed tomography (CT) scan and
ultrasound are available. In formulating a response, the nurse incorporates the knowledge that renal
biopsy :
a) helps differentiate between a solid mass and a fluid-filled cyst
b) provides an outline of the renal vascular system
c) gives specific cytological information about the lesion
d) determines if the mass is growing rapidly or slowly
42. A nurse is providing discharge instructions to a client after a hydrocelectomy. Which statement by the
client would indicate a need for further instructions?
a) I should apply ice packs to the scrotum
b) I should keep the scrotum elevated until the swelling has gone away
c) the sutures will be removed by the doctor in a few days
d) I need to avoid sexual intercourse at this time
43. A client hospitalized with urolithiasis has a sudden significant decrease in urine output. The nurse
would immediately:
a) call the physician
b) replace the foley catheter with a new one
c) tell the client to drink increased fluids
d) obtain a urine specific gravity
44. A nurse is caring for a client undergoing peritoneal dialysis. The nurse checks the client and notes that
the drainage from the outflow catheter is cloudy. The nurse should take which action?
a) stop the peritoneal dialysis
b) obtain a culture and sensitivity of the drainage
c) institute hemodialysis temporarily
d) add antibiotics to the next several dialysis bags
45. A nurse is urging a client to cough and deep breathe after nephrectomy. The client tells the nurse,

"That's easy for you to say! You don't have to do this." The nurse interprets that the client's statement is
likely a result of:
a) a stress response to the ordeal of surgery
b) a latent fear of needing dialysis if the surgery is unsuccessful
c) effects of circulating metabolites that have not been excreted by the remaining kidney
d) pain that is intensified because the location of the incision is near the diaphragm

Renal NCLEX Questions

Answers and Rationale
41) C
- Renal biopsy is a definitive test that gives specific information about whether the lesion is benign or
malignant. An ultrasound discriminates between a fluid-filled cyst and a solid mass. Renal arteriography
outlines the renal vascular system. Although some types of cancer grow more quickly than others, it is not
possible to determine this by biopsy.
42) C
- A hydrocele is an abnormal collection of fluid within the layers of the tunica vaginalis that surrounds the
testis. It may be unilateral or bilateral and can occur in an infant or adult. Hydrocelectomy is the excision
of the fluid filled sac in the tunica vaginalis. The client needs to be instructed that the sutures used during
the hydrocelectomy are absorbable. The other options are correct.
43) A
- A sudden significant decrease in urine output, to either oliguria or anuria, represents obstruction of the
urinary tract, usually at the bladder neck or urethra. This represents a medical emergency, requiring
prompt treatment to preserve kidney function. In this instance, the nurse would call the physician to report
the findings immediately. There are no data in the question to indicate that a Foley catheter is present.
Obtaining a urine specific gravity will not relieve the obstruction. Telling the client to increase fluid intake is
incorrect. Additionally, if an obstruction is present, increasing fluids can cause hydronephrosis.
44) B
- When the drainage becomes cloudy, peritonitis is suspected. A culture and sensitivity is obtained, and
broad-spectrum antibiotics are added to the dialysis solution, pending culture and sensitivity results. The
dialysis solution may also be heparinized to prevent catheter occlusion. Some clients must switch to
hemodialysis if peritonitis is severe or recurring, but the nurse does not make this decision. The peritoneal
dialysis is not stopped.
45) D
After nephrectomy the client may be in considerable pain. This is a result of the size of the incision and its
location near the diaphragm, which makes coughing and deep breathing so uncomfortable. For this
reason, opioids are used liberally, and may be most effective when provided as patient-controlled
analgesia, or through epidural analgesia. Options A, B, and C are not specifically related to this client's
situation.

46. A nurse is admitting a client with chronic renal failure to the nursing unit. The nurse anticipates that
the client will exhibit which frequent cardiovascular sign associated with chronic renal failure?
a) pulse 110 beats per minute
b) pulse 56 beats per minute
c) blood pressure 168/94 mm Hg
d) blood pressure 96/64 mm Hg
47. A nurse is preparing to teach a client who is newly diagnosed with chronic renal failure about the
disease and its management. The client has a diminished ability to learn because of uremia and anxiety.
The nurse makes it a priority to include which of the following when conducting teaching sessions with
this client?
a) family members
b) charts and diagrams
c) research articles
d) lengthy printed materials
48. A client who is newly diagnosed with chronic renal failure is scheduled for hemodialysis this morning
and asks he nurse why the daily dose of enalapril (Vasotec) has not been given. The nurse tells the client
that this medication will be given:
a) just before going to hemodialysis
b) during the hemodialysis
c) when dialysis is completed
d) at bedtime
49. A nurse is teaching a client with chronic renal failure about fluid restriction. The nurse tells the client
which of the following dessert items from the dietary menu represents the best choice?
a) ice cream
b) sherbet
c) angel food cake
d) jell-O
50. A client who is newly diagnosed with chronic renal failure is scheduled to begin hemodialysis. The
nurse interprets which of the following neurological or psychological findings exhibited by the client to be
atypical?
a) euphoria
b) labile emotions
c) withdrawal
d) depression

Renal NCLEX Questions

Answers and Rationale

46) C
- Hypertension is commonly associated with chronic renal failure. This results from a number of
mechanisms, including volume overload, renin-angiotensin system stimulation, vasoconstriction from
sympathetic stimulation, and the absence of prostaglandins. Hypertension may also be the cause of the
renal failure. It is an important item to assess because hypertension can lead to heart failure in the
chronic renal failure client as a result of increased cardiac workload in conjunction with fluid overload.
Options A, B, and D are not specifically associated with chronic renal failure.
47) A
- The client with chronic renal failure may have several barriers to learning, including anxiety and the
effects of uremia, such as short attention span and memory deficits. Uremic effects usually improve once
hemodialysis has begun. The presence of family is helpful because the family needs to understand the
disease and treatment and may help reinforce information with the client after the formal teaching session
is over. Information should also be simple, direct, and at the educational level of the client to be most
effective. Charts and diagrams may be helpful but are not the priority. Research articles will not be helpful.
48) C
- Antihypertensive medications such as enalapril are given to the client after hemodialysis. This prevents
the client from becoming hypotensive during dialysis, and prevents the medication from being removed
from the bloodstream during dialysis. There is no rationale to wait until bedtime to resume the medication.
Erratic dosing could lead to ineffective blood pressure control.
49) C
- Dietary fluid includes anything that is liquid at room temperature. This includes items such as ice cream,
sherbet, and Jell-O. With clients on a fluid restricted diet, it is helpful to avoid "hidden" fluids to whatever
extent is possible. This allows the client more fluid for drinking, which can help alleviate thirst.
50) A
- The client with chronic renal failure often experiences a variety of psychosocial changes. These are
related to uremia as well as the stress experienced by the client with a chronic, life-threatening disease.
These clients may have labile emotions or personality changes, and may exhibit withdrawal, depression,
or agitation. Delusions and psychosis also can occur. Euphoria is not part of the clinical picture for the
client in renal failure.