NCLEX Renal Questions
41. The client with an external arteriovenous shunt in place for hemodialysis is at risk for bleeding. The priority nurse action would be to:
a) check the shunt for the presence of bruit and thrill
b) observe the site once as time permits during the shift
c) check the results of the prothrombin time as they are determined
d) ensure that small clamps are attached to the arteriovenous shunt dressing
42. The nurse develops a post-procedure plan of care for a client who had a renal biopsy. The nurse avoids documenting which intervention in the plan?
a) administering analgesics as needed
b) encouraging fluids to at least 3L in the first 24 hours
c) testing serial urine samples with dipstick for occult blood
d) ambulating the client in the room and hall for short distances
43. The client with urolithiasis has a history of chronic tract infections. The nurse plans teaching the client to avoid which of hte following?
a) long-term use of antibiotics
b) weaning synthetic underwear and pantyhose
c) high-phosphate foods, such as dairy products
d) foods that make the urine more acidic, such as cranberries
44. The client who has a history of gout also is diagnosed with urolithisis and the stones are determined to be of uric acid type. The nurse gives the client instructions in which foods to limit, including:
a) milk
b) liver
c) apples
d) carrots
45. The client arrives at the emergency department with complaints of low abdominal pain and hematuria. The client is afebrile. The nurse next assesses the client to determine a history of:
a) pyelonephritis
b) glomerulonephritis
c) trauma to the bladder or abdomen
d) renal cancer in the client's family
NCLEX Renal Questions:
ANSWERS AND RATIONALE
41) D
- An arteriovenous shunt is a less common form of access site but carries a risk for bleeding when it is used because two ends of an external cannula are tunneled subcutaneously into an artery and a vein, and the ends of the cannula are joined. If accidental disconnection occurs, the client could lose blood rapidly. For this reason, small clamps are attached to the dressing that covers the insertion site for use if needed. The shunt site also should be assessed at least every 4 hours.
42) D
- Following renal biopsy, the nurse ensures that the client remains in bed for at least 24 hours. Vital signs and puncture site assessments are done frequently during this time. Encouraging fluids is done to reduce possible clot formation at the biopsy site. Serial urine samples are assayed by Hematest with urine dipsticks to evaluate bleeding. Analgesics often are needed to manage the renal colic pain that some clients feel after this procedure.
43) B
- Urolithiasis (struvite stones) can result from chronic infections. They form in urine that is alkaline and rich in ammonia, such as with a urinary tract infection. Teaching should focus on prevention of infections and ingesting foods to make the urine more acidic. The client should wear cotton (not synthetic) underclothing to prevent the accumulation of moisture and to prevent irritation of the perineal area, which can lead to infection.
44) B
- The client with uric acid stones should avoid foods containing high amounts of purines. This includes limiting or avoiding organ meats such as liver, brain, heart, kidney, and sweetbreads. Other foods to avoid include herring, sardines, anchovies, meat extracts, consommés, and gravies. Foods that are low in purines include all fruits, many vegetables, milk, cheese, eggs, refined cereals, sugars and sweets, coffee, tea, chocolate, and carbonated beverages.
45) C
- Use the process of elimination. Eliminate options A and B, knowing that any inflammatory disease or infection is accompanied by fever. Because this client is afebrile, these are not possible options. Use knowledge of anatomy and pain assessment to select option C. Pain from renal cancer is a later finding and is localized in the flank area. Review renal assessment techniques if you had difficulty with this question.
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