NCLEX Renal Questions (51-55)

Welcome to the NCLEX Renal Questions. Before you begin answering this questions, I recommend that you start from the beginning:

NCLEX Renal Questions (1-7)

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51. A client has an arteriovenous (AV) fistula in place in the right upper extremity for hemodialysis treatments. When planning care for this client, which of the following measures should the nurse implement to promote client safely?

a) take blood pressures only on the right arm to ensure accuracy
b) use the fistula for all venipunctures and intravenous infusions
c) ensure that small clamps are attached to the AV fistula dressing
d) assess the fistula for the presence of a bruit and thrill every 4 hours

52. A nurse is assessing a client who is diagnosed with cystitis. Which assessment finding is inconsistent with the typical clinical manifestations noted in this disorder?

a) hematuria
b) low back pain
c) urinary retention
d) burning on urination

53. A client with urolithiasis is scheduled for extracorporeal shock wave lithotripsy (ESWL). The nurse assesses to ensure that which of the following items are in place or maintained before sending the client for the procedure?

a) IV line and a foley catheter
b) NPO status and a foley catheter
c) signed informed consent, NPO status, and an IV line
d) signed informed consent and clear liquid restriction preprocedure

54. The home care nurse is making follow-up visits to a client following renal transplant. The nurse assesses the client for which signs of acute graft rejection?

a) hypotension, graft tenderness, and anemia
b) hypertension, oliguria, thirst, and hypothermia
c) fever, hypertension, graft tenderness, and malaise
d) fever, vomiting, hypotension, and copious amounts of dilute urine

55. A client is scheduled for computed tomography (CT) of the kidneys to rule out renal disease. As an essential preprocedure component of the nursing assessment, the nurse plans to ask the client about a history of:

a) familial renal disease
b) frequent antibiotic use
c) long-term diuretic therapy
d) allergy to shellfish or iodine





NCLEX Renal Questions:
Answers and Rationale

51) D

- Arteriovenous fistulas are created by anastomosis of an artery and a vein within the subcutaneous tissues to create access for hemodialysis. Fistulas should be evaluated for presence of thrills (palpate over the area) and bruits (auscultate with a stethoscope) as an assessment of patency.

52) C

- Clinical manifestations of cystitis usually include urinary frequency, urgency, dysuria, inability to void, or voiding only small amounts. The urine may be cloudy, with hematuria and bacteriuria. The client may complain of pain that is suprapubic or in the lower back. Nonspecific signs include fever, chills, malaise, and nausea and vomiting. Some clients may be asymptomatic, particularly the older client.

53) C

- ESWL is done with conscious sedation or general anesthesia. The client must sign an informed consent form for the procedure and must be NPO for the procedure. The client needs an IV line for the procedure as well. A Foley catheter is not needed.

54) C

- Acute rejection usually occurs within the first 3 months after transplant, although it can occur for up to 2 years posttransplant. The client exhibits fever, hypertension, malaise, and graft tenderness. Treatment is immediately begun with corticosteroids and possibly also with monoclonal antibodies and antilymphocyte agents.

55) D

- The client undergoing any type of diagnostic testing involving possible dye administration should be questioned about allergy to shellfish or iodine. This is essential to identify the risk for potential allergic reaction to contrast dye, which may be used. The other items are also useful as part of the assessment but are not as critical as the allergy determination in the preprocedure period.


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NCLEX Renal Questions (56-60)

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Nursing Questions about Leadership and Management (16-20)

Nursing Questions about Leadership and Management

16. A client who is mouth breathing is receiving oxygen by face mask. The nursing assistant asks the registered nurse (RN) why a water bottle is attached to the oxygen tubing near the wall oxygen outlet. The RN responds that the primary purpose of this feature is to:

a) prevent fluid loss from the lungs during mouth breathing
b) give the client added fluid via the respiratory rate
c) humidify the oxygen that is bypassing the client's nose
d) prevent the client from getting nosebleed

17. A nurse and a nursing assistant are assisting the respiratory therapist to position a client for postural drainage. The nursing assistant asks the nurse how the respiratory therapists selects the position used for the procedure. The nurse responds that a position is chosen that will use gravity to help drain secretions from which of the following areas?

a) trachea
b) main bronchi
c) lobes
d) alveoli

18. A registered nurse (RN) is observing a licensed practical nurse (LPN) caring for a deceased client whose eyes will be donated. The RN intervenes if the LPN performs which action?

a) elevates the head of the bed
b) closes the client's eyes
c) places wet saline gauze pads and ice pack on the eyes
d) closes the client's eyes and places a dry sterile dressing over the eyes

19. The nurse has recently been assigned to manage a pulmonary progressive unit at a large urban hospital. The nurse's leadership style is participative, with the belief that all staff members assist in decision making and the development of the unit's goals. The nurse is implementing which leadership style?

a) democratic
b) laissez faire
c) auticratic
d) situational

20. A physician has written an order for a vest restraint to be applied on a client from 10:00 pm to 7:00 am because the client becomes disoriented during the night and is at risk for falls. At 11:00 pm, the charge nurse makes rounds on all of the clients with the vest restraint, which observation by the charge nurse would indicate that the nurse who cared for this client performed an unsafe action in the use of the restraint?

a) a safety knot was used to secure the restraint
b) the client's record indicates that the restraint will be released every 2 hours
c) the restraint was applied tightly
d) the call light was placed within reach of the client





Nursing Questions about Leadership and Management:
Answers and Rationale

16) C

- The purpose of the water bottle is to humidify the oxygen that is bypassing the nose during mouth breathing. The humidified oxygen may help keep mucous membranes moist but will not substantially alter fluid balance (options A and B). A client who is breathing through the mouth is not at risk for nosebleeds.

17) C

- Postural drainage uses specific client positions that vary depending on the affected lobe(s). The positions usually involve having the head lower than the affected lung segment(s) to facilitate drainage of secretions. Postural drainage often is done in conjunction with chest percussion for maximum effectiveness. The other options are incorrect.

18) D
- When a corneal donor dies, the eyes are closed and gauze pads wet with saline are placed over them with a small ice pack. Within 2 to 4 hours, the eyes are enucleated. The cornea is usually transplanted with 24 to 48 hours. The head of the bed should also be elevated. Placing dry sterile dressings over the eyes serves no useful purpose.

19) A

- Democratic leadership is defined as participative with a focus on the belief that all members of the group have input into the decision making process. This leader acts as a resource person and facilitator. Laissez faire leaders assume a passive approach, with the decision making left to the group. Autocratic leadership dominates the group, with maintenance of strong control over the group. Situational leadership is based on the current events of the day.

20) C

- Restraints should never be applied tightly because that could impair circulation. The restraint should be applied securely (not tightly) to prevent the client from slipping through the restraint and endangering himself or herself. A safety knot should be used because it can easily be released in an emergency. Restraints, especially limb restraints, must be released every 2 hours (or per agency policy) to inspect the skin for abnormalities. The call light must always be within the client’s reach in case the client needs assistance.



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Nursing Questions about Leadership and Management (1-5)


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Nursing Questions about Leadership and Management (21-25)

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NCLEX for RN - Leadership and Management (11-15)

11. A nursing student is developing a plan of care for a client with a chest tube that is attached to a Pleur-Evac drainage system. The nurse intervenes if the student writes which incorrect intervention in the plan?

a) position the client in semi-fowler's position
b) add water to the suction chamber as it evaporates
c) tape the connection sites between the chest tube and the drainage system
d) instruct the client to avoid coughing and deep breathing


12. A nurse is caring for a client who has just had a plaster leg cast applied. The nurse would plan to prevent the development of compartment syndrome is instructing the licensed practical nurse assigned to care for the client to:

a) elevate the limb and apply ice to the affected leg
b) elevate the limb and cover the limb with bath blankets
c) place the leg in a slightly dependent  position and apply ice to the affected leg
d) keep the leg horizontal and apply ice to the affected leg

13. A registered nurse (RN) is supervising a licensed practical nurse (LPN) administering an intramuscular (IM) injection of iron to an assigned client. The RN would intervene if the LPN is observed to perform which of the following?

a) changing the needle after drawing up the dose and before injection
b) preparing an air lock when drawing up the medication
c) using a Z-track method for injection
d) massaging the injection site after injection

14. A nursing student develops a plan of care for a client with paraplegia who has a risk for injury related to spasticity of the leg muscles. On reviewing the plan, the co-assigned nurse identifies which of the following as an incorrect intervention.

a) use of padded restraints to immobilize the limb
b) performing range of motion to the affected limbs
c) removing potentially harmful objects near the spastic limbs
d) use of prescribed muscle relaxants as needed

15. A registered nurse (RN) is observing a licensed practical nurse (LPN) preparing a client for treatment with a continuous passive motion (CPM) machine. Which observation by the RN would indicate that the LPN is performing an incorrect action?

a) places the client's knee in a slightly externally rotated position
b) keeps the client's knee at the hinged joint of the machine
c) assesses the client for pressure areas at the knee and the groin
d) checks the degree of extension and flexion and the speed of the CPM machine per the physician's orders




NCLEX for RN - Leadership and Management:
ANSWERS AND RATIONALE

11) D

- It is important to encourage the client to cough and deep breathe when a chest tube drainage system is in place. This will assist in facilitating appropriate lung re-expansion. Water is added to the suction chamber as it evaporates to maintain the full suction level prescribed. Connections between the chest tube and the drainage system are taped to prevent accidental disconnection. The client is positioned in semi-Fowler’s to facilitate ease in breathing.

12) A

- Compartment syndrome is prevented by controlling edema. This is achieved most optimally with the use of elevation and application of ice. Options B, C, and D are incorrect.

13) D

- The site should not be massaged after injection because massaging could cause staining of the skin. Proper technique for administering iron by the IM route includes changing the needle after drawing up the medication and before giving it. An air lock and Z-track technique both should be used. The medication should be given in the upper outer quadrant of the buttock, not in an exposed area such as the arms or thighs.

14) A

- Range-of-motion exercises are beneficial in stretching muscles, which may diminish spasticity. Removing potentially harmful objects is a good safety measure. Use of muscle relaxants also is indicated if the spasms cause discomfort to the client or pose a risk to the client’s safety. Use of limb restraints will not alleviate spasticity and could harm the client.

15) A

- In the use of a CPM machine, the leg should be kept in a neutral position and not rotated either internally or externally. The knee should be positioned at the hinge joint of the machine. The nurse should monitor for pressure areas at the knee and the groin and should follow the physician’s orders and institutional protocol regarding extension and flexion and speed of the CPM machine.



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NCLEX for RN - Leadership and Management (6-10)

NCLEX for RN about Leadership and Management

6. A nursing instructor asks the nursing student to describe the definition of a critical path. Which of the following statements, if made by the student, indicates a need for further understanding regarding critical paths?

a) they are developed through the collaborative efforts of all members of the health care team
b) they provide an effective way of monitoring care and for reducing or controlling the length of hospital stay for the client
c) they are developed based on appropriate standards of care
d) they are nursing care plans and use the steps of the nursing process

7. A community health nurse is working with a disaster relief following a tornado. The nurse's goal for the community is to prevent as much injury and death as possible from the uncontrollable event. Finding safe housing for survivors, providing support to families, organizing counseling, and securing physical care when needed all examples of which type of prevention?

a) primary level of prevention
b) secondary level of prevention
c) tertiary level of prevention
d) aggregate care prevention

8. The nurse manager is planning to implement a change in the nursing unit from team nursing to primary nursing. The nurse anticipates that there will be resistance to the change during the change process. The primary technique that the nurse would use in implementing this change is which of the following?

a) introduce the change gradually
b) confront the individuals involved in the change process
c) use coercion to implement the change
d) manipulate the participants in the change process

9. A nurse manager is providing an educational session to nursing staff members about the phases of viral hepatitis. The nurse manager tells the staff that which clinical manifestation(s) are primarily characteristic of preicteric phase?

a) right upper quadrant pain
b) fatigue, anorexia and nausea
c) jaundice, dark-colored urine, and clay-colored stools
d) pruritus

10. A nurse is preparing a plan of care for a client who will be hospitalized for insertion of an internal cervical radiation implant. Which nursing intervention should the nurse implement in preparation for the arrival of the client?

a) prepare a private room at the end of the hallway
b) place a sign on the door that indicates that visitors are limited to 60-minute visits
c) assign one primary nurse to care for the client during the hospital stay
d) place a linen bag outside of the client's room for discarding linens after morning care





NCLEX for RN - Leadership and Management:
ANSWERS AND RATIONALE

6) D

- Use the process of elimination and knowledge regarding the definition and purpose of critical paths to direct you to option D. Note the strategic words in the question, a need for further understanding. These words indicate a negative event query and ask you to select an option that is incorrect.  If you had difficulty with this question, review critical paths.

7) C

- Tertiary prevention involves the reduction of the amount and degree of disability, injury, and damage following a crisis. Primary prevention means keeping the crisis from occurring, and secondary prevention focuses on reducing the intensity and duration of a crisis during the crisis itself. There is no known aggregate care prevention level.

8) A

- The primary technique that can used to handle resistance to change during the change process is to introduce the change gradually. Confrontation is an important strategy used to meet resistance when it occurs. Coercion is another strategy that can be used to decrease resistance to change but is not always a successful technique for managing resistance. Manipulation usually involves a covert action, such as leaving out pieces of vital information that the participants might receive negatively. It is not the best method of implementing a change.

9) B

- In the preicteric phase, the client has nonspecific complaints of fatigue, anorexia, nausea, cough, and joint pain. Options A, C, and D are clinical manifestations that occur in the icteric phase. In the posticteric phase, jaundice decreases, the color of urine and stool return to normal, and the client’s appetite improves.

10) A

- The client with an internal cervical radiation implant should be placed in a private room at the end of the hall because this location provides less of a chance of exposure of radiation to others. The client’s room should be marked with appropriate signs that indicate the presence of radiation. Visitors should be limited to 30-minute visits. Nurses assigned to this client should be rotated so that one nurse is not consistently caring for the client and exposing him or herself to excess amounts of radiation. All linens should be kept in the client’s room until the implant is removed in case the implant has dislodged and needs to be located.


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NCLEX for RN - Leadership and Management (1-5)

If you want to master the art of taking NCLEX exam on Fundamentals of Nursing... Try our Fundamentals Test Bank... It is for FREE!!!
1. A new nursing graduate is attending an agency orientation regarding the nursing model of practice implemented in the health care facility. The nurse is told that the nursing model is a team nursing approach. The nurse understands that planning care delivery will be based on which characteristic of this type of nursing model of practice?
a) a task approach method is used to provide care to clients
b) managed care concepts and tools are used in providing client care
c) an RN leads nursing personnel in providing care to a group of clients
d) a single RN is responsible for providing nursing care to a group of clients

2. The nurse manager has implemented a change in the method of the nursing delivery system from functional to team nursing. A nursing assistant is resistant to the change and is not taking an active part in facilitating the process of change. Which of the following is the best approach in dealing with the nursing assistant?

a) ignore the resistance
b) exert coercion with the nursing assistant
c) provide a positive reward system for the nursing assistant
d) confront the nursing assistant to encourage verbalization of feelings regarding the change

3. A nurse is giving a report to a nursing assistant who will be caring for a client who has hand restraints. The nurse instructs the nursing assistant to assess the skin integrity of the restrained hands every:

a) 2 hours
b) 3 hours
c) 4 hours
d) 30 minutes

4. Fibrinolysin and desoxyribonuclease (Elase) is prescribed to  treat a skin ulcer, and the nurse is observing a nursing student perform the treatment. The nurse intervenes if the nursing student is observed doing which of the following?

a) applies a thin layer of medication
b) cleans the wound with a sterile solution
c) places petrolatum gauze over the fibrinolysin and desoxyribonuclease
d) applies a thick layer of medication and covers with a dry sterile dressings

5. A nursing student is caring for a client with a brain attack (stroke) who is experiencing unilateral neglect. The nurse would intervene if the student plans to use which of the following strategies to help the client adapt to this deficit?

a) tells the client to scan the environment
b) approaches the client from the unaffected side
c) places the bedside articles on the affected side
d) moves the commode and cahir to the affected side



NCLEX for RN - Leadership and Management:
ANSWERS AND RATIONALE

1) C

- In team nursing, nursing personnel are led by a registered nurse leader in providing care to a group of clients. Option A identifies functional nursing. Option B identifies a component of case management. Option D identifies primary nursing.

2) D

- Confrontation is an important strategy to meet resistance head on. Face-to-face meetings to confront the issue at hand will allow verbalization of feelings, identification of problems and issues, and development of strategies to solve the problem. Option A will not address the problem. Option B may produce additional resistance. Option C may provide a temporary solution to the resistance but will not address the concern

3) D

- The nurse should instruct the nursing assistant to assess restraints and skin integrity every 30 minutes. Agency guidelines regarding the use of restraints should always be followed.

4) D

- The wound should be cleansed with a sterile solution and gently patted dry. A thin layer of fibrinolysin and desoxyribonuclease (Elase) is applied and covered with petrolatum gauze. If a dry powder preparation is used, for best effects, the solution should be prepared just before use.

5) B

- Unilateral neglect is an unawareness of the paralyzed side of the body, which increases the client’s risk for injury. The nurse’s role is to refocus the client’s attention to the affected side. The nurse moves personal care items and belongings to the affected side, as well as the bedside chair and commode. The nurse teaches the client to scan the environment to become aware of that half of the body and approaches the client from the affected side to increase awareness further.


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NCLEX for RN - Leadership and Management (6-10)

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NCLEX Review - Fundamentals of Nursing 7th edition (46-50)

Welcome to NCLEX Review - Fundamentals of Nursing 7th edition . Before you begin answering the questions, you may first want to take a peek about the material that will surely help you the pass the NCLEX examination :

Complete NCLEX Study Materials

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46. A client is receiving nutrition by means of parenteral nutrition (PN). A nurse monitors the client for complications of  the therapy and assesses the client for which of the following signs of hyperglycemia?

a) fever, weak pulse, and thirst
b) nausea, vomiting, and oliguria
c) sweating, chills, and abdominal pain
d) weakness, thirst, and increased urine output


47. At 8 am, a nurse checks the amount of solution left in a parenteral nutrition (PN) infusion bag for an assigned client. It is a 3000 ml bag with 1000 ml remaining. The solution is running at a rate of 100 ml/hr. The bag was hung the previous day at noon. The nurse plans to change the infusion bag and tubing today at:

a) noon
b) 2 pm
c) 4 pm
d) 8 pm

48. A nurse is changing the central line dressing of a client receiving parenteral nutrition (PN) and notes that the catheter insertion site appears reddened. The nurse next assesses which of the following items?

a) client's temperature
b) expiration date on the bag
c) time of last dressing change
d) tightness of tubing connections

49. A nurse is preparing to hang fat emulsion (lipids) and notes that the fat globules are visible at the top of the solution. The nurse takes which of the following actions?

a) rolls the bottle of solution gently
b) obtains a different bottle of solution
c) shakes the bottle of solution vigorously
d) runs the bottle of solution under warm water

50. A nurse is preparing to change the total parenteral nutrition (TPN) solution bag and tubing. The client's central venous line is located in the right subclavian vein. The nurse asks the client to take which most essential action during the tubing change?

a) breathe normally
b) turn the head to the right
c) exhale slowly and evenly
d) take a deep breath, hold it, and bear down





Fundamentals of Nursing 7th edition:
ANSWERS AND RATIONALE

46) D

- The high glucose concentration in PN places the client at risk for hyperglycemia. Signs of hyperglycemia include excessive thirst, fatigue, restlessness, confusion, weakness, Kussmaul’s respirations, diuresis, and coma, when hyperglycemia is severe. If the client has these symptoms, the blood glucose level should be checked immediately. Options A, B, and C do not identify signs specific to hyperglycemia.

47) A

- Parenteral nutrition solution should be changed every 24 hours because the PN solution is a high-concentrate glucose solution and is a medium for bacterial growth. Infection control is also aided by use of aseptic technique with bag and tubing changes. Most agencies recommend that tubing be changed every 24 hours along with the bag, although some agencies recommend changing tubing every 48 to 72 hours. The nurse always should adhere to specific agency policies. Options B, C, and D identify insufficient time frames and present the risk for infection.

48) A

- Redness at the catheter insertion site is a possible indication of infection. The nurse would next assess for other signs of infection. Of the options given, the temperature is the next item to assess. The tightness of tubing connections should be assessed each time the PN is checked; loose connections would result in leakage, not skin redness. The expiration date on the bag is a viable option, but this also should be checked at the time the solution is hung and with each shift change. The time of the last dressing change should be checked with each shift change.

49) B

The nurse should examine the bottle of fat emulsion for separation of emulsion into layers or fat globules or for the accumulation of froth. The nurse should not hang a fat emulsion if any of these are observed and should return the solution to the pharmacy. Options A, C, and D are inappropriate actions.

50) D

- The client should be asked to perform the Valsalva maneuver during tubing changes. This helps avoid air embolism during tubing changes. The nurse asks the client to take a deep breath, hold it, and bear down. If the IV line is on the right, the client turns his or her head to the left. This position will increase intrathoracic pressure. Options A and C are inappropriate and could cause the potential for an air embolism during the tubing change.



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Fundamentals of Nursing 7th edition (1-5)

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Fundamentals of Nursing 7th edition (51-55)

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NCLEX Review - Fundamentals of Nursing 7th edition (41-45)

41. An adult female client has a hemoglobin level of 10.8 g/dL. The nurse interprets that this result is most likely caused by which of the following conditions noted in the client's history?

a) dehydration
b) heart failure
c) iron deficiency anemia
d) chronic obstructive pulmonary disease


42. The nurse is conducting a dietary assessment on a client who is on a vegan diet. The nurse plans to provide dietary teaching focusing on foods high in which vitamin that may be lacking in a vegan diet?

a) vitamin A
b) vitamin B12
c) vitamin C
d) vitamin E

43. A client is recovering from abdominal surgery and has a large abdominal wound. A nurse encourages the client to eat which food item that is naturally high in vitamin C to promote wound healing?

a) milk
b) oranges
c) bananas
d) chicken

44. A postoperative client has been placed on a clear liquid diet. Select the items that the client is allowed to consume on this diet. Select all that apply

a) broth
b) coffee
c) gelatin
d) pudding
e) vegetable juice
f) pureed vegetables


45. A nurse is preparing to care for a client who will receive parenteral nutrition (PN) support. The client is receiving dextrose, amino acids, and lipids all in one solution (total nutrient admixture). The nurse plans to do which of the following?

a) use a 1.2 um filter
b) use 0.22 um filter to ensure sterility
c) use a 0.10 um filter to ensure sterility
d) administer the solution without a filter





Fundamentals of Nursing 7th edition:
ANSWERS AND RATIONALE

41) C

- The normal hemoglobin level for an adult female client is 12 to 15 g/dL. Iron deficiency anemia can result in lower hemoglobin levels. Dehydration may increase the hemoglobin level by hemoconcentration. Heart failure and chronic obstructive pulmonary disease may increase the hemoglobin level as a result of the body’s need for more oxygen-carrying capacity.

42) B

- Vegans do not consume any animal products. Vitamin B12 is found in animal products and therefore would most likely be lacking in a vegan diet. Vitamins A, C, and E are found in fresh fruits and vegetables, which are consumed in a vegan diet.

43) B

- Citrus fruits and juices are especially high in vitamin C. Bananas are high in potassium. Meats and dairy products are two food groups that are high in the B vitamins.

44) A, B, C

- A clear liquid diet consists of foods that are relatively transparent to light and are clear and liquid at room and body temperature. These foods include items such as water, bouillon, clear broth, carbonated beverages, gelatin, hard candy, lemonade, Popsicles, and regular or decaffeinated coffee or tea. The incorrect food items are items that are allowed on a full liquid diet.

45) A

- A total nutrient admixture (TNA) is a solution that combines dextrose, amino acids, and lipids in one solution. A 1.2-µm filter or larger filter should be used because the lipid particles are too large to pass through a smaller (0.22- or 0.10-µm) filter. A 0.22-µm filter is used for 2-in-1 solutions containing only dextrose and amino acids. A 0.10-µm filter is smaller than a 1.2-µm filter. Administering the solution without using a filter is not an appropriate action.


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