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NCLEX 6th Ed Renal/GU – Questions & Answers
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- NCLEX RENAL
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- NCLEX RENAL
NCLEX 6th Ed Renal/GU – Questions & Answers
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NCLEX 6th Ed Renal/GU – Questions & AnswersThe client newly diagnosed with chronic kidney disease recently has begun
hemodialysis. Knowing that the client is at risk for disequilibrium
syndrome, the nurse should assess the client during dialysis for which
associated manifestations?
A. Hypertension, tachycardia, and fever
B. Hypotension, bradycardia, and hypothermia
C. Restlessness, irritability, and generalized weakness
D. Headache, deteriorating level of consciousness, and twitching ✔️Ans -
D. Headache, deteriorating level of consciousness, and twitching
Disequilibrium syndrome is characterized by headache, mental confusion,
decreasing level of consciousness, nausea, vomiting, twitching, and
possible seizure activity. Disequilibrium syndrome is caused by rapid
removal of solutes from the body during hemodialysis. At the same time,
the blood-brain barrier interferes with the efficient removal of wastes from
brain tissue. As a result, water goes into cerebral cells because of the
osmotic gradient, causing increased intracranial pressure and onset of
symptoms. The syndrome most often occurs in clients who are new to
dialysis and is prevented by dialyzing for shorter times or at reduced blood
flow rates.
A client has developed acute kidney injury (AKI) as a complication of
glomerulonephritis. The nurse should assess the client for which expected
manifestation of AKI?
A. Bradycardia
B. Hypertension
C. Decreased cardiac output
D. Decreased central venous pressure ✔️Ans - B. Hypertension
AKI caused by glomerulonephritis is classified as intrinsic or intrarenal
failure. This form of AKI commonly manifests with hypertension,
tachycardia, oliguria, lethargy, edema, and other signs of fluid overload. AKI
,from prerenal causes is characterized by decreased blood pressure or a
recent history of the same, tachycardia, and decreased cardiac output and
central venous pressure. Bradycardia is not part of the clinical picture for
any form of renal failure.
The nurse is analyzing the post-hemodialysis laboratory test results for a
client with chronic kidney disease. The nurse interprets that the dialysis is
having an expected but nontherapeutic effect if which value is decreased?
A. Potassium
B. Creatinine
C. Phosphorus
D. Red blood cell (RBC) count ✔️Ans - D. Red blood cell (RBC) count
Hemodialysis typically lowers the amounts of fluid, sodium, potassium,
urea nitrogen, creatinine, uric acid, magnesium, and phosphate levels in the
blood. Hemodialysis also worsens anemia because RBCs are lost during
dialysis from blood sampling and anticoagulation and from residual blood
left in the dialyzer. Although all of these results are expected, only the
lowered RBC count is nontherapeutic and worsens the anemia already
caused by the disease process.
A client with chronic kidney disease (CKD) takes aluminum hydroxide gel
(ALternaGEL) as a phosphate binder. On the basis of this information, the
nurse determines that the client is most at risk for which problem?
A. Constipation
B. Dehydration
C. Inability to tolerate activity
D. Impaired physical mobility ✔️Ans - A. Constipation
The client with CKD is almost certain to have a problem with constipation
as a result of factors such as fluid restriction, fatigue that limits exercise,
and dietary restrictions. In addition, phosphate-binding antacids such as
aluminum hydroxide gel cause constipation as a side effect. The other
problems listed are unrelated to the information in the question.
,A client with an arteriovenous fistula in the left arm and who is undergoing
hemodialysis is at risk for infection. Which should the nurse formulate as
the best outcome goal for this client problem?
A. The client washes hands at least once per day.
B. The client's temperature remains lower than 101° F.
C. The client avoids blood pressure (BP) measurement in the left arm.
D. The client's white blood cell (WBC) count remains within normal limits.
✔️Ans - D. The client's white blood cell (WBC) count remains within
normal limits.
General indicators that the client is not experiencing infection include a
temperature and WBC count within normal limits. The client also should
use proper hand washing technique as a general preventive measure. Hand
washing once per day is insufficient. It is true that the client should avoid
BP measurement in the affected arm; however, this would relate more
closely to the problem of risk for injury.
The nurse is giving general instructions to a client receiving hemodialysis.
Which statement would be most appropriate for the nurse to include?
A. "It is acceptable to eat whatever you want on the day before
hemodialysis."
B. "It is acceptable to exceed the fluid restriction on the day before
hemodialysis."
C. "Medications should be double-dosed on the morning of hemodialysis
because of potential loss."
D. "Several types of medications should be withheld on the day of dialysis
until after the procedure." ✔️Ans - D. "Several types of medications
should be withheld on the day of dialysis until after the procedure."
Many medications are dialyzable, which means that they are extracted from
the bloodstream during dialysis. Therefore many medications may be
withheld on the day of dialysis until after the procedure. It is not typical for
medications to be double-dosed, because there is no way to be certain how
much of each medication is cleared by dialysis. Clients receiving
, hemodialysis are not routinely taught that it is acceptable to disregard
dietary and fluid restrictions.
A client with chronic kidney disease (CKD) has been on dialysis for 3 years.
The client is receiving the usual combination of medications for the
disease, including aluminum hydroxide as a phosphate-binding agent. The
client now presents with mental cloudiness, dementia, and complaints of
bone pain. The nurse determines that these assessment data are
compatible with which condition?
A. Advancing uremia
B. Phosphate overdose
C. Folic acid deficiency
D. Aluminum intoxication ✔️Ans - D. Aluminum intoxication
Aluminum intoxication can occur when there is accumulation of aluminum,
an ingredient in many phosphate-binding antacids. It results in mental
cloudiness, dementia, and bone pain from infiltration of the bone with
aluminum. It can be treated with aluminum-chelating agents, which make
aluminum available to be dialyzed from the body. It can be prevented by
avoiding or limiting the use of phosphate-binding agents that contain
aluminum. The data in the question are not specifically associated with the
other conditions noted in the options.
A client undergoing hemodialysis is at risk for bleeding from the heparin
used during the hemodialysis treatment. The nurse assesses for this
occurrence by periodically checking the results of which laboratory test?
A. Bleeding time
B. Thrombin time
C. Prothrombin time (PT)
D. Partial thromboplastin time (PTT) ✔️Ans - D. Partial thromboplastin
time (PTT)
Heparin is the anticoagulant used most often during hemodialysis. The
hemodialysis nurse monitors the extent of anticoagulation by checking the
PTT, which is the appropriate measure of heparin effect. Thrombin and
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