Exam (elaborations)
Renal Function NCLEX Final Exam - Qs And As
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- NCLEX RENAL
- Institution
- NCLEX RENAL
Renal Function NCLEX Final Exam - Qs And As
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Renal Function NCLEX Final Exam - Qs And AsA client is admitted for treatment of chronic renal failure (CRF). The nurse
knows that this disorder increases the client's risk of:
a) a decreased serum phosphate level secondary to kidney failure.
b) an increased serum calcium level secondary to kidney failure.
c) water and sodium retention secondary to a severe decrease in the
glomerular filtration rate.
d) metabolic alkalosis secondary to retention of hydrogen ions. ✔️Ans - C)
water and sodium retention secondary to a severe decrease in the glomerular
filtration rate.
Explanation: The client with CRF is at risk for fluid imbalance — dehydration
if the kidneys fail to concentrate urine, or fluid retention if the kidneys fail to
produce urine. Electrolyte imbalances associated with this disorder result
from the kidneys' inability to excrete phosphorus; such imbalances may lead
to hyperphosphatemia with reciprocal hypocalcemia. CRF may cause
metabolic acidosis, not metabolic alkalosis, secondary to inability of the
kidneys to excrete hydrogen ions.
A client is admitted with nausea, vomiting, and diarrhea. His blood pressure
on admission is 74/30 mm Hg. The client is oliguric and his blood urea
nitrogen (BUN) and creatinine levels are elevated. The physician will most
likely write an order for which treatment?
a) Start I.V. fluids with a normal saline solution bolus followed by a
maintenance dose.
b) Administer furosemide (Lasix) 20 mg I.V.
c) Encourage oral fluids.
d) Start hemodialysis after a temporary access is obtained. ✔️Ans - A)
Start IV fluids with normal saline solution bolus followed by a maintenance
dose.
Explanation: The client is in prerenal failure caused by hypovolemia. I.V. fluids
should be given with a bolus of normal saline solution followed by
maintenance I.V. therapy. This treatment should rehydrate the client, causing
his blood pressure to rise, his urine output to increase, and the BUN and
creatinine levels to normalize. The client wouldn't be able to tolerate oral
fluids because of the nausea, vomiting, and diarrhea. The client isn't fluid-
overloaded so his urine output won't increase with furosemide, which would
actually worsen the client's condition. The client doesn't require dialysis
, because the oliguria and elevated BUN and creatinine levels are caused by
dehydration.
Which of the following would the nurse expect to find when reviewing the
laboratory test results of a client with renal failure?
a) Increased red blood cell count
b) Decreased serum potassium level
c) Increased serum calcium level
d) Increased serum creatinine level ✔️Ans - D) Increased serum
creatinine level
Explanation: In renal failure, laboratory blood tests reveal elevations in BUN,
creatinine, potassium, magnesium, and phosphorus. Calcium levels are low.
The RBC count, hematocrit, and hemoglobin are decreased.
A nurse assesses a client shortly after living donor kidney transplant surgery.
Which postoperative finding must the nurse report to the physician
immediately?
a) Serum sodium level of 135 mEq/L
b) Serum potassium level of 4.9 mEq/L
c) Temperature of 99.2° F (37.3° C)
d) Urine output of 20 ml/hour ✔️Ans - D) Urine output of 20 ml/hour
Explanation: Because kidney transplantation carries the risk of transplant
rejection, infection, and other serious complications, the nurse should monitor
the client's urinary function closely. A decrease from the normal urine output
of 30 ml/hour is significant and warrants immediate physician notification. A
serum potassium level of 4.9 mEq/L, a serum sodium level of 135 mEq/L, and
a temperature of 99.2° F are normal assessment findings.
After teaching a group of students about how to perform peritoneal dialysis,
which statement would indicate to the instructor that the students need
additional teaching?
a) "The effluent should be allowed to drain by gravity."
b) "It is important to use strict aseptic technique."
c) "The infusion clamp should be open during infusion."
d) "It is appropriate to warm the dialysate in a microwave." ✔️Ans - D) It
is appropriate to warm the dialysate in a microwave
Explanation: The dialysate should be warmed in a commercial warmer and
never in a microwave oven. Strict aseptic technique is essential. The infusion
clamp is opened during the infusion and clamped after the infusion. When the
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