1.

Which of the following symptoms do you expect to see in a patient

diagnosed with acute pyelonephritis?

1. Jaundice and flank pain

2. Costovertebral angle tenderness and chills
3. Burning sensation on urination
4. Polyuria and nocturia

2. You have a patient that might have a urinary tract infection (UTI).
Which statement by the patient suggests that a UTI is likely?

1. “I pee a lot.”
2. “It burns when I pee.”
3. “I go hours without the urge to pee.”
4. “My pee smells sweet.”

3. Which instructions do you include in the teaching care plan for a

patient with cystitis receiving phenazopyridine (Pyridium).

1. If the urine turns orange-red, call the doctor.

2. Take phenazopyridine just before urination to relieve pain.
3. Once painful urination is relieved, discontinue prescribed antibiotics.
4. After painful urination is relieved, stop taking phenazopyridine.

4. Which patient is at greatest risk for developing a urinary tract

infection(UTI)?

1. A 35 y.o. woman with a fractured wrist

2. A 20 y.o. woman with asthma
3. A 50 y.o. postmenopausal woman
4. A 28 y.o. with angina
5. You have a patient that is receiving peritoneal dialysis. What should
you do when you notice the return fluid is slowly draining?

1. Check for kinks in the outflow tubing.

2. Raise the drainage bag above the level of the abdomen.
3. Place the patient in a reverse Trendelenburg position.
4. Ask the patient to cough.

6. What is the appropriate infusion time for the dialysate in your 38 y.o.
patient with chronic renal failure?

1. 15 minutes
2. 30 minutes
3. 1 hour
4. 2 to 3 hours

7. A 30 y.o. female patient is undergoing hemodialysis with an internal

arteriovenous fistula in place. What do you do to prevent complications
associated with this device?

1. Insert I.V. lines above the fistula.

2. Avoid taking blood pressures in the arm with the fistula.
3. Palpate pulses above the fistula.
4. Report a bruit or thrill over the fistula to the doctor.

8. Your patient becomes restless and tells you she has a headache and
feels nauseous during hemodialysis. Which complication do you
suspect?

1. Infection
2. Disequilibrium syndrome
3. Air embolus
4. Acute hemolysis
9. Your patient is complaining of muscle cramps while undergoing
hemodialysis. Which intervention is effective in relieving muscle
cramps?

1. Increase the rate of dialysis

2. Infuse normal saline solution
3. Administer a 5% dextrose solution
4. Encourage active ROM exercises

10. Your patient with chronic renal failure reports pruritus. Which
instruction should you include in this patient’s teaching plan?

1. Rub the skin vigorously with a towel

2. Take frequent baths
3. Apply alcohol-based emollients to the skin
4. Keep fingernails short and clean

11. Which intervention do you plan to include with a patient who has
renal calculi?

1. Maintain bed rest

2. Increase dietary purines
3. Restrict fluids
4. Strain all urine

12. An 18 y.o. student is admitted with dark urine, fever, and flank pain
and is diagnosed with acute glomerulonephritis. Which would most
likely be in this student’s health history?

1. Renal calculi
2. Renal trauma
3. Recent sore throat
4. Family history of acute glomerulonephritis
13. Which drug is indicated for pain related to acute renal calculi?

1. Narcotic analgesics
2. Nonsteroidal anti-inflammatory drugs (NSAIDS)
3. Muscle relaxants
4. Salicylates

14. Which of the following causes the majority of UTI’s in hospitalized

patients?

1. Lack of fluid intake

2. Inadequate perineal care
3. Invasive procedures
4. Immunosuppression

15. Clinical manifestations of acute glomerulonephritis include which of

the following?

1. Chills and flank pain

2. Oliguria and generalized edema
3. Hematuria and proteinuria
4. Dysuria and hypotension

16. You expect a patient in the oliguric phase of renal failure to have a
24 hour urine output less than:

1. 200ml
2. 400ml
3. 800ml
4. 1000ml

17. The most common early sign of kidney disease is:

1. Sodium retention
2. Elevated BUN level
3. Development of metabolic acidosis
4. Inability to dilute or concentrate urine

18. A patient is experiencing which type of incontinence if she

experiences leaking urine when she coughs, sneezes, or lifts heavy
objects?

1. Overflow
2. Reflex
3. Stress
4. Urge

19. Immediately post-op after a prostatectomy, which complications

requires priority assessment of your patient?

1. Pneumonia
2. Hemorrhage
3. Urine retention
4. Deep vein thrombosis

20. The most indicative test for prostate cancer is:

1. A thorough digital rectal examination

2. Magnetic resonance imaging (MRI)
3. Excretory urography
4. Prostate-specific antigen

21. A 22 y.o. patient with diabetic nephropathy says, “I have two

kidneys and I’m still young. If I stick to my insulin schedule, I don’t
have to worry about kidney damage, right?” Which of the following
statements is the best response?
1. “You have little to worry about as long as your kidneys keep making urine.”
2. “You should talk to your doctor because statistics show that you’re being
unrealistic.”
3. “You would be correct if your diabetes could be managed with insulin.”
4. “Even with insulin, kidney damage is still a concern.”

22. A patient diagnosed with sepsis from a UTI is being discharged.

What do you plan to include in her discharge teaching?

1. Take cool baths

2. Avoid tampon use
3. Avoid sexual activity
4. Drink 8 to 10 eight-oz glasses of water daily

23. You’re planning your medication teaching for your patient with a
UTI prescribed phenazopyridine (Pyridium). What do you include?

1. “Your urine might turn bright orange.”

2. “You need to take this antibiotic for 7 days.”
3. “Take this drug between meals and at bedtime.”
4. “Don’t take this drug if you’re allergic to penicillin.”

24. Which finding leads you to suspect acute glomerulonephritis in your

32 y.o. patient?

1. Dysuria, frequency, and urgency

2. Back pain, nausea, and vomiting
3. Hypertension, oliguria, and fatigue
4. Fever, chills, and right upper quadrant pain radiating to the back

25. What is the priority nursing diagnosis with your patient diagnosed
with end-stage renal disease?
1. Activity intolerance
2. Fluid volume excess
3. Knowledge deficit
4. Pain

26. A patient with ESRD has an arteriovenous fistula in the left arm for
hemodialysis. Which intervention do you include in his plan of care?

1. Apply pressure to the needle site upon discontinuing hemodialysis

2. Keep the head of the bed elevated 45 degrees
3. Place the left arm on an arm board for at least 30 minutes
4. Keep the left arm dry

27. Your 60 y.o. patient with pyelonephritis and possible septicemia has
had five UTIs over the past two years. She is fatigued from lack of
sleep, has lost weight, and urinates frequently even in the night. Her
labs show: sodium, 154 mEq/L; osmolarity 340 mOsm/L; glucose, 127
mg/dl; and potassium, 3.9 mEq/L. Which nursing diagnosis is priority?

1. Fluid volume deficit related to osmotic diuresis induced by hyponatremia

2. Fluid volume deficit related to inability to conserve water
3. Altered nutrition: Less than body requirements related to hypermetabolic
state
4. Altered nutrition: Less than body requirements related to catabolic effects of
insulin deficiency

28. Which sign indicated the second phase of acute renal failure?

1. Daily doubling of urine output (4 to 5 L/day)

2. Urine output less than 400 ml/day
3. Urine output less than 100 ml/day
4. Stabilization of renal function
29. Your patient had surgery to form an arteriovenous fistula for
hemodialysis. Which information is important for providing care for the
patient?

1. The patient shouldn’t feel pain during initiation of dialysis

2. The patient feels best immediately after the dialysis treatment
3. Using a stethoscope for auscultating the fistula is contraindicated
4. Taking a blood pressure reading on the affected arm can cause clotting of the
fistula

30. A patient with diabetes mellitus and renal failure begins

hemodialysis. Which diet is best on days between dialysis treatments?

1. Low-protein diet with unlimited amounts of water

2. Low-protein diet with a prescribed amount of water
3. No protein in the diet and use of a salt substitute
4. No restrictions

31. After the first hemodialysis treatment, your patient develops a

headache, hypertension, restlessness, mental confusion, nausea, and
vomiting. Which condition is indicated?

1. Disequilibrium syndrome
2. Respiratory distress
3. Hypervolemia
4. Peritonitis

32. Which action is most important during bladder training in a patient

with a neurogenic bladder?

1. Encourage the use of an indwelling urinary catheter

2. Set up specific times to empty the bladder
3. Encourage Kegel exercises
4. Force fluids

33. A patient with diabetes has had many renal calculi over the past 20
years and now has chronic renal failure. Which substance must be
reduced in this patient’s diet?

1. Carbohydrates
2. Fats
3. Protein
4. Vitamin C

34. What is the best way to check for patency of the arteriovenous
fistula for hemodialysis?

1. Pinch the fistula and note the speed of filling on release

2. Use a needle and syringe to aspirate blood from the fistula
3. Check for capillary refill of the nail beds on that extremity
4. Palpate the fistula throughout its length to assess for a thrill

35. You have a paraplegic patient with renal calculi. Which factor
contributes to the development of calculi?

1. Increased calcium loss from the bones

2. Decreased kidney function
3. Decreased calcium intake
4. High fluid intake

36. What is the most important nursing diagnosis for a patient in end-
stage renal disease?

1. Risk for injury

2. Fluid volume excess
3. Altered nutrition: less than body requirements
4. Activity intolerance

37. Frequent PVCs are noted on the cardiac monitor of a patient with
end-stage renal disease. The priority intervention is:

1. Call the doctor immediately

2. Give the patient IV lidocaine (Xylocaine)
3. Prepare to defibrillate the patient
4. Check the patient’s latest potassium level

38. A patient who received a kidney transplant returns for a follow-up

visit to the outpatient clinic and reports a lump in her breast.
Transplant recipients are:

1. At increased risk for cancer due to immunosuppression caused

by cyclosporine(Neoral)
2. Consumed with fear after the life-threatening experience of having a
transplant
3. At increased risk for tumors because of the kidney transplant
4. At decreased risk for cancer, so the lump is most likely benign

39. You’re developing a care plan with the nursing diagnosis risk for
infection for your patient that received a kidney transplant. A goal for
this patient is to:

1. Remain afebrile and have negative cultures

2. Resume normal fluid intake within 2 to 3 days
3. Resume the patient’s normal job within 2 to 3 weeks
4. Try to discontinue cyclosporine (Neoral) as quickly as possible

40. You suspect kidney transplant rejection when the patient shows
which symptoms?
1. Pain in the incision, general malaise, and hypotension
2. Pain in the incision, general malaise, and depression
3. Fever, weight gain, and diminished urine output
4. Diminished urine output and hypotension

41. Your patient returns from the operating room after abdominal aortic
aneurysm repair. Which symptom is a sign of acute renal failure?

1. Anuria
2. Diarrhea
3. Oliguria
4. Vomiting

42. Which cause of hypertension is the most common in acute renal

failure?

1. Pulmonary edema
2. Hypervolemia
3. Hypovolemia
4. Anemia

43. A patient returns from surgery with an indwelling urinary catheter

in place and empty. Six hours later, the volume is 120ml. The drainage
system has no obstructions. Which intervention has priority?

1. Give a 500 ml bolus of isotonic saline

2. Evaluate the patient’s circulation and vital signs
3. Flush the urinary catheter with sterile water or saline
4. Place the patient in the shock position, and notify the surgeon

44. You’re preparing for urinary catheterization of a trauma patient and

you observe bleeding at the urethral meatus. Which action has priority?
1. Irrigate and clean the meatus before catheterization
2. Check the discharge for occult blood before catheterization
3. Heavily lubricate the catheter before insertion
4. Delay catheterization and notify the doctor

45. What change indicates recovery in a patient with nephritic

syndrome?

1. Disappearance of protein from the urine

2. Decrease in blood pressure to normal
3. Increase in serum lipid levels
4. Gain in body weight

46. Which statement correctly distinguishes renal failure from prerenal

failure?

1. With prerenal failure, vasoactive substances such as dopamine (Intropin)

increase blood pressure
2. With prerenal failure, there is less response to
such diuretics as furosemide (Lasix)
3. With prerenal failure, an IV isotonic saline infusion increases urine output
4. With prerenal failure, hemodialysis reduces the BUN level

47. Which criterion is required before a patient can be considered for

continuous peritoneal dialysis?

1. The patient must be hemodynamically stable

2. The vascular access must have healed
3. The patient must be in a home setting
4. Hemodialysis must have failed

48. Polystyrene sulfonate (Kayexalate) is used in renal failure to:

1. Correct acidosis
2. Reduce serum phosphate levels
3. Exchange potassium for sodium
4. Prevent constipation from sorbitol use

49. Your patient has complaints of severe right-sided flank pain,

nausea, vomiting and restlessness. He appears slightly pale and is
diaphoretic. Vital signs are BP 140/90 mmHg, Pulse 118 beats/min.,
respirations 33 breaths/minute, and temperature, 98.0F. Which
subjective data supports a diagnosis of renal calculi?

1. Pain radiating to the right upper quadrant

2. History of mild flu symptoms last week
3. Dark-colored coffee-ground emesis
4. Dark, scanty urine output

50. Immunosuppression following Kidney transplantation is continued:

1. For life
2. 24 hours after transplantation
3. A week after transplantation
4. Until the kidney is not anymore rejected

Answers

1. Answer: 2. Costovertebral angle tenderness and chills

2. Answer: 2. “It burns when I pee.”.

3. Answer: 4. After painful urination is relieved, stop taking

phenazopyridine.4. Answer: 3. A 50 y.o. postmenopausal woman
5. Answer: 1. Check for kinks in the outflow tubing.

6. Answer: 1. 15 minutes

7. Answer: 2. Avoid taking blood pressures in the arm with the fistula.

8. Answer: 2. Disequilibrium syndrome

9. Answer: 2. Infuse normal saline solution

10. Answer: 4. Keep fingernails short and clean

11. Answer: 4. Strain all urine

12. Answer: 3. Recent sore throat

13. Answer: 1. Narcotic analgesics

14. Answer: 3. Invasive procedures

15. Answer: 3. Hematuria and proteinuria

16. Answer: 2. 400ml

17. Answer: 2. Elevated BUN level

18. Answer: 3. Stress

19. Answer: 2. Hemorrhage

20. Answer: 4. Prostate-specific antigen

21. Answer: 4. “Even with insulin, kidney damage is still a concern.”

22. Answer: 4. Drink 8 to 10 eight-oz glasses of water daily

23. Answer: 1. “Your urine might turn bright orange.”

24. Answer: 3. Hypertension, oliguria, and fatigue

25. Answer: 2. Fluid volume excess

26. Answer: 1. Apply pressure to the needle site upon discontinuing

hemodialysis

27. Answer: 2. Fluid volume deficit related to inability to conserve

water

28. Answer: 1. Daily doubling of urine output (4 to 5 L/day)

29. Answer: 4. Taking a blood pressure reading on the affected arm can
cause clotting of the fistula

30. Answer: 2. Low-protein diet with a prescribed amount of water

31. Answer: 1. Disequilibrium syndrome

32. Answer: 2. Set up specific times to empty the bladder

33. Answer: 3. Protein

34. Answer: 4. Palpate the fistula throughout its length to assess for a
thrill

35. Answer: 1. Increased calcium loss from the bones

36. Answer: 2. Fluid volume excess

37. Answer: 4. Check the patient’s latest potassium level

38. Answer: 1. At increased risk for cancer due to immunosuppression

caused by cyclosporine (Neoral)

39. Answer: 1. Remain afebrile and have negative cultures

40. Answer: 3. Fever, weight gain, and diminished urine output

41. Answer: 3. Oliguria

42. Answer: 2. Hypervolemia

43. Answer: 2. Evaluate the patient’s circulation and vital signs

44. Answer: 4. Delay catheterization and notify the doctor

45. Answer: 1. Disappearance of protein from the urine

46. Answer: 3. With prerenal failure, an IV isotonic saline infusion

increases urine output

47. Answer: 1. The patient must be hemodynamically stable

48. Answer: 3. Exchange potassium for sodium

49. Answer: 4. Dark, scanty urine output

50. Answer: 1. For life.