Urinary Disorders NCLEX Practice Quiz

1. A client has a history of chronic renal failure and received hemodialysis treatments three times per week through an arteriovenous (AV) fistula in the left arm. Which of the following interventions is included in this client's plan of care?

Keep the AV fistula site dry.

Keep the AV fistula wrapped in gauze.

Take the blood pressure in the left arm

Assess the AV fistula for a bruit and thrill

For a client with an arteriovenous (AV) fistula used for hemodialysis, it is essential to regularly assess the fistula for a bruit and thrill. This intervention is part of routine care to ensure the fistula is functioning properly. A bruit is a whooshing sound heard with a stethoscope caused by blood rushing through the fistula, and a thrill is a vibrating sensation felt on palpation over the fistula site, indicating blood flow. Both signs confirm that the fistula is open and working effectively, which is crucial for successful dialysis treatments. Monitoring for these signs helps detect potential problems early, such as clotting or narrowing, which could compromise the fistula’s functionality and the effectiveness of the dialysis.

Explanation

For a client with an arteriovenous (AV) fistula used for hemodialysis, it is essential to regularly assess the fistula for a bruit and thrill. This intervention is part of routine care to ensure the fistula is functioning properly. A bruit is a whooshing sound heard with a stethoscope caused by blood rushing through the fistula, and a thrill is a vibrating sensation felt on palpation over the fistula site, indicating blood flow. Both signs confirm that the fistula is open and working effectively, which is crucial for successful dialysis treatments. Monitoring for these signs helps detect potential problems early, such as clotting or narrowing, which could compromise the fistula’s functionality and the effectiveness of the dialysis.

2. Dialysis allows for the exchange of particles across a semipermeable membrane by which of the following actions?

Osmosis and diffusion

Passage of fluid toward a solution with a lower solute concentration

Allowing the passage of blood cells and protein molecules through it.

Passage of solute particles toward a solution with a higher concentration.

Dialysis functions by leveraging the processes of osmosis and diffusion across a semipermeable membrane to mimic the kidney's natural filtering functions. During dialysis, diffusion allows waste products and excess electrolytes in the blood, which are at higher concentrations, to move into the dialysis fluid, where their concentrations are lower. Simultaneously, osmosis facilitates the movement of water from the blood, where it is less concentrated with solutes, to the dialysis fluid, which is more concentrated, helping to balance fluid levels in the body. This selective membrane ensures that only small waste particles and excess ions pass through, while larger molecules like blood cells and proteins are retained, effectively cleansing the blood of toxins and managing fluid balance without removing essential components.

Explanation

Dialysis functions by leveraging the processes of osmosis and diffusion across a semipermeable membrane to mimic the kidney's natural filtering functions. During dialysis, diffusion allows waste products and excess electrolytes in the blood, which are at higher concentrations, to move into the dialysis fluid, where their concentrations are lower. Simultaneously, osmosis facilitates the movement of water from the blood, where it is less concentrated with solutes, to the dialysis fluid, which is more concentrated, helping to balance fluid levels in the body. This selective membrane ensures that only small waste particles and excess ions pass through, while larger molecules like blood cells and proteins are retained, effectively cleansing the blood of toxins and managing fluid balance without removing essential components.

3. A client receiving hemodialysis treatment arrives at the hospital with a blood pressure of 200/100. a heart rate of 110. and a respiratory rate of 36. Oxygen saturation on room air is 89%. He complains of shortness of breath. and +2 pedal edema is noted. His last hemodialysis treatment was yesterday. Which of the following interventions should be done first?

Administer oxygen

Elevate the foot of the bed

Restrict the client’s fluids

Prepare the client for hemodialysis.

For a client presenting with a high blood pressure, elevated heart rate, increased respiratory rate, and low oxygen saturation, indicating respiratory distress, the first and most urgent intervention is to administer oxygen. This action is critical to improve the client's oxygen saturation and support his breathing, addressing the immediate life-threatening symptom of hypoxia. In cases of respiratory distress, ensuring adequate oxygenation takes precedence to stabilize the patient's condition before further interventions, such as adjusting fluid balance or preparing for additional hemodialysis, are considered. Elevating the foot of the bed and restricting fluids are also important but secondary to addressing the acute respiratory compromise.

Explanation

For a client presenting with a high blood pressure, elevated heart rate, increased respiratory rate, and low oxygen saturation, indicating respiratory distress, the first and most urgent intervention is to administer oxygen. This action is critical to improve the client's oxygen saturation and support his breathing, addressing the immediate life-threatening symptom of hypoxia. In cases of respiratory distress, ensuring adequate oxygenation takes precedence to stabilize the patient's condition before further interventions, such as adjusting fluid balance or preparing for additional hemodialysis, are considered. Elevating the foot of the bed and restricting fluids are also important but secondary to addressing the acute respiratory compromise.

4. Which of the following clients is at greatest risk for developing acute renal failure?

A dialysis client who gets influenza

A teenager who has an appendectomy

A pregnant woman who has a fractured femur

A client with diabetes who has a heart catheterization

Among the scenarios presented, the client with diabetes undergoing a heart catheterization faces the highest risk of developing acute renal failure. This increased risk is attributed to the combination of pre-existing diabetes, which inherently affects kidney function, and the procedure's use of contrast dye, known to be nephrotoxic. The contrast dye can lead to contrast-induced nephropathy, particularly in patients with compromised kidney health like those with diabetes. In contrast, the other situations, while potentially challenging, do not inherently combine a high-risk condition with a high-risk procedure that directly impacts kidney function to the same extent.

Explanation

Among the scenarios presented, the client with diabetes undergoing a heart catheterization faces the highest risk of developing acute renal failure. This increased risk is attributed to the combination of pre-existing diabetes, which inherently affects kidney function, and the procedure's use of contrast dye, known to be nephrotoxic. The contrast dye can lead to contrast-induced nephropathy, particularly in patients with compromised kidney health like those with diabetes. In contrast, the other situations, while potentially challenging, do not inherently combine a high-risk condition with a high-risk procedure that directly impacts kidney function to the same extent.

5. A client is undergoing peritoneal dialysis. The dialysate dwell time is completed. and the dwell clamp is opened to allow the dialysate to drain. The nurse notes that the drainage has stopped and only 500 ml has drained; the amount the dialysate instilled was 1.500 ml. Which of the following interventions would be done first?

Change the client’s position.

Call the physician.

Check the catheter for kinks or obstruction.

Clamp the catheter and instill more dialysate at the next exchange time.

When performing peritoneal dialysis and noticing an issue with the drainage, such as significantly less fluid draining out compared to what was instilled, the first intervention should be to check the catheter for kinks or obstruction. This is a common cause of poor drainage and can often be resolved by ensuring the catheter is free of any bends or blockages that could impede the flow of dialysate. Adjusting the catheter can quickly restore proper function without needing to escalate the issue immediately to a physician. Other steps like changing the client's position can be helpful but are generally considered after ensuring that the catheter pathway is clear. This approach helps to troubleshoot and potentially solve the problem efficiently at the source.

Explanation

When performing peritoneal dialysis and noticing an issue with the drainage, such as significantly less fluid draining out compared to what was instilled, the first intervention should be to check the catheter for kinks or obstruction. This is a common cause of poor drainage and can often be resolved by ensuring the catheter is free of any bends or blockages that could impede the flow of dialysate. Adjusting the catheter can quickly restore proper function without needing to escalate the issue immediately to a physician. Other steps like changing the client's position can be helpful but are generally considered after ensuring that the catheter pathway is clear. This approach helps to troubleshoot and potentially solve the problem efficiently at the source.

6. A nurse is assessing the patency of an arteriovenous fistula in the left arm of a client who is receiving hemodialysis for the treatment of chronic renal failure. Which finding indicates that the fistula is patent?

Absence of bruit on auscultation of the fistula.

Palpation of a thrill over the fistula

Presence of a radial pulse in the left wrist

Capillary refill time less than 3 seconds in the nail beds of the fingers on the left hand.

The presence of a thrill when palpating an arteriovenous (AV) fistula indicates that the fistula is patent and functioning properly. A thrill is a vibration felt over the fistula site, caused by the turbulent flow of blood from the artery directly into the vein. This physical sensation is a key indicator used by healthcare professionals to assess the adequacy of the fistula for hemodialysis. The thrill confirms that blood is flowing at a high rate through the fistula, which is necessary for effective dialysis treatment. Other findings listed, such as the absence of a bruit, presence of a radial pulse, or capillary refill time, while important for other assessments, do not directly indicate the patency of an AV fistula. A bruit, which is a whooshing sound heard through a stethoscope, is another indicator of patency, but its absence does not necessarily mean the fistula is non-patent, making the palpation of a thrill a more definitive and reliable sign.

Explanation

The presence of a thrill when palpating an arteriovenous (AV) fistula indicates that the fistula is patent and functioning properly. A thrill is a vibration felt over the fistula site, caused by the turbulent flow of blood from the artery directly into the vein. This physical sensation is a key indicator used by healthcare professionals to assess the adequacy of the fistula for hemodialysis. The thrill confirms that blood is flowing at a high rate through the fistula, which is necessary for effective dialysis treatment. Other findings listed, such as the absence of a bruit, presence of a radial pulse, or capillary refill time, while important for other assessments, do not directly indicate the patency of an AV fistula. A bruit, which is a whooshing sound heard through a stethoscope, is another indicator of patency, but its absence does not necessarily mean the fistula is non-patent, making the palpation of a thrill a more definitive and reliable sign.

7. A client is diagnosed with chronic renal failure and told she must start hemodialysis. Client teaching would include which of the following instructions?

Follow a high potassium diet

Strictly follow the hemodialysis schedule

There will be a few changes in your lifestyle.

Use alcohol on the skin and clean it due to integumentary changes.

For a client diagnosed with chronic renal failure who must start hemodialysis, it is crucial to strictly follow the hemodialysis schedule. Hemodialysis is a treatment that helps your kidneys do their job when they can’t do it themselves, which involves regularly scheduling sessions to filter the blood. This treatment is essential for removing waste products and excess fluid from the blood when the kidneys are no longer capable of performing efficiently. Adhering to a precise schedule ensures that the blood remains as clean as possible, which is vital for the patient’s overall health and preventing further complications associated with kidney failure. Other options like following a high potassium diet or using alcohol on the skin are generally not recommended without specific medical advice, as they can be harmful under certain conditions associated with renal failure.

Explanation

For a client diagnosed with chronic renal failure who must start hemodialysis, it is crucial to strictly follow the hemodialysis schedule. Hemodialysis is a treatment that helps your kidneys do their job when they can’t do it themselves, which involves regularly scheduling sessions to filter the blood. This treatment is essential for removing waste products and excess fluid from the blood when the kidneys are no longer capable of performing efficiently. Adhering to a precise schedule ensures that the blood remains as clean as possible, which is vital for the patient’s overall health and preventing further complications associated with kidney failure. Other options like following a high potassium diet or using alcohol on the skin are generally not recommended without specific medical advice, as they can be harmful under certain conditions associated with renal failure.

8. Which of the following factors causes the nausea associated with renal failure?

Oliguria

Gastric ulcers

Electrolyte imbalances

Accumulation of waste products

The nausea associated with renal failure is primarily caused by the accumulation of waste products in the body. In renal failure, the kidneys lose their ability to effectively filter and remove waste materials and excess fluids from the blood. As these waste products build up, they can cause a condition known as uremia, where high levels of urea and other waste substances in the blood lead to a range of symptoms, including nausea, vomiting, fatigue, and loss of appetite. This buildup affects the gastrointestinal system and stimulates the vomiting center in the brain, leading to feelings of nausea. Electrolyte imbalances and other factors like gastric ulcers may also contribute to gastrointestinal symptoms, but the direct cause of nausea in renal failure patients is typically the increased level of toxins due to inadequate kidney function.

Explanation

The nausea associated with renal failure is primarily caused by the accumulation of waste products in the body. In renal failure, the kidneys lose their ability to effectively filter and remove waste materials and excess fluids from the blood. As these waste products build up, they can cause a condition known as uremia, where high levels of urea and other waste substances in the blood lead to a range of symptoms, including nausea, vomiting, fatigue, and loss of appetite. This buildup affects the gastrointestinal system and stimulates the vomiting center in the brain, leading to feelings of nausea. Electrolyte imbalances and other factors like gastric ulcers may also contribute to gastrointestinal symptoms, but the direct cause of nausea in renal failure patients is typically the increased level of toxins due to inadequate kidney function.

9. The client with chronic renal failure is at risk of developing dementia related to excessive absorption of aluminum. The nurse teaches that this is the reason that the client is being prescribed which of the following phosphate binding agents?

Alu-cap (aluminum hydroxide)

Tums (calcium carbonate)

Amphojel (aluminum hydroxide)

Basaljel (aluminum hydroxide)

In cases of chronic renal failure, patients are at risk of developing complications such as dementia due to the excessive absorption of aluminum, commonly found in certain phosphate binding agents. To mitigate this risk, patients are often prescribed non-aluminum-based phosphate binders such as Tums (calcium carbonate). Calcium carbonate serves as an effective alternative to aluminum hydroxide-based binders (like Alu-cap, Amphojel, and Basaljel), which can contribute to aluminum buildup in the body if used long-term. This buildup is particularly concerning in renal failure patients because their bodies cannot effectively eliminate aluminum, increasing the risk of aluminum toxicity and related conditions like dementia. Therefore, calcium carbonate is recommended to avoid these aluminum-related risks while still effectively reducing phosphate levels in the blood, which is necessary to manage bone and mineral disorders in renal failure.

Explanation

In cases of chronic renal failure, patients are at risk of developing complications such as dementia due to the excessive absorption of aluminum, commonly found in certain phosphate binding agents. To mitigate this risk, patients are often prescribed non-aluminum-based phosphate binders such as Tums (calcium carbonate). Calcium carbonate serves as an effective alternative to aluminum hydroxide-based binders (like Alu-cap, Amphojel, and Basaljel), which can contribute to aluminum buildup in the body if used long-term. This buildup is particularly concerning in renal failure patients because their bodies cannot effectively eliminate aluminum, increasing the risk of aluminum toxicity and related conditions like dementia. Therefore, calcium carbonate is recommended to avoid these aluminum-related risks while still effectively reducing phosphate levels in the blood, which is necessary to manage bone and mineral disorders in renal failure.

10. In a client in renal failure. which assessment finding may indicate hypocalcemia?

Headache

Serum calcium level of 5 mEq/L

Increased blood coagulation

Diarrhea

In a client with renal failure, a serum calcium level of 5 mEq/L (milliequivalents per liter) is a clear indication of hypocalcemia, which is an abnormally low level of calcium in the blood. Normal serum calcium levels typically range between 8.5 and 10.5 mg/dL (or about 4.25 to 5.25 mEq/L, taking into account the conversion factor that 1 mg/dL equals approximately 0.5 mEq/L). Calcium plays a crucial role in many bodily functions including muscle contraction, nerve function, and blood clotting. In renal failure, the kidneys' ability to maintain calcium and phosphate balance is often impaired, leading to lower calcium levels in the blood. The reported value of 5 mEq/L suggests a significant decrease from normal levels, indicating hypocalcemia, which can result in symptoms such as muscle spasms, tingling, and cardiac issues, among others. This assessment finding is therefore a direct indicator of hypocalcemia in a renal failure patient.

Explanation

In a client with renal failure, a serum calcium level of 5 mEq/L (milliequivalents per liter) is a clear indication of hypocalcemia, which is an abnormally low level of calcium in the blood. Normal serum calcium levels typically range between 8.5 and 10.5 mg/dL (or about 4.25 to 5.25 mEq/L, taking into account the conversion factor that 1 mg/dL equals approximately 0.5 mEq/L). Calcium plays a crucial role in many bodily functions including muscle contraction, nerve function, and blood clotting. In renal failure, the kidneys' ability to maintain calcium and phosphate balance is often impaired, leading to lower calcium levels in the blood. The reported value of 5 mEq/L suggests a significant decrease from normal levels, indicating hypocalcemia, which can result in symptoms such as muscle spasms, tingling, and cardiac issues, among others. This assessment finding is therefore a direct indicator of hypocalcemia in a renal failure patient.