NCLEX Practice Exam: Renal Failure & Dialysis, Part 1

More review questions for NCLEX can be found on here.

Answer the following questions for Renal Failure & Dialysis, Part 1.

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

a. Osmosis and diffusion
b. Passage of fluid toward a solution with a lower solute concentration
c. Allowing the passage of blood cells and protein molecules through it.
d. Passage of solute particles toward a solution with a higher concentration.

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

a. Follow a high potassium diet
b. Strictly follow the hemodialysis schedule
c. There will be a few changes in your lifestyle.
d. Use alcohol on the skin and clean it due to integumentary changes.

3. 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?

a. Change the client’s position.
b. Call the physician.
c. Check the catheter for kinks or obstruction.
d. Clamp the catheter and instill more dialysate at the next exchange time.

4. 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?

a. Administer oxygen
b. Elevate the foot of the bed
c. Restrict the client’s fluids
d. Prepare the client for hemodialysis.

5. 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?

a. Keep the AV fistula site dry.
b. Keep the AV fistula wrapped in gauze.
c. Take the blood pressure in the left arm
d. Assess the AV fistula for a bruit and thrill

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

a. Oliguria
b. Gastric ulcers
c. Electrolyte imbalances
d. Accumulation of waste products

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

a. A dialysis client who gets influenza
b. A teenager who has an appendectomy
c. A pregnant woman who has a fractured femur
d. A client with diabetes who has a heart catherization

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

a. Headache
b. Serum calcium level of 5 mEq/L
c. Increased blood coagulation
d. Diarrhea

9.  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?

a. Absence of bruit on auscultation of the fistula.
b. Palpation of a thrill over the fistula
c. Presence of a radial pulse in the left wrist
d. Capillary refill time less than 3 seconds in the nail beds of the fingers on the left hand.

10. 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?

a. Alu-cap (aluminum hydroxide)
b. Tums (calcium carbonate)
c. Amphojel (aluminum hydroxide)
d. Basaljel (aluminum hydroxide)

11. The client newly diagnosed with chronic renal failure recently has begun hemodialysis. Knowing that the client is at risk for disequilibrium syndrome, the nurse assesses the client during dialysis for:

a. Hypertension, tachycardia, and fever
b. Hypotension, bradycardia, and hypothermia
c. restlessness, irritability, and generalized weakness
d. Headache, deteriorating level of consciousness, and twitching.

12. A client with chronic renal failure has completed a hemodialysis treatment. The nurse would use which of the following standard indicators to evaluate the client’s status after dialysis?

a. Potassium level and weight
b. BUN and creatinine levels
c. VS and BUN
d. VS and weight

13. The hemodialysis client with a left arm fistula is at risk for steal syndrome. The nurse assesses this client for which of the following clinical manifestations?

a. Warmth, redness, and pain in the left hand.
b. Pallor, diminished pulse, and pain in the left hand.
c. Edema and reddish discoloration of the left arm
d. Aching pain, pallor, and edema in the left arm.

14. A client is admitted to the hospital and has a diagnosis of early stage chronic renal failure. Which of the following would the nurse expect to note on assessment of the client?

a. Polyuria
b. Polydipsia
c. Oliguria
d. Anuria

15. The client with chronic renal failure returns to the nursing unit following a hemodialysis treatment. On assessment the nurse notes that the client’s temperature is 100.2. Which of the following is the most appropriate nursing action?

a. Encourage fluids
b. Notify the physician
c. Monitor the site of the shunt for infection
d. Continue to monitor vital signs

16. The nurse is performing an assessment on a client who has returned from the dialysis unit following hemodialysis. The client is complaining of a headache and nausea and is extremely restless. Which of the following is the most appropriate nursing action?

a. Notify the physician
b. Monitor the client
c. Elevate the head of the bed
d. Medicate the client for nausea

17. The nurse is assisting a client on a low-potassium diet to select food items from the menu. Which of the following food items, if selected by the client, would indicate an understanding of this dietary restriction?

a. Cantaloupe
b. Spinach
c. Lima beans
d. Strawberries

18. The nurse is reviewing a list of components contained in the peritoneal dialysis solution with the client. The client asks the nurse about the purpose of the glucose contained in the solution. The nurse bases the response knowing that the glucose:

a. Prevents excess glucose from being removed from the client.
b. Decreases risk of peritonitis.
c. Prevents disequilibrium syndrome
d. Increases osmotic pressure to produce ultrafiltration.

19. The nurse is preparing to care for a client receiving peritoneal dialysis. Which of the following would be included in the nursing plan of care to prevent the major complication associated with peritoneal dialysis?

a. Monitor the clients level of consciousness
b. Maintain strict aseptic technique
c. Add heparin to the dialysate solution
d. Change the catheter site dressing daily

20. A client newly diagnosed with renal failure is receiving peritoneal dialysis. During the infusion of the dialysate the client complains of abdominal pain. Which action by the nurse is most appropriate?

a. Slow the infusion
b. Decrease the amount to be infused
c. Explain that the pain will subside after the first few exchanges
d. Stop the dialysis

Answers and Rationale for Renal Failure & Dialysis can be found here.

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