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N321 Exam 2 - NCLEX-Style Questions-Solved 2024 (Renal/GU)
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N321 Exam 2 - NCLEX-Style Questions-Solved 2024 (Renal/GU)
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N321 Exam 2 - NCLEX-Style Questions-Solved 2024 (Renal/GU)
A client admitted for acute pyelonephritis is about to start antibiotic therapy. Which
symptom would be expected in this client?
1) Hypertension
2) Flank pain on the affected side
3) Pain that radiates toward the unaffected side
4) No tenderness with deep palpation over the
CVA - ANSWER-2) Flank pain on the affected side
R: The client may complain of pain on the affected side because the kidney is enlarged
and might have formed an abscess.
Hypertension is associated with chronic pyelonephritis. Pain may radiate down the
ureters or to the epigastrium. The client would have tenderness with deep palpation
over the CVA.
A client admitted with a gunshot wound to the abdomen is transferred to the intensive
care unit after an exploratory laparotomy. I.V. fluid is being infused at 150 ml/hour.
Which assessment finding suggests that the client is experiencing acute renal failure
(ARF)?
a) Urine output of 250 ml/24 hours
b) Temperature of 100.2° F (37.8° C)
c) Serum creatinine level of 1.2 mg/dl
d) Blood urea nitrogen (BUN) level of 22 mg/dl - ANSWER-a) Urine output of 250 ml/24
hours
R: ARF, characterized by abrupt loss of kidney function, commonly causes oliguria,
which is characterized by a urine output of 250 ml/24 hours. A serum creatinine level of
1.2 mg/dl isn't diagnostic of ARF. A BUN level of 22 mg/dl or a temperature of 100.2° F
(37.8° C) wouldn't result from this disorder.
A client develops decreased renal function and requires a change in antibiotic dosage.
On which factor should the physician base the dosage change?
a) Therapeutic index
b) GI absorption rate
c) Liver function studies
d) Creatinine clearance - ANSWER-d) Creatinine clearance
R: The physician should base changes to antibiotic dosages on creatinine clearance
test results, which gauge the kidney's glomerular filtration rate; this factor is important
because most drugs are excreted at least partially by the kidneys. The GI absorption
rate, therapeutic index, and liver function studies don't help determine dosage change in
a client with decreased renal function.
, A 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. - ANSWER-c) water and
sodium retention secondary to a severe decrease in the glomerular filtration rate.
R: 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. - ANSWER-a) Start I.V.
fluids with a normal saline solution bolus followed by a maintenance dose.
R: 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.
A client is being admitted to the hospital with a diagnosis of urolithiasis and ureteral
colic. The nurse assesses the client for pain that is:
a) dull and aching in the costovetebal area
b) aching and camplike thoughout the abdomen
c) sharp and radiating posteriorly to the spinal column
d) excruciating, wavelike, and radiating toward the genitalia - ANSWER-d) excruciating,
wavelike, and radiating toward the genitalia
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