GLOBAL NEPHRO TRAINING CENTER REVIEWER

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.
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

4. Which patient is at greatest risk for developing a urinary 11. Which intervention do you plan to include with a patient
tract infection (UTI)? who has renal calculi?
1. A 35 y.o. woman with a fractured wrist 1. Maintain bed rest
2. A 20 y.o. woman with asthma 2. Increase dietary purines
3. A 50 y.o. postmenopausal woman 3. Restrict fluids
4. A 28 y.o. with angina 4. Strain all urine

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.
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

6. What is the appropriate infusion time for the dialysate in

your 38 y.o. patient with chronic renal failure? 13. Which drug is indicated for pain related to acute renal
calculi?
1. 15 minutes
2. 30 minutes 1. Narcotic analgesics
3. 1 hour 2. Nonsteroidal anti-inflammatory drugs (NSAIDS)
4. 2 to 3 hours 3. Muscle relaxants
4. Salicylates

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

an internal arteriovenous fistula in place. What do you do to 14. Which of the following causes the majority of UTI’s in
prevent complications associated with this device? hospitalized patients?
1. Insert I.V. lines above the fistula. 1. Lack of fluid intake
2. Avoid taking blood pressures in the arm with the fistula. 2. Inadequate perineal care
3. Palpate pulses above the fistula. 3. Invasive procedures
4. Report a bruit or thrill over the fistula to the doctor. 4. Immunosuppression

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15. Clinical manifestations of acute glomerulonephritis 22. A patient diagnosed with sepsis from a UTI is being
include which of the following? discharged. What do you plan to include in her discharge
teaching?
1. Chills and flank pain
2. Oliguria and generalized edema 1. Take cool baths
3. Hematuria and proteinuria 2. Avoid tampon use
4. Dysuria and hypotension 3. Avoid sexual activity
4. Drink 8 to 10 eight-oz glasses of water daily
16. You expect a patient in the oliguric phase of renal failure
to have a 24 hour urine output less than:
1. 200ml 23. You’re planning your medication teaching for your
2. 400ml patient with a UTI prescribed phenazopyridine (Pyridium).
3. 800ml What do you include?
4. 1000ml
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.”
17. The most common early sign of kidney disease is:
4. “Don’t take this drug if you’re allergic to penicillin.”
1. Sodium retention
2. Elevated BUN level
3. Development of metabolic acidosis 24. Which finding leads you to suspect acute
4. Inability to dilute or concentrate urine glomerulonephritis in your 32 y.o. patient?
1. Dysuria, frequency, and urgency
2. Back pain, nausea, and vomiting
18. A patient is experiencing which type of incontinence if
3. Hypertension, oliguria, and fatigue
she experiences leaking urine when she coughs, sneezes, or
4. Fever, chills, and right upper quadrant pain radiating to the
lifts heavy objects?
back
1. Overflow
2. Reflex
3. Stress 25. What is the priority nursing diagnosis with your patient
4. Urge diagnosed with end-stage renal disease?
1. Activity intolerance
2. Fluid volume excess
19. Immediately post-op after a prostatectomy, which
3. Knowledge deficit
complications requires priority assessment of your patient?
4. Pain
1. Pneumonia
2. Hemorrhage
3. Urine retention 26. A patient with ESRD has an arteriovenous fistula in the
4. Deep vein thrombosis left arm for hemodialysis. Which intervention do you
include in his plan of care?
20. The most indicative test for prostate cancer is:
1. Apply pressure to the needle site upon discontinuing
1. A thorough digital rectal examination
hemodialysis
2. Magnetic resonance imaging (MRI)
2. Keep the head of the bed elevated 45 degrees
3. Excretory urography
3. Place the left arm on an arm board for at least 30 minutes
4. Prostate-specific antigen
4. Keep the left arm dry

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

27. Your 60 y.o. patient with pyelonephritis and possible
two kidneys and I’m still young. If I stick to my insulin
septicemia has had five UTIs over the past two years. She is
schedule, I don’t have to worry about kidney damage,
fatigued from lack of sleep, has lost weight, and urinates
right?” Which of the following statements is the best
frequently even in the night. Her labs show: sodium, 154
response?
mEq/L; osmolarity 340 mOsm/L; glucose, 127 mg/dl; and
1. “You have little to worry about as long as your kidneys potassium, 3.9 mEq/L. Which nursing diagnosis is priority?
keep making urine.”
1. Fluid volume deficit related to osmotic diuresis induced by
2. “You should talk to your doctor because statistics show
hyponatremia
that you’re being unrealistic.”
2. Fluid volume deficit related to inability to conserve water
3. “You would be correct if your diabetes could be managed
3. Altered nutrition: Less than body requirements related to
with insulin.”
hypermetabolic state
4. “Even with insulin, kidney damage is still a concern.”
4. Altered nutrition: Less than body requirements related to
catabolic effects of insulin deficiency

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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
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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
II 1. Dialysis allows for the exchange of particles across a
semipermeable membrane by which of the following actions?
1. Osmosis and diffusion
2. Passage of fluid toward a solution with a lower solute
concentration
3. Allowing the passage of blood cells and protein molecules through
it.
4. 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?
1. Follow a high potassium diet
2. Strictly follow the hemodialysis schedule
3. There will be a few changes in your lifestyle.
4. 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?
1. Change the client’s position.
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2. Call the physician.
3. Check the catheter for kinks or obstruction.
4. 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?
1. Administer oxygen
2. Elevate the foot of the bed
3. Restrict the client’s fluids
4. 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?
1. Keep the AV fistula site dry.
2. Keep the AV fistula wrapped in gauze.
3. Take the blood pressure in the left arm
4. Assess the AV fistula for a bruit and thrill
6. Which of the following factors causes the nausea associated
with renal failure?
1. Oliguria
2. Gastric ulcers
3. Electrolyte imbalances
4. Accumulation of waste products
7. Which of the following clients is at greatest risk for developing
acute renal failure?
1. A dialysis client who gets influenza
2. A teenager who has an appendectomy
3. A pregnant woman who has a fractured femur
4. A client with diabetes who has a heart catherization
8. In a client in renal failure, which assessment finding may indicate
hypocalcemia?
1. Headache
2. Serum calcium level of 5 mEq/L
3. Increased blood coagulation
4. 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?
1. Absence of bruit on auscultation of the fistula.
2. Palpation of a thrill over the fistula
3. Presence of a radial pulse in the left wrist
4. 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?
1. Alu-cap (aluminum hydroxide)
2. Tums (calcium carbonate)
3. Amphojel (aluminum hydroxide)
4. 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:
1. Hypertension, tachycardia, and fever
2. Hypotension, bradycardia, and hypothermia
3. restlessness, irritability, and generalized weakness
4. 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?
1. Potassium level and weight
2. BUN and creatinine levels
3. VS and BUN
4. 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?
1. Warmth, redness, and pain in the left hand.
2. Pallor, diminished pulse, and pain in the left hand.
3. Edema and reddish discoloration of the left arm
4. 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?
1. Polyuria
2. Polydipsia
3. Oliguria
4. 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?
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1. Encourage fluids maintain the dwell time for the dialysis at the prescribed time
because of the risk of:
2. Notify the physician
1. Infection
3. Monitor the site of the shunt for infection
2. Hyperglycemia
4. Continue to monitor vital signs
3. Fluid overload
4. Disequilibrium syndrome
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.
22. The client with acute renal failure has a serum potassium level
Which of the following is the most appropriate nursing action?
of 5.8 mEq/L. The nurse would plan which of the following as a
1. Notify the physician priority action?
2. Monitor the client 1. Allow an extra 500 ml of fluid intake to dilute the electrolyte
concentration.
3. Elevate the head of the bed
2. Encourage increased vegetables in the diet
4. Medicate the client for nausea
3. Place the client on a cardiac monitor
4. Check the sodium level
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
23. The client with chronic renal failure who is scheduled for
dietary restriction?
hemodialysis this morning is due to receive a daily dose of
1. Cantaloupe enalapril (Vasotec). The nurse should plan to administer this
medication:
2. Spinach
1. Just before dialysis
3. Lima beans
2. During dialysis
4. Strawberries
3. On return from dialysis
4. The day after dialysis
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.
24. The client with chronic renal failure has an indwelling catheter
The nurse bases the response knowing that the glucose:
for peritoneal dialysis in the abdomen. The client spills water on
1. Prevents excess glucose from being removed from the client. the catheter dressing while bathing. The nurse should
immediately:
2. Decreases risk of peritonitis.
1. Reinforce the dressing
3. Prevents disequilibrium syndrome
2. Change the dressing
4. Increases osmotic pressure to produce ultrafiltration.
3. Flush the peritoneal dialysis catheter
4. Scrub the catheter with povidone-iodine
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
25. The client being hemodialyzed suddenly becomes short of
peritoneal dialysis?
breath and complains of chest pain. The client is tachycardic, pale,
1. Monitor the clients level of consciousness and anxious. The nurse suspects air embolism. The nurse should:
2. Maintain strict aseptic technique 1. Continue the dialysis at a slower rate after checking the lines for
air
3. Add heparin to the dialysate solution
2. Discontinue dialysis and notify the physician
4. Change the catheter site dressing daily
3. Monitor vital signs every 15 minutes for the next hour
4. Bolus the client with 500 ml of normal saline to break up the air
20. A client newly diagnosed with renal failure is receiving
embolism.
peritoneal dialysis. During the infusion of the dialysate the client
complains of abdominal pain. Which action by the nurse is most
appropriate?
26. The nurse has completed client teaching with the hemodialysis
1. Slow the infusion client about self-monitoring between hemodialysis treatments.
The nurse determines that the client best understands the
2. Decrease the amount to be infused
information given if the client states to record the daily:
3. Explain that the pain will subside after the first few exchanges
1. Pulse and respiratory rate
4. Stop the dialysis
2. Intake, output, and weight
3. BUN and creatinine levels
21. The nurse is instructing a client with diabetes mellitus about
4. Activity log
peritoneal dialysis. The nurse tells the client that it is important to

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3. Add extra warmth into the body.

27. The client with an arteriovenous shunt in place for
hemodialysis is at risk for bleeding. The nurse would do which of
the following as a priority action to prevent this complication from
occurring?
1. Check the results of the PT time as they are ordered.
2. Observe the site once per shift
3. Check the shunt for the presence of a bruit and thrill
4. Ensure that small clamps are attached to the AV shunt dressing.
28. The nurse is monitoring a client receiving peritoneal dialysis
and nurse notes that a client’s outflow is less than the inflow.
Select actions that the nurse should take.
1. Place the client in good body alignment
2. Check the level of the drainage bag
3. Contact the physician
4. Check the peritoneal dialysis system for kinks
5. Reposition the client to his or her side.
4. Promote abdominal muscle relaxation.
33. During the client’s dialysis, the nurse observes that the solution
draining from the abdomen is consistently blood tinged. The client
has a permanent peritoneal catheter in place. Which interpretation
of this observation would be correct?
1. Bleeding is expected with a permanent peritoneal catheter
2. Bleeding indicates abdominal blood vessel damage
3. Bleeding can indicate kidney damage.
4. Bleeding is caused by too-rapid infusion of the dialysate.
34. Which of the following nursing interventions should be
included in the client’s care plan during dialysis therapy?
1. Limit the client’s visitors
2. Monitor the client’s blood pressure
3. Pad the side rails of the bed
4. Keep the client NPO.

29. The nurse assesses the client who has chronic renal failure and
35. Aluminum hydroxide gel (Amphojel) is prescribed for the client
notes the following: crackles in the lung bases, elevated blood
with chronic renal failure to take at home. What is the purpose of
pressure, and weight gain of 2 pounds in one day. Based on these
giving this drug to a client with chronic renal failure?
data, which of the following nursing diagnoses is appropriate?
1. To relieve the pain of gastric hyperacidity
1. Excess fluid volume related to the kidney’s inability to maintain
fluid balance. 2. To prevent Curling’s stress ulcers
2. Increased cardiac output related to fluid overload. 3. To bind phosphorus in the intestine
3. Ineffective tissue perfusion related to interrupted arterial blood 4. To reverse metabolic acidosis.
flow.
4. Ineffective therapeutic Regimen Management related to lack of
knowledge about therapy. 36. The nurse teaches the client with chronic renal failure when to
take the aluminum hydroxide gel. Which of the following
statements would indicate that the client understands the
teaching?
30. The nurse is caring for a hospitalized client who has chronic
renal failure. Which of the following nursing diagnoses are most 1. “I’ll take it every 4 hours around the clock.”
appropriate for this client? Select all that apply.
2. “I’ll take it between meals and at bedtime.”
1. Excess Fluid Volume
3. “I’ll take it when I have a sour stomach.”
2. Imbalanced Nutrition; Less than Body Requirements
4. “I’ll take it with meals and bedtime snacks.”
3. Activity Intolerance
4. Impaired Gas Exchange
37. The client with chronic renal failure tells the nurse he takes
5. Pain. magnesium hydroxide (milk of magnesia) at home for constipation.
The nurse suggests that the client switch to psyllium hydrophilic
mucilloid (Metamucil) because:
31. What is the primary disadvantage of using peritoneal dialysis
1. MOM can cause magnesium toxicity
for long term management of chronic renal failure?
2. MOM is too harsh on the bowel
1. The danger of hemorrhage is high.
3. Metamucil is more palatable
2. It cannot correct severe imbalances.
4. MOM is high in sodium
3. It is a time consuming method of treatment.
4. The risk of contracting hepatitis is high.
38. In planning teaching strategies for the client with chronic renal
failure, the nurse must keep in mind the neurologic impact of
32. The dialysis solution is warmed before use in peritoneal dialysis uremia. Which teaching strategy would be most appropriate?
primarily to:
1. Providing all needed teaching in one extended session.
1. Encourage the removal of serum urea.
2. Validating frequently the client’s understanding of the material.
2. Force potassium back into the cells.
3. Conducting a one-on-one session with the client.

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4. Using videotapes to reinforce the material as needed. 4. Vessel sclerosis

39. The nurse helps the client with chronic renal failure develop a 45. When caring for Mr. Roberto’s AV shunt on his right arm, you
home diet plan with the goal of helping the client maintain should:
adequate nutritional intake. Which of the following diets would be
1. Cover the entire cannula with an elastic bandage
most appropriate for a client with chronic renal failure?
2. Notify the physician if a bruit and thrill are present
1. High carbohydrate, high protein
3. User surgical aseptic technique when giving shunt care
2. High calcium, high potassium, high protein
4. Take the blood pressure on the right arm instead
3. Low protein, low sodium, low potassium
4. Low protein, high potassium

40. A client with chronic renal failure has asked to be evaluated for
a home continuous ambulatory peritoneal dialysis (CAPD)
program. The nurse should explain that the major advantage of
this approach is that it:
1. Is relatively low in cost
2. Allows the client to be more independent
3. Is faster and more efficient than standard peritoneal dialysis
4. Has fewer potential complications than standard peritoneal
dialysis

41. The client asks whether her diet would change on CAPD. Which
of the following would be the nurse’s best response?
1. “Diet restrictions are more rigid with CAPD because standard
peritoneal dialysis is a more effective technique.”
2. “Diet restrictions are the same for both CAPD and standard
peritoneal dialysis.”
3. “Diet restrictions with CAPD are fewer than with standard
peritoneal dialysis because dialysis is constant.”
4. “Diet restrictions with CAPD are fewer than with standard
peritoneal dialysis because CAPD works more quickly.”

42. Which of the following is the most significant sign of peritoneal

infection?
1. Cloudy dialysate fluid
2. Swelling in the legs
3. Poor drainage of the dialysate fluid
4. Redness at the catheter insertion site

43. The main indicator of the need for hemodialysis is:

1. Ascites
2. Acidosis
3. Hypertension
4. Hyperkalemia

44. To gain access to the vein and artery, an AV shunt was used for
Mr. Roberto. The most serious problem with regards to the AV
shunt is:
1. Septicemia
2. Clot formation
3. Exsanguination

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 GLOBAL NEPHRO TRAINING CENTER REVIEWER
1. A client is complaining of severe flank and abdominal
pain. A flat plate of the abdomen shows urolithiasis. Which
of the following interventions is important?
1. Strain all urine
2. Limit fluid intake
3. Enforce strict bed rest
4. Encourage a high calcium diet
2. A client is receiving a radiation implant for the treatment
of bladder cancer. Which of the following interventions is
appropriate?
1. Flush all urine down the toilet
2. Restrict the client’s fluid intake
3. Place the client in a semi-private room
4. Monitor the client for signs and symptoms of cystitis
3. A client has just received a renal transplant and has
started cyclosporine therapy to prevent graft rejection.
Which of the following conditions is a major complication of
this drug therapy?
1. Depression
2. Hemorrhage
3. Infection
4. Peptic ulcer disease
4. A client received a kidney transplant 2 months ago. He’s
admitted to the hospital with the diagnosis of acute
rejection. Which of the following assessment findings would
be expected?
1. Hypotension
2. Normal body temperature
3. Decreased WBC count
4. Elevated BUN and creatinine levels
5. The client is to undergo kidney transplantation with a
living donor. Which of the following preoperative
assessments is important?
1. Urine output
2. Signs of graft rejection
3. Signs and symptoms of rejection
4. Client’s support system and understanding of lifestyle
changes.
6. A client had a transurethral prostatectomy for benign
prostatic hypertrophy. He’s currently being treated with a
continuous bladder irrigation and is complaining of an
increase in severity of bladder spasms. Which of the
interventions should be done first?
1. Administer an oral analgesic
2. Stop the irrigation and call the physician
3. Administer a belladonna and opium suppository as ordered
by the physician.
4. Check for the presence of clots, and make sure the
catheter is draining properly.
7. A client is admitted with a diagnosis of hydronephrosis
secondary to calculi. The calculi have been removed and
postobstructive diuresis is occurring. Which of the following
interventions should be done?
1. Take vital signs every 8 hours
2. Weigh the client every other day
3. Assess for urine output every shift
4. Monitor the client’s electrolyte levels.
8. A client has passed a renal calculus. The nurse sends the
specimen to the laboratory so it can be analyzed for which
of the following factors?
1. Antibodies
2. Type of infection
3. Composition of calculus
4. Size and number of calculi
9. Which of the following symptoms indicate acute rejection
of a transplanted kidney?
1. Edema, nausea
2. Fever, anorexia
3. Weight gain, pain at graft site
4. Increased WBC count, pain with voiding
10. Adverse reactions of prednisone therapy include which
of the following conditions?
1. Acne and bleeding gums
2. Sodium retention and constipation
3. Mood swings and increased temperature
4. Increased blood glucose levels and decreased wound
healing.
11. The nurse suspects that a client with polyuria is
experiencing water diuresis. Which laboratory value
suggests water diuresis?
1. High urine specific gravity
2. High urine osmolarity
3. Normal to low urine specific gravity
4. Elevated urine pH
12. A client is diagnosed with prostate cancer. Which test is
used to monitor progression of this disease?
1. Serum creatinine
2. Complete blood cell count (CBC)
3. Prostate specific antigen (PSA)
4. Serum potassium
13. a 27-year old client, who became paraplegic after a
swimming accident, is experiencing autonomic dysreflexia.
Which condition is the most common cause of autonomic
dysreflexia?
1. Upper respiratory infection
2. Incontinence
3. Bladder distention
4. Diarrhea
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 GLOBAL NEPHRO TRAINING CENTER REVIEWER
14. When providing discharge teaching for a client with uric
acid calculi, the nurse should an instruction to avoid which
type of diet?
1. Low-calcium
2. Low-oxalate
3. High-oxalate
4. High-purine
15. The client with urolithiasis has a history of chronic
urinary tract infections. The nurse concludes that this client
most likely has which of the following types of urinary
stones?
1. Calcium oxalate
2. Uric acid
3. Struvite
4. Cystine
16. The nurse is receiving in transfer from the
postanesthesia care unit a client who has had a
percutaneous ultrasonic lithotripsy for calculuses in the
renal pelvis. The nurse anticipates that the client’s care will
involve monitoring which of the following?
1. Suprapubic tube
2. Urethral stent
3. Nephrostomy tube
4. Jackson-Pratt drain
17. The client is admitted to the ER following a MVA. The
client was wearing a lap seat belt when the accident
occurred. The client has hematuria and lower abdominal
pain. To determine further whether the pain is due to
bladder trauma, the nurse asks the client if the pain is
referred to which of the following areas?
1. Shoulder
2. Umbilicus
3. Costovertebral angle
4. Hip
18. The client complains of fever, perineal pain, and urinary
urgency, frequency, and dysuria. To assess whether the
client’s problem is related to bacterial prostatitis, the nurse
would look at the results of the prostate examination, which
should reveal that the prostate gland is:
1. Tender, indurated, and warm to the touch
2. Soft and swollen
3. Tender and edematous with ecchymosis
4. Reddened, swollen, and boggy.
19. The nurse is taking the history of a client who has had
benign prostatic hyperplasia in the past. To determine
whether the client currently is experiencing difficulty, the
nurse asks the client about the presence of which of the
following early symptoms?
1. Urge incontinence
2. Nocturia
3. Decreased force in the stream of urine
4. Urinary retention
20. The client who has a cold is seen in the emergency room
with inability to void. Because the client has a history of
BPH, the nurse determines that the client should be
questioned about the use of which of the following
medications?
1. Diuretics
2. Antibiotics
3. Antitussives
4. Decongestants
21. The nurse is preparing to care for the client following a
renal scan. Which of the following would the nurse include
in the plan of care?
1. Place the client on radiation precautions for 18 hours
2. Save all urine in a radiation safe container for 18 hours
3. Limit contact with the client to 20 minutes per hour.
4. No special precautions except to wear gloves if in contact
with the client’s urine.
22. The client passes a urinary stone, and lab analysis of the
stone indicates that it is composed of calcium oxalate. Based
on this analysis, which of the following would the nurse
specifically include in the dietary instructions?
1. Increase intake of meat, fish, plums, and cranberries
2. Avoid citrus fruits and citrus juices
3. Avoid green, leafy vegetables such as spinach.
4. Increase intake of dairy products.
23. The client returns to the nursing unit following a
pyelolithotomy for removal of a kidney stone. A Penrose
drain is in place. Which of the following would the nurse
include on the client’s postoperative care?
1. Sterile irrigation of the Penrose drain
2. Frequent dressing changes around the Penrose drain
3. Weighing the dressings
4. Maintaining the client’s position on the affected side
24. The nurse is caring for a client following a kidney
transplant. The client develops oliguria. Which of the
following would the nurse anticipate to be prescribed as the
treatment of oliguria?
1. Encourage fluid intake
2. Administration of diuretics
3. Irrigation of foley catheter
4. Restricting fluids
25. A week after kidney transplantation the client develops
a temperature of 101, the blood pressure is elevated, and
the kidney is tender. The x-ray results the transplanted
kidney is enlarged. Based on these assessment findings, the
nurse would suspect which of the following?
1. Acute rejection
2. Chronic rejection
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3. Kidney infection
4. Kidney obstruction
26. The client with BPH undergoes a transurethral resection
of the prostate. Postoperatively, the client is receiving
continuous bladder irrigations. The nurse assesses the client
for signs of transurethral resection syndrome. Which of the
following assessment data would indicate the onset of this
syndrome?
1. Bradycardia and confusion
2. Tachycardia and diarrhea
3. Decreased urinary output and bladder spasms
4. Increased urinary output and anemia
27. The client is admitted to the hospital with BPH, and a
transurethral resection of the prostate is performed. Four
hours after surgery the nurse takes the client’s VS and
empties the urinary drainage bag. Which of the following
assessment findings would indicate the need to notify the
physician?
1. Red bloody urine
2. Urinary output of 200 ml greater than intake
3. Blood pressure of 100/50 and pulse 130.
4. Pain related to bladder spasms.
28. Which of the following symptoms is the most common
clinical finding associated with bladder cancer?
1. Suprapubic pain
2. Dysuria
3. Painless hematuria
4. Urinary retention
29. A client who has been diagnosed with bladder cancer is
scheduled for an ileal conduit. Preoperatively, the nurse
reinforces the client’s understanding of the surgical
procedure by explaining that an ileal conduit:
1. Is a temporary procedure that can be reversed later.
2. Diverts urine into the sigmoid colon, where it is expelled
through the rectum.
3. Conveys urine from the ureters to a stoma opening in the
abdomen.
4. Creates an opening in the bladder that allows urine to
drain into an external pouch.
30. After surgery for an ileal conduit, the nurse should
closely evaluate the client for the occurrence of which of the
following complications related to pelvic surgery?
1. Peritonitis
2. Thrombophlebitis
3. Ascites
4. Inguinal hernia
31. The nurse is assessing the urine of a client who has had
an ileal conduit and notes that the urine is yellow with a
moderate amount of mucus. Based on the assessment data,
which of the following nursing interventions would be most
appropriate at this time?
1. Change the appliance bag
2. Notify the physician
3. Obtain a urine specimen for culture
4. Encourage a high fluid intake
32. When teaching the client to care for an ileal conduit, the
nurse instructs the client to empty the appliance frequently,
primarily to prevent which of the following problems?
1. Rupture of the ileal conduit
2. Interruption of urine production
3. Development of odor
4. Separation of the appliance from the skin
33. The client with an ileal conduit will be using a reusable
appliance at home. The nurse should teach the client to
clean the appliance routinely with what product?
1. Baking soda
2. Soap
3. Hydrogen peroxide
4. Alcohol
34. The nurse is evaluating the discharge teaching for a
client who has an ileal conduit. Which of the following
statements indicates that the client has correctly
understood the teaching? Select all that apply.
1. “If I limit my fluid intake I will not have to empty my
ostomy pouch as often.”
2. “I can place an aspirin tablet in my pouch to decrease
odor.”
3. “I can usually keep my ostomy pouch on for 3 to 7 days
before changing it.”
4. “I must use a skin barrier to protect my skin from urine.”
5. “I should empty my ostomy pouch of urine when it is full.”
35. A female client with a urinary diversion tells the nurse,
“This urinary pouch is embarrassing. Everyone will know
that I’m not normal. I don’t see how I can go out in public
anymore.” The most appropriate nursing diagnosis for this
patient is:
1. Anxiety related to the presence of urinary diversion.
2. Deficient Knowledge about how to care for the urinary
diversion.
3. Low Self-Esteem related to feelings of worthlessness
4. Disturbed Body Image related to creation of a urinary
diversion.
36. The nurse teaches the client with a urinary diversion to
attach the appliance to a standard urine collection bag at
night. The most important reason for doing this is to
prevent:
1. Urine reflux into the stoma
2. Appliance separation
3. Urine leakage
4. The need to restrict fluids
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37. The nurse teaches the client with an ileal conduit
measures to prevent a UTI. Which of the following measures
would be most effective?
1. Avoid people with respiratory tract infections
2. Maintain a daily fluid intake of 2,000 to 3,000 ml
3. Use sterile technique to change the appliance
4. Irrigate the stoma daily.
38. A client who has been diagnosed with calculi reports
that the pain is intermittent and less colicky. Which of the
following nursing actions is most important at this time?
1. Report hematuria to the physician
2. Strain the urine carefully
3. Administer meperidine (Demerol) every 3 hours
4. Apply warm compresses to the flank area
39. A client has a ureteral catheter in place after renal
surgery. A priority nursing action for care of the ureteral
catheter would be to:
1. Irrigate the catheter with 30 ml of normal saline every 8
hours
2. Ensure that the catheter is draining freely
3. Clamp the catheter every 2 hours for 30 minutes.
4. Ensure that the catheter drains at least 30 ml an hour
40. Which of the following interventions would be most
appropriate for preventing the development of a paralytic
ileus in a client who has undergone renal surgery?
1. Encourage the client to ambulate every 2 to 4 hours
2. Offer 3 to 4 ounces of a carbonated beverage periodically.
3. Encourage use of a stool softener
4. Continue intravenous fluid therapy
41. The nurse is conducting a postoperative assessment of a
client on the first day after renal surgery. Which of the
following findings would be most important for the nurse to
report to the physician?
1. Temperature, 99.8
2. Urine output, 20 ml/hour
3. Absence of bowel sounds
4. A 2×2 inch area of serous sanguineous drainage on the
flank dressing.
42. Because a client’s renal stone was found to be composed
to uric acid, a low-purine, alkaline-ash diet was ordered.
Incorporation of which of the following food items into the
home diet would indicate that the client understands the
necessary diet modifications?
1. Milk, apples, tomatoes, and corn
2. Eggs, spinach, dried peas, and gravy.
3. Salmon, chicken, caviar, and asparagus
4. Grapes, corn, cereals, and liver.
43. Allopurinol (Zyloprim), 200 mg/day, is prescribed for the
client with renal calculi to take home. The nurse should
teach the client about which of the following side effects of
this medication?
1. Retinopathy
2. Maculopapular rash
3. Nasal congestion
4. Dizziness
44. The client has a clinic appointment scheduled 10 days
after discharge. Which laboratory finding at that time would
indicate that allopurinol (Zyloprim) has had a therapeutic
effect?
1. Decreased urinary alkaline phosphatase level
2. Increased urinary calcium excretion
3. Increased serum calcium level
4. Decreased serum uric acid level
45. When developing a plan of care for the client with stress
incontinence, the nurse should take into consideration that
stress incontinence is best defined as the involuntary loss of
urine associated with:
1. A strong urge to urinate
2. Overdistention of the bladder
3. Activities that increase abdominal pressure
4. Obstruction of the urethra
46. Which of the following assessment data would most
likely be related to a client’s current complaint of stress
incontinence?
1. The client’s intake of 2 to 3 L of fluid per day.
2. The client’s history of three full-term pregnancies
3. The client’s age of 45 years
4. The client’s history of competitive swimming
47. The nurse is developing a teaching plan for a client with
stress incontinence. Which of the following instructions
should be included?
1. Avoid activities that are stressful and upsetting
2. Avoid caffeine and alcohol
3. Do not wear a girdle
4. Limit physical exertion
48. A client has urge incontinence. Which of the following
signs and symptoms would the nurse expect to find in this
client?
1. Inability to empty the bladder
2. Loss of urine when coughing
3. Involuntary urination with minimal warning
4. Frequent dribbling of urine
49. A 72-year old male client is brought to the emergency
room by his son. The client is extremely uncomfortable and
has been unable to void for the past 12 hours. He has known
for some time that he has an enlarged prostate but has
wanted to avoid surgery. The best method for the nurse to
use when assessing for bladder distention in a male client is
to check for:
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 GLOBAL NEPHRO TRAINING CENTER REVIEWER
1. A rounded swelling above the pubis.
2. Dullness in the lower left quadrant
3. Rebound tenderness below the symphysis
4. Urine discharge from the urethral meatus
50. During a client’s urinary bladder catheterization, the
bladder is emptied gradually. The best rationale for the
nurse’s action is that completely emptying an overdistended
bladder at one time tends to cause:
1. Renal failure
2. Abdominal cramping
3. Possible shock
4. Atrophy of bladder musculature
51. The primary reason for taping an indwelling catheter
laterally to the thigh of a male client is to:
1. Eliminate pressure at the penoscrotal angle
2. Prevent the catheter from kinking in the urethra
3. Prevent accidental catheter removal
4. Allow the client to turn without kinking the catheter
52. The primary function of the prostate gland is:
1. To store underdeveloped sperm before ejaculation
2. To regulate the acidity and alkalinity of the environment
for proper sperm development.
3. To produce a secretion that aids in the nourishment and
passage of sperm
4. To secrete a hormone that stimulates the production and
maturation of sperm
53. The nurse is reviewing a medication history of a client
with BPH. Which medication should be recognized as likely
to aggravate BPH?
1. Metformin (Glucophage)
2. Buspirone (BuSpar)
3. Inhaled ipratropium (Atrovent)
4. Ophthalmic timolol (Timoptic)
54. A client is scheduled to undergo a transurethral
resection of the prostate gland (TURP). The procedure is to
be done under spinal anesthesia. Postoperatively, the nurse
should be particularly alert for early signs of:
1. Convulsions
2. Cardiac arrest
3. Renal shutdown
4. Respiratory paralysis
55. A client with BPH is being treated with terazosin
(Hytrin) 2 mg at bedtime. The nurse should monitor
the client’s:
1. Urinary nitrites
2. White blood cell count
3. Blood pressure
4. Pulse
56. A client underwent a TURP, and a large three way
catheter was inserted in the bladder with continuous
bladder irrigation. In which of the following circumstances
would the nurse increase the flow rate of the continuous
bladder irrigation?
1. When the drainage is continuous but slow
2. When the drainage appears cloudy and dark yellow
3. When the drainage becomes bright red
4. When there is no drainage of urine and irrigating solution
57. A priority nursing diagnosis for the client who is being
discharged t home 3 days after a TURP would be:
1. Deficient fluid volume
2. Imbalanced Nutrition: Less than Body Requirements
3. Impaired Tissue Integrity
4. Ineffective Airway Clearance
58. If a client’s prostate enlargement is caused by a
malignancy, which of the following blood examinations
should the nurse anticipate to assess whether metastasis
has occurred?
1. Serum creatinine level
2. Serum acid phosphatase level
3. Total nonprotein nitrogen level
4. Endogenous creatinine clearance time
59. Steroids, if used following kidney transplantation would
cause which of the following side effects?
1. Alopecia
2. Increase Cholesterol Level
3. Orthostatic Hypotension
4. Increase Blood Glucose Level
60. Mr. Roberto was readmitted to the hospital with acute
graft rejection. Which of the following assessment finding
would be expected?
1. Hypotension
2. Normal Body Temperature
3. Decreased WBC
4. Elevated BUN and Creatinine
WILSON BAUTISTA 13