1. A client with glomerulonephritis is at risk of developing acute renal failure.

The nurse monitors the client

for which sign of this complication?
a) bradycardia
b) hypertension
c) decreased cardiac output
d) decreased central venous pressure
2. A nurse provides home care instructions to a client hospitalized for a transurethral resection of the
prostate (TURP). Which statement by the client indicates a need for further instructions?
a) I need to avoid strenuous activity for 4 to 6 weeks
b) I need to maintain a daily intake of 6 to 8 glasses of water daily
c) I need to avoid lifting items greater than 30 pounds
d) I need to include prune juice in my diet
3. A nurse is caring for a client who has just returned to the nursing unit after an intravenous pyelogram
(IVP). The nurse determines that which of the following is important in the postprocedure care of this
client?
a) encouraging increased intake of oral fluids
b) ambulating the client in the hallway
c) encouraging the client to try to avoid frequently
d) maintaining the client on bedrest
4. A nurse has collected nutritional data from a client with a diagnosis of cystitis. The nurse determines
that which beverage needs to be eliminated from the client's diet to minimize the recurrence of cystitis?
a) fruit juice
b) tea
c) water
d) lemonade
5. A client with pyelonephritis is being discharged from the hospital, and the nurse provides instructions to
the client to prevent recurrence. The nurse determines that the cleint understands the information that
was given if hte client states an intention to:
a) increase fluids for 2 days if signs and symptoms of a urinary tract infection develop
b) take the prescribed antibiotics until all symptoms subside
c) return to the physician's office for scheduled follow-up urine cultures
d) decrease fluid intake if frequent urination occurs
6. A nurse is giving a client with polycystic kidney disease instructions in replacing elements lost in the
urine as a result of impaired kidney function. The nurse instructs the client to increase intake of which of
the following in the client?
a) sodium and potassium
b) sodium and water
c) water and phosphorus
d) calcium and phosphorus
7. A nurse has provided instructions to a female client with cystitis about measures to prevent recurrence.
The nurse determines that the client needs further instruction if the client verbalizes to:
a) take bubble baths for more effective hygiene
b) wear underwater made of cotton or with cotton panels
c) drink a glass of water and void after intercourse
d) avoid wearing pantyhose while wearing socks
8. A nurse has provided instructions to a client with a nephrotostomy tube regarding home care after
hospital discharge. The nurse determines that the client understands the instructions if the client
verbalizes to drink approximately how many 8-ounce glasses of water per day?

a) 2
b) 8
c) 16
d) 20
9. A client with nephrolithiasis arrives at a clinic for a follow-up visit. The laboratory analysis of the stone
that the client passed 1 week ago indicates that the stone is composed of calcium oxalate. The nurse tells
the client to avoid consuming which food item?
a) lentils
b) strawberries
c) lettuce
d) pasta
10. A client diagnosed with cancer of the bladder has a nursing diagnosis of fear related to the uncertain
outcome of upcoming cystectomy and urinary diversion. The nurse determines that this diagnosis is
appropriate if the client makes which statement?
a) I'm so afraid I won't live through all this
b) what if I have no help at home after going through this awful surgery
c) I'll never feel like myself once I can't go to the bathroom normally
d) I wish I'd never gone to the doctor at all
11. A nurse is developing a plan of care for a client with nephrotic syndrome. The nurse documents that
which important parameter needs to be assessed on a daily basis?
a) total protein levels
b) weight
c) blood urea nitrogen (BUN)
d) activity tolerance
12. A client with renal malignancy is admitted to the hospital for a diagnostic workup and probable surgery.
During the admission assessment the nurse inquires about the presence of which common symptom
related to this problem?
a) flank pain and intermittent hematuria
b) suprapubic pain and constant slight hematuria
c) flank pain and foul-smelling urine
d) abdominal pain and decreased urine output
13. A client has undergone urinary diversion after cystectomy for bladder cancer. The nurse assesses the
urostomy stoma to ensure that it is:
a) pale and pink
b) pink and dry
c) red and moist
d) dusky to beefy colored
14. A nurse is caring for a client receiving hemodialysis who has an internal arteriovenous (AV) fistula.
Which assessment finding would indicate to the nurse that the fistula is patent?
a) white fibrin specks noted in the fistula
b) palpation of a thrill over the site of the fistula
c) lack of bruit over the site of the fistula
d) a feeling of warmth at the site of the fistula
15. A nurse is caring for a client following a cystoscopy. Which assessment finding requires physician
notification?
a) bladder spasm
b) complaints of fullness and burning in the bladder
c) clots in the urine
d) back pain

16. A client with chronic renal failure is on a fluid restriction and receives aluminum hydroxide gel
(ALternaGEL) as a phosphate binder. The nurse determines that the client is at risk for which problem
(nursing diagnosis) because of these treatment measures?
a) fatigue
b) deficient fluid volume
c) constipation
d) ineffective coping
17. A client with chronic renal failure has undergone insertion of an indwelling catheter in the abdomen for
peritoneal dialysis. The nurse teaches the client to do which of the following if the peritoneal catheter
dressing gets wet?
a) flush the peritoneal dialysis catheter
b) scrub the catheter with povidone-iodine
c) reinforce the dressing
d) change the dressing
18. A client with chronic renal failure has a new medication order for epoetin alfa (Epogen). The nurse
plans to give this medication in which of the following ways?
a) with a full glass of water
b) diluted in juice to enhance taste
c) subcutaneously
d) with an antacid
19. A nurse is giving suggestions to a client with chronic renal failure about ways to reduce pruritus from
uremia. The nurse tells the client to avoid which type of skin care product?
a) lanolin-based lotion
b) bath oil
c) mild soap
d) astringent cleansing pads
20. A nurse is working with a client newly diagnosed with chronic renal failure to set up schedule for
hemodialysis. The client states, "This is so unfair I wouldn't have to do this for the rest of my life if you
people had caught this disease in time!" The nurse interprets that the client is exhibiting:
a) anger
b) projection
c) withdrawal
d) depression
21. A nurse is analyzing the laboratory results of a client with chronic renal failure who is receiving epoetin
alfa (Epogen). The nurse interprets that the medication is having the expected effect if the results indicate
an increase in which of the following levels?
a) red blood cells
b) potassium
c) creatinine
d) phosphorus
22. a nurse has formulated a nursing diagnosis of Risk for Infection for a hemodialysis client with an
arteriovenous (AV) fistula in the right arm. The nurse determines that the client has best met the outcome
criteria for this nursing diagnosis if which of the following observations is made?
a) the client states her or she should do careful handwashing once a day
b) the client states her or she should avoid blood pressure measurement in the right arm
c) the client's temperature does not exceed 100.6F
d) the client's white blood cell (WBC) count is 7500/mm3

23. A nurse is developing a teaching plan for a client with chronic renal failure who has been started on
hemodialysis. The nurse would plan to include which of the following pieces of information in discussions
with the client?
a) it's unnecessary to stay within the fluid restriction on the day before hemodialysis
b) it's all right to eat unlimited protein on the day before hemodialysis
c) daily medications should be taken after hemodialysis, not before
d) daily medications should be double-dosed if going for hemodialysis that day
24. A nurse is explaining the concept of fluid restriction to a client with chronic renal failure who has
started hemodialysis. The nurse tells the client that the fluid restriction is planned by adding the amount of
the daily urine output (if any) and:
a) 1800 to 2000 ml
b) 1200 to 1500 ml
c) 500 to 700 ml
d) 200 to 300 ml
25. A nurse is caring for a client newly diagnosed with chronic renal failure who has recently begun
hemodialysis. The nurse determines that the client has not tolerated the procedure optimally if the client
experiences which symptoms that represent disequilibrium syndrome?
a) restlessness, irritability, and generalized weakness
b) headache, deteriorating level of consciousness, and seizures
c) hypertension, tachycardia, and fever
d) hypotension, bradycardia, and hypothermia
26. A client with chronic renal failure has been on dialysis for 4 years and has been taking aluminum
hydroxide (Amphojel tablets) as prescribed as part of the medication regimen. The client develops
confusion and dementia, and complains of bone pain. The nurse interprets that this client is at risk for
developing:
a) advancing uremia
b) folic acid defieciency
c) phosphate overdose
d) aluminum intoxication
27. A client is undergoing hemodialysis and receives heparin during the dialysis procedure. The nurse
monitors the results of which of the following laboratory tests during the dialysis procedure?
a) thrombin time
b) bleeding time
c) partial thromboplastin time (PTT)
d) prothrombin time (PT)
28. A client undergoing hemodialysis becomes hypotensive. The nurse immediately prepares to take which
action?
a) administer 1000 ml 5% dextrose in water
b) administer a 250 ml normal saline bolus
c) increase the blood flow into the dialyzer
d) lower the client's legs and feet
29. A client with chronic renal failure has completed a hemodialysis treatment. The nurse measures which
parameters at the completion of the hemodialysis procedure to monitor for hemodynamic stability and to
determine effectiveness of fluid extraction?

a) vital signs and blood urea nitrogen (BUN)

b) vital signs and weight
c) sodium and potassium levels
d) BUN and creatinine levels
30. A hemodialysis client has a newly created left arm fistula. The nurse monitors the affected extremity
for which signs and symptoms that indicate a complication related to steal syndrome?
a) edema and purplish discoloration
b) aching pain, pallor, and edema
c) warmth, redness, and pain
d) pallor, diminished pulse. and pain

31. A nurse is caring for a client receiving peritoneal dialysis and notes a brownish tinge to the dialysate
output. The nurse interprets that this finding could be a result of:
a) early infection
b) insufficient fluid instillation
c) bladder perforation
d) bowel perforation
32. While reading the product literature regarding ofloxacin (Floxin), the nurse notes that
the medication could cause crystalluria. The nurse decides to tell the client taking the medication to do
which of the following to decrease the likelihood of this adverse effect?
a) avoid beverages that contain salts, such as mineral water
b) avoid carbonated soft-drink beverages
c) drink at least 1500 to 2000 ml of fluid per day
d) drink at least three glasses of milk per day
33. A nurse is caring for a client who has begun using peritoneal dialysis. The nurse determines that
which manifestation indicates the onset of peritonitis?
a) oral temperature of 100F
b) history of gastrointestinal (GI) upset 1 week ago
c) clear dialysate output
d) presence of crystals in dialysate output
34. A nurse is working on a renal unit in a local hospital. The nurse interprets that which client with renal
failure is best suited for peritoneal dialysis as a treatment option?
a) a client with severe congestive heart failure
b) a client with a history of ruptured diverticuli
c) a client with a history of herniated lumbar disk
d) a client with a history of three previous abdominal surgeries
35. A client undergoing long-term peritoneal dialysis is experiencing a problem with reduced outflow from
the dialysis catheter. The nurse assessing the client would inquire whether the client has had a recent
problem with:
a) vomiting
b) diarrhea
c) constipation
d) flatulence

36. A nurse is reviewing the health care record of a client with a diagnosis of benign prostatic hyperplasia.
The nurse that which sign exhibited by the client occurs late in the disorder?
a) nocturia
b) decreased force of urine stream
c) difficulty initiating urine stream
d) hematuria
37. A nurse is caring for a client at risk for acute renal tubular necrosis following a crush injury to the leg.
The nurse implements which measure to minimize this particular risk for the client?
a) use of sheepskin and bed cradle
b) frequent position changes in bed
c) administration of antibiotics in a timely fashion
d) careful monitoring of intravenous fluids to ensure sufficient intake
38. A clinic nurse is reviewing the laboratory results of an adult client seen in the health care clinic.
The nurse determines that the blood urea nitrogen (BUN) level is normal if which of the following is noted
on the laboratory results?
a) 35 mg/dL
b) 29 mg/dL
c) 15 mg/dL
d) 3 mg/dL
39. A nurse is caring for a client who is receiving immunosuppressant therapy including corticosteroids
following a renal transplant. The nurse would plan to carefully monitor which laboratory result for this
client?
a) serum albumin
b) blood glucose
c) magnesium
d) potassium
40. A client who has been diagnosed with chronic renal failure has been told that hemodialysis will be
required. The client becomes angry and withdrawn, and states, "I'll never be the same now."
The nurse formulates which of the following nursing diagnoses for this client?
a) disturbed thought processes
b) disturbed body image
c) anxiety
d) noncompliance
41. A nurse is caring for a client who has been diagnosed as having a kidney mass. The client asks the
nurse the reason for renal biopsy when other tests such as computed tomography (CT) scan and
ultrasound are available. In formulating a response, the nurse incorporates the knowledge that renal
biopsy :
a) helps differentiate between a solid mass and a fluid-filled cyst
b) provides an outline of the renal vascular system
c) gives specific cytological information about the lesion
d) determines if the mass is growing rapidly or slowly
42. A nurse is providing discharge instructions to a client after a hydrocelectomy. Which statement by
the client would indicate a need for further instructions?
a) I should apply ice packs to the scrotum

b) I should keep the scrotum elevated until the swelling has gone away
c) the sutures will be removed by the doctor in a few days
d) I need to avoid sexual intercourse at this time
43. A client hospitalized with urolithiasis has a sudden significant decrease in urine output. The nurse
would immediately:
a) call the physician
b) replace the foley catheter with a new one
c) tell the client to drink increased fluids
d) obtain a urine specific gravity
44. A nurse is caring for a client undergoing peritoneal dialysis. The nurse checks the client and notes that
the drainage from the outflow catheter is cloudy. The nurse should take which action?
a) stop the peritoneal dialysis
b) obtain a culture and sensitivity of the drainage
c) institute hemodialysis temporarily
d) add antibiotics to the next several dialysis bags
45. A nurse is urging a client to cough and deep breathe after nephrectomy. The client tells the nurse,
"That's easy for you to say! You don't have to do this." The nurse interprets that the client's statement is
likely a result of:
a) a stress response to the ordeal of surgery
b) a latent fear of needing dialysis if the surgery is unsuccessful
c) effects of circulating metabolites that have not been excreted by the remaining kidney
d) pain that is intensified because the location of the incision is near the diaphragm
46. A nurse is admitting a client with chronic renal failure to the nursing unit. The nurse anticipates that
the client will exhibit which frequent cardiovascular sign associated with chronic renal failure?
a) pulse 110 beats per minute
b) pulse 56 beats per minute
c) blood pressure 168/94 mm Hg
d) blood pressure 96/64 mm Hg
47. A nurse is preparing to teach a client who is newly diagnosed with chronic renal failure about the
disease and its management. The client has a diminished ability to learn because of uremia and anxiety.
The nurse makes it a priority to include which of the following when conducting teaching sessions with this
client?
a) family members
b) charts and diagrams
c) research articles
d) lengthy printed materials
48. A client who is newly diagnosed with chronic renal failure is scheduled for hemodialysis this morning
and asks he nurse why the daily dose of enalapril (Vasotec) has not been given. The nurse tells the client
that this medication will be given:
a) just before going to hemodialysis
b) during the hemodialysis
c) when dialysis is completed
d) at bedtime
49. A nurse is teaching a client with chronic renal failure about fluid restriction. The nurse tells the client

which of the following dessert items from the dietary menu represents the best choice?
a) ice cream
b) sherbet
c) angel food cake
d) jell-O
50. A client who is newly diagnosed with chronic renal failure is scheduled to begin hemodialysis. The
nurse interprets which of the following neurological or psychological findings exhibited by the client to be
atypical?
a) euphoria
b) labile emotions
c) withdrawal
d) depression