M/S Renal NCLEX Questions-Renal Function By: Anne Marie Picon, Alison Kelly, an !

a"es #$Connell %& '(e renal syste" is res)onsi*le +or all o+ t(e +ollo,in- EXCEP': a& E.cretion o+ to.ins& *& /o"eostasis o+ so iu"& c& E.cretion o+ en )ro ucts o+ *o y "eta*olis"& & /o"eostasis o+ c(lori e& 0)otassiu"1 2& Nor"al seru" creatinine le3els are: a& 2&4-5&2 "-/ L a& 4&2-4&6 "-/ L *& 4&7-%&5 "-/ L c& %&6-2&4 "-/ L 5& A client ,it( acute renal +ailure (as a seru" )otassiu" le3el o+ 7&4 "E8/L& '(e nurse ,ill )lan ,(ic( o+ t(e +ollo,in- actions as a )riority action9 a& :i3e an 644 "L o+ +lui inta;e to ilute t(e electrolyte concentration& *& C(ec; so iu" le3els& a& Place t(e client on a car iac "onitor& 0<ncrease K causes ysr(yt("ias1 *& Encoura-e ecrease 3e-eta*les in iet =& '(e ;i neys are res)onsi*le +or controllin- t(e co")osition o+ t(e e.tracellular +lui & <n or er to o t(is t(e ;i ney ,ill res)on to all EXCEP': a& An-iotensin <<& *& Renin c& A>/ & *loo +lo,

6& Flo, o+ +lui t(rou-( t(e ;i neys +ollo,s a strict )at(& Place in or er t(e )at( o+ +lui to urine& a& Ascen in- loo) o+ /enle 021 *& >istal con3olute tu*ule& 051 c& Collectin- uct& 0=1 & :lo"erulus& 0%1 7& A )atient (as se3ere e e"a an is )rescri*e Lasi. 0+urose"i e1& Co""on si e e++ects o+ t(is "e ication inclu e: a& /i-( *loo )ressure *& Consti)ation c& >e(y ration & <ncrease le3els o+ so iu"& By& Alison Kelly %1 A )atient ,(o (as c(ronic renal +ailure is sc(e ule +or (e"o ialysis t(is "ornin- is ue to recei3e a aily ose o+ enala)ril 0?asotec1& @(en s(oul t(e nurse )lan to -i3e t(is "e ication9

A& >urin- >ialysis B& !ust *e+ore >ialysis C& '(e ay a+ter >ialysis >& @(en t(e )atient returns +ro" >ialysis

%& Reasonin-: Enala)ril is an anti(y)ertensi3e an t(ese are -i3en to )atients +ollo,in(e"o ialysis to )re3ent t(e )atient +ro" *eco"in- (y)otensi3e urin- ialysis an i+ it ,as -i3en urin- ialysis t(e "e icine coul li;ely *e re"o3e in t(e *loo strea" *y t(e ialysis&

21 A )atient is ta;in- cyclos)orine 0San i""une1& @(at si-ns or sy")to"s ,oul "a;e you *elie3e t(at t(e )atient is (a3in- an a 3erse reaction9

A& Nausea B& 're"ors C& Alo)ecta >& /y)otension

E& 2& Reasonin-: '(e "ost co""on a 3erse reactions o+ cyclos)orine are ne)(roto.icity, in+ection, (y)ertension an tre"ors& So o+ t(e o)tions liste tre"ors ,oul *e t(e correct ans,er&

51 Structural an +unctional c(an-es occur in t(e ;i neys as a result o+ t(e a-in- )rocess& @(ic( o+ t(e +ollo,in- is N#' one o+ t(e c(an-es t(at ;i neys un er-o9

A& >ecrease *la er ca)acity B& Nocturnal )olyuria occurs C& Ki ney enlar-e"ent >& >ecrease -lo"erular +iltration rate 5& Reasonin-: '(e Ki neys actually lose cortical tissue an *eco"e s"aller as you a-e& '(e loss o+ cortical is cause *y re uce renal *loo +lo,&

=1 <+ a )atient (as renal isor er ,(ic( o+ t(e +ollo,in- la* results ,oul "ost li;ely e.)ect to +in 9

A& A ecrease (e"o-lo*in B& An ele3ate Bun le3el C& A ecrease RBC count >& A ecrease @BC count

=& Reasonin-: Measurin- t(e BAN le3el is a co""only use test to eter"ine renal +unction an ,ill start to rise ,(en t(e -lo"erular +iltration rate +alls *elo, =4-74B in icatin- renal isor er&

61 A client ,(o is on (e"o yalis (as a le+t ar" +istula an is at ris; +or arterial steal syn ro"e& '(e nurse assess t(e )atient +or ,(ic( o+ t(e +ollo,in- sy")to"s9 A& @ar"t(, re ness an )ain in t(e le+t (an B& Pallor, i"inis(e )ulse, )ain in t(e le+t (an C& E e"a an a re is( iscoloration on t(e le+t ar" >& An ac(in- )ain, )allor, an e e"a o+ t(e le+t ar"

6& Reasonin-: Steal Syn ro"e results +ro" 3ascular insu++iciency a+ter a +istula (as +or"e an t(e clients *e-ins to e.(i*it )allor an a i"inis(e )ulse istal to t(e +istula& '(e )atient also co")lains o+ )ain istal to t(e +istula, ,ar"t( an re ness&

71 A )atient ne,ly ia-nose ,it( renal +ailure (as Cust starte )eritoneal ialysis& >urint(e in+usion t(e client co")lains o+ a* o"inal )ain& @(at is t(e a))ro)riate action *y t(e nurse9 A& Sto) t(e ialysis B& Slo, t(e in+usion rate C& >ecrease t(e a"ount to *e in+use >& E.)lain t(at t(e )ain ,ill su*si e a+ter t(e +irst +e, e.c(an-es

7& Reasonin-: Pain urin- t(e in+lo, )ortion o+ ialysis is co""on urin- t(e +irst +e, e.c(an-es *ecause o+ )eritoneal irritation an usually isa))ears a+ter %-2 ,ee;s o+ treat"ent so t(e in+usion s(oul *e continue as or ere &

D1 A ,ee; a+ter a ;i ney trans)lant a )atient e3elo)s a te")erature o+ %4%, t(e *loo )ressure is ele3ate , t(e ;i ney is ten er an an .-ray re3eals t(at t(e ;i ney is enlar-e & Base on t(ese +in in-s t(e nurse ,oul sus)ect9 A& Acute reCection B& Ki ney <n+ection C& C(ronic reCection >& Ki ney o*struction D& Reasonin-: Acute reCection usually occurs ,it(in t(e +irst 2 ,ee;s a+ter a trans)lant& Clinical "ani+estations inclu e +e3er, "alaise, ele3ate ,*c, acute (y)ertension, -ra+t ten erness& C(ronic reCection occurs o3er a )erio o+ "ont(s to years&

Renal )at(olo-y& !a"es #$Connell %& @(at is t(e "ost li;ely cause o+ t(e co"*ination o+ -eneraliEe e e"a, (y)oal*u"ine"ia, an "ar;e )roteinuria,9 a& Ne)(rotic syn ro"e *& Acute renal +ailure c& Renal tu*ular e+ect & Arinary tract in+ection& %& a& Ne)(rotic syn ro"e is c(aracteriEe *y "ar;e )roteinuria& Because o+ t(is )atients loose al*u"in ,(ic( lea s to )eri)(eral e e"a& 2& t(e co"*ination o+ se3ere acute +lan; )ain an "icrosco)ic /e"aturia is su--esti3e o+9 A& C(olelit(iasis C& Ki ney tu"or > Arinary *la er tu"or E& Arolit(iasis& 2& E& Arolit(iasis& '(e +or"ation o+ urinary stones relates to ecrease urine 3olu"e an increase urine concentrations o+ certain su*stances&

3. 4. A positive urinary culture with a high colony count is most frequently diagnostic of: A. Acute pyelonephritis

B. Chronic pyelonephritis C. Urinary tract infection D. Papillary necrosis

3.

Urinary tract infection

4. The most frequent urinary disease seen in any pediatric clinic is: A. Urinary tract infection B. Wilm's tumor C. Nephrolithiasis =& A& Arinary tract in+ection

5. You palpate a large left intra-abdominal mass in an infant. The most likely diagnosis is: A. Wilm's tumor B. Neuroblastoma C.Autosomal recessive polycystic kidney disease (ARPKD) 6& B& Neuro*lasto"a& Alt(ou-( rare tu"ors, neuro*lasto"as are "ore +re8uent t(an ne)(ro*lasto"as 0@il"Fs tu"ors1& ARPK> is *ilateral&

6. The treatment for simple renal cyst is: A. Surgery B. Aspiration C. No treatment 7& C& No treat"ent is necessary&