Acute and Chronic Renal Failure Practice Questions
20 free Acute and Chronic Renal Failure practice questions for the NCLEX Exam. Tap an option to answer — you get instant feedback, the correct answer, and a detailed explanation for every question.
What intervention should the nurse expect to perform first for a client with acute renal failure and serum potassium of 6.8 mEq/L?
- A Administer sodium polystyrene sulfonate
- B Restrict dietary potassium
- C Administer IV calcium gluconate
- D Prepare for dialysis tomorrow
Correct answer: Administer IV calcium gluconate
IV calcium gluconate stabilizes the cardiac membrane to prevent life-threatening arrhythmias from hyperkalemia, making it the priority before other interventions.
In chronic kidney disease (CKD), which laboratory value improves when a patient is prescribed erythropoietin?
- A Serum creatinine
- B Hemoglobin
- C Calcium
- D Potassium
Correct answer: Hemoglobin
Erythropoietin stimulates red blood cell production, improving hemoglobin and hematocrit levels in CKD-related anemia.
What clinical finding is most characteristic of acute tubular necrosis (ATN)?
- A Polyuria with dilute urine
- B Oliguria with muddy brown casts
- C High specific gravity with proteinuria
- D Hematuria without casts
Correct answer: Oliguria with muddy brown casts
ATN presents with oliguria and urine containing muddy brown granular casts due to tubular cell injury.
Which condition is a common cause of prerenal acute kidney injury (AKI)?
- A Kidney stones
- B Hypovolemia
- C Acute glomerulonephritis
- D Bladder outlet obstruction
Correct answer: Hypovolemia
Prerenal AKI results from decreased renal perfusion, most commonly due to hypovolemia or hypotension.
What dietary instruction should be given to a client with chronic renal failure?
- A Increase protein intake
- B Restrict phosphorus and potassium
- C Increase dairy products for calcium
- D Increase sodium for hydration
Correct answer: Restrict phosphorus and potassium
Phosphorus and potassium accumulate in CKD; their restriction helps prevent hyperphosphatemia and hyperkalemia.
During the oliguric phase of acute renal failure, what complication should the nurse closely monitor for?
- A Hypokalemia
- B Hyponatremia
- C Metabolic alkalosis
- D Hypovolemia
Correct answer: Hyponatremia
Sodium becomes diluted due to fluid retention, leading to hyponatremia and potential neurological symptoms.
A client with end-stage renal disease (ESRD) reports muscle cramps during hemodialysis. What is the likely cause?
- A Hypocalcemia
- B Hypotension and fluid shifts
- C Hypernatremia
- D Elevated urea
Correct answer: Hypotension and fluid shifts
Rapid fluid and electrolyte shifts during dialysis can lead to hypotension and muscle cramps.
Which lab result indicates the most significant improvement in kidney function in a patient with AKI?
- A Increased urine output
- B Decreased serum creatinine
- C Decreased urine specific gravity
- D Elevated BUN
Correct answer: Decreased serum creatinine
Serum creatinine is a reliable indicator of renal function; its decline suggests recovery.
What order should the nurse question for a patient in end-stage renal disease?
- A Erythropoietin injection
- B High-protein diet
- C Phosphate binders
- D Fluid restriction
Correct answer: High-protein diet
Protein breakdown produces nitrogenous wastes that kidneys cannot excrete; thus, high-protein diets are avoided.
A client in acute renal failure is placed on a fluid restriction of 600 mL/day. What is the best nursing rationale for this order?
- A To reduce cardiac workload
- B To prevent pulmonary edema
- C To decrease urine output
- D To stimulate diuresis
Correct answer: To prevent pulmonary edema
Fluid overload in renal failure can cause pulmonary edema; restricting fluids helps prevent respiratory compromise.
Which statement by a patient with chronic kidney disease indicates a need for further teaching?
- A “I should take my phosphate binder with meals.”
- B “I should weigh myself daily.”
- C “I can use salt substitutes instead of table salt.”
- D “I should limit dairy products.”
Correct answer: “I can use salt substitutes instead of table salt.”
Salt substitutes often contain potassium, which can lead to hyperkalemia in CKD.
A patient with chronic renal failure has an elevated parathyroid hormone (PTH) level primarily due to which factor?
- A Hyperkalemia from impaired potassium excretion
- B Hypocalcemia from phosphate retention
- C Increased intestinal calcium absorption
- D Dehydration from excessive fluid loss
Correct answer: Hypocalcemia from phosphate retention
Phosphate retention binds calcium, causing hypocalcemia and secondary hyperparathyroidism.
What should the nurse's first action be upon noting a patient’s urine output of 100 mL in 8 hours?
- A Increase IV fluids
- B Notify the physician
- C Check for bladder distention
- D Document and continue monitoring
Correct answer: Check for bladder distention
Oliguria may result from urinary retention; assessment for bladder distention is a critical first step.
What is the main goal in managing acute glomerulonephritis?
- A Encourage high fluid intake
- B Reduce renal inflammation
- C Administer nephrotoxic antibiotics
- D Increase dietary potassium
Correct answer: Reduce renal inflammation
Glomerulonephritis involves immune-mediated inflammation; treatment focuses on reducing inflammation and preventing complications.
Which symptom suggests uremic encephalopathy in chronic renal failure?
- A Jaundice and pruritus
- B Tremors and confusion
- C Chest pain and palpitations
- D Muscle weakness and cramping
Correct answer: Tremors and confusion
Accumulation of uremic toxins can affect the central nervous system, causing confusion, tremors, and decreased alertness.
In advanced renal failure, which acid-base imbalance is anticipated?
- A Respiratory acidosis
- B Metabolic acidosis
- C Metabolic alkalosis
- D Respiratory alkalosis
Correct answer: Metabolic acidosis
Impaired renal excretion of hydrogen ions and bicarbonate loss cause metabolic acidosis.
What electrocardiogram (ECG) finding is expected in chronic renal failure due to electrolyte imbalance?
- A U waves
- B Peaked T waves
- C Prolonged QT interval
- D Flattened P waves
Correct answer: Peaked T waves
Hyperkalemia causes peaked T waves due to delayed ventricular repolarization.
Which intervention best helps prevent infection in a patient with a peritoneal dialysis catheter?
- A Flushing the catheter daily with heparin
- B Applying antibiotic ointment to the exit site
- C Maintaining sterile technique during exchanges
- D Irrigating the catheter with saline routinely
Correct answer: Maintaining sterile technique during exchanges
Strict sterile technique during exchanges is crucial to prevent peritonitis.
How does the nurse evaluate the effectiveness of furosemide for a client with acute renal failure?
- A Weight gain
- B Increased urine output
- C Elevated potassium level
- D Decreased blood pressure
Correct answer: Increased urine output
Furosemide is a loop diuretic; increased urine output indicates effective diuresis.
In a patient with end-stage renal disease (ESRD) prescribed aluminum hydroxide, what is the purpose of this drug?
- A Decrease potassium levels
- B Bind phosphate in the intestine
- C Stimulate red blood cell production
- D Increase calcium absorption
Correct answer: Bind phosphate in the intestine
Aluminum hydroxide binds dietary phosphate, reducing absorption and helping control hyperphosphatemia.