NCLEX RENAL & RESPIRATORY SYSTEM
COMPREHENSIVE PRACTICE EXAM – QUESTIONS &
ANSWERS
Question: A 58-year-old man new to hemodialysis is monitored for disequilibrium
syndrome. Which symptoms should the nurse prioritize?
Answer: Headache, confusion, and muscle twitching.
Rationale: Rapid solute removal during dialysis causes osmotic changes in brain cells,
leading to cerebral edema.
Question: What clinical manifestations are typical for a patient presenting with acute
pyelonephritis?
Answer: Tenderness at the costovertebral angle (CVA) and sudden bouts of shivering
(chills).
Rationale: CVA tenderness indicates kidney inflammation, while chills suggest a systemic
bacterial response.
Question: What instruction is essential for a patient prescribed Phenazopyridine (Pyridium)
for cystitis?
Answer: Cease intake once painful urination subsides.
Rationale: This medication is a local analgesic only; it does not treat the underlying
infection.
,Question: A patient with chronic renal failure (CRF) is at an increased risk for which
condition?
Answer: Retention of water and sodium due to a significant decrease in GFR.
Rationale: As the glomerular filtration rate drops, the kidneys lose the ability to excrete
excess fluid and electrolytes.
Question: Which laboratory finding indicates a significant complication during peritoneal
dialysis?
Answer: White blood cell (WBC) count of 22,000/mm³.
Rationale: High WBC counts in the dialysate or blood suggest peritonitis, a common and
serious infection.
Question: Which nursing intervention is most crucial during the oliguric phase of acute
renal failure (ARF)?
Answer: Limiting fluid intake.
Rationale: Restricted output means any excess intake can lead to heart failure and
pulmonary edema.
Question: Which standard indicators should be prioritized immediately after a
hemodialysis session?
, Answer: Vital signs and weight.
Rationale: Weight is the best indicator of fluid removal, and vital signs assess for
hemodynamic stability.
Question: How does a nurse assess for "Steal Syndrome" in a patient with an AV fistula?
Answer: Monitor for pallor, diminished pulse, and pain in the hand distal to the fistula.
Rationale: This occurs when the fistula diverts too much blood from the hand, causing
tissue ischemia.
Question: What is a common finding in the early stage of chronic renal failure?
Answer: Increased urination (polyuria).
Rationale: Initially, the kidneys lose the ability to concentrate urine, leading to high-volume
output of dilute urine.
Question: What is a priority intervention for a patient with confirmed urinary calculi?
Answer: Strain all urine and send any collected stones to the lab.
Rationale: Analyzing stone composition is vital for determining the cause and planning
future prevention.
COMPREHENSIVE PRACTICE EXAM – QUESTIONS &
ANSWERS
Question: A 58-year-old man new to hemodialysis is monitored for disequilibrium
syndrome. Which symptoms should the nurse prioritize?
Answer: Headache, confusion, and muscle twitching.
Rationale: Rapid solute removal during dialysis causes osmotic changes in brain cells,
leading to cerebral edema.
Question: What clinical manifestations are typical for a patient presenting with acute
pyelonephritis?
Answer: Tenderness at the costovertebral angle (CVA) and sudden bouts of shivering
(chills).
Rationale: CVA tenderness indicates kidney inflammation, while chills suggest a systemic
bacterial response.
Question: What instruction is essential for a patient prescribed Phenazopyridine (Pyridium)
for cystitis?
Answer: Cease intake once painful urination subsides.
Rationale: This medication is a local analgesic only; it does not treat the underlying
infection.
,Question: A patient with chronic renal failure (CRF) is at an increased risk for which
condition?
Answer: Retention of water and sodium due to a significant decrease in GFR.
Rationale: As the glomerular filtration rate drops, the kidneys lose the ability to excrete
excess fluid and electrolytes.
Question: Which laboratory finding indicates a significant complication during peritoneal
dialysis?
Answer: White blood cell (WBC) count of 22,000/mm³.
Rationale: High WBC counts in the dialysate or blood suggest peritonitis, a common and
serious infection.
Question: Which nursing intervention is most crucial during the oliguric phase of acute
renal failure (ARF)?
Answer: Limiting fluid intake.
Rationale: Restricted output means any excess intake can lead to heart failure and
pulmonary edema.
Question: Which standard indicators should be prioritized immediately after a
hemodialysis session?
, Answer: Vital signs and weight.
Rationale: Weight is the best indicator of fluid removal, and vital signs assess for
hemodynamic stability.
Question: How does a nurse assess for "Steal Syndrome" in a patient with an AV fistula?
Answer: Monitor for pallor, diminished pulse, and pain in the hand distal to the fistula.
Rationale: This occurs when the fistula diverts too much blood from the hand, causing
tissue ischemia.
Question: What is a common finding in the early stage of chronic renal failure?
Answer: Increased urination (polyuria).
Rationale: Initially, the kidneys lose the ability to concentrate urine, leading to high-volume
output of dilute urine.
Question: What is a priority intervention for a patient with confirmed urinary calculi?
Answer: Strain all urine and send any collected stones to the lab.
Rationale: Analyzing stone composition is vital for determining the cause and planning
future prevention.
