HESI Specialty Exam Prep: Renal Failure & Dialysis Nursing Care

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HESI Specialty Exam Prep:
Renal Failure & Dialysis
Nursing Care



Table of Contents
Subtopic 1: Pathophysiology and Types of Renal Insufficiency........................2
Subtopic 2: Hemodialysis – Principles and Nursing Management..................10
Subtopic 3: Peritoneal Dialysis – Technique, Risks, and Patient Education....19
Subtopic 4: Electrolyte & Fluid Imbalances in Renal Failure and Dialysis.......27
Subtopic 5: Anemia Management in Chronic Kidney Disease (CKD) and
Dialysis Clients...............................................................................................35
Subtopic 6: Medication Management in Renal Impairment and Dialysis........43
Subtopic 7: Medication Management and Pharmacologic Considerations in
Renal Patients................................................................................................52
Subtopic 8: Anemia and Hematologic Management in Dialysis Clients.........60
Subtopic 9: Transplant Candidacy, Rejection, and Post-Transplant Monitoring
(Questions 161–180)......................................................................................69
Subtopic 10: Legal, Ethical, and Cultural Considerations in Renal and Dialysis
Nursing..........................................................................................................77

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Subtopic 1: Pathophysiology and Types
of Renal Insufficiency
Question 1:

Which of the following best describes prerenal causes of acute kidney injury
(AKI)?

A. Obstruction of urinary outflow

B. Direct damage to kidney tissues

C. Decreased renal perfusion due to hypovolemia

D. Chronic damage from long-term hypertension



Correct Answer: C. Decreased renal perfusion due to hypovolemia

Rationale: Prerenal AKI is primarily due to decreased blood flow to the
kidneys, often caused by volume depletion, heart failure, or sepsis. It is a
functional issue, not structural damage.



Question 2:

Which laboratory value is the most sensitive early indicator of renal
insufficiency?

A. Serum potassium

B. Blood urea nitrogen (BUN)

C. Serum creatinine

D. Hematocrit



Correct Answer: C. Serum creatinine

Rationale: Serum creatinine rises when glomerular filtration rate (GFR)
declines, making it the most reliable indicator of kidney function in early
stages.

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Question 3:

What type of renal failure is most often caused by nephrotoxic medications
like aminoglycosides?

A. Prerenal

B. Intrarenal

C. Postrenal

D. Chronic



Correct Answer: B. Intrarenal

Rationale: Intrarenal failure involves direct damage to renal parenchyma,
often due to nephrotoxins like aminoglycoside antibiotics, contrast agents, or
rhabdomyolysis.



Question 4:

Which condition is most commonly associated with postrenal renal failure?

A. Glomerulonephritis

B. Ischemic acute tubular necrosis

C. Benign prostatic hyperplasia

D. Hypovolemic shock



Correct Answer: C. Benign prostatic hyperplasia

Rationale: Postrenal failure is caused by obstruction of urinary flow, often
from conditions like BPH, kidney stones, or tumors.



Question 5:

Which symptom is most indicative of uremia in renal insufficiency?

A. Tinnitus

B. Metallic taste in mouth

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C. Hypotension

D. Insomnia



Correct Answer: B. Metallic taste in mouth

Rationale: Uremia leads to accumulation of waste in the bloodstream,
causing symptoms like metallic taste, pruritus, and confusion.



Question 6:

Which of the following electrolyte imbalances is most commonly seen in
renal insufficiency?

A. Hypokalemia

B. Hyperkalemia

C. Hypocalcemia

D. Hypernatremia



Correct Answer: B. Hyperkalemia

Rationale: Kidneys regulate potassium; impaired function leads to its
accumulation, posing a risk for cardiac arrhythmias.



Question 7:

What is the most common cause of chronic kidney disease (CKD) in adults?

A. Lupus nephritis

B. Diabetes mellitus

C. Polycystic kidney disease

D. Obstructive uropathy



Correct Answer: B. Diabetes mellitus