1
NCLEX RN Exam Bank: Renal and Urinary
Complications, Uremia, Dialysis & Post Transplant
Care
Table of Contents
Subtopic 1: Pathophysiology and Clinical Presentation of Uremia ..................................... 2
Subtopic 2: Hemodialysis—Indications, Access & Complications .................................. 10
Subtopic 3: Peritoneal Dialysis—Technique, Risks & Patient Education ........................... 18
Subtopic 4: Electrolyte Imbalances and Renal Failure Management ............................... 27
Subtopic 5: Hemodialysis Procedure, Complications, Monitoring, and Patient Safety
(Questions 81–100) ..................................................................................................... 36
Subtopic 6: Hemodialysis Vascular Access, Complications & Infection Prevention .......... 44
Subtopic 7: Nutritional and Fluid Management in Renal Patients .................................... 52
, 2
Subtopic 1: Pathophysiology and Clinical Presentation of
Uremia
Question 1:
A patient with end-stage renal disease presents with confusion, metallic taste in mouth,
and pericardial friction rub. These symptoms are most likely associated with:
A. Hyperthyroidism
B. Uremia
C. Hypoglycemia
D. Hyperaldosteronism
Correct answer: B. Uremia
Rationale: Uremia results from the accumulation of nitrogenous waste products and is
characterized by neurologic symptoms, taste alterations, and pericarditis.
Question 2:
Which of the following laboratory findings is most indicative of uremia?
A. Hematocrit 45%
B. Blood urea nitrogen (BUN) 85 mg/dL
C. Potassium 4.5 mEq/L
D. Sodium 140 mEq/L
Correct answer: B. Blood urea nitrogen (BUN) 85 mg/dL
Rationale: A markedly elevated BUN reflects accumulation of uremic toxins due to renal
failure.
Question 3:
, 3
Uremic frost is best described as:
A. Hemorrhagic rash on the trunk
B. Scaly plaques on the extensor surfaces
C. Crystalline white deposits on the skin
D. Petechiae and bruising on limbs
Correct answer: C. Crystalline white deposits on the skin
Rationale: Uremic frost results from excretion of urea through the skin and is a hallmark of
advanced uremia.
Question 4:
What is the primary cause of anemia in uremic patients?
A. Vitamin B12 deficiency
B. Decreased erythropoietin production
C. Hemolysis from dialysis
D. Iron overload
Correct answer: B. Decreased erythropoietin production
Rationale: The kidneys produce erythropoietin, and its deficiency in chronic kidney disease
leads to normocytic anemia.
Question 5:
Which acid–base imbalance is most commonly seen in uremia?
A. Respiratory alkalosis
B. Metabolic alkalosis
C. Metabolic acidosis
D. Respiratory acidosis
, 4
Correct answer: C. Metabolic acidosis
Rationale: Uremic patients often have metabolic acidosis due to impaired excretion of
hydrogen ions and reabsorption of bicarbonate.
Question 6:
The uremic patient’s breath often has a distinctive odor referred to as:
A. Diabetic breath
B. Halitosis
C. Ammonia or urine-like odor
D. Sour citrus smell
Correct answer: C. Ammonia or urine-like odor
Rationale: Uremic fetor is a characteristic ammonia-like smell caused by the breakdown of
urea in saliva.
Question 7:
Uremia affects which of the following organ systems?
A. Only the kidneys
B. Cardiovascular and respiratory only
C. Multiple systems including CNS, GI, skin, and hematologic
D. Only the gastrointestinal tract
Correct answer: C. Multiple systems including CNS, GI, skin, and hematologic
Rationale: Uremia has systemic effects, leading to cognitive changes, GI disturbances, skin
changes, and anemia.
NCLEX RN Exam Bank: Renal and Urinary
Complications, Uremia, Dialysis & Post Transplant
Care
Table of Contents
Subtopic 1: Pathophysiology and Clinical Presentation of Uremia ..................................... 2
Subtopic 2: Hemodialysis—Indications, Access & Complications .................................. 10
Subtopic 3: Peritoneal Dialysis—Technique, Risks & Patient Education ........................... 18
Subtopic 4: Electrolyte Imbalances and Renal Failure Management ............................... 27
Subtopic 5: Hemodialysis Procedure, Complications, Monitoring, and Patient Safety
(Questions 81–100) ..................................................................................................... 36
Subtopic 6: Hemodialysis Vascular Access, Complications & Infection Prevention .......... 44
Subtopic 7: Nutritional and Fluid Management in Renal Patients .................................... 52
, 2
Subtopic 1: Pathophysiology and Clinical Presentation of
Uremia
Question 1:
A patient with end-stage renal disease presents with confusion, metallic taste in mouth,
and pericardial friction rub. These symptoms are most likely associated with:
A. Hyperthyroidism
B. Uremia
C. Hypoglycemia
D. Hyperaldosteronism
Correct answer: B. Uremia
Rationale: Uremia results from the accumulation of nitrogenous waste products and is
characterized by neurologic symptoms, taste alterations, and pericarditis.
Question 2:
Which of the following laboratory findings is most indicative of uremia?
A. Hematocrit 45%
B. Blood urea nitrogen (BUN) 85 mg/dL
C. Potassium 4.5 mEq/L
D. Sodium 140 mEq/L
Correct answer: B. Blood urea nitrogen (BUN) 85 mg/dL
Rationale: A markedly elevated BUN reflects accumulation of uremic toxins due to renal
failure.
Question 3:
, 3
Uremic frost is best described as:
A. Hemorrhagic rash on the trunk
B. Scaly plaques on the extensor surfaces
C. Crystalline white deposits on the skin
D. Petechiae and bruising on limbs
Correct answer: C. Crystalline white deposits on the skin
Rationale: Uremic frost results from excretion of urea through the skin and is a hallmark of
advanced uremia.
Question 4:
What is the primary cause of anemia in uremic patients?
A. Vitamin B12 deficiency
B. Decreased erythropoietin production
C. Hemolysis from dialysis
D. Iron overload
Correct answer: B. Decreased erythropoietin production
Rationale: The kidneys produce erythropoietin, and its deficiency in chronic kidney disease
leads to normocytic anemia.
Question 5:
Which acid–base imbalance is most commonly seen in uremia?
A. Respiratory alkalosis
B. Metabolic alkalosis
C. Metabolic acidosis
D. Respiratory acidosis
, 4
Correct answer: C. Metabolic acidosis
Rationale: Uremic patients often have metabolic acidosis due to impaired excretion of
hydrogen ions and reabsorption of bicarbonate.
Question 6:
The uremic patient’s breath often has a distinctive odor referred to as:
A. Diabetic breath
B. Halitosis
C. Ammonia or urine-like odor
D. Sour citrus smell
Correct answer: C. Ammonia or urine-like odor
Rationale: Uremic fetor is a characteristic ammonia-like smell caused by the breakdown of
urea in saliva.
Question 7:
Uremia affects which of the following organ systems?
A. Only the kidneys
B. Cardiovascular and respiratory only
C. Multiple systems including CNS, GI, skin, and hematologic
D. Only the gastrointestinal tract
Correct answer: C. Multiple systems including CNS, GI, skin, and hematologic
Rationale: Uremia has systemic effects, leading to cognitive changes, GI disturbances, skin
changes, and anemia.
