POST TEST: NEPHROLOGY, FLUID AND ELECTROLYRTES

PRE-TEST 9. Which intervention do you plan to include with a patient who

has renal calculi?
1. A 26-year-old female client seeks care for a possible A. Maintain bed rest
infection. Her symptoms include burning on urination and B. Increase dietary purines
frequent, urgent voiding of small amounts of urine. She’s C. Restrict fluids
placed on trimethoprim-sulfamethoxazole (Bactrim) to treat D. Strain all urine
possible infection. Another medication is prescribed to
decrease the pain and frequency. Which of the following is the 10. An 18 y.o. student is admitted with dark urine, fever, and
most likely medication prescribed? flank pain and is diagnosed with acute glomerulonephritis.
A. nitrofurantoin (Macrodantin) Which would most likely be in this student’s health history?
B. ibuprofen (Motrin) A. Renal calculi
C. acetaminophen with codeine B. Renal trauma
D. phenazopyridine (Pyridium) C. Recent sore throat
D. Family history of acute glomerulonephritis
2. A triple-lumen indwelling urinary catheter is inserted for
continuous bladder irrigation following a transurethral resection 11. Clinical manifestations of acute glomerulonephritis include
of the prostate. In addition to balloon inflation, the nurse is which of the following?
aware that the functions of the three lumens include: A. Chills and flank pain
A. Continuous inflow and outflow of irrigation solution. B. Polyuria and generalized edema
B. Intermittent inflow and continuous outflow of irrigation C. Hematuria and proteinuria
solution. D. Dysuria and hypotension
C. Continuous inflow and intermittent outflow of irrigation
solution. 12. A patient diagnosed with sepsis from a UTI is being
D. Intermittent flow of irrigation solution and prevention of discharged. What do you plan to include in her discharge
hemorrhage. teaching?
A. Take cool baths
3. Nurse Harry is aware that the following is an appropriate B. Avoid tampon use
nursing diagnosis for a client with renal calculi? C. Avoid sexual activity
A. Ineffective tissue perfusion D. Drink 3-4L of water daily
B. Functional urinary incontinence
C. Risk for infection 13. You’re planning your medication teaching for your patient
D. Decreased cardiac output with a UTI prescribed phenazopyridine (Pyridium). What do you
include?
4. After undergoing transurethral resection of the prostate to A. “Your urine might turn bright orange.”
treat benign prostatic hyperplasia, a male client returns to the B. “You need to take this antibiotic for 7 days.”
room with continuous bladder irrigation. On the first day after C. “Take this drug between meals and at bedtime.”
surgery, the client reports bladder pain. What should Nurse D. “Don’t take this drug if you’re allergic to penicillin.”
Anthony do first?
A. Increase the I.V. flow rate. 14. Which finding leads you to suspect acute
B. Notify the physician immediately. glomerulonephritis in your 32 y.o. patient?0/1
C. Assess the irrigation catheter for patency and drainage. A. Dysuria, frequency, and urgency
D. Administer meperidine (Demerol), 50 mg I.M., as prescribed. B. Back pain, nausea, and vomiting
C. Hypertension, edema, and proteinuria
5. The client underwent a transurethral resection of the D. Fever, chills, and right upper quadrant pain radiating to the
prostate gland 24 hours ago and is on continuous bladder back
irrigation. Nurse Yonny is aware that the following nursing
intervention is appropriate? 15. You have a paraplegic patient with renal calculi. Which
A. Tell the client to try to urinate around the catheter to factor contributes to the development of calculi?
remove blood clots. A. Increased calcium loss from the bones
B. Restrict fluids to prevent the client’s bladder from B. Decreased kidney function
becoming distended. C. Decreased calcium intake
C. Prepare to remove the catheter. D. High fluid intake
D. Use aseptic technique when irrigating the catheter.
PRE-TEST: RENAL
6. A female client with a urinary tract infection is prescribed co-
trimoxazole (trimethoprim-sulfamethoxazole). Nurse Dolly 1. Romina is a 50-year-old client with chronic kidney disease.
should provide which medication instruction? While reviewing her labs, you noted that the potassium level is
A. “Take the medication with food.” 5.7 mEq/L (5.7 mmol/L). Which patterns would the nurse watch
B. “Drink at least eight 8-oz glasses of fluid daily.” for on the cardiac monitor as a result of the laboratory value?
C. “Avoid taking antacids during co-trimoxazole therapy.” A. ST elevation
D. “Don’t be afraid to go out in the sun.” B. Prominent U wave
C. Prolonged ST segment
7. A male client is admitted for treatment of glomerulonephritis. D. Widened QRS complexes
On initial assessment, Nurse Miley detects one of the classic
signs of acute glomerulonephritis of sudden onset. Such signs 2. Marina has a sodium level of 130 mEq/L (130 mmol/L).
include: Which of the following is related to this condition?
A. generalized edema, especially of the face and A. The client who is taking diuretics
periorbital area. B. The client with hyperaldosteronism
B. green-tinged urine. C. The client with Cushing's syndrome
C. moderate to severe hypotension. D. The client who is taking corticosteroids
D. polyuria.
3. Junior’s serum phosphorus (phosphate) level is 1.8 mg/dL
8. You have a patient that might have a urinary tract infection (0.58 mmol/L). Which condition most likely caused this serum
(UTI). Which statement by the patient suggests that a UTI is phosphorus level?
likely? A. Malnutrition
A. “I pee a lot.” B. Renal insufficiency
B. “It burns when I pee.” C. Hypoparathyroidism
C. “I go hours without the urge to pee.” D. Tumor lysis syndrome
D. “My pee smells sweet.”
4. Nurse Ian is currently reading progress notes in the client's D. Rebound tenderness in left lower quadrant- on the flank or
record and reads that the night shift nurse has documented back
"insensible fluid loss of about 600 mL daily." This occurs in
which type of excretion? 3. A nurse evaluates that a client, diagnosed with obstructing
A. Urinary output left ureterolithiasis, may have passed the calculi in the urine
B. Wound drainage when which outcome has been achieved?
C. Integumentary output A. Voiding clear amber urine greater than 30 mL per hour-
D. The gastrointestinal tract possible if in the bladder but stone is in the ureter
B. No hematemesis or urinary tract infection (UTI)
5. Nurse Christian is preparing to care Alex who had just C. Absence of epigastric pain, nausea, and vomiting
undergone a renal scan. Which of the following would the D. Absence of colicky pain in the left lateral flank and groin
nurse include in the plan of care?
A. Place the client on radiation precautions for 18 hours. 4. Which of the following intravenous solutions would be
B. Save all urine in a radiation safe container for 18 hours. appropriate for a patient with severe hyponatremia secondary
C. Limit contact with the client to 20 minutes per hour. to syndrome of inappropriate antidiuretic hormone (SIADH)?
D. No special precautions except to wear gloves if in A. hypotonic solution
contact with the client’s urine. B. hypertonic solution
C. isotonic solution
PRE-TEST: FABS D. normotonic solution

1. Alan Peter has a history of heart failure and is due for a 5. A nurse is completing an admission assessment for a client
morning dose of furosemide. Which serum potassium level, if suspected of having an obstructing struvite calculus (caused
noted in the client's laboratory report, should be reported by UTI) of the right ureter. During the assessment, which is the
before administering the dose of furosemide? best question for the nurse to ask the client?
A. 3.2 mEq/L (3.2 mmol/L) A. “Are you experiencing any left flank pain?”
B. 3.8 mEq/L (3.8 mmol/L) B. “Do you like to drink cranberry, prune, or tomato juice?”
C. 4.2 mEq/L (4.2 mmol/L) C. “Have you had a history of chronic urinary tract
D. 4.8 mEq/L (4.8 mmol/L) infections (UTIs)?”
D. “How often do you eat organ meats, poultry, fish, and
2. You are currently reviewing the chart of Bong Garcia, a sardines?
client with multiple comorbidities. Several laboratory tests are
prescribed. Which laboratory test results should the nurse NOT 6. A nurse reviews the laboratory report of a client with acute
report? renal failure (ARF) and notes that the serum potassium level is
A. Platelets 35,000 mm3 (35 × 109/L) 6.8 mEq/L. Which medication should the nurse plan to
B. Sodium 150 mEq/L (150 mmol/L) administer specifically to protect the heart from the high
C. Potassium 5.0 mEq/L (5.0 mmol/L) potassium levels?
D. Segmented neutrophils 40% (0.40) A. Erythropoietin
E. White blood cells, 3000 mm3 (3.0 × 109/L) B. Regular insulin
C. 50% dextrose
3. Haley had just broken up with her boyfriend. She spent most D. Calcium gluconate- decrease K+
of the day crying and crying when suddenly she felt
lightheaded and sought consult at the ER. You review the 7. A client with chronic renal failure receives a hemodialysis
arterial blood gas results of a client and notes the following: pH treatment. The client’s weight before dialysis was 83 kilograms
7.45, Paco2 of 30 mm Hg (30 mmol/L), and HCO3– of 20 and after dialysis 80 kilograms. A nurse estimates that the
mEq/L (20 mmol/L). amount of fluid that the client lost was:
A. Metabolic acidosis, compensated A. 1 liter
B. Respiratory alkalosis, compensated B. 2 liters
C. Metabolic alkalosis, uncompensated C. 3 liters- 1L/ 1 kg
D. Respiratory acidosis, uncompensated D. 4 liters

4. Nurse Lia is caring for a client with a nasogastric tube that is 8. A nurse evaluates that a client is in the recovery phase of
attached to low suction. The nurse monitors the client for acute renal failure (ARF). Achievement of which outcomes
manifestations of which disorder that the client is at risk for? supports the nurse’s conclusion?
A. Metabolic acidosis A. urine specific gravity – 1.00
B. Metabolic alkalosis B. serum creatinine – 2 mg/dl (0.6-1.2)
C. Respiratory acidosis C. serum potassium level – 4 mmol/L
D. Respiratory alkalosis D. BUN – 30 mg/dl (10-20)

5. Jona is currently having an anxiety attack. Recent arterial 9. After a diagnosis of chronic renal failure, a client was started
blood gas values are pH = 7.53, Pao2 = 72 mm (72 mmol/L), on epoetin alfa. Which finding should a nurse expect when
and HCO3− = 28 mEq/L (28 mmol/L). Which conclusion about evaluating the desired therapeutic effectiveness of the
the client should the nurse make? medication?
A. The client has acidotic blood. A. Decrease in serum creatinine levels
B. The client is probably overreacting. B. Increase in white blood cells
C. The client is fluid volume overloaded. C. Increase in serum hematocrit- RBC= HCT
D. The client is probably hyperventilating. D. Decrease in blood pressure

10. Which nursing assessment is most accurate in determining

the patency of a client’s newly placed left forearm internal
1. After completing a health history for a female client arteriovenous (AV) fistula for hemodialysis?
experiencing recurrent urinary tract infections (UTI), a nurse A. Feeling for a bruit on the left forearm- bruit is auscultated
determines that the client should be taught to reduce her risk B. Palpating for a thrill over the fistula
for a UTI by: C. Aspirating blood from the fistula every 8 hours
A. eliminating caffeine and tea from her diet. D. Checking the client’s distal pulses and circulation
B. taking tub baths rather than showers.
C. wearing good quality synthetic underwear. - should be 11. A nurse is initiating peritoneal dialysis for a client with renal
cotton failure. During the infusion of the dialysate, the client reports
D. abstaining from sexual intercourse abdominal pain. Which intervention by the nurse is most
appropriate?
2. A client is admitted to a hospital with a diagnosis of acute A. Stopping the dialysis
pyelonephritis. Which symptom occurs most frequently and B. Slowing the infusion
should be monitored by the nurse? C. Asking if the client is constipated
A. Low-grade fever D. Explaining that the pain will subside after a few
B. Bradycardia exchanges- continue
C. Flank pain on the affected side- upper UTI
12. A nurse is concerned that a client receiving peritoneal 21. A nurse is caring for a client diagnosed with end stage
dialysis may be experiencing peritonitis. Which finding noted renal disease (ESRD). The client is 6 feet tall and weighs 180
on the nurse’s assessment supported this concern? pounds. The client’s total serum protein is 5.8 g/dL (N- 6-8). An
A. Abdominal numbness- should be diffused abd pain assessment by the nurse reveals 2+ pitting edema. The nurse
B. Cloudy dialysis output- (+) infection determines that this client’s edema is most likely the result of:
C. Radiating sternal pain A. increased capillary hydrostatic pressure. - caused by ↑
D. Decreased white blood cells- should be increased fluids
B. decreased plasma oncotic pressure. - d/t decrease in
13. A 3-year-old client presents with vomiting and diarrhea for albumin
24 hours. On routine urinalysis, which finding should indicate to C. increased capillary permeability.
a nurse that the child is dehydrated? D. decreased serum electrolytes.
A. Specific gravity 1.000.
B. Specific gravity 1.010. 22. A client has a nursing diagnosis of fluid volume deficit.
C. Specific gravity 1.020. Which vital sign, if decreased, supports this nursing diagnosis?
D. Specific gravity 1.030.- increased, FVD, body is trying to A. Temperature
conserve water B. Respiratory rate- compensation
C. Heart rate- compensation
14. A parent of a 4-year-old with acute poststreptococcal D. Blood pressure- hypotension is the primary VS
glomerulonephritis is concerned about care of the child after
discharge. A nurse should educate the parent on which 23. A client is admitted to an emergency department with
important concepts? reports of feeling weak and having “passed out.” The outside
A. Increasing protein diet. - decreased temperature is 41.3°C, and the client has been gardening.
B. Weighing the child daily to determine fluid retention or Physical assessment findings reveal poor skin turgor, dry and
loss dull mucous membranes, heart rate (HR) 120 beats per minute,
C. Returning to pre-illness activities as soon as possible- and blood pressure 92/54 mm Hg. Which nursing diagnosis
should be on bed rest should the nurse include in the client’s plan of care?
D. Administering antihypertensive medication because the A. Impaired oral mucous membrane
blood pressure is 100/60 mm Hg- only given if (+) HTN B. Fluid volume excess
C. Decreased cardiac output
15. A client presents to an emergency department with D. Fluid volume deficit- problem is DHN
periorbital edema, anorexia, and the passage of dark colored
urine (possible AGN or nephrotic syndrome). The most 24. A nurse establishes a nursing diagnosis of Risk for excess
significant history reported by the parent related to the possible fluid volume for a client diagnosed with heart failure. Which
etiology is: physiological change resulting from heart failure supports this
A. a sore throat 10 days before onset of these symptoms. diagnosis?
B. a fall off a bicycle the night before. A. Increased glomerular filtration rate (GFR)
C. eating fast food for dinner. B. Increased antidiuretic hormone (ADH) production- ↑
D. international travel to Europe 1 month ago. fluids in the body
C. Increased sodium excretion
16. A nurse is reviewing the laboratory report of a pediatric D. Increased cardiac output
client suspected of having chronic glomerulonephritis. Along
with proteinuria, which laboratory findings should the nurse 25. Which electrolyte imbalance should be the priority concern
expect? for a nurse when assessing a 10-year-old client diagnosed with
A. Elevated blood urea nitrogen and creatinine acute renal failure?
B. Decreased BUN, creatinine, and albumin- albumin should A. Hypercalcemia- hypocalcemia
be decreased B. Hyperphosphatemia
C. Elevated BUN and creatinine and albumin C. Hyperkalemia- can cause cardiac arrhythmias
D. Decreased BUN and elevated creatinine D. Hypernatremia

17. A nurse is caring for a 17-year-old client with renal 26. A client is hypotensive. A nurse closely monitors the
insufficiency from impaired blood flow to the kidneys sustained client’s electrolytes because the nurse knows that renin is
during a motor vehicle accident. Which assessment finding released in response to decreased blood flow to the kidneys.
related to renal insufficiency should be reported immediately to Which electrolytes are dependent on the renin angiotensin–
physician? aldosterone system and should be closely monitored by the
A. Oliguria nurse?
B. Dysuria A. Sodium and potassium
C. Frequency B. Sodium, chloride, and calcium
D. Urgency C. Calcium, phosphate, and magnesium
D. Magnesium, potassium, and sodium
18. For which associated complications should a nurse plan to
monitor the pediatric client with chronic kidney disease? 27. Which assessment findings for a client who is status post-
A. Hypercalcemia- ↓ calciferol, ↓ Ca+ thyroidectomy should direct a nurse to check the client’s
B. Metabolic alkalosis- acidosis serum calcium level?
C. Bone disease- d/t hypocalcemia A. Fatigue, decreased cardiac function, and tetany
D. Polycythemia- ↓ EPO B. Weakness, tachycardia, and disorientation
19. A client with chronic kidney disease has elevations in C. Muscle cramps, paresthesia, and Trousseau’s sign-
serum blood urea nitrogen (BUN) and creatinine. A nurse hypocalcemia, hyperactive muscles
interprets this to mean that the child has a reduction in: D. Weakness, edema, and orthostatic hypotension
A. serum erythropoietin. - anemia
B. growth hormone. 28. Which assessment findings should prompt a nurse to
C. glomerular filtration rate. - ↓ excretion conclude that interventions have been ineffective for a 90-year-
D. blood flow to the kidneys. - kidney injury old client with hypernatremia?
A. Lethargy and paresthesia
20. A nurse caring for a client with nephrotic syndrome should B. Muscle cramps and spasms
anticipate administering: C. Restlessness and thirst- cell shrinking will alter LOC and
A. IV fluids- already have edema activate thirst mechanism
B. ibuprofen- steroids are given D. Hot flushed skin
C. Potassium chloride
D. captopril- HTN 29. Which clinical manifestation would lead the nurse to
suspect that a client is experiencing hypermagnesemia
(excessive vasodilation)?
A. Muscle pain and acute rhabdomyolysis- does not present
in any imbalance
B. Hot, flushed skin and hypotension
C. Soft-tissue calcification and hyperreflexia
D. Increased respiratory rate and depth

30. The patient is diagnosed with hypomagnesemia

(hyperactive muscles), which nursing intervention would be
appropriate?
A. Instituting seizure precaution to prevent injury
B. Instructing the client on the importance of preventing
infection
C. Avoiding the use of tight tourniquet when drawing blood
D. Teaching the client the importance of early ambulation