NSG 4100 EXAM 1 (GALEN) NEWEST 2026 ACTUAL EXAM
TEST BANK| NSG4100 NURSING PRACTICE - ADULT
HEALTH
RENAL SYSTEM
Question 1
The nurse is caring for a client with end-stage renal disease (ESRD) who has developed uremia. Which of
the following are signs and symptoms of uremia? Select all that apply.
A. Muscle cramps
B. Pruritus
C. Metallic taste in the mouth
D. Hypotension
E. Pericardial friction rub
Answer: A, B, C, E
Rationale: Uremia, the buildup of nitrogenous waste products in the blood, affects multiple body
systems. Signs and symptoms include muscle cramps (A), pruritus (B), metallic taste (C), and pericarditis
(evidenced by a pericardial friction rub) (E). Hypertension, not hypotension (D), is a common finding in
ESRD due to fluid overload and activation of the renin-angiotensin-aldosterone system (RAAS). Uremic
pericarditis is a serious complication that is treated with more aggressive hemodialysis.
Question 2
The nurse is caring for a client with ESRD who has just returned from hemodialysis. Which finding would
require immediate intervention?
A. Temperature of 99.4°F (37.4°C)
B. Hemoglobin level of 10.8 g/dL
C. Pulse rate of 130 bpm
D. Potassium has dropped from 6.1 to 5.1 mEq/L
Answer: C. Pulse rate of 130 bpm
Rationale: A pulse rate of 130 bpm (tachycardia) after dialysis can be a sign of hypovolemic shock due to
rapid fluid removal, or it could indicate a complication like bleeding or cardiac stress. A mildly elevated
temperature (A) can be expected after dialysis. A hemoglobin of 10.8 g/dL (B) indicates chronic anemia
of ESRD and is not an emergency. A decrease in potassium from 6.1 to 5.1 mEq/L (D) is a therapeutic and
desired effect of dialysis, not a cause for concern.
,Question 3
The nurse is caring for a client with ESRD who has a potassium level of 6.1 mEq/L. What action should
the nurse take first?
A. Administer furosemide (Lasix) as prescribed.
B. Administer sodium polystyrene sulfonate (Kayexalate) as prescribed.
C. Notify the healthcare provider.
D. Review the client's current telemetry reading.
Answer: D. Review the client's current telemetry reading.
Rationale: Hyperkalemia (potassium >5.0 mEq/L) is a life-threatening emergency primarily due to its
effect on cardiac conduction. The first action is to assess for ECG changes, such as peaked T waves,
widened QRS complexes, or cardiac dysrhythmias, which signal an increased risk for cardiac arrest. After
assessment, the provider can be notified (C) and medications administered (A, B).
Question 4
The nurse is caring for a client with acute glomerulonephritis. The nurse should expect to address what
clinical manifestation that is characteristic of this health problem?
A. Hematuria
B. Glucosuria
C. Hypotension
D. Precipitous decrease in serum creatinine
Answer: A. Hematuria
Rationale: Acute glomerulonephritis is an inflammatory process affecting the glomeruli. The classic
manifestation is hematuria (blood in the urine), which may be microscopic or gross. The urine often
appears smoky or cola-colored. Hypertension, not hypotension (C), is common. Serum creatinine is
elevated, not decreased (D). Glucosuria (B) is associated with diabetes mellitus.
Question 5
The nurse is caring for an acutely ill client. What assessment finding should prompt the nurse to inform
the health care provider that the client may be exhibiting signs of acute kidney injury (AKI)?
A. The client reports left-sided flank pain.
B. The urine is cloudy and has visible sediment with a foul odor.
C. An inability to initiate voiding for 2 days.
D. Average urine output has been 10 mL/hr for several hours.
Answer: D. Average urine output has been 10 mL/hr for several hours.
Rationale: A hallmark sign of AKI is a significant decrease in urine output (oliguria), defined as less than
400 mL/day or less than 0.5 mL/kg/hr. An average output of 10 mL/hr is a critical finding that indicates
,kidney function is severely compromised. Flank pain (A) could indicate pyelonephritis or a kidney stone.
Cloudy, foul-smelling urine (B) suggests a UTI. Inability to void (C) indicates urinary retention, not AKI.
Question 6
The nurse is caring for a client receiving hemodialysis three times weekly. The client has had surgery to
form an arteriovenous fistula. What is most important for the nurse to be aware of when providing care
for this client?
A. The client feels best immediately after the dialysis treatment.
B. The client should not feel pain during initiation of dialysis.
C. Using a stethoscope for auscultating the fistula is contraindicated.
D. Taking a BP reading on the affected arm can damage the fistula.
Answer: D. Taking a BP reading on the affected arm can damage the fistula.
Rationale: An arteriovenous (AV) fistula is the client's lifeline for dialysis. The arm with the fistula must
be protected from any constriction or trauma that could compromise blood flow. Blood pressure
readings, venipunctures, and IV lines should never be placed in the access arm. Taking a blood pressure
can compress and damage the fistula, leading to thrombosis.
Question 7
The nurse is working on the renal transplant unit. To reduce the risk of infection in a client with a
transplanted kidney, it is imperative for the nurse to take what action?
A. Instruct the client to wear a face mask.
B. Bar visitors from the client's room.
C. Ensure immediate function of the donated kidney.
D. Wash hands carefully and frequently.
Answer: D. Wash hands carefully and frequently.
Rationale: Clients who have received a kidney transplant are on lifelong immunosuppressive therapy to
prevent organ rejection. This puts them at extremely high risk for infection. The single most important
intervention to prevent the spread of infection is meticulous hand hygiene.
Question 8
The nurse is assessing a client with chronic kidney disease. Which laboratory value would the nurse
expect to be elevated?
A. Hemoglobin
B. Serum calcium
C. Glomerular filtration rate (GFR)
D. Serum phosphorus
Answer: D. Serum phosphorus
, Rationale: In CKD, the kidneys lose the ability to excrete phosphorus, leading to hyperphosphatemia.
This, in turn, contributes to hypocalcemia (decreased serum calcium, B) and secondary
hyperparathyroidism. Hemoglobin (A) is typically low due to decreased erythropoietin production. GFR
(C) is the best indicator of kidney function and is decreased in CKD.
Question 9
A client with CKD has an elevated phosphorus level and has been prescribed calcium acetate. The nurse
should teach the client to take the prescribed medication at what time?
A. Daily at bedtime
B. First thing in the morning
C. With each meal
D. Only when needed
Answer: C. With each meal
Rationale: Calcium acetate is a phosphate binder. Its purpose is to bind with dietary phosphorus in the
gastrointestinal tract, preventing its absorption into the bloodstream. For it to be effective, it must be
taken with meals so it is present in the gut when food containing phosphorus is being digested.
Question 10
A client with ESRD asks why they must limit their protein intake. What is the nurse's best response?
A. "Limiting protein helps prevent fluid overload."
B. "A low-protein diet will help lower your blood pressure."
C. "The kidneys are unable to excrete the waste products of protein metabolism, like urea."
D. "Protein can cause your blood sugar to spike."
Answer: C. "The kidneys are unable to excrete the waste products of protein metabolism, like
urea."
Rationale: Protein metabolism produces nitrogenous waste products, primarily urea. In a healthy
individual, these are filtered by the kidneys and excreted in urine. In ESRD, the kidneys cannot perform
this function, and these waste products accumulate in the blood, causing uremia. Limiting protein intake
reduces the production of these wastes, helping to manage uremic symptoms.
GASTROINTESTINAL SYSTEM
Question 11
A nurse is creating a care plan for a client with acute pancreatitis and includes reduced activity. What is
the rationale for this intervention?
A. To prevent the development of deep vein thrombosis (DVT).
B. To decrease the metabolic rate and reduce pancreatic enzyme secretion.
TEST BANK| NSG4100 NURSING PRACTICE - ADULT
HEALTH
RENAL SYSTEM
Question 1
The nurse is caring for a client with end-stage renal disease (ESRD) who has developed uremia. Which of
the following are signs and symptoms of uremia? Select all that apply.
A. Muscle cramps
B. Pruritus
C. Metallic taste in the mouth
D. Hypotension
E. Pericardial friction rub
Answer: A, B, C, E
Rationale: Uremia, the buildup of nitrogenous waste products in the blood, affects multiple body
systems. Signs and symptoms include muscle cramps (A), pruritus (B), metallic taste (C), and pericarditis
(evidenced by a pericardial friction rub) (E). Hypertension, not hypotension (D), is a common finding in
ESRD due to fluid overload and activation of the renin-angiotensin-aldosterone system (RAAS). Uremic
pericarditis is a serious complication that is treated with more aggressive hemodialysis.
Question 2
The nurse is caring for a client with ESRD who has just returned from hemodialysis. Which finding would
require immediate intervention?
A. Temperature of 99.4°F (37.4°C)
B. Hemoglobin level of 10.8 g/dL
C. Pulse rate of 130 bpm
D. Potassium has dropped from 6.1 to 5.1 mEq/L
Answer: C. Pulse rate of 130 bpm
Rationale: A pulse rate of 130 bpm (tachycardia) after dialysis can be a sign of hypovolemic shock due to
rapid fluid removal, or it could indicate a complication like bleeding or cardiac stress. A mildly elevated
temperature (A) can be expected after dialysis. A hemoglobin of 10.8 g/dL (B) indicates chronic anemia
of ESRD and is not an emergency. A decrease in potassium from 6.1 to 5.1 mEq/L (D) is a therapeutic and
desired effect of dialysis, not a cause for concern.
,Question 3
The nurse is caring for a client with ESRD who has a potassium level of 6.1 mEq/L. What action should
the nurse take first?
A. Administer furosemide (Lasix) as prescribed.
B. Administer sodium polystyrene sulfonate (Kayexalate) as prescribed.
C. Notify the healthcare provider.
D. Review the client's current telemetry reading.
Answer: D. Review the client's current telemetry reading.
Rationale: Hyperkalemia (potassium >5.0 mEq/L) is a life-threatening emergency primarily due to its
effect on cardiac conduction. The first action is to assess for ECG changes, such as peaked T waves,
widened QRS complexes, or cardiac dysrhythmias, which signal an increased risk for cardiac arrest. After
assessment, the provider can be notified (C) and medications administered (A, B).
Question 4
The nurse is caring for a client with acute glomerulonephritis. The nurse should expect to address what
clinical manifestation that is characteristic of this health problem?
A. Hematuria
B. Glucosuria
C. Hypotension
D. Precipitous decrease in serum creatinine
Answer: A. Hematuria
Rationale: Acute glomerulonephritis is an inflammatory process affecting the glomeruli. The classic
manifestation is hematuria (blood in the urine), which may be microscopic or gross. The urine often
appears smoky or cola-colored. Hypertension, not hypotension (C), is common. Serum creatinine is
elevated, not decreased (D). Glucosuria (B) is associated with diabetes mellitus.
Question 5
The nurse is caring for an acutely ill client. What assessment finding should prompt the nurse to inform
the health care provider that the client may be exhibiting signs of acute kidney injury (AKI)?
A. The client reports left-sided flank pain.
B. The urine is cloudy and has visible sediment with a foul odor.
C. An inability to initiate voiding for 2 days.
D. Average urine output has been 10 mL/hr for several hours.
Answer: D. Average urine output has been 10 mL/hr for several hours.
Rationale: A hallmark sign of AKI is a significant decrease in urine output (oliguria), defined as less than
400 mL/day or less than 0.5 mL/kg/hr. An average output of 10 mL/hr is a critical finding that indicates
,kidney function is severely compromised. Flank pain (A) could indicate pyelonephritis or a kidney stone.
Cloudy, foul-smelling urine (B) suggests a UTI. Inability to void (C) indicates urinary retention, not AKI.
Question 6
The nurse is caring for a client receiving hemodialysis three times weekly. The client has had surgery to
form an arteriovenous fistula. What is most important for the nurse to be aware of when providing care
for this client?
A. The client feels best immediately after the dialysis treatment.
B. The client should not feel pain during initiation of dialysis.
C. Using a stethoscope for auscultating the fistula is contraindicated.
D. Taking a BP reading on the affected arm can damage the fistula.
Answer: D. Taking a BP reading on the affected arm can damage the fistula.
Rationale: An arteriovenous (AV) fistula is the client's lifeline for dialysis. The arm with the fistula must
be protected from any constriction or trauma that could compromise blood flow. Blood pressure
readings, venipunctures, and IV lines should never be placed in the access arm. Taking a blood pressure
can compress and damage the fistula, leading to thrombosis.
Question 7
The nurse is working on the renal transplant unit. To reduce the risk of infection in a client with a
transplanted kidney, it is imperative for the nurse to take what action?
A. Instruct the client to wear a face mask.
B. Bar visitors from the client's room.
C. Ensure immediate function of the donated kidney.
D. Wash hands carefully and frequently.
Answer: D. Wash hands carefully and frequently.
Rationale: Clients who have received a kidney transplant are on lifelong immunosuppressive therapy to
prevent organ rejection. This puts them at extremely high risk for infection. The single most important
intervention to prevent the spread of infection is meticulous hand hygiene.
Question 8
The nurse is assessing a client with chronic kidney disease. Which laboratory value would the nurse
expect to be elevated?
A. Hemoglobin
B. Serum calcium
C. Glomerular filtration rate (GFR)
D. Serum phosphorus
Answer: D. Serum phosphorus
, Rationale: In CKD, the kidneys lose the ability to excrete phosphorus, leading to hyperphosphatemia.
This, in turn, contributes to hypocalcemia (decreased serum calcium, B) and secondary
hyperparathyroidism. Hemoglobin (A) is typically low due to decreased erythropoietin production. GFR
(C) is the best indicator of kidney function and is decreased in CKD.
Question 9
A client with CKD has an elevated phosphorus level and has been prescribed calcium acetate. The nurse
should teach the client to take the prescribed medication at what time?
A. Daily at bedtime
B. First thing in the morning
C. With each meal
D. Only when needed
Answer: C. With each meal
Rationale: Calcium acetate is a phosphate binder. Its purpose is to bind with dietary phosphorus in the
gastrointestinal tract, preventing its absorption into the bloodstream. For it to be effective, it must be
taken with meals so it is present in the gut when food containing phosphorus is being digested.
Question 10
A client with ESRD asks why they must limit their protein intake. What is the nurse's best response?
A. "Limiting protein helps prevent fluid overload."
B. "A low-protein diet will help lower your blood pressure."
C. "The kidneys are unable to excrete the waste products of protein metabolism, like urea."
D. "Protein can cause your blood sugar to spike."
Answer: C. "The kidneys are unable to excrete the waste products of protein metabolism, like
urea."
Rationale: Protein metabolism produces nitrogenous waste products, primarily urea. In a healthy
individual, these are filtered by the kidneys and excreted in urine. In ESRD, the kidneys cannot perform
this function, and these waste products accumulate in the blood, causing uremia. Limiting protein intake
reduces the production of these wastes, helping to manage uremic symptoms.
GASTROINTESTINAL SYSTEM
Question 11
A nurse is creating a care plan for a client with acute pancreatitis and includes reduced activity. What is
the rationale for this intervention?
A. To prevent the development of deep vein thrombosis (DVT).
B. To decrease the metabolic rate and reduce pancreatic enzyme secretion.
