NURS 8022 – Exam 2 (2025/2026) – with Complete Questions
and Answers
Fluid, Electrolyte & Renal (Questions 1-15)
1. A nurse is teaching about antidiuretic hormone (ADH). Which statement correctly describes ADH
release?
• A. ADH is released when serum osmolality decreases below 275 mOsm/kg
• B. ADH increases water excretion by the kidneys
• C. ADH is released in response to increased plasma osmolality or decreased blood volume
• D. ADH decreases the permeability of the collecting duct
• Correct Answer: C. ADH is released when osmolality increases (>295 mOsm/kg) or when
circulating blood volume decreases, promoting water reabsorption in the collecting ducts.
2. A client has a serum osmolality of 320 mOsm/kg. The nurse interprets this as:
• A. Normal finding
• B. Fluid overload
• C. Dehydration
• D. Hemodilution
• Correct Answer: C. Normal osmolality is ~275-295 mOsm/kg. Values >295 indicate dehydration
or hyperosmolality.
3. A client's mean arterial pressure (MAP) drops from 95 to 55 mm Hg. What happens to glomerular
filtration rate (GFR)?
• A. GFR increases due to afferent vasodilation
• B. GFR remains unchanged due to autoregulation
• C. GFR decreases due to reduced renal blood flow
• D. GFR stops completely
• Correct Answer: C. GFR is pressure-dependent. MAP <70 mm Hg reduces renal blood flow and
decreases GFR; autoregulation fails below 70-80 mm Hg.
4. A client has a blood pressure of 220/130 mm Hg. Which physiological response occurs in the
kidneys?
• A. Afferent arterioles constrict to protect glomeruli
, • B. Afferent arterioles dilate to increase filtration
• C. Efferent arterioles constrict to decrease GFR
• D. No change occurs in the renal vasculature
• Correct Answer: A. The myogenic mechanism causes afferent arteriolar constriction in response
to increased BP to prevent glomerular capillary damage.
5. A client with severe diarrhea for 4 days and inability to eat or drink develops acute kidney injury.
The nurse classifies this as:
• A. Intrarenal due to ischemia
• B. Prerenal due to dehydration
• C. Postrenal due to urinary obstruction
• D. Intrinsic renal due to nephrotoxins
• Correct Answer: B. Prerenal AKI results from decreased blood flow to the kidneys (hypovolemia
from diarrhea/dehydration). It is usually reversible with volume resuscitation.
6. Nitric oxide released by glomerular endothelial cells causes which effect?
• A. Vasoconstriction of afferent arterioles
• B. Vasodilation of renal blood vessels
• C. Increased sodium reabsorption
• D. Decreased urine output
• Correct Answer: B. Nitric oxide is a potent vasodilator that increases renal blood flow and GFR.
7. A client with chronic kidney disease has a GFR of 25 mL/min. This represents which stage of CKD?
• A. Stage 2 (mild)
• B. Stage 3 (moderate)
• C. Stage 4 (severe)
• D. Stage 5 (kidney failure)
• Correct Answer: C. Stage 4 CKD = GFR 15-29 mL/min. Stage 5 is <15 mL/min.
8. Which laboratory finding is expected in a client with prerenal azotemia?
• A. BUN:Cr ratio >20:1
• B. BUN:Cr ratio <10:1
• C. Normal BUN with elevated Cr
• D. Decreased urine specific gravity
, • Correct Answer: A. Prerenal azotemia causes disproportionate BUN elevation (due to increased
reabsorption of urea) with BUN:Cr ratio >20:1.
9. A client has a serum potassium of 6.8 mEq/L. Which ECG finding is most concerning?
• A. U waves
• B. Widened QRS complex
• C. ST depression
• D. Prolonged PR interval
• Correct Answer: B. Severe hyperkalemia (>6.5) causes widened QRS, peaked T waves, and can
progress to ventricular fibrillation or asystole.
10. A client has a serum sodium of 118 mEq/L with symptoms of confusion and seizures. The most
appropriate initial treatment is:
• A. Oral salt tablets
• B. Fluid restriction
• C. Hypertonic saline (3% NaCl) IV
• D. Loop diuretics
• Correct Answer: C. Symptomatic severe hyponatremia (altered mental status, seizures) requires
hypertonic saline to slowly raise serum sodium.
11. A client with heart failure is prescribed furosemide (Lasix). Which electrolyte imbalance should the
nurse monitor for?
• A. Hyperkalemia
• B. Hypokalemia
• C. Hypernatremia
• D. Hypercalcemia
• Correct Answer: B. Loop diuretics (furosemide) cause potassium wasting in the ascending loop
of Henle → hypokalemia.
12. Which statement correctly describes the renin-angiotensin-aldosterone system (RAAS)?
• A. Renin is released when blood pressure increases
• B. Angiotensin II causes vasodilation
• C. Aldosterone increases sodium and water reabsorption
• D. RAAS decreases blood volume
and Answers
Fluid, Electrolyte & Renal (Questions 1-15)
1. A nurse is teaching about antidiuretic hormone (ADH). Which statement correctly describes ADH
release?
• A. ADH is released when serum osmolality decreases below 275 mOsm/kg
• B. ADH increases water excretion by the kidneys
• C. ADH is released in response to increased plasma osmolality or decreased blood volume
• D. ADH decreases the permeability of the collecting duct
• Correct Answer: C. ADH is released when osmolality increases (>295 mOsm/kg) or when
circulating blood volume decreases, promoting water reabsorption in the collecting ducts.
2. A client has a serum osmolality of 320 mOsm/kg. The nurse interprets this as:
• A. Normal finding
• B. Fluid overload
• C. Dehydration
• D. Hemodilution
• Correct Answer: C. Normal osmolality is ~275-295 mOsm/kg. Values >295 indicate dehydration
or hyperosmolality.
3. A client's mean arterial pressure (MAP) drops from 95 to 55 mm Hg. What happens to glomerular
filtration rate (GFR)?
• A. GFR increases due to afferent vasodilation
• B. GFR remains unchanged due to autoregulation
• C. GFR decreases due to reduced renal blood flow
• D. GFR stops completely
• Correct Answer: C. GFR is pressure-dependent. MAP <70 mm Hg reduces renal blood flow and
decreases GFR; autoregulation fails below 70-80 mm Hg.
4. A client has a blood pressure of 220/130 mm Hg. Which physiological response occurs in the
kidneys?
• A. Afferent arterioles constrict to protect glomeruli
, • B. Afferent arterioles dilate to increase filtration
• C. Efferent arterioles constrict to decrease GFR
• D. No change occurs in the renal vasculature
• Correct Answer: A. The myogenic mechanism causes afferent arteriolar constriction in response
to increased BP to prevent glomerular capillary damage.
5. A client with severe diarrhea for 4 days and inability to eat or drink develops acute kidney injury.
The nurse classifies this as:
• A. Intrarenal due to ischemia
• B. Prerenal due to dehydration
• C. Postrenal due to urinary obstruction
• D. Intrinsic renal due to nephrotoxins
• Correct Answer: B. Prerenal AKI results from decreased blood flow to the kidneys (hypovolemia
from diarrhea/dehydration). It is usually reversible with volume resuscitation.
6. Nitric oxide released by glomerular endothelial cells causes which effect?
• A. Vasoconstriction of afferent arterioles
• B. Vasodilation of renal blood vessels
• C. Increased sodium reabsorption
• D. Decreased urine output
• Correct Answer: B. Nitric oxide is a potent vasodilator that increases renal blood flow and GFR.
7. A client with chronic kidney disease has a GFR of 25 mL/min. This represents which stage of CKD?
• A. Stage 2 (mild)
• B. Stage 3 (moderate)
• C. Stage 4 (severe)
• D. Stage 5 (kidney failure)
• Correct Answer: C. Stage 4 CKD = GFR 15-29 mL/min. Stage 5 is <15 mL/min.
8. Which laboratory finding is expected in a client with prerenal azotemia?
• A. BUN:Cr ratio >20:1
• B. BUN:Cr ratio <10:1
• C. Normal BUN with elevated Cr
• D. Decreased urine specific gravity
, • Correct Answer: A. Prerenal azotemia causes disproportionate BUN elevation (due to increased
reabsorption of urea) with BUN:Cr ratio >20:1.
9. A client has a serum potassium of 6.8 mEq/L. Which ECG finding is most concerning?
• A. U waves
• B. Widened QRS complex
• C. ST depression
• D. Prolonged PR interval
• Correct Answer: B. Severe hyperkalemia (>6.5) causes widened QRS, peaked T waves, and can
progress to ventricular fibrillation or asystole.
10. A client has a serum sodium of 118 mEq/L with symptoms of confusion and seizures. The most
appropriate initial treatment is:
• A. Oral salt tablets
• B. Fluid restriction
• C. Hypertonic saline (3% NaCl) IV
• D. Loop diuretics
• Correct Answer: C. Symptomatic severe hyponatremia (altered mental status, seizures) requires
hypertonic saline to slowly raise serum sodium.
11. A client with heart failure is prescribed furosemide (Lasix). Which electrolyte imbalance should the
nurse monitor for?
• A. Hyperkalemia
• B. Hypokalemia
• C. Hypernatremia
• D. Hypercalcemia
• Correct Answer: B. Loop diuretics (furosemide) cause potassium wasting in the ascending loop
of Henle → hypokalemia.
12. Which statement correctly describes the renin-angiotensin-aldosterone system (RAAS)?
• A. Renin is released when blood pressure increases
• B. Angiotensin II causes vasodilation
• C. Aldosterone increases sodium and water reabsorption
• D. RAAS decreases blood volume
