MDC III EXAM 1 Comprehensive Practice Examination Rasmussen University | Medical-Surgical Nursing III

MDC III EXAM 1 Comprehensive Practice Examination Rasmussen University | Medical-Surgical Nursing III Section 1: Renal and Urinary Disorders (Questions 1-25) Question 1 – Chronic Kidney Disease A nurse is caring for a 62-year-old client with stage 4 chronic kidney disease. Which laboratory finding would the nurse anticipate being most consistent with this diagnosis? A) Elevated serum calcium B) Decreased serum potassium C) Elevated serum creatinine D) Decreased blood urea nitrogen Correct Answer: C Rationale: Stage 4 chronic kidney disease is characterized by significant decline in glomerular filtration rate, leading to accumulation of metabolic wastes. Serum creatinine is a reliable indicator of renal function and progressively elevates as kidney function deteriorates. Question 2 – Urolithiasis A 45-year-old male client presents to the emergency department with severe flank pain radiating to the groin. The client reports nausea and hematuria. Which nursing intervention should the nurse prioritize? A) Administer prescribed antiemetics B) Strain all urine for stones C) Obtain a 24-hour urine collection D) Prepare for immediate lithotripsy Correct Answer: B Rationale: Straining all urine is essential for clients with suspected urolithiasis to capture passed stones for analysis. Stone analysis determines composition, which guides dietary modifications and preventative treatment strategies. Question 3 – Polycystic Kidney Disease A nurse is developing a plan of care for a client diagnosed with autosomal dominant polycystic kidney disease. Which intervention should the nurse include to address the most common complication? A) Monitoring for signs of infection B) Assessing for hypertension C) Preparing for dialysis D) Administering anticoagulants Correct Answer: B Rationale: Hypertension is the most common complication of polycystic kidney disease, occurring in approximately 60-75% of clients. Blood pressure control is essential to slow the progression of renal damage and reduce cardiovascular risk. Question 4 – Pyelonephritis A 68-year-old female client is admitted with acute pyelonephritis. Which assessment finding requires immediate nursing intervention? A) Temperature of 101.2°F (38.4°C) B) Flank pain rated 6 on a 0-10 scale C) Blood pressure of 88/56 mm Hg D) Urinary frequency and urgency Correct Answer: C Rationale: Hypotension (88/56 mm Hg) indicates potential sepsis or septic shock, a life-threatening complication of pyelonephritis. Immediate intervention including fluid resuscitation and vasopressor support may be required. Question 5 – Benign Prostatic Hyperplasia A 72-year-old male client with benign prostatic hyperplasia reports awakening three to four times nightly to urinate. Which term should the nurse use to document this finding? A) Dysuria B) Oliguria C) Nocturia D) Polyuria Correct Answer: C Rationale: Nocturia is defined as awakening one or more times during the night to void. It is a common symptom of BPH caused by bladder outlet obstruction and decreased bladder capacity. Question 6 – Nephrotic Syndrome A nurse is caring for a client with nephrotic syndrome who has a normal glomerular filtration rate. Which dietary intervention should the nurse include in the plan of care? A) Strict sodium restriction to 1,500 mg daily B) Adequate protein intake in the diet C) Fluid restriction to 1,000 mL daily D) Potassium-rich foods Correct Answer: B Rationale: Clients with nephrotic syndrome and normal GFR should maintain adequate protein intake to compensate for urinary protein losses. Dietary protein prevents malnutrition and supports immune function while albumin levels are monitored. Question 7 – Renal Cell Carcinoma A client is postoperative day one following a nephrectomy for renal cell carcinoma. Which assessment finding should the nurse report to the healthcare provider immediately? A) Incisional pain rated 4 on a 0-10 scale B) Urine output of 30 mL per hour C) Blood pressure of 148/90 mm Hg D) Hemoglobin drop from 12.5 to 9.8 g/dL Correct Answer: D Rationale: A significant hemoglobin drop of 2.7 g/dL in 24 hours indicates possible hemorrhage, a major complication following nephrectomy. This finding requires immediate notification of the healthcare provider and potential intervention. Question 8 – Dialysis A client with end-stage kidney disease is scheduled for hemodialysis. Which laboratory value should the nurse monitor closely during the procedure? A) Serum sodium B) Serum potassium C) Serum calcium D) Serum albumin Correct Answer: B Rationale: Serum potassium levels must be closely monitored during hemodialysis as this electrolyte is removed through the dialysis process. Rapid shifts in potassium can cause cardiac arrhythmias, making this the priority laboratory value. Question 9 – Urinary Tract Infection An 80-year-old female client presents with confusion and urinary incontinence. The family reports no complaints of dysuria or urgency. Which action should the nurse take first? A) Obtain a urinalysis and culture B) Administer prescribed antibiotics C) Assess for dehydration D) Notify the healthcare provider Correct Answer: A Rationale: Older adults often present with atypical symptoms of urinary tract infection, such as confusion and incontinence, without classic urinary symptoms. A urinalysis and culture should be obtained to confirm the diagnosis before initiating treatment. Question 10 – Nephrostomy Care A client has a newly placed nephrostomy tube. Which nursing intervention is the highest priority in the immediate postoperative period? A) Monitoring for hemorrhage B) Measuring output every 4 hours C) Assessing for infection D) Providing skin care around the insertion site Correct Answer: A Rationale: Monitoring for hemorrhage is the highest priority after nephrostomy tube placement due to the vascular nature of the kidney. Signs of bleeding include decreasing blood pressure, increasing heart rate, and bright red drainage from the tube.