NR 570 FINAL EXAM PRACTICE TEST WITH VERIFIED ANSWERS AND
RATIONALES 2026/2027 VERSION
1.What is the most appropriate initial diagnostic approach for a patient presenting with
acute flank pain and suspected nephrolithiasis?
A. Obtain a focused history, physical examination, urinalysis, and appropriate imaging
B. Begin antibiotics in every patient
C. Immediately perform exploratory surgery
D. Assume the pain is musculoskeletal
Correct Answer: A
Rationale: Acute flank pain has several possible causes. A focused history, examination,
urinalysis, renal-function assessment, and appropriate imaging help distinguish nephrolithiasis
from infection, obstruction, vascular emergencies, and other conditions.
2.A patient with nephrolithiasis reports severe colicky flank pain radiating toward the
groin. What does this pattern most strongly suggest?
A. The stone is irritating or moving through the ureter
B. The stone is located in the stomach
C. The patient has isolated bladder inflammation
D. The patient has pneumonia
Correct Answer: A
Rationale: Ureteral stones commonly cause severe, intermittent colicky pain that may radiate
from the flank toward the groin as the stone moves.
3.Which imaging study is commonly considered the most sensitive definitive study for
suspected urinary calculi in many acute-care settings?
A. Noncontrast CT of the abdomen and pelvis
B. Chest radiograph
C. MRI of the brain
D. Abdominal ultrasound only
Correct Answer: A
Rationale: Noncontrast CT is highly sensitive for detecting urinary stones and can also identify
alternative causes of acute abdominal or flank pain.
4.Which urinalysis finding commonly supports a diagnosis of nephrolithiasis?
,A. Hematuria
B. Severe glucosuria in every case
C. Persistent ketonuria in every case
D. Complete absence of urinary abnormalities
Correct Answer: A
Rationale: Microscopic or gross hematuria is common with urinary stones because the calculus
can traumatize the urinary tract.
5.A patient with a urinary stone develops fever, hypotension, and flank pain. What is the
priority concern?
A. Infected urinary obstruction
B. Uncomplicated renal colic
C. Chronic constipation
D. Stable nephrolithiasis
Correct Answer: A
Rationale: Infection occurring with urinary obstruction can progress rapidly to sepsis and
requires urgent evaluation and management.
6.What is a major treatment goal for an uncomplicated small renal calculus?
A. Control symptoms and facilitate spontaneous passage when appropriate
B. Perform surgery on every patient
C. Restrict all fluids indefinitely
D. Administer antibiotics to every patient
Correct Answer: A
Rationale: Small stones may pass spontaneously. Management commonly focuses on analgesia,
appropriate hydration, symptom control, and facilitating passage when clinically appropriate.
7.Which medication class is commonly used as an analgesic for acute renal colic?
A. NSAIDs
B. Antacids
C. Antihistamines
D. Proton-pump inhibitors
Correct Answer: A
Rationale: NSAIDs reduce prostaglandin-mediated inflammation and ureteral pain and are
commonly used when not contraindicated.
, 8.A patient has severe hyperkalemia. Which ECG finding is classically associated with
hyperkalemia?
A. Tall, peaked T waves
B. Persistent ST elevation in every case
C. Prominent U waves
D. Narrowed QRS with no other changes
Correct Answer: A
Rationale: Hyperkalemia can produce tall, peaked T waves and, as potassium rises, progressive
conduction abnormalities and potentially life-threatening arrhythmias.
9.What is the immediate priority for a patient with severe hyperkalemia and ECG
changes?
A. Stabilize the cardiac membrane and initiate urgent potassium-lowering treatment
B. Give oral potassium
C. Delay treatment until repeat testing tomorrow
D. Encourage a high-potassium diet
Correct Answer: A
Rationale: ECG changes indicate cardiac effects of hyperkalemia. IV calcium is commonly used
to stabilize the myocardium while therapies that lower serum potassium are initiated.
10.Which electrolyte abnormality is most strongly associated with muscle weakness, ileus,
and cardiac dysrhythmias?
A. Hypokalemia
B. Hypernatremia
C. Hyperchloremia
D. Hypermagnesemia
Correct Answer: A
Rationale: Low potassium can impair skeletal and smooth muscle function and alter cardiac
conduction, potentially causing dangerous dysrhythmias.
11.What is an important initial assessment for a patient with suspected acute kidney injury
(AKI)?
A. Review baseline and current renal function, urine output, medications, and volume status
B. Assess only the patient's temperature
C. Ignore medication history
D. Assume chronic kidney disease
RATIONALES 2026/2027 VERSION
1.What is the most appropriate initial diagnostic approach for a patient presenting with
acute flank pain and suspected nephrolithiasis?
A. Obtain a focused history, physical examination, urinalysis, and appropriate imaging
B. Begin antibiotics in every patient
C. Immediately perform exploratory surgery
D. Assume the pain is musculoskeletal
Correct Answer: A
Rationale: Acute flank pain has several possible causes. A focused history, examination,
urinalysis, renal-function assessment, and appropriate imaging help distinguish nephrolithiasis
from infection, obstruction, vascular emergencies, and other conditions.
2.A patient with nephrolithiasis reports severe colicky flank pain radiating toward the
groin. What does this pattern most strongly suggest?
A. The stone is irritating or moving through the ureter
B. The stone is located in the stomach
C. The patient has isolated bladder inflammation
D. The patient has pneumonia
Correct Answer: A
Rationale: Ureteral stones commonly cause severe, intermittent colicky pain that may radiate
from the flank toward the groin as the stone moves.
3.Which imaging study is commonly considered the most sensitive definitive study for
suspected urinary calculi in many acute-care settings?
A. Noncontrast CT of the abdomen and pelvis
B. Chest radiograph
C. MRI of the brain
D. Abdominal ultrasound only
Correct Answer: A
Rationale: Noncontrast CT is highly sensitive for detecting urinary stones and can also identify
alternative causes of acute abdominal or flank pain.
4.Which urinalysis finding commonly supports a diagnosis of nephrolithiasis?
,A. Hematuria
B. Severe glucosuria in every case
C. Persistent ketonuria in every case
D. Complete absence of urinary abnormalities
Correct Answer: A
Rationale: Microscopic or gross hematuria is common with urinary stones because the calculus
can traumatize the urinary tract.
5.A patient with a urinary stone develops fever, hypotension, and flank pain. What is the
priority concern?
A. Infected urinary obstruction
B. Uncomplicated renal colic
C. Chronic constipation
D. Stable nephrolithiasis
Correct Answer: A
Rationale: Infection occurring with urinary obstruction can progress rapidly to sepsis and
requires urgent evaluation and management.
6.What is a major treatment goal for an uncomplicated small renal calculus?
A. Control symptoms and facilitate spontaneous passage when appropriate
B. Perform surgery on every patient
C. Restrict all fluids indefinitely
D. Administer antibiotics to every patient
Correct Answer: A
Rationale: Small stones may pass spontaneously. Management commonly focuses on analgesia,
appropriate hydration, symptom control, and facilitating passage when clinically appropriate.
7.Which medication class is commonly used as an analgesic for acute renal colic?
A. NSAIDs
B. Antacids
C. Antihistamines
D. Proton-pump inhibitors
Correct Answer: A
Rationale: NSAIDs reduce prostaglandin-mediated inflammation and ureteral pain and are
commonly used when not contraindicated.
, 8.A patient has severe hyperkalemia. Which ECG finding is classically associated with
hyperkalemia?
A. Tall, peaked T waves
B. Persistent ST elevation in every case
C. Prominent U waves
D. Narrowed QRS with no other changes
Correct Answer: A
Rationale: Hyperkalemia can produce tall, peaked T waves and, as potassium rises, progressive
conduction abnormalities and potentially life-threatening arrhythmias.
9.What is the immediate priority for a patient with severe hyperkalemia and ECG
changes?
A. Stabilize the cardiac membrane and initiate urgent potassium-lowering treatment
B. Give oral potassium
C. Delay treatment until repeat testing tomorrow
D. Encourage a high-potassium diet
Correct Answer: A
Rationale: ECG changes indicate cardiac effects of hyperkalemia. IV calcium is commonly used
to stabilize the myocardium while therapies that lower serum potassium are initiated.
10.Which electrolyte abnormality is most strongly associated with muscle weakness, ileus,
and cardiac dysrhythmias?
A. Hypokalemia
B. Hypernatremia
C. Hyperchloremia
D. Hypermagnesemia
Correct Answer: A
Rationale: Low potassium can impair skeletal and smooth muscle function and alter cardiac
conduction, potentially causing dangerous dysrhythmias.
11.What is an important initial assessment for a patient with suspected acute kidney injury
(AKI)?
A. Review baseline and current renal function, urine output, medications, and volume status
B. Assess only the patient's temperature
C. Ignore medication history
D. Assume chronic kidney disease
