Mastering ATI Renal System Nursing
Care: A Comprehensive -Question
Review with Evidence-Based
Rationales for Exam Success and
Clinical Application
Question: A nurse is assessing a client who has acute kidney injury (AKI).
Which of the following findings should the nurse expect during the oliguric
phase?
Answer: Decreased urine output, elevated serum creatinine, and
hyperkalemia.
Rationale: The oliguric phase of AKI is characterized by a urine output of
less than 400 mL in 24 hours. The kidneys are unable to excrete waste
products, leading to the accumulation of creatinine and potassium in the
blood.
Question: A client with chronic kidney disease (CKD) is scheduled for
hemodialysis. Which of the following medications should the nurse
withhold on the morning of dialysis?
Answer: Antihypertensive medications, particularly those that are
dialyzable.
Rationale: Many antihypertensives are removed during dialysis, which can
cause significant hypotension. Additionally, holding them helps prevent
intradialytic hypotension. The specific medication should be checked
against the dialysis unit's policy.
,Question: A nurse is reviewing the laboratory results of a client who has
end-stage renal disease (ESRD). Which of the following findings is a priority
to report to the provider?
Answer: Serum potassium level of 6.2 mEq/L.
Rationale: A serum potassium level of 6.2 mEq/L is critically high and
places the client at risk for life-threatening cardiac dysrhythmias. This is a
medical emergency requiring immediate intervention such as dialysis or
insulin with dextrose.
Question: A client receiving peritoneal dialysis reports severe abdominal
pain and the dialysate outflow is cloudy. What is the nurse's priority action?
Answer: Obtain a specimen of the outflow for culture and sensitivity.
Rationale: Cloudy dialysate effluent is the hallmark sign of peritonitis, a
serious infection. The nurse should immediately collect a sample for culture
to identify the causative organism and initiate appropriate antibiotic
therapy.
Question: A nurse is teaching a client who has CKD about dietary
restrictions. Which of the following statements indicates an understanding
of the teaching?
Answer: "I will need to limit my intake of foods high in phosphorus, like
dairy and nuts."
Rationale: In CKD, phosphorus levels rise because the kidneys cannot
excrete it. Hyperphosphatemia leads to bone disease. Clients must restrict
high-phosphorus foods and take phosphate binders with meals.
Question: A client is 2 hours post-renal biopsy. Which of the following
assessment findings requires immediate intervention?
Answer: Gross, bright red hematuria with clots.
Rationale: While microscopic hematuria is expected after a biopsy, gross
hematuria with clots indicates active, significant bleeding. This requires
immediate physician notification and bed rest.
,Question: A nurse is caring for a client with a new arteriovenous (AV) fistula
in the left arm. Which of the following interventions is appropriate?
Answer: Avoid taking blood pressure measurements in the left arm.
Rationale: The AV fistula is a surgically created connection between an
artery and a vein. It must be protected to maintain patency. Blood pressure
readings, venipunctures, and tight jewelry or clothing should be avoided on
that extremity.
Question: A client with CKD is prescribed epoetin alfa (Epogen). The nurse
understands the purpose of this medication is to:
Answer: Stimulate red blood cell production to treat anemia.
Rationale: The kidneys produce erythropoietin, which stimulates RBC
production. In CKD, this production is diminished, leading to anemia.
Epoetin alfa is an exogenous form of erythropoietin used to correct this
anemia.
Question: A nurse is assessing a client who has nephrotic syndrome. Which
of the following findings should the nurse expect?
Answer: Severe proteinuria, hypoalbuminemia, and edema.
Rationale: Nephrotic syndrome is characterized by damage to the
glomerular basement membrane, leading to massive protein loss in the
urine (proteinuria). This causes a drop in serum albumin
(hypoalbuminemia), reducing oncotic pressure and resulting in edema.
Question: A client is prescribed sevelamer (Renagel) for CKD. The nurse
should instruct the client to take this medication:
Answer: With meals.
Rationale: Sevelamer is a phosphate binder that works by binding to
dietary phosphorus in the gastrointestinal tract, preventing its absorption. It
must be taken with meals to be effective.
, Question: A nurse is performing a bladder scan on a postoperative client
and obtains a volume of 450 mL. The client is unable to void. Which of the
following actions should the nurse take first?
Answer: Attempt to catheterize the client with a straight catheter.
Rationale: A post-void residual (PVR) of 450 mL indicates urinary retention.
While non-invasive measures (like running water) can be tried, if the client
is unable to void and is uncomfortable, the first definitive action is to
catheterize to relieve the distention and prevent bladder injury.
Question: A client with AKI has a urine specific gravity of 1.012. The nurse
understands this value indicates:
Answer: The kidneys are losing their ability to concentrate urine.
Rationale: A normal specific gravity ranges from 1.005 to 1.030. A fixed
specific gravity of 1.010 is a classic sign of kidney damage, indicating the
tubules can no longer concentrate or dilute urine as needed.
Question: A nurse is preparing a client for a computed tomography (CT)
scan with IV contrast. Which of the following pre-existing conditions places
the client at highest risk for contrast-induced nephropathy?
Answer: Diabetes mellitus.
Rationale: Diabetes, especially when combined with pre-existing renal
insufficiency, is a major risk factor for contrast-induced nephropathy. The
nurse should verify the client's creatinine level and ensure adequate
hydration before and after the procedure.
Question: A client on hemodialysis has a heparin infusion running. The
nurse understands the primary purpose of this medication is to:
Answer: Prevent clotting of blood within the dialysis circuit.
Rationale: Heparin is an anticoagulant used during hemodialysis to prevent
the blood from clotting as it passes through the artificial kidney (dialyzer)
and tubing. Without it, the entire system would clot.
Care: A Comprehensive -Question
Review with Evidence-Based
Rationales for Exam Success and
Clinical Application
Question: A nurse is assessing a client who has acute kidney injury (AKI).
Which of the following findings should the nurse expect during the oliguric
phase?
Answer: Decreased urine output, elevated serum creatinine, and
hyperkalemia.
Rationale: The oliguric phase of AKI is characterized by a urine output of
less than 400 mL in 24 hours. The kidneys are unable to excrete waste
products, leading to the accumulation of creatinine and potassium in the
blood.
Question: A client with chronic kidney disease (CKD) is scheduled for
hemodialysis. Which of the following medications should the nurse
withhold on the morning of dialysis?
Answer: Antihypertensive medications, particularly those that are
dialyzable.
Rationale: Many antihypertensives are removed during dialysis, which can
cause significant hypotension. Additionally, holding them helps prevent
intradialytic hypotension. The specific medication should be checked
against the dialysis unit's policy.
,Question: A nurse is reviewing the laboratory results of a client who has
end-stage renal disease (ESRD). Which of the following findings is a priority
to report to the provider?
Answer: Serum potassium level of 6.2 mEq/L.
Rationale: A serum potassium level of 6.2 mEq/L is critically high and
places the client at risk for life-threatening cardiac dysrhythmias. This is a
medical emergency requiring immediate intervention such as dialysis or
insulin with dextrose.
Question: A client receiving peritoneal dialysis reports severe abdominal
pain and the dialysate outflow is cloudy. What is the nurse's priority action?
Answer: Obtain a specimen of the outflow for culture and sensitivity.
Rationale: Cloudy dialysate effluent is the hallmark sign of peritonitis, a
serious infection. The nurse should immediately collect a sample for culture
to identify the causative organism and initiate appropriate antibiotic
therapy.
Question: A nurse is teaching a client who has CKD about dietary
restrictions. Which of the following statements indicates an understanding
of the teaching?
Answer: "I will need to limit my intake of foods high in phosphorus, like
dairy and nuts."
Rationale: In CKD, phosphorus levels rise because the kidneys cannot
excrete it. Hyperphosphatemia leads to bone disease. Clients must restrict
high-phosphorus foods and take phosphate binders with meals.
Question: A client is 2 hours post-renal biopsy. Which of the following
assessment findings requires immediate intervention?
Answer: Gross, bright red hematuria with clots.
Rationale: While microscopic hematuria is expected after a biopsy, gross
hematuria with clots indicates active, significant bleeding. This requires
immediate physician notification and bed rest.
,Question: A nurse is caring for a client with a new arteriovenous (AV) fistula
in the left arm. Which of the following interventions is appropriate?
Answer: Avoid taking blood pressure measurements in the left arm.
Rationale: The AV fistula is a surgically created connection between an
artery and a vein. It must be protected to maintain patency. Blood pressure
readings, venipunctures, and tight jewelry or clothing should be avoided on
that extremity.
Question: A client with CKD is prescribed epoetin alfa (Epogen). The nurse
understands the purpose of this medication is to:
Answer: Stimulate red blood cell production to treat anemia.
Rationale: The kidneys produce erythropoietin, which stimulates RBC
production. In CKD, this production is diminished, leading to anemia.
Epoetin alfa is an exogenous form of erythropoietin used to correct this
anemia.
Question: A nurse is assessing a client who has nephrotic syndrome. Which
of the following findings should the nurse expect?
Answer: Severe proteinuria, hypoalbuminemia, and edema.
Rationale: Nephrotic syndrome is characterized by damage to the
glomerular basement membrane, leading to massive protein loss in the
urine (proteinuria). This causes a drop in serum albumin
(hypoalbuminemia), reducing oncotic pressure and resulting in edema.
Question: A client is prescribed sevelamer (Renagel) for CKD. The nurse
should instruct the client to take this medication:
Answer: With meals.
Rationale: Sevelamer is a phosphate binder that works by binding to
dietary phosphorus in the gastrointestinal tract, preventing its absorption. It
must be taken with meals to be effective.
, Question: A nurse is performing a bladder scan on a postoperative client
and obtains a volume of 450 mL. The client is unable to void. Which of the
following actions should the nurse take first?
Answer: Attempt to catheterize the client with a straight catheter.
Rationale: A post-void residual (PVR) of 450 mL indicates urinary retention.
While non-invasive measures (like running water) can be tried, if the client
is unable to void and is uncomfortable, the first definitive action is to
catheterize to relieve the distention and prevent bladder injury.
Question: A client with AKI has a urine specific gravity of 1.012. The nurse
understands this value indicates:
Answer: The kidneys are losing their ability to concentrate urine.
Rationale: A normal specific gravity ranges from 1.005 to 1.030. A fixed
specific gravity of 1.010 is a classic sign of kidney damage, indicating the
tubules can no longer concentrate or dilute urine as needed.
Question: A nurse is preparing a client for a computed tomography (CT)
scan with IV contrast. Which of the following pre-existing conditions places
the client at highest risk for contrast-induced nephropathy?
Answer: Diabetes mellitus.
Rationale: Diabetes, especially when combined with pre-existing renal
insufficiency, is a major risk factor for contrast-induced nephropathy. The
nurse should verify the client's creatinine level and ensure adequate
hydration before and after the procedure.
Question: A client on hemodialysis has a heparin infusion running. The
nurse understands the primary purpose of this medication is to:
Answer: Prevent clotting of blood within the dialysis circuit.
Rationale: Heparin is an anticoagulant used during hemodialysis to prevent
the blood from clotting as it passes through the artificial kidney (dialyzer)
and tubing. Without it, the entire system would clot.
