NSG 4100 EXAM 1 PRACTICE
QUESTIONS, MULTIPLE CHOICE,
CORRECT ANSWERS 2026
,Ques on 1. A client with end-stage renal disease (ESRD) has a markedly decreased glomerular
filtra on rate (GFR). Which laboratory finding should the nurse expect?
A. Decreased BUN
B. Decreased serum crea nine
C. Increased BUN and crea nine
D. Increased hemoglobin
Answer: C. Increased BUN and crea nine
Ra onale: As kidney filtra on declines, nitrogenous waste products accumulate in the blood,
causing eleva ons in BUN and serum crea nine.
Ques on 2. Which assessment finding is most concerning in a client with ESRD?
A. Potassium 6.4 mEq/L
B. Hemoglobin 10.8 g/dL
C. BUN 48 mg/dL
D. Mild fa gue
Answer: A. Potassium 6.4 mEq/L
Ra onale: Severe hyperkalemia can cause life-threatening cardiac dysrhythmias and requires
immediate interven on.
Ques on 3. Which acid-base imbalance is commonly associated with advanced renal failure?
A. Respiratory alkalosis
B. Metabolic alkalosis
C. Respiratory acidosis
D. Metabolic acidosis
Answer: D. Metabolic acidosis
Ra onale: Failing kidneys cannot adequately excrete hydrogen ions or regenerate/reabsorb
bicarbonate, promo ng metabolic acidosis.
Ques on 4. Why does anemia commonly occur in ESRD?
,A. Increased platelet destruc on
B. Decreased erythropoie n produc on
C. Excessive iron absorp on
D. Increased red blood cell produc on
Answer: B. Decreased erythropoie n produc on
Ra onale: Diseased kidneys produce inadequate erythropoie n, reducing s mula on of the
bone marrow to produce red blood cells.
Ques on 5. Which finding is characteris c of uremia?
A. Pericardi s
B. Hypoglycemia
C. Severe polycythemia
D. Respiratory alkalosis
Answer: A. Pericardi s
Ra onale: Accumula on of uremic toxins can cause inflamma on of the pericardium, producing
uremic pericardi s.
Ques on 6. A client with ESRD reports chest pain that becomes worse when lying flat. Which
addi onal finding would support uremic pericardi s?
A. Pericardial fric on rub
B. Absent bowel sounds
C. Bilateral wheezing
D. Posi ve Murphy sign
Answer: A. Pericardial fric on rub
Ra onale: A fric on rub is a classic finding of pericardial inflamma on and can occur with
uremia.
Ques on 7. Which electrolyte imbalance presents the greatest immediate threat to a client
with severe renal failure?
A. Hypocalcemia
B. Hyperkalemia
, C. Hypernatremia
D. Hypochloremia
Answer: B. Hyperkalemia
Ra onale: Elevated potassium can rapidly alter cardiac conduc on and produce fatal
dysrhythmias.
Ques on 8. A client with ESRD is prescribed epoe n alfa. What is the primary purpose of this
medica on?
A. Lower serum potassium
B. Increase red blood cell produc on
C. Remove excess phosphorus
D. Reduce blood pressure
Answer: B. Increase red blood cell produc on
Ra onale: Epoe n alfa s mulates erythropoiesis and is used to treat anemia associated with
chronic kidney disease.
Ques on 9. Which instruc on is most appropriate for a client taking a phosphate binder?
A. Take it on an empty stomach.
B. Take it with meals.
C. Take it only at bed me.
D. Take it immediately a er dialysis.
Answer: B. Take it with meals.
Ra onale: Phosphate binders work in the gastrointes nal tract by binding dietary phosphorus,
so they should generally be taken with meals.
Ques on 10. Which assessment finding indicates fluid volume excess in a client with ESRD?
A. Weight loss
B. Flat neck veins
C. Crackles and peripheral edema
D. Dry mucous membranes
QUESTIONS, MULTIPLE CHOICE,
CORRECT ANSWERS 2026
,Ques on 1. A client with end-stage renal disease (ESRD) has a markedly decreased glomerular
filtra on rate (GFR). Which laboratory finding should the nurse expect?
A. Decreased BUN
B. Decreased serum crea nine
C. Increased BUN and crea nine
D. Increased hemoglobin
Answer: C. Increased BUN and crea nine
Ra onale: As kidney filtra on declines, nitrogenous waste products accumulate in the blood,
causing eleva ons in BUN and serum crea nine.
Ques on 2. Which assessment finding is most concerning in a client with ESRD?
A. Potassium 6.4 mEq/L
B. Hemoglobin 10.8 g/dL
C. BUN 48 mg/dL
D. Mild fa gue
Answer: A. Potassium 6.4 mEq/L
Ra onale: Severe hyperkalemia can cause life-threatening cardiac dysrhythmias and requires
immediate interven on.
Ques on 3. Which acid-base imbalance is commonly associated with advanced renal failure?
A. Respiratory alkalosis
B. Metabolic alkalosis
C. Respiratory acidosis
D. Metabolic acidosis
Answer: D. Metabolic acidosis
Ra onale: Failing kidneys cannot adequately excrete hydrogen ions or regenerate/reabsorb
bicarbonate, promo ng metabolic acidosis.
Ques on 4. Why does anemia commonly occur in ESRD?
,A. Increased platelet destruc on
B. Decreased erythropoie n produc on
C. Excessive iron absorp on
D. Increased red blood cell produc on
Answer: B. Decreased erythropoie n produc on
Ra onale: Diseased kidneys produce inadequate erythropoie n, reducing s mula on of the
bone marrow to produce red blood cells.
Ques on 5. Which finding is characteris c of uremia?
A. Pericardi s
B. Hypoglycemia
C. Severe polycythemia
D. Respiratory alkalosis
Answer: A. Pericardi s
Ra onale: Accumula on of uremic toxins can cause inflamma on of the pericardium, producing
uremic pericardi s.
Ques on 6. A client with ESRD reports chest pain that becomes worse when lying flat. Which
addi onal finding would support uremic pericardi s?
A. Pericardial fric on rub
B. Absent bowel sounds
C. Bilateral wheezing
D. Posi ve Murphy sign
Answer: A. Pericardial fric on rub
Ra onale: A fric on rub is a classic finding of pericardial inflamma on and can occur with
uremia.
Ques on 7. Which electrolyte imbalance presents the greatest immediate threat to a client
with severe renal failure?
A. Hypocalcemia
B. Hyperkalemia
, C. Hypernatremia
D. Hypochloremia
Answer: B. Hyperkalemia
Ra onale: Elevated potassium can rapidly alter cardiac conduc on and produce fatal
dysrhythmias.
Ques on 8. A client with ESRD is prescribed epoe n alfa. What is the primary purpose of this
medica on?
A. Lower serum potassium
B. Increase red blood cell produc on
C. Remove excess phosphorus
D. Reduce blood pressure
Answer: B. Increase red blood cell produc on
Ra onale: Epoe n alfa s mulates erythropoiesis and is used to treat anemia associated with
chronic kidney disease.
Ques on 9. Which instruc on is most appropriate for a client taking a phosphate binder?
A. Take it on an empty stomach.
B. Take it with meals.
C. Take it only at bed me.
D. Take it immediately a er dialysis.
Answer: B. Take it with meals.
Ra onale: Phosphate binders work in the gastrointes nal tract by binding dietary phosphorus,
so they should generally be taken with meals.
Ques on 10. Which assessment finding indicates fluid volume excess in a client with ESRD?
A. Weight loss
B. Flat neck veins
C. Crackles and peripheral edema
D. Dry mucous membranes
