NP3 Final Exam 1 Questions with All
Actual Detailed Answers 2026-2027
Update.
1. The nurse is assessing a client with a diagnosis of prerenal acute kidney injury (AKI). Which
condition would the nurse expect to find in the patient's recent history?
a. Pyelonephritis
b. Dehydration
c. Bladder cancer
d. Kidney stones - Answer ANS: B
Prerenal causes of AKI are related to a decrease in perfusion, such as in clients who have
prolonged dehydration. Pyelonephritis is an intrinsic or intrarenal cause of AKI related to kidney
damage. Bladder cancer and kidney stones are postrenal causes of AKI related to urine flow
obstruction.
2. A marathon runner comes into the clinic and states "I have not urinated very much in the last
few days." The nurse notes a heart rate of 110 beats/min and a blood pressure of 86/58 mm Hg.
Which action by the nurse is most appropriate?
a. Give the client a bottle of water immediately.
b. Start an intravenous line for fluids.
c. Teach the patient to drink 2 to 3 L of water daily.
d. Perform an electrocardiogram. - Answer ANS: A
This athlete is mildly dehydrated as evidenced by the higher heart rate and lower blood
pressure. The nurse can start hydrating the client with a bottle of water first, followed by
teaching the patient to drink 2 to 3 L of water each day. An intravenous line may be needed
later, after the patient's degree of dehydration is assessed. An electrocardiogram is not
necessary at this time.
3. A client comes into the emergency department with a serum creatinine of 2.2 mg/dL (1944
mcmol/L) and a blood urea nitrogen (BUN) of 24 mL/dL (8.57 mmol/L). What question would
the nurse ask first when taking this client's history?
a. "Have you been taking any aspirin, ibuprofen, or naproxen recently?"
b. "Do you have anyone in your family with renal failure?"
c. "Have you had a diet that is low in protein recently?"
d. "Has a relative had a kidney transplant lately?" - Answer ANS: A
There are some medications that are nephrotoxic, such as the nonsteroidal anti-inflammatory
drugs ibuprofen, aspirin, and naproxen. This would be a good question to initially ask the
patient since both the serum creatinine and BUN are elevated, indicating some renal problems.
A diet high in protein could be a factor in an increased BUN.
,4. A client is admitted with acute kidney injury (AKI) and a urine output of 2000 mL/day. What is
the major concern of the nurse regarding this patient's care?
a. Edema and pain
b. Cardiac and respiratory status
c. Electrolyte and fluid imbalance
d. Mental health status - Answer ANS: C
This client may have an inflammatory cause of AKI with proteins entering the glomerulus and
holding the fluid in the filtrate, causing polyuria. Electrolyte loss and fluid balance are essential.
Edema and pain are not usually a problem with fluid loss. There could be changes in the client's
cardiac, respiratory, and mental health status if the electrolyte imbalance is not treated.
5. A client with acute kidney injury (AKI) has a blood pressure of 76/55 mm Hg. The primary
health care provider prescribed 1000 mL of normal saline to be infused over 1 hour to maintain
perfusion. The client starts to develop shortness of breath. What is the nurse's priority action?
a. Calculate the mean arterial pressure (MAP).
b. Ask for insertion of a pulmonary artery catheter.
c. Take the client's pulse.
d. Decrease the rate of the IV infusion. - Answer ANS: D
The nurse would assess that the client could be developing fluid overload and respiratory
distress and slow down the normal saline infusion. The calculation of the MAP also reflects
perfusion. The insertion of a pulmonary artery catheter would evaluate the client's
hemodynamic status, but this would not be the initial or priority action by the nurse. Vital signs
are also important after adjusting the intravenous infusion.
6. A client has a serum potassium level of 6.5 mEq/L (6.5 mmol/L), a serum creatinine level of 2
mg/dL (176 mcmol/L), and a urine output of 350 mL/day. What is the best action by the nurse?
a. Place the client on a cardiac monitor immediately.
b. Teach the client to limit high-potassium foods.
c. Continue to monitor the client's intake and output.
d. Ask to have the laboratory redraw the blood specimen. - Answer ANS: A
The best action by the nurse would be to check the cardiac status with a monitor. High-
potassium levels can lead to dysrhythmias. The other choices are logical nursing interventions
for acute kidney injury but not the best immediate action.
7. A client with diabetes mellitus type 2 has been well controlled with metformin. The client is
scheduled for magnetic resonance imaging (MRI) scan with contrast. What priority would the
nurse take at this time?
a. Teach the client about the purpose of the MRI.
b. Assess the client's blood urea nitrogen and creatinine.
,c. Tell the client to withhold metformin for 24 hours before the MRI.
d. Ask the client if he or she is taking antibiotics. - Answer ANS: C
Contrast media can be nephrotoxic (damaging to the kidneys). Metformin can also be
nephrotoxic and the client should not be exposed to two agents. Clients who have diabetes are
already at risk for renal damage.
8. A client is started on continuous venovenous hemofiltration (CVVH). Which finding would
require immediate action by the nurse?
a. Potassium level of 5.5 mEq/L (5.5 mmol/L)
b. Sodium level of 138 mEq/L (138 mmol/L)
c. Blood pressure of 76/58 mm Hg
d. Pulse rate of 88 beats/min - Answer ANS: C
Hypotension can be a problem with CVVH if replacement fluid does not provide enough volume
to maintain blood pressure. The nurse needs to monitor for ongoing fluid and electrolyte
replacement. The sodium level is normal and the potassium level is slightly elevated, which
could be normal findings for someone with acute kidney injury. A pulse rate of 88 beats/min is
within usual limits.
9. The nurse is caring for four clients with chronic kidney disease (CKD). Which client would the
nurse assess first upon initial rounding?
a. Client with a blood pressure of 158/90 mm Hg
b. Client with Kussmaul respirations
c. Client with skin itching from head to toe
d. Client with halitosis and stomatitis - Answer ANS: B
Kussmaul respirations indicate that the client has metabolic acidosis which is a complication of
CKD. The client is increasing the rate and depth of breathing to excrete carbon dioxide through
the lungs to lower serum pH. Hypertension is common in most patients with CKD, and skin
itching increases with calcium-phosphate imbalances and elevations of nitrogenous wastes,
another common finding in CKD. Uremia from CKD causes ammonia to be formed, resulting in
the common findings of halitosis and stomatitis.
10. The nurse is teaching assistive personnel (AP) about fluid restriction for a client who has
acute kidney injury (AKI). The client's 24-hour urinary output is 120 mL. How much fluid would
the client be allowed to have over the next 24 hours?
a. 380 mL
b. 500 mL
c. 620 mL
d. 750 mL - Answer ANS: C
, The general principle for fluid restriction for clients is that they may have a daily fluid intake of
500 mL plus the amount of their urinary output. In this case, 120 mL urinary output plus 500 mL
equals 620 mL fluid allowance.
11. A client with chronic kidney disease (CKD) is refusing to take his medication and has missed
two hemodialysis appointments. What is the best initial action for the nurse?
a. Discuss what the treatment regimen means to the client.
b. Refer the client to a mental health nurse practitioner.
c. Reschedule the appointments to another date and time.
d. Discuss the option of peritoneal dialysis. - Answer ANS: A
The initial action for the nurse is to assess anxiety, coping styles, and the client's acceptance of
the required treatment for CKD. The client may be in denial of the diagnosis. While rescheduling
hemodialysis appointments may help, and referral to a mental health practitioner and the
possibility of peritoneal dialysis are all viable options, assessment of the client's acceptance of
the treatment would come first.
12. A client is taking furosemide 40 mg/day for management of early chronic kidney disease
(CKD). To assess the therapeutic effect of the medication, what action of the nurse is best?
a. Obtain daily weights of the client.
b. Auscultate heart and breath sounds.
c. Palpate the client's abdomen.
d. Assess the client's diet history. - Answer ANS: A
Furosemide is a loop diuretic that helps reduce fluid overload and hypertension in patients with
early stages of CKD. One kilogram of weight equals about 1 L of fluid retained in the client, so
daily weights are necessary to monitor the response of the client to the medication. Heart and
breath sounds would be assessed if there is fluid retention, as in heart failure. Palpation of the
client's abdomen is not necessary, but the nurse would check for edema. The diet history of the
client would be helpful to assess electrolyte replacement since potassium is lost with this
diuretic, but this does not assess the effectiveness of the medication.
13. A 70-kg adult client with chronic kidney disease (CKD) is on a 40-g protein diet. The patient
has a reduced glomerular filtration rate and is not undergoing dialysis. Which result would be of
most concern to the nurse?
a. Albumin level of 2.5 g/dL (3.63 mcmol/L)
b. Phosphorus level of 5 mg/dL (1.62 mmol/L)
c. Sodium level of 135 mEq/L (135 mmol/L)
d. Potassium level of 5.5 mEq/L (5.5 mmol/L) - Answer ANS: A
Protein restriction is necessary with CKD due to the buildup of waste products from protein
breakdown. The nurse would be concerned with the low albumin level since this indicates that
the protein in the diet is not enough for the client's metabolic needs. The electrolyte values are
not related to the protein-restricted diet.
Actual Detailed Answers 2026-2027
Update.
1. The nurse is assessing a client with a diagnosis of prerenal acute kidney injury (AKI). Which
condition would the nurse expect to find in the patient's recent history?
a. Pyelonephritis
b. Dehydration
c. Bladder cancer
d. Kidney stones - Answer ANS: B
Prerenal causes of AKI are related to a decrease in perfusion, such as in clients who have
prolonged dehydration. Pyelonephritis is an intrinsic or intrarenal cause of AKI related to kidney
damage. Bladder cancer and kidney stones are postrenal causes of AKI related to urine flow
obstruction.
2. A marathon runner comes into the clinic and states "I have not urinated very much in the last
few days." The nurse notes a heart rate of 110 beats/min and a blood pressure of 86/58 mm Hg.
Which action by the nurse is most appropriate?
a. Give the client a bottle of water immediately.
b. Start an intravenous line for fluids.
c. Teach the patient to drink 2 to 3 L of water daily.
d. Perform an electrocardiogram. - Answer ANS: A
This athlete is mildly dehydrated as evidenced by the higher heart rate and lower blood
pressure. The nurse can start hydrating the client with a bottle of water first, followed by
teaching the patient to drink 2 to 3 L of water each day. An intravenous line may be needed
later, after the patient's degree of dehydration is assessed. An electrocardiogram is not
necessary at this time.
3. A client comes into the emergency department with a serum creatinine of 2.2 mg/dL (1944
mcmol/L) and a blood urea nitrogen (BUN) of 24 mL/dL (8.57 mmol/L). What question would
the nurse ask first when taking this client's history?
a. "Have you been taking any aspirin, ibuprofen, or naproxen recently?"
b. "Do you have anyone in your family with renal failure?"
c. "Have you had a diet that is low in protein recently?"
d. "Has a relative had a kidney transplant lately?" - Answer ANS: A
There are some medications that are nephrotoxic, such as the nonsteroidal anti-inflammatory
drugs ibuprofen, aspirin, and naproxen. This would be a good question to initially ask the
patient since both the serum creatinine and BUN are elevated, indicating some renal problems.
A diet high in protein could be a factor in an increased BUN.
,4. A client is admitted with acute kidney injury (AKI) and a urine output of 2000 mL/day. What is
the major concern of the nurse regarding this patient's care?
a. Edema and pain
b. Cardiac and respiratory status
c. Electrolyte and fluid imbalance
d. Mental health status - Answer ANS: C
This client may have an inflammatory cause of AKI with proteins entering the glomerulus and
holding the fluid in the filtrate, causing polyuria. Electrolyte loss and fluid balance are essential.
Edema and pain are not usually a problem with fluid loss. There could be changes in the client's
cardiac, respiratory, and mental health status if the electrolyte imbalance is not treated.
5. A client with acute kidney injury (AKI) has a blood pressure of 76/55 mm Hg. The primary
health care provider prescribed 1000 mL of normal saline to be infused over 1 hour to maintain
perfusion. The client starts to develop shortness of breath. What is the nurse's priority action?
a. Calculate the mean arterial pressure (MAP).
b. Ask for insertion of a pulmonary artery catheter.
c. Take the client's pulse.
d. Decrease the rate of the IV infusion. - Answer ANS: D
The nurse would assess that the client could be developing fluid overload and respiratory
distress and slow down the normal saline infusion. The calculation of the MAP also reflects
perfusion. The insertion of a pulmonary artery catheter would evaluate the client's
hemodynamic status, but this would not be the initial or priority action by the nurse. Vital signs
are also important after adjusting the intravenous infusion.
6. A client has a serum potassium level of 6.5 mEq/L (6.5 mmol/L), a serum creatinine level of 2
mg/dL (176 mcmol/L), and a urine output of 350 mL/day. What is the best action by the nurse?
a. Place the client on a cardiac monitor immediately.
b. Teach the client to limit high-potassium foods.
c. Continue to monitor the client's intake and output.
d. Ask to have the laboratory redraw the blood specimen. - Answer ANS: A
The best action by the nurse would be to check the cardiac status with a monitor. High-
potassium levels can lead to dysrhythmias. The other choices are logical nursing interventions
for acute kidney injury but not the best immediate action.
7. A client with diabetes mellitus type 2 has been well controlled with metformin. The client is
scheduled for magnetic resonance imaging (MRI) scan with contrast. What priority would the
nurse take at this time?
a. Teach the client about the purpose of the MRI.
b. Assess the client's blood urea nitrogen and creatinine.
,c. Tell the client to withhold metformin for 24 hours before the MRI.
d. Ask the client if he or she is taking antibiotics. - Answer ANS: C
Contrast media can be nephrotoxic (damaging to the kidneys). Metformin can also be
nephrotoxic and the client should not be exposed to two agents. Clients who have diabetes are
already at risk for renal damage.
8. A client is started on continuous venovenous hemofiltration (CVVH). Which finding would
require immediate action by the nurse?
a. Potassium level of 5.5 mEq/L (5.5 mmol/L)
b. Sodium level of 138 mEq/L (138 mmol/L)
c. Blood pressure of 76/58 mm Hg
d. Pulse rate of 88 beats/min - Answer ANS: C
Hypotension can be a problem with CVVH if replacement fluid does not provide enough volume
to maintain blood pressure. The nurse needs to monitor for ongoing fluid and electrolyte
replacement. The sodium level is normal and the potassium level is slightly elevated, which
could be normal findings for someone with acute kidney injury. A pulse rate of 88 beats/min is
within usual limits.
9. The nurse is caring for four clients with chronic kidney disease (CKD). Which client would the
nurse assess first upon initial rounding?
a. Client with a blood pressure of 158/90 mm Hg
b. Client with Kussmaul respirations
c. Client with skin itching from head to toe
d. Client with halitosis and stomatitis - Answer ANS: B
Kussmaul respirations indicate that the client has metabolic acidosis which is a complication of
CKD. The client is increasing the rate and depth of breathing to excrete carbon dioxide through
the lungs to lower serum pH. Hypertension is common in most patients with CKD, and skin
itching increases with calcium-phosphate imbalances and elevations of nitrogenous wastes,
another common finding in CKD. Uremia from CKD causes ammonia to be formed, resulting in
the common findings of halitosis and stomatitis.
10. The nurse is teaching assistive personnel (AP) about fluid restriction for a client who has
acute kidney injury (AKI). The client's 24-hour urinary output is 120 mL. How much fluid would
the client be allowed to have over the next 24 hours?
a. 380 mL
b. 500 mL
c. 620 mL
d. 750 mL - Answer ANS: C
, The general principle for fluid restriction for clients is that they may have a daily fluid intake of
500 mL plus the amount of their urinary output. In this case, 120 mL urinary output plus 500 mL
equals 620 mL fluid allowance.
11. A client with chronic kidney disease (CKD) is refusing to take his medication and has missed
two hemodialysis appointments. What is the best initial action for the nurse?
a. Discuss what the treatment regimen means to the client.
b. Refer the client to a mental health nurse practitioner.
c. Reschedule the appointments to another date and time.
d. Discuss the option of peritoneal dialysis. - Answer ANS: A
The initial action for the nurse is to assess anxiety, coping styles, and the client's acceptance of
the required treatment for CKD. The client may be in denial of the diagnosis. While rescheduling
hemodialysis appointments may help, and referral to a mental health practitioner and the
possibility of peritoneal dialysis are all viable options, assessment of the client's acceptance of
the treatment would come first.
12. A client is taking furosemide 40 mg/day for management of early chronic kidney disease
(CKD). To assess the therapeutic effect of the medication, what action of the nurse is best?
a. Obtain daily weights of the client.
b. Auscultate heart and breath sounds.
c. Palpate the client's abdomen.
d. Assess the client's diet history. - Answer ANS: A
Furosemide is a loop diuretic that helps reduce fluid overload and hypertension in patients with
early stages of CKD. One kilogram of weight equals about 1 L of fluid retained in the client, so
daily weights are necessary to monitor the response of the client to the medication. Heart and
breath sounds would be assessed if there is fluid retention, as in heart failure. Palpation of the
client's abdomen is not necessary, but the nurse would check for edema. The diet history of the
client would be helpful to assess electrolyte replacement since potassium is lost with this
diuretic, but this does not assess the effectiveness of the medication.
13. A 70-kg adult client with chronic kidney disease (CKD) is on a 40-g protein diet. The patient
has a reduced glomerular filtration rate and is not undergoing dialysis. Which result would be of
most concern to the nurse?
a. Albumin level of 2.5 g/dL (3.63 mcmol/L)
b. Phosphorus level of 5 mg/dL (1.62 mmol/L)
c. Sodium level of 135 mEq/L (135 mmol/L)
d. Potassium level of 5.5 mEq/L (5.5 mmol/L) - Answer ANS: A
Protein restriction is necessary with CKD due to the buildup of waste products from protein
breakdown. The nurse would be concerned with the low albumin level since this indicates that
the protein in the diet is not enough for the client's metabolic needs. The electrolyte values are
not related to the protein-restricted diet.
