NMNC 4510 Concept Synthesis Test Questions with Correct Answers Already Passed
Which statement explains why metabolic acidosis develops with kidney failure?
1. Inability of the renal tubules to secrete hydrogen ions and conserve bicarbonate
2. Depressed respiratory rate due to metabolic wastes, causing carbon dioxide retention
3. Inability of the renal tubules to reabsorb water to dilute the acid contents of blood
4. Impaired glomerular filtration, causing retention of sodium and metabolic waste products - Answers
Inability of the renal tubules to secrete hydrogen ions and conserve bicarbonate
Rationale:
Bicarbonate buffering is limited, hydrogen ions accumulate, and acidosis results. The rate of respirations
increases in metabolic acidosis to compensate for a low pH. The fluid balance does not significantly alter
the pH. The retention of sodium ions is related to fluid retention and edema rather than to acidosis.
A client is admitted to the hospital in the oliguric phase of acute kidney injury. The client's urine output
for the past 12 hours was 200 mL. The nurse notes a prescription for 900 mL of oral fluids over the next
24 hours. Which interpretation of the amount of prescribed fluid would the nurse make?
1. It equals the expected urinary output for the next 24 hours.
2. It will prevent the development of pneumonia and a high fever.
3. It will compensate for both insensible and expected output over the next 24 hours.
,4. It will reduce hyperkalemia, which can lead to life-threatening cardiac dysrhythmias. - Answers It will
compensate for both insensible and expected output over the next 24 hours.
Rationale:
Insensible losses are 500 mL to 1000 mL in 24 hours, with an average of about 600 mL; the measured
output is about 400 mL in 24 hours based on the available history (about 200 mL in 12 hours). Based on
the history, the expected urinary output should be about 400 mL in the next 24 hours, far less than 900
mL. More than 900 mL daily is necessary to help prevent pneumonia and its associated fever.
Hyperkalemia in acute kidney injury is caused by inadequate glomerular filtration and is not related to
fluid intake.
Which complication is the most serious for a client with kidney failure?
1. Anemia
2. Weight loss
3. Uremic frost
4. Hyperkalemia - Answers Hyperkalemia
Rationale:
Decreased glomerular filtration leads to hyperkalemia, which may cause lethal dysrhythmias such as
cardiac arrest. Anemia may occur but is not the most serious complication and should be treated in
relation to the client's clinical manifestation; erythropoietin and iron supplements usually are used.
Weight loss alone is not life threatening. Uremic frost, a layer of urea crystals on the skin, causes itching,
but it is not the most serious complication.
A client with a history of chronic kidney disease is hospitalized. Which assessment findings would alert
the nurse to suspect kidney insufficiency?
1. Facial flushing
,2. Edema and pruritus
3. Dribbling after voiding
4. Diminished force of urination - Answers Edema and pruritus
Rationale:
The accumulation of metabolic wastes in the blood (uremia) can cause pruritus; edema results from
fluid overload caused by impaired urine production. Pallor, not flushing, occurs with chronic kidney
disease as a result of anemia. Dribbling after voiding is a urinary pattern that is not caused by chronic
kidney disease; this may occur with prostate problems. Diminished force and caliber of stream occur
with an enlarged prostate, not kidney disease.
A client who has chronic kidney failure is to be treated with continuous ambulatory peritoneal dialysis
(CAPD). Which statement by the client indicates understanding of the therapy?
1. "It provides continuous contact of dialyzer and blood to clear toxins by ultrafiltration."
2. "It exchanges and cleanses blood by correction of electrolytes and excretion of creatinine."
3. "It decreases the need for immobility because it clears toxins in short and intermittent periods."
4. "It uses the peritoneum as a semipermeable membrane to clear toxins by osmosis and diffusion." -
Answers "It uses the peritoneum as a semipermeable membrane to clear toxins by osmosis and
diffusion."
Rationale:
Diffusion moves particles from an area of greater concentration to an area of lesser concentration;
osmosis moves fluid from an area of lesser to an area of greater concentration of particles, thereby
, removing waste products into the dialysate, which is then drained from the abdomen. The principle of
ultrafiltration involves a pressure gradient, which is associated with hemodialysis, not peritoneal dialysis.
Peritoneal dialysis uses the peritoneal membrane to indirectly cleanse the blood. Dialysate does not
clear toxins in a short time; exchanges may occur four or five times a day.
Which hormone influences kidney function?
1. Renin
2. Bradykinin
3. Aldosterone
4. Erythropoietin - Answers Aldosterone
Rationale:
Released from the adrenal cortex, aldosterone influences kidney function. Renin, bradykinin, and
erythropoietin are kidney hormones.
Which process is a function of the kidney hormones?
1. Prostaglandin increases blood flow and vascular permeability.
2. Bradykinin regulates intrarenal blood flow via vasodilation or vasoconstriction.
3. Renin raises blood pressure because of angiotensin and aldosterone secretion.
4. Erythropoietin promotes calcium absorption in the gastrointestinal tract tract. - Answers Renin raises
blood pressure because of angiotensin and aldosterone secretion.
Which statement explains why metabolic acidosis develops with kidney failure?
1. Inability of the renal tubules to secrete hydrogen ions and conserve bicarbonate
2. Depressed respiratory rate due to metabolic wastes, causing carbon dioxide retention
3. Inability of the renal tubules to reabsorb water to dilute the acid contents of blood
4. Impaired glomerular filtration, causing retention of sodium and metabolic waste products - Answers
Inability of the renal tubules to secrete hydrogen ions and conserve bicarbonate
Rationale:
Bicarbonate buffering is limited, hydrogen ions accumulate, and acidosis results. The rate of respirations
increases in metabolic acidosis to compensate for a low pH. The fluid balance does not significantly alter
the pH. The retention of sodium ions is related to fluid retention and edema rather than to acidosis.
A client is admitted to the hospital in the oliguric phase of acute kidney injury. The client's urine output
for the past 12 hours was 200 mL. The nurse notes a prescription for 900 mL of oral fluids over the next
24 hours. Which interpretation of the amount of prescribed fluid would the nurse make?
1. It equals the expected urinary output for the next 24 hours.
2. It will prevent the development of pneumonia and a high fever.
3. It will compensate for both insensible and expected output over the next 24 hours.
,4. It will reduce hyperkalemia, which can lead to life-threatening cardiac dysrhythmias. - Answers It will
compensate for both insensible and expected output over the next 24 hours.
Rationale:
Insensible losses are 500 mL to 1000 mL in 24 hours, with an average of about 600 mL; the measured
output is about 400 mL in 24 hours based on the available history (about 200 mL in 12 hours). Based on
the history, the expected urinary output should be about 400 mL in the next 24 hours, far less than 900
mL. More than 900 mL daily is necessary to help prevent pneumonia and its associated fever.
Hyperkalemia in acute kidney injury is caused by inadequate glomerular filtration and is not related to
fluid intake.
Which complication is the most serious for a client with kidney failure?
1. Anemia
2. Weight loss
3. Uremic frost
4. Hyperkalemia - Answers Hyperkalemia
Rationale:
Decreased glomerular filtration leads to hyperkalemia, which may cause lethal dysrhythmias such as
cardiac arrest. Anemia may occur but is not the most serious complication and should be treated in
relation to the client's clinical manifestation; erythropoietin and iron supplements usually are used.
Weight loss alone is not life threatening. Uremic frost, a layer of urea crystals on the skin, causes itching,
but it is not the most serious complication.
A client with a history of chronic kidney disease is hospitalized. Which assessment findings would alert
the nurse to suspect kidney insufficiency?
1. Facial flushing
,2. Edema and pruritus
3. Dribbling after voiding
4. Diminished force of urination - Answers Edema and pruritus
Rationale:
The accumulation of metabolic wastes in the blood (uremia) can cause pruritus; edema results from
fluid overload caused by impaired urine production. Pallor, not flushing, occurs with chronic kidney
disease as a result of anemia. Dribbling after voiding is a urinary pattern that is not caused by chronic
kidney disease; this may occur with prostate problems. Diminished force and caliber of stream occur
with an enlarged prostate, not kidney disease.
A client who has chronic kidney failure is to be treated with continuous ambulatory peritoneal dialysis
(CAPD). Which statement by the client indicates understanding of the therapy?
1. "It provides continuous contact of dialyzer and blood to clear toxins by ultrafiltration."
2. "It exchanges and cleanses blood by correction of electrolytes and excretion of creatinine."
3. "It decreases the need for immobility because it clears toxins in short and intermittent periods."
4. "It uses the peritoneum as a semipermeable membrane to clear toxins by osmosis and diffusion." -
Answers "It uses the peritoneum as a semipermeable membrane to clear toxins by osmosis and
diffusion."
Rationale:
Diffusion moves particles from an area of greater concentration to an area of lesser concentration;
osmosis moves fluid from an area of lesser to an area of greater concentration of particles, thereby
, removing waste products into the dialysate, which is then drained from the abdomen. The principle of
ultrafiltration involves a pressure gradient, which is associated with hemodialysis, not peritoneal dialysis.
Peritoneal dialysis uses the peritoneal membrane to indirectly cleanse the blood. Dialysate does not
clear toxins in a short time; exchanges may occur four or five times a day.
Which hormone influences kidney function?
1. Renin
2. Bradykinin
3. Aldosterone
4. Erythropoietin - Answers Aldosterone
Rationale:
Released from the adrenal cortex, aldosterone influences kidney function. Renin, bradykinin, and
erythropoietin are kidney hormones.
Which process is a function of the kidney hormones?
1. Prostaglandin increases blood flow and vascular permeability.
2. Bradykinin regulates intrarenal blood flow via vasodilation or vasoconstriction.
3. Renin raises blood pressure because of angiotensin and aldosterone secretion.
4. Erythropoietin promotes calcium absorption in the gastrointestinal tract tract. - Answers Renin raises
blood pressure because of angiotensin and aldosterone secretion.
