NP3 Exam 1 Questions with Answers |\ |\ |\ |\ |\
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 - CORRECT ANSWERS ✔✔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. - CORRECT ANSWERS ✔✔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?" - CORRECT
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
ANSWERS ✔✔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 - CORRECT ANSWERS ✔✔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. - CORRECT ANSWERS
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
✔✔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. -
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
CORRECT ANSWERS ✔✔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. - CORRECT
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
ANSWERS ✔✔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)
|\ |\ |\ |\ |\ |\ |\
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 - CORRECT ANSWERS ✔✔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. - CORRECT ANSWERS ✔✔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?" - CORRECT
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
ANSWERS ✔✔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 - CORRECT ANSWERS ✔✔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. - CORRECT ANSWERS
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
✔✔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. -
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
CORRECT ANSWERS ✔✔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. - CORRECT
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
ANSWERS ✔✔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)
|\ |\ |\ |\ |\ |\ |\
