NSG 4100 Exam 1 | Comprehensive Practice
Exam 2025-2026 Academic Year | Adult
Health III
Total Questions: 84 | All Answers Verified
UNIT 1: COMPLEX ELIMINATION (RENAL SYSTEM)
Questions 1-35
1. The nurse is caring for a client with end-stage renal disease (ESRD) who has developed uremia.
Which assessment finding would the nurse expect to find?
A. Increased energy levels and euphoria
B. Metallic taste in the mouth and pruritus
C. Hyperactive bowel sounds and diarrhea
D. Increased appetite and weight gain
Answer: B. Metallic taste in the mouth and pruritus are classic signs of uremia. Uremia causes metabolic
waste accumulation, leading to gastrointestinal symptoms (metallic taste, nausea, anorexia) and
integumentary manifestations (pruritus, uremic frost). Options A, C, and D are incorrect as uremia
typically causes fatigue, constipation, and anorexia .
2. A client with ESRD has just returned from hemodialysis. Which assessment finding requires
immediate intervention?
A. Pulse rate of 88 beats per minute
B. Temperature of 98.6°F (37°C)
C. Potassium level decreased from 6.1 to 5.1 mEq/L
D. Reports of headache and blurred vision
Answer: D. Headache and blurred vision may indicate dialysis disequilibrium syndrome or increased
intracranial pressure, requiring immediate intervention. A potassium decrease from 6.1 to 5.1 is
expected after dialysis. Normal pulse and temperature are reassuring .
3. The nurse is assessing a client with chronic kidney disease (CKD). Which laboratory finding is most
consistent with metabolic acidosis?
A. pH 7.38, PaCO2 40, HCO3 24
,B. pH 7.25, PaCO2 36, HCO3 18
C. pH 7.48, PaCO2 42, HCO3 30
D. pH 7.30, PaCO2 50, HCO3 24
Answer: B. pH 7.25 (acidosis) with low HCO3 18 indicates metabolic acidosis, common in CKD due to
decreased acid excretion and bicarbonate regeneration. Option A is normal. Option C indicates alkalosis.
Option D suggests respiratory acidosis .
4. A client with ESRD has a serum potassium of 6.2 mEq/L. Which action should the nurse take first?
A. Administer sodium polystyrene sulfonate (Kayexalate)
B. Notify the healthcare provider immediately
C. Review the client's telemetry for peaked T waves
D. Prepare the client for emergency hemodialysis
Answer: C. The nurse should first assess the client's cardiac status by reviewing telemetry for signs of
hyperkalemia (peaked T waves, widened QRS). This assessment guides subsequent interventions. While
notification and treatment are important, assessment is the priority .
5. The nurse is providing dietary teaching for a client with stage 4 CKD. Which food should the client
avoid?
A. Grilled chicken breast
B. Baked potato
C. White bread
D. Apple juice
Answer: B. Baked potatoes are high in potassium and should be avoided or restricted in clients with
advanced CKD. Grilled chicken (moderate protein), white bread, and apple juice are generally better
tolerated, though protein may need monitoring .
6. A client with ESRD asks why erythropoietin injections are needed. Which response by the nurse is
most accurate?
A. "Your kidneys are not producing enough erythropoietin for red blood cell production."
B. "The dialysis process destroys red blood cells, so you need replacement."
C. "You are losing blood through your gastrointestinal tract."
D. "The medications you take interfere with vitamin B12 absorption."
Answer: A. The kidneys produce erythropoietin, which stimulates bone marrow to produce RBCs. In
ESRD, erythropoietin production decreases, leading to anemia. Options B, C, and D are not the primary
mechanisms .
7. The nurse is caring for a client receiving hemodialysis via an arteriovenous (AV) fistula. Which
assessment finding indicates fistula patency?
, A. Absence of bruit on auscultation
B. Palpation of a thrill over the fistula site
C. Coolness and pallor of the affected arm
D. Capillary refill greater than 3 seconds
Answer: B. A palpable thrill and audible bruit indicate patency and adequate blood flow through the AV
fistula. Absent bruit, coolness, pallor, or delayed capillary refill suggest complications .
8. A client with chronic renal failure is prescribed sodium polystyrene sulfonate (Kayexalate). The
nurse understands this medication works by:
A. Releasing bicarbonate in exchange for sodium ions
B. Releasing sodium ions in exchange for potassium ions
C. Binding phosphorus in the gastrointestinal tract
D. Increasing calcium absorption from the intestines
Answer: B. Kayexalate works by exchanging sodium ions for potassium ions in the bowel, reducing
serum potassium levels. It does not affect bicarbonate, phosphorus, or calcium directly .
9. The nurse is caring for a client undergoing peritoneal dialysis. The client asks why blood glucose
levels are monitored. Which response is most appropriate?
A. "We monitor to check if you have developed diabetes."
B. "The dialysate contains glucose, which can affect your blood sugar."
C. "Dialysis lowers blood glucose, so we need to prevent hypoglycemia."
D. "It's a routine procedure for all clients undergoing dialysis."
Answer: B. Peritoneal dialysis solutions contain high concentrations of glucose to create an osmotic
gradient for fluid removal. This glucose can be absorbed systemically, affecting blood glucose levels.
Monitoring is essential, especially in diabetic patients .
10. A client with CKD has a hemoglobin of 9.2 g/dL and reports increasing fatigue. Which prescription
should the nurse anticipate?
A. Oral ferrous sulfate twice daily
B. Packed red blood cell transfusion
C. Epoetin alfa (Epogen) subcutaneously
D. Vitamin B12 injections weekly
Answer: C. Anemia in CKD is primarily due to decreased erythropoietin production. Epoetin alfa
(recombinant human erythropoietin) is the treatment of choice. Iron supplements may be given
adjunctively. Transfusions are reserved for severe anemia. Vitamin B12 deficiency is not the primary
cause .
Exam 2025-2026 Academic Year | Adult
Health III
Total Questions: 84 | All Answers Verified
UNIT 1: COMPLEX ELIMINATION (RENAL SYSTEM)
Questions 1-35
1. The nurse is caring for a client with end-stage renal disease (ESRD) who has developed uremia.
Which assessment finding would the nurse expect to find?
A. Increased energy levels and euphoria
B. Metallic taste in the mouth and pruritus
C. Hyperactive bowel sounds and diarrhea
D. Increased appetite and weight gain
Answer: B. Metallic taste in the mouth and pruritus are classic signs of uremia. Uremia causes metabolic
waste accumulation, leading to gastrointestinal symptoms (metallic taste, nausea, anorexia) and
integumentary manifestations (pruritus, uremic frost). Options A, C, and D are incorrect as uremia
typically causes fatigue, constipation, and anorexia .
2. A client with ESRD has just returned from hemodialysis. Which assessment finding requires
immediate intervention?
A. Pulse rate of 88 beats per minute
B. Temperature of 98.6°F (37°C)
C. Potassium level decreased from 6.1 to 5.1 mEq/L
D. Reports of headache and blurred vision
Answer: D. Headache and blurred vision may indicate dialysis disequilibrium syndrome or increased
intracranial pressure, requiring immediate intervention. A potassium decrease from 6.1 to 5.1 is
expected after dialysis. Normal pulse and temperature are reassuring .
3. The nurse is assessing a client with chronic kidney disease (CKD). Which laboratory finding is most
consistent with metabolic acidosis?
A. pH 7.38, PaCO2 40, HCO3 24
,B. pH 7.25, PaCO2 36, HCO3 18
C. pH 7.48, PaCO2 42, HCO3 30
D. pH 7.30, PaCO2 50, HCO3 24
Answer: B. pH 7.25 (acidosis) with low HCO3 18 indicates metabolic acidosis, common in CKD due to
decreased acid excretion and bicarbonate regeneration. Option A is normal. Option C indicates alkalosis.
Option D suggests respiratory acidosis .
4. A client with ESRD has a serum potassium of 6.2 mEq/L. Which action should the nurse take first?
A. Administer sodium polystyrene sulfonate (Kayexalate)
B. Notify the healthcare provider immediately
C. Review the client's telemetry for peaked T waves
D. Prepare the client for emergency hemodialysis
Answer: C. The nurse should first assess the client's cardiac status by reviewing telemetry for signs of
hyperkalemia (peaked T waves, widened QRS). This assessment guides subsequent interventions. While
notification and treatment are important, assessment is the priority .
5. The nurse is providing dietary teaching for a client with stage 4 CKD. Which food should the client
avoid?
A. Grilled chicken breast
B. Baked potato
C. White bread
D. Apple juice
Answer: B. Baked potatoes are high in potassium and should be avoided or restricted in clients with
advanced CKD. Grilled chicken (moderate protein), white bread, and apple juice are generally better
tolerated, though protein may need monitoring .
6. A client with ESRD asks why erythropoietin injections are needed. Which response by the nurse is
most accurate?
A. "Your kidneys are not producing enough erythropoietin for red blood cell production."
B. "The dialysis process destroys red blood cells, so you need replacement."
C. "You are losing blood through your gastrointestinal tract."
D. "The medications you take interfere with vitamin B12 absorption."
Answer: A. The kidneys produce erythropoietin, which stimulates bone marrow to produce RBCs. In
ESRD, erythropoietin production decreases, leading to anemia. Options B, C, and D are not the primary
mechanisms .
7. The nurse is caring for a client receiving hemodialysis via an arteriovenous (AV) fistula. Which
assessment finding indicates fistula patency?
, A. Absence of bruit on auscultation
B. Palpation of a thrill over the fistula site
C. Coolness and pallor of the affected arm
D. Capillary refill greater than 3 seconds
Answer: B. A palpable thrill and audible bruit indicate patency and adequate blood flow through the AV
fistula. Absent bruit, coolness, pallor, or delayed capillary refill suggest complications .
8. A client with chronic renal failure is prescribed sodium polystyrene sulfonate (Kayexalate). The
nurse understands this medication works by:
A. Releasing bicarbonate in exchange for sodium ions
B. Releasing sodium ions in exchange for potassium ions
C. Binding phosphorus in the gastrointestinal tract
D. Increasing calcium absorption from the intestines
Answer: B. Kayexalate works by exchanging sodium ions for potassium ions in the bowel, reducing
serum potassium levels. It does not affect bicarbonate, phosphorus, or calcium directly .
9. The nurse is caring for a client undergoing peritoneal dialysis. The client asks why blood glucose
levels are monitored. Which response is most appropriate?
A. "We monitor to check if you have developed diabetes."
B. "The dialysate contains glucose, which can affect your blood sugar."
C. "Dialysis lowers blood glucose, so we need to prevent hypoglycemia."
D. "It's a routine procedure for all clients undergoing dialysis."
Answer: B. Peritoneal dialysis solutions contain high concentrations of glucose to create an osmotic
gradient for fluid removal. This glucose can be absorbed systemically, affecting blood glucose levels.
Monitoring is essential, especially in diabetic patients .
10. A client with CKD has a hemoglobin of 9.2 g/dL and reports increasing fatigue. Which prescription
should the nurse anticipate?
A. Oral ferrous sulfate twice daily
B. Packed red blood cell transfusion
C. Epoetin alfa (Epogen) subcutaneously
D. Vitamin B12 injections weekly
Answer: C. Anemia in CKD is primarily due to decreased erythropoietin production. Epoetin alfa
(recombinant human erythropoietin) is the treatment of choice. Iron supplements may be given
adjunctively. Transfusions are reserved for severe anemia. Vitamin B12 deficiency is not the primary
cause .
