NSG 4100 (AH III) Exam 1
1. The nurse is caring for a client with End-Stage Renal Disease (ESRD) who is receiving
hemodialysis. The nurse notes the client has developed anemia. What is the primary cause of
anemia in this client?
A. Increased destruction of red blood cells by the dialysis machine B. Inability of the
kidneys to produce erythropoietin C. Chronic blood loss during the hemodialysis
procedure D. Inadequate intake of iron and folic acid
Annotation: The kidneys produce ERYTHROPOIETIN, which stimulates the bone
marrow to make RBCs. In ESRD, this production stops, leading to anemia. Treatment
often includes Epogen or Procrit.
2. A client with Acute Kidney Injury (AKI) is in the oliguric phase. Which of the following
laboratory findings should the nurse expect?
A. Hypokalemia and hypernatremia B. Hyperkalemia and metabolic acidosis C.
Decreased BUN and creatinine D. Increased urine specific gravity
Annotation: OLIGURIC = <400mL/day. Potassium builds up (Hyperkalemia) because
it’s not being excreted. Acidosis occurs because the kidneys can’t excrete hydrogen
ions or reabsorb bicarbonate.
3. The nurse is assessing a client with Cushing’s Syndrome. Which of the following clinical
manifestations is most characteristic of this disorder?
A. Weight loss and hypotension B. Moon face and buffalo hump C. Hyperpigmentation of
the skin D. Tachycardia and tremors
Annotation: CUSHING’S = TOO MUCH CORTISOL (STEROIDS). Think “Cushy” - extra
fat on the face (moon face), back (buffalo hump), and trunk (truncal obesity).
4. A client is admitted with a suspected Addisonian Crisis. Which of the following
interventions is the priority?
A. Rapid IV administration of hydrocortisone and fluids B. Administration of oral
glucose for hypoglycemia C. Monitoring for signs of infection D. Teaching the client about
long-term steroid therapy
, Annotation: ADDISON’S = NOT ENOUGH STEROIDS. A crisis is a medical emergency!
They need steroids (Hydrocortisone) and fluids (NS/D5NS) NOW to prevent
circulatory collapse.
5. The nurse is caring for a client who just returned from a renal biopsy. Which of the
following is the priority nursing action?
A. Encourage the client to ambulate immediately B. Maintain the client in a high-Fowler’s
position C. Monitor for signs of internal bleeding and hematuria D. Administer a
prophylactic antibiotic
Annotation: The kidney is highly vascular! Bleeding is the #1 risk. Keep them on the
AFFECTED side (pressure) and check for flank pain or blood in the urine.
6. A client with Chronic Kidney Disease (CKD) is prescribed Sevelamer (Renagel). The nurse
should instruct the client to take this medication:
A. On an empty stomach, 1 hour before meals B. With meals to bind phosphate in food C.
At bedtime with a full glass of water D. Only when they have symptoms of itching
Annotation: Renagel is a PHOSPHATE BINDER. It must be taken WITH FOOD to
work. High phosphate leads to low calcium and bone disease (Renal
Osteodystrophy).
7. The nurse is assessing a client with Diabetes Insipidus (DI). Which of the following findings
is consistent with this diagnosis?
A. High urine specific gravity and low urine output B. Low urine specific gravity and
massive polyuria C. Hyperglycemia and ketonuria D. Fluid volume overload and
hypertension
Annotation: DI = “Dry Inside.” Not enough ADH. They pee out liters of dilute urine
(Specific Gravity < 1.005). They are at high risk for dehydration and hypernatremia.
8. A client is diagnosed with SIADH (Syndrome of Inappropriate Antidiuretic Hormone). The
nurse should anticipate which of the following orders?
A. Rapid IV fluid resuscitation with Normal Saline B. Fluid restriction and administration
of 3% Saline C. Administration of Vasopressin D. Encouraging increased oral fluid intake
Annotation: SIADH = “Soaked Inside.” Too much ADH. They hold onto water, which
dilutes their sodium (Hyponatremia). 3% Saline (Hypertonic) is used carefully to
raise sodium levels.
1. The nurse is caring for a client with End-Stage Renal Disease (ESRD) who is receiving
hemodialysis. The nurse notes the client has developed anemia. What is the primary cause of
anemia in this client?
A. Increased destruction of red blood cells by the dialysis machine B. Inability of the
kidneys to produce erythropoietin C. Chronic blood loss during the hemodialysis
procedure D. Inadequate intake of iron and folic acid
Annotation: The kidneys produce ERYTHROPOIETIN, which stimulates the bone
marrow to make RBCs. In ESRD, this production stops, leading to anemia. Treatment
often includes Epogen or Procrit.
2. A client with Acute Kidney Injury (AKI) is in the oliguric phase. Which of the following
laboratory findings should the nurse expect?
A. Hypokalemia and hypernatremia B. Hyperkalemia and metabolic acidosis C.
Decreased BUN and creatinine D. Increased urine specific gravity
Annotation: OLIGURIC = <400mL/day. Potassium builds up (Hyperkalemia) because
it’s not being excreted. Acidosis occurs because the kidneys can’t excrete hydrogen
ions or reabsorb bicarbonate.
3. The nurse is assessing a client with Cushing’s Syndrome. Which of the following clinical
manifestations is most characteristic of this disorder?
A. Weight loss and hypotension B. Moon face and buffalo hump C. Hyperpigmentation of
the skin D. Tachycardia and tremors
Annotation: CUSHING’S = TOO MUCH CORTISOL (STEROIDS). Think “Cushy” - extra
fat on the face (moon face), back (buffalo hump), and trunk (truncal obesity).
4. A client is admitted with a suspected Addisonian Crisis. Which of the following
interventions is the priority?
A. Rapid IV administration of hydrocortisone and fluids B. Administration of oral
glucose for hypoglycemia C. Monitoring for signs of infection D. Teaching the client about
long-term steroid therapy
, Annotation: ADDISON’S = NOT ENOUGH STEROIDS. A crisis is a medical emergency!
They need steroids (Hydrocortisone) and fluids (NS/D5NS) NOW to prevent
circulatory collapse.
5. The nurse is caring for a client who just returned from a renal biopsy. Which of the
following is the priority nursing action?
A. Encourage the client to ambulate immediately B. Maintain the client in a high-Fowler’s
position C. Monitor for signs of internal bleeding and hematuria D. Administer a
prophylactic antibiotic
Annotation: The kidney is highly vascular! Bleeding is the #1 risk. Keep them on the
AFFECTED side (pressure) and check for flank pain or blood in the urine.
6. A client with Chronic Kidney Disease (CKD) is prescribed Sevelamer (Renagel). The nurse
should instruct the client to take this medication:
A. On an empty stomach, 1 hour before meals B. With meals to bind phosphate in food C.
At bedtime with a full glass of water D. Only when they have symptoms of itching
Annotation: Renagel is a PHOSPHATE BINDER. It must be taken WITH FOOD to
work. High phosphate leads to low calcium and bone disease (Renal
Osteodystrophy).
7. The nurse is assessing a client with Diabetes Insipidus (DI). Which of the following findings
is consistent with this diagnosis?
A. High urine specific gravity and low urine output B. Low urine specific gravity and
massive polyuria C. Hyperglycemia and ketonuria D. Fluid volume overload and
hypertension
Annotation: DI = “Dry Inside.” Not enough ADH. They pee out liters of dilute urine
(Specific Gravity < 1.005). They are at high risk for dehydration and hypernatremia.
8. A client is diagnosed with SIADH (Syndrome of Inappropriate Antidiuretic Hormone). The
nurse should anticipate which of the following orders?
A. Rapid IV fluid resuscitation with Normal Saline B. Fluid restriction and administration
of 3% Saline C. Administration of Vasopressin D. Encouraging increased oral fluid intake
Annotation: SIADH = “Soaked Inside.” Too much ADH. They hold onto water, which
dilutes their sodium (Hyponatremia). 3% Saline (Hypertonic) is used carefully to
raise sodium levels.
