NSG 4100 Exam 1: Complex Elimination
(Renal)
Questions with ANSWERs and Rationales
2026
QUESTION 1
A patient with end-stage renal disease (ESRD) presents with anorexia, a metallic taste in the mouth, and
metabolic abnormalities. The nurse recognizes these manifestations are characteristic of which
condition?
A. Azotemia
B. Uremia
C. Hyperkalemia
D. Metabolic acidosis
ANSWER: B. Uremia
Rationale: Uremia is a syndrome marked by elevated urea in the blood associated with fluid and
metabolic abnormalities. Classic manifestations include anorexia, metallic taste in the mouth, and
various metabolic disturbances. Azotemia refers specifically to elevated nitrogenous wastes without the
full syndrome of symptoms. Hyperkalemia is an electrolyte abnormality that can occur in renal failure
but does not encompass the full syndrome. Metabolic acidosis is a component of uremia but not the
complete syndrome.
,QUESTION 2
A patient with chronic kidney disease has a serum creatinine of 8.2 mg/dL and a GFR of 12 mL/min. The
nurse understands that this patient is experiencing:
A. Stage 3 chronic kidney disease
B. Stage 4 chronic kidney disease
C. End-stage renal disease
D. Acute kidney injury
ANSWER: C. End-stage renal disease
Rationale: End-stage renal disease is defined as a GFR of less than 15 mL/min. This patient's GFR of 12
mL/min indicates ESRD, which requires permanent dialysis or transplantation. Stage 3 CKD is GFR 30-59
mL/min, and Stage 4 is GFR 15-29 mL/min. Acute kidney injury is characterized by a rapid decline in
kidney function, not necessarily a GFR below 15 mL/min.
QUESTION 3
The nurse is caring for a patient with ESRD who has a potassium level of 6.8 mEq/L. Which medication
would the nurse anticipate administering to lower this patient's potassium level?
A. Calcium acetate
B. Epoetin alfa
C. Kayexalate
D. Digoxin
ANSWER: C. Kayexalate
Rationale: Kayexalate (sodium polystyrene sulfonate) is a cation-exchange resin that removes potassium
via the bowel. It is used to treat hyperkalemia in patients with renal failure. Calcium acetate is a
phosphate binder used to lower phosphorus levels. Epoetin alfa is used to treat anemia by stimulating
red blood cell production. Digoxin is a cardiac glycoside used for heart failure, not for lowering
potassium.
,QUESTION 4
A patient with ESRD is prescribed calcium acetate. The nurse should monitor the patient for which
potential adverse effect?
A. Hypocalcemia
B. Hypercalcemia
C. Hyperphosphatemia
D. Hypokalemia
ANSWER: B. Hypercalcemia
Rationale: Calcium acetate is a phosphate binder that works by binding dietary phosphate in the
gastrointestinal tract. While it effectively lowers phosphorus levels, it can cause hypercalcemia because
the calcium is absorbed. Patients should be monitored for signs of hypercalcemia including nausea,
vomiting, constipation, and cardiac arrhythmias.
QUESTION 5
The nurse is assessing a patient with ESRD who reports a metallic taste in the mouth and ammonia odor
on the breath. These findings are most consistent with which complication?
A. Hyperkalemia
B. Uremic gastroenteropathy
C. Uremic fetor
D. Metabolic acidosis
ANSWER: C. Uremic fetor
Rationale: Uremic fetor refers to the characteristic ammonia odor on the breath and metallic taste in
the mouth that occurs in patients with uremia. This results from the breakdown of urea to ammonia by
urease-producing bacteria in the oral cavity and gastrointestinal tract. Hyperkalemia does not cause
, these symptoms. Uremic gastroenteropathy involves gastrointestinal symptoms like nausea and
vomiting. Metabolic acidosis can cause Kussmaul respirations but not the metallic taste.
QUESTION 6
A patient with ESRD has the following laboratory values: calcium 7.8 mg/dL, phosphorus 6.5 mg/dL, and
albumin 3.2 g/dL. Which nursing intervention is most appropriate?
A. Administer IV calcium gluconate
B. Administer oral phosphate binder with meals
C. Restrict dietary protein
D. Administer erythropoietin
ANSWER: B. Administer oral phosphate binder with meals
Rationale: This patient has hypocalcemia (normal 8.5-10.5 mg/dL) and hyperphosphatemia (normal 2.5-
4.5 mg/dL). The low albumin may contribute to the low calcium. Phosphate binders are given with meals
to bind dietary phosphorus and prevent absorption, which helps manage hyperphosphatemia. IV
calcium would be given for severe symptomatic hypocalcemia. Protein restriction would not directly
address the electrolyte imbalances. Erythropoietin is for anemia.
QUESTION 7
The nurse is providing dietary education to a patient with ESRD. Which foods should the patient be
instructed to avoid due to high potassium content?
A. Apples and grapes
B. Bananas and cantaloupe
C. White bread and pasta
D. Green beans and carrots
ANSWER: B. Bananas and cantaloupe
(Renal)
Questions with ANSWERs and Rationales
2026
QUESTION 1
A patient with end-stage renal disease (ESRD) presents with anorexia, a metallic taste in the mouth, and
metabolic abnormalities. The nurse recognizes these manifestations are characteristic of which
condition?
A. Azotemia
B. Uremia
C. Hyperkalemia
D. Metabolic acidosis
ANSWER: B. Uremia
Rationale: Uremia is a syndrome marked by elevated urea in the blood associated with fluid and
metabolic abnormalities. Classic manifestations include anorexia, metallic taste in the mouth, and
various metabolic disturbances. Azotemia refers specifically to elevated nitrogenous wastes without the
full syndrome of symptoms. Hyperkalemia is an electrolyte abnormality that can occur in renal failure
but does not encompass the full syndrome. Metabolic acidosis is a component of uremia but not the
complete syndrome.
,QUESTION 2
A patient with chronic kidney disease has a serum creatinine of 8.2 mg/dL and a GFR of 12 mL/min. The
nurse understands that this patient is experiencing:
A. Stage 3 chronic kidney disease
B. Stage 4 chronic kidney disease
C. End-stage renal disease
D. Acute kidney injury
ANSWER: C. End-stage renal disease
Rationale: End-stage renal disease is defined as a GFR of less than 15 mL/min. This patient's GFR of 12
mL/min indicates ESRD, which requires permanent dialysis or transplantation. Stage 3 CKD is GFR 30-59
mL/min, and Stage 4 is GFR 15-29 mL/min. Acute kidney injury is characterized by a rapid decline in
kidney function, not necessarily a GFR below 15 mL/min.
QUESTION 3
The nurse is caring for a patient with ESRD who has a potassium level of 6.8 mEq/L. Which medication
would the nurse anticipate administering to lower this patient's potassium level?
A. Calcium acetate
B. Epoetin alfa
C. Kayexalate
D. Digoxin
ANSWER: C. Kayexalate
Rationale: Kayexalate (sodium polystyrene sulfonate) is a cation-exchange resin that removes potassium
via the bowel. It is used to treat hyperkalemia in patients with renal failure. Calcium acetate is a
phosphate binder used to lower phosphorus levels. Epoetin alfa is used to treat anemia by stimulating
red blood cell production. Digoxin is a cardiac glycoside used for heart failure, not for lowering
potassium.
,QUESTION 4
A patient with ESRD is prescribed calcium acetate. The nurse should monitor the patient for which
potential adverse effect?
A. Hypocalcemia
B. Hypercalcemia
C. Hyperphosphatemia
D. Hypokalemia
ANSWER: B. Hypercalcemia
Rationale: Calcium acetate is a phosphate binder that works by binding dietary phosphate in the
gastrointestinal tract. While it effectively lowers phosphorus levels, it can cause hypercalcemia because
the calcium is absorbed. Patients should be monitored for signs of hypercalcemia including nausea,
vomiting, constipation, and cardiac arrhythmias.
QUESTION 5
The nurse is assessing a patient with ESRD who reports a metallic taste in the mouth and ammonia odor
on the breath. These findings are most consistent with which complication?
A. Hyperkalemia
B. Uremic gastroenteropathy
C. Uremic fetor
D. Metabolic acidosis
ANSWER: C. Uremic fetor
Rationale: Uremic fetor refers to the characteristic ammonia odor on the breath and metallic taste in
the mouth that occurs in patients with uremia. This results from the breakdown of urea to ammonia by
urease-producing bacteria in the oral cavity and gastrointestinal tract. Hyperkalemia does not cause
, these symptoms. Uremic gastroenteropathy involves gastrointestinal symptoms like nausea and
vomiting. Metabolic acidosis can cause Kussmaul respirations but not the metallic taste.
QUESTION 6
A patient with ESRD has the following laboratory values: calcium 7.8 mg/dL, phosphorus 6.5 mg/dL, and
albumin 3.2 g/dL. Which nursing intervention is most appropriate?
A. Administer IV calcium gluconate
B. Administer oral phosphate binder with meals
C. Restrict dietary protein
D. Administer erythropoietin
ANSWER: B. Administer oral phosphate binder with meals
Rationale: This patient has hypocalcemia (normal 8.5-10.5 mg/dL) and hyperphosphatemia (normal 2.5-
4.5 mg/dL). The low albumin may contribute to the low calcium. Phosphate binders are given with meals
to bind dietary phosphorus and prevent absorption, which helps manage hyperphosphatemia. IV
calcium would be given for severe symptomatic hypocalcemia. Protein restriction would not directly
address the electrolyte imbalances. Erythropoietin is for anemia.
QUESTION 7
The nurse is providing dietary education to a patient with ESRD. Which foods should the patient be
instructed to avoid due to high potassium content?
A. Apples and grapes
B. Bananas and cantaloupe
C. White bread and pasta
D. Green beans and carrots
ANSWER: B. Bananas and cantaloupe
