NSG 4100 Exam 1
Adult Health: End-Stage Renal Disease Comprehensive
Examination 2026
Question 1: The nurse is caring for a client with end-stage renal disease who has developed uremia.
Which signs and symptoms should the nurse expect to assess? Select all that apply.
A. Metallic taste in the mouth
B. Increased energy levels
C. Nausea and vomiting
D. Pruritus (itching)
E. Hypertension
F. Muscle cramps
ANSWER: A, C, D, F
Rationale:
Option A (Correct): Metallic taste (dysgeusia) is a classic symptom of uremia caused by the accumulation
of urea in saliva, which breaks down to ammonia
;
.
Option B (Incorrect): Clients with uremia experience fatigue and decreased energy levels, not increased
energy, due to anemia and toxin accumulation
my.clevelandclinic.org
.
Option C (Correct): Nausea and vomiting are hallmark symptoms of uremia resulting from
gastrointestinal irritation by accumulated waste products
;
,.
Option D (Correct): Pruritus occurs in uremia due to calcium-phosphate deposits in the skin and dry skin
from reduced kidney function
;
.
Option E (Incorrect): While hypertension is common in ESRD, uremia itself is more associated with the
systemic effects of toxin accumulation rather than being a direct symptom of uremia.
Option F (Correct): Muscle cramps are a common manifestation of uremia, often related to electrolyte
imbalances and fluid shifts
;
.
Question 2: A client who has just returned from hemodialysis treatment presents with the following
assessment findings. Which finding requires IMMEDIATE intervention by the nurse?
A. Blood pressure of 130/80 mmHg
B. Temperature of 99.4°F (37.4°C)
C. Pulse rate of 130 beats per minute
D. Potassium level that dropped from 6.1 to 5.1 mEq/L
ANSWER: C
Rationale:
Option A (Incorrect): A blood pressure of 130/80 mmHg is within acceptable parameters post-dialysis
and does not require immediate intervention.
Option B (Incorrect): A temperature of 99.4°F is slightly elevated but not critically high; it may be
monitored but does not require immediate intervention.
Option C (Correct): A pulse rate of 130 bpm indicates tachycardia, which could signal hypovolemia,
bleeding, or cardiovascular compromise post-dialysis and requires immediate assessment and
intervention
;
.
Option D (Incorrect): A potassium drop from 6.1 to 5.1 mEq/L represents an expected and therapeutic
response to hemodialysis; the goal is to reduce elevated potassium levels.
Question 3: The nurse is caring for a client with end-stage renal disease who has developed uremic
pericarditis. Which intervention should the nurse anticipate as the priority treatment?
,A. Administration of antibiotics
B. Initiation of hemodialysis
C. Pericardiocentesis
D. Corticosteroid therapy
ANSWER: B
Rationale:
Option A (Incorrect): Uremic pericarditis is caused by uremic toxin accumulation, not bacterial infection,
so antibiotics are not the primary treatment.
Option B (Correct): Uremic pericarditis is treated with intensified hemodialysis to remove the uremic
toxins causing the inflammation; this is the primary treatment
;
.
Option C (Incorrect): Pericardiocentesis is reserved for cases with cardiac tamponade, not as the initial
treatment for uremic pericarditis.
Option D (Incorrect): Corticosteroids are not the first-line treatment for uremic pericarditis; dialysis is
the priority intervention.
Question 4: The nurse is caring for a client with end-stage renal disease. Which assessment finding
should the nurse report to the healthcare provider IMMEDIATELY?
A. Poor appetite reported for 2 days
B. Client is oriented to person and place only
C. Flat neck veins when supine
D. Weak peripheral pulses bilaterally
ANSWER: B
Rationale:
Option A (Incorrect): Poor appetite is common in ESRD due to uremia and should be monitored, but it is
not an immediate emergency.
Option B (Correct): Altered mental status (orientation to person and place only) indicates possible
uremic encephalopathy, severe electrolyte imbalance, or other neurological compromise requiring
immediate intervention
;
.
, Option C (Incorrect): Flat neck veins may indicate hypovolemia but are not as immediately life-
threatening as altered mental status.
Option D (Incorrect): Weak peripheral pulses should be assessed further but are not as urgent as
changes in neurological status.
Question 5: The nurse is caring for a client with end-stage renal disease. The client's potassium level is
6.8 mEq/L. Which action should the nurse take FIRST?
A. Administer sodium polystyrene sulfonate (Kayexalate)
B. Review the client's current telemetry reading
C. Notify the healthcare provider
D. Prepare to administer furosemide
ANSWER: B
Rationale:
Option A (Incorrect): While Kayexalate may be prescribed, the nurse should first assess the client's
cardiac status before implementing interventions.
Option B (Correct): The nurse should first review telemetry because hyperkalemia (K+ 6.8 mEq/L) can
cause life-threatening cardiac dysrhythmias; assessing for peaked T-waves, widened QRS, or other
changes is the priority
;
.
Option C (Incorrect): The provider should be notified, but assessment of the client's cardiac status takes
priority to determine the urgency of the situation.
Option D (Incorrect): Furosemide may be ineffective in ESRD patients with little to no urine output;
assessment comes first.
Question 6: The nurse is teaching a client with end-stage renal disease about dietary modifications.
Which client statement indicates the need for PRIORITY follow-up?
A. "I have noticed that my skin has a bronze color to it."
B. "I have noticed that my breath has an unpleasant odor to it."
C. "I try to limit my intake of dietary sodium to 2 g per day."
D. "I will make sure I consume at least 100 g of protein per day."
ANSWER: D
Rationale:
Adult Health: End-Stage Renal Disease Comprehensive
Examination 2026
Question 1: The nurse is caring for a client with end-stage renal disease who has developed uremia.
Which signs and symptoms should the nurse expect to assess? Select all that apply.
A. Metallic taste in the mouth
B. Increased energy levels
C. Nausea and vomiting
D. Pruritus (itching)
E. Hypertension
F. Muscle cramps
ANSWER: A, C, D, F
Rationale:
Option A (Correct): Metallic taste (dysgeusia) is a classic symptom of uremia caused by the accumulation
of urea in saliva, which breaks down to ammonia
;
.
Option B (Incorrect): Clients with uremia experience fatigue and decreased energy levels, not increased
energy, due to anemia and toxin accumulation
my.clevelandclinic.org
.
Option C (Correct): Nausea and vomiting are hallmark symptoms of uremia resulting from
gastrointestinal irritation by accumulated waste products
;
,.
Option D (Correct): Pruritus occurs in uremia due to calcium-phosphate deposits in the skin and dry skin
from reduced kidney function
;
.
Option E (Incorrect): While hypertension is common in ESRD, uremia itself is more associated with the
systemic effects of toxin accumulation rather than being a direct symptom of uremia.
Option F (Correct): Muscle cramps are a common manifestation of uremia, often related to electrolyte
imbalances and fluid shifts
;
.
Question 2: A client who has just returned from hemodialysis treatment presents with the following
assessment findings. Which finding requires IMMEDIATE intervention by the nurse?
A. Blood pressure of 130/80 mmHg
B. Temperature of 99.4°F (37.4°C)
C. Pulse rate of 130 beats per minute
D. Potassium level that dropped from 6.1 to 5.1 mEq/L
ANSWER: C
Rationale:
Option A (Incorrect): A blood pressure of 130/80 mmHg is within acceptable parameters post-dialysis
and does not require immediate intervention.
Option B (Incorrect): A temperature of 99.4°F is slightly elevated but not critically high; it may be
monitored but does not require immediate intervention.
Option C (Correct): A pulse rate of 130 bpm indicates tachycardia, which could signal hypovolemia,
bleeding, or cardiovascular compromise post-dialysis and requires immediate assessment and
intervention
;
.
Option D (Incorrect): A potassium drop from 6.1 to 5.1 mEq/L represents an expected and therapeutic
response to hemodialysis; the goal is to reduce elevated potassium levels.
Question 3: The nurse is caring for a client with end-stage renal disease who has developed uremic
pericarditis. Which intervention should the nurse anticipate as the priority treatment?
,A. Administration of antibiotics
B. Initiation of hemodialysis
C. Pericardiocentesis
D. Corticosteroid therapy
ANSWER: B
Rationale:
Option A (Incorrect): Uremic pericarditis is caused by uremic toxin accumulation, not bacterial infection,
so antibiotics are not the primary treatment.
Option B (Correct): Uremic pericarditis is treated with intensified hemodialysis to remove the uremic
toxins causing the inflammation; this is the primary treatment
;
.
Option C (Incorrect): Pericardiocentesis is reserved for cases with cardiac tamponade, not as the initial
treatment for uremic pericarditis.
Option D (Incorrect): Corticosteroids are not the first-line treatment for uremic pericarditis; dialysis is
the priority intervention.
Question 4: The nurse is caring for a client with end-stage renal disease. Which assessment finding
should the nurse report to the healthcare provider IMMEDIATELY?
A. Poor appetite reported for 2 days
B. Client is oriented to person and place only
C. Flat neck veins when supine
D. Weak peripheral pulses bilaterally
ANSWER: B
Rationale:
Option A (Incorrect): Poor appetite is common in ESRD due to uremia and should be monitored, but it is
not an immediate emergency.
Option B (Correct): Altered mental status (orientation to person and place only) indicates possible
uremic encephalopathy, severe electrolyte imbalance, or other neurological compromise requiring
immediate intervention
;
.
, Option C (Incorrect): Flat neck veins may indicate hypovolemia but are not as immediately life-
threatening as altered mental status.
Option D (Incorrect): Weak peripheral pulses should be assessed further but are not as urgent as
changes in neurological status.
Question 5: The nurse is caring for a client with end-stage renal disease. The client's potassium level is
6.8 mEq/L. Which action should the nurse take FIRST?
A. Administer sodium polystyrene sulfonate (Kayexalate)
B. Review the client's current telemetry reading
C. Notify the healthcare provider
D. Prepare to administer furosemide
ANSWER: B
Rationale:
Option A (Incorrect): While Kayexalate may be prescribed, the nurse should first assess the client's
cardiac status before implementing interventions.
Option B (Correct): The nurse should first review telemetry because hyperkalemia (K+ 6.8 mEq/L) can
cause life-threatening cardiac dysrhythmias; assessing for peaked T-waves, widened QRS, or other
changes is the priority
;
.
Option C (Incorrect): The provider should be notified, but assessment of the client's cardiac status takes
priority to determine the urgency of the situation.
Option D (Incorrect): Furosemide may be ineffective in ESRD patients with little to no urine output;
assessment comes first.
Question 6: The nurse is teaching a client with end-stage renal disease about dietary modifications.
Which client statement indicates the need for PRIORITY follow-up?
A. "I have noticed that my skin has a bronze color to it."
B. "I have noticed that my breath has an unpleasant odor to it."
C. "I try to limit my intake of dietary sodium to 2 g per day."
D. "I will make sure I consume at least 100 g of protein per day."
ANSWER: D
Rationale:
