NU 186 Exam 3 V2 | NU 186 Medical-
Surgical Nursing II-A | NCLEX (NGN) Q&A
with Rationale (NU186 Exam 3) | Galen
1. A nurse is caring for a client diagnosed with End-Stage Renal Disease (ESRD). Which clinical
manifestations should the nurse expect to find during the assessment? (Select all that apply.)
A. Pruritus
B. Anemia
C. Hypokalemia
D. Peripheral edema
E. Uremic frost
F. Hypotension
Correct Answer: A, B, D, E
Explanation: Pruritus in ESRD is caused by the deposition of urea crystals on the skin, also
known as uremic frost. Anemia occurs because the kidneys are unable to produce adequate
erythropoietin to stimulate red blood cell production. Peripheral edema is a result of fluid
volume overload as the kidneys lose the ability to excrete water and sodium effectively.
2. A client with Acute Kidney Injury (AKI) is in the oliguric phase. Which electrolyte
abnormality is the nurse most likely to observe?
A. Hyperkalemia
,B. Hypernatremia
C. Hypokalemia
D. Hypophosphatemia
Correct Answer: A
Explanation: During the oliguric phase of AKI, the kidneys are unable to excrete
potassium, leading to hyperkalemia. This phase is characterized by a urine output of less
than 400 mL per day. Monitoring for cardiac dysrhythmias is a priority intervention due to
the elevated potassium levels.
3. A client is receiving hemodialysis. The nurse notes the client’s blood pressure has dropped
from 140/90 mmHg to 90/60 mmHg. What is the priority nursing action?
A. Increase the blood flow rate
B. Place the client in a high-Fowler’s position
C. Administer a bolus of 0.9% Normal Saline
D. Administer an antihypertensive medication
Correct Answer: C
Explanation: Hypotension is a common complication of hemodialysis due to rapid fluid
removal. Administering an isotonic saline bolus helps restore circulating volume and
stabilize blood pressure. The nurse should also slow the ultrafiltration rate and lower the
head of the bed to Trendelenburg position if necessary.
, 4. Which lab value is the most sensitive indicator of renal function in a client with Chronic
Kidney Disease?
A. Blood Urea Nitrogen (BUN)
B. Serum Creatinine
C. Glomerular Filtration Rate (GFR)
D. Urine Specific Gravity
Correct Answer: C
Explanation: Glomerular Filtration Rate (GFR) is considered the best overall index of
kidney function. While serum creatinine is useful, GFR provides a more accurate
assessment of how well the kidneys are filtering waste. BUN can be affected by diet and
hydration status, making it less specific than GFR.
5. A nurse is teaching a client about a low-protein diet for Chronic Kidney Disease. What is the
rationale for this dietary restriction?
A. To prevent muscle wasting
B. To promote the excretion of phosphorus
C. To increase the glomerular filtration rate
D. To reduce the accumulation of nitrogenous waste products
Correct Answer: D
Surgical Nursing II-A | NCLEX (NGN) Q&A
with Rationale (NU186 Exam 3) | Galen
1. A nurse is caring for a client diagnosed with End-Stage Renal Disease (ESRD). Which clinical
manifestations should the nurse expect to find during the assessment? (Select all that apply.)
A. Pruritus
B. Anemia
C. Hypokalemia
D. Peripheral edema
E. Uremic frost
F. Hypotension
Correct Answer: A, B, D, E
Explanation: Pruritus in ESRD is caused by the deposition of urea crystals on the skin, also
known as uremic frost. Anemia occurs because the kidneys are unable to produce adequate
erythropoietin to stimulate red blood cell production. Peripheral edema is a result of fluid
volume overload as the kidneys lose the ability to excrete water and sodium effectively.
2. A client with Acute Kidney Injury (AKI) is in the oliguric phase. Which electrolyte
abnormality is the nurse most likely to observe?
A. Hyperkalemia
,B. Hypernatremia
C. Hypokalemia
D. Hypophosphatemia
Correct Answer: A
Explanation: During the oliguric phase of AKI, the kidneys are unable to excrete
potassium, leading to hyperkalemia. This phase is characterized by a urine output of less
than 400 mL per day. Monitoring for cardiac dysrhythmias is a priority intervention due to
the elevated potassium levels.
3. A client is receiving hemodialysis. The nurse notes the client’s blood pressure has dropped
from 140/90 mmHg to 90/60 mmHg. What is the priority nursing action?
A. Increase the blood flow rate
B. Place the client in a high-Fowler’s position
C. Administer a bolus of 0.9% Normal Saline
D. Administer an antihypertensive medication
Correct Answer: C
Explanation: Hypotension is a common complication of hemodialysis due to rapid fluid
removal. Administering an isotonic saline bolus helps restore circulating volume and
stabilize blood pressure. The nurse should also slow the ultrafiltration rate and lower the
head of the bed to Trendelenburg position if necessary.
, 4. Which lab value is the most sensitive indicator of renal function in a client with Chronic
Kidney Disease?
A. Blood Urea Nitrogen (BUN)
B. Serum Creatinine
C. Glomerular Filtration Rate (GFR)
D. Urine Specific Gravity
Correct Answer: C
Explanation: Glomerular Filtration Rate (GFR) is considered the best overall index of
kidney function. While serum creatinine is useful, GFR provides a more accurate
assessment of how well the kidneys are filtering waste. BUN can be affected by diet and
hydration status, making it less specific than GFR.
5. A nurse is teaching a client about a low-protein diet for Chronic Kidney Disease. What is the
rationale for this dietary restriction?
A. To prevent muscle wasting
B. To promote the excretion of phosphorus
C. To increase the glomerular filtration rate
D. To reduce the accumulation of nitrogenous waste products
Correct Answer: D
