NURS 317 Midterm Exam Questions and Correct
Answers with Complete Solutions | New Update
2026/27 | Graded A+
A client is on a 1500 ml fluid restriction for 24 hrs. At 3p, the client consumed 2/3
of the fluid allowance for 24 hrs. What are the maximum ml of fluid remaining
that the client can consume during the evening shift?
• Correct Answer: 500
• Rationale: The client consumed 2/3 of their 1500 ml allowance, which is (2/3) *
1500 = 1000 ml. The remaining fluid allowance is 1500 ml - 1000 ml = 500 ml.
The class of diuretics that act to block the chloride pump in the distal convoluted
tubules and leads to a loss of sodium and potassium and a minor loss of water is
what?
A) Carbonic anhydrase inhibitors
B) Osmotic diuretics
C) Potassium-sparing diuretics
D) Thiazide diuretics
• Correct Answer: D) Thiazide diuretics
• Rationale: Thiazide diuretics work in the distal convoluted tubule by inhibiting
the sodium-chloride cotransporter, leading to increased excretion of sodium,
chloride, and potassium. They cause a moderate diuresis. Carbonic anhydrase
inhibitors work in the proximal tubule, osmotic diuretics work in the proximal
tubule and loop of Henle, and potassium-sparing diuretics work in the collecting
duct and do not promote potassium loss.
,A client with a diagnosis of chronic kidney disease may require the administration
of which of the following drugs to treat coexisting conditions that carry a high
mortality?
• Correct Answer: Antihypertensive medications
• Rationale: Cardiovascular disease is the leading cause of mortality in patients
with CKD. Hypertension is a major risk factor for cardiovascular events and also
accelerates the progression of kidney damage. Controlling blood pressure with
antihypertensive medications (especially ACE inhibitors or ARBs) is critical to
reduce mortality and slow disease progression.
A chronic kidney disease client asks the nurse, "why do I itch all the time?" The
nurse bases her response on which of the following integumentary physiologic
factors that causes pruritis? (Select all that apply)
• Correct Answer: Decrease in perspiration, Elevated serum phosphate levels
• Rationale: Pruritus (itching) in CKD is multifactorial. Decreased sweating leads to
dry skin (xerosis), which is a primary cause. Elevated serum phosphate levels can
lead to calcium-phosphate deposition in the skin, which also triggers severe
itching. While uremic toxins are also a factor, these two are specific
integumentary factors identified in the rationale.
A client's sodium intake for one meal was 0.004g and 0.152 g. How many grams,
to the nearest hundredths, of sodium was consumed?
• Correct Answer: 0.16
• Rationale: Total sodium consumed is 0.004 g + 0.152 g = 0.156 g. Rounding to
the nearest hundredth (two decimal places) gives 0.16 g.
A patient with benign prostatic hypertrophy has just begun to take pentosan
polysulfate sodium. The nurse would notify the physician if the patient exhibited
which symptoms? (Select all that apply)
, • Correct Answer: Blood in the urine, Petechiae, Decreased blood pressure
• Rationale: Pentosan polysulfate sodium (Elmiron) is an anticoagulant. Symptoms
of bleeding, such as blood in the urine (hematuria) and petechiae, are serious
adverse effects that require immediate notification. Hypotension (decreased
blood pressure) could indicate significant blood loss or a hemorrhagic event,
which is also a critical concern with this medication.
A 50 year old man calls the clinic nurse and complains of GI upset after taking
nitrofurantoin on an empty stomach. What recommendation should the nurse
make?
• Correct Answer: Taking the medicine with or after meals
• Rationale: Nitrofurantoin is a known gastric irritant. Taking the medication with
food or milk helps to buffer the stomach and reduce the incidence of
gastrointestinal upset, such as nausea and vomiting.
A drug abuser was found unconscious after shooting up heroin 2 days prior.
Because of the pressure placed on the hip and arm, the client has developed
rhabdomyolysis. The nurse knows this can:
• Correct Answer: Obstruct the renal tubules with myoglobin and damage tubular
cells
• Rationale: Rhabdomyolysis is the breakdown of muscle tissue, which releases
large amounts of myoglobin into the bloodstream. Myoglobin is a large protein
that can precipitate and cast in the renal tubules, causing obstruction and direct
tubular toxicity, leading to acute kidney injury.
Which of the following clients is likely at the greatest risk of developing a urinary
tract infection?
A) A 25-year-old woman who is sexually active
B) A 60-year-old man with diabetes mellitus
Answers with Complete Solutions | New Update
2026/27 | Graded A+
A client is on a 1500 ml fluid restriction for 24 hrs. At 3p, the client consumed 2/3
of the fluid allowance for 24 hrs. What are the maximum ml of fluid remaining
that the client can consume during the evening shift?
• Correct Answer: 500
• Rationale: The client consumed 2/3 of their 1500 ml allowance, which is (2/3) *
1500 = 1000 ml. The remaining fluid allowance is 1500 ml - 1000 ml = 500 ml.
The class of diuretics that act to block the chloride pump in the distal convoluted
tubules and leads to a loss of sodium and potassium and a minor loss of water is
what?
A) Carbonic anhydrase inhibitors
B) Osmotic diuretics
C) Potassium-sparing diuretics
D) Thiazide diuretics
• Correct Answer: D) Thiazide diuretics
• Rationale: Thiazide diuretics work in the distal convoluted tubule by inhibiting
the sodium-chloride cotransporter, leading to increased excretion of sodium,
chloride, and potassium. They cause a moderate diuresis. Carbonic anhydrase
inhibitors work in the proximal tubule, osmotic diuretics work in the proximal
tubule and loop of Henle, and potassium-sparing diuretics work in the collecting
duct and do not promote potassium loss.
,A client with a diagnosis of chronic kidney disease may require the administration
of which of the following drugs to treat coexisting conditions that carry a high
mortality?
• Correct Answer: Antihypertensive medications
• Rationale: Cardiovascular disease is the leading cause of mortality in patients
with CKD. Hypertension is a major risk factor for cardiovascular events and also
accelerates the progression of kidney damage. Controlling blood pressure with
antihypertensive medications (especially ACE inhibitors or ARBs) is critical to
reduce mortality and slow disease progression.
A chronic kidney disease client asks the nurse, "why do I itch all the time?" The
nurse bases her response on which of the following integumentary physiologic
factors that causes pruritis? (Select all that apply)
• Correct Answer: Decrease in perspiration, Elevated serum phosphate levels
• Rationale: Pruritus (itching) in CKD is multifactorial. Decreased sweating leads to
dry skin (xerosis), which is a primary cause. Elevated serum phosphate levels can
lead to calcium-phosphate deposition in the skin, which also triggers severe
itching. While uremic toxins are also a factor, these two are specific
integumentary factors identified in the rationale.
A client's sodium intake for one meal was 0.004g and 0.152 g. How many grams,
to the nearest hundredths, of sodium was consumed?
• Correct Answer: 0.16
• Rationale: Total sodium consumed is 0.004 g + 0.152 g = 0.156 g. Rounding to
the nearest hundredth (two decimal places) gives 0.16 g.
A patient with benign prostatic hypertrophy has just begun to take pentosan
polysulfate sodium. The nurse would notify the physician if the patient exhibited
which symptoms? (Select all that apply)
, • Correct Answer: Blood in the urine, Petechiae, Decreased blood pressure
• Rationale: Pentosan polysulfate sodium (Elmiron) is an anticoagulant. Symptoms
of bleeding, such as blood in the urine (hematuria) and petechiae, are serious
adverse effects that require immediate notification. Hypotension (decreased
blood pressure) could indicate significant blood loss or a hemorrhagic event,
which is also a critical concern with this medication.
A 50 year old man calls the clinic nurse and complains of GI upset after taking
nitrofurantoin on an empty stomach. What recommendation should the nurse
make?
• Correct Answer: Taking the medicine with or after meals
• Rationale: Nitrofurantoin is a known gastric irritant. Taking the medication with
food or milk helps to buffer the stomach and reduce the incidence of
gastrointestinal upset, such as nausea and vomiting.
A drug abuser was found unconscious after shooting up heroin 2 days prior.
Because of the pressure placed on the hip and arm, the client has developed
rhabdomyolysis. The nurse knows this can:
• Correct Answer: Obstruct the renal tubules with myoglobin and damage tubular
cells
• Rationale: Rhabdomyolysis is the breakdown of muscle tissue, which releases
large amounts of myoglobin into the bloodstream. Myoglobin is a large protein
that can precipitate and cast in the renal tubules, causing obstruction and direct
tubular toxicity, leading to acute kidney injury.
Which of the following clients is likely at the greatest risk of developing a urinary
tract infection?
A) A 25-year-old woman who is sexually active
B) A 60-year-old man with diabetes mellitus
