NUR 242 MEDICAL SURGICAL EXAM 4
1.A patient with chronic kidney disease has a GFR of 18 mL/min. The
nurse identifies this as which stage of CKD?
A) Stage 1
B) Stage 2
C) Stage 3
D) Stage 4
Correct Answer: Stage 4
Rationale: CKD staging based on GFR: Stage 1 ≥90, Stage 2 60-89, Stage 3
30-59, Stage 4 15-29, Stage 5 <15. A GFR of 18 mL/min indicates severe
impairment (Stage 4) . This stage requires preparation for renal replacement
therapy and management of complications including anemia and bone
disease.
2. A patient in the oliguric phase of acute kidney injury has a potassium
level of 6.2 mEq/L. Which ECG change does the nurse expect?
A) Prominent U waves
B) Peaked T waves
C) ST segment depression
D) Prolonged QT interval
Correct Answer: Peaked T waves
Rationale: Hyperkalemia (K+ >5.5) causes tall, peaked (tented) T waves. As
potassium rises further, QRS widens and P wave disappears, leading to
ventricular fibrillation. Prominent U waves are seen in hypokalemia, not
hyperkalemia .
, 3. A patient receiving hemodialysis has a blood pressure of 180/100
mmHg. Which nursing intervention is most appropriate?
A) Administer an antihypertensive medication
B) Increase the ultrafiltration rate
C) Notify the provider immediately
D) Continue dialysis and monitor
Correct Answer: Increase the ultrafiltration rate
Rationale: Hypertension during hemodialysis often indicates fluid overload.
Increasing ultrafiltration removes excess fluid, addressing the underlying
cause. Antihypertensives may be needed if fluid removal is ineffective, but
ultrafiltration is the priority intervention .
4. Which finding in a patient receiving peritoneal dialysis requires
immediate action?
A) Clear, straw-colored effluent
B) Cloudy effluent
C) Mild abdominal discomfort
D) Slight catheter site redness
Correct Answer: Cloudy effluent
Rationale: Cloudy effluent is the classic sign of peritonitis, a serious infection
complication of peritoneal dialysis. The provider should be notified
immediately for culture and antibiotic therapy. Clear effluent is normal, and
mild discomfort is expected .
5. A patient with CKD is prescribed epoetin alfa (Epogen). Which
laboratory value indicates the medication is effective?
A) Hemoglobin 10.5 g/dL
B) Potassium 5.0 mEq/L
, C) Calcium 9.0 mg/dL
D) Phosphorus 5.0 mg/dL
Correct Answer: Hemoglobin 10.5 g/dL
Rationale: Epoetin alfa stimulates red blood cell production, treating anemia
of CKD. Target hemoglobin is 10-11 g/dL to reduce transfusion needs while
avoiding complications from overcorrection . Potassium, calcium, and
phosphorus reflect other CKD complications.
6. A patient with acute kidney injury has a BUN of 90 mg/dL and
creatinine of 6 mg/dL with a BUN:creatinine ratio >20:1. Which type of
AKI is suggested?
A) Prerenal AKI
B) Intrarenal AKI
C) Postrenal AKI
D) Chronic kidney disease
Correct Answer: Prerenal AKI
Rationale: A BUN:creatinine ratio >20:1 suggests prerenal causes such as
dehydration or decreased renal perfusion. Intrarenal AKI typically has a ratio
<15:1, and postrenal obstruction affects urine output with variable ratios .
7. A patient with CKD and hyperkalemia is advised to restrict dietary
potassium. Which food should the patient avoid?
A) Apples
B) Bananas
C) Green beans
D) White rice
Correct Answer: Bananas
, Rationale: Bananas are high in potassium and should be avoided on a
potassium-restricted diet. Apples, green beans, and white rice are lower in
potassium and safer choices .
8. A patient with end-stage renal disease is scheduled for hemodialysis.
Which laboratory value requires urgent intervention before dialysis?
A) Sodium 135 mEq/L
B) Potassium 6.5 mEq/L
C) Calcium 8.5 mg/dL
D) Hemoglobin 10.5 g/dL
Correct Answer: Potassium 6.5 mEq/L
Rationale: Hyperkalemia (K+ >5.5) is life-threatening due to cardiac
arrhythmia risk. Urgent dialysis is indicated to rapidly lower potassium levels.
Other values are within or near acceptable ranges for a CKD patient .
9. A patient with chronic kidney disease has a calcium level of 7.2 mg/dL.
Which complication is the patient at risk for?
A) Tetany
B) Hypertension
C) Edema
D) Polyuria
Correct Answer: Tetany
Rationale: Hypocalcemia causes neuromuscular irritability, leading to tetany,
Chvostek's sign, and Trousseau's sign. Calcium is monitored in CKD due to
impaired vitamin D activation and hyperphosphatemia .
10. A patient with CKD and hyperphosphatemia has a phosphate
level of 6.5 mg/dL. Which complication should the nurse monitor for?
A) Calcium-phosphate deposition and pruritus
1.A patient with chronic kidney disease has a GFR of 18 mL/min. The
nurse identifies this as which stage of CKD?
A) Stage 1
B) Stage 2
C) Stage 3
D) Stage 4
Correct Answer: Stage 4
Rationale: CKD staging based on GFR: Stage 1 ≥90, Stage 2 60-89, Stage 3
30-59, Stage 4 15-29, Stage 5 <15. A GFR of 18 mL/min indicates severe
impairment (Stage 4) . This stage requires preparation for renal replacement
therapy and management of complications including anemia and bone
disease.
2. A patient in the oliguric phase of acute kidney injury has a potassium
level of 6.2 mEq/L. Which ECG change does the nurse expect?
A) Prominent U waves
B) Peaked T waves
C) ST segment depression
D) Prolonged QT interval
Correct Answer: Peaked T waves
Rationale: Hyperkalemia (K+ >5.5) causes tall, peaked (tented) T waves. As
potassium rises further, QRS widens and P wave disappears, leading to
ventricular fibrillation. Prominent U waves are seen in hypokalemia, not
hyperkalemia .
, 3. A patient receiving hemodialysis has a blood pressure of 180/100
mmHg. Which nursing intervention is most appropriate?
A) Administer an antihypertensive medication
B) Increase the ultrafiltration rate
C) Notify the provider immediately
D) Continue dialysis and monitor
Correct Answer: Increase the ultrafiltration rate
Rationale: Hypertension during hemodialysis often indicates fluid overload.
Increasing ultrafiltration removes excess fluid, addressing the underlying
cause. Antihypertensives may be needed if fluid removal is ineffective, but
ultrafiltration is the priority intervention .
4. Which finding in a patient receiving peritoneal dialysis requires
immediate action?
A) Clear, straw-colored effluent
B) Cloudy effluent
C) Mild abdominal discomfort
D) Slight catheter site redness
Correct Answer: Cloudy effluent
Rationale: Cloudy effluent is the classic sign of peritonitis, a serious infection
complication of peritoneal dialysis. The provider should be notified
immediately for culture and antibiotic therapy. Clear effluent is normal, and
mild discomfort is expected .
5. A patient with CKD is prescribed epoetin alfa (Epogen). Which
laboratory value indicates the medication is effective?
A) Hemoglobin 10.5 g/dL
B) Potassium 5.0 mEq/L
, C) Calcium 9.0 mg/dL
D) Phosphorus 5.0 mg/dL
Correct Answer: Hemoglobin 10.5 g/dL
Rationale: Epoetin alfa stimulates red blood cell production, treating anemia
of CKD. Target hemoglobin is 10-11 g/dL to reduce transfusion needs while
avoiding complications from overcorrection . Potassium, calcium, and
phosphorus reflect other CKD complications.
6. A patient with acute kidney injury has a BUN of 90 mg/dL and
creatinine of 6 mg/dL with a BUN:creatinine ratio >20:1. Which type of
AKI is suggested?
A) Prerenal AKI
B) Intrarenal AKI
C) Postrenal AKI
D) Chronic kidney disease
Correct Answer: Prerenal AKI
Rationale: A BUN:creatinine ratio >20:1 suggests prerenal causes such as
dehydration or decreased renal perfusion. Intrarenal AKI typically has a ratio
<15:1, and postrenal obstruction affects urine output with variable ratios .
7. A patient with CKD and hyperkalemia is advised to restrict dietary
potassium. Which food should the patient avoid?
A) Apples
B) Bananas
C) Green beans
D) White rice
Correct Answer: Bananas
, Rationale: Bananas are high in potassium and should be avoided on a
potassium-restricted diet. Apples, green beans, and white rice are lower in
potassium and safer choices .
8. A patient with end-stage renal disease is scheduled for hemodialysis.
Which laboratory value requires urgent intervention before dialysis?
A) Sodium 135 mEq/L
B) Potassium 6.5 mEq/L
C) Calcium 8.5 mg/dL
D) Hemoglobin 10.5 g/dL
Correct Answer: Potassium 6.5 mEq/L
Rationale: Hyperkalemia (K+ >5.5) is life-threatening due to cardiac
arrhythmia risk. Urgent dialysis is indicated to rapidly lower potassium levels.
Other values are within or near acceptable ranges for a CKD patient .
9. A patient with chronic kidney disease has a calcium level of 7.2 mg/dL.
Which complication is the patient at risk for?
A) Tetany
B) Hypertension
C) Edema
D) Polyuria
Correct Answer: Tetany
Rationale: Hypocalcemia causes neuromuscular irritability, leading to tetany,
Chvostek's sign, and Trousseau's sign. Calcium is monitored in CKD due to
impaired vitamin D activation and hyperphosphatemia .
10. A patient with CKD and hyperphosphatemia has a phosphate
level of 6.5 mg/dL. Which complication should the nurse monitor for?
A) Calcium-phosphate deposition and pruritus
