Shadow Health Renal System Hourly Rounds Arturo Perez
Actual Exam 2026/2027 – Complete Exam-Style Questions
with Detailed Rationales | 100% Verified | Pass Guaranteed –
A+ Graded
Section A: Patient Presentation & Initial Assessment
Q1: Arturo Perez, a 44-year-old male with ESRD, presents to the emergency department
stating, "I'm short of breath and I've got some swelling going on." The nurse notes
bilateral lower extremity edema and crackles on lung auscultation. Which
pathophysiological process best explains these findings?
A. Decreased erythropoietin production leading to severe anemia and compensatory
tachypnea.
B. Acute kidney injury from contrast media exposure causing sudden fluid retention.
C. Fluid volume overload due to missed hemodialysis appointments and failed renal
filtration, resulting in pulmonary edema and peripheral edema. [CORRECT]
D. Allergic reaction to recent antibiotic therapy causing angioedema and
bronchospasm.
Correct Answer: C
Rationale: Arturo's symptoms of shortness of breath, lower extremity edema, and
crackles are classic manifestations of fluid volume overload due to ESRD and missed
dialysis. The kidneys' inability to filter blood and regulate blood volume leads to fluid
accumulation in the lungs and tissues. Option A explains fatigue but not edema, Option
B describes AKI rather than his chronic ESRD, and Option D is unsupported by the
presentation.
,Q2: During the initial interview, Arturo reports that his breathing worsens when lying
down and that symptoms intensified after helping his girlfriend bring in groceries
yesterday. The nurse recognizes that breathing difficulty when supine is called:
A. Bradypnea.
B. Orthopnea. [CORRECT]
C. Kussmaul respirations.
D. Cheyne-Stokes respirations.
Correct Answer: B
Rationale: Orthopnea is dyspnea that occurs when lying flat and improves when sitting
upright, commonly seen in fluid overload and heart failure. Option A describes slow
breathing, Option C describes deep rapid breathing seen in metabolic acidosis, and
Option D describes cyclic breathing patterns seen in neurological or cardiac conditions.
Q3: The nurse is collecting subjective data from Arturo. Which statement represents
subjective information that should be documented in the health record?
A. Bilateral 2+ pitting edema to the lower extremities observed on physical examination.
B. Blood pressure elevated at 168/94 mmHg recorded via automatic cuff.
C. Arturo stating, "I'm short of breath and I've got some swelling going on." [CORRECT]
D. Crackles auscultated in bilateral lung bases during respiratory assessment.
Correct Answer: C
,Rationale: Subjective data consists of information reported by the patient, including
symptoms, feelings, and health history. Arturo's direct quote about his symptoms is
subjective data. Options A, B, and D are objective data obtained through physical
assessment, measurement, and auscultation.
Q4: Arturo admits he missed two hemodialysis appointments this week, though he had
never missed an appointment before. The nurse should prioritize which follow-up
action?
A. Immediately discharge Arturo with a warning about appointment compliance.
B. Explore barriers to adherence, including transportation, socioeconomic factors, or
psychosocial stressors that contributed to the missed appointments. [CORRECT]
C. Contact his nephrologist to terminate his dialysis access.
D. Assume the missed appointments indicate medication nonadherence and focus
solely on pill organization education.
Correct Answer: B
Rationale: Since Arturo had perfect attendance prior to this week, the nurse should
explore underlying barriers such as transportation issues, financial constraints, or
competing priorities rather than assuming noncompliance. Option A is punitive and
unsafe given his fluid overload, Option C is inappropriate, and Option D makes an
unsupported assumption.
Q5: During the physical assessment, the nurse expects to find which combination of
findings most consistent with Arturo's presentation of ESRD and fluid overload?
A. Hypotension, flat neck veins, and dry mucous membranes.
, B. Hypertension, jugular venous distention, and bilateral basilar crackles. [CORRECT]
C. Bradycardia, clear lung sounds, and decreased central venous pressure.
D. Normal blood pressure, unilateral leg swelling, and wheezing throughout all lung
fields.
Correct Answer: B
Rationale: Fluid overload in ESRD typically presents with hypertension (from volume
expansion), jugular venous distention, and pulmonary crackles from interstitial fluid.
Option A describes hypovolemia, Option C describes bradycardia and clear lungs
inconsistent with fluid overload, and Option D incorrectly suggests unilateral swelling
and wheezing.
Q6: Arturo's girlfriend mentions that he has been increasingly fatigued over the past
month and occasionally complains of itching. The nurse associates these findings with
which ESRD-related complication?
A. Accumulation of nitrogenous wastes and uremic toxins due to inadequate filtration.
[CORRECT]
B. Hypercalcemia from excessive calcitriol production by failing kidneys.
C. Polycythemia from increased erythropoietin secretion.
D. Hypokalemia from excessive potassium loss in urine.
Correct Answer: A
Rationale: Fatigue and pruritus are common uremic symptoms caused by the
accumulation of nitrogenous wastes (urea, creatinine, uric acid) when kidneys fail to
Actual Exam 2026/2027 – Complete Exam-Style Questions
with Detailed Rationales | 100% Verified | Pass Guaranteed –
A+ Graded
Section A: Patient Presentation & Initial Assessment
Q1: Arturo Perez, a 44-year-old male with ESRD, presents to the emergency department
stating, "I'm short of breath and I've got some swelling going on." The nurse notes
bilateral lower extremity edema and crackles on lung auscultation. Which
pathophysiological process best explains these findings?
A. Decreased erythropoietin production leading to severe anemia and compensatory
tachypnea.
B. Acute kidney injury from contrast media exposure causing sudden fluid retention.
C. Fluid volume overload due to missed hemodialysis appointments and failed renal
filtration, resulting in pulmonary edema and peripheral edema. [CORRECT]
D. Allergic reaction to recent antibiotic therapy causing angioedema and
bronchospasm.
Correct Answer: C
Rationale: Arturo's symptoms of shortness of breath, lower extremity edema, and
crackles are classic manifestations of fluid volume overload due to ESRD and missed
dialysis. The kidneys' inability to filter blood and regulate blood volume leads to fluid
accumulation in the lungs and tissues. Option A explains fatigue but not edema, Option
B describes AKI rather than his chronic ESRD, and Option D is unsupported by the
presentation.
,Q2: During the initial interview, Arturo reports that his breathing worsens when lying
down and that symptoms intensified after helping his girlfriend bring in groceries
yesterday. The nurse recognizes that breathing difficulty when supine is called:
A. Bradypnea.
B. Orthopnea. [CORRECT]
C. Kussmaul respirations.
D. Cheyne-Stokes respirations.
Correct Answer: B
Rationale: Orthopnea is dyspnea that occurs when lying flat and improves when sitting
upright, commonly seen in fluid overload and heart failure. Option A describes slow
breathing, Option C describes deep rapid breathing seen in metabolic acidosis, and
Option D describes cyclic breathing patterns seen in neurological or cardiac conditions.
Q3: The nurse is collecting subjective data from Arturo. Which statement represents
subjective information that should be documented in the health record?
A. Bilateral 2+ pitting edema to the lower extremities observed on physical examination.
B. Blood pressure elevated at 168/94 mmHg recorded via automatic cuff.
C. Arturo stating, "I'm short of breath and I've got some swelling going on." [CORRECT]
D. Crackles auscultated in bilateral lung bases during respiratory assessment.
Correct Answer: C
,Rationale: Subjective data consists of information reported by the patient, including
symptoms, feelings, and health history. Arturo's direct quote about his symptoms is
subjective data. Options A, B, and D are objective data obtained through physical
assessment, measurement, and auscultation.
Q4: Arturo admits he missed two hemodialysis appointments this week, though he had
never missed an appointment before. The nurse should prioritize which follow-up
action?
A. Immediately discharge Arturo with a warning about appointment compliance.
B. Explore barriers to adherence, including transportation, socioeconomic factors, or
psychosocial stressors that contributed to the missed appointments. [CORRECT]
C. Contact his nephrologist to terminate his dialysis access.
D. Assume the missed appointments indicate medication nonadherence and focus
solely on pill organization education.
Correct Answer: B
Rationale: Since Arturo had perfect attendance prior to this week, the nurse should
explore underlying barriers such as transportation issues, financial constraints, or
competing priorities rather than assuming noncompliance. Option A is punitive and
unsafe given his fluid overload, Option C is inappropriate, and Option D makes an
unsupported assumption.
Q5: During the physical assessment, the nurse expects to find which combination of
findings most consistent with Arturo's presentation of ESRD and fluid overload?
A. Hypotension, flat neck veins, and dry mucous membranes.
, B. Hypertension, jugular venous distention, and bilateral basilar crackles. [CORRECT]
C. Bradycardia, clear lung sounds, and decreased central venous pressure.
D. Normal blood pressure, unilateral leg swelling, and wheezing throughout all lung
fields.
Correct Answer: B
Rationale: Fluid overload in ESRD typically presents with hypertension (from volume
expansion), jugular venous distention, and pulmonary crackles from interstitial fluid.
Option A describes hypovolemia, Option C describes bradycardia and clear lungs
inconsistent with fluid overload, and Option D incorrectly suggests unilateral swelling
and wheezing.
Q6: Arturo's girlfriend mentions that he has been increasingly fatigued over the past
month and occasionally complains of itching. The nurse associates these findings with
which ESRD-related complication?
A. Accumulation of nitrogenous wastes and uremic toxins due to inadequate filtration.
[CORRECT]
B. Hypercalcemia from excessive calcitriol production by failing kidneys.
C. Polycythemia from increased erythropoietin secretion.
D. Hypokalemia from excessive potassium loss in urine.
Correct Answer: A
Rationale: Fatigue and pruritus are common uremic symptoms caused by the
accumulation of nitrogenous wastes (urea, creatinine, uric acid) when kidneys fail to
