NP3 Exam 1 Questions With
Complete Answers
1. The nurse is assessing a client with a diagnosis of prerenal acute kidney
injury (AKI). Which condition would the nurse expect to find in the patient's
recent history?
a. Pyelonephritis
b. Dehydration
c. Bladder cancer
d. Kidney stones - ANSWER ANS: B
Prerenal causes of AKI are related to a decrease in perfusion, such as in
clients who have prolonged dehydration. Pyelonephritis is an intrinsic or
intrarenal cause of AKI related to kidney damage. Bladder cancer and
kidney stones are postrenal causes of AKI related to urine flow obstruction.
2. A marathon runner comes into the clinic and states "I have not urinated
very much in the last few days." The nurse notes a heart rate of 110
beats/min and a blood pressure of 86/58 mm Hg. Which action by the
nurse is most appropriate?
a. Give the client a bottle of water immediately.
b. Start an intravenous line for fluids.
c. Teach the patient to drink 2 to 3 L of water daily.
d. Perform an electrocardiogram. - ANSWER ANS: A
This athlete is mildly dehydrated as evidenced by the higher heart rate and
lower blood pressure. The nurse can start hydrating the client with a bottle
of water first, followed by teaching the patient to drink 2 to 3 L of water
each day. An intravenous line may be needed later, after the patient's
degree of dehydration is assessed. An electrocardiogram is not necessary
at this time.
3. A client comes into the emergency department with a serum creatinine of
2.2 mg/dL (1944 mcmol/L) and a blood urea nitrogen (BUN) of 24 mL/dL
,(8.57 mmol/L). What question would the nurse ask first when taking this
client's history?
a. "Have you been taking any aspirin, ibuprofen, or naproxen recently?"
b. "Do you have anyone in your family with renal failure?"
c. "Have you had a diet that is low in protein recently?"
d. "Has a relative had a kidney transplant lately?" - ANSWER ANS: A
There are some medications that are nephrotoxic, such as the nonsteroidal
anti-inflammatory drugs ibuprofen, aspirin, and naproxen. This would be a
good question to initially ask the patient since both the serum creatinine
and BUN are elevated, indicating some renal problems. A diet high in
protein could be a factor in an increased BUN.
4. A client is admitted with acute kidney injury (AKI) and a urine output of
2000 mL/day. What is the major concern of the nurse regarding this
patient's care?
a. Edema and pain
b. Cardiac and respiratory status
c. Electrolyte and fluid imbalance
d. Mental health status - ANSWER ANS: C
This client may have an inflammatory cause of AKI with proteins entering
the glomerulus and holding the fluid in the filtrate, causing polyuria.
Electrolyte loss and fluid balance are essential. Edema and pain are not
usually a problem with fluid loss. There could be changes in the client's
cardiac, respiratory, and mental health status if the electrolyte imbalance is
not treated.
5. A client with acute kidney injury (AKI) has a blood pressure of 76/55 mm
Hg. The primary health care provider prescribed 1000 mL of normal saline
to be infused over 1 hour to maintain perfusion. The client starts to develop
shortness of breath. What is the nurse's priority action?
a. Calculate the mean arterial pressure (MAP).
b. Ask for insertion of a pulmonary artery catheter.
c. Take the client's pulse.
d. Decrease the rate of the IV infusion. - ANSWER ANS: D
The nurse would assess that the client could be developing fluid overload
and respiratory distress and slow down the normal saline infusion. The
calculation of the MAP also reflects perfusion. The insertion of a pulmonary
artery catheter would evaluate the client's hemodynamic status, but this
would not be the initial or priority action by the nurse. Vital signs are also
important after adjusting the intravenous infusion.
,6. A client has a serum potassium level of 6.5 mEq/L (6.5 mmol/L), a serum
creatinine level of 2 mg/dL (176 mcmol/L), and a urine output of 350
mL/day. What is the best action by the nurse?
a. Place the client on a cardiac monitor immediately.
b. Teach the client to limit high-potassium foods.
c. Continue to monitor the client's intake and output.
d. Ask to have the laboratory redraw the blood specimen. - ANSWER ANS:
A
The best action by the nurse would be to check the cardiac status with a
monitor. High-potassium levels can lead to dysrhythmias. The other
choices are logical nursing interventions for acute kidney injury but not the
best immediate action.
7. A client with diabetes mellitus type 2 has been well controlled with
metformin. The client is scheduled for magnetic resonance imaging (MRI)
scan with contrast. What priority would the nurse take at this time?
a. Teach the client about the purpose of the MRI.
b. Assess the client's blood urea nitrogen and creatinine.
c. Tell the client to withhold metformin for 24 hours before the MRI.
d. Ask the client if he or she is taking antibiotics. - ANSWER ANS: C
Contrast media can be nephrotoxic (damaging to the kidneys). Metformin
can also be nephrotoxic and the client should not be exposed to two
agents. Clients who have diabetes are already at risk for renal damage.
8. A client is started on continuous venovenous hemofiltration (CVVH).
Which finding would require immediate action by the nurse?
a. Potassium level of 5.5 mEq/L (5.5 mmol/L)
b. Sodium level of 138 mEq/L (138 mmol/L)
c. Blood pressure of 76/58 mm Hg
d. Pulse rate of 88 beats/min - ANSWER ANS: C
Hypotension can be a problem with CVVH if replacement fluid does not
provide enough volume to maintain blood pressure. The nurse needs to
monitor for ongoing fluid and electrolyte replacement. The sodium level is
normal and the potassium level is slightly elevated, which could be normal
findings for someone with acute kidney injury. A pulse rate of 88 beats/min
is within usual limits.
9. The nurse is caring for four clients with chronic kidney disease (CKD).
Which client would the nurse assess first upon initial rounding?
, a. Client with a blood pressure of 158/90 mm Hg
b. Client with Kussmaul respirations
c. Client with skin itching from head to toe
d. Client with halitosis and stomatitis - ANSWER ANS: B
Kussmaul respirations indicate that the client has metabolic acidosis which
is a complication of CKD. The client is increasing the rate and depth of
breathing to excrete carbon dioxide through the lungs to lower serum pH.
Hypertension is common in most patients with CKD, and skin itching
increases with calcium-phosphate imbalances and elevations of
nitrogenous wastes, another common finding in CKD. Uremia from CKD
causes ammonia to be formed, resulting in the common findings of halitosis
and stomatitis.
10. The nurse is teaching assistive personnel (AP) about fluid restriction for
a client who has acute kidney injury (AKI). The client's 24-hour urinary
output is 120 mL. How much fluid would the client be allowed to have over
the next 24 hours?
a. 380 mL
b. 500 mL
c. 620 mL
d. 750 mL - ANSWER ANS: C
The general principle for fluid restriction for clients is that they may have a
daily fluid intake of 500 mL plus the amount of their urinary output. In this
case, 120 mL urinary output plus 500 mL equals 620 mL fluid allowance.
11. A client with chronic kidney disease (CKD) is refusing to take his
medication and has missed two hemodialysis appointments. What is the
best initial action for the nurse?
a. Discuss what the treatment regimen means to the client.
b. Refer the client to a mental health nurse practitioner.
c. Reschedule the appointments to another date and time.
d. Discuss the option of peritoneal dialysis. - ANSWER ANS: A
The initial action for the nurse is to assess anxiety, coping styles, and the
client's acceptance of the required treatment for CKD. The client may be in
denial of the diagnosis. While rescheduling hemodialysis appointments
may help, and referral to a mental health practitioner and the possibility of
peritoneal dialysis are all viable options, assessment of the client's
acceptance of the treatment would come first.
Complete Answers
1. The nurse is assessing a client with a diagnosis of prerenal acute kidney
injury (AKI). Which condition would the nurse expect to find in the patient's
recent history?
a. Pyelonephritis
b. Dehydration
c. Bladder cancer
d. Kidney stones - ANSWER ANS: B
Prerenal causes of AKI are related to a decrease in perfusion, such as in
clients who have prolonged dehydration. Pyelonephritis is an intrinsic or
intrarenal cause of AKI related to kidney damage. Bladder cancer and
kidney stones are postrenal causes of AKI related to urine flow obstruction.
2. A marathon runner comes into the clinic and states "I have not urinated
very much in the last few days." The nurse notes a heart rate of 110
beats/min and a blood pressure of 86/58 mm Hg. Which action by the
nurse is most appropriate?
a. Give the client a bottle of water immediately.
b. Start an intravenous line for fluids.
c. Teach the patient to drink 2 to 3 L of water daily.
d. Perform an electrocardiogram. - ANSWER ANS: A
This athlete is mildly dehydrated as evidenced by the higher heart rate and
lower blood pressure. The nurse can start hydrating the client with a bottle
of water first, followed by teaching the patient to drink 2 to 3 L of water
each day. An intravenous line may be needed later, after the patient's
degree of dehydration is assessed. An electrocardiogram is not necessary
at this time.
3. A client comes into the emergency department with a serum creatinine of
2.2 mg/dL (1944 mcmol/L) and a blood urea nitrogen (BUN) of 24 mL/dL
,(8.57 mmol/L). What question would the nurse ask first when taking this
client's history?
a. "Have you been taking any aspirin, ibuprofen, or naproxen recently?"
b. "Do you have anyone in your family with renal failure?"
c. "Have you had a diet that is low in protein recently?"
d. "Has a relative had a kidney transplant lately?" - ANSWER ANS: A
There are some medications that are nephrotoxic, such as the nonsteroidal
anti-inflammatory drugs ibuprofen, aspirin, and naproxen. This would be a
good question to initially ask the patient since both the serum creatinine
and BUN are elevated, indicating some renal problems. A diet high in
protein could be a factor in an increased BUN.
4. A client is admitted with acute kidney injury (AKI) and a urine output of
2000 mL/day. What is the major concern of the nurse regarding this
patient's care?
a. Edema and pain
b. Cardiac and respiratory status
c. Electrolyte and fluid imbalance
d. Mental health status - ANSWER ANS: C
This client may have an inflammatory cause of AKI with proteins entering
the glomerulus and holding the fluid in the filtrate, causing polyuria.
Electrolyte loss and fluid balance are essential. Edema and pain are not
usually a problem with fluid loss. There could be changes in the client's
cardiac, respiratory, and mental health status if the electrolyte imbalance is
not treated.
5. A client with acute kidney injury (AKI) has a blood pressure of 76/55 mm
Hg. The primary health care provider prescribed 1000 mL of normal saline
to be infused over 1 hour to maintain perfusion. The client starts to develop
shortness of breath. What is the nurse's priority action?
a. Calculate the mean arterial pressure (MAP).
b. Ask for insertion of a pulmonary artery catheter.
c. Take the client's pulse.
d. Decrease the rate of the IV infusion. - ANSWER ANS: D
The nurse would assess that the client could be developing fluid overload
and respiratory distress and slow down the normal saline infusion. The
calculation of the MAP also reflects perfusion. The insertion of a pulmonary
artery catheter would evaluate the client's hemodynamic status, but this
would not be the initial or priority action by the nurse. Vital signs are also
important after adjusting the intravenous infusion.
,6. A client has a serum potassium level of 6.5 mEq/L (6.5 mmol/L), a serum
creatinine level of 2 mg/dL (176 mcmol/L), and a urine output of 350
mL/day. What is the best action by the nurse?
a. Place the client on a cardiac monitor immediately.
b. Teach the client to limit high-potassium foods.
c. Continue to monitor the client's intake and output.
d. Ask to have the laboratory redraw the blood specimen. - ANSWER ANS:
A
The best action by the nurse would be to check the cardiac status with a
monitor. High-potassium levels can lead to dysrhythmias. The other
choices are logical nursing interventions for acute kidney injury but not the
best immediate action.
7. A client with diabetes mellitus type 2 has been well controlled with
metformin. The client is scheduled for magnetic resonance imaging (MRI)
scan with contrast. What priority would the nurse take at this time?
a. Teach the client about the purpose of the MRI.
b. Assess the client's blood urea nitrogen and creatinine.
c. Tell the client to withhold metformin for 24 hours before the MRI.
d. Ask the client if he or she is taking antibiotics. - ANSWER ANS: C
Contrast media can be nephrotoxic (damaging to the kidneys). Metformin
can also be nephrotoxic and the client should not be exposed to two
agents. Clients who have diabetes are already at risk for renal damage.
8. A client is started on continuous venovenous hemofiltration (CVVH).
Which finding would require immediate action by the nurse?
a. Potassium level of 5.5 mEq/L (5.5 mmol/L)
b. Sodium level of 138 mEq/L (138 mmol/L)
c. Blood pressure of 76/58 mm Hg
d. Pulse rate of 88 beats/min - ANSWER ANS: C
Hypotension can be a problem with CVVH if replacement fluid does not
provide enough volume to maintain blood pressure. The nurse needs to
monitor for ongoing fluid and electrolyte replacement. The sodium level is
normal and the potassium level is slightly elevated, which could be normal
findings for someone with acute kidney injury. A pulse rate of 88 beats/min
is within usual limits.
9. The nurse is caring for four clients with chronic kidney disease (CKD).
Which client would the nurse assess first upon initial rounding?
, a. Client with a blood pressure of 158/90 mm Hg
b. Client with Kussmaul respirations
c. Client with skin itching from head to toe
d. Client with halitosis and stomatitis - ANSWER ANS: B
Kussmaul respirations indicate that the client has metabolic acidosis which
is a complication of CKD. The client is increasing the rate and depth of
breathing to excrete carbon dioxide through the lungs to lower serum pH.
Hypertension is common in most patients with CKD, and skin itching
increases with calcium-phosphate imbalances and elevations of
nitrogenous wastes, another common finding in CKD. Uremia from CKD
causes ammonia to be formed, resulting in the common findings of halitosis
and stomatitis.
10. The nurse is teaching assistive personnel (AP) about fluid restriction for
a client who has acute kidney injury (AKI). The client's 24-hour urinary
output is 120 mL. How much fluid would the client be allowed to have over
the next 24 hours?
a. 380 mL
b. 500 mL
c. 620 mL
d. 750 mL - ANSWER ANS: C
The general principle for fluid restriction for clients is that they may have a
daily fluid intake of 500 mL plus the amount of their urinary output. In this
case, 120 mL urinary output plus 500 mL equals 620 mL fluid allowance.
11. A client with chronic kidney disease (CKD) is refusing to take his
medication and has missed two hemodialysis appointments. What is the
best initial action for the nurse?
a. Discuss what the treatment regimen means to the client.
b. Refer the client to a mental health nurse practitioner.
c. Reschedule the appointments to another date and time.
d. Discuss the option of peritoneal dialysis. - ANSWER ANS: A
The initial action for the nurse is to assess anxiety, coping styles, and the
client's acceptance of the required treatment for CKD. The client may be in
denial of the diagnosis. While rescheduling hemodialysis appointments
may help, and referral to a mental health practitioner and the possibility of
peritoneal dialysis are all viable options, assessment of the client's
acceptance of the treatment would come first.
