1
HESI Exit Exam Question Bank: Renal
Failure & Dialysis Nursing
Management
Table of Contents
Subtopic 1: Acute Kidney Injury (AKI) – Assessment and Early Interventions. .2
Subtopic 2: Chronic Kidney Disease (CKD) and Progression to Renal Failure.11
Subtopic 3: Hemodialysis—Indications, Access, and Complications..............20
Subtopic 4: Peritoneal Dialysis—Mechanisms, Care, and Troubleshooting.....29
Subtopic 5: Fluid Balance and Electrolyte Management in Renal Failure.......38
Subtopic 6: Pharmacologic Considerations in Renal Failure and Dialysis.......47
Subtopic 7: Hemodialysis—Process, Access, and Complications...................57
Subtopic 8: Peritoneal Dialysis—Procedure, Management, and Risks............66
Subtopic 9: Pediatric and Geriatric Considerations in Dialysis.......................75
Subtopic 10: Pharmacologic Considerations in Dialysis Patients...................84
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Subtopic 1: Acute Kidney Injury (AKI) –
Assessment and Early Interventions
Question 1:
A patient admitted with acute kidney injury (AKI) due to hypovolemia has a
serum creatinine level that has doubled within 48 hours. What is the nurse’s
priority intervention?
A. Encourage increased protein intake
B. Monitor urine output hourly and administer IV fluids as ordered
C. Restrict fluid intake to prevent overload
D. Administer diuretics to promote diuresis
Correct Answer: B
Rationale: Hypovolemia-induced AKI requires fluid resuscitation. Monitoring
urine output helps assess renal perfusion and function.
Question 2:
Which laboratory value is most indicative of AKI progression?
A. Hemoglobin
B. Calcium
C. Serum creatinine
D. Albumin
Correct Answer: C
Rationale: A rise in serum creatinine reflects declining glomerular filtration
and is a key indicator of AKI.
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Question 3:
Which clinical manifestation would the nurse expect in a patient in the
oliguric phase of AKI?
A. Hypokalemia
B. Hyperkalemia
C. Hypovolemia
D. Polyuria
Correct Answer: B
Rationale: The oliguric phase is marked by potassium retention due to
impaired excretion, leading to hyperkalemia.
Question 4:
The nurse is caring for a patient in AKI. What finding requires immediate
intervention?
A. BP 148/90 mmHg
B. ECG showing peaked T waves
C. BUN 45 mg/dL
D. Urine output 480 mL/day
Correct Answer: B
Rationale: Peaked T waves are a sign of severe hyperkalemia, a life-
threatening complication in AKI.
Question 5:
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A nurse is educating a patient recovering from AKI. Which dietary instruction
is most appropriate?
A. Limit potassium-rich foods like bananas and oranges
B. Increase phosphorus intake
C. Drink 3 liters of fluid per day
D. Increase magnesium supplements
Correct Answer: A
Rationale: Potassium levels are often elevated in AKI; limiting intake helps
prevent cardiac complications.
Question 6:
Which diagnostic test best confirms AKI?
A. Urinalysis
B. CT scan of kidneys
C. Serum creatinine and GFR calculation
D. Abdominal ultrasound
Correct Answer: C
Rationale: GFR and serum creatinine provide the most accurate assessment
of renal function decline.
Question 7:
In the diuretic phase of AKI, the nurse should monitor for which complication?
A. Fluid overload
HESI Exit Exam Question Bank: Renal
Failure & Dialysis Nursing
Management
Table of Contents
Subtopic 1: Acute Kidney Injury (AKI) – Assessment and Early Interventions. .2
Subtopic 2: Chronic Kidney Disease (CKD) and Progression to Renal Failure.11
Subtopic 3: Hemodialysis—Indications, Access, and Complications..............20
Subtopic 4: Peritoneal Dialysis—Mechanisms, Care, and Troubleshooting.....29
Subtopic 5: Fluid Balance and Electrolyte Management in Renal Failure.......38
Subtopic 6: Pharmacologic Considerations in Renal Failure and Dialysis.......47
Subtopic 7: Hemodialysis—Process, Access, and Complications...................57
Subtopic 8: Peritoneal Dialysis—Procedure, Management, and Risks............66
Subtopic 9: Pediatric and Geriatric Considerations in Dialysis.......................75
Subtopic 10: Pharmacologic Considerations in Dialysis Patients...................84
, 2
Subtopic 1: Acute Kidney Injury (AKI) –
Assessment and Early Interventions
Question 1:
A patient admitted with acute kidney injury (AKI) due to hypovolemia has a
serum creatinine level that has doubled within 48 hours. What is the nurse’s
priority intervention?
A. Encourage increased protein intake
B. Monitor urine output hourly and administer IV fluids as ordered
C. Restrict fluid intake to prevent overload
D. Administer diuretics to promote diuresis
Correct Answer: B
Rationale: Hypovolemia-induced AKI requires fluid resuscitation. Monitoring
urine output helps assess renal perfusion and function.
Question 2:
Which laboratory value is most indicative of AKI progression?
A. Hemoglobin
B. Calcium
C. Serum creatinine
D. Albumin
Correct Answer: C
Rationale: A rise in serum creatinine reflects declining glomerular filtration
and is a key indicator of AKI.
, 3
Question 3:
Which clinical manifestation would the nurse expect in a patient in the
oliguric phase of AKI?
A. Hypokalemia
B. Hyperkalemia
C. Hypovolemia
D. Polyuria
Correct Answer: B
Rationale: The oliguric phase is marked by potassium retention due to
impaired excretion, leading to hyperkalemia.
Question 4:
The nurse is caring for a patient in AKI. What finding requires immediate
intervention?
A. BP 148/90 mmHg
B. ECG showing peaked T waves
C. BUN 45 mg/dL
D. Urine output 480 mL/day
Correct Answer: B
Rationale: Peaked T waves are a sign of severe hyperkalemia, a life-
threatening complication in AKI.
Question 5:
, 4
A nurse is educating a patient recovering from AKI. Which dietary instruction
is most appropriate?
A. Limit potassium-rich foods like bananas and oranges
B. Increase phosphorus intake
C. Drink 3 liters of fluid per day
D. Increase magnesium supplements
Correct Answer: A
Rationale: Potassium levels are often elevated in AKI; limiting intake helps
prevent cardiac complications.
Question 6:
Which diagnostic test best confirms AKI?
A. Urinalysis
B. CT scan of kidneys
C. Serum creatinine and GFR calculation
D. Abdominal ultrasound
Correct Answer: C
Rationale: GFR and serum creatinine provide the most accurate assessment
of renal function decline.
Question 7:
In the diuretic phase of AKI, the nurse should monitor for which complication?
A. Fluid overload
