NURS 341 2025 MED SURG PRACTICE FINAL REVIEW EXAM TEST QUESTIONS WITH
WELL DETAILED ANSWERS- GRADED A+
After the insertion of an arteriovenous graft (AVG) in the right forearm, a patient complains
of pain and coldness of the right fingers. Which action should the nurse take?
a. Teach the patient about normal AVG function.
b. Remind the patient to take a daily low-dose aspirin tablet.
c. Report the patient's symptoms to the health care provider.
d. Elevate the patient's arm on pillows to above the heart level.
ANS: C
The patient's complaints suggest the development of distal ischemia (steal syndrome) and
may require revision of the AVG. Elevation of the arm above the heart will further decrease
perfusion. Pain and coolness are not normal after AVG insertion. Aspirin therapy is not
used
to maintain grafts.
DIF: Cognitive Level: Apply (application) REF: 1088
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity
When a patient with acute kidney injury (AKI) has an arterial blood pH of 7.30, the nurse will
expect an assessment finding of
a. persistent skin tenting
b. rapid, deep respirations.
c. hot, flushed face and neck.
d. bounding peripheral pulses.
ANS: B
,Patients with metabolic acidosis caused by AKI may have Kussmaul respirations as the
lungs
try to regulate carbon dioxide. Bounding pulses and vasodilation are not associated with
metabolic acidosis. Because the patient is likely to have fluid retention, poor skin turgor
would not be a finding in AKI.
DIF: Cognitive Level: Apply (application) REF: 1072
TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity
The nurse is planning care for a patient with severe heart failure who has developed
elevated
blood urea nitrogen (BUN) and creatinine levels. The primary treatment goal in the plan will
be
a. augmenting fluid volume. .
b. maintaining cardiac output.
c. diluting nephrotoxic substances
d. preventing systemic hypertension.
ANS: B
The primary goal of treatment for acute kidney injury (AKI) is to eliminate the cause and
provide supportive care while the kidneys recover. Because this patient's heart failure is
causing AKI, the care will be directed toward treatment of the heart failure. For renal failure
caused by hypertension, hypovolemia, or nephrotoxins, the other responses would be
correct.
DIF: Cognitive Level: Apply (application) REF: 1073
TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity
,A patient who has acute glomerulonephritis is hospitalized with hyperkalemia. Which
information will the nurse monitor to evaluate the effectiveness of the prescribed calcium
gluconate IV?
a. Urine volume
b. Calcium level
c. Cardiac rhythm
d. Neurologic status
ANS: C
The calcium gluconate helps prevent dysrhythmias that might be caused by the
hyperkalemia.
The nurse will monitor the other data as well, but these will not be helpful in determining
the
effectiveness of the calcium gluconate.
DIF: Cognitive Level: Apply (application) REF: 1073
TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity
Which statement by a patient with stage 5 chronic kidney disease (CKD) indicates that the
nurse's teaching about management of CKD has been effective?
a. "I need to get most of my protein from low-fat dairy products."
b. "I will increase my intake of fruits and vegetables to 5 per day."
c. "I will measure my urinary output each day to help calculate the amount I can
drink."
d. "I need to take erythropoietin to boost my immune system and help prevent
infection."
, ANS: C
The patient with end-stage renal disease is taught to measure urine output as a means of
determining an appropriate oral fluid intake. Erythropoietin is given to increase the red
blood
cell count and will not offer any benefit for immune function. Dairy products are restricted
because of the high phosphate level. Many fruits and vegetables are high in potassium and
should be restricted in the patient with CKD.
DIF: Cognitive Level: Apply (application) REF: 1082
TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity
Which information will the nurse monitor in order to determine the effectiveness of
prescribed
calcium carbonate (Caltrate) for a patient with chronic kidney disease (CKD)?
a. Blood pressure
b. Phosphate level
c. Neurologic status
d. Creatinine clearance
ANS: B
Calcium carbonate is prescribed to bind phosphorus and prevent mineral and bone
disease in
patients with CKD. The other data will not be helpful in evaluating the effectiveness of
calcium carbonate.
DIF: Cognitive Level: Apply (application) REF: 1081
TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity
WELL DETAILED ANSWERS- GRADED A+
After the insertion of an arteriovenous graft (AVG) in the right forearm, a patient complains
of pain and coldness of the right fingers. Which action should the nurse take?
a. Teach the patient about normal AVG function.
b. Remind the patient to take a daily low-dose aspirin tablet.
c. Report the patient's symptoms to the health care provider.
d. Elevate the patient's arm on pillows to above the heart level.
ANS: C
The patient's complaints suggest the development of distal ischemia (steal syndrome) and
may require revision of the AVG. Elevation of the arm above the heart will further decrease
perfusion. Pain and coolness are not normal after AVG insertion. Aspirin therapy is not
used
to maintain grafts.
DIF: Cognitive Level: Apply (application) REF: 1088
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity
When a patient with acute kidney injury (AKI) has an arterial blood pH of 7.30, the nurse will
expect an assessment finding of
a. persistent skin tenting
b. rapid, deep respirations.
c. hot, flushed face and neck.
d. bounding peripheral pulses.
ANS: B
,Patients with metabolic acidosis caused by AKI may have Kussmaul respirations as the
lungs
try to regulate carbon dioxide. Bounding pulses and vasodilation are not associated with
metabolic acidosis. Because the patient is likely to have fluid retention, poor skin turgor
would not be a finding in AKI.
DIF: Cognitive Level: Apply (application) REF: 1072
TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity
The nurse is planning care for a patient with severe heart failure who has developed
elevated
blood urea nitrogen (BUN) and creatinine levels. The primary treatment goal in the plan will
be
a. augmenting fluid volume. .
b. maintaining cardiac output.
c. diluting nephrotoxic substances
d. preventing systemic hypertension.
ANS: B
The primary goal of treatment for acute kidney injury (AKI) is to eliminate the cause and
provide supportive care while the kidneys recover. Because this patient's heart failure is
causing AKI, the care will be directed toward treatment of the heart failure. For renal failure
caused by hypertension, hypovolemia, or nephrotoxins, the other responses would be
correct.
DIF: Cognitive Level: Apply (application) REF: 1073
TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity
,A patient who has acute glomerulonephritis is hospitalized with hyperkalemia. Which
information will the nurse monitor to evaluate the effectiveness of the prescribed calcium
gluconate IV?
a. Urine volume
b. Calcium level
c. Cardiac rhythm
d. Neurologic status
ANS: C
The calcium gluconate helps prevent dysrhythmias that might be caused by the
hyperkalemia.
The nurse will monitor the other data as well, but these will not be helpful in determining
the
effectiveness of the calcium gluconate.
DIF: Cognitive Level: Apply (application) REF: 1073
TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity
Which statement by a patient with stage 5 chronic kidney disease (CKD) indicates that the
nurse's teaching about management of CKD has been effective?
a. "I need to get most of my protein from low-fat dairy products."
b. "I will increase my intake of fruits and vegetables to 5 per day."
c. "I will measure my urinary output each day to help calculate the amount I can
drink."
d. "I need to take erythropoietin to boost my immune system and help prevent
infection."
, ANS: C
The patient with end-stage renal disease is taught to measure urine output as a means of
determining an appropriate oral fluid intake. Erythropoietin is given to increase the red
blood
cell count and will not offer any benefit for immune function. Dairy products are restricted
because of the high phosphate level. Many fruits and vegetables are high in potassium and
should be restricted in the patient with CKD.
DIF: Cognitive Level: Apply (application) REF: 1082
TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity
Which information will the nurse monitor in order to determine the effectiveness of
prescribed
calcium carbonate (Caltrate) for a patient with chronic kidney disease (CKD)?
a. Blood pressure
b. Phosphate level
c. Neurologic status
d. Creatinine clearance
ANS: B
Calcium carbonate is prescribed to bind phosphorus and prevent mineral and bone
disease in
patients with CKD. The other data will not be helpful in evaluating the effectiveness of
calcium carbonate.
DIF: Cognitive Level: Apply (application) REF: 1081
TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity
