MED-SURG RENAL SYSTEM FINAL EXAMS PACK —
100 QUESTIONS
1. A client with acute kidney injury (AKI) has a serum potassium of 6.5
mEq/L. Which medication does the nurse anticipate administering
first?
A. Furosemide
B. IV calcium gluconate
C. Sodium polystyrene sulfonate
D. Regular insulin with D50
Rationale: Calcium gluconate stabilizes the cardiac membrane
immediately, preventing fatal arrhythmias from hyperkalemia.
2. A patient with chronic kidney disease (CKD) reports severe fatigue.
Which lab finding best explains the symptom?
A. Elevated creatinine
B. Low hemoglobin
C. Hyperphosphatemia
D. Low serum calcium
Rationale: Low hemoglobin results from decreased erythropoietin
production, causing anemia and fatigue.
3. A client with nephrotic syndrome is expected to exhibit which
clinical finding?
A. Hematuria
B. Weight loss
,C. Massive proteinuria
D. Hypotension
Rationale: Nephrotic syndrome causes increased glomerular
permeability, leading to large protein losses in urine.
4. The nurse caring for a client with CKD should restrict which
electrolyte most closely?
A. Sodium
B. Chloride
C. Potassium
D. Magnesium
Rationale: Potassium accumulates easily in CKD and may cause lethal
dysrhythmias.
5. Which finding indicates peritoneal dialysis is effective?
A. Cloudy dialysate return
B. Decreased fibrin strands
C. Warm dialysate return
D. Improved electrolyte levels
Rationale: Correcting electrolyte imbalances indicates effective
dialysis.
6. A client with a urinary tract obstruction is at risk for which
condition?
A. Respiratory alkalosis
B. Hydronephrosis
C. Dehydration
,D. Hypernatremia
Rationale: Obstruction causes urine backup and dilation of the renal
pelvis (hydronephrosis).
7. Which urinalysis result is most indicative of a urinary tract infection
(UTI)?
A. Protein 1+
B. Specific gravity 1.030
C. Positive nitrites
D. Glucose present
Rationale: Nitrites indicate bacterial conversion from nitrates,
commonly seen in UTIs.
8. A patient with CKD is started on sodium bicarbonate. What does
this treat?
A. Hyperkalemia
B. Metabolic acidosis
C. Hyperphosphatemia
D. Anemia
Rationale: CKD reduces bicarbonate levels, leading to metabolic
acidosis.
9. A priority intervention for a patient with hemodialysis access via AV
fistula is to:
A. Measure blood pressure on that arm
B. Start an IV above the fistula
C. Apply cold compress
, D. Assess for bruit and thrill
Rationale: A bruit/thrill indicates patency of the fistula.
10. A client with pyelonephritis is expected to report:
A. Suprapubic pain
B. Flank pain
C. Painless hematuria
D. Polyuria only
Rationale: Pyelonephritis involves kidney infection, causing flank pain.
11. Which symptom is most characteristic of urolithiasis (kidney
stones)?
A. Dysuria only
B. Fever and chills only
C. Severe flank pain radiating to groin
D. Polyuria
Rationale: Kidney stones cause sharp, colicky flank pain radiating to
the groin due to ureteral obstruction.
12. The nurse is teaching a client with CKD about dietary restrictions.
Which instruction is correct?
A. Increase potassium-rich foods
B. Limit phosphorus-rich foods
C. Increase sodium intake
D. Avoid high-protein foods entirely
Rationale: CKD leads to hyperphosphatemia; limiting phosphorus
prevents bone and cardiovascular complications.
100 QUESTIONS
1. A client with acute kidney injury (AKI) has a serum potassium of 6.5
mEq/L. Which medication does the nurse anticipate administering
first?
A. Furosemide
B. IV calcium gluconate
C. Sodium polystyrene sulfonate
D. Regular insulin with D50
Rationale: Calcium gluconate stabilizes the cardiac membrane
immediately, preventing fatal arrhythmias from hyperkalemia.
2. A patient with chronic kidney disease (CKD) reports severe fatigue.
Which lab finding best explains the symptom?
A. Elevated creatinine
B. Low hemoglobin
C. Hyperphosphatemia
D. Low serum calcium
Rationale: Low hemoglobin results from decreased erythropoietin
production, causing anemia and fatigue.
3. A client with nephrotic syndrome is expected to exhibit which
clinical finding?
A. Hematuria
B. Weight loss
,C. Massive proteinuria
D. Hypotension
Rationale: Nephrotic syndrome causes increased glomerular
permeability, leading to large protein losses in urine.
4. The nurse caring for a client with CKD should restrict which
electrolyte most closely?
A. Sodium
B. Chloride
C. Potassium
D. Magnesium
Rationale: Potassium accumulates easily in CKD and may cause lethal
dysrhythmias.
5. Which finding indicates peritoneal dialysis is effective?
A. Cloudy dialysate return
B. Decreased fibrin strands
C. Warm dialysate return
D. Improved electrolyte levels
Rationale: Correcting electrolyte imbalances indicates effective
dialysis.
6. A client with a urinary tract obstruction is at risk for which
condition?
A. Respiratory alkalosis
B. Hydronephrosis
C. Dehydration
,D. Hypernatremia
Rationale: Obstruction causes urine backup and dilation of the renal
pelvis (hydronephrosis).
7. Which urinalysis result is most indicative of a urinary tract infection
(UTI)?
A. Protein 1+
B. Specific gravity 1.030
C. Positive nitrites
D. Glucose present
Rationale: Nitrites indicate bacterial conversion from nitrates,
commonly seen in UTIs.
8. A patient with CKD is started on sodium bicarbonate. What does
this treat?
A. Hyperkalemia
B. Metabolic acidosis
C. Hyperphosphatemia
D. Anemia
Rationale: CKD reduces bicarbonate levels, leading to metabolic
acidosis.
9. A priority intervention for a patient with hemodialysis access via AV
fistula is to:
A. Measure blood pressure on that arm
B. Start an IV above the fistula
C. Apply cold compress
, D. Assess for bruit and thrill
Rationale: A bruit/thrill indicates patency of the fistula.
10. A client with pyelonephritis is expected to report:
A. Suprapubic pain
B. Flank pain
C. Painless hematuria
D. Polyuria only
Rationale: Pyelonephritis involves kidney infection, causing flank pain.
11. Which symptom is most characteristic of urolithiasis (kidney
stones)?
A. Dysuria only
B. Fever and chills only
C. Severe flank pain radiating to groin
D. Polyuria
Rationale: Kidney stones cause sharp, colicky flank pain radiating to
the groin due to ureteral obstruction.
12. The nurse is teaching a client with CKD about dietary restrictions.
Which instruction is correct?
A. Increase potassium-rich foods
B. Limit phosphorus-rich foods
C. Increase sodium intake
D. Avoid high-protein foods entirely
Rationale: CKD leads to hyperphosphatemia; limiting phosphorus
prevents bone and cardiovascular complications.
