Med-Surg Renal Failure & Dialysis Practice Exam
(Questions 1–150)
1. A patient with chronic kidney disease (CKD) presents with fatigue
and pallor. Which laboratory value best explains these symptoms?
A) Elevated potassium
B) Elevated BUN
C) Decreased hemoglobin
D) Decreased calcium
C) Decreased hemoglobin
Rationale: Anemia is common in CKD due to decreased
erythropoietin production by the kidneys, leading to low
hemoglobin levels.
2. A patient undergoing hemodialysis reports cramping during
treatment. What is the most appropriate nursing intervention?
A) Increase the ultrafiltration rate
B) Administer IV fluids as prescribed
C) Lower the dialysate temperature
D) Decrease blood flow rate
C) Lower the dialysate temperature
Rationale: Cooler dialysate can help reduce hypotension and
cramping during hemodialysis.
3. Which of the following is an early sign of acute kidney injury
(AKI)?
A) Hypernatremia
B) Oliguria
C) Hematuria
D) Polyuria
B) Oliguria
, Rationale: Oliguria, defined as urine output less than 400
mL/day, is an early indicator of AKI.
4. A patient with CKD is prescribed erythropoietin. The nurse should
monitor for which potential complication?
A) Hypotension
B) Thrombosis
C) Hyperkalemia
D) Hypoglycemia
B) Thrombosis
Rationale: Erythropoietin therapy increases red blood cell
production, which may raise the risk of blood clots.
5. A patient with end-stage renal disease (ESRD) is being prepared
for peritoneal dialysis. Which assessment is most important
before initiating therapy?
A) Lung sounds
B) Abdominal scars or hernias
C) Peripheral pulses
D) Skin turgor
B) Abdominal scars or hernias
Rationale: Prior abdominal surgeries or hernias can interfere
with dialysate flow and increase risk of complications during
peritoneal dialysis.
6. Which electrolyte imbalance is most concerning in a patient with
AKI?
A) Hypocalcemia
B) Hyperkalemia
C) Hyponatremia
D) Hypomagnesemia
B) Hyperkalemia
, Rationale: Hyperkalemia can lead to life-threatening cardiac
arrhythmias and requires prompt intervention.
7. A patient with CKD reports pruritus and dry skin. What is the
underlying cause?
A) Hyperphosphatemia
B) Hyperkalemia
C) Hypernatremia
D) Hypocalcemia
A) Hyperphosphatemia
Rationale: Elevated phosphate levels in CKD can lead to pruritus,
calcification, and dry skin.
8. During hemodialysis, a patient develops hypotension. What is the
initial nursing action?
A) Administer antihypertensive medication
B) Slow or stop ultrafiltration
C) Increase dialysate flow rate
D) Administer potassium
B) Slow or stop ultrafiltration
Rationale: Rapid fluid removal can cause hypotension; slowing
or stopping ultrafiltration helps stabilize blood pressure.
9. Which dietary recommendation is appropriate for a patient with
CKD?
A) High potassium intake
B) Low-protein diet
C) High sodium intake
D) Increased phosphorus intake
B) Low-protein diet
Rationale: A low-protein diet reduces nitrogenous waste
accumulation and slows CKD progression.
, 10. A patient undergoing peritoneal dialysis develops cloudy
effluent. What does this indicate?
A) Peritonitis
B) Adequate dialysis
C) Hypotension
D) Hyperkalemia
A) Peritonitis
Rationale: Cloudy dialysate is a common sign of infection in
peritoneal dialysis and requires prompt evaluation.
11. Which finding is most consistent with nephrotic syndrome?
A) Hematuria
B) Proteinuria >3.5 g/day
C) Polyuria
D) Hypokalemia
B) Proteinuria >3.5 g/day
Rationale: Nephrotic syndrome is characterized by heavy
proteinuria, hypoalbuminemia, and edema.
12. A patient with AKI exhibits a rapid rise in BUN and
creatinine. This is an example of:
A) Chronic kidney disease
B) Acute kidney injury
C) Nephrotic syndrome
D) Glomerulonephritis
B) Acute kidney injury
Rationale: AKI is marked by abrupt loss of kidney function with
rising BUN and creatinine levels.
13. A patient with ESRD is prescribed calcium carbonate. What is
the primary purpose of this medication?
A) Lower potassium levels
(Questions 1–150)
1. A patient with chronic kidney disease (CKD) presents with fatigue
and pallor. Which laboratory value best explains these symptoms?
A) Elevated potassium
B) Elevated BUN
C) Decreased hemoglobin
D) Decreased calcium
C) Decreased hemoglobin
Rationale: Anemia is common in CKD due to decreased
erythropoietin production by the kidneys, leading to low
hemoglobin levels.
2. A patient undergoing hemodialysis reports cramping during
treatment. What is the most appropriate nursing intervention?
A) Increase the ultrafiltration rate
B) Administer IV fluids as prescribed
C) Lower the dialysate temperature
D) Decrease blood flow rate
C) Lower the dialysate temperature
Rationale: Cooler dialysate can help reduce hypotension and
cramping during hemodialysis.
3. Which of the following is an early sign of acute kidney injury
(AKI)?
A) Hypernatremia
B) Oliguria
C) Hematuria
D) Polyuria
B) Oliguria
, Rationale: Oliguria, defined as urine output less than 400
mL/day, is an early indicator of AKI.
4. A patient with CKD is prescribed erythropoietin. The nurse should
monitor for which potential complication?
A) Hypotension
B) Thrombosis
C) Hyperkalemia
D) Hypoglycemia
B) Thrombosis
Rationale: Erythropoietin therapy increases red blood cell
production, which may raise the risk of blood clots.
5. A patient with end-stage renal disease (ESRD) is being prepared
for peritoneal dialysis. Which assessment is most important
before initiating therapy?
A) Lung sounds
B) Abdominal scars or hernias
C) Peripheral pulses
D) Skin turgor
B) Abdominal scars or hernias
Rationale: Prior abdominal surgeries or hernias can interfere
with dialysate flow and increase risk of complications during
peritoneal dialysis.
6. Which electrolyte imbalance is most concerning in a patient with
AKI?
A) Hypocalcemia
B) Hyperkalemia
C) Hyponatremia
D) Hypomagnesemia
B) Hyperkalemia
, Rationale: Hyperkalemia can lead to life-threatening cardiac
arrhythmias and requires prompt intervention.
7. A patient with CKD reports pruritus and dry skin. What is the
underlying cause?
A) Hyperphosphatemia
B) Hyperkalemia
C) Hypernatremia
D) Hypocalcemia
A) Hyperphosphatemia
Rationale: Elevated phosphate levels in CKD can lead to pruritus,
calcification, and dry skin.
8. During hemodialysis, a patient develops hypotension. What is the
initial nursing action?
A) Administer antihypertensive medication
B) Slow or stop ultrafiltration
C) Increase dialysate flow rate
D) Administer potassium
B) Slow or stop ultrafiltration
Rationale: Rapid fluid removal can cause hypotension; slowing
or stopping ultrafiltration helps stabilize blood pressure.
9. Which dietary recommendation is appropriate for a patient with
CKD?
A) High potassium intake
B) Low-protein diet
C) High sodium intake
D) Increased phosphorus intake
B) Low-protein diet
Rationale: A low-protein diet reduces nitrogenous waste
accumulation and slows CKD progression.
, 10. A patient undergoing peritoneal dialysis develops cloudy
effluent. What does this indicate?
A) Peritonitis
B) Adequate dialysis
C) Hypotension
D) Hyperkalemia
A) Peritonitis
Rationale: Cloudy dialysate is a common sign of infection in
peritoneal dialysis and requires prompt evaluation.
11. Which finding is most consistent with nephrotic syndrome?
A) Hematuria
B) Proteinuria >3.5 g/day
C) Polyuria
D) Hypokalemia
B) Proteinuria >3.5 g/day
Rationale: Nephrotic syndrome is characterized by heavy
proteinuria, hypoalbuminemia, and edema.
12. A patient with AKI exhibits a rapid rise in BUN and
creatinine. This is an example of:
A) Chronic kidney disease
B) Acute kidney injury
C) Nephrotic syndrome
D) Glomerulonephritis
B) Acute kidney injury
Rationale: AKI is marked by abrupt loss of kidney function with
rising BUN and creatinine levels.
13. A patient with ESRD is prescribed calcium carbonate. What is
the primary purpose of this medication?
A) Lower potassium levels
