,EXAM 1
1. Increased uremia results in metabolic toxins accumulating in the body. How will this manifest
in the patient?
A. Hypertension
B. Pericardial friction rub
C. Edema
D. Decreased urine output
Correct Answer: B. Pericardial friction rub
Rationale:
Uremia leads to the accumulation of metabolic toxins in the blood, which can irritate the
pericardium and cause pericarditis, manifested as a pericardial friction rub.
2. Your patient’s K⁺ level is reported at 5.9 mEq/L. What do you do next?
A. Document and recheck in 12 hours
B. Encourage oral fluids
C. Notify the MD
D. Administer potassium supplements
Correct Answer: C. Notify the MD
Rationale:
A potassium level of 5.9 mEq/L indicates hyperkalemia, a potentially life-threatening electrolyte
imbalance that can cause cardiac arrhythmias. The nurse should notify the physician immediately
for urgent management.
,3. Your patient with ESRD presents with anorexia, metallic taste in the mouth, and mental status
changes. This may be indicative of:
A. Electrolyte imbalance
B. Uremia
C. Hypocalcemia
D. Fluid overload
Correct Answer: B. Uremia
Rationale:
These are classic signs of uremia, which occurs in end-stage renal disease (ESRD) due to the
accumulation of nitrogenous waste products in the blood, affecting neurological and
gastrointestinal function.
4. The nurse is caring for assigned clients who have end-stage renal disease (ESRD). Which of
the following arterial blood gas (ABG) results should the nurse correlate to this condition?
A. pH 7.45, PaO₂ 90 mm Hg, PaCO₂ 40 mm Hg, HCO₃⁻ 24 mEq/L
B. pH 7.20, PaO₂ 80 mm Hg, PaCO₂ 36 mm Hg, HCO₃⁻ 16 mEq/L
C. pH 7.50, PaO₂ 78 mm Hg, PaCO₂ 30 mm Hg, HCO₃⁻ 20 mEq/L
D. pH 7.35, PaO₂ 85 mm Hg, PaCO₂ 45 mm Hg, HCO₃⁻ 22 mEq/L
Correct Answer: B. pH 7.20, PaO₂ 80 mm Hg, PaCO₂ 36 mm Hg, HCO₃⁻ 16 mEq/L
Rationale:
This ABG indicates metabolic acidosis, a common finding in ESRD due to the kidneys’ inability
to excrete hydrogen ions and conserve bicarbonate.
5. Which patient is priority for hemodialysis?
A. A patient with BP of 170/100
B. A patient with mild anemia
, C. A patient with stable creatinine
D. A patient with slightly elevated BUN
Correct Answer: A. A patient with BP of 170/100
Rationale:
A BP of 170/100 mm Hg in a patient with renal disease suggests fluid overload or hypertensive
emergency, both requiring urgent hemodialysis to remove excess fluid and stabilize blood
pressure.
6. ESRD increases the patient’s risk for developing:
A. Coronary artery disease (CAD)
B. Peripheral arterial disease (PAD)
C. Deep vein thrombosis (DVT)
D. Pulmonary embolism (PE)
Correct Answer: B. Peripheral arterial disease (PAD)
Rationale:
Patients with end-stage renal disease (ESRD) have a higher risk of PAD due to chronic
inflammation, vascular calcification, and atherosclerosis from uremic toxins and hypertension.
7. Your client reports indigestion. Which OTC medication is appropriate for them?
A. Aspirin
B. Pepcid (H₂ blocker)
C. Ibuprofen
D. Pepto-Bismol
Correct Answer: B. Pepcid (H₂ blocker)
Rationale:
Pepcid (famotidine) is an H₂ receptor blocker that safely reduces stomach acid without harming
the kidneys, making it a suitable OTC option for patients with renal impairment.
1. Increased uremia results in metabolic toxins accumulating in the body. How will this manifest
in the patient?
A. Hypertension
B. Pericardial friction rub
C. Edema
D. Decreased urine output
Correct Answer: B. Pericardial friction rub
Rationale:
Uremia leads to the accumulation of metabolic toxins in the blood, which can irritate the
pericardium and cause pericarditis, manifested as a pericardial friction rub.
2. Your patient’s K⁺ level is reported at 5.9 mEq/L. What do you do next?
A. Document and recheck in 12 hours
B. Encourage oral fluids
C. Notify the MD
D. Administer potassium supplements
Correct Answer: C. Notify the MD
Rationale:
A potassium level of 5.9 mEq/L indicates hyperkalemia, a potentially life-threatening electrolyte
imbalance that can cause cardiac arrhythmias. The nurse should notify the physician immediately
for urgent management.
,3. Your patient with ESRD presents with anorexia, metallic taste in the mouth, and mental status
changes. This may be indicative of:
A. Electrolyte imbalance
B. Uremia
C. Hypocalcemia
D. Fluid overload
Correct Answer: B. Uremia
Rationale:
These are classic signs of uremia, which occurs in end-stage renal disease (ESRD) due to the
accumulation of nitrogenous waste products in the blood, affecting neurological and
gastrointestinal function.
4. The nurse is caring for assigned clients who have end-stage renal disease (ESRD). Which of
the following arterial blood gas (ABG) results should the nurse correlate to this condition?
A. pH 7.45, PaO₂ 90 mm Hg, PaCO₂ 40 mm Hg, HCO₃⁻ 24 mEq/L
B. pH 7.20, PaO₂ 80 mm Hg, PaCO₂ 36 mm Hg, HCO₃⁻ 16 mEq/L
C. pH 7.50, PaO₂ 78 mm Hg, PaCO₂ 30 mm Hg, HCO₃⁻ 20 mEq/L
D. pH 7.35, PaO₂ 85 mm Hg, PaCO₂ 45 mm Hg, HCO₃⁻ 22 mEq/L
Correct Answer: B. pH 7.20, PaO₂ 80 mm Hg, PaCO₂ 36 mm Hg, HCO₃⁻ 16 mEq/L
Rationale:
This ABG indicates metabolic acidosis, a common finding in ESRD due to the kidneys’ inability
to excrete hydrogen ions and conserve bicarbonate.
5. Which patient is priority for hemodialysis?
A. A patient with BP of 170/100
B. A patient with mild anemia
, C. A patient with stable creatinine
D. A patient with slightly elevated BUN
Correct Answer: A. A patient with BP of 170/100
Rationale:
A BP of 170/100 mm Hg in a patient with renal disease suggests fluid overload or hypertensive
emergency, both requiring urgent hemodialysis to remove excess fluid and stabilize blood
pressure.
6. ESRD increases the patient’s risk for developing:
A. Coronary artery disease (CAD)
B. Peripheral arterial disease (PAD)
C. Deep vein thrombosis (DVT)
D. Pulmonary embolism (PE)
Correct Answer: B. Peripheral arterial disease (PAD)
Rationale:
Patients with end-stage renal disease (ESRD) have a higher risk of PAD due to chronic
inflammation, vascular calcification, and atherosclerosis from uremic toxins and hypertension.
7. Your client reports indigestion. Which OTC medication is appropriate for them?
A. Aspirin
B. Pepcid (H₂ blocker)
C. Ibuprofen
D. Pepto-Bismol
Correct Answer: B. Pepcid (H₂ blocker)
Rationale:
Pepcid (famotidine) is an H₂ receptor blocker that safely reduces stomach acid without harming
the kidneys, making it a suitable OTC option for patients with renal impairment.
