LEWIS MEDICAL SURGICAL NURSING 11TH
EDITION HARDING EXAM SCRIPT 2026
COMPLETE QUESTIONS AND CORRECT
ANSWERS
◉ Which assessment finding should the nurse expect when a patient
with acute kidney injury
(AKI) has an arterial blood pH of 7.30?
a. Persistent skin tenting
b. Rapid, deep respirations
c. Hot, flushed face and neck
d. Bounding peripheral pulses Answer: ANS: B
Patients with metabolic acidosis caused by AKI may have Kussmaul
respirations to eliminate
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)
TOP: Nursing Process: Assessment MSC: NCLEX: Physiological
Integrity
,◉ The nurse is planning care for a patient with severe heart failure who
has developed increased
blood urea nitrogen (BUN) and creatinine levels. What will be the
primary treatment goal in
the plan?
a. Augmenting fluid volume
b. Maintaining cardiac output
c. Diluting nephrotoxic substances
d. Preventing systemic hypertension Answer: 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 could be correct.
DIF: Cognitive Level: Apply (application) 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 Answer: 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) 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 output each day to help calculate the amount I can
drink."
d. "I need erythropoietin injections to boost my immunity and prevent
infection." Answer: ANS: C
The patient with end-stage renal disease is taught to measure urine
output as a means of
EDITION HARDING EXAM SCRIPT 2026
COMPLETE QUESTIONS AND CORRECT
ANSWERS
◉ Which assessment finding should the nurse expect when a patient
with acute kidney injury
(AKI) has an arterial blood pH of 7.30?
a. Persistent skin tenting
b. Rapid, deep respirations
c. Hot, flushed face and neck
d. Bounding peripheral pulses Answer: ANS: B
Patients with metabolic acidosis caused by AKI may have Kussmaul
respirations to eliminate
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)
TOP: Nursing Process: Assessment MSC: NCLEX: Physiological
Integrity
,◉ The nurse is planning care for a patient with severe heart failure who
has developed increased
blood urea nitrogen (BUN) and creatinine levels. What will be the
primary treatment goal in
the plan?
a. Augmenting fluid volume
b. Maintaining cardiac output
c. Diluting nephrotoxic substances
d. Preventing systemic hypertension Answer: 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 could be correct.
DIF: Cognitive Level: Apply (application) 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 Answer: 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) 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 output each day to help calculate the amount I can
drink."
d. "I need erythropoietin injections to boost my immunity and prevent
infection." Answer: ANS: C
The patient with end-stage renal disease is taught to measure urine
output as a means of
