• Med Surg Exam 09/19/2026
Med Surg EXAM 1 Capstone Assessment
Questions with Answers and Explanations
Complete Solutions, 100% Correct | New
Update | | Complete A+ Guide
A provider has ordered a serum creatinine test for a client who is being assessed for chronic kidney disease. The
client asks the nurse about the test. Which of the following responses correctly explains serum creatinine?
A. The provider ordered this test to check for an infection
B. This will tell us if your kidneys are damaged and you will need dialysis
C. We are testing to see if your kidneys are able to excrete waste through your urine
P 1
, • Med Surg Exam 09/19/2026
D. This test tells us if you are releasing excess sugar in your urine - Correct Answer :C.
Rationale: "We are testing to see if your kidneys are able to excrete waste through your urine" is correct. A
creatinine test is a test of kidney function that measures the amount of creatinine in the bloodstream. Creatinine
is a waste product of creatine, which is produced by the muscles for energy. Creatinine is removed from the
body by the kidneys, and increased levels indicate that the kidneys are not able to excrete normal amounts of
creatinine from the body. An increased serum creatinine is not seen until there is at least 50% renal function lost.
A 70-kg adult with chronic renal failure is on a 40-g protein diet. The client has a reduced glomerular filtration rate
and is not undergoing dialysis. Which result would give the nurse the most concern?
A. Albumin level of 2.5 g/dL
B. Phosphorus level of 5 mg/dL
C. Sodium level of 135 mmol/L
D. Potassium level of 5.5 mmol/L - Correct Answer :A.
Rationale: Protein restriction is necessary with chronic renal failure due to the buildup of waste products from
protein breakdown. The nurse would be concerned with the low albumin level since this indicates that the
protein in the diet is not enough for the clients metabolic needs. The electrolyte values are not related to the
protein-restricted diet.
A client is diagnosed with chronic kidney disease (CKD). What is an ideal goal of treatment set by the nurse in the
care plan to reduce the risk of pulmonary edema?
A. Maintaining oxygen saturation of 89%
B. Minimal crackles and wheezes in lung sounds
C. Maintaining a balanced intake and output
D. Limited shortness of breath upon exertion - Correct Answer :C.
Rationale: With an optimal fluid balance, the client will be more able to eject blood from the left ventricle
without increased pressure in the left ventricle and pulmonary vessels. Other ideal goals are oxygen saturations
greater than 92%, no auscultated crackles or wheezes, and no demonstrated shortness of breath.
A client who has been diagnosed with chronic kidney disease is talking to the nurse about his overall health.
Which best describes the difference between health promotion and disease management in this situation?
P 2
, • Med Surg Exam 09/19/2026
A. Health promotion involves the client being active in the care of his health despite his condition while disease
management involves seeking treatments and therapies to control the disease
B. Health promotion involves the client educating others about his condition while disease management involves
the client focusing on his own care needs
C. Health promotion means preventing the disease in the first place while disease management involves dealing
with the situation once it has occurred
D. Health promotion is promoting wellness activities during times of health while disease management involves
working with those struggling with a diagnosis - Correct Answer :A.
Rationale: "Health promotion involves the client being active in the care of his health despite his condition while
disease management involves seeking treatments and therapies to control the disease" is correct. Health
promotion and disease management are closely related in the client with a chronic illness. A client with a chronic
disease can still participate in health promotion, which involves being active in care of his health despite his
disease. Alternatively, disease management seeks to control the disease through therapy and treatment.
A nurse is discussing options for home hemodialysis with a patient who has kidney disease. Which of the
following is correct regarding home hemodialysis? Select all that apply.
A. The catheter system must remain sterile in the home
B. Home hemodialysis sessions are shorter than outpatient sessions
C. Home hemodialysis may involve nocturnal sessions
D. The home care nurse will be present to assist with the dialysis process
E. Home hemodialysis promotes patient independence - Correct Answer :A., C., E
Rationale: "The catheter system must remain sterile in the home", "Home hemodialysis may involve nocturnal
sessions" and "Home hemodialysis promotes patient independence" are correct. Home peritoneal hemodialysis
is an option for some patients with renal failure. It allows the patient to live a more normal life, and often the
patient can perform dialysis independently. There are different types of peritoneal dialysis; continuous cycling,
intermittent and nightly peritoneal dialysis. All involve the instillation of dialysate into the peritoneum, allowed to
dwell, and drained. This process of exchange is repeated on a schedule based on which type of dialysis is being
utilized. The same rules of cleanliness apply in the home that would apply in a facility. If there is a catheter that
enters the body internally, it must be kept clean. In this case, sterility must be maintained to avoid an infection.
A client has a long history of hypertension. Which category of medications would the nurse expect to be ordered
to avoid chronic kidney disease (CKD)?
A. Antibiotic
P 3
, • Med Surg Exam 09/19/2026
B. Histamine blocker
C. Bronchodilator
D. Angiotensin-converting enzyme (ACE) inhibitor - Correct Answer :D
Rationale: ACE inhibitors stop the conversion of angiotensin I to the vasoconstrictor angiotensin II. This category
of medication also blocks bradykinin and prostaglandin, increases renin, and decreases aldosterone, which
promotes vasodilation and perfusion to the kidney. Antibiotics fight infection, histamine blockers decrease
inflammation, and bronchodilators increase the size of the bronchi; none of these medications helps slow the
progression of CKD in clients with hypertension.
The nurse is caring for four clients with chronic kidney disease. Which client should the nurse assess first upon
initial rounding?
A. Woman with a blood pressure of 158/90 mm Hg
B. Client with Kussmaul respirations
C. Man with skin itching from head to toe
D. Client with halitosis and stomatitis - Correct Answer :B.
Rationale: Kussmaul respirations indicate a worsening of chronic kidney disease (CKD). The client is increasing
the rate and depth of breathing to excrete carbon dioxide through the lungs. Hypertension is common in most
clients with CKD, and skin itching increases with calcium-phosphate imbalances, another common finding in CKD.
Uremia from CKD causes ammonia to be formed, resulting in the common findings of halitosis and stomatitis.
A client is taking furosemide (Lasix) 40 mg/day for management of chronic kidney disease (CKD). To detect the
positive effect of the medication, what action of the nurse is best?
A. Obtain daily weights of the client.
B. Auscultate heart and breath sounds.
C. Palpate the clients abdomen.
D. Assess the clients diet history. - Correct Answer :A.
Rationale: Furosemide (Lasix) is a loop diuretic that helps reduce fluid overload and hypertension in clients with
early stages of CKD. One kilogram of weight equals about 1 liter of fluid retained in the client, so daily weights are
necessary to monitor the response of the client to the medication. Heart and breath sounds should be assessed
if there is fluid retention, as in heart failure. Palpation of the clients abdomen is not necessary, but the nurse
should check for edema. The diet history of the client would be helpful to assess electrolyte replacement since
potassium is lost with this diuretic, but this does not assess the effect of the medication.
P 4
Med Surg EXAM 1 Capstone Assessment
Questions with Answers and Explanations
Complete Solutions, 100% Correct | New
Update | | Complete A+ Guide
A provider has ordered a serum creatinine test for a client who is being assessed for chronic kidney disease. The
client asks the nurse about the test. Which of the following responses correctly explains serum creatinine?
A. The provider ordered this test to check for an infection
B. This will tell us if your kidneys are damaged and you will need dialysis
C. We are testing to see if your kidneys are able to excrete waste through your urine
P 1
, • Med Surg Exam 09/19/2026
D. This test tells us if you are releasing excess sugar in your urine - Correct Answer :C.
Rationale: "We are testing to see if your kidneys are able to excrete waste through your urine" is correct. A
creatinine test is a test of kidney function that measures the amount of creatinine in the bloodstream. Creatinine
is a waste product of creatine, which is produced by the muscles for energy. Creatinine is removed from the
body by the kidneys, and increased levels indicate that the kidneys are not able to excrete normal amounts of
creatinine from the body. An increased serum creatinine is not seen until there is at least 50% renal function lost.
A 70-kg adult with chronic renal failure is on a 40-g protein diet. The client has a reduced glomerular filtration rate
and is not undergoing dialysis. Which result would give the nurse the most concern?
A. Albumin level of 2.5 g/dL
B. Phosphorus level of 5 mg/dL
C. Sodium level of 135 mmol/L
D. Potassium level of 5.5 mmol/L - Correct Answer :A.
Rationale: Protein restriction is necessary with chronic renal failure due to the buildup of waste products from
protein breakdown. The nurse would be concerned with the low albumin level since this indicates that the
protein in the diet is not enough for the clients metabolic needs. The electrolyte values are not related to the
protein-restricted diet.
A client is diagnosed with chronic kidney disease (CKD). What is an ideal goal of treatment set by the nurse in the
care plan to reduce the risk of pulmonary edema?
A. Maintaining oxygen saturation of 89%
B. Minimal crackles and wheezes in lung sounds
C. Maintaining a balanced intake and output
D. Limited shortness of breath upon exertion - Correct Answer :C.
Rationale: With an optimal fluid balance, the client will be more able to eject blood from the left ventricle
without increased pressure in the left ventricle and pulmonary vessels. Other ideal goals are oxygen saturations
greater than 92%, no auscultated crackles or wheezes, and no demonstrated shortness of breath.
A client who has been diagnosed with chronic kidney disease is talking to the nurse about his overall health.
Which best describes the difference between health promotion and disease management in this situation?
P 2
, • Med Surg Exam 09/19/2026
A. Health promotion involves the client being active in the care of his health despite his condition while disease
management involves seeking treatments and therapies to control the disease
B. Health promotion involves the client educating others about his condition while disease management involves
the client focusing on his own care needs
C. Health promotion means preventing the disease in the first place while disease management involves dealing
with the situation once it has occurred
D. Health promotion is promoting wellness activities during times of health while disease management involves
working with those struggling with a diagnosis - Correct Answer :A.
Rationale: "Health promotion involves the client being active in the care of his health despite his condition while
disease management involves seeking treatments and therapies to control the disease" is correct. Health
promotion and disease management are closely related in the client with a chronic illness. A client with a chronic
disease can still participate in health promotion, which involves being active in care of his health despite his
disease. Alternatively, disease management seeks to control the disease through therapy and treatment.
A nurse is discussing options for home hemodialysis with a patient who has kidney disease. Which of the
following is correct regarding home hemodialysis? Select all that apply.
A. The catheter system must remain sterile in the home
B. Home hemodialysis sessions are shorter than outpatient sessions
C. Home hemodialysis may involve nocturnal sessions
D. The home care nurse will be present to assist with the dialysis process
E. Home hemodialysis promotes patient independence - Correct Answer :A., C., E
Rationale: "The catheter system must remain sterile in the home", "Home hemodialysis may involve nocturnal
sessions" and "Home hemodialysis promotes patient independence" are correct. Home peritoneal hemodialysis
is an option for some patients with renal failure. It allows the patient to live a more normal life, and often the
patient can perform dialysis independently. There are different types of peritoneal dialysis; continuous cycling,
intermittent and nightly peritoneal dialysis. All involve the instillation of dialysate into the peritoneum, allowed to
dwell, and drained. This process of exchange is repeated on a schedule based on which type of dialysis is being
utilized. The same rules of cleanliness apply in the home that would apply in a facility. If there is a catheter that
enters the body internally, it must be kept clean. In this case, sterility must be maintained to avoid an infection.
A client has a long history of hypertension. Which category of medications would the nurse expect to be ordered
to avoid chronic kidney disease (CKD)?
A. Antibiotic
P 3
, • Med Surg Exam 09/19/2026
B. Histamine blocker
C. Bronchodilator
D. Angiotensin-converting enzyme (ACE) inhibitor - Correct Answer :D
Rationale: ACE inhibitors stop the conversion of angiotensin I to the vasoconstrictor angiotensin II. This category
of medication also blocks bradykinin and prostaglandin, increases renin, and decreases aldosterone, which
promotes vasodilation and perfusion to the kidney. Antibiotics fight infection, histamine blockers decrease
inflammation, and bronchodilators increase the size of the bronchi; none of these medications helps slow the
progression of CKD in clients with hypertension.
The nurse is caring for four clients with chronic kidney disease. Which client should the nurse assess first upon
initial rounding?
A. Woman with a blood pressure of 158/90 mm Hg
B. Client with Kussmaul respirations
C. Man with skin itching from head to toe
D. Client with halitosis and stomatitis - Correct Answer :B.
Rationale: Kussmaul respirations indicate a worsening of chronic kidney disease (CKD). The client is increasing
the rate and depth of breathing to excrete carbon dioxide through the lungs. Hypertension is common in most
clients with CKD, and skin itching increases with calcium-phosphate imbalances, another common finding in CKD.
Uremia from CKD causes ammonia to be formed, resulting in the common findings of halitosis and stomatitis.
A client is taking furosemide (Lasix) 40 mg/day for management of chronic kidney disease (CKD). To detect the
positive effect of the medication, what action of the nurse is best?
A. Obtain daily weights of the client.
B. Auscultate heart and breath sounds.
C. Palpate the clients abdomen.
D. Assess the clients diet history. - Correct Answer :A.
Rationale: Furosemide (Lasix) is a loop diuretic that helps reduce fluid overload and hypertension in clients with
early stages of CKD. One kilogram of weight equals about 1 liter of fluid retained in the client, so daily weights are
necessary to monitor the response of the client to the medication. Heart and breath sounds should be assessed
if there is fluid retention, as in heart failure. Palpation of the clients abdomen is not necessary, but the nurse
should check for edema. The diet history of the client would be helpful to assess electrolyte replacement since
potassium is lost with this diuretic, but this does not assess the effect of the medication.
P 4
