1.

The nurse is assessing a client suspected of having developed acute

glomerulonephritis. The nurse should expect to address what clinical
manifestation that is characteristic of this health problem?
A) Hematuria
B) Precipitous decrease in serum creatinine levels
C) Hypotension unresolved by fluid administration
D) Glucosuria

2. The nurse is caring for an acutely ill client. What assessment finding should
prompt the nurse to inform the physician that the client may be exhibiting signs
of acute kidney injury (AKI)?
A) The client reports an inability to initiate voiding.
B) The client's urine is cloudy with a foul odor.
C) The client's average urine output has been 10 mL/hr for several hours.
D) The client complains of acute flank pain.

3. The nurse is caring for a client with a history of systemic lupus erythematosus
who has been recently diagnosed with end-stage kidney disease (ESKD). The
client has an elevated phosphorus level and has been prescribed calcium acetate
to bind the phosphorus. The nurse should teach the client to take the prescribed
medication at what time?
A) Only when needed
B) Daily at bedtime
C) First thing in the morning
D) With each meal

4. The nurse is working on the renal transplant unit. To reduce the risk of infection
in a client with a transplanted kidney, it is imperative for the nurse to do what?
A) Wash hands carefully and frequently.
B) Ensure immediate function of the donated kidney.
C) Instruct the client to wear a face mask.
D) Bar visitors from the client's room.

5. The nurse is caring for a client receiving hemodialysis three times weekly. The
client has had surgery to form an arteriovenous fistula. What is most important
for the nurse to be aware of when providing care for this client?
A) Using a stethoscope for auscultating the fistula is contraindicated.
B) The client feels best immediately after the dialysis treatment.
C) Taking a BP reading on the affected arm can damage the fistula.
D) The client should not feel pain during initiation of dialysis.

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 6. A client has a glomerular filtration rate (GFR) of 43 mL/min/1.73 m2. Based on
this GFR, the nurse interprets that the client's chronic kidney disease is at what
stage?
A) Stage 1
B) Stage 2
C) Stage 3
D) Stage 4

7. A football player is thought to have sustained an injury to his kidneys from being
tackled from behind. The ER nurse caring for the client reviews the initial orders
and notes an order to collect all voided urine and send it to the laboratory for
analysis. The nurse understands that this nursing intervention is important for
what reason?
A) Hematuria is the most common manifestation of renal trauma and blood losses may
be microscopic, so laboratory analysis is essential.
B) Intake and output calculations are essential and the laboratory will calculate the
precise urine output produced by this client.
C) A creatinine clearance study may be ordered at a later time and the laboratory will
hold all urine until it is determined if the test will be necessary.
D) There is great concern about electrolyte imbalances and the laboratory will monitor
the urine for changes in potassium and sodium concentrations.

8. A client admitted with nephrotic syndrome is being cared for on the medical unit.
When writing this client's care plan, based on the major clinical manifestation of
nephrotic syndrome, what nursing diagnosis should the nurse include?
A) Constipation related to immobility
B) Risk for injury related to altered thought processes
C) Hyperthermia related to the inflammatory process
D) Excess fluid volume related to generalized edema

9. The nurse coming on shift on the medical unit is taking a report on four clients.
What client does the nurse know is at the greatest risk of developing ESKD?
A) A client with a history of polycystic kidney disease
B) A client with diabetes mellitus and poorly controlled hypertension
C) A client who is morbidly obese with a history of vascular disorders
D) A client with severe chronic obstructive pulmonary disease

10. The nurse is caring for a client postoperative day 4 following a kidney transplant.
When assessing for potential signs and symptoms of rejection, what assessment
should the nurse prioritize?

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A) Assessment of the quantity of the client's urine output
B) Assessment of the client's incision
C) Assessment of the client's abdominal girth
D) Assessment for flank or abdominal pain

11. The nurse is caring for a client in acute kidney injury. Which of the following
complications would most clearly warrant the administration of polystyrene
sulfonate?
A) Hypernatremia
B) Hypomagnesemia
C) Hyperkalemia
D) Hypercalcemia

12. The nurse is caring for a client whose acute kidney injury has prerenal cause.
What most likely caused this client's health problem?
A) Heart failure
B) Glomerulonephritis
C) Ureterolithiasis
D) Aminoglycoside toxicity

13. A 45-year-old man with diabetic nephropathy has ESKD and is starting dialysis.
What should the nurse teach the client about hemodialysis?
A) “Hemodialysis is a treatment option that is usually required three times a week.”
B) “Hemodialysis is a program that will require you to commit to daily treatment.”
C) “This will require you to have surgery and a catheter will need to be inserted into
your abdomen.”
D) “Hemodialysis is a treatment that is used for a few months until your kidney heals
and starts to produce urine again.”

14. A client with ESKD receives continuous ambulatory peritoneal dialysis. The
nurse observes that the dialysate drainage fluid is cloudy. What is the nurse's
most appropriate action?
A) Inform the health care provider and assess the client for signs of infection.
B) Flush the peritoneal catheter with normal saline.
C) Remove the catheter promptly and have the catheter tip cultured.
D) Administer a bolus of IV normal saline as prescribed.

15. The nurse is planning client teaching for a client with ESKD who is scheduled
for the creation of a fistula. The nurse should teach the client what information
about the fistula?

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A) “A vein and an artery in your arm will be attached surgically.”
B) “The arm should be immobilized for 4 to 6 days.”
C) “One needle will be inserted into the fistula for each dialysis treatment.”
D) “The fistula can be used 5 to 7 days after the surgery for dialysis treatment.”

16. A client with ESKD is scheduled to begin hemodialysis. The nurse is working
with the client to adapt the client's diet to maximize the therapeutic effect and
minimize the risks of complications. The client's diet should include what
modifications? Select all that apply.
A) Decreased protein intake
B) Decreased sodium intake
C) Increased potassium intake
D) Fluid restriction
E) Vitamin D supplementation

17. A client on the critical care unit is postoperative day 1 following kidney
transplantation from a living donor. The nurse's most recent assessments indicate
that the client is producing copious quantities of dilute urine. What is the nurse's
most appropriate response?
A) Assess the client for further signs or symptoms of rejection.
B) Recognize this as an expected finding.
C) Inform the primary provider of this finding.
D) Administer exogenous antidiuretic hormone as prescribed.

18. A client is scheduled for a CT scan of the abdomen with contrast. The client has a
baseline creatinine level of 2.3 mg/dL (203 mol/L). In preparing this client for
the procedure, the nurse anticipates what orders?
A) Monitor the client's electrolyte values every hour before the procedure.
B) Preprocedure hydration and administration of acetylcysteine.
C) Hemodialysis immediately prior to the CT scan.
D) Obtain a creatinine clearance by collecting a 24-hour urine specimen.

19. The nurse is caring for a client with acute glomerular inflammation. When
assessing for the characteristic signs and symptoms of this health problem, the
nurse should include which assessments? Select all that apply.
A) Percuss for pain in the right lower abdominal quadrant.
B) Assess for the presence of peripheral edema.
C) Auscultate the client's apical heart rate for dysrhythmias.
D) Assess the client's BP.
E) Assess the client's orientation and judgment.

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 20. A client is admitted to the ICU after a motor vehicle accident. On the second day
of the hospital admission, the client develops acute kidney injury. The client is
hemodynamically unstable, but renal replacement therapy is needed to manage
the client's hypervolemia and hyperkalemia. Which of the following therapies
will the client's hemodynamic status best tolerate?
A) Hemodialysis
B) Peritoneal dialysis
C) Continuous venovenous hemodialysis (CVVHD)
D) Plasmapheresis

21. A client has presented with signs and symptoms that are characteristic of acute
kidney injury, but preliminary assessment reveals no obvious risk factors for this
health problem. The nurse should recognize the need to interview the client about
what topic?
A) Typical diet
B) Allergy status
C) Psychosocial stressors
D) Current medication use

22. An 84-year-old woman diagnosed with cancer is admitted to the oncology unit
for surgical treatment. The client has been on chemotherapeutic agents to
decrease the tumor size prior to the planned surgery. The nurse caring for the
client is aware that what precipitating factors in this client may contribute to
AKI? Select all that apply.
A) Anxiety
B) Low BMI
C) Age-related physiologic changes
D) Chronic systemic disease
E) NPO status

23. A client is being treated for AKI and the client daily weights have been ordered.
The nurse notes a weight gain of 3 pounds (1.4 kg) over the past 48 hours. What
nursing diagnosis is suggested by this assessment finding?
A) Imbalanced Nutrition: More than body requirements
B) Excess Fluid Volume
C) Sedentary Lifestyle
D) Adult Failure to Thrive

24. A 15 year old is admitted to the renal unit with a diagnosis of postinfectious
glomerular disease. The nurse should recognize that this form of kidney disease

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 may have been precipitated by what event?
A) Psychosocial stress
B) Hypersensitivity to an immunization
C) Menarche
D) Streptococcal infection

25. A client on the medical unit has a documented history of polycystic kidney
disease (PKD). What principle should guide the nurse's care of this client?
A) The disease is self-limiting and cysts usually resolve spontaneously in the fifth or
sixth decade of life.
B) The client's disease is incurable and the nurse's interventions will be supportive.
C) The client will eventually require surgical removal of the renal cysts.
D) The client is likely to respond favorably to lithotripsy treatment of the cysts.

26. The nurse is providing a health education workshop to a group of adults focusing
on cancer prevention. The nurse should emphasize what action in order to reduce
participants' risk of renal carcinoma?
A) Avoiding heavy alcohol use
B) Control of sodium intake
C) Smoking cessation
D) Adherence to recommended immunization schedules

27. The nurse performing the health interview of a client with a new onset of
periorbital edema has completed a genogram, noting the health history of the
client's siblings, parents, and grandparents. This assessment addresses the client's
risk of what kidney disorder?
A) Nephritic syndrome
B) Acute glomerulonephritis
C) Nephrotic syndrome
D) Polycystic kidney disease (PKD)

28. A client is brought to the renal unit from the PACU status postresection of a renal
tumor. Which of the following nursing actions should the nurse prioritize in the
care of this client?
A) Increasing oral intake
B) Managing postoperative pain
C) Managing dialysis
D) Increasing mobility

29. A nurse is caring for a client who is in the diuresis phase of AKI. The nurse

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 should closely monitor the client for what complication during this phase?
A) Hypokalemia
B) Hypocalcemia
C) Dehydration
D) Acute flank pain

30. The nurse is caring for a client after a motor vehicle accident. The client has
developed AKI. What are the nurse's roles in caring for this client? Select all that
apply.
A) Providing emotional support for the family
B) Monitoring for complications
C) Participating in emergency treatment of fluid and electrolyte imbalances
D) Providing nursing care for primary disorder (trauma)
E) Directing nutritional interventions

31. A 76-year-old client with ESKD has been told by the physician that it is time to
consider hemodialysis until a transplant can be found. The client tells the nurse
she is not sure she wants to undergo a kidney transplant. What would be an
appropriate response for the nurse to make?
A) “The decision is certainly yours to make, but be sure not to make a mistake.”
B) “Kidney transplants in clients your age are as successful as they are in younger
clients.”
C) “I understand your hesitancy to commit to a transplant surgery. Success is
comparatively rare.”
D) “Have you talked this over with your family?”

32. The nurse has identified the nursing diagnosis of “Risk for Infection” in a client
who undergoes peritoneal dialysis. What nursing action best addresses this risk?
A) Maintain aseptic technique when administering dialysate.
B) Wash the skin surrounding the catheter site with soap and water prior to each
exchange.
C) Add antibiotics to the dialysate as prescribed.
D) Administer prophylactic antibiotics by mouth or IV as prescribed.

33. The nurse is caring for a client who has returned to the postsurgical suite after
postanesthetic recovery from a nephrectomy. The nurse's most recent hourly
assessment reveals a significant drop in level of consciousness and BP as well as
scant urine output over the past hour. What is the nurse's best response?
A) Assess the client for signs of bleeding and inform the primary provider.
B) Monitor the client's vital signs every 15 minutes for the next hour.
C) Reposition the client and reassess vital signs.

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D) Palpate the client's flanks for pain and inform the primary provider.

34. The critical care nurse is monitoring the client's urine output and drains following
renal surgery. What should the nurse promptly report to the primary provider?
A) Increased pain on movement
B) Absence of drain output
C) Increased urine output
D) Blood-tinged serosanguineous drain output

35. The nurse is creating an education plan for a client who underwent a
nephrectomy for the treatment of a renal tumor. What should the nurse include in
the teaching plan?
A) The importance of increased fluid intake
B) Signs and symptoms of rejection
C) Inspection and care of the incision
D) Techniques for preventing metastasis

36. A client with chronic kidney disease has been hospitalized and is receiving
hemodialysis on a scheduled basis. The nurse should include which of the
following actions in the plan of care?
A) Ensure that the client moves the extremity with the vascular access site as little as
possible.
B) Change the dressing over the vascular access site at least every 12 hours.
C) Utilize the vascular access site for infusion of IV fluids.
D) Assess for a thrill or bruit over the vascular access site each shift.

37. The nurse is caring for a client who has just returned to the postsurgical unit
following renal surgery. When assessing the client's output from surgical drains,
the nurse should assess what parameters? Select all that apply.
A) Quantity of output
B) Color of the output
C) Visible characteristics of the output
D) Odor of the output
E) pH of the output

38. The nurse is caring for a client after kidney surgery. When assessing for bleeding,
what assessment parameter should the nurse evaluate?
A) Oral intake
B) Pain intensity
C) Level of consciousness

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D) Radiation of pain

39. A nurse on the renal unit is caring for a client who will soon begin peritoneal
dialysis. The family of the client asks for education about the peritoneal dialysis
catheter that has been placed in the client's peritoneum. The nurse explains the
three sections of the catheter and talks about the two cuffs on the dialysis
catheter. What would the nurse explain about the cuffs? Select all that apply.
A) The cuffs are made of Dacron polyester.
B) The cuffs stabilize the catheter.
C) The cuffs prevent the dialysate from leaking.
D) The cuffs provide a barrier against microorganisms.
E) The cuffs absorb dialysate.

40. A client with chronic kidney disease is completing an exchange during peritoneal
dialysis. The nurse observes that the peritoneal fluid is draining slowly and that
the client's abdomen is increasing in girth. What is the nurse's most appropriate
action?
A) Advance the catheter 2 to 4 cm further into the peritoneal cavity.
B) Reposition the client to facilitate drainage.
C) Aspirate from the catheter using a 60-mL syringe.
D) Infuse 50 mL of additional dialysate.

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Answer Key

1. A
2. C
3. D
4. A
5. C
6. C
7. A
8. D
9. B
10. A
11. C
12. A
13. A
14. A
15. A
16. A, B, D
17. B
18. B
19. B, D
20. C
21. D
22. C, D
23. B
24. D
25. B
26. C
27. D
28. B
29. C
30. A, B, C, D
31. B
32. A
33. A
34. B
35. C
36. D
37. A, B, C
38. C
39. A, B, C, D
40. B

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