EVALUATIVE EXAMINATION – RENAL FABS

1. Which clinical manifestation would lead the nurse to suspect that a client is
experiencing hypermagnesemia?

A. Muscle pain and acute rhabdomyolysis

B. Hot, flushed skin and hypotension
C. Soft-tissue calcification and hyperreflexia
D. decreased respiratory rate and depth
2. Which of the following clinical manifestations would a nurse expect to a client in the
diuretic phase of renal failure?

A. Edema
B. Cool skin
C. Hypertension
D. Poor skin turgor

3. Which of the following statements is incorrect about acute kidney injury?

A. Acute kidney failure is reversible.

B. Acute kidney failure is progressive.
C. Acute kidney failure has four phases.
D. Acute kidney failure is a sudden loss of kidney function.

4. A female adult client admitted with a gunshot wound to the abdomen is transferred to
the intensive care unit after an exploratory laparotomy. Which assessment finding suggests
that the client is experiencing acute renal failure (ARF)?

A. Blood urea nitrogen (BUN) level of 20 mg/dl

B. Serum creatinine level of 1.2 mg/dl
C. Serum creatinine level of .4 mg/dl
D. Urine output of< 400 ml/24 hours

5. Which of the following clinical findings would a nurse expect to a client in oliguric
phase of renal failure?

A. Dry skin
B. Hypotension
C. Hyperkalemia
D. Sunken eyeball

6. Which of the following findings would a nurse expect to a client with chronic kidney
disease?

A. High GFR
B. Low sodium
C. Weak Bones
D. High Hemoglobin
7. A male client who has been treated for chronic renal failure (CRF) is ready for
discharge. Nurse Billy should reinforce which dietary instruction?

A. “Be sure to eat meat at every meal.”

B. “Monitor your fruit intake, and eat plenty of bananas.”
C. “Increase your carbohydrate intake.”
D. “Drink plenty of fluids, and use a salt substitute.”

8. Which of the following interventions is appropriate to a client in the oliguric phase of

acute renal failure?

A. Increase fluid intake.

B. Increase protein diet.
C. Monitor body weight daily.
D. Restrict carbohydrate intake.
9. Which of the following medications would you expect to be prescribed to a client with
chronic renal failure who has edema?

A. Insulin
B. Loop diuretics
C. Erythropoietin
D. Aluminum hydroxide

10. Which of the following acid-base imbalance is common among clients with renal
failure?

A. Respiratory alkalosis
B. Respiratory acidosis
C. Metabolic alkalosis
D. Metabolic acidosis
11. What is the priority nursing diagnosis with your patient diagnosed with end-stage
renal disease?

A. Activity intolerance
B. Fluid volume excess
C. Knowledge deficit
D. Pain
12. Your patient returns from the operating room after abdominal aortic aneurysm
repair. Which symptom is a sign of acute renal failure?

A. Polyuria
B. Diarrhea
C. Oliguria
D. Vomiting
13. Which cause of hypertension is the most common in acute renal failure?

A. Pulmonary edema
B. Hypervolemia
C. Hypovolemia
D. Anemia
14. The nurse is taking care of a client diagnosed with chronic kidney disease. Which of
the following interventions is inappropriate for the client?

A. Monitor daily I&O.

B. Monitor body weight weekly.
C. Monitor for sign of decreasing LOC.
D. Limit the intake of meat and poultry.

15. Polystyrene sulfonate (Kayexalate) is used in renal failure to:

A. Correct acidosis
B. Reduce serum phosphate levels
C. Exchange potassium for sodium
D. Prevent constipation from sorbitol use
16. If the client’s serum potassium continues to rise in acute renal failure, the nurse
should be prepared for which of the following emergency situations?

A. Cardiac arrest
B. Pulmonary edema
C. Circulatory collapse
D. Hemorrhage

17. In the oliguric phase of acute renal failure, the nurse should anticipate the
development of which of the following complications?

A. Pulmonary edema
B. Metabolic alkalosis
C. Hypotension
D. Hypokalemia
18. Aluminum hydroxide gel (amphogel) is prescribed for a client with chronic renal
failure to take at home. What is the purpose of giving this drug to client with chronic renal
failure?

A. To relieve pain of gastric acidity

B. To prevent curling’s stress ulcers
C. To bind phosphate in the intestine
D. To reverse metabolic acidosis
19. The nurse helps the client with chronic renal failure develop a home diet plan with
goal of helping the client maintain adequate nutritional intake. Which of the following diets
would be most appropriate for a client with chronic renal failure?

A. High carbohydrate, high protein

B. High calcium, high potassium, high protein
C. Low protein, low sodium, low potassium
D. Low protein, high potassium

20. Which of the following represents a positive response to administration of

erythropoietin (Epogen, Procrit)?

A. Normal platelet
B. Potassium within normal range
C. Free from spontaneous fractures
D. Less fatigue

21. Which of these interventions is essential for the client in the oliguric phase of acute
kidney injury (AKI)?

A. Restrict fluids
B. Replace potassium
C. Administer blood transfusions
D. Monitor arterial blood gases (ABGs)
22. A client with renal failure is receiving epoetin alfa (Epogen) to support erythropoiesis.
The nurse questions the client about compliance with taking which of the following
medications that supports red blood cell (RBC) production?

A. iron supplement
B. zinc supplement
C. calcium supplement
D. magnesium supplement
23. The nurse is taking care of a client diagnosed with chronic kidney disease. Which of
the following is an early sign of chronic kidney disease?

A. Anuria
B. Oliguria
C. Dysuria
D. Polyuria

24. The nurse is taking care of a client diagnosed with end-stage renal disease. Which of
the following clinical manifestations would correlate with a client with end-stage renal
disease?

A. Polyuria
B. Hypernatremia
C. Hypomagnesemia
D. Metabolic alkalosis
25. A patient is admitted in the hospital due to having lower than normal potassium level
in her bloodstream. Her medical history reveals vomiting and diarrhea prior to
hospitalization. Which foods should the nurse instruct the client to increase?

A. Whole grains and nuts

B. Milk products and green, leafy vegetables
C. Pork products and canned vegetables
D. Orange juice and bananas

26. Lab tests revealed that patient’s [Na+] is 170 mEq/L. Which clinical manifestation
would nurse Natty expect to assess?

A. Thirst and confusion

B. Muscle twitching and tetany
C. Fruity breath and Kussmaul’s respirations
D. Muscle weakness and paresthesia

27. A client with very dry mouth, skin and mucous membranes is diagnosed of having
dehydration. Which intervention should the nurse perform when caring for a client
diagnosed with fluid volume deficit?

A. Assessing urinary intake and output

B. Obtaining the client’s weight weekly at different times of the day
C. Monitoring arterial blood gas (ABG) results
D. Maintaining I.V. therapy at the keep-vein-open rate

28. The patient is diagnosed with hypomagnesemia, which nursing intervention would be
appropriate?

A. Instituting seizure precaution to prevent injury

B. Instructing the client on the importance of preventing infection
C. Avoiding the use of tight tourniquet when drawing blood
D. Teaching the client the importance of early ambulation
29. Which clinical manifestation would lead the nurse to suspect that a client is
experiencing hypermagnesemia?

A. Muscle pain and acute rhabdomyolysis

B. Hot, flushed skin and hypotension
C. Soft-tissue calcification and hyperreflexia
D. Increased respiratory rate and depth

30. Which of the following intravenous solutions would be appropriate for a patient with
severe hyponatremia secondary to syndrome of inappropriate antidiuretic hormone
(SIADH)?

A. hypotonic solution
B. hypertonic solution
C. isotonic solution
D. normotonic solution
31. A 54-year-old widower with a history of chronic obstructive pulmonary disease and
was rushed to the emergency department with increasing shortness of breath, pyrexia, and
a productive cough with yellow-green sputum. He has difficulty in communicating because
of his inability to complete a sentence. Upon examination, crackles and wheezes can be
heard in the lower lobes; he has a tachycardia and a bounding pulse. Measurement of
arterial blood gas shows pH 7.3, PaCO2 68 mm Hg, HCO3 28 mmol/L, and PaO2 60 mm Hg.
How would you interpret this?

A. Respiratory Acidosis, Uncompensated

B. Respiratory Acidosis, Partially Compensated
C. Metabolic Alkalosis, Uncompensated
D. Metabolic Acidosis, Partially Compensated
32. The patient was rushed to the hospital due to vomiting and a decreased level of
consciousness. The patient displays slow and deep (Kussmaul breathing), and he is
lethargic and irritable in response to stimulation. He appears to be dehydrated, his eyes are
sunken and mucous membranes are dry, and he has a two-week history of polydipsia,
polyuria, and weight loss. Measurement of arterial blood gas shows pH 7.0, PaO2 90 mm
Hg, PaCO2 23 mm Hg, and HCO3 12 mmol/L; other results are Na+ 126 mmol/L, K+ 5
mmol/L, and Cl- 95 mmol/L. What is your assessment?

A. Respiratory Acidosis, Uncompensated

B. Respiratory Acidosis, Partially Compensated
C. Metabolic Alkalosis, Uncompensated
D. Metabolic Acidosis, Partially, Compensated
33. A cigarette vendor was brought to the emergency department of a hospital after she
fell into the ground and hurt her left leg. She is noted to be tachycardic and tachypneic.
Painkillers were carried out to lessen her pain. Suddenly, she started complaining that she
is still in pain and now experiencing muscle cramps, tingling, and paraesthesia.
Measurement of arterial blood gas reveals pH 7.6, PaO2 120 mm Hg, PaCO2 31 mm Hg, and
HCO3 25 mmol/L. What does this mean?

A. Respiratory Alkalosis, Uncompensated

B. Respiratory Acidosis, Partially Compensated
C. Metabolic Alkalosis, Uncompensated
D. Metabolic Alkalosis, Partially Compensated
34. The patient is suffering from persistent vomiting for two days now. She appears to be
lethargic and weak and has myalgia. She is noted to have dry mucus membranes and her
capillary refill takes >4 seconds. She is diagnosed as having gastroenteritis and
dehydration. Measurement of arterial blood gas shows pH 7.5, PaO2 85 mm Hg, PaCO2 40
mm Hg, and HCO3 34 mmol/L. What acid-base disorder is shown?

A. Respiratory Alkalosis, Uncompensated

B. Respiratory Acidosis, Partially Compensated
C. Metabolic Alkalosis, Uncompensated
D. Metabolic Alkalosis, Partially Compensated
35. A patient was rushed to the Emergency Room following her mother’s complaint that
the infant has been irritable, difficult to breastfeed and has had diarrhea for the past 3 days.
The infant’s respiratory rate is elevated and the fontanels are sunken. The Emergency
Room physician orders ABGs after assessing the ABCs. The results from the ABG results
show pH 7.39, PaCO2 27 mmHg and HCO3 19 mEq/L. What does this mean?

A. Respiratory Alkalosis, Fully Compensated

B. Metabolic Acidosis, Uncompensated
C. Metabolic Acidosis, Fully Compensated
D. Respiratory Acidosis, Uncompensated

36. Which of the following IV fluids should be given to a client with a hypertonic fluid
volume deficit?

A. 0.9% NaCl (Normal Saline)

B. 10% Dextrose
C. 0.25% NaCl
D. 3% Saline
37. Which of the following interventions is appropriate to a client with isotonic fluid
volume excess?

A. Increase caloric intake.

B. Increase fluid intake.
C. Increase sodium intake.
D. Administration of diuretics as prescribed.

38. Which of the following medications should the nurse expect to be prescribed by the
physician to a client with hypotonic fluid volume excess?

A. Osmotic diuretics
B. Loop diuretics
C. Salbutamol
D. Digoxin
39. A client was admitted to the hospital. The client has decreased body weight, poor skin
turgor, and a sunken eyeball. The client is most likely suffering from:

A. Fluid volume excess

B. Fluid volume deficit
C. Hyperkalemia
D. Hypokalemia
40. Which of the following assessment findings would you expect in a client with fluid
volume excess?

A. Low BP
B. Dry skin
C. Tachycardia
D. Flat neck vein
41. Which of the following findings would correlate with a client who has a fluid volume
deficit?

A. Low BUN
B. Low hematocrit
C. Low urine output
D. Low urine specific gravity

42. Which of the following interventions is appropriate to a client with fluid volume
excess?

A. Monitor body weight every week

B. Increased sodium intake
C. Avoid diuretics.
D. Monitor I & O
43. Which of the following factors can lead to hyperkalemia?

A. Diarrhea
B. Renal failure
C. Metabolic alkalosis
D. Administration of insulin

44. Which of the following findings would the nurse expect in a client with hyperkalemia?

A. Constipation
B. Increased BP
C. Increased heart rate
D. Cardiac dysrhythmia

45. All the following ECG abnormalities would occur in a patient with hypokalemia,
except:

A. Presence of u wave
B. ST depression
C. Flat T wave
D. Flat P wave
46. All the following medications are given to a client with hyperkalemia except:

A. Insulin
B. Loop diuretics
C. Beta adrenergic blockers
D. Sodium polystyrene sulfonate
47. The nurse is taking care of a client with a sodium level of 160 mEq/L. Which of the
following factors would lead to the client’s sodium level?

A. Administration of diuretics
B. Chronic renal failure
C. Diarrhea
D. Fasting

48. Which of the following interventions is appropriate for a client who has a sodium level
of 120 mEq/L and fluid volume excess?

A. Administration of osmotic diuretics

B. Administration of loop diuretics
C. Administration of .45% NaCl
D. Increasing fluid intake
49. Which of the following clients would most likely suffer from hypocalcemia?

A. A client who was diagnosed with hyperparathyroidism.

B. A client who is immobile for a few weeks.
C. A client who is taking thiazide diuretics
D. A client who has vitamin D deficiency.

50. Which of the following medications should be given to a client with hypercalcemia?

A. Calcium gluconate
B. Calcium carbonate
C. Calcium chloride
D. Calcitonin