1. What are intrarenal causes of acute kidney
Reversal of oliguria occurs with fluid
injury (AKI) (select all that apply)?
a. Anaphylaxis
b. Renal stones
c. Bladder cancer
d. Nephrotoxic drugs
e. Acute glomerulonephritis
f. Tubular obstruction by myoglobin
2. An 83-year-old female patient was found
lying on the bathroom floor. She said she fell
2 days ago and has not been able to take her
heart medicine or eat or drink anything since
then. What conditions could be causing
prerenal AKI in this patient (select all that
apply)?
a. Anaphylaxis
b. Renal calculi
c. Hypovolemia
d. Nephrotoxic drugs
e. Decreased cardiac output
3. Acute tubular necrosis (ATN) is the most
common cause of intrarenal AKI. Which
patient is most likely to develop ATN?
a. Patient with diabetes mellitus
b. Patient with hypertensive crisis
c. Patient who tried to overdose on
acetaminophen
d. Patient with major surgery who required a
blood transfusion
4. Priority Decision: A dehydrated patient is
in the Injury stage of the RIFLE staging of
AKI. What would the nurse first anticipate in
the treatment of this patient?
a. Assess daily weight
b. IV administration of fluid and furosemide
(Lasix)
c. IV administration of insulin and sodium
bicarbonate
d. Urinalysis to check for sediment, osmolality,
sodium, and specific gravity
5. What indicates to the nurse that a patient
with oliguria has prerenal oliguria?
a. Urine testing reveals a low specific gravity.
b. Causative factor is malignant hypertension.
c. Urine testing reveals a high sodium
concentration.
d.
replacement.
6. In a patient with AKI, which laboratory
urinalysis result indicates tubular damage?
a. Hematuria
b. Specific gravity fixed at 1.010
c. Urine sodium of 12 mEq/L (12 mmol/L)
d. Osmolality of 1000 mOsm/kg (1000mmol/kg)
7. Metabolic acidosis occurs in the oliguric
phase of AKI as a result of impairment of
a. ammonia synthesis.
b. excretion of sodium.
c. excretion of bicarbonate.
d. conservation of potassium.
8. What indicates to the nurse that a patient
with AKI is in the recovery phase?
a. A return to normal weight
b. A urine output of 3700 mL/day
c. Decreasing sodium and potassium levels
d. Decreasing blood urea nitrogen (BUN) and
creatinine levels
9. While caring for the patient in the oliguric
phase of AKI, the nurse monitors the patient
for associated collaborative problems. When
should the nurse notify the health care
provider?
a. Urine output is 300 mL/day.
b. Edema occurs in the feet, legs, and sacral
area.
c. Cardiac monitor reveals a depressed T wave
and elevated ST segment.
d. The patient experiences increasing muscle
weakness and abdominal cramping.
10. In caring for the patient with AKI, what
should the nurse be aware of?
a. The most common cause of death in AKI is
irreversible metabolic acidosis.
b. During the oliguric phase of AKI, daily fluid
intake is limited to 1000 mL plus the prior day’s
measured fluid loss.
c. Dietary sodium and potassium during the
oliguric phase of AKI are managed according to
the patient’s urinary output.
d. One of the most important nursing measures
in managing fluid balance in the patient with
AKI is taking accurate daily weights.
11. A 68-year-old man with a history of heart
failure resulting from hypertension has AKI
as a result of the effects of nephrotoxic
diuretics. Currently his serum potassium is
6.2 mEq/L (6.2 mmol/L) with cardiac
changes, his BUN
is 108 mg/dL (38.6 mmol/L), his serum
creatinine is 4.1 mg/dL (362 mmol/L), and his
serum HCO3− is 14 mEq/L (14 mmol/L). He
is somnolent and disoriented. Which
treatment should the nurse expect to be used
for him?
a. Loop diuretics
b. Renal replacement therapy
c. Insulin and sodium bicarbonate
d. Sodium polystyrene sulfonate (Kayexalate)
12. Prevention of AKI is important because of
the high mortality rate. Which patients are at
increased risk for AKI (select all that apply)?
a. An 86-year-old woman scheduled for a
cardiac catheterization
b. A 48-year-old man with multiple injuries
from a motor vehicle accident
c. A 32-year-old woman following a C-section
delivery for abruptio placentae
d. A 64-year-old woman with chronic heart
failure admitted with bloody stools
e. A 58-year-old man with prostate cancer
undergoing preoperative workup for
prostatectomy
13. Priority Decision: A patient on a medical
unit has a potassium level of 6.8 mEq/L.
What is the priority action that the nurse
should take?
a. Place the patient on a cardiac monitor.
b. Check the patient’s blood pressure (BP).
c. Instruct the patient to avoid high-potassium
foods.
d. Call the lab and request a redraw of the lab to
verify results.
14. A patient with AKI has a serum
potassium level of 6.7 mEq/L (6.7 mmol/L)
and the following arterial blood gas results:
pH 7.28, PaCO2 30 mm Hg, PaO2 86 mm Hg,
HCO3 − 18 mEq/L (18 mmol/L). The nurse
recognizes that treatment of the acid-base
problem with sodium bicarbonate would
cause a decrease in which value?
a. pH
b. Potassium level
c. Bicarbonate level
d. Carbon dioxide level
15. In replying to a patient’s questions about
the seriousness of her chronic kidney disease
(CKD), the nurse knows that the stage of
CKD is based on what?
a. Total daily urine output
b. Glomerular filtration rate
c. Degree of altered mental status
d. Serum creatinine and urea levels
16. The patient with CKD is receiving
dialysis, and the nurse observes excoriations
on the patient’s skin. What pathophysiologic
changes in CKD can contribute to this finding
(select all that apply)?
a. Dry skin
b. Sensory neuropathy
c. Vascular calcifications
d. Calcium-phosphate skin deposits
e. Uremic crystallization from high BUN
17. What causes the gastrointestinal (GI)
manifestation of stomatitis in the patient with
CKD?
a. High serum sodium levels
b. Irritation of the GI tract from creatinine
c. Increased ammonia from bacterial breakdown
of urea
d. Iron salts, calcium-containing phosphate
binders, and limited fluid intake
18. The patient with CKD is brought to the
emergency department with Kussmaul
respirations. What does the nurse know about
CKD that could cause this patient’s
Kussmaul respirations?
a. Uremic pleuritis is occurring.
b. There is decreased pulmonary macrophage
activity.
c. They are caused by respiratory compensation
for metabolic acidosis.
d. Pulmonary edema from heart failure and fluid
overload is occurring.
19. Which serum laboratory value indicates
to the nurse that the patient’s CKD is getting
worse?
a. Decreased BUN d. mineral and bone disorder.
b. Decreased sodium
c. Decreased creatinine 25. Which drugs will be used to treat the
d. Decreased calculated glomerular filtration rate patient with CKD for mineral and bone
(GFR) disorder (select all that apply)?
a. Cinacalcet (Sensipar)
20. What is the most serious electrolyte b. Sevelamer (Renagel)
disorder associated with kidney disease? c. IV glucose and insulin
a. Hypocalcemia d. Calcium acetate (PhosLo)
b. Hyperkalemia e. IV 10% calcium gluconate
c. Hyponatremia
d. Hypermagnesemia 26. What accurately describes the care of the
patient with CKD?
21. For a patient with CKD the nurse a. A nutrient that is commonly supplemented for
identifies a nursing diagnosis of risk for the patient on dialysis because it is dialyzable is
injury: fracture related to alterations in iron.
calcium and phosphorus metabolism. What is b. The syndrome that includes all of the signs
the pathologic process directly related to the and symptoms seen in the various body systems
increased risk for fractures? in CKD is azotemia.
a. Loss of aluminum through the impaired c. The use of morphine is contraindicated in the
kidneys patient with CKD because accumulation of its
b. Deposition of calcium phosphate in soft metabolites may cause seizures.
tissues of the body d. The use of calcium-based phosphate binders
c. Impaired vitamin D activation resulting in in the patient with CKD is contraindicated when
decreased GI absorption of calcium serum calcium levels are increased.
d. Increased release of parathyroid hormone in
response to decreased calcium levels 27. During the nursing assessment of the
patient with renal insufficiency, the nurse
22. Priority Decision: What is the most asks the patient specifically about a history of
appropriate snack for the nurse to offer a a. angina.
patient with stage 4 CKD? b. asthma.
a. Raisins c. hypertension.
b. Ice cream d. rheumatoid arthritis.
c. Dill pickles
d. Hard candy 28. The patient with chronic kidney disease is
considering whether to use peritoneal dialysis
23. Which complication of chronic kidney (PD) or hemodialysis (HD). What are
disease is treated with erythropoietin (EPO)? advantages of PD when compared to HD
a. Anemia (select all that apply)?
b. Hypertension a. Less protein loss
c. Hyperkalemia b. Rapid fluid removal
d. Mineral and bone disorder c. Less cardiovascular stress
d. Decreased hyperlipidemia
24. The patient with CKD asks why she is e. Requires fewer dietary restrictions
receiving nifedipine (Procardia) and
furosemide (Lasix). The nurse understands 29. What does the dialysate for PD routinely
that these drugs are being used to treat the contain?
patient’s a. Calcium in a lower concentration than in the
a. anemia. blood
b. hypertension. b. Sodium in a higher concentration than in the
c. hyperkalemia. blood
c. Dextrose in a higher concentration than in the
blood
d. Electrolytes in an equal concentration to that
of the blood
30. Number the following in the order of the
phases of exchange in PD. Begin with 1 and
end with 3.
a. Drain
b. Dwell
c. Inflow
31. In which type of dialysis does the patient
dialyze during sleep and leave the fluid in the
abdomen during the day?
a. Long nocturnal hemodialysis
b. Automated peritoneal dialysis (APD)
c. Continuous venovenous hemofiltration
(CVVH)
d. Continuous ambulatory peritoneal dialysis
(CAPD)
32. To prevent the most common serious
complication of PD, what is important for the
nurse to do?
a. Infuse the dialysate slowly.
b. Use strict aseptic technique in the dialysis
procedures.
c. Have the patient empty the bowel before the
inflow phase.
d. Reposition the patient frequently and promote
deep breathing.
33. A patient on hemodialysis develops a
thrombus of a subcutaneous arteriovenous
(AV) graft, requiring its removal.
While waiting for a replacement graft or
fistula, the patient is most likely to have what
done for treatment?
a. Peritoneal dialysis
b. Peripheral vascular access using radial artery
c. Silastic catheter tunneled subcutaneously to
the jugular vein
d. Peripherally inserted central catheter (PICC)
line inserted into subclavian vein
34. A man with end-stage kidney disease is
scheduled for hemodialysis following healing
of an arteriovenous fistula
(AVF). What should the nurse explain to him
that will occur during dialysis?
a. He will be able to visit, read, sleep, or watch
TV while reclining in a chair.
b. He will be placed on a cardiac monitor to
detect any adverse effects that might occur.
c. The dialyzer will remove and hold part of his
blood for 20 to 30 minutes to remove the waste
products.
d. A large catheter with two lumens will be
inserted into the fistula to send blood to and
return it from the dialyzer.
35. What is the primary way that a nurse will
evaluate the patency of an AVF?
a. Palpate for pulses distal to the graft site.
b. Auscultate for the presence of a bruit at the
site.
c. Evaluate the color and temperature of the
extremity.
d. Assess for the presence of numbness and
tingling distal to the site.
36. A patient with AKI is a candidate for
continuous renal replacement therapy
(CRRT). What is the most common indication
for use of CRRT?
a. Azotemia
b. Pericarditis
c. Fluid overload
d. Hyperkalemia
37. A patient rapidly progressing toward end-
stage kidney disease asks about the possibility
of a kidney transplant. In responding to the
patient, the nurse knows that what is a
contraindication to kidney transplantation?
a. Hepatitis C infection
b. Coronary artery disease
c. Refractory hypertension
d. Extensive vascular disease
38. Priority Decision: During the immediate
postoperative care of a recipient of a kidney
transplant, what should the nurse expect to
do?
a. Regulate fluid intake hourly based on urine
output.
b. Monitor urine-tinged drainage on abdominal
dressing.
c. Medicate the patient frequently for incisional
flank pain.
d. Remove the urinary catheter to evaluate the
ureteral implant.

39. A patient received a kidney transplant last

month. Because of the effects of
immunosuppressive drugs and CKD, what
complication of transplantation should the
nurse be assessing the patient for to decrease
the risk of mortality?
a. Infection
b. Rejection
c. Malignancy
d. Cardiovascular disease