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NURS 220 MODULE 4 EXAM 2026
LATEST QUESTIONS AND ANSWERS|
ACE YOUR GRADES.
A 50-yr-old woman with hypertension has a serum potassium
level that has acutely risen to 6.2 mEq/L. Which type of order, if
written by the health care provider, should the nurse question?
A. Limit foods high in potassium
B. Calcium gluconate IV piggyback
C. Spironolactone (Aldactone) daily
D. Administer intravenous insulin and glucose - correct answer -
C. Spironolactone (Aldactone) daily
Rationale: Spironolactone (Aldactone) is a potassium-sparing
diuretic that inhibits the exchange of sodium for potassium in the
distal renal tubule and helps to prevent potassium loss.
Spironolactone is contraindicated in a patient with hyperkalemia
(serum potassium >5.0 mEq/L). Management of patients with
hyperkalemia may include limiting foods high in potassium,
administering IV insulin and glucose, administering IV calcium
gluconate, changing to potassium-wasting diuretics (e.g.,
furosemide [Lasix]), hemodialysis, administering sodium
polystyrene sulfonate (Kayexalate), and IV fluid administration.
, Page | 2
You receive a physician's order to change a patient's IV from D5½
NS with 40 mEq KCl/L to D5NS with 20 mEq KCl/L. Which serum
laboratory values on this same patient best support the rationale
for this IV order change?
A. Sodium, 136 mEq/L; potassium, 3.6 mEq/L
B. Sodium, 145 mEq/L; potassium, 4.8 mEq/L
C. Sodium, 135 mEq/L; potassium, 4.5 mEq/L
D. Sodium, 144 mEq/L; potassium, 3.7 mEq/L - correct answer -
C. Sodium, 135 mEq/L; potassium, 4.5 mEq/L
Rationale: The normal range for serum sodium is 135 to 145
mEq/L, and the normal range for potassium is 3.5 to 5.0 mEq/L.
The change in the IV order decreases the amount of potassium
and increases the amount of sodium. Therefore, for this order to
be appropriate, the potassium level must be near the high end
and the sodium level near the low end of their respective ranges.
Which descriptions characterize acute kidney injury (select all that
apply)?
a. Primary cause of death is infection.
b. It almost always affects older people.
c. Disease course is potentially reversible.
d. Most common cause is diabetic nephropathy.
, Page | 3
e. Cardiovascular disease is most common cause of death. -
correct answer -a. Primary cause of death is infection.
c. Disease course is potentially reversible.
Rationale: Acute kidney injury (AKI) is potentially reversible. AKI
has a high mortality rate, and the primary cause of death in
patients with AKI is infection. The primary cause of death in
patients with chronic kidney failure is cardiovascular disease.
Most commonly, AKI follows severe, prolonged hypotension or
hypovolemia or exposure to a nephrotoxic agent. Older adults are
more susceptible to AKI because the number of functioning
nephrons decrease with age, but AKI can occur at any age
RIFLE defines three stages of AKI based on changes in
a. blood pressure and urine osmolality.
b. fractional excretion of urinary sodium.
c. estimation of GFR with the MDRD equation.
d. serum creatinine or urine output from baseline. - correct
answer -d. serum creatinine or urine output from baseline.
Rationale: The RIFLE classification is used to describe the stages
of AKI. RIFLE standardizes the diagnosis of AKI. Risk (R) is the
first stage of AKI, followed by injury (I), which is the second stage,
and then increasing in severity to the final or third stage of failure
(F). The two outcome variables are loss (L) and end-stage renal
, Page | 4
disease (E). The first three stages are characterized by the serum
creatinine level and urine output.
During the oliguric phase of AKI, the nurse monitors the patient
for (select all that apply)
a. hypotension.
b. ECG changes.
c. hypernatremia.
d. pulmonary edema.
e. urine with high specific gravity. - correct answer -b. ECG
changes
d. pulmonary edema
Rationale: The nurse monitors the patient in the oliguric phase of
acute renal injury for the following:
• Hypertension and pulmonary edema: When urinary output
decreases, fluid retention occurs. The severity of the symptoms
depends on the extent of the fluid overload. In the case of
reduced urine output (i.e., anuria, oliguria), the neck veins may
become distended with a bounding pulse. Edema and
hypertension may develop. Fluid overload can eventually lead to
heart failure (HF), pulmonary edema, and pericardial and pleural
effusions.
NURS 220 MODULE 4 EXAM 2026
LATEST QUESTIONS AND ANSWERS|
ACE YOUR GRADES.
A 50-yr-old woman with hypertension has a serum potassium
level that has acutely risen to 6.2 mEq/L. Which type of order, if
written by the health care provider, should the nurse question?
A. Limit foods high in potassium
B. Calcium gluconate IV piggyback
C. Spironolactone (Aldactone) daily
D. Administer intravenous insulin and glucose - correct answer -
C. Spironolactone (Aldactone) daily
Rationale: Spironolactone (Aldactone) is a potassium-sparing
diuretic that inhibits the exchange of sodium for potassium in the
distal renal tubule and helps to prevent potassium loss.
Spironolactone is contraindicated in a patient with hyperkalemia
(serum potassium >5.0 mEq/L). Management of patients with
hyperkalemia may include limiting foods high in potassium,
administering IV insulin and glucose, administering IV calcium
gluconate, changing to potassium-wasting diuretics (e.g.,
furosemide [Lasix]), hemodialysis, administering sodium
polystyrene sulfonate (Kayexalate), and IV fluid administration.
, Page | 2
You receive a physician's order to change a patient's IV from D5½
NS with 40 mEq KCl/L to D5NS with 20 mEq KCl/L. Which serum
laboratory values on this same patient best support the rationale
for this IV order change?
A. Sodium, 136 mEq/L; potassium, 3.6 mEq/L
B. Sodium, 145 mEq/L; potassium, 4.8 mEq/L
C. Sodium, 135 mEq/L; potassium, 4.5 mEq/L
D. Sodium, 144 mEq/L; potassium, 3.7 mEq/L - correct answer -
C. Sodium, 135 mEq/L; potassium, 4.5 mEq/L
Rationale: The normal range for serum sodium is 135 to 145
mEq/L, and the normal range for potassium is 3.5 to 5.0 mEq/L.
The change in the IV order decreases the amount of potassium
and increases the amount of sodium. Therefore, for this order to
be appropriate, the potassium level must be near the high end
and the sodium level near the low end of their respective ranges.
Which descriptions characterize acute kidney injury (select all that
apply)?
a. Primary cause of death is infection.
b. It almost always affects older people.
c. Disease course is potentially reversible.
d. Most common cause is diabetic nephropathy.
, Page | 3
e. Cardiovascular disease is most common cause of death. -
correct answer -a. Primary cause of death is infection.
c. Disease course is potentially reversible.
Rationale: Acute kidney injury (AKI) is potentially reversible. AKI
has a high mortality rate, and the primary cause of death in
patients with AKI is infection. The primary cause of death in
patients with chronic kidney failure is cardiovascular disease.
Most commonly, AKI follows severe, prolonged hypotension or
hypovolemia or exposure to a nephrotoxic agent. Older adults are
more susceptible to AKI because the number of functioning
nephrons decrease with age, but AKI can occur at any age
RIFLE defines three stages of AKI based on changes in
a. blood pressure and urine osmolality.
b. fractional excretion of urinary sodium.
c. estimation of GFR with the MDRD equation.
d. serum creatinine or urine output from baseline. - correct
answer -d. serum creatinine or urine output from baseline.
Rationale: The RIFLE classification is used to describe the stages
of AKI. RIFLE standardizes the diagnosis of AKI. Risk (R) is the
first stage of AKI, followed by injury (I), which is the second stage,
and then increasing in severity to the final or third stage of failure
(F). The two outcome variables are loss (L) and end-stage renal
, Page | 4
disease (E). The first three stages are characterized by the serum
creatinine level and urine output.
During the oliguric phase of AKI, the nurse monitors the patient
for (select all that apply)
a. hypotension.
b. ECG changes.
c. hypernatremia.
d. pulmonary edema.
e. urine with high specific gravity. - correct answer -b. ECG
changes
d. pulmonary edema
Rationale: The nurse monitors the patient in the oliguric phase of
acute renal injury for the following:
• Hypertension and pulmonary edema: When urinary output
decreases, fluid retention occurs. The severity of the symptoms
depends on the extent of the fluid overload. In the case of
reduced urine output (i.e., anuria, oliguria), the neck veins may
become distended with a bounding pulse. Edema and
hypertension may develop. Fluid overload can eventually lead to
heart failure (HF), pulmonary edema, and pericardial and pleural
effusions.
