NUR 265 Exam 1 – Renal,
GI/Hepatic, Immunology, &
Cardiac Valves
100 Questions with Answers &
Rationales
THIS DOCUMENT CONTAINS:
➢ GUARANTEE PASSING SCORE
➢ QUESTIONS AND ANSWERS
➢ EXPERT VERIFIED EXPLANATIONS
➢ FORMAT SET OF MULTIPLE-CHOICE
,Renal / AKI / CKD (Questions 1–30)
1. A client with chronic kidney disease (CKD) has a potassium level of 6.8
mEq/L. The nurse assesses a peaked T wave on the cardiac monitor. What is the
priority action?
A. Administer sodium polystyrene sulfonate (Kayexalate).
B. Prepare the client for emergency hemodialysis.
C. Administer IV calcium gluconate.
D. Restrict all oral intake.
Correct Answer: C. Rationale: IV calcium gluconate stabilizes the cardiac membrane
in severe hyperkalemia and is given first to prevent life-threatening dysrhythmias.
Kayexalate and dialysis remove potassium but take longer to work.
2. The nurse is caring for a client with acute kidney injury (AKI) in the oliguric
phase. Which finding is most concerning?
A. Urine output of 300 mL in 24 hours.
B. Serum potassium of 5.9 mEq/L.
C. Blood pressure of 140/90 mm Hg.
D. Weight gain of 1 kg in 24 hours.
Correct Answer: B. Rationale: Severe hyperkalemia (K > 6.0) is life-threatening in
AKI due to decreased excretion. It can cause cardiac arrest and requires immediate
intervention.
3. A client on hemodialysis has an arteriovenous (AV) fistula in the right arm.
Which action by the nurse is appropriate?
A. Take blood pressure in the right arm.
B. Palpate for a thrill over the fistula.
C. Draw blood from the fistula site.
D. Apply a tight tourniquet above the fistula.
Correct Answer: B. Rationale: A palpable thrill and audible bruit indicate patency of
the AV fistula. Blood pressure, venipuncture, and tight tourniquets should never be
done on the fistula arm.
4. The nurse is teaching a client with CKD about a low-phosphorus diet. Which
food should the client avoid?
A. Apples
B. Cabbage
C. Dairy products (milk, cheese)
D. White bread
, Correct Answer: C. Rationale: Dairy products are high in phosphorus. Clients with
CKD should limit phosphorus to prevent bone disease and vascular calcification.
5. A client with nephrotic syndrome has massive proteinuria and edema. Which
lab value supports this diagnosis?
A. Serum albumin 2.0 g/dL (low).
B. Serum sodium 145 mEq/L.
C. BUN 10 mg/dL.
D. Hemoglobin 15 g/dL.
Correct Answer: A. Rationale: Nephrotic syndrome causes loss of protein in urine,
leading to hypoalbuminemia (low serum albumin), which contributes to edema.
6. The nurse is caring for a client with acute kidney injury (AKI) in the diuretic
phase. Which complication is the greatest risk?
A. Hyperkalemia
B. Dehydration and hypovolemia
C. Pulmonary edema
D. Metabolic acidosis
Correct Answer: B. Rationale: The diuretic phase of AKI involves massive fluid loss,
leading to dehydration, hypotension, and electrolyte depletion (hypokalemia,
hyponatremia).
7. Which client is at highest risk for developing acute kidney injury (AKI)?
A. Client with a urinary tract infection.
B. Client receiving IV contrast dye for a CT scan.
C. Client with benign prostatic hyperplasia (BPH).
D. Client with controlled hypertension.
Correct Answer: B. Rationale: IV contrast dye is nephrotoxic and a common cause
of hospital-acquired AKI (contrast-induced nephropathy).
8. A client with ESRD reports bone pain and muscle weakness. The nurse
suspects which complication?
A. Hypercalcemia
B. Secondary hyperparathyroidism
C. Hypokalemia
D. Metabolic alkalosis
Correct Answer: B. Rationale: In CKD, phosphate retention leads to hypocalcemia,
stimulating PTH release (secondary hyperparathyroidism), which causes bone
resorption and pain.
GI/Hepatic, Immunology, &
Cardiac Valves
100 Questions with Answers &
Rationales
THIS DOCUMENT CONTAINS:
➢ GUARANTEE PASSING SCORE
➢ QUESTIONS AND ANSWERS
➢ EXPERT VERIFIED EXPLANATIONS
➢ FORMAT SET OF MULTIPLE-CHOICE
,Renal / AKI / CKD (Questions 1–30)
1. A client with chronic kidney disease (CKD) has a potassium level of 6.8
mEq/L. The nurse assesses a peaked T wave on the cardiac monitor. What is the
priority action?
A. Administer sodium polystyrene sulfonate (Kayexalate).
B. Prepare the client for emergency hemodialysis.
C. Administer IV calcium gluconate.
D. Restrict all oral intake.
Correct Answer: C. Rationale: IV calcium gluconate stabilizes the cardiac membrane
in severe hyperkalemia and is given first to prevent life-threatening dysrhythmias.
Kayexalate and dialysis remove potassium but take longer to work.
2. The nurse is caring for a client with acute kidney injury (AKI) in the oliguric
phase. Which finding is most concerning?
A. Urine output of 300 mL in 24 hours.
B. Serum potassium of 5.9 mEq/L.
C. Blood pressure of 140/90 mm Hg.
D. Weight gain of 1 kg in 24 hours.
Correct Answer: B. Rationale: Severe hyperkalemia (K > 6.0) is life-threatening in
AKI due to decreased excretion. It can cause cardiac arrest and requires immediate
intervention.
3. A client on hemodialysis has an arteriovenous (AV) fistula in the right arm.
Which action by the nurse is appropriate?
A. Take blood pressure in the right arm.
B. Palpate for a thrill over the fistula.
C. Draw blood from the fistula site.
D. Apply a tight tourniquet above the fistula.
Correct Answer: B. Rationale: A palpable thrill and audible bruit indicate patency of
the AV fistula. Blood pressure, venipuncture, and tight tourniquets should never be
done on the fistula arm.
4. The nurse is teaching a client with CKD about a low-phosphorus diet. Which
food should the client avoid?
A. Apples
B. Cabbage
C. Dairy products (milk, cheese)
D. White bread
, Correct Answer: C. Rationale: Dairy products are high in phosphorus. Clients with
CKD should limit phosphorus to prevent bone disease and vascular calcification.
5. A client with nephrotic syndrome has massive proteinuria and edema. Which
lab value supports this diagnosis?
A. Serum albumin 2.0 g/dL (low).
B. Serum sodium 145 mEq/L.
C. BUN 10 mg/dL.
D. Hemoglobin 15 g/dL.
Correct Answer: A. Rationale: Nephrotic syndrome causes loss of protein in urine,
leading to hypoalbuminemia (low serum albumin), which contributes to edema.
6. The nurse is caring for a client with acute kidney injury (AKI) in the diuretic
phase. Which complication is the greatest risk?
A. Hyperkalemia
B. Dehydration and hypovolemia
C. Pulmonary edema
D. Metabolic acidosis
Correct Answer: B. Rationale: The diuretic phase of AKI involves massive fluid loss,
leading to dehydration, hypotension, and electrolyte depletion (hypokalemia,
hyponatremia).
7. Which client is at highest risk for developing acute kidney injury (AKI)?
A. Client with a urinary tract infection.
B. Client receiving IV contrast dye for a CT scan.
C. Client with benign prostatic hyperplasia (BPH).
D. Client with controlled hypertension.
Correct Answer: B. Rationale: IV contrast dye is nephrotoxic and a common cause
of hospital-acquired AKI (contrast-induced nephropathy).
8. A client with ESRD reports bone pain and muscle weakness. The nurse
suspects which complication?
A. Hypercalcemia
B. Secondary hyperparathyroidism
C. Hypokalemia
D. Metabolic alkalosis
Correct Answer: B. Rationale: In CKD, phosphate retention leads to hypocalcemia,
stimulating PTH release (secondary hyperparathyroidism), which causes bone
resorption and pain.
