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NCLEX PHARMACOLOGY TEST BANK RENAL
& URINARY SYSTEMS 2026-2027 EDITION 100
EXAM QUESTIONS & DETAILED RATIONALES.
## Topic 1: Loop Diuretics (Questions 1–10)
**1.** A patient with pulmonary edema and chronic kidney disease
(GFR 25 mL/min) receives IV furosemide. Which assessment finding
indicates therapeutic effect?
A. Blood pressure 180/90 mmHg
B. Urine output 200 mL in 2 hours
C. Crackles auscultated in bilateral lung bases
D. Serum potassium 3.2 mEq/L
**Answer:** B. Urine output 200 mL in 2 hours
**Rationale:** Therapeutic effect of loop diuretics is increased urine
output (≥0.5 mL/kg/hour). Option C indicates persistent fluid overload.
Option D is an adverse effect (hypokalemia).
---
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**2.** A nurse prepares to administer bumetanide 1 mg IV. The patient
also takes gentamicin. Which action is most important?
A. Give both medications in same IV line
B. Monitor for increased risk of ototoxicity
C. Administer bumetanide after gentamicin
D. Increase fluid intake to 3 L/day
**Answer:** B. Monitor for increased risk of ototoxicity
**Rationale:** Loop diuretics and aminoglycosides (gentamicin) are
both ototoxic; concurrent use increases risk of irreversible hearing loss.
Monitor auditory function.
---
**3.** A patient on torsemide reports muscle weakness and cramping.
Which potassium level would confirm the nurse’s suspicion?
A. 5.2 mEq/L
B. 4.0 mEq/L
C. 3.1 mEq/L
D. 6.0 mEq/L
**Answer:** C. 3.1 mEq/L
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**Rationale:** Loop diuretics cause hypokalemia (normal 3.5–5.0). K+
<3.5 can cause muscle weakness, cramps, and arrhythmias.
---
**4.** Which patient is at highest risk for furosemide-induced
ototoxicity?
A. Patient receiving oral furosemide 20 mg daily
B. Patient receiving IV push furosemide 40 mg over 2 minutes
C. Patient receiving furosemide 40 mg IV over 10 minutes
D. Patient receiving furosemide 20 mg IM
**Answer:** B. Patient receiving IV push furosemide 40 mg over 2
minutes
**Rationale:** Rapid IV administration (>20 mg/min) increases
ototoxicity risk. Recommended rate: ≤20 mg/min. Slow infusion
preferred.
---
**5.** A patient with heart failure and gout is prescribed furosemide.
What effect does furosemide have on uric acid?
A. Decreases uric acid levels
B. Increases uric acid levels
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C. No effect on uric acid
D. Converts uric acid to allantoin
**Answer:** B. Increases uric acid levels
**Rationale:** Loop diuretics increase uric acid reabsorption,
potentially precipitating gout attacks. Monitor uric acid levels.
---
**6.** A patient on furosemide has digoxin 0.25 mg daily. Which
laboratory test should be monitored closely?
A. Serum sodium
B. Serum potassium
C. Serum chloride
D. Serum magnesium
**Answer:** B. Serum potassium
**Rationale:** Hypokalemia from furosemide increases digoxin toxicity
risk (arrhythmias, nausea, visual changes). Maintain K+ >4.0.
---
NCLEX PHARMACOLOGY TEST BANK RENAL
& URINARY SYSTEMS 2026-2027 EDITION 100
EXAM QUESTIONS & DETAILED RATIONALES.
## Topic 1: Loop Diuretics (Questions 1–10)
**1.** A patient with pulmonary edema and chronic kidney disease
(GFR 25 mL/min) receives IV furosemide. Which assessment finding
indicates therapeutic effect?
A. Blood pressure 180/90 mmHg
B. Urine output 200 mL in 2 hours
C. Crackles auscultated in bilateral lung bases
D. Serum potassium 3.2 mEq/L
**Answer:** B. Urine output 200 mL in 2 hours
**Rationale:** Therapeutic effect of loop diuretics is increased urine
output (≥0.5 mL/kg/hour). Option C indicates persistent fluid overload.
Option D is an adverse effect (hypokalemia).
---
,2|Page
**2.** A nurse prepares to administer bumetanide 1 mg IV. The patient
also takes gentamicin. Which action is most important?
A. Give both medications in same IV line
B. Monitor for increased risk of ototoxicity
C. Administer bumetanide after gentamicin
D. Increase fluid intake to 3 L/day
**Answer:** B. Monitor for increased risk of ototoxicity
**Rationale:** Loop diuretics and aminoglycosides (gentamicin) are
both ototoxic; concurrent use increases risk of irreversible hearing loss.
Monitor auditory function.
---
**3.** A patient on torsemide reports muscle weakness and cramping.
Which potassium level would confirm the nurse’s suspicion?
A. 5.2 mEq/L
B. 4.0 mEq/L
C. 3.1 mEq/L
D. 6.0 mEq/L
**Answer:** C. 3.1 mEq/L
,3|Page
**Rationale:** Loop diuretics cause hypokalemia (normal 3.5–5.0). K+
<3.5 can cause muscle weakness, cramps, and arrhythmias.
---
**4.** Which patient is at highest risk for furosemide-induced
ototoxicity?
A. Patient receiving oral furosemide 20 mg daily
B. Patient receiving IV push furosemide 40 mg over 2 minutes
C. Patient receiving furosemide 40 mg IV over 10 minutes
D. Patient receiving furosemide 20 mg IM
**Answer:** B. Patient receiving IV push furosemide 40 mg over 2
minutes
**Rationale:** Rapid IV administration (>20 mg/min) increases
ototoxicity risk. Recommended rate: ≤20 mg/min. Slow infusion
preferred.
---
**5.** A patient with heart failure and gout is prescribed furosemide.
What effect does furosemide have on uric acid?
A. Decreases uric acid levels
B. Increases uric acid levels
, 4|Page
C. No effect on uric acid
D. Converts uric acid to allantoin
**Answer:** B. Increases uric acid levels
**Rationale:** Loop diuretics increase uric acid reabsorption,
potentially precipitating gout attacks. Monitor uric acid levels.
---
**6.** A patient on furosemide has digoxin 0.25 mg daily. Which
laboratory test should be monitored closely?
A. Serum sodium
B. Serum potassium
C. Serum chloride
D. Serum magnesium
**Answer:** B. Serum potassium
**Rationale:** Hypokalemia from furosemide increases digoxin toxicity
risk (arrhythmias, nausea, visual changes). Maintain K+ >4.0.
---
