NUR 220 | NUR 220 Medical Surgical Nursing Exam
3 Version 2 | Questions with Correct Answers and
Expert Explanation for Each Question | Baltimore
City Community College
1. A nurse is caring for a patient with acute kidney injury (AKI). Which of the following
findings would suggest the cause is prerenal?
A. Recent use of aminoglycoside antibiotics
B. Blood pressure of 88/46 mmHg
C. Presence of kidney stones on imaging
D. Bladder cancer with urethral obstruction
Correct Answer: B
Expert Explanation: Prerenal AKI is caused by factors that reduce systemic
circulation and blood flow to the kidneys. Hypovolemia and hypotension are
primary causes because they lead to decreased glomerular perfusion pressure.
Identifying and treating the underlying cause of reduced blood flow can often
reverse this stage of kidney injury. Other options like nephrotoxic drugs or urinary
tract obstructions represent intrarenal or postrenal causes. Monitoring blood
pressure and fluid status is the nurse’s priority to prevent permanent renal damage.
,2. A patient with chronic kidney disease (CKD) has a serum potassium level of 6.8
mEq/L. Which assessment should the nurse perform first?
A. Check for muscle weakness
B. Assess for abdominal cramping
C. Monitor urine output for 24 hours
D. Evaluate the electrocardiogram (EKG)
Correct Answer: D
Expert Explanation: Hyperkalemia is the most serious electrolyte disorder in renal
failure because it can cause lethal cardiac arrhythmias. The nurse should
immediately assess the patient for EKG changes such as peaked T waves or a
widened QRS complex. Potassium levels are normally regulated by the kidneys,
which become inefficient during acute or chronic failure. Administering medications
like insulin with glucose or calcium gluconate may be necessary for stabilization.
Patient safety depends on rapid recognition and intervention to prevent cardiac
arrest.
3. When assessing a patient with a newly created arteriovenous (AV) fistula in the left
arm, which finding requires immediate notification to the physician?
A. Presence of a palpable thrill
B. Slight redness at the incision line
,C. Report of mild bruising at the site
D. Absence of a bruit upon auscultation
Correct Answer: D
Expert Explanation: The absence of a bruit or thrill indicates that the AV fistula
may be clotted or failing. A palpable thrill and audible bruit are expected findings
that confirm blood flow through the access. The nurse must check these signs every
shift to ensure the patency of the hemodialysis site. Compromised blood flow
requires urgent intervention to save the access and allow for dialysis treatments.
Nursing care also includes ensuring no blood pressures or sticks are performed on
the affected arm.
4. A patient undergoing peritoneal dialysis (PD) complains of abdominal pain, and the
nurse notes the dialysate drainage is cloudy. What is the priority nursing action?
A. Obtain a sample of the effluent for culture
B. Increase the dwell time for better clearance
C. Warm the dialysate before the next cycle
D. Administer an analgesic for the pain
Correct Answer: A
, Expert Explanation: Cloudy dialysate drainage is the primary indicator of
peritonitis, a common and serious complication of peritoneal dialysis. The nurse
must prioritize obtaining a culture of the effluent to identify the causative organism.
Peritonitis can lead to systemic sepsis and damage to the peritoneal membrane if
not treated quickly. Prophylactic or targeted antibiotic therapy is usually started
based on the culture results and clinical presentation. Patient education on sterile
technique is vital to prevent future occurrences of this infection.
5. The nurse is preparing to administer erythropoietin alfa to a patient with CKD.
Which lab value must be monitored to evaluate effectiveness?
A. Serum creatinine
B. Blood urea nitrogen
C. Hemoglobin levels
D. Serum phosphorus
Correct Answer: C
Expert Explanation: Erythropoietin is a hormone produced by the kidneys that
stimulates the bone marrow to produce red blood cells. In CKD, the kidneys fail to
produce enough erythropoietin, leading to chronic anemia. Hemoglobin levels are
monitored to determine the efficacy of the medication and to avoid over-correction.
Excessive hemoglobin increases the risk of hypertension and thromboembolic
3 Version 2 | Questions with Correct Answers and
Expert Explanation for Each Question | Baltimore
City Community College
1. A nurse is caring for a patient with acute kidney injury (AKI). Which of the following
findings would suggest the cause is prerenal?
A. Recent use of aminoglycoside antibiotics
B. Blood pressure of 88/46 mmHg
C. Presence of kidney stones on imaging
D. Bladder cancer with urethral obstruction
Correct Answer: B
Expert Explanation: Prerenal AKI is caused by factors that reduce systemic
circulation and blood flow to the kidneys. Hypovolemia and hypotension are
primary causes because they lead to decreased glomerular perfusion pressure.
Identifying and treating the underlying cause of reduced blood flow can often
reverse this stage of kidney injury. Other options like nephrotoxic drugs or urinary
tract obstructions represent intrarenal or postrenal causes. Monitoring blood
pressure and fluid status is the nurse’s priority to prevent permanent renal damage.
,2. A patient with chronic kidney disease (CKD) has a serum potassium level of 6.8
mEq/L. Which assessment should the nurse perform first?
A. Check for muscle weakness
B. Assess for abdominal cramping
C. Monitor urine output for 24 hours
D. Evaluate the electrocardiogram (EKG)
Correct Answer: D
Expert Explanation: Hyperkalemia is the most serious electrolyte disorder in renal
failure because it can cause lethal cardiac arrhythmias. The nurse should
immediately assess the patient for EKG changes such as peaked T waves or a
widened QRS complex. Potassium levels are normally regulated by the kidneys,
which become inefficient during acute or chronic failure. Administering medications
like insulin with glucose or calcium gluconate may be necessary for stabilization.
Patient safety depends on rapid recognition and intervention to prevent cardiac
arrest.
3. When assessing a patient with a newly created arteriovenous (AV) fistula in the left
arm, which finding requires immediate notification to the physician?
A. Presence of a palpable thrill
B. Slight redness at the incision line
,C. Report of mild bruising at the site
D. Absence of a bruit upon auscultation
Correct Answer: D
Expert Explanation: The absence of a bruit or thrill indicates that the AV fistula
may be clotted or failing. A palpable thrill and audible bruit are expected findings
that confirm blood flow through the access. The nurse must check these signs every
shift to ensure the patency of the hemodialysis site. Compromised blood flow
requires urgent intervention to save the access and allow for dialysis treatments.
Nursing care also includes ensuring no blood pressures or sticks are performed on
the affected arm.
4. A patient undergoing peritoneal dialysis (PD) complains of abdominal pain, and the
nurse notes the dialysate drainage is cloudy. What is the priority nursing action?
A. Obtain a sample of the effluent for culture
B. Increase the dwell time for better clearance
C. Warm the dialysate before the next cycle
D. Administer an analgesic for the pain
Correct Answer: A
, Expert Explanation: Cloudy dialysate drainage is the primary indicator of
peritonitis, a common and serious complication of peritoneal dialysis. The nurse
must prioritize obtaining a culture of the effluent to identify the causative organism.
Peritonitis can lead to systemic sepsis and damage to the peritoneal membrane if
not treated quickly. Prophylactic or targeted antibiotic therapy is usually started
based on the culture results and clinical presentation. Patient education on sterile
technique is vital to prevent future occurrences of this infection.
5. The nurse is preparing to administer erythropoietin alfa to a patient with CKD.
Which lab value must be monitored to evaluate effectiveness?
A. Serum creatinine
B. Blood urea nitrogen
C. Hemoglobin levels
D. Serum phosphorus
Correct Answer: C
Expert Explanation: Erythropoietin is a hormone produced by the kidneys that
stimulates the bone marrow to produce red blood cells. In CKD, the kidneys fail to
produce enough erythropoietin, leading to chronic anemia. Hemoglobin levels are
monitored to determine the efficacy of the medication and to avoid over-correction.
Excessive hemoglobin increases the risk of hypertension and thromboembolic
