NURS EXAM-MANAGEMENT OF PATIENTS WITH KIDNEY
DISORDERS QUESTIONS with correct answers
The nurse is assessing a patient suspected of having developed acute
glomerulonephritis. The nurse should expect to address what clinical manifestation
that is characteristic of this health problem?
A) Hematuria
B) Precipitous decrease in serum creatinine levels
C) Hypotension unresolved by fluid administration
D) Glucosuria
The primary presenting feature of acute glomerulonephritis is hematuria (blood in
the urine), which may be microscopic (identifiable through microscopic
examination) or macroscopic or gross (visible to the eye). Proteinuria, primarily
albumin, which is present, is due to increased permeability of the glomerular
membrane. Blood urea nitrogen (BUN) and serum creatinine levels may rise as urine
output drops. Some degree of edema and hypertension is noted in most patients.
The nurse is caring for acutely ill patient. What assessment finding should
prompt the nurse to inform the physician that the patient may be exhibiting signs of
acute kidney injury (AKI)?
A) The patient is complains of an inability to initiate voiding.
B) The patients urine is cloudy with a foul odor.
C) The patients average urine output has been 10 mL/hr for several
hours.
D) The patient complains of acute flank pain.
Oliguria (<500 mL/d of urine) is the most common clinical situation seen in AKI.
Flank pain and inability to initiate voiding are not characteristic of AKI. Cloudy,
foul- smelling urine is suggestive of a urinary tract infection.
The nurse is caring for a patient with a history of systemic lupus
erythematosus who has been recently diagnosed with end-stage kidney disease
(ESKD). The patient has an elevated phosphorus level and has been prescribed
calcium acetate to bind the phosphorus. The nurse should teach the patient to take
the prescribed phosphorus-binding medication at what time?
A) Only when needed
B) Daily at bedtime
C) First thing in the morning
D) With each meal
Both calcium carbonate and calcium acetate are medications that bind with the
phosphate and assist in excreting the phosphate from the body, in turn lowering the
phosphate levels. Phosphate-binding medications must be administered with food to
be effective.
The nurse is working on the renal transplant unit. To reduce the risk of
infection in a patient with a transplanted kidney, it is imperative for the nurse to
do what?
1|Page
,NURS EXAM-MANAGEMENT OF PATIENTS WITH KIDNEY
DISORDERS QUESTIONS with correct answers
A) Wash hands carefully and frequently.
B) Ensure immediate function of the donated kidney.
C) Instruct the patient to wear a face mask.
D) Bar visitors from the patients room.
The nurse ensures that the patient is protected from exposure to infection by
hospital staff, visitors, and other patients with active infections. Careful
handwashing is imperative; face masks may be worn by hospital staff and visitors
to reduce the risk for transmitting infectious agents while the patient is receiving
high doses of immunosuppressants. Visitors may be limited, but are not normally
barred outright. Ensuring kidney function is vital, but does not prevent infection.
The nurse is caring for a patient receiving hemodialysis three times weekly.
The patient has had surgery to form an arteriovenous fistula. What is most
important for the nurse to be aware of when providing care for this patient?
A) Using a stethoscope for auscultating the fistula is contraindicated.
B) The patient feels best immediately after the dialysis treatment.
C) Taking a BP reading on the affected arm can damage the fistula.
D) The patient should not feel pain during initiation of dialysis.
When blood flow is reduced through the access for any reason (hypotension,
application of BP cuff/tourniquet), the access site can clot. Auscultation of a bruit in
the fistula is one way to determine patency. Typically, patients feel fatigued
immediately after hemodialysis because of the rapid change in fluid and electrolyte
status. Although the area over the fistula may have some decreased sensation, a
needle stick is still painful.
A patient has a glomerular filtration rate (GFR) of 43 mL/min/1.73 m2. Based
on this GFR, the nurse interprets that the patients chronic kidney disease is at what
stage?
A) Stage 1
B) Stage 2
C) Stage 3
D) Stage 4
Stages of chronic renal failure are based on the GFR. Stage 3 is defined by a GFR in
the range of 30 to 59 mL/min/1.73 m2. This is considered a moderate decrease in
GFR.
A football player is thought to have sustained an injury to his kidneys from
being tackled from behind. The ER nurse caring for the patient reviews the initial
orders written by the physician and notes that an order to collect all voided urine
and send it to the laboratory for analysis. The nurse understands that this nursing
intervention is important for what reason?
A) Hematuria is the most common manifestation of renal trauma and
blood losses may be microscopic, so laboratory analysis is essential.
B) Intake and output calculations are essential and the laboratory will calculate
2|Page
,NURS EXAM-MANAGEMENT OF PATIENTS WITH KIDNEY
DISORDERS QUESTIONS with correct answers
the precise urine output produced by this patient.
3|Page
, NURS EXAM-MANAGEMENT OF PATIENTS WITH KIDNEY
DISORDERS QUESTIONS with correct answers
C) A creatinine clearance study may be ordered at a later time and the
laboratory will hold all urine until it is determined if the test will be
necessary.
D) There is great concern about electrolyte imbalances and the laboratory will
monitor the urine for changes in potassium and sodium concentrations.
Hematuria is the most common manifestation of renal trauma; its presence after
trauma suggests renal injury. Hematuria may not occur, or it may be detectable only
on microscopic examination. All urine should be saved and sent to the laboratory for
analysis to detect RBCs and to evaluate the course of bleeding. Measuring intake
and output is not a function of the laboratory. The laboratory does not save urine to
test creatinine clearance at a later time. The laboratory does not monitor the urine
for sodium or potassium concentrations.
A patient admitted with nephrotic syndrome is being cared for on the medical
unit. When writing this patients care plan, based on the major clinical manifestation
of nephrotic syndrome, what nursing diagnosis should the nurse include?
A) Constipation related to immobility
B) Risk for injury related to altered thought processes
C) Hyperthermia related to the inflammatory process
D) Excess fluid volume related to generalized edema
The major clinical manifestation of nephrotic syndrome is edema, so the appropriate
nursing diagnosis is Excess fluid volume related to generalized edema. Edema is
usually soft, pitting, and commonly occurs around the eyes, in dependent areas,
and in the abdomen.
The nurse coming on shift on the medical unit is taking a report on four
patients. What patient does the nurse know is at the greatest risk of developing
ESKD?
A) A patient with a history of polycystic kidney disease
B) A patient with diabetes mellitus and poorly controlled hypertension
C) A patient who is morbidly obese with a history of vascular disorders
D) A patient with severe chronic obstructive pulmonary disease
Systemic diseases, such as diabetes mellitus (leading cause); hypertension; chronic
glomerulonephritis; pyelonephritis; obstruction of the urinary tract; hereditary
lesions, such as in polycystic kidney disease; vascular disorders; infections;
medications; or toxic agents may cause ESKD. A patient with more than one of
these risk factors is at the greatest risk for developing ESKD. Therefore, the patient
with diabetes and hypertension is likely at highest risk for ESKD.
The nurse is caring for a patient postoperative day 4 following a kidney
transplant. When assessing for potential signs and symptoms of rejection, what
assessment should the nurse prioritize?
A) Assessment of the quantity of the patients urine output
B) Assessment of the patients incision
4|Page
DISORDERS QUESTIONS with correct answers
The nurse is assessing a patient suspected of having developed acute
glomerulonephritis. The nurse should expect to address what clinical manifestation
that is characteristic of this health problem?
A) Hematuria
B) Precipitous decrease in serum creatinine levels
C) Hypotension unresolved by fluid administration
D) Glucosuria
The primary presenting feature of acute glomerulonephritis is hematuria (blood in
the urine), which may be microscopic (identifiable through microscopic
examination) or macroscopic or gross (visible to the eye). Proteinuria, primarily
albumin, which is present, is due to increased permeability of the glomerular
membrane. Blood urea nitrogen (BUN) and serum creatinine levels may rise as urine
output drops. Some degree of edema and hypertension is noted in most patients.
The nurse is caring for acutely ill patient. What assessment finding should
prompt the nurse to inform the physician that the patient may be exhibiting signs of
acute kidney injury (AKI)?
A) The patient is complains of an inability to initiate voiding.
B) The patients urine is cloudy with a foul odor.
C) The patients average urine output has been 10 mL/hr for several
hours.
D) The patient complains of acute flank pain.
Oliguria (<500 mL/d of urine) is the most common clinical situation seen in AKI.
Flank pain and inability to initiate voiding are not characteristic of AKI. Cloudy,
foul- smelling urine is suggestive of a urinary tract infection.
The nurse is caring for a patient with a history of systemic lupus
erythematosus who has been recently diagnosed with end-stage kidney disease
(ESKD). The patient has an elevated phosphorus level and has been prescribed
calcium acetate to bind the phosphorus. The nurse should teach the patient to take
the prescribed phosphorus-binding medication at what time?
A) Only when needed
B) Daily at bedtime
C) First thing in the morning
D) With each meal
Both calcium carbonate and calcium acetate are medications that bind with the
phosphate and assist in excreting the phosphate from the body, in turn lowering the
phosphate levels. Phosphate-binding medications must be administered with food to
be effective.
The nurse is working on the renal transplant unit. To reduce the risk of
infection in a patient with a transplanted kidney, it is imperative for the nurse to
do what?
1|Page
,NURS EXAM-MANAGEMENT OF PATIENTS WITH KIDNEY
DISORDERS QUESTIONS with correct answers
A) Wash hands carefully and frequently.
B) Ensure immediate function of the donated kidney.
C) Instruct the patient to wear a face mask.
D) Bar visitors from the patients room.
The nurse ensures that the patient is protected from exposure to infection by
hospital staff, visitors, and other patients with active infections. Careful
handwashing is imperative; face masks may be worn by hospital staff and visitors
to reduce the risk for transmitting infectious agents while the patient is receiving
high doses of immunosuppressants. Visitors may be limited, but are not normally
barred outright. Ensuring kidney function is vital, but does not prevent infection.
The nurse is caring for a patient receiving hemodialysis three times weekly.
The patient has had surgery to form an arteriovenous fistula. What is most
important for the nurse to be aware of when providing care for this patient?
A) Using a stethoscope for auscultating the fistula is contraindicated.
B) The patient feels best immediately after the dialysis treatment.
C) Taking a BP reading on the affected arm can damage the fistula.
D) The patient should not feel pain during initiation of dialysis.
When blood flow is reduced through the access for any reason (hypotension,
application of BP cuff/tourniquet), the access site can clot. Auscultation of a bruit in
the fistula is one way to determine patency. Typically, patients feel fatigued
immediately after hemodialysis because of the rapid change in fluid and electrolyte
status. Although the area over the fistula may have some decreased sensation, a
needle stick is still painful.
A patient has a glomerular filtration rate (GFR) of 43 mL/min/1.73 m2. Based
on this GFR, the nurse interprets that the patients chronic kidney disease is at what
stage?
A) Stage 1
B) Stage 2
C) Stage 3
D) Stage 4
Stages of chronic renal failure are based on the GFR. Stage 3 is defined by a GFR in
the range of 30 to 59 mL/min/1.73 m2. This is considered a moderate decrease in
GFR.
A football player is thought to have sustained an injury to his kidneys from
being tackled from behind. The ER nurse caring for the patient reviews the initial
orders written by the physician and notes that an order to collect all voided urine
and send it to the laboratory for analysis. The nurse understands that this nursing
intervention is important for what reason?
A) Hematuria is the most common manifestation of renal trauma and
blood losses may be microscopic, so laboratory analysis is essential.
B) Intake and output calculations are essential and the laboratory will calculate
2|Page
,NURS EXAM-MANAGEMENT OF PATIENTS WITH KIDNEY
DISORDERS QUESTIONS with correct answers
the precise urine output produced by this patient.
3|Page
, NURS EXAM-MANAGEMENT OF PATIENTS WITH KIDNEY
DISORDERS QUESTIONS with correct answers
C) A creatinine clearance study may be ordered at a later time and the
laboratory will hold all urine until it is determined if the test will be
necessary.
D) There is great concern about electrolyte imbalances and the laboratory will
monitor the urine for changes in potassium and sodium concentrations.
Hematuria is the most common manifestation of renal trauma; its presence after
trauma suggests renal injury. Hematuria may not occur, or it may be detectable only
on microscopic examination. All urine should be saved and sent to the laboratory for
analysis to detect RBCs and to evaluate the course of bleeding. Measuring intake
and output is not a function of the laboratory. The laboratory does not save urine to
test creatinine clearance at a later time. The laboratory does not monitor the urine
for sodium or potassium concentrations.
A patient admitted with nephrotic syndrome is being cared for on the medical
unit. When writing this patients care plan, based on the major clinical manifestation
of nephrotic syndrome, what nursing diagnosis should the nurse include?
A) Constipation related to immobility
B) Risk for injury related to altered thought processes
C) Hyperthermia related to the inflammatory process
D) Excess fluid volume related to generalized edema
The major clinical manifestation of nephrotic syndrome is edema, so the appropriate
nursing diagnosis is Excess fluid volume related to generalized edema. Edema is
usually soft, pitting, and commonly occurs around the eyes, in dependent areas,
and in the abdomen.
The nurse coming on shift on the medical unit is taking a report on four
patients. What patient does the nurse know is at the greatest risk of developing
ESKD?
A) A patient with a history of polycystic kidney disease
B) A patient with diabetes mellitus and poorly controlled hypertension
C) A patient who is morbidly obese with a history of vascular disorders
D) A patient with severe chronic obstructive pulmonary disease
Systemic diseases, such as diabetes mellitus (leading cause); hypertension; chronic
glomerulonephritis; pyelonephritis; obstruction of the urinary tract; hereditary
lesions, such as in polycystic kidney disease; vascular disorders; infections;
medications; or toxic agents may cause ESKD. A patient with more than one of
these risk factors is at the greatest risk for developing ESKD. Therefore, the patient
with diabetes and hypertension is likely at highest risk for ESKD.
The nurse is caring for a patient postoperative day 4 following a kidney
transplant. When assessing for potential signs and symptoms of rejection, what
assessment should the nurse prioritize?
A) Assessment of the quantity of the patients urine output
B) Assessment of the patients incision
4|Page
