MIND PLUG | STUDY SMARTER. NOT HARDER.
NP3 Exam 1 (2025) – Complete Verified
Questions & 100% Correct Answers
1. The nurse is assessing a client with a diagnosis of prerenal acute kidney injury (AKI). Which condition
would the nurse expect to find in the patient's recent history?
a. Pyelonephritis
b. Dehydration
c. Bladder cancer
d. Kidney stones
ANS: B
Prerenal causes of AKI are related to a decrease in perfusion, such as in clients who have prolonged
dehydration. Pyelonephritis is an intrinsic or intrarenal cause of AKI related to kidney damage. Bladder
cancer and kidney stones are postrenal causes of AKI related to urine flow obstruction.
2. A marathon runner comes into the clinic and states "I have not urinated very much in the last few
days." The nurse notes a heart rate of 110 beats/min and a blood pressure of 86/58 mm Hg. Which
action by the nurse is most appropriate?
a. Give the client a bottle of water immediately.
b. Start an intravenous line for fluids.
c. Teach the patient to drink 2 to 3 L of water daily.
d. Perform an electrocardiogram.
ANS: A
This athlete is mildly dehydrated as evidenced by the higher heart rate and lower blood pressure. The
nurse can start hydrating the client with a bottle of water first, followed by teaching the patient to drink
2 to 3 L of water each day. An intravenous line may be needed later, after the patient's degree of
dehydration is assessed. An electrocardiogram is not necessary at this time.
3. A client comes into the emergency department with a serum creatinine of 2.2 mg/dL (1944 mcmol/L)
and a blood urea nitrogen (BUN) of 24 mL/dL (8.57 mmol/L). What question would the nurse ask first
when taking this client's history?
MIND PLUG – VERIFIED • ACCURATE • 100% CORRECT • LATEST 2025 EDITION
,MIND PLUG | STUDY SMARTER. NOT HARDER.
a. "Have you been taking any aspirin, ibuprofen, or naproxen recently?"
b. "Do you have anyone in your family with renal failure?"
c. "Have you had a diet that is low in protein recently?"
d. "Has a relative had a kidney transplant lately?"
ANS: A
There are some medications that are nephrotoxic, such as the nonsteroidal anti-inflammatory drugs
ibuprofen, aspirin, and naproxen. This would be a good question to initially ask the patient since both
the serum creatinine and BUN are elevated, indicating some renal problems. A diet high in protein could
be a factor in an increased BUN.
4. A client is admitted with acute kidney injury (AKI) and a urine output of 2000 mL/day. What is the
major concern of the nurse regarding this patient's care?
a. Edema and pain
b. Cardiac and respiratory status
c. Electrolyte and fluid imbalance
d. Mental health status
ANS: C
This client may have an inflammatory cause of AKI with proteins entering the glomerulus and holding
the fluid in the filtrate, causing polyuria. Electrolyte loss and fluid balance are essential. Edema and pain
are not usually a problem with fluid loss. There could be changes in the client's cardiac, respiratory, and
mental health status if the electrolyte imbalance is not treated.
5. A client with acute kidney injury (AKI) has a blood pressure of 76/55 mm Hg. The primary health care
provider prescribed 1000 mL of normal saline to be infused over 1 hour to maintain perfusion. The client
starts to develop shortness of breath. What is the nurse's priority action?
a. Calculate the mean arterial pressure (MAP).
b. Ask for insertion of a pulmonary artery catheter.
c. Take the client's pulse.
d. Decrease the rate of the IV infusion.
MIND PLUG – VERIFIED • ACCURATE • 100% CORRECT • LATEST 2025 EDITION
,MIND PLUG | STUDY SMARTER. NOT HARDER.
ANS: D
The nurse would assess that the client could be developing fluid overload and respiratory distress and
slow down the normal saline infusion. The calculation of the MAP also reflects perfusion. The insertion
of a pulmonary artery catheter would evaluate the client's hemodynamic status, but this would not be
the initial or priority action by the nurse. Vital signs are also important after adjusting the intravenous
infusion.
6. A client has a serum potassium level of 6.5 mEq/L (6.5 mmol/L), a serum creatinine level of 2 mg/dL
(176 mcmol/L), and a urine output of 350 mL/day. What is the best action by the nurse?
a. Place the client on a cardiac monitor immediately.
b. Teach the client to limit high-potassium foods.
c. Continue to monitor the client's intake and output.
d. Ask to have the laboratory redraw the blood specimen.
ANS: A
The best action by the nurse would be to check the cardiac status with a monitor. High-potassium levels
can lead to dysrhythmias. The other choices are logical nursing interventions for acute kidney injury but
not the best immediate action.
7. A client with diabetes mellitus type 2 has been well controlled with metformin. The client is scheduled
for magnetic resonance imaging (MRI) scan with contrast. What priority would the nurse take at this
time?
a. Teach the client about the purpose of the MRI.
b. Assess the client's blood urea nitrogen and creatinine.
c. Tell the client to withhold metformin for 24 hours before the MRI.
d. Ask the client if he or she is taking antibiotics.
ANS: C
Contrast media can be nephrotoxic (damaging to the kidneys). Metformin can also be nephrotoxic and
the client should not be exposed to two agents. Clients who have diabetes are already at risk for renal
damage.
MIND PLUG – VERIFIED • ACCURATE • 100% CORRECT • LATEST 2025 EDITION
, MIND PLUG | STUDY SMARTER. NOT HARDER.
8. A client is started on continuous venovenous hemofiltration (CVVH). Which finding would require
immediate action by the nurse?
a. Potassium level of 5.5 mEq/L (5.5 mmol/L)
b. Sodium level of 138 mEq/L (138 mmol/L)
c. Blood pressure of 76/58 mm Hg
d. Pulse rate of 88 beats/min
ANS: C
Hypotension can be a problem with CVVH if replacement fluid does not provide enough volume to
maintain blood pressure. The nurse needs to monitor for ongoing fluid and electrolyte replacement. The
sodium level is normal and the potassium level is slightly elevated, which could be normal findings for
someone with acute kidney injury. A pulse rate of 88 beats/min is within usual limits.
9. The nurse is caring for four clients with chronic kidney disease (CKD). Which client would the nurse
assess first upon initial rounding?
a. Client with a blood pressure of 158/90 mm Hg
b. Client with Kussmaul respirations
c. Client with skin itching from head to toe
d. Client with halitosis and stomatitis
ANS: B
Kussmaul respirations indicate that the client has metabolic acidosis which is a complication of CKD. The
client is increasing the rate and depth of breathing to excrete carbon dioxide through the lungs to lower
serum pH. Hypertension is common in most patients with CKD, and skin itching increases with calcium-
phosphate imbalances and elevations of nitrogenous wastes, another common finding in CKD. Uremia
from CKD causes ammonia to be formed, resulting in the common findings of halitosis and stomatitis.
10. The nurse is teaching assistive personnel (AP) about fluid restriction for a client who has acute
kidney injury (AKI). The client's 24-hour urinary output is 120 mL. How much fluid would the client be
allowed to have over the next 24 hours?
MIND PLUG – VERIFIED • ACCURATE • 100% CORRECT • LATEST 2025 EDITION
NP3 Exam 1 (2025) – Complete Verified
Questions & 100% Correct Answers
1. The nurse is assessing a client with a diagnosis of prerenal acute kidney injury (AKI). Which condition
would the nurse expect to find in the patient's recent history?
a. Pyelonephritis
b. Dehydration
c. Bladder cancer
d. Kidney stones
ANS: B
Prerenal causes of AKI are related to a decrease in perfusion, such as in clients who have prolonged
dehydration. Pyelonephritis is an intrinsic or intrarenal cause of AKI related to kidney damage. Bladder
cancer and kidney stones are postrenal causes of AKI related to urine flow obstruction.
2. A marathon runner comes into the clinic and states "I have not urinated very much in the last few
days." The nurse notes a heart rate of 110 beats/min and a blood pressure of 86/58 mm Hg. Which
action by the nurse is most appropriate?
a. Give the client a bottle of water immediately.
b. Start an intravenous line for fluids.
c. Teach the patient to drink 2 to 3 L of water daily.
d. Perform an electrocardiogram.
ANS: A
This athlete is mildly dehydrated as evidenced by the higher heart rate and lower blood pressure. The
nurse can start hydrating the client with a bottle of water first, followed by teaching the patient to drink
2 to 3 L of water each day. An intravenous line may be needed later, after the patient's degree of
dehydration is assessed. An electrocardiogram is not necessary at this time.
3. A client comes into the emergency department with a serum creatinine of 2.2 mg/dL (1944 mcmol/L)
and a blood urea nitrogen (BUN) of 24 mL/dL (8.57 mmol/L). What question would the nurse ask first
when taking this client's history?
MIND PLUG – VERIFIED • ACCURATE • 100% CORRECT • LATEST 2025 EDITION
,MIND PLUG | STUDY SMARTER. NOT HARDER.
a. "Have you been taking any aspirin, ibuprofen, or naproxen recently?"
b. "Do you have anyone in your family with renal failure?"
c. "Have you had a diet that is low in protein recently?"
d. "Has a relative had a kidney transplant lately?"
ANS: A
There are some medications that are nephrotoxic, such as the nonsteroidal anti-inflammatory drugs
ibuprofen, aspirin, and naproxen. This would be a good question to initially ask the patient since both
the serum creatinine and BUN are elevated, indicating some renal problems. A diet high in protein could
be a factor in an increased BUN.
4. A client is admitted with acute kidney injury (AKI) and a urine output of 2000 mL/day. What is the
major concern of the nurse regarding this patient's care?
a. Edema and pain
b. Cardiac and respiratory status
c. Electrolyte and fluid imbalance
d. Mental health status
ANS: C
This client may have an inflammatory cause of AKI with proteins entering the glomerulus and holding
the fluid in the filtrate, causing polyuria. Electrolyte loss and fluid balance are essential. Edema and pain
are not usually a problem with fluid loss. There could be changes in the client's cardiac, respiratory, and
mental health status if the electrolyte imbalance is not treated.
5. A client with acute kidney injury (AKI) has a blood pressure of 76/55 mm Hg. The primary health care
provider prescribed 1000 mL of normal saline to be infused over 1 hour to maintain perfusion. The client
starts to develop shortness of breath. What is the nurse's priority action?
a. Calculate the mean arterial pressure (MAP).
b. Ask for insertion of a pulmonary artery catheter.
c. Take the client's pulse.
d. Decrease the rate of the IV infusion.
MIND PLUG – VERIFIED • ACCURATE • 100% CORRECT • LATEST 2025 EDITION
,MIND PLUG | STUDY SMARTER. NOT HARDER.
ANS: D
The nurse would assess that the client could be developing fluid overload and respiratory distress and
slow down the normal saline infusion. The calculation of the MAP also reflects perfusion. The insertion
of a pulmonary artery catheter would evaluate the client's hemodynamic status, but this would not be
the initial or priority action by the nurse. Vital signs are also important after adjusting the intravenous
infusion.
6. A client has a serum potassium level of 6.5 mEq/L (6.5 mmol/L), a serum creatinine level of 2 mg/dL
(176 mcmol/L), and a urine output of 350 mL/day. What is the best action by the nurse?
a. Place the client on a cardiac monitor immediately.
b. Teach the client to limit high-potassium foods.
c. Continue to monitor the client's intake and output.
d. Ask to have the laboratory redraw the blood specimen.
ANS: A
The best action by the nurse would be to check the cardiac status with a monitor. High-potassium levels
can lead to dysrhythmias. The other choices are logical nursing interventions for acute kidney injury but
not the best immediate action.
7. A client with diabetes mellitus type 2 has been well controlled with metformin. The client is scheduled
for magnetic resonance imaging (MRI) scan with contrast. What priority would the nurse take at this
time?
a. Teach the client about the purpose of the MRI.
b. Assess the client's blood urea nitrogen and creatinine.
c. Tell the client to withhold metformin for 24 hours before the MRI.
d. Ask the client if he or she is taking antibiotics.
ANS: C
Contrast media can be nephrotoxic (damaging to the kidneys). Metformin can also be nephrotoxic and
the client should not be exposed to two agents. Clients who have diabetes are already at risk for renal
damage.
MIND PLUG – VERIFIED • ACCURATE • 100% CORRECT • LATEST 2025 EDITION
, MIND PLUG | STUDY SMARTER. NOT HARDER.
8. A client is started on continuous venovenous hemofiltration (CVVH). Which finding would require
immediate action by the nurse?
a. Potassium level of 5.5 mEq/L (5.5 mmol/L)
b. Sodium level of 138 mEq/L (138 mmol/L)
c. Blood pressure of 76/58 mm Hg
d. Pulse rate of 88 beats/min
ANS: C
Hypotension can be a problem with CVVH if replacement fluid does not provide enough volume to
maintain blood pressure. The nurse needs to monitor for ongoing fluid and electrolyte replacement. The
sodium level is normal and the potassium level is slightly elevated, which could be normal findings for
someone with acute kidney injury. A pulse rate of 88 beats/min is within usual limits.
9. The nurse is caring for four clients with chronic kidney disease (CKD). Which client would the nurse
assess first upon initial rounding?
a. Client with a blood pressure of 158/90 mm Hg
b. Client with Kussmaul respirations
c. Client with skin itching from head to toe
d. Client with halitosis and stomatitis
ANS: B
Kussmaul respirations indicate that the client has metabolic acidosis which is a complication of CKD. The
client is increasing the rate and depth of breathing to excrete carbon dioxide through the lungs to lower
serum pH. Hypertension is common in most patients with CKD, and skin itching increases with calcium-
phosphate imbalances and elevations of nitrogenous wastes, another common finding in CKD. Uremia
from CKD causes ammonia to be formed, resulting in the common findings of halitosis and stomatitis.
10. The nurse is teaching assistive personnel (AP) about fluid restriction for a client who has acute
kidney injury (AKI). The client's 24-hour urinary output is 120 mL. How much fluid would the client be
allowed to have over the next 24 hours?
MIND PLUG – VERIFIED • ACCURATE • 100% CORRECT • LATEST 2025 EDITION
