A.

B.
C.
D.
A.
B.
C.
D.
E.
A.
B.
C.
D.
A.
B.
C.
D.
A.
B.
A.
B.
C.
D.
A.
B.
C.
D.
A.
B.
C.
D.
A.
B.
A.
B.
C.

ARF
Text Mode Text version of the exam
1) The cause of ___________ failure is impaired blood supply to the kidney (Fluid Volume Deficit, hemorrhage, heart
failure, shock)
prerenal
Intrarenal
Postrenal
perirenal
2) What electrolytes are in urine?
Na
K
Cl
HCO3All of the above
3) Which diagnostic test would be monitored to evaluate glomerulat filtration rateand renal function?
Sreum creatinine and BUN
Urinalysis
Kidney biopsy
creatinine clearance
4) Marina with acute renal failure moves into the diuretic phase after one week of therapy. During this phase the
client must be assessed for signs of developing:
Hypovolemia
renal failure
metabolic acidosis
hyperkalemia
5) true or false? Creatinine, phosphate, sulfates, and uric acid should not be present in urine because they signify
renal failure.
True
False
6) The nurse is reviewing laboratory results on a client with acute renal failure. Which one of the following should be
reported immediately?
Blood urea nitrogen 50 mg/dl
Hemoglobin of 10.3 mg/dl
Venous blood pH 7.30
Serum potassium 6 mEq/L
7)Nurse Liza is assigned to care for a client who has returned to the nursing unit after left nephrectomy. Nurse Lizas
highest priority would be
Hourly urine output
Temperature
Able to turn side to side
Able to sips clear liquidQ.
8) The charge nurse assigned in the care for a client with acute renal failure and hypernatremia to you, a newly
graduated RN. Which actions can you delegate to the nursing assistant?
Provide oral care every 3-4 hours
Monitor for indications of dehydration
Administer 0.45% saline by IV line
Assess daily weights for trends
9) __________ in BUN/Creatinine ratio indicate fluid volume excess,malnutrition and fluid volume excess or
malnutrition ?
Increase
Decrease
10) The most serious electrolyte disorder associated with kidney disease is
hypermagnesemia
hyponatremia
hyperkalemia

D.
A.
B.
C.
D.
A.
B.
C.
D.
A.
B.
C.
D.
A.
B.
C.
D.
A.
B.
C.
D.
A.
B.
C.
D.
A.
B.
C.
D.

A.
B.
C.
D.
E.
A.
B.
C.
D.
A.
B.

metabolic acidosis
11) A client in acute renal failure is a candidate for continuous renal placement therapy (CRRT). The most common
indication for use of CRRT is
azotemia
pericarditis
hyperkalemia
fluid overload
12) A history of infection specifically caused by group A beta-hemolytic streptococci is associated with which of the
following disorders?
Acute glomerulonephritis
Acute renal failure
Chronic renal failure
Nephrotic syndrome
13) The leading cause of ESRD is the client with a history of
hypotension
anemia
prostate cancer
diabetes Mellitus
14) The risk for __________________ is particularly high when ischemia and exposure to a nephrotoxin occur at the
same time.
acute tubular necrosis or tubular necrosis
acute glomerulonephritis
chronic renal failure
UTI
15) What controls the amount of water absorption?
antidiuretic hormone (Vasopressin)
melanin
thyroxine
prolactin
16) What does urine mostly consist of?
H2O (Water)
NaCl (Salt)
Urea
KCl
17) How much water do normal kidneys excrete each day?
3-4 liters
5-6 liters
1-2 liters
7-8 liters
18) Chronic kidney disease is defined by Kidney Disease Outcomes Quality Initiative (K/DOQI) as evidence of
structural or functional kidney abnormalities (abnormal urinalysis, imaging studies, or histology) that persists for at
least ______________ months, with or without a decreased GFR.
1
2
3
6
12
19) What is the # 1 renal function test?
Renal Clearance/Creatinine Clearance
Osmolarity
Serum Creatinine
BUN
20) For a male client in the oliguric phase of acute renal failure (ARF), which nursing intervention is most important?
Encouraging coughing and deep breathing
Promoting carbohydrate intake

C.
D.
A.
B.
C.
D.
A.
B.
C.
D.
A.
B.
C.
A.
B.
C.
D.

A.
B.
C.
D.
A.
B.
C.
D.
A.
B.
C.
D.
A.
B.
A.
B.
C.
D.

A.

Limiting fluid intake

Providing pain-relief measures
21) How much salt do normal kidneys excrete each day?
1-2 mg
5g
3-4 g
6-8 g
22) Which is a normal value of Blood Urea Nitrogen (BUN)?
0.5-1.1 mg/dL
5-20 mg/dL
40-70 mg/dL
250-500 mg/dL
23) When the kidneys cannot effectively regulate fluid and electrolyte balance and eliminate metabolic waste
products, intake of these substances must be regulated. Fluid and Sodium intake are ________.
encouraged
limited
restricted
24) The nurse is caring for the client who has had a renal biopsy. Which of the following interventions would the
nurse avoid in the care of the client after this procedure?
Encourage fluids to at least 3L in the first 24 hours
Administering narcotics as needed
Testing serial samples iwth dipsticks for occult blood
Ambulating the client in the room and hall for short distances
25) A female client is admitted with a diagnosis of acute renal failure. She is awake, alert, oriented, and complaining
of severe back pain, nausea and vomiting and abdominal cramps. Her vital signs are blood pressure 100/70 mm Hg,
pulse 110, respirations 30, and oral temperature 100.4F (38C). Her electrolytes are sodium 120 mEq/L, potassium
5.2 mEq/L; her urinary output for the first 8 hours is 50 ml. The client is displaying signs of which electrolyte
imbalance?
Hyponatremia
Hyperkalemia
Hyperphosphatemia
Hypercalcemia
26) how many ml/hr of urine output is the normal minimum?
30
35
40
45
27) Signs and symptoms of acute kidney rejection that the nurse should teach the patient to observe for include
tachycardia and headache
fever and painful transplant site
severe hypotension and weight loss
recurrent urinary tract infections and oral yeast infections
28) ________ renal failure is a slow, insidious process of kidney destruction. It may go unrecognized for years as
nephrons are destroyed and renal mass is reduced.
Chronic
Acute
29) The client with renal failure should be on which type of diet?
high protein, high carbohydrate, low calorie
adequate calorie intake, high carbohydrate, limited protein
Limited protein, low carbohydrate, adequate calorie intake
Low calorie, limited protein, low carbohydrate
30) A client suffering from acute renal failure has an unexpected increase in urinary output to 150ml/hr. The nurse
assesses that the client has entered the second phase of acute renal failure. Nursing actions throughout this phase
include observation for signs and symptoms of
Hypervolemia, hypokalemia, and hypernatremia.

B.
C.
D.
A.
B.
C.
D.
A.
B.
C.
D.
A.
B.
C.
D.
A.
B.
C.
D.
A.
B.
C.
D.
A.
B.
A.
B.
C.
A.
B.
C.
D.

A.
B.
C.
D.

Hypervolemia, hyperkalemia, and hypernatremia.

Hypovolemia, wide fluctuations in serum sodium and potassium levels.
Hypovolemia, no fluctuation in serum sodium and potassium levels.
31) _________ is the most frequent complication during hemodialysis.
hypertension
bleeding
Infection
Dialysis dementia
32) After 1 week a client with acute renal failure moves, into the diuretic phase. During this phase the client must be
carefully assessed for signs of:
Hypovolemia
Hyperkalemia
Metabolic acidosis
Chronic renal failure
33) What is the #1 cause of death when kidneys fail?
hyperkalemia
hypokalemia
hypernatremia
hyponatremia
34) The nurse is reviewing laboratory results on a client with acute renal failure. Which one of the following should be
reported IMMEDIATELY?
Blood urea nitrogen 50 mg/dl
Hemoglobin of 10.3 mg/dl
Venous blood pH 7.30
Serum potassium 6 mEq/L
35) When the kidneys have too few nephrons to excrete metabolic wastes and regulate fluid and electrolyte balance
adequately, the client is said to have ____________, the final stage of Chronic Renal Failure.
End-stage renal disease (ESRD)
renal insufficiency
acute tubular necrosis
dialysis
36) _________ renal Failure is a rapid decline in renal function with an abrupt onset
acute
chronic
37) How do kidneys control Na+ levels and K+ levels?
The kidneys release renin, which controls angiotensin. The angiotensin controls aldosterone.
Aldosterone controls the levels of Na+ and K+
Kidneys release aldosterone which controls renin. Renin causes the release of angiotensin.
Angiotensin controls the levels of Na+ and K+
The kidneys release renin which controls K+. The kidneys release angiotensin which causes
Na+ realease.
38) Anti-hypertensive therapy in patients with chronic renal disease is for?
Renal protection
Cardiovascular protection
Both renal and cardiovascular protection
None of the above
39) ____________ is a treatment for renal failure in which blood id continuously circulated (artery to vein or vein to
vein) and filtered, allowing excess water and solutes to empty into a collecting device. Fluid may be replaced with a
balanced electrolyte solution as needed during treatment.
Hemodialysis
Continuous ambulatory peritoneal dialysis
Continuous cyclic peritoneal dialysis
Continuous Renal Replacement Therapy
40) __________ failure is caused by obstruction of urine flow. (urethral obstruction by enlarged prostate or tumor;
ureteral or kidney pelvis obstruction by calculi)

A.
B.
C.
D.
A.
B.
C.
D.
A.
B.
C.
D.
A.
B.
C.
D.
A.
B.
C.
D.
E.

A.
B.
C.
D.
A.
B.
C.
D.
A.
B.
C.
D.

A.
B.
C.
D.

prerenal
intrarenal
postrenal
perirenal
41) Agents that damage the kidney tissue are called:
nephrons
nephrotoxins
antibodies
enterotoxins
42) Which phase of Acute Renal Failure results in FVE and edema due to salt and water retention, hypertension,
Azotemia, hyperkalemia, muscle weakness, nausea, diarrhea, and high serum creatinine and BUN levels?
initiation phase
maintenance phase
recovery phase
intrarenal phase
43) A patient rapidly progressing toward ESRD asks about the possibility of a kidney transplant. In responding to the
patient, the nurse knows that contraindications to kidney transplantation include
hepatitis C infection
extensive vascular disease
coronary artery disease
refractory hypertension
44) Which of the following medications does not interfere with either creatinine secretion or the assay used to
measure the serum creatinine?
Ibuprofen
Cimetidine
Trimethoprim
Cefoxitin
Flucytosine
45) A female client with acute renal failure is undergoing dialysis for the first time. The nurse in charge monitors the
client closely for dialysis equilibrium syndrome, a complication that is most common during the first few dialysis
sessions. Typically, dialysis equilibrium syndrome causes:
confusion, headache, and seizures.
acute bone pain and confusion.
weakness, tingling, and cardiac arrhythmias.
hypotension, tachycardia, and tachypnea.
46) Clients with chronic renal failure should notify the physician of any weight:
loss of 2 pounds over a 5 day period
gain of 2 pounds over a 2 day period
loss of 5 pounds over a 5 day period
gain of 5 pounds over a 2 day period
47) Nurse Tristan is caring for a male client in acute renal failure. The nurse should expect hypertonic glucose,
insulin infusions, and sodium bicarbonate to be used to treat:
hypernatremia.
hypokalemia.
hyperkalemia.
hypercalcemia.
48) The client with ESRD tells the nurse that she hates the thought of being tied to the machine, but is also glad to
start dialysis because she will be able to eat and drink what she wants. Based on this information, the nuse identifies
the nursing diagnosis of
self-esteem disturbance related to dependence on dialysis
anxiety related to perceived threat to health status and role functioning
ineffective management of therapeutic regimen related to lack of knowledge of treatment
plan
risk for imbalanced nutrition: more than body requirements, related to increased dietary
intake

A.
B.
C.
D.
A.
B.
C.
D.

A.
B.
C.
D.
A.
B.
A.
B.
C.
D.

A.
B.
C.
D.
A.
B.
C.
D.
A.
B.
C.
D.
A.
B.
C.
D.
A.
B.

49) How acidic is urine compared to blood?

100 times more acidic
200 times less acidic
1000 times more acidic
2000 times more acidic
50) Impaired metabolic processes such as Hyperkalemia, Acidosis, Hyperlipidemia, Hyperuricemia, and malnutrition
are some effects of ___________.
hematuria
oliguria
uremia
nephrotoxins
51) ________ failure is caused by Acute damage to renal tissue and nephrons or acute tubular necrosis: abrupt
decline in tubular and glomerular function due to either prolonged ischemia and/or exposure to nephrotoxins. (Acute
glomerulonephritis, malignant hypertension, ischemia; nephrotoxic drugs or substances; red blood cell destruction;
muscle tissue breakdown due to trauma, heatstroke)
Prerenal
Intrarenal
Postrenal
Perirenal
52) Common early manifestation of kidney disease are loss of concentration and dilute urine and loss of ability to
concentrate and dilute urine .
True
False
53) A client with acute renal failure is aware that the most serious complication of this condition is:
Constipation
Anemia
Infection
Platelet dysfunction
54) The nurse is performing an assessment on a client who has returned from the dialysis unit following
hemodialysis. The client is complaining of a headache and nausea and is extremely restless. Which of the following
is the most appropriate nursing action?
Notify the physician
Monitor the client
Elevate the head of the bed
Medicate the client for nausea
55) How much KCL do normal kidneys excrete each day?
6-8 g
1g
6-8 mg
3 mg
56) Clients on continuous ambulatory peritoneal dialysis (CAPD) must empty their peritoneal cavity and replace the
dialysate every __________ hours.
24
6-8
4-6
48
57) Which of these drugs is nephrotoxic?
Diuretics
ACE inhibitors
NSAIDs
Sodium bicarbonate/ Potassium bicarbonate
58) A client is admitted to the hospital and has a diagnosis of early stage chronic renal failure. Which of the following
would the nurse expect to note on assessment of the client?
Polyuria
Polydypsia

C.
D.

Oliguria
Anuria
59) A client on peritoneal dialysis notices that the collecting bag of dialysate is cloudy, what is this an indication of?
A.
The client needs to change their dialysate
B.
The patient needs a kidney transplant
C.
Medication was added to the dialysate
D.
The patient is infected and experiencing peritonitis
60) End-stage renal disease is defined as GFR less than ________________ ml/min per 1.73m2.
A.
45
B.
30
C.
15
D.
10
E.
5
61) During the _________ phase of Acute Renal Failure, Oliguria develops and the kidneys cannot efficiently
eliminate metabolic wastes, water, electrolytes, and acids.
A.
maintenance
B.
initiation
C.
recovery
62) What tests and results prove the presence of dilute urine?
A.
Fixed Specific Gravity (1.010), and/or Fixed osmolality (300 mOsm/l)
B.
GFR (100 ml/min), and/or Specific Gravity (1.030)
C.
Serum Creatinine (1.5 mg/dl)
63) Which of the following are abnormal to be found in the urine?
A.
K
B.
Amino acids
C.
Glucose
D.
all of the above
E.
Amino acids and glucose
64) ESRD occurs when the GFR is less than ___ per minute.
A.
5 ml
B.
10 ml
C.
15 ml
D.
25 ml
65) urine in the blood
A.
uremia
B.
uticaria
C.
urethritis
D.
urethrorrhea
Answers and Rationales
1.
A. prerenal
2.
E. All of the above
3.
D. creatinine cleatance
4.
A. Hypovolemia
5.
B. False . Creatinine, phosphate, sulfates, and uric acid should be found in urine.
6.
D. Serum potassium 6 mEq/L . Although all of these findings are abnormal, the elevated
potassium is a life threatening finding and must be reported immediately.
7.
A. Hourly urine output . After nephrectomy, it is necessary to measure urine output hourly.
This is done to assess the effectiveness of the remaining kidney also to detect renal failure early.
8.
A. Provide oral care every 3-4 hours . Providing oral care is within the scope of practice
for the nursing assistant. Monitoring and assessing clients, as well as administering IV fluids, require
the additional education and skill of the RN.
9.
B. Decrease
10.
C. hyperkalemia
11.
D. fluid overload
12.
A. Acute glomerulonephritis

13.
14.
15.
16.
17.
18.
19.
20.

21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
31.
32.
33.
34.
35.
36.
37.
38.
39.
40.
41.
42.
43.
44.
45.

Acute glomerulonephritis is also associated with varicella zoster virus, hepatitis B,

and Epstein-Barr virus.
Acute renal failure is associated with hypoperfusion to the kidney, parenchymal
damage to the glomeruli or tubules, and obstruction at a point distal to the kidney.
Chronic renal failure may be caused by systemic disease, hereditary lesions,
medications, toxic agents, infections, and medications.
Nephrotic syndrome is caused by disorders such as chronic glomerulonephritis,
systemic lupus erythematosus, multiple myeloma, and renal vein thrombosis.
D. diabetes Mellitus
A. acute tubular necrosis or tubular necrosis
A. antidiuretic hormone
A. H2O (Water)
C. 1-2 liters
C. 3
A. Renal Clearance/Creatinine Clearance
C. Limiting fluid intake . During the oliguric phase of ARF, urine output decreases
markedly, possibly leading to fluid overload. Limiting oral and I.V. fluid intake can prevent fluid
overload and its complications, such as heart failure and pulmonary edema. Encouraging coughing
and deep breathing is important for clients with various respiratory disorders. Promoting carbohydrate
intake may be helpful in ARF but doesnt take precedence over fluid limitation. Controlling pain isnt
important because ARF rarely causes pain.
D. 6-8 g
B. 5-20 mg/dL
B. limited
D. Ambulating the client in the room and hall for short distances
A. Hyponatremia . The normal serum sodium level is 135 145 mEq/L. The clients serum
sodium is below normal. Hyponatremia also manifests itself with abdominal cramps and nausea and
vomiting
A. 30
B. fever and painful transplant site
A. chronic
B. adequate calorie intake, high carbohydrate, limited protein
C. Hypovolemia, wide fluctuations in serum sodium and potassium levels. The
second phase of ARF is the diuretic phase or high output phase. The diuresis can result in an output of
up to 10L/day of dilute urine. Loss of fluids and electrolytes occur.
A. hypertension
A. Hypovolemia
A. hyperkalemia
D. Serum potassium 6 mEq/L. Although all of these findings are abnormal, the elevated
potassium is a life threatening finding and must be reported immediately.
A. End-stage renal disease (ESRD)
A. acute
A. The kidneys release renin, which controls angiotensin. The angiotensin controls
aldosterone. Aldosterone controls the levels of Na+ and K+
C. Both renal and cardiovascular protection
D. Continuous Renal Replacement Therapy
C. postrenal
B. nephrotoxins
B. maintenance phase
B. extensive vascular disease
A. Ibuprofen
A. confusion, headache, and seizures. Dialysis equilibrium syndrome causes confusion, a
decreasing level of consciousness, headache, and seizures. These findings, which may last several
days, probably result from a relative excess of interstitial or intracellular solutes caused by rapid

46.
47.

48.
49.
50.
51.

solute removal from the blood. The resultant organ swelling interferes with normal physiologic
functions. To prevent this syndrome, many dialysis centers keep first-time sessions short and use a
reduced blood flow rate. Acute bone pain and confusion are associated with aluminum intoxication,
another potential complication of dialysis. Weakness, tingling, and cardiac arrhythmias suggest
hyperkalemia, which is associated with renal failure. Hypotension, tachycardia, and tachypnea signal
hemorrhage, another dialysis complication.
D. gain of 5 pounds over a 2 day period
C. hyperkalemia. Hyperkalemia is a common complication of acute renal failure. Its lifethreatening if immediate action isnt taken to reverse it. The administration of glucose and regular
insulin, with sodium bicarbonate if necessary, can temporarily prevent cardiac arrest by moving
potassium into the cells and temporarily reducing serum potassium levels. Hypernatremia,
hypokalemia, and hypercalcemia dont usually occur with acute renal failure and arent treated with
glucose, insulin, or sodium bicarbonate.
C. ineffective management of therapeutic regimen related to lack of knowledge of
treatment plan
C. 1000 times more acidic
C. uremia
B. Intrarenal

52.
53.
54.
55.
56.
57.
58.
59.
60.
61.
62.
63.
64.
65.

A. True
C. Infection . Infection is responsible for one third of the traumatic or surgically induced
death of clients with renal failure as well as medical induced acute renal failure (ARF)
A. Notify the physician
A. 6-8 g
C. 4-6
C. NSAIDs
A. Polyuria
D. The patient is infected and experiencing peritonitis
C. 15
A. maintenance
A. Fixed Specific Gravity (1.010), and/or Fixed osmolality (300 mOsm/l)
E. Amino acids and glucose. Amino acids (proteins) found in the urine indicate trauma to
the glomeruli. Glucose found in the urine indicate BS levels to be above the renal threshold.
C. 15 ml
A. uremia