1. A client is started on lisinopril therapy.

Which assessment finding requires

immediate action?

1. Blood pressure 129/80 mm Hg.

2. Heart rate 100/min.
3. Serum creatinine 2.5 mg/dL (221 µmol/L).
4. Serum potassium 3.5 mEq/L (3.5 mmol/L).

2. A client with uncontrolled hypertension is prescribed clonidine. What

Instruction is most important for the clinic nurse to give this client?

1. Avoid consuming high-sodium foods.

2. Change positions slowly to prevent dizziness.
3. Don't stop taking this medication abruptly.
4. Use an oral moisturizer to relieve dry mouth.

3. A client with hypertension and type 2 diabetes has recently started taking
chlorthalldone. Which report by the client is most concerning to the nurse?
1. Dizziness on standing
2. Fasting blood glucose of 160 mg/dL (8.9 mmol/L)
3. Presence of muscle cramps
4. Sunburn on both arms

4. The nurse is assessing a client with hypertension and essential tremor 2

hours after receiving a first dose of propranolol. Which assessment is most
concerning to the nurse?
1. Client reports a headache.
2. Current blood pressure is 160/88 mm Hg.
3. Heart rate has dropped from 70/min to 60/min.
4. Slight wheezes auscultated during inspiration.
5. A client is being discharged after having a stent placed in the left anterior
descending coronary artery. The client is prescribed clopidogrel Which
client data obtained by the nurse would be concerning in relation to this
new medication? Select all that apply

1. Blood pressure of 120/84 mm Hg

2. Heart rate of 98/min
3. Platelet count of 200,000/mm³ (200 x 109/L)
4. Report of Ginkgo biloba use
5. Report of peptic ulcer disease

6. A client in the emergency department has an acute myocardial infarction.

The health care provider (HCP) has prescribed thrombolytic therapy. Which
assessment data should the nurse report immediately to the HCP?

1. Client has a history of Rheumatoid Arthritis

2. Client is currently menstruating
3. Client rates chest pain as 8 on a scale of 0-10
4. Client has uncontrolled Hypertension

7. The nurse is caring for a client who is taking an anticoagulant. The nurse
should teach the client to: 
a. report incidents of diarrhea.
b. avoid foods high in vitamin K.
c. use a straight razor when shaving. 
d. take aspirin for pain relief.

8. Side effects associated with adrenergic agonists are could include which of
the following
a. slowed heart rate.
b. constriction of the pupils.
c. hypertension.
d. increased gastrointestinal secretions.
9. side effects associated with the use of cholinergic drugs include *
a. constipation and insomnia.
b. diarrhea and urinary urgency.
c. tachycardia and hypertension.
d. dry mouth and tachycardia.

10. The nurse is caring for a 2-year-old who is refusing oral antibiotics. What is the nurse's next
action?

A. Ask the health care provider to switch to IV antibiotics

B. Hide the antibiotic in the child's favorite food or beverage
C. Offer the child a choice of orange or apple juice with the antibiotic
D. Tell the child that the medication tastes just like candy

11. A patient who is receiving a Dobutamine drug needs which of the following *
a. constant cardiac monitoring until stabilized.
b. frequent blood tests, including drug levels.
c. a combination of beta adrenergic blockers.
d. dietary changes to prevent irritation of the heart muscle.

12. ACE inhibitors work on the renin–angiotensin system to prevent the conversion of angiotensin I
to angiotensin II. Because this blocking occurs in the cells in the lung, which is usually the site of
this conversion, use of ACE inhibitors often results in *

a. spontaneous pneumothorax.

b. pneumonia.

c. unrelenting cough.

d. respiratory depression

13. A client with acute kidney injury has a serum potassium level of 7.0 mEq/L (7.0 mmol/L). The
nurse should plan which actions as a priority? Select all that apply.
1. Place the client on a cardiac monitor.
2. Notify the health care provider (HCP).
3. Put the client on NPO (nothing by mouth) status except for ice chips.
4. Review the client’s medications to determine if any contain or retain potassium.
5. Allow an extra 500 mL of intravenous fluid intake to dilute the electrolyte concentration.
 14. You are the admitting nurse for a patient with nephrotic syndrome. Which assessment finding
supports this diagnosis?
1. Edema formation
2. Hypotension
3. Increased urine output
4. Flank pain

15. A client has nephrotic syndrome. To aid in the resolution of the client's edema, the physician
prescribes 25% albumin. In addition to an absence of edema, the nurse should evaluate the
client for which expected outcome?
1. Crackles in the lung bases.
2. Blood pressure elevation.
3. Cerebral edema.
4. Cool skin temperature in lower extremities.

16. A child is admitted to the hospital with a diagnosis of nephrotic syndrome. The nurse reads the
child’s medical record and expects to note documentation of which manifestations of this
disorder? Select all that apply.
1. Edema
2. Proteinuria
3. Hypertension
4. Abdominal pain
5. Increased weight
6. Hypoalbuminemia

17. A UAP reports to you that a patient with acute kidney failure has had a urine output of 350 mL
over the past 24 hours after receiving furosemide 40 mg IV push. The UAP asks you how this can
happen. What is your best response?
1.“During the oliguric phase of acute kidney failure, patients often do not respond well to either fluid
challenges or diuretics.”
2.“There must be some sort of error. Someone must have failed to record the urine output.”
3.“A patient with acute kidney failure retains sodium and water, which counteracts the action of the
furosemide.”
4.“The gradual accumulation of nitrogenous waste products results in the retention of water and
sodium.”

18. The client is diagnosed with acute renal failure. The nurse assesses peripheral edema, increased
bounding pulses, and jugular vein distention. Which interventions should the nurse implement?
Select all that apply.
1. Administer intravenous diuretics.
2. Provide the client with a regular diet.
3. Place the client on strict intake and output (I&O).
4. Put the client on fluid restriction.
5. Weigh the client weekly in the same clothes.

19. The nurse has given instructions to the client with chronic kidney disease about reducing
pruritus from uremia. The nurse determines that the client needs further teaching if the client
states the intention to use which item for skin care?
1. Mild soap
2. Oil in the bath water
3. Lanolin-based lotion
4. Alcohol cleansing pads

20. The nurse plans care for a client diagnosed with Renal Failure. Which findings does the nurse
expect to find documented in the client’s medical record? Select all that apply.
1. Edema
2. Anemia
3. Polyuria
4. Bradycardia
5. Hypotension
6. Osteoporosis

21. A client has an arteriovenous (AV) fistula in place in the right upper extremity for hemodialysis
treatments. When planning care for this client, which measure should the nurse implement to
promote client safety?
1. Take blood pressures only on the right arm to ensure accuracy.
2. Use the fistula for all venipunctures and intravenous infusions.
3. Ensure that small clamps are attached to the AV fistula dressing.
4. Assess the fistula for the presence of a bruit and thrill every 4 hours.

22. A client with chronic kidney disease is about to begin hemodialysis therapy. The client asks the
nurse about the frequency and scheduling of hemodialysis treatments. What information should
the nurse supply to the client regarding the typical hemodialysis schedule?
1. It is 2 hours of treatment 6 days per week
2. It is 5 hours of treatment 2 days per week
3. It is 2 to 3 hours of treatment 5 days per week
4. It is 3 to 4 hours of treatment 3 days per week

23. A client with chronic kidney disease returns to the nursing unit after receiving his second
hemodialysis treatment; the nurse is monitoring the client closely for signs of disequilibrium
syndrome. What is a sign of this syndrome?
1 Irritability
2 Tachycardia
3 Hypothermia
4 Mental confusion

24. A hospitalized client with chronic kidney disease has returned to the nursing unit after a
hemodialysis treatment. The nurse should check predialysis and postdialysis documentation of
which parameters to determine the effectiveness of the procedure?
1 Blood pressure and weight
2 Weight and blood urea nitrogen
3 Potassium level and creatinine levels
4 Blood urea nitrogen and creatinine levels

25. A client has been admitted to the hospital with a diagnosis of acute glomerulonephritis.
During history taking, the nurse should ask the client about a recent history of which event?
1. Bleeding ulcer
2. Myocardial infarction
3. Deep vein thrombosis
4. Streptococcal infection

26. The nurse is reviewing the assessment findings and laboratory results of a child diagnosed with
new-onset glomerulonephritis. Which finding should the nurse most likely expect to note?
1 Hypotension
2 Tea-colored urine
3 Low serum potassium
4 Elevated creatinine levels

27. The nurse is preparing a plan of care for the client diagnosed with acute glomerulonephritis.
Which outcome would be a long-term goal for the client?
1. The client will maintain a BP of less than 160/90.
2. The client will maintain adequate renal functioning.
3. The client will have no white blood cells in the urine.
4. The client will have a urinary output of >30 mL/hr.

28. A 15-year-old has been diagnosed with acute glomerulonephritis and has been in the hospital
for 1 day. Which of the following findings requires immediate action?
1. Large amount of generalized edema.
2. Urine specific gravity of 1.030.
3. Large amount of albumin in the urine.
4. 24-hour output of 1,500 mL.

29. Which of the following meals would be most appropriate for a 15-year-old with
glomerulonephritis with severe hypertension?
1. Egg noodles, hamburger, canned peas, milk.
2. Baked ham, baked potato, pear, canned carrots, milk.
3. Baked chicken, rice, beans, orange juice.
4. Hot dog on a bun, corn chips, pickle, cookie, milk.

30. A 10-year-old with glomerulonephritis reports a headache and blurred vision. The nurse should
immediately:
1. Put the client to bed.
2. Obtain the child's blood pressure.
3. Notify the physician.
4. Administer acetaminophen (Tylenol).

31. A nurse is caring for a client with glomerulonephritis. What should the nurse instruct the client
to do to prevent recurrent attacks?
1. Take showers instead of tub baths.
2. Continue the same restrictions on fluid intake.
3. Avoid situations that involve physical activity.
4. Seek early treatment for respiratory tract infections.
 32. A nurse is caring for a client who is admitted with ureteral colic and hematuria. The client also
has stage 1 hypertension and is overweight. The decrease of which clinical indicator associated
with this client’s status should the nurse be most concerned about at this time?
1. Pain
2. Weight
3. Hematuria
4. Hypertension

33. Laboratory data reveal a calcium phosphate renal calculus in a client diagnosed with renal
calculi. Which statement indicates the client understands the discharge teaching?
1. “I am going to eat liver and organ meats only once a week.”
2. “I should drink at least two glasses of cranberry juice a day.”
3. “I must limit how much milk and dairy products consume.”
4. “I will urinate at least every 2 hours so I won’t develop a stone.”

34. The male client diagnosed with renal calculi is admitted to the medical unit from the emergency
department. Which nursing intervention should the nurse implement first?
1. Strain the client’s urine.
2. Give the client a urinal.
3. Encourage oral fluids.
4. Monitor the intake and output.

35. The client is being admitted to the hospital. Which clinical manifestations would the nurse
expect to assess for the client diagnosed with renal calculi in the kidney?
1. Dull, aching flank pain and microscopic hematuria.
2. Increased hunger and thirst and abdominal pain.
3. Gross hematuria and dull suprapubic pain with voiding.
4. Severe pain of 10 on a 1–10 pain scale when urinating.

36. The male client diagnosed with renal calculi is scheduled for a 24-hour urine specimen
collection. Which interventions should the nurse implement? Select all that apply.
1. Keep the client NPO during the 24-hour urine collection time.
2. Instruct the client to urinate and then discard this urine when starting collection.
3. Tell the client to urinate into the urinal at the bedside.
4. Insert an indwelling catheter in the client after having client empty bladder.
5. Place all the urine in the specific urine containers.

37. The client is diagnosed with uric acid calculi. Which foods should the client eliminate from the
diet to help prevent reoccurrence?
1. Red wine and colas.
2. Asparagus and cabbage.
3. Sweetbreads and ham.
4. Cheese and eggs.

38. A nurse is caring for a client with a ureteral calculus. Which are the most important nursing
actions? Select all that apply.
1. Limiting fluid intake at night
2. Monitoring intake and output
3. Straining the urine at each voiding
4. Recording the client’s blood pressure
5. Administering the prescribed analgesic

39. A client has a history of urolithiasis related to hyperuricemia. To prevent the formation of future
stones, the nurse instructs the client to avoid which food?
1. Liver
2. Carrots
3. White rice
4. Skim milk

40. A client with calcium oxalate renal calculi is told to limit dietary intake of oxalate. The nurse
provides the client with a list of foods high in oxalate and places which items on the list? Select
all that apply.
1. Beets
2. Spinach
3. Rhubarb
4. Black tea
5. Cantaloupe
6. Watermelon