Category 1
A client with stage 4 chronic kidney disease (CKD) is prescribed calcitriol. Which statement by the client indicates an understanding of why this medication is prescribed?
A. “It will help my kidneys remove excess phosphorus from my blood.”
B. “It will increase my calcium absorption and help prevent bone problems.”
C. “It will increase my red blood cell production and treat my anemia.”
D. “It will help my kidneys excrete excess potassium.”
Correct Answer: B
Rationale: In CKD, the kidneys have decreased ability to convert vitamin D to its active form. Calcitriol is active vitamin D, which increases intestinal calcium absorption and helps maintain calcium balance and bone health. CKD can cause hypocalcemia and secondary hyperparathyroidism, contributing to renal bone disease.
Quick memory:
CKD → ↓ active vitamin D → ↓ calcium absorption → ↑ PTH → bone problems
Calcitriol → active vitamin D → ↑ calcium absorption → protects bones
A client with chronic kidney disease (CKD) has a potassium level of 6.2 mEq/L. Which is the priority nursing action?
A. Administer sodium polystyrene sulfonate (Kayexalate) as prescribed
B. Place the client on a low-potassium diet
C. Notify the provider immediately
D. Recheck potassium in 6 hours
Answer: C
Rationale: Hyperkalemia >6 mEq/L is life-threatening due to risk of arrhythmia. Immediate provider notification is required for urgent intervention
A client who had a urostomy 5 days ago calls the nurse because the urine in the pouch has changed. Which finding requires the nurse to instruct the client to seek immediate medical evaluation?
A. The stoma appears moist and pink-red, with a small amount of mucus in the urine.
B. The urine has a mild mucus-like appearance and the client reports mild abdominal discomfort.
C. The stoma has become dusky purple, and the client reports increasing abdominal pain and decreased urine output.
D. The urine is slightly cloudy, and the client reports occasional mucus strands in the pouch.
Correct Answer: C
Rationale: A healthy urostomy stoma should be moist and pink to red. A dusky, purple, brown, gray, or black stoma suggests impaired blood supply and possible ischemia/necrosis, which is a surgical emergency. The combination of stoma color change + decreasing urine output + increasing pain makes this particularly concerning.
A nurse is assessing four clients with adrenal disorders. Which client should the nurse assess first?
A. A client with Cushing syndrome who has a blood pressure of 168/94 mm Hg, blood glucose of 212 mg/dL, and reports easy bruising.
B. A client with Addison’s disease who has BP 82/48 mm Hg, HR 124/min, severe weakness, and potassium of 6.1 mEq/L.
C. A client with Cushing syndrome who has thin extremities, central obesity, and purple abdominal striae.
D. A client with Addison’s disease who reports increased skin pigmentation, fatigue, and a craving for salty foods.
Correct Answer: B
Rationale: The client with Addison’s disease is showing signs of a possible Addisonian crisis, which can cause severe hypotension, hypovolemic shock, hyperkalemia, and cardiovascular collapse. This client requires immediate intervention.
A client with primary hypothyroidism is prescribed levothyroxine. Which statement by the client indicates a need for additional teaching?
A. “I will take this medication in the morning on an empty stomach.”
B. “I will take my calcium supplement at the same time as my levothyroxine so I don't forget it.”
C. “I should have my thyroid blood tests checked as recommended by my provider.”
D. “I should report a rapid heartbeat, tremors, or unusual nervousness to my healthcare provider.”
Correct Answer: B
Rationale:
A client with type 1 diabetes is admitted with DKA. Assessment findings include:
Which action should the nurse anticipate first?
A. Administer IV regular insulin infusion.
B. Administer IV potassium replacement.
C. Administer an isotonic IV fluid bolus.
D. Administer IV sodium bicarbonate.
Correct Answer: C. Administer an isotonic IV fluid bolus.
DKA → severe hyperglycemia → osmotic diuresis → massive fluid loss → hypovolemia → ↓ tissue perfusion
Which are common complications of CKD? (Select all that apply.)
A. Anemia
B. Hyperkalemia
C. Hypocalcemia
D. Fluid overload
E. Hypernatremia
Answer: A, B, C, D
Rationale: CKD causes anemia, electrolyte imbalances (high K⁺, low Ca²⁺), and fluid overload. Sodium is usually normal or slightly elevated.
A client with open-angle glaucoma is prescribed timolol ophthalmic drops. At a follow-up visit, which finding should the nurse recognize as the most concerning and report to the provider?
A. The client reports mild burning immediately after instilling the drops.
B. The client reports that vision is becoming progressively more difficult to see in the peripheral fields.
C. The client reports seeing halos around lights and experiencing severe eye pain with nausea and vomiting.
D. The client reports mild redness of the eye after administering the medication.
Correct Answer: C.
Rationale: Severe eye pain + halos around lights + nausea/vomiting suggests acute angle-closure glaucoma, caused by a rapid increase in intraocular pressure (IOP). This is an ocular emergency because prolonged elevation of IOP can cause permanent optic nerve damage and vision loss.
A nurse is providing discharge teaching to a client who is returning home after cataract surgery. Which statements by the client indicate correct understanding of the postoperative instructions? Select all that apply.
A. “I will avoid bending, straining, and lifting heavy objects until my provider tells me it is safe.”
B. “If my eye feels itchy, I can gently rub it as long as I wash my hands first.”
C. “I will wear the prescribed eye shield at night to protect my eye while I sleep.”
D. “I will immediately report severe eye pain, sudden vision loss, or a sudden increase in floaters or flashes.”
E. “I will wear sunglasses outdoors to reduce glare and protect my healing eye from bright light.”
F. “If my vision improves, I can stop using the prescribed eye drops.”
G. “I can resume strenuous exercise as soon as I feel comfortable after surgery.”
Correct Answers: A, C, D, E
A client with type 1 diabetes uses a basal-bolus insulin regimen. The client takes insulin glargine once daily and insulin lispro with meals. The client tells the nurse:
“I’m not eating breakfast today because I feel nauseated, so I’m going to skip my morning insulin.”
Which response by the nurse is most appropriate?
A. “Skip both insulins because you are not eating.”
B. “Take the insulin lispro anyway because mealtime insulin should never be withheld.”
C. “Your basal insulin should generally continue even when you are not eating, but your mealtime insulin may need to be adjusted based on your blood glucose and your provider’s sick-day instructions.”
D. “Skip the glargine and take the lispro after you eat lunch.”
Correct Answer: C
Rationale:
Which task should the RN perform personally rather than delegate?
A. Monitor urine output on stable post-op client
B. Teach insulin administration to newly diagnosed diabetes
C. Assist with ambulation
D. Obtain vital signs
Answer: B
Rationale: Teaching requires RN knowledge and assessment of understanding. Other tasks can be delegated.
A client with acute kidney injury has urine output of 25 mL over the last 2 hours and BP 85/50 mmHg. Which is the priority intervention?
A. Obtain urinalysis.
B. Restrict potassium intake
C. Prepare for dialysis
D. Administer IV fluids
Answer: D
Rationale: Hypotension with oliguria indicates prerenal AKI. Restoring perfusion with IV fluids is first priority.
A client with diabetic retinopathy is receiving discharge instructions about preventing further vision loss. Which statement by the client indicates a need for additional teaching?
A. “I will keep my blood glucose within my target range to help prevent further damage to my eyes.”
B. “I will have regular dilated eye examinations even if my vision seems normal.”
C. “I should control my blood pressure because high blood pressure can worsen diabetic retinopathy.”
D. “If my vision is not blurry or painful, I don't need to worry about my retinopathy getting worse.”
Correct Answer: D
Rationale: Diabetic retinopathy can progress without noticeable symptoms, especially in its early stages. A client should continue regular ophthalmologic examinations even when vision appears normal. Waiting until vision becomes blurry can allow significant retinal damage to occur.
A client on hemodialysis presents with muscle cramps, hypotension, and K⁺ 3.2 mEq/L. Which is the priority intervention?
A. Administer IV fluids
B. Administer potassium supplement
C. Hold next dialysis session
D. Notify provider
Answer: B
Rationale: Hypokalemia can cause arrhythmias and muscle weakness. Rapid replacement is needed.
A nurse is reviewing assessment findings for clients with thyroid disorders. Which findings are consistent with hyperthyroidism? Select all that apply.
A. Heat intolerance and excessive sweating
B. Bradycardia
C. Weight loss despite an increased appetite
D. Constipation
E. Tremors and nervousness
F. Cold intolerance
G. Frequent bowel movements
H. Fatigue and slowed thinking
Correct Answers: A, C, E, G
Rationales:
A nurse is assessing a client with type 2 diabetes mellitus during a routine follow-up visit. Which finding is most concerning and requires the nurse to intervene first?
A. Reports numbness and tingling in both feet
B. Reports blurred vision that has gradually worsened over the past year
C. Has a small, painless ulcer on the plantar surface of the foot
D. Reports new-onset dysphasia and difficulty speaking
Correct Answer: D. Reports new-onset dysphasia and difficulty speaking.
Rationale: New-onset dysphasia (difficulty speaking or understanding language) can indicate an acute stroke. A client with diabetes has an increased risk for cerebrovascular disease, so this finding requires immediate assessment and intervention.
A client receiving hemodialysis develops sudden chest pain, dyspnea, and hypotension. What is the priority action?
A. Document the episode
B. Administer prescribed antihypertensive
C. Reposition supine and elevate legs
D. Stop dialysis and notify the provider
Answer: D
Rationale: Sudden hypotension and chest pain indicate dialysis-related complication (air embolism, hypotension). Stop dialysis immediately.
A nurse is assessing an 82-year-old client who reports increasing difficulty hearing conversations and seeing clearly in dimly lit areas. The client uses reading glasses and a hearing aid. Which intervention is most important for reducing this client's risk for falls?
A. Encourage the client to use the hearing aid only when communicating with others.
B. Keep the client's room brightly illuminated and remove clutter and loose rugs from walking paths.
C. Encourage the client to avoid walking independently because sensory changes make falls unavoidable.
D. Place frequently used items on high shelves so the client does not need to bend down to retrieve them.
Correct Answer: B
Rationale: Aging commonly causes decreased visual acuity, reduced ability to see in low light, slower adaptation to changes in lighting, and hearing loss. These sensory changes can impair environmental awareness and increase fall risk. Adequate lighting and removal of environmental hazards are key fall-prevention strategies.
Which are priority actions for a client undergoing peritoneal dialysis? (Select all that apply.)
A. Monitor for cloudy effluent
B. Keep catheter site sterile
C. Encourage ambulation immediately post-dialysis
D. Record input and output accurately
E. Warm dialysate before infusion
Answer: A, B, D, E
Rationale: Preventing infection and monitoring fluid balance is essential. Ambulation is limited initially.
Which medication is contraindicated in a client with CKD and hyperkalemia?
A. Furosemide
B. Lisinopril
C. Calcium carbonate
D. Erythropoietin
Answer: B
Rationale: ACE inhibitors (like lisinopril) increase potassium, worsening hyperkalemia.
Which factors increase risk for ischemic stroke? (Select all that apply.)
A. Hypertension
B. Diabetes
C. Atrial fibrillation
D. Smoking
E. Hypotension
Answer: A, B, C, D
Rationale: Stroke risk is increased by HTN, DM, AFib, and smoking. Hypotension is not a primary risk factor.
A 64-year-old female with end-stage renal disease (ESRD) on hemodialysis presents to the clinic with complaints of muscle cramps and itching. Laboratory results reveal:
Phosphorus: 6.8 mg/dL (elevated)
Calcium: 7.9 mg/dL (low)
Creatinine: elevated
PTH: elevated
The provider diagnoses hyperphosphatemia related to chronic kidney disease.
Which intervention should the nurse prioritize in managing this patient’s condition?
A. Administer IV calcium gluconate immediately
B. Encourage increased intake of dairy products
C. Administer Sevelamer with meals
D. Restrict potassium-rich foods
Correct Answer: C. Administer Sevelamer with meals. Rationale: In chronic kidney disease, the kidneys cannot excrete phosphorus effectively, leading to:
Hyperphosphatemia
Hypocalcemia (phosphorus binds calcium)
Secondary hyperparathyroidism
Bone demineralization
Pruritus
Phosphate binders (such as calcium acetate or sevelamer) are given with meals to:
Bind dietary phosphorus in the gut
Prevent absorption
Lower serum phosphate levels
Why the Other Options Are Incorrect:
A. IV calcium gluconate
Used for symptomatic hypocalcemia or cardiac instability — not routine phosphate control.
B. Increase dairy
Dairy is high in phosphorus and would worsen the problem.
D. Restrict potassium
Important in CKD, but does not address hyperphosphatemia.
An 80-year-old client with Ménière’s disease is prescribed meclizine for episodes of vertigo. Which finding requires the nurse to intervene first?
A. The client reports mild dry mouth after taking the medication.
B. The client reports feeling sleepy and nearly fell while walking to the bathroom.
C. The client reports that nausea has improved since starting the medication.
D. The client reports that episodes of vertigo are occurring less frequently.
Correct Answer: B
Rationale: Meclizine can cause drowsiness, dizziness, and impaired coordination, which can significantly increase fall risk, particularly in older adults who may already have impaired balance from Ménière’s disease. A client who is nearly falling requires immediate attention and fall-prevention measures.
A nurse enters a client’s room and finds the client barely responsive to verbal stimuli. The client’s blood glucose is 38 mg/dL (2.1 mmol/L). Which action should the nurse take first?
A. Give the client 4 oz (120 mL) of fruit juice.
B. Administer IV dextrose or glucagon according to available access and protocol.
C. Recheck the blood glucose level in 15 minutes before initiating treatment.
D. Give the client glucose tablets and encourage them to chew and swallow.
Correct Answer: B
Key point: A barely responsive client cannot safely swallow. Do not give anything by mouth because of the risk for aspiration. Severe hypoglycemia requires rapid treatment with IV dextrose or glucagon
A client with CKD and ascites reports confusion, decreased urine output, and low BP. Which actions are priority? (Select all that apply.)
A. Assess vital signs and level of consciousness
B. Notify provider immediately
C. Administer prescribed diuretic
D. Prepare for IV fluid resuscitation
E. Document findings
Answer: A, B, D
Rationale: Hypotension, confusion, and oliguria indicate shock/AKI. Immediate assessment and provider notification are priority; diuretics could worsen hypotension.