Q.1 Which of the following is the most common cause of acute kidney injury (AKI) in critically ill patients?
Sepsis
Kidney stones
Polycystic kidney disease
Chronic hypertension
Explanation - Sepsis is the leading cause of AKI in critically ill patients due to systemic infection, inflammation, and hemodynamic instability leading to decreased renal perfusion.
Correct answer is: Sepsis
Q.2 What is the best initial nursing intervention for a patient with hyperkalemia due to renal failure?
Encourage oral fluids
Administer insulin and glucose as prescribed
Restrict sodium intake
Monitor temperature
Explanation - Insulin with glucose shifts potassium into cells, providing a rapid but temporary reduction in serum potassium, crucial in hyperkalemia management.
Correct answer is: Administer insulin and glucose as prescribed
Q.3 In chronic kidney disease, which electrolyte imbalance is most common?
Hypercalcemia
Hypokalemia
Hyperkalemia
Hypophosphatemia
Explanation - Hyperkalemia is common due to the kidney's inability to excrete potassium, leading to potentially life-threatening arrhythmias.
Correct answer is: Hyperkalemia
Q.4 Which of the following is a key indicator of fluid overload in a patient with renal dysfunction?
Dry mucous membranes
Edema and crackles in lungs
Weight loss
Hypotension
Explanation - Fluid overload manifests as edema and pulmonary congestion (crackles) due to reduced excretion of fluids in renal dysfunction.
Correct answer is: Edema and crackles in lungs
Q.5 During hemodialysis, which complication should a nurse monitor for most urgently?
Nausea
Hypotension
Mild headache
Pruritus
Explanation - Hypotension is the most urgent complication during dialysis, often caused by rapid fluid removal, requiring prompt nursing intervention.
Correct answer is: Hypotension
Q.6 Which diet modification is most appropriate for a patient with renal failure?
High protein, high potassium
Low protein, low potassium
High calcium, high phosphorus
Low fat, high sodium
Explanation - Low protein reduces nitrogenous waste, while low potassium prevents hyperkalemia in renal failure management.
Correct answer is: Low protein, low potassium
Q.7 Which diagnostic test best evaluates glomerular filtration rate (GFR)?
Serum creatinine
Blood urea nitrogen
Creatinine clearance test
Urine specific gravity
Explanation - Creatinine clearance is the best clinical estimate of GFR, reflecting kidney function more accurately than serum creatinine alone.
Correct answer is: Creatinine clearance test
Q.8 What is the primary nursing concern for a patient with end-stage renal disease awaiting dialysis?
Risk of constipation
Risk of infection
Risk of bleeding
Risk of hypoglycemia
Explanation - Patients with ESRD are highly immunocompromised and at risk for infections, especially related to dialysis access sites.
Correct answer is: Risk of infection
Q.9 Which type of dialysis can be performed at home by the patient?
Peritoneal dialysis
Hemodialysis
Continuous renal replacement therapy
Hemofiltration
Explanation - Peritoneal dialysis can be done at home as it uses the patient’s peritoneum as the filter, allowing independence in treatment.
Correct answer is: Peritoneal dialysis
Q.10 Why are patients with chronic renal failure often anemic?
Increased destruction of red blood cells
Deficiency of erythropoietin
Loss of blood in urine
Iron overload
Explanation - The kidneys produce erythropoietin, which stimulates RBC production. In renal failure, this hormone decreases, causing anemia.
Correct answer is: Deficiency of erythropoietin
Q.11 Which symptom is most characteristic of uremic syndrome?
Jaundice
Pruritus
Hypoglycemia
Weight gain
Explanation - Pruritus (itching) is a hallmark of uremic syndrome due to accumulation of uremic toxins and imbalances in calcium-phosphorus metabolism.
Correct answer is: Pruritus
Q.12 In a patient on dialysis, which laboratory value should be monitored most closely?
Calcium
Hemoglobin
Potassium
Chloride
Explanation - Serum potassium is critical to monitor in dialysis patients because hyperkalemia can cause fatal arrhythmias.
Correct answer is: Potassium
Q.13 What is the best nursing intervention to reduce the risk of infection in a patient with a dialysis catheter?
Apply warm compress
Use strict aseptic technique
Encourage fluid intake
Change position frequently
Explanation - Strict aseptic technique during catheter care prevents infection, which is a common complication in dialysis patients.
Correct answer is: Use strict aseptic technique
Q.14 Which medication is commonly given to manage anemia in chronic kidney disease?
Iron supplements
Erythropoiesis-stimulating agents
Vitamin B12 injections
Anticoagulants
Explanation - ESAs like epoetin alfa stimulate RBC production to treat anemia in chronic kidney disease.
Correct answer is: Erythropoiesis-stimulating agents
Q.15 A patient with renal dysfunction has metabolic acidosis. What is the cause?
Increased bicarbonate reabsorption
Retention of hydrogen ions
Excessive vomiting
Loss of CO2
Explanation - Kidneys fail to excrete hydrogen ions in renal dysfunction, leading to metabolic acidosis.
Correct answer is: Retention of hydrogen ions
Q.16 Which clinical sign indicates hypocalcemia in a patient with chronic renal failure?
Trousseau’s sign
Kussmaul’s respirations
Polyuria
Bradycardia
Explanation - Trousseau’s sign indicates hypocalcemia, common in chronic renal failure due to altered vitamin D metabolism.
Correct answer is: Trousseau’s sign
Q.17 Why are phosphate binders prescribed for patients with chronic kidney disease?
To lower calcium
To reduce phosphorus absorption
To increase urine output
To control potassium levels
Explanation - Phosphate binders prevent hyperphosphatemia by reducing dietary phosphate absorption in CKD patients.
Correct answer is: To reduce phosphorus absorption
Q.18 Which vital sign change is an early indication of fluid overload in renal failure?
Tachycardia
Bradycardia
Hypothermia
Tachypnea
Explanation - Tachycardia is an early compensatory response to increased fluid volume and decreased oxygen delivery.
Correct answer is: Tachycardia
Q.19 Which urine output value indicates oliguria in adults?
< 30 ml/hr
< 100 ml/hr
< 400 ml/day
< 500 ml/day
Explanation - Oliguria is defined as urine output less than 400 ml/day in adults, indicating impaired kidney function.
Correct answer is: < 400 ml/day
Q.20 In peritoneal dialysis, cloudy dialysate drainage is a sign of:
Peritonitis
Dialysis adequacy
Hyperkalemia
Catheter obstruction
Explanation - Cloudy dialysate drainage indicates peritonitis, a serious complication of peritoneal dialysis.
Correct answer is: Peritonitis
Q.21 Which of the following medications must be used cautiously in renal failure due to nephrotoxicity?
Acetaminophen
NSAIDs
Insulin
Beta-blockers
Explanation - NSAIDs reduce renal blood flow and can worsen kidney function, so they must be used cautiously in renal failure.
Correct answer is: NSAIDs
Q.22 Which complication is associated with long-term hemodialysis?
Renal stone formation
Dialysis disequilibrium syndrome
Amyloidosis
Liver cirrhosis
Explanation - Long-term hemodialysis can cause beta-2 microglobulin amyloidosis, leading to joint and bone problems.
Correct answer is: Amyloidosis
Q.23 Why are fluid restrictions necessary for patients with renal dysfunction?
To prevent dehydration
To reduce edema and hypertension
To increase urine output
To promote appetite
Explanation - Fluid restriction helps control fluid overload, reducing edema and hypertension in renal patients.
Correct answer is: To reduce edema and hypertension
Q.24 Which lab test best reflects kidney’s ability to excrete waste products?
Serum creatinine
Hemoglobin
Blood glucose
Cholesterol
Explanation - Serum creatinine levels rise when kidneys fail to excrete waste, making it a key indicator of renal function.
Correct answer is: Serum creatinine
Q.25 A patient with AKI is on strict input-output monitoring. What finding requires immediate reporting?
Urine output of 50 ml/hr
Urine output of 20 ml/hr
Intake of 1500 ml/day
Weight gain of 0.5 kg
Explanation - Urine output less than 30 ml/hr indicates impaired renal perfusion or worsening AKI and must be reported immediately.
Correct answer is: Urine output of 20 ml/hr