Pance Renal System - Final Test Review (Qns & Ans) - 2025, Exams of Nursing

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Renal System

Final Test Review

(Questions & Solutions)

I. Acid–Base Disorders (Questions 1–6)

1. A 68-year-old with COPD exacerbation develops acute hypercapnia. ABG: pH 7.25, PaCO₂ 65 mm Hg, HCO₃⁻ 26 mEq/L. What is the primary disorder? A) Acute respiratory acidosis B) Chronic respiratory acidosis C) Metabolic acidosis D) Metabolic alkalosis ANS: A Rationale: pH low with elevated PaCO₂ and near‐normal HCO₃⁻ indicates acute respiratory acidosis.
2. A 45-year-old diabetic in DKA has pH 7.10, PaCO₂ 28 mm Hg, HCO₃⁻ 8 mEq/L. Which best describes this ABG? A) Primary metabolic acidosis with respiratory compensation B) Primary respiratory alkalosis C) Primary metabolic alkalosis D) Mixed respiratory and metabolic acidosis ANS: A Rationale: Low pH with low HCO₃⁻ and compensatory low PaCO₂ indicates primary metabolic acidosis.
3. A patient on high‐dose loop diuretics has pH 7.50, PaCO₂ 48 mm Hg, HCO₃⁻ 38 mEq/L. Primary disorder? A) Metabolic alkalosis B) Respiratory alkalosis C) Metabolic acidosis D) Respiratory acidosis ANS: A Rationale: Alkalemic pH with high HCO₃⁻ and elevated PaCO₂ (compensation) indicates metabolic alkalosis.
4. A woman with panic attacks has pH 7.55, PaCO₂ 28 mm Hg, HCO₃⁻ 24

D) Glomerulonephritis ANS: A Rationale: FeNa < 1% indicates prerenal azotemia due to reduced renal perfusion.

8. A hospitalized patient with bladder catheter has creatinine jump and bladder ultrasound shows bilateral hydroureter. Diagnosis? A) Postrenal AKI B) Prerenal AKI C) ATN D) Interstitial nephritis ANS: A Rationale: Obstruction at bladder leads to postrenal AKI; bilateral hydronephrosis confirms.
9. A septic ICU patient on aminoglycosides develops muddy brown casts and FeNa >2%. Diagnosis? A) Acute tubular necrosis B) Prerenal AKI C) Obstructive AKI D) Minimal change disease ANS: A Rationale: Muddy brown casts and FeNa >2% indicate intrinsic ATN from nephrotoxins.
10. A patient with acute interstitial nephritis from antibiotics has eosinophiluria, rash, and fever. Best initial step? A) Discontinue offending drug B) IV high‐dose steroids immediately C) Hemodialysis D) Increase antibiotic dose ANS: A Rationale: Stop the causative agent first; steroids if no recovery.
11. A burn patient with volume resuscitation develops oliguria and

BUN:Cr ratio 10:1. Most likely AKI type? A) Intrinsic (ATN) B) Prerenal C) Postrenal D) GN ANS: A Rationale: BUN:Cr ~10:1 suggests intrinsic renal damage, common in severe burns.

12. Contrast‐induced AKI prevention includes: A) IV isotonic saline B) N‐acetylcysteine alone C) Loop diuretics D) High‐protein diet ANS: A Rationale: IV saline before/after contrast reduces nephrotoxicity. III. Chronic Kidney Disease/ESRD (Questions 13–18)
13. A diabetic with GFR 45 mL/min has stage 3 CKD. Next lab to monitor mineral bone disease? A) Serum phosphorus, calcium, and PTH B) LFTs C) TSH D) Fasting glucose ANS: A Rationale: CKD‐MBD monitored via Ca, P, and PTH.
14. A CKD stage 5 patient on HD has persistent hyperphosphatemia despite binders. Next add? A) Sevelamer B) Calcium supplements C) Loop diuretic D) Thiazide ANS: A Rationale: Non‐calcium phosphate binders like sevelamer reduce

Rationale: ESA targets 10–11.5 g/dL to minimize cardiovascular risks. IV. Congenital/Structural Renal Disorders (Questions 19–23)

19. A prenatal ultrasound shows bilateral enlarged echogenic kidneys with loss of corticomedullary differentiation. Postnatal oliguria. Likely? A) Autosomal recessive polycystic kidney disease B) Multicystic dysplastic kidney C) Simple renal cysts D) ARPKD ANS: A Rationale: ARPKD presents prenatally with enlarged echogenic kidneys and neonatal renal failure.
20. A 6-month-old with recurrent UTIs is found to have hydroureteronephrosis on VCUG. Diagnosis? A) Vesicoureteral reflux B) UPJ obstruction C) Prune belly syndrome D) Posterior urethral valves ANS: A Rationale: VUR leads to reflux of urine causing hydronephrosis and UTIs in infants.
21. A 2-year-old with hematuria and flank pain has 3-cm unilateral renal cysts; parents unaffected. Most likely? A) Autosomal dominant polycystic kidney disease B) Multicystic dysplastic kidney C) Simple cyst D) ARPKD ANS: A Rationale: ADPKD can present in childhood with bilateral cysts; unilateral cysts suggest simple cyst but flank pain suggests ADPKD.
22. A 15-year-old with hypertension and a bruit over the right flank. Renal artery US shows narrowing. Likely diagnosis?

A) Fibromuscular dysplasia B) Atherosclerosis C) Polycystic kidney disease D) Nephroblastoma ANS: A Rationale: Young females with flank bruit and hypertension often have fibromuscular dysplasia.

23. Multicystic dysplastic kidney is characterized by: A) Nonfunctioning kidney replaced by cysts, often unilateral B) Bilateral ARPKD C) Adult ADPKD D) Medullary sponge kidney ANS: A Rationale: MCDK is a congenital nonfunctional kidney replaced by multiple cysts, usually unilateral. V. Electrolyte Disorders (Questions 24–29)
24. A CHF patient on loop diuretics develops muscle cramps, weakness, and U-wave on ECG. K⁺ is 2.8 mEq/L. Next step? A) IV potassium replacement B) Spironolactone C) Increase furosemide D) Sodium bicarbonate ANS: A Rationale: Severe hypokalemia with ECG changes needs urgent IV K⁺ replacement.
25. A dialysis patient has serum K⁺ 7.0 mEq/L and peaked T waves. Immediate therapy? A) IV calcium gluconate B) Oral kayexalate C) IV insulin + glucose D) IV furosemide ANS: A

A) Fluid restriction B) IV hypotonic fluids C) High‐dose saline bolus D) Thiazide diuretics ANS: A Rationale: Volume‐expanded hyponatremia in CHF is managed with fluid restriction and diuretics. VI. Fluid Imbalances (Questions 30–34)

30. A 70-year-old with vomiting and diarrhea has BP 85/60, HR 120, skin turgor decreased. Initial management? A) IV isotonic saline bolus B) Oral rehydration only C) D5W infusion D) Hypertonic saline ANS: A Rationale: Hypovolemic shock requires rapid isotonic crystalloid resuscitation.
31. A cirrhotic patient has ascites and edema with low serum albumin. Primary pathology? A) Decreased oncotic pressure B) Increased capillary oncotic pressure C) Hypovolemia D) SIADH ANS: A Rationale: Hypoalbuminemia reduces plasma oncotic pressure, favoring fluid extravasation.
32. A burn patient with 50% TBSA has 4 mL/kg × %TBSA crystalloid in first 24 hrs; half in first 8 hrs. Formula? A) Parkland formula B) Ringer‐Gallon formula C) Colloid replacement formula D) Holliday–Segar formula

ANS: A

Rationale: Parkland (4 mL/kg/%TBSA) guides burn fluid resuscitation.

33. A hyponatremic patient with seizure—Na⁺ 115 mEq/L. Best immediate therapy? A) Hypertonic saline B) Oral water restriction C) Loop diuretics D) D5W ANS: A Rationale: Severe symptomatic hyponatremia requires careful hypertonic saline to raise Na⁺ and reduce cerebral edema.
34. A 60-year-old with pancreatitis is NPO and hypotensive. Which maintenance fluid is optimal? A) Lactated Ringer’s B) D5W C) 0.45% saline D) NS + KCl + D ANS: A Rationale: Balanced crystalloids (LR) closely match plasma and correct hypovolemia in acute settings. VII. Neoplasms (Questions 35–40)
35. A 55-year-old smoker has painless hematuria. CT urography reveals a 3 - cm enhancing renal mass. Next management? A) Partial nephrectomy B) Radical nephrectomy C) Biopsy only D) Observation ANS: A Rationale: Small (<4 cm) RCC is managed with nephron-sparing partial nephrectomy when feasible.
36. A 10-year-old with abdominal mass, hematuria, and WT1 mutation.

Rationale: Dialysis‐associated cystic changes increase RCC risk.

40. A patient with FH of Lynch syndrome has early onset colon and renal cancers. Genetics? A) DNA mismatch repair gene mutation B) VHL mutation C) BRCA D) TSC ANS: A Rationale: Lynch syndrome involves MMR mutations predisposing to colon and renal malignancies.

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Acid-Base Disorders A 60-year-old male with COPD presents with confusion and headache. ABG: pH 7.28, PaCO₂ 56 mmHg, HCO₃⁻ 25 mEq/L. What is the most likely acid-base disturbance? A) Metabolic alkalosis B) Respiratory acidosis C) Metabolic acidosis D) Respiratory alkalosis ANS: B Rationale: The pH is low (acidosis), PaCO₂ is high (respiratory), HCO₃⁻ is normal. This is respiratory acidosis. A diabetic patient with Kussmaul respirations has lab values: pH 7.10, PaCO₂ 22 mmHg, HCO₃⁻ 8 mEq/L. Which is the primary disorder? A) Respiratory acidosis B) Metabolic acidosis C) Metabolic alkalosis D) Respiratory alkalosis ANS: B Rationale: The low HCO₃⁻ and low pH suggest metabolic acidosis, with compensatory decrease in PaCO₂.

Which of the following is LEAST likely to cause a normal anion gap metabolic acidosis? A) Diarrhea B) Renal tubular acidosis C) Lactic acidosis D) Carbonic anhydrase inhibitor use ANS: C Rationale: Lactic acidosis causes an increased anion gap; the others cause normal anion gap (hyperchloremic) acidosis. A patient with vomiting for 3 days develops pH 7.50, HCO₃⁻ 36 mEq/L, PaCO₂ 46 mmHg. What is the most probable diagnosis? A) Metabolic alkalosis B) Metabolic acidosis C) Respiratory acidosis D) Respiratory alkalosis ANS: A Rationale: Increased pH and HCO₃⁻ indicates metabolic alkalosis; PaCO₂ is elevated as a compensatory response. Which compensatory change would be expected in a patient with chronic respiratory alkalosis? A) Increased renal generation of HCO₃⁻ B) Increased renal excretion of HCO₃⁻ C) Decreased respiratory rate D) Renal retention of hydrogen ions ANS: B Rationale: Kidney will excrete more bicarbonate (HCO₃⁻) to compensate for respiratory alkalosis. Acute Kidney Injury (AKI) / Acute Renal Failure A 70-year-old man with heart failure develops decreased urine output, BUN/creatinine ratio 35:1, and FENa <1%. What is the most likely cause of his AKI?

to 4.0 mg/dL after IV fluids. His urine is brown. What is the probable etiology? A) Acute glomerulonephritis B) Rhabdomyolysis-induced ATN C) Prerenal azotemia D) Acute interstitial nephritis ANS: B Rationale: Brown urine after exertion indicates myoglobinuria from rhabdomyolysis leading to ATN. Chronic Kidney Disease (CKD) / End-stage Renal Disease (ESRD) Which electrolyte abnormality is MOST characteristic of advanced CKD? A) Hypophosphatemia B) Hypercalcemia C) Hyperphosphatemia D) Hyperaldosteronism ANS: C Rationale: Reduced phosphate excretion in CKD leads to hyperphosphatemia. A CKD patient presents with normocytic anemia. What is the most likely cause? A) Iron deficiency B) Vitamin B12 deficiency C) Erythropoietin deficiency D) Hemolysis ANS: C Rationale: EPO is produced by the kidney; deficiency causes normocytic anemia. A 58-year-old diabetic has proteinuria and declining GFR. Renal biopsy shows Kimmelstiel-Wilson nodules. What is the diagnosis? A) FSGS B) Diabetic nephropathy C) Minimal change disease

D) Amyloidosis ANS: B Rationale: Kimmelstiel-Wilson nodules are pathognomonic for diabetic nephropathy. Which is a recommended dietary modification for a patient with ESRD on dialysis? A) Increased potassium intake B) Increased phosphorus intake C) Restricted protein intake D) Restricted sodium intake ANS: D Rationale: Sodium restriction is essential to manage fluid overload and hypertension. Which of the following is NOT an indication for initiation of renal replacement therapy in CKD? A) Uremic encephalopathy B) Severe hyperkalemia C) GFR <60 mL/min alone D) Volume overload unresponsive to diuretics ANS: C Rationale: Dialysis is indicated by symptoms or severe complications, not by GFR alone unless <15 mL/min. Congenital or Structural Renal Disorders A neonate with a palpable abdominal mass and hypertension is diagnosed with bilateral enlarged, cystic kidneys. What is the most likely diagnosis? A) Multicystic dysplastic kidney B) Autosomal recessive polycystic kidney disease C) Horseshoe kidney D) Renal agenesis ANS: B Rationale: Bilateral cystic kidneys and early presentation suggest ARPKD.

D) NPHS

ANS: B

Rationale: COL4A5 mutations cause Alport syndrome (hearing, eyes, hematuria). Electrolyte Disorders Rapid correction of chronic hyponatremia is most likely to result in which complication? A) Hyperkalemia B) Pulmonary edema C) Central pontine myelinolysis D) Nephrogenic diabetes insipidus ANS: C Rationale: Rapid sodium correction can cause osmotic demyelination syndrome. A patient presents with muscle weakness, peaked T waves, and new ECG changes. What is the first-line acute management? A) Loop diuretic administration B) Intravenous calcium gluconate C) Kayexalate D) Beta-2 agonist inhalation ANS: B Rationale: IV calcium stabilizes cardiac membranes in acute hyperkalemia. Which of the following causes hypokalemia via increased renal potassium wasting? A) Addison's disease B) Liddle syndrome C) Primary hyperaldosteronism D) ACE inhibitor therapy ANS: C Rationale: Aldosterone increases renal K+ excretion.

Which laboratory finding is most consistent with SIADH? A) Decreased plasma ADH B) Plasma osmolality <275 mOsm/kg, urine osmolality >100 mOsm/kg C) Hyperkalemia D) Hypocalcemia ANS: B Rationale: SIADH has low plasma osmolality and inappropriately concentrated urine. Which electrolyte abnormality is common in tumor lysis syndrome? A) Hypophosphatemia B) Hyperkalemia C) Hypouricemia D) Hypocalcemia ANS: B Rationale: Rapid cell lysis releases intracellular potassium. Fluid Imbalances A patient with cirrhosis and ascites is most prone to which type of fluid imbalance? A) Hypervolemic hypotonic hyponatremia B) Hypovolemic hypernatremia C) Isovolemic hypernatremia D) Hypovolemic hyponatremia ANS: A Rationale: Cirrhotics retain water, increasing total body water (hypervolemia) and diluting sodium (hypotonic hyponatremia). What is the recommended rate of serum sodium correction in severe symptomatic hyponatremia? A) <4 mEq/L in 24 hours B) <8 mEq/L in 24 hours C) <10 mEq/L in 24 hours D) <20 mEq/L in 24 hours ANS: B