NUR 242 Exam 4 – Med-Surg Concepts (2026)
Galen College of Nursing | Actual Questions &
Answers with Rationales
Study Tips for NUR 242 Exam 4
Master renal pathophysiology: Understand stages of CKD, electrolyte
imbalances (hyperkalemia, hyperphosphatemia), and dialysis (hemodialysis
vs. peritoneal dialysis). Know AV fistula assessment and complications .
Know hematologic disorders: Differentiate anemias (iron deficiency,
pernicious, aplastic), sickle cell crisis management, bleeding disorders
(hemophilia, ITP, DIC), and leukemia/lymphoma .
Understand shock types: Differentiate hypovolemic, cardiogenic, septic,
anaphylactic, and neurogenic shock. Know hemodynamic parameters and
management priorities .
Learn immunologic and infectious diseases: HIV/AIDS (CD4 counts,
opportunistic infections), TB (airborne precautions, medications),
meningitis, sepsis, and transmission-based precautions .
Study musculoskeletal disorders: Fracture types, traction, compartment
syndrome, joint arthroplasty precautions, and spinal cord injury
complications (autonomic dysreflexia) .
Know burn care: Burn classification, fluid resuscitation (Parkland formula),
wound care, infection prevention, and complications (inhalation injury,
Curling's ulcer) .
Understand end-of-life care: Signs of approaching death, symptom
management (pain, dyspnea, nausea), family support, and advance directives
.
,Master perioperative nursing: Preoperative assessment, intraoperative care,
PACU monitoring, and post-operative complications (DVT, PE, atelectasis,
wound infection, dehiscence) .
Practice with case studies: Apply knowledge to patient scenarios requiring
critical thinking and prioritization .
Review medications: Common meds for each condition (epoetin, phosphate
binders, anticoagulants, immunosuppressants, antibiotics, opioids) and their
side effects
Section 1: Renal and Genitourinary Disorders (Questions 1-70)
1. A patient with chronic kidney disease (CKD) has a glomerular filtration
rate (GFR) of 18 mL/min. The nurse understands that this indicates:
A. Stage 4 CKD
B. Stage 1 CKD
C. Stage 2 CKD
D. Stage 3 CKD
Answer: A. Stage 4 CKD
Rationale: CKD staging: Stage 1: GFR ≥90; Stage 2: 60-89; Stage 3: 30-59;
Stage 4: 15-29; Stage 5: <15 . A GFR of 18 mL/min indicates severe impairment
(Stage 4) .
2. A patient with end-stage renal disease (ESRD) is scheduled for
hemodialysis. Which laboratory value requires immediate intervention
before dialysis?
A. Potassium 6.5 mEq/L
B. Sodium 135 mEq/L
C. Calcium 8.5 mg/dL
D. Hemoglobin 10.5 g/dL
Answer: A. Potassium 6.5 mEq/L
Rationale: Hyperkalemia (K+ >5.5) is life-threatening and requires urgent
dialysis. Other values are within or near normal ranges .
,3. A patient with CKD has a phosphate level of 7.2 mg/dL. Which medication
is prescribed to lower serum phosphate?
A. Calcium acetate (PhosLo)
B. Epoetin alfa (Epogen)
C. Sevelamer (Renagel)
D. Both A and C
Answer: D. Both A and C
Rationale: Calcium acetate and sevelamer are phosphate binders that reduce
intestinal absorption of phosphate. They are taken with meals .
4. The nurse is assessing a patient's arteriovenous (AV) fistula for patency.
Which finding indicates adequate blood flow?
A. Palpable thrill
B. Absent bruit
C. Cold extremity
D. Edema at the site
Answer: A. Palpable thrill
Rationale: A thrill (vibration) and bruit (sound) indicate blood flow through
the AV fistula. Absence indicates occlusion .
5. A patient with CKD has a hemoglobin of 8.2 g/dL. The nurse understands
that anemia in CKD is caused by:
A. Decreased erythropoietin production
B. Iron deficiency
C. Vitamin B12 deficiency
D. Hemolysis
Answer: A. Decreased erythropoietin production
Rationale: The kidneys produce erythropoietin. In CKD, decreased
erythropoietin causes anemia. Erythropoiesis-stimulating agents (epoetin
alfa) are used for treatment .
6. A patient receiving hemodialysis has a fever and hypotension during
treatment. The nurse suspects:
A. Infection
B. Air embolism
, C. Dialysis disequilibrium syndrome
D. Hemolysis
Answer: A. Infection
Rationale: Fever and hypotension during dialysis suggest bacteremia or
sepsis. The dialysis access site is a common source of infection .
7. A patient with CKD has a potassium level of 6.2 mEq/L. Which ECG
change is expected?
A. Peaked T waves
B. Prominent U waves
C. ST depression
D. Prolonged QT interval
Answer: A. Peaked T waves
Rationale: Hyperkalemia causes tall, peaked T waves. As potassium
increases, QRS widens and P wave disappears .
8. A patient with acute kidney injury (AKI) has a urine output of 20
mL/hour. Which phase of AKI is this?
A. Oliguric phase
B. Diuretic phase
C. Recovery phase
D. Initiation phase
Answer: A. Oliguric phase
Rationale: Oliguric phase is defined by urine output <400 mL/day (or <20
mL/hour). This phase lasts 1-3 weeks .
9. A patient with AKI has a urine output of 3,000 mL/day. The nurse
recognizes this as:
A. Diuretic phase
B. Oliguric phase
C. Normal output
D. Recovery phase
Answer: A. Diuretic phase
Rationale: The diuretic phase follows the oliguric phase, with increased urine
output. Monitor for dehydration and electrolyte loss .
Galen College of Nursing | Actual Questions &
Answers with Rationales
Study Tips for NUR 242 Exam 4
Master renal pathophysiology: Understand stages of CKD, electrolyte
imbalances (hyperkalemia, hyperphosphatemia), and dialysis (hemodialysis
vs. peritoneal dialysis). Know AV fistula assessment and complications .
Know hematologic disorders: Differentiate anemias (iron deficiency,
pernicious, aplastic), sickle cell crisis management, bleeding disorders
(hemophilia, ITP, DIC), and leukemia/lymphoma .
Understand shock types: Differentiate hypovolemic, cardiogenic, septic,
anaphylactic, and neurogenic shock. Know hemodynamic parameters and
management priorities .
Learn immunologic and infectious diseases: HIV/AIDS (CD4 counts,
opportunistic infections), TB (airborne precautions, medications),
meningitis, sepsis, and transmission-based precautions .
Study musculoskeletal disorders: Fracture types, traction, compartment
syndrome, joint arthroplasty precautions, and spinal cord injury
complications (autonomic dysreflexia) .
Know burn care: Burn classification, fluid resuscitation (Parkland formula),
wound care, infection prevention, and complications (inhalation injury,
Curling's ulcer) .
Understand end-of-life care: Signs of approaching death, symptom
management (pain, dyspnea, nausea), family support, and advance directives
.
,Master perioperative nursing: Preoperative assessment, intraoperative care,
PACU monitoring, and post-operative complications (DVT, PE, atelectasis,
wound infection, dehiscence) .
Practice with case studies: Apply knowledge to patient scenarios requiring
critical thinking and prioritization .
Review medications: Common meds for each condition (epoetin, phosphate
binders, anticoagulants, immunosuppressants, antibiotics, opioids) and their
side effects
Section 1: Renal and Genitourinary Disorders (Questions 1-70)
1. A patient with chronic kidney disease (CKD) has a glomerular filtration
rate (GFR) of 18 mL/min. The nurse understands that this indicates:
A. Stage 4 CKD
B. Stage 1 CKD
C. Stage 2 CKD
D. Stage 3 CKD
Answer: A. Stage 4 CKD
Rationale: CKD staging: Stage 1: GFR ≥90; Stage 2: 60-89; Stage 3: 30-59;
Stage 4: 15-29; Stage 5: <15 . A GFR of 18 mL/min indicates severe impairment
(Stage 4) .
2. A patient with end-stage renal disease (ESRD) is scheduled for
hemodialysis. Which laboratory value requires immediate intervention
before dialysis?
A. Potassium 6.5 mEq/L
B. Sodium 135 mEq/L
C. Calcium 8.5 mg/dL
D. Hemoglobin 10.5 g/dL
Answer: A. Potassium 6.5 mEq/L
Rationale: Hyperkalemia (K+ >5.5) is life-threatening and requires urgent
dialysis. Other values are within or near normal ranges .
,3. A patient with CKD has a phosphate level of 7.2 mg/dL. Which medication
is prescribed to lower serum phosphate?
A. Calcium acetate (PhosLo)
B. Epoetin alfa (Epogen)
C. Sevelamer (Renagel)
D. Both A and C
Answer: D. Both A and C
Rationale: Calcium acetate and sevelamer are phosphate binders that reduce
intestinal absorption of phosphate. They are taken with meals .
4. The nurse is assessing a patient's arteriovenous (AV) fistula for patency.
Which finding indicates adequate blood flow?
A. Palpable thrill
B. Absent bruit
C. Cold extremity
D. Edema at the site
Answer: A. Palpable thrill
Rationale: A thrill (vibration) and bruit (sound) indicate blood flow through
the AV fistula. Absence indicates occlusion .
5. A patient with CKD has a hemoglobin of 8.2 g/dL. The nurse understands
that anemia in CKD is caused by:
A. Decreased erythropoietin production
B. Iron deficiency
C. Vitamin B12 deficiency
D. Hemolysis
Answer: A. Decreased erythropoietin production
Rationale: The kidneys produce erythropoietin. In CKD, decreased
erythropoietin causes anemia. Erythropoiesis-stimulating agents (epoetin
alfa) are used for treatment .
6. A patient receiving hemodialysis has a fever and hypotension during
treatment. The nurse suspects:
A. Infection
B. Air embolism
, C. Dialysis disequilibrium syndrome
D. Hemolysis
Answer: A. Infection
Rationale: Fever and hypotension during dialysis suggest bacteremia or
sepsis. The dialysis access site is a common source of infection .
7. A patient with CKD has a potassium level of 6.2 mEq/L. Which ECG
change is expected?
A. Peaked T waves
B. Prominent U waves
C. ST depression
D. Prolonged QT interval
Answer: A. Peaked T waves
Rationale: Hyperkalemia causes tall, peaked T waves. As potassium
increases, QRS widens and P wave disappears .
8. A patient with acute kidney injury (AKI) has a urine output of 20
mL/hour. Which phase of AKI is this?
A. Oliguric phase
B. Diuretic phase
C. Recovery phase
D. Initiation phase
Answer: A. Oliguric phase
Rationale: Oliguric phase is defined by urine output <400 mL/day (or <20
mL/hour). This phase lasts 1-3 weeks .
9. A patient with AKI has a urine output of 3,000 mL/day. The nurse
recognizes this as:
A. Diuretic phase
B. Oliguric phase
C. Normal output
D. Recovery phase
Answer: A. Diuretic phase
Rationale: The diuretic phase follows the oliguric phase, with increased urine
output. Monitor for dehydration and electrolyte loss .
