NUR 265 Comprehensive Final
Exam
Medical-Surgical Nursing
Galen College of Nursing
THIS DOCUMENT CONTAINS:
➢ GUARANTEE PASSING SCORE
➢ QUESTIONS AND ANSWERS
➢ EXPERT VERIFIED EXPLANATIONS
➢ FORMAT SET OF MULTIPLE-CHOICE
,Renal / Urinary (Questions 1–15)
1. A client with chronic kidney disease (CKD) has a potassium level of 6.2
mEq/L. Which intervention should the nurse implement first?
A. Administer sodium polystyrene sulfonate (Kayexalate).
B. Prepare the client for emergency hemodialysis.
C. Place the client on a cardiac monitor.
D. Restrict all oral intake.
Correct Answer: C. Rationale: Hyperkalemia (K > 6.0) can cause fatal cardiac
dysrhythmias. The priority is to place the client on a cardiac monitor to detect
changes (peaked T waves, wide QRS) while preparing for other treatments.
2. A client on hemodialysis has an arteriovenous (AV) fistula in the left arm.
Which action by the nurse is appropriate?
A. Take blood pressure in the left arm.
B. Palpate for a thrill over the fistula.
C. Draw blood from the fistula site.
D. Apply a tight tourniquet above the fistula.
Correct Answer: B. Rationale: A palpable thrill and audible bruit indicate patency of
the AV fistula. Blood pressure, venipuncture, and tight tourniquets should never be
done on the fistula arm.
3. The nurse is caring for a client with acute kidney injury (AKI) in the oliguric
phase. Which finding is most concerning?
A. Urine output of 300 mL in 24 hours.
B. Serum potassium of 5.9 mEq/L.
C. Blood pressure of 140/90.
D. Weight gain of 1 kg in 24 hours.
Correct Answer: B. Rationale: Severe hyperkalemia (K > 6.0) is life-threatening in
AKI due to decreased excretion. It can cause cardiac arrest and requires immediate
intervention.
4. A client with nephrotic syndrome has massive proteinuria and edema. Which
lab value supports this diagnosis?
A. Serum albumin 2.0 g/dL (low).
B. Serum sodium 145 mEq/L.
, C. BUN 10 mg/dL.
D. Hemoglobin 15 g/dL.
Correct Answer: A. Rationale: Nephrotic syndrome causes loss of protein in urine,
leading to hypoalbuminemia (low serum albumin), which contributes to edema.
5. The nurse is teaching a client with CKD about a low-phosphorus diet. Which
food should the client avoid?
A. Apples
B. Cabbage
C. Dairy products (milk, cheese)
D. White bread
Correct Answer: C. Rationale: Dairy products are high in phosphorus. Clients with
CKD should limit phosphorus to prevent bone disease and vascular calcification.
6. A client on peritoneal dialysis reports severe abdominal pain and cloudy
dialysate output. What is the priority action?
A. Increase the dwell time.
B. Send a sample for culture and sensitivity.
C. Administer oral pain medication.
D. Flush the catheter with heparin.
Correct Answer: B. Rationale: Cloudy dialysate is the hallmark sign of peritonitis.
The nurse should obtain a sample for culture immediately and notify the provider.
7. Which client is at highest risk for developing acute kidney injury (AKI)?
A. Client with a urinary tract infection.
B. Client receiving IV contrast dye for a CT scan.
C. Client with benign prostatic hyperplasia (BPH).
D. Client with controlled hypertension.
Correct Answer: B. Rationale: IV contrast dye is nephrotoxic and a common cause
of hospital-acquired AKI (contrast-induced nephropathy).
8. A client with ESRD reports bone pain and muscle weakness. The nurse
suspects which complication?
A. Hypercalcemia
B. Secondary hyperparathyroidism
C. Hypokalemia
D. Metabolic alkalosis
Correct Answer: B. Rationale: In CKD, phosphate retention leads to hypocalcemia,
stimulating PTH release (secondary hyperparathyroidism), which causes bone
resorption and pain.
Exam
Medical-Surgical Nursing
Galen College of Nursing
THIS DOCUMENT CONTAINS:
➢ GUARANTEE PASSING SCORE
➢ QUESTIONS AND ANSWERS
➢ EXPERT VERIFIED EXPLANATIONS
➢ FORMAT SET OF MULTIPLE-CHOICE
,Renal / Urinary (Questions 1–15)
1. A client with chronic kidney disease (CKD) has a potassium level of 6.2
mEq/L. Which intervention should the nurse implement first?
A. Administer sodium polystyrene sulfonate (Kayexalate).
B. Prepare the client for emergency hemodialysis.
C. Place the client on a cardiac monitor.
D. Restrict all oral intake.
Correct Answer: C. Rationale: Hyperkalemia (K > 6.0) can cause fatal cardiac
dysrhythmias. The priority is to place the client on a cardiac monitor to detect
changes (peaked T waves, wide QRS) while preparing for other treatments.
2. A client on hemodialysis has an arteriovenous (AV) fistula in the left arm.
Which action by the nurse is appropriate?
A. Take blood pressure in the left arm.
B. Palpate for a thrill over the fistula.
C. Draw blood from the fistula site.
D. Apply a tight tourniquet above the fistula.
Correct Answer: B. Rationale: A palpable thrill and audible bruit indicate patency of
the AV fistula. Blood pressure, venipuncture, and tight tourniquets should never be
done on the fistula arm.
3. The nurse is caring for a client with acute kidney injury (AKI) in the oliguric
phase. Which finding is most concerning?
A. Urine output of 300 mL in 24 hours.
B. Serum potassium of 5.9 mEq/L.
C. Blood pressure of 140/90.
D. Weight gain of 1 kg in 24 hours.
Correct Answer: B. Rationale: Severe hyperkalemia (K > 6.0) is life-threatening in
AKI due to decreased excretion. It can cause cardiac arrest and requires immediate
intervention.
4. A client with nephrotic syndrome has massive proteinuria and edema. Which
lab value supports this diagnosis?
A. Serum albumin 2.0 g/dL (low).
B. Serum sodium 145 mEq/L.
, C. BUN 10 mg/dL.
D. Hemoglobin 15 g/dL.
Correct Answer: A. Rationale: Nephrotic syndrome causes loss of protein in urine,
leading to hypoalbuminemia (low serum albumin), which contributes to edema.
5. The nurse is teaching a client with CKD about a low-phosphorus diet. Which
food should the client avoid?
A. Apples
B. Cabbage
C. Dairy products (milk, cheese)
D. White bread
Correct Answer: C. Rationale: Dairy products are high in phosphorus. Clients with
CKD should limit phosphorus to prevent bone disease and vascular calcification.
6. A client on peritoneal dialysis reports severe abdominal pain and cloudy
dialysate output. What is the priority action?
A. Increase the dwell time.
B. Send a sample for culture and sensitivity.
C. Administer oral pain medication.
D. Flush the catheter with heparin.
Correct Answer: B. Rationale: Cloudy dialysate is the hallmark sign of peritonitis.
The nurse should obtain a sample for culture immediately and notify the provider.
7. Which client is at highest risk for developing acute kidney injury (AKI)?
A. Client with a urinary tract infection.
B. Client receiving IV contrast dye for a CT scan.
C. Client with benign prostatic hyperplasia (BPH).
D. Client with controlled hypertension.
Correct Answer: B. Rationale: IV contrast dye is nephrotoxic and a common cause
of hospital-acquired AKI (contrast-induced nephropathy).
8. A client with ESRD reports bone pain and muscle weakness. The nurse
suspects which complication?
A. Hypercalcemia
B. Secondary hyperparathyroidism
C. Hypokalemia
D. Metabolic alkalosis
Correct Answer: B. Rationale: In CKD, phosphate retention leads to hypocalcemia,
stimulating PTH release (secondary hyperparathyroidism), which causes bone
resorption and pain.
