NUR 265 – Medical Surgical Nursing Exam 1
Galen College of Nursing (2026)
200 Questions & Verified Answers with
Rationales
THIS DOCUMENT CONTAINS:
➢ GUARANTEE PASSING SCORE
➢ QUESTIONS AND ANSWERS
➢ EXPERT VERIFIED EXPLANATIONS
➢ FORMAT SET OF MULTIPLE-CHOICE
,Renal & Urinary Disorders (1–35)
1. The nurse is caring for a client with nephrotic syndrome and severe
proteinuria. Which action is most appropriate?
A) Administer furosemide
B) Administer lisinopril
C) Restrict fluids
D) Increase dietary protein
✅ Correct Answer: B – Administer lisinopril
Rationale: ACE inhibitors reduce intraglomerular pressure and proteinuria, slowing
kidney damage. Furosemide treats edema but not protein loss.
2. Which client’s lab finding requires priority follow-up?
A) Creatinine 1.1 mg/dL
B) Potassium 4.0 mEq/L
C) Creatinine rise from 0.9 → 2.5 mg/dL 2 days post-AAA repair
D) Mild hyponatremia
✅ Correct Answer: C – Creatinine rise from 0.9 → 2.5 mg/dL post-AAA repair
Rationale: Acute kidney injury (AKI) is life-threatening; the sharp creatinine rise
demands immediate evaluation.
3. A client receiving gentamicin has a trough level of 3.2 mcg/mL. What should
the nurse do first?
A) Draw peak and trough levels
B) Give the next dose as scheduled
C) Notify the provider
D) Increase IV fluids
✅ Correct Answer: A – Draw peak and trough levels
Rationale: Elevated trough indicates drug accumulation and risk of nephrotoxicity;
levels guide dose adjustment.
4. A client with CKD has deep, rapid respirations. After raising the HOB, what is
the next action?
A) Obtain ABGs
B) Order a chest x-ray
C) Give oxygen
D) Encourage deep breathing
,✅ Correct Answer: A – Obtain ABGs
Rationale: Kussmaul breathing suggests metabolic acidosis; ABGs confirm the
diagnosis.
5. A hemodialysis client says, “I limit sodium to 5 g/day.” Which response is
correct?
A) “That is the recommended amount.”
B) “You need to reduce sodium to 2–4 g/day.”
C) “Sodium is not restricted on dialysis.”
D) “Only potassium matters.”
✅ Correct Answer: B – “You need to reduce sodium to 2–4 g/day.”
*Rationale: Recommended sodium intake for CKD/dialysis is 2–4 g/day; 5 g is too
high.*
6. A late-stage CKD client reports muscle weakness and tremors. What should
the nurse do?
A) Reassure that this is normal
B) Notify the provider
C) Give a calcium supplement
D) Increase dialysis time
✅ Correct Answer: B – Notify the provider
Rationale: Muscle weakness/tremors may indicate electrolyte imbalance (e.g.,
hypokalemia post-dialysis).
7. A client who had hemodialysis yesterday now has a temperature of 101.4°F.
Priority action?
A) Give acetaminophen
B) Notify the provider
C) Increase fluid intake
D) Document and continue to monitor
✅ Correct Answer: B – Notify the provider
Rationale: Fever after dialysis may signal access infection or bacteremia; requires
prompt evaluation.
8. When changing a peritoneal dialysis catheter dressing, which action is
correct?
A) Use sterile gloves only
B) Place a mask on the client
C) Use clean gloves only
D) No special precautions
, ✅ Correct Answer: B – Place a mask on the client
Rationale: Both nurse and client should wear masks to reduce airborne contamination.
9. A new nurse is caring for a peritoneal dialysis client. Which action indicates
correct technique?
A) Warming dialysate in a microwave
B) Repositioning the client to improve flow
C) Keeping the client flat throughout
D) Ignoring air bubbles in the tubing
✅ Correct Answer: B – Repositioning the client to improve flow
Rationale: Turning side-to-side helps drainage; microwaving is unsafe, and air bubbles
must be removed.
10. A CKD client’s potassium is 6.5 mEq/L. Priority intervention?
A) Give oral potassium supplement
B) Prepare for emergent dialysis
C) Encourage high-potassium foods
D) Document as expected
✅ Correct Answer: B – Prepare for emergent dialysis
Rationale: Severe hyperkalemia is life-threatening; dialysis rapidly lowers potassium.
11. Stage 4 CKD. Which finding is most concerning?
A) BP 145/90 mmHg
B) Creatinine 3.5 mg/dL
C) Potassium 5.9 mEq/L
D) Hemoglobin 10.5 g/dL
✅ Correct Answer: C – Potassium 5.9 mEq/L
Rationale: This level can cause cardiac arrhythmias; needs immediate treatment.
12. AKI, oliguric phase. Which requires priority intervention?
A) Urine output 20 mL/hr ×6 hr
B) Potassium 6.2 mEq/L
C) BP 145/90 mmHg
D) Mild peripheral edema
✅ Correct Answer: B – Potassium 6.2 mEq/L
Rationale: Life-threatening hyperkalemia requires emergent management
(insulin/dextrose, dialysis).
13. A client with CKD is prescribed epoetin alfa (Epogen). Purpose?
A) Lower potassium
B) Stimulate RBC production
Galen College of Nursing (2026)
200 Questions & Verified Answers with
Rationales
THIS DOCUMENT CONTAINS:
➢ GUARANTEE PASSING SCORE
➢ QUESTIONS AND ANSWERS
➢ EXPERT VERIFIED EXPLANATIONS
➢ FORMAT SET OF MULTIPLE-CHOICE
,Renal & Urinary Disorders (1–35)
1. The nurse is caring for a client with nephrotic syndrome and severe
proteinuria. Which action is most appropriate?
A) Administer furosemide
B) Administer lisinopril
C) Restrict fluids
D) Increase dietary protein
✅ Correct Answer: B – Administer lisinopril
Rationale: ACE inhibitors reduce intraglomerular pressure and proteinuria, slowing
kidney damage. Furosemide treats edema but not protein loss.
2. Which client’s lab finding requires priority follow-up?
A) Creatinine 1.1 mg/dL
B) Potassium 4.0 mEq/L
C) Creatinine rise from 0.9 → 2.5 mg/dL 2 days post-AAA repair
D) Mild hyponatremia
✅ Correct Answer: C – Creatinine rise from 0.9 → 2.5 mg/dL post-AAA repair
Rationale: Acute kidney injury (AKI) is life-threatening; the sharp creatinine rise
demands immediate evaluation.
3. A client receiving gentamicin has a trough level of 3.2 mcg/mL. What should
the nurse do first?
A) Draw peak and trough levels
B) Give the next dose as scheduled
C) Notify the provider
D) Increase IV fluids
✅ Correct Answer: A – Draw peak and trough levels
Rationale: Elevated trough indicates drug accumulation and risk of nephrotoxicity;
levels guide dose adjustment.
4. A client with CKD has deep, rapid respirations. After raising the HOB, what is
the next action?
A) Obtain ABGs
B) Order a chest x-ray
C) Give oxygen
D) Encourage deep breathing
,✅ Correct Answer: A – Obtain ABGs
Rationale: Kussmaul breathing suggests metabolic acidosis; ABGs confirm the
diagnosis.
5. A hemodialysis client says, “I limit sodium to 5 g/day.” Which response is
correct?
A) “That is the recommended amount.”
B) “You need to reduce sodium to 2–4 g/day.”
C) “Sodium is not restricted on dialysis.”
D) “Only potassium matters.”
✅ Correct Answer: B – “You need to reduce sodium to 2–4 g/day.”
*Rationale: Recommended sodium intake for CKD/dialysis is 2–4 g/day; 5 g is too
high.*
6. A late-stage CKD client reports muscle weakness and tremors. What should
the nurse do?
A) Reassure that this is normal
B) Notify the provider
C) Give a calcium supplement
D) Increase dialysis time
✅ Correct Answer: B – Notify the provider
Rationale: Muscle weakness/tremors may indicate electrolyte imbalance (e.g.,
hypokalemia post-dialysis).
7. A client who had hemodialysis yesterday now has a temperature of 101.4°F.
Priority action?
A) Give acetaminophen
B) Notify the provider
C) Increase fluid intake
D) Document and continue to monitor
✅ Correct Answer: B – Notify the provider
Rationale: Fever after dialysis may signal access infection or bacteremia; requires
prompt evaluation.
8. When changing a peritoneal dialysis catheter dressing, which action is
correct?
A) Use sterile gloves only
B) Place a mask on the client
C) Use clean gloves only
D) No special precautions
, ✅ Correct Answer: B – Place a mask on the client
Rationale: Both nurse and client should wear masks to reduce airborne contamination.
9. A new nurse is caring for a peritoneal dialysis client. Which action indicates
correct technique?
A) Warming dialysate in a microwave
B) Repositioning the client to improve flow
C) Keeping the client flat throughout
D) Ignoring air bubbles in the tubing
✅ Correct Answer: B – Repositioning the client to improve flow
Rationale: Turning side-to-side helps drainage; microwaving is unsafe, and air bubbles
must be removed.
10. A CKD client’s potassium is 6.5 mEq/L. Priority intervention?
A) Give oral potassium supplement
B) Prepare for emergent dialysis
C) Encourage high-potassium foods
D) Document as expected
✅ Correct Answer: B – Prepare for emergent dialysis
Rationale: Severe hyperkalemia is life-threatening; dialysis rapidly lowers potassium.
11. Stage 4 CKD. Which finding is most concerning?
A) BP 145/90 mmHg
B) Creatinine 3.5 mg/dL
C) Potassium 5.9 mEq/L
D) Hemoglobin 10.5 g/dL
✅ Correct Answer: C – Potassium 5.9 mEq/L
Rationale: This level can cause cardiac arrhythmias; needs immediate treatment.
12. AKI, oliguric phase. Which requires priority intervention?
A) Urine output 20 mL/hr ×6 hr
B) Potassium 6.2 mEq/L
C) BP 145/90 mmHg
D) Mild peripheral edema
✅ Correct Answer: B – Potassium 6.2 mEq/L
Rationale: Life-threatening hyperkalemia requires emergent management
(insulin/dextrose, dialysis).
13. A client with CKD is prescribed epoetin alfa (Epogen). Purpose?
A) Lower potassium
B) Stimulate RBC production
