NUR 265 FINAL EXAM
Medical-Surgical Nursing – Galen College
57 Actual & Most Tested Questions with
Answers and Rationales
THIS DOCUMENT CONTAINS:
➢ GUARANTEE PASSING SCORE
➢ QUESTIONS AND ANSWERS
➢ EXPERT VERIFIED EXPLANATIONS
➢ FORMAT SET OF MULTIPLE-CHOICE
,Questions 1–20: Renal & Genitourinary Disorders
1. The nurse is caring for a client with nephrotic syndrome who has severe
proteinuria. Which prescribed medication should the nurse administer to
reduce protein loss?
A) Furosemide (Lasix)
B) Lisinopril
C) Metoprolol
D) Spironolactone
Answer: B) Lisinopril
Rationale: ACE inhibitors like lisinopril reduce intraglomerular pressure, which
decreases urinary protein excretion and slows the progression of kidney damage in
nephrotic syndrome.
2. A client with chronic kidney disease (CKD) has a potassium level of 6.8
mEq/L. Which assessment finding requires the most immediate action?
A) Blood pressure 148/90 mmHg
B) Respiratory rate of 22 breaths/min
C) ECG showing peaked T waves
D) Urine output of 40 mL/hr
Answer: C) ECG showing peaked T waves
Rationale: Peaked T waves are an early ECG sign of hyperkalemia, which can rapidly
progress to cardiac dysrhythmias, including ventricular fibrillation or asystole. This
requires immediate intervention such as calcium gluconate, insulin, and kayexalate.
3. A client on hemodialysis is found to have an arteriovenous (AV) fistula with a
palpable thrill and audible bruit. Which action should the nurse take?
A) Notify the provider immediately
B) Document the findings as expected
C) Apply a cold compress to the site
D) Elevate the affected arm on pillows
Answer: B) Document the findings as expected
Rationale: A palpable thrill and audible bruit indicate that the AV fistula is patent
and functioning properly. These are expected and desired findings in a client with an
AV fistula for hemodialysis access.
4. The nurse is teaching a client with CKD about dietary restrictions. Which
client statement indicates a need for further teaching?
A) "I will limit my sodium intake to 2 grams per day."
, B) "I can eat bananas and oranges for extra potassium."
C) "I need to watch my fluid intake between dialysis sessions."
D) "I should avoid salt substitutes that contain potassium."
Answer: B) "I can eat bananas and oranges for extra potassium."
Rationale: Bananas and oranges are high in potassium. Clients with CKD are at risk
for hyperkalemia and should restrict high-potassium foods. This statement indicates
a misunderstanding of dietary needs.
5. A client with end-stage renal disease (ESRD) reports severe itching (pruritus)
all over the body. Which intervention is most appropriate?
A) Apply alcohol-based lotion to dry skin
B) Administer oral diphenhydramine (Benadryl)
C) Encourage hot showers to relieve itching
D) Restrict dietary phosphorus intake
Answer: D) Restrict dietary phosphorus intake
Rationale: Pruritus in ESRD is often caused by hyperphosphatemia and the resulting
deposition of phosphate crystals in the skin. Restricting dietary phosphorus and
administering phosphate binders are key interventions to reduce itching.
6. A client receiving peritoneal dialysis reports abdominal pain and notes that
the dialysate outflow appears cloudy. What is the priority nursing action?
A) Warm the dialysate solution before next exchange
B) Send a sample of the effluent for culture and sensitivity
C) Increase the dwell time of the dialysate
D) Administer oral acetaminophen for pain
Answer: B) Send a sample of the effluent for culture and sensitivity
Rationale: Cloudy dialysate effluent is a classic sign of peritonitis, a serious
complication of peritoneal dialysis. The priority is to obtain a sample for culture to
identify the causative organism and guide antibiotic therapy.
7. The nurse is reviewing laboratory results for a client with CKD. Which finding
is most consistent with this diagnosis?
A) Elevated serum calcium
B) Decreased serum creatinine
C) Elevated blood urea nitrogen (BUN)
D) Decreased serum potassium
Answer: C) Elevated blood urea nitrogen (BUN)
Rationale: BUN and creatinine are both elevated in CKD due to the kidneys'
decreased ability to excrete nitrogenous wastes. BUN is also affected by dehydration
and protein intake, but elevation is expected in kidney disease.
Medical-Surgical Nursing – Galen College
57 Actual & Most Tested Questions with
Answers and Rationales
THIS DOCUMENT CONTAINS:
➢ GUARANTEE PASSING SCORE
➢ QUESTIONS AND ANSWERS
➢ EXPERT VERIFIED EXPLANATIONS
➢ FORMAT SET OF MULTIPLE-CHOICE
,Questions 1–20: Renal & Genitourinary Disorders
1. The nurse is caring for a client with nephrotic syndrome who has severe
proteinuria. Which prescribed medication should the nurse administer to
reduce protein loss?
A) Furosemide (Lasix)
B) Lisinopril
C) Metoprolol
D) Spironolactone
Answer: B) Lisinopril
Rationale: ACE inhibitors like lisinopril reduce intraglomerular pressure, which
decreases urinary protein excretion and slows the progression of kidney damage in
nephrotic syndrome.
2. A client with chronic kidney disease (CKD) has a potassium level of 6.8
mEq/L. Which assessment finding requires the most immediate action?
A) Blood pressure 148/90 mmHg
B) Respiratory rate of 22 breaths/min
C) ECG showing peaked T waves
D) Urine output of 40 mL/hr
Answer: C) ECG showing peaked T waves
Rationale: Peaked T waves are an early ECG sign of hyperkalemia, which can rapidly
progress to cardiac dysrhythmias, including ventricular fibrillation or asystole. This
requires immediate intervention such as calcium gluconate, insulin, and kayexalate.
3. A client on hemodialysis is found to have an arteriovenous (AV) fistula with a
palpable thrill and audible bruit. Which action should the nurse take?
A) Notify the provider immediately
B) Document the findings as expected
C) Apply a cold compress to the site
D) Elevate the affected arm on pillows
Answer: B) Document the findings as expected
Rationale: A palpable thrill and audible bruit indicate that the AV fistula is patent
and functioning properly. These are expected and desired findings in a client with an
AV fistula for hemodialysis access.
4. The nurse is teaching a client with CKD about dietary restrictions. Which
client statement indicates a need for further teaching?
A) "I will limit my sodium intake to 2 grams per day."
, B) "I can eat bananas and oranges for extra potassium."
C) "I need to watch my fluid intake between dialysis sessions."
D) "I should avoid salt substitutes that contain potassium."
Answer: B) "I can eat bananas and oranges for extra potassium."
Rationale: Bananas and oranges are high in potassium. Clients with CKD are at risk
for hyperkalemia and should restrict high-potassium foods. This statement indicates
a misunderstanding of dietary needs.
5. A client with end-stage renal disease (ESRD) reports severe itching (pruritus)
all over the body. Which intervention is most appropriate?
A) Apply alcohol-based lotion to dry skin
B) Administer oral diphenhydramine (Benadryl)
C) Encourage hot showers to relieve itching
D) Restrict dietary phosphorus intake
Answer: D) Restrict dietary phosphorus intake
Rationale: Pruritus in ESRD is often caused by hyperphosphatemia and the resulting
deposition of phosphate crystals in the skin. Restricting dietary phosphorus and
administering phosphate binders are key interventions to reduce itching.
6. A client receiving peritoneal dialysis reports abdominal pain and notes that
the dialysate outflow appears cloudy. What is the priority nursing action?
A) Warm the dialysate solution before next exchange
B) Send a sample of the effluent for culture and sensitivity
C) Increase the dwell time of the dialysate
D) Administer oral acetaminophen for pain
Answer: B) Send a sample of the effluent for culture and sensitivity
Rationale: Cloudy dialysate effluent is a classic sign of peritonitis, a serious
complication of peritoneal dialysis. The priority is to obtain a sample for culture to
identify the causative organism and guide antibiotic therapy.
7. The nurse is reviewing laboratory results for a client with CKD. Which finding
is most consistent with this diagnosis?
A) Elevated serum calcium
B) Decreased serum creatinine
C) Elevated blood urea nitrogen (BUN)
D) Decreased serum potassium
Answer: C) Elevated blood urea nitrogen (BUN)
Rationale: BUN and creatinine are both elevated in CKD due to the kidneys'
decreased ability to excrete nitrogenous wastes. BUN is also affected by dehydration
and protein intake, but elevation is expected in kidney disease.
