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