NUR 242 MEDICAL-SURGICAL NURSING EXAM 3 2026/2027 |
Questions and Verified Answers with Rationales | 100%
Correct Grade A | Galen College | Pass Guaranteed
Renal/Urinary Disorders (20 Questions)
AKI, CKD, Dialysis, UTI, Glomerulonephritis, Nephrolithiasis
Q1: A 68-year-old patient with heart failure is admitted with decreased urine output, BUN
45 mg/dL, creatinine 2.8 mg/dL (baseline 1.0), and FENa <1%. Which type of acute
kidney injury is most likely?
A. Intrinsic acute tubular necrosis from nephrotoxic medications
B. Prerenal AKI from decreased renal perfusion due to poor cardiac output [CORRECT]
C. Postrenal AKI from urinary tract obstruction
D. Interstitial nephritis from allergic reaction
Correct Answer: B
Rationale: The FENa (fractional excretion of sodium) <1% indicates sodium avidity by
functional kidneys responding to decreased perfusion—characteristic of prerenal AKI.
The BUN:Creatinine ratio >20:1 also suggests prerenal etiology. Heart failure reduces
cardiac output and renal perfusion. Intrinsic ATN (Option A) would show FENa >2% and
muddy brown casts. Postrenal (Option C) would show obstruction signs. Interstitial
nephritis (Option D) would show eosinophils and medication exposure.
Q2: A patient with AKI has the following arterial blood gas: pH 7.28, HCO3 18 mEq/L,
PaCO2 32 mmHg. Which metabolic complication is present?
A. Respiratory acidosis from pulmonary edema
B. Metabolic acidosis with respiratory compensation from impaired acid excretion
[CORRECT]
C. Respiratory alkalosis from hyperventilation
D. Metabolic alkalosis from vomiting
Correct Answer: B
,Rationale: The low pH (acidemia), low bicarbonate (metabolic acidosis), and low PaCO2
(respiratory compensation—hyperventilation to blow off CO2) indicate metabolic
acidosis from impaired renal acid excretion and bicarbonate regeneration in AKI. The
anion gap would be elevated. Respiratory acidosis (Option A) would show high PaCO2.
Respiratory alkalosis (Option C) would show high pH. Metabolic alkalosis (Option D)
would show high bicarbonate.
Q3: Which nursing intervention is PRIORITY for a patient with AKI and serum potassium
6.8 mEq/L?
A. Administer oral sodium polystyrene sulfonate (Kayexalate)
B. Prepare for emergent hemodialysis and administer calcium gluconate to stabilize
cardiac membranes [CORRECT]
C. Increase IV fluid rate to dilute potassium
D. Administer insulin and glucose to shift potassium intracellularly
Correct Answer: B
Rationale: Potassium >6.5 mEq/L with ECG changes (peaked T waves, widened QRS) is
life-threatening requiring emergent dialysis. Calcium gluconate stabilizes cardiac
membranes (first priority), followed by insulin/glucose, bicarbonate, and dialysis. Oral
Kayexalate (Option A) works too slowly for emergency. Increasing fluids (Option C)
doesn't address hyperkalemia directly. Insulin/glucose (Option D) is important but
doesn't protect the heart immediately like calcium.
Q4: A patient with CKD Stage 4 (GFR 25 mL/min) develops anemia with hemoglobin 8.5
g/dL. Which pathophysiologic mechanism explains this?
A. Iron deficiency from poor dietary intake
B. Decreased erythropoietin production by damaged kidneys [CORRECT]
C. Vitamin B12 deficiency from malabsorption
D. Hemolysis from uremic toxins
Correct Answer: B
Rationale: The kidneys produce erythropoietin (EPO), which stimulates red blood cell
production in bone marrow. In CKD, peritubular fibroblasts are damaged, reducing EPO
and causing normocytic, normochromic anemia. While iron deficiency (Option A) may
,coexist, EPO deficiency is primary. B12 deficiency (Option C) causes megaloblastic
anemia. Hemolysis (Option D) is not the primary CKD anemia mechanism.
Q5: Which dietary modification is appropriate for a patient with CKD Stage 3 (GFR 45
mL/min)?
A. High protein intake to prevent malnutrition
B. Restrict protein to 0.6-0.8 g/kg/day, limit sodium, potassium, and phosphorus
[CORRECT]
C. Unlimited potassium and phosphorus intake
D. High sodium diet to maintain blood pressure
Correct Answer: B
Rationale: CKD dietary management includes moderate protein restriction (0.6-0.8
g/kg/day for non-dialysis CKD) to reduce nitrogenous waste, plus sodium restriction
(<2g/day) for blood pressure, potassium restriction to prevent hyperkalemia, and
phosphorus restriction with binders to prevent bone disease. High protein (Option A)
accelerates CKD progression. Unlimited potassium/phosphorus (Option C) causes
dangerous complications. High sodium (Option D) worsens hypertension and fluid
overload.
Q6: A patient on hemodialysis via left arm AV fistula is scheduled for blood draw. Which
action is correct?
A. Use the AV fistula arm for venipuncture since it has good blood flow
B. Avoid the fistula arm; use alternative sites for all venipuncture and BP measurements
[CORRECT]
C. Apply tourniquet tightly above the fistula to make veins more visible
D. Perform venipuncture distal to the fistula anastomosis only
Correct Answer: B
Rationale: The AV fistula arm is "vascular access—do not use" for venipuncture, IVs, or
BP measurements to prevent infection, thrombosis, or damage to the lifeline access.
Use the contralateral arm or legs. Using the fistula arm (Option A) risks access failure.
Tourniquets (Option C) and any punctures (Option D) are contraindicated in the fistula
arm.
, Q7: A patient on peritoneal dialysis reports cloudy effluent, abdominal pain, and fever
101.2°F. Which complication is suspected and what is the priority nursing action?
A. Peritonitis; obtain effluent sample for cell count and culture, administer
intraperitoneal antibiotics [CORRECT]
B. Catheter exit site infection; apply topical antibiotic ointment
C. Dialysis disequilibrium syndrome; slow the exchange rate
D. Hernia; support with abdominal binder
Correct Answer: A
Rationale: Cloudy effluent with abdominal pain and fever is classic peritonitis—the most
serious PD complication. Priority is obtaining effluent for WBC count (>100 cells/mm3
with >50% neutrophils indicates peritonitis) and culture, then initiating empiric
intraperitoneal antibiotics (covering gram-positive and gram-negative organisms). Exit
site infection (Option B) presents with local erythema/purulence. Disequilibrium (Option
C) causes neurologic symptoms. Hernia (Option D) causes bulging, not cloudy fluid.
Q8: A female patient presents with dysuria, urinary frequency, urgency, and suprapubic
pain without fever. Urinalysis shows positive nitrites and leukocyte esterase. Which
condition is most likely?
A. Acute pyelonephritis
B. Acute cystitis (lower UTI) [CORRECT]
C. Acute prostatitis
D. Glomerulonephritis
Correct Answer: B
Rationale: Dysuria, frequency, urgency, and suprapubic pain without systemic symptoms
(fever, flank pain) indicates lower UTI/cystitis. Positive nitrites (bacterial reduction of
nitrates) and leukocyte esterase (WBCs) confirm infection. Pyelonephritis (Option A)
would show fever, chills, flank pain, and CVA tenderness. Prostatitis (Option C) occurs in
males with perineal pain. Glomerulonephritis (Option D) presents with hematuria,
proteinuria, edema, and hypertension, not dysuria.
Q9: Which organism is the most common cause of uncomplicated community-acquired
UTIs in women?
A. Pseudomonas aeruginosa
B. Staphylococcus saprophyticus
Questions and Verified Answers with Rationales | 100%
Correct Grade A | Galen College | Pass Guaranteed
Renal/Urinary Disorders (20 Questions)
AKI, CKD, Dialysis, UTI, Glomerulonephritis, Nephrolithiasis
Q1: A 68-year-old patient with heart failure is admitted with decreased urine output, BUN
45 mg/dL, creatinine 2.8 mg/dL (baseline 1.0), and FENa <1%. Which type of acute
kidney injury is most likely?
A. Intrinsic acute tubular necrosis from nephrotoxic medications
B. Prerenal AKI from decreased renal perfusion due to poor cardiac output [CORRECT]
C. Postrenal AKI from urinary tract obstruction
D. Interstitial nephritis from allergic reaction
Correct Answer: B
Rationale: The FENa (fractional excretion of sodium) <1% indicates sodium avidity by
functional kidneys responding to decreased perfusion—characteristic of prerenal AKI.
The BUN:Creatinine ratio >20:1 also suggests prerenal etiology. Heart failure reduces
cardiac output and renal perfusion. Intrinsic ATN (Option A) would show FENa >2% and
muddy brown casts. Postrenal (Option C) would show obstruction signs. Interstitial
nephritis (Option D) would show eosinophils and medication exposure.
Q2: A patient with AKI has the following arterial blood gas: pH 7.28, HCO3 18 mEq/L,
PaCO2 32 mmHg. Which metabolic complication is present?
A. Respiratory acidosis from pulmonary edema
B. Metabolic acidosis with respiratory compensation from impaired acid excretion
[CORRECT]
C. Respiratory alkalosis from hyperventilation
D. Metabolic alkalosis from vomiting
Correct Answer: B
,Rationale: The low pH (acidemia), low bicarbonate (metabolic acidosis), and low PaCO2
(respiratory compensation—hyperventilation to blow off CO2) indicate metabolic
acidosis from impaired renal acid excretion and bicarbonate regeneration in AKI. The
anion gap would be elevated. Respiratory acidosis (Option A) would show high PaCO2.
Respiratory alkalosis (Option C) would show high pH. Metabolic alkalosis (Option D)
would show high bicarbonate.
Q3: Which nursing intervention is PRIORITY for a patient with AKI and serum potassium
6.8 mEq/L?
A. Administer oral sodium polystyrene sulfonate (Kayexalate)
B. Prepare for emergent hemodialysis and administer calcium gluconate to stabilize
cardiac membranes [CORRECT]
C. Increase IV fluid rate to dilute potassium
D. Administer insulin and glucose to shift potassium intracellularly
Correct Answer: B
Rationale: Potassium >6.5 mEq/L with ECG changes (peaked T waves, widened QRS) is
life-threatening requiring emergent dialysis. Calcium gluconate stabilizes cardiac
membranes (first priority), followed by insulin/glucose, bicarbonate, and dialysis. Oral
Kayexalate (Option A) works too slowly for emergency. Increasing fluids (Option C)
doesn't address hyperkalemia directly. Insulin/glucose (Option D) is important but
doesn't protect the heart immediately like calcium.
Q4: A patient with CKD Stage 4 (GFR 25 mL/min) develops anemia with hemoglobin 8.5
g/dL. Which pathophysiologic mechanism explains this?
A. Iron deficiency from poor dietary intake
B. Decreased erythropoietin production by damaged kidneys [CORRECT]
C. Vitamin B12 deficiency from malabsorption
D. Hemolysis from uremic toxins
Correct Answer: B
Rationale: The kidneys produce erythropoietin (EPO), which stimulates red blood cell
production in bone marrow. In CKD, peritubular fibroblasts are damaged, reducing EPO
and causing normocytic, normochromic anemia. While iron deficiency (Option A) may
,coexist, EPO deficiency is primary. B12 deficiency (Option C) causes megaloblastic
anemia. Hemolysis (Option D) is not the primary CKD anemia mechanism.
Q5: Which dietary modification is appropriate for a patient with CKD Stage 3 (GFR 45
mL/min)?
A. High protein intake to prevent malnutrition
B. Restrict protein to 0.6-0.8 g/kg/day, limit sodium, potassium, and phosphorus
[CORRECT]
C. Unlimited potassium and phosphorus intake
D. High sodium diet to maintain blood pressure
Correct Answer: B
Rationale: CKD dietary management includes moderate protein restriction (0.6-0.8
g/kg/day for non-dialysis CKD) to reduce nitrogenous waste, plus sodium restriction
(<2g/day) for blood pressure, potassium restriction to prevent hyperkalemia, and
phosphorus restriction with binders to prevent bone disease. High protein (Option A)
accelerates CKD progression. Unlimited potassium/phosphorus (Option C) causes
dangerous complications. High sodium (Option D) worsens hypertension and fluid
overload.
Q6: A patient on hemodialysis via left arm AV fistula is scheduled for blood draw. Which
action is correct?
A. Use the AV fistula arm for venipuncture since it has good blood flow
B. Avoid the fistula arm; use alternative sites for all venipuncture and BP measurements
[CORRECT]
C. Apply tourniquet tightly above the fistula to make veins more visible
D. Perform venipuncture distal to the fistula anastomosis only
Correct Answer: B
Rationale: The AV fistula arm is "vascular access—do not use" for venipuncture, IVs, or
BP measurements to prevent infection, thrombosis, or damage to the lifeline access.
Use the contralateral arm or legs. Using the fistula arm (Option A) risks access failure.
Tourniquets (Option C) and any punctures (Option D) are contraindicated in the fistula
arm.
, Q7: A patient on peritoneal dialysis reports cloudy effluent, abdominal pain, and fever
101.2°F. Which complication is suspected and what is the priority nursing action?
A. Peritonitis; obtain effluent sample for cell count and culture, administer
intraperitoneal antibiotics [CORRECT]
B. Catheter exit site infection; apply topical antibiotic ointment
C. Dialysis disequilibrium syndrome; slow the exchange rate
D. Hernia; support with abdominal binder
Correct Answer: A
Rationale: Cloudy effluent with abdominal pain and fever is classic peritonitis—the most
serious PD complication. Priority is obtaining effluent for WBC count (>100 cells/mm3
with >50% neutrophils indicates peritonitis) and culture, then initiating empiric
intraperitoneal antibiotics (covering gram-positive and gram-negative organisms). Exit
site infection (Option B) presents with local erythema/purulence. Disequilibrium (Option
C) causes neurologic symptoms. Hernia (Option D) causes bulging, not cloudy fluid.
Q8: A female patient presents with dysuria, urinary frequency, urgency, and suprapubic
pain without fever. Urinalysis shows positive nitrites and leukocyte esterase. Which
condition is most likely?
A. Acute pyelonephritis
B. Acute cystitis (lower UTI) [CORRECT]
C. Acute prostatitis
D. Glomerulonephritis
Correct Answer: B
Rationale: Dysuria, frequency, urgency, and suprapubic pain without systemic symptoms
(fever, flank pain) indicates lower UTI/cystitis. Positive nitrites (bacterial reduction of
nitrates) and leukocyte esterase (WBCs) confirm infection. Pyelonephritis (Option A)
would show fever, chills, flank pain, and CVA tenderness. Prostatitis (Option C) occurs in
males with perineal pain. Glomerulonephritis (Option D) presents with hematuria,
proteinuria, edema, and hypertension, not dysuria.
Q9: Which organism is the most common cause of uncomplicated community-acquired
UTIs in women?
A. Pseudomonas aeruginosa
B. Staphylococcus saprophyticus
