NU189 | NU 189 Medical-Surgical Nursing II Exam
2 v3 | Questions with Correct Answers and Expert
Explanation for Each Question | Galen
1. A patient with Acute Kidney Injury (AKI) is in the oliguric phase. Which clinical
manifestation should the nurse expect to observe?
A. Urinary output of 600 mL/day
B. Serum creatinine level of 0.8 mg/dL
C. Hypotension and tachycardia
D. Hyperkalemia and metabolic acidosis
Correct Answer: D
Expert Explanation: In the oliguric phase of AKI, the kidneys fail to excrete
metabolic wastes and electrolytes. This leads to the retention of potassium,
resulting in hyperkalemia, and the inability to excrete hydrogen ions, leading to
metabolic acidosis. The nurse must monitor for cardiac arrhythmias associated with
high potassium levels.
2. A nurse is assessing a client’s arteriovenous (AV) fistula for hemodialysis. Which
finding indicates a functional access site?
A. Absence of a bruit upon auscultation
B. Redness and warmth around the incision
,C. Coolness and pallor distal to the site
D. A palpable thrill over the site
Correct Answer: D
Expert Explanation: A palpable thrill and an audible bruit are normal findings
indicating that the blood is flowing properly through the AV fistula. If these are
absent, it suggests a clot or obstruction within the access site. The nurse should also
check for distal pulses to ensure adequate circulation to the hand.
3. Which medication is typically withheld before a scheduled hemodialysis treatment
to prevent complications?
A. Insulin
B. Stool softeners
C. Lisinopril
D. Phosphate binders
Correct Answer: C
Expert Explanation: Antihypertensive medications like Lisinopril are often held
before dialysis because the procedure itself can cause significant hypotension.
Dialysis removes fluid and can lower blood pressure, which would be exacerbated
,by the medication. The nurse should check the physician’s specific orders regarding
pre-dialysis medications.
4. A client with Chronic Kidney Disease (CKD) has a phosphorus level of 6.2 mg/dL.
Which medication does the nurse anticipate administering?
A. Furosemide
B. Calcium acetate
C. Potassium chloride
D. Epoetin alfa
Correct Answer: B
Expert Explanation: Calcium acetate is a phosphate binder used to treat
hyperphosphatemia in CKD patients. It works by binding to phosphorus in the
gastrointestinal tract, allowing it to be excreted in the stool. This medication must
be taken with meals to be effective in binding dietary phosphorus.
5. A nurse is teaching a client about peritoneal dialysis. Which symptom should the
nurse instruct the client to report immediately as a sign of peritonitis?
A. Cloudy or opaque effluent
B. Clear dialysate drainage
C. Increased appetite
, D. Firmness of the abdomen after infusion
Correct Answer: A
Expert Explanation: Cloudy or opaque dialysate drainage is one of the earliest
signs of peritonitis, an infection of the peritoneal cavity. Clients may also experience
abdominal pain, rebound tenderness, and fever. Prompt recognition and treatment
with antibiotics are necessary to prevent systemic infection.
6. A client is diagnosed with Cushing’s Syndrome. Which physical assessment finding is
most characteristic of this condition?
A. Truncal obesity and a buffalo hump
B. Weight loss and hypotension
C. Bronze-colored skin pigmentation
D. Exophthalmos and tremors
Correct Answer: A
Expert Explanation: Cushing’s Syndrome is caused by an excess of cortisol, which
leads to fat redistribution. This results in the classic ‘moon face,’ truncal obesity, and
a fat pad on the back known as a buffalo hump. The nurse should also monitor for
hypertension and hyperglycemia in these patients.
2 v3 | Questions with Correct Answers and Expert
Explanation for Each Question | Galen
1. A patient with Acute Kidney Injury (AKI) is in the oliguric phase. Which clinical
manifestation should the nurse expect to observe?
A. Urinary output of 600 mL/day
B. Serum creatinine level of 0.8 mg/dL
C. Hypotension and tachycardia
D. Hyperkalemia and metabolic acidosis
Correct Answer: D
Expert Explanation: In the oliguric phase of AKI, the kidneys fail to excrete
metabolic wastes and electrolytes. This leads to the retention of potassium,
resulting in hyperkalemia, and the inability to excrete hydrogen ions, leading to
metabolic acidosis. The nurse must monitor for cardiac arrhythmias associated with
high potassium levels.
2. A nurse is assessing a client’s arteriovenous (AV) fistula for hemodialysis. Which
finding indicates a functional access site?
A. Absence of a bruit upon auscultation
B. Redness and warmth around the incision
,C. Coolness and pallor distal to the site
D. A palpable thrill over the site
Correct Answer: D
Expert Explanation: A palpable thrill and an audible bruit are normal findings
indicating that the blood is flowing properly through the AV fistula. If these are
absent, it suggests a clot or obstruction within the access site. The nurse should also
check for distal pulses to ensure adequate circulation to the hand.
3. Which medication is typically withheld before a scheduled hemodialysis treatment
to prevent complications?
A. Insulin
B. Stool softeners
C. Lisinopril
D. Phosphate binders
Correct Answer: C
Expert Explanation: Antihypertensive medications like Lisinopril are often held
before dialysis because the procedure itself can cause significant hypotension.
Dialysis removes fluid and can lower blood pressure, which would be exacerbated
,by the medication. The nurse should check the physician’s specific orders regarding
pre-dialysis medications.
4. A client with Chronic Kidney Disease (CKD) has a phosphorus level of 6.2 mg/dL.
Which medication does the nurse anticipate administering?
A. Furosemide
B. Calcium acetate
C. Potassium chloride
D. Epoetin alfa
Correct Answer: B
Expert Explanation: Calcium acetate is a phosphate binder used to treat
hyperphosphatemia in CKD patients. It works by binding to phosphorus in the
gastrointestinal tract, allowing it to be excreted in the stool. This medication must
be taken with meals to be effective in binding dietary phosphorus.
5. A nurse is teaching a client about peritoneal dialysis. Which symptom should the
nurse instruct the client to report immediately as a sign of peritonitis?
A. Cloudy or opaque effluent
B. Clear dialysate drainage
C. Increased appetite
, D. Firmness of the abdomen after infusion
Correct Answer: A
Expert Explanation: Cloudy or opaque dialysate drainage is one of the earliest
signs of peritonitis, an infection of the peritoneal cavity. Clients may also experience
abdominal pain, rebound tenderness, and fever. Prompt recognition and treatment
with antibiotics are necessary to prevent systemic infection.
6. A client is diagnosed with Cushing’s Syndrome. Which physical assessment finding is
most characteristic of this condition?
A. Truncal obesity and a buffalo hump
B. Weight loss and hypotension
C. Bronze-colored skin pigmentation
D. Exophthalmos and tremors
Correct Answer: A
Expert Explanation: Cushing’s Syndrome is caused by an excess of cortisol, which
leads to fat redistribution. This results in the classic ‘moon face,’ truncal obesity, and
a fat pad on the back known as a buffalo hump. The nurse should also monitor for
hypertension and hyperglycemia in these patients.
