Ultimate NUR 265 Medical-Surgical Nursing
Exam Guide – Galen College 180+ Practice
Questions with Correct ✔Correct
Answers & Clinical Rationales|2026|2027
1. A client with acute kidney injury (AKI) has a urine output of 10 mL/hr for 2
consecutive hours. Which laboratory value requires the nurse’s immediate
notification of the provider?
A) BUN 28 mg/dL
B) Potassium 6.4 mEq/L
C) Creatinine 1.8 mg/dL
D) Sodium 134 mEq/L
✅ ✔Correct Answer: B
💡 Rationale: Hyperkalemia >6.0 mEq/L in AKI can cause fatal dysrhythmias and
requires urgent treatment (calcium gluconate, insulin/dextrose, dialysis
preparation). Other values are elevated but not immediately life-threatening.
,2. Which nursing intervention is priority for a client receiving continuous bladder
irrigation (CBI) after transurethral resection of the prostate (TURP)?
A) Maintain catheter traction for 6 hours
B) Adjust irrigation rate to keep effluent light pink
C) Restrict oral fluids to prevent bladder overdistention
D) Administer prophylactic antibiotics every 12 hours
✅ ✔Correct Answer: B
💡 Rationale: CBI rate is titrated to maintain light pink/clear drainage to prevent
clot formation and obstruction. Traction is typically temporary; fluids are
encouraged; antibiotics are not routine unless infection is present.
3. A client with cirrhosis develops hepatic encephalopathy. Which finding
indicates worsening condition?
A) Asterixis
B) Fetor hepaticus
C) Lethargy progressing to stupor
D) Spider angiomas
✅ ✔Correct Answer: C
💡 Rationale: Progression from lethargy to stupor/coma indicates worsening
cerebral ammonia toxicity and requires immediate intervention. Asterixis and
fetor are expected early signs; spider angiomas are chronic.
,4. The nurse is caring for a client with acute pancreatitis. Which order should the
nurse question?
A) NPO status
B) IV morphine 4 mg every 4 hours PRN
C) Clear liquid diet advancing as tolerated
D) Serum lipase q12h
✅ ✔Correct Answer: C
💡 Rationale: Oral intake is contraindicated during acute pancreatitis until pain
resolves and enzymes normalize. Advancing to clear liquids too early can
stimulate pancreatic secretion and worsen inflammation.
5. A client with CKD stage 5 is scheduled for hemodialysis. Which assessment
finding requires the nurse to hold the session and notify the provider?
A) Weight gain of 2 kg
B) Hemoglobin 9.2 g/dL
C) Systolic BP 88 mmHg
D) Potassium 5.1 mEq/L
✅ ✔Correct Answer: C
💡 Rationale: Hypotension increases risk of dialysis-induced hemodynamic
collapse. The session may need to be delayed or modified with saline
bolus/vasopressors. Weight gain, mild anemia, and borderline K+ are expected
and managed during dialysis.
, 6. Which medication requires the nurse to monitor for ototoxicity in a client
receiving treatment for AKI?
A) Furosemide
B) Lisinopril
C) Sodium bicarbonate
D) Epoetin alfa
✅ ✔Correct Answer: A
💡 Rationale: Loop diuretics like furosemide can cause ototoxicity, especially with
rapid IV push or in renal impairment. Monitor for tinnitus, hearing loss, and
vertigo.
7. A client with hepatorenal syndrome is admitted. Which intervention is priority?
A) Administer lactulose
B) Restrict sodium to 1 g/day
C) Prepare for albumin and vasoconstrictor therapy
D) Encourage high-protein diet
✅ ✔Correct Answer: C
💡 Rationale: Hepatorenal syndrome is treated with albumin expansion plus
vasoconstrictors (midodrine/octreotide or terlipressin) to improve renal
perfusion. Lactulose is for encephalopathy; protein restriction is outdated; sodium
restriction is long-term.
Exam Guide – Galen College 180+ Practice
Questions with Correct ✔Correct
Answers & Clinical Rationales|2026|2027
1. A client with acute kidney injury (AKI) has a urine output of 10 mL/hr for 2
consecutive hours. Which laboratory value requires the nurse’s immediate
notification of the provider?
A) BUN 28 mg/dL
B) Potassium 6.4 mEq/L
C) Creatinine 1.8 mg/dL
D) Sodium 134 mEq/L
✅ ✔Correct Answer: B
💡 Rationale: Hyperkalemia >6.0 mEq/L in AKI can cause fatal dysrhythmias and
requires urgent treatment (calcium gluconate, insulin/dextrose, dialysis
preparation). Other values are elevated but not immediately life-threatening.
,2. Which nursing intervention is priority for a client receiving continuous bladder
irrigation (CBI) after transurethral resection of the prostate (TURP)?
A) Maintain catheter traction for 6 hours
B) Adjust irrigation rate to keep effluent light pink
C) Restrict oral fluids to prevent bladder overdistention
D) Administer prophylactic antibiotics every 12 hours
✅ ✔Correct Answer: B
💡 Rationale: CBI rate is titrated to maintain light pink/clear drainage to prevent
clot formation and obstruction. Traction is typically temporary; fluids are
encouraged; antibiotics are not routine unless infection is present.
3. A client with cirrhosis develops hepatic encephalopathy. Which finding
indicates worsening condition?
A) Asterixis
B) Fetor hepaticus
C) Lethargy progressing to stupor
D) Spider angiomas
✅ ✔Correct Answer: C
💡 Rationale: Progression from lethargy to stupor/coma indicates worsening
cerebral ammonia toxicity and requires immediate intervention. Asterixis and
fetor are expected early signs; spider angiomas are chronic.
,4. The nurse is caring for a client with acute pancreatitis. Which order should the
nurse question?
A) NPO status
B) IV morphine 4 mg every 4 hours PRN
C) Clear liquid diet advancing as tolerated
D) Serum lipase q12h
✅ ✔Correct Answer: C
💡 Rationale: Oral intake is contraindicated during acute pancreatitis until pain
resolves and enzymes normalize. Advancing to clear liquids too early can
stimulate pancreatic secretion and worsen inflammation.
5. A client with CKD stage 5 is scheduled for hemodialysis. Which assessment
finding requires the nurse to hold the session and notify the provider?
A) Weight gain of 2 kg
B) Hemoglobin 9.2 g/dL
C) Systolic BP 88 mmHg
D) Potassium 5.1 mEq/L
✅ ✔Correct Answer: C
💡 Rationale: Hypotension increases risk of dialysis-induced hemodynamic
collapse. The session may need to be delayed or modified with saline
bolus/vasopressors. Weight gain, mild anemia, and borderline K+ are expected
and managed during dialysis.
, 6. Which medication requires the nurse to monitor for ototoxicity in a client
receiving treatment for AKI?
A) Furosemide
B) Lisinopril
C) Sodium bicarbonate
D) Epoetin alfa
✅ ✔Correct Answer: A
💡 Rationale: Loop diuretics like furosemide can cause ototoxicity, especially with
rapid IV push or in renal impairment. Monitor for tinnitus, hearing loss, and
vertigo.
7. A client with hepatorenal syndrome is admitted. Which intervention is priority?
A) Administer lactulose
B) Restrict sodium to 1 g/day
C) Prepare for albumin and vasoconstrictor therapy
D) Encourage high-protein diet
✅ ✔Correct Answer: C
💡 Rationale: Hepatorenal syndrome is treated with albumin expansion plus
vasoconstrictors (midodrine/octreotide or terlipressin) to improve renal
perfusion. Lactulose is for encephalopathy; protein restriction is outdated; sodium
restriction is long-term.
