Galen College NUR 265 Final Exam Prep – Medical-Surgical
Nursing Complete 180+ Question Practice Test & Evidence-
Based Rationales
1. A client with chronic kidney disease (CKD) has a potassium level of 6.2 mEq/L.
Which intervention should the nurse implement first?
A. Administer sodium polystyrene sulfonate (Kayexalate).
B. Prepare the client for emergency hemodialysis.
C. Place the client on a cardiac monitor.
D. Restrict all oral intake.
✔Correct Answer: C
Rationale: Hyperkalemia (K+ > 6.0) can cause fatal cardiac dysrhythmias. The
priority is to place the client on a cardiac monitor to detect changes (peaked T
waves, wide QRS) while preparing for other treatments .
2. A client on hemodialysis has an arteriovenous (AV) fistula in the left arm.
Which action by the nurse is appropriate?
,A. Take blood pressure in the left arm.
B. Palpate for a thrill over the fistula.
C. Draw blood from the fistula site.
D. Apply a tight tourniquet above the fistula.
✔Correct Answer: B
Rationale: A palpable thrill and audible bruit indicate patency of the AV fistula.
Blood pressure, venipuncture, and tight tourniquets should never be done on the
fistula arm .
3. The nurse is caring for a client with nephrotic syndrome who has severe
proteinuria. Which of the following actions should the nurse take?
A. Administer furosemide.
B. Administer lisinopril.
C. Restrict fluids.
D. Increase protein intake.
✔Correct Answer: B
Rationale: ACE inhibitors (lisinopril) reduce proteinuria by lowering
intraglomerular pressure, which slows the progression of kidney damage .
,4. A client with acute kidney injury (AKI) in the oliguric phase has a serum
potassium of 6.8 mEq/L and ECG changes. Which medication should the nurse
prepare to administer?
A. IV insulin and dextrose.
B. Oral potassium chloride.
C. IV calcium gluconate.
D. IV furosemide.
✔Correct Answer: C
Rationale: IV calcium gluconate is given first in severe hyperkalemia to stabilize
the cardiac membrane and prevent dysrhythmias. Insulin/dextrose shifts
potassium into cells but takes longer .
5. A client with CKD has a hemoglobin of 8.2 g/dL. The nurse anticipates an
order for which medication?
A. Iron sulfate.
B. Epoetin alfa (Epogen, Procrit).
C. Folic acid.
D. Vitamin B12.
, ✔Correct Answer: B
Rationale: CKD causes decreased erythropoietin production by the
kidneys. Epoetin alfa is synthetic erythropoietin used to stimulate red blood cell
production and treat anemia of CKD .
6. A client receiving peritoneal dialysis reports abdominal pain and the dialysate
outflow is cloudy. What should the nurse do first?
A. Send a sample of the effluent for culture and sensitivity.
B. Administer oral pain medication.
C. Irrigate the peritoneal catheter with normal saline.
D. Remove the peritoneal dialysis catheter.
✔Correct Answer: A
Rationale: Cloudy dialysate outflow is the hallmark sign of peritonitis. The nurse
should send a sample for culture and sensitivity to identify the organism and
guide antibiotic therapy .
7. Which breakfast choice indicates a client with CKD understands a low-sodium
diet?
A. Bacon and eggs with toast.
B. Oatmeal with fresh blueberries.
Nursing Complete 180+ Question Practice Test & Evidence-
Based Rationales
1. A client with chronic kidney disease (CKD) has a potassium level of 6.2 mEq/L.
Which intervention should the nurse implement first?
A. Administer sodium polystyrene sulfonate (Kayexalate).
B. Prepare the client for emergency hemodialysis.
C. Place the client on a cardiac monitor.
D. Restrict all oral intake.
✔Correct Answer: C
Rationale: Hyperkalemia (K+ > 6.0) can cause fatal cardiac dysrhythmias. The
priority is to place the client on a cardiac monitor to detect changes (peaked T
waves, wide QRS) while preparing for other treatments .
2. A client on hemodialysis has an arteriovenous (AV) fistula in the left arm.
Which action by the nurse is appropriate?
,A. Take blood pressure in the left arm.
B. Palpate for a thrill over the fistula.
C. Draw blood from the fistula site.
D. Apply a tight tourniquet above the fistula.
✔Correct Answer: B
Rationale: A palpable thrill and audible bruit indicate patency of the AV fistula.
Blood pressure, venipuncture, and tight tourniquets should never be done on the
fistula arm .
3. The nurse is caring for a client with nephrotic syndrome who has severe
proteinuria. Which of the following actions should the nurse take?
A. Administer furosemide.
B. Administer lisinopril.
C. Restrict fluids.
D. Increase protein intake.
✔Correct Answer: B
Rationale: ACE inhibitors (lisinopril) reduce proteinuria by lowering
intraglomerular pressure, which slows the progression of kidney damage .
,4. A client with acute kidney injury (AKI) in the oliguric phase has a serum
potassium of 6.8 mEq/L and ECG changes. Which medication should the nurse
prepare to administer?
A. IV insulin and dextrose.
B. Oral potassium chloride.
C. IV calcium gluconate.
D. IV furosemide.
✔Correct Answer: C
Rationale: IV calcium gluconate is given first in severe hyperkalemia to stabilize
the cardiac membrane and prevent dysrhythmias. Insulin/dextrose shifts
potassium into cells but takes longer .
5. A client with CKD has a hemoglobin of 8.2 g/dL. The nurse anticipates an
order for which medication?
A. Iron sulfate.
B. Epoetin alfa (Epogen, Procrit).
C. Folic acid.
D. Vitamin B12.
, ✔Correct Answer: B
Rationale: CKD causes decreased erythropoietin production by the
kidneys. Epoetin alfa is synthetic erythropoietin used to stimulate red blood cell
production and treat anemia of CKD .
6. A client receiving peritoneal dialysis reports abdominal pain and the dialysate
outflow is cloudy. What should the nurse do first?
A. Send a sample of the effluent for culture and sensitivity.
B. Administer oral pain medication.
C. Irrigate the peritoneal catheter with normal saline.
D. Remove the peritoneal dialysis catheter.
✔Correct Answer: A
Rationale: Cloudy dialysate outflow is the hallmark sign of peritonitis. The nurse
should send a sample for culture and sensitivity to identify the organism and
guide antibiotic therapy .
7. Which breakfast choice indicates a client with CKD understands a low-sodium
diet?
A. Bacon and eggs with toast.
B. Oatmeal with fresh blueberries.
