NUR 265
OBJECTIVE ASSESSMENT - EXAM
NUR 265 Exam 1
Medical-Surgical Nursing (2026/2027)
Galen College of Nursing | Advanced Concepts of Medical-Surgical Nursing
50 100% 2026/2027
QUESTIONS VERIFIED ANSWERS EDITION
TOPICS COVERED
• Renal & Urinary Disorders • GI & Hepatic Disorders
• Cardiovascular Disorders • Endocrine & Immune Disorders
• Respiratory Disorders • Fluid, Electrolyte & Acid-Base
COVER PAGE - 1
,SECTION 1 | Renal and Urinary Disorders | Q1-Q10 | NUR 265 2026/2027
Q1 Question 1 of 50
A 68-year-old male is admitted with acute kidney injury following coronary artery
bypass grafting. His urine output has dropped to 15 mL/hr for the past 6 hours, and
his serum creatinine has risen from 0.9 mg/dL to 2.4 mg/dL. Which nursing
intervention is the priority for this client?
A. Administer a loop diuretic to increase urine output immediately.
B. Assess for signs of fluid overload and monitor daily weights.
C. Restrict all oral fluid intake to 500 mL per day.
D. Begin peritoneal dialysis within the first 24 hours of diagnosis.
Correct Answer: B
Rationale:
In acute kidney injury, the priority nursing intervention is assessing fluid status and monitoring for
overload, as impaired renal excretion leads to volume retention. Administering diuretics may be
ineffective in intrinsic AKI, fluid restriction is individualized, and dialysis is reserved for specific
indications like refractory hyperkalemia or fluid overload.
Q2 Question 2 of 50
A 54-year-old female with chronic kidney disease stage 4 is being educated about
dietary modifications. She asks why protein intake must be restricted. What is the
nurse's best response?
A. Protein restriction prevents the buildup of nitrogenous waste products that the kidneys cannot
adequately excrete.
B. High protein intake causes permanent scarring of the renal tubules and accelerates fibrosis.
C. Protein foods contain excessive potassium, which worsens cardiac conduction in CKD clients.
D. Restricting protein improves glomerular filtration rate by reducing intrarenal pressure.
Correct Answer: A
Rationale:
In CKD, reduced GFR impairs the excretion of nitrogenous wastes from protein metabolism, leading to
azotemia. Protein restriction of 0.6-0.8 g/kg/day reduces urea generation and delays progression. While
some protein foods are high in potassium, this is not the primary rationale for protein restriction.
NUR 265 - 2026/2027 | Passing Score: 80% | Page 2 of 26
, Q3 Question 3 of 50
A 42-year-old male with nephrotic syndrome presents with severe periorbital edema,
ascites, and a serum albumin of 1.8 g/dL. The nurse notes that his blood pressure is
158/96 mmHg. Which pathophysiologic mechanism best explains the hypertension in
this client?
A. Decreased glomerular filtration triggers compensatory activation of the
renin-angiotensin-aldosterone system.
B. Massive proteinuria causes hypoalbuminemia, leading to intravascular volume depletion and
reflex tachycardia.
C. Sodium and water retention secondary to decreased oncotic pressure activates
volume-dependent mechanisms.
D. Endothelial dysfunction from circulating immune complexes directly increases systemic
vascular resistance.
Correct Answer: C
Rationale:
In nephrotic syndrome, hypoalbuminemia reduces plasma oncotic pressure, causing fluid shifts into
interstitial spaces. The kidneys respond by retaining sodium and water, leading to volume expansion and
hypertension. While RAAS may be involved, the primary mechanism is sodium and water retention due
to decreased oncotic pressure.
Q4 Question 4 of 50
A 73-year-old female on hemodialysis three times weekly complains of muscle cramps
in her legs during the last hour of treatment. Her blood pressure has dropped from
142/88 to 98/62 mmHg. What is the most appropriate nursing action?
A. Increase the ultrafiltration rate to complete the prescribed fluid removal faster.
B. Administer a bolus of normal saline and reduce the ultrafiltration rate.
C. Give oral potassium supplements to correct the electrolyte imbalance causing cramps.
D. Discontinue dialysis immediately and transfer the client to the emergency department.
Correct Answer: B
Rationale:
Muscle cramps and hypotension during hemodialysis indicate intradialytic hypotension from rapid fluid
removal. The appropriate intervention is to slow ultrafiltration and administer a saline bolus to restore
intravascular volume. Increasing ultrafiltration worsens hypotension, and potassium supplements are
contraindicated without confirmed hypokalemia.
NUR 265 - 2026/2027 | Passing Score: 80% | Page 3 of 26
OBJECTIVE ASSESSMENT - EXAM
NUR 265 Exam 1
Medical-Surgical Nursing (2026/2027)
Galen College of Nursing | Advanced Concepts of Medical-Surgical Nursing
50 100% 2026/2027
QUESTIONS VERIFIED ANSWERS EDITION
TOPICS COVERED
• Renal & Urinary Disorders • GI & Hepatic Disorders
• Cardiovascular Disorders • Endocrine & Immune Disorders
• Respiratory Disorders • Fluid, Electrolyte & Acid-Base
COVER PAGE - 1
,SECTION 1 | Renal and Urinary Disorders | Q1-Q10 | NUR 265 2026/2027
Q1 Question 1 of 50
A 68-year-old male is admitted with acute kidney injury following coronary artery
bypass grafting. His urine output has dropped to 15 mL/hr for the past 6 hours, and
his serum creatinine has risen from 0.9 mg/dL to 2.4 mg/dL. Which nursing
intervention is the priority for this client?
A. Administer a loop diuretic to increase urine output immediately.
B. Assess for signs of fluid overload and monitor daily weights.
C. Restrict all oral fluid intake to 500 mL per day.
D. Begin peritoneal dialysis within the first 24 hours of diagnosis.
Correct Answer: B
Rationale:
In acute kidney injury, the priority nursing intervention is assessing fluid status and monitoring for
overload, as impaired renal excretion leads to volume retention. Administering diuretics may be
ineffective in intrinsic AKI, fluid restriction is individualized, and dialysis is reserved for specific
indications like refractory hyperkalemia or fluid overload.
Q2 Question 2 of 50
A 54-year-old female with chronic kidney disease stage 4 is being educated about
dietary modifications. She asks why protein intake must be restricted. What is the
nurse's best response?
A. Protein restriction prevents the buildup of nitrogenous waste products that the kidneys cannot
adequately excrete.
B. High protein intake causes permanent scarring of the renal tubules and accelerates fibrosis.
C. Protein foods contain excessive potassium, which worsens cardiac conduction in CKD clients.
D. Restricting protein improves glomerular filtration rate by reducing intrarenal pressure.
Correct Answer: A
Rationale:
In CKD, reduced GFR impairs the excretion of nitrogenous wastes from protein metabolism, leading to
azotemia. Protein restriction of 0.6-0.8 g/kg/day reduces urea generation and delays progression. While
some protein foods are high in potassium, this is not the primary rationale for protein restriction.
NUR 265 - 2026/2027 | Passing Score: 80% | Page 2 of 26
, Q3 Question 3 of 50
A 42-year-old male with nephrotic syndrome presents with severe periorbital edema,
ascites, and a serum albumin of 1.8 g/dL. The nurse notes that his blood pressure is
158/96 mmHg. Which pathophysiologic mechanism best explains the hypertension in
this client?
A. Decreased glomerular filtration triggers compensatory activation of the
renin-angiotensin-aldosterone system.
B. Massive proteinuria causes hypoalbuminemia, leading to intravascular volume depletion and
reflex tachycardia.
C. Sodium and water retention secondary to decreased oncotic pressure activates
volume-dependent mechanisms.
D. Endothelial dysfunction from circulating immune complexes directly increases systemic
vascular resistance.
Correct Answer: C
Rationale:
In nephrotic syndrome, hypoalbuminemia reduces plasma oncotic pressure, causing fluid shifts into
interstitial spaces. The kidneys respond by retaining sodium and water, leading to volume expansion and
hypertension. While RAAS may be involved, the primary mechanism is sodium and water retention due
to decreased oncotic pressure.
Q4 Question 4 of 50
A 73-year-old female on hemodialysis three times weekly complains of muscle cramps
in her legs during the last hour of treatment. Her blood pressure has dropped from
142/88 to 98/62 mmHg. What is the most appropriate nursing action?
A. Increase the ultrafiltration rate to complete the prescribed fluid removal faster.
B. Administer a bolus of normal saline and reduce the ultrafiltration rate.
C. Give oral potassium supplements to correct the electrolyte imbalance causing cramps.
D. Discontinue dialysis immediately and transfer the client to the emergency department.
Correct Answer: B
Rationale:
Muscle cramps and hypotension during hemodialysis indicate intradialytic hypotension from rapid fluid
removal. The appropriate intervention is to slow ultrafiltration and administer a saline bolus to restore
intravascular volume. Increasing ultrafiltration worsens hypotension, and potassium supplements are
contraindicated without confirmed hypokalemia.
NUR 265 - 2026/2027 | Passing Score: 80% | Page 3 of 26
