Exam 1: NUR 265 (2026/2026 Update) Advanced Concepts of
Medical-Surgical Nursing Review
Complete 200-Practice-Question Bank with Verified Answers
& Rationales
BLOCK 1: CARE OF PATIENTS WITH COMPLEX RENAL DISORDERS (Questions 1–45)
Q1. The nurse is caring for a client who has nephrotic syndrome with severe proteinuria. Which action
should the nurse take?
A) Administer furosemide
B) Administer lisinopril
C) Restrict fluids
D) Increase protein intake
Answer: B
Rationale: ACE inhibitors like lisinopril reduce proteinuria by lowering intraglomerular pressure, which
slows kidney damage progression. They are standard therapy in nephrotic syndrome to decrease urinary
protein loss.
Q2. The nurse is reviewing labs of assigned clients. Which client requires priority follow-up with the
primary health care provider?
A) Client 2 days post-abdominal aortic aneurysm (AAA) repair with creatinine increasing from 0.9 to 2.5
mg/dL
B) Client with creatinine stable at 1.1 mg/dL
C) Client with potassium 4.0 mEq/L
D) Client with mild hyponatremia
Answer: A
,Rationale: A significant increase in creatinine post-surgery indicates possible acute kidney injury (AKI),
requiring urgent evaluation. Normal creatinine is approximately 0.5–1.2 mg/dL, and a sharp rise signals
reduced glomerular filtration.
Q3. A client with acute kidney injury (AKI) has a serum potassium level of 6.8 mEq/L. What is the nurse's
priority intervention?
A) Administer sodium polystyrene sulfonate (Kayexalate) orally
B) Prepare the client for emergent hemodialysis
C) Administer IV calcium gluconate
D) Restrict dietary potassium intake
Answer: C
Rationale: IV calcium gluconate is given emergently to stabilize cardiac membranes and prevent
life‑threatening arrhythmias in severe hyperkalemia. It does not lower potassium but protects the heart
while other treatments take effect。
Q4. A client with chronic kidney disease (CKD) is prescribed epoetin alfa (Epogen). The nurse
understands that this medication is given to treat which complication?
A) Hyperkalemia
B) Anemia
C) Metabolic acidosis
D) Hyperphosphatemia
Answer: B
Rationale: Damaged kidneys do not produce enough erythropoietin (EPO), which stimulates red blood
cell production in the bone marrow, resulting in anemia. Epoetin alfa is synthetic EPO used to treat
anemia of CKD.
Q5. The nurse is caring for a client with AKI in the oliguric phase. Which assessment finding requires
immediate intervention?
A) Urine output of 350 mL in 24 hours
B) Blood pressure 138/88 mm Hg
,C) Crackles auscultated in bilateral lung bases
D) Serum creatinine 1.2 mg/dL
Answer: C
Rationale: Crackles in the lung bases indicate pulmonary edema due to fluid overload, a life‑threatening
complication of the oliguric phase of AKI requiring immediate intervention.
Q6. A client with CKD has a phosphate level of 7.2 mg/dL. Which medication should the nurse anticipate
administering?
A) Calcium acetate (PhosLo)
B) Sodium polystyrene sulfonate (Kayexalate)
C) Sevelamer carbonate (Renvela)
D) Both A and C
Answer: D
Rationale: Both calcium acetate and sevelamer are phosphate binders that prevent dietary phosphate
absorption. Hyperphosphatemia is common in CKD due to decreased renal excretion.
Q7. The nurse is teaching a client with CKD about dietary restrictions. Which statement by the client
indicates understanding?
A) "I need to eat more bananas and oranges to keep my potassium up."
B) "I should limit foods high in phosphorus like dairy products and nuts."
C) "I can eat as much protein as I want because I need it for healing."
D) "I should increase my fluid intake to flush out my kidneys."
Answer: B
Rationale: In CKD, kidneys cannot excrete phosphorus, leading to hyperphosphatemia. Clients should
limit high‑phosphorus foods including dairy, nuts, beans, and colas.
Q8. The nurse is assessing a client with AKI. Which finding is most consistent with the diuretic phase of
AKI?
, A) Urine output of 4,000 mL in 24 hours
B) Serum creatinine rising to 3.0 mg/dL
C) Blood pressure 180/100 mm Hg
D) Worsening pulmonary edema
Answer: A
Rationale: The diuretic phase of AKI is characterized by gradually increasing urine output (up to 3 –
5 L/24 hours). The kidneys are recovering but may not concentrate urine effectively, leading to large
urine volumes.
Q9. A client is diagnosed with Goodpasture syndrome. The nurse understands that this condition
involves:
A) Autoimmune attack on the glomerular basement membrane and lungs
B) Bacterial infection of the renal tubules
C) Cyst formation in the kidneys
D) Obstruction of the urinary tract
Answer: A
Rationale: Goodpasture syndrome is an autoimmune disease in which antibodies attack the glomerular
basement membrane in the kidneys and the alveolar basement membrane in the lungs, causing rapidly
progressive glomerulonephritis and pulmonary hemorrhage。
Q10. The nurse is caring for a client with CKD who has an arteriovenous (AV) fistula in the left arm.
Which action is appropriate?
A) Check the fistula for a bruit and thrill every 4 hours
B) Obtain blood pressure readings from the left arm
C) Start an IV in the left arm if needed
D) Draw all blood samples from the fistula site
Answer: A
Medical-Surgical Nursing Review
Complete 200-Practice-Question Bank with Verified Answers
& Rationales
BLOCK 1: CARE OF PATIENTS WITH COMPLEX RENAL DISORDERS (Questions 1–45)
Q1. The nurse is caring for a client who has nephrotic syndrome with severe proteinuria. Which action
should the nurse take?
A) Administer furosemide
B) Administer lisinopril
C) Restrict fluids
D) Increase protein intake
Answer: B
Rationale: ACE inhibitors like lisinopril reduce proteinuria by lowering intraglomerular pressure, which
slows kidney damage progression. They are standard therapy in nephrotic syndrome to decrease urinary
protein loss.
Q2. The nurse is reviewing labs of assigned clients. Which client requires priority follow-up with the
primary health care provider?
A) Client 2 days post-abdominal aortic aneurysm (AAA) repair with creatinine increasing from 0.9 to 2.5
mg/dL
B) Client with creatinine stable at 1.1 mg/dL
C) Client with potassium 4.0 mEq/L
D) Client with mild hyponatremia
Answer: A
,Rationale: A significant increase in creatinine post-surgery indicates possible acute kidney injury (AKI),
requiring urgent evaluation. Normal creatinine is approximately 0.5–1.2 mg/dL, and a sharp rise signals
reduced glomerular filtration.
Q3. A client with acute kidney injury (AKI) has a serum potassium level of 6.8 mEq/L. What is the nurse's
priority intervention?
A) Administer sodium polystyrene sulfonate (Kayexalate) orally
B) Prepare the client for emergent hemodialysis
C) Administer IV calcium gluconate
D) Restrict dietary potassium intake
Answer: C
Rationale: IV calcium gluconate is given emergently to stabilize cardiac membranes and prevent
life‑threatening arrhythmias in severe hyperkalemia. It does not lower potassium but protects the heart
while other treatments take effect。
Q4. A client with chronic kidney disease (CKD) is prescribed epoetin alfa (Epogen). The nurse
understands that this medication is given to treat which complication?
A) Hyperkalemia
B) Anemia
C) Metabolic acidosis
D) Hyperphosphatemia
Answer: B
Rationale: Damaged kidneys do not produce enough erythropoietin (EPO), which stimulates red blood
cell production in the bone marrow, resulting in anemia. Epoetin alfa is synthetic EPO used to treat
anemia of CKD.
Q5. The nurse is caring for a client with AKI in the oliguric phase. Which assessment finding requires
immediate intervention?
A) Urine output of 350 mL in 24 hours
B) Blood pressure 138/88 mm Hg
,C) Crackles auscultated in bilateral lung bases
D) Serum creatinine 1.2 mg/dL
Answer: C
Rationale: Crackles in the lung bases indicate pulmonary edema due to fluid overload, a life‑threatening
complication of the oliguric phase of AKI requiring immediate intervention.
Q6. A client with CKD has a phosphate level of 7.2 mg/dL. Which medication should the nurse anticipate
administering?
A) Calcium acetate (PhosLo)
B) Sodium polystyrene sulfonate (Kayexalate)
C) Sevelamer carbonate (Renvela)
D) Both A and C
Answer: D
Rationale: Both calcium acetate and sevelamer are phosphate binders that prevent dietary phosphate
absorption. Hyperphosphatemia is common in CKD due to decreased renal excretion.
Q7. The nurse is teaching a client with CKD about dietary restrictions. Which statement by the client
indicates understanding?
A) "I need to eat more bananas and oranges to keep my potassium up."
B) "I should limit foods high in phosphorus like dairy products and nuts."
C) "I can eat as much protein as I want because I need it for healing."
D) "I should increase my fluid intake to flush out my kidneys."
Answer: B
Rationale: In CKD, kidneys cannot excrete phosphorus, leading to hyperphosphatemia. Clients should
limit high‑phosphorus foods including dairy, nuts, beans, and colas.
Q8. The nurse is assessing a client with AKI. Which finding is most consistent with the diuretic phase of
AKI?
, A) Urine output of 4,000 mL in 24 hours
B) Serum creatinine rising to 3.0 mg/dL
C) Blood pressure 180/100 mm Hg
D) Worsening pulmonary edema
Answer: A
Rationale: The diuretic phase of AKI is characterized by gradually increasing urine output (up to 3 –
5 L/24 hours). The kidneys are recovering but may not concentrate urine effectively, leading to large
urine volumes.
Q9. A client is diagnosed with Goodpasture syndrome. The nurse understands that this condition
involves:
A) Autoimmune attack on the glomerular basement membrane and lungs
B) Bacterial infection of the renal tubules
C) Cyst formation in the kidneys
D) Obstruction of the urinary tract
Answer: A
Rationale: Goodpasture syndrome is an autoimmune disease in which antibodies attack the glomerular
basement membrane in the kidneys and the alveolar basement membrane in the lungs, causing rapidly
progressive glomerulonephritis and pulmonary hemorrhage。
Q10. The nurse is caring for a client with CKD who has an arteriovenous (AV) fistula in the left arm.
Which action is appropriate?
A) Check the fistula for a bruit and thrill every 4 hours
B) Obtain blood pressure readings from the left arm
C) Start an IV in the left arm if needed
D) Draw all blood samples from the fistula site
Answer: A
