,NUR 265 Exam 1 Medical-Surgical Nursing
2026
Question 1
A client with chronic kidney disease (CKD) has a serum phosphorus of 6.8
mg/dL. Which medication should the nurse anticipate administering?
A. Calcium acetate
B. Ferrous sulfate
C. Sodium polystyrene sulfonate
D. Erythropoietin
Correct Answer: A. Calcium acetate
Rationale: Calcium acetate is a phosphate binder used to reduce serum
phosphorus levels in CKD by binding dietary phosphate in the GI tract.
Ferrous sulfate treats anemia, sodium polystyrene sulfonate treats
hyperkalemia, and erythropoietin treats anemia. Hyperphosphatemia is
managed with phosphate binders.
Question 2
The nurse is caring for a client with acute pancreatitis who reports severe
abdominal pain. Which position should the nurse encourage to reduce
pain?
A. Supine with legs extended
B. Prone position
C. Side-lying with knees flexed (fetal position)
D. High-Fowler's position
Correct Answer: C. Side-lying with knees flexed (fetal position)
,Rationale: The fetal position reduces tension on the abdominal wall and
pancreas, helping to relieve pain in pancreatitis. Supine and prone positions
increase abdominal tension and pain. High-Fowler's does not specifically
reduce pancreatic pain.
Question 3
A client with heart failure is prescribed spironolactone. Which laboratory
value requires close monitoring?
A. Serum sodium
B. Serum potassium
C. Serum calcium
D. Serum magnesium
Correct Answer: B. Serum potassium
Rationale: Spironolactone is a potassium-sparing diuretic that can cause
hyperkalemia. Serum potassium must be closely monitored, especially in
clients with renal impairment or those taking ACE inhibitors/ARBs.
Question 4
The nurse is assessing a client with cirrhosis who has asterixis. What does
this finding indicate?
A. Portal hypertension
B. Hepatic encephalopathy
C. Ascites
D. Esophageal varices
Correct Answer: B. Hepatic encephalopathy
, Rationale: Asterixis (liver flap or flapping tremor) is a classic sign of hepatic
encephalopathy due to elevated serum ammonia. Portal hypertension,
ascites, and esophageal varices are complications of cirrhosis but are not
directly associated with asterixis.
Question 5
A client with COPD is receiving oxygen at 2 L/min via nasal cannula. The
nurse notes the client is lethargic and confused. What is the priority action?
A. Increase oxygen to 4 L/min
B. Decrease oxygen to 1 L/min
C. Check arterial blood gases (ABGs)
D. Administer naloxone
Correct Answer: C. Check arterial blood gases (ABGs)
Rationale: Lethargy and confusion in a COPD client on oxygen may indicate
carbon dioxide narcosis. ABGs should be checked to assess PaCO₂ and pH.
Decreasing oxygen may be necessary but assessment comes first. Naloxone is
for opioid overdose.
Question 6
The nurse is caring for a client with diabetic ketoacidosis (DKA). Which
intravenous fluid is the priority for initial resuscitation?
A. 0.9% normal saline
B. 0.45% normal saline
C. D5W
D. Lactated Ringer's
Correct Answer: A. 0.9% normal saline
2026
Question 1
A client with chronic kidney disease (CKD) has a serum phosphorus of 6.8
mg/dL. Which medication should the nurse anticipate administering?
A. Calcium acetate
B. Ferrous sulfate
C. Sodium polystyrene sulfonate
D. Erythropoietin
Correct Answer: A. Calcium acetate
Rationale: Calcium acetate is a phosphate binder used to reduce serum
phosphorus levels in CKD by binding dietary phosphate in the GI tract.
Ferrous sulfate treats anemia, sodium polystyrene sulfonate treats
hyperkalemia, and erythropoietin treats anemia. Hyperphosphatemia is
managed with phosphate binders.
Question 2
The nurse is caring for a client with acute pancreatitis who reports severe
abdominal pain. Which position should the nurse encourage to reduce
pain?
A. Supine with legs extended
B. Prone position
C. Side-lying with knees flexed (fetal position)
D. High-Fowler's position
Correct Answer: C. Side-lying with knees flexed (fetal position)
,Rationale: The fetal position reduces tension on the abdominal wall and
pancreas, helping to relieve pain in pancreatitis. Supine and prone positions
increase abdominal tension and pain. High-Fowler's does not specifically
reduce pancreatic pain.
Question 3
A client with heart failure is prescribed spironolactone. Which laboratory
value requires close monitoring?
A. Serum sodium
B. Serum potassium
C. Serum calcium
D. Serum magnesium
Correct Answer: B. Serum potassium
Rationale: Spironolactone is a potassium-sparing diuretic that can cause
hyperkalemia. Serum potassium must be closely monitored, especially in
clients with renal impairment or those taking ACE inhibitors/ARBs.
Question 4
The nurse is assessing a client with cirrhosis who has asterixis. What does
this finding indicate?
A. Portal hypertension
B. Hepatic encephalopathy
C. Ascites
D. Esophageal varices
Correct Answer: B. Hepatic encephalopathy
, Rationale: Asterixis (liver flap or flapping tremor) is a classic sign of hepatic
encephalopathy due to elevated serum ammonia. Portal hypertension,
ascites, and esophageal varices are complications of cirrhosis but are not
directly associated with asterixis.
Question 5
A client with COPD is receiving oxygen at 2 L/min via nasal cannula. The
nurse notes the client is lethargic and confused. What is the priority action?
A. Increase oxygen to 4 L/min
B. Decrease oxygen to 1 L/min
C. Check arterial blood gases (ABGs)
D. Administer naloxone
Correct Answer: C. Check arterial blood gases (ABGs)
Rationale: Lethargy and confusion in a COPD client on oxygen may indicate
carbon dioxide narcosis. ABGs should be checked to assess PaCO₂ and pH.
Decreasing oxygen may be necessary but assessment comes first. Naloxone is
for opioid overdose.
Question 6
The nurse is caring for a client with diabetic ketoacidosis (DKA). Which
intravenous fluid is the priority for initial resuscitation?
A. 0.9% normal saline
B. 0.45% normal saline
C. D5W
D. Lactated Ringer's
Correct Answer: A. 0.9% normal saline
