NUR 265 Exam 1 – Medical-Surgical Nursing –
(2026/2027)
Actual Questions & ANSWERs (Galen College of Nursing)
Complete Practice Exam with Comprehensive
Rationales
CARDIOVASCULAR SYSTEM
Question 1: 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) Administer lisinopril
Rationale for Option A: Furosemide is a loop diuretic that may be used to manage edema in nephrotic
syndrome, but it does not address the underlying proteinuria or slow kidney damage progression. While
it may be part of the treatment plan, it is not the priority intervention for reducing proteinuria.
Rationale for Option B: ACE inhibitors like lisinopril reduce proteinuria by lowering intraglomerular
pressure, which slows kidney damage progression in nephrotic syndrome. They are standard therapy to
decrease urinary protein loss and protect kidney function, making this the correct intervention.
Rationale for Option C: Fluid restriction may be necessary if the client has severe edema or fluid
overload, but it does not address the proteinuria itself. This is a supportive measure rather than a
primary treatment for the underlying condition.
Rationale for Option D: Increasing protein intake is contraindicated in nephrotic syndrome as it can
worsen proteinuria and increase the workload on damaged kidneys. A moderate protein restriction is
typically recommended instead.
Question 2: The nurse is reviewing labs of assigned clients. Which client requires priority follow-up with
the primary healthcare provider?
,A) Temperature of 99.8°F
B) Temperature of 101.4°F
C) Mild fatigue
D) Slight nausea
ANSWER: B) Temperature of 101.4°F
Rationale for Option A: A temperature of 99.8°F is slightly elevated but not considered a fever requiring
immediate intervention. This may be monitored but does not require priority follow-up.
Rationale for Option B: Fever above 101°F post-dialysis indicates possible infection and requires prompt
assessment and intervention. The nurse should assess for other signs of infection and notify the provider
immediately, making this the priority.
Rationale for Option C: Mild fatigue is a common, nonspecific symptom that may be related to many
conditions. While it should be monitored, it does not require immediate priority follow-up unless
accompanied by other concerning symptoms.
Rationale for Option D: Slight nausea is a common symptom that may have various causes. While
uncomfortable, it is not typically a priority concern unless severe, persistent, or accompanied by other
serious symptoms.
Question 3: Which finding in a client who had hemodialysis yesterday requires immediate follow-up?
A) Temperature of 99.8°F
B) Temperature of 101.4°F
C) Mild fatigue
D) Slight nausea
ANSWER: B) Temperature of 101.4°F
Rationale for Option A: A temperature of 99.8°F is slightly elevated but not considered a significant fever
in the post-hemodialysis period. This should be monitored but does not require immediate intervention.
Rationale for Option B: Fever post-hemodialysis is a red flag for sepsis or access-related infection. The
nurse should assess for other signs of infection and notify the provider immediately, as this can indicate
a life-threatening complication.
Rationale for Option C: Mild fatigue is common after hemodialysis due to fluid shifts and the dialysis
procedure itself. This is an expected finding that typically resolves with rest.
Rationale for Option D: Slight nausea may occur after hemodialysis due to fluid and electrolyte shifts.
While uncomfortable, it is not typically an emergency unless severe or accompanied by other serious
symptoms.
Question 4: A client with heart failure is receiving furosemide. Which assessment finding should the
nurse report to the provider immediately?
,A) Blood pressure of 110/70 mmHg
B) Potassium level of 3.2 mEq/L
C) Weight loss of 2 pounds in 24 hours
D) Urine output of 50 mL/hr
ANSWER: B) Potassium level of 3.2 mEq/L
Rationale for Option A: A blood pressure of 110/70 mmHg is within normal limits and indicates adequate
perfusion. This is an acceptable finding in a client receiving diuretics for heart failure.
Rationale for Option B: A potassium level of 3.2 mEq/L indicates hypokalemia (normal range 3.5-5.0
mEq/L). Furosemide is a loop diuretic that causes potassium loss, and hypokalemia can cause life-
threatening cardiac dysrhythmias. This requires immediate intervention and potassium replacement.
Rationale for Option C: Weight loss of 2 pounds in 24 hours indicates effective diuresis and fluid removal
in a client with heart failure. This is an expected and desired outcome of furosemide therapy.
Rationale for Option D: Urine output of 50 mL/hr equals 1200 mL/day, which is adequate kidney
function. This is a normal finding and indicates the kidneys are responding appropriately to the diuretic.
Question 5: The nurse is caring for a client with acute coronary syndrome. Which intervention should
the nurse implement first?
A) Administer sublingual nitroglycerin
B) Obtain a 12-lead ECG
C) Assess pain level using a 0-10 scale
D) Place the client on continuous cardiac monitoring
ANSWER: D) Place the client on continuous cardiac monitoring
Rationale for Option A: While nitroglycerin is important for relieving chest pain and improving coronary
blood flow, establishing cardiac monitoring takes priority to detect life-threatening dysrhythmias that
can occur with acute coronary syndrome.
Rationale for Option B: Obtaining a 12-lead ECG is crucial for diagnosing myocardial infarction and
should be done within 10 minutes of arrival, but continuous monitoring must be established first to
ensure immediate detection of dysrhythmias.
Rationale for Option C: Pain assessment is important for guiding treatment, but ensuring cardiac
monitoring is in place to detect potentially fatal dysrhythmias takes priority in the ABCs (airway,
breathing, circulation) framework.
Rationale for Option D: Placing the client on continuous cardiac monitoring is the priority to immediately
detect life-threatening dysrhythmias such as ventricular fibrillation or ventricular tachycardia that can
occur with acute coronary syndrome. This ensures patient safety and allows for immediate intervention.
, Question 6: A client is receiving warfarin therapy. Which laboratory value should the nurse monitor to
evaluate therapeutic effectiveness?
A) Prothrombin time (PT) and INR
B) Activated partial thromboplastin time (aPTT)
C) Platelet count
D) Bleeding time
ANSWER: A) Prothrombin time (PT) and INR
Rationale for Option A: Warfarin works by inhibiting vitamin K-dependent clotting factors, which
prolongs the PT. The INR (International Normalized Ratio) standardizes PT results and is the primary
monitoring tool for warfarin therapy. The therapeutic INR range is typically 2.0-3.0 for most conditions.
Rationale for Option B: The aPTT is used to monitor heparin therapy, not warfarin. Heparin affects the
intrinsic pathway of coagulation, while warfarin affects the extrinsic pathway measured by PT/INR.
Rationale for Option C: Platelet count is monitored for clients receiving heparin to detect heparin-
induced thrombocytopenia (HIT), but it is not used to monitor warfarin effectiveness.
Rationale for Option D: Bleeding time assesses platelet function and is not used to monitor warfarin
therapy. It is rarely used in clinical practice today.
Question 7: The nurse is teaching a client about lifestyle modifications for hypertension. Which
statement by the client indicates understanding?
A) "I can continue to use salt substitutes without restriction."
B) "I should limit my alcohol intake to no more than 2 drinks per day."
C) "I will exercise for 30 minutes most days of the week."
D) "I can stop taking my medication once my blood pressure is normal."
ANSWER: C) "I will exercise for 30 minutes most days of the week."
Rationale for Option A: Many salt substitutes contain potassium chloride, which can be dangerous for
clients with kidney disease or those taking certain medications like ACE inhibitors or potassium-sparing
diuretics. Salt substitutes should be used with caution and provider approval.
Rationale for Option B: Current guidelines recommend limiting alcohol to no more than 1 drink per day
for women and 2 drinks per day for men. However, this statement does not specify gender, and for
women, this would exceed recommendations.
Rationale for Option C: Regular aerobic exercise for at least 30 minutes on most days of the week is
recommended for blood pressure control. This can lower systolic blood pressure by 4-9 mmHg and
demonstrates understanding of lifestyle modifications.
(2026/2027)
Actual Questions & ANSWERs (Galen College of Nursing)
Complete Practice Exam with Comprehensive
Rationales
CARDIOVASCULAR SYSTEM
Question 1: 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) Administer lisinopril
Rationale for Option A: Furosemide is a loop diuretic that may be used to manage edema in nephrotic
syndrome, but it does not address the underlying proteinuria or slow kidney damage progression. While
it may be part of the treatment plan, it is not the priority intervention for reducing proteinuria.
Rationale for Option B: ACE inhibitors like lisinopril reduce proteinuria by lowering intraglomerular
pressure, which slows kidney damage progression in nephrotic syndrome. They are standard therapy to
decrease urinary protein loss and protect kidney function, making this the correct intervention.
Rationale for Option C: Fluid restriction may be necessary if the client has severe edema or fluid
overload, but it does not address the proteinuria itself. This is a supportive measure rather than a
primary treatment for the underlying condition.
Rationale for Option D: Increasing protein intake is contraindicated in nephrotic syndrome as it can
worsen proteinuria and increase the workload on damaged kidneys. A moderate protein restriction is
typically recommended instead.
Question 2: The nurse is reviewing labs of assigned clients. Which client requires priority follow-up with
the primary healthcare provider?
,A) Temperature of 99.8°F
B) Temperature of 101.4°F
C) Mild fatigue
D) Slight nausea
ANSWER: B) Temperature of 101.4°F
Rationale for Option A: A temperature of 99.8°F is slightly elevated but not considered a fever requiring
immediate intervention. This may be monitored but does not require priority follow-up.
Rationale for Option B: Fever above 101°F post-dialysis indicates possible infection and requires prompt
assessment and intervention. The nurse should assess for other signs of infection and notify the provider
immediately, making this the priority.
Rationale for Option C: Mild fatigue is a common, nonspecific symptom that may be related to many
conditions. While it should be monitored, it does not require immediate priority follow-up unless
accompanied by other concerning symptoms.
Rationale for Option D: Slight nausea is a common symptom that may have various causes. While
uncomfortable, it is not typically a priority concern unless severe, persistent, or accompanied by other
serious symptoms.
Question 3: Which finding in a client who had hemodialysis yesterday requires immediate follow-up?
A) Temperature of 99.8°F
B) Temperature of 101.4°F
C) Mild fatigue
D) Slight nausea
ANSWER: B) Temperature of 101.4°F
Rationale for Option A: A temperature of 99.8°F is slightly elevated but not considered a significant fever
in the post-hemodialysis period. This should be monitored but does not require immediate intervention.
Rationale for Option B: Fever post-hemodialysis is a red flag for sepsis or access-related infection. The
nurse should assess for other signs of infection and notify the provider immediately, as this can indicate
a life-threatening complication.
Rationale for Option C: Mild fatigue is common after hemodialysis due to fluid shifts and the dialysis
procedure itself. This is an expected finding that typically resolves with rest.
Rationale for Option D: Slight nausea may occur after hemodialysis due to fluid and electrolyte shifts.
While uncomfortable, it is not typically an emergency unless severe or accompanied by other serious
symptoms.
Question 4: A client with heart failure is receiving furosemide. Which assessment finding should the
nurse report to the provider immediately?
,A) Blood pressure of 110/70 mmHg
B) Potassium level of 3.2 mEq/L
C) Weight loss of 2 pounds in 24 hours
D) Urine output of 50 mL/hr
ANSWER: B) Potassium level of 3.2 mEq/L
Rationale for Option A: A blood pressure of 110/70 mmHg is within normal limits and indicates adequate
perfusion. This is an acceptable finding in a client receiving diuretics for heart failure.
Rationale for Option B: A potassium level of 3.2 mEq/L indicates hypokalemia (normal range 3.5-5.0
mEq/L). Furosemide is a loop diuretic that causes potassium loss, and hypokalemia can cause life-
threatening cardiac dysrhythmias. This requires immediate intervention and potassium replacement.
Rationale for Option C: Weight loss of 2 pounds in 24 hours indicates effective diuresis and fluid removal
in a client with heart failure. This is an expected and desired outcome of furosemide therapy.
Rationale for Option D: Urine output of 50 mL/hr equals 1200 mL/day, which is adequate kidney
function. This is a normal finding and indicates the kidneys are responding appropriately to the diuretic.
Question 5: The nurse is caring for a client with acute coronary syndrome. Which intervention should
the nurse implement first?
A) Administer sublingual nitroglycerin
B) Obtain a 12-lead ECG
C) Assess pain level using a 0-10 scale
D) Place the client on continuous cardiac monitoring
ANSWER: D) Place the client on continuous cardiac monitoring
Rationale for Option A: While nitroglycerin is important for relieving chest pain and improving coronary
blood flow, establishing cardiac monitoring takes priority to detect life-threatening dysrhythmias that
can occur with acute coronary syndrome.
Rationale for Option B: Obtaining a 12-lead ECG is crucial for diagnosing myocardial infarction and
should be done within 10 minutes of arrival, but continuous monitoring must be established first to
ensure immediate detection of dysrhythmias.
Rationale for Option C: Pain assessment is important for guiding treatment, but ensuring cardiac
monitoring is in place to detect potentially fatal dysrhythmias takes priority in the ABCs (airway,
breathing, circulation) framework.
Rationale for Option D: Placing the client on continuous cardiac monitoring is the priority to immediately
detect life-threatening dysrhythmias such as ventricular fibrillation or ventricular tachycardia that can
occur with acute coronary syndrome. This ensures patient safety and allows for immediate intervention.
, Question 6: A client is receiving warfarin therapy. Which laboratory value should the nurse monitor to
evaluate therapeutic effectiveness?
A) Prothrombin time (PT) and INR
B) Activated partial thromboplastin time (aPTT)
C) Platelet count
D) Bleeding time
ANSWER: A) Prothrombin time (PT) and INR
Rationale for Option A: Warfarin works by inhibiting vitamin K-dependent clotting factors, which
prolongs the PT. The INR (International Normalized Ratio) standardizes PT results and is the primary
monitoring tool for warfarin therapy. The therapeutic INR range is typically 2.0-3.0 for most conditions.
Rationale for Option B: The aPTT is used to monitor heparin therapy, not warfarin. Heparin affects the
intrinsic pathway of coagulation, while warfarin affects the extrinsic pathway measured by PT/INR.
Rationale for Option C: Platelet count is monitored for clients receiving heparin to detect heparin-
induced thrombocytopenia (HIT), but it is not used to monitor warfarin effectiveness.
Rationale for Option D: Bleeding time assesses platelet function and is not used to monitor warfarin
therapy. It is rarely used in clinical practice today.
Question 7: The nurse is teaching a client about lifestyle modifications for hypertension. Which
statement by the client indicates understanding?
A) "I can continue to use salt substitutes without restriction."
B) "I should limit my alcohol intake to no more than 2 drinks per day."
C) "I will exercise for 30 minutes most days of the week."
D) "I can stop taking my medication once my blood pressure is normal."
ANSWER: C) "I will exercise for 30 minutes most days of the week."
Rationale for Option A: Many salt substitutes contain potassium chloride, which can be dangerous for
clients with kidney disease or those taking certain medications like ACE inhibitors or potassium-sparing
diuretics. Salt substitutes should be used with caution and provider approval.
Rationale for Option B: Current guidelines recommend limiting alcohol to no more than 1 drink per day
for women and 2 drinks per day for men. However, this statement does not specify gender, and for
women, this would exceed recommendations.
Rationale for Option C: Regular aerobic exercise for at least 30 minutes on most days of the week is
recommended for blood pressure control. This can lower systolic blood pressure by 4-9 mmHg and
demonstrates understanding of lifestyle modifications.
