NUR 265 MEDICAL-SURGICAL NURSING (PDF) | 2026 EXAM
QUESTIONS AND ANSWERS + RATIONALES | STUDY GUIDE |
100% CORRECT
1. A patient with cirrhosis develops ascites and is prescribed spironolactone. Which
assessment finding indicates that the medication is having the desired therapeutic effect?
A) Decreased abdominal girth and increased urinary output
B) Increased serum sodium and decreased potassium
C) Weight gain and peripheral edema
D) Elevated liver enzymes and jaundice
Correct Answer: A) Decreased abdominal girth and increased urinary output
Rationale: Spironolactone is a potassium-sparing diuretic used to manage ascites in cirrhosis.
The desired effect is reduced fluid volume, evidenced by decreased abdominal girth and
increased urinary output, indicating the diuretic is mobilizing fluid. Hyponatremia and
hyperkalemia are adverse effects requiring monitoring.
2. Which clinical manifestation is the nurse most likely to observe in a patient with acute
kidney injury (AKI) experiencing hyperkalemia?
A) Muscle cramps and hyporeflexia
B) Nausea and vomiting
C) Cardiac arrhythmias and ECG changes
D) Polyuria and polydipsia
Correct Answer: C) Cardiac arrhythmias and ECG changes
Rationale: Hyperkalemia (elevated potassium) is a life-threatening complication of AKI that
primarily affects cardiac conduction. The nurse should monitor for ECG changes such as peaked
T waves, prolonged PR interval, and widened QRS, which can progress to lethal arrhythmias .
Neuromuscular manifestations are more prominent in other electrolyte imbalances.
3. The nurse is caring for a patient with acute pancreatitis. Which laboratory value is most
indicative of this condition?
A) Elevated serum amylase and lipase
B) Decreased serum calcium
C) Elevated liver function tests
D) Decreased serum glucose
Correct Answer: A) Elevated serum amylase and lipase
Rationale: In acute pancreatitis, serum amylase and lipase levels are markedly elevated due to
leakage from inflamed pancreatic cells. Lipase is more specific to the pancreas and remains
elevated longer. While decreased calcium and elevated glucose can occur, amylase and lipase are
the primary diagnostic indicators .
, 4. A patient with chronic pancreatitis is prescribed pancreatic enzyme replacement therapy.
Which instruction should the nurse include in the teaching plan?
A) Take the enzymes with meals and snacks to aid digestion
B) Take the enzymes on an empty stomach for better absorption
C) Swallow the capsules whole without chewing
D) Avoid taking the enzymes with any food to prevent side effects
Correct Answer: A) Take the enzymes with meals and snacks to aid digestion
Rationale: Pancreatic enzyme replacement therapy is taken with meals and snacks to replace the
enzymes the pancreas can no longer produce. This aids in the digestion of fats, proteins, and
carbohydrates, preventing malnutrition and steatorrhea . The enzymes should be taken
throughout the meal.
5. The nurse is assessing a patient with an arteriovenous (AV) fistula for hemodialysis.
Which finding indicates adequate vascular access function?
A) Absence of a bruit over the fistula site
B) Presence of a palpable thrill and audible bruit
C) Coolness and pallor of the extremity
D) Edema and pain at the access site
Correct Answer: B) Presence of a palpable thrill and audible bruit
Rationale: A palpable thrill (vibration) and audible bruit (whooshing sound) indicate that the AV
fistula has adequate blood flow for hemodialysis . Absence of these findings or signs of
infection, ischemia, or aneurysm require immediate provider notification.
6. A patient presents with a dissecting abdominal aortic aneurysm. What is the priority
nursing action?
A) Assess peripheral pulses and prepare for emergency surgery
B) Administer pain medication and monitor for hypertension
C) Apply warm compresses and position the patient flat
D) Call for immediate medical assistance and prepare for transfer
Correct Answer: A) Assess peripheral pulses and prepare for emergency surgery
Rationale: A dissecting abdominal aortic aneurysm is a life-threatening emergency that often
requires immediate surgical intervention . The priority is to assess for perfusion deficits
(decreased pulses), notify the provider, and prepare the patient for emergency surgery. This is a
time-critical situation.
7. A patient with chronic kidney disease (CKD) is prescribed epoetin alfa. The nurse
understands that this medication is administered to:
A) Reduce potassium levels
B) Stimulate red blood cell production
C) Lower blood pressure
D) Increase white blood cell count
, Correct Answer: B) Stimulate red blood cell production
Rationale: Epoetin alfa is a synthetic form of erythropoietin that stimulates the bone marrow to
produce red blood cells. It is used to treat anemia in patients with CKD whose kidneys cannot
produce enough natural erythropoietin. This reduces the need for blood transfusions.
8. The nurse is preparing to administer a blood transfusion to a patient. Which action is
most important to prevent a transfusion reaction?
A) Verify the patient's identity with two identifiers
B) Administer the blood at room temperature
C) Premedicate the patient with diphenhydramine
D) Check the expiration date on the blood bag
Correct Answer: A) Verify the patient's identity with two identifiers
Rationale: Verifying the patient's identity using two unique identifiers (e.g., name and date of
birth) is the most critical step in preventing hemolytic transfusion reactions. It ensures that the
blood product is being given to the correct patient. Patient safety in transfusion begins with
accurate identification.
9. A patient is diagnosed with right-sided heart failure. Which assessment finding would the
nurse expect?
A) Crackles in the lung bases
B) Jugular venous distension and peripheral edema
C) Orthopnea and dyspnea on exertion
D) S3 heart sound and cough
Correct Answer: B) Jugular venous distension and peripheral edema
Rationale: Right-sided heart failure results in systemic venous congestion. This manifests as
jugular venous distension (JVD), peripheral edema, hepatomegaly, and ascites. Crackles,
orthopnea, and S3 are signs of left-sided heart failure (pulmonary congestion).
10. The nurse is teaching a patient about lifestyle modifications to manage heart failure.
Which statement indicates a need for further teaching?
A) "I will weigh myself daily and report a weight gain of 2-3 pounds."
B) "I will limit my sodium intake to 2 grams per day."
C) "I will stop taking my diuretic if I feel dizzy."
D) "I will take my medications as prescribed and not skip doses."
Correct Answer: C) "I will stop taking my diuretic if I feel dizzy."
Rationale: Diuretics are a cornerstone of heart failure management. Stopping them without
consulting the provider can lead to fluid overload. Dizziness may indicate dehydration or
hypotension, requiring provider notification, but the patient should not self-discontinue the
medication. Daily weights are crucial for monitoring fluid status .
QUESTIONS AND ANSWERS + RATIONALES | STUDY GUIDE |
100% CORRECT
1. A patient with cirrhosis develops ascites and is prescribed spironolactone. Which
assessment finding indicates that the medication is having the desired therapeutic effect?
A) Decreased abdominal girth and increased urinary output
B) Increased serum sodium and decreased potassium
C) Weight gain and peripheral edema
D) Elevated liver enzymes and jaundice
Correct Answer: A) Decreased abdominal girth and increased urinary output
Rationale: Spironolactone is a potassium-sparing diuretic used to manage ascites in cirrhosis.
The desired effect is reduced fluid volume, evidenced by decreased abdominal girth and
increased urinary output, indicating the diuretic is mobilizing fluid. Hyponatremia and
hyperkalemia are adverse effects requiring monitoring.
2. Which clinical manifestation is the nurse most likely to observe in a patient with acute
kidney injury (AKI) experiencing hyperkalemia?
A) Muscle cramps and hyporeflexia
B) Nausea and vomiting
C) Cardiac arrhythmias and ECG changes
D) Polyuria and polydipsia
Correct Answer: C) Cardiac arrhythmias and ECG changes
Rationale: Hyperkalemia (elevated potassium) is a life-threatening complication of AKI that
primarily affects cardiac conduction. The nurse should monitor for ECG changes such as peaked
T waves, prolonged PR interval, and widened QRS, which can progress to lethal arrhythmias .
Neuromuscular manifestations are more prominent in other electrolyte imbalances.
3. The nurse is caring for a patient with acute pancreatitis. Which laboratory value is most
indicative of this condition?
A) Elevated serum amylase and lipase
B) Decreased serum calcium
C) Elevated liver function tests
D) Decreased serum glucose
Correct Answer: A) Elevated serum amylase and lipase
Rationale: In acute pancreatitis, serum amylase and lipase levels are markedly elevated due to
leakage from inflamed pancreatic cells. Lipase is more specific to the pancreas and remains
elevated longer. While decreased calcium and elevated glucose can occur, amylase and lipase are
the primary diagnostic indicators .
, 4. A patient with chronic pancreatitis is prescribed pancreatic enzyme replacement therapy.
Which instruction should the nurse include in the teaching plan?
A) Take the enzymes with meals and snacks to aid digestion
B) Take the enzymes on an empty stomach for better absorption
C) Swallow the capsules whole without chewing
D) Avoid taking the enzymes with any food to prevent side effects
Correct Answer: A) Take the enzymes with meals and snacks to aid digestion
Rationale: Pancreatic enzyme replacement therapy is taken with meals and snacks to replace the
enzymes the pancreas can no longer produce. This aids in the digestion of fats, proteins, and
carbohydrates, preventing malnutrition and steatorrhea . The enzymes should be taken
throughout the meal.
5. The nurse is assessing a patient with an arteriovenous (AV) fistula for hemodialysis.
Which finding indicates adequate vascular access function?
A) Absence of a bruit over the fistula site
B) Presence of a palpable thrill and audible bruit
C) Coolness and pallor of the extremity
D) Edema and pain at the access site
Correct Answer: B) Presence of a palpable thrill and audible bruit
Rationale: A palpable thrill (vibration) and audible bruit (whooshing sound) indicate that the AV
fistula has adequate blood flow for hemodialysis . Absence of these findings or signs of
infection, ischemia, or aneurysm require immediate provider notification.
6. A patient presents with a dissecting abdominal aortic aneurysm. What is the priority
nursing action?
A) Assess peripheral pulses and prepare for emergency surgery
B) Administer pain medication and monitor for hypertension
C) Apply warm compresses and position the patient flat
D) Call for immediate medical assistance and prepare for transfer
Correct Answer: A) Assess peripheral pulses and prepare for emergency surgery
Rationale: A dissecting abdominal aortic aneurysm is a life-threatening emergency that often
requires immediate surgical intervention . The priority is to assess for perfusion deficits
(decreased pulses), notify the provider, and prepare the patient for emergency surgery. This is a
time-critical situation.
7. A patient with chronic kidney disease (CKD) is prescribed epoetin alfa. The nurse
understands that this medication is administered to:
A) Reduce potassium levels
B) Stimulate red blood cell production
C) Lower blood pressure
D) Increase white blood cell count
, Correct Answer: B) Stimulate red blood cell production
Rationale: Epoetin alfa is a synthetic form of erythropoietin that stimulates the bone marrow to
produce red blood cells. It is used to treat anemia in patients with CKD whose kidneys cannot
produce enough natural erythropoietin. This reduces the need for blood transfusions.
8. The nurse is preparing to administer a blood transfusion to a patient. Which action is
most important to prevent a transfusion reaction?
A) Verify the patient's identity with two identifiers
B) Administer the blood at room temperature
C) Premedicate the patient with diphenhydramine
D) Check the expiration date on the blood bag
Correct Answer: A) Verify the patient's identity with two identifiers
Rationale: Verifying the patient's identity using two unique identifiers (e.g., name and date of
birth) is the most critical step in preventing hemolytic transfusion reactions. It ensures that the
blood product is being given to the correct patient. Patient safety in transfusion begins with
accurate identification.
9. A patient is diagnosed with right-sided heart failure. Which assessment finding would the
nurse expect?
A) Crackles in the lung bases
B) Jugular venous distension and peripheral edema
C) Orthopnea and dyspnea on exertion
D) S3 heart sound and cough
Correct Answer: B) Jugular venous distension and peripheral edema
Rationale: Right-sided heart failure results in systemic venous congestion. This manifests as
jugular venous distension (JVD), peripheral edema, hepatomegaly, and ascites. Crackles,
orthopnea, and S3 are signs of left-sided heart failure (pulmonary congestion).
10. The nurse is teaching a patient about lifestyle modifications to manage heart failure.
Which statement indicates a need for further teaching?
A) "I will weigh myself daily and report a weight gain of 2-3 pounds."
B) "I will limit my sodium intake to 2 grams per day."
C) "I will stop taking my diuretic if I feel dizzy."
D) "I will take my medications as prescribed and not skip doses."
Correct Answer: C) "I will stop taking my diuretic if I feel dizzy."
Rationale: Diuretics are a cornerstone of heart failure management. Stopping them without
consulting the provider can lead to fluid overload. Dizziness may indicate dehydration or
hypotension, requiring provider notification, but the patient should not self-discontinue the
medication. Daily weights are crucial for monitoring fluid status .
