NUR 265/NUR265: Exam 1
Advanced Concepts in Medical-Surgical Nursing
2026-2028 Testing Cycle | Complete Guide
50 Questions With Answers & Expert Rationales.
Guaranteed Pass | Graded A+ | Galen
Q1: A client with acute kidney injury has entered the diuretic phase and is producing 4.2 liters of
urine daily. Which assessment finding requires the most immediate nursing intervention?
A. Weight loss of 1.5 kg over 24 hours
B. Urine specific gravity of 1.025
C. Serum potassium of 2.6 mEq/L with flat T waves and U waves on the ECG
D. Blood urea nitrogen decreasing from 92 to 74 mg/dL
Correct Answer: C
Rationale: Correct because the diuretic phase of AKI produces massive urine output that leads to
excessive renal potassium wasting, resulting in hypokalemia that manifests as flat T waves and
prominent U waves, predisposing the client to life-threatening ventricular dysrhythmias. Option
A represents expected fluid loss from diuresis, option B indicates inappropriately concentrated
urine for this phase when isosthenuria is more common, and option D demonstrates improving
azotemia rather than an acute electrolyte emergency. In the diuretic phase, the nurse must
monitor serum electrolytes every 4 to 6 hours and replace potassium cautiously to prevent
cardiac complications.
Q2: A client is admitted with hematemesis and coffee-ground emesis secondary to a bleeding
duodenal ulcer. Which findings indicate the client is developing hypovolemic shock? Select all
that apply.
A. Hematochezia
B. Tachycardia at 128 beats/min
C. Cool, clammy skin
D. Blood pressure of 178/104 mmHg
,E. Decreased urine output of 18 mL/hour
F. Warm, flushed skin and bounding pulses
Correct Answer(s): B, C, E
Rationale: Correct because tachycardia, cool clammy skin, and oliguria are classic
compensatory responses to decreased intravascular volume, reflecting sympathetic nervous
system activation and inadequate tissue perfusion during hypovolemic shock. Option A is
characteristic of lower GI bleeding rather than upper GI hemorrhage, option D indicates
hypertension which is inconsistent with the hypotension seen in shock, and option F describes
the vasodilation and warm skin associated with distributive shock rather than hypovolemia. For
acute upper GI bleeding, the nurse must recognize these early hemodynamic changes and initiate
two large-bore IVs and crystalloid resuscitation before irreversible end-organ damage occurs.
Q3: A client in the post-anesthesia care unit has a blood pressure of 140/80 mmHg. The nurse
calculates the mean arterial pressure to evaluate organ perfusion. What is the client’s MAP?
A. 100 mmHg
B. 110 mmHg
C. 90 mmHg
D. 95 mmHg
Correct Answer: A
Rationale: Correct because the mean arterial pressure is calculated using the formula (SBP + 2 ×
DBP) ÷ 3, yielding (140 + 160) ÷ 3 = 300 ÷ 3 = 100 mmHg, which falls within the normal range
of 70 to 105 mmHg. Option B incorrectly adds the systolic and diastolic values without division,
option C fails to apply the proper weighted formula for diastolic pressure, and option D uses
simple averaging that does not reflect true perfusion pressure. Maintaining a MAP above 65
mmHg is essential for adequate cerebral, coronary, and renal perfusion, particularly in the
immediate postoperative period.
Q4: A client with stage 5 chronic kidney disease who is not yet receiving dialysis asks the nurse
about protein intake. Which dietary instruction is most appropriate?
A. Increase protein intake to 1.2 grams per kilogram daily
B. Restrict protein to 0.6 to 0.8 grams per kilogram daily
C. Consume unlimited protein to prevent muscle wasting
D. Eat only plant-based proteins exclusively
Correct Answer: B
, Rationale: Correct because clients with stage 5 CKD who are not on dialysis require protein
restriction to 0.6 to 0.8 grams per kilogram to reduce the accumulation of nitrogenous waste
products and uremic toxins while maintaining nutritional status. Option A describes the protein
requirement for clients on maintenance hemodialysis who need higher intake to compensate for
dialytic losses, option C would exacerbate uremia and accelerate the need for renal replacement
therapy, and option D is unnecessary because moderate animal protein can be included within the
restricted allowance. The nurse must collaborate with a renal dietitian to balance protein
restriction with adequate caloric intake to prevent malnutrition.
Q5: A client with cirrhosis has a serum ammonia level of 112 mcg/dL and is increasingly
somnolent. Which intervention is the nurse’s immediate priority?
A. Administer IV dextrose 50% to treat hypoglycemia
B. Increase dietary protein to correct albumin deficit
C. Schedule an urgent liver ultrasound
D. Administer lactulose and document mental status changes
Correct Answer: D
Rationale: Correct because lactulose acidifies the colonic lumen, trapping ammonia and
promoting its excretion through the gut, which directly addresses the elevated ammonia causing
hepatic encephalopathy and somnolence. Option A is inappropriate unless hypoglycemia is
documented, option B would increase ammonia production from protein metabolism and worsen
encephalopathy, and option C is diagnostic but does not address the immediate neuropsychiatric
crisis. For hepatic encephalopathy, the nurse must prioritize ammonia reduction, monitor
neurologic status using a standardized grading scale, and ensure the client has two to three soft
bowel movements daily.
Q6: A client with ST-elevation myocardial infarction undergoes successful percutaneous
coronary intervention. Which findings indicate successful coronary reperfusion? Select all that
apply.
A. Resolution of ST-segment elevation on the 12-lead ECG
B. Return of severe crushing chest pain
C. TIMI 3 flow documented on angiography
D. Peak troponin level at 72 hours post-procedure
E. Development of sustained ventricular fibrillation
Correct Answer(s): A, C
Advanced Concepts in Medical-Surgical Nursing
2026-2028 Testing Cycle | Complete Guide
50 Questions With Answers & Expert Rationales.
Guaranteed Pass | Graded A+ | Galen
Q1: A client with acute kidney injury has entered the diuretic phase and is producing 4.2 liters of
urine daily. Which assessment finding requires the most immediate nursing intervention?
A. Weight loss of 1.5 kg over 24 hours
B. Urine specific gravity of 1.025
C. Serum potassium of 2.6 mEq/L with flat T waves and U waves on the ECG
D. Blood urea nitrogen decreasing from 92 to 74 mg/dL
Correct Answer: C
Rationale: Correct because the diuretic phase of AKI produces massive urine output that leads to
excessive renal potassium wasting, resulting in hypokalemia that manifests as flat T waves and
prominent U waves, predisposing the client to life-threatening ventricular dysrhythmias. Option
A represents expected fluid loss from diuresis, option B indicates inappropriately concentrated
urine for this phase when isosthenuria is more common, and option D demonstrates improving
azotemia rather than an acute electrolyte emergency. In the diuretic phase, the nurse must
monitor serum electrolytes every 4 to 6 hours and replace potassium cautiously to prevent
cardiac complications.
Q2: A client is admitted with hematemesis and coffee-ground emesis secondary to a bleeding
duodenal ulcer. Which findings indicate the client is developing hypovolemic shock? Select all
that apply.
A. Hematochezia
B. Tachycardia at 128 beats/min
C. Cool, clammy skin
D. Blood pressure of 178/104 mmHg
,E. Decreased urine output of 18 mL/hour
F. Warm, flushed skin and bounding pulses
Correct Answer(s): B, C, E
Rationale: Correct because tachycardia, cool clammy skin, and oliguria are classic
compensatory responses to decreased intravascular volume, reflecting sympathetic nervous
system activation and inadequate tissue perfusion during hypovolemic shock. Option A is
characteristic of lower GI bleeding rather than upper GI hemorrhage, option D indicates
hypertension which is inconsistent with the hypotension seen in shock, and option F describes
the vasodilation and warm skin associated with distributive shock rather than hypovolemia. For
acute upper GI bleeding, the nurse must recognize these early hemodynamic changes and initiate
two large-bore IVs and crystalloid resuscitation before irreversible end-organ damage occurs.
Q3: A client in the post-anesthesia care unit has a blood pressure of 140/80 mmHg. The nurse
calculates the mean arterial pressure to evaluate organ perfusion. What is the client’s MAP?
A. 100 mmHg
B. 110 mmHg
C. 90 mmHg
D. 95 mmHg
Correct Answer: A
Rationale: Correct because the mean arterial pressure is calculated using the formula (SBP + 2 ×
DBP) ÷ 3, yielding (140 + 160) ÷ 3 = 300 ÷ 3 = 100 mmHg, which falls within the normal range
of 70 to 105 mmHg. Option B incorrectly adds the systolic and diastolic values without division,
option C fails to apply the proper weighted formula for diastolic pressure, and option D uses
simple averaging that does not reflect true perfusion pressure. Maintaining a MAP above 65
mmHg is essential for adequate cerebral, coronary, and renal perfusion, particularly in the
immediate postoperative period.
Q4: A client with stage 5 chronic kidney disease who is not yet receiving dialysis asks the nurse
about protein intake. Which dietary instruction is most appropriate?
A. Increase protein intake to 1.2 grams per kilogram daily
B. Restrict protein to 0.6 to 0.8 grams per kilogram daily
C. Consume unlimited protein to prevent muscle wasting
D. Eat only plant-based proteins exclusively
Correct Answer: B
, Rationale: Correct because clients with stage 5 CKD who are not on dialysis require protein
restriction to 0.6 to 0.8 grams per kilogram to reduce the accumulation of nitrogenous waste
products and uremic toxins while maintaining nutritional status. Option A describes the protein
requirement for clients on maintenance hemodialysis who need higher intake to compensate for
dialytic losses, option C would exacerbate uremia and accelerate the need for renal replacement
therapy, and option D is unnecessary because moderate animal protein can be included within the
restricted allowance. The nurse must collaborate with a renal dietitian to balance protein
restriction with adequate caloric intake to prevent malnutrition.
Q5: A client with cirrhosis has a serum ammonia level of 112 mcg/dL and is increasingly
somnolent. Which intervention is the nurse’s immediate priority?
A. Administer IV dextrose 50% to treat hypoglycemia
B. Increase dietary protein to correct albumin deficit
C. Schedule an urgent liver ultrasound
D. Administer lactulose and document mental status changes
Correct Answer: D
Rationale: Correct because lactulose acidifies the colonic lumen, trapping ammonia and
promoting its excretion through the gut, which directly addresses the elevated ammonia causing
hepatic encephalopathy and somnolence. Option A is inappropriate unless hypoglycemia is
documented, option B would increase ammonia production from protein metabolism and worsen
encephalopathy, and option C is diagnostic but does not address the immediate neuropsychiatric
crisis. For hepatic encephalopathy, the nurse must prioritize ammonia reduction, monitor
neurologic status using a standardized grading scale, and ensure the client has two to three soft
bowel movements daily.
Q6: A client with ST-elevation myocardial infarction undergoes successful percutaneous
coronary intervention. Which findings indicate successful coronary reperfusion? Select all that
apply.
A. Resolution of ST-segment elevation on the 12-lead ECG
B. Return of severe crushing chest pain
C. TIMI 3 flow documented on angiography
D. Peak troponin level at 72 hours post-procedure
E. Development of sustained ventricular fibrillation
Correct Answer(s): A, C
