NUR 265 Exam 1 Practice Advanced Concepts In Medical-
Surgical Nursing 2026-2027 Questions With Verified Correct
Answers And Rationale
1. A client with chronic kidney disease (CKD) stage 4 asks the nurse about dietary
protein restrictions. Which statement by the client indicates understanding of the
teaching?
A) "I should increase my protein intake to maintain muscle mass."
B) "I need to limit protein to slow the progression of kidney damage."
C) "I can eat unlimited protein as long as I take my phosphate binders."
D) "Protein restriction is only necessary if I am on hemodialysis."
Correct Answer: B) "I need to limit protein to slow the progression of kidney
damage."
Expert Rationale: In CKD stages 3-5 (non-dialysis), protein is restricted to 0.6-0.8
g/kg/day to reduce nitrogenous waste accumulation, slow uremia progression, and
decrease glomerular hyperfiltration. Once on dialysis, protein requirements increase
to 1.2 g/kg/day due to protein loss during dialysis.
2. A client with acute kidney injury (AKI) has a serum potassium level of 6.8
mEq/L. Which intervention should the nurse anticipate as the FIRST priority?
A) Administer oral sodium polystyrene sulfonate (Kayexalate)
B) Prepare the client for emergency hemodialysis
C) Administer intravenous calcium gluconate
D) Restrict dietary potassium and recheck in 4 hours
Correct Answer: C) Administer intravenous calcium gluconate
Expert Rationale: A potassium level of 6.8 mEq/L represents severe hyperkalemia
with high risk for cardiac dysrhythmias. IV calcium gluconate is the FIRST priority
as it antagonizes the cardiac effects of hyperkalemia by stabilizing the myocardial
cell membrane, preventing life-threatening ventricular dysrhythmias. It does NOT
lower potassium levels but protects the heart while other interventions
(insulin/glucose, Kayexalate, dialysis) work to reduce potassium.
,3. The nurse is caring for a client receiving hemodialysis. Which assessment finding
during dialysis requires IMMEDIATE intervention?
A) Blood pressure of 148/92 mmHg
B) Client reports mild cramping in the lower extremities
C) Tingling around the lips and a positive Chvostek sign
D) Weight loss of 2 kg during the 4-hour treatment
Correct Answer: C) Tingling around the lips and a positive Chvostek sign
Expert Rationale: Tingling around the lips and a positive Chvostek sign indicate
hypocalcemia, which can progress to tetany, seizures, or laryngospasm. During
hemodialysis, rapid electrolyte shifts (especially calcium and phosphate) can occur.
This requires immediate calcium replacement. Mild cramping and a 2 kg weight loss
are expected during ultrafiltration. BP of 148/92 is elevated but not immediately life-
threatening.
4. Which infection control action is MOST appropriate when changing a peritoneal
dialysis catheter dressing?
A) Use clean gloves only and perform hand hygiene before and after
B) Place a mask on the client and use sterile technique for the dressing change
C) Use sterile gloves only; a mask is unnecessary if the client is afebrile
D) No protective equipment is needed if the exit site appears clean and dry
Correct Answer: B) Place a mask on the client and use sterile technique for the
dressing change
Expert Rationale: Peritonitis is the most serious complication of peritoneal dialysis.
Both the nurse AND the client must wear masks during dressing changes and tubing
connections to prevent airborne bacteria from contaminating the catheter site or the
lumen of the tubing. Sterile technique is essential for all peritoneal dialysis
connections and dressing changes.
,5. A client with nephrotic syndrome is being discharged. Which instruction should
the nurse include regarding the primary pathophysiology of this condition?
A) "Your kidneys are not filtering waste products effectively, leading to uremia."
B) "The glomeruli are damaged and allow large amounts of protein to leak into your
urine."
C) "Your kidneys are producing too much renin, causing severe hypertension."
D) "The renal tubules are unable to reabsorb sodium, causing fluid overload."
Correct Answer: B) "The glomeruli are damaged and allow large amounts of
protein to leak into your urine."
Expert Rationale: Nephrotic syndrome is characterized by massive proteinuria
(>3.5 g/day) due to increased glomerular permeability from damaged glomeruli. This
leads to hypoalbuminemia, edema, hyperlipidemia, and lipiduria. The classic triad is
proteinuria, hypoalbuminemia, and edema. It is NOT primarily a filtration failure
(that's CKD/AKI) or a renin issue.
6. The nurse preceptor observes a newly hired nurse caring for a client receiving
peritoneal dialysis. Which action indicates CORRECT technique?
A) Warming the dialysate bag in the microwave for 2 minutes before infusion
B) Repositioning the client side-to-side during dialysis to improve dialysate flow and
drainage
C) Placing the client flat in bed with the head of bed at 0 degrees during the entire
dwell time
D) Ignoring small air bubbles in the tubing because they will be absorbed by the
peritoneum
Correct Answer: B) Repositioning the client side-to-side during dialysis to improve
dialysate flow and drainage
Expert Rationale: Turning the client from side to side uses gravity to enhance
dialysate flow into and out of the peritoneal cavity, improving drainage and
distribution. Dialysate should NEVER be microwaved (causes protein denaturation
and uneven heating); use a heating pad or warm water bath. The head of bed should
be elevated 30-45 degrees to promote diaphragmatic excursion and reduce risk of
, aspiration. Air bubbles must be removed to prevent poor drainage, discomfort, and
reduced exchange efficiency.
7. A client with end-stage renal disease (ESRD) on hemodialysis reports muscle
weakness and tremors. Which electrolyte imbalance should the nurse suspect?
A) Hypercalcemia
B) Hyperkalemia or hypokalemia
C) Hypernatremia
D) Hypermagnesemia
Correct Answer: B) Hyperkalemia or hypokalemia
Expert Rationale: Muscle weakness and tremors in a dialysis client can indicate
severe electrolyte imbalances, particularly hyperkalemia (dangerous high potassium)
or hypokalemia (post-dialysis). Both can cause neuromuscular symptoms, cardiac
dysrhythmias, and are medical emergencies. The nurse should immediately assess
vital signs, obtain an EKG, and notify the provider. Calcium imbalances cause
different symptoms (Chvostek/Trousseau for hypocalcemia; constipation and
confusion for hypercalcemia).
8. A client with AKI has the following arterial blood gas (ABG) results: pH 7.30,
PaCO2 28 mmHg, HCO3- 16 mEq/L. Which acid-base disturbance is present?
A) Respiratory acidosis with partial compensation
B) Metabolic acidosis with full compensation
C) Metabolic acidosis with partial respiratory compensation
D) Respiratory alkalosis with metabolic compensation
Correct Answer: C) Metabolic acidosis with partial respiratory compensation
Expert Rationale: The pH of 7.30 is acidic (normal 7.35-7.45). The HCO3- of 16
mEq/L is low (normal 22-26), indicating metabolic acidosis as the primary disorder.
The PaCO2 of 28 mmHg is low (normal 35-45), showing the lungs are attempting to
compensate by hyperventilating to blow off CO2. However, the pH remains
abnormal at 7.30, indicating only PARTIAL compensation. In AKI, metabolic
Surgical Nursing 2026-2027 Questions With Verified Correct
Answers And Rationale
1. A client with chronic kidney disease (CKD) stage 4 asks the nurse about dietary
protein restrictions. Which statement by the client indicates understanding of the
teaching?
A) "I should increase my protein intake to maintain muscle mass."
B) "I need to limit protein to slow the progression of kidney damage."
C) "I can eat unlimited protein as long as I take my phosphate binders."
D) "Protein restriction is only necessary if I am on hemodialysis."
Correct Answer: B) "I need to limit protein to slow the progression of kidney
damage."
Expert Rationale: In CKD stages 3-5 (non-dialysis), protein is restricted to 0.6-0.8
g/kg/day to reduce nitrogenous waste accumulation, slow uremia progression, and
decrease glomerular hyperfiltration. Once on dialysis, protein requirements increase
to 1.2 g/kg/day due to protein loss during dialysis.
2. A client with acute kidney injury (AKI) has a serum potassium level of 6.8
mEq/L. Which intervention should the nurse anticipate as the FIRST priority?
A) Administer oral sodium polystyrene sulfonate (Kayexalate)
B) Prepare the client for emergency hemodialysis
C) Administer intravenous calcium gluconate
D) Restrict dietary potassium and recheck in 4 hours
Correct Answer: C) Administer intravenous calcium gluconate
Expert Rationale: A potassium level of 6.8 mEq/L represents severe hyperkalemia
with high risk for cardiac dysrhythmias. IV calcium gluconate is the FIRST priority
as it antagonizes the cardiac effects of hyperkalemia by stabilizing the myocardial
cell membrane, preventing life-threatening ventricular dysrhythmias. It does NOT
lower potassium levels but protects the heart while other interventions
(insulin/glucose, Kayexalate, dialysis) work to reduce potassium.
,3. The nurse is caring for a client receiving hemodialysis. Which assessment finding
during dialysis requires IMMEDIATE intervention?
A) Blood pressure of 148/92 mmHg
B) Client reports mild cramping in the lower extremities
C) Tingling around the lips and a positive Chvostek sign
D) Weight loss of 2 kg during the 4-hour treatment
Correct Answer: C) Tingling around the lips and a positive Chvostek sign
Expert Rationale: Tingling around the lips and a positive Chvostek sign indicate
hypocalcemia, which can progress to tetany, seizures, or laryngospasm. During
hemodialysis, rapid electrolyte shifts (especially calcium and phosphate) can occur.
This requires immediate calcium replacement. Mild cramping and a 2 kg weight loss
are expected during ultrafiltration. BP of 148/92 is elevated but not immediately life-
threatening.
4. Which infection control action is MOST appropriate when changing a peritoneal
dialysis catheter dressing?
A) Use clean gloves only and perform hand hygiene before and after
B) Place a mask on the client and use sterile technique for the dressing change
C) Use sterile gloves only; a mask is unnecessary if the client is afebrile
D) No protective equipment is needed if the exit site appears clean and dry
Correct Answer: B) Place a mask on the client and use sterile technique for the
dressing change
Expert Rationale: Peritonitis is the most serious complication of peritoneal dialysis.
Both the nurse AND the client must wear masks during dressing changes and tubing
connections to prevent airborne bacteria from contaminating the catheter site or the
lumen of the tubing. Sterile technique is essential for all peritoneal dialysis
connections and dressing changes.
,5. A client with nephrotic syndrome is being discharged. Which instruction should
the nurse include regarding the primary pathophysiology of this condition?
A) "Your kidneys are not filtering waste products effectively, leading to uremia."
B) "The glomeruli are damaged and allow large amounts of protein to leak into your
urine."
C) "Your kidneys are producing too much renin, causing severe hypertension."
D) "The renal tubules are unable to reabsorb sodium, causing fluid overload."
Correct Answer: B) "The glomeruli are damaged and allow large amounts of
protein to leak into your urine."
Expert Rationale: Nephrotic syndrome is characterized by massive proteinuria
(>3.5 g/day) due to increased glomerular permeability from damaged glomeruli. This
leads to hypoalbuminemia, edema, hyperlipidemia, and lipiduria. The classic triad is
proteinuria, hypoalbuminemia, and edema. It is NOT primarily a filtration failure
(that's CKD/AKI) or a renin issue.
6. The nurse preceptor observes a newly hired nurse caring for a client receiving
peritoneal dialysis. Which action indicates CORRECT technique?
A) Warming the dialysate bag in the microwave for 2 minutes before infusion
B) Repositioning the client side-to-side during dialysis to improve dialysate flow and
drainage
C) Placing the client flat in bed with the head of bed at 0 degrees during the entire
dwell time
D) Ignoring small air bubbles in the tubing because they will be absorbed by the
peritoneum
Correct Answer: B) Repositioning the client side-to-side during dialysis to improve
dialysate flow and drainage
Expert Rationale: Turning the client from side to side uses gravity to enhance
dialysate flow into and out of the peritoneal cavity, improving drainage and
distribution. Dialysate should NEVER be microwaved (causes protein denaturation
and uneven heating); use a heating pad or warm water bath. The head of bed should
be elevated 30-45 degrees to promote diaphragmatic excursion and reduce risk of
, aspiration. Air bubbles must be removed to prevent poor drainage, discomfort, and
reduced exchange efficiency.
7. A client with end-stage renal disease (ESRD) on hemodialysis reports muscle
weakness and tremors. Which electrolyte imbalance should the nurse suspect?
A) Hypercalcemia
B) Hyperkalemia or hypokalemia
C) Hypernatremia
D) Hypermagnesemia
Correct Answer: B) Hyperkalemia or hypokalemia
Expert Rationale: Muscle weakness and tremors in a dialysis client can indicate
severe electrolyte imbalances, particularly hyperkalemia (dangerous high potassium)
or hypokalemia (post-dialysis). Both can cause neuromuscular symptoms, cardiac
dysrhythmias, and are medical emergencies. The nurse should immediately assess
vital signs, obtain an EKG, and notify the provider. Calcium imbalances cause
different symptoms (Chvostek/Trousseau for hypocalcemia; constipation and
confusion for hypercalcemia).
8. A client with AKI has the following arterial blood gas (ABG) results: pH 7.30,
PaCO2 28 mmHg, HCO3- 16 mEq/L. Which acid-base disturbance is present?
A) Respiratory acidosis with partial compensation
B) Metabolic acidosis with full compensation
C) Metabolic acidosis with partial respiratory compensation
D) Respiratory alkalosis with metabolic compensation
Correct Answer: C) Metabolic acidosis with partial respiratory compensation
Expert Rationale: The pH of 7.30 is acidic (normal 7.35-7.45). The HCO3- of 16
mEq/L is low (normal 22-26), indicating metabolic acidosis as the primary disorder.
The PaCO2 of 28 mmHg is low (normal 35-45), showing the lungs are attempting to
compensate by hyperventilating to blow off CO2. However, the pH remains
abnormal at 7.30, indicating only PARTIAL compensation. In AKI, metabolic
