NUR 265 EXAM 1 PRACTICE EXAM GALEN COLLEGE OF NURSING — ADVANCED MEDICAL-SURGICAL NURSING 2026/2027 COMPLETE (100) CURRENT TESTING QUESTIONS AND CORRECT ANSWERS WITH DETAILED RATIONALES.

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NUR 265 EXAM 1 PRACTICE EXAM GALEN COLLEGE OF
NURSING — ADVANCED MEDICAL-SURGICAL NURSING
2026/2027 COMPLETE (100) CURRENT TESTING
QUESTIONS AND CORRECT ANSWERS WITH DETAILED
RATIONALES.
NURSING
Prepare for the NUR 265 Exam 1 – Galen College with a focused study resource
designed to reinforce high-priority medical-surgical nursing concepts. It supports
review of neurological disorders, burns and shock, complex patient assessment,
emergency interventions, prioritization, and evidence-based nursing care. Use the
material to strengthen clinical reasoning, reinforce key concepts, and identify areas
that may require additional review before the exam. This resource is best suited for
Galen College of Nursing NUR 265 students preparing for Exam 3 and reviewing
advanced medical-surgical nursing concepts.



MULTIPLE CHOICE.
RENAL SYSTEM — ACUTE KIDNEY INJURY (AKI)
1. The nurse is caring for a patient in the oliguric phase of acute kidney
injury (AKI). Which laboratory value would be most concerning?
• A) Serum creatinine 2.0 mg/dL
• B) Serum potassium 6.5 mEq/L
• C) Blood urea nitrogen (BUN) 35 mg/dL
• D) Serum sodium 138 mEq/L
Answer: B) Serum potassium 6.5 mEq/L
Rationale: Hyperkalemia (K⁺ > 5.0 mEq/L) is a life-threatening
complication of AKI due to decreased renal excretion. A level of 6.5 mEq/L
can cause fatal cardiac arrhythmias. Creatinine and BUN are elevated in
AKI but are not immediately lethal. Sodium within normal range is
unremarkable.

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2. Which finding is the earliest sign of acute kidney injury (AKI)?
• A) Oliguria (urine output < 30 mL/hr)
• B) Flank pain
• C) Hematuria
• D) Hypertension
Answer: A) Oliguria (urine output < 30 mL/hr)
Rationale: The oliguric phase of AKI begins with a sudden decrease in
urine output, often within hours of the insult. Flank pain, hematuria, and
hypertension may accompany other renal pathologies, but oliguria is the
classic initial indicator of AKI.


3. A patient with acute kidney injury has a serum potassium of 6.8 mEq/L.
The nurse should anticipate administering which medication first?
• A) Oral sodium polystyrene sulfonate (Kayexalate)
• B) IV calcium gluconate
• C) IV insulin with dextrose
• D) IV sodium bicarbonate
Answer: B) IV calcium gluconate
Rationale: Hyperkalemia with a potassium > 6.5 mEq/L is a critical finding.
The priority intervention to prevent cardiac arrest is to stabilize the
cardiac membrane with IV calcium gluconate. Insulin with dextrose shifts
potassium into cells, and Kayexalate removes potassium via the GI tract,
but calcium gluconate is the first priority.


4. Which of the following is a prerenal cause of acute kidney injury (AKI)?
• A) Acute tubular necrosis

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• B) Nephrotoxic medications
• C) Hypovolemia from hemorrhage
• D) Bladder outlet obstruction
Answer: C) Hypovolemia from hemorrhage
Rationale: Prerenal AKI occurs due to decreased blood flow to the kidneys
before the blood reaches the kidney. Causes include intravascular
volume depletion (hemorrhage, dehydration, burns) and reduced cardiac
output. Intrarenal causes include tubular necrosis and nephrotoxicity.
Postrenal causes include obstruction downstream of the kidney.


5. The nurse is assessing a patient with AKI. Which of the following is a
sign of uremia?
• A) Hypertension and tachycardia
• B) Anorexia, nausea, and pruritus
• C) Polyuria and polydipsia
• D) Hyperkalemia and hyponatremia
Answer: B) Anorexia, nausea, and pruritus
Rationale: Uremia (accumulation of waste products in the blood)
manifests with anorexia, nausea, vomiting, pruritus (itching), and
neurological changes. Hypertension, edema, and dysrhythmias are signs
of fluid overload in AKI.


6. The nurse is caring for a client with acute kidney injury who is in the
diuretic phase. Which complication should the nurse monitor for?
• A) Fluid overload
• B) Hyperkalemia
• C) Hypokalemia
• D) Hypertension

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Answer: C) Hypokalemia
Rationale: In the diuretic phase of AKI, the kidneys begin to excrete large
volumes of dilute urine. This can lead to significant electrolyte losses,
particularly hypokalemia and hyponatremia. Fluid and electrolyte
replacement is essential during this phase.


7. A patient with AKI has a serum creatinine that has increased from 1.0
mg/dL to 2.8 mg/dL over 24 hours. The nurse should interpret this as:
• A) Expected finding in the recovery phase
• B) Indication of improving renal function
• C) Worsening renal function requiring further assessment
• D) Normal variation
Answer: C) Worsening renal function requiring further assessment
Rationale: A rapid rise in serum creatinine indicates worsening renal
function and requires prompt assessment. Creatinine is a more sensitive
indicator of renal function than BUN because it is not affected by protein
intake or hydration status.


8. Which nursing intervention is appropriate for a patient in the oliguric
phase of AKI?
• A) Encourage oral fluids to 3 L/day
• B) Restrict potassium and sodium as prescribed
• C) Increase protein intake to promote healing
• D) Administer IV fluids at 200 mL/hr
Answer: B) Restrict potassium and sodium as prescribed
Rationale: In the oliguric phase, the kidneys cannot excrete potassium,
sodium, or fluid effectively. Dietary restrictions include low to moderate
protein, potassium, and sodium as prescribed. Fluid intake is typically
restricted to replacement of insensible losses plus urine output.