,NUR 265 Exam 1 - 2026/2027 Practice Study Guide
NUR 265 Exam 1 | Advanced Concepts of Medical-Surgical Nursing | Galen
College | Q & A | 2026/2027 100%Pass (PDF)
1. After hemorrhage, urine output falls and creatinine rises. Which AKI mechanism is most likely?
A) Renal perfusion may be inadequate to sustain GFR
B) Reduced renal perfusion causing prerenal AKI
C) Reduced renal erythropoietin production
D) Dialysis disequilibrium syndrome
Correct Answer: B) Reduced renal perfusion causing prerenal AKI
Rationale: Hemorrhage lowers effective circulating volume and renal perfusion, reducing GFR before intrinsic
structural damage necessarily occurs. The other choices describe different mechanisms or complications and
do not best fit this scenario.
2. A patient with AKI has potassium 6.7 mEq/L and peaked T waves. Which problem is the immediate
priority?
A) Myoglobin-mediated tubular toxicity and obstruction
B) Phosphate retention with reduced calcitriol and secondary hyperparathyroidism
C) Hyperkalemia with risk for lethal dysrhythmia
D) Peritonitis
Correct Answer: C) Hyperkalemia with risk for lethal dysrhythmia
Rationale: Severe hyperkalemia alters cardiac conduction and can progress rapidly to ventricular dysrhythmia
or arrest. The other choices describe different mechanisms or complications and do not best fit this scenario.
3. Creatinine rises after several days of gentamicin despite adequate blood pressure. Which cause is
most likely?
A) Metabolic acidosis from impaired hydrogen excretion
B) Intrinsic acute tubular injury from nephrotoxicity
C) Uremic toxin accumulation
D) Tubing kinks, catheter position, and patient positioning
Correct Answer: B) Intrinsic acute tubular injury from nephrotoxicity
Rationale: Aminoglycosides can injure renal tubular cells, producing intrinsic AKI even when perfusion is
adequate. The other choices describe different mechanisms or complications and do not best fit this scenario.
4. Bladder distention, BPH, oliguria, and rising creatinine point to which category of AKI?
A) Reduced plasma oncotic pressure from urinary protein loss
B) Postrenal AKI from urinary outflow obstruction
C) Daily body weight under consistent conditions
D) Refractory hyperkalemia with ECG changes
Correct Answer: B) Postrenal AKI from urinary outflow obstruction
Rationale: BPH can obstruct bladder outflow, raising upstream pressure and reducing filtration. The other
choices describe different mechanisms or complications and do not best fit this scenario.
5. Which new finding most strongly indicates fluid overload during oliguric AKI?
A) Heavy proteinuria, hypoalbuminemia, edema, and hyperlipidemia
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, NUR 265 Exam 1 - 2026/2027 Practice Study Guide
B) A palpable thrill and audible bruit
C) With meals
D) Crackles with falling oxygen saturation
Correct Answer: D) Crackles with falling oxygen saturation
Rationale: Impaired sodium and water excretion can cause pulmonary edema, producing crackles, dyspnea,
and hypoxemia. The other choices describe different mechanisms or complications and do not best fit this
scenario.
6. During the diuretic phase of AKI, which complication requires close monitoring?
A) Avoid it unless specifically approved by the renal care team
B) Hypovolemia with electrolyte depletion
C) Blood-pressure measurement or venipuncture
D) Baked potato
Correct Answer: B) Hypovolemia with electrolyte depletion
Rationale: Recovering tubules may excrete large volumes before concentrating ability normalizes, causing
dehydration and electrolyte loss. The other choices describe different mechanisms or complications and do
not best fit this scenario.
7. Which 24-hour trend most strongly supports worsening renal filtration?
A) Reduced renal erythropoietin production
B) Rising creatinine with decreasing urine output
C) Dialysis disequilibrium syndrome
D) Water shifts into brain cells and causes cerebral edema
Correct Answer: B) Rising creatinine with decreasing urine output
Rationale: Creatinine accumulation and oliguria are key indicators of declining filtration. The other choices
describe different mechanisms or complications and do not best fit this scenario.
8. Why is a persistent MAP of 58 mmHg concerning in a patient at risk for AKI?
A) Renal perfusion may be inadequate to sustain GFR
B) Phosphate retention with reduced calcitriol and secondary hyperparathyroidismC)
Peritonitis
D) Tall peaked T waves
Correct Answer: A) Renal perfusion may be inadequate to sustain GFR
Rationale: Sustained hypotension can cause prerenal ischemia and, if prolonged, acute tubular injury. The
other choices describe different mechanisms or complications and do not best fit this scenario.
9. Rhabdomyolysis can produce intrinsic AKI through which mechanism?
A) Uremic toxin accumulation
B) Tubing kinks, catheter position, and patient positioning
C) Prominent U waves with increased dysrhythmia risk
D) Myoglobin-mediated tubular toxicity and obstruction
Page 3
NUR 265 Exam 1 | Advanced Concepts of Medical-Surgical Nursing | Galen
College | Q & A | 2026/2027 100%Pass (PDF)
1. After hemorrhage, urine output falls and creatinine rises. Which AKI mechanism is most likely?
A) Renal perfusion may be inadequate to sustain GFR
B) Reduced renal perfusion causing prerenal AKI
C) Reduced renal erythropoietin production
D) Dialysis disequilibrium syndrome
Correct Answer: B) Reduced renal perfusion causing prerenal AKI
Rationale: Hemorrhage lowers effective circulating volume and renal perfusion, reducing GFR before intrinsic
structural damage necessarily occurs. The other choices describe different mechanisms or complications and
do not best fit this scenario.
2. A patient with AKI has potassium 6.7 mEq/L and peaked T waves. Which problem is the immediate
priority?
A) Myoglobin-mediated tubular toxicity and obstruction
B) Phosphate retention with reduced calcitriol and secondary hyperparathyroidism
C) Hyperkalemia with risk for lethal dysrhythmia
D) Peritonitis
Correct Answer: C) Hyperkalemia with risk for lethal dysrhythmia
Rationale: Severe hyperkalemia alters cardiac conduction and can progress rapidly to ventricular dysrhythmia
or arrest. The other choices describe different mechanisms or complications and do not best fit this scenario.
3. Creatinine rises after several days of gentamicin despite adequate blood pressure. Which cause is
most likely?
A) Metabolic acidosis from impaired hydrogen excretion
B) Intrinsic acute tubular injury from nephrotoxicity
C) Uremic toxin accumulation
D) Tubing kinks, catheter position, and patient positioning
Correct Answer: B) Intrinsic acute tubular injury from nephrotoxicity
Rationale: Aminoglycosides can injure renal tubular cells, producing intrinsic AKI even when perfusion is
adequate. The other choices describe different mechanisms or complications and do not best fit this scenario.
4. Bladder distention, BPH, oliguria, and rising creatinine point to which category of AKI?
A) Reduced plasma oncotic pressure from urinary protein loss
B) Postrenal AKI from urinary outflow obstruction
C) Daily body weight under consistent conditions
D) Refractory hyperkalemia with ECG changes
Correct Answer: B) Postrenal AKI from urinary outflow obstruction
Rationale: BPH can obstruct bladder outflow, raising upstream pressure and reducing filtration. The other
choices describe different mechanisms or complications and do not best fit this scenario.
5. Which new finding most strongly indicates fluid overload during oliguric AKI?
A) Heavy proteinuria, hypoalbuminemia, edema, and hyperlipidemia
Page 2
, NUR 265 Exam 1 - 2026/2027 Practice Study Guide
B) A palpable thrill and audible bruit
C) With meals
D) Crackles with falling oxygen saturation
Correct Answer: D) Crackles with falling oxygen saturation
Rationale: Impaired sodium and water excretion can cause pulmonary edema, producing crackles, dyspnea,
and hypoxemia. The other choices describe different mechanisms or complications and do not best fit this
scenario.
6. During the diuretic phase of AKI, which complication requires close monitoring?
A) Avoid it unless specifically approved by the renal care team
B) Hypovolemia with electrolyte depletion
C) Blood-pressure measurement or venipuncture
D) Baked potato
Correct Answer: B) Hypovolemia with electrolyte depletion
Rationale: Recovering tubules may excrete large volumes before concentrating ability normalizes, causing
dehydration and electrolyte loss. The other choices describe different mechanisms or complications and do
not best fit this scenario.
7. Which 24-hour trend most strongly supports worsening renal filtration?
A) Reduced renal erythropoietin production
B) Rising creatinine with decreasing urine output
C) Dialysis disequilibrium syndrome
D) Water shifts into brain cells and causes cerebral edema
Correct Answer: B) Rising creatinine with decreasing urine output
Rationale: Creatinine accumulation and oliguria are key indicators of declining filtration. The other choices
describe different mechanisms or complications and do not best fit this scenario.
8. Why is a persistent MAP of 58 mmHg concerning in a patient at risk for AKI?
A) Renal perfusion may be inadequate to sustain GFR
B) Phosphate retention with reduced calcitriol and secondary hyperparathyroidismC)
Peritonitis
D) Tall peaked T waves
Correct Answer: A) Renal perfusion may be inadequate to sustain GFR
Rationale: Sustained hypotension can cause prerenal ischemia and, if prolonged, acute tubular injury. The
other choices describe different mechanisms or complications and do not best fit this scenario.
9. Rhabdomyolysis can produce intrinsic AKI through which mechanism?
A) Uremic toxin accumulation
B) Tubing kinks, catheter position, and patient positioning
C) Prominent U waves with increased dysrhythmia risk
D) Myoglobin-mediated tubular toxicity and obstruction
Page 3
