NUR 242 MEDICAL-SURGICAL NURSING EXAM 3 REVIEW
2026/2027 | Complete Guide with Questions and Verified
Answers | 100% Correct | Galen College | Pass Guaranteed -
A+ Graded
Renal/Urinary Disorders (AKI, CKD, Dialysis, UTI, Glomerulonephritis,
Nephrolithiasis)
Q1: A 68-year-old patient with heart failure is admitted with decreased urine output,
elevated BUN/Cr ratio (>20:1), and FENa <1%. The nurse recognizes these findings are
consistent with:
A. Intrinsic acute kidney injury from nephrotoxic medications
B. Prerenal AKI due to hypoperfusion from decreased cardiac output
C. Postrenal AKI from urinary tract obstruction
D. Chronic kidney disease stage 5
Correct Answer: B
Rationale: Prerenal AKI is characterized by hypoperfusion (here from heart failure),
BUN/Cr ratio >20:1, and low FENa (<1%) indicating intact tubular function with sodium
conservation. Intrinsic AKI (option A) would show high FENa (>2%). Postrenal (option C)
requires obstruction evidence. CKD (option D) is chronic, not acute.
,Q2: A patient with AKI has the following labs: potassium 6.8 mEq/L, ECG showing
peaked T waves and widened QRS. The priority nursing intervention is:
A. Administer oral potassium-binding resin (sodium polystyrene sulfonate)
B. Prepare for emergent dialysis
C. Administer IV calcium gluconate to stabilize cardiac membranes
D. Insert Foley catheter for accurate output measurement
Correct Answer: C
Rationale: ECG changes (peaked T waves, widened QRS) indicate cardiotoxicity from
hyperkalemia. IV calcium gluconate (or chloride) is the immediate priority to protect the
heart. Options A and B are important but don't immediately stabilize cardiac
membranes. Option D is unrelated to the emergency.
Q3: A patient with CKD stage 4 (GFR 25 mL/min) is being educated about dietary
modifications. Which statement by the patient indicates understanding?
A. "I should increase my protein intake to maintain muscle mass."
B. "I need to limit potassium, phosphorus, and sodium in my diet."
C. "I should drink at least 3 liters of fluid daily to flush my kidneys."
D. "I need to increase calcium supplements to prevent bone disease."
Correct Answer: B
Rationale: CKD dietary management includes limiting potassium (hyperkalemia risk),
phosphorus (bone disease), and sodium (fluid retention/HTN). Protein is restricted
,(option A), not increased. Fluids may be restricted (option C), not increased. Calcium
supplements (option D) are used cautiously due to vascular calcification
risk—phosphate binders are preferred.
Q4: A patient on hemodialysis via AV fistula reports the access site feels cool and there
is no palpable thrill. The nurse suspects:
A. Normal variation in fistula function
B. Fistula stenosis or thrombosis requiring immediate intervention
C. Infection at the access site
D. Adequate dialysis clearance
Correct Answer: B
Rationale: A functional AV fistula should have a palpable thrill (vibration from turbulent
flow) and bruit. Absence suggests thrombosis or stenosis—vascular emergency
threatening dialysis access. Option A is dangerous—this is never normal. Infection
(option C) would show warmth, erythema, purulence. Option D is opposite—no flow
means no clearance.
Q5: A patient undergoing peritoneal dialysis reports cloudy effluent and abdominal pain.
Temperature is 38.2°C. The priority nursing action is:
A. Continue dialysis and monitor for spontaneous resolution
B. Obtain effluent for cell count, Gram stain, culture, and initiate empiric intraperitoneal
antibiotics
C. Switch to hemodialysis immediately
, D. Administer oral antibiotics and discharge home
Correct Answer: B
Rationale: Cloudy effluent + pain + fever = peritonitis, the most serious PD complication.
Immediate effluent sampling and empiric antibiotics (covering gram-positive and
gram-negative organisms) are essential. Option A risks sepsis. Option C may be needed
later but antibiotics come first. Option D is inadequate—peritonitis requires aggressive
IP antibiotics, not oral.
Q6: A 24-year-old woman presents with dysuria, frequency, urgency, and suprapubic
pain. Urinalysis shows positive leukocyte esterase, nitrites, and 50 WBCs/hpf. The nurse
anticipates treatment with:
A. Ciprofloxacin 500mg PO BID for 3 days
B. Nitrofurantoin 100mg PO BID for 5 days
C. Ceftriaxone 1g IV daily
D. Vancomycin 1g IV q12h
Correct Answer: B
Rationale: Uncomplicated lower UTI (cystitis) in a young woman is treated with
nitrofurantoin (5 days), TMP-SMX (3 days), or fosfomycin (single dose).
Fluoroquinolones (option A) are reserved for complicated infections due to resistance.
Options C and D are for pyelonephritis or complicated infections.
2026/2027 | Complete Guide with Questions and Verified
Answers | 100% Correct | Galen College | Pass Guaranteed -
A+ Graded
Renal/Urinary Disorders (AKI, CKD, Dialysis, UTI, Glomerulonephritis,
Nephrolithiasis)
Q1: A 68-year-old patient with heart failure is admitted with decreased urine output,
elevated BUN/Cr ratio (>20:1), and FENa <1%. The nurse recognizes these findings are
consistent with:
A. Intrinsic acute kidney injury from nephrotoxic medications
B. Prerenal AKI due to hypoperfusion from decreased cardiac output
C. Postrenal AKI from urinary tract obstruction
D. Chronic kidney disease stage 5
Correct Answer: B
Rationale: Prerenal AKI is characterized by hypoperfusion (here from heart failure),
BUN/Cr ratio >20:1, and low FENa (<1%) indicating intact tubular function with sodium
conservation. Intrinsic AKI (option A) would show high FENa (>2%). Postrenal (option C)
requires obstruction evidence. CKD (option D) is chronic, not acute.
,Q2: A patient with AKI has the following labs: potassium 6.8 mEq/L, ECG showing
peaked T waves and widened QRS. The priority nursing intervention is:
A. Administer oral potassium-binding resin (sodium polystyrene sulfonate)
B. Prepare for emergent dialysis
C. Administer IV calcium gluconate to stabilize cardiac membranes
D. Insert Foley catheter for accurate output measurement
Correct Answer: C
Rationale: ECG changes (peaked T waves, widened QRS) indicate cardiotoxicity from
hyperkalemia. IV calcium gluconate (or chloride) is the immediate priority to protect the
heart. Options A and B are important but don't immediately stabilize cardiac
membranes. Option D is unrelated to the emergency.
Q3: A patient with CKD stage 4 (GFR 25 mL/min) is being educated about dietary
modifications. Which statement by the patient indicates understanding?
A. "I should increase my protein intake to maintain muscle mass."
B. "I need to limit potassium, phosphorus, and sodium in my diet."
C. "I should drink at least 3 liters of fluid daily to flush my kidneys."
D. "I need to increase calcium supplements to prevent bone disease."
Correct Answer: B
Rationale: CKD dietary management includes limiting potassium (hyperkalemia risk),
phosphorus (bone disease), and sodium (fluid retention/HTN). Protein is restricted
,(option A), not increased. Fluids may be restricted (option C), not increased. Calcium
supplements (option D) are used cautiously due to vascular calcification
risk—phosphate binders are preferred.
Q4: A patient on hemodialysis via AV fistula reports the access site feels cool and there
is no palpable thrill. The nurse suspects:
A. Normal variation in fistula function
B. Fistula stenosis or thrombosis requiring immediate intervention
C. Infection at the access site
D. Adequate dialysis clearance
Correct Answer: B
Rationale: A functional AV fistula should have a palpable thrill (vibration from turbulent
flow) and bruit. Absence suggests thrombosis or stenosis—vascular emergency
threatening dialysis access. Option A is dangerous—this is never normal. Infection
(option C) would show warmth, erythema, purulence. Option D is opposite—no flow
means no clearance.
Q5: A patient undergoing peritoneal dialysis reports cloudy effluent and abdominal pain.
Temperature is 38.2°C. The priority nursing action is:
A. Continue dialysis and monitor for spontaneous resolution
B. Obtain effluent for cell count, Gram stain, culture, and initiate empiric intraperitoneal
antibiotics
C. Switch to hemodialysis immediately
, D. Administer oral antibiotics and discharge home
Correct Answer: B
Rationale: Cloudy effluent + pain + fever = peritonitis, the most serious PD complication.
Immediate effluent sampling and empiric antibiotics (covering gram-positive and
gram-negative organisms) are essential. Option A risks sepsis. Option C may be needed
later but antibiotics come first. Option D is inadequate—peritonitis requires aggressive
IP antibiotics, not oral.
Q6: A 24-year-old woman presents with dysuria, frequency, urgency, and suprapubic
pain. Urinalysis shows positive leukocyte esterase, nitrites, and 50 WBCs/hpf. The nurse
anticipates treatment with:
A. Ciprofloxacin 500mg PO BID for 3 days
B. Nitrofurantoin 100mg PO BID for 5 days
C. Ceftriaxone 1g IV daily
D. Vancomycin 1g IV q12h
Correct Answer: B
Rationale: Uncomplicated lower UTI (cystitis) in a young woman is treated with
nitrofurantoin (5 days), TMP-SMX (3 days), or fosfomycin (single dose).
Fluoroquinolones (option A) are reserved for complicated infections due to resistance.
Options C and D are for pyelonephritis or complicated infections.
