2026/2027
Galen College NUR 265 Exam 3
Medical-Surgical Nursing
Comprehensive Study Guide and
Practice Test Bank Review for
2026/2027
Question 1:
A nurse is providing discharge teaching to a client newly diagnosed with nephrotic
syndrome. Which client statement indicates an appropriate understanding of infection
prevention measures associated with this condition?
A. “I should avoid drinking large amounts of fluids every day.”
B. “I must protect myself from developing an infection.”
C. “I should stop taking my corticosteroid medication once swelling improves.”
D. “I need to increase my sodium intake to prevent dehydration.”
Correct Answer: B. “I must protect myself from developing an infection.”
Rationale:
Clients with nephrotic syndrome are at increased risk for infection due to urinary loss
of immunoglobulins and possible immunosuppressive therapy such as corticosteroids.
Therefore, infection prevention measures are a critical part of discharge teaching.
Option A is incorrect because fluid intake recommendations vary depending on
edema and renal function. Option C is incorrect because corticosteroids should never
be abruptly discontinued without provider guidance. Option D is incorrect because
sodium is usually restricted to reduce edema and fluid retention rather than increased.
Question 2:
The nurse reviews laboratory results for a client who underwent abdominal aortic
aneurysm (AAA) repair 2 days ago. Which finding requires immediate follow-up with
the primary care provider?
A. Potassium level of 4.1 mEq/L
B. Hemoglobin of 11.2 g/dL
C. Increase in creatinine from 0.9 mg/dL to 2.5 mg/dL
D. Blood glucose of 146 mg/dL
Correct Answer: C. Increase in creatinine from 0.9 mg/dL to 2.5 mg/dL
,2026/2027
Rationale:
A significant rise in serum creatinine following AAA repair may indicate acute
kidney injury caused by decreased renal perfusion, embolization, or surgical
complications. This is a priority finding because worsening renal function can rapidly
become life-threatening. The remaining findings may require monitoring but are not
as urgent. Mild postoperative anemia and mild hyperglycemia are relatively common
after surgery and are less immediately concerning.
Question 3:
A nurse is caring for a client hospitalized with acute kidney injury caused by
dehydration. Which assessment finding should the nurse report to the provider
immediately?
A. Urine output of 40 mL/hr
B. Blood pressure of 146/88 mmHg
C. Tall, peaked T waves on the cardiac monitor
D. Dry mucous membranes
Correct Answer: C. Tall, peaked T waves on the cardiac monitor
Rationale:
Tall, peaked T waves are a classic manifestation of hyperkalemia, which can lead to
lethal cardiac dysrhythmias if untreated. Clients with acute kidney injury are at high
risk for potassium retention because the kidneys are unable to excrete potassium
effectively. Dry mucous membranes and mild hypertension may occur with
dehydration or renal dysfunction but are not as immediately life-threatening. Urine
output of 40 mL/hr is acceptable in many adults.
Question 4:
A client receiving IV gentamicin develops oliguria and elevated blood pressure.
Which action should the nurse take first?
A. Encourage increased oral fluid intake
B. Obtain a prescription for gentamicin peak and trough levels
C. Administer a prescribed diuretic
D. Restrict the client’s sodium intake
Correct Answer: B. Obtain a prescription for gentamicin peak and trough levels
Rationale:
Gentamicin is nephrotoxic and can cause acute kidney injury. Oliguria and
hypertension may indicate worsening renal impairment. Peak and trough levels help
determine whether the medication concentration is toxic and guide dosage
adjustments. Increasing fluids without assessing renal status could worsen fluid
overload. Diuretics and sodium restriction may be appropriate later but do not address
the immediate concern of possible gentamicin toxicity.
,2026/2027
Question 5:
A client with chronic kidney disease reports muscle weakness, diarrhea, and tingling
in the hands. Which nursing action should be taken first?
A. Encourage ambulation
B. Check the client’s most recent serum electrolyte levels
C. Administer prescribed pain medication
D. Place the client on fluid restriction
Correct Answer: B. Check the client’s most recent serum electrolyte levels
Rationale:
Muscle weakness, diarrhea, and paresthesia may indicate electrolyte imbalances such
as hyperkalemia or hypocalcemia, both common in chronic kidney disease.
Electrolyte abnormalities can rapidly progress to serious complications including
cardiac dysrhythmias. The nurse should first assess laboratory values to determine the
severity of the imbalance. The remaining interventions may become necessary later
but are not the priority.
Question 6:
A client receiving hemodialysis three times weekly states, “I try to limit my intake of
dietary sodium to 5 grams a day.” Which response by the nurse is most appropriate?
A. “That amount of sodium intake is usually acceptable.”
B. “You should eliminate sodium completely from your diet.”
C. “Your sodium intake goal is generally much lower than that.”
D. “You only need to limit sodium on dialysis days.”
Correct Answer: C. “Your sodium intake goal is generally much lower than that.”
Rationale:
Clients with chronic kidney disease on dialysis are usually instructed to significantly
restrict sodium intake to reduce fluid retention, edema, and hypertension. An intake of
5 grams daily is excessive for most dialysis clients. Eliminating sodium entirely is
unrealistic and potentially harmful. Sodium restriction should be maintained
consistently rather than only on dialysis days.
Question 7:
A nurse is teaching a client in the late stages of chronic kidney disease. Which
statement by the client demonstrates correct understanding of the teaching?
A. “Fatigue and weakness are expected and should not be reported.”
B. “I should stop taking my medications if I feel dizzy.”
, 2026/2027
C. “If I develop fatigue or weakness, I should report it to my doctor.”
D. “Dialysis will cure my kidney disease.”
Correct Answer: C. “If I develop fatigue or weakness, I should report it to my
doctor.”
Rationale:
Fatigue and weakness may indicate worsening anemia, electrolyte imbalance, or
progression of kidney disease and should be reported promptly. Dialysis manages
symptoms and replaces some kidney function but does not cure chronic kidney
disease. Clients should not independently stop prescribed medications. Recognizing
and reporting worsening symptoms is an important self-management skill.
Question 8:
A client has just returned from hemodialysis treatment. Which finding requires
immediate nursing intervention?
A. Blood pressure of 90/58 mmHg
B. Mild fatigue
C. Temperature of 99°F (37.2°C)
D. Decreased appetite
Correct Answer: A. Blood pressure of 90/58 mmHg
Rationale:
Hypotension is a common but potentially serious complication after hemodialysis due
to rapid fluid removal. Severe hypotension can lead to dizziness, shock, falls, and
inadequate tissue perfusion. The nurse should assess the client immediately and
intervene appropriately. Mild fatigue and decreased appetite are less urgent and may
occur after dialysis.
Question 9:
A nurse is changing the dressing of a client receiving peritoneal dialysis. Which
action demonstrates appropriate infection control technique?
A. Leaving the catheter exposed to air during the procedure
B. Wearing sterile gloves only
C. Placing a mask on the client during dressing changes
D. Cleansing the catheter with tap water
Correct Answer: C. Placing a mask on the client during dressing changes
Rationale:
Peritoneal dialysis clients are at high risk for peritonitis. Both the nurse and client
should wear masks during dressing changes to minimize contamination from
Galen College NUR 265 Exam 3
Medical-Surgical Nursing
Comprehensive Study Guide and
Practice Test Bank Review for
2026/2027
Question 1:
A nurse is providing discharge teaching to a client newly diagnosed with nephrotic
syndrome. Which client statement indicates an appropriate understanding of infection
prevention measures associated with this condition?
A. “I should avoid drinking large amounts of fluids every day.”
B. “I must protect myself from developing an infection.”
C. “I should stop taking my corticosteroid medication once swelling improves.”
D. “I need to increase my sodium intake to prevent dehydration.”
Correct Answer: B. “I must protect myself from developing an infection.”
Rationale:
Clients with nephrotic syndrome are at increased risk for infection due to urinary loss
of immunoglobulins and possible immunosuppressive therapy such as corticosteroids.
Therefore, infection prevention measures are a critical part of discharge teaching.
Option A is incorrect because fluid intake recommendations vary depending on
edema and renal function. Option C is incorrect because corticosteroids should never
be abruptly discontinued without provider guidance. Option D is incorrect because
sodium is usually restricted to reduce edema and fluid retention rather than increased.
Question 2:
The nurse reviews laboratory results for a client who underwent abdominal aortic
aneurysm (AAA) repair 2 days ago. Which finding requires immediate follow-up with
the primary care provider?
A. Potassium level of 4.1 mEq/L
B. Hemoglobin of 11.2 g/dL
C. Increase in creatinine from 0.9 mg/dL to 2.5 mg/dL
D. Blood glucose of 146 mg/dL
Correct Answer: C. Increase in creatinine from 0.9 mg/dL to 2.5 mg/dL
,2026/2027
Rationale:
A significant rise in serum creatinine following AAA repair may indicate acute
kidney injury caused by decreased renal perfusion, embolization, or surgical
complications. This is a priority finding because worsening renal function can rapidly
become life-threatening. The remaining findings may require monitoring but are not
as urgent. Mild postoperative anemia and mild hyperglycemia are relatively common
after surgery and are less immediately concerning.
Question 3:
A nurse is caring for a client hospitalized with acute kidney injury caused by
dehydration. Which assessment finding should the nurse report to the provider
immediately?
A. Urine output of 40 mL/hr
B. Blood pressure of 146/88 mmHg
C. Tall, peaked T waves on the cardiac monitor
D. Dry mucous membranes
Correct Answer: C. Tall, peaked T waves on the cardiac monitor
Rationale:
Tall, peaked T waves are a classic manifestation of hyperkalemia, which can lead to
lethal cardiac dysrhythmias if untreated. Clients with acute kidney injury are at high
risk for potassium retention because the kidneys are unable to excrete potassium
effectively. Dry mucous membranes and mild hypertension may occur with
dehydration or renal dysfunction but are not as immediately life-threatening. Urine
output of 40 mL/hr is acceptable in many adults.
Question 4:
A client receiving IV gentamicin develops oliguria and elevated blood pressure.
Which action should the nurse take first?
A. Encourage increased oral fluid intake
B. Obtain a prescription for gentamicin peak and trough levels
C. Administer a prescribed diuretic
D. Restrict the client’s sodium intake
Correct Answer: B. Obtain a prescription for gentamicin peak and trough levels
Rationale:
Gentamicin is nephrotoxic and can cause acute kidney injury. Oliguria and
hypertension may indicate worsening renal impairment. Peak and trough levels help
determine whether the medication concentration is toxic and guide dosage
adjustments. Increasing fluids without assessing renal status could worsen fluid
overload. Diuretics and sodium restriction may be appropriate later but do not address
the immediate concern of possible gentamicin toxicity.
,2026/2027
Question 5:
A client with chronic kidney disease reports muscle weakness, diarrhea, and tingling
in the hands. Which nursing action should be taken first?
A. Encourage ambulation
B. Check the client’s most recent serum electrolyte levels
C. Administer prescribed pain medication
D. Place the client on fluid restriction
Correct Answer: B. Check the client’s most recent serum electrolyte levels
Rationale:
Muscle weakness, diarrhea, and paresthesia may indicate electrolyte imbalances such
as hyperkalemia or hypocalcemia, both common in chronic kidney disease.
Electrolyte abnormalities can rapidly progress to serious complications including
cardiac dysrhythmias. The nurse should first assess laboratory values to determine the
severity of the imbalance. The remaining interventions may become necessary later
but are not the priority.
Question 6:
A client receiving hemodialysis three times weekly states, “I try to limit my intake of
dietary sodium to 5 grams a day.” Which response by the nurse is most appropriate?
A. “That amount of sodium intake is usually acceptable.”
B. “You should eliminate sodium completely from your diet.”
C. “Your sodium intake goal is generally much lower than that.”
D. “You only need to limit sodium on dialysis days.”
Correct Answer: C. “Your sodium intake goal is generally much lower than that.”
Rationale:
Clients with chronic kidney disease on dialysis are usually instructed to significantly
restrict sodium intake to reduce fluid retention, edema, and hypertension. An intake of
5 grams daily is excessive for most dialysis clients. Eliminating sodium entirely is
unrealistic and potentially harmful. Sodium restriction should be maintained
consistently rather than only on dialysis days.
Question 7:
A nurse is teaching a client in the late stages of chronic kidney disease. Which
statement by the client demonstrates correct understanding of the teaching?
A. “Fatigue and weakness are expected and should not be reported.”
B. “I should stop taking my medications if I feel dizzy.”
, 2026/2027
C. “If I develop fatigue or weakness, I should report it to my doctor.”
D. “Dialysis will cure my kidney disease.”
Correct Answer: C. “If I develop fatigue or weakness, I should report it to my
doctor.”
Rationale:
Fatigue and weakness may indicate worsening anemia, electrolyte imbalance, or
progression of kidney disease and should be reported promptly. Dialysis manages
symptoms and replaces some kidney function but does not cure chronic kidney
disease. Clients should not independently stop prescribed medications. Recognizing
and reporting worsening symptoms is an important self-management skill.
Question 8:
A client has just returned from hemodialysis treatment. Which finding requires
immediate nursing intervention?
A. Blood pressure of 90/58 mmHg
B. Mild fatigue
C. Temperature of 99°F (37.2°C)
D. Decreased appetite
Correct Answer: A. Blood pressure of 90/58 mmHg
Rationale:
Hypotension is a common but potentially serious complication after hemodialysis due
to rapid fluid removal. Severe hypotension can lead to dizziness, shock, falls, and
inadequate tissue perfusion. The nurse should assess the client immediately and
intervene appropriately. Mild fatigue and decreased appetite are less urgent and may
occur after dialysis.
Question 9:
A nurse is changing the dressing of a client receiving peritoneal dialysis. Which
action demonstrates appropriate infection control technique?
A. Leaving the catheter exposed to air during the procedure
B. Wearing sterile gloves only
C. Placing a mask on the client during dressing changes
D. Cleansing the catheter with tap water
Correct Answer: C. Placing a mask on the client during dressing changes
Rationale:
Peritoneal dialysis clients are at high risk for peritonitis. Both the nurse and client
should wear masks during dressing changes to minimize contamination from
