NUR 265 Exam 1: Advanced Medical-
Surgical Nursing |150 Questions and
Answers With Rationale
EXAM
Q1: The nurse is caring for a client who has nephrotic
syndrome with severe proteinuria. Which action should the
nurse take?
A) Administer furosemide
B) Administer lisinopril
C) Restrict fluids
D) Increase protein intake
Answer: B — ACE inhibitors like lisinopril reduce proteinuria by
lowering intraglomerular pressure, which slows kidney damage
progression. They are standard therapy in nephrotic syndrome to
decrease urinary protein loss.
Q2: The nurse is reviewing labs of assigned clients. Which
client requires priority follow-up?
A) Client 2 days post-abdominal aortic aneurysm repair with
creatinine increasing from 0.9 to 2.5 mg/dL
,B) Client with creatinine stable at 1.1 mg/dL
C) Client with potassium 4.0 mEq/L
D) Client with mild hyponatremia
Answer: A — A significant increase in creatinine post-surgery
indicates possible acute kidney injury (AKI), requiring urgent
evaluation. Normal creatinine is approximately 0.5–1.2 mg/dL, and
a sharp rise signals reduced glomerular filtration.
Q3: A client with acute kidney injury (AKI) has a serum
potassium level of 6.8 mEq/L. What is the nurse's priority
intervention?
A) Administer sodium polystyrene sulfonate (Kayexalate) orally
B) Prepare the client for emergent hemodialysis
C) Administer IV calcium gluconate
D) Restrict dietary potassium intake
Answer: C — IV calcium gluconate is given emergently to
stabilize cardiac membranes and prevent life-threatening
arrhythmias in severe hyperkalemia. It does not lower potassium
but protects the heart while other treatments take effect.
Q4: A client with chronic kidney disease (CKD) is prescribed
epoetin alfa (Epogen). The nurse understands that this
medication is given to treat which complication?
,A) Hyperkalemia
B) Anemia
C) Metabolic acidosis
D) Hyperphosphatemia
Answer: B — Damaged kidneys do not produce enough
erythropoietin (EPO), which stimulates red blood cell production,
resulting in anemia. Epoetin alfa is synthetic EPO used to treat
anemia of CKD.
Q5: A client with cirrhosis develops increasing abdominal
girth and discomfort. Which order is most likely?
A) Furosemide
B) Spironolactone
C) Beta-blockers
D) Albumin
Answer: B — Spironolactone is the preferred diuretic for ascites
in cirrhosis because it is potassium-sparing and helps manage
fluid without causing electrolyte depletion.
Q6: What is a classic sign of cardiac tamponade?
Answer: Classic signs include muffled heart sounds, jugular
venous distention, and pulsus paradoxus. The most classic and
specific sign is muffled heart sounds.
, Q7: The nurse is working in a rehab center assisting a client
who had an MI to increase activity tolerance. Which symptom
indicates a need to stop the client's current activity?
A) Respirations increased from 22 to 28
B) Systolic blood pressure decreased from 126/96 to 106/68 mm
Hg
C) Pulse increased from 86 to 98
D) SaO₂ level decreased from 98% to 95%
Answer: B — A drop in systolic blood pressure during activity
indicates decreased cardiac output and myocardial ischemia,
requiring immediate cessation of activity.
Q8: The nurse should immediately follow up with which client
on the cardiac floor?
A) Being treated for atrial fibrillation with amiodarone drip and
assessed to have dysarthria
B) Receiving diltiazem for atrial fibrillation with decrease in systolic
BP from 148 to 123 mm Hg
C) 2 days post-CABG with capillary blood glucose of 312 mg/dL
D) Being treated for PVCs with potassium chloride infusion and
oral atenolol
Answer: A — Dysarthria (slurred speech) in a patient on
amiodarone may indicate stroke or amiodarone toxicity and
requires immediate follow-up.
Surgical Nursing |150 Questions and
Answers With Rationale
EXAM
Q1: The nurse is caring for a client who has nephrotic
syndrome with severe proteinuria. Which action should the
nurse take?
A) Administer furosemide
B) Administer lisinopril
C) Restrict fluids
D) Increase protein intake
Answer: B — ACE inhibitors like lisinopril reduce proteinuria by
lowering intraglomerular pressure, which slows kidney damage
progression. They are standard therapy in nephrotic syndrome to
decrease urinary protein loss.
Q2: The nurse is reviewing labs of assigned clients. Which
client requires priority follow-up?
A) Client 2 days post-abdominal aortic aneurysm repair with
creatinine increasing from 0.9 to 2.5 mg/dL
,B) Client with creatinine stable at 1.1 mg/dL
C) Client with potassium 4.0 mEq/L
D) Client with mild hyponatremia
Answer: A — A significant increase in creatinine post-surgery
indicates possible acute kidney injury (AKI), requiring urgent
evaluation. Normal creatinine is approximately 0.5–1.2 mg/dL, and
a sharp rise signals reduced glomerular filtration.
Q3: A client with acute kidney injury (AKI) has a serum
potassium level of 6.8 mEq/L. What is the nurse's priority
intervention?
A) Administer sodium polystyrene sulfonate (Kayexalate) orally
B) Prepare the client for emergent hemodialysis
C) Administer IV calcium gluconate
D) Restrict dietary potassium intake
Answer: C — IV calcium gluconate is given emergently to
stabilize cardiac membranes and prevent life-threatening
arrhythmias in severe hyperkalemia. It does not lower potassium
but protects the heart while other treatments take effect.
Q4: A client with chronic kidney disease (CKD) is prescribed
epoetin alfa (Epogen). The nurse understands that this
medication is given to treat which complication?
,A) Hyperkalemia
B) Anemia
C) Metabolic acidosis
D) Hyperphosphatemia
Answer: B — Damaged kidneys do not produce enough
erythropoietin (EPO), which stimulates red blood cell production,
resulting in anemia. Epoetin alfa is synthetic EPO used to treat
anemia of CKD.
Q5: A client with cirrhosis develops increasing abdominal
girth and discomfort. Which order is most likely?
A) Furosemide
B) Spironolactone
C) Beta-blockers
D) Albumin
Answer: B — Spironolactone is the preferred diuretic for ascites
in cirrhosis because it is potassium-sparing and helps manage
fluid without causing electrolyte depletion.
Q6: What is a classic sign of cardiac tamponade?
Answer: Classic signs include muffled heart sounds, jugular
venous distention, and pulsus paradoxus. The most classic and
specific sign is muffled heart sounds.
, Q7: The nurse is working in a rehab center assisting a client
who had an MI to increase activity tolerance. Which symptom
indicates a need to stop the client's current activity?
A) Respirations increased from 22 to 28
B) Systolic blood pressure decreased from 126/96 to 106/68 mm
Hg
C) Pulse increased from 86 to 98
D) SaO₂ level decreased from 98% to 95%
Answer: B — A drop in systolic blood pressure during activity
indicates decreased cardiac output and myocardial ischemia,
requiring immediate cessation of activity.
Q8: The nurse should immediately follow up with which client
on the cardiac floor?
A) Being treated for atrial fibrillation with amiodarone drip and
assessed to have dysarthria
B) Receiving diltiazem for atrial fibrillation with decrease in systolic
BP from 148 to 123 mm Hg
C) 2 days post-CABG with capillary blood glucose of 312 mg/dL
D) Being treated for PVCs with potassium chloride infusion and
oral atenolol
Answer: A — Dysarthria (slurred speech) in a patient on
amiodarone may indicate stroke or amiodarone toxicity and
requires immediate follow-up.
