,NUR 265 Exam 1 Review – Complete Question
Bank
1. A patient with acute kidney injury (AKI) has a serum potassium of 6.8 mEq/L.
Which nursing intervention is the priority?
A) Administer oral sodium polystyrene sulfonate (Kayexalate)
B) Prepare the patient for emergency hemodialysis
C) Administer IV calcium gluconate
D) Restrict dietary potassium intake
Correct Answer: C) Administer IV calcium gluconate
*Rationale: IV calcium gluconate is the priority intervention for severe hyperkalemia
because it stabilizes the cardiac membrane and prevents life-threatening arrhythmias.
While Kayexalate and dialysis remove potassium, calcium gluconate provides immediate
cardiac protection. Dietary restriction is a long-term measure. *
2. A patient with heart failure is exhibiting crackles in the lungs, jugular vein
distention, and peripheral edema. Which nursing diagnosis is most appropriate?
A) Impaired Gas Exchange
B) Fluid Volume Excess
C) Decreased Cardiac Output
D) Activity Intolerance
Correct Answer: B) Fluid Volume Excess
*Rationale: The patient's symptoms (crackles, JVD, peripheral edema) are classic signs
of fluid volume excess (hypervolemia) secondary to heart failure. While impaired gas
exchange and decreased cardiac output are also present, fluid volume excess is the
primary problem causing these manifestations. *
3. A patient with COPD has an arterial blood gas (ABG) showing pH 7.32, PaCO2
58, and HCO3 30. The nurse interprets this as:
,A) Uncompensated respiratory acidosis
B) Partially compensated respiratory acidosis
C) Fully compensated respiratory acidosis
D) Metabolic alkalosis with respiratory compensation
Correct Answer: C) Fully compensated respiratory acidosis
*Rationale: The pH is low (acidosis), PaCO2 is elevated (respiratory cause), and HCO3 is
elevated (metabolic compensation). The pH is moving toward normal (7.35-7.45) but
remains slightly acidic, indicating full compensation because the kidneys have retained
bicarbonate to raise the pH. *
4. A patient is receiving IV furosemide (Lasix) for pulmonary edema. Which
assessment finding indicates the medication is effective?
A) Decreased urine output
B) Decreased crackles and improved breathing
C) Increased peripheral edema
D) Elevated blood pressure
Correct Answer: B) Decreased crackles and improved breathing
*Rationale: Furosemide is a loop diuretic that reduces fluid volume. Effectiveness is
indicated by increased urine output, decreased crackles (pulmonary congestion),
improved breathing, and weight loss. Decreased crackles indicate that fluid is being
removed from the lungs. *
5. A patient with diabetes insipidus is expected to have which urine specific gravity
finding?
A) 1.005 (dilute urine)
B) 1.020 (normal)
C) 1.030 (concentrated)
D) 1.040 (very concentrated)
Correct Answer: A) 1.005 (dilute urine)
*Rationale: Diabetes insipidus is characterized by the inability to concentrate urine due
to ADH deficiency or resistance. Urine specific gravity is low (dilute), typically 1.001-
1.005. The patient produces large volumes of dilute urine. *
, 6. The nurse is caring for a patient with hyperthyroidism (Graves' disease). Which
finding is most consistent with this diagnosis?
A) Cold intolerance and bradycardia
B) Weight gain and fatigue
C) Exophthalmos and tachycardia
D) Constipation and dry skin
Correct Answer: C) Exophthalmos and tachycardia
*Rationale: Graves' disease causes hyperthyroidism, characterized by exophthalmos
(bulging eyes), tachycardia, heat intolerance, weight loss, and diaphoresis. Cold
intolerance, weight gain, and bradycardia are signs of hypothyroidism. *
7. A patient with hypothyroidism is prescribed levothyroxine (Synthroid). Which
instruction should the nurse include in patient teaching?
A) Take the medication with meals to reduce gastric upset
B) Take the medication on an empty stomach in the morning
C) The medication can be stopped once symptoms improve
D) Take the medication at bedtime for better absorption
Correct Answer: B) Take the medication on an empty stomach in the morning
*Rationale: Levothyroxine should be taken on an empty stomach, 30-60 minutes before
breakfast, to maximize absorption. It should be taken consistently at the same time each
day and should not be stopped abruptly. *
8. Which laboratory value is most concerning in a patient with chronic kidney
disease (CKD)?
A) Serum creatinine 2.5 mg/dL
B) Serum potassium 6.2 mEq/L
C) Serum calcium 9.0 mg/dL
D) Serum phosphorus 4.0 mg/dL
Correct Answer: B) Serum potassium 6.2 mEq/L
*Rationale: Hyperkalemia (potassium > 5.0 mEq/L) is the most life-threatening
Bank
1. A patient with acute kidney injury (AKI) has a serum potassium of 6.8 mEq/L.
Which nursing intervention is the priority?
A) Administer oral sodium polystyrene sulfonate (Kayexalate)
B) Prepare the patient for emergency hemodialysis
C) Administer IV calcium gluconate
D) Restrict dietary potassium intake
Correct Answer: C) Administer IV calcium gluconate
*Rationale: IV calcium gluconate is the priority intervention for severe hyperkalemia
because it stabilizes the cardiac membrane and prevents life-threatening arrhythmias.
While Kayexalate and dialysis remove potassium, calcium gluconate provides immediate
cardiac protection. Dietary restriction is a long-term measure. *
2. A patient with heart failure is exhibiting crackles in the lungs, jugular vein
distention, and peripheral edema. Which nursing diagnosis is most appropriate?
A) Impaired Gas Exchange
B) Fluid Volume Excess
C) Decreased Cardiac Output
D) Activity Intolerance
Correct Answer: B) Fluid Volume Excess
*Rationale: The patient's symptoms (crackles, JVD, peripheral edema) are classic signs
of fluid volume excess (hypervolemia) secondary to heart failure. While impaired gas
exchange and decreased cardiac output are also present, fluid volume excess is the
primary problem causing these manifestations. *
3. A patient with COPD has an arterial blood gas (ABG) showing pH 7.32, PaCO2
58, and HCO3 30. The nurse interprets this as:
,A) Uncompensated respiratory acidosis
B) Partially compensated respiratory acidosis
C) Fully compensated respiratory acidosis
D) Metabolic alkalosis with respiratory compensation
Correct Answer: C) Fully compensated respiratory acidosis
*Rationale: The pH is low (acidosis), PaCO2 is elevated (respiratory cause), and HCO3 is
elevated (metabolic compensation). The pH is moving toward normal (7.35-7.45) but
remains slightly acidic, indicating full compensation because the kidneys have retained
bicarbonate to raise the pH. *
4. A patient is receiving IV furosemide (Lasix) for pulmonary edema. Which
assessment finding indicates the medication is effective?
A) Decreased urine output
B) Decreased crackles and improved breathing
C) Increased peripheral edema
D) Elevated blood pressure
Correct Answer: B) Decreased crackles and improved breathing
*Rationale: Furosemide is a loop diuretic that reduces fluid volume. Effectiveness is
indicated by increased urine output, decreased crackles (pulmonary congestion),
improved breathing, and weight loss. Decreased crackles indicate that fluid is being
removed from the lungs. *
5. A patient with diabetes insipidus is expected to have which urine specific gravity
finding?
A) 1.005 (dilute urine)
B) 1.020 (normal)
C) 1.030 (concentrated)
D) 1.040 (very concentrated)
Correct Answer: A) 1.005 (dilute urine)
*Rationale: Diabetes insipidus is characterized by the inability to concentrate urine due
to ADH deficiency or resistance. Urine specific gravity is low (dilute), typically 1.001-
1.005. The patient produces large volumes of dilute urine. *
, 6. The nurse is caring for a patient with hyperthyroidism (Graves' disease). Which
finding is most consistent with this diagnosis?
A) Cold intolerance and bradycardia
B) Weight gain and fatigue
C) Exophthalmos and tachycardia
D) Constipation and dry skin
Correct Answer: C) Exophthalmos and tachycardia
*Rationale: Graves' disease causes hyperthyroidism, characterized by exophthalmos
(bulging eyes), tachycardia, heat intolerance, weight loss, and diaphoresis. Cold
intolerance, weight gain, and bradycardia are signs of hypothyroidism. *
7. A patient with hypothyroidism is prescribed levothyroxine (Synthroid). Which
instruction should the nurse include in patient teaching?
A) Take the medication with meals to reduce gastric upset
B) Take the medication on an empty stomach in the morning
C) The medication can be stopped once symptoms improve
D) Take the medication at bedtime for better absorption
Correct Answer: B) Take the medication on an empty stomach in the morning
*Rationale: Levothyroxine should be taken on an empty stomach, 30-60 minutes before
breakfast, to maximize absorption. It should be taken consistently at the same time each
day and should not be stopped abruptly. *
8. Which laboratory value is most concerning in a patient with chronic kidney
disease (CKD)?
A) Serum creatinine 2.5 mg/dL
B) Serum potassium 6.2 mEq/L
C) Serum calcium 9.0 mg/dL
D) Serum phosphorus 4.0 mg/dL
Correct Answer: B) Serum potassium 6.2 mEq/L
*Rationale: Hyperkalemia (potassium > 5.0 mEq/L) is the most life-threatening
