,NUR 265 Exam 1 Medical-Surgical Nursing
Question 1
The nurse caring for a client with nephrotic syndrome with severe
proteinuria should take which of the following actions?
A. Administer furosemide
B. Administer lisinopril
C. Restrict fluids
D. Increase protein intake
Correct Answer: B. Administer lisinopril
Rationale: ACE inhibitors like lisinopril reduce proteinuria by lowering
intraglomerular pressure, which slows kidney damage progression in
nephrotic syndrome. Furosemide addresses edema but does not treat
proteinuria. Fluid restriction is not typically indicated unless severe
hyponatremia exists, and protein intake should be moderate, not increased,
to avoid further renal stress.
Question 2
A client with chronic kidney disease (CKD) has a serum potassium of 6.5
mEq/L. Which intervention should the nurse anticipate first?
,A. Administer oral potassium supplements
B. Administer calcium gluconate IV
C. Restrict dietary potassium
D. Prepare for hemodialysis
Correct Answer: B. Administer calcium gluconate IV
Rationale: Calcium gluconate is administered IV to stabilize the cardiac
membrane and prevent life-threatening arrhythmias in severe hyperkalemia.
This is the priority action. Insulin with glucose, sodium bicarbonate, and
kayexalate are also used to shift or remove potassium, but calcium is given
first for cardiac protection. Dialysis is reserved for refractory cases.
Question 3
A client with acute kidney injury (AKI) is in the oliguric phase. Which
assessment finding is most concerning?
A. Urine output of 300 mL in 24 hours
B. Serum creatinine of 2.5 mg/dL
C. Serum potassium of 6.0 mEq/L
D. Blood urea nitrogen (BUN) of 40 mg/dL
Correct Answer: C. Serum potassium of 6.0 mEq/L
Rationale: In the oliguric phase of AKI, potassium excretion is severely
impaired, leading to life-threatening hyperkalemia. A potassium of 6.0 mEq/L
can cause fatal cardiac arrhythmias and requires immediate intervention.
Oliguria (urine output < 400 mL/24 hours) and elevated creatinine/BUN are
expected findings but are not immediately life-threatening.
, Question 4
The nurse is caring for a client with cirrhosis who develops ascites. Which
intervention is most appropriate?
A. High-sodium diet
B. Daily weights and abdominal girth measurements
C. Fluid restriction to 3 L/day
D. Encourage vigorous activity
Correct Answer: B. Daily weights and abdominal girth measurements
Rationale: Daily weights and abdominal girth measurements are the best
indicators of fluid accumulation and response to treatment in ascites. A low-
sodium diet (not high) is indicated. Fluid restriction may be needed but is
typically 1.5–2 L/day, not 3 L. Activity should be balanced with rest to reduce
metabolic demands.
Question 5
A client with pancreatitis is experiencing severe abdominal pain. Which
medication should the nurse anticipate administering?
A. Morphine sulfate
B. Meperidine
C. Hydromorphone
D. Fentanyl
Correct Answer: A. Morphine sulfate
Question 1
The nurse caring for a client with nephrotic syndrome with severe
proteinuria should take which of the following actions?
A. Administer furosemide
B. Administer lisinopril
C. Restrict fluids
D. Increase protein intake
Correct Answer: B. Administer lisinopril
Rationale: ACE inhibitors like lisinopril reduce proteinuria by lowering
intraglomerular pressure, which slows kidney damage progression in
nephrotic syndrome. Furosemide addresses edema but does not treat
proteinuria. Fluid restriction is not typically indicated unless severe
hyponatremia exists, and protein intake should be moderate, not increased,
to avoid further renal stress.
Question 2
A client with chronic kidney disease (CKD) has a serum potassium of 6.5
mEq/L. Which intervention should the nurse anticipate first?
,A. Administer oral potassium supplements
B. Administer calcium gluconate IV
C. Restrict dietary potassium
D. Prepare for hemodialysis
Correct Answer: B. Administer calcium gluconate IV
Rationale: Calcium gluconate is administered IV to stabilize the cardiac
membrane and prevent life-threatening arrhythmias in severe hyperkalemia.
This is the priority action. Insulin with glucose, sodium bicarbonate, and
kayexalate are also used to shift or remove potassium, but calcium is given
first for cardiac protection. Dialysis is reserved for refractory cases.
Question 3
A client with acute kidney injury (AKI) is in the oliguric phase. Which
assessment finding is most concerning?
A. Urine output of 300 mL in 24 hours
B. Serum creatinine of 2.5 mg/dL
C. Serum potassium of 6.0 mEq/L
D. Blood urea nitrogen (BUN) of 40 mg/dL
Correct Answer: C. Serum potassium of 6.0 mEq/L
Rationale: In the oliguric phase of AKI, potassium excretion is severely
impaired, leading to life-threatening hyperkalemia. A potassium of 6.0 mEq/L
can cause fatal cardiac arrhythmias and requires immediate intervention.
Oliguria (urine output < 400 mL/24 hours) and elevated creatinine/BUN are
expected findings but are not immediately life-threatening.
, Question 4
The nurse is caring for a client with cirrhosis who develops ascites. Which
intervention is most appropriate?
A. High-sodium diet
B. Daily weights and abdominal girth measurements
C. Fluid restriction to 3 L/day
D. Encourage vigorous activity
Correct Answer: B. Daily weights and abdominal girth measurements
Rationale: Daily weights and abdominal girth measurements are the best
indicators of fluid accumulation and response to treatment in ascites. A low-
sodium diet (not high) is indicated. Fluid restriction may be needed but is
typically 1.5–2 L/day, not 3 L. Activity should be balanced with rest to reduce
metabolic demands.
Question 5
A client with pancreatitis is experiencing severe abdominal pain. Which
medication should the nurse anticipate administering?
A. Morphine sulfate
B. Meperidine
C. Hydromorphone
D. Fentanyl
Correct Answer: A. Morphine sulfate
