NUR 265 Exam 1 – Medical-Surgical
Nursing – (2026/2027) Actual Questions
& Answers (Galen College of Nursing)
EXAM OVERVIEW
NUR 265 Exam 1 at Galen College of Nursing covers Complex Elimination (Renal,
GI, Hepatic) and Complex Perfusion (Cardiovascular) concepts. Key topics
include:
• Renal: Acute Kidney Injury (AKI), Chronic Kidney Disease (CKD), dialysis,
electrolytes, nephrotic syndrome
• Cardiac: Heart failure, myocardial infarction, dysrhythmias, hypertension
• Endocrine: Diabetes, thyroid disorders, SIADH, diabetes insipidus
• GI/Hepatic: Pancreatitis, cirrhosis, hepatic encephalopathy
• Respiratory: COPD, pneumonia, ARDS, chest tubes
SECTION A: COMPLEX ELIMINATION — RENAL & ELECTROLYTES (Questions
1. The patient has a potassium level of 6.8 mEq/L. Which ECG change should
the nurse expect to see first?
,A. ST elevation
B. Prolonged QT interval
C. Peaked T waves
D. U waves
Answer: C. Peaked T waves
Rationale: Hyperkalemia makes the heart more excitable. The earliest classic ECG
change is tall, peaked T waves. U waves are associated with hypokalemia.
2. A patient with CKD has a calcium of 6.9 mg/dL and phosphate of 6.5 mg/dL.
What is the priority complication?
A. Constipation
B. Tetany and muscle spasms
C. Dehydration
D. Bradycardia
Answer: B. Tetany and muscle spasms
Rationale: In CKD, the kidneys cannot activate Vitamin D or excrete phosphate.
Low calcium with high phosphate creates a risk for tetany, which can be assessed
with Chvostek or Trousseau signs.
3. What lab value best indicates that dialysis is working?
A. Potassium 5.0 mEq/L
B. BUN and creatinine decreased
,C. Hemoglobin increased
D. Albumin increased
Answer: B. BUN and creatinine decreased
Rationale: Dialysis removes nitrogenous waste products. A decrease in BUN and
creatinine is the best indicator that dialysis is effectively clearing waste products.
4. The nurse caring for a client with nephrotic syndrome with severe proteinuria
should take which action?
A. Administer furosemide
B. Administer lisinopril
C. Restrict fluids
D. Increase protein intake
Answer: B. Administer lisinopril
Rationale: 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.
5. Which client requires priority follow-up with the primary healthcare
provider?
A. Client 2 days post-AAA 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. Client 2 days post-AAA repair with creatinine increasing from 0.9 to
2.5 mg/dL
Rationale: A rapid rise in creatinine post-abdominal aortic aneurysm repair
suggests acute kidney injury (AKI) from decreased renal perfusion. This is a priority
because it indicates possible renal compromise requiring immediate intervention.
6. What is the normal GFR (glomerular filtration rate)?
A. 60-80 mL/min
B. 80-100 mL/min
C. 120-125 mL/min
D. 150-175 mL/min
Answer: C. 120-125 mL/min
Rationale: Normal GFR is approximately 120-125 mL/min. A GFR below 15
indicates kidney failure requiring dialysis or transplant.
7. A patient with CKD is prescribed epoetin alfa (Epogen). The nurse
understands this medication is given to treat which condition?
A. Hyperkalemia
B. Anemia
Nursing – (2026/2027) Actual Questions
& Answers (Galen College of Nursing)
EXAM OVERVIEW
NUR 265 Exam 1 at Galen College of Nursing covers Complex Elimination (Renal,
GI, Hepatic) and Complex Perfusion (Cardiovascular) concepts. Key topics
include:
• Renal: Acute Kidney Injury (AKI), Chronic Kidney Disease (CKD), dialysis,
electrolytes, nephrotic syndrome
• Cardiac: Heart failure, myocardial infarction, dysrhythmias, hypertension
• Endocrine: Diabetes, thyroid disorders, SIADH, diabetes insipidus
• GI/Hepatic: Pancreatitis, cirrhosis, hepatic encephalopathy
• Respiratory: COPD, pneumonia, ARDS, chest tubes
SECTION A: COMPLEX ELIMINATION — RENAL & ELECTROLYTES (Questions
1. The patient has a potassium level of 6.8 mEq/L. Which ECG change should
the nurse expect to see first?
,A. ST elevation
B. Prolonged QT interval
C. Peaked T waves
D. U waves
Answer: C. Peaked T waves
Rationale: Hyperkalemia makes the heart more excitable. The earliest classic ECG
change is tall, peaked T waves. U waves are associated with hypokalemia.
2. A patient with CKD has a calcium of 6.9 mg/dL and phosphate of 6.5 mg/dL.
What is the priority complication?
A. Constipation
B. Tetany and muscle spasms
C. Dehydration
D. Bradycardia
Answer: B. Tetany and muscle spasms
Rationale: In CKD, the kidneys cannot activate Vitamin D or excrete phosphate.
Low calcium with high phosphate creates a risk for tetany, which can be assessed
with Chvostek or Trousseau signs.
3. What lab value best indicates that dialysis is working?
A. Potassium 5.0 mEq/L
B. BUN and creatinine decreased
,C. Hemoglobin increased
D. Albumin increased
Answer: B. BUN and creatinine decreased
Rationale: Dialysis removes nitrogenous waste products. A decrease in BUN and
creatinine is the best indicator that dialysis is effectively clearing waste products.
4. The nurse caring for a client with nephrotic syndrome with severe proteinuria
should take which action?
A. Administer furosemide
B. Administer lisinopril
C. Restrict fluids
D. Increase protein intake
Answer: B. Administer lisinopril
Rationale: 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.
5. Which client requires priority follow-up with the primary healthcare
provider?
A. Client 2 days post-AAA 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. Client 2 days post-AAA repair with creatinine increasing from 0.9 to
2.5 mg/dL
Rationale: A rapid rise in creatinine post-abdominal aortic aneurysm repair
suggests acute kidney injury (AKI) from decreased renal perfusion. This is a priority
because it indicates possible renal compromise requiring immediate intervention.
6. What is the normal GFR (glomerular filtration rate)?
A. 60-80 mL/min
B. 80-100 mL/min
C. 120-125 mL/min
D. 150-175 mL/min
Answer: C. 120-125 mL/min
Rationale: Normal GFR is approximately 120-125 mL/min. A GFR below 15
indicates kidney failure requiring dialysis or transplant.
7. A patient with CKD is prescribed epoetin alfa (Epogen). The nurse
understands this medication is given to treat which condition?
A. Hyperkalemia
B. Anemia
