ADVANCED MED-SURG EXAM 1 PREMIUM
STUDY GUIDE NCLEX-STYLE QUESTIONS &
ANSWERS
This premium practice exam bundle delivers high-yield, NCLEX-
style multiple-choice questions meticulously aligned with
advanced medical-surgical nursing curricula. Every question
features a clear, italicized correct answer and an advanced,
bolded rationale designed to sharpen critical clinical judgment
and master complex pathophysiology. It serves as the ultimate
high-tier study tool for nursing students aiming to ace their first
major examination.
Question 1
A client with Chronic Kidney Disease (CKD) reports
severe generalized itching, a persistent metallic
taste, and muscle cramps. The nurse notes white,
powdery crystals on the client’s forehead and upper
lip. Which laboratory value is most critical for the
nurse to evaluate?
A. Serum Calcium
B. Serum Potassium
C. Blood Urea Nitrogen (BUN)
D. Hemoglobin
Answer: C. Blood Urea Nitrogen (BUN)
Rationale: The client is exhibiting clinical
manifestations of uremia, including uremic pruritus
,and uremic frost, which occur due to the
accumulation of systemic nitrogenous waste
products. While calcium and potassium are affected
in CKD, the specific buildup of urea and creatinine
directly correlates with these dermatological and
neurological uremic symptoms.
Question 2
The nurse is caring for a client with Nephrotic
Syndrome. Which clinical finding should the nurse
prioritize for immediate intervention?
A. 3+ pitting edema in both lower extremities
B. A respiratory rate of 28 breaths/minute with
bilateral crackles
C. Total serum cholesterol of 290 mg/dL
D. Urine output containing 4.2 grams of protein over
24 hours
Answer: B. A respiratory rate of 28 breaths/minute
with bilateral crackles
Rationale: While severe hypoalbuminemia in
Nephrotic Syndrome causes massive third-spacing
(edema) and hyperlipidemia, fluid shifting into the
pulmonary interstitium (pulmonary edema)
compromises oxygenation and ventilation, making it
an immediate ABC priority.
,Question 3
A client undergoes an arteriovenous (AV) fistula
placement in the left arm for hemodialysis access.
Which action should the nurse include in the
immediate post-operative plan of care?
A. Draw routine morning labs from the left cephalic
vein.
B. Check the left radial pulse and capillary refill
every 15 minutes for the first hour.
C. Apply a tight compression dressing to the
surgical site to minimize swelling.
D. Keep the left arm dependent to increase blood
flow to the anastomosis.
Answer: B. Check the left radial pulse and capillary
refill every 15 minutes for the first hour.
Rationale: Frequent vascular checks are essential
to monitor for arterial insufficiency or steal
syndrome distal to the fistula. Restricting blood flow
with a tight dressing, drawing blood, or placing the
arm in a dependent position can cause thrombosis
or occlusion of the newly formed access.
Question 4
The nurse reviews the dietary logs of a client
undergoing peritoneal dialysis. The client reports
, consuming 6.5 grams of sodium and 1,200 mg of
phosphorus daily. Which instruction is most critical
for the nurse to provide?
A. "You need to increase your fluid intake to flush
out the excess sodium."
B. "Reduce your sodium intake to 2 to 4 grams daily
to prevent fluid overload and hypertension."
C. "Increase your phosphorus intake to balance
your calcium levels."
D. "Your diet is appropriate because dialysis
removes all excess electrolytes."
Answer: B. "Reduce your sodium intake to 2 to 4
grams daily to prevent fluid overload and
hypertension."
Rationale: Clients on dialysis must restrict sodium
to 2–4 grams daily to prevent extreme fluid
retention, which can lead to heart failure and
pulmonary edema. Consuming over 5 grams of
sodium poses severe cardiorespiratory risks.
Question 5
A client returning from hemodialysis is noted to
have a temperature of 101.6°F (38.7°C), a blood
pressure of 92/54 mmHg, and generalized chills.
Which action should the nurse take first?
STUDY GUIDE NCLEX-STYLE QUESTIONS &
ANSWERS
This premium practice exam bundle delivers high-yield, NCLEX-
style multiple-choice questions meticulously aligned with
advanced medical-surgical nursing curricula. Every question
features a clear, italicized correct answer and an advanced,
bolded rationale designed to sharpen critical clinical judgment
and master complex pathophysiology. It serves as the ultimate
high-tier study tool for nursing students aiming to ace their first
major examination.
Question 1
A client with Chronic Kidney Disease (CKD) reports
severe generalized itching, a persistent metallic
taste, and muscle cramps. The nurse notes white,
powdery crystals on the client’s forehead and upper
lip. Which laboratory value is most critical for the
nurse to evaluate?
A. Serum Calcium
B. Serum Potassium
C. Blood Urea Nitrogen (BUN)
D. Hemoglobin
Answer: C. Blood Urea Nitrogen (BUN)
Rationale: The client is exhibiting clinical
manifestations of uremia, including uremic pruritus
,and uremic frost, which occur due to the
accumulation of systemic nitrogenous waste
products. While calcium and potassium are affected
in CKD, the specific buildup of urea and creatinine
directly correlates with these dermatological and
neurological uremic symptoms.
Question 2
The nurse is caring for a client with Nephrotic
Syndrome. Which clinical finding should the nurse
prioritize for immediate intervention?
A. 3+ pitting edema in both lower extremities
B. A respiratory rate of 28 breaths/minute with
bilateral crackles
C. Total serum cholesterol of 290 mg/dL
D. Urine output containing 4.2 grams of protein over
24 hours
Answer: B. A respiratory rate of 28 breaths/minute
with bilateral crackles
Rationale: While severe hypoalbuminemia in
Nephrotic Syndrome causes massive third-spacing
(edema) and hyperlipidemia, fluid shifting into the
pulmonary interstitium (pulmonary edema)
compromises oxygenation and ventilation, making it
an immediate ABC priority.
,Question 3
A client undergoes an arteriovenous (AV) fistula
placement in the left arm for hemodialysis access.
Which action should the nurse include in the
immediate post-operative plan of care?
A. Draw routine morning labs from the left cephalic
vein.
B. Check the left radial pulse and capillary refill
every 15 minutes for the first hour.
C. Apply a tight compression dressing to the
surgical site to minimize swelling.
D. Keep the left arm dependent to increase blood
flow to the anastomosis.
Answer: B. Check the left radial pulse and capillary
refill every 15 minutes for the first hour.
Rationale: Frequent vascular checks are essential
to monitor for arterial insufficiency or steal
syndrome distal to the fistula. Restricting blood flow
with a tight dressing, drawing blood, or placing the
arm in a dependent position can cause thrombosis
or occlusion of the newly formed access.
Question 4
The nurse reviews the dietary logs of a client
undergoing peritoneal dialysis. The client reports
, consuming 6.5 grams of sodium and 1,200 mg of
phosphorus daily. Which instruction is most critical
for the nurse to provide?
A. "You need to increase your fluid intake to flush
out the excess sodium."
B. "Reduce your sodium intake to 2 to 4 grams daily
to prevent fluid overload and hypertension."
C. "Increase your phosphorus intake to balance
your calcium levels."
D. "Your diet is appropriate because dialysis
removes all excess electrolytes."
Answer: B. "Reduce your sodium intake to 2 to 4
grams daily to prevent fluid overload and
hypertension."
Rationale: Clients on dialysis must restrict sodium
to 2–4 grams daily to prevent extreme fluid
retention, which can lead to heart failure and
pulmonary edema. Consuming over 5 grams of
sodium poses severe cardiorespiratory risks.
Question 5
A client returning from hemodialysis is noted to
have a temperature of 101.6°F (38.7°C), a blood
pressure of 92/54 mmHg, and generalized chills.
Which action should the nurse take first?
