NUR 265 EXAM 1 | QUESTIONS AND CORRECT
ANSWERS WITH DETAILED RATIONALES
GALEN COLLEGE OF NURSING | 2026/2027
UPDATE
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SECTION A: COMPLEX ELIMINATION — RENAL DISORDERS Questions
1–50
Question 1
A patient with chronic kidney disease (CKD) has a potassium level of 6.8
mEq/L. Which ECG change should the nurse expect to observe first?
A) ST elevation
B) Prolonged QT interval
C) Peaked T waves
D) U waves
Correct Answer: C) Peaked T waves
Rationale: Hyperkalemia increases myocardial excitability. The earliest and
most characteristic ECG change is tall, peaked (tented) T waves. ST
elevation is associated with myocardial injury, prolonged QT can occur with
electrolyte imbalances but is not the earliest sign of hyperkalemia, and U
waves are characteristic of hypokalemia, not hyperkalemia.
,---
Question 2
A patient with CKD has a calcium level of 6.9 mg/dL and phosphate of 6.5
mg/dL. What is the priority complication the nurse should monitor for?
A) Constipation
B) Tetany and muscle spasms
C) Dehydration
D) Bradycardia
Correct Answer: B) Tetany and muscle spasms
Rationale: In CKD, the kidneys cannot activate vitamin D or excrete
phosphate effectively. Low calcium combined with high phosphate creates a
significant risk for hypocalcemia-induced tetany, which can manifest as
Chvostek's sign and Trousseau's sign. This is a priority because it can lead
to life-threatening laryngospasm or seizures.
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Question 3
A patient newly diagnosed with nephrotic syndrome asks the nurse about
their condition. Which statement indicates correct understanding of the
teaching?
A) "I should increase my intake of foods high in potassium."
B) "I can stop taking my medications once I feel better."
,C) "I must protect myself from developing an infection."
D) "I should limit my fluid intake to 500 mL per day."
Correct Answer: C) "I must protect myself from developing an infection."
Rationale: Nephrotic syndrome causes loss of immunoglobulins in the
urine, leading to immunosuppression and increased infection risk. Patients
should be educated about infection prevention strategies including good
hygiene, avoiding sick contacts, and reporting signs of infection early. Fluid
and potassium recommendations must be individualized based on lab
values and clinical status.
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Question 4
The nurse is caring for a client who has just returned from hemodialysis
treatment. Which finding requires immediate follow-up?
A) Temperature of 99.4°F (37.4°C)
B) Potassium decreased from 6.1 to 5.1 mEq/L
C) Pulse of 130 beats/min
D) Report of feeling tired
Correct Answer: C) Pulse of 130 beats/min
Rationale: Tachycardia (pulse >100 beats/min) after hemodialysis may
indicate hypovolemia, hypotension, or bleeding. While mild temperature
elevation and fatigue are common post-dialysis, significant tachycardia
, requires immediate assessment for potential complications including
hemorrhage, disequilibrium syndrome, or cardiovascular instability. A
decreased potassium level indicates effective dialysis.
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Question 5
A patient with cirrhosis develops increasing abdominal girth and
discomfort. What medication should the nurse expect the healthcare
provider to order?
A) Furosemide (Lasix)
B) Spironolactone
C) Beta-blockers
D) Albumin
Correct Answer: B) Spironolactone
Rationale: Ascites from cirrhosis is managed with potassium-sparing
diuretics such as spironolactone, which antagonizes aldosterone to reduce
fluid retention while maintaining electrolyte balance. Furosemide may be
used but carries greater risk of electrolyte depletion and hypokalemia. Beta-
blockers are used for portal hypertension and variceal prophylaxis, not
primary ascites management.
---
Question 6
ANSWERS WITH DETAILED RATIONALES
GALEN COLLEGE OF NURSING | 2026/2027
UPDATE
---
SECTION A: COMPLEX ELIMINATION — RENAL DISORDERS Questions
1–50
Question 1
A patient with chronic kidney disease (CKD) has a potassium level of 6.8
mEq/L. Which ECG change should the nurse expect to observe first?
A) ST elevation
B) Prolonged QT interval
C) Peaked T waves
D) U waves
Correct Answer: C) Peaked T waves
Rationale: Hyperkalemia increases myocardial excitability. The earliest and
most characteristic ECG change is tall, peaked (tented) T waves. ST
elevation is associated with myocardial injury, prolonged QT can occur with
electrolyte imbalances but is not the earliest sign of hyperkalemia, and U
waves are characteristic of hypokalemia, not hyperkalemia.
,---
Question 2
A patient with CKD has a calcium level of 6.9 mg/dL and phosphate of 6.5
mg/dL. What is the priority complication the nurse should monitor for?
A) Constipation
B) Tetany and muscle spasms
C) Dehydration
D) Bradycardia
Correct Answer: B) Tetany and muscle spasms
Rationale: In CKD, the kidneys cannot activate vitamin D or excrete
phosphate effectively. Low calcium combined with high phosphate creates a
significant risk for hypocalcemia-induced tetany, which can manifest as
Chvostek's sign and Trousseau's sign. This is a priority because it can lead
to life-threatening laryngospasm or seizures.
---
Question 3
A patient newly diagnosed with nephrotic syndrome asks the nurse about
their condition. Which statement indicates correct understanding of the
teaching?
A) "I should increase my intake of foods high in potassium."
B) "I can stop taking my medications once I feel better."
,C) "I must protect myself from developing an infection."
D) "I should limit my fluid intake to 500 mL per day."
Correct Answer: C) "I must protect myself from developing an infection."
Rationale: Nephrotic syndrome causes loss of immunoglobulins in the
urine, leading to immunosuppression and increased infection risk. Patients
should be educated about infection prevention strategies including good
hygiene, avoiding sick contacts, and reporting signs of infection early. Fluid
and potassium recommendations must be individualized based on lab
values and clinical status.
---
Question 4
The nurse is caring for a client who has just returned from hemodialysis
treatment. Which finding requires immediate follow-up?
A) Temperature of 99.4°F (37.4°C)
B) Potassium decreased from 6.1 to 5.1 mEq/L
C) Pulse of 130 beats/min
D) Report of feeling tired
Correct Answer: C) Pulse of 130 beats/min
Rationale: Tachycardia (pulse >100 beats/min) after hemodialysis may
indicate hypovolemia, hypotension, or bleeding. While mild temperature
elevation and fatigue are common post-dialysis, significant tachycardia
, requires immediate assessment for potential complications including
hemorrhage, disequilibrium syndrome, or cardiovascular instability. A
decreased potassium level indicates effective dialysis.
---
Question 5
A patient with cirrhosis develops increasing abdominal girth and
discomfort. What medication should the nurse expect the healthcare
provider to order?
A) Furosemide (Lasix)
B) Spironolactone
C) Beta-blockers
D) Albumin
Correct Answer: B) Spironolactone
Rationale: Ascites from cirrhosis is managed with potassium-sparing
diuretics such as spironolactone, which antagonizes aldosterone to reduce
fluid retention while maintaining electrolyte balance. Furosemide may be
used but carries greater risk of electrolyte depletion and hypokalemia. Beta-
blockers are used for portal hypertension and variceal prophylaxis, not
primary ascites management.
---
Question 6
