Galen College NUR 242 Exam 4 (pdf) | 2026/2027 | Med-Surg Q&A |
Medical-Surgical Nursing
1. A patient with chronic kidney disease (CKD) has a glomerular filtration rate
(GFR) of 18 mL/min. The nurse understands that this indicates:
A) Stage 1 CKD
B) Stage 2 CKD
C) Stage 3 CKD
D) Stage 4 CKD
Correct Answer: Stage 4 CKD
Rationale: CKD staging is based on GFR: Stage 1 (≥90), Stage 2 (60-89),
Stage 3 (30-59), Stage 4 (15-29), and Stage 5 (<15). A GFR of 18 mL/min
indicates severe impairment (Stage 4), meaning the patient is approaching
end-stage renal disease and may soon require renal replacement therapy.
2. A patient with end-stage renal disease (ESRD) is scheduled for
hemodialysis. Which laboratory value requires immediate intervention before
dialysis?
A) Potassium 6.5 mEq/L
B) Sodium 135 mEq/L
C) Calcium 8.5 mg/dL
D) Hemoglobin 10.5 g/dL
Correct Answer: Potassium 6.5 mEq/L
Rationale: A potassium level of 6.5 mEq/L is a critical hyperkalemia finding
that can cause life-threatening cardiac arrhythmias. This requires immediate
intervention, often including emergent dialysis. The other values are within
normal limits and do not require the same level of urgency.
,3. A nurse is assessing a patient with a newly created AV fistula for
hemodialysis. Which finding indicates adequate maturation and function of
the fistula?
A) Absence of a bruit
B) Absence of a thrill
C) Presence of a palpable thrill and audible bruit
D) Coolness and pallor of the extremity
Correct Answer: Presence of a palpable thrill and audible bruit
Rationale: A palpable thrill (vibration) and an audible bruit (whooshing
sound) over the AV fistula are signs of adequate blood flow and maturation.
These findings indicate the fistula is functioning properly for hemodialysis
access. An absence of thrill/bruit or signs of poor perfusion suggest
complications.
4. A patient on hemodialysis is at risk for which complication during the
treatment?
A) Hypertension
B) Hypervolemia
C) Hypovolemia and hypotension
D) Hyperkalemia
Correct Answer: Hypovolemia and hypotension
Rationale: Hemodialysis removes fluid from the body. If too much fluid is
removed too quickly, the patient can become hypovolemic and hypotensive.
This is a common complication during dialysis. The other options are
,conditions that dialysis is intended to correct, not complications of the
treatment itself.
5. A patient with chronic kidney disease (CKD) has a serum phosphate level
of 6.2 mg/dL. The nurse should anticipate an order for which medication?
A) Calcium gluconate
B) A phosphate binder
C) Insulin and glucose
D) Sodium polystyrene sulfonate
Correct Answer: A phosphate binder
Rationale: Hyperphosphatemia is a common complication of CKD. Phosphate
binders, such as calcium acetate or sevelamer, are administered with meals
to bind dietary phosphate in the GI tract, preventing its absorption and
lowering serum phosphate levels. Kayexalate is used for hyperkalemia.
6. A patient with chronic kidney disease (CKD) is experiencing pruritus. The
nurse understands this is most likely due to:
A) Anemia
B) Hyperphosphatemia and uremic toxins
C) Hypokalemia
D) Fluid overload
Correct Answer: Hyperphosphatemia and uremic toxins
Rationale: Pruritus (itching) in CKD is often caused by the deposition of
calcium phosphate crystals in the skin (due to hyperphosphatemia) and the
accumulation of uremic toxins. Anemia can cause fatigue, but not itching.
Hypokalemia and fluid overload do not typically cause pruritus.
, 7. The nurse is caring for a patient with chronic kidney disease (CKD) who
has a hemoglobin of 9.0 g/dL. This anemia is most likely due to:
A) Iron deficiency
B) Vitamin B12 deficiency
C) Decreased production of erythropoietin
D) Folate deficiency
Correct Answer: Decreased production of erythropoietin
Rationale: The kidneys produce erythropoietin (EPO), which stimulates red
blood cell production. In CKD, the damaged kidneys produce less EPO,
leading to anemia. This is a hallmark of renal failure and is treated with
erythropoietin-stimulating agents (ESAs).
8. A patient receiving erythropoietin-stimulating agent (ESA) therapy for CKD
anemia should be monitored for which potential adverse effect?
A) Hypotension
B) Hypertension
C) Bradycardia
D) Hypoglycemia
Correct Answer: Hypertension
Rationale: ESAs can cause hypertension, which is a significant side effect.
Blood pressure should be monitored closely during ESA therapy, and
antihypertensive medications may need to be adjusted. Anemia itself can
cause hypotension, but ESAs can raise blood pressure.
Medical-Surgical Nursing
1. A patient with chronic kidney disease (CKD) has a glomerular filtration rate
(GFR) of 18 mL/min. The nurse understands that this indicates:
A) Stage 1 CKD
B) Stage 2 CKD
C) Stage 3 CKD
D) Stage 4 CKD
Correct Answer: Stage 4 CKD
Rationale: CKD staging is based on GFR: Stage 1 (≥90), Stage 2 (60-89),
Stage 3 (30-59), Stage 4 (15-29), and Stage 5 (<15). A GFR of 18 mL/min
indicates severe impairment (Stage 4), meaning the patient is approaching
end-stage renal disease and may soon require renal replacement therapy.
2. A patient with end-stage renal disease (ESRD) is scheduled for
hemodialysis. Which laboratory value requires immediate intervention before
dialysis?
A) Potassium 6.5 mEq/L
B) Sodium 135 mEq/L
C) Calcium 8.5 mg/dL
D) Hemoglobin 10.5 g/dL
Correct Answer: Potassium 6.5 mEq/L
Rationale: A potassium level of 6.5 mEq/L is a critical hyperkalemia finding
that can cause life-threatening cardiac arrhythmias. This requires immediate
intervention, often including emergent dialysis. The other values are within
normal limits and do not require the same level of urgency.
,3. A nurse is assessing a patient with a newly created AV fistula for
hemodialysis. Which finding indicates adequate maturation and function of
the fistula?
A) Absence of a bruit
B) Absence of a thrill
C) Presence of a palpable thrill and audible bruit
D) Coolness and pallor of the extremity
Correct Answer: Presence of a palpable thrill and audible bruit
Rationale: A palpable thrill (vibration) and an audible bruit (whooshing
sound) over the AV fistula are signs of adequate blood flow and maturation.
These findings indicate the fistula is functioning properly for hemodialysis
access. An absence of thrill/bruit or signs of poor perfusion suggest
complications.
4. A patient on hemodialysis is at risk for which complication during the
treatment?
A) Hypertension
B) Hypervolemia
C) Hypovolemia and hypotension
D) Hyperkalemia
Correct Answer: Hypovolemia and hypotension
Rationale: Hemodialysis removes fluid from the body. If too much fluid is
removed too quickly, the patient can become hypovolemic and hypotensive.
This is a common complication during dialysis. The other options are
,conditions that dialysis is intended to correct, not complications of the
treatment itself.
5. A patient with chronic kidney disease (CKD) has a serum phosphate level
of 6.2 mg/dL. The nurse should anticipate an order for which medication?
A) Calcium gluconate
B) A phosphate binder
C) Insulin and glucose
D) Sodium polystyrene sulfonate
Correct Answer: A phosphate binder
Rationale: Hyperphosphatemia is a common complication of CKD. Phosphate
binders, such as calcium acetate or sevelamer, are administered with meals
to bind dietary phosphate in the GI tract, preventing its absorption and
lowering serum phosphate levels. Kayexalate is used for hyperkalemia.
6. A patient with chronic kidney disease (CKD) is experiencing pruritus. The
nurse understands this is most likely due to:
A) Anemia
B) Hyperphosphatemia and uremic toxins
C) Hypokalemia
D) Fluid overload
Correct Answer: Hyperphosphatemia and uremic toxins
Rationale: Pruritus (itching) in CKD is often caused by the deposition of
calcium phosphate crystals in the skin (due to hyperphosphatemia) and the
accumulation of uremic toxins. Anemia can cause fatigue, but not itching.
Hypokalemia and fluid overload do not typically cause pruritus.
, 7. The nurse is caring for a patient with chronic kidney disease (CKD) who
has a hemoglobin of 9.0 g/dL. This anemia is most likely due to:
A) Iron deficiency
B) Vitamin B12 deficiency
C) Decreased production of erythropoietin
D) Folate deficiency
Correct Answer: Decreased production of erythropoietin
Rationale: The kidneys produce erythropoietin (EPO), which stimulates red
blood cell production. In CKD, the damaged kidneys produce less EPO,
leading to anemia. This is a hallmark of renal failure and is treated with
erythropoietin-stimulating agents (ESAs).
8. A patient receiving erythropoietin-stimulating agent (ESA) therapy for CKD
anemia should be monitored for which potential adverse effect?
A) Hypotension
B) Hypertension
C) Bradycardia
D) Hypoglycemia
Correct Answer: Hypertension
Rationale: ESAs can cause hypertension, which is a significant side effect.
Blood pressure should be monitored closely during ESA therapy, and
antihypertensive medications may need to be adjusted. Anemia itself can
cause hypotension, but ESAs can raise blood pressure.
