NUR 265/NUR265: Exam 1
Advanced Concepts in Medical-Surgical Nursing
2026-2028 Testing Cycle | Newly Released
50 Questions With Answers & Expert Rationales Guaranteed
Pass | Graded A+ | Galen
Q1: A client is admitted with acute kidney injury (AKI) and is currently in the oliguric phase.
The nurse is reviewing the client's assessment findings. Which findings are consistent with this
phase of AKI? Select all that apply.
A. Urine output of 4.5 L in the past 24 hours
B. Peaked T waves on the cardiac monitor
C. Flat T waves and prominent U waves on the ECG
D. Kussmaul respirations noted at 28 breaths/min
E. 2+ pitting edema in bilateral lower extremities
F. Hypotension and tachycardia with poor skin turgor
Correct Answer(s): B, D, E
Rationale: Correct because the oliguric phase of AKI is characterized by urine output less than
400 mL/day, fluid volume excess manifesting as edema and hypertension, hyperkalemia causing
peaked T waves, and metabolic acidosis triggering Kussmaul respirations as the body
compensates. Option A is incorrect because high urine output defines the diuretic phase, while
option C describes hypokalemia seen in the diuretic phase, and option F describes hypovolemia
which is inconsistent with the fluid overload state of oliguric AKI. In AKI oliguric phase, the
nurse must monitor strict intake and output, daily weights, and cardiac rhythm continuously due
to the life-threatening potential of hyperkalemia.
,Q2: A client in the intensive care unit has a blood pressure of 92/58 mmHg. The nurse needs to
calculate the mean arterial pressure (MAP) to assess organ perfusion. What is the client's MAP?
A. 69 mmHg
B. 75 mmHg
C. 58 mmHg
D. 82 mmHg
Correct Answer: A
Rationale: Correct because the MAP calculation follows the formula (SBP + 2 × DBP) ÷ 3,
which yields (92 + 116) ÷ 3 = 208 ÷ 3 = 69.3 mmHg, rounded to 69 mmHg. Option B incorrectly
averages the pressures without weighting the diastolic component, while option C uses only the
diastolic pressure and option D incorrectly adds the pressures without division. For organ
perfusion, the MAP must remain above 65 mmHg, so this value warrants close monitoring and
potential intervention to prevent hypoperfusion.
Q3: A client with cirrhosis is receiving lactulose for hepatic encephalopathy. Which finding
indicates to the nurse that the treatment is effective?
A. Increased serum ammonia level from 85 to 110 mcg/dL
B. Asterixis present bilaterally
C. Client reports two to three soft stools daily
D. Client becomes increasingly somnolent and difficult to arouse
Correct Answer: C
Rationale: Correct because lactulose works by acidifying the colonic contents, which traps
ammonia and promotes its excretion through the gastrointestinal tract via loose stools, thereby
reducing serum ammonia levels and improving encephalopathy. Option A indicates worsening
encephalopathy, option B is a sign of progressive neurologic involvement rather than
improvement, and option D represents deterioration toward coma. For hepatic encephalopathy,
the nurse must monitor stool frequency, serum ammonia trends, and mental status changes to
evaluate therapeutic response.
, Q4: The nurse is caring for a client admitted with unstable angina. Which findings are consistent
with this diagnosis? Select all that apply.
A. Chest pain occurring at rest
B. Elevated troponin I level of 0.8 ng/mL
C. ST-segment depression noted on the 12-lead ECG
D. ST-segment elevation in two contiguous leads
E. Chest pain completely relieved by rest and nitroglycerin
F. New onset of severe angina within the past month
Correct Answer(s): A, C, F
Rationale: Correct because unstable angina is characterized by ischemic symptoms at rest, new-
onset severe angina, or increasing frequency of angina, with ECG changes such as ST-segment
depression or T-wave inversion, but without myocardial necrosis. Option B indicates myocardial
infarction since troponin rises with cellular death, option D is diagnostic of STEMI rather than
unstable angina, and option E describes stable angina where symptoms are predictable and
relieved by rest. In ACS differentiation, the absence of troponin elevation distinguishes unstable
angina from NSTEMI, making serial troponin monitoring essential.
Q5: A client presents to the emergency department with a potassium level of 6.8 mEq/L and a
widened QRS complex on the cardiac monitor. Which intervention is the nurse's FIRST priority?
A. Administer sodium polystyrene sulfonate (Kayexalate) orally
B. Administer 10 units of regular insulin with 50 mL of dextrose 50% IV
C. Administer furosemide 40 mg IV push
D. Administer calcium gluconate 1 g IV
Correct Answer: D
Rationale: Correct because calcium gluconate is the first-line intervention for hyperkalemia with
ECG changes, as it stabilizes the myocardial cell membrane and prevents life-threatening
ventricular dysrhythmias without lowering the serum potassium level. Option A eliminates
potassium through the GI tract but acts too slowly for emergent stabilization, option B shifts
potassium intracellularly but does not protect the heart immediately, and option C enhances renal
excretion but is not the priority when the myocardium is already compromised. The priority
intervention is always cardiac stabilization with calcium before implementing therapies that shift
or eliminate potassium.
Advanced Concepts in Medical-Surgical Nursing
2026-2028 Testing Cycle | Newly Released
50 Questions With Answers & Expert Rationales Guaranteed
Pass | Graded A+ | Galen
Q1: A client is admitted with acute kidney injury (AKI) and is currently in the oliguric phase.
The nurse is reviewing the client's assessment findings. Which findings are consistent with this
phase of AKI? Select all that apply.
A. Urine output of 4.5 L in the past 24 hours
B. Peaked T waves on the cardiac monitor
C. Flat T waves and prominent U waves on the ECG
D. Kussmaul respirations noted at 28 breaths/min
E. 2+ pitting edema in bilateral lower extremities
F. Hypotension and tachycardia with poor skin turgor
Correct Answer(s): B, D, E
Rationale: Correct because the oliguric phase of AKI is characterized by urine output less than
400 mL/day, fluid volume excess manifesting as edema and hypertension, hyperkalemia causing
peaked T waves, and metabolic acidosis triggering Kussmaul respirations as the body
compensates. Option A is incorrect because high urine output defines the diuretic phase, while
option C describes hypokalemia seen in the diuretic phase, and option F describes hypovolemia
which is inconsistent with the fluid overload state of oliguric AKI. In AKI oliguric phase, the
nurse must monitor strict intake and output, daily weights, and cardiac rhythm continuously due
to the life-threatening potential of hyperkalemia.
,Q2: A client in the intensive care unit has a blood pressure of 92/58 mmHg. The nurse needs to
calculate the mean arterial pressure (MAP) to assess organ perfusion. What is the client's MAP?
A. 69 mmHg
B. 75 mmHg
C. 58 mmHg
D. 82 mmHg
Correct Answer: A
Rationale: Correct because the MAP calculation follows the formula (SBP + 2 × DBP) ÷ 3,
which yields (92 + 116) ÷ 3 = 208 ÷ 3 = 69.3 mmHg, rounded to 69 mmHg. Option B incorrectly
averages the pressures without weighting the diastolic component, while option C uses only the
diastolic pressure and option D incorrectly adds the pressures without division. For organ
perfusion, the MAP must remain above 65 mmHg, so this value warrants close monitoring and
potential intervention to prevent hypoperfusion.
Q3: A client with cirrhosis is receiving lactulose for hepatic encephalopathy. Which finding
indicates to the nurse that the treatment is effective?
A. Increased serum ammonia level from 85 to 110 mcg/dL
B. Asterixis present bilaterally
C. Client reports two to three soft stools daily
D. Client becomes increasingly somnolent and difficult to arouse
Correct Answer: C
Rationale: Correct because lactulose works by acidifying the colonic contents, which traps
ammonia and promotes its excretion through the gastrointestinal tract via loose stools, thereby
reducing serum ammonia levels and improving encephalopathy. Option A indicates worsening
encephalopathy, option B is a sign of progressive neurologic involvement rather than
improvement, and option D represents deterioration toward coma. For hepatic encephalopathy,
the nurse must monitor stool frequency, serum ammonia trends, and mental status changes to
evaluate therapeutic response.
, Q4: The nurse is caring for a client admitted with unstable angina. Which findings are consistent
with this diagnosis? Select all that apply.
A. Chest pain occurring at rest
B. Elevated troponin I level of 0.8 ng/mL
C. ST-segment depression noted on the 12-lead ECG
D. ST-segment elevation in two contiguous leads
E. Chest pain completely relieved by rest and nitroglycerin
F. New onset of severe angina within the past month
Correct Answer(s): A, C, F
Rationale: Correct because unstable angina is characterized by ischemic symptoms at rest, new-
onset severe angina, or increasing frequency of angina, with ECG changes such as ST-segment
depression or T-wave inversion, but without myocardial necrosis. Option B indicates myocardial
infarction since troponin rises with cellular death, option D is diagnostic of STEMI rather than
unstable angina, and option E describes stable angina where symptoms are predictable and
relieved by rest. In ACS differentiation, the absence of troponin elevation distinguishes unstable
angina from NSTEMI, making serial troponin monitoring essential.
Q5: A client presents to the emergency department with a potassium level of 6.8 mEq/L and a
widened QRS complex on the cardiac monitor. Which intervention is the nurse's FIRST priority?
A. Administer sodium polystyrene sulfonate (Kayexalate) orally
B. Administer 10 units of regular insulin with 50 mL of dextrose 50% IV
C. Administer furosemide 40 mg IV push
D. Administer calcium gluconate 1 g IV
Correct Answer: D
Rationale: Correct because calcium gluconate is the first-line intervention for hyperkalemia with
ECG changes, as it stabilizes the myocardial cell membrane and prevents life-threatening
ventricular dysrhythmias without lowering the serum potassium level. Option A eliminates
potassium through the GI tract but acts too slowly for emergent stabilization, option B shifts
potassium intracellularly but does not protect the heart immediately, and option C enhances renal
excretion but is not the priority when the myocardium is already compromised. The priority
intervention is always cardiac stabilization with calcium before implementing therapies that shift
or eliminate potassium.
