NUR 265 EXAMS 1–3 & FINAL MEDICAL-
SURGICAL NURSING (VERIFIED ANSWERS)
PLUS RATIONALES 2026/2027 Q&A | INSTANT
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Core Domains
• Fluid, Electrolyte, and Acid-Base Balance
• Renal and Urinary System Disorders (AKI, CKD, Dialysis)
• Gastrointestinal and Liver Disorders (Cirrhosis, Pancreatitis, Hepatitis)
• Cardiovascular Disorders (Heart Failure, MI, Dysrhythmias)
• Respiratory Disorders (COPD, ARDS, Pneumonia)
• Endocrine Disorders (Diabetes Mellitus, Thyroid Disorders)
• Perioperative and Emergency Nursing Care
• Shock, Sepsis, and Multisystem Organ Failure
• Hematologic and Immunologic Disorders
• Neurological Disorders and Increased Intracranial Pressure
Introduction
This comprehensive assessment is designed to prepare nursing students for the
NUR 265 Advanced Concepts of Medical-Surgical Nursing exams at Galen
College of Nursing. It evaluates advanced knowledge of complex, multisystem
adult health problems including renal, gastrointestinal, cardiovascular,
respiratory, and endocrine disorders. The exam employs multiple-choice,
NCLEX-style questions with clinical scenarios that test prioritization, clinical
,judgment, and evidence-based nursing interventions. Emphasis is placed on
real-world application, patient safety, and critical decision-making to ensure
students are ready for both course examinations and NCLEX-RN success.
SECTION ONE: QUESTIONS 1–100
Question 1
A client with chronic kidney disease (CKD) has a potassium level of 6.2
mEq/L. Which intervention should the nurse implement first?
A. Administer sodium polystyrene sulfonate (Kayexalate).
B. Prepare the client for emergency hemodialysis.
C. Place the client on a cardiac monitor.
D. Restrict all oral intake.
C
RATIONALE: Hyperkalemia (K+ > 6.0) can cause fatal cardiac
dysrhythmias. The priority is to place the client on a cardiac monitor to detect
ECG changes (peaked T waves, wide QRS) while preparing for other
treatments.
Question 2
A client on hemodialysis has an arteriovenous (AV) fistula in the left arm.
Which action by the nurse is appropriate?
A. Take blood pressure in the left arm.
B. Palpate for a thrill over the fistula.
C. Draw blood from the fistula site.
D. Apply a tight tourniquet above the fistula.
B
, RATIONALE: A palpable thrill and audible bruit indicate patency of the
AV fistula. Blood pressure, venipuncture, and tight tourniquets should never
be done on the fistula arm.
Question 3
The nurse is caring for a client with nephrotic syndrome who has severe
proteinuria. Which action should the nurse take?
A. Administer furosemide.
B. Administer lisinopril.
C. Restrict fluids.
D. Increase protein intake.
B
RATIONALE: ACE inhibitors like lisinopril reduce intraglomerular
pressure, which decreases urinary protein loss and slows the progression of
kidney damage. This is first-line therapy for nephrotic syndrome.
Question 4
The nurse is reviewing lab results. Which client requires priority follow-up
with the provider?
A. Client 2 days post-AAA repair with creatinine increase 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
A
, RATIONALE: A rapid rise in serum creatinine (0.9 to 2.5) indicates Acute
Kidney Injury (AKI) requiring urgent evaluation. Post-surgical patients are at
high risk for prerenal azotemia or ischemic injury.
Question 5
A client with acute kidney injury (AKI) has a serum potassium of 6.8 mEq/L.
What is the priority intervention?
A. Administer sodium polystyrene sulfonate (Kayexalate) orally
B. Prepare the client for emergent hemodialysis
C. Administer IV calcium gluconate
D. Restrict dietary potassium intake
C
RATIONALE: IV calcium gluconate is given emergently to stabilize cardiac
membranes and prevent life-threatening arrhythmias in severe hyperkalemia
(>6.5). It does NOT lower potassium but protects the heart while other
treatments take effect.
Question 6
A client with chronic kidney disease (CKD) is prescribed epoetin alfa
(Epogen). The nurse understands this treats which complication?
A. Hyperkalemia
B. Anemia
C. Metabolic acidosis
D. Hyperphosphatemia
B
SURGICAL NURSING (VERIFIED ANSWERS)
PLUS RATIONALES 2026/2027 Q&A | INSTANT
DOWNLOAD PDF
Core Domains
• Fluid, Electrolyte, and Acid-Base Balance
• Renal and Urinary System Disorders (AKI, CKD, Dialysis)
• Gastrointestinal and Liver Disorders (Cirrhosis, Pancreatitis, Hepatitis)
• Cardiovascular Disorders (Heart Failure, MI, Dysrhythmias)
• Respiratory Disorders (COPD, ARDS, Pneumonia)
• Endocrine Disorders (Diabetes Mellitus, Thyroid Disorders)
• Perioperative and Emergency Nursing Care
• Shock, Sepsis, and Multisystem Organ Failure
• Hematologic and Immunologic Disorders
• Neurological Disorders and Increased Intracranial Pressure
Introduction
This comprehensive assessment is designed to prepare nursing students for the
NUR 265 Advanced Concepts of Medical-Surgical Nursing exams at Galen
College of Nursing. It evaluates advanced knowledge of complex, multisystem
adult health problems including renal, gastrointestinal, cardiovascular,
respiratory, and endocrine disorders. The exam employs multiple-choice,
NCLEX-style questions with clinical scenarios that test prioritization, clinical
,judgment, and evidence-based nursing interventions. Emphasis is placed on
real-world application, patient safety, and critical decision-making to ensure
students are ready for both course examinations and NCLEX-RN success.
SECTION ONE: QUESTIONS 1–100
Question 1
A client with chronic kidney disease (CKD) has a potassium level of 6.2
mEq/L. Which intervention should the nurse implement first?
A. Administer sodium polystyrene sulfonate (Kayexalate).
B. Prepare the client for emergency hemodialysis.
C. Place the client on a cardiac monitor.
D. Restrict all oral intake.
C
RATIONALE: Hyperkalemia (K+ > 6.0) can cause fatal cardiac
dysrhythmias. The priority is to place the client on a cardiac monitor to detect
ECG changes (peaked T waves, wide QRS) while preparing for other
treatments.
Question 2
A client on hemodialysis has an arteriovenous (AV) fistula in the left arm.
Which action by the nurse is appropriate?
A. Take blood pressure in the left arm.
B. Palpate for a thrill over the fistula.
C. Draw blood from the fistula site.
D. Apply a tight tourniquet above the fistula.
B
, RATIONALE: A palpable thrill and audible bruit indicate patency of the
AV fistula. Blood pressure, venipuncture, and tight tourniquets should never
be done on the fistula arm.
Question 3
The nurse is caring for a client with nephrotic syndrome who has severe
proteinuria. Which action should the nurse take?
A. Administer furosemide.
B. Administer lisinopril.
C. Restrict fluids.
D. Increase protein intake.
B
RATIONALE: ACE inhibitors like lisinopril reduce intraglomerular
pressure, which decreases urinary protein loss and slows the progression of
kidney damage. This is first-line therapy for nephrotic syndrome.
Question 4
The nurse is reviewing lab results. Which client requires priority follow-up
with the provider?
A. Client 2 days post-AAA repair with creatinine increase 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
A
, RATIONALE: A rapid rise in serum creatinine (0.9 to 2.5) indicates Acute
Kidney Injury (AKI) requiring urgent evaluation. Post-surgical patients are at
high risk for prerenal azotemia or ischemic injury.
Question 5
A client with acute kidney injury (AKI) has a serum potassium of 6.8 mEq/L.
What is the priority intervention?
A. Administer sodium polystyrene sulfonate (Kayexalate) orally
B. Prepare the client for emergent hemodialysis
C. Administer IV calcium gluconate
D. Restrict dietary potassium intake
C
RATIONALE: IV calcium gluconate is given emergently to stabilize cardiac
membranes and prevent life-threatening arrhythmias in severe hyperkalemia
(>6.5). It does NOT lower potassium but protects the heart while other
treatments take effect.
Question 6
A client with chronic kidney disease (CKD) is prescribed epoetin alfa
(Epogen). The nurse understands this treats which complication?
A. Hyperkalemia
B. Anemia
C. Metabolic acidosis
D. Hyperphosphatemia
B
