NUR 265 ADVANCED MED-SURG ULTIMATE EXAM
BUNDLE FULL SEMESTER CRITICAL CARE REVIEW
GALEN COLLEGE OF NURSING
Master your advanced medical-surgical nursing exams with this
comprehensive, NCLEX-aligned question bank featuring high-yield
multiple-choice questions tailored to the Galen College of Nursing
curriculum. Every question includes clear answer keys and in-depth, bolded
rationales to build deep critical thinking for complex multi-system disorders,
critical care settings, and advanced renal management. It is the ultimate,
time-saving study resource designed to help you ace your midterms, unit
exams, and comprehensive final with confidence.
Unit 1: Advanced Renal & Fluid/Electrolyte
Management
Q1. A client with an acute kidney injury (AKI) has
a serum potassium level of 6.8 mEq/L and tall,
peaked T-waves on the electrocardiogram (ECG).
Which prescribed medication should the nurse
administer first?
A. Regular insulin 10 units IV push with 50%
dextrose
B. Sodium polystyrene sulfonate 30g orally
C. Furosemide 40 mg IV push
D. Calcium gluconate 10% IV over 2 to 3 minutes
Answer: D
Rationale: Calcium gluconate does not lower
serum potassium levels, but it immediately
stabilizes the myocardial cell membrane,
,protecting the heart from lethal ventricular
dysrhythmias. Insulin/dextrose and furosemide
take longer to act, while sodium polystyrene
sulfonate is too slow for emergency deployment.
Q2. During the first hour of a client's initial
hemodialysis session, the client complains of a
severe headache, nausea, and extreme
restlessness. The nurse notes mild muscle
twitching. What is the priority nursing action?
A. Increase the blood flow rate on the dialysis
machine to terminate therapy early.
B. Notify the nephrologist and prepare to slow or
stop the dialysis treatment.
C. Administer an IV antiemetic and continue
treatments at the prescribed rate.
D. Administer a rapid bolus of 50% dextrose
intravenously.
Answer: B
Rationale: The client is exhibiting classic signs
of Dialysis Disequilibrium Syndrome (DDS),
which is caused by a rapid shift of solutes from
the blood, leading to cerebral edema. The
priority is to slow or stop the dialysis run to
prevent seizures and coma.
,Q3. A client is admitted with severe dehydration,
a blood pressure of 82/50 mmHg, and an average
urine output of 12 mL/hour over the past 4 hours.
The BUN is 48 mg/dL and serum creatinine is 2.5
mg/dL. The nurse correctly classifies this
condition as which type of acute kidney injury?
A. Prerenal AKI
B. Intrarenal acute tubular necrosis (ATN)
C. Postrenal obstruction
D. Intrinsic glomerulonephritis
Answer: A
Rationale: Prerenal AKI stems from factors
external to the kidneys that reduce systemic
blood flow and renal perfusion, such as severe
dehydration and hypotension. Decreased
perfusion directly drops the glomerular filtration
rate (GFR).
Q4. A nurse is evaluating the laboratory results
for a client with End-Stage Renal Disease (ESRD)
secondary to chronic glomerulonephritis. Which
electrolyte profile is anticipated?
A. Hypokalemia, hypophosphatemia, and
hypercalcemia
B. Hyperkalemia, hyperphosphatemia, and
hypocalcemia
, C. Hypokalemia, hypernatremia, and hypercalcemia
D. Hypermagnesemia, hypophosphatemia, and
hypercalcemia
Answer: B
Rationale: Failing kidneys cannot clear
potassium or phosphorus, resulting in
hyperkalemia and hyperphosphatemia. High
phosphorus levels mechanically bind ionized
calcium, and a lack of renal vitamin D activation
results in hypocalcemia.
Q5. A client undergoing continuous ambulatory
peritoneal dialysis (CAPD) contacts the clinic to
report that the drained dialysate fluid looks
cloudy. What does this clinical finding suggest
to the nurse?
A. A normal accumulation of fibrin strands within the
peritoneal cavity.
B. The onset of peritonitis, requiring immediate
medical evaluation.
C. An early indicator of systemic bowel perforation.
D. Adequate clearance of large-protein uremic
toxins.
Answer: B
Rationale: Cloudy or turbid peritoneal dialysate
effluent is the hallmark sign of peritonitis. The
BUNDLE FULL SEMESTER CRITICAL CARE REVIEW
GALEN COLLEGE OF NURSING
Master your advanced medical-surgical nursing exams with this
comprehensive, NCLEX-aligned question bank featuring high-yield
multiple-choice questions tailored to the Galen College of Nursing
curriculum. Every question includes clear answer keys and in-depth, bolded
rationales to build deep critical thinking for complex multi-system disorders,
critical care settings, and advanced renal management. It is the ultimate,
time-saving study resource designed to help you ace your midterms, unit
exams, and comprehensive final with confidence.
Unit 1: Advanced Renal & Fluid/Electrolyte
Management
Q1. A client with an acute kidney injury (AKI) has
a serum potassium level of 6.8 mEq/L and tall,
peaked T-waves on the electrocardiogram (ECG).
Which prescribed medication should the nurse
administer first?
A. Regular insulin 10 units IV push with 50%
dextrose
B. Sodium polystyrene sulfonate 30g orally
C. Furosemide 40 mg IV push
D. Calcium gluconate 10% IV over 2 to 3 minutes
Answer: D
Rationale: Calcium gluconate does not lower
serum potassium levels, but it immediately
stabilizes the myocardial cell membrane,
,protecting the heart from lethal ventricular
dysrhythmias. Insulin/dextrose and furosemide
take longer to act, while sodium polystyrene
sulfonate is too slow for emergency deployment.
Q2. During the first hour of a client's initial
hemodialysis session, the client complains of a
severe headache, nausea, and extreme
restlessness. The nurse notes mild muscle
twitching. What is the priority nursing action?
A. Increase the blood flow rate on the dialysis
machine to terminate therapy early.
B. Notify the nephrologist and prepare to slow or
stop the dialysis treatment.
C. Administer an IV antiemetic and continue
treatments at the prescribed rate.
D. Administer a rapid bolus of 50% dextrose
intravenously.
Answer: B
Rationale: The client is exhibiting classic signs
of Dialysis Disequilibrium Syndrome (DDS),
which is caused by a rapid shift of solutes from
the blood, leading to cerebral edema. The
priority is to slow or stop the dialysis run to
prevent seizures and coma.
,Q3. A client is admitted with severe dehydration,
a blood pressure of 82/50 mmHg, and an average
urine output of 12 mL/hour over the past 4 hours.
The BUN is 48 mg/dL and serum creatinine is 2.5
mg/dL. The nurse correctly classifies this
condition as which type of acute kidney injury?
A. Prerenal AKI
B. Intrarenal acute tubular necrosis (ATN)
C. Postrenal obstruction
D. Intrinsic glomerulonephritis
Answer: A
Rationale: Prerenal AKI stems from factors
external to the kidneys that reduce systemic
blood flow and renal perfusion, such as severe
dehydration and hypotension. Decreased
perfusion directly drops the glomerular filtration
rate (GFR).
Q4. A nurse is evaluating the laboratory results
for a client with End-Stage Renal Disease (ESRD)
secondary to chronic glomerulonephritis. Which
electrolyte profile is anticipated?
A. Hypokalemia, hypophosphatemia, and
hypercalcemia
B. Hyperkalemia, hyperphosphatemia, and
hypocalcemia
, C. Hypokalemia, hypernatremia, and hypercalcemia
D. Hypermagnesemia, hypophosphatemia, and
hypercalcemia
Answer: B
Rationale: Failing kidneys cannot clear
potassium or phosphorus, resulting in
hyperkalemia and hyperphosphatemia. High
phosphorus levels mechanically bind ionized
calcium, and a lack of renal vitamin D activation
results in hypocalcemia.
Q5. A client undergoing continuous ambulatory
peritoneal dialysis (CAPD) contacts the clinic to
report that the drained dialysate fluid looks
cloudy. What does this clinical finding suggest
to the nurse?
A. A normal accumulation of fibrin strands within the
peritoneal cavity.
B. The onset of peritonitis, requiring immediate
medical evaluation.
C. An early indicator of systemic bowel perforation.
D. Adequate clearance of large-protein uremic
toxins.
Answer: B
Rationale: Cloudy or turbid peritoneal dialysate
effluent is the hallmark sign of peritonitis. The
