NUR 209 / NUR209 Exam 4 Final Guide
2026/2027 | Medical-Surgical Nursing II | 300
High-Yield Questions with Verified Answers
& Rationales | Fortis College | Grade A+
Section 1: Renal & Genitourinary Disorders (Questions 1-25)
1. A patient with chronic kidney disease is completing an exchange during peritoneal
dialysis. The nurse observes that the peritoneal fluid is draining slowly and that the
patient's abdomen is increasing in girth. What is the nurse's most appropriate
action?
A) Advance the catheter 2 to 4 cm further into the peritoneal cavity
B) Reposition the patient to facilitate drainage
C) Aspirate from the catheter using a 60 mL syringe
D) Infuse 50 mL of additional dialysate
Correct Answer: B
Rationale: Slow drainage and increasing abdominal girth indicate outflow problems.
Repositioning the patient can help facilitate drainage by shifting the catheter position within
the abdomen. Catheter manipulation should only be done by trained personnel .
, 2. A patient with ESKD receives continuous ambulatory peritoneal dialysis. The nurse
observes that the dialysate drainage fluid is cloudy. What is the nurse's most
appropriate action?
A) Inform the physician and assess the patient for signs of infection
B) Flush the catheter with normal saline
C) Increase the frequency of exchanges
D) Document the finding as expected
Correct Answer: A
Rationale: Cloudy dialysate is a sign of peritonitis, a serious complication of peritoneal
dialysis. The nurse should notify the physician immediately and assess the patient for fever,
abdominal pain, and other signs of infection .
3. The nurse has identified the nursing diagnosis of "risk for infection" in a patient
who undergoes peritoneal dialysis. What nursing action best addresses this risk?
A) Maintain aseptic technique when administering dialysate
B) Wash the skin surrounding the catheter site with soap and water prior to each exchange
C) Add antibiotics to the dialysate as ordered
D) Administer prophylactic antibiotics by mouth or IV as ordered
Correct Answer: A
Rationale: Maintaining aseptic technique during all connections and exchanges is the most
effective way to prevent peritonitis in peritoneal dialysis patients. Hand hygiene and sterile
technique are essential .
, 4. The nurse coming on shift is taking a report on four patients. Which patient does
the nurse know is at greatest risk for developing ESKD?
A) A patient with a history of polycystic kidney disease
B) A patient with diabetes mellitus and poorly controlled hypertension
C) A patient with a history of recurrent urinary tract infections
D) A patient with nephrotic syndrome
Correct Answer: B
Rationale: Diabetes mellitus and poorly controlled hypertension are the two leading causes
of end-stage kidney disease (ESKD). Together, they account for the majority of ESKD
cases .
5. Which laboratory value requires immediate intervention in a patient with acute
kidney injury?
A) Potassium 6.3 mEq/L
B) Sodium 138 mEq/L
C) Calcium 9.2 mg/dL
D) Hemoglobin 13 g/dL
Correct Answer: A
, Rationale: Severe hyperkalemia (potassium >6.0 mEq/L) can cause life-threatening cardiac
dysrhythmias. This requires immediate intervention, including cardiac monitoring and
administration of calcium gluconate, insulin/glucose, or sodium polystyrene sulfonate .
6. What accurately describes the care of the patient with CKD regarding phosphate
binders?
A) Calcium-based phosphate binders are used when serum calcium levels are low
B) Calcium-based phosphate binders are contraindicated when serum calcium levels are
increased
C) Phosphate binders should be taken on an empty stomach
D) Phosphate binders are only used in acute kidney injury
Correct Answer: B
Rationale: In the patient with CKD, when serum calcium levels are increased, calcium-
based phosphate binders are not used. This prevents hypercalcemia, which can worsen
vascular calcifications .
7. A patient on hemodialysis develops a thrombus of a subcutaneous arteriovenous
(AV) graft. While waiting for a replacement graft or fistula, the patient is most likely to
have what done for treatment?
A) Peritoneal dialysis
B) Peripheral vascular access using radial artery
2026/2027 | Medical-Surgical Nursing II | 300
High-Yield Questions with Verified Answers
& Rationales | Fortis College | Grade A+
Section 1: Renal & Genitourinary Disorders (Questions 1-25)
1. A patient with chronic kidney disease is completing an exchange during peritoneal
dialysis. The nurse observes that the peritoneal fluid is draining slowly and that the
patient's abdomen is increasing in girth. What is the nurse's most appropriate
action?
A) Advance the catheter 2 to 4 cm further into the peritoneal cavity
B) Reposition the patient to facilitate drainage
C) Aspirate from the catheter using a 60 mL syringe
D) Infuse 50 mL of additional dialysate
Correct Answer: B
Rationale: Slow drainage and increasing abdominal girth indicate outflow problems.
Repositioning the patient can help facilitate drainage by shifting the catheter position within
the abdomen. Catheter manipulation should only be done by trained personnel .
, 2. A patient with ESKD receives continuous ambulatory peritoneal dialysis. The nurse
observes that the dialysate drainage fluid is cloudy. What is the nurse's most
appropriate action?
A) Inform the physician and assess the patient for signs of infection
B) Flush the catheter with normal saline
C) Increase the frequency of exchanges
D) Document the finding as expected
Correct Answer: A
Rationale: Cloudy dialysate is a sign of peritonitis, a serious complication of peritoneal
dialysis. The nurse should notify the physician immediately and assess the patient for fever,
abdominal pain, and other signs of infection .
3. The nurse has identified the nursing diagnosis of "risk for infection" in a patient
who undergoes peritoneal dialysis. What nursing action best addresses this risk?
A) Maintain aseptic technique when administering dialysate
B) Wash the skin surrounding the catheter site with soap and water prior to each exchange
C) Add antibiotics to the dialysate as ordered
D) Administer prophylactic antibiotics by mouth or IV as ordered
Correct Answer: A
Rationale: Maintaining aseptic technique during all connections and exchanges is the most
effective way to prevent peritonitis in peritoneal dialysis patients. Hand hygiene and sterile
technique are essential .
, 4. The nurse coming on shift is taking a report on four patients. Which patient does
the nurse know is at greatest risk for developing ESKD?
A) A patient with a history of polycystic kidney disease
B) A patient with diabetes mellitus and poorly controlled hypertension
C) A patient with a history of recurrent urinary tract infections
D) A patient with nephrotic syndrome
Correct Answer: B
Rationale: Diabetes mellitus and poorly controlled hypertension are the two leading causes
of end-stage kidney disease (ESKD). Together, they account for the majority of ESKD
cases .
5. Which laboratory value requires immediate intervention in a patient with acute
kidney injury?
A) Potassium 6.3 mEq/L
B) Sodium 138 mEq/L
C) Calcium 9.2 mg/dL
D) Hemoglobin 13 g/dL
Correct Answer: A
, Rationale: Severe hyperkalemia (potassium >6.0 mEq/L) can cause life-threatening cardiac
dysrhythmias. This requires immediate intervention, including cardiac monitoring and
administration of calcium gluconate, insulin/glucose, or sodium polystyrene sulfonate .
6. What accurately describes the care of the patient with CKD regarding phosphate
binders?
A) Calcium-based phosphate binders are used when serum calcium levels are low
B) Calcium-based phosphate binders are contraindicated when serum calcium levels are
increased
C) Phosphate binders should be taken on an empty stomach
D) Phosphate binders are only used in acute kidney injury
Correct Answer: B
Rationale: In the patient with CKD, when serum calcium levels are increased, calcium-
based phosphate binders are not used. This prevents hypercalcemia, which can worsen
vascular calcifications .
7. A patient on hemodialysis develops a thrombus of a subcutaneous arteriovenous
(AV) graft. While waiting for a replacement graft or fistula, the patient is most likely to
have what done for treatment?
A) Peritoneal dialysis
B) Peripheral vascular access using radial artery
