NUR 265 EXAM 4 - ADVANCED
MEDICAL-SURGICAL NURSING
QUESTIONS AND ANSWERS WITH
VERIFIED SOLUTIONS 2026/2027
UPDATE. JUST RELEASED
1. A patient with acute kidney injury (AKI) has a serum potassium level of 6.8 mEq/L. Which
of the following orders should the nurse prioritize?
A. Administering oral sodium polystyrene sulfonate (Kayexalate)
B. Providing a low-potassium diet tray
C. Initiating a 24-hour urine collection
D. Obtaining a stat 12-lead electrocardiogram (ECG)
Answer: D
Conceptual Explanation: Hyperkalemia can cause life-threatening cardiac dysrhythmias.
The priority is to assess the heart’s electrical activity via ECG before or while initiating
interventions to lower potassium.
2. A client is in the oliguric phase of AKI. Which clinical manifestation does the nurse expect
to find?
A. Hypokalemia and hypernatremia
,B. Urine output of 600 mL/day
C. Increased BUN and serum creatinine
D. Metabolic alkalosis
Answer: C
Conceptual Explanation: During the oliguric phase, waste products accumulate
(azotemia), leading to increased BUN and creatinine. Output is typically <400 mL/day, and
metabolic acidosis, not alkalosis, occurs.
3. Which assessment finding in a patient with an arteriovenous (AV) fistula for hemodialysis
requires immediate notification of the healthcare provider?
A. A palpable thrill over the site
B. An audible bruit upon auscultation
C. Absence of a thrill or bruit
D. Ecchymosis at the puncture sites after dialysis
Answer: C
Conceptual Explanation: The absence of a thrill or bruit indicates that the fistula may be
clotted or obstructed, requiring urgent intervention to restore patency.
4. A patient undergoing peritoneal dialysis reports that the outflow is cloudy. What is the
nurse’s priority action?
A. Advance the catheter further into the abdomen
, B. Stop the dialysis immediately and flush the tubing
C. Obtain a sample for culture and sensitivity
D. Apply a heating pad to the abdomen for comfort
Answer: C
Conceptual Explanation: Cloudy dialysate outflow is an early sign of peritonitis. The nurse
must obtain a culture to identify the infecting organism while monitoring for other signs of
infection.
5. A patient is admitted with 40% total body surface area (TBSA) burns. Using the Parkland
formula (4mL x kg x %TBSA), calculate the total fluid for the first 24 hours for a patient
weighing 70kg.
A. 5,600 mL
B. 2,800 mL
C. 11,200 mL
D. 8,400 mL
Answer: C
Conceptual Explanation: 4 mL x 70 kg x 40 = 11,200 mL. Half of this is given in the first 8
hours, and the remainder over the following 16 hours.
MEDICAL-SURGICAL NURSING
QUESTIONS AND ANSWERS WITH
VERIFIED SOLUTIONS 2026/2027
UPDATE. JUST RELEASED
1. A patient with acute kidney injury (AKI) has a serum potassium level of 6.8 mEq/L. Which
of the following orders should the nurse prioritize?
A. Administering oral sodium polystyrene sulfonate (Kayexalate)
B. Providing a low-potassium diet tray
C. Initiating a 24-hour urine collection
D. Obtaining a stat 12-lead electrocardiogram (ECG)
Answer: D
Conceptual Explanation: Hyperkalemia can cause life-threatening cardiac dysrhythmias.
The priority is to assess the heart’s electrical activity via ECG before or while initiating
interventions to lower potassium.
2. A client is in the oliguric phase of AKI. Which clinical manifestation does the nurse expect
to find?
A. Hypokalemia and hypernatremia
,B. Urine output of 600 mL/day
C. Increased BUN and serum creatinine
D. Metabolic alkalosis
Answer: C
Conceptual Explanation: During the oliguric phase, waste products accumulate
(azotemia), leading to increased BUN and creatinine. Output is typically <400 mL/day, and
metabolic acidosis, not alkalosis, occurs.
3. Which assessment finding in a patient with an arteriovenous (AV) fistula for hemodialysis
requires immediate notification of the healthcare provider?
A. A palpable thrill over the site
B. An audible bruit upon auscultation
C. Absence of a thrill or bruit
D. Ecchymosis at the puncture sites after dialysis
Answer: C
Conceptual Explanation: The absence of a thrill or bruit indicates that the fistula may be
clotted or obstructed, requiring urgent intervention to restore patency.
4. A patient undergoing peritoneal dialysis reports that the outflow is cloudy. What is the
nurse’s priority action?
A. Advance the catheter further into the abdomen
, B. Stop the dialysis immediately and flush the tubing
C. Obtain a sample for culture and sensitivity
D. Apply a heating pad to the abdomen for comfort
Answer: C
Conceptual Explanation: Cloudy dialysate outflow is an early sign of peritonitis. The nurse
must obtain a culture to identify the infecting organism while monitoring for other signs of
infection.
5. A patient is admitted with 40% total body surface area (TBSA) burns. Using the Parkland
formula (4mL x kg x %TBSA), calculate the total fluid for the first 24 hours for a patient
weighing 70kg.
A. 5,600 mL
B. 2,800 mL
C. 11,200 mL
D. 8,400 mL
Answer: C
Conceptual Explanation: 4 mL x 70 kg x 40 = 11,200 mL. Half of this is given in the first 8
hours, and the remainder over the following 16 hours.
