NUR 265 (Advanced Concepts of Medical-Surgical Nursing) content, typically associated
with Galen College of Nursing. Questions are organized by exam with verified answers
and rationales to support exam preparation and clinical reasoning .
Renal, Endocrine, Diabetes, Gastrointestinal/Liver Disorders
1. A client with nephrotic syndrome and severe proteinuria is being cared for by
the nurse. Which of the following actions should the nurse take?
A) Administer furosemide
B) Administer lisinopril
C) Restrict fluids
D) Increase protein intake
Answer: B) Administer lisinopril
Rationale: ACE inhibitors like lisinopril reduce proteinuria by lowering intraglomerular
pressure, which slows kidney damage progression in nephrotic syndrome .
2. The nurse is reviewing laboratory results for assigned clients. Which client
requires priority follow-up with the primary healthcare provider?
A) Temperature of 99.8°F
B) Temperature of 101.4°F
,C) Mild fatigue
D) Slight nausea
Answer: B) Temperature of 101.4°F
Rationale: Fever above 101°F in a post-dialysis or immunocompromised client indicates
possible infection and requires prompt assessment and intervention .
3. A client who had hemodialysis yesterday reports feeling unwell. Which finding
requires immediate follow-up?
A) Temperature of 99.8°F
B) Temperature of 101.4°F
C) Mild fatigue
D) Slight nausea
Answer: B) Temperature of 101.4°F
Rationale: Fever post-hemodialysis is a red flag for sepsis or access-related infection.
The nurse should assess for other signs of infection and notify the provider
immediately .
4. The nurse is teaching a client with CKD on hemodialysis about dietary sodium.
Which client statement indicates a need for further teaching?
A) "I try to limit my dietary sodium to 5 grams per day."
B) "I avoid adding salt to my food."
C) "I read labels on processed foods for sodium content."
D) "I avoid salt substitutes containing potassium."
Answer: A) "I try to limit my dietary sodium to 5 grams per day."
Rationale: Sodium intake should be restricted to 2-4 grams per day in hemodialysis to
help manage hypertension and fluid balance. Five grams exceeds the recommended
limit .
,5. A client with cirrhosis develops asterixis (liver flap) and lethargy. Which
laboratory finding is most consistent with hepatic encephalopathy?
A) Elevated serum albumin
B) Decreased ammonia level
C) Elevated ammonia level
D) Increased platelet count
Answer: C) Elevated ammonia level
Rationale: Hepatic encephalopathy is associated with elevated ammonia due to the
liver's inability to convert ammonia to urea. Asterixis and lethargy are clinical signs .
6. A patient with type 2 diabetes controlled with diet and metformin also has
severe rheumatoid arthritis. The healthcare provider prescribes prednisone. The
nurse should anticipate that the patient may require:
A) Administration of insulin while taking prednisone
B) Development of acute hypoglycemia during the RA exacerbation
C) A decreased dose of metformin while on prednisone
D) A diet higher in carbohydrates while on prednisone
Answer: A) Administration of insulin while taking prednisone
Rationale: Prednisone increases blood glucose levels and may lead to temporary insulin
dependence, even in diet-controlled diabetics. Blood glucose must be closely monitored
during steroid therapy .
7. A patient with a new diagnosis of type 2 diabetes has an HbA1c of 10.2%. The
priority discharge goal is:
A) HbA1c level below 7%
B) Fasting blood glucose below 200 mg/dL
C) Daily glucose self-monitoring with pre-meal and bedtime checks
D) Demonstration of correct insulin injection technique
Answer: A) HbA1c level below 7%
Rationale: The HbA1c reflects average blood glucose over 2-3 months and is the best
, measure of long-term glucose control. Target HbA1c for most adults with diabetes is
<7% to reduce complication risk .
8. A patient with type 1 diabetes rides a bicycle to work every day. The nurse
teaches the patient to administer morning insulin into which site?
A) Thigh
B) Buttock
C) Abdomen
D) Arm
Answer: C) Abdomen
Rationale: The abdomen has the fastest and most consistent insulin absorption rate.
Extremities used in exercise may absorb insulin faster during activity, increasing
hypoglycemia risk .
9. The nurse caring for a client receiving peritoneal dialysis notes that dialysate
outflow is less than inflow. What is the appropriate action?
A) Turn the client from side to side
B) Increase the flow rate of the dialysate
C) Notify the healthcare provider immediately
D) Document the finding as normal
Answer: A) Turn the client from side to side
Rationale: Repositioning the client can improve the gravity-dependent flow of dialysate
and relieve outflow obstruction. If outflow remains low after repositioning, further
assessment is needed .
10. When changing a peritoneal dialysis catheter dressing, which infection control
action is appropriate?
with Galen College of Nursing. Questions are organized by exam with verified answers
and rationales to support exam preparation and clinical reasoning .
Renal, Endocrine, Diabetes, Gastrointestinal/Liver Disorders
1. A client with nephrotic syndrome and severe proteinuria is being cared for by
the nurse. Which of the following actions should the nurse take?
A) Administer furosemide
B) Administer lisinopril
C) Restrict fluids
D) Increase protein intake
Answer: B) Administer lisinopril
Rationale: ACE inhibitors like lisinopril reduce proteinuria by lowering intraglomerular
pressure, which slows kidney damage progression in nephrotic syndrome .
2. The nurse is reviewing laboratory results for assigned clients. Which client
requires priority follow-up with the primary healthcare provider?
A) Temperature of 99.8°F
B) Temperature of 101.4°F
,C) Mild fatigue
D) Slight nausea
Answer: B) Temperature of 101.4°F
Rationale: Fever above 101°F in a post-dialysis or immunocompromised client indicates
possible infection and requires prompt assessment and intervention .
3. A client who had hemodialysis yesterday reports feeling unwell. Which finding
requires immediate follow-up?
A) Temperature of 99.8°F
B) Temperature of 101.4°F
C) Mild fatigue
D) Slight nausea
Answer: B) Temperature of 101.4°F
Rationale: Fever post-hemodialysis is a red flag for sepsis or access-related infection.
The nurse should assess for other signs of infection and notify the provider
immediately .
4. The nurse is teaching a client with CKD on hemodialysis about dietary sodium.
Which client statement indicates a need for further teaching?
A) "I try to limit my dietary sodium to 5 grams per day."
B) "I avoid adding salt to my food."
C) "I read labels on processed foods for sodium content."
D) "I avoid salt substitutes containing potassium."
Answer: A) "I try to limit my dietary sodium to 5 grams per day."
Rationale: Sodium intake should be restricted to 2-4 grams per day in hemodialysis to
help manage hypertension and fluid balance. Five grams exceeds the recommended
limit .
,5. A client with cirrhosis develops asterixis (liver flap) and lethargy. Which
laboratory finding is most consistent with hepatic encephalopathy?
A) Elevated serum albumin
B) Decreased ammonia level
C) Elevated ammonia level
D) Increased platelet count
Answer: C) Elevated ammonia level
Rationale: Hepatic encephalopathy is associated with elevated ammonia due to the
liver's inability to convert ammonia to urea. Asterixis and lethargy are clinical signs .
6. A patient with type 2 diabetes controlled with diet and metformin also has
severe rheumatoid arthritis. The healthcare provider prescribes prednisone. The
nurse should anticipate that the patient may require:
A) Administration of insulin while taking prednisone
B) Development of acute hypoglycemia during the RA exacerbation
C) A decreased dose of metformin while on prednisone
D) A diet higher in carbohydrates while on prednisone
Answer: A) Administration of insulin while taking prednisone
Rationale: Prednisone increases blood glucose levels and may lead to temporary insulin
dependence, even in diet-controlled diabetics. Blood glucose must be closely monitored
during steroid therapy .
7. A patient with a new diagnosis of type 2 diabetes has an HbA1c of 10.2%. The
priority discharge goal is:
A) HbA1c level below 7%
B) Fasting blood glucose below 200 mg/dL
C) Daily glucose self-monitoring with pre-meal and bedtime checks
D) Demonstration of correct insulin injection technique
Answer: A) HbA1c level below 7%
Rationale: The HbA1c reflects average blood glucose over 2-3 months and is the best
, measure of long-term glucose control. Target HbA1c for most adults with diabetes is
<7% to reduce complication risk .
8. A patient with type 1 diabetes rides a bicycle to work every day. The nurse
teaches the patient to administer morning insulin into which site?
A) Thigh
B) Buttock
C) Abdomen
D) Arm
Answer: C) Abdomen
Rationale: The abdomen has the fastest and most consistent insulin absorption rate.
Extremities used in exercise may absorb insulin faster during activity, increasing
hypoglycemia risk .
9. The nurse caring for a client receiving peritoneal dialysis notes that dialysate
outflow is less than inflow. What is the appropriate action?
A) Turn the client from side to side
B) Increase the flow rate of the dialysate
C) Notify the healthcare provider immediately
D) Document the finding as normal
Answer: A) Turn the client from side to side
Rationale: Repositioning the client can improve the gravity-dependent flow of dialysate
and relieve outflow obstruction. If outflow remains low after repositioning, further
assessment is needed .
10. When changing a peritoneal dialysis catheter dressing, which infection control
action is appropriate?
