NUR 275 Midterm Exam 2024/2025: Real
Questions with Verified Answers &
Rationales (Graded A+)
,Question 1
A patient with chronic kidney disease (CKD) presents with a serum potassium level of 6.2
mEq/L. The nurse notes peaked T waves on the electrocardiogram (ECG). Which provider
prescription should the nurse implement first?
A) Administer oral sodium polystyrene sulfonate
B) Give intravenous regular insulin with 50% dextrose
C) Initiate a continuous infusion of normal saline
D) Administer intravenous calcium gluconate
VERIFIED ANSWER: D) Administer intravenous calcium gluconate
EXPLANATION: In severe hyperkalemia with corresponding ECG changes (peaked T
waves), the immediate priority is to stabilize the myocardial cell membrane to prevent lethal
dysrhythmias. Calcium gluconate acts within minutes to protect the heart but does not
lower potassium levels. Insulin with dextrose shifts potassium into the cells and should be
given next, while sodium polystyrene sulfonate eliminates potassium via the GI tract but
takes hours to work.
Question 2
The nurse is managing the care of a client in the oliguric phase of acute kidney injury (AKI).
Which acid-base imbalance is this client at the highest risk for developing?
A) Metabolic alkalosis
B) Respiratory acidosis
C) Metabolic acidosis
D) Respiratory alkalosis
VERIFIED ANSWER: C) Metabolic acidosis
EXPLANATION: During the oliguric phase of AKI, the kidneys lose their ability to excrete
hydrogen ions and metabolic waste products. Additionally, there is a decreased synthesis of
bicarbonate ions. This combination of retained hydrogen ions and depleted bicarbonate
reserves leads directly to metabolic acidosis.
Question 3
A client undergoing a primary survey in the emergency department after a motor vehicle
accident exhibits tracheal deviation to the right and absent breath sounds on the left. Which
action must the nurse anticipate taking immediately?
A) Preparing for urgent endotracheal intubation
,B) Assisting with a needle decompression on the left side
C) Setting up a chest drainage system on the right side
D) Obtaining a portable emergency chest X-ray
VERIFIED ANSWER: B) Assisting with a needle decompression on the left side
EXPLANATION: Tracheal deviation combined with absent breath sounds indicates a
tension pneumothorax, which is an immediate, life-threatening emergency during the
"Breathing" phase of the primary survey. Air accumulation on the affected side (left)
pushes mediastinal structures to the opposite side (right). Immediate needle decompression
is required to relieve intrathoracic pressure before a definitive chest tube is placed.
Question 4
A nurse is preparing a client for an automated peritoneal dialysis exchange. The client reports
mild abdominal cramping as the warm dialysate fluid begins to infuse. What is the most
appropriate nursing intervention?
A) Stop the infusion immediately and notify the healthcare provider
B) Slow the rate of the infusion and reassure the client
C) Aspirate the fluid from the peritoneal cavity to check for clots
D) Administer a prescribed dose of an intravenous narcotic analgesic
VERIFIED ANSWER: B) Slow the rate of the infusion and reassure the client
EXPLANATION: Mild abdominal cramping or a feeling of fullness is common during the
initial inflow phase of peritoneal dialysis, especially if the fluid is infusing rapidly. Slowing
the infusion rate usually alleviates the discomfort. Stopping the procedure or calling the
provider is unnecessary unless the pain becomes severe or is accompanied by cloudy
outflow (signs of peritonitis).
Question 5
During an 8-hour shift, a client has the following intake and output record: 500 mL of normal
saline IV, 150 mL of oral water, 120 mL of juice, 450 mL of urine, and 200 mL of liquid
stool. What is the client's precise net fluid balance for the shift?
A) +120 mL
B) +320 mL
C) +150 mL
D) -120 mL
VERIFIED ANSWER: A) +120 mL
, EXPLANATION: Total intake is calculated as 500 mL (IV) + 150 mL (water) + 120 mL
(juice) = 770 mL. Total output is calculated as 450 mL (urine) + 200 mL (stool) = 650 mL.
Net balance = Total Intake (770 mL) - Total Output (650 mL) = +120 mL.
Question 6
Which condition or scenario is classified strictly as a postrenal cause of acute kidney injury
(AKI)?
A) Anaphylactic shock causing severe hypotension
B) Bilateral ureteral calculi blocking urine flow
C) Aminoglycoside antibiotic toxicity causing tubular necrosis
D) Severe hemorrhage following a traumatic pelvic fracture
VERIFIED ANSWER: B) Bilateral ureteral calculi blocking urine flow
EXPLANATION: Postrenal AKI is caused by mechanical obstructions that prevent the
outflow of urine anywhere from the collecting ducts to the urethra. Bilateral ureteral
calculi obstruct urine passage, increasing retrograde pressure within the kidney. Shock
and hemorrhage are prerenal causes, while medication toxicity is an intrarenal cause.
Question 7
A trauma nurse is performing a primary survey on an unresponsive patient. According to the
standard ABCDE framework, which assessment parameter belongs under the "Disability"
category?
A) Verification of bilateral chest wall expansion
B) Evaluation of pupil size, equality, and reactivity
C) Measurement of core body temperature and skin integrity
D) Checking central pulse quality and capillary refill time
VERIFIED ANSWER: B) Evaluation of pupil size, equality, and reactivity
EXPLANATION: The "Disability" (D) component of the primary survey focuses on a
rapid neurological evaluation. This includes determining the Glasgow Coma Scale (GCS)
score, checking mental status, and assessing pupil size, equality, and response to light.
Chest expansion falls under Breathing (B), temperature falls under Exposure (E), and
pulses fall under Circulation (C).
Question 8
Questions with Verified Answers &
Rationales (Graded A+)
,Question 1
A patient with chronic kidney disease (CKD) presents with a serum potassium level of 6.2
mEq/L. The nurse notes peaked T waves on the electrocardiogram (ECG). Which provider
prescription should the nurse implement first?
A) Administer oral sodium polystyrene sulfonate
B) Give intravenous regular insulin with 50% dextrose
C) Initiate a continuous infusion of normal saline
D) Administer intravenous calcium gluconate
VERIFIED ANSWER: D) Administer intravenous calcium gluconate
EXPLANATION: In severe hyperkalemia with corresponding ECG changes (peaked T
waves), the immediate priority is to stabilize the myocardial cell membrane to prevent lethal
dysrhythmias. Calcium gluconate acts within minutes to protect the heart but does not
lower potassium levels. Insulin with dextrose shifts potassium into the cells and should be
given next, while sodium polystyrene sulfonate eliminates potassium via the GI tract but
takes hours to work.
Question 2
The nurse is managing the care of a client in the oliguric phase of acute kidney injury (AKI).
Which acid-base imbalance is this client at the highest risk for developing?
A) Metabolic alkalosis
B) Respiratory acidosis
C) Metabolic acidosis
D) Respiratory alkalosis
VERIFIED ANSWER: C) Metabolic acidosis
EXPLANATION: During the oliguric phase of AKI, the kidneys lose their ability to excrete
hydrogen ions and metabolic waste products. Additionally, there is a decreased synthesis of
bicarbonate ions. This combination of retained hydrogen ions and depleted bicarbonate
reserves leads directly to metabolic acidosis.
Question 3
A client undergoing a primary survey in the emergency department after a motor vehicle
accident exhibits tracheal deviation to the right and absent breath sounds on the left. Which
action must the nurse anticipate taking immediately?
A) Preparing for urgent endotracheal intubation
,B) Assisting with a needle decompression on the left side
C) Setting up a chest drainage system on the right side
D) Obtaining a portable emergency chest X-ray
VERIFIED ANSWER: B) Assisting with a needle decompression on the left side
EXPLANATION: Tracheal deviation combined with absent breath sounds indicates a
tension pneumothorax, which is an immediate, life-threatening emergency during the
"Breathing" phase of the primary survey. Air accumulation on the affected side (left)
pushes mediastinal structures to the opposite side (right). Immediate needle decompression
is required to relieve intrathoracic pressure before a definitive chest tube is placed.
Question 4
A nurse is preparing a client for an automated peritoneal dialysis exchange. The client reports
mild abdominal cramping as the warm dialysate fluid begins to infuse. What is the most
appropriate nursing intervention?
A) Stop the infusion immediately and notify the healthcare provider
B) Slow the rate of the infusion and reassure the client
C) Aspirate the fluid from the peritoneal cavity to check for clots
D) Administer a prescribed dose of an intravenous narcotic analgesic
VERIFIED ANSWER: B) Slow the rate of the infusion and reassure the client
EXPLANATION: Mild abdominal cramping or a feeling of fullness is common during the
initial inflow phase of peritoneal dialysis, especially if the fluid is infusing rapidly. Slowing
the infusion rate usually alleviates the discomfort. Stopping the procedure or calling the
provider is unnecessary unless the pain becomes severe or is accompanied by cloudy
outflow (signs of peritonitis).
Question 5
During an 8-hour shift, a client has the following intake and output record: 500 mL of normal
saline IV, 150 mL of oral water, 120 mL of juice, 450 mL of urine, and 200 mL of liquid
stool. What is the client's precise net fluid balance for the shift?
A) +120 mL
B) +320 mL
C) +150 mL
D) -120 mL
VERIFIED ANSWER: A) +120 mL
, EXPLANATION: Total intake is calculated as 500 mL (IV) + 150 mL (water) + 120 mL
(juice) = 770 mL. Total output is calculated as 450 mL (urine) + 200 mL (stool) = 650 mL.
Net balance = Total Intake (770 mL) - Total Output (650 mL) = +120 mL.
Question 6
Which condition or scenario is classified strictly as a postrenal cause of acute kidney injury
(AKI)?
A) Anaphylactic shock causing severe hypotension
B) Bilateral ureteral calculi blocking urine flow
C) Aminoglycoside antibiotic toxicity causing tubular necrosis
D) Severe hemorrhage following a traumatic pelvic fracture
VERIFIED ANSWER: B) Bilateral ureteral calculi blocking urine flow
EXPLANATION: Postrenal AKI is caused by mechanical obstructions that prevent the
outflow of urine anywhere from the collecting ducts to the urethra. Bilateral ureteral
calculi obstruct urine passage, increasing retrograde pressure within the kidney. Shock
and hemorrhage are prerenal causes, while medication toxicity is an intrarenal cause.
Question 7
A trauma nurse is performing a primary survey on an unresponsive patient. According to the
standard ABCDE framework, which assessment parameter belongs under the "Disability"
category?
A) Verification of bilateral chest wall expansion
B) Evaluation of pupil size, equality, and reactivity
C) Measurement of core body temperature and skin integrity
D) Checking central pulse quality and capillary refill time
VERIFIED ANSWER: B) Evaluation of pupil size, equality, and reactivity
EXPLANATION: The "Disability" (D) component of the primary survey focuses on a
rapid neurological evaluation. This includes determining the Glasgow Coma Scale (GCS)
score, checking mental status, and assessing pupil size, equality, and response to light.
Chest expansion falls under Breathing (B), temperature falls under Exposure (E), and
pulses fall under Circulation (C).
Question 8
