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CLN500: Medical-Surgical Nursing –
Questions with Correct Answers.
Total Questions: 60
Format: Multiple choice (45) + clinical scenarios (10) + select all that apply (5)
Target Level: Undergraduate (BSN) / Graduate (MSN) bridge
DOMAIN I: FLUID, ELECTROLYTE & ACID-BASE DISORDERS (8 questions)
Q1. A patient with heart failure is receiving furosemide (Lasix) 40 mg IV. Which laboratory
value requires immediate nursing intervention?
A. Serum potassium 3.2 mEq/L
B. Serum sodium 135 mEq/L
C. Serum chloride 100 mEq/L
D. Serum calcium 9.5 mg/dL
Correct Answer: A
Rationale: Furosemide is a loop diuretic that causes potassium wasting. Hypokalemia (K⁺
<3.5) can lead to cardiac arrhythmias, muscle weakness, and digoxin toxicity. Normal
sodium (B) 135-145, chloride (C) 98-106, calcium (D) 8.5-10.2 – all normal.
Q2. A patient with chronic kidney disease (CKD) has a potassium level of 6.8 mEq/L and
ECG changes (peaked T waves). Which intervention should the nurse implement FIRST?
A. Administer sodium polystyrene sulfonate (Kayexalate) orally
B. Give intravenous calcium gluconate
C. Start an insulin and dextrose infusion
D. Prepare the patient for hemodialysis
Correct Answer: B
Rationale: Calcium gluconate stabilizes the cardiac membrane and is the priority to
prevent life-threatening arrhythmias. Insulin/dextrose (C) shifts potassium into cells but
takes 15-30 minutes. Kayexalate (A) removes potassium slowly. Dialysis (D) is definitive but
not first in an emergency.
Q3. A patient with diabetic ketoacidosis (DKA) has an arterial blood gas (ABG) showing: pH
7.25, PaCO₂ 32 mmHg, HCO₃ 14 mEq/L. Which acid-base disorder is present?
A. Metabolic acidosis with respiratory compensation
B. Metabolic alkalosis with respiratory compensation
, 2
C. Respiratory acidosis with metabolic compensation
D. Mixed metabolic and respiratory acidosis
Correct Answer: A
Rationale: pH low = acidosis. HCO₃ low (14) = metabolic acidosis. PaCO₂ low (32) indicates
respiratory compensation (hyperventilation to blow off CO₂). Primary metabolic acidosis
with appropriate compensation.
Q4. A patient is admitted with hyponatremia (Na⁺ 118 mEq/L) and seizure activity. Which
intravenous solution should the nurse prepare?
A. 0.9% normal saline
B. 0.45% sodium chloride
C. 3% sodium chloride
D. Lactated Ringer’s solution
Correct Answer: C
Rationale: Severe symptomatic hyponatremia with seizures requires hypertonic saline
(3% NaCl) to raise serum sodium gradually. Normal saline (0.9%) is isotonic and too slow;
hypotonic solutions (0.45%) would worsen hyponatremia.
Q5. A patient’s ABG results: pH 7.50, PaCO₂ 48 mmHg, HCO₃ 32 mEq/L. The nurse
interprets this as:
A. Uncompensated respiratory alkalosis
B. Uncompensated metabolic alkalosis
C. Metabolic alkalosis with respiratory compensation
D. Mixed respiratory acidosis and metabolic alkalosis
Correct Answer: C
Rationale: pH high = alkalosis. HCO₃ elevated (32) = primary metabolic alkalosis. PaCO₂
elevated (48) = respiratory compensation (hypoventilation to retain CO₂). Compensation is
partial (pH not normalized).
Q6. A patient with hypernatremia (Na⁺ 155 mEq/L) has dry mucous membranes, oliguria,
and confusion. The nurse should anticipate an order for:
A. 0.9% normal saline
B. 5% dextrose in water (D5W)
C. 3% sodium chloride
D. Albumin
, 3
Correct Answer: B
Rationale: Hypernatremia indicates free water deficit. D5W provides free water after
glucose is metabolized. Normal saline (A) contains sodium; 3% saline (C) would worsen
hypernatremia.
Q7. Which patient is most at risk for developing hypermagnesemia?
A. A patient with chronic alcoholism
B. A patient with end-stage renal disease taking magnesium-containing antacids
C. A patient with prolonged nasogastric suction
D. A patient with hyperparathyroidism
Correct Answer: B
Rationale: Kidneys excrete magnesium. ESRD patients cannot excrete excess magnesium;
magnesium-containing antacids or laxatives can cause life-threatening hypermagnesemia.
Alcoholism (A) causes hypomagnesemia.
Q8. A patient receiving furosemide (Lasix) reports muscle cramps and fatigue. The nurse
notes a flat T wave and a U wave on the cardiac monitor. Which electrolyte imbalance is
likely?
A. Hyperkalemia
B. Hypokalemia
C. Hypercalcemia
D. Hypomagnesemia
Correct Answer: B
Rationale: Loop diuretics cause potassium loss. Hypokalemia causes U waves, flat T waves,
and muscle cramps. Hyperkalemia (A) has peaked T waves; hypomagnesemia (D) may also
occur but ECG finding of U wave is classic for hypokalemia.
DOMAIN II: CARDIOVASCULAR DISORDERS (8 questions)
Q9. A patient with acute coronary syndrome (ACS) reports chest pain unrelieved by two
sublingual nitroglycerin tablets. The nurse administers morphine sulfate 2 mg IV. Which
effect of morphine is most beneficial in this situation?
A. Increased cardiac contractility
B. Reduced preload and afterload, decreased oxygen demand
C. Peripheral vasoconstriction
D. Increased heart rate
CLN500: Medical-Surgical Nursing –
Questions with Correct Answers.
Total Questions: 60
Format: Multiple choice (45) + clinical scenarios (10) + select all that apply (5)
Target Level: Undergraduate (BSN) / Graduate (MSN) bridge
DOMAIN I: FLUID, ELECTROLYTE & ACID-BASE DISORDERS (8 questions)
Q1. A patient with heart failure is receiving furosemide (Lasix) 40 mg IV. Which laboratory
value requires immediate nursing intervention?
A. Serum potassium 3.2 mEq/L
B. Serum sodium 135 mEq/L
C. Serum chloride 100 mEq/L
D. Serum calcium 9.5 mg/dL
Correct Answer: A
Rationale: Furosemide is a loop diuretic that causes potassium wasting. Hypokalemia (K⁺
<3.5) can lead to cardiac arrhythmias, muscle weakness, and digoxin toxicity. Normal
sodium (B) 135-145, chloride (C) 98-106, calcium (D) 8.5-10.2 – all normal.
Q2. A patient with chronic kidney disease (CKD) has a potassium level of 6.8 mEq/L and
ECG changes (peaked T waves). Which intervention should the nurse implement FIRST?
A. Administer sodium polystyrene sulfonate (Kayexalate) orally
B. Give intravenous calcium gluconate
C. Start an insulin and dextrose infusion
D. Prepare the patient for hemodialysis
Correct Answer: B
Rationale: Calcium gluconate stabilizes the cardiac membrane and is the priority to
prevent life-threatening arrhythmias. Insulin/dextrose (C) shifts potassium into cells but
takes 15-30 minutes. Kayexalate (A) removes potassium slowly. Dialysis (D) is definitive but
not first in an emergency.
Q3. A patient with diabetic ketoacidosis (DKA) has an arterial blood gas (ABG) showing: pH
7.25, PaCO₂ 32 mmHg, HCO₃ 14 mEq/L. Which acid-base disorder is present?
A. Metabolic acidosis with respiratory compensation
B. Metabolic alkalosis with respiratory compensation
, 2
C. Respiratory acidosis with metabolic compensation
D. Mixed metabolic and respiratory acidosis
Correct Answer: A
Rationale: pH low = acidosis. HCO₃ low (14) = metabolic acidosis. PaCO₂ low (32) indicates
respiratory compensation (hyperventilation to blow off CO₂). Primary metabolic acidosis
with appropriate compensation.
Q4. A patient is admitted with hyponatremia (Na⁺ 118 mEq/L) and seizure activity. Which
intravenous solution should the nurse prepare?
A. 0.9% normal saline
B. 0.45% sodium chloride
C. 3% sodium chloride
D. Lactated Ringer’s solution
Correct Answer: C
Rationale: Severe symptomatic hyponatremia with seizures requires hypertonic saline
(3% NaCl) to raise serum sodium gradually. Normal saline (0.9%) is isotonic and too slow;
hypotonic solutions (0.45%) would worsen hyponatremia.
Q5. A patient’s ABG results: pH 7.50, PaCO₂ 48 mmHg, HCO₃ 32 mEq/L. The nurse
interprets this as:
A. Uncompensated respiratory alkalosis
B. Uncompensated metabolic alkalosis
C. Metabolic alkalosis with respiratory compensation
D. Mixed respiratory acidosis and metabolic alkalosis
Correct Answer: C
Rationale: pH high = alkalosis. HCO₃ elevated (32) = primary metabolic alkalosis. PaCO₂
elevated (48) = respiratory compensation (hypoventilation to retain CO₂). Compensation is
partial (pH not normalized).
Q6. A patient with hypernatremia (Na⁺ 155 mEq/L) has dry mucous membranes, oliguria,
and confusion. The nurse should anticipate an order for:
A. 0.9% normal saline
B. 5% dextrose in water (D5W)
C. 3% sodium chloride
D. Albumin
, 3
Correct Answer: B
Rationale: Hypernatremia indicates free water deficit. D5W provides free water after
glucose is metabolized. Normal saline (A) contains sodium; 3% saline (C) would worsen
hypernatremia.
Q7. Which patient is most at risk for developing hypermagnesemia?
A. A patient with chronic alcoholism
B. A patient with end-stage renal disease taking magnesium-containing antacids
C. A patient with prolonged nasogastric suction
D. A patient with hyperparathyroidism
Correct Answer: B
Rationale: Kidneys excrete magnesium. ESRD patients cannot excrete excess magnesium;
magnesium-containing antacids or laxatives can cause life-threatening hypermagnesemia.
Alcoholism (A) causes hypomagnesemia.
Q8. A patient receiving furosemide (Lasix) reports muscle cramps and fatigue. The nurse
notes a flat T wave and a U wave on the cardiac monitor. Which electrolyte imbalance is
likely?
A. Hyperkalemia
B. Hypokalemia
C. Hypercalcemia
D. Hypomagnesemia
Correct Answer: B
Rationale: Loop diuretics cause potassium loss. Hypokalemia causes U waves, flat T waves,
and muscle cramps. Hyperkalemia (A) has peaked T waves; hypomagnesemia (D) may also
occur but ECG finding of U wave is classic for hypokalemia.
DOMAIN II: CARDIOVASCULAR DISORDERS (8 questions)
Q9. A patient with acute coronary syndrome (ACS) reports chest pain unrelieved by two
sublingual nitroglycerin tablets. The nurse administers morphine sulfate 2 mg IV. Which
effect of morphine is most beneficial in this situation?
A. Increased cardiac contractility
B. Reduced preload and afterload, decreased oxygen demand
C. Peripheral vasoconstriction
D. Increased heart rate
