Galen College of Nursing
C OMPR EHENS I VE EXAMI NAT I ON
NUR 242 Exam 1 ()
Medical-Surgical Nursing
Course: NUR 242 - Medical-Surgical
Nursing
Total Questions: 100 Multiple-Choice Questions
Academic Year: 2026 - 2027
Student Name:
Date:
Galen College of Nursing | A+ Guarantee Exam Preparation
, Section 1: Fluid and Electrolyte Imbalances (Q1 - Q20)
Q1: A nurse is caring for a client with heart failure who presents with crackles in the lungs, jugular venous distension (JVD), and
3+ pitting edema of the lower extremities. The nurse understands that these findings are consistent with which fluid imbalance?
A. Fluid volume deficit (hypovolemia)
B. Fluid volume excess (hypervolemia) [CORRECT]
C. Isotonic fluid imbalance
D. Third-spacing fluid shift
Correct Answer: B
Rationale: Hypervolemia is characterized by fluid volume excess resulting in crackles from pulmonary congestion, JVD, and edema due to
increased hydrostatic pressure. Heart failure impairs cardiac output, leading to sodium and water retention via RAAS activation. Fluid volume
deficit would present with hypotension, tachycardia, and dry mucous membranes, which are opposite findings.
Q2: A client with hypervolemia has the following laboratory results: Hct 32%, BUN 8 mg/dL, and albumin 2.8 g/dL. The nurse
recognizes that which value is most consistent with fluid volume excess?
A. Hct 32%
B. BUN 8 mg/dL
C. Albumin 2.8 g/dL
D. All of the above [CORRECT]
Correct Answer: D
Rationale: In hypervolemia, Hct decreases due to hemodilution from excess fluid. BUN decreases because of dilutional effects and increased renal
perfusion. Albumin decreases as a result of hemodilution and may also reflect underlying liver or nutritional issues contributing to fluid retention.
All three values are consistent with the dilutional effects seen in fluid volume excess.
Q3: The nurse is developing a teaching plan for a client with hypervolemia. Which instruction should the nurse include as a
priority?
A. Increase intake of potassium-rich foods
B. Restrict sodium and fluid intake as prescribed [CORRECT]
C. Drink at least 3 liters of water daily
D. Use salt substitutes liberally on food
Correct Answer: B
Rationale: Sodium restriction is a priority for hypervolemia because sodium promotes water retention through osmotic mechanisms. Fluid
restriction is also commonly prescribed to prevent further volume expansion. Increasing water intake or using salt substitutes would worsen fluid
overload, and salt substitutes may contain potassium chloride, which is contraindicated in renal patients.
Q4: A client presents with vomiting, diarrhea, and decreased skin turgor. The nurse notes hypotension, tachycardia, and oliguria.
Which fluid imbalance does the nurse suspect?
A. Hypervolemia
B. Hypovolemia (fluid volume deficit) [CORRECT]
C. SIADH
D. Hypercalcemia
Correct Answer: B
Rationale: Hypovolemia results from fluid loss exceeding intake, as seen with vomiting and diarrhea. Signs include hypotension from decreased
vascular volume, tachycardia as a compensatory sympathetic response, decreased skin turgor from loss of interstitial fluid, and oliguria from
decreased renal perfusion. SIADH causes fluid retention, not loss. Hypercalcemia presents with neurological and cardiac symptoms, not volume
depletion.
Q5: A client with fluid volume deficit has the following lab values: Hct 58%, BUN 32 mg/dL, urine specific gravity 1.035. The
nurse understands these findings indicate which response?
A. Fluid overload with hemodilution
NUR 242 Exam 1 | Galen College of Nursing | Page 1
, B. Hemoconcentration from fluid loss [CORRECT]
C. Renal failure with decreased GFR
D. Acute hemorrhage requiring transfusion
Correct Answer: B
Rationale: Elevated Hct, BUN, and urine specific gravity are classic findings of hemoconcentration, which occurs when fluid is lost from the
vascular space, concentrating blood components. The kidneys conserve water by increasing specific gravity. These are compensatory mechanisms
to maintain perfusion, not indicators of renal failure per se. While hemorrhage can cause these findings, the data alone point to hemoconcentration
from any cause of fluid deficit.
Q6: A client with a serum sodium level of 152 mEq/L is exhibiting agitation, confusion, and dry mucous membranes. Which
nursing intervention is the priority?
A. Administer hypertonic saline IV
B. Restrict fluid intake
C. Provide water replacement and monitor neurologic status [CORRECT]
D. Administer sodium polystyrene sulfonate (Kayexalate)
Correct Answer: C
Rationale: Hypernatremia (Na > 145 mEq/L) results from water loss exceeding sodium loss. The priority intervention is water replacement (oral or
IV hypotonic solutions) along with neurologic monitoring because severe hypernatremia can cause seizures. Fluid restriction would worsen
hypernatremia. Hypertonic saline is used for hyponatremia. Correction must occur slowly to prevent cerebral edema from rapid fluid shifts.
Q7: A nurse is caring for a client diagnosed with SIADH. Which finding would the nurse expect?
A. Serum sodium 148 mEq/L, urine output 80 mL/hr
B. Serum sodium 122 mEq/L, urine output 15 mL/hr [CORRECT]
C. Serum sodium 140 mEq/L, urine specific gravity 1.005
D. Serum sodium 135 mEq/L, urine specific gravity 1.030
Correct Answer: B
Rationale: SIADH causes excessive ADH secretion, leading to water retention and dilutional hyponatremia (Na < 135 mEq/L). The kidneys
reabsorb free water, producing concentrated urine with high specific gravity (>1.020) and low urine output. Sodium 148 mEq/L indicates
hypernatremia. A sodium of 140 mEq/L is normal, and specific gravity of 1.005 indicates dilute urine, both inconsistent with SIADH.
Q8: A client with severe hyponatremia (Na 118 mEq/L) is experiencing seizures. The nurse anticipates which emergency
intervention?
A. Administration of 3% hypertonic saline [CORRECT]
B. Administration of 0.9% normal saline
C. Oral sodium tablets
D. Fluid restriction to 500 mL/day
Correct Answer: A
Rationale: Severe hyponatremia with neurological symptoms requires emergent hypertonic saline (3% NaCl) to rapidly raise serum sodium.
However, correction must be controlled and gradual to prevent central pontine myelinolysis. Isotonic saline and oral sodium tablets are too slow
for emergency treatment. Fluid restriction is for mild, stable cases without neurological symptoms.
Q9: The nurse is reviewing the ECG rhythm strip of a client with a serum potassium level of 6.8 mEq/L. Which ECG change
should the nurse expect to identify?
A. U waves and flattened T waves
B. Peaked T waves and widened QRS complexes [CORRECT]
C. Prolonged PR interval and narrow QRS
D. Absent P waves and shortened QT interval
Correct Answer: B
Rationale: Hyperkalemia (K > 5.0 mEq/L) causes characteristic ECG changes including peaked T waves (earliest sign), widened QRS complexes,
and flattened or absent P waves. As potassium rises further, it can progress to a sine wave pattern and cardiac arrest. U waves and flattened T
waves are seen in hypokalemia. Prolonged PR interval is associated with first-degree heart block from other causes.
NUR 242 Exam 1 | Galen College of Nursing | Page 2
C OMPR EHENS I VE EXAMI NAT I ON
NUR 242 Exam 1 ()
Medical-Surgical Nursing
Course: NUR 242 - Medical-Surgical
Nursing
Total Questions: 100 Multiple-Choice Questions
Academic Year: 2026 - 2027
Student Name:
Date:
Galen College of Nursing | A+ Guarantee Exam Preparation
, Section 1: Fluid and Electrolyte Imbalances (Q1 - Q20)
Q1: A nurse is caring for a client with heart failure who presents with crackles in the lungs, jugular venous distension (JVD), and
3+ pitting edema of the lower extremities. The nurse understands that these findings are consistent with which fluid imbalance?
A. Fluid volume deficit (hypovolemia)
B. Fluid volume excess (hypervolemia) [CORRECT]
C. Isotonic fluid imbalance
D. Third-spacing fluid shift
Correct Answer: B
Rationale: Hypervolemia is characterized by fluid volume excess resulting in crackles from pulmonary congestion, JVD, and edema due to
increased hydrostatic pressure. Heart failure impairs cardiac output, leading to sodium and water retention via RAAS activation. Fluid volume
deficit would present with hypotension, tachycardia, and dry mucous membranes, which are opposite findings.
Q2: A client with hypervolemia has the following laboratory results: Hct 32%, BUN 8 mg/dL, and albumin 2.8 g/dL. The nurse
recognizes that which value is most consistent with fluid volume excess?
A. Hct 32%
B. BUN 8 mg/dL
C. Albumin 2.8 g/dL
D. All of the above [CORRECT]
Correct Answer: D
Rationale: In hypervolemia, Hct decreases due to hemodilution from excess fluid. BUN decreases because of dilutional effects and increased renal
perfusion. Albumin decreases as a result of hemodilution and may also reflect underlying liver or nutritional issues contributing to fluid retention.
All three values are consistent with the dilutional effects seen in fluid volume excess.
Q3: The nurse is developing a teaching plan for a client with hypervolemia. Which instruction should the nurse include as a
priority?
A. Increase intake of potassium-rich foods
B. Restrict sodium and fluid intake as prescribed [CORRECT]
C. Drink at least 3 liters of water daily
D. Use salt substitutes liberally on food
Correct Answer: B
Rationale: Sodium restriction is a priority for hypervolemia because sodium promotes water retention through osmotic mechanisms. Fluid
restriction is also commonly prescribed to prevent further volume expansion. Increasing water intake or using salt substitutes would worsen fluid
overload, and salt substitutes may contain potassium chloride, which is contraindicated in renal patients.
Q4: A client presents with vomiting, diarrhea, and decreased skin turgor. The nurse notes hypotension, tachycardia, and oliguria.
Which fluid imbalance does the nurse suspect?
A. Hypervolemia
B. Hypovolemia (fluid volume deficit) [CORRECT]
C. SIADH
D. Hypercalcemia
Correct Answer: B
Rationale: Hypovolemia results from fluid loss exceeding intake, as seen with vomiting and diarrhea. Signs include hypotension from decreased
vascular volume, tachycardia as a compensatory sympathetic response, decreased skin turgor from loss of interstitial fluid, and oliguria from
decreased renal perfusion. SIADH causes fluid retention, not loss. Hypercalcemia presents with neurological and cardiac symptoms, not volume
depletion.
Q5: A client with fluid volume deficit has the following lab values: Hct 58%, BUN 32 mg/dL, urine specific gravity 1.035. The
nurse understands these findings indicate which response?
A. Fluid overload with hemodilution
NUR 242 Exam 1 | Galen College of Nursing | Page 1
, B. Hemoconcentration from fluid loss [CORRECT]
C. Renal failure with decreased GFR
D. Acute hemorrhage requiring transfusion
Correct Answer: B
Rationale: Elevated Hct, BUN, and urine specific gravity are classic findings of hemoconcentration, which occurs when fluid is lost from the
vascular space, concentrating blood components. The kidneys conserve water by increasing specific gravity. These are compensatory mechanisms
to maintain perfusion, not indicators of renal failure per se. While hemorrhage can cause these findings, the data alone point to hemoconcentration
from any cause of fluid deficit.
Q6: A client with a serum sodium level of 152 mEq/L is exhibiting agitation, confusion, and dry mucous membranes. Which
nursing intervention is the priority?
A. Administer hypertonic saline IV
B. Restrict fluid intake
C. Provide water replacement and monitor neurologic status [CORRECT]
D. Administer sodium polystyrene sulfonate (Kayexalate)
Correct Answer: C
Rationale: Hypernatremia (Na > 145 mEq/L) results from water loss exceeding sodium loss. The priority intervention is water replacement (oral or
IV hypotonic solutions) along with neurologic monitoring because severe hypernatremia can cause seizures. Fluid restriction would worsen
hypernatremia. Hypertonic saline is used for hyponatremia. Correction must occur slowly to prevent cerebral edema from rapid fluid shifts.
Q7: A nurse is caring for a client diagnosed with SIADH. Which finding would the nurse expect?
A. Serum sodium 148 mEq/L, urine output 80 mL/hr
B. Serum sodium 122 mEq/L, urine output 15 mL/hr [CORRECT]
C. Serum sodium 140 mEq/L, urine specific gravity 1.005
D. Serum sodium 135 mEq/L, urine specific gravity 1.030
Correct Answer: B
Rationale: SIADH causes excessive ADH secretion, leading to water retention and dilutional hyponatremia (Na < 135 mEq/L). The kidneys
reabsorb free water, producing concentrated urine with high specific gravity (>1.020) and low urine output. Sodium 148 mEq/L indicates
hypernatremia. A sodium of 140 mEq/L is normal, and specific gravity of 1.005 indicates dilute urine, both inconsistent with SIADH.
Q8: A client with severe hyponatremia (Na 118 mEq/L) is experiencing seizures. The nurse anticipates which emergency
intervention?
A. Administration of 3% hypertonic saline [CORRECT]
B. Administration of 0.9% normal saline
C. Oral sodium tablets
D. Fluid restriction to 500 mL/day
Correct Answer: A
Rationale: Severe hyponatremia with neurological symptoms requires emergent hypertonic saline (3% NaCl) to rapidly raise serum sodium.
However, correction must be controlled and gradual to prevent central pontine myelinolysis. Isotonic saline and oral sodium tablets are too slow
for emergency treatment. Fluid restriction is for mild, stable cases without neurological symptoms.
Q9: The nurse is reviewing the ECG rhythm strip of a client with a serum potassium level of 6.8 mEq/L. Which ECG change
should the nurse expect to identify?
A. U waves and flattened T waves
B. Peaked T waves and widened QRS complexes [CORRECT]
C. Prolonged PR interval and narrow QRS
D. Absent P waves and shortened QT interval
Correct Answer: B
Rationale: Hyperkalemia (K > 5.0 mEq/L) causes characteristic ECG changes including peaked T waves (earliest sign), widened QRS complexes,
and flattened or absent P waves. As potassium rises further, it can progress to a sine wave pattern and cardiac arrest. U waves and flattened T
waves are seen in hypokalemia. Prolonged PR interval is associated with first-degree heart block from other causes.
NUR 242 Exam 1 | Galen College of Nursing | Page 2
