Galen College of Nursing
NUR 242 Med-Surg Nursing
Exam 2 () | A+ Guarantee
100 Questions | Comprehensive Review with Detailed Rationales
Section 1: Fluid and Electrolyte Imbalances (Comprehensive Review)
Q1 - Q20
Q1: A nurse is assessing a client with heart failure who presents with crackles in the bilateral lung bases, jugular
venous distension (JVD), and 3+ pitting edema in the lower extremities. The nurse recognizes these findings are
consistent with which fluid imbalance?
A. Hypovolemia
B. Fluid volume excess (hypervolemia) **[CORRECT]**
C. Third spacing
D. Fluid volume deficit
Correct Answer: B
Rationale: Crackles, JVD, and pitting edema are classic signs of fluid volume excess resulting from heart failure. The heart's inability to pump
effectively causes fluid to back up into the pulmonary and systemic circulations. Hypovolemia would present with hypotension, tachycardia,
and dry mucous membranes, which are opposite findings.
Q2: A client with fluid volume excess has the following laboratory results: hemoglobin 10.2 g/dL, hematocrit 30%,
BUN 8 mg/dL, and albumin 2.8 g/dL. Which finding is most consistent with fluid overload?
A. Elevated hemoglobin
B. Decreased hematocrit, BUN, and albumin **[CORRECT]**
C. Elevated BUN with normal albumin
D. Decreased hemoglobin with elevated BUN
Correct Answer: B
Rationale: In hypervolemia, excess fluid dilutes blood components, causing decreased hematocrit, BUN, and albumin levels. The hemodilution
effect occurs because the fluid excess proportionally exceeds the solid components of blood. This is an important laboratory indicator that helps
distinguish fluid overload from other conditions.
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. Weigh yourself daily at the same time wearing similar clothing **[CORRECT]**
C. Restrict physical activity to bed rest
D. Consume a high-protein diet to replace albumin
Correct Answer: B
Rationale: Daily weights are the most reliable indicator of fluid balance trends. A weight gain of 1 kg (2.2 lbs) is approximately equivalent to 1
liter of retained fluid. Weighing at the same time each day with similar clothing ensures consistency and allows the nurse and client to monitor
for worsening or improving fluid retention.
Q4: A client presents to the emergency department following severe vomiting and diarrhea for the past 3 days. The
nurse observes dry mucous membranes, decreased skin turgor, and orthostatic hypotension. Which intervention is
the priority?
A. Administer a diuretic as prescribed
B. Initiate isotonic intravenous fluid replacement **[CORRECT]**
1
, C. Encourage oral fluid intake of water only
D. Apply compression stockings to lower extremities
Correct Answer: B
Rationale: This client exhibits classic signs of hypovolemia (fluid volume deficit) secondary to gastrointestinal losses. The priority intervention is
isotonic IV fluid replacement (e.g., 0.9% normal saline or lactated Ringer's) to restore circulating volume and perfusion. Oral fluids alone may
be insufficient given the severity of dehydration, and diuretics would worsen the deficit.
Q5: A client with hypovolemia has the following laboratory findings: hematocrit 58%, BUN 32 mg/dL, serum
osmolality 310 mOsm/kg, and urine specific gravity 1.035. The nurse understands that these findings indicate which
physiological response?
A. Hemodilution from fluid retention
B. Hemoconcentration from fluid loss **[CORRECT]**
C. Renal failure with decreased GFR
D. SIADH causing water retention
Correct Answer: B
Rationale: Elevated hematocrit, BUN, osmolality, and urine specific gravity all reflect hemoconcentration, which occurs when fluid is lost while
solutes remain in the vascular space. The kidneys attempt to conserve water by concentrating urine (high specific gravity). These lab values are
the hallmark of fluid volume deficit.
Q6: A client with a serum sodium level of 152 mEq/L is exhibiting agitation, confusion, and severe thirst. Which
nursing intervention is most appropriate?
A. Administer hypertonic saline intravenously
B. Restrict all oral and intravenous fluids
C. Provide water replacement and monitor neurologic status **[CORRECT]**
D. Administer a loop diuretic to promote sodium excretion
Correct Answer: C
Rationale: This client has hypernatremia (Na > 145 mEq/L), most commonly caused by water loss exceeding sodium loss. The primary
treatment is water replacement, either orally or intravenously with hypotonic solutions. The nurse must also monitor neurologic status and
implement seizure precautions because hypernatremia can cause neuronal dehydration and seizures.
Q7: The nurse is caring for a client with hypernatremia. Which principle is most critical when planning fluid
replacement therapy?
A. Correct the sodium level as rapidly as possible
B. Administer hypertonic saline to dilute serum sodium
C. Correct the sodium level slowly to prevent cerebral edema **[CORRECT]**
D. Restrict all fluids until sodium normalizes
Correct Answer: C
Rationale: Hypernatremia must be corrected slowly, typically no faster than 10-12 mEq/L per 24 hours. Rapid correction causes water to shift
into brain cells, leading to cerebral edema, seizures, and potentially death. This is a critical safety principle in electrolyte management.
Q8: A client with syndrome of inappropriate antidiuretic hormone secretion (SIADH) has a serum sodium level of
122 mEq/L. Which clinical manifestation should the nurse expect to find?
A. Constipation and bone pain
B. Confusion, lethargy, and headache **[CORRECT]**
C. Muscle cramps and tetany
D. Tachycardia and bounding peripheral pulses
Correct Answer: B
Rationale: SIADH causes water retention that dilutes serum sodium, leading to hyponatremia. As sodium drops below 135 mEq/L and especially
below 120 mEq/L, cerebral edema develops due to water shifting into brain cells. This produces neurological symptoms including confusion,
lethargy, headache, and in severe cases, seizures and coma.
2
, Q9: A client with severe hyponatremia (Na 118 mEq/L) is ordered to receive hypertonic saline. The nurse
understands that rapid correction of hyponatremia can cause which life-threatening condition?
A. Cerebral edema
B. Central pontine myelinolysis **[CORRECT]**
C. Hypertensive crisis
D. Tetany and seizures
Correct Answer: B
Rationale: Rapid correction of chronic hyponatremia can cause central pontine myelinolysis (CPM), a devastating and often irreversible
neurological condition in which the myelin sheath in the pons is destroyed. Sodium correction should not exceed 8-10 mEq/L in the first 24
hours. This safety principle is critical for NCLEX-RN and clinical practice.
Q10: A client with chronic kidney disease has a serum potassium level of 6.8 mEq/L. Which electrocardiographic
(ECG) change should the nurse anticipate?
A. U waves and flat T waves
B. Peaked T waves, widened QRS complex, and flat P waves **[CORRECT]**
C. Prolonged PR interval and narrow QRS
D. Sinus bradycardia with a normal ST segment
Correct Answer: B
Rationale: Hyperkalemia (K > 5.0 mEq/L) produces characteristic ECG changes that progress with increasing potassium levels. Peaked T waves
are the earliest change, followed by widened QRS complex, flat or absent P waves, and eventually a sine wave pattern. The nurse must report
these changes immediately.
Q11: A client with a serum potassium level of 7.2 mEq/L is experiencing muscle weakness and paresthesias. Which
medication is the priority to administer as a cardiac membrane stabilizer?
A. Regular insulin and 50% dextrose
B. Sodium polystyrene sulfonate (Kayexalate)
C. Calcium gluconate **[CORRECT]**
D. Furosemide (Lasix) IV push
Correct Answer: C
Rationale: Calcium gluconate is the first-line emergency treatment for severe hyperkalemia because it stabilizes the cardiac cell membrane
against depolarization, protecting the heart from life-threatening arrhythmias. It does not lower serum potassium levels but buys time for other
treatments (insulin + D50, Kayexalate, dialysis) to take effect.
Q12: The nurse is preparing to administer intravenous potassium replacement to a client with hypokalemia (K 2.8
mEq/L). Which safety consideration is most important?
A. Administer the potassium as a rapid IV bolus for quick correction
B. Infuse potassium at a rate not exceeding 10-20 mEq/hr via an infusion pump **[CORRECT]**
C. Mix the potassium in a small volume of 50 mL for rapid delivery
D. Administer potassium without cardiac monitoring since it is only mildly low
Correct Answer: B
Rationale: IV potassium must NEVER be administered as a bolus or rapid push because concentrated potassium can cause cardiac arrest. The
maximum infusion rate is 10-20 mEq/hr, and the maximum concentration is 40 mEq/100 mL. An infusion pump must be used, and cardiac
monitoring is essential.
Q13: A client with hypokalemia (K 3.0 mEq/L) presents with muscle weakness, fatigue, and constipation. The nurse
reviews the ECG and identifies which abnormality associated with low potassium?
A. Peaked T waves and widened QRS
B. U waves, flat T waves, and ST segment depression **[CORRECT]**
C. Tall, narrow P waves and shortened PR interval
D. Sinus tachycardia with a normal QRS complex
3
NUR 242 Med-Surg Nursing
Exam 2 () | A+ Guarantee
100 Questions | Comprehensive Review with Detailed Rationales
Section 1: Fluid and Electrolyte Imbalances (Comprehensive Review)
Q1 - Q20
Q1: A nurse is assessing a client with heart failure who presents with crackles in the bilateral lung bases, jugular
venous distension (JVD), and 3+ pitting edema in the lower extremities. The nurse recognizes these findings are
consistent with which fluid imbalance?
A. Hypovolemia
B. Fluid volume excess (hypervolemia) **[CORRECT]**
C. Third spacing
D. Fluid volume deficit
Correct Answer: B
Rationale: Crackles, JVD, and pitting edema are classic signs of fluid volume excess resulting from heart failure. The heart's inability to pump
effectively causes fluid to back up into the pulmonary and systemic circulations. Hypovolemia would present with hypotension, tachycardia,
and dry mucous membranes, which are opposite findings.
Q2: A client with fluid volume excess has the following laboratory results: hemoglobin 10.2 g/dL, hematocrit 30%,
BUN 8 mg/dL, and albumin 2.8 g/dL. Which finding is most consistent with fluid overload?
A. Elevated hemoglobin
B. Decreased hematocrit, BUN, and albumin **[CORRECT]**
C. Elevated BUN with normal albumin
D. Decreased hemoglobin with elevated BUN
Correct Answer: B
Rationale: In hypervolemia, excess fluid dilutes blood components, causing decreased hematocrit, BUN, and albumin levels. The hemodilution
effect occurs because the fluid excess proportionally exceeds the solid components of blood. This is an important laboratory indicator that helps
distinguish fluid overload from other conditions.
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. Weigh yourself daily at the same time wearing similar clothing **[CORRECT]**
C. Restrict physical activity to bed rest
D. Consume a high-protein diet to replace albumin
Correct Answer: B
Rationale: Daily weights are the most reliable indicator of fluid balance trends. A weight gain of 1 kg (2.2 lbs) is approximately equivalent to 1
liter of retained fluid. Weighing at the same time each day with similar clothing ensures consistency and allows the nurse and client to monitor
for worsening or improving fluid retention.
Q4: A client presents to the emergency department following severe vomiting and diarrhea for the past 3 days. The
nurse observes dry mucous membranes, decreased skin turgor, and orthostatic hypotension. Which intervention is
the priority?
A. Administer a diuretic as prescribed
B. Initiate isotonic intravenous fluid replacement **[CORRECT]**
1
, C. Encourage oral fluid intake of water only
D. Apply compression stockings to lower extremities
Correct Answer: B
Rationale: This client exhibits classic signs of hypovolemia (fluid volume deficit) secondary to gastrointestinal losses. The priority intervention is
isotonic IV fluid replacement (e.g., 0.9% normal saline or lactated Ringer's) to restore circulating volume and perfusion. Oral fluids alone may
be insufficient given the severity of dehydration, and diuretics would worsen the deficit.
Q5: A client with hypovolemia has the following laboratory findings: hematocrit 58%, BUN 32 mg/dL, serum
osmolality 310 mOsm/kg, and urine specific gravity 1.035. The nurse understands that these findings indicate which
physiological response?
A. Hemodilution from fluid retention
B. Hemoconcentration from fluid loss **[CORRECT]**
C. Renal failure with decreased GFR
D. SIADH causing water retention
Correct Answer: B
Rationale: Elevated hematocrit, BUN, osmolality, and urine specific gravity all reflect hemoconcentration, which occurs when fluid is lost while
solutes remain in the vascular space. The kidneys attempt to conserve water by concentrating urine (high specific gravity). These lab values are
the hallmark of fluid volume deficit.
Q6: A client with a serum sodium level of 152 mEq/L is exhibiting agitation, confusion, and severe thirst. Which
nursing intervention is most appropriate?
A. Administer hypertonic saline intravenously
B. Restrict all oral and intravenous fluids
C. Provide water replacement and monitor neurologic status **[CORRECT]**
D. Administer a loop diuretic to promote sodium excretion
Correct Answer: C
Rationale: This client has hypernatremia (Na > 145 mEq/L), most commonly caused by water loss exceeding sodium loss. The primary
treatment is water replacement, either orally or intravenously with hypotonic solutions. The nurse must also monitor neurologic status and
implement seizure precautions because hypernatremia can cause neuronal dehydration and seizures.
Q7: The nurse is caring for a client with hypernatremia. Which principle is most critical when planning fluid
replacement therapy?
A. Correct the sodium level as rapidly as possible
B. Administer hypertonic saline to dilute serum sodium
C. Correct the sodium level slowly to prevent cerebral edema **[CORRECT]**
D. Restrict all fluids until sodium normalizes
Correct Answer: C
Rationale: Hypernatremia must be corrected slowly, typically no faster than 10-12 mEq/L per 24 hours. Rapid correction causes water to shift
into brain cells, leading to cerebral edema, seizures, and potentially death. This is a critical safety principle in electrolyte management.
Q8: A client with syndrome of inappropriate antidiuretic hormone secretion (SIADH) has a serum sodium level of
122 mEq/L. Which clinical manifestation should the nurse expect to find?
A. Constipation and bone pain
B. Confusion, lethargy, and headache **[CORRECT]**
C. Muscle cramps and tetany
D. Tachycardia and bounding peripheral pulses
Correct Answer: B
Rationale: SIADH causes water retention that dilutes serum sodium, leading to hyponatremia. As sodium drops below 135 mEq/L and especially
below 120 mEq/L, cerebral edema develops due to water shifting into brain cells. This produces neurological symptoms including confusion,
lethargy, headache, and in severe cases, seizures and coma.
2
, Q9: A client with severe hyponatremia (Na 118 mEq/L) is ordered to receive hypertonic saline. The nurse
understands that rapid correction of hyponatremia can cause which life-threatening condition?
A. Cerebral edema
B. Central pontine myelinolysis **[CORRECT]**
C. Hypertensive crisis
D. Tetany and seizures
Correct Answer: B
Rationale: Rapid correction of chronic hyponatremia can cause central pontine myelinolysis (CPM), a devastating and often irreversible
neurological condition in which the myelin sheath in the pons is destroyed. Sodium correction should not exceed 8-10 mEq/L in the first 24
hours. This safety principle is critical for NCLEX-RN and clinical practice.
Q10: A client with chronic kidney disease has a serum potassium level of 6.8 mEq/L. Which electrocardiographic
(ECG) change should the nurse anticipate?
A. U waves and flat T waves
B. Peaked T waves, widened QRS complex, and flat P waves **[CORRECT]**
C. Prolonged PR interval and narrow QRS
D. Sinus bradycardia with a normal ST segment
Correct Answer: B
Rationale: Hyperkalemia (K > 5.0 mEq/L) produces characteristic ECG changes that progress with increasing potassium levels. Peaked T waves
are the earliest change, followed by widened QRS complex, flat or absent P waves, and eventually a sine wave pattern. The nurse must report
these changes immediately.
Q11: A client with a serum potassium level of 7.2 mEq/L is experiencing muscle weakness and paresthesias. Which
medication is the priority to administer as a cardiac membrane stabilizer?
A. Regular insulin and 50% dextrose
B. Sodium polystyrene sulfonate (Kayexalate)
C. Calcium gluconate **[CORRECT]**
D. Furosemide (Lasix) IV push
Correct Answer: C
Rationale: Calcium gluconate is the first-line emergency treatment for severe hyperkalemia because it stabilizes the cardiac cell membrane
against depolarization, protecting the heart from life-threatening arrhythmias. It does not lower serum potassium levels but buys time for other
treatments (insulin + D50, Kayexalate, dialysis) to take effect.
Q12: The nurse is preparing to administer intravenous potassium replacement to a client with hypokalemia (K 2.8
mEq/L). Which safety consideration is most important?
A. Administer the potassium as a rapid IV bolus for quick correction
B. Infuse potassium at a rate not exceeding 10-20 mEq/hr via an infusion pump **[CORRECT]**
C. Mix the potassium in a small volume of 50 mL for rapid delivery
D. Administer potassium without cardiac monitoring since it is only mildly low
Correct Answer: B
Rationale: IV potassium must NEVER be administered as a bolus or rapid push because concentrated potassium can cause cardiac arrest. The
maximum infusion rate is 10-20 mEq/hr, and the maximum concentration is 40 mEq/100 mL. An infusion pump must be used, and cardiac
monitoring is essential.
Q13: A client with hypokalemia (K 3.0 mEq/L) presents with muscle weakness, fatigue, and constipation. The nurse
reviews the ECG and identifies which abnormality associated with low potassium?
A. Peaked T waves and widened QRS
B. U waves, flat T waves, and ST segment depression **[CORRECT]**
C. Tall, narrow P waves and shortened PR interval
D. Sinus tachycardia with a normal QRS complex
3
