NUR 242 Med-Surg Nursing Exam 2 Galen College
Actual Exam 2026/2027 – Complete Exam-Style
Questions & Answers | 100% Certified Verified – Pass
GuaranteedD– A+ Graded.PDF
NUR 242: Medical-Surgical Nursing Concepts (Exam 2). It covers high-yield concepts
including fluid and electrolyte imbalances, acid-base disorders (ABGs), perioperative
nursing, and cardiovascular conditions (CAD, angina, MI, heart failure).
Section 1: Fluid, Electrolyte, and Acid-Base Imbalances (Questions 1–35)
1. A nurse is evaluating a client's morning fluid status. Which assessment finding is
the most sensitive and accurate indicator of overall fluid volume shifts?
A. Skin turgor over the sternum
B. Hourly intake and output records
C. Daily weight measured at the same time every morning
D. Urine specific gravity measurements
Answer: C
Rationale: Daily body weight remains the most sensitive indicator of acute fluid
volume changes; 1 liter of fluid equals roughly 2.2 lbs (1 kg).
2. A client with severe heart failure is receiving IV furosemide. The nurse notes the
client has developed new-onset flat T waves, prominent U waves, and skeletal muscle
leg cramps. Which electrolyte imbalance should the nurse suspect?
A. Hyperkalemia
,B. Hypokalemia
C. Hyponatremia
D. Hypercalcemia
Answer: B
Rationale: Leg cramps, flattened T waves, and prominent U waves are classic
presentation hallmarks of hypokalemia, a common side effect of loop diuretics.
3. A client presents with a serum sodium level of 118 mEq/L. Which nursing
intervention is a priority safe implementation for this client?
A. Restricting oral fluid intake to 800 mL/day
B. Initiating seizure precautions and placing suction at the bedside
C. Administering a rapid IV bolus of 3% hypertonic saline
D. Encouraging increased oral water intake
Answer: B
Rationale: Severe hyponatremia (below 120 mEq/L) places the client at extreme risk
for cerebral edema, encephalopathy, and life-threatening seizures.
4. The nurse is caring for a client with primary hyperparathyroidism. Which
electrolyte imbalance is this client at greatest risk for developing?
A. Hypocalcemia
B. Hypercalcemia
C. Hypermagnesemia
D. Hypophosphatemia
Answer: B
Rationale: Hyperparathyroidism triggers excess release of parathyroid hormone
(PTH), which increases bone resorption and drives calcium levels up into the blood.
5. A client's arterial blood gas (ABG) values read: pH 7.31, $PaCO_2$ 52 mmHg,
$HCO_3^-$ 24 mEq/L. How should the nurse interpret these findings?
A. Uncompensated metabolic acidosis
,B. Uncompensated respiratory acidosis
C. Fully compensated respiratory acidosis
D. Combined respiratory and metabolic acidosis
Answer: B
Rationale: The pH is low (acidosis), the $PaCO_2$ is high (respiratory driver), and
the $HCO_3^-$ is normal, indicating an uncompensated respiratory issue.
6. A client with an active small bowel obstruction has had continuous nasogastric
(NG) tube suctioning for 48 hours. Which acid-base imbalance is this client at risk of
experiencing?
A. Metabolic acidosis
B. Metabolic alkalosis
C. Respiratory acidosis
D. Respiratory alkalosis
Answer: B
Rationale: Loss of gastric hydrochloric acid through continuous NG suction or
severe vomiting depletes metabolic acids, shifting the body into metabolic alkalosis.
7. A client with type 1 diabetes mellitus presents to the emergency department with
deep, rapid, gasping respirations (Kussmaul breathing). The nurse understands this
compensatory respiratory mechanism is an attempt to blow off which substance?
A. Oxygen
B. Carbon dioxide
C. Bicarbonate
D. Nitrous oxide
Answer: B
Rationale: Kussmaul respirations are the body's respiratory compensation method
to blow off volatile $CO_2$ and lower systemic acid levels during diabetic
ketoacidosis.
, 8. A client is admitted with severe chronic panic disorder and hyperventilation. Which
ABG profile matches this clinical scenario?
A. pH 7.50, $PaCO_2$ 28 mmHg, $HCO_3^-$ 23 mEq/L
B. pH 7.32, $PaCO_2$ 55 mmHg, $HCO_3^-$ 28 mEq/L
C. pH 7.48, $PaCO_2$ 42 mmHg, $HCO_3^-$ 32 mEq/L
D. pH 7.28, $PaCO_2$ 35 mmHg, $HCO_3^-$ 18 mEq/L
Answer: A
Rationale: Hyperventilation causes excessive elimination of carbon dioxide, driving
a low $PaCO_2$ and an elevated alkaline pH (respiratory alkalosis).
9. The nurse reviews a client's lab results and finds a potassium level of 6.2 mEq/L.
Which cardiac monitor finding requires immediate notification of the healthcare
provider?
A. Prolonged QT interval and depressed ST segment
B. Tall, peaked T waves and a widened QRS complex
C. Multiple premature ventricular contractions (PVCs)
D. Paroxysmal supraventricular tachycardia
Answer: B
Rationale: Hyperkalemia alters cardiac conduction, causing narrow, peaked T
waves, PR prolongation, and widening of the QRS complex, which can progress to
ventricular fibrillation.
10. A client with chronic kidney disease (CKD) reports tingling around the mouth
(perioral numbness) and muscle spasms when their blood pressure is taken. Which
assessment technique should the nurse perform next?
A. Assess for Babinski reflex
B. Check for Trousseau’s sign by inflating a blood pressure cuff above systolic pressure
C. Monitor for the presence of a fluid wave
D. Assess skin elasticity over the abdomen
Answer: B
Actual Exam 2026/2027 – Complete Exam-Style
Questions & Answers | 100% Certified Verified – Pass
GuaranteedD– A+ Graded.PDF
NUR 242: Medical-Surgical Nursing Concepts (Exam 2). It covers high-yield concepts
including fluid and electrolyte imbalances, acid-base disorders (ABGs), perioperative
nursing, and cardiovascular conditions (CAD, angina, MI, heart failure).
Section 1: Fluid, Electrolyte, and Acid-Base Imbalances (Questions 1–35)
1. A nurse is evaluating a client's morning fluid status. Which assessment finding is
the most sensitive and accurate indicator of overall fluid volume shifts?
A. Skin turgor over the sternum
B. Hourly intake and output records
C. Daily weight measured at the same time every morning
D. Urine specific gravity measurements
Answer: C
Rationale: Daily body weight remains the most sensitive indicator of acute fluid
volume changes; 1 liter of fluid equals roughly 2.2 lbs (1 kg).
2. A client with severe heart failure is receiving IV furosemide. The nurse notes the
client has developed new-onset flat T waves, prominent U waves, and skeletal muscle
leg cramps. Which electrolyte imbalance should the nurse suspect?
A. Hyperkalemia
,B. Hypokalemia
C. Hyponatremia
D. Hypercalcemia
Answer: B
Rationale: Leg cramps, flattened T waves, and prominent U waves are classic
presentation hallmarks of hypokalemia, a common side effect of loop diuretics.
3. A client presents with a serum sodium level of 118 mEq/L. Which nursing
intervention is a priority safe implementation for this client?
A. Restricting oral fluid intake to 800 mL/day
B. Initiating seizure precautions and placing suction at the bedside
C. Administering a rapid IV bolus of 3% hypertonic saline
D. Encouraging increased oral water intake
Answer: B
Rationale: Severe hyponatremia (below 120 mEq/L) places the client at extreme risk
for cerebral edema, encephalopathy, and life-threatening seizures.
4. The nurse is caring for a client with primary hyperparathyroidism. Which
electrolyte imbalance is this client at greatest risk for developing?
A. Hypocalcemia
B. Hypercalcemia
C. Hypermagnesemia
D. Hypophosphatemia
Answer: B
Rationale: Hyperparathyroidism triggers excess release of parathyroid hormone
(PTH), which increases bone resorption and drives calcium levels up into the blood.
5. A client's arterial blood gas (ABG) values read: pH 7.31, $PaCO_2$ 52 mmHg,
$HCO_3^-$ 24 mEq/L. How should the nurse interpret these findings?
A. Uncompensated metabolic acidosis
,B. Uncompensated respiratory acidosis
C. Fully compensated respiratory acidosis
D. Combined respiratory and metabolic acidosis
Answer: B
Rationale: The pH is low (acidosis), the $PaCO_2$ is high (respiratory driver), and
the $HCO_3^-$ is normal, indicating an uncompensated respiratory issue.
6. A client with an active small bowel obstruction has had continuous nasogastric
(NG) tube suctioning for 48 hours. Which acid-base imbalance is this client at risk of
experiencing?
A. Metabolic acidosis
B. Metabolic alkalosis
C. Respiratory acidosis
D. Respiratory alkalosis
Answer: B
Rationale: Loss of gastric hydrochloric acid through continuous NG suction or
severe vomiting depletes metabolic acids, shifting the body into metabolic alkalosis.
7. A client with type 1 diabetes mellitus presents to the emergency department with
deep, rapid, gasping respirations (Kussmaul breathing). The nurse understands this
compensatory respiratory mechanism is an attempt to blow off which substance?
A. Oxygen
B. Carbon dioxide
C. Bicarbonate
D. Nitrous oxide
Answer: B
Rationale: Kussmaul respirations are the body's respiratory compensation method
to blow off volatile $CO_2$ and lower systemic acid levels during diabetic
ketoacidosis.
, 8. A client is admitted with severe chronic panic disorder and hyperventilation. Which
ABG profile matches this clinical scenario?
A. pH 7.50, $PaCO_2$ 28 mmHg, $HCO_3^-$ 23 mEq/L
B. pH 7.32, $PaCO_2$ 55 mmHg, $HCO_3^-$ 28 mEq/L
C. pH 7.48, $PaCO_2$ 42 mmHg, $HCO_3^-$ 32 mEq/L
D. pH 7.28, $PaCO_2$ 35 mmHg, $HCO_3^-$ 18 mEq/L
Answer: A
Rationale: Hyperventilation causes excessive elimination of carbon dioxide, driving
a low $PaCO_2$ and an elevated alkaline pH (respiratory alkalosis).
9. The nurse reviews a client's lab results and finds a potassium level of 6.2 mEq/L.
Which cardiac monitor finding requires immediate notification of the healthcare
provider?
A. Prolonged QT interval and depressed ST segment
B. Tall, peaked T waves and a widened QRS complex
C. Multiple premature ventricular contractions (PVCs)
D. Paroxysmal supraventricular tachycardia
Answer: B
Rationale: Hyperkalemia alters cardiac conduction, causing narrow, peaked T
waves, PR prolongation, and widening of the QRS complex, which can progress to
ventricular fibrillation.
10. A client with chronic kidney disease (CKD) reports tingling around the mouth
(perioral numbness) and muscle spasms when their blood pressure is taken. Which
assessment technique should the nurse perform next?
A. Assess for Babinski reflex
B. Check for Trousseau’s sign by inflating a blood pressure cuff above systolic pressure
C. Monitor for the presence of a fluid wave
D. Assess skin elasticity over the abdomen
Answer: B
