NUR 265 / NUR265 EXAM 1 ADVANCED
CONCEPTS IN MEDICAL-SURGICAL NURSING
EXAM 1 | QUESTIONS AND ANSWERS RATED A+
| 2026/2027
Question 1
A client with heart failure is admitted with fluid volume overload. Which assessment
finding is the earliest indicator of fluid volume excess?
A) Dyspnea
B) Edema
C) Weight gain
D) Jugular venous distention
Answer: C
Rationale: Daily weight gain is the earliest indicator of fluid volume excess. A weight
gain of 2-3 pounds in 24 hours or 5 pounds in a week indicates fluid retention before
other signs such as edema or dyspnea become apparent.
Question 2
Which electrolyte imbalance is most commonly associated with the use of loop diuretics
such as furosemide?
A) Hyponatremia
B) Hypokalemia
C) Hypercalcemia
D) Hypomagnesemia
Answer: B
Rationale: Loop diuretics inhibit sodium and chloride reabsorption in the ascending
loop of Henle, leading to increased potassium excretion. Hypokalemia is the most
common electrolyte imbalance associated with loop diuretic use.
,Question 3
A client's arterial blood gas results show: pH 7.32, PaCO₂ 48 mmHg, HCO₃ 24 mEq/L.
Which condition does this indicate?
A) Metabolic acidosis
B) Metabolic alkalosis
C) Respiratory acidosis
D) Respiratory alkalosis
Answer: C
Rationale: A pH below 7.35 indicates acidosis. PaCO₂ is elevated (> 45 mmHg),
indicating respiratory acidosis. The HCO₃ is normal (22-26 mEq/L), so there is no
metabolic compensation.
Question 4
A client with chronic kidney disease has a potassium level of 6.2 mEq/L. The nurse
should anticipate which intervention?
A) Administer potassium chloride
B) Encourage potassium-rich foods
C) Administer sodium polystyrene sulfonate (Kayexalate)
D) Restrict fluid intake
Answer: C
Rationale: A potassium level of 6.2 mEq/L indicates hyperkalemia, a life-threatening
complication of CKD. Sodium polystyrene sulfonate (Kayexalate) binds potassium in the
GI tract and promotes its excretion. Potassium supplements and potassium-rich foods
should be avoided.
Question 5
What is the primary function of antidiuretic hormone (ADH) in fluid balance?
A) Increases sodium excretion
B) Promotes water reabsorption in the kidneys
,C) Stimulates aldosterone release
D) Increases potassium excretion
Answer: B
Rationale: ADH is released from the posterior pituitary in response to increased serum
osmolality. It promotes water reabsorption in the renal collecting ducts, leading to
increased fluid volume and decreased serum osmolality.
Question 6
A client with syndrome of inappropriate antidiuretic hormone (SIADH) would most likely
exhibit which finding?
A) Serum sodium of 150 mEq/L
B) Serum sodium of 125 mEq/L
C) Serum potassium of 5.5 mEq/L
D) Serum potassium of 3.0 mEq/L
Answer: B
Rationale: SIADH causes excessive ADH release, leading to water retention and
dilutional hyponatremia. Serum sodium below 135 mEq/L is characteristic.
Question 7
The nurse is caring for a client with diabetic ketoacidosis (DKA). Which electrolyte
imbalance is of greatest concern?
A) Hyponatremia
B) Hyperkalemia
C) Hypokalemia
D) Hypercalcemia
Answer: C
Rationale: In DKA, potassium shifts from the intracellular to extracellular space due to
acidosis. Insulin therapy drives potassium back into cells, causing severe hypokalemia.
Potassium levels must be monitored closely during treatment.
, Question 8
A client with hyperkalemia is prescribed insulin and dextrose. The nurse understands the
purpose of this intervention is to:
A) Increase potassium excretion
B) Shift potassium from ECF to ICF
C) Stabilize the cardiac membrane
D) Bind potassium in the GI tract
Answer: B
Rationale: Insulin drives potassium into cells (ICF), lowering serum potassium levels.
Dextrose prevents hypoglycemia. This is a temporary measure until definitive treatment
can be implemented.
Question 9
A client with hypokalemia should be assessed for which ECG change?
A) Peaked T waves
B) Flattened T waves and prominent U waves
C) Widened QRS complex
D) Prolonged PR interval
Answer: B
Rationale: Hypokalemia causes flattened T waves and prominent U waves on ECG.
Peaked T waves are characteristic of hyperkalemia.
Question 10
A client with hyponatremia (sodium 125 mEq/L) is at risk for which complication?
A) Cardiac arrhythmias
B) Seizures
C) Muscle spasms
D) Peripheral edema
CONCEPTS IN MEDICAL-SURGICAL NURSING
EXAM 1 | QUESTIONS AND ANSWERS RATED A+
| 2026/2027
Question 1
A client with heart failure is admitted with fluid volume overload. Which assessment
finding is the earliest indicator of fluid volume excess?
A) Dyspnea
B) Edema
C) Weight gain
D) Jugular venous distention
Answer: C
Rationale: Daily weight gain is the earliest indicator of fluid volume excess. A weight
gain of 2-3 pounds in 24 hours or 5 pounds in a week indicates fluid retention before
other signs such as edema or dyspnea become apparent.
Question 2
Which electrolyte imbalance is most commonly associated with the use of loop diuretics
such as furosemide?
A) Hyponatremia
B) Hypokalemia
C) Hypercalcemia
D) Hypomagnesemia
Answer: B
Rationale: Loop diuretics inhibit sodium and chloride reabsorption in the ascending
loop of Henle, leading to increased potassium excretion. Hypokalemia is the most
common electrolyte imbalance associated with loop diuretic use.
,Question 3
A client's arterial blood gas results show: pH 7.32, PaCO₂ 48 mmHg, HCO₃ 24 mEq/L.
Which condition does this indicate?
A) Metabolic acidosis
B) Metabolic alkalosis
C) Respiratory acidosis
D) Respiratory alkalosis
Answer: C
Rationale: A pH below 7.35 indicates acidosis. PaCO₂ is elevated (> 45 mmHg),
indicating respiratory acidosis. The HCO₃ is normal (22-26 mEq/L), so there is no
metabolic compensation.
Question 4
A client with chronic kidney disease has a potassium level of 6.2 mEq/L. The nurse
should anticipate which intervention?
A) Administer potassium chloride
B) Encourage potassium-rich foods
C) Administer sodium polystyrene sulfonate (Kayexalate)
D) Restrict fluid intake
Answer: C
Rationale: A potassium level of 6.2 mEq/L indicates hyperkalemia, a life-threatening
complication of CKD. Sodium polystyrene sulfonate (Kayexalate) binds potassium in the
GI tract and promotes its excretion. Potassium supplements and potassium-rich foods
should be avoided.
Question 5
What is the primary function of antidiuretic hormone (ADH) in fluid balance?
A) Increases sodium excretion
B) Promotes water reabsorption in the kidneys
,C) Stimulates aldosterone release
D) Increases potassium excretion
Answer: B
Rationale: ADH is released from the posterior pituitary in response to increased serum
osmolality. It promotes water reabsorption in the renal collecting ducts, leading to
increased fluid volume and decreased serum osmolality.
Question 6
A client with syndrome of inappropriate antidiuretic hormone (SIADH) would most likely
exhibit which finding?
A) Serum sodium of 150 mEq/L
B) Serum sodium of 125 mEq/L
C) Serum potassium of 5.5 mEq/L
D) Serum potassium of 3.0 mEq/L
Answer: B
Rationale: SIADH causes excessive ADH release, leading to water retention and
dilutional hyponatremia. Serum sodium below 135 mEq/L is characteristic.
Question 7
The nurse is caring for a client with diabetic ketoacidosis (DKA). Which electrolyte
imbalance is of greatest concern?
A) Hyponatremia
B) Hyperkalemia
C) Hypokalemia
D) Hypercalcemia
Answer: C
Rationale: In DKA, potassium shifts from the intracellular to extracellular space due to
acidosis. Insulin therapy drives potassium back into cells, causing severe hypokalemia.
Potassium levels must be monitored closely during treatment.
, Question 8
A client with hyperkalemia is prescribed insulin and dextrose. The nurse understands the
purpose of this intervention is to:
A) Increase potassium excretion
B) Shift potassium from ECF to ICF
C) Stabilize the cardiac membrane
D) Bind potassium in the GI tract
Answer: B
Rationale: Insulin drives potassium into cells (ICF), lowering serum potassium levels.
Dextrose prevents hypoglycemia. This is a temporary measure until definitive treatment
can be implemented.
Question 9
A client with hypokalemia should be assessed for which ECG change?
A) Peaked T waves
B) Flattened T waves and prominent U waves
C) Widened QRS complex
D) Prolonged PR interval
Answer: B
Rationale: Hypokalemia causes flattened T waves and prominent U waves on ECG.
Peaked T waves are characteristic of hyperkalemia.
Question 10
A client with hyponatremia (sodium 125 mEq/L) is at risk for which complication?
A) Cardiac arrhythmias
B) Seizures
C) Muscle spasms
D) Peripheral edema
