Galen NUR 242 Exam 2 | Medical-Surgical Nursing Concepts |
Comprehensive Practice Examination | High-Yield Clinical Questions,
Answers & Detailed Rationales | Patient Assessment, Clinical
Judgment, Prioritization & Nursing Management | Ultimate Exam
Mastery Guide | Premium Study Companion
Question #1
A 72-year-old patient with heart failure is receiving IV furosemide. The nurse notes the patient's
serum potassium level has dropped to 3.2 mEq/L. Which assessment finding would the nurse most
likely observe that correlates with this electrolyte imbalance?
A. Muscle twitching and positive Chvostek's sign
B. Flattened T waves and U waves on ECG
C. Hypertension and bounding pulses
D. Nausea, vomiting, and abdominal cramping
Correct Answer: B
Explanation: Hypokalemia (potassium < 3.5 mEq/L) causes flattened T waves, prominent U waves, and
ST-segment depression on ECG. Muscle twitching and Chvostek's sign indicate hypocalcemia.
Hypertension is not characteristic of hypokalemia; hypotension may occur. While nausea can occur,
the hallmark ECG changes are most specific. Clinical Pearl: Loop diuretics like furosemide cause
potassium wasting; monitor ECG changes and consider potassium replacement.
Question #2
A patient with severe vomiting for three days presents with muscle weakness, lethargy, and a serum
sodium level of 118 mEq/L. Which intervention should the nurse anticipate implementing?
,A. Administer 3% hypertonic saline at 100 mL/hr
B. Restrict oral fluid intake to 500 mL/day
C. Administer IV normal saline at 150 mL/hr
D. Prepare for rapid infusion of 0.45% saline
Correct Answer: B
Explanation: This patient has severe hyponatremia (sodium < 120 mEq/L) with symptoms. The priority
intervention is fluid restriction to prevent cerebral edema. Rapid correction of sodium can cause
osmotic demyelination syndrome. Hypertonic saline is reserved for severe symptomatic cases with
seizure or coma and must be administered cautiously. The rate of correction should not exceed 8-10
mEq/L in 24 hours.
Question #3
A nurse is caring for a patient with hypermagnesemia secondary to renal failure. Which clinical
manifestation would the nurse expect to find?
A. Hyperactive deep tendon reflexes
B. Tachycardia and hypertension
C. Flaccid paralysis and respiratory depression
D. Positive Trousseau's sign
Correct Answer: C
Explanation: Hypermagnesemia depresses neuromuscular transmission, causing flaccid paralysis,
decreased deep tendon reflexes, and respiratory depression. Cardiac effects include bradycardia and
hypotension. Hyperactive reflexes and positive Trousseau's sign are seen in hypocalcemia or
hypomagnesemia. Clinical Pearl: Magnesium is excreted renally; patients with renal failure are at high
risk for hypermagnesemia when receiving magnesium-containing medications.
Question #4
A patient with burns covering 40% of total body surface area is at risk for which fluid shift during the
first 24 hours post-injury?
,A. Third-space fluid shifting causing edema
B. Intracellular to extracellular shift
C. Extracellular to intracellular shift
D. Intravascular to interstitial shift
Correct Answer: D
Explanation: In major burns, capillary permeability increases, causing fluid to shift from the
intravascular compartment to the interstitial space (third spacing). This leads to hypovolemia,
hypotension, and edema. Intracellular shifts are not the primary concern; isotonic fluid loss from the
vascular space is the hallmark. Clinical Pearl: Burn patients require aggressive fluid resuscitation using
the Parkland formula in the first 24 hours to maintain perfusion.
Question #5
The nurse is assessing a patient with hypercalcemia secondary to malignancy. Which findings would
the nurse expect? Select the priority finding.
A. Muscle cramps and paresthesias
B. Positive Chvostek's and Trousseau's signs
C. Polyuria, polydipsia, and dehydration
D. Hyperactive deep tendon reflexes
Correct Answer: C
Explanation: Hypercalcemia causes nephrogenic diabetes insipidus, resulting in polyuria, polydipsia,
and dehydration due to calcium interference with ADH action. Muscle cramps, paresthesias, and
positive Chvostek's sign indicate hypocalcemia. Hypercalcemia causes muscle weakness, not
hyperactivity. Clinical Pearl: Hypercalcemia is a medical emergency; IV normal saline and loop
diuretics are used to promote calcium excretion.
Question #6
A patient has the following laboratory values: sodium 148 mEq/L, potassium 5.2 mEq/L, chloride 110
mEq/L, and BUN 28 mg/dL. Which clinical manifestation would the nurse expect?
, A. Thirst and dry mucous membranes
B. Hand spasms and tingling
C. Bradycardia and hypotension
D. Diarrhea and abdominal distention
Correct Answer: A
Explanation: Sodium 148 mEq/L indicates hypernatremia from water deficit. Clinical manifestations
include intense thirst, dry mucous membranes, oliguria, and confusion. Hyperkalemia (5.2 mEq/L)
may cause cardiac dysrhythmias, not hand spasms. Hypotension and bradycardia are not typical of
hypernatremia. Clinical Pearl: Treatment of hypernatremia requires gradual correction to avoid
cerebral edema; decrease sodium no faster than 0.5-1 mEq/L per hour.
Question #7
The nurse is evaluating a patient's intake and output. The patient has an NG tube set to low
continuous suction. Which laboratory value should the nurse monitor most closely?
A. Serum albumin
B. Serum potassium
C. Serum calcium
D. Serum magnesium
Correct Answer: B
Explanation: NG suction removes gastric fluid, which is high in potassium and hydrogen ions (HCl).
Prolonged suction leads to hypokalemia and metabolic alkalosis. While albumin, calcium, and
magnesium may be affected, potassium is the most immediate concern. Clinical Pearl: When a patient
has NG suction, monitor electrolytes daily and replace potassium as needed; consider adding H2
blockers to reduce gastric acid loss.
Question #8
A patient with chronic kidney disease has a phosphorus level of 6.8 mg/dL and calcium of 7.2 mg/dL.
Which nursing intervention is appropriate?
Comprehensive Practice Examination | High-Yield Clinical Questions,
Answers & Detailed Rationales | Patient Assessment, Clinical
Judgment, Prioritization & Nursing Management | Ultimate Exam
Mastery Guide | Premium Study Companion
Question #1
A 72-year-old patient with heart failure is receiving IV furosemide. The nurse notes the patient's
serum potassium level has dropped to 3.2 mEq/L. Which assessment finding would the nurse most
likely observe that correlates with this electrolyte imbalance?
A. Muscle twitching and positive Chvostek's sign
B. Flattened T waves and U waves on ECG
C. Hypertension and bounding pulses
D. Nausea, vomiting, and abdominal cramping
Correct Answer: B
Explanation: Hypokalemia (potassium < 3.5 mEq/L) causes flattened T waves, prominent U waves, and
ST-segment depression on ECG. Muscle twitching and Chvostek's sign indicate hypocalcemia.
Hypertension is not characteristic of hypokalemia; hypotension may occur. While nausea can occur,
the hallmark ECG changes are most specific. Clinical Pearl: Loop diuretics like furosemide cause
potassium wasting; monitor ECG changes and consider potassium replacement.
Question #2
A patient with severe vomiting for three days presents with muscle weakness, lethargy, and a serum
sodium level of 118 mEq/L. Which intervention should the nurse anticipate implementing?
,A. Administer 3% hypertonic saline at 100 mL/hr
B. Restrict oral fluid intake to 500 mL/day
C. Administer IV normal saline at 150 mL/hr
D. Prepare for rapid infusion of 0.45% saline
Correct Answer: B
Explanation: This patient has severe hyponatremia (sodium < 120 mEq/L) with symptoms. The priority
intervention is fluid restriction to prevent cerebral edema. Rapid correction of sodium can cause
osmotic demyelination syndrome. Hypertonic saline is reserved for severe symptomatic cases with
seizure or coma and must be administered cautiously. The rate of correction should not exceed 8-10
mEq/L in 24 hours.
Question #3
A nurse is caring for a patient with hypermagnesemia secondary to renal failure. Which clinical
manifestation would the nurse expect to find?
A. Hyperactive deep tendon reflexes
B. Tachycardia and hypertension
C. Flaccid paralysis and respiratory depression
D. Positive Trousseau's sign
Correct Answer: C
Explanation: Hypermagnesemia depresses neuromuscular transmission, causing flaccid paralysis,
decreased deep tendon reflexes, and respiratory depression. Cardiac effects include bradycardia and
hypotension. Hyperactive reflexes and positive Trousseau's sign are seen in hypocalcemia or
hypomagnesemia. Clinical Pearl: Magnesium is excreted renally; patients with renal failure are at high
risk for hypermagnesemia when receiving magnesium-containing medications.
Question #4
A patient with burns covering 40% of total body surface area is at risk for which fluid shift during the
first 24 hours post-injury?
,A. Third-space fluid shifting causing edema
B. Intracellular to extracellular shift
C. Extracellular to intracellular shift
D. Intravascular to interstitial shift
Correct Answer: D
Explanation: In major burns, capillary permeability increases, causing fluid to shift from the
intravascular compartment to the interstitial space (third spacing). This leads to hypovolemia,
hypotension, and edema. Intracellular shifts are not the primary concern; isotonic fluid loss from the
vascular space is the hallmark. Clinical Pearl: Burn patients require aggressive fluid resuscitation using
the Parkland formula in the first 24 hours to maintain perfusion.
Question #5
The nurse is assessing a patient with hypercalcemia secondary to malignancy. Which findings would
the nurse expect? Select the priority finding.
A. Muscle cramps and paresthesias
B. Positive Chvostek's and Trousseau's signs
C. Polyuria, polydipsia, and dehydration
D. Hyperactive deep tendon reflexes
Correct Answer: C
Explanation: Hypercalcemia causes nephrogenic diabetes insipidus, resulting in polyuria, polydipsia,
and dehydration due to calcium interference with ADH action. Muscle cramps, paresthesias, and
positive Chvostek's sign indicate hypocalcemia. Hypercalcemia causes muscle weakness, not
hyperactivity. Clinical Pearl: Hypercalcemia is a medical emergency; IV normal saline and loop
diuretics are used to promote calcium excretion.
Question #6
A patient has the following laboratory values: sodium 148 mEq/L, potassium 5.2 mEq/L, chloride 110
mEq/L, and BUN 28 mg/dL. Which clinical manifestation would the nurse expect?
, A. Thirst and dry mucous membranes
B. Hand spasms and tingling
C. Bradycardia and hypotension
D. Diarrhea and abdominal distention
Correct Answer: A
Explanation: Sodium 148 mEq/L indicates hypernatremia from water deficit. Clinical manifestations
include intense thirst, dry mucous membranes, oliguria, and confusion. Hyperkalemia (5.2 mEq/L)
may cause cardiac dysrhythmias, not hand spasms. Hypotension and bradycardia are not typical of
hypernatremia. Clinical Pearl: Treatment of hypernatremia requires gradual correction to avoid
cerebral edema; decrease sodium no faster than 0.5-1 mEq/L per hour.
Question #7
The nurse is evaluating a patient's intake and output. The patient has an NG tube set to low
continuous suction. Which laboratory value should the nurse monitor most closely?
A. Serum albumin
B. Serum potassium
C. Serum calcium
D. Serum magnesium
Correct Answer: B
Explanation: NG suction removes gastric fluid, which is high in potassium and hydrogen ions (HCl).
Prolonged suction leads to hypokalemia and metabolic alkalosis. While albumin, calcium, and
magnesium may be affected, potassium is the most immediate concern. Clinical Pearl: When a patient
has NG suction, monitor electrolytes daily and replace potassium as needed; consider adding H2
blockers to reduce gastric acid loss.
Question #8
A patient with chronic kidney disease has a phosphorus level of 6.8 mg/dL and calcium of 7.2 mg/dL.
Which nursing intervention is appropriate?
