NUR 212 Midterm Exam | Comprehensive Practice Questions,
Answers & Detailed Rationales 2026/2027
Question 1
What clinical manifestations are typical of Fluid Volume Deficit
(Hypovolemia)?
• A. Tachycardia, flattened neck veins, dry mucous membranes,
decreased urine output, and poor skin turgor.
• B. Bounding pulses, jugular venous distension, crackles in lungs,
and peripheral edema.
• C. Bradycardia, hypertension, and excessive clear polyuria.
• D. Normal vital signs with sudden severe weight gain.
Correct Answer: A. Tachycardia, flattened neck veins, dry mucous
membranes, decreased urine output, and poor skin turgor.
Detailed Rationale: Hypovolemia results from a loss of extracellular
fluid. The body compensates for reduced circulating blood volume by
increasing heart rate (tachycardia) and conserving water through the
kidneys (oliguria).
Question 2
What physical assessment findings are characteristic of Fluid Volume
Excess (Hypervolemia)?
• A. Bounding peripheral pulses, elevated blood pressure, jugular
venous distension (JVD), pitting edema, and pulmonary crackles.
, • B. Weak thready pulses, flat neck veins, and dry mucous
membranes.
• C. Sudden weight loss and poor skin turgor.
• D. Bradycardia and absent breath sounds.
Correct Answer: A. Bounding peripheral pulses, elevated blood
pressure, jugular venous distension (JVD), pitting edema, and
pulmonary crackles.
Detailed Rationale: Hypervolemia causes expanded intravascular and
interstitial fluid volume, increasing hydrostatic pressure and leading to
vascular congestion, edema, and fluid accumulation in the alveoli.
Question 3
What is the primary pathophysiology and manifestation of
Hyponatremia?
• A. Serum sodium below 135 mEq/L leading to cellular swelling,
confusion, headache, lethargy, and potential seizures.
• B. Serum sodium above 145 mEq/L causing severe cellular
dehydration and restlessness.
• C. Potassium shift into cells resulting in peaked T waves and
ventricular dysrhythmias.
• D. Calcium precipitation in soft tissues and bone demineralization.
Correct Answer: A. Serum sodium below 135 mEq/L leading to cellular
swelling, confusion, headache, lethargy, and potential seizures.
Detailed Rationale: Low extracellular sodium lowers serum osmolality,
creating an osmotic gradient that drives water into brain cells, causing
,cerebral edema and neurological symptoms ranging from lethargy to
seizures.
Question 4
What are the common causes and clinical signs of Hypernatremia?
• A. Serum sodium above 145 mEq/L caused by water loss or
excessive sodium intake, manifesting as extreme thirst, dry sticky
mucous membranes, restlessness, and flushed skin.
• B. Fluid overload caused by excessive hypotonic fluid
administration with muscle twitching.
• C. Addisonian crisis with profound hypotension and
hyperpigmentation.
• D. Rapid potassium depletion resulting in flaccid paralysis.
Correct Answer: A. Serum sodium above 145 mEq/L caused by water
loss or excessive sodium intake, manifesting as extreme thirst, dry sticky
mucous membranes, restlessness, and flushed skin.
Detailed Rationale: Hypernatremia increases extracellular osmolality,
pulling water out of cells (cellular dehydration). Thirst is an early and
sensitive indicator, accompanied by central nervous system irritability.
Question 5
What ECG changes and clinical signs characterize Hypokalemia?
• A. Flattened T waves, prominent U waves, ST-segment depression,
muscle weakness, and cardiac dysrhythmias.
• B. Tall peaked T waves, widened QRS complex, and bradycardia.
• C. Shortened QT interval and severe muscle rigidity.
, • D. Normal ECG with sudden hyperactive reflexes.
Correct Answer: A. Flattened T waves, prominent U waves, ST-segment
depression, muscle weakness, and cardiac dysrhythmias.
Detailed Rationale: Potassium maintains resting membrane potential in
cardiac and skeletal muscle. Hypokalemia hyperpolarizes cell
membranes, slowing repolarization, which manifests as ECG
repolarization abnormalities and muscle weakness.
Question 6
What is the immediate emergency management for severe
Hyperkalemia with ECG changes?
• A. Administration of intravenous calcium gluconate to stabilize
cardiac membranes, followed by regular insulin and glucose to
shift potassium into cells.
• B. Administration of oral potassium supplements and high-sodium
diet.
• C. Infusion of 0.45% sodium chloride at a rapid rate.
• D. Application of ice packs and restriction of fluids.
Correct Answer: A. Administration of intravenous calcium gluconate to
stabilize cardiac membranes, followed by regular insulin and glucose to
shift potassium into cells.
Detailed Rationale: Severe hyperkalemia (potassium > 6.5 mEq/L)
depolarizes cardiac tissue, risking lethal ventricular fibrillation. Calcium
protects the heart muscle immediately, while insulin/glucose
temporarily drives potassium intracellularly.
Answers & Detailed Rationales 2026/2027
Question 1
What clinical manifestations are typical of Fluid Volume Deficit
(Hypovolemia)?
• A. Tachycardia, flattened neck veins, dry mucous membranes,
decreased urine output, and poor skin turgor.
• B. Bounding pulses, jugular venous distension, crackles in lungs,
and peripheral edema.
• C. Bradycardia, hypertension, and excessive clear polyuria.
• D. Normal vital signs with sudden severe weight gain.
Correct Answer: A. Tachycardia, flattened neck veins, dry mucous
membranes, decreased urine output, and poor skin turgor.
Detailed Rationale: Hypovolemia results from a loss of extracellular
fluid. The body compensates for reduced circulating blood volume by
increasing heart rate (tachycardia) and conserving water through the
kidneys (oliguria).
Question 2
What physical assessment findings are characteristic of Fluid Volume
Excess (Hypervolemia)?
• A. Bounding peripheral pulses, elevated blood pressure, jugular
venous distension (JVD), pitting edema, and pulmonary crackles.
, • B. Weak thready pulses, flat neck veins, and dry mucous
membranes.
• C. Sudden weight loss and poor skin turgor.
• D. Bradycardia and absent breath sounds.
Correct Answer: A. Bounding peripheral pulses, elevated blood
pressure, jugular venous distension (JVD), pitting edema, and
pulmonary crackles.
Detailed Rationale: Hypervolemia causes expanded intravascular and
interstitial fluid volume, increasing hydrostatic pressure and leading to
vascular congestion, edema, and fluid accumulation in the alveoli.
Question 3
What is the primary pathophysiology and manifestation of
Hyponatremia?
• A. Serum sodium below 135 mEq/L leading to cellular swelling,
confusion, headache, lethargy, and potential seizures.
• B. Serum sodium above 145 mEq/L causing severe cellular
dehydration and restlessness.
• C. Potassium shift into cells resulting in peaked T waves and
ventricular dysrhythmias.
• D. Calcium precipitation in soft tissues and bone demineralization.
Correct Answer: A. Serum sodium below 135 mEq/L leading to cellular
swelling, confusion, headache, lethargy, and potential seizures.
Detailed Rationale: Low extracellular sodium lowers serum osmolality,
creating an osmotic gradient that drives water into brain cells, causing
,cerebral edema and neurological symptoms ranging from lethargy to
seizures.
Question 4
What are the common causes and clinical signs of Hypernatremia?
• A. Serum sodium above 145 mEq/L caused by water loss or
excessive sodium intake, manifesting as extreme thirst, dry sticky
mucous membranes, restlessness, and flushed skin.
• B. Fluid overload caused by excessive hypotonic fluid
administration with muscle twitching.
• C. Addisonian crisis with profound hypotension and
hyperpigmentation.
• D. Rapid potassium depletion resulting in flaccid paralysis.
Correct Answer: A. Serum sodium above 145 mEq/L caused by water
loss or excessive sodium intake, manifesting as extreme thirst, dry sticky
mucous membranes, restlessness, and flushed skin.
Detailed Rationale: Hypernatremia increases extracellular osmolality,
pulling water out of cells (cellular dehydration). Thirst is an early and
sensitive indicator, accompanied by central nervous system irritability.
Question 5
What ECG changes and clinical signs characterize Hypokalemia?
• A. Flattened T waves, prominent U waves, ST-segment depression,
muscle weakness, and cardiac dysrhythmias.
• B. Tall peaked T waves, widened QRS complex, and bradycardia.
• C. Shortened QT interval and severe muscle rigidity.
, • D. Normal ECG with sudden hyperactive reflexes.
Correct Answer: A. Flattened T waves, prominent U waves, ST-segment
depression, muscle weakness, and cardiac dysrhythmias.
Detailed Rationale: Potassium maintains resting membrane potential in
cardiac and skeletal muscle. Hypokalemia hyperpolarizes cell
membranes, slowing repolarization, which manifests as ECG
repolarization abnormalities and muscle weakness.
Question 6
What is the immediate emergency management for severe
Hyperkalemia with ECG changes?
• A. Administration of intravenous calcium gluconate to stabilize
cardiac membranes, followed by regular insulin and glucose to
shift potassium into cells.
• B. Administration of oral potassium supplements and high-sodium
diet.
• C. Infusion of 0.45% sodium chloride at a rapid rate.
• D. Application of ice packs and restriction of fluids.
Correct Answer: A. Administration of intravenous calcium gluconate to
stabilize cardiac membranes, followed by regular insulin and glucose to
shift potassium into cells.
Detailed Rationale: Severe hyperkalemia (potassium > 6.5 mEq/L)
depolarizes cardiac tissue, risking lethal ventricular fibrillation. Calcium
protects the heart muscle immediately, while insulin/glucose
temporarily drives potassium intracellularly.
