NUR 212 Final Exam | Complete Practice Questions, Correct
Answers & Detailed Rationales (2026/2027)
Question 1
What are the classic signs of Hyponatremia (serum sodium <
135mEq/L)?
• A. Lethargy, confusion, muscle twitching, seizures, and cerebral
edema
• B. Extreme thirst, dry mucous membranes, and flushed skin
• C. Hypertension, bounding peripheral pulses, and peripheral
edema
• D. Bradycardia and deep, rapid Kussmaul respirations
Correct Answer: A. Lethargy, confusion, muscle twitching, seizures, and
cerebral edema
Detailed Rationale: Hyponatremia causes a shift of water into brain
cells due to osmotic gradient changes, leading to cellular swelling,
neurological dysfunction (confusion, lethargy, seizures), and potentially
cerebral edema.
Question 2
What electrocardiographic (ECG) changes are characteristic of severe
Hyperkalemia?
• A. Tall peaked T waves, widened QRS complexes, and prolonged
PR intervals
, • B. Flattened T waves and prominent U waves
• C. Shortened QT interval and ST depression
• D. Normal sinus rhythm with absent P waves only
Correct Answer: A. Tall peaked T waves, widened QRS complexes, and
prolonged PR intervals
Detailed Rationale: Elevated serum potassium alters cardiac cell
membrane resting potential. Classic ECG progression in hyperkalemia
starts with tall peaked T waves, followed by widened QRS, prolonged
PR, and eventual ventricular fibrillation or asystole.
Question 3
What clinical signs indicate Hypocalcemia (Chvostek's and Trousseau's
signs)?
• A. Facial muscle twitching when tapping the facial nerve
(Chvostek's) and carpal spasm induced by inflation of a blood
pressure cuff (Trousseau's)
• B. Flank pain radiating to the groin with hematuria
• C. Unilateral facial drooping and slurred speech
• D. Involuntary tremors at rest and pill-rolling hand movements
Correct Answer: A. Facial muscle twitching when tapping the facial
nerve (Chvostek's) and carpal spasm induced by inflation of a blood
pressure cuff (Trousseau's)
Detailed Rationale: Hypocalcemia increases neuromuscular irritability.
Chvostek's sign (facial twitching) and Trousseau's sign (carpal spasm)
are classic physical examination findings reflecting latent tetany.
,Question 4
What is the primary manifestation of severe Hypomagnesemia?
• A. Neuromuscular hyperirritability, tremors, hyperactive deep
tendon reflexes, and cardiac dysrhythmias (e.g., Torsades de
pointes)
• B. Flaccid muscle paralysis and absent deep tendon reflexes
• C. Severe hypotension and bradycardia
• D. Polyuria and glycosuria
Correct Answer: A. Neuromuscular hyperirritability, tremors,
hyperactive deep tendon reflexes, and cardiac dysrhythmias (e.g.,
Torsades de pointes)
Detailed Rationale: Magnesium regulates neuromuscular activity and
cardiac electrical stability. Deficiency causes hyper-excitability,
manifested by tremors, hyperreflexia, seizures, and lethal ventricular
rhythms like Torsades de pointes.
Question 5
What arterial blood gas (ABG) results characterize Acute Respiratory
Acidosis?
• A. Low pH (< 7.35), high 𝑃𝑎𝐶𝑂2 (> 45 mmHg), and normal or
slightly elevated 𝐻𝐶𝑂3−
• B. High pH (> 7.45), low 𝑃𝑎𝐶𝑂2 (< 35 mmHg), and normal 𝐻𝐶𝑂3−
• C. Low pH (< 7.35), low 𝐻𝐶𝑂3− (< 22 mEq/L), and normal 𝑃𝑎𝐶𝑂2
• D. High pH (> 7.45), high 𝐻𝐶𝑂3− (> 26 mEq/L), and normal 𝑃𝑎𝐶𝑂2
, Correct Answer: A. Low pH (< 7.35), high 𝑃𝑎𝐶𝑂2 (> 45 mmHg), and
normal or slightly elevated 𝐻𝐶𝑂3−
Detailed Rationale: Respiratory acidosis results from alveolar
hypoventilation, leading to retention of carbon dioxide (𝐶𝑂2 ), which
combines with water to form carbonic acid, dropping blood pH.
Question 6
What are common causes of Metabolic Alkalosis?
• A. Prolonged vomiting, gastric suctioning, and diuretic therapy
• B. Diabetic ketoacidosis, severe diarrhea, and renal failure
• C. Opioid overdose and chronic obstructive pulmonary disease
(COPD)
• D. Hyperventilation due to anxiety or panic attacks
Correct Answer: A. Prolonged vomiting, gastric suctioning, and diuretic
therapy
Detailed Rationale: Metabolic alkalosis is caused by a loss of acid (such
as hydrochloric acid from vomiting or gastric suction) or gain of base
(such as bicarbonate ingestion), resulting in an elevated pH and high
bicarbonate level.
Question 7
What physical assessment findings are characteristic of Fluid Volume
Excess (Hypervolemia)?
• A. Bounding peripheral pulses, jugular venous distension (JVD),
peripheral pitting edema, crackles in lung bases, and weight gain
Answers & Detailed Rationales (2026/2027)
Question 1
What are the classic signs of Hyponatremia (serum sodium <
135mEq/L)?
• A. Lethargy, confusion, muscle twitching, seizures, and cerebral
edema
• B. Extreme thirst, dry mucous membranes, and flushed skin
• C. Hypertension, bounding peripheral pulses, and peripheral
edema
• D. Bradycardia and deep, rapid Kussmaul respirations
Correct Answer: A. Lethargy, confusion, muscle twitching, seizures, and
cerebral edema
Detailed Rationale: Hyponatremia causes a shift of water into brain
cells due to osmotic gradient changes, leading to cellular swelling,
neurological dysfunction (confusion, lethargy, seizures), and potentially
cerebral edema.
Question 2
What electrocardiographic (ECG) changes are characteristic of severe
Hyperkalemia?
• A. Tall peaked T waves, widened QRS complexes, and prolonged
PR intervals
, • B. Flattened T waves and prominent U waves
• C. Shortened QT interval and ST depression
• D. Normal sinus rhythm with absent P waves only
Correct Answer: A. Tall peaked T waves, widened QRS complexes, and
prolonged PR intervals
Detailed Rationale: Elevated serum potassium alters cardiac cell
membrane resting potential. Classic ECG progression in hyperkalemia
starts with tall peaked T waves, followed by widened QRS, prolonged
PR, and eventual ventricular fibrillation or asystole.
Question 3
What clinical signs indicate Hypocalcemia (Chvostek's and Trousseau's
signs)?
• A. Facial muscle twitching when tapping the facial nerve
(Chvostek's) and carpal spasm induced by inflation of a blood
pressure cuff (Trousseau's)
• B. Flank pain radiating to the groin with hematuria
• C. Unilateral facial drooping and slurred speech
• D. Involuntary tremors at rest and pill-rolling hand movements
Correct Answer: A. Facial muscle twitching when tapping the facial
nerve (Chvostek's) and carpal spasm induced by inflation of a blood
pressure cuff (Trousseau's)
Detailed Rationale: Hypocalcemia increases neuromuscular irritability.
Chvostek's sign (facial twitching) and Trousseau's sign (carpal spasm)
are classic physical examination findings reflecting latent tetany.
,Question 4
What is the primary manifestation of severe Hypomagnesemia?
• A. Neuromuscular hyperirritability, tremors, hyperactive deep
tendon reflexes, and cardiac dysrhythmias (e.g., Torsades de
pointes)
• B. Flaccid muscle paralysis and absent deep tendon reflexes
• C. Severe hypotension and bradycardia
• D. Polyuria and glycosuria
Correct Answer: A. Neuromuscular hyperirritability, tremors,
hyperactive deep tendon reflexes, and cardiac dysrhythmias (e.g.,
Torsades de pointes)
Detailed Rationale: Magnesium regulates neuromuscular activity and
cardiac electrical stability. Deficiency causes hyper-excitability,
manifested by tremors, hyperreflexia, seizures, and lethal ventricular
rhythms like Torsades de pointes.
Question 5
What arterial blood gas (ABG) results characterize Acute Respiratory
Acidosis?
• A. Low pH (< 7.35), high 𝑃𝑎𝐶𝑂2 (> 45 mmHg), and normal or
slightly elevated 𝐻𝐶𝑂3−
• B. High pH (> 7.45), low 𝑃𝑎𝐶𝑂2 (< 35 mmHg), and normal 𝐻𝐶𝑂3−
• C. Low pH (< 7.35), low 𝐻𝐶𝑂3− (< 22 mEq/L), and normal 𝑃𝑎𝐶𝑂2
• D. High pH (> 7.45), high 𝐻𝐶𝑂3− (> 26 mEq/L), and normal 𝑃𝑎𝐶𝑂2
, Correct Answer: A. Low pH (< 7.35), high 𝑃𝑎𝐶𝑂2 (> 45 mmHg), and
normal or slightly elevated 𝐻𝐶𝑂3−
Detailed Rationale: Respiratory acidosis results from alveolar
hypoventilation, leading to retention of carbon dioxide (𝐶𝑂2 ), which
combines with water to form carbonic acid, dropping blood pH.
Question 6
What are common causes of Metabolic Alkalosis?
• A. Prolonged vomiting, gastric suctioning, and diuretic therapy
• B. Diabetic ketoacidosis, severe diarrhea, and renal failure
• C. Opioid overdose and chronic obstructive pulmonary disease
(COPD)
• D. Hyperventilation due to anxiety or panic attacks
Correct Answer: A. Prolonged vomiting, gastric suctioning, and diuretic
therapy
Detailed Rationale: Metabolic alkalosis is caused by a loss of acid (such
as hydrochloric acid from vomiting or gastric suction) or gain of base
(such as bicarbonate ingestion), resulting in an elevated pH and high
bicarbonate level.
Question 7
What physical assessment findings are characteristic of Fluid Volume
Excess (Hypervolemia)?
• A. Bounding peripheral pulses, jugular venous distension (JVD),
peripheral pitting edema, crackles in lung bases, and weight gain
