NUR209 / NUR 209 MEDICAL-SURGICAL NURSING II EXAM 2
REVIEW: 200 VERIFIED MULTIPLE-CHOICE QUESTIONS WITH
RATIONALES COVERING CHRONIC RENAL FAILURE,
HYPERKALEMIA MANAGEMENT, PACEMAKER POST-OPERATIVE
CARE, CARDIAC DISORDERS, ENDOCRINE EMERGENCIES,
RESPIRATORY CONDITIONS, GASTROINTESTINAL
PATHOLOGIES, NEUROLOGICAL IMPAIRMENTS, AND
ADVANCED SYSTEMIC DISEASE MANAGEMENT (LATEST
2026/2027 UPDATE)
1. A client with chronic renal failure is experiencing hyperkalemia.
Which dietary instruction should the nurse include in the teaching
plan?
A. Increase intake of bananas and oranges to maintain energy levels.
B. Restrict intake of tomatoes, potatoes, and salt substitutes.
C. Encourage consumption of melons and potatoes for potassium
replacement.
D. Limit fluid intake to 500 mL per day to prevent further electrolyte
imbalance.
Correct Answer: B
Rationale: In chronic renal failure, the kidneys cannot effectively excrete
potassium, leading to hyperkalemia. Foods high in potassium such as
bananas, oranges, tomatoes, potatoes, melons, and salt substitutes
must be restricted. Increasing these foods would worsen hyperkalemia.
,Fluid restriction may be needed but is not the primary dietary
intervention for hyperkalemia.
2. The nurse is caring for a patient with severe hyperkalemia. Which
electrocardiogram (ECG) change is most characteristic of this
condition?
A. Flat T waves
B. Prominent U waves
C. Peaked T waves
D. Prolonged PR interval
Correct Answer: C
Rationale: Peaked (tall, tented) T waves are the earliest and most
characteristic ECG change seen in hyperkalemia. Flat T waves are seen
in hypokalemia. Prominent U waves are associated with hypokalemia.
Prolonged PR interval can occur but is not the hallmark finding.
3. A patient with severe hyperkalemia is not on dialysis. Which set of
orders should the nurse anticipate from the healthcare provider?
A. IV insulin, D₅₀, and sodium bicarbonate given IV push sequentially.
B. Oral potassium supplements and loop diuretics.
C. IV calcium gluconate and oral sodium polystyrene sulfonate only.
D. IV normal saline and potassium-sparing diuretics.
Correct Answer: A
Rationale: For severe hyperkalemia in a patient not on dialysis, the
standard emergency treatment includes IV insulin (to drive potassium
into cells), D₅₀ (to prevent hypoglycemia from insulin), and sodium
bicarbonate (to shift potassium intracellularly). Calcium gluconate may
be given to stabilize the cardiac membrane but is not the only
treatment. Oral potassium supplements would worsen the condition.
,4. A nurse receives a critical lab value reporting a serum potassium of
6.8 mEq/L. What is the nurse's priority action?
A. Document the lab value in the chart and continue monitoring.
B. Call the healthcare provider promptly and document the critical
value.
C. Administer IV potassium chloride as a replacement.
D. Place the patient on a cardiac monitor and wait for the next lab draw.
Correct Answer: B
Rationale: A potassium level of 6.8 mEq/L is critically high and can lead
to fatal cardiac arrhythmias. The nurse must immediately notify the
healthcare provider and document the critical lab value. Placing the
patient on a cardiac monitor is also important, but the priority is to
notify the provider for immediate orders.
5. A patient on dialysis has severe hyperkalemia. What is the most
effective treatment for this patient?
A. IV insulin and D₅₀
B. Hemodialysis
C. Oral sodium polystyrene sulfonate
D. IV calcium gluconate
Correct Answer: B
Rationale: For a patient already on dialysis, hemodialysis is the most
rapid and effective method to remove excess potassium from the blood.
Other treatments like insulin and kayexalate may be used but dialysis is
definitive.
6. The nurse is assessing a patient with a newly placed pacemaker.
Which post-operative instruction is most important to prevent
complications?
, A. Perform range-of-motion exercises on the affected arm immediately.
B. Limit movement of the arm and shoulder on the side of the
pacemaker.
C. Keep the arm on the pacemaker side elevated above the heart.
D. Apply ice packs to the incision site continuously for 48 hours.
Correct Answer: B
Rationale: Limiting movement of the arm and shoulder on the side of
the pacemaker insertion helps prevent dislodgment of the leads. Range-
of-motion exercises are typically restricted initially. Ice packs may be
applied but are not the primary instruction.
7. A patient with a pacemaker reports fever, redness, and drainage at
the incision site. What should the nurse do first?
A. Remove the pacemaker dressing and clean the site.
B. Notify the healthcare provider of these signs of infection.
C. Apply a warm compress to the site.
D. Administer prescribed antibiotics immediately.
Correct Answer: B
Rationale: Fever, redness, and drainage are signs of infection. The nurse
should notify the healthcare provider promptly. Antibiotics may be
prescribed, but the provider must be informed first.
8. A client with acute coronary syndrome reports chest pressure and
shortness of breath. Which action should the nurse take first?
A. Administer aspirin 325 mg.
B. Obtain a 12-lead ECG.
C. Assess airway, breathing, circulation, and vital signs.
D. Prepare for cardiac catheterization.
REVIEW: 200 VERIFIED MULTIPLE-CHOICE QUESTIONS WITH
RATIONALES COVERING CHRONIC RENAL FAILURE,
HYPERKALEMIA MANAGEMENT, PACEMAKER POST-OPERATIVE
CARE, CARDIAC DISORDERS, ENDOCRINE EMERGENCIES,
RESPIRATORY CONDITIONS, GASTROINTESTINAL
PATHOLOGIES, NEUROLOGICAL IMPAIRMENTS, AND
ADVANCED SYSTEMIC DISEASE MANAGEMENT (LATEST
2026/2027 UPDATE)
1. A client with chronic renal failure is experiencing hyperkalemia.
Which dietary instruction should the nurse include in the teaching
plan?
A. Increase intake of bananas and oranges to maintain energy levels.
B. Restrict intake of tomatoes, potatoes, and salt substitutes.
C. Encourage consumption of melons and potatoes for potassium
replacement.
D. Limit fluid intake to 500 mL per day to prevent further electrolyte
imbalance.
Correct Answer: B
Rationale: In chronic renal failure, the kidneys cannot effectively excrete
potassium, leading to hyperkalemia. Foods high in potassium such as
bananas, oranges, tomatoes, potatoes, melons, and salt substitutes
must be restricted. Increasing these foods would worsen hyperkalemia.
,Fluid restriction may be needed but is not the primary dietary
intervention for hyperkalemia.
2. The nurse is caring for a patient with severe hyperkalemia. Which
electrocardiogram (ECG) change is most characteristic of this
condition?
A. Flat T waves
B. Prominent U waves
C. Peaked T waves
D. Prolonged PR interval
Correct Answer: C
Rationale: Peaked (tall, tented) T waves are the earliest and most
characteristic ECG change seen in hyperkalemia. Flat T waves are seen
in hypokalemia. Prominent U waves are associated with hypokalemia.
Prolonged PR interval can occur but is not the hallmark finding.
3. A patient with severe hyperkalemia is not on dialysis. Which set of
orders should the nurse anticipate from the healthcare provider?
A. IV insulin, D₅₀, and sodium bicarbonate given IV push sequentially.
B. Oral potassium supplements and loop diuretics.
C. IV calcium gluconate and oral sodium polystyrene sulfonate only.
D. IV normal saline and potassium-sparing diuretics.
Correct Answer: A
Rationale: For severe hyperkalemia in a patient not on dialysis, the
standard emergency treatment includes IV insulin (to drive potassium
into cells), D₅₀ (to prevent hypoglycemia from insulin), and sodium
bicarbonate (to shift potassium intracellularly). Calcium gluconate may
be given to stabilize the cardiac membrane but is not the only
treatment. Oral potassium supplements would worsen the condition.
,4. A nurse receives a critical lab value reporting a serum potassium of
6.8 mEq/L. What is the nurse's priority action?
A. Document the lab value in the chart and continue monitoring.
B. Call the healthcare provider promptly and document the critical
value.
C. Administer IV potassium chloride as a replacement.
D. Place the patient on a cardiac monitor and wait for the next lab draw.
Correct Answer: B
Rationale: A potassium level of 6.8 mEq/L is critically high and can lead
to fatal cardiac arrhythmias. The nurse must immediately notify the
healthcare provider and document the critical lab value. Placing the
patient on a cardiac monitor is also important, but the priority is to
notify the provider for immediate orders.
5. A patient on dialysis has severe hyperkalemia. What is the most
effective treatment for this patient?
A. IV insulin and D₅₀
B. Hemodialysis
C. Oral sodium polystyrene sulfonate
D. IV calcium gluconate
Correct Answer: B
Rationale: For a patient already on dialysis, hemodialysis is the most
rapid and effective method to remove excess potassium from the blood.
Other treatments like insulin and kayexalate may be used but dialysis is
definitive.
6. The nurse is assessing a patient with a newly placed pacemaker.
Which post-operative instruction is most important to prevent
complications?
, A. Perform range-of-motion exercises on the affected arm immediately.
B. Limit movement of the arm and shoulder on the side of the
pacemaker.
C. Keep the arm on the pacemaker side elevated above the heart.
D. Apply ice packs to the incision site continuously for 48 hours.
Correct Answer: B
Rationale: Limiting movement of the arm and shoulder on the side of
the pacemaker insertion helps prevent dislodgment of the leads. Range-
of-motion exercises are typically restricted initially. Ice packs may be
applied but are not the primary instruction.
7. A patient with a pacemaker reports fever, redness, and drainage at
the incision site. What should the nurse do first?
A. Remove the pacemaker dressing and clean the site.
B. Notify the healthcare provider of these signs of infection.
C. Apply a warm compress to the site.
D. Administer prescribed antibiotics immediately.
Correct Answer: B
Rationale: Fever, redness, and drainage are signs of infection. The nurse
should notify the healthcare provider promptly. Antibiotics may be
prescribed, but the provider must be informed first.
8. A client with acute coronary syndrome reports chest pressure and
shortness of breath. Which action should the nurse take first?
A. Administer aspirin 325 mg.
B. Obtain a 12-lead ECG.
C. Assess airway, breathing, circulation, and vital signs.
D. Prepare for cardiac catheterization.
