MEDICAL-SURGICAL
NURSING
Comprehensive Workbook & Exam Prep
50-Page Master Edition
Unit 1: Foundations & Fluid Balance
Core Concepts
The foundation of medical-surgical nursing lies in maintaining homeostasis. Fluid and
electrolyte balance is heavily regulated by the kidneys, lungs, and endocrine system
, (ADH, Aldosterone). Potassium is primarily intracellular, and alterations (hypokalemia
or hyperkalemia) dramatically affect cardiac resting membrane potentials, leading to life-
threatening dysrhythmias. Sodium regulates extracellular fluid volume and osmolality;
hyponatremia often presents with severe neurological changes such as confusion or
seizures due to cerebral edema. Acid-base balance relies on the respiratory buffer
(retaining or blowing off CO2) and the metabolic buffer (kidneys retaining or excreting
HCO3).
Practice Test Bank
Q1. A patient's morning potassium is 2.8 mEq/L. Which electrocardiogram (ECG)
finding is expected?
A. Tall peaked T waves
B. Prominent U waves
C. Widened QRS complex
D. Elevated ST segment
R AT IONALE & ANSW ER
B is correct. Hypokalemia causes flattened T waves, prominent U waves, and ST depression.
Hyperkalemia causes tall peaked T waves and widened QRS complexes.
,Q2. The nurse is evaluating an arterial blood gas (ABG) result: pH 7.30, PaCO2 55 mm
Hg, HCO3 24 mEq/L. What is the correct interpretation?
A. Respiratory Acidosis
B. Metabolic Acidosis
C. Respiratory Alkalosis
D. Metabolic Alkalosis
R AT IONALE & ANSW ER
A is correct. The pH is low (<7.35), indicating acidosis. The PaCO2 is high (>45), indicating a
respiratory cause. The HCO3 is normal (22-26), meaning there is no metabolic compensation yet.
Q3. Which patient is at the highest risk for developing hypovolemic shock?
A. A patient with a cervical spinal cord injury
B. A patient with 30% Total Body Surface Area burns
C. A patient with a massive acute myocardial infarction
D. A patient experiencing a severe anaphylactic reaction
R AT IONALE & ANSW ER
B is correct. Burns cause a massive shift of plasma from the intravascular space to the interstitial
space, leading to profound hypovolemic shock. Spinal cord injury causes neurogenic shock, MI
causes cardiogenic shock, and anaphylaxis causes distributive shock.
,Q4. When assessing a patient with severe hyponatremia (Na+ 115 mEq/L), the nurse
should prioritize monitoring for which complication?
A. Ventricular dysrhythmias
B. Seizures and altered mental status
C. Deep vein thrombosis
D. Hyperglycemia and polyuria
R AT IONALE & ANSW ER
B is correct. Severe hyponatremia creates an osmotic gradient that causes water to shift into brain
cells, leading to cerebral edema, confusion, lethargy, and seizures.
Chapter 1 Personal Study Notes
,
,
NURSING
Comprehensive Workbook & Exam Prep
50-Page Master Edition
Unit 1: Foundations & Fluid Balance
Core Concepts
The foundation of medical-surgical nursing lies in maintaining homeostasis. Fluid and
electrolyte balance is heavily regulated by the kidneys, lungs, and endocrine system
, (ADH, Aldosterone). Potassium is primarily intracellular, and alterations (hypokalemia
or hyperkalemia) dramatically affect cardiac resting membrane potentials, leading to life-
threatening dysrhythmias. Sodium regulates extracellular fluid volume and osmolality;
hyponatremia often presents with severe neurological changes such as confusion or
seizures due to cerebral edema. Acid-base balance relies on the respiratory buffer
(retaining or blowing off CO2) and the metabolic buffer (kidneys retaining or excreting
HCO3).
Practice Test Bank
Q1. A patient's morning potassium is 2.8 mEq/L. Which electrocardiogram (ECG)
finding is expected?
A. Tall peaked T waves
B. Prominent U waves
C. Widened QRS complex
D. Elevated ST segment
R AT IONALE & ANSW ER
B is correct. Hypokalemia causes flattened T waves, prominent U waves, and ST depression.
Hyperkalemia causes tall peaked T waves and widened QRS complexes.
,Q2. The nurse is evaluating an arterial blood gas (ABG) result: pH 7.30, PaCO2 55 mm
Hg, HCO3 24 mEq/L. What is the correct interpretation?
A. Respiratory Acidosis
B. Metabolic Acidosis
C. Respiratory Alkalosis
D. Metabolic Alkalosis
R AT IONALE & ANSW ER
A is correct. The pH is low (<7.35), indicating acidosis. The PaCO2 is high (>45), indicating a
respiratory cause. The HCO3 is normal (22-26), meaning there is no metabolic compensation yet.
Q3. Which patient is at the highest risk for developing hypovolemic shock?
A. A patient with a cervical spinal cord injury
B. A patient with 30% Total Body Surface Area burns
C. A patient with a massive acute myocardial infarction
D. A patient experiencing a severe anaphylactic reaction
R AT IONALE & ANSW ER
B is correct. Burns cause a massive shift of plasma from the intravascular space to the interstitial
space, leading to profound hypovolemic shock. Spinal cord injury causes neurogenic shock, MI
causes cardiogenic shock, and anaphylaxis causes distributive shock.
,Q4. When assessing a patient with severe hyponatremia (Na+ 115 mEq/L), the nurse
should prioritize monitoring for which complication?
A. Ventricular dysrhythmias
B. Seizures and altered mental status
C. Deep vein thrombosis
D. Hyperglycemia and polyuria
R AT IONALE & ANSW ER
B is correct. Severe hyponatremia creates an osmotic gradient that causes water to shift into brain
cells, leading to cerebral edema, confusion, lethargy, and seizures.
Chapter 1 Personal Study Notes
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