Adult Medical-Surgical Nursing
Test Bank – Practice Questions and
Answers for Med Surg Nursing
1. Fluid and Electrolytes: Hyperkalemia Management
Description: This question tests knowledge of emergency interventions for a patient
with dangerously high potassium levels. Keywords: hyperkalemia, potassium, calcium
gluconate, ECG changes, emergency.
Q: A patient with acute kidney injury has a serum potassium level of 7.2 mEq/L. The ECG
shows peaked T waves. Which prescription should the nurse implement first?
A. Administer oral sodium polystyrene sulfonate.
B. Administer IV calcium gluconate. ✅
C. Administer IV regular insulin and dextrose.
D. Prepare the patient for emergency dialysis.
Correct Answer: B. Administer IV calcium gluconate.
Rationale: Calcium gluconate is the first-line emergency treatment for hyperkalemia with
ECG changes because it stabilizes the myocardial cell membrane, protecting the heart
from lethal arrhythmias. It does not lower potassium but immediately antagonizes its
cardiac effects.
2. Fluid and Electrolytes: Hypokalemia
,Description: This question assesses recognition of clinical manifestations and risk
factors for low potassium. Keywords: hypokalemia, potassium, digoxin, muscle
weakness, arrhythmias.
Q: A patient on furosemide and digoxin reports muscle weakness and palpitations. The
nurse notes a serum potassium of 3.1 mEq/L. Which finding is most concerning?
A. Blood pressure of 118/76 mm Hg.
B. Heart rate of 88 beats/min and irregular.
C. Increased digoxin toxicity risk. ✅
D. Serum sodium of 138 mEq/L.
Correct Answer: C. Increased digoxin toxicity risk.
Rationale: Hypokalemia increases the risk of digoxin toxicity. Both hypokalemia and
digoxin toxicity can cause arrhythmias. The combination is dangerous. Muscle weakness
is also a sign of hypokalemia, but the digoxin interaction is the priority concern.
3. Fluid and Electrolytes: Hypernatremia
Description: This question tests understanding of safe correction of high sodium
levels. Keywords: hypernatremia, sodium, water deficit, correction rate, cerebral edema.
Q: A patient with a serum sodium of 158 mEq/L is receiving IV fluids. Which assessment
finding indicates the correction is occurring too rapidly?
A. Urine output of 50 mL/hr.
B. Improved level of consciousness.
C. Seizures and headache. ✅
D. Blood pressure of 130/80 mm Hg.
Correct Answer: C. Seizures and headache.
Rationale: Rapid correction of hypernatremia can cause cerebral edema, leading to
,seizures, headache, and lethargy. Sodium should generally be lowered no faster than
0.5–1 mEq/L/hr.
4. Fluid and Electrolytes: Hypocalcemia
Description: This question evaluates signs of low calcium and the associated nursing
intervention. Keywords: hypocalcemia, calcium, Chvostek's sign, Trousseau's sign,
tetany.
Q: A patient who had a thyroidectomy reports tingling in the fingers and around the
mouth. Which assessment should the nurse perform first?
A. Check for Chvostek's sign. ✅
B. Assess deep tendon reflexes.
C. Obtain a serum magnesium level.
D. Administer a phosphate binder.
Correct Answer: A. Check for Chvostek's sign.
Rationale: Tingling in the fingers and circumoral area suggests hypocalcemia, a common
complication after thyroidectomy due to parathyroid damage. Chvostek's sign (facial
nerve twitching) is a quick bedside test for hypocalcemia. Trousseau's sign is also
checked.
5. Fluid and Electrolytes: Hypercalcemia
Description: This question tests knowledge of manifestations and emergency treatment
of high calcium. Keywords: hypercalcemia, calcium, kidney stones, constipation,
hydration.
, Q: A patient with metastatic bone cancer has a serum calcium of 13.5 mg/dL. Which
intervention should the nurse anticipate?
A. Administering a calcium channel blocker.
B. Encouraging a high-calcium diet.
C. Administering IV fluids and furosemide. ✅
D. Restricting oral fluids.
Correct Answer: C. Administering IV fluids and furosemide.
Rationale: Hypercalcemia is treated with IV normal saline to promote renal excretion of
calcium, followed by a loop diuretic (e.g., furosemide) to prevent fluid overload and
enhance calcium excretion. Thiazide diuretics are avoided.
6. Fluid and Electrolytes: Hypomagnesemia
Description: This question assesses the relationship between magnesium and other
electrolytes. Keywords: hypomagnesemia, magnesium, hypokalemia, hypocalcemia,
alcohol use.
Q: A patient with chronic alcoholism has a serum magnesium level of 1.2 mg/dL. Which
electrolyte imbalance should the nurse monitor for?
A. Hyperkalemia.
B. Hypokalemia. ✅
C. Hypernatremia.
D. Hypercalcemia.
Correct Answer: B. Hypokalemia.
Rationale: Hypomagnesemia often accompanies hypokalemia and hypocalcemia.
Magnesium is necessary for potassium to enter cells; without it, hypokalemia is
refractory to treatment.
Test Bank – Practice Questions and
Answers for Med Surg Nursing
1. Fluid and Electrolytes: Hyperkalemia Management
Description: This question tests knowledge of emergency interventions for a patient
with dangerously high potassium levels. Keywords: hyperkalemia, potassium, calcium
gluconate, ECG changes, emergency.
Q: A patient with acute kidney injury has a serum potassium level of 7.2 mEq/L. The ECG
shows peaked T waves. Which prescription should the nurse implement first?
A. Administer oral sodium polystyrene sulfonate.
B. Administer IV calcium gluconate. ✅
C. Administer IV regular insulin and dextrose.
D. Prepare the patient for emergency dialysis.
Correct Answer: B. Administer IV calcium gluconate.
Rationale: Calcium gluconate is the first-line emergency treatment for hyperkalemia with
ECG changes because it stabilizes the myocardial cell membrane, protecting the heart
from lethal arrhythmias. It does not lower potassium but immediately antagonizes its
cardiac effects.
2. Fluid and Electrolytes: Hypokalemia
,Description: This question assesses recognition of clinical manifestations and risk
factors for low potassium. Keywords: hypokalemia, potassium, digoxin, muscle
weakness, arrhythmias.
Q: A patient on furosemide and digoxin reports muscle weakness and palpitations. The
nurse notes a serum potassium of 3.1 mEq/L. Which finding is most concerning?
A. Blood pressure of 118/76 mm Hg.
B. Heart rate of 88 beats/min and irregular.
C. Increased digoxin toxicity risk. ✅
D. Serum sodium of 138 mEq/L.
Correct Answer: C. Increased digoxin toxicity risk.
Rationale: Hypokalemia increases the risk of digoxin toxicity. Both hypokalemia and
digoxin toxicity can cause arrhythmias. The combination is dangerous. Muscle weakness
is also a sign of hypokalemia, but the digoxin interaction is the priority concern.
3. Fluid and Electrolytes: Hypernatremia
Description: This question tests understanding of safe correction of high sodium
levels. Keywords: hypernatremia, sodium, water deficit, correction rate, cerebral edema.
Q: A patient with a serum sodium of 158 mEq/L is receiving IV fluids. Which assessment
finding indicates the correction is occurring too rapidly?
A. Urine output of 50 mL/hr.
B. Improved level of consciousness.
C. Seizures and headache. ✅
D. Blood pressure of 130/80 mm Hg.
Correct Answer: C. Seizures and headache.
Rationale: Rapid correction of hypernatremia can cause cerebral edema, leading to
,seizures, headache, and lethargy. Sodium should generally be lowered no faster than
0.5–1 mEq/L/hr.
4. Fluid and Electrolytes: Hypocalcemia
Description: This question evaluates signs of low calcium and the associated nursing
intervention. Keywords: hypocalcemia, calcium, Chvostek's sign, Trousseau's sign,
tetany.
Q: A patient who had a thyroidectomy reports tingling in the fingers and around the
mouth. Which assessment should the nurse perform first?
A. Check for Chvostek's sign. ✅
B. Assess deep tendon reflexes.
C. Obtain a serum magnesium level.
D. Administer a phosphate binder.
Correct Answer: A. Check for Chvostek's sign.
Rationale: Tingling in the fingers and circumoral area suggests hypocalcemia, a common
complication after thyroidectomy due to parathyroid damage. Chvostek's sign (facial
nerve twitching) is a quick bedside test for hypocalcemia. Trousseau's sign is also
checked.
5. Fluid and Electrolytes: Hypercalcemia
Description: This question tests knowledge of manifestations and emergency treatment
of high calcium. Keywords: hypercalcemia, calcium, kidney stones, constipation,
hydration.
, Q: A patient with metastatic bone cancer has a serum calcium of 13.5 mg/dL. Which
intervention should the nurse anticipate?
A. Administering a calcium channel blocker.
B. Encouraging a high-calcium diet.
C. Administering IV fluids and furosemide. ✅
D. Restricting oral fluids.
Correct Answer: C. Administering IV fluids and furosemide.
Rationale: Hypercalcemia is treated with IV normal saline to promote renal excretion of
calcium, followed by a loop diuretic (e.g., furosemide) to prevent fluid overload and
enhance calcium excretion. Thiazide diuretics are avoided.
6. Fluid and Electrolytes: Hypomagnesemia
Description: This question assesses the relationship between magnesium and other
electrolytes. Keywords: hypomagnesemia, magnesium, hypokalemia, hypocalcemia,
alcohol use.
Q: A patient with chronic alcoholism has a serum magnesium level of 1.2 mg/dL. Which
electrolyte imbalance should the nurse monitor for?
A. Hyperkalemia.
B. Hypokalemia. ✅
C. Hypernatremia.
D. Hypercalcemia.
Correct Answer: B. Hypokalemia.
Rationale: Hypomagnesemia often accompanies hypokalemia and hypocalcemia.
Magnesium is necessary for potassium to enter cells; without it, hypokalemia is
refractory to treatment.
