with Answers & Rationales A. Flaccid muscles B. Positive Trousseau sign C.
Bradycardia D. Hyperactive bowel sounds only
NCLEX-style review. Each question: four options,
Ans: B - Carpal spasm with BP cuff inflation
then the correct answer and a brief rationale. For
(Trousseau) and facial twitching (Chvostek) indicate
educational review only; follow your facility policy hypocalcemia.
and current guidelines.
9. Which signs suggest hypercalcemia?
1. Fluids, Electrolytes & Acid-Base A. Tetany B. Hyperreflexia C. Constipation,
1. Which ECG change is expected with lethargy, kidney stones D. Muscle spasms
hypokalemia? Ans: C - "Bones, stones, groans, moans": weakness,
A. Shortened PR interval B. Peaked T waves C. U constipation, polyuria, stones, confusion.
waves and flattened T waves D. Widened QRS only 10. A client post-thyroidectomy reports
Ans: C - Hypokalemia produces flat T waves, ST tingling around the mouth. Priority concern?
depression and U waves; peaked T waves signal A. Hyperkalemia B. Hypermagnesemia C.
hyperkalemia. Hypernatremia D. Hypocalcemia from parathyroid
2. Which ECG finding is an early sign of injury
hyperkalemia? Ans: D - Perioral numbness and tingling signal
A. U waves B. Prolonged QT only C. Absent P waves hypocalcemia; check calcium and Chvostek sign.
only D. Tall, peaked T waves 11. First sign of magnesium toxicity?
Ans: D - Early hyperkalemia causes tall peaked T A. Hyperreflexia B. Loss of deep tendon reflexes C.
waves, later widened QRS and sine wave pattern. Hypertension D. Tachycardia
3. A client with K+ 6.8 mEq/L and peaked T Ans: B - Reflex loss precedes respiratory depression;
waves needs which drug first? antidote is calcium gluconate.
A. Oral sodium polystyrene B. IV calcium gluconate 12. A client on magnesium sulfate has RR 9.
C. Oral potassium binder only D. IV furosemide Priority action?
Ans: B - Calcium stabilizes the myocardial A. Recheck in 1 hour B. Slow infusion only C.
membrane first; insulin with dextrose then shifts K+ Encourage deep breaths D. Stop infusion and give
into cells. calcium gluconate
4. Which therapy shifts potassium into cells? Ans: D - Respiratory depression is magnesium
A. Hemodialysis B. Sodium polystyrene C. Regular toxicity; stop infusion and give the antidote.
insulin with dextrose D. Furosemide 13. Hypomagnesemia increases risk of:
Ans: C - Insulin plus glucose (and albuterol) moves A. Hypotension only B. Constipation C. Torsades de
K+ intracellularly as a temporary measure. pointes and tremors D. Bradycardia only
5. A client with serum sodium 118 mEq/L has Ans: C - Low magnesium causes neuromuscular
seizures. Expected prescription? irritability and ventricular dysrhythmias.
A. D5W B. 3% hypertonic saline C. 0.45% saline D. 14. Which ABG indicates metabolic acidosis?
Free water A. pH 7.30, PaCO2 55 B. pH 7.50, PaCO2 28 C. pH
Ans: B - Symptomatic severe hyponatremia is 7.30, HCO3 16 D. pH 7.50, HCO3 32
treated with hypertonic saline, corrected slowly to Ans: C - Low pH with low bicarbonate is metabolic
avoid demyelination. acidosis (e.g., DKA).
6. Best intervention for SIADH? 15. Which ABG indicates respiratory acidosis?
A. Hypotonic IV fluids B. Sodium restriction C. Fluid A. pH 7.30, HCO3 16 B. pH 7.50, HCO3 32 C. pH
restriction D. Increased oral fluids 7.50, PaCO2 28 D. pH 7.30, PaCO2 58
Ans: C - SIADH causes water retention and dilutional Ans: D - Low pH with high PaCO2 reflects
hyponatremia; restrict fluids. hypoventilation (COPD, sedation).
7. Diabetes insipidus is characterized by: 16. Persistent vomiting commonly causes:
A. Scant concentrated urine B. Hypertension and A. Metabolic alkalosis B. Metabolic acidosis C.
edema C. Weight gain D. Large volumes of dilute Respiratory acidosis D. Respiratory alkalosis
urine with low specific gravity Ans: A - Loss of gastric HCl leaves excess
Ans: D - Lack of ADH causes polyuria, dilute urine, bicarbonate; NG suction does likewise.
thirst and risk of dehydration.
Med-Surg Nursing Review - 400 Questions | 1
,17. Anxiety-induced hyperventilation leads to: 26. Maximum safe peripheral IV potassium
A. Respiratory alkalosis B. Metabolic alkalosis C. rate is generally:
Respiratory acidosis D. Metabolic acidosis A. Bolus over 5 min B. 40 mEq/hr C. 20 mEq/min D.
Ans: A - Excess CO2 exhaled raises pH; have client 10 mEq/hr
breathe slowly. Ans: D - Potassium must be diluted and infused
18. In the ROME mnemonic, "Respiratory slowly by pump; never IV push.
Opposite" means: 27. Why must IV potassium never be given by
A. HCO3 and CO2 move opposite B. pH and CO2 IV push?
move in opposite directions C. pH and CO2 move A. Can cause cardiac arrest B. Causes phlebitis only
together D. pH and HCO3 move opposite C. Causes hypotension only D. Is inactive
Ans: B - Respiratory: pH up with CO2 down. Ans: A - Rapid potassium can cause fatal
Metabolic: pH and HCO3 move in the Same (Equal) dysrhythmias.
direction. 28. Before giving potassium supplements, the
19. Kussmaul respirations are seen in: nurse should verify:
A. Asthma B. Diabetic ketoacidosis C. Pneumonia A. Urine output B. Serum glucose C. Temperature
D. COPD D. Oxygen saturation
Ans: B - Deep rapid breathing compensates for Ans: A - Kidneys excrete potassium; hold and notify
metabolic acidosis. if output is below 30 mL/hr.
20. Which IV fluid is isotonic? 29. Which drug can cause hyperkalemia?
A. D5 in 0.225% NaCl B. 0.45% sodium chloride C. A. Hydrochlorothiazide B. Furosemide C. Insulin D.
3% sodium chloride D. 0.9% sodium chloride Spironolactone
Ans: D - 0.9% NS, lactated Ringer's and D5W Ans: D - Potassium-sparing diuretics, ACE inhibitors
(initially) are isotonic. and ARBs raise potassium.
21. Which fluid draws water out of cells? 30. Which client is at greatest risk for
A. 3% sodium chloride B. D5W C. 0.45% sodium hypokalemia?
chloride D. 0.225% sodium chloride A. Chronic kidney disease B. Receiving furosemide
Ans: A - Hypertonic solutions pull fluid into the with poor intake C. Burns on day 1 D. Receiving
vascular space; monitor for fluid overload. spironolactone
22. Which finding indicates fluid volume Ans: B - Loop diuretics, vomiting, diarrhea and
deficit? insulin lower potassium.
A. Bounding pulse B. Tachycardia and flat neck 31. Which diet should a client with
veins C. Weight gain D. Crackles hyperkalemia avoid?
Ans: B - Hypovolemia: low BP, rapid thready pulse, A. Green beans B. Apples C. White rice D. Bananas,
poor turgor, concentrated urine. oranges and potatoes
23. Which finding indicates fluid volume Ans: D - High-potassium foods include bananas,
excess? oranges, tomatoes, potatoes, spinach.
A. Poor skin turgor B. Dry mucosa C. Flat neck 32. Hypokalemia increases the risk of toxicity
veins D. Crackles and jugular vein distention from:
Ans: D - Overload causes edema, bounding pulse, A. Digoxin B. Metformin C. Warfarin D. Atenolol
crackles and weight gain. Ans: A - Low potassium enhances digoxin binding
24. A weight gain of 1 kg equals about how and ectopy.
much fluid retained? 33. Hypernatremia manifestations include:
A. 2 liters B. 1 liter C. 250 mL D. 500 mL A. Hypotension only B. Seizures with low osmolality
Ans: B - 1 kg of weight equals approximately 1 L of C. Thirst, dry mucous membranes, agitation D.
fluid; daily weight is the best indicator of fluid status. Edema only
25. Which measure best reflects fluid balance? Ans: C - Water shifts from brain cells causing
A. Skin turgor B. Daily weight C. Blood pressure D. confusion; correct slowly.
Temperature 34. Rapid correction of chronic hyponatremia
Ans: B - Weigh at same time, same scale, same risks:
clothing. A. Cerebral edema B. Hypercalcemia C. Osmotic
demyelination D. Hypokalemia
Ans: C - Increase sodium no more than about 8-10
mEq/L in 24 hours.
Med-Surg Nursing Review - 400 Questions | 2
, 35. Calcium and phosphorus levels are 44. Third spacing is best described as:
typically: A. Fluid loss through skin B. Excess intake C. Fluid
A. Directly related B. Unrelated C. Inversely related shifting into interstitial or body cavities D. Fluid
D. Both equal excreted in urine
Ans: C - When one rises the other falls; CKD causes Ans: C - Occurs in burns, ascites, and sepsis causing
high phosphorus and low calcium. intravascular depletion.
36. Phosphate binders for a client with CKD 45. Total parenteral nutrition is typically
should be given: infused via:
A. At bedtime only B. After dialysis only C. With A. Central venous catheter B. Subcutaneous route
meals D. On empty stomach C. Intradermal route D. Peripheral IV
Ans: C - They bind dietary phosphorus in the gut. Ans: A - High osmolarity requires a large central
37. Which lab finding is expected in vein.
dehydration? 46. If TPN is abruptly stopped, the nurse
A. Elevated BUN/creatinine ratio and urine specific should anticipate:
gravity B. Low urine specific gravity C. Low A. Hyperkalemia B. Hyperglycemia C. Fluid
hematocrit D. Low sodium overload D. Hypoglycemia
Ans: A - Concentrated blood and urine are seen. Ans: D - Insulin response persists; hang D10W if
38. Normal arterial pH is: solution unavailable.
A. 7.45-7.55 B. 7.25-7.35 C. 7.00-7.20 D. 7.35-7.45 47. Which TPN complication requires
Ans: D - Below 7.35 is acidosis; above 7.45 is monitoring blood glucose?
alkalosis. A. Hyperglycemia B. Hypertension C. Hypothermia
39. Normal PaCO2 range is: D. Bradycardia
A. 35-45 mmHg B. 22-26 mmHg C. 80-100 mmHg Ans: A - Dextrose-rich solution often needs insulin
D. 45-55 mmHg coverage.
Ans: A - HCO3 normal is 22-26 mEq/L; PaO2 is 48. A client has pitting edema 3+. This means:
80-100 mmHg. A. Pit 8 mm lasting over 2 minutes B. Pit about 6
40. Salicylate overdose commonly begins with: mm, lasting 15-30 seconds C. Pit 4 mm disappears
A. Respiratory alkalosis B. Metabolic alkalosis C. quickly D. 2 mm pit disappears rapidly
Normal ABG D. Respiratory acidosis Ans: B - 1+ 2 mm, 2+ 4 mm, 3+ 6 mm, 4+ 8 mm
Ans: A - Salicylates stimulate the respiratory center; and persists.
metabolic acidosis follows. 49. Orthostatic hypotension commonly signals:
41. Severe diarrhea is associated with: A. Fluid volume deficit B. Fluid volume excess C.
A. Metabolic acidosis B. Respiratory alkalosis C. Hypernatremia only D. Hyperkalemia only
Metabolic alkalosis D. Respiratory acidosis Ans: A - A drop of 20 systolic or 10 diastolic with
Ans: A - Bicarbonate is lost in stool. position change suggests volume depletion.
42. D5W is avoided in a client with increased 50. Which action is most important for a client
ICP because it: receiving a loop diuretic?
A. Causes hypernatremia B. Is too acidic C. A. Monitor potassium level B. Monitor calcium only
Becomes hypotonic and worsens cerebral edema D. C. Restrict protein D. Give with antacids
Is hypertonic Ans: A - Hypokalemia is a major adverse effect; also
Ans: C - Dextrose is metabolized leaving free water. assess for ototoxicity.
43. A client with tetany should be placed on: 51. Refeeding syndrome primarily causes:
A. Bedrest with legs elevated B. Contact A. Hyperkalemia B. Hypernatremia C.
precautions C. Seizure precautions D. Fluid Hypercalcemia D. Hypophosphatemia
restriction Ans: D - Reintroducing nutrition shifts phosphorus
Ans: C - Hypocalcemia lowers seizure threshold and into cells, causing weakness and arrhythmias.
may cause laryngospasm; keep airway equipment 2. Cardiovascular
close.
Med-Surg Nursing Review - 400 Questions | 3