NUR 121 – Medical-Surgical Nursing I
Complete Study Guide & Comprehensive Exam
Review Quality Questions with Answers and
Detailed Rationales
SECTION 1: FLUID & ELECTROLYTE BALANCE
Question 1
A 72-year-old female patient is admitted with severe diarrhea for 3 days. Her
vital signs are: HR 118 bpm, BP 88/52 mmHg, RR 22/min, temperature
98.6°F. Laboratory results show: Na 148 mEq/L, K 3.2 mEq/L, Cl 110 mEq/L,
BUN 45 mg/dL, creatinine 2.1 mg/dL. Which of the following is the priority
nursing intervention?
A) Administer IV normal saline at 150 mL/hr
B) Administer IV potassium chloride replacement
C) Administer oral rehydration solution
D) Administer IV dextrose 5% in water
Answer: A. Administer IV normal saline at 150 mL/hr
Rationale: This patient has hypovolemic hypernatremia with evidence of acute
kidney injury (elevated BUN and creatinine). The priority is fluid resuscitation
with isotonic saline to restore intravascular volume. Potassium replacement
(B) is important but secondary to volume resuscitation. Oral rehydration (C)
is insufficient for this degree of dehydration. D5W (D) would worsen
hypernatremia by shifting water intracellularly without correcting volume
deficit.
Question 2
A 65-year-old male patient with heart failure presents with confusion, muscle
cramps, and nausea. His serum sodium is 125 mEq/L. He has a history of
,taking thiazide diuretics. Which of the following nursing interventions should
be implemented first?
A) Restrict fluid intake to 1,000 mL/day
B) Administer 3% hypertonic saline
C) Administer oral sodium supplements
D) Discontinue the thiazide diuretic
Answer: A. Restrict fluid intake to 1,000 mL/day
Rationale: This patient has dilutional hyponatremia from thiazide use and
heart failure. Fluid restriction is the first-line intervention for chronic
hyponatremia. Hypertonic saline (B) is reserved for severe or symptomatic
hyponatremia with neurologic symptoms. Oral sodium supplements (C) are
not the primary treatment. Discontinuing thiazide (D) is important but fluid
restriction is the priority.
Question 3
A patient's arterial blood gas results show: pH 7.30, PaCO2 55 mmHg, HCO3
24 mEq/L. Which of the following nursing interventions is most appropriate?
A) Administer sodium bicarbonate
B) Assist with non-invasive positive pressure ventilation
C) Administer IV fluids
D) Administer potassium chloride
Answer: B. Assist with non-invasive positive pressure ventilation
Rationale: The ABG shows respiratory acidosis (low pH, elevated PaCO2,
normal HCO3). This indicates inadequate ventilation. The priority
intervention is to improve ventilation with BiPAP/CPAP. Sodium bicarbonate
(A) is not indicated for respiratory acidosis. IV fluids (C) are not the primary
treatment. Potassium (D) is unrelated to this acid-base imbalance.
Question 4
,A patient with chronic kidney disease has a serum potassium level of 6.8
mEq/L. The cardiac monitor shows tall peaked T waves. Which of the
following interventions should the nurse anticipate first?
A) Administer calcium gluconate IV
B) Administer sodium polystyrene sulfonate
C) Administer insulin with dextrose
D) Prepare for hemodialysis
Answer: A. Administer calcium gluconate IV
Rationale: Calcium gluconate is administered first to stabilize cardiac
membranes and prevent arrhythmias in severe hyperkalemia. Sodium
polystyrene sulfonate (B) and insulin with dextrose (C) lower potassium but
take longer to work. Hemodialysis (D) is a definitive treatment but not the
first intervention.
Question 5
A patient with small bowel obstruction has an NG tube to low intermittent
suction. Which electrolyte imbalance is this patient at highest risk for
developing?
A) Hyperkalemia
B) Hypokalemia
C) Hyponatremia
D) Hypernatremia
Answer: B. Hypokalemia
Rationale: NG suction removes gastric contents rich in potassium and
hydrogen ions, leading to hypokalemia and metabolic alkalosis. Hyperkalemia
(A) is not associated with NG suction. Hyponatremia (C) and hypernatremia
(D) are less common with NG suction.
Question 6
A patient with severe vomiting has the following ABG results: pH 7.50, PaCO2
48 mmHg, HCO3 32 mEq/L. Which acid-base imbalance is present?
, A) Metabolic alkalosis with partial respiratory compensation
B) Respiratory acidosis with metabolic compensation
C) Metabolic acidosis with respiratory compensation
D) Respiratory alkalosis with metabolic compensation
Answer: A. Metabolic alkalosis with partial respiratory compensation
Rationale: The elevated pH (7.50) and elevated HCO3 (32) indicate metabolic
alkalosis. The elevated PaCO2 (48) represents respiratory compensation
(hypoventilation). Vomiting causes loss of gastric acid (HCl), leading to
metabolic alkalosis.
Question 7
A patient is receiving IV fluids at 125 mL/hr. Which of the following
assessment findings indicates fluid volume excess?
A) Urine output 60 mL/hr
B) Weight gain of 1 kg in 24 hours
C) Jugular venous distension and crackles in lung bases
D) Blood pressure 110/70 mmHg
Answer: C. Jugular venous distension and crackles in lung bases
Rationale: JVD and crackles are classic signs of fluid volume excess
(hypervolemia). Urine output 60 mL/hr (A) is normal. Weight gain of 1 kg (B)
is significant but less specific than clinical signs. Normal BP (D) does not rule
out fluid overload.
Question 8
A patient has a serum magnesium level of 1.0 mEq/L. Which of the following
assessment findings would the nurse expect?
A) Hypertension and tachycardia
B) Tremors and hyperactive reflexes
C) Bradycardia and lethargy
D) Constipation and hypoactive reflexes
Complete Study Guide & Comprehensive Exam
Review Quality Questions with Answers and
Detailed Rationales
SECTION 1: FLUID & ELECTROLYTE BALANCE
Question 1
A 72-year-old female patient is admitted with severe diarrhea for 3 days. Her
vital signs are: HR 118 bpm, BP 88/52 mmHg, RR 22/min, temperature
98.6°F. Laboratory results show: Na 148 mEq/L, K 3.2 mEq/L, Cl 110 mEq/L,
BUN 45 mg/dL, creatinine 2.1 mg/dL. Which of the following is the priority
nursing intervention?
A) Administer IV normal saline at 150 mL/hr
B) Administer IV potassium chloride replacement
C) Administer oral rehydration solution
D) Administer IV dextrose 5% in water
Answer: A. Administer IV normal saline at 150 mL/hr
Rationale: This patient has hypovolemic hypernatremia with evidence of acute
kidney injury (elevated BUN and creatinine). The priority is fluid resuscitation
with isotonic saline to restore intravascular volume. Potassium replacement
(B) is important but secondary to volume resuscitation. Oral rehydration (C)
is insufficient for this degree of dehydration. D5W (D) would worsen
hypernatremia by shifting water intracellularly without correcting volume
deficit.
Question 2
A 65-year-old male patient with heart failure presents with confusion, muscle
cramps, and nausea. His serum sodium is 125 mEq/L. He has a history of
,taking thiazide diuretics. Which of the following nursing interventions should
be implemented first?
A) Restrict fluid intake to 1,000 mL/day
B) Administer 3% hypertonic saline
C) Administer oral sodium supplements
D) Discontinue the thiazide diuretic
Answer: A. Restrict fluid intake to 1,000 mL/day
Rationale: This patient has dilutional hyponatremia from thiazide use and
heart failure. Fluid restriction is the first-line intervention for chronic
hyponatremia. Hypertonic saline (B) is reserved for severe or symptomatic
hyponatremia with neurologic symptoms. Oral sodium supplements (C) are
not the primary treatment. Discontinuing thiazide (D) is important but fluid
restriction is the priority.
Question 3
A patient's arterial blood gas results show: pH 7.30, PaCO2 55 mmHg, HCO3
24 mEq/L. Which of the following nursing interventions is most appropriate?
A) Administer sodium bicarbonate
B) Assist with non-invasive positive pressure ventilation
C) Administer IV fluids
D) Administer potassium chloride
Answer: B. Assist with non-invasive positive pressure ventilation
Rationale: The ABG shows respiratory acidosis (low pH, elevated PaCO2,
normal HCO3). This indicates inadequate ventilation. The priority
intervention is to improve ventilation with BiPAP/CPAP. Sodium bicarbonate
(A) is not indicated for respiratory acidosis. IV fluids (C) are not the primary
treatment. Potassium (D) is unrelated to this acid-base imbalance.
Question 4
,A patient with chronic kidney disease has a serum potassium level of 6.8
mEq/L. The cardiac monitor shows tall peaked T waves. Which of the
following interventions should the nurse anticipate first?
A) Administer calcium gluconate IV
B) Administer sodium polystyrene sulfonate
C) Administer insulin with dextrose
D) Prepare for hemodialysis
Answer: A. Administer calcium gluconate IV
Rationale: Calcium gluconate is administered first to stabilize cardiac
membranes and prevent arrhythmias in severe hyperkalemia. Sodium
polystyrene sulfonate (B) and insulin with dextrose (C) lower potassium but
take longer to work. Hemodialysis (D) is a definitive treatment but not the
first intervention.
Question 5
A patient with small bowel obstruction has an NG tube to low intermittent
suction. Which electrolyte imbalance is this patient at highest risk for
developing?
A) Hyperkalemia
B) Hypokalemia
C) Hyponatremia
D) Hypernatremia
Answer: B. Hypokalemia
Rationale: NG suction removes gastric contents rich in potassium and
hydrogen ions, leading to hypokalemia and metabolic alkalosis. Hyperkalemia
(A) is not associated with NG suction. Hyponatremia (C) and hypernatremia
(D) are less common with NG suction.
Question 6
A patient with severe vomiting has the following ABG results: pH 7.50, PaCO2
48 mmHg, HCO3 32 mEq/L. Which acid-base imbalance is present?
, A) Metabolic alkalosis with partial respiratory compensation
B) Respiratory acidosis with metabolic compensation
C) Metabolic acidosis with respiratory compensation
D) Respiratory alkalosis with metabolic compensation
Answer: A. Metabolic alkalosis with partial respiratory compensation
Rationale: The elevated pH (7.50) and elevated HCO3 (32) indicate metabolic
alkalosis. The elevated PaCO2 (48) represents respiratory compensation
(hypoventilation). Vomiting causes loss of gastric acid (HCl), leading to
metabolic alkalosis.
Question 7
A patient is receiving IV fluids at 125 mL/hr. Which of the following
assessment findings indicates fluid volume excess?
A) Urine output 60 mL/hr
B) Weight gain of 1 kg in 24 hours
C) Jugular venous distension and crackles in lung bases
D) Blood pressure 110/70 mmHg
Answer: C. Jugular venous distension and crackles in lung bases
Rationale: JVD and crackles are classic signs of fluid volume excess
(hypervolemia). Urine output 60 mL/hr (A) is normal. Weight gain of 1 kg (B)
is significant but less specific than clinical signs. Normal BP (D) does not rule
out fluid overload.
Question 8
A patient has a serum magnesium level of 1.0 mEq/L. Which of the following
assessment findings would the nurse expect?
A) Hypertension and tachycardia
B) Tremors and hyperactive reflexes
C) Bradycardia and lethargy
D) Constipation and hypoactive reflexes
