NUR 265 MEDICAL-SURGICAL NURSING EXAM 1
2026 | Versions 1 2 & 3 | Galen College of Nursing |
100% Correct | Pass Guaranteed - A+ Graded
VERSION 1: FLUID & ELECTROLYTE IMBALANCES (30 Questions)
Q1. A 72-year-old patient with heart failure is receiving IV furosemide (Lasix) 40 mg
daily. The nurse notes the patient's serum sodium is 128 mEq/L. Which clinical
manifestation would the nurse expect to find first?
A. Seizures and coma
B. Muscle weakness and fatigue [CORRECT]
C. Hyperreflexia and tetany
D. Oliguria and hypertension
Rationale: Early signs of hyponatremia include muscle weakness, fatigue, and
headache as water shifts into cells causing cerebral edema. Seizures (A) occur with
severe hyponatremia (<120 mEq/L). C describes hypocalcemia. D is unrelated to
hyponatremia.
Correct Answer: B
Q2. The nurse is caring for a patient with syndrome of inappropriate antidiuretic
hormone (SIADH). The patient's serum sodium is 118 mEq/L. What is the priority
nursing intervention?
A. Administer 3% hypertonic saline rapidly
B. Implement seizure precautions and restrict free water intake [CORRECT]
C. Encourage the patient to drink large amounts of water
D. Administer potassium chloride IV push
,Rationale: For severe hyponatremia (Na+ <120 mEq/L), seizure precautions and fluid
restriction are critical. Hypertonic saline (A) is given only for severe symptoms and
must be administered slowly to avoid osmotic demyelination. C worsens
hyponatremia. D is inappropriate.
Correct Answer: B
Q3. A patient with diabetes insipidus has a serum sodium of 152 mEq/L. Which
assessment finding would the nurse expect?
A. Weight gain and peripheral edema
B. Polyuria, polydipsia, and dry mucous membranes [CORRECT]
C. Muscle cramps and hyperactive reflexes
D. Bradycardia and hypotension
Rationale: Diabetes insipidus causes hypernatremia due to excessive water loss,
leading to polyuria, polydipsia, and signs of dehydration. A describes fluid overload.
C describes hypocalcemia or hyponatremia. D is unrelated.
Correct Answer: B
Q4. The nurse is monitoring a patient receiving 3% saline for severe hyponatremia.
What is the maximum safe rate of sodium correction to prevent osmotic
demyelination syndrome?
A. 1-2 mEq/L per hour
B. 4-6 mEq/L in the first 24 hours [CORRECT]
C. 12-15 mEq/L in the first 24 hours
D. 20 mEq/L in the first 48 hours
,Rationale: Sodium correction should not exceed 4-6 mEq/L in the first 24 hours and
8-12 mEq/L in 48 hours to prevent osmotic demyelination syndrome (central pontine
myelinolysis). Faster rates (A, C, D) increase risk of permanent neurological damage.
Correct Answer: B
Q5. A patient with hypernatremia (Na+ 156 mEq/L) is receiving hypotonic IV fluids.
Which complication would the nurse monitor for most closely?
A. Hyperkalemia
B. Cerebral edema from rapid correction [CORRECT]
C. Metabolic alkalosis
D. Hypercalcemia
Rationale: Rapid correction of hypernatremia can cause cerebral edema as water
shifts into brain cells. The correction rate should not exceed 0.5 mEq/L per hour or
10-12 mEq/L per day. A, C, and D are not primary complications of hypernatremia
correction.
Correct Answer: B
Q6. The nurse is reviewing lab values for a patient with vomiting and diarrhea. Which
finding indicates the patient is at highest risk for hyponatremia?
A. Serum osmolality 310 mOsm/kg
B. Urine sodium 15 mEq/L with low serum sodium [CORRECT]
C. Hematocrit 48%
D. BUN 25 mg/dL
Rationale: Inappropriate urinary sodium excretion (>20 mEq/L) with low serum
sodium suggests renal losses or SIADH. A indicates hyperosmolality (hypernatremia).
, C and D suggest hemoconcentration but do not specifically indicate hyponatremia
risk.
Correct Answer: B
Q7. A patient with liver cirrhosis develops ascites and is started on spironolactone.
The nurse should monitor for which electrolyte imbalance?
A. Hyponatremia and hyperkalemia [CORRECT]
B. Hypernatremia and hypokalemia
C. Hypercalcemia and hypomagnesemia
D. Hypochloremia and metabolic acidosis
Rationale: Spironolactone is a potassium-sparing diuretic that can cause
hyperkalemia. Patients with cirrhosis and ascites are also prone to hyponatremia due
to water retention. B describes loop diuretic effects. C and D are not primary
concerns with spironolactone.
Correct Answer: A
Q8. The nurse is caring for a patient with hypernatremia who is confused and
lethargic. Which nursing diagnosis is the highest priority?
A. Risk for falls
B. Risk for injury related to altered mental status and seizures [CORRECT]
C. Excess fluid volume
D. Impaired skin integrity
Rationale: Hypernatremia causes cellular dehydration and altered mental status,
increasing risk of injury and seizures. Safety is the priority per Maslow's hierarchy. A is
secondary. C is incorrect as hypernatremia indicates water deficit. D is not the
priority.
2026 | Versions 1 2 & 3 | Galen College of Nursing |
100% Correct | Pass Guaranteed - A+ Graded
VERSION 1: FLUID & ELECTROLYTE IMBALANCES (30 Questions)
Q1. A 72-year-old patient with heart failure is receiving IV furosemide (Lasix) 40 mg
daily. The nurse notes the patient's serum sodium is 128 mEq/L. Which clinical
manifestation would the nurse expect to find first?
A. Seizures and coma
B. Muscle weakness and fatigue [CORRECT]
C. Hyperreflexia and tetany
D. Oliguria and hypertension
Rationale: Early signs of hyponatremia include muscle weakness, fatigue, and
headache as water shifts into cells causing cerebral edema. Seizures (A) occur with
severe hyponatremia (<120 mEq/L). C describes hypocalcemia. D is unrelated to
hyponatremia.
Correct Answer: B
Q2. The nurse is caring for a patient with syndrome of inappropriate antidiuretic
hormone (SIADH). The patient's serum sodium is 118 mEq/L. What is the priority
nursing intervention?
A. Administer 3% hypertonic saline rapidly
B. Implement seizure precautions and restrict free water intake [CORRECT]
C. Encourage the patient to drink large amounts of water
D. Administer potassium chloride IV push
,Rationale: For severe hyponatremia (Na+ <120 mEq/L), seizure precautions and fluid
restriction are critical. Hypertonic saline (A) is given only for severe symptoms and
must be administered slowly to avoid osmotic demyelination. C worsens
hyponatremia. D is inappropriate.
Correct Answer: B
Q3. A patient with diabetes insipidus has a serum sodium of 152 mEq/L. Which
assessment finding would the nurse expect?
A. Weight gain and peripheral edema
B. Polyuria, polydipsia, and dry mucous membranes [CORRECT]
C. Muscle cramps and hyperactive reflexes
D. Bradycardia and hypotension
Rationale: Diabetes insipidus causes hypernatremia due to excessive water loss,
leading to polyuria, polydipsia, and signs of dehydration. A describes fluid overload.
C describes hypocalcemia or hyponatremia. D is unrelated.
Correct Answer: B
Q4. The nurse is monitoring a patient receiving 3% saline for severe hyponatremia.
What is the maximum safe rate of sodium correction to prevent osmotic
demyelination syndrome?
A. 1-2 mEq/L per hour
B. 4-6 mEq/L in the first 24 hours [CORRECT]
C. 12-15 mEq/L in the first 24 hours
D. 20 mEq/L in the first 48 hours
,Rationale: Sodium correction should not exceed 4-6 mEq/L in the first 24 hours and
8-12 mEq/L in 48 hours to prevent osmotic demyelination syndrome (central pontine
myelinolysis). Faster rates (A, C, D) increase risk of permanent neurological damage.
Correct Answer: B
Q5. A patient with hypernatremia (Na+ 156 mEq/L) is receiving hypotonic IV fluids.
Which complication would the nurse monitor for most closely?
A. Hyperkalemia
B. Cerebral edema from rapid correction [CORRECT]
C. Metabolic alkalosis
D. Hypercalcemia
Rationale: Rapid correction of hypernatremia can cause cerebral edema as water
shifts into brain cells. The correction rate should not exceed 0.5 mEq/L per hour or
10-12 mEq/L per day. A, C, and D are not primary complications of hypernatremia
correction.
Correct Answer: B
Q6. The nurse is reviewing lab values for a patient with vomiting and diarrhea. Which
finding indicates the patient is at highest risk for hyponatremia?
A. Serum osmolality 310 mOsm/kg
B. Urine sodium 15 mEq/L with low serum sodium [CORRECT]
C. Hematocrit 48%
D. BUN 25 mg/dL
Rationale: Inappropriate urinary sodium excretion (>20 mEq/L) with low serum
sodium suggests renal losses or SIADH. A indicates hyperosmolality (hypernatremia).
, C and D suggest hemoconcentration but do not specifically indicate hyponatremia
risk.
Correct Answer: B
Q7. A patient with liver cirrhosis develops ascites and is started on spironolactone.
The nurse should monitor for which electrolyte imbalance?
A. Hyponatremia and hyperkalemia [CORRECT]
B. Hypernatremia and hypokalemia
C. Hypercalcemia and hypomagnesemia
D. Hypochloremia and metabolic acidosis
Rationale: Spironolactone is a potassium-sparing diuretic that can cause
hyperkalemia. Patients with cirrhosis and ascites are also prone to hyponatremia due
to water retention. B describes loop diuretic effects. C and D are not primary
concerns with spironolactone.
Correct Answer: A
Q8. The nurse is caring for a patient with hypernatremia who is confused and
lethargic. Which nursing diagnosis is the highest priority?
A. Risk for falls
B. Risk for injury related to altered mental status and seizures [CORRECT]
C. Excess fluid volume
D. Impaired skin integrity
Rationale: Hypernatremia causes cellular dehydration and altered mental status,
increasing risk of injury and seizures. Safety is the priority per Maslow's hierarchy. A is
secondary. C is incorrect as hypernatremia indicates water deficit. D is not the
priority.
