NUR 265 EXAM BANK 2026 | CONTAINS EXAM 1 ,2, 3 AND 4 |
ALL CURRENTLY TESTING QUESTIONS WITH VERIFIED
ANSWERS AND RATIONALES | ADVANCED MEDICAL-SURGICAL
NURSING EXAM ACCURATE AND EXPERT VERIFIED FOR
GUARANTEED PASS | LATEST UPDATE
CONTENTS
EXAM 1: Fluid & Electrolytes, Acid-Base, Renal, and GI Disorders
EXAM 2: Cardiovascular, Respiratory, and Endocrine Disorders
EXAM 3: Neurological, Musculoskeletal, and Complex Medical Conditions
EXAM 4: Critical Care, Shock States, Oncology, and Multi-System Failure
EXAM 1
FLUID & ELECTROLYTES, ACID-BASE, RENAL, AND GI
1. A client with heart failure has a serum sodium of 125 mEq/L. Which finding is
most concerning?
A) Thirst
B) Muscle cramps
C) Confusion and lethargy
D) Dry mucous membranes
Correct Answer: C
Rationale: Hyponatremia (<135) causes water to shift into brain cells, leading to
cerebral edema. Confusion, lethargy, and seizures are the most dangerous
neurological signs. Thirst (A) and dry mucous membranes (D) indicate
hypernatremia. Muscle cramps (B) occur but are not as immediately life-
threatening as altered mental status.
2. A client's potassium is 6.8 mEq/L. Which intervention FIRST?
A) Administer sodium polystyrene sulfonate (Kayexalate)
B) Administer IV calcium gluconate
C) Restrict dietary potassium
1
,D) Prepare for hemodialysis
Correct Answer: B
Rationale: Severe hyperkalemia (>6.5) can cause fatal cardiac arrhythmias.
Calcium gluconate is given FIRST to stabilize myocardial membranes. Kayexalate
(A) removes potassium but takes hours. Dietary restriction (C) is long-term.
Hemodialysis (D) is needed if other measures fail.
3. A client with prolonged vomiting has K+ 3.0 mEq/L. Expected finding?
A) Hyperactive bowel sounds
B) Muscle weakness and lethargy
C) Tachycardia
D) Hypertension
Correct Answer: B
Rationale: Hypokalemia (<3.5) causes muscle weakness, fatigue, and hyporeflexia.
Bowel sounds are decreased (ileus), not hyperactive (A). Tachycardia is not
typical; bradycardia and hypotension occur (C, D).
4. A DKA client has a K+ of 5.8 mEq/L. Why is this elevated?
A) Total body potassium excess
B) Shift from ICF to ECF due to acidosis
C) Acute kidney injury
D) Excessive dietary intake
Correct Answer: B
Rationale: In DKA, hydrogen ions move into cells, pushing potassium out into the
extracellular space. Despite the high serum level, total body potassium is actually
depleted. As insulin is given and acidosis corrects, potassium shifts back, requiring
careful replacement.
5. A CHF client is on a 2-gram sodium diet. Which meal indicates understanding?
A) Canned vegetable soup and saltine crackers
B) Grilled chicken with fresh green beans and an orange
C) Ham sandwich with pickles
D) Frozen pizza and a diet soda
2
,Correct Answer: B
Rationale: Fresh, unprocessed foods like grilled chicken and fresh vegetables are
naturally low in sodium. Canned soup (A), ham/pickles (C), and frozen pizza (D)
are ultra-high in sodium.
6. Serum magnesium is 1.0 mEq/L. Which assessment finding is expected?
A) Hyperactive deep tendon reflexes (DTRs)
B) Muscle weakness
C) Bradycardia
D) Respiratory depression
Correct Answer: A
Rationale: Hypomagnesemia (<1.5) increases neuromuscular irritability, causing
hyperactive DTRs, tremors, and seizures. Muscle weakness (B), bradycardia (C),
and respiratory depression (D) are signs of *hyper*magnesemia.
7. Client on IV magnesium has RR 10/min and absent DTRs. Next action?
A) Continue the infusion and monitor
B) Stop infusion, prepare calcium gluconate
C) Increase the infusion rate
D) Place client in Trendelenburg
Correct Answer: B
Rationale: RR <12 and absent DTRs indicate magnesium toxicity. Calcium
gluconate is the antidote. Continuing (A) or increasing (C) is dangerous.
Trendelenburg (D) does not reverse toxicity.
8. Serum calcium is 6.5 mg/dL. Which sign is expected?
A) Positive Chvostek's sign
B) Muscle weakness
C) Constipation
D) Lethargy
Correct Answer: A
Rationale: Hypocalcemia (<8.5) causes neuromuscular hyperexcitability.
Chvostek's (facial twitching when tapping the facial nerve) and Trousseau's signs
3
, are classic. Muscle weakness (B), constipation (C), and lethargy (D) are signs of
*hyper*calcemia.
9. A cancer client has calcium of 12.5 mg/dL. Anticipated treatment?
A) IV normal saline and loop diuretics
B) Oral calcium supplements
C) Vitamin D therapy
D) Fluid restriction
Correct Answer: A
Rationale: Hypercalcemia (often from bone metastasis) is treated with aggressive
IV hydration (normal saline) to dilute calcium, followed by loop diuretics
(furosemide) to enhance renal excretion. Supplements (B), Vitamin D (C), and
fluid restriction (D) would worsen it.
10. ABG: pH 7.30, PaCO2 50, HCO3 24. Interpretation?
A) Metabolic acidosis
B) Metabolic alkalosis
C) Respiratory acidosis
D) Respiratory alkalosis
Correct Answer: C
Rationale: pH <7.35 = acidosis. PaCO2 >45 = respiratory cause. HCO3 is normal
(22-26). This is uncompensated respiratory acidosis (e.g., COPD exacerbation).
11. ABG: pH 7.32, PaCO2 35, HCO3 18. Interpretation?
A) Metabolic acidosis
B) Metabolic alkalosis
C) Respiratory acidosis
D) Respiratory alkalosis
Correct Answer: A
Rationale: pH low = acidosis. HCO3 low (<22) = metabolic cause. PaCO2 is normal.
This is uncompensated metabolic acidosis (e.g., DKA, renal failure).
12. ABG: pH 7.48, PaCO2 30, HCO3 24. Interpretation?
4
ALL CURRENTLY TESTING QUESTIONS WITH VERIFIED
ANSWERS AND RATIONALES | ADVANCED MEDICAL-SURGICAL
NURSING EXAM ACCURATE AND EXPERT VERIFIED FOR
GUARANTEED PASS | LATEST UPDATE
CONTENTS
EXAM 1: Fluid & Electrolytes, Acid-Base, Renal, and GI Disorders
EXAM 2: Cardiovascular, Respiratory, and Endocrine Disorders
EXAM 3: Neurological, Musculoskeletal, and Complex Medical Conditions
EXAM 4: Critical Care, Shock States, Oncology, and Multi-System Failure
EXAM 1
FLUID & ELECTROLYTES, ACID-BASE, RENAL, AND GI
1. A client with heart failure has a serum sodium of 125 mEq/L. Which finding is
most concerning?
A) Thirst
B) Muscle cramps
C) Confusion and lethargy
D) Dry mucous membranes
Correct Answer: C
Rationale: Hyponatremia (<135) causes water to shift into brain cells, leading to
cerebral edema. Confusion, lethargy, and seizures are the most dangerous
neurological signs. Thirst (A) and dry mucous membranes (D) indicate
hypernatremia. Muscle cramps (B) occur but are not as immediately life-
threatening as altered mental status.
2. A client's potassium is 6.8 mEq/L. Which intervention FIRST?
A) Administer sodium polystyrene sulfonate (Kayexalate)
B) Administer IV calcium gluconate
C) Restrict dietary potassium
1
,D) Prepare for hemodialysis
Correct Answer: B
Rationale: Severe hyperkalemia (>6.5) can cause fatal cardiac arrhythmias.
Calcium gluconate is given FIRST to stabilize myocardial membranes. Kayexalate
(A) removes potassium but takes hours. Dietary restriction (C) is long-term.
Hemodialysis (D) is needed if other measures fail.
3. A client with prolonged vomiting has K+ 3.0 mEq/L. Expected finding?
A) Hyperactive bowel sounds
B) Muscle weakness and lethargy
C) Tachycardia
D) Hypertension
Correct Answer: B
Rationale: Hypokalemia (<3.5) causes muscle weakness, fatigue, and hyporeflexia.
Bowel sounds are decreased (ileus), not hyperactive (A). Tachycardia is not
typical; bradycardia and hypotension occur (C, D).
4. A DKA client has a K+ of 5.8 mEq/L. Why is this elevated?
A) Total body potassium excess
B) Shift from ICF to ECF due to acidosis
C) Acute kidney injury
D) Excessive dietary intake
Correct Answer: B
Rationale: In DKA, hydrogen ions move into cells, pushing potassium out into the
extracellular space. Despite the high serum level, total body potassium is actually
depleted. As insulin is given and acidosis corrects, potassium shifts back, requiring
careful replacement.
5. A CHF client is on a 2-gram sodium diet. Which meal indicates understanding?
A) Canned vegetable soup and saltine crackers
B) Grilled chicken with fresh green beans and an orange
C) Ham sandwich with pickles
D) Frozen pizza and a diet soda
2
,Correct Answer: B
Rationale: Fresh, unprocessed foods like grilled chicken and fresh vegetables are
naturally low in sodium. Canned soup (A), ham/pickles (C), and frozen pizza (D)
are ultra-high in sodium.
6. Serum magnesium is 1.0 mEq/L. Which assessment finding is expected?
A) Hyperactive deep tendon reflexes (DTRs)
B) Muscle weakness
C) Bradycardia
D) Respiratory depression
Correct Answer: A
Rationale: Hypomagnesemia (<1.5) increases neuromuscular irritability, causing
hyperactive DTRs, tremors, and seizures. Muscle weakness (B), bradycardia (C),
and respiratory depression (D) are signs of *hyper*magnesemia.
7. Client on IV magnesium has RR 10/min and absent DTRs. Next action?
A) Continue the infusion and monitor
B) Stop infusion, prepare calcium gluconate
C) Increase the infusion rate
D) Place client in Trendelenburg
Correct Answer: B
Rationale: RR <12 and absent DTRs indicate magnesium toxicity. Calcium
gluconate is the antidote. Continuing (A) or increasing (C) is dangerous.
Trendelenburg (D) does not reverse toxicity.
8. Serum calcium is 6.5 mg/dL. Which sign is expected?
A) Positive Chvostek's sign
B) Muscle weakness
C) Constipation
D) Lethargy
Correct Answer: A
Rationale: Hypocalcemia (<8.5) causes neuromuscular hyperexcitability.
Chvostek's (facial twitching when tapping the facial nerve) and Trousseau's signs
3
, are classic. Muscle weakness (B), constipation (C), and lethargy (D) are signs of
*hyper*calcemia.
9. A cancer client has calcium of 12.5 mg/dL. Anticipated treatment?
A) IV normal saline and loop diuretics
B) Oral calcium supplements
C) Vitamin D therapy
D) Fluid restriction
Correct Answer: A
Rationale: Hypercalcemia (often from bone metastasis) is treated with aggressive
IV hydration (normal saline) to dilute calcium, followed by loop diuretics
(furosemide) to enhance renal excretion. Supplements (B), Vitamin D (C), and
fluid restriction (D) would worsen it.
10. ABG: pH 7.30, PaCO2 50, HCO3 24. Interpretation?
A) Metabolic acidosis
B) Metabolic alkalosis
C) Respiratory acidosis
D) Respiratory alkalosis
Correct Answer: C
Rationale: pH <7.35 = acidosis. PaCO2 >45 = respiratory cause. HCO3 is normal
(22-26). This is uncompensated respiratory acidosis (e.g., COPD exacerbation).
11. ABG: pH 7.32, PaCO2 35, HCO3 18. Interpretation?
A) Metabolic acidosis
B) Metabolic alkalosis
C) Respiratory acidosis
D) Respiratory alkalosis
Correct Answer: A
Rationale: pH low = acidosis. HCO3 low (<22) = metabolic cause. PaCO2 is normal.
This is uncompensated metabolic acidosis (e.g., DKA, renal failure).
12. ABG: pH 7.48, PaCO2 30, HCO3 24. Interpretation?
4
