NUR 242 Med-Surg Nursing Exams 1-5 Review Guide Actual Exam 2026/2027 –
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Section 1: Exam 1 Review - Fluid, Electrolyte, Acid-Base &
Perioperative Care (30 Questions)
Q1: A patient with severe diarrhea has a heart rate of 118 bpm, blood pressure 92/58
mmHg, and dry mucous membranes. The nurse notes poor skin turgor and
concentrated urine. Which laboratory finding is most consistent with this patient's
condition?
A. Urine specific gravity 1.002
B. Urine specific gravity 1.032
C. Serum osmolality 260 mOsm/kg
D. Hematocrit 32%
Correct Answer: B
Rationale: Fluid volume deficit from severe diarrhea causes the kidneys to conserve
water, resulting in concentrated urine with high specific gravity (>1.030). Low urine
specific gravity and low serum osmolality indicate fluid overload, while a low hematocrit
would suggest hemodilution rather than hemoconcentration.
Q2: A patient with heart failure has bilateral crackles, jugular venous distention, and 3+
pitting edema in the lower extremities. Which laboratory value would the nurse expect?
A. Hematocrit 48%
B. BUN 32 mg/dL
C. Serum osmolality 290 mOsm/kg
D. Urine specific gravity 1.002
,Correct Answer: D
Rationale: Fluid volume excess dilutes the blood and causes the kidneys to excrete
dilute urine. A urine specific gravity below 1.005 is consistent with fluid overload.
Elevated hematocrit and BUN indicate hemoconcentration from dehydration, while
normal serum osmolality does not reflect excess fluid volume.
Q3: A patient weighs 70 kg and has gained 3 kg over 2 days. The nurse calculates this
weight gain represents approximately how many liters of fluid retention?
A. 1.5 liters
B. 3 liters
C. 4.5 liters
D. 6 liters
Correct Answer: B
Rationale: One kilogram of body weight gain equals approximately one liter of fluid
retention. Therefore, a 3 kg weight gain represents approximately 3 liters of retained
fluid. Daily weights are the most reliable indicator of fluid status in patients with heart
failure or renal disorders.
Q4: A patient has the following arterial blood gas results: pH 7.30, PaCO2 50 mmHg,
HCO3 24 mEq/L. Which acid-base disorder is present?
A. Metabolic acidosis
B. Respiratory acidosis
C. Metabolic alkalosis
D. Respiratory alkalosis
Correct Answer: B
Rationale: The pH of 7.30 indicates acidosis. The PaCO2 of 50 mmHg is elevated above
the normal range of 35-45 mmHg, indicating a respiratory cause. The HCO3 of 24
mEq/L is within normal range (22-28), confirming this is uncompensated respiratory
acidosis, commonly seen in COPD or opioid-induced respiratory depression.
,Q5: A patient with metabolic alkalosis has a pH of 7.50, PaCO2 48 mmHg, and HCO3 34
mEq/L. Which clinical condition is most likely causing this disorder?
A. Diabetic ketoacidosis
B. Severe vomiting or nasogastric suction
C. Salicylate overdose
D. Severe diarrhea
Correct Answer: B
Rationale: Metabolic alkalosis with elevated HCO3 is commonly caused by loss of
gastric acid through vomiting or nasogastric suction. The elevated PaCO2 represents
compensatory hypoventilation. Diabetic ketoacidosis and severe diarrhea cause
metabolic acidosis, while salicylate overdose causes respiratory alkalosis and
metabolic acidosis.
Q6: A patient has a serum potassium of 2.9 mEq/L. Which ECG change should the nurse
anticipate?
A. Peaked T waves
B. ST depression, flattened T waves, and prominent U waves
C. Widened QRS complex
D. Shortened PR interval
Correct Answer: B
Rationale: Hypokalemia (serum potassium <3.5 mEq/L) causes characteristic ECG
changes including ST segment depression, flattened or inverted T waves, and prominent
U waves. Peaked T waves and widened QRS complexes are associated with
hyperkalemia.
Q7: A patient with hypocalcemia exhibits facial twitching when the nurse taps the facial
nerve anterior to the ear. This finding is known as:
A. Trousseau's sign
B. Chvostek's sign
C. Homans' sign
D. Kernig's sign
Correct Answer: B
, Rationale: Chvostek's sign is elicited by tapping the facial nerve (cranial nerve VII)
anterior to the ear, resulting in facial muscle twitching in hypocalcemia. Trousseau's
sign is carpopedal spasm induced by inflating a blood pressure cuff. Homans' sign is
for DVT, and Kernig's sign is for meningitis.
Q8: A patient with hyperkalemia (serum potassium 6.8 mEq/L) is receiving treatment.
Which intervention is given first to stabilize the myocardium?
A. Regular insulin with dextrose
B. Sodium polystyrene sulfonate (Kayexalate)
C. Calcium gluconate
D. Hemodialysis
Correct Answer: C
Rationale: Calcium gluconate is administered first in severe hyperkalemia to stabilize
the cardiac cell membrane and prevent life-threatening dysrhythmias such as ventricular
fibrillation. It does not lower serum potassium but provides immediate cardioprotection
while other interventions reduce potassium levels.
Q9: A patient has a serum magnesium of 0.9 mEq/L. Which assessment finding is most
consistent with this value?
A. Absent deep tendon reflexes
B. Positive Chvostek's sign and cardiac dysrhythmias
C. Respiratory depression
D. Bradycardia
Correct Answer: B
Rationale: Hypomagnesemia (serum magnesium <1.5 mEq/L) causes neuromuscular
irritability manifested by positive Chvostek's and Trousseau's signs, tremors, seizures,
and cardiac dysrhythmias. Absent DTRs and respiratory depression are associated with
hypermagnesemia.
Q10: A patient with severe dehydration has a serum sodium of 152 mEq/L. Which
symptom should the nurse expect?
A. Confusion and seizures
Comprehensive Test Bundle with Detailed Rationales | 100% Verified | Pass
Guaranteed – A+ Graded
Section 1: Exam 1 Review - Fluid, Electrolyte, Acid-Base &
Perioperative Care (30 Questions)
Q1: A patient with severe diarrhea has a heart rate of 118 bpm, blood pressure 92/58
mmHg, and dry mucous membranes. The nurse notes poor skin turgor and
concentrated urine. Which laboratory finding is most consistent with this patient's
condition?
A. Urine specific gravity 1.002
B. Urine specific gravity 1.032
C. Serum osmolality 260 mOsm/kg
D. Hematocrit 32%
Correct Answer: B
Rationale: Fluid volume deficit from severe diarrhea causes the kidneys to conserve
water, resulting in concentrated urine with high specific gravity (>1.030). Low urine
specific gravity and low serum osmolality indicate fluid overload, while a low hematocrit
would suggest hemodilution rather than hemoconcentration.
Q2: A patient with heart failure has bilateral crackles, jugular venous distention, and 3+
pitting edema in the lower extremities. Which laboratory value would the nurse expect?
A. Hematocrit 48%
B. BUN 32 mg/dL
C. Serum osmolality 290 mOsm/kg
D. Urine specific gravity 1.002
,Correct Answer: D
Rationale: Fluid volume excess dilutes the blood and causes the kidneys to excrete
dilute urine. A urine specific gravity below 1.005 is consistent with fluid overload.
Elevated hematocrit and BUN indicate hemoconcentration from dehydration, while
normal serum osmolality does not reflect excess fluid volume.
Q3: A patient weighs 70 kg and has gained 3 kg over 2 days. The nurse calculates this
weight gain represents approximately how many liters of fluid retention?
A. 1.5 liters
B. 3 liters
C. 4.5 liters
D. 6 liters
Correct Answer: B
Rationale: One kilogram of body weight gain equals approximately one liter of fluid
retention. Therefore, a 3 kg weight gain represents approximately 3 liters of retained
fluid. Daily weights are the most reliable indicator of fluid status in patients with heart
failure or renal disorders.
Q4: A patient has the following arterial blood gas results: pH 7.30, PaCO2 50 mmHg,
HCO3 24 mEq/L. Which acid-base disorder is present?
A. Metabolic acidosis
B. Respiratory acidosis
C. Metabolic alkalosis
D. Respiratory alkalosis
Correct Answer: B
Rationale: The pH of 7.30 indicates acidosis. The PaCO2 of 50 mmHg is elevated above
the normal range of 35-45 mmHg, indicating a respiratory cause. The HCO3 of 24
mEq/L is within normal range (22-28), confirming this is uncompensated respiratory
acidosis, commonly seen in COPD or opioid-induced respiratory depression.
,Q5: A patient with metabolic alkalosis has a pH of 7.50, PaCO2 48 mmHg, and HCO3 34
mEq/L. Which clinical condition is most likely causing this disorder?
A. Diabetic ketoacidosis
B. Severe vomiting or nasogastric suction
C. Salicylate overdose
D. Severe diarrhea
Correct Answer: B
Rationale: Metabolic alkalosis with elevated HCO3 is commonly caused by loss of
gastric acid through vomiting or nasogastric suction. The elevated PaCO2 represents
compensatory hypoventilation. Diabetic ketoacidosis and severe diarrhea cause
metabolic acidosis, while salicylate overdose causes respiratory alkalosis and
metabolic acidosis.
Q6: A patient has a serum potassium of 2.9 mEq/L. Which ECG change should the nurse
anticipate?
A. Peaked T waves
B. ST depression, flattened T waves, and prominent U waves
C. Widened QRS complex
D. Shortened PR interval
Correct Answer: B
Rationale: Hypokalemia (serum potassium <3.5 mEq/L) causes characteristic ECG
changes including ST segment depression, flattened or inverted T waves, and prominent
U waves. Peaked T waves and widened QRS complexes are associated with
hyperkalemia.
Q7: A patient with hypocalcemia exhibits facial twitching when the nurse taps the facial
nerve anterior to the ear. This finding is known as:
A. Trousseau's sign
B. Chvostek's sign
C. Homans' sign
D. Kernig's sign
Correct Answer: B
, Rationale: Chvostek's sign is elicited by tapping the facial nerve (cranial nerve VII)
anterior to the ear, resulting in facial muscle twitching in hypocalcemia. Trousseau's
sign is carpopedal spasm induced by inflating a blood pressure cuff. Homans' sign is
for DVT, and Kernig's sign is for meningitis.
Q8: A patient with hyperkalemia (serum potassium 6.8 mEq/L) is receiving treatment.
Which intervention is given first to stabilize the myocardium?
A. Regular insulin with dextrose
B. Sodium polystyrene sulfonate (Kayexalate)
C. Calcium gluconate
D. Hemodialysis
Correct Answer: C
Rationale: Calcium gluconate is administered first in severe hyperkalemia to stabilize
the cardiac cell membrane and prevent life-threatening dysrhythmias such as ventricular
fibrillation. It does not lower serum potassium but provides immediate cardioprotection
while other interventions reduce potassium levels.
Q9: A patient has a serum magnesium of 0.9 mEq/L. Which assessment finding is most
consistent with this value?
A. Absent deep tendon reflexes
B. Positive Chvostek's sign and cardiac dysrhythmias
C. Respiratory depression
D. Bradycardia
Correct Answer: B
Rationale: Hypomagnesemia (serum magnesium <1.5 mEq/L) causes neuromuscular
irritability manifested by positive Chvostek's and Trousseau's signs, tremors, seizures,
and cardiac dysrhythmias. Absent DTRs and respiratory depression are associated with
hypermagnesemia.
Q10: A patient with severe dehydration has a serum sodium of 152 mEq/L. Which
symptom should the nurse expect?
A. Confusion and seizures
