NUR 242 Exams 1–4 – Med-Surg Nursing Concepts – (2026) Actual Questions & Answers (GCN) 100% Guarantee Pass 2026/2027
OBJECTIVE ASSESSMENT - EXAM
NUR 242 Exams 1-4 - Med-Surg Nursing
Concepts - (2026) Actual Questions &
Answers (GCN) 100% Guarantee Pass
2026/2027
200 100%
QUESTIONS VERIFIED ANSWERS EDITION
TOPICS COVERED
Perioperative Care & Fluid/Electrolyte Balance Neurological & Musculoskeletal Disorders
Cardiovascular & Respiratory Disorders Acid-Base Balance & Shock Management
Gastrointestinal, Renal & Endocrine Systems Complex Multisystem Critical Care
COVER PAGE - 1
R 242 Exams 1-4 - Med-Surg Nursing Concepts - (2026) Actual Questions & Answers (GCN) 100% Guarantee Pass 2026/2027 - 2026/2027 | Passing Score: 80% | Page 1 of
,SECTION 1 | Perioperative Care, Fluids & Electrolytes, and Acid-Base Balance | Q1-Q50 | 2026/2027
Q1 Question 1 of 200
A 67-year-old male is scheduled for an elective total hip arthroplasty tomorrow morning. During
preoperative teaching, the nurse instructs the patient on use of the incentive spirometer. Which
patient action indicates the need for further teaching?
A. Sitting upright at the edge of the bed before using the device
B. Inhaling sharply and rapidly through the mouthpiece to raise the piston
C. Holding the breath for 3 to 5 seconds at peak inspiration
D. Using the device 10 times every hour while awake
Correct Answer: B
Rationale:
Slow, sustained inhalation rather than a sharp rapid breath is required to maximize alveolar expansion
and prevent postoperative atelectasis. Sharp rapid inhalation does not sustain flow long enough to
effectively inflate dependent alveoli. The other actions are correct techniques.
Q2 Question 2 of 200
A 42-year-old female is receiving 0.9% normal saline at 125 mL/hr following an appendectomy. The
morning labs show serum sodium of 132 mEq/L and mild ankle edema. Which finding most strongly
indicates fluid volume overload rather than simple dilutional hyponatremia?
A. Dry oral mucosa with cracked lips
B. Jugular venous distension with the head of bed at 45 degrees
C. Hyperactive deep tendon reflexes in the biceps
D. Urine specific gravity reading of 1.030
Correct Answer: B
Rationale:
Jugular venous distension at 45 degrees reflects elevated right atrial pressure characteristic of fluid
volume overload. Dry mucosa and high specific gravity suggest dehydration, while hyperactive reflexes
suggest hyponatremia of other causes. These findings distinguish overload from dilutional hyponatremia.
, Q3 Question 3 of 200
A 58-year-old male is admitted with severe vomiting for three days. Arterial blood gases reveal pH
7.50, PaCO2 46 mmHg, HCO3 34 mEq/L. Which primary acid-base imbalance does this patient
exhibit?
A. Uncompensated respiratory alkalosis
B. Compensated metabolic acidosis
C. Partially compensated metabolic alkalosis
D. Uncompensated respiratory acidosis
Correct Answer: C
Rationale:
An elevated pH with elevated HCO3 indicates metabolic alkalosis, and the elevated PaCO2 shows partial
respiratory compensation. Vomiting causes loss of gastric acid, driving the alkalosis. The respiratory
system attempts to compensate by retaining CO2 through hypoventilation.
Q4 Question 4 of 200
A 73-year-old female received morphine 4 mg IV twenty minutes ago for postoperative pain after a
cholecystectomy. She is now somnolent with a respiratory rate of 8 breaths per minute and an SpO2
of 88% on room air. Which medication should the nurse prepare to administer?
A. Naloxone 0.4 mg IV push
B. Flumazenil 0.2 mg IV
C. Nalbuphine 10 mg IV
D. Furosemide 20 mg IV
Correct Answer: A
Rationale:
Naloxone is the opioid antagonist used to reverse opioid-induced respiratory depression. The low
respiratory rate and oxygen saturation following IV morphine indicate opioid toxicity requiring reversal.
Flumazenil reverses benzodiazepines, and nalbuphine is an agonist-antagonist not appropriate for acute
reversal.
R 242 Exams 1-4 - Med-Surg Nursing Concepts - (2026) Actual Questions & Answers (GCN) 100% Guarantee Pass 2026/2027 - 2026/2027 | Passing Score: 80% | Page 2 of
, Q5 Question 5 of 200
A 55-year-old male with a small bowel obstruction has a nasogastric tube to low intermittent suction.
His morning labs show K 3.1 mEq/L, Cl 88 mEq/L, pH 7.48, HCO3 32 mEq/L. Which imbalance
pattern is most concerning and should be corrected first?
A. Hypokalemic hypochloremic metabolic alkalosis
B. Hyperkalemic metabolic acidosis
C. Respiratory acidosis with hyperchloremia
D. Metabolic acidosis with hypokalemia
Correct Answer: A
Rationale:
NG suction removes hydrogen, chloride, and potassium, producing the classic hypokalemic
hypochloremic metabolic alkalosis. The low chloride perpetuates the alkalosis by forcing bicarbonate
reabsorption. Correcting chloride and potassium is essential before the alkalosis can resolve.
Q6 Question 6 of 200
A 64-year-old male is 6 hours postoperative after a colon resection. He reports pain at 8/10 and has
not used the incentive spirometer since surgery. His SpO2 is 93% on room air. Which nursing action
is the priority?
A. Administer the prescribed PRN ondansetron for nausea
B. Medicate for pain, then coach the patient on incentive spirometry
C. Apply oxygen at 2 L/min via nasal cannula
D. Encourage ambulation in the hallway with assistance
Correct Answer: B
Rationale:
Uncontrolled pain inhibits deep breathing, so analgesia must be given before incentive spirometry
coaching will be effective. Treating pain addresses the root cause of poor ventilation. Oxygen would treat
the number but not the underlying splinting and shallow breathing.
R 242 Exams 1-4 - Med-Surg Nursing Concepts - (2026) Actual Questions & Answers (GCN) 100% Guarantee Pass 2026/2027 - 2026/2027 | Passing Score: 80% | Page 3 of
OBJECTIVE ASSESSMENT - EXAM
NUR 242 Exams 1-4 - Med-Surg Nursing
Concepts - (2026) Actual Questions &
Answers (GCN) 100% Guarantee Pass
2026/2027
200 100%
QUESTIONS VERIFIED ANSWERS EDITION
TOPICS COVERED
Perioperative Care & Fluid/Electrolyte Balance Neurological & Musculoskeletal Disorders
Cardiovascular & Respiratory Disorders Acid-Base Balance & Shock Management
Gastrointestinal, Renal & Endocrine Systems Complex Multisystem Critical Care
COVER PAGE - 1
R 242 Exams 1-4 - Med-Surg Nursing Concepts - (2026) Actual Questions & Answers (GCN) 100% Guarantee Pass 2026/2027 - 2026/2027 | Passing Score: 80% | Page 1 of
,SECTION 1 | Perioperative Care, Fluids & Electrolytes, and Acid-Base Balance | Q1-Q50 | 2026/2027
Q1 Question 1 of 200
A 67-year-old male is scheduled for an elective total hip arthroplasty tomorrow morning. During
preoperative teaching, the nurse instructs the patient on use of the incentive spirometer. Which
patient action indicates the need for further teaching?
A. Sitting upright at the edge of the bed before using the device
B. Inhaling sharply and rapidly through the mouthpiece to raise the piston
C. Holding the breath for 3 to 5 seconds at peak inspiration
D. Using the device 10 times every hour while awake
Correct Answer: B
Rationale:
Slow, sustained inhalation rather than a sharp rapid breath is required to maximize alveolar expansion
and prevent postoperative atelectasis. Sharp rapid inhalation does not sustain flow long enough to
effectively inflate dependent alveoli. The other actions are correct techniques.
Q2 Question 2 of 200
A 42-year-old female is receiving 0.9% normal saline at 125 mL/hr following an appendectomy. The
morning labs show serum sodium of 132 mEq/L and mild ankle edema. Which finding most strongly
indicates fluid volume overload rather than simple dilutional hyponatremia?
A. Dry oral mucosa with cracked lips
B. Jugular venous distension with the head of bed at 45 degrees
C. Hyperactive deep tendon reflexes in the biceps
D. Urine specific gravity reading of 1.030
Correct Answer: B
Rationale:
Jugular venous distension at 45 degrees reflects elevated right atrial pressure characteristic of fluid
volume overload. Dry mucosa and high specific gravity suggest dehydration, while hyperactive reflexes
suggest hyponatremia of other causes. These findings distinguish overload from dilutional hyponatremia.
, Q3 Question 3 of 200
A 58-year-old male is admitted with severe vomiting for three days. Arterial blood gases reveal pH
7.50, PaCO2 46 mmHg, HCO3 34 mEq/L. Which primary acid-base imbalance does this patient
exhibit?
A. Uncompensated respiratory alkalosis
B. Compensated metabolic acidosis
C. Partially compensated metabolic alkalosis
D. Uncompensated respiratory acidosis
Correct Answer: C
Rationale:
An elevated pH with elevated HCO3 indicates metabolic alkalosis, and the elevated PaCO2 shows partial
respiratory compensation. Vomiting causes loss of gastric acid, driving the alkalosis. The respiratory
system attempts to compensate by retaining CO2 through hypoventilation.
Q4 Question 4 of 200
A 73-year-old female received morphine 4 mg IV twenty minutes ago for postoperative pain after a
cholecystectomy. She is now somnolent with a respiratory rate of 8 breaths per minute and an SpO2
of 88% on room air. Which medication should the nurse prepare to administer?
A. Naloxone 0.4 mg IV push
B. Flumazenil 0.2 mg IV
C. Nalbuphine 10 mg IV
D. Furosemide 20 mg IV
Correct Answer: A
Rationale:
Naloxone is the opioid antagonist used to reverse opioid-induced respiratory depression. The low
respiratory rate and oxygen saturation following IV morphine indicate opioid toxicity requiring reversal.
Flumazenil reverses benzodiazepines, and nalbuphine is an agonist-antagonist not appropriate for acute
reversal.
R 242 Exams 1-4 - Med-Surg Nursing Concepts - (2026) Actual Questions & Answers (GCN) 100% Guarantee Pass 2026/2027 - 2026/2027 | Passing Score: 80% | Page 2 of
, Q5 Question 5 of 200
A 55-year-old male with a small bowel obstruction has a nasogastric tube to low intermittent suction.
His morning labs show K 3.1 mEq/L, Cl 88 mEq/L, pH 7.48, HCO3 32 mEq/L. Which imbalance
pattern is most concerning and should be corrected first?
A. Hypokalemic hypochloremic metabolic alkalosis
B. Hyperkalemic metabolic acidosis
C. Respiratory acidosis with hyperchloremia
D. Metabolic acidosis with hypokalemia
Correct Answer: A
Rationale:
NG suction removes hydrogen, chloride, and potassium, producing the classic hypokalemic
hypochloremic metabolic alkalosis. The low chloride perpetuates the alkalosis by forcing bicarbonate
reabsorption. Correcting chloride and potassium is essential before the alkalosis can resolve.
Q6 Question 6 of 200
A 64-year-old male is 6 hours postoperative after a colon resection. He reports pain at 8/10 and has
not used the incentive spirometer since surgery. His SpO2 is 93% on room air. Which nursing action
is the priority?
A. Administer the prescribed PRN ondansetron for nausea
B. Medicate for pain, then coach the patient on incentive spirometry
C. Apply oxygen at 2 L/min via nasal cannula
D. Encourage ambulation in the hallway with assistance
Correct Answer: B
Rationale:
Uncontrolled pain inhibits deep breathing, so analgesia must be given before incentive spirometry
coaching will be effective. Treating pain addresses the root cause of poor ventilation. Oxygen would treat
the number but not the underlying splinting and shallow breathing.
R 242 Exams 1-4 - Med-Surg Nursing Concepts - (2026) Actual Questions & Answers (GCN) 100% Guarantee Pass 2026/2027 - 2026/2027 | Passing Score: 80% | Page 3 of
