NUR 242 / NUR242 Medical-Surgical Nursing Exam 1
Practice Test Actual 2025/2026 with Detailed
Rationales | 100% Verified | Pass Guaranteed – A+
Graded
SECTION 1: FLUID, ELECTROLYTE, & ACID-BASE BALANCE (10 Questions)
Q1. A patient has a serum sodium level of 125 mEq/L. Which assessment finding is
most concerning?
● A. Thirst
● B. Muscle twitching
● C. Confusion and lethargy
● D. Dry mucous membranes
● Correct Answer: C
● Rationale: Hyponatremia (Na <135 mEq/L) causes cerebral edema leading to
confusion, lethargy, and seizures.
Q2. A patient's arterial blood gas shows pH 7.25, PaCO2 55 mmHg, HCO3 24 mEq/L.
What is the acid-base disorder?
● A. Metabolic acidosis
● B. Metabolic alkalosis
● C. Respiratory acidosis
● D. Respiratory alkalosis
● Correct Answer: C
● Rationale: Low pH with elevated PaCO2 indicates respiratory acidosis.
Q3. A patient with hypovolemic shock has a heart rate of 130 bpm and blood
pressure of 82/50 mmHg. Which fluid is most appropriate?
● A. Hypotonic solution
● B. Hypertonic solution
, ● C. Isotonic crystalloid
● D. Colloid only
● Correct Answer: C
● Rationale: Isotonic crystalloids (NS or LR) are first-line for fluid resuscitation.
Q4. A patient has a serum potassium level of 6.8 mEq/L. Which EKG change is
expected?
● A. U waves
● B. Flattened T waves
● C. Tall peaked T waves
● D. ST depression
● Correct Answer: C
● Rationale: Tall peaked T waves are characteristic of hyperkalemia.
Q5. A patient's ABG shows pH 7.50, PaCO2 40 mmHg, HCO3 32 mEq/L. What is the
acid-base disorder?
● A. Metabolic acidosis
● B. Metabolic alkalosis
● C. Respiratory acidosis
● D. Respiratory alkalosis
● Correct Answer: B
● Rationale: Elevated pH with elevated HCO3 indicates metabolic alkalosis.
Q6. A patient with hyperkalemia is prescribed sodium polystyrene sulfonate. What is
the mechanism?
● A. Increases potassium excretion in urine
● B. Binds potassium in the gastrointestinal tract
● C. Increases aldosterone production
● D. Promotes potassium movement into cells
● Correct Answer: B
● Rationale: Sodium polystyrene sulfonate exchanges sodium for potassium in
the GI tract.
Q7. A patient has a serum calcium level of 7.2 mg/dL. Which assessment finding is
expected?
● A. Muscle spasms
● B. Constipation
, ● C. Lethargy
● D. Thirst
● Correct Answer: A
● Rationale: Hypocalcemia causes muscle twitching and spasms (tetany).
Q8. A patient who is NPO for surgery is at risk for which electrolyte imbalance?
● A. Hypokalemia
● B. Hyperkalemia
● C. Hyponatremia
● D. Hypercalcemia
● Correct Answer: A
● Rationale: NPO status can lead to potassium depletion.
Q9. A patient's ABG shows pH 7.32, PaCO2 30 mmHg, HCO3 18 mEq/L. What is the
acid-base disorder?
● A. Metabolic acidosis
● B. Metabolic alkalosis
● C. Respiratory acidosis
● D. Respiratory alkalosis
● Correct Answer: A
● Rationale: Low pH and low HCO3 indicate metabolic acidosis.
Q10. A patient with a sodium level of 118 mEq/L is at risk for which complication?
● A. Seizures
● B. Muscle cramps
● C. Hypertension
● D. Tachycardia
● Correct Answer: A
● Rationale: Severe hyponatremia causes cerebral edema and seizures.
SECTION 2: PERIOPERATIVE NURSING CARE (8 Questions)
Q11. A patient is 6 hours post-operative from abdominal surgery and reports severe
pain. The nurse administers morphine 2 mg IV. What is the most important
assessment to perform?
Practice Test Actual 2025/2026 with Detailed
Rationales | 100% Verified | Pass Guaranteed – A+
Graded
SECTION 1: FLUID, ELECTROLYTE, & ACID-BASE BALANCE (10 Questions)
Q1. A patient has a serum sodium level of 125 mEq/L. Which assessment finding is
most concerning?
● A. Thirst
● B. Muscle twitching
● C. Confusion and lethargy
● D. Dry mucous membranes
● Correct Answer: C
● Rationale: Hyponatremia (Na <135 mEq/L) causes cerebral edema leading to
confusion, lethargy, and seizures.
Q2. A patient's arterial blood gas shows pH 7.25, PaCO2 55 mmHg, HCO3 24 mEq/L.
What is the acid-base disorder?
● A. Metabolic acidosis
● B. Metabolic alkalosis
● C. Respiratory acidosis
● D. Respiratory alkalosis
● Correct Answer: C
● Rationale: Low pH with elevated PaCO2 indicates respiratory acidosis.
Q3. A patient with hypovolemic shock has a heart rate of 130 bpm and blood
pressure of 82/50 mmHg. Which fluid is most appropriate?
● A. Hypotonic solution
● B. Hypertonic solution
, ● C. Isotonic crystalloid
● D. Colloid only
● Correct Answer: C
● Rationale: Isotonic crystalloids (NS or LR) are first-line for fluid resuscitation.
Q4. A patient has a serum potassium level of 6.8 mEq/L. Which EKG change is
expected?
● A. U waves
● B. Flattened T waves
● C. Tall peaked T waves
● D. ST depression
● Correct Answer: C
● Rationale: Tall peaked T waves are characteristic of hyperkalemia.
Q5. A patient's ABG shows pH 7.50, PaCO2 40 mmHg, HCO3 32 mEq/L. What is the
acid-base disorder?
● A. Metabolic acidosis
● B. Metabolic alkalosis
● C. Respiratory acidosis
● D. Respiratory alkalosis
● Correct Answer: B
● Rationale: Elevated pH with elevated HCO3 indicates metabolic alkalosis.
Q6. A patient with hyperkalemia is prescribed sodium polystyrene sulfonate. What is
the mechanism?
● A. Increases potassium excretion in urine
● B. Binds potassium in the gastrointestinal tract
● C. Increases aldosterone production
● D. Promotes potassium movement into cells
● Correct Answer: B
● Rationale: Sodium polystyrene sulfonate exchanges sodium for potassium in
the GI tract.
Q7. A patient has a serum calcium level of 7.2 mg/dL. Which assessment finding is
expected?
● A. Muscle spasms
● B. Constipation
, ● C. Lethargy
● D. Thirst
● Correct Answer: A
● Rationale: Hypocalcemia causes muscle twitching and spasms (tetany).
Q8. A patient who is NPO for surgery is at risk for which electrolyte imbalance?
● A. Hypokalemia
● B. Hyperkalemia
● C. Hyponatremia
● D. Hypercalcemia
● Correct Answer: A
● Rationale: NPO status can lead to potassium depletion.
Q9. A patient's ABG shows pH 7.32, PaCO2 30 mmHg, HCO3 18 mEq/L. What is the
acid-base disorder?
● A. Metabolic acidosis
● B. Metabolic alkalosis
● C. Respiratory acidosis
● D. Respiratory alkalosis
● Correct Answer: A
● Rationale: Low pH and low HCO3 indicate metabolic acidosis.
Q10. A patient with a sodium level of 118 mEq/L is at risk for which complication?
● A. Seizures
● B. Muscle cramps
● C. Hypertension
● D. Tachycardia
● Correct Answer: A
● Rationale: Severe hyponatremia causes cerebral edema and seizures.
SECTION 2: PERIOPERATIVE NURSING CARE (8 Questions)
Q11. A patient is 6 hours post-operative from abdominal surgery and reports severe
pain. The nurse administers morphine 2 mg IV. What is the most important
assessment to perform?
