Galen College NUR 242 Exam 2 (pdf) | 2026/2027 | Med-Surg Q&A |
Medical-Surgical Nursing
1. A client with heart failure is being monitored for fluid volume status. Which
intervention is the most effective for monitoring this client?
A) Monitor urine specific gravity once per shift.
B) Assess skin turgor every 4 hours.
C) Weigh the client every morning before breakfast.
D) Measure oral intake each shift.
Correct Answer: Weigh the client every morning before breakfast.
Rationale: Daily weight at the same time, using the same scale, and with the
client wearing similar clothing is the most sensitive indicator of overall fluid
status. Weight changes reflect fluid shifts earlier and more accurately than
skin turgor, intake and output, or urine specific gravity, especially in clients
with heart failure.
2. A client has a serum potassium level of 2.5 mEq/L. Which action should
the nurse take when preparing to administer IV potassium chloride?
A) Administer KCl IV push for rapid correction.
B) Confirm adequate blood return of the IV access before administration.
C) Mix potassium in a small syringe to reduce fluid volume.
D) Give potassium without an infusion pump.
Correct Answer: Confirm adequate blood return of the IV access before
administration.
Rationale: Potassium is a vesicant and an irritant; infiltration can cause
severe tissue injury. It must be administered via an infusion pump and never
,given as an IV push or bolus. Confirming adequate blood return ensures the
IV is patent and reduces the risk of infiltration.
3. A client with diabetes insipidus is demonstrating signs of dehydration.
Which laboratory finding would the nurse expect?
A) Decreased serum osmolality.
B) Decreased urine specific gravity.
C) Decreased serum sodium.
D) Decreased BUN.
Correct Answer: Decreased urine specific gravity.
Rationale: Diabetes insipidus is characterized by a deficiency of ADH, leading
to the excretion of large volumes of dilute urine. Urine specific gravity is
decreased (<1.005) and serum osmolality is increased (>295 mOsm/kg) due
to water loss.
4. A client is admitted with fluid volume overload. Which assessment finding
is most consistent with this condition?
A) Orthostatic hypotension.
B) Dry mucous membranes.
C) Distended neck veins.
D) Decreased skin turgor.
Correct Answer: Distended neck veins.
Rationale: Distended neck veins (jugular venous distension) are a sign of
fluid volume excess. Orthostatic hypotension, dry mucous membranes, and
decreased skin turgor are signs of fluid volume deficit.
,5. The nurse is caring for a client with a serum sodium level of 120 mEq/L.
Which sign would the nurse expect to find?
A) Thirst and dry mucous membranes.
B) Muscle cramps and hyperreflexia.
C) Confusion and seizures.
D) Hypertension and bounding pulses.
Correct Answer: Confusion and seizures.
Rationale: Hyponatremia (serum sodium <135 mEq/L) causes water to shift
into brain cells, leading to cerebral edema. Neurological changes such as
confusion, seizures, and coma are the primary concerns. Thirst and dry
mucous membranes are signs of hypernatremia. Muscle cramps and
hyperreflexia are signs of hypocalcemia.
6. A client is exhibiting signs of hyperkalemia. Which ECG change would the
nurse expect to observe?
A) Flattened T waves.
B) Prominent U waves.
C) Peaked T waves.
D) ST segment depression.
Correct Answer: Peaked T waves.
Rationale: Hyperkalemia (serum potassium >5.0 mEq/L) is characterized by
peaked (tall, tented) T waves on the ECG. Flattened T waves and ST
depression are seen in hypokalemia. Prominent U waves are associated with
hypokalemia.
, 7. The nurse is caring for a client with metabolic acidosis. Which
compensatory mechanism would the nurse expect?
A) Decreased respiratory rate.
B) Increased respiratory rate.
C) Decreased heart rate.
D) Increased blood pressure.
Correct Answer: Increased respiratory rate.
Rationale: In metabolic acidosis, the respiratory system compensates by
increasing the rate and depth of breathing (Kussmaul respirations) to exhale
more CO2, which is an acid. This is a rapid compensatory mechanism.
Decreased respiratory rate would worsen the acidosis.
8. A client's arterial blood gas (ABG) results show a pH of 7.30, PaCO2 of 55
mmHg, and HCO3 of 24 mEq/L. Which acid-base imbalance is present?
A) Metabolic acidosis.
B) Metabolic alkalosis.
C) Respiratory acidosis.
D) Respiratory alkalosis.
Correct Answer: Respiratory acidosis.
Rationale: The pH is low (acidosis) and the PaCO2 is elevated (>45 mmHg),
which is consistent with respiratory acidosis. The HCO3 is normal, indicating
that this is an acute respiratory acidosis without renal compensation. The
ROME method (Respiratory Opposite, Metabolic Equal) can be used to
interpret ABGs.
Medical-Surgical Nursing
1. A client with heart failure is being monitored for fluid volume status. Which
intervention is the most effective for monitoring this client?
A) Monitor urine specific gravity once per shift.
B) Assess skin turgor every 4 hours.
C) Weigh the client every morning before breakfast.
D) Measure oral intake each shift.
Correct Answer: Weigh the client every morning before breakfast.
Rationale: Daily weight at the same time, using the same scale, and with the
client wearing similar clothing is the most sensitive indicator of overall fluid
status. Weight changes reflect fluid shifts earlier and more accurately than
skin turgor, intake and output, or urine specific gravity, especially in clients
with heart failure.
2. A client has a serum potassium level of 2.5 mEq/L. Which action should
the nurse take when preparing to administer IV potassium chloride?
A) Administer KCl IV push for rapid correction.
B) Confirm adequate blood return of the IV access before administration.
C) Mix potassium in a small syringe to reduce fluid volume.
D) Give potassium without an infusion pump.
Correct Answer: Confirm adequate blood return of the IV access before
administration.
Rationale: Potassium is a vesicant and an irritant; infiltration can cause
severe tissue injury. It must be administered via an infusion pump and never
,given as an IV push or bolus. Confirming adequate blood return ensures the
IV is patent and reduces the risk of infiltration.
3. A client with diabetes insipidus is demonstrating signs of dehydration.
Which laboratory finding would the nurse expect?
A) Decreased serum osmolality.
B) Decreased urine specific gravity.
C) Decreased serum sodium.
D) Decreased BUN.
Correct Answer: Decreased urine specific gravity.
Rationale: Diabetes insipidus is characterized by a deficiency of ADH, leading
to the excretion of large volumes of dilute urine. Urine specific gravity is
decreased (<1.005) and serum osmolality is increased (>295 mOsm/kg) due
to water loss.
4. A client is admitted with fluid volume overload. Which assessment finding
is most consistent with this condition?
A) Orthostatic hypotension.
B) Dry mucous membranes.
C) Distended neck veins.
D) Decreased skin turgor.
Correct Answer: Distended neck veins.
Rationale: Distended neck veins (jugular venous distension) are a sign of
fluid volume excess. Orthostatic hypotension, dry mucous membranes, and
decreased skin turgor are signs of fluid volume deficit.
,5. The nurse is caring for a client with a serum sodium level of 120 mEq/L.
Which sign would the nurse expect to find?
A) Thirst and dry mucous membranes.
B) Muscle cramps and hyperreflexia.
C) Confusion and seizures.
D) Hypertension and bounding pulses.
Correct Answer: Confusion and seizures.
Rationale: Hyponatremia (serum sodium <135 mEq/L) causes water to shift
into brain cells, leading to cerebral edema. Neurological changes such as
confusion, seizures, and coma are the primary concerns. Thirst and dry
mucous membranes are signs of hypernatremia. Muscle cramps and
hyperreflexia are signs of hypocalcemia.
6. A client is exhibiting signs of hyperkalemia. Which ECG change would the
nurse expect to observe?
A) Flattened T waves.
B) Prominent U waves.
C) Peaked T waves.
D) ST segment depression.
Correct Answer: Peaked T waves.
Rationale: Hyperkalemia (serum potassium >5.0 mEq/L) is characterized by
peaked (tall, tented) T waves on the ECG. Flattened T waves and ST
depression are seen in hypokalemia. Prominent U waves are associated with
hypokalemia.
, 7. The nurse is caring for a client with metabolic acidosis. Which
compensatory mechanism would the nurse expect?
A) Decreased respiratory rate.
B) Increased respiratory rate.
C) Decreased heart rate.
D) Increased blood pressure.
Correct Answer: Increased respiratory rate.
Rationale: In metabolic acidosis, the respiratory system compensates by
increasing the rate and depth of breathing (Kussmaul respirations) to exhale
more CO2, which is an acid. This is a rapid compensatory mechanism.
Decreased respiratory rate would worsen the acidosis.
8. A client's arterial blood gas (ABG) results show a pH of 7.30, PaCO2 of 55
mmHg, and HCO3 of 24 mEq/L. Which acid-base imbalance is present?
A) Metabolic acidosis.
B) Metabolic alkalosis.
C) Respiratory acidosis.
D) Respiratory alkalosis.
Correct Answer: Respiratory acidosis.
Rationale: The pH is low (acidosis) and the PaCO2 is elevated (>45 mmHg),
which is consistent with respiratory acidosis. The HCO3 is normal, indicating
that this is an acute respiratory acidosis without renal compensation. The
ROME method (Respiratory Opposite, Metabolic Equal) can be used to
interpret ABGs.
