NUR265 ADVANCED MEDICAL-SURGICAL NURSING EXAM 1 – LATEST
2026/2027 UPDATE 400 QUESTIONS WITH VERIFIED ANSWERS &
DETAILED RATIONALES ALREADY GRADED A+
GALEN COLLEGE OF NURSING
SECTION 1: FLUID & ELECTROLYTE IMBALANCES (Questions 1–50)
1. A client with heart failure is admitted with fluid volume excess. Which
assessment finding is the priority for the nurse to report to the
healthcare provider?
A) +3 pitting edema in bilateral lower extremities
B) Jugular venous distention (JVD) at 45 degrees
C) Crackles auscultated in the lung bases
D) Weight gain of 2 kg (4.4 lbs) in 24 hours
Answer: C) Crackles auscultated in the lung bases
Rationale: Crackles (rales) in the lung bases indicate pulmonary congestion
and fluid accumulation in the alveoli, which is a sign of worsening heart
failure and impending pulmonary edema. This is a priority finding because
it represents a life-threatening complication of fluid volume excess that
requires immediate intervention. While JVD, edema, and weight gain are also
signs of fluid overload, crackles indicate the most acute and dangerous
progression—pulmonary involvement. The nurse should elevate the head of
the
bed, administer oxygen, and notify the healthcare provider immediately to
prevent respiratory failure. Untreated pulmonary edema can rapidly progress
to respiratory arrest and cardiac failure.
2. A client has a serum sodium level of 125 mEq/L. Which clinical manifestation
would the nurse expect to assess?
1
, A) Increased thirst and dry mucous membranes
B) Muscle twitching and hyperreflexia
C) Confusion, headache, and lethargy
D) Polydipsia and polyuria
Answer: C) Confusion, headache, and lethargy
Rationale: Hyponatremia (serum sodium < 135 mEq/L) causes water to shift
into brain cells due to osmotic gradient changes, leading to cerebral edema.
This results in neurologic symptoms including confusion, headache, lethargy,
and in severe cases, seizures and coma. Increased thirst and dry mucous
membranes are signs of hypernatremia (elevated sodium) because the body
attempts to compensate for cellular dehydration. Muscle twitching and
hyperreflexia are associated with hypocalcemia or hypomagnesemia, which
affect neuromuscular excitability. Polydipsia and polyuria are characteristic
of diabetes mellitus or diabetes insipidus, not hyponatremia. The nurse
should monitor neurologic status closely and implement fall precautions for
this client. Rapid correction of hyponatremia can cause osmotic demyelination
syndrome, so fluid restriction or hypertonic saline must be administered
carefully.
3. A client with chronic kidney disease has a serum potassium level of
6.8 mEq/L. Which intervention should the nurse implement first?
A) Administer oral sodium polystyrene sulfonate (Kayexalate)
B) Prepare for hemodialysis
C) Place the client on a cardiac monitor
D) Administer IV calcium gluconate
Answer: C) Place the client on a cardiac monitor
Rationale: Hyperkalemia (serum potassium > 5.0 mEq/L) is life-threatening
because it can cause fatal cardiac dysrhythmias, including ventricular
2
, fibrillation and asystole. The priority intervention is to place the client
on continuous cardiac monitoring to detect ECG changes early. ECG findings
in hyperkalemia include peaked T waves, widened QRS, prolonged PR interval,
and eventual sine-wave pattern or ventricular fibrillation. After initiating
monitoring, the nurse should administer calcium gluconate (to stabilize the
cardiac membrane), insulin with dextrose (to shift potassium into cells),
sodium polystyrene sulfonate (to remove potassium from the GI tract), and
prepare for hemodialysis if needed. Airway, breathing, and circulation
(including cardiac monitoring) are always the priorities in the ABCDE
framework. Without cardiac monitoring, lethal dysrhythmias may go unnoticed
until it is too late to intervene.
4. A client is receiving IV potassium chloride (KCl) 40 mEq in 100 mL of
normal saline. Which nursing action is essential when administering this
medication?
A) Administer via IV push over 2 minutes
B) Infuse through a central venous catheter only
C) Assess the IV site for phlebitis and infiltration
D) Mix with lactated Ringer's solution for optimal absorption
Answer: C) Assess the IV site for phlebitis and infiltration
Rationale: Potassium chloride is a severe tissue irritant. Extravasation
(leakage into surrounding tissues) can cause tissue necrosis, sloughing, and
significant injury. The nurse must assess the IV site frequently for signs
of phlebitis (redness, warmth, pain along the vein) or infiltration
(swelling, coolness, pallor). KCl should NEVER be administered via IV push
(bolus) because it can cause fatal cardiac arrest; it must be diluted and
infused at a rate no faster than 10–20 mEq/hr through a peripheral line or
up to 40 mEq/hr through a central line. Potassium should not be mixed with
lactated Ringer's solution because LR contains potassium and can lead to
hyperkalemia. Central venous access is preferred for concentrations >
3
, 40 mEq/L but not absolutely required for diluted solutions. Patient
education should include reporting any burning or pain at the IV site.
5. A client has arterial blood gas (ABG) results: pH 7.30, PaCO2 50 mmHg,
HCO3 24 mEq/L. The nurse interprets these results as:
A) Metabolic acidosis
B) Metabolic alkalosis
C) Respiratory acidosis
D) Respiratory alkalosis
Answer: C) Respiratory acidosis
Rationale: This ABG shows a low pH (7.30, normal 7.35–7.45), indicating
acidosis. The PaCO2 is elevated at 50 mmHg (normal 35–45 mmHg), which is
the
primary cause of the acidosis because CO2 is an acid. The HCO3 is normal at
24 mEq/L (normal 22–26 mEq/L), indicating no metabolic compensation is
occurring yet. The underlying problem is respiratory (elevated CO2 due to
hypoventilation), so this is uncompensated respiratory acidosis. This pattern
is commonly seen in conditions such as COPD exacerbation, pneumonia,
respiratory depression from opioid overdose, or neuromuscular disorders
affecting the respiratory muscles. If the kidneys compensate, the HCO3 would
begin to rise above 26 mEq/L. The nurse should assess respiratory status,
administer oxygen, and prepare to support ventilation if needed.
6. A client with diabetic ketoacidosis (DKA) has the following ABG results:
pH 7.28, PaCO2 30 mmHg, HCO3 16 mEq/L. Which interpretation is correct?
A) Metabolic acidosis with full respiratory compensation
B) Metabolic acidosis with partial respiratory compensation
C) Respiratory acidosis with metabolic compensation
D) Respiratory alkalosis with metabolic compensation
4
2026/2027 UPDATE 400 QUESTIONS WITH VERIFIED ANSWERS &
DETAILED RATIONALES ALREADY GRADED A+
GALEN COLLEGE OF NURSING
SECTION 1: FLUID & ELECTROLYTE IMBALANCES (Questions 1–50)
1. A client with heart failure is admitted with fluid volume excess. Which
assessment finding is the priority for the nurse to report to the
healthcare provider?
A) +3 pitting edema in bilateral lower extremities
B) Jugular venous distention (JVD) at 45 degrees
C) Crackles auscultated in the lung bases
D) Weight gain of 2 kg (4.4 lbs) in 24 hours
Answer: C) Crackles auscultated in the lung bases
Rationale: Crackles (rales) in the lung bases indicate pulmonary congestion
and fluid accumulation in the alveoli, which is a sign of worsening heart
failure and impending pulmonary edema. This is a priority finding because
it represents a life-threatening complication of fluid volume excess that
requires immediate intervention. While JVD, edema, and weight gain are also
signs of fluid overload, crackles indicate the most acute and dangerous
progression—pulmonary involvement. The nurse should elevate the head of
the
bed, administer oxygen, and notify the healthcare provider immediately to
prevent respiratory failure. Untreated pulmonary edema can rapidly progress
to respiratory arrest and cardiac failure.
2. A client has a serum sodium level of 125 mEq/L. Which clinical manifestation
would the nurse expect to assess?
1
, A) Increased thirst and dry mucous membranes
B) Muscle twitching and hyperreflexia
C) Confusion, headache, and lethargy
D) Polydipsia and polyuria
Answer: C) Confusion, headache, and lethargy
Rationale: Hyponatremia (serum sodium < 135 mEq/L) causes water to shift
into brain cells due to osmotic gradient changes, leading to cerebral edema.
This results in neurologic symptoms including confusion, headache, lethargy,
and in severe cases, seizures and coma. Increased thirst and dry mucous
membranes are signs of hypernatremia (elevated sodium) because the body
attempts to compensate for cellular dehydration. Muscle twitching and
hyperreflexia are associated with hypocalcemia or hypomagnesemia, which
affect neuromuscular excitability. Polydipsia and polyuria are characteristic
of diabetes mellitus or diabetes insipidus, not hyponatremia. The nurse
should monitor neurologic status closely and implement fall precautions for
this client. Rapid correction of hyponatremia can cause osmotic demyelination
syndrome, so fluid restriction or hypertonic saline must be administered
carefully.
3. A client with chronic kidney disease has a serum potassium level of
6.8 mEq/L. Which intervention should the nurse implement first?
A) Administer oral sodium polystyrene sulfonate (Kayexalate)
B) Prepare for hemodialysis
C) Place the client on a cardiac monitor
D) Administer IV calcium gluconate
Answer: C) Place the client on a cardiac monitor
Rationale: Hyperkalemia (serum potassium > 5.0 mEq/L) is life-threatening
because it can cause fatal cardiac dysrhythmias, including ventricular
2
, fibrillation and asystole. The priority intervention is to place the client
on continuous cardiac monitoring to detect ECG changes early. ECG findings
in hyperkalemia include peaked T waves, widened QRS, prolonged PR interval,
and eventual sine-wave pattern or ventricular fibrillation. After initiating
monitoring, the nurse should administer calcium gluconate (to stabilize the
cardiac membrane), insulin with dextrose (to shift potassium into cells),
sodium polystyrene sulfonate (to remove potassium from the GI tract), and
prepare for hemodialysis if needed. Airway, breathing, and circulation
(including cardiac monitoring) are always the priorities in the ABCDE
framework. Without cardiac monitoring, lethal dysrhythmias may go unnoticed
until it is too late to intervene.
4. A client is receiving IV potassium chloride (KCl) 40 mEq in 100 mL of
normal saline. Which nursing action is essential when administering this
medication?
A) Administer via IV push over 2 minutes
B) Infuse through a central venous catheter only
C) Assess the IV site for phlebitis and infiltration
D) Mix with lactated Ringer's solution for optimal absorption
Answer: C) Assess the IV site for phlebitis and infiltration
Rationale: Potassium chloride is a severe tissue irritant. Extravasation
(leakage into surrounding tissues) can cause tissue necrosis, sloughing, and
significant injury. The nurse must assess the IV site frequently for signs
of phlebitis (redness, warmth, pain along the vein) or infiltration
(swelling, coolness, pallor). KCl should NEVER be administered via IV push
(bolus) because it can cause fatal cardiac arrest; it must be diluted and
infused at a rate no faster than 10–20 mEq/hr through a peripheral line or
up to 40 mEq/hr through a central line. Potassium should not be mixed with
lactated Ringer's solution because LR contains potassium and can lead to
hyperkalemia. Central venous access is preferred for concentrations >
3
, 40 mEq/L but not absolutely required for diluted solutions. Patient
education should include reporting any burning or pain at the IV site.
5. A client has arterial blood gas (ABG) results: pH 7.30, PaCO2 50 mmHg,
HCO3 24 mEq/L. The nurse interprets these results as:
A) Metabolic acidosis
B) Metabolic alkalosis
C) Respiratory acidosis
D) Respiratory alkalosis
Answer: C) Respiratory acidosis
Rationale: This ABG shows a low pH (7.30, normal 7.35–7.45), indicating
acidosis. The PaCO2 is elevated at 50 mmHg (normal 35–45 mmHg), which is
the
primary cause of the acidosis because CO2 is an acid. The HCO3 is normal at
24 mEq/L (normal 22–26 mEq/L), indicating no metabolic compensation is
occurring yet. The underlying problem is respiratory (elevated CO2 due to
hypoventilation), so this is uncompensated respiratory acidosis. This pattern
is commonly seen in conditions such as COPD exacerbation, pneumonia,
respiratory depression from opioid overdose, or neuromuscular disorders
affecting the respiratory muscles. If the kidneys compensate, the HCO3 would
begin to rise above 26 mEq/L. The nurse should assess respiratory status,
administer oxygen, and prepare to support ventilation if needed.
6. A client with diabetic ketoacidosis (DKA) has the following ABG results:
pH 7.28, PaCO2 30 mmHg, HCO3 16 mEq/L. Which interpretation is correct?
A) Metabolic acidosis with full respiratory compensation
B) Metabolic acidosis with partial respiratory compensation
C) Respiratory acidosis with metabolic compensation
D) Respiratory alkalosis with metabolic compensation
4
