NUR 230 Exam 1 (Updated 2026–2027 Edition) |
Health Assessment & Nursing Fundamentals
Review | Comprehensive Study Guide with Practice
Questions, Answers & Detailed Rationales | A+
Success Resource
NURSING FUNDAMENTALS
COMPREHENSIVE STUDY WORKBOOK
60 High-Yield Practice Questions with Full Rationales
Based on Nursing Fundamentals Comprehensive Exam 2024
HOW TO USE THIS WORKBOOK
This workbook contains 60 multiple-choice questions reverse-engineered from Nursing
Fundamentals Comprehensive Exam 2024 content. Questions mirror the tone, format, and difficulty
of clinical NCLEX-style questions. For each question: (1) Read the clinical scenario carefully. (2)
Select your answer before reading the rationale. (3) Study the Distractor Analysis to understand
why the wrong options are tempting.
DOMAIN DISTRIBUTION
PRACTICE QUESTIONS
Question 1 (Domain: Electrolytes & Fluid Balance)
A patient admitted with prolonged vomiting is noted to have generalized muscle weakness and leg
cramps. The practical nurse (PN) anticipates that which laboratory finding is most consistent with
these manifestations?
A) Serum sodium 148 mEq/L
B) Serum potassium 2.8 mEq/L
C) Serum calcium 10.5 mg/dL
D) Serum magnesium 2.1 mEq/L
Correct Answer: B
Rationale: Hypokalemia (low serum potassium) impairs the sodium-potassium pump mechanism,
resulting in muscle weakness and leg cramps. Prolonged vomiting causes significant potassium
loss through gastric secretions.
Distractor Analysis: Hypernatremia (A) causes neurological symptoms, not leg cramps; normal
calcium (C) and magnesium (D) values would not explain these findings.
Question 2 (Domain: Electrolytes & Fluid Balance)
A PN is reviewing the cardiac monitor of a patient with a serum potassium of 2.6 mEq/L. Which
cardiac dysrhythmia should the PN anticipate?
A) Sinus bradycardia
,B) Peaked T-waves
C) Premature ventricular contractions (PVCs)
D) Widened QRS complexes
Correct Answer: C
Rationale: Hypokalemia increases myocardial irritability, predisposing the patient to premature
ventricular contractions (PVCs) and potentially life-threatening dysrhythmias. Potassium is critical
for normal cardiac conduction.
Distractor Analysis: Peaked T-waves (B) and widened QRS complexes (D) are hallmarks of
hyperkalemia; bradycardia (A) is also associated with hyperkalemia, not hypokalemia.
Question 3 (Domain: Electrolytes & Fluid Balance)
A patient's serum potassium is 6.8 mEq/L. The PN reviews the ECG and expects to find which
change first?
A) Flattened P-waves and prominent U-waves
B) Tall, peaked T-waves and a shortened QT interval
C) ST-segment depression and presence of U-waves
D) Prolonged PR interval only
Correct Answer: B
Rationale: The earliest ECG change in hyperkalemia is tall, peaked (tent-shaped) T-waves,
accompanied by a shortened QT interval, reflecting accelerated ventricular repolarization.
Distractor Analysis: Flattened P-waves and U-waves (A) and ST depression with U-waves (C) are
classic hypokalemia changes; a prolonged PR interval alone (D) appears later in hyperkalemia
progression.
Question 4 (Domain: Electrolytes & Fluid Balance)
A patient receiving aggressive IV fluid replacement for dehydration develops bounding pulses,
jugular vein distension, and crackles in the lung bases. The PN recognizes these findings as
indicative of which condition?
A) Hypovolemia
B) Third-spacing
C) Fluid volume excess
D) Hypernatremia
Correct Answer: C
Rationale: Bounding pulses, jugular vein distension, and pulmonary crackles are hallmark signs of
fluid volume excess (hypervolemia), which can result from overly aggressive IV fluid administration.
Distractor Analysis: Hypovolemia (A) produces weak, thready pulses and flat neck veins;
third-spacing (B) moves fluid out of the vascular compartment and presents similarly to
hypovolemia; hypernatremia (D) relates to sodium concentration, not volume status per se.
Question 5 (Domain: Electrolytes & Fluid Balance)
, A PN is caring for a patient with chronic renal failure. Which electrolyte imbalance is the PN most
likely to find when reviewing the patient's laboratory results?
A) Hypokalemia and hyponatremia
B) Hyperkalemia and hyperphosphatemia
C) Hypocalcemia and hypomagnesemia
D) Hyponatremia and hypochloremia
Correct Answer: B
Rationale: Chronic renal failure impairs the kidney's ability to excrete potassium and phosphate,
leading to hyperkalemia and hyperphosphatemia. These are the most dangerous and common
electrolyte disturbances in renal failure.
Distractor Analysis: Hypokalemia (A) is not typical of renal failure; hypocalcemia occurs secondarily
but hypomagnesemia (C) is not the primary concern; hyponatremia/hypochloremia (D) may occur
but are not the most clinically significant imbalances.
Question 6 (Domain: Electrolytes & Fluid Balance)
A patient with a serum sodium of 122 mEq/L is exhibiting confusion and headache. The PN
understands that which mechanism is primarily responsible for the neurological symptoms?
A) Decreased serum osmolality causes cerebral edema
B) Increased serum osmolality causes cellular dehydration
C) Reduced chloride causes neurotransmitter imbalance
D) Elevated potassium inhibits sodium channel function
Correct Answer: A
Rationale: Hyponatremia decreases serum osmolality, causing water to shift into brain cells by
osmosis, resulting in cerebral edema and neurological symptoms such as confusion, headache,
and seizures.
Distractor Analysis: Increased osmolality (B) is the mechanism in hypernatremia; reduced chloride
(C) and elevated potassium (D) do not directly account for the neurological manifestations of
hyponatremia.
Question 7 (Domain: Electrolytes & Fluid Balance)
A PN is monitoring a patient who is receiving a loop diuretic. Which electrolyte loss should the PN
monitor most closely?
A) Sodium and chloride only
B) Potassium, sodium, and magnesium
C) Calcium and phosphorus
D) Bicarbonate and phosphorus
Correct Answer: B
Rationale: Loop diuretics (e.g., furosemide) inhibit reabsorption in the loop of Henle, causing loss of
potassium, sodium, and magnesium, all of which require monitoring to prevent dangerous
imbalances.
Health Assessment & Nursing Fundamentals
Review | Comprehensive Study Guide with Practice
Questions, Answers & Detailed Rationales | A+
Success Resource
NURSING FUNDAMENTALS
COMPREHENSIVE STUDY WORKBOOK
60 High-Yield Practice Questions with Full Rationales
Based on Nursing Fundamentals Comprehensive Exam 2024
HOW TO USE THIS WORKBOOK
This workbook contains 60 multiple-choice questions reverse-engineered from Nursing
Fundamentals Comprehensive Exam 2024 content. Questions mirror the tone, format, and difficulty
of clinical NCLEX-style questions. For each question: (1) Read the clinical scenario carefully. (2)
Select your answer before reading the rationale. (3) Study the Distractor Analysis to understand
why the wrong options are tempting.
DOMAIN DISTRIBUTION
PRACTICE QUESTIONS
Question 1 (Domain: Electrolytes & Fluid Balance)
A patient admitted with prolonged vomiting is noted to have generalized muscle weakness and leg
cramps. The practical nurse (PN) anticipates that which laboratory finding is most consistent with
these manifestations?
A) Serum sodium 148 mEq/L
B) Serum potassium 2.8 mEq/L
C) Serum calcium 10.5 mg/dL
D) Serum magnesium 2.1 mEq/L
Correct Answer: B
Rationale: Hypokalemia (low serum potassium) impairs the sodium-potassium pump mechanism,
resulting in muscle weakness and leg cramps. Prolonged vomiting causes significant potassium
loss through gastric secretions.
Distractor Analysis: Hypernatremia (A) causes neurological symptoms, not leg cramps; normal
calcium (C) and magnesium (D) values would not explain these findings.
Question 2 (Domain: Electrolytes & Fluid Balance)
A PN is reviewing the cardiac monitor of a patient with a serum potassium of 2.6 mEq/L. Which
cardiac dysrhythmia should the PN anticipate?
A) Sinus bradycardia
,B) Peaked T-waves
C) Premature ventricular contractions (PVCs)
D) Widened QRS complexes
Correct Answer: C
Rationale: Hypokalemia increases myocardial irritability, predisposing the patient to premature
ventricular contractions (PVCs) and potentially life-threatening dysrhythmias. Potassium is critical
for normal cardiac conduction.
Distractor Analysis: Peaked T-waves (B) and widened QRS complexes (D) are hallmarks of
hyperkalemia; bradycardia (A) is also associated with hyperkalemia, not hypokalemia.
Question 3 (Domain: Electrolytes & Fluid Balance)
A patient's serum potassium is 6.8 mEq/L. The PN reviews the ECG and expects to find which
change first?
A) Flattened P-waves and prominent U-waves
B) Tall, peaked T-waves and a shortened QT interval
C) ST-segment depression and presence of U-waves
D) Prolonged PR interval only
Correct Answer: B
Rationale: The earliest ECG change in hyperkalemia is tall, peaked (tent-shaped) T-waves,
accompanied by a shortened QT interval, reflecting accelerated ventricular repolarization.
Distractor Analysis: Flattened P-waves and U-waves (A) and ST depression with U-waves (C) are
classic hypokalemia changes; a prolonged PR interval alone (D) appears later in hyperkalemia
progression.
Question 4 (Domain: Electrolytes & Fluid Balance)
A patient receiving aggressive IV fluid replacement for dehydration develops bounding pulses,
jugular vein distension, and crackles in the lung bases. The PN recognizes these findings as
indicative of which condition?
A) Hypovolemia
B) Third-spacing
C) Fluid volume excess
D) Hypernatremia
Correct Answer: C
Rationale: Bounding pulses, jugular vein distension, and pulmonary crackles are hallmark signs of
fluid volume excess (hypervolemia), which can result from overly aggressive IV fluid administration.
Distractor Analysis: Hypovolemia (A) produces weak, thready pulses and flat neck veins;
third-spacing (B) moves fluid out of the vascular compartment and presents similarly to
hypovolemia; hypernatremia (D) relates to sodium concentration, not volume status per se.
Question 5 (Domain: Electrolytes & Fluid Balance)
, A PN is caring for a patient with chronic renal failure. Which electrolyte imbalance is the PN most
likely to find when reviewing the patient's laboratory results?
A) Hypokalemia and hyponatremia
B) Hyperkalemia and hyperphosphatemia
C) Hypocalcemia and hypomagnesemia
D) Hyponatremia and hypochloremia
Correct Answer: B
Rationale: Chronic renal failure impairs the kidney's ability to excrete potassium and phosphate,
leading to hyperkalemia and hyperphosphatemia. These are the most dangerous and common
electrolyte disturbances in renal failure.
Distractor Analysis: Hypokalemia (A) is not typical of renal failure; hypocalcemia occurs secondarily
but hypomagnesemia (C) is not the primary concern; hyponatremia/hypochloremia (D) may occur
but are not the most clinically significant imbalances.
Question 6 (Domain: Electrolytes & Fluid Balance)
A patient with a serum sodium of 122 mEq/L is exhibiting confusion and headache. The PN
understands that which mechanism is primarily responsible for the neurological symptoms?
A) Decreased serum osmolality causes cerebral edema
B) Increased serum osmolality causes cellular dehydration
C) Reduced chloride causes neurotransmitter imbalance
D) Elevated potassium inhibits sodium channel function
Correct Answer: A
Rationale: Hyponatremia decreases serum osmolality, causing water to shift into brain cells by
osmosis, resulting in cerebral edema and neurological symptoms such as confusion, headache,
and seizures.
Distractor Analysis: Increased osmolality (B) is the mechanism in hypernatremia; reduced chloride
(C) and elevated potassium (D) do not directly account for the neurological manifestations of
hyponatremia.
Question 7 (Domain: Electrolytes & Fluid Balance)
A PN is monitoring a patient who is receiving a loop diuretic. Which electrolyte loss should the PN
monitor most closely?
A) Sodium and chloride only
B) Potassium, sodium, and magnesium
C) Calcium and phosphorus
D) Bicarbonate and phosphorus
Correct Answer: B
Rationale: Loop diuretics (e.g., furosemide) inhibit reabsorption in the loop of Henle, causing loss of
potassium, sodium, and magnesium, all of which require monitoring to prevent dangerous
imbalances.
