NUR 242 Med-Surg Nursing | Exam 1 Questions
And Answers | 2026/2027 Updated Study Tests
With Detailed Rationale
Question 1.
A nurse is assessing a patient admitted with community-acquired pneumonia. Which
finding is the priority to report to the provider?
A. Respiratory rate of 24 breaths per minute.
B. Oxygen saturation of 89% on room air.
C. Temperature of 101.2°F (38.4°C).
D. Productive cough with yellow sputum.
Correct Answer: B
Rationale: An oxygen saturation of 89% on room air indicates significant hypoxemia
(normal is ≥95%). This is the priority finding because hypoxemia can rapidly lead to tissue
hypoxia, organ dysfunction, and respiratory failure. While an elevated respiratory rate,
fever, and productive cough are expected findings in pneumonia, they are less immediately
life-threatening than hypoxemia. The nurse should apply supplemental oxygen, reassess,
and notify the provider immediately.
Question 2.
The nurse is caring for a postoperative patient on day 2 after abdominal surgery. The
patient's temperature is 100.8°F (38.2°C), the incision is clean and dry, and lung
sounds are diminished in the bases. The nurse suspects atelectasis. The most
important nursing intervention is to:
A. Administer acetaminophen and reassess in 4 hours.
B. Encourage deep breathing, incentive spirometry, and early ambulation.
C. Prepare the patient for a chest X-ray.
D. Increase the IV fluid rate to treat dehydration.
Correct Answer: B
Rationale: Atelectasis (collapse of alveoli) is the most common postoperative pulmonary
complication, especially after abdominal or thoracic surgery. It typically presents within
,24–48 hours with low-grade fever, diminished breath sounds, and crackles. The most
important intervention is prevention and treatment through deep breathing exercises,
incentive spirometry (10 times per hour while awake), early ambulation, and effective pain
management to allow adequate respiratory effort. While a chest X-ray may confirm the
diagnosis, it is not the priority intervention. Acetaminophen treats fever but not the
underlying cause.
Question 3.
A patient has a serum potassium level of 6.8 mEq/L. The nurse notes peaked T waves
on the cardiac monitor and reports the finding. The nurse knows that the most
immediate threat of severe hyperkalemia is:
A. Hypotension and shock.
B. Cardiac dysrhythmias and ventricular fibrillation.
C. Respiratory depression and apnea.
D. Seizures and coma.
Correct Answer: B
Rationale: Severe hyperkalemia (>6.0 mEq/L) is life-threatening because it causes cardiac
muscle depolarization abnormalities. ECG changes progress from peaked T waves (earliest
sign) to flattened P waves, widened QRS complex, sine wave pattern, and ultimately
ventricular fibrillation or asystole. The most immediate threat is fatal cardiac dysrhythmia.
Treatment includes: IV calcium gluconate (cardiac membrane stabilization), insulin with
dextrose (shifts K+ intracellularly), sodium bicarbonate, beta-agonists, and kayexalate or
dialysis for removal.
Question 4.
A patient with heart failure is receiving furosemide 40 mg IV twice daily. The nurse
should monitor for which electrolyte imbalance most commonly associated with loop
diuretics?
A. Hypernatremia.
B. Hypokalemia.
C. Hypercalcemia.
D. Hypermagnesemia.
, Correct Answer: B
Rationale: Loop diuretics (furosemide, bumetanide, torsemide) inhibit the Na+-K+-2Cl-
cotransporter in the thick ascending loop of Henle, causing increased excretion of sodium,
chloride, potassium, magnesium, and calcium. Hypokalemia is the most common and
clinically significant electrolyte imbalance, which can cause muscle weakness, fatigue,
constipation, and cardiac dysrhythmias (U waves, ST depression, ventricular ectopy). The
nurse should monitor serum electrolytes, encourage potassium-rich foods, and administer
potassium supplements if prescribed.
Question 5.
The nurse is caring for a patient with a nasogastric (NG) tube set to low intermittent
suction. The nurse notes that the patient has not had any tube drainage for 4 hours
and complains of abdominal distension and nausea. The nurse's priority action is to:
A. Irrigate the NG tube with 30 mL of normal saline.
B. Reposition the patient and check the tube for kinks or blockage.
C. Remove the NG tube and notify the provider.
D. Increase the suction to high continuous suction.
Correct Answer: B
Rationale: Lack of NG tube drainage with abdominal distension and nausea suggests the
tube may be clogged, kinked, or displaced. The nurse should first check for kinks in the
tubing, verify connections, assess suction settings, and reposition the patient. If these
measures fail, gentle irrigation with 20–30 mL of normal saline (per protocol) may be
performed. The tube should NOT be removed without provider orders. Increasing suction
without assessing for blockage first is inappropriate and can cause mucosal damage.
Question 6.
A patient is admitted with diabetic ketoacidosis (DKA). Arterial blood gas results
show: pH 7.25, PaCO2 28 mmHg, HCO3- 14 mEq/L. The nurse recognizes these
findings as consistent with:
A. Respiratory acidosis.
B. Metabolic acidosis with respiratory compensation.
C. Metabolic alkalosis.
And Answers | 2026/2027 Updated Study Tests
With Detailed Rationale
Question 1.
A nurse is assessing a patient admitted with community-acquired pneumonia. Which
finding is the priority to report to the provider?
A. Respiratory rate of 24 breaths per minute.
B. Oxygen saturation of 89% on room air.
C. Temperature of 101.2°F (38.4°C).
D. Productive cough with yellow sputum.
Correct Answer: B
Rationale: An oxygen saturation of 89% on room air indicates significant hypoxemia
(normal is ≥95%). This is the priority finding because hypoxemia can rapidly lead to tissue
hypoxia, organ dysfunction, and respiratory failure. While an elevated respiratory rate,
fever, and productive cough are expected findings in pneumonia, they are less immediately
life-threatening than hypoxemia. The nurse should apply supplemental oxygen, reassess,
and notify the provider immediately.
Question 2.
The nurse is caring for a postoperative patient on day 2 after abdominal surgery. The
patient's temperature is 100.8°F (38.2°C), the incision is clean and dry, and lung
sounds are diminished in the bases. The nurse suspects atelectasis. The most
important nursing intervention is to:
A. Administer acetaminophen and reassess in 4 hours.
B. Encourage deep breathing, incentive spirometry, and early ambulation.
C. Prepare the patient for a chest X-ray.
D. Increase the IV fluid rate to treat dehydration.
Correct Answer: B
Rationale: Atelectasis (collapse of alveoli) is the most common postoperative pulmonary
complication, especially after abdominal or thoracic surgery. It typically presents within
,24–48 hours with low-grade fever, diminished breath sounds, and crackles. The most
important intervention is prevention and treatment through deep breathing exercises,
incentive spirometry (10 times per hour while awake), early ambulation, and effective pain
management to allow adequate respiratory effort. While a chest X-ray may confirm the
diagnosis, it is not the priority intervention. Acetaminophen treats fever but not the
underlying cause.
Question 3.
A patient has a serum potassium level of 6.8 mEq/L. The nurse notes peaked T waves
on the cardiac monitor and reports the finding. The nurse knows that the most
immediate threat of severe hyperkalemia is:
A. Hypotension and shock.
B. Cardiac dysrhythmias and ventricular fibrillation.
C. Respiratory depression and apnea.
D. Seizures and coma.
Correct Answer: B
Rationale: Severe hyperkalemia (>6.0 mEq/L) is life-threatening because it causes cardiac
muscle depolarization abnormalities. ECG changes progress from peaked T waves (earliest
sign) to flattened P waves, widened QRS complex, sine wave pattern, and ultimately
ventricular fibrillation or asystole. The most immediate threat is fatal cardiac dysrhythmia.
Treatment includes: IV calcium gluconate (cardiac membrane stabilization), insulin with
dextrose (shifts K+ intracellularly), sodium bicarbonate, beta-agonists, and kayexalate or
dialysis for removal.
Question 4.
A patient with heart failure is receiving furosemide 40 mg IV twice daily. The nurse
should monitor for which electrolyte imbalance most commonly associated with loop
diuretics?
A. Hypernatremia.
B. Hypokalemia.
C. Hypercalcemia.
D. Hypermagnesemia.
, Correct Answer: B
Rationale: Loop diuretics (furosemide, bumetanide, torsemide) inhibit the Na+-K+-2Cl-
cotransporter in the thick ascending loop of Henle, causing increased excretion of sodium,
chloride, potassium, magnesium, and calcium. Hypokalemia is the most common and
clinically significant electrolyte imbalance, which can cause muscle weakness, fatigue,
constipation, and cardiac dysrhythmias (U waves, ST depression, ventricular ectopy). The
nurse should monitor serum electrolytes, encourage potassium-rich foods, and administer
potassium supplements if prescribed.
Question 5.
The nurse is caring for a patient with a nasogastric (NG) tube set to low intermittent
suction. The nurse notes that the patient has not had any tube drainage for 4 hours
and complains of abdominal distension and nausea. The nurse's priority action is to:
A. Irrigate the NG tube with 30 mL of normal saline.
B. Reposition the patient and check the tube for kinks or blockage.
C. Remove the NG tube and notify the provider.
D. Increase the suction to high continuous suction.
Correct Answer: B
Rationale: Lack of NG tube drainage with abdominal distension and nausea suggests the
tube may be clogged, kinked, or displaced. The nurse should first check for kinks in the
tubing, verify connections, assess suction settings, and reposition the patient. If these
measures fail, gentle irrigation with 20–30 mL of normal saline (per protocol) may be
performed. The tube should NOT be removed without provider orders. Increasing suction
without assessing for blockage first is inappropriate and can cause mucosal damage.
Question 6.
A patient is admitted with diabetic ketoacidosis (DKA). Arterial blood gas results
show: pH 7.25, PaCO2 28 mmHg, HCO3- 14 mEq/L. The nurse recognizes these
findings as consistent with:
A. Respiratory acidosis.
B. Metabolic acidosis with respiratory compensation.
C. Metabolic alkalosis.
