NSG 3100 Fundamental Concepts & Skills I Exam 2 | Questions And
Answers With Rationale | 2026/2027 Updates
Question 1.
A nurse is caring for a patient with a serum sodium level of 128 mEq/L. Which clinical manifestation should the nurse
expect to assess?
A. Dry mucous membranes and intense thirst.
B. Restlessness, irritability, and possible seizures.
C. Decreased urine output and weight gain.
D. Flushed skin and fever.
Correct Answer: B
Rationale:
A sodium level of 128 mEq/L indicates hyponatremia (normal: 135-145 mEq/L). As sodium levels drop, water shifts into
cells causing cerebral edema. Early symptoms include headache, nausea, and confusion; severe hyponatremia causes
restlessness, irritability, seizures, and coma. Dry mucous membranes and thirst (A) indicate hypernatremia. Decreased
urine output (C) suggests SIADH but is not the primary manifestation. Flushed skin and fever (D) are unrelated.
Question 2.
A nurse is reviewing a patient's laboratory results and notes a potassium level of 5.8 mEq/L. The nurse recognizes this
value as:
A. Within normal range.
B. Hypokalemia.
C. Hyperkalemia.
D. Severe hyponatremia.
Correct Answer: C
Rationale:
The normal serum potassium range is 3.5 to 5.0 mEq/L. A level of 5.8 mEq/L indicates hyperkalemia (elevated potassium),
which can cause life-threatening cardiac dysrhythmias. The nurse should notify the provider immediately, monitor cardiac
rhythm, and prepare for interventions such as calcium gluconate, insulin with glucose, sodium polystyrene sulfonate
(Kayexalate), or dialysis depending on severity and patient presentation.
Question 3.
A nurse is caring for a patient with diabetes who is experiencing diaphoresis, tremors, and confusion. The patient's blood
glucose is 54 mg/dL. The nurse's first action is to:
A. Administer 1 mg of glucagon subcutaneously.
B. Give 15 grams of fast-acting carbohydrate (e.g., glucose tablets, juice).
C. Initiate an IV infusion of D5W at 125 mL/hr.
Page 1
,D. Notify the provider and request a stat serum glucose verification.
Correct Answer: B
Rationale:
The patient is experiencing symptomatic hypoglycemia (blood glucose <70 mg/dL with adrenergic and neuroglycopenic
symptoms). The 'Rule of 15' for conscious patients dictates giving 15 grams of fast-acting carbohydrate immediately,
rechecking in 15 minutes, and repeating if still below 70 mg/dL. Glucagon (A) is reserved for unconscious patients. IV
dextrose (C) is used for severe hypoglycemia or altered consciousness. The nurse should treat immediately rather than
waiting for provider notification (D).
Question 4.
A nurse is caring for a patient who is receiving total parenteral nutrition (TPN) through a central venous catheter. The nurse
notes the TPN bag is empty and a new bag is not yet available. The nurse should:
A. Hang a bag of D5W to prevent hypoglycemia until the TPN arrives.
B. Clamp the catheter and wait for the new TPN bag.
C. Flush the catheter with heparin and discontinue the infusion.
D. Infuse normal saline at the same rate as the TPN.
Correct Answer: A
Rationale:
When TPN is interrupted, the nurse must hang dextrose-containing fluid (D5W or D10W) to prevent rebound hypoglycemia,
which can occur because the patient's pancreas has been producing high levels of insulin in response to the high glucose
concentration in TPN. Clamping the line (B) or discontinuing the infusion (C) risks severe hypoglycemia. Normal saline (D)
does not provide glucose and is inappropriate.
Question 5.
A nurse is caring for a patient receiving hemodialysis. During dialysis, the patient complains of muscle cramps and nausea.
The nurse recognizes these symptoms as likely caused by:
A. Dialysis disequilibrium syndrome.
B. Rapid fluid removal and hypotension.
C. Heparin overdose.
D. Air
embolism. Correct
Answer: B
Rationale:
Muscle cramps and nausea during hemodialysis are commonly caused by rapid ultrafiltration (fluid removal) leading to
hypotension and electrolyte shifts. The nurse should slow the ultrafiltration rate, assess blood pressure, and administer
normal saline if ordered. Dialysis disequilibrium syndrome (A) causes neurological symptoms (headache, confusion,
seizures). Heparin overdose (C) causes bleeding. Air embolism (D) causes sudden respiratory distress and chest pain.
Page 2
, Question 6.
A nurse is caring for a patient with a history of heart failure who is prescribed furosemide (Lasix) 40 mg PO daily. The
nurse should monitor the patient for which adverse effect? A. Hyperkalemia.
B. Hypokalemia.
C. Hypernatremia.
D. Fluid overload.
Correct Answer: B
Rationale:
Furosemide is a loop diuretic that acts on the ascending loop of Henle, causing excretion of sodium, chloride, and water-
along with potassium. Hypokalemia is a common and potentially dangerous adverse effect that can cause cardiac
dysrhythmias. The nurse should monitor potassium levels and assess for signs of hypokalemia (muscle weakness,
irregular pulse). Patients may be prescribed potassium supplements or encouraged to eat potassium-rich foods.
Question 7.
A nurse is caring for a patient who is prescribed magnesium sulfate for preeclampsia. The nurse should monitor for toxicity
by assessing:
A. Deep tendon reflexes, respiratory rate, and urine output.
B. Blood pressure, heart rate, and fetal heart rate.
C. Level of consciousness, pupil reaction, and grip strength.
D. Temperature, blood glucose, and oxygen saturation.
Correct Answer: A
Rationale:
Magnesium sulfate toxicity manifests as loss of deep tendon reflexes (first sign), respiratory depression (<12 breaths/min),
and decreased urine output (<30 mL/hr or <100 mL/4hr). The antidote for magnesium toxicity is calcium gluconate, which
should be readily available. While blood pressure and fetal heart rate (B) are important assessments in preeclampsia, they
are not the primary indicators of magnesium toxicity.
Question 8.
A nurse is caring for a patient with a history of chronic obstructive pulmonary disease (COPD). The patient is prescribed
oxygen at 2 L/min via nasal cannula. The nurse understands that the rationale for low-flow oxygen in COPD is:
A. High-flow oxygen causes oxygen toxicity in COPD patients.
B. COPD patients rely on hypoxic drive to stimulate breathing.
C. Low-flow oxygen is less expensive and equally effective.
D. High-flow oxygen dries the mucous membranes excessively.
Correct Answer: B
Rationale:
Page 3
Answers With Rationale | 2026/2027 Updates
Question 1.
A nurse is caring for a patient with a serum sodium level of 128 mEq/L. Which clinical manifestation should the nurse
expect to assess?
A. Dry mucous membranes and intense thirst.
B. Restlessness, irritability, and possible seizures.
C. Decreased urine output and weight gain.
D. Flushed skin and fever.
Correct Answer: B
Rationale:
A sodium level of 128 mEq/L indicates hyponatremia (normal: 135-145 mEq/L). As sodium levels drop, water shifts into
cells causing cerebral edema. Early symptoms include headache, nausea, and confusion; severe hyponatremia causes
restlessness, irritability, seizures, and coma. Dry mucous membranes and thirst (A) indicate hypernatremia. Decreased
urine output (C) suggests SIADH but is not the primary manifestation. Flushed skin and fever (D) are unrelated.
Question 2.
A nurse is reviewing a patient's laboratory results and notes a potassium level of 5.8 mEq/L. The nurse recognizes this
value as:
A. Within normal range.
B. Hypokalemia.
C. Hyperkalemia.
D. Severe hyponatremia.
Correct Answer: C
Rationale:
The normal serum potassium range is 3.5 to 5.0 mEq/L. A level of 5.8 mEq/L indicates hyperkalemia (elevated potassium),
which can cause life-threatening cardiac dysrhythmias. The nurse should notify the provider immediately, monitor cardiac
rhythm, and prepare for interventions such as calcium gluconate, insulin with glucose, sodium polystyrene sulfonate
(Kayexalate), or dialysis depending on severity and patient presentation.
Question 3.
A nurse is caring for a patient with diabetes who is experiencing diaphoresis, tremors, and confusion. The patient's blood
glucose is 54 mg/dL. The nurse's first action is to:
A. Administer 1 mg of glucagon subcutaneously.
B. Give 15 grams of fast-acting carbohydrate (e.g., glucose tablets, juice).
C. Initiate an IV infusion of D5W at 125 mL/hr.
Page 1
,D. Notify the provider and request a stat serum glucose verification.
Correct Answer: B
Rationale:
The patient is experiencing symptomatic hypoglycemia (blood glucose <70 mg/dL with adrenergic and neuroglycopenic
symptoms). The 'Rule of 15' for conscious patients dictates giving 15 grams of fast-acting carbohydrate immediately,
rechecking in 15 minutes, and repeating if still below 70 mg/dL. Glucagon (A) is reserved for unconscious patients. IV
dextrose (C) is used for severe hypoglycemia or altered consciousness. The nurse should treat immediately rather than
waiting for provider notification (D).
Question 4.
A nurse is caring for a patient who is receiving total parenteral nutrition (TPN) through a central venous catheter. The nurse
notes the TPN bag is empty and a new bag is not yet available. The nurse should:
A. Hang a bag of D5W to prevent hypoglycemia until the TPN arrives.
B. Clamp the catheter and wait for the new TPN bag.
C. Flush the catheter with heparin and discontinue the infusion.
D. Infuse normal saline at the same rate as the TPN.
Correct Answer: A
Rationale:
When TPN is interrupted, the nurse must hang dextrose-containing fluid (D5W or D10W) to prevent rebound hypoglycemia,
which can occur because the patient's pancreas has been producing high levels of insulin in response to the high glucose
concentration in TPN. Clamping the line (B) or discontinuing the infusion (C) risks severe hypoglycemia. Normal saline (D)
does not provide glucose and is inappropriate.
Question 5.
A nurse is caring for a patient receiving hemodialysis. During dialysis, the patient complains of muscle cramps and nausea.
The nurse recognizes these symptoms as likely caused by:
A. Dialysis disequilibrium syndrome.
B. Rapid fluid removal and hypotension.
C. Heparin overdose.
D. Air
embolism. Correct
Answer: B
Rationale:
Muscle cramps and nausea during hemodialysis are commonly caused by rapid ultrafiltration (fluid removal) leading to
hypotension and electrolyte shifts. The nurse should slow the ultrafiltration rate, assess blood pressure, and administer
normal saline if ordered. Dialysis disequilibrium syndrome (A) causes neurological symptoms (headache, confusion,
seizures). Heparin overdose (C) causes bleeding. Air embolism (D) causes sudden respiratory distress and chest pain.
Page 2
, Question 6.
A nurse is caring for a patient with a history of heart failure who is prescribed furosemide (Lasix) 40 mg PO daily. The
nurse should monitor the patient for which adverse effect? A. Hyperkalemia.
B. Hypokalemia.
C. Hypernatremia.
D. Fluid overload.
Correct Answer: B
Rationale:
Furosemide is a loop diuretic that acts on the ascending loop of Henle, causing excretion of sodium, chloride, and water-
along with potassium. Hypokalemia is a common and potentially dangerous adverse effect that can cause cardiac
dysrhythmias. The nurse should monitor potassium levels and assess for signs of hypokalemia (muscle weakness,
irregular pulse). Patients may be prescribed potassium supplements or encouraged to eat potassium-rich foods.
Question 7.
A nurse is caring for a patient who is prescribed magnesium sulfate for preeclampsia. The nurse should monitor for toxicity
by assessing:
A. Deep tendon reflexes, respiratory rate, and urine output.
B. Blood pressure, heart rate, and fetal heart rate.
C. Level of consciousness, pupil reaction, and grip strength.
D. Temperature, blood glucose, and oxygen saturation.
Correct Answer: A
Rationale:
Magnesium sulfate toxicity manifests as loss of deep tendon reflexes (first sign), respiratory depression (<12 breaths/min),
and decreased urine output (<30 mL/hr or <100 mL/4hr). The antidote for magnesium toxicity is calcium gluconate, which
should be readily available. While blood pressure and fetal heart rate (B) are important assessments in preeclampsia, they
are not the primary indicators of magnesium toxicity.
Question 8.
A nurse is caring for a patient with a history of chronic obstructive pulmonary disease (COPD). The patient is prescribed
oxygen at 2 L/min via nasal cannula. The nurse understands that the rationale for low-flow oxygen in COPD is:
A. High-flow oxygen causes oxygen toxicity in COPD patients.
B. COPD patients rely on hypoxic drive to stimulate breathing.
C. Low-flow oxygen is less expensive and equally effective.
D. High-flow oxygen dries the mucous membranes excessively.
Correct Answer: B
Rationale:
Page 3
