,NUR 242 EXAM 2 - Original Practice Study Guide
NUR 242 exam 2| Medical-Surgical 2026 Update |
100% Correct – Galen College
1. A patient with vomiting and diarrhea has lost 2.2 lb (1 kg) since yesterday. Which interpretation is most
appropriate?
A) The change is unrelated to fluid balance
B) The patient gained lean muscle
C) The patient has likely lost about 1 liter of body fluid
D) The patient retained about 2 liters of fluid
Correct Answer: The patient has likely lost about 1 liter of body fluid
Rationale: Rapid short-term weight change usually reflects fluid balance. About 1 kg of body weight corresponds to
roughly 1 liter of water, making daily weight one of the most sensitive indicators of fluid change.
2. Which finding most strongly suggests extracellular fluid volume deficit?
A) Jugular venous distention
B) Bounding pulses and crackles
C) Rapid weight gain with edema
D) Orthostatic hypotension with tachycardia
Correct Answer: Orthostatic hypotension with tachycardia
Rationale: Volume depletion reduces venous return and cardiac output, often causing tachycardia and orthostatic blood-
pressure changes.
3. Which assessment finding is most consistent with fluid volume excess?
A) New crackles with dependent edema
B) Dry mucous membranes
C) Flat neck veins
D) Concentrated urine with weight loss
Correct Answer: New crackles with dependent edema
Rationale: Excess intravascular and interstitial fluid can cause pulmonary crackles, edema, weight gain, and elevated
venous pressure.
4. A patient with severe hyponatremia becomes confused and has a seizure. What best explains the
neurologic findings?
A) Calcium precipitates in the brain
B) Brain cells rapidly dehydrate
C) Potassium leaves the neurons completely
D) Water shifts into brain cells, causing cerebral edema
Correct Answer: Water shifts into brain cells, causing cerebral edema
Rationale: Low serum sodium lowers extracellular osmolality, promoting water movement into cells. Cerebral edema can
cause headache, confusion, seizures, and coma. In clinical practice, this concept should be integrated with current
assessment findings, safety priorities, medication effects, and reassessment of the patient response.
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, NUR 242 EXAM 2 - Original Practice Study Guide
5. Which symptom is common with hypernatremia?
A) Persistent bradycardia only
B) Intense thirst and neurologic irritability
C) Profound hypoglycemia
D) No neurologic changes
Correct Answer: Intense thirst and neurologic irritability
Rationale: Hypernatremia reflects a relative water deficit and can cause intense thirst, agitation, weakness, and other
neurologic manifestations. In clinical practice, this concept should be integrated with current assessment findings, safety
priorities, medication effects, and reassessment of the patient response.
6. A patient taking a loop diuretic develops muscle weakness and U waves on ECG. Which electrolyte
abnormality is most likely?
A) Hyperkalemia
B) Hypokalemia
C) Hypercalcemia
D) Hypermagnesemia
Correct Answer: Hypokalemia
Rationale: Loop diuretics can increase potassium loss. Hypokalemia may cause weakness, flattened T waves, ST
depression, U waves, and dysrhythmias. In clinical practice, this concept should be integrated with current assessment
findings, safety priorities, medication effects, and reassessment of the patient response.
7. Which ECG change is most concerning for hyperkalemia?
A) Isolated sinus tachycardia only
B) Prominent U waves
C) Tall peaked T waves with progressive conduction abnormalities
D) Short PR interval with no other changes
Correct Answer: Tall peaked T waves with progressive conduction abnormalities
Rationale: Hyperkalemia alters cardiac conduction and may progress from peaked T waves to PR prolongation, QRS
widening, ventricular dysrhythmias, and arrest. In clinical practice, this concept should be integrated with current
assessment findings, safety priorities, medication effects, and reassessment of the patient response.
8. A patient with hypocalcemia reports tingling around the mouth and muscle cramps. Which additional
finding would support the diagnosis?
A) Positive Trousseau sign
B) Absent gag reflex only
C) Pitting edema
D) Jaundice
Correct Answer: Positive Trousseau sign
Rationale: Hypocalcemia increases neuromuscular excitability and may produce paresthesias, tetany, Chvostek and
Trousseau signs, and seizures. In clinical practice, this concept should be integrated with current assessment findings,
safety priorities, medication effects, and reassessment of the patient response.
Page 3
NUR 242 exam 2| Medical-Surgical 2026 Update |
100% Correct – Galen College
1. A patient with vomiting and diarrhea has lost 2.2 lb (1 kg) since yesterday. Which interpretation is most
appropriate?
A) The change is unrelated to fluid balance
B) The patient gained lean muscle
C) The patient has likely lost about 1 liter of body fluid
D) The patient retained about 2 liters of fluid
Correct Answer: The patient has likely lost about 1 liter of body fluid
Rationale: Rapid short-term weight change usually reflects fluid balance. About 1 kg of body weight corresponds to
roughly 1 liter of water, making daily weight one of the most sensitive indicators of fluid change.
2. Which finding most strongly suggests extracellular fluid volume deficit?
A) Jugular venous distention
B) Bounding pulses and crackles
C) Rapid weight gain with edema
D) Orthostatic hypotension with tachycardia
Correct Answer: Orthostatic hypotension with tachycardia
Rationale: Volume depletion reduces venous return and cardiac output, often causing tachycardia and orthostatic blood-
pressure changes.
3. Which assessment finding is most consistent with fluid volume excess?
A) New crackles with dependent edema
B) Dry mucous membranes
C) Flat neck veins
D) Concentrated urine with weight loss
Correct Answer: New crackles with dependent edema
Rationale: Excess intravascular and interstitial fluid can cause pulmonary crackles, edema, weight gain, and elevated
venous pressure.
4. A patient with severe hyponatremia becomes confused and has a seizure. What best explains the
neurologic findings?
A) Calcium precipitates in the brain
B) Brain cells rapidly dehydrate
C) Potassium leaves the neurons completely
D) Water shifts into brain cells, causing cerebral edema
Correct Answer: Water shifts into brain cells, causing cerebral edema
Rationale: Low serum sodium lowers extracellular osmolality, promoting water movement into cells. Cerebral edema can
cause headache, confusion, seizures, and coma. In clinical practice, this concept should be integrated with current
assessment findings, safety priorities, medication effects, and reassessment of the patient response.
Page 2
, NUR 242 EXAM 2 - Original Practice Study Guide
5. Which symptom is common with hypernatremia?
A) Persistent bradycardia only
B) Intense thirst and neurologic irritability
C) Profound hypoglycemia
D) No neurologic changes
Correct Answer: Intense thirst and neurologic irritability
Rationale: Hypernatremia reflects a relative water deficit and can cause intense thirst, agitation, weakness, and other
neurologic manifestations. In clinical practice, this concept should be integrated with current assessment findings, safety
priorities, medication effects, and reassessment of the patient response.
6. A patient taking a loop diuretic develops muscle weakness and U waves on ECG. Which electrolyte
abnormality is most likely?
A) Hyperkalemia
B) Hypokalemia
C) Hypercalcemia
D) Hypermagnesemia
Correct Answer: Hypokalemia
Rationale: Loop diuretics can increase potassium loss. Hypokalemia may cause weakness, flattened T waves, ST
depression, U waves, and dysrhythmias. In clinical practice, this concept should be integrated with current assessment
findings, safety priorities, medication effects, and reassessment of the patient response.
7. Which ECG change is most concerning for hyperkalemia?
A) Isolated sinus tachycardia only
B) Prominent U waves
C) Tall peaked T waves with progressive conduction abnormalities
D) Short PR interval with no other changes
Correct Answer: Tall peaked T waves with progressive conduction abnormalities
Rationale: Hyperkalemia alters cardiac conduction and may progress from peaked T waves to PR prolongation, QRS
widening, ventricular dysrhythmias, and arrest. In clinical practice, this concept should be integrated with current
assessment findings, safety priorities, medication effects, and reassessment of the patient response.
8. A patient with hypocalcemia reports tingling around the mouth and muscle cramps. Which additional
finding would support the diagnosis?
A) Positive Trousseau sign
B) Absent gag reflex only
C) Pitting edema
D) Jaundice
Correct Answer: Positive Trousseau sign
Rationale: Hypocalcemia increases neuromuscular excitability and may produce paresthesias, tetany, Chvostek and
Trousseau signs, and seizures. In clinical practice, this concept should be integrated with current assessment findings,
safety priorities, medication effects, and reassessment of the patient response.
Page 3
