NUR 274/NURS 274 Final Exam Comprehensive Review | Questions and Answers with Rationales |
2026/2027 Update - Medgar Evers College.
Commonly Occurring Health Problems I
Medgar Evers College
75 Full-Length Questions, Answers & Rationales
I. Fluid, Electrolyte & Acid-Base Disorders
1. Fluid Volume Deficit
A client has experienced vomiting and diarrhea for 3 days. Which assessment finding is most
consistent with fluid volume deficit?
A. Bounding pulse and jugular venous distention
B. Orthostatic hypotension and tachycardia
C. Crackles and peripheral edema
D. Increased central venous pressure
Correct Answer: B. Orthostatic hypotension and tachycardia
Rationale: Hypovolemia decreases circulating volume. Compensatory tachycardia, postural
hypotension, dry mucous membranes, decreased urine output, weak pulses, weight loss, and
reduced venous filling are expected. Your Final guide specifically identifies these manifestations
with fluid-volume deficit. [studocu.com] - Final Exam Stud…
2. Fluid Volume Excess
A client with heart failure develops increasing fluid volume excess. Which assessment finding
should the nurse expect?
A. Flat neck veins
B. Weight loss
C. Crackles, jugular venous distention, and peripheral edema
D. Decreased central venous pressure
Correct Answer: C
Rationale: Hypervolemia increases intravascular and interstitial volume, producing edema, JVD,
crackles, hypertension, weight gain, and potentially pulmonary edema. [studocu.com] - Final
Exam Stud…
,3. Best Indicator of Fluid Change
Which measurement is most useful for evaluating short-term fluid-volume changes in a
hospitalized adult?
A. Daily weight measured under consistent conditions
B. Height
C. Abdominal skin pigmentation
D. Pupil size
Correct Answer: A
Rationale: Daily weight is one of the most sensitive indicators of fluid gain or loss.
Approximately 1 kg of acute weight change corresponds to about 1 L of fluid.
4. Hypernatremia
A client's serum sodium is 151 mEq/L. Which manifestation is most concerning?
A. Progressive confusion and seizure activity
B. Increased bowel sounds
C. Bradycardia with excessive salivation
D. Painless peripheral edema only
Correct Answer: A
Rationale: Hypernatremia causes cellular dehydration, including dehydration of brain cells.
Neurologic manifestations may progress from restlessness and confusion to seizures and coma.
5. Severe Hyponatremia
A client has a sodium level of 118 mEq/L, headache, confusion, and new seizure activity. Which
nursing action has highest priority?
A. Encourage unrestricted water intake
B. Initiate seizure precautions and promptly notify the provider
C. Give potassium supplementation
D. Encourage ambulation
Correct Answer: B
,Rationale: Severe symptomatic hyponatremia is a neurologic emergency. Airway protection and
seizure precautions are priorities. Hypertonic saline may be prescribed, but correction must be
carefully controlled to avoid osmotic demyelination.
6. Hyperkalemia
Which ECG change should the nurse associate most strongly with hyperkalemia?
A. Tall, peaked T waves
B. Prominent U waves
C. Shortened PR interval with narrow QRS
D. Persistent sinus tachycardia only
Correct Answer: A
Rationale: Hyperkalemia commonly produces tall peaked T waves and, as severity increases,
PR prolongation, QRS widening, loss of P waves, and potentially lethal ventricular
dysrhythmias.
7. Severe Hyperkalemia
A client has a potassium level of 6.8 mEq/L and ECG changes. Calcium gluconate is prescribed.
What is the primary purpose of this medication?
A. Remove potassium through the kidneys
B. Shift potassium into cells
C. Stabilize the cardiac membrane while other treatments reduce potassium
D. Replace sodium
Correct Answer: C
Rationale: IV calcium does not lower serum potassium. It temporarily stabilizes myocardial
cells and reduces immediate dysrhythmia risk. Insulin with glucose, beta-agonists, potassium
binders, diuretics, or dialysis may be used to lower or redistribute potassium depending on the
situation.
8. Hypokalemia
A client receiving furosemide has a potassium level of 2.9 mEq/L. Which assessment finding
should the nurse anticipate?
, A. Peaked T waves and diarrhea
B. Muscle weakness and ventricular dysrhythmias
C. Hyperactive reflexes and tetany
D. Severe hypertension
Correct Answer: B
Rationale: Hypokalemia impairs neuromuscular and cardiac function. Weakness, decreased
reflexes, constipation/ileus, flattened T waves, U waves, and ventricular dysrhythmias can occur.
9. Potassium Administration
Which prescription should the nurse question immediately?
A. Potassium chloride diluted in IV fluid and administered by pump
B. Oral potassium replacement with food
C. IV potassium chloride administered by direct IV push
D. Serum potassium rechecked after replacement
Correct Answer: C
Rationale: Potassium must never be administered by IV push because a concentrated bolus can
cause fatal dysrhythmias.
10. Hypocalcemia
A client who underwent thyroid surgery develops perioral tingling and carpal spasm when a
blood-pressure cuff is inflated. Which imbalance should the nurse suspect?
A. Hypernatremia
B. Hypercalcemia
C. Hypocalcemia
D. Hyperkalemia
Correct Answer: C
Rationale: Trousseau sign, Chvostek sign, paresthesias, muscle spasms, hyperreflexia, and
seizures are associated with hypocalcemia, which can occur after inadvertent parathyroid injury.
11. Hypercalcemia
2026/2027 Update - Medgar Evers College.
Commonly Occurring Health Problems I
Medgar Evers College
75 Full-Length Questions, Answers & Rationales
I. Fluid, Electrolyte & Acid-Base Disorders
1. Fluid Volume Deficit
A client has experienced vomiting and diarrhea for 3 days. Which assessment finding is most
consistent with fluid volume deficit?
A. Bounding pulse and jugular venous distention
B. Orthostatic hypotension and tachycardia
C. Crackles and peripheral edema
D. Increased central venous pressure
Correct Answer: B. Orthostatic hypotension and tachycardia
Rationale: Hypovolemia decreases circulating volume. Compensatory tachycardia, postural
hypotension, dry mucous membranes, decreased urine output, weak pulses, weight loss, and
reduced venous filling are expected. Your Final guide specifically identifies these manifestations
with fluid-volume deficit. [studocu.com] - Final Exam Stud…
2. Fluid Volume Excess
A client with heart failure develops increasing fluid volume excess. Which assessment finding
should the nurse expect?
A. Flat neck veins
B. Weight loss
C. Crackles, jugular venous distention, and peripheral edema
D. Decreased central venous pressure
Correct Answer: C
Rationale: Hypervolemia increases intravascular and interstitial volume, producing edema, JVD,
crackles, hypertension, weight gain, and potentially pulmonary edema. [studocu.com] - Final
Exam Stud…
,3. Best Indicator of Fluid Change
Which measurement is most useful for evaluating short-term fluid-volume changes in a
hospitalized adult?
A. Daily weight measured under consistent conditions
B. Height
C. Abdominal skin pigmentation
D. Pupil size
Correct Answer: A
Rationale: Daily weight is one of the most sensitive indicators of fluid gain or loss.
Approximately 1 kg of acute weight change corresponds to about 1 L of fluid.
4. Hypernatremia
A client's serum sodium is 151 mEq/L. Which manifestation is most concerning?
A. Progressive confusion and seizure activity
B. Increased bowel sounds
C. Bradycardia with excessive salivation
D. Painless peripheral edema only
Correct Answer: A
Rationale: Hypernatremia causes cellular dehydration, including dehydration of brain cells.
Neurologic manifestations may progress from restlessness and confusion to seizures and coma.
5. Severe Hyponatremia
A client has a sodium level of 118 mEq/L, headache, confusion, and new seizure activity. Which
nursing action has highest priority?
A. Encourage unrestricted water intake
B. Initiate seizure precautions and promptly notify the provider
C. Give potassium supplementation
D. Encourage ambulation
Correct Answer: B
,Rationale: Severe symptomatic hyponatremia is a neurologic emergency. Airway protection and
seizure precautions are priorities. Hypertonic saline may be prescribed, but correction must be
carefully controlled to avoid osmotic demyelination.
6. Hyperkalemia
Which ECG change should the nurse associate most strongly with hyperkalemia?
A. Tall, peaked T waves
B. Prominent U waves
C. Shortened PR interval with narrow QRS
D. Persistent sinus tachycardia only
Correct Answer: A
Rationale: Hyperkalemia commonly produces tall peaked T waves and, as severity increases,
PR prolongation, QRS widening, loss of P waves, and potentially lethal ventricular
dysrhythmias.
7. Severe Hyperkalemia
A client has a potassium level of 6.8 mEq/L and ECG changes. Calcium gluconate is prescribed.
What is the primary purpose of this medication?
A. Remove potassium through the kidneys
B. Shift potassium into cells
C. Stabilize the cardiac membrane while other treatments reduce potassium
D. Replace sodium
Correct Answer: C
Rationale: IV calcium does not lower serum potassium. It temporarily stabilizes myocardial
cells and reduces immediate dysrhythmia risk. Insulin with glucose, beta-agonists, potassium
binders, diuretics, or dialysis may be used to lower or redistribute potassium depending on the
situation.
8. Hypokalemia
A client receiving furosemide has a potassium level of 2.9 mEq/L. Which assessment finding
should the nurse anticipate?
, A. Peaked T waves and diarrhea
B. Muscle weakness and ventricular dysrhythmias
C. Hyperactive reflexes and tetany
D. Severe hypertension
Correct Answer: B
Rationale: Hypokalemia impairs neuromuscular and cardiac function. Weakness, decreased
reflexes, constipation/ileus, flattened T waves, U waves, and ventricular dysrhythmias can occur.
9. Potassium Administration
Which prescription should the nurse question immediately?
A. Potassium chloride diluted in IV fluid and administered by pump
B. Oral potassium replacement with food
C. IV potassium chloride administered by direct IV push
D. Serum potassium rechecked after replacement
Correct Answer: C
Rationale: Potassium must never be administered by IV push because a concentrated bolus can
cause fatal dysrhythmias.
10. Hypocalcemia
A client who underwent thyroid surgery develops perioral tingling and carpal spasm when a
blood-pressure cuff is inflated. Which imbalance should the nurse suspect?
A. Hypernatremia
B. Hypercalcemia
C. Hypocalcemia
D. Hyperkalemia
Correct Answer: C
Rationale: Trousseau sign, Chvostek sign, paresthesias, muscle spasms, hyperreflexia, and
seizures are associated with hypocalcemia, which can occur after inadvertent parathyroid injury.
11. Hypercalcemia
