Page 1 of 95
NSG 123 — MED SURG 1 FINAL EXAM QUESTIONS 2026 EXAM LATEST VERSION
SOLVED QUESTIONS & ANSWERS VERIFIED 100 %
NSG 123 — MED SURG 1 FINAL EXAM
QUESTIONS WITH RATIONALES
SECTION 1: FLUIDS, ELECTROLYTES & ACID-BASE (Q1–Q25)
1. A nurse is caring for a client who has a prescription for 0.45% sodium chloride IV
at 100 mL/hr. The nurse identifies this solution as which type?
A. Isotonic
B. Hypotonic
C. Hypertonic
D. Colloid
Correct Answer: B
Rationale: 0.45% sodium chloride is hypotonic, meaning it has a lower osmolarity than
plasma and moves fluid into cells. It is used to treat cellular dehydration but can cause
fluid overload and cerebral edema.
2. A nurse is assessing a client who has been receiving 3% sodium chloride IV for
severe hyponatremia. Which finding requires immediate intervention?
A. Serum sodium 132 mEq/L
B. Crackles in the lung bases and jugular vein distention
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C. Urine output of 50 mL/hr
D. Client reports mild thirst
Correct Answer: B
Rationale: 3% sodium chloride is hypertonic and can cause fluid overload, manifested
by crackles and JVD. These findings indicate pulmonary edema and require immediate
intervention.
3. A nurse is reviewing laboratory results for a client and notes a potassium level of
6.8 mEq/L. Which action should the nurse take first?
A. Administer sodium polystyrene sulfonate orally
B. Obtain a 12-lead ECG and notify the provider
C. Administer regular insulin with glucose IV
D. Restrict dietary potassium intake
Correct Answer: B
Rationale: Severe hyperkalemia can cause life-threatening cardiac arrhythmias. The
first action is to obtain an ECG to assess cardiac status and notify the provider
immediately. Calcium gluconate is the first-line stabilizer.
4. A nurse is caring for a client who has hypocalcemia following a thyroidectomy.
Which finding should the nurse expect?
A. Positive Chvostek's sign
B. Decreased deep tendon reflexes
C. Hypertension
D. Bradycardia
Correct Answer: A
Rationale: Hypocalcemia causes neuromuscular irritability, manifested by Chvostek's
sign (facial twitching) and Trousseau's sign. It can also cause tetany, seizures, and
laryngospasm.
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5. A nurse is interpreting ABGs for a client with COPD: pH 7.32, PaCO₂ 58 mm Hg,
HCO₃ 28 mEq/L. Which condition does the nurse identify?
A. Uncompensated respiratory acidosis
B. Compensated respiratory acidosis
C. Uncompensated metabolic alkalosis
D. Compensated metabolic acidosis
Correct Answer: B
Rationale: Low pH with high PaCO₂ indicates respiratory acidosis. The elevated HCO₃
indicates renal compensation, making it partially compensated respiratory acidosis.
6. A nurse is caring for a client who has a magnesium level of 1.0 mEq/L. Which
finding should the nurse expect?
A. Increased deep tendon reflexes and tremors
B. Decreased deep tendon reflexes
C. Hypertension and bradycardia
D. Constipation and ileus
Correct Answer: A
Rationale: Hypomagnesemia causes neuromuscular irritability, including hyperreflexia,
tremors, tetany, and seizures. It often coexists with hypokalemia and hypocalcemia.
7. A nurse is assessing a client who has fluid volume excess. Which finding should
the nurse expect?
A. Flat neck veins
B. Decreased skin turgor
C. Bounding pulses and crackles
D. Urine output of 15 mL/hr
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Correct Answer: C
Rationale: Fluid volume excess causes bounding pulses, crackles, JVD, edema, and
weight gain. Decreased skin turgor and low urine output indicate fluid deficit.
8. A nurse is caring for a client who has a phosphorus level of 1.5 mg/dL. Which
finding is most concerning?
A. Muscle weakness and respiratory depression
B. Increased appetite
C. Hypertension
D. Polyuria
Correct Answer: A
Rationale: Severe hypophosphatemia causes muscle weakness, respiratory failure,
and impaired cardiac function. It can also cause confusion, seizures, and
rhabdomyolysis.
9. A nurse is administering IV potassium chloride to a client. Which action is
correct?
A. Administer as a rapid IV push
B. Dilute in 50 mL and infuse over 5 minutes
C. Administer via pump at a rate not exceeding 10 mEq/hr
D. Add to a hanging blood transfusion
Correct Answer: C
Rationale: IV potassium must never be given as a bolus because it can cause fatal
cardiac arrest. It should be diluted and infused via pump at a rate not exceeding 10
mEq/hr, ideally 5–10 mEq/hr.
10. A nurse is assessing a client who has metabolic alkalosis. Which finding should
the nurse expect?
NSG 123 — MED SURG 1 FINAL EXAM QUESTIONS 2026 EXAM LATEST VERSION
SOLVED QUESTIONS & ANSWERS VERIFIED 100 %
NSG 123 — MED SURG 1 FINAL EXAM
QUESTIONS WITH RATIONALES
SECTION 1: FLUIDS, ELECTROLYTES & ACID-BASE (Q1–Q25)
1. A nurse is caring for a client who has a prescription for 0.45% sodium chloride IV
at 100 mL/hr. The nurse identifies this solution as which type?
A. Isotonic
B. Hypotonic
C. Hypertonic
D. Colloid
Correct Answer: B
Rationale: 0.45% sodium chloride is hypotonic, meaning it has a lower osmolarity than
plasma and moves fluid into cells. It is used to treat cellular dehydration but can cause
fluid overload and cerebral edema.
2. A nurse is assessing a client who has been receiving 3% sodium chloride IV for
severe hyponatremia. Which finding requires immediate intervention?
A. Serum sodium 132 mEq/L
B. Crackles in the lung bases and jugular vein distention
, Page 2 of 95
C. Urine output of 50 mL/hr
D. Client reports mild thirst
Correct Answer: B
Rationale: 3% sodium chloride is hypertonic and can cause fluid overload, manifested
by crackles and JVD. These findings indicate pulmonary edema and require immediate
intervention.
3. A nurse is reviewing laboratory results for a client and notes a potassium level of
6.8 mEq/L. Which action should the nurse take first?
A. Administer sodium polystyrene sulfonate orally
B. Obtain a 12-lead ECG and notify the provider
C. Administer regular insulin with glucose IV
D. Restrict dietary potassium intake
Correct Answer: B
Rationale: Severe hyperkalemia can cause life-threatening cardiac arrhythmias. The
first action is to obtain an ECG to assess cardiac status and notify the provider
immediately. Calcium gluconate is the first-line stabilizer.
4. A nurse is caring for a client who has hypocalcemia following a thyroidectomy.
Which finding should the nurse expect?
A. Positive Chvostek's sign
B. Decreased deep tendon reflexes
C. Hypertension
D. Bradycardia
Correct Answer: A
Rationale: Hypocalcemia causes neuromuscular irritability, manifested by Chvostek's
sign (facial twitching) and Trousseau's sign. It can also cause tetany, seizures, and
laryngospasm.
, Page 3 of 95
5. A nurse is interpreting ABGs for a client with COPD: pH 7.32, PaCO₂ 58 mm Hg,
HCO₃ 28 mEq/L. Which condition does the nurse identify?
A. Uncompensated respiratory acidosis
B. Compensated respiratory acidosis
C. Uncompensated metabolic alkalosis
D. Compensated metabolic acidosis
Correct Answer: B
Rationale: Low pH with high PaCO₂ indicates respiratory acidosis. The elevated HCO₃
indicates renal compensation, making it partially compensated respiratory acidosis.
6. A nurse is caring for a client who has a magnesium level of 1.0 mEq/L. Which
finding should the nurse expect?
A. Increased deep tendon reflexes and tremors
B. Decreased deep tendon reflexes
C. Hypertension and bradycardia
D. Constipation and ileus
Correct Answer: A
Rationale: Hypomagnesemia causes neuromuscular irritability, including hyperreflexia,
tremors, tetany, and seizures. It often coexists with hypokalemia and hypocalcemia.
7. A nurse is assessing a client who has fluid volume excess. Which finding should
the nurse expect?
A. Flat neck veins
B. Decreased skin turgor
C. Bounding pulses and crackles
D. Urine output of 15 mL/hr
, Page 4 of 95
Correct Answer: C
Rationale: Fluid volume excess causes bounding pulses, crackles, JVD, edema, and
weight gain. Decreased skin turgor and low urine output indicate fluid deficit.
8. A nurse is caring for a client who has a phosphorus level of 1.5 mg/dL. Which
finding is most concerning?
A. Muscle weakness and respiratory depression
B. Increased appetite
C. Hypertension
D. Polyuria
Correct Answer: A
Rationale: Severe hypophosphatemia causes muscle weakness, respiratory failure,
and impaired cardiac function. It can also cause confusion, seizures, and
rhabdomyolysis.
9. A nurse is administering IV potassium chloride to a client. Which action is
correct?
A. Administer as a rapid IV push
B. Dilute in 50 mL and infuse over 5 minutes
C. Administer via pump at a rate not exceeding 10 mEq/hr
D. Add to a hanging blood transfusion
Correct Answer: C
Rationale: IV potassium must never be given as a bolus because it can cause fatal
cardiac arrest. It should be diluted and infused via pump at a rate not exceeding 10
mEq/hr, ideally 5–10 mEq/hr.
10. A nurse is assessing a client who has metabolic alkalosis. Which finding should
the nurse expect?
