NUR 242 MED SURG ACTUAL EXAM 2 (ALL CORRECT &
VERIFIED) GALEN COLLEGE OF NURSING QUESTIONS WITH
RATIONALES (WELL DETAILED ANSWERS) GRADE A+
1. You’re monitoring the fluid volume status for a client with heart failure and is at risk for
dehydration. Which of the following interventions is most effective when monitoring this client?
Weigh the client every morning before breakfast
2. The nurse is caring for clients with fluid overload and are at risk for developing complications.
Which of the clients should the nurse identify as being at the greatest risk?
22 yo diagnosed c CHF @ 5 yo
62 yo recently diagnosed c hepatic cirrhosis
76 yo who receives hemodialysis 3x/wk for chronic kidney disease
32 yo being treated c abx for pneumonia
55 yo who receives anticoag therapy for DVT
3. The nurse is caring for a client who is receiving prescribed 0.9% Sodium chloride NS IV at a rate
of 100ml/hr for tx of dehydration. Which of the following findings requires immediate follow-up
by the nurse?
Distended neck veins when the pt is in semi fowlers position
4. The nurse has attended a staff education conference about fluid and electrolyte imbalances.
Which of the following statements by the nurse demonstrates correct understanding of the
conference?
The client who has hyponatremia is likely to develop an acute onset of confusion
5. The nurse is preparing to administer potassium chloride IV to a client who has potassium liable
or 2.6 which of the following actions should the nurse take?
Ensure adequate blood return of the IV access before administration.
6. The nurse is caring for a client whose ECG demonstrates changes characteristic of hypokalemia.
Which of the following assessment findings should the nurse expect?
Hypoactive bowel sounds
7. The nurse is caring for a client who has a serum potassium level of 2.7 which of the following
medications prescribed to the patient should the nurse question?
Hydrochlorothiazide
, 8. The nurse is caring for a client who has been receiving prescribed furosemide and has potassium
level of 2.8. Which of the following assessments should the nurse perform first?
Apical pulse rate and depth of respirations
9. The nurse is caring for a client who has cardiac dysrhythmia. The nurse should be concerned
about which of the following lab values?
Potassium level of 6
10. The nurse is assigned to 4 clients on a med surg floor. Which of the following clients should the
nurse determine is at the greatest risk for developing hypercalcemia?
Client with hyperparathyroidism
Client taking furosemide for heart failure
Client with longstanding osteoarthritis
Client with wound drain
11. The nurse is assigned to 4 clients who have fluid and electrolyte imbalances. After receiving
report, which of the clients should the nurse assess first?
Client with serum potassium level of 5 and is reporting occasional palpitations
Client who has a serum sodium level of 147, dry mouth, and a pulse of 101
Client serum magnesium level of 4.2, is drowsy, and a pulse of 54
Client with serum calcium level of 11, hypoactive bowel sounds, and constipation
12. The nurse is caring for a client who has metabolic alkalosis. For which of the following clinical
manifestations should the nurse monitor?
Skeletal muscle weakness
13. The nurse is caring for a client that takes antiacids for heartburn. The nurse should consider that
this client is at risk for developing
Metabolic alkalosis
14. The nurse is reviewing the medical record of the following assigned clients with an acid base
imbalance. Which client should the nurse recognize as being at risk for metabolic acidosis?
Client with renal failure and oliguria
15. The nurse is reviewing the lab values of a client who has respiratory acidosis. Which of the
following findings should the nurse expect?
VERIFIED) GALEN COLLEGE OF NURSING QUESTIONS WITH
RATIONALES (WELL DETAILED ANSWERS) GRADE A+
1. You’re monitoring the fluid volume status for a client with heart failure and is at risk for
dehydration. Which of the following interventions is most effective when monitoring this client?
Weigh the client every morning before breakfast
2. The nurse is caring for clients with fluid overload and are at risk for developing complications.
Which of the clients should the nurse identify as being at the greatest risk?
22 yo diagnosed c CHF @ 5 yo
62 yo recently diagnosed c hepatic cirrhosis
76 yo who receives hemodialysis 3x/wk for chronic kidney disease
32 yo being treated c abx for pneumonia
55 yo who receives anticoag therapy for DVT
3. The nurse is caring for a client who is receiving prescribed 0.9% Sodium chloride NS IV at a rate
of 100ml/hr for tx of dehydration. Which of the following findings requires immediate follow-up
by the nurse?
Distended neck veins when the pt is in semi fowlers position
4. The nurse has attended a staff education conference about fluid and electrolyte imbalances.
Which of the following statements by the nurse demonstrates correct understanding of the
conference?
The client who has hyponatremia is likely to develop an acute onset of confusion
5. The nurse is preparing to administer potassium chloride IV to a client who has potassium liable
or 2.6 which of the following actions should the nurse take?
Ensure adequate blood return of the IV access before administration.
6. The nurse is caring for a client whose ECG demonstrates changes characteristic of hypokalemia.
Which of the following assessment findings should the nurse expect?
Hypoactive bowel sounds
7. The nurse is caring for a client who has a serum potassium level of 2.7 which of the following
medications prescribed to the patient should the nurse question?
Hydrochlorothiazide
, 8. The nurse is caring for a client who has been receiving prescribed furosemide and has potassium
level of 2.8. Which of the following assessments should the nurse perform first?
Apical pulse rate and depth of respirations
9. The nurse is caring for a client who has cardiac dysrhythmia. The nurse should be concerned
about which of the following lab values?
Potassium level of 6
10. The nurse is assigned to 4 clients on a med surg floor. Which of the following clients should the
nurse determine is at the greatest risk for developing hypercalcemia?
Client with hyperparathyroidism
Client taking furosemide for heart failure
Client with longstanding osteoarthritis
Client with wound drain
11. The nurse is assigned to 4 clients who have fluid and electrolyte imbalances. After receiving
report, which of the clients should the nurse assess first?
Client with serum potassium level of 5 and is reporting occasional palpitations
Client who has a serum sodium level of 147, dry mouth, and a pulse of 101
Client serum magnesium level of 4.2, is drowsy, and a pulse of 54
Client with serum calcium level of 11, hypoactive bowel sounds, and constipation
12. The nurse is caring for a client who has metabolic alkalosis. For which of the following clinical
manifestations should the nurse monitor?
Skeletal muscle weakness
13. The nurse is caring for a client that takes antiacids for heartburn. The nurse should consider that
this client is at risk for developing
Metabolic alkalosis
14. The nurse is reviewing the medical record of the following assigned clients with an acid base
imbalance. Which client should the nurse recognize as being at risk for metabolic acidosis?
Client with renal failure and oliguria
15. The nurse is reviewing the lab values of a client who has respiratory acidosis. Which of the
following findings should the nurse expect?
