NUR 242 — EXAM 2: ANSWER SHEET & DETAILED RATIONALES
All 100 Questions | All Units | Galen Values Referenced | Detailed Explanation for Every Answer
■ Read EVERY rationale — even for questions you got right. Understanding WHY is what passes the exam.
QUICK ANSWER GRID
Q# Ans Q# Ans Q# Ans Q# Ans Q# Ans
1 B 21 B 41 B 61 C 81 B
2 B 22 A 42 B 62 B 82 B
3 B 23 B 43 B 63 B 83 B
4 C 24 B 44 B 64 B 84 B
5 B 25 B 45 B 65 B 85 B
6 B 26 B 46 B 66 B 86 B
7 B 27 B 47 B 67 B 87 B
8 B 28 B 48 C 68 C 88 B
9 B 29 B 49 B 69 B 89 B
10 B 30 B 50 A 70 C 90 B
11 B 31 B 51 B 71 B 91 B
12 B 32 B 52 B 72 B 92 C
13 B 33 C 53 C 73 B 93 B
14 B 34 B 54 B 74 B 94 A
15 B 35 B 55 B 75 B 95 B
16 B 36 B 56 B 76 B 96 B
17 B 37 A 57 B 77 B 97 B
18 B 38 B 58 B 78 B 98 B
19 B 39 B 59 B 79 B 99 B
20 B 40 B 60 B 80 B 100 B
DETAILED RATIONALES — READ ALL OF THESE!
★ FLUIDS & DEHYDRATION
Question 1
✓ Correct Answer: B
Daily weights on the same scale at the same time is the MOST RELIABLE indicator of fluid status — 1 kg of weight =
approximately 1 liter of fluid. Skin turgor is LESS RELIABLE in older adults (option A). Thirst (C) and blood pressure
changes (D) are late signs of dehydration.
Question 2
✓ Correct Answer: B
BOX 13.3 lists the key features of fluid overload: bounding pulse, distended neck veins, moist crackles, and weight gain. Option A
describes dehydration (thready pulse, poor skin turgor). Option C describes metabolic acidosis. Option D also describes
dehydration.
Question 3
✓ Correct Answer: B
BOX 13.1 shows ileostomy as a dehydration risk and long-term corticosteroids as a fluid OVERLOAD risk. The correct clinical
approach is to assess for BOTH imbalances simultaneously — not just one.
,Question 4
✓ Correct Answer: C
Per the Critical Rescue NSP (p.259): if signs of worsening fluid overload are present (bounding pulse, JVD, crackles,
edema, UO) NOTIFY the primary health care provider IMMEDIATELY. Remain with the patient. You cannot give furosemide
without an order, and restricting fluids without an order is outside nursing scope.
Question 5
✓ Correct Answer: B
The body compensates for dehydration (hypovolemia) primarily through VASOCONSTRICTION and increased PERIPHERAL
RESISTANCE to maintain blood pressure when circulating volume is reduced. This is why the pulse is rapid (heart works
harder) but thready (vessels constricted). Vasodilation (A) would worsen hypotension.
★ SODIUM IMBALANCES
Question 6
✓ Correct Answer: B
Sodium 124 mEq/L is below Galen normal (135–145 mEq/L) = HYPONATREMIA. In older adults, SUDDEN ACUTE CONFUSION
is the hallmark presenting sign of hyponatremia. Water shifts INTO brain cells cerebral edema increased ICP
confusion/seizures. All other lab values listed are within normal range.
Question 7
✓ Correct Answer: B
3% hypertonic saline has MORE sodium than the blood, creating an osmotic gradient that pulls water OUT of swollen brain
cells. It is used ONLY for SEVERE symptomatic hyponatremia (seizures, coma). It is NOT for dehydration (0.9% NS or LR). Must
be infused slowly with continuous monitoring.
Question 8
✓ Correct Answer: B
In hypernatremia, brain cells have ADAPTED to the high sodium environment. Rapid lowering of sodium causes water to rush
BACK INTO brain cells too quickly cerebral edema. This is osmotic demyelination syndrome — PERMANENT brain damage.
Always correct sodium imbalances gradually.
Question 9
✓ Correct Answer: B
Na+ 148 mEq/L = HYPERNATREMIA (above Galen normal 135–145). High sodium water shifts OUT of brain brain SHRINKS
cells dehydrate AGITATION, restlessness, and INTENSE THIRST (the hallmark of hypernatremia). NOT confusion and
seizures (that is hyponatremia). NOT edema (that is fluid overload).
Question 10
✓ Correct Answer: B
Drinking 6 liters of plain water daily causes DILUTIONAL hyponatremia — excessive water dilutes the sodium concentration in
the blood even though total body sodium may be normal. This is the "relative sodium deficit" from BOX 13.4. Psychiatric
★ POTASSIUM IMBALANCES
polydipsia works the same way.
Question 11
✓ Correct Answer: B
K+ 2.8 mEq/L = HYPOKALEMIA (below Galen 3.5–5.0). Low K+ reduces cell excitability. ECG shows: ST segment DEPRESSION
(segment drops below baseline), FLAT or INVERTED T waves (T wave flattens), and U WAVE (extra deflection after T). Peaked
T waves (A) = HYPERKALEMIA. ST elevation (D) = MI/pericarditis.
Question 12
✓ Correct Answer: B
Per NPSG and NSP Drug Alert (p.264): CONFIRM UO 30 mL/hr first (kidneys must excrete K+) AND verify the K+ is properly
diluted (never IV push). Giving K+ with poor urine output dangerous hyperkalemia. IV push causes immediate cardiac
arrest. Informed consent (D) is not required for IV potassium.
, Question 13
✓ Correct Answer: B
Calcium gluconate IV is the FIRST intervention for hyperkalemia with ECG changes because it stabilizes the cardiac membrane
IMMEDIATELY (within minutes). It does not lower K+ — it protects the heart while other treatments take effect. Kayexalate (A)
works slowly. Dialysis (C) takes time to set up.
Question 14
✓ Correct Answer: B
Insulin activates the Na+/K+ ATPase pump, which drives K+ FROM the bloodstream INTO cells — TEMPORARILY lowering
serum K+ and protecting the heart. Glucose is given simultaneously to prevent hypoglycemia from the insulin. This is a
bridge treatment while permanent removal (dialysis, kayexalate) is arranged.
Question 15
✓ Correct Answer: B
Per NSP Action Alert (p.264): if IV K+ INFILTRATES (1) STOP the IV solution immediately, (2) REMOVE the venous access, (3)
NOTIFY the provider, (4) DOCUMENT, (5) PHOTOGRAPH the site. Potassium is a severe tissue irritant causing necrosis. Slowing
the rate (A, C) while the line is infiltrated is wrong.
Question 16
✓ Correct Answer: B
The DIAPHRAGM is a skeletal muscle. Hypokalemia causes skeletal muscle weakness — including the diaphragm — which
directly impairs VENTILATION. This is why the NSP Action Alert states to assess respiratory status q2h in hypokalemia
patients. It does NOT cause bronchospasm (A), pulmonary edema (C), or inflammatory lung damage (D).
Question 17
✓ Correct Answer: B
Spironolactone is a POTASSIUM-SPARING diuretic — it retains K+. Adding high-K+ foods would cause HYPERKALEMIA. The
correct teaching is to AVOID high-K+ foods (bananas, oranges, potatoes) and salt substitutes while on spironolactone.
Furosemide (loop diuretic) is OPPOSITE
— it wastes K+ so you DO need high-K+ foods with that one.
★ CALCIUM & MAGNESIUM
Question 18
✓ Correct Answer: B
TROUSSEAU SIGN (Fig 13.11): Inflate BP cuff above systolic pressure for 1–4 minutes POSITIVE = palmar FLEXION (hand and
wrist flex inward into carpal spasm). Indicates HYPOCALCEMIA or HYPOMAGNESEMIA. Homans sign (C) = calf pain with
dorsiflexion (DVT). Babinski
(D) = toe extension with plantar stimulation (upper motor neuron).
Question 19
✓ Correct Answer: B
PARESTHESIAS (tingling/numbness in fingers, toes, lips) are the FIRST neuromuscular sign of hypocalcemia, appearing
before muscle spasms or tetany. They occur because low Ca2+ increases sodium movement across excitable membranes,
making nerves fire inappropriately. Shortened QT (C) = HYPERCALCEMIA. Blood clots (D) = hypercalcemia.
Question 20
✓ Correct Answer: B
Per the Patient-Centered Care: Gender Health note (p.266): postmenopausal females are at risk for CHRONIC calcium loss
related to a reduction in estrogen. Estrogen normally helps maintain bone density and calcium balance. After menopause, this
protection is gone calcium loss hypocalcemia and osteoporosis risk.
Question 21
✓ Correct Answer: B
Per the Critical Rescue NSP (p.268): ABSENT deep tendon reflexes (DTRs) during IV Mg therapy = HYPERMAGNESEMIA TOXICITY.
The sequence is: DTRs diminish ABSENT respiratory muscles weaken RESPIRATORY ARREST. STOP the infusion
IMMEDIATELY. Give CALCIUM GLUCONATE IV (antidote). Do NOT document as expected (A) or give more Mg (D).
All 100 Questions | All Units | Galen Values Referenced | Detailed Explanation for Every Answer
■ Read EVERY rationale — even for questions you got right. Understanding WHY is what passes the exam.
QUICK ANSWER GRID
Q# Ans Q# Ans Q# Ans Q# Ans Q# Ans
1 B 21 B 41 B 61 C 81 B
2 B 22 A 42 B 62 B 82 B
3 B 23 B 43 B 63 B 83 B
4 C 24 B 44 B 64 B 84 B
5 B 25 B 45 B 65 B 85 B
6 B 26 B 46 B 66 B 86 B
7 B 27 B 47 B 67 B 87 B
8 B 28 B 48 C 68 C 88 B
9 B 29 B 49 B 69 B 89 B
10 B 30 B 50 A 70 C 90 B
11 B 31 B 51 B 71 B 91 B
12 B 32 B 52 B 72 B 92 C
13 B 33 C 53 C 73 B 93 B
14 B 34 B 54 B 74 B 94 A
15 B 35 B 55 B 75 B 95 B
16 B 36 B 56 B 76 B 96 B
17 B 37 A 57 B 77 B 97 B
18 B 38 B 58 B 78 B 98 B
19 B 39 B 59 B 79 B 99 B
20 B 40 B 60 B 80 B 100 B
DETAILED RATIONALES — READ ALL OF THESE!
★ FLUIDS & DEHYDRATION
Question 1
✓ Correct Answer: B
Daily weights on the same scale at the same time is the MOST RELIABLE indicator of fluid status — 1 kg of weight =
approximately 1 liter of fluid. Skin turgor is LESS RELIABLE in older adults (option A). Thirst (C) and blood pressure
changes (D) are late signs of dehydration.
Question 2
✓ Correct Answer: B
BOX 13.3 lists the key features of fluid overload: bounding pulse, distended neck veins, moist crackles, and weight gain. Option A
describes dehydration (thready pulse, poor skin turgor). Option C describes metabolic acidosis. Option D also describes
dehydration.
Question 3
✓ Correct Answer: B
BOX 13.1 shows ileostomy as a dehydration risk and long-term corticosteroids as a fluid OVERLOAD risk. The correct clinical
approach is to assess for BOTH imbalances simultaneously — not just one.
,Question 4
✓ Correct Answer: C
Per the Critical Rescue NSP (p.259): if signs of worsening fluid overload are present (bounding pulse, JVD, crackles,
edema, UO) NOTIFY the primary health care provider IMMEDIATELY. Remain with the patient. You cannot give furosemide
without an order, and restricting fluids without an order is outside nursing scope.
Question 5
✓ Correct Answer: B
The body compensates for dehydration (hypovolemia) primarily through VASOCONSTRICTION and increased PERIPHERAL
RESISTANCE to maintain blood pressure when circulating volume is reduced. This is why the pulse is rapid (heart works
harder) but thready (vessels constricted). Vasodilation (A) would worsen hypotension.
★ SODIUM IMBALANCES
Question 6
✓ Correct Answer: B
Sodium 124 mEq/L is below Galen normal (135–145 mEq/L) = HYPONATREMIA. In older adults, SUDDEN ACUTE CONFUSION
is the hallmark presenting sign of hyponatremia. Water shifts INTO brain cells cerebral edema increased ICP
confusion/seizures. All other lab values listed are within normal range.
Question 7
✓ Correct Answer: B
3% hypertonic saline has MORE sodium than the blood, creating an osmotic gradient that pulls water OUT of swollen brain
cells. It is used ONLY for SEVERE symptomatic hyponatremia (seizures, coma). It is NOT for dehydration (0.9% NS or LR). Must
be infused slowly with continuous monitoring.
Question 8
✓ Correct Answer: B
In hypernatremia, brain cells have ADAPTED to the high sodium environment. Rapid lowering of sodium causes water to rush
BACK INTO brain cells too quickly cerebral edema. This is osmotic demyelination syndrome — PERMANENT brain damage.
Always correct sodium imbalances gradually.
Question 9
✓ Correct Answer: B
Na+ 148 mEq/L = HYPERNATREMIA (above Galen normal 135–145). High sodium water shifts OUT of brain brain SHRINKS
cells dehydrate AGITATION, restlessness, and INTENSE THIRST (the hallmark of hypernatremia). NOT confusion and
seizures (that is hyponatremia). NOT edema (that is fluid overload).
Question 10
✓ Correct Answer: B
Drinking 6 liters of plain water daily causes DILUTIONAL hyponatremia — excessive water dilutes the sodium concentration in
the blood even though total body sodium may be normal. This is the "relative sodium deficit" from BOX 13.4. Psychiatric
★ POTASSIUM IMBALANCES
polydipsia works the same way.
Question 11
✓ Correct Answer: B
K+ 2.8 mEq/L = HYPOKALEMIA (below Galen 3.5–5.0). Low K+ reduces cell excitability. ECG shows: ST segment DEPRESSION
(segment drops below baseline), FLAT or INVERTED T waves (T wave flattens), and U WAVE (extra deflection after T). Peaked
T waves (A) = HYPERKALEMIA. ST elevation (D) = MI/pericarditis.
Question 12
✓ Correct Answer: B
Per NPSG and NSP Drug Alert (p.264): CONFIRM UO 30 mL/hr first (kidneys must excrete K+) AND verify the K+ is properly
diluted (never IV push). Giving K+ with poor urine output dangerous hyperkalemia. IV push causes immediate cardiac
arrest. Informed consent (D) is not required for IV potassium.
, Question 13
✓ Correct Answer: B
Calcium gluconate IV is the FIRST intervention for hyperkalemia with ECG changes because it stabilizes the cardiac membrane
IMMEDIATELY (within minutes). It does not lower K+ — it protects the heart while other treatments take effect. Kayexalate (A)
works slowly. Dialysis (C) takes time to set up.
Question 14
✓ Correct Answer: B
Insulin activates the Na+/K+ ATPase pump, which drives K+ FROM the bloodstream INTO cells — TEMPORARILY lowering
serum K+ and protecting the heart. Glucose is given simultaneously to prevent hypoglycemia from the insulin. This is a
bridge treatment while permanent removal (dialysis, kayexalate) is arranged.
Question 15
✓ Correct Answer: B
Per NSP Action Alert (p.264): if IV K+ INFILTRATES (1) STOP the IV solution immediately, (2) REMOVE the venous access, (3)
NOTIFY the provider, (4) DOCUMENT, (5) PHOTOGRAPH the site. Potassium is a severe tissue irritant causing necrosis. Slowing
the rate (A, C) while the line is infiltrated is wrong.
Question 16
✓ Correct Answer: B
The DIAPHRAGM is a skeletal muscle. Hypokalemia causes skeletal muscle weakness — including the diaphragm — which
directly impairs VENTILATION. This is why the NSP Action Alert states to assess respiratory status q2h in hypokalemia
patients. It does NOT cause bronchospasm (A), pulmonary edema (C), or inflammatory lung damage (D).
Question 17
✓ Correct Answer: B
Spironolactone is a POTASSIUM-SPARING diuretic — it retains K+. Adding high-K+ foods would cause HYPERKALEMIA. The
correct teaching is to AVOID high-K+ foods (bananas, oranges, potatoes) and salt substitutes while on spironolactone.
Furosemide (loop diuretic) is OPPOSITE
— it wastes K+ so you DO need high-K+ foods with that one.
★ CALCIUM & MAGNESIUM
Question 18
✓ Correct Answer: B
TROUSSEAU SIGN (Fig 13.11): Inflate BP cuff above systolic pressure for 1–4 minutes POSITIVE = palmar FLEXION (hand and
wrist flex inward into carpal spasm). Indicates HYPOCALCEMIA or HYPOMAGNESEMIA. Homans sign (C) = calf pain with
dorsiflexion (DVT). Babinski
(D) = toe extension with plantar stimulation (upper motor neuron).
Question 19
✓ Correct Answer: B
PARESTHESIAS (tingling/numbness in fingers, toes, lips) are the FIRST neuromuscular sign of hypocalcemia, appearing
before muscle spasms or tetany. They occur because low Ca2+ increases sodium movement across excitable membranes,
making nerves fire inappropriately. Shortened QT (C) = HYPERCALCEMIA. Blood clots (D) = hypercalcemia.
Question 20
✓ Correct Answer: B
Per the Patient-Centered Care: Gender Health note (p.266): postmenopausal females are at risk for CHRONIC calcium loss
related to a reduction in estrogen. Estrogen normally helps maintain bone density and calcium balance. After menopause, this
protection is gone calcium loss hypocalcemia and osteoporosis risk.
Question 21
✓ Correct Answer: B
Per the Critical Rescue NSP (p.268): ABSENT deep tendon reflexes (DTRs) during IV Mg therapy = HYPERMAGNESEMIA TOXICITY.
The sequence is: DTRs diminish ABSENT respiratory muscles weaken RESPIRATORY ARREST. STOP the infusion
IMMEDIATELY. Give CALCIUM GLUCONATE IV (antidote). Do NOT document as expected (A) or give more Mg (D).
