NUR 242 Medical-Surgical Nursing Exam 1 Actual Exam
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Section 1: Fluid, Electrolyte & Acid-Base Balance (15 Questions)
Q1: A 68-year-old patient presents with confusion, nausea, and muscle cramps.
Laboratory results reveal a serum sodium level of 128 mEq/L. Which clinical
manifestation should the nurse prioritize as the most concerning?
A. Nausea requiring antiemetic administration
B. Confusion indicating potential seizure risk
C. Muscle cramps affecting mobility
D. Hypertension requiring antihypertensive therapy
Correct Answer: B
Rationale: Confusion in hyponatremia (serum Na⁺ <135 mEq/L) indicates cerebral
edema from water shifting into brain cells, which can rapidly progress to seizures, coma,
and death; this requires immediate intervention to prevent neurological deterioration.
Q2: A patient with heart failure is receiving 3% saline IV for severe hyponatremia. Which
assessment finding requires the nurse to immediately stop the infusion and notify the
provider?
A. Urine output of 50 mL/hour
B. Sudden onset of headache and confusion
,C. Blood pressure of 140/90 mmHg
D. Respiratory rate of 18 breaths/minute
Correct Answer: B
Rationale: Rapid correction of hyponatremia with hypertonic saline can cause osmotic
demyelination syndrome (central pontine myelinolysis); sudden headache and
confusion are warning signs of this potentially fatal complication.
Q3: The nurse is reviewing morning laboratory results. Which patient should be
assessed FIRST?
A. Patient with K⁺ 3.2 mEq/L and scheduled for cardiac catheterization
B. Patient with Na⁺ 148 mEq/L and decreased skin turgor
C. Patient with Ca²⁺ 7.8 mg/dL and positive Chvostek's sign
D. Patient with Mg²⁺ 1.0 mEq/L and tremors
Correct Answer: A
Rationale: Hypokalemia (K⁺ <3.5 mEq/L) causes cardiac arrhythmias and U waves on
ECG; this patient is scheduled for an invasive cardiac procedure, creating a high risk for
lethal arrhythmias during the procedure—this is the highest priority using ABCs and
patient safety principles.
Q4: A patient with chronic kidney disease has a serum potassium of 6.8 mEq/L. Which
ECG change should the nurse anticipate and monitor for?
A. Flattened T waves and ST depression
,B. Tall, peaked T waves and widened QRS complex
C. Prolonged PR interval and absent P waves
D. ST elevation and pathological Q waves
Correct Answer: B
Rationale: Hyperkalemia (K⁺ >5.5 mEq/L) causes characteristic tall, peaked T waves
initially, followed by widened QRS complexes and potential progression to ventricular
fibrillation due to impaired cardiac repolarization and conduction.
Q5: The nurse is caring for a patient post-thyroidectomy who develops carpopedal
spasm and a positive Trousseau's sign. Which electrolyte imbalance is most likely
present?
A. Hypernatremia
B. Hypocalcemia
C. Hypermagnesemia
D. Hypophosphatemia
Correct Answer: B
Rationale: Hypocalcemia (Ca²⁺ <8.5 mg/dL) causes increased neuromuscular
excitability; Trousseau's sign (carpal spasm with BP cuff inflation) and Chvostek's sign
(facial twitching with tapping) are classic indicators of latent tetany from hypocalcemia,
common after thyroid surgery due to parathyroid gland manipulation.
, Q6: A patient with alcohol use disorder is admitted with tremors, hyperreflexia, and
seizures. Laboratory results show Mg²⁺ 1.2 mEq/L. Which intervention should the nurse
implement FIRST?
A. Administer oral magnesium oxide
B. Initiate seizure precautions and administer IV magnesium sulfate
C. Place the patient on fluid restriction
D. Administer calcium gluconate IV push
Correct Answer: B
Rationale: Hypomagnesemia (Mg²⁺ <1.5 mEq/L) causes hyperreflexia, tremors, and
seizures; IV magnesium sulfate is the treatment of choice for severe deficiency, and
seizure precautions are essential for patient safety—prioritizing ABCs and preventing
injury.
Q7: A patient has the following arterial blood gas results: pH 7.30, PaCO₂ 48 mmHg,
HCO₃⁻ 24 mEq/L. Which acid-base disorder is present?
A. Metabolic acidosis with compensation
B. Respiratory acidosis without compensation
C. Metabolic alkalosis with compensation
D. Respiratory alkalosis without compensation
Correct Answer: B
2026/2027 – Comprehensive Test with Detailed Rationales |
100% Verified | Pass Guaranteed – A+ Graded
Section 1: Fluid, Electrolyte & Acid-Base Balance (15 Questions)
Q1: A 68-year-old patient presents with confusion, nausea, and muscle cramps.
Laboratory results reveal a serum sodium level of 128 mEq/L. Which clinical
manifestation should the nurse prioritize as the most concerning?
A. Nausea requiring antiemetic administration
B. Confusion indicating potential seizure risk
C. Muscle cramps affecting mobility
D. Hypertension requiring antihypertensive therapy
Correct Answer: B
Rationale: Confusion in hyponatremia (serum Na⁺ <135 mEq/L) indicates cerebral
edema from water shifting into brain cells, which can rapidly progress to seizures, coma,
and death; this requires immediate intervention to prevent neurological deterioration.
Q2: A patient with heart failure is receiving 3% saline IV for severe hyponatremia. Which
assessment finding requires the nurse to immediately stop the infusion and notify the
provider?
A. Urine output of 50 mL/hour
B. Sudden onset of headache and confusion
,C. Blood pressure of 140/90 mmHg
D. Respiratory rate of 18 breaths/minute
Correct Answer: B
Rationale: Rapid correction of hyponatremia with hypertonic saline can cause osmotic
demyelination syndrome (central pontine myelinolysis); sudden headache and
confusion are warning signs of this potentially fatal complication.
Q3: The nurse is reviewing morning laboratory results. Which patient should be
assessed FIRST?
A. Patient with K⁺ 3.2 mEq/L and scheduled for cardiac catheterization
B. Patient with Na⁺ 148 mEq/L and decreased skin turgor
C. Patient with Ca²⁺ 7.8 mg/dL and positive Chvostek's sign
D. Patient with Mg²⁺ 1.0 mEq/L and tremors
Correct Answer: A
Rationale: Hypokalemia (K⁺ <3.5 mEq/L) causes cardiac arrhythmias and U waves on
ECG; this patient is scheduled for an invasive cardiac procedure, creating a high risk for
lethal arrhythmias during the procedure—this is the highest priority using ABCs and
patient safety principles.
Q4: A patient with chronic kidney disease has a serum potassium of 6.8 mEq/L. Which
ECG change should the nurse anticipate and monitor for?
A. Flattened T waves and ST depression
,B. Tall, peaked T waves and widened QRS complex
C. Prolonged PR interval and absent P waves
D. ST elevation and pathological Q waves
Correct Answer: B
Rationale: Hyperkalemia (K⁺ >5.5 mEq/L) causes characteristic tall, peaked T waves
initially, followed by widened QRS complexes and potential progression to ventricular
fibrillation due to impaired cardiac repolarization and conduction.
Q5: The nurse is caring for a patient post-thyroidectomy who develops carpopedal
spasm and a positive Trousseau's sign. Which electrolyte imbalance is most likely
present?
A. Hypernatremia
B. Hypocalcemia
C. Hypermagnesemia
D. Hypophosphatemia
Correct Answer: B
Rationale: Hypocalcemia (Ca²⁺ <8.5 mg/dL) causes increased neuromuscular
excitability; Trousseau's sign (carpal spasm with BP cuff inflation) and Chvostek's sign
(facial twitching with tapping) are classic indicators of latent tetany from hypocalcemia,
common after thyroid surgery due to parathyroid gland manipulation.
, Q6: A patient with alcohol use disorder is admitted with tremors, hyperreflexia, and
seizures. Laboratory results show Mg²⁺ 1.2 mEq/L. Which intervention should the nurse
implement FIRST?
A. Administer oral magnesium oxide
B. Initiate seizure precautions and administer IV magnesium sulfate
C. Place the patient on fluid restriction
D. Administer calcium gluconate IV push
Correct Answer: B
Rationale: Hypomagnesemia (Mg²⁺ <1.5 mEq/L) causes hyperreflexia, tremors, and
seizures; IV magnesium sulfate is the treatment of choice for severe deficiency, and
seizure precautions are essential for patient safety—prioritizing ABCs and preventing
injury.
Q7: A patient has the following arterial blood gas results: pH 7.30, PaCO₂ 48 mmHg,
HCO₃⁻ 24 mEq/L. Which acid-base disorder is present?
A. Metabolic acidosis with compensation
B. Respiratory acidosis without compensation
C. Metabolic alkalosis with compensation
D. Respiratory alkalosis without compensation
Correct Answer: B
