NUR 242 Medical-Surgical Nursing Exam 1 Actual Exam
2026/2027 – Comprehensive Test with Detailed Rationales |
100% Verified | Pass Guaranteed – A+ Graded
Section 1: Fluid, Electrolyte & Acid-Base Balance (15 Questions)
Q1: A 72-year-old patient with heart failure has the following assessment findings: JVD
+3, bilateral crackles, peripheral edema 2+, and a 3 kg weight gain in 48 hours. Which
pathophysiological mechanism explains the peripheral edema?
A. Decreased capillary hydrostatic pressure causing fluid shift into cells
B. Increased hydrostatic pressure in venous circulation forcing fluid into interstitial
spaces
C. Decreased plasma oncotic pressure from low albumin
D. Increased lymphatic drainage overwhelming the interstitial space
Correct Answer: B
Rationale: In heart failure, impaired cardiac pumping increases venous pressure
(preload), which raises capillary hydrostatic pressure and forces fluid into interstitial
spaces, causing peripheral edema; JVD and weight gain confirm systemic fluid overload
from the failing heart's inability to handle circulating volume.
Q2: A patient with severe dehydration has dry mucous membranes, decreased skin
turgor, tachycardia (HR 118), and orthostatic hypotension (BP supine 110/70, standing
82/56). Which fluid compartment is primarily depleted?
A. Intracellular fluid (ICF)
,B. Interstitial fluid only
C. Intravascular and interstitial fluid (ECF)
D. Transcellular fluid
Correct Answer: C
Rationale: Dehydration primarily depletes extracellular fluid (ECF), which includes both
intravascular (plasma) and interstitial compartments; orthostatic hypotension and
tachycardia indicate intravascular volume depletion, while decreased skin turgor reflects
interstitial fluid loss—ICF depletion occurs later with severe or prolonged dehydration.
Q3: A patient with syndrome of inappropriate antidiuretic hormone (SIADH) has a serum
sodium of 126 mEq/L. Which clinical manifestation should the nurse monitor as the
highest priority?
A. Muscle cramps in the lower extremities
B. Confusion and altered level of consciousness
C. Nausea and decreased appetite
D. Mild headache
Correct Answer: B
Rationale: Confusion and altered LOC in hyponatremia indicate cerebral edema from
water shifting into brain cells via osmosis; this can rapidly progress to seizures, coma,
and brain herniation—neurological monitoring is the highest priority as it represents the
most life-threatening complication of severe hyponatremia.
,Q4: A patient with diabetes insipidus has a serum sodium of 152 mEq/L, severe thirst,
and agitation. Which intervention should the nurse implement FIRST?
A. Restrict oral fluids to 1 L per day
B. Administer desmopressin (DDAVP) as ordered and encourage oral fluids
C. Administer loop diuretics to increase urine output
D. Insert an indwelling urinary catheter
Correct Answer: B
Rationale: Diabetes insipidus causes hypernatremia from excessive free water loss;
desmopressin replaces deficient ADH to reduce urine output, and oral fluids replace the
free water deficit—fluid restriction worsens hypernatremia, and diuretics would
exacerbate the dehydration.
Q5: A patient has the following laboratory results: potassium 2.9 mEq/L, magnesium 1.3
mEq/L, and ECG shows flattened T waves and prominent U waves. Which cardiac
rhythm should the nurse anticipate as the greatest risk?
A. Atrial fibrillation
B. Ventricular tachycardia or fibrillation
C. First-degree AV block
D. Sinus bradycardia
Correct Answer: B
, Rationale: Hypokalemia and hypomagnesemia both prolong the QT interval and
predispose to life-threatening ventricular arrhythmias including torsades de pointes and
ventricular fibrillation; the U waves and flattened T waves on ECG are early warning
signs of increased myocardial irritability requiring immediate electrolyte replacement.
Q6: A patient with chronic kidney disease has a potassium of 6.5 mEq/L with peaked T
waves on ECG. Which medication should the nurse prepare to administer FIRST?
A. Furosemide 40 mg IV push
B. Calcium gluconate 1 g IV
C. Sodium polystyrene sulfonate (Kayexalate) 15 g orally
D. Regular insulin 10 units with dextrose 50% IV
Correct Answer: B
Rationale: Calcium gluconate is administered first in severe hyperkalemia with ECG
changes because it stabilizes cardiac cell membranes and antagonizes the toxic effects
of potassium on the heart, preventing ventricular fibrillation—this is an immediate
life-saving intervention before other potassium-lowering therapies.
Q7: A patient post-parathyroidectomy develops perioral numbness and carpopedal
spasm when the blood pressure cuff is inflated. Which electrolyte imbalance is present?
A. Hypophosphatemia
B. Hypocalcemia
C. Hypermagnesemia
2026/2027 – Comprehensive Test with Detailed Rationales |
100% Verified | Pass Guaranteed – A+ Graded
Section 1: Fluid, Electrolyte & Acid-Base Balance (15 Questions)
Q1: A 72-year-old patient with heart failure has the following assessment findings: JVD
+3, bilateral crackles, peripheral edema 2+, and a 3 kg weight gain in 48 hours. Which
pathophysiological mechanism explains the peripheral edema?
A. Decreased capillary hydrostatic pressure causing fluid shift into cells
B. Increased hydrostatic pressure in venous circulation forcing fluid into interstitial
spaces
C. Decreased plasma oncotic pressure from low albumin
D. Increased lymphatic drainage overwhelming the interstitial space
Correct Answer: B
Rationale: In heart failure, impaired cardiac pumping increases venous pressure
(preload), which raises capillary hydrostatic pressure and forces fluid into interstitial
spaces, causing peripheral edema; JVD and weight gain confirm systemic fluid overload
from the failing heart's inability to handle circulating volume.
Q2: A patient with severe dehydration has dry mucous membranes, decreased skin
turgor, tachycardia (HR 118), and orthostatic hypotension (BP supine 110/70, standing
82/56). Which fluid compartment is primarily depleted?
A. Intracellular fluid (ICF)
,B. Interstitial fluid only
C. Intravascular and interstitial fluid (ECF)
D. Transcellular fluid
Correct Answer: C
Rationale: Dehydration primarily depletes extracellular fluid (ECF), which includes both
intravascular (plasma) and interstitial compartments; orthostatic hypotension and
tachycardia indicate intravascular volume depletion, while decreased skin turgor reflects
interstitial fluid loss—ICF depletion occurs later with severe or prolonged dehydration.
Q3: A patient with syndrome of inappropriate antidiuretic hormone (SIADH) has a serum
sodium of 126 mEq/L. Which clinical manifestation should the nurse monitor as the
highest priority?
A. Muscle cramps in the lower extremities
B. Confusion and altered level of consciousness
C. Nausea and decreased appetite
D. Mild headache
Correct Answer: B
Rationale: Confusion and altered LOC in hyponatremia indicate cerebral edema from
water shifting into brain cells via osmosis; this can rapidly progress to seizures, coma,
and brain herniation—neurological monitoring is the highest priority as it represents the
most life-threatening complication of severe hyponatremia.
,Q4: A patient with diabetes insipidus has a serum sodium of 152 mEq/L, severe thirst,
and agitation. Which intervention should the nurse implement FIRST?
A. Restrict oral fluids to 1 L per day
B. Administer desmopressin (DDAVP) as ordered and encourage oral fluids
C. Administer loop diuretics to increase urine output
D. Insert an indwelling urinary catheter
Correct Answer: B
Rationale: Diabetes insipidus causes hypernatremia from excessive free water loss;
desmopressin replaces deficient ADH to reduce urine output, and oral fluids replace the
free water deficit—fluid restriction worsens hypernatremia, and diuretics would
exacerbate the dehydration.
Q5: A patient has the following laboratory results: potassium 2.9 mEq/L, magnesium 1.3
mEq/L, and ECG shows flattened T waves and prominent U waves. Which cardiac
rhythm should the nurse anticipate as the greatest risk?
A. Atrial fibrillation
B. Ventricular tachycardia or fibrillation
C. First-degree AV block
D. Sinus bradycardia
Correct Answer: B
, Rationale: Hypokalemia and hypomagnesemia both prolong the QT interval and
predispose to life-threatening ventricular arrhythmias including torsades de pointes and
ventricular fibrillation; the U waves and flattened T waves on ECG are early warning
signs of increased myocardial irritability requiring immediate electrolyte replacement.
Q6: A patient with chronic kidney disease has a potassium of 6.5 mEq/L with peaked T
waves on ECG. Which medication should the nurse prepare to administer FIRST?
A. Furosemide 40 mg IV push
B. Calcium gluconate 1 g IV
C. Sodium polystyrene sulfonate (Kayexalate) 15 g orally
D. Regular insulin 10 units with dextrose 50% IV
Correct Answer: B
Rationale: Calcium gluconate is administered first in severe hyperkalemia with ECG
changes because it stabilizes cardiac cell membranes and antagonizes the toxic effects
of potassium on the heart, preventing ventricular fibrillation—this is an immediate
life-saving intervention before other potassium-lowering therapies.
Q7: A patient post-parathyroidectomy develops perioral numbness and carpopedal
spasm when the blood pressure cuff is inflated. Which electrolyte imbalance is present?
A. Hypophosphatemia
B. Hypocalcemia
C. Hypermagnesemia
