NUR 242 Med-Surg Nursing Exam 2 Actual Exam 2026/2027 –
Comprehensive Assessment with Detailed Rationales | 100%
Verified | Pass Guaranteed – A+ Graded
Section 1: Fluid, Electrolyte & Acid-Base Balance
Q1: A patient admitted with severe vomiting and diarrhea for 3 days presents with poor
skin turgor, dry mucous membranes, tachycardia, and orthostatic hypotension. The
nurse expects the urine specific gravity to be:
A. <1.005
B. 1.010
C. 1.020
D. >1.030
D. >1.030 [CORRECT]
Correct Answer: D
Rationale: Fluid volume deficit from vomiting and diarrhea causes concentrated urine as
the kidneys conserve water. Urine specific gravity >1.030 indicates concentrated urine,
consistent with dehydration. Values <1.005 suggest fluid volume excess or diabetes
insipidus.
Q2: A patient with heart failure is receiving IV fluids at 125 mL/hr. The nurse auscultates
crackles in the lung bases, notes a bounding pulse, and observes 2+ pitting edema in
the lower extremities. Which laboratory finding is MOST consistent with this
presentation?
,A. Increased BUN
B. Increased hematocrit
C. Decreased sodium
D. Increased urine specific gravity
C. Decreased sodium [CORRECT]
Correct Answer: C
Rationale: Fluid volume excess causes hemodilution, resulting in decreased sodium,
decreased BUN, decreased hematocrit/hemoglobin, and decreased urine specific
gravity (<1.005). Increased BUN and increased H/H are seen in fluid volume deficit, not
excess.
Q3: A patient with a serum sodium of 128 mEq/L reports headache, confusion, and
muscle cramps. The nurse recognizes these findings as consistent with:
A. Hypernatremia
B. Hyponatremia
C. Hyperkalemia
D. Hypocalcemia
B. Hyponatremia [CORRECT]
Correct Answer: B
Rationale: Normal serum sodium is 135-145 mEq/L. A level of 128 mEq/L indicates
hyponatremia, which manifests with headache, confusion, nausea, muscle cramps, and
,seizures in severe cases. Hypernatremia (>145) causes agitation, thirst, and
restlessness.
Q4: A patient with a serum potassium of 2.8 mEq/L is on cardiac monitoring. Which
ECG change should the nurse anticipate?
A. Peaked T waves
B. ST depression, flat T waves, and U waves
C. Widened QRS complex
D. Prolonged PR interval
B. ST depression, flat T waves, and U waves [CORRECT]
Correct Answer: B
Rationale: Hypokalemia (K+ <3.5 mEq/L) produces characteristic ECG changes
including ST segment depression, flattened T waves, and prominent U waves. Peaked T
waves and widened QRS are associated with hyperkalemia. The patient requires
cautious potassium replacement.
Q5: A patient with acute kidney injury presents with a serum potassium of 6.2 mEq/L.
The nurse observes tall, peaked T waves on the cardiac monitor. The priority
intervention is:
A. Administer oral potassium supplements
B. Prepare for administration of calcium gluconate
C. Increase dietary potassium intake
, D. Administer IV insulin with dextrose
B. Prepare for administration of calcium gluconate [CORRECT]
Correct Answer: B
Rationale: Hyperkalemia (K+ >5.0 mEq/L) with peaked T waves indicates cardiotoxicity.
Calcium gluconate is the first-line emergency treatment to stabilize cardiac membranes
and prevent life-threatening dysrhythmias including ventricular fibrillation and cardiac
arrest.
Q6: A postoperative patient exhibits facial muscle spasms when the nurse taps the
facial nerve anterior to the ear. This positive Chvostek sign indicates:
A. Hypercalcemia
B. Hypocalcemia
C. Hypermagnesemia
D. Hypomagnesemia
B. Hypocalcemia [CORRECT]
Correct Answer: B
Rationale: Chvostek sign (facial muscle twitching with facial nerve tapping) and
Trousseau sign (carpal spasm with blood pressure cuff inflation) are classic indicators
of hypocalcemia (Ca2+ <9 mg/dL). Both hypocalcemia and hypomagnesemia can
cause these signs, but Chvostek is most classically associated with hypocalcemia.
Comprehensive Assessment with Detailed Rationales | 100%
Verified | Pass Guaranteed – A+ Graded
Section 1: Fluid, Electrolyte & Acid-Base Balance
Q1: A patient admitted with severe vomiting and diarrhea for 3 days presents with poor
skin turgor, dry mucous membranes, tachycardia, and orthostatic hypotension. The
nurse expects the urine specific gravity to be:
A. <1.005
B. 1.010
C. 1.020
D. >1.030
D. >1.030 [CORRECT]
Correct Answer: D
Rationale: Fluid volume deficit from vomiting and diarrhea causes concentrated urine as
the kidneys conserve water. Urine specific gravity >1.030 indicates concentrated urine,
consistent with dehydration. Values <1.005 suggest fluid volume excess or diabetes
insipidus.
Q2: A patient with heart failure is receiving IV fluids at 125 mL/hr. The nurse auscultates
crackles in the lung bases, notes a bounding pulse, and observes 2+ pitting edema in
the lower extremities. Which laboratory finding is MOST consistent with this
presentation?
,A. Increased BUN
B. Increased hematocrit
C. Decreased sodium
D. Increased urine specific gravity
C. Decreased sodium [CORRECT]
Correct Answer: C
Rationale: Fluid volume excess causes hemodilution, resulting in decreased sodium,
decreased BUN, decreased hematocrit/hemoglobin, and decreased urine specific
gravity (<1.005). Increased BUN and increased H/H are seen in fluid volume deficit, not
excess.
Q3: A patient with a serum sodium of 128 mEq/L reports headache, confusion, and
muscle cramps. The nurse recognizes these findings as consistent with:
A. Hypernatremia
B. Hyponatremia
C. Hyperkalemia
D. Hypocalcemia
B. Hyponatremia [CORRECT]
Correct Answer: B
Rationale: Normal serum sodium is 135-145 mEq/L. A level of 128 mEq/L indicates
hyponatremia, which manifests with headache, confusion, nausea, muscle cramps, and
,seizures in severe cases. Hypernatremia (>145) causes agitation, thirst, and
restlessness.
Q4: A patient with a serum potassium of 2.8 mEq/L is on cardiac monitoring. Which
ECG change should the nurse anticipate?
A. Peaked T waves
B. ST depression, flat T waves, and U waves
C. Widened QRS complex
D. Prolonged PR interval
B. ST depression, flat T waves, and U waves [CORRECT]
Correct Answer: B
Rationale: Hypokalemia (K+ <3.5 mEq/L) produces characteristic ECG changes
including ST segment depression, flattened T waves, and prominent U waves. Peaked T
waves and widened QRS are associated with hyperkalemia. The patient requires
cautious potassium replacement.
Q5: A patient with acute kidney injury presents with a serum potassium of 6.2 mEq/L.
The nurse observes tall, peaked T waves on the cardiac monitor. The priority
intervention is:
A. Administer oral potassium supplements
B. Prepare for administration of calcium gluconate
C. Increase dietary potassium intake
, D. Administer IV insulin with dextrose
B. Prepare for administration of calcium gluconate [CORRECT]
Correct Answer: B
Rationale: Hyperkalemia (K+ >5.0 mEq/L) with peaked T waves indicates cardiotoxicity.
Calcium gluconate is the first-line emergency treatment to stabilize cardiac membranes
and prevent life-threatening dysrhythmias including ventricular fibrillation and cardiac
arrest.
Q6: A postoperative patient exhibits facial muscle spasms when the nurse taps the
facial nerve anterior to the ear. This positive Chvostek sign indicates:
A. Hypercalcemia
B. Hypocalcemia
C. Hypermagnesemia
D. Hypomagnesemia
B. Hypocalcemia [CORRECT]
Correct Answer: B
Rationale: Chvostek sign (facial muscle twitching with facial nerve tapping) and
Trousseau sign (carpal spasm with blood pressure cuff inflation) are classic indicators
of hypocalcemia (Ca2+ <9 mg/dL). Both hypocalcemia and hypomagnesemia can
cause these signs, but Chvostek is most classically associated with hypocalcemia.
