NUR 242 Med-Surg Nursing Exams 1-4 All-in-One Review Actual Exam 2026/2027
– Comprehensive Bundle with Detailed Rationales | 100% Verified | Pass
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Section 1: Exam 1 Review - Fluid, Electrolyte, Acid-Base & Pain
Management (Questions 1-40)
Q1: A client admitted with severe gastroenteritis has been vomiting for 48 hours.
Assessment reveals tachycardia (HR 118), weak and thready pulses, orthostatic
hypotension (BP drops 25 mmHg systolic upon standing), poor skin turgor, dry mucous
membranes, and urine output of 15 mL/hour. Which fluid imbalance is present?
A. Fluid volume excess
B. Fluid volume deficit
C. Syndrome of inappropriate antidiuretic hormone (SIADH)
D. Third-spacing of fluids
Correct Answer: B
,Rationale: The client exhibits classic signs of fluid volume deficit (FVD) including
tachycardia, weak/thready pulses, orthostatic hypotension, poor skin turgor, dry mucous
membranes, and decreased urine output; these findings result from extracellular fluid
loss through vomiting per Galen NUR 242 fluid and electrolyte management standards.
Q2: A client with heart failure has gained 3 kg over 2 days, has bilateral crackles, JVD,
bounding pulse, and blood pressure of 168/94 mmHg. Laboratory values show
decreased hemoglobin and hematocrit and decreased BUN. Which fluid imbalance is
present?
A. Fluid volume deficit
B. Fluid volume excess
C. Dehydration
D. Hypovolemic shock
Correct Answer: B
Rationale: Fluid volume excess (FVE) is characterized by weight gain, JVD, crackles,
bounding pulse, hypertension, and hemodilution (decreased H/H and BUN); heart failure
causes sodium and water retention leading to hypervolemia per Galen NUR 242
cardiovascular and fluid management standards.
,Q3: A client's laboratory report shows a serum sodium of 128 mEq/L. The client is
confused and lethargic. Which nursing intervention is the priority?
A. Administer 3% hypertonic saline rapidly to correct the sodium
B. Monitor for seizures, restrict free water intake, and administer saline per protocol
C. Encourage the client to drink large volumes of water to dilute the sodium
D. Administer furosemide to promote sodium excretion
Correct Answer: B
Rationale: Hyponatremia (Na+ <135 mEq/L) causes cerebral edema manifesting as
confusion and seizures; management includes free water restriction, cautious sodium
replacement (not too rapidly to prevent osmotic demyelination), and seizure precautions
per Galen NUR 242 electrolyte management standards.
Q4: A client with diabetic ketoacidosis has an arterial blood gas showing pH 7.28,
PaCO2 32 mmHg, and HCO3- 14 mEq/L. Which acid-base disturbance is present?
A. Respiratory acidosis with metabolic compensation
B. Metabolic acidosis with respiratory compensation
, C. Respiratory alkalosis with metabolic compensation
D. Metabolic alkalosis with respiratory compensation
Correct Answer: B
Rationale: The low pH (7.28) indicates acidosis; the low HCO3- (14) identifies the
metabolic component; the low PaCO2 (32) represents respiratory compensation
(hyperventilation blowing off CO2); this is classic metabolic acidosis with respiratory
compensation consistent with DKA per Galen NUR 242 ABG interpretation standards.
Q5: A client with COPD has an ABG showing pH 7.32, PaCO2 58 mmHg, and HCO3- 30
mEq/L. Which acid-base disturbance is present?
A. Respiratory acidosis with metabolic compensation
B. Metabolic acidosis with respiratory compensation
C. Respiratory alkalosis without compensation
D. Metabolic alkalosis with respiratory compensation
Correct Answer: A
– Comprehensive Bundle with Detailed Rationales | 100% Verified | Pass
Guaranteed – A+ Graded
Section 1: Exam 1 Review - Fluid, Electrolyte, Acid-Base & Pain
Management (Questions 1-40)
Q1: A client admitted with severe gastroenteritis has been vomiting for 48 hours.
Assessment reveals tachycardia (HR 118), weak and thready pulses, orthostatic
hypotension (BP drops 25 mmHg systolic upon standing), poor skin turgor, dry mucous
membranes, and urine output of 15 mL/hour. Which fluid imbalance is present?
A. Fluid volume excess
B. Fluid volume deficit
C. Syndrome of inappropriate antidiuretic hormone (SIADH)
D. Third-spacing of fluids
Correct Answer: B
,Rationale: The client exhibits classic signs of fluid volume deficit (FVD) including
tachycardia, weak/thready pulses, orthostatic hypotension, poor skin turgor, dry mucous
membranes, and decreased urine output; these findings result from extracellular fluid
loss through vomiting per Galen NUR 242 fluid and electrolyte management standards.
Q2: A client with heart failure has gained 3 kg over 2 days, has bilateral crackles, JVD,
bounding pulse, and blood pressure of 168/94 mmHg. Laboratory values show
decreased hemoglobin and hematocrit and decreased BUN. Which fluid imbalance is
present?
A. Fluid volume deficit
B. Fluid volume excess
C. Dehydration
D. Hypovolemic shock
Correct Answer: B
Rationale: Fluid volume excess (FVE) is characterized by weight gain, JVD, crackles,
bounding pulse, hypertension, and hemodilution (decreased H/H and BUN); heart failure
causes sodium and water retention leading to hypervolemia per Galen NUR 242
cardiovascular and fluid management standards.
,Q3: A client's laboratory report shows a serum sodium of 128 mEq/L. The client is
confused and lethargic. Which nursing intervention is the priority?
A. Administer 3% hypertonic saline rapidly to correct the sodium
B. Monitor for seizures, restrict free water intake, and administer saline per protocol
C. Encourage the client to drink large volumes of water to dilute the sodium
D. Administer furosemide to promote sodium excretion
Correct Answer: B
Rationale: Hyponatremia (Na+ <135 mEq/L) causes cerebral edema manifesting as
confusion and seizures; management includes free water restriction, cautious sodium
replacement (not too rapidly to prevent osmotic demyelination), and seizure precautions
per Galen NUR 242 electrolyte management standards.
Q4: A client with diabetic ketoacidosis has an arterial blood gas showing pH 7.28,
PaCO2 32 mmHg, and HCO3- 14 mEq/L. Which acid-base disturbance is present?
A. Respiratory acidosis with metabolic compensation
B. Metabolic acidosis with respiratory compensation
, C. Respiratory alkalosis with metabolic compensation
D. Metabolic alkalosis with respiratory compensation
Correct Answer: B
Rationale: The low pH (7.28) indicates acidosis; the low HCO3- (14) identifies the
metabolic component; the low PaCO2 (32) represents respiratory compensation
(hyperventilation blowing off CO2); this is classic metabolic acidosis with respiratory
compensation consistent with DKA per Galen NUR 242 ABG interpretation standards.
Q5: A client with COPD has an ABG showing pH 7.32, PaCO2 58 mmHg, and HCO3- 30
mEq/L. Which acid-base disturbance is present?
A. Respiratory acidosis with metabolic compensation
B. Metabolic acidosis with respiratory compensation
C. Respiratory alkalosis without compensation
D. Metabolic alkalosis with respiratory compensation
Correct Answer: A
