,NUR 242 Exam 1 | Medical-Surgical Nursing Concepts
(2026/2027) PDF | Galen College
1. Hypokalemia is most likely to produce which ECG change?
A) Flattened T waves and prominent U waves
B) Peaked T waves
C) Widened QRS complex
D) Prolonged PR interval
Correct Answer: Flattened T waves and prominent U waves
Rationale: Hypokalemia (<3.5 mEq/L) delays ventricular repolarization, causing
T‑wave flattening or inversion and the appearance of U waves after the T wave.
Peaked T waves and widened QRS indicate hyperkalemia. The nurse must
monitor the ECG and report these changes.
2. When caring for a client with severe hyperkalemia and ECG changes, the
priority medication is:
A) Sodium polystyrene sulfonate
B) Intravenous calcium gluconate
C) Insulin with glucose
D) Furosemide
Correct Answer: Intravenous calcium gluconate
Rationale: Calcium gluconate stabilizes the cardiac membrane and prevents
life‑threatening arrhythmias. It is the first priority when ECG changes are
,present. Potassium‑lowering therapies, such as insulin with glucose or
Kayexalate, follow but do not provide immediate cardioprotection.
3. An ABG result of pH 7.30, PaCO₂ 50, HCO₃⁻ 25 is interpreted as:
A) Metabolic alkalosis
B) Respiratory alkalosis
C) Respiratory acidosis
D) Metabolic acidosis
Correct Answer: Respiratory acidosis
Rationale: The low pH indicates acidosis, and the elevated PaCO₂ points to a
respiratory cause. HCO₃⁻ is within normal limits, so no renal compensation has
occurred. This pattern is consistent with acute hypoventilation, such as in opioid
overdose or COPD exacerbation.
4. A client with heart failure has a serum sodium of 128 mEq/L and crackles.
Which intervention is expected?
A) 0.9% saline bolus
B) Hypertonic saline infusion
C) Increased oral sodium intake
D) Fluid restriction and diuretics
Correct Answer: Fluid restriction and diuretics
, Rationale: Heart failure causes hypervolemic hyponatremia due to excess total
body water diluting serum sodium. Fluid restriction and diuretics remove excess
fluid and improve sodium concentration. Isotonic or hypertonic saline would
worsen fluid overload.
5. The nurse can delegate which comfort measure to the UAP for a client with a
wound infection of the arm?
A) Apply prescription antibiotic ointment
B) Elevate the arm above the heart
C) Perform sterile wound irrigation
D) Assess circulation and document findings
Correct Answer: Elevate the arm above the heart
Rationale: UAP can assist with positioning and basic comfort measures.
Applying medication, performing sterile procedures, and performing
assessments fall within the scope of licensed nursing personnel. The nurse
retains accountability for delegation.
6. In a facility, the no‑lift policy means:
A) Mechanical lifting devices and safe handling equipment are provided and
used
B) Only RNs lift patients manually
C) Patients must assist with all repositioning
D) Staff manually lift only lightweight patients
(2026/2027) PDF | Galen College
1. Hypokalemia is most likely to produce which ECG change?
A) Flattened T waves and prominent U waves
B) Peaked T waves
C) Widened QRS complex
D) Prolonged PR interval
Correct Answer: Flattened T waves and prominent U waves
Rationale: Hypokalemia (<3.5 mEq/L) delays ventricular repolarization, causing
T‑wave flattening or inversion and the appearance of U waves after the T wave.
Peaked T waves and widened QRS indicate hyperkalemia. The nurse must
monitor the ECG and report these changes.
2. When caring for a client with severe hyperkalemia and ECG changes, the
priority medication is:
A) Sodium polystyrene sulfonate
B) Intravenous calcium gluconate
C) Insulin with glucose
D) Furosemide
Correct Answer: Intravenous calcium gluconate
Rationale: Calcium gluconate stabilizes the cardiac membrane and prevents
life‑threatening arrhythmias. It is the first priority when ECG changes are
,present. Potassium‑lowering therapies, such as insulin with glucose or
Kayexalate, follow but do not provide immediate cardioprotection.
3. An ABG result of pH 7.30, PaCO₂ 50, HCO₃⁻ 25 is interpreted as:
A) Metabolic alkalosis
B) Respiratory alkalosis
C) Respiratory acidosis
D) Metabolic acidosis
Correct Answer: Respiratory acidosis
Rationale: The low pH indicates acidosis, and the elevated PaCO₂ points to a
respiratory cause. HCO₃⁻ is within normal limits, so no renal compensation has
occurred. This pattern is consistent with acute hypoventilation, such as in opioid
overdose or COPD exacerbation.
4. A client with heart failure has a serum sodium of 128 mEq/L and crackles.
Which intervention is expected?
A) 0.9% saline bolus
B) Hypertonic saline infusion
C) Increased oral sodium intake
D) Fluid restriction and diuretics
Correct Answer: Fluid restriction and diuretics
, Rationale: Heart failure causes hypervolemic hyponatremia due to excess total
body water diluting serum sodium. Fluid restriction and diuretics remove excess
fluid and improve sodium concentration. Isotonic or hypertonic saline would
worsen fluid overload.
5. The nurse can delegate which comfort measure to the UAP for a client with a
wound infection of the arm?
A) Apply prescription antibiotic ointment
B) Elevate the arm above the heart
C) Perform sterile wound irrigation
D) Assess circulation and document findings
Correct Answer: Elevate the arm above the heart
Rationale: UAP can assist with positioning and basic comfort measures.
Applying medication, performing sterile procedures, and performing
assessments fall within the scope of licensed nursing personnel. The nurse
retains accountability for delegation.
6. In a facility, the no‑lift policy means:
A) Mechanical lifting devices and safe handling equipment are provided and
used
B) Only RNs lift patients manually
C) Patients must assist with all repositioning
D) Staff manually lift only lightweight patients
