1|Page
NUR 242 EXAM 4 – 2026/2027 CRITICAL CARE &
COMPLEX MEDICAL-SURGICAL NURSING 300
QUESTIONS | ANSWERS & RATIONALES | A+
GRADE
## Table of Contents
| Section | Topic | Questions |
|---------|------------------------------|-----------|
| 1 | Fluid & Electrolyte Balance | 1–40 |
| 2 | Acid-Base Disorders & ABG Interpretation | 41–75 |
| 3 | Cardiovascular Emergencies (MI, HF, Shock) | 76–120 |
| 4 | Respiratory Failure & Mechanical Ventilation | 121–155 |
| 5 | Neurological Emergencies (Stroke, TBI, Seizures) | 156–195 |
| 6 | Renal & Endocrine Crises (DKA, AKI, Thyroid Storm) | 196–235 |
| 7 | Sepsis & Multi-Organ Dysfunction Syndrome (MODS) | 236–265 |
| 8 | Perioperative & Postoperative Complications | 266–285 |
| 9 | Ethical & Legal Issues in Critical Care | 286–300 |
---
,2|Page
## Section 1: Fluid & Electrolyte Balance (Critical Care Focus)
**Questions 1–40**
**1.** A patient with heart failure presents with JVD, crackles, and 3+
pitting edema. Which electrolyte imbalance is most concerning with
aggressive furosemide therapy?
A) Hypernatremia
B) Hypokalemia
C) Hypercalcemia
D) Hypermagnesemia
**Answer: B** – Loop diuretics increase K+ excretion; hypokalemia
increases dysrhythmia risk.
**2.** A patient has serum Na+ 118 mEq/L, confusion, and seizure.
Which IV fluid is contraindicated?
A) 0.9% normal saline
B) 3% hypertonic saline
C) Lactated Ringer’s
D) 0.45% normal saline
**Answer: D** – Hypotonic fluids worsen cerebral edema in severe
hyponatremia.
,3|Page
**3.** A post-op patient has urine output 20 mL/hr over 4 hours, BP
90/60, HR 120. Which electrolyte abnormality is expected?
A) Hyperkalemia
B) Hypokalemia
C) Hypernatremia
D) Hypocalcemia
**Answer: A** – Acute kidney injury from hypovolemia causes
decreased K+ excretion → hyperkalemia.
**4.** Which EKG change is most consistent with severe hypokalemia
(K+ 2.1 mEq/L)?
A) Tall peaked T waves
B) Prominent U wave
C) Shortened QT interval
D) Widened QRS
**Answer: B** – Hypokalemia causes U waves, flat T waves, and
prolonged QT.
**5.** A patient with cirrhosis and ascites has serum Mg 1.0 mg/dL.
Which medication is most likely to worsen this?
A) Furosemide
B) Spironolactone
C) Lactulose
, 4|Page
D) Metoprolol
**Answer: A** – Loop diuretics cause renal Mg wasting.
**6.** A patient with hypercalcemia (Ca 13.5 mg/dL) is admitted.
Which EKG finding is expected?
A) Prolonged QT interval
B) Shortened QT interval
C) Peaked T waves
D) U waves
**Answer: B** – Hypercalcemia shortens QT interval.
**7.** Which IV fluid is preferred for initial resuscitation in
hypovolemic shock?
A) 0.45% NaCl
B) D5W
C) Lactated Ringer’s
D) 3% NaCl
**Answer: C** – Isotonic crystalloid (LR or NS) is first-line.
**8.** A patient with SIADH has Na+ 122 mEq/L. Which intervention
is most appropriate?
A) Fluid restriction
B) 3% saline bolus
NUR 242 EXAM 4 – 2026/2027 CRITICAL CARE &
COMPLEX MEDICAL-SURGICAL NURSING 300
QUESTIONS | ANSWERS & RATIONALES | A+
GRADE
## Table of Contents
| Section | Topic | Questions |
|---------|------------------------------|-----------|
| 1 | Fluid & Electrolyte Balance | 1–40 |
| 2 | Acid-Base Disorders & ABG Interpretation | 41–75 |
| 3 | Cardiovascular Emergencies (MI, HF, Shock) | 76–120 |
| 4 | Respiratory Failure & Mechanical Ventilation | 121–155 |
| 5 | Neurological Emergencies (Stroke, TBI, Seizures) | 156–195 |
| 6 | Renal & Endocrine Crises (DKA, AKI, Thyroid Storm) | 196–235 |
| 7 | Sepsis & Multi-Organ Dysfunction Syndrome (MODS) | 236–265 |
| 8 | Perioperative & Postoperative Complications | 266–285 |
| 9 | Ethical & Legal Issues in Critical Care | 286–300 |
---
,2|Page
## Section 1: Fluid & Electrolyte Balance (Critical Care Focus)
**Questions 1–40**
**1.** A patient with heart failure presents with JVD, crackles, and 3+
pitting edema. Which electrolyte imbalance is most concerning with
aggressive furosemide therapy?
A) Hypernatremia
B) Hypokalemia
C) Hypercalcemia
D) Hypermagnesemia
**Answer: B** – Loop diuretics increase K+ excretion; hypokalemia
increases dysrhythmia risk.
**2.** A patient has serum Na+ 118 mEq/L, confusion, and seizure.
Which IV fluid is contraindicated?
A) 0.9% normal saline
B) 3% hypertonic saline
C) Lactated Ringer’s
D) 0.45% normal saline
**Answer: D** – Hypotonic fluids worsen cerebral edema in severe
hyponatremia.
,3|Page
**3.** A post-op patient has urine output 20 mL/hr over 4 hours, BP
90/60, HR 120. Which electrolyte abnormality is expected?
A) Hyperkalemia
B) Hypokalemia
C) Hypernatremia
D) Hypocalcemia
**Answer: A** – Acute kidney injury from hypovolemia causes
decreased K+ excretion → hyperkalemia.
**4.** Which EKG change is most consistent with severe hypokalemia
(K+ 2.1 mEq/L)?
A) Tall peaked T waves
B) Prominent U wave
C) Shortened QT interval
D) Widened QRS
**Answer: B** – Hypokalemia causes U waves, flat T waves, and
prolonged QT.
**5.** A patient with cirrhosis and ascites has serum Mg 1.0 mg/dL.
Which medication is most likely to worsen this?
A) Furosemide
B) Spironolactone
C) Lactulose
, 4|Page
D) Metoprolol
**Answer: A** – Loop diuretics cause renal Mg wasting.
**6.** A patient with hypercalcemia (Ca 13.5 mg/dL) is admitted.
Which EKG finding is expected?
A) Prolonged QT interval
B) Shortened QT interval
C) Peaked T waves
D) U waves
**Answer: B** – Hypercalcemia shortens QT interval.
**7.** Which IV fluid is preferred for initial resuscitation in
hypovolemic shock?
A) 0.45% NaCl
B) D5W
C) Lactated Ringer’s
D) 3% NaCl
**Answer: C** – Isotonic crystalloid (LR or NS) is first-line.
**8.** A patient with SIADH has Na+ 122 mEq/L. Which intervention
is most appropriate?
A) Fluid restriction
B) 3% saline bolus
