Page 1 of 34
GALEN NSG 3100 – EXAM 1
COMPREHENSIVE NURSING & ADVANCED
CONCEPTS STUDY GUIDE (2026/2027
UPDATE)
1. A nurse is assessing a patient with a sodium level of 128
mEq/L. Which finding is most concerning?
a) Muscle twitching
b) Abdominal cramping
c) Altered mental status
d) Dry mucous membranes
Answer: c) Altered mental status
Rationale: Severe hyponatremia (Na <125) causes cerebral
edema. Altered mental status indicates increased intracranial
pressure, which is a neurological emergency. Dry mucous
membranes are seen in hypernatremia.
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2. Scenario: A patient post-op day 1 has a potassium of 2.9
mEq/L. The nurse sees a lidocaine drip infusing. What is the
priority action?
a) Increase the IV fluid rate
b) Stop the lidocaine drip immediately
c) Administer IV potassium as ordered
d) Document the finding as expected
Answer: b) Stop the lidocaine drip immediately
Rationale: Hypokalemia (K <3.5) potentiates lidocaine toxicity,
increasing risk of seizures and cardiac arrest. The nurse must stop
the infusion and notify the provider before any other action.
3. Which ECG change is classic for hyperkalemia?
a) U waves
b) ST segment depression
c) Peaked T waves
d) Prolonged PR interval
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Answer: c) Peaked T waves
Rationale: Peaked (tented) T waves are the earliest ECG sign of
hyperkalemia. U waves are seen in hypokalemia. ST depression is
non-specific.
4. A patient with heart failure has a calcium level of 12.5
mg/dL. Which medication should the nurse prepare to
administer?
a) Calcium gluconate
b) Calcitonin
c) Magnesium sulfate
d) Potassium chloride
Answer: b) Calcitonin
Rationale: Calcitonin lowers serum calcium by inhibiting bone
resorption. Calcium gluconate is used for hypocalcemia or to
stabilize cardiac membranes in hyperkalemia.
, Page 4 of 34
5. Scenario: A patient receiving IV magnesium sulfate for
preeclampsia reports “feeling hot” and has absent deep
tendon reflexes. The nurse’s priority action is:
a) Turn off the magnesium infusion
b) Administer calcium gluconate
c) Place the patient in Trendelenburg
d) Increase the IV rate of maintenance fluids
Answer: a) Turn off the magnesium infusion
Rationale: Absent DTRs indicate magnesium toxicity. The first step is
to stop the infusion. Calcium gluconate is the antidote but is
given after stopping the infusion and obtaining an order.
6. Which assessment finding indicates that IV fluid
resuscitation for a patient in hypovolemic shock is effective?
a) Heart rate increases from 110 to 130
b) Urine output increases from 10 to 40 mL/hr
c) Blood pressure decreases from 100/60 to 90/50
GALEN NSG 3100 – EXAM 1
COMPREHENSIVE NURSING & ADVANCED
CONCEPTS STUDY GUIDE (2026/2027
UPDATE)
1. A nurse is assessing a patient with a sodium level of 128
mEq/L. Which finding is most concerning?
a) Muscle twitching
b) Abdominal cramping
c) Altered mental status
d) Dry mucous membranes
Answer: c) Altered mental status
Rationale: Severe hyponatremia (Na <125) causes cerebral
edema. Altered mental status indicates increased intracranial
pressure, which is a neurological emergency. Dry mucous
membranes are seen in hypernatremia.
,Page 2 of 34
2. Scenario: A patient post-op day 1 has a potassium of 2.9
mEq/L. The nurse sees a lidocaine drip infusing. What is the
priority action?
a) Increase the IV fluid rate
b) Stop the lidocaine drip immediately
c) Administer IV potassium as ordered
d) Document the finding as expected
Answer: b) Stop the lidocaine drip immediately
Rationale: Hypokalemia (K <3.5) potentiates lidocaine toxicity,
increasing risk of seizures and cardiac arrest. The nurse must stop
the infusion and notify the provider before any other action.
3. Which ECG change is classic for hyperkalemia?
a) U waves
b) ST segment depression
c) Peaked T waves
d) Prolonged PR interval
,Page 3 of 34
Answer: c) Peaked T waves
Rationale: Peaked (tented) T waves are the earliest ECG sign of
hyperkalemia. U waves are seen in hypokalemia. ST depression is
non-specific.
4. A patient with heart failure has a calcium level of 12.5
mg/dL. Which medication should the nurse prepare to
administer?
a) Calcium gluconate
b) Calcitonin
c) Magnesium sulfate
d) Potassium chloride
Answer: b) Calcitonin
Rationale: Calcitonin lowers serum calcium by inhibiting bone
resorption. Calcium gluconate is used for hypocalcemia or to
stabilize cardiac membranes in hyperkalemia.
, Page 4 of 34
5. Scenario: A patient receiving IV magnesium sulfate for
preeclampsia reports “feeling hot” and has absent deep
tendon reflexes. The nurse’s priority action is:
a) Turn off the magnesium infusion
b) Administer calcium gluconate
c) Place the patient in Trendelenburg
d) Increase the IV rate of maintenance fluids
Answer: a) Turn off the magnesium infusion
Rationale: Absent DTRs indicate magnesium toxicity. The first step is
to stop the infusion. Calcium gluconate is the antidote but is
given after stopping the infusion and obtaining an order.
6. Which assessment finding indicates that IV fluid
resuscitation for a patient in hypovolemic shock is effective?
a) Heart rate increases from 110 to 130
b) Urine output increases from 10 to 40 mL/hr
c) Blood pressure decreases from 100/60 to 90/50
