, NUR 242 EXAM 2 MED SURG NURSING PREP (2026)
Questions 1–50
1. A patient with hypertension is prescribed hydrochlorothiazide. Which
finding indicates a therapeutic effect?
• A) Heart rate 110 bpm
• B) Blood pressure 128/78 mmHg
• C) Weight gain 2 kg
• D) Potassium 3.2 mEq/L
*Rationale: Thiazide diuretics lower BP by reducing fluid volume. A BP
<130/80 indicates therapeutic effect. Hypokalemia is an adverse effect.*
2. Which dietary instruction is most important for a patient taking
spironolactone (Aldactone)?
• A) Increase potassium-rich foods
• B) Avoid potassium-rich foods (bananas, oranges)
• C) Increase sodium intake
• D) Limit fluid to 1 L/day
Rationale: Spironolactone is potassium-sparing. Hyperkalemia is a risk, so
avoid high-potassium foods.
3. A patient with chronic kidney disease (CKD) has a hemoglobin of 8.5
g/dL. Which medication does the nurse anticipate?
• A) Epoetin alfa (Epogen)
• B) Furosemide
• C) Spironolactone
• D) Sevelamer
*Rationale: Epoetin alfa stimulates RBC production for anemia of CKD. Target
Hgb 10–11 g/dL.*
4. A patient receiving hemodialysis complains of muscle cramps and
dizziness toward the end of treatment. The nurse suspects:
• A) Hyperkalemia
• B) Hypotension from rapid fluid removal
• C) Dialysis disequilibrium syndrome
• D) Air embolism
Rationale: Hypotension during dialysis is common from rapid ultrafiltration.
Slow rate, give saline.
, 5. Which lab finding is most concerning in a patient with CKD?
• A) BUN 55 mg/dL
• B) Potassium 6.8 mEq/L
• C) Creatinine 4.5 mg/dL
• D) Phosphorus 5.0 mg/dL
Rationale: Hyperkalemia >6.5 can cause cardiac arrest. Emergent treatment
required.
6. A patient with CKD is prescribed calcium acetate (PhosLo). The nurse
instructs the patient to take it:
• A) With meals
• B) On an empty stomach
• C) At bedtime
• D) First thing in the morning
Rationale: Phosphate binders must be taken with meals to bind dietary
phosphorus in the gut.
7. Which finding suggests a patient with ESRD is experiencing fluid
overload?
• A) Orthostatic hypotension
• B) Jugular vein distention and crackles
• C) Dry mucous membranes
• D) Weight loss
Rationale: Fluid overload causes JVD, crackles, edema, hypertension, and
weight gain.
8. A patient with CKD is scheduled for an arteriovenous (AV) fistula
creation. Which instruction is correct?
• A) Avoid BP measurements and blood draws in that arm after surgery
• B) Use the AV fistula arm for all venipunctures
• C) Sleep on the AV fistula arm
• D) Wear tight sleeves over the fistula
Rationale: Protect the AV fistula arm – no BP, no blood draws, no compression,
no tight clothing.
9. Which assessment finding in a patient with an AV fistula indicates
patency?
• A) Palpable thrill and audible bruit
• B) Absent pulse
• C) Cold extremity
Questions 1–50
1. A patient with hypertension is prescribed hydrochlorothiazide. Which
finding indicates a therapeutic effect?
• A) Heart rate 110 bpm
• B) Blood pressure 128/78 mmHg
• C) Weight gain 2 kg
• D) Potassium 3.2 mEq/L
*Rationale: Thiazide diuretics lower BP by reducing fluid volume. A BP
<130/80 indicates therapeutic effect. Hypokalemia is an adverse effect.*
2. Which dietary instruction is most important for a patient taking
spironolactone (Aldactone)?
• A) Increase potassium-rich foods
• B) Avoid potassium-rich foods (bananas, oranges)
• C) Increase sodium intake
• D) Limit fluid to 1 L/day
Rationale: Spironolactone is potassium-sparing. Hyperkalemia is a risk, so
avoid high-potassium foods.
3. A patient with chronic kidney disease (CKD) has a hemoglobin of 8.5
g/dL. Which medication does the nurse anticipate?
• A) Epoetin alfa (Epogen)
• B) Furosemide
• C) Spironolactone
• D) Sevelamer
*Rationale: Epoetin alfa stimulates RBC production for anemia of CKD. Target
Hgb 10–11 g/dL.*
4. A patient receiving hemodialysis complains of muscle cramps and
dizziness toward the end of treatment. The nurse suspects:
• A) Hyperkalemia
• B) Hypotension from rapid fluid removal
• C) Dialysis disequilibrium syndrome
• D) Air embolism
Rationale: Hypotension during dialysis is common from rapid ultrafiltration.
Slow rate, give saline.
, 5. Which lab finding is most concerning in a patient with CKD?
• A) BUN 55 mg/dL
• B) Potassium 6.8 mEq/L
• C) Creatinine 4.5 mg/dL
• D) Phosphorus 5.0 mg/dL
Rationale: Hyperkalemia >6.5 can cause cardiac arrest. Emergent treatment
required.
6. A patient with CKD is prescribed calcium acetate (PhosLo). The nurse
instructs the patient to take it:
• A) With meals
• B) On an empty stomach
• C) At bedtime
• D) First thing in the morning
Rationale: Phosphate binders must be taken with meals to bind dietary
phosphorus in the gut.
7. Which finding suggests a patient with ESRD is experiencing fluid
overload?
• A) Orthostatic hypotension
• B) Jugular vein distention and crackles
• C) Dry mucous membranes
• D) Weight loss
Rationale: Fluid overload causes JVD, crackles, edema, hypertension, and
weight gain.
8. A patient with CKD is scheduled for an arteriovenous (AV) fistula
creation. Which instruction is correct?
• A) Avoid BP measurements and blood draws in that arm after surgery
• B) Use the AV fistula arm for all venipunctures
• C) Sleep on the AV fistula arm
• D) Wear tight sleeves over the fistula
Rationale: Protect the AV fistula arm – no BP, no blood draws, no compression,
no tight clothing.
9. Which assessment finding in a patient with an AV fistula indicates
patency?
• A) Palpable thrill and audible bruit
• B) Absent pulse
• C) Cold extremity
