NSG 223 Med-Surg 2 Exam 1 2026 Questions & Verified Answers Medical-
Surgical Nursing Review.
Fluid & Electrolytes (Questions 1–15)
1. A nurse assesses a patient with heart failure who has been receiving
furosemide. Which laboratory value requires immediate intervention?
A. Serum sodium 135 mEq/L
B. Serum potassium 3.1 mEq/L
C. Serum calcium 9.2 mg/dL
D. Serum magnesium 2.1 mg/dL
Answer: B
Rationale: Hypokalemia (K+ <3.5 mEq/L) from loop diuretics increases the risk of
dysrhythmias. The other values are normal.
2. A patient with severe vomiting develops metabolic alkalosis. Which
compensatory mechanism would the nurse expect?
,A. Hypoventilation
B. Hyperventilation
C. Increased urine pH
D. Decreased serum bicarbonate
Answer: A
Rationale: The lungs compensate by hypoventilating (retaining CO₂) to raise
PaCO₂ and partially correct alkalosis. Hyperventilation would worsen alkalosis.
3. Which clinical manifestation is most indicative of hypernatremia?
A. Muscle twitching
B. Neurologic changes (confusion, restlessness)
C. Tingling of fingers
D. Nausea and vomiting
Answer: B
Rationale: Hypernatremia shrinks brain cells, causing altered mental status.
Muscle twitching/tingling suggest hypocalcemia or hypomagnesemia.
,4. A patient’s arterial blood gas (ABG) shows: pH 7.30, PaCO₂ 55 mm Hg, HCO₃⁻ 24
mEq/L. Which condition is present?
A. Metabolic acidosis
B. Metabolic alkalosis
C. Respiratory acidosis
D. Respiratory alkalosis
Answer: C
Rationale: Low pH (acidosis), elevated PaCO₂ (normal 35–45), and normal HCO₃⁻
indicate acute respiratory acidosis.
5. The nurse is administering IV potassium chloride. Which action is safest?
A. Dilute in a small volume IV push.
B. Give via gravity infusion at 20 mEq/hour.
C. Ensure rate does not exceed 10 mEq/hour in peripheral line.
D. Administer undiluted through central line.
Answer: C
, Rationale: Maximum safe peripheral infusion is 10 mEq/hour (some facilities
allow up to 20 mEq/hour with monitoring). IV push or undiluted potassium can
cause cardiac arrest.
6. Which electrocardiographic change is associated with hypocalcemia?
A. Widened QRS
B. Peaked T waves
C. Prolonged QT interval
D. Shortened QT interval
Answer: C
Rationale: Hypocalcemia prolongs the QT interval, increasing risk for torsades de
pointes. Peaked T waves suggest hyperkalemia.
7. A patient has hypermagnesemia secondary to renal failure. What assessment
finding is most concerning?
A. Deep tendon reflexes 3+
B. Respiratory rate 10 breaths/min
C. Blood pressure 140/90 mm Hg
D. Serum magnesium 2.5 mg/dL
Surgical Nursing Review.
Fluid & Electrolytes (Questions 1–15)
1. A nurse assesses a patient with heart failure who has been receiving
furosemide. Which laboratory value requires immediate intervention?
A. Serum sodium 135 mEq/L
B. Serum potassium 3.1 mEq/L
C. Serum calcium 9.2 mg/dL
D. Serum magnesium 2.1 mg/dL
Answer: B
Rationale: Hypokalemia (K+ <3.5 mEq/L) from loop diuretics increases the risk of
dysrhythmias. The other values are normal.
2. A patient with severe vomiting develops metabolic alkalosis. Which
compensatory mechanism would the nurse expect?
,A. Hypoventilation
B. Hyperventilation
C. Increased urine pH
D. Decreased serum bicarbonate
Answer: A
Rationale: The lungs compensate by hypoventilating (retaining CO₂) to raise
PaCO₂ and partially correct alkalosis. Hyperventilation would worsen alkalosis.
3. Which clinical manifestation is most indicative of hypernatremia?
A. Muscle twitching
B. Neurologic changes (confusion, restlessness)
C. Tingling of fingers
D. Nausea and vomiting
Answer: B
Rationale: Hypernatremia shrinks brain cells, causing altered mental status.
Muscle twitching/tingling suggest hypocalcemia or hypomagnesemia.
,4. A patient’s arterial blood gas (ABG) shows: pH 7.30, PaCO₂ 55 mm Hg, HCO₃⁻ 24
mEq/L. Which condition is present?
A. Metabolic acidosis
B. Metabolic alkalosis
C. Respiratory acidosis
D. Respiratory alkalosis
Answer: C
Rationale: Low pH (acidosis), elevated PaCO₂ (normal 35–45), and normal HCO₃⁻
indicate acute respiratory acidosis.
5. The nurse is administering IV potassium chloride. Which action is safest?
A. Dilute in a small volume IV push.
B. Give via gravity infusion at 20 mEq/hour.
C. Ensure rate does not exceed 10 mEq/hour in peripheral line.
D. Administer undiluted through central line.
Answer: C
, Rationale: Maximum safe peripheral infusion is 10 mEq/hour (some facilities
allow up to 20 mEq/hour with monitoring). IV push or undiluted potassium can
cause cardiac arrest.
6. Which electrocardiographic change is associated with hypocalcemia?
A. Widened QRS
B. Peaked T waves
C. Prolonged QT interval
D. Shortened QT interval
Answer: C
Rationale: Hypocalcemia prolongs the QT interval, increasing risk for torsades de
pointes. Peaked T waves suggest hyperkalemia.
7. A patient has hypermagnesemia secondary to renal failure. What assessment
finding is most concerning?
A. Deep tendon reflexes 3+
B. Respiratory rate 10 breaths/min
C. Blood pressure 140/90 mm Hg
D. Serum magnesium 2.5 mg/dL
