NSG 223 Med-Surg 2 Exam 1 2026 Practice Questions & Verified Answers
Medical-Surgical Nursing Review.
Questions 1–10: Fluid & Electrolytes
1. A patient with heart failure has a serum potassium of 2.9 mEq/L. Which
medication should the nurse hold?
A. Metoprolol
B. Furosemide
C. Lisinopril
D. Digoxin
Answer: D
Rationale: Hypokalemia increases the risk of digoxin toxicity, leading to
dysrhythmias. Furosemide causes potassium loss, but the priority is holding
digoxin until potassium normalizes.
2. Which ECG change is most consistent with hyperkalemia?
A. U waves
,B. Peaked T waves
C. ST segment elevation
D. Prolonged PR interval
Answer: B
Rationale: Peaked T waves are an early sign of hyperkalemia. U waves are seen in
hypokalemia.
3. A patient with hyponatremia (Na 118 mEq/L) has a seizure. What is the priority
nursing action?
A. Administer 3% saline IV
B. Restrict water intake
C. Administer IV push furosemide
D. Draw blood for repeat electrolytes
Answer: A
Rationale: Severe symptomatic hyponatremia with seizures requires hypertonic
saline to rapidly increase serum sodium.
,4. Which IV fluid is most appropriate for a patient with increased intracranial
pressure and hypernatremia?
A. 0.9% normal saline
B. D5W
C. 0.45% saline
D. 3% saline
Answer: B
Rationale: D5W is hypotonic after metabolism, lowering sodium levels gradually.
Hypernatremia with ICP requires cautious hypotonic fluids.
5. A patient with hypocalcemia reports tingling around the mouth. The nurse taps
the facial nerve just below the zygomatic arch, causing facial twitching. This is
called:
A. Trousseau’s sign
B. Kernig’s sign
C. Brudzinski’s sign
D. Chvostek’s sign
Answer: D
, Rationale: Chvostek’s sign (facial twitching on tapping) indicates hypocalcemia.
Trousseau’s sign is carpal spasm with BP cuff inflation.
6. A patient with renal failure has a phosphorus level of 7.2 mg/dL. Which
medication should the nurse anticipate?
A. Calcium acetate
B. Magnesium sulfate
C. Potassium chloride
D. Sodium polystyrene sulfonate
Answer: A
Rationale: Calcium acetate binds dietary phosphate in the gut, lowering serum
phosphorus in renal failure.
7. Which finding in a patient receiving IV potassium infusion requires immediate
action?
A. Serum potassium of 3.8 mEq/L
B. IV site redness
C. Patient reports burning at site
D. Infusion rate of 20 mEq/hour
Medical-Surgical Nursing Review.
Questions 1–10: Fluid & Electrolytes
1. A patient with heart failure has a serum potassium of 2.9 mEq/L. Which
medication should the nurse hold?
A. Metoprolol
B. Furosemide
C. Lisinopril
D. Digoxin
Answer: D
Rationale: Hypokalemia increases the risk of digoxin toxicity, leading to
dysrhythmias. Furosemide causes potassium loss, but the priority is holding
digoxin until potassium normalizes.
2. Which ECG change is most consistent with hyperkalemia?
A. U waves
,B. Peaked T waves
C. ST segment elevation
D. Prolonged PR interval
Answer: B
Rationale: Peaked T waves are an early sign of hyperkalemia. U waves are seen in
hypokalemia.
3. A patient with hyponatremia (Na 118 mEq/L) has a seizure. What is the priority
nursing action?
A. Administer 3% saline IV
B. Restrict water intake
C. Administer IV push furosemide
D. Draw blood for repeat electrolytes
Answer: A
Rationale: Severe symptomatic hyponatremia with seizures requires hypertonic
saline to rapidly increase serum sodium.
,4. Which IV fluid is most appropriate for a patient with increased intracranial
pressure and hypernatremia?
A. 0.9% normal saline
B. D5W
C. 0.45% saline
D. 3% saline
Answer: B
Rationale: D5W is hypotonic after metabolism, lowering sodium levels gradually.
Hypernatremia with ICP requires cautious hypotonic fluids.
5. A patient with hypocalcemia reports tingling around the mouth. The nurse taps
the facial nerve just below the zygomatic arch, causing facial twitching. This is
called:
A. Trousseau’s sign
B. Kernig’s sign
C. Brudzinski’s sign
D. Chvostek’s sign
Answer: D
, Rationale: Chvostek’s sign (facial twitching on tapping) indicates hypocalcemia.
Trousseau’s sign is carpal spasm with BP cuff inflation.
6. A patient with renal failure has a phosphorus level of 7.2 mg/dL. Which
medication should the nurse anticipate?
A. Calcium acetate
B. Magnesium sulfate
C. Potassium chloride
D. Sodium polystyrene sulfonate
Answer: A
Rationale: Calcium acetate binds dietary phosphate in the gut, lowering serum
phosphorus in renal failure.
7. Which finding in a patient receiving IV potassium infusion requires immediate
action?
A. Serum potassium of 3.8 mEq/L
B. IV site redness
C. Patient reports burning at site
D. Infusion rate of 20 mEq/hour
