NUR 242 — EXAM 2: ANSWER SHEET & DETAILED RATIONALES
All 100 Questions | All Units | Galen Values Referenced | Detailed Explanation for Every Answer
■ Read EVERY rationale — even for questions you got right. Understanding WHY is what passes the exam.
QUICK ANSWER GRID
Q# Ans Q# Ans Q# Ans Q# Ans Q# Ans
1 B 21 B 41 B 61 C 81 B
2 B 22 A 42 B 62 B 82 B
3 B 23 B 43 B 63 B 83 B
4 C 24 B 44 B 64 B 84 B
5 B 25 B 45 B 65 B 85 B
6 B 26 B 46 B 66 B 86 B
7 B 27 B 47 B 67 B 87 B
8 B 28 B 48 C 68 C 88 B
9 B 29 B 49 B 69 B 89 B
10 B 30 B 50 A 70 C 90 B
11 B 31 B 51 B 71 B 91 B
12 B 32 B 52 B 72 B 92 C
13 B 33 C 53 C 73 B 93 B
14 B 34 B 54 B 74 B 94 A
15 B 35 B 55 B 75 B 95 B
16 B 36 B 56 B 76 B 96 B
17 B 37 A 57 B 77 B 97 B
18 B 38 B 58 B 78 B 98 B
19 B 39 B 59 B 79 B 99 B
20 B 40 B 60 B 80 B 100 B
DETAILED RATIONALES — READ ALL OF THESE!
★ FLUIDS & DEHYDRATION
Question 1
✓ Correct Answer: B
Daily weights on the same scale at the same time is the MOST RELIABLE indicator of fluid status — 1 kg of weight = approximately 1 liter of
fluid. Skin turgor is LESS RELIABLE in older adults (option A). Thirst (C) and blood pressure changes (D) are late signs of dehydration.
Question 2
✓ Correct Answer: B
BOX 13.3 lists the key features of fluid overload: bounding pulse, distended neck veins, moist crackles, and weight gain. Option A describes
dehydration (thready pulse, poor skin turgor). Option C describes metabolic acidosis. Option D also describes dehydration.
Question 3
✓ Correct Answer: B
BOX 13.1 shows ileostomy as a dehydration risk and long-term corticosteroids as a fluid OVERLOAD risk. The correct clinical approach is to
assess for BOTH imbalances simultaneously — not just one.
, Question 4
✓ Correct Answer: C
Per the Critical Rescue NSP (p.259): if signs of worsening fluid overload are present (bounding pulse, ↑JVD, crackles, ↑edema, ↓UO) →
NOTIFY the primary health care provider IMMEDIATELY. Remain with the patient. You cannot give furosemide without an order, and restricting
fluids without an order is outside nursing scope.
Question 5
✓ Correct Answer: B
The body compensates for dehydration (hypovolemia) primarily through VASOCONSTRICTION and increased PERIPHERAL RESISTANCE to
maintain blood pressure when circulating volume is reduced. This is why the pulse is rapid (heart works harder) but thready (vessels
constricted). Vasodilation (A) would worsen hypotension.
★ SODIUM IMBALANCES
Question 6
✓ Correct Answer: B
Sodium 124 mEq/L is below Galen normal (135–145 mEq/L) = HYPONATREMIA. In older adults, SUDDEN ACUTE CONFUSION is the
hallmark presenting sign of hyponatremia. Water shifts INTO brain cells → cerebral edema → increased ICP → confusion/seizures. All other lab
values listed are within normal range.
Question 7
✓ Correct Answer: B
3% hypertonic saline has MORE sodium than the blood, creating an osmotic gradient that pulls water OUT of swollen brain cells. It is used
ONLY for SEVERE symptomatic hyponatremia (seizures, coma). It is NOT for dehydration (0.9% NS or LR). Must be infused slowly with
continuous monitoring.
Question 8
✓ Correct Answer: B
In hypernatremia, brain cells have ADAPTED to the high sodium environment. Rapid lowering of sodium causes water to rush BACK INTO brain
cells too quickly → cerebral edema. This is osmotic demyelination syndrome — PERMANENT brain damage. Always correct sodium
imbalances gradually.
Question 9
✓ Correct Answer: B
Na+ 148 mEq/L = HYPERNATREMIA (above Galen normal 135–145). High sodium → water shifts OUT of brain → brain SHRINKS → cells
dehydrate → AGITATION, restlessness, and INTENSE THIRST (the hallmark of hypernatremia). NOT confusion and seizures (that is
hyponatremia). NOT edema (that is fluid overload).
Question 10
✓ Correct Answer: B
Drinking 6 liters of plain water daily causes DILUTIONAL hyponatremia — excessive water dilutes the sodium concentration in the blood even
though total body sodium may be normal. This is the "relative sodium deficit" from BOX 13.4. Psychiatric polydipsia works the same way.
★ POTASSIUM IMBALANCES
Question 11
✓ Correct Answer: B
K+ 2.8 mEq/L = HYPOKALEMIA (below Galen 3.5–5.0). Low K+ reduces cell excitability. ECG shows: ST segment DEPRESSION (segment
drops below baseline), FLAT or INVERTED T waves (T wave flattens), and U WAVE (extra deflection after T). Peaked T waves (A) =
HYPERKALEMIA. ST elevation (D) = MI/pericarditis.
Question 12
✓ Correct Answer: B
Per NPSG and NSP Drug Alert (p.264): CONFIRM UO ≥30 mL/hr first (kidneys must excrete K+) AND verify the K+ is properly diluted (never IV
push). Giving K+ with poor urine output → dangerous hyperkalemia. IV push causes immediate cardiac arrest. Informed consent (D) is not
required for IV potassium.
All 100 Questions | All Units | Galen Values Referenced | Detailed Explanation for Every Answer
■ Read EVERY rationale — even for questions you got right. Understanding WHY is what passes the exam.
QUICK ANSWER GRID
Q# Ans Q# Ans Q# Ans Q# Ans Q# Ans
1 B 21 B 41 B 61 C 81 B
2 B 22 A 42 B 62 B 82 B
3 B 23 B 43 B 63 B 83 B
4 C 24 B 44 B 64 B 84 B
5 B 25 B 45 B 65 B 85 B
6 B 26 B 46 B 66 B 86 B
7 B 27 B 47 B 67 B 87 B
8 B 28 B 48 C 68 C 88 B
9 B 29 B 49 B 69 B 89 B
10 B 30 B 50 A 70 C 90 B
11 B 31 B 51 B 71 B 91 B
12 B 32 B 52 B 72 B 92 C
13 B 33 C 53 C 73 B 93 B
14 B 34 B 54 B 74 B 94 A
15 B 35 B 55 B 75 B 95 B
16 B 36 B 56 B 76 B 96 B
17 B 37 A 57 B 77 B 97 B
18 B 38 B 58 B 78 B 98 B
19 B 39 B 59 B 79 B 99 B
20 B 40 B 60 B 80 B 100 B
DETAILED RATIONALES — READ ALL OF THESE!
★ FLUIDS & DEHYDRATION
Question 1
✓ Correct Answer: B
Daily weights on the same scale at the same time is the MOST RELIABLE indicator of fluid status — 1 kg of weight = approximately 1 liter of
fluid. Skin turgor is LESS RELIABLE in older adults (option A). Thirst (C) and blood pressure changes (D) are late signs of dehydration.
Question 2
✓ Correct Answer: B
BOX 13.3 lists the key features of fluid overload: bounding pulse, distended neck veins, moist crackles, and weight gain. Option A describes
dehydration (thready pulse, poor skin turgor). Option C describes metabolic acidosis. Option D also describes dehydration.
Question 3
✓ Correct Answer: B
BOX 13.1 shows ileostomy as a dehydration risk and long-term corticosteroids as a fluid OVERLOAD risk. The correct clinical approach is to
assess for BOTH imbalances simultaneously — not just one.
, Question 4
✓ Correct Answer: C
Per the Critical Rescue NSP (p.259): if signs of worsening fluid overload are present (bounding pulse, ↑JVD, crackles, ↑edema, ↓UO) →
NOTIFY the primary health care provider IMMEDIATELY. Remain with the patient. You cannot give furosemide without an order, and restricting
fluids without an order is outside nursing scope.
Question 5
✓ Correct Answer: B
The body compensates for dehydration (hypovolemia) primarily through VASOCONSTRICTION and increased PERIPHERAL RESISTANCE to
maintain blood pressure when circulating volume is reduced. This is why the pulse is rapid (heart works harder) but thready (vessels
constricted). Vasodilation (A) would worsen hypotension.
★ SODIUM IMBALANCES
Question 6
✓ Correct Answer: B
Sodium 124 mEq/L is below Galen normal (135–145 mEq/L) = HYPONATREMIA. In older adults, SUDDEN ACUTE CONFUSION is the
hallmark presenting sign of hyponatremia. Water shifts INTO brain cells → cerebral edema → increased ICP → confusion/seizures. All other lab
values listed are within normal range.
Question 7
✓ Correct Answer: B
3% hypertonic saline has MORE sodium than the blood, creating an osmotic gradient that pulls water OUT of swollen brain cells. It is used
ONLY for SEVERE symptomatic hyponatremia (seizures, coma). It is NOT for dehydration (0.9% NS or LR). Must be infused slowly with
continuous monitoring.
Question 8
✓ Correct Answer: B
In hypernatremia, brain cells have ADAPTED to the high sodium environment. Rapid lowering of sodium causes water to rush BACK INTO brain
cells too quickly → cerebral edema. This is osmotic demyelination syndrome — PERMANENT brain damage. Always correct sodium
imbalances gradually.
Question 9
✓ Correct Answer: B
Na+ 148 mEq/L = HYPERNATREMIA (above Galen normal 135–145). High sodium → water shifts OUT of brain → brain SHRINKS → cells
dehydrate → AGITATION, restlessness, and INTENSE THIRST (the hallmark of hypernatremia). NOT confusion and seizures (that is
hyponatremia). NOT edema (that is fluid overload).
Question 10
✓ Correct Answer: B
Drinking 6 liters of plain water daily causes DILUTIONAL hyponatremia — excessive water dilutes the sodium concentration in the blood even
though total body sodium may be normal. This is the "relative sodium deficit" from BOX 13.4. Psychiatric polydipsia works the same way.
★ POTASSIUM IMBALANCES
Question 11
✓ Correct Answer: B
K+ 2.8 mEq/L = HYPOKALEMIA (below Galen 3.5–5.0). Low K+ reduces cell excitability. ECG shows: ST segment DEPRESSION (segment
drops below baseline), FLAT or INVERTED T waves (T wave flattens), and U WAVE (extra deflection after T). Peaked T waves (A) =
HYPERKALEMIA. ST elevation (D) = MI/pericarditis.
Question 12
✓ Correct Answer: B
Per NPSG and NSP Drug Alert (p.264): CONFIRM UO ≥30 mL/hr first (kidneys must excrete K+) AND verify the K+ is properly diluted (never IV
push). Giving K+ with poor urine output → dangerous hyperkalemia. IV push causes immediate cardiac arrest. Informed consent (D) is not
required for IV potassium.
