NUR 265 Exam 2 Actual Exam 2026/2027: Complete Exam-Style
Questions with Detailed Rationales | 100% Verified | Pass
Guaranteed – A+ Graded
TABLE OF CONTENTS
Section 1 | Fluid and Electrolyte Imbalances in Critical Care | Q1 – Q10
Section 2 | Acid-Base Disorders and ABG Interpretation | Q11 – Q20
Section 3 | Hemodynamic Monitoring and Shock States | Q21 – Q30
Section 4 | Cardiac Disorders and Critical Interventions | Q31 – Q40
Section 5 | Respiratory Failure and Mechanical Ventilation | Q41 – Q50
Instructions: Choose the single best answer. Pass: 80% in 90 minutes.
══════════════════════════════════════
SECTION 1: FLUID AND ELECTROLYTE IMBALANCES IN CRITICAL CARE Q1 – Q10
══════════════════════════════════════
Question 1 of 50
A 68-year-old man is postoperative day 3 after transurethral resection of the prostate.
He is receiving continuous bladder irrigation and intravenous 5% dextrose in water at
125 mL/hr. This morning he is lethargic and difficult to arouse. Laboratory studies reveal
a serum sodium of 124 mEq/L. The nurse's priority intervention is to:
A. Administer a bolus of 3% hypertonic saline to rapidly correct the sodium
B. Notify the provider and anticipate orders to restrict free water and gradually correct
the sodium ✓ CORRECT
C. Increase the intravenous fluid rate to dilute the sodium concentration
D. Administer a loop diuretic to promote renal excretion of water
Correct Answer: B
Rationale: Hyponatremia in this setting is likely dilutional from excessive free water
intake, so restricting free water and gradual correction prevents osmotic demyelination
,syndrome. Administering hypertonic saline rapidly would be dangerous because
correcting chronic or severe hyponatremia faster than 8-12 mEq/L per day can cause
permanent neurological damage. Postoperative nurses must carefully track irrigation
fluid volumes and net fluid balance because absorbed hypotonic irrigation solution can
precipitate hyponatremia.
Question 2 of 50
A 55-year-old man with end-stage renal disease missed his last two dialysis
appointments and arrives in the emergency department complaining of palpitations. His
electrocardiogram shows peaked T waves and a widened QRS complex. Laboratory
studies reveal a serum potassium of 6.8 mEq/L. The nurse knows that the priority
action is to:
A. Administer sodium polystyrene sulfonate rectally
B. Begin emergent hemodialysis immediately
C. Administer intravenous calcium gluconate to stabilize the cardiac membrane ✓
CORRECT
D. Give intravenous insulin and dextrose to shift potassium intracellularly
Correct Answer: C
Rationale: Calcium gluconate is the first-line intervention for hyperkalemia with
electrocardiogram changes because it antagonizes cardiac membrane excitability
within minutes. While insulin and dextrose lower serum potassium, they do not provide
immediate cardiac protection, and dialysis takes too long to arrange in an emergency.
Critical care nurses should always obtain a 12-lead ECG when potassium exceeds 6.0
mEq/L because visible changes demand immediate membrane stabilization before
other therapies.
Question 3 of 50
,A 42-year-old woman is recovering from a total thyroidectomy when she reports perioral
tingling and muscle cramps in her hands. During the assessment, the nurse elicits a
positive Chvostek sign. Her vital signs are stable, but her voice sounds slightly hoarse.
The nurse should:
A. Administer intravenous potassium chloride
B. Prepare the patient for emergent return to the operating room
C. Increase the rate of the patient's maintenance saline infusion
D. Administer intravenous calcium gluconate and monitor airway patency ✓ CORRECT
Correct Answer: D
Rationale: Hypocalcemia after thyroidectomy results from parathyroid gland
manipulation or accidental removal, and intravenous calcium replacement is indicated
when the patient exhibits Chvostek sign, perioral tingling, or tetany. Returning to the
operating room is unnecessary because the parathyroids are often stunned rather than
permanently damaged, and potassium or saline will not address the low ionized
calcium. Postoperative nurses should keep calcium gluconate at the bedside after
thyroid surgery and watch for laryngeal stridor, which signals severe hypocalcemia and
potential airway compromise.
Question 4 of 50
An 82-year-old woman with a recent ischemic stroke is transferred to the acute care
unit. She has poor oral intake due to dysphagia and her family reports she refuses most
fluids. Her serum sodium is 158 mEq/L, urine osmolality is high, and she is mildly
confused. The nurse should:
A. Calculate the free water deficit and replace it slowly over 48 hours ✓ CORRECT
B. Administer a bolus of 0.9% normal saline to restore volume
C. Restrict all oral and intravenous fluids to stimulate thirst
D. Give a loop diuretic to promote sodium excretion
Correct Answer: A
, Rationale: Hypernatremia from free water loss requires replacement of the calculated
deficit at a controlled rate, typically over 48 hours, to prevent cerebral edema from rapid
correction. Normal saline contains sodium and would worsen the hypernatremia, while
fluid restriction is dangerous in a patient who cannot perceive or respond to thirst due to
neurological impairment. Neuro nurses should monitor serum sodium every 4-6 hours
during correction because overly aggressive rehydration can cause seizures from acute
brain swelling.
Question 5 of 50
A 45-year-old man with a history of alcohol use disorder and cirrhosis is admitted after
experiencing multiple ventricular ectopic beats. His laboratory studies reveal a serum
magnesium of 1.2 mg/dL. He is alert but complains of severe weakness. The nurse
should:
A. Prepare for immediate synchronized cardioversion
B. Administer intravenous magnesium sulfate and monitor deep tendon reflexes ✓
CORRECT
C. Administer intravenous calcium chloride to stabilize the myocardium
D. Start oral magnesium oxide tablets via nasogastric tube
Correct Answer: B
Rationale: Severe hypomagnesemia can precipitate ventricular arrhythmias and
potentiate digoxin toxicity, and intravenous magnesium sulfate is the standard
replacement route in critical care because oral absorption is unreliable and too slow.
Calcium chloride is used for hyperkalemia or magnesium toxicity, not hypomagnesemia,
and oral replacement is inadequate when the patient is acutely symptomatic. Critical
care nurses must check deep tendon reflexes before and during magnesium infusion
because absent reflexes signal impending magnesium toxicity and respiratory
depression.
Questions with Detailed Rationales | 100% Verified | Pass
Guaranteed – A+ Graded
TABLE OF CONTENTS
Section 1 | Fluid and Electrolyte Imbalances in Critical Care | Q1 – Q10
Section 2 | Acid-Base Disorders and ABG Interpretation | Q11 – Q20
Section 3 | Hemodynamic Monitoring and Shock States | Q21 – Q30
Section 4 | Cardiac Disorders and Critical Interventions | Q31 – Q40
Section 5 | Respiratory Failure and Mechanical Ventilation | Q41 – Q50
Instructions: Choose the single best answer. Pass: 80% in 90 minutes.
══════════════════════════════════════
SECTION 1: FLUID AND ELECTROLYTE IMBALANCES IN CRITICAL CARE Q1 – Q10
══════════════════════════════════════
Question 1 of 50
A 68-year-old man is postoperative day 3 after transurethral resection of the prostate.
He is receiving continuous bladder irrigation and intravenous 5% dextrose in water at
125 mL/hr. This morning he is lethargic and difficult to arouse. Laboratory studies reveal
a serum sodium of 124 mEq/L. The nurse's priority intervention is to:
A. Administer a bolus of 3% hypertonic saline to rapidly correct the sodium
B. Notify the provider and anticipate orders to restrict free water and gradually correct
the sodium ✓ CORRECT
C. Increase the intravenous fluid rate to dilute the sodium concentration
D. Administer a loop diuretic to promote renal excretion of water
Correct Answer: B
Rationale: Hyponatremia in this setting is likely dilutional from excessive free water
intake, so restricting free water and gradual correction prevents osmotic demyelination
,syndrome. Administering hypertonic saline rapidly would be dangerous because
correcting chronic or severe hyponatremia faster than 8-12 mEq/L per day can cause
permanent neurological damage. Postoperative nurses must carefully track irrigation
fluid volumes and net fluid balance because absorbed hypotonic irrigation solution can
precipitate hyponatremia.
Question 2 of 50
A 55-year-old man with end-stage renal disease missed his last two dialysis
appointments and arrives in the emergency department complaining of palpitations. His
electrocardiogram shows peaked T waves and a widened QRS complex. Laboratory
studies reveal a serum potassium of 6.8 mEq/L. The nurse knows that the priority
action is to:
A. Administer sodium polystyrene sulfonate rectally
B. Begin emergent hemodialysis immediately
C. Administer intravenous calcium gluconate to stabilize the cardiac membrane ✓
CORRECT
D. Give intravenous insulin and dextrose to shift potassium intracellularly
Correct Answer: C
Rationale: Calcium gluconate is the first-line intervention for hyperkalemia with
electrocardiogram changes because it antagonizes cardiac membrane excitability
within minutes. While insulin and dextrose lower serum potassium, they do not provide
immediate cardiac protection, and dialysis takes too long to arrange in an emergency.
Critical care nurses should always obtain a 12-lead ECG when potassium exceeds 6.0
mEq/L because visible changes demand immediate membrane stabilization before
other therapies.
Question 3 of 50
,A 42-year-old woman is recovering from a total thyroidectomy when she reports perioral
tingling and muscle cramps in her hands. During the assessment, the nurse elicits a
positive Chvostek sign. Her vital signs are stable, but her voice sounds slightly hoarse.
The nurse should:
A. Administer intravenous potassium chloride
B. Prepare the patient for emergent return to the operating room
C. Increase the rate of the patient's maintenance saline infusion
D. Administer intravenous calcium gluconate and monitor airway patency ✓ CORRECT
Correct Answer: D
Rationale: Hypocalcemia after thyroidectomy results from parathyroid gland
manipulation or accidental removal, and intravenous calcium replacement is indicated
when the patient exhibits Chvostek sign, perioral tingling, or tetany. Returning to the
operating room is unnecessary because the parathyroids are often stunned rather than
permanently damaged, and potassium or saline will not address the low ionized
calcium. Postoperative nurses should keep calcium gluconate at the bedside after
thyroid surgery and watch for laryngeal stridor, which signals severe hypocalcemia and
potential airway compromise.
Question 4 of 50
An 82-year-old woman with a recent ischemic stroke is transferred to the acute care
unit. She has poor oral intake due to dysphagia and her family reports she refuses most
fluids. Her serum sodium is 158 mEq/L, urine osmolality is high, and she is mildly
confused. The nurse should:
A. Calculate the free water deficit and replace it slowly over 48 hours ✓ CORRECT
B. Administer a bolus of 0.9% normal saline to restore volume
C. Restrict all oral and intravenous fluids to stimulate thirst
D. Give a loop diuretic to promote sodium excretion
Correct Answer: A
, Rationale: Hypernatremia from free water loss requires replacement of the calculated
deficit at a controlled rate, typically over 48 hours, to prevent cerebral edema from rapid
correction. Normal saline contains sodium and would worsen the hypernatremia, while
fluid restriction is dangerous in a patient who cannot perceive or respond to thirst due to
neurological impairment. Neuro nurses should monitor serum sodium every 4-6 hours
during correction because overly aggressive rehydration can cause seizures from acute
brain swelling.
Question 5 of 50
A 45-year-old man with a history of alcohol use disorder and cirrhosis is admitted after
experiencing multiple ventricular ectopic beats. His laboratory studies reveal a serum
magnesium of 1.2 mg/dL. He is alert but complains of severe weakness. The nurse
should:
A. Prepare for immediate synchronized cardioversion
B. Administer intravenous magnesium sulfate and monitor deep tendon reflexes ✓
CORRECT
C. Administer intravenous calcium chloride to stabilize the myocardium
D. Start oral magnesium oxide tablets via nasogastric tube
Correct Answer: B
Rationale: Severe hypomagnesemia can precipitate ventricular arrhythmias and
potentiate digoxin toxicity, and intravenous magnesium sulfate is the standard
replacement route in critical care because oral absorption is unreliable and too slow.
Calcium chloride is used for hyperkalemia or magnesium toxicity, not hypomagnesemia,
and oral replacement is inadequate when the patient is acutely symptomatic. Critical
care nurses must check deep tendon reflexes before and during magnesium infusion
because absent reflexes signal impending magnesium toxicity and respiratory
depression.
