NUR 242 Exam 1 () | Med-Surg
Nursing | Galen College (A+ Guarantee) | PDF
1. A patient has a serum sodium level of 118 mEq/L.
Which assessment finding is most critical to report
immediately?
A. Muscle cramps
B. Nausea and vomiting
C. Altered mental status
D. Dry mucous membranes
Correct Answer: C
Rationale: Severe hyponatremia (Na <120) can cause
cerebral edema, leading to seizures, coma, or brain
herniation. Altered mental status is a late sign requiring
immediate intervention.
2. Which IV fluid is most appropriate for a patient with
hypernatremia caused by dehydration?
A. 0.45% NaCl (½ normal saline)
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,B. 3% NaCl
C. 0.9% NaCl
D. Lactated Ringer’s
Correct Answer: A
Rationale: Hypotonic fluids (0.45% NaCl) dilute serum
sodium. Hypertonic saline (3%) is for severe symptomatic
hyponatremia, not hypernatremia.
3. A patient with heart failure has edema and crackles.
Serum potassium is 5.8 mEq/L. Which diuretic is most
appropriate?
A. Furosemide (Lasix)
B. Spironolactone
C. Hydrochlorothiazide
D. Mannitol
Correct Answer: A
Rationale: Furosemide is a loop diuretic that treats fluid
overload and lowers potassium (useful in hyperkalemia).
2
,Spironolactone is potassium-sparing and would worsen
hyperkalemia.
4. A patient’s potassium level is 2.9 mEq/L. Which ECG
change would the nurse expect?
A. Tall, peaked T waves
B. Widened QRS complex
C. Flat T waves and prominent U waves
D. Prolonged PR interval without U waves
Correct Answer: C
Rationale: Hypokalemia (K <3.5) causes flat T waves, ST
depression, and prominent U waves. Tall peaked T waves
are seen in hyperkalemia.
5. Which food choice indicates a patient with
hypokalemia needs further teaching?
A. Baked potato with skin
B. Banana
3
, C. Canned peaches in syrup
D. Spinach salad
Correct Answer: C
Rationale: Canned peaches in syrup are low in potassium.
Potatoes, bananas, and spinach are potassium-rich. The
patient needs high-potassium foods.
6. A patient with chronic kidney disease has a calcium
level of 12.5 mg/dL. Which assessment finding is most
concerning?
A. Positive Chvostek’s sign
B. Muscle twitching
C. Lethargy and confusion
D. Bone pain
Correct Answer: C
Rationale: Severe hypercalcemia (>12 mg/dL) can cause
neurologic depression, lethargy, confusion, and cardiac
arrest. Chvostek’s sign indicates hypocalcemia.
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Nursing | Galen College (A+ Guarantee) | PDF
1. A patient has a serum sodium level of 118 mEq/L.
Which assessment finding is most critical to report
immediately?
A. Muscle cramps
B. Nausea and vomiting
C. Altered mental status
D. Dry mucous membranes
Correct Answer: C
Rationale: Severe hyponatremia (Na <120) can cause
cerebral edema, leading to seizures, coma, or brain
herniation. Altered mental status is a late sign requiring
immediate intervention.
2. Which IV fluid is most appropriate for a patient with
hypernatremia caused by dehydration?
A. 0.45% NaCl (½ normal saline)
1
,B. 3% NaCl
C. 0.9% NaCl
D. Lactated Ringer’s
Correct Answer: A
Rationale: Hypotonic fluids (0.45% NaCl) dilute serum
sodium. Hypertonic saline (3%) is for severe symptomatic
hyponatremia, not hypernatremia.
3. A patient with heart failure has edema and crackles.
Serum potassium is 5.8 mEq/L. Which diuretic is most
appropriate?
A. Furosemide (Lasix)
B. Spironolactone
C. Hydrochlorothiazide
D. Mannitol
Correct Answer: A
Rationale: Furosemide is a loop diuretic that treats fluid
overload and lowers potassium (useful in hyperkalemia).
2
,Spironolactone is potassium-sparing and would worsen
hyperkalemia.
4. A patient’s potassium level is 2.9 mEq/L. Which ECG
change would the nurse expect?
A. Tall, peaked T waves
B. Widened QRS complex
C. Flat T waves and prominent U waves
D. Prolonged PR interval without U waves
Correct Answer: C
Rationale: Hypokalemia (K <3.5) causes flat T waves, ST
depression, and prominent U waves. Tall peaked T waves
are seen in hyperkalemia.
5. Which food choice indicates a patient with
hypokalemia needs further teaching?
A. Baked potato with skin
B. Banana
3
, C. Canned peaches in syrup
D. Spinach salad
Correct Answer: C
Rationale: Canned peaches in syrup are low in potassium.
Potatoes, bananas, and spinach are potassium-rich. The
patient needs high-potassium foods.
6. A patient with chronic kidney disease has a calcium
level of 12.5 mg/dL. Which assessment finding is most
concerning?
A. Positive Chvostek’s sign
B. Muscle twitching
C. Lethargy and confusion
D. Bone pain
Correct Answer: C
Rationale: Severe hypercalcemia (>12 mg/dL) can cause
neurologic depression, lethargy, confusion, and cardiac
arrest. Chvostek’s sign indicates hypocalcemia.
4
