NUR 242 Exam 2 Medical-Surgical Nursing
Concepts (2026/2027) PDF | Nursing | Galen
College
1. A patient has a serum sodium of 118 mEq/L. Which
assessment finding is most critical to report?
A) Muscle cramps
B) Dry mucous membranes
C) Altered mental status
D) Hypotension
Answer: C
*Rationale: Severe hyponatremia (≤120 mEq/L) can
cause cerebral edema, seizures, and coma. Altered
mental status is a priority finding requiring immediate
intervention.*
2. A patient with heart failure has edema and weight
gain. Which electrolyte imbalance is most likely?
1
,A) Hypernatremia
B) Hyponatremia (dilutional)
C) Hyperkalemia
D) Hypokalemia
Answer: B
Rationale: Fluid overload dilutes serum sodium, causing
dilutional hyponatremia despite normal total body sodium.
This is common in heart failure.
3. Which IV fluid is most appropriate for a patient with
diabetic ketoacidosis (DKA) and hypotension?
A) 0.45% NaCl
B) 3% NaCl
C) 0.9% NaCl
D) D5W
Answer: C
Rationale: Isotonic normal saline (0.9% NaCl) rapidly
2
,restores intravascular volume and corrects hypotension in
DKA. Hypotonic fluids would worsen shock.
4. A patient has a potassium level of 6.8 mEq/L. Which
ECG change would you expect?
A) Flattened T waves
B) Prominent U waves
C) Tall, peaked T waves
D) Prolonged PR interval
Answer: C
*Rationale: Hyperkalemia (K+ >5.5) causes tall, peaked
T waves. Flattened T waves and U waves are seen in
hypokalemia.*
5. Which ABG finding indicates respiratory acidosis?
A) pH 7.48, PaCO2 30, HCO3 22
B) pH 7.32, PaCO2 55, HCO3 26
3
, C) pH 7.36, PaCO2 40, HCO3 24
D) pH 7.28, PaCO2 30, HCO3 18
Answer: B
*Rationale: Respiratory acidosis = pH <7.35 and
PaCO2 >45. Option B shows pH 7.32 and PaCO2 55.*
6. A post-op patient has a pH 7.50, PaCO2 50, HCO3
32. This indicates:
A) Uncompensated respiratory acidosis
B) Fully compensated metabolic alkalosis
C) Partially compensated metabolic alkalosis
D) Mixed disorder
Answer: C
Rationale: pH >7.45 (alkalosis) with elevated HCO3
indicates metabolic alkalosis. PaCO2 is also elevated
(normally would decrease as compensation), so
compensation is partial.
4
Concepts (2026/2027) PDF | Nursing | Galen
College
1. A patient has a serum sodium of 118 mEq/L. Which
assessment finding is most critical to report?
A) Muscle cramps
B) Dry mucous membranes
C) Altered mental status
D) Hypotension
Answer: C
*Rationale: Severe hyponatremia (≤120 mEq/L) can
cause cerebral edema, seizures, and coma. Altered
mental status is a priority finding requiring immediate
intervention.*
2. A patient with heart failure has edema and weight
gain. Which electrolyte imbalance is most likely?
1
,A) Hypernatremia
B) Hyponatremia (dilutional)
C) Hyperkalemia
D) Hypokalemia
Answer: B
Rationale: Fluid overload dilutes serum sodium, causing
dilutional hyponatremia despite normal total body sodium.
This is common in heart failure.
3. Which IV fluid is most appropriate for a patient with
diabetic ketoacidosis (DKA) and hypotension?
A) 0.45% NaCl
B) 3% NaCl
C) 0.9% NaCl
D) D5W
Answer: C
Rationale: Isotonic normal saline (0.9% NaCl) rapidly
2
,restores intravascular volume and corrects hypotension in
DKA. Hypotonic fluids would worsen shock.
4. A patient has a potassium level of 6.8 mEq/L. Which
ECG change would you expect?
A) Flattened T waves
B) Prominent U waves
C) Tall, peaked T waves
D) Prolonged PR interval
Answer: C
*Rationale: Hyperkalemia (K+ >5.5) causes tall, peaked
T waves. Flattened T waves and U waves are seen in
hypokalemia.*
5. Which ABG finding indicates respiratory acidosis?
A) pH 7.48, PaCO2 30, HCO3 22
B) pH 7.32, PaCO2 55, HCO3 26
3
, C) pH 7.36, PaCO2 40, HCO3 24
D) pH 7.28, PaCO2 30, HCO3 18
Answer: B
*Rationale: Respiratory acidosis = pH <7.35 and
PaCO2 >45. Option B shows pH 7.32 and PaCO2 55.*
6. A post-op patient has a pH 7.50, PaCO2 50, HCO3
32. This indicates:
A) Uncompensated respiratory acidosis
B) Fully compensated metabolic alkalosis
C) Partially compensated metabolic alkalosis
D) Mixed disorder
Answer: C
Rationale: pH >7.45 (alkalosis) with elevated HCO3
indicates metabolic alkalosis. PaCO2 is also elevated
(normally would decrease as compensation), so
compensation is partial.
4
