NUR 242 Exam 3 Medical-Surgical Nursing
Concepts (2026/2027) PDF | Nursing | Galen
College
1. A patient has a serum sodium of 118 mEq/L. Which
clinical manifestation is most concerning?
a) Muscle cramps
b) Dry mucous membranes
c) Altered mental status
d) Hyperreflexia
Answer: c) Altered mental status
Rationale: Severe hyponatremia (Na <120) causes
cerebral edema, leading to confusion, seizures, coma.
Altered mental status requires immediate intervention.
2. Which IV fluid is most appropriate for a patient with
diabetic ketoacidosis (DKA) and hypotension?
a) 0.45% NaCl
b) 3% NaCl
1
,c) 0.9% NaCl
d) D5W
Answer: c) 0.9% NaCl
Rationale: Isotonic saline expands intravascular volume
rapidly in hypotensive DKA; hypotonic fluids may worsen
hypotension.
3. A patient with heart failure has a potassium level of
2.9 mEq/L. Which assessment finding is expected?
a) Flattened T waves
b) Peaked T waves
c) Widened QRS
d) Absent P waves
Answer: a) Flattened T waves
Rationale: Hypokalemia causes flattened T waves, U
waves, and ST depression. Peaked T waves are seen in
hyperkalemia.
4. A patient is receiving furosemide 40 mg IV. Which
electrolyte imbalance requires the most immediate action?
2
,a) Sodium 135 mEq/L
b) Chloride 100 mEq/L
c) Potassium 2.8 mEq/L
d) Calcium 9.5 mg/dL
Answer: c) Potassium 2.8 mEq/L
Rationale: Severe hypokalemia can cause cardiac
dysrhythmias (e.g., ventricular tachycardia). Furosemide is
a loop diuretic that depletes potassium.
5. Which ABG result indicates uncompensated metabolic
acidosis?
a) pH 7.32, PaCO2 48, HCO3 20
b) pH 7.25, PaCO2 30, HCO3 14
c) pH 7.48, PaCO2 44, HCO3 30
d) pH 7.36, PaCO2 40, HCO3 24
Answer: b) pH 7.25, PaCO2 30, HCO3 14
Rationale: Low pH (acidosis) + low HCO3 = metabolic
acidosis. PaCO2 is low (compensatory), but pH still
abnormal → uncompensated.
3
, 6. A patient has a calcium level of 6.8 mg/dL. What sign
should the nurse assess for?
a) Chvostek’s sign
b) Trousseau’s sign
c) Positive Babinski
d) Hypoactive bowel sounds
Answer: a) Chvostek’s sign
Rationale: Hypocalcemia (<8.5 mg/dL) increases
neuromuscular excitability; Chvostek’s (facial twitching
with tap) and Trousseau’s (carpopedal spasm) are classic
signs.
7. ABG: pH 7.52, PaCO2 30, HCO3 24. What is the
primary disorder?
a) Metabolic acidosis
b) Metabolic alkalosis
c) Respiratory acidosis
d) Respiratory alkalosis
Answer: d) Respiratory alkalosis
4
Concepts (2026/2027) PDF | Nursing | Galen
College
1. A patient has a serum sodium of 118 mEq/L. Which
clinical manifestation is most concerning?
a) Muscle cramps
b) Dry mucous membranes
c) Altered mental status
d) Hyperreflexia
Answer: c) Altered mental status
Rationale: Severe hyponatremia (Na <120) causes
cerebral edema, leading to confusion, seizures, coma.
Altered mental status requires immediate intervention.
2. Which IV fluid is most appropriate for a patient with
diabetic ketoacidosis (DKA) and hypotension?
a) 0.45% NaCl
b) 3% NaCl
1
,c) 0.9% NaCl
d) D5W
Answer: c) 0.9% NaCl
Rationale: Isotonic saline expands intravascular volume
rapidly in hypotensive DKA; hypotonic fluids may worsen
hypotension.
3. A patient with heart failure has a potassium level of
2.9 mEq/L. Which assessment finding is expected?
a) Flattened T waves
b) Peaked T waves
c) Widened QRS
d) Absent P waves
Answer: a) Flattened T waves
Rationale: Hypokalemia causes flattened T waves, U
waves, and ST depression. Peaked T waves are seen in
hyperkalemia.
4. A patient is receiving furosemide 40 mg IV. Which
electrolyte imbalance requires the most immediate action?
2
,a) Sodium 135 mEq/L
b) Chloride 100 mEq/L
c) Potassium 2.8 mEq/L
d) Calcium 9.5 mg/dL
Answer: c) Potassium 2.8 mEq/L
Rationale: Severe hypokalemia can cause cardiac
dysrhythmias (e.g., ventricular tachycardia). Furosemide is
a loop diuretic that depletes potassium.
5. Which ABG result indicates uncompensated metabolic
acidosis?
a) pH 7.32, PaCO2 48, HCO3 20
b) pH 7.25, PaCO2 30, HCO3 14
c) pH 7.48, PaCO2 44, HCO3 30
d) pH 7.36, PaCO2 40, HCO3 24
Answer: b) pH 7.25, PaCO2 30, HCO3 14
Rationale: Low pH (acidosis) + low HCO3 = metabolic
acidosis. PaCO2 is low (compensatory), but pH still
abnormal → uncompensated.
3
, 6. A patient has a calcium level of 6.8 mg/dL. What sign
should the nurse assess for?
a) Chvostek’s sign
b) Trousseau’s sign
c) Positive Babinski
d) Hypoactive bowel sounds
Answer: a) Chvostek’s sign
Rationale: Hypocalcemia (<8.5 mg/dL) increases
neuromuscular excitability; Chvostek’s (facial twitching
with tap) and Trousseau’s (carpopedal spasm) are classic
signs.
7. ABG: pH 7.52, PaCO2 30, HCO3 24. What is the
primary disorder?
a) Metabolic acidosis
b) Metabolic alkalosis
c) Respiratory acidosis
d) Respiratory alkalosis
Answer: d) Respiratory alkalosis
4
