NUR 242 Exam 1 Medical-Surgical Nursing Galen College of
Nursing Question Bank (Latest 2026/2027 Edition) – 100%
Correct Questions, Answers & Detailed Rationales
Total Questions: 55 |
Time Allowed: 90 Minutes |
Passing Score: 80%
Instructions: Select the BEST answer for each question. For SATA questions, select all
that apply.
SECTION 1: FLUID, ELECTROLYTE & ACID-BASE BALANCE
Questions 1–8
Question 1
A 68-year-old patient is admitted with vomiting and diarrhea for 3 days. Vital signs: BP
92/58 mmHg, HR 118 bpm, RR 24/min, temperature 37.2°C (99.0°F). The nurse notes
dry mucous membranes, decreased skin turgor, and orthostatic hypotension. Laboratory
results: serum sodium 148 mEq/L, serum osmolality 310 mOsm/kg, urine specific
gravity 1.030. Which nursing diagnosis is the priority?
A. Excess Fluid Volume related to compromised regulatory mechanisms
B. Deficient Fluid Volume related to active fluid loss
C. Risk for Electrolyte Imbalance related to altered intake
D. Impaired Gas Exchange related to metabolic acidosis
Correct Answer: B
,Rationale: The patient presents with classic signs of hypovolemia (dehydration):
tachycardia, hypotension, dry mucous membranes, decreased skin turgor, orthostatic
changes, concentrated urine (high specific gravity), and hypernatremia (serum sodium
148 mEq/L). Option A is incorrect because the patient has fluid deficit, not excess.
Option C is a potential risk but not the priority diagnosis given the active, life-threatening
volume depletion. Option D is incorrect because there is no evidence of impaired gas
exchange or metabolic acidosis in the data provided.
Question 2
A patient with chronic kidney disease reports muscle weakness, fatigue, and
palpitations. The cardiac monitor shows peaked T waves and widened QRS complexes.
Laboratory results reveal serum potassium 6.8 mEq/L. Which intervention should the
nurse implement first?
A. Administer oral potassium supplements
B. Prepare to administer calcium gluconate IV
C. Encourage the patient to eat potassium-rich foods
D. Insert a Foley catheter for strict intake and output
Correct Answer: B
Rationale: A serum potassium of 6.8 mEq/L indicates severe hyperkalemia with ECG
changes (peaked T waves, widened QRS), which can progress to ventricular fibrillation
or asystole. Calcium gluconate IV is the priority to stabilize cardiac membranes and
prevent lethal arrhythmias. Option A is incorrect and dangerous because the patient
already has excess potassium. Option C is incorrect because potassium-rich foods
would worsen hyperkalemia. Option D is important for monitoring but does not address
the immediate life-threatening cardiac risk.
,Question 3
A 72-year-old patient with syndrome of inappropriate antidiuretic hormone (SIADH) has
a serum sodium level of 126 mEq/L. The patient is alert and oriented but reports a
headache and nausea. Which nursing intervention is most appropriate?
A. Administer 3% saline via rapid IV bolus
B. Restrict oral fluids to 800 mL per day
C. Encourage the patient to drink sports drinks to replace sodium
D. Administer furosemide IV push to promote diuresis
Correct Answer: B
Rationale: SIADH causes dilutional hyponatremia due to water retention; fluid restriction
is the primary treatment for mild to moderate hyponatremia (serum sodium >120
mEq/L) in alert patients. Option A is incorrect because rapid correction with hypertonic
saline risks osmotic demyelination syndrome and is reserved for severe symptomatic
hyponatremia. Option C is incorrect because additional fluids worsen dilutional
hyponatremia. Option D is incorrect because diuretics are not first-line for SIADH and
can worsen electrolyte imbalances.
Question 4
A patient in diabetic ketoacidosis has the following arterial blood gas (ABG) results: pH
7.28, PaCO₂ 28 mmHg, HCO₃⁻ 14 mEq/L, PaO₂ 92 mmHg. How should the nurse
interpret these results?
A. Respiratory acidosis with partial compensation
B. Metabolic acidosis with respiratory compensation
C. Metabolic alkalosis with respiratory compensation
D. Respiratory alkalosis with metabolic compensation
Correct Answer: B
, Rationale: The pH of 7.28 indicates acidosis. The low HCO₃⁻ (14 mEq/L) identifies the
primary disorder as metabolic acidosis. The low PaCO₂ (28 mmHg) indicates
hyperventilation, which is the body's compensatory respiratory response to blow off
acid (CO₂). Option A is incorrect because the primary disorder is metabolic, not
respiratory. Option C is incorrect because the pH is acidic, not alkaline. Option D is
incorrect because the primary disorder is not respiratory alkalosis.
Question 5
A patient with heart failure develops fluid volume excess. Which actions should the
nurse implement? Select all that apply.
A. Administer prescribed loop diuretics
B. Monitor daily weights at the same time each day
C. Encourage fluid intake of 3,000 mL per day
D. Assess lung sounds every 4 hours
E. Elevate the patient's lower extremities
Correct Answers: A, B, D, E
Rationale: Fluid volume excess in heart failure requires diuretic therapy (A), daily weight
monitoring to assess fluid status (B), frequent respiratory assessment to detect
pulmonary edema (D), and leg elevation to promote venous return and reduce peripheral
edema (E). Option C is incorrect because heart failure patients with fluid excess require
fluid restriction, not increased intake; 3,000 mL would exacerbate hypervolemia.
Question 6
A post-thyroidectomy patient reports perioral numbness and tingling in the fingers. The
nurse elicits a positive Trousseau's sign. Which electrolyte imbalance is most likely?
Nursing Question Bank (Latest 2026/2027 Edition) – 100%
Correct Questions, Answers & Detailed Rationales
Total Questions: 55 |
Time Allowed: 90 Minutes |
Passing Score: 80%
Instructions: Select the BEST answer for each question. For SATA questions, select all
that apply.
SECTION 1: FLUID, ELECTROLYTE & ACID-BASE BALANCE
Questions 1–8
Question 1
A 68-year-old patient is admitted with vomiting and diarrhea for 3 days. Vital signs: BP
92/58 mmHg, HR 118 bpm, RR 24/min, temperature 37.2°C (99.0°F). The nurse notes
dry mucous membranes, decreased skin turgor, and orthostatic hypotension. Laboratory
results: serum sodium 148 mEq/L, serum osmolality 310 mOsm/kg, urine specific
gravity 1.030. Which nursing diagnosis is the priority?
A. Excess Fluid Volume related to compromised regulatory mechanisms
B. Deficient Fluid Volume related to active fluid loss
C. Risk for Electrolyte Imbalance related to altered intake
D. Impaired Gas Exchange related to metabolic acidosis
Correct Answer: B
,Rationale: The patient presents with classic signs of hypovolemia (dehydration):
tachycardia, hypotension, dry mucous membranes, decreased skin turgor, orthostatic
changes, concentrated urine (high specific gravity), and hypernatremia (serum sodium
148 mEq/L). Option A is incorrect because the patient has fluid deficit, not excess.
Option C is a potential risk but not the priority diagnosis given the active, life-threatening
volume depletion. Option D is incorrect because there is no evidence of impaired gas
exchange or metabolic acidosis in the data provided.
Question 2
A patient with chronic kidney disease reports muscle weakness, fatigue, and
palpitations. The cardiac monitor shows peaked T waves and widened QRS complexes.
Laboratory results reveal serum potassium 6.8 mEq/L. Which intervention should the
nurse implement first?
A. Administer oral potassium supplements
B. Prepare to administer calcium gluconate IV
C. Encourage the patient to eat potassium-rich foods
D. Insert a Foley catheter for strict intake and output
Correct Answer: B
Rationale: A serum potassium of 6.8 mEq/L indicates severe hyperkalemia with ECG
changes (peaked T waves, widened QRS), which can progress to ventricular fibrillation
or asystole. Calcium gluconate IV is the priority to stabilize cardiac membranes and
prevent lethal arrhythmias. Option A is incorrect and dangerous because the patient
already has excess potassium. Option C is incorrect because potassium-rich foods
would worsen hyperkalemia. Option D is important for monitoring but does not address
the immediate life-threatening cardiac risk.
,Question 3
A 72-year-old patient with syndrome of inappropriate antidiuretic hormone (SIADH) has
a serum sodium level of 126 mEq/L. The patient is alert and oriented but reports a
headache and nausea. Which nursing intervention is most appropriate?
A. Administer 3% saline via rapid IV bolus
B. Restrict oral fluids to 800 mL per day
C. Encourage the patient to drink sports drinks to replace sodium
D. Administer furosemide IV push to promote diuresis
Correct Answer: B
Rationale: SIADH causes dilutional hyponatremia due to water retention; fluid restriction
is the primary treatment for mild to moderate hyponatremia (serum sodium >120
mEq/L) in alert patients. Option A is incorrect because rapid correction with hypertonic
saline risks osmotic demyelination syndrome and is reserved for severe symptomatic
hyponatremia. Option C is incorrect because additional fluids worsen dilutional
hyponatremia. Option D is incorrect because diuretics are not first-line for SIADH and
can worsen electrolyte imbalances.
Question 4
A patient in diabetic ketoacidosis has the following arterial blood gas (ABG) results: pH
7.28, PaCO₂ 28 mmHg, HCO₃⁻ 14 mEq/L, PaO₂ 92 mmHg. How should the nurse
interpret these results?
A. Respiratory acidosis with partial compensation
B. Metabolic acidosis with respiratory compensation
C. Metabolic alkalosis with respiratory compensation
D. Respiratory alkalosis with metabolic compensation
Correct Answer: B
, Rationale: The pH of 7.28 indicates acidosis. The low HCO₃⁻ (14 mEq/L) identifies the
primary disorder as metabolic acidosis. The low PaCO₂ (28 mmHg) indicates
hyperventilation, which is the body's compensatory respiratory response to blow off
acid (CO₂). Option A is incorrect because the primary disorder is metabolic, not
respiratory. Option C is incorrect because the pH is acidic, not alkaline. Option D is
incorrect because the primary disorder is not respiratory alkalosis.
Question 5
A patient with heart failure develops fluid volume excess. Which actions should the
nurse implement? Select all that apply.
A. Administer prescribed loop diuretics
B. Monitor daily weights at the same time each day
C. Encourage fluid intake of 3,000 mL per day
D. Assess lung sounds every 4 hours
E. Elevate the patient's lower extremities
Correct Answers: A, B, D, E
Rationale: Fluid volume excess in heart failure requires diuretic therapy (A), daily weight
monitoring to assess fluid status (B), frequent respiratory assessment to detect
pulmonary edema (D), and leg elevation to promote venous return and reduce peripheral
edema (E). Option C is incorrect because heart failure patients with fluid excess require
fluid restriction, not increased intake; 3,000 mL would exacerbate hypervolemia.
Question 6
A post-thyroidectomy patient reports perioral numbness and tingling in the fingers. The
nurse elicits a positive Trousseau's sign. Which electrolyte imbalance is most likely?
