NUR 242 EXAM 2
Medical-Surgical Nursing Concepts
Galen College of Nursing
High-Yield Qs to mirror the Exam
Verified Answers with Rationales
This Exam Features:
NUR 242 Exam 2 Mental Health Nursing (Galen
College) including 50 high-yield questions
written to mirror actual course exams. Covers
core Medical-Surgical Nursing Concepts with clear,
accurate, and student-friendly explanations. Perfect for mastering
high-priority topics and boosting exam confidence.
,1.
The nurse is monitoring fluid volume status of the client who has heart failure
and is at risk for clinical dehydration. Which of the following interventions is the
most effective for monitoring this client?
A. Monitor urine specific gravity once per shift
B. Assess skin turgor every 4 hours
C. Weigh the client every morning before breakfast
D. Measure oral intake each shift
Correct Answer: C. Weigh the client every morning before breakfast
Expert rationale: Daily weight at the same time, same scale, same clothing
conditions is the most sensitive indicator of overall fluid status. Weight changes
reflect fluid shifts earlier and more accurately than skin turgor, I&O alone, or urine
specific gravity—especially in heart failure.
2.
The nurse is caring for assigned clients who have fluid overload and are at risk
for the development of complications. Which clients from the box below should
the nurse identify at being at the greatest risk?
1. 22 y/o diagnosed with congenital heart failure at age 5
2. 62 y/o who is recently diagnosed with hepatic cirrhosis
3. 36 y/o who received hemodialysis 3 times a week for chronic kidney
disease.
A. Client 1 only
B. Client 2 only
C. Client 3 only
D. Clients 2 and 3
,Correct Answer: D. Clients 2 and 3
Expert rationale: Cirrhosis causes hypoalbuminemia and portal HTN → third
spacing/ascites/edema. CKD on hemodialysis has impaired fluid excretion and can
rapidly develop volume overload between treatments. Congenital HF also
increases risk, but cirrhosis + CKD/dialysis generally represent the highest fluid-
overload complication risk profiles.
3.
The nurse is caring for a client who is receiving prescribed 0.9% sodium chloride
or normal saline IV at a rate of 200ml/hr for treatment of dehydration. Which of
the following findings requires immediate follow up by the nurse?
A. Dry mucous membranes
B. Orthostatic hypotension
C. Distended neck vein when the patient is in semi-flower position
D. Capillary refill 3 seconds
Correct Answer: C. Distended neck vein when the patient is in semi-flower
position
Expert rationale: Distended neck veins suggest fluid volume overload (or
worsening HF) and can indicate the client is not tolerating the infusion rate (200
mL/hr is substantial). This finding has the highest urgency because it signals risk
for pulmonary edema and decompensation.
4.
The nurse has attended a staff education conference about fluid and electrolyte
imbalances. Which of the following statements by the nurse indicates a correct
understanding of the conference?
A. The client who has hyponatremia is likely to develop acute onset of confusion
B. The client who has hypernatremia is likely to develop bradycardia first
,C. The client who has hypokalemia is likely to develop bounding pulses
D. The client who has hypercalcemia is likely to develop tetany
Correct Answer: A. The client who has hyponatremia is likely to develop acute
onset of confusion
Expert rationale: Hyponatremia causes water to shift into brain cells → cerebral
edema → confusion, headache, seizures (especially if rapid drop). Tetany is more
consistent with hypocalcemia, not hypercalcemia.
5.
A nurse is preparing to administer 10 mEq of potassium chloride IV to a client
who has a potassium level of 2.5 mEq/L. Which of the following actions should
the nurse take?
A. Administer KCl IV push for rapid correction
B. Confirm adequate blood return of the IV access before administration
C. Mix potassium in a small syringe to reduce fluid volume
D. Give potassium without an infusion pump
Correct Answer: B. Confirm adequate blood return of the IV access before
administration
Expert rationale: Potassium is a vesicant/irritant; infiltration can cause severe
tissue injury. It must be diluted, infused via pump, and never IV push. Verifying
patency (blood return when appropriate for IV type/policy) helps reduce
infiltration risk.
6.
A nurse is caring for a client whose electrocardiogram demonstrates changing
characteristics of hypokalemia. Which of the following assessment finding
should the nurse suspect?
,A. Hyperactive bowel sounds
B. Hypoactive bowel sounds
C. Bounding peripheral pulses
D. Warm, flushed skin
Correct Answer: B. Hypoactive bowel sounds
Expert rationale: Hypokalemia decreases smooth muscle activity → decreased GI
motility (hypoactive bowel sounds, constipation, ileus). ECG changes can include
flat T waves, U waves, ST depression, and dysrhythmias.
7.
The nurse is caring for a client who has a serum potassium level of 2.7mEq/L.
Which of the following medications if prescribed for the client should the nurse
question?
A. Spironolactone
B. Hydrochlorothiazide (HCTZ)
C. Lisinopril
D. Potassium chloride supplement
Correct Answer: B. Hydrochlorothiazide (HCTZ)
Expert rationale: Thiazide diuretics are potassium-wasting and can worsen
hypokalemia, increasing risk for dangerous dysrhythmias. (ACE inhibitors and
spironolactone tend to raise potassium; KCl is appropriate.)
8.
The nurse is caring for a client who has been receiving prescribed furosemide
and has potassium level of 2.8mEq/L. Which of the following assessments
should the nurse perform first?
A. Assess bowel sounds
,B. Check hand grasps
C. Apical pulse rate and depth of respirations
D. Assess pedal edema
Correct Answer: C. Apical pulse rate and depth of respirations
Expert rationale: Hypokalemia can cause life-threatening cardiac dysrhythmias
and respiratory muscle weakness. Prioritize ABCs/cardiopulmonary status first
(apical pulse, rhythm if available, respiratory depth/effort).
9.
The nurse is caring for a client who has cardiac dysrhythmias. The nurse should
be concerned about which of the following lab value?
A. Potassium level of 3.4 mEq/L
B. Potassium level of 4.0 mEq/L
C. Potassium level of 5.0 mEq/L
D. Potassium level of 6 mEq/L
Correct Answer: D. Potassium level of 6 mEq/L
Expert rationale: Hyperkalemia (≥5.1; severe often ≥6) increases risk for lethal
dysrhythmias (peaked T waves, widened QRS, sine wave). This is the most urgent
electrolyte abnormality tied directly to rhythm instability.
10.
The nurse is assigned to four clients on a medical surgical floor. Which of the
following clients should the nurse determine has the greatest risk for developing
hypercalcemia?
A. A client with chronic pancreatitis
B. A client with hypoparathyroidism
, C. A client with hyperparathyroidism
D. A client with vitamin D deficiency
Correct Answer: C. A client with hyperparathyroidism
Expert rationale: Excess PTH increases calcium by bone resorption, renal calcium
reabsorption, and activating vitamin D → hypercalcemia. Hypoparathyroidism and
vitamin D deficiency are associated with hypocalcemia.
11.
The nurse is assigned to four clients who have fluid and electrolyte imbalances
after receiving the change of shift report. Which if the following clients should
the nurse assess first?
A. Client who has potassium 3.2 and mild nausea
B. Client who has sodium 132 and headache
C. Client who has serum magnesium level of 4.2 and is drowsy and has pulse of
54.
D. Client who has calcium 8.4 and perioral tingling
Correct Answer: C. Client who has serum magnesium level of 4.2 and is drowsy
and has pulse of 54
Expert rationale: Hypermagnesemia depresses neuromuscular and cardiac
function → bradycardia, hypotension, respiratory depression, and can progress
to cardiac arrest. Drowsiness + HR 54 signals clinically significant instability and
priority assessment/intervention.
12.
The nurse is caring for a client who has metabolic alkalosis. Which of the
following clinical manifestations should the nurse monitor?
A. Kussmaul respirations
Medical-Surgical Nursing Concepts
Galen College of Nursing
High-Yield Qs to mirror the Exam
Verified Answers with Rationales
This Exam Features:
NUR 242 Exam 2 Mental Health Nursing (Galen
College) including 50 high-yield questions
written to mirror actual course exams. Covers
core Medical-Surgical Nursing Concepts with clear,
accurate, and student-friendly explanations. Perfect for mastering
high-priority topics and boosting exam confidence.
,1.
The nurse is monitoring fluid volume status of the client who has heart failure
and is at risk for clinical dehydration. Which of the following interventions is the
most effective for monitoring this client?
A. Monitor urine specific gravity once per shift
B. Assess skin turgor every 4 hours
C. Weigh the client every morning before breakfast
D. Measure oral intake each shift
Correct Answer: C. Weigh the client every morning before breakfast
Expert rationale: Daily weight at the same time, same scale, same clothing
conditions is the most sensitive indicator of overall fluid status. Weight changes
reflect fluid shifts earlier and more accurately than skin turgor, I&O alone, or urine
specific gravity—especially in heart failure.
2.
The nurse is caring for assigned clients who have fluid overload and are at risk
for the development of complications. Which clients from the box below should
the nurse identify at being at the greatest risk?
1. 22 y/o diagnosed with congenital heart failure at age 5
2. 62 y/o who is recently diagnosed with hepatic cirrhosis
3. 36 y/o who received hemodialysis 3 times a week for chronic kidney
disease.
A. Client 1 only
B. Client 2 only
C. Client 3 only
D. Clients 2 and 3
,Correct Answer: D. Clients 2 and 3
Expert rationale: Cirrhosis causes hypoalbuminemia and portal HTN → third
spacing/ascites/edema. CKD on hemodialysis has impaired fluid excretion and can
rapidly develop volume overload between treatments. Congenital HF also
increases risk, but cirrhosis + CKD/dialysis generally represent the highest fluid-
overload complication risk profiles.
3.
The nurse is caring for a client who is receiving prescribed 0.9% sodium chloride
or normal saline IV at a rate of 200ml/hr for treatment of dehydration. Which of
the following findings requires immediate follow up by the nurse?
A. Dry mucous membranes
B. Orthostatic hypotension
C. Distended neck vein when the patient is in semi-flower position
D. Capillary refill 3 seconds
Correct Answer: C. Distended neck vein when the patient is in semi-flower
position
Expert rationale: Distended neck veins suggest fluid volume overload (or
worsening HF) and can indicate the client is not tolerating the infusion rate (200
mL/hr is substantial). This finding has the highest urgency because it signals risk
for pulmonary edema and decompensation.
4.
The nurse has attended a staff education conference about fluid and electrolyte
imbalances. Which of the following statements by the nurse indicates a correct
understanding of the conference?
A. The client who has hyponatremia is likely to develop acute onset of confusion
B. The client who has hypernatremia is likely to develop bradycardia first
,C. The client who has hypokalemia is likely to develop bounding pulses
D. The client who has hypercalcemia is likely to develop tetany
Correct Answer: A. The client who has hyponatremia is likely to develop acute
onset of confusion
Expert rationale: Hyponatremia causes water to shift into brain cells → cerebral
edema → confusion, headache, seizures (especially if rapid drop). Tetany is more
consistent with hypocalcemia, not hypercalcemia.
5.
A nurse is preparing to administer 10 mEq of potassium chloride IV to a client
who has a potassium level of 2.5 mEq/L. Which of the following actions should
the nurse take?
A. Administer KCl IV push for rapid correction
B. Confirm adequate blood return of the IV access before administration
C. Mix potassium in a small syringe to reduce fluid volume
D. Give potassium without an infusion pump
Correct Answer: B. Confirm adequate blood return of the IV access before
administration
Expert rationale: Potassium is a vesicant/irritant; infiltration can cause severe
tissue injury. It must be diluted, infused via pump, and never IV push. Verifying
patency (blood return when appropriate for IV type/policy) helps reduce
infiltration risk.
6.
A nurse is caring for a client whose electrocardiogram demonstrates changing
characteristics of hypokalemia. Which of the following assessment finding
should the nurse suspect?
,A. Hyperactive bowel sounds
B. Hypoactive bowel sounds
C. Bounding peripheral pulses
D. Warm, flushed skin
Correct Answer: B. Hypoactive bowel sounds
Expert rationale: Hypokalemia decreases smooth muscle activity → decreased GI
motility (hypoactive bowel sounds, constipation, ileus). ECG changes can include
flat T waves, U waves, ST depression, and dysrhythmias.
7.
The nurse is caring for a client who has a serum potassium level of 2.7mEq/L.
Which of the following medications if prescribed for the client should the nurse
question?
A. Spironolactone
B. Hydrochlorothiazide (HCTZ)
C. Lisinopril
D. Potassium chloride supplement
Correct Answer: B. Hydrochlorothiazide (HCTZ)
Expert rationale: Thiazide diuretics are potassium-wasting and can worsen
hypokalemia, increasing risk for dangerous dysrhythmias. (ACE inhibitors and
spironolactone tend to raise potassium; KCl is appropriate.)
8.
The nurse is caring for a client who has been receiving prescribed furosemide
and has potassium level of 2.8mEq/L. Which of the following assessments
should the nurse perform first?
A. Assess bowel sounds
,B. Check hand grasps
C. Apical pulse rate and depth of respirations
D. Assess pedal edema
Correct Answer: C. Apical pulse rate and depth of respirations
Expert rationale: Hypokalemia can cause life-threatening cardiac dysrhythmias
and respiratory muscle weakness. Prioritize ABCs/cardiopulmonary status first
(apical pulse, rhythm if available, respiratory depth/effort).
9.
The nurse is caring for a client who has cardiac dysrhythmias. The nurse should
be concerned about which of the following lab value?
A. Potassium level of 3.4 mEq/L
B. Potassium level of 4.0 mEq/L
C. Potassium level of 5.0 mEq/L
D. Potassium level of 6 mEq/L
Correct Answer: D. Potassium level of 6 mEq/L
Expert rationale: Hyperkalemia (≥5.1; severe often ≥6) increases risk for lethal
dysrhythmias (peaked T waves, widened QRS, sine wave). This is the most urgent
electrolyte abnormality tied directly to rhythm instability.
10.
The nurse is assigned to four clients on a medical surgical floor. Which of the
following clients should the nurse determine has the greatest risk for developing
hypercalcemia?
A. A client with chronic pancreatitis
B. A client with hypoparathyroidism
, C. A client with hyperparathyroidism
D. A client with vitamin D deficiency
Correct Answer: C. A client with hyperparathyroidism
Expert rationale: Excess PTH increases calcium by bone resorption, renal calcium
reabsorption, and activating vitamin D → hypercalcemia. Hypoparathyroidism and
vitamin D deficiency are associated with hypocalcemia.
11.
The nurse is assigned to four clients who have fluid and electrolyte imbalances
after receiving the change of shift report. Which if the following clients should
the nurse assess first?
A. Client who has potassium 3.2 and mild nausea
B. Client who has sodium 132 and headache
C. Client who has serum magnesium level of 4.2 and is drowsy and has pulse of
54.
D. Client who has calcium 8.4 and perioral tingling
Correct Answer: C. Client who has serum magnesium level of 4.2 and is drowsy
and has pulse of 54
Expert rationale: Hypermagnesemia depresses neuromuscular and cardiac
function → bradycardia, hypotension, respiratory depression, and can progress
to cardiac arrest. Drowsiness + HR 54 signals clinically significant instability and
priority assessment/intervention.
12.
The nurse is caring for a client who has metabolic alkalosis. Which of the
following clinical manifestations should the nurse monitor?
A. Kussmaul respirations
