NUR 242 — EXAM 2: 100 HIGH-YIELD NCLEX-STYLE QUESTIONS
All Units: Fluids/Electrolytes/Acid-Base | Cardiovascular | Urinary/Renal | GI | Pharmacology | All Galen Values Applied
DIRECTIONS: Select the ONE BEST answer. Each question is unique — no repeats. Record answers on a separate sheet. Use Galen
Standardized Values for ALL lab-related questions.
★ FLUIDS & DEHYDRATION
1. A nurse is caring for a 78-year-old patient admitted with suspected dehydration. Which assessment finding is the MOST
RELIABLE early indicator of fluid status change in this patient?
A. Skin turgor returning slowly when pinched on the forearm
B. A 3-pound weight loss compared to yesterday's documented weight on the same scale
C. Complaints of thirst and dry mouth
D. Blood pressure of 102/68 mmHg
2. A nurse is assessing a patient with fluid overload. Which combination of findings from BOX 13.3 is MOST consistent with
this diagnosis?
A. Thready pulse, poor skin turgor, dark concentrated urine, sunken eyes
B. Bounding pulse, distended neck veins, moist crackles on auscultation, sudden weight gain
C. Bradycardia, Kussmaul respirations, warm flushed dry skin
D. Hypotension, tachycardia, decreased urine output, restlessness
3. The nurse is reviewing BOX 13.1 causes of fluid imbalances. A patient just had an ileostomy placed and is also on
long-term corticosteroid therapy. Based on the action plan, which fluid imbalance is this patient MOST at risk for?
A. Fluid overload only — corticosteroids cause fluid retention
B. Dehydration from ileostomy AND fluid overload from corticosteroids — assess for BOTH imbalances
C. Neither — these two conditions cancel each other out
D. Fluid overload only — ileostomy output is minimal
4. A nurse receives a critical rescue alert: a patient with fluid overload has a bounding pulse, increasing neck vein distention,
crackles throughout the lung fields, and urine output of 18 mL/hr. What is the nurse's FIRST action?
A. Administer the scheduled oral furosemide dose
B. Restrict all oral fluids immediately without provider order
C. Notify the primary health care provider immediately and remain with the patient
D. Reposition the patient to the right lateral decubitus position
5. A patient with dehydration has a blood pressure of 86/54 mmHg and heart rate of 118 bpm. The nurse understands the
body is compensating through which primary mechanism per the textbook?
A. Vasodilation and decreased peripheral resistance to improve blood flow
B. Vasoconstriction and increased peripheral resistance to maintain blood pressure
C. Decreased heart rate to conserve cardiac energy
D. Release of insulin to drive fluid into the cells
★ SODIUM IMBALANCES
6. A nurse is caring for an 82-year-old patient in a long-term care facility who became acutely confused over the past 6
hours. The patient has no fever, no focal neurological deficits, and the family says "she was perfectly fine yesterday." Using
the Galen normal sodium value of 135–145 mEq/L, which lab result would BEST explain this presentation?
A. Sodium 141 mEq/L — within normal range, not the cause
B. Sodium 124 mEq/L — hyponatremia causing cerebral edema and acute confusion
C. Potassium 3.8 mEq/L — normal, not contributing
D. Glucose 108 mg/dL — slightly above Galen normal of 70–110 mg/dL, causing confusion
,7. A patient is ordered 3% hypertonic saline for severe hyponatremia with active seizures. The nurse knows this solution is
used because it:
A. Replaces free water lost through insensible losses
B. Creates an osmotic gradient that pulls excess water OUT of swollen brain cells to reduce cerebral edema
C. Is the standard first-line solution for all sodium imbalances regardless of severity
D. Rapidly raises sodium to normal in less than one hour to stop the seizure
8. A patient with hypernatremia (sodium 156 mEq/L per Galen normal 135–145 mEq/L) is being treated with hypotonic IV
fluids. The nurse understands that fluids must be replaced SLOWLY because rapid correction causes which complication?
A. Osmotic demyelination syndrome — permanent brain damage from too-rapid sodium lowering
B. Cerebral edema — water rushes back into brain cells too quickly as sodium drops
C. Hyperkalemia — sodium and potassium have an inverse relationship
D. Pulmonary edema — excess fluid from IV administration
9. Using Galen values (Na+ 135–145 mEq/L), a patient's sodium is 148 mEq/L. The nurse is assessing the patient. Which
finding is MOST consistent with this sodium level?
A. Confusion, lethargy, hypoactive bowel sounds, and seizure activity
B. Agitation, restlessness, intense thirst, and muscle weakness
C. Bounding pulse, weight gain, and dependent pitting edema
D. Positive Chvostek sign and carpopedal spasm with blood pressure cuff inflation
10. A nurse is teaching a patient about hyponatremia prevention. The patient states: "I drink about 6 liters of water every day
because I read it was healthy." The nurse recognizes this places the patient at risk for which type of hyponatremia?
A. Actual sodium deficit from GI fluid losses
B. Relative hyponatremia from dilution — excessive water intake dilutes serum sodium
C. Hypernatremia — excess water consumption causes high sodium levels
D. No risk — drinking extra water is always beneficial for kidney function
★ POTASSIUM IMBALANCES
11. A patient on furosemide (Lasix) for heart failure has a potassium level of 2.8 mEq/L (Galen normal: 3.5–5.0 mEq/L). The
nurse reviews the 12-lead ECG. Which ECG finding does the nurse MOST expect to see?
A. Tall, peaked, narrow T waves with a widened QRS complex
B. ST segment depression, flat or inverted T waves, and a U wave appearing after the T wave
C. Prolonged PR interval with progressive lengthening until a QRS is dropped
D. Elevated ST segments in leads II, III, and aVF
12. A nurse is preparing to administer IV potassium chloride 20 mEq in 100 mL NS over 2 hours to a patient with
hypokalemia. Before hanging the bag, which action is the HIGHEST PRIORITY SAFETY CHECK?
A. Confirm the patient has eaten a full meal to prevent nausea from the potassium
B. Verify urine output is at least 30 mL/hr AND confirm the solution is properly diluted — never give K+ IV push
C. Check blood pressure before and after administration to monitor for hypotension
D. Have the patient sign an informed consent form for the IV potassium
13. A patient's potassium level is 6.4 mEq/L (Galen normal: 3.5–5.0 mEq/L). The cardiac monitor shows tall peaked T
waves. The nurse notifies the Rapid Response Team. Which intervention does the nurse prepare for FIRST to
IMMEDIATELY protect the heart?
A. Administer kayexalate (sodium polystyrene sulfonate) rectally to remove potassium
B. Administer calcium gluconate IV to stabilize the cardiac membrane
C. Initiate dialysis to remove excess potassium from the bloodstream
D. Restrict all dietary potassium sources immediately
14. A nursing student asks why glucose and insulin are given together for hyperkalemia. The BEST explanation by the nurse
preceptor is:
, A. "Insulin permanently removes potassium from the body through the kidneys."
B. "Insulin activates the Na+/K+ ATPase pump, temporarily driving potassium FROM the bloodstream INTO the cells, lowering
serum levels while we prepare definitive treatment."
C. "Glucose neutralizes the toxic effect of potassium directly on heart cells."
D. "Together they treat the underlying cause of hyperkalemia which is always uncontrolled diabetes."
15. A nurse notes that a patient's IV solution containing potassium chloride has infiltrated the surrounding tissue. Using the
NSP Action Alert from the textbook, what is the correct sequence of actions?
A. Slow the infusion rate and apply a warm compress to the site
B. Stop the IV solution immediately, remove the venous access, notify the provider, document, and photograph the site
C. Flush the IV line with normal saline and continue the infusion at a slower rate
D. Contact pharmacy for a more dilute potassium solution and restart in the same site
16. A patient with hypokalemia reports shallow breathing and SpO2 of 91%. The nurse understands this is occurring
because:
A. Hypokalemia causes bronchospasm, narrowing the airways
B. The diaphragm is a skeletal muscle — hypokalemia causes muscle weakness that directly impairs ventilation
C. Low potassium causes pulmonary edema, filling the alveoli with fluid
D. Hypokalemia triggers the release of inflammatory mediators that damage lung tissue
17. A patient being discharged on spironolactone (Aldactone) for heart failure asks what foods to eat. Which response by the
nurse is CORRECT based on Galen values and drug pharmacology?
A. "Eat plenty of bananas, oranges, and potatoes to replace the potassium this drug causes you to lose."
B. "Avoid high-potassium foods like bananas, oranges, and potatoes — spironolactone retains potassium, so adding more risks
dangerous hyperkalemia."
C. "Your diet does not matter as long as you take the medication consistently."
D. "Increase sodium in your diet to balance the potassium this drug removes."
★ CALCIUM & MAGNESIUM
18. A nurse inflates a blood pressure cuff on a patient's arm above systolic pressure and holds it for 2 minutes. The patient's
hand and wrist flex inward into a spasm. The nurse documents this finding as positive for which sign, and which electrolyte
imbalance does it indicate?
A. Positive Chvostek sign — indicating hyperkalemia
B. Positive Trousseau sign — indicating hypocalcemia or hypomagnesemia
C. Positive Homans sign — indicating deep vein thrombosis
D. Positive Babinski sign — indicating upper motor neuron damage
19. A patient's calcium is 7.6 mg/dL (Galen normal: 9–10.5 mg/dL). Which assessment finding does the nurse prioritize
FIRST when caring for this patient?
A. Constipation and decreased bowel sounds — calcium affects GI motility
B. Paresthesias (tingling and numbness in the fingers and around the mouth) — the FIRST neuromuscular sign of
hypocalcemia
C. Shortened QT interval on the ECG — a late cardiac complication
D. Blood clot formation in the lower extremities — calcium promotes clotting
20. A postmenopausal female patient is diagnosed with hypocalcemia. The nurse understands that this patient has
increased risk for this imbalance because of which gender-related factor from the textbook?
A. Females produce more aldosterone, which blocks calcium absorption
B. Reduction in estrogen after menopause is related to chronic calcium loss from bone
C. Females have smaller kidneys that excrete more calcium than males
D. Postmenopausal females absorb more phosphorus, which binds calcium in the gut
All Units: Fluids/Electrolytes/Acid-Base | Cardiovascular | Urinary/Renal | GI | Pharmacology | All Galen Values Applied
DIRECTIONS: Select the ONE BEST answer. Each question is unique — no repeats. Record answers on a separate sheet. Use Galen
Standardized Values for ALL lab-related questions.
★ FLUIDS & DEHYDRATION
1. A nurse is caring for a 78-year-old patient admitted with suspected dehydration. Which assessment finding is the MOST
RELIABLE early indicator of fluid status change in this patient?
A. Skin turgor returning slowly when pinched on the forearm
B. A 3-pound weight loss compared to yesterday's documented weight on the same scale
C. Complaints of thirst and dry mouth
D. Blood pressure of 102/68 mmHg
2. A nurse is assessing a patient with fluid overload. Which combination of findings from BOX 13.3 is MOST consistent with
this diagnosis?
A. Thready pulse, poor skin turgor, dark concentrated urine, sunken eyes
B. Bounding pulse, distended neck veins, moist crackles on auscultation, sudden weight gain
C. Bradycardia, Kussmaul respirations, warm flushed dry skin
D. Hypotension, tachycardia, decreased urine output, restlessness
3. The nurse is reviewing BOX 13.1 causes of fluid imbalances. A patient just had an ileostomy placed and is also on
long-term corticosteroid therapy. Based on the action plan, which fluid imbalance is this patient MOST at risk for?
A. Fluid overload only — corticosteroids cause fluid retention
B. Dehydration from ileostomy AND fluid overload from corticosteroids — assess for BOTH imbalances
C. Neither — these two conditions cancel each other out
D. Fluid overload only — ileostomy output is minimal
4. A nurse receives a critical rescue alert: a patient with fluid overload has a bounding pulse, increasing neck vein distention,
crackles throughout the lung fields, and urine output of 18 mL/hr. What is the nurse's FIRST action?
A. Administer the scheduled oral furosemide dose
B. Restrict all oral fluids immediately without provider order
C. Notify the primary health care provider immediately and remain with the patient
D. Reposition the patient to the right lateral decubitus position
5. A patient with dehydration has a blood pressure of 86/54 mmHg and heart rate of 118 bpm. The nurse understands the
body is compensating through which primary mechanism per the textbook?
A. Vasodilation and decreased peripheral resistance to improve blood flow
B. Vasoconstriction and increased peripheral resistance to maintain blood pressure
C. Decreased heart rate to conserve cardiac energy
D. Release of insulin to drive fluid into the cells
★ SODIUM IMBALANCES
6. A nurse is caring for an 82-year-old patient in a long-term care facility who became acutely confused over the past 6
hours. The patient has no fever, no focal neurological deficits, and the family says "she was perfectly fine yesterday." Using
the Galen normal sodium value of 135–145 mEq/L, which lab result would BEST explain this presentation?
A. Sodium 141 mEq/L — within normal range, not the cause
B. Sodium 124 mEq/L — hyponatremia causing cerebral edema and acute confusion
C. Potassium 3.8 mEq/L — normal, not contributing
D. Glucose 108 mg/dL — slightly above Galen normal of 70–110 mg/dL, causing confusion
,7. A patient is ordered 3% hypertonic saline for severe hyponatremia with active seizures. The nurse knows this solution is
used because it:
A. Replaces free water lost through insensible losses
B. Creates an osmotic gradient that pulls excess water OUT of swollen brain cells to reduce cerebral edema
C. Is the standard first-line solution for all sodium imbalances regardless of severity
D. Rapidly raises sodium to normal in less than one hour to stop the seizure
8. A patient with hypernatremia (sodium 156 mEq/L per Galen normal 135–145 mEq/L) is being treated with hypotonic IV
fluids. The nurse understands that fluids must be replaced SLOWLY because rapid correction causes which complication?
A. Osmotic demyelination syndrome — permanent brain damage from too-rapid sodium lowering
B. Cerebral edema — water rushes back into brain cells too quickly as sodium drops
C. Hyperkalemia — sodium and potassium have an inverse relationship
D. Pulmonary edema — excess fluid from IV administration
9. Using Galen values (Na+ 135–145 mEq/L), a patient's sodium is 148 mEq/L. The nurse is assessing the patient. Which
finding is MOST consistent with this sodium level?
A. Confusion, lethargy, hypoactive bowel sounds, and seizure activity
B. Agitation, restlessness, intense thirst, and muscle weakness
C. Bounding pulse, weight gain, and dependent pitting edema
D. Positive Chvostek sign and carpopedal spasm with blood pressure cuff inflation
10. A nurse is teaching a patient about hyponatremia prevention. The patient states: "I drink about 6 liters of water every day
because I read it was healthy." The nurse recognizes this places the patient at risk for which type of hyponatremia?
A. Actual sodium deficit from GI fluid losses
B. Relative hyponatremia from dilution — excessive water intake dilutes serum sodium
C. Hypernatremia — excess water consumption causes high sodium levels
D. No risk — drinking extra water is always beneficial for kidney function
★ POTASSIUM IMBALANCES
11. A patient on furosemide (Lasix) for heart failure has a potassium level of 2.8 mEq/L (Galen normal: 3.5–5.0 mEq/L). The
nurse reviews the 12-lead ECG. Which ECG finding does the nurse MOST expect to see?
A. Tall, peaked, narrow T waves with a widened QRS complex
B. ST segment depression, flat or inverted T waves, and a U wave appearing after the T wave
C. Prolonged PR interval with progressive lengthening until a QRS is dropped
D. Elevated ST segments in leads II, III, and aVF
12. A nurse is preparing to administer IV potassium chloride 20 mEq in 100 mL NS over 2 hours to a patient with
hypokalemia. Before hanging the bag, which action is the HIGHEST PRIORITY SAFETY CHECK?
A. Confirm the patient has eaten a full meal to prevent nausea from the potassium
B. Verify urine output is at least 30 mL/hr AND confirm the solution is properly diluted — never give K+ IV push
C. Check blood pressure before and after administration to monitor for hypotension
D. Have the patient sign an informed consent form for the IV potassium
13. A patient's potassium level is 6.4 mEq/L (Galen normal: 3.5–5.0 mEq/L). The cardiac monitor shows tall peaked T
waves. The nurse notifies the Rapid Response Team. Which intervention does the nurse prepare for FIRST to
IMMEDIATELY protect the heart?
A. Administer kayexalate (sodium polystyrene sulfonate) rectally to remove potassium
B. Administer calcium gluconate IV to stabilize the cardiac membrane
C. Initiate dialysis to remove excess potassium from the bloodstream
D. Restrict all dietary potassium sources immediately
14. A nursing student asks why glucose and insulin are given together for hyperkalemia. The BEST explanation by the nurse
preceptor is:
, A. "Insulin permanently removes potassium from the body through the kidneys."
B. "Insulin activates the Na+/K+ ATPase pump, temporarily driving potassium FROM the bloodstream INTO the cells, lowering
serum levels while we prepare definitive treatment."
C. "Glucose neutralizes the toxic effect of potassium directly on heart cells."
D. "Together they treat the underlying cause of hyperkalemia which is always uncontrolled diabetes."
15. A nurse notes that a patient's IV solution containing potassium chloride has infiltrated the surrounding tissue. Using the
NSP Action Alert from the textbook, what is the correct sequence of actions?
A. Slow the infusion rate and apply a warm compress to the site
B. Stop the IV solution immediately, remove the venous access, notify the provider, document, and photograph the site
C. Flush the IV line with normal saline and continue the infusion at a slower rate
D. Contact pharmacy for a more dilute potassium solution and restart in the same site
16. A patient with hypokalemia reports shallow breathing and SpO2 of 91%. The nurse understands this is occurring
because:
A. Hypokalemia causes bronchospasm, narrowing the airways
B. The diaphragm is a skeletal muscle — hypokalemia causes muscle weakness that directly impairs ventilation
C. Low potassium causes pulmonary edema, filling the alveoli with fluid
D. Hypokalemia triggers the release of inflammatory mediators that damage lung tissue
17. A patient being discharged on spironolactone (Aldactone) for heart failure asks what foods to eat. Which response by the
nurse is CORRECT based on Galen values and drug pharmacology?
A. "Eat plenty of bananas, oranges, and potatoes to replace the potassium this drug causes you to lose."
B. "Avoid high-potassium foods like bananas, oranges, and potatoes — spironolactone retains potassium, so adding more risks
dangerous hyperkalemia."
C. "Your diet does not matter as long as you take the medication consistently."
D. "Increase sodium in your diet to balance the potassium this drug removes."
★ CALCIUM & MAGNESIUM
18. A nurse inflates a blood pressure cuff on a patient's arm above systolic pressure and holds it for 2 minutes. The patient's
hand and wrist flex inward into a spasm. The nurse documents this finding as positive for which sign, and which electrolyte
imbalance does it indicate?
A. Positive Chvostek sign — indicating hyperkalemia
B. Positive Trousseau sign — indicating hypocalcemia or hypomagnesemia
C. Positive Homans sign — indicating deep vein thrombosis
D. Positive Babinski sign — indicating upper motor neuron damage
19. A patient's calcium is 7.6 mg/dL (Galen normal: 9–10.5 mg/dL). Which assessment finding does the nurse prioritize
FIRST when caring for this patient?
A. Constipation and decreased bowel sounds — calcium affects GI motility
B. Paresthesias (tingling and numbness in the fingers and around the mouth) — the FIRST neuromuscular sign of
hypocalcemia
C. Shortened QT interval on the ECG — a late cardiac complication
D. Blood clot formation in the lower extremities — calcium promotes clotting
20. A postmenopausal female patient is diagnosed with hypocalcemia. The nurse understands that this patient has
increased risk for this imbalance because of which gender-related factor from the textbook?
A. Females produce more aldosterone, which blocks calcium absorption
B. Reduction in estrogen after menopause is related to chronic calcium loss from bone
C. Females have smaller kidneys that excrete more calcium than males
D. Postmenopausal females absorb more phosphorus, which binds calcium in the gut
