NUR 265 Exam 1 Medical-Surgical Nursing
(2026/2027) PDF | Nursing | Galen College
1. A nurse is caring for a client with Syndrome of
Inappropriate Antidiuretic Hormone (SIADH). Which serum
sodium level would the nurse anticipate?
A. 155 mEq/L
B. 130 mEq/L
C. 145 mEq/L
D. 140 mEq/L
Answer: B. 130 mEq/L
Rationale: SIADH causes excess water retention, leading
to dilutional hyponatremia (sodium <135 mEq/L). Options
A (155) indicates hypernatremia, while C and D are
normal.
2. A client with Diabetes Insipidus (DI) has a urine specific
gravity of 1.001. How should the nurse interpret this?
A. Normal finding
B. Indicates concentrated urine
1
,C. Indicates dilute urine
D. Suggests kidney failure
Answer: C. Indicates dilute urine
Rationale: DI causes excessive dilute urine due to lack of
ADH. Normal specific gravity is 1.005-1.030. A value of
1.001 is very dilute.
3. A nurse is administering IV fluid to a client with
hypernatremia. Which fluid is most appropriate?
A. 0.45% NaCl (half-normal saline)
B. 3% NaCl
C. D5W
D. 0.9% NaCl
Answer: A. 0.45% NaCl
Rationale: Hypernatremia indicates high sodium.
Hypotonic fluids (0.45% NaCl) help dilute serum sodium.
3% NaCl is hypertonic and would worsen hypernatremia.
4. A client with hypokalemia reports muscle weakness and
ECG shows a U wave. What is the priority nursing action?
2
,A. Administer IV potassium chloride at 20 mEq/hour
B. Prepare for defibrillation
C. Place client on fall precautions
D. Administer sodium polystyrene sulfonate
Answer: A. Administer IV potassium chloride at 20
mEq/hour
Rationale: Hypokalemia with ECG changes requires
prompt replacement. IV KCl is given at no more than 10-
20 mEq/hour via central line or 5-10 mEq/hour
peripheral.
5. A client’s potassium level is 6.8 mEq/L. Which
intervention should the nurse implement first?
A. Administer IV calcium gluconate
B. Give sodium polystyrene sulfonate orally
C. Start an insulin and dextrose drip
D. Place the client on a cardiac monitor
Answer: D. Place the client on a cardiac monitor
Rationale: Hyperkalemia (K>5.0) can cause lethal
3
, dysrhythmias. The first action is cardiac monitoring.
Calcium gluconate stabilizes the cardiac membrane but
only after monitoring is in place.
6. A client with heart failure has a sodium level of 118
mEq/L. The client has a seizure. What is the priority
intervention?
A. Administer 3% NaCl IV
B. Restrict free water
C. Administer loop diuretic
D. Give oral sodium tablets
Answer: A. Administer 3% NaCl IV
Rationale: Severe symptomatic hyponatremia with
seizures requires hypertonic saline (3% NaCl) to rapidly
raise serum sodium. Free water restriction is for
asymptomatic hyponatremia.
7. A nurse is assessing a client with fluid volume overload.
Which finding is most concerning?
A. Jugular vein distension
4
(2026/2027) PDF | Nursing | Galen College
1. A nurse is caring for a client with Syndrome of
Inappropriate Antidiuretic Hormone (SIADH). Which serum
sodium level would the nurse anticipate?
A. 155 mEq/L
B. 130 mEq/L
C. 145 mEq/L
D. 140 mEq/L
Answer: B. 130 mEq/L
Rationale: SIADH causes excess water retention, leading
to dilutional hyponatremia (sodium <135 mEq/L). Options
A (155) indicates hypernatremia, while C and D are
normal.
2. A client with Diabetes Insipidus (DI) has a urine specific
gravity of 1.001. How should the nurse interpret this?
A. Normal finding
B. Indicates concentrated urine
1
,C. Indicates dilute urine
D. Suggests kidney failure
Answer: C. Indicates dilute urine
Rationale: DI causes excessive dilute urine due to lack of
ADH. Normal specific gravity is 1.005-1.030. A value of
1.001 is very dilute.
3. A nurse is administering IV fluid to a client with
hypernatremia. Which fluid is most appropriate?
A. 0.45% NaCl (half-normal saline)
B. 3% NaCl
C. D5W
D. 0.9% NaCl
Answer: A. 0.45% NaCl
Rationale: Hypernatremia indicates high sodium.
Hypotonic fluids (0.45% NaCl) help dilute serum sodium.
3% NaCl is hypertonic and would worsen hypernatremia.
4. A client with hypokalemia reports muscle weakness and
ECG shows a U wave. What is the priority nursing action?
2
,A. Administer IV potassium chloride at 20 mEq/hour
B. Prepare for defibrillation
C. Place client on fall precautions
D. Administer sodium polystyrene sulfonate
Answer: A. Administer IV potassium chloride at 20
mEq/hour
Rationale: Hypokalemia with ECG changes requires
prompt replacement. IV KCl is given at no more than 10-
20 mEq/hour via central line or 5-10 mEq/hour
peripheral.
5. A client’s potassium level is 6.8 mEq/L. Which
intervention should the nurse implement first?
A. Administer IV calcium gluconate
B. Give sodium polystyrene sulfonate orally
C. Start an insulin and dextrose drip
D. Place the client on a cardiac monitor
Answer: D. Place the client on a cardiac monitor
Rationale: Hyperkalemia (K>5.0) can cause lethal
3
, dysrhythmias. The first action is cardiac monitoring.
Calcium gluconate stabilizes the cardiac membrane but
only after monitoring is in place.
6. A client with heart failure has a sodium level of 118
mEq/L. The client has a seizure. What is the priority
intervention?
A. Administer 3% NaCl IV
B. Restrict free water
C. Administer loop diuretic
D. Give oral sodium tablets
Answer: A. Administer 3% NaCl IV
Rationale: Severe symptomatic hyponatremia with
seizures requires hypertonic saline (3% NaCl) to rapidly
raise serum sodium. Free water restriction is for
asymptomatic hyponatremia.
7. A nurse is assessing a client with fluid volume overload.
Which finding is most concerning?
A. Jugular vein distension
4
