NLE Foundations of Medical-Surgical Nursing Reviewer 2026

Answer: C. 60%

Step 1: Recall the standard physiology fact about total body water (TBW). Step 2: TBW is approximately 60% of adult body weight — this is the standard value used in all nursing and medical references. Step 3: Of this 60%, about two-thirds (40% of body weight) is intracellular fluid (ICF), and one-third (20% of body weight) is extracellular fluid (ECF). Step 4: Why the wrong answers are incorrect — 40% and 50% underestimate TBW; 70% is sometimes cited for infants, not adults. Step 5: Key takeaway: In a 70 kg adult, total body water is about 42 liters.

Answer: B. Urine output of 15 mL/hr and poor skin turgor

Step 1: Fluid volume deficit (FVD / hypovolemia) means the extracellular fluid volume is depleted. Step 2: When ECF is low, the kidneys conserve water, producing oliguria — urine output below 30 mL/hr (normal minimum). 15 mL/hr is clearly oliguria. Step 3: Poor skin turgor is a classic sign of dehydration — the skin 'tents' because the interstitial fluid is reduced. Step 4: Why the other options are wrong — bounding pulse, distended neck veins, crackles, edema, elevated BP, and weight gain are all signs of fluid volume EXCESS (hypervolemia), the opposite condition. Step 5: In the Philippine setting, acute gastroenteritis is a very common cause of FVD, especially in children and elderly patients.

Answer: C. Position the patient in semi- to high-Fowler's position

Step 1: Apply Maslow's hierarchy — airway and breathing (physiologic safety) is always the top priority. Step 2: Respiratory distress means the patient is having difficulty breathing, likely due to pulmonary edema from fluid volume excess. Step 3: Positioning in semi- to high-Fowler's (30–90 degrees) uses gravity to shift fluid away from the lungs and reduces venous return to the heart, immediately easing breathing effort. Step 4: Why the other options are second-priority — fluid restriction and diuretics are correct interventions, but they take time to work. Daily weight is assessment, not an emergency action. Step 5: Remember: airway → breathing → circulation (ABC) guides nursing priority, especially in acute settings.

Answer: C. Hyponatremia

Step 1: Know the normal serum sodium range: 135–145 mEq/L. Step 2: The patient's value is 128 mEq/L, which is BELOW 135 mEq/L. Step 3: Any sodium level below 135 mEq/L is called hyponatremia (hypo = low, natremia = sodium in blood). Step 4: Why the other options are wrong — hypernatremia means sodium ABOVE 145 mEq/L; 128 mEq/L is clearly not normal; hyperkalemia refers to elevated potassium, not sodium. Step 5: Clinical tip: hyponatremia is fundamentally a water problem — too much water relative to sodium, causing cells to swell, especially brain cells, leading to neurologic symptoms like headache, confusion, and seizures.

Answer: B. Verify that urine output is at least 30 mL/hr

Step 1: Potassium is excreted primarily by the kidneys. If the kidneys are not functioning adequately (as evidenced by low urine output), potassium will accumulate in the blood. Step 2: Administering potassium to a patient with low urine output risks hyperkalemia, which can cause fatal cardiac dysrhythmias. Step 3: A urine output of at least 30 mL/hr confirms the kidneys are working well enough to excrete excess potassium. Step 4: Why the other options are DANGEROUS — IV push potassium can cause immediate cardiac arrest and is NEVER done; potassium must always be diluted; the maximum safe rate on a general unit is 10 mEq/hr, NOT 30 mEq/hr. Step 5: This is a high-yield NLE safety rule: NEVER give potassium by IV push; ALWAYS check urine output first.

Answer: C. Tall, peaked T waves

Step 1: Recall the ECG changes associated with potassium imbalances — this is a high-yield NLE topic. Step 2: Hyperkalemia (K⁺ above 5.0 mEq/L) causes tall, peaked (tent-shaped) T waves on ECG. This is the earliest and most classic ECG finding. Step 3: As hyperkalemia worsens, the QRS widens and can progress to ventricular fibrillation or asystole. Step 4: Why the other options are wrong — prominent U waves and flattened T waves are signs of HYPOKALEMIA (low potassium), not hyperkalemia. A prolonged PR interval alone is not specific to hyperkalemia. Step 5: Memory aid: 'High K+ = High T wave peaks; Low K+ = Low, flat T waves with U waves visible.'

Answer: B. Chvostek's sign

Step 1: Identify what is being described — the nurse is tapping the facial nerve (cranial nerve VII) anterior to the ear. Step 2: A positive Chvostek's sign is the facial muscle twitching that occurs when CN VII is tapped. It indicates neuromuscular irritability from hypocalcemia or hypomagnesemia. Step 3: Why the other options are wrong — Trousseau's sign involves inflating a BP cuff on the arm and observing carpal spasm (also a sign of hypocalcemia); Homans' sign is calf pain on dorsiflexion (DVT assessment); Babinski's sign is the plantar reflex for upper motor neuron lesions. Step 4: Both Chvostek's and Trousseau's signs indicate the same condition — low ionized calcium causing nerve hyperexcitability. Step 5: Memory aid: 'Chvostek = Cheek (facial nerve tap); Trousseau = Tourniquet (BP cuff on arm).'

Answer: C. Respiratory acidosis

Step 1: Apply the ROME method step by step. Step 2: pH = 7.30 → below 7.35 = ACIDOSIS. Step 3: PaCO₂ = 55 mmHg → above the normal 35–45 mmHg = elevated CO₂. Step 4: Apply ROME — Respiratory Opposite: pH is LOW and PaCO₂ is HIGH (they move in OPPOSITE directions) = RESPIRATORY problem. Since pH is low (acidosis), this is Respiratory ACIDOSIS. Step 5: HCO₃⁻ = 24 mEq/L is normal (22–26 mEq/L), confirming the kidneys have not yet compensated, meaning this is uncompensated respiratory acidosis. Common causes include COPD, oversedation, or any condition causing hypoventilation (CO₂ retention).

Answer: B. Isotonic; it expands the intravascular volume without causing fluid shifts

Step 1: Know the classification of 0.9% NaCl (Normal Saline). Step 2: 0.9% NaCl is an ISOTONIC solution — its osmolality (~308 mOsm/L) is close to normal plasma osmolality (280–300 mOsm/L). Step 3: Because it is isotonic, it does not cause fluid to shift between compartments (no osmotic gradient). It stays in the extracellular space and expands the intravascular volume, making it ideal for hypovolemia and shock. Step 4: Why the other options are wrong — hypotonic solutions (like 0.45% NaCl) move water INTO cells and would worsen hypotension; hypertonic solutions pull water OUT of cells and are used for cerebral edema or severe hyponatremia. Step 5: Also isotonic: Lactated Ringer's solution — another common fluid for hypovolemia and surgical patients.

Answer: B. Loss of deep tendon reflexes

Step 1: Recall that magnesium acts as a natural calcium channel blocker and neuromuscular depressant. Step 2: In hypermagnesemia (Mg²⁺ above 2.5 mEq/L), excess magnesium depresses neuromuscular transmission and the central nervous system. Step 3: The hallmark clinical sign is LOSS (absence) of deep tendon reflexes (DTRs), particularly the patellar reflex. This signals dangerous magnesium toxicity. Step 4: Why the other options are wrong — positive Chvostek's sign and muscle cramps/tetany are signs of HYPO-magnesemia (low magnesium, causing neuromuscular irritability); tall peaked T waves indicate hyperkalemia. Step 5: If DTRs are lost, respiratory depression and cardiac arrest can follow. The antidote for hypermagnesemia is IV calcium gluconate.

Answer: B. Negative feedback loop

Step 1 — Understand homeostasis: The body must keep internal conditions (temperature, pH, blood glucose) within narrow limits. Step 2 — Identify the mechanism: A negative feedback loop detects a change from the set point and triggers a corrective response that REVERSES that change — for example, rising body temperature triggers sweating and vasodilation to cool the body back down. Step 3 — Eliminate the distractors: A positive feedback loop AMPLIFIES a change (e.g., labor contractions, blood clotting) — it does not restore balance. The General Adaptation Syndrome (GAS) is Selye's model of the whole-body stress response, not specifically the mechanism of homeostasis. The Local Adaptation Syndrome (LAS) is a localized tissue response such as inflammation. Step 4 — Conclusion: The negative feedback loop is the primary mechanism of homeostasis.

Answer: C. Alarm stage

Step 1 — Recall Selye's GAS: There are three stages — Alarm, Resistance, and Exhaustion. Step 2 — Identify the alarm stage: The alarm stage is the immediate 'fight-or-flight' response mediated by the sympathetic nervous system and the HPA axis. It produces increased heart rate, increased blood pressure, diaphoresis (sweating), anxiety, and elevated blood glucose — exactly what this patient is showing. Step 3 — Eliminate distractors: The resistance stage occurs when the stressor persists and the body attempts to adapt and return to homeostasis — vital signs begin to normalize. The exhaustion stage occurs when adaptive reserves are depleted, leading to physiologic decline. 'Recovery stage' is not a recognized stage of GAS. Step 4 — Conclusion: Acute sympathetic activation with tachycardia, hypertension, and diaphoresis immediately after a stressor = Alarm stage.