1|Page
NUR 155 – Fluid & Electrolytes,
Acid–Base Balance, IV Therapy,
Blood Administration
Exam Structure:
Subject: Nursing / Fluid & Electrolytes, Acid-Base Balance, IV Therapy, Blood
Administration
Source: Provided Document
Format: Multiple-Choice Questions & Answers with Rationales
1. The nurse will be caring for a patient who is severely malnourished.
Laboratory test results show that the patient's albumin level is
critically low. What assessment finding will the nurse expect to note
when meeting with the patient?
A. The patient has generalized 3+ pitting edema.
B. The patient is confused and disoriented.
C. The patient's urine is dark and very concentrated.
D. The patient lung sounds are very diminished.
Correct Answer: A. The patient has generalized 3+ pitting edema.
Rationale:
1. Albumin is a key plasma protein that maintains oncotic (colloid
osmotic) pressure within the bloodstream.
2. Critically low albumin levels result in decreased oncotic pressure.
3. This pressure imbalance allows fluid to shift from the intravascular
space into the interstitial tissues.
4. This fluid shift manifests clinically as generalized, dependent pitting
edema.
, 2|Page
2. The nurse is reviewing the patient's laboratory results. Which result
must be communicated to the physician immediately?
A. Serum chloride level 85 mEq/L
B. Serum sodium level 134 mEq/L
C. Serum potassium level 6.8 mEq/L
D. Serum magnesium level 2.3 mEq/L
Correct Answer: C. Serum potassium level 6.8 mEq/L
Rationale:
1. The normal range for serum potassium is typically 3.5 to 5.0 mEq/L.
2. A level of 6.8 mEq/L represents severe hyperkalemia.
3. Hyperkalemia directly affects cardiac muscle cell excitability.
4. This places the patient at immediate, high risk for life-threatening
cardiac arrhythmias, such as ventricular fibrillation or asystole.
3. The nurse is caring for a patient who is at risk for fluid overload as a
result of a history of congestive heart failure. Which intervention will
the nurse teach the patient to perform at home to monitor fluid
balance?
A. "Check to make sure that your urine is a bright yellow color."
B. "Weigh yourself every morning before breakfast."
C. "Count your heart rate every evening before you go to bed."
D. "Drink plain water rather than soda, coffee, or fruit juice."
Correct Answer: B. "Weigh yourself every morning before breakfast."
Rationale:
1. Daily weight is one of the most sensitive and objective indicators of
fluid volume status.
2. A rapid weight gain of 2-3 pounds (approximately 1-1.5 kg) over 24-
48 hours is likely due to fluid retention, not body mass gain.
3. Early detection of fluid retention allows for prompt intervention (e.g.,
medication adjustment) to prevent acute decompensated heart
failure and pulmonary edema.
4. The nurse is caring for a patient who is admitted to the hospital
with diabetic ketoacidosis. Which assessment finding indicates an
attempt made by the patient's body to correct the pH?
A. The patient's respirations are very deep and rapid.
B. The patient's urine is dark and concentrated.
, 3|Page
C. The patient's skin is pale, cool, and diaphoretic.
D. The patient is sleepy and difficult to arouse.
Correct Answer: A. The patient's respirations are very deep and rapid.
Rationale:
1. Diabetic ketoacidosis (DKA) is a state of metabolic acidosis due to
ketone accumulation.
2. The primary respiratory compensation for metabolic acidosis is
hyperventilation (Kussmaul respirations).
3. By exhaling more carbon dioxide (a volatile acid), the body lowers the
PaCO2, which helps raise the blood pH toward normal.
4. This is a compensatory mechanism, not a curative one, but its
presence indicates the body is attempting to correct the acid-base
imbalance.
5. The nurse is caring for a patient who takes furosemide (Lasix) daily
to treat congestive heart failure. The nurse will watch for which
electrolyte imbalance that may occur as a result of this therapy?
A. Hypocalcemia
B. Hypernatremia
C. Hypokalemia
D. Hyperphosphatemia
Correct Answer: C. Hypokalemia
Rationale:
1. Furosemide is a loop diuretic that acts on the ascending loop of Henle
in the kidney.
2. Its mechanism inhibits sodium reabsorption, but it also promotes the
loss of potassium in the urine (potassium-wasting diuretic).
3. Chronic use without adequate potassium replacement or use of
potassium-sparing agents can lead to hypokalemia.
4. Hypokalemia can cause muscle weakness, fatigue, and dangerous
cardiac arrhythmias.
6. The nurse is caring for a patient who was brought to the ER after
overdosing on narcotic pain medication. The patient was found
unresponsive with no respirations. Arterial blood gases were drawn
shortly after the patient's arrival to the hospital. Which results will the
nurse expect to see?
, 4|Page
A. pH 7.56, PaCO2 32 mm Hg, HCO3 32 mEq/L, PaO2 90 mm Hg
B. pH 7.35, PaCO2 45 mm Hg, HCO3 26 mEq/L, PaO2 70 mm Hg
C. pH 7.45, PaCO2 38 mm Hg, HCO3 28 mEq/L, PaO2 80 mm Hg
D. pH 7.27, PaCO2 58 mm Hg, HCO3 24 mEq/L, PaO2 60 mm Hg
Correct Answer: D. pH 7.27, PaCO2 58 mm Hg, HCO3 24 mEq/L, PaO2 60
mm Hg
Rationale:
1. Narcotic overdose causes central nervous system depression and
respiratory suppression (hypoventilation).
2. Hypoventilation leads to retention of carbon dioxide (CO2), which
combines with water to form carbonic acid.
3. The increased arterial carbon dioxide (PaCO2 >45 mm Hg) and
resulting acidosis (pH <7.35) define acute respiratory acidosis.
4. The low PaO2 reflects hypoxemia from inadequate ventilation. The
bicarbonate (HCO3) is normal, indicating no renal compensation has
had time to occur.
7. The nurse is caring for a patient who is admitted to the hospital
with dehydration and gastroenteritis. The patient attempted to walk
to the bathroom and fainted right after getting out of bed. Which is the
most likely cause of the patient's collapse?
A. Orthostatic hypotension
B. Circulatory overload
C. Hemolytic reaction
D. Catheter embolism
Correct Answer: A. Orthostatic hypotension
Rationale:
1. Dehydration leads to a decrease in intravascular fluid volume
(hypovolemia).
2. Upon standing, gravity causes blood to pool in the lower extremities.
3. With reduced circulating volume, the body cannot compensate
adequately to maintain cerebral perfusion.
4. This results in a sudden drop in blood pressure (orthostatic
hypotension), leading to syncope (fainting).
8. The nurse is caring for a patient whose ABG results reveal the
following: pH 7.56, PaCO2 32 mm Hg, HCO3 42 mEq/L, PaO2 90 mm
NUR 155 – Fluid & Electrolytes,
Acid–Base Balance, IV Therapy,
Blood Administration
Exam Structure:
Subject: Nursing / Fluid & Electrolytes, Acid-Base Balance, IV Therapy, Blood
Administration
Source: Provided Document
Format: Multiple-Choice Questions & Answers with Rationales
1. The nurse will be caring for a patient who is severely malnourished.
Laboratory test results show that the patient's albumin level is
critically low. What assessment finding will the nurse expect to note
when meeting with the patient?
A. The patient has generalized 3+ pitting edema.
B. The patient is confused and disoriented.
C. The patient's urine is dark and very concentrated.
D. The patient lung sounds are very diminished.
Correct Answer: A. The patient has generalized 3+ pitting edema.
Rationale:
1. Albumin is a key plasma protein that maintains oncotic (colloid
osmotic) pressure within the bloodstream.
2. Critically low albumin levels result in decreased oncotic pressure.
3. This pressure imbalance allows fluid to shift from the intravascular
space into the interstitial tissues.
4. This fluid shift manifests clinically as generalized, dependent pitting
edema.
, 2|Page
2. The nurse is reviewing the patient's laboratory results. Which result
must be communicated to the physician immediately?
A. Serum chloride level 85 mEq/L
B. Serum sodium level 134 mEq/L
C. Serum potassium level 6.8 mEq/L
D. Serum magnesium level 2.3 mEq/L
Correct Answer: C. Serum potassium level 6.8 mEq/L
Rationale:
1. The normal range for serum potassium is typically 3.5 to 5.0 mEq/L.
2. A level of 6.8 mEq/L represents severe hyperkalemia.
3. Hyperkalemia directly affects cardiac muscle cell excitability.
4. This places the patient at immediate, high risk for life-threatening
cardiac arrhythmias, such as ventricular fibrillation or asystole.
3. The nurse is caring for a patient who is at risk for fluid overload as a
result of a history of congestive heart failure. Which intervention will
the nurse teach the patient to perform at home to monitor fluid
balance?
A. "Check to make sure that your urine is a bright yellow color."
B. "Weigh yourself every morning before breakfast."
C. "Count your heart rate every evening before you go to bed."
D. "Drink plain water rather than soda, coffee, or fruit juice."
Correct Answer: B. "Weigh yourself every morning before breakfast."
Rationale:
1. Daily weight is one of the most sensitive and objective indicators of
fluid volume status.
2. A rapid weight gain of 2-3 pounds (approximately 1-1.5 kg) over 24-
48 hours is likely due to fluid retention, not body mass gain.
3. Early detection of fluid retention allows for prompt intervention (e.g.,
medication adjustment) to prevent acute decompensated heart
failure and pulmonary edema.
4. The nurse is caring for a patient who is admitted to the hospital
with diabetic ketoacidosis. Which assessment finding indicates an
attempt made by the patient's body to correct the pH?
A. The patient's respirations are very deep and rapid.
B. The patient's urine is dark and concentrated.
, 3|Page
C. The patient's skin is pale, cool, and diaphoretic.
D. The patient is sleepy and difficult to arouse.
Correct Answer: A. The patient's respirations are very deep and rapid.
Rationale:
1. Diabetic ketoacidosis (DKA) is a state of metabolic acidosis due to
ketone accumulation.
2. The primary respiratory compensation for metabolic acidosis is
hyperventilation (Kussmaul respirations).
3. By exhaling more carbon dioxide (a volatile acid), the body lowers the
PaCO2, which helps raise the blood pH toward normal.
4. This is a compensatory mechanism, not a curative one, but its
presence indicates the body is attempting to correct the acid-base
imbalance.
5. The nurse is caring for a patient who takes furosemide (Lasix) daily
to treat congestive heart failure. The nurse will watch for which
electrolyte imbalance that may occur as a result of this therapy?
A. Hypocalcemia
B. Hypernatremia
C. Hypokalemia
D. Hyperphosphatemia
Correct Answer: C. Hypokalemia
Rationale:
1. Furosemide is a loop diuretic that acts on the ascending loop of Henle
in the kidney.
2. Its mechanism inhibits sodium reabsorption, but it also promotes the
loss of potassium in the urine (potassium-wasting diuretic).
3. Chronic use without adequate potassium replacement or use of
potassium-sparing agents can lead to hypokalemia.
4. Hypokalemia can cause muscle weakness, fatigue, and dangerous
cardiac arrhythmias.
6. The nurse is caring for a patient who was brought to the ER after
overdosing on narcotic pain medication. The patient was found
unresponsive with no respirations. Arterial blood gases were drawn
shortly after the patient's arrival to the hospital. Which results will the
nurse expect to see?
, 4|Page
A. pH 7.56, PaCO2 32 mm Hg, HCO3 32 mEq/L, PaO2 90 mm Hg
B. pH 7.35, PaCO2 45 mm Hg, HCO3 26 mEq/L, PaO2 70 mm Hg
C. pH 7.45, PaCO2 38 mm Hg, HCO3 28 mEq/L, PaO2 80 mm Hg
D. pH 7.27, PaCO2 58 mm Hg, HCO3 24 mEq/L, PaO2 60 mm Hg
Correct Answer: D. pH 7.27, PaCO2 58 mm Hg, HCO3 24 mEq/L, PaO2 60
mm Hg
Rationale:
1. Narcotic overdose causes central nervous system depression and
respiratory suppression (hypoventilation).
2. Hypoventilation leads to retention of carbon dioxide (CO2), which
combines with water to form carbonic acid.
3. The increased arterial carbon dioxide (PaCO2 >45 mm Hg) and
resulting acidosis (pH <7.35) define acute respiratory acidosis.
4. The low PaO2 reflects hypoxemia from inadequate ventilation. The
bicarbonate (HCO3) is normal, indicating no renal compensation has
had time to occur.
7. The nurse is caring for a patient who is admitted to the hospital
with dehydration and gastroenteritis. The patient attempted to walk
to the bathroom and fainted right after getting out of bed. Which is the
most likely cause of the patient's collapse?
A. Orthostatic hypotension
B. Circulatory overload
C. Hemolytic reaction
D. Catheter embolism
Correct Answer: A. Orthostatic hypotension
Rationale:
1. Dehydration leads to a decrease in intravascular fluid volume
(hypovolemia).
2. Upon standing, gravity causes blood to pool in the lower extremities.
3. With reduced circulating volume, the body cannot compensate
adequately to maintain cerebral perfusion.
4. This results in a sudden drop in blood pressure (orthostatic
hypotension), leading to syncope (fainting).
8. The nurse is caring for a patient whose ABG results reveal the
following: pH 7.56, PaCO2 32 mm Hg, HCO3 42 mEq/L, PaO2 90 mm
