RASMUSSEN PATHOPHYSIOLOGY EXAM 2 2026/2027 |
Complete Questions | Verified Answers | Real Exam | 100%
SOLVED | Pass Guaranteed - A+ Graded
Section 1: Fluid, Electrolyte, and Acid-Base Imbalances (20 Questions)
Q1
A nurse is caring for a client who has been receiving diuretic therapy and presents with
muscle weakness, fatigue, and ECG showing flattened T waves and prominent U waves.
Which electrolyte imbalance is most likely?
A. Hypernatremia
B. Hyponatremia
C. Hypokalemia
D. Hyperkalemia
Correct Answer: C
Rationale: Hypokalemia (serum potassium <3.5 mEq/L) characteristically produces ECG
changes including flattened or inverted T waves, prominent U waves, ST-segment
depression, and prolonged QT interval. Clinical manifestations include muscle
weakness, fatigue, constipation, and ileus. Diuretic therapy (particularly thiazide and
loop diuretics) is a common cause of potassium wasting. Hypernatremia (A) and
hyponatremia (B) do not produce these specific ECG changes. Hyperkalemia (D)
produces opposite ECG changes: peaked T waves, widened QRS complex, and absent P
waves. The nurse should assess for hypokalemia causes, monitor cardiac rhythm, and
administer potassium replacement as prescribed.
Q2
,A client with chronic kidney disease presents with serum potassium of 6.2 mEq/L and
ECG showing peaked T waves. Which medication should the nurse anticipate
administering first?
A. Insulin and glucose
B. Sodium polystyrene sulfonate (Kayexalate)
C. Calcium gluconate
D. Albuterol nebulizer
Correct Answer: C
Rationale: In severe hyperkalemia with ECG changes (peaked T waves indicating cardiac
membrane instability), IV calcium gluconate or calcium chloride is administered first to
antagonize potassium's effects on cardiac membranes and prevent life-threatening
arrhythmias. This is a membrane stabilizer that works within minutes but does not
lower potassium levels. Insulin and glucose (A) shift potassium intracellularly (works in
15-30 minutes). Kayexalate (B) eliminates potassium through the GI tract (hours).
Albuterol (D) also shifts potassium intracellularly. The sequence is: calcium first for
cardiac protection, then agents to shift potassium (insulin/glucose, albuterol), then
elimination (kayexalate, dialysis). The nurse should obtain a 12-lead ECG, establish IV
access, and prepare for emergency treatment.
Q3
A client presents with nausea, vomiting, and muscle cramps. Laboratory results show
pH 7.48, PaCO₂ 42 mm Hg, and HCO₃⁻ 32 mEq/L. Which acid-base imbalance is
present?
A. Respiratory acidosis
B. Respiratory alkalosis
C. Metabolic acidosis
D. Metabolic alkalosis
,Correct Answer: D
Rationale: Metabolic alkalosis is characterized by increased pH (>7.45) and increased
bicarbonate (>26 mEq/L). The PaCO₂ is normal (40 ± 2), indicating acute metabolic
alkalosis without full respiratory compensation (which would show elevated PaCO₂ as
hypoventilation compensates). The likely cause is vomiting, which causes loss of
gastric acid (HCl), leading to bicarbonate retention. Respiratory acidosis (A) would show
decreased pH and increased PaCO₂. Respiratory alkalosis (B) would show increased pH
and decreased PaCO₂. Metabolic acidosis (C) would show decreased pH and decreased
HCO₃⁻. The nurse should assess for causes, monitor for complications (hypokalemia,
arrhythmias), and treat underlying cause (volume replacement, antiemetics, possible
acid replacement).
Q4
A client with chronic obstructive pulmonary disease (COPD) presents with confusion,
headache, and somnolence. ABG results show pH 7.32, PaCO₂ 68 mm Hg, HCO₃⁻ 35
mEq/L. Which interpretation is correct?
A. Acute respiratory acidosis without compensation
B. Chronic respiratory acidosis with metabolic compensation
C. Metabolic alkalosis with respiratory compensation
D. Mixed respiratory and metabolic acidosis
Correct Answer: B
Rationale: The ABG shows acidemia (pH <7.35), elevated PaCO₂ (respiratory acidosis
component), and elevated HCO₃⁻ (metabolic compensation). In chronic respiratory
acidosis, the kidneys retain bicarbonate to compensate for chronic CO₂ retention,
bringing pH toward normal (though rarely completely normal). Acute respiratory
acidosis (A) would show normal HCO₃⁻. Metabolic alkalosis (C) would show increased
pH. Mixed acidosis (D) would show decreased HCO₃⁻. The clinical picture (chronic
, COPD with acute confusion) suggests chronic CO₂ retention with possible acute
exacerbation. The nurse should assess for causes of acute-on-chronic respiratory
failure, provide oxygen carefully (risk of CO₂ narcosis), and prepare for possible
mechanical ventilation.
Q5
A client with heart failure is receiving furosemide and develops muscle weakness,
paresthesias, and cardiac arrhythmias. Laboratory results show magnesium 1.2 mEq/L.
Which statement about this electrolyte imbalance is accurate?
A. It commonly coexists with hypocalcemia and hypokalemia
B. It causes decreased neuromuscular excitability
C. It is treated with calcium supplementation
D. It produces shortened QT interval on ECG
Correct Answer: A
Rationale: Hypomagnesemia (<1.5 mEq/L) commonly coexists with hypokalemia and
hypocalcemia because magnesium is necessary for potassium and calcium
homeostasis. Low magnesium impairs PTH secretion and action, causing
hypocalcemia, and promotes renal potassium wasting. Hypomagnesemia causes
increased neuromuscular excitability (tremors, tetany, seizures—not decreased, B).
Treatment is magnesium replacement (C is incorrect—calcium treats hypocalcemia or
hyperkalemia). ECG shows prolonged PR and QT intervals, not shortened (D). The nurse
should assess for concurrent electrolyte abnormalities, monitor cardiac rhythm, and
administer magnesium sulfate as prescribed (IV for severe, oral for mild).
Q6
Complete Questions | Verified Answers | Real Exam | 100%
SOLVED | Pass Guaranteed - A+ Graded
Section 1: Fluid, Electrolyte, and Acid-Base Imbalances (20 Questions)
Q1
A nurse is caring for a client who has been receiving diuretic therapy and presents with
muscle weakness, fatigue, and ECG showing flattened T waves and prominent U waves.
Which electrolyte imbalance is most likely?
A. Hypernatremia
B. Hyponatremia
C. Hypokalemia
D. Hyperkalemia
Correct Answer: C
Rationale: Hypokalemia (serum potassium <3.5 mEq/L) characteristically produces ECG
changes including flattened or inverted T waves, prominent U waves, ST-segment
depression, and prolonged QT interval. Clinical manifestations include muscle
weakness, fatigue, constipation, and ileus. Diuretic therapy (particularly thiazide and
loop diuretics) is a common cause of potassium wasting. Hypernatremia (A) and
hyponatremia (B) do not produce these specific ECG changes. Hyperkalemia (D)
produces opposite ECG changes: peaked T waves, widened QRS complex, and absent P
waves. The nurse should assess for hypokalemia causes, monitor cardiac rhythm, and
administer potassium replacement as prescribed.
Q2
,A client with chronic kidney disease presents with serum potassium of 6.2 mEq/L and
ECG showing peaked T waves. Which medication should the nurse anticipate
administering first?
A. Insulin and glucose
B. Sodium polystyrene sulfonate (Kayexalate)
C. Calcium gluconate
D. Albuterol nebulizer
Correct Answer: C
Rationale: In severe hyperkalemia with ECG changes (peaked T waves indicating cardiac
membrane instability), IV calcium gluconate or calcium chloride is administered first to
antagonize potassium's effects on cardiac membranes and prevent life-threatening
arrhythmias. This is a membrane stabilizer that works within minutes but does not
lower potassium levels. Insulin and glucose (A) shift potassium intracellularly (works in
15-30 minutes). Kayexalate (B) eliminates potassium through the GI tract (hours).
Albuterol (D) also shifts potassium intracellularly. The sequence is: calcium first for
cardiac protection, then agents to shift potassium (insulin/glucose, albuterol), then
elimination (kayexalate, dialysis). The nurse should obtain a 12-lead ECG, establish IV
access, and prepare for emergency treatment.
Q3
A client presents with nausea, vomiting, and muscle cramps. Laboratory results show
pH 7.48, PaCO₂ 42 mm Hg, and HCO₃⁻ 32 mEq/L. Which acid-base imbalance is
present?
A. Respiratory acidosis
B. Respiratory alkalosis
C. Metabolic acidosis
D. Metabolic alkalosis
,Correct Answer: D
Rationale: Metabolic alkalosis is characterized by increased pH (>7.45) and increased
bicarbonate (>26 mEq/L). The PaCO₂ is normal (40 ± 2), indicating acute metabolic
alkalosis without full respiratory compensation (which would show elevated PaCO₂ as
hypoventilation compensates). The likely cause is vomiting, which causes loss of
gastric acid (HCl), leading to bicarbonate retention. Respiratory acidosis (A) would show
decreased pH and increased PaCO₂. Respiratory alkalosis (B) would show increased pH
and decreased PaCO₂. Metabolic acidosis (C) would show decreased pH and decreased
HCO₃⁻. The nurse should assess for causes, monitor for complications (hypokalemia,
arrhythmias), and treat underlying cause (volume replacement, antiemetics, possible
acid replacement).
Q4
A client with chronic obstructive pulmonary disease (COPD) presents with confusion,
headache, and somnolence. ABG results show pH 7.32, PaCO₂ 68 mm Hg, HCO₃⁻ 35
mEq/L. Which interpretation is correct?
A. Acute respiratory acidosis without compensation
B. Chronic respiratory acidosis with metabolic compensation
C. Metabolic alkalosis with respiratory compensation
D. Mixed respiratory and metabolic acidosis
Correct Answer: B
Rationale: The ABG shows acidemia (pH <7.35), elevated PaCO₂ (respiratory acidosis
component), and elevated HCO₃⁻ (metabolic compensation). In chronic respiratory
acidosis, the kidneys retain bicarbonate to compensate for chronic CO₂ retention,
bringing pH toward normal (though rarely completely normal). Acute respiratory
acidosis (A) would show normal HCO₃⁻. Metabolic alkalosis (C) would show increased
pH. Mixed acidosis (D) would show decreased HCO₃⁻. The clinical picture (chronic
, COPD with acute confusion) suggests chronic CO₂ retention with possible acute
exacerbation. The nurse should assess for causes of acute-on-chronic respiratory
failure, provide oxygen carefully (risk of CO₂ narcosis), and prepare for possible
mechanical ventilation.
Q5
A client with heart failure is receiving furosemide and develops muscle weakness,
paresthesias, and cardiac arrhythmias. Laboratory results show magnesium 1.2 mEq/L.
Which statement about this electrolyte imbalance is accurate?
A. It commonly coexists with hypocalcemia and hypokalemia
B. It causes decreased neuromuscular excitability
C. It is treated with calcium supplementation
D. It produces shortened QT interval on ECG
Correct Answer: A
Rationale: Hypomagnesemia (<1.5 mEq/L) commonly coexists with hypokalemia and
hypocalcemia because magnesium is necessary for potassium and calcium
homeostasis. Low magnesium impairs PTH secretion and action, causing
hypocalcemia, and promotes renal potassium wasting. Hypomagnesemia causes
increased neuromuscular excitability (tremors, tetany, seizures—not decreased, B).
Treatment is magnesium replacement (C is incorrect—calcium treats hypocalcemia or
hyperkalemia). ECG shows prolonged PR and QT intervals, not shortened (D). The nurse
should assess for concurrent electrolyte abnormalities, monitor cardiac rhythm, and
administer magnesium sulfate as prescribed (IV for severe, oral for mild).
Q6
