HONDROS NUR 176 EXAM 1 2026/2027 | 100% Correct
Answers with Complete Solutions | Fundamentals of Nursing
II | NCLEX-RN Aligned | Hondros College | Pass Guaranteed -
A+ Graded
Domain 1: Fluid & Electrolyte Balance (Questions 1-15)
Q1: A 68-year-old patient is admitted with dehydration secondary to vomiting and
diarrhea for 3 days. Assessment reveals: BP 90/60 mmHg, HR 118 bpm (weak, thready),
skin turgor poor (tenting lasting >5 seconds), dry mucous membranes, and urine output
20 mL/hour. Serum sodium is 152 mEq/L. What is the priority nursing intervention?
A. Administer hypotonic IV solution (0.45% NS) to move fluid into cells
B. Administer isotonic IV solution (Lactated Ringer's) to expand intravascular volume
[CORRECT]
C. Administer hypertonic IV solution (D5NS) to pull fluid from interstitial spaces
D. Encourage oral fluid intake with free water to dilute serum sodium
Correct Answer: B
,Rationale: This patient presents with fluid volume deficit (hypovolemia) and
hypernatremia (serum sodium 152 mEq/L; normal 135-145). The priority is to restore
intravascular volume with isotonic fluids (Lactated Ringer's or 0.9% NS) . Isotonic
solutions remain in the intravascular space, expanding plasma volume and improving
perfusion. Distractor A is incorrect because hypotonic solutions would move water into
cells, potentially worsening hypotension and cardiovascular collapse. Distractor C is
incorrect because hypertonic solutions would further dehydrate cells and are
contraindicated in hypovolemic patients. Distractor D is incorrect because oral fluids are
insufficient for severe dehydration, and free water could cause rapid sodium shifts
leading to cerebral edema.
Q2: A patient with heart failure is receiving furosemide (Lasix) 40 mg IV daily.
Assessment reveals: weight gain 2 kg in 24 hours, bilateral crackles in lung bases, JVD
at 45-degree head elevation, and SpO2 88% on room air. Serum potassium is 3.0 mEq/L.
What is the priority nursing intervention?
A. Increase dietary potassium intake and continue current diuretic regimen
B. Administer potassium supplements and notify provider for possible increase in
diuretic dosage [CORRECT]
C. Hold the diuretic and administer potassium-sparing diuretic only
D. Restrict sodium intake and maintain fluid intake at 3 liters daily
Correct Answer: B
,Rationale: This patient demonstrates fluid volume excess (weight gain, crackles, JVD)
with hypokalemia (K+ 3.0 mEq/L; normal 3.5-5.0). The priority is to administer
potassium supplements to prevent cardiac dysrhythmias and notify the provider for
potential diuretic adjustment . Hypokalemia can cause life-threatening arrhythmias and
must be corrected. Distractor A is insufficient because dietary potassium cannot correct
a 3.0 mEq/L deficit quickly enough. Distractor C is incorrect because holding the
diuretic would worsen fluid overload. Distractor D is incorrect because 3 liters of fluid
would exacerbate the fluid overload; fluid restriction is indicated.
Q3: A patient with chronic kidney disease presents with muscle weakness, flaccid
paralysis, and peaked T waves on ECG. Laboratory results show serum potassium 6.8
mEq/L. What is the nurse's priority action?
A. Administer oral potassium supplements to stabilize the myocardium
B. Prepare for emergency dialysis immediately
C. Administer calcium gluconate IV to stabilize cardiac membranes [CORRECT]
D. Insert Foley catheter for accurate urine output measurement
Correct Answer: C
Rationale: This patient has severe hyperkalemia (K+ 6.8 mEq/L) with life-threatening
cardiac manifestations (peaked T waves). The immediate priority is to protect the heart
by administering calcium gluconate IV, which stabilizes cardiac cell membranes . This is
, given while preparing other interventions. Distractor A is incorrect and
dangerous—additional potassium would be lethal. Distractor B is important but not the
immediate first step; cardiac protection takes precedence. Distractor D is important for
monitoring but does not address the life-threatening cardiac instability.
Q4: A patient receiving total parenteral nutrition (TPN) develops tremors, muscle
twitching, and a positive Chvostek sign. Serum calcium is 7.2 mg/dL. What is the
priority nursing intervention?
A. Administer oral calcium carbonate supplements
B. Administer IV calcium gluconate immediately [CORRECT]
C. Increase vitamin D supplementation in the TPN solution
D. Apply restraints to prevent injury from tremors
Correct Answer: B
Rationale: This patient has hypocalcemia (Ca++ 7.2 mg/dL; normal 8.5-10.5) with
neuromuscular irritability evidenced by Chvostek sign and tremors. IV calcium
gluconate is the priority for symptomatic hypocalcemia to prevent laryngospasm and
tetany . Distractor A is insufficient for acute symptomatic hypocalcemia. Distractor C
addresses long-term management but not the acute crisis. Distractor D addresses
safety but not the underlying electrolyte emergency.
Answers with Complete Solutions | Fundamentals of Nursing
II | NCLEX-RN Aligned | Hondros College | Pass Guaranteed -
A+ Graded
Domain 1: Fluid & Electrolyte Balance (Questions 1-15)
Q1: A 68-year-old patient is admitted with dehydration secondary to vomiting and
diarrhea for 3 days. Assessment reveals: BP 90/60 mmHg, HR 118 bpm (weak, thready),
skin turgor poor (tenting lasting >5 seconds), dry mucous membranes, and urine output
20 mL/hour. Serum sodium is 152 mEq/L. What is the priority nursing intervention?
A. Administer hypotonic IV solution (0.45% NS) to move fluid into cells
B. Administer isotonic IV solution (Lactated Ringer's) to expand intravascular volume
[CORRECT]
C. Administer hypertonic IV solution (D5NS) to pull fluid from interstitial spaces
D. Encourage oral fluid intake with free water to dilute serum sodium
Correct Answer: B
,Rationale: This patient presents with fluid volume deficit (hypovolemia) and
hypernatremia (serum sodium 152 mEq/L; normal 135-145). The priority is to restore
intravascular volume with isotonic fluids (Lactated Ringer's or 0.9% NS) . Isotonic
solutions remain in the intravascular space, expanding plasma volume and improving
perfusion. Distractor A is incorrect because hypotonic solutions would move water into
cells, potentially worsening hypotension and cardiovascular collapse. Distractor C is
incorrect because hypertonic solutions would further dehydrate cells and are
contraindicated in hypovolemic patients. Distractor D is incorrect because oral fluids are
insufficient for severe dehydration, and free water could cause rapid sodium shifts
leading to cerebral edema.
Q2: A patient with heart failure is receiving furosemide (Lasix) 40 mg IV daily.
Assessment reveals: weight gain 2 kg in 24 hours, bilateral crackles in lung bases, JVD
at 45-degree head elevation, and SpO2 88% on room air. Serum potassium is 3.0 mEq/L.
What is the priority nursing intervention?
A. Increase dietary potassium intake and continue current diuretic regimen
B. Administer potassium supplements and notify provider for possible increase in
diuretic dosage [CORRECT]
C. Hold the diuretic and administer potassium-sparing diuretic only
D. Restrict sodium intake and maintain fluid intake at 3 liters daily
Correct Answer: B
,Rationale: This patient demonstrates fluid volume excess (weight gain, crackles, JVD)
with hypokalemia (K+ 3.0 mEq/L; normal 3.5-5.0). The priority is to administer
potassium supplements to prevent cardiac dysrhythmias and notify the provider for
potential diuretic adjustment . Hypokalemia can cause life-threatening arrhythmias and
must be corrected. Distractor A is insufficient because dietary potassium cannot correct
a 3.0 mEq/L deficit quickly enough. Distractor C is incorrect because holding the
diuretic would worsen fluid overload. Distractor D is incorrect because 3 liters of fluid
would exacerbate the fluid overload; fluid restriction is indicated.
Q3: A patient with chronic kidney disease presents with muscle weakness, flaccid
paralysis, and peaked T waves on ECG. Laboratory results show serum potassium 6.8
mEq/L. What is the nurse's priority action?
A. Administer oral potassium supplements to stabilize the myocardium
B. Prepare for emergency dialysis immediately
C. Administer calcium gluconate IV to stabilize cardiac membranes [CORRECT]
D. Insert Foley catheter for accurate urine output measurement
Correct Answer: C
Rationale: This patient has severe hyperkalemia (K+ 6.8 mEq/L) with life-threatening
cardiac manifestations (peaked T waves). The immediate priority is to protect the heart
by administering calcium gluconate IV, which stabilizes cardiac cell membranes . This is
, given while preparing other interventions. Distractor A is incorrect and
dangerous—additional potassium would be lethal. Distractor B is important but not the
immediate first step; cardiac protection takes precedence. Distractor D is important for
monitoring but does not address the life-threatening cardiac instability.
Q4: A patient receiving total parenteral nutrition (TPN) develops tremors, muscle
twitching, and a positive Chvostek sign. Serum calcium is 7.2 mg/dL. What is the
priority nursing intervention?
A. Administer oral calcium carbonate supplements
B. Administer IV calcium gluconate immediately [CORRECT]
C. Increase vitamin D supplementation in the TPN solution
D. Apply restraints to prevent injury from tremors
Correct Answer: B
Rationale: This patient has hypocalcemia (Ca++ 7.2 mg/dL; normal 8.5-10.5) with
neuromuscular irritability evidenced by Chvostek sign and tremors. IV calcium
gluconate is the priority for symptomatic hypocalcemia to prevent laryngospasm and
tetany . Distractor A is insufficient for acute symptomatic hypocalcemia. Distractor C
addresses long-term management but not the acute crisis. Distractor D addresses
safety but not the underlying electrolyte emergency.
