PHARMACOLOGY NURS 251 MODULE 7 EXAM 2026/2027
| Portage Learning ABCnursing Geneva College | Verified
Edition Questions & Answers | Pass Guaranteed - A+
Graded
Section 1: Fluid, Electrolyte & Acid-Base Management (Questions 1-20)
Q1: A patient with severe dehydration is prescribed 0.9% NaCl at 250 mL/hr. The nurse notes
the patient's serum chloride is 110 mEq/L and bicarbonate is 20 mEq/L. Which complication is
most likely to occur if this fluid is continued at the current rate?
A. Metabolic alkalosis
B. Hyperchloremic metabolic acidosis
C. Hypokalemia
D. Hypernatremia
Correct Answer: B
Rationale: 0.9% NaCl has a high chloride concentration relative to plasma, which can cause
hyperchloremia, leading to the renal excretion of bicarbonate and resulting in hyperchloremic
metabolic acidosis. Options A and D are incorrect because normal saline does not typically
cause alkalosis or hypernatremia since it is isotonic. Option C is incorrect because while shifts
can occur, the specific complication of high-volume normal saline is hyperchloremic metabolic
acidosis. Module 7 Exam Insight: Portage Learning heavily tests the specific acid-base
imbalances caused by different crystalloids, particularly the hyperchloremic metabolic acidosis
risk associated with 0.9% NaCl.
Q2: A patient with a history of severe liver disease presents with hypovolemic shock. Which
intravenous fluid is contraindicated for this patient?
A. 0.9% NaCl
B. Lactated Ringer's
C. 0.45% NaCl
D. D5W
Correct Answer: B
Rationale: Lactated Ringer's contains lactate, which is converted to bicarbonate in the liver;
therefore, it is contraindicated in patients with severe liver disease who cannot metabolize
lactate. 0.9% NaCl, 0.45% NaCl, and D5W do not require hepatic metabolism for safe
clearance. Module 7 Exam Insight: ABCnursing frequently tests contraindications for balanced
crystalloids, requiring you to differentiate LR from normal saline based on liver function and
baseline pH.
,Q3: A nursing student is preparing to administer Dextrose 5% in Water (D5W) to a patient. The
student asks the nurse why this fluid is not used for volume resuscitation. What is the best
response by the nurse?
A. "D5W is a hypertonic solution that causes dangerous fluid shifts."
B. "D5W is initially isotonic but becomes hypotonic once the dextrose is metabolized, leaving
free water."
C. "D5W contains electrolytes that can cause hyperkalemia in volume-depleted patients."
D. "D5W is a colloid that increases intravascular volume too rapidly."
Correct Answer: B
Rationale: D5W is initially isotonic in the bag, but because the dextrose is quickly metabolized
by the body for calories, it leaves behind free water, making it functionally hypotonic in the
vascular space. It provides minimal lasting volume expansion. It is not hypertonic, contains no
electrolytes, and is not a colloid. Module 7 Exam Insight: Geneva College exams consistently
require the understanding that D5W's tonicity changes after administration, making it a
free-water provider rather than a volume expander.
Q4: A patient with hyponatremia reports a severe headache, confusion, and has a seizure.
Which IV fluid and administration rate should the nurse anticipate for this patient?
A. 0.45% NaCl at 150 mL/hr
B. 3% NaCl via continuous infusion pump
C. D5W at 100 mL/hr
D. Lactated Ringer's at 200 mL/hr
Correct Answer: B
Rationale: Severe, symptomatic hyponatremia (manifesting as seizures, coma, or severe
confusion) requires cautious administration of hypertonic saline (3% NaCl) via an infusion pump
to rapidly increase serum sodium and reduce cerebral edema. Hypotonic solutions (0.45%
NaCl, D5W) and isotonic solutions (LR) are inappropriate for acute symptomatic hyponatremia
as they do not draw water out of the brain cells effectively enough. Module 7 Exam Insight:
Module 7 tests the differentiation between asymptomatic hyponatremia (fluid restriction) and
symptomatic hyponatremia (3% NaCl) as a critical safety application.
Q5: A patient with severe hypoalbuminemia and fluid overload secondary to liver cirrhosis is
prescribed an intravenous fluid to pull fluid into the vascular space. Which fluid category is most
appropriate?
A. Hypotonic crystalloid
B. Hypertonic crystalloid
C. Colloid
D. Isotonic crystalloid
Correct Answer: C
Rationale: Colloids (such as albumin) contain large molecules that do not readily pass through
semipermeable membranes, exerting colloidal osmotic pressure that pulls fluid from the
interstitial and intracellular spaces into the vascular space. Crystalloids rapidly diffuse into the
interstitial space and are less effective for oncotic pressure correction in hypoalbuminemia.
,Module 7 Exam Insight: Portage Learning emphasizes the physiological mechanism of colloids
versus crystalloids, specifically testing albumin use in cirrhosis and severe hypoalbuminemia.
Q6: A patient has a serum potassium level of 2.8 mEq/L. The provider orders Potassium
Chloride 20 mEq IV. Which nursing action is correct?
A. Administer the 20 mEq as a rapid IV push over 1 minute.
B. Administer the 20 mEq via peripheral IV at a rate of 20 mEq/hr.
C. Administer the 20 mEq via peripheral IV at a rate of 40 mEq/hr.
D. Administer the 20 mEq as an IV bolus to rapidly correct the arrhythmia risk.
Correct Answer: B
Rationale: IV potassium must never be given as an IV push or bolus due to the risk of cardiac
arrest. The maximum recommended rate for peripheral IV administration is typically 10 mEq/hr,
but up to 20 mEq/hr may be given via a peripheral line with cardiac monitoring; rates >10
mEq/hr generally require a central line. Rapid IV push and 40 mEq/hr via peripheral line are
unsafe. Module 7 Exam Insight: ABCnursing heavily tests the absolute safety rules of IV
potassium: never IV push, maximum rates, and central line requirements for high doses, making
this a high-frequency critical safety question.
Q7: A patient with heart failure is receiving furosemide and has a potassium level of 3.0 mEq/L.
The nurse administers oral potassium supplements, but the potassium level remains low after
24 hours. The nurse should assess for which concurrent electrolyte deficiency?
A. Hypercalcemia
B. Hypomagnesemia
C. Hyperphosphatemia
D. Hyponatremia
Correct Answer: B
Rationale: Hypokalemia can be refractory to potassium replacement if the patient is also
hypomagnesemic, as magnesium is required for the proper cellular function of the Na/K-ATPase
pump. Correction of hypomagnesemia is often necessary before hypokalemia can be resolved.
The other imbalances do not directly inhibit potassium repletion. Module 7 Exam Insight:
Geneva College exams frequently link loop diuretic therapy to both potassium and magnesium
losses, testing the concept of refractory hypokalemia due to low magnesium.
Q8: A patient with end-stage renal disease has a serum potassium level of 7.2 mEq/L with tall,
peaked T waves on the ECG. The nurse prepares to administer which medication first to protect
the myocardium?
A. Regular insulin and D50W
B. Sodium polystyrene sulfonate (Kayexalate)
C. Calcium gluconate
D. Albuterol nebulizer
Correct Answer: C
Rationale: Calcium gluconate (or calcium chloride) is the first medication administered in
hyperkalemic emergencies with ECG changes because it stabilizes the myocardial cell
membrane, protecting against life-threatening arrhythmias. It does not lower the potassium level
, but buys time. Insulin/D50W, albuterol, and Kayexalate shift or excrete potassium but take
longer to work and do not offer immediate myocardial protection. Module 7 Exam Insight:
Module 7 prioritizes the ABCs of hyperkalemia management; calcium gluconate is always the
first answer for cardiac protection before shifting or excreting potassium.
Q9: A patient with chronic kidney disease is prescribed sodium polystyrene sulfonate
(Kayexalate) for hyperkalemia. Which adverse effect should the nurse monitor for and educate
the patient about?
A. Constipation and bowel necrosis
B. Hypertension and tachycardia
C. Acute kidney injury
D. Respiratory alkalosis
Correct Answer: A
Rationale: Kayexalate is a cation-exchange resin that binds potassium in the GI tract,
exchanging it for sodium. It is notorious for causing GI complications, specifically severe
constipation and, in rare but serious cases, ischemic colitis or bowel necrosis. It does not
directly cause hypertension, AKI, or respiratory alkalosis. Module 7 Exam Insight: Portage
Learning tests the black box warnings and severe adverse effects of common medications;
Kayexalate's risk for bowel necrosis is a classic Module 7 distractor-elimination question.
Q10: A patient is receiving IV calcium gluconate for severe hypocalcemia. Which nursing
intervention is most critical during this infusion?
A. Monitor for hypernatremia
B. Assess for tissue extravasation and necrosis
C. Encourage high-phosphate foods
D. Restrict fluid intake to prevent pulmonary edema
Correct Answer: B
Rationale: IV calcium solutions are highly irritating to tissues and can cause severe tissue
necrosis, cellulitis, and skin sloughing if extravasation occurs. The nurse must monitor the IV
site closely and ensure proper patency. Hypernatremia is not associated with calcium gluconate;
phosphate should actually be restricted or monitored as it binds calcium; and fluid restriction is
not the priority over preventing tissue damage. Module 7 Exam Insight: ABCnursing focuses on
local IV adverse effects for high-risk electrolytes; calcium gluconate extravasation is a
must-know safety priority over systemic effects.
Q11: A patient with multiple myeloma presents with severe bone pain, confusion, and polyuria.
Labs show a calcium level of 14 mg/dL. Which medication does the nurse anticipate
administering to inhibit osteoclast bone resorption?
A. Calcitonin
B. 0.9% NaCl
C. Zoledronic acid
D. Furosemide
Correct Answer: C
| Portage Learning ABCnursing Geneva College | Verified
Edition Questions & Answers | Pass Guaranteed - A+
Graded
Section 1: Fluid, Electrolyte & Acid-Base Management (Questions 1-20)
Q1: A patient with severe dehydration is prescribed 0.9% NaCl at 250 mL/hr. The nurse notes
the patient's serum chloride is 110 mEq/L and bicarbonate is 20 mEq/L. Which complication is
most likely to occur if this fluid is continued at the current rate?
A. Metabolic alkalosis
B. Hyperchloremic metabolic acidosis
C. Hypokalemia
D. Hypernatremia
Correct Answer: B
Rationale: 0.9% NaCl has a high chloride concentration relative to plasma, which can cause
hyperchloremia, leading to the renal excretion of bicarbonate and resulting in hyperchloremic
metabolic acidosis. Options A and D are incorrect because normal saline does not typically
cause alkalosis or hypernatremia since it is isotonic. Option C is incorrect because while shifts
can occur, the specific complication of high-volume normal saline is hyperchloremic metabolic
acidosis. Module 7 Exam Insight: Portage Learning heavily tests the specific acid-base
imbalances caused by different crystalloids, particularly the hyperchloremic metabolic acidosis
risk associated with 0.9% NaCl.
Q2: A patient with a history of severe liver disease presents with hypovolemic shock. Which
intravenous fluid is contraindicated for this patient?
A. 0.9% NaCl
B. Lactated Ringer's
C. 0.45% NaCl
D. D5W
Correct Answer: B
Rationale: Lactated Ringer's contains lactate, which is converted to bicarbonate in the liver;
therefore, it is contraindicated in patients with severe liver disease who cannot metabolize
lactate. 0.9% NaCl, 0.45% NaCl, and D5W do not require hepatic metabolism for safe
clearance. Module 7 Exam Insight: ABCnursing frequently tests contraindications for balanced
crystalloids, requiring you to differentiate LR from normal saline based on liver function and
baseline pH.
,Q3: A nursing student is preparing to administer Dextrose 5% in Water (D5W) to a patient. The
student asks the nurse why this fluid is not used for volume resuscitation. What is the best
response by the nurse?
A. "D5W is a hypertonic solution that causes dangerous fluid shifts."
B. "D5W is initially isotonic but becomes hypotonic once the dextrose is metabolized, leaving
free water."
C. "D5W contains electrolytes that can cause hyperkalemia in volume-depleted patients."
D. "D5W is a colloid that increases intravascular volume too rapidly."
Correct Answer: B
Rationale: D5W is initially isotonic in the bag, but because the dextrose is quickly metabolized
by the body for calories, it leaves behind free water, making it functionally hypotonic in the
vascular space. It provides minimal lasting volume expansion. It is not hypertonic, contains no
electrolytes, and is not a colloid. Module 7 Exam Insight: Geneva College exams consistently
require the understanding that D5W's tonicity changes after administration, making it a
free-water provider rather than a volume expander.
Q4: A patient with hyponatremia reports a severe headache, confusion, and has a seizure.
Which IV fluid and administration rate should the nurse anticipate for this patient?
A. 0.45% NaCl at 150 mL/hr
B. 3% NaCl via continuous infusion pump
C. D5W at 100 mL/hr
D. Lactated Ringer's at 200 mL/hr
Correct Answer: B
Rationale: Severe, symptomatic hyponatremia (manifesting as seizures, coma, or severe
confusion) requires cautious administration of hypertonic saline (3% NaCl) via an infusion pump
to rapidly increase serum sodium and reduce cerebral edema. Hypotonic solutions (0.45%
NaCl, D5W) and isotonic solutions (LR) are inappropriate for acute symptomatic hyponatremia
as they do not draw water out of the brain cells effectively enough. Module 7 Exam Insight:
Module 7 tests the differentiation between asymptomatic hyponatremia (fluid restriction) and
symptomatic hyponatremia (3% NaCl) as a critical safety application.
Q5: A patient with severe hypoalbuminemia and fluid overload secondary to liver cirrhosis is
prescribed an intravenous fluid to pull fluid into the vascular space. Which fluid category is most
appropriate?
A. Hypotonic crystalloid
B. Hypertonic crystalloid
C. Colloid
D. Isotonic crystalloid
Correct Answer: C
Rationale: Colloids (such as albumin) contain large molecules that do not readily pass through
semipermeable membranes, exerting colloidal osmotic pressure that pulls fluid from the
interstitial and intracellular spaces into the vascular space. Crystalloids rapidly diffuse into the
interstitial space and are less effective for oncotic pressure correction in hypoalbuminemia.
,Module 7 Exam Insight: Portage Learning emphasizes the physiological mechanism of colloids
versus crystalloids, specifically testing albumin use in cirrhosis and severe hypoalbuminemia.
Q6: A patient has a serum potassium level of 2.8 mEq/L. The provider orders Potassium
Chloride 20 mEq IV. Which nursing action is correct?
A. Administer the 20 mEq as a rapid IV push over 1 minute.
B. Administer the 20 mEq via peripheral IV at a rate of 20 mEq/hr.
C. Administer the 20 mEq via peripheral IV at a rate of 40 mEq/hr.
D. Administer the 20 mEq as an IV bolus to rapidly correct the arrhythmia risk.
Correct Answer: B
Rationale: IV potassium must never be given as an IV push or bolus due to the risk of cardiac
arrest. The maximum recommended rate for peripheral IV administration is typically 10 mEq/hr,
but up to 20 mEq/hr may be given via a peripheral line with cardiac monitoring; rates >10
mEq/hr generally require a central line. Rapid IV push and 40 mEq/hr via peripheral line are
unsafe. Module 7 Exam Insight: ABCnursing heavily tests the absolute safety rules of IV
potassium: never IV push, maximum rates, and central line requirements for high doses, making
this a high-frequency critical safety question.
Q7: A patient with heart failure is receiving furosemide and has a potassium level of 3.0 mEq/L.
The nurse administers oral potassium supplements, but the potassium level remains low after
24 hours. The nurse should assess for which concurrent electrolyte deficiency?
A. Hypercalcemia
B. Hypomagnesemia
C. Hyperphosphatemia
D. Hyponatremia
Correct Answer: B
Rationale: Hypokalemia can be refractory to potassium replacement if the patient is also
hypomagnesemic, as magnesium is required for the proper cellular function of the Na/K-ATPase
pump. Correction of hypomagnesemia is often necessary before hypokalemia can be resolved.
The other imbalances do not directly inhibit potassium repletion. Module 7 Exam Insight:
Geneva College exams frequently link loop diuretic therapy to both potassium and magnesium
losses, testing the concept of refractory hypokalemia due to low magnesium.
Q8: A patient with end-stage renal disease has a serum potassium level of 7.2 mEq/L with tall,
peaked T waves on the ECG. The nurse prepares to administer which medication first to protect
the myocardium?
A. Regular insulin and D50W
B. Sodium polystyrene sulfonate (Kayexalate)
C. Calcium gluconate
D. Albuterol nebulizer
Correct Answer: C
Rationale: Calcium gluconate (or calcium chloride) is the first medication administered in
hyperkalemic emergencies with ECG changes because it stabilizes the myocardial cell
membrane, protecting against life-threatening arrhythmias. It does not lower the potassium level
, but buys time. Insulin/D50W, albuterol, and Kayexalate shift or excrete potassium but take
longer to work and do not offer immediate myocardial protection. Module 7 Exam Insight:
Module 7 prioritizes the ABCs of hyperkalemia management; calcium gluconate is always the
first answer for cardiac protection before shifting or excreting potassium.
Q9: A patient with chronic kidney disease is prescribed sodium polystyrene sulfonate
(Kayexalate) for hyperkalemia. Which adverse effect should the nurse monitor for and educate
the patient about?
A. Constipation and bowel necrosis
B. Hypertension and tachycardia
C. Acute kidney injury
D. Respiratory alkalosis
Correct Answer: A
Rationale: Kayexalate is a cation-exchange resin that binds potassium in the GI tract,
exchanging it for sodium. It is notorious for causing GI complications, specifically severe
constipation and, in rare but serious cases, ischemic colitis or bowel necrosis. It does not
directly cause hypertension, AKI, or respiratory alkalosis. Module 7 Exam Insight: Portage
Learning tests the black box warnings and severe adverse effects of common medications;
Kayexalate's risk for bowel necrosis is a classic Module 7 distractor-elimination question.
Q10: A patient is receiving IV calcium gluconate for severe hypocalcemia. Which nursing
intervention is most critical during this infusion?
A. Monitor for hypernatremia
B. Assess for tissue extravasation and necrosis
C. Encourage high-phosphate foods
D. Restrict fluid intake to prevent pulmonary edema
Correct Answer: B
Rationale: IV calcium solutions are highly irritating to tissues and can cause severe tissue
necrosis, cellulitis, and skin sloughing if extravasation occurs. The nurse must monitor the IV
site closely and ensure proper patency. Hypernatremia is not associated with calcium gluconate;
phosphate should actually be restricted or monitored as it binds calcium; and fluid restriction is
not the priority over preventing tissue damage. Module 7 Exam Insight: ABCnursing focuses on
local IV adverse effects for high-risk electrolytes; calcium gluconate extravasation is a
must-know safety priority over systemic effects.
Q11: A patient with multiple myeloma presents with severe bone pain, confusion, and polyuria.
Labs show a calcium level of 14 mg/dL. Which medication does the nurse anticipate
administering to inhibit osteoclast bone resorption?
A. Calcitonin
B. 0.9% NaCl
C. Zoledronic acid
D. Furosemide
Correct Answer: C
