NUR125 Exam 4 – Joyce University
Fluid, Electrolytes, Acid-Base, IV Therapy, Blood Transfusions, TPN, & Pharmacology
Updated 2026 | 180+ Questions | Correct Answers with Rationales!!
Section 1: Fluid & Electrolyte Balance
1. A patient has a serum sodium of 118 mEq/L. Which assessment finding is most
concerning?
A. Muscle cramps
B. Dry mucous membranes
C. Altered mental status
D. Thirst
Correct Answer: C
• Rationale: Severe hyponatremia (Na <120) causes cerebral edema and neurological
changes.
• A: Muscle cramps occur but are less urgent.
• B: Dry mucous membranes suggest dehydration, not severe hyponatremia.
• D: Thirst is more common in hypernatremia.
2. Which IV fluid is most appropriate for a patient with increased intracranial pressure and
hypernatremia?
A. 0.45% NaCl
B. 3% NaCl
C. D5W
D. Lactated Ringer’s
Correct Answer: A
• Rationale: Hypotonic fluid (0.45% NaCl) lowers serum sodium and reduces
osmolality.
• B: 3% NaCl would worsen hypernatremia.
, • C: D5W is hypotonic but can cause rapid fluid shift; not first-line.
• D: Lactated Ringer’s is isotonic and not corrective for hypernatremia.
3. A patient with heart failure has 3+ pitting edema, crackles, and jugular venous
distension. Which lab finding is expected?
A. Decreased BNP
B. Increased serum osmolality
C. Decreased hematocrit
D. Increased serum sodium
Correct Answer: C
• Rationale: Fluid overload causes hemodilution, lowering hematocrit.
• A: BNP increases in heart failure.
• B: Osmolality decreases with excess water.
• D: Sodium is usually normal or low in fluid overload.
4. A patient with burns has a serum potassium of 6.2 mEq/L. Which intervention is
priority?
A. Administer potassium chloride IV
B. Place on cardiac monitor
C. Encourage oral fluids
D. Apply warm blankets
Correct Answer: B
• Rationale: Hyperkalemia (K >5.5) causes cardiac arrhythmias; monitoring is priority.
• A: Potassium chloride would worsen hyperkalemia.
• C: Oral fluids do not lower potassium quickly.
• D: Warm blankets do not treat hyperkalemia.
5. Which ECG change is most consistent with hypokalemia?
A. Tall peaked T waves
,B. Widened QRS
C. Flat T wave and U wave
D. Prolonged PR interval
Correct Answer: C
• Rationale: Hypokalemia causes flat T waves, U waves, and ST depression.
• A: Tall T waves = hyperkalemia.
• B: Widened QRS = hyperkalemia.
• D: Prolonged PR = hyperkalemia or heart block.
6. A patient with diarrhea has serum potassium 3.0 mEq/L. The nurse should assess for:
A. Hyperreflexia
B. Muscle weakness and ileus
C. Tetany
D. Hypertension
Correct Answer: B
• Rationale: Hypokalemia causes muscle weakness, decreased reflexes, and ileus.
• A: Hyperreflexia occurs in hypocalcemia or hyperkalemia? (No — hypokalemia causes
hyporeflexia).
• C: Tetany = hypocalcemia.
• D: Hypertension not directly related.
7. Which IV fluid is contraindicated in a patient with traumatic brain injury and increased
ICP?
A. 0.9% NaCl
B. 3% NaCl
C. 0.45% NaCl
D. Lactated Ringer’s
Correct Answer: C
, • Rationale: Hypotonic fluids (0.45% NaCl) can worsen cerebral edema.
• A: Isotonic saline is safe.
• B: Hypertonic saline may be used to reduce ICP.
• D: Lactated Ringer’s is isotonic and safe.
8. A patient with syndrome of inappropriate antidiuretic hormone (SIADH) has a serum
sodium of 122 mEq/L. Which intervention is most appropriate?
A. Restrict free water intake
B. Administer 3% NaCl bolus
C. Encourage oral fluids
D. Give furosemide without monitoring
Correct Answer: A
• Rationale: SIADH causes water retention; fluid restriction is first-line.
• B: Hypertonic saline reserved for severe symptoms.
• C: Fluids worsen hyponatremia.
• D: Furosemide may be used but with monitoring, not alone.
9. A patient with diabetes insipidus has urine output of 800 mL in 2 hours. Which lab
finding is expected?
A. Decreased serum sodium
B. Increased urine specific gravity
C. Increased serum osmolality
D. Decreased serum potassium
Correct Answer: C
• Rationale: Diabetes insipidus causes large water loss, leading to hypernatremia and
increased serum osmolality.
• A: Sodium increases.
• B: Urine specific gravity decreases (dilute urine).
Fluid, Electrolytes, Acid-Base, IV Therapy, Blood Transfusions, TPN, & Pharmacology
Updated 2026 | 180+ Questions | Correct Answers with Rationales!!
Section 1: Fluid & Electrolyte Balance
1. A patient has a serum sodium of 118 mEq/L. Which assessment finding is most
concerning?
A. Muscle cramps
B. Dry mucous membranes
C. Altered mental status
D. Thirst
Correct Answer: C
• Rationale: Severe hyponatremia (Na <120) causes cerebral edema and neurological
changes.
• A: Muscle cramps occur but are less urgent.
• B: Dry mucous membranes suggest dehydration, not severe hyponatremia.
• D: Thirst is more common in hypernatremia.
2. Which IV fluid is most appropriate for a patient with increased intracranial pressure and
hypernatremia?
A. 0.45% NaCl
B. 3% NaCl
C. D5W
D. Lactated Ringer’s
Correct Answer: A
• Rationale: Hypotonic fluid (0.45% NaCl) lowers serum sodium and reduces
osmolality.
• B: 3% NaCl would worsen hypernatremia.
, • C: D5W is hypotonic but can cause rapid fluid shift; not first-line.
• D: Lactated Ringer’s is isotonic and not corrective for hypernatremia.
3. A patient with heart failure has 3+ pitting edema, crackles, and jugular venous
distension. Which lab finding is expected?
A. Decreased BNP
B. Increased serum osmolality
C. Decreased hematocrit
D. Increased serum sodium
Correct Answer: C
• Rationale: Fluid overload causes hemodilution, lowering hematocrit.
• A: BNP increases in heart failure.
• B: Osmolality decreases with excess water.
• D: Sodium is usually normal or low in fluid overload.
4. A patient with burns has a serum potassium of 6.2 mEq/L. Which intervention is
priority?
A. Administer potassium chloride IV
B. Place on cardiac monitor
C. Encourage oral fluids
D. Apply warm blankets
Correct Answer: B
• Rationale: Hyperkalemia (K >5.5) causes cardiac arrhythmias; monitoring is priority.
• A: Potassium chloride would worsen hyperkalemia.
• C: Oral fluids do not lower potassium quickly.
• D: Warm blankets do not treat hyperkalemia.
5. Which ECG change is most consistent with hypokalemia?
A. Tall peaked T waves
,B. Widened QRS
C. Flat T wave and U wave
D. Prolonged PR interval
Correct Answer: C
• Rationale: Hypokalemia causes flat T waves, U waves, and ST depression.
• A: Tall T waves = hyperkalemia.
• B: Widened QRS = hyperkalemia.
• D: Prolonged PR = hyperkalemia or heart block.
6. A patient with diarrhea has serum potassium 3.0 mEq/L. The nurse should assess for:
A. Hyperreflexia
B. Muscle weakness and ileus
C. Tetany
D. Hypertension
Correct Answer: B
• Rationale: Hypokalemia causes muscle weakness, decreased reflexes, and ileus.
• A: Hyperreflexia occurs in hypocalcemia or hyperkalemia? (No — hypokalemia causes
hyporeflexia).
• C: Tetany = hypocalcemia.
• D: Hypertension not directly related.
7. Which IV fluid is contraindicated in a patient with traumatic brain injury and increased
ICP?
A. 0.9% NaCl
B. 3% NaCl
C. 0.45% NaCl
D. Lactated Ringer’s
Correct Answer: C
, • Rationale: Hypotonic fluids (0.45% NaCl) can worsen cerebral edema.
• A: Isotonic saline is safe.
• B: Hypertonic saline may be used to reduce ICP.
• D: Lactated Ringer’s is isotonic and safe.
8. A patient with syndrome of inappropriate antidiuretic hormone (SIADH) has a serum
sodium of 122 mEq/L. Which intervention is most appropriate?
A. Restrict free water intake
B. Administer 3% NaCl bolus
C. Encourage oral fluids
D. Give furosemide without monitoring
Correct Answer: A
• Rationale: SIADH causes water retention; fluid restriction is first-line.
• B: Hypertonic saline reserved for severe symptoms.
• C: Fluids worsen hyponatremia.
• D: Furosemide may be used but with monitoring, not alone.
9. A patient with diabetes insipidus has urine output of 800 mL in 2 hours. Which lab
finding is expected?
A. Decreased serum sodium
B. Increased urine specific gravity
C. Increased serum osmolality
D. Decreased serum potassium
Correct Answer: C
• Rationale: Diabetes insipidus causes large water loss, leading to hypernatremia and
increased serum osmolality.
• A: Sodium increases.
• B: Urine specific gravity decreases (dilute urine).
