NUR 170(Hondros) Exam 1 | Study Guide with Practice
Questions and Answers|
Section 1: Fluid & Electrolyte Balance (Questions 1-12)
1. A nurse assesses clients at a family practice clinic for risk factors that could lead to
dehydration. Which client is at greatest risk for dehydration?
a. A 36-year-old prescribed long-term steroid therapy.
b. A 55-year-old who recently received intravenous fluids.
c. A 76-year-old who is cognitively impaired.
d. An 83-year-old with congestive heart failure.
<details> <summary><strong>Answer & Rationale</strong></summary>
Correct Answer: c. A 76-year-old who is cognitively impaired.
Rationale: Older adults are at higher risk for dehydration due to decreased thirst perception
and reduced kidney function. Cognitive impairment (e.g., dementia) further increases this
risk because the patient may forget to drink or be unable to communicate thirst . While CHF
requires careful fluid management, these patients usually retain fluid; cognitive impairment
directly inhibits the ability to seek hydration.
</details>
2. A patient with a 5-day history of nausea and vomiting presents to the emergency
department. What primary acid-base imbalance do you expect?
a. Metabolic Acidosis (decreased pH, decreased HCO3)
b. Metabolic Alkalosis (increased pH, increased HCO3)
c. Respiratory Acidosis (decreased pH, increased CO2)
d. Respiratory Alkalosis (increased pH, decreased CO2)
<details> <summary><strong>Answer & Rationale</strong></summary>
Correct Answer: b. Metabolic Alkalosis (increased pH, increased HCO3)
Rationale: Prolonged vomiting leads to the loss of gastric acid (hydrochloric acid). The loss of
hydrogen ions causes the blood pH to become alkaline (increased pH). The kidneys retain
bicarbonate (HCO3) to compensate, resulting in an elevated HCO3 .
</details>
3. The nurse is reviewing lab results for a patient who is NPO and receiving IV fluids of
0.9% Normal Saline at 125 mL/hr. Which sodium level requires immediate intervention?
,a. 135 mEq/L
b. 138 mEq/L
c. 142 mEq/L
d. 148 mEq/L
<details> <summary><strong>Answer & Rationale</strong></summary>
Correct Answer: d. 148 mEq/L
Rationale: Normal serum sodium is 135-145 mEq/L. A level of 148 indicates hypernatremia
(elevated sodium). This suggests the patient is hypernatremic, which could be due to
inadequate free water or excessive sodium intake. Because 0.9% Normal Saline is isotonic
but contains sodium, the nurse must assess for fluid volume deficit and signs of neurologic
impairment.
</details>
4. A patient is admitted with severe diarrhea and dehydration. The nurse assesses flat neck
veins, poor skin turgor, and a BP of 85/52. These are signs of:
a. Fluid volume excess (FVE)
b. Fluid volume deficit (FVD)
c. Anaphylactic shock
d. Pulmonary edema
<details> <summary><strong>Answer & Rationale</strong></summary>
Correct Answer: b. Fluid volume deficit (FVD)
Rationale: Diarrhea causes significant loss of water and electrolytes. Flat neck veins,
hypotension, poor turgor, and tachycardia are hallmark signs of hypovolemia (FVD). The
priority is to replace fluids to restore perfusion.
</details>
5. A patient presents with muscle twitching, a positive Chvostek’s sign, and reports tingling
in the fingers. Which electrolyte imbalance is the priority?
a. Hyperkalemia
b. Hypokalemia
c. Hypercalcemia
d. Hypocalcemia
<details> <summary><strong>Answer & Rationale</strong></summary>
Correct Answer: d. Hypocalcemia
Rationale: Chvostek’s sign (facial twitching when the facial nerve is tapped) and Trousseau’s
sign (carpal spasm) are classic indicators of hypocalcemia (low calcium). These signs indicate
, neuromuscular irritability, which can progress to laryngospasm or seizures if not treated
promptly.
</details>
6. A patient with chronic kidney disease has a potassium level of 6.8 mEq/L. The nurse
should immediately:
a. Encourage the patient to eat a banana.
b. Place the patient on a cardiac monitor.
c. Administer a saline lock.
d. Restrict oral fluids.
<details> <summary><strong>Answer & Rationale</strong></summary>
Correct Answer: b. Place the patient on a cardiac monitor.
Rationale: A potassium level of 6.8 is critical (normal ~3.5-5.0). Hyperkalemia this severe
causes tall peaked T waves, widened QRS, and potential cardiac arrest. The priority action is
continuous cardiac monitoring to detect life-threatening dysrhythmias immediately.
</details>
7. Which assessment finding indicates that a patient with hypokalemia is responding
appropriately to IV potassium replacement therapy?
a. The patient reports decreased muscle cramping.
b. The patient’s bowel sounds are hypoactive.
c. The patient’s heart rate is 110 bpm and irregular.
d. The patient’s deep tendon reflexes are absent.
<details> <summary><strong>Answer & Rationale</strong></summary>
Correct Answer: a. The patient reports decreased muscle cramping.
Rationale: Hypokalemia (low K+) causes muscle weakness, cramping, and fatigue. As
potassium levels normalize, muscle function improves, and the patient should report less
cramping. Options b, c, and d indicate worsening or unresolved electrolyte issues.
</details>
8. A nurse is administering IV potassium chloride. Which action is essential for safety?
a. Administer as an IV push to correct the imbalance quickly.
b. Ensure the dose is mixed in a solution and run via infusion pump.
c. Apply a warm compress to the infusion site to prevent phlebitis.
d. Hang the bag as a primary line at 200 mL/hr.
<details> <summary><strong>Answer & Rationale</strong></summary>
Correct Answer: b. Ensure the dose is mixed in a solution and run via infusion pump.
Questions and Answers|
Section 1: Fluid & Electrolyte Balance (Questions 1-12)
1. A nurse assesses clients at a family practice clinic for risk factors that could lead to
dehydration. Which client is at greatest risk for dehydration?
a. A 36-year-old prescribed long-term steroid therapy.
b. A 55-year-old who recently received intravenous fluids.
c. A 76-year-old who is cognitively impaired.
d. An 83-year-old with congestive heart failure.
<details> <summary><strong>Answer & Rationale</strong></summary>
Correct Answer: c. A 76-year-old who is cognitively impaired.
Rationale: Older adults are at higher risk for dehydration due to decreased thirst perception
and reduced kidney function. Cognitive impairment (e.g., dementia) further increases this
risk because the patient may forget to drink or be unable to communicate thirst . While CHF
requires careful fluid management, these patients usually retain fluid; cognitive impairment
directly inhibits the ability to seek hydration.
</details>
2. A patient with a 5-day history of nausea and vomiting presents to the emergency
department. What primary acid-base imbalance do you expect?
a. Metabolic Acidosis (decreased pH, decreased HCO3)
b. Metabolic Alkalosis (increased pH, increased HCO3)
c. Respiratory Acidosis (decreased pH, increased CO2)
d. Respiratory Alkalosis (increased pH, decreased CO2)
<details> <summary><strong>Answer & Rationale</strong></summary>
Correct Answer: b. Metabolic Alkalosis (increased pH, increased HCO3)
Rationale: Prolonged vomiting leads to the loss of gastric acid (hydrochloric acid). The loss of
hydrogen ions causes the blood pH to become alkaline (increased pH). The kidneys retain
bicarbonate (HCO3) to compensate, resulting in an elevated HCO3 .
</details>
3. The nurse is reviewing lab results for a patient who is NPO and receiving IV fluids of
0.9% Normal Saline at 125 mL/hr. Which sodium level requires immediate intervention?
,a. 135 mEq/L
b. 138 mEq/L
c. 142 mEq/L
d. 148 mEq/L
<details> <summary><strong>Answer & Rationale</strong></summary>
Correct Answer: d. 148 mEq/L
Rationale: Normal serum sodium is 135-145 mEq/L. A level of 148 indicates hypernatremia
(elevated sodium). This suggests the patient is hypernatremic, which could be due to
inadequate free water or excessive sodium intake. Because 0.9% Normal Saline is isotonic
but contains sodium, the nurse must assess for fluid volume deficit and signs of neurologic
impairment.
</details>
4. A patient is admitted with severe diarrhea and dehydration. The nurse assesses flat neck
veins, poor skin turgor, and a BP of 85/52. These are signs of:
a. Fluid volume excess (FVE)
b. Fluid volume deficit (FVD)
c. Anaphylactic shock
d. Pulmonary edema
<details> <summary><strong>Answer & Rationale</strong></summary>
Correct Answer: b. Fluid volume deficit (FVD)
Rationale: Diarrhea causes significant loss of water and electrolytes. Flat neck veins,
hypotension, poor turgor, and tachycardia are hallmark signs of hypovolemia (FVD). The
priority is to replace fluids to restore perfusion.
</details>
5. A patient presents with muscle twitching, a positive Chvostek’s sign, and reports tingling
in the fingers. Which electrolyte imbalance is the priority?
a. Hyperkalemia
b. Hypokalemia
c. Hypercalcemia
d. Hypocalcemia
<details> <summary><strong>Answer & Rationale</strong></summary>
Correct Answer: d. Hypocalcemia
Rationale: Chvostek’s sign (facial twitching when the facial nerve is tapped) and Trousseau’s
sign (carpal spasm) are classic indicators of hypocalcemia (low calcium). These signs indicate
, neuromuscular irritability, which can progress to laryngospasm or seizures if not treated
promptly.
</details>
6. A patient with chronic kidney disease has a potassium level of 6.8 mEq/L. The nurse
should immediately:
a. Encourage the patient to eat a banana.
b. Place the patient on a cardiac monitor.
c. Administer a saline lock.
d. Restrict oral fluids.
<details> <summary><strong>Answer & Rationale</strong></summary>
Correct Answer: b. Place the patient on a cardiac monitor.
Rationale: A potassium level of 6.8 is critical (normal ~3.5-5.0). Hyperkalemia this severe
causes tall peaked T waves, widened QRS, and potential cardiac arrest. The priority action is
continuous cardiac monitoring to detect life-threatening dysrhythmias immediately.
</details>
7. Which assessment finding indicates that a patient with hypokalemia is responding
appropriately to IV potassium replacement therapy?
a. The patient reports decreased muscle cramping.
b. The patient’s bowel sounds are hypoactive.
c. The patient’s heart rate is 110 bpm and irregular.
d. The patient’s deep tendon reflexes are absent.
<details> <summary><strong>Answer & Rationale</strong></summary>
Correct Answer: a. The patient reports decreased muscle cramping.
Rationale: Hypokalemia (low K+) causes muscle weakness, cramping, and fatigue. As
potassium levels normalize, muscle function improves, and the patient should report less
cramping. Options b, c, and d indicate worsening or unresolved electrolyte issues.
</details>
8. A nurse is administering IV potassium chloride. Which action is essential for safety?
a. Administer as an IV push to correct the imbalance quickly.
b. Ensure the dose is mixed in a solution and run via infusion pump.
c. Apply a warm compress to the infusion site to prevent phlebitis.
d. Hang the bag as a primary line at 200 mL/hr.
<details> <summary><strong>Answer & Rationale</strong></summary>
Correct Answer: b. Ensure the dose is mixed in a solution and run via infusion pump.
