NR 324 Adult Health I - Exam 2 Comprehensive
Assessment (2026/2027 Update) 50 Questions |
Grade A Verified Solutions.
DOMAIN 1: FLUID & ELECTROLYTE IMBALANCES (14 Questions)
Question 1 (Multiple-Choice)
A 68-year-old female with a history of heart failure is receiving furosemide 40 mg IV daily. The
nurse reviews the morning laboratory results and notes a serum sodium level of 128 mEq/L.
Which clinical manifestation would the nurse expect to assess first?
A. Bounding peripheral pulses and jugular venous distention
B. Headache, confusion, and muscle cramps
C. Dry mucous membranes and intense thirst
D. Hyperactive deep tendon reflexes and hypertension
Answer: B [CORRECT]
Rationale: A serum sodium of 128 mEq/L indicates hyponatremia. In hyponatremia, water shifts
into cells causing cerebral edema, which manifests as headache, confusion, and muscle cramps.
These neurological symptoms occur because the brain is highly sensitive to osmotic shifts. The
nurse should prioritize neurological assessment, as severe hyponatremia can progress to
seizures and coma. This patient is at risk due to loop diuretic use, which promotes sodium and
water excretion.
Question 2 (SATA)
A nurse is caring for a client diagnosed with syndrome of inappropriate antidiuretic hormone
(SIADH). Which nursing interventions are appropriate? (Select all that apply.)
A. Restrict fluid intake to 800-1200 mL/day
B. Monitor daily weights and intake/output
C. Administer hypertonic saline (3% NaCl) as first-line treatment
D. Assess for signs of cerebral edema
,E. Encourage increased oral fluid intake to dilute sodium
F. Monitor serum sodium levels every 4-6 hours
Answers: A, B, D, F [CORRECT]
Rationale: SIADH causes water retention and dilutional hyponatremia due to excessive ADH
secretion. Fluid restriction (800-1200 mL/day) is the primary treatment for mild to moderate
SIADH. Daily weights and strict I&O monitoring track fluid status. Cerebral edema assessment is
critical because water shifts into brain cells. Serum sodium requires frequent monitoring to
guide treatment. Hypertonic saline is reserved for severe symptomatic hyponatremia (Na+ <120
mEq/L or neurologic symptoms), not first-line. Increased fluid intake would worsen dilutional
hyponatremia.
Question 3 (Multiple-Choice)
A client with diabetes insipidus (DI) has a serum sodium of 152 mEq/L and reports extreme
thirst and polyuria (8 L/day). Which IV fluid would the nurse anticipate the provider to order?
A. 0.9% Normal Saline (isotonic)
B. 3% Sodium Chloride (hypertonic)
C. D5W (dextrose 5% in water)
D. Lactated Ringer's (isotonic)
Answer: C [CORRECT]
Rationale: Diabetes insipidus causes hypernatremia (>145 mEq/L) due to insufficient ADH,
leading to excessive free water loss. D5W provides free water to correct the free water deficit.
Once infused, dextrose is metabolized, leaving free water that shifts into cells to correct cellular
dehydration. Normal saline contains sodium (154 mEq/L) and would not correct hypernatremia.
Hypertonic saline is contraindicated as it would worsen hypernatremia. Gradual correction is
essential to prevent cerebral edema from rapid osmotic shifts (max decrease 0.5 mEq/L/hr).
Question 4 (Multiple-Choice)
A nurse is reviewing morning labs for a client with hypernatremia. Which finding would the
nurse correlate with this electrolyte imbalance?
A. Bounding pulses, crackles in lungs, and weight gain
B. Restlessness, dry mucous membranes, and intense thirst
, C. Muscle weakness, hypoactive bowel sounds, and U waves on ECG
D. Positive Chvostek's sign and carpal spasms
Answer: B [CORRECT]
Rationale: Hypernatremia (>145 mEq/L) causes intracellular dehydration as water shifts out of
cells into the hypertonic extracellular space. Clinical manifestations include restlessness,
irritability, weakness, dry/sticky mucous membranes, intense thirst, and decreased skin turgor.
The brain is particularly vulnerable, and severe hypernatremia can cause seizures and coma.
Bounding pulses and crackles indicate fluid volume excess. Muscle weakness and U waves
indicate hypokalemia. Chvostek's sign indicates hypocalcemia.
Question 5 (Multiple-Choice)
A client with a serum potassium of 2.8 mEq/L is receiving digoxin. The nurse recognizes this
client is at greatest risk for which complication?
A. Hyperkalemia-induced cardiac arrest
B. Digoxin toxicity due to reduced potassium levels
C. Hypercalcemia with tetany
D. Metabolic alkalosis with compensatory respiratory acidosis
Answer: B [CORRECT]
Rationale: Hypokalemia (<3.5 mEq/L) increases the risk of digoxin toxicity. Digoxin and
potassium compete for the same binding sites on the Na+/K+-ATPase pump in cardiac cells.
When potassium is low, more digoxin binds to these sites, increasing its pharmacologic effect
and toxicity risk. Manifestations include nausea, vomiting, visual disturbances (yellow-green
halos), and life-threatening dysrhythmias. The nurse must hold digoxin and notify the provider
immediately if hypokalemia is present.
Question 6 (ABG/Calculation-Based)
A client with hypokalemia (K+ 2.9 mEq/L) is on cardiac monitoring. The nurse observes the
following ECG changes. Which finding is MOST consistent with this electrolyte imbalance?
A. Peaked T waves, widened QRS complex, and absent P waves
B. Flattened T waves, prominent U waves, and ST-segment depression
C. Shortened QT interval and tall peaked P waves
D. Prolonged PR interval and widened QRS with normal T waves
Assessment (2026/2027 Update) 50 Questions |
Grade A Verified Solutions.
DOMAIN 1: FLUID & ELECTROLYTE IMBALANCES (14 Questions)
Question 1 (Multiple-Choice)
A 68-year-old female with a history of heart failure is receiving furosemide 40 mg IV daily. The
nurse reviews the morning laboratory results and notes a serum sodium level of 128 mEq/L.
Which clinical manifestation would the nurse expect to assess first?
A. Bounding peripheral pulses and jugular venous distention
B. Headache, confusion, and muscle cramps
C. Dry mucous membranes and intense thirst
D. Hyperactive deep tendon reflexes and hypertension
Answer: B [CORRECT]
Rationale: A serum sodium of 128 mEq/L indicates hyponatremia. In hyponatremia, water shifts
into cells causing cerebral edema, which manifests as headache, confusion, and muscle cramps.
These neurological symptoms occur because the brain is highly sensitive to osmotic shifts. The
nurse should prioritize neurological assessment, as severe hyponatremia can progress to
seizures and coma. This patient is at risk due to loop diuretic use, which promotes sodium and
water excretion.
Question 2 (SATA)
A nurse is caring for a client diagnosed with syndrome of inappropriate antidiuretic hormone
(SIADH). Which nursing interventions are appropriate? (Select all that apply.)
A. Restrict fluid intake to 800-1200 mL/day
B. Monitor daily weights and intake/output
C. Administer hypertonic saline (3% NaCl) as first-line treatment
D. Assess for signs of cerebral edema
,E. Encourage increased oral fluid intake to dilute sodium
F. Monitor serum sodium levels every 4-6 hours
Answers: A, B, D, F [CORRECT]
Rationale: SIADH causes water retention and dilutional hyponatremia due to excessive ADH
secretion. Fluid restriction (800-1200 mL/day) is the primary treatment for mild to moderate
SIADH. Daily weights and strict I&O monitoring track fluid status. Cerebral edema assessment is
critical because water shifts into brain cells. Serum sodium requires frequent monitoring to
guide treatment. Hypertonic saline is reserved for severe symptomatic hyponatremia (Na+ <120
mEq/L or neurologic symptoms), not first-line. Increased fluid intake would worsen dilutional
hyponatremia.
Question 3 (Multiple-Choice)
A client with diabetes insipidus (DI) has a serum sodium of 152 mEq/L and reports extreme
thirst and polyuria (8 L/day). Which IV fluid would the nurse anticipate the provider to order?
A. 0.9% Normal Saline (isotonic)
B. 3% Sodium Chloride (hypertonic)
C. D5W (dextrose 5% in water)
D. Lactated Ringer's (isotonic)
Answer: C [CORRECT]
Rationale: Diabetes insipidus causes hypernatremia (>145 mEq/L) due to insufficient ADH,
leading to excessive free water loss. D5W provides free water to correct the free water deficit.
Once infused, dextrose is metabolized, leaving free water that shifts into cells to correct cellular
dehydration. Normal saline contains sodium (154 mEq/L) and would not correct hypernatremia.
Hypertonic saline is contraindicated as it would worsen hypernatremia. Gradual correction is
essential to prevent cerebral edema from rapid osmotic shifts (max decrease 0.5 mEq/L/hr).
Question 4 (Multiple-Choice)
A nurse is reviewing morning labs for a client with hypernatremia. Which finding would the
nurse correlate with this electrolyte imbalance?
A. Bounding pulses, crackles in lungs, and weight gain
B. Restlessness, dry mucous membranes, and intense thirst
, C. Muscle weakness, hypoactive bowel sounds, and U waves on ECG
D. Positive Chvostek's sign and carpal spasms
Answer: B [CORRECT]
Rationale: Hypernatremia (>145 mEq/L) causes intracellular dehydration as water shifts out of
cells into the hypertonic extracellular space. Clinical manifestations include restlessness,
irritability, weakness, dry/sticky mucous membranes, intense thirst, and decreased skin turgor.
The brain is particularly vulnerable, and severe hypernatremia can cause seizures and coma.
Bounding pulses and crackles indicate fluid volume excess. Muscle weakness and U waves
indicate hypokalemia. Chvostek's sign indicates hypocalcemia.
Question 5 (Multiple-Choice)
A client with a serum potassium of 2.8 mEq/L is receiving digoxin. The nurse recognizes this
client is at greatest risk for which complication?
A. Hyperkalemia-induced cardiac arrest
B. Digoxin toxicity due to reduced potassium levels
C. Hypercalcemia with tetany
D. Metabolic alkalosis with compensatory respiratory acidosis
Answer: B [CORRECT]
Rationale: Hypokalemia (<3.5 mEq/L) increases the risk of digoxin toxicity. Digoxin and
potassium compete for the same binding sites on the Na+/K+-ATPase pump in cardiac cells.
When potassium is low, more digoxin binds to these sites, increasing its pharmacologic effect
and toxicity risk. Manifestations include nausea, vomiting, visual disturbances (yellow-green
halos), and life-threatening dysrhythmias. The nurse must hold digoxin and notify the provider
immediately if hypokalemia is present.
Question 6 (ABG/Calculation-Based)
A client with hypokalemia (K+ 2.9 mEq/L) is on cardiac monitoring. The nurse observes the
following ECG changes. Which finding is MOST consistent with this electrolyte imbalance?
A. Peaked T waves, widened QRS complex, and absent P waves
B. Flattened T waves, prominent U waves, and ST-segment depression
C. Shortened QT interval and tall peaked P waves
D. Prolonged PR interval and widened QRS with normal T waves
