NUR 2755 / NUR2755 Exam 2: Multidimensional Care IV /
MDC 4 – Rasmussen Actual Exam Complete Questions &
Rationales | Advanced Nursing Care | Pass Guaranteed -
A+ Graded
Complex Fluid, Electrolyte & Acid-Base Disorders
Q1: A 58-year-old patient with a history of alcohol use disorder is admitted with a
sodium level of 108 mEq/L and altered mental status. The provider orders 3%
hypertonic saline. What is the maximum safe rate of sodium correction to prevent
central pontine myelinolysis?
A. 10 to 12 mEq/L in the first 24 hours
B. 8 to 10 mEq/L in the first 24 hours
C. 4 to 6 mEq/L in the first 24 hours, not exceeding 8 mEq/L [CORRECT]
D. 2 mEq/L per hour continuously until normalized
Correct Answer: C
Rationale: The best answer is C. Correcting chronic hyponatremia too quickly can cause
osmotic demyelination syndrome, so guidelines cap the rise at roughly 4 to 6 mEq/L in
the first day with an absolute limit around 8 mEq/L. You raise it just enough to stop
severe symptoms, then slow down and let the body adjust.
Q2: A patient with end-stage renal disease missed dialysis and presents with peaked T
waves on the EKG, a widened QRS complex, and a potassium level of 7.2 mEq/L. Which
intervention should the nurse anticipate as the immediate first step?
A. Administer sodium polystyrene sulfonate orally
B. Give regular insulin with dextrose IV
C. Administer calcium gluconate IV to stabilize the cardiac membrane [CORRECT]
D. Begin emergent hemodialysis immediately
Correct Answer: C
,Rationale: The best answer is C. When you see EKG changes from hyperkalemia,
calcium gluconate is the first move because it protects the heart from arrhythmias while
you work on shifting potassium into cells with insulin and glucose. Dialysis removes it
from the body but takes time to set up, so it isn't the very first intervention when the
rhythm is threatened.
Q3: A patient with crush injuries arrives in the trauma bay with a potassium of 6.8
mEq/L and a sinusoidal wave pattern on the monitor. After calcium stabilization, which
combination of therapies best shifts potassium intracellularly while the team prepares
for dialysis?
A. Sodium polystyrene sulfonate and furosemide
B. Regular insulin with dextrose and nebulized albuterol [CORRECT]
C. Calcium chloride and magnesium sulfate
D. Bicarbonate and kayexalate alone
Correct Answer: B
Rationale: The best answer is B. Insulin with dextrose drives potassium into cells
through stimulation of the sodium-potassium pump, and high-dose beta-2 agonists like
albuterol do the same through a different mechanism. Using both together provides a
robust intracellular shift while you arrange for definitive removal.
Q4: A patient on long-term furosemide therapy and digoxin presents with muscle
cramps, weakness, and an EKG showing flattened T waves and prominent U waves. The
nurse recognizes these findings are consistent with which electrolyte disturbance?
A. Hyperkalemia
B. Hypokalemia [CORRECT]
C. Hypercalcemia
D. Hyponatremia
Correct Answer: B
Rationale: The best answer is B. Loop diuretics waste potassium, and low potassium
shows up on the EKG as flattened T waves and U waves. It also potentiates digoxin
toxicity, so this patient needs careful potassium replacement and close cardiac
monitoring.
, Q5: A patient who recently had a thyroidectomy develops perioral numbness and
carpopedal spasm. The nurse elicits a positive Chvostek sign. Which electrolyte
imbalance is most likely present?
A. Hypocalcemia [CORRECT]
B. Hypermagnesemia
C. Hypokalemia
D. Hypernatremia
Correct Answer: A
Rationale: The best answer is A. Hypocalcemia irritates neuromuscular tissue and
produces Chvostek and Trousseau signs, along with perioral numbness and tetany.
After thyroid surgery, accidental parathyroid removal or injury is a classic cause, and you
need to check an ionized calcium level right away.
Q6: A patient with metastatic bone cancer presents with confusion, constipation, and a
shortened QT interval on EKG. The nurse suspects which electrolyte abnormality?
A. Hypocalcemia
B. Hypercalcemia [CORRECT]
C. Hypomagnesemia
D. Hyponatremia
Correct Answer: B
Rationale: The best answer is B. Hypercalcemia from bone mets causes the classic
"stones, bones, groans, and psychiatric overtones" pattern, plus a shortened QT interval.
You need to hydrate aggressively and consider bisphosphonates or calcitonin to bring
the level down.
Q7: A patient in the ICU develops torsades de pointes. The nurse prepares to administer
which electrolyte replacement as part of the emergent treatment?
A. Potassium chloride
B. Calcium gluconate
C. Magnesium sulfate [CORRECT]
D. Sodium bicarbonate
Correct Answer: C
Rationale: The best answer is C. Magnesium sulfate is the first-line treatment for
torsades de pointes, even if the serum magnesium level is normal. It stabilizes the
myocardial membrane and often terminates the polymorphic ventricular tachycardia.
MDC 4 – Rasmussen Actual Exam Complete Questions &
Rationales | Advanced Nursing Care | Pass Guaranteed -
A+ Graded
Complex Fluid, Electrolyte & Acid-Base Disorders
Q1: A 58-year-old patient with a history of alcohol use disorder is admitted with a
sodium level of 108 mEq/L and altered mental status. The provider orders 3%
hypertonic saline. What is the maximum safe rate of sodium correction to prevent
central pontine myelinolysis?
A. 10 to 12 mEq/L in the first 24 hours
B. 8 to 10 mEq/L in the first 24 hours
C. 4 to 6 mEq/L in the first 24 hours, not exceeding 8 mEq/L [CORRECT]
D. 2 mEq/L per hour continuously until normalized
Correct Answer: C
Rationale: The best answer is C. Correcting chronic hyponatremia too quickly can cause
osmotic demyelination syndrome, so guidelines cap the rise at roughly 4 to 6 mEq/L in
the first day with an absolute limit around 8 mEq/L. You raise it just enough to stop
severe symptoms, then slow down and let the body adjust.
Q2: A patient with end-stage renal disease missed dialysis and presents with peaked T
waves on the EKG, a widened QRS complex, and a potassium level of 7.2 mEq/L. Which
intervention should the nurse anticipate as the immediate first step?
A. Administer sodium polystyrene sulfonate orally
B. Give regular insulin with dextrose IV
C. Administer calcium gluconate IV to stabilize the cardiac membrane [CORRECT]
D. Begin emergent hemodialysis immediately
Correct Answer: C
,Rationale: The best answer is C. When you see EKG changes from hyperkalemia,
calcium gluconate is the first move because it protects the heart from arrhythmias while
you work on shifting potassium into cells with insulin and glucose. Dialysis removes it
from the body but takes time to set up, so it isn't the very first intervention when the
rhythm is threatened.
Q3: A patient with crush injuries arrives in the trauma bay with a potassium of 6.8
mEq/L and a sinusoidal wave pattern on the monitor. After calcium stabilization, which
combination of therapies best shifts potassium intracellularly while the team prepares
for dialysis?
A. Sodium polystyrene sulfonate and furosemide
B. Regular insulin with dextrose and nebulized albuterol [CORRECT]
C. Calcium chloride and magnesium sulfate
D. Bicarbonate and kayexalate alone
Correct Answer: B
Rationale: The best answer is B. Insulin with dextrose drives potassium into cells
through stimulation of the sodium-potassium pump, and high-dose beta-2 agonists like
albuterol do the same through a different mechanism. Using both together provides a
robust intracellular shift while you arrange for definitive removal.
Q4: A patient on long-term furosemide therapy and digoxin presents with muscle
cramps, weakness, and an EKG showing flattened T waves and prominent U waves. The
nurse recognizes these findings are consistent with which electrolyte disturbance?
A. Hyperkalemia
B. Hypokalemia [CORRECT]
C. Hypercalcemia
D. Hyponatremia
Correct Answer: B
Rationale: The best answer is B. Loop diuretics waste potassium, and low potassium
shows up on the EKG as flattened T waves and U waves. It also potentiates digoxin
toxicity, so this patient needs careful potassium replacement and close cardiac
monitoring.
, Q5: A patient who recently had a thyroidectomy develops perioral numbness and
carpopedal spasm. The nurse elicits a positive Chvostek sign. Which electrolyte
imbalance is most likely present?
A. Hypocalcemia [CORRECT]
B. Hypermagnesemia
C. Hypokalemia
D. Hypernatremia
Correct Answer: A
Rationale: The best answer is A. Hypocalcemia irritates neuromuscular tissue and
produces Chvostek and Trousseau signs, along with perioral numbness and tetany.
After thyroid surgery, accidental parathyroid removal or injury is a classic cause, and you
need to check an ionized calcium level right away.
Q6: A patient with metastatic bone cancer presents with confusion, constipation, and a
shortened QT interval on EKG. The nurse suspects which electrolyte abnormality?
A. Hypocalcemia
B. Hypercalcemia [CORRECT]
C. Hypomagnesemia
D. Hyponatremia
Correct Answer: B
Rationale: The best answer is B. Hypercalcemia from bone mets causes the classic
"stones, bones, groans, and psychiatric overtones" pattern, plus a shortened QT interval.
You need to hydrate aggressively and consider bisphosphonates or calcitonin to bring
the level down.
Q7: A patient in the ICU develops torsades de pointes. The nurse prepares to administer
which electrolyte replacement as part of the emergent treatment?
A. Potassium chloride
B. Calcium gluconate
C. Magnesium sulfate [CORRECT]
D. Sodium bicarbonate
Correct Answer: C
Rationale: The best answer is C. Magnesium sulfate is the first-line treatment for
torsades de pointes, even if the serum magnesium level is normal. It stabilizes the
myocardial membrane and often terminates the polymorphic ventricular tachycardia.
