🧪 Fluid, Electrolytes, & Acid-Base Mastery:
2026 NGN Edition
Comprehensive Cheat Sheets + 30 High-Yield MCQs + Detailed Rationales
Shop: Premium Nursing Resources
© 2026 All Rights Reserved
📑 Section 1: ABG Interpretation (The "Tic-Tac-Toe"
Method)
Normal Ranges
pH: 7.35 – 7.45
PaCO2: 35 – 45 mmHg (Respiratory)
HCO3: 22 – 26 mEq/L (Metabolic)
Quick Analysis Rules (ROME)
Respiratory Opposite: pH ↑ and PaCO2 ↓ (Alkalosis) OR pH ↓ and PaCO2 ↑ (Acidosis).
Metabolic Equal: pH ↑ and HCO3 ↑ (Alkalosis) OR pH ↓ and HCO3 ↓ (Acidosis).
📑 Section 2: Electrolyte Imbalance "Must-Knows"
Potassium (K+): 3.5 – 5.0 mEq/L
Hyperkalemia: Peaked T-waves, widened QRS. Priority: Calcium Gluconate (protect heart) &
Insulin/Dextrose.
Hypokalemia: U-waves, flat T-waves. Priority: Never IV push K+ (Fatal).
Sodium (Na+): 135 – 145 mEq/L
Hypernatremia: Dehydration, thirst, dry tongue.
Hyponatremia: Seizure precautions! Confusion and cerebral edema.
, 📑 Section 3: 30 High-Yield Practice Questions
Q1. A client’s ABG results are: pH 7.30, PaCO2 52, HCO3 24. How does the nurse interpret these
findings?
A. Metabolic Acidosis
B. Respiratory Acidosis
C. Respiratory Alkalosis
D. Metabolic Alkalosis
Q2. (SATA) A client with a potassium level of 6.2 mEq/L is admitted. Which EKG changes should the
nurse anticipate? Select all that apply.
A. Peaked T-waves.
B. Presence of U-waves.
C. Widened QRS complex.
D. ST-segment depression.
E. Flat P-waves.
Q3. A nurse is caring for a client with a sodium level of 128 mEq/L. Which nursing intervention is the
priority?
A. Encourage increased water intake.
B. Initiate seizure precautions.
C. Administer a hypotonic IV solution.
D. Provide a high-salt diet.
Q4. A client with heart failure presents with a weight gain of 4 lbs in 24 hours and crackles in the
lungs. Which fluid imbalance does the nurse suspect?
A. Fluid Volume Deficit
B. Hyperkalemia
C. Fluid Volume Excess
D. Hypomagnesemia
Q5. (SATA) Which assessment findings are consistent with Hypocalcemia? Select all that apply.
A. Positive Trousseau’s sign.
B. Positive Chvostek’s sign.
C. Constipation.
D. Tingling around the mouth.
E. Diminished deep tendon reflexes.
Q6. Which IV fluid is considered "Hypotonic" and used to treat intracellular dehydration?
A. 0.9% Normal Saline
B. Lactated Ringer’s
2026 NGN Edition
Comprehensive Cheat Sheets + 30 High-Yield MCQs + Detailed Rationales
Shop: Premium Nursing Resources
© 2026 All Rights Reserved
📑 Section 1: ABG Interpretation (The "Tic-Tac-Toe"
Method)
Normal Ranges
pH: 7.35 – 7.45
PaCO2: 35 – 45 mmHg (Respiratory)
HCO3: 22 – 26 mEq/L (Metabolic)
Quick Analysis Rules (ROME)
Respiratory Opposite: pH ↑ and PaCO2 ↓ (Alkalosis) OR pH ↓ and PaCO2 ↑ (Acidosis).
Metabolic Equal: pH ↑ and HCO3 ↑ (Alkalosis) OR pH ↓ and HCO3 ↓ (Acidosis).
📑 Section 2: Electrolyte Imbalance "Must-Knows"
Potassium (K+): 3.5 – 5.0 mEq/L
Hyperkalemia: Peaked T-waves, widened QRS. Priority: Calcium Gluconate (protect heart) &
Insulin/Dextrose.
Hypokalemia: U-waves, flat T-waves. Priority: Never IV push K+ (Fatal).
Sodium (Na+): 135 – 145 mEq/L
Hypernatremia: Dehydration, thirst, dry tongue.
Hyponatremia: Seizure precautions! Confusion and cerebral edema.
, 📑 Section 3: 30 High-Yield Practice Questions
Q1. A client’s ABG results are: pH 7.30, PaCO2 52, HCO3 24. How does the nurse interpret these
findings?
A. Metabolic Acidosis
B. Respiratory Acidosis
C. Respiratory Alkalosis
D. Metabolic Alkalosis
Q2. (SATA) A client with a potassium level of 6.2 mEq/L is admitted. Which EKG changes should the
nurse anticipate? Select all that apply.
A. Peaked T-waves.
B. Presence of U-waves.
C. Widened QRS complex.
D. ST-segment depression.
E. Flat P-waves.
Q3. A nurse is caring for a client with a sodium level of 128 mEq/L. Which nursing intervention is the
priority?
A. Encourage increased water intake.
B. Initiate seizure precautions.
C. Administer a hypotonic IV solution.
D. Provide a high-salt diet.
Q4. A client with heart failure presents with a weight gain of 4 lbs in 24 hours and crackles in the
lungs. Which fluid imbalance does the nurse suspect?
A. Fluid Volume Deficit
B. Hyperkalemia
C. Fluid Volume Excess
D. Hypomagnesemia
Q5. (SATA) Which assessment findings are consistent with Hypocalcemia? Select all that apply.
A. Positive Trousseau’s sign.
B. Positive Chvostek’s sign.
C. Constipation.
D. Tingling around the mouth.
E. Diminished deep tendon reflexes.
Q6. Which IV fluid is considered "Hypotonic" and used to treat intracellular dehydration?
A. 0.9% Normal Saline
B. Lactated Ringer’s
