NUR 3300 Exam 2 – Nursing Practice II – (2026) Actual Questions & Answers
(WPU).
Fluids, Electrolytes, & Acid‑Base
1. A patient has a serum potassium of 2.9 mEq/L. Which assessment finding is
most concerning?
A) Muscle weakness
B) ECG with flat T waves
C) Shallow respirations
D) Paralytic ileus
Answer: C – Shallow respirations
Rationale: Severe hypokalemia can weaken respiratory muscles, leading to
hypoventilation and respiratory failure. Muscle weakness and ileus also occur but
do not pose immediate life‑threat like respiratory compromise.
2. A patient with heart failure has a serum sodium of 118 mEq/L. Which
intervention is priority?
A) Restrict free water
B) Administer 3% hypertonic saline
,C) Give furosemide IV push
D) Place on seizure precautions
Answer: A – Restrict free water
Rationale: Mild to moderate hyponatremia (not causing severe symptoms) is
managed with fluid restriction. Hypertonic saline is for severe symptomatic
hyponatremia (seizures, coma). Furosemide can worsen sodium loss.
3. Which ABG finding indicates uncompensated metabolic acidosis?
A) pH 7.30, PaCO₂ 30, HCO₃ 18
B) pH 7.48, PaCO₂ 48, HCO₃ 32
C) pH 7.25, PaCO₂ 50, HCO₃ 24
D) pH 7.35, PaCO₂ 45, HCO₃ 26
Answer: A – pH 7.30 (<7.35), PaCO₂ 30 (low), HCO₃ 18 (low)
Rationale: Low pH + low HCO₃ = metabolic acidosis. PaCO₂ is low (compensatory
hyperventilation) but pH still abnormal = partially compensated.
4. A patient receiving IV furosemide develops muscle cramps and a positive
Chvostek’s sign. Which lab abnormality is most likely?
,A) Hypokalemia
B) Hyponatremia
C) Hypomagnesemia
D) Hypocalcemia
Answer: D – Hypocalcemia
Rationale: Chvostek’s sign (facial twitching when tapping over facial nerve) is a
classic sign of hypocalcemia. Loop diuretics can cause calcium loss.
5. The nurse is reviewing labs: Na 152, Cl 110, BUN 42, creatinine 0.8, urine
specific gravity 1.030. What condition is suggested?
A) SIADH
B) Diabetes insipidus
C) Dehydration
D) Acute kidney injury
Answer: C – Dehydration
Rationale: Hypernatremia, elevated BUN (with normal Cr), and high specific
gravity indicate volume depletion. SIADH causes low Na, DI causes low specific
gravity.
, 6. A post‑op day 1 patient has urine output of 20 mL/hr over 4 hours. Which
action should the nurse take first?
A) Notify the provider
B) Increase IV fluid rate
C) Check BP and HR
D) Give furosemide
Answer: C – Check BP and HR
Rationale: Rule out hypovolemia first. Orthostatic hypotension suggests
dehydration as cause of oliguria. Increasing fluids without assessment risks fluid
overload.
7. Which IV fluid is most appropriate for a patient with diabetic ketoacidosis and a
serum sodium of 128 mEq/L?
A) 0.9% normal saline
B) 0.45% saline
C) 3% saline
D) D5W
(WPU).
Fluids, Electrolytes, & Acid‑Base
1. A patient has a serum potassium of 2.9 mEq/L. Which assessment finding is
most concerning?
A) Muscle weakness
B) ECG with flat T waves
C) Shallow respirations
D) Paralytic ileus
Answer: C – Shallow respirations
Rationale: Severe hypokalemia can weaken respiratory muscles, leading to
hypoventilation and respiratory failure. Muscle weakness and ileus also occur but
do not pose immediate life‑threat like respiratory compromise.
2. A patient with heart failure has a serum sodium of 118 mEq/L. Which
intervention is priority?
A) Restrict free water
B) Administer 3% hypertonic saline
,C) Give furosemide IV push
D) Place on seizure precautions
Answer: A – Restrict free water
Rationale: Mild to moderate hyponatremia (not causing severe symptoms) is
managed with fluid restriction. Hypertonic saline is for severe symptomatic
hyponatremia (seizures, coma). Furosemide can worsen sodium loss.
3. Which ABG finding indicates uncompensated metabolic acidosis?
A) pH 7.30, PaCO₂ 30, HCO₃ 18
B) pH 7.48, PaCO₂ 48, HCO₃ 32
C) pH 7.25, PaCO₂ 50, HCO₃ 24
D) pH 7.35, PaCO₂ 45, HCO₃ 26
Answer: A – pH 7.30 (<7.35), PaCO₂ 30 (low), HCO₃ 18 (low)
Rationale: Low pH + low HCO₃ = metabolic acidosis. PaCO₂ is low (compensatory
hyperventilation) but pH still abnormal = partially compensated.
4. A patient receiving IV furosemide develops muscle cramps and a positive
Chvostek’s sign. Which lab abnormality is most likely?
,A) Hypokalemia
B) Hyponatremia
C) Hypomagnesemia
D) Hypocalcemia
Answer: D – Hypocalcemia
Rationale: Chvostek’s sign (facial twitching when tapping over facial nerve) is a
classic sign of hypocalcemia. Loop diuretics can cause calcium loss.
5. The nurse is reviewing labs: Na 152, Cl 110, BUN 42, creatinine 0.8, urine
specific gravity 1.030. What condition is suggested?
A) SIADH
B) Diabetes insipidus
C) Dehydration
D) Acute kidney injury
Answer: C – Dehydration
Rationale: Hypernatremia, elevated BUN (with normal Cr), and high specific
gravity indicate volume depletion. SIADH causes low Na, DI causes low specific
gravity.
, 6. A post‑op day 1 patient has urine output of 20 mL/hr over 4 hours. Which
action should the nurse take first?
A) Notify the provider
B) Increase IV fluid rate
C) Check BP and HR
D) Give furosemide
Answer: C – Check BP and HR
Rationale: Rule out hypovolemia first. Orthostatic hypotension suggests
dehydration as cause of oliguria. Increasing fluids without assessment risks fluid
overload.
7. Which IV fluid is most appropriate for a patient with diabetic ketoacidosis and a
serum sodium of 128 mEq/L?
A) 0.9% normal saline
B) 0.45% saline
C) 3% saline
D) D5W
