SDIULF • WEIVER MAXE
Nursing Fundamentals
NURS School of Nursing — Comprehensive Review
F L U I D S & E L E C T R O LY T E S · N U T R I T I O N · B L O O D A D M I N I S T R A T I O N
FLUID
Nursing Fundamentals — Comprehensive Review
F LU I D & E L E C T R O LYT E S , E N T E R A L / PA R E N T E R A L N U T R I T I O N , B LO O D T R A N S F U S I O N
INSTITUTION School of Nursing COURSE CODE NURS-FUND-REVIEW
PROGRAM Nursing — ADN / BSN Pathway ACADEMIC YEAR
EXAM TITLE Fluids, Electrolytes, Nutrition & TOTAL QUESTIONS 80+ Comprehensive Questions
Transfusion
COURSE TITLE Nursing Fundamentals FORMAT Multiple Choice / Definition / Select All
That Apply
EXAMINATION INSTRUCTIONS
▸ Select the single best answer for each question unless otherwise indicated.
▸ Questions cover electrolyte imbalances, fluid volume disorders, enteral/parenteral nutrition, aspiration prevention, blood
product administration, and transfusion reactions.
▸ Verified answers with detailed rationales are provided for comprehensive exam preparation.
▸ Pay close attention to the differences between dehydration and hypovolemia, and the treatment protocols for hyperkalemia
and transfusion reactions.
ELECTROLYTES, IV FLUIDS, NUTRITION & BLOOD TRANSFUSION Questions 1 –
SAFETY 80+
1. Which supplements can interact with medications, and what are the specific interactions?
A. No supplements interact with medications.
B. St. John's wort decreases effectiveness of birth control/cardiac meds/antidepressants; Vitamin K reduces warfarin
effectiveness; Antioxidants (C, E) can reduce chemotherapy effectiveness.
C. Only prescription medications interact with supplements.
D. Vitamin supplements are always safe to combine with medications.
CORRECT ANSWER B — St. John's wort (birth control/cardiac/antidepressants), Vitamin K (warfarin), Antioxidants C & E
(chemotherapy)
RATIONALE Herbal and vitamin supplements have significant drug interactions: St. John's wort induces cytochrome P450
enzymes, accelerating metabolism of oral contraceptives, cardiac glycosides, and antidepressants — reducing
their effectiveness. Vitamin K is the antidote to warfarin; increased dietary/supplemental intake antagonizes
warfarin's anticoagulant effect, increasing thrombosis risk. High-dose antioxidants (vitamins C and E) may
protect cancer cells from oxidative damage induced by chemotherapy and radiation, potentially reducing
treatment efficacy. Excessive intake of any supplement can cause toxicity — iron overload damages the liver;
excess vitamin A causes teratogenicity and reduced bone density. Always assess supplement use during
medication reconciliation.
, 2. What is the difference between overt and silent (covert) aspiration?
A. There is no difference — both are obvious.
B. Overt aspiration has noticeable symptoms (cough, wheezing, choking); silent aspiration has NO obvious symptoms
— the patient aspirates without showing signs.
C. Silent aspiration only occurs during sleep.
D. Overt aspiration is less dangerous.
CORRECT ANSWER B — Overt: visible symptoms (cough, wheeze, choking); Silent: no obvious symptoms despite
aspiration
RATIONALE Overt aspiration triggers protective airway reflexes — sudden cough, wheezing, dyspnea, congestion,
heartburn, throat clearing, or chest discomfort as the body recognizes and attempts to expel the foreign
material. Silent (covert) aspiration is particularly dangerous because the patient shows no observable signs —
the cough reflex is absent or ineffective. This is common in neurologically impaired patients (stroke,
dementia, decreased consciousness) and the elderly. Silent aspiration often presents only with subtle signs:
decreased O₂ saturation, increased heart rate, increased respiratory rate, or low-grade fever. Tube feeding
patients must be monitored for both types. Diagnosis requires videofluoroscopic swallow study (VFSS) or
fiberoptic endoscopic evaluation of swallowing (FEES).
3. What steps prevent tube feeding aspiration?
A. Position the patient flat to promote digestion.
B. Verify initial placement by x-ray; check placement q4h by pH; check residual q4h; maintain HOB 30-45° during
feeding and 1 hour after bolus.
C. Check tube placement only at the beginning of each shift.
D. Position the patient supine after feeding to prevent reflux.
CORRECT ANSWER B — Verify by x-ray initially; check pH q4h; check residual q4h; HOB 30-45° during and 1 hour post-
bolus
RATIONALE Aspiration prevention for tube-fed patients follows evidence-based protocols: (1) Confirm initial tube
placement with abdominal x-ray (gold standard) before first use — auscultation and aspirate appearance are
NOT reliable; (2) Check placement every 4 hours by verifying gastric pH (1-5.5 = gastric placement; >6 =
intestinal or respiratory placement); (3) Assess feeding tolerance every 4 hours by measuring gastric residual
volume — follow facility policy for residuals >250 mL (typically hold and recheck in 1 hour); (4) Maintain head
of bed at 30-45 degrees continuously during continuous feedings and for at least 1 hour after
intermittent/bolus feedings to use gravity to prevent reflux; (5) Monitor for signs of aspiration: decreased
SpO₂, increased HR/BP/RR, wheezing, new cough.
4. What is the difference between enteral and parenteral nutrition?
A. They are identical.
B. Enteral nutrition uses the GI tract (feeding tube); parenteral nutrition is administered intravenously (PPN or TPN).
C. Enteral is IV; parenteral is oral.
D. Both require a central venous catheter.
CORRECT ANSWER B — Enteral: via GI tract (tube); Parenteral: intravenous (PPN or TPN)
RATIONALE Enteral nutrition delivers formula directly into the stomach or small intestine via feeding tubes (NG, NJ, OG, G-
tube, PEG, J-tube). It is preferred whenever the GI tract is functional because it maintains gut integrity,
prevents bacterial translocation, is more physiologic, and has fewer complications than parenteral nutrition.
Parenteral nutrition bypasses the GI tract entirely — PPN (partial) is administered via peripheral IV for short-
term supplemental nutrition; TPN (total) is administered via central venous catheter for patients who cannot
use their GI tract (bowel obstruction, severe pancreatitis, short bowel syndrome, high-output fistula). TPN
carries higher risks: infection (CLABSI), hyperglycemia, liver dysfunction, and electrolyte imbalances.
Nursing Fundamentals
NURS School of Nursing — Comprehensive Review
F L U I D S & E L E C T R O LY T E S · N U T R I T I O N · B L O O D A D M I N I S T R A T I O N
FLUID
Nursing Fundamentals — Comprehensive Review
F LU I D & E L E C T R O LYT E S , E N T E R A L / PA R E N T E R A L N U T R I T I O N , B LO O D T R A N S F U S I O N
INSTITUTION School of Nursing COURSE CODE NURS-FUND-REVIEW
PROGRAM Nursing — ADN / BSN Pathway ACADEMIC YEAR
EXAM TITLE Fluids, Electrolytes, Nutrition & TOTAL QUESTIONS 80+ Comprehensive Questions
Transfusion
COURSE TITLE Nursing Fundamentals FORMAT Multiple Choice / Definition / Select All
That Apply
EXAMINATION INSTRUCTIONS
▸ Select the single best answer for each question unless otherwise indicated.
▸ Questions cover electrolyte imbalances, fluid volume disorders, enteral/parenteral nutrition, aspiration prevention, blood
product administration, and transfusion reactions.
▸ Verified answers with detailed rationales are provided for comprehensive exam preparation.
▸ Pay close attention to the differences between dehydration and hypovolemia, and the treatment protocols for hyperkalemia
and transfusion reactions.
ELECTROLYTES, IV FLUIDS, NUTRITION & BLOOD TRANSFUSION Questions 1 –
SAFETY 80+
1. Which supplements can interact with medications, and what are the specific interactions?
A. No supplements interact with medications.
B. St. John's wort decreases effectiveness of birth control/cardiac meds/antidepressants; Vitamin K reduces warfarin
effectiveness; Antioxidants (C, E) can reduce chemotherapy effectiveness.
C. Only prescription medications interact with supplements.
D. Vitamin supplements are always safe to combine with medications.
CORRECT ANSWER B — St. John's wort (birth control/cardiac/antidepressants), Vitamin K (warfarin), Antioxidants C & E
(chemotherapy)
RATIONALE Herbal and vitamin supplements have significant drug interactions: St. John's wort induces cytochrome P450
enzymes, accelerating metabolism of oral contraceptives, cardiac glycosides, and antidepressants — reducing
their effectiveness. Vitamin K is the antidote to warfarin; increased dietary/supplemental intake antagonizes
warfarin's anticoagulant effect, increasing thrombosis risk. High-dose antioxidants (vitamins C and E) may
protect cancer cells from oxidative damage induced by chemotherapy and radiation, potentially reducing
treatment efficacy. Excessive intake of any supplement can cause toxicity — iron overload damages the liver;
excess vitamin A causes teratogenicity and reduced bone density. Always assess supplement use during
medication reconciliation.
, 2. What is the difference between overt and silent (covert) aspiration?
A. There is no difference — both are obvious.
B. Overt aspiration has noticeable symptoms (cough, wheezing, choking); silent aspiration has NO obvious symptoms
— the patient aspirates without showing signs.
C. Silent aspiration only occurs during sleep.
D. Overt aspiration is less dangerous.
CORRECT ANSWER B — Overt: visible symptoms (cough, wheeze, choking); Silent: no obvious symptoms despite
aspiration
RATIONALE Overt aspiration triggers protective airway reflexes — sudden cough, wheezing, dyspnea, congestion,
heartburn, throat clearing, or chest discomfort as the body recognizes and attempts to expel the foreign
material. Silent (covert) aspiration is particularly dangerous because the patient shows no observable signs —
the cough reflex is absent or ineffective. This is common in neurologically impaired patients (stroke,
dementia, decreased consciousness) and the elderly. Silent aspiration often presents only with subtle signs:
decreased O₂ saturation, increased heart rate, increased respiratory rate, or low-grade fever. Tube feeding
patients must be monitored for both types. Diagnosis requires videofluoroscopic swallow study (VFSS) or
fiberoptic endoscopic evaluation of swallowing (FEES).
3. What steps prevent tube feeding aspiration?
A. Position the patient flat to promote digestion.
B. Verify initial placement by x-ray; check placement q4h by pH; check residual q4h; maintain HOB 30-45° during
feeding and 1 hour after bolus.
C. Check tube placement only at the beginning of each shift.
D. Position the patient supine after feeding to prevent reflux.
CORRECT ANSWER B — Verify by x-ray initially; check pH q4h; check residual q4h; HOB 30-45° during and 1 hour post-
bolus
RATIONALE Aspiration prevention for tube-fed patients follows evidence-based protocols: (1) Confirm initial tube
placement with abdominal x-ray (gold standard) before first use — auscultation and aspirate appearance are
NOT reliable; (2) Check placement every 4 hours by verifying gastric pH (1-5.5 = gastric placement; >6 =
intestinal or respiratory placement); (3) Assess feeding tolerance every 4 hours by measuring gastric residual
volume — follow facility policy for residuals >250 mL (typically hold and recheck in 1 hour); (4) Maintain head
of bed at 30-45 degrees continuously during continuous feedings and for at least 1 hour after
intermittent/bolus feedings to use gravity to prevent reflux; (5) Monitor for signs of aspiration: decreased
SpO₂, increased HR/BP/RR, wheezing, new cough.
4. What is the difference between enteral and parenteral nutrition?
A. They are identical.
B. Enteral nutrition uses the GI tract (feeding tube); parenteral nutrition is administered intravenously (PPN or TPN).
C. Enteral is IV; parenteral is oral.
D. Both require a central venous catheter.
CORRECT ANSWER B — Enteral: via GI tract (tube); Parenteral: intravenous (PPN or TPN)
RATIONALE Enteral nutrition delivers formula directly into the stomach or small intestine via feeding tubes (NG, NJ, OG, G-
tube, PEG, J-tube). It is preferred whenever the GI tract is functional because it maintains gut integrity,
prevents bacterial translocation, is more physiologic, and has fewer complications than parenteral nutrition.
Parenteral nutrition bypasses the GI tract entirely — PPN (partial) is administered via peripheral IV for short-
term supplemental nutrition; TPN (total) is administered via central venous catheter for patients who cannot
use their GI tract (bowel obstruction, severe pancreatitis, short bowel syndrome, high-output fistula). TPN
carries higher risks: infection (CLABSI), hyperglycemia, liver dysfunction, and electrolyte imbalances.
