Fluid Electrolyte & Acid-Base Imbalances Actual Exam
2026/2027 – Complete Exam-Style Questions with Detailed
Rationales | 100% Verified | Pass Guaranteed – A+ Graded
Q1: A 72-year-old male with a history of heart failure presents with weight gain of 8
pounds over 3 days, bilateral crackles, JVD, and 3+ pitting edema in the lower
extremities. His urine specific gravity is 1.005. The nurse recognizes these findings as
consistent with:
A. Fluid volume deficit with concentrated urine
B. Fluid volume excess with dilute urine [CORRECT]
C. Normal fluid status with appropriate compensatory mechanisms
D. Dehydration secondary to diuretic overuse
Correct Answer: B
Rationale: This patient presents classic signs of fluid volume excess (hypervolemia):
weight gain, crackles (pulmonary edema), JVD, and peripheral edema. The low urine
specific gravity (1.005 < 1.010) indicates dilute urine as the kidneys attempt to excrete
excess fluid. Fluid volume deficit (A) would show concentrated urine (specific gravity
>1.030) and signs of dehydration. The findings are clearly abnormal (C). Diuretic
overuse (D) would cause fluid loss and concentrated urine, not weight gain and edema.
100% VERIFIED – Rasmussen NUR2502 MDC3
Q2: A patient with syndrome of inappropriate antidiuretic hormone (SIADH) has a serum
sodium of 118 mEq/L. The nurse should anticipate which initial intervention?
,A. Administration of 3% hypertonic saline at a rapid rate to correct sodium quickly
B. Fluid restriction and slow sodium correction to prevent central pontine myelinolysis
[CORRECT]
C. Aggressive IV normal saline infusion to dilute serum sodium
D. Administration of loop diuretics to promote sodium retention
Correct Answer: B
Rationale: SIADH causes euvolemic hyponatremia due to water retention. The primary
treatment is fluid restriction (typically 800-1200 mL/day). If hypertonic saline is used for
severe symptoms (seizures, altered mental status), correction must be slow (≤8-12
mEq/L per 24 hours) to prevent osmotic demyelination syndrome (central pontine
myelinolysis). Rapid correction (A) is dangerous. Normal saline (C) may worsen
hyponatremia in SIADH. Loop diuretics (D) are used in hypervolemic hyponatremia, not
SIADH. 100% VERIFIED – Rasmussen NUR2502 MDC3
Q3: A patient with diabetic ketoacidosis (DKA) has ABG results: pH 7.25, PaCO2 28
mmHg, HCO3 12 mEq/L. The nurse interprets this as:
A. Respiratory acidosis with metabolic compensation
B. Metabolic acidosis with partial respiratory compensation [CORRECT]
C. Respiratory alkalosis with metabolic compensation
D. Metabolic alkalosis with respiratory compensation
Correct Answer: B
Rationale: Using ROME: pH is low (7.25 < 7.35), indicating acidosis. HCO3 is low (12 <
22), indicating metabolic acidosis. PaCO2 is low (28 < 35), showing respiratory
,compensation (Kussmaul respirations). The pH remains abnormal, indicating only
partial compensation. This is classic DKA. Respiratory acidosis (A) would show
elevated PaCO2. Respiratory alkalosis (C) and metabolic alkalosis (D) would show
elevated pH. 100% VERIFIED – Rasmussen NUR2502 MDC3
Q4: A patient receiving furosemide for heart failure develops muscle weakness,
constipation, and U waves on ECG. The nurse should anticipate:
A. Hyperkalemia requiring kayexalate administration
B. Hypokalemia requiring oral or IV potassium replacement [CORRECT]
C. Hypernatremia requiring free water replacement
D. Hypocalcemia requiring calcium gluconate
Correct Answer: B
Rationale: Loop diuretics (furosemide) cause significant potassium wasting through the
kidneys. Hypokalemia manifestations include muscle weakness, constipation, ileus, and
ECG changes (U waves, flattened T waves, ST depression). U waves are pathognomonic
for hypokalemia. Hyperkalemia (A) would show peaked T waves and widened QRS.
Hypernatremia (C) causes thirst and confusion. Hypocalcemia (D) causes tetany and
prolonged QT. 100% VERIFIED – Rasmussen NUR2502 MDC3
Q5: A patient with chronic kidney disease has a serum potassium of 6.8 mEq/L and ECG
showing peaked T waves and widened QRS complexes. The priority intervention is:
A. Administration of sodium polystyrene sulfonate (Kayexalate) orally
B. Administration of regular insulin with dextrose IV
C. Administration of calcium gluconate IV [CORRECT]
, D. Preparation for emergent hemodialysis
Correct Answer: C
Rationale: This patient has life-threatening hyperkalemia with ECG changes indicating
cardiac instability. Calcium gluconate is administered first to stabilize the myocardium
by antagonizing potassium's effects on cardiac conduction, preventing fatal
dysrhythmias. Insulin with dextrose (B) shifts potassium intracellularly but takes 15-30
minutes and does not protect the heart immediately. Kayexalate (A) acts slowly (hours).
Hemodialysis (D) is definitive but not the immediate first step when cardiac changes are
present. 100% VERIFIED – Rasmussen NUR2502 MDC3
Q6: A patient with severe vomiting and NG tube suction has ABG results: pH 7.52,
PaCO2 48 mmHg, HCO3 38 mEq/L. The nurse understands the primary disturbance is:
A. Metabolic acidosis from lactic acid accumulation
B. Metabolic alkalosis from loss of gastric acid [CORRECT]
C. Respiratory acidosis from hypoventilation
D. Respiratory alkalosis from hyperventilation
Correct Answer: B
Rationale: The pH is elevated (7.52 > 7.45), indicating alkalosis. HCO3 is significantly
elevated (38 > 26), indicating metabolic alkalosis. The elevated PaCO2 (48) represents
hypoventilation compensation, not a primary respiratory problem. Vomiting and NG
suction cause loss of gastric acid (HCl), leading to metabolic alkalosis. The body
compensates by retaining CO2 (hypoventilation). Metabolic acidosis (A) would show
2026/2027 – Complete Exam-Style Questions with Detailed
Rationales | 100% Verified | Pass Guaranteed – A+ Graded
Q1: A 72-year-old male with a history of heart failure presents with weight gain of 8
pounds over 3 days, bilateral crackles, JVD, and 3+ pitting edema in the lower
extremities. His urine specific gravity is 1.005. The nurse recognizes these findings as
consistent with:
A. Fluid volume deficit with concentrated urine
B. Fluid volume excess with dilute urine [CORRECT]
C. Normal fluid status with appropriate compensatory mechanisms
D. Dehydration secondary to diuretic overuse
Correct Answer: B
Rationale: This patient presents classic signs of fluid volume excess (hypervolemia):
weight gain, crackles (pulmonary edema), JVD, and peripheral edema. The low urine
specific gravity (1.005 < 1.010) indicates dilute urine as the kidneys attempt to excrete
excess fluid. Fluid volume deficit (A) would show concentrated urine (specific gravity
>1.030) and signs of dehydration. The findings are clearly abnormal (C). Diuretic
overuse (D) would cause fluid loss and concentrated urine, not weight gain and edema.
100% VERIFIED – Rasmussen NUR2502 MDC3
Q2: A patient with syndrome of inappropriate antidiuretic hormone (SIADH) has a serum
sodium of 118 mEq/L. The nurse should anticipate which initial intervention?
,A. Administration of 3% hypertonic saline at a rapid rate to correct sodium quickly
B. Fluid restriction and slow sodium correction to prevent central pontine myelinolysis
[CORRECT]
C. Aggressive IV normal saline infusion to dilute serum sodium
D. Administration of loop diuretics to promote sodium retention
Correct Answer: B
Rationale: SIADH causes euvolemic hyponatremia due to water retention. The primary
treatment is fluid restriction (typically 800-1200 mL/day). If hypertonic saline is used for
severe symptoms (seizures, altered mental status), correction must be slow (≤8-12
mEq/L per 24 hours) to prevent osmotic demyelination syndrome (central pontine
myelinolysis). Rapid correction (A) is dangerous. Normal saline (C) may worsen
hyponatremia in SIADH. Loop diuretics (D) are used in hypervolemic hyponatremia, not
SIADH. 100% VERIFIED – Rasmussen NUR2502 MDC3
Q3: A patient with diabetic ketoacidosis (DKA) has ABG results: pH 7.25, PaCO2 28
mmHg, HCO3 12 mEq/L. The nurse interprets this as:
A. Respiratory acidosis with metabolic compensation
B. Metabolic acidosis with partial respiratory compensation [CORRECT]
C. Respiratory alkalosis with metabolic compensation
D. Metabolic alkalosis with respiratory compensation
Correct Answer: B
Rationale: Using ROME: pH is low (7.25 < 7.35), indicating acidosis. HCO3 is low (12 <
22), indicating metabolic acidosis. PaCO2 is low (28 < 35), showing respiratory
,compensation (Kussmaul respirations). The pH remains abnormal, indicating only
partial compensation. This is classic DKA. Respiratory acidosis (A) would show
elevated PaCO2. Respiratory alkalosis (C) and metabolic alkalosis (D) would show
elevated pH. 100% VERIFIED – Rasmussen NUR2502 MDC3
Q4: A patient receiving furosemide for heart failure develops muscle weakness,
constipation, and U waves on ECG. The nurse should anticipate:
A. Hyperkalemia requiring kayexalate administration
B. Hypokalemia requiring oral or IV potassium replacement [CORRECT]
C. Hypernatremia requiring free water replacement
D. Hypocalcemia requiring calcium gluconate
Correct Answer: B
Rationale: Loop diuretics (furosemide) cause significant potassium wasting through the
kidneys. Hypokalemia manifestations include muscle weakness, constipation, ileus, and
ECG changes (U waves, flattened T waves, ST depression). U waves are pathognomonic
for hypokalemia. Hyperkalemia (A) would show peaked T waves and widened QRS.
Hypernatremia (C) causes thirst and confusion. Hypocalcemia (D) causes tetany and
prolonged QT. 100% VERIFIED – Rasmussen NUR2502 MDC3
Q5: A patient with chronic kidney disease has a serum potassium of 6.8 mEq/L and ECG
showing peaked T waves and widened QRS complexes. The priority intervention is:
A. Administration of sodium polystyrene sulfonate (Kayexalate) orally
B. Administration of regular insulin with dextrose IV
C. Administration of calcium gluconate IV [CORRECT]
, D. Preparation for emergent hemodialysis
Correct Answer: C
Rationale: This patient has life-threatening hyperkalemia with ECG changes indicating
cardiac instability. Calcium gluconate is administered first to stabilize the myocardium
by antagonizing potassium's effects on cardiac conduction, preventing fatal
dysrhythmias. Insulin with dextrose (B) shifts potassium intracellularly but takes 15-30
minutes and does not protect the heart immediately. Kayexalate (A) acts slowly (hours).
Hemodialysis (D) is definitive but not the immediate first step when cardiac changes are
present. 100% VERIFIED – Rasmussen NUR2502 MDC3
Q6: A patient with severe vomiting and NG tube suction has ABG results: pH 7.52,
PaCO2 48 mmHg, HCO3 38 mEq/L. The nurse understands the primary disturbance is:
A. Metabolic acidosis from lactic acid accumulation
B. Metabolic alkalosis from loss of gastric acid [CORRECT]
C. Respiratory acidosis from hypoventilation
D. Respiratory alkalosis from hyperventilation
Correct Answer: B
Rationale: The pH is elevated (7.52 > 7.45), indicating alkalosis. HCO3 is significantly
elevated (38 > 26), indicating metabolic alkalosis. The elevated PaCO2 (48) represents
hypoventilation compensation, not a primary respiratory problem. Vomiting and NG
suction cause loss of gastric acid (HCl), leading to metabolic alkalosis. The body
compensates by retaining CO2 (hypoventilation). Metabolic acidosis (A) would show
