NUR 340 EXAM 470 QUESTIONS & CORRECT
ANSWERS WITH RATIONALES LATEST 2025
Chapter 8
During a period of extreme excess fluid volume, a renal dialysis client may be
administered which type of IV solution to shrink the swollen cells by pulling water
out of the cell?
A. 0.9% sodium chloride
B. 5% dextrose and water
C. 3% Sodium Chloride
D. Lactated Ringer's Solution
C. 3% Sodium Chloride
Rationale: When cells are placed in a hypotonic solution, which has a lower
effective osmolality than the ICF, they swell as water moves into the cell. When
they are placed in a hypertonic solution, which has a greater effective osmolality
than the ICF, they shrink as water is pulled out the cell
The nurse at a long term care facility encourages the older adults to drink even
though they may not feel thirsty at the time. Which statement supports the nurse's
action?
A. Older adults often experience a decrease in the sensation of thirst, even when
serum sodium levels are high
B. The metabolic needs for both fluid and sodium in older adults differ from those
of younger individuals
C. Regulation and maintenance of effective circulating volume by the kidneys is
less effective in older adults
D. The renin-angiotensin-aldosterone system (RAAS) is less able to facilitate
sodium clearances
A. Older adults often experience a decrease in the sensation of thirst, even when
serum sodium levels are high
Rationale: Older adults are prone to hypodipsia even when osmolality and serum
sodium levels are elevated, a fact that is compounded by sensory and/or neurologic
,deficits. Hypodipsia in older adults is not related to differing metabolic needs,
ineffective kidney function, or compromise of the RAAS
A client has been diagnosed with a brain tumor that cannot be removed surgically.
During each office visit the nurse will be assessing the client for syndrome of
inappropriate antidiuretic hormone (SIADH). Which assessment would alert the
clinic nurse that the client may be developing this complication
A. Report of decreased urine output, no edema noted in ankles, increasing
headache
B. Hyperglycemia, dry mucous membranes, projectile vomiting
C. Fever, diarrhea, nausea
D. Muscle cramps, tingling around the mouth/lips, unexplained bruising
A. Report of decreased urine output, no edema noted in ankles, increasing
headaches
Rationale: SIADH manifests as a dilutional hyponatremia. Decrease urine output,
absence of edema, and headaches are signs of this. Hyperglycemia, dry mucous
membranes, and projectile vomiting are signs and symptoms of diabetes insipidus.
Fever, diarrhea, and nausea are signs and symptoms of common flu. Muscle
cramps, tingling around the mouth/lips, and unexplained bruising are signs and
symptoms of hypocalcemia
A 77-year old female hospital client has contracted Clostridium difficile during her
stay and is experiencing severe diarrhea. Which statement best conveys a risk that
this woman faces?
A. She is susceptible to isotonic fluid volume deficit
B. She is prone to isotonic volume excess
C. She could develop third-spacing edema as a result of plasma protein losses
D. She is at risk of compensatory fluid volume overload secondary to
gastrointestinal water and electrolyte losses
A. She is susceptible to isotonic fluid volume deficit
Rationale: This woman is at risk of isotonic fluid volume deficit and sodium
,imbalances as a result of her diarrhea. She is not likely to develop fluid volume
excess or thirst spacing as consequences of diarrhea
The nurse volunteering in the medical tend for a road race on a hot, humid day is
asked to see a runner who has collapsed on the road. The nurse notes he has sunken
eyes, a temperature of 100 F (37.7 C), and dizziness. These are signs of a fluid
volume deficit. Recognizing fluid volume deficit, which of these interventions
does the nurse carry out first
A. Offer water by mouth
B. Begin cooling of his body by ice packs
C. Give him a transfusion of FFP
D. Give him an electrolyte solution by mouth
D. Give him an electrolyte solution by mouth
Rationale: Fluid volume deficit results in postural hypotension (dizziness while
upright) due to decreased blood volume. Sunken eyes and elevated also point to a
fluid volume deficit. The most important action to take is to replace fluid; however,
pure water without accompanying electrolytes, such as sodium, may cause
hyponatermia (water retention and a decrease in serum osmolality). Thus, an oral
electrolyte solution is recommended; in more severe cases an IV would be
appropriate
A client is brought to the emergency department with reports of shortness of
breath. Assessment reveals a full, bounding pulse, severe edema, and audible
crackles in lower lung field bilaterally. The nurse notifies the physician to obtain
orders for which of these problems?
A. Hyponatermia
B. Fluid volume excess
C. Hypocalcemia
D. Hyperkalemia
B. Fluid volume excess
Rationale: peripheral and pulmonary edema as well as a bounding pulse and
dyspnea are indicators of fluid volume overload
A client with a diagnosis of schizophrenia has been admitted with suspected
hyponatermia after consuming copious quantities of tap water. Which finding does
the nurse anticipate uncovering related to this problem?
, A. High urine specific gravity, tachycardia and a weak, thready pulse
B. Low blood pressure, dry mouth and increased urine osmolality
C. Increased hematocrit and blood urea nitrogen; seizures
D. Muscle weakness, lethargy and headaches
D. Muscle weakness, lethargy and headaches
Rationale: Weakness, lethargy, and nausea are noted manifestations of
hyponatermia, which may occur with psychogenic polydipsia. High urine specific
gravity; tachycardia; and a weak, thready pulse are associated with hypernatremia,
while low blood pressure, fever, and increased osmolality are manifestations of
fluid volume deficit. Increased hematocrit and blood urea nitrogen and seizures are
also associated with hypernatremia
The nurse evaluates the ECG of a client who has developed hypokalemia
secondary to diuretic use. Which manifestation of hypokalemia does the nurse
anticipate on the ECG?
A. Irregular heart rate and a peaked T wave
B. A low T wave and an absent P wave
C. A prominent U wave and a flattened T wave
D. A narrow QRS complex and an absent U wave
C. A prominent U wave and a flattened T wave
Rationale: ECG changes associated with hypokalemia include a prominent U wave
and a flattening of the T wave. Atrial fibrillation, a low P wave, and the absence of
a U wave are not associated with hypokalemia
The nurse on the cardiac unit has noted that the client's potassium level is 6.1
mEq/L (6.1 mmol/L). The nurse has notified the physician and removed the banana
from the client's meal tray. When explaining the nursing actions to the client,
which statement is appropriate?
A. "Your potassium level is high so I need you to let me know if you feel
numbness, tingling or weakness."
B. "Your potassium levels in your blood are higher than they should be, which
brings a risk of changes in kidney function."
C. "I need to monitor you for signs of high potassium; tell me if you feel as if your
heart is beating quickly."
ANSWERS WITH RATIONALES LATEST 2025
Chapter 8
During a period of extreme excess fluid volume, a renal dialysis client may be
administered which type of IV solution to shrink the swollen cells by pulling water
out of the cell?
A. 0.9% sodium chloride
B. 5% dextrose and water
C. 3% Sodium Chloride
D. Lactated Ringer's Solution
C. 3% Sodium Chloride
Rationale: When cells are placed in a hypotonic solution, which has a lower
effective osmolality than the ICF, they swell as water moves into the cell. When
they are placed in a hypertonic solution, which has a greater effective osmolality
than the ICF, they shrink as water is pulled out the cell
The nurse at a long term care facility encourages the older adults to drink even
though they may not feel thirsty at the time. Which statement supports the nurse's
action?
A. Older adults often experience a decrease in the sensation of thirst, even when
serum sodium levels are high
B. The metabolic needs for both fluid and sodium in older adults differ from those
of younger individuals
C. Regulation and maintenance of effective circulating volume by the kidneys is
less effective in older adults
D. The renin-angiotensin-aldosterone system (RAAS) is less able to facilitate
sodium clearances
A. Older adults often experience a decrease in the sensation of thirst, even when
serum sodium levels are high
Rationale: Older adults are prone to hypodipsia even when osmolality and serum
sodium levels are elevated, a fact that is compounded by sensory and/or neurologic
,deficits. Hypodipsia in older adults is not related to differing metabolic needs,
ineffective kidney function, or compromise of the RAAS
A client has been diagnosed with a brain tumor that cannot be removed surgically.
During each office visit the nurse will be assessing the client for syndrome of
inappropriate antidiuretic hormone (SIADH). Which assessment would alert the
clinic nurse that the client may be developing this complication
A. Report of decreased urine output, no edema noted in ankles, increasing
headache
B. Hyperglycemia, dry mucous membranes, projectile vomiting
C. Fever, diarrhea, nausea
D. Muscle cramps, tingling around the mouth/lips, unexplained bruising
A. Report of decreased urine output, no edema noted in ankles, increasing
headaches
Rationale: SIADH manifests as a dilutional hyponatremia. Decrease urine output,
absence of edema, and headaches are signs of this. Hyperglycemia, dry mucous
membranes, and projectile vomiting are signs and symptoms of diabetes insipidus.
Fever, diarrhea, and nausea are signs and symptoms of common flu. Muscle
cramps, tingling around the mouth/lips, and unexplained bruising are signs and
symptoms of hypocalcemia
A 77-year old female hospital client has contracted Clostridium difficile during her
stay and is experiencing severe diarrhea. Which statement best conveys a risk that
this woman faces?
A. She is susceptible to isotonic fluid volume deficit
B. She is prone to isotonic volume excess
C. She could develop third-spacing edema as a result of plasma protein losses
D. She is at risk of compensatory fluid volume overload secondary to
gastrointestinal water and electrolyte losses
A. She is susceptible to isotonic fluid volume deficit
Rationale: This woman is at risk of isotonic fluid volume deficit and sodium
,imbalances as a result of her diarrhea. She is not likely to develop fluid volume
excess or thirst spacing as consequences of diarrhea
The nurse volunteering in the medical tend for a road race on a hot, humid day is
asked to see a runner who has collapsed on the road. The nurse notes he has sunken
eyes, a temperature of 100 F (37.7 C), and dizziness. These are signs of a fluid
volume deficit. Recognizing fluid volume deficit, which of these interventions
does the nurse carry out first
A. Offer water by mouth
B. Begin cooling of his body by ice packs
C. Give him a transfusion of FFP
D. Give him an electrolyte solution by mouth
D. Give him an electrolyte solution by mouth
Rationale: Fluid volume deficit results in postural hypotension (dizziness while
upright) due to decreased blood volume. Sunken eyes and elevated also point to a
fluid volume deficit. The most important action to take is to replace fluid; however,
pure water without accompanying electrolytes, such as sodium, may cause
hyponatermia (water retention and a decrease in serum osmolality). Thus, an oral
electrolyte solution is recommended; in more severe cases an IV would be
appropriate
A client is brought to the emergency department with reports of shortness of
breath. Assessment reveals a full, bounding pulse, severe edema, and audible
crackles in lower lung field bilaterally. The nurse notifies the physician to obtain
orders for which of these problems?
A. Hyponatermia
B. Fluid volume excess
C. Hypocalcemia
D. Hyperkalemia
B. Fluid volume excess
Rationale: peripheral and pulmonary edema as well as a bounding pulse and
dyspnea are indicators of fluid volume overload
A client with a diagnosis of schizophrenia has been admitted with suspected
hyponatermia after consuming copious quantities of tap water. Which finding does
the nurse anticipate uncovering related to this problem?
, A. High urine specific gravity, tachycardia and a weak, thready pulse
B. Low blood pressure, dry mouth and increased urine osmolality
C. Increased hematocrit and blood urea nitrogen; seizures
D. Muscle weakness, lethargy and headaches
D. Muscle weakness, lethargy and headaches
Rationale: Weakness, lethargy, and nausea are noted manifestations of
hyponatermia, which may occur with psychogenic polydipsia. High urine specific
gravity; tachycardia; and a weak, thready pulse are associated with hypernatremia,
while low blood pressure, fever, and increased osmolality are manifestations of
fluid volume deficit. Increased hematocrit and blood urea nitrogen and seizures are
also associated with hypernatremia
The nurse evaluates the ECG of a client who has developed hypokalemia
secondary to diuretic use. Which manifestation of hypokalemia does the nurse
anticipate on the ECG?
A. Irregular heart rate and a peaked T wave
B. A low T wave and an absent P wave
C. A prominent U wave and a flattened T wave
D. A narrow QRS complex and an absent U wave
C. A prominent U wave and a flattened T wave
Rationale: ECG changes associated with hypokalemia include a prominent U wave
and a flattening of the T wave. Atrial fibrillation, a low P wave, and the absence of
a U wave are not associated with hypokalemia
The nurse on the cardiac unit has noted that the client's potassium level is 6.1
mEq/L (6.1 mmol/L). The nurse has notified the physician and removed the banana
from the client's meal tray. When explaining the nursing actions to the client,
which statement is appropriate?
A. "Your potassium level is high so I need you to let me know if you feel
numbness, tingling or weakness."
B. "Your potassium levels in your blood are higher than they should be, which
brings a risk of changes in kidney function."
C. "I need to monitor you for signs of high potassium; tell me if you feel as if your
heart is beating quickly."
