NUR2502 / NUR 2502 Exam 1 Multidimensional Care III /
MDC 3 – Rasmussen University Actual Exam – Complete
Questions and Answers with Detailed Rationales – Pass
Guaranteed – A+ Graded
Foundations: Complex Fluid/Electrolyte & Acid-Base Disorders
Q1: A patient with severe hyponatremia has a sodium level of 118 mEq/L and is alert
but mildly confused. The provider orders hypertonic saline 3%. The nurse should
administer this at a rate no faster than:
A. 4-6 mEq/L in the first 24 hours
B. 8-12 mEq/L in the first 24 hours [CORRECT]
C. 15-20 mEq/L in the first 24 hours
D. 25 mEq/L in the first 24 hours
Correct Answer: B
Rationale: The best answer is B. This is correct because in severe hyponatremia, we
correct sodium slowly—no more than 8-12 mEq/L in the first 24 hours—to avoid osmotic
demyelination syndrome, which can cause permanent neurological damage. Faster
correction might fix the numbers but destroy the patient's brain in the process.
Q2: A patient with hypernatremia (serum sodium 158 mEq/L) is receiving free water
replacement. The nurse should monitor most closely for which complication during
correction?
A. Hyperglycemia
B. Cerebral edema from overly rapid correction [CORRECT]
C. Hyperkalemia
D. Metabolic acidosis
,Correct Answer: B
Rationale: The best answer is B. This is correct because when you correct
hypernatremia too quickly, water shifts into brain cells faster than they can adapt,
causing cerebral edema, seizures, and potentially brain herniation. The brain
compensates for chronic hypernatremia by producing idiogenic osmoles, and those
don't dissipate instantly when you drop the sodium.
Q3: A patient has a potassium of 2.2 mEq/L and is receiving IV potassium replacement.
The maximum safe infusion rate via a peripheral line is:
A. 5 mEq/hour
B. 10 mEq/hour [CORRECT]
C. 20 mEq/hour
D. 40 mEq/hour
Correct Answer: B
Rationale: The best answer is B. This is correct because potassium is never given IV
push—ever—and via peripheral line we max out at 10 mEq/hour to prevent phlebitis and
cardiac complications. If you need faster replacement for life-threatening hypokalemia,
you need a central line and continuous cardiac monitoring, but even then you don't
exceed 20 mEq/hour.
Q4: A patient with severe hyperkalemia has peaked T waves on ECG. Which medication
does the nurse administer first to protect the myocardium?
A. Regular insulin with 50% dextrose
B. Sodium polystyrene sulfonate (Kayexalate)
C. Calcium gluconate [CORRECT]
D. Albuterol nebulizer
Correct Answer: C
Rationale: The best answer is C. This is correct because in severe hyperkalemia with
ECG changes, IV calcium gluconate is administered first to stabilize the cardiac
, membrane, even before measures that lower potassium like insulin+glucose or
albuterol. Calcium doesn't lower the potassium level—it just buys you time by protecting
the heart from arrhythmias while you work on shifting potassium intracellularly and
eliminating it.
Q5: A patient with acute kidney injury has a potassium of 7.2 mEq/L, wide QRS
complexes, and is hypotensive. In addition to calcium gluconate, which combination
should the nurse anticipate?
A. Insulin with glucose and emergent dialysis [CORRECT]
B. Kayexalate alone
C. Furosemide and normal saline
D. Sodium bicarbonate only
Correct Answer: A
Rationale: The best answer is A. This is correct because with ECG changes and
hemodynamic instability, this patient needs immediate potassium shifting with insulin
and glucose, but more importantly needs emergent dialysis since Kayexalate works too
slowly and the patient is unstable. When you see wide QRS in hyperkalemia, you're
approaching sine wave and cardiac arrest—this is a code waiting to happen.
Q6: A patient post-thyroidectomy develops circumoral numbness and carpopedal
spasm. Chvostek sign is positive. The nurse should prepare to administer:
A. Oral calcium carbonate
B. IV calcium gluconate [CORRECT]
C. Vitamin D supplementation
D. Magnesium sulfate
Correct Answer: B
Rationale: The best answer is B. This is correct because this patient has acute
symptomatic hypocalcemia with tetany and positive Chvostek sign after thyroid
surgery—likely due to parathyroid gland disruption. Oral calcium won't act fast enough
MDC 3 – Rasmussen University Actual Exam – Complete
Questions and Answers with Detailed Rationales – Pass
Guaranteed – A+ Graded
Foundations: Complex Fluid/Electrolyte & Acid-Base Disorders
Q1: A patient with severe hyponatremia has a sodium level of 118 mEq/L and is alert
but mildly confused. The provider orders hypertonic saline 3%. The nurse should
administer this at a rate no faster than:
A. 4-6 mEq/L in the first 24 hours
B. 8-12 mEq/L in the first 24 hours [CORRECT]
C. 15-20 mEq/L in the first 24 hours
D. 25 mEq/L in the first 24 hours
Correct Answer: B
Rationale: The best answer is B. This is correct because in severe hyponatremia, we
correct sodium slowly—no more than 8-12 mEq/L in the first 24 hours—to avoid osmotic
demyelination syndrome, which can cause permanent neurological damage. Faster
correction might fix the numbers but destroy the patient's brain in the process.
Q2: A patient with hypernatremia (serum sodium 158 mEq/L) is receiving free water
replacement. The nurse should monitor most closely for which complication during
correction?
A. Hyperglycemia
B. Cerebral edema from overly rapid correction [CORRECT]
C. Hyperkalemia
D. Metabolic acidosis
,Correct Answer: B
Rationale: The best answer is B. This is correct because when you correct
hypernatremia too quickly, water shifts into brain cells faster than they can adapt,
causing cerebral edema, seizures, and potentially brain herniation. The brain
compensates for chronic hypernatremia by producing idiogenic osmoles, and those
don't dissipate instantly when you drop the sodium.
Q3: A patient has a potassium of 2.2 mEq/L and is receiving IV potassium replacement.
The maximum safe infusion rate via a peripheral line is:
A. 5 mEq/hour
B. 10 mEq/hour [CORRECT]
C. 20 mEq/hour
D. 40 mEq/hour
Correct Answer: B
Rationale: The best answer is B. This is correct because potassium is never given IV
push—ever—and via peripheral line we max out at 10 mEq/hour to prevent phlebitis and
cardiac complications. If you need faster replacement for life-threatening hypokalemia,
you need a central line and continuous cardiac monitoring, but even then you don't
exceed 20 mEq/hour.
Q4: A patient with severe hyperkalemia has peaked T waves on ECG. Which medication
does the nurse administer first to protect the myocardium?
A. Regular insulin with 50% dextrose
B. Sodium polystyrene sulfonate (Kayexalate)
C. Calcium gluconate [CORRECT]
D. Albuterol nebulizer
Correct Answer: C
Rationale: The best answer is C. This is correct because in severe hyperkalemia with
ECG changes, IV calcium gluconate is administered first to stabilize the cardiac
, membrane, even before measures that lower potassium like insulin+glucose or
albuterol. Calcium doesn't lower the potassium level—it just buys you time by protecting
the heart from arrhythmias while you work on shifting potassium intracellularly and
eliminating it.
Q5: A patient with acute kidney injury has a potassium of 7.2 mEq/L, wide QRS
complexes, and is hypotensive. In addition to calcium gluconate, which combination
should the nurse anticipate?
A. Insulin with glucose and emergent dialysis [CORRECT]
B. Kayexalate alone
C. Furosemide and normal saline
D. Sodium bicarbonate only
Correct Answer: A
Rationale: The best answer is A. This is correct because with ECG changes and
hemodynamic instability, this patient needs immediate potassium shifting with insulin
and glucose, but more importantly needs emergent dialysis since Kayexalate works too
slowly and the patient is unstable. When you see wide QRS in hyperkalemia, you're
approaching sine wave and cardiac arrest—this is a code waiting to happen.
Q6: A patient post-thyroidectomy develops circumoral numbness and carpopedal
spasm. Chvostek sign is positive. The nurse should prepare to administer:
A. Oral calcium carbonate
B. IV calcium gluconate [CORRECT]
C. Vitamin D supplementation
D. Magnesium sulfate
Correct Answer: B
Rationale: The best answer is B. This is correct because this patient has acute
symptomatic hypocalcemia with tetany and positive Chvostek sign after thyroid
surgery—likely due to parathyroid gland disruption. Oral calcium won't act fast enough
