NR324 Practice Exam | 1
NR324 — Fluid, Electrolyte & Acid-Base Balance
50-Question Practice Examination
MC = Multiple Choice | SATA = Select All That Apply
1. [SATA] A nurse is caring for a patient admitted with severe vomiting for 4 days. ABG results show
pH 7.51, PaCO₂ 50 mmHg, HCO₃ 38 mEq/L. Which of the following nursing interventions are
appropriate? (Select all that apply.)
A. Administer IV normal saline with potassium chloride as ordered
B. Encourage the patient to breathe into a paper bag
C. Hold any ordered antacids or sodium bicarbonate
D. Monitor potassium levels closely for concurrent hypokalemia
E. Administer sodium bicarbonate IV to correct the alkalosis
F. Assess lung sounds and monitor for compensatory hypoventilation
2. A patient with chronic COPD presents with ABG results: pH 7.37, PaCO₂ 55 mmHg, HCO₃ 31
mEq/L. Which interpretation is correct?
A. Uncompensated Respiratory Acidosis
B. Partially Compensated Respiratory Acidosis
C. Fully Compensated Respiratory Acidosis
D. Metabolic Alkalosis with Respiratory Compensation
3. A nurse receives an order to administer IV potassium chloride 40 mEq in 100 mL NS. Which action is
the nurse's priority before initiating the infusion?
A. Assess the patient's blood pressure
B. Confirm urine output is at least 30 mL/hr and place the patient on continuous cardiac monitoring
C. Check the patient's most recent sodium level
D. Verify the potassium is premixed and administer via IV push over 5 minutes
4. [SATA] A patient with heart failure is admitted with crackles in bilateral lung bases, 3+ pitting edema,
weight gain of 6 lbs in 2 days, and SpO₂ 88% on room air. Which assessment findings are consistent
with Fluid Volume Excess? (Select all that apply.)
A. Bounding pulse
B. Distended neck veins
C. Flat neck veins
D. BUN decreased (hemodilution)
E. Urine specific gravity >1.030
F. Serum sodium decreased (dilutional hyponatremia)
5. A patient in the ICU has the following ABG: pH 7.26, PaCO₂ 29 mmHg, HCO₃ 13 mEq/L. The patient
is in septic shock with lactic acidosis and Kussmaul respirations are noted. Which interpretation is
correct?
A. Uncompensated Metabolic Acidosis
B. Partially Compensated Metabolic Acidosis
C. Fully Compensated Respiratory Alkalosis
D. Partially Compensated Respiratory Alkalosis
, NR324 Practice Exam | 2
6. A nurse is preparing to administer IV magnesium sulfate to a patient with severe hypomagnesemia.
Which finding would require the nurse to stop the infusion and notify the provider immediately?
A. Respiratory rate of 16 breaths/min
B. Blood pressure of 128/76 mmHg
C. Absence of the patellar (knee-jerk) reflex
D. Urine output of 35 mL/hr
7. [SATA] A patient with end-stage renal disease has a serum potassium of 6.8 mEq/L with tall peaked
T waves on the ECG. Which interventions does the nurse anticipate? (Select all that apply.)
A. Administer calcium gluconate IV to stabilize cardiac membranes
B. Administer insulin with dextrose to shift potassium into cells
C. Encourage potassium-rich foods such as bananas and orange juice
D. Administer sodium polystyrene sulfonate (Kayexalate) to promote GI excretion
E. Administer furosemide to promote renal excretion of potassium
F. Prepare the patient for dialysis
8. A nurse is monitoring a patient receiving 3% hypertonic saline for severe symptomatic hyponatremia
(Na 112 mEq/L with seizures). Which complication is associated with correcting sodium too rapidly?
A. Hyperkalemia
B. Osmotic demyelination syndrome
C. Metabolic alkalosis
D. Dilutional hyponatremia recurrence
9. A post-thyroidectomy patient reports tingling around the mouth and muscle cramping in the hands 12
hours after surgery. Which assessment finding would the nurse expect to confirm hypocalcemia?
A. Shortened QT interval on ECG
B. Positive Trousseau's sign
C. Hyperactive bowel sounds
D. Peaked T waves on ECG
10. [SATA] A nurse is educating a patient with chronic kidney disease about hyperphosphatemia
management. Which instructions should the nurse include? (Select all that apply.)
A. Take phosphate-binding medications with meals
B. Increase intake of dairy products and dark colas
C. Limit processed foods high in phosphate additives
D. Expect concurrent low calcium levels due to the reciprocal relationship
E. Avoid nuts and organ meats
F. Dialysis can be used to remove excess phosphate in renal failure
11. A nurse is caring for a patient receiving an IV infusion at 125 mL/hr. After 4 hours, the nurse notes
that 950 mL has infused instead of the expected 500 mL. What is the nurse's priority action?
A. Slow the infusion rate and continue monitoring
B. Auscultate lung sounds and assess respiratory status, then notify the provider
C. Obtain a chest X-ray stat
D. Weigh the patient immediately and compare to baseline
12. A patient presents with agitation, confusion, intense thirst, dry and sticky mucous membranes, and
a red swollen tongue. Serum sodium is 158 mEq/L. Which condition does the nurse recognize?
A. Hyponatremia from SIADH
NR324 — Fluid, Electrolyte & Acid-Base Balance
50-Question Practice Examination
MC = Multiple Choice | SATA = Select All That Apply
1. [SATA] A nurse is caring for a patient admitted with severe vomiting for 4 days. ABG results show
pH 7.51, PaCO₂ 50 mmHg, HCO₃ 38 mEq/L. Which of the following nursing interventions are
appropriate? (Select all that apply.)
A. Administer IV normal saline with potassium chloride as ordered
B. Encourage the patient to breathe into a paper bag
C. Hold any ordered antacids or sodium bicarbonate
D. Monitor potassium levels closely for concurrent hypokalemia
E. Administer sodium bicarbonate IV to correct the alkalosis
F. Assess lung sounds and monitor for compensatory hypoventilation
2. A patient with chronic COPD presents with ABG results: pH 7.37, PaCO₂ 55 mmHg, HCO₃ 31
mEq/L. Which interpretation is correct?
A. Uncompensated Respiratory Acidosis
B. Partially Compensated Respiratory Acidosis
C. Fully Compensated Respiratory Acidosis
D. Metabolic Alkalosis with Respiratory Compensation
3. A nurse receives an order to administer IV potassium chloride 40 mEq in 100 mL NS. Which action is
the nurse's priority before initiating the infusion?
A. Assess the patient's blood pressure
B. Confirm urine output is at least 30 mL/hr and place the patient on continuous cardiac monitoring
C. Check the patient's most recent sodium level
D. Verify the potassium is premixed and administer via IV push over 5 minutes
4. [SATA] A patient with heart failure is admitted with crackles in bilateral lung bases, 3+ pitting edema,
weight gain of 6 lbs in 2 days, and SpO₂ 88% on room air. Which assessment findings are consistent
with Fluid Volume Excess? (Select all that apply.)
A. Bounding pulse
B. Distended neck veins
C. Flat neck veins
D. BUN decreased (hemodilution)
E. Urine specific gravity >1.030
F. Serum sodium decreased (dilutional hyponatremia)
5. A patient in the ICU has the following ABG: pH 7.26, PaCO₂ 29 mmHg, HCO₃ 13 mEq/L. The patient
is in septic shock with lactic acidosis and Kussmaul respirations are noted. Which interpretation is
correct?
A. Uncompensated Metabolic Acidosis
B. Partially Compensated Metabolic Acidosis
C. Fully Compensated Respiratory Alkalosis
D. Partially Compensated Respiratory Alkalosis
, NR324 Practice Exam | 2
6. A nurse is preparing to administer IV magnesium sulfate to a patient with severe hypomagnesemia.
Which finding would require the nurse to stop the infusion and notify the provider immediately?
A. Respiratory rate of 16 breaths/min
B. Blood pressure of 128/76 mmHg
C. Absence of the patellar (knee-jerk) reflex
D. Urine output of 35 mL/hr
7. [SATA] A patient with end-stage renal disease has a serum potassium of 6.8 mEq/L with tall peaked
T waves on the ECG. Which interventions does the nurse anticipate? (Select all that apply.)
A. Administer calcium gluconate IV to stabilize cardiac membranes
B. Administer insulin with dextrose to shift potassium into cells
C. Encourage potassium-rich foods such as bananas and orange juice
D. Administer sodium polystyrene sulfonate (Kayexalate) to promote GI excretion
E. Administer furosemide to promote renal excretion of potassium
F. Prepare the patient for dialysis
8. A nurse is monitoring a patient receiving 3% hypertonic saline for severe symptomatic hyponatremia
(Na 112 mEq/L with seizures). Which complication is associated with correcting sodium too rapidly?
A. Hyperkalemia
B. Osmotic demyelination syndrome
C. Metabolic alkalosis
D. Dilutional hyponatremia recurrence
9. A post-thyroidectomy patient reports tingling around the mouth and muscle cramping in the hands 12
hours after surgery. Which assessment finding would the nurse expect to confirm hypocalcemia?
A. Shortened QT interval on ECG
B. Positive Trousseau's sign
C. Hyperactive bowel sounds
D. Peaked T waves on ECG
10. [SATA] A nurse is educating a patient with chronic kidney disease about hyperphosphatemia
management. Which instructions should the nurse include? (Select all that apply.)
A. Take phosphate-binding medications with meals
B. Increase intake of dairy products and dark colas
C. Limit processed foods high in phosphate additives
D. Expect concurrent low calcium levels due to the reciprocal relationship
E. Avoid nuts and organ meats
F. Dialysis can be used to remove excess phosphate in renal failure
11. A nurse is caring for a patient receiving an IV infusion at 125 mL/hr. After 4 hours, the nurse notes
that 950 mL has infused instead of the expected 500 mL. What is the nurse's priority action?
A. Slow the infusion rate and continue monitoring
B. Auscultate lung sounds and assess respiratory status, then notify the provider
C. Obtain a chest X-ray stat
D. Weigh the patient immediately and compare to baseline
12. A patient presents with agitation, confusion, intense thirst, dry and sticky mucous membranes, and
a red swollen tongue. Serum sodium is 158 mEq/L. Which condition does the nurse recognize?
A. Hyponatremia from SIADH
