Medical-Surgical Nursing Advanced Prep:
Master Ignatavicius Concepts Practice Questions
& Detailed Explanations
Subject: Medical-Surgical Nursing (Ignatavicius 11th Ed.) | Subtopic: Fluid and
Electrolyte Balance
Question 1: A client with a history of heart failure is admitted with acute pulmonary edema.
Laboratory results indicate a serum sodium level of 128 mEq/L. Which pathophysiological
mechanism best explains the development of hyponatremia in this patient?
A) Increased renal excretion of sodium due to loop diuretic therapy.
B) Dilutional hyponatremia resulting from water retention exceeding sodium retention.
C) Activation of the RAAS leading to excessive aldosterone-mediated sodium loss.
D) Third-spacing of sodium into the interstitial compartment due to capillary leak.
Correct Answer: B) Dilutional hyponatremia resulting from water retention exceeding
sodium retention.
Explanation: In heart failure, decreased cardiac output leads to decreased renal perfusion. This
activates the renin-angiotensin-aldosterone system (RAAS) and stimulates antidiuretic hormone
(ADH) release, resulting in water retention. When water retention outpaces sodium retention,
the serum sodium concentration decreases, resulting in dilutional hyponatremia. While diuretics
(Option A) contribute, the primary pathophysiological driver in the context of HF-associated
hyponatremia is the expansion of total body water relative to sodium.
Question 2: A patient is receiving an infusion of 3% Sodium Chloride for severe symptomatic
hyponatremia. The nurse observes new-onset muscle weakness, decreased deep tendon reflexes,
and worsening respiratory depression. What is the most appropriate immediate nursing action?
A) Increase the infusion rate to correct the sodium deficit faster.
B) Administer a bolus of furosemide to manage potential volume overload.
C) Stop the infusion and notify the provider immediately.
D) Obtain an arterial blood gas (ABG) to assess for respiratory acidosis.
Correct Answer: C) Stop the infusion and notify the provider immediately.
,Explanation: The symptoms described (muscle weakness, hyporeflexia, respiratory depression)
are classic indicators of hypermagnesemia or potentially a rapid shift in electrolytes. More
importantly, when administering hypertonic saline (3% NaCl), the nurse must be vigilant for
fluid overload and rapid shifts that can cause osmotic demyelination syndrome. The presentation
of respiratory depression suggests the patient is experiencing a serious complication, and the
infusion must be halted to prevent further harm.
Question 3: Which of the following ECG changes should the nurse prioritize when caring for a
client with a serum potassium level of 6.8 mEq/L?
A) Prominent U waves and inverted T waves.
B) Tall, peaked T waves and prolonged PR interval.
C) Shortened QT interval and ST-segment depression.
D) Widened QRS complex and disappearance of P waves.
Correct Answer: D) Widened QRS complex and disappearance of P waves.
Explanation: Hyperkalemia presents in a predictable progression on the ECG. Initial changes
include tall, peaked T waves. As the potassium level rises (typically >6.5–7.0 mEq/L), the
conduction velocity slows, resulting in a prolonged PR interval, widening of the QRS complex,
and the eventual loss of the P wave. These changes indicate an imminent risk of ventricular
fibrillation or asystole. Option A is characteristic of hypokalemia, while Option C is seen in
hypercalcemia.
Question 4: A patient with acute kidney injury (AKI) is at risk for metabolic acidosis. How does
the body compensate for this imbalance through the respiratory system?
A) By decreasing the rate and depth of respirations to retain $CO_2$.
B) By increasing the rate and depth of respirations to eliminate $CO_2$.
C) By increasing the production of bicarbonate by the lungs.
D) By decreasing the production of carbonic acid in the alveoli.
Correct Answer: B) By increasing the rate and depth of respirations to eliminate $CO_2$.
Explanation: In metabolic acidosis, the pH of the blood drops due to a decrease in bicarbonate
or an increase in fixed acids. The lungs compensate by increasing the respiratory rate and depth
(Kussmaul respirations) to "blow off" $CO_2$, which is an acid-forming gas. By decreasing
$PaCO_2$ (a volatile acid), the carbonic acid-bicarbonate ratio is adjusted toward a more
normal pH. Options A, C, and D are physiologically incorrect regarding compensatory
mechanisms.
,Question 5: A client is receiving magnesium sulfate for pre-eclampsia. Which assessment
finding is the most sensitive indicator of early magnesium toxicity?
A) Absent patellar deep tendon reflexes.
B) Respiratory rate of 10 breaths/minute.
C) Decreased urinary output to <30 mL/hr.
D) Sudden drop in blood pressure.
Correct Answer: A) Absent patellar deep tendon reflexes.
Explanation: Magnesium sulfate acts as a central nervous system depressant. The patellar reflex
(knee-jerk) is one of the first reflexes to be suppressed as serum magnesium levels reach toxic
ranges. While respiratory depression (Option B) is a more severe indicator of toxicity, the loss of
deep tendon reflexes occurs earlier and serves as the primary clinical marker for the nurse to
titrate or stop the infusion.
Question 6: A patient with chronic obstructive pulmonary disease (COPD) has an ABG showing
pH 7.28, $PaCO_2$ 65 mm Hg, and $HCO_3^-$ 28 mEq/L. How should the nurse interpret
these results?
A) Fully compensated respiratory acidosis.
B) Uncompensated respiratory acidosis.
C) Partially compensated respiratory acidosis.
D) Mixed acid-base disorder.
Correct Answer: C) Partially compensated respiratory acidosis.
Explanation: The pH is low (acidosis), and the $PaCO_2$ is elevated, identifying a respiratory
cause (Respiratory Acidosis). The $HCO_3^-$ is elevated above the normal range (22–26
mEq/L), indicating that the kidneys are actively working to retain bicarbonate to buffer the
excess acid. Because the pH has not yet returned to the normal range (7.35–7.45), the
compensation is considered "partial."
Question 7: Which clinical finding would the nurse expect in a patient with severe
hypocalcemia?
A) Positive Chvostek’s sign.
B) Shortened ST segment.
, C) Hyperactive deep tendon reflexes.
D) Both A and C.
Correct Answer: D) Both A and C.
Explanation: Hypocalcemia increases neuromuscular excitability. A positive Chvostek’s sign
(twitching of the facial muscles in response to tapping over the facial nerve) and Trousseau’s
sign (carpal spasm) are classic clinical indicators. Additionally, hypocalcemia leads to
hyperreflexia and potential tetany due to the lowered threshold for neuronal depolarization.
Option B (shortened ST segment) is associated with hypercalcemia.
Question 8: When assessing a patient with fluid volume deficit, which finding is the most
reliable indicator of dehydration?
A) Tachycardia and hypotension.
B) Elevated hemoglobin and hematocrit.
C) Increased serum osmolality and urine specific gravity.
D) Poor skin turgor and dry mucous membranes.
Correct Answer: C) Increased serum osmolality and urine specific gravity.
Explanation: While tachycardia and hypotension (Option A) occur in hypovolemia, they are not
specific to dehydration alone. Clinical signs like skin turgor (Option D) can be subjective,
especially in older adults. Laboratory markers such as increased serum osmolality (reflecting
concentrated plasma) and increased urine specific gravity (reflecting the kidneys' attempt to
conserve water) provide objective, physiological evidence of hemoconcentration and
dehydration.
Question 9: A client is diagnosed with SIADH (Syndrome of Inappropriate Antidiuretic
Hormone). Which nursing intervention is the highest priority?
A) Encourage high fluid intake to dilute serum sodium.
B) Implement strict fluid restriction and monitor daily weights.
C) Administer isotonic saline at a rapid rate.
D) Monitor for signs of hypernatremia and dehydration.
Correct Answer: B) Implement strict fluid restriction and monitor daily weights.
Master Ignatavicius Concepts Practice Questions
& Detailed Explanations
Subject: Medical-Surgical Nursing (Ignatavicius 11th Ed.) | Subtopic: Fluid and
Electrolyte Balance
Question 1: A client with a history of heart failure is admitted with acute pulmonary edema.
Laboratory results indicate a serum sodium level of 128 mEq/L. Which pathophysiological
mechanism best explains the development of hyponatremia in this patient?
A) Increased renal excretion of sodium due to loop diuretic therapy.
B) Dilutional hyponatremia resulting from water retention exceeding sodium retention.
C) Activation of the RAAS leading to excessive aldosterone-mediated sodium loss.
D) Third-spacing of sodium into the interstitial compartment due to capillary leak.
Correct Answer: B) Dilutional hyponatremia resulting from water retention exceeding
sodium retention.
Explanation: In heart failure, decreased cardiac output leads to decreased renal perfusion. This
activates the renin-angiotensin-aldosterone system (RAAS) and stimulates antidiuretic hormone
(ADH) release, resulting in water retention. When water retention outpaces sodium retention,
the serum sodium concentration decreases, resulting in dilutional hyponatremia. While diuretics
(Option A) contribute, the primary pathophysiological driver in the context of HF-associated
hyponatremia is the expansion of total body water relative to sodium.
Question 2: A patient is receiving an infusion of 3% Sodium Chloride for severe symptomatic
hyponatremia. The nurse observes new-onset muscle weakness, decreased deep tendon reflexes,
and worsening respiratory depression. What is the most appropriate immediate nursing action?
A) Increase the infusion rate to correct the sodium deficit faster.
B) Administer a bolus of furosemide to manage potential volume overload.
C) Stop the infusion and notify the provider immediately.
D) Obtain an arterial blood gas (ABG) to assess for respiratory acidosis.
Correct Answer: C) Stop the infusion and notify the provider immediately.
,Explanation: The symptoms described (muscle weakness, hyporeflexia, respiratory depression)
are classic indicators of hypermagnesemia or potentially a rapid shift in electrolytes. More
importantly, when administering hypertonic saline (3% NaCl), the nurse must be vigilant for
fluid overload and rapid shifts that can cause osmotic demyelination syndrome. The presentation
of respiratory depression suggests the patient is experiencing a serious complication, and the
infusion must be halted to prevent further harm.
Question 3: Which of the following ECG changes should the nurse prioritize when caring for a
client with a serum potassium level of 6.8 mEq/L?
A) Prominent U waves and inverted T waves.
B) Tall, peaked T waves and prolonged PR interval.
C) Shortened QT interval and ST-segment depression.
D) Widened QRS complex and disappearance of P waves.
Correct Answer: D) Widened QRS complex and disappearance of P waves.
Explanation: Hyperkalemia presents in a predictable progression on the ECG. Initial changes
include tall, peaked T waves. As the potassium level rises (typically >6.5–7.0 mEq/L), the
conduction velocity slows, resulting in a prolonged PR interval, widening of the QRS complex,
and the eventual loss of the P wave. These changes indicate an imminent risk of ventricular
fibrillation or asystole. Option A is characteristic of hypokalemia, while Option C is seen in
hypercalcemia.
Question 4: A patient with acute kidney injury (AKI) is at risk for metabolic acidosis. How does
the body compensate for this imbalance through the respiratory system?
A) By decreasing the rate and depth of respirations to retain $CO_2$.
B) By increasing the rate and depth of respirations to eliminate $CO_2$.
C) By increasing the production of bicarbonate by the lungs.
D) By decreasing the production of carbonic acid in the alveoli.
Correct Answer: B) By increasing the rate and depth of respirations to eliminate $CO_2$.
Explanation: In metabolic acidosis, the pH of the blood drops due to a decrease in bicarbonate
or an increase in fixed acids. The lungs compensate by increasing the respiratory rate and depth
(Kussmaul respirations) to "blow off" $CO_2$, which is an acid-forming gas. By decreasing
$PaCO_2$ (a volatile acid), the carbonic acid-bicarbonate ratio is adjusted toward a more
normal pH. Options A, C, and D are physiologically incorrect regarding compensatory
mechanisms.
,Question 5: A client is receiving magnesium sulfate for pre-eclampsia. Which assessment
finding is the most sensitive indicator of early magnesium toxicity?
A) Absent patellar deep tendon reflexes.
B) Respiratory rate of 10 breaths/minute.
C) Decreased urinary output to <30 mL/hr.
D) Sudden drop in blood pressure.
Correct Answer: A) Absent patellar deep tendon reflexes.
Explanation: Magnesium sulfate acts as a central nervous system depressant. The patellar reflex
(knee-jerk) is one of the first reflexes to be suppressed as serum magnesium levels reach toxic
ranges. While respiratory depression (Option B) is a more severe indicator of toxicity, the loss of
deep tendon reflexes occurs earlier and serves as the primary clinical marker for the nurse to
titrate or stop the infusion.
Question 6: A patient with chronic obstructive pulmonary disease (COPD) has an ABG showing
pH 7.28, $PaCO_2$ 65 mm Hg, and $HCO_3^-$ 28 mEq/L. How should the nurse interpret
these results?
A) Fully compensated respiratory acidosis.
B) Uncompensated respiratory acidosis.
C) Partially compensated respiratory acidosis.
D) Mixed acid-base disorder.
Correct Answer: C) Partially compensated respiratory acidosis.
Explanation: The pH is low (acidosis), and the $PaCO_2$ is elevated, identifying a respiratory
cause (Respiratory Acidosis). The $HCO_3^-$ is elevated above the normal range (22–26
mEq/L), indicating that the kidneys are actively working to retain bicarbonate to buffer the
excess acid. Because the pH has not yet returned to the normal range (7.35–7.45), the
compensation is considered "partial."
Question 7: Which clinical finding would the nurse expect in a patient with severe
hypocalcemia?
A) Positive Chvostek’s sign.
B) Shortened ST segment.
, C) Hyperactive deep tendon reflexes.
D) Both A and C.
Correct Answer: D) Both A and C.
Explanation: Hypocalcemia increases neuromuscular excitability. A positive Chvostek’s sign
(twitching of the facial muscles in response to tapping over the facial nerve) and Trousseau’s
sign (carpal spasm) are classic clinical indicators. Additionally, hypocalcemia leads to
hyperreflexia and potential tetany due to the lowered threshold for neuronal depolarization.
Option B (shortened ST segment) is associated with hypercalcemia.
Question 8: When assessing a patient with fluid volume deficit, which finding is the most
reliable indicator of dehydration?
A) Tachycardia and hypotension.
B) Elevated hemoglobin and hematocrit.
C) Increased serum osmolality and urine specific gravity.
D) Poor skin turgor and dry mucous membranes.
Correct Answer: C) Increased serum osmolality and urine specific gravity.
Explanation: While tachycardia and hypotension (Option A) occur in hypovolemia, they are not
specific to dehydration alone. Clinical signs like skin turgor (Option D) can be subjective,
especially in older adults. Laboratory markers such as increased serum osmolality (reflecting
concentrated plasma) and increased urine specific gravity (reflecting the kidneys' attempt to
conserve water) provide objective, physiological evidence of hemoconcentration and
dehydration.
Question 9: A client is diagnosed with SIADH (Syndrome of Inappropriate Antidiuretic
Hormone). Which nursing intervention is the highest priority?
A) Encourage high fluid intake to dilute serum sodium.
B) Implement strict fluid restriction and monitor daily weights.
C) Administer isotonic saline at a rapid rate.
D) Monitor for signs of hypernatremia and dehydration.
Correct Answer: B) Implement strict fluid restriction and monitor daily weights.
