WGU D444 Adult Health 1 Objective Assessment Study
Bundle | 150 Q&A Bank with Step-by-Step Rationales |
Covers OA Version 1 & Version 2 Blueprints | Nursing
Remediations Included
Fluid, Electrolytes, & Acid-Base Imbalances (Questions 1–10)
1. A patient with severe hyperparathyroidism reports progressive
muscle weakness, bone pain, and constipation. Which electrolyte
imbalance is the primary cause of these clinical manifestations?
A. Hypocalcemia
B. Hypokalemia
C. Hypercalcemia
D. Hypernatremia
Rationale: Hyperparathyroidism results in excess secretion of parathyroid
hormone (PTH), which increases bone resorption and drives calcium into
the extracellular fluid. Hypercalcemia acts as a neuromuscular sedative,
causing muscle flaccidity, constipation, bradycardia, and lethargy.
2. The nurse is caring for a client with an acute exacerbation of
ulcerative colitis who has experienced 12 watery stools in the past 24
hours. The arterial blood gas (ABG) results are: pH 7.31, PaCO2 36
mmHg, HCO3 17 mEq/L. How should the nurse classify this
imbalance?
A. Uncompensated metabolic acidosis
,B. Fully compensated respiratory acidosis
C. Partially compensated metabolic alkalosis
D. Uncompensated respiratory alkalosis
Rationale: The pH is low (< 7.35), indicating acidosis. The bicarbonate
(HCO3) is low (< 22 mEq/L), which matches the acidosis profile
(metabolic). The PaCO2 is within normal limits (35–45 mmHg), meaning
the respiratory system has not yet initiated compensation. This points
directly to uncompensated metabolic acidosis driven by lower
gastrointestinal base loss. [1]
3. A patient is admitted to the intensive care unit with severe diabetic
ketoacidosis (DKA). The nurse initiates a continuous regular insulin
infusion. Which intracellular electrolyte shift must the nurse monitor
closely during the first 4 hours of therapy?
A. Sodium shifts out of the cells, causing hypernatremia
B. Potassium shifts into the cells, causing rapid hypokalemia
C. Calcium binds to albumin, causing severe hypercalcemia
D. Magnesium moves out of the vascular space, causing hypomagnesemia
Rationale: Insulin administration drives both glucose and potassium out of
the intravascular space back into the intracellular compartment. As insulin
treats DKA, serum potassium levels drop sharply, requiring proactive
potassium replacement even if baseline levels appear normal.
4. A patient with a history of liver cirrhosis and severe ascites is
prescribed spironolactone. Which laboratory parameter indicates an
adverse effect unique to this medication class?
A. Serum potassium level of 5.6 mEq/L
B. Serum sodium level of 132 mEq/L
,C. Serum creatinine of 0.8 mg/dL
D. Blood urea nitrogen (BUN) of 14 mg/dL
Rationale: Spironolactone is a potassium-sparing diuretic that acts as an
aldosterone antagonist in the distal renal tubules. It retains potassium while
excreting sodium and water, making hyperkalemia (> 5.0 mEq/L) a primary
adverse effect that requires monitoring.
5. The nurse notes a positive Chvostek's sign upon tapping the facial
nerve of a patient who recently underwent a total thyroidectomy.
Which prescription should the nurse secure from the provider
immediately?
A. Potassium chloride 20 mEq IV piggyback
B. Calcium gluconate 10% intravenously
C. Sodium chloride 3% hypertonic solution
D. Magnesium sulfate 2 g intramuscularly
Rationale: Accidental removal or injury to the parathyroid glands during a
thyroidectomy causes a sharp drop in parathyroid hormone, resulting in
acute hypocalcemia. A positive Chvostek's sign (facial twitching) indicates
neuromuscular hyperexcitabilty, which requires urgent treatment with IV
calcium gluconate.
6. A patient presents to the emergency room hyperventilating due to
an acute panic attack. The nurse anticipates which initial arterial
blood gas profile?
A. pH 7.32, PaCO2 50 mmHg, HCO3 24 mEq/L
B. pH 7.48, PaCO2 40 mmHg, HCO3 30 mEq/L
C. pH 7.51, PaCO2 28 mmHg, HCO3 23 mEq/L
D. pH 7.35, PaCO2 35 mmHg, HCO3 22 mEq/L
, Rationale: Hyperventilation causes excessive elimination of carbon dioxide
(CO2). The loss of volatile acid increases the pH (> 7.45) and decreases
the PaCO2 (< 35 mmHg) while the renal bicarbonate remains normal,
resulting in acute respiratory alkalosis.
7. A patient with syndrome of inappropriate antidiuretic hormone
(SIADH) has a serum sodium level of 118 mEq/L and is experiencing
confusion and lethargy. Which fluid order is appropriate to correct
this specific water excess state?
A. 0.45% Normal Saline at 125 mL/hr
B. 5% Dextrose in Water (D5W) at 100 mL/hr
C. 3% Hypertonic Saline via an infusion pump at 30 mL/hr
D. Lactated Ringer's solution at 150 mL/hr
Rationale: SIADH causes excessive water retention, leading to dilutional
hyponatremia. When sodium drops below 120 mEq/L and neurological
symptoms manifest, slow administration of a hypertonic solution like 3%
Saline is required to shift fluid out of swollen brain cells.
8. Which physiological mechanism serves as the primary, fastest
responder to buffer daily metabolic acid production before renal
compensation occurs?
A. The carbonic acid-bicarbonate chemical buffer system
B. Respiratory hyperventilation to eliminate fixed acids
C. Renal secretion of ammonium ions into the urine
D. Intracellular shifting of sodium ions into bone tissue
Rationale: The chemical buffer systems (predominantly the carbonic acid-
bicarbonate system) react within fractions of a second to minimize pH
Bundle | 150 Q&A Bank with Step-by-Step Rationales |
Covers OA Version 1 & Version 2 Blueprints | Nursing
Remediations Included
Fluid, Electrolytes, & Acid-Base Imbalances (Questions 1–10)
1. A patient with severe hyperparathyroidism reports progressive
muscle weakness, bone pain, and constipation. Which electrolyte
imbalance is the primary cause of these clinical manifestations?
A. Hypocalcemia
B. Hypokalemia
C. Hypercalcemia
D. Hypernatremia
Rationale: Hyperparathyroidism results in excess secretion of parathyroid
hormone (PTH), which increases bone resorption and drives calcium into
the extracellular fluid. Hypercalcemia acts as a neuromuscular sedative,
causing muscle flaccidity, constipation, bradycardia, and lethargy.
2. The nurse is caring for a client with an acute exacerbation of
ulcerative colitis who has experienced 12 watery stools in the past 24
hours. The arterial blood gas (ABG) results are: pH 7.31, PaCO2 36
mmHg, HCO3 17 mEq/L. How should the nurse classify this
imbalance?
A. Uncompensated metabolic acidosis
,B. Fully compensated respiratory acidosis
C. Partially compensated metabolic alkalosis
D. Uncompensated respiratory alkalosis
Rationale: The pH is low (< 7.35), indicating acidosis. The bicarbonate
(HCO3) is low (< 22 mEq/L), which matches the acidosis profile
(metabolic). The PaCO2 is within normal limits (35–45 mmHg), meaning
the respiratory system has not yet initiated compensation. This points
directly to uncompensated metabolic acidosis driven by lower
gastrointestinal base loss. [1]
3. A patient is admitted to the intensive care unit with severe diabetic
ketoacidosis (DKA). The nurse initiates a continuous regular insulin
infusion. Which intracellular electrolyte shift must the nurse monitor
closely during the first 4 hours of therapy?
A. Sodium shifts out of the cells, causing hypernatremia
B. Potassium shifts into the cells, causing rapid hypokalemia
C. Calcium binds to albumin, causing severe hypercalcemia
D. Magnesium moves out of the vascular space, causing hypomagnesemia
Rationale: Insulin administration drives both glucose and potassium out of
the intravascular space back into the intracellular compartment. As insulin
treats DKA, serum potassium levels drop sharply, requiring proactive
potassium replacement even if baseline levels appear normal.
4. A patient with a history of liver cirrhosis and severe ascites is
prescribed spironolactone. Which laboratory parameter indicates an
adverse effect unique to this medication class?
A. Serum potassium level of 5.6 mEq/L
B. Serum sodium level of 132 mEq/L
,C. Serum creatinine of 0.8 mg/dL
D. Blood urea nitrogen (BUN) of 14 mg/dL
Rationale: Spironolactone is a potassium-sparing diuretic that acts as an
aldosterone antagonist in the distal renal tubules. It retains potassium while
excreting sodium and water, making hyperkalemia (> 5.0 mEq/L) a primary
adverse effect that requires monitoring.
5. The nurse notes a positive Chvostek's sign upon tapping the facial
nerve of a patient who recently underwent a total thyroidectomy.
Which prescription should the nurse secure from the provider
immediately?
A. Potassium chloride 20 mEq IV piggyback
B. Calcium gluconate 10% intravenously
C. Sodium chloride 3% hypertonic solution
D. Magnesium sulfate 2 g intramuscularly
Rationale: Accidental removal or injury to the parathyroid glands during a
thyroidectomy causes a sharp drop in parathyroid hormone, resulting in
acute hypocalcemia. A positive Chvostek's sign (facial twitching) indicates
neuromuscular hyperexcitabilty, which requires urgent treatment with IV
calcium gluconate.
6. A patient presents to the emergency room hyperventilating due to
an acute panic attack. The nurse anticipates which initial arterial
blood gas profile?
A. pH 7.32, PaCO2 50 mmHg, HCO3 24 mEq/L
B. pH 7.48, PaCO2 40 mmHg, HCO3 30 mEq/L
C. pH 7.51, PaCO2 28 mmHg, HCO3 23 mEq/L
D. pH 7.35, PaCO2 35 mmHg, HCO3 22 mEq/L
, Rationale: Hyperventilation causes excessive elimination of carbon dioxide
(CO2). The loss of volatile acid increases the pH (> 7.45) and decreases
the PaCO2 (< 35 mmHg) while the renal bicarbonate remains normal,
resulting in acute respiratory alkalosis.
7. A patient with syndrome of inappropriate antidiuretic hormone
(SIADH) has a serum sodium level of 118 mEq/L and is experiencing
confusion and lethargy. Which fluid order is appropriate to correct
this specific water excess state?
A. 0.45% Normal Saline at 125 mL/hr
B. 5% Dextrose in Water (D5W) at 100 mL/hr
C. 3% Hypertonic Saline via an infusion pump at 30 mL/hr
D. Lactated Ringer's solution at 150 mL/hr
Rationale: SIADH causes excessive water retention, leading to dilutional
hyponatremia. When sodium drops below 120 mEq/L and neurological
symptoms manifest, slow administration of a hypertonic solution like 3%
Saline is required to shift fluid out of swollen brain cells.
8. Which physiological mechanism serves as the primary, fastest
responder to buffer daily metabolic acid production before renal
compensation occurs?
A. The carbonic acid-bicarbonate chemical buffer system
B. Respiratory hyperventilation to eliminate fixed acids
C. Renal secretion of ammonium ions into the urine
D. Intracellular shifting of sodium ions into bone tissue
Rationale: The chemical buffer systems (predominantly the carbonic acid-
bicarbonate system) react within fractions of a second to minimize pH
