NSG3130/NSG 3130 Fundamental II Exam Blueprint
Replica Actual 2026/2027 with Detailed Rationales | 100%
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SECTION 1: FLUID, ELECTROLYTE & ACID-BASE BALANCE (Questions
1–16)
Q1: A client is admitted with a serum sodium level of 128 mEq/L. The nurse notes the
client is lethargic and has dry mucous membranes. Which nursing intervention is the
priority?
A. Restrict fluid intake to 1,000 mL/day
B. Administer IV hypertonic saline immediately
C. Increase oral fluid intake and monitor neurologic status [CORRECT]
D. Place the client in Trendelenburg position
Correct Answer: C
Rationale: Correct because hyponatremia with mild symptoms (lethargy, dry mucous
membranes) is managed by gradual sodium correction with increased oral fluids and
close neurologic monitoring. Priority is preventing rapid correction, which risks osmotic
demyelination syndrome.
Q2: A client receiving loop diuretic therapy develops muscle weakness and cardiac
dysrhythmias. Laboratory results reveal a potassium level of 2.8 mEq/L. Which ECG
change is most characteristic of this imbalance?
,A. Tall, peaked T waves
B. Shortened PR interval
C. Flattened T waves and prominent U waves [CORRECT]
D. Widened QRS complex
Correct Answer: C
Rationale: Correct because hypokalemia produces characteristic ECG changes including
flattened T waves, ST-segment depression, and prominent U waves. Tall peaked T
waves indicate hyperkalemia, not hypokalemia.
Q3: A postoperative client has a serum calcium level of 7.8 mg/dL. The nurse should
assess for which clinical manifestation first?
A. Positive Trousseau sign [CORRECT]
B. Flank pain and hematuria
C. Deep tendon hyperreflexia
D. Decreased gastrointestinal motility
Correct Answer: A
Rationale: Correct because hypocalcemia causes increased neuromuscular irritability,
and a positive Trousseau sign (carpal spasm with blood pressure cuff inflation) is a
classic early indicator. Priority is identifying tetany risk before progression to
laryngospasm.
,Q4: A client with chronic kidney disease has arterial blood gas results: pH 7.32, PaCO₂
38 mmHg, HCO₃⁻ 18 mEq/L. Which acid-base imbalance is present?
A. Respiratory acidosis
B. Metabolic acidosis [CORRECT]
C. Respiratory alkalosis
D. Metabolic alkalosis
Correct Answer: B
Rationale: Correct because the low pH (acidemia) with normal PaCO₂ and decreased
HCO₃⁻ indicates a primary metabolic acidosis. The PaCO₂ is appropriately
compensating but not fully corrected, consistent with the renal system's limited
compensation capacity.
Q5: A nurse is caring for a client receiving IV potassium chloride at 10 mEq/hr via
peripheral line. Which action by the nurse requires immediate intervention?
A. Diluting potassium in 100 mL of normal saline
B. Administering potassium via IV push [CORRECT]
C. Monitoring the IV site every 2 hours
D. Checking the potassium level before administration
Correct Answer: B
, Rationale: Correct because potassium chloride must never be administered by IV push
due to risk of cardiac arrest from severe hyperkalemia. It must always be diluted and
infused slowly via controlled IV infusion with cardiac monitoring.
Q6: A client with heart failure is prescribed furosemide 40 mg IV. The nurse should
monitor for which electrolyte imbalance most commonly associated with this
medication?
A. Hypernatremia
B. Hypokalemia [CORRECT]
C. Hypercalcemia
D. Hypermagnesemia
Correct Answer: B
Rationale: Correct because loop diuretics such as furosemide inhibit sodium and
chloride reabsorption in the ascending loop of Henle, causing potassium wasting in the
urine. Hypokalemia is the most common electrolyte disturbance requiring monitoring
and supplementation.
Q7: A client has arterial blood gas results: pH 7.48, PaCO₂ 30 mmHg, HCO₃⁻ 24 mEq/L.
Which clinical condition is most likely causing this imbalance?
A. Severe vomiting
B. Anxiety-induced hyperventilation [CORRECT]
C. Chronic obstructive pulmonary disease
Replica Actual 2026/2027 with Detailed Rationales | 100%
Verified | Pass Guaranteed
SECTION 1: FLUID, ELECTROLYTE & ACID-BASE BALANCE (Questions
1–16)
Q1: A client is admitted with a serum sodium level of 128 mEq/L. The nurse notes the
client is lethargic and has dry mucous membranes. Which nursing intervention is the
priority?
A. Restrict fluid intake to 1,000 mL/day
B. Administer IV hypertonic saline immediately
C. Increase oral fluid intake and monitor neurologic status [CORRECT]
D. Place the client in Trendelenburg position
Correct Answer: C
Rationale: Correct because hyponatremia with mild symptoms (lethargy, dry mucous
membranes) is managed by gradual sodium correction with increased oral fluids and
close neurologic monitoring. Priority is preventing rapid correction, which risks osmotic
demyelination syndrome.
Q2: A client receiving loop diuretic therapy develops muscle weakness and cardiac
dysrhythmias. Laboratory results reveal a potassium level of 2.8 mEq/L. Which ECG
change is most characteristic of this imbalance?
,A. Tall, peaked T waves
B. Shortened PR interval
C. Flattened T waves and prominent U waves [CORRECT]
D. Widened QRS complex
Correct Answer: C
Rationale: Correct because hypokalemia produces characteristic ECG changes including
flattened T waves, ST-segment depression, and prominent U waves. Tall peaked T
waves indicate hyperkalemia, not hypokalemia.
Q3: A postoperative client has a serum calcium level of 7.8 mg/dL. The nurse should
assess for which clinical manifestation first?
A. Positive Trousseau sign [CORRECT]
B. Flank pain and hematuria
C. Deep tendon hyperreflexia
D. Decreased gastrointestinal motility
Correct Answer: A
Rationale: Correct because hypocalcemia causes increased neuromuscular irritability,
and a positive Trousseau sign (carpal spasm with blood pressure cuff inflation) is a
classic early indicator. Priority is identifying tetany risk before progression to
laryngospasm.
,Q4: A client with chronic kidney disease has arterial blood gas results: pH 7.32, PaCO₂
38 mmHg, HCO₃⁻ 18 mEq/L. Which acid-base imbalance is present?
A. Respiratory acidosis
B. Metabolic acidosis [CORRECT]
C. Respiratory alkalosis
D. Metabolic alkalosis
Correct Answer: B
Rationale: Correct because the low pH (acidemia) with normal PaCO₂ and decreased
HCO₃⁻ indicates a primary metabolic acidosis. The PaCO₂ is appropriately
compensating but not fully corrected, consistent with the renal system's limited
compensation capacity.
Q5: A nurse is caring for a client receiving IV potassium chloride at 10 mEq/hr via
peripheral line. Which action by the nurse requires immediate intervention?
A. Diluting potassium in 100 mL of normal saline
B. Administering potassium via IV push [CORRECT]
C. Monitoring the IV site every 2 hours
D. Checking the potassium level before administration
Correct Answer: B
, Rationale: Correct because potassium chloride must never be administered by IV push
due to risk of cardiac arrest from severe hyperkalemia. It must always be diluted and
infused slowly via controlled IV infusion with cardiac monitoring.
Q6: A client with heart failure is prescribed furosemide 40 mg IV. The nurse should
monitor for which electrolyte imbalance most commonly associated with this
medication?
A. Hypernatremia
B. Hypokalemia [CORRECT]
C. Hypercalcemia
D. Hypermagnesemia
Correct Answer: B
Rationale: Correct because loop diuretics such as furosemide inhibit sodium and
chloride reabsorption in the ascending loop of Henle, causing potassium wasting in the
urine. Hypokalemia is the most common electrolyte disturbance requiring monitoring
and supplementation.
Q7: A client has arterial blood gas results: pH 7.48, PaCO₂ 30 mmHg, HCO₃⁻ 24 mEq/L.
Which clinical condition is most likely causing this imbalance?
A. Severe vomiting
B. Anxiety-induced hyperventilation [CORRECT]
C. Chronic obstructive pulmonary disease
