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NSG 3100 Exam 4 Galen College of
Nursing | Fluid Electrolytes Acid-Base
& Nutrition Questions with
Rationales
Prepare for NSG 3100 Exam 4 at Galen College of
Nursing with this focused question bank covering fluid
and electrolyte balance, acid-base interpretation, and
nutritional concepts. Includes hyponatremia,
hypokalemia, isotonic solutions, metabolic acidosis,
enteral medication administration, and cultural dietary
considerations. Detailed rationales and clinical reasoning
help you understand priority assessments and nursing
interventions. Updated for 2026/2027.
Fluid & Electrolyte Balance
1. A nurse is caring for a client who has a serum sodium level of 120 mEq/L. Which
assessment is the priority?
A. Monitor for muscle weakness and leg cramps.
B. Monitor neurological status, including level of consciousness.
C. Monitor for excessive thirst and dry mucous membranes.
D. Monitor for cardiac dysrhythmias.
B. Monitor neurological status, including level of consciousness.
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Rationale: A sodium level of 120 mEq/L indicates severe hyponatremia. Sodium
is critical for maintaining fluid balance across cell membranes, especially in the
brain. Low sodium causes water to shift into brain cells, leading to cerebral
edema, which can manifest as confusion, lethargy, seizures, and coma.
Neurological assessment is the highest priority because changes can be life-
threatening. While muscle cramps (A) and cardiac issues (D) can occur,
neurological deterioration is the most immediate and dangerous consequence.
2. A client with heart failure is prescribed furosemide (Lasix). The client's serum
potassium is 3.0 mEq/L. Which action should the nurse take?
A. Administer the furosemide as prescribed.
B. Request an order for a potassium supplement before giving the diuretic.
C. Encourage the client to increase intake of potassium-rich foods.
D. Hold the diuretic and notify the healthcare provider immediately.
B. Request an order for a potassium supplement before giving the diuretic.
Rationale: Furosemide is a loop diuretic that causes potassium excretion. The
normal potassium range is 3.5-5.0 mEq/L. A level of 3.0 mEq/L is hypokalemic.
Giving a diuretic that further depletes potassium could precipitate life-
threatening cardiac dysrhythmias. The safe action is to replace the potassium
first, then administer the diuretic as ordered. Increasing dietary potassium (C) is
helpful for long-term management but not sufficient for acute correction.
3. A client is admitted with vomiting and diarrhea for three days. Which of the
following is one of the first indications of fluid volume deficit?
A. Bradycardia
B. Tachycardia
C. Hypertension
D. Bounding pulses
B. Tachycardia.
Rationale: As fluid volume decreases, the body compensates by increasing heart
rate to maintain cardiac output and perfusion to vital organs. Tachycardia is
one of the earliest signs of hypovolemia. Bradycardia (A) and hypertension (C)
are not expected findings. Bounding pulses (D) are associated with fluid
overload, not deficit.
4. A client requires fluid replacement with an isotonic solution. Which of the
following solutions does the nurse anticipate will be ordered?
A. 0.45% sodium chloride (half-normal saline)
B. 3% sodium chloride
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C. Lactated Ringer's solution
D. 5% dextrose in water (D5W)
C. Lactated Ringer's solution.
Rationale: Isotonic solutions have the same osmolality as body fluids and
expand the intravascular volume without causing fluid shifts. Lactated Ringer's
and 0.9% normal saline are common isotonic solutions. 0.45% sodium chloride
(A) is hypotonic, 3% sodium chloride (B) is hypertonic, and D5W (D) is isotonic
in the bag but becomes hypotonic once the dextrose is metabolized.
5. A client with chronic kidney disease has a potassium level of 6.5 mEq/L. Which
electrocardiogram (ECG) change is most characteristic of this imbalance?
A. U waves
B. Tall, peaked T waves
C. Prolonged QT interval
D. ST segment depression
B. Tall, peaked T waves.
Rationale: Hyperkalemia (potassium >5.0 mEq/L) initially causes tall, peaked T
waves on an ECG. This can progress to a widened QRS, prolonged PR interval,
and eventually lethal arrhythmias like ventricular fibrillation. U waves (A) are
associated with hypokalemia. Prolonged QT (C) is associated with
hypocalcemia.
Acid-Base Balance
6. A child has ingested a large amount of aspirin. The nurse suspects signs and
symptoms consistent with which acid-base imbalance?
A. Respiratory alkalosis
B. Metabolic acidosis
C. Respiratory acidosis
D. Metabolic alkalosis
B. Metabolic acidosis.
Rationale: Aspirin (acetylsalicylic acid) is an acid. In large quantities, it
overwhelms the body's buffering systems, leading to metabolic acidosis.
Initially, salicylates can stimulate the respiratory center causing
hyperventilation (respiratory alkalosis), but as the drug accumulates, metabolic
acidosis becomes the primary and more dangerous disorder.
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7. A client with COPD has an arterial blood gas (ABG) result of pH 7.32, PaCO₂ 58
mmHg, and HCO₃⁻ 30 mEq/L. How does the nurse interpret these results?
A. Uncompensated respiratory acidosis
B. Partially compensated respiratory acidosis
C. Fully compensated respiratory acidosis
D. Metabolic alkalosis
B. Partially compensated respiratory acidosis.
Rationale: The pH (7.32) is acidemic (< 7.35). The PaCO₂ (58) is elevated,
indicating the primary disorder is respiratory acidosis. The HCO₃⁻ (30) is
elevated, which is the kidneys' attempt to compensate by retaining bicarbonate.
Because the pH is still abnormal despite the compensatory mechanism, the
condition is partially compensated. If the pH had returned to normal, it would
be fully compensated (C).
8. A client with severe vomiting has the following ABG: pH 7.48, PaCO₂ 42 mmHg,
HCO₃⁻ 32 mEq/L. The nurse identifies this as which acid-base imbalance?
A. Metabolic alkalosis
B. Respiratory alkalosis
C. Metabolic acidosis
D. Respiratory acidosis
A. Metabolic alkalosis.
Rationale: The pH (7.48) is alkalemic (> 7.45). The HCO₃⁻ (32) is elevated,
indicating a metabolic cause. The PaCO₂ is within normal limits, so there is no
respiratory compensation yet. Vomiting causes loss of gastric acid (hydrochloric
acid), leading to a loss of hydrogen ions and a relative increase in bicarbonate,
resulting in metabolic alkalosis.
Nutrition
9. A client who practices Judaism or Islam is likely to avoid which food item?
A. Beef
B. Pork
C. Shellfish
D. Dairy products
B. Pork.
NSG 3100 Exam 4 Galen College of
Nursing | Fluid Electrolytes Acid-Base
& Nutrition Questions with
Rationales
Prepare for NSG 3100 Exam 4 at Galen College of
Nursing with this focused question bank covering fluid
and electrolyte balance, acid-base interpretation, and
nutritional concepts. Includes hyponatremia,
hypokalemia, isotonic solutions, metabolic acidosis,
enteral medication administration, and cultural dietary
considerations. Detailed rationales and clinical reasoning
help you understand priority assessments and nursing
interventions. Updated for 2026/2027.
Fluid & Electrolyte Balance
1. A nurse is caring for a client who has a serum sodium level of 120 mEq/L. Which
assessment is the priority?
A. Monitor for muscle weakness and leg cramps.
B. Monitor neurological status, including level of consciousness.
C. Monitor for excessive thirst and dry mucous membranes.
D. Monitor for cardiac dysrhythmias.
B. Monitor neurological status, including level of consciousness.
,2|Page
Rationale: A sodium level of 120 mEq/L indicates severe hyponatremia. Sodium
is critical for maintaining fluid balance across cell membranes, especially in the
brain. Low sodium causes water to shift into brain cells, leading to cerebral
edema, which can manifest as confusion, lethargy, seizures, and coma.
Neurological assessment is the highest priority because changes can be life-
threatening. While muscle cramps (A) and cardiac issues (D) can occur,
neurological deterioration is the most immediate and dangerous consequence.
2. A client with heart failure is prescribed furosemide (Lasix). The client's serum
potassium is 3.0 mEq/L. Which action should the nurse take?
A. Administer the furosemide as prescribed.
B. Request an order for a potassium supplement before giving the diuretic.
C. Encourage the client to increase intake of potassium-rich foods.
D. Hold the diuretic and notify the healthcare provider immediately.
B. Request an order for a potassium supplement before giving the diuretic.
Rationale: Furosemide is a loop diuretic that causes potassium excretion. The
normal potassium range is 3.5-5.0 mEq/L. A level of 3.0 mEq/L is hypokalemic.
Giving a diuretic that further depletes potassium could precipitate life-
threatening cardiac dysrhythmias. The safe action is to replace the potassium
first, then administer the diuretic as ordered. Increasing dietary potassium (C) is
helpful for long-term management but not sufficient for acute correction.
3. A client is admitted with vomiting and diarrhea for three days. Which of the
following is one of the first indications of fluid volume deficit?
A. Bradycardia
B. Tachycardia
C. Hypertension
D. Bounding pulses
B. Tachycardia.
Rationale: As fluid volume decreases, the body compensates by increasing heart
rate to maintain cardiac output and perfusion to vital organs. Tachycardia is
one of the earliest signs of hypovolemia. Bradycardia (A) and hypertension (C)
are not expected findings. Bounding pulses (D) are associated with fluid
overload, not deficit.
4. A client requires fluid replacement with an isotonic solution. Which of the
following solutions does the nurse anticipate will be ordered?
A. 0.45% sodium chloride (half-normal saline)
B. 3% sodium chloride
,3|Page
C. Lactated Ringer's solution
D. 5% dextrose in water (D5W)
C. Lactated Ringer's solution.
Rationale: Isotonic solutions have the same osmolality as body fluids and
expand the intravascular volume without causing fluid shifts. Lactated Ringer's
and 0.9% normal saline are common isotonic solutions. 0.45% sodium chloride
(A) is hypotonic, 3% sodium chloride (B) is hypertonic, and D5W (D) is isotonic
in the bag but becomes hypotonic once the dextrose is metabolized.
5. A client with chronic kidney disease has a potassium level of 6.5 mEq/L. Which
electrocardiogram (ECG) change is most characteristic of this imbalance?
A. U waves
B. Tall, peaked T waves
C. Prolonged QT interval
D. ST segment depression
B. Tall, peaked T waves.
Rationale: Hyperkalemia (potassium >5.0 mEq/L) initially causes tall, peaked T
waves on an ECG. This can progress to a widened QRS, prolonged PR interval,
and eventually lethal arrhythmias like ventricular fibrillation. U waves (A) are
associated with hypokalemia. Prolonged QT (C) is associated with
hypocalcemia.
Acid-Base Balance
6. A child has ingested a large amount of aspirin. The nurse suspects signs and
symptoms consistent with which acid-base imbalance?
A. Respiratory alkalosis
B. Metabolic acidosis
C. Respiratory acidosis
D. Metabolic alkalosis
B. Metabolic acidosis.
Rationale: Aspirin (acetylsalicylic acid) is an acid. In large quantities, it
overwhelms the body's buffering systems, leading to metabolic acidosis.
Initially, salicylates can stimulate the respiratory center causing
hyperventilation (respiratory alkalosis), but as the drug accumulates, metabolic
acidosis becomes the primary and more dangerous disorder.
, 4|Page
7. A client with COPD has an arterial blood gas (ABG) result of pH 7.32, PaCO₂ 58
mmHg, and HCO₃⁻ 30 mEq/L. How does the nurse interpret these results?
A. Uncompensated respiratory acidosis
B. Partially compensated respiratory acidosis
C. Fully compensated respiratory acidosis
D. Metabolic alkalosis
B. Partially compensated respiratory acidosis.
Rationale: The pH (7.32) is acidemic (< 7.35). The PaCO₂ (58) is elevated,
indicating the primary disorder is respiratory acidosis. The HCO₃⁻ (30) is
elevated, which is the kidneys' attempt to compensate by retaining bicarbonate.
Because the pH is still abnormal despite the compensatory mechanism, the
condition is partially compensated. If the pH had returned to normal, it would
be fully compensated (C).
8. A client with severe vomiting has the following ABG: pH 7.48, PaCO₂ 42 mmHg,
HCO₃⁻ 32 mEq/L. The nurse identifies this as which acid-base imbalance?
A. Metabolic alkalosis
B. Respiratory alkalosis
C. Metabolic acidosis
D. Respiratory acidosis
A. Metabolic alkalosis.
Rationale: The pH (7.48) is alkalemic (> 7.45). The HCO₃⁻ (32) is elevated,
indicating a metabolic cause. The PaCO₂ is within normal limits, so there is no
respiratory compensation yet. Vomiting causes loss of gastric acid (hydrochloric
acid), leading to a loss of hydrogen ions and a relative increase in bicarbonate,
resulting in metabolic alkalosis.
Nutrition
9. A client who practices Judaism or Islam is likely to avoid which food item?
A. Beef
B. Pork
C. Shellfish
D. Dairy products
B. Pork.
