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NUR2392 Final Exam: Multidimensional
Care II (MDC 2) Questions With Verified
Solutions And Rationales
Section 1: Fluid, Electrolyte & Acid-Base Balance (Questions 1-
15)
1. A 72-year-old male is admitted with vomiting and diarrhea for 3 days. His vital
signs are BP 92/58 mmHg, HR 118 bpm, RR 22/min. He has dry mucous
membranes, decreased skin turgor, and flat neck veins. His lab work shows BUN
42 mg/dL, creatinine 1.8 mg/dL, Hct 52%, and urine specific gravity 1.032. Which
fluid order should the nurse anticipate?
A. 0.45% NaCl at 125 mL/hr
B. 0.9% NaCl at 250 mL/hr
C. D5W at 100 mL/hr
D. 3% NaCl at 50 mL/hr
Correct Answer: B
Rationale: This patient presents with fluid volume deficit (hypovolemia)
evidenced by hypotension, tachycardia, dry mucous membranes, elevated
BUN/Cr ratio (>20:1), elevated Hct, and high urine specific gravity. Isotonic 0.9%
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NaCl is the appropriate initial resuscitation fluid as it expands intravascular
volume without causing fluid shifts between compartments. Hypotonic fluids
would shift into cells and worsen vascular depletion, while hypertonic 3% NaCl is
reserved for severe hyponatremia .
2. A 58-year-old female with heart failure presents with 3+ pitting edema, crackles
bilaterally, JVD, and an S3 gallop. Her daily weight has increased by 4 lbs over 2
days. Her lab work shows BUN 12 mg/dL, Hct 38%, and urine specific gravity
1.008. Which intervention is the nurse's priority?
A. Administer furosemide 40 mg IV push
B. Restrict fluids to 1,500 mL/day and sodium to 2 g/day
C. Start 0.9% NaCl at 125 mL/hr
D. Administer 25% albumin 100 mL IV
Correct Answer: B
Rationale: This patient has fluid volume excess (hypervolemia) secondary to heart
failure, evidenced by edema, crackles, JVD, S3 gallop, weight gain, and dilute urine
(specific gravity <1.010). Priority management includes fluid and sodium
restriction plus diuretic therapy. Additional IV fluids would worsen overload, and
albumin is contraindicated as it expands intravascular volume further .
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3. A 45-year-old female with small cell lung cancer develops confusion, headache,
and muscle cramps. Her serum sodium is 118 mEq/L. Which nursing intervention
is most appropriate?
A. Administer 3% NaCl at 100 mL/hr
B. Implement strict fluid restriction to 800-1,000 mL/day
C. Start 0.9% NaCl at 150 mL/hr
D. Encourage oral fluid intake to 3,000 mL/day
Correct Answer: B
Rationale: This patient has hyponatremia likely secondary to SIADH from small cell
lung cancer. The primary management for SIADH-induced hyponatremia is fluid
restriction (800-1,000 mL/day) to allow the body to excrete excess water and
correct sodium gradually. Hypertonic saline is reserved for severe symptomatic
hyponatremia .
4. A patient is admitted with nausea, vomiting, and diarrhea for the past 5 days.
Heart rate is 130 bpm, BP is 96/50, mucous membranes are dry, and there is poor
skin turgor. Which type of fluid replacement is most appropriate?
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A. Hypotonic
B. Isotonic
C. Hypertonic
D. Colloids
Correct Answer: B
Rationale: The patient is showing signs of hypovolemia (tachycardia, hypotension,
dry mucous membranes, poor skin turgor). Isotonic fluids like Lactated Ringer's or
0.9% Normal Saline are the first-line treatment to expand intravascular volume
and restore hemodynamic stability. Hypotonic fluids would pull water into cells
and worsen vascular depletion, while hypertonic fluids would pull water from
cells and could cause hypernatremia .
5. What is the normal serum sodium range?
A. 125-135 mEq/L
B. 136-145 mEq/L
C. 140-150 mEq/L
D. 120-130 mEq/L
Correct Answer: B
Rationale: The normal serum sodium range is 136-145 mEq/L. Sodium is the
NUR2392 Final Exam: Multidimensional
Care II (MDC 2) Questions With Verified
Solutions And Rationales
Section 1: Fluid, Electrolyte & Acid-Base Balance (Questions 1-
15)
1. A 72-year-old male is admitted with vomiting and diarrhea for 3 days. His vital
signs are BP 92/58 mmHg, HR 118 bpm, RR 22/min. He has dry mucous
membranes, decreased skin turgor, and flat neck veins. His lab work shows BUN
42 mg/dL, creatinine 1.8 mg/dL, Hct 52%, and urine specific gravity 1.032. Which
fluid order should the nurse anticipate?
A. 0.45% NaCl at 125 mL/hr
B. 0.9% NaCl at 250 mL/hr
C. D5W at 100 mL/hr
D. 3% NaCl at 50 mL/hr
Correct Answer: B
Rationale: This patient presents with fluid volume deficit (hypovolemia)
evidenced by hypotension, tachycardia, dry mucous membranes, elevated
BUN/Cr ratio (>20:1), elevated Hct, and high urine specific gravity. Isotonic 0.9%
,2|Page
NaCl is the appropriate initial resuscitation fluid as it expands intravascular
volume without causing fluid shifts between compartments. Hypotonic fluids
would shift into cells and worsen vascular depletion, while hypertonic 3% NaCl is
reserved for severe hyponatremia .
2. A 58-year-old female with heart failure presents with 3+ pitting edema, crackles
bilaterally, JVD, and an S3 gallop. Her daily weight has increased by 4 lbs over 2
days. Her lab work shows BUN 12 mg/dL, Hct 38%, and urine specific gravity
1.008. Which intervention is the nurse's priority?
A. Administer furosemide 40 mg IV push
B. Restrict fluids to 1,500 mL/day and sodium to 2 g/day
C. Start 0.9% NaCl at 125 mL/hr
D. Administer 25% albumin 100 mL IV
Correct Answer: B
Rationale: This patient has fluid volume excess (hypervolemia) secondary to heart
failure, evidenced by edema, crackles, JVD, S3 gallop, weight gain, and dilute urine
(specific gravity <1.010). Priority management includes fluid and sodium
restriction plus diuretic therapy. Additional IV fluids would worsen overload, and
albumin is contraindicated as it expands intravascular volume further .
,3|Page
3. A 45-year-old female with small cell lung cancer develops confusion, headache,
and muscle cramps. Her serum sodium is 118 mEq/L. Which nursing intervention
is most appropriate?
A. Administer 3% NaCl at 100 mL/hr
B. Implement strict fluid restriction to 800-1,000 mL/day
C. Start 0.9% NaCl at 150 mL/hr
D. Encourage oral fluid intake to 3,000 mL/day
Correct Answer: B
Rationale: This patient has hyponatremia likely secondary to SIADH from small cell
lung cancer. The primary management for SIADH-induced hyponatremia is fluid
restriction (800-1,000 mL/day) to allow the body to excrete excess water and
correct sodium gradually. Hypertonic saline is reserved for severe symptomatic
hyponatremia .
4. A patient is admitted with nausea, vomiting, and diarrhea for the past 5 days.
Heart rate is 130 bpm, BP is 96/50, mucous membranes are dry, and there is poor
skin turgor. Which type of fluid replacement is most appropriate?
, 4|Page
A. Hypotonic
B. Isotonic
C. Hypertonic
D. Colloids
Correct Answer: B
Rationale: The patient is showing signs of hypovolemia (tachycardia, hypotension,
dry mucous membranes, poor skin turgor). Isotonic fluids like Lactated Ringer's or
0.9% Normal Saline are the first-line treatment to expand intravascular volume
and restore hemodynamic stability. Hypotonic fluids would pull water into cells
and worsen vascular depletion, while hypertonic fluids would pull water from
cells and could cause hypernatremia .
5. What is the normal serum sodium range?
A. 125-135 mEq/L
B. 136-145 mEq/L
C. 140-150 mEq/L
D. 120-130 mEq/L
Correct Answer: B
Rationale: The normal serum sodium range is 136-145 mEq/L. Sodium is the
