Chamberlain University NR 226 Final Exam
(pdf) | 2026/2027 | Fundamentals Patient Care
Q&A | Nursing
Comprehensive 120-question practice exam aligned to fluids, electrolytes, acid–base balance, grief and loss, stress and
coping, pain, sleep, perioperative care, bowel elimination, ethics, legal principles, and gerontological nursing.
1. A nurse is assessing a client who has hypercalcemia. Which finding should the nurse expect?
A. Hyperactive bowel sounds
B. Positive Chvostek sign
C. Confusion
D. Peaked T waves
Correct Answer: C
Rationale: Hypercalcemia commonly causes neurologic depression, including lethargy, confusion,
weakness, nausea, vomiting, and bone pain.
Why the other options are incorrect:
Option A is incorrect: Hypercalcemia typically slows gastrointestinal motility and causes constipation
rather than hyperactive bowel sounds.
Option B is incorrect: A positive Chvostek sign is associated with hypocalcemia and neuromuscular
irritability.
Option D is incorrect: Peaked T waves are a characteristic ECG change of hyperkalemia.
2. A nurse reviews a client's serum sodium level of 130 mEq/L. Which client is at highest risk for
this finding?
A. A client taking furosemide
B. A client in renal failure
C. A client taking a multivitamin
D. A client admitted to hospice
Correct Answer: A
Rationale: Loop diuretics such as furosemide can cause sodium and water loss and are a common
cause of hyponatremia.
Why the other options are incorrect:
Option B is incorrect: Renal failure more commonly contributes to fluid and sodium retention,
although sodium abnormalities can vary.
Option C is incorrect: A routine multivitamin is not a typical cause of hyponatremia.
Option D is incorrect: Hospice admission alone does not specifically explain a sodium of 130 mEq/L.
3. Which statement demonstrates correct understanding of hormonal regulation of fluid and
electrolyte balance?
A. The pituitary gland secretes aldosterone.
B. The pituitary gland secretes antidiuretic hormone.
C. The kidneys secrete antidiuretic hormone.
D. The adrenal cortex secretes antidiuretic hormone.
Correct Answer: B
1
,Rationale: Antidiuretic hormone is secreted by the posterior pituitary and increases renal water
reabsorption.
Why the other options are incorrect:
Option A is incorrect: Aldosterone is secreted by the adrenal cortex rather than the pituitary gland.
Option C is incorrect: ADH acts on the kidneys, but the kidneys do not secrete it.
Option D is incorrect: The adrenal cortex secretes aldosterone, not ADH.
4. A client's record notes insensible fluid loss. Through which route does this loss occur?
A. Measured urine output
B. Wound drainage
C. The skin and lungs
D. Emesis
Correct Answer: C
Rationale: Insensible fluid loss occurs continuously through evaporation from the skin and water vapor
exhaled by the lungs and is not directly measured.
Why the other options are incorrect:
Option A is incorrect: Measured urine output is a sensible loss.
Option B is incorrect: Wound drainage can be collected and measured, making it sensible loss.
Option D is incorrect: Emesis is a measurable gastrointestinal loss and is therefore a sensible loss.
5. A nursing student delegates intake and output measurement to a UAP. Which UAP statement
indicates correct understanding?
A. I will not count liquid stool as output.
B. I will estimate perspiration as small or large.
C. I will not record a café mocha as intake.
D. I will record the amount of all voided urine.
Correct Answer: D
Rationale: All measurable intake and output must be recorded, including all voided urine and fluid-
containing beverages such as a café mocha.
Why the other options are incorrect:
Option A is incorrect: Liquid stool is measurable output and must be included.
Option B is incorrect: Perspiration is an insensible loss and is not normally recorded as an estimated
I&O amount.
Option C is incorrect: A café mocha is oral intake and must be recorded.
6. While inserting a peripheral IV catheter, the nurse should continue advancing the catheter when
which finding occurs?
A. The vein appears distended under the needle
B. The client reports no discomfort
C. The catheter moves without resistance
D. Blood appears in the flashback chamber
Correct Answer: D
Rationale: Blood return in the flashback chamber indicates that the needle has entered the vein, allowing
the catheter to be advanced.
Why the other options are incorrect:
Option A is incorrect: Vein visibility alone does not confirm successful needle entry into the lumen.
2
, Option B is incorrect: Client discomfort is not a reliable indicator of correct catheter placement.
Option C is incorrect: Easy advancement alone does not confirm intraluminal placement and may
indicate infiltration if performed incorrectly.
7. Which method is the best ongoing indicator of a client's fluid balance?
A. Skin color
B. Fluid intake alone
C. Temperature
D. Daily weight
Correct Answer: D
Rationale: Daily weight measured under consistent conditions is the best practical indicator of fluid gain
or loss because 1 kg is approximately equivalent to 1 L of fluid.
Why the other options are incorrect:
Option A is incorrect: Skin color does not provide a reliable measurement of fluid balance.
Option B is incorrect: Intake alone does not account for output or insensible losses.
Option C is incorrect: Temperature may change with hydration status or illness but is not the best
monitor of fluid balance.
8. Which IV fluid is isotonic and commonly used to expand intravascular volume?
A. Dextrose 5% in water
B. 0.45% sodium chloride
C. 0.9% sodium chloride
D. 3% sodium chloride
Correct Answer: C
Rationale: 0.9% sodium chloride is isotonic and remains primarily in the extracellular compartment,
making it useful for intravascular volume expansion.
Why the other options are incorrect:
Option A is incorrect: D5W is initially isotonic but becomes hypotonic after dextrose is metabolized.
Option B is incorrect: 0.45% sodium chloride is hypotonic and can cause cells to swell.
Option D is incorrect: 3% sodium chloride is hypertonic and is reserved for severe symptomatic
hyponatremia under close monitoring.
9. Which effect should the nurse expect after administering a hypotonic IV solution?
A. No net movement of water across cell membranes
B. Immediate excretion of all administered fluid
C. Movement of water out of cells, causing cell shrinkage
D. Movement of water into cells, causing cell swelling
Correct Answer: D
Rationale: A hypotonic solution has a lower osmolality than blood, so water moves by osmosis into the
relatively more concentrated intracellular compartment.
Why the other options are incorrect:
Option A is incorrect: Isotonic fluids produce little net water movement.
Option B is incorrect: The kidneys gradually regulate fluid excretion, but immediate complete
excretion does not occur.
Option C is incorrect: Water leaves cells when hypertonic fluids are administered.
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, 10. A client receives a hypertonic IV solution. Which cellular response should the nurse anticipate?
A. Increased intracellular water
B. No osmotic shift
C. Cell shrinkage
D. Cell swelling
Correct Answer: C
Rationale: A hypertonic solution has a higher osmolality than plasma, pulling water out of cells and
causing them to shrink.
Why the other options are incorrect:
Option A is incorrect: Water moves out rather than into the intracellular space.
Option B is incorrect: Hypertonic solutions create a significant osmotic gradient.
Option D is incorrect: Cell swelling occurs with hypotonic solutions.
11. Which definition best describes osmolality?
A. The total weight of a solution
B. The amount of fluid removed by evaporation
C. The pressure required to move water across a membrane
D. The number of particles per kilogram of water
Correct Answer: D
Rationale: Osmolality measures solute particle concentration per kilogram of water and reflects the
osmotic activity of a solution.
Why the other options are incorrect:
Option A is incorrect: Osmolality reflects solute concentration rather than the solution's total weight.
Option B is incorrect: Evaporation describes insensible fluid loss, not osmolality.
Option C is incorrect: This describes osmotic pressure rather than osmolality itself.
12. A client gains 2.2 lb (1 kg) over 2 days. This change is most consistent with retention of
approximately how much fluid?
A. 1 L
B. 5 L
C. 2 L
D. 0.5 L
Correct Answer: A
Rationale: One kilogram, or 2.2 lb, of body weight is approximately equivalent to 1 L of retained fluid.
Why the other options are incorrect:
Option B is incorrect: 5 L would correspond to approximately 11 lb.
Option C is incorrect: 2 L would correspond to approximately 4.4 lb.
Option D is incorrect: 0.5 L would correspond to approximately 1.1 lb.
13. Which assessment finding is most concerning in a client with fluid volume excess?
A. Dyspnea with crackles
B. Flattened neck veins
C. Decreased blood pressure
D. Dry mucous membranes
Correct Answer: A
4
(pdf) | 2026/2027 | Fundamentals Patient Care
Q&A | Nursing
Comprehensive 120-question practice exam aligned to fluids, electrolytes, acid–base balance, grief and loss, stress and
coping, pain, sleep, perioperative care, bowel elimination, ethics, legal principles, and gerontological nursing.
1. A nurse is assessing a client who has hypercalcemia. Which finding should the nurse expect?
A. Hyperactive bowel sounds
B. Positive Chvostek sign
C. Confusion
D. Peaked T waves
Correct Answer: C
Rationale: Hypercalcemia commonly causes neurologic depression, including lethargy, confusion,
weakness, nausea, vomiting, and bone pain.
Why the other options are incorrect:
Option A is incorrect: Hypercalcemia typically slows gastrointestinal motility and causes constipation
rather than hyperactive bowel sounds.
Option B is incorrect: A positive Chvostek sign is associated with hypocalcemia and neuromuscular
irritability.
Option D is incorrect: Peaked T waves are a characteristic ECG change of hyperkalemia.
2. A nurse reviews a client's serum sodium level of 130 mEq/L. Which client is at highest risk for
this finding?
A. A client taking furosemide
B. A client in renal failure
C. A client taking a multivitamin
D. A client admitted to hospice
Correct Answer: A
Rationale: Loop diuretics such as furosemide can cause sodium and water loss and are a common
cause of hyponatremia.
Why the other options are incorrect:
Option B is incorrect: Renal failure more commonly contributes to fluid and sodium retention,
although sodium abnormalities can vary.
Option C is incorrect: A routine multivitamin is not a typical cause of hyponatremia.
Option D is incorrect: Hospice admission alone does not specifically explain a sodium of 130 mEq/L.
3. Which statement demonstrates correct understanding of hormonal regulation of fluid and
electrolyte balance?
A. The pituitary gland secretes aldosterone.
B. The pituitary gland secretes antidiuretic hormone.
C. The kidneys secrete antidiuretic hormone.
D. The adrenal cortex secretes antidiuretic hormone.
Correct Answer: B
1
,Rationale: Antidiuretic hormone is secreted by the posterior pituitary and increases renal water
reabsorption.
Why the other options are incorrect:
Option A is incorrect: Aldosterone is secreted by the adrenal cortex rather than the pituitary gland.
Option C is incorrect: ADH acts on the kidneys, but the kidneys do not secrete it.
Option D is incorrect: The adrenal cortex secretes aldosterone, not ADH.
4. A client's record notes insensible fluid loss. Through which route does this loss occur?
A. Measured urine output
B. Wound drainage
C. The skin and lungs
D. Emesis
Correct Answer: C
Rationale: Insensible fluid loss occurs continuously through evaporation from the skin and water vapor
exhaled by the lungs and is not directly measured.
Why the other options are incorrect:
Option A is incorrect: Measured urine output is a sensible loss.
Option B is incorrect: Wound drainage can be collected and measured, making it sensible loss.
Option D is incorrect: Emesis is a measurable gastrointestinal loss and is therefore a sensible loss.
5. A nursing student delegates intake and output measurement to a UAP. Which UAP statement
indicates correct understanding?
A. I will not count liquid stool as output.
B. I will estimate perspiration as small or large.
C. I will not record a café mocha as intake.
D. I will record the amount of all voided urine.
Correct Answer: D
Rationale: All measurable intake and output must be recorded, including all voided urine and fluid-
containing beverages such as a café mocha.
Why the other options are incorrect:
Option A is incorrect: Liquid stool is measurable output and must be included.
Option B is incorrect: Perspiration is an insensible loss and is not normally recorded as an estimated
I&O amount.
Option C is incorrect: A café mocha is oral intake and must be recorded.
6. While inserting a peripheral IV catheter, the nurse should continue advancing the catheter when
which finding occurs?
A. The vein appears distended under the needle
B. The client reports no discomfort
C. The catheter moves without resistance
D. Blood appears in the flashback chamber
Correct Answer: D
Rationale: Blood return in the flashback chamber indicates that the needle has entered the vein, allowing
the catheter to be advanced.
Why the other options are incorrect:
Option A is incorrect: Vein visibility alone does not confirm successful needle entry into the lumen.
2
, Option B is incorrect: Client discomfort is not a reliable indicator of correct catheter placement.
Option C is incorrect: Easy advancement alone does not confirm intraluminal placement and may
indicate infiltration if performed incorrectly.
7. Which method is the best ongoing indicator of a client's fluid balance?
A. Skin color
B. Fluid intake alone
C. Temperature
D. Daily weight
Correct Answer: D
Rationale: Daily weight measured under consistent conditions is the best practical indicator of fluid gain
or loss because 1 kg is approximately equivalent to 1 L of fluid.
Why the other options are incorrect:
Option A is incorrect: Skin color does not provide a reliable measurement of fluid balance.
Option B is incorrect: Intake alone does not account for output or insensible losses.
Option C is incorrect: Temperature may change with hydration status or illness but is not the best
monitor of fluid balance.
8. Which IV fluid is isotonic and commonly used to expand intravascular volume?
A. Dextrose 5% in water
B. 0.45% sodium chloride
C. 0.9% sodium chloride
D. 3% sodium chloride
Correct Answer: C
Rationale: 0.9% sodium chloride is isotonic and remains primarily in the extracellular compartment,
making it useful for intravascular volume expansion.
Why the other options are incorrect:
Option A is incorrect: D5W is initially isotonic but becomes hypotonic after dextrose is metabolized.
Option B is incorrect: 0.45% sodium chloride is hypotonic and can cause cells to swell.
Option D is incorrect: 3% sodium chloride is hypertonic and is reserved for severe symptomatic
hyponatremia under close monitoring.
9. Which effect should the nurse expect after administering a hypotonic IV solution?
A. No net movement of water across cell membranes
B. Immediate excretion of all administered fluid
C. Movement of water out of cells, causing cell shrinkage
D. Movement of water into cells, causing cell swelling
Correct Answer: D
Rationale: A hypotonic solution has a lower osmolality than blood, so water moves by osmosis into the
relatively more concentrated intracellular compartment.
Why the other options are incorrect:
Option A is incorrect: Isotonic fluids produce little net water movement.
Option B is incorrect: The kidneys gradually regulate fluid excretion, but immediate complete
excretion does not occur.
Option C is incorrect: Water leaves cells when hypertonic fluids are administered.
3
, 10. A client receives a hypertonic IV solution. Which cellular response should the nurse anticipate?
A. Increased intracellular water
B. No osmotic shift
C. Cell shrinkage
D. Cell swelling
Correct Answer: C
Rationale: A hypertonic solution has a higher osmolality than plasma, pulling water out of cells and
causing them to shrink.
Why the other options are incorrect:
Option A is incorrect: Water moves out rather than into the intracellular space.
Option B is incorrect: Hypertonic solutions create a significant osmotic gradient.
Option D is incorrect: Cell swelling occurs with hypotonic solutions.
11. Which definition best describes osmolality?
A. The total weight of a solution
B. The amount of fluid removed by evaporation
C. The pressure required to move water across a membrane
D. The number of particles per kilogram of water
Correct Answer: D
Rationale: Osmolality measures solute particle concentration per kilogram of water and reflects the
osmotic activity of a solution.
Why the other options are incorrect:
Option A is incorrect: Osmolality reflects solute concentration rather than the solution's total weight.
Option B is incorrect: Evaporation describes insensible fluid loss, not osmolality.
Option C is incorrect: This describes osmotic pressure rather than osmolality itself.
12. A client gains 2.2 lb (1 kg) over 2 days. This change is most consistent with retention of
approximately how much fluid?
A. 1 L
B. 5 L
C. 2 L
D. 0.5 L
Correct Answer: A
Rationale: One kilogram, or 2.2 lb, of body weight is approximately equivalent to 1 L of retained fluid.
Why the other options are incorrect:
Option B is incorrect: 5 L would correspond to approximately 11 lb.
Option C is incorrect: 2 L would correspond to approximately 4.4 lb.
Option D is incorrect: 0.5 L would correspond to approximately 1.1 lb.
13. Which assessment finding is most concerning in a client with fluid volume excess?
A. Dyspnea with crackles
B. Flattened neck veins
C. Decreased blood pressure
D. Dry mucous membranes
Correct Answer: A
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