NUR 210 EXAM 3 OBJECTIVES 2026/2027 | 100% Correct
Answers with Complete Solutions | Fluid & Electrolytes,
Nutrition, Elimination, Oxygenation, Pain Management,
Perioperative, End-of-Life | Pass Guaranteed - A+ Graded
Unit 1: Fluid, Electrolyte, & Acid-Base Balance (20 Questions)
Q1: A 72-year-old patient is admitted with vomiting and diarrhea for 3 days. Vital signs:
BP 92/58 mmHg, HR 118 bpm, RR 24/min, temp 37.2°C (99.0°F). Laboratory values:
Na+ 142 mEq/L, K+ 3.2 mEq/L, Cl- 98 mEq/L, HCO3- 22 mEq/L, BUN 48 mg/dL,
creatinine 1.4 mg/dL, hematocrit 52%. The nurse recognizes these findings are
consistent with which condition?
A. Fluid volume excess with dilutional hyponatremia
B. Fluid volume deficit with hemoconcentration and prerenal azotemia
C. Metabolic alkalosis with hypokalemia
D. Normal fluid status with age-related renal changes
Correct Answer: B
Rationale: The patient presents with classic signs of fluid volume deficit (hypovolemia).
[CORRECT] Key indicators include: low BP (92/58), tachycardia (HR 118), elevated
hematocrit (52% - hemoconcentration from fluid loss), elevated BUN with relatively
normal creatinine (BUN:Cr ratio >20:1 indicates prerenal azotemia from reduced renal
,perfusion), and history of GI fluid losses (vomiting/diarrhea). The BUN 48 with
creatinine 1.4 gives ratio of 34:1, classic for prerenal state. Potassium 3.2 is low from GI
losses. This requires immediate fluid resuscitation.
Why other options are incorrect:
● A: Fluid volume excess would show low hematocrit, hyponatremia, and signs of
edema/JVD; this patient has hemoconcentration.
● C: HCO3- 22 is low-normal, not elevated; metabolic alkalosis would require HCO3-
>26 and likely hypochloremia.
● D: These are acute, significant abnormalities requiring intervention, not normal
age-related changes.
Q2: A patient with heart failure is receiving intravenous furosemide 40 mg twice daily.
The nurse monitors for signs of excessive diuresis. Which laboratory finding indicates
the patient requires immediate intervention?
A. Serum sodium 138 mEq/L and potassium 4.0 mEq/L
B. Serum sodium 130 mEq/L and potassium 2.8 mEq/L
C. Serum sodium 145 mEq/L and potassium 5.2 mEq/L
D. Serum sodium 142 mEq/L and potassium 3.8 mEq/L
Correct Answer: B
Rationale: Loop diuretics cause significant electrolyte wasting, particularly potassium
and magnesium. [CORRECT] Potassium 2.8 mEq/L represents severe hypokalemia
(<3.0) that can cause life-threatening cardiac arrhythmias (ventricular tachycardia,
,fibrillation), muscle weakness, and rhabdomyolysis. Hyponatremia (130 mEq/L)
indicates excessive free water loss or SIADH. This combination requires immediate
potassium replacement (oral or IV with cardiac monitoring) and possible reduction in
diuretic dose. Critical values requiring immediate provider notification are K+ <2.5 or
>6.5, Na+ <120 or >160.
Why other options are incorrect:
● A: These are normal electrolyte values; no intervention required.
● C: Potassium 5.2 is mildly elevated but not immediately dangerous; sodium 145
is normal.
● D: These are normal values; no electrolyte abnormalities present.
Q3: A patient has arterial blood gas (ABG) results: pH 7.25, PaCO2 55 mmHg, HCO3- 24
mEq/L. The nurse interprets these results as indicating which acid-base disorder?
A. Respiratory acidosis with metabolic compensation
B. Respiratory acidosis without compensation
C. Metabolic acidosis with respiratory compensation
D. Metabolic alkalosis with respiratory compensation
Correct Answer: B
Rationale: pH 7.25 (<7.35) indicates acidosis. PaCO2 55 (>45) indicates respiratory
cause (retained CO2). HCO3- 24 (22-26 normal) indicates no metabolic compensation
has occurred yet. [CORRECT] This is acute respiratory acidosis, seen in opioid overdose,
airway obstruction, acute respiratory failure, or excessive sedation. The kidneys require
, 24-48 hours to compensate by retaining HCO3-, so normal HCO3- indicates this is an
acute process. The nurse should assess airway, breathing, and ventilation status
immediately.
Why other options are incorrect:
● A: Compensation would show elevated HCO3- (>26) as kidneys retain
bicarbonate; this takes days.
● C: Metabolic acidosis would show low HCO3- (<22) and typically low PaCO2
(compensatory hyperventilation).
● D: Metabolic alkalosis would show elevated pH and elevated HCO3-, not acidosis.
Q4: A patient with chronic obstructive pulmonary disease (COPD) has ABG results: pH
7.36, PaCO2 58 mmHg, HCO3- 33 mEq/L. Which interpretation is correct?
A. Acute respiratory acidosis requiring immediate intubation
B. Chronic respiratory acidosis with full metabolic compensation
C. Metabolic alkalosis due to diuretic use
D. Mixed respiratory and metabolic acidosis
Correct Answer: B
Rationale: pH 7.36 is within normal range (7.35-7.45). PaCO2 58 is elevated (chronic
hypoventilation). HCO3- 33 is elevated (metabolic compensation). [CORRECT] This
pattern indicates chronic respiratory acidosis with full renal compensation. In COPD,
chronic CO2 retention occurs over weeks to months, allowing kidneys to compensate by
reabsorbing HCO3- and excreting H+. The "1 for 10 rule" approximates compensation:
Answers with Complete Solutions | Fluid & Electrolytes,
Nutrition, Elimination, Oxygenation, Pain Management,
Perioperative, End-of-Life | Pass Guaranteed - A+ Graded
Unit 1: Fluid, Electrolyte, & Acid-Base Balance (20 Questions)
Q1: A 72-year-old patient is admitted with vomiting and diarrhea for 3 days. Vital signs:
BP 92/58 mmHg, HR 118 bpm, RR 24/min, temp 37.2°C (99.0°F). Laboratory values:
Na+ 142 mEq/L, K+ 3.2 mEq/L, Cl- 98 mEq/L, HCO3- 22 mEq/L, BUN 48 mg/dL,
creatinine 1.4 mg/dL, hematocrit 52%. The nurse recognizes these findings are
consistent with which condition?
A. Fluid volume excess with dilutional hyponatremia
B. Fluid volume deficit with hemoconcentration and prerenal azotemia
C. Metabolic alkalosis with hypokalemia
D. Normal fluid status with age-related renal changes
Correct Answer: B
Rationale: The patient presents with classic signs of fluid volume deficit (hypovolemia).
[CORRECT] Key indicators include: low BP (92/58), tachycardia (HR 118), elevated
hematocrit (52% - hemoconcentration from fluid loss), elevated BUN with relatively
normal creatinine (BUN:Cr ratio >20:1 indicates prerenal azotemia from reduced renal
,perfusion), and history of GI fluid losses (vomiting/diarrhea). The BUN 48 with
creatinine 1.4 gives ratio of 34:1, classic for prerenal state. Potassium 3.2 is low from GI
losses. This requires immediate fluid resuscitation.
Why other options are incorrect:
● A: Fluid volume excess would show low hematocrit, hyponatremia, and signs of
edema/JVD; this patient has hemoconcentration.
● C: HCO3- 22 is low-normal, not elevated; metabolic alkalosis would require HCO3-
>26 and likely hypochloremia.
● D: These are acute, significant abnormalities requiring intervention, not normal
age-related changes.
Q2: A patient with heart failure is receiving intravenous furosemide 40 mg twice daily.
The nurse monitors for signs of excessive diuresis. Which laboratory finding indicates
the patient requires immediate intervention?
A. Serum sodium 138 mEq/L and potassium 4.0 mEq/L
B. Serum sodium 130 mEq/L and potassium 2.8 mEq/L
C. Serum sodium 145 mEq/L and potassium 5.2 mEq/L
D. Serum sodium 142 mEq/L and potassium 3.8 mEq/L
Correct Answer: B
Rationale: Loop diuretics cause significant electrolyte wasting, particularly potassium
and magnesium. [CORRECT] Potassium 2.8 mEq/L represents severe hypokalemia
(<3.0) that can cause life-threatening cardiac arrhythmias (ventricular tachycardia,
,fibrillation), muscle weakness, and rhabdomyolysis. Hyponatremia (130 mEq/L)
indicates excessive free water loss or SIADH. This combination requires immediate
potassium replacement (oral or IV with cardiac monitoring) and possible reduction in
diuretic dose. Critical values requiring immediate provider notification are K+ <2.5 or
>6.5, Na+ <120 or >160.
Why other options are incorrect:
● A: These are normal electrolyte values; no intervention required.
● C: Potassium 5.2 is mildly elevated but not immediately dangerous; sodium 145
is normal.
● D: These are normal values; no electrolyte abnormalities present.
Q3: A patient has arterial blood gas (ABG) results: pH 7.25, PaCO2 55 mmHg, HCO3- 24
mEq/L. The nurse interprets these results as indicating which acid-base disorder?
A. Respiratory acidosis with metabolic compensation
B. Respiratory acidosis without compensation
C. Metabolic acidosis with respiratory compensation
D. Metabolic alkalosis with respiratory compensation
Correct Answer: B
Rationale: pH 7.25 (<7.35) indicates acidosis. PaCO2 55 (>45) indicates respiratory
cause (retained CO2). HCO3- 24 (22-26 normal) indicates no metabolic compensation
has occurred yet. [CORRECT] This is acute respiratory acidosis, seen in opioid overdose,
airway obstruction, acute respiratory failure, or excessive sedation. The kidneys require
, 24-48 hours to compensate by retaining HCO3-, so normal HCO3- indicates this is an
acute process. The nurse should assess airway, breathing, and ventilation status
immediately.
Why other options are incorrect:
● A: Compensation would show elevated HCO3- (>26) as kidneys retain
bicarbonate; this takes days.
● C: Metabolic acidosis would show low HCO3- (<22) and typically low PaCO2
(compensatory hyperventilation).
● D: Metabolic alkalosis would show elevated pH and elevated HCO3-, not acidosis.
Q4: A patient with chronic obstructive pulmonary disease (COPD) has ABG results: pH
7.36, PaCO2 58 mmHg, HCO3- 33 mEq/L. Which interpretation is correct?
A. Acute respiratory acidosis requiring immediate intubation
B. Chronic respiratory acidosis with full metabolic compensation
C. Metabolic alkalosis due to diuretic use
D. Mixed respiratory and metabolic acidosis
Correct Answer: B
Rationale: pH 7.36 is within normal range (7.35-7.45). PaCO2 58 is elevated (chronic
hypoventilation). HCO3- 33 is elevated (metabolic compensation). [CORRECT] This
pattern indicates chronic respiratory acidosis with full renal compensation. In COPD,
chronic CO2 retention occurs over weeks to months, allowing kidneys to compensate by
reabsorbing HCO3- and excreting H+. The "1 for 10 rule" approximates compensation:
