GALEN NUR 210 EXAM 3 2026/2027 | 100% Correct Answers
with Complete Solutions | Fluid & Electrolytes, Nutrition,
Elimination, Oxygenation, Pain, Perioperative, End-of-Life |
Pass Guaranteed - A+ Graded
Unit 1: Fluid, Electrolyte, & Acid-Base Balance (20 Questions)
Q1: A 72-year-old male with heart failure is receiving intravenous furosemide (Lasix).
The nurse notes the following laboratory results: Na+ 148 mEq/L, K+ 3.0 mEq/L, Cl- 90
mEq/L, BUN 35 mg/dL, creatinine 1.8 mg/dL. Which electrolyte imbalance requires
immediate intervention?
A. Hypernatremia requiring fluid restriction
B. Hypokalemia requiring potassium replacement [CORRECT]
C. Hyponatremia requiring sodium administration
D. Hyperchloremia requiring bicarbonate therapy
Correct Answer: B
Rationale: Furosemide is a loop diuretic that causes potassium wasting. Potassium of
3.0 mEq/L is critically low (normal 3.5-5.0) and places the patient at immediate risk for
cardiac arrhythmias, including ventricular tachycardia and fibrillation. ECG changes
include flattened T waves, U waves, and ST depression. Immediate oral or IV potassium
replacement is required with continuous cardiac monitoring. While Na+ 148 indicates
,mild hypernatremia (option A), this is less immediately dangerous than severe
hypokalemia. Option C is incorrect (sodium is elevated, not decreased). Option D is
incorrect (chloride is low, not high; metabolic alkalosis from volume contraction is
expected with furosemide use).
Q2: A patient has the following arterial blood gas results: pH 7.32, PaCO2 55 mmHg,
HCO3 26 mEq/L. Which acid-base imbalance is present?
A. Metabolic acidosis with respiratory compensation
B. Respiratory acidosis with metabolic compensation [CORRECT]
C. Metabolic alkalosis with respiratory compensation
D. Respiratory alkalosis with metabolic compensation
Correct Answer: B
Rationale: pH <7.35 indicates acidosis. PaCO2 >45 indicates respiratory acidosis
(retained CO2). HCO3 is normal (22-26), indicating acute respiratory acidosis without
significant metabolic compensation (compensatory metabolic alkalosis would show
elevated HCO3 >26). Common causes include COPD, opioid overdose, neuromuscular
disorders, airway obstruction. Option A would show low HCO3. Option C would show
high pH and high HCO3. Option D would show high pH and low PaCO2.
Q3: A patient with diabetic ketoacidosis has the following ABGs: pH 7.25, PaCO2 22
mmHg, HCO3 12 mEq/L. Which compensatory mechanism is occurring?
,A. Hyperventilation to decrease PaCO2 [CORRECT]
B. Hypoventilation to increase PaCO2
C. Increased renal retention of bicarbonate
D. Decreased renal excretion of hydrogen ions
Correct Answer: A
Rationale: DKA causes metabolic acidosis (low HCO3 from ketone accumulation). The
respiratory system compensates via Kussmaul respirations (hyperventilation) to blow
off CO2, reducing PaCO2 and raising pH toward normal. This is an immediate
compensatory mechanism; renal compensation (retaining bicarbonate, excreting H+ as
ammonium) takes 2-3 days. Option B would worsen acidosis. Options C and D describe
renal compensation, which is not yet active in acute DKA.
Q4: A patient with severe vomiting has the following ABGs: pH 7.48, PaCO2 48 mmHg,
HCO3 35 mEq/L. Which condition is likely causing this acid-base disturbance?
A. Diabetic ketoacidosis
B. Loss of gastric acid from vomiting [CORRECT]
C. Salicylate overdose
D. Excessive mechanical ventilation
Correct Answer: B
, Rationale: pH >7.45 indicates alkalosis. Elevated HCO3 (35) indicates metabolic
alkalosis. PaCO2 is elevated (48), showing respiratory compensation (hypoventilation to
retain CO2). Vomiting causes loss of gastric acid (HCl), leading to metabolic alkalosis
with hypochloremia and hypokalemia. Option A causes metabolic acidosis. Option C
causes respiratory alkalosis initially, then mixed. Option D causes respiratory alkalosis.
Q5: A patient has a serum calcium level of 7.2 mg/dL (normal 8.5-10.5). Which clinical
manifestation is most specific to this electrolyte imbalance?
A. Positive Trousseau's sign and Chvostek's sign [CORRECT]
B. Decreased deep tendon reflexes and hypotension
C. Widened QRS complex and peaked T waves on ECG
D. Oliguria and jugular venous distention
Correct Answer: A
Rationale: Hypocalcemia (<8.5 mg/dL) increases neuromuscular excitability—positive
Trousseau's sign (carpal spasm with BP cuff inflation) and Chvostek's sign (facial
twitching with facial nerve tap), tetany, muscle cramps, laryngospasm, seizures. ECG
shows prolonged QT interval. Option B describes hypermagnesemia. Option C describes
hyperkalemia. Option D describes fluid volume excess.
Q6: A patient with chronic kidney disease has a serum phosphorus level of 5.8 mg/dL
(normal 2.5-4.5). Which complication is most concerning?
with Complete Solutions | Fluid & Electrolytes, Nutrition,
Elimination, Oxygenation, Pain, Perioperative, End-of-Life |
Pass Guaranteed - A+ Graded
Unit 1: Fluid, Electrolyte, & Acid-Base Balance (20 Questions)
Q1: A 72-year-old male with heart failure is receiving intravenous furosemide (Lasix).
The nurse notes the following laboratory results: Na+ 148 mEq/L, K+ 3.0 mEq/L, Cl- 90
mEq/L, BUN 35 mg/dL, creatinine 1.8 mg/dL. Which electrolyte imbalance requires
immediate intervention?
A. Hypernatremia requiring fluid restriction
B. Hypokalemia requiring potassium replacement [CORRECT]
C. Hyponatremia requiring sodium administration
D. Hyperchloremia requiring bicarbonate therapy
Correct Answer: B
Rationale: Furosemide is a loop diuretic that causes potassium wasting. Potassium of
3.0 mEq/L is critically low (normal 3.5-5.0) and places the patient at immediate risk for
cardiac arrhythmias, including ventricular tachycardia and fibrillation. ECG changes
include flattened T waves, U waves, and ST depression. Immediate oral or IV potassium
replacement is required with continuous cardiac monitoring. While Na+ 148 indicates
,mild hypernatremia (option A), this is less immediately dangerous than severe
hypokalemia. Option C is incorrect (sodium is elevated, not decreased). Option D is
incorrect (chloride is low, not high; metabolic alkalosis from volume contraction is
expected with furosemide use).
Q2: A patient has the following arterial blood gas results: pH 7.32, PaCO2 55 mmHg,
HCO3 26 mEq/L. Which acid-base imbalance is present?
A. Metabolic acidosis with respiratory compensation
B. Respiratory acidosis with metabolic compensation [CORRECT]
C. Metabolic alkalosis with respiratory compensation
D. Respiratory alkalosis with metabolic compensation
Correct Answer: B
Rationale: pH <7.35 indicates acidosis. PaCO2 >45 indicates respiratory acidosis
(retained CO2). HCO3 is normal (22-26), indicating acute respiratory acidosis without
significant metabolic compensation (compensatory metabolic alkalosis would show
elevated HCO3 >26). Common causes include COPD, opioid overdose, neuromuscular
disorders, airway obstruction. Option A would show low HCO3. Option C would show
high pH and high HCO3. Option D would show high pH and low PaCO2.
Q3: A patient with diabetic ketoacidosis has the following ABGs: pH 7.25, PaCO2 22
mmHg, HCO3 12 mEq/L. Which compensatory mechanism is occurring?
,A. Hyperventilation to decrease PaCO2 [CORRECT]
B. Hypoventilation to increase PaCO2
C. Increased renal retention of bicarbonate
D. Decreased renal excretion of hydrogen ions
Correct Answer: A
Rationale: DKA causes metabolic acidosis (low HCO3 from ketone accumulation). The
respiratory system compensates via Kussmaul respirations (hyperventilation) to blow
off CO2, reducing PaCO2 and raising pH toward normal. This is an immediate
compensatory mechanism; renal compensation (retaining bicarbonate, excreting H+ as
ammonium) takes 2-3 days. Option B would worsen acidosis. Options C and D describe
renal compensation, which is not yet active in acute DKA.
Q4: A patient with severe vomiting has the following ABGs: pH 7.48, PaCO2 48 mmHg,
HCO3 35 mEq/L. Which condition is likely causing this acid-base disturbance?
A. Diabetic ketoacidosis
B. Loss of gastric acid from vomiting [CORRECT]
C. Salicylate overdose
D. Excessive mechanical ventilation
Correct Answer: B
, Rationale: pH >7.45 indicates alkalosis. Elevated HCO3 (35) indicates metabolic
alkalosis. PaCO2 is elevated (48), showing respiratory compensation (hypoventilation to
retain CO2). Vomiting causes loss of gastric acid (HCl), leading to metabolic alkalosis
with hypochloremia and hypokalemia. Option A causes metabolic acidosis. Option C
causes respiratory alkalosis initially, then mixed. Option D causes respiratory alkalosis.
Q5: A patient has a serum calcium level of 7.2 mg/dL (normal 8.5-10.5). Which clinical
manifestation is most specific to this electrolyte imbalance?
A. Positive Trousseau's sign and Chvostek's sign [CORRECT]
B. Decreased deep tendon reflexes and hypotension
C. Widened QRS complex and peaked T waves on ECG
D. Oliguria and jugular venous distention
Correct Answer: A
Rationale: Hypocalcemia (<8.5 mg/dL) increases neuromuscular excitability—positive
Trousseau's sign (carpal spasm with BP cuff inflation) and Chvostek's sign (facial
twitching with facial nerve tap), tetany, muscle cramps, laryngospasm, seizures. ECG
shows prolonged QT interval. Option B describes hypermagnesemia. Option C describes
hyperkalemia. Option D describes fluid volume excess.
Q6: A patient with chronic kidney disease has a serum phosphorus level of 5.8 mg/dL
(normal 2.5-4.5). Which complication is most concerning?
