NURS-B260 FUNDAMENTALS EXAM
#3 PRACTICE QUESTIONS WITH
100% DETAILED CORRECT
ANSWERS 2025/2026
Section 1: Fluid & Electrolyte Balance (Questions 1–25)
1. A nurse is caring for a client who has nausea and is vomiting. The nurse should identify the
client is at risk for which of the following acid-base imbalances?
A. Respiratory alkalosis
B. Respiratory acidosis
C. Metabolic alkalosis
D. Metabolic acidosis
Answer: C – Metabolic alkalosis
Rationale: Loss of gastric acid (HCl) through vomiting causes a loss of hydrogen ions and
chloride, leading to an increase in bicarbonate. This results in metabolic alkalosis. The classic
presentation is hypokalemia and hypochloremia with an elevated blood pH .
2. A nurse is assessing a client who has respiratory acidosis. Which of the following findings
should the nurse expect?
A. Dry skin
B. Lethargy
C. Numbness of fingers
D. Abdominal pain
Answer: B – Lethargy
Rationale: Respiratory acidosis causes central nervous system depression due to increased CO₂
levels (hypercapnia). Early signs include headache and confusion, progressing to lethargy and
eventually coma if untreated. Dry skin is more typical of dehydration, while numbness of fingers
is seen in respiratory alkalosis .
3. A nurse is assisting with the care of a client who has metabolic alkalosis. Which of the
following actions should the nurse take?
A. Plan to administer sodium bicarbonate to the client
,B. Have the client breathe into a paper bag
C. Encourage the client to breathe slowly
D. Place the client on seizure precautions
Answer: D – Place the client on seizure precautions
Rationale: Metabolic alkalosis can lead to hypocalcemia and hypokalemia, which increase
neuromuscular irritability and seizure risk. Seizure precautions (padding side rails, ensuring
suction is available) are essential. Breathing into a paper bag is for respiratory alkalosis .
4. What is the normal range for serum potassium?
A. 1.3–2.1 mEq/L
B. 3.5–5.0 mEq/L
C. 9.0–10.5 mg/dL
D. 136–145 mEq/L
Answer: B – 3.5–5.0 mEq/L
*Rationale: Potassium's normal range is 3.5 to 5.0 mEq/L. Levels < 3.5 indicate hypokalemia; >
5.0 indicate hyperkalemia. Magnesium is 1.3–2.1 mEq/L, calcium is 9.0–10.5 mg/dL, and sodium
is 136–145 mEq/L .*
5. Which assessment finding is most consistent with hypokalemia (potassium < 3.5 mEq/L)?
A. Muscle cramping and cardiac arrest
B. Fatigue, leg cramps, and bradycardia
C. Tetany and Chvostek's sign
D. Constipation and bone pain
Answer: B – Fatigue, leg cramps, and bradycardia
Rationale: Hypokalemia causes fatigue, muscle weakness, leg cramps, bradycardia, and ECG
changes (U waves, flat T waves). Hyperkalemia causes muscle cramping and cardiac arrest.
Tetany is from hypocalcemia .
6. A patient has a potassium level of 6.2 mEq/L. Which ECG change does the nurse expect to
see first?
A. U waves
B. Peaked T waves
C. Wide QRS complex
D. Prolonged PR interval
Answer: B – Peaked T waves
*Rationale: Peaked ("tented") T waves are the earliest ECG sign of hyperkalemia, typically seen
at potassium levels 5.5–6.5 mEq/L. As potassium rises further (7–8 mEq/L), QRS widens and P
waves flatten. U waves are seen in hypokalemia .*
7. The nurse evaluates that discharge teaching for a patient with hypocalcemia has been
effective when the patient states:
, A. "I shouldn't take antacids such as TUMS."
B. "I should notify my healthcare provider if I start to feel tingling or numbness around my
mouth."
C. "I'll need to cut down on protein in my diet."
D. "I will watch my urine for signs of kidney stones."
Answer: B – "I should notify my healthcare provider if I start to feel tingling or numbness
around my mouth."
Rationale: Circumoral paresthesia (tingling/numbness around the mouth) is a sign of impending
tetany from worsening hypocalcemia. This requires immediate notification of the provider.
TUMS contain calcium, which would be beneficial, not harmful .
8. A patient is admitted with severe bleeding from a fractured femur. Which IV fluid does the
nurse anticipate as most appropriate?
A. Normal saline (0.9% NaCl)
B. 3% saline
C. 5% dextrose in water (D5W)
D. 5% dextrose in 0.225% saline
Answer: A – Normal saline (0.9% NaCl)
Rationale: Normal saline is an isotonic fluid and is appropriate for initial resuscitation of fluid
(blood) loss from hemorrhagic shock. It expands intravascular volume without causing rapid
shifts. Hypertonic fluids (3% saline) are used for severe hyponatremia, not hemorrhage .
9. A nurse notices a patient gained 6 pounds overnight. The nurse interprets this as
approximately how many liters of fluid retention?
A. 1 liter
B. 2 liters
C. 3 liters
D. 6 liters
Answer: C – 3 liters
*Rationale: One kilogram (2.2 lbs) of weight gain equals approximately 1 liter of retained fluid.
Therefore, a 6 lb gain = approximately 3 liters of fluid retention. Daily weight is the best
indicator of fluid status .*
10. What is the minimum urine output per hour for an adult to maintain adequate kidney
perfusion?
A. 10 mL/hr
B. 20 mL/hr
C. 30 mL/hr
D. 50 mL/hr
#3 PRACTICE QUESTIONS WITH
100% DETAILED CORRECT
ANSWERS 2025/2026
Section 1: Fluid & Electrolyte Balance (Questions 1–25)
1. A nurse is caring for a client who has nausea and is vomiting. The nurse should identify the
client is at risk for which of the following acid-base imbalances?
A. Respiratory alkalosis
B. Respiratory acidosis
C. Metabolic alkalosis
D. Metabolic acidosis
Answer: C – Metabolic alkalosis
Rationale: Loss of gastric acid (HCl) through vomiting causes a loss of hydrogen ions and
chloride, leading to an increase in bicarbonate. This results in metabolic alkalosis. The classic
presentation is hypokalemia and hypochloremia with an elevated blood pH .
2. A nurse is assessing a client who has respiratory acidosis. Which of the following findings
should the nurse expect?
A. Dry skin
B. Lethargy
C. Numbness of fingers
D. Abdominal pain
Answer: B – Lethargy
Rationale: Respiratory acidosis causes central nervous system depression due to increased CO₂
levels (hypercapnia). Early signs include headache and confusion, progressing to lethargy and
eventually coma if untreated. Dry skin is more typical of dehydration, while numbness of fingers
is seen in respiratory alkalosis .
3. A nurse is assisting with the care of a client who has metabolic alkalosis. Which of the
following actions should the nurse take?
A. Plan to administer sodium bicarbonate to the client
,B. Have the client breathe into a paper bag
C. Encourage the client to breathe slowly
D. Place the client on seizure precautions
Answer: D – Place the client on seizure precautions
Rationale: Metabolic alkalosis can lead to hypocalcemia and hypokalemia, which increase
neuromuscular irritability and seizure risk. Seizure precautions (padding side rails, ensuring
suction is available) are essential. Breathing into a paper bag is for respiratory alkalosis .
4. What is the normal range for serum potassium?
A. 1.3–2.1 mEq/L
B. 3.5–5.0 mEq/L
C. 9.0–10.5 mg/dL
D. 136–145 mEq/L
Answer: B – 3.5–5.0 mEq/L
*Rationale: Potassium's normal range is 3.5 to 5.0 mEq/L. Levels < 3.5 indicate hypokalemia; >
5.0 indicate hyperkalemia. Magnesium is 1.3–2.1 mEq/L, calcium is 9.0–10.5 mg/dL, and sodium
is 136–145 mEq/L .*
5. Which assessment finding is most consistent with hypokalemia (potassium < 3.5 mEq/L)?
A. Muscle cramping and cardiac arrest
B. Fatigue, leg cramps, and bradycardia
C. Tetany and Chvostek's sign
D. Constipation and bone pain
Answer: B – Fatigue, leg cramps, and bradycardia
Rationale: Hypokalemia causes fatigue, muscle weakness, leg cramps, bradycardia, and ECG
changes (U waves, flat T waves). Hyperkalemia causes muscle cramping and cardiac arrest.
Tetany is from hypocalcemia .
6. A patient has a potassium level of 6.2 mEq/L. Which ECG change does the nurse expect to
see first?
A. U waves
B. Peaked T waves
C. Wide QRS complex
D. Prolonged PR interval
Answer: B – Peaked T waves
*Rationale: Peaked ("tented") T waves are the earliest ECG sign of hyperkalemia, typically seen
at potassium levels 5.5–6.5 mEq/L. As potassium rises further (7–8 mEq/L), QRS widens and P
waves flatten. U waves are seen in hypokalemia .*
7. The nurse evaluates that discharge teaching for a patient with hypocalcemia has been
effective when the patient states:
, A. "I shouldn't take antacids such as TUMS."
B. "I should notify my healthcare provider if I start to feel tingling or numbness around my
mouth."
C. "I'll need to cut down on protein in my diet."
D. "I will watch my urine for signs of kidney stones."
Answer: B – "I should notify my healthcare provider if I start to feel tingling or numbness
around my mouth."
Rationale: Circumoral paresthesia (tingling/numbness around the mouth) is a sign of impending
tetany from worsening hypocalcemia. This requires immediate notification of the provider.
TUMS contain calcium, which would be beneficial, not harmful .
8. A patient is admitted with severe bleeding from a fractured femur. Which IV fluid does the
nurse anticipate as most appropriate?
A. Normal saline (0.9% NaCl)
B. 3% saline
C. 5% dextrose in water (D5W)
D. 5% dextrose in 0.225% saline
Answer: A – Normal saline (0.9% NaCl)
Rationale: Normal saline is an isotonic fluid and is appropriate for initial resuscitation of fluid
(blood) loss from hemorrhagic shock. It expands intravascular volume without causing rapid
shifts. Hypertonic fluids (3% saline) are used for severe hyponatremia, not hemorrhage .
9. A nurse notices a patient gained 6 pounds overnight. The nurse interprets this as
approximately how many liters of fluid retention?
A. 1 liter
B. 2 liters
C. 3 liters
D. 6 liters
Answer: C – 3 liters
*Rationale: One kilogram (2.2 lbs) of weight gain equals approximately 1 liter of retained fluid.
Therefore, a 6 lb gain = approximately 3 liters of fluid retention. Daily weight is the best
indicator of fluid status .*
10. What is the minimum urine output per hour for an adult to maintain adequate kidney
perfusion?
A. 10 mL/hr
B. 20 mL/hr
C. 30 mL/hr
D. 50 mL/hr
