Fluid Electrolyte & Acid-Base Balance Actual Exam
2026/2027 – Complete Exam-Style Questions with Detailed
Rationales | 100% Verified | Pass Guaranteed – A+ Graded
Q1: A 78-year-old male with a history of heart failure is admitted with shortness of
breath and weight gain of 6 pounds over 3 days. On assessment, the nurse notes
bilateral crackles, jugular venous distension, and 2+ pitting edema in the lower
extremities. Which nursing intervention is the priority for this patient?
A. Administer IV normal saline at 125 mL/hr to improve perfusion
B. Apply compression stockings and elevate the head of bed to 90 degrees
C. Monitor daily weights, strict I&O, and administer prescribed diuretics while
maintaining a low-sodium diet [CORRECT]
D. Encourage the patient to drink 2-3 liters of fluid daily to prevent dehydration
Correct Answer: C
Rationale: This patient presents with classic signs of fluid volume excess
(hypervolemia) secondary to heart failure—weight gain, JVD, crackles, and edema. The
priority interventions include monitoring fluid status through daily weights and I&O,
administering diuretics to promote excretion, and restricting sodium to prevent further
fluid retention. Option A would worsen fluid overload. Option B's 90-degree elevation is
excessive for comfort and doesn't address the underlying fluid excess. Option D would
exacerbate the condition. 100% VERIFIED – Rasmussen NUR2392 MDC2
Q2: A nurse is caring for a patient with severe dehydration following 5 days of persistent
diarrhea. The patient's serum sodium is 152 mEq/L. Which type of IV fluid should the
nurse anticipate the provider to order?
,A. 0.45% sodium chloride (half-normal saline)
B. 3% sodium chloride (hypertonic saline)
C. 0.9% sodium chloride (normal saline)
D. Dextrose 5% in water (D5W) [CORRECT]
Correct Answer: D
Rationale: This patient has hypernatremia (serum sodium >145 mEq/L) due to water
loss from diarrhea. The primary treatment is free water replacement to correct the water
deficit. D5W is hypotonic and provides free water once the dextrose is metabolized,
making it appropriate for hypernatremia. Half-normal saline (A) is also hypotonic but
contains sodium, which is not ideal when the goal is dilutional correction. Hypertonic
saline (B) would worsen hypernatremia. Normal saline (C) is isotonic and would not
effectively correct the free water deficit. 100% VERIFIED – Rasmussen NUR2392 MDC2
Q3: A patient receiving IV potassium replacement at 30 mEq/hr via peripheral line
develops severe pain at the infusion site with tissue blanching. The nurse recognizes
this as a sign of:
A. Allergic reaction to the potassium chloride
B. Phlebitis from the IV catheter
C. Extravasation of hypertonic potassium solution causing tissue necrosis [CORRECT]
D. Normal expected discomfort from potassium administration
Correct Answer: C
Rationale: Potassium is a vesicant and hypertonic solution that can cause severe tissue
damage if it extravasates. The maximum recommended rate for peripheral
,administration is 10 mEq/hr; this patient is receiving 30 mEq/hr, which requires a central
line. The blanching and severe pain indicate extravasation, not simple phlebitis (B) or an
allergic reaction (A). Option D is dangerous—potassium extravasation can cause tissue
necrosis and requires immediate intervention. 100% VERIFIED – Rasmussen NUR2392
MDC2
Q4: A 62-year-old female with chronic kidney disease presents with muscle weakness,
paresthesias, and ECG showing peaked T waves and widened QRS complexes. Her
serum potassium is 6.8 mEq/L. Which intervention should the nurse prepare to
administer FIRST?
A. Sodium polystyrene sulfonate (Kayexalate) orally
B. Regular insulin with dextrose IV push
C. Calcium gluconate IV [CORRECT]
D. Hemodialysis
Correct Answer: C
Rationale: This patient has life-threatening hyperkalemia (K+ >6.5 mEq/L) with ECG
changes indicating cardiac instability. Calcium gluconate is administered first to
stabilize the myocardium by antagonizing potassium's effects on cardiac conduction,
preventing fatal dysrhythmias. Insulin with dextrose (B) shifts potassium intracellularly
but takes 15-30 minutes and does not protect the heart immediately. Kayexalate (A)
removes potassium through the GI tract but acts slowly (hours). Hemodialysis (D) is
definitive but not the immediate first step when cardiac changes are present. 100%
VERIFIED – Rasmussen NUR2392 MDC2
, Q5: A patient with a history of alcohol use disorder is admitted with tremors, seizures,
and hypocalcemia. During the physical exam, the nurse inflates a blood pressure cuff on
the patient's arm and observes carpal spasm within 3 minutes. This finding is known as:
A. Chvostek's sign
B. Trousseau's sign [CORRECT]
C. Babinski's sign
D. Homans' sign
Correct Answer: B
Rationale: Trousseau's sign is the elicitation of carpal spasm (wrist and finger flexion)
when a blood pressure cuff is inflated above systolic pressure for 3 minutes, indicating
latent tetany from hypocalcemia. Chvostek's sign (A) is facial twitching elicited by
tapping the facial nerve. Babinski's sign (C) indicates upper motor neuron lesions.
Homans' sign (D) is calf pain with foot dorsiflexion, historically associated with DVT
(though unreliable). 100% VERIFIED – Rasmussen NUR2392 MDC2
Q6: A patient with severe hypomagnesemia (Mg 1.2 mg/dL) is receiving IV magnesium
sulfate. Which assessment finding would indicate to the nurse that the magnesium level
is becoming dangerously elevated?
A. Hyperactive deep tendon reflexes and muscle tremors
B. Decreased or absent deep tendon reflexes [CORRECT]
C. Increased respiratory rate and depth
D. Hypertension and tachycardia
Correct Answer: B
2026/2027 – Complete Exam-Style Questions with Detailed
Rationales | 100% Verified | Pass Guaranteed – A+ Graded
Q1: A 78-year-old male with a history of heart failure is admitted with shortness of
breath and weight gain of 6 pounds over 3 days. On assessment, the nurse notes
bilateral crackles, jugular venous distension, and 2+ pitting edema in the lower
extremities. Which nursing intervention is the priority for this patient?
A. Administer IV normal saline at 125 mL/hr to improve perfusion
B. Apply compression stockings and elevate the head of bed to 90 degrees
C. Monitor daily weights, strict I&O, and administer prescribed diuretics while
maintaining a low-sodium diet [CORRECT]
D. Encourage the patient to drink 2-3 liters of fluid daily to prevent dehydration
Correct Answer: C
Rationale: This patient presents with classic signs of fluid volume excess
(hypervolemia) secondary to heart failure—weight gain, JVD, crackles, and edema. The
priority interventions include monitoring fluid status through daily weights and I&O,
administering diuretics to promote excretion, and restricting sodium to prevent further
fluid retention. Option A would worsen fluid overload. Option B's 90-degree elevation is
excessive for comfort and doesn't address the underlying fluid excess. Option D would
exacerbate the condition. 100% VERIFIED – Rasmussen NUR2392 MDC2
Q2: A nurse is caring for a patient with severe dehydration following 5 days of persistent
diarrhea. The patient's serum sodium is 152 mEq/L. Which type of IV fluid should the
nurse anticipate the provider to order?
,A. 0.45% sodium chloride (half-normal saline)
B. 3% sodium chloride (hypertonic saline)
C. 0.9% sodium chloride (normal saline)
D. Dextrose 5% in water (D5W) [CORRECT]
Correct Answer: D
Rationale: This patient has hypernatremia (serum sodium >145 mEq/L) due to water
loss from diarrhea. The primary treatment is free water replacement to correct the water
deficit. D5W is hypotonic and provides free water once the dextrose is metabolized,
making it appropriate for hypernatremia. Half-normal saline (A) is also hypotonic but
contains sodium, which is not ideal when the goal is dilutional correction. Hypertonic
saline (B) would worsen hypernatremia. Normal saline (C) is isotonic and would not
effectively correct the free water deficit. 100% VERIFIED – Rasmussen NUR2392 MDC2
Q3: A patient receiving IV potassium replacement at 30 mEq/hr via peripheral line
develops severe pain at the infusion site with tissue blanching. The nurse recognizes
this as a sign of:
A. Allergic reaction to the potassium chloride
B. Phlebitis from the IV catheter
C. Extravasation of hypertonic potassium solution causing tissue necrosis [CORRECT]
D. Normal expected discomfort from potassium administration
Correct Answer: C
Rationale: Potassium is a vesicant and hypertonic solution that can cause severe tissue
damage if it extravasates. The maximum recommended rate for peripheral
,administration is 10 mEq/hr; this patient is receiving 30 mEq/hr, which requires a central
line. The blanching and severe pain indicate extravasation, not simple phlebitis (B) or an
allergic reaction (A). Option D is dangerous—potassium extravasation can cause tissue
necrosis and requires immediate intervention. 100% VERIFIED – Rasmussen NUR2392
MDC2
Q4: A 62-year-old female with chronic kidney disease presents with muscle weakness,
paresthesias, and ECG showing peaked T waves and widened QRS complexes. Her
serum potassium is 6.8 mEq/L. Which intervention should the nurse prepare to
administer FIRST?
A. Sodium polystyrene sulfonate (Kayexalate) orally
B. Regular insulin with dextrose IV push
C. Calcium gluconate IV [CORRECT]
D. Hemodialysis
Correct Answer: C
Rationale: This patient has life-threatening hyperkalemia (K+ >6.5 mEq/L) with ECG
changes indicating cardiac instability. Calcium gluconate is administered first to
stabilize the myocardium by antagonizing potassium's effects on cardiac conduction,
preventing fatal dysrhythmias. Insulin with dextrose (B) shifts potassium intracellularly
but takes 15-30 minutes and does not protect the heart immediately. Kayexalate (A)
removes potassium through the GI tract but acts slowly (hours). Hemodialysis (D) is
definitive but not the immediate first step when cardiac changes are present. 100%
VERIFIED – Rasmussen NUR2392 MDC2
, Q5: A patient with a history of alcohol use disorder is admitted with tremors, seizures,
and hypocalcemia. During the physical exam, the nurse inflates a blood pressure cuff on
the patient's arm and observes carpal spasm within 3 minutes. This finding is known as:
A. Chvostek's sign
B. Trousseau's sign [CORRECT]
C. Babinski's sign
D. Homans' sign
Correct Answer: B
Rationale: Trousseau's sign is the elicitation of carpal spasm (wrist and finger flexion)
when a blood pressure cuff is inflated above systolic pressure for 3 minutes, indicating
latent tetany from hypocalcemia. Chvostek's sign (A) is facial twitching elicited by
tapping the facial nerve. Babinski's sign (C) indicates upper motor neuron lesions.
Homans' sign (D) is calf pain with foot dorsiflexion, historically associated with DVT
(though unreliable). 100% VERIFIED – Rasmussen NUR2392 MDC2
Q6: A patient with severe hypomagnesemia (Mg 1.2 mg/dL) is receiving IV magnesium
sulfate. Which assessment finding would indicate to the nurse that the magnesium level
is becoming dangerously elevated?
A. Hyperactive deep tendon reflexes and muscle tremors
B. Decreased or absent deep tendon reflexes [CORRECT]
C. Increased respiratory rate and depth
D. Hypertension and tachycardia
Correct Answer: B
