NUR 254 Exam 3: Questions with Correct Answers &
Complete Solutions | Galen College of Nursing
(2026/2027 Edition)
SECTION 1: FLUID, ELECTROLYTE, AND ACID-BASE BALANCE
Question 1.
A 68-year-old patient with heart failure is receiving intravenous furosemide 40 mg twice
daily. The nurse reviews the morning laboratory results and notes the following: serum
sodium 148 mEq/L, serum potassium 3.1 mEq/L, serum chloride 112 mEq/L, and BUN
28 mg/dL. Based on these findings, which nursing intervention is the priority?
A. Administer a potassium-sparing diuretic as prescribed.
B. Encourage the patient to increase dietary sodium intake.
C. Assess the patient for cardiac dysrhythmias and muscle weakness.
D. Decrease the furosemide infusion rate by 50%.
Correct Answer: C. Assess the patient for cardiac dysrhythmias and muscle weakness.
Rationale: The laboratory values reveal hypokalemia (serum potassium 3.1 mEq/L;
normal range 3.5–5.0 mEq/L), a known adverse effect of loop diuretic therapy with
furosemide. Hypokalemia is the priority concern because it increases myocardial
irritability and can precipitate life-threatening cardiac dysrhythmias, including ventricular
tachycardia and fibrillation. Additionally, hypokalemia causes skeletal muscle weakness
and can lead to respiratory muscle paralysis in severe cases. The nurse must first
assess for clinical manifestations of hypokalemia before implementing other
interventions. Option A is incorrect because administering a potassium-sparing diuretic
requires a physician's order and is not an independent nursing action; furthermore,
assessment must precede intervention. Option B is incorrect because the patient has
,hypernatremia (sodium 148 mEq/L; normal 135–145 mEq/L), and increasing sodium
intake would exacerbate fluid retention and worsen heart failure. Option D is incorrect
because nurses cannot independently alter prescribed medication infusion rates
without a provider's order.
Question 2.
A patient admitted with diabetic ketoacidosis (DKA) has the following arterial blood gas
(ABG) results: pH 7.28, PaCO₂ 28 mmHg, HCO₃⁻ 14 mEq/L, and PaO₂ 92 mmHg. The
nurse recognizes that the primary acid-base disturbance and the body's compensatory
mechanism are:
A. Respiratory acidosis with metabolic compensation.
B. Metabolic acidosis with respiratory compensation.
C. Metabolic alkalosis with respiratory compensation.
D. Respiratory alkalosis with metabolic compensation.
Correct Answer: B. Metabolic acidosis with respiratory compensation.
Rationale: The ABG results demonstrate a primary metabolic acidosis: the pH is below
7.35 (7.28), indicating acidemia; the HCO₃⁻ is decreased (14 mEq/L; normal 22–26
mEq/L), confirming a metabolic origin; and the PaCO₂ is decreased (28 mmHg; normal
35–45 mmHg), indicating hyperventilation as a compensatory mechanism. In DKA,
ketone body accumulation causes metabolic acidosis. The respiratory system
compensates via Kussmaul respirations (hyperventilation) to blow off carbon dioxide
and raise the pH toward normal. Option A is incorrect because respiratory acidosis
would present with an elevated PaCO₂ and decreased pH, not a decreased PaCO₂.
Option C is incorrect because metabolic alkalosis would present with an elevated pH
and elevated HCO₃⁻. Option D is incorrect because respiratory alkalosis would present
with an elevated pH and decreased PaCO₂ without a primary metabolic acidosis.
,Question 3.
The nurse is caring for a patient with syndrome of inappropriate antidiuretic hormone
(SIADH). Which clinical manifestation would the nurse expect to find during the
assessment?
A. Dry mucous membranes and poor skin turgor
B. Decreased urine specific gravity and polyuria
C. Weight gain, headache, and decreased level of consciousness
D. Hypernatremia with intense thirst
Correct Answer: C. Weight gain, headache, and decreased level of consciousness.
Rationale: SIADH is characterized by excessive ADH secretion, leading to water
retention, dilutional hyponatremia, and concentrated urine. The retained water causes
weight gain, while dilutional hyponatremia (serum sodium typically <135 mEq/L) causes
cerebral edema, manifesting as headache, nausea, confusion, seizures, and decreased
level of consciousness. Option A is incorrect because dry mucous membranes and poor
skin turgor are signs of dehydration and hypovolemia, which are opposite to the
fluid-overloaded state of SIADH. Option B is incorrect because SIADH causes
concentrated urine (increased specific gravity) and oliguria, not dilute urine and polyuria.
Option D is incorrect because SIADH causes dilutional hyponatremia, not
hypernatremia.
Question 4.
A patient with end-stage renal disease on hemodialysis presents with muscle twitching,
a positive Chvostek sign, and prolonged QT interval on the ECG. The nurse suspects
which electrolyte imbalance?
A. Hyperkalemia
B. Hypocalcemia
C. Hypermagnesemia
D. Hyponatremia
, Correct Answer: B. Hypocalcemia.
Rationale: Hypocalcemia (serum calcium <8.5 mg/dL) is common in patients with
chronic kidney disease due to impaired activation of vitamin D and phosphate retention.
Clinical manifestations include neuromuscular irritability (muscle twitching, tetany), a
positive Chvostek sign (facial muscle contraction when tapping the facial nerve),
Trousseau sign, and cardiac effects including prolonged QT interval, which predisposes
to torsades de pointes. Option A is incorrect because hyperkalemia typically causes
peaked T waves, widened QRS complexes, and ventricular fibrillation, not a prolonged
QT interval or Chvostek sign. Option C is incorrect because hypermagnesemia causes
muscle weakness, hypotension, bradycardia, and respiratory depression, not
neuromuscular irritability. Option D is incorrect because while hyponatremia can cause
seizures and altered mental status, it does not typically produce a positive Chvostek
sign or prolonged QT interval.
Question 5.
The nurse is preparing to administer 1 liter of 0.9% sodium chloride (normal saline) over
8 hours via gravity drip using tubing with a drip factor of 15 gtt/mL. How many drops
per minute should the nurse set the infusion to deliver?
A. 15 gtt/min
B. 31 gtt/min
C. 63 gtt/min
D. 125 gtt/min
Correct Answer: B. 31 gtt/min.
Rationale: The drip rate calculation follows the formula: (Total volume in mL × Drip
factor in gtt/mL) ÷ Total time in minutes. Calculation: (1,000 mL × 15 gtt/mL) ÷ 480
minutes (8 hours × 60 minutes) = 15,000 gtt ÷ 480 min = 31.25 gtt/min, which rounds to
31 gtt/min. Option A is incorrect because it represents a miscalculation using 500 mL
Complete Solutions | Galen College of Nursing
(2026/2027 Edition)
SECTION 1: FLUID, ELECTROLYTE, AND ACID-BASE BALANCE
Question 1.
A 68-year-old patient with heart failure is receiving intravenous furosemide 40 mg twice
daily. The nurse reviews the morning laboratory results and notes the following: serum
sodium 148 mEq/L, serum potassium 3.1 mEq/L, serum chloride 112 mEq/L, and BUN
28 mg/dL. Based on these findings, which nursing intervention is the priority?
A. Administer a potassium-sparing diuretic as prescribed.
B. Encourage the patient to increase dietary sodium intake.
C. Assess the patient for cardiac dysrhythmias and muscle weakness.
D. Decrease the furosemide infusion rate by 50%.
Correct Answer: C. Assess the patient for cardiac dysrhythmias and muscle weakness.
Rationale: The laboratory values reveal hypokalemia (serum potassium 3.1 mEq/L;
normal range 3.5–5.0 mEq/L), a known adverse effect of loop diuretic therapy with
furosemide. Hypokalemia is the priority concern because it increases myocardial
irritability and can precipitate life-threatening cardiac dysrhythmias, including ventricular
tachycardia and fibrillation. Additionally, hypokalemia causes skeletal muscle weakness
and can lead to respiratory muscle paralysis in severe cases. The nurse must first
assess for clinical manifestations of hypokalemia before implementing other
interventions. Option A is incorrect because administering a potassium-sparing diuretic
requires a physician's order and is not an independent nursing action; furthermore,
assessment must precede intervention. Option B is incorrect because the patient has
,hypernatremia (sodium 148 mEq/L; normal 135–145 mEq/L), and increasing sodium
intake would exacerbate fluid retention and worsen heart failure. Option D is incorrect
because nurses cannot independently alter prescribed medication infusion rates
without a provider's order.
Question 2.
A patient admitted with diabetic ketoacidosis (DKA) has the following arterial blood gas
(ABG) results: pH 7.28, PaCO₂ 28 mmHg, HCO₃⁻ 14 mEq/L, and PaO₂ 92 mmHg. The
nurse recognizes that the primary acid-base disturbance and the body's compensatory
mechanism are:
A. Respiratory acidosis with metabolic compensation.
B. Metabolic acidosis with respiratory compensation.
C. Metabolic alkalosis with respiratory compensation.
D. Respiratory alkalosis with metabolic compensation.
Correct Answer: B. Metabolic acidosis with respiratory compensation.
Rationale: The ABG results demonstrate a primary metabolic acidosis: the pH is below
7.35 (7.28), indicating acidemia; the HCO₃⁻ is decreased (14 mEq/L; normal 22–26
mEq/L), confirming a metabolic origin; and the PaCO₂ is decreased (28 mmHg; normal
35–45 mmHg), indicating hyperventilation as a compensatory mechanism. In DKA,
ketone body accumulation causes metabolic acidosis. The respiratory system
compensates via Kussmaul respirations (hyperventilation) to blow off carbon dioxide
and raise the pH toward normal. Option A is incorrect because respiratory acidosis
would present with an elevated PaCO₂ and decreased pH, not a decreased PaCO₂.
Option C is incorrect because metabolic alkalosis would present with an elevated pH
and elevated HCO₃⁻. Option D is incorrect because respiratory alkalosis would present
with an elevated pH and decreased PaCO₂ without a primary metabolic acidosis.
,Question 3.
The nurse is caring for a patient with syndrome of inappropriate antidiuretic hormone
(SIADH). Which clinical manifestation would the nurse expect to find during the
assessment?
A. Dry mucous membranes and poor skin turgor
B. Decreased urine specific gravity and polyuria
C. Weight gain, headache, and decreased level of consciousness
D. Hypernatremia with intense thirst
Correct Answer: C. Weight gain, headache, and decreased level of consciousness.
Rationale: SIADH is characterized by excessive ADH secretion, leading to water
retention, dilutional hyponatremia, and concentrated urine. The retained water causes
weight gain, while dilutional hyponatremia (serum sodium typically <135 mEq/L) causes
cerebral edema, manifesting as headache, nausea, confusion, seizures, and decreased
level of consciousness. Option A is incorrect because dry mucous membranes and poor
skin turgor are signs of dehydration and hypovolemia, which are opposite to the
fluid-overloaded state of SIADH. Option B is incorrect because SIADH causes
concentrated urine (increased specific gravity) and oliguria, not dilute urine and polyuria.
Option D is incorrect because SIADH causes dilutional hyponatremia, not
hypernatremia.
Question 4.
A patient with end-stage renal disease on hemodialysis presents with muscle twitching,
a positive Chvostek sign, and prolonged QT interval on the ECG. The nurse suspects
which electrolyte imbalance?
A. Hyperkalemia
B. Hypocalcemia
C. Hypermagnesemia
D. Hyponatremia
, Correct Answer: B. Hypocalcemia.
Rationale: Hypocalcemia (serum calcium <8.5 mg/dL) is common in patients with
chronic kidney disease due to impaired activation of vitamin D and phosphate retention.
Clinical manifestations include neuromuscular irritability (muscle twitching, tetany), a
positive Chvostek sign (facial muscle contraction when tapping the facial nerve),
Trousseau sign, and cardiac effects including prolonged QT interval, which predisposes
to torsades de pointes. Option A is incorrect because hyperkalemia typically causes
peaked T waves, widened QRS complexes, and ventricular fibrillation, not a prolonged
QT interval or Chvostek sign. Option C is incorrect because hypermagnesemia causes
muscle weakness, hypotension, bradycardia, and respiratory depression, not
neuromuscular irritability. Option D is incorrect because while hyponatremia can cause
seizures and altered mental status, it does not typically produce a positive Chvostek
sign or prolonged QT interval.
Question 5.
The nurse is preparing to administer 1 liter of 0.9% sodium chloride (normal saline) over
8 hours via gravity drip using tubing with a drip factor of 15 gtt/mL. How many drops
per minute should the nurse set the infusion to deliver?
A. 15 gtt/min
B. 31 gtt/min
C. 63 gtt/min
D. 125 gtt/min
Correct Answer: B. 31 gtt/min.
Rationale: The drip rate calculation follows the formula: (Total volume in mL × Drip
factor in gtt/mL) ÷ Total time in minutes. Calculation: (1,000 mL × 15 gtt/mL) ÷ 480
minutes (8 hours × 60 minutes) = 15,000 gtt ÷ 480 min = 31.25 gtt/min, which rounds to
31 gtt/min. Option A is incorrect because it represents a miscalculation using 500 mL
