NURS 8022 – Exam 2 (2025/2026) – with Complete Questions
and Answers
Fluid, Electrolyte & Renal (Questions 1-15)
1. A client has a serum sodium of 152 mEq/L. Which clinical manifestation is
most concerning?
• A. Thirst and dry mucous membranes
• B. Altered mental status and seizures
• C. Muscle cramps
• D. Oliguria
• Correct Answer: B. Severe hypernatremia causes brain cell dehydration →
altered mental status, seizures, coma. Thirst is an early symptom.
2. A client with heart failure is on a loop diuretic and develops metabolic
alkalosis. Which additional finding is expected?
• A. Hyperkalemia
• B. Hypokalemia
• C. Hypercalcemia
• D. Hypomagnesemia only
• Correct Answer: B. Loop diuretics cause potassium wasting. Hypokalemia
perpetuates metabolic alkalosis (intracellular H+ shift).
3. A client has a serum calcium of 11.5 mg/dL (normal 8.5-10.2). Which finding is
expected?
• A. Positive Chvostek's sign
• B. Muscle tetany
• C. Constipation and lethargy
• D. Prolonged QT interval
, • Correct Answer: C. Hypercalcemia causes "bones, stones, groans,
psychiatric overtones": constipation, lethargy, kidney stones, bone pain.
4. A client has a serum phosphorus of 1.2 mg/dL (normal 2.5-4.5). The nurse
should monitor for which complication?
• A. Muscle weakness and respiratory failure
• B. Tetany
• C. Hypertension
• D. Polyuria
• Correct Answer: A. Severe hypophosphatemia causes ATP depletion →
muscle weakness, respiratory failure, hemolysis, and cardiac dysfunction.
5. A client with chronic kidney disease has a serum potassium of 6.5 mEq/L.
Which medication should the nurse prepare to administer first?
• A. Sodium polystyrene sulfonate (Kayexalate)
• B. Insulin and dextrose IV
• C. Calcium gluconate IV
• D. Furosemide IV
• Correct Answer: C. Calcium gluconate stabilizes cardiac membranes in
severe hyperkalemia, preventing arrhythmias while other measures lower
potassium.
6. A client has acute kidney injury with a FeNa of 3.5% and urine sodium of 45
mEq/L. This indicates:
• A. Prerenal AKI
• B. Intrarenal AKI (acute tubular necrosis)
• C. Postrenal AKI
• D. Normal kidney function
• Correct Answer: B. FeNa >2% and urine sodium >40 suggest acute tubular
necrosis (intrinsic AKI). Prerenal AKI has FeNa <1% and urine sodium <20.
,7. Which medication is the antidote for hyperkalemia-induced cardiac toxicity?
• A. Insulin
• B. Albuterol
• C. Calcium gluconate
• D. Sodium bicarbonate
• Correct Answer: C. Calcium gluconate (or calcium chloride) stabilizes
myocardial cell membranes, reducing the risk of ventricular fibrillation.
8. A client with SIADH is placed on fluid restriction. Which finding indicates
treatment is effective?
• A. Decreasing urine output
• B. Rising serum sodium level
• C. Decreasing serum osmolality
• D. Weight gain
• Correct Answer: B. Effective treatment of SIADH (fluid restriction,
demeclocycline, conivaptan) results in rising serum sodium toward normal.
9. A client with diabetes insipidus is started on desmopressin (DDAVP). Which
finding indicates a therapeutic response?
• A. Increased urine output and decreased thirst
• B. Decreased urine output and increased urine osmolality
• C. Decreased serum sodium
• D. Weight loss
• Correct Answer: B. Desmopressin (ADH analog) increases water
reabsorption → decreased urine volume, increased urine osmolality,
decreased thirst.
10. A client has a serum magnesium of 0.8 mEq/L (normal 1.5-2.5). Which ECG
finding is most concerning?
, • A. Peaked T waves
• B. Prolonged QT interval
• C. Shortened QT interval
• D. U waves
• Correct Answer: B. Hypomagnesemia prolongs QT interval, predisposing to
torsades de pointes.
11. A client with hypermagnesemia (serum Mg 4.5 mEq/L) would most likely
present with:
• A. Hyperreflexia and tetany
• B. Hyporeflexia and respiratory depression
• C. Hypertension and tachycardia
• D. Seizures
• Correct Answer: B. Hypermagnesemia causes neuromuscular blockade:
hyporeflexia, muscle weakness, respiratory depression, and hypotension.
12. Which intravenous fluid is most appropriate for initial resuscitation of a
client with hypovolemic hyponatremia?
• A. 3% hypertonic saline
• B. 0.9% normal saline
• C. 0.45% half-normal saline
• D. D5W
• Correct Answer: B. Hypovolemic hyponatremia requires volume repletion
with isotonic saline (0.9% NS). Hypertonic saline is for severe symptomatic
hyponatremia.
13. A client has an anion gap of 22 mEq/L (normal 8-12). Which condition is
most likely?
• A. Diarrhea
and Answers
Fluid, Electrolyte & Renal (Questions 1-15)
1. A client has a serum sodium of 152 mEq/L. Which clinical manifestation is
most concerning?
• A. Thirst and dry mucous membranes
• B. Altered mental status and seizures
• C. Muscle cramps
• D. Oliguria
• Correct Answer: B. Severe hypernatremia causes brain cell dehydration →
altered mental status, seizures, coma. Thirst is an early symptom.
2. A client with heart failure is on a loop diuretic and develops metabolic
alkalosis. Which additional finding is expected?
• A. Hyperkalemia
• B. Hypokalemia
• C. Hypercalcemia
• D. Hypomagnesemia only
• Correct Answer: B. Loop diuretics cause potassium wasting. Hypokalemia
perpetuates metabolic alkalosis (intracellular H+ shift).
3. A client has a serum calcium of 11.5 mg/dL (normal 8.5-10.2). Which finding is
expected?
• A. Positive Chvostek's sign
• B. Muscle tetany
• C. Constipation and lethargy
• D. Prolonged QT interval
, • Correct Answer: C. Hypercalcemia causes "bones, stones, groans,
psychiatric overtones": constipation, lethargy, kidney stones, bone pain.
4. A client has a serum phosphorus of 1.2 mg/dL (normal 2.5-4.5). The nurse
should monitor for which complication?
• A. Muscle weakness and respiratory failure
• B. Tetany
• C. Hypertension
• D. Polyuria
• Correct Answer: A. Severe hypophosphatemia causes ATP depletion →
muscle weakness, respiratory failure, hemolysis, and cardiac dysfunction.
5. A client with chronic kidney disease has a serum potassium of 6.5 mEq/L.
Which medication should the nurse prepare to administer first?
• A. Sodium polystyrene sulfonate (Kayexalate)
• B. Insulin and dextrose IV
• C. Calcium gluconate IV
• D. Furosemide IV
• Correct Answer: C. Calcium gluconate stabilizes cardiac membranes in
severe hyperkalemia, preventing arrhythmias while other measures lower
potassium.
6. A client has acute kidney injury with a FeNa of 3.5% and urine sodium of 45
mEq/L. This indicates:
• A. Prerenal AKI
• B. Intrarenal AKI (acute tubular necrosis)
• C. Postrenal AKI
• D. Normal kidney function
• Correct Answer: B. FeNa >2% and urine sodium >40 suggest acute tubular
necrosis (intrinsic AKI). Prerenal AKI has FeNa <1% and urine sodium <20.
,7. Which medication is the antidote for hyperkalemia-induced cardiac toxicity?
• A. Insulin
• B. Albuterol
• C. Calcium gluconate
• D. Sodium bicarbonate
• Correct Answer: C. Calcium gluconate (or calcium chloride) stabilizes
myocardial cell membranes, reducing the risk of ventricular fibrillation.
8. A client with SIADH is placed on fluid restriction. Which finding indicates
treatment is effective?
• A. Decreasing urine output
• B. Rising serum sodium level
• C. Decreasing serum osmolality
• D. Weight gain
• Correct Answer: B. Effective treatment of SIADH (fluid restriction,
demeclocycline, conivaptan) results in rising serum sodium toward normal.
9. A client with diabetes insipidus is started on desmopressin (DDAVP). Which
finding indicates a therapeutic response?
• A. Increased urine output and decreased thirst
• B. Decreased urine output and increased urine osmolality
• C. Decreased serum sodium
• D. Weight loss
• Correct Answer: B. Desmopressin (ADH analog) increases water
reabsorption → decreased urine volume, increased urine osmolality,
decreased thirst.
10. A client has a serum magnesium of 0.8 mEq/L (normal 1.5-2.5). Which ECG
finding is most concerning?
, • A. Peaked T waves
• B. Prolonged QT interval
• C. Shortened QT interval
• D. U waves
• Correct Answer: B. Hypomagnesemia prolongs QT interval, predisposing to
torsades de pointes.
11. A client with hypermagnesemia (serum Mg 4.5 mEq/L) would most likely
present with:
• A. Hyperreflexia and tetany
• B. Hyporeflexia and respiratory depression
• C. Hypertension and tachycardia
• D. Seizures
• Correct Answer: B. Hypermagnesemia causes neuromuscular blockade:
hyporeflexia, muscle weakness, respiratory depression, and hypotension.
12. Which intravenous fluid is most appropriate for initial resuscitation of a
client with hypovolemic hyponatremia?
• A. 3% hypertonic saline
• B. 0.9% normal saline
• C. 0.45% half-normal saline
• D. D5W
• Correct Answer: B. Hypovolemic hyponatremia requires volume repletion
with isotonic saline (0.9% NS). Hypertonic saline is for severe symptomatic
hyponatremia.
13. A client has an anion gap of 22 mEq/L (normal 8-12). Which condition is
most likely?
• A. Diarrhea
