,NR 226 Exam 2 Study Guide | Fundamentals – Patient
Care | Chamberlain | Latest 2026/2027 Update (PDF)
1. A nurse is assessing a client who has a serum sodium level of 128 mEq/L. Which manifestation
should the nurse expect?
A) Thirst and dry mucous membranes
B) Confusion and headache
C) Tachycardia and hypotension
D) Muscle cramps and hyperreflexia
Correct Answer: Confusion and headache
Rationale: Hyponatremia (serum sodium < 135 mEq/L) causes cerebral edema, leading to confusion,
headache, nausea, and seizures. Thirst and dry mucous membranes are signs of hypernatremia.
Muscle cramps and hyperreflexia are associated with hypocalcemia.
2. A client is admitted with a serum potassium level of 6.8 mEq/L. Which action should the nurse take
first?
A) Administer sodium polystyrene sulfonate
B) Obtain a 12-lead ECG
C) Administer IV calcium gluconate
D) Prepare for emergency dialysis
Correct Answer: Obtain a 12-lead ECG
Rationale: A serum potassium of 6.8 mEq/L is significantly elevated and can cause life-threatening
cardiac dysrhythmias. The nurse should first obtain a 12-lead ECG to assess for cardiac changes such as
tall peaked T-waves, widened QRS, or ventricular arrhythmias. This assessment guides immediate
intervention.
3. A nurse is assessing a client who has a serum calcium level of 7.5 mg/dL. Which manifestation
should the nurse expect?
,A) Muscle weakness and fatigue
B) Positive Chvostek's sign
C) Decreased deep tendon reflexes
D) Constipation
Correct Answer: Positive Chvostek's sign
Rationale: Hypocalcemia (serum calcium < 8.5 mg/dL) increases neuromuscular excitability, leading to
positive Chvostek's sign (facial twitching when the facial nerve is tapped) and Trousseau's sign (carpal
spasm). Muscle weakness, fatigue, decreased deep tendon reflexes, and constipation are not
characteristic of hypocalcemia.
4. A client's arterial blood gas results are pH 7.30, PaCO2 50 mmHg, and HCO3 24 mEq/L. Which acid-
base imbalance should the nurse identify?
A) Metabolic acidosis
B) Metabolic alkalosis
C) Respiratory acidosis
D) Respiratory alkalosis
Correct Answer: Respiratory acidosis
Rationale: A pH of 7.30 indicates acidosis. The PaCO2 of 50 mmHg is elevated (> 45 mmHg), indicating
that the respiratory system is the cause of the acidosis. The HCO3 of 24 mEq/L is within normal limits,
indicating no metabolic compensation. This is uncompensated respiratory acidosis.
5. A nurse is assessing a client who has been receiving nasogastric suction for 3 days. Which acid-base
imbalance should the nurse anticipate?
A) Metabolic acidosis
B) Metabolic alkalosis
C) Respiratory acidosis
D) Respiratory alkalosis
, Correct Answer: Metabolic alkalosis
Rationale: Nasogastric suction removes gastric acid (hydrochloric acid), leading to a loss of hydrogen
ions and chloride. This results in metabolic alkalosis with increased bicarbonate levels. Metabolic
acidosis is associated with diarrhea or DKA.
6. A client is receiving a blood transfusion and develops fever, chills, and hypotension. Which type of
transfusion reaction should the nurse suspect?
A) Febrile non-hemolytic reaction
B) Acute hemolytic reaction
C) Transfusion-related acute lung injury
D) Allergic reaction
Correct Answer: Acute hemolytic reaction
Rationale: Acute hemolytic reactions are characterized by fever, chills, hypotension, and low back
pain. They are caused by ABO incompatibility and are life-threatening. Febrile non-hemolytic
reactions present with fever and chills but not hypotension.
7. A nurse is preparing to administer a blood transfusion. Which action is essential before initiating
the transfusion?
A) Verify the blood product with another nurse using two patient identifiers
B) Administer a diuretic to prevent fluid overload
C) Premedicate the client with diphenhydramine
D) Warm the blood product to 40°C
Correct Answer: Verify the blood product with another nurse using two patient identifiers
Rationale: Verification of blood products with another nurse using two patient identifiers is an
essential safety step to prevent transfusion reactions from incompatible blood. Premedication and
diuretics are not routine prerequisites for all transfusions.
Care | Chamberlain | Latest 2026/2027 Update (PDF)
1. A nurse is assessing a client who has a serum sodium level of 128 mEq/L. Which manifestation
should the nurse expect?
A) Thirst and dry mucous membranes
B) Confusion and headache
C) Tachycardia and hypotension
D) Muscle cramps and hyperreflexia
Correct Answer: Confusion and headache
Rationale: Hyponatremia (serum sodium < 135 mEq/L) causes cerebral edema, leading to confusion,
headache, nausea, and seizures. Thirst and dry mucous membranes are signs of hypernatremia.
Muscle cramps and hyperreflexia are associated with hypocalcemia.
2. A client is admitted with a serum potassium level of 6.8 mEq/L. Which action should the nurse take
first?
A) Administer sodium polystyrene sulfonate
B) Obtain a 12-lead ECG
C) Administer IV calcium gluconate
D) Prepare for emergency dialysis
Correct Answer: Obtain a 12-lead ECG
Rationale: A serum potassium of 6.8 mEq/L is significantly elevated and can cause life-threatening
cardiac dysrhythmias. The nurse should first obtain a 12-lead ECG to assess for cardiac changes such as
tall peaked T-waves, widened QRS, or ventricular arrhythmias. This assessment guides immediate
intervention.
3. A nurse is assessing a client who has a serum calcium level of 7.5 mg/dL. Which manifestation
should the nurse expect?
,A) Muscle weakness and fatigue
B) Positive Chvostek's sign
C) Decreased deep tendon reflexes
D) Constipation
Correct Answer: Positive Chvostek's sign
Rationale: Hypocalcemia (serum calcium < 8.5 mg/dL) increases neuromuscular excitability, leading to
positive Chvostek's sign (facial twitching when the facial nerve is tapped) and Trousseau's sign (carpal
spasm). Muscle weakness, fatigue, decreased deep tendon reflexes, and constipation are not
characteristic of hypocalcemia.
4. A client's arterial blood gas results are pH 7.30, PaCO2 50 mmHg, and HCO3 24 mEq/L. Which acid-
base imbalance should the nurse identify?
A) Metabolic acidosis
B) Metabolic alkalosis
C) Respiratory acidosis
D) Respiratory alkalosis
Correct Answer: Respiratory acidosis
Rationale: A pH of 7.30 indicates acidosis. The PaCO2 of 50 mmHg is elevated (> 45 mmHg), indicating
that the respiratory system is the cause of the acidosis. The HCO3 of 24 mEq/L is within normal limits,
indicating no metabolic compensation. This is uncompensated respiratory acidosis.
5. A nurse is assessing a client who has been receiving nasogastric suction for 3 days. Which acid-base
imbalance should the nurse anticipate?
A) Metabolic acidosis
B) Metabolic alkalosis
C) Respiratory acidosis
D) Respiratory alkalosis
, Correct Answer: Metabolic alkalosis
Rationale: Nasogastric suction removes gastric acid (hydrochloric acid), leading to a loss of hydrogen
ions and chloride. This results in metabolic alkalosis with increased bicarbonate levels. Metabolic
acidosis is associated with diarrhea or DKA.
6. A client is receiving a blood transfusion and develops fever, chills, and hypotension. Which type of
transfusion reaction should the nurse suspect?
A) Febrile non-hemolytic reaction
B) Acute hemolytic reaction
C) Transfusion-related acute lung injury
D) Allergic reaction
Correct Answer: Acute hemolytic reaction
Rationale: Acute hemolytic reactions are characterized by fever, chills, hypotension, and low back
pain. They are caused by ABO incompatibility and are life-threatening. Febrile non-hemolytic
reactions present with fever and chills but not hypotension.
7. A nurse is preparing to administer a blood transfusion. Which action is essential before initiating
the transfusion?
A) Verify the blood product with another nurse using two patient identifiers
B) Administer a diuretic to prevent fluid overload
C) Premedicate the client with diphenhydramine
D) Warm the blood product to 40°C
Correct Answer: Verify the blood product with another nurse using two patient identifiers
Rationale: Verification of blood products with another nurse using two patient identifiers is an
essential safety step to prevent transfusion reactions from incompatible blood. Premedication and
diuretics are not routine prerequisites for all transfusions.
