Chamberlain University NR 226 Exam 2 (pdf) |
2026/2027 | Fundamentals Patient Care: Fluids,
Electrolytes, Acid-Base Balance & Sleep Q&A |
Nursing
Exam alignment: fluid and electrolyte balance, acid-base balance, IV principles, and sleep fundamentals.
1. Which route is an example of insensible water loss?
A. Fluid lost through an ostomy bag
B. Measured urine output
C. Wound drainage collected in a drainage device
D. Water vapor exhaled through the lungs
Correct Answer: D
Rationale: Insensible water loss occurs continuously and is not consciously perceived or directly
measured, such as water vapor lost through respiration and evaporation from the skin.
Why the other options are incorrect:
Option A is incorrect: Ostomy output can be measured and is therefore a sensible loss.
Option B is incorrect: Measured urine output is a sensible loss.
Option C is incorrect: Wound drainage collected and measured is a sensible loss.
2. A client receives a hypertonic IV solution. The nurse expects the solution to cause which effect?
A. Water movement out of cells, causing shrinkage
B. Water movement into cells, causing swelling
C. Immediate renal excretion of all administered fluid
D. No net water movement across cell membranes
Correct Answer: A
Rationale: A hypertonic solution has a higher solute concentration than plasma. Water moves by
osmosis from the intracellular compartment toward the higher extracellular osmolarity, causing cells to
shrink.
Why the other options are incorrect:
Option B is incorrect: Water moves into cells with hypotonic solutions.
Option C is incorrect: The kidneys regulate volume over time, but they do not immediately excrete all
administered IV fluid.
Option D is incorrect: Minimal net water movement is expected with isotonic solutions.
3. A client's arterial blood gas results are pH 7.49, PaCO2 29 mmHg, and HCO3− 23 mEq/L. Which
acid-base imbalance is present?
A. Metabolic acidosis
B. Metabolic alkalosis
C. Respiratory acidosis
D. Respiratory alkalosis
Correct Answer: D
1
,Rationale: The pH above 7.45 confirms alkalosis. A PaCO2 below 35 mmHg reflects excessive carbon
dioxide excretion, and the normal bicarbonate level identifies the disturbance as respiratory alkalosis.
Why the other options are incorrect:
Option A is incorrect: Metabolic acidosis would show a decreased pH and decreased HCO3−.
Option B is incorrect: Metabolic alkalosis would show an increased pH and increased HCO3−.
Option C is incorrect: Respiratory acidosis would show a decreased pH and increased PaCO2.
4. Which set lists the three major types of extracellular fluid?
A. Intravascular, intracellular, and cerebrospinal
B. Transcellular, intracellular, and plasma
C. Interstitial, intravascular, and transcellular
D. Intracellular, interstitial, and lymphatic
Correct Answer: C
Rationale: Extracellular fluid includes interstitial fluid surrounding cells, intravascular fluid within vessels,
and transcellular fluid within epithelial-lined spaces.
Why the other options are incorrect:
Option A is incorrect: Intracellular fluid is separate from extracellular fluid.
Option B is incorrect: Intracellular fluid is not extracellular, even though plasma is intravascular.
Option D is incorrect: Intracellular fluid is not part of extracellular fluid.
5. Which finding is most consistent with acute hyponatremia?
A. Polyuria caused by osmotic diuresis
B. Cerebral dysfunction from brain cell swelling
C. Decreased antidiuretic hormone secretion
D. Cerebral dysfunction from brain cell shrinkage
Correct Answer: B
Rationale: A rapid decrease in serum sodium lowers extracellular osmolality. Water moves into brain
cells by osmosis, causing cerebral edema, increased intracranial pressure, and neurologic dysfunction.
Why the other options are incorrect:
Option A is incorrect: Polyuria may occur in some sodium and water disorders, but it is not the
characteristic central nervous system effect of acute hyponatremia.
Option C is incorrect: Hyponatremia is more often associated with ADH excess or impaired water
excretion, not decreased ADH secretion.
Option D is incorrect: Brain cell shrinkage occurs with hypernatremia, when extracellular fluid is
relatively hypertonic.
6. Which route is an abnormal method of fluid loss?
A. Fluid lost through wound drainage
B. Urinary excretion through the kidneys
C. Perspiration through the skin
D. Exhalation through the lungs
Correct Answer: A
Rationale: Wound drainage is an abnormal fluid loss route because it reflects tissue injury or surgery
rather than routine physiologic elimination.
Why the other options are incorrect:
Option B is incorrect: Urinary excretion is a normal regulated route of fluid elimination.
2
, Option C is incorrect: Perspiration is a normal route of fluid and heat loss.
Option D is incorrect: Respiratory water loss is a normal physiologic route.
7. Which drop factor is associated with microdrip IV tubing?
A. 60 gtt/mL
B. 15 gtt/mL
C. 20 gtt/mL
D. 10 gtt/mL
Correct Answer: A
Rationale: Microdrip tubing delivers 60 drops per milliliter. This drop factor is used when small, carefully
controlled infusion volumes are required.
Why the other options are incorrect:
Option B is incorrect: 15 gtt/mL is a macrodrip drop factor.
Option C is incorrect: 20 gtt/mL is a macrodrip drop factor.
Option D is incorrect: 10 gtt/mL is a macrodrip drop factor.
8. Cataplexy is best defined as:
A. A measurable form of fluid loss
B. A sleep study that evaluates breathing and brain activity
C. Excessive sleep lasting more than 9 hours
D. Temporary loss of voluntary muscle function
Correct Answer: D
Rationale: Cataplexy is a sudden, temporary loss of voluntary muscle tone that is often triggered by
strong emotion and is classically associated with narcolepsy.
Why the other options are incorrect:
Option A is incorrect: Measurable fluid loss is sensible loss, not cataplexy.
Option B is incorrect: A sleep study is a polysomnogram.
Option C is incorrect: Excessively long sleep is hypersomnolence.
9. Which finding best describes hypersomnolence?
A. Excessive sleepiness despite adequate sleep opportunity
B. A temporary loss of voluntary muscle function
C. An inability to initiate sleep due to pain
D. A disruption of the 24-hour sleep-wake cycle
Correct Answer: A
Rationale: Hypersomnolence is characterized by excessive daytime sleepiness or prolonged sleep,
commonly defined as sleep exceeding about 9 hours despite adequate opportunity for sleep.
Why the other options are incorrect:
Option B is incorrect: Temporary loss of voluntary muscle function describes cataplexy.
Option C is incorrect: Difficulty initiating sleep is more consistent with insomnia or a contributing
symptom such as pain.
Option D is incorrect: A disrupted 24-hour rhythm describes a circadian rhythm sleep-wake disorder.
10. A nurse is reviewing a client's electrolyte panel. Which serum potassium result is within the
expected reference range?
A. 5.4 mEq/L
3
2026/2027 | Fundamentals Patient Care: Fluids,
Electrolytes, Acid-Base Balance & Sleep Q&A |
Nursing
Exam alignment: fluid and electrolyte balance, acid-base balance, IV principles, and sleep fundamentals.
1. Which route is an example of insensible water loss?
A. Fluid lost through an ostomy bag
B. Measured urine output
C. Wound drainage collected in a drainage device
D. Water vapor exhaled through the lungs
Correct Answer: D
Rationale: Insensible water loss occurs continuously and is not consciously perceived or directly
measured, such as water vapor lost through respiration and evaporation from the skin.
Why the other options are incorrect:
Option A is incorrect: Ostomy output can be measured and is therefore a sensible loss.
Option B is incorrect: Measured urine output is a sensible loss.
Option C is incorrect: Wound drainage collected and measured is a sensible loss.
2. A client receives a hypertonic IV solution. The nurse expects the solution to cause which effect?
A. Water movement out of cells, causing shrinkage
B. Water movement into cells, causing swelling
C. Immediate renal excretion of all administered fluid
D. No net water movement across cell membranes
Correct Answer: A
Rationale: A hypertonic solution has a higher solute concentration than plasma. Water moves by
osmosis from the intracellular compartment toward the higher extracellular osmolarity, causing cells to
shrink.
Why the other options are incorrect:
Option B is incorrect: Water moves into cells with hypotonic solutions.
Option C is incorrect: The kidneys regulate volume over time, but they do not immediately excrete all
administered IV fluid.
Option D is incorrect: Minimal net water movement is expected with isotonic solutions.
3. A client's arterial blood gas results are pH 7.49, PaCO2 29 mmHg, and HCO3− 23 mEq/L. Which
acid-base imbalance is present?
A. Metabolic acidosis
B. Metabolic alkalosis
C. Respiratory acidosis
D. Respiratory alkalosis
Correct Answer: D
1
,Rationale: The pH above 7.45 confirms alkalosis. A PaCO2 below 35 mmHg reflects excessive carbon
dioxide excretion, and the normal bicarbonate level identifies the disturbance as respiratory alkalosis.
Why the other options are incorrect:
Option A is incorrect: Metabolic acidosis would show a decreased pH and decreased HCO3−.
Option B is incorrect: Metabolic alkalosis would show an increased pH and increased HCO3−.
Option C is incorrect: Respiratory acidosis would show a decreased pH and increased PaCO2.
4. Which set lists the three major types of extracellular fluid?
A. Intravascular, intracellular, and cerebrospinal
B. Transcellular, intracellular, and plasma
C. Interstitial, intravascular, and transcellular
D. Intracellular, interstitial, and lymphatic
Correct Answer: C
Rationale: Extracellular fluid includes interstitial fluid surrounding cells, intravascular fluid within vessels,
and transcellular fluid within epithelial-lined spaces.
Why the other options are incorrect:
Option A is incorrect: Intracellular fluid is separate from extracellular fluid.
Option B is incorrect: Intracellular fluid is not extracellular, even though plasma is intravascular.
Option D is incorrect: Intracellular fluid is not part of extracellular fluid.
5. Which finding is most consistent with acute hyponatremia?
A. Polyuria caused by osmotic diuresis
B. Cerebral dysfunction from brain cell swelling
C. Decreased antidiuretic hormone secretion
D. Cerebral dysfunction from brain cell shrinkage
Correct Answer: B
Rationale: A rapid decrease in serum sodium lowers extracellular osmolality. Water moves into brain
cells by osmosis, causing cerebral edema, increased intracranial pressure, and neurologic dysfunction.
Why the other options are incorrect:
Option A is incorrect: Polyuria may occur in some sodium and water disorders, but it is not the
characteristic central nervous system effect of acute hyponatremia.
Option C is incorrect: Hyponatremia is more often associated with ADH excess or impaired water
excretion, not decreased ADH secretion.
Option D is incorrect: Brain cell shrinkage occurs with hypernatremia, when extracellular fluid is
relatively hypertonic.
6. Which route is an abnormal method of fluid loss?
A. Fluid lost through wound drainage
B. Urinary excretion through the kidneys
C. Perspiration through the skin
D. Exhalation through the lungs
Correct Answer: A
Rationale: Wound drainage is an abnormal fluid loss route because it reflects tissue injury or surgery
rather than routine physiologic elimination.
Why the other options are incorrect:
Option B is incorrect: Urinary excretion is a normal regulated route of fluid elimination.
2
, Option C is incorrect: Perspiration is a normal route of fluid and heat loss.
Option D is incorrect: Respiratory water loss is a normal physiologic route.
7. Which drop factor is associated with microdrip IV tubing?
A. 60 gtt/mL
B. 15 gtt/mL
C. 20 gtt/mL
D. 10 gtt/mL
Correct Answer: A
Rationale: Microdrip tubing delivers 60 drops per milliliter. This drop factor is used when small, carefully
controlled infusion volumes are required.
Why the other options are incorrect:
Option B is incorrect: 15 gtt/mL is a macrodrip drop factor.
Option C is incorrect: 20 gtt/mL is a macrodrip drop factor.
Option D is incorrect: 10 gtt/mL is a macrodrip drop factor.
8. Cataplexy is best defined as:
A. A measurable form of fluid loss
B. A sleep study that evaluates breathing and brain activity
C. Excessive sleep lasting more than 9 hours
D. Temporary loss of voluntary muscle function
Correct Answer: D
Rationale: Cataplexy is a sudden, temporary loss of voluntary muscle tone that is often triggered by
strong emotion and is classically associated with narcolepsy.
Why the other options are incorrect:
Option A is incorrect: Measurable fluid loss is sensible loss, not cataplexy.
Option B is incorrect: A sleep study is a polysomnogram.
Option C is incorrect: Excessively long sleep is hypersomnolence.
9. Which finding best describes hypersomnolence?
A. Excessive sleepiness despite adequate sleep opportunity
B. A temporary loss of voluntary muscle function
C. An inability to initiate sleep due to pain
D. A disruption of the 24-hour sleep-wake cycle
Correct Answer: A
Rationale: Hypersomnolence is characterized by excessive daytime sleepiness or prolonged sleep,
commonly defined as sleep exceeding about 9 hours despite adequate opportunity for sleep.
Why the other options are incorrect:
Option B is incorrect: Temporary loss of voluntary muscle function describes cataplexy.
Option C is incorrect: Difficulty initiating sleep is more consistent with insomnia or a contributing
symptom such as pain.
Option D is incorrect: A disrupted 24-hour rhythm describes a circadian rhythm sleep-wake disorder.
10. A nurse is reviewing a client's electrolyte panel. Which serum potassium result is within the
expected reference range?
A. 5.4 mEq/L
3
