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NURB 240: Fundamentals in Nursing II
Section 1: Advanced Fluid, Electrolyte, and Acid-Base Balance
1. A client with chronic kidney disease (CKD) presents with a serum potassium level of 6.8
mEq/L and tall, peaked T-waves on the ECG. Which medication should the nurse
anticipate administering first to protect the heart?
A) Sodium polystyrene sulfonate (Kayexalate)
B) 10% Calcium Gluconate IV
C) Regular insulin and 50% Dextrose
D) Furosemide (Lasix)
Elaboration: While insulin and Kayexalate lower potassium, Calcium Gluconate is the priority
in emergent hyperkalemia because it antagonizes the membrane-excitability effect of
potassium on the myocardium, preventing immediate cardiac arrest.
2. A nurse is evaluating the arterial blood gas (ABG) results for a client with severe,
persistent vomiting: pH 7.52, $PaCO_2$ 45 mmHg, $HCO_3$ 34 mEq/L. This indicates:
A) Respiratory Alkalosis
B) Uncompensated Metabolic Alkalosis
C) Compensated Metabolic Acidosis
D) Uncompensated Respiratory Acidosis
Elaboration: The pH is high (alkalosis). The bicarbonate ($HCO_3$) is high (metabolic). The
$PaCO_2$ is within the normal range (uncompensated), indicating the loss of gastric acid
($HCl$) has created a metabolic imbalance.
3. A client is receiving a continuous infusion of 3% Sodium Chloride (Hypertonic Saline).
Which assessment finding requires the nurse to stop the infusion immediately?
A) Increased urine output
B) New-onset crackles in the lung bases and shortness of breath
C) Dry mucous membranes
D) Serum sodium of 138 mEq/L
,Elaboration: Hypertonic solutions pull fluid rapidly into the vascular space. If the heart cannot
handle the increased preload, the client will develop acute pulmonary edema (manifested by
crackles).
4. A client has a positive Trousseau’s sign. The nurse should anticipate which electrolyte
replacement?
A) Potassium Chloride
B) Calcium Gluconate or Magnesium Sulfate
C) Sodium Chloride
D) Phosphate Binder
Elaboration: Trousseau's sign (carpal spasm with BP cuff inflation) indicates hypocalcemia or
hypomagnesemia, both of which increase neuromuscular excitability.
5. Which physiological mechanism does the body utilize as the fastest response to correct
a drop in blood pH?
A) Renal excretion of hydrogen ions
B) The respiratory system (increasing rate and depth of breaths)
C) Renal reabsorption of bicarbonate
D) Intracellular protein buffering
Elaboration: The respiratory system reacts within minutes to change the $CO_2$ level (acid).
The renal system is the most powerful buffer but takes 24–48 hours to fully respond.
Section 2: Advanced Oxygenation and Airway Management
6. A client with a tracheostomy requires suctioning. Which action by the nurse is
appropriate?
A) Applying suction while inserting the catheter.
B) Hyperoxygenating the client with 100% $O_2$ for 30–60 seconds before the
procedure.
C) Suctioning for a total of 30 seconds per pass.
D) Maintaining clean technique during the procedure.
Elaboration: Suctioning removes oxygen along with secretions. Hyperoxygenation prevents
procedure-induced hypoxia. Suction should never exceed 10–15 seconds.
, 7. A nurse observes "tidaling" in the water-seal chamber of a client's chest tube drainage
system. What is the nurse's interpretation?
A) There is a leak in the system.
B) The suction is set too high.
C) The system is functioning normally.
D) The lung has fully re-expanded.
Elaboration: Tidaling (the rise and fall of water with respirations) confirms that the chest tube
is patent and the pleural space is communicating with the drainage system. If tidaling stops,
the tube is either kinked or the lung has re-expanded.
8. A client is two hours postoperative following a thyroidectomy. The nurse hears high-
pitched, inspiratory stridor. What is the priority intervention?
A) Administer an oral analgesic.
B) Notify the surgeon and prepare for emergency tracheostomy.
C) Encourage the client to cough and deep breathe.
D) Lower the head of the bed to 15 degrees.
Elaboration: Stridor indicates acute laryngeal edema and impending upper airway
obstruction, a medical emergency following neck surgery.
9. Which oxygen delivery device is most appropriate for a client who requires a precise
$FiO_2$ of 24%?
A) Nasal Cannula
B) Venturi Mask
C) Simple Face Mask
D) Non-rebreather Mask
Elaboration: The Venturi mask is the only non-invasive device capable of delivering a specific,
fixed concentration of oxygen, making it ideal for clients with COPD.
10. A client with a chest tube is accidentally disconnected from the drainage unit. What is
the nurse’s immediate action?
A) Clamp the chest tube near the insertion site.
B) Submerge the end of the tube in 2 cm of sterile water.
C) Cover the site with an occlusive dressing.
NURB 240: Fundamentals in Nursing II
Section 1: Advanced Fluid, Electrolyte, and Acid-Base Balance
1. A client with chronic kidney disease (CKD) presents with a serum potassium level of 6.8
mEq/L and tall, peaked T-waves on the ECG. Which medication should the nurse
anticipate administering first to protect the heart?
A) Sodium polystyrene sulfonate (Kayexalate)
B) 10% Calcium Gluconate IV
C) Regular insulin and 50% Dextrose
D) Furosemide (Lasix)
Elaboration: While insulin and Kayexalate lower potassium, Calcium Gluconate is the priority
in emergent hyperkalemia because it antagonizes the membrane-excitability effect of
potassium on the myocardium, preventing immediate cardiac arrest.
2. A nurse is evaluating the arterial blood gas (ABG) results for a client with severe,
persistent vomiting: pH 7.52, $PaCO_2$ 45 mmHg, $HCO_3$ 34 mEq/L. This indicates:
A) Respiratory Alkalosis
B) Uncompensated Metabolic Alkalosis
C) Compensated Metabolic Acidosis
D) Uncompensated Respiratory Acidosis
Elaboration: The pH is high (alkalosis). The bicarbonate ($HCO_3$) is high (metabolic). The
$PaCO_2$ is within the normal range (uncompensated), indicating the loss of gastric acid
($HCl$) has created a metabolic imbalance.
3. A client is receiving a continuous infusion of 3% Sodium Chloride (Hypertonic Saline).
Which assessment finding requires the nurse to stop the infusion immediately?
A) Increased urine output
B) New-onset crackles in the lung bases and shortness of breath
C) Dry mucous membranes
D) Serum sodium of 138 mEq/L
,Elaboration: Hypertonic solutions pull fluid rapidly into the vascular space. If the heart cannot
handle the increased preload, the client will develop acute pulmonary edema (manifested by
crackles).
4. A client has a positive Trousseau’s sign. The nurse should anticipate which electrolyte
replacement?
A) Potassium Chloride
B) Calcium Gluconate or Magnesium Sulfate
C) Sodium Chloride
D) Phosphate Binder
Elaboration: Trousseau's sign (carpal spasm with BP cuff inflation) indicates hypocalcemia or
hypomagnesemia, both of which increase neuromuscular excitability.
5. Which physiological mechanism does the body utilize as the fastest response to correct
a drop in blood pH?
A) Renal excretion of hydrogen ions
B) The respiratory system (increasing rate and depth of breaths)
C) Renal reabsorption of bicarbonate
D) Intracellular protein buffering
Elaboration: The respiratory system reacts within minutes to change the $CO_2$ level (acid).
The renal system is the most powerful buffer but takes 24–48 hours to fully respond.
Section 2: Advanced Oxygenation and Airway Management
6. A client with a tracheostomy requires suctioning. Which action by the nurse is
appropriate?
A) Applying suction while inserting the catheter.
B) Hyperoxygenating the client with 100% $O_2$ for 30–60 seconds before the
procedure.
C) Suctioning for a total of 30 seconds per pass.
D) Maintaining clean technique during the procedure.
Elaboration: Suctioning removes oxygen along with secretions. Hyperoxygenation prevents
procedure-induced hypoxia. Suction should never exceed 10–15 seconds.
, 7. A nurse observes "tidaling" in the water-seal chamber of a client's chest tube drainage
system. What is the nurse's interpretation?
A) There is a leak in the system.
B) The suction is set too high.
C) The system is functioning normally.
D) The lung has fully re-expanded.
Elaboration: Tidaling (the rise and fall of water with respirations) confirms that the chest tube
is patent and the pleural space is communicating with the drainage system. If tidaling stops,
the tube is either kinked or the lung has re-expanded.
8. A client is two hours postoperative following a thyroidectomy. The nurse hears high-
pitched, inspiratory stridor. What is the priority intervention?
A) Administer an oral analgesic.
B) Notify the surgeon and prepare for emergency tracheostomy.
C) Encourage the client to cough and deep breathe.
D) Lower the head of the bed to 15 degrees.
Elaboration: Stridor indicates acute laryngeal edema and impending upper airway
obstruction, a medical emergency following neck surgery.
9. Which oxygen delivery device is most appropriate for a client who requires a precise
$FiO_2$ of 24%?
A) Nasal Cannula
B) Venturi Mask
C) Simple Face Mask
D) Non-rebreather Mask
Elaboration: The Venturi mask is the only non-invasive device capable of delivering a specific,
fixed concentration of oxygen, making it ideal for clients with COPD.
10. A client with a chest tube is accidentally disconnected from the drainage unit. What is
the nurse’s immediate action?
A) Clamp the chest tube near the insertion site.
B) Submerge the end of the tube in 2 cm of sterile water.
C) Cover the site with an occlusive dressing.
