NUR 254 EXAM 2 | 50 Questions and
Answers | 2025 Update | 100% Correct-
Galen College of Nursing.
SECTION I: FLUIDS, ELECTROLYTES & ACID-BASE BALANCE
1. A client is admitted with prolonged vomiting. Which acid-base imbalance should the nurse
anticipate?
A. Metabolic acidosis
B. Metabolic alkalosis
C. Respiratory acidosis
D. Respiratory alkalosis
Correct Answer: B
Vomiting causes loss of gastric hydrochloric acid (H⁺ and Cl⁻), leading to metabolic alkalosis.
ABGs typically show elevated pH (>7.45) and elevated HCO₃⁻ (>26 mEq/L).
2. Which client is at greatest risk for hyperkalemia?
A. Client with nasogastric suction
B. Client taking furosemide daily
C. Client with acute kidney injury receiving ACE inhibitors
D. Client with excessive diaphoresis
Correct Answer: C
ACE inhibitors reduce aldosterone secretion, decreasing potassium excretion; combined
with AKI (impaired renal excretion), hyperkalemia risk is high. Options A and B cause potassium
loss; D causes sodium/water loss primarily.
3. A client's ABG: pH 7.28, PaCO₂ 52, HCO₃⁻ 24. The nurse interprets this as:
A. Respiratory acidosis
B. Respiratory alkalosis
,C. Metabolic acidosis
D. Metabolic alkalosis
Correct Answer: A
Low pH with elevated PaCO₂ and normal HCO₃⁻ indicates acute respiratory acidosis
(hypoventilation). The kidneys have not yet compensated.
4. Which assessment finding is most consistent with hypocalcemia?
A. Decreased deep tendon reflexes
B. Positive Trousseau's sign
C. Bradycardia with hypertension
D. Polyuria and polydipsia
Correct Answer: B
Trousseau's sign (carpal spasm with BP cuff inflation) and Chvostek's sign indicate
neuromuscular irritability of hypocalcemia. Hypercalcemia causes decreased reflexes and
polyuria.
5. A client receiving IV potassium chloride reports burning at the site. What is the nurse's
priority action?
A. Stop the infusion permanently and notify the provider
B. Slow the infusion rate and assess the IV site
C. Increase the rate to finish the infusion faster
D. Massage the site vigorously
Correct Answer: B
KCl should never exceed 10 mEq/hr peripherally and must always be diluted. Slowing the
rate and assessing for infiltration/phlebitis is priority. Never give KCl IV push.
6. SATA — Which clients are at risk for fluid volume deficit? (Select all that apply.)
A. Client with severe diarrhea
B. Client with third-degree burns over 30% TBSA
C. Client with heart failure on fluid restriction
D. Client with prolonged fever and diaphoresis
,E. Client receiving continuous bladder irrigation
F. Client with syndrome of inappropriate ADH (SIADH)
Correct Answer: A, B, D
Diarrhea, major burns, and fever/diaphoresis all cause significant fluid loss. Heart failure
and SIADH cause fluid excess; bladder irrigation is an instillation, not a loss.
7. The nurse notes a client has a positive Chvostek's sign after thyroidectomy. Which
intervention is priority?
A. Administer sodium bicarbonate
B. Prepare to administer IV calcium gluconate
C. Restrict dietary calcium
D. Place the client on seizure precautions only
Correct Answer: B
Post-thyroidectomy hypocalcemia (parathyroid injury) causes neuromuscular irritability. IV
calcium gluconate treats symptomatic hypocalcemia. Seizure precautions are supportive, not
definitive.
8. Which IV solution is isotonic?
A. 0.45% NaCl
B. 3% NaCl
C. Lactated Ringer's
D. 0.225% NaCl
Correct Answer: C
LR (273 mOsm/L) is isotonic. 0.45% and 0.225% NaCl are hypotonic; 3% NaCl is hypertonic.
9. A client with severe metabolic acidosis has a pH of 7.15. Which compensation does the nurse
expect?
A. Hypoventilation with CO₂ retention
B. Hyperventilation with CO₂ blowing off
C. Renal retention of hydrogen ions
D. Renal excretion of bicarbonate
, Correct Answer: B
The respiratory system compensates for metabolic acidosis via hyperventilation (Kussmaul
respirations), lowering PaCO₂.
10. Which finding indicates fluid volume excess?
A. Flat neck veins when supine
B. Bibasilar crackles and jugular venous distention
C. Urine output of 50 mL/hr
D. Poor skin turgor
Correct Answer: B
Crackles and JVD are classic signs of fluid overload. Poor skin turgor and flat neck veins
indicate deficit.
11. A client has a serum sodium of 118 mEq/L. Which is the priority nursing concern?
A. Hyperactive reflexes
B. Seizure activity
C. Hypertension
D. Polyuria
Correct Answer: B
Severe hyponatremia (<120 mEq/L) causes cerebral edema and seizures. Sodium must be
corrected slowly (no more than 8–10 mEq/L in 24 hr) to avoid osmotic demyelination.
12. SATA — Which interventions are appropriate for a client with hyperkalemia? (Select all that
apply.)
A. Administer IV calcium gluconate
B. Administer regular insulin with dextrose
C. Administer sodium polystyrene sulfonate
D. Administer additional IV potassium
E. Prepare for dialysis if refractory
F. Restrict dietary sodium
Answers | 2025 Update | 100% Correct-
Galen College of Nursing.
SECTION I: FLUIDS, ELECTROLYTES & ACID-BASE BALANCE
1. A client is admitted with prolonged vomiting. Which acid-base imbalance should the nurse
anticipate?
A. Metabolic acidosis
B. Metabolic alkalosis
C. Respiratory acidosis
D. Respiratory alkalosis
Correct Answer: B
Vomiting causes loss of gastric hydrochloric acid (H⁺ and Cl⁻), leading to metabolic alkalosis.
ABGs typically show elevated pH (>7.45) and elevated HCO₃⁻ (>26 mEq/L).
2. Which client is at greatest risk for hyperkalemia?
A. Client with nasogastric suction
B. Client taking furosemide daily
C. Client with acute kidney injury receiving ACE inhibitors
D. Client with excessive diaphoresis
Correct Answer: C
ACE inhibitors reduce aldosterone secretion, decreasing potassium excretion; combined
with AKI (impaired renal excretion), hyperkalemia risk is high. Options A and B cause potassium
loss; D causes sodium/water loss primarily.
3. A client's ABG: pH 7.28, PaCO₂ 52, HCO₃⁻ 24. The nurse interprets this as:
A. Respiratory acidosis
B. Respiratory alkalosis
,C. Metabolic acidosis
D. Metabolic alkalosis
Correct Answer: A
Low pH with elevated PaCO₂ and normal HCO₃⁻ indicates acute respiratory acidosis
(hypoventilation). The kidneys have not yet compensated.
4. Which assessment finding is most consistent with hypocalcemia?
A. Decreased deep tendon reflexes
B. Positive Trousseau's sign
C. Bradycardia with hypertension
D. Polyuria and polydipsia
Correct Answer: B
Trousseau's sign (carpal spasm with BP cuff inflation) and Chvostek's sign indicate
neuromuscular irritability of hypocalcemia. Hypercalcemia causes decreased reflexes and
polyuria.
5. A client receiving IV potassium chloride reports burning at the site. What is the nurse's
priority action?
A. Stop the infusion permanently and notify the provider
B. Slow the infusion rate and assess the IV site
C. Increase the rate to finish the infusion faster
D. Massage the site vigorously
Correct Answer: B
KCl should never exceed 10 mEq/hr peripherally and must always be diluted. Slowing the
rate and assessing for infiltration/phlebitis is priority. Never give KCl IV push.
6. SATA — Which clients are at risk for fluid volume deficit? (Select all that apply.)
A. Client with severe diarrhea
B. Client with third-degree burns over 30% TBSA
C. Client with heart failure on fluid restriction
D. Client with prolonged fever and diaphoresis
,E. Client receiving continuous bladder irrigation
F. Client with syndrome of inappropriate ADH (SIADH)
Correct Answer: A, B, D
Diarrhea, major burns, and fever/diaphoresis all cause significant fluid loss. Heart failure
and SIADH cause fluid excess; bladder irrigation is an instillation, not a loss.
7. The nurse notes a client has a positive Chvostek's sign after thyroidectomy. Which
intervention is priority?
A. Administer sodium bicarbonate
B. Prepare to administer IV calcium gluconate
C. Restrict dietary calcium
D. Place the client on seizure precautions only
Correct Answer: B
Post-thyroidectomy hypocalcemia (parathyroid injury) causes neuromuscular irritability. IV
calcium gluconate treats symptomatic hypocalcemia. Seizure precautions are supportive, not
definitive.
8. Which IV solution is isotonic?
A. 0.45% NaCl
B. 3% NaCl
C. Lactated Ringer's
D. 0.225% NaCl
Correct Answer: C
LR (273 mOsm/L) is isotonic. 0.45% and 0.225% NaCl are hypotonic; 3% NaCl is hypertonic.
9. A client with severe metabolic acidosis has a pH of 7.15. Which compensation does the nurse
expect?
A. Hypoventilation with CO₂ retention
B. Hyperventilation with CO₂ blowing off
C. Renal retention of hydrogen ions
D. Renal excretion of bicarbonate
, Correct Answer: B
The respiratory system compensates for metabolic acidosis via hyperventilation (Kussmaul
respirations), lowering PaCO₂.
10. Which finding indicates fluid volume excess?
A. Flat neck veins when supine
B. Bibasilar crackles and jugular venous distention
C. Urine output of 50 mL/hr
D. Poor skin turgor
Correct Answer: B
Crackles and JVD are classic signs of fluid overload. Poor skin turgor and flat neck veins
indicate deficit.
11. A client has a serum sodium of 118 mEq/L. Which is the priority nursing concern?
A. Hyperactive reflexes
B. Seizure activity
C. Hypertension
D. Polyuria
Correct Answer: B
Severe hyponatremia (<120 mEq/L) causes cerebral edema and seizures. Sodium must be
corrected slowly (no more than 8–10 mEq/L in 24 hr) to avoid osmotic demyelination.
12. SATA — Which interventions are appropriate for a client with hyperkalemia? (Select all that
apply.)
A. Administer IV calcium gluconate
B. Administer regular insulin with dextrose
C. Administer sodium polystyrene sulfonate
D. Administer additional IV potassium
E. Prepare for dialysis if refractory
F. Restrict dietary sodium
