NR226 CJE FINAL EXAM
QUESTIONS AND ANSWER GUIDE WITH 100% CORRECT ANSWERS
Chamberlain University 2026 180 Questions with Answers and Rationales
1. What is the normal serum sodium range?
Answer: 135-145 mEq/L
Rationale: Sodium is the main extracellular cation. It controls water distribution between
cells and the vascular space and is needed for nerve and muscle impulse transmission.
2. What lab value and clinical findings indicate hypernatremia?
Answer: Serum sodium greater than 145 mEq/L; thirst, dry sticky mucous membranes,
restlessness, agitation, confusion, and seizures in severe cases.
Rationale: Excess sodium relative to water pulls fluid out of cells, shrinking brain cells and
producing neurologic signs. Causes include dehydration, inadequate water intake, and
excess sodium intake.
3. What lab value and clinical findings indicate hyponatremia?
Answer: Serum sodium less than 135 mEq/L; headache, confusion, nausea, muscle cramps,
lethargy, seizures, and coma.
Rationale: Low serum sodium (often from water intoxication, SIADH, or diuretics) causes
water to move into cells, producing cerebral edema.
4. Which safety measure does the nurse implement for a client with severe
hyponatremia?
Answer: Seizure precautions: bed in low position, padded side rails, suction and oxygen
available, frequent neurologic checks.
Rationale: Cerebral edema from low sodium lowers the seizure threshold, so protecting the
client from injury is the priority.
5. What is the normal total serum calcium range?
Answer: 9-10.5 mg/dL
Rationale: Calcium is needed for muscle contraction, blood clotting, nerve transmission,
and bone strength.
6. What are the causes and signs of hypercalcemia?
Answer: Greater than 10.5 mg/dL; caused by prolonged immobility, hyperparathyroidism,
and malignancy; signs are constipation, kidney stones (renal calculi), muscle weakness,
lethargy, and dysrhythmias.
Rationale: Immobility releases calcium from bone, and excess calcium depresses
neuromuscular excitability, slowing GI motility and muscle function.
,7. What are the signs of hypocalcemia?
Answer: Less than 9 mg/dL; tingling around the mouth and fingers, muscle cramps, tetany,
positive Chvostek and Trousseau signs, seizures, and prolonged QT interval.
Rationale: Low calcium makes nerves and muscles hyperexcitable.
8. How is Chvostek's sign elicited and what does it indicate?
Answer: Tap the facial nerve in front of the ear; twitching of the facial muscles is positive
and indicates hypocalcemia.
Rationale: Low calcium increases nerve irritability, so a light tap triggers muscle
contraction.
9. How is Trousseau's sign elicited and what does it indicate?
Answer: Inflate a blood pressure cuff above systolic pressure for 1-3 minutes; carpal spasm
(hand and wrist contraction) is positive and indicates hypocalcemia.
Rationale: Ischemia from the cuff unmasks latent tetany caused by low calcium.
10. What is the normal serum potassium range?
Answer: 3.5-5.0 mEq/L
Rationale: Potassium is the major intracellular cation and is essential for cardiac, skeletal,
and smooth muscle function and for the action potential.
11. What are the signs of hyperkalemia?
Answer: Greater than 5.0 mEq/L; muscle weakness, cramps, paresthesias, diarrhea, peaked
T waves, widened QRS, bradycardia, and cardiac arrest.
Rationale: Excess potassium disrupts membrane repolarization, and the heart is most at
risk. Causes include renal failure, Addison's disease, potassium-sparing diuretics, and excess
intake.
12. What are the signs of hypokalemia?
Answer: Less than 3.5 mEq/L; fatigue, muscle weakness, leg cramps, constipation or ileus,
shallow respirations, flattened T waves, U waves, and dysrhythmias.
Rationale: Low potassium impairs muscle contraction. Causes include loop diuretics,
vomiting, diarrhea, and NG suction.
13. What must the nurse verify before giving IV potassium?
Answer: That urine output is adequate (at least 30 mL/hr).
Rationale: The kidneys excrete potassium, so giving it to a client with poor urine output can
cause dangerous hyperkalemia.
14. Can potassium chloride be given by IV push?
Answer: No. It must be diluted and infused slowly with an infusion pump.
Rationale: IV push potassium can cause fatal cardiac arrest.
, 15. What is the action of sodium polystyrene sulfonate (Kayexalate)?
Answer: It removes potassium from the body through the GI tract; used to treat
hyperkalemia.
Rationale: The resin exchanges sodium for potassium in the bowel, and the potassium is
excreted in the stool.
16. What are the signs of hypovolemia (fluid volume deficit)?
Answer: Tachycardia, hypotension, weak thready pulse, decreased urine output, dry mucous
membranes, poor skin turgor, flat neck veins, and weight loss.
Rationale: Loss of fluid and electrolytes reduces circulating volume, and the heart
compensates by increasing rate.
17. What is the most accurate indicator of fluid balance?
Answer: Daily weight, taken at the same time, on the same scale, in similar clothing.
Rationale: One kilogram of weight change equals about 1 liter of fluid gained or lost.
18. What are the signs of fluid volume excess?
Answer: Weight gain, edema, crackles, bounding pulse, jugular vein distention,
hypertension, and dyspnea.
Rationale: Excess volume raises hydrostatic pressure, pushing fluid into tissues and the
lungs.
19. What is an isotonic IV solution, and what is it used for?
Answer: A fluid with the same osmolality as plasma (0.9% NaCl, lactated Ringer's); it
expands extracellular and vascular volume.
Rationale: There is no net movement of water in or out of cells, so isotonic fluids treat
hypovolemia and dehydration.
20. What is a hypotonic IV solution, and what is it used for?
Answer: A fluid less concentrated than plasma (0.45% NaCl); it moves water from the
vascular space into cells to hydrate them.
Rationale: Lower osmolality draws water into cells. Use cautiously because rapid shifts can
cause hypotension and cerebral edema.
21. What is a hypertonic IV solution, and what is it used for?
Answer: A fluid more concentrated than plasma (3% NaCl, D5 0.9% NaCl); it pulls water
from cells into the vascular space.
Rationale: Higher osmolality raises blood volume. Give slowly by pump with close
monitoring for fluid overload.
22. What is the normal arterial blood pH?
Answer: 7.35-7.45
Rationale: A pH below 7.35 is acidosis and above 7.45 is alkalosis.
QUESTIONS AND ANSWER GUIDE WITH 100% CORRECT ANSWERS
Chamberlain University 2026 180 Questions with Answers and Rationales
1. What is the normal serum sodium range?
Answer: 135-145 mEq/L
Rationale: Sodium is the main extracellular cation. It controls water distribution between
cells and the vascular space and is needed for nerve and muscle impulse transmission.
2. What lab value and clinical findings indicate hypernatremia?
Answer: Serum sodium greater than 145 mEq/L; thirst, dry sticky mucous membranes,
restlessness, agitation, confusion, and seizures in severe cases.
Rationale: Excess sodium relative to water pulls fluid out of cells, shrinking brain cells and
producing neurologic signs. Causes include dehydration, inadequate water intake, and
excess sodium intake.
3. What lab value and clinical findings indicate hyponatremia?
Answer: Serum sodium less than 135 mEq/L; headache, confusion, nausea, muscle cramps,
lethargy, seizures, and coma.
Rationale: Low serum sodium (often from water intoxication, SIADH, or diuretics) causes
water to move into cells, producing cerebral edema.
4. Which safety measure does the nurse implement for a client with severe
hyponatremia?
Answer: Seizure precautions: bed in low position, padded side rails, suction and oxygen
available, frequent neurologic checks.
Rationale: Cerebral edema from low sodium lowers the seizure threshold, so protecting the
client from injury is the priority.
5. What is the normal total serum calcium range?
Answer: 9-10.5 mg/dL
Rationale: Calcium is needed for muscle contraction, blood clotting, nerve transmission,
and bone strength.
6. What are the causes and signs of hypercalcemia?
Answer: Greater than 10.5 mg/dL; caused by prolonged immobility, hyperparathyroidism,
and malignancy; signs are constipation, kidney stones (renal calculi), muscle weakness,
lethargy, and dysrhythmias.
Rationale: Immobility releases calcium from bone, and excess calcium depresses
neuromuscular excitability, slowing GI motility and muscle function.
,7. What are the signs of hypocalcemia?
Answer: Less than 9 mg/dL; tingling around the mouth and fingers, muscle cramps, tetany,
positive Chvostek and Trousseau signs, seizures, and prolonged QT interval.
Rationale: Low calcium makes nerves and muscles hyperexcitable.
8. How is Chvostek's sign elicited and what does it indicate?
Answer: Tap the facial nerve in front of the ear; twitching of the facial muscles is positive
and indicates hypocalcemia.
Rationale: Low calcium increases nerve irritability, so a light tap triggers muscle
contraction.
9. How is Trousseau's sign elicited and what does it indicate?
Answer: Inflate a blood pressure cuff above systolic pressure for 1-3 minutes; carpal spasm
(hand and wrist contraction) is positive and indicates hypocalcemia.
Rationale: Ischemia from the cuff unmasks latent tetany caused by low calcium.
10. What is the normal serum potassium range?
Answer: 3.5-5.0 mEq/L
Rationale: Potassium is the major intracellular cation and is essential for cardiac, skeletal,
and smooth muscle function and for the action potential.
11. What are the signs of hyperkalemia?
Answer: Greater than 5.0 mEq/L; muscle weakness, cramps, paresthesias, diarrhea, peaked
T waves, widened QRS, bradycardia, and cardiac arrest.
Rationale: Excess potassium disrupts membrane repolarization, and the heart is most at
risk. Causes include renal failure, Addison's disease, potassium-sparing diuretics, and excess
intake.
12. What are the signs of hypokalemia?
Answer: Less than 3.5 mEq/L; fatigue, muscle weakness, leg cramps, constipation or ileus,
shallow respirations, flattened T waves, U waves, and dysrhythmias.
Rationale: Low potassium impairs muscle contraction. Causes include loop diuretics,
vomiting, diarrhea, and NG suction.
13. What must the nurse verify before giving IV potassium?
Answer: That urine output is adequate (at least 30 mL/hr).
Rationale: The kidneys excrete potassium, so giving it to a client with poor urine output can
cause dangerous hyperkalemia.
14. Can potassium chloride be given by IV push?
Answer: No. It must be diluted and infused slowly with an infusion pump.
Rationale: IV push potassium can cause fatal cardiac arrest.
, 15. What is the action of sodium polystyrene sulfonate (Kayexalate)?
Answer: It removes potassium from the body through the GI tract; used to treat
hyperkalemia.
Rationale: The resin exchanges sodium for potassium in the bowel, and the potassium is
excreted in the stool.
16. What are the signs of hypovolemia (fluid volume deficit)?
Answer: Tachycardia, hypotension, weak thready pulse, decreased urine output, dry mucous
membranes, poor skin turgor, flat neck veins, and weight loss.
Rationale: Loss of fluid and electrolytes reduces circulating volume, and the heart
compensates by increasing rate.
17. What is the most accurate indicator of fluid balance?
Answer: Daily weight, taken at the same time, on the same scale, in similar clothing.
Rationale: One kilogram of weight change equals about 1 liter of fluid gained or lost.
18. What are the signs of fluid volume excess?
Answer: Weight gain, edema, crackles, bounding pulse, jugular vein distention,
hypertension, and dyspnea.
Rationale: Excess volume raises hydrostatic pressure, pushing fluid into tissues and the
lungs.
19. What is an isotonic IV solution, and what is it used for?
Answer: A fluid with the same osmolality as plasma (0.9% NaCl, lactated Ringer's); it
expands extracellular and vascular volume.
Rationale: There is no net movement of water in or out of cells, so isotonic fluids treat
hypovolemia and dehydration.
20. What is a hypotonic IV solution, and what is it used for?
Answer: A fluid less concentrated than plasma (0.45% NaCl); it moves water from the
vascular space into cells to hydrate them.
Rationale: Lower osmolality draws water into cells. Use cautiously because rapid shifts can
cause hypotension and cerebral edema.
21. What is a hypertonic IV solution, and what is it used for?
Answer: A fluid more concentrated than plasma (3% NaCl, D5 0.9% NaCl); it pulls water
from cells into the vascular space.
Rationale: Higher osmolality raises blood volume. Give slowly by pump with close
monitoring for fluid overload.
22. What is the normal arterial blood pH?
Answer: 7.35-7.45
Rationale: A pH below 7.35 is acidosis and above 7.45 is alkalosis.
