SAUNDERS NCLEX-PN1 EXAM 3
FLUID/ELECTROLYTES ACID/BASE QUESTIONS
AND EXPERT ANSWERS GUARANTEED PASS A
GRADED 2023-2024
The nurse is caring for a client with heart failure. On assessment, the nurse notes that the client is
dyspneic and crackles are audible on auscultation. What additional signs would the nurse expect
to note in this client if excess fluid volume is present?
a. Weight loss
b. Flat neck and hand veins
c. An increase in blood pressure
d. Decreased central venous pressure (CVP)
c. An increase in blood pressure
Rationale:
Assessment findings associated with fluid volume excess include cough, dyspnea, crackles,
tachypnea, tachycardia, elevated blood pressure, bounding pulse, elevated CVP, weight gain,
edema, neck and hand vein distention, altered level of consciousness, and decreased hematocrit.
The remaining options identify signs noted in fluid volume deficit.
The nurse is preparing to care for a client with a potassium deficit. The nurse reviews the client's
record and determines that the client was at risk for developing the potassium deficit because of
which situation?
a. Sustained tissue damage
b. Requires nasogastric suction
c. Has a history of Addison's disease
d. Is taking a potassium-retaining diuretic
b. Requires nasogastric suction
Rationale:
Potassium-rich gastrointestinal fluids are lost through gastrointestinal suction, placing the client
at risk for hypokalemia. The client with tissue damage or Addison's disease and the client taking
a potassium-retaining diuretic are at risk for hyperkalemia.
The nurse reviews a client's electrolyte laboratory report and notes that the potassium level is 2.5
mEq/L. Which pattern would the nurse note on the electrocardiogram as a result of the laboratory
value?
a. U waves
b. Absent P waves
,c. Elevated T waves
d. Elevated ST segment
a. U waves
Rationale:
Electrocardiographic changes include inverted T waves, ST segment depression, and prominent
U waves. Absent P waves are not a characteristic of hypokalemia but may be noted in a client
with atrial fibrillation, junctional rhythms, or ventricular rhythms.
The nurse provides instructions to a client with a low potassium level about the foods that are
high in potassium and tells the client to consume which foods? Select all that apply.
a. Peas
b. Raisins
c. Potatoes
d. Cantaloupe
e. Cauliflower
f. Strawberries
b. Raisins
c. Potatoes
d. Cantaloupe
f. Strawberries
Rationale:
Common food sources of potassium include avocado, bananas, cantaloupe, carrots, fish,
mushrooms, oranges, potatoes, pork, beef, veal, raisins, spinach, strawberries, and tomatoes.
Peas and cauliflower are high in magnesium.
The nurse is reviewing laboratory results and notes that a client's serum sodium level is 150
mEq/L. The nurse reports the serum sodium level to the health care provider (HCP) and the HCP
prescribes dietary instructions based on the sodium level. Which food item does the nurse
instruct the client to avoid?
a. Peas
b. Nuts
c. Cauliflower
d. Processed oat cereals
d. Processed oat cereals
Rationale:
A serum sodium level of 150 mEq/L indicates hypernatremia. On the basis of this finding, the
nurse would instruct the client to avoid foods high in sodium. Nuts, cauliflower, and peas are
good food sources of phosphorus. Peas are also a good source of magnesium. Processed foods
are high in sodium content.
The nurse is assessing a client with a suspected diagnosis of hypocalcemia. Which clinical
manifestation would the nurse expect to note in the client?
a. Twitching
,b. Hypoactive bowel sounds
c. Negative Trousseau's sign
d. Hypoactive deep tendon reflexes
a. Twitching
Rationale:
Signs of hypocalcemia include paresthesias followed by numbness, hyperactive deep tendon
reflexes, and a positive Trousseau's or Chvostek's sign. Additional signs of hypocalcemia include
increased neuromuscular excitability, muscle cramps, twitching, tetany, seizures, irritability, and
anxiety. Gastrointestinal symptoms include increased gastric motility, hyperactive bowel sounds,
abdominal cramping, and diarrhea.
The nurse caring for a client with hypocalcemia would expect to note which change on the
electrocardiogram (ECG)?
a. Widened T wave
b. Prominent U wave
c. Prolonged QT interval
d. Shortened ST segment
c. Prolonged QT interval
Rationale:
Electrocardiographic changes that occur in a client with hypocalcemia include a prolonged ST or
QT interval. A shortened ST segment and a widened T wave occur with hypercalcemia.
Prominent U waves occur with hypokalemia.
The nurse reviews the electrolyte results of an assigned client and notes that the potassium level
is 5.7 mEq/L. Which finding would the nurse expect to note on the electrocardiogram as a result
of the laboratory value?
a. ST depression
b. Inverted T wave
c. Prominent U wave
d. Tall peaked T waves
d. Tall peaked T waves
Rationale:
Electrocardiographic changes associated with hyperkalemia include flat P waves, prolonged PR
intervals, widened QRS complexes, and tall peaked T waves.
The nurse caring for a group of clients reviews the electrolyte laboratory results and notes a
sodium level of 130 mEq/L on one client's laboratory report. The nurse understands that which
client is at highest risk for the development of a sodium value at this level?
a. The client who is taking diuretics
b. The client with hyperaldosteronism
c. The client with Cushing's syndrome
d. The client who is taking corticosteroids
, a. The client who is taking diuretics
Rationale:
Hyponatremia can occur in the client taking diuretics. The client taking corticosteroids and the
client with hyperaldosteronism or Cushing's syndrome are at risk for hypernatremia.
The nurse is caring for a client with heart failure who is receiving high doses of a diuretic. On
assessment, the nurse notes that the client has flat neck veins, generalized muscle weakness, and
diminished deep tendon reflexes. The nurse suspects hyponatremia. What additional signs would
the nurse expect to note in a client with hyponatremia?
a. Muscle twitches
b. Decreased urinary output
c. Hyperactive bowel sounds
d. Increased specific gravity of the urine
c. Hyperactive bowel sounds
Rationale:
Hyperactive bowel sounds indicate hyponatremia. The remaining options are signs of
hypernatremia. In hyponatremia, muscle weakness, increased urinary output, and decreased
specific gravity of the urine would be noted.
The nurse reviews a client's laboratory report and notes that the client's serum phosphorus level
is 2 mg/dL. Which condition most likely caused this serum phosphorus level?
a. Alcoholism
b. Renal insufficiency
c. Hypoparathyroidism
d. Tumor lysis syndrome
a. Alcoholism
Rationale:
Causative factors relate to malnutrition or starvation and the use of aluminum hydroxide-based
or magnesium-based antacids. Malnutrition is associated with alcoholism. Renal insufficiency,
hypoparathyroidism, and tumor lysis syndrome are causative factors of hyperphosphatemia.
The nurse is reading a health care provider's (HCP) progress notes in the client's record and reads
that the HCP has documented "insensible fluid loss of approximately 800 mL daily." The nurse
interprets that this type of fluid loss can occur through which route?
a. The skin
b. Urinary output
c. Wound drainage
d. The gastrointestinal tract
a. The skin
Rationale:
Insensible losses occur daily through the skin and the lungs. Sensible losses are those of which
the person is aware, such as through urination, wound drainage, and gastrointestinal tract losses.
FLUID/ELECTROLYTES ACID/BASE QUESTIONS
AND EXPERT ANSWERS GUARANTEED PASS A
GRADED 2023-2024
The nurse is caring for a client with heart failure. On assessment, the nurse notes that the client is
dyspneic and crackles are audible on auscultation. What additional signs would the nurse expect
to note in this client if excess fluid volume is present?
a. Weight loss
b. Flat neck and hand veins
c. An increase in blood pressure
d. Decreased central venous pressure (CVP)
c. An increase in blood pressure
Rationale:
Assessment findings associated with fluid volume excess include cough, dyspnea, crackles,
tachypnea, tachycardia, elevated blood pressure, bounding pulse, elevated CVP, weight gain,
edema, neck and hand vein distention, altered level of consciousness, and decreased hematocrit.
The remaining options identify signs noted in fluid volume deficit.
The nurse is preparing to care for a client with a potassium deficit. The nurse reviews the client's
record and determines that the client was at risk for developing the potassium deficit because of
which situation?
a. Sustained tissue damage
b. Requires nasogastric suction
c. Has a history of Addison's disease
d. Is taking a potassium-retaining diuretic
b. Requires nasogastric suction
Rationale:
Potassium-rich gastrointestinal fluids are lost through gastrointestinal suction, placing the client
at risk for hypokalemia. The client with tissue damage or Addison's disease and the client taking
a potassium-retaining diuretic are at risk for hyperkalemia.
The nurse reviews a client's electrolyte laboratory report and notes that the potassium level is 2.5
mEq/L. Which pattern would the nurse note on the electrocardiogram as a result of the laboratory
value?
a. U waves
b. Absent P waves
,c. Elevated T waves
d. Elevated ST segment
a. U waves
Rationale:
Electrocardiographic changes include inverted T waves, ST segment depression, and prominent
U waves. Absent P waves are not a characteristic of hypokalemia but may be noted in a client
with atrial fibrillation, junctional rhythms, or ventricular rhythms.
The nurse provides instructions to a client with a low potassium level about the foods that are
high in potassium and tells the client to consume which foods? Select all that apply.
a. Peas
b. Raisins
c. Potatoes
d. Cantaloupe
e. Cauliflower
f. Strawberries
b. Raisins
c. Potatoes
d. Cantaloupe
f. Strawberries
Rationale:
Common food sources of potassium include avocado, bananas, cantaloupe, carrots, fish,
mushrooms, oranges, potatoes, pork, beef, veal, raisins, spinach, strawberries, and tomatoes.
Peas and cauliflower are high in magnesium.
The nurse is reviewing laboratory results and notes that a client's serum sodium level is 150
mEq/L. The nurse reports the serum sodium level to the health care provider (HCP) and the HCP
prescribes dietary instructions based on the sodium level. Which food item does the nurse
instruct the client to avoid?
a. Peas
b. Nuts
c. Cauliflower
d. Processed oat cereals
d. Processed oat cereals
Rationale:
A serum sodium level of 150 mEq/L indicates hypernatremia. On the basis of this finding, the
nurse would instruct the client to avoid foods high in sodium. Nuts, cauliflower, and peas are
good food sources of phosphorus. Peas are also a good source of magnesium. Processed foods
are high in sodium content.
The nurse is assessing a client with a suspected diagnosis of hypocalcemia. Which clinical
manifestation would the nurse expect to note in the client?
a. Twitching
,b. Hypoactive bowel sounds
c. Negative Trousseau's sign
d. Hypoactive deep tendon reflexes
a. Twitching
Rationale:
Signs of hypocalcemia include paresthesias followed by numbness, hyperactive deep tendon
reflexes, and a positive Trousseau's or Chvostek's sign. Additional signs of hypocalcemia include
increased neuromuscular excitability, muscle cramps, twitching, tetany, seizures, irritability, and
anxiety. Gastrointestinal symptoms include increased gastric motility, hyperactive bowel sounds,
abdominal cramping, and diarrhea.
The nurse caring for a client with hypocalcemia would expect to note which change on the
electrocardiogram (ECG)?
a. Widened T wave
b. Prominent U wave
c. Prolonged QT interval
d. Shortened ST segment
c. Prolonged QT interval
Rationale:
Electrocardiographic changes that occur in a client with hypocalcemia include a prolonged ST or
QT interval. A shortened ST segment and a widened T wave occur with hypercalcemia.
Prominent U waves occur with hypokalemia.
The nurse reviews the electrolyte results of an assigned client and notes that the potassium level
is 5.7 mEq/L. Which finding would the nurse expect to note on the electrocardiogram as a result
of the laboratory value?
a. ST depression
b. Inverted T wave
c. Prominent U wave
d. Tall peaked T waves
d. Tall peaked T waves
Rationale:
Electrocardiographic changes associated with hyperkalemia include flat P waves, prolonged PR
intervals, widened QRS complexes, and tall peaked T waves.
The nurse caring for a group of clients reviews the electrolyte laboratory results and notes a
sodium level of 130 mEq/L on one client's laboratory report. The nurse understands that which
client is at highest risk for the development of a sodium value at this level?
a. The client who is taking diuretics
b. The client with hyperaldosteronism
c. The client with Cushing's syndrome
d. The client who is taking corticosteroids
, a. The client who is taking diuretics
Rationale:
Hyponatremia can occur in the client taking diuretics. The client taking corticosteroids and the
client with hyperaldosteronism or Cushing's syndrome are at risk for hypernatremia.
The nurse is caring for a client with heart failure who is receiving high doses of a diuretic. On
assessment, the nurse notes that the client has flat neck veins, generalized muscle weakness, and
diminished deep tendon reflexes. The nurse suspects hyponatremia. What additional signs would
the nurse expect to note in a client with hyponatremia?
a. Muscle twitches
b. Decreased urinary output
c. Hyperactive bowel sounds
d. Increased specific gravity of the urine
c. Hyperactive bowel sounds
Rationale:
Hyperactive bowel sounds indicate hyponatremia. The remaining options are signs of
hypernatremia. In hyponatremia, muscle weakness, increased urinary output, and decreased
specific gravity of the urine would be noted.
The nurse reviews a client's laboratory report and notes that the client's serum phosphorus level
is 2 mg/dL. Which condition most likely caused this serum phosphorus level?
a. Alcoholism
b. Renal insufficiency
c. Hypoparathyroidism
d. Tumor lysis syndrome
a. Alcoholism
Rationale:
Causative factors relate to malnutrition or starvation and the use of aluminum hydroxide-based
or magnesium-based antacids. Malnutrition is associated with alcoholism. Renal insufficiency,
hypoparathyroidism, and tumor lysis syndrome are causative factors of hyperphosphatemia.
The nurse is reading a health care provider's (HCP) progress notes in the client's record and reads
that the HCP has documented "insensible fluid loss of approximately 800 mL daily." The nurse
interprets that this type of fluid loss can occur through which route?
a. The skin
b. Urinary output
c. Wound drainage
d. The gastrointestinal tract
a. The skin
Rationale:
Insensible losses occur daily through the skin and the lungs. Sensible losses are those of which
the person is aware, such as through urination, wound drainage, and gastrointestinal tract losses.
