Potassium, because your heart likes rhythm, not freestyle.
Which lab value requires immediate intervention?
A. K⁺ 3.8
B. K⁺ 5.0
C. K⁺ 6.2
D. K⁺ 4.2
C. K. 6.2
Rationale: >6.0 = dangerous → risk for lethal arrhythmias.
Which IV solution is considered isotonic?
A. 0.45% NaCl
B. 3% NaCl
C. 0.9% NaCl
D. D5W (after metabolism)
C. 0.9% NaCL (Normal Saline)
Rationale:
A nurse is teaching a client about calcium intake. Which food is the best source of calcium?
A. White rice
B. Spinach
C. Chicken breast
D. Apples
B. Spinach
Rationale: Leafy green vegetables like spinach are good sources of calcium compared to the other options.
Which patient is at highest risk for AKI?
A. Young athlete
B. Older adult with dehydration
C. Child with infection
D. Pregnant patient
B. Older adult with dehydration.
Rationale: Older adults + dehydration → decreased perfusion → pre-renal AKI.
A patient has absent deep tendon reflexes. Which electrolyte imbalance is most likely?
A. Hypocalcemia
B. Hypermagnesemia
C. Hypokalemia
D. Hypernatremia
B. Hypermagnesemia
Rationale:
Magnesium acts as a CNS depressant → high levels cause:
A patient with hypokalemia may exhibit:
A. Diarrhea
B. Muscle weakness
C. Peaked T waves
D. Bradycardia
B. Muscle weakness
Rationale: Low potassium → decreased muscle function, including respiratory muscles.
A patient with sodium 122 mEq/L is confused and lethargic. What is the priority intervention?
A. Restrict fluids
B. Administer hypertonic saline
C. Encourage oral fluids
D. Give loop diuretics
B. Administer hypertonic saline
Severe hyponatremia + neuro symptoms = hypertonic saline treatment
Which serum calcium level should the nurse recognize as low?
A. 8.2 mg/dL
B. 9.5 mg/dL
C. 10.1 mg/dL
D. 10.8 mg/dL
A. 8.2 mg/dL
Rationale: Normal calcium is about 8.5–10.5 mg/dL; 8.2 is low.
Which is a hallmark of AKI?
A. Gradual onset
B. Irreversible damage
C. Sudden decline in kidney function
D. Lifelong dialysis
C. Sudden decline in kidney function
Rationale: AKI = abrupt, potentially reversible kidney injury.
Which assessment finding indicates fluid volume excess?
A. Flat neck veins
B. Hypotension
C. Crackles in lungs
D. Weak pulses
C. Crackles in lungs
Which action should the nurse take first for potassium 6.8?
A. Administer Kayexalate
B. Give Calcium gGuconate
C. Restrict potassium
D. Monitor labs
B. Give Calcium Gluconate
Rationale: Calcium gluconate stabilizes the cardiac membrane immediately → priority before shifting/removing K⁺.
A patient with hypernatremia is most likely to exhibit:
A. Confusion
B. Seizures
C. Muscle weakness
D. All of the above
D. All of the above
Rationale: Hypernatremia causes neuro changes due to cellular dehydration → confusion, seizures, weakness.
A client with hypocalcemia is most at risk for which complication?
A. Bradycardia
B. Muscle spasms
C. Constipation
D. Hypotension
B. Muscle spasms
Rationale: Low calcium increases neuromuscular excitability, leading to tetany and spasms.
Which lab trend suggests CKD progression?
A. Creatinine returns to baseline
B. Persistent elevated Creatinine
C. Sudden potassium spike
D. Temporary oliguria
B. Persistent elevated Creatinine.
Rationale: CKD = chronic, sustained elevation in creatinine.
A patient has dry mucous membranes, tachycardia, and decreased urine output. Which condition is most likely?
A. Fluid volume excess
B. Fluid volume deficit
C. SIADH
D. Hypernatremia
B. Fluid volume deficit
Which ECG changes are seen in hypokalemia? Select all that apply.
A. U waves
B. Flattened T waves
C. Peaked T waves
D. ST depression
E. Wide QRS
A- U waves, B- Flattened T waves, D- ST depression
Hypokalemia = U waves, flat T waves, ST depression
Peaked T waves = hyperkalemia
Which intervention is appropriate for mild hyponatremia without severe symptoms?
A. Hypertonic saline
B. Fluid restriction
C. Rapid IV fluids
D. Dialysis
B. Fluid Restriction
Rationale: Mild cases = restrict fluids to prevent further dilution. Hypertonic saline is for severe cases.
A nurse is caring for a client with acute hypocalcemia. Which assessment finding requires immediate intervention?
A. Tingling around the mouth
B. Positive Chvostek’s sign
C. Stridor and laryngeal spasms
D. Muscle cramps in the legs
C. Stridor and laryngeal spasms
Rationale: Airway compromise is life-threatening and requires immediate action.
Which findings are consistent with CKD? Select all that apply.
A. Chronic anemia
B. Hyperphosphatemia
C. Hypocalcemia
D. Sudden oliguria
E. Long-term hypertension
A- Chronic anemia, B- Hyperphosphatemia, C- Hypocalcemia, E- Long-term hypertension
Rationale:
CKD = chronic changes
Electrolyte imbalance: ↑ phosphate, ↓ calcium
Anemia from ↓ erythropoietin
Oliguria is more acute (AKI)
Which intervention is appropriate for a patient with hypermagnesemia?
A. Administer Magnesium Sulfate
B. Encourage foods high in magnesium
C. Administer Calcium Gluconate
D. Restrict calcium intake
C. Administer Calcium Gluconate
Rationale:
Calcium antagonizes magnesium, helping reverse symptoms like respiratory depression and cardiac issues.
Which interventions are appropriate for hyperkalemia? (Select all that apply)
A. Administer insulin & glucose
B. Give Sodium Polystyrene Sulfonate
C. Administer Calcium Gluconate
D. Encourage potassium-rich foods
E. Give IV magnesium
A- Administer insulin & glucose, B- Give Sodium Polystyrene Sulfonate, C- Administer Calcium Gluconate
Rationale:
Stabilize heart (calcium), shift K⁺ (insulin), remove K⁺ (Kayexalate)
Which symptoms are associated with hyponatremia? Select all that apply.
A. Headache
B. Confusion
C. Seizures
D. Increased thirst
E. Bradycardia
A- Headache, B- Confusion, C- Seizures
Rationale: Low sodium causes brain swelling → neuro symptoms. Thirst is more common in hypernatremia.
A client has hypocalcemia and is experiencing muscle twitching and a positive Trousseau’s sign. What is the nurse’s priority action?
A. Place the client on seizure precautions
B. Administer oral calcium supplements
C. Encourage high-fiber diet
D. Restrict fluid intake
A. Place the client on seizure precautions.
Rationale: Neuromuscular irritability increases risk of seizures; safety is the priority.
Which nursing actions are appropriate for AKI? Select all that apply.
A. Monitor intake/output
B. Daily weights
C. Restrict fluids (if ordered)
D. Administer nephrotoxic drugs
E. Monitor potassium
A-Monitor intake/output, B- Daily weights, C- Restrict fluids, E- Monitor potassium.
Rationale:
Track fluid status closely
Avoid nephrotoxins
Monitor potassium due to retention risk
Which are signs of fluid volume deficit? (Select all that apply)
A. Tachycardia
B. Dry mucous membranes
C. Bounding pulses
D. Decreased urine output
E. Hypertension
A, B, D
Rationale:
Tachycardia = compensation
Dry mucous membranes = dehydration
↓ urine output = kidneys conserving fluid
Bounding pulses & HTN = fluid excess