Week 7 — Fluid Volume Imbalances & Regulatory Mechanisms (Nos.

1–25)

1. A client with congestive heart failure has gained 3 kg in 3 days. Which assessment finding best indicates
acute fluid retention?
A. Serum albumin 3.8 g/dL
B. Peripheral edema with pitting +3
C. Urine output 1,200 mL/24 hr
D. Oral mucous membranes moist
2. The nurse suspects hypervolemia in a postoperative patient. Which vital sign change is most consistent
with hypervolemia?
A. Temp 38.3°C (100.9°F)
B. Pulse 56 beats/min and regular
C. BP 150/95 mm Hg and bounding pulses
D. Respirations 10 breaths/min, shallow
3. A client with dehydration from gastroenteritis has weak, thready pulses and flat neck veins when supine.
Which IV order is highest priority?
A. D5W at 75 mL/hr
B. 0.9% sodium chloride bolus 500 mL IV STAT
C. Lactated Ringer’s 50 mL/hr
D. 0.45% sodium chloride 100 mL/hr
4. Which laboratory value would the nurse expect with isotonic fluid loss (e.g., hemorrhage)?
A. Increased hematocrit
B. Decreased serum sodium
C. Decreased blood urea nitrogen (BUN)
D. Decreased hemoglobin and hematocrit
5. A patient receiving a continuous infusion of intravenous albumin (25%) develops sudden shortness of
breath and tachycardia. What is the nurse’s most appropriate immediate action?
A. Slow the infusion rate and notify provider
B. Stop the infusion and assess respiratory status
C. Administer a diuretic as ordered
D. Reposition supine and check albumin vial
6. Which acid–base change is expected with severe vomiting (loss of gastric acid)?
A. Respiratory acidosis
B. Metabolic alkalosis
C. Metabolic acidosis
D. Respiratory alkalosis
7. A patient has a positive orthostatic blood pressure reading (drop >20 mm Hg systolic) and tachycardia
when moving from supine to standing. Which fluid imbalance does this indicate?
A. Hypervolemia
B. Hypovolemia (fluid volume deficit)
C. Euvolemia
D. Third-spacing
8. A nurse is teaching a patient with heart failure about low-sodium diet. Which canned food is best to
avoid?
A. Fresh peaches
B. Canned chicken noodle soup
C. Frozen green beans
D. Canned pineapple
9. A client receiving a potassium-sparing diuretic complains of muscle weakness and palpitations. Which
serum laboratory should the nurse check first?
A. Sodium
B. Potassium
C. Calcium
D. Magnesium
10. The physician orders 3% hypertonic saline for a patient with symptomatic hyponatremia. What is the
major nursing concern during infusion?
A. Hypoventilation
B. Central pontine myelinolysis (osmotic demyelination) if corrected too rapidly
C. Development of hypokalemia
D. Hypoglycemia
11. Which of the following signs is most characteristic of third-spacing (e.g., peritonitis with fluid shift into
abdomen)?
A. Elevated urine output
B. Increased central venous pressure (CVP)
C. Hypotension and hemoconcentration
D. Peripheral edema with increased serum albumin
12. A client with cirrhosis has ascites and hyponatremia. Which mechanism primarily causes dilutional
hyponatremia in this context?
A. Excess sodium intake
B. Water retention due to ADH stimulation from decreased effective circulating volume
C. Renal sodium wasting from diuretics only
D. Increased aldosterone causing hypernatremia
13. For a patient with hypervolemia and pulmonary edema, which position is best to facilitate breathing?
A. Right lateral decubitus
B. High Fowler’s (sitting upright)
C. Trendelenburg (head down)
D. Supine with legs elevated
14. A nurse assesses a patient with diagnostics showing low urine specific gravity. Which condition is most
likely?
A. Dehydration from vomiting
B. Diabetes insipidus (polyuria with dilute urine)
C. SIADH (urine concentrated)
D. Hyperglycemia causing osmotic diuresis
15. The nurse is monitoring an older adult on a thiazide diuretic. Which nursing concern is highest for this
client?
A. Hyperkalemia
B. Hyponatremia and orthostatic hypotension
C. Elevated magnesium
D. Respiratory depression
16. A client with fluid volume deficit has BUN:creatinine ratio of 30:1. The nurse interprets this as:
A. Normal renal function
B. Suggestive of prerenal azotemia due to hypovolemia
C. Intrarenal failure
D. Postrenal obstruction
17. Which physical sign best differentiates edema due to low plasma oncotic pressure (hypoalbuminemia)
from heart failure–related edema?
A. Rapid improvement with diuretics in hypoalbuminemia
B. Generalized anasarca and ascites often seen with hypoalbuminemia
C. Pulmonary crackles only in hypoalbuminemia
D. Bounding pulses in hypoalbuminemia
18. A client’s central venous pressure (CVP) monitoring is low. Which nursing action is most appropriate?
A. Administer IV fluids as ordered and reassess
B. Restrict fluids immediately
C. Give high-dose diuretics
D. Increase head of bed to 90°
19. Which electrolyte abnormality causes the most concern for development of life-threatening
dysrhythmias?
A. Hyponatremia
B. Hypokalemia and hyperkalemia
C. Hypocalcemia only
D. Hypomagnesemia only
20. A postoperative patient has a urine output of 20 mL/hr for the past 4 hours. Which is the best immediate
nursing action?
A. Encourage oral fluid intake and reassess in 2 hours
B. Report to provider and assess intake/output, bladder distention, vitals, and assess labs
C. Administer prescribed diuretic to increase urine output
D. Document and continue routine care
21. Which of the following is an appropriate nursing diagnosis for a patient with fluid volume excess due to
renal failure?
A. Deficient fluid volume related to hemorrhage
B. Excess fluid volume related to decreased renal excretion
C. Risk for injury related to confusion only
D. Impaired gas exchange unrelated to fluid status
22. For a patient with SIADH, which lab pattern is expected?
A. High serum sodium, low urine sodium
B. Low serum osmolality and high urine osmolality
C. High serum osmolality and dilute urine
D. Low urine osmolality and hypernatremia
23. A client with severe pancreatitis becomes hypotensive due to third-spacing and fluid sequestration.
Which IV fluid is most appropriate initially?
A. D5W
B. 0.9% NaCl (normal saline) bolus
 C. 3% NaCl
D. Albumin 5%
24. Which assessment finding is most consistent with acute pulmonary edema from fluid overload?
A. Bradycardia and clear breath sounds
B. Pink, frothy sputum and diffuse crackles
C. Painless peripheral edema only
D. Dry skin and decreased JVD
25. A patient with nephrotic syndrome has heavy proteinuria and low serum albumin. Which intervention is
most important?
A. Encourage high-protein diet and monitor edema/weight
B. Restrict fluids only and give loop diuretics PRN
C. Immediate hemodialysis
D. Limit protein intake to prevent loss

Week 8 — Electrolyte Imbalances & Acid-Base (Nos. 26–50)

26. A client’s serum osmolality is ordered. Which statement about serum osmolality is correct?
A. It is primarily determined by serum potassium and chloride.
B. Normal serum osmolality is approximately 280–295 mOsm/kg.
C. It decreases with severe hyperglycemia.
D. It is irrelevant in assessment of sodium disorders.
27. Which value is within normal range for serum sodium?
A. 120 mEq/L
B. 135–145 mEq/L
C. 150–160 mEq/L
D. 125–129 mEq/L
28. A patient with hyponatremia (Na+ 122 mEq/L) shows confusion and seizures. What is the most
appropriate immediate intervention?
A. Rapid infusion of hypotonic fluid
B. Give hypertonic saline (3%) per protocol with close monitoring
C. Give oral sodium tablets only
D. Give insulin and dextrose infusion
29. Which ECG change is most characteristic of hyperkalemia?
A. Peaked T waves and widened QRS complexes
B. Prominent U waves and flattened T waves
C. Prolonged QT interval only
D. ST segment depression
30. A client with chronic alcoholism presents with muscle cramps and tetany. Lab shows serum magnesium
low. Which other electrolyte disturbance commonly coexists and should be assessed?
A. Hypernatremia
B. Hypokalemia and hypocalcemia
C. Hypercalcemia
D. Hyperkalemia
31. The nurse reviews arterial blood gas (ABG) results: pH 7.25, PaCO₂ 72 mm Hg, HCO₃⁻ 28 mEq/L.
What is the acid-base diagnosis?
A. Respiratory acidosis with metabolic alkalosis compensation
B. Respiratory acidosis uncompensated (acute)
C. Metabolic acidosis with respiratory compensation
D. Metabolic alkalosis
32. ABG shows pH 7.50, PaCO₂ 30 mm Hg, HCO₃⁻ 24 mEq/L. The nurse interprets this as:
A. Respiratory alkalosis, acute
B. Metabolic alkalosis, uncompensated
C. Respiratory acidosis with metabolic compensation
D. Mixed acid-base disorder
33. Which intervention is highest priority for a patient with diabetic ketoacidosis (DKA) leading to
metabolic acidosis?
A. Give oral sodium bicarbonate immediately
B. Fluid resuscitation (normal saline) and insulin therapy as ordered
C. Restrict potassium replacement
D. Administer calcium gluconate
34. A client on loop diuretics develops muscle weakness and constipation. Which lab would the nurse
check?
A. Serum calcium
B. Serum potassium (expect low)
 C. Serum sodium only
D. Serum phosphate only
35. A patient with chronic kidney disease has hyperphosphatemia. Which electrolyte abnormality is
commonly associated?
A. Hypocalcemia due to phosphate binding calcium
B. Hypernatremia
C. Hypokalemia
D. Hypermagnesemia only
36. In metabolic alkalosis due to vomiting, which electrolyte abnormality commonly occurs?
A. Hyperkalemia
B. Hypokalemia due to renal compensation and K+ losses
C. Hypercalcemia
D. Hyponatremia only
37. A clinician orders serum osmolality measurement. Which solutes are the major contributors to serum
osmolality?
A. Sodium, glucose, and urea (BUN)
B. Potassium, chloride, bicarbonate
C. Calcium and magnesium only
D. Albumin and globulin
38. Which intravenous fluid is most appropriate for a patient with hypernatremia and euvolemic status (e.g.,
diabetes insipidus)?
A. 0.9% NaCl
B. D5W (isotonic in bag, becomes free water)
C. 3% NaCl
D. 0.45% NaCl only
39. A patient who took an overdose of sodium bicarbonate presents with pH 7.55 and hypoventilation.
Which disorder is present?
A. Metabolic acidosis
B. Metabolic alkalosis with respiratory compensation
C. Respiratory acidosis only
D. Mixed disorder
40. The nurse is educating about potassium-rich foods. Which selection is highest in potassium?
A. White bread
B. Bananas and oranges
C. Applesauce
D. Crackers
41. A client’s ABG: pH 7.30, PaCO₂ 32 mm Hg, HCO₃⁻ 15 mEq/L. Interpretation:
A. Metabolic acidosis with partial respiratory compensation
B. Respiratory alkalosis with metabolic compensation
C. Metabolic alkalosis
D. Mixed metabolic and respiratory alkalosis
42. Which sign is most suggestive of hypocalcemia?
A. Hyperreflexia, positive Chvostek’s and Trousseau’s signs
B. Muscle flaccidity and decreased deep tendon reflexes
C. Polyuria and polydipsia only
D. Stones, bones, groans, and psychiatric overtones (hypercalcemia signs)
43. A patient receives IV calcium gluconate for severe hypocalcemia. The nurse will monitor for which
immediate adverse effect?
A. Bradycardia and hypotension if given too rapidly
B. Respiratory depression only
C. Hyperkalemia immediately
D. Increased intracranial pressure
44. The nurse is caring for a child with severe dehydration and hypernatremia. Which fluid is most
appropriate initial choice?
A. Rapid infusion of 3% saline
B. Isotonic fluid, such as 0.9% NaCl, to restore intravascular volume then gradual free water
replacement
C. Immediate hypotonic fluid (0.45% NaCl) rapid bolus
D. Dextrose 10% IV bolus
45. A patient with COPD has chronic respiratory acidosis. Which ABG pattern would reflect chronic
compensation?
A. Low pH, high PaCO₂, low HCO₃⁻
B. Slightly low pH, high PaCO₂, elevated HCO₃⁻ (renal compensation)
C. High pH, low PaCO₂, low HCO₃⁻
D. Normal pH, normal PaCO₂, normal HCO₃⁻
46. Which medication is used to treat severe hyperkalemia emergently by stabilizing cardiac membranes?
A. IV calcium (calcium gluconate or calcium chloride)
 B. Sodium bicarbonate PO only
C. Furosemide orally only
D. Oral potassium binder only
47. The nurse recognizes that which patient is at highest risk for hypomagnesemia?
A. Chronic alcohol user with poor intake
B. Patient receiving magnesium sulfate infusion for preeclampsia
C. Patient with chronic kidney disease on dialysis
D. Patient taking potassium-sparing diuretics only
48. A client with metabolic acidosis from renal failure will have which compensatory respiratory response?
A. Hypoventilation to retain CO₂
B. Kussmaul respirations (deep, rapid) to blow off CO₂
C. Cheyne–Stokes breathing only
D. No change in respiratory pattern
49. A patient with severe hyponatremia is receiving hypertonic saline. Which monitoring is most important
during infusion?
A. Hourly glucose checks only
B. Frequent neurologic assessments and serum sodium monitoring to avoid rapid correction
C. Daily weight only
D. Only monitor urine output every 12 hours
50. A client presents with muscle weakness, urinary retention, and peaked T waves on ECG. Which
emergency treatment may be ordered immediately?
A. IV insulin with dextrose, nebulized albuterol, and calcium gluconate as stabilizer
B. Oral potassium supplements
C. IV sodium bicarbonate only
D. Immediate potassium infusion

Week 9 — Burn Injury & Renal Disorders (Nos. 51–75)

51. A patient arrives with partial-thickness burns covering 30% TBSA (total body surface area). During
emergent phase (first 24 hours), the priority nursing action is:
A. Provide high-protein oral diet
B. Initiate fluid resuscitation per Parkland formula and monitor urine output
C. Begin wound grafting immediately
D. Give high-dose antibiotics prophylactically
52. The Parkland formula prescribes 4 mL/kg/%TBSA of LR for first 24 hours with half given in first 8
hours. For a 70-kg patient with 30% burns, how much LR in first 8 hours?
A. 4,200 mL
B. 8,400 mL
C. 2,100 mL
D. 1,400 mL
53. Which urine output target indicates adequate resuscitation in an adult burn patient?
A. 0.5–1.0 mL/kg/hr (approx. 30–50 mL/hr for many adults)
B. 0.1 mL/kg/hr
C. 2.5 mL/kg/hr
D. 0 mL/hr (anuria)
54. A burn patient has myoglobinuria after electrical burn. What complication is the nurse most concerned
about?
A. Pulmonary edema only
B. Acute tubular necrosis (ATN) and acute kidney injury from myoglobin obstruction
C. Hypernatremia only
D. Cerebral edema
55. The priority in initial wound care for partial-thickness burns is to:
A. Apply topical topical antibiotics and sterile dressing after cleansing
B. Immediately debride to bone
C. Leave blisters intact and avoid cleaning
D. Immerse in ice water for 30 minutes
56. A client with chronic renal failure develops metabolic acidosis and hyperkalemia. Which dietary
instruction is most important?
A. Encourage high-potassium foods
B. Restrict potassium and phosphorus intake per renal diet
C. Liberalize protein intake without restrictions
D. No fluid restriction
57. Which lab trend is most typical of chronic renal failure (end-stage renal disease)?
A. Low BUN and low creatinine
B. Elevated BUN and creatinine with hyperphosphatemia and hypocalcemia
 C. Hypophosphatemia and hypercalcemia only
D. Low potassium due to renal retention
58. A patient on hemodialysis reports headache, nausea, and restlessness during dialysis; BP is dropping.
The nurse suspects dialysis disequilibrium syndrome. What is the appropriate action?
A. Stop dialysis, notify provider, and treat symptoms (reduce rate/stop)
B. Increase dialysis rate to clear solutes faster
C. Administer high-dose bicarbonate bolus routinely
D. Give IV potassium
59. Which statement about peritoneal dialysis (PD) is true?
A. PD uses the peritoneal membrane as a semipermeable membrane for solute/water exchange.
B. PD is contraindicated for patients with extensive abdominal surgery only if small.
C. PD always causes hypotension.
D. PD requires vascular access similar to hemodialysis.
60. A patient with urolithiasis (kidney stone) has severe colicky flank pain radiating to the groin. Which
nursing action is most appropriate for pain control?
A. Encourage ambulation and give prescribed opioid analgesic PRN
B. Immediate lithotripsy without analgesia
C. Discourage fluids to reduce pain
D. Cold packs to the flank only
61. A client with calcium oxalate stones should be educated to:
A. Increase oxalate-rich food intake (spinach, rhubarb)
B. Decrease sodium intake and maintain adequate hydration to reduce stone formation
C. Eliminate dietary calcium completely
D. Drink only cranberry juice
62. A patient with cystitis (lower UTI) complains of dysuria and frequency. Which is best first-line nursing
education?
A. Use spermicidal agents to prevent UTIs
B. Increase fluid intake, take full course of prescribed antibiotics, and void frequently
C. Restrict fluids and avoid voiding frequently
D. Use antibiotics only when symptoms worsen
63. A 70-year-old male with benign prostatic hyperplasia (BPH) is at increased risk for which urinary
problem that can predispose to infection?
A. Stress incontinence only
B. Urinary retention leading to postvoid residual and UTIs
C. Overflow incontinence only without retention
D. Polyuria without retention
64. In assessing a client with acute glomerulonephritis, which finding will the nurse likely observe?
A. Hematuria, proteinuria, edema, and hypertension
B. Polyuria and weight loss only
C. High urine output and low BUN
D. Hypotension and no hematuria
65. Which is the priority nursing concern for a patient with nephrotic syndrome?
A. Monitoring for infections and managing massive edema due to protein loss
B. Teaching to increase sodium intake
C. Encouraging heavy exercise to mobilize edema
D. Immediate renal transplant without evaluation
66. A patient with suspected acute tubular necrosis (ATN) will have which urine characteristic in the
oliguric phase?
A. High specific gravity concentrated urine
B. Muddy brown granular casts and low urine output
C. Clear, high volume urine
D. No proteinuria
67. For a client undergoing continuous renal replacement therapy (CRRT), which nursing intervention is
essential?
A. Monitor hemodynamic status and anticoagulation parameters closely
B. Provide unlimited fluids
C. Avoid checking labs frequently
D. Stop therapy for minor hypotension
68. A patient with ureterolithiasis is scheduled for extracorporeal shock wave lithotripsy (ESWL).
Preoperative teaching should include:
A. Expect no discomfort and immediate stone removal with no follow-up
B. There may be bruising and mild hematuria postprocedure; strain urine for stone fragments
C. No analgesia required after the procedure
D. Avoid fluids for 48 hours postprocedure
69. Which sign is an early indicator of acute kidney injury (AKI)?
A. Sudden increase in serum creatinine and decreased urine output (oliguria)
B. Persistent polyuria and low creatinine
 C. Normal BUN but low creatinine only
D. Increased urine specific gravity only
70. A nurse is teaching a patient with chronic renal failure about medication safety. Which over-the-counter
medication should be avoided?
A. Acetaminophen in recommended doses
B. NSAIDs (e.g., ibuprofen) because they can reduce renal blood flow and worsen kidney function
C. Topical antihistamine only
D. Oral iron supplement only
71. For a burn patient, what is the most accurate early indicator of adequate tissue perfusion during
resuscitation?
A. Presence of peripheral pulses and urinary output within target range
B. Core temperature only
C. Capillary refill only in burned tissue
D. Hemoglobin alone
72. Which sign indicates compartment syndrome in a patient with circumferential full-thickness burn of an
extremity?
A. Decreased pain and improved pulses
B. Pain out of proportion, tense swelling, decreased distal pulses and sensation — immediate
escharotomy may be needed
C. Increased capillary refill and warmth
D. Decreased anxiety only
73. A burn patient is in the hypermetabolic phase after the first 48 hours. Nutrition plan should include:
A. Low-calorie, low-protein diet
B. High-calorie, high-protein diet to support healing
C. No enteral feeding until wounds heal completely
D. Only IV dextrose solutions
74. A client with ESRD on hemodialysis has chronic anemia. Which treatment is commonly used to manage
anemia of CKD?
A. Oral iron only, no other therapy
B. Erythropoiesis-stimulating agents (e.g., epoetin alfa) plus iron supplementation
C. Blood transfusion only weekly
D. No treatment necessary
75. Which is the most important infection control precaution for nurses caring for patients with urinary
catheters to prevent catheter-associated UTI (CAUTI)?
A. Keep catheter and tubing below bladder level, maintain closed drainage system, and perform hand
hygiene
B. Irrigate catheter daily with antiseptic regardless of obstruction
C. Change catheter every 3 days routinely
D. Clamp catheter intermittently

Week 10 — Communicable Disease Nursing Concepts (Chain of Infection), Immunity &

76. Which link in the chain of infection is broken by standard hand hygiene?
A. Portal of exit only
B. Mode of transmission (and reduction of organisms on hands)
C. Susceptible host only
D. Infectious agent only
77. Which is an example of a reservoir for infection?
A. Contaminated water, human carrier, or animals where pathogens live and multiply
B. Airborne droplet only
C. Gloves only
D. Sterile instruments only
78. Which vaccine type contains live attenuated organisms and typically confers long-lasting immunity but
is contraindicated in immunocompromised clients?
A. Inactivated (killed) vaccine
B. Live attenuated vaccine (e.g., MMR, varicella)
C. Toxoid vaccine only
D. Subunit recombinant vaccine only
79. A parent asks why the measles (rubeola) vaccine is given as MMR. The nurse explains that measles
commonly presents with:
A. Koplik spots, high fever, cough, coryza, conjunctivitis, and a maculopapular rash starting on the face
and spreading downward
B. Vesicular crops on trunk only
 C. Bullous lesions and flaccid skin only
D. Stiff neck and petechial rash
80. Which statement about German measles (rubella) is true and important for women of childbearing age?
A. Rubella infection in early pregnancy may cause congenital rubella syndrome with cardiac defects and
deafness — pregnant women should avoid exposure and vaccination is contraindicated during
pregnancy.
B. Rubella is harmless in pregnancy.
C. Rubella causes Koplik spots only.
D. Rubella infection confers no immunity.
81. A child presents with chickenpox. Which nursing instruction is appropriate to prevent secondary
infection of lesions?
A. Keep fingernails short, encourage mittens, and keep lesions clean; use skin care and call provider for
signs of bacterial infection
B. Scratch lesions to relieve pruritus and speed healing
C. Apply topical steroids to all lesions without consultation
D. Encourage close contact with other children to build immunity
82. For influenza, which group is highest priority for annual vaccination?
A. Healthy adults 20–30 only
B. Pregnant women, older adults, chronic disease patients, and health care workers
C. People who never travel
D. Children only
83. A patient with suspected pulmonary tuberculosis (TB) is placed on airborne precautions. Which PPE is
required for staff entering the room?
A. Surgical mask only
B. N95 or equivalent respirator and negative-pressure room
C. Cloth mask only
D. No mask if vaccinated
84. Which nursing action is most important when administering antibiotic therapy to a patient with active
pertussis (whooping cough)?
A. Ensure early macrolide therapy (e.g., azithromycin) for patient and close contacts to reduce
transmission, and provide droplet precautions
B. Wait for cough to resolve before treating contacts
C. Antibiotics are ineffective and never used
D. Only give antitussives and no antibiotics
85. A school nurse identifies a child with mumps (parotitis). Which complication should the nurse assess
for?
A. Orchitis in postpubertal males and possible deafness or meningitis complications
B. Chronic arthritis only
C. Cardiac tamponade
D. Renal failure only
86. A patient has suspected pertussis but is critically ill. What isolation precautions does the nurse apply
initially?
A. Contact precautions only
B. Droplet precautions (mask within 3 feet) plus standard precautions until pertussis confirmed/treated
C. No precautions necessary
D. Airborne precautions
87. Which patient is at highest risk for severe complications from measles (rubeola)?
A. Healthy adult with prior measles vaccination
B. Infant and immunocompromised patient (risk of pneumonia, encephalitis)
C. Young adult who had measles in childhood
D. Teen with no chronic disease and two vaccine doses
88. Which statement about active vs. passive immunity is correct?
A. Active immunity results from exposure to an antigen and produces long-term memory; passive
immunity provides immediate but short-term protection (e.g., immunoglobulin).
B. Passive immunity provides lifelong protection.
C. Active immunity only occurs from maternal antibodies.
D. Passive immunity develops only after vaccination.
89. A pregnant nurse is advised about varicella exposure. The most appropriate recommendation is:
A. If nonimmune and exposed during pregnancy, notify occupational health and provider—varicella
exposure in pregnancy is serious; passive immunoglobulin may be considered. Avoid caring for infected
patients.
B. Continue to work without precautions
C. Varicella exposure is safe in pregnancy always
D. Vaccinate immediately with live vaccine during pregnancy
90. A client with community-acquired pneumonia (CAP) is being discharged. Which instruction is most
important for preventing spread?
A. Finish prescribed antibiotic course, stay home until afebrile for 24–48 hours, and practice respiratory
 hygiene
B. Stop antibiotics once feeling better
C. No need to cover mouth when coughing
D. Share utensils to build immunity
91. Which sign/symptom is most suggestive of pertussis in an unimmunized infant?
A. Paroxysmal coughing spells with inspiratory “whoop” and possible apneic spells
B. Mild rhinorrhea only
C. Skin rash with vesicles
D. Chronic joint pain
92. A patient with suspected diphtheria should be managed how initially?
A. Droplet precautions, antitoxin administration, and antibiotics as ordered; notify public health
B. No precautions needed; provide supportive care only
C. Immediate live vaccine administration during infection
D. Allow patient to mingle in common areas
93. For a patient with active pulmonary TB, which anti-TB drug requires monitoring of liver function tests
due to hepatotoxicity risk?
A. Isoniazid and rifampin (both require monitoring LFTs)
B. Penicillin only
C. Amoxicillin only
D. Metronidazole only
94. A community outbreak of meningococcal disease has occurred. The public health nurse advises
prophylaxis for close contacts. Which agent is commonly used for chemoprophylaxis?
A. Oral rifampin, ciprofloxacin, or IM ceftriaxone for close contacts as indicated
B. No prophylaxis required for close contacts
C. Oral erythromycin for everyone in the city
D. Only handwashing
95. A patient asks why some vaccines require booster doses. The nurse explains boosters are given because:
A. Some vaccines (e.g., tetanus) produce waning immunity over time and require booster to re-stimulate
immune memory
B. Boosters are only for children under 1 year old
C. Boosters are given to cause illness deliberately
D. Boosters are always live viruses
96. Which measure best reduces transmission of seasonal influenza in a hospital during outbreak?
A. Vaccination of staff, prompt isolation of symptomatic patients, droplet precautions, and antiviral
therapy as indicated
B. No measures—allow natural spread
C. Vaccinate only visitors
D. Only close the hospital
97. A patient diagnosed with tuberculosis asks how long is the usual minimum period of infectiousness after
starting appropriate therapy. The nurse answers:
A. Patients are generally considered noninfectious after 2 weeks of effective therapy and clinical
improvement, but this can vary; follow public health guidance.
B. Infectiousness stops immediately after first dose always
C. Infectious for life
D. Infectiousness is unchanged by treatment
98. A child presents with parotid swelling and low-grade fever. The nurse suspects mumps. The nurse
should instruct caregivers to:
A. Keep the child home until 9 days after onset of swelling and ensure adequate hydration and pain
control; notify public health if unvaccinated
B. Send child to school as normal
C. Give aspirin to children for fever routinely
D. Expose child to other children to confer immunity
99. A healthcare worker unsure of their immunity to measles needs to know which test proves immunity?
A. Measles IgG serology (positive IgG indicates immunity) or documented vaccination history / lab
confirmation
B. CBC only
C. Chest X-ray only
D. Urinalysis
100. Which of the following best describes herd immunity?
A. Immunity at population level when sufficient proportion are immune, reducing transmission and
protecting vulnerable persons who are not immune
B. Individual immunity after any sickness only
C. Immunity that applies only to animals
D. Immunity that requires 100% vaccination always
Answer Key with Brief Rationales (Answers 1–100)
Format: Question # — Correct option. Short rationale (1–2 lines).

1. B — Rapid weight gain and pitting edema +3 indicate fluid retention; albumin normal; urine output high
would argue against retention.
2. C — Hypervolemia causes hypertension and bounding pulses from increased intravascular volume.
3. B — Hypovolemia with weak pulses needs isotonic crystalloid bolus (0.9% NS) for volume
resuscitation.
4. A — Loss of plasma volume concentrates blood — hematocrit typically increases in acute isotonic loss.
5. B — Stop infusion for acute dyspnea/tachycardia and assess for pulmonary overload or transfusion
reaction.
6. B — Loss of gastric HCl (vomiting) leads to metabolic alkalosis from loss of acid.
7. B — Orthostatic hypotension + tachycardia indicates decreased circulating volume (hypovolemia).
8. B — Canned soups are high in sodium; fresh fruit is low.
9. B — Potassium-sparing diuretics raise K+ — check potassium level for hyperkalemia.
10. B — Rapid correction of hyponatremia risks osmotic demyelination; careful monitoring required.
11. C — Third-spacing leads to hypotension and hemoconcentration as fluid leaves vascular space.
12. B — Low effective circulating volume stimulates ADH → water retention → dilutional hyponatremia.
13. B — Upright positioning (High Fowler’s) eases breathing and reduces pulmonary congestion.
14. B — Diabetes insipidus produces dilute urine and low specific gravity.
15. B — Thiazides predispose to hyponatremia and orthostatic hypotension, especially in elderly.
16. B — Elevated BUN:Cr ratio (>20:1) suggests prerenal azotemia from reduced perfusion/hypovolemia.
17. B — Hypoalbuminemia causes generalized edema (anasarca) and ascites due to low oncotic pressure.
18. A — Low CVP indicates low preload; fluid bolus per orders is appropriate while monitoring.
19. B — Both hypo- and hyperkalemia predispose to life-threatening arrhythmias.
20. B — Oliguria needs immediate assessment (intake/output, retention, labs) and provider notification.
21. B — Excess fluid volume related to decreased renal excretion appropriately frames the problem.
22. B — SIADH: low serum osmolality (dilutional hyponatremia) with inappropriately concentrated urine.
23. B — Isotonic crystalloid bolus restores circulating volume in third-spacing; LR often chosen.
24. B — Pink, frothy sputum and diffuse crackles are classic for pulmonary edema from fluid overload.
25. A — Nephrotic syndrome causes protein loss → low albumin → edema; high-protein diet and edema
monitoring are important.
26. B — Normal serum osmolality is ~280–295 mOsm/kg; key to fluid/electrolyte assessment.
27. B — Normal sodium range is 135–145 mEq/L.
28. B — Symptomatic severe hyponatremia may need cautious hypertonic saline under protocol.
29. A — Peaked T waves and widening QRS are classic for hyperkalemia and risk for arrhythmia.
30. B — Hypomagnesemia often coexists with hypokalemia and hypocalcemia in alcoholism.
31. B — High PaCO₂ with elevated pH? Actually pH 7.25 with PaCO₂ 72 and HCO₃⁻ 28 shows acute
respiratory acidosis (high PaCO₂) with minimal metabolic compensation.
32. A — Low PaCO₂ and alkalotic pH indicate respiratory alkalosis (acute).
33. B — DKA management priority: fluids and insulin; potassium must be monitored and replaced as
insulin shifts K+ intracellularly.
34. B — Loop diuretics cause hypokalemia leading to weakness/constipation.
35. A — Phosphate retention binds calcium → hypocalcemia common in CKD.
36. B — Vomiting leads to H+ loss and metabolic alkalosis; kidneys excrete K+ causing hypokalemia.
37. A — Sodium, glucose, and BUN (urea) are major contributors to serum osmolality.
38. B — D5W supplies free water (after dextrose metabolized) for hypernatremia with euvolemia; correct
slowly.
39. B — Excess alkali ingestion → metabolic alkalosis; hypoventilation is respiratory compensation.
40. B — Fruits like bananas and oranges are potassium rich.
41. A — Low pH with low HCO₃⁻ and relatively low PaCO₂ indicates metabolic acidosis with partial
respiratory compensation.
42. A — Hypocalcemia causes neuromuscular excitability — Chvostek/Trousseau positive.
43. A — Rapid IV calcium can cause bradycardia and hypotension; administer slowly with monitoring.
44. B — Restore intravascular volume first with isotonic fluid, then correct free water gradually.
45. B — Chronic respiratory acidosis shows partial renal compensation: elevated HCO₃⁻ with near-normal
pH.
46. A — IV calcium stabilizes cardiac membranes in hyperkalemia while other measures shift K+
intracellularly.
47. A — Chronic alcoholism with poor intake and GI losses is a common cause of hypomagnesemia.
48. B — Metabolic acidosis prompts Kussmaul respirations to blow off CO₂.
49. B — Preventing overly rapid sodium correction and monitoring neuro status is critical.
50. A — Insulin + dextrose shifts K+ intracellularly; nebulized beta2 agonists help; calcium stabilizes heart.
51. B — Parkland formula fluid resuscitation and urine output monitoring are priorities in emergent burn
care.
 52. A — Parkland: 4 mL × 70 kg × 30% = 8,400 mL in 24 hr; half in first 8 hr = 4,200 mL.
53. A — Adult urine output goal generally 0.5–1.0 mL/kg/hr after resuscitation to indicate adequate
perfusion.
54. B — Myoglobinuria may cause ATN/AKI due to tubular obstruction and toxicity.
55. A — Cleanse, apply topical antimicrobial dressings, and maintain sterile technique for partial-thickness
burns.
56. B — CKD patients commonly need potassium and phosphorus restriction with careful diet.
57. B — CKD labs show ↑BUN/Cr, ↑phosphate, ↓calcium (secondary hyperparathyroidism).
58. A — Dialysis disequilibrium may require stopping or slowing dialysis and supportive care.
59. A — PD uses the peritoneal membrane as the exchange surface; it’s not the same as vascular access.
60. A — Analgesia and ambulation may help stone passage; encourage fluids unless contraindicated.
61. B — Lower sodium and adequate hydration reduce calcium stone formation; avoid excessive oxalates.
62. B — Hydration, full antibiotic course, and frequent voiding are key to resolve cystitis.
63. B — BPH causes urinary retention and residual urine, raising UTI risk.
64. A — Acute GN presents with hematuria, proteinuria, edema, and hypertension.
65. A — Infection risk and edema management are priorities in nephrotic syndrome.
66. B — ATN often shows muddy brown casts and oliguria in the oliguric phase.
67. A — CRRT requires frequent monitoring of hemodynamics and anticoagulation.
68. B — ESWL may cause bruising/hematuria; patient should strain urine for fragments postprocedure.
69. A — Sudden rise in creatinine with oliguria/azotemia indicates AKI.
70. B — NSAIDs can reduce renal perfusion and worsen kidney injury; avoid in CKD.
71. A — Urine output and peripheral perfusion are practical indicators of adequate resuscitation.
72. B — Compartment syndrome signs (pain, tense swelling, decreased pulses) require escharotomy or
fasciotomy.
73. B — Burns increase metabolic demand; high-calorie/high-protein nutrition supports healing.
74. B — ESAs plus iron are standard to treat anemia of CKD; transfusions reserved for refractory cases.
75. A — Prevent CAUTI by maintaining closed system, drainage below bladder, and hand hygiene.
76. B — Hand hygiene breaks mode of transmission and reduces spread from reservoirs.
77. A — Reservoirs can be humans, animals, environmental sources where pathogens multiply.
78. B — Live attenuated vaccines elicit strong immunity but are contraindicated in immunocompromised.
79. A — Measles has prodromal cough, coryza, conjunctivitis, Koplik spots, and maculopapular rash.
80. A — Rubella infection in early pregnancy causes congenital defects; vaccination contraindicated in
pregnancy.
81. A — Prevent excoriation and secondary infection by keeping nails short and lesions clean.
82. B — High-priority groups for influenza vaccine include pregnant women, elderly, chronic illness, and
HCWs.
83. B — TB requires airborne precautions (N95, negative pressure) to prevent inhalation of droplet nuclei.
84. A — Macrolides reduce transmission; droplet precautions and treatment of contacts recommended.
85. A — Mumps can cause orchitis (postpubertal males) and CNS complications; assess accordingly.
86. B — Pertussis spreads by droplets—use droplet precautions and treat early.
87. B — Infants and immunocompromised persons are at highest risk for measles complications.
88. A — Active immunity produces memory; passive provides immediate short-term protection.
89. A — Nonimmune pregnant worker exposed to varicella must notify work and provider; passive
immunoglobulin considered.
90. A — Completing antibiotics and staying home while infectious prevents spread of CAP.
91. A — Infants may present with apnea and paroxysmal cough; pertussis can be severe in infants.
92. A — Diphtheria requires antitoxin, antibiotics, droplet precautions, and public health notification.
93. A — Isoniazid and rifampin are hepatotoxic and require LFT monitoring.
94. A — Close contacts usually receive rifampin, ciprofloxacin, or IM ceftriaxone prophylactically per
guidance.
95. A — Boosters renew waning immunity (tetanus is classic example).
96. A — Vaccination, isolation of symptomatic, droplet precautions, and antivirals where indicated reduce
spread.
97. A — Many sources state patients often become less infectious after ~2 weeks of effective therapy, but
follow public health guidance and conversion of sputum.
98. A — Keep child home while contagious, maintain hydration and analgesia; notify public health for
unvaccinated cases.
99. A — Positive measles IgG or documented vaccination indicates immunity.
100. A — Herd immunity reduces spread when high proportion of population is immune, protecting
vulnerable.

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