Fluid and electrolyte management is a fundamental and critical aspect of patient care, particularly in the hospital setting. Selecting the appropriate IV fluid is a therapeutic decision with significant consequences, requiring a deep understanding of physiology and pharmacology. As detailed in the PharmD curriculum through courses like Patient Care 4 and Sterile Compounding, pharmacists must be experts in the properties of intravenous fluids and the management of electrolyte abnormalities. This quiz will test your knowledge on crystalloids, colloids, parenteral nutrition, and the management of common electrolyte disorders, all essential skills for a practicing pharmacist.
1. Which of the following IV fluids is considered a “balanced” isotonic crystalloid because its composition more closely resembles human plasma?
- a. 0.9% Sodium Chloride (Normal Saline)
- b. Lactated Ringer’s (LR)
- c. Dextrose 5% in Water (D5W)
- d. 3% Sodium Chloride
Answer: b. Lactated Ringer’s (LR)
2. A patient is in hypovolemic shock. What is the most appropriate initial fluid for resuscitation?
- a. D5W
- b. 0.45% Sodium Chloride
- c. Albumin 25%
- d. Lactated Ringer’s or 0.9% Sodium Chloride
Answer: d. Lactated Ringer’s or 0.9% Sodium Chloride
3. In the body, D5W is considered a hypotonic solution because:
- a. The dextrose is rapidly metabolized, leaving behind free water.
- b. It has a lower osmolarity than plasma in the bag.
- c. It contains a high concentration of sodium.
- d. It is a colloid.
Answer: a. The dextrose is rapidly metabolized, leaving behind free water.
4. Administration of large volumes of 0.9% Sodium Chloride can lead to what type of acid-base disturbance?
- a. Hyperchloremic metabolic acidosis
- b. Metabolic alkalosis
- c. Respiratory acidosis
- d. Respiratory alkalosis
Answer: a. Hyperchloremic metabolic acidosis
5. The “Management of Electrolyte Abnormalities” is a specific learning module in which course?
- a. PHA5784C Patient Care 4
- b. PHA5104 Sterile Compounding
- c. PHA5703 Pharmacy Law and Ethics
- d. PHA5878C Patient Care 3
Answer: a. PHA5784C Patient Care 4
6. Which of the following is an emergent, life-threatening complication of severe hyperkalemia?
- a. Seizures
- b. Cardiac arrhythmias
- c. Respiratory depression
- d. Acute liver failure
Answer: b. Cardiac arrhythmias
7. What is the immediate first step in treating a patient with hyperkalemia and peaked T-waves on their ECG?
- a. Administer IV insulin and dextrose.
- b. Administer IV sodium polystyrene sulfonate.
- c. Administer IV calcium gluconate or calcium chloride.
- d. Administer IV potassium chloride.
Answer: c. Administer IV calcium gluconate or calcium chloride.
8. The purpose of administering calcium in the setting of severe hyperkalemia is to:
- a. Lower the serum potassium level.
- b. Stabilize the cardiac membrane and prevent arrhythmias.
- c. Shift potassium into the cells.
- d. Increase the renal excretion of potassium.
Answer: b. Stabilize the cardiac membrane and prevent arrhythmias.
9. In a patient with severe, symptomatic hyponatremia, what is the most appropriate fluid choice?
- a. D5W
- b. 0.9% Sodium Chloride
- c. 3% Sodium Chloride (Hypertonic Saline)
- d. Lactated Ringer’s
Answer: c. 3% Sodium Chloride (Hypertonic Saline)
10. Rapid correction of chronic hyponatremia can lead to what devastating neurological condition?
- a. Wernicke-Korsakoff syndrome
- b. Cerebral edema
- c. Osmotic demyelination syndrome
- d. Aseptic meningitis
Answer: c. Osmotic demyelination syndrome
11. Parenteral nutrition is a topic covered in the Sterile Compounding course.
- a. True
- b. False
Answer: a. True
12. Albumin is what type of IV fluid?
- a. Isotonic crystalloid
- b. Hypotonic crystalloid
- c. Colloid
- d. Hypertonic crystalloid
Answer: c. Colloid
13. How do colloid solutions like albumin work?
- a. They provide free water to the body.
- b. They increase plasma oncotic pressure, holding and drawing fluid into the intravascular space.
- c. They are rapidly metabolized for energy.
- d. They correct acid-base disorders.
Answer: b. They increase plasma oncotic pressure, holding and drawing fluid into the intravascular space.
14. A patient is receiving a parenteral nutrition (PN) formulation. The three macronutrients in a “3-in-1” PN are dextrose, amino acids, and:
- a. Electrolytes
- b. Vitamins
- c. Intravenous fat emulsion (IVFE)
- d. Trace elements
Answer: c. Intravenous fat emulsion (IVFE)
15. What is the maximum safe infusion rate for IV potassium chloride through a peripheral line?
- a. 5 mEq/hour
- b. 10 mEq/hour
- c. 20 mEq/hour
- d. 40 mEq/hour
Answer: b. 10 mEq/hour
16. Which electrolyte must often be corrected before potassium levels will normalize?
- a. Sodium
- b. Calcium
- c. Magnesium
- d. Phosphate
Answer: c. Magnesium
17. A patient with hypercalcemia might be treated with IV hydration and which other agent?
- a. A thiazide diuretic
- b. A loop diuretic like furosemide
- c. Calcium supplements
- d. Vitamin D
Answer: b. A loop diuretic like furosemide
18. Parenteral calculations are a topic covered in the Sterile Compounding course.
- a. True
- b. False
Answer: a. True
19. A patient has a serum phosphate of 1.8 mg/dL (normal 2.5-4.5). This patient has:
- a. Hyperphosphatemia
- b. Hypophosphatemia
- c. Normal phosphate
- d. Hyperkalemia
Answer: b. Hypophosphatemia
20. Rationalizing the appropriate administration of injection medications, including concentration and compatibility concerns, is a key objective in the Hospital IPPE.
- a. True
- b. False
Answer: a. True
21. A patient taking a loop diuretic like furosemide is at risk for which electrolyte abnormalities?
- a. Hyperkalemia and Hypermagnesemia
- b. Hypokalemia and Hypomagnesemia
- c. Hypernatremia
- d. Hypercalcemia
Answer: b. Hypokalemia and Hypomagnesemia
22. Which of the following is NOT a method to shift potassium into the cells to acutely treat hyperkalemia?
- a. IV insulin and dextrose
- b. High-dose albuterol nebulization
- c. IV sodium bicarbonate
- d. IV furosemide
Answer: d. IV furosemide
23. “Maintenance” IV fluids are designed to:
- a. Rapidly expand intravascular volume in shock.
- b. Correct a severe electrolyte abnormality.
- c. Replace ongoing daily losses of water and electrolytes.
- d. Provide full nutritional support.
Answer: c. Replace ongoing daily losses of water and electrolytes.
24. The an active learning session on the renal system covers electrolyte abnormalities.
- a. True
- b. False
Answer: a. True
25. A patient with a corrected serum calcium of 7.9 mg/dL (normal 8.5-10.5) has hypocalcemia. A classic physical exam sign for this is:
- a. Asterixis
- b. Chvostek’s sign or Trousseau’s sign
- c. JVD (Jugular venous distention)
- d. Pitting edema
Answer: b. Chvostek’s sign or Trousseau’s sign
26. The osmolarity of a parenteral nutrition solution is a critical parameter to determine if it can be infused:
- a. Quickly or slowly.
- b. Through a peripheral or central line.
- c. With or without a filter.
- d. To a pediatric or adult patient.
Answer: b. Through a peripheral or central line.
27. Which of the following is NOT a crystalloid solution?
- a. 0.9% NaCl
- b. Lactated Ringer’s
- c. Albumin 5%
- d. D5W
Answer: c. Albumin 5%
28. An active learning session on managing electrolyte abnormalities is part of the Patient Care 4 course.
- a. True
- b. False
Answer: a. True
29. The lactate in Lactated Ringer’s solution is metabolized in the liver to what compound, which can help correct acidosis?
- a. Pyruvate
- b. Glucose
- c. Bicarbonate
- d. Acetate
Answer: c. Bicarbonate
30. The “Management of Electrolyte Abnormalities” is a lecture within the Renal System module.
- a. True
- b. False
Answer: a. True
31. What is the primary risk of using hypotonic fluids like 0.45% NaCl?
- a. Hypernatremia
- b. Fluid overload
- c. Cerebral edema
- d. Hyperchloremic acidosis
Answer: c. Cerebral edema
32. The majority of the body’s total water is located in which compartment?
- a. Intravascular
- b. Interstitial
- c. Intracellular
- d. Transcellular
Answer: c. Intracellular
33. A patient with hypervolemic hyponatremia (e.g., due to heart failure) should be treated with:
- a. IV hydration with normal saline.
- b. Fluid restriction and diuretics.
- c. A high-sodium diet.
- d. 3% hypertonic saline.
Answer: b. Fluid restriction and diuretics.
34. A patient is receiving a TPN containing a 3-in-1 admixture. What size filter should be used for its administration?
- a. 0.22 micron
- b. 1.2 micron
- c. 5 micron
- d. No filter is needed.
Answer: b. 1.2 micron
35. A pharmacist’s role in fluid and electrolyte management includes all of the following EXCEPT:
- a. Recommending appropriate IV fluid therapy.
- b. Calculating rates for electrolyte infusions.
- c. Inserting a central venous catheter.
- d. Monitoring for efficacy and adverse effects.
Answer: c. Inserting a central venous catheter.
36. A patient has a serum potassium of 3.1 mEq/L. This is classified as:
- a. Normal
- b. Mild hypokalemia
- c. Severe hypokalemia
- d. Hyperkalemia
Answer: b. Mild hypokalemia
37. Which of the following is a symptom of severe hypomagnesemia?
- a. Bradycardia
- b. Hypertension
- c. Seizures and Torsades de Pointes
- d. Constipation
Answer: c. Seizures and Torsades de Pointes
38. The stability and compatibility of IV admixtures is a topic in the Sterile Compounding course.
- a. True
- b. False
Answer: a. True
39. A patient is prescribed an IV infusion of potassium phosphate. The pharmacist must be careful to:
- a. Infuse it as rapidly as possible.
- b. Ensure the rate of both the potassium and phosphate administration is safe.
- c. Administer it undiluted.
- d. Mix it with a calcium-containing fluid.
Answer: b. Ensure the rate of both the potassium and phosphate administration is safe.
40. A patient with diabetic ketoacidosis (DKA) presents with dehydration. What is the initial fluid of choice for resuscitation?
- a. D5W
- b. 0.9% NaCl
- c. 0.45% NaCl
- d. Albumin
Answer: b. 0.9% NaCl
41. The term “tonicity” refers to the effect a solution has on:
- a. The pH of the blood.
- b. Cell volume (causing cells to shrink or swell).
- c. The patient’s blood pressure.
- d. The patient’s heart rate.
Answer: b. Cell volume (causing cells to shrink or swell).
42. A patient with severe hyperphosphatemia from tumor lysis syndrome may be treated with:
- a. IV phosphate
- b. A phosphate binder
- c. IV hydration and rasburicase
- d. All of the above.
Answer: c. IV hydration and rasburicase
43. A pharmacist reviewing an order for IV calcium chloride must recognize that it contains ____ times more elemental calcium than calcium gluconate.
- a. 2
- b. 3
- c. 5
- d. 10
Answer: b. 3
44. A key part of managing fluid status in a hospitalized patient is:
- a. Monitoring daily weights.
- b. Tracking “ins and outs” (fluid intake and output).
- c. Assessing for physical signs like edema or JVD.
- d. All of the above.
Answer: d. All of the above.
45. Which of the following is a cause of hypervolemic hypernatremia?
- a. Diabetes insipidus
- b. Diarrhea and vomiting
- c. Administration of large volumes of hypertonic saline.
- d. Heart failure
Answer: c. Administration of large volumes of hypertonic saline.
46. The goal of using an isotonic fluid is to:
- a. Cause fluid to shift out of the cells.
- b. Cause fluid to shift into the cells.
- c. Expand the extracellular fluid volume without causing major fluid shifts.
- d. Provide free water only.
Answer: c. Expand the extracellular fluid volume without causing major fluid shifts.
47. A pharmacist must ensure that any IV admixture is physically and chemically compatible before it is dispensed.
- a. True
- b. False
Answer: a. True
48. An active learning session covering electrolyte abnormalities is part of which course?
- a. PHA5784C Patient Care 4
- b. PHA5163L Professional Skills Lab 3
- c. PHA5781 Patient Care I
- d. PHA5782C Patient Care 2
Answer: a. PHA5784C Patient Care 4
49. In a patient with hypernatremia due to free water loss (e.g., from diabetes insipidus), the treatment is:
- a. 3% Saline
- b. Fluid restriction
- c. Replacement of free water, often with D5W or oral water.
- d. A loop diuretic.
Answer: c. Replacement of free water, often with D5W or oral water.
50. The ultimate goal of understanding IV fluids and electrolytes is to:
- a. Be able to calculate osmolarity without a calculator.
- b. Restore and maintain patient homeostasis while avoiding iatrogenic harm.
- c. Always recommend the most expensive fluid product.
- d. Memorize all normal lab value ranges.
Answer: b. Restore and maintain patient homeostasis while avoiding iatrogenic harm.