Anesthesia Fluids, Blood & Coagulation Practice Questions

What is the chloride concentration in 0.9% sodium chloride injection?

1. 103 mEq/L
2. 154 mEq/L
3. 308 mEq/L
4. 513 mEq/L

Correct answer: B

0.9% sodium chloride contains 9 g NaCl per liter. Dividing by the molecular weight of NaCl (58.44 g/mol) gives approximately 0.154 mol/L. Because chloride is monovalent, this equals 154 mEq/L of chloride; the sodium concentration is also 154 mEq/L. The value 308 describes the solution's calculated osmolarity in mOsm/L, not its chloride concentration.

Source: DailyMed, 0.9% Sodium Chloride Injection USP, Description: https://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=47a0313f-36df-4fa6-a828-c9e1946ba9b0

An adult has confirmed potassium of 6.8 mEq/L and new ECG changes attributable to hyperkalemia. Which intervention directly counteracts the cardiac membrane effects while potassium-lowering treatment is arranged?

1. Intravenous calcium gluconate
2. Intravenous insulin with glucose
3. Intravenous sodium bicarbonate
4. Nebulized albuterol

Correct answer: A

Intravenous calcium provides cardiac membrane stabilization in hyperkalemia with ECG changes; it does not lower the potassium concentration. Insulin with glucose and nebulized albuterol shift potassium into cells and serve a different purpose. Sodium bicarbonate is not recommended routinely for acute hyperkalemia. Treatment also requires potassium removal as appropriate, ECG and potassium reassessment, and glucose monitoring after insulin. Calcium formulation and administration depend on the clinical setting.

Source: UK Kidney Association. Management of Hyperkalaemia in Adults, July 2026 update, guidelines 16.2–16.5 and 17: https://www.ukkidney.org/health-professionals/guidelines/treatment-acute-hyperkalaemia-adults-0

Ten minutes after starting a red-cell transfusion, an adult develops rigors, new back pain, and a temperature rise from 37.0°C to 39.0°C. Blood pressure and breathing are currently stable, with no urticaria or wheezing. Which immediate action is most appropriate?

1. Pause transfusion and restart slowly if acetaminophen reduces the fever
2. Continue transfusion while sending blood for a hemolysis screen
3. Stop transfusion, assess the patient, and maintain IV access without flushing the blood-containing line
4. Stop transfusion and give epinephrine for an assumed allergic reaction

Correct answer: C

Stop the transfusion immediately and assess airway, breathing, circulation, and vital signs. Maintain IV access without flushing the existing blood-containing line; use a new line if required. Notify the transfusion service and treating clinician, repeat patient/unit identity checks, and retain the component and administration set for investigation. Fever, rigors, and back pain require evaluation for acute hemolysis and bacterial contamination as well as other reactions. Stable blood pressure does not exclude a serious reaction. A febrile nonhemolytic reaction is a diagnosis of exclusion, and epinephrine is not indicated solely for these findings without anaphylaxis.

Source: Australian Red Cross Lifeblood. Management of suspected reactions. https://www.lifeblood.com.au/health-professionals/clinical-practice/adverse-events/management-of-suspected-reactions

What fluid and coagulation topics should AA students prioritize?

Review crystalloid composition, electrolyte abnormalities, fluid responsiveness, blood components, transfusion reactions, massive transfusion, coagulation testing, anticoagulants, and perioperative hemostasis.

Are these questions from the Anesthesia Review practice bank?

Yes. The previews use selected questions from the Anesthesia Review bank with their original choices, explanations, and references.

How should I organize fluids, blood, and coagulation review?

Separate the subject into volume replacement, electrolyte correction, oxygen-carrying capacity, component therapy, coagulation defects, and emergency reactions, then practice deciding which problem is most urgent.