fluids and electrolytes nclex questions

This Fluids and Electrolytes practice test aims to help nurses refresh knowledge on normal values of electrolytes, implications for care, and management of patients with alterations in fluid and electrolyte balance. Included in this practice test are multiple-choice and innovative response questions.

Read each item carefully, analyzing what is asked from the question, and choose the best response/responses from the options provided. Note the time it takes for you to complete this test, simulating how the NCLEX-RN and other examinations are given.

Try to answer each question in 1 minute. Correct answers and rationale are provided at the end of the test.

1. 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 manifestations would the nurse expect to note in this client if excess fluid volume is present?

A. Weight loss and dry skin
B. Flat neck and hand veins and decreased urinary output
C. An increase in blood pressure and increased respirations
D. Weakness and decreased central venous pressure (CVP)

2. 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 is 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. Uric acid level of 9.4 mg/dL (559 μmol/L)

3. Potassium chloride intravenously is prescribed for a client with hypokalemia. Which actions should the nurse take to plan for the preparation and administration of the potassium? Select all that apply.

A. Obtain an intravenous (IV) infusion pump.
B. Monitor urine output during administration.
C. Prepare the medication for bolus administration.
D. Monitor the IV site for signs of infiltration or phlebitis.
E.. Ensure that the medication is diluted in the appropriate volume of fluid.
F. Ensure that the bag is labeled so that it reads the volume of potassium in the solution.

4. The nurse reviews laboratory results and notes that a client’s serum sodium level is 150 mEq/L (150 mmol/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 acceptable food items does the nurse instruct the client to consume? Select all that apply.

A. Peas
B. Nuts
C. Cheese
D. Cauliflower
E. Processed oat cereals

5. 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

6. Which client is at risk of developing a sodium level at 130 mEq/L (130 mmol/L)?

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

7. The nurse is caring for a client with heart failure who receives 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

8. The nurse reviews a client’s laboratory report and notes that the client’s serum phosphorus (phosphate) level is 1.8 mg/dL (0.45 mmol/L). Which condition most likely caused this serum phosphorus level?

A. Malnutrition
B. Renal insufficiency
C. Hypoparathyroidism
D. Tumor lysis syndrome

9. The nurse is reading a health care provider’s (HCP’s) progress notes in the client’s record and reads that the HCP has documented “insensible fluid loss of approximately 800 mL daily.” The nurse makes a notation that insensible fluid loss occurs through which type of excretion?

A. Urinary output
B. Wound drainage
C. Integumentary output
D. The gastrointestinal tract

10. The nurse is assigned to care for a group of clients. On reviewing the clients’ medical records, the nurse determines which client is most likely at risk for a fluid volume deficit?

A. A client with an ileostomy
B. A client with heart failure
C. A client on long-term corticosteroid therapy
D. A client receiving frequent wound irrigations

11. The nurse caring for a client who has been receiving intravenous (IV) diuretics suspects that the client is experiencing a fluid volume deficit. Which assessment finding would the nurse note in a client with this condition?

A. Weight loss and poor skin turgor
B. Lung congestion and increased heart rate
C. Decreased hematocrit and increased urine output
D. Increased respiration and increased blood pressure

12. Which client is at risk of developing a potassium level of 5.5 mEq/L (5.5 mmol/L)?

A. The client with colitis
B. The client with Cushing’s syndrome
C. The client who has been overusing laxatives
D. The client who has sustained a traumatic burn

13. The client receives an I.V. infusion of 5% dextrose in normal saline running at 125 mL/hour. When hanging a new bag of fluid, the nurse notes swelling and hardness at the infusion site. The nurse should first:

A. Discontinue the infusion.
B. Apply a warm soak to the site.
C. Stop the flow of solution temporarily.
D. Irrigate the needle with normal saline

14. A client with Addison’s disease is admitted to the medical unit. The nurse diagnoses the client with Deficient fluid volume related to inadequate fluid intake and fluid loss secondary to inadequate adrenal hormone secretion. As the client’s oral intake increases, which of the following fluids would be most appropriate?

A. Milk and diet soda.
B. Water and eggnog.
C. Bouillon and juice.
D. Coffee and milkshakes.

15. The client’s serum potassium level is elevated in acute renal failure, and the nurse administers sodium polystyrene sulfonate (Kayexalate). This drug acts to:

A. Increase potassium excretion from the colon.
B. Release hydrogen ions for sodium ions.
B. Increase calcium absorption in the colon.
D. Exchange sodium for potassium ions in the colon.

16. The client with acute renal failure asks the nurse for a snack. Because the client’s potassium level is elevated, which of the following snacks is most appropriate?

A. A gelatin dessert.
B. Yogurt.
C. An orange.
D. Peanuts.

17. The nurse assesses the client with chronic renal failure and notes the following: crackles in the lung bases, elevated blood pressure, and weight gain of 2 lb in 1 day. Based on these data, which of the following nursing diagnoses is appropriate?

A. Excess fluid volume related to the kidney’s inability to maintain fluid balance.
B. Ineffective breathing pattern related to fluid in the lungs.
C. Ineffective tissue perfusion related to interrupted arterial blood flow.
D. Ineffective therapeutic regimen management related to lack of knowledge about therapy

18. 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

19. A pt, experiencing multisystem fluid volume deficit, has the symptoms of tachycardia, pale, cool skin, & decreased urine output. The nurse realizes these findings are most likely a direct result of which of the following?

A. the body’s natural compensatory mechanisms
B. pharmacological effects of a diuretic
C. effects of rapidly infused intravenous fluids
D. cardiac failure

20. You are caring for a client with severe hypokalemia. The physician has ordered IV potassium to be administered at 10 mEq/hr. The client complains of burning along their vein. What should you do?

A. Change the electrolyte.
B. Switch to an oral formulation.
C. Increase the speed of transfusion.
D. Dilute the infusion

21. A nurse is caring for a client with metastatic breast cancer who is extremely lethargic and very slow to respond to stimuli. The laboratory report indicates a serum calcium level of 12.0 mg/dl, a serum potassium level of 3.9 mEq/L, a serum chloride level of 101 mEq/L, and a serum sodium level of 140 mEq/L. Based on this information, the nurse determines that the client’s symptoms are most likely associated with which electrolyte imbalance?

A. Hypocalcemia
B. Hyperkalemia
C. Hypokalemia
D. Hypercalcemia

22. A postoperative client has been placed on a clear liquid diet. The nurse should provide the client with which items that are allowed to be consumed on this diet? Select all that apply.

A. Broth
B. Coffee
C. Gelatin
D. Pudding
E. Vegetable juice
F. Pureed vegetables

23. The nurse assesses a client and notes puffy eyelids, swollen ankles, and crackles at both lung bases. The nurse understands that these clinical findings are most specifically associated with fluid excess in which of the following compartments?

A. Interstitial compartment.
B. Intravascular compartment.
C. Extracellular compartment.
D. Intracellular compartment

24. An expected physiologic response to a low potassium level is:

A. Cardiac dysrhythmias.
B. Hyperglycemia.
C. Hypertension.
D. Increased energy.

25. The nurse monitors the serum electrolyte levels of a client who is taking digoxin (Lanoxin). Which of the following electrolyte imbalances is a common cause of digoxin toxicity?

A. Hyponatremia.
B. Hypomagnesemia.
C. Hypocalcemia.
D. Hypokalemia.

Answers and Rationale

Nhiña Sandeep de Rosas, MAN, DIH, DSHRM, RN currently works for the Department of Health CHD Mimaropa as a Training Specialist. She is also a Nurse Licensure Exam and NCLEX-RN reviewer on her free time. She has her USRN licenses in New York and Vermont, having passed the NCLEX-RN in 2007.Since 2006, she has been a nurse educator and worked as a clinical instructor and classroom lecturer for Unciano Colleges (College of Nursing) in Antipolo City. She has earned her Master’s Degree in Nursing and Diploma in International Health at the University of the Philippines Open University; and her Diploma in Strategic Human Resource Management at the Ateneo de Manila University.



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