NSG 3850 Exam 1 Review
Pathophysiology for Nurses II - Fluid & Electrolytes
Comprehensive Practice Exam - 2026
1. A nurse is educating a patient about routes of electrolyte loss. Which of the following should the
nurse include as normal routes of electrolyte loss? (Select all that apply)
A. Sweat
B. Urine
C. Feces
D. Respiration
E. Saliva
ANSWER: A, B, C, D
Rationale:
A. Sweat: CORRECT - Sweat is a normal route of electrolyte loss, particularly sodium and chloride.
B. Urine: CORRECT - Urine is the primary route of electrolyte elimination from the body, regulated by
the kidneys.
C. Feces: CORRECT - Feces contain electrolytes that are not absorbed in the gastrointestinal tract.
D. Respiration: CORRECT - Respiration results in fluid and electrolyte loss through water vapor in exhaled
air.
E. Saliva: INCORRECT - While saliva contains electrolytes, we do not lose electrolytes via saliva because
saliva is typically swallowed and reabsorbed.
2. A patient with hyperphosphatemia is at risk for developing which electrolyte imbalance?
,A. Hypercalcemia
B. Hypocalcemia
C. Hyperkalemia
D. Hyponatremia
ANSWER: B
Rationale:
A. Hypercalcemia: INCORRECT - This is the opposite of what occurs with hyperphosphatemia.
B. Hypocalcemia: CORRECT - Hyperphosphatemia creates low calcium due to the inverse relationship
between phosphate and calcium ions. When phosphate levels are high, calcium binds with phosphate,
decreasing serum calcium levels.
C. Hyperkalemia: INCORRECT - Potassium is not directly affected by phosphate levels in this manner.
D. Hyponatremia: INCORRECT - Sodium is not directly affected by phosphate levels in this manner.
3. The nurse understands that the relationship between phosphate and calcium ions is:
A. Direct relationship
B. Inverse relationship
C. No relationship
D. Proportional relationship
ANSWER: B
Rationale:
A. Direct relationship: INCORRECT - A direct relationship would mean both increase or decrease
together, which is not the case.
B. Inverse relationship: CORRECT - Phosphate and calcium have an inverse (reverse) relationship. When
one increases, the other decreases.
C. No relationship: INCORRECT - These electrolytes are closely related and affect each other.
D. Proportional relationship: INCORRECT - This would suggest they change in the same direction, which
is incorrect.
4. A patient with heart failure presents with dependent edema. The nurse understands that the
pathophysiology at the capillary level involves:
A. Decreased hydrostatic pressure
B. Increased hydrostatic pressure
C. Decreased oncotic pressure
,D. Increased oncotic pressure
ANSWER: B
Rationale:
A. Decreased hydrostatic pressure: INCORRECT - Decreased hydrostatic pressure would not cause fluid
to move into the interstitial space.
B. Increased hydrostatic pressure: CORRECT - In heart failure with dependent edema, there is increased
hydrostatic pressure in the capillaries, which forces fluid into the interstitial compartment, causing
edema.
C. Decreased oncotic pressure: INCORRECT - While decreased oncotic pressure can cause edema, this is
not the primary mechanism in heart failure.
D. Increased oncotic pressure: INCORRECT - Increased oncotic pressure would draw fluid into the
capillaries, not cause edema.
5. Why does a patient with heart failure have increased fluid in the interstitial compartment?
A. Decreased capillary permeability
B. Increased hydrostatic pressure
C. Decreased blood volume
D. Increased lymphatic drainage
ANSWER: B
Rationale:
A. Decreased capillary permeability: INCORRECT - This would actually decrease fluid movement into
tissues.
B. Increased hydrostatic pressure: CORRECT - The increased hydrostatic pressure from heart failure
pushes fluid out of the capillaries and into the interstitial space.
C. Decreased blood volume: INCORRECT - Heart failure typically involves fluid overload, not decreased
blood volume.
D. Increased lymphatic drainage: INCORRECT - The lymphatic system is overwhelmed, not increased, in
heart failure.
6. A patient has gained 2 pounds in 24 hours. The nurse recognizes this as indicative of:
A. Normal weight fluctuation
B. Fluid excess
C. Fat gain
D. Muscle gain
, ANSWER: B
Rationale:
A. Normal weight fluctuation: INCORRECT - A 2-pound gain in 24 hours is not normal and indicates
pathology.
B. Fluid excess: CORRECT - A 2-pound increase in weight is a sign of fluid excess (approximately 1 liter of
fluid retention).
C. Fat gain: INCORRECT - Fat cannot be gained this rapidly; it requires caloric surplus over time.
D. Muscle gain: INCORRECT - Muscle cannot be gained this rapidly; it requires exercise and time.
7. Which of the following are signs of fluid excess? (Select all that apply)
A. Distended jugular veins
B. Bounding pulses
C. Increased pulse pressure
D. Edema
E. Shortness of breath (SOB)
F. Increased heart rate
G. Elevated blood pressure
ANSWER: A, B, C, D, E, F, G
Rationale:
A. Distended jugular veins: CORRECT - Jugular vein distension indicates increased venous pressure from
fluid overload.
B. Bounding pulses: CORRECT - Bounding pulses occur with increased circulating volume.
C. Increased pulse pressure: CORRECT - Fluid excess causes increased pulse pressure (difference
between systolic and diastolic).
D. Edema: CORRECT - Fluid accumulation in tissues causes edema.
E. Shortness of breath (SOB): CORRECT - Pulmonary edema from fluid excess causes respiratory distress.
F. Increased heart rate: CORRECT - The heart compensates for increased volume by increasing rate.
G. Elevated blood pressure: CORRECT - Increased circulating volume elevates blood pressure.
8. The nurse assesses a patient with fluid excess. Which cardiac findings would be expected? (Select all
that apply)
A. Increased heart rate
Pathophysiology for Nurses II - Fluid & Electrolytes
Comprehensive Practice Exam - 2026
1. A nurse is educating a patient about routes of electrolyte loss. Which of the following should the
nurse include as normal routes of electrolyte loss? (Select all that apply)
A. Sweat
B. Urine
C. Feces
D. Respiration
E. Saliva
ANSWER: A, B, C, D
Rationale:
A. Sweat: CORRECT - Sweat is a normal route of electrolyte loss, particularly sodium and chloride.
B. Urine: CORRECT - Urine is the primary route of electrolyte elimination from the body, regulated by
the kidneys.
C. Feces: CORRECT - Feces contain electrolytes that are not absorbed in the gastrointestinal tract.
D. Respiration: CORRECT - Respiration results in fluid and electrolyte loss through water vapor in exhaled
air.
E. Saliva: INCORRECT - While saliva contains electrolytes, we do not lose electrolytes via saliva because
saliva is typically swallowed and reabsorbed.
2. A patient with hyperphosphatemia is at risk for developing which electrolyte imbalance?
,A. Hypercalcemia
B. Hypocalcemia
C. Hyperkalemia
D. Hyponatremia
ANSWER: B
Rationale:
A. Hypercalcemia: INCORRECT - This is the opposite of what occurs with hyperphosphatemia.
B. Hypocalcemia: CORRECT - Hyperphosphatemia creates low calcium due to the inverse relationship
between phosphate and calcium ions. When phosphate levels are high, calcium binds with phosphate,
decreasing serum calcium levels.
C. Hyperkalemia: INCORRECT - Potassium is not directly affected by phosphate levels in this manner.
D. Hyponatremia: INCORRECT - Sodium is not directly affected by phosphate levels in this manner.
3. The nurse understands that the relationship between phosphate and calcium ions is:
A. Direct relationship
B. Inverse relationship
C. No relationship
D. Proportional relationship
ANSWER: B
Rationale:
A. Direct relationship: INCORRECT - A direct relationship would mean both increase or decrease
together, which is not the case.
B. Inverse relationship: CORRECT - Phosphate and calcium have an inverse (reverse) relationship. When
one increases, the other decreases.
C. No relationship: INCORRECT - These electrolytes are closely related and affect each other.
D. Proportional relationship: INCORRECT - This would suggest they change in the same direction, which
is incorrect.
4. A patient with heart failure presents with dependent edema. The nurse understands that the
pathophysiology at the capillary level involves:
A. Decreased hydrostatic pressure
B. Increased hydrostatic pressure
C. Decreased oncotic pressure
,D. Increased oncotic pressure
ANSWER: B
Rationale:
A. Decreased hydrostatic pressure: INCORRECT - Decreased hydrostatic pressure would not cause fluid
to move into the interstitial space.
B. Increased hydrostatic pressure: CORRECT - In heart failure with dependent edema, there is increased
hydrostatic pressure in the capillaries, which forces fluid into the interstitial compartment, causing
edema.
C. Decreased oncotic pressure: INCORRECT - While decreased oncotic pressure can cause edema, this is
not the primary mechanism in heart failure.
D. Increased oncotic pressure: INCORRECT - Increased oncotic pressure would draw fluid into the
capillaries, not cause edema.
5. Why does a patient with heart failure have increased fluid in the interstitial compartment?
A. Decreased capillary permeability
B. Increased hydrostatic pressure
C. Decreased blood volume
D. Increased lymphatic drainage
ANSWER: B
Rationale:
A. Decreased capillary permeability: INCORRECT - This would actually decrease fluid movement into
tissues.
B. Increased hydrostatic pressure: CORRECT - The increased hydrostatic pressure from heart failure
pushes fluid out of the capillaries and into the interstitial space.
C. Decreased blood volume: INCORRECT - Heart failure typically involves fluid overload, not decreased
blood volume.
D. Increased lymphatic drainage: INCORRECT - The lymphatic system is overwhelmed, not increased, in
heart failure.
6. A patient has gained 2 pounds in 24 hours. The nurse recognizes this as indicative of:
A. Normal weight fluctuation
B. Fluid excess
C. Fat gain
D. Muscle gain
, ANSWER: B
Rationale:
A. Normal weight fluctuation: INCORRECT - A 2-pound gain in 24 hours is not normal and indicates
pathology.
B. Fluid excess: CORRECT - A 2-pound increase in weight is a sign of fluid excess (approximately 1 liter of
fluid retention).
C. Fat gain: INCORRECT - Fat cannot be gained this rapidly; it requires caloric surplus over time.
D. Muscle gain: INCORRECT - Muscle cannot be gained this rapidly; it requires exercise and time.
7. Which of the following are signs of fluid excess? (Select all that apply)
A. Distended jugular veins
B. Bounding pulses
C. Increased pulse pressure
D. Edema
E. Shortness of breath (SOB)
F. Increased heart rate
G. Elevated blood pressure
ANSWER: A, B, C, D, E, F, G
Rationale:
A. Distended jugular veins: CORRECT - Jugular vein distension indicates increased venous pressure from
fluid overload.
B. Bounding pulses: CORRECT - Bounding pulses occur with increased circulating volume.
C. Increased pulse pressure: CORRECT - Fluid excess causes increased pulse pressure (difference
between systolic and diastolic).
D. Edema: CORRECT - Fluid accumulation in tissues causes edema.
E. Shortness of breath (SOB): CORRECT - Pulmonary edema from fluid excess causes respiratory distress.
F. Increased heart rate: CORRECT - The heart compensates for increased volume by increasing rate.
G. Elevated blood pressure: CORRECT - Increased circulating volume elevates blood pressure.
8. The nurse assesses a patient with fluid excess. Which cardiac findings would be expected? (Select all
that apply)
A. Increased heart rate
