1
A+ Guaranteed. Fluid & Electrolyte Mastery: NCLEX
Questions & Answers with Expert Explanations
📘 Why Choose This Document?
● 🎯 100% NCLEX-RN Focused – Every question targets exam-style content with
high-yield concepts in Fluid & Electrolyte imbalances.
● ✍️ Detailed Explanations – Each question comes with a clear, student-friendly
explanation so you understand why the answer is correct.
● 💯 Compiled by Professionals – This bundle is created and verified by Registered
Nurses and NCLEX tutors with firsthand experience in exam coaching.
● 📚 Ideal for Nursing Students, Test-Takers – Whether you're preparing for
NCLEX-RN, HESI, ATI, or your finals, this document is your success blueprint.
Compiled and Approved by:
✔ Registered Nurses
✔ Certified NCLEX Tutors
✔ Nursing Faculty Experts
, 2
A+ Guaranteed. Fluid & Electrolyte Mastery: NCLEX
Questions & Answers with Expert Explanations
1. Which electrolyte imbalance is most likely to occur in a patient with severe
diarrhea?
a. Hypercalcemia
b. Hypokalemia
c. Hypermagnesemia
d. Hypernatremia
The answer is: b. Hypokalemia
Explanation
Diarrhea leads to significant potassium loss because the intestines hold large amounts of
this electrolyte. Hypokalemia presents with muscle weakness, fatigue, and potentially
dangerous cardiac arrhythmias. On ECG, it may show as flattened T waves or prominent
U waves. Hypernatremia is more associated with dehydration. Hypercalcemia and
hypermagnesemia are less common in diarrhea cases and usually arise from different
etiologies like malignancy or renal failure. It's critical to monitor potassium levels closely
and replace potassium as needed to prevent complications in patients with gastrointestinal
losses.
2. What is the most important assessment for a nurse to perform when administering
intravenous potassium chloride (KCl)?
a. Lung sounds
b. Bowel sounds
c. ECG monitoring
d. Visual acuity
The answer is: c. ECG monitoring
Explanation
Potassium affects cardiac conduction, and IV potassium chloride can lead to serious
cardiac arrhythmias if not administered correctly. ECG monitoring helps detect early
changes like peaked T waves or widened QRS complexes. Potassium must always be
given slowly and never by IV push. Lung sounds and bowel sounds, while important, are
not directly affected by potassium levels. Visual acuity is unrelated. Monitoring heart
rhythm is the top priority during potassium replacement to prevent lethal arrhythmias.
, 3
3. Which symptom would a nurse most likely observe in a patient with
hypernatremia?
a. Bradycardia
b. Hypotension
c. Restlessness and confusion
d. Diaphoresis
The answer is: c. Restlessness and confusion
Explanation
Hypernatremia often results in neurological symptoms due to fluid shifts causing brain
cell dehydration. Patients may appear agitated, restless, or confused, and in severe cases,
experience seizures or coma. The condition is often due to water loss or sodium gain
(e.g., dehydration, diabetes insipidus, or excessive sodium intake). Bradycardia and
hypotension are more common in volume depletion regardless of sodium level.
Diaphoresis is a symptom of fever or sympathetic stimulation, not sodium excess. Prompt
rehydration is key in treatment.
4. A patient with heart failure is receiving furosemide. Which electrolyte imbalance
should the nurse monitor for?
a. Hyperkalemia
b. Hypernatremia
c. Hypokalemia
d. Hypercalcemia
The answer is: c. Hypokalemia
Explanation
Furosemide is a loop diuretic that increases renal excretion of potassium, sodium, and
water. Hypokalemia is a common side effect, increasing the risk for arrhythmias,
especially in heart failure patients who may also be on digoxin. Nurses must monitor
potassium levels, ECG changes, and muscle strength regularly. Hyperkalemia is more
associated with potassium-sparing diuretics. Hypernatremia can occur with water loss but
is less common with loop diuretics. Hypercalcemia is not a typical concern with
furosemide.
5. Which condition is most likely to cause dilutional hyponatremia?
a. Diabetes mellitus
, 4
b. Syndrome of inappropriate antidiuretic hormone (SIADH)
c. Cushing’s syndrome
d. Hyperparathyroidism
The answer is: b. Syndrome of inappropriate antidiuretic hormone (SIADH)
Explanation
SIADH leads to excessive ADH secretion, causing the kidneys to retain water. This
water retention dilutes serum sodium levels, resulting in hyponatremia. Although total
sodium is unchanged, the increased water volume lowers its concentration. Patients may
present with headache, confusion, and seizures in severe cases. Diabetes mellitus can
cause hypernatremia due to osmotic diuresis. Cushing’s syndrome affects cortisol levels,
and hyperparathyroidism affects calcium regulation, not sodium. Fluid restriction and
addressing the underlying cause are key interventions.
6. What is the best dietary source of potassium for a patient recovering from
hypokalemia?
a. White bread
b. Apple juice
c. Banana
d. Cheese
The answer is: c. Banana
Explanation
Bananas are one of the richest natural sources of potassium, making them an excellent
food choice for patients recovering from hypokalemia. Other good sources include
oranges, spinach, potatoes, and avocados. Apple juice contains minimal potassium, and
white bread and cheese are poor sources. Adequate potassium intake helps restore
neuromuscular and cardiac function. Nurses should educate patients on incorporating
high-potassium foods into their diet while monitoring for signs of overcorrection,
especially in those with renal impairment.
7. Which fluid is most appropriate for treating a patient with hyponatremia due to
excessive fluid intake?
a. 0.45% saline
b. D5W
c. Lactated Ringer’s
d. 3% saline
The answer is: d. 3% saline
Explanation
In cases of severe hyponatremia with neurological symptoms, 3% hypertonic saline is
A+ Guaranteed. Fluid & Electrolyte Mastery: NCLEX
Questions & Answers with Expert Explanations
📘 Why Choose This Document?
● 🎯 100% NCLEX-RN Focused – Every question targets exam-style content with
high-yield concepts in Fluid & Electrolyte imbalances.
● ✍️ Detailed Explanations – Each question comes with a clear, student-friendly
explanation so you understand why the answer is correct.
● 💯 Compiled by Professionals – This bundle is created and verified by Registered
Nurses and NCLEX tutors with firsthand experience in exam coaching.
● 📚 Ideal for Nursing Students, Test-Takers – Whether you're preparing for
NCLEX-RN, HESI, ATI, or your finals, this document is your success blueprint.
Compiled and Approved by:
✔ Registered Nurses
✔ Certified NCLEX Tutors
✔ Nursing Faculty Experts
, 2
A+ Guaranteed. Fluid & Electrolyte Mastery: NCLEX
Questions & Answers with Expert Explanations
1. Which electrolyte imbalance is most likely to occur in a patient with severe
diarrhea?
a. Hypercalcemia
b. Hypokalemia
c. Hypermagnesemia
d. Hypernatremia
The answer is: b. Hypokalemia
Explanation
Diarrhea leads to significant potassium loss because the intestines hold large amounts of
this electrolyte. Hypokalemia presents with muscle weakness, fatigue, and potentially
dangerous cardiac arrhythmias. On ECG, it may show as flattened T waves or prominent
U waves. Hypernatremia is more associated with dehydration. Hypercalcemia and
hypermagnesemia are less common in diarrhea cases and usually arise from different
etiologies like malignancy or renal failure. It's critical to monitor potassium levels closely
and replace potassium as needed to prevent complications in patients with gastrointestinal
losses.
2. What is the most important assessment for a nurse to perform when administering
intravenous potassium chloride (KCl)?
a. Lung sounds
b. Bowel sounds
c. ECG monitoring
d. Visual acuity
The answer is: c. ECG monitoring
Explanation
Potassium affects cardiac conduction, and IV potassium chloride can lead to serious
cardiac arrhythmias if not administered correctly. ECG monitoring helps detect early
changes like peaked T waves or widened QRS complexes. Potassium must always be
given slowly and never by IV push. Lung sounds and bowel sounds, while important, are
not directly affected by potassium levels. Visual acuity is unrelated. Monitoring heart
rhythm is the top priority during potassium replacement to prevent lethal arrhythmias.
, 3
3. Which symptom would a nurse most likely observe in a patient with
hypernatremia?
a. Bradycardia
b. Hypotension
c. Restlessness and confusion
d. Diaphoresis
The answer is: c. Restlessness and confusion
Explanation
Hypernatremia often results in neurological symptoms due to fluid shifts causing brain
cell dehydration. Patients may appear agitated, restless, or confused, and in severe cases,
experience seizures or coma. The condition is often due to water loss or sodium gain
(e.g., dehydration, diabetes insipidus, or excessive sodium intake). Bradycardia and
hypotension are more common in volume depletion regardless of sodium level.
Diaphoresis is a symptom of fever or sympathetic stimulation, not sodium excess. Prompt
rehydration is key in treatment.
4. A patient with heart failure is receiving furosemide. Which electrolyte imbalance
should the nurse monitor for?
a. Hyperkalemia
b. Hypernatremia
c. Hypokalemia
d. Hypercalcemia
The answer is: c. Hypokalemia
Explanation
Furosemide is a loop diuretic that increases renal excretion of potassium, sodium, and
water. Hypokalemia is a common side effect, increasing the risk for arrhythmias,
especially in heart failure patients who may also be on digoxin. Nurses must monitor
potassium levels, ECG changes, and muscle strength regularly. Hyperkalemia is more
associated with potassium-sparing diuretics. Hypernatremia can occur with water loss but
is less common with loop diuretics. Hypercalcemia is not a typical concern with
furosemide.
5. Which condition is most likely to cause dilutional hyponatremia?
a. Diabetes mellitus
, 4
b. Syndrome of inappropriate antidiuretic hormone (SIADH)
c. Cushing’s syndrome
d. Hyperparathyroidism
The answer is: b. Syndrome of inappropriate antidiuretic hormone (SIADH)
Explanation
SIADH leads to excessive ADH secretion, causing the kidneys to retain water. This
water retention dilutes serum sodium levels, resulting in hyponatremia. Although total
sodium is unchanged, the increased water volume lowers its concentration. Patients may
present with headache, confusion, and seizures in severe cases. Diabetes mellitus can
cause hypernatremia due to osmotic diuresis. Cushing’s syndrome affects cortisol levels,
and hyperparathyroidism affects calcium regulation, not sodium. Fluid restriction and
addressing the underlying cause are key interventions.
6. What is the best dietary source of potassium for a patient recovering from
hypokalemia?
a. White bread
b. Apple juice
c. Banana
d. Cheese
The answer is: c. Banana
Explanation
Bananas are one of the richest natural sources of potassium, making them an excellent
food choice for patients recovering from hypokalemia. Other good sources include
oranges, spinach, potatoes, and avocados. Apple juice contains minimal potassium, and
white bread and cheese are poor sources. Adequate potassium intake helps restore
neuromuscular and cardiac function. Nurses should educate patients on incorporating
high-potassium foods into their diet while monitoring for signs of overcorrection,
especially in those with renal impairment.
7. Which fluid is most appropriate for treating a patient with hyponatremia due to
excessive fluid intake?
a. 0.45% saline
b. D5W
c. Lactated Ringer’s
d. 3% saline
The answer is: d. 3% saline
Explanation
In cases of severe hyponatremia with neurological symptoms, 3% hypertonic saline is
