FLUID, ELECTROLYTE, AND ACID–BASE
IMBALANCES: ADVANCED NCLEX-STYLE
QUESTIONS WITH CORRECT ANSWERS AND
RATIONALES (2025–2026)
An older adult patient with a history of renal failure is
brought in to the emergency department with
sudden onset of acute confusion, worsening muscle
weakness in the extremities, abdominal cramps, and
a weak, rapid, and thready pulse. What are the
immediate nursing interventions to stabilize the
patient? Select all that apply.
1 Administering diuretics
2 Administering 0.9% saline
3 Administering antipsychotics
4 Administering calcium channel blockers
,5 Administering 5% dextrose in 0.45% sodium
chloride - CORRECT ANSWERS-1. Administering
diuretics
2. Administering 0.9% saline
5. Administering 5% dextrose in 0.45% sodium
chloride
The patient's symptoms indicate hypernatremia.
Administering diuretics that promote sodium loss
and administering fluids such as 0.9% saline and 5%
dextrose in 0.45% sodium chloride to restore the
fluid balance are the immediate interventions
needed to stabilize the patient. The patient's acute
confusion is caused by high sodium levels, so
antipsychotic drugs should not be administered.
Sodium decreases the heart contractibility by
retarding the movement of calcium into the heart
cells. Therefore, calcium channel blockers should
not be administered.
The nurse is providing care to a patient who is
experiencing tachypnea. Which intervention is most
appropriate to maintain the patient's fluid balance?
1 Encourage oral fluids.
2 Increase intravenous fluids.
3 Implement fluid restrictions.
,4 Administer prescribed diuretic. - CORRECT
ANSWERS-2 Increase intravenous fluids.
Tachypnea: rapid breathing. The patient who is
experiencing tachypnea will experience an increase
in insensible water loss, increasing the risk for
dehydration. The most appropriate intervention by
the nurse is to increase intravenous fluids.
Encouraging oral fluids is not recommended due to
the increased risk for aspiration that occurs with
tachypnea. Fluid restrictions and diuretics are not
recommended, as these will increase the patient's
risk for dehydration.
Which will the nurse include when documenting a
patient's fluid intake for the shift? Select all that
apply.
1 Emesis
2 Enemas
3 Oral fluids
4 Solid foods
5 Irrigation fluids - CORRECT ANSWERS-2 Enemas
3 Oral fluids
5 Irrigation fluids
Intake that is considered measurable when
documenting a patient's fluid intake for the shift
, include enemas, oral fluids, and irrigation fluids.
Emesis is a measurable output. Solid foods are
considered intake but these cannot be measured.
The nurse is providing care to a patient who is
admitted with fluid volume overload. Which
electrolyte imbalances does the nurse anticipate for
this patient based on the admitting diagnosis? Select
all that apply.
1 Hyponatremia
2 Hypokalemia
3 Hypercalcemia
4 Hypochloremia
5 Hypermagnesemia - CORRECT ANSWERS-1
Hyponatremia
2 Hypokalemia
4 Hypochloremia
A patient admitted with fluid volume overload will
often experience hyponatremia, hypokalemia, and
hypocholoremia. Hypercalcemia and
hypermagnesemia are not anticipated electrolyte
imbalances associated with fluid volume overload.
A patient admitted with fluid overload from heart
failure is treated with diuretic therapy. What
IMBALANCES: ADVANCED NCLEX-STYLE
QUESTIONS WITH CORRECT ANSWERS AND
RATIONALES (2025–2026)
An older adult patient with a history of renal failure is
brought in to the emergency department with
sudden onset of acute confusion, worsening muscle
weakness in the extremities, abdominal cramps, and
a weak, rapid, and thready pulse. What are the
immediate nursing interventions to stabilize the
patient? Select all that apply.
1 Administering diuretics
2 Administering 0.9% saline
3 Administering antipsychotics
4 Administering calcium channel blockers
,5 Administering 5% dextrose in 0.45% sodium
chloride - CORRECT ANSWERS-1. Administering
diuretics
2. Administering 0.9% saline
5. Administering 5% dextrose in 0.45% sodium
chloride
The patient's symptoms indicate hypernatremia.
Administering diuretics that promote sodium loss
and administering fluids such as 0.9% saline and 5%
dextrose in 0.45% sodium chloride to restore the
fluid balance are the immediate interventions
needed to stabilize the patient. The patient's acute
confusion is caused by high sodium levels, so
antipsychotic drugs should not be administered.
Sodium decreases the heart contractibility by
retarding the movement of calcium into the heart
cells. Therefore, calcium channel blockers should
not be administered.
The nurse is providing care to a patient who is
experiencing tachypnea. Which intervention is most
appropriate to maintain the patient's fluid balance?
1 Encourage oral fluids.
2 Increase intravenous fluids.
3 Implement fluid restrictions.
,4 Administer prescribed diuretic. - CORRECT
ANSWERS-2 Increase intravenous fluids.
Tachypnea: rapid breathing. The patient who is
experiencing tachypnea will experience an increase
in insensible water loss, increasing the risk for
dehydration. The most appropriate intervention by
the nurse is to increase intravenous fluids.
Encouraging oral fluids is not recommended due to
the increased risk for aspiration that occurs with
tachypnea. Fluid restrictions and diuretics are not
recommended, as these will increase the patient's
risk for dehydration.
Which will the nurse include when documenting a
patient's fluid intake for the shift? Select all that
apply.
1 Emesis
2 Enemas
3 Oral fluids
4 Solid foods
5 Irrigation fluids - CORRECT ANSWERS-2 Enemas
3 Oral fluids
5 Irrigation fluids
Intake that is considered measurable when
documenting a patient's fluid intake for the shift
, include enemas, oral fluids, and irrigation fluids.
Emesis is a measurable output. Solid foods are
considered intake but these cannot be measured.
The nurse is providing care to a patient who is
admitted with fluid volume overload. Which
electrolyte imbalances does the nurse anticipate for
this patient based on the admitting diagnosis? Select
all that apply.
1 Hyponatremia
2 Hypokalemia
3 Hypercalcemia
4 Hypochloremia
5 Hypermagnesemia - CORRECT ANSWERS-1
Hyponatremia
2 Hypokalemia
4 Hypochloremia
A patient admitted with fluid volume overload will
often experience hyponatremia, hypokalemia, and
hypocholoremia. Hypercalcemia and
hypermagnesemia are not anticipated electrolyte
imbalances associated with fluid volume overload.
A patient admitted with fluid overload from heart
failure is treated with diuretic therapy. What
