NCLEX-RN Fluid & Electrolytes Complete
Exam 2026/2027 – Complete Exam-Style
Questions | 100% Verified | Detailed
Rationales – Pass Guaranteed – A+
Graded
Section 1: Fluid Volume Disorders (Questions 1–20)
Question 1
A nurse is assessing a client with suspected fluid overload. Which assessment
finding would be most consistent with this condition?
A) Thready pulse and hypotension
B) Decreased jugular venous distention
C) Bounding pulse and hypertension
D) Dry mucous membranes and poor skin turgor
Correct Answer: C
Rationale: Fluid overload (hypervolemia) presents with bounding pulses due to
increased stroke volume, hypertension from elevated circulating volume,
and jugular venous distention. Tachycardia may also be present. Thready pulses,
hypotension, dry mucous membranes, and poor skin turgor are characteristic of
dehydration (hypovolemia), not fluid overload .
,Question 2
A client with heart failure has gained 2 kg in 24 hours. Which laboratory finding
would the nurse anticipate?
A) Serum osmolality 310 mOsm/kg
B) Hemoglobin 18 g/dL
C) Serum sodium 128 mEq/L
D) Urine specific gravity 1.035
Correct Answer: C
Rationale: Fluid overload causes hemodilution, resulting in decreased serum
sodium (hyponatremia). A 2 kg weight gain in 24 hours represents approximately 2
liters of fluid retention. Serum osmolality decreases (<275 mOsm/kg) in fluid
overload, hemoglobin decreases (not increases), and urine specific gravity
decreases (dilute urine) .
Question 3
The RN is assessing a 70-year-old client admitted to the unit with severe
dehydration. Which finding requires immediate intervention by the nurse?
A) Client behavior that changes from anxious to lethargic
B) Deep furrows on the surface of the tongue
C) Poor skin turgor with tenting remaining for 2 minutes after the skin is pinched
D) Urine output of 950 mL for the past 24 hours
Correct Answer: A
Rationale: Immediate intervention is required when a client's behavior changes
from anxious to lethargic. This change in mental status suggests poor cerebral
,blood flow and fluid shifts within brain cells—a sign of worsening dehydration
that can progress to hypovolemic shock. Deep furrows on the tongue, poor skin
turgor, and low urine output are all caused by fluid volume deficit but do not
indicate immediately life-threatening complications .
Question 4
A client with heart failure is receiving furosemide (Lasix). On assessment, the
nurse notes dyspnea and crackles. What additional manifestations would the nurse
expect if excess fluid volume is present? (Select all that apply)
A) Weight loss and dry skin
B) Flat neck and hand veins
C) Increase in blood pressure
D) Increased respiratory rate
E) Decreased urinary output
Correct Answer: C, D
Rationale: Fluid volume excess (hypervolemia) findings include cough, dyspnea,
crackles, tachypnea, tachycardia, elevated blood pressure, bounding pulse,
elevated CVP, weight gain, edema, neck and hand vein distention, altered
level of consciousness, and decreased hematocrit. Dry skin, flat neck/hand veins,
decreased urinary output, and decreased CVP are noted in fluid volume deficit .
Question 5
, Which intervention is the priority for a client experiencing acute pulmonary edema
secondary to fluid overload?
A) Restrict oral fluids to 500 mL/day
B) Administer furosemide intravenously
C) Place the client in high Fowler's position
D) Prepare for endotracheal intubation
Correct Answer: C
Rationale: High Fowler's position is the initial priority intervention as it uses
gravity to reduce venous return (preload) and improve ventilation-perfusion
matching. While diuretics and fluid restriction are important, positioning
provides immediate relief and should be implemented first .
Question 6
A client with syndrome of inappropriate antidiuretic hormone (SIADH) has a
serum sodium of 118 mEq/L. Which intervention should the nurse anticipate?
A) Administration of hypertonic saline
B) Fluid restriction to 800-1000 mL/day
C) Intravenous furosemide push
D) Oral potassium supplementation
Correct Answer: B
Rationale: In SIADH, fluid restriction is the primary treatment to correct
dilutional hyponatremia. Hypertonic saline is reserved for severe symptomatic
hyponatremia with neurological compromise due to risk of central pontine
myelinolysis with rapid correction. Furosemide may be used but is not first-line .
Exam 2026/2027 – Complete Exam-Style
Questions | 100% Verified | Detailed
Rationales – Pass Guaranteed – A+
Graded
Section 1: Fluid Volume Disorders (Questions 1–20)
Question 1
A nurse is assessing a client with suspected fluid overload. Which assessment
finding would be most consistent with this condition?
A) Thready pulse and hypotension
B) Decreased jugular venous distention
C) Bounding pulse and hypertension
D) Dry mucous membranes and poor skin turgor
Correct Answer: C
Rationale: Fluid overload (hypervolemia) presents with bounding pulses due to
increased stroke volume, hypertension from elevated circulating volume,
and jugular venous distention. Tachycardia may also be present. Thready pulses,
hypotension, dry mucous membranes, and poor skin turgor are characteristic of
dehydration (hypovolemia), not fluid overload .
,Question 2
A client with heart failure has gained 2 kg in 24 hours. Which laboratory finding
would the nurse anticipate?
A) Serum osmolality 310 mOsm/kg
B) Hemoglobin 18 g/dL
C) Serum sodium 128 mEq/L
D) Urine specific gravity 1.035
Correct Answer: C
Rationale: Fluid overload causes hemodilution, resulting in decreased serum
sodium (hyponatremia). A 2 kg weight gain in 24 hours represents approximately 2
liters of fluid retention. Serum osmolality decreases (<275 mOsm/kg) in fluid
overload, hemoglobin decreases (not increases), and urine specific gravity
decreases (dilute urine) .
Question 3
The RN is assessing a 70-year-old client admitted to the unit with severe
dehydration. Which finding requires immediate intervention by the nurse?
A) Client behavior that changes from anxious to lethargic
B) Deep furrows on the surface of the tongue
C) Poor skin turgor with tenting remaining for 2 minutes after the skin is pinched
D) Urine output of 950 mL for the past 24 hours
Correct Answer: A
Rationale: Immediate intervention is required when a client's behavior changes
from anxious to lethargic. This change in mental status suggests poor cerebral
,blood flow and fluid shifts within brain cells—a sign of worsening dehydration
that can progress to hypovolemic shock. Deep furrows on the tongue, poor skin
turgor, and low urine output are all caused by fluid volume deficit but do not
indicate immediately life-threatening complications .
Question 4
A client with heart failure is receiving furosemide (Lasix). On assessment, the
nurse notes dyspnea and crackles. What additional manifestations would the nurse
expect if excess fluid volume is present? (Select all that apply)
A) Weight loss and dry skin
B) Flat neck and hand veins
C) Increase in blood pressure
D) Increased respiratory rate
E) Decreased urinary output
Correct Answer: C, D
Rationale: Fluid volume excess (hypervolemia) findings include cough, dyspnea,
crackles, tachypnea, tachycardia, elevated blood pressure, bounding pulse,
elevated CVP, weight gain, edema, neck and hand vein distention, altered
level of consciousness, and decreased hematocrit. Dry skin, flat neck/hand veins,
decreased urinary output, and decreased CVP are noted in fluid volume deficit .
Question 5
, Which intervention is the priority for a client experiencing acute pulmonary edema
secondary to fluid overload?
A) Restrict oral fluids to 500 mL/day
B) Administer furosemide intravenously
C) Place the client in high Fowler's position
D) Prepare for endotracheal intubation
Correct Answer: C
Rationale: High Fowler's position is the initial priority intervention as it uses
gravity to reduce venous return (preload) and improve ventilation-perfusion
matching. While diuretics and fluid restriction are important, positioning
provides immediate relief and should be implemented first .
Question 6
A client with syndrome of inappropriate antidiuretic hormone (SIADH) has a
serum sodium of 118 mEq/L. Which intervention should the nurse anticipate?
A) Administration of hypertonic saline
B) Fluid restriction to 800-1000 mL/day
C) Intravenous furosemide push
D) Oral potassium supplementation
Correct Answer: B
Rationale: In SIADH, fluid restriction is the primary treatment to correct
dilutional hyponatremia. Hypertonic saline is reserved for severe symptomatic
hyponatremia with neurological compromise due to risk of central pontine
myelinolysis with rapid correction. Furosemide may be used but is not first-line .
