Fluid & Electrolyte NCLEX Practice EXAM 2026-2027
LATEST UPDATED VERSION QUESTIONS AND ANSWERS
The nurse is caring for a pt who is anxious & dizzy following a traumatic experience. The arterial blood
gas findings include: pH 7.48, PaO2 110, PaCO2 25, & HCO3 24. The nurse would anticipate which initial
intervention to correct this problem?
1. Encourage the pt to breathe in & out slowly into a paper bag.
2. Immediately administer oxygen via a mask & monitor oxygen saturation.
3. Prepare to start an intravenous fluid bolus using isotonic fluids.
4. Anticipate the administration of intravenous sodium bicarbonate. - answer>>Answer: 1
Rationale 1: This pt is exhibiting signs of hyperventilation that is confirmed with the blood gas results of
respiratory alkalosis. Breathing into a paper bag will help the pt to retain carbon dioxide & lower oxygen
levels to normal, correcting the cause of the problem.
Rationale 2: The oxygen levels are high, so oxygen is not indicated, & would exacerbate the problem if
given. Intravenous fluids would not be the initial intervention.
Rationale 3: Not enough information is given to determine the need for intravenous fluids.
Rationale 4: Bicarbonate would be contraindicated as the pH is already high.
A pt is prescribed 20 mEq of potassium chloride. The nurse realizes that the reason the pt is receiving
this replacement is
1. to sustain respiratory function.
2. to help regulate acid-base balance.
3. to keep a vein open.
4. to encourage urine output. - answer>>Answer: 2
Rationale 1: Potassium does not sustain respiratory function.
Rationale 2: Electrolytes have many functions. They assist in regulating water balance, help regulate &
maintain acid-base balance, contribute to enzyme reactions, & are essential for neuromuscular activity.
Rationale 3: Intravenous fluids are used to keep venous access not potassium.
Rationale 4: Urinary output is impacted by fluid intake not potassium.
,An elderly pt does not complain of thirst. What should the nurse do to assess that this pt is not
dehydrated?
1. Ask the physician for an order to begin intravenous fluid replacement.
2. Ask the physician to order a chest x-ray.
3. Assess the urine for osmolality.
4. Ask the physician for an order for a brain scan. - answer>>Answer: 3
Rationale 1: It is inappropriate to seek an IV at this stage.
Rationale 2: There is no indication the pt is experiencing pulmonary complications thus a cheat x-ray is
not indicated.
Rationale 3: The thirst mechanism declines with aging, which makes older adults more vulnerable to
dehydration & hyperosmolality. The nurse should check the pt's urine for osmolality as a 1st step in
determining hydration status before other detailed & invasive testing is done.
Rationale 4: There is no data to support the need for a brain scan.
An elderly pt who is being medicated for pain had an episode of incontinence. The nurse realizes that
this pt is at risk for developing
1. dehydration.
2. over-hydration.
3. fecal incontinence.
4. a stroke. - answer>>Correct Answer: 1
Rationale 1: Functional changes of aging also affect fluid balance. Older adults who have self-care
deficits, or who are confused, depressed, tube-fed, on bed rest, or taking medications (such as
sedatives, tranquilizers, diuretics, & laxatives), are at greatest risk for fluid volume imbalance.
Rationale 2: There is inadequate evidence to support the risk of over-hydration.
Rationale 3: There is inadequate evidence to support the risk of fecal incontinence.
Rationale 4: There is inadequate evidence to support the risk of a stroke.
The nurse assesses a pt's weight loss as being 22 lbs. How many liters of fluid did this pt lose? -
answer>>Correct Answer: 10
Rationale: Each liter of body fluid weighs 1 kg or 2.2 lbs. This pt has lost 10 liters of fluid.
,A postoperative pt with a fluid volume deficit is prescribed progressive ambulation yet is weak from an
inadequate fluid status. What can the nurse do to help this pt?
1. Assist the pt to maintain a standing position for several minutes.
2. This pt should be on bed rest.
3. Assist the pt to move into different positions in stages.
4. Contact physical therapy to provide a walker. - answer>>Answer: 3
Rationale 1: The pt should avoid prolonged standing.
Rationale 2: Bed rest can promote skin breakdown.
Rationale 3: The pt needs to be taught how to avoid orthostatic hypotension which would include
assisting & teaching the pt how to move from one position to another in stages.
Rationale 4: A physician referral is needed for physical therapy intervention & is not indicated in this
situation.
A postoperative pt is diagnosed with fluid volume overload. Which of the following should the nurse
assess in this pt?
1. poor skin turgor
2. decreased urine output
3. distended neck veins
4. concentrated hemoglobin & hematocrit levels - answer>>Answer: 3
Rationale 1: Poor skin turgor is associated with fluid volume deficit.
Rationale 2: Decreased urine output is associated with fluid volume deficit.
Rationale 3: Circulatory overload causes manifestations such as a full, bounding pulse; distended neck &
peripheral veins; increased central venous pressure; cough; dyspnea; orthopnea; rales in the lungs;
pulmonary edema; polyuria; ascites; peripheral edema, or if severe, anasarca, in which dilution of
plasma by excess fluid causes a decreased hematocrit & blood urea nitrogen (BUN); & possible cerebral
edema.
Rationale 4: Increased hemoglobin & hematocrit values are associated with fluid volume deficit.
An elderly pt is at home after being diagnosed with fluid volume overload. Which of the following
should the home care nurse instruct this pt to do?
1. Wear support hose.
, 2. Keep legs in a dependent position.
3. Avoid wearing shoes while in the home.
4. Try to sleep without extra pillows. - answer>>Answer: 1
Rationale 1: The home care nurse should instruct this pt about ways to decrease dependent edema,
which include wearing support hose, elevating feet when in a sitting position, & resting in a recliner or
bed with extra pillows.
Rationale 2: The pt should elevate the legs.
Rationale 3: As long as the shoes are well fitting, there is not reason to avoid wearing them.
Rationale 4: It is appropriate for the pt to use extra pillows to keep the head up while sleeping.
A pt with fluid retention related to renal problems is admitted to the hospital. The nurse realizes that
this pt could possibly have which of the following electrolyte imbalances?
1. hypokalemia
2. hypernatremia
3. carbon dioxide
4. magnesium - answer>>Answer: 2
Rationale 1: The kidneys are the principal organs involved in the elimination of potassium. Renal failure
is often associated with elevations potassium levels.
Rationale 2: The kidney is the primary regulator of sodium in the body. Fluid retention is associated with
hypernatremia.
Rationale 3: Carbon dioxide abnormalities are not normally seen in this type of pt.
Rationale 4: Magnesium abnormalities are not normally seen in this type of pt.
An elderly pt comes into the clinic with the complaint of watery diarrhea for several days with
abdominal & muscle cramping. The nurse realizes that this pt is demonstrating which of the following?
1. hypernatremia
2. hyponatremia
3. fluid volume excess
4. hyperkalemia - answer>>Answer: 2
LATEST UPDATED VERSION QUESTIONS AND ANSWERS
The nurse is caring for a pt who is anxious & dizzy following a traumatic experience. The arterial blood
gas findings include: pH 7.48, PaO2 110, PaCO2 25, & HCO3 24. The nurse would anticipate which initial
intervention to correct this problem?
1. Encourage the pt to breathe in & out slowly into a paper bag.
2. Immediately administer oxygen via a mask & monitor oxygen saturation.
3. Prepare to start an intravenous fluid bolus using isotonic fluids.
4. Anticipate the administration of intravenous sodium bicarbonate. - answer>>Answer: 1
Rationale 1: This pt is exhibiting signs of hyperventilation that is confirmed with the blood gas results of
respiratory alkalosis. Breathing into a paper bag will help the pt to retain carbon dioxide & lower oxygen
levels to normal, correcting the cause of the problem.
Rationale 2: The oxygen levels are high, so oxygen is not indicated, & would exacerbate the problem if
given. Intravenous fluids would not be the initial intervention.
Rationale 3: Not enough information is given to determine the need for intravenous fluids.
Rationale 4: Bicarbonate would be contraindicated as the pH is already high.
A pt is prescribed 20 mEq of potassium chloride. The nurse realizes that the reason the pt is receiving
this replacement is
1. to sustain respiratory function.
2. to help regulate acid-base balance.
3. to keep a vein open.
4. to encourage urine output. - answer>>Answer: 2
Rationale 1: Potassium does not sustain respiratory function.
Rationale 2: Electrolytes have many functions. They assist in regulating water balance, help regulate &
maintain acid-base balance, contribute to enzyme reactions, & are essential for neuromuscular activity.
Rationale 3: Intravenous fluids are used to keep venous access not potassium.
Rationale 4: Urinary output is impacted by fluid intake not potassium.
,An elderly pt does not complain of thirst. What should the nurse do to assess that this pt is not
dehydrated?
1. Ask the physician for an order to begin intravenous fluid replacement.
2. Ask the physician to order a chest x-ray.
3. Assess the urine for osmolality.
4. Ask the physician for an order for a brain scan. - answer>>Answer: 3
Rationale 1: It is inappropriate to seek an IV at this stage.
Rationale 2: There is no indication the pt is experiencing pulmonary complications thus a cheat x-ray is
not indicated.
Rationale 3: The thirst mechanism declines with aging, which makes older adults more vulnerable to
dehydration & hyperosmolality. The nurse should check the pt's urine for osmolality as a 1st step in
determining hydration status before other detailed & invasive testing is done.
Rationale 4: There is no data to support the need for a brain scan.
An elderly pt who is being medicated for pain had an episode of incontinence. The nurse realizes that
this pt is at risk for developing
1. dehydration.
2. over-hydration.
3. fecal incontinence.
4. a stroke. - answer>>Correct Answer: 1
Rationale 1: Functional changes of aging also affect fluid balance. Older adults who have self-care
deficits, or who are confused, depressed, tube-fed, on bed rest, or taking medications (such as
sedatives, tranquilizers, diuretics, & laxatives), are at greatest risk for fluid volume imbalance.
Rationale 2: There is inadequate evidence to support the risk of over-hydration.
Rationale 3: There is inadequate evidence to support the risk of fecal incontinence.
Rationale 4: There is inadequate evidence to support the risk of a stroke.
The nurse assesses a pt's weight loss as being 22 lbs. How many liters of fluid did this pt lose? -
answer>>Correct Answer: 10
Rationale: Each liter of body fluid weighs 1 kg or 2.2 lbs. This pt has lost 10 liters of fluid.
,A postoperative pt with a fluid volume deficit is prescribed progressive ambulation yet is weak from an
inadequate fluid status. What can the nurse do to help this pt?
1. Assist the pt to maintain a standing position for several minutes.
2. This pt should be on bed rest.
3. Assist the pt to move into different positions in stages.
4. Contact physical therapy to provide a walker. - answer>>Answer: 3
Rationale 1: The pt should avoid prolonged standing.
Rationale 2: Bed rest can promote skin breakdown.
Rationale 3: The pt needs to be taught how to avoid orthostatic hypotension which would include
assisting & teaching the pt how to move from one position to another in stages.
Rationale 4: A physician referral is needed for physical therapy intervention & is not indicated in this
situation.
A postoperative pt is diagnosed with fluid volume overload. Which of the following should the nurse
assess in this pt?
1. poor skin turgor
2. decreased urine output
3. distended neck veins
4. concentrated hemoglobin & hematocrit levels - answer>>Answer: 3
Rationale 1: Poor skin turgor is associated with fluid volume deficit.
Rationale 2: Decreased urine output is associated with fluid volume deficit.
Rationale 3: Circulatory overload causes manifestations such as a full, bounding pulse; distended neck &
peripheral veins; increased central venous pressure; cough; dyspnea; orthopnea; rales in the lungs;
pulmonary edema; polyuria; ascites; peripheral edema, or if severe, anasarca, in which dilution of
plasma by excess fluid causes a decreased hematocrit & blood urea nitrogen (BUN); & possible cerebral
edema.
Rationale 4: Increased hemoglobin & hematocrit values are associated with fluid volume deficit.
An elderly pt is at home after being diagnosed with fluid volume overload. Which of the following
should the home care nurse instruct this pt to do?
1. Wear support hose.
, 2. Keep legs in a dependent position.
3. Avoid wearing shoes while in the home.
4. Try to sleep without extra pillows. - answer>>Answer: 1
Rationale 1: The home care nurse should instruct this pt about ways to decrease dependent edema,
which include wearing support hose, elevating feet when in a sitting position, & resting in a recliner or
bed with extra pillows.
Rationale 2: The pt should elevate the legs.
Rationale 3: As long as the shoes are well fitting, there is not reason to avoid wearing them.
Rationale 4: It is appropriate for the pt to use extra pillows to keep the head up while sleeping.
A pt with fluid retention related to renal problems is admitted to the hospital. The nurse realizes that
this pt could possibly have which of the following electrolyte imbalances?
1. hypokalemia
2. hypernatremia
3. carbon dioxide
4. magnesium - answer>>Answer: 2
Rationale 1: The kidneys are the principal organs involved in the elimination of potassium. Renal failure
is often associated with elevations potassium levels.
Rationale 2: The kidney is the primary regulator of sodium in the body. Fluid retention is associated with
hypernatremia.
Rationale 3: Carbon dioxide abnormalities are not normally seen in this type of pt.
Rationale 4: Magnesium abnormalities are not normally seen in this type of pt.
An elderly pt comes into the clinic with the complaint of watery diarrhea for several days with
abdominal & muscle cramping. The nurse realizes that this pt is demonstrating which of the following?
1. hypernatremia
2. hyponatremia
3. fluid volume excess
4. hyperkalemia - answer>>Answer: 2
