NSG 3850 EXAM 1 REVIEW: FLUID AND
ELECTROLYTE HOMEOSTASIS AND
IMBALANCES 2026
1. A nurse is assessing a patient who has experienced significant vomiting and diarrhea over the past
three days. Which finding would be most consistent with an extracellular fluid volume deficit?
A) Bounding peripheral pulses
B) Distended neck veins when supine
C) Sudden weight loss of 4 pounds
D) Crackles in the lung bases
ANSWER: C) Sudden weight loss of 4 pounds
Rationale:
A) Bounding peripheral pulses: Incorrect. Bounding pulses are characteristic of fluid volume excess, not
deficit. In volume deficit, pulses are typically weak and thready due to decreased circulating blood
volume.
B) Distended neck veins when supine: Incorrect. Flat neck veins, not distended, are seen in volume
deficit due to decreased central venous pressure. Distended neck veins indicate volume excess.
,C) Sudden weight loss of 4 pounds: Correct. Sudden weight loss is a sensitive and reliable indicator of
extracellular fluid volume deficit. Each liter of fluid loss corresponds to approximately 2.2 pounds (1 kg)
of weight loss.
D) Crackles in the lung bases: Incorrect. Crackles indicate fluid accumulation in the lungs, which is
associated with volume excess, not deficit. Volume deficit would present with decreased breath sounds
or no adventitious sounds.
2. A patient with chronic heart failure is exhibiting signs of fluid volume excess. Which assessment
finding would the nurse expect to observe?
A) Longitudinal furrows on the tongue
B) Postural hypotension with tachycardia
C) Bounding pulses with neck vein distention
D) Decreased skin turgor with dry mucous membranes
ANSWER: C) Bounding pulses with neck vein distention
Rationale:
A) Longitudinal furrows on the tongue: Incorrect. This finding is associated with fluid volume deficit,
indicating dehydration and decreased extracellular fluid volume.
B) Postural hypotension with tachycardia: Incorrect. These are compensatory mechanisms seen in fluid
volume deficit as the body attempts to maintain perfusion to vital organs.
C) Bounding pulses with neck vein distention: Correct. Bounding pulses result from increased stroke
volume and cardiac output in volume excess. Neck vein distention occurs due to elevated central venous
pressure from increased circulating volume.
D) Decreased skin turgor with dry mucous membranes: Incorrect. These findings indicate dehydration
and fluid volume deficit, not excess. In volume excess, skin turgor is typically normal or may appear taut
with edema.
,3. A nurse is calculating the percentage of body water for a 65-year-old female patient. Which
percentage would be most appropriate based on age and gender?
A) 60% of body weight
B) 50% of body weight
C) 55% of body weight
D) 45% of body weight
ANSWER: B) 50% of body weight
Rationale:
A) 60% of body weight: Incorrect. This percentage applies to adult men who typically have greater
muscle mass and less body fat. Women generally have a higher proportion of body fat.
B) 50% of body weight: Correct. Adult women typically have about 50% of body weight as water due to a
greater proportion of body fat compared to men. Body fat contains less water than lean tissue.
C) 55% of body weight: Incorrect. This percentage might apply to adult men, not women. Women
generally range from 45-55% depending on age and body composition.
D) 45% of body weight: Incorrect. This percentage is too low for most adult women. Older adults may
have less body water, but 50% is the standard reference for adult women.
4. A patient is admitted with severe dehydration. The nurse understands that the thirst mechanism is
primarily triggered by which physiologic process?
A) Decreased serum sodium levels
B) Increased osmolality of extracellular fluid
C) Decreased angiotensin II levels
, D) Increased circulating blood volume
ANSWER: B) Increased osmolality of extracellular fluid
Rationale:
A) Decreased serum sodium levels: Incorrect. Decreased serum sodium would lead to decreased
osmolality, which would not trigger thirst. Thirst is stimulated by increased osmolality, not decreased.
B) Increased osmolality of extracellular fluid: Correct. Osmoreceptor-mediated thirst is triggered when
the osmolality of extracellular fluid increases. This occurs when there is a loss of water relative to
solutes, causing cells to shrink and stimulate thirst centers in the hypothalamus.
C) Decreased angiotensin II levels: Incorrect. Decreased angiotensin II would not stimulate thirst.
Angiotensin II, when elevated, stimulates thirst as part of the renin-angiotensin-aldosterone system
response to decreased circulating volume.
D) Increased circulating blood volume: Incorrect. Increased circulating blood volume would inhibit thirst
mechanisms. Thirst is stimulated by decreased circulating blood volume, which triggers baroreceptor-
mediated thirst.
5. A nurse is assessing a patient who has experienced significant blood loss from a traumatic injury. The
patient's blood pressure is 90/60 mmHg, heart rate is 115 beats/min, and skin is cool and clammy.
Which fluid compartment has been primarily affected?
A) Intracellular compartment
B) Extracellular vascular compartment
C) Interstitial compartment
D) Transcellular compartment
ANSWER: B) Extracellular vascular compartment
ELECTROLYTE HOMEOSTASIS AND
IMBALANCES 2026
1. A nurse is assessing a patient who has experienced significant vomiting and diarrhea over the past
three days. Which finding would be most consistent with an extracellular fluid volume deficit?
A) Bounding peripheral pulses
B) Distended neck veins when supine
C) Sudden weight loss of 4 pounds
D) Crackles in the lung bases
ANSWER: C) Sudden weight loss of 4 pounds
Rationale:
A) Bounding peripheral pulses: Incorrect. Bounding pulses are characteristic of fluid volume excess, not
deficit. In volume deficit, pulses are typically weak and thready due to decreased circulating blood
volume.
B) Distended neck veins when supine: Incorrect. Flat neck veins, not distended, are seen in volume
deficit due to decreased central venous pressure. Distended neck veins indicate volume excess.
,C) Sudden weight loss of 4 pounds: Correct. Sudden weight loss is a sensitive and reliable indicator of
extracellular fluid volume deficit. Each liter of fluid loss corresponds to approximately 2.2 pounds (1 kg)
of weight loss.
D) Crackles in the lung bases: Incorrect. Crackles indicate fluid accumulation in the lungs, which is
associated with volume excess, not deficit. Volume deficit would present with decreased breath sounds
or no adventitious sounds.
2. A patient with chronic heart failure is exhibiting signs of fluid volume excess. Which assessment
finding would the nurse expect to observe?
A) Longitudinal furrows on the tongue
B) Postural hypotension with tachycardia
C) Bounding pulses with neck vein distention
D) Decreased skin turgor with dry mucous membranes
ANSWER: C) Bounding pulses with neck vein distention
Rationale:
A) Longitudinal furrows on the tongue: Incorrect. This finding is associated with fluid volume deficit,
indicating dehydration and decreased extracellular fluid volume.
B) Postural hypotension with tachycardia: Incorrect. These are compensatory mechanisms seen in fluid
volume deficit as the body attempts to maintain perfusion to vital organs.
C) Bounding pulses with neck vein distention: Correct. Bounding pulses result from increased stroke
volume and cardiac output in volume excess. Neck vein distention occurs due to elevated central venous
pressure from increased circulating volume.
D) Decreased skin turgor with dry mucous membranes: Incorrect. These findings indicate dehydration
and fluid volume deficit, not excess. In volume excess, skin turgor is typically normal or may appear taut
with edema.
,3. A nurse is calculating the percentage of body water for a 65-year-old female patient. Which
percentage would be most appropriate based on age and gender?
A) 60% of body weight
B) 50% of body weight
C) 55% of body weight
D) 45% of body weight
ANSWER: B) 50% of body weight
Rationale:
A) 60% of body weight: Incorrect. This percentage applies to adult men who typically have greater
muscle mass and less body fat. Women generally have a higher proportion of body fat.
B) 50% of body weight: Correct. Adult women typically have about 50% of body weight as water due to a
greater proportion of body fat compared to men. Body fat contains less water than lean tissue.
C) 55% of body weight: Incorrect. This percentage might apply to adult men, not women. Women
generally range from 45-55% depending on age and body composition.
D) 45% of body weight: Incorrect. This percentage is too low for most adult women. Older adults may
have less body water, but 50% is the standard reference for adult women.
4. A patient is admitted with severe dehydration. The nurse understands that the thirst mechanism is
primarily triggered by which physiologic process?
A) Decreased serum sodium levels
B) Increased osmolality of extracellular fluid
C) Decreased angiotensin II levels
, D) Increased circulating blood volume
ANSWER: B) Increased osmolality of extracellular fluid
Rationale:
A) Decreased serum sodium levels: Incorrect. Decreased serum sodium would lead to decreased
osmolality, which would not trigger thirst. Thirst is stimulated by increased osmolality, not decreased.
B) Increased osmolality of extracellular fluid: Correct. Osmoreceptor-mediated thirst is triggered when
the osmolality of extracellular fluid increases. This occurs when there is a loss of water relative to
solutes, causing cells to shrink and stimulate thirst centers in the hypothalamus.
C) Decreased angiotensin II levels: Incorrect. Decreased angiotensin II would not stimulate thirst.
Angiotensin II, when elevated, stimulates thirst as part of the renin-angiotensin-aldosterone system
response to decreased circulating volume.
D) Increased circulating blood volume: Incorrect. Increased circulating blood volume would inhibit thirst
mechanisms. Thirst is stimulated by decreased circulating blood volume, which triggers baroreceptor-
mediated thirst.
5. A nurse is assessing a patient who has experienced significant blood loss from a traumatic injury. The
patient's blood pressure is 90/60 mmHg, heart rate is 115 beats/min, and skin is cool and clammy.
Which fluid compartment has been primarily affected?
A) Intracellular compartment
B) Extracellular vascular compartment
C) Interstitial compartment
D) Transcellular compartment
ANSWER: B) Extracellular vascular compartment
