NSG 3800 Comprehensive actual Exam Review 2026/2027 |
Adult Health II | NCLEX-Style Practice Questions, Answers &
Detailed Rationales
Questions 1–50: Fluid, Electrolytes, Renal & Acid–Base
1. A patient with vomiting and diarrhea has BP 88/54 mmHg, HR
118/min, dry mucous membranes, and concentrated urine. Which
finding is the priority concern?
A. Fluid-volume deficit
B. Fluid-volume excess
C. Hypercalcemia
D. Respiratory alkalosis
Correct Answer: A. Fluid-volume deficit
Rationale: Hypotension, tachycardia, dry mucosa, and concentrated
urine are classic indicators of extracellular fluid loss.
2. Which assessment is most reliable for evaluating daily fluid-balance
changes in a hospitalized patient?
A. Skin turgor
B. Daily body weight
C. Blood pressure once daily
D. Urine color
Correct Answer: B. Daily body weight
Rationale: Daily weight is one of the most sensitive indicators of overall
fluid gain or loss.
3. A patient with heart failure gains 2 kg in 48 hours. How should the
nurse interpret this finding?
,A. Expected nutritional improvement
B. Possible fluid retention
C. Resolution of heart failure
D. Dehydration
Correct Answer: B. Possible fluid retention
Rationale: Rapid weight gain is usually related to fluid accumulation
rather than tissue gain.
4. Which ECG finding is most concerning in a patient with severe
hyperkalemia?
A. Flattened T waves
B. Peaked T waves
C. Shortened PR interval only
D. Prominent U waves
Correct Answer: B. Peaked T waves
Rationale: Hyperkalemia can cause tall peaked T waves and progressive
conduction abnormalities.
5. A patient receiving IV potassium reports burning at the IV site. What
should the nurse do first?
A. Increase the infusion rate
B. Assess the IV site and infusion
C. Apply a heating pad
D. Add potassium to the IV bag
Correct Answer: B. Assess the IV site and infusion
Rationale: IV potassium can cause significant tissue irritation and must
be administered carefully through a patent IV.
6. Which patient is at greatest risk for hyperkalemia?
A. Patient taking furosemide
,B. Patient with chronic kidney disease
C. Patient with prolonged vomiting
D. Patient taking hydrochlorothiazide
Correct Answer: B. Patient with chronic kidney disease
Rationale: Reduced renal potassium excretion increases the risk for
hyperkalemia.
7. Which food should the nurse recommend to a patient with
hypokalemia?
A. Applesauce
B. White rice
C. Baked potato
D. Cranberry juice
Correct Answer: C. Baked potato
Rationale: Potatoes are potassium-rich foods and can help increase
dietary potassium when appropriate.
8. A patient has a sodium level of 124 mEq/L and develops a seizure.
Which intervention is the priority?
A. Encourage oral fluids
B. Institute seizure precautions and protect the airway
C. Administer potassium
D. Place the patient flat without monitoring
Correct Answer: B. Institute seizure precautions and protect the
airway
Rationale: Severe symptomatic hyponatremia can cause cerebral
edema and seizures, making neurologic and airway protection priorities.
9. Which assessment is most consistent with hypernatremia?
A. Moist skin and bradycardia
, B. Neurologic changes and intense thirst
C. Positive Chvostek sign
D. Tetany
Correct Answer: B. Neurologic changes and intense thirst
Rationale: Hypernatremia commonly produces cellular dehydration,
thirst, and neurologic manifestations.
10. Which electrolyte imbalance can produce a positive Chvostek sign?
A. Hypernatremia
B. Hypocalcemia
C. Hyperkalemia
D. Hypermagnesemia
Correct Answer: B. Hypocalcemia
Rationale: Hypocalcemia increases neuromuscular excitability and may
produce Chvostek and Trousseau signs.
11. A patient with hypocalcemia is at increased risk for which
complication?
A. Tetany
B. Flaccid paralysis from hyperkalemia
C. Severe constipation
D. Polyuria from diabetes insipidus
Correct Answer: A. Tetany
Rationale: Low calcium increases neuromuscular excitability and can
cause muscle spasms and tetany.
12. Which finding is most consistent with hypercalcemia?
A. Diarrhea
B. Muscle tetany
C. Constipation
Adult Health II | NCLEX-Style Practice Questions, Answers &
Detailed Rationales
Questions 1–50: Fluid, Electrolytes, Renal & Acid–Base
1. A patient with vomiting and diarrhea has BP 88/54 mmHg, HR
118/min, dry mucous membranes, and concentrated urine. Which
finding is the priority concern?
A. Fluid-volume deficit
B. Fluid-volume excess
C. Hypercalcemia
D. Respiratory alkalosis
Correct Answer: A. Fluid-volume deficit
Rationale: Hypotension, tachycardia, dry mucosa, and concentrated
urine are classic indicators of extracellular fluid loss.
2. Which assessment is most reliable for evaluating daily fluid-balance
changes in a hospitalized patient?
A. Skin turgor
B. Daily body weight
C. Blood pressure once daily
D. Urine color
Correct Answer: B. Daily body weight
Rationale: Daily weight is one of the most sensitive indicators of overall
fluid gain or loss.
3. A patient with heart failure gains 2 kg in 48 hours. How should the
nurse interpret this finding?
,A. Expected nutritional improvement
B. Possible fluid retention
C. Resolution of heart failure
D. Dehydration
Correct Answer: B. Possible fluid retention
Rationale: Rapid weight gain is usually related to fluid accumulation
rather than tissue gain.
4. Which ECG finding is most concerning in a patient with severe
hyperkalemia?
A. Flattened T waves
B. Peaked T waves
C. Shortened PR interval only
D. Prominent U waves
Correct Answer: B. Peaked T waves
Rationale: Hyperkalemia can cause tall peaked T waves and progressive
conduction abnormalities.
5. A patient receiving IV potassium reports burning at the IV site. What
should the nurse do first?
A. Increase the infusion rate
B. Assess the IV site and infusion
C. Apply a heating pad
D. Add potassium to the IV bag
Correct Answer: B. Assess the IV site and infusion
Rationale: IV potassium can cause significant tissue irritation and must
be administered carefully through a patent IV.
6. Which patient is at greatest risk for hyperkalemia?
A. Patient taking furosemide
,B. Patient with chronic kidney disease
C. Patient with prolonged vomiting
D. Patient taking hydrochlorothiazide
Correct Answer: B. Patient with chronic kidney disease
Rationale: Reduced renal potassium excretion increases the risk for
hyperkalemia.
7. Which food should the nurse recommend to a patient with
hypokalemia?
A. Applesauce
B. White rice
C. Baked potato
D. Cranberry juice
Correct Answer: C. Baked potato
Rationale: Potatoes are potassium-rich foods and can help increase
dietary potassium when appropriate.
8. A patient has a sodium level of 124 mEq/L and develops a seizure.
Which intervention is the priority?
A. Encourage oral fluids
B. Institute seizure precautions and protect the airway
C. Administer potassium
D. Place the patient flat without monitoring
Correct Answer: B. Institute seizure precautions and protect the
airway
Rationale: Severe symptomatic hyponatremia can cause cerebral
edema and seizures, making neurologic and airway protection priorities.
9. Which assessment is most consistent with hypernatremia?
A. Moist skin and bradycardia
, B. Neurologic changes and intense thirst
C. Positive Chvostek sign
D. Tetany
Correct Answer: B. Neurologic changes and intense thirst
Rationale: Hypernatremia commonly produces cellular dehydration,
thirst, and neurologic manifestations.
10. Which electrolyte imbalance can produce a positive Chvostek sign?
A. Hypernatremia
B. Hypocalcemia
C. Hyperkalemia
D. Hypermagnesemia
Correct Answer: B. Hypocalcemia
Rationale: Hypocalcemia increases neuromuscular excitability and may
produce Chvostek and Trousseau signs.
11. A patient with hypocalcemia is at increased risk for which
complication?
A. Tetany
B. Flaccid paralysis from hyperkalemia
C. Severe constipation
D. Polyuria from diabetes insipidus
Correct Answer: A. Tetany
Rationale: Low calcium increases neuromuscular excitability and can
cause muscle spasms and tetany.
12. Which finding is most consistent with hypercalcemia?
A. Diarrhea
B. Muscle tetany
C. Constipation
