HESI Fluid Balance Case Study Questions and answers With Rationales|| GRADED A+|| LATEST UPDATE 2026/27

HESI Fluid Balance Case Study Questions and
answers With Rationales|| GRADED A+|| LATEST
UPDATE 2026/27
STUDY 1: Dehydration
A 76-year-old client is admitted with vomiting, diarrhea, dry mucous membranes, and
decreased urine output.



1. Which assessment finding is most concerning?

A. Dry skin
B. BP 88/52 mmHg
C. Fatigue
D. Thirst

✅ Correct Answer: B
📝 Rationale: Hypotension indicates severe fluid volume deficit and possible shock.



2. Which laboratory value supports dehydration?

A. Sodium 128 mEq/L
B. Hematocrit 55%
C. Potassium 3.8 mEq/L
D. Calcium 9.2 mg/dL

✅ Correct Answer: B
📝 Rationale: Hemoconcentration occurs with fluid loss, raising hematocrit.



3. Which IV fluid is most appropriate initially?

A. D5W
B. 0.9% Normal Saline
C. 0.45% Saline
D. 3% Saline

, ✅ Correct Answer: B
📝 Rationale: Isotonic fluids restore intravascular volume rapidly.



4. Which urine output indicates improvement?

A. 10 mL/hr
B. 20 mL/hr
C. 30 mL/hr
D. 50 mL/hr

✅ Correct Answer: D
📝 Rationale: Adequate renal perfusion is ≥30 mL/hr; 50 mL/hr shows recovery.



5. What electrolyte imbalance is most likely?

A. Hyperkalemia
B. Hyponatremia
C. Hypernatremia
D. Hypercalcemia

✅ Correct Answer: C
📝 Rationale: Water loss exceeds sodium loss in dehydration.




CASE STUDY 2: Fluid Volume Overload (FVE)
A client with CHF presents with crackles, weight gain, and edema.



6. Which finding confirms fluid overload?

A. Dry mucous membranes
B. Jugular vein distention
C. Decreased BP
D. Weak pulses

✅ Correct Answer: B
📝 Rationale: JVD indicates increased intravascular volume.