NURS 320 FINAL EXAM – HEALTH AND ILLNESS
CONCEPTS IDREXEL UNIVERSITY | 2026
RESEARCH-BASED FINAL REVIEW
1. Which assessment finding most strongly suggests extracellular fluid volume deficit?
A) Orthostatic hypotension with tachycardia
B) Bounding peripheral pulses
C) Bilateral dependent edema
D) Jugular venous distention
Correct Answer: Orthostatic hypotension with tachycardia
Rationale: A reduction in extracellular fluid volume decreases circulating blood volume and
commonly produces tachycardia and orthostatic hypotension. Bounding pulses, edema, and
jugular venous distention are more consistent with fluid excess. Orthostatic changes are
especially important because they indicate impaired compensation when the patient
changes position.
2. A nurse evaluates a patient receiving IV fluids for dehydration. Which finding best
indicates improvement?
A) Increasing thirst
B) Urine output of 35 mL/hr with improving blood pressure
C) Increasing heart rate
D) Newly developed orthostatic dizziness
Correct Answer: Urine output of 35 mL/hr with improving blood pressure
Rationale: Adequate urine output and improved blood pressure indicate restoration of
circulating volume and renal perfusion. Persistent thirst, tachycardia, and orthostatic
dizziness suggest that the deficit remains. Urine output is particularly useful because the
kidneys respond to reduced circulating volume by conserving water and sodium.
3. Which electrolyte has the greatest influence on extracellular fluid osmolality?
A) Potassium
B) Calcium
C) Sodium
,D) Magnesium
Correct Answer: Sodium
Rationale: Sodium is the major extracellular cation and is the principal determinant of
extracellular fluid osmolality. Potassium is the major intracellular cation. Calcium and
magnesium have important neuromuscular and cellular functions but contribute much less to
overall extracellular osmolality than sodium.
4. A patient gains 2 kg over several days because of fluid retention. Approximately how
much additional fluid does this represent?
A) 200 mL
B) 500 mL
C) 1 L
D) 2 L
Correct Answer: 2 L
Rationale: A rapid change of approximately 1 kg in body weight generally corresponds to
about 1 liter of retained or lost fluid. Therefore, a 2-kg increase suggests approximately 2
liters of additional body fluid. This principle makes daily weights a sensitive method for
monitoring fluid balance.
5. Which laboratory value is most directly useful when evaluating renal function and
possible fluid imbalance?
A) Serum creatinine
B) Hemoglobin
C) Albumin
D) Total cholesterol
Correct Answer: Serum creatinine
Rationale: Serum creatinine is a major indicator of kidney filtration and is therefore useful
when assessing renal function and fluid regulation. Hemoglobin can help evaluate blood
concentration and anemia, while albumin relates to oncotic pressure. Cholesterol does not
directly assess fluid balance or renal filtration.
6. Which assessment finding is most consistent with fluid volume excess?
A) Flat neck veins
B) Dry mucous membranes
,C) Crackles and dependent edema
D) Concentrated urine
Correct Answer: Crackles and dependent edema
Rationale: Excess extracellular fluid can increase hydrostatic pressure and move fluid into
tissues, producing edema. When fluid accumulates in the pulmonary circulation, crackles
may occur. Dry mucous membranes, flat neck veins, and concentrated urine are more
commonly associated with fluid volume deficit.
7. Why does severe hypoalbuminemia contribute to edema?
A) It increases intracellular potassium.
B) It decreases plasma oncotic pressure.
C) It increases sodium excretion.
D) It causes arterial vasoconstriction.
Correct Answer: It decreases plasma oncotic pressure.
Rationale: Albumin is a major contributor to plasma colloid oncotic pressure, which helps
retain water within the vascular compartment. When albumin decreases, fluid more readily
moves from plasma into interstitial spaces, producing edema. The other options do not
explain the primary mechanism of hypoalbuminemic edema.
8. Which solution is isotonic and commonly used for extracellular volume replacement?
A) 0.9% sodium chloride
B) 0.45% sodium chloride
C) 3% sodium chloride
D) D5W after glucose metabolism
Correct Answer: 0.9% sodium chloride
Rationale: Normal saline, or 0.9% sodium chloride, is an isotonic crystalloid that expands
extracellular fluid volume. Half-normal saline is hypotonic, whereas 3% saline is hypertonic.
Although D5W initially behaves as an isotonic solution in the bag, its physiologic distribution
after glucose metabolism differs substantially.
9. Which manifestation would the nurse expect with significant hypernatremia?
A) Muscle weakness and confusion
B) Severe dependent edema only
C) Profound bradycardia
, D) Absent thirst
Correct Answer: Muscle weakness and confusion
Rationale: Hypernatremia generally reflects excessive sodium relative to water and causes
cellular dehydration, particularly affecting neurologic function. Patients may develop intense
thirst, restlessness, confusion, weakness, or seizures when severe. Edema is not the defining
manifestation, and thirst generally increases rather than disappears.
10. A patient with severe symptomatic hyponatremia is prescribed hypertonic saline.
Which nursing action is most important?
A) Infuse it rapidly without monitoring.
B) Monitor serum sodium and neurologic status closely.
C) Encourage unlimited free-water intake.
D) Administer hypotonic fluid simultaneously.
Correct Answer: Monitor serum sodium and neurologic status closely.
Rationale: Hypertonic saline can rapidly increase serum sodium and is reserved for carefully
selected symptomatic patients. Excessively rapid correction can cause serious neurologic
injury. Frequent assessment of neurologic status and serum sodium helps the nurse identify
worsening symptoms or overly rapid correction.
11. Which ECG-related problem is most concerning in a patient with significant
hypokalemia?
A) Cardiac dysrhythmia
B) Hypertension
C) Sinus bradycardia from hyperkalemia
D) Complete absence of cardiac electrical activity in every case
Correct Answer: Cardiac dysrhythmia
Rationale: Potassium is essential for normal myocardial electrical activity. Significant
hypokalemia can produce conduction abnormalities, ectopy, and potentially dangerous
dysrhythmias. The nurse should therefore monitor cardiac rhythm when potassium levels are
substantially abnormal, particularly when the patient has symptoms or cardiac disease.
12. A patient with severe hypokalemia and cardiac dysrhythmias requires potassium
replacement. Which route may be prescribed when rapid correction is necessary?
A) Intramuscular potassium
B) Subcutaneous potassium
CONCEPTS IDREXEL UNIVERSITY | 2026
RESEARCH-BASED FINAL REVIEW
1. Which assessment finding most strongly suggests extracellular fluid volume deficit?
A) Orthostatic hypotension with tachycardia
B) Bounding peripheral pulses
C) Bilateral dependent edema
D) Jugular venous distention
Correct Answer: Orthostatic hypotension with tachycardia
Rationale: A reduction in extracellular fluid volume decreases circulating blood volume and
commonly produces tachycardia and orthostatic hypotension. Bounding pulses, edema, and
jugular venous distention are more consistent with fluid excess. Orthostatic changes are
especially important because they indicate impaired compensation when the patient
changes position.
2. A nurse evaluates a patient receiving IV fluids for dehydration. Which finding best
indicates improvement?
A) Increasing thirst
B) Urine output of 35 mL/hr with improving blood pressure
C) Increasing heart rate
D) Newly developed orthostatic dizziness
Correct Answer: Urine output of 35 mL/hr with improving blood pressure
Rationale: Adequate urine output and improved blood pressure indicate restoration of
circulating volume and renal perfusion. Persistent thirst, tachycardia, and orthostatic
dizziness suggest that the deficit remains. Urine output is particularly useful because the
kidneys respond to reduced circulating volume by conserving water and sodium.
3. Which electrolyte has the greatest influence on extracellular fluid osmolality?
A) Potassium
B) Calcium
C) Sodium
,D) Magnesium
Correct Answer: Sodium
Rationale: Sodium is the major extracellular cation and is the principal determinant of
extracellular fluid osmolality. Potassium is the major intracellular cation. Calcium and
magnesium have important neuromuscular and cellular functions but contribute much less to
overall extracellular osmolality than sodium.
4. A patient gains 2 kg over several days because of fluid retention. Approximately how
much additional fluid does this represent?
A) 200 mL
B) 500 mL
C) 1 L
D) 2 L
Correct Answer: 2 L
Rationale: A rapid change of approximately 1 kg in body weight generally corresponds to
about 1 liter of retained or lost fluid. Therefore, a 2-kg increase suggests approximately 2
liters of additional body fluid. This principle makes daily weights a sensitive method for
monitoring fluid balance.
5. Which laboratory value is most directly useful when evaluating renal function and
possible fluid imbalance?
A) Serum creatinine
B) Hemoglobin
C) Albumin
D) Total cholesterol
Correct Answer: Serum creatinine
Rationale: Serum creatinine is a major indicator of kidney filtration and is therefore useful
when assessing renal function and fluid regulation. Hemoglobin can help evaluate blood
concentration and anemia, while albumin relates to oncotic pressure. Cholesterol does not
directly assess fluid balance or renal filtration.
6. Which assessment finding is most consistent with fluid volume excess?
A) Flat neck veins
B) Dry mucous membranes
,C) Crackles and dependent edema
D) Concentrated urine
Correct Answer: Crackles and dependent edema
Rationale: Excess extracellular fluid can increase hydrostatic pressure and move fluid into
tissues, producing edema. When fluid accumulates in the pulmonary circulation, crackles
may occur. Dry mucous membranes, flat neck veins, and concentrated urine are more
commonly associated with fluid volume deficit.
7. Why does severe hypoalbuminemia contribute to edema?
A) It increases intracellular potassium.
B) It decreases plasma oncotic pressure.
C) It increases sodium excretion.
D) It causes arterial vasoconstriction.
Correct Answer: It decreases plasma oncotic pressure.
Rationale: Albumin is a major contributor to plasma colloid oncotic pressure, which helps
retain water within the vascular compartment. When albumin decreases, fluid more readily
moves from plasma into interstitial spaces, producing edema. The other options do not
explain the primary mechanism of hypoalbuminemic edema.
8. Which solution is isotonic and commonly used for extracellular volume replacement?
A) 0.9% sodium chloride
B) 0.45% sodium chloride
C) 3% sodium chloride
D) D5W after glucose metabolism
Correct Answer: 0.9% sodium chloride
Rationale: Normal saline, or 0.9% sodium chloride, is an isotonic crystalloid that expands
extracellular fluid volume. Half-normal saline is hypotonic, whereas 3% saline is hypertonic.
Although D5W initially behaves as an isotonic solution in the bag, its physiologic distribution
after glucose metabolism differs substantially.
9. Which manifestation would the nurse expect with significant hypernatremia?
A) Muscle weakness and confusion
B) Severe dependent edema only
C) Profound bradycardia
, D) Absent thirst
Correct Answer: Muscle weakness and confusion
Rationale: Hypernatremia generally reflects excessive sodium relative to water and causes
cellular dehydration, particularly affecting neurologic function. Patients may develop intense
thirst, restlessness, confusion, weakness, or seizures when severe. Edema is not the defining
manifestation, and thirst generally increases rather than disappears.
10. A patient with severe symptomatic hyponatremia is prescribed hypertonic saline.
Which nursing action is most important?
A) Infuse it rapidly without monitoring.
B) Monitor serum sodium and neurologic status closely.
C) Encourage unlimited free-water intake.
D) Administer hypotonic fluid simultaneously.
Correct Answer: Monitor serum sodium and neurologic status closely.
Rationale: Hypertonic saline can rapidly increase serum sodium and is reserved for carefully
selected symptomatic patients. Excessively rapid correction can cause serious neurologic
injury. Frequent assessment of neurologic status and serum sodium helps the nurse identify
worsening symptoms or overly rapid correction.
11. Which ECG-related problem is most concerning in a patient with significant
hypokalemia?
A) Cardiac dysrhythmia
B) Hypertension
C) Sinus bradycardia from hyperkalemia
D) Complete absence of cardiac electrical activity in every case
Correct Answer: Cardiac dysrhythmia
Rationale: Potassium is essential for normal myocardial electrical activity. Significant
hypokalemia can produce conduction abnormalities, ectopy, and potentially dangerous
dysrhythmias. The nurse should therefore monitor cardiac rhythm when potassium levels are
substantially abnormal, particularly when the patient has symptoms or cardiac disease.
12. A patient with severe hypokalemia and cardiac dysrhythmias requires potassium
replacement. Which route may be prescribed when rapid correction is necessary?
A) Intramuscular potassium
B) Subcutaneous potassium
