ELECTROLYTE IMBALANCES GALEN COLLEGE OF NURSING [2026/2027] – NURSING
QUESTIONS & ANSWERS, STUDY GUIDE & PRACTICE TEST – COMPREHENSIVE QUESTIONS
AND ANSWERS | VERIFIED AND WELLDETAILED ANSWERS | DETAILED EXPLANATIONS AND
RATIONALES | COMPLETE EXAM PREPARATION STUDY GUIDE | PRACTICE QUESTIONS |
LATEST EXAM UPDATE
• **CORE DOMAINS***
• Sodium balance: hyponatremia and hypernatremia
• Potassium balance: hypokalemia and hyperkalemia
• Calcium balance: hypocalcemia and hypercalcemia
• Magnesium balance: hypomagnesemia and hypermagnesemia
• Phosphate balance and associated electrolyte disorders
• Fluid balance, osmolality, and renal regulation
• Assessment, laboratory interpretation, and clinical manifestations
• Nursing interventions, medication considerations, and patient safety
• Emergency management and cardiac/neurologic complications
• **INTRODUCTION***
This comprehensive assessment is designed to evaluate understanding of electrolyte
imbalances and their implications for nursing practice. The questions assess foundational
concepts, terminology, physiological mechanisms, laboratory interpretation, manifestations,
risk factors, nursing assessment, interventions, safety, and clinical decision-making. Multiple-
choice questions are used to reinforce recognition of characteristic findings while also
requiring application of knowledge to realistic patient situations. Particular emphasis is
placed on distinguishing similar electrolyte disorders, recognizing potentially life-threatening
complications, interpreting assessment findings, and selecting appropriate nursing actions.
Effective preparation requires understanding not only which findings are associated with an
imbalance, but also why those findings occur and how nurses should respond.
SECTION ONE: QUESTIONS 1–100
Question 1. Which electrolyte is the primary determinant of extracellular fluid osmolality
and plays a major role in regulating water distribution?
A. Potassium
B. Sodium
C. Calcium
D. Magnesium
,Correct Answer: B. Sodium
Explanation: Sodium is the major extracellular cation and is a principal determinant of
extracellular fluid osmolality. Changes in serum sodium commonly reflect disturbances in
water balance as well as sodium balance.
Question 2. Which serum sodium value is generally considered within the expected adult
range?
A. 115 mEq/L
B. 124 mEq/L
C. 140 mEq/L
D. 158 mEq/L
Correct Answer: C. 140 mEq/L
Explanation: Normal adult serum sodium is generally approximately 135–145 mEq/L,
although reference ranges can vary slightly among laboratories.
Question 3. A nurse is assessing a client with hyponatremia. Which finding is most
concerning?
A. Mild thirst
B. Increased appetite
C. New-onset seizure activity
D. Warm, flushed skin
Correct Answer: C. New-onset seizure activity
Explanation: Severe hyponatremia can cause cerebral edema and significant neurologic
dysfunction. Seizures indicate severe neurologic involvement and require immediate
intervention.
Question 4. Which client is at greatest risk for dilutional hyponatremia?
A. A client receiving excessive hypotonic intravenous fluid
B. A client consuming a high-sodium diet
C. A client receiving a potassium supplement
D. A client with isolated hypercalcemia
Correct Answer: A. A client receiving excessive hypotonic intravenous fluid
Explanation: Excessive hypotonic fluid increases free water relative to sodium and can dilute
serum sodium concentration, producing dilutional hyponatremia.
Question 5. Which assessment finding is commonly associated with mild to moderate
hyponatremia?
, A. Confusion
B. Bounding reflexes with tetany
C. Severe constipation
D. Peaked T waves
Correct Answer: A. Confusion
Explanation: Neurologic manifestations such as headache, confusion, lethargy, and
weakness can occur with hyponatremia because changes in serum osmolality affect brain
cells.
Question 6. Which condition is classically associated with dilutional hyponatremia caused
by excessive antidiuretic hormone activity?
A. Diabetes insipidus
B. Syndrome of inappropriate antidiuretic hormone secretion
C. Hyperaldosteronism
D. Hyperparathyroidism
Correct Answer: B. Syndrome of inappropriate antidiuretic hormone secretion
Explanation: Excessive ADH promotes water retention, which can dilute serum sodium.
SIADH is therefore an important cause of euvolemic dilutional hyponatremia.
Question 7. A client with severe hyponatremia is at risk for which complication?
A. Cerebral edema
B. Renal calculi
C. Pulmonary fibrosis
D. Bone marrow suppression
Correct Answer: A. Cerebral edema
Explanation: A significant decrease in extracellular osmolality causes water to move into
cells. Cerebral cellular swelling can produce headache, confusion, seizures, decreased level
of consciousness, and potentially brain herniation.
Question 8. Which nursing intervention is appropriate for a client with hyponatremia
related to excessive free-water intake?
A. Encourage unrestricted water intake
B. Implement prescribed fluid restriction
C. Administer potassium without an order
D. Encourage a completely sodium-free diet
Correct Answer: B. Implement prescribed fluid restriction
QUESTIONS & ANSWERS, STUDY GUIDE & PRACTICE TEST – COMPREHENSIVE QUESTIONS
AND ANSWERS | VERIFIED AND WELLDETAILED ANSWERS | DETAILED EXPLANATIONS AND
RATIONALES | COMPLETE EXAM PREPARATION STUDY GUIDE | PRACTICE QUESTIONS |
LATEST EXAM UPDATE
• **CORE DOMAINS***
• Sodium balance: hyponatremia and hypernatremia
• Potassium balance: hypokalemia and hyperkalemia
• Calcium balance: hypocalcemia and hypercalcemia
• Magnesium balance: hypomagnesemia and hypermagnesemia
• Phosphate balance and associated electrolyte disorders
• Fluid balance, osmolality, and renal regulation
• Assessment, laboratory interpretation, and clinical manifestations
• Nursing interventions, medication considerations, and patient safety
• Emergency management and cardiac/neurologic complications
• **INTRODUCTION***
This comprehensive assessment is designed to evaluate understanding of electrolyte
imbalances and their implications for nursing practice. The questions assess foundational
concepts, terminology, physiological mechanisms, laboratory interpretation, manifestations,
risk factors, nursing assessment, interventions, safety, and clinical decision-making. Multiple-
choice questions are used to reinforce recognition of characteristic findings while also
requiring application of knowledge to realistic patient situations. Particular emphasis is
placed on distinguishing similar electrolyte disorders, recognizing potentially life-threatening
complications, interpreting assessment findings, and selecting appropriate nursing actions.
Effective preparation requires understanding not only which findings are associated with an
imbalance, but also why those findings occur and how nurses should respond.
SECTION ONE: QUESTIONS 1–100
Question 1. Which electrolyte is the primary determinant of extracellular fluid osmolality
and plays a major role in regulating water distribution?
A. Potassium
B. Sodium
C. Calcium
D. Magnesium
,Correct Answer: B. Sodium
Explanation: Sodium is the major extracellular cation and is a principal determinant of
extracellular fluid osmolality. Changes in serum sodium commonly reflect disturbances in
water balance as well as sodium balance.
Question 2. Which serum sodium value is generally considered within the expected adult
range?
A. 115 mEq/L
B. 124 mEq/L
C. 140 mEq/L
D. 158 mEq/L
Correct Answer: C. 140 mEq/L
Explanation: Normal adult serum sodium is generally approximately 135–145 mEq/L,
although reference ranges can vary slightly among laboratories.
Question 3. A nurse is assessing a client with hyponatremia. Which finding is most
concerning?
A. Mild thirst
B. Increased appetite
C. New-onset seizure activity
D. Warm, flushed skin
Correct Answer: C. New-onset seizure activity
Explanation: Severe hyponatremia can cause cerebral edema and significant neurologic
dysfunction. Seizures indicate severe neurologic involvement and require immediate
intervention.
Question 4. Which client is at greatest risk for dilutional hyponatremia?
A. A client receiving excessive hypotonic intravenous fluid
B. A client consuming a high-sodium diet
C. A client receiving a potassium supplement
D. A client with isolated hypercalcemia
Correct Answer: A. A client receiving excessive hypotonic intravenous fluid
Explanation: Excessive hypotonic fluid increases free water relative to sodium and can dilute
serum sodium concentration, producing dilutional hyponatremia.
Question 5. Which assessment finding is commonly associated with mild to moderate
hyponatremia?
, A. Confusion
B. Bounding reflexes with tetany
C. Severe constipation
D. Peaked T waves
Correct Answer: A. Confusion
Explanation: Neurologic manifestations such as headache, confusion, lethargy, and
weakness can occur with hyponatremia because changes in serum osmolality affect brain
cells.
Question 6. Which condition is classically associated with dilutional hyponatremia caused
by excessive antidiuretic hormone activity?
A. Diabetes insipidus
B. Syndrome of inappropriate antidiuretic hormone secretion
C. Hyperaldosteronism
D. Hyperparathyroidism
Correct Answer: B. Syndrome of inappropriate antidiuretic hormone secretion
Explanation: Excessive ADH promotes water retention, which can dilute serum sodium.
SIADH is therefore an important cause of euvolemic dilutional hyponatremia.
Question 7. A client with severe hyponatremia is at risk for which complication?
A. Cerebral edema
B. Renal calculi
C. Pulmonary fibrosis
D. Bone marrow suppression
Correct Answer: A. Cerebral edema
Explanation: A significant decrease in extracellular osmolality causes water to move into
cells. Cerebral cellular swelling can produce headache, confusion, seizures, decreased level
of consciousness, and potentially brain herniation.
Question 8. Which nursing intervention is appropriate for a client with hyponatremia
related to excessive free-water intake?
A. Encourage unrestricted water intake
B. Implement prescribed fluid restriction
C. Administer potassium without an order
D. Encourage a completely sodium-free diet
Correct Answer: B. Implement prescribed fluid restriction
