NCLEX Fluid and Electrolyte Balance 2 — Questions and Answers
Question 1: A patient with a sodium level of 118 mEq/L develops confusion and seizures. Which IV fluid is most appropriate?
- D5W (5% dextrose in water)
- 0.45% NaCl (half normal saline)
- 3% NaCl (hypertonic saline) (Correct answer)
- Lactated Ringer's solution
Correct answer: 3% NaCl (hypertonic saline)
Severe symptomatic hyponatremia with neurological symptoms requires hypertonic saline (3% NaCl) to safely correct the sodium deficit.
Question 2: Positive Chvostek's and Trousseau's signs are classic clinical manifestations of which electrolyte imbalance?
- Hypokalemia
- Hypocalcemia (Correct answer)
- Hypomagnesemia
- Hypophosphatemia
Correct answer: Hypocalcemia
Both signs indicate increased neuromuscular excitability caused by hypocalcemia.
Question 3: A patient has a serum potassium of 6.2 mEq/L. Which food should the nurse instruct the patient to avoid?
- White bread
- Bananas (Correct answer)
- Apples
- White rice
Correct answer: Bananas
Bananas are high in potassium and must be avoided by patients with hyperkalemia to prevent further elevation.
Question 4: Which assessment finding is most characteristic of fluid volume excess (hypervolemia)?
- Decreased blood pressure
- Tachycardia with a weak, thready pulse
- Crackles (rales) in the lungs (Correct answer)
- Decreased skin turgor
Correct answer: Crackles (rales) in the lungs
Fluid volume excess causes pulmonary edema, which produces crackles on lung auscultation.
Question 5: A patient with chronic alcoholism is most at risk for which electrolyte imbalance?
- Hypermagnesemia
- Hypomagnesemia (Correct answer)
- Hyperphosphatemia
- Hypercalcemia
Correct answer: Hypomagnesemia
Chronic alcoholism causes poor nutritional intake and increased renal excretion of magnesium, leading to hypomagnesemia.
Question 6: Which assessment finding is most consistent with hypernatremia?
- Muscle weakness and flaccidity
- Decreased deep tendon reflexes
- Intense thirst and dry mucous membranes (Correct answer)
- Bradycardia
Correct answer: Intense thirst and dry mucous membranes
High serum sodium creates an osmotic gradient that draws water from cells, causing intense thirst and dry mucous membranes.
Question 7: A patient receiving TPN after prolonged starvation develops severe hypophosphatemia. This is associated with which syndrome?
- Cushing's syndrome
- Refeeding syndrome (Correct answer)
- Dumping syndrome
- Malabsorption syndrome
Correct answer: Refeeding syndrome
Refeeding syndrome occurs when nutrition is reintroduced after starvation, causing rapid cellular uptake of phosphate and dropping serum levels dangerously.
NCLEX Fluid and Electrolyte Balance 2
A patient with a sodium level of 118 mEq/L develops confusion and seizures.
Which IV fluid is most appropriate?