Nclexrn Quiz: Fluid And Electrolyte Imbalances
20 questions · exam conditions
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Fluid And Electrolyte ImbalancesQuestion 1 of 20

A 70-year-old client with heart failure is admitted for fluid volume excess and is receiving a loop diuretic. The client has bilateral crackles and 3+ pitting edema. Vital signs: blood pressure 156/88 mm Hg, heart rate 98/min, respiratory rate 24/min, oxygen saturation 92% on 2 L/min nasal cannula. Labs: sodium 126 mEq/L (low), potassium 4.1 mEq/L. Which symptom indicates a need for FURTHER assessment?

New onset confusion and headache
Bilateral ankle edema that improves with leg elevation
Mild exertional dyspnea that resolves with rest
Nocturia occurring twice nightly
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Nclexrn Quiz

Nclexrn Quiz: Fluid And Electrolyte Imbalances

Practice Fluid And Electrolyte Imbalances in Nclexrn with focused quiz questions that help you check what you know, review explanations, and build confidence with test-style prompts.

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This quiz focuses on Fluid And Electrolyte Imbalances, giving you a quick way to practice the rules, question types, and explanations that matter most for Nclexrn.

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Question 1

A 70-year-old client with heart failure is admitted for fluid volume excess and is receiving a loop diuretic. The client has bilateral crackles and 3+ pitting edema. Vital signs: blood pressure 156/88 mm Hg, heart rate 98/min, respiratory rate 24/min, oxygen saturation 92% on 2 L/min nasal cannula. Labs: sodium 126 mEq/L (low), potassium 4.1 mEq/L. Which symptom indicates a need for FURTHER assessment?

  1. New onset confusion and headache (correct answer)
  2. Bilateral ankle edema that improves with leg elevation
  3. Mild exertional dyspnea that resolves with rest
  4. Nocturia occurring twice nightly
Explanation: This question tests clinical judgment in managing fluid and electrolyte imbalances, specifically recognizing cerebral symptoms of severe hyponatremia. The key assessment finding is new onset confusion and headache in a patient with hyponatremia (126 mEq/L) and fluid overload. New onset confusion and headache (A) is the BEST choice for further assessment because these are signs of cerebral edema from severe hyponatremia requiring immediate intervention. Bilateral ankle edema (B), mild exertional dyspnea (C), and nocturia (D) are expected findings in heart failure with fluid overload and don't indicate acute deterioration. The decision-making principle is that neurological symptoms in hyponatremia indicate cerebral edema requiring urgent treatment to prevent seizures or coma. A transferable strategy is to prioritize neurological assessment in hyponatremic patients, as mental status changes herald life-threatening complications.

Question 2

A 6-year-old child with acute gastroenteritis has had vomiting and watery diarrhea for 2 days and is lethargic with decreased tears. Vital signs: heart rate 132/min, respiratory rate 24/min, blood pressure 88/50 mm Hg; capillary refill 4 seconds. Labs: potassium 2.9 mEq/L (low), bicarbonate 18 mEq/L (low). What is the nurse's PRIORITY action for this child?

  1. Administer an antidiarrheal medication as prescribed to reduce stool output
  2. Initiate isotonic intravenous fluids and anticipate potassium replacement as ordered (correct answer)
  3. Offer clear liquids only and reassess hydration status in 2 hours
  4. Restrict fluids to prevent worsening electrolyte dilution
Explanation: This question tests clinical judgment in managing fluid and electrolyte imbalances, specifically hypovolemic shock with hypokalemia in a pediatric patient. The key assessment finding is severe dehydration with hypotension, tachycardia, delayed capillary refill, and critical hypokalemia (2.9 mEq/L). Initiating isotonic IV fluids and anticipating potassium replacement (B) is the BEST choice because it addresses the immediate circulatory collapse while preparing for electrolyte correction once urine output is established. Antidiarrheal medication (A) doesn't address the life-threatening hypovolemia; clear liquids only (C) is insufficient for severe dehydration with shock; fluid restriction (D) would be fatal in hypovolemic shock. The decision-making principle is that pediatric hypovolemic shock requires rapid isotonic fluid resuscitation, with potassium replacement after establishing adequate perfusion and urine output. A transferable strategy is to prioritize circulatory stabilization in pediatric dehydration before correcting electrolyte imbalances, as potassium replacement requires functioning kidneys.

Question 3

A 33-year-old client with suspected diabetes insipidus reports urinating 'every 30 minutes' and drinking large amounts of water. Vital signs: blood pressure 98/60 mm Hg, heart rate 116/min; urine output 350 mL/hr for 3 hours. Labs: sodium 154 mEq/L (135–145), urine specific gravity 1.003 (1.005–1.030). What is the nurse's PRIORITY action for this client?

  1. Restrict all fluids to prevent further sodium elevation
  2. Begin strict intake and output measurement and notify the provider of suspected diabetes insipidus findings (correct answer)
  3. Administer oral sodium tablets to correct the sodium level
  4. Prepare to administer potassium chloride for suspected hypokalemia
Explanation: This question tests clinical judgment in managing fluid and electrolyte imbalances. The priority concern is hypernatremia with high urine output and low specific gravity, suggestive of diabetes insipidus. Beginning strict intake and output measurement and notifying the provider is the best choice to confirm diagnosis and initiate treatment like desmopressin. Restricting fluids would worsen dehydration; oral sodium tablets are contraindicated; potassium administration is not indicated without labs. The decision-making principle is to monitor fluid balance precisely in suspected diabetes insipidus to guide hormone replacement. Avoid rapid sodium correction to prevent complications. A transferable strategy is to use I&O trends to identify endocrine-related fluid imbalances early in polyuric clients.

Question 4

A 69-year-old client with heart failure reports worsening orthopnea and has gained 2.7 kg (6 lb) in 5 days. Assessment: crackles throughout, 3+ edema; vital signs: blood pressure 172/94 mm Hg, heart rate 110/min, respiratory rate 28/min, oxygen saturation 88% on room air. Labs: sodium 124 mEq/L (135–145). What is the nurse's PRIORITY action?

  1. Start seizure precautions, apply supplemental oxygen, and administer hypotonic intravenous fluids
  2. Apply supplemental oxygen and position the client upright to improve ventilation (correct answer)
  3. Encourage increased free-water intake to correct the low sodium level and prevent seizures
  4. Collect a urine specimen to measure sodium level before initiating treatment
Explanation: The priority is to support oxygenation and ventilation. This client has acute heart failure exacerbation with pulmonary edema: crackles, orthopnea, 3+ edema, and O2 saturation 88%. Upright positioning decreases venous return and improves lung mechanics, and supplemental oxygen raises arterial oxygenation while awaiting definitive diuretic therapy. Starting seizure precautions and giving hypotonic intravenous fluids is unsafe: hypotonic fluids would further lower serum sodium and increase fluid overload, and seizure precautions do not address the immediate respiratory threat. Encouraging increased free-water intake is also harmful because free water dilutes sodium further and worsens heart failure. Collecting a urine specimen to measure sodium before intervening delays the urgent oxygen supply and does not treat the current respiratory distress. Although hyponatremia needs evaluation and eventual management, oxygenation is the priority in this fluid-overloaded patient.

Question 5

A 49-year-old client is 8 hours post-op after cholecystectomy and has had repeated vomiting. Assessment: weakness and paresthesias; vital signs: blood pressure 126/74 mm Hg, heart rate 62/min. Labs: potassium 3.2 mEq/L (3.5–5.0). Which laboratory value change requires IMMEDIATE intervention by the nurse?

  1. Glucose increases from 96 to 110 mg/dL
  2. Sodium increases from 138 to 140 mEq/L
  3. Chloride increases from 101 to 103 mEq/L
  4. Potassium decreases from 3.6 to 3.2 mEq/L (correct answer)
Explanation: This question tests clinical judgment in managing fluid and electrolyte imbalances. The key assessment finding is hypokalemia with weakness and paresthesias post-operatively from vomiting. The potassium decrease from 3.6 to 3.2 mEq/L requires immediate intervention to prevent cardiac or neuromuscular complications. Minor increases in sodium, chloride, and glucose are not critical. The decision-making principle is to address dropping potassium promptly in clients with GI losses. Ensure safe replacement. A transferable strategy is to monitor labs serially after surgery and intervene on downward trends in electrolytes.

Question 6

A 74-year-old client with heart failure is receiving intravenous furosemide and now reports dizziness and headache. Assessment: crackles improved, but client appears drowsy; vital signs: blood pressure 136/78 mm Hg, heart rate 88/min. Labs: sodium 122 mEq/L (135–145). Which laboratory value change requires IMMEDIATE intervention by the nurse?

  1. Sodium decreases from 130 to 122 mEq/L (correct answer)
  2. Blood urea nitrogen decreases from 24 to 18 mg/dL
  3. Chloride decreases from 102 to 100 mEq/L
  4. Creatinine decreases from 1.2 to 1.0 mg/dL
Explanation: This question tests clinical judgment in managing fluid and electrolyte imbalances. The key assessment finding is hyponatremia with drowsiness and headache in a heart failure client receiving diuretics. The sodium decrease from 130 to 122 mEq/L requires immediate intervention to prevent seizures or coma. Decreases in BUN, chloride, and creatinine are not critical and may reflect dilution or improved renal function. The decision-making principle is to monitor for rapid sodium drops during diuresis and adjust therapy to avoid severe hyponatremia. Fluid restriction and hypertonic saline may be needed cautiously. A transferable strategy is to track serial electrolytes during diuretic therapy in heart failure to intervene on worsening imbalances promptly.

Question 7

A 31-year-old client with known diabetes insipidus is admitted for evaluation after stopping prescribed medication. Assessment: dry mucous membranes, tachycardia; urine output 4.5 L over 12 hours. Labs: sodium 157 mEq/L (135–145). Which laboratory value change requires IMMEDIATE intervention by the nurse?

  1. Sodium increases from 148 to 157 mEq/L (correct answer)
  2. Potassium increases from 4.0 to 4.6 mEq/L
  3. Chloride decreases from 103 to 100 mEq/L
  4. Calcium increases from 9.0 to 9.6 mg/dL
Explanation: This question tests clinical judgment in managing fluid and electrolyte imbalances. The key assessment finding is hypernatremia with high urine output and dehydration in untreated diabetes insipidus. The sodium increase from 148 to 157 mEq/L requires immediate intervention to prevent severe neurological effects. Minor increases in potassium, decreases in chloride, and increases in calcium are not urgent. The decision-making principle is to act on rising sodium in polyuric states with fluid and hormone therapy. Monitor for rapid changes. A transferable strategy is to resume medications promptly and hydrate in clients with known endocrine fluid disorders.

Question 8

A 73-year-old client with heart failure is admitted with dyspnea and edema. Assessment: crackles, jugular venous distention; vital signs: blood pressure 160/86 mm Hg, heart rate 98/min, respiratory rate 24/min. Labs: sodium 127 mEq/L (135–145). What is the nurse's PRIORITY action for this client?

  1. Encourage the client to drink water to prevent dehydration
  2. Start hypotonic intravenous fluids to correct sodium slowly
  3. Administer potassium chloride to prevent dysrhythmias
  4. Assess neurologic status and implement fluid restriction as prescribed while monitoring respiratory status (correct answer)
Explanation: This question tests clinical judgment in managing fluid and electrolyte imbalances. The priority concern is hyponatremia with fluid overload signs like crackles and dyspnea in heart failure. Assessing neurologic status and implementing fluid restriction while monitoring respiratory status is the best choice to manage safely. Encouraging water worsens hyponatremia; potassium is not indicated; hypotonic fluids would dilute further. The decision-making principle is to restrict fluids in dilutional hyponatremia to allow sodium normalization. Monitor for worsening symptoms. A transferable strategy is to combine neuro and resp assessments with restriction in cardiac clients with low sodium.

Question 9

A 3-year-old child is seen in the emergency department for 2 days of vomiting and watery diarrhea. Assessment: lethargy, sunken eyes, dry mucous membranes, capillary refill 4 seconds; vital signs: heart rate 148/min, respiratory rate 28/min, blood pressure 86/50 mm Hg, temperature 37.4°C (99.3°F). Labs: potassium 3.0 mEq/L (3.5–5.0), bicarbonate 18 mEq/L (22–28). What is the nurse's PRIORITY action for this child?

  1. Administer a rapid isotonic intravenous fluid bolus per pediatric protocol and reassess perfusion. (correct answer)
  2. Give oral potassium supplements now and reassess the potassium level before starting intravenous fluid replacement.
  3. Restrict oral and intravenous fluids until the diarrhea stops to avoid further fluid and electrolyte losses.
  4. Prepare to administer insulin with dextrose intravenously to shift potassium from the blood into cells.
Explanation: The child's tachycardia, low blood pressure, prolonged capillary refill, sunken eyes, and lethargy indicate hypovolemic shock from dehydration. The priority is to restore perfusion with a rapid isotonic intravenous fluid bolus and reassess. Oral potassium replacement before fluid resuscitation focuses on the low potassium while the child is still volume depleted; fluid replacement must come first. Restricting oral and intravenous fluids will worsen the dehydration and delay recovery of the child's perfusion. Insulin with dextrose drives potassium into cells and is used for hyperkalemia, not for the hypokalemia present here; giving it would make the potassium level even lower. The correct sequence is to treat the life-threatening hypovolemia first, then address any electrolyte imbalances if still needed.

Question 10

An 82-year-old client with a history of dementia and chronic kidney disease stage 3 is brought to the emergency department from a nursing facility for acute confusion and lethargy after 2 days of poor oral intake. Assessment shows dry mucous membranes, poor skin turgor, and urine output 15 mL/hr; vital signs: blood pressure 92/54 mm Hg, heart rate 112/min, respiratory rate 18/min, temperature 37.1°C (98.8°F). Labs: sodium 156 mEq/L (135–145), blood urea nitrogen 38 mg/dL (7–20), creatinine 1.8 mg/dL (0.6–1.3). What is the nurse's PRIORITY action for this client?

  1. Initiate seizure precautions and prepare to administer hypertonic saline as ordered for the elevated serum sodium level
  2. Encourage oral free-water intake every 30 minutes and recheck the serum sodium level in 4 hours
  3. Start an intravenous infusion of 0.9% normal saline and monitor intake and output closely (correct answer)
  4. Administer furosemide intravenously as a bolus to promote sodium excretion and lower the serum sodium level
Explanation: This client has hypovolemic hypernatremia: low blood pressure, tachycardia, oliguria, dry mucous membranes, and elevated BUN and creatinine after poor intake. The priority is to restore intravascular volume with an isotonic fluid. Starting 0.9% normal saline and monitoring intake and output addresses the volume deficit without causing a rapid drop in serum sodium, a key safety concern in this older adult with chronic kidney disease. Seizure precautions with hypertonic saline would add more sodium and worsen the hypernatremic state, so they are not the first action. Encouraging oral free water is unsafe and insufficient here: the client is confused, already volume-depleted, and unable to take fluids rapidly enough to restore perfusion. Giving furosemide intravenously promotes sodium and water loss, further depleting the already low intravascular volume and worsening hypotension and oliguria. Therefore, isotonic IV saline is the priority intervention.

Question 11

A 76-year-old client with heart failure (ejection fraction 30%) presents to an urgent care clinic with 3 days of worsening dyspnea and ankle swelling. Assessment: crackles at lung bases, 2+ pitting edema, weight gain of 3.2 kg (7 lb) in 1 week; vital signs: blood pressure 168/92 mm Hg, heart rate 104/min, respiratory rate 26/min, oxygen saturation 90% on room air. Labs: sodium 128 mEq/L (135–145), serum osmolality 268 mOsm/kg (275–295). What is the nurse's PRIORITY action for this client?

  1. Encourage increased oral water intake to slowly correct the client's dilutional hyponatremia
  2. Place the client in high-Fowler position and apply supplemental oxygen per protocol (correct answer)
  3. Administer desmopressin to reduce urine output and prevent further sodium loss in the urine
  4. Obtain a 24-hour urine collection to quantify sodium excretion before initiating diuretic therapy
Explanation: The client's oxygen saturation of 90%, crackles, and tachypnea indicate acute respiratory compromise from fluid overload. The priority is to place the client in high-Fowler position and support oxygenation. Encouraging increased oral water intake would add more free water to a client who is already fluid overloaded and hyponatremic, making both problems worse. Administering desmopressin promotes water retention and reduced urine water loss, the opposite of the diuresis this client needs, and it does not correct the sodium imbalance. Obtaining a 24-hour urine collection is a diagnostic step, but using it as the first action delays the urgent respiratory support. The correct priority action is therefore the high-Fowler position with supplemental oxygen.

Question 12

A 6-year-old child with gastroenteritis has diarrhea and abdominal cramping. Assessment: muscle weakness; vital signs: heart rate 124/min, blood pressure 92/56 mm Hg. Labs: potassium 3.1 mEq/L (3.5–5.0). What is the nurse's PRIORITY action?

  1. Administer potassium replacement as prescribed after verifying adequate urine output and continue hydration therapy (correct answer)
  2. Administer intravenous calcium gluconate to stabilize the myocardium and prevent life-threatening dysrhythmias caused by low potassium
  3. Encourage a low-potassium diet and hold potassium-containing foods until repeat serum levels normalize to prevent hyperkalemia
  4. Obtain a stool culture and wait for sensitivity results before initiating potassium replacement or other treatment
Explanation: This child has hypokalemia (potassium 3.1 mEq/L) with muscle weakness and tachycardia from ongoing GI losses. The priority is to replace potassium safely: confirm adequate urine output to ensure the kidneys can clear the potassium, then give replacement while continuing hydration. Intravenous calcium gluconate is used to protect the heart in hyperkalemia (or to treat acute hypocalcemia), not to correct a potassium deficit, so it does not address this child's problem. A low-potassium diet and withholding potassium-containing foods would worsen hypokalemia. Obtaining a stool culture and waiting for sensitivity results delays the needed potassium replacement and hydration; cultures may be indicated later, but they are not the priority in symptomatic hypokalemia. Choose the option that replaces potassium in a child with confirmed urine output.

Question 13

A 39-year-old client with suspected diabetes insipidus is admitted for evaluation after reporting polyuria and polydipsia. Vital signs: blood pressure 100/64 mm Hg, heart rate 112/min; skin is dry. Labs: sodium 154 mEq/L (high), serum osmolality 312 mOsm/kg (high), urine specific gravity 1.001 (low). What is the nurse's PRIORITY action for this client?

  1. Restrict oral fluids to prevent worsening hypernatremia from excessive free water intake
  2. Initiate seizure precautions and notify the provider of hypernatremia with dilute urine (correct answer)
  3. Administer hypotonic intravenous fluids without an order and rapidly lower serum sodium
  4. Encourage increased oral sodium intake to correct the elevated serum osmolality from hypernatremia
Explanation: The priority is to prevent life-threatening neurological complications from hypernatremia. This client has high serum sodium with dilute urine, indicating diabetes insipidus and water loss. The nurse must initiate seizure precautions and notify the provider immediately. Restricting oral fluids would worsen hypernatremia because the client is already dehydrated from free water loss. Administering hypotonic IV fluids without an order is outside the nurse's scope, and rapid sodium correction risks cerebral edema. Encouraging increased sodium intake would further raise the already high sodium and osmolality. The key is recognizing the combination of hypernatremia with dilute urine as a medical emergency.

Question 14

A 58-year-old client is 12 hours post-abdominal surgery and reports generalized weakness and new palpitations. Vital signs: blood pressure 118/70 mm Hg, heart rate 116/min, respiratory rate 20/min, oxygen saturation 96% on room air; bowel sounds are hypoactive. Labs: potassium 2.8 mEq/L (low), magnesium 1.6 mg/dL (low-normal). Telemetry shows frequent premature ventricular contractions. What is the nurse's PRIORITY action for this client?

  1. Administer potassium replacement per protocol and maintain continuous cardiac monitoring (correct answer)
  2. Encourage the client to ambulate to improve gastrointestinal motility
  3. Request an order to discontinue telemetry and obtain a 12-lead electrocardiogram later today
  4. Administer an intravenous calcium gluconate infusion to stabilize the myocardium
Explanation: This question tests clinical judgment in managing fluid and electrolyte imbalances, specifically critical hypokalemia with cardiac manifestations. The key assessment finding is hypokalemia (2.8 mEq/L) with cardiac dysrhythmias (PVCs) and associated hypomagnesemia. Administering potassium replacement per protocol with continuous cardiac monitoring (A) is the BEST choice because it addresses the life-threatening dysrhythmias while ensuring safe replacement. Encouraging ambulation (B) is unsafe with active dysrhythmias and severe hypokalemia; discontinuing telemetry (C) removes critical monitoring during a cardiac emergency; calcium gluconate (D) is used for hyperkalemia, not hypokalemia. The decision-making principle is that hypokalemia with cardiac manifestations requires immediate potassium replacement with continuous monitoring due to risk of ventricular fibrillation. A transferable strategy is to prioritize cardiac safety in severe hypokalemia, remembering that magnesium must also be replaced for effective potassium correction.

Question 15

A 62-year-old client is 1 day post-operative after bowel resection and has a nasogastric tube to low suction. The client reports weakness and muscle cramps. Vital signs: blood pressure 124/76 mm Hg, heart rate 102/min. Labs: potassium 3.0 mEq/L (low), chloride 94 mEq/L (low). What is the nurse's PRIORITY action for this client?

  1. Hold the next dose of opioid pain medication and reassess bowel sounds
  2. Administer potassium replacement and assess for dysrhythmias (correct answer)
  3. Request an order for sodium bicarbonate to correct the electrolyte imbalance
  4. Encourage increased oral free-water intake to correct the chloride level
Explanation: This question tests clinical judgment in managing fluid and electrolyte imbalances, specifically hypokalemia from gastric losses. The key assessment finding is hypokalemia (3.0 mEq/L) with hypochloremia from nasogastric suction, presenting with weakness and muscle cramps. Administering potassium replacement and assessing for dysrhythmias (B) is the BEST choice because hypokalemia increases risk of cardiac dysrhythmias and must be corrected promptly. Holding opioids (A) doesn't address the electrolyte emergency; sodium bicarbonate (C) is inappropriate as there's no acidosis indicated; encouraging water intake (D) won't correct potassium or chloride deficits. The decision-making principle is that gastric losses cause hypokalemic, hypochloremic metabolic alkalosis requiring potassium and chloride replacement with cardiac monitoring. A transferable strategy is to anticipate electrolyte losses with nasogastric suction and monitor for signs of hypokalemia including weakness, cramps, and dysrhythmias.

Question 16

A 62-year-old client is 24 hours post-op after prostate surgery and has been receiving intravenous fluids and has had intermittent vomiting. Assessment: muscle weakness and ileus; vital signs: blood pressure 132/78 mm Hg, heart rate 64/min. Labs: potassium 3.0 mEq/L (3.5–5.0). Which symptom indicates a need for FURTHER assessment?

  1. Intermittent mild muscle cramps in the calves
  2. Decreased bowel sounds consistent with the known ileus
  3. Generalized fatigue that improves with rest and repositioning
  4. New onset irregular heart rhythm on telemetry (correct answer)
Explanation: With a potassium of 3.0 mEq/L, the priority is to recognize hypokalemia-related cardiac irritability. New onset irregular heart rhythm on telemetry is the finding that signals a possible arrhythmia and requires further assessment, including an ECG and evaluation of the rhythm. Intermittent mild muscle cramps in the calves are an expected manifestation of hypokalemia, so they do not indicate a new complication. Decreased bowel sounds consistent with the known ileus only restates the ileus already documented in the assessment, not a change requiring further workup. Generalized fatigue that improves with rest and repositioning is nonspecific and improving, rather than an acute change suggesting an arrhythmia. In hypokalemia, prioritize new rhythm changes over expected neuromuscular and gastrointestinal findings.

Question 17

A 54-year-old client is 1 day post-op after abdominal surgery and reports new muscle weakness and palpitations. Assessment shows decreased bowel sounds; vital signs: blood pressure 118/70 mm Hg, heart rate 58/min, respiratory rate 16/min, oxygen saturation 97% on room air. Labs: potassium 2.9 mEq/L (3.5–5.0), magnesium 1.6 mg/dL (1.7–2.2); telemetry shows flattened T waves and U waves. What is the nurse's PRIORITY action for this client?

  1. Administer calcium gluconate intravenously to stabilize the myocardium
  2. Encourage high-sodium foods and restrict free water intake
  3. Hold all intravenous fluids and recheck potassium in the morning
  4. Administer intravenous potassium chloride via infusion pump and maintain continuous cardiac monitoring (correct answer)
Explanation: This question tests clinical judgment in managing fluid and electrolyte imbalances. The key assessment finding is hypokalemia with ECG changes like flattened T waves and U waves, indicating risk for dysrhythmias. Administering intravenous potassium chloride via infusion pump with cardiac monitoring is the best choice to safely correct the deficit and monitor for complications. Encouraging high-sodium foods and restricting water is irrelevant; holding fluids delays correction; calcium gluconate is used for hyperkalemia, not hypokalemia. The decision-making principle is to replace potassium intravenously for symptomatic hypokalemia while ensuring cardiac monitoring to prevent arrhythmias. Magnesium levels should also be checked as they influence potassium correction. A transferable strategy is to correlate electrolyte labs with ECG findings and prioritize replacement therapy in post-operative clients with gastrointestinal losses.

Question 18

A 79-year-old client with a history of hypertension is admitted for dehydration after 3 days of nausea and poor intake. Assessment: dry mucous membranes, tachycardia; vital signs: blood pressure 88/52 mm Hg, heart rate 120/min. Labs: sodium 155 mEq/L (135–145). What is the nurse's PRIORITY action?

  1. Obtain a daily weight tomorrow to evaluate fluid status
  2. Administer 3% hypertonic saline to rapidly correct sodium
  3. Encourage the client to drink 2 liters of water immediately
  4. Initiate intravenous isotonic fluids per protocol and reassess blood pressure and urine output (correct answer)
Explanation: This question tests clinical judgment in managing fluid and electrolyte imbalances. The priority concern is hypovolemic hypernatremia with hypotension and tachycardia from poor intake. Initiating intravenous isotonic fluids is the best choice to restore volume and gradually correct sodium. Hypertonic saline would exacerbate hypernatremia; immediate large oral intake risks aspiration; delaying for weight overlooks urgency. The decision-making principle is to use isotonic solutions first in hypovolemic hypernatremia to stabilize hemodynamics. Follow with hypotonic fluids if needed, monitoring sodium closely. A transferable strategy is to assess volume status before choosing fluid type in elderly clients with nausea and electrolyte issues.

Question 19

An 84-year-old client is evaluated in an outpatient clinic for increasing confusion and constipation after several days of limited fluid intake. Assessment: dry mucous membranes, decreased skin turgor; vital signs: blood pressure 100/62 mm Hg, heart rate 108/min. Labs: sodium 153 mEq/L (135–145). What is the nurse's PRIORITY action?

  1. Teach the client to limit fluid intake to reduce sodium level
  2. Notify the provider and anticipate intravenous isotonic fluid administration while monitoring neurologic status (correct answer)
  3. Administer 3% hypertonic saline as a standing order
  4. Administer spironolactone to promote sodium excretion
Explanation: This question tests clinical judgment in managing fluid and electrolyte imbalances. The priority concern is hypernatremia with confusion and dehydration signs in an elderly client. Notifying the provider and anticipating intravenous isotonic fluids while monitoring neurologic status is the best choice to correct safely. Teaching fluid restriction would worsen hypernatremia; hypertonic saline is contraindicated; spironolactone does not address sodium elevation. The decision-making principle is to restore volume gradually in hypovolemic hypernatremia while watching for neurologic changes. Avoid rapid correction to prevent edema. A transferable strategy is to involve providers early for fluid orders in confused elderly clients with intake issues.

Question 20

An 82-year-old client with a history of mild dementia and hypertension is brought to the emergency department from an assisted living facility with new confusion, dry mucous membranes, and poor skin turgor after 2 days of low oral intake. Vital signs: blood pressure 92/54 mm Hg, heart rate 112/min, respiratory rate 18/min, temperature 37.0°C (98.6°F); urine output is 15 mL/hr. Labs: sodium 156 mEq/L (high), blood urea nitrogen 38 mg/dL (high), creatinine 1.6 mg/dL (high). What is the nurse's PRIORITY action for this client?

  1. Encourage the client to drink oral fluids and recheck sodium in 4 hours
  2. Initiate isotonic intravenous fluids and implement strict intake and output monitoring (correct answer)
  3. Administer intravenous furosemide as prescribed to lower the sodium level
  4. Request an order for hypertonic saline infusion to correct the sodium level rapidly
Explanation: This question tests clinical judgment in managing fluid and electrolyte imbalances, specifically hypernatremia with dehydration. The key assessment finding is hypernatremia (156 mEq/L) with signs of severe dehydration including hypotension, tachycardia, oliguria, and elevated BUN/creatinine. Initiating isotonic IV fluids with strict I&O monitoring (B) is the BEST choice because it addresses the immediate need for volume replacement while preventing too-rapid sodium correction that could cause cerebral edema. Encouraging oral fluids (A) is insufficient for this severely dehydrated patient with confusion and hemodynamic instability; furosemide (C) would worsen dehydration and is contraindicated; hypertonic saline (D) would dangerously increase the already elevated sodium. The decision-making principle is that hypernatremia with volume depletion requires isotonic fluid resuscitation first to restore hemodynamic stability, followed by gradual sodium correction with hypotonic fluids. A transferable strategy is to prioritize volume replacement in hypernatremic dehydration before addressing the sodium imbalance, monitoring for signs of cerebral edema during correction.