HESI Fluid Balance Case Study Questions and
Answers
Question 1
Since the client has a fluid volume deficit, the nurse anticipates a decrease in which vital
sign when she changes position?
a. Respiratory rate
b. Blood pressure
c. Temperature
d. Pulse rate
Rationale: Fluid volume deficit often causes orthostatic hypotension due to reduced
circulating volume. The body compensates with tachycardia, but blood pressure drops
when changing position, increasing risk of dizziness and falls.
Question 2
Which laboratory finding best confirms fluid volume deficit?
a. Decreased hematocrit
b. Increased urine specific gravity
c. Decreased serum sodium
d. Increased serum potassium
Rationale: With fluid volume deficit, urine becomes concentrated, raising specific
gravity. Hematocrit may also rise due to hemoconcentration, but urine concentration is a
more direct indicator.
Question 3
The nurse notes dry mucous membranes and poor skin turgor. What is the priority
nursing intervention?
a. Encourage oral fluids
b. Administer IV fluids as prescribed
c. Provide mouth care
d. Monitor daily weights
Rationale: Severe dehydration requires rapid restoration of intravascular volume. Oral
fluids may be insufficient or unsafe if the patient is unstable. Daily weights and mouth
care are supportive but not priority.
Question 4
Which electrolyte imbalance is most likely with fluid volume deficit?
a. Hyponatremia
b. Hypernatremia
c. Hypokalemia
d. Hyperkalemia
Rationale: Water loss without proportional sodium loss concentrates serum sodium,
leading to hypernatremia. This can cause neurological symptoms such as confusion
and seizures.
, Question 5
What is the most accurate method to monitor fluid balance in a hospitalized patient?
a. Monitor intake and output
b. Assess skin turgor
c. Check daily weights
d. Monitor vital signs
Rationale: Daily weights are the most sensitive indicator of fluid balance, reflecting
subtle changes in body fluid status. Intake/output and vital signs are helpful but less
precise.
Question 6
Which assessment finding indicates improvement in fluid volume status?
a. Decreased urine output
b. Stable blood pressure
c. Dry mucous membranes
d. Tachycardia
Rationale: Restoration of intravascular volume stabilizes blood pressure. Persistent
tachycardia or dry mucous membranes suggest ongoing deficit.
Question 7
The nurse is monitoring IV fluid therapy. Which complication is most concerning?
a. Crackles in lungs
b. Warm IV site
c. Increased urine output
d. Slight edema at ankles
Rationale: Crackles indicate fluid overload and possible pulmonary edema, requiring
immediate intervention.
Question 8
Which lab value best reflects hydration status?
a. Serum creatinine
b. Urine specific gravity
c. Serum calcium
d. Hemoglobin
Rationale: It directly measures urine concentration, reflecting hydration status.
Question 9
Which nursing action prevents complications of orthostatic hypotension?
a. Encourage rapid position changes
b. Assist with slow position changes
c. Restrict oral fluids
d. Increase diuretic therapy
Rationale: Gradual movement reduces risk of dizziness and falls.
Question 10
Answers
Question 1
Since the client has a fluid volume deficit, the nurse anticipates a decrease in which vital
sign when she changes position?
a. Respiratory rate
b. Blood pressure
c. Temperature
d. Pulse rate
Rationale: Fluid volume deficit often causes orthostatic hypotension due to reduced
circulating volume. The body compensates with tachycardia, but blood pressure drops
when changing position, increasing risk of dizziness and falls.
Question 2
Which laboratory finding best confirms fluid volume deficit?
a. Decreased hematocrit
b. Increased urine specific gravity
c. Decreased serum sodium
d. Increased serum potassium
Rationale: With fluid volume deficit, urine becomes concentrated, raising specific
gravity. Hematocrit may also rise due to hemoconcentration, but urine concentration is a
more direct indicator.
Question 3
The nurse notes dry mucous membranes and poor skin turgor. What is the priority
nursing intervention?
a. Encourage oral fluids
b. Administer IV fluids as prescribed
c. Provide mouth care
d. Monitor daily weights
Rationale: Severe dehydration requires rapid restoration of intravascular volume. Oral
fluids may be insufficient or unsafe if the patient is unstable. Daily weights and mouth
care are supportive but not priority.
Question 4
Which electrolyte imbalance is most likely with fluid volume deficit?
a. Hyponatremia
b. Hypernatremia
c. Hypokalemia
d. Hyperkalemia
Rationale: Water loss without proportional sodium loss concentrates serum sodium,
leading to hypernatremia. This can cause neurological symptoms such as confusion
and seizures.
, Question 5
What is the most accurate method to monitor fluid balance in a hospitalized patient?
a. Monitor intake and output
b. Assess skin turgor
c. Check daily weights
d. Monitor vital signs
Rationale: Daily weights are the most sensitive indicator of fluid balance, reflecting
subtle changes in body fluid status. Intake/output and vital signs are helpful but less
precise.
Question 6
Which assessment finding indicates improvement in fluid volume status?
a. Decreased urine output
b. Stable blood pressure
c. Dry mucous membranes
d. Tachycardia
Rationale: Restoration of intravascular volume stabilizes blood pressure. Persistent
tachycardia or dry mucous membranes suggest ongoing deficit.
Question 7
The nurse is monitoring IV fluid therapy. Which complication is most concerning?
a. Crackles in lungs
b. Warm IV site
c. Increased urine output
d. Slight edema at ankles
Rationale: Crackles indicate fluid overload and possible pulmonary edema, requiring
immediate intervention.
Question 8
Which lab value best reflects hydration status?
a. Serum creatinine
b. Urine specific gravity
c. Serum calcium
d. Hemoglobin
Rationale: It directly measures urine concentration, reflecting hydration status.
Question 9
Which nursing action prevents complications of orthostatic hypotension?
a. Encourage rapid position changes
b. Assist with slow position changes
c. Restrict oral fluids
d. Increase diuretic therapy
Rationale: Gradual movement reduces risk of dizziness and falls.
Question 10
