HESI FluId & ElEctrolytE ImbalancE Exam – latESt 2026
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Section 1: Fluid Balance & Regulation (Questions 1-5)
Q1. The nurse is caring for a patient with heart failure who has gained 2 kg in 24 hours. This weight gain
is equivalent to how many liters of fluid retention?
A. 0.5 liters
B. 1 liter
C. 2 liters
D. 4 liters
Answer: C. 2 liters
Rationale: One kilogram of body weight equals approximately 1 liter of fluid. Therefore, a 2 kg weight gain
in 24 hours represents 2 liters of fluid retention. Daily weight monitoring is the most accurate indicator of
fluid balance. Weight gain of 0.5-1 kg/day suggests significant fluid retention requiring intervention.
Q2. A patient has serum sodium of 118 mEq/L. The nurse identifies this as which type of imbalance?
A. Hypernatremia
B. Hyponatremia
C. Hyperkalemia
D. Hypokalemia
Answer: B. Hyponatremia
,Rationale: Normal serum sodium is 135-145 mEq/L. Hyponatremia is defined as sodium less than 135
mEq/L. Severe hyponatremia is less than 120 mEq/L and can cause neurologic symptoms including
seizures, coma, and brain herniation. This patient's level of 118 mEq/L represents severe hyponatremia
requiring immediate intervention.
Q3. The nurse understands that antidiuretic hormone (ADH) primarily affects fluid balance by:
A. Increasing sodium excretion
B. Increasing water reabsorption in the kidney collecting ducts
C. Decreasing thirst sensation
D. Increasing urine output
Answer: B. Increasing water reabsorption in the kidney collecting ducts
Rationale: ADH (vasopressin) acts on the collecting ducts of the kidneys to increase water reabsorption,
concentrating urine and conserving water. This increases intravascular volume. ADH is released in
response to increased serum osmolality or decreased blood volume. Opposite effects are seen with
diabetes insipidus (ADH deficiency).
Q4. A patient has a serum osmolality of 320 mOsm/kg (normal 275-295). The nurse expects which
finding?
A. Decreased thirst
B. Increased ADH secretion
C. Increased urine output
D. Decreased sodium levels
Answer: B. Increased ADH secretion
, Rationale: Increased serum osmolality (hyperosmolality) stimulates osmoreceptors in the hypothalamus,
triggering ADH release and thirst. ADH increases water reabsorption to dilute the blood and lower
osmolality. Decreased osmolality suppresses ADH. Urine output decreases with ADH release.
Q5. A patient with burns has massive fluid shifts. The nurse understands that fluid moves from the
intravascular space to the interstitial space during the initial burn phase due to:
A. Increased capillary permeability
B. Decreased hydrostatic pressure
C. Increased plasma proteins
D. Decreased interstitial osmotic pressure
Answer: A. Increased capillary permeability
Rationale: Burn injury causes release of inflammatory mediators (histamine, bradykinin, prostaglandins)
that increase capillary permeability. This allows fluid, electrolytes, and proteins to leak from the
intravascular space into the interstitial space (third spacing), causing edema and intravascular volume
depletion (burn shock).
## Section 2: Sodium Imbalances (Questions 6-10)
Q6. A patient with hyponatremia (sodium 122 mEq/L) develops confusion and a seizure. Which
intervention should the nurse anticipate first?
A. Administer 3% hypertonic saline IV
B. Restrict oral fluid intake
C. Administer loop diuretics
D. Give oral sodium tablets
Answer: A. Administer 3% hypertonic saline IV
EdItIon||QuEStIonS and anSwErS wItH ratIonalES/GradEd
a+/2026 updatE/100% corrEct /InStant download
Section 1: Fluid Balance & Regulation (Questions 1-5)
Q1. The nurse is caring for a patient with heart failure who has gained 2 kg in 24 hours. This weight gain
is equivalent to how many liters of fluid retention?
A. 0.5 liters
B. 1 liter
C. 2 liters
D. 4 liters
Answer: C. 2 liters
Rationale: One kilogram of body weight equals approximately 1 liter of fluid. Therefore, a 2 kg weight gain
in 24 hours represents 2 liters of fluid retention. Daily weight monitoring is the most accurate indicator of
fluid balance. Weight gain of 0.5-1 kg/day suggests significant fluid retention requiring intervention.
Q2. A patient has serum sodium of 118 mEq/L. The nurse identifies this as which type of imbalance?
A. Hypernatremia
B. Hyponatremia
C. Hyperkalemia
D. Hypokalemia
Answer: B. Hyponatremia
,Rationale: Normal serum sodium is 135-145 mEq/L. Hyponatremia is defined as sodium less than 135
mEq/L. Severe hyponatremia is less than 120 mEq/L and can cause neurologic symptoms including
seizures, coma, and brain herniation. This patient's level of 118 mEq/L represents severe hyponatremia
requiring immediate intervention.
Q3. The nurse understands that antidiuretic hormone (ADH) primarily affects fluid balance by:
A. Increasing sodium excretion
B. Increasing water reabsorption in the kidney collecting ducts
C. Decreasing thirst sensation
D. Increasing urine output
Answer: B. Increasing water reabsorption in the kidney collecting ducts
Rationale: ADH (vasopressin) acts on the collecting ducts of the kidneys to increase water reabsorption,
concentrating urine and conserving water. This increases intravascular volume. ADH is released in
response to increased serum osmolality or decreased blood volume. Opposite effects are seen with
diabetes insipidus (ADH deficiency).
Q4. A patient has a serum osmolality of 320 mOsm/kg (normal 275-295). The nurse expects which
finding?
A. Decreased thirst
B. Increased ADH secretion
C. Increased urine output
D. Decreased sodium levels
Answer: B. Increased ADH secretion
, Rationale: Increased serum osmolality (hyperosmolality) stimulates osmoreceptors in the hypothalamus,
triggering ADH release and thirst. ADH increases water reabsorption to dilute the blood and lower
osmolality. Decreased osmolality suppresses ADH. Urine output decreases with ADH release.
Q5. A patient with burns has massive fluid shifts. The nurse understands that fluid moves from the
intravascular space to the interstitial space during the initial burn phase due to:
A. Increased capillary permeability
B. Decreased hydrostatic pressure
C. Increased plasma proteins
D. Decreased interstitial osmotic pressure
Answer: A. Increased capillary permeability
Rationale: Burn injury causes release of inflammatory mediators (histamine, bradykinin, prostaglandins)
that increase capillary permeability. This allows fluid, electrolytes, and proteins to leak from the
intravascular space into the interstitial space (third spacing), causing edema and intravascular volume
depletion (burn shock).
## Section 2: Sodium Imbalances (Questions 6-10)
Q6. A patient with hyponatremia (sodium 122 mEq/L) develops confusion and a seizure. Which
intervention should the nurse anticipate first?
A. Administer 3% hypertonic saline IV
B. Restrict oral fluid intake
C. Administer loop diuretics
D. Give oral sodium tablets
Answer: A. Administer 3% hypertonic saline IV
