NURS 103: Fundamentals of Nursing - Fluid & Electrolyte Balance
(Advanced Level) 2026 |WCU
1. A patient with chronic kidney disease presents with a serum potassium level
of 6.4 mEq/L. Which of the following is the most immediate priority for the
nurse?
A. Obtaining a 12-lead electrocardiogram (ECG) to check for peaked T waves
B. Assessing the patient for muscle weakness and cramping
C. Administering sodium polystyrene sulfonate (Kayexalate) orally
D. Encouraging the patient to increase fluid intake to dilute the potassium
Answer: A
Rationale: Hyperkalemia (K+ > 5.0) can cause life-threatening cardiac dysrhythmias. An
ECG is the priority to assess for immediate cardiac risks like peaked T waves or widened
QRS complexes.
2. A patient is receiving an intravenous infusion of 3% Sodium Chloride. Which
assessment finding requires the most urgent intervention by the nurse?
A. Serum sodium level of 140 mEq/L
B. New onset of crackles at the lung bases
C. Increased urine output of 50 mL/hr
D. Complaints of thirst and dry mouth
Answer: B
Rationale: 3% NaCl is a hypertonic solution which can cause rapid fluid shifts into the
intravascular space, leading to circulatory overload and pulmonary edema. New crackles
indicate fluid in the lungs.
,3. A nurse is caring for a patient with a diagnosis of Syndrome of Inappropriate
Antidiuretic Hormone (SIADH). What electrolyte abnormality is most
characteristic of this condition?
A. Hypernatremia due to water loss
B. Hypokalemia due to renal excretion
C. Dilutional hyponatremia
D. Hypercalcemia from bone resorption
Answer: C
Rationale: SIADH involves excessive ADH, causing the body to retain too much water,
which dilutes the sodium in the blood, leading to hyponatremia.
4. Which physiological mechanism is primarily responsible for maintaining the
oncotic pressure within the capillaries?
A. The concentration of Sodium ions
B. Hydrostatic pressure from the heart’s contraction
C. The presence of plasma proteins, specifically albumin
D. The movement of water through osmosis
Answer: C
Rationale: Colloid osmotic pressure (oncotic pressure) is exerted by proteins, notably
albumin, which pulls water into the circulatory system.
5. A patient has been vomiting for 48 hours and has a nasogastric tube to low
intermittent suction. For which acid-base imbalance is this patient at highest
risk?
A. Respiratory Acidosis
B. Respiratory Alkalosis
C. Metabolic Acidosis
D. Metabolic Alkalosis
Answer: D
, Rationale: Vomiting and NG suction result in the loss of gastric acid (hydrochloric acid),
leading to an excess of bicarbonate in the blood and metabolic alkalosis.
6. A nurse observes a positive Trousseau’s sign in a patient following a
thyroidectomy. This finding is associated with a deficiency in which electrolyte?
A. Calcium
B. Potassium
C. Sodium
D. Magnesium
Answer: A
Rationale: Trousseau’s sign (carpal spasm induced by inflating a blood pressure cuff) is a
classic sign of hypocalcemia, often occurring if the parathyroid glands are damaged during
thyroid surgery.
7. When assessing a patient with hypervolemia, which clinical manifestation
would the nurse expect to find?
A. Flattened neck veins when supine
B. Weak, thready pulse
C. Decreased central venous pressure
D. Distended jugular veins
Answer: D
Rationale: Fluid volume excess (hypervolemia) increases venous pressure, leading to
visible jugular venous distention (JVD).
(Advanced Level) 2026 |WCU
1. A patient with chronic kidney disease presents with a serum potassium level
of 6.4 mEq/L. Which of the following is the most immediate priority for the
nurse?
A. Obtaining a 12-lead electrocardiogram (ECG) to check for peaked T waves
B. Assessing the patient for muscle weakness and cramping
C. Administering sodium polystyrene sulfonate (Kayexalate) orally
D. Encouraging the patient to increase fluid intake to dilute the potassium
Answer: A
Rationale: Hyperkalemia (K+ > 5.0) can cause life-threatening cardiac dysrhythmias. An
ECG is the priority to assess for immediate cardiac risks like peaked T waves or widened
QRS complexes.
2. A patient is receiving an intravenous infusion of 3% Sodium Chloride. Which
assessment finding requires the most urgent intervention by the nurse?
A. Serum sodium level of 140 mEq/L
B. New onset of crackles at the lung bases
C. Increased urine output of 50 mL/hr
D. Complaints of thirst and dry mouth
Answer: B
Rationale: 3% NaCl is a hypertonic solution which can cause rapid fluid shifts into the
intravascular space, leading to circulatory overload and pulmonary edema. New crackles
indicate fluid in the lungs.
,3. A nurse is caring for a patient with a diagnosis of Syndrome of Inappropriate
Antidiuretic Hormone (SIADH). What electrolyte abnormality is most
characteristic of this condition?
A. Hypernatremia due to water loss
B. Hypokalemia due to renal excretion
C. Dilutional hyponatremia
D. Hypercalcemia from bone resorption
Answer: C
Rationale: SIADH involves excessive ADH, causing the body to retain too much water,
which dilutes the sodium in the blood, leading to hyponatremia.
4. Which physiological mechanism is primarily responsible for maintaining the
oncotic pressure within the capillaries?
A. The concentration of Sodium ions
B. Hydrostatic pressure from the heart’s contraction
C. The presence of plasma proteins, specifically albumin
D. The movement of water through osmosis
Answer: C
Rationale: Colloid osmotic pressure (oncotic pressure) is exerted by proteins, notably
albumin, which pulls water into the circulatory system.
5. A patient has been vomiting for 48 hours and has a nasogastric tube to low
intermittent suction. For which acid-base imbalance is this patient at highest
risk?
A. Respiratory Acidosis
B. Respiratory Alkalosis
C. Metabolic Acidosis
D. Metabolic Alkalosis
Answer: D
, Rationale: Vomiting and NG suction result in the loss of gastric acid (hydrochloric acid),
leading to an excess of bicarbonate in the blood and metabolic alkalosis.
6. A nurse observes a positive Trousseau’s sign in a patient following a
thyroidectomy. This finding is associated with a deficiency in which electrolyte?
A. Calcium
B. Potassium
C. Sodium
D. Magnesium
Answer: A
Rationale: Trousseau’s sign (carpal spasm induced by inflating a blood pressure cuff) is a
classic sign of hypocalcemia, often occurring if the parathyroid glands are damaged during
thyroid surgery.
7. When assessing a patient with hypervolemia, which clinical manifestation
would the nurse expect to find?
A. Flattened neck veins when supine
B. Weak, thready pulse
C. Decreased central venous pressure
D. Distended jugular veins
Answer: D
Rationale: Fluid volume excess (hypervolemia) increases venous pressure, leading to
visible jugular venous distention (JVD).
