1
HESI Exit Exam Question Bank:
Fluid & Electrolyte Imbalances
in Med-Surg Nursing
Table of Contents
Subtopic 1: Sodium Imbalances – Hyponatremia and Hypernatremia.............2
Subtopic 2: Potassium Imbalances – Hypokalemia and Hyperkalemia..........10
Subtopic 3: Calcium and Magnesium Imbalances – Hypocalcemia,
Hypercalcemia, Hypomagnesemia, and Hypermagnesemia..........................19
Subtopic 4: Acid-Base Imbalances – Metabolic & Respiratory Acidosis and
Alkalosis.........................................................................................................27
Subtopic 5: Fluid Volume Deficit and Dehydration in Medical-Surgical Patients
.......................................................................................................................36
Subtopic 6: Fluid Volume Excess and Edema Management in Med-Surg.......44
Subtopic 7: Acid-Base Imbalances and Compensation Mechanisms..............52
Subtopic 8: Intravenous (IV) Fluid Types and Clinical Applications................61
Subtopic 9: Fluid and Electrolyte Imbalances in Renal and Cardiac Disorders
.......................................................................................................................69
Subtopic 10: Nursing Interventions and Safety Priorities in Fluid & Electrolyte
Management..................................................................................................78
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Subtopic 1: Sodium Imbalances –
Hyponatremia and Hypernatremia
Question 1:
A patient presents with confusion, headache, and nausea. Laboratory tests
reveal a serum sodium level of 122 mEq/L. What is the most appropriate
initial nursing intervention?
A. Administer oral sodium tablets
B. Implement seizure precautions
C. Infuse D5W IV at a rapid rate
D. Encourage increased water intake
Correct Answer: B. Implement seizure precautions
Rationale: Severe hyponatremia (Na+ <125 mEq/L) can lead to cerebral
edema and increased risk of seizures. Seizure precautions should be
implemented immediately to protect the patient from harm while other
interventions are being prepared.
Question 2:
A client with SIADH is admitted with a serum sodium of 118 mEq/L. What IV
fluid order does the nurse anticipate from the provider?
A. 0.45% NaCl
B. 3% NaCl
C. Lactated Ringer's
D. D5W
Correct Answer: B. 3% NaCl
, 3
Rationale: In symptomatic severe hyponatremia, hypertonic saline (3% NaCl)
is indicated to raise serum sodium levels cautiously and reduce cerebral
edema. D5W and hypotonic fluids are contraindicated.
Question 3:
Which assessment finding is most concerning in a patient with
hyponatremia?
A. Muscle cramps
B. Thirst
C. Decreased level of consciousness
D. Dry mucous membranes
Correct Answer: C. Decreased level of consciousness
Rationale: A change in mental status may indicate cerebral edema or early
signs of increased intracranial pressure, which can be life-threatening in
hyponatremia.
Question 4:
A nurse reviews the sodium level of a patient receiving tube feedings. The
sodium level is 149 mEq/L. What intervention is most appropriate?
A. Increase the feeding rate
B. Provide free water with feedings
C. Switch to a high-sodium formula
D. Administer a sodium supplement
Correct Answer: B. Provide free water with feedings
Rationale: Tube feedings without adequate water can cause hypernatremia.
Administering free water helps correct this imbalance.
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Question 5:
What is a priority nursing diagnosis for a client with hypernatremia?
A. Risk for fluid volume deficit
B. Impaired skin integrity
C. Risk for infection
D. Impaired gas exchange
Correct Answer: A. Risk for fluid volume deficit
Rationale: Hypernatremia often results from a relative water loss rather than
sodium gain, leading to dehydration and fluid volume deficit.
Question 6:
Which clinical sign is associated with hypernatremia?
A. Bradycardia
B. Restlessness and irritability
C. Diarrhea
D. Peripheral edema
Correct Answer: B. Restlessness and irritability
Rationale: Hypernatremia leads to cellular dehydration, particularly in the
brain, resulting in neurologic symptoms like agitation, restlessness, and
irritability.
Question 7:
The nurse is caring for a patient on sodium-restricted diet due to chronic
heart failure. Which meal choice requires further teaching?
A. Grilled chicken with rice and vegetables
B. Canned soup and ham sandwich
HESI Exit Exam Question Bank:
Fluid & Electrolyte Imbalances
in Med-Surg Nursing
Table of Contents
Subtopic 1: Sodium Imbalances – Hyponatremia and Hypernatremia.............2
Subtopic 2: Potassium Imbalances – Hypokalemia and Hyperkalemia..........10
Subtopic 3: Calcium and Magnesium Imbalances – Hypocalcemia,
Hypercalcemia, Hypomagnesemia, and Hypermagnesemia..........................19
Subtopic 4: Acid-Base Imbalances – Metabolic & Respiratory Acidosis and
Alkalosis.........................................................................................................27
Subtopic 5: Fluid Volume Deficit and Dehydration in Medical-Surgical Patients
.......................................................................................................................36
Subtopic 6: Fluid Volume Excess and Edema Management in Med-Surg.......44
Subtopic 7: Acid-Base Imbalances and Compensation Mechanisms..............52
Subtopic 8: Intravenous (IV) Fluid Types and Clinical Applications................61
Subtopic 9: Fluid and Electrolyte Imbalances in Renal and Cardiac Disorders
.......................................................................................................................69
Subtopic 10: Nursing Interventions and Safety Priorities in Fluid & Electrolyte
Management..................................................................................................78
, 2
Subtopic 1: Sodium Imbalances –
Hyponatremia and Hypernatremia
Question 1:
A patient presents with confusion, headache, and nausea. Laboratory tests
reveal a serum sodium level of 122 mEq/L. What is the most appropriate
initial nursing intervention?
A. Administer oral sodium tablets
B. Implement seizure precautions
C. Infuse D5W IV at a rapid rate
D. Encourage increased water intake
Correct Answer: B. Implement seizure precautions
Rationale: Severe hyponatremia (Na+ <125 mEq/L) can lead to cerebral
edema and increased risk of seizures. Seizure precautions should be
implemented immediately to protect the patient from harm while other
interventions are being prepared.
Question 2:
A client with SIADH is admitted with a serum sodium of 118 mEq/L. What IV
fluid order does the nurse anticipate from the provider?
A. 0.45% NaCl
B. 3% NaCl
C. Lactated Ringer's
D. D5W
Correct Answer: B. 3% NaCl
, 3
Rationale: In symptomatic severe hyponatremia, hypertonic saline (3% NaCl)
is indicated to raise serum sodium levels cautiously and reduce cerebral
edema. D5W and hypotonic fluids are contraindicated.
Question 3:
Which assessment finding is most concerning in a patient with
hyponatremia?
A. Muscle cramps
B. Thirst
C. Decreased level of consciousness
D. Dry mucous membranes
Correct Answer: C. Decreased level of consciousness
Rationale: A change in mental status may indicate cerebral edema or early
signs of increased intracranial pressure, which can be life-threatening in
hyponatremia.
Question 4:
A nurse reviews the sodium level of a patient receiving tube feedings. The
sodium level is 149 mEq/L. What intervention is most appropriate?
A. Increase the feeding rate
B. Provide free water with feedings
C. Switch to a high-sodium formula
D. Administer a sodium supplement
Correct Answer: B. Provide free water with feedings
Rationale: Tube feedings without adequate water can cause hypernatremia.
Administering free water helps correct this imbalance.
, 4
Question 5:
What is a priority nursing diagnosis for a client with hypernatremia?
A. Risk for fluid volume deficit
B. Impaired skin integrity
C. Risk for infection
D. Impaired gas exchange
Correct Answer: A. Risk for fluid volume deficit
Rationale: Hypernatremia often results from a relative water loss rather than
sodium gain, leading to dehydration and fluid volume deficit.
Question 6:
Which clinical sign is associated with hypernatremia?
A. Bradycardia
B. Restlessness and irritability
C. Diarrhea
D. Peripheral edema
Correct Answer: B. Restlessness and irritability
Rationale: Hypernatremia leads to cellular dehydration, particularly in the
brain, resulting in neurologic symptoms like agitation, restlessness, and
irritability.
Question 7:
The nurse is caring for a patient on sodium-restricted diet due to chronic
heart failure. Which meal choice requires further teaching?
A. Grilled chicken with rice and vegetables
B. Canned soup and ham sandwich
