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Saunders 9th Edition Chapter 8: Fluids & Electrolytes |
140 NCLEX Practice Questions 2025-2026 with Verified
Rationales”
Question 1 (Multiple Choice - Single Response)
A patient with heart failure has serum sodium of 128 mEq/L and reports confusion.
What is the priority nursing action?
A. Restrict oral fluids
B. Encourage increased sodium intake
C. Administer prescribed diuretic
D. Monitor daily weight
Correct Answer: A. Restrict oral fluids
Rationale:
Hyponatremia with confusion indicates dilutional hyponatremia, often caused by
, 2
fluid overload in heart failure. The priority is fluid restriction to prevent
worsening neurological symptoms. Diuretics may be used but do not correct the
immediate cause without fluid control. Increased sodium intake is not the first
action, and weight monitoring is important but not emergent.
Question 2 (Multiple Choice - Single Response)
A patient with hypokalemia is receiving IV potassium chloride. Which finding
requires immediate intervention?
A. Burning at the IV site
B. Serum potassium of 3.0 mEq/L
C. Cardiac monitor shows U waves
D. Infusion rate of 20 mEq/hour
Correct Answer: D. Infusion rate of 20 mEq/hour
Rationale:
IV potassium should never exceed 10 mEq/hour through a peripheral line due
to risk of cardiac arrest and vein irritation. Burning at the site is common but not
life-threatening. U waves and low potassium are expected findings in hypokalemia.
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Question 3 (Multiple Choice - Single Response)
A patient with diabetic ketoacidosis (DKA) is receiving insulin infusion. Which
electrolyte should the nurse monitor closely?
A. Sodium
B. Potassium
C. Calcium
D. Magnesium
Correct Answer: B. Potassium
Rationale:
Insulin causes potassium to shift into cells, which can precipitate hypokalemia
even if levels are initially normal. Potassium monitoring is essential to prevent
arrhythmias. Sodium, calcium, and magnesium may also change but are less
immediately critical.
Question 4 (Multiple Choice - Single Response)
A patient’s ABG shows: pH 7.31, HCO₃⁻ 18, PaCO₂ 35. Which condition is
indicated?
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A. Metabolic acidosis
B. Metabolic alkalosis
C. Respiratory acidosis
D. Respiratory alkalosis
Correct Answer: A. Metabolic acidosis
Rationale:
A low pH with low bicarbonate and normal PaCO₂ indicates uncompensated
metabolic acidosis. Conditions like DKA or severe diarrhea can cause this.
Respiratory disorders would affect CO₂ rather than bicarbonate.
Question 5 (Multiple Choice - Single Response)
A patient receiving loop diuretics develops muscle weakness and irregular
heartbeats. Which electrolyte is most likely abnormal?
A. Potassium
B. Sodium
C. Magnesium
D. Calcium
Correct Answer: A. Potassium
Saunders 9th Edition Chapter 8: Fluids & Electrolytes |
140 NCLEX Practice Questions 2025-2026 with Verified
Rationales”
Question 1 (Multiple Choice - Single Response)
A patient with heart failure has serum sodium of 128 mEq/L and reports confusion.
What is the priority nursing action?
A. Restrict oral fluids
B. Encourage increased sodium intake
C. Administer prescribed diuretic
D. Monitor daily weight
Correct Answer: A. Restrict oral fluids
Rationale:
Hyponatremia with confusion indicates dilutional hyponatremia, often caused by
, 2
fluid overload in heart failure. The priority is fluid restriction to prevent
worsening neurological symptoms. Diuretics may be used but do not correct the
immediate cause without fluid control. Increased sodium intake is not the first
action, and weight monitoring is important but not emergent.
Question 2 (Multiple Choice - Single Response)
A patient with hypokalemia is receiving IV potassium chloride. Which finding
requires immediate intervention?
A. Burning at the IV site
B. Serum potassium of 3.0 mEq/L
C. Cardiac monitor shows U waves
D. Infusion rate of 20 mEq/hour
Correct Answer: D. Infusion rate of 20 mEq/hour
Rationale:
IV potassium should never exceed 10 mEq/hour through a peripheral line due
to risk of cardiac arrest and vein irritation. Burning at the site is common but not
life-threatening. U waves and low potassium are expected findings in hypokalemia.
, 3
Question 3 (Multiple Choice - Single Response)
A patient with diabetic ketoacidosis (DKA) is receiving insulin infusion. Which
electrolyte should the nurse monitor closely?
A. Sodium
B. Potassium
C. Calcium
D. Magnesium
Correct Answer: B. Potassium
Rationale:
Insulin causes potassium to shift into cells, which can precipitate hypokalemia
even if levels are initially normal. Potassium monitoring is essential to prevent
arrhythmias. Sodium, calcium, and magnesium may also change but are less
immediately critical.
Question 4 (Multiple Choice - Single Response)
A patient’s ABG shows: pH 7.31, HCO₃⁻ 18, PaCO₂ 35. Which condition is
indicated?
, 4
A. Metabolic acidosis
B. Metabolic alkalosis
C. Respiratory acidosis
D. Respiratory alkalosis
Correct Answer: A. Metabolic acidosis
Rationale:
A low pH with low bicarbonate and normal PaCO₂ indicates uncompensated
metabolic acidosis. Conditions like DKA or severe diarrhea can cause this.
Respiratory disorders would affect CO₂ rather than bicarbonate.
Question 5 (Multiple Choice - Single Response)
A patient receiving loop diuretics develops muscle weakness and irregular
heartbeats. Which electrolyte is most likely abnormal?
A. Potassium
B. Sodium
C. Magnesium
D. Calcium
Correct Answer: A. Potassium
