NCLEX Fluids & Electrolyte Exam Practice Questions and Answers

180 Questions and Answers

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A strong understanding of fluid and electrolyte balance is essential for delivering safe, accurate, and timely nursing interventions—especially in critical care, medical-surgical, and emergency settings. This NCLEX Fluids & Electrolyte Exam Practice Questions and Answers resource is expertly developed to reinforce your clinical knowledge and prepare you for high-priority NCLEX-RN questions related to hydration, imbalances, and patient safety.

This practice exam covers essential topics such as fluid compartments, osmosis, diffusion, and the regulation of major electrolytes including sodium, potassium, calcium, magnesium, phosphate, and chloride. It dives deep into causes, signs and symptoms, nursing assessments, and interventions for common conditions like dehydration, fluid overload, hyponatremia, hyperkalemia, hypocalcemia, and acid-base imbalances.

Each question is structured to challenge your ability to apply knowledge in clinical scenarios that mirror real NCLEX-style case questions. You’ll practice interpreting lab values, identifying abnormal findings, prioritizing nursing interventions, and providing effective patient education on managing electrolyte-related conditions.

This resource also integrates important nursing concepts such as IV therapy, fluid replacement strategies, diuretic use, monitoring for complications, and recognizing early signs of imbalance. Special attention is given to populations at risk—such as the elderly, pediatric patients, and those with renal or cardiac conditions.

Aligned with the current NCLEX-RN test plan, the exam reinforces clinical judgment, safety, and patient-centered care. It prepares you to confidently answer high-yield questions that require rapid thinking and in-depth understanding of complex physiological changes.

Ideal for nursing students, graduates, and international nurses preparing for the NCLEX, this tool ensures you’re equipped to manage critical care situations where fluid and electrolyte management is vital. By mastering these questions, you’ll improve your exam readiness and strengthen your ability to deliver life-saving care with precision and confidence.

Sample Questions and Answers

  1. Which of the following is the most accurate indicator of fluid status?
  • A) Daily weight
  • B) Blood pressure
  • C) Pulse rate
  • D) Urine output
  • Answer: A) Daily weight
  1. A patient with hyperkalemia should avoid which of the following foods?
  • A) Oranges
  • B) Apples
  • C) Grapes
  • D) Strawberries
  • Answer: A) Oranges
  1. Which of the following symptoms is commonly seen in a patient with hyponatremia?
  • A) Hyperactive reflexes
  • B) Decreased level of consciousness
  • C) Increased thirst
  • D) Muscle twitching
  • Answer: B) Decreased level of consciousness
  1. A nurse is caring for a patient receiving intravenous (IV) fluids. Which of the following signs would indicate fluid overload?
  • A) Edema
  • B) Weight loss
  • C) Hypotension
  • D) Decreased respiratory rate
  • Answer: A) Edema
  1. Which electrolyte imbalance is most commonly associated with the use of loop diuretics?
  • A) Hypercalcemia
  • B) Hypokalemia
  • C) Hypernatremia
  • D) Hypomagnesemia
  • Answer: B) Hypokalemia
  1. A patient with kidney failure is at risk for which electrolyte imbalance?
  • A) Hyperkalemia
  • B) Hyponatremia
  • C) Hypocalcemia
  • D) Hypermagnesemia
  • Answer: A) Hyperkalemia
  1. Which of the following findings would the nurse expect in a patient with dehydration?
  • A) Decreased urine output
  • B) Hyperactive bowel sounds
  • C) Edema in extremities
  • D) Increased heart rate
  • Answer: A) Decreased urine output
  1. A patient with a sodium level of 130 mEq/L is diagnosed with hyponatremia. The nurse expects which of the following treatments?
  • A) Administration of hypertonic saline
  • B) Fluid restriction
  • C) Administration of potassium supplements
  • D) Administration of diuretics
  • Answer: A) Administration of hypertonic saline
  1. Which of the following is the most common cause of hypercalcemia?
  • A) Renal failure
  • B) Parathyroid disorders
  • C) Malnutrition
  • D) Diarrhea
  • Answer: B) Parathyroid disorders
  1. Which assessment finding is most indicative of hyperkalemia?
  • A) Flattened T waves
  • B) Deep tendon reflex hyperactivity
  • C) Tall, peaked T waves
  • D) Decreased urinary output
  • Answer: C) Tall, peaked T waves
  1. Which of the following is the priority nursing intervention for a patient with hypernatremia?
  • A) Administer isotonic saline
  • B) Increase fluid intake
  • C) Encourage salt intake
  • D) Administer diuretics
  • Answer: B) Increase fluid intake
  1. A nurse is monitoring a patient with hypocalcemia. Which of the following is a common symptom?
  • A) Nausea
  • B) Muscle spasms
  • C) Confusion
  • D) Hyperactive reflexes
  • Answer: B) Muscle spasms
  1. A patient is receiving IV fluids with 5% dextrose. What is the primary concern for the nurse?
  • A) Hyperglycemia
  • B) Hyperkalemia
  • C) Fluid overload
  • D) Hypotension
  • Answer: A) Hyperglycemia
  1. Which of the following is a common cause of hypomagnesemia?
  • A) Excessive alcohol use
  • B) Hyperparathyroidism
  • C) Hyperglycemia
  • D) Chronic kidney disease
  • Answer: A) Excessive alcohol use
  1. Which of the following is the most appropriate treatment for a patient with hypermagnesemia?
  • A) Administration of calcium gluconate
  • B) Diuretic therapy
  • C) Administration of potassium chloride
  • D) Fluid restriction
  • Answer: B) Diuretic therapy
  1. A nurse is caring for a patient with dehydration. Which of the following symptoms would the nurse expect to observe?
  • A) Bradycardia
  • B) Hypotension
  • C) Slow capillary refill
  • D) Increased urine output
  • Answer: B) Hypotension
  1. A patient is diagnosed with hyperphosphatemia. The nurse should monitor for which of the following symptoms?
  • A) Tetany
  • B) Decreased muscle tone
  • C) Decreased deep tendon reflexes
  • D) Bradycardia
  • Answer: A) Tetany
  1. A nurse is caring for a patient with potassium 6.5 mEq/L. Which of the following interventions is appropriate?
  • A) Administer sodium bicarbonate
  • B) Prepare the patient for dialysis
  • C) Administer potassium supplements
  • D) Decrease intravenous fluids
  • Answer: B) Prepare the patient for dialysis
  1. A patient is receiving IV fluids with sodium chloride. The nurse should monitor the patient for signs of:
  • A) Hypokalemia
  • B) Fluid overload
  • C) Hyperglycemia
  • D) Hypercalcemia
  • Answer: B) Fluid overload
  1. Which of the following laboratory findings is consistent with metabolic acidosis?
  • A) Low pH, low bicarbonate
  • B) Low pH, high bicarbonate
  • C) High pH, low bicarbonate
  • D) High pH, high bicarbonate
  • Answer: A) Low pH, low bicarbonate
  1. A nurse is caring for a patient with severe dehydration. Which of the following is the most appropriate fluid for initial replacement?
  • A) Dextrose 5% in water (D5W)
  • B) Normal saline (0.9% sodium chloride)
  • C) Lactated Ringer’s solution
  • D) 5% albumin
  • Answer: B) Normal saline (0.9% sodium chloride)
  1. Which of the following is a symptom of hyperkalemia?
  • A) Constipation
  • B) Bradycardia
  • C) Hypertension
  • D) Nausea
  • Answer: B) Bradycardia
  1. A nurse is caring for a patient receiving IV fluids. The patient complains of pain and redness at the IV site. The nurse should suspect:
  • A) Phlebitis
  • B) Infiltration
  • C) Fluid overload
  • D) Air embolism
  • Answer: A) Phlebitis
  1. Which of the following electrolytes is most commonly associated with bone health?
  • A) Calcium
  • B) Sodium
  • C) Potassium
  • D) Magnesium
  • Answer: A) Calcium
  1. A patient with severe hyponatremia is at risk for which of the following complications?
  • A) Seizures
  • B) Hypertension
  • C) Bradycardia
  • D) Polyuria
  • Answer: A) Seizures
  1. The nurse is monitoring a patient with hyperkalemia. The nurse expects which of the following interventions?
  • A) Increase oral potassium intake
  • B) Administer sodium bicarbonate
  • C) Restrict fluid intake
  • D) Administer insulin and glucose
  • Answer: D) Administer insulin and glucose
  1. Which of the following is an early sign of hypokalemia?
  • A) Muscle weakness
  • B) Nausea and vomiting
  • C) Chest pain
  • D) Seizures
  • Answer: A) Muscle weakness
  1. A patient with hyperkalemia is most at risk for which of the following?
  • A) Cardiac arrhythmias
  • B) Hypotension
  • C) Bradycardia
  • D) Respiratory depression
  • Answer: A) Cardiac arrhythmias
  1. A patient is receiving diuretics. The nurse should monitor the patient for signs of:
  • A) Hyperkalemia
  • B) Hypokalemia
  • C) Hypercalcemia
  • D) Hyponatremia
  • Answer: B) Hypokalemia
  1. A nurse is caring for a patient with third-space fluid shift. The nurse should monitor the patient for which of the following?
  • A) Increased blood pressure
  • B) Edema and weight gain
  • C) Dry mucous membranes
  • D) Decreased heart rate
  • Answer: B) Edema and weight gain

 

  1. Which of the following is a common cause of hypernatremia?
  • A) Excessive water intake
  • B) Inadequate water intake
  • C) Diuretic use
  • D) Hypothyroidism
  • Answer: B) Inadequate water intake
  1. A patient with a potassium level of 7.0 mEq/L is at risk for which of the following?
  • A) Respiratory failure
  • B) Hypotension
  • C) Hyperglycemia
  • D) Renal failure
  • Answer: A) Respiratory failure
  1. A patient is receiving intravenous potassium. The nurse should monitor for which of the following complications?
  • A) Hyperkalemia
  • B) Hypertension
  • C) Cardiac arrhythmias
  • D) Hyperglycemia
  • Answer: C) Cardiac arrhythmias
  1. A patient with dehydration should be treated with which of the following types of fluid replacement?
  • A) Hypotonic solution
  • B) Isotonic solution
  • C) Hypertonic solution
  • D) None of the above
  • Answer: B) Isotonic solution
  1. A nurse is caring for a patient with hypovolemia. Which of the following is the primary goal of treatment?
  • A) Reduce edema
  • B) Increase blood pressure
  • C) Replace lost fluids and electrolytes
  • D) Prevent infection
  • Answer: C) Replace lost fluids and electrolytes

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