NORCET Nursing Foundation – Fluids & Electrolytes Balance

Test 01 • 50 MCQs • 50 Marks • 30 Minutes

Conceptual + Clinical + Case-Based + Scenario-Based Questions

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Q1. What is the major fluid compartment in the human body?

A. Intracellular fluid B. Intravascular fluid C. Transcellular fluid D. Interstitial fluid

Answer: A. Intracellular fluid
Intracellular fluid (ICF) is the fluid contained within cells and represents the largest fluid compartment of the body.

Q2. Which electrolyte is the major cation of extracellular fluid?

A. Potassium B. Sodium C. Magnesium D. Phosphate

Answer: B. Sodium
Sodium is the principal extracellular cation and plays a major role in extracellular fluid volume and osmolality.

Q3. Which electrolyte is the major intracellular cation?

A. Sodium B. Chloride C. Potassium D. Calcium

Answer: C. Potassium
Potassium is the major intracellular cation and is essential for cellular function, nerve transmission and cardiac electrical activity.

Q4. A patient has dry mucous membranes, poor skin turgor, tachycardia and decreased urine output. Which condition is most likely?

A. Fluid volume excess B. Fluid volume deficit C. Hypercalcemia D. Hypermagnesemia

Answer: B. Fluid volume deficit
Dry mucous membranes, tachycardia, decreased urine output and poor skin turgor are common clinical indicators of dehydration or fluid volume deficit.

Q5. Which assessment finding is most concerning in a patient with severe fluid volume deficit?

A. Bounding pulse B. Hypotension and altered mental status C. Peripheral edema D. Crackles with hypertension

Answer: B. Hypotension and altered mental status
Severe fluid loss can reduce circulating volume and tissue perfusion, leading to hypotension, altered consciousness and potentially hypovolemic shock.

Q6. Which finding is most consistent with fluid volume excess?

A. Dry tongue B. Orthostatic hypotension C. Peripheral edema and pulmonary crackles D. Concentrated urine

Answer: C. Peripheral edema and pulmonary crackles
Excess extracellular fluid can cause peripheral edema, weight gain, elevated blood pressure and pulmonary congestion with crackles.

Q7. Which is the most reliable routine indicator of overall fluid balance?

A. Daily body weight B. Skin color C. Hair texture D. Nail length

Answer: A. Daily body weight
Daily weight, measured under consistent conditions, is one of the most sensitive indicators of changes in total body fluid.

Q8. Approximately how much change in body weight represents 1 liter of fluid?

A. 0.1 kg B. 1 kg C. 5 kg D. 10 kg

Answer: B. 1 kg
Approximately 1 liter of water weighs about 1 kilogram, so rapid changes in daily weight can reflect fluid gain or loss.

Q9. A patient has severe diarrhea for two days. Which complication is the nurse most concerned about?

A. Fluid and electrolyte imbalance B. Fluid overload only C. Hypervolemia only D. Increased bone density

Answer: A. Fluid and electrolyte imbalance
Persistent diarrhea can cause significant water and electrolyte losses, particularly sodium and potassium.

Q10. Which IV solution is isotonic and commonly used for extracellular volume replacement?

A. 0.9% sodium chloride B. 3% sodium chloride C. 0.45% sodium chloride D. Sterile water for IV injection

Answer: A. 0.9% sodium chloride
0.9% sodium chloride is an isotonic crystalloid commonly used for extracellular volume replacement.

Q11. Which IV solution is classified as hypotonic?

A. 0.9% sodium chloride B. 0.45% sodium chloride C. 3% sodium chloride D. Lactated Ringer's solution

Answer: B. 0.45% sodium chloride
0.45% sodium chloride contains less sodium than plasma and is classified as a hypotonic solution.

Q12. Which IV fluid is hypertonic?

A. 0.45% sodium chloride B. 0.9% sodium chloride C. 3% sodium chloride D. 5% dextrose in water in its bag

Answer: C. 3% sodium chloride
3% sodium chloride is a hypertonic saline solution and requires careful monitoring because rapid changes in serum sodium can cause serious neurologic complications.

Q13. Which electrolyte imbalance is particularly associated with muscle weakness and cardiac dysrhythmias?

A. Potassium imbalance B. Chloride imbalance only C. Phosphate imbalance only D. Water imbalance only

Answer: A. Potassium imbalance
Both hypokalemia and hyperkalemia can affect neuromuscular function and cardiac conduction, potentially causing life-threatening dysrhythmias.

Q14. A patient's serum potassium is 2.8 mEq/L. Which finding should the nurse anticipate?

A. Muscle weakness B. Severe hypertension only C. Bounding pulse only D. Hyperactive reflexes in every case

Answer: A. Muscle weakness
Hypokalemia can cause muscle weakness, fatigue, constipation, abnormal cardiac rhythms and characteristic ECG changes.

Q15. Which ECG finding is classically associated with hypokalemia?

A. Prominent U waves B. Shortened QT interval only C. Peaked T waves D. Complete absence of P waves in every case

Answer: A. Prominent U waves
Hypokalemia may produce flattened T waves, ST depression and prominent U waves.

Q16. Which ECG finding is strongly associated with hyperkalemia?

A. Peaked T waves B. Prominent U waves C. Normal ECG in all cases D. Isolated prolonged QT only

Answer: A. Peaked T waves
Early ECG changes in hyperkalemia commonly include tall, narrow, peaked T waves. Severe hyperkalemia can progress to conduction abnormalities and cardiac arrest.

Q17. A patient with potassium level 6.8 mEq/L has muscle weakness and ECG abnormalities. What is the priority?

A. Treat as a potentially life-threatening emergency B. Encourage a high-potassium diet C. Delay treatment until tomorrow D. Give potassium supplement

Answer: A. Treat as a potentially life-threatening emergency
Severe hyperkalemia with ECG changes can rapidly cause fatal cardiac dysrhythmias and requires urgent treatment.

Q18. Which food is generally rich in potassium?

A. Banana B. Refined sugar C. Table salt D. Plain cooking oil

Answer: A. Banana
Bananas are a commonly recognized dietary source of potassium. Other sources include potatoes, beans, leafy greens and several fruits.

Q19. A patient receiving IV potassium complains of severe pain at the IV site. What should the nurse do first?

A. Ignore the pain B. Assess the IV site and infusion immediately C. Increase the infusion rate D. Add potassium to the IV bag without an order

Answer: B. Assess the IV site and infusion immediately
IV potassium can cause significant tissue injury if infiltration or extravasation occurs. The infusion and IV site require immediate assessment.

Q20. Which statement about IV potassium administration is correct?

A. IV potassium should generally never be given as an undiluted IV push B. Potassium should always be given as IV push C. Potassium does not affect the heart D. Monitoring is unnecessary

Answer: A. IV potassium should generally never be given as an undiluted IV push
Rapid IV potassium administration can cause fatal cardiac arrhythmias. It must be diluted and administered using an appropriate controlled infusion protocol.

Q21. Normal serum sodium is approximately:

A. 70–90 mEq/L B. 135–145 mEq/L C. 180–200 mEq/L D. 20–40 mEq/L

Answer: B. 135–145 mEq/L
The commonly used adult reference range for serum sodium is approximately 135–145 mEq/L, although laboratory ranges may vary slightly.

Q22. A patient has a sodium level of 124 mEq/L. Which symptom is especially concerning?

A. Seizure B. Mild thirst only C. Increased appetite D. Normal orientation

Answer: A. Seizure
Significant hyponatremia can cause cerebral edema and neurologic manifestations including confusion, decreased consciousness and seizures.

Q23. Which finding is commonly associated with hypernatremia?

A. Thirst and neurologic changes B. Always severe edema C. Prominent U waves D. Tetany in every case

Answer: A. Thirst and neurologic changes
Hypernatremia generally reflects a deficit of water relative to sodium and can cause intense thirst, irritability, confusion, weakness and seizures when severe.

Q24. A patient with severe vomiting develops hyponatremia. Which assessment is the priority?

A. Neurologic status B. Hair growth C. Nail shape D. Visual acuity only

Answer: A. Neurologic status
Significant sodium abnormalities can affect brain function, so changes in mental status and neurologic findings require close monitoring.

Q25. Which electrolyte is important for neuromuscular function and bone health?

A. Calcium B. Chloride only C. Sodium only D. Water only

Answer: A. Calcium
Calcium is essential for bone mineralization, muscle contraction, nerve transmission and blood coagulation.

Q26. Which clinical finding is characteristic of hypocalcemia?

A. Tetany and muscle spasms B. Flaccid paralysis in every case C. Severe thirst only D. Peripheral edema only

Answer: A. Tetany and muscle spasms
Low calcium increases neuromuscular excitability and may cause tingling, muscle cramps, tetany and seizures.

Q27. Which bedside signs may be associated with hypocalcemia?

A. Chvostek and Trousseau signs B. Cullen and Grey Turner signs C. Kernig and Brudzinski only D. Babinski and Romberg only

Answer: A. Chvostek and Trousseau signs
Chvostek and Trousseau signs indicate increased neuromuscular excitability and may be present in hypocalcemia.

Q28. A patient with hypercalcemia is most likely to complain of:

A. Constipation and weakness B. Tetany in every case C. Severe muscle spasms only D. Continuous diarrhea in every case

Answer: A. Constipation and weakness
Hypercalcemia can cause weakness, fatigue, constipation, polyuria, polydipsia and altered mental status.

Q29. Which electrolyte is strongly associated with neuromuscular stability and is often linked with refractory hypokalemia when deficient?

A. Magnesium B. Chloride C. Sodium D. Water

Answer: A. Magnesium
Magnesium is important for neuromuscular and cardiac function. Magnesium deficiency can contribute to persistent hypokalemia that is difficult to correct.

Q30. Which finding may occur with hypomagnesemia?

A. Tremors and neuromuscular irritability B. Complete absence of reflexes in every case C. Severe fluid overload only D. Hyperpigmentation only

Answer: A. Tremors and neuromuscular irritability
Low magnesium may cause tremor, muscle cramps, hyperreflexia, seizures and cardiac dysrhythmias.

Q31. Which electrolyte abnormality can cause respiratory muscle weakness when severe?

A. Severe hypokalemia B. Mild hypernatremia only C. Mild hyperchloremia only D. Mild hypercalcemia only

Answer: A. Severe hypokalemia
Severe potassium deficiency can produce generalized muscle weakness and, in severe cases, respiratory muscle impairment.

Q32. A patient has prolonged vomiting. Which acid-base imbalance is commonly associated with persistent loss of gastric acid?

A. Metabolic alkalosis B. Metabolic acidosis C. Respiratory acidosis D. Respiratory alkalosis only

Answer: A. Metabolic alkalosis
Persistent vomiting causes loss of gastric hydrochloric acid and can contribute to metabolic alkalosis, often accompanied by chloride and potassium losses.

Q33. A patient has severe diarrhea. Which acid-base disturbance is commonly associated with bicarbonate loss?

A. Metabolic acidosis B. Metabolic alkalosis C. Respiratory alkalosis only D. Respiratory acidosis only

Answer: A. Metabolic acidosis
Diarrhea can cause significant bicarbonate loss from the gastrointestinal tract, leading to metabolic acidosis.

Q34. Which patient is at greatest risk for fluid volume excess?

A. A patient with severe renal impairment B. A healthy adult after normal exercise C. A patient with mild thirst D. A patient with one normal bowel movement

Answer: A. A patient with severe renal impairment
Reduced renal function can impair sodium and water excretion, increasing the risk of fluid retention and volume overload.

Q35. A patient receiving large-volume IV fluids develops dyspnea and bilateral crackles. What should the nurse do first?

A. Assess respiratory status and notify the appropriate clinician promptly B. Increase the IV rate C. Encourage unlimited oral fluids D. Place the patient flat without assessment

Answer: A. Assess respiratory status and notify the appropriate clinician promptly
New dyspnea and crackles after fluid administration may indicate pulmonary fluid accumulation. Respiratory assessment and rapid intervention are priorities.

Q36. Which finding suggests inadequate renal perfusion or significant fluid deficit?

A. Decreased urine output B. Clear excessive urine with edema C. Increased urine output in every case D. Normal urine output

Answer: A. Decreased urine output
Reduced urine output can occur when circulating volume or renal perfusion decreases. The cause should be assessed promptly.

Q37. Which intervention is most appropriate for a patient at risk for fluid volume deficit?

A. Monitor intake and output, vital signs and daily weight B. Restrict all fluids without an order C. Ignore urine output D. Administer diuretics routinely

Answer: A. Monitor intake and output, vital signs and daily weight
Accurate monitoring helps identify worsening fluid deficit and evaluate the response to therapy.

Q38. Which finding is most suggestive of dehydration in an older adult?

A. Acute confusion with decreased intake and concentrated urine B. Increased appetite only C. Warm moist skin only D. Bradycardia with hypertension only

Answer: A. Acute confusion with decreased intake and concentrated urine
Older adults may have a reduced thirst response, and dehydration may present with weakness, confusion, decreased urine output and concentrated urine.

Q39. A patient has a serum potassium of 2.9 mEq/L and is receiving digoxin. Why is this especially concerning?

A. Hypokalemia can increase the risk of digoxin toxicity B. Hypokalemia prevents digoxin absorption completely C. Potassium has no cardiac effects D. Digoxin always increases potassium

Answer: A. Hypokalemia can increase the risk of digoxin toxicity
Low potassium increases myocardial sensitivity to digoxin and can increase the risk of dysrhythmias and toxicity.

Q40. Which assessment is most important when administering a large amount of IV fluid to a patient with heart failure?

A. Respiratory status and signs of pulmonary congestion B. Hair growth C. Visual acuity only D. Nail length

Answer: A. Respiratory status and signs of pulmonary congestion
Patients with heart failure may be particularly vulnerable to fluid overload, making respiratory assessment essential.

Q41. Which electrolyte is the major extracellular anion?

A. Chloride B. Potassium C. Calcium D. Magnesium

Answer: A. Chloride
Chloride is the major extracellular anion and contributes to osmotic balance and acid-base regulation.

Q42. A patient has prolonged vomiting with low chloride and potassium levels. Which combination is most likely?

A. Hypochloremia and hypokalemia B. Hyperchloremia and hyperkalemia C. Hypernatremia and hypercalcemia only D. Hypermagnesemia only

Answer: A. Hypochloremia and hypokalemia
Repeated vomiting can cause gastric chloride and hydrogen ion losses, while potassium depletion may also occur.

Q43. Which nursing action helps prevent errors when monitoring fluid balance?

A. Accurately measure and document all significant intake and output B. Estimate urine output visually C. Record output only once per week D. Ignore IV fluids

Answer: A. Accurately measure and document all significant intake and output
Accurate intake and output measurement is essential for evaluating fluid balance and treatment response.

Q44. A patient with severe dehydration has tachycardia, hypotension and cool extremities. Which complication should the nurse suspect?

A. Hypovolemic shock B. Fluid overload C. Hypercalcemia only D. Pulmonary edema from excess fluid

Answer: A. Hypovolemic shock
Severe loss of intravascular volume can impair tissue perfusion and progress to hypovolemic shock.

Q45. Which patient requires the most immediate assessment?

A. Patient with potassium 6.7 mEq/L and ECG changes B. Patient with mild thirst C. Patient with sodium 140 mEq/L D. Patient with normal urine output

Answer: A. Patient with potassium 6.7 mEq/L and ECG changes
Severe hyperkalemia with ECG changes is a potentially life-threatening emergency because of the risk of fatal cardiac dysrhythmias.

Q46. A patient receiving IV fluids suddenly develops severe dyspnea, crackles and falling oxygen saturation. What is the priority nursing action?

A. Assess airway and breathing and initiate urgent intervention B. Increase the IV fluid rate C. Encourage the patient to drink more water D. Ignore the findings

Answer: A. Assess airway and breathing and initiate urgent intervention
Acute respiratory deterioration after IV fluid administration may indicate pulmonary edema or another serious complication. ABC priorities come first.

Q47. A patient with hyponatremia suddenly becomes confused and develops a seizure. What is the nurse's priority?

A. Protect the patient from injury and manage the emergency B. Encourage oral water intake C. Leave the patient alone D. Give a potassium supplement without an order

Answer: A. Protect the patient from injury and manage the emergency
Seizure associated with severe hyponatremia is a neurologic emergency. Immediate safety, airway/breathing assessment and appropriate medical management are priorities.

Q48. Which statement about correcting severe electrolyte abnormalities is most appropriate?

A. Correction should be performed carefully according to the cause and clinical situation B. All electrolyte abnormalities should be corrected as rapidly as possible C. Monitoring is unnecessary D. Laboratory values are irrelevant

Answer: A. Correction should be performed carefully according to the cause and clinical situation
Rapid correction of some electrolyte disorders, especially sodium abnormalities, can cause serious neurologic complications. Treatment must be individualized and monitored.

Q49. Which combination best indicates effective fluid-balance monitoring?

A. Daily weight, intake/output, vital signs, edema and respiratory assessment B. Hair color and appetite only C. Weight once a month only D. Pulse only

Answer: A. Daily weight, intake/output, vital signs, edema and respiratory assessment
Fluid balance is best evaluated using multiple clinical indicators rather than relying on a single measurement.

Q50. A patient has vomiting, hypotension, tachycardia, decreased urine output and a potassium level of 2.7 mEq/L. Which nursing priority is most appropriate?

A. Recognize the combined fluid and electrolyte emergency and initiate prompt assessment/intervention B. Encourage strenuous exercise C. Restrict all fluids without an order D. Ignore the potassium value

Answer: A. Recognize the combined fluid and electrolyte emergency and initiate prompt assessment/intervention
This patient has evidence of significant volume depletion plus severe hypokalemia. Both conditions can compromise circulation and cardiac function and require prompt clinical management.

NORCET Exams Preparation Series - Day 2 ( Fluids and Electrolytes Balance )