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NCLEX-RN: Fluids, Electrolytes and Acid-Base Balance — quiz
15 multiple-choice questions covering Sodium, Potassium, Calcium, Magnesium, Fluid Volume Imbalances. One answer each; you get a score at the end and the explanation for every question. No account needed.
Updated 2026-11-03. Keys 1–4 pick an answer, Enter moves on. Redo it any time, in order or shuffled.
The questions
Answers and explanations are shown after you finish.
- Sodium
A nurse reviews a patient's basic metabolic panel and notes a serum sodium level of 148 mEq/L. How should this value be classified?
- Severe hypokalemia
- Hyponatremia
- Hypernatremia
- Normal
- Sodium
A patient with SIADH develops a headache, lethargy, and confusion. What is the underlying physiologic mechanism causing these neurologic symptoms?
- Sodium shifts out of cells causing cellular dehydration
- Potassium excess altering cardiac conduction
- Calcium deficiency increasing neuromuscular excitability
- Water shifts into brain cells causing cerebral swelling
- Sodium
A patient with diabetes insipidus has a serum sodium of 152 mEq/L and is symptomatic. Which IV fluid order should the nurse anticipate, and why?
- 0.45% NaCl given slowly to rehydrate cells without causing cerebral edema
- 3% NaCl given rapidly to quickly restore sodium
- D10W given rapidly to dilute serum sodium
- 0.9% NaCl to expand intravascular volume
- Potassium
Which serum potassium value falls within the normal range?
- 3.0 mEq/L
- 3.8 mEq/L
- 5.5 mEq/L
- 6.0 mEq/L
- Potassium
A patient receiving long-term furosemide therapy reports leg cramps and fatigue, and the nurse notes a U wave on the ECG. Which electrolyte imbalance is most likely?
- Hyperkalemia
- Hypomagnesemia
- Hypokalemia
- Hypercalcemia
- Potassium
A patient with renal failure has a serum potassium of 6.8 mEq/L and peaked T waves on ECG. What is the nurse's priority action?
- Restrict dietary potassium
- Administer IV calcium gluconate
- Administer insulin and dextrose
- Administer sodium polystyrene sulfonate
- Calcium
During assessment, a nurse inflates a blood pressure cuff above systolic pressure and observes carpal spasm after several minutes. This finding indicates which electrolyte imbalance?
- Hypercalcemia
- Hypocalcemia
- Hyperkalemia
- Hypermagnesemia
- Calcium
A patient with hypercalcemia due to malignancy is being treated. Which class of diuretic should the nurse question if ordered?
- Loop diuretics
- Thiazide diuretics
- Carbonic anhydrase inhibitors
- Osmotic diuretics
- Magnesium
A patient with chronic alcoholism presents with tremors, hyperreflexia, and a positive Chvostek's sign. Which lab value should the nurse check first?
- Serum sodium
- Serum phosphate
- Serum magnesium
- Serum potassium
- Magnesium
A pregnant patient receiving magnesium sulfate for preeclampsia loses her patellar reflex. What should the nurse do first?
- Increase the magnesium infusion rate
- Stop the magnesium infusion and notify the provider
- Document as an expected finding
- Administer additional calcium gluconate without stopping the infusion
- Fluid Volume Imbalances
A patient presents with jugular vein distention, a bounding pulse, crackles in the lungs, and a 4 lb weight gain in two days. Which condition does the nurse suspect?
- Hypokalemia
- Hypernatremia
- Fluid volume excess
- Fluid volume deficit
- IV Fluid Types
A patient in hypovolemic shock needs rapid volume expansion. Which IV fluid is most appropriate?
- D5W
- 0.9% NaCl
- 3% NaCl
- 0.45% NaCl
- ABG Interpretation
Using the ROME mnemonic, if a patient's pH is decreased and PaCO2 is increased, how should this be classified?
- Metabolic alkalosis
- Respiratory alkalosis
- Respiratory acidosis
- Metabolic acidosis
- Acid-Base Disorders
A patient with a COPD exacerbation has ABG results: pH 7.30, PaCO2 55 mmHg, HCO3 24 mEq/L. Which compensatory mechanism would the nurse expect over the next few days if this persists?
- Increased respiratory rate to blow off CO2
- Renal retention of bicarbonate
- Hypoventilation to retain CO2
- Renal excretion of bicarbonate
- Acid-Base Disorders
A patient in diabetic ketoacidosis exhibits rapid, deep breathing. What is the purpose of this respiratory pattern?
- To retain bicarbonate
- To compensate for metabolic acidosis by blowing off CO2
- To retain CO2 and raise pH
- To compensate for metabolic alkalosis
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