Great — below is a 50-item randomized NCLEX-style midterm exam for Fluids, Electrolytes
& Acid–Base Balance (Lessons I–IV).
No PDF — exam only, followed by an answer key at the end. Format is exam-style (questions
then answers), with a mix of situational items and items on diffusion, osmosis,
hydrostatic/osmotic pressures, hormones (ADH, aldosterone, ANP), electrolytes, ABG
interpretation, IV fluids, nursing priorities, and safety.
💧 MIDTERM EXAM — FLUIDS,
ELECTROLYTES & ACID–BASE BALANCE
(Lessons I–IV)
Name: ___________________________ Score: ______ /50
Directions: Choose the best answer (A–D) for each question.
1. A postoperative patient has urine output 20 mL/hr, dry mucous membranes, and HR 118.
Which action is highest priority?
A. Encourage oral water intake only
B. Report oliguria and prepare for IV fluid bolus as ordered
C. Restrict fluids to prevent overload
D. Document and reassess in 6 hours
2. Which process moves solutes from area of higher concentration to lower concentration
without energy?
A. Active transport
B. Osmosis
C. Diffusion
D. Filtration
3. A patient with CHF develops sudden dyspnea and crackles. Which IV action should the
nurse take first?
A. Increase the IV rate to improve perfusion
B. Stop or slow the IV infusion and notify the provider
C. Give a bolus of isotonic fluid
D. Elevate the patient's legs
4. Which electrolyte imbalance commonly causes peaked T waves on ECG?
A. Hypokalemia
B. Hyperkalemia
C. Hypocalcemia
D. Hypernatremia
5. Which statement best describes osmosis?
A. Movement of solute down its concentration gradient
B. Movement of water across a semipermeable membrane toward higher solute
concentration
C. Filtration of fluid driven by hydrostatic pressure
D. Active pumping of ions using ATP
6. A serum Na⁺ of 150 mEq/L with dry mucous membranes and confusion indicates:
A. Hyponatremia from fluid excess
B. Hypernatremia from water deficit
C. Normal sodium level
D. Pseudohyponatremia
7. A patient is hyperventilating from anxiety. ABG likely to show:
A. pH 7.50, PaCO₂ 30 mmHg, HCO₃⁻ 24 mEq/L
B. pH 7.30, PaCO₂ 55 mmHg, HCO₃⁻ 24 mEq/L
C. pH 7.25, PaCO₂ 38 mmHg, HCO₃⁻ 18 mEq/L
D. pH 7.40, PaCO₂ 40 mmHg, HCO₃⁻ 24 mEq/L
8. Which hormone causes kidneys to reabsorb water (concentrate urine)?
A. Aldosterone
B. ADH (antidiuretic hormone)
C. ANP (atrial natriuretic peptide)
D. Renin
9. Which IV solution is isotonic and commonly used for fluid resuscitation?
A. 0.9% NaCl (normal saline)
B. 0.45% NaCl (half normal)
C. D5W (after dextrose metabolized)
D. 3% NaCl
10.A client with prolonged vomiting has pH 7.52, HCO₃⁻ 32 mEq/L, PaCO₂ 46 mmHg. What
is the acid-base disturbance?
A. Metabolic alkalosis (uncompensated)
B. Metabolic acidosis
C. Respiratory alkalosis
D. Respiratory acidosis
11.A patient on loop diuretics reports muscle cramps and ECG shows U waves. Which lab
should the nurse expect?
A. Na⁺ 140 mEq/L
B. K⁺ 2.8 mEq/L
C. Ca²⁺ 11 mg/dL
D. Mg²⁺ 3.0 mEq/L
12.Hydrostatic pressure in capillaries causes:
A. Pulling fluid into capillaries due to plasma proteins
B. Pushing fluid out of capillaries into interstitial space
C. Active transport of sodium
D. Osmotic movement of water into cells
13.Which finding would the nurse expect with fluid volume excess?
A. Flat neck veins, hypotension
B. Weight gain, bounding pulse, JVD (jugular venous distention)
C. Sunken eyes, poor skin turgor
D. Increased hematocrit and BUN
14.A patient’s ABG shows pH 7.31, PaCO₂ 60 mmHg, HCO₃⁻ 28 mEq/L. Interpretation:
A. Respiratory acidosis, partially compensated
B. Metabolic acidosis
C. Respiratory alkalosis
D. Fully compensated metabolic alkalosis
15.Which mechanism requires ATP to move sodium out of the cell and potassium into the
cell?
A. Diffusion
B. Osmosis
C. Na⁺/K⁺ pump (active transport)
D. Filtration
16.A post-op patient with decreased urine output and central venous pressure high. Which
nursing diagnosis is most likely?
A. Fluid volume deficit (hypovolemia)
B. Fluid volume excess (hypervolemia)
C. Risk for infection
D. Impaired skin integrity
17.A patient has hyponatremic seizure. Which treatment might be ordered emergently?
A. Hypotonic IV fluids
B. 3% hypertonic saline (as ordered with monitoring)
C. Loop diuretics
D. Oral water bolus
18.What best describes oncotic (colloid osmotic) pressure?
A. Pressure generated by the heart to push blood forward
B. Pulling force into capillaries due to plasma proteins like albumin
C. Pressure that forces filtration from interstitial space into capillaries
D. Pressure from lymphatic drainage
19.A client with DKA has ABG pH 7.20, HCO₃⁻ 14 mEq/L, PaCO₂ 30 mmHg. This is:
A. Metabolic acidosis with respiratory compensation
B. Respiratory acidosis
C. Metabolic alkalosis
D. Respiratory alkalosis
20.Which nursing action is unsafe when administering IV potassium chloride (KCl)?
A. Infusing slowly via IV pump with dilution
B. Giving undiluted KCl as an IV push (bolus)
C. Checking urine output before administering
D. Monitoring cardiac rhythm during infusion
21.A patient has a urine specific gravity of 1.035. This suggests:
A. Hemodilution
B. Concentrated urine—possible dehydration or ADH effect
C. Normal hydration
D. Diabetes insipidus
22.Which electrolyte imbalance causes positive Chvostek and Trousseau signs?
A. Hyperkalemia
B. Hypocalcemia
C. Hypernatremia
D. Hypomagnesemia
23.Which IV fluid should be avoided in increased intracranial pressure (ICP) because it may
increase cerebral water content?
A. 0.9% NaCl
B. 3% NaCl (hypertonic)
C. D5W (hypotonic after dextrose metabolized)
D. Lactated Ringer’s
24.A patient with chronic kidney disease has K⁺ 6.2 mEq/L and tall, peaked T waves. The
nurse expects which order?
A. Oral potassium supplement
B. IV insulin with dextrose (temporary shift of K⁺ into cells)
C. Restrict fluids only
D. Give IV magnesium
25.A nurse reviews a patient’s 24-hour intake and output. Which finding suggests fluid
retention?
A. Net negative balance of 1,000 mL
B. Weight increase of 2 kg in 24 hours
C. Urine output > 2 L/day
D. Consistent daily weights
26.The thirst mechanism is stimulated primarily by:
A. Decreased blood glucose
B. Increased plasma osmolarity sensed by the hypothalamus
C. Decreased ADH
D. Increased urine output
27.A patient has metabolic alkalosis from nasogastric suctioning. Which clinical sign would
be expected?
A. Hyperventilation
B. Decreased respiratory rate (hypoventilation) as compensation
C. Kussmaul respirations
D. Increased acid production in urine
28.A nurse teaching about electrolyte-rich foods should advise a patient needing potassium
replacement to eat:
A. Bananas, potatoes, oranges
B. Cheese and milk only
C. White bread and rice
D. Low-potassium diet
29.Which condition results from excessive ADH secretion (SIADH)?
A. Hypernatremia with polyuria
B. Hyponatremia with concentrated urine and low urine output
C. Diabetes insipidus
D. Volume depletion with high serum osmolarity
30.A patient has Hct 55% (up from baseline) and BUN elevated. These labs most likely
indicate:
A. Fluid volume excess
B. Hemodilution
C. Dehydration (hemoconcentration)
D. Acute liver failure
31.Which process moves fluid across capillary membranes driven by blood pressure?
A. Osmosis
B. Diffusion
C. Filtration (hydrostatic pressure)
D. Active transport
32.A client on spironolactone (potassium-sparing diuretic) should be monitored for:
A. Hypokalemia
B. Hyperkalemia
C. Hypercalcemia
D. Hypomagnesemia
33.A patient presents with pH 7.48, PaCO₂ 48 mmHg, HCO₃⁻ 34 mEq/L. Best interpretation:
A. Metabolic alkalosis with respiratory compensation (hypoventilation)
B. Respiratory alkalosis
C. Metabolic acidosis
D. Uncompensated respiratory acidosis
34.Which nursing intervention helps prevent hospital-acquired pneumonia in immobilized
patients?
A. Encourage incentive spirometry and ambulation
B. Limit oral fluids to prevent aspiration
C. Keep patient supine at all times
D. Avoid coughing to prevent pain
35.Which electrolyte is essential for muscle contraction and nerve conduction and is mostly
intracellular?
A. Sodium
B. Potassium
C. Calcium
D. Bicarbonate
36.A patient with hyponatremia (Na⁺ 122 mEq/L) is confused and disoriented. Which is an
appropriate immediate action?
A. Encourage water intake and observe
B. Notify provider—severe symptomatic hyponatremia may require hypertonic saline per
order
C. Give loop diuretic without orders
D. Restrict sodium intake
37.Which IV solution is hypertonic and used to pull water out of cells into intravascular
space?
A. 0.9% NaCl
B. D5W after metabolism (hypotonic)
C. 3% NaCl
D. 0.45% NaCl
38.A patient with severe diarrhea for 3 days is most at risk for which acid-base imbalance?
A. Metabolic alkalosis
B. Metabolic acidosis (loss of bicarbonate)
C. Respiratory acidosis
D. Respiratory alkalosis
39.Which lab value is safest/normal for serum potassium?
A. 2.9 mEq/L
B. 3.2 mEq/L
C. 3.8 mEq/L
D. 6.0 mEq/L
40.A patient shows decreased deep tendon reflexes, hypotension, and bradycardia after
magnesium sulfate infusion. Which imbalance?
A. Hypomagnesemia
B. Hypermagnesemia
C. Hypocalcemia
D. Hypernatremia
41.The nurse is educating a patient about the Na⁺/K⁺ pump. Which statement shows
understanding?
A. It uses ATP to move Na⁺ out and K⁺ into the cell against gradients
B. It moves water from low to high solute concentrations
C. It requires no energy and works by diffusion
D. It is responsible for moving oxygen across membranes
42.Which anion is the primary extracellular cation controlling osmolality?
A. Potassium
B. Sodium
C. Calcium
D. Phosphate
43.A patient with metabolic acidosis is expected to have which respiratory pattern?
A. Slow and shallow breathing
B. Rapid and deep breathing (Kussmaul) to blow off CO₂
C. Periodic apnea
D. No change in respiration
44.A nurse notices dependent pitting edema and 2-kg weight gain in 24 hours. Which is the
best immediate nursing action?
A. Notify provider for assessment and possible diuretic order
B. Ignore unless patient complains
C. Restrict potassium intake
D. Encourage aggressive oral fluids
45.Which laboratory finding indicates dehydration rather than overhydration?
A. Low urine specific gravity, low BUN
B. High urine specific gravity, elevated BUN and Hct
C. Low hematocrit and low BUN
D. Low serum osmolarity
46.Which patient is at highest risk for developing fluid volume deficit?
A. Elderly adult with diarrhea and decreased thirst sensation
B. Young adult drinking sugary beverages
C. Middle-aged adult taking ACE inhibitor with normal appetite
D. Active athlete drinking water frequently
47.Which is correct regarding D5W (5% dextrose in water) after infusion?
A. It remains isotonic indefinitely in the bloodstream
B. Dextrose is metabolized and the solution becomes effectively hypotonic
C. It is hypertonic and permanently increases serum osmolarity
D. It is contraindicated in dehydration
48.A patient with severe hyperkalemia (K⁺ 7.0 mEq/L) is at risk for:
A. Constipation and dry skin
B. Life-threatening cardiac dysrhythmias
C. Tetany and hyperreflexia
D. Seizures due to low sodium
49.Which assessment best indicates effective rehydration in a dehydrated patient?
A. Decreased urine output and dry mucous membranes
B. Improved skin turgor, moist mucous membranes, urine output >30 mL/hr
C. Increased heart rate and low BP
D. Weight loss of 1.5 kg in 24 hours
50.A patient has hypovolemia and low perfusion; lactate is elevated. Which intervention is
highest priority?
A. Begin isotonic fluid resuscitation per protocol and monitor response
B. Restrict fluids to prevent overload
C. Encourage oral water only
D. Start hypertonic saline immediately without orders
🧾 ANSWER KEY
1. B
2. C
3. B
4. B
5. B
6. B
7. A
8. B
9. A
10.A
11.B
12.B
13.B
14.A
15.C
16.B
17.B
18.B
19.A
20.B
21.B
22.B
23.C
24.B
25.B
26.B
27.B
28.A
29.B
30.C
31.C
32.B
33.A
34.A
35.B
36.B
37.C
38.B
39.C
40.B
41.A
42.B
43.B
44.A
45.B
46.A
47.B
48.B
49.B
50.A
Would you like this same randomized exam exported as a printable PDF (two pages —
questions and separate answer key), or would you like a quiz-only version (no answers) for
classroom use?