Electrolytes NCLEX Questions with Rationale

NCLEX RN Practice Questions cover various areas, such as pharmacology, medical-surgical nursing, pediatric care, and mental health.

NCLEX Electrolytes Questions - NCLEX Questions on Electrolytes

Electrolytes NCLEX Questions Test Strategies

ION	Normal Serum Concentration In mEq/L or mg/dL
1. Sodium	135 to 145
2. Potassium	3.5 to 5.0
3. Calcium	9 to 10.5
4. Magnesium	1.3 to 2.1
5. Phosphorus	3 to 4.5

Summary EKG Changes with electrolyte imbalance

Electrolyte Imbalance	EKG interpretation
1. Hypokalemia	ST depression with inverted and flat T wave, see for prominent U wave
2. Hyperkalemia	Tall T waves, flat P waves, Widened PR and QRS
3. Hypocalcemia	Wide ST and QT interval
4. Hypercalcemia	Short ST with wide T
5. Hypomagnesemia	Depressed ST w ith tall T
6. Hypermagnesemia	Wide QRS and PR

 

1. Potassium shouldn't be given intramuscular, IV push or subcutaneous.
2. A nurse should access renal functions, cardiovascular, neuromuscular, gastrointestinal, respiratory and heart condition before administrating any electrolyte. 
3. In case of any increase in serum electrolyte, we give diuretics. Care should be taken not to give potassium sparing diuretics in Hyperkalemia or Give Osmotic diuretics in case of Hypernatremia.
4. See for the EKG changes in any electrolyte imbalances.
5. There is an inverse relation with the serum concentration of calcium and phosphorous, whenever, calcium level is low, phosphorus level is high and vise-versa. So, when taking any nursing management procedures for hypo or hyper calcemia or phosphatemia, you should access the counter electrolye level and condition.
6. Chvostek's sign and Trousseau's sign are the signs of hypocalcemia in which there is muscle spasm.
7. Take care while moving the patients with hypercalcemia as generally in this condition, the calcium is taken from bone and there is chance of fracture.

NGN Case Study:
Patient's History: Mr. Saigrace, a 65-year-old male, was admitted to the hospital with complaints of confusion, muscle weakness, and seizures. His past medical history was significant for high blood pressure and diabetes. He was on diuretic medications for the past few months. On examination, his blood pressure was found to be low and his pulse was weak.

Nurse's Notes: 1/31, Admitted with complaints of confusion, muscle weakness, and seizures.
BP: 90/60 mmHg, Pulse: weak PMH: HTN, DM On diuretic meds 2/1, Sodium level: 125 mEq/L (Hyponatremia) Started on sodium chloride IV infusions. Potassium level: 3.2 mEq/L (Hypokalemia) 

Physician's Order:

1. Sodium chloride IV infusion
2. Monitor electrolyte levels
3. Reduce dose of diuretic medication
4. Dietary restriction of sodium
5. Lab Values: Sodium: 125 mEq/L Potassium: 3.2 mEq/L 

Question 1. 
What is the most likely cause of the patient's confusion, muscle weakness, and seizures?
(a) Hypertension
(b) Diabetes Mellitus
(c) Hyponatremia
(d) Hypokalemia
(e) Diuretic medication
Answer:
Correct Options: (c) Hyponatremia and (d) Hypokalemia 

Explanation:
(c) Hyponatremia (low sodium levels) is noted in the patient's lab values (125 mEq/L). Symptoms of hyponatremia include confusion, muscle weakness, and seizures, which are also present in the patient.

(d) Hypokalemia (low potassium levels) is also noted in the patient's lab values (3.2 mEq/L) and can cause similar symptoms.

(b) HTN and DM are present in the patient's PMH (past medical history), but are not the immediate cause of the symptoms.

(e) The diuretic medication the patient was on may have contributed to the low electrolyte levels, which is why the physician ordered to reduce the dose of the medication and monitor electrolyte levels. However, the main cause is the low sodium and potassium levels. 

Question 2. 
What is the most likely cause of the patient's hyponatremia and hypokalemia?
(a) Excessive fluid intake
(b) Increased use of diuretics
(c) Kidney disease
(d) Medication side effect
Answer: 
(b) Increased use of diuretics

Explanation:

1. The patient is admitted with symptoms of confusion, muscle weakness, and seizures and has a low blood pressure and weak pulse.
2. The patient has a history of hypertension and diabetes and is on diuretic medication.
3. The sodium level is low (125 mEq/L) and the potassium level is also low (3.2 mEq/L).
4. The physician has ordered a reduction in the dose of diuretic medication and a dietary restriction of sodium.

These factors suggest that the increased use of diuretics is the most likely cause of the patient's hyponatremia and hypokalemia. Option (a) (excessive fluid intake) is not likely since the patient has a low blood pressure and is being monitored for electrolyte levels. Option (c) (kidney disease) may also contribute, but the focus is on reducing the dose of diuretics and dietary restrictions of sodium. Option (d) (medication side effect) is also a possibility, but the focus is on the patient's use of diuretics. 

Question 3. 
What is the correct nursing intervention for the patient with hyponatremia and hypokalemia as noted in the scenario?
(a) Stop sodium chloride IV infusion
(b) Increase dose of diuretic medication
(c) No dietary restriction of sodium
(d) Monitor fluid intake and output
Answer:
(d) Monitor fluid intake and output

Explanation: 
(a) Stopping the sodium chloride IV infusion would be detrimental to the patient as they are suffering from hyponatremia, which is a low level of sodium in the blood. Sodium chloride infusion is necessary to replenish the sodium levels.

(b) Increasing the dose of diuretic medication would further lower the potassium levels, as diuretics increase urine output and can result in the loss of potassium and other electrolytes.

(c) No dietary restriction of sodium would not be appropriate as the patient is already suffering from hyponatremia, which could be due to excessive sodium intake. The dietary restriction of sodium is necessary to regulate sodium levels.

(d) Monitoring fluid intake and output is important to ensure that the patient is not retaining excess fluid and electrolytes. This will help to regulate the electrolyte levels and prevent further fluctuations. 

Question 4. 
What nursing intervention should be taken for the patient’s electrolyte imbalances?
(a) Increase the dose of diuretic medication
(b) Stop sodium chloride IV infusions
(c) Remove dietary restriction of sodium
(d) Monitor electrolyte levels
Answer:
(d) Monitor electrolyte levels

Explanation: 
The physician has already ordered the appropriate interventions for the patient's electrolyte imbalances including sodium chloride IV infusion, reducing the dose of diuretic medication, and dietaiy restriction of sodium. The most important intervention at this point is to monitor the patient's electrolyte levels to ensure they are improving and within normal range.

Option (a) is incorrect because increasing the dose of diuretic medication may worsen the patient's hyponatremia and hypokalemia. Option (b) is incorrect because stopping the sodium chloride IV infusions may result in further decline of the patient's sodium levels. Option (c) is incorrect because removing the dietary restriction of sodium may lead to further imbalances in the patient's electrolyte levels. 

Question 5. 
What is the nursing intervention for Hyponatremia?
(a) Provide sodium chloride IV infusions
(b) Provide osmotic diuretics
(c) Choose hormone replacement procedure
(d) Reduce the dose of diuretics
Answer:
(a) Provide sodium chloride IV infusions

Explanation: 
If Hyponatremia is due to fluid or blood loss, vomiting or diarrhea, the nursing intervention would be to provide sodium chloride IV infusions. Option (b) is not correct as osmotic diuretics are used in case of excess fluid volume and not in case of Hyponatremia. Option (c) is incorrect as it is only applicable if the cause is Addison's disease. Option (d) is correct only if the cause of Hyponatremia is due to certain medications such as diuretics. 

Question 6. 
What is the nursing intervention for hypokalemia?
(a) Provide sodium chloride IV infusions
(b) Administer diuretics
(c) Supplement dietary potassium sources
(d) Reduce the dose of drugs causing hypokalemia
Answer:
 (c) Supplement dietary potassium sources
 
Explanation: 
Option (a) is incorrect as hypokalemia is not caused by fluid or blood loss and does not require sodium chloride IV infusions.

Option (b) is incorrect as the use of diuretics may further deplete potassium levels.

Option (d) is incorrect as reducing the dose of drugs causing hypokalemia may not be enough to treat the condition and may require additional interventions.

Option (c) is correct as supplementing dietary potassium sources such as bananas, spinach, or other green leafy vegetables can help to raise potassium levels in cases of moderately low potassium levels. However, severe hypokalemic states may require supplemental potassium. 

Electrolytes NCLEX Practice Questions

Question 1.
Mrs. Anita is a 65 year old female with a history of high blood pressure and type 2 diabetes. She was recently hospitalized due to dehydration and low sodium levels. Her sodium levels were measured to be 125 mEq/L. The nurse administers a sodium chloride IV infusion and monitors her vital signs closely. Mrs. Anita experiences no adverse reactions and her sodium levels return to normal range after the infusion.
What is the normal range for sodium levels in the body?
(a) 125-135 mEq/L
(b) 135-145 mEq/L
(c) 145-155 mEq/L
(d) 155-165 mEq/L
Answer: 
(b) 135-145 mEq/L

Rationale: 
The normal range for sodium levels in the body is 135-145 mEq/L. This is necessary for the body to conduct nerve impulses, contract and relax muscles, and maintain the proper balance of water and minerals. 

Explanation: 
Mrs. Anita's sodium levels were measured to be 125 mEq/L, which is below the normal range. This is a condition known as hyponatremia, and can cause symptoms such as seizures, nausea, confusion, restlessness, muscle weakness, and fatigue. In order to correct this, the nurse administered a sodium chloride IV infusion, which helped to bring Mrs. Anita's sodium levels back to the normal range.

Question 2.
Mrs. Anita is a 65 year old woman with a history of kidney disease and hypertension. She has been experiencing symptoms of fatigue, muscle weakness, and irregular heartbeat. Upon examination, it is found that Mrs. Anita's potassium levels are low at 2.8 mEq/L.
What is the most likely cause of Mrs. Anita's low potassium levels?
(a) Excessive potassium intake in diet
(b) Strong physical activity and exercise
(c) Chronic kidney disease and use of certain medications such as diuretics
(d) Exposure to heat and dehydration 
Answer: 
(c) Chronic kidney disease and use of certain medications such as diuretics

Explanation: 
It is important to maintain proper potassium levels in the body as it helps with various bodily functions including fluid balance and regulation of muscle contractions and electrical impulses. Chronic kidney disease and use of certain medications such as diuretics can lead to decreased potassium excretion and result in low potassium levels. It is important for healthcare professionals to identify and address the cause of abnormal potassium levels in order to properly treat the condition.

Rationale: 
The most likely cause of Mrs. Anita's low potassium levels is chronic kidney disease and use of certain medications such as diuretics, as these can lead to decreased potassium excretion. Excessive potassium intake in diet and strong physical activity and exercise would not typically cause low potassium levels, and exposure to heat and dehydration can cause high potassium levels rather than low. 

Question 3.
A 43 year old male patient, Burman, has been admitted to the hospital for dehydration due to diarrhea. The nurse checks his vital signs and notices that his sodium level is low, at 130 mEq/L. The nurse also notes that Burman has a history of using diuretics for hypertension.
Question 3 What is the most appropriate nursing intervention for Burman's low sodium levels?
(a) Administer osmotic diuretics
(b) Administer non-osmotic diuretics
(c) Provide sodium chloride IV infusions
(d) Reduce the dose of Burman's diuretics
Answer: 
(c) Provide sodium chloride IV infusions 

Rationale:
The nurse should provide sodium chloride IV infusions to Burman as his low sodium levels are due to fluid loss from diarrhea. Osmotic diuretics would not be appropriate as they are used for excess fluid volume, and non-osmotic diuretics would only further promote sodium excretion. Reducing the dose of Burman's diuretics may not be enough to correct his low sodium levels.

Question 4.
Mrs. Prasanna is a 65 year old female with a history of hypertension and type 2 diabetes. She was admitted to the hospital for uncontrolled blood sugar levels and dehydration. During her stay, the nursing staff noticed that her sodium levels were consistently low and her potassium levels were consistently high. The nursing staff implemented a low sodium diet and administered diuretics to help decrease the potassium levels. However, Mrs. Prasanna's electrolyte levels remained abnormal despite these interventions. Further investigation revealed that Mrs. Prasanna had been taking a potassium-sparing diuretic for her hypertension without realizing the potential for electrolyte imbalances.
What is the most likely cause of Mrs. Prasanna's abnormal electrolyte levels?
(a) A low sodium diet
(b) A high potassium diet
(c) The use of diuretics
(d) A history of type 2 diabetes
Answer: 
(c) The use of diuretics

Rationale: 
The most likely cause of Mrs. Prasanna's abnormal electrolyte levels is the use of diuretics, specifically a potassium-sparing diuretic. While Mrs. Prasanna's low sodium levels and high potassium levels may have been exacerbated by a low sodium diet and uncontrolled diabetes, the use of a potassium-sparing diuretic would have contributed to the abnormal levels by preventing the excretion of potassium in the urine.

Question 5.
Mrs. Kiara is a 63 year old woman who has been experiencing muscle weakness, fatigue, and seizures. Upon examination, her sodium levels were found to be 125 mEq/L. She has a history of heart disease and is currently taking loop diuretics for her congestive heart failure.
What is the most likely cause of Mrs. Kiara's hyponatremia?
(a) High sodium intake in diet
(b) High level of sodium excretion due to diarrhea
(c) Low sodium intake or sodium reabsorption in kidney disease
(d) Use of loop diuretics
Answer: 
(d) Use of loop diuretics

Explanation: 
Loop diuretics, such as the ones Mrs. Kiara is taking, can cause hyponatremia by promoting the excretion of sodium and water from the body. Other causes of hyponatremia include high levels of sodium excretion due to diarrhea, vomiting, or diuresis; low sodium intake or reabsorption in kidney disease; and certain medications and diseases, such as Addison's disease and hypothyroidism. It is important for healthcare providers to carefully monitor electrolyte levels and adjust treatment accordingly in order to prevent imbalances and complications. 

Rationale: 
Mrs. Kiara's hyponatremia is likely caused by her use of loop diuretics, which promotes sodium excretion. Option A is incorrect because there is no mention of high sodium intake in the case study. Option B is incorrect because there is no mention of diarrhea in the case study. Option C is incorrect because there is no mention of kidney disease in the case study.

Question 6.
Mr. A is a 40-year-old male who has been experiencing symptoms of fatigue, muscle weakness, and irregular heartbeat. His blood work reveals that he has hypokalemia with a potassium level of 2.8 mEq/L. The patient has a history of diarrhea and has been taking loop diuretics for his hypertension. He has also been experiencing nausea and vomiting for the past few days.
Which of the following is NOT a cause of hypokalemia?
(a) High levels of sodium excretion
(b) Low sodium intake or sodium reabsorption in kidney diseases
(c) Addison's disease
(d) Increased physical activity
Answer: 
(d) Increased physical activity

Rationale: 
Increased physical activity is not a cause of hypokalemia Causes of hypokalemia include high levels of sodium excretion due to diarrhea, diuresis, or excessive diaphoresis; low sodium intake or sodium reabsorption in kidney diseases; Addison's disease; and certain medications like loop diuretics which reject sodium and water from the body.

Question 7.
Mrs. Kiara is a 63 year old woman with a history of high blood pressure and heart disease. She has been prescribed diuretics for the past year to help control her blood pressure. Recently, Mrs. Kiara has been experiencing symptoms such as muscle weakness, fatigue, and confusion. Upon admission to the hospital, her laboratory results show a sodium level of 128 mEq/L and a potassium level of 2.5 mEq/L.
Which of the following is the most appropriate nursing intervention for Mrs. Kiara's hyponatremia and hypokalemia?
(a) Administering diuretics
(b) Providing sodium chloride IV infusions
(c) Reducing the dose or eliminating the use of diuretics
(d) Providing osmotic diuretics
Answer: 
(c) Reducing the dose or eliminating the use of diuretics 

Rationale: 
Mrs. Kiara's hyponatremia and hypokalemia are likely due to the use of diuretics, which promote the excretion of sodium and potassium from the body. The most appropriate nursing intervention in this case would be to reduce the dose or eliminate the use of diuretics in order to allow Mrs. Kiara's electrolyte levels to return to normal. 

Administering diuretics or providing sodium chloride IV infusions would only further exacerbate the electrolyte imbalances, while providing osmotic diuretics would not be effective in increasing sodium excretion.

Question 8.
Mrs. Kiara is a 65 year old woman with a history of hyperparathyroidism. She presents to the hospital with complaints of weakness and fatigue. Upon examination, her serum calcium levels are found to be 12.5 mg/dL.
What is the most likely diagnosis for Mrs. Kiara?
(a) Hypocalcemia
(b) Hypercalcemia
(c) Hypomagnesemia
(d) Hypermagnesemia
Answer:
(b) Hypercalcemia

Explanation: 
Hypercalcemia is characterized by an excess of calcium in the blood, typically due to an underlying medical condition such as hyperparathyroidism or hyperthyroidism. Mrs. Kiara's history of hyperparathyroidism is a known risk factor for hypercalcemia, further supporting the diagnosis. Hypocalcemia, hypomagnesemia, and hypermagnesemia are all characterized by abnormal levels of electrolytes, but they do not fit the given presentation of Mrs. Kiara's symptoms and laboratory values.

Rationale: 
The normal range for serum calcium levels is 9-10.5 mg/dL. Mrs. Kiara's serum calcium levels are found to be 12.5 mg/dL, which is above the normal range. This indicates a diagnosis of hypercalcemia. 

Question 9.
Mrs. Anita is a 61 year old woman with a history of hypertension and hyperthyroidism. She was recently admitted to the hospital with symptoms of weakness, tremors, and palpitations. Upon examination, the healthcare team found that Mrs. Anita's serum calcium level was 12.5 mg/dL.
What is the most likely diagnosis for Mrs. Anita based on her serum calcium level?
(a) Hypocalcemia
(b) Hypercalcemia
(c) Hypomagnesemia
(d) Hypermagnesemia
Answer: 
(b) Hypercalcemia

Explanation: 
The other options, A. Hypocalcemia, C. Hypomagnesemia, and D. Hypermagnesemia, are all incorrect because they refer to low levels of calcium, magnesium, and magnesium, respectively. Mrs. Anita's serum calcium level is elevated, not low, indicating hypercalcemia rather.

Rationale: 
Mrs. Anita's serum calcium level of 12.5 mg/dL is above the normal range of 9-10.5 mg/dL, indicating a diagnosis of hypercalcemia. The causes of hypercalcemia may include hyperparathyroidism, hyperthyroidism, certain kidney diseases, or certain drugs such as glucocorticoids or lithium.

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