Fluid Volume Deficit and Excess Practice Questions
23 free Fluid Volume Deficit and Excess practice questions for the NCLEX Exam. Tap an option to answer — you get instant feedback, the correct answer, and a detailed explanation for every question.
A patient with continuous vomiting and diarrhea is most likely to exhibit which of the following assessment findings?
- A Jugular venous distention at rest
- B Bounding peripheral pulses
- C Dry mucous membranes, orthostatic hypotension
- D Dependent peripheral edema
Correct answer: Dry mucous membranes, orthostatic hypotension
Vomiting and diarrhea cause fluid losses leading to intravascular volume decrease, resulting in dry mucous membranes and orthostatic hypotension, signs of fluid volume deficit.
Which laboratory finding would you expect in a patient with fluid volume excess (isotonic expansion)?
- A Elevated hematocrit and elevated BUN
- B Decreased hematocrit and decreased BUN
- C High sodium and increased urine specific gravity
- D Increased serum osmolality and elevated sodium
Correct answer: Decreased hematocrit and decreased BUN
In isotonic fluid overload, there is dilution of blood components leading to a decrease in hematocrit and BUN.
Which of the following is a late sign of fluid volume excess?
- A Mild gradual weight gain over days
- B Bounding peripheral pulses on palpation
- C Pulmonary edema with pink frothy sputum
- D Slight dependent peripheral edema
Correct answer: Pulmonary edema with pink frothy sputum
Pulmonary edema with pink frothy sputum is a serious, late manifestation of fluid overload; early signs include mild edema and weight gain.
In managing a patient with hypervolemia, which nursing action should the nurse implement?
- A Encourage a high-sodium daily diet
- B Weigh the patient daily on the same scale
- C Increase the rate of isotonic IV fluids
- D Keep the head of the bed flat continuously
Correct answer: Weigh the patient daily on the same scale
Daily weights are key to monitoring fluid retention; consistency in scale, time, and clothing enhances accuracy in fluid overload management.
Which of the following patients is at highest risk for fluid volume deficit?
- A A patient with kidney failure retaining sodium and water
- B A patient on high-dose diuretic therapy with vomiting
- C A patient with cirrhosis and ascites
- D A patient with heart failure and dependent edema
Correct answer: A patient on high-dose diuretic therapy with vomiting
Vomiting along with diuretic therapy leads to fluid loss and the risk of hypovolemia; the other scenarios are more associated with fluid volume excess.
Which of the following is an appropriate indicator that fluid volume deficit is resolving?
- A Serum sodium climbs to 155 mEq/L
- B Skin turgor still shows tenting
- C Urine output > 30 mL/hr with stable BP
- D Patient gains 3 kg over 24 hours
Correct answer: Urine output > 30 mL/hr with stable BP
Adequate urine output and stable blood pressure suggest the restoration of intravascular volume, indicating resolution of fluid volume deficit.
A nurse is caring for a patient with severe burns. The nurse expects the patient to be at risk for:
- A Fluid volume excess from sodium retention
- B Fluid volume deficit with third-spacing of fluid
- C Hypernatremia without any volume change
- D Isotonic overload from capillary refilling
Correct answer: Fluid volume deficit with third-spacing of fluid
Severe burns can damage capillaries leading to fluid shifting into the interstitial space (third spacing) and intravascular volume deficit even with overall fluid increase.
A patient has low blood pressure, tachycardia, dry mucous membranes, and increased urine specific gravity. Which solution will most likely be ordered?
- A 0.45% saline (hypotonic)
- B 5% dextrose in water
- C 0.9% saline (isotonic)
- D 3% saline (hypertonic)
Correct answer: 0.9% saline (isotonic)
Signs indicate intravascular volume loss (hypovolemia); an isotonic solution is likely to be ordered for safe intravascular volume expansion.
A nurse is monitoring a patient with Congestive heart failure and notes a gain of 2 kg in 24 hours, bilateral crackles on auscultation, and jugular venous distention. These findings are most consistent with:
- A Fluid volume deficit
- B Dehydration
- C Fluid volume excess
- D Hypovolemia
Correct answer: Fluid volume excess
Rapid weight gain, crackles, and JVD are indicative of fluid retention and overload, specifically fluid volume excess.
A patient receiving large volumes of isotonic IV fluids without monitoring develops crackles, JVD, and weight gain. Which mechanism explains this?
- A Excessive fluid shifted from intracellular to interstitial compartment
- B Excessive isotonic fluid increased intravascular volume → overload
- C Excessive hypotonic fluid caused intracellular volume expansion
- D Fluid loss into third space caused intravascular depletion
Correct answer: Excessive isotonic fluid increased intravascular volume → overload
Administering large amounts of isotonic fluid can increase intravascular volume and cause hypervolemia if regulatory mechanisms are overwhelmed.
Which statement by a patient indicates understanding of teaching about managing fluid volume excess at home?
- A I will weigh myself once a week to check for fluid retention.
- B I will call my doctor if I gain more than 0.5 kg (1.1 lb) in one day.
- C I can drink as much fluid as I like because the excess will just shift compartments.
- D I should increase salt intake to prevent losing fluid.
Correct answer: I will call my doctor if I gain more than 0.5 kg (1.1 lb) in one day.
Monitoring weight daily for a gain of more than 0.5 kg is crucial in recognizing fluid retention and need for prompt medical attention.
A nurse is monitoring a patient with Congestive heart failure and notes a gain of 2 kg in 24 hours, bilateral crackles on auscultation and jugular venous distention. These findings are most consistent with:
- A Fluid volume deficit
- B Dehydration
- C Fluid volume excess
- D Hypovolemia
Correct answer: Fluid volume excess
Rapid weight gain, crackles, JVD indicate fluid retention and overload (hypervolemia or fluid volume excess).
A patient with fluid volume deficit is most at risk for which complication?
- A Acute pulmonary edema
- B Third-spacing of fluids
- C Sustained hypertension
- D Rapid daily weight gain
Correct answer: Third-spacing of fluids
In fluid volume deficit, fluid may shift to interstitial/third spaces (e.g., burns, ascites) further decreasing intravascular volume.
The primary nursing intervention for a patient in hypovolemia is:
- A Restrict all oral fluids
- B Administer prescribed isotonic IV fluids
- C Administer hypertonic saline immediately
- D Elevate the head of bed to 60°
Correct answer: Administer prescribed isotonic IV fluids
In fluid volume deficit (hypovolemia), the goal is to restore intravascular fluid volume, often with isotonic IV solutions like 0.9% NS.
A nurse notes that a patient’s urine output is 20 mL/hr for 3 hours, skin turgor is tenting, and capillary refill is 4 seconds. These findings are most indicative of:
- A Fluid volume excess
- B Balanced fluid status
- C Fluid volume deficit
- D SIADH-related water intoxication
Correct answer: Fluid volume deficit
Low urine output, poor skin turgor, prolonged capillary refill suggest decreased circulating volume and fluid deficit.
A patient has low blood pressure, tachycardia, dry mucous membranes and increased urine specific gravity. Which solution will most likely be ordered?
- A 0.45% saline (hypotonic)
- B 5% dextrose in water
- C 0.9% saline (isotonic)
- D 3% saline (hypertonic)
Correct answer: 0.9% saline (isotonic)
Signs indicate intravascular volume loss (hypovolemia); an isotonic solution expands intravascular volume safely. Hypotonic/hypertonic are inappropriate for pure volume replacement.
A patient receiving large volumes of isotonic IV fluids without monitoring develops crackles, JVD and weight gain. Which mechanism explains this?
- A Excessive fluid shifted from intracellular to interstitial compartment
- B Excessive isotonic fluid increased intravascular volume → overload
- C Excessive hypotonic fluid caused intracellular volume expansion
- D Fluid loss into third space caused intravascular depletion
Correct answer: Excessive isotonic fluid increased intravascular volume → overload
Administering large amounts of isotonic fluid increases intravascular volume and can cause hypervolemia if regulatory mechanisms are overwhelmed.
A patient with advanced Chronic kidney disease is showing periorbital edema, ascites, and a hematocrit that has dropped from 40 % to 30 % over a week. What is most likely happening?
- A Dehydration from excess renal losses
- B Fluid volume excess from impaired excretion
- C Hypotonic dehydration from water loss
- D Corrected anemia following dialysis
Correct answer: Fluid volume excess from impaired excretion
CKD impairs fluid excretion → fluid retention → extracellular fluid expansion leading to edema, ascites, hemodilution (hematocrit drop).
During assessment of a patient with suspected fluid volume excess, which vital sign and finding pair should the nurse expect?
- A Hypotension and weak, thready pulse
- B Hypertension and bounding pulse
- C Bradycardia and dry skin
- D Tachycardia and flat neck veins
Correct answer: Hypertension and bounding pulse
Fluid volume excess increases circulating volume → increased BP and bounding (strong) pulse; in deficit you’d see hypotension and weak thready pulse.
A patient with fluid volume deficit is getting 0.9% saline. The nurse should monitor for which potentially adverse outcome?
- A Hyponatremia from sodium dilution
- B Fluid overload if infused too quickly
- C Hyperkalemia from potassium shift
- D Pulmonary embolism from venous stasis
Correct answer: Fluid overload if infused too quickly
Even isotonic fluid, if given too fast or in excess, can result in fluid volume overload (hypervolemia) especially if cardiac/renal function is compromised.
Which of the following is a key difference between dehydration and fluid volume deficit?
- A Dehydration is water loss only; fluid volume deficit is water and solute loss
- B The two terms are identical and fully interchangeable
- C Fluid volume deficit occurs only with kidney failure
- D Dehydration reliably leads to fluid volume excess
Correct answer: Dehydration is water loss only; fluid volume deficit is water and solute loss
Dehydration refers to loss of free water (often increases serum sodium); fluid volume deficit (hypovolemia) refers to loss of both water and electrolytes from extracellular fluid.
A patient has a serum sodium of 120 mEq/L, decreased urine output, and swollen hands and ankles. The nurse interprets this as:
- A Hypernatremia secondary to acute fluid loss
- B Dilutional hyponatremia from fluid volume excess
- C Isotonic dehydration with normal serum osmolality
- D Hypovolemia caused by excessive sodium loss
Correct answer: Dilutional hyponatremia from fluid volume excess
Low serum sodium with edema suggests dilution from excess fluid (fluid volume excess) rather than volume deficit.
A nurse is caring for a patient with ascites and peripheral edema due to liver cirrhosis. Which of the following interventions is most appropriate?
- A Encourage a liberal dietary sodium intake daily
- B Administer a rapid IV hypotonic saline bolus
- C Restrict sodium and fluids; give diuretics as ordered
- D Increase oral free-water intake to dilute serum
Correct answer: Restrict sodium and fluids; give diuretics as ordered
In fluid volume excess from liver cirrhosis, limiting sodium/fluid and using diuretics helps reduce retention and tissue edema/ascites.