Pathophysiology Online Module 13: Fluid, Electrolyte Imbalances Tests

What is the mechanism by which the sodium-potassium pump operates? a. Passive diffusion b. Active transport c. Facilitated diffusion d. Osmosis

b. Active transport

Which disorder causes hypomagnesemia? a. Hyperphosphatemia b. Chronic alcoholism c. Oliguric renal failure d. Clinical dehydration

b. Chronic alcoholism

Which situation causes hypernatremia? a. Decreased aldosterone secretion b. Decreased antidiuretic hormone secretion c. Compulsive water drinking d. Excessive dietary potassium

b. Decreased antidiuretic hormone secretion

Excessive antidiuretic hormone (ADH) secretion can cause what changes in electrolyte concentration? a. Increased serum sodium concentration b. Decreased serum sodium concentration c. Increased serum potassium concentration d. Decreased serum potassium concentration

b. Decreased serum sodium concentration

Hyperaldosteronism causes what imbalance(s)? a. ECV deficit and hyperkalemia b. ECV excess and hypokalemia c. Hyponatremia and hyperkalemia d. Excessive water reabsorption without affecting sodium concentration

b. ECV excess and hypokalemia

Which imbalance occurs with oliguric renal failure? a. Metabolic alkalosis b. Hyperkalemia c. Hypokalemia d. Hypophosphatemia

b. Hyperkalemia

What are the principal components of cell membranes? a. Proteins and ions b. Lipids and proteins c. Water and collagen d. Collagen and lipids

b. Lipids and proteins

Which individual is at highest risk for developing hypernatremia? a. Mr. W, who self-administers a daily tap-water enema to manage a partial bowel obstruction b. Mr. X, who receives tube feedings because he is comatose after a stroke c. Mr. Y, who has ectopic production of ADH from small cell carcinoma of the lung d. Mr. Z, who is receiving IV 0.9% NaCl at a fast rate

b. Mr. X, who receives tube feedings because he is comatose after a stroke

What are the clinical manifestations of moderate to severe hypokalemia? a. Muscle spasms and rapid respirations b. Muscle weakness and cardiac dysrhythmias c. Confusion and irritability d. Vomiting and diarrhea

b. Muscle weakness and cardiac dysrhythmias

Which process is responsible for distribution of fluid between the interstitial and intracellular compartments? a. Filtration b. Osmosis c. Active transport d. Diffusion

b. Osmosis

Mrs. Gunro, who is 8 months pregnant, has developed eclampsia and is receiving intravenous magnesium sulfate to prevent seizures. What assessment should you perform regularly to determine if her infusion rate is too high? a. Patellar reflex; if it becomes more and more hyperactive, her infusion rate probably is too high and she is at risk for respiratory depression or cardiac arrest. b. Patellar reflex; if it becomes weak or absent, her infusion rate probably is too high and she is at risk for respiratory depression or cardiac arrest. c. Patellar reflex; if it stays the same, her infusion rate probably is too high and she is at risk for respiratory depression or cardiac arrest. d. Watch for seizure activity. If no seizures occur, her infusion rate is correct.

b. Patellar reflex; if it becomes weak or absent, her infusion rate probably is too high and she is at risk for respiratory depression or cardiac arrest.

Ms. Cancer is hospitalized with a malignant tumor that secretes parathyroid hormone-related peptide. How should you monitor for the resulting electrolyte imbalance? a. Serum calcium, Chvostek and Trousseau signs b. Serum calcium, bowel function, level of consciousness c. Serum potassium, Chvostek and Trousseau signs d. Serum potassium, bowel function, level of consciousness

b. Serum calcium, bowel function, level of consciousness

In which direction(s) does the sodium-potassium pump move sodium and potassium ions? a. Sodium into the cell and potassium out of the cell b. Sodium out of the cell and potassium into the cell c. Both sodium and potassium out of the cell d. Both sodium and potassium into the cell

b. Sodium out of the cell and potassium into the cell

What term describes a fluid when the pH of the fluid increases? a. acidic b. alkaline c. toxic d. concentrated

b. alkaline

When sodium channels open in the plasma membrane of a neuron, what process is initiated? a. inhibition b. depolarization c. repolarization d. hyperpolarization

b. depolarization

To generate an action potential, a nerve or muscle cell must reach what state? a. resting membrane potential b. threshold potential c. hyperpolarization d. 0 mV

b. threshold potential

What fraction of total body water (TBW) volume is contained in the intracellular compartment in adults? a. Three fourths b. Two thirds c. One half d. One third

b. two thirds

What is one of the signs and symptoms of extracellular fluid volume excess? a. Tachycardia b. Increased serum sodium concentration c. Bounding pulse d. Increased hematocrit

c. Bounding pulse

What is necessary for facilitated diffusion to occur? a. Carrier proteins in the plasma membrane b. Energy in the form of ATP c. Microtubules in the cytoplasm d. Vesicles for endocytosis

a. Carrier proteins in the plasma membrane

What is the typical effect of hypernatremia on the central nervous system? a. Confusion b. Excitation c. Insomnia d. Hallucinations

a. Confusion

Which manifestation is one of the signs and symptoms of clinical dehydration? a. Decreased urine output b. Increased skin turgor c. Increased blood pressure d. Decreased heart rate

a. Decreased urine output

"My feet swell if I eat salt," says Mr. Cor, who has chronic compensated heart failure, "so I stopped eating it like my nurse practitioner said, but I do not understand how salt causes swelling." Choose the best response. a. Salt holds water in your blood and makes more pressure against your blood vessels, so fluid leaks out into your tissues and makes them swell. b. Gravity makes more pressure down by your feet than up at the top of your body, so more fluid leaks into your tissues at your feet and they swell. c. Salt makes your blood vessels relax and the blood does not flow as fast, so some of it leaks into your tissues and makes swelling. d. Salt binds to the proteins in your blood and changes the osmotic pressure so more fluid can leak out and stay in the tissues, causing swelling.

a. Salt holds water in your blood and makes more pressure against your blood vessels, so fluid leaks out into your tissues and makes them swell.

What are the clinical manifestations of extracellular fluid volume deficit? a. Weak pulse, low blood pressure, and increased heart rate b. Thirst, dry mucous membranes, and diarrhea c. Confusion, lethargy, coma, and perhaps seizures d. Cardiac dysrhythmias, paresthesias, and muscle weakness

a. Weak pulse, low blood pressure, and increased heart rate

What is an ion? a. a charged particle b. the end product of a chemical reaction c. an acid d. sodium

a. a charged particle

What age group has a larger volume of extracellular fluid than intracellular fluid? a. Infants b. Adolescents c. Young adults d. Older adults

a. infants

Which ion has a higher concentration in the extracellular fluid than in the intracellular fluid? a. Sodium ions b. Phosphate ions c. Magnesium ions d. Potassium ions

a. sodium ions

What are the clinical manifestations of hyponatremia? a. Weak pulse, low blood pressure, and increased heart rate b. Thirst, dry mucous membranes, and diarrhea c. Confusion, lethargy, coma, and perhaps seizures d. Cardiac dysrhythmias, paresthesias, and muscle weakness

c. Confusion, lethargy, coma, and perhaps seizures

How is total body water (TBW) in older adults different from TBW in young adults? a. Increased due to decreased adipose tissue and decreased bone mass b. Increased due to decreased renal function and hormonal fluctuations c. Decreased due to increased adipose tissue and decreased muscle mass d. Decreased due to renal changes that cause diuresis with sodium excretion

c. Decreased due to increased adipose tissue and decreased muscle mass

Which alteration in capillary dynamics can lead to edema? a. Decreased capillary hydrostatic pressure b. Increased capillary colloid osmotic pressure c. Decreased lymphatic flow d. Decreased capillary membrane permeability

c. Decreased lymphatic flow

Mrs. Frisioni has drainage from an intestinal fistula that is being managed at home while it heals. You are the home health nurse who changes the dressing. Today she is already lying down when you arrive, saying that she feels "weak and dizzy" when she stands. Her supine blood pressure is 92/70, heart rate 78. When she sits up, she slumps sideways and is temporarily unresponsive while you are deflating the blood pressure cuff. You could read only the systolic pressure, which was 77, before she fell sideways and you could tell that her heart rate was very fast while you were deflating the cuff. She has regained consciousness now that she is lying down. What should you do before you telephone her physician or nurse practitioner? Why? a. Sit her up again, with proper support, so you can have an accurate upright blood pressure and heart rate to report. b. Give her a drink of water or juice, talk with her to calm her down, and ask if she slept well last night. c. Give her water or juice and some salty crackers and ask if she has had any diarrhea and vomiting. d. Assess small vein filling time, look for ankle edema, and ask if she had any fluid to drink yet today.

c. Give her water or juice and some salty crackers and ask if she has had any diarrhea and vomiting.

Which two electrolyte imbalances cause increased neuromuscular excitability? a. Hypokalemia and hyperphosphatemia b. Hyperkalemia and hypophosphatemia c. Hypocalcemia and hypomagnesemia d. Hypercalcemia and hypermagnesemia

c. Hypocalcemia and hypomagnesemia

Which condition can cause hypokalemia? a. Oliguric renal failure b. Pancreatitis c. Insulin overdose d. Hyperparathyroidism

c. Insulin overdose

Which person needs teaching regarding increasing dietary intake of potassium to help prevent or manage an electrolyte imbalance for which she has high risk? a. Mrs. A, who has advanced breast cancer and takes very large doses of vitamin D in hopes of a cancer cure b. Mrs. B, who has fatty stools from taking an OTC weight-loss product that decreases absorption of fat c. Mrs. C, who has chronic heart failure that is treated with diuretics d. Mrs. D, who has anorexia and chronic oliguric renal failure

c. Mrs. C, who has chronic heart failure that is treated with diuretics

Which individual should you monitor most carefully for development of metabolic acidosis? a. Mr. A, who is in the diuretic phase of acute renal failure b. Mr. B, who has had hypokalemia for over a week c. Ms. C, who has had diarrhea for over a week d. Ms. D, who has newly diagnosed Cushing syndrome

c. Ms. C, who has had diarrhea for over a week

What useful purpose does an ion channel serve? a. Prevent ions from crossing a membrane b. Prevent ions from leaving a membrane once they have entered it c. Transport ions across a membrane down an electrochemical gradient d. Transport ions across a membrane against an electrochemical gradient

c. Transport ions across a membrane down an electrochemical gradient

What is the major buffer in the extracellular fluid? a. Hemoglobin b. Albumin c. Bicarbonate d. Phosphate

c. bicarbonate

Which term indicates the inward-pulling force of particles in the vascular fluid? a. Capillary hydrostatic pressure b. Interstitial osmotic pressure c. Capillary osmotic pressure d. Interstitial hydrostatic pressure

c. capillary osmotic pressure

What causes the clinical manifestations of severe symptomatic hypophosphatemia? a. Excess proteins b. Renal damage c. Deficiency of ATP d. Hypocalcemia

c. deficiency of ATP

A person who overuses magnesium-aluminum antacids for a long period of time is likely to develop which electrolyte imbalance? a. Hypokalemia b. Hyperkalemia c. Hypophosphatemia d. Hyperphosphatemia

c. hypophosphatemia

The resting membrane potential of a cell is determined primarily by the concentration gradient of which ion across the membrane? a. hydrogen b. chloride c. potassium d. sodium

c. potassium

What moves through a membrane during osmosis? a. Sodium ions b. Glucose c. Water d. Any molecule

c. water

How do clinical conditions that increase microvascular permeability cause edema? a. Through altering the negative charge on the capillary basement membrane, which enables excessive fluid to accumulate in the interstitial compartment b. By causing movement of fluid from the vascular compartment into the intracellular compartment, which leads to cell swelling c. Through leakage of vascular fluid into the interstitial fluid, which increases interstitial fluid hydrostatic pressure d. By allowing plasma proteins to leak into the interstitial fluid, which draws in excess fluid by increasing the interstitial fluid osmotic pressure

d. By allowing plasma proteins to leak into the interstitial fluid, which draws in excess fluid by increasing the interstitial fluid osmotic pressure

"My 2-month-old baby is throwing up and has frequent diarrhea," says Mr. Worry over the telephone. "I keep giving him Pedialyte [oral electrolyte replacement solution] like you said, but I am worried that he will get dehydrated and I shall not know it." Choose the best response. a. Clinical dehydration is the combination of extracellular fluid volume deficit and hypernatremia, so those are the diagnostic criteria. b. If he does not wet his diaper all afternoon and his neck veins look flat when he is lying down, then he is probably dehydrated. c. If he sleeps more than usual and acts tired when he is awake, then he is probably dehydrated. d. If the soft spot on the top of his head feels sunken in and his mouth is dry between his cheek and his gums, then he is probably dehydrated.

d. If the soft spot on the top of his head feels sunken in and his mouth is dry between his cheek and his gums, then he is probably dehydrated.

Mr. Thanatos has a positive Chvostek sign. How should you interpret this finding? a. Either hypocalcemia or hypomagnesemia, or both b. Either hypercalcemia or hypermagnesemia, or both c. Either hypokalemia or hyperkalemia d. Increased neuromuscular excitability

d. Increased neuromuscular excitability

What characterizes a semipermeable membrane? a. it has abnormal pores in it b. It prevents movement of all molecules except those that are actively transported. c. It allows particles such as sodium ions to pass freely, but not potassium ions. d. It allows water to pass freely but not particles such as sodium ions.

d. It allows water to pass freely but not particles such as sodium ions.

Your assessment in the middle of your shift reveals the following changes this morning for four of your patients. Which one should you report most urgently to a physician? a. Mrs. A, whose serum potassium concentration is decreasing and has developed abdominal distention but says her breathing is fine. b. Mrs. B, whose serum calcium concentration is decreasing and has developed constipation but is alert and says she feels fine. c. Mrs. C, whose serum calcium concentration is increasing and has developed constipation but is alert and says she feels fine. d. Mrs. D, whose serum potassium concentration is increasing and has developed cardiac dysrhythmias but says her breathing is fine.

d. Mrs. D, whose serum potassium concentration is increasing and has developed cardiac dysrhythmias but says her breathing is fine.

You are volunteering in a remote area after an earthquake. A man was pulled from the wreckage after being trapped in a basement for 3 days. He has no injuries but is dazed and confused. The triage team sends him to you for oral rehydration. As they bring him to you on a stretcher, you see that his neck veins are collapsing every time he inhales. Quick assessment shows that his mouth is very dry and his pulse is weak. You have two fluids available: bottled water and salty soup. Which one should you give him? Why? a. Bottled water because he is so weak that he might choke on the fluid when he swallows and water would be less damaging to the lungs than salty soup. b. Bottled water because it will rehydrate his cells. c. Salty soup because he needs nutrition as well as fluid. d. Salty soup because it will provide some sodium to help hold the fluid in his blood vessels and interstitial fluid.

d. Salty soup because it will provide some sodium to help hold the fluid in his blood vessels and interstitial fluid.

What useful purpose does active transport serve? a. Stabilize molecules as they diffuse in body fluids b. Stabilize molecules in the bloodstream c. Transport molecules across a membrane down a concentration gradient (from an area of high concentration to an area of low concentration) d. Transport molecules across a membrane against a concentration gradient (from an area of low concentration to an area of high concentration)

d. Transport molecules across a membrane against a concentration gradient (from an area of low concentration to an area of high concentration)

The osmolality of a solution describes what characteristic? a. pH b. temperature c. toxicity d. concentration

d. concentration

A person who has hyperparathyroidism is likely to develop which imbalance? a. Hypokalemia b. Hyperkalemia c. Hypocalcemia d. Hypercalcemia

d. hypercalcemia

Which electrolyte is found in higher concentration in the intracellular fluid than in the extracellular fluid? a. sodium b. calcium c. chloride d. potassium

d. potassium