Ch. 24 fluid and electrolyte
The person at highest risk for developing hypernatremia is a person who
receives tube feedings because he or she is comatose after a stroke.
Clinical manifestations of extracellular fluid volume deficit include
weak pulse, low blood pressure, and increased heart rate.
Clinical manifestations of hyponatremia include
confusion, lethargy, coma, and perhaps seizures.
What age group has a larger volume of extracellular fluid than intracellular fluid?
Infants
How do clinical conditions that increase vascular permeability cause edema?
By allowing plasma proteins to leak into the interstitial fluid, which draws in excess fluid by increasing the interstitial fluid osmotic pressure
Which alteration can lead to edema?
Decreased lymphatic flow
Hyperaldosteronism causes
ECV excess and hypokalemia. Hyperaldosteronism causes excessive renal retention of sodium and water and excessive potassium excretion, which lead to ECV excess and hypokalemia
Which event is likely to lead to hyponatremia?
Frequent nasogastric tube irrigation with water
What is the most likely explanation for a diagnosis of hypernatremia in an elderly patient receiving tube feeding?
Inadequate water intake
A patient diagnosed with chronic compensated heart failure reports that, ―My feet swell if I eat salt but I don't understand why.‖ The nurse's best response is:
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.‖
How is a patient hospitalized with a malignant tumor that secretes parathyroid hormone monitored for the resulting electrolyte imbalance?
Serum calcium, bowel function, level of consciousness Parathyroid hormone increases the plasma calcium concentration, and constipation and lethargy are manifestations of hypercalcemia.
Which change in a patient's assessment has the greatest urgency?
Serum potassium concentration is increasing; has developed cardiac dysrhythmias, but denies any difficulty breathing.
A patient, who is 8 months pregnant has developed eclampsia and is receiving intravenous magnesium sulfate to prevent seizures. To determine if her infusion rate is too high, you should regularly assess which of the following?
The Chvostek sign.
Which electrolyte imbalances cause increased neuromuscular excitability?
Which electrolyte imbalances cause increased neuromuscular excitability?
Effects of hypernatremia on the central nervous system typically include
a. confusion.
An increase in the resting membrane potential (hyperpolarized) is associated with
a. hypokalemia.
The electrolyte that has a higher concentration in the extracellular fluid than in the intracellular fluid is _ ions.
a. sodium
Signs and symptoms of extracellular fluid volume excess include
bounding pulse.
Abnormalities in intracellular regulation of enzyme activity and cellular production of ATP are associated with
c. hypophosphatemia.
A person who overuses magnesium-aluminum antacids for a long period of time is likely to develop
c. hypophosphatemia. Antacid overuse for a long time can cause hypophosphatemia by binding phosphate in the gastrointestinal tract and preventing its absorption.
A known cause of hypokalemia is
c. insulin overdose.
The inward-pulling force of particles in the vascular fluid is called pressure.
capillary osmotic
Causes of hypomagnesemia include
chronic alcoholism.
A person who has hyperparathyroidism is likely to develop
d. hypercalcemia.
A patient has a positive Chvostek sign. The nurse interprets this as a sign of
d. increased neuromuscular excitability.
Hypernatremia may be caused by
decreased antidiuretic hormone secretion. Decreased antidiuretic hormone secretion (diabetes insipidus) prevents water reabsorption in the kidneys, which creates large volumes of dilute urine and causes hypernatremia.
Excessive antidiuretic hormone (ADH) secretion can cause _ concentration.
decreased serum sodium
Signs and symptoms of clinical dehydration include
decreased urine output.
Clinical manifestations of severe symptomatic hypophosphatemia are caused by
deficiency of ATP.
The nurse provides teaching regarding dietary intake of potassium to avoid an electrolyte imbalance when a patient
has chronic heart failure that is treated with diuretics.
Decreased neuromuscular excitability is often the result of
hypercalcemia and hypermagnesemia.
The imbalance that occurs with oliguric renal failure is
hyperkalemia.
Clinical manifestations of moderate to severe hypokalemia include
muscle weakness and cardiac dysrhythmias.
The process responsible for distribution of fluid between the interstitial and intracellular compartments is
osmosis.
Osmoreceptors located in the hypothalamus control the release of
vasopressin (antidiuretic hormone, ADH).
