Ch. 8, prep U - fluid/electrolyte, Fluids and electrolytes patho, Porth's Ch 39 Disorders of Fluid and Electrolyte Balance, Module 2: Fluid and Electrolytes / Module 5: Acid Base, Prep U CH.8, Chapter 8 -Exam 1
A client with a diagnosis of liver cirrhosis secondary to alcohol abuse has a distended abdomen as a result of fluid accumulation in his peritoneal cavity (ascites). Which of the following pathophysiologic processes contributes to this third spacing?
Abnormal increase in transcellular fluid volume
Which of the following combinations of ions are most likely to bind, forming molecules?
Anion and cation
Which of the following assessments should be prioritized in the care of a client who is being treated for a serum potassium level of 2.7 mEq/L?
Cardiac monitoring looking for prolonged PR interval and flattening of the T wave
When caring for a patient with hyperkalemia, the nurse prioritizes assessment of which of the following body systems?
Cardiovascular
Diabetes inspibidus (DI)
Caused by deficiency of ADH or a decreased renal response to ADH -Unable to concentrate their urine during periods of water restriction and they exert large volumes of uringe (3-20 L/day) -Large urine out put is accompanied by excessive thirst
In a person with fluid volume deficit, there is a dehydration of brain and nerve cells. What can occur if fluid volume deficit is corrected too rapidly?
Cerebral edema occurs with potentially severe neurologic impairment.
Which of the following is an anion?
Chloride
A client develops interstitial edema as a result of decreased:
Colloidal osmotic pressure
The nurse is caring for a patient who receives hemodialysis. The nurse knows that hemodialysis involves movement of charged or uncharged particles along a concentration gradient. Which of the following best describe this process?
Diffusion
Polydipsia
Excessive thirst
The nurse is caring for a patient with a tumor obstructing the lymphatic system. For which of the following consequences does the nurse assess?
Fluid accumulating in the interstitial spaces distal to the tumor
Hypertonic solution
Has greater osmolality than ICF -They shrink as water is pulled out of the cell
Hypotonic solution
Has lower osmolality than ICF -they will swell as water moves into the cell
The nurse is caring for a patient who takes lithium to manage his bipolar disorder. The nurse carefully observes the patient for which of the following electrolyte imbalance?
Hypercalcemia
A nurse observes peaked, narrow T waves on the electrocardiogram of a patient suffering from renal failure. The nurse suspects that the client is experiencing which of the following conditions?
Hyperkalemia
A nurse is caring for a patient with hypoparathyroidism. Which of the following is a major concern for the patient?
Hypocalcemia
A nurse working on a cardiac unit knows that monitoring magnesium levels is important for which of the following reasons?
Hypomagnesemia causes intracellular potassium depletion, creating risk for cardiac arrhythmias.
A community health nurse who is attending a marathon recognizes which of the following types of hypotonic hyponatremia is likely when a patient reports muscle weakness, cramping, and general fatigue in spite of adequate water hydration during the run?
Hypovolemic
A nurse is caring for a patient whose serum potassium level is 2.6 mEq/L. The nurse anticipates which of the following interventions will be prescribed?
IV infusion of 10 mEq potassium chloride in 100-mL normal saline solution over 1 hour times three doses
The edema of venous thrombosis (thrombophlebitis) is related to which of the following?
Increased capillary pressure
An adult client has the following results of his morning blood work: Potassium: 2.5 mmol/l Sodium: 136 mmol/l Calcium: 2.3 mmol/l Magnesium: 1.01 mmol/l How should the nurse best respond to these values?
Inform the care provider and monitor the client's cardiac status.
A client is brought to the emergency department semicomatose and a blood glucose reading of 673. He is diagnosed with diabetic ketoacidosis (DKA). Blood gas results are as follows: serum pH 7.29 and HCO3− level 19 mEq/dL; PCO2 level 32 mm Hg. The nurse should anticipate that which of the following orders may correct this diabetic ketosis?
Initiating an insulin IV infusion along with fluid replacement
Which of the following interventions is a priority for the nurse when caring for a patient with hypokalemia?
Initiating cardiac monitoring
A female client with a history of chronic renal failure has a total serum calcium level of 7.9 mg/dL. While performing an assessment, the nurse should focus on which of the following clinical manifestations associated with this calcium level?
Intermittent muscle spasms and complaints of numbness around her mouth
Lymph fluid arises directly from which one of the following spaces?
Interstitial
Which one of the following is a cause of osmotic edema?
Low blood levels of albumin
A client tells the nurse that the client has been taking Alka-Seltzer (bicarbonate—antacid) four times a day for the past 2 weeks for an upset stomach. Upon assessment of the client, the nurse notes hyperactive reflexes, tetany, and mental confusion. Arterial blood gases reveal pH 7.55; serum HCO3− 37. The nurse suspects the client may be experiencing:
Metabolic alkalosis
Anions
Negatively charged ions -They are attracted to anode
The nurse is administering a unit of packed red blood cells to a patient and piggybacks the unit of blood through a solution of 0.9% NaCl. Blood cells placed in a solution of 0.9% saline will do which of the following?
Neither shrink nor swell
Insensible water loss
Occur without persons awareness -The water loss that occurs through evaporative losses of skin and moisten the air in respiration system
Pitting edema
Occurs when the accumulation of interstitial fluid exceeds the absorptive capacity of the tissue gel
Hypothalamic sensory neurons that promote thirst when stimulated are called which of the following?
Osmoreceptors
Water movement from the side of the membrane having a lesser number of particles and greater concentration of water to the side having a greater number of particles and lesser concentration of water is termed:
Osmosis
Pressure generated as water moves across a membrane is also known as which of the following?
Osmotic pressure
Vitamin D, officially classified as a vitamin, functions as a hormone in the body. What other hormone is necessary in the body for vitamin D to work?
Parathyroid hormone
nonelectrolytes
Particles that doe not dissociate into ions such as glucose and urea
A nurse is caring for a group of patients. Which one does the nurse plan to monitor for hyperkalemia?
Patient who has been admitted with metabolic acidosis
Cations
Positively charged ions -They are attracted to cathode of a wet electron cell and are
The nurse caring for a bedridden client who has sacral edema plans care to prevent risk from what type of injury?
Pressure ulcers
In isotonic fluid volume deficit, changes in total body water are accompanied by:
Proportionate losses of sodium
Osmolarity
Refers to the osmolar concentration in 1 L of solution (mOsm/L H2O) -Often used when referring to fluids outside the body
tonicity
Refers to the tension or effect that a solution with impermeable solutes exerts on cell size because of water movement across the cell membrane
Syndrome of inappropriate ADH (SIADH)
Results from failure of the negative feedback system that regulates the release and inhibition of ADH -ADH secretion continues even when serum osmolality is decreased, causing marked water retention and dilution hyppnatremia
Isotonic solution
Same effective osmolality as the ICF -Neither shrink or swell -Ex: 0.9% sodium cloride
A nurse caring for a client with a diagnosis of diabetes insipidus (DI) should prioritize the close monitoring of which of the following electrolyte levels?
Sodium
The effective circulating volume is the major regulator of water balance in the body. What else does it regulate?
Sodium
When caring for patients with disorders of sodium balance, the nurse asks the provider which of the following findings are consistent with hypernatremia?
Sodium 158 mEq/L and serum osmolality of 320 mOsm/kg
A nurse is caring for a patient with a low sodium level and increased water retention. Hematocrit and blood urea nitrogen levels are decreased, urine osmolality is high, and serum osmolality is low. A chest x-ray shows a possible lung mass. Based on these findings, which of the following problems could the patient be diagnosed with?
Syndrome of inappropriate antidiuretic hormone (ADH)
Osmosis
The movement of water across a semipermeable membrane
Osmotic pressure
The pressure that is generated as water moves across the semipermeable membrane
obligatory urine output
The urine output that is required to eliminate these wastes
Antidiuretic hormone (ADH)
Vasopressin, controls the reabsorption of water by the kidneys
The nurse is assessing a client with fluid volume excess. The nurse anticipates the client would manifest:
Weight Gain
Nonpitting edema
Which the swollen area becomes firm and discolored, occurs when plasma proteins have accumulated in the tissue space and coagulated
The nurse has just received the lab results of a client's calcium level. The nurse identifies a normal calcium level as? a) 9.0 to 10.5 mg/dL b) 3.5 to 5.3 mg/dL c) 13.5 to 14.5 mg/dL d) 12.0 to 15.0 mg/dL
a) 9.0 to 10.5 mg/dL -A decreased level calcium is 3.5 to 5.3 mg/dL -A elevated level of calcium includes 12.0 to 15.0 mg/dL and 13.5 to 14.5 mg/dL
The nurse is assessing a client who has developed hypocalcemia. The nurse anticipates the assessment date to include: select all that apply. a) bone pain b) serum calcium less that 8.5 mg/dL c) tetany d) lethargy e) negative trousseau sign f) signs of kidney stone
a) bone pain b) serum calcium less that 8.5 mg/dL c) tetany -Calcium is important for neuronal excitably, is necessary for skeletal, cardiac and smooth muscle contractions -Nerves exposed to low level of ionized calcium show decreased threashold for excitation, repetitive response to a single activity, and in extreme cases, continuously activity
The health care provider has ordered the administration of a hypertonic intravenous (IV) solution for a client. The nurse anticipates that the IV fluid will cause water to shift how? a) from the intracellular to intravascular space b) from the transcellular to intracellular space c) from the interstitial to trancellular space d) from the intravascular to interstitial space
a) from the intracellular to intravascular space -water moves from the side of the membrane having a lesser number of particles and greater concentration of water to the side having greater number of particles and lesser concentration of water -A hypertonic solution: provides a greater number of particles and will cause water to move from he intracellular space to the intravascular space.
Water movement from the side of the membrane having a lesser number of particles and greater concentration of water to the side having a greater number of particles and lesser concentration of water is termed? a) osmosis b) active transport c) filtration d) diffusion
a) osmosis -Osmosis is the force that moves water from the side of the membrane having lesser number of particles and greater concentration of water to the side having a greater number of particles and lesser concentration of water -Active transport: is the movement of ions agains an electrical or chemical gradient. -Diffusion: is the process by which particles in solution move from an area of higher concentrations to lower, resulting in equal distribution -Filtration: is the process of passing a liquid through a filter that is accomplished by gravity, vacuum or pressure
A client who experienced a traumatic head injury report extreme thirst. The nurse notes that the client is consuming 10 to 15 L of ice water daily and is experiencing polyuria. Which does the nurse suspect? a) syndrome of inappropriate antidiuretic hormone (SIADH) b) diabetes insipidus (DI) c) psychogenic polydispsia d) diabeties melitus
b) diabetes insipidus (DI) -Diabetes insibidus: is caused by a defficiency or decreased response to ADH. a person with DI are unable to concentrate their urine during periods of water restriction, and they excrete large volumes of urine (3-20 L/day) -The large output is accompanied by extreme thirst and temporary neurogenic DI can be result from traumatic head injury
The nurse is caring for a client with isotonic fluid volume deficit. The nurse would anticipate the client to manifest: select all that apply. a) weight gain b) hypotension c) decreased by temperature d) tachycardia and weak pulse e) decreased urine output f) increased hematocrit and BUN
b) hypotension d) tachycardia and weak pulse e) decreased urine output f) increased hematocrit and BUN -Isotonic fluid volume deficit results when water and electrolytes are lost in isotonic proportions. It is almost always caused by a loss of body fluids and is often accompanied by a decrease in fluid intake. The manifestations reflect a decreased extracellular fluid and include this, loss of body weight, decreased output, impaired temp regulation, concentration of blood cells, and BUN
A client tells the nurse that the client has been taking aka-seltzer (bicarbonate-antacid) 4x a day for the past 2 weeks for an upset stomach. Upon assessment of the client, the nurse notes hyperactive reflexes, tetany, and mental confusion. Arterial blood gases reveal pH 7.55; serum HCO3- 37. The nurse suspects the client may be experiencing a) respiratory alkalosis b) metabolic alkalosis c) metabolic acidosis d) respiratory acidosis
b) metabolic alkalosis -It is characterized by a serum pH grater than 7.45; and serum HCO3- greater than 29 mEq/L; and a base excess greater than 3 -transient or acute alkalosis is common during or immediately following excess oral ingestion of bicarbonate antacids
The nurse is caring for a client who is experiencing an increased level of aldosterone secretion. The nurse anticipates that the client may develop? a) water and potassium retention b) sodium and water retention c) potassium and sodium excretion d) potassium retention and water excretion
b) sodium and water retention -Aldosterone: acts at the level of the cortical collecting tubules of the kidneys to increased sodium reabsorption and water retention while increasing potassium elimination
A nurse is caring for the following group of clients. Select the client most likely to be diagnosed with respiratory alkalosis? a) a 45 year old male with pneumothorax after a car accident b) a 63 year old male with a 40 year history of smoking and chronic lung disease c) a 26 year old female with anxiety who has been hyperventalating d) a 18 year old female who has overdosed on narcotics
c) a 26 year old female with anxiety who has been hyperventalating -Respiratory alkalosis: can occur with hyperventilating and the loss of CO2. -the other 3 clients are more at risk for respiratory acidosis as a result of retaining CO2
The nurse is assessing a client with hyperkalemia. The nurse is aware that the organ at most risk for this client would be the? a) lungs b) liver c) heart d) brain
c) heart -The most serious effect of hyperkalemia is on the heart -Hyperkalemia decreases membrane excitability, produces a delay in atrial and ventricular depolarization, and it increases the rate of ventricular repolerization -Brain is at risk for alteration in sodium -Liver and lungs are at risk for hypokalemia
The nurse is reviewing the following lab results of a client diagnosed with renal failure: pH: 7.24 PCO2: 38 mm Hg HCO3: 18 mEq/L The nurse would interpret this as? a) metabolic alkalosis b) respiratory alkalosis c) metabolic acidosis d) respiratory acidosis
c) metabolic acidosis -Would be diagnosed based on the findings related to a low pH level (7.3) and a low bicarbonate level. -Respiratory acidosis: represents a decreased pH and an increased PCO2 -Metabolic alkalosis: represents an increased pH and a increased HCO3 -Respiratory alkalosis: represents an increased pH and decreased PCO2
The nurse is assessing a client for early manifestations of hyponatremia. The nurse would assess the client for? a) dry, sticky mucous membrane b) tachycardia c) muscle weakness d) peaked T wave on the EKG
c) muscle weakenes -Muscle cramps, weakness, and fatigue reflect the effect of hyponatremia on skeletal muscles function and are often early signs of hyponatremia -Hyperkalemia: reflects from the peaked T wave on the EKG -Hypernatremia: reflects the dry, sticky mucous membrane as well as tachycardia
The nurse is reviewing a clients arterial blood gas (ABG) results. The nurse interprets the clients pH level as normal when the results identify a? a) pH of 7- 7.25 b) pH of 7.55-7.8 c) pH of 7.35-7.45 d) ph of 6.55- 7.12
c) pH of 7.35-7.45 -Acidotic states is represented by pH of 6.55- 7.12 and pH of 7- 7.25 -Alkalotic state is represented by pH of 7.55-7.8
The physician has ordered an anion gap as a laboratory test for a client experiencing metabolic acidosis. The nurse recognizes that the test will measure? a) base excess or deficit b) chloride and bicarbonate c) phosphates, sufates, and proteins d) ratio of hydrochloric acid and bicarbonate
c) phosphates, sufates, and proteins -Anion gap: describes the difference between the serum concentration of the major measured cation (Na) and the sum of the measured anions (Cl and HCO3-) -The difference represents the concentration of unmeasured anions, such as phosphates, sulfates, organic acids, and proteins
The nurse is aware that the major role of the kidneys is regulated acid-base balance is to increase the production of? a) HCl b) H+ c) H2CO3 d) HCO3-
d) HCO3- -The kidneys play role in maintaining acid base balance. They accomplish this through the reabsorption go HCO3-, regulation of H+ secretion, and generation of new HCO3-.
The nurse is assessing a client who is experiencing hyperventilation. The nurse is aware that the client is at risk for? a) decreased pH b) increased H2CO3 c) increased PCO2 d) decreased PCO2
d) decreased PCO2 -Increased ventilation will result in a decreased blood carbon dioxide (PCO2) -Decreased ventilation results in retention of CO2 build up of acid with decreased in pH and increased in the formation of H2CO3 in blood
During the assessment of a client with heart failure, the nurse uses finger pressure to determine if edema is present in the lower extremities. When would the nurse document pitting edema? a) indention is not present b) the skin is thickened and hard c) the area is firm and discolored d) indentation remains after the finger has been removed
d) indentation remains after the finger has been removed -lymphedema: thickened and hard skin -Peripheral vascular insufficiency: is indicated when the area is firm and discolored
The nurse would anticipate the laboratory results of a client experiencing metabolic acidosis to include? a) pH 7.45 and HCO3 of 24 mEq/L b) pH 7.25 and HCO3 of 18 mEq/L c) pH 7.35 and HCO3 of 22 mEq/L d) pH 7.50 and HCO3 of 45 mEq/L
d) pH 7.50 and HCO3 of 45 mEq/L -Metabolic acidosis: is based on both increase of pH and HCO3 levels
The nurse is reviewing lab results of a client diagnosed with metabolic acidosis. The most important electrolyte for the nurse to assess would be? a) sodium (Na+) b) calcium(Ca2+) c) magneasium (Mg2+) d) potassium (K+)
d) potassium -when excess H+ is present in the ECF, it moves into the ICF in exchange for K+ , and when excess K is present in the ECF, it moves into the ICF in exchange for H+ -Altherations in potassium levels can affect acid-base balance, and changes in acid-base balance and influence potassium levels -Acidosis tends to increase serum potassium levels by causing potassium to move form the ICF to the ECF
The nurse is assessing a client with fluid volume excess. The nurse anticipates the client would manifest? a) decreased blood pressure b) weak, rapid pulse c) increased BUN d) weight gain
d) weight gain -Isotonic fluid volume excess is manifested by and increases in interstitial and vascular fluids and is characterized by weight gain over a short period of time
Which of the following best describes the concentration of solute in a particular volume of fluid based on electrolyte equivalency?
mEq/L
When caring for the client with a hyperkalemia, the nurse recognizes the body should respond in which of these ways?
secrete potassium in the distal tubules for excretion
Osmolality
the osmolar concentration in 1 kg of water (mOsm/kg H2O) -Often used when referring to fluids inside the body
A heart failure client has gotten confused and took too many of his "water pills" (diuretics). On admission, his serum potassium level was 2.6 mEq/L. Of the following assessments, which correlate to this hypokalemia finding? Select all that apply.
- Constipation - Polyuria - Paresthesia with numbness of the lips/mouth
Interstitial or tissue hydrostatic pressure
- Opposes the movement of water out of the capillary - normally negative, contributes to the outward movement of water into interstitial space
Capillary colloidal osmotic pressure
- Pulls water back into the capillary - 28 mm Hg - Osmotic pressure is generated by the plasma proteins that re too large to pass through the pores of the capillary wall
Sodium
-Most plentiful electrolyte in ECF -normal level 135-145 mEq/L -Kidneys are extremely efficient in regualating sodium output
Capillary filtration pressure
-Pushed water out of the capillary into the interstitial space -is because of hydrostatic pressure -30-40 mm Hg at arterial end -10-15 mm Hg at venous end - 25 mm Hg in the middle
Interstitial colloidal osmotic pressure
-the pull of water out of capillary into the interstital space - reflects the small amount of plasma protein that normally escape into interstitial space from capillary
A patient is admitted to the emergency department after being involved in an automobile accident with possible internal bleeding. What type of isotonic intravenous (IV) solution does the nurse prepare to infuse?
0.9% NaCl
the 2 types of DI
1.) Neurogenic: caused by inflammatory, autoimmune, or vascular disease that affect the hypothalamic-neuropophyseal system. 2.) Nephrogenic: Characterized by impairment of urine-concentrating abilities and free water conservation
4 main forces that control movement of water between the capillary and interstitial space
1.) capillary filtration pressure 2.) capillary colloidal osmotic pressure 3.) intersital or tissue hydrostatic pressure 4.) interstital colloidal osmotic pressure
2 stimuli for true thirst based on water needs
1.) cellular dehydration caused by an increase in ECF osmolality 2.) a decreased in effective circulating volume, which may or may not be associated with a decrease in serum osmolality
Mechanisms that contribute to edema formation
1.) increase the capillary filtration pressure 2.) decrease the capillary colloidal osmotic pressure 3.) increase capillary permeability 4.) produce obstruction to lymph flow
3 Extracellular fluid compartments
1.) interstital (tissue) space: 14% Acts as a transport vehicle for gases, nutrients, wastes, and other materials that move between the vascular compartments and body cells 2.) Plasma (vascular) compartment: 5% of body weight 3.) Transcellular compartment: includes the cerebrospinal fluid and fluid contained in the various body spaces such as peritoneal, pleural, and pericardial cavities. about 1% of ECF
2 disorders of water and sodium
1.) isotonic contraction or expansion of the ECF volume brought about the proportionate changes in sodium and water 2.) hypotonic dilution or hypertonic concentration of the ECF brought about disproportionate changes in sodium and water
Body weight consists of which of the following percentages of body water?
60%
A nurse observes peaked, narrow T waves on the electrocardiogram of a patient suffering from renal failure. The nurse suspects that the client is experiencing which of the following conditions?
9.0 to 10.5 mg/dL
Cerebral edema occurs with potentially severe neurologic impairment.
9.0 to 10.5 mg/dL
Hypodispsia
A decrease in abilty to sense thirst
Of the following clients, which would be at highest risk for developing hyperkalemia?
A male admitted for acute renal failure following a drug overdose
