Chapter 4

What would the instructor tell her students is the average daily fluid intake for an adult?

2000 mL

A patient's serum sodium concentration is within the normal range. What should the nurse estimate the serum osmolality to be?

275-300 mOsm/kg

What should the nurse estimate a normal serum osmolality to be?

275-300 mOsm/kg

A nurse can estimate serum osmolality at the bedside by using a formula. A patient who has a serum sodium level of 140 mEq/L would have a serum osmolality of what?

280 mOsm/kg

Which electrolyte is a major anion in body fluid?

chloride

What intravenous solution would be the safest for a patient with hypernatremia in need of fluid volume replacement?

0.45% sodium chloride

Which is considered an isotonic solution?

0.9% normal saline

A client who is semiconscious presents with restlessness and weakness. The nurse assesses a dry, swollen tongue; body temperature of 99.3 °F; and a urine specific gravity of 1.020. What is the most likely serum sodium value for this client?

165 mEq/L

The average daily fluid intake for an adult is what?

2000 mL

What is a complication of SIADH?

cerebral edema

Which could be a potential cause of respiratory acidosis?

hypoventilation

One of the best indicators of the patient's renal function?

serum creatine 0.6-1.2

To compensate for decreased fluid volume (hypovolemia), the nurse can anticipate which response by the body?

tachycardia

Hyperchloremia S/S

tachypneic, lethargy, weakness, diminished cognitive ability, pitting edema

Who might be at high risk for experiencing low serum magnesium levels?

a patient with cirrhosis of the liver r/t heavy alcohol consumption

A volume-depleted patient would present with which of the following diagnostic lab results?

BUN:creatine of 24:1

A fluid volume deficit can be caused by either dehydration or hypovolemia. What is the distinction between the two?

In hypovolemia only blood volume is low.

What effect does breathing faster have on arterial pH level?

Increases arterial pH

Which of the following is a factor affecting an increase in urine osmolality?

SIADH

Which of the following is a clinical manifestation of fluid volume excess (FVE)?

Shortness of breath Distended neck veins Crackles in the lung fields

What mechanism in the sodium potassium pump will move the excess body fluid?

active transport

What is one of the most important indications of an acid-base imbalance that is shown in an ABG?

bicarbonate

What is the major chemical regulator of plasma pH?

bicarbonate-carbonic acid buffer system

The nurse should be alert to which clinical manifestation associated with air embolism?

chest pain (angina)

Upon shift report, the nurse states the following laboratory values: pH, 7.44; PaCO2, 30mmHg; and HCO3, 21 mEq/L for a client with noted acid-base disturbances. Which acid-base imbalance do both nurses agree is the client's current state?

compensated respiratory alkalosis

Which findings indicate that a client has developed water intoxication secondary to treatment for DI?

confusion and seizures

An adult client is brought in to the clinic feeling thirsty with dry, sticky mucous membranes; decreased urine output; fever; a rough tongue; and lethargy. The nurse reconciles the client's medication list and notes that salt tablets had been prescribed. What would the nurse do next?

consider sodium restriction with discontinuation of salt tablets

Which of the following is a clinical manifestation of fluid volume excess (FVE)?

crackles, jugular distention, SOB

What would you do as a nurse if you noticed your patient's IV was red, warm, swollen, and had localized pain?

d/c immediately

Which electrocardiogram changes will a patient with hyperkalemia display?

peaked T waves

The nurse is caring for a client in heart failure with signs of hypervolemia. Which vital sign is indicative of the disease process?

elevated BP

Which laboratory result does the nurse identify as a direct result of the client's hypovolemic status with hemoconcentration?

elevated hematocrit

Hypokalemia can cause which symptom to occur?

excessive thirst

Which condition is a predisposing factor for respiratory alkalosis?

extreme anxiety

A low potassium usually results in what?

fatigue, cramps, weakness

While hypovolemia is to be avoided, there is also an accompanying danger for blood clots and urinary stones. What condition contributes to the possible development of these life-threatening events?

hemoconcentration

A client presents with anorexia, nausea and vomiting, deep bone pain, abdominal pain, confusion, and constipation. What are these symptoms indicative of?

hypercalcemia

A nurse is caring for a client in acute renal failure. The nurse should expect hypertonic glucose, insulin infusions, and sodium bicarbonate to be used to treat what?

hyperkalemia

You should anticipate the administration of what fluid when treating a patient with FVD r/t CDiff-related diarrhea?

hypotonic or isotonic solutions

The nurse is caring for a client diagnosed with chronic obstructive pulmonary disease (COPD) and experiencing respiratory acidosis. The client asks what is making the acidotic state. The nurse is most correct to identify which result of the disease process that causes the fall in pH?

inability to blow off CO2

What effect does breathing faster have on arterial pH level?

increased arterial pH

Early signs of hypervolemia include what?

increased breathing effort and weight gain

hypertonic solution

increases the number of dissolved particles in the patient's blood, creating pressure for fluid in the tissues to shift to the capillaries and increase the blood volume

What do we know about evaluating skin turgor?

inelastic skin turgor is a normal part of aging

What does the nurse understand is the primary method by which fluid volume is regulated?

urine excretion

Which daily assessment data is necessary to determine changes in the client's hypervolemia status?

weight

Which pair of organs is responsible for regulatory processes and compensation?

lungs/kidneys

Which acid-base imbalance is most likely to occur with NG tube placement?

metabolic alkalosis

Hypokalemia is associated with this acid-base imbalance.

metaboliic alkalosis

Following a unilateral adrenalectomy, a nurse should assess for hyperkalemia as indicated by

muscle weakness

What process is primarily responsible for maintaining fluid balance along a concentration gradient?

osmosis

Hypertonic solution increases the number of dissolved particles in the patient's blood, creating pressure for fluid in the tissues to shift to the capillaries and increase the blood volume. What term(s) are associated with this process?

osmosis and osmolality

Oncotic pressure refers to the what?

osmotic pressure exerted by proteins

What is the term for the amount of hydrogen ions in a solution?

pH

What the term is for the amount of hydrogen ions in a solution?

pH

From what system would a sympathetic reaction to falling result in elevated HR, anxiety, thirst, and decreased urinary output

renin-angiotensin-aldosterone system

The nurse would expect to identify which acid-base disturbance in a patient experiencing depressed respirations?

respiratory acidosis

SOB is associated with this acid-base imbalance.

respiratory alkalosis

What role do the kidneys play in maintaining normal fluid balance?

selectively retaining needed substances and excreting waste

What clinical indication of hyperphosphatemia does the nurse assess in a patient?

tetany (involuntary contraction of muscles)

What occurs when fluid moves out of the intravascular space, but not into the intracellular space?

third spacing