Davis Ch. 8: Fluid & Fluid Imbalances

What causes fluid shift from osmotic pressure? Select all that apply.

- Albumin - Hypertonic fluids - Hypotonic fluids - Mannitol

What is the best indicator of kidney function in a client who is experiencing fluid and electrolyte imbalances?

Creatinine level

Which lab values are impacted by fluid volume deficit? Select all that apply.

- Hemoglobin and hematocrit - Urine specific gravity - Sodium - Serum osmolality

Fluid therapy for a 22-year-old female patient who is pregnant and admitted with hyperemesis gravidarum after vomiting for the last seven days.

Crystalloid Rationale: Crystalloid therapy would be used in fluid replacement for a pregnant patient with hyperemesis. More specifically, an isotonic solution is indicated initially to restore the vascular volume and followed by a hypotonic solution to rehydrate the cells. Colloid therapy would not be indicated. The use of colloid therapy would be contraindicated because fluid would pull from the extravascular to the intravascular space.

Fluid replacement for a 28-year-old female with severe hyponatremia and low blood pressure from adrenal insufficiency and a lack of aldosterone.

Hypertonic solution Rationale: A hypertonic solution will increase serum sodium levels while shifting fluid into the circulation and creating vascular expansion, thereby raising the blood pressure. An isotonic solution would not correct the hyponatremia, only the low blood pressure.

What conditions cause fluid volume excess? Select all that apply.

- Cirrhosis - Adrenal gland disorder - Heart failure

Which findings could lead to the presence of edema? Select all that apply.

- Decreased oncotic pressure - Decreased albumin

Which types of fluid solutions would result in fluid shifting within the body? Select all that apply.

- Hypertonic - Hypotonic - Colloid - Crystalloid

A client is experiencing symptoms of fluid volume excess. Which actions should the nurse take? Select all that apply.

- Limit daily intake of fluid and sodium - Monitor daily weight - Eliminate sodium-containing IV fluids - Administer diuretics, as ordered

Treatment for a 45-year-old in hypovolemic shock from blood loss after a gunshot wound.

Albumin Rationale: Albumin expands the vascular space and is not contraindicated in bleeding disorders. Mannitol is an osmotic diuretic and will cause additional fluid loss.

A client has been receiving parenteral therapy while in the hospital. As a result of fluid administration, fluid shifting is noted with the cells of the body becoming more edematous. Which type of fluid would the nurse anticipate being responsible for cellular swelling?

Hypotonic solution

Fluid replacement for an 18-year-old male patient with a normal blood pressure, experiencing leg cramps after completing a marathon.

Hypotonic solution Rationale: A hypotonic solution shifts fluid out of the vessels into the cells, which improves the dehydration causing the leg cramps. A hypertonic solution would pull more fluid from the already dry cells.

Fluid requirement for a 58-year-old male patient admitted with hypokalemia who requires intravenous potassium replacement therapy.

KCL with IV solution Rationale: Potassium replacement therapy is considered a high-alert medication and should never be administered as an IVP bolus, which could cause dysrhythmias and cardiac arrest. Safety considerations require that potassium be administered as part of an IV solution over an extended period of time.

Fluid therapy for a healthy 38-year-old male who is admitted for a simple outpatient surgical procedure.

Lactated Ringer's (LR) Rationale: In this clinical situation there is no reason to suspect a fluid imbalance before surgery. An isotonic fluid (LR) would be indicated for short-term fluid therapy, such as this. Five percent dextrose in water (D5W) is a hypotonic fluid that could potentially cause fluid shift into the cells.

Fluid therapy for a 16-year-old female trauma patient who has head trauma and suspected cerebral edema following an automobile accident.

Mannitol Rationale: Mannitol is an osmotic diuretic that decreases cerebral edema. Albumin is a protein that draws fluid into the vascular space and would make cerebral edema worse.

An elderly client who is hypotensive has been admitted to the nursing unit for fluid replacement therapy. What intravenous solution would the nurse expect to administer?

Normal saline

Fluid replacement therapy for an 80-year-old male patient who is hypotensive.

Normal saline Rationale: An isotonic fluid would be indicated for replacement therapy for a hypotensive elderly patient to fill the vascular space. Three percent normal saline is a hypertonic solution and would cause fluid shifting and worsen cellular dehydration.

Which compensatory mechanism would be initiated in the body in response to a low volume state?

Release of antidiuretic hormone