Fluid and Electrolytes

The neuro ICU nurse is caring for a client with head trauma and subsequent syndrome of inappropriate anti diuretic hormone (SIADH). The nurse notes confusion and muscle weakness, and correctly understands that which of the following is occurring?

Decreased serum osmolarity, as excess water is being retained by the kidneys SIADH causes excess water to be retained, rather than be excreted by the kidneys. In this client, the serum osmolarity decreases, resulting in hyponatremia. SIADH is caused by oversecretion of anti-diuretic hormone.

The nurse has an order to give hypertonic saline (3% NaCI) to a client with increased intracranial pressure. The nurse correctly understands that the effect of this will be which of the following?

Fluid will move out of the cells and into the extracellular fluid Hypertonic solutions, or solutions with a greater concentration of solutes than blood, will cause fluid to move out of cells and into the extracellular fluid. This fluid movement into the intravascular space decreases cerebral edema.

Blood plasma is normally found in which of the following spaces?

In the intravascular space, in the extracellular fluid Blood plasma is normally located inside blood vessels, but outside of cells. There it is part of the extracellular fluid.

Protein inside the bloodstream is pulling water into the vessels. This is referred to as which type of pressure?

Oncotic pressure The pressure is produced by albumin (protein) in the bloodstream that pulls water into vessels is termed 'oncotic pressure' - osmotic pressure is produced when particles pull water towards them. This creates balance in the concentration, or osmolarity of fluids between compartments

The student nurse is learning about a fluid compartment whose primary cation is potassium (K). Which of the following is the correct fluid found in this compartment?

Intracellular fluid - Extracellular fluid & intravascular fluid & interstitial fluid is Sodium (Na)

The nursing student is learning about isotonic solutions, and demonstrates correct understanding with which of the following statements?

"Giving an isotonic solution to a client prevents red blood cells from shrinking or swelling by osmosis" An isotonic solution is one that has the same concentration gradient as body cells. Therefore, adding this solution into the bloodstream will not cause any movement of particles into or out of cells. - Cell swelling and subsequent lysis occur when a hypotonic solution is given, which is LESS concentrated than body cells, causing fluid to enter cells through their semipermeable membranes. - Cell shrinkage occurs when a hypertonic solution is given, which causes water to leave the cells and enter extracellular fluid. Isotonic solutions do not cause this. - Isotonic solution administration does not activate ATP

The extracellular fluid (ECF) is divided into two parts: intravascular fluid and interstitial fluid. Under normal circumstances, which of the following is the correct proportion of these fluids?

20% intravascular/80% interstitial Intravascular fluid is primarily made up of blood plasma, and is approx 20% of the extracellular fluid found in the body. Interstitial fluid is primarily made up of a water solvent containing electrolytes, waste products, and hormones. This makes up approximately 80% of the extracellular fluid contained in the body.

The student nurse is observing his preceptor give a hypotonic solution to a client to treat dehydration. The preceptor explains that hypotonic solutions can cause extra fluid to move into the intracellular space. The student correctly understands that, under normal circumstances, which percentage of the body fluid is intracellular fluid?

70% The total proportion of body fluid contained within cells is about 70%. This is termed "intracellular fluid" or ICF.

Osmotic pressure refers to which of the following?

A concentration gradient Osmotic pressure is related to the concentration of a solution. Water moves from an area of low concentration to an area of high concentration. The force that moves water in this manner is osmotic pressure.

Oncotic pressure refers to which of the following?

A pulling force (Oncotic pressure is created by protein pulling fluid toward itself. Albumin is the most powerful pulling protein in the body) - hydrostatic pressure is the pressure of water in contained area - pushing pressure - osmotic pressure is a concentration gradient which moves water toward the higher concentration of particles.

Hydrostatic pressure refers to which of the following?

A pushing pressure Hydrostatic pressure refers to the physical pressure exerted by water which forces fluid out of an area of high pressure into an area of lower pressure. Hydrostatic pressure is the physical pressure of water.

A nursing student is priming IV tubing to administer 0.9% Normal Saline to a client. The preceptor asks the student the implications of giving an isotonic solution. Which response by the student is correct?

An isotonic solution has the same osmolarity as blood Isotonic solutions such as 0.9% Normal Saline are the same concentration as blood. This means that isotonic solutions will not cause fluid shifts to occur due to changes in osmolarity.

Which element would be added to total parenteral nutrition to support osmotic pressure in the circulatory system?

Chloride (Several vitamins and nutrients are added to parenteral nutrition to support the client's health and prevent malnutrition. Chloride is an electrolyte that may be added to parenteral nutrition bc it supports osmotic pressure in the circulatory system and regulated acid-base balance)

Pressure produced in the glomerulus of the kidney forces water and some particles out into the glomerular capsule. This pressure is referred to as which of the following?

Hydrostatic pressure. Hydrostatic pressure causes water and certain particles to enter the glomerular capsule, producing urine. - Oncotic pressure pulls fluid toward proteins, rather than pushing fluid away.

The term "interstitial" is best defined as which of the following?

In the tissues, but outside the blood vessels "Interstitial" refers to the space outside of cells, and outside of blood vessels. This is fluid found within the tissues. - Interstitial fluid is found within the tissues, not "in between" them. - If a fluid is located inside blood vessels, it is either intravascular fluid or intracellular fluid if it is inside cells. - A fluid found within cells is termed intracellular fluid, not interstitial fluid.

The nursing student is learning about the toxicity of a solution, and discovers that a 0.45% NaCI is a hypotonic solution. The student correctly understands that this is which of the following?

Less concentrated than blood (Hypotonic IV solutions are less concentrated than blood. 1/2 Normal Saline is an example of a hypotonic IV solution. - solution that is more concentrated than blood is a hypertonic solution - solution with same concentration as blood is isotonic solution

The nurse checks a client's blood glucose level and the result is higher than normal (hyperglycemia). Which of the following pressures would be at play in this client's bloodstream?

Osmotic pressure (osmotic pressure is created when particles such as glucose, in the bloodstream are in a higher concentration than particles outside of the bloodstream. This causes water to enter the bloodstream due to the osmotic pressure created by the particles. - When a glucose level is high, the opposite occurs: fluid moves toward the area of high glucose concentration, which equates to movement into the vessels.

A solute can be which of the following? Select all that apply

Salt, Electrolytes, Sugar, Nutrients A solute is a particle that is dissolved in solution. Salt, electrolytes, sugar and nutrients all dissolve in solutions. Water is a solvent.

The primary cation found outside body cells is which?

Sodium (Na) Sodium is the primary cation found in the extracellular fluid, or outside of the cell, while potassium is the primary cation inside of the cell. (Magnesium is found primarily inside body cells & Calcium is usually found in greater concentrations outside body cells than inside them, it is not the primary extracellular cation)

A client with severe hemorrhage has been ordered to receive albumin. Which of the following is a contraindication to administering albumin? Select all that apply

The client would not tolerate a rapid increase in blood volume (Albumin should not be administered to a client who cannot tolerate a rapid increase in blood volume) The client has a history of allergic reaction to albumin (Albumin is a product known as a volume expander that can be administered to increase volume in client's circulation. It may be given in cases of shock or severe bleeding when the client needs more fluid in circulation) - If a client is going into shock from hemorrhage, albumin administration would help to increase blood volume. - Clients with pancreatitis often have lowered albumin levels, and administering albumin is not contraindicated. - With a burn client, albumin is commonly given to replace blood volume loss

The preceptor is discussing diffusion of particles in the kidneys. The student nurse correctly understands diffusion as which of the following?

The movement of salts and waste products across a concentration gradient. Diffusion is the movement of particles, such as salts and waste products, across a concentration gradient. This is how the blood rids the body of waste, which occurs in the kidneys. Facilitated diffusion - using protein carrier (particles are too big to naturally cross semipermeable membrane) Osmosis - movement of water ATP - active transport