Chapter 16 - Study Questions
A patient with consistent dietary intake who loses 1 kg of weight in 1 day has lost _________________ mL of fluid.
1000
True or False. Adipose tissue has a higher percentage of water in the tissue.
False
True or False. The kidneys are the primary route for 90% of daily potassium intake.
True
The parathyroid hormone (PTH) regulates the movement of calcium into & out of: a. bones b. blood c. muscles d. liver
a. bones
Which of the following acid-base imbalances is the common cause for respiratory failure? a. respiratory acidosis b. respiratory alkalosis c. metabolic alkalosis d. metabolic acidosis
a. respiratory acidosis
Which of the following acid-base imbalances is the common cause for sedative or opioid overdose? a. respiratory acidosis b. respiratory alkalosis c. metabolic alkalosis d. metabolic acidosis
a. respiratory acidosis
Which of the following acid-base imbalances matches the mechanism "increased carbonic acid (H2CO3)"? a. respiratory acidosis b. respiratory alkalosis c. metabolic alkalosis d. metabolic acidosis
a. respiratory acidosis
Which of the following are cations? Select all that apply. a. sodium b. phosphate c. calcium d. potassium e. bicarbonate f. chloride
a. sodium c. calcium d. potassium
These are clinical findings of fluid volume deficit: Select all that apply. a. tenting of the skin b. increased RR and temperature c. muscle weakness d. elevated BP
a. tenting of the skin b. increased RR and temperature c. muscle weakness
Examples of third spacing are: Select all that apply. a. peripheral edema b. ascites c. burn blister d. lymphedema
b. ascites c. burn blister
What is the normal pH range of the blood, and what ratio of base to acid does this reflect? a. 7.32 to 7.42; 25 to 2 b. 7.32 to 7.42; 28 to 2 c. 7.35 to 7.45; 20 to 1 d. 7.35 to 7.45; 30 to 1
c. 7.35 to 7.45; 20 to 1 The other answers are incorrect
A patient with chronic kidney disease has hyperphosphatemia. What is a commonly associated electrolyte imbalance? a. Hypokalemia b. Hyponatremia c. Hypocalcemia d. Hypomagnesemia
c. Hypocalcemia Kidneys are the major route of phosphate excretion, a function that is impaired in renal failure. A reciprocal relationship exists between phosphorus and calcium, and high serum phosphate levels of kidney failure cause low calcium concentration in the serum.
The GI tract normally secretes _____ mls daily, most of this is reabsorbed a. 2,000 b. 3,500 c. 6,000 d. 8,000
d. 8,000
Which of these electrolyte imbalances is the cause of "metabolic alkalosis"? (select all that apply) a. hypernatremia b. hyponatremia c. hyperkalemia d. hypokalemia e. hypercalcemia f. hypocalcemia g. hyperphosphatemia h. hypophosphatemia i. hypermagnesemia j. hypomagnesemia
d. hypokalemia
Which of these electrolyte imbalances is the cause of "prolonged immobilization"? (select all that apply) a. hypernatremia b. hyponatremia c. hyperkalemia d. hypokalemia e. hypercalcemia f. hypocalcemia g. hyperphosphatemia h. hypophosphatemia i. hypermagnesemia j. hypomagnesemia
e. hypercalcemia
Which of these electrolyte imbalances is the cause of "parathyroidectomy cause"? (select all that apply) a. hypernatremia b. hyponatremia c. hyperkalemia d. hypokalemia e. hypercalcemia f. hypocalcemia g. hyperphosphatemia h. hypophosphatemia i. hypermagnesemia j. hypomagnesemia
f. hypocalcemia
A woman has ham with gravy and green beans cooked with salt pork for dinner. What fluid regulation mechanisms are stimulated by the intake of these foods?
intake of these foods stimulates antidiuretic hormone (ADH) release from the posterior pituitary, which increases water reabsorption from the kidney, lowering the sodium concentration but increasing vascular volume and hydrostatic pressure, perhaps causing fluid shift into interstitial spaces
A woman has ham with gravy and green beans cooked with salt pork for dinner. What could happen to the woman's serum osmolality because of this meal?
serum osmolality increases as a large amount of sodium is absorbed
A patient has a serum Na + of 147 mEq/L (147 mmol/L), blood urea nitrogen (BUN) of 6 mg/dL (2.1 mmol/L), and a blood glucose level of 126 mg/dL (7.0 mmol/L). The patient's effective serum osmolality is ________ mOsm/kg. Is the patient's plasma osmolality normal, increased, or decreased?
2x147 + 6/2.8 + 126/18 = 303.14 The patient's plasma osmolality is increased.
A man who weighs 90 kg has a total body water content of approximately _________________ L.
54 to 45 L: 90 kg × 60% = 54, 90 kg × 50% = 45
A nurse is caring for a client who has emphysema and chronic respiratory acidosis. The nurse should monitor the client for which of the following electrolyte imbalances? A. Hyperkalemia B. Hyponatremia C. Hypercalcemia D. Hypomagnesemia
A. Hyperkalemia The nurse should monitor the client for hyperkalemia because chronic respiratory acidosis can result in high potassium levels due to potassium shifting out of the cells into the extracellular fluid.
A nurse is assessing a client who has heart failure and is taking daily furosemide. The client's apical pulse is weak and irregular. The nurse should identify these findings as manifestations of which of the following electrolyte imbalances? A. Hypokalemia B. Hypophosphatemia C. Hypercalcemia D. Hypermagnesemia
A. Hypokalemia Furosemide can cause the loss of potassium, sodium, calcium, and magnesium. Manifestations of hypokalemia can include shallow respirations, muscle weakness, lethargy, and ectopic heartbeats.
A nurse is caring for a client who is in the oliguric-anuric stage of acute kidney injury. The client reports diarrhea, a dull headache, palpitations, and muscle tingling and weakness. Which of the following actions should the nurse take first? A. Administer an analgesic to the client B. Check the client's electrolyte values C. Measure the client's weight D. Restrict the client's protein intake
B. Check the client's electrolyte values The nurse should apply the urgent versus nonurgent priority-setting framework when caring for the client. Using this framework, the nurse should consider urgent needs to be the priority because they pose a greater threat to the client. The nurse might also need to use Maslow's hierarchy of needs, the ABC priority-setting framework, and/or nursing knowledge to identify which finding is the most urgent. The nurse should check the client's most recent potassium value because these findings are manifestations of hyperkalemia, which can lead to cardiac dysrhythmias.
A nurse is caring for a client who has chronic glomerulonephritis with oliguria. For which of the following electrolyte imbalances should the nurse monitor? A. Hypercalcemia B. Hyperkalemia C. Hypomagnesemia D. Hypophosphatemia
B. Hyperkalemia Oliguria resulting from chronic glomerulonephritis causes potassium retention, leading to levels above the expected reference range of 3.5 to 5 mEq/L. Other electrolyte imbalances common with this disorder affect sodium and phosphorus levels. Chronic glomerulonephritis eventually leads to end-stage kidney disease.
A nurse is assessing a client who is receiving continuous ambulatory peritoneal dialysis. Which of the following findings should the nurse report to the provider? A. WBC 6,000/mm^3 B. Potassium 3.0 mEq/L C. Clear, pale yellow drainage D. Report of abdominal fullness
B. Potassium 3.0 mEq/L A potassium level of 3.0 mEq/L is below the expected reference range and can cause dysrhythmias. Dialysis removes fluid, waste products, and electrolytes from the blood and can cause hypokalemia.
A nurse is caring for a client who has a major burn injury and is experiencing third spacing. Which of the following fluid or electrolyte imbalances should the nurse expect? A. Hypokalemia B. Hypernatremia C. Elevated Hct D. Decreased Hgb
C. Elevated Hct The nurse should expect a client who is experiencing third spacing resulting from a major burn to have an elevated hematocrit level as blood volume is reduced by vascular dehydration.
True or False. Hypocalcemia symptoms are depressed reflexes, increased BP, & psychosis.
False
Identify the acid-base imbalances represented by the following laboratory values. pH: 7.44 PaCO2: 54 mm Hg HCO3-: 36 mEq/L PaO2: 90 mm Hg
Interpretation: compensated or chronic metabolic alkalosis indicated 1. PaCO2 and HCO3 − are abnormal. 2. pH is within normal range but toward alkalosis 3. PaCO2 is > 45 mm Hg, indicating respiratory acidosis. 4. HCO3 − is > 26 mEq, indicating metabolic alkalosis. Because the body will not overcompensate, the metabolic alkalosis is a closer match with the pH. 5. The high PaCO2 indicates the ability of the lungs to compensate for the metabolic alkalosis. 6. The PaO2 is within normal limits.
Identify the acid-base imbalances represented by the following laboratory values. pH: 7.35 PaCO2: 60 mm Hg HCO3-: 40 mEq/L PaO2: 84 mm Hg
Interpretation: compensated respiratory acidosis as reflected by high HCO3 − and pH in normal range 1. PaCO2 and HCO3 − are abnormal. 2. pH is within normal range but toward acidosis. 3. PaCO2 is > 45 mm Hg, indicating respiratory acidosis. 4. HCO3 − is > 26 mEq, indicating metabolic alkalosis. 5. Because the body will not overcompensate, the respiratory acidosis is a closer match with the pH. The high HCO3 − indicates the ability of the kidneys to compensate for the respiratory acidosis. 6. PaO2 is within normal limits, but on the low end, which supports the respiratory system as the causative concern.
Identify the acid-base imbalances represented by the following laboratory values. pH: 7.20 PaCO2: 25 mm Hg HCO3-: 15 mEq/L PaO2: 96 mm Hg
Interpretation: metabolic acidosis; partially compensated 1. pH, PaCO2 and HCO3 − are abnormal. 2. pH < 7.35 shows acidosis. 3. PaCO2 is < 35 mm Hg, indicating respiratory alkalosis. The PaCO2 is in the opposite direction of the pH. 4. HCO3 − is < 22 mEq, indicating metabolic acidosis, which matches the pH. 5. The low PaCO2 indicate the lungs are trying to compensate for the metabolic acidosis. 6. The PaO2 is within normal limits.
Identify the acid-base imbalances represented by the following laboratory values. pH: 7.62 PaCO2: 48 mm Hg HCO3-: 45 mEq/L PaO2: 98 mm Hg
Interpretation: metabolic alkalosis; partially compensated 1. pH, PaCO2 and HCO3 − are abnormal. 2. pH > 7.45 shows alkalosis. 3. PaCO2 is > 45 mm Hg, indicating respiratory acidosis, and is opposite of the pH. 4. HCO3 − is > 26 mEq, indicating metabolic alkalosis, which matches the pH. 5. The PaCO2 in the opposite direction of the alkalotic pH shows that the lungs are trying to compensate for the alkalosis. 6. The PaO2 is within normal limits.
Identify the acid-base imbalances represented by the following laboratory values. pH: 7.26 PaCO2: 56 mm Hg HCO3-: 24 mEq/L PaO2: 68 mm Hg
Interpretation: respiratory acidosis 1. pH, PaCO2 and PaO2 are abnormal. 2. pH < 7.35 shows acidosis. 3. PaCO2 is > 45 mm Hg, matching the pH and indicating respiratory acidosis. 4. HCO3 − is normal. 5. Compensation is not evident until the kidneys have time to retain bicarbonate. 6. PaO2 is < 80 mm Hg, indicating hypoxemia, which may occur with chronic obstructive pulmonary disease (COPD).
Identify the acid-base imbalances represented by the following laboratory values. pH: 7.50 PaCO2: 30 mm Hg HCO3-: 24 mEq/L PaO2: 79 mm Hg
Interpretation: respiratory alkalosis 1. pH, PaCO2 , and PaO2 are abnormal. 2. pH > 7.45 shows alkalosis. 3. PaCO2 is < 35 mm Hg, indicating respiratory alkalosis. Respiratory alkalosis matches the pH. 4. HCO3 − is within 22 to 26 mEq/L which is normal. 5. No compensation is occurring. Although uncommon, if the HCO3 − were decreased, compensation would be present. 6. The PaO2 is < 80 mm Hg, indicating hypoxemia, which is a common cause of respiratory alkalosis.
True or False. An intact thirst mechanism is the MAIN protection against dehydration or hyperosmolality
True
True or False. Hyperkalemia and hypokalemia can both cause dysrhythmias and respiratory arrest.
True
True or False. Reducing Na+ levels by more than 8-15 mEq/L in 8 hrs can cause rapid shifts of fluid into cells (cerebral edema)
True
Which of the following descriptions matches the mechanism of "active transport"? a. Adenosine triphosphate (ATP) required b. Force exerted by a fluid c. Flow of water from low-solute concentration to high-solute concentration d. Passive movement of molecules from a high concentration to lower concentration
a. Adenosine triphosphate (ATP) required
To provide free water and intracellular fluid hydration for a patient with acute gastroenteritis who is NPO, the nurse would expect administration of which infusion? a. Dextrose 5% in water b. Dextrose 10% in water c. Lactated Ringer's solution d. Dextrose 5% in normal saline (0.9%)
a. Dextrose 5% in water Fluids such as 5% dextrose in water (D5W) allow water to move from the ECF to the ICF. Although D5W is physiologically isotonic, the dextrose is rapidly metabolized, leaving free water to shift into cells.
Which of the following descriptions matches the mechanism of "osmotic pressure"? a. Force determined by osmolality of a fluid b. Pressure exerted by plasma proteins c. Force exerted by a fluid d. Uses a protein carrier molecule
a. Force determined by osmolality of a fluid
The nurse is admitting a patient to the clinical unit from surgery. Being alert to potential fluid volume alterations, what assessment data will be important for the nurse to monitor to identify early changes in the patient's postoperative fluid volume (select all that apply)? a. Intake and output b. Skin turgor c. Lung sounds d. Respiratory rate e. Level of consciousness
a. Intake and output b. Skin turgor c. Lung sounds d. Respiratory rate e. Level of consciousness All of these are important in assessing fluid balance in a postoperative patient. Daily weight along with these assessments will provide data about potential fluid volume abnormalities.
What are characteristics of the phosphate buffer system (select all that apply)? a. Neutralizes a strong base to a weak base and water b. Resultant sodium biphosphate is eliminated by kidneys c. Free acid radicals dissociate into H+ and CO2 , buffering excess base d. Neutralizes a strong acid to yield sodium biphosphate, a weak acid, and salt e. Shifts chloride in and out of red blood cells in exchange for sodium bicarbonate, buffering both acids and bases
a. Neutralizes a strong base to a weak base and water b. Resultant sodium biphosphate is eliminated by kidneys d. Neutralizes a strong acid to yield sodium biphosphate, a weak acid, and salt Base neutralization to a weak base, water, and salt and elimination of sodium biphosphate by the kidneys are characteristic of the phosphate buffer system. Free acid radical dissociation is characteristic of the protein buffer system. Chloride shifting in and out of red blood cells is characteristic of the hemoglobin buffer system.
What are the characteristics of the carbonic acid-bicarbonate buffer system (select all that apply)? a. The lungs eliminate CO2 b. Neutralizes HCl acid to yield carbonic acid and salt c. H2CO3 formed by neutralization dissociates into H2O and CO2 d. Shifts H+ in and out of cell in exchange for other cations, such as potassium and sodium e. Free basic radicals dissociate into ammonia and OH− , which combines with H+ to form water
a. The lungs eliminate CO2 b. Neutralizes HCl acid to yield carbonic acid and salt c. H2CO3 formed by neutralization dissociates into H2O and CO2 CO2 elimination by the lungs, neutralized HCl, and H2CO3 formation are all part of the carbonic acid-bicarbonate buffer system. Shifts of H+ in and out of the cell are characteristics of the cellular buffer system. Free basic radical dissociation is characteristic of the protein buffer system.
Which statement(s) about fluid in the human body is (are) true (select all that apply)? a. The primary hypothalamic mechanism of water intake is thirst. b. Third spacing refers to the abnormal movement of fluid into interstitial spaces. c. A cell surrounded by hypoosmolar fluid will shrink and die as water moves out of the cell. d. A cell surrounded by hyperosmolar fluid will shrink and die as water moves out of the cell. e. Concentrations of Na + and K+ in interstitial and intracellular fluids
a. The primary hypothalamic mechanism of water intake is thirst. d. A cell surrounded by hyperosmolar fluid will shrink and die as water moves out of the cell. e. Concentrations of Na + and K+ in interstitial and intracellular fluids With fluid volume deficit, the osmoreceptors stimulate thirst. Hyperosmolar extracellular fluid (ECF) draws fluid out of the cells. The sodium-potassium pump maintains the fluid balance between the intracellular fluid (ICF) and ECF. Third spacing is when fluid moves into spaces that normally have little or no fluid. A cell surrounded by hypoosmolar fluid will swell and burst as water moves into the cell.
Direction of fluid shift "from blood vessels to interstitium" and mechanism of fluid movement "plasma hydrostatic pressure" matches which event factor? a. burns b. dehydration c. fluid overload d. hyponatremia
a. burns
Which of these electrolyte imbalances is the cause of "diabetes insipidus"? (select all that apply) a. hypernatremia b. hyponatremia c. hyperkalemia d. hypokalemia e. hypercalcemia f. hypocalcemia g. hyperphosphatemia h. hypophosphatemia i. hypermagnesemia j. hypomagnesemia
a. hypernatremia
Which of these electrolyte imbalances is the cause of "loop and thiazide diuretics"? (select all that apply) a. hypernatremia b. hyponatremia c. hyperkalemia d. hypokalemia e. hypercalcemia f. hypocalcemia g. hyperphosphatemia h. hypophosphatemia i. hypermagnesemia j. hypomagnesemia
a. hypernatremia b. hyponatremia d. hypokalemia e. hypercalcemia f. hypocalcemia
Which of these electrolyte imbalances is the cause of "hyperaldosteronism"? (select all that apply) a. hypernatremia b. hyponatremia c. hyperkalemia d. hypokalemia e. hypercalcemia f. hypocalcemia g. hyperphosphatemia h. hypophosphatemia i. hypermagnesemia j. hypomagnesemia
a. hypernatremia d. hypokalemia
Which of these electrolyte imbalances is the cause of "osmotic diuresis"? (select all that apply) a. hypernatremia b. hyponatremia c. hyperkalemia d. hypokalemia e. hypercalcemia f. hypocalcemia g. hyperphosphatemia h. hypophosphatemia i. hypermagnesemia j. hypomagnesemia
a. hypernatremia d. hypokalemia
Which of these electrolyte imbalances is the cause of "fleet enemas"? (select all that apply) a. hypernatremia b. hyponatremia c. hyperkalemia d. hypokalemia e. hypercalcemia f. hypocalcemia g. hyperphosphatemia h. hypophosphatemia i. hypermagnesemia j. hypomagnesemia
a. hypernatremia d. hypokalemia f. hypocalcemia g. hyperphosphatemia
Factors that cause sodium retention_____,_______,_______& cause potassium excretion. Select all that apply. a. hyponatremia b. low blood volume c. aldosterone excretion d. hypotonic IV fluids
a. hyponatremia b. low blood volume c. aldosterone excretion
Signs of fluid volume excess: Select all that apply. a. jugular venous distention b. bounding pulses c. pulmonary edema d. orthostatic hypotension
a. jugular venous distention b. bounding pulses c. pulmonary edema
Direction of fluid shift "from blood vessels to interstitium" and mechanism of fluid movement "oncotic pressure" matches which event factor? a. low serum albumin b. administration of 10% glucose c. application of elastic bandages d. dehydration
a. low serum albumin
An elevated level of this electrolyte is common in acute kidney injury & chronic kidney disease. a. phosphate b. calcium c. sodium d. magnesium
a. phosphate
Symptoms of hypernatremia with decreased ECF volume: Select all that apply. a. weight loss b. elevated BP c. agitation, seizures, coma d. hypotension e. pulmonary edema f. flushed skin
a. weight loss c. agitation, seizures, coma d. hypotension f. flushed skin
One liter of fluid is equal to: a. 1.5 lbs. b. 2.2 lbs. c. 3.7 lbs. d. 4.4 lbs.
b. 2.2 lbs.
A patient with a pH of 7.29 has metabolic acidosis. Which value is useful in determining whether the cause of the acidosis is an acid gain or a bicarbonate loss? a. PaCO2 b. Anion gap c. Serum Na + level d. Bicarbonate level
b. Anion gap Anion Gap = Na + − (HCO3 − + Cl − ). Calculate the anion gap by subtracting the serum bicarbonate and chloride levels from the serum sodium level. It should normally be 8 to 12 mmol/L. The anion gap is increased in metabolic acidosis associated with acid gain (e.g., diabetic ketoacidosis) but is normal in metabolic acidosis caused by bicarbonate loss (e.g., diarrhea).
While caring for an 84-year-old patient, the nurse monitors the patient's fluid and electrolyte balance, recognizing what as a normal change of aging? a. Hyperkalemia b. Hyponatremia c. Decreased insensible fluid loss d. Increased plasma oncotic pressures
b. Hyponatremia A decrease in renin and aldosterone and an increase in ADH and atrial natriuretic peptide (ANP) lead to decreased sodium reabsorption and increased water retention by the kidney, both of which lead to hyponatremia. Loss of subcutaneous tissue and thinning dermis of aging lead to increased moisture lost through the skin. Plasma oncotic pressure is often decreased because of lack of protein intake.
A patient is taking diuretic drugs. Which fluid or electrolyte imbalance can occur in this patient (select all that apply)? a. Hyperkalemia b. Hyponatremia c. Hypocalcemia d. Hypotonic fluid loss e. Hypertonic fluid loss
b. Hyponatremia c. Hypocalcemia Because of the osmotic pressure of sodium, water will be excreted with the sodium lost with the diuretic. A change in the relative concentration of sodium will not be seen, but an isotonic fluid loss will occur. Diuretics can also cause a loss of calcium in the urine.
With which disorder is hyperkalemia often associated? a. Hypoglycemia b. Metabolic acidosis c. Respiratory alkalosis d. Decreased urine potassium levels
b. Metabolic acidosis In metabolic acidosis, hydrogen ions in the blood are taken into the cell in exchange for potassium ions as a means of buffering excess acids. This results in an increase in serum potassium until the kidneys have time to excrete the excess potassium
Which of the following descriptions matches the mechanism of "oncotic pressure"? a. Force determined by osmolality of a fluid b. Pressure exerted by plasma proteins c. Force exerted by a fluid d. Uses a protein carrier molecule
b. Pressure exerted by plasma proteins
Direction of fluid shift "from blood vessels to interstitium" and mechanism of fluid movement "osmosis" matches which event factor? a. low serum albumin b. administration of 10% glucose c. application of elastic bandages d. dehydration
b. administration of 10% glucose
Which of the following is the most accurate measure of volume status? a. intake & output b. daily weight c. BUN, sodium & hematocrit levels d. Specific gravity of the urine
b. daily weight
Direction of fluid shift "from extracellular compartment to the cell" and mechanism of fluid movement "interstitial hydrostatic pressure" matches which event factor? a. burns b. dehydration c. fluid overload d. hyponatremia
b. dehydration
Which of these electrolyte imbalances is the cause of "primary polydipsia"? (select all that apply) a. hypernatremia b. hyponatremia c. hyperkalemia d. hypokalemia e. hypercalcemia f. hypocalcemia g. hyperphosphatemia h. hypophosphatemia i. hypermagnesemia j. hypomagnesemia
b. hyponatremia
Which of these electrolyte imbalances is the cause of "early burn stage"? (select all that apply) a. hypernatremia b. hyponatremia c. hyperkalemia d. hypokalemia e. hypercalcemia f. hypocalcemia g. hyperphosphatemia h. hypophosphatemia i. hypermagnesemia j. hypomagnesemia
b. hyponatremia c. hyperkalemia
Which of the following acid-base imbalances is the common cause for mechanical over ventilation? a. respiratory acidosis b. respiratory alkalosis c. metabolic alkalosis d. metabolic acidosis
b. respiratory alkalosis
Which of the following acid-base imbalances is the common cause for response to anxiety, fear, and pain? a. respiratory acidosis b. respiratory alkalosis c. metabolic alkalosis d. metabolic acidosis
b. respiratory alkalosis
Which of the following acid-base imbalances matches the mechanism "decreased carbonic acid (H2CO3)"? a. respiratory acidosis b. respiratory alkalosis c. metabolic alkalosis d. metabolic acidosis
b. respiratory alkalosis
Reasons why a patient might have hyperkalemia: Select all that apply. a. insulin therapy b. tissue breakdown c. diarrhea & vomiting d. tumor lysis syndrome e. renal failure f. salt substitutes
b. tissue breakdown d. tumor lysis syndrome e. renal failure f. salt substitutes
A common collaborative problem related to both hyperkalemia and hypokalemia is which potential complication? a. Seizures b. Paralysis c. Dysrhythmias d. Acute kidney injury
c. Dysrhythmias Potassium maintains normal cardiac rhythm, transmission and conduction of nerve impulses, and contraction of muscles. Cardiac cells have the most clinically significant changes with potassium imbalances because of changes in cardiac conduction. Although paralysis may occur with severe potassium imbalances, cardiac changes are seen earlier and much more commonly.
Which of the following descriptions matches the mechanism of "osmosis"? a. Uses a protein carrier molecule b. Force exerted by a fluid c. Flow of water from low-solute concentration to high-solute concentration d. Passive movement of molecules from a high concentration to lower concentration
c. Flow of water from low-solute concentration to high-solute concentration
Which of the following descriptions matches the mechanism of "hydrostatic pressure"? a. Force determined by osmolality of a fluid b. Pressure exerted by plasma proteins c. Force exerted by a fluid d. Uses a protein carrier molecule
c. Force exerted by a fluid
What is an example of an appropriate IV solution to treat an extracellular fluid volume deficit? a. D5W b. 3% saline c. Lactated Ringer's solution d. D5W in ½ normal saline (0.45%)
c. Lactated Ringer's solution An isotonic solution does not change the osmolality of the blood and does not cause fluid shifts between the ECF and ICF. In the case of ECF loss, an isotonic solution, such as lactated Ringer's solution, is ideal because it stays in the extracellular compartment. A hypertonic solution would pull fluid from the cells into the ECF, resulting in cellular fluid loss and possible vascular overload.
A patient who has a large amount of carbon dioxide in the blood also has what in the blood? a. Large amount of carbonic acid and low hydrogen ion concentration b. Small amount of carbonic acid and low hydrogen ion concentration c. Large amount of carbonic acid and high hydrogen ion concentration d. Small amount of carbonic acid and high hydrogen ion concentration
c. Large amount of carbonic acid and high hydrogen ion concentration The amount of CO2 in the blood directly relates to carbonic acid concentration and subsequently hydrogen ion concentration. The CO2 combines with water in the blood to form carbonic acid and in cases in which CO2 is retained in the blood, acidosis occurs.
As fluid circulates through the capillaries, there is movement of fluid between the capillaries and interstitium. What describes the fluid movement that would cause edema (select all that apply)? a. Plasma hydrostatic pressure is less than plasma oncotic pressure. b. Plasma oncotic pressure is higher than interstitial oncotic pressure. c. Plasma hydrostatic pressure is higher than plasma oncotic pressure. d. Plasma hydrostatic pressure is less than interstitial hydrostatic pressure. e. Interstitial hydrostatic pressure is lower than plasma hydrostatic pressure.
c. Plasma hydrostatic pressure is higher than plasma oncotic pressure. e. Interstitial hydrostatic pressure is lower than plasma hydrostatic pressure. At the arterial end of the capillary, capillary hydrostatic pressure exceeds plasma oncotic pressure and fluid moves into the interstitial space. At the capillary level, hydrostatic pressure is the major force causing fluid to shift from vascular to the interstitial space. The other options would not cause edema.
Direction of fluid shift "from interstitium to vessels" and mechanism of fluid movement "interstitial hydrostatic pressure" matches which event factor? a. low serum albumin b. administration of 10% glucose c. application of elastic bandages d. dehydration
c. application of elastic bandages
Fluid and electrolytes are transported by this method which occurs with the use of proteins a. diffusion b. active transport c. facilitated diffusion d. osmosis e. hydrostatic pressure f. oncotic pressure
c. facilitated diffusion
Direction of fluid shift "from cell to extracellular compartment and from interstitium to vessels" and mechanism of fluid movement "tissue oncotic pressure" matches which event factor? a. burns b. dehydration c. fluid overload d. hyponatremia
c. fluid overload
Which of these electrolyte imbalances is the cause of "chronic kidney disease"? (select all that apply) a. hypernatremia b. hyponatremia c. hyperkalemia d. hypokalemia e. hypercalcemia f. hypocalcemia g. hyperphosphatemia h. hypophosphatemia i. hypermagnesemia j. hypomagnesemia
c. hyperkalemia f. hypocalcemia g. hyperphosphatemia i. hypermagnesemia
Which of the following acid-base imbalances is the common cause for baking soda used as antacid? a. respiratory acidosis b. respiratory alkalosis c. metabolic alkalosis d. metabolic acidosis
c. metabolic alkalosis
Which of the following acid-base imbalances is the common cause for prolonged vomiting? a. respiratory acidosis b. respiratory alkalosis c. metabolic alkalosis d. metabolic acidosis
c. metabolic alkalosis
Which of the following acid-base imbalances matches the mechanism "increased base bicarbonate (HCO3-)"? a. respiratory acidosis b. respiratory alkalosis c. metabolic alkalosis d. metabolic acidosis
c. metabolic alkalosis
In a patient with a positive Chvostek's sign, the nurse would expect the IV administration of which medication? a. Calcitonin b. Vitamin D c. Loop diuretics d. Calcium gluconate
d. Calcium gluconate Chvostek's sign is a contraction of facial muscles in response to a tap over the facial nerve. This indicates the neuromuscular irritability of low calcium levels. IV calcium is the treatment used to prevent laryngeal spasms and respiratory arrest. Calcitonin and loop diuretics are treatments for hypercalcemia. Oral vitamin D supplements are part of the treatment for hypocalcemia but not for impending tetany.
In a patient with sodium imbalances, the primary clinical manifestations are related to alterations in what body system? a. Kidneys b. Cardiovascular system c. Musculoskeletal system d. Central nervous system
d. Central nervous system As water shifts into and out of cells in response to the osmolality of the blood, the cells that are most sensitive to shrinking or swelling are those of the brain, resulting in neurologic symptoms.
What is a compensatory mechanism for metabolic alkalosis? a. Shifting of bicarbonate into cells in exchange for chloride b. Kidney conservation of bicarbonate and excretion of hydrogen ions c. Deep, rapid respirations (Kussmaul respirations) to increase CO2 excretion d. Decreased respiratory rate and depth to retain CO2 and kidney excretion of bicarbonate
d. Decreased respiratory rate and depth to retain CO2 and kidney excretion of bicarbonate Decreased respiratory rate and kidney excretion of HCO3 − compensates for metabolic alkalosis. Shifting of bicarbonate for Cl − may buffer acute respiratory alkalosis. The kidney conserves bicarbonate and excretes hydrogen to compensate for respiratory acidosis. Kussmaul respirations occur with metabolic acidosis to compensate.
What stimulates aldosterone secretion from the adrenal cortex? a. Excessive water intake b. Increased serum osmolality c. Decreased serum potassium d. Decreased sodium and water
d. Decreased sodium and water Aldosterone is secreted by the adrenal cortex in response to a decrease in plasma volume (loss of water) and resulting decreased renal perfusion; decreased serum sodium, increased serum potassium, or adrenocorticotropic hormone (ACTH).
Which patient is at risk for hypernatremia? a. Has an aldosterone deficiency b. Has prolonged vomiting and diarrhea c. Receives excessive IV 5% dextrose solution d. Has impaired consciousness and decreased thirst sensitivity
d. Has impaired consciousness and decreased thirst sensitivity A major cause of hypernatremia is a water deficit, which can occur in those with a decreased sensitivity to thirst, the major protection against hyperosmolality. All other conditions lead to hyponatremia
Which of the following descriptions matches the mechanism of "diffusion"? a. Uses a protein carrier molecule b. Force exerted by a fluid c. Flow of water from low-solute concentration to high-solute concentration d. Passive movement of molecules from a high concentration to lower concentration
d. Passive movement of molecules from a high concentration to lower concentration
Priority Decision: On assessment of a central venous access device (CVAD) site, the nurse notes that the transparent dressing is loose along 2 sides. What should the nurse do immediately? a. Wait and change the dressing when it is due. b. Tape the 2 loose sides down and document. c. Apply a gauze dressing over the transparent dressing and tape securely. d. Remove the dressing and apply a new transparent dressing using sterile technique.
d. Remove the dressing and apply a new transparent dressing using sterile technique. The greatest risk with central venous access device (CVAD) is systemic infection. Dressings that are loose should be changed at once to reduce this risk.
Which of the following descriptions matches the mechanism of "facilitated diffusion"? a. Force determined by osmolality of a fluid b. Pressure exerted by plasma proteins c. Force exerted by a fluid d. Uses a protein carrier molecule
d. Uses a protein carrier molecule
Which of these electrolyte imbalances is the cause of "chronic alcoholism"? (select all that apply) a. hypernatremia b. hyponatremia c. hyperkalemia d. hypokalemia e. hypercalcemia f. hypocalcemia g. hyperphosphatemia h. hypophosphatemia i. hypermagnesemia j. hypomagnesemia
d. hypokalemia f. hypocalcemia i. hypermagnesemia j. hypomagnesemia
Which of these electrolyte imbalances is the cause of "excess milk of magnesia"? (select all that apply) a. hypernatremia b. hyponatremia c. hyperkalemia d. hypokalemia e. hypercalcemia f. hypocalcemia g. hyperphosphatemia h. hypophosphatemia i. hypermagnesemia j. hypomagnesemia
d. hypokalemia h. hypophosphatemia i. hypermagnesemia
Direction of fluid shift "from interstitium to vessels" and mechanism of fluid movement "osmosis" matches which event factor? a. burns b. dehydration c. fluid overload d. hyponatremia
d. hyponatremia
A new nurse caring for a pt. with hypocalcemia needs further teaching about this condition if they: a. Vitamin D supplements b. test for hypocalcemia with Chvostek's sign c. IV calcium gluconate d. inducing hyperventilation
d. inducing hyperventilation
Which body compartment has the most amount of fluid in the body? a. extracellular b. blood vessels c. interstitial spaces d. intracellular
d. intracellular
Which of the following acid-base imbalances is the common cause for diabetic ketosis? a. respiratory acidosis b. respiratory alkalosis c. metabolic alkalosis d. metabolic acidosis
d. metabolic acidosis
Which of the following acid-base imbalances is the common cause for renal failure? a. respiratory acidosis b. respiratory alkalosis c. metabolic alkalosis d. metabolic acidosis
d. metabolic acidosis
Which of the following acid-base imbalances is the common cause for severe shock? a. respiratory acidosis b. respiratory alkalosis c. metabolic alkalosis d. metabolic acidosis
d. metabolic acidosis
Which of the following acid-base imbalances matches the mechanism "decreased base bicarbonate (HCO3-)"? a. respiratory acidosis b. respiratory alkalosis c. metabolic alkalosis d. metabolic acidosis
d. metabolic acidosis
Which of these electrolyte imbalances is the cause of "Vitamin D deficiency"? (select all that apply) a. hypernatremia b. hyponatremia c. hyperkalemia d. hypokalemia e. hypercalcemia f. hypocalcemia g. hyperphosphatemia h. hypophosphatemia i. hypermagnesemia j. hypomagnesemia
f. hypocalcemia h. hypophosphatemia
