Exam 1 (Fluids, Electrolytes, Acid-Base)

Question 0

Normal range for K+

Answer 0

3.5-5.0 mEq/L

Question 1

Na+ normal range

Answer 1

136-145 mEq/L

Question 2

Normal range for Ca++

Answer 2

8.8-10.5 mg/dL

Question 3

Normal range of Mg+

Answer 3

1.3-2.1 mEq/L

Question 4

Normal range for Cl-

Answer 4

95-105 mEq/L

Question 5

Normal range for phosphate (mostly HPO4-)

Answer 5

3.0-4.5 mg/L

Question 6

Normal range for pH

Answer 6

7.35-7.45

Question 7

Normal range for CO2

Answer 7

35-44 mm Hg

Question 8

Normal range for O2

Answer 8

80-100 mm Hg

Question 9

Normal range for bicarbonate (HCO3)?

Answer 9

21-28 mEq/L

Question 10

Osmolality

Answer 10

The concentration of a solution in terms of osmoles of solutes per kilogram of solvent.

High osmolality means that there is less water than solute - WATER DEFICIT

Low osmolality means that there is more water than solute - WATER EXCESS

Question 11

Osmolarity

Answer 11

The concentration of a solution n terms of osmoles or milliosmoles of solutes per liter of solution. (The solutes, or solid particles, are electrolytes such as sodium.)

Question 12

Isotonic

Answer 12

Having the same concentration of solute as another solution – this means each solution has the same oncotic pressure.

Having equal tension

Question 13

Hypotonic

Answer 13

Having a smaller concentration of solute than another solution

The solution having the smaller concentration exerts less oncotic pressure than the solution with greater concentration of solutes.

Question 14

Hypertonic

Answer 14

Having a greater concentration of solute than another solution

The solution having the greater concentration exerts more oncotic pressure than the solution with smaller concentration of solutes

Question 15

Colloid osmotic pressure

Answer 15

Colloids are particles with large molecular weights

The colloids are too large to move across the membrane

Plasma colloid osmotic pressure is the osmotic pressure exerted by these proteins

Question 16

Tissue hydrostatic pressure

Answer 16

The pressure exerted on the interstitial fluid by the elastic recoil of the tissues in any region of the body

This force tends to push water from the interstitial fluid back into the capillaries

Question 17

High/low osmolarity causes:

Answer 17

High osmolarity causes:

• Thirst -> increased water intake
• ADH release -> water reabsorbed from urine

Low osmolarity causes:

• Lack of thirst -> decreased water intake
• Decreased ADH release -> water lost in urine

Question 18

True/False

Increased levels of ADH decrease urine output

Answer 18

True

ADH prevents diuresis by causing more water to be absorbed in the kidney tubules. If more water is absorbed, there is less water left to eliminate as waste, decreasing urine output.

Question 19

Clinical manifestations r/t ADH elevation

Answer 19

Mild central nervous system dysfunction: malaise, anorexia, nausea, vomiting, headache

Severe central nervous system dysfunction: confusion, lethargy, seizures, coma, fatal cerebral herniation

Question 20

Comparison of ADH & Aldosterone

Answer 20

• ADH is the “tap water” hormone - causes kidneys to reabsorb water; renal absorption of water due to ADH makes a smaller volume of more concentrated urine
• Aldosterone is the “saltwater” hormone - causes kidneys to reabsorb sodium and water; renal reabsorption of sodium and water due to aldosterone makes a smaller volume of urine

Question 21

Hypovolemia Clinical Manifestations (S/S)

Answer 21

_ Sudden weight loss
_ Postural blood pressure decrease with concurrent increased heart rate
- Flat neck veins when a patient is supine
- Prolonged small vein filling time
- Prolonged capillary refill time
- Lightheadedness
- Dizziness
- Syncope
- Oliguria or small volume of concentrated urine
- Decreased skin turgor
- Dryness of oral mucous membranes btwn cheek & gum
- Hard stools
- Soft sunken eyeballs
- Longitudinal furrows in the tongue
- Absence of tears & sweat
- In infants, fontanel may be sunken; neck veins not reliably assessed in infants

Question 23

Types of abnormal fluid loss

Answer 23

• Emesis (vomiting)
• Tubes in the GI tract or other body cavities
• Hemorrhage
• Drainage from fistulas, wounds, or open skin
• Paracentesis

Question 24

The nurse is caring for a client with congestive heart failure. On assessment, the nurse notes that the client is dyspneic and that crackles are audible on auscultation. The nurse suspects excess fluid volume. What additional signs would the nurse expect to note in this client if excess fluid volume is present?

1. Weight loss
2. Flat neck and hand veins
3. An increase in blood pressure
4. A decreased central venous pressure (CVP)

Answer 24

3. An increase in blood pressure

A fluid volume excess is also known as overhydration or fluid overload and occurs when fluid intake or fluid retention exceeds the fluid needs of the body. Assessment findings associated with fluid volume excess include cough, dyspmnea, crackles, tachypnea, tachycardia, elevated blood pressure, bounding pulse, elevated CVP, weight gain, edema, neck and hand vein distention, altered level of consciousness, and decreased hematocrit.

Question 25

A nurse is preparing to care for a client with a potassium deficit. The nurse reviews the client’s record and determines that the client was at risk for developing the potassium deficit because the client:

1. Sustained tissue damage
2. Requires nasogastric suction
3. Has a history of Addison’s disease
4. Is taking a potassium-sparing diuretic

Answer 25

2. Requires nasogastric suction

The normal serum potassium level is 3.5 mEq/L to 5.1 mEq/L. A potassium deficit is known as hypokalemia. Potassium-rich gastrointestinal fluids are lost through gastrointestinal suction, placing the client

Question 26

The nurse would identify which set of blood gas values as consistent with a diagnosis of respiratory acidosis in a client?

1. pH 7.0; PaCO2 42, HCO3- 24
2. pH 7.46; PaCO2 38, HCO3- 22
3. pH 7.35; PaCO2 44, HCO3- 26
4. pH 7.32; PaCO2 48, HCO3- 25

Answer 26

1. 4
   The nurse would expect to see a decreased pH and increased PaCO2 in a client with respiratory acidosis (pH 7.32; PaCO2 48, HCO3- 25). Normal pH is 7.35 to 7.45, and normal PaCO2 is 35 to 45 mm Hg. This series of values (pH 7.0; PaCO2 42, HCO3- 24) indicates a very low pH, which is moving into the range of incompatibility f with life. This series of values (pH 7.46; PaCO2 38, HCO3- 22) is mostly within normal range with just a slight elevation in the pH. This series of values (pH 7.35; PaCO2 44, HCO3- 26) are within the normal range.

Question 27

An older adult client is experiencing difficulty with edema and fluid overload. What nursing intervention would be the most accurate in evaluating the client’s fluid balance?

1. Measure the intake and output
2. Check for thirst and skin turgor
3. Evaluate changes in daily weight
4. Evaluate vital signs every 3 hours

Answer 27

2. 3
   The priority assessment for a client with fluid problems is to obtain the daily weight. Weight gain and loss are the most accurate measurements of fluid gain and loss. Checking tissue turgor on an older adult is not very accurate since many older adults have poor turgor. Thirst is too nonspecific. The I&O is important, but it is not as accurate in evaluating the amount of fluid retained as is the daily weight.