Chapter 36 - Fluid & Electrolytes (Week 6 Quiz)

Question 1

A ______ is a solid substance dissolved in body fluids. It can be crystalloid (readily dissolves) or colloid (larger molecule that does not dissolve as easy)

Answer 1

solute

Question 2

Define solute

Answer 2

● A solute is a solid substance dissolved in body fluids.

Question 3

An ______ is a substance that develops an electrical charge when dissolved in water.
●

Answer 3

electrolyte

Question 4

_______fluid is fluid contained within the cells.

______ fluid is fluid outside the cells. It consists of three types of fluid: interstitial, intravascular, and transcellular fluid.

Answer 4

Intracellular

Extracellular

Question 5

A ______ is an electrolyte that carries a positive charge. They include sodium (Na+), potassium (K+), calcium (Ca2+), and magnesium (Mg2+).

An ______ is an electrolyte that carries a negative charge. Examples are chloride (Cl−), bicarbonate (HCO3−), phosphate (HPO42−), and sulfate (SO42−).

Answer 5

cation

anion

Question 6

An ______ is a substance that develops an electrical charge when dissolved in water.

Answer 6

electrolyte

Question 7

Identify the major electrolytes in the ICF and ECF.

Answer 7

These cellular fluids contain the following major electrolytes:
● In intracellular fluid (ICF), the major cations are potassium (K+) and magnesium (Mg2+), and the major anion is phosphate (HPO42−) .
● In extracellular fluid (ECF), the major cation is sodium (Na+), and the major anions are chloride (Cl−) and bicarbonate (HCO3−).

Question 8

What are the functions of body fluids?

Answer 8

1. maintain blood volume
2. regulate body temp
3. transport material to and from cells
4. serve as medium for cellular metabolism
5. Assist with digestion of food
6. Serve as medium for excreting waste

Question 9

T or F: Water content varies with age, sex, adipose tissue. The more fat you have the less water you have compared to a person of a lean build.

Answer 9

true.

p.914

Question 10

Most body fluid is contained withing two compartments:

_______fluid is fluid contained within the cells. It is essential for cell function and metabolism.

______ fluid is fluid outside the cells. It carries water, electrolytes, nutrients, and oxygen to cells and removes waste products. It consists of three types of fluid: interstitial, intravascular, and transcellular fluid.

Answer 10

Intracellular

Extracellular

Question 11

Most body fluid is contained withing two compartments:

_______fluid is fluid contained within the cells. It is essential for cell function and metabolism.

______ fluid is fluid outside the cells. It carries water, electrolytes, nutrients, and oxygen to cells and removes waste products. It consists of three types of fluid: interstitial, intravascular, and transcellular fluid.

Answer 11

Intracellular

Extracellular

Question 12

_____ fluid lies between the body cells. excess of this fluid is called edema.

____ fluid is the plasma within the blood. It transports blood cells.

______ fluid includes specializes fluids such as cerebrospinal, pleural, peritoneal, synovial, and digestive juices.

Answer 12

interstitial, intravascular, and transcellular fluid.

Question 13

______ is the accumulation of fluid in the peritoneal cavity, causing abdominal swelling.

Answer 13

ascites

Question 14

A ______ is an electrolyte that carries a positive charge. They include sodium (Na+), potassium (K+), calcium (Ca2+), and magnesium (Mg2+).

An ______ is an electrolyte that carries a negative charge. Examples are chloride (Cl−), bicarbonate (HCO3−), phosphate (HPO42−), and sulfate (SO42−).

Answer 14

cation

CaNaK Mg

anion

Question 15

Identify the major electrolytes in the ICF and ECF.

Answer 15

These cellular fluids contain the following major electrolytes:
● In intracellular fluid (ICF), the major cations are potassium (K+) and magnesium (Mg2+), and the major anion is phosphate (HPO42−) .

● In extracellular fluid (ECF), the major cation is sodium (Na+), and the major anions are chloride (Cl−) and bicarbonate (HCO3−).

Question 16

_______: movement of water across a membrane from one area of less concentrated solution to greater concentrated solution

_______: movement of molecules of solute from Higher to lower concentration

Answer 16

Osmosis

Diffusion

Question 17

________: movement water & smaller particles from area of high pressure to one of low pressure

____ ______: movement of molecules (electrolytes) from area of low concentration to high concentration

Answer 17

Filtration

Active transport

Question 18

_______: movement of water across a membrane from one area of less concentrated solution to greater concentrated solution

________: movement water & smaller particles from area of high pressure to one of low pressure

Answer 18

Osmosis (concentration)

Filtration (pressure)

Question 19

____ ______: movement of molecules (electrolytes) from area of low concentration to high concentration

_______: movement of molecules of solute from Higher to lower concentration

Answer 19

Active transport (low to high uses energy, like climbing stairs to get to the top of a slide)

Diffusion (going down a slide)

Question 20

_______: movement of water across a membrane from one area of less concentrated solution to greater concentrated solution

________: movement water & smaller particles from area of high pressure to one of low pressure

Answer 20

Osmosis (concentration related - not pressure)…goes toward concentrated area to dilute it.

Filtration (pressure related)

Question 21

What are the three passive transport systems?

Answer 21

osmosis, diffusion, filtration

Question 22

The concentration of solutes providing pressure in body fluid is called….

____ refers to the # of particles of solute per kg of water.

Answer 22

osmolality

osmols

Question 23

The concentration of solutes providing pressure in body fluid is called….

____ refers to the # of particles of solute per kg of water.

Answer 23

osmolality (also called tonicity)

osmols

Question 24

______ pressure is the force created by fluid within a closed system and is responsible for normal circulation of blood. Blood flows from the high pressure arterial system to the low pressure capillaries and veins.

Answer 24

hydrostatic

Question 25

______ pressure is the FORCE created by fluid within a closed system and is responsible for normal circulation of blood. Blood flows from the high pressure arterial system to the low pressure capillaries and veins.

Answer 25

hydrostatic

Question 26

____ pressure is the power of a solution to DRAW water.

Answer 26

osmotic pressure

Question 27

____ pressure is the power of a solution to DRAW water.

Answer 27

osmotic pressure

Plasma proteins in the blood exert osmotic pressure.

Question 28

Identify the appropriate mechanism: osmosis, diffusion, filtration, or active transport.

● Molecules move across a membrane to equalize concentration.

● Fluid moves across a membrane to equalize concentration.

● Molecules move against a concentration gradient.

● Molecules move to equalize pressure.

Answer 28

Answer:
Diffusion

Answer:
Osmosis

Answer:
Active transport

Answer:
Filtration

Question 29

Identify the appropriate mechanism: osmosis, diffusion, filtration, or active transport.

● Molecules move across a membrane to equalize concentration.

● Fluid moves across a membrane to equalize concentration.

● Molecules move against a concentration gradient.

● Molecules move to equalize pressure.

Answer 29

Answer:
Diffusion

Answer:
Osmosis

Answer:
Active transport

Answer:
Filtration

Question 30

T or F: IOM recommends 2700 mL/day women, 3500 mL/day men.

Answer 30

True. And this is much higher than the 6-8 8-ounce glasses…

Question 31

Situations that increase plasma osmalality and promote thirtst include

Answer 31

excessive fluid loss
excessive sodium intae
decreased fluid intake

Question 32

Situations that increase plasma osmalality and promote thirtst include

Answer 32

excessive fluid loss
excessive sodium intake
decreased fluid intake

Question 33

What is the difference between sensible and insensible fluid loss?

Answer 33

Sensible can be perceived and easily measured.

Insensible cannot… it is evaporation through skin, lungs and accounts for about 900mL/day

Question 34

What are ways fluid leaves the body (output)

Answer 34

Urine: 1500 mL/day

Skin: perspiration

Lungs: exhalation

Feces: 100–200 mL/day

Question 35

_____ are the principal regulator of fluid and electrolyte balance.

Answer 35

Kidneys

Question 36

The pituitary gland releases _____ if the fluid volume/pressure is low. It causes the kidney to retain fluid.

Answer 36

ADH
AntiDiuretic Hormone

Anti diuretic..against diuretic….against water loss.

Question 37

The pituitary gland releases _____ if the fluid volume/pressure in the body is low. It causes the kidney to retain fluid.

Answer 37

ADH
AntiDiuretic Hormone

Anti diuretic..against diuretic….against water loss.

Question 38

When extracellular fluid volume is decreased, the kidney release renin. Renin converts angiotensin I into II. What does angiotensin II do?

Answer 38

acts on the nephrons to retain sodium and water.

It also directs adrenal cortex to release aldosterone.

Question 39

When aldosterone is released it stimulates the kidneys to reabsorb _____ and excrete _____.

Answer 39

Sodium; potassium

Question 40

When aldosterone is released it stimulates the kidneys to reabsorb _____ and excrete _____.

Answer 40

Sodium; potassium

aldostee salty

Question 41

______ is the discharge of sodium through urine.

Answer 41

Natriuresis.

NAtriuresis
Na=Sodium
uresis=excretion of urine

Question 42

T or F: Moderate potassium deficiency is associated with increased blood pressure.

Answer 42

True

Question 43

____ can donate hydrogen ions

____ can accept hydrogen ions

Answer 43

acid

base (alkali)

Question 44

Remember: for every 1 number on the pH scale, it is TEN TIMEs more or less acidic or basic

Answer 44

Example:

An acid that is 4 on pH is ten times more acidic than a pH of 5.

Question 45

Three complex mechanisms maintain acid-base balance. They are :

Answer 45

1. Buffers
2. Respiratory control of CO2 (carbon dioxide)
3. renal regulation of HCO3 (bicarbonate)

Question 46

How do buffer systems work?

Answer 46

Weak acid and weak base either absorb or release hydrogen ions.

Question 47

Carbonic Acid-SOdium bicarbonate systems balance between carbonic acid (H2CO3) and sodium bicarbonate (NaHCO3). As long as they stay in balance (20:1 NaHCO3:H2CO3), the body’s pH remains the same.

If bicarbonate, used to neutralize acid, becomes depleted, the pH will drop and become more acidic. This is called…

Answer 47

acidosis

remember the lower the number the more acidic.

Question 48

The lungs are the second line of defense to restore normal pH. They control the body’s carbonic acid supply by carbond dioxide _____ or _____.

Answer 48

retention or removal

Question 49

T or F: When the body is too acidic, the body will rapid/deep breathe.

Answer 49

True. Does this to remove carbon dioxide which will raise the pH to a more neutral number.

Question 50

T or F: When the body is too acidic, the body will rapid/deep breathe.

Answer 50

True. Does this to remove carbon dioxide which will raise the pH to a more neutral number.

Breathe it OUT

Question 51

T or F: If the pH is too high (too alkaline), the lungs will try to conserve carbon dioxide through shallow respiration.

Answer 51

True!

This is how the carbonic acid-sodium bicarbonate buffer system works.

Question 52

The last line of defense is the kidneys, which regulate the concentration of plasma _____.

Answer 52

bicarbonate

Question 53

Briefly describe the three mechanisms used to maintain pH.

Answer 53

Answer:
The three mechanisms that maintain pH (acid–base balance) are buffers, respiratory mechanisms, and renal mechanisms:
● Buffers. Buffer systems respond to electrolyte imbalances to prevent wide swings in pH. A buffer system consists of a weak acid and a weak base. These molecules react with strong acids or bases to keep them from altering the pH by either absorbing free hydrogen ions or releasing free hydrogen ions (H+).
● Respiratory. When the serum pH is too acidic (pH is low), the lungs remove carbon dioxide (CO2) through rapid, deep breathing. This reduces the amount of carbon dioxide available to make carbonic acid (H2CO3)in the body. If the serum pH is too alkaline (pH is high), the lungs try to conserve carbon dioxide through shallow respirations.
● Renal. The kidneys affect pH by regulating the amount of bicarbonate (a base, HCO3−) that is kept in the body. If the serum pH is too acidic, the kidneys reabsorb additional bicarbonate to neutralize the acid. If the serum pH is too alkaline, the kidneys excrete additional bicarbonate to lower the amount of base and thereby decrease the pH. The kidneys also buffer pH by forming acids and ammonium (a base).

Question 54

Rank order the acid–base balance mechanisms from most rapidly acting to the most slowly acting.

Answer 54

Answer:
The three acid–base balance mechanisms are ranked as follows:
● Buffers act the most rapidly.
● Respiratory mechanisms are intermediate.
● Renal mechanisms act the slowest.

Question 55

The last line of defense is the kidneys, which regulate the concentration of plasma _____.

Answer 55

bicarbonate

The kidneys are slow at doing it, but they can neutralize a larger amount of acid or base than the other methods.

Question 56

_____ _____ _____ occurs when there is a proportional loss of fluid and electrolytes from the ECF.

Answer 56

deficient fluid volume

Two examples:
Hypovolemia - loss of blood volume
Dehydration - negative fluid balance with loss of water.

Question 57

Three causes of dehydration?

Answer 57

1. insufficient intake
2. excessive fluid loss (bleeding, vomiting, diarrhea); electrolytes will be lost
3. Fluid shifts (from Intravascular to body tissue).

Question 58

____ _____ is an emergency condition in which severe blood and fluid loss make the heart unable to pump enough blood to the body. This type of shock can cause many organs to stop working.

Answer 58

Hypovolemic shock

Question 59

____ _____ is defined as a decrease in systolic blood pressure of 20 mm Hg or a decrease in diastolic blood pressure of 10 mm Hg within three minutes of standing when compared with blood pressure from the sitting or supine position. Dizzy upon standing.

Answer 59

Orthostatic hypotension

Question 60

Symptoms of dehydration?

Answer 60

Dry skin and mucous membranes
Nonelastic skin and tongue turgor
Decreased urine output 
rise in temperature
Muscle weakness

Question 61

T or F: A patient with fluid volume deficit usually has elevated BUN to creatinine ratio and elevated hematocrit.

Answer 61

True.

Same amount of solid substances in less water = more concentration.

Question 62

T or F: Specific gravity of the urine increases as the kidneys attempt to conserve water, resulting in more concentrated urine.

Answer 62

True.

Instead of a lot of pee, you get less pee but dark and cloudy.

Question 63

_____, or fluid overload, is the medical condition where there is too much fluid in the blood. The opposite condition is hypovolemia, which is too little fluid volume in the blood.

Answer 63

Hypervolemia

Question 64

What are some causes of excess fluid volume?

Answer 64

1. excessive salt intake
2. disease affecting kidney or liver function.
3. poor pumping action of the heart

Question 65

What are some causes of excess fluid volume? What are some signs?

Answer 65

1. excessive salt intake
2. disease affecting kidney or liver function.
3. poor pumping action of the heart

Opposite of hypo… full of water like a balloon so:

1. BP elevated
2. pulse bounding
3. respiration increase and are shallow
4. neck veins distended

Question 66

What are some causes of excess fluid volume? What are some signs?

Answer 66

1. excessive salt intake
2. disease affecting kidney or liver function.
3. poor pumping action of the heart

Opposite of hypo… full of water like a balloon so:

1. BP elevated
2. pulse bounding
3. respiration increase and are shallow
4. neck veins distended
5. edema
6. Lots of pee
7. cool skin (sweating/cooling)

Question 67

T or F: In sever fluid overload you may encounter crackles in the lungs, dyspnea, and ascites.

Answer 67

True

Question 68

Define deficient fluid volume and excess fluid volume.

Answer 68

Answer:
These terms have the following definitions:
● Deficient fluid volume occurs when there is a proportional loss of water and electrolytes from the ECF. It may occur as a result of insufficient intake of isotonic fluid; bleeding; excessive loss through urine, skin, insensible losses, or the gastrointestinal tract; or loss of fluid into a third space.
● Excess fluid volume involves excessive retention of sodium and water in the ECF. A synonym is hypervolemia. Fluid volume excess occurs as a result of excessive salt intake, disease affecting kidney or liver function, or poor pumping action of the heart.

Question 69

Identify the signs and symptoms of deficient fluid volume and excess fluid volume.

Answer 69

Answer:
The following are signs and symptoms related to fluid volume:
● Deficient fluid volume (hypovolemia):
● The first symptom of hypovolemia is thirst. If the patient is able to recognize and respond to this symptom by drinking liquid, no further treatment may be required. If fluid is not available or the patient is unable to consume the liquid, the syndrome progresses. As fluid volume decreases, the heart pumps the remaining blood faster but not as powerfully, resulting in a rapid, weak pulse and a low blood pressure, although, initially as fluid is lost and the heart beats faster, the blood pressure rises through vasoconstriction in an attempt to keep blood flow and oxygenation going. Eventually, compensatory mechanisms wear out and blood pressure falls.
● Water is pulled from the interstitial spaces and the intracellular fluid into the vascular system, resulting in dry skin and mucous membranes, decreased skin turgor, and decreased urine output.
● Patients complain of muscle weakness, fatigue, and feeling warm. Temperature increases because the body is less able to cool itself through perspiration. In an older adult, temperature will rise but may not be elevated above normal body temperature.
● Weight is a sensitive measure of fluid loss. A sudden 5% loss of body weight is considered clinically significant. When loss approaches 8%, fluid loss is severe. A loss of 15% of body weight due to fluid loss is usually fatal.
● The patient with fluid volume deficit usually has an elevated blood urea nitrogen (BUN) level and elevated hematocrit. Both values increase because there is less water in proportion to the solid substances being measured. Specific gravity of the urine increases.
● Excess fluid volume (hypervolemia):
● The blood pressure is elevated, pulse is bounding, and respirations are increased and shallow.
● The neck veins may become distended, and edema develops in dependent areas.
● The skin is pale and cool.
● Urine output becomes dilute, and volume increases.
● The patient rapidly gains weight. In severe fluid overload, the patient develops moist crackles in the lungs, dyspnea, and ascites (excess peritoneal fluid).
● Hemodilution causes BUN, hematocrit, and the specific gravity of urine to decrease.

Question 70

Describe dehydration and hypervolemia.

Answer 70

Answer:
● Dehydration implies the loss of water only.
● Hypervolemia implies excess water.
Neither involves changes in electrolyte levels

Question 71

The last line of defense is the kidneys, which regulate the concentration of plasma _____.

Answer 71

bicarbonate

The kidneys are slow at doing it, but they can neutralize a larger amount of acid or base than the other methods.

Question 72

______ is a mechanism by which the kidneys can regulate the plasma pH. It is slower than respiratory compensation, but has a greater ability to restore normal values.

Answer 72

Renal compensation

Question 73

What is hyponatremia?

Answer 73

condition that occurs when the level of sodium in your blood is abnormally low

Question 74

What is hyponatremia?

Answer 74

condition that occurs when the level of sodium in your blood is abnormally low

Question 75

What is hypernatremia?

Answer 75

an elevated sodium level in the blood

Question 76

____ occurs when pH falls below 7.35

_____ occurs hen pH increases above 7.45

ABG is used to monitor this balance.

Answer 76

acidosis

alkalosis

Question 77

Difference between metabolic and respiratory acidosis/alkalosis?

Answer 77

resp disturbance vs metabolic disturbance causing the issue.

Question 78

REMEMBER:

pH = 7.35-7.45

CO2 = 35-45 mmHg

HCO3 = 22-26 mEq/L

Answer 78

pH = 7.35-7.45

CO2 = 35-45

HCO3 = 22-26

Question 79

What are the steps to interpret Acid Base balance?

Answer 79

1. Examine the pH

2. Examine Pco2 amd HCO3

Question 80

What are the steps to interpret Acid Base balance?

Answer 80

1. Examine the pH - acidic?alkalotic?normal?
2. Examine Pco2 and HCO3:
   * *which one at fault? you can tell by which one has abnormal number
   * *high or low? (acid or basic)?
3. Compensation? (takes 3 days for kidneys to compensate)
   * **If pH abnormal and only one ABG are abnormal = no comp
   * **If pH abnormal and one ABG are abnormal PLUS a the other is beginning to change (or changed) = partial compensation

***pH is normal BUT ABG’s are both abnormal = Full compensation

Question 81

Interpret the following ABG results.

pH = 7.53 PCO2 = 26 mm Hg HCO3− = 22 mEq/L

pH = 7.40 PCO2 = 39 mm Hg HCO3− = 25 mEq/L

pH = 7.30 PCO2 = 70 mm Hg HCO3− = 30 mEq/L

pH = 7.48 PCO2 = 46 mm Hg HCO3− = 30 mEq/L

Answer 81

Answer:
Respiratory alkalosis uncompensated

Answer:
Normal ABG results

Answer:
Respiratory acidosis, partially compensated

Answer:
Metabolic alkalosis, partially compensated

Question 82

Difference between metabolic and respiratory acidosis/alkalosis?

Answer 82

resp disturbance vs metabolic disturbance causing the issue.

Metabolic = HCO3
Respiratory = CO2

When one system is compromised or having trouble the other will attempt to balance out. Kidneys take 3 days to compensate for imbalance.

Question 83

Identify the signs and symptoms of deficient fluid volume and excess fluid volume.

Answer 83

Answer:
The following are signs and symptoms related to fluid volume:
● Deficient fluid volume (hypovolemia):
● The first symptom of hypovolemia is thirst. If the patient is able to recognize and respond to this symptom by drinking liquid, no further treatment may be required. If fluid is not available or the patient is unable to consume the liquid, the syndrome progresses. As fluid volume decreases, the heart pumps the remaining blood faster but not as powerfully, resulting in a rapid, weak pulse and a low blood pressure, although, initially as fluid is lost and the heart beats faster, the blood pressure rises through vasoconstriction in an attempt to keep blood flow and oxygenation going. Eventually, compensatory mechanisms wear out and blood pressure falls.
● Water is pulled from the interstitial spaces and the intracellular fluid into the vascular system, resulting in dry skin and mucous membranes, decreased skin turgor, and decreased urine output.
● Patients complain of muscle weakness, fatigue, and feeling warm. Temperature increases because the body is less able to cool itself through perspiration. In an older adult, temperature will rise but may not be elevated above normal body temperature.
● Weight is a sensitive measure of fluid loss. A sudden 5% loss of body weight is considered clinically significant. When loss approaches 8%, fluid loss is severe. A loss of 15% of body weight due to fluid loss is usually fatal.
● The patient with fluid volume deficit usually has an elevated blood urea nitrogen (BUN) level and elevated hematocrit. Both values increase because there is less water in proportion to the solid substances being measured. Specific gravity of the urine increases.

● Excess fluid volume (hypervolemia):
● The blood pressure is elevated, pulse is bounding, and respirations are increased and shallow.
● The neck veins may become distended, and edema develops in dependent areas.
● The skin is pale and cool.
● Urine output becomes dilute, and volume increases.
● The patient rapidly gains weight. In severe fluid overload, the patient develops moist crackles in the lungs, dyspnea, and ascites (excess peritoneal fluid).
● Hemodilution causes BUN, hematocrit, and the specific gravity of urine to decrease.

Question 84

Nursing interventions include:

Answer 84

Dietary teaching

Oral electrolyte supplements

Limiting or facilitating oral fluid intake

Parenteral replacement of fluids and/or electrolytes

POTASSIUM CAN KILL!

Question 85

Why is daily weight an accurate way of measuring fluid loss?

Answer 85

Each kg of body weight is equivalent to 1 liter of fluid.

loss of 5 pounds post diarrhea = 2300 mL

Question 86

Identify ten physical assessment components that can be used to monitor fluid, electrolyte, and acid–base balance.

Answer 86

Answer:
The following physical assessment components can be used to monitor fluid, electrolyte, and acid–base balance:
● Skin is evaluated for six components: color, temperature, moisture content, continuity, turgor, and edema.
● The status of the mucous membranes provides information about fluid and electrolyte balance.
● All of the vital signs reflect information about fluid, electrolyte, and acid–base balance.
● If you suspect fluid volume deficit, be sure to assess the patient for orthostatic hypotension.
● Capillary refill and venous filling also offer information about fluid status.
● Respiratory rate and pattern, as well as breath sounds, offer clues about fluid, electrolyte, and acid–base status.
● Assess orientation, level of consciousness, reflexes, and fatigue.
● Monitoring daily change in weight is an accurate method of assessing fluid status.
● Measure all fluids consumed or excreted in a 24-hour period.

Question 87

What aspects should be evaluated in a nursing history focused on fluid, electrolyte, and acid–base balance?

Answer 87

Answer:
The nursing history related to fluids, electrolytes, and acid–base balance includes questions about intake and output, underlying medical conditions, and current health problems. The following topics need to be assessed:
●   Demographic data
●   Past medical history
●   Current health concerns
●   Food and fluid intakes
●   Fluid elimination
●   Medications
●   Lifestyle

Question 88

What is a CBC test?

Answer 88

complete blood count (rbc wbc platelets)

Question 89

What is being tested during urinalysis?

Answer 89

urine pH (5-9)
specific gravity

Question 90

How do hypertonic fluids work?

Answer 90

When administered, they pull fluids and electrolytes from the intracellular and interstitial compartments into the intravascular compartment. This stabilizes blood pressure, increases uring output, reduces edema.

Imagine someone is swollen with edema…. you put salt into the arteries….water is drawn away from the parts with edema and into the blood… it run through the kidneys and the kidneys say bye felicia and the volume if water in the body decreases.

Question 91

What is infiltration?

Answer 91

damage to the vein that allows fluid to leak into the interstitial space.

Question 92

Identify laboratory tests that monitor fluid, electrolyte, and acid–base balance.

Answer 92

Answer:
The following lab tests monitor fluid, electrolyte, and acid–base balance:
● Serum electrolytes measures sodium, potassium, chloride, and bicarbonate levels. Test often includes blood urea nitrogen (BUN), creatinine, and glucose.
● Serum osmolality is a measure of the solute concentration of the blood.
● Urine osmolality is the solute concentration of urine.
● Hematocrit is a measure of the percent of RBCs in whole blood.
● Specific gravity measures the kidney’s ability to concentrate or dilute urine in relation to the plasma.
● ABGs measure acid–base balance and oxygen status.

Question 93

Give at least five strategies to prevent fluid and electrolyte imbalance.

Answer 93

Answer:
Answers may include any five of the following strategies to prevent fluid and electrolyte imbalance:
● Drink at least eight to ten 8-ounce glasses of water per day. Educate the client about usual fluid needs and circumstances that increase fluid needs, such as high environmental temperature, fever, gastrointestinal fluid loss, or draining wounds. Base your teaching on the client’s current intake and the changes required to meet fluid goals.
● Instruct clients to use thirst as guide. When the client is physically able to access liquid, this is a useful tool.
● Limit consumption of fluids high in salt, sugar, caffeine, or alcohol.
● Teach the client to contact a healthcare provider if he experiences prolonged vomiting, diarrhea, or inability to tolerate liquids or food.
● Encourage clients to drink water before, during, and after strenuous exercise.
● Identify medications or conditions that place the client at risk for imbalances. For example, if the client is receiving a potassium-wasting diuretic, she will need to increase her potassium intake, either by taking a supplement or by altering her diet.
● Caution clients to avoid routine use of laxatives, antacids, weight-loss products, or enemas. All of these products may cause imbalances.
● Instruct the client to weigh himself daily if fluid balance is critical or if the client is experiencing excessive loss.
● Instruct the client to contact a health professional if there is a sudden change of weight, decreased urine output, swelling in dependent areas, shortness of breath, or dizziness.
● Encourage clients to eat a well-balanced diet, including dairy products rich in calcium.

Question 94

What is the purpose of IV fluids?

Answer 94

Answer:
IV fluids are used for the following reasons:
● To expand intravascular volume
● To correct an underlying imbalance in fluids or electrolytes
● To compensate for an ongoing problem that is affecting either fluids or electrolytes

Question 95

Under what conditions would a central venous access device be preferable to a peripheral device?

Answer 95

Answer:
A central venous access device would be preferable to a peripheral device in these situations:
● When highly irritating or hyperosmolar solutions are administered
● When the client is severely fluid depleted and a peripheral line cannot be started
● When central venous pressure monitoring is prescribed
● For parenteral nutrition
● For long-term IV therapy

Question 96

Put in order of use for shortest to longest therapy…

midline peripheral catheter
central venous access device
butterfly

Answer 96

Shortest = butterfly

middle range = midline peripheral catheter (longer than butterfly)

Longest = central venous access device

Question 97

Put in order of use for shortest to longest therapy…

midline peripheral catheter
central venous access device (PICC is an example)
butterfly

Answer 97

Shortest = butterfly

middle range = midline peripheral catheter (longer than butterfly)

Longest = central venous access device

Question 98

What factors should be considered when selecting an insertion site for a peripheral IV line?

Answer 98

Answer:
When selecting an insertion site for a peripheral IV line, the following client factors should be considered:
●   Age
●   Body size
●   Clinical status
●   Skin condition
●   Impairments
●   Type of fluid
●   Duration expectation of IV therapy

Question 99

What is phlebitis?

Answer 99

inflammation of the vein; vein is irritated; redness, pain, swelling, palpable cord along vein. Sluggish infusion rate, elevated temp.

If this happens, discontinue immediately.

Question 100

Describe the difference between infiltration and extravasation as a complication of IV therapy.

Answer 100

Answer:
These complications of IV therapy have the following difference:
● Infiltration involves a nonvesicant solution. May cause burning sensation.
● Extravasation involves a vesicant (solution that causes the formation of blisters and subsequent tissue sloughing and necrosis).

Question 101

What is phlebitis?

Answer 101

inflammation of the vein

Question 102

Describe the difference between infiltration and extravasation as a complication of IV therapy.

Answer 102

Answer:
These complications of IV therapy have the following difference:
● Infiltration involves a nonvesicant solution.
● Extravasation involves a vesicant (solution that causes the formation of blisters and subsequent tissue sloughing and necrosis).

Question 103

A patient was brought to the emergency department with complaints of extreme fatigue, nausea, vomiting, and muscle weakness. Lab results reveal the following: Na+ = 140 mEq/L; K+ = 2.0 mEq/L; Ca2+ = 8.6 mg/dl; Mg2+ = 1.6 mg/dL; and Cl– = 96 mEq/L. The electrocardiogram (ECG) tracing has a flat T wave and frequent PVCs (premature ventricular contractions). The patient’s prescribed daily oral medications include furosemide 20 mg, digoxin 0.25 mg, and aspirin 81 mg. The nurse recognizes that these symptoms and diagnostic information are consistent with which of the following?

1) Hypocalcemia
2) Hypernatremia
3) Hypokalemia
4) Hypermagnesemia

Answer 103

Answer:
3) Hypokalemia

Rationale:
The serum potassium level is low (norm = 3.5 to 5.0 mEq/L). PVCs related to cardiac irritability and a flat T wave on an ECG are also indicative of hypokalemia. The patient takes furosemide (Lasix), a diuretic that can induce hypokalemia.

Question 104

A patient was brought to the emergency department with complaints of extreme fatigue, nausea, vomiting, and muscle weakness. Lab results reveal the following: Na+ = 140 mEq/L; K+ = 2.0 mEq/L; Ca2+ = 8.6 mg/dL; Mg2+ = 1.4 mg/dL; and Cl– = 96 mEq/L. The electrocardiogram (ECG) tracing has a flat T wave and frequent PVCs (premature ventricular contractions). The patient’s prescribed daily oral medications include furosemide 20 mg, digoxin 0.25 mg, and aspirin 81 mg. Why might the nurse question the order for digoxin 0.25 mg orally daily?

1) Based on the digoxin level, the dose may need to be increased.
2) The patient is at risk for an elevated digoxin level at this time.
3) Digoxin and furosemide should never be taken together.
4) The nurse should not be concerned about the order as written.

Answer 104

2) The patient is at risk for an elevated digoxin level at this time.

Rationale:
The hypokalemic patient on digoxin is at high risk for digoxin toxicity. The patient’s serum digoxin level will need to be assessed as she receives potassium supplementation. Digoxin and furosemide can be taken together.

Question 105

Which of the following is considered a first-line intravenous solution for a patient with hypovolemia?

1) 0.9% NaCl (normal saline)
2) 0.45% NaCl (1/2 normal saline)
3) Dextran (a plasma expander)
4) D5W (5% dextrose in water)

Answer 105

Answer:
1) 0.9% NaCl (normal saline)

Rationale:
Hypovolemia occurs when there is a proportional loss of water and electrolytes from the extracellular fluid.

Normal saline is an isotonic fluid that remains inside the intravascular space, thus increasing volume.

Solutions of 0.45% NaCl and D5W are hypotonic fluids and therefore would pull body water from the intravascular compartment into the interstitial fluid compartment, leading to cellular death.

Dextran is a hypertonic fluid that pulls fluid and electrolytes from the intercellular and interstitial compartments into the intravascular compartment and can be used in cases of hypovolemia but is not considered as a first choice.

Question 106

A patient has been admitted to the hospital with medical diagnoses of hypervolemia, acute renal failure, and cardiac dysrhythmias. The patient’s vital signs are the following: T = 98.4°F (36.9°C); P = 110; R = 32; BP = 162/102. On physical examination the nurse notes distended neck veins and 3+ pitting edema in both lower extremities. The patient reports he has been drinking and eating as usual but has been unable to urinate. Which is the most appropriate nursing diagnosis for this patient?

1) Excess Fluid Volume related to excessive food and fluid intake
2) Deficient Fluid Volume related to increased metabolic demands
3) Imbalanced Electrolytes secondary to fluid shifts
4) Excess Fluid Volume secondary to acute renal failure

Answer 106

Answer:
4) Excess Fluid Volume secondary to acute renal failure

Rationale:
This patient is experiencing Excess Fluid Volume secondary to acute renal failure.

There is no indication that he has engaged in excessive food or fluid intake.

There is no laboratory result to indicate an electrolyte imbalance, although his test results will most likely demonstrate abnormalities because of the acute renal failure.

Question 107

A patient is in respiratory distress. The physician has ordered arterial blood gases (ABGs). The results are the following: pH = 7.50; PCO2 = 26; HCO3 = 24 mEq/L. How should the nurse interpret the ABGs?

1) Respiratory acidosis
2) Respiratory alkalosis
3) Metabolic acidosis
4) Metabolic alkalosis

Answer 107

Answer:
2) Respiratory alkalosis

Rationale:
The ABGs are consistent with respiratory alkalosis. The pH is elevated, indicating alkalosis. The PCO2 is decreased, which is also consistent with alkalosis. The HCO3 is within normal range.

Question 108

A patient is in respiratory distress. The physician has ordered arterial blood gases (ABGs). The results are the following: pH = 7.50; PCO2 = 26; HCO3 = 24 mEq/L. How should the nurse interpret the ABGs?

1) Respiratory acidosis
2) Respiratory alkalosis
3) Metabolic acidosis
4) Metabolic alkalosis

Answer 108

Answer:
2) Respiratory alkalosis

Rationale:
The ABGs are consistent with respiratory alkalosis. The pH is elevated, indicating alkalosis. The PCO2 is decreased, which is also consistent with alkalosis (PCO2 is related to respiratory). The HCO3 is within normal range.

Question 109

For a patient in respiratory distress, the first arterial blood gases (ABGs) were the following: pH = 7.50; PCO2 = 26; HCO3 = 24 mEq/L. The ABGs were repeated the next morning. The new results are the following: pH = 7.47; PCO2 = 26 mmol/L; HCO3 = 28 mEq/L. The nurse recognizes that the values have changed and that the patient is now experiencing

1) respiratory acidosis.
2) metabolic alkalosis.
3) partial compensation.
4) complete compensation.

Answer 109

Answer:
3) partial compensation.

Rationale:
Although the pH remains alkalotic, the bicarbonate level has begun to rise to compensate for the low PCO2. Complete compensation occurs when the pH returns to normal.

Question 110

The student nurse is reviewing a patient’s laboratory reports. Which of the following results should be reported to the primary care provider?

1) Na+ = 126 mEq/L
2) K+ = 3.8 mEq/L
3) Ca2+ = 9.2 mg/dL
4) Mg2+ = 1.8 mg/dL

Answer 110

Answer:
1) Na+ = 126 mEq/L

Rationale:
Serum sodium of 126 mEq/L indicates significant hyponatremia. The student nurse should report the findings to the nurse with whom she is working (or the primary care provider, depending on agency policy) who will report the findings to the primary care provider. The other laboratory results are all within normal limits.