Chapter 16 Fluid, Electrolyte, and Acid-Base Imbalances study guide Flashcards Preview

Med-Surg > Chapter 16 Fluid, Electrolyte, and Acid-Base Imbalances study guide > Flashcards

Flashcards in Chapter 16 Fluid, Electrolyte, and Acid-Base Imbalances study guide Deck (42)
Loading flashcards...
1

A patient with consistent dietary intake who loses 1 kg of weight in 1 day has lost ____ mL

1000

2

Which statements about fluid in the human body 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 intertitial and intracellular fluids are maintained by the sodium potassium pump

a, d, e
Rational: 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 will swell and burst as water moves into the cell

3

Force exerted by a fluid

Hydrostatic pressure

4

Uses a protein carrier molecule

Facilitated diffusion

5

Pressure exerted by plasma proteins

Oncotic pressure

6

Adenosine triphosphate (ATP) required

Active transport

7

Force determined by osmoality of a fluid

Osmotic pressure

8

Flow of water from low solute concentration to a high solute concentration

Osmosis

9

Passive movement of molecules from a high concentration to lower concentration

Diffusion

10

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.
Rational: 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

11

Burns
Direction of fluid shift
Mechanism of fluid movement involved

Direction of fluid shift: From blood vessels to interstitium

Mechanism of fluid movement involved: Plasma hydrostatic pressure

12

Dehydration
Direction of fluid shift
Mechanism of fluid movement involved

Direction of fluid shift: From extracellular compartment to cell

Mechanism of fluid movement involved: Interstitial hydrostatic pressure

13

Fluid overload
Direction of fluid shift
Mechanism of fluid movement involved

Direction of fluid shift: From cell to extracellular compartment & from interstitium to vessels

Mechanism of fluid movement involved: Tissue oncotic pressure

14

Hyonatremia
Direction of fluid shift
Mechanism of fluid movement involved

Direction of fluid shift: From interstitium to vessels

Mechanism of fluid movement involved: Osmosis

15

Low serum albumin
Direction of fluid shift:
Mechanism of fluid movement involved:

Direction of fluid shift: From blood vessels to interstitium

Mechanism of fluid movement involved: Oncotic pressure

16

Administration of 10% Glucose
Direction of fluid shift:
Mechanism of fluid movement involved:

Direction of fluid shift: From blood vessels to interstitium

Mechanism of fluid movement involved: Osmosis

17

Application of elastic bandages
Direction of fluid shift:
Mechanism of fluid movement involved:

Direction of fluid shift: From interstitium to vessels

Mechanism of fluid movement involved: Interstitial hydrostatic pressure

18

A woman has ham with gravy and green beans cooked with salt pork for dinner.
a. What could happen to the woman's serum osmolality as a result of this meal?
b. What fluid regulation mechanisms are stimulated by the intake of these foods?

a. Serum osmolality increases as a large amount of sodium is absorbed.

b. 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.

19

While caring for an 84-year-old patient, the nurse monitors the patient's fluid and electrolyte balance, recognizing that normal changes of aging are likely to cause:
a: Hyperkalemia
b. Hyponatremia
c. Decreased insensible fluid loss
d. Increased plasma oncotic pressure

b. Hyponatremia
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. Skin changes lead to increased insensible water loss, and plasma oncotic pressure is more often decreased because of lack of protein intake.

20

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, b, c, d, e
All of these are important in assessing fluid balance in a postop patient. Daily weight along with these assessments will provide data about potential fluid volume abnormalities

21

Which patient is a risk of hypernatremia?

a. Has a deficiency of aldosterone
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

22

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

Rational: As water shifts into and out of cells in response to the osmoality of the blood, the cells that are most sensitive to shrinking or swelling are those of the brain, resulting in neurologic symptoms

23

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, c
Rational: 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.

24

With which disorder is hyperkalemia frequently associated with?
a. Hypoglycemia
b. Metabolic acidosis
c. Respiratory alkalosis
d. Decreased urine potassium levels

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 potassium

25

In a patient with a positive Chvostek's sign, the nurse would anticipate 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 and IV calcium is the treatment used to prevent laryngeal spasms and respiratory arrest. Calcitonin is indicated for treatment of high calcium levels and loop diuretics may be used to decrease calcium levels. Oral vitamin D supplements are part of the treatment for hypocalcemia but not for impending tetany.

26

A patient with chronic kidney disease has hyperphosphatemia. What is a commonly associate 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.

27

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

7.35 to 7.45; 20 to 1. The other answers are incorrect.

28

What are the characteristics of carbonic acid-bicarbonate buffer system (select all that apply)?

a. CO2 is eliminated by the lung

b. Neutralizes HCl acid to yield carbonic acid and salt

c. H2CO3 formed by neutralization dissociates into H20 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+ that combines with H+ to form water

a. CO2 is eliminated by the lung
b. Neutralizes HCl acid to yield carbonic acid and salt
c. H2CO3 formed by neutralization dissociates into H20 and CO2

Shifts of H+ in and out of the cell are characteristics of the cellular buffer system. Free basic radical dissociation in characteristic of the protein buffer system.

29

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 radials 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 exchanged 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

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.

30

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 and high hydrogen ion concentration

d. Small amount of carbonic acid and high hydrogen ion concentration

c. Large amount of carbonic and high hydrogen ion concentration

The amount of carbon dioxide in the blood directly relates to carbonic acid concentration and subsequently hydrogen ion concentration. The carbon dioxide combines with water in the blood to form carbonic acid and in cases in which carbon dioxide is retained in the blood, acidosis occurs.