Chapter 29-Fluids & Electrolytes

Question 1

Body water is composed of these three fluids?

Answer 1

Intracellular fluid (ICF), 
interstitial fluid (ISF), 
plasma volume (PV)

Question 2

Where is intra-vascular fluid found?

Answer 2

Inside the blood vessels

Question 3

Where is extravascular fluid found?

Answer 3

Outside the blood vessels

• Lymph
• Cerebrospinal fluid

Question 4

Where is interstitial fluid located?

Answer 4

In the space between cells, tissues, and organs

Question 5

What does extravascular volume consist of?

Answer 5

Plasma and interstitial fluid

Question 6

What does extracellular volume consist of?

Answer 6

Interstitial fluid and intracellular fluid

Question 7

The adult body is _____% water

Answer 7

60%

Question 8

What fraction of total body water is extracellular fluid?

Answer 8

ECF=1/3

Question 9

What fraction of total body water is intracellular fluid?

Answer 9

ICF=2/3

Question 10

Of the total extracellular fluid contained in total body water, what fraction is plasma volume?

Answer 10

PV=1/3

Question 11

Of the total extracellular fluid contained in total body water, what fraction is interstitial fluid?

Answer 11

ISF=2/3

Question 12

Plasma proteins exert constant osmotic pressure called colloid oncotic pressure (COP). Normal COP is _____ mm Hg

Answer 12

24 mm Hg

Question 13

Interstitial fluid exerts hydrostatic pressure (HP). Normal hydrostatic pressure is _____ mm Hg

Answer 13

17 mm Hg

Question 14

These are solutions containing fluids and electrolytes that are normally found in the body. They do not contain proteins and there is no risk for viral transmission, anaphylaxis, or alteration in coagulation profile

Answer 14

Crystalloids

Question 15

These are used as maintenance fluids to compensate for insensible fluid losses, to replace fluids, to manage specific fluid and electrolyte disturbances, and promote urinary flow

Answer 15

Crystalloids

Question 16

Normal saline (0.9% sodium chloride),
Half normal saline (0.45% sodium chloride),
Hypertonic saline (3% sodium chloride),
Lactated ringer's,
D5W

What kind of fluid are these classified as?

Answer 16

Crystalloids

Question 17

What indications call for the use of Crystalloids?

Answer 17

Acute liver failure, acute nephrosis, adult respiratory distress syndrome, burns, cardiopulmonary bypass, hypoproteinemia, renal dialysis, reduction of the risk for DVT

Question 18

What are the adverse affects of crystalloids?

Answer 18

May cause edema, especially peripheral are pulmonary; they dilute plasma proteins, reducing COP; effects may be short-lived; for prolonged infusions may worsen alkalosis or acidosis

Question 19

These fluids contain protein substances, increase colloid osmotic pressure, move fluid from interstitial compartment to plasma compartment (when plasma protein levels are low)

Answer 19

Colloids

Question 20

What are the adverse affects of colloids?

Answer 20

May cause altered coagulation, resulting in bleeding.

They have no clotting factors or oxygen carrying capacity. Rarely, dextran therapy causes anaphylaxis or renal failure

Question 21

What is the only class of fluids that are able to carry oxygen?

Answer 21

Blood products

Question 22

This class of fluids carries oxygen, increases tissue oxygenation, increases plasma volume, pull fluid from extravascular space into intravascular space (plasma expanders), and is the most expensive and least available because they require human donors.

Answer 22

Blood products

Question 23

What blood products are used in the management of acute bleeding?

Answer 23

Cryoprecipitate and plasma protein factors (PPF)

Question 24

What blood product is used to increase clotting factor levels in patients with demonstrated deficiency?

Answer 24

Fresh frozen plasma (FFP)

Question 25

What blood product is used to increase oxygen-carrying capacity in patients with anemia, substantial hemoglobin deficits, and those who have lost up to 25% of their total blood volume

Answer 25

Packed red blood cells (PRBCs)

Question 26

Which blood product is most beneficial in cases of extreme blood loss (greater than 25%)?

Answer 26

Whole blood Whole blood contains plasma proteins which help draw fluid back into blood vessels from the surrounding tissue

Question 27

The patient was taken to the trauma unit after a motorcycle accident. It is estimated that he has lost 30% of his blood volume is in hypovolemic shock. The nurse anticipates a transfusion with which product?

Answer 27

Whole blood

Question 28

What are the adverse affects of blood product infusion?

Answer 28

Incompatibility with recipients immune system, crossmatch testing, transfusion reaction, anaphylaxis, transmission of pathogens to recipient (hepatitis, HIV)

Question 29

What are the principal extracellular fluid electrolytes?

Answer 29

Sodium (Na+) & chloride (Cl-)

Question 30

What is the principal intracellular fluid electrolyte?

Answer 30

Potassium (K+)

Question 31

What are the other significant electrolytes?

Answer 31

Calcium, magnesium, phosphorus

Question 32

What is the normal range for potassium outside of cells

Answer 32

3.5 - 5 mEq/L

Question 33

What foods contain potassium?

Answer 33

Bananas, oranges, apricots, date, raisins, broccoli, green beans, potatoes, tomatoes, meats, fish, wheat bread, lagumes

Question 34

Excess dietary potassium is excreted via the _____?

Answer 34

Kidneys

Question 35

Hyperkalemia is evident with lab values greater than _____ mEQ/L

Answer 35

5.5

Question 36

What are some causes for hyperkalemia?

Answer 36

Potassium supplements, ACE inhibitors, renal failure, excessive loss from cells, potassium sparing diuretics, burns, trauma, metabolic acidosis, infections

Question 37

Hypokalemia where presents for deficiency with lab values less than _____ mEq/L

Answer 37

3.5

Question 38

What are indications for excessive potassium loss?

Answer 38

Alkalosis, corticosteroids, diarrhea, ketoacidosis, laxative misuse, hyperaldosteronism, increased secretion of mineralocorticoids, Burns, Thiazide/thiazide-like diuretics, vomiting, malabsorption

Question 39

A deficit of _____, in the presence of Digoxin therapy, can cause toxicity, resulting in serious ventricular dysrhythmias

Answer 39

Potassium

Question 40

_____ is responsible for muscle contraction, transmission of nerve impulses, regulation of heartbeat, maintenance of acid-base balance, isotonicity

Answer 40

Potassium

Question 41

What condition does a nurse identify as a late manifestation of hypokalemia?

Answer 41

Palpitations

Question 42

What are some primary conditions a nurse identifies as early manifestations of hypokalemia?

Answer 42

Muscle weakness, hypotension, lethargy

Question 43

Which conditions require the administration of potassium?

Answer 43

Potassium deficiency, irregular heartbeats, management of tackydysrhythmias that can occur after cardiac surgery

Question 44

What are the adverse affects of oral potassium?

Answer 44

Diarrhea, nausea, vomiting, G.I. bleeding, ulceration

Question 45

What are the adverse affects of IV administration of potassium?

Answer 45

Pain at injection site, phlebitis

Question 46

What are the facts of excessive administration of potassium?

Answer 46

Hyperkalemia, toxic effects

Question 47

What are the manifestations of hyperkalemia?

Answer 47

Muscle weakness, Paris, paralysis, cardiac rhythm irregularities (leading to possible ventricular fibrillation and cardiac arrest)

Question 48

What is the treatment for severe hyperkalemia?

Answer 48

Are you sodium bicarbonate, calcium gluconate or calcium chloride, dextrose with insulin; Sodium polystyrene sulfonate (Kayexalate) or hemodialysis to remove excess potassium

Question 49

A patient is hypokalemic and will be receiving intravenous potassium. The patient is not on a heart monitor. How should the nurse administer the potassium replacement?

Answer 49

No more than 10 mEq/hr If patient is on cardiac monitor a rate of 20 mEq/hr may be used

Question 50

What is the most abundant positively charged electrolyte outside cells?

Answer 50

Sodium

Question 51

What is the normal concentration of sodium outside of the cells?

Answer 51

135-145 mEq/L

Question 52

Which foods are sodium rich?

Answer 52

Salt, fish, meats, foods flavored or preserved with salt.

Question 53

What are the symptoms of hyponatremia?

Answer 53

Lethargy, stomach cramps, hypotension, vomiting, diarrhea, seizures

Question 54

What are the causes of hyponatremia?

Answer 54

Excessive perspiration, prolonged diarrhea or vomiting, renal disorders, alkalosis, increased secretions of medical record records, burns, corticosteroid use, crash diets, malabsorption

Question 55

What are the symptoms of hyper natremia?

Answer 55

Water retention; hypertension; red, flushed skin; dry sticky mucous membranes; increased thirst; elevated temperature; decreased urine output

Question 56

What are the causes of hypernatremia?

Answer 56

Poor renal excretion stemming from kidney malfunction; inadequate water consumption; dehydration

Question 57

What functions does sodium control?

Answer 57

Water distribution, what an electrolyte balance, of moderate pressure of body fluids, participation in acid-base balance

Question 58

What are the functions are controlled by Potassium?

Answer 58

Muscle contraction, transmission of nerve impulses, regulation of heartbeat, maintenance of acid-base balance, isotonicity

Question 59

How is mild hyponatremia treated?

Answer 59

Oral sodium chloride and/or fluid restriction

Question 60

How is severe hyponatremia treated?

Answer 60

Intervenous normal saline or lactated ringers

Question 61

Adverse affects of oral administration of sodium?

Answer 61

Nausea, vomiting, cramps

Question 62

What are the adverse affects of IV administration of sodium?

Answer 62

Venous phlebitis

Question 63

What assessment should be done before giving potassium?

Answer 63

ECG

Question 64

Potassium should never be given via ______

Answer 64

IV bolus

Question 65

How are oral forms of potassium given?

Answer 65

Diluted in water or fruit juice to minimize G.I. distress or irritation. Monitor for complaints of nausea, vomiting, G.I. Pain, or G.I. bleeding

Question 66

Polystyrene sulfonate (Kayexalate) should never be given with _____, _____, or _____

Answer 66

Sorbitol, laxatives, antacids

Question 67

Which solution should the nurse administered with packed red blood cells?

Answer 67

Normal saline, 0.9% sodium chloride

Question 68

Albumin and dextran fall within which fluid category?

Answer 68

Colloids

Question 69

This fluid category is commonly known as maintenance fluids

Answer 69

Crystalloids

Question 70

Total protein levels in the body should range between ___ to ___ g/dL.

Answer 70

5.4-7.4 g/dL If the level falls below 5.3, fluid shifts out of blood vessels and into tissues