Fluid, Electrolytes, and Acid-Base Balance (Concepts) Flashcards
(237 cards)
1
Q
The average healthy adult’s weight is ______ and what is its percentage?
A
Water; 60 %
2
Q
T/F: In good health this volume remain relatively constant, and a person’s weight varies by less than 0.2 kg (0.5 lb) in 24 hours, regardless of the amount of fluid ingested.
A
T
3
Q
What are the cellular functions of water?
A
- A medium for metabolic reactions within cells
- A transporter for nutrients, waste products, and other substances
- A lubricant
- An insulator and shock absorber
- A means of regulating and maintaining body temperature
4
Q
Who has the highest proportion of water? Accounting 70-80 % of their body weight?
A
Infants
5
Q
T/F: The proportion of water decreases as we age.
A
T
6
Q
T/F: Women generally have lower percentage of body water than men.
A
T
7
Q
This is due because of lower levels of ______ and great percentage of ______.
A
muscle mass; fat tissue
8
Q
T/F: Fat tissue is essentially free of water, whereas lean tissue contains a significant amount of water. Therefore, water makes up a greater percentage of a lean individual’s body weight than of an individual who is obese.
A
T
9
Q
The body’s fluid is divided into two major compartments, what are them?
A
Intracellular Fluid (ICF) and Extracellular Fluid (ECF)
10
Q
It is found within the cells of the body. It constitutes approximately two thirds of the total body fluid in adults.
A
Intracellular Fluid (ICF)
11
Q
It is found outside the cells and accounts for about one third of total body fluid.
A
Extracellular Fluid (ECF)
12
Q
T/F: ECF is not further subdivided into compartments.
A
F
13
Q
It accounts for approximately 20% of ECF and is found within the vascular system.
A
Intravascular fluid or Plasma
14
Q
It is accounting for approximately 75% of ECF, surrounds the cells.
A
Interstitial Fluid
15
Q
The other compartments of ECF include the:
A
lymph and transcellular fluids
16
Q
Transcellular fluids include:
A
- cerebrospinal
- pericardial
- pancreatic
- pleural
- intraocular
- biliary
- peritoneal
- synovial fluids
17
Q
It is vital to normal cell functioning. It contains solutes such as oxygen, electrolytes, and glucose, and it provides a medium in which metabolic processes of the cell take place.
A
Intracellular fluids
18
Q
T/F: Although ECF is in the smaller of the two compartments, it is the transport system that carries oxygen and nutrients to, and waste products from, body cells.
A
T
19
Q
Extracellular and intracellular fluids contain:
A
- oxygen from the lungs
- dissolved nutrients from the gastrointestinal tract
- excretory products of metabolism such as carbon dioxide
- charged particles called ions.
20
Q
Many salts dissociate in water; that is, they break up into electrically charged ions. The salt called _________ breaks up into one ion of sodium (Na+) and one ion of chloride (Cl−).
A
Sodium chloride
21
Q
These charged particles are called _______ because they are capable of conducting electricity.
A
Electrolytes
22
Q
T/F: The number of ions that carry a positive charge, called cations, and ions that carry a negative charge, called anions, should be equal.
A
T
23
Q
What are the following: sodium (Na+), potassium (K+), calcium (Ca2+), and magnesium (Mg2+).
A
Cations
24
Q
What are the following: chloride (Cl−), bicarbonate (HCO3−), phosphate (PO34–), and sulfate (SO24–).
A
Anions
25
Electrolytes generally are measured in _________ or _______. The first term refers to the chemical combining power of the ion, or the capacity of cations to combine with anions to form molecules, whereas the second term refers to the weight of the ion.
Milliequivalent per liter (mEq/L); milligrams per 100 milliliters (mg/100 mL)
26
T/F: 1 mEq of any anion equals 1 mEq of any cation in terms of their capacity to combine into molecules. Therefore, sodium and chloride combine equally, so 1 mEq of Na+ equals 1 mEq of Cl−.
T
27
T/F: A molecule of sodium is equal in weight to a molecule of chloride.
F
28
_________ levels frequently are reported in milligrams per deciliter (1 dL = 100 mL) instead of milliequivalents per liter.
Calcium
29
It also is important to remember that laboratory tests are usually performed using ________, an extracellular fluid. These results reflect what is happening in ECF, more specifically within intravascular fluid, but generally it is not possible to directly measure electrolyte concentrations within body cells.
Blood plasma
30
T/F: The composition of fluids varies from one body compartment to another
T
31
T/F: In ECF, the principal electrolytes are sodium, chloride, and bicarbonate. Other electrolytes such as potassium, calcium, and magnesium are present, but in much smaller quantities.
T
32
Plasma and interstitial fluid, the two primary components of ECF, contain essentially the same electrolytes and solutes, with the exception of _______. Plasma is a protein-rich fluid, containing large amounts of________, but interstitial fluid contains little or no protein
protein; albumin
33
T/F: The composition of ICF differs significantly from that of ECF.
T
34
Potassium and magnesium are the _________ present in ICF, and phosphate and sulfate are the _________. As in ECF, other electrolytes are present within the cell, but in much smaller concentrations.
primary cations; major anions
35
Other body fluids such as gastric and intestinal secretions also contain electrolytes. This is of particular concern when these fluids are lost from the body (for example, in severe vomiting or diarrhea, or when gastric suction removes gastric secretions). ___________ can result from excessive losses through these routes.
Fluid and electrolyte imbalances
36
The body fluid compartments are separated from one another by __________ and the _______. Although these are completely permeable to water, they are considered to be selectively permeable to solutes, because substances other than water move across them with varying degrees of ease.
cell membranes; capillary membrane
37
___________ are substances dissolved in a liquid. They may be crystalloids (salts that dissolve readily into true solutions) or colloids (substances such as large protein molecules that do not readily dissolve into true solutions).
Solutes
38
A _________ is the component of a solution that can dissolve a solute. In the body, ________ is the solvent; the solutes include electrolytes, gases such as oxygen and carbon dioxide, glucose, urea, amino acids, and proteins.
Solvent; water
39
The concentration of solutes in body fluids is usually expressed as the ___________. It is determined by the total solute concentration within a fluid compartment and is measured as parts of solute per kilogram of water.
Osmolality
40
Osmolality is reported as:
milliosmoles per kilogram (mOsm/kg).
41
Sodium is by far the greatest determinant of the osmolality of _________, or serum osmolality, although glucose and urea also contribute.
plasma
42
Potassium, glucose, and urea are the primary determinants of the osmolality of ___________.
intracellular fluid.
43
The term _____________ may also be used to refer to the osmolality of one solution in relation to another solution.
tonicity
44
In relation to body fluids, an _____________ has the same osmolality as ECF. Normal saline, 0.9% sodium chloride, is an example of an isotonic solution.
isotonic solution
45
____________, such as 3% sodium chloride, have a higher osmolality than ECF.
Hypertonic solutions
46
______________, such as 0.45% sodium chloride, have a lower osmolality than ECF.
Hypotonic solutions
47
____________ is the power of a solution to pull water across a semipermeable membrane.
Osmotic pressure
48
When two solutions of different concentrations are separated by a semipermeable membrane, the solution with the ________ solute concentration exerts a higher osmotic pressure, pulling water across the membrane to equalize the concentrations of the solutions.
higher
49
Infusing a hypertonic IV solution such as 3% sodium chloride will pull fluid out of red blood cells (RBCs) and into plasma, causing the cells to ________.
shrink
50
On the other hand, a hypotonic solution administered intravenously will cause the RBCs to ________ as water is pulled into the cells by their higher osmotic pressure.
swell
51
In the body, plasma proteins also exert osmotic pressure called ___________ , holding water in plasma, and when necessary pulling water from the interstitial space into the vascular compartment. This is an important mechanism for maintaining vascular volume.
colloid osmotic pressure or oncotic pressure
52
Diffusion occurs when two solutes of different concentrations are separated by a _______.
semipermeable membrane
53
The__________ of diffusion of a solute varies according to the size of the molecules, the concentration of the solution, and the temperature of the solution.
rate
54
Which of the following are true?
- Larger molecules move less quickly than smaller ones - molecules move from a solution of higher concentration to a solution of lower concentration
- increases in temperature increase the rate of motion of molecules and therefore the rate of diffusion.
All of the above
55
_________ is a specific kind of diffusion in which water moves across cell membranes, from the less concentrated solution (the solution with less solute and more water) to the more concentrated solution (the solution with more solute and less water).
Osmosis
56
In other words, water moves toward the higher concentration of solute in an attempt to________ the concentrations of both water and solute.
equalize
57
Osmosis occurs in the body when the concentration of solutes is _________ on one side of a selectively permeable membrane, such as the capillary membrane, than on the other side.
higher
58
______ is a process whereby fluid and solutes move together across a membrane from an area of higher pressure to an area of lower pressure. An example of filtration is the movement of fluid and nutrients from the capillaries of the arterioles to the interstitial fluid around the cells.
Filtration
59
The pressure that results in the movement of the fluid and solutes out of a compartment is called __________.
filtration pressure
60
__________ is the pressure exerted by a fluid within a closed system on the walls of the container in which it is contained.
Hydrostatic Pressure
61
Which of the following are true?
- The hydrostatic pressure of blood is the force exerted by blood against blood vessel walls.
- The plasma proteins and other solutes in the blood exert osmotic pressure.
- Osmotic pressure opposes and balances the force of hydrostatic pressure, and holds fluid in the vascular compartment to maintain the vascular volume.
- When hydrostatic pressure is greater than osmotic pressure, fluid filters out of the blood vessels.
All of the above
62
_________ is the difference between the hydrostatic pressure and the osmotic pressure.
Filtration pressure
63
It is the movement of solutes across cell membranes from a less concentrated solution to a more concentrated one. This process differs from diffusion and osmosis, which are passive processes, in that metabolic energy is expended.
Active transport
64
It is the movement of solutes across cell membranes from a less concentrated solution to a more concentrated one. This process differs from diffusion and osmosis, which are passive processes, in that metabolic energy is expended.
Active transport
65
T/F: The process of active transport is of particular importance in maintaining the differences in sodium and potassium ion concentrations of ECF and ICF.
T
66
Which of the following are true?
- Under normal conditions, sodium concentrations are lower in ECF, and potassium concentrations are higher in ICF.
- To maintain these proportions, an active transport mechanism (the sodium-potassium pump) is activated, moving sodium from cells into plasma and potassium from plasma into cells.
- Active transport moves and holds sodium and potassium against their diffusion gradients.
2nd and 3rd only - Under normal conditions, sodium concentrations are higher in ECF, and potassium concentrations are higher in ICF.
67
T/F: In a healthy person, the volumes and chemical composition of the fluid compartments stay within specific and narrow limits. Normally, fluid intake and fluid loss are balanced. Illness can upset this balance so that the body has too little or too much fluid.
T
68
During periods of normal activity at moderate temperature, the average adult drinks about _______, despite the fact that they need ________ for normal functioning.
1,500 mL/day; 2,500 mL/day
69
The additional 1,000-mL volume is acquired from _______ and from the oxidation of these foods during metabolic processes.
foods
70
The water content of food is relatively large, contributing about ________.
750 mL/day
71
Water as a by-product of food metabolism accounts for most of the remaining fluid volume required. This quantity is approximately _______ for the average adult
200 mL/day
72
The thirst mechanism is the primary regulator of fluid intake. The thirst center is located in the __________ of the brain.
hypothalamus
73
A number of stimuli trigger the thirst center causing the sensation of thirst and the desire to drink fluids, including:
- the osmotic pressure of body fluids
- vascular volume
- angiotensin (a hormone released in response to decreased blood flow to the kidneys),
74
Thirst is normally relieved immediately after drinking a small amount of fluid, when the ingested fluid distends the _________, but before the fluid is actually absorbed from the gastrointestinal tract.
upper gastrointestinal tract
75
However, this relief is only temporary, and thirst returns in about 15 minutes. The thirst is again temporarily relieved by drinking a small amount of fluid. This mechanism protects the individual from drinking too much, because it takes between ___________ for fluid to be absorbed and distributed throughout the body.
30 minutes and 1 hour
76
________ is formed by the kidneys and excreted from the urinary bladder, and is the major route of fluid output.
Urine
77
Normal urine output for an adult is __________ per 24 hours, or at least 0.5 mL per kilogram per hour.
1,400 to 1,500 mL
78
Which of the following is/are true:
- In healthy people, urine output may vary noticeably from day to day.
- Urine volume should automatically decrease as fluid intake increases.
- If fluid losses through other routes are large, however, urine volume should increase to maintain fluid balance.
1st one only - Urine volume should automatically increase as fluid intake increases; If fluid losses through other routes are large, however, urine volume should decrease to maintain fluid balance.
79
The ___________ that passes from the small intestine into the large intestine contains both water and electrolytes.
chyme
80
The volume of chyme entering the large intestine in an adult is normally about _________. Of this amount, all but about _______ is reabsorbed in the proximal half of the large intestine. The reabsorbed volume contains primarily water and electrolytes.
1,500 mL/day; 100 mL
81
Insensible fluid losses occur through the _________. They are called insensible because it is usually not noticeable and cannot be measured.
skin and the lungs
82
Insensible fluid loss through the skin occurs in two ways; ____________.
diffusion and perspiration
83
Water loss through diffusion is not noticeable but normally accounts for _________. This loss can be significantly increased if the protective layer of the skin is damaged, as with burns or large abrasions.
300 to 400 mL/day
84
________, which may be noticeable but is not measurable, varies depending on factors such as environmental temperature, body temperature, and metabolic activity.
Perspiration
85
Fever and exercise increase __________, thereby increasing fluid losses through the skin.
metabolic activity and heat production
86
Another type of insensible loss is the water in_________. In an adult, this is normally 300 to 400 mL/day. When respiratory rate accelerates, for example, due to exercise or an elevated body temperature, this loss can increase.
exhaled air
87
Certain fluid losses are required to maintain normal body function. These are known as_________.
obligatory losses
88
Approximately__________ of fluid must be excreted through the kidneys of an adult each day to eliminate metabolic waste products.
500 mL
89
Water lost through respirations, the skin, and in feces also are obligatory losses, necessary for temperature regulation and elimination of waste products. The total of all these losses is approximately ___________.
1,300 mL/day
90
The volume and composition of body fluids are regulated through ___________.
several homeostatic mechanisms
91
A number of organs and systems contribute to this regulation, including the:
kidneys, lungs, and the cardiovascular and gastrointestinal systems
92
The_______ are the primary regulator of body fluids and electrolyte balance.
kidneys
93
The kidneys help maintain homeostasis by:
- They regulate the volume and osmolality of ECF by regulating water and electrolyte excretion.
- The kidneys control the reabsorption of water from plasma filtrate and ultimately the amount excreted as urine.
- Electrolyte balance is maintained by selective retention and excretion by the kidneys.
- The kidneys also play a significant role in acid–base regulation, excreting hydrogen ion (H+) and retaining bicarbonate.
All of the above
94
Although 135 to 180 L of plasma per day is normally filtered in an adult, only about ______ of urine is excreted.
1.5 L
95
_______, which regulates water excretion from the kidney, is synthesized in the anterior portion of the hypothalamus and acts on the collecting ducts of the nephrons. When serum osmolality rises, it is produced, causing the collecting ducts to become more permeable to water.
ADH
96
Which of the following are what AHD does:
- This increased permeability allows more water to be reabsorbed into the blood. As more water is reabsorbed, urine output falls and serum osmolality decreases because the water dilutes body fluids.
- Conversely, if serum osmolality decreases, ADH is suppressed, the collecting ducts become less permeable to water, and urine output increases. Excess water is excreted, and serum osmolality returns to normal.
All of the above
97
Other factors also affect the production and release of ADH, including:
blood volume, temperature, pain, stress, and some drugs such as opiates, barbiturates, and nicotine
98
The ________ is another neuroendocrine control mechanism that contributes to maintaining fluid balance. Specialized receptors in the kidneys respond to changes in renal perfusion, stimulating it.
renin- angiotensin-aldosterone system
99
If blood flow or pressure to the kidney decreases,________ is released.
renin
100
Renin causes the conversion of angiotensinogen to _______, which is then converted to _________ by angiotensin-converting enzyme.
angiotensin I; angiotensin II
101
___________ acts directly on the nephrons to promote sodium and water retention. In addition, it stimulates the release of aldosterone from the adrenal cortex.
Angiotensin II
102
________ also promotes sodium retention in the distal nephron.
Aldosterone
103
The net effect of the renin-angiotensin- aldosterone system is to increase _________ (and renal perfusion) through sodium and water retention.
blood volume
104
________ is released from cells in the atrium of the heart in response to excess blood volume and stretching of the atrial walls. Acting on the nephrons, it promotes sodium wasting and acts as a potent diuretic, thus decreasing blood volume. It also inhibits thirst, reducing fluid intake.
Atrial natriuretic factor (ANF)
105
T/F:
1st statement: Electrolytes are present in all body fluids and fluid compartments. Just as maintaining fluid balance is vital to normal body functioning, so is maintaining electrolyte balance.
2nd statement: Although the concentration of specific electrolytes differs between fluid compartments, a balance of cations (positively charged ions) and anions (negatively charged ions) always exists.
Both T
106
Electrolytes are important for:
* Maintaining fluid balance
* Contributing to acid–base regulation
* Facilitating enzyme reactions
* Transmitting neuromuscular reactions.
107
T/F:
1st statement: Most electrolytes enter the body through dietary intake and are excreted in the urine. Some electrolytes, such as sodium chloride and potassium, are not stored by the body and must be consumed daily to maintain normal levels.
2nd Statement: Other electrolytes, such as calcium, are stored in the body; when serum levels drop, ions can shift out of storage into the blood to maintain adequate serum levels for normal functioning, at least in the short term.
Both T
108
Functions:
* Regulating ECF volume and distribution
* Maintaining blood volume
* Transmitting nerve impulses and contracting muscles
Regulation:
* Renal reabsorption or excretion
* Aldosterone increases Na+ reabsorption in
collecting duct of nephrons
Sodium (Na+)
109
Functions:
* Maintaining ICF osmolality
* Transmitting nerve and other electrical impulses
* Regulating cardiac impulse transmission and muscle contraction
* Skeletal and smooth muscle function * Regulating acid–base balance
Regulations:
* Renal excretion
* Aldosterone increases K+ excretion
* Movement into and out of cells
* Insulin helps move K+ into cells; tissue damage
and acidosis shift K+ out of cells into ECF
Potassium (K+)
110
Functions:
* Forming bones and teeth
* Transmitting nerve impulses
* Regulating muscle contractions
* Maintaining cardiac pacemaker (automaticity) * Blood clotting
Regulations:
* Redistribution between bones and ECF
* Parathyroid hormone and calcitriol increase serum Ca2+ levels; calcitonin decreases serum levels
Calcium (Ca2+)
111
Functions:
* Intracellular metabolism
* Operating sodium-potassium pump * Relaxing muscle contractions
* Transmitting nerve impulses
* Regulating cardiac function
Regulations:
* Conservation and excretion by kidneys
* Intestinal absorption increased by vitamin D and parathyroid hormone
Magnesium (Mg2+)
112
Functions:
* HCl production
* Regulating ECF balance and vascular volume
* Regulating acid–base balance
* Buffer in oxygen–carbon dioxide exchange in RBCs
Regulations:
* Excreted and reabsorbed along with sodium in the kidneys
* Aldosterone increases chloride reabsorption with sodium
Chloride (Cl−)
113
Functions:
* Forming bones and teeth
* Metabolizing carbohydrate, protein, and fat
* Cellular metabolism; producing ATP and DNA * Muscle, nerve, and RBC function
* Regulating acid–base balance
* Regulating calcium levels
Regulations:
* Excretion and reabsorption along with sodium in the kidneys
* Parathyroid hormone decreases serum levels by increasing renal excretion
* Reciprocal relationship with calcium: increasing serum calcium decreases phosphate levels; decreasing serum calcium increases phosphate
Phosphate (PO43–)
114
Functions:
* Major body buffer involved in acid–base regulation
Regulations:
* Excretion and reabsorption by the kidneys * Regeneration by kidneys
Bicarbonate (HCO3−)
115
Identify the Electrolyte: The most abundant cation in ECF and a major contributor to serum osmolality. Normal serum sodium levels are 135 to 145 mEq/L.
Sodium
116
Identify the Electrolyte: The major cation in ICF, with only a small amount found in the ECF. ICF levels of it are usually 125 to 140 mEq/L, while normal serum levels are 3.5 to 5.0 mEq/L.
Potassium
117
Identify the Electrolyte: The vast majority (99%) of it in the body is stored in the skeletal system, with a relatively small amount in extracellular fluid.
Calcium
118
Which are true in the regulation of calcium?
- ECF calcium is regulated by a complex interaction of parathyroid hormone, calcitonin (a hormone produced by the thyroid), and calcitriol (a metabolite of vitamin D).
- When calcium levels in the ECF fall, parathyroid hormone and calcitriol cause calcium to be released from bones into ECF and increase the absorption of calcium in the intestines, thus raising serum calcium levels.
- Conversely, calcitonin stimulates the deposition of calcium in bone, increasing the concentration of calcium ions in the blood.
1st and 2nd statements only - Conversely, calcitonin stimulates the deposition of calcium in bone, reducing the concentration of calcium ions in the blood.
119
Identify the Electrolyte: It found primarily in the skeleton and ICF, where it is the second most abundant intracellular cation. It is important for intracellular metabolism, particularly in the production and use of ATP. It has a normal serum level of 1.5 to 2.5 mEq/L.
Magnesium
120
Identify the Electrolyte: The major anion of ECF, and normal serum levels are 95 to 108 mEq/L.
Chloride
121
Identify the Electrolyte: the major anion of ICF. It also is found in ECF, bone, skeletal muscle, and nerve tissue. Normal serum levels of it in adults range from 2.5 to 4.5 mg/dL. Children have much higher phosphate levels than adults, with that of a newborn nearly twice that of an adult. Higher levels of growth hormone and a faster rate of skeletal growth probably account for this difference.
Phosphate
122
Identify the Electrolyte: It is present in both ICF and ECF. Its primary function is regulating acid–base balance as an essential component of the body’s buffering system. Unlike electrolytes that must be consumed in the diet, adequate amounts of it are produced through metabolic processes. The normal serum level is 22 to 26 mEq/L.
Bicarbonate
123
T/F: An important part of regulating the homeostasis of body fluids is regulating their acidity and alkalinity.
T
124
The relative acidity or alkalinity of a solution is measured by its_________, which is an inverse reflection of the hydrogen ion concentration of the solution.
pH
125
T/F: Body fluids are normally maintained within a narrow range that is slightly acidic.
F - Body fluids are normally maintained within a narrow range that is slightly alkaline.
126
The normal pH of arterial blood is between _________.
7.35 and 7.45
127
T/F: Acids are continually produced during metabolism.
T
128
_________ prevent excessive changes in pH by binding with or releasing hydrogen ions.
Buffers
129
The following are what buffers do, except:
- If body fluids become too acidic, meaning excess hydrogen ions are present in body fluids, buffers bind with the hydrogen ions.
- If body fluids become too alkaline, meaning not enough hydrogen ions are present in body fluids, buffers can release hydrogen ions.
- The action of a buffer is not immediate and is limited in its capacity to maintain or restore normal acid–base balance.
3rd statement - The action of a buffer is IMMEDIATE, but limited in its capacity to maintain or restore normal acid–base balance.
130
The major buffer in ECF is the ___________. The amounts of bicarbonate and carbonic acid in the body vary; however, as long as a ratio of 20 parts of bicarbonate to 1 part of carbonic acid is maintained, the pH remains within its normal range of 7.35 to 7.45.
bicarbonate (HCO3 ) and carbonic acid (H2CO3) system
131
The following are signs of acid-base imbalances, except:
- Adding a strong acid to ECF can change this ratio because bicarbonate is depleted in neutralizing the acid. When this happens, the pH drops, and the client has a condition called acidosis.
- Adding a strong base to ECF, depleting carbonic acid as it combines with the base. In this case the pH rises and the client has alkalosis.
- Plasma proteins, hemoglobin, and phosphates also function as buffers in body fluids.
3rd Statement - This is not a sign of imbalance.
132
The lungs help regulate acid–base balance by eliminating or retaining ____________.
carbon dioxide (CO2)
133
When combined with water, carbon dioxide forms _________ (CO2 + H2O = H2CO3). This chemical reaction is reversible; it breaks down into carbon dioxide and water.
carbonic acid
134
The lungs help regulate acid–base balance by altering the rate and depth of _________. The response of the respiratory system to changes in pH is rapid, occurring within minutes.
respirations
135
__________ is a powerful stimulator of the respiratory center in the brain.
Carbon Dioxide
136
T/F:
Statement 1: When blood levels of carbonic acid and carbon dioxide rise, the respiratory center is stimulated and the rate and depth of respiration increase. This causes an increased amount of carbon dioxide to be exhaled, and carbonic acid levels fall.
Statement 2: By contrast, when blood levels of carbonic acid and carbon dioxide fall, the rate and depth of respiration decrease. This causes an increased level of carbon dioxide to be retained, and carbonic acid levels rise.
Both T
137
T/F:
Statement 1: Although buffers and the respiratory system can compensate for changes in pH, the kidneys are the ultimate long-term regulator of acid–base balance.
Statement 2: They are fast to respond to changes, requiring hours to days to correct imbalances, and their response is more permanent and selective than that of the other systems.
1st Statement T 2nd Statement F - Kidneys are slower to respond to changes, requiring hours to days to correct imbalances, but their response is more permanent and selective than that of the other systems.
138
The kidneys maintain acid–base balance by selectively excreting or conserving bicarbonate and hydrogen ions. How so? Which is not true?
- When excess hydrogen ions are present and pH falls (acidosis), the kidneys reabsorb and regenerate bicarbonate and excrete hydrogen ions.
- When insufficient hydrogen ions are present and pH rises (alkalosis), excess bicarbonate is excreted and hydrogen ions are retained.
None
139
Which of the following are true about infants and growing children's ability to maintain fluid, electrolytes, and acid-base balance?
- Infants and growing children have much lesser fluid turnover than adults because their higher metabolic rate increases fluid loss.
- Infants lose more fluid through the kidneys because immature kidneys are less able to conserve water than adult kidneys.
- Infants’ respiratory rate is much higher than that of adults, and their body surface area is proportionately greater than that of adults, both of which increases insensible fluid losses.
- This higher turnover of fluid, combined with the losses produced by disease, can create critical fluid imbalances in children much more rapidly than in adults.
2nd, 3rd, and 4th statements - Infants and growing children have much GREATER fluid turnover than adults because their higher metabolic rate increases fluid loss.
140
Which of the following are false about older people's ability to maintain fluid, electrolytes, and acid-base balance?
- In older people, the normal aging process does not affect fluid balance.
- The thirst response is often diminished.
- Antidiuretic hormone levels remain normal or may even be elevated, but the nephrons become less able to conserve water in response to ADH.
- Lower levels of atrial natriuretic factor in older adults may also contribute to this impaired ability to conserve water. These normal changes of aging increase the risk of dehydration.
- When combined with the increased likelihood of heart diseases, impaired renal function, and multiple drug regimens, the older adult’s risk for fluid and electrolyte imbalance is significant.
1st and 4th statements - the normal aging process MAY affect fluid balance; HIGHER levels of atrial natriuretic factor in older adults may also contribute to this impaired ability to conserve water. These normal changes of aging increase the risk of dehydration.
141
Which of the following are true about Sex and body Size with regards to fluid, electrolyte, and acid-base imbalances?
- Total body water also is affected by sex and body size.
- Fat cells contain little or no water, but lean muscle tissue has a high water content; therefore, people with a higher percentage of body fat have less body water than people with a higher percentage of lean muscle.
- Women generally have proportionately more body fat and, therefore, less body water than men.
- Water accounts for approximately 60% of an adult man’s weight, but approximately 52% of an adult woman’s weight. In someone who is obese this percentage may be even lower, with water accounting for only 30% to 40% of the person’s weight.
All of them are True
142
T/F: People with an illness and those participating in strenuous activity are at increased risk for fluid and electrolyte imbalances when the environmental temperature is high.
T
143
T/F: Fluid losses through sweating are decreased in hot environments as the body attempts to dissipate heat. These losses are even greater in people who are not accustomed to a hot environment.
F - Fluid losses through sweating are INCREASED in hot environments as the body attempts to dissipate heat. These losses are even greater in people who are not accustomed to a hot environment.
144
Both electrolytes and water are lost through sweating. When only water is replaced, ________ is a risk.
electrolyte depletion
145
A person who is electrolyte depleted may experience:
- fatigue
- weakness
- headache
- gastrointestinal symptoms such as anorexia and nausea.
146
The risk of adverse effects is even greater if lost water is not replaced. It may cause body temperature rises, and the person is at risk for heat exhaustion or heatstroke; this happens when a person’s ________ exceeds the body’s ability to dissipate heat.
heat production
147
T/F:
1st Statement: Consuming adequate amounts of cool liquids, particularly during strenuous activity, reduces the risk of adverse effects from heat.
2nd Statement: Balanced electrolyte solutions and carbohydrate-electrolyte solutions such as sports drinks are recommended because they replace both water and electrolytes lost through perspiration.
Both T
148
___________ such as diet, exercise, stress, and alcohol consumption affect fluid, electrolyte, and acid–base balance.
Lifestyle factors
149
Intake of fluids and electrolytes is affected by diet. Choose the following that exhibits it:
- People with anorexia nervosa or bulimia are at risk for severe fluid and electrolyte imbalances because of inadequate intake or purging regimens (e.g., induced vomiting, use of diuretics and laxatives).
- Seriously malnourished people have decreased serum protein levels, and may develop edema because serum osmotic pressure is reduced.
- When calorie in- take is not adequate to meet the body’s needs, fat stores are broken down and fatty acids are released, increasing the risk of acidosis.
All of the statements
150
Regular weight-bearing exercise such as walking or running has a beneficial effect on calcium balance. The rate of bone loss that occurs in postmenopausal women and older men is slowed with weight-bearing exercise, reducing the risk of __________.
osteoporosis
151
Stress can increase cellular metabolism, blood glucose concentration, and catecholamine levels. In addition, stress can increase production of ADH and stimulate the renin-angiotensin-aldosterone system, both of which decrease urine production. The overall response of the body to stress is to ________ blood volume.
increase
152
Heavy alcohol consumption increases the risk of ______ calcium, magnesium, and phosphate levels. People who drink large amounts of alcohol are also at risk for_________ associated with breakdown of fat tissue.
low; acidosis
153
T/F: A number of factors such as illness, trauma, surgery, and medications can affect the body’s ability to maintain fluid, electrolyte, and acid– base balance.
T
154
The kidneys play a major role in maintaining fluid, electrolyte, and acid–base balances, and _________ is a significant cause of imbalances.
renal disease
155
In addition, decreased blood flow to the kidneys due to cardiovascular disease stimulates the renin-angiotensin-aldosterone system, causing ___________.
sodium and water retention
156
Choose the following that conveys fluid loss:
- Diseases such as diabetes mellitus, cancer, and chronic obstructive lung disease may affect acid–base balance.
- Clients who are confused or unable to communicate their needs
- Vomiting, diarrhea, or nasogastric suction
- Tissue trauma, such as burns
- Medications such as diuretics or corticosteroids
2nd, 3rd, and 4th only - 1st coneys acid-base imbalance and 5th one might cause fluid loss or fluid retention.
157
Fluid imbalances are of two basic types:
isotonic and osmolar
158
_________ occur when water and electrolytes are lost or gained in equal proportions, so that the osmolality of body fluids remains constant.
Isotonic imbalances
159
_________ involve the loss or gain of only water, so that the osmolality of the serum is altered.
Osmolar imbalances
160
four categories of fluid imbalances may occur:
(1) an isotonic loss of water and electrolytes,
(2) an isotonic gain of water and electrolytes,
(3) a hyperosmolar loss of only water, and
(4) a hypo-osmolar gain of only water.
161
__________ occurs when the body loses both water and electrolytes from the ECF in similar proportions.
Isotonic fluid volume deficit (FVD)
162
In FVD, fluid is initially lost from the intravascular compartment, so it often is called ____________.
hypovolemia
163
In ____________, fluid shifts from the vascular space into an area where it is not readily accessible as extracellular fluid. This fluid remains in the body but is essentially unavailable for use, causing an isotonic fluid volume deficit. Fluid may be isolated in the bowel, in injured tissue (e.g., severe burns), or in potential spaces such as the peritoneal or pleural cavities.
third space syndrome
164
Third spacing has two distinct phases:
loss and reabsorption
165
The client with third space syndrome during the_________ has an isotonic fluid deficit. During the__________, tissues begin to heal and fluid moves back into the intravascular space.
loss phase; reabsorption phase
166
T/F: Careful nursIng assessment is vital to effectively identify and intervene for clients experiencing third spacing. Because fluid shifts from the vascular compartment (loss phase) and then back into the vascular compartment after time (reabsorption phase), assessment for manifestations of fluid volume deficit and excess is vital.
T
167
___________ occurs when the body retains both water and sodium in similar proportions to normal ECF. This is commonly referred to as __________ (increased blood volume).
Fluid volume excess (FVE); hypervolemia
168
T/F:
1st Statement: FVE is always secondary to an increase in the total body sodium content, which leads to an increase in total body water.
2nd Statement: Because both water and sodium are retained, the serum sodium concentration remains essentially normal and the excess volume of fluid is isotonic.
Both T
169
Specific causes of FVE include:
(a) excessive intake of sodium chloride;
(b) administering sodium-containing infusions too rapidly, particularly to clients with impaired regulatory mechanisms; and
(c) disease processes that alter regulatory mechanisms, such as heart failure, renal failure, cirrhosis of the liver, and Cushing’s syndrome.
170
Excess interstitial fluid is known as _________. It is typically is most apparent in areas where the tissue pressure is low, such as around the eyes, and in dependent tissues (known as dependent ________), where hydrostatic capillary pressure is high.
edema
171
Edema can be caused by several different mechanisms. The three main mechanisms are:
- increased capillary hydrostatic pressure
- decreased serum osmotic pressure
- increased capillary permeability.
172
FVE increases _________, pushing fluid into the interstitial tissues. This type of edema is often seen in dependent tissues such as the feet, ankles, and sacrum because of the effects of gravity.
capillary hydrostatic pressure
173
Low levels of plasma proteins from malnutrition or liver or kidney diseases can reduce ____________, so that fluid cannot be held in the capillaries. This allows fluid to leak into interstitial spaces, causing edema.
serum osmotic pressure
174
With tissue trauma and some disorders such as allergic reactions, capillaries become more __________, allowing fluid to escape into interstitial tissues.
permeable
175
T/F: Obstructed lymph flow also impairs the movement of fluid from interstitial tissues back into the vascular compartment, resulting in edema.
T
176
The edema that leaves a small depression or pit after finger pressure is applied to the swollen area.
Pitting Edema
177
T/F: The pit is caused by the movement of fluid to adjacent tissue, _________ from the point of pressure. Within 10 to 30 seconds the pit normally disappears as fluid returns to the area.
away
178
Pitting edema of 2mm, barely detectable.
1+
179
Pitting edema of 2-4mm
2+
180
Pitting edema of 5-7mm
3+
181
Pitting edema of more than 7mm
4+
182
___________, or a hyperosmolar fluid imbalance, occurs when water is lost from the body, leaving the client with excess sodium.
Dehydration
183
Because water is lost while electrolytes, particularly sodium, are retained, ____________ increase.
serum osmolality and serum sodium levels
184
Water is drawn into the vascular compartment from the interstitial space and cells, resulting in ___________.
cellular dehydration
185
The following can lead to dehydration, except:
- Older adults are at particular risk for dehydration because of decreased thirst sensation.
- Dehydration can also affect clients who are hyperventilating, have a prolonged fever, are in diabetic ketoacidosis, or are receiving enteral feedings with insufficient water intake.
None of the above
186
__________, or a hypo-osmolar fluid imbalance, occurs when water is gained in excess of electrolytes, resulting in low serum osmolality and low serum sodium levels.
Overhydration
187
Water is drawn into the cells, causing them to________. In the brain, this can lead to cerebral edema and impaired neurologic function.
swell
188
Overhydration, sometimes called__________, often occurs when both fluid and electrolytes are lost, for example, through excessive sweating, but only water is replaced.
water intoxication
189
It is a sodium deficit, or serum sodium level of less than 135 mEq/L, and is, in acute care settings, a common electrolyte imbalance.
Hyponatremia
190
Because of sodium’s role in determining the osmolality of ECF, hyponatremia typically results in a _____________.
low serum osmolality
191
________ is drawn out of the vascular compartment into interstitial tissues and the cells, causing the clinical manifestations associated with this disorder.
Water
192
As sodium levels decrease, the brain and nervous system are affected by cellular edema. ____________, serum levels below 115 mEq/L, is a medical emergency and can lead to increasing intracranial pressure and coma
Severe hyponatremia
193
It is excess sodium in ECF, or a serum so- dium of greater than 145 mEq/L.
Hypernatremia
194
Because the osmotic pressure of ECF is increased, fluid moves out of the cells into the ECF. As a result, the cells become________. Like hyponatremia, the primary manifestations of hypernatremia are neurologic in nature.
dehydrated
195
It is important to note that normally a person’s ___________ protects against hypernatremia. When an individual becomes thirsty, the body is stimulated to drink water, which helps correct the hypernatremia.
thirst mechanism
196
Which of the following is not at risk for developing hypernatremia?
- those who are unable to access water, such as clients who are unconscious
- clients who are unable to request fluids such as infants or older adults with dementia
- ill clients with an impaired thirst mechanism
- patients with good eating habits
patients with good eating habits
197
It is a potassium deficit, defined as a serum potassium level of less than 3.5 mEq/L.
Hypokalemia
198
__________ of potassium through vomiting and gastric suction are common causes of hypokalemia, as is the use of potassium-wasting diuretics, such as thiazide or loop diuretics.
Gastrointestinal losses
199
T/F:
1st Statement: Symptoms of hypokalemia are usually mild until the level drops below 3 mEq/L, unless the decrease in potassium is rapid.
2nd Statement: When the decrease is gradual, the body compensates by shifting potassium from the intracellular environment into the serum.
Both T
200
It is a potassium excess, defined as a serum potassium level greater than 5.0 mEq/L. It is less common than hypokalemia, and rarely occurs in clients with normal renal function.
Hyperkalemia
201
T/F: Hyperkalemia is more dangerous than hypokalemia and can lead to cardiac arrest. Symptoms are more severe and severe and occur at lower levels when the increase in potassium is rapid.
T
202
It is a calcium deficit, defined as a total serum calcium level of less than 8.5 mg/dL or an ionized calcium level of less than 4.5 mEq/L. Severe depletion of calcium can cause tetany with muscle spasms and paresthesias (numbness and tingling around the mouth, hands, and feet), and can lead to seizures.
Hypocalcemia
203
Two signs indicate hypocalcemia:
Chvostek's sign and Trousseau's sign
204
It is a contraction of the facial muscles in response to tapping the facial nerve in front of the ear.
Chvostek’s sign
205
It is a carpal spasm in response to inflating a blood pressure cuff on the upper arm to 20 mmHg greater than the systolic pressure for 2 to 5 minutes.
Trousseau’s sign
206
Which of the following does not cause hypocalcemia:
- Those whose parathyroid glands have been re- moved. This is frequently associated with thyroidectomy or other neck surgery, which can result in unintentional removal or damage to the parathyroid glands.
- Low serum magnesium levels (hypomagnese- mia)
- Those that have chronic alcoholism
None of the above
207
It is a calcium excess, defined as a total serum calcium level greater than 10.5 mg/dL, or an ionized calcium level of greater than 5.5 mEq/L. It most often occurs when calcium is released in excess from the bony skeleton. This is usually due to malignancy or prolonged immobilization.
Hypercalcemia
208
It is a magnesium deficiency, defined as a serum magnesium level of less than 1.5 mEq/L. It occurs more fre- quently than hypermagnesemia.
Hypomagnesemia
209
__________ is the most common cause of hypomagnesemia. Magnesium deficiency also may aggravate the manifestations of alcohol withdrawal, such as delirium tremens (DTs).
Chronic alcoholism
210
It is a magnesium excess, defined as a serum magnesium level above 2.5 mEq/L, due to increased intake or de- creased excretion. It is often iatrogenic, meaning caused by medical treatment; usually the cause is oversupplementation with magnesium.
Hypermagnesemia
211
It is a chloride deficit, defined as a serum chlo- ride level below 95 mEq/L, and is usually related to excess loss of chloride through the GI tract, kidneys, or sweating.
Hypochloremia
212
T/F: Hypochloremic clients are at risk for alkalosis, and may experience muscle twitching, tremors, or tetany.
T
213
It is a chloride excess, defined as a serum chloride level above 108 mEq/L. Excess replacement of sodium chloride or potassium chloride is a risk factor for high serum chloride levels, as are conditions that lead to hypernatremia.
Hyperchloremia
214
The manifestations of hyperchloremia include:
acidosis, weakness, and lethargy, with the risk of dysrhythmias or coma
215
T/F:
1st Statement: Phosphate (PO43–) is found in both intracellular and extracellular fluid. Most of the phosphorus (P+) in the body exists as PO43–.
2nd Statement: Phosphate is critical for cellular metabolism because it is a major component of adenosine triphosphate (ATP).
Both T
216
It is a phosphate deficit, defined as a se- rum phosphate level of less than 2.5 mg/dL.
Hypophosphatemia
217
The following can cause hypophosphatemia except:
- Glucose and insulin administration
- Total parenteral nutrition can
- Alcohol withdrawal
- Acid–base imbalances
- Use of antacids that bind with phosphate in the GI tract
- Hypercalcemia
Hypercalcemia
218
Manifestations of hypophosphatemia include:
paresthesias, muscle weakness and pain, mental changes, and possibly seizures
219
It is a phosphate excess, defined as a serum phosphate level greater than 4.5 mg/dL. It occurs when phosphate shifts out of the cells into extracellular fluids (e.g., due to tissue trauma or chemotherapy), in renal failure, or when excess phosphate is administered or ingested.
Hyperphosphatemia
220
T/F: Infants who are fed cow’s milk are not at risk for hyperphosphatemia, as are people who use phosphate-containing enemas or laxatives.
F - they are at risk
221
Manifestations of hyperphosphatemia include:
numbness and tingling around the mouth and in the fingertips, muscle spasms, and tetany
222
Acid–base imbalances are usually classified as __________ by the general or underlying cause of the disorder.
respiratory or metabolic
223
__________ are normally regulated by the lungs through the retention or excretion of carbon dioxide, and problems lead to respiratory acidosis or alkalosis.
Carbonic acid levels
224
_____________ are regulated by the kidneys, and problems lead to metabolic acidosis or alkalosis. Healthy regulatory systems will attempt to correct acid–base imbalances, a process called compensation.
Bicarbonate and hydrogen ion levels
225
Any condition that causes carbon dioxide retention, either due to hypoventilation or impaired lung function, causes carbonic acid levels to increase and pH to fall below 7.35, a condition known as ____________.
respiratory acidosis
226
The following contributes to respiratory acidosis, except?
- serious lung diseases such as asthma and chronic obstructive pulmonary disease (COPD)
- central nervous system depression due to anesthesia or a narcotic overdose can slow the respiratory rate enough to cause carbon dioxide retention.
None
227
T/F: When respiratory acidosis occurs, the kidneys retain bicarbonate to restore the normal carbonic acid to bicarbonate ratio.
T
228
T/F: The kidneys are relatively fast to respond to changes in acid–base balance, however, so this compensatory response may require hours to days to restore normal pH.
F - relatively SLOW
229
When a person hyperventilates, more carbon dioxide than normal is exhaled, carbonic acid levels fall, and the pH rises to greater than 7.45. This condition is called ___________.
respiratory alkalosis
230
The following are causes of respiratory alkalosis:
- Psychogenic or anxiety-related hyperventilation
- Fever and respiratory infections.
231
T/F: In respiratory alkalosis, the kidneys will excrete bicarbonate to return pH to within the normal range. Often, however, the cause of the hyperventilation is eliminated and pH returns to normal before renal compensation occurs.
T
232
When bicarbonate levels are low in relation to the amount of carbonic acid in the body, pH falls and metabolic acidosis develops.
metabolic acidosis
233
The following are causes of metabolic acidosis except:
- Renal failure and the inability of the kidneys to excrete hydrogen ions and produce bicarbonate.
- Too much acid is produced in the body, for example, in diabetic ketoacidosis or starvation when fat tissue is broken down for energy.
- Cardiovascular Dysfunction
Cardiovascular Dysfunction
234
T/F: Metabolic acidosis stimulates the respiratory center, and the rate and depth of respirations increase. Carbon dioxide is eliminated and carbonic acid levels fall, minimizing the change in pH. This respiratory compensation occurs within minutes of the onset of the pH imbalance.
T
235
In metabolic alkalosis, the amount of bicarbonate in the body exceeds the normal 20-to-1 ratio.
236
The following are causes of metabolic alkalosis:
- Ingestion of bicarbonate of soda as an antacid - Prolonged vomiting with loss of hydrochloric acid from the stomach.
237
The respiratory center is depressed in metabolic alkalosis, and respirations slow and become shallower. Carbon dioxide is retained and carbonic acid lev- els increase, helping balance the excess bicarbonate.
