Electrolytes Flashcards
Name the electrolytes found in the ECF
Sodium
Chloride
Calcium
Bicarbonate
Name the electrolytes found in the ICF
Potassium
Phosphate
Magnesium
What is a normal range for Sodium
135-145 mEq/L
_______ helps prevent cellular swelling.
Sodium Potassium pump
Diuretics can cause ______ loss which is also linked to hyponatremia.
Potassium loss (hypokalemia)
What is a major cause of low Na levels.
SIADH
What are some causes of SIADH?
Oat cell carcinoma, CNS disorders (stroke, trauma), Pulmonary disorders
What type of pulmonary disorders are linked to SIADH?
Asthma, COPD, oat cell carcinoma of lung
How is SIADH treated?
Treat underlying cause
Limit fluids, or fluid restriction
Possible hypertonic solution if severe
If someone has increased sodium what effect will this have on thirst? (increased or decreased)
Increased thirst
If someone has decreased Na levels what can you expect from their ADH secretion? (Increased or decreased)
Decreased (directly related)
If someone has decreased levels of sodium what effect does this have on aldosterone? (increased secretion or decreased section)
Increased secretion of aldosterone to conserve Na
The sodium potassium pump transports Na ions ______. (out of cells or into cells?)
Out of cells
K tends to diffuse ______. (inward or outward)
outward
Na tends to diffuse _______. (inward or outward)
inward
Name 3 conditions that place someone at risk for hyponatremia?
Heart failure
Cancer
GI disorders with fluid loss
An important cause of hypernatremia is due to pulmonary infections from loss of water vapor from ________.
hyperventilation
Name a common condition associated with hypernatremia?
Diabetes insipidus
The body’s main defense to hypernatremia is _____.
Thirst
If you were walking across the Sahara Desert with an empty canteen, the amount of ADH secreted would most likely: A. increase B. Decrease C. Stay the same D. Have no effect
A. Increase; to retain fluid ADH secretion increases
_____ occurs when fluid moves from an are with more fluid to an area with less fluid.
Osmosis
Hydrostatic pressure which pushes fluid out of capillaries is opposed by colloid osmotic pressure which involves:
A. Reduced renin secretion
B. A decrease in aldosterone
C. Pulling power of albumin to reabsorb water
D. An increase in ADH secretion.
C. Albumin in capillaries draws water toward it (reabsorption)
When a person's BP drops the kidneys respond by: A. Secreting Renin B. Producing aldosterone C. Slowing release of ADH D. Secreting ANP
A. juxtaglomerular cells in kidneys secrete renin in response to low BP or low sodium (renin secretion will increase BP)
Giving a hpertonic IV solution may cause too much fluid to be:
A. Pulled from cells into bloodstream, causing cells to shrink
B. Pulled from bloodstream into cells
C. Pushed out of bloodstream into extravascular spaces
D. Pulled from cells into bloodstream which may cause cells to increase in size
A. Causes fluid to be pulled from cells into bloodstream causing cell shrinkage
Name the negatively charged electrolytes or anions?
Bicarb
Chloride
Phosphorous
Name the positively charged electrolytes also called cations.
Potassium
Sodium
Calcium
Magnesium
________ helps maintain osmotic pressure (water pulling pressure) in ECF.
Chloride
_________ affects serum osmalility.
Na
_________ is major ECF electrolyte involved in structure and function of bones & teeth.
Ca
__________ located in the ICF is essential for energy metabolism.
Phosphorus
________ in the ICF acts as a catalyst for enzyme reactions.
Magnesium
\_\_\_\_\_\_\_\_\_\_\_ is a common cause of hypernatremia. A. SIADH B. Diabetes Mellitus or inspidus C. Vomiting D. Malnutrition
B. Diabetes Mellitus or inspidus
Name an example of an active transport mechanism.
Sodium potassium pump
\_\_\_\_\_\_\_ secrete aldosterone which influences sodium and potassium balance in the kidneys. A. Hypothalamus B. Pituatary Gland C. GI Tract D. Kidneys
B. Pituitary Gland
When the heart counteracts the renin angiotensin aldosterone system when it secretes \_\_\_\_\_\_\_, causing sodium excretion. A. Aldsterone B. Renin C. ANP D. Potassium
C. ANP
The parathyroid gland plays a role in electrolyte balance of ________ and _________.
Calcium and phosphorous
When _____ is secreted from the parathyroid glands it draws calcium into blood from bones and moves phosphorous from blood to kidneys.
Parathyroid hormone
The thyroid gland secretes _____ which lowers calcium levels and prevents calcium release from the bones.
Calcitonin
Sodium and _____ balance are closely related. When too much sodium is released then ______ will decrease.
Fluid; Fluid levels
When kidneys fail \_\_\_\_\_\_ builds up in the body which can be fatal. A. Magnesium B. Calcium C. Phosphorous D. Potassium
D. Potassium
A diuretic may cause a ______ in electrolytes. An IV fluid will cause a _______ in electrolytes.
Decrease; Increase
\_\_\_\_\_\_ regulate sodium and potassium balance. A. Heart B. Parathyroid glands C. Kidneys D. Liver
C. Kidneys
\_\_\_\_\_\_\_ secrete aldosterone, which influences sodium and potassium balance. A. Heart B. Adrenal Glands C. Kidneys D. Liver
B. Adrenal glands
When a burn damages cells you would expect the cells to release this major electrolyte? A. Potassium B. Chloride C. Calcium D. Sodium
A. Potassium–a major electrolyte inside cell that leaks out into extra cellular fluid after major trauma such as burn
Diuretics affect the kidneys by altering the absorption and excretion of A. Water only B. Electrolytes only C. Water and electrolytes D. Other drugs
C. Water and electrolytes
The main extracellular cation is: A. Calcium B. Potassium C. Bicarboate D. Sodium
D. Sodium is the main ECF cation. It helps regulate fluid balance in body
In the nephron, most electrolytes are reabsorbed in the: A. Proximal Tubule B. Glomerulus C. Loop of Henle D. Distal tube
A. Proximal Tubule reabsorbs most electrolytes from filtrate
Potassium is essential for conduction electrical impulses because it causes ions to:
A. Clump together to generate a current
B. Shift in and out of cell to conduct a current
C. Trap sodium inside cell to maintain current
D. Adhere to each other to create a current
B. Shift in and out of cell; Potassium causes ions to shift in and out of cell
Older adults are at increased risk for electrolyte imbalances because with age, kidneys have:
A. Increased glomerular filtration rate
B. Fewer functioning nephrons
C. Increased ability to concentrate urine
D. Increased blood flow
B. Fewer functioning nephrons
They also have a decreased glomerular filtration rate and diminished ability to concentrate urine
\_\_\_\_\_ is a calculation based on hydrogen ions in a solution as well as the amount of acids and bases. A. PaCO2 B. Bicarbonate C. Metabolism D. pH
D. pH
_______ (acids or bases) accept H+ and _______ (acids or bases) donate H+ ions.
Bases accept
Acidse donate
\_\_\_\_\_\_\_ is an example of an acid. A. Hydrogen B. H2CO3 C. HCO3 D. PaCO2
B. H2CO3 is carbonic acid
If you have a solution that has an increased pH or decreased H+ ions it would be considered a ________ (acid or base)
Base
A solution with a pH above 7 is considered a ______ (acid, base?)
Base, or alkaline
Arterial blood is slightly \_\_\_\_\_ ranging from 7.35-7.45 A. Neutral B. Alkaline C. Aciditic D. abnormal
B. Alkaline
\_\_\_\_\_\_ occurs when H+ accumulate and/or bicarbonate is lost. A. Alkalosis B. Acidosis C. Neutrality D. Instability
B. Acidosis
When pH rises three regulatory systems can activate:
What are they?
Chemical buffers- protect tissue and cells by combining with offending acid or base to neutralize harmful effects.
Respiratory system- uses hypoventilation or hyperventilation
Kidneys by excreting or retaining acids and bases as needed.
Which regulatory method is quicker?
Respiratory
Chemical buffers in the blood, ____, and _____serve as the body’s efficient pH balancing system.
ECF, ICF
Name the three main chemical buffers.
Bicarbonate, Phosphate, and protein
An example of a weak acid is _____.
An example of a weak base is ______.
An example of a strong acid is _______.
Weak acids= carbonic acid
Weak base= Bicarbonate
Strong acids= Hydrochloric acid
This buffer system is especially effective in renal tubules. Its buffers react with either acids or bases. A. Bicarbonate B. Phosphate C. Hydrochloric acid D. Carbonic Acid
B. Phosphate
_______ buffers are the most plentiful buffers in the body and work inside and outside the cell. In contrast, _____ is the body’s primary buffer system that buffers blood & interstitial fluid. ________ buffer is especially effective in renal tubules.
Protein buffers are most plentiful
Bicarbonate is body’s primary buffer system
Phosphate buffer system
_________ serves as the 2nd line of defense against acid base imbalances.
Respiratory system
_______ in the medulla of the brain sense pH changes and vary the rate and depth of breathing to compensate.
Chemoreceptors
Breathing faster or deeper eliminates _____ from the lungs. After the body detects a pH change it will reduces it by ________.
CO2; hypoventilation
When a persons breathing rate increases then CO2 will ______ (increase or decrease)
decrease
What is used to measure the effectiveness of ventilation. A. pH B. PaCO2 C. PaO2 D. HCO3
B. PaCO2
_____ is responsible for long term acid base balance in the body.
Kidneys
\_\_\_\_\_\_\_ represents the metabolic component of acid base balance. A. pH B. PaCO2 C. PaO2 D. HCO3
D. HCO3 or bicarbonate
What is a normal bicarbonate range?
22-26 mEq/L
When a lack of bicarbonate causes acidosis the lungs will _____ breathing rate.
A. Increase
B. Decrease
Increase
T or F: When the body compensates partially the pH will return to normal.
False; In partial compensation the pH does not return to normal
When the metabolic disturbance is primary cause of acid base balance what compensates?
A. kidneys
B. Lungs
C. Heart
B. Lungs
When an excess of bicarbonate causes alkalosis how will the lungs respond?
Decreases the rate of breathing
When ______ is low or in a state of alkalosis the kidneys will excrete bicarbonate and hold on to more acid to lower pH.
PaCO2
The relationship between PaCO2 and pH is A. Directly related B. Linearly related C. Inversely related D. Not related
C. Inversely related; if PaCO2 increases then pH will decrease
T or F: The ABG can be used to assess effectiveness of breathing, overall acid base balance and monitor patients response to treatment.
True
_____ moves in the same direction of pH.
A. PaCO2
B. PaO2
C. HCO3
C. HCO3
What is the normal PaO2?
80-100 mmHg
_______ provides the information about the respiratory component of acid base balance.
A. PaCO2
B. PaO2
C. HCO3
PaCO2
____ value provides information about the metabolic aspect of acid base status.
A. Bicarbonate
B. PaCO2
C. PaO2
A. Bicarb
PaCO2 represents the _____ component of acid base balance while HCO3 represents the _______ component of acid base balance.
Respiratory
Metabolic
If pH is high you would expect your HCO3 level to be ______ (high, low)
high
______ provides information on the patient’s oxygenation status.
A. PaO2
B. PaCO2
C. HCO3
A. PaO2
_____ represents the level of unmeasured anions in extracellular fluid
Anion Gap
What is normal range for Anion Gap?
8-14 mEq/L
T or F: The anion gap can help differentiate acidotic conditions.
True
The kidneys will respond with bicarbonate excretion and increased acid retention when PaCO2 is _____. (low, high)
Low
The kidneys respond to acid base disturbances by: A. Adjusting PaCO2 levels B. Producing phosphate buffers C. Producing protein buffers D. excreting or reabsorbing H or Bicarb
D. excreting or reabsorbing H or Bicarb
If your patient is breathing rapidly his body is attempting to A. Retain CO2 B. Get rid of CO2 C. Improve buffering of bicarb D. Produce more carbonic acid H2CO3
B.
If your patient has higher than normal pH (alkalosis) you would expect to also see: A. high PaCO2 and high bicarbonate B. low PaCO2 and high bircarbonate C. low bicarbonate and high PaCO2 D. Low PaCO2 and low bicarbonate
B. A low PaCO2 means less CO2 is in the blood, which raises pH; When pH is raised then bicarbonate level also increases
The lab reports the following ABG: pH 7.33, PaCO2 40, and bicarb 20 mEq/L these results can be intrepreted as: A. Respiratory Acidosis B. Metabolic Acidosis C. Respiratory Alkalosis D. Metabolic Alkalosis
B. Metabolic acidosis; because PaCO2 is normal and bicarbonate is low the primary cause is metabolic
The following ABG can be intrepreted as:
pH 7.52; PaCO2 47; Bicarb 36
A. Normal
B. Respiratory acidosis
C. Respiratory alkalosis with respiratory compensation
D. Metabolic alkalosis with respiratory compensation
D. Ph is alkalotic; elevated PaCO2 represents the efforts of respiratory system to compensate for the alkalosis by retaining carbon dioxide
\_\_\_\_\_ is key measurement associated in assessing a patient's fluid status. A. pH B. PaCO2 C. Blood pressure D. Bicarbonate
C. Blood Pressure
T or F: BP is related to the amount of blood the heart pumps and is unrelated to the amount of vasoconstriction present.
False: BP is related to both amount of blood pumped by heart and extend of vasoconstriction present
T or F: PAP and CVP can help assess fluid volume status.
True
_____ are inserted into radial or brachial artery and can continuously monitor blood pressure and take samples.
Arterial lines
_____ directly measures BP whereas _____ directly measures other pressures.
Arterial line
Pulmonary artery catheter
\_\_\_\_\_\_ provides a clearer picture of fluid volume status. A. A line B. Pulmonary artery Catheter C. BP D. Weight
B. Pulmonary artery catheter
When monitoring PAP or PAWP during fluid overload their values will ______ (increase, decrease)
increase
If a person is low on blood volume their CO is ______ (increased, decreased, unchanged)
Decreased
\_\_\_\_\_ refers to pressure of blood inside the central venous circulation. A. PAP B. PAWP C. CVP D. CO
C. CVP
What is a normal CVP range?
2-8 mmHg or (2-6 cm H2O)
If you see an increased CVP what does this mean for the patients fluid volume? (high or low)
High
A shift of fluids from intravascular space to areas not intracellular which can include abdominal cavity, pleural cavity, or pericardial sac is called?
3rd space fluid shift which placed one at high risk of hypovolemia
A loss of body fluids that increases osmolality and causes increased Na serum levels.
A. Dehydration
B. Hypovolemia
C. Hypervolemia
A Dehydration
A loss of isotonic fluids from extracellular space, bleeding or 3rd space fluid shift places one at higher risk?
A. Dehydration
B. Hypovolemia
C. Hypervolemia
B. Hypovolemia
Normal values for the following: CVP = ? PAP = ? PAWP = ? CO = ?
CVP = 2-6 cm H2O PAP = 10-20 cmH2O PAWP = 4-12 mmHg CO = 4-8 L/min
How can a patients breathing pattern change during fluid overload which is a potential complication of IV therapy
Causes crackles on ascultation
T or F: Increased O2 requirements is a sign of fluid overload
True
T or F: During hypervolemia one can affect the osmolality of fluids to increase
False; During hypervolemia the osmolality of fluids do not normally change as fluid and solutes normally increased in equal proportion
Pink, frothy sputum is a hallmark of ______ _______.
Pulmonary Edema
Edema that occurs in the lungs happens as the ____ side of the heart backs up as it becomes overloaded and pump efficiency declines.
Left side
T or F: Hypevolemia may manifest with low O2 levels & pulmonary congestion on xrays.
True; with early tachypnea partial pressure of arterial CO2 may be low causing a drop in pH and respiratory alkalosis
One treatment of hypervolemia is to administer ____.
diuretics
What two medications may be given to a patient with pulmonary edema to dilate blood vessels to reduce pulmonary congestion and amount of blood returning to heart.
Nitroglycerin
Morphine
This medication can treat heart failure by strengthening cardiac contractions and slowing heart rate.
Digoxin
_______ may be needed when kidneys are not working properly and in hemodynamically unstable patients who are hypervolemic.
CCRT -continuous Renal replacement therapy
T or F: Distended veins in the hands or neck is a sign of hypervolemia
True
T or F: Respiratory distress such as tachypnea or dyspnea can be a sign of hypervolemia
True
T or F: A third heart sound S3 may be heard during times when volumes in the body are diminished.
False: it is heard when ventricles are volume overloaded
________ occurs when excess fluid moves from extracellular space to intracellular space; this shift may cause cells to swell and occurs as a means of balancing concentration of fluid between those 2 spaces.
Water intoxication
By causing the body to hold on to electrolyte free water \_\_\_\_\_\_ can cause water intoxication. A. Pulmonary edema B. Heart failure C. SIADH D. O2 toxicity
C. SIADH
T or F: Indications of water intoxication include low NA levels and increased ICP which occurs as brain cells swell. Also, headache and personality changes may be first sign or change in LOC.
True
T or F: The use of hypotonic fluid such as D5W is a standard treatment of water intoxication.
False: Restricting oral and parenteral fluid intake, avoiding the use of hypotonic IV solutions until serum sodium rises is a normal treatment;
T or F: The use of hypertonic solutions for water intoxication are used in severe cases and draw fluid out of cells but require close patient monitoring.
True
Excess isotonic fluid in extracellular spaces define: A. Hypervolemia B. Hypvolemia C. Dehydration D. Water intoxication
A. Hypervolemia
Excess fluid in the intracellular space from exracellular space refers to: A. Hypervolemia B. Hypovolemia C. Dehydration D. Water Intoxication
D. Water intoxication
A severe fluid gain is evidenced by a weight gain of more than ____.
10%
Hypotonic fluid loss from extracellular space is: A. Hypervolemia B. Hypovolemia C. Dehydration D. Water intoxication
B. Hypovolemia
Lack of water in extracellular spaces that causes fluid to shift out of cells, which often then shrink; often due to any situation that accelerates fluid loss. A. Hypervolemia B. Hypovolemia C. Dehydration D. Water intoxication
C. Dehydration
Populations at risk for dehydration include: A. Infants B. Adolescents C. Patients with SIADH D. Young Adults
A. Infants
Changes in orthostatic hypotension allows the nurse to detect early signs of: A. Hypovolemia B. Low serum osmolality C. High serum Osmolality D. Hyhpervolemia
A. Hypovolemia; changes in BP and pulse are two initial changes seen with hypovolemia
The first step to take for hypovolemic shock is: A. Assess for dehydration B. Administer IV fluids C. Insert a urinary catheter D. Prepare for surgery
B. Rapid infusion of IV fluids to to the nature of its emergency
A sign of hypervolemia is: A. Increased urine output B. Clear, water eyes C. Severe hypertension D. Rapid, Bounding pulse
D. Rapid bounding pulse due to excess fluid in intravascular space; if pink frothy sputum exists this signals pulmonary edema
Water intoxication can be caused by
A. Administering too much hypertonic fluid
B. Administering too much hypotonic fluid
C. encouraging too much fluid intake
D. Administering too much isotonic fluid.
B. Too much hypotonic fluid can cause water intoxication as water will shift from blood vessels into cells
______ directly affects how well the body’s cells, nerves, and muscles function by maintaining cells electrical neutrality and osmolality. (which electrolyte)
Potassium
What are the normal serum potassium levels in the body?
3.5-5.0 mEq/L
T or F: the Potassium level in the cell is much higher, but it is usually not measured.
True
Three factors that affect potassium levels include:
Na-K pump
Renal regulation
pH level
_____ and potassium have a reciprocal relationship.
Sodium
T or F: The kidneys have no effective mechanism to combat loss of K and may excrete it even when it is low or intake is zero.
True
T or F: A change in pH does not affect serum K levels.
False; It would affect the serum K as H and K freely exchange across plasma cell
Acidosis can cause _______.
A. Hyperkalemia
B. Hypokalemia
A. Hyperkalemia as excess H moves into cells and pushes out K
T or F: The body cannot conserve potassium.
True
The use of this common medication administered to asthmatics may cause hypovolemia.
Albuterol or epinephrine
The pneumonic SUCTION can be used to identify signs and symptoms of hypokalemia, explain the signs.
S = Skeletal muscle weakness U= U wave on ECG C= Constipation T= Toxic effects from digoxin I= Irregular, weak pulse O= Orthostatic hypotension N= Numbness
T or F: You never give K by IV push or bolus, it can be fatal.
True
Low levels of this electrolyte makes it hard for kidneys to conserve Potassium.
Magnesium
