Fluid Electrolyte And Acid-Base .

Question 1

Approximately _ of the average healthy adult’s weight is water, the primary body fluid.

Answer 1

60%

Question 2

The body’s fluid is divided into two major compartments, _ and _.

Answer 2

intracellular
extracellular

Question 3

_ is found within the cells of the body. It constitutes approximately two thirds of the total body fluid in adults

Answer 3

Intracellular fluid (ICF)

Question 4

_ is found outside the cells and accounts for about one third of total body fluid.

Answer 4

Extracellular fluid (ECF)

Question 5

The two main compartments of ECF are _ and _.

Answer 5

intravascular
interstitial

Question 6

Extracellular and intracellular fluids contain oxygen from the lungs, dissolved nutrients from the gastrointestinal tract, excretory products of metabolism such as carbon dioxide, and charged particles called _.

Answer 6

ions

Question 7

The term _ refers to the chemical combining power of the ion, or the capacity of cations to combine with anions to form molecules, whereas the term milligram refers to the weight of the ion.

Answer 7

milliequivalent

Question 8

_ is the power of a solution to pull water across a semipermeable membrane.

Answer 8

Osmotic pressure

Question 9

_ occurs when two solutes of different concentrations are separated by a semipermeable membrane

Answer 9

Diffusion

Question 10

_ 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)

Answer 10

Osmosis

Question 11

_ is a process whereby fluid and solutes move together across a membrane from an area of higher pressure to an area of lower pressure.

Answer 11

Filtration

Question 12

The pressure that results in the movement of the fluid and solutes out of a compartment is called _.

Answer 12

filtration pressure

Question 13

_ is the pressure exerted by a fluid within a closed system on the walls of the container in which it is contained.

Answer 13

Hydrostatic pressure

Question 14

_ is the movement of solutes across cell membranes from a less concentrated solution to a more concentrated one

Answer 14

Active transport

Question 15

An _ is a substance that releases hydrogen ions (H+) in solution.

_, or _, have a low hydrogen ion concentration and can accept hydrogen ions in solution.

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.

Answer 15

acid
Bases
alkalis
pH

Question 16

_ prevent excessive changes in pH by binding with or releasing hydrogen ions. The action of a _ is immediate, but limited in its capacity to maintain or restore normal acid–base balance.

Answer 16

Buffers

Question 17

FACTORS AFFECTING BODY FLUID, ELECTROLYTES, AND ACID–BASE BALANCE

Answer 17

The ability of the body to adjust fluids, electrolytes, and acid–base balance is influenced by age, sex and body size, environmental temperature, and lifestyle.

Question 18

Fluid imbalances are of two basic types: _ and _.

A _ occur when water and electrolytes are lost or gained in equal proportions, so that the osmolality of body fluids remains constant.

_ involve the loss or gain of only water, so that the osmolality of the serum is altered.

Answer 18

isotonic and osmolar

isotonic mbalances
Osmolar imbalances

Question 19

_ occurs when the body loses both water and electrolytes from the ECF in similar proportions. Thus, the decreased volume of fluid remains isotonic. In FVD, fluid is initially lost from the intravascular compartment, so it often is called _.

Answer 19

Isotonic fluid volume deficit (FVD)
hypovolemia

Question 20

In _, fluid shifts from the vascular space into an area where it is not readily accessible as extracellular fluid.

Answer 20

third space syndrome

Question 21

_ occurs when the body retains both water and sodium in similar proportions to normal ECF. This is commonly referred to as _ (increased blood volume).

Answer 21

Fluid volume excess (FVE)
hypervolemia

Question 22

_ is edema that leaves a small depression or pit after finger pressure is applied to the swollen area.

Answer 22

Pitting edema

Question 23

_, 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.

Answer 23

Overhydration

Question 24

_, or a hyperosmolar fluid imbalance, occurs when water is lost from the body, leaving the client with excess sodium.

Answer 24

Dehydration

Question 25

Excess and Deficit:

Sodium
Potassium
Calcium
Magnesium
Chloride
Phosphate

Answer 25

Hyponatremia, Hypernatremia
Hypokalemia, Hyperkalemia
Hypocalcemia, Hypercalcemia
Hypomagnesemia, Hypermagnesemia
Hypochloremia, Hyperchloremia
Hypophosphatemia, Hyperphosphatemia

Question 26

_ are usually classified as respiratory or metabolic by the general or underlying cause of the disorder.

Answer 26

Acid–base imbalances

Question 27

Healthy regulatory systems will attempt to correct acid–base imbalances, a process called _.

Answer 27

compensation

Question 28

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 _.

Answer 28

respiratory acidosis

Question 29

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 _.

Answer 29

respiratory alkalosis

Question 30

In _, the amount of bicarbonate in the body exceeds the normal 20-to-1 ratio.

Answer 30

metabolic alkalosis

Question 31

An older nursing home resident has refused to eat or drink for several days and is admitted to the hospital. The nurse should expect which assessment finding?
1. Increased blood pressure
2. Weak, rapid pulse
3. Moist mucous membranes
4. Jugular vein distention

Answer 31

1. Answer: 2. Rationale: All other options are indicative of fluid volume excess. A client who has not eaten or drunk anything for several days would be experiencing fluid volume deficit. Cognitive Level: Applying. Client Need: Physiological Integrity. Nursing Process: Assessment. Learning Outcomes: 52-4; 52-5.

Question 32

A man brings his elderly wife to the emergency department. He states that she has been vomiting and has had diarrhea for the past 2 days. She appears lethargic and is complaining of leg cramps. What should the nurse do first?
1. Start an IV.
2. Review the results of serum electrolytes.
3. Offer the woman foods that are high in sodium and potassium content.
4. Administer an antiemetic.

Answer 32

2. Answer: 2. Rationale: Further assessment is needed to determine appropriate action. While the nurse may perform some of the interventions in options 1, 3, and 4, assessment is needed initially. Cognitive Level: Applying. Client Need: Physiological Integrity. Nursing Process: Assessment. Learning Outcome: 52-8.

Question 33

3. The nurse administers an IV solution of D5 1/2NS to a postoperative client. This is classified as what type of intravenous solution? _____________

Answer 33

3. Answer: Hypertonic. Cognitive Level: Remembering. Client Need: Physiological Integrity. Nursing Process: Implementation. Learning Outcome: 52-1.

Question 34

An older client comes to the emergency department experiencing chest pain and shortness of breath. An arterial blood gas is ordered. Which of the following ABG results indicates respiratory acidosis?
1. pH 7.54; PaCO2 28 mmHg; HCO3 22 mEq/L
2. pH 7.32; PaCO2 46 mmHg; HCO3 24 mEq/L
3. pH 7.31; PaCO2 35 mmHg; HCO3 20 mEq/L
4. pH 7.50; PaCO2 37 mmHg; HCO3 28 mEq/L

Answer 34

4. Answer: 2. Rationale: Because of the retention of CO2, the clinical profile of respiratory acidosis includes decreased pH < 7.35, PaCO2 > 42 mmHg, with varying levels of HCO3 related to hypoventilation. Option 1 is respiratory alkalosis, which occurs because of blowing off of CO2 resulting in a decreased level of acid and retention or production of bicarbonate, which in turn results in pH >7.45, PaCO2 < 38 mmHg, HCO3 > 26 mEq/L related to hyperventilation. Option 3: Metabolic acidosis occurs because of a gain of hydrogen ions or a loss of HCO3 with a pH < 7.35, normal PaCO2 of 35–45 mmHg, and HCO3 < 22 mEq/L, often caused by diarrhea, bicarbonate infusion, or retention related to kidney failure. Option 4: Metabolic alkalosis is caused by gain of bicarbonate or loss of hydrogen ions related to vomiting, gastric suction, or loss of upper gastrointestinal secretions by various other methods. Cognitive Level: Applying. Client Need: Physiological Integrity. Nursing Process: Assessment. Learning Outcomes: 52-2; 52-5.

Question 35

The intake and output (I&O) record of a client with a nasogastric tube who has been attached to suction for 2 days shows greater output than input. Which nursing diagnoses are most applicable? Select all that apply.
1. Deficient Fluid Volume
2. Risk for Deficient Fluid Volume
3. Impaired Oral Mucous Membranes
4. Impaired Gas Exchange
5. Decreased Cardiac Output

Answer 35

5. Answer: 1, 3, and 5. Rationale: Options 1, 3, and 5 relate to fluid volume deficit. The data indicate an actual problem, which excludes option 2. Option 4 relates more to fluid volume excess. Cognitive Level:

Question 36

Which client statement indicates a need for further teaching regarding treatment for hypokalemia?
1. “I will use avocado in my salads.”
2. “I will be sure to check my heart rate before I take my digoxin.”
3. “I will take my potassium in the morning after eating breakfast.”
4. “I will stop using my salt substitute.”

Answer 36

6. Answer: 4. Rationale: Salt substitutes contain potassium. The client can still use it within reason. Option 1: Avocado is higher in potassium than most foods. Option 2: Hypokalemia can potentiate digoxin toxicity and checking the pulse will help the client avoid this. Option 3: It is important to take potassium with food to avoid gastric upset. Cognitive Level: Applying. Client Need: Physiological Integrity. Nursing Process: Evaluation. Learning Outcomes: 52-7; 52-8.

Question 37

An older man is admitted to the medical unit with a diagnosis of dehydration. Which sign or symptom is most representative of a sodium imbalance?
1. Hyperreflexia
2. Mental confusion
3. Irregular pulse
4. Muscle weakness

Answer 37

7. Answer: 2. Rationale: Sodium contributes to the function of neural tissue. Because calcium contributes to the function of voluntary muscle contraction, options 1 and 4 are more appropriate for calcium imbalances. Option 3: Because potassium and calcium contribute to cardiac function, irregular pulse is more likely to be associated with those alterations. Cognitive Level: Applying. Client Need: Physiological Integrity. Nursing Process: Assessment. Learning Outcome: 52-5.

Question 38

The client’s arterial blood gas results are pH 7.32; PaCO2 58; HCO3 32. The nurse knows that the client is experiencing which acid–base imbalance?
1. Metabolic acidosis
2. Respiratory acidosis
3. Metabolic alkalosis
4. Respiratory alkalosis

Answer 38

8. Answer: 2. Rationale: Because of CO2 retention the PaCO2 is elevated. CO2 is involved in production of acid, which will result in a decreased pH. HCO3 will vary. Option 1: Metabolic acidosis involves a loss of bicarbonate, but no retention of CO2. Option 3: Metabolic alkalosis involves a loss of acid or retention of HCO3, but no retention of CO2. Option 4: Respiratory alkalosis involves a loss of CO2 resulting in an increased pH. Cognitive Level: Applying. Client Need: Physiological Integrity. Nursing Process: Assessment. Learning Outcome: 52-5.

Question 39

A client is admitted to the hospital for hypocalcemia. Nursing interventions relating to which system would have the highest priority?
1. Renal
2. Cardiac
3. Gastrointestinal
4. Neuromuscular

Answer 39

9. Answer: 4. Rationale: The major clinical signs and symptoms of hypocalcemia are due to increased neuromuscular activity and not the renal, cardiac, or GI systems. Cognitive Level: Analyzing. Client Need: Physiological Integrity. Nursing Process: Implementation. Learning Outcome: 52-8.

Question 40

The nurse would assess for signs of hypomagnesemia in which of the following clients? Select all that apply.
1. A client with renal failure
2. A client with pancreatitis
3. A client taking magnesium-containing antacids
4. A client with excessive nasogastric drainage
5. A client with chronic alcoholism

Answer 40

10. Answer: 2, 4, and 5. Rationale: Options 1 and 3 relate to hypermagnesemia. Cognitive Level: Analyzing. Client Need: Physiological Integrity. Nursing Process: Assessment. Learning Outcomes: 52-4; 52-5.