which are forces that favour filtration?
capillary hydrostatic pressure
capillary oncotic pressure
interstitial hydostatic pressure
interstitial oncotic pressure
Which are forces that oppose filtration?
interstitial hydrostatic pressure
Which are causes for edema
increased capillary hydrostatic pressure
decreased plasma oncotic pressure
increased capillary membrane permeability
lympathic obstruction
too much candy
Infants are most susceptible to significant losses in total body water because of an infant’s
High body surface–to–body size ratio
Slow metabolic rate
Kidneys are not mature enough to counter fluid losses
Inability to communicate adequately when he or she is thirsty
Obesity creates a greater risk for dehydration in people because:
Adipose cells contain little water because fat is water repelling.
The metabolic rate of obese adults is slower than the rate of lean adults.
The rate of urine output of obese adults is higher than the rate of output of lean adults
The thirst receptors of the hypothalamus do not function effectively
A patient’s blood gases reveal the following findings: pH, 7.3; bicarbonate (HCO3) 27 mEq/L; carbon dioxide (CO2), 58 mm Hg. What is the interpretation of these gases?
Respiratory alkalosis
Metabolic acidosis
Respiratory acidosis
Metabolic alkalosis
Water movement between the intracellular fluid (ICF) compartment and the extracellular fluid (ECF) compartment is primarily a function of:
Osmotic forces
Plasma oncotic pressure
Antidiuretic hormone
Hydrostatic forces
In addition to osmosis, what force is involved in the movement of water between the plasma and interstitial fluid spaces?
Oncotic pressure
Buffering
Hydrostatic pressure
Venous obstruction is a cause of edema because of an increase in which pressure?
Capillary hydrostatic
Interstitial hydrostatic
Capillary oncotic
Interstitial oncotic
As edema accumulates it gets trapped in...
a second space
a third space
Sodium accounts for 90% of the ...... cations (positively charged ions)
ICF
ECF
potassium is a major cation of ......
what is the minimal daily requirement of sodium?
200 mg
600 mg
500 mg
what are the two major functions of Angiotensin 2?
vasoconstriction (which elevates blood pressure)
stimulates the secretion of aldosterone
it prevents sodium from leaving the cell
ANP and BNP increase sodium and water excretion by the kidneys this
increases blood volume and blood pressure
decreases blood volume and blood pressure
ADH ________ the permeability of renal tubular cells to water which ______ water reabsorption and promotes the restoration of plasma volume and blood pressure.
increases, increases
decreases, increases
The term isotonic refers to a solution that has the _______ concentration of solutes as plasma
more
less
the same
Isotonic fluid loss results in in....
hypervolemia
hypovolemia
Excess isotonic fluids results in...
Hypertonic fluid alterations occur when osmolality of the ECF is ______above normal. The most common causes are an increased concentration of ECF.....
elevated, sodium (hypernatrium)
elevated potassium (hyperkalemia)
Hypernatremia occurs when serum sodium levels exceed_______. And can be caused by a ______ of water or _____in sodium
147 mEq/L, Loss of water or gain in sodium
127 mEq/L, loss of water or gain in sodium,
intracellular fluid contains a greater proportion of total body water than does extracellular fluid
All the homeostatic mechanisms that monitor and adjust the composition of body fluids respond to changes in the ECF, not in the ICF
no receptors directly monitor fluid or electrolyte balance
diffusion is the movement of molecules from an area of high concentration to an area of low concentration.
Osmosis is the movement of water between two compartments by a membrane permeable to water but not to solute. Moves form LOW solute to HIGH solute concentration and requires no energy
What is osmotic pressure?
The amount of pressure required to move water
the amount of pressure required to stop osmotic flow of water
Hydrostatic pressure is
the major force that pushes water out of the vascular system at the capillary level
the force of water being moved
osmotic pressure is pressure exerted by colloids in solution
the pressure of cancer
Causes of edema
plasma to interstitial fluid shift
increased capillary permeability
lymph obstruction
sodium retention
What is the pathophysiology of third spacing?
A massive inflammatory response leads to the release of histamine and bradykinin which increases capillary permeability and with hydrostatic pressure fluid leaks into the interstitium
Any process that results in decreased protein intake, production, storage, or increased protein loss decreases the colloid osmotic pressure which prevents fluid from being pulled back into the vessels and leads to fluid accumulating in the interstitium.
Signs and symptoms of thirdspacing
decreased urine output despite adequate intake
increased HR
Decreased BP
Increased weight
Edema, acites
Increased ADH
Why are infants more predisposed to serious, rapid fluid volume deficits?
limited ability to concentrate urine
greater ratio of surface area to volume
higher metabolic rate
S/S of Hypervolemia:
cyanosis
rapid breathing
weight gain
edema including cerbral edema
rapid bouding pulse
What is the reference range for Sodium in Adults?
125-135 mEq/L
135-145 mEq/L
hypernatremia is caused by :
water loss or sodium gain
water gain or sodium loss
How to treat Hypernatremia
diurectics
iv 5% dextrose in water or hypotonic saline
HYPOnatremia results form
lost of sodium containing fluids or water excess
critical value is <120 mEq/L
Potassium is
a major ICF cation
necessary for transmission and conduction of nerve and muscle impluses
cellular growth
maintenance of cardiac rhythms
Acid-base balance
what facilitates potassium into the cells:
sodium
insulin
aldosterone
epinephrine
alkalosis
Calcium balance is controlled by
parathyroid hormone
calcitonin
vitamin D
Iron
A person with chronic heart failure has edema in the lower legs and sacral area. The nurse practitioner suspects this is due to a(n):
increase in capillary hydrostatic pressure;
Decrease in lymph obstruction pressure
Decrease in capillary hydrostatic pressure
Secretion of ADH and the perception of thirst are stimulated by
an increase in plasma osmolality
a decrease in plasma osmolaity
The nurse monitors the fluid and electrolyte status of the older adult with the knowledge that impairment of the thirst mechanism may lead to
hypernatremia
Hyponatremia
Intravenous potassium chloride is ordered for treatment of a patient with hypokalemia. In administering the potassium solution, the nurse is aware that
to prevent cardiac arrhythmias and arrest, the maximum amount of KCl to be administered in 1 hour is 10 mEq
to prevent cardiac arrhythmias and arrest, the maximum amount of KCl to be administered in 1 hour is 20 mEq
A patient who has required prolonged mechanical ventilation has the following arterial blood gas results: pH 7.48, PO2 85 mm Hg, PCO2 32 mm Hg, and HCO3 25 mEq/L. The nurse interprets these results as
respiratory alkalosis
respiratory acidosis
normal
The electrolyte imbalance hypercalcemia exhibits which clinical manifestations?
Diarrhea
Calcium based kidney stones
ECG showing narrow T waves
Lethargy
Bradycardia
The electrolyte imbalance hypokalemia exhibits which clinical manifestations?
Paralytic ileus
Sinus bradycardia
Atrioventricular block
Dry mucous membranes
Tetany
A third of the body’s fluid is contained in the extracellular interstitial fluid spaces that include
Urine
Intraocular fluids
Lymph
Blood plasma
Sweat
An imbalance of potassium can produce which dysfunctions?
Weakness skeletal muscles
Cardiac dysrhythmias
Smooth muscle atony
Visual impairment
Hearing loss
Which statements regarding total body water (TBW) are true?
During childhood, TBW slowly decreases in relationship to body weight.
Gender has no influence on TBW until old age.
Men tend to have greater TBW as a result of their muscle mass.
Estrogen plays a role in female TBW.
Older adults experience a decrease in TBW as a result of decreased muscle mass.
Sodium Regulates osmolality in the extracellular fluid (ECF) space.
Chloride Is inversely related to HCO3 concentration.
Potassium Is a major determinant of resting membrane potential.
Phosphate An intracellular metabolic form is adenosine triphosphate (ATP).
Potassium Changes in hydrogen ion concentration affect this electrolyte
At the arterial end of capillaries, fluid moves from the intravascular space into the interstitial space because the
Interstitial hydrostatic pressure is higher than the capillary hydrostatic pressure.
Capillary hydrostatic pressure is higher than the capillary oncotic pressure.
Interstitial oncotic pressure is higher than the interstitial hydrostatic pressure.
Capillary oncotic pressure is lower than the interstitial hydrostatic pressure.
Low plasma albumin causes edema as a result of a reduction in which pressure?
Plasma oncotic
Secretion of antidiuretic hormone (ADH) and the perception of thirst are stimulated by a(n
Decrease in serum sodium
Increase in plasma osmolality
Increase in glomerular filtration rate
Decrease in osmoreceptor stimulation
Thirst activates osmoreceptors by an increase in which blood plasma?
Aldosterone
Osmotic pressure
It is true that natriuretic peptides:
Decrease blood pressure and increase sodium and water excretion
Increase blood pressure and decrease sodium and water excretion
Increase heart rate and decrease potassium excretion.
Which enzyme is secreted by the juxtaglomerular cells of the kidney when circulating blood volume is reduced?
Angiotensin I
Angiotensin II
Renin
What mechanism can cause hypernatremia?
Syndrome of inappropriate antidiuretic hormone
Hypersecretion of aldosterone
Brief bouts of vomiting or diarrhea
Excessive diuretic therapy
What causes the clinical manifestations of confusion, convulsions, cerebral hemorrhage, and coma in hypernatremia?
High sodium in the blood vessels pulls water out of the brain cells into the blood vessels, causing brain cells to shrink.
High sodium in the blood vessels draws chloride into the brain cells followed by water, causing the brain cells to swell.
Vomiting-induced metabolic alkalosis, resulting in the loss of chloride, causes:
Retained sodium to bind with the chloride
Hydrogen to move into the cell and exchange with potassium to maintain cation balance
Retention of bicarbonate to maintain the anion balance
Hypoventilation to compensate for the metabolic alkalosis
The pathophysiologic process of edema is related to which mechanism?
Sodium depletion
Decreased capillary hydrostatic pressure
Lymphatic obstruction
Insulin is used to treat hyperkalemia because it:
Stimulates sodium to be removed from the cell in exchange for potassium.
Binds to potassium to remove it through the kidneys
Transports potassium from the blood to the cell along with glucose.
Breaks down the chemical components of potassium, causing it to be no longer effective.
A major determinant of the resting membrane potential necessary for the transmission of nerve impulses is the ratio between
Intracellular and extracellular Na+
Intracellular Na+ and extra
Intracellular and extracellular K+
Intracellular K+ and extracel
During acidosis, the body compensates for the increase in serum hydrogen ions by shifting hydrogen ions into the cell in exchange for which electrolyte?
Oxygen
Sodium
Potassium
Magnesium
Causes of hyperkalemia include:
Hyperparathyroidism and malnutrition
Vomiting and diarrhea
Renal failure and Addison disease
The calcium and phosphate balance is influenced by which three substances?
Parathyroid hormone, vasopressin, and vitamin D
Parathyroid hormone, calcitonin, and vitamin D
It is true that Kussmaul respirations indicate:
Anxiety is a cause of respiratory acidosis.
A compensatory measure is needed to correct metabolic acidosi
Diabetic ketoacidosis is the cause of the metabolic acidosis
Chvostek and Trousseau signs indicate which electrolyte imbalance?
Hypokalemia
Hyperkalemia
HYPOCalcemia
Hypercalcemia
An excessive use of magnesium-containing antacids and aluminum-containing antacids can result in:
Hypophosphatemia
Hypomagnesemia
The most common cause of hypermagnesemia is:
Renal failure
Pancreatitis
Two thirds of the body’s water is found in its:
Intracellular fluid compartments
Interstitial fluid spaces
Increased capillary hydrostatic pressure results in edema because of:
Sodium and water retention
Losses or diminished production of plasma albumin
The existence of hyperkalemia is likely to result in which changes to a person’s electrocardiogram (ECG)?
Flattened U waves
Peaked T waves
Depressed ST segments
Causes of hypocalcemia include:
Repeated blood administration
The electrolyte imbalance called hyponatremia exhibits which clinical manifestations?
Headache
Seizures
Paranoia
Confusion
What is the effect of low plasma albumin?
Clotting factors decrease, thus increasing the chance of prolonged bleeding
Osmotic pressure decreases, thus water moves from the capillaries to the interstitium