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Fluids Study Guide
Nursing 120
1. Aldosterone regulates fluid and electrolyte balance by:
a. Promoting sodium loss by the kidney when plasma osmolarity is increased.
b. Stimulating the kidneys to retain water when plasma osmolarity is increased.
c. Blocking reabsorption of sodium by the kidney when plasma osmolarity is increased.
d. Promoting sodium reabsorption by the kidney when plasma osmolarity is decreased.
2. The ideal fluid replacement for the patient with an ECF fluid volume (only) deficit is:
a. Isotonic
b. Hypotonic (slowly)
c. Isotonic (preferred) or hypertonic (with great caution)
d. A plasma expander
3. The ideal fluid replacement for the patient with an ICF fluid volume deficit and expansion of the ECF is:
a. Isotonic
b. Hypotonic (slowly)
c. Isotonic (preferred) or hypertonic (with great caution)
d. A plasma expander
4. The ideal fluid replacement for the patient with an ECF fluid volume deficit and expansion of the ICF is:
a. Isotonic
b. Hypotonic (slowly)
c. Isotonic (preferred) or hypertonic (with great caution)
d. A plasma expander
5. The type of dehydration that results in the most SERIOUS depletion of the intravascular space is:
a. Isotonic
b. Hypotonic
c. Hypertonic
d. Hypovolemic
6. What change in vital signs would a nurse assess if a patient developed postural hypotension?
a. Increase in blood pressure, drop in pulse
b. Increase in blood pressure, increase in pulse
c. Drop in blood pressure, increase in pulse
d. Drop in blood pressure, drop in pulse
7. When the nurse takes the client’s blood pressure in a sitting position, and then in a standing position, the systolic pressure is 24 mm Hg lower with the client standing compared with the pressure taken with the client sitting. The nurse would correctly interpret this assessment finding as:
a. Hypervolemia
b. Hypertonic dehydration
c. Orthostatic hypotension
d. Hypotension
8. Which of the following compensatory mechanisms occurs as a result of hypertonic dehydration?
a. Release of ANP from the atria of the heart
b. Release of ADH from the pituitary gland
c. Fluid shift from the ECF to the ICF
d. Increased aldosterone release from the adrenal gland
9. Which of the following compensatory mechanisms occurs as a result of isotonic dehydration?
a. Release of ANP from the atria of the heart
b. Release of ADH from the pituitary gland
c. Fluid shift from the ECF to the ICF
d. Increased aldosterone release from the adrenal gland
10. Which of the following compensatory mechanisms occurs as a result of isotonic overhydration?
a. Release of ANP from the atria of the heart
b. Release of ADH from the pituitary gland
c. Fluid shift from the ECF to the ICF
d. Increased aldosterone release from the adrenal gland
11. What affect does atrial natriuretic peptide (ANP) have on the kidney and fluid balance?
a. Increased aldosterone levels lead to increased reaborption of sodium and water.
b. Decreased aldosterone levels lead to increased sodium and water excretion.
c. Intravascular fluid and blood pressure increases.
d. Urine output is reduced as the posterior pituitary decreases ADH production.
12. The nurse assesses the urine specific gravity of 1.035 as an indication of:
a. Overhydration
b. Dehydration
c. Normal value for an adult
d. Metabolic acidosis
13. In ________________ overhydration, both the ECF and the ICF have excessive fluid.
a. Isotonic
b. Hypotonic
c. Hypertonic
d. Hypervolemic
14. In __________________ overhydration, only the ECF has excessive fluid and the ICF does not have a fluid imbalance.
a. Isotonic
b. Hypotonic
c. Hypertonic
d. Hypovolemic
15. In ____________________ overhydration, the ECF has fluid overload, and the ICF is dehydrated.
a. Isotonic
b. Hypotonic
c. Hypertonic
d. Hypervolemic
16. Which of the following fluid imbalances corresponds with water-loss hypernatremia?
a. Hypertonic dehydration
b. Hypertonic overhydration
c. Hypotonic dehydration
d. Hypotonic overhydration
17. Which of the following fluid imbalances corresponds with sodium-gain hypernatremia?
a. Hypertonic dehydration
b. Hypertonic overhydration
c. Hypotonic dehydration
d. Hypotonic overhydration
18. Which of the following fluid imbalances corresponds with dilutional hyponatremia (water gain)?
a. Hypertonic dehydration
b. Hypertonic overhydration
c. Hypotonic dehydration
d. Hypotonic overhydration
19. Which of the following fluid imbalances corresponds with sodium-loss hyponatremia?
a. Hypertonic dehydration
b. Hypertonic overhydration
c. Hypotonic dehydration
d. Hypotonic overhydration
20. During an 8-hour shift, a client drinks two 6-ounce cups of tea and vomits 125 mL of fluid. Intravenous fluids absorbed equalled the urinary output. During this 8-hour period, the client’s fluid balance would be:
a. +55 mL
b. +137 mL
c. +235 mL
d. +485 mL
21. A client weighed 210 pounds on admission to the hospital. After 2 days of diuretic therapy, the client weighs 205.5 pounds. The nurse could estimate that the amount of fluid the client has lost is:
a. 0.5 L
b. 1.0 L
c. 2.0 L
d. 3.5 L
22. After a Whipple procedure for cancer of the pancreas, a client is to receive the following intravenous (IV) fluids over 24 hours: 1000 mL D5W; 0.5 liter normal saline; 1500 mL D5NS. In addition, an antibiotic piggyback in 50 mL D5W is ordered every 8 hours. The nurse calculates that the client’s IV fluid intake for 24 hours will be:
a. 3150 mL
b. 3200 mL
c. 3650 mL
d. 3750 mL
23. Which condition is most likely to cause formation of edema?
a. Increased plasma osmotic pressure; increased plasma hydrostatic pressure
b. Increased plasma osmotic pressure; decreased plasma hydrostatic pressure
c. Decreased plasma osmotic pressure; increased plasma hydrostatic pressure
d. Decreased plasma osmotic pressure; decreased plasma hydrostatic pressure
24. Which intravenous solution should you be prepared to administer to a client who has isotonic dehydration?
a. Dextrose 5% in water
b. Dextrose 10% in water
c. 0.45% Saline
d. Lactated ringers (LR)
25. A note on your client's chart states, "Observe for evidence of third spacing." Which of the following statements accurately depicts this phenomenon?
a. A shift of fluid from the ECF to the ICF that results in cellular lysis.
b. Increased fluid in the intravascular and interstitial spaces.
c. Massive fluid loss due to drainage from a wound.
d. Fluid is sequestered in an area and unavailable for use.
26. When the hydrostatic pressure in the intravascular space is very high, what will happen to the intravascular fluid?
a. More fluid is forced out of the intravascular space, resulting in cellular edema and lysis.
b. More fluid is forced out of the intravascular space, resulting in interstitial edema.
c. No net movement of fluid occurs, since intravascular oncotic pressure also rises to compensate.
d. More fluid is retained in the intravascular space, due to increased blood pressure.
27. If a person has not been eating an adequate diet for a prolonged period (protein calorie malnutrition), why will you see fluid in the interstitial space (edema)?
a. The malnourished client is exhibiting hypotonic dehydration, resulting in fluid shifts.
b. The low oncotic pressure in the intravascular space cannot pull fluid back into the capillary.
c. The malnourished client is exhibiting hypertonic dehydration, resulting in fluid shifts.
d. A higher percentage of body weight is fluid, despite the decrease in calories.
28. Expected action of atrial natriuretic peptide (ANP):
a. Decreased urine output, increased urine osmolarity.
b. Increased urine output, increased urine osmolarity.
c. Decreased urine output, decreased urine osmolarity.
d. Increased urine output, decreased urine osmolarity.
29. Clinical manifestations of hyponatremia include:
a. Tachycardia, skeletal muscle weakness, abdominal cramps, vomiting, headache, and lethargy
b. Hypoactive bowel sounds, constipation, flattened T waves on the ECG
c. Excessive bleeding, muscle spasms and tetany, hyperactive deep tendon reflexes
d. Digtoxicity, stridor, dysphagia, positive Chvostek's and Trousseau's sign
30. Clinical manifestations of hypernatremia include:
a. Hypotension, tented T waves on the ECG, profound weakness, intestinal hypermotility
b. Thirst, velvety skin, dry mucous membranes, agitation, twitching, irritability, hyperreflexia
c. Polyuria, kidney stones, decreased clotting time, muscle weakness, constipation
d. Flushing, warmth, depressed respirations, bradycardia, decreased urinary output
31. Marvin S., a 38 year old schizophrenic patient in a local mental hospital, is brought to the emergency room. He appears thirsty all of the time. His urine output is around 17 liters per day. He has been found drinking water from toilets and drinking other patient's liquids. He is not very communicative and will not explain why he is so thirsty.
What disorder do you suspect?
a. Diabetes insipidus (DI)
b. Diabetes mellitus (DM)
c. Syndrome of inappropriate antidiuretic hormone secretion (SIADH)
d. Hyperaldosteronism
32. Steve L., a 17 year old male is admitted to the Intensive Care Unit with a closed head injury secondary to a motor vehicle crash. Within 24 hours Steve's urine output is 8 liters a day; electrolytes indicate hypernatremia.
What disorder do you suspect?
a. Diabetes insipidus (DI)
b. Diabetes mellitus (DM)
c. Syndrome of inappropriate antidiuretic hormone secretion (SIADH)
d. Hyperaldosteronism
33. The physician states that Mrs. Jones is "third spacing" following her colon resection. What might be the consequences in terms of her urine output and blood pressure?
a. Urinary output will increase; blood pressure will increase.
b. Urinary output will decrease; blood pressure will decrease.
c. Third spacing generally has no significant effect on urinary output or blood pressure.
d. Urinary output will decrease; blood pressure will increase.
34. In preparation for a Barium Enema, Mr. Brown has an order for tapwater enemas until clear. What would be the result, in terms of his fluid and electrolye balance, if Mr. Brown needed several of the enemas?
a. Should have no effect at all.
b. Hypotonic overhydration
c. Hypernatremia
d. Isotonic overhydration
35. Match the following clinical conditions to the most likely type of resulting fluid imbalances. Answers can be used more than once.
Clinical Conditions Resulting Fluid Imbalances
_4____a. Vomiting 1. Hypertonic dehydration
_1____b. Diabetes insipidus 2. Hypotonic dehydration
_4____c. Hemorrhage 3. Relative dehydration
_5____d. Infusions of D5W 4. Isotonic dehydration
7_____e. Infusions of 0.9% NS 5. Hypotonic overhydration
5_____f. SIADH 6. Hypertonic overhydration
6_____g. Infusion of 3% NS 7. Isotonic overhydration
3_____h. Ascites
7_____i. Chronic renal failure
1_____j. Unconsciousness
7_____k. Congestive heart failure
1_____l. Diabetic ketoacidosis
2_____m. Malnourished alcoholic
4_____n. Gastrointestinal suction
7_____o. Cushings syndrome
7_____p. Hyperaldosteronism
2_____q. Adrenal insufficiency
36. Which of the following clients has a lower proportion of water to total body weight?
a middle aged or an elderly female
an obese or a slender client
a male or a female client
a baby or a child
37. List sources of fluid in the body and sources of fluid loss:
Fluid Intake Fluid Output
Oral/ enteral fluids Urine
Water from ingested foods Emesis
Metabolic water (water of oxidation) Feces
Intravenous therapy (parenteral) Drainage from body cavities
Enemas/ irrigation fluids Insensible loss (skin, lungs)
38. Discuss each of the following conditions in terms of etiologic factors, defining characteristics (signs and symptoms), and nursing interventions:
Fluid Volume Deficit
Etiology=
Loss of water from body exceeds intake.
Inadequate intake of water (most common).
Increased output (excessive water loss).
Relative dehydration: deficiency of fluid in the vascular space without an overall deficiency of total body water (fluid shifts).
Defining Characteristics=
Pulse rapid and thready.
Decreased BP.
Postural (orthostatic) hypotension.
Tachycardia, tachypnea.
Weight loss over short period.
CVP less than 4 cm.
Flat neck and hand veins in dependent positions.
Dry skin and mucous membranes.
Turgor poor (tenting).
Thirst.
Mental status changes.
Increased H & H, BUN due to plasma concentration.
Nursing Interventions=
Replace fluid loss.
Treat underlying cause.
Promote oral intake (if permissible).
Accurate monitoring of daily weight, I & O, skin turgor, LOC, VS.
Monitor lab values (urine SpG, BUN, CBC, electrolytes).
Monitor lips, tongue, MM.
Fluid Volume Excess
Etiology=
Excess of body fluid.
Excessive fluid intake (water gain).
Inadequate excretion of urine (insufficient water loss).
May also have a relative excess of fluid in the vascular compartment.
Defining Characteristics=
Bounding pulses.
Elevated BP.
Distended neck and hand veins.
Weight gain over short period.
CVP over 12 cm.
Peripheral edema (pitting or generalized).
Pulmonary edema.
Moist crackles, SOB, tachypnea, dyspnea.
Decreased H & H, BUN (due to plasma dilution).
Nursing Implications=
Fluid and sodium restrictions.
Diuretic therapy.
Monitor lung status.
Accurate monitoring of daily weight, I & O, skin turgor, LOC, VS.
Monitor lab values (urine SpG, BUN, CBC, electrolytes).