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Study Guide for Fluid and Electrolytes

1. What is homeostasis? A. The way the body attempts to keep itself in a balanced physiologic state. B. A balance of solvents and solutes for proper body functioning. C. A balance of fluid and electrolytes to maintain proper body function. D. The regulation of water and blood with other body substances. 2. Name five functions of water in the body: 1. 2. 3. 4. 5. 3. Identify the body fluids that fit the following descriptions: Intracellular fluid Interstitial fluid Plasma or intravascular fluid A. Fluid within cells; comprises about 60% of body fluids: __________________ B. Contains a high level of potassium, and small amounts of sodium and chloride:_____________________________________ C. Fluid that is measured clinically (because of its accessibility): ____________________ D. Extracellular fluids (ECF): ____________________and _________________________________ 4. Stanley, 32-years-old, weighs 180 pounds. His body weight contains about ________ pounds of fluid. This fluid includes _______ pounds of fluid within cells (ICF) and _______ pounds of ECF. Most of his ECF is likely to be (plasma? interstitial fluid?). 5. Define the following terms: Ion: Electrolyte: Cation Anion Solvent Solute Milliequivalent (mEq) Milligram (mg) Gradient Passive transport Active transport Equilibrium Electroneutrality 6. Principle ions in Electrolyte balance (fill in) ECF ions ICF ions

7. Complete this exercise about body fluids and electrolytes. A. Circle the anion(s) in this list: Bicarbonate Sodium Chloride Magnesium Glucose Phosphorus Potassium Protein Calcium B. Circle the cation(s) in this list: Bicarbonate Sodium Chloride Magnesium Glucose Phosphorus Potassium Protein Calcium C. Which of the above is/are nonelectrolyte(s)? __________________________________________________________ 8. What drives diffusion across a semipermeable membrane? A. temperature B. differences in solute concentration

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C. differences in water concentration D. reaction of water to form ions E. affinity of membrane lipids for water 9. Osmosis is A. the pressure caused by solute concentration B. the diffusion of water across a semipermeable membrane C. the condition of having increased solute concentration on one side of a membrane D. the result of mixing solute and water E. a, c and d 10. Complete these statements about osmosis: A. water is moving __________ its concentration gradient B. water is moving ______________ the side of the membrane with the higher water concentration C. water is moving ______________ the side of the membrane with the higher solute concentration D. the ____________ is "pulling" water to its side of the membrane 11. Facilitated diffusion A. occurs when small molecules pass through the lipid bilayer of a cell membrane B. does not require protein channels or pores imbedded in the membrane to allow molecules to pass through C. uses ATP for energy, but simple diffusion does not D. is the method used to transport glucose across the cell membrane E. moves against the concentration gradient 12. Which of the following is/ are true concerning active transport? A. Flows with the gradient B. Sodium-potassium pump is most common example C. Moves uphill D. Does not requires ATP E. Uses carrier molecules F. B, C, and E G. A, D 13. Oxygen enters a cell via? A. diffusion B. osmosis C. filtration D. active transport 14. Choose the correct answers: A.Hydrostatic pressure is a force that (pushes out of? pulls into?) blood vessels. B. Colloidal osmotic pressure (COP) is a force that (pushes out of? pulls into) vessels. 15. There is a net movement of water across a selectively permeable membrane into a (an): A. Hypotonic solution B. Isotonic solution C. Hypertonic solution D. None of thesewater does not move across selectively permeable membrane 16. In clients receiving 5% dextrose water intravenously, the nurse needs to be alert for which possible complication? A. Cell swelling B. Cerebral cell dehydration C. Hypertension D. Hypotension 17. Almost all of the osmotic pressure in extracellular fluids (ECF) is due to: (1) Na+ and Cl(2) K+ and HCO3(3) BUN and glucose 18. A 0.9% NaCl solution is (hyper? iso? hypo?) tonic to human cells. 19. Human cells placed in hypertonic solutions are likely to (shrink? swell?). 20. Jane Smith has a viral stomach flu with gastroenteritis and nausea, vomiting, watery diarrhea, fever, and body aches for the past 3 days. The nurse knows that an isotonic solution is best given for severe dehydration and anticipates that which of the following will be ordered A. D5/LR

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B. 0.45 % NaCl C. 3% NaCl D. 0.9% NaCl 21. An IV solution of 3.0 NaCl will draw fluid from the A. plasma into the interstitial space B. intravascular space into the cells C. cells and interstitium into the intravascular space D. plasma into the cells 22. Indicate whether the following factors will cause the body to save or lose sodium by circling the correct answer: A. The renin-angiotensin-aldosterone mechanism: Save Na_ Lose Na_ No effect on Na_ B. ANP (atrial natriuretic peptide): Save Na_ Lose Na_ No effect on Na_ C. ADH (antidiuretic hormone): Save Na_Lose Na_ No effect on Na_ 23. List three important functions of sodium in the body. _________________________________________ _________________________________________ _________________________________________ 24. Visualize the hypothalamus when blood passing through it is slightly thicker or more concentrated than normal (increased serum osmolarity). The hypothalamus then directs the posterior pituitary to secrete ADH, which has the following effects: A. ADH stimulates kidney tubule cells to become (more? less?) permeable to water. In other words, ADH tells kidneys to save the water! ADH (increases? decreases?) blood volume (blood becomes less thick) as urine output is (increased? decreased?). B. The name antidiuretic hormone (ADH) indicates that its effects are (similar to? opposite of?) those of diuretics. 25. Discuss two disorders of ADH in this exercise. A. Tonya has diabetes insipidus (DI). Her body produces too (much? little?) ADH. Without treatment she is more likely to produce (15? 0.5?) L of urine each day, causing her thirst to (increase? decrease?) as her blood is (concentrated? dilute?). This will cause water loss (hypo? hyper?) ______natremia. B. Mark has SIADH. His condition involves (over? under?) production of ADH. Fluid (retention? deficit?) occurs leading to (dehydration? edema?), dilution of solutes such as sodium, which causes water gain (hypo? hyper?) __________natremia, and (decreased? increased?) serum osmolarity. 26. The main source of potassium each day is typically through diet. List several good sources of this electrolyte. ________________________________________________________________________________________________________________________ 27. Answer the following questions concerning potassium: A. The hormone insulin facilitates movement of K+ (into? out of?) cells. B. Metabolic acidosis facilitates movement of K+ (into? out of?) cells. C. Severe exercise and cell trauma (including burns or excessive GI activity) move K+ (into? out of?) blood. D. Aldosterone (increases? decreases?) tubular secretion of K+ into urine and thereby (increases? decreases?) serum potassium. E. Addisons disease has (deficient? excessive?) production of aldosterone. The patient with Addison's is more likely to develop (hypo? hype r?) kalemia. F. Sammy has lost much fluid during his prolonged diarrhea. He is at risk for __________kalemia. G. Cushings syndrome (increases? decreases?) serum potassium. 28. As preparation for a barium enema, Mr. Brown has an order for tapwater enemas until clear. What would be the result, in terms of his electrolyte balance, if Mr. Brown needed several of the enemas? ________________________________________________________________________________________________________________________ 29. Mr. Bones has a serum calcium level of 7 mg/dL, as a result of acute pancreatitis. Describe the pathophysiologic changes for which you should assess: ________________________________________________________________________________________________________________________ 30. Mr. B. Rittle has a serum calcium level of 12 mg/dL, as a result of metastatic bone cancer. Describe the pathophysiologic changes for which you should assess: ________________________________________________________________________________________________________________________ 31. Mr. Ed Dema has been receiving Furosemide (Lasix), a loop diuretic which causes potassium loss. His serum potassium level is 3.1 mEq/L. What assessment findings would you expect? ________________________________________________________________________________________________________________________

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32. Mrs. Seca is to receive 1000 ml of 5% dextrose in 0.45 NaCl with 40 mEq of potassium added. What precautions are indicated in administration of her IV fluids? ________________________________________________________________________________________________________________________ 33. Compare calcium, phosphate, and magnesium by circling all correct answers in this exercise. A. Serum level of 3.5 mg/dL is most normal for: Ca2+ Mg2+ PO43B. Renal failure is likely to cause high serum levels of: Ca2+ Mg2+ PO43C. Malnutrition is likely to cause low levels of: Ca2+ Mg2+ PO43D. Tetany and muscle spasms with positive Trousseaus and Chvosteks signs typically accompany low levels of: Ca2+ Mg2+ PO43E. Lethargy or coma are likely to accompany high levels of: Ca2+ Mg2+ PO4334. Complete this exercise about phosphate (PO43-): A. Most phosphate is located in (bones? serum?). Of the phosphate that is outside of bone, most is in (ICF? ECF?), so injury to cells is likely to (increase? decrease?) serum levels of PO43-. B. Normal serum phosphate levels are in the range of (3.0 to 4.5? 8.5 to 10.5?) mg/dL. 35. Write hyper or hypo next to causes of hyperphosphatemia or hypophosphatemia. A. Chronic use of antacids with aluminum or calcium that bind phosphate: ___________ B. Alcoholism (with associated malnutrition): _____________________________________ C. Phosphate-containing enemas: ______________________ D. Massive trauma: _____________ E. Renal failure: ________________ 36. List dietary sources of phosphate that can help to prevent and also treat hypophosphatemia. ________________________________________________________________________________________________________________________ 37. Circle the correct answer: The effect of calcitonin is to (raise? lower?) serum calcium. The effect of PTH is to (raise? lower?) serum calcium. The effect of vitamin D is to (raise? lower?) serum calcium. The effect of PTH is to (raise? lower?) serum phosphate. The effect of vitamin D is to (raise? lower?) serum phosphate. 38. Which electrolyte imbalances are mainly the result of renal failure? ________________________________________________________________________________________________________________________ 39. Which electrolytes have a large role in acid-base balance? ________________________________________________________________________________________________________________________ 40. Both hyponatremia and hypernatremia can produce what symptoms? ________________________________________________________________________________________________________________________ 41. Both hypokalemia and hyperkalemia can cause: ________________________________________________________________________________________________________________________ 42. Which electrolyte imbalances predispose to digoxin toxicity? ________________________________________________________________________________________________________________________ 43. What medications will contribute to hypokalemia? ________________________________________________________________________________________________________________________ 44. What medications will contribute to hyperkalemia? ________________________________________________________________________________________________________________________ 45. Increased chloride equals (increased? decreased?) sodium. 45. Increased chloride equals (increased? decreased?) bicarbonate (HCO3-).