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Chapter 10—Assessment and Care for Clients with Fluid and Electrolyte Disturbances
MULTIPLE CHOICE
1. Which of these terms refers to the maintenance of the body’s internal environment within narrow
limits?
a. homeostasis c. diffusion
b. osmosis d. elimination
ANS: A
Homeostasis is the maintenance of the body’s internal environment within narrow limits. Homeostasis
relies on osmosis, diffusion, and elimination to maintain the internal environment.
2. The smallest unit of chemical structure that cannot be altered by chemical change is called:
a. an element c. a molecule
b. an atom d. a compound
ANS: B
An atom is the smallest unit of chemical structure. It cannot be altered by chemical change.
4. Which of these terms refers to electrically charged ions present in both intracellular and extracellular
fluids?
a. electrolytes c. particles
b. molecules d. solutes
ANS: A
Electrolytes are electrically charged ions (cations or anions) that are present in both intracellular and
extracellular fluids.
5. Which of these terms describes negatively charged particles within the body?
a. anions c. electrolytes
b. cations d. elements
ANS: A
There are two types of ions. Anions are negatively charged particles, while cations are positively
charged particles.
8. Identify which of these processes is used by sodium to control the body’s fluid balance?
a. active transport c. filtration
b. diffusion d. osmosis
ANS: D
The major extracellular fluid electrolyte, sodium, regulates fluid balance through osmotic pressure
(osmosis). Normal serum sodium range for an adult is from 135 to 145 mEq/L.
9. When a client’s blood pH is greater than 7.45, the client is in which of these states?
a. acidosis c. neutral
b. alkalosis d. buffer
ANS: B
The normal body pH range of blood is from 7.35 to 7.45; blood pH above (alkalosis) or below
(acidosis) this range can cause profound physiologic problems. A blood pH level below 7.45 is within
the normal range.
10. Which of these terms describes the movement of water through a semipermeable or selectively
permeable membrane to equalize the concentration of salts or other solutes?
a. active transport c. filtration
b. diffusion d. osmosis
ANS: D
Osmosis is the diffusion of a solvent (usually water) through a semipermeable membrane from an area
of higher concentration to one of lower concentration. During osmosis, only the water molecules move
through the membrane, not the molecules dissolved in the solvent.
12. The movement of a solute from an area of higher concentration to an area of lower concentration until
equilibrium is reached is called:
a. active transport c. filtration
b. diffusion d. osmosis
ANS: B
Diffusion, the movement of substances (e.g., molecules of gases, liquids, or solids) from an area of
higher molecular concentration to one of lower molecular concentration, occurs because of the kinetic
energy in molecules; molecules are constantly moving and colliding with each other, forcing them to
move farther apart. An example of diffusion is the movement of oxygen from the lungs to the
bloodstream because the oxygen concentration in the blood is lower than that in the lungs.
13. The movement of both water and substances as a result of hydrostatic pressure is called:
a. active transport c. filtration
b. diffusion d. osmosis
ANS: C
Filtration is a process in which solvents and the substances dissolved in them are forced through cell
membranes by hydrostatic pressure (i.e., the pressure the fluid exerts against the membrane).
14. The movement of substances across cell membranes using chemical energy and carrier molecules is
called:
a. active transport c. filtration
b. diffusion d. osmosis
ANS: A
Substances constantly move in and out of cells by passing through the cell membrane without the cell
expending energy (passive transport) or by requiring the cell to expend energy (active transport).
15. The process by which substances can pass through the cell membrane without energy expenditure on
the part of the cell is called:
a. active transport c. permeability
b. passive transport d. dialysis
ANS: B
Substances constantly move in and out of cells by passing through the cell membrane without the cell
expending energy (passive transport).
17. Which of these terms describes any solution put into the body with the same osmolality as blood
plasma?
a. hypertonic c. ionic
b. hypotonic d. isotonic
ANS: D
Isotonic solutions have the same molecular concentration or osmolality as those within the cell; they
do not affect the size of the cell.
18. What is the name of the process where pressure is exerted against the cell membrane by water inside
the cell?
a. cell pressure c. osmotic pressure
b. isotonic pressure d. hydrostatic pressure
ANS: C
Osmotic pressure is the pressure that is exerted against the cell membrane by the force of water on the
inside of the cell.
20. What is required to maintain fluid balance between the intracellular and extracellular compartments?
a. There is a constant exchange of water between the compartments.
b. The hypothalamus sends each compartment messages regarding the need for retaining or
releasing fluid to the cells.
c. The kidneys retain and excrete fluid as needed for fluid balance.
d. The lymph nodes throughout the body regulate fluid balance.
ANS: A
The proportions of extracellular and intracellular fluid vary with age. The balance of fluid between
plasma and interstitial fluid is regulated by hydrostatic pressure (blood pressure) and osmotic pressure.
If the intracellular fluid becomes hypertonic in relation to the extracellular fluid, water moves by
osmosis from the extracellular fluid into the cell to restore balance. If the intracellular fluid becomes
hypotonic in relation to the extracellular fluid, the process just described is reversed, resulting in a
constant exchange between the compartments.
21. Which of these body fluid compartments contains the largest amount of water in the body?
a. intravascular c. intracellular
b. interstitial d. extracellular
ANS: C
Body fluids are contained in two compartments. The intracellular fluid (ICF) compartment contains
the largest amount of water in the body and consists of all of the water and ions within the cells. The
extracellular fluid (ECF) compartment contains the body fluids remaining outside the cells: either
interstitial fluid (fluid in the tissue spaces around each cell) or intravascular fluid (plasma within blood
vessels, lymph within the lymphatic system, and small amounts of specialized fluids such as
cerebrospinal fluid or synovial fluid).
23. When fluid accumulates in tissue spaces, the resulting condition is called:
a. edema c. decompartmentalization
b. dehydration d. fluid insufficiency
ANS: A
The balance of fluid between plasma and interstitial fluid is regulated by hydrostatic pressure (blood
pressure) and osmotic pressure. Edema occurs when fluid accumulates in the interstitial fluid
compartment.
24. Which of these organs plays the major role in maintaining the body’s fluid and electrolyte balance?
a. kidneys c. lungs
b. colon d. skin
ANS: A
The kidneys are major organs of fluid balance, excreting up to 1,500 mL of water daily, based on the
amount of fluid ingested and amount of waste or solutes excreted. When an extracellular fluid volume
deficit occurs, certain hormones (antidiuretic hormone, aldosterone, and renin) are released to prompt
the kidneys to conserve water. The interaction of these hormones with renal function serves as the
body’s compensatory mechanism to maintain homeostasis.
PTS: 1 DIF: Comprehension REF: White (2013)
25. The nurse is monitoring the intake and output of a client. The nurse is aware that the average adult
loses how many milliliters of fluid daily?
a. 1,000 c. 2,500
b. 1,800 d. 3,600
ANS: C
Approximately 2,500 mL of fluid is normally lost daily through the skin (insensible water loss and
perspiration), lungs (insensible water loss), and gastrointestinal tract (feces). The kidneys are major
organs of fluid balance, excreting up to 1,500 mL of water daily, based on the amount of fluid ingested
and amount of waste or solutes excreted.
26. When a client’s sodium level is low, which of the following occurs?
a. Bicarbonate ions move into the intracellular compartment.
b. Chloride level is unchanged.
c. Chloride level is low.
d. Kidneys secrete bicarbonate ions.
ANS: C
Chloride, the major extracellular anion, functions with sodium to maintain osmotic pressure and aid in
maintaining acid-base balance. There is a direct relationship between the values of these electrolytes.
27. The nurse is caring for a client with hyponatremia. When reviewing the client’s health history, the
nurse can identify the condition is the result of:
a. eating foods high in sodium c. prolonged vomiting or diarrhea
b. nasal suctioning d. dehydration
ANS: C
Hyponatremia, a serum sodium value of less than 136 mEq/L, results from a sodium deficit as a result
of prolonged vomiting, diarrhea, or a water excess that results in edema.
28. Increased sodium intake, decreased sodium loss, or excessive water loss can lead to which of these
disturbances?
a. hypernatremia c. metabolic acidosis
b. hyponatremia d. respiratory alkalosis
ANS: A
Hypernatremia, a serum sodium level greater than 145 mEq/L, results from excess sodium or water
loss and movement of water from cells to the extracellular space.
31. What term refers to the condition in which a person has a potassium level of less than 3.5 mEq/L?
a. hyperkalemia c. hypokalemia
b. hypernatremia d. hyponatremia
ANS: C
Hypokalemia, a serum potassium level of less than 3.5 mEq/L, can result from the use of diuretics or
from gastrointestinal tract disturbances.
33. Which of these substances is required for calcium absorption within the gastrointestinal (GI) tract?
a. albumin c. triglycerides
b. glucose d. vitamin D
ANS: D
Adequate dietary intake of vitamin D is required for calcium absorption.
34. The nurse is reviewing the laboratory results of an assigned client. The nurse recognizes the normal
value of ionized serum calcium for adults is:
a. less than 4.5 mEq/L c. 5.7 to 9.0 mEq/L
b. 4.5 to 5.6 mEq/L d. 9.1 to 10.5 mEq/L
ANS: B
The normal range of serum calcium (ionized) is 4.5 to 5.6 mEq/L; the total serum calcium (ionized and
bound to albumin) range for adults is 9.0 to 10.5 mg/dL.
36. A client’s calcium level is 9.5 mg/dL. A nurse would expect the client’s phosphate level to be:
a. high c. low
b. the same as the calcium level d. normal
ANS: D
Phosphate and calcium have an inverse relationship. If one electrolyte is elevated, the other will be
decreased. The normal range of serum calcium (ionized) is 4.5 to 5.6 mEq/L; the total serum calcium
(ionized and bound to albumin) range for adults is 9.0 to 10.5 mg/dL. The normal serum phosphorus
range is 1.7 to 2.6 mEq/L.
38. The client states his serum magnesium level is finally normal. The nurse identifies the client’s normal
value range as:
a. 1.2 to 1.5 mEq/L c. 2.7 to 4.0 mEq/L
b. 1.5 to 2.5 mEq/L d. 4.1 to 6.0 mEq/L
ANS: B
Normal range of serum magnesium is 1.5 to 2.5 mEq/L.
41. Decreased magnesium levels can be associated with which of the following?
a. chronic alcoholism c. Addison’s disease
b. renal failure d. uncontrolled diabetes mellitus
ANS: A
Hypomagnesemia, a serum magnesium level of less than 1.5 mEq/L, is most often the result of chronic
alcoholism or is secondary to prescribed medications.
42. A client’s magnesium level is 0.9 mEq/L. A nurse would expect the client’s calcium and potassium
levels to be:
a. elevated c. decreased
b. the same as the magnesium level d. normal
ANS: C
There is a direct relationship between calcium, potassium, and magnesium. Normal range of serum
magnesium is 1.5 to 2.5 mEq/L. A level of 0.9 mEq/L is a decrease; therefore, all levels would be
decreased.
43. A client is taking medications that include digoxin, baby aspirin, K-Dur, and Lasix. The client
complains of muscle cramps and facial tics. The nurse discovers the client has positive Chvostek’s and
Trousseau’s signs, has hypotension, and is confused. If the client is exhibiting signs of
hypomagnesemia, which of these findings would the nurse also expect the client to exhibit?
a. elevated serum calcium and potassium levels
b. decreased serum calcium and potassium levels
c. impaired acid-base balance
d. bradycardia and cardiac dysryhthmias
ANS: B
Magnesium, found in intracellular fluid and in combination with calcium and phosphorus in bone,
muscle, and soft tissue, is important in the metabolism of carbohydrates and proteins. Normal range of
serum magnesium is 1.5 to 2.5 mEq/L. Hypomagnesemia, a serum magnesium level of less than 1.5
mEq/L, is most often the result of chronic alcoholism or is secondary to prescribed medications. There
is a direct relationship between the levels of magnesium, potassium, and calcium; if one is decreased,
the others will also be decreased.
46. When caring for a client with a phosphate level of 4.7 mg/dL, the nurse would expect the client’s
calcium level to be:
a. elevated c. decreased
b. equal to the phosphate level d. normal
ANS: C
Phosphate and calcium have an inverse relationship. If one electrolyte is elevated, the other will be
decreased. The normal serum phosphorus range is 2.5 to 4.5 mg/dL.
47. When caring for a client with a chloride level of 120 mEq/L, the nurse would expect the client’s
sodium level to be:
a. elevated c. decreased
b. the same as the chloride level d. normal
ANS: A
Chloride, the major extracellular anion, functions with sodium to maintain osmotic pressure and aid in
maintaining acid-base balance. There is a direct relationship between the values of these electrolytes.
48. The nurse is caring for a client with a critically high potassium level. The client has received sodium
polystyrene sulfonate (Kayexalate). The nurse determines the medication’s effectiveness if the client’s
repeat serum potassium level is:
a. 6.2 mEq/L c. 5.5 mEq/L
b. 5.8 meq/L d. 4.9 mEq/L
ANS: D
The normal serum potassium level in the adult is 3.5 to 5.0 mEq/L.
49. A client has had blood drawn for determination of serum electrolyte levels. The nurse identifies which
of the following as an abnormal value?
a. sodium, 148 mEq/L c. calcium, 9.5 mg/dL
b. potassium, 3.8 mEq/L d. bicarbonate, 26 mEq/L
ANS: A
The normal serum electrolyte ranges are sodium, 135 to 145 mEq/L; potassium, 3.5 to 5.0 mEq/L;
calcium, 8.5 to 10.5 mg/dL; bicarbonate, 22 to 28 mEq/L. The serum sodium level is the only
abnormal value.
MULTIPLE RESPONSE
1. The nurse is assessing a client with congestive heart failure for edema. Which areas are best to assess
for pitting edema? (Select all that apply.)
a. forehead d. ankles
b. arms e. legs
c. hands f. sacrum
ANS: B, C, D, E, F
The main symptom of fluid volume excess is edema. It may be confined to a specific area (localized)
or occur throughout the body (generalized). The skin is taut, shiny, smooth, and pale in localized
edema. Assess and palpate edematous areas for color, tenderness, and temperature. Firmly press your
thumb against the edematous area or a dependent portion of the client’s body (hands, arms, feet,
ankles, legs, or sacrum) for 5 seconds.
2. Which of the following should be included when a nurse is recording a client’s output? (Select all
that apply.)
a. NG tube drainage d. diarrhea
b. vomitus e. surgical drain
c. urine
ANS: A, B, C, D, E
A client’s intake and output should be measured and recorded for a 24-hour period to assess for an
actual or potential imbalance. Output that should be recorded includes: urine, vomitus, diarrhea, and
drainage from tubes such as gastric suction or surgical drains.
— Hyvä ystävä, sanoi äiti: voitko sanoa, millä keinoin minä hänet
lähetän.
— Sulje ovi.
‒‒‒
Emo, pääs joka painoit,
kun saapui murhe,
ja silmäsi suljit,
kun lankesi hämy
liki sua sekä meitä —
Ah äiti,
sidotaan yhä ruusuja siellä,
sidotaan sulokukkia, ruusuja
pilareiden valkeiden ympäri —
ah, kiedotaan kukkia,
äiti —
vuoks toisten.
Kun Jesperseniltä oli tultu vähän eteenpäin, teki tie mutkan kirkon
edustalla.
— Täälläpä on lämmintä.
— Päivää, päivää, vastasi koulumestari.
Äiti sulki oven. Käytävän toiselta puolelta oli Tine jo kuullut hänen
äänensä ja avannut kamarin oven.
— Ylös taas, ylös taas, huusi hän. Vanhin poika oli kaatunut.
Ihmiset epäröivät.
Laulakaa lapset, sanoi äiti, ja alkoi itsekin. Ukko kuuli sen ja yhä
voimakkaampana kaikui laulun sävel. Äidin kirkas ääni kuului ylinnä
muita:
— Kas poikaa, kas poikaa, huusi äiti, joka oli pakahtua naurusta
tuolillaan.
Mutta jos pieni musta eläin todella löytyi ja hän oli saanut sen
kauniiden kynsiensä väliin, katseli hän sitä mielellään kauan ja sanoi:
Toki on
valo lemmen kaikista kaunein,
mi kasvoilla lempivän loistaa,
kun äkkiä, tietämättänsä,
hän kohtaa armahansa.
Mut kun alas aurinko käy, maan kaiken pimeä kattaa, tuli
lemmen myöskin sammuu — ja saapuu yö.
Valo auringon kaunis on, joka päivä sen soihtu syttyy, kaikk'
katsoo kehrää sen. Mut hän, joka milloinkaan ikiliekkiä
lemmen nähnyt palavan sekä sammuvan ei, hän päivän
valtaa ei tunne, ei ymmärrä yön pimeää.
Laulu lakkasi.
Äiti ei vastannut.
Mutta vähän ajan perästä hän lauloi taas — ja silloin olivat hänen
kasvonsa ylöspäin kääntyneet ja loistivat kalpeina pimeässä; hänen
kasvoihinsa saattoi joskus tulla ilme, joka muistutti ristiinnaulittua —:
Sinne hän aina meni hämärissä tai illan tullen, mutta silloin olivat
aina Tine ja lapset hänen kintereillään.
— Hyvää yötä.
Lumi peitti puutarhan. Puissa oli huurretta. Pakkasessa
kimaltelivat lumikiteet.
— Niin sanotaan.
— Mitäkö huomasivat?
Äiti puhui:
— Ehkäpä.
*****
Mutta saattoi tulla aikoja, jolloin äiti luki. Kirjakaapin ovea avattiin
yhtämittaa. Äiti otti sieltä kaikenlaisia kirjoja. Renki ajoi
Sönderborgiin ja renki toi kirjoja.