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70 Cards in this Set
- Front
- Back
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Fluid and electrolyte balance is necessary for the internal equilibrium, known as ________. |
Homeostasis |
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Although it varies with age, body fat, and gender, what is the approximate percentage of fluid that makes up and adult? |
60% |
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Fluid that is in cells and makes up 2/3 of body fluid. |
Intracellular |
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Fluid that is outside the cells is known as what? |
Extracellular fluid |
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Fluid within blood vessels |
Intavascular |
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Fluid that surrounds the cells |
Interstitial |
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Fluid that fills up the spaces of chambers that are created or formed from the linings of epithelial cells. |
Transcellular fluid |
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Active chemicals that carry positive (cations) and negative (anions) electrical charges. |
Electrolytes |
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5 major electrolytes that carry positive (cations) electrical charges |
Sodium Potassium Calcium Magnesium Hydrogen Ions |
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Five major electrolytes that carry negative (anions) electrical charges. |
Chloride Bicarbonate Phosphate Sulfate Negatively charged protein ions |
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What measurement is electrolytes normally measured in? |
Millequivalents (mEq) per liter |
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The diffusion of water caused by fluid and solute concentration gradients |
Osmosis |
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Movement of fluid through capillary walls depends on what two pressures? |
Hydrostatic Osmotic |
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This type of pressure is exerted on walls of blood vessels. |
Hydrostatic |
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This type of pressure is exerted by protein in plasma. |
Osmotic |
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The direction of fluid movement depends on the difference of these two pressures? |
Hydrostatic and osmotic |
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The process of where fluid moves from an area of low solute concentration to an area of high solute concentration. |
Osmosis |
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The process where solutes move from an area of higher concentration to one of lower concentration. |
Diffusion |
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The movement of water, and where solutes occur from area of high hydrostatic pressure to an area of low hydrostatic pressure |
Filtration |
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This active transport maintains higher concentration of extracellular sodium and intracellular potassium |
Sodium-potassium pump |
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Four ways electrolytes are lost. |
Kidney - urine Skin loss - sweating by fever, exercise & burns Lungs - through respirations GI tract - large losses due to diarrhea & fistulas |
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FVD |
Fluid volume deficit |
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FVE |
Fluid volume excess |
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A fluid volume deficit is considered what? |
Hypovolemia |
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Causes of FVD |
Abnormal fluid loss - vomiting, diarrhea, sweating, GI suctioning Decreased intake - anorexia, nausea, lack of access to fluids Third-space fluid shifts - due to burns, ascites Additional causes - diabetes insipudus, adrenal insufficiency, hemorrhage |
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A fluid volume excess is considered what? |
Hypervolemia |
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Causes of FVE |
Fluid overload or diminished homeostatic mechanisms Heart failure, kidney injury, cirrhosis of liver Consumption of excessive amounts of salt Excessive administration of sodium-containing fluids |
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Signs of FVD (hypovolemia) |
Acute weight loss Decreased skin turgor Oliguria Concentrated urine Prolonged capillary refill Low blood pressure Flattened neck veins Dizziness Weakness Thirst & confusion Increased pulse Muscle cramps Sunken eyes Nausea Increased temp Cool, clammy, pale skin |
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Signs of FVE (hypervolemia) |
Acute weight gain Peripheral edema Ascites Distended jugular Crackles, shortness of breath Elevated blood pressure Bounding pulse & cough Increased respiratory rate Increased urine output BUN HCT |
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Ways to manage fluid volume excess. |
Diuretics, dialysis, dietary restrictions of sodium |
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Hyponatremia and hypernatremia are caused by an imbalance of what electrolyte? |
Sodium |
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Hypokalemia and hyperkalemia are an imbalance of what electrolyte? |
Potassium |
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Hypocalcemia and hypercalcemia are caused by an imbalance of what electrolyte? |
Calcium |
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Hypomagnesemia and hypermagnesemia are caused by an imbalance of what electrolyte? |
Magnesium |
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Hypophosphatemia and hyperphosphatemia are caused by an imbalance of what electrolyte? |
Phosphorous |
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Hypochloremia and hypercholremia are caused by an imbalance of what electrolyte? |
Chloride |
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Serum sodium levels less than 135 mEq/L |
Hyponatremia |
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Serum sodium greater than 145 mEq/L |
Hypernatremia |
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Serum potassium less than 3.5 mEq/L |
Hypokalemia |
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Potassium greater than 5.0 mEq/L |
Hyperkalemia |
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Below are characteristics of what increased electrolyte level: - seldom occurs in patients with normal renal function - increased risk in older adults - cardiac arrest is frequently associated |
Hyperkalemia |
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Serum calcium level less than 8.6 mg/dL |
Hypocalcium |
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Serum calcium level less than 8.6 mg/dL |
Hypocalcium |
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Serum calcium levels greater than 10.4 mg/dL |
Hypercalcemia |
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Serum magnesium level less than 1.8 mg/dL |
Hypomagnesemia |
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Serum magnesium levels great than 2.6 mg/dL |
Hypermagnesemia |
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Serum phosphate level below 2.7 mg/dL |
Hypophosphatemia |
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Serum phosphate level above 4.5 mg/dL |
Hyperphosphatemia |
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Serum chloride levels less than 97mEq/L |
Hypochloremia |
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Serum chloride levels more than 107 mEq/L |
Hyperchloremia |
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The nurse is caring for a client in the intensive care unit (ICU) following a near-drowning event in saltwater. The client is restless, lethargic, and demonstrating tremors. Additional assessment findings include swollen and dry tongue, flushed skin, and peripheral edema. The nurse anticipates that the client’s serum sodium value would be 155 mEq/L (155 mmol/L) 145 mEq/L (145 mmol/L) 135 mEq/L (135 mmol/L) 125 mEq/L (125 mmol/L) |
155 mEq/L (155 mmol/L) Hypernatremia is a serum sodium concentration >145 mEq/L (>145 mmol/L). A cause of hypernatremia is near drowning in seawater (which contains a sodium concentration of approximately 500 mEq/L). S/S of hypernatremia include thirst, elevated body temperature, swollen and dry tongue and sticky mucous membranes, hallucinations, lethargy, restlessness, irritability, simple partial or tonic-clonic seizures, pulmonary edema, hyperreflexia, twitching, nausea, vomiting, anorexia, elevated pulse, and elevated blood pressure. |
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Air embolism is a potential complication of IV therapy. The nurse should be alert to which clinical manifestation associated with air embolism? Chest pain Hypertension Slow pulse Jaundice |
Chest Pain Manifestations of air embolism include dyspnea and cyanosis; hypotension; weak, rapid pulse; loss of consciousness; and chest, shoulder, and low back pain. |
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The nurse is analyzing the arterial blood gas (ABG) results of a client diagnosed with severe pneumonia. Which of the following ABG results indicates respiratory acidosis? pH: 7.20, PaCO2: 65 mm Hg, HCO3–: 26 mEq/L pH: 7.32, PaCO2: 40 mm Hg, HCO3–: 18 mEq/L pH: 7.50, PaCO2: 30 mm Hg, HCO3–: 24 mEq/L pH: 7.40, PaCO2: 40 mm Hg, HCO3–: 24 mEq /L |
pH: 7.20, PaCO2: 65 mm Hg, HCO3–: 26 mEq/L Respiratory acidosis is a clinical disorder in which the pH is less than 7.35–7.40 and the PaCO2 is greater than 40–45 mm Hg and a compensatory increase in the plasma HCO3– occurs. Respiratory acidosis may be either acute or chronic. |
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A client reports tingling in the fingers as well as feeling depressed. The nurse assesses positive Trousseau’s and Chvostek’s signs. Which decreased laboratory results does the nurse observe when the client’s laboratory work has returned? Potassium Phosphorus Calcium Iron |
Calcium Calcium deficit is associated with the following symptoms: numbness and tingling of the fingers, toes, and circumoral region; positive Trousseau’s sign and Chvostek’s sign; seizures, carpopedal spasms, hyperactive deep tendon reflexes, irritability, bronchospasm, anxiety, impaired clotting time, decreased prothrombin, diarrhea, and hypotension. |
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A client presents with muscle weakness, tremors, slow muscle movements, and vertigo. The following are the client's laboratory values: Sodium 134 mEq/L (134 mmol/L) Potassium 3.2 mEq/L (3.2 mmol/L) Chloride 111 mEq/L (111 mmol/L) Magnesium 1.1 mg/dL (0.45 mmol/L) Calcium 8.4 mg/dL (2.1 mmol/L) hyponatremia hypokalemia hypocalcemia hypomagnesemia |
hypomagnesemia Magnesium, the second most abundant intracellular cation, plays a role in both carbohydrate and protein metabolism. The most common cause of this imbalance is loss in the gastrointestinal tract. Hypomagnesemia is a value less than 1.3 mg/dL (0.45 mmol/L). Signs and symptoms include muscle weakness, tremors, irregular movements, tetany, vertigo, focal seizures, and positive Chvostek’s and Trousseau’s signs. |
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A client with a suspected overdose of an unknown drug is admitted to the emergency department. Arterial blood gas values indicate respiratory acidosis. What should the nurse do first? Prepare to assist with ventilation. Monitor the client's heart rhythm. Prepare for gastric lavage. Obtain a urine specimen for drug screening. |
Prepare to assist with ventilation. Respiratory acidosis is associated with hypoventilation; in this client, hypoventilation suggests intake of a drug that has suppressed the brain's respiratory center. Therefore, the nurse should assume the client has respiratory depression and should prepare to assist with ventilation. After the client's respiratory function has been stabilized, the nurse can safely monitor the heart rhythm, prepare for gastric lavage, and obtain a urine specimen for drug screening. |
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A physician orders an isotonic I.V. solution for a client. Which solution should the nurse plan to administer? 5% dextrose and normal saline solution Lactated Ringer's solution Half-normal saline solution 10% dextrose in water |
Lactated Ringer's solution Lactated Ringer's solution, with an osmolality of approximately 273 mOsm/L, is isotonic. The nurse shouldn't give half-normal saline solution because it's hypotonic, with an osmolality of 154 mOsm/L. Giving 5% dextrose and normal saline solution (with an osmolality of 559 mOsm/L) or 10% dextrose in water (with an osmolality of 505 mOsm/L) also would be incorrect because these solutions are hypertonic. |
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Your client has a diagnosis of hypervolemia. What would be an important intervention that you would initiate? Give medications that promote fluid retention. Limit sodium and water intake. Assess for dehydration. Teach client behaviors that decrease urination. |
Limit sodium and water intake. Implement prescribed interventions such as limiting sodium and water intake and administering ordered medications that promote fluid elimination. |
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Which of the following is the most common cause of symptomatic hypomagnesemia in the United States? Alcoholism Intestinal resection Inflammatory bowel disease Loss of gastric acid |
Alcoholism Alcoholism is currently the most common cause of symptomatic hypomagnesemia in the United States. Any disruption in small bowel function, as in intestinal resection or inflammatory bowel disease, can lead to hypomagnesemia. |
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A client who complains of an “acid stomach” has been taking baking soda (sodium bicarbonate) regularly as a self-treatment. This may place the client at risk for which acid–base imbalance? metabolic alkalosis metabolic acidosis respiratory acidosis respiratory alkalosis |
metabolic alkalosis Metabolic alkalosis results in increased plasma pH because of accumulated base bicarbonate or decreased hydrogen ion concentrations. The client’s regular use of baking soda (sodium bicarbonate) may create a risk for this condition. |
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A client hospitalized for treatment of a pulmonary embolism develops respiratory alkalosis. Which clinical findings commonly accompany respiratory alkalosis? Headache or blurry vision Abdominal pain or diarrhea Hallucinations or tinnitus Light-headedness or paresthesia |
Light-headedness or paresthesia The client with respiratory alkalosis may complain of light-headedness or paresthesia (numbness and tingling in the arms and legs). Headache, blurry vision, abdominal pain, and diarrhea may accompany respiratory acidosis. |
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To confirm an acid–base imbalance, it is necessary to assess which findings from a client’s arterial blood gas (ABG) results? Select all that apply.
pH PaCO2 HCO3 Glucose Na+ K+ |
pH PaCO2 HCO3 Arterial blood gas (ABG) results are the main tool for measuring blood pH, CO2 content (PaCO2), and bicarbonate (HCO3). The two types of acid-base imbalances are acidosis and alkalosis |
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A client with Guillain-Barré syndrome develops respiratory acidosis as a result of reduced alveolar ventilation. Which combination of arterial blood gas (ABG) values confirms respiratory acidosis? pH, 7.5; PaCO2 30 mm Hg pH, 7.40; PaCO2 35 mm Hg pH, 7.35; PaCO2 40 mm H pH, 7.25; PaCO2 50 mm Hg |
pH, 7.25; PaCO2 50 mm Hg In respiratory acidosis, ABG analysis reveals an arterial pH below 7.35 and partial pressure of arterial carbon dioxide (PaCO2) above 45 mm Hg. Therefore, the combination of a pH value of 7.25 and a PaCO2 value of 50 mm Hg confirms respiratory acidosis. |
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With which condition should the nurse expect that a decrease in serum osmolality will occur? Influenza Hyperglycemia Kidney failure Uremia |
Kidney Failure Failure of the kidneys results in multiple fluid and electrolyte abnormalities including fluid volume overload. If renal function is so severely impaired that pharmacologic agents cannot act efficiently, other modalities are considered to remove sodium and fluid from the body. |
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Which is the preferred route of administration for potassium? |
Oral |
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A client with respiratory acidosis is admitted to the intensive care unit for close observation. What client complication associated with respiratory acidosis would the nurse observe? |
papilledema If respiratory acidosis is severe, intracranial pressure may rise, causing papilledema. |
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The nurse is caring for a client diagnosed with bulimia. The client is being treated for a serum potassium concentration of 2.9 mEq/L (2.9 mmol/L). Which statement made by the client indicates the need for further teaching? “I can use laxatives and enemas but only once a week.” “A good breakfast for me will include milk and a couple of bananas.” “I will be sure to buy frozen vegetables when I grocery shop.” “I will take a potassium supplement daily as prescribed.” |
“I can use laxatives and enemas but only once a week.” |
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Which electrolyte is a major cation in body fluid? |
Potassium |
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A client with pancreatic cancer has the following blood chemistry profile: Glucose, fasting: 204 mg/dl; blood urea nitrogen (BUN): 12 mg/dl; Creatinine: 0.9 mg/dl; Sodium: 136 mEq/L; Potassium: 2.2 mEq/L; Chloride: 99 mEq/L; CO2: 33 mEq/L. Which result should the nurse identify as critical and report immediately? CO2 Sodium Chloride Potassium |
Potassium |
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A client comes to the emergency department with status asthmaticus. His respiratory rate is 48 breaths/minute, and he is wheezing. An arterial blood gas analysis reveals a pH of 7.52, a partial pressure of arterial carbon dioxide (PaCO2) of 30 mm Hg, PaO2 of 70 mm Hg, and bicarbonate (HCO3??') of 26 mEq/L. What disorder is indicated by these findings? Metabolic acidosis Respiratory acidosis Metabolic alkalosis Respiratory alkalosis |
Respiratory alkalosis |
