NTR 604 MODULE 2 EXAM QUESTIONS
WITH CORRECT ANSWERS
volume overload (hypervolemia) - Answer-- water retention with a decrease in
sodium concentration
Hypovolemia - Answer-- Renal or extrarenal losses of fluid
>> Renal loss - diuretics, hypoaldosteronism, salt-wasting nephropathies
>> Extra renal loss - hemorrhage, loss of GI fluids (vomiting, suctioning, diarrhea, fistula
drainage),
skin losses (heat, wounds such as burns or fistula)
- S/S
>> Sleepiness, apathy, orthostatic hypotension, tachycardia, collapsed veins, ↓ skin
turgor
>>↑ BUN/Cr ratio, ↑ HCT, ↑ urine specific gravity and osmolality
- Treatment - restore plasma volume using NS, blood products, colloids
Dehydration - Answer-- Intracellular H20 deficits (net H20 loss)
>>↑ insensible losses, loss of hypotonic fluids
>> Solute gain - hypertonic saline
- Signs/symptoms
>> Thirst, dry mucous membranes, ↓ saliva, tachycardia, hypotension, fever
>> AMS, weakness
- Treatment - calculate fluid deficit
- Hypotonic saline (1⁄2 NS) or D5W
- Avoid rapid correction!
Hypervolemia - Answer-- Expansion of ECF volume
>> Occurs with decreased renal excretion of Na+ and H20
>>>Acute/chronic renal failure
>>>Nephrotic syndrome, cirrhosis
>> ↑ IVF administration
- Signs/symptoms
>> SOB, edema, wt gain, distended neck veins
>> ↓ sodium, chloride, hemoglobin, hematocrit, BUN, and albumin
- Treatment - H20 and Na+ restriction
edema - Answer-accumulation of fluid in the interstitial fluid; categorized according to
the level of indentation as well as for how long it stays indented
Goes from 0+ to 4+ and as the # increases, the higher the degree of indentation and the
longer it stays depressed
electrolytes - Answer-- includes sodium, potassium, calcium,
magnesium, chloride, bicarbonate,
, phosphate, sulphate
- ions dissociate to form charged particles when dissolved in water
body solutes that are not electrolytes - Answer-- includes glucose, protein, urea, lactate,
organic acids that remain stable when dissolved in water
sodium (univalent ions Na+, K+): mEq = mmol) - Answer-Major cation of ECF
- 35% to 40% of it is in skeleton and not very available
- it regulates ECF and plasma volume, nerve impulses, and
muscle contraction
- gains = diet, medications, saline IV solutions
- losses = urine, sweat, GI secretions
hyponatremia (sodium disorder) - Answer-- plasma sodium less than 135
- represents a relative loss of sodium in proportion to water
- Most common causes: fluid overload,
excessive urinary, GI or sweat losses, SIADH,
medications, hypothyroidism, nephrotic
syndrome, cirrhosis, cardiac failure, renal
failure
SIADH: syndrome of inappropriate antidiuretic hormone secretion (ADH is secreted
inappropriately with respect to plasma osmolality) - Answer-- this condition - results in
concentrated urine in the setting of ↓
osmolality.
- Intake of water combined with ↑ levels of this hormone causes
expansion of ECF volume and dilutional hyponatremia
hypernatremia (sodium disorder) - Answer-- plasma sodium is above 145
- deficit of water in relation to total body sodium
- causes: free water loss, hypotonic fluid loss, Na+ gain or inadequate water
intake
potassium - Answer-- Major cation of ICF
- Normal water balance, osmotic equilibrium, acid-base balance,
neuromuscular activity, cellular growth
- Readily absorbed from small intestine
- Mostly excreted from urine
- gains - food, medications, IV fluids containing it
- losses - renal, GI and skin. 90% of intake is excreted in urine.
- Obligatory losses of 5-10 mmol/day, even if intake is low
- majority of it is in the cells in the ICF and the body releases it into the ECF when there
is cell breakdown or when the pH drops
hypokalemia - Answer--plasma potassium <3.5 mEq/L
- Causes: usually due to increased losses rather than inadequate intake
WITH CORRECT ANSWERS
volume overload (hypervolemia) - Answer-- water retention with a decrease in
sodium concentration
Hypovolemia - Answer-- Renal or extrarenal losses of fluid
>> Renal loss - diuretics, hypoaldosteronism, salt-wasting nephropathies
>> Extra renal loss - hemorrhage, loss of GI fluids (vomiting, suctioning, diarrhea, fistula
drainage),
skin losses (heat, wounds such as burns or fistula)
- S/S
>> Sleepiness, apathy, orthostatic hypotension, tachycardia, collapsed veins, ↓ skin
turgor
>>↑ BUN/Cr ratio, ↑ HCT, ↑ urine specific gravity and osmolality
- Treatment - restore plasma volume using NS, blood products, colloids
Dehydration - Answer-- Intracellular H20 deficits (net H20 loss)
>>↑ insensible losses, loss of hypotonic fluids
>> Solute gain - hypertonic saline
- Signs/symptoms
>> Thirst, dry mucous membranes, ↓ saliva, tachycardia, hypotension, fever
>> AMS, weakness
- Treatment - calculate fluid deficit
- Hypotonic saline (1⁄2 NS) or D5W
- Avoid rapid correction!
Hypervolemia - Answer-- Expansion of ECF volume
>> Occurs with decreased renal excretion of Na+ and H20
>>>Acute/chronic renal failure
>>>Nephrotic syndrome, cirrhosis
>> ↑ IVF administration
- Signs/symptoms
>> SOB, edema, wt gain, distended neck veins
>> ↓ sodium, chloride, hemoglobin, hematocrit, BUN, and albumin
- Treatment - H20 and Na+ restriction
edema - Answer-accumulation of fluid in the interstitial fluid; categorized according to
the level of indentation as well as for how long it stays indented
Goes from 0+ to 4+ and as the # increases, the higher the degree of indentation and the
longer it stays depressed
electrolytes - Answer-- includes sodium, potassium, calcium,
magnesium, chloride, bicarbonate,
, phosphate, sulphate
- ions dissociate to form charged particles when dissolved in water
body solutes that are not electrolytes - Answer-- includes glucose, protein, urea, lactate,
organic acids that remain stable when dissolved in water
sodium (univalent ions Na+, K+): mEq = mmol) - Answer-Major cation of ECF
- 35% to 40% of it is in skeleton and not very available
- it regulates ECF and plasma volume, nerve impulses, and
muscle contraction
- gains = diet, medications, saline IV solutions
- losses = urine, sweat, GI secretions
hyponatremia (sodium disorder) - Answer-- plasma sodium less than 135
- represents a relative loss of sodium in proportion to water
- Most common causes: fluid overload,
excessive urinary, GI or sweat losses, SIADH,
medications, hypothyroidism, nephrotic
syndrome, cirrhosis, cardiac failure, renal
failure
SIADH: syndrome of inappropriate antidiuretic hormone secretion (ADH is secreted
inappropriately with respect to plasma osmolality) - Answer-- this condition - results in
concentrated urine in the setting of ↓
osmolality.
- Intake of water combined with ↑ levels of this hormone causes
expansion of ECF volume and dilutional hyponatremia
hypernatremia (sodium disorder) - Answer-- plasma sodium is above 145
- deficit of water in relation to total body sodium
- causes: free water loss, hypotonic fluid loss, Na+ gain or inadequate water
intake
potassium - Answer-- Major cation of ICF
- Normal water balance, osmotic equilibrium, acid-base balance,
neuromuscular activity, cellular growth
- Readily absorbed from small intestine
- Mostly excreted from urine
- gains - food, medications, IV fluids containing it
- losses - renal, GI and skin. 90% of intake is excreted in urine.
- Obligatory losses of 5-10 mmol/day, even if intake is low
- majority of it is in the cells in the ICF and the body releases it into the ECF when there
is cell breakdown or when the pH drops
hypokalemia - Answer--plasma potassium <3.5 mEq/L
- Causes: usually due to increased losses rather than inadequate intake
