1. A client develops interstitial edema as a result of decreased:
A) Vascular volume
B) Hydrostatic pressure
C) Capillary permeability
D) Colloidal osmotic pressure
Ans: D
Feedback:
Edema can be defined as palpable swelling produced by an increased interstitial fluid
volume. The physiologic mechanisms that contribute to edema formation include factors
that (1) increase capillary filtration (hydrostatic) pressure, (2) decrease the capillary
colloid osmotic pressure, (3) increase capillary permeability, or (4) produce obstruction
to lymph flow.
2. A client has been receiving intravenous normal saline at a rate of 125 mL/hour since her
surgery 2 days earlier. As a result, she has developed an increase in vascular volume and
edema. Which of the following phenomena accounts for this client's edema?
A) Obstruction of lymph flow
B) Increased capillary permeability
C) Decreased capillary colloidal osmotic pressure
D) Increased capillary filtration pressure
Ans: D
Feedback:
An increase in vascular volume results in an increase in capillary filtration pressure.
Consequently, movement of vascular fluid into the interstitial spaces increases and
edema ensues. An increase in vascular volume does not directly result in obstruction of
lymph flow, increased capillary permeability, or decreased capillary colloidal osmotic
pressure.
3. The most reliable method for measuring body water or fluid volume increase is by
assessing:
A) Tissue turgor
B) Intake and output
C) Body weight change
D) Serum sodium levels
Ans: C
Page 1
, Feedback:
Daily weights are a reliable index of water volume gain (1 L of water weighs 2.2
pounds). Daily weight measurements taken at the same time each day with the same
amount of clothing provide a useful index of water gain due to edema. When an
unbalanced distribution of body water exists in the tissues and organs, assessment of
surface skin tissue turgor will be inaccurate. Measurement of renal output is unreliable
because fluid retention may be a compensatory response, or the renal system may be
dysfunctional. Serum sodium levels are affected by multiple variables other than body
water volume.
4. A client with a diagnosis of liver cirrhosis secondary to alcohol abuse has a distended
abdomen as a result of fluid accumulation in his peritoneal cavity (ascites). Which of the
following pathophysiologic processes contributes to this third spacing?
A) Abnormal increase in transcellular fluid volume
B) Increased capillary colloidal osmotic pressure
C) Polydipsia
D) Impaired hormonal control of fluid volume
Ans: A
Feedback:
Third spacing represents the loss or trapping of extracellular fluid (ECF) in the
transcellular space and a consequent increase in transcellular fluid volume. The serous
cavities are part of the transcellular compartment located in strategic body areas where
there is continual movement of body structures—the pericardial sac, the peritoneal
cavity, and the pleural cavity. Polydipsia and increased fluid intake alone are insufficient
to cause third spacing, and increased capillary colloidal osmotic pressure would result in
increased intracellular fluid (ICF). The etiology of third spacing does not normally
include alterations in hormonal control of fluid balance.
5. A 2-week-old infant (full-term at birth) is admitted to the pediatrics unit with “spitting
up large amounts of formula” and diarrhea. The infant has developed a weak suck
reflex. Which of the following statements about total body water (TBW) is accurate in
this situation?
A) About 52% of the infants' weight accounts for the amount of water in their body.
B) Because of the infants' higher fat ratio, one should anticipate an increased TBW to
as high as 90%.
C) Most full-term infants have a TBW of approximately 75% due to their high
metabolic rate.
D) Most of an infant's TBW remains in the ICF compartment, so they should be able
to transfer needed water into the ECF space.
Ans: C
Page 2
, Feedback:
Infants normally have more TBW than older children or adults. TBW constitutes
approximately 75% to 80% of body weight in full-term infants and an even greater
percentage in premature infants. In males, the TBW decreases in the elderly population
to approximately 52% TBW. Obesity decreases TBW, with levels as low as 30% to 40%
of body weight in adults. Infants have more than half of their TBW in their ECF
compartment, as compared to adults.
6. A client diagnosed with schizophrenia has been admitted to the emergency department
(ED) after ingesting more than 2 gallons of water in one sitting. Which of the following
pathophysiologic processes may result from the sudden water gain?
A) Hypernatremia
B) Water movement from the extracellular to the intracellular compartment
C) Syndrome of inappropriate secretion of ADH (SIADH)
D) Isotonic fluid excess in the extracellular fluid compartment
Ans: B
Feedback:
Excess water ingestion coupled with impaired water excretion (or rapid ingestion at a
rate that exceeds renal excretion) in persons with psychogenic polydipsia can lead to
water intoxication (hyponatremia). A disproportionate gain of water with no
accompanying gain in sodium results in the movement of water from the extracellular to
the intracellular compartment. Hyponatremia accompanies this process. Because of the
lack of sodium increase, accumulated fluid is hypotonic, not isotonic. SIADH is not a
consequence of excess water intake.
7. A nurse caring for a client with a diagnosis of diabetes insipidus (DI) should prioritize
the close monitoring of which of the following electrolyte levels?
A) Potassium
B) Sodium
C) Magnesium
D) Calcium
Ans: B
Feedback:
The high water intake and high urine output that characterize diabetes insipidus create a
risk of sodium imbalance. DI may present with hypernatremia and dehydration,
especially in persons without free access to water, or with damage to the hypothalamic
thirst center and altered thirst sensation.
Page 3
, 8. The syndrome of inappropriate antidiuretic hormone (SIADH) is characterized by:
A) Increased osmolality level of 360 mOsm/kg
B) Excessive thirst with fluid intake of 7000 mL/day
C) Copious dilute urination with output of 5000 mL/day
D) Low serum sodium level of 122 mEq/L
Ans: D
Feedback:
SIADH results from a failure of the negative feedback system that regulates the release
and inhibition of antidiuretic hormone (ADH). ADH secretion continues even when
serum osmolality is decreased, causing water retention and dilutional hyponatremia.
Diabetes insipidus, deficiency or decreased response to ADH, is characterized by
increased serum osmolality, excessive thirst, and polyuria. Urine output decreases in
SIADH despite adequate or increased fluid intake.
9. In isotonic fluid volume deficit, changes in total body water are accompanied by:
A) Intravascular hypotonicity
B) Increased intravascular water
C) Increases in intracellular sodium
D) Proportionate losses of sodium
Ans: D
Feedback:
Isotonic fluid volume deficit causes a proportionate loss of sodium and water.
Hypotonicity results from water retention or sodium loss. Increased intravascular water
causes sodium to move into the cell excessively.
10. A client with a history of heart and kidney failure is brought to the emergency
department. Upon assessment/diagnosis, it is determined the client is in decompensated
heart failure. Of the following assessment findings, which are associated with excess
intracellular water? Select all that apply.
A) Lethargy
B) Confusion
C) Hyperactive deep tendon reflexes
D) Seizures
E) Firm, rubbery tissue when palpating lower extremities
Ans: A, B, D
Page 4
A) Vascular volume
B) Hydrostatic pressure
C) Capillary permeability
D) Colloidal osmotic pressure
Ans: D
Feedback:
Edema can be defined as palpable swelling produced by an increased interstitial fluid
volume. The physiologic mechanisms that contribute to edema formation include factors
that (1) increase capillary filtration (hydrostatic) pressure, (2) decrease the capillary
colloid osmotic pressure, (3) increase capillary permeability, or (4) produce obstruction
to lymph flow.
2. A client has been receiving intravenous normal saline at a rate of 125 mL/hour since her
surgery 2 days earlier. As a result, she has developed an increase in vascular volume and
edema. Which of the following phenomena accounts for this client's edema?
A) Obstruction of lymph flow
B) Increased capillary permeability
C) Decreased capillary colloidal osmotic pressure
D) Increased capillary filtration pressure
Ans: D
Feedback:
An increase in vascular volume results in an increase in capillary filtration pressure.
Consequently, movement of vascular fluid into the interstitial spaces increases and
edema ensues. An increase in vascular volume does not directly result in obstruction of
lymph flow, increased capillary permeability, or decreased capillary colloidal osmotic
pressure.
3. The most reliable method for measuring body water or fluid volume increase is by
assessing:
A) Tissue turgor
B) Intake and output
C) Body weight change
D) Serum sodium levels
Ans: C
Page 1
, Feedback:
Daily weights are a reliable index of water volume gain (1 L of water weighs 2.2
pounds). Daily weight measurements taken at the same time each day with the same
amount of clothing provide a useful index of water gain due to edema. When an
unbalanced distribution of body water exists in the tissues and organs, assessment of
surface skin tissue turgor will be inaccurate. Measurement of renal output is unreliable
because fluid retention may be a compensatory response, or the renal system may be
dysfunctional. Serum sodium levels are affected by multiple variables other than body
water volume.
4. A client with a diagnosis of liver cirrhosis secondary to alcohol abuse has a distended
abdomen as a result of fluid accumulation in his peritoneal cavity (ascites). Which of the
following pathophysiologic processes contributes to this third spacing?
A) Abnormal increase in transcellular fluid volume
B) Increased capillary colloidal osmotic pressure
C) Polydipsia
D) Impaired hormonal control of fluid volume
Ans: A
Feedback:
Third spacing represents the loss or trapping of extracellular fluid (ECF) in the
transcellular space and a consequent increase in transcellular fluid volume. The serous
cavities are part of the transcellular compartment located in strategic body areas where
there is continual movement of body structures—the pericardial sac, the peritoneal
cavity, and the pleural cavity. Polydipsia and increased fluid intake alone are insufficient
to cause third spacing, and increased capillary colloidal osmotic pressure would result in
increased intracellular fluid (ICF). The etiology of third spacing does not normally
include alterations in hormonal control of fluid balance.
5. A 2-week-old infant (full-term at birth) is admitted to the pediatrics unit with “spitting
up large amounts of formula” and diarrhea. The infant has developed a weak suck
reflex. Which of the following statements about total body water (TBW) is accurate in
this situation?
A) About 52% of the infants' weight accounts for the amount of water in their body.
B) Because of the infants' higher fat ratio, one should anticipate an increased TBW to
as high as 90%.
C) Most full-term infants have a TBW of approximately 75% due to their high
metabolic rate.
D) Most of an infant's TBW remains in the ICF compartment, so they should be able
to transfer needed water into the ECF space.
Ans: C
Page 2
, Feedback:
Infants normally have more TBW than older children or adults. TBW constitutes
approximately 75% to 80% of body weight in full-term infants and an even greater
percentage in premature infants. In males, the TBW decreases in the elderly population
to approximately 52% TBW. Obesity decreases TBW, with levels as low as 30% to 40%
of body weight in adults. Infants have more than half of their TBW in their ECF
compartment, as compared to adults.
6. A client diagnosed with schizophrenia has been admitted to the emergency department
(ED) after ingesting more than 2 gallons of water in one sitting. Which of the following
pathophysiologic processes may result from the sudden water gain?
A) Hypernatremia
B) Water movement from the extracellular to the intracellular compartment
C) Syndrome of inappropriate secretion of ADH (SIADH)
D) Isotonic fluid excess in the extracellular fluid compartment
Ans: B
Feedback:
Excess water ingestion coupled with impaired water excretion (or rapid ingestion at a
rate that exceeds renal excretion) in persons with psychogenic polydipsia can lead to
water intoxication (hyponatremia). A disproportionate gain of water with no
accompanying gain in sodium results in the movement of water from the extracellular to
the intracellular compartment. Hyponatremia accompanies this process. Because of the
lack of sodium increase, accumulated fluid is hypotonic, not isotonic. SIADH is not a
consequence of excess water intake.
7. A nurse caring for a client with a diagnosis of diabetes insipidus (DI) should prioritize
the close monitoring of which of the following electrolyte levels?
A) Potassium
B) Sodium
C) Magnesium
D) Calcium
Ans: B
Feedback:
The high water intake and high urine output that characterize diabetes insipidus create a
risk of sodium imbalance. DI may present with hypernatremia and dehydration,
especially in persons without free access to water, or with damage to the hypothalamic
thirst center and altered thirst sensation.
Page 3
, 8. The syndrome of inappropriate antidiuretic hormone (SIADH) is characterized by:
A) Increased osmolality level of 360 mOsm/kg
B) Excessive thirst with fluid intake of 7000 mL/day
C) Copious dilute urination with output of 5000 mL/day
D) Low serum sodium level of 122 mEq/L
Ans: D
Feedback:
SIADH results from a failure of the negative feedback system that regulates the release
and inhibition of antidiuretic hormone (ADH). ADH secretion continues even when
serum osmolality is decreased, causing water retention and dilutional hyponatremia.
Diabetes insipidus, deficiency or decreased response to ADH, is characterized by
increased serum osmolality, excessive thirst, and polyuria. Urine output decreases in
SIADH despite adequate or increased fluid intake.
9. In isotonic fluid volume deficit, changes in total body water are accompanied by:
A) Intravascular hypotonicity
B) Increased intravascular water
C) Increases in intracellular sodium
D) Proportionate losses of sodium
Ans: D
Feedback:
Isotonic fluid volume deficit causes a proportionate loss of sodium and water.
Hypotonicity results from water retention or sodium loss. Increased intravascular water
causes sodium to move into the cell excessively.
10. A client with a history of heart and kidney failure is brought to the emergency
department. Upon assessment/diagnosis, it is determined the client is in decompensated
heart failure. Of the following assessment findings, which are associated with excess
intracellular water? Select all that apply.
A) Lethargy
B) Confusion
C) Hyperactive deep tendon reflexes
D) Seizures
E) Firm, rubbery tissue when palpating lower extremities
Ans: A, B, D
Page 4
