Test bank For Nurs_3365_pathophysiology 2024
b b b b b
1. Abclientbdevelopsbinterstitialbedemabasbabresultbofbdecreased:
A) Vascularbvolume
B) Hydrostaticbpressure
C) Capillarybpermeability
D) Colloidalbosmoticbpressureb
Ans:b D
Feedback:
Edemabcanbbebdefinedbasbpalpablebswellingbproducedbbybanbincreasedbinterstitialbfluidbvol
ume.bThebphysiologicbmechanismsbthatbcontributebtobedemabformationbincludebfactorsbthatb
(1)bincreasebcapillarybfiltrationb(hydrostatic)bpressure,b(2)bdecreasebthebcapillarybcolloidbos
moticbpressure,b(3)bincreasebcapillarybpermeability,borb(4)bproducebobstructionbtoblymphbfl
ow.
2. Abclientbhasbbeenbreceivingbintravenousbnormalbsalinebatbabratebofb125bmL/hourbsincebherbs
urgeryb2bdaysbearlier.bAsbabresult,bshebhasbdevelopedbanbincreasebinbvascularbvolumebandbed
ema.bWhichbofbthebfollowingbphenomenabaccountsbforbthisbclient'sbedema?
A) Obstructionbofblymphbflow
B) Increasedbcapillarybpermeability
C) Decreasedbcapillarybcolloidalbosmoticbpressure
D) Increasedbcapillarybfiltrationbpressureb
Ans:b D
Feedback:
Anbincreasebinbvascularbvolumebresultsbinbanbincreasebinbcapillarybfiltrationbpressure.bCons
equently,bmovementbofbvascularbfluidbintobthebinterstitialbspacesbincreasesbandbedemabensu
es.bAnbincreasebinbvascularbvolumebdoesbnotbdirectlybresultbinbobstructionbofblymphbflow,bin
creasedbcapillarybpermeability,borbdecreasedbcapillarybcolloidalbosmoticbpressure.
3. Thebmostbreliablebmethodbforbmeasuringbbodybwaterborbfluidbvolumebincreasebisbbyba
ssessing:
A) Tissuebturgor
B) Intakebandboutput
C) Bodybweightbchange
D) Serumbsodiumblevelsb
Ans:b C
Pageb1
, Feedback:
Dailybweightsbarebabreliablebindexbofbwaterbvolumebgainb(1bLbofbwaterbweighsb2.2bpound
s).bDailybweightbmeasurementsbtakenbatbthebsamebtimebeachbdaybwithbthebsamebamountbo
fbclothingbprovidebabusefulbindexbofbwaterbgainbduebtobedema.bWhenbanbunbalancedbdistr
ibutionbofbbodybwaterbexistsbinbthebtissuesbandborgans,bassessmentbofbsurfacebskinbtissueb
turgorbwillbbebinaccurate.bMeasurementbofbrenalboutputbisbunreliablebbecausebfluidbretenti
onbmaybbebabcompensatorybresponse,borbthebrenalbsystembmaybbebdysfunctional.bSerumb
sodiumblevelsbarebaffectedbbybmultiplebvariablesbotherbthanbbodybwaterbvolume.
4. Abclientbwithbabdiagnosisbofbliverbcirrhosisbsecondarybtobalcoholbabusebhasbabdistendedbabd
omenbasbabresultbofbfluidbaccumulationbinbhisbperitonealbcavityb(ascites).bWhichbofbthebfollo
wingbpathophysiologicbprocessesbcontributesbtobthisbthirdbspacing?
A) Abnormalbincreasebinbtranscellularbfluidbvolume
B) Increasedbcapillarybcolloidalbosmoticbpressure
C) Polydipsia
D) Impairedbhormonalbcontrolbofbfluidbvolumeb
Ans:b A
Feedback:
Thirdbspacingbrepresentsbtheblossborbtrappingbofbextracellularbfluidb(ECF)binbthebtranscellul
arbspacebandbabconsequentbincreasebinbtranscellularbfluidbvolume.bThebserousbcavitiesbarebp
artbofbthebtranscellularbcompartmentblocatedbinbstrategicbbodybareasbwherebtherebisbcontinu
albmovementbofbbodybstructures—
thebpericardialbsac,bthebperitonealbcavity,bandbthebpleuralbcavity.bPolydipsiabandbincreasedbf
luidbintakebalonebarebinsufficientbtobcausebthirdbspacing,bandbincreasedbcapillarybcolloidalbo
smoticbpressurebwouldbresultbinbincreasedbintracellularbfluidb(ICF).bThebetiologybofbthirdbsp
acingbdoesbnotbnormallybincludebalterationsbinbhormonalbcontrolbofbfluidbbalance.
5. Ab2-week-oldbinfantb(full-
termbatbbirth)bisbadmittedbtobthebpediatricsbunitbwithb“spittingbupblargebamountsbofbformul
a”bandbdiarrhea.bThebinfantbhasbdevelopedbabweakbsuckbreflex.bWhichbofbthebfollowingbs
tatementsbaboutbtotalbbodybwaterb(TBW)bisbaccuratebinbthisbsituation?
A) Aboutb52%bofbthebinfants'bweightbaccountsbforbthebamountbofbwaterbinbtheirbbody.
B) Becausebofbthebinfants'bhigherbfatbratio,bonebshouldbanticipatebanbincreasedbTBWbtoba
sbhighbasb90%.
C) Mostbfull-
termbinfantsbhavebabTBWbofbapproximatelyb75%bduebtobtheirbhighbmetabolicbr
ate.
D) Mostbofbanbinfant'sbTBWbremainsbinbthebICFbcompartment,bsobtheybshouldbbebablebt
obtransferbneededbwaterbintobthebECFbspace.
Ans:b C
Pageb2
, Feedback:
InfantsbnormallybhavebmorebTBWbthanbolderbchildrenborbadults.bTBWbconstitutesbapproxi
matelyb75%btob80%bofbbodybweightbinbfull-
termbinfantsbandbanbevenbgreaterbpercentagebinbprematurebinfants.bInbmales,bthebTBWbdecr
easesbinbthebelderlybpopulationbtobapproximatelyb52%bTBW.bObesitybdecreasesbTBW,bwit
hblevelsbasblowbasb30%btob40%bofbbodybweightbinbadults.bInfantsbhavebmorebthanbhalfbofbthei
rbTBWbinbtheirbECFbcompartment,basbcomparedbtobadults.
6. Abclientbdiagnosedbwithbschizophreniabhasbbeenbadmittedbtobthebemergencybdepartmentb(
ED)bafterbingestingbmorebthanb2bgallonsbofbwaterbinbonebsitting.bWhichbofbthebfollowingbpa
thophysiologicbprocessesbmaybresultbfrombthebsuddenbwaterbgain?
A) Hypernatremia
B) Waterbmovementbfrombthebextracellularbtobthebintracellularbcompartment
C) SyndromebofbinappropriatebsecretionbofbADHb(SIADH)
D) Isotonicbfluidbexcessbinbthebextracellularbfluidbcompartmentb
Ans:b B
Feedback:
Excessbwaterbingestionbcoupledbwithbimpairedbwaterbexcretionb(orbrapidbingestionbatbabrate
bthatbexceedsbrenal bexcretion)binbpersonsbwithbpsychogenicbpolydipsiabcanbleadbtobwaterbin
toxicationb(hyponatremia).bAbdisproportionatebgainbofbwaterbwithbnobaccompanyingbgainbi
nbsodiumbresultsbinbthebmovementbofbwaterbfrombthebextracellularbtobthebintracellularbcomp
artment.bHyponatremiabaccompaniesbthisbprocess.bBecausebofbtheblackbofbsodiumbincrease
,baccumulatedbfluidbisbhypotonic,bnotbisotonic.bSIADHbisbnotbabconsequencebofbexcessbwat
erbintake.
7. Abnursebcaringbforbabclientbwithbabdiagnosisbofbdiabetesbinsipidusb(DI)bshouldbprioritizebt
hebclosebmonitoringbofbwhichbofbthebfollowingbelectrolyteblevels?
A) Potassium
B) Sodium
C) Magnesium
D) Calciumb
Ans:b B
Feedback:
Thebhighbwaterbintakebandbhighburineboutputbthatbcharacterizebdiabetesbinsipidusbcreatebabris
kbofbsodiumbimbalance.bDIbmaybpresentbwithbhypernatremiabandbdehydration,bespeciallybi
nbpersonsbwithoutbfreebaccessbtobwater,borbwithbdamagebtobthebhypothalamicbthirstbcenterba
ndbalteredbthirstbsensation.
Pageb3
, 8. Thebsyndromebofbinappropriatebantidiureticbhormoneb(SIADH)bisbcharacterizedbby:
A) Increasedbosmolalityblevelbofb360bmOsm/kg
B) Excessivebthirstbwithbfluidbintakebofb7000bmL/day
C) Copiousbdiluteburinationbwithboutputbofb5000bmL/day
D) Lowbserumbsodiumblevelbofb122bmEq/Lb
Ans:b D
Feedback:
SIADHbresultsbfrombabfailurebofbthebnegativebfeedbackbsystembthatbregulatesbthebreleaseban
dbinhibitionbofbantidiureticbhormoneb(ADH).bADHbsecretionbcontinuesbevenbwhenbserumb
osmolalitybisbdecreased,bcausingbwaterbretentionbandbdilutionalbhyponatremia.
Diabetesbinsipidus,bdeficiencyborbdecreasedbresponsebtobADH,bisbcharacterizedbbybincreas
edbserumbosmolality,bexcessivebthirst,bandbpolyuria.bUrineboutputbdecreasesbinbSIADHbdesp
itebadequateborbincreasedbfluidbintake.
9. Inbisotonicbfluidbvolumebdeficit,bchangesbinbtotalbbodybwaterbarebaccompaniedbby:
A) Intravascularbhypotonicity
B) Increasedbintravascularbwater
C) Increasesbinbintracellularbsodium
D) Proportionateblossesbofbsodiumb
Ans:b D
Feedback:
Isotonicbfluidbvolumebdeficitbcausesbabproportionateblossbofbsodiumbandbwater.bHypotonici
tybresultsbfrombwaterbretentionborbsodiumbloss.bIncreasedbintravascularbwaterbcausesbsodiu
mbtobmovebintobthebcellbexcessively.
10. Abclientbwithbabhistorybofbheartbandbkidneybfailurebisbbroughtbtobthebemergencybdepartme
nt.bUponbassessment/diagnosis,bitbisbdeterminedbthebclientbisbinbdecompensatedbheartbfailu
re.bOfbthebfollowingbassessmentbfindings,bwhichbarebassociatedbwithbexcessbintracellularb
water?bSelectballbthatbapply.
A) Lethargy
B) Confusion
C) Hyperactivebdeepbtendonbreflexes
D) Seizures
E) Firm,brubberybtissuebwhenbpalpatingblowerbextremitiesb
Ans:b A,bB,bD
Pageb4
b b b b b
1. Abclientbdevelopsbinterstitialbedemabasbabresultbofbdecreased:
A) Vascularbvolume
B) Hydrostaticbpressure
C) Capillarybpermeability
D) Colloidalbosmoticbpressureb
Ans:b D
Feedback:
Edemabcanbbebdefinedbasbpalpablebswellingbproducedbbybanbincreasedbinterstitialbfluidbvol
ume.bThebphysiologicbmechanismsbthatbcontributebtobedemabformationbincludebfactorsbthatb
(1)bincreasebcapillarybfiltrationb(hydrostatic)bpressure,b(2)bdecreasebthebcapillarybcolloidbos
moticbpressure,b(3)bincreasebcapillarybpermeability,borb(4)bproducebobstructionbtoblymphbfl
ow.
2. Abclientbhasbbeenbreceivingbintravenousbnormalbsalinebatbabratebofb125bmL/hourbsincebherbs
urgeryb2bdaysbearlier.bAsbabresult,bshebhasbdevelopedbanbincreasebinbvascularbvolumebandbed
ema.bWhichbofbthebfollowingbphenomenabaccountsbforbthisbclient'sbedema?
A) Obstructionbofblymphbflow
B) Increasedbcapillarybpermeability
C) Decreasedbcapillarybcolloidalbosmoticbpressure
D) Increasedbcapillarybfiltrationbpressureb
Ans:b D
Feedback:
Anbincreasebinbvascularbvolumebresultsbinbanbincreasebinbcapillarybfiltrationbpressure.bCons
equently,bmovementbofbvascularbfluidbintobthebinterstitialbspacesbincreasesbandbedemabensu
es.bAnbincreasebinbvascularbvolumebdoesbnotbdirectlybresultbinbobstructionbofblymphbflow,bin
creasedbcapillarybpermeability,borbdecreasedbcapillarybcolloidalbosmoticbpressure.
3. Thebmostbreliablebmethodbforbmeasuringbbodybwaterborbfluidbvolumebincreasebisbbyba
ssessing:
A) Tissuebturgor
B) Intakebandboutput
C) Bodybweightbchange
D) Serumbsodiumblevelsb
Ans:b C
Pageb1
, Feedback:
Dailybweightsbarebabreliablebindexbofbwaterbvolumebgainb(1bLbofbwaterbweighsb2.2bpound
s).bDailybweightbmeasurementsbtakenbatbthebsamebtimebeachbdaybwithbthebsamebamountbo
fbclothingbprovidebabusefulbindexbofbwaterbgainbduebtobedema.bWhenbanbunbalancedbdistr
ibutionbofbbodybwaterbexistsbinbthebtissuesbandborgans,bassessmentbofbsurfacebskinbtissueb
turgorbwillbbebinaccurate.bMeasurementbofbrenalboutputbisbunreliablebbecausebfluidbretenti
onbmaybbebabcompensatorybresponse,borbthebrenalbsystembmaybbebdysfunctional.bSerumb
sodiumblevelsbarebaffectedbbybmultiplebvariablesbotherbthanbbodybwaterbvolume.
4. Abclientbwithbabdiagnosisbofbliverbcirrhosisbsecondarybtobalcoholbabusebhasbabdistendedbabd
omenbasbabresultbofbfluidbaccumulationbinbhisbperitonealbcavityb(ascites).bWhichbofbthebfollo
wingbpathophysiologicbprocessesbcontributesbtobthisbthirdbspacing?
A) Abnormalbincreasebinbtranscellularbfluidbvolume
B) Increasedbcapillarybcolloidalbosmoticbpressure
C) Polydipsia
D) Impairedbhormonalbcontrolbofbfluidbvolumeb
Ans:b A
Feedback:
Thirdbspacingbrepresentsbtheblossborbtrappingbofbextracellularbfluidb(ECF)binbthebtranscellul
arbspacebandbabconsequentbincreasebinbtranscellularbfluidbvolume.bThebserousbcavitiesbarebp
artbofbthebtranscellularbcompartmentblocatedbinbstrategicbbodybareasbwherebtherebisbcontinu
albmovementbofbbodybstructures—
thebpericardialbsac,bthebperitonealbcavity,bandbthebpleuralbcavity.bPolydipsiabandbincreasedbf
luidbintakebalonebarebinsufficientbtobcausebthirdbspacing,bandbincreasedbcapillarybcolloidalbo
smoticbpressurebwouldbresultbinbincreasedbintracellularbfluidb(ICF).bThebetiologybofbthirdbsp
acingbdoesbnotbnormallybincludebalterationsbinbhormonalbcontrolbofbfluidbbalance.
5. Ab2-week-oldbinfantb(full-
termbatbbirth)bisbadmittedbtobthebpediatricsbunitbwithb“spittingbupblargebamountsbofbformul
a”bandbdiarrhea.bThebinfantbhasbdevelopedbabweakbsuckbreflex.bWhichbofbthebfollowingbs
tatementsbaboutbtotalbbodybwaterb(TBW)bisbaccuratebinbthisbsituation?
A) Aboutb52%bofbthebinfants'bweightbaccountsbforbthebamountbofbwaterbinbtheirbbody.
B) Becausebofbthebinfants'bhigherbfatbratio,bonebshouldbanticipatebanbincreasedbTBWbtoba
sbhighbasb90%.
C) Mostbfull-
termbinfantsbhavebabTBWbofbapproximatelyb75%bduebtobtheirbhighbmetabolicbr
ate.
D) Mostbofbanbinfant'sbTBWbremainsbinbthebICFbcompartment,bsobtheybshouldbbebablebt
obtransferbneededbwaterbintobthebECFbspace.
Ans:b C
Pageb2
, Feedback:
InfantsbnormallybhavebmorebTBWbthanbolderbchildrenborbadults.bTBWbconstitutesbapproxi
matelyb75%btob80%bofbbodybweightbinbfull-
termbinfantsbandbanbevenbgreaterbpercentagebinbprematurebinfants.bInbmales,bthebTBWbdecr
easesbinbthebelderlybpopulationbtobapproximatelyb52%bTBW.bObesitybdecreasesbTBW,bwit
hblevelsbasblowbasb30%btob40%bofbbodybweightbinbadults.bInfantsbhavebmorebthanbhalfbofbthei
rbTBWbinbtheirbECFbcompartment,basbcomparedbtobadults.
6. Abclientbdiagnosedbwithbschizophreniabhasbbeenbadmittedbtobthebemergencybdepartmentb(
ED)bafterbingestingbmorebthanb2bgallonsbofbwaterbinbonebsitting.bWhichbofbthebfollowingbpa
thophysiologicbprocessesbmaybresultbfrombthebsuddenbwaterbgain?
A) Hypernatremia
B) Waterbmovementbfrombthebextracellularbtobthebintracellularbcompartment
C) SyndromebofbinappropriatebsecretionbofbADHb(SIADH)
D) Isotonicbfluidbexcessbinbthebextracellularbfluidbcompartmentb
Ans:b B
Feedback:
Excessbwaterbingestionbcoupledbwithbimpairedbwaterbexcretionb(orbrapidbingestionbatbabrate
bthatbexceedsbrenal bexcretion)binbpersonsbwithbpsychogenicbpolydipsiabcanbleadbtobwaterbin
toxicationb(hyponatremia).bAbdisproportionatebgainbofbwaterbwithbnobaccompanyingbgainbi
nbsodiumbresultsbinbthebmovementbofbwaterbfrombthebextracellularbtobthebintracellularbcomp
artment.bHyponatremiabaccompaniesbthisbprocess.bBecausebofbtheblackbofbsodiumbincrease
,baccumulatedbfluidbisbhypotonic,bnotbisotonic.bSIADHbisbnotbabconsequencebofbexcessbwat
erbintake.
7. Abnursebcaringbforbabclientbwithbabdiagnosisbofbdiabetesbinsipidusb(DI)bshouldbprioritizebt
hebclosebmonitoringbofbwhichbofbthebfollowingbelectrolyteblevels?
A) Potassium
B) Sodium
C) Magnesium
D) Calciumb
Ans:b B
Feedback:
Thebhighbwaterbintakebandbhighburineboutputbthatbcharacterizebdiabetesbinsipidusbcreatebabris
kbofbsodiumbimbalance.bDIbmaybpresentbwithbhypernatremiabandbdehydration,bespeciallybi
nbpersonsbwithoutbfreebaccessbtobwater,borbwithbdamagebtobthebhypothalamicbthirstbcenterba
ndbalteredbthirstbsensation.
Pageb3
, 8. Thebsyndromebofbinappropriatebantidiureticbhormoneb(SIADH)bisbcharacterizedbby:
A) Increasedbosmolalityblevelbofb360bmOsm/kg
B) Excessivebthirstbwithbfluidbintakebofb7000bmL/day
C) Copiousbdiluteburinationbwithboutputbofb5000bmL/day
D) Lowbserumbsodiumblevelbofb122bmEq/Lb
Ans:b D
Feedback:
SIADHbresultsbfrombabfailurebofbthebnegativebfeedbackbsystembthatbregulatesbthebreleaseban
dbinhibitionbofbantidiureticbhormoneb(ADH).bADHbsecretionbcontinuesbevenbwhenbserumb
osmolalitybisbdecreased,bcausingbwaterbretentionbandbdilutionalbhyponatremia.
Diabetesbinsipidus,bdeficiencyborbdecreasedbresponsebtobADH,bisbcharacterizedbbybincreas
edbserumbosmolality,bexcessivebthirst,bandbpolyuria.bUrineboutputbdecreasesbinbSIADHbdesp
itebadequateborbincreasedbfluidbintake.
9. Inbisotonicbfluidbvolumebdeficit,bchangesbinbtotalbbodybwaterbarebaccompaniedbby:
A) Intravascularbhypotonicity
B) Increasedbintravascularbwater
C) Increasesbinbintracellularbsodium
D) Proportionateblossesbofbsodiumb
Ans:b D
Feedback:
Isotonicbfluidbvolumebdeficitbcausesbabproportionateblossbofbsodiumbandbwater.bHypotonici
tybresultsbfrombwaterbretentionborbsodiumbloss.bIncreasedbintravascularbwaterbcausesbsodiu
mbtobmovebintobthebcellbexcessively.
10. Abclientbwithbabhistorybofbheartbandbkidneybfailurebisbbroughtbtobthebemergencybdepartme
nt.bUponbassessment/diagnosis,bitbisbdeterminedbthebclientbisbinbdecompensatedbheartbfailu
re.bOfbthebfollowingbassessmentbfindings,bwhichbarebassociatedbwithbexcessbintracellularb
water?bSelectballbthatbapply.
A) Lethargy
B) Confusion
C) Hyperactivebdeepbtendonbreflexes
D) Seizures
E) Firm,brubberybtissuebwhenbpalpatingblowerbextremitiesb
Ans:b A,bB,bD
Pageb4
