Fluid Volume Imbalances Homework 2

Homework #2 1. Fill in the table with assessment findings of fluid volume imbalances: Fluid Volume Deficit (FVD) Fluid Volume Excess (FVE) Dizziness or Orthostatic Hypotension Edema on upper and lower extremities Lethargy Shortness of Breath Dry Mouth or Skin High Blood Pressure Thirst or Nausea Abdominal Distention or cramping Low Blood Pressure Headache 2. Fill in the table with lab results of fluid volume imbalances: Lab FVD FVE Hct Increased Decreased Serum osmolarity Increased Decreased Urine specific gravity Increased Decreased Serum sodium Increased Abnormally Decreased Abnormally Electrolytes, BUN, CR Increased Decreased 3. Identify whether the following statements are true (T) or false (F) Homework #2 a._____ A patient with consistent dietary intake who loses 1 kg of weight in 1 day has lost 500 mls of fluid. F b._____ Major tissue damage that causes release of intracellular electrolytes into extracellular fluid will cause hypernatremia. T c._____ A cell surrounded by a hypo-osmolar fluid will shrink and die as water moves out of the cell. F d._____ Third spacing refers to the abnormal movement of fluid into nonfunctional spaces. T e._____ The primary hypothalamic mechanism of water intake is thirst. T f._____ Monitoring weight is considered more accurate than monitoring intake and output. T 4. Aldosterone is secreted by the adrenal cortex in response to : a._____ Excessive water intake b._____ Loss of serum potassium c._____ Increased release of renin d._____ Increased serum osmolality. Correct 5. A patient at risk for hypernatremia is one who: a._____ Has a deficiency of aldosterone b._____ Has prolonged vomiting and diarrhea c._____ Receives excessive 5% dextrose (D5W) solution intravenously d.____Has impaired consciousness and decreased thirst sensitivity. Correct Homework #2 6. Symptoms of sodium imbalances are primarily manifested through altered: a._____ Kidney function b._____ Cardiovascular function c._____ Neuromuscular function d._____ Central nervous system function - Correct 7. Match the electrolyte imbalances with their primary associated causes (answers may be used more than once) 4 Metabolic alkalosis 1. Hypernatremia 6 Parathyroidectomy 2. Hypocalcemia 1 Diabetes insipidus 3. Hypermagnesemia 7&8 Chronic alcoholism 4. Hypokalemia 6 Prolonged immobilization 5. Hyperphosphatemia 5 Fleet’s enemas 6. Hypercalcemia 3 Milk of Magnesia use in renal failure 7. Hypomagnesemia 2 Vitamin D deficiency 8. Hyponatremia 8. A patient with chronic kidney disease has hyperphosphatemia. A commonly associated electrolyte imbalance is: a._____ Hypokalemia Homework #2 b._____ Hyponatremia c._____ Hypocalcemia- Correct d._____ Hypomagnesemia 9. Match the acid-base imbalances with their common causes (answers may be used more than once) 4 Prolonged vomiting 1. Respiratory acidosis 3 Renal failure 2. Respiratory alkalosis 2 Response to anxiety, fear, and pain 3. Metabolic acidosis 1 Respiratory failure 4. Metabolic alkalosis 4 Baking soda use as antacid 4 Diabetic ketosis 1 Sedative or opioid overdose 10. Identify and describe the compensatory mechanism that occurs in each of the following: a) Respiratory acidosis: Respiratory Acidosis is usually a result of failure of ventilation and the accumulation of carbon dioxide. Cellular Buffering which is plasma protein usually occurs which elevates the bicarbonate in the blood or there is renal compensation which is excretion of carbonic acid which allows the reabsorption of bicarbonate into the blood. b) Metabolic acidosis: Metabolic Acidosis occurs when the acid produced or ingested by the body is elevated. The body will begin to increase the absorption of hydrogen ions which proteins and carbonate from the bone. Homework #2 c) Metabolic alkalosis: Metabolic Alkalosis occurs when there is an increase in bicarbonate in the body, usually caused by excessive vomiting. The respiratory response to metabolic alkalosis is usually hypoventilation. 11. A client who has been diagnosed with acute renal failure has an intake of 2,000 mL and a urine output of 200 mL for the past 24 hours. Which assessment by the nurse is most important? a._____ Palpate peripheral pulses b._____ Auscultate breath sounds- Correct c._____ Check urine specific gravity d._____ Monitor blood urea nitrogen and creatinine 12. Fill in the table with standard lab values: Sodium 136-145 mEq/L Potassium 3.5-5.0 mEq/L Chloride 98-106 mEq/L BUN 10-20 mg/dL Creatinine M – 0.6-1.2 mg/dL F – 0.5-1.1 mg/dL Magnesium 1.3-2.1 mg/dL Calcium 9-10.5 mg/dL Phosphorus 3.0-4.5 mg/dL 13. An older adult client is admitted to the hospital with a history of intractable vomiting for 3 days. During the admission interview, the nurse notes that the client is confused. Which Homework #2 fluid, electrolyte, and acid-base imbalances are most likely affecting the client? (Select all that apply) a._____ Hyponatremia- correct b._____ Hypernatremia c._____ Respiratory acidosis d._____ Metabolic alkalosis e._____ Fluid volume excess f._____ Fluid volume deficit- correct 14. A nurse assessing a client who experienced a seizure during a water-drinking contest should associate the client’s seizure with which electrolyte imbalance? a._____ Hyponatremia related to actual decrease in sodium- correct b._____ Hyponatremia related to relative decrease in sodium c._____ Hypernatremia related to actual increase in sodium d._____ Hypernatremia related to relative increase in sodium 15. A nurse is caring for a client who has been diagnosed with uncompensated respiratory acidosis secondary to hypoxia. When reviewing this client’s laboratory data, which value should the nurse anticipate? a._____ Increased pH b._____ Increased PaCO2- correct Homework #2 c._____ Decreased HCO3- d._____ Decreased serum calcium level 16. Fill in the table with food sources of the following electrolytes: (at least 4) Sodium Aged Cheese, Salmon or Fish, Dried Sunflower Seeds, Clams or Shrimp, Tomato Sauce, Beets, Celery, Carrots, Spinach, Red Meat Potassium Lentil, Potatoes, Avocado, Salmon, Coconut Water, Yogurt, Banana, Watermelon, Sweet Potatoes, Nuts, Prunes & Dates Calcium Seeds, Cheese, Yogurt, Sardines, Almonds, Whey Protein found in milk, Dark leafy greens (spinach and kale)