Electrolyte Imbalances Quiz

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Questions and Answers

What is a potential complication of hypernatremia due to increased serum sodium levels?

Excessive water intake

Decreased osmolality of the blood

Increased fluid retention in the interstitial space

Cellular dehydration (correct)

Which of the following is NOT a clinical feature associated with hypernatremia?

Thirst

Altered mental status

Fatigue

Muscle spasms (correct)

What management strategy is recommended for mild hypernatremia?

A low-salt diet (correct)

Immediate diuretics

High dose corticosteroids

Intravenous infusion of hypertonic fluids

Hyponatremia is defined as a serum sodium level below what threshold?

135 mEq/L Signup and view all the answers

Which of the following conditions can lead to a high sodium loss, contributing to hyponatremia?

Excessive sweating Signup and view all the answers

What is the primary therapeutic goal in treating electrolyte imbalances?

To correct the electrolyte imbalance Signup and view all the answers

What treatment is appropriate for hypercalcemia?

Hypotonic fluids or calcitonin Signup and view all the answers

Which of the following indicates hyperkalemia?

Greater than 5 mEq/L Signup and view all the answers

What is the normal serum sodium level considered as hyponatremia?

Less than 135 mEq/L Signup and view all the answers

Which ion is associated with a condition requiring hypomagnesemia treatment?

Magnesium Signup and view all the answers

What condition is indicated by a serum chloride level greater than 112 mEq/L?

Hyperchloremia Signup and view all the answers

Which of the following is not a consequence of high sodium levels in the blood?

Decreased blood volume Signup and view all the answers

What should be the initial focus when treating electrolyte imbalances?

Identifying the underlying cause Signup and view all the answers

What is the most serious clinical feature of hyperkalemia?

Heart block Signup and view all the answers

Which dietary source should be restricted to manage mild hyperkalemia?

Dried fruits Signup and view all the answers

What is the definition of hypokalemia?

Serum potassium level below 3.5 mEq/L Signup and view all the answers

Which symptom is most commonly associated with hypokalemia?

Muscle weakness Signup and view all the answers

Which treatment is appropriate for severe hypokalemia?

Provide oral or parenteral potassium supplements Signup and view all the answers

What characterizes acidosis?

pH below 7.35 Signup and view all the answers

Which of the following is a mechanism that helps regulate acid-base balance?

Increase in respiratory rate Signup and view all the answers

What is the potential consequence if acidosis and alkalosis are not treated promptly?

Fatal outcome Signup and view all the answers

What is a respiratory cause of acidosis?

Shallow breathing or hypoventilation Signup and view all the answers

Which of the following is a treatment for metabolic alkalosis?

Administration of ammonium chloride in severe cases Signup and view all the answers

What is a symptom associated with metabolic acidosis?

Deep, rapid respirations (Kussmaul breathing) Signup and view all the answers

Which nursing assessment is crucial before administering potassium?

Assess ECG Signup and view all the answers

What condition can result from an excessive intake of sodium bicarbonate?

Metabolic alkalosis Signup and view all the answers

What monitoring is essential during IV potassium infusion?

Ensure infusion is given at a rate not exceeding 10 mEq/hr Signup and view all the answers

Which of the following can indicate respiratory alkalosis?

Hyperventilation due to anxiety Signup and view all the answers

Which symptom indicates a central nervous system stimulation due to alkalosis?

Nervousness and hyperactive reflexes Signup and view all the answers

For what is monitoring serum electrolyte levels important during therapy?

To evaluate therapeutic response and prevent imbalances Signup and view all the answers

What is the best method to monitor for signs of transfusion reactions?

Following blood administration procedures closely Signup and view all the answers

What is the primary indication for using isotonic crystalloids?

Expanding plasma volume in low blood pressure scenarios Signup and view all the answers

Which statement best describes hypertonic crystalloids?

They draw water into the intravascular space, relieving cellular edema. Signup and view all the answers

What effect do hypotonic crystalloids typically have on the body?

They can lead to hypotension due to intravascular depletion. Signup and view all the answers

What is a common adverse effect of isotonic crystalloids?

Fluid overload Signup and view all the answers

Colloids are primarily used for which condition?

Hypovolemic shock Signup and view all the answers

What is a characteristic of blood products compared to crystalloids and colloids?

They require human donors. Signup and view all the answers

Which blood product is indicated for increasing clotting factor levels?

Fresh frozen plasma Signup and view all the answers

What is a serious potential adverse effect of colloid administration?

Altered coagulation Signup and view all the answers

Which electrolyte imbalance is commonly associated with renal impairment?

Hyperkalemia Signup and view all the answers

How do sodium bicarbonate and sodium sulfate differ?

Sodium sulfate has a higher charge than sodium bicarbonate. Signup and view all the answers

What is the primary mechanism of action for hypertonic crystalloids?

Infusion leads to dehydration of cells. Signup and view all the answers

What is one key feature of blood products?

They can cause transfusion reactions. Signup and view all the answers

What is a serious risk associated with dextran therapy?

Anaphylaxis Signup and view all the answers

What percentage of total body weight does water constitute in a middle-aged adult?

60% Signup and view all the answers

Which hormone is primarily responsible for regulating sodium levels in the body?

Aldosterone Signup and view all the answers

What is the normal range for osmolality in mOsm/kg?

275–295 Signup and view all the answers

What happens when hypertonic intravenous fluid is administered?

Water moves from interstitial space to plasma Signup and view all the answers

Which of the following is a primary regulator of fluid output?

Kidneys Signup and view all the answers

What type of fluids are crystalloids?

IV solutions with electrolytes Signup and view all the answers

What is the role of the renin–angiotensin-aldosterone system?

Regulates fluid output Signup and view all the answers

Which IV solution has a hypertonic effect when administered?

Hypertonic saline (3% NaCl) Signup and view all the answers

What is the greatest contributor to changes in osmolality?

Sodium Signup and view all the answers

What bodily condition can deficient fluid balance disorders lead to?

Dehydration Signup and view all the answers

In which scenario would IV fluid therapy be indicated?

To support blood pressure during dehydration Signup and view all the answers

What primarily drives the thirst mechanism in the body?

Osmolality changes Signup and view all the answers

What is isotonic intravenous fluid characterized by?

No fluid shift occurs Signup and view all the answers

Which type of IV solution is designed to replace lost fluids and promote urine output?

Crystalloids Signup and view all the answers

What is the pharmacotherapy approach commonly used to correct hypokalemia?

Providing oral or intravenous potassium supplementation Signup and view all the answers

Which condition is most likely to result from laxative misuse, as seen in the case of Sandy?

Hypokalemia Signup and view all the answers

Which nursing action is essential when managing fluid and electrolyte imbalances?

Monitoring serum electrolyte levels regularly Signup and view all the answers

What common cause may lead to metabolic alkalosis that a nurse should recognize?

Chronic use of antacids Signup and view all the answers

What is the primary role of intravenous fluid therapy in treating acid-base disorders?

To restore fluid balance and facilitate the correction of pH Signup and view all the answers

What physiological effect does elevated serum sodium have on the body's cells?

Dehydrates cells by drawing fluid from them Signup and view all the answers

Which clinical feature is NOT typically associated with hypernatremia?

Abdominal cramping Signup and view all the answers

What management strategy is recommended for treating acute hypernatremia in a hypovolemic patient?

Intravenous infusion of hypotonic fluids Signup and view all the answers

What is a common cause of hyponatremia related to renal function?

Advanced kidney disease leading to sodium loss Signup and view all the answers

During management of a patient with mild hypernatremia, which dietary approach is recommended?

A low-salt diet Signup and view all the answers

What should be monitored when administering sodium bicarbonate therapy to patients with cardiac disease?

Arterial blood gas reports Signup and view all the answers

Which of the following is a contraindication for ammonium chloride therapy?

Liver disease Signup and view all the answers

What dilution method is recommended for oral potassium to minimize gastrointestinal distress?

Diluting in water or fruit juice Signup and view all the answers

What is the appropriate rate for intravenous potassium administration in critically ill patients?

20 mEq/hr or more Signup and view all the answers

What electrolyte imbalance is indicated by a potassium level of 2.8 mEq/L?

Hypokalemia Signup and view all the answers

What could be a significant complication of administering ammonium chloride too quickly?

Ammonium toxicity Signup and view all the answers

During assessment, which symptom should a nurse monitor for in a patient taking oral potassium?

Nausea and vomiting Signup and view all the answers

Which electrolyte imbalance is most associated with dehydration?

Hypernatremia Signup and view all the answers

What is a common symptom of hyperkalemia?

Muscle twitching Signup and view all the answers

Which dietary change is recommended for managing mild hypokalemia?

Increase intake of dried fruits Signup and view all the answers

What should be administered in severe hyperkalemia to counteract potassium toxicity on the heart?

Calcium gluconate Signup and view all the answers

What pH value indicates alkalosis?

pH above 7.45 Signup and view all the answers

Which of the following is a cause of hypokalemia?

Strenuous muscle activity Signup and view all the answers

In the management of mild hyperkalemia, which food source should be restricted?

Potatoes Signup and view all the answers

Which symptom is likely to occur due to hypokalemia?

Muscle weakness Signup and view all the answers

What is the critical management action for treating acidosis?

Treating the underlying cause Signup and view all the answers

What is the normal osmolality range in mOsm/kg for a healthy adult?

275–295 mOsm/kg Signup and view all the answers

What primarily regulates fluid intake in the human body?

Thirst mechanism Signup and view all the answers

What occurs when hypotonic intravenous fluid is administered?

Water moves from plasma to interstitial space Signup and view all the answers

Which type of fluid is characterized by its ability to closely mimic the body's extracellular fluid?

Isotonic crystalloids Signup and view all the answers

Which hormone is identified as a key regulator of sodium levels in the body?

Aldosterone Signup and view all the answers

What is the primary function of intravenous fluid therapy?

To replace fluids and electrolytes Signup and view all the answers

What is the main purpose of administering isotonic crystalloids?

To expand plasma volume without major fluid shifts Signup and view all the answers

Which of the following is a common indication for the use of hypertonic crystalloids?

To relieve cerebral oedema Signup and view all the answers

What is a potential consequence of deficient fluid balance disorders?

Dehydration Signup and view all the answers

What is the primary adverse effect associated with hypotonic crystalloids?

Hypotension Signup and view all the answers

What is the definition of tonicity in relation to fluid movement?

The ability of a solution to cause a change in water movement Signup and view all the answers

Which intravenously administered fluid is considered hypertonic?

Hypertonic saline (3% NaCl) Signup and view all the answers

What is the role of 5% albumin as a colloid solution?

To increase osmotic pressure and expand plasma volume Signup and view all the answers

What type of fluid could be used to treat excess fluid balance disorders?

Diuretics Signup and view all the answers

Which of the following is an adverse effect of blood products?

Anaphylaxis Signup and view all the answers

Which of the following is NOT a cause of water and electrolyte loss?

Increased fluid intake Signup and view all the answers

Which IV fluid type is designed to enter the interstitial spaces and intracellular fluid?

Crystalloids Signup and view all the answers

What characterizes the difference between whole blood and packed red blood cells (PRBCs)?

Whole blood includes plasma and is better for extreme loss Signup and view all the answers

What is the primary indicator for administering isotonic crystalloids?

To maintain blood volume Signup and view all the answers

Which electrolyte is essential for nerve conduction and membrane permeability?

Sodium Signup and view all the answers

What fluid shift occurs when hypertonic intravenous fluid is administered?

Water moves from interstitial space to plasma Signup and view all the answers

A common underlying issue associated with electrolyte imbalance is:

Renal impairment Signup and view all the answers

What is an adverse effect specifically associated with dextran therapy?

Anaphylaxis Signup and view all the answers

Which solution is indicated for increasing clotting factor levels in patients?

Fresh frozen plasma Signup and view all the answers

Colloids primarily function by:

Rapidly expanding plasma volume Signup and view all the answers

What is the key safety measure associated with administering blood products?

Crossmatch testing Signup and view all the answers

Study Notes

Drugs for Fluid and Electrolyte Imbalances, and Acid-Base Disorders

Drugs treat imbalances in fluid, electrolytes, and acid-base.
Learning objectives include describing conditions requiring intravenous fluids, explaining sodium and potassium replacement therapies, discussing acidosis/alkalosis causes and treatments, and nurses' roles in pharmacologic management of these imbalances.
A case study highlights Sandy, a 16-year-old, whose low sodium (136 mEq/L) and potassium (2.8 mEq/L) levels, potentially due to a fad diet and laxative use, necessitate assessment and management of electrolyte imbalances.

Body Fluid Compartments

Water comprises ~60% of a middle-aged adult's body weight.
Continuous fluid exchange occurs across semipermeable membranes, between intracellular and extracellular compartments.
Large molecules and less ionized substances cross membranes with difficulty.

Major Fluid Compartments in the Body

Intracellular fluid (25L): Within cells (40% of body weight)
Interstitial fluid (12L): Surrounding cells.
Plasma (3L): Fluid in blood vessels.

Control of Water Balance

Water balance is critical for homeostasis.
Imbalances of body fluids, electrolytes, and acid-base levels often necessitate intravenous (IV) therapy.

Osmolality

Osmolality measures dissolved solutes per kilogram of fluid (~275-295 mOsm/kg).
Common solutes include sodium, glucose, and urea.
Changes in osmolality cause water movement; Sodium is the main contributor and is regulated by aldosterone.

Tonicity

Tonicity describes a solution's ability to cause water movement across a membrane due to osmotic forces.
Plasma tonicity is used as a reference point for IV solutions.

Osmosis

Water moves from areas of low to high osmolality.
Hypertonic IV fluid shifts water from interstitial space to plasma.
Hypotonic IV fluid shifts water from plasma to interstitial space.
Isotonic fluids cause no significant fluid shift.

Movement of Fluids and Solution Tonicity

Isotonic: Equal osmolality; no net fluid movement.
Hypertonic: Higher osmolality; draws water out of cells.
Hypotonic: Lower osmolality; draws water into cells.

Regulation of Fluid Intake & Output

Fluid intake/output is controlled by complex mechanisms.
Thirst primarily regulates fluid intake.
Kidneys, the renin-angiotensin-aldosterone system, and antidiuretic hormone (ADH) regulate fluid output.

Fluid Balance Disorders

Deficient fluid balance (dehydration/shock) necessitates oral/intravenous fluid therapy.
Excess fluid balance (fluid overload) requires diuretics.
Identifying and addressing the underlying cause is paramount in fluid and electrolyte management.

Fluid Replacement Agents

Fluid replacement corrects net fluid loss in the body (dehydration/shock).
Intravenous fluid therapy maintains blood volume and blood pressure.

Intravenous Fluid Therapy

IV fluids replace lost fluids/electrolytes (vomiting, diarrhea, laxatives, extensive sweating, burns, hemorrhage, uncontrolled ketoacidosis).
Crystalloids and colloids are used in IV therapy.

Crystalloids

Crystalloid IV solutions contain electrolytes.
These mimic extracellular fluid (ECF) and help replace depleted fluids and promote urine output.
Tonicity dictates the compartment the fluid enters.

Selected Crystalloid IV Solutions

Crystalloid solutions vary in tonicity.
Normal saline (0.9% NaCl) is isotonic; lactated Ringer's and Plasma-Lyte 148 solutions are also isotonic.
Hypotonic solutions (like 0.45% saline) have lower and hypertonic solutions (like dextrose in water or normal saline) have higher osmolality than plasma.

Isotonic Crystalloids

Isotonic crystalloids expand plasma volume without significant fluid shifts between compartments.
These are primary choices in cases of fluid loss or low blood pressure. Normal saline is the most common choice.

Hypertonic Crystalloids

Hypertonic crystalloids draw water from cells/tissues into vascular compartment.
Indications include treating cellular edema, specifically cerebral edema.

Hypotonic Crystalloids

Hypotonic solutions shift water from plasma to cells and tissues.
Not for expanding plasma volume; use in situations of hypernatremia and cellular dehydration.

Adverse effects of Crystalloids

Isotonic/hypertonic solutions may cause fluid overload.
Hypotonic solutions might cause intravascular volume depletion and can cause hypotension/cellular swelling. This can lead to peripheral edema.

Colloids

Colloids contain large molecules (proteins, starches) that mainly exert their effect in the intravascular space.
They expand plasma volume more quickly due to osmotic pressure, drawing water from interstitial and intracellular spaces into the vascular compartment.
Colloids are used to treat hypovolemia, shock, burns, or hemorrhage.

Selected Colloid Solutions (Plasma Volume Expanders)

Various colloids, like albumin, dextrans, and hetastarch, are used as plasma volume expanders. They generally have isotonic tonicity.

Selected colloid solutions

Normal serum albumin is the most frequent utilized colloid.
Dextran is a synthetic polysaccharide, causing rapid plasma volume expansion.
Hetastarch is a synthetic colloid similar to albumin, exerting effects over a longer period.

Adverse effects of Colloids

Colloids, generally safe, can temporarily alter coagulation; blood-clotting factors should be monitored.
Rare cases of anaphylaxis or kidney problems have occurred.

Blood Products

Blood products are the only fluids that carry oxygen, supporting tissue oxygenation and increasing plasma volume.
Human donors are required, making these fluids the most expensive.

Indications for Blood Products

Cryoprecipitate/plasma protein factors are indicated for acute bleeding (>20% blood loss).
Fresh frozen plasma (FFP) increases clotting factor levels in situations with demonstrated deficiencies.
Packed red blood cells (PRBCs) increase oxygen-carrying capacity in cases of anemia or significant blood loss, up to 25% loss.
Whole blood has the same uses as packed red blood cells, but is beneficial in severe cases of blood loss (more than 25% loss).

Adverse effects of Blood Products

Blood products can induce incompatibility responses with the recipient's immune system.
Crossmatching is critical to avoid transfusion reactions, anaphylaxis, and the transmission of pathogens (e.g., hepatitis, HIV).

Electrolyte Balance

Positively or negatively charged inorganic molecules (electrolytes) are essential for nerve conduction, membrane permeability, water balance, and other bodily functions.

Electrolytes Important to Human Physiology

A table of common cation and anion electrolytes and their formulas is provided for reference.