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Questions and Answers
What is the primary reason women have less total body water compared to men?
Which of the following factors does NOT affect water needs?
What percentage of total body water do older adults typically have?
What is the correct distribution of water in the extracellular fluid compartment?
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Which of the following is considered a sensible loss of water?
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What is the main function of aldosterone in fluid balance regulation?
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Which component of the fluid balance system is responsible for regulating the release of antidiuretic hormone (ADH)?
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Which of the following compartments contains the majority of water in adults?
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What triggers the secretion of renin in the kidneys?
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Passive transport in the body primarily involves which of the following processes?
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Which mechanism requires cellular energy to move substances against their concentration gradient?
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Which of the following is NOT a common cause of fluid volume deficit?
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What is the most accurate method for assessing daily fluid loss in a patient?
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Which clinical manifestation indicates a late sign of fluid volume deficit?
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What is the primary intervention for managing a patient with fluid volume deficit due to diarrhea?
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Which of the following is NOT a common cause of fluid volume excess?
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What is a late symptom of fluid volume excess?
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Which intervention is essential for managing fluid volume excess?
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Which of the following electrolyte functions contributes to fluid balance?
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What lab value change is expected in fluid volume excess due to medication effects?
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Which symptom is NOT commonly associated with potassium deficiency?
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Which of the following is a common cause of hypokalemia?
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What is the recommended daily allowance (RDA) for potassium?
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How does stress-activated aldosterone affect potassium levels?
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Which food group is the BEST source of potassium?
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What is the primary role of chloride in the body?
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What causes hypochloremia?
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Which statement about calcium is incorrect?
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Hyperchloremia can typically be precipitated by which condition?
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What is the recommended dietary allowance (RDA) for chloride?
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Which symptom is most commonly associated with hyperkalemia?
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What is a critical consideration when administering IV potassium?
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Which condition is NOT a potential cause of hyperkalemia?
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Which treatment option for hyperkalemia is administered non-emergently?
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What dietary modifications should be made to help manage potassium levels?
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Which of the following conditions is NOT a cause of hypocalcemia?
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Which symptom is commonly associated with severe hypocalcemia?
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What is the primary function of parathyroid hormone (PTH) in the body?
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Which treatment method should NEVER be utilized for calcium administration?
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Which of the following dietary sources provides the highest calcium levels?
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What is a common clinical manifestation of hypo-natremia?
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Which of the following is a potential cause of hyper-natremia?
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What intervention is important for managing hypo-natremia?
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In the context of sodium regulation, what role does aldosterone play?
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Which of the following foods should be avoided to help manage hyper-natremia?
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What is a significant risk associated with hyper-cortisolism in sodium regulation?
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Which of the following interventions is essential when addressing hyper-natremia?
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What is the normal sodium serum level range for an adult?
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What is the Recommended Dietary Allowance (RDA) for phosphorus?
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Which of the following is a major function of phosphorus in the body?
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What symptom is most likely associated with hypophosphatemia?
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What is a common cause of hyperphosphatemia?
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Which food source is primarily associated with high phosphorus content?
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Study Notes
Water
- Transportation of nutrients and waste products
- Medium for chemical reactions
- Lubricant
- Maintenance of body’s acid-base balance
- Heat regulation through evaporation
- Water needs vary by age, gender, activity level and body composition
- Infants have a larger proportion of extracellular fluid than adults
- Older adults have less overall total body water and are more susceptible to fluid shifts
- Sources of water gain: food, liquids and water produced by metabolism
- Sources of water loss: insensible (lungs, sweat, stool), sensible (urine)
Fluid Compartments
- Intracellular fluid (ICF): fluid within cells, largest compartment
- Extracellular fluid (ECF): fluid outside the cells, further divided into intravascular and interstitial fluid.
- Intravascular: plasma within blood vessels
- Interstitial: Fluid between tissues
Regulation of Fluid Balance
- Thirst mechanism: controlled by the hypothalamus
- Kidneys: filter blood at a rate of 125 ml/min or 180 L/day, excrete 1-2 liters of urine/day, secrete renin
- Lungs: regulate CO2 levels and water vapor
- Skin: regulates fluid loss through sweat
- Hormonal regulation:
- ADH (Antidiuretic Hormone)
- Secreted by the posterior pituitary gland
- Released when water levels or blood pressure are low, or sodium is high
- Stimulates the kidneys to conserve water
- Renin-Angiotensin-Aldosterone System (RAAS)
- Renin: an enzyme secreted by the kidneys
- Triggers the release of aldosterone
- Aldosterone: secreted by the adrenal cortex, reduces sodium excretion to conserve water and increase blood pressure
- ADH (Antidiuretic Hormone)
Transport
- Passive transport: does not require energy
- Diffusion: movement of particles from an area of high concentration to low, resulting in equal distribution
- Filtration: movement of fluid from an area of higher pressure to lower pressure
- Osmosis: movement of water from an area of low concentration to high, resulting in equal distribution
- Active transport: requires cellular energy to move substances from low concentration to high, regardless of charges.
- Movement of Sodium, Potassium, Calcium, Iron, Hydrogen, Amino Acids, Glucose
Fluid Volume Deficit (Hypovolemia/Dehydration)
- Causes: Diarrhea, Vomiting, Excessive Sweating, High Fever, Increased urine output, decreased IV hydration
- Signs and symptoms: Decreased urination, dry mucous membranes, thirst, cool hands and feet, sudden weight loss, decreased pulse pressure, decreased skin turgor, depressed fontanelles in infants
- Late signs: Hypotension, Tachycardia, Tachypnea
- Interventions: Find and correct the cause, Replace fluids
Fluid Volume Excess/Hypervolemia/Fluid Volume Overload
- Causes: Congestive heart failure (CHF), excess fluid intake, excessive sodium intake, impaired kidney function, cirrhosis
- Symptoms: Sudden weight gain, edema, wheezing, dry cough, periorbital edema, headache, crackles, and water intoxication.
- Late symptoms: High blood pressure (HTN), pulmonary edema, wet cough with frothy sputum, increased intracranial pressure (ICP), shortness of breath, and rapid heart rate (tachycardia) and distended jugular veins (JVD).
- Interventions: Monitor sodium intake, I & O, edema, skin turgor, breath sounds, daily weight measurements, monitor for fluid volume deficit
Electrolytes
- Promote neuromuscular irritability
- Maintain fluid balance
- Regulate acid-base balance
Sodium
- RDA: 1500 mg
- Major cation in extracellular fluid
- Deficiency (hyponatremia): caused by sodium loss or water excess, symptoms include headaches, muscle cramps, weakness, low urine specific gravity, nausea, vomiting, abdominal cramps, confusion, disorientation, convulsions, coma, hypotension, and oliguria.
- Toxicity (hypernatremia): caused by sodium excess or water loss, symptoms include intense thirst, edema, high blood pressure (HTN), dry/sticky mucous membranes, decreased urine output, flushed appearance, oliguria, fever, and weakness.
- Interventions for sodium imbalances: Monitor I & O, replace fluid loss with sodium-containing fluids (not plain water!), avoid sodium-rich foods, monitor water losses from fever, infection, increase respiratory rate.
- Key points: Sodium imbalance can affect potassium balance
- Normal serum Sodium Level: 135-145 mEq/L
Potassium
- RDA: 4700 mg/day
- Functions: Regulation of water and electrolyte content within cells, Acid-base balance, nerve impulse transmission, regulating heartbeat, insulin release, protein synthesis, glucose use and storage.
- Sources: Fruits (orange and yellow), vegetables, tea, raisins, meat
- Deficiency (hypokalemia): caused by renal excretion without conservation, excessive GI losses, diuretics, steroids, medications like Lanoxin, loss from cells due to burns or trauma. Symptoms include lethargy, low blood pressure and heart rate, low shallow respirations, leg cramps, limp muscles, lethal cardiac arrest
- Toxicity (hyperkalemia): caused by renal disease or failure, severe tissue damage releases potassium from cells, foods high in potassium, excess salt substitutes, blood transfusions, metabolic acidosis, potassium-sparing diuretics. Symptoms include muscle weakness, changes in cardiac rhythm (potentially cardiac arrest), tall tented T waves on EKG, confusion, diarrhea, tachycardia followed by bradycardia, muscle twitching, anuria, nausea, diarrhea, colic, paresthesia, flaccid paralysis.
- Treatment for potassium imbalances: Monitor I & O, replace potassium orally or intravenously (diluted), increase dietary intake of potassium-rich foods, monitor electrolyte levels
Magnesium
- Key Points: Hypokalemia may induce digoxin toxicity
- Treatment: Monitor intake and output, replace potassium with oral or IV (diluted), increase dietary intake, monitor electrolyte levels
Chloride
- RDA: equal to Sodium 1500 mg/day
- Major anion of extracellular fluid compartment
- Function: fluid and acid-base balance, hydrochloric acid formation, osmotic pressure maintenance
- Sources: table salt, chlorinated water
- Deficiency (hypochloremia): caused by vomiting, prolonged NG suction or fistula drainage, sodium loss
- Toxicity (hyperchloremia): usually precipitated by dehydration, may occur when bicarbonate levels are low
Calcium
- RDA: 1000- 1200 mg/day
- 99% stored in bones and teeth
- Requires vitamin D for absorption
- Inverse relationship with phosphorus
- Sources: milk, milk products, dark green leafy vegetables
Calcium Deficiency (Hypocalcemia)
- Causes: Infusion of excess citrated blood, inadequate intake, surgical removal/hypoactive parathyroid, pancreatic disease, small bowel disease, excessive GI losses, massive SQ infection, burns, renal failure, lactose intolerance, immobility, thyroidectomy
- Symptoms: rickets, osteoporosis, osteomalacia, positive Chvostek’s sign, positive Trousseau’s sign, poor clotting, neuromuscular excitability and tetany, diarrhea, ECG changes, tachycardia, anxiety, psychosis
- Treatment: Oral calcium carbonate, IV calcium gluconate, calcium-rich foods and supplements
Phosphorus
- RDA: 700 mg/day
- Chiefly intracellular anion
- 85% in bones and teeth
- Inverse relationship with Calcium
- Requires adequate Vitamin D for absorption
- Functions: Health of bones and teeth, Buffer in acid-base balance, metabolism of CHO, protein, and fat, Activation of B complex vitamins, Formation/activation of ATP
- Sources: Milk/milk products, meat, CHO portion of carbonated beverages
Phosphorus Deficiency (Hypophosphatemia)
- Causes: Dietary insufficiency, Impaired renal function, Excess aluminum-based antacids
- Symptoms: Muscle weakness (especially of the respiratory muscles), pathologic fractures, pain in the long bones, disorientation, diarrhea
- Treatment: Mild: Oral supplements, Severe: IV Phosphorus, Monitor I&O, daily weight, VS q 4hr, assess respiration and breath sounds, seizure precautions, drink 8 oz water every hour to prevent kidney stones
Phosphorus Toxicity (Hyperphosphatemia)
- Causes: Renal insufficiency, increased dietary intake of phosphate or Vitamin D
- Symptoms: Tingling around the nose, tetany
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Description
This quiz covers essential aspects of water in the human body, including its roles, sources, and the regulation of fluid balance. Explore topics such as fluid compartments, the effects of age and activity level on hydration, and how the body maintains hydration through various mechanisms. Test your knowledge on the significance of water in human physiology.
