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Cardiovascular Physiology9th EditionDavid Mohrman, Lois Heller 135 solutions A nurse is reviewing lab reports. The nurse recalls blood plasma is located in which of the following fluid compartments? a. Intracellular fluid (ICF) d. Intravascular fluid Rationale: Blood plasma is the intravascular fluid. ICF is fluid in the cells. ECF is all the fluid outside the cells. Interstitial fluid is fluid between the cells and outside the blood vessels. A 35-year-old male weighs 70 kg. Approximately how much of this weight is ICF? a. 5 L d. 42 L While planning care for elderly individuals, the nurse remembers the elderly are at a higher risk for developing dehydration because they have a(n): a. Higher total body water
volume b. Decreased muscle mass Which of the following patients should the nurse assess for a decreased oncotic pressure in the capillaries? A patient with: a. A high-protein diet b. Liver failure Rationale: Liver failure leads to lost or diminished plasma albumin production, and this contributes to decreased plasma oncotic pressure. Water movement between the ICF and ECF compartments is determined by: a. Osmotic forces a. Osmotic forces An experiment was designed to test the effects of the Starling forces on fluid movement. Which of the following alterations would result in fluid moving into the interstitial space? a. Increased capillary oncotic pressure d. Increased interstitial oncotic pressure When planning care for a dehydrated patient, the nurse remembers the principle of water balance is closely related to _____ balance. a. Potassium d. Sodium Rationale: Because water follows the osmotic gradients established by changes in salt concentration, water balance is tied to sodium balance. A 70-year-old male with chronic renal failure presents with edema. Which of the following is the most likely cause of this condition? a. Increased capillary oncotic pressure c. Increased capillary hydrostatic pressure Rationale: Increased capillary hydrostatic pressure would facilitate increased movement from the capillary to the interstitial space, leading to edema. A 10-year-old male is brought to the emergency room (ER) because he is incoherent and semiconscious. CT scan reveals that he is suffering from cerebral edema. This type of edema is referred to as: a. Localized edema a. Localized edema Rationale: Cerebral edema is a form of localized edema. Generalized edema is manifested by a more uniform distribution of fluid in interstitial spaces. Pitting edema is due to a pit left in the skin. Lymphedema is due to swelling in interstitial spaces, primarily in the extremities. A nurse is teaching the staff about antidiuretic hormone (ADH). Which information should the nurse include? Secretion of ADH is stimulated by: a. Increased serum potassium b. Increased plasma osmolality Which statement by the staff indicates teaching was successful concerning aldosterone? Secretion of aldosterone results in: a. Decreased plasma osmolality c. Increased blood volume Rationale: Aldosterone promotes renal sodium and water reabsorption and excretion of potassium, thus, increasing blood volume. A 25-year-old male is diagnosed with a hormone-secreting tumor of the adrenal cortex. Which finding would the nurse expect to see in the lab results? a. Decreased blood volume b. Decreased blood K+ levels Rationale: Aldosterone is secreted from the adrenal cortex. It promotes renal sodium and water reabsorption and excretion of potassium, leading to decreased potassium levels. A patient has been searching on the Internet about natriuretic hormones. When the patient asks the nurse what do these hormones do, how should the nurse respond? Natriuretic hormones affect the balance of: a. Calcium b. Sodium Rationale: Natriuretic hormones are sometimes called a "third factor" in sodium regulation. A 5-year-old male presents to the ER with delirium and sunken eyes. After diagnosing him with severe dehydration, the primary care provider orders fluid replacement. The nurse administers a hypertonic intravenous solution. Which of the following would be expected? a. Symptoms subside quickly d. Intracellular dehydration A hypertonic solution would cause fluid to move into the extracellular space, leading to intracellular dehydration. Which of the following patients is the most at risk for developing hypernatremia? A patient with: a. Vomiting c. Dehydration Rationale: Dehydration leads to hypernatremia because an increase in sodium occurs with a net loss in water. Vomiting leads to hyponatremia. Diuretic use would lead to sodium loss. Hypoaldosteronism leads to hyponatremia. The most common cause of pure water deficit is: a. Renal water loss a. Renal water loss Rationale: The most common cause of water loss is increased renal clearance of free water as a result of impaired tubular function. Hyperlipidemia and hyperglycemia are associated with: a. Hypernatremia b. Hypertonic hyponatremia A 52-year-old diabetic male presents to the ER with lethargy, confusion, and depressed reflexes. His wife indicates that he does not follow the prescribed diet and takes his medication sporadically. Lab results indicate hyperglycemia. Which assessment finding is most likely to occur? a. Clammy skin b. Decreased sodium Rationale: Hypertonic hyponatremia develops with hyperglycemia. Increases in plasma lipids displace water volume and decrease sodium concentration, leading to the symptoms described. When taking care of a patient with hyperkalemia, which principle is priority? Hyperkalemia causes a(n) _____ in resting membrane potential with _____ excitability of cardiac muscle. a. Increase; increased a. Increase; increased Which of the following patients is most prone to hypochloremia? A patient with: a. Hypernatremia d. Increased bicarbonate intake Rationale: Hypochloremia is the result of elevated bicarbonate concentration, as occurs in metabolic alkalosis. Which of the following conditions would cause the nurse to monitor for hyperkalemia? a.
Excess aldosterone b. Acute acidosis Rationale:In acidosis, ECF hydrogen ions shift into the cells in exchange for ICF potassium and sodium; hyperkalemia and acidosis therefore often occur together. Which organ system should the nurse monitor when the patient has long-term potassium deficits? a. Central nervous system (CNS) c. Kidneys Rationale: Long-term potassium deficits lasting more than 1 month may damage renal tissue, with interstitial fibrosis and tubular atrophy. A 42-year-old female presents to her primary care provider reporting muscle weakness and cardiac abnormalities. Laboratory tests indicate that she is hypokalemic. Which of the following could be the cause of her condition? a. Respiratory acidosis d. Primary hyperaldosteronism Rationale: Primary hyperaldosteronism, with excessive secretion of aldosterone from an adrenal adenoma (tumor) also causes potassium wasting. Acidosis is related to hyperkalemia, not hypokalemia. Constipation can occur with hypokalemia but does not cause it. Hypoglycemia is not related to muscle weakness. A 19-year-old male presents to his primary care provider reporting restlessness, muscle cramping, and diarrhea. Lab tests reveal that he is hyperkalemic. Which of the following could have caused his condition? a. Primary hyperaldosteronism b. Acidosis Rationale: During acute acidosis, hydrogen ions accumulate in the ICF and potassium shifts out of the cell to the ECF, causing hyperkalemia. Primary hyperaldosteronism is associated with hypokalemia, not hyperkalemia. Insulin secretion helps reduce potassium levels in the cell, not cause it. Diuretics would cause hypokalemia, not hyperkalemia. A 60-year-old female is diagnosed with hyperkalemia. Which assessment finding should the nurse expect to observe? a. Weak pulse c. Oliguria Rationale: Hyperkalemia is manifested by oliguria. Hypokalemia is manifested by a weak pulse; it is not caused by hyperkalemia. Hypokalemia is manifested by excessive thirst. Diarrhea, not constipation, is a manifestation of hyperkalemia. Which of the following buffer pairs is considered the major plasma buffering system? a. Protein/fat b. Carbonic acid/bicarbonate Rationale: The carbonic acid/bicarbonate buffer pair operates in both the lung and the kidney and is a major extracellular buffer. A nurse recalls regulation of acid-base balance through removal or retention of volatile acids is accomplished by the: a. Buffer systems c. Lungs Rationale: The volatile acid is carbonic acid (H2CO3), which readily dissociates into carbon dioxide (CO2) and water (H2O). The CO2 is then eliminated by the lungs. Physiologic pH is maintained around 7.4 because carbonic acid and bicarbonate exist in a ratio of: a. 20:1 a. 20:1
Which patient is most prone to metabolic alkalosis? A patient with: a. Retention of metabolic acids c. Excessive loss of chloride (Cl) Rationale: When acid loss is caused by vomiting, renal compensation is not very effective because loss of Cl stimulates renal retention of bicarbonate, leading to alkalosis. Retention of metabolic acids would lead to acidosis, not alkalosis. Hypoaldosteronism leads to hyponatremia and does not cause alkalosis. Hyperventilation leads to respiratory alkalosis, not metabolic alkalosis. Which patient should the nurse assess for both hyperkalemia and metabolic acidosis? A patient diagnosed with: a. Diabetes insipidus d. Renal failure Rationale: Renal failure is associated with hyperkalemia and metabolic acidosis. Diabetes insipidus results in hypernatremia. Pulmonary disorders are a cause of respiratory acidosis or alkalosis but do not affect hyperkalemia. Cushing syndrome results in hypernatremia. For a patient experiencing metabolic acidosis, the body will compensate by: a. Excreting H+ through the kidneys b. Hyperventilating Rationale: In an attempt to compensate for metabolic acidosis, the lungs hyperventilate to blow off CO2. It is the lungs hyperventilating that would compensate for metabolic acidosis, not the kidneys. CO2 retention would increase the acidotic state. Aldosterone would conserve water, but does not help compensate for acidosis.
Which finding would support the diagnosis of respiratory acidosis? a. Vomiting c. Pneumonia Rationale: Respiratory acidosis occurs with hypoventilation, and pneumonia leads to hypoventilation. Vomiting leads to loss of acids and then to alkalosis. Hyperventilation leads to respiratory alkalosis, not acidosis. Metabolic acidosis is caused by an increase in noncarbonic acids. A 54-year-old male with a long history of smoking complains of excessive tiredness, shortness of breath, and overall ill feelings. Lab results reveal decreased pH, increased CO2, and normal bicarbonate ion. These findings help to confirm the diagnosis of: a. Respiratory alkalosis c. Respiratory acidosis Rationale: A decreased pH indicates acidosis. With increased CO2, it is respiratory acidosis. For a patient with respiratory acidosis, chronic compensation by the body will include: a. Kidney excretion of H+ a. Kidney excretion of H+ Rationale: The kidneys excrete H+ to compensate for respiratory acidosis. A 55-year-old female presents to her primary care provider and reports dizziness, confusion, and tingling in the extremities. Blood tests reveal an elevated pH, decreased PCO2, and slightly decreased HCO3. Which of the following is the most likely diagnosis? a. Respiratory alkalosis with renal compensation a. Respiratory alkalosis with renal compensation Rationale: With an elevated pH, the diagnosis must be alkalosis. Since the PCO2 is low, it is likely respiratory with a slight decrease in HCO3 indicating renal compensation. Outcomes of laboratory tests include an elevated level of natriuretic peptides. Which organ is the priority assessment? a.
Lungs B. Heart Rationale: Elevated natriuretic peptides indicate problems with the heart or the vasculature. A 60-year-old male with a 30-year history of smoking is diagnosed with a hormone-secreting lung tumor. Further testing indicates that the tumor secretes ADH. Which of the following assessment findings should the nurse expect? (Select all that apply.) a.
Confusion A, B, C, D Rationale: Secretion of ADH leads to water intoxication with symptoms of cerebral edema, with confusion and convulsions; weakness; nausea; muscle twitching; headache; and weight gain, not loss. The nurse would anticipate the patient with syndrome of inappropriate ADH (SIADH) to demonstrate which of the following symptoms? (Select all that apply.) a. Weakness A, B, C, E Rationale: Weakness, nausea, muscle twitching, headache, and weight gain, not loss, are common symptoms of chronic water accumulation. The interstitial fluid amounts to 12 L how many L of plasma 3L how many L of intracellular fluid 25L facilitates the outward movement of water from the capillary to the interstitial space. Capillary hydrostatic pressure (blood pressure) osmotically attracts water from the interstitial space back into the capillary Capillary (plasma) oncotic pressure facilitates the inward movement of water from the interstitial space into the capillary. Interstitial hydrostatic pressure osmotically attracts water from the capillary into the interstitial space. Interstitial oncotic pressure Accumulation of fluid within the interstitial spaces edema causes of edema ØIncrease in capillary hydrostatic pressure Øleads to sodium and water reabsorption back into the circulation and excretion of potassium aldosterone natriuretic system hormones produced in the myocardium kidneys detect low blood pressure and secrete? renin baroreceptors are found in? carotid sinus and aortic arch Renin combines with an enzyme called angiotensinogen from the liver and converts to angiotensin I Angiotensin II causes? vasoconstriction that raises the blood pressure Aldosterone is released by the adrenal gland and works on the kidneys by directing the nephron units of the kidney to reabsorb sodium (and water follows along). ADH is released from the posterior pituitary gland and vasoconstricts arteries and capillaries what are the normal levels of sodium? 135-145 mEq/L Responsible for ECF osmolarity, determines where water moves negatively charged, can switch with chloride ions in circulating blood; this assists in maintaining acid-base balance bicarb high sodium are accompanied by? high chloride changes in calcium affect? body functions Parathyroid hormone and calcitonin control? calcium balance within the body Occurs with hypernatremia or a bicarbonate deficit Hyperchloremia Serum sodium >145 mEq/L hypernatremia clinical manifestation of hypernatremia Thirst, weight gain, bounding pulse, and increased blood pressure, twitching of muscles Hyponatremia deficient sodium in the blood defined as elevation of chloride greater than 105 hyperchloremia hypoerchloremia is accompanied by? hypernatremia plasma bicarb deficit occur with? metabolic acidosis hyponatremia decreases? osmolality where cells swell and rupture sodium under <135 hyponatremia causes of hyponatremia ØPure sodium loss Hyponatremia manifestations Øcerebral edema and increased intracranial pressure hyponatremia leads to? hypovolemia and see hypotension, tachycardia, decreased urine output if you see excess water see weight gain, edema, ascites, jugular vein distention syndrome of inappropriate ADH (SIADH) excessive secretion of
antidiuretic hormone Syndrome of Inappropriate Antidiuretic Hormone (SIADH) manifestation cerebral edema (with confusion and convulsions), weakness, muscle twitching, nausea, headache, and weight gain hypochloremia is a result of? hyponatremia or elevated bicarb
Hypochloremia develops as a result of vomiting and the loss of HCl Hypochloremia under 96 potassium regulares intracellular electrical neutrality in relation to Na+ and H+ potassium is essential for? transmission and conduction of nerve impulses, normal cardiac rhythms, and skeletal and smooth muscle contraction changes in ph can affect? potassium balance can influence potassium levels -aldosterone Potassium level <3.5 mEq/L hypokalemia causes of hypokalemia are? reduced intake of potassium, increased entry of potassium into cells, and increased loss of potassium manifestation of hypokalemia ØMembrane hyperpolarization causes a decrease in neuromuscular excitability, skeletal muscle weakness, smooth muscle atony, and cardiac dysrhythmias if magnesium isn't within normal limits potassium cannot? enter the cell and replacement therapy will not work calcium serum concentrate 8.8-10.5 function of calcium in the body structure of bones and teeth, blood clotting, hormone secretion, cell receptor function, plasma membrane stability, transmission of nerve impulses, muscle contraction causes of hypocalcemia ØInadequate intestinal absorption, deposition of ionized calcium into bone or soft tissue, blood administration what does hypocalcemia effect? ØIncreased neuromuscular excitability causes of hypercalcemia ØHyperparathyroidism effects of hypercalcemia ØMany nonspecific: fatigue, weakness, lethargy, anorexia, nausea, constipation control phosphate Parathyroid hormone, vitamin D3, and calcitonin normal phosphate value 2.5-5.0 mg/dL Hypophosphatemia causes ØIntestinal malabsorption (vitamin D deficiency, use of magnesium- and aluminum-containing antacids, long-term alcohol abuse) Hypophosphatemia effects ØReduced capacity for oxygen transport by red blood cells, thus disturbed energy metabolism Hyperphosphatemia causes ØAcute or chronic renal failure with significant loss of glomerular filtration Hyperphosphatemia effects ØSymptoms
primarily related to low serum calcium levels (caused by high phosphate levels) similar to the results of hypocalcemia ØSystemic increase in H+ concentration or decrease in bicarbonate (base) acidosis ØSystemic decrease in H+ concentration or increase in bicarbonate alkalosis elevation of pco2 as a result of ventilation depression Respiratory acidosis depression of (carbon dioxide) pco2 as a result of alveolar hyperventilation Respiratory alkalosis Ødepression of HCO3- or an increase in noncarbonic acids Metabolic acidosis elevation of (bicarb)HCO3- usually caused by an excessive loss of metabolic acids Metabolic alkalosis Occurs when serum pH is less than 7.35 and more hydrogen ions (H+) are present. acidosis Increase in carbon dioxide levels Respiratory acidosis Decreased serum bicarbonate ion Metabolic acidosis Occurs when serum pH of greater than 7.45. alkalosis Decreased carbon dioxide levels Respiratory alkalosis Decreased serum bicarbonate ion Metabolic alkalosis Which organ system should the nurse monitor when the patient has potassium deficits?Which organ system should the nurse monitor when the patient has long-term potassium deficits? A. Central nervous system (CNS).
Which of the following conditions would cause hyperkalemia?Advanced kidney disease is a common cause of hyperkalemia. A diet high in potassium. Eating too much food that is high in potassium can also cause hyperkalemia, especially in people with advanced kidney disease. Foods such as cantaloupe, honeydew melon, orange juice, and bananas are high in potassium.
Which of the following patients are at the highest risk for developing Hypernatremia a patient with?The greatest risk factor is age older than 65 years. In addition, mental or physical disability may result in impaired thirst sensation, an impaired ability to express thirst, and/or decreased access to water. Hypernatremia often is the result of several concurrent factors.
Which of the following conditions is commonly associated with hyperkalemia and metabolic acidosis?Hypoaldosteronism leads to hyponatremia and does not cause alkalosis. Hyperventilation leads to respiratory alkalosis, not metabolic alkalosis. Rationale: Renal failure is associated with hyperkalemia and metabolic acidosis.
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Which organ system should the nurse monitor when the patient has long term potassium deficits quizlet?
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