fluid and lytes

  1. Approximately what %age of the total body weight is water?
    A – 55
    B – 75
    C – 60
    D – 80
    C – 60
  2. Which of the following is most likely to have the highet %age of LBM?
    A – 25yom
    B – 55yom
    C – 25yof
    D – 55yof
    A – 25yom
  3. Which of the following is not a fxn of body water
    a - serves as a substrate for metabolic fxn
    b – fxn to maintain temp
    c – has a key role in circulatory system
    d – sufficient hydration status is required to maintain balance regulated by inner ear
    d – sufficient hydration status is required to maintain balance regulated by inner ear
  4. Total body water is roughly distributed as follows between ICF and ECF:

    C – 1/3 ECF; 2/3 ICF
  5. If abnormal accumulation of fluid occurs in the ICF compartment ot body cavities, the following is most likely to occur

    B – edema
  6. The primary cation of ECF is

    C – Na2+
  7. The primary cation of ICF is

    A – K+
  8. The primary anion of ICF is

    D – Phos
  9. The primary anion of ECF is

    B – Cl-
  10. Non electrolyte components of body fluids that d/n dissociate in solution include all of the following except:
    A – NaCl
    B – glucose
    C – urea
    D – creatinine
    A – NaCl
  11. Under normal circumstances the following is true:

    A – electroneutrality is maintained by anions = cations
  12. The component of plasma that is the principle determinant of colloid oncotic pressure is:

    D - albumin
  13. Osmolality is defined a:

    B – the # of osmotically active particles per kg of solvent
  14. The normal range for osmolality is:

    C – 290-310 mOsm/L
  15. In addition to osmosis the regulation of body fluid compartments also occurs via all of the following except:

    C – hypoventilation
  16. Maintaining the composition and volume of body fluid wnl is the fxn of:

    B - kidney, heart, lungs, pituitary gland, adrenal gland, parathyroid gland
  17. ADH is an integral component of fluid homeostasis because as [ADH] increases,

    A – renal water retention increases
  18. The majority of sensible losses of water occur via

    D – urine (1200-1500 mL/d), lungs – 400 mL/d, skin - 500-600 mL/d, GI tract – 100-200 mL/d
  19. Considering the lyte composition of bodily fluids, a pt that has losses of NG suction of ~2L/d would likely benefit from the replacement of ___ to maintain homeostasis

    • D – Cl- (gastric contents are rich in cl-, small bowel,
    • pancreatic secretions are alkaline and high in bicarb)
  20. Potential causes of a fluid deficit include all of the following except:

    D – hypertensive emergency (3rd spacing = shift of fluid from vascular space into a portion of the body which is not easily exchanged w/ the rest of the ECF. This is an example of when fluid deficit d/n necessarily mean hydration. Polyuria is seen in DKA, GI losses seen with n/v/d/fistula and drainage tubes/suction)
  21. potential causes of fluid overload include all of the following except

    C – hyperventilation
  22. This classification of diuretics (including furosemide) may lead to increased urinary excretion of l;ytes including Ca++, mag, and particularly K+;

    C – loop diuretics
  23. this diuretic is known for conserving K+

    A – aldactone
  24. In the setting of critical illness or injury, a pt displays dec urine output, hypotension, tachycardia, high urine specific gravity and osmolality, elevated crit, poor skin turgor, with minimal, if any changes in body wt. The clinician should consider:

    A – third spacing
  25. All of the following therapies are considered SOC for the trx of 3rd spacing except:
    A – hyperbaric chamber
    B – IV fluids
    C – transfusion
    D – correction of the underlying cause
    A – hyperbaric chamber
  26. In interpreting ABG (arterial blood gas); it is important to recognize that the following pHrange is considered wnl:

    C – 7.35-7.45
  27. In ABGs, < __ is considered acidosis and > ___ is considered alkalaosis

    B – 7.35;7.45
  28. Steps to interpreting ABG
    • 1) access alkalosis (pH >7.45) or acidosis (pH < 7.35)
    • 2) assess pCO2(respiratory) and HC03 (renal) to determine if respiratory or metabolic d/o
  29. On an ABG, an abnormal pC02 generally indicated a primary or compensatory __d/o:

    C – respiratory
  30. On an ABG, an abnormal HC03 generally indicated a primary or compensatory __d/o:

    C – metabolic
  31. Compensation for metabolic d/o occurs via the __ and takes approximately __ hours

    A – lung; 12-24
  32. Side effects of acidosis may include the following:

    A - ‘lyte abnormalities, namely K+ AND decreased tissue perfusion
  33. A normal anion gap (the [] of unmeasured ions in the blood) is ___ mEq/L:

    D -10-12
  34. Anion gap calculation
    • Na- (Cl+HCO3). Can use serum C)2 to substitute for bicarb.
    • Most common causes of anion gap acidosis are ketoacidosis, lactic acidosis (shock) renal failure. Less common causes include methanol, ethylene glycol (antifreeze) and salicylate ingestion.
  35. Normal anion gap (hyperchloremic) acidosis may be caused by all of the following except:

    B – excessive vomiting
  36. A metabolic acidosis w/ elevated anion gap may be caused by the following:

    • C – renal failure and thiamine deficiency
    • Thiamine is essential for normal glc metabolism, in its absence, lactic acid is produced leading to lactic acidosis.
  37. A common cause of metabolic alkalosis is

    A – high NGT output
  38. Diuretics should be used judiciously in part to prevent the acid base d/o known as:

    • B – contraction alkalosis
    • Volume depletion is also referred to as this d/t overall dehydration or overuse of diuretics. The hypovolemia that develops decreases real tubule perfusion, that in turn increases the proximal absorption of bicarb in the renal tubules leading to inc plasma bicarb []. Additionally, the decrease in renal perfusion stimulates bicarb reabsorption
  39. The following ‘lyte disturbance can cause a deficit of hydrogen ions in the ECP, precipitating an alkalosis

    A – hypokalemia
  40. In providing PN to a pt w/ metabolic alkalosis, the clinician should pay careful attention to the provision of salts as:

    A – acetates
  41. Respiratory acidosis occurs when

    D – ventilation is inadequate to remove C02
  42. When providing nutrition support to a pt w/ respiratory acidosis, the following should be considered
    A – pulmonary enteral formulas are usually beneficial in this population
    B – metabolic cart studies have little use in this population
    C – total kcal administered ate likely to have more effect than kcal derived solely for CHO
    D –CHO kcal are to be minimized
    C – total kcal administered ate likely to have more effect than kcal derived solely for CHO
  43. Conditions associated with causing respiratory acidosis include all of the following except:

    A – hyperphosphatemia
  44. Respiratory alkalosis is caused by an increased stimulation of respiration. Conditions that may cause this include all of the following except:

    A – excessive alkali ingestion
  45. An important fxn of Na is

    D – to maintain serum osmolality and fluid volume
  46. Na is largely regulated by this organ and hormone:

    C – kidneys, aldosterone
  47. The ___ is essential in accessing the cause and subsequently tx a low na

    A – serum osmolality
  48. IV NS contains __ mEq of Na/L:

    B – 154
  49. Hypernatremia is always associated with a ___ state:

    C – hypertonic
  50. Calculate the free water deficit of a 70 kg man with a serum sodium of 158:

    A – 4.8 L
  51. Water deficit calculation
    H20 deficit (L) = 0.6 x wt (kg) x [1 – (140/measured Na+)]
  52. Calculate the sodium deficiency of a 58 kg female w/ a serum na+ of 122 (in mEq)

    B – 626
  53. Na+ deficit formula
    Na_ deficit (mEq) = (140 – meas Na+) x [0.6 x wt(kg)]
  54. The depletion combined w/ rapid cellular influx of the flowing ‘lytes is characteristic of refeeding syndrome

    C – phos, mag, k+
  55. One should consider the potential for refeeding syndrome when assessing the following population

    D – all of the above
  56. The lyte that is integral to maintaining cell volume, pH, enzyme function, neuromuscular/cardiac fxn and cell growth is

    D – K+
  57. Cardiac arrhythmias, muscle weakness, ileus, EKG changes and even paralysis can occur with this lyte abnormality

    C – hypokalemia
  58. Hyperkalemia may occur d/t:

    D – all of the above
  59. The following statements describe characteristics of phos except:

    C – the majority of total body phos exists in ECF
  60. Hypophosphatemia can result in all of the following except for:

    C – increased muscular excitability
  61. An elevated phos is usually the result of:

    D – both renal insufficiency and cellular destruction, as in trauma or w/ certain meds
  62. It is not uncommon for pancreatitis to precipitate this ‘lyte abnormality

    A – Ca++ and Mag
  63. Aside from inadequate GI absorption and refeeding syndrome, this is also a common cause of hypomagnesemia

    D – DKA
  64. Causes of hypermagnesemia in a healthy, adequately hydrated, non stressed pt with normal kidney fxn may include

    D – excessive laxative use
  65. Low [serum ca++] stimulate the release of this hormone which increases bone resorption, stimulates renal conservation of ca++ and activates cit D which increases GI absorption of Ca++

    B – PTH
  66. In response to elevated [serum ca++], the __ releases __ horomone, which inhibits bone resorption

    B – thyroid, calcitonin
  67. Adjust the calcium for a pt w/ an albumin of 2.4 and a Ca++ of 6.9

    C – 8.2
  68. Causes of hypocalcemia can include all of the following except

    B – bone cancer
  69. Adjusted calcium calculation
    [(4.0 – meas albumin)* 0.8)]+ measured calcium = adjusted ca++
  70. In the absence of excessive exogenous provision of calcium, in a pt w/ normal renal fxn the most common cause(s) for hypercalcemia is

    A – hyperparathyroidism and bone cancer
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fluid and lytes
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