Fluid & Electrolyte questions

Daytonite, BSN, RN · Nov 18, 2008

1. which client is at greatest risk for fluid imbalance?

a. an 85 yr old receiving feedings per peg tube w/ a 102 fever.

b. an adolescent mowing the lawn on a hot day drinking iced tea.

c. a healthy 70 yr old man who states not liking to drink water.

d. a middle aged woman who is vomiting w/ isotonic iv fluids.

i chose "b". a fluid imbalance is a loss or gain of fluid or a fluid shift from the cells to the vascular space or vice versa. "b" is probably sweating and losing electrolytes but only replacing his fluid loss with tea which is primarily water with no electrolytes in it so he will experience a fluid imbalance. in all the other answer choices, the people were getting some kind of regular fluid or fluid replacement. "a" has a peg tube so is getting regular fluid and electrolytes. "c" is just not drinking water and it doesn't mention he isn't refusing other liquids. "d" is vomiting but has an iv of isotonic fluid.

2. a client is experiencing fluid volume excess. which nursing intervention would be appropriate?

a. auscultate lung bases and observe for dyspnea.

b. perform weekly weights and check skin turgor.

c. have the client drink hypotonic fluids.

d. administer hypertonic fluids as ordered.

i chose "a". they are asking for a nursing intervention. i would be assessing for signs and symptoms of fluid overload. "b" is also a good choice, but waiting a week is too long and skin turgor is something more likely to be noticed with dehydration. "c" and "d" are just goofy.

3. a client is admitted w/ dehydration caused by severe blood loss. over an 8 hr shift the client has voided 220cc. what might be the underlying pathophysiology of the decreased urine output?

a. insensible losses are greater in dehydration.

b. obligatory losses are greater in dehydration.

c. the atrial natriuretic factor is causing the body to conserve fluid.

d. the renin-angiotensin-aldosterone system causes conservation of fluid.

the answer is "d". the raa system is involved with the volume of blood that circulates as well as cardiac output and hypertension. look up renin and what it does and its connection to angiotensin.

4. which pathophysiological situation would most likely promote the development of edema?

a. an arterial hydrostatic pressure of 40mm hg.

b. a venous hydrostaic pressure of 10mm hg.

c. an oncotic colloidal pressure of 15mm hg.

d. a tissure interstitial pressure of 10mm hg.

i would say the answer is "c". it is actually more complex than that and is a result of "c" and "d" but that is not provided for in your answer choices. oncotic colloidal pressure exerts a greater influence over tissue (interstitial) oncotic pressure, so "c" has to win out by default. you can read about the chemistry of these on these websites (http://www.cvphysiology.com/microcirculation/m011.htm and

http://www.cvphysiology.com/microcirculation/m012.htm). hydrostatic pressure pushes the water away from the heart and into the cells. oncotic pressure pushes the water out of the cells and back toward the heart. if water is remaining in the cells (edema) it is because there isn't enough oncotic pressure to push it out. see this explanation of hydrostatic and oncotic pressure on this previous thread:

https://allnurses.com/forums/f205/could-somebody-please-explain-hydrostatic-oncotic-pressure-325965.html

skinny_mini88 · Nov 18, 2008

Thanks for your help daytonite!! i really appreciate the explanation too b/c i wanted to know the reason behind the answer not just the answer so THANKS AGAIN!!!

TexasCowgirl24 · Nov 22, 2008

i was working on a hmwk assignment and there was a few questions i wasn't sure of. if anyone could confirm if was right or not and explain please. thanks!!
1. which client is at greatest risk for fluid imbalance?
a. an 85 yr old receiving feedings per peg tube w/ a 102 fever.
b. an adolescent mowing the lawn on a hot day drinking iced tea.
c. a healthy 70 yr old man who states not liking to drink water.
d. a middle aged woman who is vomiting w/ isotonic iv fluids.
i was thinking a b/c of the fever. is this the correct answer?
i agree, the eldely are at an increased risk for dehydration
2. a client is experiencing fluid volume excess. which nursing intervention would be appropriate?
a. auscultate lung bases and observe for dyspnea.
b. perform weekly weights and check skin turgor.
c. have the client drink hypotonic fluids.
d. administer hypertonic fluids as ordered.
i was thinking a b/c volume excess results in pulmonary congestion and edema and you can experience shortness of breath and crackles on auscultation. is this the correct answer?
a is correct -b: need to weight daily- c & d- if you have excess you don't increase the fluid intake
3. a client is admitted w/ dehydration caused by severe blood loss. over an 8 hr shift the client has voided 220cc. what might be the underlying pathophysiology of the decreased urine output?
a. insensible losses are greater in dehydration.
b. obligatory losses are greater in dehydration.
c. the atrial natriuretic factor is causing the body to conserve fluid.
d. the renin-angiotensin-aldosterone system causes conservation of fluid.
i have no clue what the answer is on this question. how should i look a
4. which pathophysiological situation would most likely promote the development of edema?
a. an arterial hydrostatic pressure of 40mm hg.
b. a venous hydrostaic pressure of 10mm hg.
c. an oncotic colloidal pressure of 15mm hg.
d. a tissure interstitial pressure of 10mm hg.
i have no clue on the answer for this one either. can someone explain this to me??

daytonite rocked these answers

Razor25 · Feb 9, 2009

How does long term corticosteriod therapy causes fluid volume excess?

Daytonite, BSN, RN · Feb 9, 2009

How does long term corticosteriod therapy causes fluid volume excess?

They cause retention of sodium by the kidneys. Hypernatremia results in the body retaining water. Where sodium goes, water follows.