FLUID-ELECTROLYTE IMBALANCES

Electrolytes- minerals in the blood and other body fluids

 Cation- positively charge: K, Na, Mg, Ca
 Anion- negatively charge: P, Cl
- Taken as compound in the body- dissociates into ions

POTASSIUM: 3.5- 5 mEq/L

Food sources:
1. Passion fruit
2. Jackfruit
3. Banana
4. Avocado
5. grapefruit
Major intracellular electrolyte- most abundant inside the cell
Maintains osmolality intracellular- concentration
Nerve impulses and transmission
Muscle contractility
o Skeletal
o Smooth
o Cardiac- K- KARDIAC!
Acid- Base Balance
o CELLULAR ION EXCHANGE
 ACIDOSIS: increased H blood
 H blood- cell
 K cell- blood= HYPERKALEMIA
 ALKALOSIS: decreased H blood
 H cell- blood
 K blood- cell= HYPOKALEMIA
KIDNEY – excretes K (80% of K intake- excreted through the urine)

HYPOKALEMIA:
Causes:
1. GI losses
Diarrhea
Vomiting
GI fistula
GI suctioning
2. Decreased K intake
Malnutrition/ starvation
Coma
Strict dieting
3. Diuretics: K wasting
Loop diuretic- furosemide (Lasix)
Thiazide- hydrochlorothiazide
Osmotic- Mannitol- DOC: Increasing ICP
Carbonic Anhydrase Inhibitor- acetazolamide (DIAMOX): Treatment for increasing IOP- glaucoma
4. CUSHING’S DISEASE
Increase 3S: salt, sugar and sex
Salt: aldosterone- Na and water retention- increased Na, decreased K
Sugar: cortisol- gluconeogenesis, glycogenolysis- hyperglycemia
Sex: androgen
5. BURN: ACUTE/ Fluid Remobilization Phase
Phases:
i. Fluid Accumulation Phase/ Emergent
 Fluid- IV (plasma) shift- interstitial
 Cell destruction: K cell- blood- HYPERKALEMIA
  Na goes with plasma- HYPONATREMIA
ii. Fluid Remobilization Phase/ Acute
 Fluid interstitial- shift back- IV
 Hypervolemia- hemodilution: HYPOKALEMIA, HYPONATREMIA
iii. Convalescent- healing and repair

6. ALKALOSIS: decrease H blood

H cell- blood
K blood- cell

MANIFESTATIONS: “everything is low, slow and dry”

1. Body weakness (Limp muscle)- early manifestation (lower extremities)
2. Leg cramps
3. Low shallow respiration- weakness of the respiratory muscle
4. Low BP
5. Lethargy- drowsiness/ confusion
6. Constipation- decreased peristaltic movement- WOF: complication paralytic ileus
7. KARDIAC: ARRYTHMIA- ECG: Prominent/ Presence of U wave

MANAGEMENT:
1. Identify and stop ongoing K losses
2. Treat the underlying cause
3. Medications:
 K supplement:
o ORAL K tablet: KCl tablet, Kalium Durule
o KCl solution- drink with juice- improve palatability
o Parenteral: IV incorporation
 NO: IM, direct IVTT, bolus
 Infusion pump
o Assess renal function/ urine output
 BUN- Urea- end product of CHON metabolism
 Creatinine- end product of muscle metabolism
4. Increase K intake
 Dietary sources: Banana, oranges, gra[es, cantaloupe, watermelon, apricots
5. K sparing diuretics
 SEAT
o Spironolactone
o Eplerenone
o Amiloride
o Triamterene

HYPERKALEMIA
Causes: MACHINE
MEDICATION
 K sparing diuretics
 ACE Inhibitors- antihypertensive: inhibits the conversion of angiotensin 2- decrease aldosterone- decrease Na,
increase K
 NSAIDS- decreases K excretion

ACIDOSIS
 Increase H blood
 H blood- cell
 K cell- blood

CELLULAR DESTRUCTION
 K CELL- BLOOD
o Cellular injury
o Burn- Fluid Accumulation Phase/ Emergent
o Hemolysis
o Chemotherapy

HYPOALDOSTERONISM/ ADDISON’S DISEASE

 Decrease in aldosterone- Na and water excretion- decrease Na, Increase K
INCREASE K INTAKE
 Parenteral administration of K containing medication
 Increase K in the diet

NEPHRONS- damaged (functional unit of the kidneys): RENAL FAILURE

 K retention- fatal
 Indication: Hemodialysis

EXCRETION IMPAIRED: RENAL FAILURE

 Renal Failure- most common cause of Hyperkalemia

MANIFESTATIONS: MURDER

“everything is HIGH, FAST and WET”

MUSCLE WEAKNESS
 Late sign

URINE OUTPUT
 Oliguria/ anuria- Renal Failure

RESPIRATORY MUSCLE WEAKNESS

 Muscle exhaustion

DECREASED CARDIAC CONTRACTILITY/ DYSRYTHMIAS

DIARRHEA- increasing peristaltic movement
 Increasing HR
 KARDIAC: ECG: Tall tented T wave/ Peaked T wave

EARLY SIGN:
Muscle twitching and cramps= weakness= Flaccid paralysis

RHYTHM CHANGES

MANAGEMENT:
1. Decrease K intake/ limit
2. Treat underlying cause
3. Hemodialysis- Renal Failure
4. Medications:
a. Calcium Gluconate- increases cardiac contractility
i. Prevent dysrhythmias
ii. ANTIDOTE: to prevent CARDIAC ARREST
b. Insulin- Regular: IVTT
i. Carries K- cell
c. Kayexalate/ Exchange Resin/ Sodium Polysterene Sulfonate
i. Acts in the GI tract- PO/ enema
ii. Exchange of Na and K (Na- meds; K body)
iii. Na- absorbed by the GI; K excreted – feces
iv. WOF: Hypernatremia
d. Diuretics: K wasting

1. Which of the ff conditions can cause Hypokalemia?

b. Addison’s disease- Hyperkalemia c. Metabolic alkalosis
c. Use of Spironolactone- Hyperkalemia d. All of these
Alkalosis- K- cell

2. Which of the following symptom could the nurse observe being manifested by clients suspected of Hypokalemia?
a. Tachycardia c. Leg weakness
b. Increased bowel motility d. Peaked T wave
 Everything is low, slow and dry

3. Electrolyte imbalance may lead to changes in cardiac rhythm. During monitoring of a client, the nurse noted presence
of a prominent U wave. This ECG finding is commonly seen in case of:
a. Hypercalcemia c. Hypocalcemia
b. Hypenatremia d. Hypokalemia
4. To check for the presence of dysrhythmia in a client with potassium imbalance, the nurse should assess the client’s
pulse for 1 full minute. The best to assess is the:
a. Brachial pulse b. Carotid pulse c. Radial pulse d. Apical pulse
5. Which of the following is a contraindication in administering oral or IV potassium supplements?
a. Anorexia b. Diarrhea c. Oliguria d. Liver disease
6. To correctly administer a parenteral potassium, the nurse knows that when administering potassium she must:
a. Agitate the IV bag
b. Do not use infusion pump; use regular infusion set
c. Administer the drug IM for a slower absorption and to prevent toxicity
d. Administer the drug via IV Push

7. In caring for a client with Chronic Renal Disease, the nurse knows that all of the following are the management of
Hyperkalemia except?
a. D50 Water with Regular Insulin c. Calcium Gluconate
b. Na polysterene sulfonate d. Digoxin
8. A client is taking spironolactone complains of irregular heart rate, diarrhea, and stomach cramping. The nurse
concludes that the client is experiencing :
A.Hyponatremia C.Hyperkalemia
B.Hypercalcemia D.Hypernatremia
9. A client had been diagnosed to have congestive heart failure . Which of the following medications may be prescribed
to the client to promote sodium excretion while conserving potassium? Select all that apply.
1.spironolactone 2.furosemide 3.amiloride
4.chlorothiazide 5.triamtrene 6.ethacrynic acid
A. 1,2,3 B. 1,3,5 C. 2, 3, 5 D. 4,5,6
10. The nurse suspects hypokalemia is present when the client experiences which of the following signs and symptoms:
a.Sunken eyeballs, deep, rapid respiration, excessive thirst.- dehydration
b.Edema, distended neck vein, bounding pulse.- Hypervolemia
c.Abdominal cramps, diarrhea, dysrhythmias- Hyperkalemia
d.Apathy, weakness, abdominal distention.
11. The client’s serum potassium is 6.0 mEq/L. which of the following medications does the nurse prepare to administer?
a.Na Polysterene Sulfonate c.Aluminum hydroxide
b.Magnesium sulfate d.Sodium bicarbonate

12. The client’s serum potassium level is 6.2 mEq/L. Which of the following interventions is appropriate for the client?
a.Aluminum hydroxide c.TPN administration
b.Exchange resin d.Vitamin D- Hypocalcemia
13. The client is experiencing metabolic alkalosis. Which of the following electrolyte imbalances may occur?
a.Hypokalemia c.Hypernatremia
b.Hyperkalemia d.Hypophosphatemia
14. Potassium must be taken everyday to prevent hypokalemia. Which of the following are the dietary sources of
potassium?
a. tomatoes, mushrooms and apricots c. green leafy vegetable
b. whole grains d. peanuts and dry beans

SODIUM: 135- 145 mEq/L

Most abundant electrolyte extracellular
Maintains the concentration of the ECF
Nerve impulses and transmission
Na- K Pump
o Active Transport- requires energy
o Shifting: solute (electrolyte) – lesser to higher concentration
o BURN: cellular destruction
o K cell- blood; Na blood- cell
o PISO
o Potassium In; Sodium Out
o 3E:
 Energy: ATP
 Enzyme: ATPase
 Electrolyte: magnesium
HYPONATREMIA:

Causes:
1. GI losses- diarrhea and vomiting
2. Diuretics- mannitol (osmotic) – cerebral swelling- Increases ICP- fluid shifting IC to EC- hypervolemia- diuresis
Hypervolemia- dilution- dilutional hyponatremia
3. Inadequate salt intake/ Low salt diet

TYPES:
1. Hypervolemic Hyponatremia
Increase blood volume; decrease Na
Heart failure- decrease CO- decrease renal perfusion- RAAS- water retention
Liver cirrhosis/ hypoalbuminemia
2. Euvolemic Hyponatremia
Normal blood volume; decrease Na
SIADH- increased of ADH
ADH- water reabsorption in the kidney tubules
Increase water, decrease Na- dilutional Hyponatremia
3. Hypovolemic Hyponatremia
Decrease blood volume; decrease Na
Severe dietary deficiency
GI losses

MANIFESTATIONS: SALT LOSS

STUPOR/ COMA
Na- Neurologic
Increase blood volume- OSMOSIS- shifting of fluid into a more concentrated solution- fluid shift: blood- cell-
swell= CEREBRAL EDEMA
Decrease blood volume- OSMOSIS- fluid shift: cell- blood- shrink= CELLULAR DEHYDRATION
ANOREXIA
Nausea and vomiting
LETHARGY
TENDON REFLEXES- decreased
Neuromuscular depression
LIMP MUSCLE- weakness
ORTHOSTATIC HYPOTENSION
Hypovolemic Hyponatremia
SEIZURES/ HEADACHE
STOMACH CRAMPING

MANAGEMENT:
1. Provide Safety- Seizure Precaution
2. WODAC- Weigh OD (Once a day) AC (ante cebum) before breakfast
3. Provide Na replacement
a. IVF containing Na (PNSS/ .9% NaCl)
b. Na supplement: NaHCO3
4. Encourage food high in Na
a. Most common dietary source- table salt/NaCl
b. Preservatives/ Processed
5. SIADH- Limit water intake

HYPERNATREMIA
Causes: MODEL

M- Medication/ Meal
NaHCO3, acetaminophen, aspirin, ibuprofen

O- Osmotic diuretic
K wasting- excretes K, retains Na

D- Diabetes Insipidus- polyuria

Decrease water, increase Na
E- Excessive water loss
L- Low water intake

Other Causes: D
Diuretics
Dehydration- Water deficit
Diabetes Insipidus
Docs- iatrogenic- IVF
Diarrhea- watery diarrhea- losing more water than Na
Disease- Cushing’s Disease, elevated aldosterone- retention of Na

MANIFESTATIONS: FRIED SALT

F- Fever- DHN
R- Restlessness, irritability, anxiety, confusion- neurologic
I-Increased BP/ Fluid retention- Hypervolemic Hypernatremia- Cushing’s Disease
E- Edema: peripheral/ pitting- Hypervolemic Hypernatremia
D- Decreased Urine output/ Dry mouth- Dehydration- Hypovolemic Hypernatremia

S- Skin flushing- DHN/ fever

A-Agitation- neurologic – Neuromuscular excitability
L- Low grade fever
T- Thirst- DHN

MANAGEMENT:
1. Treat the underlying cause
2. Hypotonic IVF
3. Diuretics
4. Reduce level gradually
5. Limit Na intake/ Low salt diet
15. Which of the following factors would least likely cause cerebral edema?
a. Water intoxication c. SIADH
b. Over infusion of hypertonic solution d. Excessive water intake
water intoxication- more water than Na- shift: blood- cell- swelling
SIADH- dilutional hyponatremia- more water than Na- swelling
Excessive water intake- more water than Na
Hypertonic solution: D5LR, D5NM, D10Water
Concentrated- osmosis: shifting- cell- blood- cell: shrink

CALCIUM: 8.5- 10 mg/dl

99% of Ca- bones and teeth
Muscle Contraction- increases myocardial contractility – inotropic effect
Transmission of neural impulses
Blood clotting system- 4
Inhibit cell destruction

Regulations:
1. PTG/ Parathyroid Gland- produces PTH/ Parathormone
Functions:
Increases bone resorption of Ca: Ca bone- blood
Increases GI absorption of Ca
Increases renal reabsorption of Ca
Increases Ca level- PTH and Ca: direct relationship

2. Thyroid Gland
Follicle/ Follicular cells- produces thyroglobulin + iodine (diet) = MIT monoiodothyronine, DIT
Diiodothyronine : 1 MIT + 1 DIT= T3= Triiodothyronine; 2 MIT= T4= Thyroxine
Parafollicular Cells- produces CALCITONIN
o Reduces osteoclast activity
o Increased osteoblast
o Decrease serum Ca level- Ca: used in the bone
o Calcitonin and Ca: inverse relationship
3. Vitamin D
o SOURCE: sunlight, diet, supplement
o LIVER: hydroxylated
o KIDNEY: activated – CALCITRIOL or 1, 25 DIHYDROXYCHOLECALCIFEROL
o Function: helps GI absorption of Ca
 o Relationship: DIRECT

4. Phosphorus
85% of phosphorus- bones and teeth
Increased P and Ca- BONE: mineralization
P (anion); Ca (cation)= Ca Phosphate- stones/ crystal formation- deposit into the major organs of the
body
Blood: Inverse relationship

HYPOCALCEMIA
Causes:
1. GI losses
2. Decreased Ca intake
3. Vitamin D deficiency- no activated Vit D- calcitriol- decreased absorption of Ca in the GI
4. Renal Failure- kidney: activates Vit D
5. Liver disease- liver: hydroxylation of Vit D
6. Hypoparathyroidism – decrease PTH- decrease of Ca
7. Medications- Calcitonin- decrease osteoclast, promotes osteoblast – decrease Ca

MANIFESTATIONS: CATS
Ca- protects the cell wall, prevents destruction
Decrease Ca level- decrease Ca outside the cell- Na gets inside the cell- neuromuscular excitability

C- Convulsion
A-Arrythmias
ECG: Prolonged QT interval- Torsades de pointes
T- Tetany
Neuromuscular excitability: hyperreflexia
S- Stridor and spasm
SPASM: Facial spasm- tapping the facial nerve (anterior to the ear)- contraction of the ipsilateral facial muscle-
CHVOSTEK’S SIGN
o Carpopedal spasm- inflate the sphygmomanometer above systolic BP for 3 minutes: TROUSSEAU’S
SIGN
 Adduction of the thumb
 Flexion of the metacarpalphalangeal joints
 Extension of the interphalangeal joints
 Flexion of the wrist
Thyroidectomy- accidental removal of the PTG
o Decrease PTH- decrease Ca level
o WOF: laryngospasm- stridor- airway obstruction
o Bedside: tracheostomy set and Ca Gluconate

MANAGEMENT:
1. Replace Calcium
a. Ca gluconate
b. Oral calcium supplement
2. Increase Ca intake: milk and dairy products, poultry products, sardines, dilis
3. Treat the underlying cause- Hypoparathyroidism
4. Vitamin D- GI absorption of Ca

HYPERCALCEMIA
Causes:
1. Endocrine
a. Hyperparathyroidism- increase PTH- increase Ca
2. Malignancy
a. Metastatic cancer to the bone
b. Bone cancer- increase bone resorption of Ca: Ca bone- cells
3. MEDICATIONS:
a. Vitamin D
b. Thiazide
c. Vitamin A
4. Immobilization

CHIMPANZEES

C- Calcium intake increase

H- Hyperparathyroidism
I-Immobilization- increase Ca resorption in the bone
M- Multiple Myeloma
Abnormal proliferation of plasma cell in the bone marrow
Results to bone destruction- increasing bone resorption of Ca- increase Ca in the blood
 P- Parathyroid adenoma/ hyperplasia – increase PTH- increase Ca
A-ALCOHOL
Increases cortisol level – decreases osteoblast and increases osteoclast
Ca bone- blood
N- Neoplasm
Z- Zollinger Ellison Syndrome
Increased gastrin level in the blood- secretes a compound that increases Ca level
E- Excessive Vitamin D
Activated level of vit D- calcitriol- increases GI absorption of Ca
E- Excessive Vitamin A
Increases bone resorption of Ca
S- Sarcoidosis
Increase stimulation of activated vit D by the macrophages

MANIFESTATIONS: “Stones, bones, moans and groans”

STONES
Development of Ca stones – lead to Renal Failure
Renal Stones:
o Calcium- oxalate/ phosphate (most common renal stones)
o Struvite- infection (UTI)
o Uric Acid
o Cystine- hereditary
S/Sx: Polyuria, Nocturia, PAIN
BONES
Bone destruction
Bone Pain
MOANS
Psychiatric Moans
Effect in the NS: lethargy, fatigue, memory loss, depression, psychosis
Neuromuscular depression
GROANS
Abdominal Groans
GI Sx: nausea, vomiting, constipation, indigestion

ECG: Shortened QT interval- arrythmia

MANAGEMENT:
1. Rehydration: PNSS/ .9% NaCl, Increase OFI
2. Encourage mobility- prevent stone formation
3. Limit Ca intake
4. Ca Gluconate toxicity- antidote: Mg SO4
5. Medication: Biphosphonates (IV Pamidronate infusion)

16. A home care nurse assesses for complications in a client with bone cancer. What electrolyte disorder should the nurse
anticipate in the client?
A.Hypercalcemia C.Hypomagnesemia
B.Hyperkalemia D.Hyponatremia
17. A nurse is caring for a female client diagnosed with hypoparathyroidism. The nurse understands that for the
parathyroid hormone to exert its effects, what must be present?
A.Increased calcium level C.Adequate Vitamin D level
B.Functioning thyroid gland D.Decreased phosphate level
PTH- increases GI absorption of Ca
Vit D- helps GI absorption of Ca

MAGNESIUM: 1.5- 2.5 mEq/L

2ND most abundant electrolyte intracellular
Regulates Calcium level- helps excrete excess Ca
Contraction and relaxation of muscle
Production and transport of energy
Potent vasodilator
o PIH- vasospasm/ vasoconstriction- increase BP- seizure
o DOC: Mg SO4- prevent seizure, decreases BP
o MgSO4 Toxicity: decrease RR below 12 cpm, absence DTR
Controls Ach in the myoneural junction
o Increase Mg- increase control of Mg- less Ach in the muscle- Neuromuscular depression
 o Decrease Mg- decrease in control- more Ach muscle- Neuromuscular excitability
HYPOMAGNESEMIA
Causes:
1. GI losses
2. Decrease Mg intake- eating deficiency, dieting, coma, anorexia
3. Burn- Mg follows K (Fluid Remobilization Phase) hemodilution
4. Diuretics- K wasting
5. Alcoholism- decreases Mg absorption in the GI tract

MANIFESTATIONS:
1. Vasoconstriction- Increase BP
2. Decrease Mg- more Ach muscle- NM excitability
a. Hyperreflexia
b. Tetany and spasm- Chvostek and Trousseu’s sign
c. Increase HR
d. Seizure

MANAGEMENT:
1. Oral supplement- assess for renal function
2. Increase dietary intake of Mg- green leafy vegetables
3. Discontinue medications- promote Mg loss (K wasting diuretics)
4. Severe: Mg SO4- give slowly, IV- antidote: Ca Gluconate

HYPERMAGNESEMIA
Causes:
1. Renal Failure
2. Addison’s Disease
3. BURN- Fluid Accumulation Phase- cell destruction- Mg cell- blood
4. Increase Mg intake
5. Mg containing medications:
o Antacids- AlMgOH
o Treatment for PIH- MgSO4
o Laxatives- Mg- diarrhea

MANIFESTATIONS:
Increase Mg- increase control- less Ach muscle- NM depression
1. Vasodilation- HYPOTENSION
2. Hyporeflexia
3. Body weakness
4. Respiratory depression
5. Coma
6. Decrease HR

LOW- BP, HR, RR, Reflexes, Energy

MANAGEMENT:
1. Limit Mg intake
2. Antidote: Ca Gluconate
3. K wasting diuretic- promote excretion of Mg
4. Hemodialysis- severe cases
5. Assess for CARDIAC
18. A client positive for Chvostek test is most likely suffering from which of the following disorders?
A.Calcium excess C.Potassium excess
B.Magnesium deficit D.Bicarbonate deficit

CHLORIDE: 95- 105 mEq/L

Major anion in the ECF
Food sources: eggs, milk and leafy vegetables
Essential for water balance
Helps Na in the osmolality of the ECF
o Na and Cl: direct relationship
Acid- Base Balance (HCO3 and Cl)
o ACIDOSIS: decrease HCO3- kidneys: retain HCO3, excrete Cl- N pH
o ALKALOSIS: increase HCO3- kidneys: retain Cl, excrete HCO3- N pH
Formation of HCl acid
o Provides optimum pH for action of pepsin, activation of pepsinogen
Maintains homeostasis: Na and K
Activation of salivary amylase-
Necessary for the formation of the CSF
19. A 39-year-old patient is admitted with severe vomiting and abdominal pain. His admission laboratory findings reveal
hypochloremia. Which electrolyte would you expect to be deficient?
a.calcium b. sodium c. magnesium d. phosphorus
20. The nurse is caring for the client with increased intracranial pressure. The nurse would note which of the following
trends in vital signs if the intracranial pressure is rising?
a.Increasing temperature, increasing pulse, increasing respirations, decreasing blood pressure
b.Increasing temperature, decreasing pulse, decreasing respirations, increasing blood pressure
c.Decreasing temperature, decreasing pulse, increasing respirations, decreasing blood pressure
d.Decreasing temperature, increasing pulse, decreasing respirations, increasing blood pressure

Increased ICP- Cushing TRIAD:

Increase BP- systolic: widened pulse pressure
Decrease CR
Decrease RR

Increase temperature
POSITION: 30 to 45 degree HOB elevated
Purpose: Prevent brainstem herniation: (cardiac and respiratory)
21. Which finding suggests that a patient has received too much medication in preventing seizure complications in client
with PIH?
a. muscle weakness c. tachycardia- hypoMg
b. tetany- HypoMg d. hyperreflexia- HypoMg
Treatment for PIH: MgSO4 – Toxicity
Increase Mg- NM depression

22. The client has developed ascites. The nurse should recognize that the pathologic basis for the development of ascites
in clients with cirrhosis is portal hypertension and
a.An excess serum sodium level c.A decreased flow of hepatic lymph
b.An increased metabolism of aldosterone d.A decreased serum albumin level
Cirrhosis of the liver- decreased CHON synthesis- hypoalbuminemia- fluid shifting- ascites
Hypoalbuminemia- decrease colloid oncotic pressure
23. Pulmonary edema is a potential danger that we nurses should monitor in post pneumonectomy.The sign that typifies
this condition is:
A.elevated temperature C.frothy pink sputum
B.pleuritic pain D.pitting edema
Pulmonary edema- increase hydrostatic pressure (pressure exerted against the wall of the capillaries)- rupture of
capillaries- pink frothy sputum
24. Which intervention is most appropriate for the patient receiving continuous magnesium sulfate infusion?
a. insert an indwelling urinary catheter c. administer calcium gluconate every 4 hours- toxicity
b. attach the patient to a cardiac monitor d. perform neurologic examination every 2 hours.
25. The nurse is caring for a patient diagnosed with Chronic Renal Failure. The nurse must evaluate for what possible
complication that may occur due to kidney’s inability to activate Vitamin D?
a.hyperphosphatemia c. Hypocalcemia
b.Hyperkalemia d.Hyponatremia
26. When assessing a patient for fluid and electrolyte balance, the nurse is aware that the organs most important in
maintaining this balance are the:
A.pituitary gland and pancreas C.brainstem and heart
B.liver and gallbladder D.lungs and kidneys
27. Which of the following assessment findings does not indicate dehydration?
a.Warm, flushed, dry skin c.Dark, concentrated urine
b.Sudden weight gain d.Increased hematocrit
28. Electrolytes are charged ions present both compartments that function to maintain body’s homeostasis. Which of the
following electrolytes is least likely present intracellularly?
a. potassium b. magnesium c. phosphorus d. calcium

Intracellular: cation: K, Mg
Anion: P
Extracellular: cation: Na, Ca
Anion: Cl
Ca: 99% - bones and teeth
1%- ECF
29. The following are common factors that trigger Renin- Angiotensin Aldosterone System. Which of the following does
not apply?
a. pregnancy b. CHF c. Dehydration d. SIADH
Pregnancy- maternal and fetal circulation (RAAS)
CHF- decrease in cardiac contractility (inotropic)- decrease CO- decrease renal perfusion- juxtaglomerular cell of
the kidney releases renin- RAAS
DHN- water deficit- decrease renal perfusion- RAAS
 SIADH- increase ADH- more water, less Na- Dilutional Hyponatremia

30. Which of the following disease condition can least likely lead to hypernatrmia?
a. Cushing’s disease c. Diabetes Inspidus
b. Addison’s disease d. Dehydration
Cushing- increase aldosterone- increase Na
DI- less water, more Na
DHN- water deficit: less water, more Na
Addisons- decrease aldosterone- decrease Na
31. A client diagnosed with hypomagnesemia was rushed to the hospital, during assessment the nurse notes which of the
following expected manifestations?
a. diminished DTR b. constipation c. hypertension d. hyporeflexia
decrease Mg- decrease control- more Ach muscle- NM excitability
Mg- potent vasodilator: decrease Mg- vasoconstriction- increase BP
32. When the person’s blood pressure drops, the kidney responds by:
a. secreting renin c. Producing aldosterone
b. activating Vitamin D d. secreting ANP
ANP- atrial natriuretic peptide (heart)
Aldosterone- adrenal cortex: 3 layers
Zona glumerulosa- mineralocorticoid- aldosterone- SALT
Zona fasciculata- glucocorticoid- cortisol- SUGAR
Zona reticularis- androgen- SEX
Vitamin D- calcium absorption in the GI tract
Renin- produced in the juxtaglomerular of the kidneys
33. A construction worker labors outside and sweats profusely. What hormone will his body release in large quantities to
help him retain water?
a. insulin b. ADH c. renin d. cortisol
insulin- carries glucose to the cell
renin- RAAS
cortisol- gluconeogenesis/ glycogenolysis
ADH- water reabsorption the kidney tubules
- Produced by the hypothalamus, stored and released by the PPG
34. The amount of total body fluid is affected by all of the ff. EXCEPT:
a. Gender b. Body fat d. Race
c. Age
Gender: Adult male- 60% of the weight- fluid
Adult female- 50% of the weight- fluid

Body Fats- holds less water

Skeletal muscle cell- holds more water

Age:
- Preterm neonate- 90% of the weight- water
- Full term neonate- 80%
- Infant- 70%
- Child (5)- 65%
- Adult- 60%
- Elderly- 45- 50%
35. CSF and pleural fluids are considered as:
a. Interstitial fluid c. Transcellular fluid
b. Intracellular fluid d. Intravascular fluid
Body Compartment:
IC- 2/3 of the body fluid, 28 L in a 70kg adult
EC- 1/3 of the body fluid, 14 L
Interstitial- spaces between cells, 10- 11 L
Intravascular- inside the blood vessel- blood- plasma- 3L
Transcellular- inside the body cavities, 1L
o Eyeballs- aqueous, vitreous
o Inner ear- endolymph and prelymph
o CNS- CSF
o Lungs (pleural cavity)- pleural fluid
o heart- pericardial fluid
o joints- synovial fluid
36. In a 70 kilogram male, the approximate amount of total body fluid is around:
a. 28L b. 42L c. 55L d. 15L
IC- 28L + EC- 14 L= 42L (60% of the body weight)
37. Fluid volume deficit can occur in cases of diarrhea, vomiting, burns, and diabetes insipidus. The nurse must monitor
the client for clinical manifestations of hypovolemia, which includes:
 a. Postural hypotension c. Capillary refill of 3 seconds
b. Increased CVP d. Bounding pulse
38. In a client with hypovolemia due to severe diarrhea and vomiting, which of the ff is/are expected laboratory test
result?
a. Low specific gravity of urine c.High hematocrit
b. Poor skin turgor d. Low CVP
A-urine is diluted – Hypervolemia
B- DHN- Hypovolemia
D- Hypovolemia
C- concentrated blood- hemoconcentration- increased Hct level- LABORATORY
Situation - Basic knowledge on fluid imbalances and intravenous solutions is necessary for care of clients with problems
with fluids and electrolytes.
39. A nurse is assigned to care for a group of clients. On review of the clients’ medical records, the nurse determines that
which client is at risk for deficient fluid volume?
A. A client with colostomy C. A client with decreased kidney function
B. A client with congestive heart failure D. A client receiving frequent wound irrigation
D- introduce fluid – hypervolemia
C- fluid retention- hypervolemia
B- CHF- RAAS- hypervolemia
40. The nurse is making initial rounds on the nursing unit to assess the condition of assigned clients. The nurse notes
that the client’s IV is cool, pale and swollen and the solution is not infusing. The nurse concludes that which of the
following complications has been experienced by the client?
A. Infection B. Phlebitis C. Infiltration D. Thrombophelibitis
A-inflammation- warm
B- itis- warm
D- itis- warm
Infiltration- cold

41. An elderly patient is scheduled for radiographic tests, which require cleansing enema and fasting for eight hours.
During this period, which of these nursing diagnoses is MOST important to include in the patient’s care plan?
A. High risk for impaired skin integrity. D. Alteration in nutrition (more than body
B. Bowel incontinence requirements)
C. High risk for fluid volume deficit
42. When evaluating an elderly client for fluid volume imbalance, which of the following is the LEAST reliable indicator?
A. fluid intake and output C. daily body weight
B. skin turgor D. urine specific gravity
Situation – Since electrolyte imbalances are common, the nurse must understand the underlying causative disorders to
help clients achieve the most positive health outcome.
43. To determine if a patient has symptoms of hyperkalemia, which of these assessments would provide the MOST
accurate information?
A. Test the patient’s patellar reflex C. Evaluate the patient’s heart rhythm
B. Auscultate the patient’s abdomen D. Take the patient’s blood pressure
44. The nurse evaluates which of the following clients to be at risk for developing hypernatremia?
A. 62-year-old with congestive heart failure taking loop diuretics
B. 50-year-old with pneumonia, diaphoresis, and high fever
C. 39-year-old with diarrhea and vomiting
D. 60-year-old with lung cancer and SIADH
A- diuretics- excretion of electrolyte- HypoN
B-increase insensible fluid-less water, more Na- HyperN
C- GI losses- HypoN
D- Lung Cancer- Small Cell Lung Carcinoma- ability to secrete ADH- SIADH- dilutional hypoN
45. A client is receiving an intravenous magnesium infusion to correct a serum level of 1.4 mEq/L. Which of the following
assessments would alert the nurse to immediately stop the infusion?
A. diarrhea C. premature ventricular contractions
B. absent patellar reflex- DTR D. increase in blood pressure
Mg toxicity- NM depression
46. The nurse is caring for a bedridden client admitted with multiple myeloma and a serum calcium level of 13 mEq/dL.
Which of the following is the MOST appropriate nursing action?
A. Provide passive ROM exercises and encourage fluid intake.
B. Teach the client to increase intake of green leafy vegetables.
C. Place a tracheotomy tray at the bedside.- laryngospasm - HypoCa
D. Administer calcium gluconate IM as ordered.
47. An older adult admitted with heart failure and a sodium level of 113 mEq/L is behaving aggressively towards the staff
and does not recognize family members. When the family expresses concern about the client’s behaviour, the nurse
would respond MOST appropriately by stating
A. “The client may be suffering from dementia, and the hospitalization has worsened the confusion.”
B. “Older adults get confused in the hospital.”
 C. “The sodium level is low, and confusion will resolve as levels normalize.”
D. “The sodium level is high and the behaviour is a result of dehydration.”
K- Kardiac
Na- Neurologic

48. A client with serum sodium of 115 mEq/L has been receiving 3% NS at 50 mL/hour for 16 hours. This morning the
client feels tired and short of breath. Which of the following interventions apply?
A. turn down the infusion C. assess for signs of fluid overload
B. check the latest sodium level D. place a call to the physician
49. When the post-cardiac surgery patient demonstrates restlessness, nausea, weakness, and peaked T waves, the nurse
reviews the patient's serum electrolytes anticipating which abnormality?
A. hyperkalemia C. hypomagnesemia
B. hypercalcemia D. hyponatremia

Phosphorus: 2.5 – 4.5 mg/dl

major intracellular anion
IC osmolality- concentration
Bone formation- mineralization (P and Ca)
Essential component of RNA and DNA
ENERGY- ATP- Adenosine Triphosphate
Protects RBC from lysis- component of G6PD
o Glucose 6- Phosphate Dehydrogenase Deficiency- lysis of RBC
o G6PD- protects the RBC
P and Ca: blood- inversely proportional