NCLEX Practice Exam for Fluids, Electrolytes & Homeostasis 2

EXPLANATION

 

✔Correct answer:

Antidiuretic Hormone (ADH) and Aldosterone. The regulation of sodium levels in the body is primarily influenced by the hormones Antidiuretic Hormone (ADH) and Aldosterone. ADH, released by the posterior pituitary gland, helps the kidneys reabsorb water, which indirectly affects sodium concentration by altering the volume of fluid in which sodium is dissolved. Aldosterone, released by the adrenal cortex, directly influences the reabsorption of sodium in the renal tubules. When sodium is reabsorbed, water follows, helping to maintain both sodium and fluid balance in the body.

Think of your body as a swimming pool. ADH is like the pool cover that prevents water from evaporating, keeping the water level stable. Aldosterone is like the pool's filtration system, selectively keeping what's needed (sodium) and getting rid of what's not (potassium). Both systems work together to keep the pool's water level and salt concentration balanced.

When sodium levels are low or when there is a decrease in blood volume or blood pressure, the renin-angiotensin-aldosterone system is activated. This leads to the secretion of aldosterone, which prompts the kidneys to reabsorb more sodium and excrete potassium. ADH works in tandem by making the kidneys more permeable to water, allowing more water to be reabsorbed back into the bloodstream, thus concentrating the urine and diluting the blood.

 

✘Incorrect answer options:

Vasopressin (ADH) and Follicle-Stimulating Hormone (FSH). FSH is primarily involved in the regulation of the reproductive system and has no direct role in sodium homeostasis. While ADH does play a role, FSH does not, making this option incorrect.

Progesterone alongside aldosterone. Progesterone is a hormone involved in the menstrual cycle and pregnancy and does not have a direct role in sodium regulation. Aldosterone does play a role, but progesterone does not.

Extracellular Fluid (ECF) levels and Adrenocorticotropic Hormone (ACTH). ACTH stimulates the release of cortisol, not aldosterone, and is not directly involved in sodium regulation. ECF levels are a result of sodium regulation, not a hormonal regulator.

 

References

• Lewis, S. L., Bucher, L., Heitkemper, M. M., & Harding, M. (2017). Medical-Surgical Nursing: Assessment and Management of Clinical Problems. Elsevier.
• Ignatavicius, D. D., Workman, M. L., & Rebar, C. R. (2018). Medical-Surgical Nursing: Concepts for Interprofessional Collaborative Care. Elsevier.

EXPLANATION

 

✔Correct answer:

High risk for injury due to confusion. Hypocalcemia, or low levels of calcium in the blood, can lead to a variety of symptoms, including muscle spasms, tingling in the extremities, and confusion. The confusion can be particularly concerning because it increases the patient's risk for injury. For example, the patient may be disoriented and have difficulty navigating their environment, leading to falls or other accidents.

Imagine walking through a maze with foggy glasses. The foggy glasses represent the confusion caused by low calcium levels. You're more likely to bump into walls or trip over obstacles because your vision is impaired. Similarly, Julia's confusion due to hypocalcemia makes it more challenging for her to navigate her environment safely, increasing her risk for injury.

Calcium plays a crucial role in nerve function and signal transmission. When calcium levels are low, it can disrupt the normal functioning of the nervous system, leading to symptoms like confusion. This disruption can impair the patient's cognitive function, making it difficult for them to make sound judgments and increasing the likelihood of accidents or injuries.

 

✘Incorrect answer options:

Elevated risk for injury related to bleeding. While calcium does play a role in the blood clotting process, hypocalcemia is not primarily associated with an elevated risk for bleeding-related injuries. Conditions like hemophilia or anticoagulant therapy are more likely to result in this nursing diagnosis.

Bowel constipation. Low calcium levels are not directly related to bowel constipation. Hypocalcemia primarily affects neuromuscular function and does not have a significant impact on bowel movements or gastrointestinal motility.

Ineffective airway clearance. Hypocalcemia can cause muscle spasms and tingling but is not directly associated with respiratory issues that would lead to ineffective airway clearance. Conditions like asthma or chronic obstructive pulmonary disease (COPD) are more likely to result in this nursing diagnosis.

 

References

• Carafoli, E., & Krebs, J. (2016). Why Calcium? How Calcium Became the Best Communicator. The Journal of Biological Chemistry, 291(40), 20849–20857.
• Cooper, M. S., & Gittoes, N. J. (2008). Diagnosis and management of hypocalcaemia. BMJ, 336(7656), 1298-1302.

EXPLANATION

 

✔Correct answer:

Irregular heartbeats or cardiac arrhythmias. Hypermagnesemia, or elevated levels of magnesium in the blood, can have a profound impact on cardiac function. One of the most concerning symptoms is cardiac arrhythmias, which are irregular heartbeats. Magnesium plays a role in the electrical activity of the heart, and elevated levels can disrupt the normal rhythm, leading to arrhythmias. This can be particularly dangerous and requires immediate medical attention, as it can lead to more severe cardiac events or even cardiac arrest if not managed promptly.

Imagine the heart as a well-orchestrated musical band, with each musician (cell) playing their part to create a harmonious melody (heartbeat). Magnesium acts like the conductor, ensuring everyone keeps time. If the conductor starts making erratic gestures (hypermagnesemia), the band's rhythm gets disrupted, leading to a chaotic performance (arrhythmias).

Magnesium is a crucial electrolyte that acts as a cofactor for many enzymatic reactions in the body, including those that regulate muscle and nerve function. In the heart, magnesium stabilizes the electrical activity across cell membranes. Elevated levels of magnesium can depress the excitability of these membranes, leading to a slowing down of electrical impulses, which can manifest as arrhythmias.

 

✘Incorrect answer options:

Increased heart rate or tachycardia. Hypermagnesemia is more likely to cause bradycardia, or a slower heart rate, rather than tachycardia. Elevated magnesium levels can depress the electrical activity of the heart, making tachycardia unlikely.

Elevated blood pressure or hypertension. Hypermagnesemia generally leads to vasodilation and could potentially cause hypotension, or low blood pressure, rather than hypertension.

Overactive deep-tendon reflexes. Elevated magnesium levels are more likely to cause decreased deep-tendon reflexes or even their absence, rather than making them overactive. This is because magnesium acts as a natural calcium blocker, inhibiting muscle contractions.

 

References

• Ignatavicius, D. D., Workman, M. L., & Rebar, C. R. (2017). Medical-Surgical Nursing: Concepts for Interprofessional Collaborative Care. Elsevier.
• Marieb, E. N., & Hoehn, K. (2018). Human Anatomy & Physiology. Pearson.

EXPLANATION

 

✔Correct answer:

Osmosis. Osmosis is the term that describes the net movement of water molecules from an area of higher concentration to an area of lower concentration through a semipermeable membrane. In the context of intravenous fluids, understanding osmosis is crucial because it helps healthcare providers select the appropriate type of fluid that will most effectively restore cellular hydration. For example, a hypotonic solution might be used to encourage water to move into the cells, thereby rehydrating them.

Imagine you have two rooms separated by a door that only allows dogs to pass through. If you put 10 dogs in one room and only 2 in the other, some dogs from the crowded room will want to move to the less crowded room through the door, seeking more space and comfort. Similarly, in osmosis, water molecules move through a semipermeable membrane (the "door") from an area of higher concentration (the "crowded room") to an area of lower concentration (the "less crowded room") to achieve balance.

Cell membranes are semipermeable, meaning they allow certain substances to pass through while blocking others. Water molecules can freely move through these membranes. In a clinical setting, understanding how osmosis works is essential for managing fluid balance in patients, especially those who have undergone surgery or are critically ill. The type of intravenous fluid chosen can either hydrate the cells, remain in the extracellular fluid, or even draw water out of the cells, depending on its osmolarity compared to the body's fluids.

 

✘Incorrect answer options:

Brownian motion. Brownian motion refers to the random movement of particles suspended in a fluid. While it involves movement, it is not the same as the directed movement of water molecules from a higher to a lower concentration.

Filtration. Filtration is the process by which particles are removed from a fluid by passing it through a filter. In the body, this occurs in places like the kidneys, but it is not the process responsible for the movement of water across cell membranes to restore cellular hydration.

Diffusion. Diffusion is a broader term that refers to the movement of molecules from an area of higher concentration to an area of lower concentration. While osmosis is a type of diffusion, the term specifically applies to the movement of water molecules, making it the most accurate answer for this question.

 

References

• Lewis, S. L., Dirksen, S. R., Heitkemper, M. M., Bucher, L., & Camera, I. M. (2017). Medical-Surgical Nursing: Assessment and Management of Clinical Problems. Elsevier Health Sciences.
• Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-Surgical Nursing: Concepts for Interprofessional Collaborative Care. Elsevier Health Sciences.

EXPLANATION

 

✔Correct answer:

Elevated levels of breathing and perspiration. Marathon runners like Tim are at an increased risk for fluid volume deficit (FVD) primarily due to elevated levels of breathing and perspiration. When Tim runs long distances, his body's metabolic rate increases, leading to higher rates of breathing and sweating. Both of these processes result in the loss of fluids and electrolytes, which can quickly lead to dehydration if not adequately replaced. This is why it's crucial for athletes to hydrate before, during, and after physical exertion to maintain fluid balance.

Think of Tim's body as a car engine running a long race. The engine heats up and needs coolant (fluids) to keep it from overheating. If the coolant runs low because it's being used up too quickly (through sweating and breathing), the engine risks overheating and breaking down (fluid volume deficit).

The human body maintains fluid balance through various physiological mechanisms, including the kidneys, which filter and reabsorb fluids, and the sweat glands, which release fluids to cool the body. When Tim runs, his body's need for oxygen increases, leading to faster breathing rates. His body also produces more heat, which is dissipated through sweating. Both of these physiological responses contribute to fluid loss, making him more susceptible to FVD.

 

✘Incorrect answer options:

An underlying disease process. While underlying diseases can contribute to fluid imbalances, there's no indication that Tim has an underlying disease affecting his fluid balance. His risk is primarily due to his physical activity.

Lowered diuresis rates. Lowered diuresis rates would actually reduce the risk of fluid volume deficit, as less fluid would be lost through urination. In Tim's case, the risk comes from increased fluid loss, not decreased fluid excretion.

Reduced rates of breathing and perspiration. Reduced rates of breathing and perspiration would likely decrease the risk of fluid volume deficit, as less fluid would be lost. Tim's risk is elevated due to increased rates of these processes.

 

References

• Potter, P. A., Perry, A. G., Stockert, P., & Hall, A. (2016). Fundamentals of Nursing. Elsevier.
• Smeltzer, S. C., & Bare, B. G. (2018). Brunner & Suddarth's Textbook of Medical-Surgical Nursing. Wolters Kluwer.

EXPLANATION

 

✔Correct answer:

Bicarbonate. When chloride levels are low, as in Mia's case, bicarbonate reabsorption in the kidneys tends to increase proportionately. This is because chloride and bicarbonate often engage in an exchange process in the renal tubules. When chloride is low, bicarbonate ions are reabsorbed back into the bloodstream instead of being excreted in the urine. This can have implications for acid-base balance, as increased bicarbonate levels can lead to a more alkaline (higher pH) state. For Mia, who has a history of congestive heart failure, understanding this relationship is crucial for managing her condition, as heart failure patients are often at risk for electrolyte and acid-base imbalances.

Imagine a seesaw where chloride and bicarbonate are sitting on opposite ends. If chloride (one end of the seesaw) goes down, bicarbonate (the other end) goes up. They are inversely related in this balancing act. When there's less chloride available to be on the "seesaw," bicarbonate takes the opportunity to rise, affecting the overall balance.

The kidneys are the primary regulators of electrolyte and acid-base balance in the body. They achieve this through various mechanisms, including ion exchange processes in the renal tubules. When chloride levels are low, the kidneys compensate by increasing the reabsorption of bicarbonate ions, which can subsequently affect the body's pH levels. This is particularly important in the context of congestive heart failure, where fluid and electrolyte imbalances are common and can have significant clinical implications.

 

✘Incorrect answer options:

Potassium. While potassium is an important electrolyte that is regulated by the kidneys, it is not directly affected by low chloride levels in the manner described. Potassium levels are more closely related to sodium levels and are regulated by hormones like aldosterone.

Sodium. Sodium and chloride often go hand in hand in terms of reabsorption, but low chloride levels do not necessarily lead to increased sodium reabsorption. Sodium reabsorption is more directly influenced by hormones like aldosterone and natriuretic peptides.

Hydrogen. Hydrogen ions are important for acid-base balance, but their reabsorption is not directly influenced by low chloride levels. Hydrogen ion concentration is more directly affected by mechanisms that regulate pH, such as the bicarbonate buffer system.

 

References

• Guyton, A. C., & Hall, J. E. (2016). Textbook of Medical Physiology. Elsevier.
• Sherwood, L. (2015). Human Physiology: From Cells to Systems. Cengage Learning.

EXPLANATION

 

✔Correct answer:

The role of Vitamin D. Vitamin D plays a pivotal role in the absorption of calcium from the gastrointestinal tract. When you consume calcium-rich foods, the presence of Vitamin D helps to increase the efficiency of calcium absorption in the small intestine. Specifically, Vitamin D enhances the expression of proteins that are involved in the active transport of calcium ions across the intestinal epithelial cells, thereby facilitating its absorption into the bloodstream.

Imagine calcium as a VIP guest at an exclusive event, and Vitamin D as the special access pass that allows the guest to enter more easily. Without the access pass (Vitamin D), the VIP guest (calcium) would find it difficult to get into the event (be absorbed into the body), missing out on all the fun activities (physiological processes like bone formation).

Vitamin D undergoes two hydroxylation processes in the liver and kidneys to become its active form, calcitriol. Calcitriol then acts on the small intestine to increase the synthesis of calbindin, a calcium-binding protein that aids in the transport of calcium through the intestinal cells and into the bloodstream. This is crucial for maintaining calcium homeostasis, which is vital for bone health, nerve function, and muscle contractions.

 

✘Incorrect answer options:

Influence of Vitamin C. While Vitamin C is essential for various bodily functions like immune response and collagen synthesis, it does not play a direct role in calcium absorption. Vitamin C is more involved in the absorption of iron and has no significant impact on how calcium is absorbed in the gastrointestinal tract.

Presence of Hydrochloric Acid (HCl). Hydrochloric acid in the stomach aids in the digestion of food and the activation of digestive enzymes but does not directly facilitate calcium absorption. Its primary role is to create an acidic environment for the breakdown of proteins and other macromolecules.

Levels of Blood Glucose. Blood glucose levels have no direct relationship with calcium absorption. Glucose is primarily involved in providing energy for cellular functions and is regulated by hormones like insulin and glucagon. It does not influence the absorption of calcium in the gastrointestinal tract.

 

References

• Nordin, B. E. C. (2010). Calcium and osteoporosis. Nutrition, 16(7-8), 49-57.
• Holick, M. F. (2007). Vitamin D deficiency. New England Journal of Medicine, 357(3), 266-281.

EXPLANATION

 

✔Correct answer:

Engaging in the chloride shift process. Chloride plays a crucial role in maintaining acid-base balance through a process known as the chloride shift. This process occurs in red blood cells and involves the exchange of chloride ions (Cl-) and bicarbonate ions (HCO3-). When carbon dioxide (CO2) is transported to the lungs to be expelled, it first combines with water to form carbonic acid (H2CO3), which then dissociates into bicarbonate and hydrogen ions. The bicarbonate ions exit the red blood cells and enter the plasma, while chloride ions move into the red blood cells to maintain electrical neutrality. This chloride shift is essential for the efficient transport and elimination of CO2, a key factor in acid-base balance.

Imagine a dance floor where everyone needs a partner to maintain balance. Bicarbonate ions decide to leave the dance floor (red blood cells) to join the audience (plasma). To keep the dance floor balanced, chloride ions step in as replacement partners. This "partner swap" ensures that the dance floor remains balanced, just as the chloride shift helps maintain acid-base balance in the body.

The chloride shift is a vital physiological mechanism that enables the body to maintain its acid-base homeostasis. By facilitating the exchange of bicarbonate and chloride ions, it allows for the effective transport of CO2 from tissues to the lungs for elimination. This is especially important in conditions where acid-base imbalances may occur, such as chronic kidney disease, where the renal system's ability to regulate acid-base balance is compromised.

 

✘Incorrect answer options:

Stabilizing the balance of cations within the intracellular and extracellular fluid. While chloride does contribute to the overall ionic balance, its primary role in acid-base balance is not the stabilization of cations within fluids. Cations like sodium and potassium play a more direct role in this aspect.

Accompanying sodium to regulate serum osmolarity. Although chloride often accompanies sodium in regulating serum osmolarity, this is not its primary role in acid-base balance. Serum osmolarity is more about fluid balance rather than acid-base homeostasis.

Facilitating the disassociation of carbonic acid. Chloride does not directly facilitate the dissociation of carbonic acid. This process is primarily catalyzed by the enzyme carbonic anhydrase and results in the formation of bicarbonate and hydrogen ions.

 

References

• Costanzo, L. S. (2018). Physiology. Elsevier Health Sciences.
• Boron, W. F., & Boulpaep, E. L. (2016). Medical Physiology. Elsevier.

EXPLANATION

 

✔Correct answer:

Persistent diarrhea episodes. A significant reduction in bicarbonate levels is most commonly associated with persistent diarrhea episodes. Bicarbonate is an essential component of the body's buffering system, which helps maintain the acid-base balance. When a person experiences persistent diarrhea, the gastrointestinal tract loses not only water but also essential electrolytes, including bicarbonate. This loss can lead to metabolic acidosis, a condition characterized by an imbalance in the body's pH levels.

Think of bicarbonate as the baking soda in a recipe that keeps everything balanced. If you're continuously losing this "baking soda" (bicarbonate) due to persistent "spills" (diarrhea), the overall "recipe" (your body's pH balance) will be off, leading to a "sour" situation (metabolic acidosis).

In the case of persistent diarrhea, the large intestine doesn't get the chance to reabsorb water and bicarbonate effectively. This leads to a decrease in serum bicarbonate levels, disrupting the body's acid-base balance and potentially leading to metabolic acidosis. Immediate intervention is required to correct this imbalance, often involving fluid and electrolyte replacement therapy.

 

✘Incorrect answer options:

Profuse sweating or diaphoresis. Sweating primarily results in the loss of water and sodium, not bicarbonate. While sweating can lead to dehydration, it does not directly affect bicarbonate levels in the body.

Repeated vomiting incidents. Vomiting can actually lead to a loss of hydrochloric acid from the stomach, which might result in an increase in bicarbonate levels as the body tries to compensate for the loss of acid, leading to metabolic alkalosis, not acidosis.

Excessive urinary output or diuresis. Diuresis primarily affects levels of other electrolytes like sodium and potassium. While it can have an impact on acid-base balance, it's not the primary cause of a significant reduction in bicarbonate levels.

 

References

• Lewis, S. L., Bucher, L., Heitkemper, M. M., & Harding, M. (2017). Medical-Surgical Nursing: Assessment and Management of Clinical Problems. Elsevier.
• Ignatavicius, D. D., Workman, M. L., & Rebar, C. R. (2018). Medical-Surgical Nursing: Concepts for Interprofessional Collaborative Care. Elsevier.

EXPLANATION

 

✔Correct answer:

By altering the rate and depth of breathing. The respiratory system plays a critical role in maintaining the body's acid-base balance by adjusting the rate and depth of breathing. When the blood becomes too acidic (low pH), the respiratory center in the brain is stimulated to increase the rate and depth of breathing. This allows for more carbon dioxide (CO2) to be expelled from the lungs, effectively reducing the acidity of the blood. Conversely, if the blood becomes too alkaline (high pH), the respiratory rate and depth decrease, retaining more CO2 and thus increasing the acidity of the blood.

Think of the respiratory system as a ventilation system in a room filled with smoke (CO2). If the smoke level rises, making the air "acidic," the ventilation system speeds up to clear out the smoke. If there's too little smoke, making the air "alkaline," the ventilation system slows down to maintain a balance. Similarly, the respiratory system adjusts the rate and depth of breathing to keep the "air" (blood) in the body at just the right level of acidity or alkalinity.

The respiratory system's ability to alter breathing rate and depth is a rapid response mechanism for acid-base regulation. It can adjust the blood pH within minutes, making it a crucial first line of defense against acid-base imbalances. This is in contrast to the renal system, which also plays a role in acid-base balance but takes hours to days to effect a change.

 

✘Incorrect answer options:

Through the formation of bicarbonate. The formation of bicarbonate is not a direct function of the respiratory system. While bicarbonate is a crucial buffer in the blood, its formation and reabsorption are primarily renal functions.

By ramping up mucus production. Mucus production is not directly related to acid-base balance. While mucus serves important functions in trapping pathogens and aiding in their removal, it does not play a role in regulating the pH of the blood.

Through the reabsorption of bicarbonate. The reabsorption of bicarbonate is a renal function and not a responsibility of the respiratory system. The kidneys reabsorb bicarbonate to help neutralize acidic substances in the blood, but this is not a role played by the lungs.

 

References

• Costanzo, L. S. (2018). Physiology. Elsevier Health Sciences.
• West, J. B. (2015). Respiratory Physiology: The Essentials. Wolters Kluwer Health.

EXPLANATION

 

✔Correct answer:

A hypotonic solution offers free water, aiding in renal solute excretion. In cases of fluid volume deficit (FVD) like Maria's, especially following an episode of severe diarrhea, the primary concern is rehydration and electrolyte balance. Hypotonic solutions, such as 0.45% saline, are less concentrated than body fluids, which allows for the free movement of water into both the intracellular and extracellular spaces. This helps in rehydrating the cells and aids in renal solute excretion, which is particularly beneficial in cases where the kidneys may be stressed due to dehydration.

Imagine a garden where the soil is extremely dry and the plants are wilting. If you water the garden with a solution that is too concentrated with nutrients (like a hypertonic solution), you risk damaging the plants further. However, if you use plain water (akin to a hypotonic solution), it will be absorbed by the soil and reach the roots of the plants, helping them to perk up. Similarly, a hypotonic solution offers "free water" that can be easily absorbed by Maria's cells, helping her body to recover from dehydration.

The kidneys play a vital role in maintaining fluid and electrolyte balance. When the body is dehydrated, the kidneys may have to work harder to excrete waste products. A hypotonic solution provides free water, which not only helps in rehydration but also aids the kidneys in flushing out solutes, thereby reducing the workload on these vital organs.

 

✘Incorrect answer options:

A hypotonic solution delivers an abundance of sodium and chloride ions. This is incorrect because hypotonic solutions are actually low in sodium and chloride ions compared to isotonic solutions. Their primary purpose is to provide free water for cellular rehydration.

Hypotonic solutions are advised in large volumes immediately after surgery. This is not accurate. Hypotonic solutions are generally not recommended immediately post-surgery due to the risk of causing cellular edema.

A hypotonic solution is employed to manage low sodium levels in the blood. This is incorrect. Hypotonic solutions can actually exacerbate low sodium levels (hyponatremia) and are generally not used for this purpose.

 

References

• Lewis, S. L., Dirksen, S. R., Heitkemper, M. M., Bucher, L., & Camera, I. M. (2017). Medical-Surgical Nursing: Assessment and Management of Clinical Problems. Elsevier Health Sciences.
• Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-Surgical Nursing: Concepts for Interprofessional Collaborative Care. Elsevier Health Sciences.

EXPLANATION

 

✔Correct answer:

Reduced levels of serum potassium. Metabolic alkalosis is characterized by an elevated pH and bicarbonate levels in the blood. One of the key clinical manifestations to look out for in metabolic alkalosis is hypokalemia, or reduced levels of serum potassium. This occurs because the body tries to compensate for the elevated pH by moving hydrogen ions out of the cells and into the bloodstream. To maintain ionic balance, potassium ions move into the cells, leading to a decrease in serum potassium levels.

Imagine your body as a busy kitchen where the chefs are trying to make a balanced dish. If they suddenly find that the dish is too spicy (alkaline), they might try to balance it by adding some sweetness (acid). In doing so, they might use up all the sugar available in the kitchen (potassium in the blood), making it scarce. Just like the chefs would look for more sugar, as a nurse, you'd be on the lookout for reduced levels of serum potassium in Lisa's blood tests.

Potassium plays a vital role in cellular function, including the maintenance of electrical gradients in neurons and muscle cells. Reduced levels of serum potassium can lead to a range of symptoms, including muscle weakness, cramps, and even cardiac arrhythmias. Therefore, monitoring potassium levels is crucial in patients suspected of metabolic alkalosis, as it can have significant implications for cardiac and neuromuscular function.

 

✘Incorrect answer options:

Low blood pressure. While metabolic alkalosis can affect various systems, it is not directly associated with low blood pressure. Low blood pressure is more commonly seen in conditions like dehydration or sepsis.

Variability in urine production. Metabolic alkalosis does not typically cause variability in urine production. Conditions affecting urine output are more likely related to renal function or fluid balance, rather than acid-base imbalances.

Elevated central venous pressure (CVP). Elevated CVP is not a direct clinical manifestation of metabolic alkalosis. It is more commonly associated with conditions like heart failure or fluid overload.

 

References

• Lewis, S. L., Dirksen, S. R., Heitkemper, M. M., Bucher, L., & Camera, I. M. (2017). Medical-Surgical Nursing: Assessment and Management of Clinical Problems. Elsevier Health Sciences.
• Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-Surgical Nursing: Concepts for Interprofessional Collaborative Care. Elsevier Health Sciences.

EXPLANATION

 

✔Correct answer:

Chloride and Potassium. Persistent vomiting can lead to significant losses of chloride and potassium, both of which are essential electrolytes for various physiological functions. Chloride is crucial for maintaining acid-base balance, fluid balance, and osmotic pressure. Potassium is vital for heart function, muscle contractions, and nerve signaling. The loss of these electrolytes can lead to a range of complications, including cardiac arrhythmias, muscle weakness, and altered mental status. For John, who has been experiencing persistent vomiting due to a gastrointestinal infection, monitoring and replenishing these electrolytes will be a critical part of his nursing care.

Think of the body as a complex electrical circuit that requires specific "conductors" (electrolytes) to function correctly. Chloride and potassium are like copper and silver wires in this circuit. If you were to lose these essential wires (akin to vomiting), the electrical circuit (body) would start to malfunction, potentially leading to severe issues. Just like you'd urgently need to replace the missing wires in the circuit, John's body urgently needs to replenish its lost chloride and potassium to prevent complications.

Chloride and potassium are involved in maintaining the body's acid-base balance and cellular membrane potential. Chloride often works in tandem with sodium to regulate the osmotic pressure between compartments. Potassium is essential for the sodium-potassium pump, an essential cellular mechanism that maintains the electrical gradient across cell membranes, necessary for nerve impulse transmission and muscle contraction. When vomiting occurs, the loss of these electrolytes disrupts this delicate balance, leading to a host of potential issues that can be life-threatening if not promptly addressed.

 

✘Incorrect answer options:

Calcium and Potassium. While potassium is indeed lost during vomiting, calcium is not the primary electrolyte lost. Calcium imbalances are more commonly associated with conditions like hypoparathyroidism or vitamin D deficiency.

Calcium and Magnesium. Neither calcium nor magnesium are the primary electrolytes lost during vomiting. These are more commonly affected in other conditions like malabsorption syndromes or specific types of kidney diseases.

Phosphorus and Sodium. While sodium can be affected by vomiting, it is not the primary electrolyte lost. Phosphorus is also not primarily lost during vomiting and is more commonly affected in conditions like malabsorption or chronic kidney disease.

 

References

• Smeltzer, S. C., Bare, B. G., Hinkle, J. L., & Cheever, K. H. (2018). Brunner & Suddarth's Textbook of Medical-Surgical Nursing (14th ed.). Wolters Kluwer.
• McCance, K. L., & Huether, S. E. (2018). Pathophysiology: The Biologic Basis for Disease in Adults and Children (8th ed.). Elsevier.

EXPLANATION

 

✔Correct answer:

Consume more green vegetables. Green leafy vegetables like spinach, kale, and Swiss chard are excellent sources of magnesium. Magnesium is an essential mineral that plays a vital role in various physiological functions, including muscle and nerve function, bone health, and energy production. Given Sara's chronic fatigue, increasing her magnesium intake could potentially help improve her symptoms. Magnesium is also involved in the synthesis of DNA, RNA, and the antioxidant glutathione, making it crucial for overall health.

Think of magnesium as the oil in a car's engine. Just like oil helps the engine run smoothly, magnesium helps our body's systems function more efficiently. If you don't have enough oil, the engine starts to wear down and doesn't perform well. Similarly, a lack of magnesium can lead to fatigue and other health issues. Green leafy vegetables are like the premium oil that keeps the engine in top condition.

Magnesium is the fourth most abundant mineral in the human body and is essential for over 300 biochemical reactions. It helps maintain normal nerve and muscle function, supports a healthy immune system, keeps the heartbeat steady, and helps bones remain strong. It also helps regulate blood glucose levels and aids in the production of energy and protein. Therefore, incorporating more green vegetables into Sara's diet would be a beneficial step in managing her chronic fatigue.

 

✘Incorrect answer options:

Spread butter on her toast. Butter is primarily a source of saturated fats and does not contain significant amounts of magnesium. While it may add flavor to her toast, it won't help in increasing her magnesium levels, which is the primary goal for managing her chronic fatigue.

Incorporate cheese into her meals. Cheese is a good source of calcium and protein but is not particularly high in magnesium. While it can be part of a balanced diet, it should not be the primary source for someone looking to increase their magnesium intake.

Add tomatoes to her salads. Tomatoes are a good source of vitamins like vitamin C and other antioxidants but are not particularly rich in magnesium. While they can be a healthy addition to a balanced diet, they won't significantly contribute to increasing magnesium levels.

 

References

• Gropper, S. S., Smith, J. L., & Groff, J. L. (2009). Advanced Nutrition and Human Metabolism. Wadsworth, Cengage Learning.
• Lutz, C. A., Przytulski, K. R., & Rutherford, J. (2011). Nutrition and Diet Therapy. F.A. Davis Company.

EXPLANATION

 

✔Correct answer:

Aldosterone. Aldosterone plays a significant role in the reabsorption of chloride ions, particularly in the renal system. This hormone is secreted by the adrenal glands and acts on the renal tubules, promoting the reabsorption of sodium ions. As sodium ions are reabsorbed, chloride ions often follow passively due to the electrical attraction between the two ions. This process helps to maintain electrolyte balance and blood pressure, which is particularly important for patients like Jack who have hypertension and are on diuretic therapy.

Think of aldosterone as a magnet that attracts sodium ions back into the bloodstream from the renal tubules. As these sodium ions are pulled back, chloride ions, being negatively charged, naturally follow the positively charged sodium ions due to their electrical attraction, much like metal filings sticking to a magnet. This "magnetic pull" helps to keep the electrolyte balance in check.

The regulation of chloride reabsorption via aldosterone is a key physiological mechanism that maintains both electrolyte balance and blood volume. For patients on diuretic therapy, understanding this mechanism is crucial as diuretics often affect sodium and, consequently, chloride reabsorption. Monitoring levels of aldosterone and understanding its role can guide adjustments in diuretic therapy and help manage potential electrolyte imbalances.

 

✘Incorrect answer options:

Estrogen. Estrogen does not play a direct role in the reabsorption of chloride ions. While it may have some impact on fluid and electrolyte balance, particularly in women, its primary functions are related to the reproductive system and secondary sexual characteristics.

Renin. Renin is involved in the renin-angiotensin-aldosterone system, which ultimately leads to the secretion of aldosterone. However, renin itself does not directly affect the reabsorption of chloride ions. It acts more as a trigger for a cascade of events that eventually involve aldosterone.

Antidiuretic Hormone (ADH). Antidiuretic Hormone (ADH) primarily affects water reabsorption in the kidneys by making the renal tubules more permeable to water. While it plays a role in fluid balance, it does not directly influence the reabsorption of chloride ions.

 

References

• Guyton, A. C., & Hall, J. E. (2016). Textbook of Medical Physiology. Elsevier.
• Sherwood, L. (2015). Human Physiology: From Cells to Systems. Cengage Learning.

EXPLANATION

 

✔Correct answer:

Potassium. Intracellular fluid (ICF) is the fluid within cells and constitutes about two-thirds of the body's total water content. The major cation (positively charged ion) in the ICF is potassium (K+). Potassium plays a crucial role in cellular functions such as maintaining resting membrane potential, transmitting electrical impulses in nerve cells, and regulating muscle contractions.

Imagine the cell as a tiny factory. Just like electricity is essential for running machines in a factory, potassium is essential for the cell's "machinery" to function properly. Without enough potassium, the cell can't do its job effectively.

Potassium is vital for the function of all living cells and is crucial for maintaining the electrical balance across cell membranes. It is involved in the Na+/K+ pump, which helps maintain the resting membrane potential and is essential for the function of neurons and muscle cells, including the cardiac muscle.

 

✘Incorrect answer options:

Phosphorus. Phosphorus is an important anion in the ICF, but it is not the major cation. It is involved in the formation of ATP and nucleic acids.

Magnesium. Magnesium is present in the ICF but not in as high concentrations as potassium. It plays a role in enzymatic reactions and stabilizes the structure of nucleic acids and ribosomes.

Sodium. Sodium is the major cation in the extracellular fluid (ECF), not the ICF. The Na+/K+ pump actively transports sodium out of the cell, maintaining a low intracellular concentration.

 

References

• Marieb, E. N., & Hoehn, K. (2018). Human Anatomy & Physiology (11th ed.). Pearson.
• McCance, K. L., & Huether, S. E. (2018). Pathophysiology: The Biologic Basis for Disease in Adults and Children (8th ed.). Elsevier.

EXPLANATION

 

✔Correct answer:

Serum protein levels. Calcium levels in the blood are often influenced by the levels of serum proteins, particularly albumin. Albumin is the most abundant protein in the blood and serves as a carrier for various substances, including calcium. A significant portion of the calcium in the blood is bound to albumin, while the rest is ionized or free, which is the biologically active form. Therefore, when interpreting calcium levels, it's crucial to also consider serum protein levels to get an accurate picture of the patient's calcium status.

Imagine calcium as passengers on a bus, and albumin as the bus itself. If there are fewer buses (low albumin levels), then even if the number of passengers (calcium levels) appears normal, you might actually have an imbalance because not all passengers have a bus to ride on. Therefore, you need to know the number of buses to accurately assess if you have the right number of passengers.

The relationship between calcium and albumin is essential for various physiological processes, including blood clotting, muscle contraction, and nerve transmission. When albumin levels are low, the total calcium levels may appear low as well, even though the ionized calcium levels may be within the normal range. This is why many clinicians adjust the total calcium level based on the albumin level using a formula to get a more accurate measure of the body's calcium status.

 

✘Incorrect answer options:

Blood fats. While blood fats or lipids are important for many physiological processes, they do not have a direct relationship with calcium levels. Lipids are more related to metabolic syndromes, cardiovascular diseases, and other conditions but do not influence calcium levels directly.

Sodium concentration. Sodium is an essential electrolyte that maintains fluid balance and is crucial for nerve and muscle function. However, sodium levels do not have a direct impact on calcium levels. Both are regulated through different mechanisms and pathways, making it unnecessary to consider sodium concentration when interpreting calcium levels.

Blood glucose levels. Blood glucose levels are critical for diagnosing and managing conditions like diabetes mellitus but do not have a direct relationship with calcium levels. Calcium and glucose are regulated by different hormones and metabolic pathways, so glucose levels are not typically considered in the context of calcium levels.

 

References

• Payne, R. B., Little, A. J., Williams, R. B., & Milner, J. R. (1973). Interpretation of serum calcium in patients with abnormal serum proteins. British Medical Journal, 4(5893), 643-646.
• Thode, J., Fogh-Andersen, N., & Siggaard-Andersen, O. (1990). Ionized calcium analyzer with a new design. Clinical Chemistry, 36(8), 1449-1453.

EXPLANATION

 

✔Correct answer:

Slowing down the respiratory rate. Metabolic alkalosis is a condition where the body has an excess of bicarbonate ions (HCO3-) or a deficiency of hydrogen ions (H+), leading to an increase in blood pH. The body's natural compensatory mechanism for metabolic alkalosis is to slow down the respiratory rate. By doing so, the body retains more carbon dioxide (CO2), which combines with water to form carbonic acid (H2CO3). This acid dissociates into bicarbonate and hydrogen ions, helping to lower the pH and counteract the alkalosis.

Imagine you're trying to balance two baskets of apples and oranges. If you have too many oranges (representing alkalinity), you'd naturally want to add more apples (representing acidity) to even things out. In Emily's case, her body is "adding more apples" by slowing down her breathing to keep more CO2 (acidic component) in her system, attempting to balance the excess of bicarbonate (alkaline component).

In metabolic alkalosis, the kidneys usually try to excrete more bicarbonate ions to restore balance. However, the respiratory system also plays a crucial role in acid-base homeostasis. When the body detects elevated pH levels, chemoreceptors in the medulla oblongata and carotid bodies signal the respiratory center to decrease the rate and depth of respiration. This leads to an increase in PaCO2, which in turn increases the level of carbonic acid, helping to bring the pH back to a more balanced state.

 

✘Incorrect answer options:

Speeding up the respiratory rate. Speeding up the respiratory rate would actually exacerbate the problem by causing respiratory alkalosis. This would lead to the exhalation of more CO2, further increasing the pH and making the metabolic alkalosis worse.

Enhancing urine output. Increasing urine output would not directly address the issue of metabolic alkalosis. In fact, it could potentially worsen the condition by causing further loss of electrolytes like potassium and chloride, which are often already low in metabolic alkalosis.

Reducing urine output. Reducing urine output is not a compensatory mechanism for metabolic alkalosis. The kidneys may try to excrete more bicarbonate ions, but reducing urine output would likely lead to fluid retention and exacerbate other underlying conditions, especially in a patient with chronic kidney disease like Emily.

 

References

• Lewis, S. L., Dirksen, S. R., Heitkemper, M. M., Bucher, L., & Camera, I. M. (2017). Medical-Surgical Nursing: Assessment and Management of Clinical Problems. Elsevier Health Sciences.
• Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-Surgical Nursing: Concepts for Interprofessional Collaborative Care. Elsevier Health Sciences.

EXPLANATION

 

✔Correct answer:

Loss of gastrointestinal fluids due to diarrhea. Isotonic fluid volume deficit (FVD) occurs when there is a proportional loss of water and electrolytes from the extracellular fluid compartment. One of the most common causes of isotonic FVD is the loss of gastrointestinal fluids due to conditions like diarrhea. In such cases, both water and electrolytes are lost in significant amounts, leading to a decrease in the overall volume of extracellular fluid. This can result in symptoms like dry mucous membranes, decreased skin turgor, and hypotension. For Mark, who has come into the emergency department with symptoms of dehydration, it would be essential to assess for any recent episodes of diarrhea or other gastrointestinal issues that could have led to this condition.

Think of the body's fluid balance as a well-balanced fish tank where both water and salts are essential for the fish (cells) to survive. If you were to suddenly remove a bucket of water along with the salts (akin to diarrhea), the balance would be disrupted, and the fish would struggle to survive. Just like you'd need to replace both water and salts to restore the fish tank's balance, Mark would need both fluids and electrolytes to recover.

The gastrointestinal system plays a vital role in maintaining fluid and electrolyte balance. When diarrhea occurs, the body loses its ability to reabsorb water and electrolytes in the intestines, leading to isotonic FVD. This can have a cascading effect on various physiological systems, including cardiovascular and renal systems, as they work harder to maintain homeostasis. Immediate intervention is often required to prevent severe complications like shock or acute kidney injury.

 

✘Incorrect answer options:

Dysfunction in the regulation of thirst. While a dysfunction in the regulation of thirst can lead to dehydration, it typically results in hypertonic FVD, where there is a greater loss of water compared to electrolytes, leading to increased osmolality.

Unperceived water loss during an extended fever. Extended fever can indeed lead to fluid loss through increased metabolic rate and perspiration. However, this usually results in hypertonic FVD because the loss is primarily water, not a balanced loss of water and electrolytes.

Insufficient intake of both fluids and electrolytes. While insufficient intake can lead to FVD, it is not typically isotonic in nature unless there is a balanced deficiency in the intake of both fluids and electrolytes, which is relatively rare compared to other causes like diarrhea.

 

References

• Potter, P. A., Perry, A. G., Stockert, P., & Hall, A. (2016). Fundamentals of Nursing (9th ed.). Elsevier.
• Lewis, S. L., Dirksen, S. R., Heitkemper, M. M., & Bucher, L. (2017). Medical-Surgical Nursing: Assessment and Management of Clinical Problems (10th ed.). Elsevier.

EXPLANATION

 

✔Correct answer:

Concentration of hydrogen. Acidosis is characterized by an increase in hydrogen ion concentration in the body, leading to a lower pH in the blood. Hydrogen ions are the primary determinant of acidity or alkalinity in a solution. In the context of acidosis, an excess of hydrogen ions means that the blood becomes more acidic. This can occur due to respiratory issues, where there is inadequate removal of CO2, or metabolic issues, where there is an accumulation of acids like lactic acid or ketones.

Think of hydrogen ions as the "sour" ingredient in a recipe. If you add too much of this sour ingredient, the whole dish becomes too acidic or sour. Similarly, when there's an excess of hydrogen ions in the blood, it turns the "dish" (the body's internal environment) too acidic, leading to acidosis.

The body has various mechanisms to regulate hydrogen ion concentration and maintain acid-base balance. These include the bicarbonate buffering system, respiratory regulation through the rate and depth of breathing, and renal regulation through the excretion or reabsorption of hydrogen ions. When these mechanisms are overwhelmed or compromised, it can lead to an imbalance like acidosis.

 

✘Incorrect answer options:

Involvement of chloride. While chloride is an important anion that often accompanies sodium in maintaining fluid balance, it is not a primary contributor to acidosis. Chloride imbalances are more associated with conditions like hyperchloremic acidosis, but the key factor there is still the concentration of hydrogen ions.

Inclusion of potassium. Potassium is crucial for cellular function, particularly in muscle and nerve cells, but it is not a direct contributor to acidosis. However, acidosis can affect potassium levels by causing a shift of potassium from cells into the bloodstream, potentially leading to hyperkalemia.

Presence of sodium. Sodium is primarily involved in regulating fluid balance and blood pressure. It does not directly contribute to the development of acidosis. Sodium imbalances are more likely to result in conditions like hypernatremia or hyponatremia.

 

References

• Adrogué, H. J., & Madias, N. E. (2012). The challenge of hyponatremia. The Journal of the American Society of Nephrology, 23(7), 1140-1148.
• Kraut, J. A., & Madias, N. E. (2010). Metabolic acidosis: pathophysiology, diagnosis and management. Nature Reviews Nephrology, 6(5), 274-285.

EXPLANATION

 

✔Correct answer:

Chronic alcohol abuse. Chronic alcohol abuse is a significant risk factor for hypophosphatemia, which is a condition characterized by low levels of phosphate in the blood. Alcohol affects the metabolism of phosphate in several ways. First, alcohol interferes with the absorption of phosphate from the gastrointestinal tract. Second, it leads to increased excretion of phosphate by the kidneys. Third, the metabolism of alcohol produces acidic byproducts that can lead to acid-base imbalances, further affecting phosphate levels.

Imagine your body as a car engine that needs oil (phosphate) to run smoothly. Chronic alcohol abuse is like using poor-quality oil or not putting in enough oil, causing the engine to run inefficiently and eventually break down. Just like how an engine needs oil for various functions, your body needs phosphate for bone health, nerve function, and muscle contractions.

Phosphate is essential for various physiological processes, including energy production in the form of adenosine triphosphate (ATP), bone mineralization, and acid-base balance. Chronic alcohol abuse disrupts these processes by affecting the homeostasis of phosphate. The result is muscle weakness, confusion, and other symptoms that Martin is experiencing.

 

✘Incorrect answer options:

Paget's disease of the bone. Paget's disease of the bone is characterized by excessive bone resorption and formation, leading to structurally disorganized bone. This condition often results in elevated levels of serum phosphate, not decreased levels. The increased bone turnover releases more phosphate into the bloodstream, making hypophosphatemia unlikely in this case.

Advanced liver cirrhosis. Advanced liver cirrhosis can lead to various electrolyte imbalances, but it is not commonly associated with hypophosphatemia. Liver cirrhosis primarily affects the metabolism of proteins and carbohydrates and the synthesis of clotting factors. While it can lead to malnutrition, which may indirectly affect phosphate levels, it is not a direct cause of low serum phosphate.

End-stage renal failure. End-stage renal failure is more likely to cause hyperphosphatemia, not hypophosphatemia. The kidneys play a crucial role in phosphate homeostasis, and their failure leads to decreased excretion of phosphate. As a result, phosphate accumulates in the body, leading to elevated serum phosphate levels rather than decreased levels.

 

References

• Lederer, E. (2014). Disorders of Phosphate Balance. In: Skorecki K, Chertow GM, Marsden PA, Taal MW, Yu ASL, eds. Brenner and Rector's The Kidney. 10th ed. Elsevier.
• Elisaf, M., & Siamopoulos, K. C. (1997). Fractional excretion of phosphate in normal subjects and in patients with hypophosphatemia or hyperphosphatemia. Renal Failure, 19(4), 443-449.

EXPLANATION

 

✔Correct answer:

0.9% Sodium Chloride. 0.9% Sodium Chloride, commonly known as Normal Saline, is an isotonic solution, meaning it has the same osmotic pressure as bodily fluids. When a patient like Jennifer comes in with dehydration, administering an isotonic solution helps to replenish lost fluids without causing a shift in water balance between the cells and the extracellular fluid. This is crucial for maintaining homeostasis and ensuring that cells neither swell nor shrink, which could lead to further complications.

Consider your body as a fish tank where the fish represent your cells. The water in the tank is like your body's fluids. If the water level drops too low (dehydration), you need to add more water. However, you can't just add any water; it needs to be treated to have the same salt concentration as the existing tank water. Using 0.9% Sodium Chloride (Normal Saline) is like adding treated water that matches the existing water conditions, ensuring the fish (cells) stay healthy and the tank environment remains stable.

Isotonic solutions like 0.9% Sodium Chloride are effective in treating dehydration because they replace lost fluids and electrolytes without altering the concentration of ions in the body. This is particularly important for maintaining the function of vital organs like the heart and kidneys. Sodium and chloride ions in the solution help in maintaining the osmotic balance and acid-base balance, which are often disrupted in dehydration.

 

✘Incorrect answer options:

0.45% Sodium Chloride. This is a hypotonic solution, meaning it has a lower osmotic pressure than bodily fluids. Administering this could cause cells to swell, leading to complications.

3% Sodium Chloride. This is a hypertonic solution with a higher osmotic pressure than bodily fluids. Using this could cause cells to shrink, leading to further dehydration at the cellular level.

Dextrose 10% in Water (D10%W). This is also a hypertonic solution. While it provides a quick source of energy in the form of glucose, it's not suitable for treating dehydration as it can draw water out of the cells.

 

References

• Adrogue, H. J., & Madias, N. E. (2000). Hypernatremia. The New England Journal of Medicine, 342(20), 1493-1499.
• Mount, D. B., & Zandi-Nejad, K. (2019). Fluid and Electrolyte Disturbances. In Harrison's Principles of Internal Medicine (20th ed., pp. 341-352). McGraw-Hill Education.

EXPLANATION

 

✔Correct answer:

Selective constriction of specific arteriolar segments within the nephron. Angiotensin II is a potent vasoconstrictor that plays a critical role in the regulation of blood pressure and fluid balance, particularly in the kidneys. In the context of renal physiology, angiotensin II selectively constricts the efferent arterioles within the nephron. This action increases the glomerular filtration pressure, thereby aiding in the filtration of blood through the glomerulus even when the overall blood pressure is low. For Emily, who has hypertension and suspected renal impairment, understanding the role of angiotensin II is crucial for her healthcare team. It can help them make informed decisions about her treatment, especially if medications like ACE inhibitors or angiotensin II receptor blockers are being considered.

Imagine the nephron as a water filtration plant and the arterioles as pipes bringing water in and out. Angiotensin II acts like a valve that can tighten one of the outgoing pipes (efferent arteriole), increasing the pressure inside the plant (glomerulus). This ensures that even if there's less water (blood) coming in, the plant can still effectively filter out impurities (waste products).

The renin-angiotensin-aldosterone system (RAAS) is a hormonal cascade that kicks in when the body senses low blood volume or low blood pressure. Renin, an enzyme released by the kidneys, converts angiotensinogen to angiotensin I, which is then converted to angiotensin II by the action of angiotensin-converting enzyme (ACE). Angiotensin II has multiple actions, including the constriction of blood vessels, stimulation of aldosterone release, and direct effects on the kidneys to retain sodium and water. In Emily's case, the role of angiotensin II could be particularly significant given her hypertension and potential renal impairment.

 

✘Incorrect answer options:

Promoting the secretion of progesterone into the renal tubules. Angiotensin II has no role in the secretion of progesterone into the renal tubules. Progesterone is a sex hormone that is not directly involved in renal water balance or blood pressure regulation.

Facilitating blood coagulation within the nephron. Angiotensin II does not facilitate blood coagulation within the nephron. Its primary role is in the regulation of blood pressure and fluid balance, not in the coagulation process.

Enabling the catalysis of calcium-rich nutrients within the kidney. Angiotensin II does not catalyze calcium-rich nutrients within the kidney. Its main functions are related to vasoconstriction and the regulation of sodium and water balance, rather than the metabolism of calcium or other nutrients.

 

References

• Marieb, E. N., & Hoehn, K. (2018). Human Anatomy & Physiology (11th ed.). Pearson.
• McCance, K. L., & Huether, S. E. (2018). Pathophysiology: The Biologic Basis for Disease in Adults and Children (8th ed.). Elsevier.

EXPLANATION

 

✔Correct answer:

The renal tubules. The renal tubules are the primary site for electrolyte reabsorption in the kidneys. They consist of the proximal convoluted tubule, the loop of Henle, and the distal convoluted tubule. Each of these segments has specialized cells that reabsorb various electrolytes like sodium, potassium, and calcium, among others. Hormones such as aldosterone and antidiuretic hormone (ADH) act on these tubules to regulate electrolyte balance, making them crucial in maintaining homeostasis.

Think of the renal tubules as a series of specialized conveyor belts in a factory. Each belt (or segment of the tubule) has workers (cells) trained to pick up specific items (electrolytes) from the belt and place them back into circulation. If the conveyor belt isn't working correctly, the factory's output (in this case, balanced electrolytes) will be compromised.

The renal tubules are intricately involved in the reabsorption and secretion of various substances, including electrolytes. They work in conjunction with the glomerulus, which initially filters the blood. The filtrate then passes through the renal tubules, where electrolytes are selectively reabsorbed based on the body's needs. Hormones like aldosterone act on the distal convoluted tubule to increase sodium reabsorption, which indirectly influences the balance of other electrolytes like potassium and hydrogen ions.

 

✘Incorrect answer options:

The renal glomerulus. The glomerulus is primarily involved in the initial filtration of blood to form the glomerular filtrate. While it plays a crucial role in kidney function, it is not the site where electrolyte reabsorption occurs.

The urinary bladder. The urinary bladder is a storage organ for urine and does not play a role in electrolyte reabsorption. Its primary function is to store urine until it is eliminated from the body.

The renal pelvis. The renal pelvis is a funnel-shaped structure that collects urine from the renal tubules and directs it into the ureter. It does not have a role in the reabsorption of electrolytes.

 

References

• Ignatavicius, D. D., Workman, M. L., & Rebar, C. R. (2017). Medical-Surgical Nursing: Concepts for Interprofessional Collaborative Care. Elsevier.
• Marieb, E. N., & Hoehn, K. (2018). Human Anatomy & Physiology. Pearson.

EXPLANATION

 

✔Correct answer:

Concentration of Carbon Dioxide. The arterial blood gas (ABG) test measures several components to assess a patient's respiratory and metabolic status, but the gaseous element specifically measured is carbon dioxide (CO2). CO2 is a byproduct of cellular metabolism and is transported in the blood to the lungs, where it is expelled through exhalation. Elevated levels of CO2 in the blood can indicate hypoventilation or respiratory failure, while low levels can suggest hyperventilation or respiratory alkalosis. Monitoring CO2 levels is crucial in the ICU setting, especially for patients with severe respiratory conditions like pneumonia, to guide treatment interventions.

Think of CO2 as the "exhaust fumes" of a car. Just like you would measure the exhaust fumes to gauge a car's engine efficiency and pollution levels, measuring CO2 levels in an ABG test helps you understand how efficiently the "engine" of the body (the respiratory system) is working. Too much "exhaust" (CO2) could mean the system is not working well, while too little could indicate it's working too hard.

CO2 levels are intricately linked with the body's acid-base balance. CO2 combines with water in the blood to form carbonic acid, which dissociates into bicarbonate and hydrogen ions. This reaction is reversible and is a key component of the body's buffering system to maintain pH levels. Therefore, CO2 levels not only indicate respiratory status but also provide insights into the body's acid-base balance.

 

✘Incorrect answer options:

Presence of Hydrogen. While hydrogen ion concentration is crucial for determining the pH level and thus the acid-base balance, it is not a gaseous element. Hydrogen ions are measured to determine the pH but are not the focus when assessing gaseous elements in an ABG.

Level of Bicarbonate. Bicarbonate levels are indeed measured in an ABG test, but bicarbonate is not a gaseous element. It serves as a buffer to help regulate acid-base balance but is not the primary focus when assessing gaseous elements.

Measure of pH. The pH is a measure of the acidity or alkalinity of the blood and is an important component of an ABG test. However, pH is not a gaseous element; it is a scale that measures the concentration of hydrogen ions in a solution.

 

References

• Cairo, J. M., & Pilbeam, S. P. (2016). Mosby's Respiratory Care Equipment. Elsevier Health Sciences.
• Hough, A. (2014). Physiology in Childbearing: With Anatomy and Related Biosciences. Elsevier Health Sciences.

EXPLANATION

 

✔Correct answer:

Gender of the individual. While it may seem that gender could influence total body water percentage, it is not a significant standalone factor. The reason gender appears to influence total body water is more due to the differences in body composition between males and females, such as the amount of muscle mass and fat tissue, rather than gender itself. Therefore, when calculating total body water percentage, the focus should be on factors like muscle mass and fat tissue rather than the gender of the individual.

Think of total body water as the amount of fuel in different models of cars. While some might assume that the brand of the car (gender) would determine fuel capacity, it's actually the specific features like engine size and design (muscle mass, fat tissue) that are the real influencers. So, just like you wouldn't solely rely on a car's brand to determine its fuel capacity, you shouldn't rely solely on gender to determine total body water percentage.

Total body water is distributed in various compartments like intracellular fluid and extracellular fluid. The distribution and percentage of this water are influenced by the cellular structure, which is determined by factors like muscle mass and fat tissue. Muscle tissues have a higher water content compared to fat tissues. Therefore, individuals with more muscle mass will have a higher total body water percentage, irrespective of their gender.

 

✘Incorrect answer options:

The presence of fat tissue. Fat tissue has a lower water content compared to muscle tissue. Therefore, individuals with higher amounts of fat tissue will generally have a lower total body water percentage. This makes the presence of fat tissue a significant influencer in calculating total body water.

Age of the patient. As people age, the percentage of muscle mass tends to decrease, and fat tissue may increase. This change in body composition can lead to a decrease in total body water percentage, making age a significant factor to consider.

Amount of muscle mass. Muscle tissue has a high water content. Therefore, individuals with more muscle mass will generally have a higher total body water percentage. This makes the amount of muscle mass a significant factor in calculating total body water.

 

References

• Watson, P. E., Watson, I. D., & Batt, R. D. (1980). Total body water volumes for adult males and females estimated from simple anthropometric measurements. The American Journal of Clinical Nutrition, 33(1), 27-39.
• Cheuvront, S. N., & Kenefick, R. W. (2014). Dehydration: physiology, assessment, and performance effects. Comprehensive Physiology, 4(1), 257-285.

EXPLANATION

 

✔Correct answer:

Nephron's Loop of Henle. The primary site for magnesium reabsorption in the kidneys is the Loop of Henle, specifically the thick ascending limb. This is where about 60-70% of filtered magnesium is reabsorbed. The process is passive and is driven by the electrical gradient established by the active reabsorption of sodium and chloride ions. Understanding this physiology is crucial for Nurse Taylor as she monitors Mark's magnesium levels, especially if diuretics affecting the Loop of Henle are involved in his treatment plan.

Think of the Loop of Henle as a recycling center within the kidney. Just as a recycling center sorts and reclaims valuable materials, the Loop of Henle reclaims essential electrolytes like magnesium. If this "recycling center" isn't working efficiently, valuable "materials" like magnesium could be lost, leading to an imbalance.

The Loop of Henle's role in magnesium reabsorption is vital for maintaining homeostasis. If Mark's magnesium levels are low, understanding the function of the Loop of Henle can help Nurse Taylor anticipate how different medications or conditions might further impact those levels. For example, certain diuretics that act on the Loop of Henle could exacerbate hypomagnesemia and would need to be carefully managed.

 

✘Incorrect answer options:

Renal Glomerulus. The renal glomerulus is the site of initial filtration in the kidneys, where blood is filtered to produce a renal filtrate that eventually becomes urine. While it's crucial for initiating the process that leads to urine formation, it doesn't directly participate in the reabsorption of magnesium. Its primary function is to act as a sieve, separating waste products and excess substances from the blood.

Secretion of Parathyroid Hormone. Parathyroid hormone (PTH) is more concerned with the regulation of calcium and phosphate levels in the blood. While it does have some indirect effects on magnesium, its primary role is not in the reabsorption of magnesium. PTH mainly acts on the bones, kidneys, and intestines to increase calcium levels in the blood.

Anterior Pituitary Gland. The anterior pituitary gland is responsible for secreting a variety of hormones that regulate several physiological processes, from growth to stress response. However, it doesn't have a direct role in the reabsorption of magnesium. Its functions are more generalized and affect multiple systems rather than specifically targeting renal magnesium reabsorption.

 

References

• Lewis, S. L., Bucher, L., Heitkemper, M. M., & Harding, M. (2017). Medical-Surgical Nursing: Assessment and Management of Clinical Problems. Elsevier.
• Ignatavicius, D. D., Workman, M. L., & Rebar, C. R. (2018). Medical-Surgical Nursing: Concepts for Interprofessional Collaborative Care. Elsevier.

EXPLANATION

 

✔Correct answer:

Lasix (Furosemide). Lasix (Furosemide) is a loop diuretic that works by inhibiting the reabsorption of sodium and chloride in the ascending loop of Henle in the kidneys. This action leads to increased urine output, which can exacerbate Olivia's existing fluid volume deficit. In elderly patients like Olivia, who are already at risk for dehydration, the use of Lasix can be particularly concerning. Nurse Casey should closely monitor Olivia's fluid status and consider alternative medications or supportive therapies to manage her fluid volume deficit.

Imagine your body as a water tank and the kidneys as a faucet that controls the water level. Lasix essentially opens the faucet wider, letting more water (urine) out. If the tank is already low on water (fluid volume deficit), opening the faucet wider will make the situation worse.

The kidneys play a crucial role in maintaining fluid balance by filtering blood and excreting waste products through urine. The loop of Henle is a part of the nephron in the kidney where reabsorption of water and electrolytes occurs. Lasix interferes with this process, leading to increased urine output and potential fluid loss, which can worsen a fluid volume deficit.

 

✘Incorrect answer options:

Digoxin (Lanoxin). Digoxin is used to treat heart failure and arrhythmias. While it does affect the cardiovascular system, it does not directly cause fluid loss. However, it can be dangerous in the context of dehydration because low fluid volume can concentrate the drug and lead to toxicity.

Insulin (Humulin, Novolin, Lantus). Insulin is used to lower blood sugar levels in diabetic patients. While it can cause fluid shifts due to osmotic effects, it does not directly lead to fluid loss via diuresis. However, high blood sugar levels can cause polyuria, which could contribute to fluid loss, but the insulin itself would not be the cause.

Synthroid (Levothyroxine). This medication is used to treat hypothyroidism and does not have a diuretic effect. It would not exacerbate a fluid volume deficit.

 

References

• Potter, P. A., Perry, A. G., Stockert, P., & Hall, A. (2016). Fundamentals of Nursing (9th ed.). Elsevier.
• Lewis, S. L., Dirksen, S. R., Heitkemper, M. M., & Bucher, L. (2017). Medical-Surgical Nursing: Assessment and Management of Clinical Problems (10th ed.). Elsevier.

EXPLANATION

 

✔Correct answer:

Electrical neutrality. Electrical neutrality refers to the balance of positively and negatively charged ions across cell membranes. This balance is crucial for maintaining cellular function, including the transmission of nerve impulses, muscle contractions, and other physiological processes. In the context of Lisa's complex electrolyte imbalance, understanding the concept of electrical neutrality is essential for managing her condition effectively. An imbalance in electrolytes can disrupt this neutrality, leading to a host of problems ranging from muscle twitching and weakness to life-threatening issues like cardiac arrhythmias.

Imagine a dance floor where couples are dancing. Each couple consists of one leader and one follower, similar to a positively charged ion and a negatively charged ion. The dance floor is in harmony when there are equal numbers of leaders and followers (positively and negatively charged ions), representing electrical neutrality. If more leaders or followers suddenly join in without a partner, the dance floor becomes chaotic, much like how an imbalance in ions can disrupt cellular function.

The cell membrane is selectively permeable, allowing certain ions to pass through while blocking others. Sodium (Na+) and potassium (K+) are the primary cations, while chloride (Cl-) and bicarbonate (HCO3-) are the primary anions that help maintain this balance. The sodium-potassium pump actively transports these ions in and out of the cell to maintain electrical neutrality. When this balance is disrupted due to illness, medication, or other factors, it can lead to a range of symptoms and complications that require prompt medical intervention.

 

✘Incorrect answer options:

Electrical stability. While the term "electrical stability" might sound relevant, it is not the specific term used to describe the balance of ions across cell membranes. Electrical stability is more commonly associated with electrical circuits and not cellular physiology.

Sodium-potassium exchange mechanism. This refers to the active transport system that moves sodium and potassium ions across the cell membrane but does not encompass the overall balance of all ions, both positive and negative, that contribute to electrical neutrality.

Osmotic action. Osmotic action refers to the movement of water across a semipermeable membrane and is not the term used to describe the balance of ions across cell membranes. While osmosis can be influenced by ion concentrations, it is not synonymous with electrical neutrality.

 

References

• Marieb, E. N., & Hoehn, K. (2018). Human Anatomy & Physiology. Pearson.
• Porth, C. M., & Matfin, G. (2009). Pathophysiology: Concepts of Altered Health States. Lippincott Williams & Wilkins.

EXPLANATION

 

✔Correct answer:

Contributing to the narrowing of blood vessels. Magnesium is an essential mineral that plays a critical role in various physiological processes, but it does not contribute to the narrowing (vasoconstriction) of blood vessels. In fact, magnesium has a vasodilatory effect, meaning it helps to relax and widen blood vessels. This property is particularly beneficial in conditions like hypertension and coronary artery disease, as in Robert's case, where improved blood flow is desired. Magnesium's vasodilatory effect is mediated through its action on smooth muscle cells in the blood vessel walls, leading to relaxation and increased blood flow.

Think of a busy highway with multiple lanes (blood vessels). During rush hour (stress or disease states), the lanes can get congested, slowing down traffic (blood flow). Magnesium acts like a traffic control system that opens up additional lanes (vasodilation), allowing cars (blood cells) to move more freely and reach their destinations (tissues) more efficiently. It doesn't contribute to closing lanes and making traffic worse (vasoconstriction).

Magnesium is involved in over 300 enzymatic reactions in the body, including those related to protein synthesis, muscle and nerve function, and blood glucose control. It also plays a role in the active transport of calcium and potassium ions across cell membranes, a process crucial for nerve impulse conduction, muscle contraction, and maintaining a normal heart rhythm. Therefore, understanding the functions of magnesium is essential for managing patients with cardiovascular conditions.

 

✘Incorrect answer options:

Aiding in the metabolism of proteins. Magnesium is indeed involved in protein synthesis. It acts as a cofactor for enzymes that facilitate these metabolic processes.

Enabling the transport of sodium ions. Magnesium plays a role in the active transport of ions like sodium across cell membranes, which is essential for maintaining cellular homeostasis.

Facilitating the contraction of cardiac muscle. Magnesium is crucial for normal cardiac function. It helps regulate the contraction and relaxation of cardiac muscle by influencing calcium ion channels in the heart.

 

References

• Gropper, S. S., Smith, J. L., & Carr, T. P. (2017). Advanced Nutrition and Human Metabolism (7th ed.). Cengage Learning.
• McCance, K. L., & Huether, S. E. (2018). Pathophysiology: The Biologic Basis for Disease in Adults and Children (8th ed.). Elsevier.

EXPLANATION

 

✔Correct answer:

Evaluate the electrolyte levels, paying special attention to serum sodium.  John's symptoms of muscle cramps, twitching, and dizziness, combined with his excessive water consumption and frequent urination, strongly suggest an electrolyte imbalance, specifically hyponatremia (low sodium levels). Sodium plays a critical role in maintaining cellular function, nerve impulses, and muscle contractions. When sodium levels are too low, it can lead to a range of symptoms, including those John is experiencing. Given his psychiatric condition and the symptoms he's displaying, it's crucial to evaluate his electrolyte levels, with a particular focus on serum sodium, to confirm the diagnosis and guide treatment.

Imagine your body as a well-balanced fish tank where fish (cells) and plants (tissues) live in harmony. Sodium is like the salt in the water that keeps everything balanced. If you add too much fresh water (excessive water consumption) without enough salt, the fish and plants start to act strangely—similar to how John's muscles are cramping and twitching. To fix the issue, you'd need to check the salt level in the water (serum sodium levels) to know how to restore balance.

Sodium is the primary cation in the extracellular fluid and plays a vital role in osmoregulation, which is the balance of water and electrolytes in the body. When sodium levels are low, water moves into cells, causing them to swell. This can lead to a range of symptoms affecting the nervous system and muscles, among other tissues. In severe cases, it can even lead to seizures or coma. Therefore, monitoring sodium levels is crucial for diagnosing and managing hyponatremia.

 

✘Incorrect answer options:

Analyze urine, specifically looking for the presence of white blood cells. While urine analysis can provide valuable information about kidney function and potential infections, it would not directly address John's symptoms of muscle cramps, twitching, and dizziness, which are more likely related to an electrolyte imbalance.

Consider the results of an EEG. An EEG (Electroencephalogram) is used to detect abnormalities related to electrical activity of the brain. While it might be relevant in cases of seizures or other neurological conditions, it would not be the primary focus for symptoms likely related to electrolyte imbalance.

Examine the complete blood count, focusing on platelet counts. A complete blood count (CBC) can provide information about various blood cells, including platelets. However, it would not give insights into John's symptoms, which are more indicative of an electrolyte imbalance, specifically hyponatremia.

 

References

• Ignatavicius, D. D., Workman, M. L., & Rebar, C. R. (2017). Medical-Surgical Nursing: Concepts for Interprofessional Collaborative Care. Elsevier.
• Lewis, S. L., Bucher, L., Heitkemper, M. M., & Harding, M. (2017). Medical-Surgical Nursing: Assessment and Management of Clinical Problems. Elsevier.

EXPLANATION

 

✔Correct answer:

Utilizing carbon dioxide (CO2) to control hydrogen ion levels. The lungs play a vital role in maintaining acid-base balance by regulating the levels of carbon dioxide (CO2) in the blood. CO2 is a byproduct of cellular metabolism and is carried in the blood to the lungs, where it is expelled through exhalation. The concentration of CO2 in the blood directly influences the blood's pH level. When CO2 levels rise, the blood becomes more acidic, triggering the respiratory center in the brain to increase the rate and depth of breathing to expel more CO2, thus raising the pH and making the blood more alkaline.

Imagine the lungs as the exhaust system of a car. If the exhaust system is not working well, harmful gases like CO2 build up, affecting the car's performance. Similarly, the lungs act as the body's "exhaust system," expelling excess CO2 to ensure the internal environment remains balanced. If the lungs don't effectively remove CO2, the body's "performance" suffers due to acidosis.

The relationship between CO2 and hydrogen ions is mediated by carbonic acid (H2CO3), which dissociates into bicarbonate (HCO3-) and hydrogen ions (H+). This reaction is reversible and is catalyzed by the enzyme carbonic anhydrase. When CO2 levels are high, more carbonic acid is formed, which then dissociates into more hydrogen ions, making the blood acidic. Conversely, when CO2 levels are low, the reaction reverses, reducing the hydrogen ion concentration and making the blood more alkaline.

 

✘Incorrect answer options:

Dividing carbonic acid into two components. While it's true that carbonic acid dissociates into bicarbonate and hydrogen ions, this process primarily occurs in the blood and is not a direct function of the lungs. The lungs' main role is to remove CO2, not to divide carbonic acid.

Reclaiming bicarbonate ions. The reclamation of bicarbonate ions is primarily a renal function, not a respiratory one. The kidneys reclaim bicarbonate ions to help regulate acid-base balance but this is not a role played by the lungs.

Transporting hydrogen ions towards the renal tubules. The transport of hydrogen ions to the renal tubules is a function of the kidneys, not the lungs. The kidneys excrete or reabsorb hydrogen ions as part of their role in maintaining acid-base balance.

 

References

• Boron, W. F., & Boulpaep, E. L. (2016). Medical Physiology. Elsevier.
• Marieb, E. N., & Hoehn, K. (2018). Human Anatomy & Physiology. Pearson.

EXPLANATION

 

✔Correct answer:

In the bowel. Chloride is absorbed in the bowel, specifically in the ileum and colon. This process is essential for maintaining electrolyte balance and is particularly relevant in the context of gastrointestinal function. For a post-surgical patient like Grace, who has undergone abdominal surgery, understanding the role of the bowel in chloride absorption is crucial. Surgical interventions in the abdominal area can disrupt normal bowel function, potentially affecting chloride absorption and leading to imbalances.

Think of the bowel as a sponge that soaks up water and various nutrients, including electrolytes like chloride. Just as a sponge absorbs water to become saturated, the bowel absorbs chloride to help maintain the body's overall electrolyte balance. If the sponge is compromised (like in the case of abdominal surgery), its ability to soak up water efficiently may be affected.

The bowel's role in chloride absorption is part of the larger system of electrolyte regulation in the body. Chloride ions are absorbed in the ileum and colon through various transporters and channels, often in conjunction with other ions like sodium. This process is essential for maintaining the acid-base balance and overall homeostasis, especially in patients who may be at risk for electrolyte imbalances due to surgical interventions or other medical conditions.

 

✘Incorrect answer options:

Within the liver. The liver is not the primary site for chloride absorption. Its main functions include detoxification, metabolism, and bile production but not electrolyte absorption.

Within the kidney. While the kidneys do play a significant role in electrolyte balance, they are not the primary site for chloride absorption in the context of this question, which focuses on the bowel.

In the stomach. The stomach's main function is to break down food and initiate digestion. While it does contain hydrochloric acid, which includes chloride ions, it is not the primary site for chloride absorption.

 

References

• Guyton, A. C., & Hall, J. E. (2016). Textbook of Medical Physiology. Elsevier.
• Sherwood, L. (2015). Human Physiology: From Cells to Systems. Cengage Learning.

EXPLANATION

 

✔Correct answer:

Albumin. Albumin is a plasma protein that plays a crucial role in maintaining oncotic pressure, which is the pressure exerted by proteins in the blood plasma that usually tends to pull water into the circulatory system. In cases of acute kidney injury like Mark's, where fluid shifts between intravascular and interstitial compartments may be necessary, albumin is often used to manipulate these shifts effectively. Administering albumin can help draw fluid back into the vascular system from the interstitial spaces, aiding in volume expansion and potentially improving kidney function.

Think of the vascular system as a sponge that needs to soak up water (fluid) from its surroundings. Albumin acts like a magnet within that sponge, pulling water towards it. When you add more albumin, you're essentially making the sponge more effective at soaking up and holding onto water, helping to balance the fluid between the sponge and its surroundings.

Albumin is synthesized in the liver and constitutes about 50% of the total plasma proteins. It plays a vital role in various physiological functions, including the transport of hormones, drugs, and other substances. Its primary role in this context is to maintain oncotic pressure, which is essential for the regulation of fluid balance between the intravascular and interstitial compartments. In acute kidney injury, where fluid balance is often compromised, the administration of albumin can be a valuable therapeutic strategy.

 

✘Incorrect answer options:

Ensure. Ensure is a nutritional supplement and not suitable for manipulating fluid shifts between intravascular and interstitial compartments. It is primarily used for dietary supplementation and does not have the oncotic properties needed for this specific medical situation.

Total Parenteral Nutrition (TPN). TPN is used for providing nutrition intravenously, bypassing the usual process of eating and digestion. While it does deliver fluids, it is not specifically designed to manipulate fluid shifts between compartments and lacks the oncotic properties of albumin.

Whole blood. Whole blood transfusions are generally used in cases of significant blood loss due to surgery, trauma, or other conditions. While it does contain albumin, it also contains other elements like red and white blood cells, which are not necessary for the sole purpose of manipulating fluid shifts.

 

References

• Ignatavicius, D. D., Workman, M. L., & Rebar, C. R. (2017). Medical-Surgical Nursing: Concepts for Interprofessional Collaborative Care. Elsevier.
• Lewis, S. L., Bucher, L., Heitkemper, M. M., & Harding, M. (2017). Medical-Surgical Nursing: Assessment and Management of Clinical Problems. Elsevier.

EXPLANATION

 

✔Correct answer:

Glucose. In the extracellular fluid (ECF), glucose is a predominant component that serves as an essential energy source for cells. The ECF acts as a medium for the transport of substances like nutrients, electrolytes, and waste products between different parts of the body. In a critical condition like severe sepsis, as in Emily's case, maintaining proper glucose levels in the ECF is crucial for cellular function and overall metabolic balance. Glucose is especially vital for the brain, which relies almost exclusively on glucose for energy.

Think of the extracellular fluid as a highway that connects various towns (cells). On this highway, you'll find different types of vehicles (water, electrolytes, proteins) carrying essential goods. Glucose is like the fuel trucks on this highway. While not the most numerous, they are crucial because they carry the fuel (glucose) that all the towns (cells) need to keep running, especially in emergency situations.

Glucose in the ECF is derived from dietary carbohydrates and is also produced by the liver. It is transported into cells by specific transporters, most notably GLUT4 in muscle and adipose tissue, which is insulin-dependent. In conditions like sepsis, glucose metabolism can be altered, leading to hyperglycemia or hypoglycemia, both of which can have detrimental effects. Therefore, monitoring and managing glucose levels are essential aspects of critical care nursing.

 

✘Incorrect answer options:

Fatty Acids. While fatty acids are important for cellular function, they are not predominantly found in the extracellular fluid. They are usually bound to proteins like albumin when transported in the blood.

Hormones. Hormones are signaling molecules that are present in the extracellular fluid but are not its predominant component. They are usually secreted in response to specific stimuli and act on target cells.

Oxygen. Oxygen is carried by hemoglobin in red blood cells and is not freely floating in the extracellular fluid. While essential for cellular respiration, it is not a predominant component of the ECF.

 

References

• Porth, C. M., & Matfin, G. (2009). Pathophysiology: Concepts of Altered Health States (8th ed.). Lippincott Williams & Wilkins.
• McCance, K. L., & Huether, S. E. (2018). Pathophysiology: The Biologic Basis for Disease in Adults and Children (8th ed.). Elsevier.

EXPLANATION

 

✔Correct answer:

A potential sign of a transfusion reaction. An elevation in body temperature during a blood transfusion is a red flag that should not be ignored. It could be indicative of a transfusion reaction, which is a serious and potentially life-threatening complication. Transfusion reactions can occur when the body's immune system attacks the transfused blood, leading to symptoms such as fever, chills, and more severe manifestations like hemolysis or anaphylaxis. Immediate intervention is required, including stopping the transfusion and notifying the healthcare provider for further evaluation and management.

Think of a blood transfusion like introducing a new member into a tightly-knit community. If the community (your body) senses that the new member (transfused blood) doesn't fit in, alarms go off. In this case, the "alarm" is the elevated body temperature, signaling that something might be wrong and immediate action is needed.

During a transfusion reaction, the immune system releases various cytokines and inflammatory mediators, which can cause an increase in body temperature. This is the body's way of signaling that something is not right. Fever in the context of a blood transfusion should always be treated as a potential transfusion reaction until proven otherwise, and appropriate steps should be taken to manage the situation, including discontinuing the transfusion and initiating supportive therapies as needed.

 

✘Incorrect answer options:

A routine reaction to the blood transfusion. An elevation in body temperature is not a routine reaction to a blood transfusion and should be taken seriously. Ignoring this symptom could lead to severe complications.

An indication of systemic infection (sepsis). While fever is a symptom of sepsis, the timing of the fever in relation to the transfusion makes it more likely to be a transfusion reaction. Sepsis would typically present with additional symptoms and would require a different set of interventions.

A typical bodily function unrelated to the transfusion. Given that the elevated temperature occurred during the transfusion, it is unlikely to be unrelated. It's crucial to consider the timing and context of symptoms when evaluating potential complications.

 

References

• Lewis, S. L., Dirksen, S. R., Heitkemper, M. M., Bucher, L., & Camera, I. M. (2017). Medical-Surgical Nursing: Assessment and Management of Clinical Problems. Elsevier Health Sciences.
• Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-Surgical Nursing: Concepts for Interprofessional Collaborative Care. Elsevier Health Sciences.

EXPLANATION

 

✔Correct answer:

Utilization of surgical drains. Surgical drains are used to remove excess fluid, such as blood or pus, from a surgical site to promote healing and prevent infection. However, these drains can also lead to the loss of important electrolytes like sodium, potassium, and chloride. In Karen's case, who is recovering from abdominal surgery with multiple surgical drains in place, the risk of electrolyte imbalance is heightened. Monitoring her electrolyte levels is crucial for maintaining homeostasis and ensuring a smooth recovery.

Imagine your body as a well-balanced fish tank. Normally, the water (fluids) and minerals (electrolytes) are in perfect harmony. Now, suppose you have to remove some water from the tank due to an issue (surgical site). When you do this, you're not just removing water; you're also taking away essential minerals that the fish (cells) need to survive. That's what surgical drains do; they remove not just unwanted fluids but also essential electrolytes.

Electrolytes like sodium, potassium, and chloride are essential for various physiological functions, including nerve impulse transmission, muscle contraction, and acid-base balance. The loss of these electrolytes through surgical drains can lead to imbalances that may manifest as muscle cramps, weakness, irregular heart rhythms, and even altered mental status. Therefore, it's crucial to monitor electrolyte levels in patients with surgical drains and administer replacement therapy as needed.

 

✘Incorrect answer options:

Prolonged consumption of water. While excessive water intake can dilute electrolyte concentrations, it generally does not exacerbate the excretion of electrolytes.

Administration of nasogastric feedings. Nasogastric feedings are more likely to provide electrolytes and other nutrients rather than exacerbate their excretion.

Physical immobility due to fractures. Immobility may lead to other complications like muscle atrophy or deep vein thrombosis but is unlikely to directly exacerbate the excretion of electrolytes.

 

References

• Ignatavicius, D. D., Workman, M. L., & Rebar, C. R. (2020). Medical-Surgical Nursing: Concepts for Interprofessional Collaborative Care (9th ed.). Elsevier.
• Smeltzer, S. C., Bare, B. G., Hinkle, J. L., & Cheever, K. H. (2018). Brunner & Suddarth's Textbook of Medical-Surgical Nursing (14th ed.). Wolters Kluwer.

EXPLANATION

 

✔Correct answer:

Decreased cardiac output. Fluid Volume Deficit (FVD) can have a significant impact on cardiac output. The heart relies on an adequate volume of blood to pump effectively. When there is a deficit in fluid volume, as in Mr. Goggins' case, the heart has less blood to pump, leading to decreased cardiac output. This can result in poor tissue perfusion, leading to a cascade of problems including fatigue, weakness, and even organ failure if not addressed promptly.

Imagine the heart as a water pump and the blood as the water it needs to pump. If there's not enough water (blood), the pump (heart) can't do its job effectively. Just like a water pump struggles to provide water to a garden when the water level is low, the heart struggles to supply blood to the body when fluid volume is deficient.

Cardiac output is calculated as the heart rate multiplied by the stroke volume (the amount of blood ejected by the left ventricle in one contraction). When fluid volume is low, stroke volume decreases because there's less blood filling the heart chambers. This forces the heart to work harder, often leading to an increased heart rate as the body tries to maintain adequate cardiac output. However, this compensatory mechanism is not sufficient to make up for the decreased stroke volume, resulting in overall decreased cardiac output.

 

✘Incorrect answer options:

Vomiting. While vomiting can be a cause or symptom of Fluid Volume Deficit, it is not a nursing diagnosis that directly addresses the cardiac implications of FVD. Vomiting is more of a symptom or a cause rather than a consequence affecting cardiac output.

Altered urinary elimination. Altered urinary elimination could be a symptom or result of FVD but does not directly address the cardiac output issue. It is more related to kidney function and fluid balance rather than the heart's ability to pump blood effectively.

Increased cardiac output. Increased cardiac output is unlikely in the context of Fluid Volume Deficit. In fact, the body might initially try to increase cardiac output as a compensatory mechanism, but this is usually not sustainable and leads to decreased cardiac output.

 

References

• Potter, P. A., Perry, A. G., Stockert, P., & Hall, A. (2016). Fundamentals of Nursing. Elsevier.
• Smeltzer, S. C., & Bare, B. G. (2018). Brunner & Suddarth's Textbook of Medical-Surgical Nursing. Wolters Kluwer.

EXPLANATION

 

✔Correct answer:

A diet that incorporates 2 grams of sodium. The minimum daily requirement for sodium for an adult is around 500 mg, but most guidelines, including those from the American Heart Association, recommend a daily intake of no more than 2,300 mg (approximately 2 grams) for the general population. For individuals like Lisa, who have hypertension, the recommendation is even lower, at 1,500 mg per day. Sodium plays a crucial role in maintaining fluid balance, nerve function, and muscle contractions. However, excessive sodium intake can exacerbate hypertension and increase the risk of heart disease and stroke.

Think of sodium in your diet like the oil in a car's engine. You need a certain amount to keep everything running smoothly. Too little, and you risk damaging the engine (your body). However, too much oil can also cause problems, like leaks or even engine failure. In the same way, you need just the right amount of sodium to keep your "body engine" running optimally, especially when you have conditions like hypertension that require careful management.

Sodium is an essential electrolyte that helps regulate water balance in and around cells and is crucial for generating electrical signals in the nervous system. In the context of hypertension, excessive sodium can cause the body to retain water, increasing blood volume and, consequently, blood pressure. Therefore, managing sodium intake is a key aspect of hypertension management, along with other lifestyle changes like exercise and medication.

 

✘Incorrect answer options:

A diet consisting of 1500 calories aimed at weight loss. While a calorie-restricted diet may help with weight loss, it doesn't necessarily meet the minimum sodium requirement unless specifically designed to do so.

A diet completely devoid of salt. Sodium is an essential nutrient, and a diet completely devoid of salt could lead to hyponatremia, a condition characterized by dangerously low levels of sodium in the body.

A diet that includes 4 grams of sodium. Consuming 4 grams of sodium per day would exceed the recommended daily limit for most adults and could be particularly harmful for individuals with hypertension, potentially worsening their condition.

 

References

• Whelton, P. K., Carey, R. M., Aronow, W. S., et al. (2018). 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults. Journal of the American College of Cardiology, 71(19), e127-e248.
• Appel, L. J., Frohlich, E. D., Hall, J. E., Pearson, T. A., Sacco, R. L., Seals, D. R., ... & Roccella, E. J. (2011). The importance of population-wide sodium reduction as a means to prevent cardiovascular disease and stroke: a call to action from the American Heart Association. Circulation, 123(10), 1138-1143.

EXPLANATION

 

✔Correct answer:

Withhold the digoxin dosage and assess Emily's potassium levels. Emily's symptoms of nausea, a high apical pulse rate of 130, and irregular heartbeat are concerning signs that could indicate digoxin toxicity. Digoxin is a medication used to treat heart conditions, but it has a narrow therapeutic window, meaning the difference between a therapeutic and toxic dose is small. Lasix (furosemide), a diuretic Emily is also taking, can lead to the depletion of potassium, which in turn can make the body more susceptible to the effects of digoxin. Therefore, withholding the digoxin dosage and assessing Emily's potassium levels are crucial steps in preventing further complications.

Think of digoxin like a very potent spice in a recipe—just a pinch can make the dish perfect, but a little too much can ruin it. Lasix is like another ingredient that, while good on its own, can make the dish too spicy when combined with that potent spice. If you suspect the dish is becoming too spicy (digoxin toxicity), it's best to hold off on adding more spice (withhold digoxin) and check the balance of other ingredients (assess potassium levels).

Potassium plays a critical role in cardiac function, including the regulation of heart rate and rhythm. Low levels of potassium can sensitize the myocardium to the actions of digoxin, increasing the risk of toxicity. This can lead to arrhythmias, which are potentially life-threatening. Monitoring potassium levels in patients on digoxin and Lasix is essential for safe and effective care.

 

✘Incorrect answer options:

Eliminate the orange juice from Emily's meal tray. While orange juice is high in potassium and could theoretically help if Emily were hypokalemic, this action alone would not address the immediate concern of potential digoxin toxicity and its severe implications.

Flag Emily as a patient with high risk for hyperkalemia. Given that Emily is on Lasix, a diuretic that can lead to potassium loss, she is actually at risk for hypokalemia, not hyperkalemia. Flagging her for hyperkalemia would not be appropriate in this context.

Evaluate Emily for additional symptoms of hypernatremia. While it's important to monitor electrolyte levels in patients on diuretics like Lasix, the immediate concern based on Emily's symptoms is potential digoxin toxicity, which is more directly related to potassium levels than sodium levels.

 

References

• Ignatavicius, D. D., Workman, M. L., & Rebar, C. R. (2017). Medical-Surgical Nursing: Concepts for Interprofessional Collaborative Care. Elsevier.
• Lewis, S. L., Bucher, L., Heitkemper, M. M., & Harding, M. (2017). Medical-Surgical Nursing: Assessment and Management of Clinical Problems. Elsevier.

EXPLANATION

 

✔Correct answer:

Intracellular compartment. The majority of the body's water is primarily contained in the intracellular compartment, which is the fluid located within the cells. Approximately two-thirds of the body's total water content is found in this compartment. Understanding this is crucial for comprehending fluid balance and how dehydration can affect the body at a cellular level. For Maria, who is admitted with severe dehydration, it's essential to recognize that the intracellular compartment is likely to be significantly affected, which can have cascading effects on cellular function and overall health.

Imagine the body as a large building with multiple rooms (cells). Each room has its own water tank (intracellular compartment) that supplies water for various needs. If the building's overall water supply decreases (dehydration), the tanks in each room will start to run low, affecting the functioning of the entire building. Therefore, it's crucial to keep these tanks adequately filled to ensure the smooth operation of the building (body).

Water in the intracellular compartment is vital for numerous cellular processes, including metabolic reactions, temperature regulation, and waste elimination. When dehydration occurs, the intracellular compartment is affected, leading to cellular dysfunction. Cells may shrink, metabolic processes may slow down, and waste products may accumulate. This can result in symptoms ranging from fatigue and confusion to more severe complications like kidney failure or cardiac issues. Therefore, understanding the role of the intracellular compartment in fluid balance is crucial for effective patient care.

 

✘Incorrect answer options:

Interstitial compartment. While the interstitial compartment does contain a significant amount of fluid, it is not the primary location for the body's water. It serves as a transitional space for fluid between the intravascular and intracellular compartments.

Extracellular compartment. The extracellular compartment includes both the interstitial and intravascular compartments. While it does contain a considerable amount of fluid, it still holds less than the intracellular compartment.

Intravascular compartment. This compartment contains the blood plasma and is part of the extracellular fluid. It holds a much smaller percentage of the body's total water compared to the intracellular compartment.

 

References

• Marieb, E. N., & Hoehn, K. (2018). Human Anatomy & Physiology (11th ed.). Pearson.
• Guyton, A. C., & Hall, J. E. (2015). Textbook of Medical Physiology (13th ed.). Elsevier.

EXPLANATION

 

✔Correct answer:

Potential for decreased cardiac output. Hypertonic fluid volume excess (FVE) occurs when there is an imbalance in the body's fluid homeostasis, leading to an excessive amount of fluid in the extracellular compartment. This condition is particularly concerning for cardiac patients like Sarah, as it can place additional strain on the heart. The heart has to work harder to pump the increased volume of blood, which can lead to decreased cardiac output over time if the heart is unable to keep up. In Sarah's case, the nursing diagnosis most relevant to her hypertonic FVE status would be "Potential for decreased cardiac output."

Imagine the cardiovascular system as a garden watering system. The heart is the pump, and the blood vessels are the hoses. If you suddenly add more water (fluid) to the system but the pump (heart) isn't strong enough to handle the extra load, the water won't reach all the plants (organs) effectively. Just like you'd worry about the pump's ability to handle the extra water, in Sarah's case, the concern is whether her heart can manage the extra fluid load.

The heart's ability to pump blood effectively is known as cardiac output, calculated as the heart rate multiplied by the stroke volume. In conditions like hypertonic FVE, the increased fluid volume can lead to elevated venous return, stretching the heart's chambers beyond their optimal capacity. According to the Frank-Starling law of the heart, there is an optimal level of stretch that allows for the most efficient contraction. Exceeding this level can lead to decreased cardiac output, making it a critical nursing diagnosis in the management of hypertonic FVE.

 

✘Incorrect answer options:

Ineffective breathing pattern. While fluid volume excess can lead to pulmonary edema and breathing difficulties, hypertonic FVE specifically is more likely to affect cardiac output than breathing patterns directly.

Potential for increased cardiac output. This diagnosis would be counterintuitive in the context of hypertonic FVE. The heart is more likely to struggle with the increased fluid volume, leading to a potential decrease in cardiac output rather than an increase.

Ineffective airway clearance. While hypertonic FVE can have various systemic effects, it is not directly related to airway clearance. The primary concern in hypertonic FVE, especially in a cardiac unit, would be its impact on cardiac output.

 

References

• Ignatavicius, D. D., Workman, M. L., & Rebar, C. R. (2018). Medical-Surgical Nursing: Concepts for Interprofessional Collaborative Care (9th ed.). Elsevier.
• Smeltzer, S. C., Bare, B. G., Hinkle, J. L., & Cheever, K. H. (2018). Brunner & Suddarth's Textbook of Medical-Surgical Nursing (14th ed.). Wolters Kluwer.

EXPLANATION

 

✔Correct answer:

Reabsorption of sodium and excretion of potassium. The endocrine system plays a crucial role in maintaining electrolyte balance, particularly through hormones like aldosterone, which is produced by the adrenal glands. Aldosterone acts on the renal tubules to promote the reabsorption of sodium ions back into the bloodstream and the excretion of potassium ions into the urine. This is especially important for patients like Nina, who has chronic kidney disease, as her kidneys may not be as efficient in maintaining this balance, leading to electrolyte imbalances that can have serious consequences.

Think of the endocrine system as a traffic cop at a busy intersection, directing cars (ions) to go in certain directions to keep traffic flowing smoothly. When the traffic cop (aldosterone) notices that there are too many sodium "cars" trying to leave the "town" (body), it directs them to turn around and go back into circulation. Meanwhile, it allows potassium "cars" to exit, maintaining a balanced "traffic flow" that keeps the "town" functioning well.

The regulation of sodium and potassium is vital for various physiological processes, including nerve impulse transmission, muscle contraction, and fluid balance. An imbalance in these electrolytes can lead to symptoms ranging from muscle weakness and cramps to life-threatening conditions like cardiac arrhythmias. Therefore, the endocrine system's role in regulating these ions is crucial for overall homeostasis and particularly important in conditions like chronic kidney disease, where the kidneys' regulatory functions are compromised.

 

✘Incorrect answer options:

Reabsorption of chloride and excretion of sodium. The endocrine system, specifically through aldosterone, primarily focuses on sodium and potassium regulation rather than chloride and sodium.

Reabsorption of potassium and excretion of sodium. This is incorrect because aldosterone actually promotes the reabsorption of sodium and the excretion of potassium, not the other way around.

Reabsorption of sodium and excretion of chloride. While sodium reabsorption is accurate, the primary excretion promoted by aldosterone is that of potassium, not chloride.

 

References

• Lewis, S. L., Dirksen, S. R., Heitkemper, M. M., Bucher, L., & Camera, I. M. (2017). Medical-Surgical Nursing: Assessment and Management of Clinical Problems. Elsevier Health Sciences.
• Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-Surgical Nursing: Concepts for Interprofessional Collaborative Care. Elsevier Health Sciences.

EXPLANATION

 

✔Correct answer:

Emission of calcitonin. Calcitonin is the hormone responsible for reducing high levels of calcium in the blood. It is produced by the parafollicular cells (also known as C cells) of the thyroid gland. When serum calcium levels rise, calcitonin is released to counteract the effects. It does this by inhibiting the activity of osteoclasts, the cells responsible for breaking down bone and releasing calcium into the bloodstream. Additionally, calcitonin increases the excretion of calcium by the kidneys, thereby lowering serum calcium levels.

Think of calcitonin as a traffic cop that steps in when there are too many cars (calcium) on the road (in the blood). The traffic cop directs some cars to take an alternate route (excretion by kidneys) and puts up a roadblock to prevent more cars from entering the main road (inhibiting osteoclasts). This helps to reduce traffic congestion (high calcium levels).

Calcitonin serves as a regulatory mechanism to maintain calcium homeostasis. It acts in opposition to parathyroid hormone (PTH), which is released when calcium levels are low and works to increase them. While PTH stimulates osteoclast activity and reduces renal excretion of calcium, calcitonin does the opposite, ensuring that calcium levels remain within a narrow, physiologically optimal range.

 

✘Incorrect answer options:

Release of parathyroid hormone. Parathyroid hormone (PTH) is actually released when there is a decrease in serum calcium levels, not an increase. PTH works to raise calcium levels by stimulating osteoclast activity and reducing calcium excretion by the kidneys.

Secretion of aldosterone. Aldosterone is a hormone that regulates sodium and potassium levels, not calcium. It is released by the adrenal glands and acts on the kidneys to increase sodium reabsorption and potassium excretion.

Production of renin. Renin is an enzyme released by the kidneys that plays a role in regulating blood pressure. It does this by converting angiotensinogen to angiotensin I, which is then converted to angiotensin II, a potent vasoconstrictor. Renin does not have a direct role in calcium regulation.

 

References

• Potts, J. T. (2005). Parathyroid hormone: past and present. The Journal of Endocrinology, 187(3), 311-325.
• Bilezikian, J. P., Khan, A., Potts, J. T., Brandi, M. L., Clarke, B. L., Shoback, D., ... & Thakker, R. V. (2011). Hypoparathyroidism in the adult: epidemiology, diagnosis, pathophysiology, target-organ involvement, treatment, and challenges for future research. Journal of Bone and Mineral Research, 26(10), 2317-2337.

EXPLANATION

 

✔Correct answer:

Inaccessible for circulatory function. Third-spacing refers to the phenomenon where fluid accumulates in compartments that are not easily accessible by the circulatory system, such as the peritoneal cavity or interstitial spaces. The primary concern with third-spacing, especially in Henry's post-operative state, is that this fluid is essentially "lost" to the circulatory system. This can lead to decreased intravascular volume, resulting in hypovolemia, decreased cardiac output, and potential shock. For Henry, who has just undergone abdominal surgery, this is a significant concern as it can complicate his recovery and may require interventions like fluid resuscitation to stabilize his condition.

Imagine the circulatory system as a city's water supply network. Normally, water flows through pipes (blood vessels) to various parts of the city (body) to meet the needs of its residents (cells). Now, imagine a scenario where a significant amount of water starts leaking into underground reservoirs (third spaces) that are not connected to the main network. This would mean less water is available for the city, leading to potential water shortages (hypovolemia) and affecting the well-being of its residents.

The circulatory system relies on a delicate balance of fluid volume to maintain adequate blood pressure and ensure that tissues receive sufficient oxygen and nutrients. When fluid is sequestered in the third space, it disrupts this balance, leading to decreased intravascular volume. This can result in reduced cardiac output, poor tissue perfusion, and, in severe cases, hypovolemic shock. Therefore, recognizing and addressing third-spacing is crucial in post-operative care to prevent these complications.

 

✘Incorrect answer options:

Enriched with acidic substances. While the composition of third-spaced fluid can vary, the primary concern is not its acidity but rather its inaccessibility to the circulatory system.

Excessive solute concentration leading to hypervolemia. Third-spacing actually leads to a reduction in effective circulatory volume, not an increase. The concern is hypovolemia, not hypervolemia.

Diluted concentration leading to water intoxication. The issue with third-spacing is not the dilution of fluid but its removal from the circulatory system, leading to potential hypovolemia and associated complications.

 

References

• Ignatavicius, D. D., Workman, M. L., & Rebar, C. R. (2020). Medical-Surgical Nursing: Concepts for Interprofessional Collaborative Care (9th ed.). Elsevier.
• Smeltzer, S. C., Bare, B. G., Hinkle, J. L., & Cheever, K. H. (2018). Brunner & Suddarth's Textbook of Medical-Surgical Nursing (14th ed.). Wolters Kluwer.

EXPLANATION

 

✔Correct answer:

Evaluate Jonas's potassium levels and consult the physician for potential IV additives. Given Jonas's history of substantial diarrhea, he has lost a significant amount of fluid and electrolytes, including potassium. Diarrhea often leads to hypokalemia (low potassium levels), which can have severe consequences such as cardiac arrhythmias. The physician has ordered an IV of 0.45% NaCl combined with 5% dextrose, which will help with hydration and caloric needs but does not address the potential potassium loss. Therefore, the most appropriate nursing intervention is to evaluate Jonas's potassium levels and consult the physician for potential IV additives like potassium chloride.

Think of Jonas's body as a leaking bucket. The bucket is losing water (fluids) and marbles (electrolytes like potassium) through the leak (diarrhea). While the IV of 0.45% NaCl and 5% dextrose is like adding more water to the bucket, it doesn't replace the lost marbles. To fully address the issue, you need to check how many marbles are left (potassium levels) and consider adding more (IV additives) to maintain balance.

Potassium is essential for various physiological functions, including muscle contraction and nerve impulse transmission. Low levels of potassium can disrupt these functions and lead to complications like muscle weakness, cramps, and cardiac issues. Monitoring potassium levels in the context of substantial fluid loss is crucial for comprehensive patient care and to prevent potential complications.

 

✘Incorrect answer options:

Prepare all antibiotic infusions using the prescribed 0.45% NaCl with 5% dextrose. While it's important to follow physician orders for IV fluids, this option doesn't address the immediate concern of potential potassium loss due to diarrhea. Antibiotic infusions are not directly related to Jonas's electrolyte imbalance.

Monitor Jonas for any indicators of hyperkalemia. Given Jonas's history of substantial diarrhea, the concern would more likely be hypokalemia (low potassium levels) rather than hyperkalemia (high potassium levels). Monitoring for hyperkalemia would not be the most appropriate intervention in this case.

Secure an infusion controller device from the central supply. While ensuring accurate IV infusion rates is important, this option does not directly address the immediate concern of potential potassium loss, which is critical given Jonas's condition.

 

References

• Ignatavicius, D. D., Workman, M. L., & Rebar, C. R. (2017). Medical-Surgical Nursing: Concepts for Interprofessional Collaborative Care. Elsevier.
• Lewis, S. L., Bucher, L., Heitkemper, M. M., & Harding, M. (2017). Medical-Surgical Nursing: Assessment and Management of Clinical Problems. Elsevier.

EXPLANATION

 

✔Correct answer:

Rapid heart rate. Fluid volume deficit (FVD), commonly known as dehydration, is a condition where the body loses more fluids than it takes in. This imbalance can lead to a decrease in intravascular, interstitial, and intracellular fluid in the body. One of the body's compensatory mechanisms for FVD is to increase the heart rate. The heart pumps faster to maintain adequate cardiac output and perfusion to vital organs, despite the reduced fluid volume in the circulatory system.

Think of the circulatory system as a water pump system. If there's less water (fluid) in the system, the pump (heart) has to work faster to make sure water reaches all parts of the system (body).

When fluid volume decreases, the baroreceptors in the aortic arch and carotid sinus sense the reduced pressure and send signals to the brain. The sympathetic nervous system is then activated, releasing catecholamines like adrenaline, which stimulate the heart to beat faster. This is an attempt to maintain adequate blood flow to vital organs.

 

✘Incorrect answer options:

Strong, bounding pulse. A strong, bounding pulse is more indicative of fluid volume excess, not deficit. In FVD, the pulse is more likely to be weak and thready due to decreased stroke volume and cardiac output.

Distended neck veins. Distended neck veins are a sign of fluid volume excess or right-sided heart failure. In FVD, neck veins would likely appear flat due to the reduced blood volume.

Crackles in the lungs. Crackles in the lungs are often a sign of fluid overload in the lungs, possibly indicating conditions like heart failure or pulmonary edema. In FVD, the lungs are unlikely to have crackles; instead, they would be clear upon auscultation.

 

References

• Potter, P. A., Perry, A. G., Stockert, P., & Hall, A. (2016). Fundamentals of Nursing (9th ed.). Elsevier.
• Ignatavicius, D. D., Workman, M. L., & Rebar, C. R. (2017). Medical-Surgical Nursing: Concepts for Interprofessional Collaborative Care (9th ed.). Elsevier.

EXPLANATION

 

✔Correct answer:

Decreased levels of calcium (Hypocalcemia). Hypocalcemia, or low levels of calcium in the blood, can be associated with hyperphosphatemia, or high levels of phosphate. Calcium and phosphate have an inverse relationship in the body; when levels of one are high, the other tends to be low. This is because both minerals are integral to bone metabolism and cellular function, and they often compete for absorption and excretion. When calcium levels are low, the body may retain more phosphate, leading to elevated phosphate levels.

Think of calcium and phosphate as two sides of a seesaw. When one side goes down (low calcium levels), the other side goes up (high phosphate levels). Just like how a balanced seesaw is crucial for a fun playground experience, a balanced level of calcium and phosphate is essential for optimal body function.

Calcium and phosphate ions are essential for various physiological processes, including bone mineralization, nerve function, and muscle contractions. The parathyroid hormone (PTH) and calcitriol (active Vitamin D) regulate the levels of these ions. When calcium levels are low, PTH secretion increases, leading to increased phosphate excretion by the kidneys. However, in certain conditions like renal failure or hypoparathyroidism, this regulatory mechanism may be impaired, leading to both hypocalcemia and hyperphosphatemia.

 

✘Incorrect answer options:

Elevated levels of potassium (Hyperkalemia). Hyperkalemia, or elevated levels of potassium, does not have a direct relationship with phosphate levels. While both are important electrolytes, their regulation and functions in the body are largely independent of each other. Hyperkalemia is more likely to be associated with conditions like renal failure or excessive potassium intake but does not directly cause hyperphosphatemia.

Raised levels of blood sugar (Hyperglycemia). Hyperglycemia, or high blood sugar levels, is not directly related to phosphate levels. While diabetes can lead to various electrolyte imbalances due to effects on kidney function, it does not specifically cause hyperphosphatemia. The primary concern with hyperglycemia is its impact on insulin levels and cellular glucose uptake.

Reduced levels of sodium (Hyponatremia). Hyponatremia, or low sodium levels, does not have a direct impact on phosphate levels. Sodium is primarily regulated by the renin-angiotensin-aldosterone system and antidiuretic hormone, which do not directly affect phosphate homeostasis. While both sodium and phosphate are important electrolytes, their regulation is largely independent.

 

References

• Bertrand, J., & Pallet, N. (2019). Disorders of Phosphate Metabolism: Hypophosphatemia and Hyperphosphatemia. In: Floege J, Johnson RJ, Feehally J, eds. Comprehensive Clinical Nephrology. 6th ed. Elsevier.
• Cooper, M. S., & Gittoes, N. J. (2008). Diagnosis and management of hypocalcaemia. BMJ, 336(7656), 1298-1302.

EXPLANATION

 

✔Correct answer:

Aiding in fat metabolism processes. Body fluids serve multiple functions, including acting as a medium for various physiological processes, but they are not directly involved in aiding fat metabolism processes. Fat metabolism is primarily a biochemical process that occurs at the cellular level, involving enzymes and hormones rather than body fluids. While fluids do play a role in transporting these enzymes and hormones, they are not directly responsible for the metabolism of fats.

Think of body fluids as the highway system of a city. Cars (nutrients, hormones, and other substances) use these highways to get to various destinations (cells, tissues, organs). While the highway system is crucial for transportation, it doesn't directly help the cars run more efficiently or use less fuel—that's the job of the car's internal mechanics, much like how fat metabolism is a separate internal process.

Body fluids are essential for maintaining homeostasis and are involved in various functions like transporting nutrients, gases, and waste products; acting as a medium for chemical reactions; and conveying electrical charges for nerve impulse transmission. However, the metabolism of fats is a complex biochemical process that involves the breakdown of fatty acids in the mitochondria, facilitated by enzymes and regulated by hormones like insulin and glucagon.

 

✘Incorrect answer options:

Conveying electrical charges throughout the body. Body fluids, particularly those rich in electrolytes, are essential for conveying electrical charges, especially in nerve and muscle cells. This is crucial for the transmission of nerve impulses and muscle contractions.

Providing a cushioning effect for internal organs. Body fluids, such as cerebrospinal fluid and synovial fluid, do provide a cushioning effect for internal organs and joints, protecting them from shock and injury.

Facilitating the transport of essential nutrients. Body fluids act as a medium for transporting essential nutrients like glucose, amino acids, and minerals to various cells and tissues throughout the body.

 

References

• Ignatavicius, D. D., Workman, M. L., & Rebar, C. R. (2017). Medical-Surgical Nursing: Concepts for Interprofessional Collaborative Care. Elsevier.
• Marieb, E. N., & Hoehn, K. (2018). Human Anatomy & Physiology. Pearson.

EXPLANATION

 

✔Correct answer:

Protein molecules. The intracellular fluid (ICF) compartment is the largest of the body's fluid compartments and is primarily located within the cells. Besides water, which makes up the bulk of this fluid, the ICF is rich in protein molecules. These proteins serve various functions, including acting as enzymes, providing structural support, and facilitating intracellular signaling. Understanding the composition of the ICF is crucial for nursing students as it lays the foundation for understanding fluid balance, osmosis, and cellular function. An imbalance in the ICF composition can lead to cellular dysfunction and contribute to various pathological conditions.

Think of a cell as a factory. The factory building itself is like the cell membrane, and the workers inside are like the proteins. Just as workers are essential for the factory to function, proteins are crucial for cellular activities. The factory also needs water and other materials, but without the workers (proteins), the factory can't produce anything or function correctly.

The ICF is separated from the extracellular fluid (ECF) by the cell membrane, a semi-permeable barrier that controls the passage of substances in and out of the cell. Proteins often cannot cross this membrane due to their size and charge, making them a significant component of the ICF. These proteins influence the osmotic balance and pressure within the cell, affecting how water and other substances move across the cell membrane. Therefore, understanding the role of proteins in the ICF is essential for grasping more complex topics like fluid shifts and cellular hydration.

 

✘Incorrect answer options:

Sodium ions. Sodium ions are primarily found in the extracellular fluid, not the intracellular fluid. The sodium-potassium pump actively works to keep sodium levels low inside the cell and high outside the cell.

Glucose molecules. While glucose is essential for cellular function, it is not stored in significant amounts in the intracellular fluid. Cells use glucose for energy but do not keep large reserves inside.

Uric acid molecules. Uric acid is a waste product of purine metabolism and is not stored in the intracellular fluid. Elevated levels of uric acid are usually associated with conditions like gout and are not a primary component of the ICF.

 

References

• Marieb, E. N., & Hoehn, K. (2018). Human Anatomy & Physiology (11th ed.). Pearson.
• Porth, C. M., & Matfin, G. (2009). Pathophysiology: Concepts of Altered Health States (8th ed.). Lippincott Williams & Wilkins.

EXPLANATION

 

✔Correct answer:

Phosphorus. Intracellular fluid (ICF) is the fluid within cells and makes up about two-thirds of the body's total water content. The primary anion in the ICF is phosphorus. Phosphorus plays a vital role in cellular function, including energy storage and transfer, as it is a key component of adenosine triphosphate (ATP). It is also essential for the synthesis of nucleic acids and coenzymes. Understanding the composition of ICF is crucial for healthcare providers, as imbalances can lead to cellular dysfunction and, consequently, to various clinical conditions.

Imagine the cell as a factory. Just like a factory needs electricity to power its machinery, a cell needs ATP for energy. Phosphorus is like the electrical wiring in the factory that helps generate and transfer this energy. Without adequate phosphorus, the "factory" would not be able to function efficiently, leading to a breakdown in operations.

Phosphorus is not just a bystander in the cell; it actively participates in many cellular processes. It is involved in the formation of bones and teeth, the conversion of food into energy, and the synthesis of proteins for the growth, maintenance, and repair of cells and tissues. An imbalance in intracellular phosphorus can have wide-ranging effects, including muscle weakness, bone pain, and even confusion or changes in mental status.

 

✘Incorrect answer options:

Chloride. While chloride is an important anion, it is more predominantly found in extracellular fluid (ECF) rather than in ICF.

Potassium. Potassium is indeed the primary cation in the ICF, but it is not an anion. The question specifically asks for the predominant anion.

Sodium. Sodium is the primary cation in extracellular fluid (ECF), not in ICF. Moreover, it is a cation, not an anion.

 

References

• Lewis, S. L., Dirksen, S. R., Heitkemper, M. M., Bucher, L., & Camera, I. M. (2017). Medical-Surgical Nursing: Assessment and Management of Clinical Problems. Elsevier Health Sciences.
• Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-Surgical Nursing: Concepts for Interprofessional Collaborative Care. Elsevier Health Sciences.

EXPLANATION

 

✔Correct answer:

Malabsorption syndrome. Hypomagnesemia, or low levels of magnesium in the blood, can be caused by various factors, one of which is malabsorption syndrome. This condition occurs when the intestines are unable to adequately absorb nutrients, including magnesium, from the food that is ingested. Malabsorption can be due to several underlying issues such as celiac disease, Crohn's disease, or certain medications that interfere with nutrient absorption. For Clara, who has low magnesium levels, it would be crucial to investigate whether malabsorption syndrome could be an underlying cause, as this would significantly impact her treatment plan.

Think of the digestive system as a conveyor belt in a factory that sorts and processes raw materials (food). Normally, the conveyor belt efficiently sorts these materials and sends them to the right departments (body cells) for use. However, if there's a malfunction in the sorting mechanism (malabsorption), essential materials like magnesium might not get to where they're needed, causing a shortage in the factory's production line (body).

Magnesium is an essential mineral that plays a vital role in numerous physiological processes, including muscle and nerve function, bone health, and regulating blood sugar levels. When malabsorption syndrome occurs, the intestines fail to absorb magnesium effectively, leading to hypomagnesemia. This can result in a range of symptoms such as muscle cramps, irregular heartbeat, and even seizures in severe cases. Therefore, identifying and treating the underlying cause is crucial for effective patient care.

 

✘Incorrect answer options:

Kidney failure. While kidney failure can indeed lead to electrolyte imbalances, it is more commonly associated with hypermagnesemia (high magnesium levels) rather than hypomagnesemia. The kidneys usually excrete excess magnesium, and failure to do so would lead to elevated levels.

Chronic constipation. This condition is not directly linked to hypomagnesemia. Constipation is more often associated with dehydration and imbalances in other electrolytes like potassium and sodium but not typically magnesium.

Insufficient vitamin D intake. While vitamin D is essential for calcium absorption, it does not directly affect magnesium levels. A deficiency in vitamin D would more likely lead to issues related to calcium metabolism rather than causing hypomagnesemia.

 

References

• Smeltzer, S. C., Bare, B. G., Hinkle, J. L., & Cheever, K. H. (2018). Brunner & Suddarth's Textbook of Medical-Surgical Nursing (14th ed.). Wolters Kluwer.
• McCance, K. L., & Huether, S. E. (2018). Pathophysiology: The Biologic Basis for Disease in Adults and Children (8th ed.). Elsevier.

EXPLANATION

 

✔Correct answer:

Stage 3 Pressure Ulcer. A Stage 3 Pressure Ulcer is characterized by full-thickness skin and tissue loss. Subcutaneous fat may be visible, but bone, tendon, or muscle are not exposed. Slough and/or eschar may be present on some parts of the wound bed. The depth of a Stage 3 pressure ulcer varies by anatomical location, and the ulcer can extend down to, but not through, the underlying fascia. The description provided in the question matches the characteristics of a Stage 3 Pressure Ulcer.

Think of the skin and underlying tissue as layers of clothing. A Stage 1 pressure ulcer is like a stain on the outer layer of clothing (the skin). A Stage 2 pressure ulcer is like a tear that goes through the first layer, exposing the layer underneath. A Stage 3 pressure ulcer is like a tear that goes through multiple layers of clothing, exposing even deeper layers, but not all the way to the innermost layer.

The skin is the body's largest organ and serves as a protective barrier. When sustained pressure is applied to the skin, it can lead to reduced blood flow to the area, causing tissue damage and cell death. A Stage 3 pressure ulcer indicates significant damage that extends through the entire thickness of the skin and into the underlying tissue.

 

✘Incorrect answer options:

Stage 1 Pressure Ulcer. A Stage 1 Pressure Ulcer is characterized by non-blanchable erythema of intact skin, typically a red area that does not turn white when pressed.

Stage 2 Pressure Ulcer. A Stage 2 Pressure Ulcer involves partial-thickness loss of skin with exposed dermis. The wound bed is viable, pink or red, and moist, and may also present as an intact or ruptured blister.

Stage 4 Pressure Ulcer. A Stage 4 Pressure Ulcer involves full-thickness skin and tissue loss with exposed or directly palpable fascia, muscle, tendon, ligament, cartilage, or bone in the ulcer.

 

References

• European Pressure Ulcer Advisory Panel, National Pressure Injury Advisory Panel and Pan Pacific Pressure Injury Alliance. (2019). Prevention and Treatment of Pressure Ulcers/Injuries: Clinical Practice Guideline. Emily Haesler (Ed.). EPUAP/NPIAP/PPPIA.
• Edsberg, L. E., Black, J. M., Goldberg, M., McNichol, L., Moore, L., & Sieggreen, M. (2016). Revised National Pressure Ulcer Advisory Panel Pressure Injury Staging System. J Wound Ostomy Continence Nurs, 43(6), 585-597.

EXPLANATION

 

✔Correct answer:

Risk of water intoxication. Water intoxication is not a potential complication when administering hypertonic fluids. Hypertonic fluids have a higher concentration of solutes compared to the body's cells, which means they draw water out of the cells and into the bloodstream. This action is opposite to what would occur in water intoxication, where an excess of water dilutes the electrolytes in the body, leading to cellular swelling and potentially life-threatening complications.

Imagine you're trying to balance the amount of salt in a pot of soup (the body). Adding hypertonic fluids is like adding extra salt to the soup, making it saltier. Water intoxication would be like adding too much water to the soup, diluting it. In the case of hypertonic fluids, you're making the soup saltier, not diluting it, so the risk is not in making it too watery but rather in making it too salty.

Hypertonic fluids can lead to an osmotic gradient that favors the movement of water out of the cells and into the extracellular fluid. This can result in cellular dehydration and shrinkage, but it does not lead to water intoxication, which is characterized by an excess of water in the body and cellular swelling.

 

✘Incorrect answer options:

Shrinkage of cells. Cellular shrinkage is a potential complication of hypertonic fluid administration. The hypertonic solution will draw water out of the cells, leading to their shrinkage, which can disrupt cellular function and lead to complications.

Dehydration at the cellular level. Dehydration at the cellular level is another potential complication when administering hypertonic fluids. The high solute concentration in these fluids can pull water out of the cells, leading to cellular dehydration.

Excess in fluid volume. Excess fluid volume is also a potential complication, especially if hypertonic fluids are administered too quickly or in too high a volume. This can lead to conditions like hypertension and potentially exacerbate heart failure.

 

References

• Adrogué, H. J., & Madias, N. E. (2000). Hypernatremia. The New England Journal of Medicine, 342(20), 1493-1499.
• Sterns, R. H., Riggs, J. E., & Schochet, S. S. (1986). Osmotic demyelination syndrome following correction of hyponatremia. The New England Journal of Medicine, 314(24), 1535-1542.

EXPLANATION

 

✔Correct answer:

Small intestinal mucosa. The majority of water reabsorption in the gastrointestinal system occurs in the small intestine. The small intestine is lined with villi and microvilli, which significantly increase the surface area for absorption. These structures facilitate the efficient absorption of not only nutrients but also water. Understanding this is crucial for managing patients like Lisa, who has chronic gastrointestinal issues leading to fluid imbalances. Effective rehydration strategies would need to consider the small intestine's role in water absorption to ensure that she receives adequate fluid replacement.

Imagine the gastrointestinal system as a series of interconnected pools, with each pool representing a different part of the system. The small intestine would be the pool with the most advanced filtration system, capable of absorbing water quickly and efficiently. If you had to refill all the pools, focusing on optimizing the filtration system in the small intestine pool would be the most effective strategy.

The small intestine is the primary site for digestion and absorption in the gastrointestinal system. It is divided into three parts: the duodenum, jejunum, and ileum. Each of these segments has specialized cells in its lining that facilitate the absorption of various nutrients and water. The small intestine's ability to absorb water is also influenced by the osmotic gradients set up by the absorption of nutrients like glucose and electrolytes like sodium. Therefore, understanding the small intestine's role is vital for managing fluid imbalances effectively.

 

✘Incorrect answer options:

Esophageal lining. The esophagus primarily serves as a conduit for food from the mouth to the stomach. It does not play a significant role in water absorption, and its lining is not designed for this function.

Colonic mucosa. While the colon does participate in water reabsorption, it is not the primary site for this process. The colon mainly absorbs water to solidify feces but does not match the small intestine's efficiency in water absorption.

Gastric lining. The stomach's primary function is to break down food into chyme through mechanical and chemical digestion. While some water may be absorbed here, the majority of water absorption occurs in the small intestine.

 

References

• Guyton, A. C., & Hall, J. E. (2015). Textbook of Medical Physiology (13th ed.). Elsevier.
• Tortora, G. J., & Derrickson, B. H. (2018). Principles of Anatomy and Physiology (15th ed.). Wiley.

EXPLANATION

 

✔Correct answer:

Accurately measure and document both fluid intake and output as well as daily weights. Mr. Johnson's symptoms of severe diarrhea, lethargy, poor skin turgor, tachycardia, and hyperactive reflexes are indicative of fluid and electrolyte imbalances, possibly leading to severe dehydration. Accurate measurement and documentation of both fluid intake and output, along with daily weights, are crucial for assessing the severity of his condition and guiding appropriate treatment. This information will help healthcare providers adjust his fluid and electrolyte replacement therapy, thereby addressing the underlying cause of his symptoms.

Think of Mr. Johnson's body as a complex plumbing system. If you have a leak in your home's plumbing, you'd want to know exactly how much water you're losing and from where. Similarly, by accurately measuring and documenting fluid intake and output, you're identifying the "leaks" in Mr. Johnson's system, allowing for targeted "repairs" through appropriate fluid and electrolyte replacement.

Fluid balance is vital for maintaining homeostasis in the body. Fluid intake and output, along with daily weights, provide valuable data on the body's fluid status. Weight changes can indicate fluid retention or loss, while monitoring intake and output helps in assessing kidney function and the effectiveness of fluid replacement. Tachycardia and poor skin turgor are clinical signs of dehydration, emphasizing the need for meticulous fluid balance monitoring.

 

✘Incorrect answer options:

Utilize wrist restraints to prevent feeding tube dislodgement. While preventing feeding tube dislodgement is important, it is not the priority in this situation. Mr. Johnson's symptoms point to a severe fluid and electrolyte imbalance that requires immediate attention.

Provide salt tablets and oversee hypertonic parenteral fluid administration. Administering hypertonic fluids or salt tablets without a thorough assessment could exacerbate Mr. Johnson's condition. It's essential to first understand the extent of his fluid and electrolyte imbalances through accurate measurement and documentation.

Prescribe sedative medications to calm the patient. Sedative medications are not appropriate in this situation and could potentially worsen Mr. Johnson's lethargy and overall condition. The priority is to address the underlying fluid and electrolyte imbalances.

 

References

• Ignatavicius, D. D., Workman, M. L., & Rebar, C. R. (2017). Medical-Surgical Nursing: Concepts for Interprofessional Collaborative Care. Elsevier.
• Lewis, S. L., Dirksen, S. R., Heitkemper, M. M., & Bucher, L. (2014). Medical-Surgical Nursing: Assessment and Management of Clinical Problems. Elsevier.

EXPLANATION

 

✔Correct answer:

Packed red blood cells (PRBC). In cases of severe bleeding due to trauma, such as a motor vehicle accident, the primary goal is to restore oxygen-carrying capacity and volume as quickly as possible. Packed red blood cells (PRBCs) are the go-to choice for this purpose. PRBCs contain a high concentration of red blood cells, which are essential for carrying oxygen to tissues and organs. Rapid infusion of PRBCs helps to quickly restore hemoglobin levels, thereby improving the oxygen-carrying capacity of the blood and preventing hypoxia in vital organs.

Think of the circulatory system as a delivery service that brings oxygen to various "customers" (organs and tissues) in the body. If there's a massive "roadblock" (bleeding), fewer "delivery trucks" (red blood cells) can get through, causing a delay in oxygen delivery. Infusing PRBCs is like sending in a fleet of extra delivery trucks to make sure all customers get their oxygen on time.

The rapid infusion of PRBCs not only helps in restoring oxygen-carrying capacity but also aids in maintaining adequate blood volume, which is crucial for maintaining blood pressure and perfusion to vital organs. The absence of plasma in PRBCs makes it a concentrated source of red blood cells, allowing for quicker restoration of hemoglobin levels and less fluid overload, which is particularly beneficial in trauma settings.

 

✘Incorrect answer options:

Platelets. While platelets are essential for clotting, they are not typically infused rapidly to restore oxygen-carrying capacity in cases of severe bleeding.

Fresh frozen plasma (FFP). FFP contains clotting factors and can help in coagulation, but it is not the primary choice for rapid restoration of oxygen-carrying capacity.

Dextran. Dextran is a plasma volume expander and does not contain the red blood cells needed for rapid restoration of oxygen-carrying capacity. It is used to treat hypovolemia but won't effectively restore hemoglobin levels quickly.

 

References

• Lewis, S. L., Dirksen, S. R., Heitkemper, M. M., Bucher, L., & Camera, I. M. (2017). Medical-Surgical Nursing: Assessment and Management of Clinical Problems. Elsevier Health Sciences.
• Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-Surgical Nursing: Concepts for Interprofessional Collaborative Care. Elsevier Health Sciences.