Potter & Perry: Fundamentals of Nursing, 7th Edition

Answer Key to Study Guide

Chapter 41: Fluid, Electrolyte, and Acid-Base Balance

1. a. Is the fluid outside the cell (interstitial, intravascular, and transcellular fluid)
b. Comprises all fluid within the cells of the body (42% of body weight)
2. Positively charged electrolytes (sodium, potassium, and calcium)
3. Negatively charged electrolytes (chloride, bicarbonate, and sulfate)
4. Represents the number of grams of the specific electrolyte dissolved in a liter of
plasma
5. Is an electrolyte; oxygen, carbon dioxide, glucose, and proteins
6. Involves the movement of a pure solvent across a semipermeable membrane from
an area of lesser solute concentration to an area of greater solute concentration.
7. The concentration of a solution is measured in osmols, which reflects the amount of
a substance in the form of molecules, ions, or both.
8. Is the drawing power of water and depends on the number of molecules in solution
9. The osmotic pressure of a solution
10. Another term that describes the concentration of solution
11. The solutions on both sides of the semipermeable membrane are equal in
concentration (expand the body’s fluid volume without causing a fluid shift from
one compartment to another).
12. A solution of higher osmotic pressure (pulls fluid from cells, causing them to
shrink)
13. A solution of lower osmotic pressure (moves fluids into the cells, causing them to
enlarge)
14. Random movement of a solute in a solution across a semipermeable membrane
from an area of higher concentration to an area of lower concentration
15. The difference between two concentrations
16. Is the process by which water and diffusible substances move together across a
membrane, in response to fluid pressure, moving from an area of higher pressure to
one of lower pressure
17. Requires metabolic activity and expenditure of energy to move substances across
the cell membrane
18. a. Fluid intake
b. Hormonal controls
c. Fluid output
19. Continually monitor the serum osmotic pressure
20. Excess fluid is lost.
21. Risk for clients who are unable to perceive or respond to the thirst mechanism
22. Is stored in the pituitary gland and is released in response to changes in the blood
osmolarity
23. a. Causes vasoconstriction
b. Causes massive selective vasoconstriction of blood vessels and relocates blood

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Answer Key to Study Guide 41-2

flow to kidneys and stimulates the release of aldosterone (when the sodium is low)
c. Adrenal cortex releases in response to increased plasma potassium levels
24. Plays a critical role in the balance of fluid and electrolytes and the maintenance of
vascular tone
25. a. Kidneys
b. Skin
c. Lungs
d. Gastrointestinal tract
26. a. Is continuous and occurs through the skin and lungs, not perceived by the person
b. Occurs through excess perspiration and can be perceived by the client
27. See Table 41-1, p. 967

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 Answer Key to Study Guide 41-3

Electrolyte Values Function Regulatory Mechanism

Sodium 135-145 mEq/L Major contributor to maintain Dietary intake and
water balance aldosterone secretion
Potassium 3.5-5.0 mEq/L Is necessary for glycogen Dietary intake and renal
deposits in the liver and skeletal excretion regulate
muscle, transmission and potassium.
conduction of nerve impulses,
normal cardiac conduction, and
skeletal and smooth muscle
contraction
Calcium 4.5-5.5 mg/dL Bone and teeth formation, blood Absorbed from intestine,
clotting, hormone secretion, cell excreted by the kidneys
membrane integrity, cardiac and resorbed or
conduction, transmission of deposited in bone
nerve impulses, and muscle Regulated by parathyroid
contraction hormone, vitamin D, and
calcitonin
Magnesium 1.5-2.5 mEq/L Essential for enzyme activities, Serum magnesium is
neurochemical activities, and regulated by dietary
cardiac and skeletal muscle intake, renal
excitability mechanisms, and actions
of the parathyroid
hormone (PTH).
Chloride 95-105 mEq/L Chloride is the major anion in Serum chloride is
extracellular fluid (ECF). The regulated by dietary
transport of chloride follows intake and the kidneys.
sodium.
Bicarbonate 22-26 (arterial) The bicarbonate ion is an The kidneys regulate
mEq/L essential component of the bicarbonate.
24-30 (venous) carbonic acid–bicarbonate
mEq/L buffering system essential to
acid-base balance.
Phosphate 2.8-4.5 mg/dL It assists in acid-base regulation. Phosphate is normally
Phosphate and calcium help to absorbed through the
develop and maintain bones and gastrointestinal (GI)
teeth. Phosphate also promotes tract. It is regulated by
normal neuromuscular action and dietary intake, renal
participates in carbohydrate excretion, intestinal
metabolism. absorption, and PTH.

28. a. Chemical
b. Biological
c. Physiological buffering
29.
Imbalance Laboratory Finding Signs and Symptoms

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Answer Key to Study Guide
Hyponatremia Serum sodium level below
135 mEq/L, serum
osmolality 280 mOsm/kg,
and urine specific gravity
below 1.010 (if not caused
by syndrome of
inappropriate antidiuretic
hormone [SIADH])
Hypernatremia Serum sodium levels above
145 mEq/L, serum
osmolality 300 mOsm/kg,
and urine specific gravity
1.030 (if not caused by
diabetes insipidus)
Hypokalemia Serum potassium level
below 3.5 mEq/L and
electrocardiogram (ECG)
abnormalities: flattened T
wave; ST segment
depression; U wave;
potentiated digoxin effects
(e.g., ventricular
dysrhythmias)
Hyperkalemia Serum potassium level
above 5.0 mEq/L and ECG
abnormalities: peaked T
wave and widened QRS
complex (bradycardia, heart
block, dysrhythmias);
eventually QRS pattern
widens and cardiac arrest
occurs
Hypocalcemia Serum ionized calcium level
below 4.5 mEq/L or total
serum calcium below 8.5
mg/dL and ECG
abnormalities: ventricular
tachycardia
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41-4
Apprehension, personality
change, postural
hypotension, postural
dizziness, abdominal
cramping, nausea and
vomiting, diarrhea,
tachycardia, dry mucous
membranes, convulsions,
and coma
Extreme thirst, dry and
flushed skin, dry and sticky
tongue and mucous
membranes, postural
hypotension, fever,
agitation, convulsions,
restlessness, and irritability
Weakness and fatigue,
muscle weakness, nausea
and vomiting, intestinal
distention, decreased bowel
sounds, decreased deep
tendon reflexes, ventricular
dysrhythmias, paresthesias,
and weak, irregular pulse
Anxiety, dysrhythmias,
paresthesia, weakness,
abdominal cramps, and
diarrhea
Numbness and tingling of
fingers and circumoral
(around mouth) region,
hyperactive reflexes,
positive Trousseau’s sign
(carpopedal spasm with
hypoxia), positive
Chvostek’s sign
(contraction of facial
muscles when facial nerve
is tapped), tetany, muscle
cramps, and pathological
Answer Key to Study Guide 41-5

Hypercalcemia Serum ionized calcium level
above 5.5 mEq/L or total
serum calcium level above
10.5 mg/dL; x-ray
examination showing
generalized osteoporosis,
widespread bone cavitation,
radiopaque urinary stones;
and elevated blood urea
nitrogen (BUN) level 25
mg/100 mL and elevated
creatinine level 1.5 mg/100
mL caused by fluid volume
deficit (FVD) or renal
damage caused by
urolithiasis; ECG
abnormalities: heart block
Hypomagnesemia Serum magnesium level
below 1.5 mEq/L
Hypermagnesemia Serum magnesium level
above 2.5 mEq/L; ECG
abnormalities: prolonged
QT interval, AV block
fractures (chronic
hypocalcemia)
Anorexia, nausea and
vomiting, weakness,
hypoactive reflexes,
lethargy, flank pain (from
kidney stones), decreased
level of consciousness,
personality changes, and
cardiac arrest
Muscular tremors,
hyperactive deep tendon
reflexes, confusion and
disorientation, tachycardia,
hypertension,
dysrhythmias, and positive
Chvostek’s sign and
Trousseau’s sign
Acute elevations in
magnesium levels:
hypoactive deep tendon
reflexes, decreased depth
and rate of respirations,
hypotension, and flushing

30. a. Measures the hydrogen ion concentration in the body fluids (7.35 to 7.45)
b. Is the partial pressure of carbon dioxide in arterial blood (35 to 45 mm Hg)
c. Is the partial pressure of oxygen in the blood (80 to 100 mm Hg)
d. Is the point at which hemoglobin is saturated by oxygen (95% to 99%)
e. Is the amount of blood buffer (hemoglobin and bicarbonate) that exists (+/– 2
mEq/L)
f. Is the major renal component of acid-base balance (22 to 26 mEq/L)
31.
Acid-Base Imbalance Laboratory Findings Signs and Symptoms
Respiratory acidosis Arterial blood gas Confusion, dizziness,
alterations: pH < 7.35, lethargy, headache,
PaCO2 > 45 mm Hg, PaO2 < ventricular dysrhythmias,

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Answer Key to Study Guide 41-6

80 mm Hg, and bicarbonate warm and flushed skin,

Respiratory alkalosis
Metabolic acidosis
Metabolic alkalosis
level normal (if
uncompensated) or >26
mEq/L (if compensated)
Arterial blood gas
alterations: pH > 7.45,
PaCO2 < 35 mm Hg, PaO2
normal, and bicarbonate
level normal (if short lived
or uncompensated) or < 22
mEq/L (if compensated)
Arterial blood gas
alterations: pH < 7.35,
PaCO2 normal (if
uncompensated) or < 35 mm
Hg (if compensated), PaO2
normal or increased (with
rapid, deep respirations),
bicarbonate level < 22
mEq/L, and oxygen
saturation normal
Arterial blood gas
alterations: pH > 7.45,
PaCO2 normal (if
uncompensated) or > 45 mm
Hg (if compensated), PaO2
normal, and bicarbonate
level > 26 mEq/L
muscular twitching,
convulsions, and coma
Dizziness, confusion,
dysrhythmias, tachypnea,
numbness and tingling of
extremities, convulsions,
and coma
Headache, lethargy,
confusion, dysrhythmias,
tachypnea with deep
respirations, abdominal
cramps, and flushed skin
Dizziness; dysrhythmias;
numbness and tingling of
fingers, toes, and
circumoral region; muscle
cramps; tetany

32. a. Age—Very young; very old

b. Gender—Women
c. Environment—Diet, exercise, and hot weather and sweating
d. Chronic diseases—Cancer; cardiovascular disease, such as congestive heart
failure; endocrine disease, such as Cushing’s disease and diabetes mellitus;
malnutrition; chronic obstructive pulmonary disease; and renal disease
e. Trauma—Crush injuries, head injuries, burns
f. Therapies—Diuretics, steroids, intravenous (IV) therapy, and total parenteral
nutrition (TPN)
g. Gastrointestinal losses – Gastroenteritis; nasogastric suctioning; fistulas
33. Infants and children have greater water needs and are more vulnerable to fluid
volume alterations; fever in children creates an increase in the rate of insensible
water loss; adolescents have increased metabolic processes; older adults have
decreased thirst sensation, which often causes electrolyte imbalances
34. Surgery, head and chest trauma, shock, and second- and third-degree burns place
the clients at risk.
35. The more extensive the surgery and fluid loss, the greater the body’s response.

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Answer Key to Study Guide 41-7

36. The greater the body surface burned, the greater the fluid loss.
37. Predispose to respiratory acidosis and/or respiratory alkalosis
38. Can result in cerebral edema and diabetes insipidus
39. Cancer, congestive heart failure (CHF), or renal disease
40. Depends on the type and progression of the cancer and its treatment (diarrhea and
anorexia)
41. Diminished cardiac output, which reduces kidney perfusion and decreases urine
output
42. Causes an abnormal retention of sodium, chloride, potassium, and water (metabolic
acidosis)
43. Gastroenteritis and nasogastric suctioning result in the loss of fluid, potassium, and
chloride ions.
44. Vigorous exercise or exposure to extreme temperatures
45. Recent changes in appetite or the ability to chew and swallow (breakdown of
glycogen and fat stores, metabolic acidosis, hypoalbuminemia, edema)
46. History of smoking or alcohol consumption (respiratory acidosis)
47. Diuretics—Metabolic alkalosis, hyperkalemia, and hypokalemia
Steroids—Metabolic alkalosis
Potassium supplements—GI disturbances, including intestinal and gastric ulcers
and diarrhea
Respiratory center depressants (e.g., opioid analgesics)—Decreased rate and depth
of respirations, resulting in respiratory acidosis
Antibiotics—Nephrotoxicity (e.g., vancomycin, methicillin, or aminoglycosides);
hyperkalemia and/or hypernatremia (e.g., azlocillin, carbenicillin, piperacillin,
ticarcillin, or Unasyn)
Calcium carbonate (Tums)—Mild metabolic alkalosis with nausea and vomiting
Magnesium hydroxide (Milk of Magnesia)—Hypokalemia
Nonsteroidal antiinflammatory drugs—Nephrotoxicity
48. a. Weight loss of 5% to 8%: Mild to moderate fluid volume deficit (FVD)
b. Irritability: Metabolic or respiratory alkalosis, hyperosmolar imbalance,
hypernatremia, hypokalemia
c. Lethargy: FVD, metabolic acidosis or alkalosis, respiratory acidosis,
hypercalcemia
d. Periorbital edema: Fluid volume excess (FVE)
e. Sticky, dry mucous membranes: FVD, hypernatremia
f. Chvostek’s sign: Hypocalcemia
g. Distended neck veins: FVE
h. Dysrhythmias: Metabolic acidosis, respiratory alkalosis and acidosis, potassium
imbalance, hypomagnesemia
i. Weak pulse: FVD, hypokalemia
j. Low blood pressure: FVD, hyponatremia, hyperkalemia, hypermagnesemia
k. Third heart sound: FVE
l. Increased respiratory rate: FVE, respiratory alkalosis, metabolic acidosis
m. Crackles: FVE
n. Anorexia: Metabolic acidosis
o. Abdominal cramps: Metabolic acidosis

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Answer Key to Study Guide 41-8

p. Poor skin turgor: FVD

q. Oliguria or anuria: FVD, FVE
r. Increased specific gravity: FVD
s. Muscle cramps, tetany: Hypocalcemia, metabolic or respiratory alkalosis
t. Hypertonicity of muscles on palpation: Hypocalcemia, hypomagnesemia,
metabolic alkalosis
u. Decreased or absent deep tendon reflexes: Hypokalemia, hypercalcemia
v. Increased temperature: Hypernatremia, hyperosmolar imbalance, metabolic
acidosis
w. Distended abdomen: Third-space syndrome
x. Cold, clammy skin: FVD
y. 2+ edema: FVE
49. Decreased cardiac output
50. Acute confusion
51. Deficient fluid volume
52. Excess fluid volume
53. Impaired gas exchange
54. Risk for injury
55. Deficient knowledge regarding disease management
56. Impaired oral mucous membrane
57. Impaired skin integrity
58. Ineffective tissue perfusion
59. a. Will be free of complications associated with the IV device throughout the
duration of IV therapy
b. Will demonstrate fluid balance as evidenced by moist, mucous membranes,
balanced intake and output (I&O), and stable weights within 48 hours
c. Will have serum electrolyte levels within the normal range within 48 hours
60. May be appropriate when the client’s GI tract is healthy but the client cannot ingest
fluids
61. Clients who retain fluids and have fluid volume excess require restriction of fluids.
62. Includes TPN, crystalloids, and colloids
63. Is a nutritionally adequate hypertonic solution consisting of glucose, nutrients, and
electrolytes administered peripherally, percutaneously, implanted, or tunneled
64. Is to correct or prevent fluid and electrolyte imbalances
65. Are catheters, cannulas, or infusion ports designed for repeated access to the
vascular system
66. a. Isotonic: Dextrose 5% in water, 0.9% sodium chloride (normal saline [NS]),
lactated Ringer’s
b. Hypotonic: 0.45% sodium chloride (half normal saline), 0.33% sodium chloride
(one-third normal saline),
c. Hypertonic: Dextrose 10% in water, 3% to 5% sodium chloride, dextrose 5% in
0.9% sodium chloride, dextrose 5% in 0.45% sodium chloride, dextrose 5% in
lactated Ringer’s
67. Infiltration Scale
Grade Clinical Criteria
0 No symptoms

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Answer Key to Study Guide 41-9

1 Skin blanched
Edema, < 1 inch in any direction
Cool to touch
With or without pain
2 Skin blanched
Edema 1-6 inches in any direction
Cool to touch
With or without pain
3 Skin blanched, translucent
Gross edema >6 inches in any direction
Cool to touch
Mild to moderate pain
Possible numbness
4 Skin blanched, translucent
Skin tight, leaking
Skin discolored, bruised, swollen
Gross edema >6 inches in any direction
Deep pitting tissue edema
Circulatory impairment
Moderate to severe pain
Infiltration of any amount of blood product,
irritant, or vesicant

Phlebitis Scale
Grade Clinical Criteria
0 No symptoms
1 Erythema at access site with or without pain
2 Pain at access site with erythema and/or edema
3 Pain at access site with erythema and/or edema
Streak formation
Palpable venous cord
4 Pain at access site with erythema and/or edema
Streak formation
Palpable venous cord >1 inch in length
Purulent drainage

68. A technique in which a vein is punctured through the skin by a rigid stylet
(butterfly), a stylet covered with a plastic cannula (ONC), or a needle attached to a
syringe
69. For administering small hourly volumes (<20 mL/hr) and for clients who are at risk
for volume overloads
70. a. Keeping the system sterile
b. Changing solutions, tubing, and site dressings
c. Assisting the client with self-care activities
71. a. Increase circulating blood volume after surgery, trauma, or hemorrhage
b. Increase the number of red blood cells (RBCs) and maintain hemoglobin levels in

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Answer Key to Study Guide 41-10

clients with severe anemia

c. Provide selected cellular components as replacement therapy
72. A, B, O, AB blood types
73. Type O
74. AB individual
75. An antigen-antibody reaction and can range from mild response to severe
anaphylactic shock, which can be life threatening
76. Is the collection and reinfusion of a client’s own blood
77. a. An 18-gauge or 19-gauge cannula
b. In-line filter tubing
c. Explain the procedure, and instruct the client to report any side effects.
d. Signed informed consent
e. Baseline vital signs (VS)
f. Two registered nurses (RNs) must check the labels on the blood product to the
client’s identification number, blood group, and complete name.
g. Begin transfusion slowly; the first 15 minutes stay with client.
h. Packed RBCs transfused in 2 to 4 hours
78.
Reaction Cause Clinical Manifestations
Acute Infusion of ABO-incompatible Chills, fever, low back pain,
hemolytic whole blood, RBCs, or flushing, tachycardia,
components containing 10 tachypnea, hypotension,
mL or more of RBCs vascular collapse,
Antibodies in the recipient’s hemoglobinuria,
plasma attach to antigens on hemoglobinemia, bleeding,
transfused RBCs, causing acute renal failure, shock,
RBC destruction cardiac arrest, death
Febrile, Sensitization to donor white Sudden chills and fever (rise in
nonhemo- blood cells, platelets, or temperature of greater than
lytic (most plasma proteins 1° C), headache, flushing,
common) anxiety, muscle pain
Mild allergic Sensitivity to foreign plasma Flushing, itching, urticaria
proteins (hives)
Anaphylactic Infusion of IgA proteins to IgA- Anxiety, urticaria, wheezing,
deficient recipient who has progressing to cyanosis,
developed IgA antibody shock, possible cardiac
arrest
Circulatory Fluid administered faster than Cough, dyspnea, pulmonary
overload the circulation can congestion (rales), headache,
accommodate hypertension, tachycardia,
distended neck veins
Sepsis Transfusion of contaminated Rapid onset of chills, high
blood components fever, vomiting, diarrhea,
and marked hypotension and
shock

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Answer Key to Study Guide 41-11

79. a. Sudden chills and fever

b. Headache
c. Flushing
d. Anxiety
e. Muscle pain
80. Keep the IV line open with 0.9% NS.
81. Do not turn off the blood, and turn on NS that is connected to the Y-tubing infusion
set.
82. Notify health care provider.
83. Remain with client, observing signs and symptoms; monitor VS every 5 minutes.
84. Prepare to administer emergency drugs per protocol.
85. Prepare to perform cardiopulmonary resuscitation.
86. Obtain a urine specimen and send to laboratory (RBC hemolysis).
87. The blood container, tubing, attached labels, and transfusion record are saved and
returned to the laboratory.
88. 4. Extracellular fluid is all the fluid outside the cell and has three compartments.
89. 3. A combination of increased PaCO2, excess carbonic acid, and an increased
hydrogen ion concentration
90. 1. Any condition that results in the loss of GI fluids predisposes the client to the
development of dehydration and a variety of electrolyte disturbances.
91. 3. Is marked by a decreased PaCO2 and an increased pH; anxiety with
hyperventilation is a cause
92. Refer to the answer in the back of the study guide.

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