NUR 521: Exam 1 Study Guide Fluid, Electrolyte,
and Acid-Base Balance with complete solution.
Exam 1 Study Guide NUR 521
(Chapters 10, 34, 35, 36, 37)
Chapter 10 (20 questions)
1. Understand the special needs of the older adult pertaining to fluid and electrolytes
a. Impact of water loss including “insensible fluid loss”
i. Water makes up most of our bodies. An older adult’s water percentage
(45% for women and 55% for men) is about 10% less than a young adult.
ii. they have less body reserve (meaning that interruptions with body fluids
are more severe for the geriatric population & imbalances with fluids
always affect electrolytes [less water means more electrolytes; less
electrolytes means more water] → thus interrupting homeostasis all
together)
b. Organ function
i. Sodium and water regulation become less efficient w/ aging
ii. Kidneys (less able to concentrate urine and conserve H2O and Na), Renal
blood flow and glomerular filtration decline
iii. Thirst Mechanism (hypothalamus is the thirst center in brain) Perception
of thirst decrease
c. Muscle mass
i. skeletal muscle retains the most water (men have more skeletal muscle so
they have a higher percentage than women [they hold more fat and
adipose tissue does not retain much water])
ii. In this population: Lean muscle mass is decreased, and body fat is
increased.
d. Increased risks (e.g. dehydration)
i. (Risk factors for FVD) Those with a: self-care deficit, confused,
depressed, tube fed on bed rest, in extremely hot weather, taking
medications.
ii. Dehydration: can cause fever and further dehydration
iii. Functional impairments- (arthritis or stroke) can impair ability to access
fluids
iv. Cognitive impairment- interferes with recognition of thirst and ability to
respond to it
v. Early manifestation for dehydration in older adult: change in mental status
2. Review the natural compensatory mechanisms within the body as it attempts to shift
fluids to maintain homeostasis
a. ADH-
i. released by the posterior pituitary gland, regulates water excretion from
the kidneys. Increased response to stress such as nausea, pain, surgery
anesthesia. Inhibited amount by alcohol and medications like phenytoin
and increased blood volume and decreased osmolality. Pg 232
b. Renin
mailto:https://www.stuvia.com/user/Wisdoms
, i. angiotensin helps maintain intravascular fluid balance and blood pressure.
A decrease in blood flow or BP stimulates receptors to produce renin. Pg.
232
c. Aldosterone
i. Aldosterone promotes sodium and water retention in the distal nephron of
the kidney, restoring blood volume. Pg 232
d. Vital signs and physical presentation
i. When blood pressure and blood volume are low → the body’s heart rate
will increase and vessels will constrict to compensate for the depressed
BP/BV so it increases to put out the little blood available to distribute
3. Memorize the information pertaining to each electrolyte posted to include the
following: (all from the powerpoint)
a. Possible causes of the deficit or excess (study the slides)
b. Clinical manifestations (it is important that you recognize signs and symptoms a
patient is having to correlate with disease and priority interventions)
c. Possible treatment
d. Nursing responsibilities and intervention
e. Expand your knowledge on specific foods that are high and low in each
electrolyte so that you may choose the correct items to teach your patient. For
example: high phosphorus categories aside from what is listed in the PowerPoint
include protein-rich foods such as meats, chicken, fish, nuts, beans and dairy
products.
Electrolyte: Sodium Hyponatremia <135 Hypernatremia >145
Normal: 135-145
Symptoms Poor skin turgor, Dry mucosa, Headache, Thirst, Elevated temperature, Dry, swollen tongue,
Decreased salivation, Decreased BP, Sticky mucosa, Neuro symptoms, Restlessness,
Nausea, Abdominal cramping, Neuro Weakness, Seizures or coma
changes, Muscle weakness
Causes adrenal insufficiency, water intoxication, Excess water loss, Excess Na admin. Diabetes
vomiting, diarrhea, sweating, diuretics insipidus, Heat stroke, Hypertonic IV solution
Treatment Water restriction, Sodium replacement Hypotonic solution (0.45 NaCl, D5w)
Responsibilities/Inter Monitor sodium, Assessment, prevent Assess OTC sodium, Mental status, Prevention,
vention cerebral edema, Teach about effects of Encourage fluids, H20 via tube feeding
medication and manifestations
Foods Fresh, frozen or dried fruits: Berries, Smoked, cured, salted, or canned meat, fish or
apples, bananas, pears, etc. Grains and poultry including bacon, cold cuts, ham,
beans: Dried beans, brown rice, farro, frankfurters, sausage, sardines, caviar and
quinoa and whole wheat pasta. Starchy anchovies. Frozen breaded meats and dinners, such
vegetables: Potatoes, sweet potatoes, as burritos and pizza. Canned entrees, such as
butternut squash and parsnips. Fresh or ravioli, spam and chili. Salted nuts. Beans canned
with salt added.
2
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, frozen meat and poultry: Chicken, turkey,
beef or pork.
Electrolyte: Hypokalemia <3.5 Hyperkalemia >5.3
Potassium
Normal: 3.5 - 5.3
Symptoms Fatigue , N/V / anorexia Dysrhythmias, Cardiac changes, Dysrhythmias, Possible cardiac
Muscle weakness, Leg cramps / arrest, Potential respiratory impairment, Muscle
paresthesia, Glucose intolerance, ↓ weakness, Paresthesia, Tremors, twitching,
muscle strength, ↓ cardiac output, Anxiety, GI manifestations
Polyuria / altered renal function Treatment-Monitor EKG, Kayexalate, IV sodium
bicarbonate, IV calcium gluconate, Regular
insulin, D50 (hypertonic), b -2 agonists, Limit
dietary K+
Causes GI losses, Medications, Alterations of treatment related, Impaired renal fx,
acid-base balance, Hyperaldosteronism, Hyperaldosteronism, Tissue trauma, Acidosis
Poor dietary intake
Treatment Increase dietary K+, K+ replacement, Monitor EKG, Kayexalate, IV sodium bicarbonate,
D5W IV calcium gluconate, Regular insulin, D50
(hypertonic), b -2 agonists, Limit dietary K+
Responsibilities/Inter Assessment, health history, physical, Assess serum K+, Monitor medication effects,
vention Monitor EKG, ABG’s, Dietary K+, Initiate dietary K+ restriction, Dietary teaching
Watch IV site
Foods cherries, tangerine, lettuce, peppers, beef, Dried fruits (raisins, apricots), Beans, lentils,
egg, peanut butter, rice, tea, noodles Potatoes, Winter squash (acorn, butternut),
Spinach, broccoli, Beet greens, Avocado, Bananas,
Cantaloupe, Oranges, orange juice, Coconut water,
Tomatoes, Dairy and plant milks (soy, almond),
Yogurt, Cashews, almonds, Chicken, Salmon
Electrolyte: Calcium Hypocalemia <9 Hyper
Normal: 9 - 11
Symptoms Tetany (spasms), Circumoral numbness, H/A – Anorexia, N/V, Dehydration, Constipation,
Paresthesia, Hyperactive DTR’s, Abdominal/bone pain, Excessive urination, Severe
Trousseau’s sign, Chvostek’s sign, thirst, Confusion, impaired memory, slurred
Seizures, Respiratory symptoms, speech, lethargy, acute psychotic behavior or coma
Dyspnea
3
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, Causes Hypoparathyroidism, Malabsorption, Malignancies, Hyperparathyroidism, Tumors,
Pancreatitis, Alkalosis, Massive Immobilization, Thiazide diuretics, Vitamin A &
transfusion of citrated blood, Renal D intoxication, Lithium and theophylline toxicity
failure, Medications
Treatment Oral calcium, Vitamin D, Diet with Treat underlying cause, Volume expansion and
calcium saline diuresis, Phosphates, Bisphosphonates,
Calcitonin
Responsibilities/Inter Assessment, Teach weight bearing Assessment (crisis has high mortality rate),
vention exercises, Education on meds and diet, encourage ambulation, Fluids 3-4 liters/day,
IV calcium administration, Observe Provide fluids containing Na (unless
airway (r/t potential laryngospasm) contraindicated), Fiber (constipation)
Foods Bok choy, Chicory, Collard greens, Corn, Dairy products. Products like milk, yogurt, cheese,
Dandelion greens, Kale Soybeans, Dark Green, Leafy Vegetables, Figs,
Flour Tortillas, Canned Baked Beans
Electrolyte: Hypomagnesemia <1.8 Hypermagnesemia >3
Magnesium
Normal: 1.8 - 3
Symptoms Mood changes, Neuromuscular Flushing; NV, low BP, Diminished DTRs,
irritability (seizures), Muscle weakness, Drowsiness, Muscle weakness, Depressed
Tremors, EKG changes, Dysrhythmias, respirations, EKG changes, Dysrhythmias, Coma /
HTN, tachycardia, Positive Babinski, cardiac arrest
Chvostek and Trousseau
Causes Alcoholism, GI losses, Enteral/parenteral Renal failure, Diabetic ketoacidosis, Excessive
feeding deficient in Mg, Medications, MgSO4
Rapid administration of citrated blood,
Diabetic ketoacidosis, Sepsis,
Burns/hypothermia
Treatment Diet, Oral Mg, MgSO4 IV IV calcium gluconate, Loop diuretics, IV NS or
RL, Hemodialysis (if renal patient)
Responsibilities/Inter Assessment, Ensure safety, Pt teaching r/t Assessment, Avoid MgS04 meds and/or
vention diet, medications, ETOH, IV site care, compounds, Pt teaching r/t OTC medications with
Monitor/tx potential hypocalcemia MgSO4
Foods fresh fruit and veggies, chicken greens, nuts, seeds, dry beans, whole grains, wheat
germ, wheat and oat bran.
Electrolyte: Hypophosphatemia < 2.5 Hyperphosphatemia >4.5
4
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and Acid-Base Balance with complete solution.
Exam 1 Study Guide NUR 521
(Chapters 10, 34, 35, 36, 37)
Chapter 10 (20 questions)
1. Understand the special needs of the older adult pertaining to fluid and electrolytes
a. Impact of water loss including “insensible fluid loss”
i. Water makes up most of our bodies. An older adult’s water percentage
(45% for women and 55% for men) is about 10% less than a young adult.
ii. they have less body reserve (meaning that interruptions with body fluids
are more severe for the geriatric population & imbalances with fluids
always affect electrolytes [less water means more electrolytes; less
electrolytes means more water] → thus interrupting homeostasis all
together)
b. Organ function
i. Sodium and water regulation become less efficient w/ aging
ii. Kidneys (less able to concentrate urine and conserve H2O and Na), Renal
blood flow and glomerular filtration decline
iii. Thirst Mechanism (hypothalamus is the thirst center in brain) Perception
of thirst decrease
c. Muscle mass
i. skeletal muscle retains the most water (men have more skeletal muscle so
they have a higher percentage than women [they hold more fat and
adipose tissue does not retain much water])
ii. In this population: Lean muscle mass is decreased, and body fat is
increased.
d. Increased risks (e.g. dehydration)
i. (Risk factors for FVD) Those with a: self-care deficit, confused,
depressed, tube fed on bed rest, in extremely hot weather, taking
medications.
ii. Dehydration: can cause fever and further dehydration
iii. Functional impairments- (arthritis or stroke) can impair ability to access
fluids
iv. Cognitive impairment- interferes with recognition of thirst and ability to
respond to it
v. Early manifestation for dehydration in older adult: change in mental status
2. Review the natural compensatory mechanisms within the body as it attempts to shift
fluids to maintain homeostasis
a. ADH-
i. released by the posterior pituitary gland, regulates water excretion from
the kidneys. Increased response to stress such as nausea, pain, surgery
anesthesia. Inhibited amount by alcohol and medications like phenytoin
and increased blood volume and decreased osmolality. Pg 232
b. Renin
mailto:https://www.stuvia.com/user/Wisdoms
, i. angiotensin helps maintain intravascular fluid balance and blood pressure.
A decrease in blood flow or BP stimulates receptors to produce renin. Pg.
232
c. Aldosterone
i. Aldosterone promotes sodium and water retention in the distal nephron of
the kidney, restoring blood volume. Pg 232
d. Vital signs and physical presentation
i. When blood pressure and blood volume are low → the body’s heart rate
will increase and vessels will constrict to compensate for the depressed
BP/BV so it increases to put out the little blood available to distribute
3. Memorize the information pertaining to each electrolyte posted to include the
following: (all from the powerpoint)
a. Possible causes of the deficit or excess (study the slides)
b. Clinical manifestations (it is important that you recognize signs and symptoms a
patient is having to correlate with disease and priority interventions)
c. Possible treatment
d. Nursing responsibilities and intervention
e. Expand your knowledge on specific foods that are high and low in each
electrolyte so that you may choose the correct items to teach your patient. For
example: high phosphorus categories aside from what is listed in the PowerPoint
include protein-rich foods such as meats, chicken, fish, nuts, beans and dairy
products.
Electrolyte: Sodium Hyponatremia <135 Hypernatremia >145
Normal: 135-145
Symptoms Poor skin turgor, Dry mucosa, Headache, Thirst, Elevated temperature, Dry, swollen tongue,
Decreased salivation, Decreased BP, Sticky mucosa, Neuro symptoms, Restlessness,
Nausea, Abdominal cramping, Neuro Weakness, Seizures or coma
changes, Muscle weakness
Causes adrenal insufficiency, water intoxication, Excess water loss, Excess Na admin. Diabetes
vomiting, diarrhea, sweating, diuretics insipidus, Heat stroke, Hypertonic IV solution
Treatment Water restriction, Sodium replacement Hypotonic solution (0.45 NaCl, D5w)
Responsibilities/Inter Monitor sodium, Assessment, prevent Assess OTC sodium, Mental status, Prevention,
vention cerebral edema, Teach about effects of Encourage fluids, H20 via tube feeding
medication and manifestations
Foods Fresh, frozen or dried fruits: Berries, Smoked, cured, salted, or canned meat, fish or
apples, bananas, pears, etc. Grains and poultry including bacon, cold cuts, ham,
beans: Dried beans, brown rice, farro, frankfurters, sausage, sardines, caviar and
quinoa and whole wheat pasta. Starchy anchovies. Frozen breaded meats and dinners, such
vegetables: Potatoes, sweet potatoes, as burritos and pizza. Canned entrees, such as
butternut squash and parsnips. Fresh or ravioli, spam and chili. Salted nuts. Beans canned
with salt added.
2
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, frozen meat and poultry: Chicken, turkey,
beef or pork.
Electrolyte: Hypokalemia <3.5 Hyperkalemia >5.3
Potassium
Normal: 3.5 - 5.3
Symptoms Fatigue , N/V / anorexia Dysrhythmias, Cardiac changes, Dysrhythmias, Possible cardiac
Muscle weakness, Leg cramps / arrest, Potential respiratory impairment, Muscle
paresthesia, Glucose intolerance, ↓ weakness, Paresthesia, Tremors, twitching,
muscle strength, ↓ cardiac output, Anxiety, GI manifestations
Polyuria / altered renal function Treatment-Monitor EKG, Kayexalate, IV sodium
bicarbonate, IV calcium gluconate, Regular
insulin, D50 (hypertonic), b -2 agonists, Limit
dietary K+
Causes GI losses, Medications, Alterations of treatment related, Impaired renal fx,
acid-base balance, Hyperaldosteronism, Hyperaldosteronism, Tissue trauma, Acidosis
Poor dietary intake
Treatment Increase dietary K+, K+ replacement, Monitor EKG, Kayexalate, IV sodium bicarbonate,
D5W IV calcium gluconate, Regular insulin, D50
(hypertonic), b -2 agonists, Limit dietary K+
Responsibilities/Inter Assessment, health history, physical, Assess serum K+, Monitor medication effects,
vention Monitor EKG, ABG’s, Dietary K+, Initiate dietary K+ restriction, Dietary teaching
Watch IV site
Foods cherries, tangerine, lettuce, peppers, beef, Dried fruits (raisins, apricots), Beans, lentils,
egg, peanut butter, rice, tea, noodles Potatoes, Winter squash (acorn, butternut),
Spinach, broccoli, Beet greens, Avocado, Bananas,
Cantaloupe, Oranges, orange juice, Coconut water,
Tomatoes, Dairy and plant milks (soy, almond),
Yogurt, Cashews, almonds, Chicken, Salmon
Electrolyte: Calcium Hypocalemia <9 Hyper
Normal: 9 - 11
Symptoms Tetany (spasms), Circumoral numbness, H/A – Anorexia, N/V, Dehydration, Constipation,
Paresthesia, Hyperactive DTR’s, Abdominal/bone pain, Excessive urination, Severe
Trousseau’s sign, Chvostek’s sign, thirst, Confusion, impaired memory, slurred
Seizures, Respiratory symptoms, speech, lethargy, acute psychotic behavior or coma
Dyspnea
3
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, Causes Hypoparathyroidism, Malabsorption, Malignancies, Hyperparathyroidism, Tumors,
Pancreatitis, Alkalosis, Massive Immobilization, Thiazide diuretics, Vitamin A &
transfusion of citrated blood, Renal D intoxication, Lithium and theophylline toxicity
failure, Medications
Treatment Oral calcium, Vitamin D, Diet with Treat underlying cause, Volume expansion and
calcium saline diuresis, Phosphates, Bisphosphonates,
Calcitonin
Responsibilities/Inter Assessment, Teach weight bearing Assessment (crisis has high mortality rate),
vention exercises, Education on meds and diet, encourage ambulation, Fluids 3-4 liters/day,
IV calcium administration, Observe Provide fluids containing Na (unless
airway (r/t potential laryngospasm) contraindicated), Fiber (constipation)
Foods Bok choy, Chicory, Collard greens, Corn, Dairy products. Products like milk, yogurt, cheese,
Dandelion greens, Kale Soybeans, Dark Green, Leafy Vegetables, Figs,
Flour Tortillas, Canned Baked Beans
Electrolyte: Hypomagnesemia <1.8 Hypermagnesemia >3
Magnesium
Normal: 1.8 - 3
Symptoms Mood changes, Neuromuscular Flushing; NV, low BP, Diminished DTRs,
irritability (seizures), Muscle weakness, Drowsiness, Muscle weakness, Depressed
Tremors, EKG changes, Dysrhythmias, respirations, EKG changes, Dysrhythmias, Coma /
HTN, tachycardia, Positive Babinski, cardiac arrest
Chvostek and Trousseau
Causes Alcoholism, GI losses, Enteral/parenteral Renal failure, Diabetic ketoacidosis, Excessive
feeding deficient in Mg, Medications, MgSO4
Rapid administration of citrated blood,
Diabetic ketoacidosis, Sepsis,
Burns/hypothermia
Treatment Diet, Oral Mg, MgSO4 IV IV calcium gluconate, Loop diuretics, IV NS or
RL, Hemodialysis (if renal patient)
Responsibilities/Inter Assessment, Ensure safety, Pt teaching r/t Assessment, Avoid MgS04 meds and/or
vention diet, medications, ETOH, IV site care, compounds, Pt teaching r/t OTC medications with
Monitor/tx potential hypocalcemia MgSO4
Foods fresh fruit and veggies, chicken greens, nuts, seeds, dry beans, whole grains, wheat
germ, wheat and oat bran.
Electrolyte: Hypophosphatemia < 2.5 Hyperphosphatemia >4.5
4
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