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NRSE 320 – Exam #1 Study Guide – Comprehensive Q&A – Nursing School
Essentials – LATEST VERSION 2025
Mechanisms Controlling Fluid and Electrolyte Movement
• Osmotic pressure
o Amount of pressure required to stop osmotic flow of water
o Determined by the concentration of solutes in the solution
• Fluid tonicity
o The ability of an extracellular solution to make water move into or out of a cell by osmosis
Fluid Spacing (Distribution of Body Water: First Spacing
Normal distribution in ICF and ECF
Fluid Spacing (Distribution of Body Water: Second Spacing
Abnormal (edema) accumulation of interstitial fluid
Fluid Spacing (Distribution of Body Water: Third Spacing
• Fluid is trapped and unavailable for functional use
o Ascites
o pleural effusion
o pericardial effusion
o angioedema
Gains of Fluid and Electrolytes
• Healthy people gain fluids by drinking and eating
• Daily I&O of water are equal
Losses of Fluid and Electrolytes
• Kidney:
o urine output of 1mL/kg/hr in all age groups
• Skin loss:
o sensible due to sweating and insensible due to fever, exercise, and burns
• Lungs:
o 300 mL every day, greater with increased respirations
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• GI tract:
o large losses due to diarrhea and fistulas
Regulation of Water Balance
• Insensible water loss
o Invisible vaporization from lungs and skin and water in the excreted stool
o Loss of approximately 600 to 900 mL/day (unable to exactly measure)
o No electrolyte loss
o 1 liter of water equals 1 kg or 2.2 lbs
Hypovolemia
• Extracellular Fluid Volume deficit
• The loss of ECF volume exceeds the intake of fluid
Hypovolemia: Clinical Manifestations
• CNS effects
• restlessness
• drowsiness
• lethargy
• confusion
• postural hypotension
• tachycardia
• tachypnea
• weakness
• dizziness
• weight loss
• seizures
• coma
Hypovolemia: Treatment
Replace water and electrolytes with balanced IV solutions
Hypovolemia: Nursing Management
• Deficient fluid volume
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• Decreased cardiac output
• Risk for deficient fluid volume
• Potential complication: Hypovolemic shock
Hypervolemia
• Excessive Extracellular Fluid Volume
• Excessive intake of fluids, abnormal retention of water and sodium
Hypervolemia: Clinical Manifestations
• Headache
• confusion
• lethargy
• peripheral edema
• jugular venous distention
• bounding pulse
• hypertension
• dyspnea
• crackles
• pulmonary edema
• muscle spasms
• weight gain
• seizures
• coma.
Hypervolemia: Treatment
Remove fluid without changing electrolyte composition or osmolality of ECF
Hypervolemia: Nursing Management
• Excess fluid volume
• Impaired gas exchange
• Risk for impaired skin integrity
• Activity intolerance
• Disturbed body image
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• Potential complications: Pulmonary edema, ascites
The care of patients with either a fluid deficiency or excess: Nursing Implications
• I&O
• vital signs
• Monitor cardiovascular changes
• Assess respiratory changes
• Neurologic changes
• Daily weights
• Skin assessment
Fluid and Electrolyte Imbalances
• Directly caused by illness or disease
• Result of therapeutic measures
o IV Fluid replacements
o Diuretics
Normal Serum Levels: Bicarbonate (HCO3−)
22-26 mEq/L (22-26 mmol/L)
Normal Serum Levels: Chloride (Cl−)
96-106 mEq/L (96-106 mmol/L)
Normal Serum Levels: Potassium (K+)
3.5-5.0 mEq/L (3.5-5.0 mmol/L)
Normal Serum Levels: Phosphate (PO43−)*
2.4-4.4 mg/dL (0.78-1.42 mmol/L)
Normal Serum Levels: Magnesium (Mg2+)
1.5-2.5 mEq/L (0.75-1.25 mmol/L)
Normal Serum Levels: Sodium (Na+)
135-145 mEq/L
Normal Serum Levels: Calcium (Ca2+) (total)
8.6-10.2 mg/dL
Normal Serum Levels: Calcium (ionized)
NRSE 320 – Exam #1 Study Guide – Comprehensive Q&A – Nursing School
Essentials – LATEST VERSION 2025
Mechanisms Controlling Fluid and Electrolyte Movement
• Osmotic pressure
o Amount of pressure required to stop osmotic flow of water
o Determined by the concentration of solutes in the solution
• Fluid tonicity
o The ability of an extracellular solution to make water move into or out of a cell by osmosis
Fluid Spacing (Distribution of Body Water: First Spacing
Normal distribution in ICF and ECF
Fluid Spacing (Distribution of Body Water: Second Spacing
Abnormal (edema) accumulation of interstitial fluid
Fluid Spacing (Distribution of Body Water: Third Spacing
• Fluid is trapped and unavailable for functional use
o Ascites
o pleural effusion
o pericardial effusion
o angioedema
Gains of Fluid and Electrolytes
• Healthy people gain fluids by drinking and eating
• Daily I&O of water are equal
Losses of Fluid and Electrolytes
• Kidney:
o urine output of 1mL/kg/hr in all age groups
• Skin loss:
o sensible due to sweating and insensible due to fever, exercise, and burns
• Lungs:
o 300 mL every day, greater with increased respirations
,2|Page
• GI tract:
o large losses due to diarrhea and fistulas
Regulation of Water Balance
• Insensible water loss
o Invisible vaporization from lungs and skin and water in the excreted stool
o Loss of approximately 600 to 900 mL/day (unable to exactly measure)
o No electrolyte loss
o 1 liter of water equals 1 kg or 2.2 lbs
Hypovolemia
• Extracellular Fluid Volume deficit
• The loss of ECF volume exceeds the intake of fluid
Hypovolemia: Clinical Manifestations
• CNS effects
• restlessness
• drowsiness
• lethargy
• confusion
• postural hypotension
• tachycardia
• tachypnea
• weakness
• dizziness
• weight loss
• seizures
• coma
Hypovolemia: Treatment
Replace water and electrolytes with balanced IV solutions
Hypovolemia: Nursing Management
• Deficient fluid volume
,3|Page
• Decreased cardiac output
• Risk for deficient fluid volume
• Potential complication: Hypovolemic shock
Hypervolemia
• Excessive Extracellular Fluid Volume
• Excessive intake of fluids, abnormal retention of water and sodium
Hypervolemia: Clinical Manifestations
• Headache
• confusion
• lethargy
• peripheral edema
• jugular venous distention
• bounding pulse
• hypertension
• dyspnea
• crackles
• pulmonary edema
• muscle spasms
• weight gain
• seizures
• coma.
Hypervolemia: Treatment
Remove fluid without changing electrolyte composition or osmolality of ECF
Hypervolemia: Nursing Management
• Excess fluid volume
• Impaired gas exchange
• Risk for impaired skin integrity
• Activity intolerance
• Disturbed body image
, 4|Page
• Potential complications: Pulmonary edema, ascites
The care of patients with either a fluid deficiency or excess: Nursing Implications
• I&O
• vital signs
• Monitor cardiovascular changes
• Assess respiratory changes
• Neurologic changes
• Daily weights
• Skin assessment
Fluid and Electrolyte Imbalances
• Directly caused by illness or disease
• Result of therapeutic measures
o IV Fluid replacements
o Diuretics
Normal Serum Levels: Bicarbonate (HCO3−)
22-26 mEq/L (22-26 mmol/L)
Normal Serum Levels: Chloride (Cl−)
96-106 mEq/L (96-106 mmol/L)
Normal Serum Levels: Potassium (K+)
3.5-5.0 mEq/L (3.5-5.0 mmol/L)
Normal Serum Levels: Phosphate (PO43−)*
2.4-4.4 mg/dL (0.78-1.42 mmol/L)
Normal Serum Levels: Magnesium (Mg2+)
1.5-2.5 mEq/L (0.75-1.25 mmol/L)
Normal Serum Levels: Sodium (Na+)
135-145 mEq/L
Normal Serum Levels: Calcium (Ca2+) (total)
8.6-10.2 mg/dL
Normal Serum Levels: Calcium (ionized)
