1. Apclientpdevelopspinterstitialpedemapaspapresultpofpdecreased:
A) Vascularpvolume
B) Hydrostaticppressure
C) Capillaryppermeability
D) Colloidalposmoticppressurep
Ans:p D
Feedback:
Edemapcanpbepdefinedpasppalpablepswellingpproducedpbypanpincreasedpinterstitialpfluidpvol
ume.pThepphysiologicpmechanismspthatpcontributeptopedemapformationpincludepfactorspthat
p(1)pincreasepcapillarypfiltrationp(hydrostatic)ppressure,p(2)pdecreasepthepcapillarypcolloidpo
smoticppressure,p(3)pincreasepcapillaryppermeability,porp(4)pproducepobstructionptoplymphpf
low.
2. Apclientphaspbeenpreceivingpintravenouspnormalpsalinepatpapratepofp125pmL/hourpsincepherps
urgeryp2pdayspearlier.pAspapresult,pshephaspdevelopedpanpincreasepinpvascularpvolumepandped
ema.pWhichpofpthepfollowingpphenomenapaccountspforpthispclient'spedema?
A) Obstructionpofplymphpflow
B) Increasedpcapillaryppermeability
C) Decreasedpcapillarypcolloidalposmoticppressure
D) Increasedpcapillarypfiltrationppressurep
Ans:p D
Feedback:
Anpincreasepinpvascularpvolumepresultspinpanpincreasepinpcapillarypfiltrationppressure.pCons
equently,pmovementpofpvascularpfluidpintopthepinterstitialpspacespincreasespandpedemapens
ues.pAnpincreasepinpvascularpvolumepdoespnotpdirectlypresultpinpobstructionpofplymphpflow,p
increasedpcapillaryppermeability,porpdecreasedpcapillarypcolloidalposmoticppressure.
3. Thepmostpreliablepmethodpforpmeasuringpbodypwaterporpfluidpvolumepincreasepispbypa
ssessing:
A) Tissuepturgor
B) Intakepandpoutput
C) Bodypweightpchange
D) Serumpsodiumplevelsp
Ans:p C
Pagep1
, Feedback:
Dailypweightsparepapreliablepindexpofpwaterpvolumepgainp(1pLpofpwaterpweighsp2.2ppounds)
.pDailypweightpmeasurementsptakenpatpthepsameptimepeachpdaypwithpthepsamepamountpofpcl
othingpprovidepapusefulpindexpofpwaterpgainpdueptopedema.pWhenpanpunbalancedpdistributi
onpofpbodypwaterpexistspinptheptissuespandporgans,passessmentpofpsurfacepskinptissuepturgorp
willpbepinaccurate.pMeasurementpofprenalpoutputpispunreliablepbecausepfluidpretentionpmayp
bepapcompensatorypresponse,porptheprenalpsystempmaypbepdysfunctional.pSerumpsodiumple
velsparepaffectedpbypmultiplepvariablespotherpthanpbodypwaterpvolume.
4. Apclientpwithpapdiagnosispofpliverpcirrhosispsecondaryptopalcoholpabusephaspapdistendedpabd
omenpaspapresultpofpfluidpaccumulationpinphispperitonealpcavityp(ascites).pWhichpofpthepfollo
wingppathophysiologicpprocessespcontributesptopthispthirdpspacing?
A) Abnormalpincreasepinptranscellularpfluidpvolume
B) Increasedpcapillarypcolloidalposmoticppressure
C) Polydipsia
D) Impairedphormonalpcontrolpofpfluidpvolumep
Ans:p A
Feedback:
Thirdpspacingprepresentsptheplossporptrappingpofpextracellularpfluidp(ECF)pinptheptranscellul
arpspacepandpapconsequentpincreasepinptranscellularpfluidpvolume.pThepserouspcavitiesparepp
artpofptheptranscellularpcompartmentplocatedpinpstrategicpbodypareaspwhereptherepispcontinu
alpmovementpofpbodypstructures—
theppericardialpsac,pthepperitonealpcavity,pandptheppleuralpcavity.pPolydipsiapandpincreasedpf
luidpintakepaloneparepinsufficientptopcausepthirdpspacing,pandpincreasedpcapillarypcolloidalpo
smoticppressurepwouldpresultpinpincreasedpintracellularpfluidp(ICF).pThepetiologypofpthirdps
pacingpdoespnotpnormallypincludepalterationspinphormonalpcontrolpofpfluidpbalance.
5. Ap2-week-oldpinfantp(full-
termpatpbirth)pispadmittedptoptheppediatricspunitpwithp“spittingpupplargepamountspofpformu
la”pandpdiarrhea.pThepinfantphaspdevelopedpapweakpsuckpreflex.pWhichpofpthepfollowingps
tatementspaboutptotalpbodypwaterp(TBW)pispaccuratepinpthispsituation?
A) Aboutp52%pofpthepinfants'pweightpaccountspforpthepamountpofpwaterpinptheirpbody.
B) Becausepofpthepinfants'phigherpfatpratio,ponepshouldpanticipatepanpincreasedpTBWptopa
sphighpasp90%.
C) Mostpfull-
termpinfantsphavepapTBWpofpapproximatelyp75%pdueptoptheirphighpmetabolicp
rate.
D) Mostpofpanpinfant'spTBWpremainspinpthepICFpcompartment,psoptheypshouldpbepablept
optransferpneededpwaterpintopthepECFpspace.
Ans:p C
Pagep2
, Feedback:
InfantspnormallyphavepmorepTBWpthanpolderpchildrenporpadults.pTBWpconstitutespapproxi
matelyp75%ptop80%pofpbodypweightpinpfull-
termpinfantspandpanpevenpgreaterppercentagepinpprematurepinfants.pInpmales,pthepTBWpdecr
easespinpthepelderlyppopulationptopapproximatelyp52%pTBW.pObesitypdecreasespTBW,pwit
hplevelspasplowpasp30%ptop40%pofpbodypweightpinpadults.pInfantsphavepmorepthanphalfpofpthe
irpTBWpinptheirpECFpcompartment,paspcomparedptopadults.
6. Apclientpdiagnosedpwithpschizophreniaphaspbeenpadmittedptopthepemergencypdepartmentp(
ED)pafterpingestingpmorepthanp2pgallonspofpwaterpinponepsitting.pWhichpofpthepfollowingppa
thophysiologicpprocessespmaypresultpfrompthepsuddenpwaterpgain?
A) Hypernatremia
B) Waterpmovementpfrompthepextracellularptopthepintracellularpcompartment
C) SyndromepofpinappropriatepsecretionpofpADHp(SIADH)
D) Isotonicpfluidpexcesspinpthepextracellularpfluidpcompartmentp
Ans:p B
Feedback:
Excesspwaterpingestionpcoupledpwithpimpairedpwaterpexcretionp(orprapidpingestionpatpaprate
pthatpexceedsprenalpexcretion)pinppersonspwithppsychogenicppolydipsiapcanpleadptopwaterpin
toxicationp(hyponatremia).pApdisproportionatepgainpofpwaterpwithpnopaccompanyingpgainpi
npsodiumpresultspinpthepmovementpofpwaterpfrompthepextracellularptopthepintracellularpcomp
artment.pHyponatremiapaccompaniespthispprocess.pBecausepofptheplackpofpsodiumpincrease
,paccumulatedpfluidpisphypotonic,pnotpisotonic.pSIADHpispnotpapconsequencepofpexcesspwat
erpintake.
7. Apnursepcaringpforpapclientpwithpapdiagnosispofpdiabetespinsipidusp(DI)pshouldpprioritizept
hepclosepmonitoringpofpwhichpofpthepfollowingpelectrolyteplevels?
A) Potassium
B) Sodium
C) Magnesium
D) Calcium
Ans:p B
p
Feedback:
Thephighpwaterpintakepandphighpurinepoutputpthatpcharacterizepdiabetespinsipiduspcreatepapri
skpofpsodiumpimbalance.pDIpmayppresentpwithphypernatremiapandpdehydration,pespeciallyp
inppersonspwithoutpfreepaccessptopwater,porpwithpdamageptopthephypothalamicpthirstpcenterp
andpalteredpthirstpsensation.
Pagep3
, 8. Thepsyndromepofpinappropriatepantidiureticphormonep(SIADH)pispcharacterizedpby:
A) Increasedposmolalityplevelpofp360pmOsm/kg
B) Excessivepthirstpwithpfluidpintakepofp7000pmL/day
C) Copiouspdilutepurinationpwithpoutputpofp5000pmL/day
D) Lowpserumpsodiumplevelpofp122pmEq/Lp
Ans:p D
Feedback:
SIADHpresultspfrompapfailurepofpthepnegativepfeedbackpsystempthatpregulatespthepreleasepand
pinhibitionpofpantidiureticphormonep(ADH).pADHpsecretionpcontinuespevenpwhenpserumpos
molalitypispdecreased,pcausingpwaterpretentionpandpdilutionalphyponatremia.
Diabetespinsipidus,pdeficiencyporpdecreasedpresponseptopADH,pispcharacterizedpbypincrease
dpserumposmolality,pexcessivepthirst,pandppolyuria.pUrinepoutputpdecreasespinpSIADHpdespit
epadequateporpincreasedpfluidpintake.
9. Inpisotonicpfluidpvolumepdeficit,pchangespinptotalpbodypwaterparepaccompaniedpby:
A) Intravascularphypotonicity
B) Increasedpintravascularpwater
C) Increasespinpintracellularpsodium
D) Proportionateplossespofpsodiump
Ans:p D
Feedback:
Isotonicpfluidpvolumepdeficitpcausespapproportionateplosspofpsodiumpandpwater.pHypotonicit
ypresultspfrompwaterpretentionporpsodiumploss.pIncreasedpintravascularpwaterpcausespsodiump
topmovepintopthepcellpexcessively.
10. Apclientpwithpaphistorypofpheartpandpkidneypfailurepispbroughtptopthepemergencypdepartme
nt.pUponpassessment/diagnosis,pitpispdeterminedpthepclientpispinpdecompensatedpheartpfailu
re.pOfpthepfollowingpassessmentpfindings,pwhichparepassociatedpwithpexcesspintracellularp
water?pSelectpallpthatpapply.
A) Lethargy
B) Confusion
C) Hyperactivepdeepptendonpreflexes
D) Seizures
E) Firm,prubberyptissuepwhenppalpatingplowerpextremitiesp
Ans:p A,pB,pD
Pagep4
A) Vascularpvolume
B) Hydrostaticppressure
C) Capillaryppermeability
D) Colloidalposmoticppressurep
Ans:p D
Feedback:
Edemapcanpbepdefinedpasppalpablepswellingpproducedpbypanpincreasedpinterstitialpfluidpvol
ume.pThepphysiologicpmechanismspthatpcontributeptopedemapformationpincludepfactorspthat
p(1)pincreasepcapillarypfiltrationp(hydrostatic)ppressure,p(2)pdecreasepthepcapillarypcolloidpo
smoticppressure,p(3)pincreasepcapillaryppermeability,porp(4)pproducepobstructionptoplymphpf
low.
2. Apclientphaspbeenpreceivingpintravenouspnormalpsalinepatpapratepofp125pmL/hourpsincepherps
urgeryp2pdayspearlier.pAspapresult,pshephaspdevelopedpanpincreasepinpvascularpvolumepandped
ema.pWhichpofpthepfollowingpphenomenapaccountspforpthispclient'spedema?
A) Obstructionpofplymphpflow
B) Increasedpcapillaryppermeability
C) Decreasedpcapillarypcolloidalposmoticppressure
D) Increasedpcapillarypfiltrationppressurep
Ans:p D
Feedback:
Anpincreasepinpvascularpvolumepresultspinpanpincreasepinpcapillarypfiltrationppressure.pCons
equently,pmovementpofpvascularpfluidpintopthepinterstitialpspacespincreasespandpedemapens
ues.pAnpincreasepinpvascularpvolumepdoespnotpdirectlypresultpinpobstructionpofplymphpflow,p
increasedpcapillaryppermeability,porpdecreasedpcapillarypcolloidalposmoticppressure.
3. Thepmostpreliablepmethodpforpmeasuringpbodypwaterporpfluidpvolumepincreasepispbypa
ssessing:
A) Tissuepturgor
B) Intakepandpoutput
C) Bodypweightpchange
D) Serumpsodiumplevelsp
Ans:p C
Pagep1
, Feedback:
Dailypweightsparepapreliablepindexpofpwaterpvolumepgainp(1pLpofpwaterpweighsp2.2ppounds)
.pDailypweightpmeasurementsptakenpatpthepsameptimepeachpdaypwithpthepsamepamountpofpcl
othingpprovidepapusefulpindexpofpwaterpgainpdueptopedema.pWhenpanpunbalancedpdistributi
onpofpbodypwaterpexistspinptheptissuespandporgans,passessmentpofpsurfacepskinptissuepturgorp
willpbepinaccurate.pMeasurementpofprenalpoutputpispunreliablepbecausepfluidpretentionpmayp
bepapcompensatorypresponse,porptheprenalpsystempmaypbepdysfunctional.pSerumpsodiumple
velsparepaffectedpbypmultiplepvariablespotherpthanpbodypwaterpvolume.
4. Apclientpwithpapdiagnosispofpliverpcirrhosispsecondaryptopalcoholpabusephaspapdistendedpabd
omenpaspapresultpofpfluidpaccumulationpinphispperitonealpcavityp(ascites).pWhichpofpthepfollo
wingppathophysiologicpprocessespcontributesptopthispthirdpspacing?
A) Abnormalpincreasepinptranscellularpfluidpvolume
B) Increasedpcapillarypcolloidalposmoticppressure
C) Polydipsia
D) Impairedphormonalpcontrolpofpfluidpvolumep
Ans:p A
Feedback:
Thirdpspacingprepresentsptheplossporptrappingpofpextracellularpfluidp(ECF)pinptheptranscellul
arpspacepandpapconsequentpincreasepinptranscellularpfluidpvolume.pThepserouspcavitiesparepp
artpofptheptranscellularpcompartmentplocatedpinpstrategicpbodypareaspwhereptherepispcontinu
alpmovementpofpbodypstructures—
theppericardialpsac,pthepperitonealpcavity,pandptheppleuralpcavity.pPolydipsiapandpincreasedpf
luidpintakepaloneparepinsufficientptopcausepthirdpspacing,pandpincreasedpcapillarypcolloidalpo
smoticppressurepwouldpresultpinpincreasedpintracellularpfluidp(ICF).pThepetiologypofpthirdps
pacingpdoespnotpnormallypincludepalterationspinphormonalpcontrolpofpfluidpbalance.
5. Ap2-week-oldpinfantp(full-
termpatpbirth)pispadmittedptoptheppediatricspunitpwithp“spittingpupplargepamountspofpformu
la”pandpdiarrhea.pThepinfantphaspdevelopedpapweakpsuckpreflex.pWhichpofpthepfollowingps
tatementspaboutptotalpbodypwaterp(TBW)pispaccuratepinpthispsituation?
A) Aboutp52%pofpthepinfants'pweightpaccountspforpthepamountpofpwaterpinptheirpbody.
B) Becausepofpthepinfants'phigherpfatpratio,ponepshouldpanticipatepanpincreasedpTBWptopa
sphighpasp90%.
C) Mostpfull-
termpinfantsphavepapTBWpofpapproximatelyp75%pdueptoptheirphighpmetabolicp
rate.
D) Mostpofpanpinfant'spTBWpremainspinpthepICFpcompartment,psoptheypshouldpbepablept
optransferpneededpwaterpintopthepECFpspace.
Ans:p C
Pagep2
, Feedback:
InfantspnormallyphavepmorepTBWpthanpolderpchildrenporpadults.pTBWpconstitutespapproxi
matelyp75%ptop80%pofpbodypweightpinpfull-
termpinfantspandpanpevenpgreaterppercentagepinpprematurepinfants.pInpmales,pthepTBWpdecr
easespinpthepelderlyppopulationptopapproximatelyp52%pTBW.pObesitypdecreasespTBW,pwit
hplevelspasplowpasp30%ptop40%pofpbodypweightpinpadults.pInfantsphavepmorepthanphalfpofpthe
irpTBWpinptheirpECFpcompartment,paspcomparedptopadults.
6. Apclientpdiagnosedpwithpschizophreniaphaspbeenpadmittedptopthepemergencypdepartmentp(
ED)pafterpingestingpmorepthanp2pgallonspofpwaterpinponepsitting.pWhichpofpthepfollowingppa
thophysiologicpprocessespmaypresultpfrompthepsuddenpwaterpgain?
A) Hypernatremia
B) Waterpmovementpfrompthepextracellularptopthepintracellularpcompartment
C) SyndromepofpinappropriatepsecretionpofpADHp(SIADH)
D) Isotonicpfluidpexcesspinpthepextracellularpfluidpcompartmentp
Ans:p B
Feedback:
Excesspwaterpingestionpcoupledpwithpimpairedpwaterpexcretionp(orprapidpingestionpatpaprate
pthatpexceedsprenalpexcretion)pinppersonspwithppsychogenicppolydipsiapcanpleadptopwaterpin
toxicationp(hyponatremia).pApdisproportionatepgainpofpwaterpwithpnopaccompanyingpgainpi
npsodiumpresultspinpthepmovementpofpwaterpfrompthepextracellularptopthepintracellularpcomp
artment.pHyponatremiapaccompaniespthispprocess.pBecausepofptheplackpofpsodiumpincrease
,paccumulatedpfluidpisphypotonic,pnotpisotonic.pSIADHpispnotpapconsequencepofpexcesspwat
erpintake.
7. Apnursepcaringpforpapclientpwithpapdiagnosispofpdiabetespinsipidusp(DI)pshouldpprioritizept
hepclosepmonitoringpofpwhichpofpthepfollowingpelectrolyteplevels?
A) Potassium
B) Sodium
C) Magnesium
D) Calcium
Ans:p B
p
Feedback:
Thephighpwaterpintakepandphighpurinepoutputpthatpcharacterizepdiabetespinsipiduspcreatepapri
skpofpsodiumpimbalance.pDIpmayppresentpwithphypernatremiapandpdehydration,pespeciallyp
inppersonspwithoutpfreepaccessptopwater,porpwithpdamageptopthephypothalamicpthirstpcenterp
andpalteredpthirstpsensation.
Pagep3
, 8. Thepsyndromepofpinappropriatepantidiureticphormonep(SIADH)pispcharacterizedpby:
A) Increasedposmolalityplevelpofp360pmOsm/kg
B) Excessivepthirstpwithpfluidpintakepofp7000pmL/day
C) Copiouspdilutepurinationpwithpoutputpofp5000pmL/day
D) Lowpserumpsodiumplevelpofp122pmEq/Lp
Ans:p D
Feedback:
SIADHpresultspfrompapfailurepofpthepnegativepfeedbackpsystempthatpregulatespthepreleasepand
pinhibitionpofpantidiureticphormonep(ADH).pADHpsecretionpcontinuespevenpwhenpserumpos
molalitypispdecreased,pcausingpwaterpretentionpandpdilutionalphyponatremia.
Diabetespinsipidus,pdeficiencyporpdecreasedpresponseptopADH,pispcharacterizedpbypincrease
dpserumposmolality,pexcessivepthirst,pandppolyuria.pUrinepoutputpdecreasespinpSIADHpdespit
epadequateporpincreasedpfluidpintake.
9. Inpisotonicpfluidpvolumepdeficit,pchangespinptotalpbodypwaterparepaccompaniedpby:
A) Intravascularphypotonicity
B) Increasedpintravascularpwater
C) Increasespinpintracellularpsodium
D) Proportionateplossespofpsodiump
Ans:p D
Feedback:
Isotonicpfluidpvolumepdeficitpcausespapproportionateplosspofpsodiumpandpwater.pHypotonicit
ypresultspfrompwaterpretentionporpsodiumploss.pIncreasedpintravascularpwaterpcausespsodiump
topmovepintopthepcellpexcessively.
10. Apclientpwithpaphistorypofpheartpandpkidneypfailurepispbroughtptopthepemergencypdepartme
nt.pUponpassessment/diagnosis,pitpispdeterminedpthepclientpispinpdecompensatedpheartpfailu
re.pOfpthepfollowingpassessmentpfindings,pwhichparepassociatedpwithpexcesspintracellularp
water?pSelectpallpthatpapply.
A) Lethargy
B) Confusion
C) Hyperactivepdeepptendonpreflexes
D) Seizures
E) Firm,prubberyptissuepwhenppalpatingplowerpextremitiesp
Ans:p A,pB,pD
Pagep4
