Nutrition Therapy and Pathophysiology 3rd Edition Nelms Test Bank

Nutrition Therapy and Pathophysiology
3rd Edition Nelms Test Bank

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Chapter 07 - Fluid and Electrolyte Balance
1. What percentage of a typical adult male’s body is comprised of water?
a. 40%
b. 50%
c. 60%
d. 70%
e. 80%
ANSWER: c
DIFFICULTY: Bloom’s: Remember
REFERENCES: Normal Anatomy and Physiology of Fluids and Electrolytes
2. What kind of tissue has the lowest percentage of water in the body?
a. muscle
b. fat
c. skin
d. connective
e. epithelial
ANSWER: b
3. How much of the body’s water is found within cells (intracellular fluid)?
a. 1/4
b. 1/3
c. 1/2
d. 2/3
e. 3/4
ANSWER: d
4. What is the best definition of diuresis?

a. the production of excessive amounts of urine
b. accumulation of edema within a joint
c. accumulation of edema within the abdomen
d. dehydration caused from excessive bleeding
e. kidney pain caused by stones
ANSWER: a
REFERENCES: Glossary
5. What does hypokalemia mean?

a. high serum potassium
b. high serum calcium
c. low lymph calcium
d. low serum calcium
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e. low serum potassium

ANSWER: e
6. What is the term for abnormal fluid accumulation in the peritoneal cavity (often due to liver disease)?
a. diuresis
b. ascites
c. hypernatremia
d. water intoxication
e. edema
ANSWER: b
7. The force that pulls water across membranes is referred to as:

a. edema force
b. diffusion force
c. electrolyte force
d. osmotic pressure
e. gradient pressure
ANSWER: d
8. What percentage of bodyfluid is in plasma?

a. 0.05%
b. 1%
c. 6.6%
d. 9%
e. 14%
ANSWER: c
9. What is the normal range of osmolality for the blood?

a. 280 to 320 mOsm/kg H2O
b. 325 to 375 mOsm/kg H2O
c. 380 to 420 mOsm/kg H2O
d. 425 to 475 mOsm/kg H2O
e. 580 to 620 mOsm/kg H2O
ANSWER: a

10. What is likely to occur when cells are exposed to a hypertonic solution?
a. dehydration
b. swelling
c. edema
d. destruction
e. equilibrium
ANSWER: a
11. Precise determination of metabolic water is:

a. calculated by using osmolarity
b. calculated by using osmolality
c. calculated using urine output
d. constant from hour to hour
e. not possible
ANSWER: e
12. What route of fluid loss is the most variable and will accommodate changes in dietary fluid intake?
a. feces
b. respiration
c. urine
d. perspiration
e. metabolism
ANSWER: c
13. What is the specific gravity of water?

a. 0.25
b. 0.5
c. 0.75
d. 1.0
e. 2.0
ANSWER: d
14. How much fluid should an average adult consume each day under normal circumstances?
a. 20–25 mL/kg
b. 30–35 mL/kg
c. 40–45 mL/kg
d. 50–55 mL/kg
e. 60–65 mL/kg
ANSWER: b
15. Ions with a positive charge are referred to as:

a. electrolytes
b. cations
c. anions
d. molecules
e. particles
ANSWER: b
REFERENCES: Body Solutes
16. What is the major cation in the ECF (extracellular fluid)?

a. sodium
b. calcium
c. chloride
d. potassium
e. glucose
ANSWER: a
17. How much sodium does 1 tsp of table salt contain?

a. 900 mg
b. 1,300 mg
c. 1,800 mg
d. 2,300 mg
e. 3,000 mg
ANSWER: d
18. Baroreceptors within blood vessels are stimulated by:

a. high osmolarity
b. low osmolarity
c. high glucose concentration
d. high hydrostatic pressure
e. low hydrostatic pressure
ANSWER: e
REFERENCES: Physiological Regulation of Fluid and Electrolytes

19. What hormone is released from the kidney and stimulates conversion of angiotensinogen to angiotensin I?
a. arginine vasopressin
b. antidiuretic hormone
c. renin
d. pepsin
e. aldosterone
ANSWER: c
20. Serum calcium exists in a reciprocal relationship with what other electrolyte?
a. magnesium
b. potassium
c. phosphorus
d. chloride
e. sodium
ANSWER: c
21. What is hypovolemia?

a. ascites within joints
b. extracellular fluid deficit
c. intracellular fluid deficit
d. blood that’s too acidic
e. blood that’s too alkaline
ANSWER: b
REFERENCES: Disorders of Fluid Balance
22. What color of urine reflects dehydration?

a. clear and colorless
b. light yellow
c. red
d. dark amber
e. green
ANSWER: d
23. What is the most common cause of hypervolemia?

a. decrease in urinary output
b. diarrhea
c. chronic vomiting
d. water intoxication
e. low salt diet

ANSWER: a
24. The pitting depth of edema is based on what numerical scale?

a. 1 to 3
b. 0 to 3
c. 0 to 4
d. 1 to 5
e. 1 to 10
ANSWER: c
25. What is the least likely (but possible) cause of hyponatremia?

a. alcoholism
b. use of diuretics
c. too little water consumption
d. IV therapy without electrolytes
e. lack of dietary sodium
ANSWER: e
26. Hypernatremia can theoretically be caused by either an increase in sodium or a:

a. increase in potassium consumption
b. decrease in potassium consumption
c. decrease in blood glucose
d. increase in water consumption
e. decrease in water consumption
ANSWER: e
27. Loss of gastric acids through vomiting can lead to:

a. metabolic alkalosis
b. metabolic acidosis
c. diabetes insipidus
d. hyponatremia
e. hypernatremia
ANSWER: a

28. What is the most common cause of hyperkalemia?
a. liver cirrhosis
b. inadequate excretion of potassium from renal failure
c. inadequate excretion of sodium from renal failure
d. high blood cholesterol levels
e. chronically low blood pressure
ANSWER: b
29. How much of the body’s calcium is found in body fluids?

a. 20%
b. 12%
c. 9%
d. 5%
e. 1%
ANSWER: e
30. Malignant tumors that metastasize to bone can lead to:

a. hypocalcemia
b. hyperkalemia
c. hypercalcemia
d. hypernatremia
e. hyperkalemia
ANSWER: c
31. How much of the body’s magnesium is within bone?

a. 5-6%
b. 25%
c. 35-40%
d. 50-60%
e. 85%
ANSWER: d
32. The medication cyclosporine can cause excessive urinary loss of what electrolyte?
a. calcium
b. magnesium
c. potassium
d. phosphorus
e. sodium
ANSWER: b
33. Magnesium is used to treat what high-risk condition of pregnancy ?

a. preeclampsia
b. spina bifida
c. Downs’ syndrome
d. leukocytosis
e. thrombocytosis
ANSWER: a
34. Hypophosphatemia is defined as a serum phosphate level:

a. <0.3 mg/dL
b. <1.3 mg/dL
c. <2.3 mg/dL
d. <3.3 mg/dL
e. <4.3 mg/dL
ANSWER: c
35. Hypercalcemia is defined as a serum calcium level:

a. >15 mg/dL
b. >11 mg/dL
c. >8 mg/dL
d. >5 mg/dL
e. >1 mg/dL
ANSWER: b
Case Study Multiple Choice

Mr. M has been diagnosed with chronic kidney disease Stage 5, requiring dialysis. His initial chemistries panel
indicates he has low sodium, chloride and calcium levels as well as high potassium and phosphorus levels. The
physician has put him on a fluid restriction, a potassium restriction, and a phosphorus restriction.
36. Which of the following is contributing to Mr. M’s fluid imbalance?

a. kidney disease
b. liver disease
c. aldosterone secretion exceeding production
d. excessive thirst

e. poor diet
ANSWER: a
PREFACE NAME: chronic kidney disease
37. The type of fluid involved in Mr. M’s imbalance is:

a. intracellular
b. transcellular
c. extracellular
d. pericardial
e. ascites
ANSWER: c
38. What is one reason that a physician might order a potassium restriction?
a. potassium interacting with kidney disease medications
b. high potassium levels stimulating the secretion of aldosterone by the adrenal glands
c. high potassium levels causing the retention of vasopressin
d. potassium directly interacting with calcium
e. diet containing very high levels of potassium
ANSWER: b
39. One of the reasons for his high phosphorus could be:
a. the P restriction is altering the levels in the blood
b. hypoglycemia
c. low magnesium
d. high potassium
e. low calcium
ANSWER: e
40. The physician has placed Mr. M on a diuretic. A good measure of how he is responding to this medication would be:
a. serum PTH concentration
b. serum albumin concentration
c. serum phosphorus concentration
d. fluid inputs and outputs

e. serum calcium concentration

ANSWER: d
41. At birth, total body water accounts for approximately 75% of the infant’s weight.
a. True
b. False
ANSWER: True
42. Extracellular fluid is divided into three compartments: interstitial, intravascular, and transcellular (or transitional).
a. True
b. False
ANSWER: True
43. Osmotic pressure can be expressed as either osmolarity or hydraulic force.

a. True
b. False
ANSWER: False
44. Total urine output is the sum of obligatory urine and facultative urine.
a. True
b. False
ANSWER: True
45. In the ECF, the major cation is magnesium, and major anions are chloride and calcium.
a. True
b. False
ANSWER: False
46. In older adults, thirst sensation increases.

a. True
b. False
ANSWER: False

47. Decreasing hydrostatic pressure stimulates the renin– angiotensin–aldosterone system regulation of fluids and
electrolytes.
a. True
b. False
ANSWER: True
48. Medications such as diuretics are often prescribed to purposefully increase ECF volume.
a. True
b. False
ANSWER: False
49. The most common cause of hypovolemia is a decrease in urinary output such as that seen in acute liver failure.
a. True
b. False
ANSWER: False
50. Elevated concentrations of potassium in the ECF can occur when hemolysis of red blood cells increases, such as with
leukocytosis or thrombocytosis.
a. True
b. False
ANSWER: True
51. Maintenance of fluid balance is significantly integrated with maintenance of _______________ balance.
ANSWER: electrolyte
REFERENCES: Introduction
52. Body water content declines throughout the life span and often falls below _______________ percent in adults older
than 65 years old.
ANSWER: 50
53. Transcellular fluids are those fluids found in secretions within _______________.
ANSWER: organs

54. Solutes that do not disperse in fluid, such as large protein molecules, are called _______________.
ANSWER: colloids
55. Osmotic pressure can be expressed as either osmolarity or _______________.

ANSWER: osmolality
56. Precise determination of _______________ water is not possible; it is thus usually estimated by using intakes of
carbohydrate, protein, and _______________ as variables.
ANSWER: metabolic; fat
57. The solute concentration in the urine is determined by measuring its _______________.
ANSWER: specific gravity
58. Beverages range between 84% and 100% water, with _______________ being at the lower end of the range.
ANSWER: fruit juices
59. Negatively charged ions are called _______________.

ANSWER: anions
60. The major cation in the ICF is _______________.

ANSWER: potassium
61. The mechanism of thirst is regulated in the _______________.

ANSWER: hypothalamus
62. When blood volume increases, hydrostatic pressure _______________.

ANSWER: increases


63. Increasing amounts of angiotensin II stimulate release of the hormone _______________ from the adrenal cortex.
ANSWER: aldosterone
64. Vasopressin causes fluid to be reabsorbed in the tubules of the _______________.

ANSWER: kidney
65. Vitamin D increases absorption of _______________ in the small intestine.

ANSWER: calcium
66. Natural licorice and chewing tobacco, if swallowed, contain an _______________ compound that will also stimulate
increases in urinary _______________ excretion.
ANSWER: aldosterone; potassium
67. Hypocalcemia most commonly results from a deficit of _______________ or from abnormal vitamin
_______________ metabolism.
ANSWER: PTH; D
68. Hypophosphatemia can result from vitamin _______________ deficiency.

ANSWER: D
69. Hypomagnesemia occurs during withdrawal from _______________.

ANSWER: alcohol
70. Calcium gluconate, given intravenously, can reverse the effects of _______________.
ANSWER: hypermagnesemia
71. Describe the functions of water in the body.

ANSWER: The functions of water in the body include transporting nutrients, transporting and excreting metabolic
waste, supporting cell shape and structure, lubricating friction generating surfaces, and sustaining normal
body temperature.
DIFFICULTY: Bloom’s: Apply
REFERENCES: Introduction
72. Explain the role of arginine vasopressin in fluid balance.

ANSWER: Arginine vasopressin (AVP) -- previously known as antidiuretic hormone, acts on the renal tubules to
reduce urine output in response to dehydration and hyperosmolality.
73. Describe insensible fluid loss.

ANSWER: Insensible loss is fluid loss that cannot be easily measured (usually refers to fluid lost via sweat and
respirations).
74. Explain what factors influence movement of solutes.

ANSWER: Factors influencing movement of solutes include molecular size (smaller molecules move more easily),
electrical charge of the molecule, hydrostatic pressure, and method of solute transport.
75. List the three general categories of alterations in fluid balance.

ANSWER: 1) Changes in fluid volume; 2) changes in fluid concentration or osmolality; 3) changes in fluid
composition.
76. Describe the “third spaces”.

ANSWER: Fluids can accumulate within body cavities in spaces between organs. These are often called the “third
spaces” and include peritoneal, pericardial, and thoracic cavities as well as the joints and bursae. For the
normal healthy individual, these spaces hold insignificant amounts of fluid. However, in illness or injury,
fluid accumulation in these spaces may become significant. For example, fluid may accumulate in the
peritoneal cavity with liver disease, causing the condition known as ascites.
77. Explain the types of solutes in the body, including the major electrolytes.
ANSWER: Solutes in body fluids include both electrolytes (ions) and other molecules. Electrolytes dissociate in
fluid to form one or more charged particles. Other molecules, such as glucose, protein, urea, lactate, and
other organic acids, remain stable in solution. The major electrolytes in the body are sodium, potassium,
calcium, magnesium, chloride, bicarbonate, phosphate, and sulfate. Ions with a positive charge are
referred to as cations, and negatively charged ions are called anions.
78. Describe the thirst mechanism.

ANSWER: Cellular sensors within the interstitial fluid are affected by changes in the fluid around them. They
trigger the hypothalamus to interpret these signals as thirst and as a result, the individual will be
stimulated to increase his or her fluid intake. This thirst mechanism cannot always be relied on, however.
In older adults, thirst sensation decreases. In the trained, elite athlete, thirst sensation may not be a valid
indication of need for additional fluid.
79. Describe the clinical manifestations of hyponatremia.

ANSWER: Often, clinical manifestations of hyponatremia do not appear until levels of sodium fall below 120
mEq/L. Signs and symptoms that do occur are consistent with changes in osmolality. As serum
osmolality falls, water enters the brain cells. Nausea, vomiting, lethargy, confusion, and even seizures
can result. All signs and symptoms are more pronounced if hyponatremia occurs rapidly. Laboratory
measurements will confirm a serum sodium of <136 mEq/L. Plasma osmolality will be <285 mOsm/kg.
80. Describe the treatment for hyperkalemia.

ANSWER: Treatment of the underlying cause is crucial in correcting hyperkalemia. In a short-term emergency
situation, calcium gluconate can be given intravenously to decrease the abnormalities in cardiac cells that
could lead to cardiac arrest. Additionally, both glucose and insulin can be used to shift potassium from
the ECF to the ICF. Correction of any acid-base imbalance also results in potassium movement into the
ICF. Cation exchange resins such as Kayexalate can be given to allow the exchange of sodium for
potassium in the large intestine. For long-term treatment, dialysis and a potassium-restricted diet are
primary interventions to control hyperkalemia. It is also crucial to prevent malnutrition through adequate
nutrition support.

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Nutrition Therapy and Pathophysiology

3rd Edition Nelms Test Bank

4. What is the best definition of diuresis?

5. What does hypokalemia mean?

e. low serum potassium

7. The force that pulls water across membranes is referred to as:

8. What percentage of bodyfluid is in plasma?

9. What is the normal range of osmolality for the blood?

Copyright Cengage Learning. Powered by Cognero. Page 2

11. Precise determination of metabolic water is:

13. What is the specific gravity of water?

15. Ions with a positive charge are referred to as:

16. What is the major cation in the ECF (extracellular fluid)?

17. How much sodium does 1 tsp of table salt contain?

18. Baroreceptors within blood vessels are stimulated by:

Copyright Cengage Learning. Powered by Cognero. Page 4

21. What is hypovolemia?

22. What color of urine reflects dehydration?

23. What is the most common cause of hypervolemia?

e. low salt diet

24. The pitting depth of edema is based on what numerical scale?

25. What is the least likely (but possible) cause of hyponatremia?

26. Hypernatremia can theoretically be caused by either an increase in sodium or a:

27. Loss of gastric acids through vomiting can lead to:

Copyright Cengage Learning. Powered by Cognero. Page 6

29. How much of the body’s calcium is found in body fluids?

30. Malignant tumors that metastasize to bone can lead to:

31. How much of the body’s magnesium is within bone?

33. Magnesium is used to treat what high-risk condition of pregnancy ?

34. Hypophosphatemia is defined as a serum phosphate level:

35. Hypercalcemia is defined as a serum calcium level:

Case Study Multiple Choice

36. Which of the following is contributing to Mr. M’s fluid imbalance?

Copyright Cengage Learning. Powered by Cognero. Page 8

37. The type of fluid involved in Mr. M’s imbalance is:

Copyright Cengage Learning. Powered by Cognero. Page 9

e. serum calcium concentration

43. Osmotic pressure can be expressed as either osmolarity or hydraulic force.

46. In older adults, thirst sensation increases.

DIFFICULTY: Bloom’s: Remember

DIFFICULTY: Bloom’s: Remember

55. Osmotic pressure can be expressed as either osmolarity or _______________.

59. Negatively charged ions are called _______________.

60. The major cation in the ICF is _______________.

61. The mechanism of thirst is regulated in the _______________.

62. When blood volume increases, hydrostatic pressure _______________.

Copyright Cengage Learning. Powered by Cognero. Page 12

DIFFICULTY: Bloom’s: Remember

64. Vasopressin causes fluid to be reabsorbed in the tubules of the _______________.

65. Vitamin D increases absorption of _______________ in the small intestine.

68. Hypophosphatemia can result from vitamin _______________ deficiency.

69. Hypomagnesemia occurs during withdrawal from _______________.

71. Describe the functions of water in the body.

72. Explain the role of arginine vasopressin in fluid balance.

73. Describe insensible fluid loss.

74. Explain what factors influence movement of solutes.

75. List the three general categories of alterations in fluid balance.

76. Describe the “third spaces”.

78. Describe the thirst mechanism.

79. Describe the clinical manifestations of hyponatremia.