Pathophysiology and Fluid Balance: Nursing Exam Review

What causes muscle atrophy after immobilization?

Lack of muscle use.

What is the most likely cause of hypertrophy in a client with hypertension and obesity?

Chronic increased workload causes cells to enlarge.

What is metaplasia in cellular adaptation?

Replacement of normal columnar ciliated bronchial epithelial cells by stratified squamous cells.

What leads to tissue damage in severe frostbite?

Decreased blood flow caused by hypoxia and subsequent cell injury.

Cause of cell injury during a hemorrhagic stroke.

Hypoxia and ATP depletion.

What condition can develop due to severe peripheral vascular disease and diabetes?

Ischemia can cause ischemia of tissue and result necrosis and dry gangrene.

What happens during ischemia that causes cell swelling?

the lack of oxygen stops aerobic respiration, so the cell can't make enough ATP (energy).

Without ATP, the sodium-potassium pump (Na⁺/K⁺ ATPase) fails. Normally, this pump keeps sodium (Na⁺) out of the cell and potassium (K⁺) inside.

When the pump stops working:

• Na⁺ builds up inside the cell

• K⁺ leaks out

Because sodium accumulates, water follows Na⁺ into the cell by osmosis, since water moves toward areas of higher solute concentration.

What is it called when columnar ciliated bronchial epithelial cells are replaced by stratified squamous cells

Metaplasia

What is the significance of lysosomal enzyme leakage during chemical injury?

It causes enzymatic digestion of the nucleus and halts DNA synthesis.

What type of necrosis is commonly associated with severe ischemia or chemical injury?

It commonly affects the kidneys and the heart.

What distinguishes apoptosis from necrosis?

Apoptosis is programmed cell death affecting scattered single cells.

What is an example of a maladaptive cellular change?

A 44 year old man with a 60 pack year smoking history and grade 3 lung cancer.

What is the correct understanding of hypertrophy and hyperplasia?

Cells such as neurons have little capacity for hyperplastic growth.

What is hypertrophy?

Hypertrophy occurs when cells increase in number, not in size.

How do antioxidants protect cells?

They inhibit the actions of reactive oxygen species and reduce oxidative cell injury.

Why is immediate treatment important during a myocardial infarction?

To limit lactic acid buildup and prevent irreversible cellular changes.

What stimulates the secretion of antidiuretic hormone (ADH)?

High blood osmolarity and low blood volume.

What is an example of tertiary prevention in nursing?

Administering IV antihypertensive medication to a patient with severe symptoms and high no.

What is primary prevention of ischemic cellular injury?

Teaching healthy adults about smoking cessation to reduce vascular damage.

What causes interstitial edema?

Decreased oncotic pressure allows fluid to move from the vascular space into the tissues.

What is the most reliable way to measure an increase in body fluid volume?

Monitoring body weight changes.

What is isotonic fluid volume defecit

Total body water and salt is lost in proportional amounts.

Why are older adults at risk for dehydration?

Decreased thirst sensation even with high serum sodium.

Indicative findings of hypervolemia

Peripheral edema and elevated bp

Symptoms of fluid volume excess

Peripheral edema, increased bounding pulse, elevated B/P, shortness of breath p, bilateral crackles

Edema is commonly associated with

Congestive heart failure

What happens in isotonic fluid volume deficit?

Total body water and sodium are lost in proportionate amounts.

Why are older adults at increased risk for dehydration?

The sensation of thirst often decreases even when serum sodium is high.

What are indicative findings of hypervolemia?

Peripheral edema and elevated blood pressure.

What symptoms suggest a client has fluid volume excess?

Shortness of breath, bounding pulse, severe edema, and bilateral crackles.

What condition is generalized edema, or anasarca, commonly associated with?

Congestive heart failure.

What hypertonic solution may be given during extreme fluid volume excess to a dialysis patient?

3% sodium chloride to pull water back in.

What risk does an older hospitalized client with severe diarrhea face?

Isotonic fluid volume deficit due to loss of both water and electrolytes.

What is the first intervention for a collapsed runner on a hot day showing signs of fluid volume deficit?

Provide an electrolyte solution orally.

What is diabetes insipidus?

lack of ADH

Why should sodium be monitored closely in a client with diabetes insipidus?

Excessive free water loss places the client at risk for hypernatremia.

What is the priority for a client with a potassium level of 2.7 mEq/L?

Cardiac monitoring because hypokalemia can cause prolonged PR intervals and flatten t wave.

What is the highest risk for a client with acute renal failure after a drug overdose?

Hyperkalemia due to ineffective potassium excretion by the kidneys

What symptoms should be assessed in a client with chronic renal failure and a calcium level of 7.9 mg/dL?

Intermittent muscle spasms and numbness around the mouth which are manifestations of hypocalcemia.

What symptoms may a client with schizophrenia and excessive water intake develop?

Muscle weakness, lethargy, and headaches due to hyponatremia.

What should a client with a potassium level of 6.1 mEq/L be advised to report?

Hyperkalemia can effect heart. look out for Numbness, tingling, or weakness.

What findings are likely in a client with longstanding hypocalcemia secondary to kidney disease?

Muscular spasms and tingling in the hands and feet.

What results from immediate buffering in response to a pH imbalance?

Bicarbonate and carbonic acid regulation.

How does low bicarbonate identify a primary metabolic problem in ABG interpretation?

It indicates metabolic acidosis.

Breathing pattern associated with metabolic acidosis

Fast breathing

What is a likely diagnosis for a hospital patient with normal oxygen, increased carbon dioxide, and a respiratory rate of 12?

Respiratory acidosis due to hypoventilation.

How does a 77-year-old woman with COPD compensate for chronic CO2 retention?

Through renal retention of bicarbonate.

What should you practice labeling quickly in your notes?

Electrolyte normal ranges.

What should you review to understand electrolyte disorders?

Naming conventions for electrolyte disorders.

What do you need to decide if an ABG is compensated?

Compensation rules.

What does a 17-year-old boy with pH 7.21 and HCO3 18 indicate?

Metabolic acidosis that is not compensated.

What supports a diagnosis of metabolic acidosis in a client with poorly controlled diabetes mellitus?

A base deficit due to suspected ketoacidosis.

What is the most likely cause of aortic stenosis in an older man?

Calcification of the aortic valve after cellular injury causes calcium deposits.

Metabolic vs respiratory acidosis

metabolic: low pH, low bicarb

respiratory: low pH, high CO2