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ch: 24 white Answer Section

MULTIPLE CHOICE 1. ANS: A Homeostasis is the maintenance of the bodys internal environment within narrow limits. Homeostasis relies on osmosis, diffusion, and elimination to maintain the internal environment. PTS: 1 DIF: Knowledge REF: White (2010) 2. ANS: B An atom is the smallest unit of chemical structure. It cannot be altered by chemical change. PTS: 1 DIF: Knowledge REF: White (2010) 3. ANS: D Electrolytes are compounds that decompose or break down into separate ions when placed in water. PTS: 1 DIF: Knowledge REF: White (2010) 4. ANS: A Electrolytes are electrically charged ions (cations or anions) that are present in both intracellular and extracellular fluids. PTS: 1 DIF: Knowledge REF: White (2010) 5. ANS: A There are two types of ions. Anions are negatively charged particles, while cations are positively charged particles. PTS: 1 DIF: Knowledge REF: White (2010) 6. ANS: D The water percentage for an adult is 60%, for an older adult 45% to 55%, for an embryo 97%, for an infant 70% to 80%, and for a child 60% to 77%. PTS: 1 DIF: Knowledge REF: White (2010) 7. ANS: C The water percentage for an adult is 60%, for an older adult 45% to 55%, for an embryo 97%, for an infant 70% to 80%, and for a child 60% to 77%. PTS: 1 DIF: Knowledge REF: White (2010) 8. ANS: C The two most important gases in the human body are oxygen to nourish cells and carbon dioxide, which is the waste product of cells. There is a delicate balance between these two gases in maintaining homeostasis. PTS: 1 DIF: Knowledge REF: White (2010) 9. ANS: A When a chemical substance is placed in a solution, the end result is an acid (hydrogen ions with a positive charge). PTS: 1 10. ANS: B DIF: Knowledge REF: White (2010)

The chemical result of the dissociation of a substance produces the combination of an ion and hydrogen ions, resulting in a base. PTS: 1 DIF: Knowledge REF: White (2010) 11. ANS: C The chemical reaction of the combination of an acid and a base results in the formation of a salt. PTS: 1 DIF: Knowledge REF: White (2010) 12. ANS: C The normal body pH range of blood is from 7.35 to 7.45; blood pH above or below this range can cause profound physiologic problems. A blood pH level below 7.35 means that the concentration of hydrogen ions is elevated. A blood pH above 7.45 indicates excessive loss of hydrogen ions, resulting in alkalosis. PTS: 1 DIF: Comprehension REF: White (2010) 13. ANS: D The major extracellular fluid electrolyte, sodium, regulates fluid balance through osmotic pressure (osmosis). Normal serum sodium range for an adult is from 135 to 145 mEq/L. PTS: 1 DIF: Application REF: White (2010) 14. ANS: A The normal body pH range of blood is from 7.35 to 7.45; blood pH above or below this range can cause profound physiologic problems. A blood pH level below 7.35 means that the concentration of hydrogen ions is elevated, resulting in acidosis, which can cause coma, weak or irregular heartbeat, or severe hypotension. A blood pH above 7.45 indicates excessive loss of hydrogen ions, resulting in alkalosis, with symptoms such as apathy, irritability, delirium, or spasmodic muscle contractions. PTS: 1 DIF: Application REF: White (2010) 15. ANS: B The normal body pH range of blood is from 7.35 to 7.45; blood pH above or below this range can cause profound physiologic problems. A blood pH level below 7.35 means that the concentration of hydrogen ions is elevated, resulting in acidosis, which can cause coma, weak or irregular heartbeat, or severe hypotension. A blood pH above 7.45 indicates excessive loss of hydrogen ions, resulting in alkalosis, with symptoms such as apathy, irritability, delirium, or spasmodic muscle contractions. PTS: 1 DIF: Application REF: White (2010) 16. ANS: A The normal body pH range of blood is from 7.35 to 7.45; blood pH above or below this range can cause profound physiologic problems. A blood pH level below 7.35 means that the concentration of hydrogen ions is elevated, resulting in acidosis. PTS: 1 DIF: Knowledge REF: White (2010) 17. ANS: B The normal body pH range of blood is from 7.35 to 7.45; blood pH above (alkalosis) or below (acidosis) this range can cause profound physiologic problems. A blood pH level below 7.45 is within the normal range. PTS: 1 DIF: Knowledge REF: White (2010) 18. ANS: D The normal body pH range of blood is from 7.35 to 7.45; blood pH above or below this range can cause profound physiologic problems. A blood pH above 7.45 indicates excessive loss of hydrogen ions, resulting in alkalosis, with symptoms such as apathy, irritability, delirium, or spasmodic muscle contractions.

PTS: 1 DIF: Application REF: White (2010) 19. ANS: B The phosphate buffer system, composed of sodium monohydrogen phosphate and sodium dihydrogen phosphate, regulates the pH of intracellular fluid and fluid in the kidney tubules by buffering organic acids found in the body. PTS: 1 DIF: Knowledge REF: White (2010) 20. ANS: D Osmosis is the diffusion of a solvent (usually water) through a semipermeable membrane from an area of higher concentration to one of lower concentration. During osmosis, only the water molecules move through the membrane, not the molecules dissolved in the solvent. PTS: 1 DIF: Knowledge REF: White (2010) 21. ANS: B Osmolality of a solution is determined by laboratory test measuring the number of molecules within water. PTS: 1 DIF: Comprehension REF: White (2010) 22. ANS: B Diffusion, the movement of substances (e.g., molecules of gases, liquids, or solids) from an area of higher molecular concentration to one of lower molecular concentration, occurs because of the kinetic energy in molecules; molecules are constantly moving and colliding with each other, forcing them to move farther apart. An example of diffusion is the movement of oxygen from the lungs to the bloodstream because the oxygen concentration in the blood is lower than that in the lungs. PTS: 1 DIF: Knowledge REF: White (2010) 23. ANS: C Filtration is a process in which solvents and the substances dissolved in them are forced through cell membranes by hydrostatic pressure (i.e., the pressure the fluid exerts against the membrane). PTS: 1 DIF: Knowledge REF: White (2010) 24. ANS: A Substances constantly move in and out of cells by passing through the cell membrane without the cell expending energy (passive transport) or by requiring the cell to expend energy (active transport). PTS: 1 DIF: Comprehension REF: White (2010) 25. ANS: B Substances constantly move in and out of cells by passing through the cell membrane without the cell expending energy (passive transport). PTS: 1 DIF: Comprehension REF: White (2010) 26. ANS: A Diffusion, the movement of substances (e.g., molecules of gases, liquids, or solids) from an area of higher molecular concentration to one of lower molecular concentration, occurs because of the kinetic energy in molecules; molecules are constantly moving and colliding with each other, forcing them to move farther apart. An example of diffusion is the movement of oxygen from the lungs to the bloodstream, because the oxygen concentration in the blood is lower than that in the lungs. PTS: 1 27. ANS: D DIF: Comprehension REF: White (2010)

Isotonic solutions have the same molecular concentration or osmolality as those within the cell; they do not affect the size of the cell. PTS: 1 DIF: Knowledge REF: White (2010) 28. ANS: A A hypertonic solution has a molecular concentration higher than that within the cell, resulting in the movement of water from the cell and a decrease in cell size. For example, when red blood cells shrivel because of osmosis, they are unable to function. PTS: 1 DIF: Comprehension REF: White (2010) 29. ANS: C Osmotic pressure is the pressure that is exerted against the cell membrane by the force of water on the inside of the cell. PTS: 1 DIF: Comprehension REF: White (2010) 30. ANS: A Active transport requires the cell to use energy to move molecules in and out of the cells. Carrier molecules are used to move substances in and out of cells during active transport. For example, important ions such as sodium and potassium enter and leave cells by the process of transport. PTS: 1 DIF: Comprehension REF: White (2010) 31. ANS: A The proportions of extracellular and intracellular fluid vary with age. The balance of fluid between plasma and interstitial fluid is regulated by hydrostatic pressure (blood pressure) and osmotic pressure. If the intracellular fluid becomes hypertonic in relation to the extracellular fluid, water moves by osmosis from the extracellular fluid into the cell to restore balance. If the intracellular fluid becomes hypotonic in relation to the extracellular fluid, the process just described is reversed, resulting in a constant exchange between the compartments. PTS: 1 DIF: Comprehension REF: White (2010) 32. ANS: C Body fluids are contained in two compartments. The intracellular fluid (ICF) compartment contains the largest amount of water in the body and consists of all of the water and ions within the cells. The extracellular fluid (ECF) compartment contains the body fluids remaining outside the cells: either interstitial fluid (fluid in the tissue spaces around each cell) or intravascular fluid (plasma within blood vessels, lymph within the lymphatic system, and small amounts of specialized fluids such as cerebrospinal fluid or synovial fluid). PTS: 1 DIF: Comprehension REF: White (2010) 33. ANS: C Potassium, the major electrolyte in intracellular fluid, maintains normal nerve and muscle activity and osmotic pressure within the cells and aids in the cellular metabolism of carbohydrates and proteins. PTS: 1 DIF: Comprehension REF: White (2010) 34. ANS: A The balance of fluid between plasma and interstitial fluid is regulated by hydrostatic pressure (blood pressure) and osmotic pressure. Edema occurs when fluid accumulates in the interstitial fluid compartment. PTS: 1 35. ANS: A DIF: Comprehension REF: White (2010)

The kidneys are major organs of fluid balance, excreting up to 1,500 mL of water daily, based on the amount of fluid ingested and amount of waste or solutes excreted. When an extracellular fluid volume deficit occurs, certain hormones (antidiuretic hormone, aldosterone, and renin) are released to prompt the kidneys to conserve water. The interaction of these hormones with renal function serves as the bodys compensatory mechanism to maintain homeostasis. PTS: 1 DIF: Comprehension REF: White (2010) 36. ANS: C Approximately 2,500 mL of fluid is normally lost daily through the skin (insensible water loss and perspiration), lungs (insensible water loss), and gastrointestinal tract (feces). The kidneys are major organs of fluid balance, excreting up to 1,500 mL of water daily, based on the amount of fluid ingested and amount of waste or solutes excreted. PTS: 1 DIF: Comprehension REF: White (2010) 37. ANS: A The posterior pituitary gland controls the secretion of the antidiuretic hormone (ADH), which results in the reabsoption of water in the kidney tubules. PTS: 1 DIF: Application REF: White (2010) 38. ANS: C Chloride, the major extracellular anion, functions with sodium to maintain osmotic pressure and aid in maintaining acid-base balance. There is a direct relationship between the values of these electrolytes. PTS: 1 DIF: Application REF: White (2010) 39. ANS: C Hyponatremia, a serum sodium value of less than 136 mEq/L, results from a sodium deficit as a result of prolonged vomiting, diarrhea, or a water excess that results in edema. PTS: 1 DIF: Application REF: White (2010) 40. ANS: A Hypernatremia, a serum sodium level greater than 145 mEq/L, results from excess sodium or water loss and movement of water from cells to the extracellular space. PTS: 1 DIF: Comprehension REF: White (2010) 41. ANS: A Potassium, the major electrolyte in intracellular fluid, maintains normal nerve and muscle activity and osmotic pressure within the cells and aids in the cellular metabolism of carbohydrates and proteins. PTS: 1 DIF: Comprehension REF: White (2010) 42. ANS: A In efforts to maintain homeostasis, the kidneys can either excrete or retain potassium. PTS: 1 DIF: Knowledge REF: White (2010) 43. ANS: C Hypokalemia, a serum potassium level of less than 3.5 mEq/L, can result from the use of diuretics or from gastrointestinal tract disturbances. PTS: 1 44. ANS: A DIF: Knowledge REF: White (2010)

The normal serum potassium range is 3.5 to 5.0 mEq/L. Hyperkalemia, a serum potassium level greater than 5.0 mEq/L, results from inadequate excretion from the kidneys or from excessive trauma; it can be life threatening. PTS: 1 DIF: Knowledge REF: White (2010) 45. ANS: D Calcium is essential for blood clotting, muscle functioning, nerve impulse transmission, and bone and teeth integrity. PTS: 1 DIF: Comprehension REF: White (2010) 46. ANS: D Adequate dietary intake of vitamin D is required for calcium absorption. PTS: 1 DIF: Comprehension REF: White (2010) 47. ANS: B The normal range of serum calcium (ionized) is 4.5 to 5.6 mEq/L; the total serum calcium (ionized and bound to albumin) range for adults is 9.0 to 10.5 mg/dL. PTS: 1 DIF: Application REF: White (2010) 48. ANS: D The normal range of serum calcium (ionized) is 4.5 to 5.6 mg/dL; the total serum calcium (ionized and bound to albumin) range for adults is 8.5 to 10.5 mg/dL. PTS: 1 DIF: Application REF: White (2010) 49. ANS: B Hypercalcemia, a total serum calcium level of more than 10.5 mg/dL or ionized serum calcium level of less than 5.6 mEq/L, can result from bone disease such as a metastatic tumor or excessive calcium intake. PTS: 1 DIF: Application REF: White (2010) 50. ANS: D Phosphate and calcium have an inverse relationship. If one electrolyte is elevated, the other will be decreased. The normal range of serum calcium (ionized) is 4.5 to 5.6 mEq/L; the total serum calcium (ionized and bound to albumin) range for adults is 9.0 to 10.5 mg/dL. The normal serum phosphorus range is 1.7 to 2.6 mEq/L. PTS: 1 DIF: Application REF: White (2010) 51. ANS: B Magnesium, found in intracellular fluid and in combination with calcium and phosphorus in bone, muscle, and soft tissue, is important in the metabolism of carbohydrates and proteins. PTS: 1 DIF: Comprehension 52. ANS: B Normal range of serum magnesium is 1.5 to 2.5 mEq/L. REF: White (2010)

PTS: 1 DIF: Application REF: White (2010) 53. ANS: D Hypermagnesemia, a serum magnesium level greater than 2.5 mEq/L, results from ketoacidosis, renal failure, or excessive intake of magnesium antacids. PTS: 1 54. ANS: A DIF: Knowledge REF: White (2010)

Hypermagnesemia, a serum magnesium level greater than 2.5 mEq/L, results from ketoacidosis, renal failure, or excessive intake of magnesium antacids. PTS: 1 DIF: Application REF: White (2010) 55. ANS: A Hypomagnesemia, a serum magnesium level of less than 1.5 mEq/L, is most often the result of chronic alcoholism or is secondary to prescribed medications. PTS: 1 DIF: Comprehension REF: White (2010) 56. ANS: A There is a direct relationship between calcium, potassium, and magnesium. Normal range of serum magnesium is 1.5 to 2.5 mEq/L. A level of 0.9 mEq/L is a decrease; therefore, all levels would be decreased. PTS: 1 DIF: Application REF: White (2010) 57. ANS: C There is a direct relationship between calcium, potassium, and magnesium. Normal range of serum magnesium is 1.5 to 2.5 mEq/L. A level of 0.9 mEq/L is a decrease; therefore, all levels would be decreased. PTS: 1 DIF: Application REF: White (2010) 58. ANS: B Magnesium, found in intracellular fluid and in combination with calcium and phosphorus in bone, muscle, and soft tissue, is important in the metabolism of carbohydrates and proteins. Normal range of serum magnesium is 1.5 to 2.5 mEq/L. Hypomagnesemia, a serum magnesium level of less than 1.5 mEq/L, is most often the result of chronic alcoholism or is secondary to prescribed medications. There is a direct relationship between the levels of magnesium, potassium, and calcium; if one is decreased, the others will also be decreased. PTS: 1 DIF: Application REF: White (2010) 59. ANS: B Phosphate functions with calcium in the bones and teeth. PTS: 1 DIF: Knowledge REF: White (2010) 60. ANS: C The normal serum phosphorus range is 1.7 to 2.6 mg/dL. PTS: 1 DIF: Knowledge REF: White (2010) 61. ANS: C Phosphate and calcium have an inverse relationship. If one electrolyte is elevated, the other will be decreased. The normal serum phosphorus range is 2.5 to 4.5 mg/dL. PTS: 1 DIF: Application REF: White (2010) 62. ANS: A The bodys main method of excretion for most electrolytes is through the kidneys. PTS: 1 DIF: Knowledge REF: White (2010) 63. ANS: A Chloride, the major extracellular anion, functions with sodium to maintain osmotic pressure and aid in maintaining acid-base balance. There is a direct relationship between the values of these electrolytes. PTS: 1 DIF: Analysis REF: White (2010)

64. ANS: D Body pH is maintained by the buffer systems, the respiratory system, and the kidneys. Chloride, the major extracellular anion, functions with sodium to maintain osmotic pressure and aid in maintaining acid-base balance. There is a direct relationship between the values of these electrolytes. PTS: 1 DIF: Knowledge REF: White (2010) 65. ANS: A Body pH is maintained by the buffer systems, the respiratory system, and the kidneys. The diagnostic test used to evaluate this effectiveness are arterial blood gases. PTS: 1 DIF: Comprehension REF: White (2010) 66. ANS: C The lungs regulates the amount of carbon dioxide circulating in the blood through the retention or excretion of the gas. PTS: 1 DIF: Knowledge REF: White (2010) 67. ANS: C Respiratory acidosis is caused by hypoventilation or respiratory depression; if this situation occurs suddenly, the condition is life-threatening. Continual depression of the respiratory rate results in chronic respiratory acidosis. In respiratory acidosis, the blood pH level is below 7.35, the partial carbon dioxide level is greater than 45 mmHg, and there is an excess of carbonic acid. PTS: 1 DIF: Analysis REF: White (2010) 68. ANS: C A client experiences respiratory alkalosis as a result of hypoxia (decrease in H+ ions). The most common causative agent is anxiety. PTS: 1 DIF: Application REF: White (2010) 69. ANS: D Respiratory alkalosis is caused by hyperventilation, which can be precipitated by anxiety, fear, pain, fever, rapid mechanical ventilation, hypoxia at high altitudes, or by disease conditions such as brain tumors. In respiratory alkalosis, the blood pH is above 7.45 and the partial carbon dioxide level is less than 35 mmHg. PTS: 1 DIF: Comprehension REF: White (2010) 70. ANS: A Metabolic acidosis is caused by kidney disease, vomiting, diarrhea, diabetes mellitus, or use of diuretics. In metabolic acidosis, the blood pH is below 7.35 (indicating an increase in H+ ions or a loss of bicarbonate). PTS: 1 DIF: Application REF: White (2010) 71. ANS: B Metabolic alkalosis is caused by excessive ingestion of antacids or milk, or by excessive oral or parenteral administration of sodium bicarbonate or other alkaline salts. In metabolic alkalosis, the blood pH is greater than 7.45 (indicating a lose of H+ ions) and an increase in bicarbonate. PTS: 1 DIF: Application REF: White (2010) 72. ANS: C Metabolic alkalosis is caused by excessive ingestion of antacids or milk, or by excessive oral or parenteral administration of sodium bicarbonate or other alkaline salts and prolonged nasogastric suctioning. Overly vigorous mechanical ventilation and pain result in respiratory alkalosis. Hyperkalemia results in metabolic acidosis.

PTS: 1 DIF: Analysis REF: White (2010) 73. ANS: C The normal pH is 7.35 to 7.45. The normal pCO2 is 34 to 45 mmHg. In the client experiencing respiratory acidosis, the nurse would expect to find the pH range to be decreased and the pCO2 range to be increased. Guillain-Barr syndrome caused the decrease in the respiratory function due to paralysis of the intercostal muscles and the diaphragm. PTS: 1 DIF: Analysis REF: White (2010) 74. ANS: D The normal serum potassium level in the adult is 3.5 to 5.0 mEq/L. PTS: 1 DIF: Analysis REF: White (2010) 75. ANS: B Clinical manifestations of respiratory alkalosis include tachypnea, mental status changes, dizziness, pallor around the mouth, spasms of the muscles of the hands, and hypokalemia. PTS: 1 DIF: Analysis REF: White (2010) 76. ANS: D The normal pH range is 7.35 to 7.45. In a client experiencing a respiratory condition, an opposite relationship will be seen between the pH level and the pCO2 levels. In an acidosis condition, the pH value is decreased and the pCO2 value is increased. A client experiencing a diagnosis of pneumonia is at risk for respiratory acidosis as a result of hypoxia (increase in H+ ions). PTS: 1 DIF: Analysis REF: White (2010) 77. ANS: A The normal serum electrolyte ranges are sodium, 135 to 145 mEq/L; potassium, 3.5 to 5.0 mEq/L; calcium, 8.5 to 10.5 mg/dL; bicarbonate, 22 to 28 mEq/L. The serum sodium level is the only abnormal value. PTS: 1 DIF: Analysis REF: White (2010) 78. ANS: C The findings associated in a client experiencing fluid volume excess include cough, dyspnea, crackles, tachypnea, tachycardia, and elevated blood pressure and a bounding pulse, weight gain, edema, neck and hand vein distention, altered level of consciousness, and a decreased hematocrit. PTS: 1 DIF: Synthesis REF: White (2010) 79. ANS: A The normal serum potassium range is 3.5 to 5.0 mEq/L. Hypokalemia, a serum potassium level of less than 3.5 mEq/L, can result from the use of diuretics or from gastrointestinal tract disturbances. Administering furosemide to a client with a low potassium level could result in dysrhythmias in the client. PTS: 1 DIF: Analysis REF: White (2010) 80. ANS: A Kussmauls respirations are characterized by abnormally deep, regular, and increased in rate. In the remaining answer options, respirations have some but not all the characteristics. PTS: 1 DIF: Analysis REF: White (2010)

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