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Therapeutics Exam 1 - Fluid & Electrolytes

Total questions: 128

Worksheet time: 1hrs 22mins

Name
Class
Date
1.

The proximal tubule reabsorbs how much of the glomerular filtrate

a)

1/3

b)

2/3

c)

1/4

d)

3/4

2.

What does the loop of henle transport?

a)

solutes

b)

water

c)

free fluid

d)

electrolytes

3.

What does the distal nephron regulate?

a)

water balance

b)

solute levels

c)

sodium levels

d)

electrolyte levels

4.

Changes in osmolality in plasma is detected by

a)

baroreceptors

b)

oligoreceptors

c)

osmoreceptors

d)

prostaglandin receptors

5.

What hormone enhances water reabsorption in the kidney

a)

ADH

b)

aldosterone

c)

renin

6.

ADH is released when plasma osmolality rises by

a)

5%

b)

+1%

c)

10%

d)

15%

7.

ADH can be released with normal osmolality if arterial blood volume is decreasing by

a)

1-5%

b)

6-10%

c)

11-15%

d)

15-20%

8.

Which ADH receptor induces vasoconstriction and prostaglandin release

a)

V1b

b)

V1a

c)

V2

9.

Which ADH receptor mediates effects of ADH on pituitary and facilitates release of ACTH

a)

V1a

b)

V1b

c)

V2

10.

What ADH receptor induces antidiuretic response, modulates release of factor VIII and von Willebrand factors

a)

V1a

b)

V1b

c)

V2

11.

Aldosterone

a)

comes from adrenal gland

b)

release stimulate by low body Na

c)

causes vasoconstriction

d)

increased water reabsorption, Na reabsorption, and K secretion

12.

ICF accounts for _ TBW

a)

1/3

b)

2/3

c)

1/2

d)

3/4

13.

ECF accounts for _ TBW

a)

1/3

b)

2/3

c)

1/2

d)

3/4

14.

Of the ECF, what % is interstitial or intravascular fluid

a)

80% inter

20% intra

b)

70% inter

30% intra

c)

60% inter

40% intra

d)

50% inter

50% intra

15.

What aspects regulate body water

a)

thirst

b)

ADH

c)

electrolytes

d)

Na

16.

Normal intake of water comes from

a)

liquid: 1100ml

b)

food: 1000ml

c)

oxidant: 300ml

d)

total daily intake: 2400ml/day

17.

Lack of water in the body across all compartments

a)

hypovolemia

b)

dehydration

c)

deprivation

d)

hypotension

18.

Lack of fluid in the intravascular space

a)

hypovolemia

b)

dehydration

c)

deprivation

d)

hypotension

19.

clinical features of water excess

a)

muscle relaxation

b)

weight gain

c)

edema

d)

blurred vision

20.

Lab findings with excess water

a)

H/H, BUN - normal to low

b)

Urine - Na reduced, specific gravity <1.01

c)

Na - can be low

d)

Mg - high levels

21.

causes of excess water include

a)

CHF

b)

compulsive intake

c)

SIADH

d)

renal impairment

22.

Treatment of excess water includes

a)

replace 1/2 TBW on day 1

b)

fluid restrictions

c)

increase fluid intake

d)

hypotonic fluids

23.

Colloids

a)

contain protein or starch molecules

b)

used to decrease capillary oncotic pressure so that intravascular volume is decreased

c)

plasma expanders - do not have oxygen carrying capacity

d)

blood products

24.

True or False: plasma expanders can be used to replace vascular volume without the need for typing and crossmatching

a)

True

b)

False

25.

what is given to replace blood volume because they increase volume and oxygen carrying capacity

a)

proteins

b)

blood products

c)

plasma expanders

d)

colloids

26.

What is used to maintain plasma oncotic pressure

a)

proteins

b)

blood products

c)

plasma expanders

d)

colloids

27.

Crystalloids

a)

contain proteins

b)

used to replace fluids and electrolytes

c)

treats acid base disorders

d)

provide small numbers of calories

28.

Normal Saline

a)

slightly hypertonic but considered isotonic

b)

remains in interstitial space

c)

no free water

d)

will not rehydrate

29.

Dextrose 5% in water

a)

slightly hypertonic but considered isotonic

b)

free water

c)

no electrolytes

d)

contains proteins

30.

Each mEq is approximately = to a millimole because univalent electrolytes (when ionized) carry one charge per particle

a)

univalent

b)

divalent

31.

Because each particle contains 2 charges when ionized the mEq per L or the number of electrical charges per L when divided by the charge per ion will give the approximate number of particles or milliosmoles per L

a)

univalent

b)

divalent

32.

2(Na)+glucose/18 + BUN/2.8

a)

urine electrolytes

b)

serum osmolality

c)

sodium homeostasis

33.

What increases osmolality

a)

increase Na, glucose, BUN

b)

diabetes insipidus

c)

overhydration

d)

toxic substances

34.

What decreases osmolality

a)

dehydration

b)

SIADH

c)

low Na

d)

high Na

35.

What is a major determinant of ECF osmolality

a)

K homeostasis

b)

Na homeostasis

c)

Ca homeostasis

d)

Mg homeostasis

36.

Na homeostasis in the kidney

a)

promote water reabsorption

b)

promote Na excretion

c)

tubular reabsorption

d)

increase ECF pressure

37.

Aldosterone in regards to Na homeostasis

a)

tubular reabsorption

b)

promote water reabsorption

c)

promote Na reabsorption

d)

promote Na excretion

38.

normal serum osmolality

a)

isotonic hyponatremia

b)

hypertonic hyponatremia

c)

hypotonic hyponatremia

39.

elevated serum osmolality

a)

isotonic hyponatremia

b)

hypertonic hyponaremia

c)

hypotonic hyponatremia

40.

What does the natriuretic hormone in regards to Na homeostasis

a)

tubular reabsorption

b)

promote Na reabsorption

c)

promote water reabsorption

d)

promote Na excretion

41.

low serum osmolality

a)

isotonic hyponatremia

b)

hypertonic hyponatremia

c)

hypotonic hyponatremia

42.

In hyperglycemia, Na 1.7 mEq/L for every 100 mg/dL in glucose

a)

decrease, increase

b)

increase, decrease

c)

increase, increase

d)

decrease, decrease

43.

What is typically >450 mOsm/kg

a)

total body serum

b)

urine Na

c)

urine osmolality

d)

ECF

44.

deficit of ECF volume and Na with a greater deficit in Na than water

a)

hypotonic hypovolemic hyponatremia

b)

hypotonic euvolemic hyponatremia

c)

hypotonic hypervolemic hyponatremia

45.

What causes hypotonic hypovolemic hyponatremia

a)

dehydration

b)

3rd spacing

c)

diuretics

d)

adrenal insufficiency

46.

normal total body Na and small increased ECF volume

a)

hypotonic hypovolemic hyponatremia

b)

hypotonic euvolemic hyponatremia

c)

hypotonic hypervolemic hyponatremia

47.

Causes of hypotonic euvolemic hyponatremia

a)

SIADH

b)

hyperthyroidism

c)

water intoxication

d)

cortisol deficiency

48.

elevated total body Na and expanded ECF, water gain greater then Na

a)

hypotonic hypovolemic hyponatremia

b)

hypotonic euvolemic hyponatremia

c)

hypotonic hypervolemic hyponatremia

49.

Causes of hypotonic hypervolemic hyponatremia

a)

CHF

b)

cirrhosis

c)

SIADH

d)

renal nephrotic syndromes

50.

sx due to hypovolemia

a)

hypovolemic

b)

isovolemic

c)

hypervolemic

51.

sx of hypotonicity due to cellular swelling with CNS; sx of cerebral edema and increased ICP

a)

hypovolemic

b)

isovolemic

c)

hypervolemic

52.

Treatment of hypovolemic hyponatremia

a)

normal saline over 6-12 hours to replace ECF

b)

Max rate of correction: 12mEq/L of Na in 24 hrs and 18mEq/L in 48 hrs

c)

Immediately infuse hypertonic saline

d)

Decrease ECF volume over a slow period of time

53.

Treatment of euvolemic hyponatremia

a)

water restriction

b)

Tolvaptan

c)

Conivaptan

d)

Loop diuretics

54.

Treatment of hypervolemic hyponatremia

a)

restriction of water and salt

b)

Conivaptan/Tolvapatan

c)

loop diuretics

d)

hypertonic NaCl

55.

Hyponatremia has a serum Na of _ mEq/L

a)

<120

b)

<150

c)

<135

d)

<140

56.

Hypernatremia has a serum Na of _ mEq/L

a)

>120

b)

>150

c)

>135

d)

>140

57.

associated with hypertonicity and results from a state of relative water deficit

a)

Hyponatremia

b)

Hypernatremia

58.

both a loss of Na and water, with water in deficit being greater

a)

hypovolemic hypernatremia

b)

isovolemic hypernatremia

c)

hypervolemic hypernatemia

59.

Causes of hypovolemic hypernatremia

a)

renal losses are replaced with fluids containing more Na than amount loss

b)

diuretics

c)

laxative induced diarrhea

d)

DI

60.

isolated pure water loss, total body Na is normal

a)

hypovolemic hypernatremia

b)

isovolemic hypernatremia

c)

hypervolemic hypernatremia

61.

Causes of isovolemic hypernatremia

a)

Cushings

b)

cellular dehydration

c)

DI

d)

Iatrogenic

62.

increases in total body Na and water, with a greater increase in Na

a)

Hypovolemic hypernatremia

b)

Isovolemic hypernatremia

c)

Hypervolemic Hypernatremia

63.

Causes of hypervolemic hypernatremia

a)

Na bicarb during codes

b)

hypertonic feedings in infants

c)

cushings

d)

hypotonic saline used in abortions

64.

hypernatremia s/s

a)

hypotonicity

b)

cellular rehydration

c)

idiogenic osmoles

d)

CNS changes

65.

what is the mEq/L with severe sx for hypernatremia

a)

120

b)

140

c)

160

d)

180

66.

Tx of hypovolemic hypernatremia

a)

restore intravascular volume

b)

replace water deficit

c)

correct serum Na

d)

post obstructive diuresis

67.

Tx of hyperglycemia hypovolemic hypernatremia

a)

correct hyperglycemia

b)

correct serum Na before estimating water deficit

c)

replace water deficit

d)

induce hypoglycemia

68.

Tx for hypervolemic hypernatremia

a)

replace water deficit

b)

eliminate Na excess

c)

furosemide

d)

cause hyperglycemia

69.

Tx for isovolemic hypernatremia

a)

replace water deficit

b)

tx underlying condition

c)

pharm tx for DI

d)

hypertonic saline

70.

What does Cl follow

a)

K

b)

Mg

c)

Na

d)

Ca

71.

associated with metabolic alkalosis, hyponatremia, diuretics

a)

hypochloremia

b)

hyperchloremia

c)

hypokalemia

d)

hyperkalemia

72.

Tx of hypochloremia

a)

correct underlying problems

b)

NaCl tablets

c)

saline solution

d)

change IV fluids

73.

associated with metabolic acidosis, respiratory alkalosis, hypernatremia, Cl loading

a)

hypochloremia

b)

hyperchloremia

c)

hypokalemia

d)

hyperkalemia

74.

Tx for hyperchloremia

a)

correct acidosis

b)

change IV fluids

c)

correct underlying condition

d)

correct alkalosis

75.

What is the primary extracellular anion

a)

Cl

b)

K

c)

Mg

d)

Ca

76.

What is the primary intracellular cation

a)

Cl

b)

K

c)

Mg

d)

Ca

77.

Where is K mainly found

a)

inside the cell

b)

outside the cell

78.

What are the major functions of K

a)

decrease BP

b)

cell metabolism

c)

resting membrane potential

d)

increase Na

79.

Which organ regulates total body potassium

a)

liver

b)

spleen

c)

kidney

d)

stomach

80.

How does serum pH affect K redistribution

a)

increases metabolic acidosis

b)

increases metabolic alkalosis

c)

decreases metabolic alkalosis

d)

maintains respiratory acids

81.

How does the adrenergic system influence K redistribution

a)

decrease B2 agonists

b)

decrease B2 blockade

c)

increase a1 agonists

d)

increase a1 blockade

82.

How does insulin influence K redistribution

a)

increase excess

b)

decrease excess

c)

increase deficit

d)

decrease deficit

83.

Causes of hypokalemia

a)

low intake

b)

plasma volume contraction leading to secondary increase in aldosterone

c)

GI - direct loss from vomiting

d)

drugs

84.

Hypokalemia s/s

a)

arrhythmias

b)

increased digitalis toxicity

c)

muscle weakness and cramps

d)

excess water intake

85.

Tx of hypokalemia

a)

salt forms of K

b)

oral replacements

c)

IV replacements

d)

K-sparing diuretics

86.

Which K sparing diuretics tx hypokalemia

a)

eplerenone

b)

spironolactone

c)

triamterene

d)

Amiloride

87.

causes of hyperkalemia

a)

redistribution

b)

renal failure

c)

excess intake

d)

drugs

88.

What is associated with cardiac >6 mEq/L

a)

peaked T waves

b)

short QT

c)

increased rate of repolarization

d)

decreased rate of depolarization

89.

What is associated with >7-8 mEq/L

a)

loss of P wave

b)

delayed depolarization

c)

slowed cardiac conduction

d)

widening of QRS

90.

What is associated with >9-10 mEq/L

a)

arrhythmias

b)

V fib

c)

asystole

d)

death

91.

Tx of symptomatic, moderate to severe hyperkalemia

a)

antagonism of membrane action

b)

decrease extracellular K by shifting into cell

c)

remove K from body

d)

correct underlying problem

92.

onset of calcium gluconate

a)

used for antagonism of membrane

b)

onset of 1-2 min

c)

duration 30-60 min

d)

used for removal of K from body

93.

insulin/dextrose use in hyperkalemia

a)

onset 15-30 min

b)

peak 60 min

c)

duration 2-6 h

d)

used to hide K

94.

Albuterol nebs in tx of hyperkalemia

a)

onset 30 min

b)

duration 1-2 h

c)

used to hide K

d)

used as antagonism of membrane

95.

what is used in cases of metabolic acidosis

a)

albuterol

b)

insulin

c)

dextrose

d)

sodium bicarb

96.

sodium polystyrene sulfonate in the tx of hyperkalemia

a)

onset 1-2 h

b)

lowers over 4-6 h

c)

used to remove K from body

d)

separate from other meds by 3 h

97.

Tx of asymptomatic, mild to moderate hyperkalemia

a)

patiromer

b)

Na zirconium cyclocilicate

c)

loop diuretic

d)

removal of cause

98.

which drug is a cation exchange polymer with a delayed onset of 7 h

a)

sodium polystyrene sulfonate

b)

patiromer

c)

sodium zirconium cyclosilicate

d)

loop diuretics

99.

What drug is an inorganic cation exchange crystalline compound with a delayed onset of 1 hour

a)

patiromer

b)

sodium polystyrene sulfonate

c)

sodium zirconium cyclosilicate

d)

loop diuretics

100.

what drugs are adjusted in 1 week intervals

a)

patiromer

b)

sodium zirconium cyclosilicate

c)

loop diuretics

d)

sodium polystyrene sulfonate

101.

which increases Ca binding

a)

metabolic acidosis

b)

metabolic alkalosis

102.

Which decreases Ca

a)

metabolic acidosis

b)

metabolic alkalosis

103.

Causes of hypercalcemia

a)

malignancy

b)

hyperparathyroidism

c)

drugs

d)

DI

104.

Hypercalcemia s/s

a)

crisis = >15mg/dl

b)

anorexia

c)

N/V

d)

constipation

105.

complications of hypercalcemia

a)

deposition in BV and organs

b)

insulin deficiency

c)

nephrolithiasis

d)

nephrocalcinosis

106.

Tx of hypercalcemia

a)

normal saline

b)

loop diuretics

c)

calcitonin

d)

bisphosphonates

e)

denosumab

107.

What are the first line bisphosphonates

a)

pamidronate

b)

zoledronic acid

c)

etidronate

d)

ibandronate

108.

which tx is best for patients resistance to bisphosphonates

a)

calcitonin

b)

corticosteroids

c)

denosumab

d)

cinacalet

109.

Which drug is used in patients with thyroid cancer

a)

corticosteroids

b)

bisphosphonates

c)

calcitonin

d)

cinacalet

110.

Causes of hypocalcemia

a)

hypoparathyroidism

b)

Vitamin C deficiency

c)

hypoalbuminemia

d)

drugs

111.

Hypocalcemia s/s

a)

fatigue

b)

muscle spasms

c)

prolonged QT

d)

latent tetany

112.

Tx for symptomatic hypocalcemia

a)

IV bolus no faster than 60mg/min

b)

infusion of elemental Ca

c)

Vit C

d)

Oral Ca

113.

Tx for asymptomatic hypocalcemia

a)

oral calcium

b)

vit D

c)

IV bolus

d)

Infusion of elemental Ca

114.

Where is Mg mainly found

a)

inside the cell

b)

outside the cell

115.

Causes of hypermagnesemia

a)

decreased renal excretion from kidney disease

b)

tx of toxemia in pregnancy

c)

ureteral irrigants

d)

cathartics

116.

Tx of hypermegnesemia

a)

calcium IV

b)

hemodialysis

c)

supportive treatment

d)

promote renal excretion by loop diuretics

117.

Causes of hypomagnesemia

a)

reduced absorption in GI

b)

reduced intake - alcoholism

c)

increased loss in GI

d)

decreased renal excretion

118.

Hypocalcemia s/s

a)

Neuromusclar - muscle twitching

b)

Psychiatric - apathy

c)

decrease in calcium and K levels

d)

Cardiac - premature ventricular beats

119.

Tx of hypocalcemia

a)

oral magnesium oxide

b)

slow IV administration

c)

multiple IM doses

d)

hemodialysis

120.

What is the primary intracellular anion

a)

Cl

b)

P

c)

K

d)

Mg

121.

Causes of hyperphosphatemia

a)

rhabdomyolysis

b)

decrease P excretion

c)

increase tubular reabsorption

d)

inadequte P intake

122.

Tx of severe hyperphosphatemia

a)

calcium acetate

b)

ferric citrate

c)

IV calcium salts

d)

normal saline

123.

Tx of non-severe hyperphosphatemia

a)

IV calcium

b)

normal saline

c)

ferric citrate

d)

calcium acetate

124.

Which drug has significant iron abrosption

a)

lanthanum carbonate

b)

ferric citrate

c)

calcium acetate

d)

sucroferric oxyhydroxide

125.

Which drug has no significant iron absorption

a)

ferric citrate

b)

calcium acetate

c)

sucroferric oxyhydroxide

d)

lanthanum carbonate

126.

Causes of hypophosphatemia

a)

starvation

b)

phosphate binding drugs

c)

intracellular P shifts

d)

increased P excretion

127.

Tx for moderate hypophosphatemia

a)

low fat milk

b)

oral drug

c)

parenteral

d)

normal saline

128.

Tx of severe hypophosphatermia

a)

low fat milk

b)

oral drug

c)

parenteral drugs

d)

normal saline

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