CRNA Fluids Electrolytes Basics Quiz Review

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Quizzes Created: 20 | Total Attempts: 5,079
Questions: 39 | Attempts: 486

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CRNA Quizzes & Trivia

CRNA nurses are regarded as advanced practice nurses and therefore held highly in the medical profession. This quiz helps you as a nurse to test your knowledge on basic fluids electrolytes and related information. All the best.


Questions and Answers
  • 1. 

    A change in the tonicity of _____ regulates ADH secretion. 

    • A.

      ECF

    • B.

      ICF

    Correct Answer
    A. ECF
    Explanation
    A change in the tonicity of the extracellular fluid (ECF) regulates ADH secretion. ADH, or antidiuretic hormone, is responsible for regulating the body's water balance. When the ECF becomes hypertonic (higher concentration of solutes), it stimulates the release of ADH from the posterior pituitary gland. This hormone acts on the kidneys to increase water reabsorption and decrease urine production, thereby helping to restore normal tonicity in the ECF. On the other hand, if the ECF becomes hypotonic (lower concentration of solutes), ADH secretion is inhibited, allowing for increased urine production and the excretion of excess water.

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  • 2. 

    Adults typically require _____ mL/day of fluid.

    Correct Answer
    2000
    Explanation
    DAILY BODY LOSSES
    Kidneys 1-2 L/day
    Skin via evaporation (varies)
    Lungs 300-400 mL/day
    GI 100-200 mL/day

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  • 3. 

    General anesthesia increases the release of ADH, predisposing patients to hyponatremia due to increased water retention.

    • A.

      True

    • B.

      False

    Correct Answer
    A. True
    Explanation
    General anesthesia can disrupt the normal regulation of hormones in the body, including the release of antidiuretic hormone (ADH). ADH helps regulate water balance in the body by promoting water reabsorption in the kidneys. When ADH levels are increased, water retention increases, leading to a dilution of sodium levels in the blood, which is known as hyponatremia. Therefore, it is true that general anesthesia can increase the release of ADH and predispose patients to hyponatremia due to increased water retention.

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  • 4. 

    Third spacing is usually mobilized and returned to the intravascular space by post op day:

    • A.

      0

    • B.

      1

    • C.

      3

    • D.

      8

    Correct Answer
    C. 3
    Explanation
    Third spacing refers to the accumulation of fluid in the interstitial spaces, which can occur after surgery. This fluid is typically reabsorbed and returned to the intravascular space by postoperative day 3. Therefore, the correct answer is 3.

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  • 5. 

    Hypovolemia can occur via polyuria, diaphoresis, and NPO status but also can be attributed to redistribution of water within the body leading to a reduced circulating volume such as with burns and third spacing.

    • A.

      True

    • B.

      False

    Correct Answer
    A. True
    Explanation
    The statement explains that hypovolemia can occur due to various reasons such as polyuria, diaphoresis, NPO status, as well as redistribution of water within the body, such as with burns and third spacing. This means that the statement is true, as it correctly states the possible causes of hypovolemia.

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  • 6. 

    PEEP is generally used for management of:

    • A.

      Hypervolemia

    • B.

      Hypovolemia

    Correct Answer
    A. Hypervolemia
    Explanation
    PEEP, or positive end-expiratory pressure, is a technique used in mechanical ventilation to prevent alveolar collapse during expiration. It helps to maintain a certain level of pressure in the lungs at the end of the breathing cycle, which improves oxygenation and prevents atelectasis. Hypervolemia refers to an excessive volume of fluid in the blood vessels, which can lead to increased hydrostatic pressure and fluid leakage into the interstitial spaces. PEEP is not used for the management of hypervolemia, but rather for conditions such as acute respiratory distress syndrome (ARDS) or acute lung injury (ALI) where there is impaired gas exchange and lung compliance.

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  • 7. 

    With hypovolemia, the dicrotic notch on the a-line tracing will ______ along the dicrotic limb.

    • A.

      Descend

    • B.

      Ascend

    Correct Answer
    A. Descend
    Explanation
    In hypovolemia, there is a decrease in blood volume, which leads to a decrease in cardiac output. This decrease in cardiac output causes a decrease in arterial pressure, resulting in a lower dicrotic notch on the a-line tracing. Therefore, the dicrotic notch will descend along the dicrotic limb.

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  • 8. 

    When treating hypernatremia associated with a water deficit, you should correct the Na+ level over 48 hours with a ______ solution.

    • A.

      Hypotonic

    • B.

      Hypertonic

    • C.

      Isotonic

    Correct Answer
    A. Hypotonic
    Explanation
    0.6 x weight x (Na – 140/140) = L of fluid needed over 48 hours to lower sodium to 140

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  • 9. 

    Hypernatremia increases MAC, decreases Vd (decreased dose of IV agents needed) , and decreases CO (faster onset of inhalation agents).

    • A.

      True

    • B.

      False

    Correct Answer
    A. True
    Explanation
    Postpone OR if Na >150

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  • 10. 

    Na+ < _____ mEq/L is associated with seizures.

    Correct Answer
    115
    Explanation
    A sodium level below 115 mEq/L is associated with seizures. This means that when the concentration of sodium in the blood falls below this level, it can lead to the development of seizures. Sodium plays a crucial role in maintaining the balance of fluids in the body and is essential for proper nerve and muscle function. When sodium levels are too low, it can disrupt the normal electrical activity in the brain, increasing the risk of seizures.

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  • 11. 

    When treating hyponatremia, it is important to replace Na+ slowly, at a rate of 0.5-1.5 mEq/L/hr.

    • A.

      True

    • B.

      False

    Correct Answer
    A. True
    Explanation
    Rapid correction can cause central pontine myelinolysis which is demyelination of the brain stem resulting in permanent neurological damage.

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  • 12. 

    Hypokalemia is associated with which EKG changes:

    • A.

      Flattened T waves, decreased ST segment, widened QRS

    • B.

      Peaked T waves, increased ST segment, narrow QRS

    • C.

      Asystole

    • D.

      Torsades

    Correct Answer
    A. Flattened T waves, decreased ST segment, widened QRS
    Explanation
    Hypokalemia is a condition characterized by low levels of potassium in the blood. One of the EKG changes associated with hypokalemia is flattened T waves, which refers to a decrease in the amplitude of the T wave. Additionally, hypokalemia can cause a decrease in the ST segment, which is the period between the end of the S wave and the beginning of the T wave. Lastly, hypokalemia can lead to a widened QRS complex, which represents the time it takes for the electrical signal to travel through the ventricles.

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  • 13. 

    The potential for digitalis toxicity increases with hyperkalemia.

    • A.

      True

    • B.

      False

    Correct Answer
    B. False
    Explanation
    Hypokalemia

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  • 14. 

    Hyperventilation decreases K+.

    • A.

      True

    • B.

      False

    Correct Answer
    A. True
    Explanation
    Hyperventilation is the act of breathing rapidly and deeply, which leads to a decrease in carbon dioxide levels in the blood. This causes a shift in the acid-base balance of the body, resulting in a decrease in hydrogen ions (H+). To compensate for this decrease in H+, the body excretes potassium ions (K+) through the kidneys. Therefore, hyperventilation can lead to a decrease in K+ levels in the body.

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  • 15. 

    An infusion of calcium, dextrose, and insulin is used for treatment of:

    • A.

      Hyperkalemia

    • B.

      Hypernatremia

    • C.

      Hypokalemia

    • D.

      TECHNICALLY....

    Correct Answer
    A. Hyperkalemia
    Explanation
    Ca++ to increase heart rate and contractility

    Dextrose stimulates glyogen synthesis - increasing K+ uptake
    Insulin drives K+ into cells

    Give insulin before dextrose.

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  • 16. 

    Trousseau's and Chvostek's signs are symptoms of hypercalcemia.

    • A.

      True

    • B.

      False

    Correct Answer
    B. False
    Explanation
    Hypocalcemia.

    Associated w/hyperactive deep tendon reflexes, laryngospasm, convulsions, and prolonged QT/ST segments.

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  • 17. 

    Blood products contain _______ to inhibit clotting in storage.  This substance binds with calcium, rendering it ineffective.

    Correct Answer
    citrate
    Explanation
    Blood products, such as plasma or platelets, need to be stored for extended periods before use. However, clotting can occur during storage, rendering the products unusable. To prevent this, blood products are treated with citrate, a substance that binds with calcium. Calcium is essential for the clotting process, so by binding with it, citrate inhibits clotting and keeps the blood products viable for transfusion.

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  • 18. 

    Due to coagluation issues, ___ mL/kg is the maximum allowed volume of hetastarch.

    Correct Answer
    20
    Explanation
    The statement suggests that there are coagulation issues, which means that the blood is not clotting properly. Hetastarch is a type of colloid solution that is used to increase blood volume. However, in cases of coagulation issues, the maximum allowed volume of hetastarch is limited to 20 mL/kg. This restriction is likely in place to prevent further complications or risks associated with coagulation issues.

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  • 19. 

    What would be the total maintenance fluid rate for a 14 kg child?

    Correct Answer
    48
    Explanation
    The total maintenance fluid rate for a 14 kg child is 48. This means that the child would require 48 mL of fluid per hour to maintain their hydration levels. The maintenance fluid rate is calculated based on the child's weight, with a standard formula used to determine the appropriate amount of fluid needed. In this case, the calculation has resulted in a total of 48 mL per hour for the 14 kg child.

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  • 20. 

    What would be the total maintenance fluid rate for a 240 kg man?

    Correct Answer
    280
    Explanation
    Yikes.

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  • 21. 

    Your 55 kg patient has been NPO for 6 hours - what is their NPO deficit?

    Correct Answer
    570, 570ml
    Explanation
    To calculate the NPO (nil per os, meaning nothing by mouth) deficit, you need to consider the fluid requirements for the patient based on their weight. The standard approach is to use the Holliday-Segar formula, which recommends 4 mL/kg/hour for the first 10 kg of body weight, 2 mL/kg/hour for the next 10 kg, and 1 mL/kg/hour for each additional kg.
    Let's calculate it for the given patient:
    For the first 10 kg: 4 mL/kg/hour × 10 kg = 40 mL/hour For the next 10 kg: 2 mL/kg/hour × 10 kg = 20 mL/hour For the remaining 35 kg: 1 mL/kg/hour × 35 kg = 35 mL/hour
    Total fluid requirement per hour = 40 mL/hour + 20 mL/hour + 35 mL/hour = 95 mL/hour
    Now, if the patient has been NPO for 6 hours, the NPO deficit would be:
    NPO deficit = Total fluid requirement per hour × NPO hours NPO deficit = 95 mL/hour × 6 hours = 570 mL
    So, the NPO deficit for the 55 kg patient who has been NPO for 6 hours is 570 mL.

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  • 22. 

    1st hour½ NPO deficit (mL) + 3rd space loss (mL) + maintenance rate (mL)2nd Hour1/4th NPO deficit (mL) + 3rd space loss (mL) + Maintenance rate3rd Hour1/4th NPO deficit (mL) + 3rd space loss (mL) + Maintenance rate 4th hour and beyond3rd space loss (mL) + Maintenance rate  ( =mL/fluid/hour)

    • A.

      True

    • B.

      False

    Correct Answer
    A. True
    Explanation
    The given statement is true because it accurately describes the calculation of fluid replacement in a patient. The formula provided outlines the amount of fluid that should be administered to a patient over a period of time. It takes into account the NPO deficit, which is the amount of fluid that the patient has not consumed due to being nil per os (nothing by mouth). It also includes the third space loss, which refers to fluid that has accumulated in areas of the body where it is not easily accessible or measurable. Finally, the formula incorporates the maintenance rate, which is the amount of fluid needed to maintain normal bodily functions. By following this formula, healthcare providers can ensure that patients receive the appropriate amount of fluid replacement.

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  • 23. 

    An 79 kg male with colon cancer presents  for an open colon resection at Grant Medical Center. He states that he has been NPO for 8 hours prior to surgery. How much fluid would you anticipate administering during the 1st hour of surgery?

    Correct Answer
    1227
    Explanation
    NPO deficit = 952 mL/2 = 476
    Maintenance = 119
    Additional = 8mL/kg = 632
    476 + 119 + 632 = 1227

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  • 24. 

    Serial Hct levels will reflect acute blood loss.

    • A.

      True

    • B.

      False

    Correct Answer
    B. False
    Explanation
    Reflect ratio of RBC's to plasma

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  • 25. 

    An 45kg women with preoperative Hct of 35%.  How much loss  will decrease her to a Hct of 30%?

    Correct Answer
    450
    Explanation
    EBV = 70mL/kg for an adult
    70 mL x 45 kg = 3150 mL
    (35 - 30/35) x 3150
    0.14 x 3150 = 450 mL

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  • 26. 

    One unit of PRBC's raised Hgb by ___ g/dL.

    Correct Answer
    1
    Explanation
    Hct by 2-3%

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  • 27. 

    In healthy patients, a Hgb < ___ g/dL is associated with an increased resting cardiac output in order to maintain normal oxygen delivery.

    Correct Answer
    7
    Explanation
    In healthy patients, a Hgb (hemoglobin) level below 7 g/dL is associated with an increased resting cardiac output. This means that when the hemoglobin level falls below 7 g/dL, the heart has to pump more blood in order to maintain normal oxygen delivery to the body. Hemoglobin is responsible for carrying oxygen from the lungs to the tissues, so a decrease in its level can lead to decreased oxygen delivery.

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  • 28. 

    Most serious of reactions to transfusions are those due to ____ incompatibility.

    Correct Answer
    ABO
    Explanation
    Activated the complement system, causes intravascular hemolysis

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  • 29. 

    Your patient had a rough night on Park Street and unfortunately fell onto somebody's machete, now they are exsanguinating in front of you in the operating room.  You initiate the massive transfusion protocol without having time to send a type & screen.  You give your initial 2 units of un-crossmatched O- PRBC's when your type and screen returns.  You should now begin giving the patient their own blood type, which is A+.

    • A.

      True

    • B.

      False

    Correct Answer
    B. False
    Explanation
    Switching to patient’s specific type may cause major intravascular hemolysis of donor RBCs

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  • 30. 

    ABO compatibility screening is required for platelet and FFP administration.

    • A.

      True

    • B.

      False

    Correct Answer
    B. False
    Explanation
    These two products are pooled from different donors - they trigger the most transfusion reactions.

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