CRNA Fluids Electrolytes Basics Quiz Review

1. 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.

True

False

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.

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.

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

Hyperkalemia

Hypernatremia

Hypokalemia

TECHNICALLY....

Ca++ to increase heart rate and contractility

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

Give insulin before dextrose.

Explanation

Ca++ to increase heart rate and contractility

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

Give insulin before dextrose.

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

True

False

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

Explanation

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

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

0

1

3

8

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.

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.

5. Match the following additional fluid requirements with their type of procedure:

4-8 mL/kg

2-4 mL/kg

0-2 mL/kg

Submit

6.

1st hour	½ NPO deficit (mL) + 3rd space loss (mL) + maintenance rate (mL)
2nd Hour	1/4th NPO deficit (mL) + 3rd space loss (mL) + Maintenance rate
3rd Hour	1/4th NPO deficit (mL) + 3rd space loss (mL) + Maintenance rate
4th hour and beyond	3rd space loss (mL) + Maintenance rate ( =mL/fluid/hour)

True

False

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.

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.

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

True

False

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.

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.

8. Match the following

Increased Na+, Hct, BUN/Creat ratio, and urine specific gravity

Decreased Na+, Hct, and urine specific gravity

Submit

9. Match the following

4 mL/kg/hr

Add 1 mL/kg/hr

Add 2 mL/kg/hr

Patients over 20 kg: Take their weight in kg and add 40 = total maintenance rate.

Explanation

Patients over 20 kg: Take their weight in kg and add 40 = total maintenance rate.

Submit

10. Hypokalemia is associated with which EKG changes:

Flattened T waves, decreased ST segment, widened QRS

Peaked T waves, increased ST segment, narrow QRS

Asystole

Torsades

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.

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.

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

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.

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.

Submit

13. Match the following

1:1 mL of blood loss

3:1 mL of blood loss

Submit

14. A change in the tonicity of _____ regulates ADH secretion.

ECF

ICF

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.

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.

15. Match the following

Intracellular fluid

Extracellular fluid

Submit

16. Match the following

Loss of extracellular fluid.

Not enough H2O relative to Na+.

Submit

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

Descend

Ascend

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.

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.

18. Match the following

Contains all clotting factors

Contains clotting factors I, VIII, and XIII.

Submit

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

True

False

Postpone OR if Na >150

Explanation

Postpone OR if Na >150

20. PEEP is generally used for management of:

Hypervolemia

Hypovolemia

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.

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.

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

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.

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.

Submit

23. Match the following

Hypomagnesemia

Hypermagnesemia

Submit

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

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.

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.

Submit

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

True

False

Hypocalcemia.

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

Explanation

Hypocalcemia.

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

27. ABO compatibility screening is required for platelet and FFP administration.

True

False

These two products are pooled from different donors - they trigger the most transfusion reactions.

Explanation

These two products are pooled from different donors - they trigger the most transfusion reactions.

28. 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+.

True

False

Switching to patient’s specific type may cause major intravascular hemolysis of donor RBCs

Explanation

Switching to patient’s specific type may cause major intravascular hemolysis of donor RBCs

29. Hyperventilation decreases K+.

True

False

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.

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.

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

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.

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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31. Serial Hct levels will reflect acute blood loss.

True

False

Reflect ratio of RBC's to plasma

Explanation

Reflect ratio of RBC's to plasma

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

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.

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.

Submit

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

Hypotonic

Hypertonic

Isotonic

0.6 x weight x (Na – 140/140) = L of fluid needed over 48 hours to lower sodium to 140

Explanation

0.6 x weight x (Na – 140/140) = L of fluid needed over 48 hours to lower sodium to 140

34. Match the following

Anti-A and Anti-B antibodies

Anti-B

Anti-A

No antibodies

Submit

35. Adults typically require _____ mL/day of fluid.

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

Explanation

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

Submit

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

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.

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

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

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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38. The potential for digitalis toxicity increases with hyperkalemia.

True

False

Hypokalemia

Explanation

Hypokalemia

39. 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?

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

Explanation

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

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