Chapter 27: Water, Electrolytes, and Acid-Base Balance

Multiple Choice
1. Which of the following fluid compartments contains the largest volume of water? A) plasma B) interstitial compartment C) intracellular compartment D) extracellular compartment E) lymph Answer: c Level: 1 2. Which of the following fluid compartments contains the smallest volume of water? A) plasma B) interstitial compartment C) intracellular compartment D) extracellular compartment E) cytoplasm Answer: a Level: 1 3. Synovial fluid is a part of which of the following fluid compartments? A) plasma B) interstitial C) intracellular D) extracellular E) cytoplasm Answer: d Level: 1 4. Which of the following individuals would have the largest percentage of their bodyweight as water? A) a small 7-year-old female B) a lean 35-year-old male athlete C) a chunky 52-year-old male athlete D) a healthy 88-year-old male E) an adult female marathon runner Answer: a Level: 2 5. A) B) Which of the following people would be most severely affected by prolonged vomiting? 3-year-old male 15-year-old male

C) 35-year-old male D) 35-year-old female E) 50-year-old male Answer: a Level: 2 6. Extracellular fluid has a A) higher protein content than intracellular fluid. B) higher potassium content that intracellular fluid. C) higher sodium content than intracellular fluid. D) higher magnesium content than intracellular fluid E) higher number of large organic molecules than intracellular fluid. Answer: c Level: 2 7. The predominant intracellular cation is A) potassium. B) sodium. C) calcium. D) magnesium. E) chloride. Answer: a Level: 1 8. The predominant extracellular cation is A) bicarbonate. B) sodium. C) chloride. D) potassium. E) hydrogen ion. Answer: b Level: 2 9. The distribution of sodium and potassium ions between intracellular and extracellular compartments is A) potassium mainly intracellular; sodium mainly in extracellular. B) sodium mainly intracellular; potassium mainly in extracellular. C) little of either intracellular but large amounts of both extracellular. D) equal amounts of both ions, in both intracellular and extracellular fluids. E) none of the above Answer: a Level: 2 10. One difference between the plasma and interstitial fluid is that the plasma has significantly more _____ than interstitial fluid. A) protein

B) bicarbonate C) chloride D) water volume E) hydrogen ions Answer: a Level: 2 11. Serum electrolyte concentrations are most often expressed as A) mg %. B) mmHg. C) mg/dl. D) mEq/L. E) none of the above Answer: d Level: 1 12. Water moves back and forth across the plasma membrane by the process of A) osmosis. B) filtration. C) facilitated diffusion. D) active transport. E) endocytosis. Answer: a Level: 1 13. The cation that plays a major role in determining the osmotic pressure of the plasma is A) sodium. B) potassium. C) chloride. D) phosphate. E) hydrogen ion. Answer: a Level: 1 14. The major route of excretion for sodium ions (under normal conditions) is the A) skin. B) kidney. C) GI tract. D) adrenal cortex. E) sweat. Answer: b Level: 1 15. A) B) When aldosterone is absent, sodium reabsorption in the nephron is greatly increased. greatly decreased.

C) unchanged. Answer: b Level: 2 16. As the rate of sweat production increases, the amount of sodium lost in the urine A) increases. B) decreases. C) remains the same. Answer: b Level: 2 17. Receptors sensitive to changes in the osmolality of extracellular fluid are the A) baroreceptors. B) chemoreceptors. C) osmoreceptors. D) pressoreceptors. E) proprioreceptors. Answer: c Level: 1 18. Renin is released by the A) lungs. B) kidney. C) spleen. D) liver. E) pancreas. Answer: b Level: 1 19. Which of the following events occurs last? A) release of renin by the kidney B) release of aldosterone by the adrenal cortex C) sodium reabsorption by the kidney tubules D) angiotensinogen angiotensin I E) angiotensin I angiotensin II Answer: c Level: 2 20. The primary regulator of plasma sodium concentration is A) renin. B) aldosterone. C) antidiuretic hormone (ADH). D) atrial natriuretic hormone. E) insulin. Answer: c Level: 2

21. Which of the following is most likely to happen to a group of students who relax by drinking a pitcher of their favorite beverage? A) an increase in urine volume B) an increase in urine osmolality C) an increase in ADH production D) increased aldosterone secretion E) a decrease in urine volume Answer: a Level: 2 22. Antidiuretic hormone (ADH) A) increases plasma osmolality. B) is secreted by the anterior pituitary. C) increases water reabsorption in the kidneys. D) causes the production of a large volume of urine. E) increases urine volume. Answer: c Level: 2 23. A decrease in plasma osmolality would increase A) ADH production. B) plasma sodium levels. C) renin production. D) urine production. E) thirst. Answer: d Level: 3 24. The stimulus for secretion of atrial natriuretic hormone is increased A) blood osmolality. B) aldosterone production. C) blood pressure in atria of heart. D) blood pressure in kidney's afferent arterioles. E) blood pressure in the ventricles of the heart. Answer: c Level: 1 25. Elevated blood pressure under resting conditions results in increased urinary output because A) baroreceptors signal the hypothalamus to increase ADH secretion. B) elevated blood pressure stimulates renin secretion. C) the amount of angiotensin II formed is increased. D) aldosterone levels increase. E) baroreceptors signal the hypothalamus to decrease ADH secretion. Answer: e

Level: 2 26. You've been working outside in the hot sun and are dripping wet with sweat. Your fluid intake has been minimal as you have been too busy to stop and get a drink. You would expect A) your blood osmolality to be low. B) an increase in the production of urine. C) aldosterone levels to decrease. D) ADH levels to increase. E) ADH levels to decrease. Answer: d Level: 3 27. Increased ADH secretion could be stimulated by which of the following situations? A) increased renal blood flow B) increased blood osmolality C) increased atrial natriuretic hormone production D) increased blood pressure E) decreased blood osmolality Answer: b Level: 2 28. Atrial natriuretic hormone increases A) urine volume. B) ADH secretion. C) aldosterone secretion. D) the reabsorption of sodium ions. E) blood volume. Answer: a Level: 2 29. Which of the following would be expected to cause hyponatremia? A) high intake of sodium B) increased aldosterone production C) increased urine output D) increased ADH production E) decreased ADH production Answer: d Level: 2 30. Oversecretion of aldosterone causes A) hyperkalemia. B) hypercalcemia. C) hypernatremia. D) increased urine volume. E) hyponatremia. Answer: c

Level: 2 31. Chloride ions A) are cations. B) are found only inside cells. C) are part of the DNA molecule. D) are lost when vomiting. E) are not found in extracellular fluid. Answer: d Level: 2 32. Decreased extracellular potassium levels cause A) cells to become more excitable. B) hyperpolarization of cell membranes. C) more action potentials to be generated. D) increased permeability of cell membranes. E) hypopolarization of cell membranes. Answer: b Level: 2 33. Which of the following statements concerning potassium ions is false? A) An increase in the extracellular potassium ion concentration leads to depolarization. B) Potassium ions are secreted into the nephron by the distal convoluted tubule. C) When aldosterone levels are high, potassium secretion is low. D) Aldosterone secretion is stimulated by high blood levels of potassium ions. E) none of the above are false Answer: c Level: 2 34. Potassium levels in the body are regulated by A) ADH. B) PTH. C) calcitonin. D) aldosterone. E) insulin. Answer: d Level: 1 35. Oversecretion of aldosterone causes A) decreased secretion of calcium by the kidney. B) increased secretion of potassium by the kidney. C) decreased reabsorption of sodium by the kidney. D) increased reabsorption of phosphate ions by the kidney. E) decreased secretion of potassium by the kidney. Answer: b Level: 2

36. Aldosterone secretion may be stimulated by A) ADH. B) elevated potassium levels. C) excess water intake. D) elevated sodium levels. E) low potassium levels. Answer: b Level: 2 37. The most common cause of hyperkalemia is A) vomiting. B) increased dietary intake. C) increased urinary output. D) cellular injury or death. E) diarrhea. Answer: d Level: 2 38. Which of the following will the body begin to do in order to compensate for hyperkalemia? A) vasoconstriction of blood vessels B) increase ADH secretion C) decrease aldosterone secretion D) increase the release of atrial natriuretic hormone E) increase aldosterone secretion Answer: e Level: 2 39. Hyperkalemia is defined as A) excess excitability of kalems. B) reduction of plasma calcium level. C) increase in plasma potassium level. D) increase in plasma sodium level. E) decrease in plasma potassium level. Answer: c Level: 1 40. Which of the following is correctly matched? A) alkalosis hypokalemia B) cell destruction hypokalemia C) increased secretion of aldosterone hyperkalemia D) overuse of diuretics - hyperkalemia E) acidosis hypokalemia Answer: a Level: 2

41. Most of the calcium in the body is in the A) bones. B) plasma. C) kidneys. D) GI tract. E) extracellular fluid. Answer: a Level: 1 42. In hypocalcemia, A) depolarization is prevented. B) PTH production is reduced. C) blood calcium levels are increased. D) neuromuscular excitability increases. E) neuromuscular excitability decreases. Answer: d Level: 2 43. Calcium balance is influenced by A) ADH and parathyroid hormone levels. B) ADH and aldosterone levels. C) parathyroid hormone and vitamin D levels. D) aldosterone and parathyroid hormone levels. E) insulin and glucagon Answer: c Level: 1 44. Calcium's roles in the body include A) bone health. B) muscle contraction. C) blood clotting. D) action potentials in heart muscle. E) all of the above Answer: e Level: 2 45. An increase in parathyroid hormone levels results in A) increased rate of bone resorption. B) increased rate of vitamin D degradation. C) increased concentration of potassium ions in the urine. D) increased rate of calcium ion excretion by the kidneys. E) decreased levels of blood calcium. Answer: a Level: 2

46. Adequate calcium absorption from the GI tract depends on A) serum K levels. B) serum calcitonin levels. C) adequate amounts of vitamin D. D) the osmolality of the extracellular fluid. E) adequate amounts of vitamin C. Answer: c Level: 2 47. Stimulus for the secretion of parathyroid hormone is a decrease in serum A) potassium levels. B) calcium levels. C) calcitonin levels. D) phosphate levels. E) sodium levels. Answer: b Level: 1 48. Parathyroid hormone effects the A) bones, heart, and blood. B) kidney, liver, and spleen. C) intestine, kidneys, and bone. D) liver, stomach, and small intestine. E) stomach, pancreas, and bone Answer: c Level: 1 49. The main regulator of serum phosphate levels is a transport process in the A) liver. B) kidneys. C) pancreas. D) small intestine. E) large intestine. Answer: b Level: 2 50. A major complication of thyroid surgery is the accidental damaging or removal of the parathyroid glands. This damage or removal of the parathyroid glands can result in A) increased sodium retention. B) increased plasma volume. C) decreased plasma calcium. D) delayed healing. E) increased plasma calcium. Answer: c Level: 2

51. Calcitonin A) promotes the absorption of calcium from the gastrointestinal tract. B) promotes osteoclast activity in the bones. C) reduces calcium excretion by the kidneys. D) reduces extracellular calcium ion levels. E) increases blood calcium levels. Answer: d Level: 2 52. Increased osmolality of the ECF A) increases thirst. B) inhibits ADH. C) increases renin secretion. D) increases aldosterone secretion. E) decreases thirst. Answer: a Level: 1 53. The sensation of thirst results from A) an increase in the plasma volume. B) hypertension (increased blood pressure). C) stimulation of osmoreceptor cells in the hypothalamus. D) a decrease in the osmolality of the extracellular fluid. E) stimulation of baroreceptors. Answer: c Level: 2 54. Angiotensin II increases blood volume by stimulating A) thirst. B) vasodilatation. C) water movement into the cells. D) renal excretion of sodium. E) ADH production. Answer: a Level: 2 55. Under normal conditions, most water loss from the body is through the A) skin. B) kidneys. C) lungs. D) GI tract. E) sweat. Answer: b Level: 1 56. Which of the following is an example of water conservation by the body?

A) diarrhea B) perspiration C) decreased water intake D) decreased urine volume E) increased urine volume Answer: d Level: 2 57. Sensible perspiration A) contains only water. B) is water lost through simple evaporation. C) is secreted by the sweat glands. D) is invisible on the skin. E) is secreted by salivary glands. Answer: c Level: 1 58. Loss of a large volume of sweat will A) decrease the hematocrit. B) decrease ADH production. C) increase the blood pressure. D) increase the osmolality of body fluids. E) decrease the osmolality of body fluids. Answer: d Level: 2 59. In which of the following situations does one see large volumes of dilute urine produced? A) ADH levels decrease B) renin levels increase C) aldosterone levels increase D) parathyroid hormone levels decrease E) ADH levels increase. Answer: a Level: 2 60. A person working in the hot sun loses the greatest amount of water from the A) lungs. B) urine. C) mouth. D) skin. E) GI tract. Answer: d Level: 2 61. A) pH increases with acidity.

B) is measured on a scale of 0 to 10. C) is a measure of the hydrogen ion concentration. D) reflects sodium content of body fluids. E) is not related to amounts of carbon dioxide in the body. Answer: c Level: 2 62. Which of the following substances releases hydrogen ions into a solution? A) acids B) bases C) salts D) glucose E) water Answer: a Level: 1 63. Chemicals that function to minimize changes in the pH of body fluids are called A) buffers. B) inhibitors. C) accelerators. D) activators. E) stabilizers. Answer: a Level: 1 64. If the hydrogen ion concentration in the blood increases, bicarbonate ions act as buffers by A) removing excess hydrogen ions from the plasma. B) releasing hydrogen ions into the plasma. C) dissociating into H+ and CO3-. D) combining with chloride ions. E) combining with hemoglobin. Answer: a Level: 2 65. Which of the following is not a buffer system of the body? A) bicarbonate buffer system B) phosphate buffer system C) protein buffer system D) NaCl buffer system E) hemoglobin buffer Answer: d Level: 1 66. A) Body fluid pH will rise dramatically when sodium is excreted by the kidney.

B) large amounts of bicarbonate are ingested. C) carbonic acid is formed. D) the respiratory rate decreases. E) carbon dioxide levels increase. Answer: b Level: 2 67. As a result of hyperventilation, A) the body pH decreases. B) the plasma PCO2 level decreases. C) the kidney will increase the rate of hydrogen ion excretion. D) more bicarbonate ions are added to the plasma. E) the plasma PCO2 level increases. Answer: b Level: 2 68. An increase in blood CO2 levels is followed by a(n) ____ in H+ ions and a(n) ____ in blood pH. A) decrease, decrease B) decrease, increase C) increase, increase D) increase, decrease E) increase, no change Answer: d Level: 2 69. Which of the following terms does not belong with the other three? A) acidosis B) pH increases C) H+ ion concentration increases D) carbonic acid levels increase E) pH decreases Answer: b Level: 2 70. Mr. I.M.A. Wreck's plasma pH is 7.2. Which of the following indicates that the body is attempting to compensate and return the body pH to normal? A) an increase in respiration rate B) a decrease in respiration rate C) no change in respiration rate Answer: a Level: 2 71. A) B) In renal compensation of acidosis, H+ secretion decreases; bicarbonate excretion increases. H+ secretion decreases; bicarbonate reabsorption increases.

C) H+ secretion increases; bicarbonate reabsorption increases. D) H+ secretion increases; bicarbonate excretion increases. E) H+ secretion decreases; bicarbonate excretion decreases. Answer: c Level: 2 72. Which of the following can play a role in buffering the pH of urine? A) ammonia B) bicarbonate ions C) phosphate ions D) A and B only E) A, B, C Answer: e Level: 1 73. The normal pH for blood plasma is A) 7.00. B) 7.25. C) 7.40. D) 7.55. E) 7.60. Answer: c Level: 1 74. Once alkalosis has occurred, which of the following would you expect to happen? A) increased respiratory rate B) a plasma pH less than 7.40 C) retention of hydrogen ions by the kidney D) increased renal reabsorption of bicarbonate ions E) secretion of hydrogen ions by the kidney Answer: c Level: 2 75. Hyposecretion of aldosterone would lead to A) increased secretion of hydrogen ions. B) decreased secretion of hydrogen ions. C) no change in secretion of hydrogen ions. Answer: b Level: 2 76. When normal buffer mechanisms are overwhelmed by excessive numbers of hydrogen ions, which of the following will result? A) acidosis B) alkalosis C) neither of these Answer: a

Level: 2 77. A falling blood pH and a rising concentration of carbon dioxide due to emphysema, indicate A) metabolic acidosis. B) metabolic alkalosis. C) respiratory acidosis. D) respiratory alkalosis. E) none of the above Answer: c Level: 2 78. Ingesting large amounts of sodium bicarbonate can lead to A) metabolic acidosis. B) metabolic alkalosis. C) respiratory acidosis. D) respiratory alkalosis. E) none of the above Answer: b Level: 2 79. Respiratory alkalosis can occur as a result of A) asphyxia. B) asthma. C) severe emphysema. D) hyperventilation. E) hypoventilation. Answer: d Level: 2 80. Prolonged vomiting of stomach contents will result in A) metabolic acidosis. B) metabolic alkalosis. C) respiratory acidosis. D) respiratory alkalosis. E) none of the above Answer: b Level: 2 Questions 81 through 83 are all based on the following case study: You have just admitted Mary Roberts, a 70-year-old woman, to the hospital for GI bleeding. Her blood pressure is 130/80, pulse 80/min and irregular, respirations 18/min, and temperature 99.2. Mrs. Roberts denies pain at this time although she appears anxious and very pale. Her medical history includes lung cancer that was diagnosed two weeks ago, peptic ulcer disease with reflux esophagitis, and fluid retention. Admission lab work shows a plasma Na+ of 152 mEq/L and K+ of 2.8 mEq/L.

81. Which of the following regulatory mechanisms would be stimulated as a result of the increased osmolality that results from a Na+ level of 152 mEq/L? A) increased urine output B) an increased release of ADH C) an increase in renin production D) an increase in the secretion of aldosterone E) a decreased release of ADH Answer: b Level: 3 82. The increase in extracellular osmolality would cause A) water to move out of the cells. B) water to move into the cells. C) no change in the net movement of water into or out of the cells. Answer: a Level: 3 83. The K+ level of 2.8 mEq/L indicates hypokalemia. Low plasma K+ levels will cause A) thirst. B) muscle weakness. C) increased body temperature. D) tremors, tetany, and convulsions. E) paralysis. Answer: b Level: 3 84. Bob Trotts has an enteropathogenic E. coli infection resulting in severe diarrhea for 2 days. This could produce which of the following. 1. acidosis 2. alkalosis 3. increased respiration 4. decreased respiration 5. increased ADH secretion 6. increased renin secretion 7. increased urine concentration A) 1, 3, 5, 6, 7 B) 2, 4, 5, 6, 7 C) 1, 3, 6 D) 2, 4, 5, 7 E) 1, 4, 5, 7 Answer: a Level: 3 85. Azetazolamide (Diamox) is a diuretic. It functions by blocking the activity of carbonic anhydrase inside kidney tubule cells. This slows the formation of carbonic acid. By slowing the

formation of hydrogen ions in the cells of the tubule, sodium reabsorption is also slowed. This results in the diuretic effect. Select from the following list the possible side-effects of Azetazolamide. 1. acidosis 2. reduced movement of bicarbonate ion into the plasma 3. an alkaline urine is produced 4. respiration increases A) 1, 4 B) 2, 3 C) 1, 2, 3 D) 2, 3, 4 E) 1, 2, 3, 4 Answer: e Level: 3 For questions 86 to 91 use the following key to choose the best answer. A) Choose this if the first item is greater than the second item. B) Choose this if the first item is less than the second item. C) Choose this if the first item is equal or nearly equal to the second item. 86. 1. the percent adult weight that is water; 2. the percent of body weight that is water in a child Answer: b Level: 2 87. 1. the amount of body water in the intracellular compartment; 2. the amount of body water in the extracellular compartment Answer: a Level: 2 88. 1. amount of sodium in urine when aldosterone levels are high; 2. amount of sodium in urine when aldosterone levels are low Answer: b Level: 2 89. 1. calcium absorption from intestine when vitamin D is present; 2. calcium absorption from intestine when vitamin D is absent Answer: a Level: 2 90. 1. pH of body fluids when carbon dioxide content increases; 2. pH of body fluids when carbon dioxide content decreases Answer: b Level: 2 91. 1. amount of bicarbonate ions in the urine during compensation for alkalosis;

2. amount of bicarbonate ions in the urine during compensation for acidosis Answer: a Level: 2 For questions 92 to 97 indicate which acid-base imbalance is most likely to occur as a result of each condition described. A) respiratory acidosis B) respiratory alkalosis C) metabolic acidosis D) metabolic alkalosis 92. untreated diabetes mellitus Answer: c Level: 2 93. hypoventilation Answer: a Level: 2 94. excessive intake of antacids Answer: d Level: 2 95. asthma attack Answer: a Level: 2 96. hyperventilation Answer: b Level: 2 97. prolonged diarrhea resulting in excessive loss of bicarbonate Answer: c Level: 2

Fill in the Blank

100. The main extracellular anion is __________. Answer: chloride Level: 1 101. The main intracellular cation is __________. Answer: potassium Level: 1 102. ADH causes the renal tubules to retain __________. Answer: water Level: 1 103. Potassium secretion in the renal tubules is regulated by __________. Answer: aldosterone Level: 1 104. Normal plasma pH is __________. Answer: 7.4 Level: 1

Essay Questions
105. Aldosterone can stimulate the secretion of hydrogen ions by the kidney. Predict the consequences of increased aldosterone secretion on body fluid pH. Answer: Aldosterone hypersecretion will result in an increase in body fluid pH, as the number of hydrogen ions excreted by the body will increase. Level: 3 106. A patient suffering from diabetes mellitus often develops a condition called ketoacidosis (an acidosis caused by an accumulation of acidic ketone bodies in the plasma). A patient in this situation will tend to hyperventilate in order to compensate for the acidosis. Explain why hyperventilation might help this situation. Answer: Hyperventilation can help correct ketoacidosis by blowing off carbon dioxide and water from the lungs and reducing the possibility that carbon dioxide and water will combine to form carbonic acid. Thus, hyperventilation helps to decrease the excess acid accumulation and return the pH to normal. Level: 3 107. A person suffering from second and third degree burns over 60% of their body develops hyperkalemia. Why does this happen? Answer: Hyperkalemia occurs as a result of cellular injury and/or death from the burns. The potassium inside the cells leaks out into the extracellular fluid, thereby raising the serum potassium levels. Level: 3

108. The respiratory rate of a hospitalized patient increased from 12 per minute to 38 per minute. This increase in respiratory rate continued for 5 minutes. Would the following blood parameters increase, decrease, or remain the same? a. pH b. hydrogen ion concentration c. carbon dioxide concentration Answer: A) pH will increase B) hydrogen ion concentration will decrease C) carbon dioxide concentration will decrease Level: 3 109. A patient has suffered lesions in the hypothalamus and lost the ability to produce ADH. Despite this loss, plasma sodium levels are maintained at normal or near-normal levels. a. Speculate why the urine output of this individual increases dramatically. b. If the urine output increases dramatically, what must happen to fluid intake in order to maintain homeostasis? Answer: A) ADH acts on the renal tubules to cause reabsorption of water. If ADH is no longer produced, there will be decreased water reabsorption in the kidney and increased urine production. B) If urine output has increased, then oral intake must increase proportionally. Level: 3 110. Use the following table to answer the questions below: Approximate Electrolyte Composition of Body Secretions Gastric Sweat Intestinal + Na mEq/L 60 45 80 K+ mEq/L 9 5 21 Cl mEq/L 84 58 48 HCO3 mEq/L 0 0 22 PH 1-2 6 8.5 a. A loss of which body secretion is most likely to cause metabolic acidosis? b. A loss of which type of body secretion is most likely to result in metabolic alkalosis? c. A loss of which type of body secretion is most likely to result in hypokalemia? Answer: A) intestinal B) gastric C) intestinal Level: 3