Anatomy & Physiology ch 26
Anatomy & Physiology ch 26 Biol 2301
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Human Anatomy & Physiology, 8e (Marieb/Hoehn) Chapter 26 Fluid, Electrolyte, and AcidBase Balance Matching Questions Match the following: A) Intracellular B) Interstitial C) Nonelectrolytes D) Extracellular E) Electrolytes 1) Dissociate in water. Diff: 2 Page Ref: 996 2) Do not dissociate. Diff: 2 Page Ref: 996 3) The fluid compartments outside the cell. Diff: 2 Page Ref: 996 4) Fluid compartments located within the cell. Diff: 2 Page Ref: 996 5) Spaces between cells. Diff: 2 Page Ref: 996 Answers: 1) E 2) C 3) D 4) A 5) B 1 Copyright © 2010 Pearson Education, Inc. Match the following: A) Hyperkalemia B) Hypermagnesemia C) Hypernatremia D) Hypocalcemia E) Hyponatremia 6) Magnesium excess. Diff: 1 Page Ref: 1003 7) Calcium depletion. Diff: 1 Page Ref: 1003 8) Sodium excess. Diff: 2 Page Ref: 1003 9) Potassium excess. Diff: 2 Page Ref: 1003 10) Sodium depletion. Diff: 2 Page Ref: 1003 Answers: 6) B 7) D 8) C 9) A 10) E 2 Copyright © 2010 Pearson Education, Inc. Match the following: A) Hypoproteinemia B) Edema C) Aldosterone D) Hyponatremia E) Addison's disease 11) An atypical accumulation of fluid in the interstitial space. Diff: 2 Page Ref: 1001 12) A condition of unusually low levels of plasma proteins resulting in tissue edema. Diff: 2 Page Ref: 1002 13) A disorder entailing deficient mineralocorticoid hormone production by the adrenal cortex. Diff: 2 Page Ref: 1002 14) Regulates sodium ion concentrations in the extracellular fluid. Diff: 2 Page Ref: 1004 15) A condition due to excessive water intake that results in net osmosis into tissue cells. This leads to severe metabolic disturbances. Diff: 2 Page Ref: 1003; Tbl. 26.1 Answers: 11) B 12) A 13) E 14) C 15) D 3 Copyright © 2010 Pearson Education, Inc. Match the electrolyte composition for the following: A) interstitial fluid B) blood plasma C) intracellular fluid 16) Sodium ions are highest in ________. Diff: 1 Page Ref: 997; Fig. 26.2 17) Potassium ions are highest in ________. Diff: 1 Page Ref: 997; Fig. 26.2 18) Phosphate ions are highest in ________. Diff: 1 Page Ref: 997; Fig. 26.2 19) Bicarbonate ions are highest in ________. Diff: 1 Page Ref: 997; Fig. 26.2 20) Proteins are highest in ________. Diff: 1 Page Ref: 997; Fig. 26.2 Answers: 16) B 17) C 18) C 19) A 20) C True/False Questions 1) Adipose tissue is one of the most hydrated of all tissues in the human body. Answer: FALSE Diff: 1 Page Ref: 996 2) The most abundant cation in intracellular fluid is sodium. Answer: FALSE Diff: 1 Page Ref: 997 3) Electrolytes determine most of the chemical and physical reactions of the body. Answer: TRUE Diff: 1 Page Ref: 996 4) Solutes, regardless of size, are able to move freely between compartments because water carries them along the osmotic gradients. Answer: FALSE Diff: 2 Page Ref: 998 5) The thirst center in the brain is located in the hypothalamus. Answer: TRUE Diff: 2 Page Ref: 999 4 Copyright © 2010 Pearson Education, Inc. 5 Copyright © 2010 Pearson Education, Inc. 6) Dehydration can be caused by endocrine disturbances such as diabetes mellitus or diabetes insipidus. Answer: TRUE Diff: 1 Page Ref: 1001 7) It is impossible to overhydrate because people need as much water as they can drink to carry out ordinary body functions. Answer: FALSE Diff: 1 Page Ref: 1001 8) Water imbalance, in which output exceeds intake, causing an imbalance in body fluids, is termed dehydration. Answer: TRUE Diff: 1 Page Ref: 1001 9) Salts are lost from the body in perspiration, feces, and urine. Answer: TRUE Diff: 1 Page Ref: 1002 10) Hypoproteinemia reflects a condition of unusually high levels of plasma proteins and causes tissue edema. Answer: FALSE Diff: 2 Page Ref: 1002 11) Although the sodium content of the body may be altered, its concentration in the ECF remains stable because of immediate adjustments in water volume. Answer: TRUE Diff: 1 Page Ref: 10021003 12) Sodium is pivotal to fluid and electrolyte balance and to the homeostasis of all body systems. Answer: TRUE Diff: 1 Page Ref: 1002 13) When aldosterone release is inhibited, sodium reabsorption cannot occur beyond the collecting tube. Answer: TRUE Diff: 3 Page Ref: 1004 14) Aldosterone stimulates the reabsorption of sodium while enhancing potassium secretion. Answer: TRUE Diff: 3 Page Ref: 1005; Fig. 26.8 15) Pressure diuresis decreases blood volume and blood pressure. Answer: TRUE Diff: 1 Page Ref: 1004; Fig. 26.9 6 Copyright © 2010 Pearson Education, Inc. 7 Copyright © 2010 Pearson Education, Inc. 16) Aldosterone is secreted in response to low extracellular potassium. Answer: FALSE Diff: 3 Page Ref: 10061007 17) To remain properly hydrated, water intake must equal water output. Answer: TRUE Diff: 1 Page Ref: 998 18) The main way the kidney regulates potassium ions is to excrete them. Answer: TRUE Diff: 1 Page Ref: 1004 19) Atrial natriuretic peptide reduces blood pressure and blood volume by inhibiting nearly all events that promote vasodilation and potassium and water retention. Answer: FALSE Diff: 1 Page Ref: 1005; Fig. 26.9 20) Premenstrual edema may be due to enhanced reabsorption of sodium chloride. Answer: TRUE Diff: 3 Page Ref: 1005 21) Heavy consumption of salt substitutes high in potassium can present a serious clinical problem when aldosterone release is not normal. Answer: TRUE Diff: 2 Page Ref: 1007 22) Hypercalcemia causes muscle tetany. Answer: FALSE Diff: 1 Page Ref: 1003; Tbl. 26.1 23) The two hormones responsible for the regulation of calcium are pituitary hormone and calcitonin. Answer: FALSE Diff: 1 Page Ref: 1008 24) Calcitonin targets the bones and causes the release of calcium from storage when serum levels are low. Answer: FALSE Diff: 2 Page Ref: 1008 25) The normal pH of blood is 7.357.45. Answer: TRUE Diff: 1 Page Ref: 1008 26) Most acidic substances (hydrogen ions) originate as byproducts of cellular metabolism. 8 Copyright © 2010 Pearson Education, Inc. Answer: TRUE Diff: 1 Page Ref: 1009 27) Weak acids are able to act as chemical buffering systems for the body because they partially dissociate. Answer: TRUE Diff: 2 Page Ref: 1009 28) The phosphate buffer system is relatively unimportant for buffering blood plasma. Answer: TRUE Diff: 1 Page Ref: 1010 29) The single most important blood buffer system is the bicarbonate buffer system. Answer: TRUE Diff: 1 Page Ref: 1009 30) One of the most powerful and plentiful sources of buffers is the protein buffer system. Answer: TRUE Diff: 1 Page Ref: 1010 31) As ventilation increases and more carbon dioxide is removed from the blood, the hydrogen ion concentration of the blood decreases. Answer: TRUE Diff: 1 Page Ref: 10101011 32) Regulation of the acidbase system is accomplished mainly through respiratory control, and the kidneys also play a small role. Answer: FALSE Diff: 2 Page Ref: 10101014 33) Severe damage to the respiratory system rarely will result in acidbase imbalances. Answer: FALSE Diff: 1 Page Ref: 1011 34) Respiratory acidosis results when lungs are obstructed and gas exchange is inefficient. Answer: TRUE Diff: 3 Page Ref: 1014 35) Prolonged hyperventilation can cause alkalosis. Answer: TRUE Diff: 2 Page Ref: 1014 36) Thirst is always a reliable indicator of body water need. Answer: FALSE Diff: 2 Page Ref: 999 9 Copyright © 2010 Pearson Education, Inc. 37) Blood acidity results in depression of the CNS, whereas blood alkalosis results in overexcitement of the CNS. Answer: TRUE Diff: 1 Page Ref: 1014 MultipleChoice Questions 1) The body’s water volume is closely tied to the level of which of the following ions? A) calcium ions B) potassium ions C) hydrogen ions D) sodium ions Answer: D Diff: 2 Page Ref: 10021004 2) The term hypotonic hydration refers to ________. A) the feeling one might have after a long swim B) the unpleasant feeling people have after drinking too much liquor C) a condition that may result from renal insufficiency or drinking extraordinary amounts of water D) a condition that is caused by high levels of sodium in the extracellular fluid compartment Answer: C Diff: 1 Page Ref: 1001 3) Hypoproteinemia is a condition of unusually low levels of plasma proteins. This problem is often characterized by ________. A) tissue edema B) extreme weight loss C) extreme weight gain D) nerve damage Answer: A Diff: 1 Page Ref: 1002 4) Which of the following hormones is important in the regulation of sodium ion concentrations in the extracellular fluid? A) antidiuretic hormone B) erythropoietin C) aldosterone D) renin Answer: C Diff: 1 Page Ref: 1004 5) Atrial natriuretic peptide is a hormone that is made in the atria of the heart. The influence of this hormone is to ________. 10 Copyright © 2010 Pearson Education, Inc. A) enhance atrial contractions B) activate the reninangiotensin mechanism C) prevent pH changes caused by organic acids D) reduce blood pressure and blood volume by inhibiting sodium and water retention Answer: D Diff: 1 Page Ref: 10041005 11 Copyright © 2010 Pearson Education, Inc. 6) Respiratory acidosis can occur when ________. A) a person consumes excessive amounts of antacids B) a person's breathing is shallow due to obstruction C) a runner has completed a very long marathon D) the kidneys secrete hydrogen ions Answer: B Diff: 1 Page Ref: 1014 7) Which of the following two organs function as the most important physiological buffer systems? A) the lungs and the kidneys B) the adrenal glands and the testes C) the thyroid gland and the heart D) the stomach and the liver Answer: A Diff: 1 Page Ref: 10101011 8) Which of the choices below is not an essential role of salts in the body? A) neuromuscular activity B) membrane permeability C) secretory activity D) anabolism of proteins Answer: D Diff: 2 Page Ref: 1002 9) Which of the choices below exerts primary control over sodium levels in the body? A) ADH B) aldosterone C) water levels D) glucocorticoids Answer: B Diff: 1 Page Ref: 1004 10) The fluid link between the external and internal environment is ________. A) plasma B) intracellular fluid C) interstitial fluid D) cerebrospinal fluid Answer: A Diff: 1 Page Ref: 996 12 Copyright © 2010 Pearson Education, Inc. 11) Newborn infants have a relatively higher ________ content in their ECF than do adults. A) iron B) sodium C) magnesium D) bicarbonate Answer: B Diff: 1 Page Ref: 1015 12) Whereas sodium is found mainly in the extracellular fluid, most ________ is found in the intracellular fluid. A) iron B) chloride C) potassium D) magnesium Answer: C Diff: 1 Page Ref: 997; Fig. 26.2 13) Which of the following describes the distribution of sodium and potassium between cells and body fluids? A) K mainly in the cells, Na in the body fluids B) Na mainly in the cells, K in the body fluids C) equal amounts of each ion in the cells and body fluids D) little of either in the cells, but large amounts of each in the body fluids Answer: A Diff: 1 Page Ref: 997; Fig. 26.2 14) Problems with fluid, electrolyte, and acidbase balance are particularly common in infants because of their ________. A) inefficient kidneys B) comparatively low metabolic rates C) low rate of insensible water loss D) low daily rate of fluid exchange Answer: A Diff: 1 Page Ref: 1015 15) The single most important factor influencing potassium ion secretion is ________. A) the potassium ion content in the renal tubule cells B) the pH of the ICF C) intracellular sodium levels D) potassium ion concentration in blood plasma Answer: D Diff: 1 Page Ref: 1006 13 Copyright © 2010 Pearson Education, Inc. 16) The term alkaline reserve is used to describe the ________ buffer system. A) phosphate B) hemoglobin C) bicarbonate D) protein Answer: C Diff: 1 Page Ref: 1009 17) A falling blood pH and a rising partial pressure of carbon dioxide due to pneumonia or emphysema indicates ________. A) respiratory acidosis B) respiratory alkalosis C) metabolic acidosis D) metabolic alkalosis Answer: A Diff: 1 Page Ref: 1014; Tbl. 26.2 18) The movement of fluids between cellular compartments ________. A) requires active transport B) is regulated by osmotic and hydrostatic forces C) requires ATP for the transport to take place D) involves filtration Answer: B Diff: 1 Page Ref: 998 19) What hormone reduces blood pressure and blood volume by inhibiting nearly all events that promote vasoconstriction and sodium ion and water retention? A) ADH B) aldosterone C) atrial natriuretic peptide D) thyroxine Answer: C Diff: 1 Page Ref: 1005 20) Which of the following is not a method for regulating the hydrogen ion concentration in blood? A) chemical buffer systems B) diet C) respiratory changes D) renal mechanism Answer: B Diff: 1 Page Ref: 1009 14 Copyright © 2010 Pearson Education, Inc. 21) Which of the following is not a chemical buffer system? A) bicarbonate B) phosphate C) nucleic acid D) protein Answer: C Diff: 1 Page Ref: 1009 22) Extracellular fluid in the human body is composed of all of the following except ________. A) lymph and interstitial fluid B) blood plasma C) cerebrospinal fluid D) glucose Answer: D Diff: 2 Page Ref: 997998 23) Which of the following statements is true regarding fluid shifts? A) Nonelectrolytes are the controlling factor in directing fluid shifts. B) Electrolytes are not as important as proteins in regulating fluid shifts in the body. C) Electrolytes have greater osmotic power than nonelectrolytes and therefore have the greatest ability to cause fluid shifts. D) There are always more positive electrolytes than negative in a solution; it is therefore impossible to follow fluid shifts. Answer: C Diff: 2 Page Ref: 996997 24) Which of the following hormones is important in stimulating water conservation in the kidneys? A) aldosterone B) thymosin C) antidiuretic hormone D) atrial natriuretic peptide Answer: C Diff: 2 Page Ref: 1000 25) The maintenance of the proper pH of the body fluids may be the result of ________. A) the control of respiratory ventilation B) the operation of the various buffer systems in the stomach C) the active secretion of OH into the filtrate by the kidney tubule cells D) control of the acids produced in the stomach Answer: A Diff: 2 Page Ref: 10101011 15 Copyright © 2010 Pearson Education, Inc. 26) Which of the following is not a disorder of water balance? A) excessive hydration due to excess ADH secretion B) hypotonic hydration, in which sodium content is normal but water content is high C) edema or tissue swelling, which is usually due to an increased capillary hydrostatic pressure D) excess water in interstitial spaces due to a low level of plasma proteins Answer: A Diff: 2 Page Ref: 10011002 27) The regulation of sodium ________. A) is due to specific sodium receptors in the hypothalamus B) is linked to blood pressure C) involves aldosterone, a hormone that increases sodium excretion in the kidneys D) involves hypothalamic osmoreceptor detection of ion concentration Answer: B Diff: 2 Page Ref: 1004 28) Select the correct statement about renal mechanisms of acidbase balance. A) The kidneys are not able to excrete phosphoric acid. B) Excreted hydrogen ions are unbound in the filtrate. C) Kidney tubule cells are able to synthesize bicarbonate ion. D) The kidneys are the most important mechanism for eliminating all bicarbonate ions. Answer: C Diff: 2 Page Ref: 1011 29) Blood analysis indicates a low pH, and the patient is breathing rapidly. Given your knowledge of acidbase balance, which of the following is most likely? A) respiratory acidosis B) metabolic acidosis C) metabolic alkalosis D) respiratory alkalosis Answer: B Diff: 2 Page Ref: 1014; Tbl. 26.2 30) A patient is breathing slowly and blood pH analysis indicates an abnormally high value. What is the likely diagnosis? A) respiratory acidosis B) metabolic acidosis C) metabolic alkalosis D) respiratory alkalosis Answer: C Diff: 2 Page Ref: 1014; Tbl. 26.2 16 Copyright © 2010 Pearson Education, Inc. 31) One of the major physiological factors that triggers thirst is ________. A) a dry mouth from high temperatures B) becoming overly agitated C) drinking caffeinated beverages D) a rise in plasma osmolality Answer: D Diff: 3 Page Ref: 999 32) Annie has just eaten a large order of heavily salted french fries, some pickled eggs, and some cheese. How will consuming this much salt affect her physiology? A) It will increase the osmolality of the blood. B) There will be a temporary increase in blood volume. C) She will experience hypotension. D) There will be a shift in the pH of her body fluids to the higher side of the pH scale. Answer: B Diff: 3 Page Ref: 10021003 33) The most important force causing net water flow across capillary walls is ________. A) osmotic pressure of plasma proteins B) hydrostatic pressure of capillary blood C) hydrostatic pressure of interstitial fluid D) intracellular hydrostatic pressure Answer: B Diff: 3 Page Ref: 997998 34) Which of the following does not depend on the presence of electrolytes? A) membrane polarity B) neuromuscular excitability C) maintenance of osmotic relations between cells and ECF D) amount of body fat Answer: D Diff: 3 Page Ref: 996 35) The regulation of potassium balance ________. A) is not linked to sodium balance B) includes renal secretion, but never absorption C) is accomplished mainly by hepatic mechanisms D) involves aldosteroneinduced secretion of potassium Answer: D Diff: 3 Page Ref: 10051006 17 Copyright © 2010 Pearson Education, Inc. FillintheBlank/Short Answer Questions 1) ________ occurs when carbon dioxide is eliminated faster than it is produced. Answer: Respiratory alkalosis Diff: 1 Page Ref: 1014; Tbl. 26.2 2) The female hormone ________ seems to decrease sodium reabsorption, thus promoting sodium and water loss by the kidney. Answer: progesterone Diff: 1 Page Ref: 1005 3) The preferred intracellular negative ion is ________. Answer: hydrogen phosphate Diff: 1 Page Ref: 997; Fig. 26.2 4) The most important ECF buffer of HCl is ________. Answer: sodium bicarbonate Diff: 1 Page Ref: 1009 5) The most important hormone that regulates calcium ions in the body is ________. Answer: PTH (parathyroid hormone) Diff: 1 Page Ref: 1008 6) Molecules that can act reversibly as acids or bases depending upon the pH of their environment are called ________. Answer: amphoteric Diff: 1 Page Ref: 1010 7) The breakdown of phosphoruscontaining proteins releases ________ acid. Answer: phosphoric Diff: 1 Page Ref: 1010 8) Arterial blood pH below 7.35 is called ________. Answer: acidemia or acidosis Diff: 1 Page Ref: 1008 9) ________ reduces blood pressure and volume by inhibiting nearly all events that promote vasoconstriction and the retention of sodium ions and water. Answer: Atrial natriuretic peptide Diff: 1 Page Ref: 10041005 10) What provides the shortestterm mechanism for preventing acidbase imbalances in the body? The longestterm mechanism? Answer: Chemical buffers act within a fraction of a second to resist a pH change. The longest term mechanism is the kidney system, which ordinarily requires from several hours to a day or 18 Copyright © 2010 Pearson Education, Inc. more to effect changes in blood pH. Diff: 1 Page Ref: 10091011 11) What is the effect of acidosis on the body? Of alkalosis? Answer: When the body is in acute acidosis, the nervous system becomes so severely depressed that the person goes into a coma and death soon follows. Alkalosis causes overexcitement of the nervous system. Characteristic signs include muscle tetany, extreme nervousness, and convulsions. Death often results from respiratory arrest. Diff: 2 Page Ref: 1014; Tbl. 26.2 12) Describe the mechanisms by which the kidneys remove hydrogen ions from the body. Answer: Virtually all of the H that leaves the body in urine is secreted into the filtrate. The tubule cells, including collecting ducts, appear to respond directly to the pH of the ECF and to alter their rate of H secretion accordingly. The secreted H ions are obtained from the dissociation of carbonic acid within the tubule cells. For each H ion actively secreted into the tubule lumen, one sodium ion is reabsorbed into the tubule cell from the filtrate, thus maintaining the electrochemical balance. Diff: 2 Page Ref: 10111012 13) Describe the influence of rising PTH levels on bone, the small intestine, and the kidneys. Answer: Parathyroid hormone (PTH) activates osteoclasts that break down the bone matrix, resulting in the release of Ca and PO 43 to the blood. PTH enhances intestinal absorption of 2+ Ca indirectly by stimulating the kidneys to transform vitamin D to its active form, which is necessary for calcium absorption by the small intestine. PTH increases the reabsorption of calcium by the renal tubules, which simultaneously decreases phosphate ion reabsorption. Diff: 2 Page Ref: 1008 14) When the blood becomes hypertonic (too many solutes), ADH is released. What is the effect of ADH on the kidney tubules? Answer: The release of ADH causes the kidney tubules to reabsorb excess water, resulting in the excretion of concentrated urine. Diff: 1 Page Ref: 10001001 15) Why would an infant with colic be suffering from respiratory alkalosis? Answer: If the infant is uncomfortable and cries forcefully for long periods of time, this would be similar to hyperventilation. Hyperventilation would cause respiratory alkalosis because the infant is losing carbon dioxide rapidly. Diff: 2 Page Ref: 1015 16) How does the respiratory system influence the buffer systems of the body? Answer: The respiratory system maintains a constant bicarbonate level in the bloodstream by outgassing carbon dioxide. In the event of a respiratory problem the bicarbonate system might not be a constant. Diff: 3 Page Ref: 10101011 19 Copyright © 2010 Pearson Education, Inc. 20 Copyright © 2010 Pearson Education, Inc. 17) Identify and describe the operation of the three major chemical buffers of the body. Answer: The bicarbonate buffer system (carbonic acid plus sodium bicarbonate) acts to tie up the hydrogen ions released by a strong acid, thus converting it to a weaker acid, which lowers the pH only slightly. For a strong base, the carbonic acid will be forced to donate more H to tie up the OH released by the base, with the net result of replacement of a strong base by a weak one. The pH rise is very small. The phosphate buffer system, composed of the sodium salts of dihydrogen phosphate and monohydrogen phosphate, acts in a similar fashion to the bicarbonate system. NaH P2 a4ts as a weak acid; Na HPO2 acts4as a weak base. Hydrogen ions released by strong acids are tied up in weak acids; strong bases are converted to weak bases. Amino acids + of the protein buffer system release H when the pH begins to rise by dissociating carboxyl groups, or bind hydrogen ions with amine groups to form NH 3+ when the pH falls. Diff: 3 Page Ref: 10091011 18) When does a person experience greater thirst, during periods when ADH release is elicited or during periods when aldosterone release is elicited? Answer: A person experiences greater thirst during periods when ADH release is elicited. Diff: 2 Page Ref: 9981001 Clinical Questions 1) A patient is admitted to the hospital in complete collapse. His blood pH is 6.8, and his HCO is 20 mEq/L. What diagnosis would you give and what prognosis? A medical history reveals that this patient is a chronic alcoholic. Answer: The pH and bicarbonate levels and the history of alcoholism indicate metabolic acidosis. With a pH below 7.0, the patient will go into a coma and death soon follows. Diff: 3 Page Ref: 1014 2) A pregnant woman complains to her doctor that her ankles and feet stay swollen all of the time. She is very worried about this. As her doctor, what would you tell her? Answer: She is showing edema, an atypical accumulation of fluid in the spaces between cells (interstitial spaces). This is caused by her pregnancy due to a high blood volume that increases capillary hydrostatic pressure and enhances capillary permeability. She should be monitored for the edema during the pregnancy, but it should clear up at the end of the pregnancy. Diff: 2 Page Ref: 10011002 3) Helen is a 62yearold smoker. Her physician has diagnosed her as having emphysema that has caused her to hypoventilate. She is tired and sedentary. Besides having difficulty breathing, what other condition is contributing to her tiredness? Answer: Helen is suffering from respiratory acidosis because she is retaining too much carbon dioxide. Her shallow breathing, due to the damage to her lungs from the disease, is the cause. In order to release the carbon dioxide, one must be able to breathe normally (deep breathing would be optimal). Diff: 2 Page Ref: 1014; Tbl. 26.2 21 Copyright © 2010 Pearson Education, Inc. 4) Recently Alex's family noticed that he is craving salt to the point where he uses it excessively on his food. He also has a need to consume strange substances such as clay and burnt match tips. What might be the cause of this strange behavior? Answer: Alex may be suffering from Addison's disease, a disorder entailing deficient mineralocorticoid hormone production by the adrenal cortex. Sometimes when the necessary electrolytes are deficient, people crave strange substances such as chalk, clay, starch, or burnt match tips. This unusual habit is called pica. Diff: 3 Page Ref: 1002 5) After traveling from Los Angeles to Denver, Claire finds she is not feeling well and checks into a clinic for help. The clinic's diagnosis is respiratory alkalosis. What has caused this problem? Answer: Respiratory alkalosis is always caused by hyperventilation. Claire is experiencing the effect of the high altitude and was overcompensating or trying to do too much the first day in Denver. Diff: 2 Page Ref: 1014; Tbl. 26.2 6) A patient is 72 years old and was admitted to the hospital for severe shortness of breath and edema to her lower extremities. She was diagnosed with heart failure. A symptom of heart failure is generalized edema. Explain the finding of generalized edema in heart failure. Answer: Edema is an atypical accumulation of fluid in the interstitial space, leading to tissue swelling. Heart failure is one cause of edema. Diff: 3 Page Ref: 10011002 7) A 13yearold girl is admitted to the psychiatric unit for anorexia. Her body weight is 89 lbs. and height is 64 inches. She admits to frequent selfinduced vomiting and abuse of laxatives. She was treated on the medical unit with intravenous fluids. Now that she is on the psychiatric unit she is experiencing fluid retention as evidenced by mild puffiness and bloating. Explain these symptoms. Answer: It is not uncommon for anorexics who are chronically fluid depleted to develop a compensatory increased production of aldosterone, which causes the kidneys to conserve sodium and water. Diff: 3 Page Ref: 1004 8) A patient's anxiety caused her to develop respiratory alkalosis. The nurse instructs the patient to take some slow deep breaths. Explain why this would be effective. Answer: Instructing the patient to breathe more slowly will increase the patient's blood level of CO . Having the patient breathe into a paper bag would also increase blood CO levels. 2 2 Diff: 2 Page Ref: 1014; Tbl. 26.2 22 Copyright © 2010 Pearson Education, Inc.