Exam

Name___________________________________

MATCHING. Choose the item in column 2 that best matches each item in column 1.

Match the following:

1) Dissociate into ions in water. A) Intracellular

1)

2) Do not dissociate in solution. B) Nonelectrolytes

2)

3) The main fluid compartment outside C) Extracellular

3)
the cells.
D) Electrolytes
4) The main fluid compartment located
4)
within the cell. E) Interstitial

5) Fluid in the spaces between cells.

5)

Match the following:

6) Magnesium excess. A) Hyponatremia

6)

7) Calcium depletion. B) Hypocalcemia

7)

8) Sodium excess. C) Hyperkalemia

8)

9) Potassium excess. D) Hypernatremia

9)

10) Sodium depletion. E) Hypermagnesemia

10)

Match the following:

11) An atypical accumulation of fluid in A) Edema

11)
the interstitial space.
B) Dehydration
12) Fluid loss, either the loss of water or
12)
the loss of water and solutes together.

1
 13) A disorder entailing deficient A) Addison's disease
13)
aldosterone production by the adrenal
cortex. B) Hyponatremia

14) Regulates sodium ion concentrations C) Aldosterone 14)

in the extracellular fluid.

15) A condition due to excessive water

15)
intake that results in net osmosis into
tissue cells. This leads to severe
metabolic disturbances.

Match the electrolyte composition for the following:

16) The concentration of sodium ions is A) Intracellular fluid

16)
highest in ________.
B) Interstitial fluid
17) The concentration of potassium ions is
17)
highest in ________. C) Blood plasma

18) The concentration of phosphate ions is

18)
highest in ________.

19) The concentration of bicarbonate ions

19)
is highest in ________.

20) The concentration of protein anions is

20)
highest in ________.

Match the following:

21) Possibly caused by severe diarrhea or A) Metabolic alkalosis

21)
untreated diabetes mellitus.
B) Respiratory acidosis
22) Possibly occurring with emphysema,
22)
extreme obesity, or narcotic overdose. C) Metabolic acidosis

23) Possibly caused by asthma, D) Respiratory alkalosis 23)

pneumonia, or a severe panic attack.

24) Possibly caused by vomiting, use of

24)
diuretics, or use of antacids.

TRUE/FALSE. Write 'T' if the statement is true and 'F' if the statement is false.

25) Adipose tissue is one of the most hydrated of all tissues in the human body. 25)

26) The most abundant cation in intracellular fluid is sodium. 26)

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27) Electrolytes determine most of the chemical and physical reactions of body fluids. 27)

28) Solutes, regardless of size, are able to move freely between compartments because water carries 28)
them along the osmotic gradients.

29) The thirst center in the brain is located in the hypothalamus. 29)

30) Dehydration can be caused by endocrine disturbances such as diabetes mellitus or diabetes 30)
insipidus.

31) It is impossible to overhydrate because people need as much water as they can drink to carry out 31)
ordinary body functions.

32) Water imbalance, in which output exceeds intake, causing an imbalance in body fluids, is termed 32)
dehydration.

33) Salts are lost from the body in perspiration and urine only. 33)

34) Excessive loss of water from the extracellular fluid (ECF) leads to a rise in osmotic pressure in the 34)
ECF which causes cells to shrink as water leaves by osmosis.

35) Although the sodium content of the body may be altered, its concentration in the ECF remains 35)
relatively stable because of immediate adjustments in water volume.

36) Sodium is pivotal to fluid and electrolyte balance and to the homeostasis of all body systems. 36)

37) When aldosterone release is inhibited, sodium reabsorption cannot occur beyond the distal 37)
convoluted tubule.

38) Aldosterone stimulates the reabsorption of sodium while enhancing potassium secretion. 38)

39) Some potassium ions are reabsorbed from the kidney filtrate via type A intercalated cells, a unique 39)
population of collecting duct cells.

40) Aldosterone is secreted in response to low extracellular potassium. 40)

41) To remain properly hydrated, water intake must equal water output. 41)

42) The main way the kidney regulates potassium ions is to excrete them. 42)

43) Obligatory water loss occurs because humans always take in more fluids through eating and 43)
drinking than they need to maintain water balance.

44) Premenstrual edema may be due to enhanced reabsorption of sodium chloride. 44)

45) Heavy consumption of salt substitutes high in potassium can present a serious clinical problem 45)
when aldosterone release is not normal.

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 46) Insensible water loss includes water lost in feces. 46)

47) The two hormones responsible for the regulation of calcium are pituitary hormone and calcitonin. 47)

48) Calcitonin targets the bones and causes the release of calcium from storage when serum calcium 48)
levels are low.

49) The normal pH of blood is 7.35-7.45. 49)

50) Most acidic substances (hydrogen ions) originate as by-products of cellular metabolism. 50)

51) Weak acids are able to act as chemical buffering systems for the body because they only partially 51)
dissociate.

52) The phosphate buffer system is relatively unimportant for buffering blood plasma. 52)

53) The single most important blood buffer system is the bicarbonate buffer system. 53)

54) One of the most powerful and plentiful sources of buffers is the protein buffer system. 54)

55) As ventilation increases and more carbon dioxide is removed from the blood, the hydrogen ion 55)
concentration of the blood decreases.

56) Carotid artery and aortic baroreceptors are involved in long term adjustment to total body sodium 56)
ion content.

57) Respiratory acidosis results when lungs are obstructed and gas exchange is inefficient. 57)

58) Prolonged hyperventilation can cause alkalosis. 58)

59) Thirst is normally triggered by hypothalamic osmoreceptors sensitive to a 1 -2% increase in plasma 59)
osmolality.

60) Blood acidity results in depression of the CNS, whereas blood alkalosis results in overexcitement 60)
of the CNS.

MULTIPLE CHOICE. Choose the one alternative that best completes the statement or answers the question.

61) The body's water volume is closely tied to the level of which of the following ions? 61)
A) hydrogen ions B) sodium ions C) potassium ions D) calcium ions

62) The term hypotonic hydration refers to ________. 62)

A) the feeling one might have after profuse sweating with exertion
B) a condition that may result from renal insufficiency or drinking excessive amounts of water
C) a condition that is caused by high levels of sodium in the extracellular fluid compartment
D) the unpleasant feeling people have after drinking too much liquor

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63) When antidiuretic hormone (ADH) levels are low, ________. 63)
A) nearly all of the filtered water is reabsorbed
B) a small volume of concentrated urine is excreted
C) most of the water reaching the collecting ducts is not reabsorbed
D) aquaporins are inserted into the collecting duct principal cell apical membranes

64) Which of the following hormones is important in the regulation of sodium ion concentrations in 64)
the extracellular fluid?
A) erythropoietin B) renin
C) antidiuretic hormone D) aldosterone

65) Atrial natriuretic peptide (ANP) is a hormone that is made in the atria of the heart. The influence 65)
of this hormone is to ________.
A) prevent pH changes caused by organic acids
B) enhance atrial contractions
C) reduce blood pressure and blood volume by inhibiting sodium and water retention
D) activate the renin-angiotensin mechanism

66) Respiratory acidosis can occur when ________. 66)

A) a person consumes excessive amounts of antacids
B) a person's breathing is shallow due to obstruction
C) the kidneys secrete hydrogen ions
D) a runner has completed a very long marathon

67) Total body water is NOT a function of which of the following? 67)
A) amount of water ingested B) body mass
C) amount of body fat D) age

68) Which of the choices below is NOT an essential role of salts in the body? 68)
A) membrane permeability B) secretory activity
C) neuromuscular activity D) anabolism of lipids

69) Which of the choices below exerts primary control over sodium levels in the body? 69)
A) glucocorticoids B) water levels C) aldosterone D) ADH

70) The fluid link between the external and internal environment is ________. 70)
A) plasma B) cerebrospinal fluid
C) intracellular fluid D) interstitial fluid

71) In a car accident, Jane suffered a chest injury that resulted in impaired breathing and respiratory 71)
acidosis. How will her body compensate for this imbalance?
A) Kidneys eliminate bicarbonate ions. B) Kidneys eliminate carbon dioxide.
C) Kidneys retain bicarbonate ions. D) Kidneys retain hydrogen ions.

72) Whereas sodium is found mainly in the extracellular fluid, most ________ is found in the 72)
intracellular fluid.
A) chloride B) potassium C) bicarbonate D) iron

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73) Which of the following describes the distribution of sodium and potassium between cells and body 73)
fluids?
A) Na+ mainly in the cells, K+ in the body fluids
B) K+ mainly in the cells, Na + 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

74) For bulk flow across capillary walls, ________. 74)

A) hydrostatic pressure of the interstitial space returns fluid to the capillary
B) hydrostatic pressure of blood forces nearly protein-free plasma out of the blood into the
interstitial space
C) fluid runs into lymphatic capillaries that empty into the interstitial space
D) osmotic pressure of plasma proteins pulls fluid from the capillary into the interstitial space

75) The single most important factor influencing potassium ion secretion is ________. 75)
A) intracellular sodium levels
B) the pH of the intracellular fluid
C) the potassium ion content in the renal tubule cells
D) potassium ion concentration in extracellular fluid

76) Amphoteric molecules _______. 76)

A) can function as acids at low pH
B) can function as an acid or a base depending on the pH
C) trigger pH imbalances and must be neutralized by buffers
D) can function as bases at high pH

77) A falling blood pH and a rising partial pressure of carbon dioxide due to pneumonia or 77)
emphysema indicates ________.
A) respiratory alkalosis B) metabolic alkalosis
C) respiratory acidosis D) metabolic acidosis

78) The movement of fluids between cellular compartments ________. 78)

A) requires active transport
B) requires ATP for the transport to take place
C) always involves filtration
D) is regulated by osmotic and hydrostatic forces

79) What hormone reduces blood pressure and blood volume by inhibiting nearly all events that 79)
promote vasoconstriction and sodium ion and water retention?
A) antidiuretic hormone (ADH) B) atrial natriuretic peptide (ANP)
C) aldosterone D) thyroxine

80) When a strong acid such as HCl is added to the carbonic acid buffer system, _________. 80)
A) carbonic acid is converted into bicarbonate
B) hydrochloric acid is neutralized by sodium hydroxide
C) more carbonic acid is formed
D) the blood plasma pH is reduced

81) Which of the following is NOT a chemical buffer system? 81)

A) bicarbonate B) phosphate C) protein D) nitrogen

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82) Which of the following is NOT a trigger for juxtaglomerular granular cells to release renin? 82)
A) increased extracellular fluid water levels
B) decreased stretch of the granular cells of the afferent arterioles
C) decreased filtrate NaCl concentration
D) sympathetic stimulation

83) Which of the following statements is true regarding fluid shifts? 83)
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) There are always more positive electrolytes than negative in a solution; it is therefore
impossible to follow fluid shifts.
D) Electrolytes have greater osmotic power than nonelectrolytes and therefore have the greatest
ability to cause fluid shifts.

84) Which of the following would describe nonelectrolytes? 84)

A) inorganic salts B) inorganic acids
C) organic bases D) polar covalent compounds

85) The maintenance of the proper pH of the body fluids may be the result of ________. 85)
A) control of the acids produced in the stomach
B) the control of respiratory ventilation
C) the operation of the various buffer systems in the stomach
D) the active secretion of OH- into the filtrate by the kidney tubule cells

86) Which of the following is NOT a disorder of water balance? 86)

A) excess water in interstitial spaces due to a low level of plasma proteins
B) hypotonic hydration, in which sodium content is normal but water content is high
C) excessive hydration due to excess atrial natriuretic peptide (ANP) secretion
D) edema or tissue swelling, which is usually due to an increased capillary hydrostatic pressure

87) The regulation of sodium ________. 87)

A) involves aldosterone, a hormone that increases sodium excretion in the kidneys
B) is linked to blood pressure
C) involves hypothalamic osmoreceptor detection of ion concentration
D) is due to specific sodium receptors in the hypothalamus

88) Blood analysis indicates a low pH, and the patient is breathing rapidly. Given your knowledge of 88)
acid-base balance, which of the following is most likely?
A) metabolic alkalosis B) respiratory alkalosis
C) metabolic acidosis D) respiratory acidosis

89) A patient is breathing slowly, and blood pH analysis indicates an abnormally high value. What is 89)
the likely diagnosis?
A) respiratory acidosis B) respiratory alkalosis
C) metabolic alkalosis D) metabolic acidosis

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90) Which of the following is NOT a likely source of hydrogen ions in blood plasma? 90)
A) anaerobic metabolism of glucose
B) metabolism of proteins containing phosphorus
C) metabolism of fats
D) aerobic metabolism of glucose

91) Annie has just eaten a large order of heavily salted French fries, some pickled eggs, and some 91)
cheese. How will consuming this much salt affect her physiology?
A) There will be a temporary increase in blood volume.
B) She will experience hypotension.
C) It will cause a prolonged increase in the osmolality of the blood.
D) There will be a shift in the pH of her body fluids to the higher side of the pH scale.

92) The most important force causing net outward water flow across capillary walls is ________. 92)
A) osmotic pressure of plasma proteins B) intracellular hydrostatic pressure
C) hydrostatic pressure of interstitial fluid D) hydrostatic pressure of capillary blood

93) When the blood becomes acidic (acidosis) and bicarbonate ions have been depleted, new 93)
bicarbonate ions must be generated in the plasma. Which of the following is NOT a means for
replenishing bicarbonate ions?
A) Bicarbonate ions are reclaimed by tubular reabsorption.
B) Glutamine is metabolized by deamination, oxidation, and acidification.
C) Buffered hydrogen ions are excreted in urine.
D) Ammonium ions are excreted in urine.

94) The regulation of potassium balance ________. 94)

A) is not linked to sodium balance
B) involves aldosterone-induced secretion of potassium
C) includes renal secretion, but never absorption
D) is accomplished mainly by hepatic mechanisms

95) After completing a marathon on a particularly warm day, Dave consumes four liters of water. 95)
Soon after, he begins to feel nauseous and starts vomiting. What is likely happening to Dave?
A) obligatory water loss
B) dehydration
C) hypoproteinemia; unusually low levels of plasma proteins
D) hyponatremia; very low extracellular sodium ion concentration

96) Mary finds that she regularly retains water at a certain point in the menstrual cycle. Which of the 96)
following is chemically similar to aldosterone, and like aldosterone, enhances NaCl reabsorption in
the renal tubules?
A) estrogen B) follicle-stimulating hormone
C) luteinizing hormone D) progesterone

97) Nancy is experiencing an acute panic attack. While hyperventilating, she remembers to open a 97)
paper bag and breathe into it. What is Nancy trying to prevent?
A) respiratory acidosis B) respiratory alkalosis
C) metabolic acidosis D) metabolic alkalosis

8
 98) If the thyroid and parathyroid glands are surgically removed, which of the following would go out 98)
of balance without replacement therapy?
A) calcium ion levels B) potassium ion levels
C) anion levels D) sodium ion levels

99) Insufficient parathyroid hormone production in the body could result in ________. 99)
A) muscle weakness B) kidney stones
C) muscle twitching D) cardiac arrhythmia

100) In the case of edema, excess fluid is held in which fluid compartment(s)? 100)
A) blood plasma B) intracellular fluid and interstitial fluid
C) interstitial fluid D) intracellular fluid

101) Falling arterial blood pressure promotes ________. 101)

A) vasodilation B) enhanced sodium ion loss in urine
C) vasoconstriction D) enhanced water loss in urine

102) An illness causes Doug to experience severe diarrhea and an accompanying loss of 102)
bicarbonate-rich secretions. How can this metabolic acidosis be compensated?
A) hypoventilation B) enhanced sodium ion loss in urine
C) increased renin secretion D) increased respiratory rate and depth

SHORT ANSWER. Write the word or phrase that best completes each statement or answers the question.

103) What provides the shortest-term mechanism for preventing acid-base imbalances in the 103)
body? The longest-term mechanism?

104) What is the effect of acidosis on the body? Of alkalosis? 104)

105) Describe the mechanisms by which the kidneys remove hydrogen ions from the body. 105)

106) Describe the influence of rising parathyroid hormone (PTH) levels on bone, the small 106)
intestine, and the kidneys.

107) When the blood becomes hypertonic (too many solutes) due to dehydration, antidiuretic 107)
hormone (ADH) is released. What is the effect of ADH on the kidney tubules?

108) Why would an infant with colic be suffering from respiratory alkalosis? 108)

109) How does the respiratory system influence the buffer systems of the body? 109)

110) Identify and describe the operation of the three major chemical buffers of the body. 110)

111) List and describe three stimuli that activate the hypothalamic thirst center. 111)

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ESSAY. Write your answer in the space provided or on a separate sheet of paper.

112) A patient is admitted to the hospital in complete collapse. His blood pH is 6.8, and his HCO 3 - is 20 mEq/L.
What diagnosis would you give and what prognosis? A medical history reveals that this patient is a chronic
alcoholic.

113) 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?

114) Helen is a 62-year-old smoker. Her physician has diagnosed her as having emphysema that has caused her to
hypoventilate. Surprisingly, when her blood pH is checked, it is 7.40. Why?

115) 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?

116) 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.

117) A 13-year-old girl is admitted to the psychiatric unit for anorexia. Her body weight is 89 lbs. and height is 64
inches. She admits to frequent self-induced 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.

118) 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.

10
Answer Key
Testname: UNTITLED26

1) D
2) B
3) C
4) A
5) E
6) E
7) B
8) D
9) C
10) A
11) A
12) B
13) A
14) C
15) B
16) C
17) A
18) A
19) B
20) A
21) C
22) B
23) D
24) A
25) FALSE
26) FALSE
27) TRUE
28) FALSE
29) TRUE
30) TRUE
31) FALSE
32) TRUE
33) FALSE
34) TRUE
35) TRUE
36) TRUE
37) TRUE
38) TRUE
39) TRUE
40) FALSE
41) TRUE
42) TRUE
43) FALSE
44) TRUE
45) TRUE
46) FALSE
47) FALSE
48) FALSE
49) TRUE
50) TRUE
11
Answer Key
Testname: UNTITLED26

51) TRUE
52) TRUE
53) TRUE
54) TRUE
55) TRUE
56) TRUE
57) TRUE
58) TRUE
59) TRUE
60) TRUE
61) B
62) B
63) C
64) D
65) C
66) B
67) A
68) D
69) C
70) A
71) C
72) B
73) B
74) B
75) D
76) B
77) C
78) D
79) B
80) C
81) D
82) A
83) D
84) D
85) B
86) C
87) B
88) C
89) C
90) D
91) A
92) D
93) A
94) B
95) D
96) A
97) B
98) A
99) C
100) C
12
Answer Key
Testname: UNTITLED26

101) C
102) D
103) 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 more to effect changes in blood pH.
104) 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.
105) 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.
106) Parathyroid hormone (PTH) activates osteoclasts that break down the bone matrix, resulting in the release of Ca 2+
and PO 4 3- to the blood. PTH enhances intestinal absorption of Ca 2+ 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.
107) The release of ADH causes the kidney tubules to reabsorb excess water, resulting in the excretion of concentrated
urine.
108) 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.
109) The respiratory system maintains a constant bicarbonate level in the bloodstream by outgassing carbon dioxide. In the
event of a respiratory problem the CO 2 to bicarbonate ratio might change, in turn changing buffering effects on pH.
110) 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 2 PO4
acts as a weak acid; Na 2 HPO4 acts as 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.
111) Hypothalamic osmoreceptors detect ECF osmolality through changes in plasma membrane stretch that result from
gaining or losing water. Dry mouth resulting from increased blood osmotic pressure and reduced saliva production.
A substantial decrease in blood volume or pressure, as in hemorrhage, also triggers the thirst mechanism.
112) 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.
113) 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 and her BP for possible pre -eclampsia,
and urine should be periodically checked for proteinuria, but the edema should clear up at the end of the pregnancy
once both blood volume and uterine pressure on venous return disappear.
114) 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). However, because this has been a long -term problem, her
kidneys have excreted greater amounts of acids while retaining HCO 3 - , thus providing renal compensation to her
chronic respiratory acidosis.
115) 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.

13
Answer Key
Testname: UNTITLED26

116) Edema is an atypical accumulation of fluid in the interstitial space, leading to tissue swelling. Heart failure is one
cause of edema.
117) 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.
118) Instructing the patient to breathe more slowly will reduce the elimination of CO 2 . Breathing into a paper bag will
cause retention of CO 2 .

14