Fluid Volume Excess (Hypervolemia)


  • Fluid volume excess (FVE) refers to an isotonic expansion of ECF (Extra cellular fluid) caused by the abnormal retention of water and sodium in approximately the same proportions in which they normally exist in the ECF
  • It is always secondary to an increase in the total body sodium content which lead an increase to total body water, due to there is isotonic retention of body substances the serum sodium concentration remains essentially normal


  • FVE may be related to simple fluid overload or diminished functions of the homeostatic mechanisms responsible for regulating fluid balance

Contributing factors include

  • Heart failure
  • Renal failure
  • Cirrhosis of liver
  • Other contributing factors are
  • Consumption of excessive amount of table or other sodium salts
  • Administration of excessive sodium containing fluid to patient with impaired regulatory mechanisms (Beck – 2000)

Clinical Manifestation

  • Clinical manifestation of FVE start from expansion of the extra cellular fluid (ECF) and include
  • Edema
  • Distended Neck Veins
  • And Crackles (abnormal lung sound) Other manifestations include
  • Tachycardia
  • Increased blood pressure
  • Increased pulse pressure
  • Increased central venous pressure
  • Increased Wt
  • Increased urine output
  • Shortness of breath (SOB) and wheezing


  • Laboratory data useful in diagnosing FVE include BUN and hematocrit level
  • In both FVE both of these values may be decreased because of plasma dilution
  • Other causes include low protein intake and anemia
  • In chronic renal failure both serum osmolality and sodium level are decreased due to excessive retention of water
  • x- ray chest reveal pulmonary congestion
  • LFT
  • RFT

Medical Management

  • Treat the cause
  • If the fluid excess is related to excessive administration of sodium containing fluids, discontinuing the infusion may be all that is needed
  • Symptomatic treatment consist of diuretics and restriction fluids and sodium
  • Hemodialysis
  • Nutritional therapy – restrict sodium in diet
  • Pure water may be used

Nursing Management

  • To asses for FVE
  • The nurse measure intake and output at regular intervals to identify excessive fluid retention
  • Daily Wt of patient
  • To assess breath sounds at regular intervals
  • The nurse monitors degree of edema in most depending parts of body as feet, ankles, sacral region bed ridden patient
  • The degree of pitting edema is assessed
  • Preventing FVE
  • Detecting and controlling FVE
  • Teaching, patients about edema

Adult Health Nursing MCQs/BCQs- 4th Semester

1. The Cranial nerves are ____ in pairs

  1. 10
  2. 8
  3. 6
  4. 4
  5. 12

2. Causes of Hyper parathyroidism

  1. Neck trauma
  2. Parathyroid adenoma
  3. Carcinoma
  4. All of the above
  5. None of the available choices

3. _________ is a group of metabolic disorders characterized by elevated levels of blood insulin

  1. Pineal gland
  2. Diabetes mellitus
  3. Thymus gland
  4. Hyper thyroidism
  5. Diabetes insipidus

4. Primary hypertension or essential hypertension observed in

  1. Obesity
  2. Use of salt in excess
  3. Aging
  4. All of the above
  5. Alcohol and smoking

5. Valve in the heart between left atrium and left ventricle is called

  1. Bicuspid valve
  2. Tricuspid valve
  3. Cardio Sphincter valve
  4. None of the available choices
  5. Ileocecal valve

6. The pituitary gland lies In the hypophyseal fossa of the ________

  1. Nasal bone
  2. None of the available choices
  3. Temporal bone
  4. Sphenoid bone of the cranial cavity
  5. Both nasal bone and temporal bone

7. An abnormally dilated tortures superficial vein caused by incompetent veins is observed in the disorder

  1. Deep venous thrombosis
  2. Varicose vein
  3. Venous thrombosis
  4. Atherosclerosis
  5. Arteriosclerosis

8. The Central Nervous system (CNS) is composed of

  1. Brain and spinal cord
  2. None of these
  3. Digestive system
  4. Lungs and heart
  5. Liver and kidney

9. It is characterized by progressive loss of joint cartilage and happens in the disorder:

  1. Osteoporosis
  2. Osteoarthritis
  3. Fracture
  4. Osteomalacia
  5. T.B of the bone

10. __________ is the disorder in which there is reduction of bone density in it, the rate of bone resorption is greater than the rate of bone formation

  1. Osteoarthritis
  2. Rheumatoid arthritis
  3. Osteoporosis
  4. Osteomyelitis
  5. Osteitis deformans

11. Cerebro Spinal Fluid (CSF)is secreted continuously at the rate of per day

  1. 800 ml
  2. 1000 ml
  3. 720 ml
  4. 400 ml
  5. 500 ml

12. A condition in where arteries become narrowed and hardened due to an excessive buildup of plaque around the artery wall the disorder is known as ?

  1. Varicose vein
  2. Aneurism
  3. Atherosclerosis
  4. Venous thrombosis
  5. Arteriosclerosis

13. The weight of the pituitary gland about _____ and consist _____ distinct parts that originate from different types of cells

  1. 350mg / 5parts
  2. 500mg / 2 parts
  3. 400mg / 2 parts
  4. 600mg / 4 parts
  5. 500mg / 3 parts

14. Following are the clinical manifestations of CVA or brain attack except one:

  1. Increase cognition
  2. Confusion or changes in mental status
  3. Visual disturbance
  4. Numbness
  5. Motor, perceptual & sensory loss

15. It causes decreased density and possible fracture and often referred to (Silent Disease)

  1. Osteomalacia
  2. Osteoporosis
  3. Bone tumor
  4. Tuberculosis
  5. Rheumatoid arthritis

16. _______ is a lens opacity or cloudiness or blurred vision a leading cause of disability in older patient:

  1. Conjunctivitis
  2. Foreign body in the eye
  3. Cataract
  4. Retinal detachment
  5. Glaucoma

17. The thyroid gland is situated in the neck in front of the larynx and trachea at the level of :

  1. None of the available choices
  2. 3rd 4th and 5th cervical and 2nd thoracic vertebrae
  3. 2nd 3rd and 4th cervical and 1st thoracic vertebrae
  4. 1st 2nd and 3rd cervical and 2nd thoracic vertebrae
  5. 5th 6th and 7th cervical and 1st thoracic vertebrae

18. Basal Ganglia, Thalamus, Hypothalamus are other parts of:

  1. Cerebrum
  2. Pons
  3. Mid brain
  4. Cerebellum
  5. Medulla oblongata

19. For descriptive purposes each hemisphere of cerebrum is divided into lobes

  1. 6
  2. 4
  3. 2
  4. 8
  5. 10

20. Dura mater, arachnoid mater, pia mater are the layers of

  1. Spinal cord
  2. Both Brain and Spinal cord
  3. Heart
  4. Brain
  5. Vertebral column

21. A ________ an ischemic stroke or

  1. None of these
  2. CVS
  3. CVA
  4. CNS
  5. PNS

22. _______ is the largest part of the brain and it occupies the anterior and middle cranial fossa

  1. Mid brain
  2. Medulla oblongata
  3. Cerebrum
  4. None of the available choices
  5. Cerebellum

23. _______ is defined as acute hemorrhage from nostril, nasal cavity or nasopharynx

  1. Peptic ulcer
  2. Epistaxis
  3. T.B
  4. Gastritis
  5. Malena

24. _____ is the removal of a part of the body

  1. Soft tissue injury
  2. Paget’s disease of the bone
  3. Amputation
  4. Fracture
  5. Osteomyelitis

25. Following are the Key sign and symptoms occurs in as increased metabolic rate, weight loss, good appetite, anxiety etc.

  1. Hypothyroidism
  2. Cushing syndrome
  3. Hypo thyroidism
  4. Hyper thyroidism
  5. Hyper parathyroidism

26. The nursing intervention of trigeminal neuralgia except one?

  1. Recognize the patient’s anxiety
  2. Allow the patient to rub his/her face with soapy water
  3. Provide post-operative care
  4. Instruct the patient to rinse mouth after eating when tooth brushing cause pain
  5. Monitor patient for bone marrow depression during long term drug therapy

27. High Blood Pressure is said to be present if it is at or above in young men:

  1. 100/60mmHg
  2. 130/90mmHg
  3. 120/80mmHg
  4. 110/70mmHg
  5. 140/90mmHg

28. Clinical presentation as difficulty in breathing, wheezing, chest tightness, restlessness, shortness of breathing (SOB) found in :

  1. Emphysema
  2. Liver failure
  3. Asthma
  4. Renal failure
  5. Dyspnea

29. ______ is disorder of posterior lobe of pituitary gland due to deficiency of vasopressin the anti-diuretic hormone (ADH)?

  1. Addison’s disease
  2. Gestational diabetes mellitus
  3. Hypothyroidism
  4. Diabetes mellitus
  5. Diabetes insipidus

30. Which type of joint is freely moveable?

  1. Synarthrodial and Amphiarthrodial
  2. Diarthrosis
  3. Amphiarthrodial
  4. Synarthrodial
  5. None of the available choices

31. Following are the clinical manifestations of the hyperthyroidism except one?

  1. Decreased respiration rate
  2. Palpitations
  3. Nervousness
  4. Pulse rate between 90 and 160 beats per minutes
  5. Poor tolerance of heat

32. The functions of hypothalamus includes except one:

  1. Control of autonomic nervous system
  2. Thirst and water balance
  3. Body temperature
  4. Bone growth
  5. Appetite

33. According to classification of fracture the open fracture means:

  1. Severeal bone fracture
  2. Complete fracture
  3. Simple no break in skin
  4. Break the skin and mucous membrane
  5. Greenstick

34. Following sign and symptoms are often observed as bone fracture, recent weight loss, arthritis, pallor of skin, kidney stone, and constipation in disorder of:

  1. Anemia
  2. Hypothyroidism
  3. Hypoparathyroidism
  4. Hyperparathyroidism
  5. Hyperthyroidism

35. The causative agent of pulmonary tuberculosis is:

  1. Pneumococcus
  2. Mycobacterium
  3. E-coli
  4. Streptococcus
  5. H-influenza

36. ______ results from excessive adreno-cortical activity observed in:

  1. Systemic lupus erythematous
  2. Cushing syndrome
  3. Nephrotic syndrome
  4. Diabetes mellitus
  5. Addison’s disease

37. The key features observed as polyuria, polydipsia, polyphagia, fatigue, sudden vision changes I the disorder of:

  1. Diabetes mellitus
  2. Gastroenteritis
  3. Cholicystitis
  4. Myasthenia gravis
  5. Hydro nephrosis

38. Diabetes insipidus is a disorder of:

  1. Pineal gland
  2. Pancreatic gland
  3. Thymus gland
  4. Anterior lobe of pituitary gland
  5. Posterior lobe of pituitary gland

39. The heart has _____ chambers in it

  1. 6
  2. 3
  3. 2
  4. 4
  5. 5

40. A chronic metabolic disorder in which a bone is excessively broken down is known as:

  1. Strain and sprain
  2. Paget’s disease of the above
  3. Osteoporosis
  4. Rheumatoid arthritis
  5. Osteoarthritis

Adult Health Nursing MCQs

1) It is clinical condition in which the arterial PH is greater then 7.45 PaCO3 is less then 38 mmHg.
A. Respiratory distress
B. Alkalosis & Acidosis
C. Respiratory acidosis
D. Respiratory alkalosis

2) Which nursing diagnosis is most applicable to client with fecal incontinences?
A. Risk for deficient fluid volume
B. Disturbed body image
C. Bowel incontinence
D. Altered nutrition: more than body requirement

3) Cystitis is a type of urinary tract infection of:
A. Uncomplicated lower or upper UTI
B. Upper UTI
C. Complicated lower or upper UTI
D. Lower UTI

4) When counseling a client in ways to prevent cholecystitis, which of the following guidelines is most important?
A. Eat a low-fat low cholesterol diet
B. Limit exercise to 10 minutes/day
C. Keep weight proportionate to height
D. Eat a low-protein diet

5) % of abortion in the first 12 weeks of pregnancy result from chromosomal abnormalities:
A. 50 to 80
B. 20 to 30
C. 30 to 40
D. 40 to 45

6) The patient should be setting when deep breating and coughing because this position:
A. Loosens respiratory secretions
B. Helps the patient to support their incision wiht a pillow
C. Allows the patient to observe their area and relex
D. Is physically more comfortable for the patient

7) Five minutes after the client’s first post operative exercise, the client’s vital sign have not yet return to baseline. Which is an appropriate nursing diagnosis:
A. Alteration in comfort
B. Risk for activity intolerance
C. Impaired physical mobility
D. Risk for discuss syndrome
8) The doctor has ordered 500 mg of a medication po once a day. The tablets on hand are labeled as 1 tablet = 250 mg. How many tablets will you administer to your patient?
A. 03 Tablets
B. 1 Tablets
C. 02 Tablets
D. 04 Tablets

9) Foods high in purine are restricted to patients in:
A. Calcium stones
B. Oxalate stones
C. Uric acid stones
D. Struvite stones

10) What is/are the most common cause(s) of chronic liver disease?
A. Obesity
B. Bacteria
C. Gall bladder stones
D. Alcohol abuse

11) Inflammation of the lower end of the esophagus leading to a back flow of gastric juices is called:
A. Structural abnormalities
B. Lactose intolerance
C. Acid reflux
D. Reflux esophagitis

12) Which statement about appendicitis is accurate and true?
A. Mc Burney’s point tenderness is suggestive of appendicitis
B. Lefty lower quadrant pain is suggestive of a appendicitis
C. Appendicitis is more common among females than males
D. A high fiber diet is a risk factor associated with appendicitis

13) Renal cell carcinoma which is greater than 7 cm tumor limited to the kidney, no evidence of lymph node involvement & metastatic disease is called:
A. Stage II RCC
B. Stage I RCC
C. Stage IV RCC
D. Stage III RCC

14) Excessive bleeding occurs at frequent intervals in reproductive disorders is:
A. Menometrorrhagia
B. Menorrhagia
C. Polymenorrhea
D. Metrorrhagia

15) A hernia is the of an organ or tissue out of the body cavity in which it is normally found:
A. Trauma
B. Syndrome
C. Protrusion
D. Pressure

16) Swelling of the salivary glands in mumps is called:
A. Periodontitis
B. Parotitis
C. Granuloma

D. Salivitis

17) Painless enlargement of one or more lymph nodes on one side of the neck is:
A. Tuberculosis
B. Non Hodgkin disease
C. Lymphomas
D. Hodgkin’s Disease

18) When establishing realistic goal, the nurse:
A. Bases of the goals on the narse’s personal knowledge
B. Must have the client cooperation
C. Knows the resourses of the health care facility, family and the client
D. Must have a client who is phyiscally and emotionally stable

19) Puberty age in female is:
A. 18 to 19 years
B. 19 to 20 years
C. 16 to 17 years
D. 10 to 14 years

20) A client being treated for chronic cholecystitis should be given which of the following instructions?
A. Use anti cholinergic as prescribed
B. Increase protein in diet
C. Avoid antacids
D. Increase rest

21) Which nursing diagnosis is most applicable to client with fecal incontinence?
A. Altered Nutrition:more than body requirement
B. Risk for Deficient fluid volume
C. Bowel Incontinence
D. Disturbed body image

22) What can reduce a patient’s anxiety and postsurgical pain?
A. Preoperative checklist
B. Psychological counseling
C. Preoperative teaching
D. Preoperative medication
23) A hiatus hernia occurs when the upper part of the stomach is dislocated through the hole, called a Hiatus, in the , into the chest:
A. Duodenum
B. Abdominal cavity
C. Diaphragm
D. Esophagus

24) Mechanical obstruction of intestine in which bowel twists and turns on itself:
A. Adhesions
B. Amyloidosis
C. Volvulus
D. Stenosis

25) Which electrolyte is essential for enyzme and neurological activities?
A. Magnesium
B. Phosphate
C. Potassium
D. Chloride

26) Which of the following stage the carcinogen is irreversible?
A. Progression stage
B. Promotion stage
C. Initiation
D. Regression

27) From the following nursing diagnosis which is suitable for hemorrhoids:
A. Urinary retention related to postoperative reflux spasm and fear of pain
B. Imbalance nutrition less than body requirement
C. Anxity related to surgical intervention
D. Constipation related to ignoring the urge to defecate because of pain during elimination

28) Which one is the best investigation to find out the stone in urinary tract:
A. Ultrasound
B. M.R.I
C. I.V.P
D. CT scan

29) Which is the most common complication of peptic ulcer disease?
A. Haemorrhage
B. Penetration
C. Gastric outlet obstruction
D. Perforation

30) In what order should one perform an abdominal assessment:
A. Inspection, percussion, palpitation, auscultation
B. Inspection, auscultation, percussion, palpitation
C. Percussion, Palpitation, Inspection, Auscultation
D. Palpitation, Inspection, Percussion,. auscultation

31) From the following in which operation patient needs sitz bath:
A. Appendectomy
B. Colostomy
C. Hysterectomy
D. Hemorrhoids

32) Food poisoning “should be suspected with persons who shared food within the previous 1-6 hours, and symptoms of nausea, vomiting,and idarrhea, typically, this is due to:
A. Emetics
B. Infection
C. Intoxication
D. Inebrition

33) Is a malignant disorder of hemopoietic tissues, associated increased number of
leukocytosis in the blood:
A. Hemophilia
B. H. Influenza
C. Leukemia
D. Poly cythemia

34) is primarily a disease of children older than 2 years of age:
A. Acute glomerulonephritis
B. Nephrotic syndrome
C. Renal abscess
D. Acute pyelonephritis

35) Spread of cancer cells from the primary tumor to distant sites:
A. Dysplasia
B. Metaplasia
C. Malignant
D. Metastasis

36) What intervention is the best relieve constipation during pregnancy?
A. Lying flat on back when sleeping
B. Taking a mild over-the counter laxative
C. Reduction of iron intake by half or more
D. Increasing the consumption of fruits and vegetable

37) Anemia which can be classified based on the body temperature and antibodies react with the RBC antigen is:
A. Polycythemia
B. Aplastic anemia
C. Immune hemolytic anemia
D. Hemolytic anemia
38) is disorder in which bone lose density and become porous and fragile:
A. Menarche
B. Osteoporoses
C. Formix
D. Dysmenoria

39) The most appropriate tool in confirmation of malignancy in the patient is:
A. History
B. Physical examination
C. Blood CP
D. Biopsy of tissue

40) Normal Glomerular filtration rate (GFR) per minute is:
A. 115 ml
B. 100 ml
C. 105 ml
D. 120 ml