AIIMS Delhi NO- 2019
Medical & Surgical Nursing
Easy
All are crystalloid solution; except:
Appeared in: AIIMS Delhi NO- 2019
Explanation
- HES (Hydroxyethyl Starch) is a synthetic colloid solution, not a crystalloid.
- Colloids are characterized by large molecules (in this case, starch) that do not easily pass through the semipermeable capillary membranes.
- Because they remain in the bloodstream, colloids act as plasma volume expanders, increasing the oncotic pressure within the blood vessels.
- This property makes them distinct from crystalloids, which distribute more widely into the body's tissues.
Why Other Options Were Wrong
- Option A: Normal saline (0.9% Sodium Chloride) is a classic example of an isotonic crystalloid solution. It is widely used for fluid resuscitation and to treat extracellular fluid volume deficits.
- Option B: Ringer lactate (also known as Hartmann's solution) is an isotonic crystalloid solution. It contains multiple electrolytes (sodium, potassium, calcium, chloride) and lactate, making it similar in composition to blood plasma.
- Option C: 5% Dextrose in water (D5W) is a crystalloid solution. Although it is isotonic in the bag, the dextrose is quickly metabolized by the body, leaving behind free water. This makes it effectively hypotonic, allowing it to hydrate the cells.
Related Visual
Clinical Relevance
- Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Classification of intravenous fluids (Crystalloids vs. Colloids) as background academic context rather than a clinical decision trigger.
- Understanding the difference between crystalloids and colloids is fundamental for nurses in selecting the appropriate IV fluid. Crystalloids are the first choice for most cases of dehydration and electrolyte imbalance.
- Colloids like HES are reserved for specific situations, such as rapid volume expansion in severe hypovolemic shock, as they are more effective at increasing intravascular volume per unit infused.
- Nurses must monitor for different adverse effects: fluid overload and pulmonary edema are risks with both, but colloids carry an additional risk of anaphylactic reactions, acute kidney injury, and interference with blood coagulation.
How to Approach the Question
- This is an 'except' question, which requires you to find the option that does not fit with the others.
- First, identify the core concept in the question stem: 'crystalloid solution'.
- Define or recall the characteristics of a crystalloid solution: it contains small molecules (like electrolytes and glucose) that can easily move across cell membranes.
- Systematically evaluate each option against this definition.
- Normal saline, Ringer lactate, and 5% Dextrose all fit the definition of a crystalloid.
- HES (Hydroxyethyl Starch) contains large starch molecules, which is the defining characteristic of a colloid. Therefore, it is the exception.
Concept Tested & Keywords
- Concept Tested: Classification of intravenous fluids (Crystalloids vs. Colloids)
- Stem keywords: crystalloid solution, intravenous fluids, IV fluids
- Lead-in keywords: except
- Negative lead-in flag: The question uses 'except', asking to identify the option that does not belong to the group of crystalloid solutions.
Question ID
QmjIkenvqoAfF-ywIBsy3x
Reference Book
E6 Nursing Fundamentals Potter Perry 12e Part 5 p. 68-70
E6 Nursing Brunner Adult Health 3SA Vol 1 Part 1 p. 142-144
E6 Medicine Davidson Principles Practice 24e p. 373-375
Practise the full AIIMS Delhi NO- 2019
Attempt every question from this paper in a timed mock, then review the full solution for each one.
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