This concise, exam-focused review on Plasma volume expanders MCQs With Answer helps B. Pharm students master pharmacology, formulation, and clinical use of crystalloids and colloids. Topics include mechanisms of action, oncotic versus osmotic effects, common agents (normal saline, Ringer’s lactate, albumin, gelatin, dextrans, hydroxyethyl starch), indications, dosing, adverse effects, monitoring, pharmacokinetics, compatibility, and regulatory issues. Questions emphasize hemodynamic principles, fluid composition, electrolyte and acid–base impacts, coagulopathy and renal safety, and practical pharmacy considerations like preparation, storage, and prescribing cautions. Detailed, clinically relevant items build problem-solving skills for exams and practice. Now let’s test your knowledge with 30 MCQs on this topic.
Q1. Which of the following best describes the primary distinction between crystalloids and colloids?
- Difference in sterility standards
- Difference in osmotic activity and molecular size
- Difference in pH only
- Difference in administration route
Correct Answer: Difference in osmotic activity and molecular size
Q2. Which crystalloid is most likely to cause a hyperchloremic metabolic acidosis when given in large volumes?
- Lactated Ringer’s solution
- 5% dextrose in water
- 0.9% sodium chloride (normal saline)
- Plasma-lyte
Correct Answer: 0.9% sodium chloride (normal saline)
Q3. Which colloid is a natural plasma protein product commonly used for volume expansion and maintains oncotic pressure?
- Dextran 40
- Hydroxyethyl starch (HES)
- Albumin 5% or 20%
- Gelatin-based solution
Correct Answer: Albumin 5% or 20%
Q4. A major concern with synthetic hydroxyethyl starches (HES) is:
- High risk of hypoglycemia
- Increased risk of acute kidney injury and coagulopathy
- Severe hyperkalemia in most patients
- Immediate anaphylaxis in all patients
Correct Answer: Increased risk of acute kidney injury and coagulopathy
Q5. Which fluid is most appropriate to replace ongoing isotonic losses (e.g., vomiting) in an otherwise stable patient?
- Albumin 20%
- 0.9% sodium chloride (normal saline)
- Dextran 70
- Hydroxyethyl starch 130/0.4
Correct Answer: 0.9% sodium chloride (normal saline)
Q6. The oncotic pressure exerted by colloids primarily helps to:
- Increase intracellular fluid volume
- Pull fluid from the interstitial space into the intravascular compartment
- Increase gastrointestinal absorption of drugs
- Reduce plasma sodium concentration
Correct Answer: Pull fluid from the interstitial space into the intravascular compartment
Q7. Which of the following is a gelatin-derived colloid used as a plasma expander?
- Polygeline
- Albumin
- Hetastarch
- Dextran 40
Correct Answer: Polygeline
Q8. In severe hypovolemia with hypotension and active bleeding, which is a key advantage of colloids over crystalloids?
- Colloids are less expensive
- Colloids remain in the intravascular space longer, requiring less volume
- Colloids always improve coagulation
- Colloids do not affect renal function
Correct Answer: Colloids remain in the intravascular space longer, requiring less volume
Q9. Which plasma expander is most associated with interference in blood cross-matching and platelet function at high doses?
- Albumin
- Gelatin
- Dextran
- Normal saline
Correct Answer: Dextran
Q10. What is the typical clinical indication for using albumin 20% rather than 5%?
- To provide rapid intravascular volume expansion with smaller volumes
- To treat hyponatremia
- To replace ongoing crystalloid losses
- To correct hyperkalemia
Correct Answer: To provide rapid intravascular volume expansion with smaller volumes
Q11. Which electrolyte disturbance can large volumes of Ringer’s lactate help mitigate compared with normal saline?
- Hypernatremia
- Hyperchloremic metabolic acidosis
- Hypokalemia
- Hypermagnesemia
Correct Answer: Hyperchloremic metabolic acidosis
Q12. Which parameter is most important to monitor when administering colloids in critically ill patients?
- Serum bilirubin only
- Hemodynamic status, urine output, and renal function
- C-reactive protein level
- Serum vitamin B12
Correct Answer: Hemodynamic status, urine output, and renal function
Q13. Which statement about 5% dextrose in water (D5W) is correct regarding its distribution after infusion?
- It stays entirely in the intravascular space
- It becomes effectively hypotonic and distributes across total body water
- It acts as a strong colloid increasing oncotic pressure
- It is ideal for replacing extracellular sodium losses
Correct Answer: It becomes effectively hypotonic and distributes across total body water
Q14. A contraindication for dextran administration is:
- History of severe anaphylactic reaction to dextran
- Mild dehydration without hypotension
- Controlled hypertension
- Isolated hyponatremia
Correct Answer: History of severe anaphylactic reaction to dextran
Q15. Which volume expander is preferred when large volumes are needed and cost is a major constraint, with acceptable safety in most patients?
- Albumin 20%
- Crystalloids such as normal saline or Ringer’s lactate
- Hydroxyethyl starch
- Dextran 70
Correct Answer: Crystalloids such as normal saline or Ringer’s lactate
Q16. The mechanism by which hydroxyethyl starches exert volume expansion mainly involves:
- Increasing intracellular osmolarity
- Raising intravascular oncotic pressure via large polymer molecules
- Direct stimulation of aldosterone release
- Binding and inactivating sodium channels
Correct Answer: Raising intravascular oncotic pressure via large polymer molecules
Q17. Which adverse effect is specifically associated with rapid infusion of large volumes of normal saline?
- Hyperchloremic metabolic acidosis and decreased renal perfusion
- Immediate hemolysis
- Platelet hyperactivity
- Pulmonary fibrosis
Correct Answer: Hyperchloremic metabolic acidosis and decreased renal perfusion
Q18. For a patient with traumatic brain injury where osmotic balance is critical, which fluid is generally avoided due to risk of increasing intracranial pressure?
- Hypertonic saline
- 5% dextrose in water (D5W)
- Albumin 5%
- Plasma-lyte
Correct Answer: 5% dextrose in water (D5W)
Q19. In the context of perioperative fluid management, goal-directed therapy often uses:
- Fixed-rate large-volume crystalloid infusion for all patients
- Physiologic endpoints (stroke volume, cardiac output) to titrate crystalloids or colloids
- Only colloids irrespective of monitoring
- Only oral fluids
Correct Answer: Physiologic endpoints (stroke volume, cardiac output) to titrate crystalloids or colloids
Q20. Which statement about albumin as a plasma expander is true?
- Albumin has no effect on drug protein binding
- Albumin may alter binding of highly protein-bound drugs and affect their free fraction
- Albumin is synthetic and not derived from human plasma
- Albumin causes severe coagulopathy in therapeutic doses
Correct Answer: Albumin may alter binding of highly protein-bound drugs and affect their free fraction
Q21. The use of dextran is associated with which laboratory artifact that pharmacists should be aware of?
- False high blood glucose readings
- Interference with platelet function and clotting assays
- False low serum sodium levels
- Increased serum amylase readings
Correct Answer: Interference with platelet function and clotting assays
Q22. Which statement correctly describes the volume effect of 5% albumin when administered intravenously?
- 5% albumin exerts no oncotic effect and rapidly leaves the vasculature
- 5% albumin has an oncotic effect roughly equivalent to plasma and expands plasma volume by approximately the infused volume
- 5% albumin causes permanent intravascular sequestration of fluid
- 5% albumin acts identically to dextran 70
Correct Answer: 5% albumin has an oncotic effect roughly equivalent to plasma and expands plasma volume by approximately the infused volume
Q23. When compounding or handling plasma expanders in the hospital pharmacy, which practice is essential?
- Store all colloids at room temperature without expiry checks
- Follow aseptic technique, check compatibility, and adhere to storage and expiration instructions
- Always dilute colloids with dextrose before dispensing
- Freeze thawed albumin once for reuse
Correct Answer: Follow aseptic technique, check compatibility, and adhere to storage and expiration instructions
Q24. A patient with severe hypoalbuminemia from liver failure is most likely to benefit from which intervention for short-term intravascular volume support?
- Oral sodium restriction only
- Intravenous albumin infusion
- Routine use of dextran
- Administration of 5% dextrose
Correct Answer: Intravenous albumin infusion
Q25. Which factor is a major consideration in choosing between colloids and crystalloids for resuscitation?
- Color of the solution
- Cost, duration of intravascular effect, safety profile, and clinical context
- Patient hair color
- Time of day
Correct Answer: Cost, duration of intravascular effect, safety profile, and clinical context
Q26. Which type of study provided strong evidence linking certain HES preparations to increased mortality and kidney injury in critically ill patients?
- In vitro cell culture studies only
- Large randomized controlled clinical trials and meta-analyses
- Single-case reports
- Animal hair analysis
Correct Answer: Large randomized controlled clinical trials and meta-analyses
Q27. Plasma-lyte differs from normal saline primarily because:
- It contains higher chloride concentration than saline
- It is a balanced crystalloid with electrolyte composition closer to plasma and lower chloride
- It is a colloid
- It contains albumin
Correct Answer: It is a balanced crystalloid with electrolyte composition closer to plasma and lower chloride
Q28. Which monitoring parameter helps detect early fluid overload when administering volume expanders?
- Capillary refill only
- Daily weight, respiratory rate, oxygen saturation, and peripheral edema assessment
- Serum bilirubin every hour
- Fasting blood glucose
Correct Answer: Daily weight, respiratory rate, oxygen saturation, and peripheral edema assessment
Q29. In patients with sepsis, current evidence suggests initial fluid resuscitation should prioritize:
- Aggressive colloid use in all patients
- Careful use of crystalloids with individualized assessment and monitoring; avoid routine HES in severe sepsis
- Only albumin for every patient
- No fluids at all
Correct Answer: Careful use of crystalloids with individualized assessment and monitoring; avoid routine HES in severe sepsis
Q30. Which statement is true about the effect of large-volume crystalloids on interstitial fluid?
- Crystalloids remain entirely intravascular and do not expand interstitial fluid
- Large volumes of crystalloids distribute to interstitial and intracellular compartments, potentially causing edema
- Crystalloids shrink the interstitial compartment permanently
- Crystalloids convert to colloids after 24 hours
Correct Answer: Large volumes of crystalloids distribute to interstitial and intracellular compartments, potentially causing edema
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