lOMoARcPSD|16253014
Chapter 10 study questions from the book
Adult Health I (Sam Houston State University)
Studocu is not sponsored or endorsed by any college or university
Downloaded by Caroline Rivera (carolineriverar@yahoo.com)
lOMoARcPSD|16253014
Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 15e
Chapter 10
Fluid and Electrolytes
A)
Nutritional status
B)
Potassium balance
C)
Calcium balance
D)
Fluid volume status
Ans:
D
rt
You are caring for a patient who has a diagnosis of syndrome of inappropriate antidiuretic hormone
secretion (SIADH). Your patients plan of care includes assessment of specific gravity every 4 hours. The
results of this test will allow the nurse to assess what aspect of the patients health?
es
A
1.
260
ot
Feedback:
A)
B)
C)
Diminished deep tendon reflexes
Tachycardia
Cool, clammy skin
Acute flank pain
ur
D)
You are caring for a patient admitted with a diagnosis of acute kidney injury. When you review your
patients most recent laboratory reports, you note that the patients magnesium levels are high. You should
prioritize assessment for which of the following health problems?
si
n
2.
gN
A specific gravity will detect if the patient has a fluid volume deficit or fluid volume excess. Nutrition,
potassium, and calcium levels are not directly indicated.
N
Ans:
3.
A
Feedback:
To gauge a patients magnesium status, the nurse should check deep tendon reflexes. If the reflex is
absent, this may indicate high serum magnesium. Tachycardia, flank pain, and cool, clammy skin are not
typically associated with hypermagnesemia.
You are working on a burns unit and one of your acutely ill patients is exhibiting signs and symptoms of
third spacing. Based on this change in status, you should expect the patient to exhibit signs and
symptoms of what imbalance?
Downloaded by Caroline Rivera (carolineriverar@yahoo.com)
lOMoARcPSD|16253014
Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 15e
Metabolic alkalosis
B)
Hypermagnesemia
C)
Hypercalcemia
D)
Hypovolemia
Ans:
D
es
A
rt
A)
261
Feedback:
Third-spacing fluid shift, which occurs when fluid moves out of the intravascular space but not into the
intracellular space, can cause hypovolemia. Increased calcium and magnesium levels are not indicators
of third-spacing fluid shift. Burns typically cause acidosis, not alkalosis.
A patient with a longstanding diagnosis of generalized anxiety disorder presents to the emergency room.
The triage nurse notes upon assessment that the patient is hyperventilating. The triage nurse is aware that
hyperventilation is the most common cause of which acidbase imbalance?
Respiratory acidosis
B)
Respiratory alkalosis
C)
Increased PaCO2
Ans:
si
n
D)
gN
A)
ot
4.
CNS disturbances
B
N
ur
Feedback:
5.
The most common cause of acute respiratory alkalosis is hyperventilation. Extreme anxiety can lead to
hyperventilation. Acute respiratory acidosis occurs in emergency situations, such as pulmonary edema,
and is exhibited by hypoventilation and decreased PaCO2. CNS disturbances are found in extreme
hyponatremia and fluid overload.
You are an emergency-room nurse caring for a trauma patient. Your patient has the following arterial
blood gas results: pH 7.26, PaCO2 28, HCO3 11 mEq/L. How would you interpret these results?
A)
Respiratory acidosis with no compensation
B)
Metabolic alkalosis with a compensatory alkalosis
Downloaded by Caroline Rivera (carolineriverar@yahoo.com)
lOMoARcPSD|16253014
Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 15e
C)
Metabolic acidosis with no compensation
D)
Metabolic acidosis with a compensatory respiratory alkalosis
Ans:
D
262
rt
Feedback:
A)
Air emboli
B)
Phlebitis
C)
Infiltration
D)
Fluid overload
Ans:
C
si
n
Feedback:
ot
You are making initial shift assessments on your patients. While assessing one patients peripheral IV
site, you note edema around the insertion site. How should you document this complication related to IV
therapy?
gN
6.
es
A
A low pH indicates acidosis (normal pH is 7.35 to 7.45). The PaCO3 is also low, which causes alkalosis.
The bicarbonate is low, which causes acidosis. The pH bicarbonate more closely corresponds with a
decrease in pH, making the metabolic component the primary problem.
ur
Infiltration is the administration of nonvesicant solution or medication into the surrounding tissue. This
can occur when the IV cannula dislodges or perforates the wall of the vein. Infiltration is characterized
by edema around the insertion site, leakage of IV fluid from the insertion site, discomfort and coolness
in the area of infiltration, and a significant decrease in the flow rate. Air emboli, phlebitis, and fluid
overload are not indications of infiltration.
7.
You are performing an admission assessment on an older adult patient newly admitted for end-stage
liver disease. What principle should guide your assessment of the patients skin turgor?
Overhydration is common among healthy older adults.
B)
Dehydration causes the skin to appear spongy.
C)
Inelastic skin turgor is a normal part of aging.
D)
Skin turgor cannot be assessed in patients over 70.
N
A)
Downloaded by Caroline Rivera (carolineriverar@yahoo.com)
lOMoARcPSD|16253014
Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 15e
Ans:
263
C
Feedback:
The physician has ordered a peripheral IV to be inserted before the patient goes for computed
tomography. What should the nurse do when selecting a site on the hand or arm for insertion of an IV
catheter?
es
A
8.
rt
Inelastic skin is a normal change of aging. However, this does not mean that skin turgor cannot be
assessed in older patients. Dehydration, not overhydration, causes inelastic skin with tenting.
Overhydration, not dehydration, causes the skin to appear edematous and spongy.
Choose a hairless site if available.
B)
Consider potential effects on the patients mobility when selecting a site.
C)
Have the patient briefly hold his arm over his head before insertion.
D)
Leave the tourniquet on for at least 3 minutes.
Ans:
B
gN
Feedback:
ot
A)
9.
A nurse in the neurologic ICU has orders to infuse a hypertonic solution into a patient with increased
intracranial pressure. This solution will increase the number of dissolved particles in the patients blood,
creating pressure for fluids in the tissues to shift into the capillaries and increase the blood volume. This
process is best described as which of the following?
Hydrostatic pressure
ur
A)
si
n
Ideally, both arms and hands are carefully inspected before choosing a specific venipuncture site that
does not interfere with mobility. Instruct the patient to hold his arm in a dependent position to increase
blood flow. Never leave a tourniquet in place longer than 2 minutes. The site does not necessarily need
to be devoid of hair.
N
B)
Osmosis and osmolality
C)
Diffusion
D)
Active transport
Ans:
B
Feedback:
Downloaded by Caroline Rivera (carolineriverar@yahoo.com)
lOMoARcPSD|16253014
Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 15e
264
Osmosis is the movement of fluid from a region of low solute concentration to a region of high solute
concentration across a semipermeable membrane. Hydrostatic pressure refers to changes in water or
volume related to water pressure. Diffusion is the movement of solutes from an area of greater
concentration to lesser concentration; the solutes in an intact vascular system are unable to move so
diffusion normally should not be taking place. Active transport is the movement of molecules against the
concentration gradient and requires adenosine triphosphate (ATP) as an energy source; this process
typically takes place at the cellular level and is not involved in vascular volume changes.
Hypophosphatemia
B)
Hypocalcemia
C)
Hypermagnesemia
D)
Hyperkalemia
Ans:
B
gN
Feedback:
ot
A)
es
A
rt
10. You are the surgical nurse caring for a 65-year-old female patient who is postoperative day 1 following a
thyroidectomy. During your shift assessment, the patient complains of tingling in her lips and fingers.
She tells you that she has an intermittent spasm in her wrist and hand and she exhibits increased muscle
tone. What electrolyte imbalance should you first suspect?
si
n
Tetany is the most characteristic manifestation of hypocalcemia and hypomagnesemia. Sensations of
tingling may occur in the tips of the fingers, around the mouth, and, less commonly, in the feet.
Hypophosphatemia creates central nervous dysfunction, resulting in seizures and coma.
Hypermagnesemia creates hypoactive reflexes and somnolence. Signs of hyperkalemia include
paresthesias and anxiety.
11. A nurse is planning care for a nephrology patient with a new nursing graduate. The nurse states, A
patient in renal failure partially loses the ability to regulate changes in pH. What is the cause of this
partial inability?
The kidneys regulate and reabsorb carbonic acid to change and maintain pH.
ur
A)
The kidneys buffer acids through electrolyte changes.
C)
The kidneys regenerate and reabsorb bicarbonate to maintain a stable pH.
D)
The kidneys combine carbonic acid and bicarbonate to maintain a stable pH.
Ans:
C
N
B)
Feedback:
Downloaded by Caroline Rivera (carolineriverar@yahoo.com)
lOMoARcPSD|16253014
Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 15e
265
The kidneys regulate the bicarbonate level in the ECF; they can regenerate bicarbonate ions as well as
reabsorb them from the renal tubular cells. In respiratory acidosis and most cases of metabolic acidosis,
the kidneys excrete hydrogen ions and conserve bicarbonate ions to help restore balance. The lungs
regulate and reabsorb carbonic acid to change and maintain pH. The kidneys do not buffer acids through
electrolyte changes; buffering occurs in reaction to changes in pH. Carbonic acid works as the chemical
medium to exchange O2 and CO2 in the lungs to maintain a stable pH whereas the kidneys use
bicarbonate as the chemical medium to maintain a stable pH by moving and eliminating H+.
B)
Metabolic acidosis
C)
Metabolic alkalosis
D)
Respiratory acidosis
Ans:
C
Feedback:
ot
Hypercalcemia
gN
A)
es
A
rt
12. You are caring for a 65-year-old male patient admitted to your medical unit 72 hours ago with pyloric
stenosis. A nasogastric tube placed upon admission has been on low intermittent suction ever since.
Upon review of the mornings blood work, you notice that the patients potassium is below reference
range. You should recognize that the patient may be at risk for what imbalance?
si
n
Probably the most common cause of metabolic alkalosis is vomiting or gastric suction with loss of
hydrogen and chloride ions. The disorder also occurs in pyloric stenosis in which only gastric fluid is
lost. Vomiting, gastric suction, and pyloric stenosis all remove potassium and can cause hypokalemia.
This patient would not be at risk for hypercalcemia; hyperparathyroidism and cancer account for almost
all cases of hypercalcemia. The nasogastric tube is removing stomach acid and will likely raise pH.
Respiratory acidosis is unlikely since no change was reported in the patients respiratory status.
13. The nurse is preparing to insert a peripheral IV catheter into a patient who will require fluids and IV
antibiotics. How should the nurse always start the process of insertion?
Leave one hand ungloved to assess the site.
ur
A)
N
B)
Cleanse the skin with normal saline.
C)
Ask the patient about allergies to latex or iodine.
D)
Remove excessive hair from the selected site.
Ans:
C
Feedback:
Downloaded by Caroline Rivera (carolineriverar@yahoo.com)
lOMoARcPSD|16253014
Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 15e
266
Before preparing the skin, the nurse should ask the patient if he or she is allergic to latex or iodine,
which are products commonly used in preparing for IV therapy. A local reaction could result in irritation
to the IV site, or, in the extreme, it could result in anaphylaxis, which can be life threatening. Both hands
should always be gloved when preparing for IV insertion, and latex-free gloves must be used or the
patient must report not having latex allergies. The skin is not usually cleansed with normal saline prior to
insertion. Removing excessive hair at the selected site is always secondary to allergy inquiry.
B)
Metabolic alkalosis
C)
Respiratory alkalosis
D)
Metabolic acidosis
Ans:
A
es
A
Respiratory acidosis
ot
A)
rt
14. A patient who is being treated for pneumonia starts complaining of sudden shortness of breath. An
arterial blood gas (ABG) is drawn. The ABG has the following values: pH 7.21, PaCO2 64 mm Hg,
HCO3 = 24 mm Hg. What does the ABG reflect?
gN
Feedback:
si
n
The pH is below 7.40, PaCO2 is greater than 40, and the HCO3 is normal; therefore, it is a respiratory
acidosis, and compensation by the kidneys has not begun, which indicates this was probably an acute
event. The HCO3 of 24 is within the normal range so it is not metabolic alkalosis. The pH of 7.21
indicates an acidosis, not alkalosis. The pH of 7.21 indicates it is an acidosis but the HCO3 of 24 is
within the normal range, ruling out metabolic acidosis.
15. One day after a patient is admitted to the medical unit, you note that the patient is oliguric. You notify
the acute-care nurse practitioner who orders a fluid challenge of 200 mL of normal saline solution over
15 minutes. This intervention will achieve which of the following?
Help distinguish hyponatremia from hypernatremia
ur
A)
Help evaluate pituitary gland function
C)
Help distinguish reduced renal blood flow from decreased renal function
N
B)
D)
Help provide an effective treatment for hypertension-induced oliguria
Ans:
C
Feedback:
If a patient is not excreting enough urine, the health care provider needs to determine whether the
Downloaded by Caroline Rivera (carolineriverar@yahoo.com)
lOMoARcPSD|16253014
Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 15e
267
depressed renal function is the result of reduced renal blood flow, which is a fluid volume deficit (FVD
or prerenal azotemia), or acute tubular necrosis that results in necrosis or cellular death from prolonged
FVD. A typical example of a fluid challenge involves administering 100 to 200 mL of normal saline
solution over 15 minutes. The response by a patient with FVD but with normal renal function is
increased urine output and an increase in blood pressure. Laboratory examinations are needed to
distinguish hyponatremia from hypernatremia. A fluid challenge is not used to evaluate pituitary gland
function. A fluid challenge may provide information regarding hypertension-induced oliguria, but it is
not an effective treatment.
es
A
rt
16. The community health nurse is performing a home visit to an 84-year-old woman recovering from hip
surgery. The nurse notes that the woman seems uncharacteristically confused and has dry mucous
membranes. When asked about her fluid intake, the patient states, I stop drinking water early in the day
because it is just too difficult to get up during the night to go to the bathroom. What would be the nurses
best response?
I will need to have your medications adjusted so you will need to be readmitted to the hospital for a
complete workup.
B)
Limiting your fluids can create imbalances in your body that can result in confusion. Maybe we
need to adjust the timing of your fluids.
C)
It is normal to be a little confused following surgery, and it is safe not to urinate at night.
D)
If you build up too much urine in your bladder, it can cause you to get confused, especially when
your body is under stress.
Ans:
B
Feedback:
gN
ot
A)
si
n
In elderly patients, the clinical manifestations of fluid and electrolyte disturbances may be subtle or
atypical. For example, fluid deficit may cause confusion or cognitive impairment in the elderly person.
There is no mention of medications in the stem of the question or any specific evidence given for the
need for readmission to the hospital. Confusion is never normal, common, or expected in the elderly.
Urinary retention does normally cause confusion.
N
ur
17. A 73-year-old man comes into the emergency department (ED) by ambulance after slipping on a small
carpet in his home. The patient fell on his hip with a resultant fracture. He is alert and oriented; his
pupils are equal and reactive to light and accommodation. His heart rate is elevated, he is anxious and
thirsty, a Foley catheter is placed, and 40 mL of urine is present. What is the nurses most likely
explanation for the low urine output?
A)
The man urinated prior to his arrival to the ED and will probably not need to have the Foley
catheter kept in place.
B)
The man likely has a traumatic brain injury, lacks antidiuretic hormone (ADH), and needs
vasopressin.
C)
The man is experiencing symptoms of heart failure and is releasing atrial natriuretic peptide that
results in decreased urine output.
Downloaded by Caroline Rivera (carolineriverar@yahoo.com)
lOMoARcPSD|16253014
Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 15e
268
D)
The man is having a sympathetic reaction, which has stimulated the reninangiotensinaldosterone
system that results in diminished urine output.
Ans:
D
Feedback:
es
A
rt
Renin is released by the juxtaglomerular cells of the kidneys in response to decreased renal perfusion.
Angiotensin-converting enzyme converts angiotensin I to angiotensin II. Angiotensin II, with its
vasoconstrictor properties, increases arterial perfusion pressure and stimulates thirst. As the sympathetic
nervous system is stimulated, aldosterone is released in response to an increased release of renin, which
decreases urine production. Based on the nursing assessment and mechanism of injury, this is the most
likely causing the lower urine output. The man urinating prior to his arrival to the ED is unlikely; the fall
and hip injury would make his ability to urinate difficult. No assessment information indicates he has a
head injury or heart failure.
Leave the hair intact.
B)
Shave the area.
C)
Clip the hair in the area.
D)
Remove the hair with a depilatory.
Ans:
C
si
n
gN
A)
ot
18. A nurse educator is reviewing peripheral IV insertion with a group of novice nurses. How should these
nurses be encouraged to deal with excess hair at the intended site?
Feedback:
ur
Hair can be a source of infection and should be removed by clipping; it should not be left at the site.
Shaving the area can cause skin abrasions, and depilatories can irritate the skin.
N
19. You are the nurse evaluating a newly admitted patients laboratory results, which include several values
that are outside of reference ranges. Which of the following would cause the release of antidiuretic
hormone (ADH)?
A)
Increased serum sodium
B)
Decreased serum potassium
C)
Decreased hemoglobin
D)
Increased platelets
Downloaded by Caroline Rivera (carolineriverar@yahoo.com)
lOMoARcPSD|16253014
Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 15e
Ans:
269
A
Feedback:
rt
Increased serum sodium causes increased thirst and the release of ADH by the posterior pituitary gland.
When serum osmolality decreases and thirst and ADH secretions are suppressed, the kidney excretes
more water to restore normal osmolality. Levels of potassium, hemoglobin, and platelets do not directly
affect ADH release.
es
A
20. A newly graduated nurse is admitting a patient with a long history of emphysema. The new nurses
preceptor is going over the patients past lab reports with the new nurse. The nurse takes note that the
patients PaCO2 has been between 56 and 64 mm Hg for several months. The preceptor asks the new
nurse why they will be cautious administering oxygen. What is the new nurses best response?
The patients calcium will rise dramatically due to pituitary stimulation.
B)
Oxygen will increase the patients intracranial pressure and create confusion.
C)
Oxygen may cause the patient to hyperventilate and become acidotic.
D)
Using oxygen may result in the patient developing carbon dioxide narcosis and hypoxemia.
Ans:
D
gN
Feedback:
ot
A)
si
n
When PaCO2 chronically exceeds 50 mm Hg, it creates insensitivity to CO2 in the respiratory medulla,
and the use of oxygen may result in the patient developing carbon dioxide narcosis and hypoxemia. No
information indicates the patients calcium will rise dramatically due to pituitary stimulation. No
feedback system that oxygen stimulates would create an increase in the patients intracranial pressure and
create confusion. Increasing the oxygen would not stimulate the patient to hyperventilate and become
acidotic; rather, it would cause hypoventilation and acidosis.
ur
21. The nurse is providing care for a patient with chronic obstructive pulmonary disease. When describing
the process of respiration the nurse explains how oxygen and carbon dioxide are exchanged between the
pulmonary capillaries and the alveoli. The nurse is describing what process?
N
A)
Diffusion
B)
Osmosis
C)
Active transport
D)
Filtration
Ans:
A
Downloaded by Caroline Rivera (carolineriverar@yahoo.com)
lOMoARcPSD|16253014
Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 15e
270
Feedback:
es
A
rt
Diffusion is the natural tendency of a substance to move from an area of higher concentration to one of
lower concentration. It occurs through the random movement of ions and molecules. Examples of
diffusion are the exchange of oxygen and carbon dioxide between the pulmonary capillaries and alveoli
and the tendency of sodium to move from the ECF compartment, where the sodium concentration is
high, to the ICF, where its concentration is low. Osmosis occurs when two different solutions are
separated by a membrane that is impermeable to the dissolved substances; fluid shifts through the
membrane from the region of low solute concentration to the region of high solute concentration until
the solutions are of equal concentration. Active transport implies that energy must be expended for the
movement to occur against a concentration gradient. Movement of water and solutes occurring from an
area of high hydrostatic pressure to an area of low hydrostatic pressure is filtration.
22. When planning the care of a patient with a fluid imbalance, the nurse understands that in the human
body, water and electrolytes move from the arterial capillary bed to the interstitial fluid. What causes
this to occur?
Active transport of hydrogen ions across the capillary walls
B)
Pressure of the blood in the renal capillaries
C)
Action of the dissolved particles contained in a unit of blood
D)
Hydrostatic pressure resulting from the pumping action of the heart
Ans:
D
si
n
Feedback:
gN
ot
A)
ur
An example of filtration is the passage of water and electrolytes from the arterial capillary bed to the
interstitial fluid; in this instance, the hydrostatic pressure results from the pumping action of the heart.
Active transport does not move water and electrolytes from the arterial capillary bed to the interstitial
fluid, filtration does. The number of dissolved particles in a unit of blood is concerned with osmolality.
The pressure in the renal capillaries causes renal filtration.
N
23. The baroreceptors, located in the left atrium and in the carotid and aortic arches, respond to changes in
the circulating blood volume and regulate sympathetic and parasympathetic neural activity as well as
endocrine activities. Sympathetic stimulation constricts renal arterioles, causing what effect?
A)
Decrease in the release of aldosterone
B)
Increase of filtration in the Loop of Henle
C)
Decrease in the reabsorption of sodium
D)
Decrease in glomerular filtration
Downloaded by Caroline Rivera (carolineriverar@yahoo.com)
lOMoARcPSD|16253014
Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 15e
Ans:
271
D
Feedback:
rt
Sympathetic stimulation constricts renal arterioles; this decreases glomerular filtration, increases the
release of aldosterone, and increases sodium and water reabsorption. None of the other listed options
occurs with increased sympathetic stimulation.
es
A
24. You are the nurse caring for a 77-year-old male patient who has been involved in a motor vehicle
accident. You and your colleague note that the patients labs indicate minimally elevated serum
creatinine levels, which your colleague dismisses. What can this increase in creatinine indicate in older
adults?
Substantially reduced renal function
B)
Acute kidney injury
C)
Decreased cardiac output
D)
Alterations in ratio of body fluids to muscle mass
Ans:
A
gN
Feedback:
ot
A)
si
n
Normal physiologic changes of aging, including reduced cardiac, renal, and respiratory function, and
reserve and alterations in the ratio of body fluids to muscle mass, may alter the responses of elderly
people to fluid and electrolyte changes and acidbase disturbances. Renal function declines with age, as
do muscle mass and daily exogenous creatinine production. Therefore, high-normal and minimally
elevated serum creatinine values may indicate substantially reduced renal function in older adults. Acute
kidney injury is likely to cause a more significant increase in serum creatinine.
ur
25. You are the nurse caring for a patient who is to receive IV daunorubicin, a chemotherapeutic agent. You
start the infusion and check the insertion site as per protocol. During your most recent check, you note
that the IV has infiltrated so you stop the infusion. What is your main concern with this infiltration?
Extravasation of the medication
B)
Discomfort to the patient
C)
Blanching at the site
D)
Hypersensitivity reaction to the medication
Ans:
A
N
A)
Downloaded by Caroline Rivera (carolineriverar@yahoo.com)
lOMoARcPSD|16253014
Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 15e
272
Feedback:
Irritating medications, such as chemotherapeutic agents, can cause pain, burning, and redness at the site.
Blistering, inflammation, and necrosis of tissues can occur. The extent of tissue damage is determined by
the medication concentration, the quantity that extravasated, infusion site location, the tissue response,
and the extravasation duration. Extravasation is the priority over the other listed consequences.
B)
Dilute urine
C)
Increased muscle tone
D)
Joint pain
Ans:
B
ot
Diarrhea
gN
A)
es
A
rt
26. The nurse caring for a patient post colon resection is assessing the patient on the second postoperative
day. The nasogastric tube (NG) remains patent and continues at low intermittent wall suction. The IV is
patent and infusing at 125 mL/hr. The patient reports pain at the incision site rated at a 3 on a 0-to-10
rating scale. During your initial shift assessment, the patient complains of cramps in her legs and a
tingling sensation in her feet. Your assessment indicates decreased deep tendon reflexes (DTRs) and you
suspect the patient has hypokalemia. What other sign or symptom would you expect this patient to
exhibit?
Feedback:
ur
si
n
Manifestations of hypokalemia include fatigue, anorexia, nausea, vomiting, muscle weakness, leg
cramps, decreased bowel motility, paresthesias (numbness and tingling), and dysrhythmias. If prolonged,
hypokalemia can lead to an inability of the kidneys to concentrate urine, causing dilute urine (resulting
in polyuria, nocturia) and excessive thirst. Potassium depletion suppresses the release of insulin and
results in glucose intolerance. Decreased muscle strength and DTRs can be found on physical
assessment. You would expect decreased, not increased, muscle strength with hypokalemia. The patient
would not have diarrhea following bowel surgery, and increased bowel motility is inconsistent with
hypokalemia.
N
27. You are caring for a patient who is being treated on the oncology unit with a diagnosis of lung cancer
with bone metastases. During your assessment, you note the patient complains of a new onset of
weakness with abdominal pain. Further assessment suggests that the patient likely has a fluid volume
deficit. You should recognize that this patient may be experiencing what electrolyte imbalance?
A)
Hypernatremia
B)
Hypomagnesemia
C)
Hypophosphatemia
D)
Hypercalcemia
Downloaded by Caroline Rivera (carolineriverar@yahoo.com)
lOMoARcPSD|16253014
Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 15e
Ans:
273
D
Feedback:
es
A
rt
The most common causes of hypercalcemia are malignancies and hyperparathyroidism. Anorexia,
nausea, vomiting, and constipation are common symptoms of hypercalcemia. Dehydration occurs with
nausea, vomiting, anorexia, and calcium reabsorption at the proximal renal tubule. Abdominal and bone
pain may also be present. Primary manifestations of hypernatremia are neurologic and would not include
abdominal pain and dehydration. Tetany is the most characteristic manifestation of hypomagnesemia,
and this scenario does not mention tetany. The patients presentation is inconsistent with
hypophosphatemia.
28. A medical nurse educator is reviewing a patients recent episode of metabolic acidosis with members of
the nursing staff. What should the educator describe about the role of the kidneys in metabolic acidosis?
The kidneys retain hydrogen ions and excrete bicarbonate ions to help restore balance.
B)
The kidneys excrete hydrogen ions and conserve bicarbonate ions to help restore balance.
C)
The kidneys react rapidly to compensate for imbalances in the body.
D)
The kidneys regulate the bicarbonate level in the intracellular fluid.
Ans:
B
gN
ot
A)
si
n
Feedback:
ur
The kidneys regulate the bicarbonate level in the ECF; they can regenerate bicarbonate ions as well as
reabsorb them from the renal tubular cells. In respiratory acidosis and most cases of metabolic acidosis,
the kidneys excrete hydrogen ions and conserve bicarbonate ions to help restore balance. In respiratory
and metabolic alkalosis, the kidneys retain hydrogen ions and excrete bicarbonate ions to help restore
balance. The kidneys obviously cannot compensate for the metabolic acidosis created by renal failure.
Renal compensation for imbalances is relatively slow (a matter of hours or days).
29. The nurse in the medical ICU is caring for a patient who is in respiratory acidosis due to inadequate
ventilation. What diagnosis could the patient have that could cause inadequate ventilation?
Endocarditis
B)
Multiple myeloma
C)
Guillain-Barr syndrome
D)
Overdose of amphetamines
N
A)
Downloaded by Caroline Rivera (carolineriverar@yahoo.com)
lOMoARcPSD|16253014
Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 15e
Ans:
274
C
Feedback:
es
A
rt
Respiratory acidosis is always due to inadequate excretion of CO2 with inadequate ventilation, resulting
in elevated plasma CO2 concentrations and, consequently, increased levels of carbonic acid. Acute
respiratory acidosis occurs in emergency situations, such as acute pulmonary edema, aspiration of a
foreign object, atelectasis, pneumothorax, overdose of sedatives, sleep apnea, administration of oxygen
to a patient with chronic hypercapnia (excessive CO2 in the blood), severe pneumonia, and acute
respiratory distress syndrome. Respiratory acidosis can also occur in diseases that impair respiratory
muscles, such as muscular dystrophy, myasthenia gravis, and Guillain-Barr syndrome. The other listed
diagnoses are not associated with respiratory acidosis.
Respiratory acidosis
B)
Metabolic alkalosis
C)
Respiratory alkalosis
D)
Mixed acidbase disorder
Ans:
D
si
n
Feedback:
gN
A)
ot
30. The ICU nurse is caring for a patient who experienced trauma in a workplace accident. The patient is
complaining of having trouble breathing with abdominal pain. An ABG reveals the following results: pH
7.28, PaCO2 50 mm Hg, HCO3 23 mEq/L. The nurse should recognize the likelihood of what acidbase
disorder?
ur
Patients can simultaneously experience two or more independent acidbase disorders. A normal pH in the
presence of changes in the PaCO2 and plasma HCO3 concentration immediately suggests a mixed
disorder, making the other options incorrect.
31. A patient has questioned the nurses administration of IV normal saline, asking whether sterile water
would be a more appropriate choice than saltwater. Under what circumstances would the nurse
administer electrolyte-free water intravenously?
Never, because it rapidly enters red blood cells, causing them to rupture.
B)
When the patient is severely dehydrated resulting in neurologic signs and symptoms
C)
When the patient is in excess of calcium and/or magnesium ions
D)
When a patients fluid volume deficit is due to acute or chronic renal failure
N
A)
Downloaded by Caroline Rivera (carolineriverar@yahoo.com)
lOMoARcPSD|16253014
Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 15e
Ans:
275
A
Feedback:
rt
IV solutions contain dextrose or electrolytes mixed in various proportions with water. Pure, electrolytefree water can never be administered by IV because it rapidly enters red blood cells and causes them to
rupture.
B)
Increased conservation of sodium
C)
Increased total body water
D)
Decreased renal blood flow
E)
Decreased excretion of potassium
Ans:
A, D, E
ot
Decreased kidney mass
gN
A)
es
A
32. A gerontologic nurse is teaching students about the high incidence and prevalence of dehydration in
older adults. What factors contribute to this phenomenon? Select all that apply.
Feedback:
si
n
Dehydration in the elderly is common as a result of decreased kidney mass, decreased glomerular
filtration rate, decreased renal blood flow, decreased ability to concentrate urine, inability to conserve
sodium, decreased excretion of potassium, and a decrease of total body water.
ur
33. You are called to your patients room by a family member who voices concern about the patients status.
On assessment, you find the patient tachypnic, lethargic, weak, and exhibiting a diminished cognitive
ability. You also find 3+ pitting edema. What electrolyte imbalance is the most plausible cause of this
patients signs and symptoms?
Hypocalcemia
B)
Hyponatremia
N
A)
C)
Hyperchloremia
D)
Hypophosphatemia
Ans:
C
Feedback:
Downloaded by Caroline Rivera (carolineriverar@yahoo.com)
lOMoARcPSD|16253014
Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 15e
276
The signs and symptoms of hyperchloremia are the same as those of metabolic acidosis: hypervolemia
and hypernatremia. Tachypnea; weakness; lethargy; deep, rapid respirations; diminished cognitive
ability; and hypertension occur. If untreated, hyperchloremia can lead to a decrease in cardiac output,
dysrhythmias, and coma. A high chloride level is accompanied by a high sodium level and fluid
retention. With hypocalcemia, you would expect tetany. There would not be edema with hyponatremia.
Signs or symptoms of hypophosphatemia are mainly neurologic.
Metastases
B)
Excessive potassium intake
C)
Water intoxication
D)
Excessive administration of chloride
Ans:
D
ot
A)
es
A
rt
34. Diagnostic testing has been ordered to differentiate between normal anion gap acidosis and high anion
gap acidosis in an acutely ill patient. What health problem typically precedes normal anion gap acidosis?
gN
Feedback:
Normal anion gap acidosis results from the direct loss of bicarbonate, as in diarrhea, lower intestinal
fistulas, ureterostomies, and use of diuretics; early renal insufficiency; excessive administration of
chloride; and the administration of parenteral nutrition without bicarbonate or bicarbonate-producing
solutes (e.g., lactate). Based on these facts, the other listed options are incorrect.
A)
Cimetidine
Maalox
ur
B)
si
n
35. The nurse is caring for a patient in metabolic alkalosis. The patient has an NG tube to low intermittent
suction for a diagnosis of bowel obstruction. What drug would the nurse expect to find on the
medication orders?
Potassium chloride elixir
D)
Furosemide
Ans:
A
N
C)
Feedback:
H2 receptor antagonists, such as cimetidine (Tagamet), reduce the production of gastric HCl, thereby
decreasing the metabolic alkalosis associated with gastric suction. Maalox is an oral simethicone used to
Downloaded by Caroline Rivera (carolineriverar@yahoo.com)
lOMoARcPSD|16253014
Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 15e
277
break up gas in the GI system and would be of no benefit in treating a patient in metabolic alkalosis. KCl
would only be given if the patient were hypokalemic, which is not stated in the scenario. Furosemide
(Lasix) would only be given if the patient were fluid overloaded, which is not stated in the scenario.
rt
36. You are caring for a patient with a diagnosis of pancreatitis. The patient was admitted from a homeless
shelter and is a vague historian. The patient appears malnourished and on day 3 of the patients admission
total parenteral nutrition (TPN) has been started. Why would you know to start the infusion of TPN
slowly?
Patients receiving TPN are at risk for hypercalcemia if calories are started too rapidly.
B)
Malnourished patients receiving parenteral nutrition are at risk for hypophosphatemia if calories
are started too aggressively.
C)
Malnourished patients who receive fluids too rapidly are at risk for hypernatremia.
D)
Patients receiving TPN need a slow initiation of treatment in order to allow digestive enzymes to
accumulate
Ans:
B
ot
es
A
A)
gN
Feedback:
si
n
The nurse identifies patients who are at risk for hypophosphatemia and monitors them. Because
malnourished patients receiving parenteral nutrition are at risk when calories are introduced too
aggressively, preventive measures involve gradually introducing the solution to avoid rapid shifts of
phosphorus into the cells. Patients receiving TPN are not at risk for hypercalcemia or hypernatremia if
calories or fluids are started to rapidly. Digestive enzymes are not a relevant consideration.
37. You are doing discharge teaching with a patient who has hypophosphatemia during his time in hospital.
The patient has a diet ordered that is high in phosphate. What foods would you teach this patient to
include in his diet? Select all that apply.
Milk
ur
A)
Beef
C)
Poultry
N
B)
D)
Green vegetables
E)
Liver
Ans:
A, C, E
Feedback:
Downloaded by Caroline Rivera (carolineriverar@yahoo.com)
lOMoARcPSD|16253014
Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 15e
278
If the patient experiences mild hypophosphatemia, foods such as milk and milk products, organ meats,
nuts, fish, poultry, and whole grains should be encouraged.
Hypertension
B)
Kussmaul respirations
C)
Increased DTRs
D)
Shallow respirations
Ans:
D
es
A
A)
rt
38. You are caring for a patient with a secondary diagnosis of hypermagnesemia. What assessment finding
would be most consistent with this diagnosis?
ot
Feedback:
gN
If hypermagnesemia is suspected, the nurse monitors the vital signs, noting hypotension and shallow
respirations. The nurse also observes for decreased DTRs and changes in the level of consciousness.
Kussmaul breathing is a deep and labored breathing pattern associated with severe metabolic acidosis,
particularly diabetic ketoacidosis (DKA), but also renal failure. This type of patient is associated with
decreased DTRs, not increased DTRs.
A)
B)
Apples
Asparagus
Carrots
ur
C)
si
n
39. A patients most recent laboratory results show a slight decrease in potassium. The physician has opted to
forego drug therapy but has suggested increasing the patients dietary intake of potassium. Which of the
following would be a good source of potassium?
Bananas
Ans:
D
N
D)
Feedback:
Bananas are high in potassium. Apples, carrots, and asparagus are not high in potassium.
40. The nurse is assessing the patient for the presence of a Chvosteks sign. What electrolyte imbalance
would a positive Chvosteks sign indicate?
Downloaded by Caroline Rivera (carolineriverar@yahoo.com)
lOMoARcPSD|16253014
Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 15e
Hypermagnesemia
B)
Hyponatremia
C)
Hypocalcemia
D)
Hyperkalemia
Ans:
C
rt
A)
279
es
A
Feedback:
N
ur
si
n
gN
ot
You can induce Chvosteks sign by tapping the patients facial nerve adjacent to the ear. A brief
contraction of the upper lip, nose, or side of the face indicates Chvosteks sign. Both hypomagnesemia
and hypocalcemia may be tested using the Chvosteks sign.
Downloaded by Caroline Rivera (carolineriverar@yahoo.com)