TEST BANK MEDICAL SURGICAL NURSING CONCEPTS PRACTICE , 3RD EDITION BY SUSAN C.DEWIT , CANDICE K. KUMAGAI

SAMPLE Chapter 03: Fluid, Electrolytes, Acid-Base Balance, and Intravenous Therapy deWit: Medical-Surgical Nursing: Concepts & Practice, 3rd Edition MULTIPLE CHOICE 1. The nurse uses a diagram to demonstrate how in dehydration the water is drawn into the plasma from the cells by which process? a. Distillation b. Diffusion c. Filtration d. Osmosis ANS: D The process of osmosis accomplishes the movement of water from the cells into the plasma, causing dehydration. PTS: 1 DIF: Cognitive Level: Knowledge REF: 32 OBJ: 3 (theory) TOP: Dehydration KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 2. The nurse assessing a patient with vomiting and diarrhea observes that the urine is scant and concentrated. Which controlling factor is responsible for compensatory reabsorption of water? a. Osmoreceptors in the hypothalamus b. Antidiuretic hormone in the posterior pituitary c. Baroreceptors in the carotid sinus d. Insulin from the pancreas ANS: B The antidiuretic hormone controls how much water leaves the body by reabsorbing water in the renal tubules. TEST BANK MEDICAL SURGICAL NURSING CONCEPTS PRACTICE , 3RD EDITION BY SUSAN C.DEWIT , CANDICE K. KUMAGAI PTS: 1 DIF: Cognitive Level: Comprehension REF: 30 OBJ: 2 (theory) TOP: Regulation of Body Fluids KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 3. The nurse uses a picture to show how ions equalize their concentration by which passive transport process? a. Osmosis b. Filtration c. Titration d. Diffusion ANS: D Diffusion is the process by which substances move back and forth across compartment membranes until they are equally divided. PTS: 1 DIF: Cognitive Level: Knowledge REF: 31 OBJ: 2 (theory) TOP: Diffusion KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 4. Which term describes the active transport process that moves sodium and potassium into or out of cells? a. Filtration b. Sodium pump c. Diffusion d. Osmosis ANS: B The sodium pump is the mechanism by which sodium and potassium are moved into or out of cells regardless of the concentration. PTS: 1 DIF: Cognitive Level: Knowledge REF: 32 OBJ: 2 (theory) TOP: Active Transport KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 5. The patient taking furosemide (Lasix) to correct excess edema shows a weight loss of 5.5 pounds in 24 hours. The nurse calculates that this weight loss is equivalent to how many liters (L) of fluid? a. 1 L b. 1.5 L c. 2.0 L d. 2.5 L ANS: D Each kilogram (2.2 pounds) of weight loss is equivalent to 1 liter of fluid. Therefore, 5.5 pounds ÷ 2.2 pounds = 2.5 liters. PTS: 1 DIF: Cognitive Level: Application REF: 33, Clinical Cues OBJ: 1 (clinical) TOP: Fluid Loss KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation 6. The nurse is caring for a patient with a potassium level of 2.9 mEq/L. The nurse should carefully monitor the patient for which potential problem? a. Excessive urinary output b. Abdominal distention c. Increased reflexes d. Hyperactive bowel sounds ANS: B A potassium level lower than 3.5 mEq/L results in reduced urine output, cardiac dysrhythmia, muscle weakness, abdominal pain and distention, paralytic ileus, lethargy, and confusion. PTS: 1 DIF: Cognitive Level: Application REF: 41, Table 3-4 OBJ: 15 (clinical) TOP: Hypokalemia KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity: Basic Care and Comfort 7. While the nurse is washing the face of a patient in renal failure, the patient demonstrates a spasm of the lips and face. Which laboratory value corresponds with the nurse’s assessment findings? a. Potassium of 3.4 mEq/L b. Calcium of 7.9 mg/dL c. Sodium of 140 mEq/L d. Phosphorus of 2.8 mg/dL ANS: B Chvostek sign is a signal of hypocalcemia. It occurs when the facial nerve is tapped or stroked about an inch in front of the earlobe and results in unilateral twitching of the face. Hypocalcemia occurs when the calcium level drops below 8.4. A potassium level of 3.4 mEq/L and a sodium level of 140 mEq/L are findings within normal limits. A patient in renal failure is most likely to have a high phosphorus level rather than a low phosphorus level, and 2.8 mg/dL is within the range consistent with hypophosphatemia. PTS: 1 DIF: Cognitive Level: Analysis REF: 43, Table 3-4 OBJ: 4 (theory) TOP: Chvostek Sign KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease 8. Which finding is most important for the nurse to confirm prior to hanging an intravenous (IV) bag containing potassium? a. Verify a blood pressure of at least 60 mm Hg diastolic. b. Check for urine output of at least 30 mL/hr. c. Ensure filter placement on the IV line. d. Verify a pulse of at least 50 beats/min. ANS: B An adequate urine output must be present prior to the administration of potassium to ensure adequate excretion of potassium, preventing hyperkalemia. PTS: 1 DIF: Cognitive Level: Application REF: 43, Safety Alert OBJ: 10 (theory) TOP: Administration of IV Potassium KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential 9. Which statement demonstrates that the patient accurately understands the nurse’s teaching related to a low-sodium diet? a. “I can have all the dried fruits I want.” b. “I’m looking forward to a tall glass of tomato juice.” c. “I’m going to eat my favorite avocado and orange salad.” d. “I’m going to eat a cheeseburger with extra ketchup.” ANS: C Avocado and oranges have no significant sodium content. Dried fruits, tomato juice, cheese, and ketchup are foods with high sodium content that should be limited or avoided. PTS: 1 DIF: Cognitive Level: Application REF: 43, Nutrition Considerations OBJ: 4 (clinical) TOP: Low-Sodium Diet KEY: Nursing Process Step: Evaluation MSC: NCLEX: Physiological Integrity: Basic Care and Comfort 10. The nurse is caring for an 80-year-old patient. Which finding is the best early indicator of dehydration in this patient? a. Reduced skin turgor b. Constipation c. Increased temperature d. Thirst ANS: B The nurse understands that this patient’s age places him at greater risk for dehydration. Constipation is the best early indicator of dehydration in the older adult. Older adults have age-related poor skin turgor. Increased temperature and thirst are later signs of dehydration. PTS: 1 DIF: Cognitive Level: Analysis REF: 33-34 OBJ: 5 (theory) TOP: Dehydration in the Older Adult KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease 11. The patient with long-term obstructive pulmonary disease has a pH of 7, HCO3– of 18 mEq/L, and a PaCO2 of 40 mm Hg. These laboratory values are consistent with which acid-base imbalance? a. Respiratory alkalosis b. Metabolic alkalosis c. Respiratory acidosis d. Metabolic acidosis ANS: D These results are indicative of metabolic acidosis. PTS: 1 DIF: Cognitive Level: Application REF: 46 OBJ: 15 (clinical) TOP: Respiratory Acidosis KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance 12. The nurse is caring for a young patient with asthma. Which activity should the nurse encourage in order to help prevent respiratory acidosis? a. Engage in deep-breathing exercises every 2 hours. b. Drink 8 ounces of fluid every 4 hours. c. Ambulate for 15 minutes twice a day. d. Sleep with the head of the bed elevated 45 degrees. ANS: A Deep breathing blows off CO2, which reduces the acid ions, thus preventing respiratory acidosis. Drinking fluids prevents dehydration and keeps secretions moist and thin, and sleeping with the head of the bed elevated will ease breathing and improve gas exchange. Ambula