TEST BANK For Medical-
p p p
Surgical Nursing, Concepts and Practice, 5th Edition (Stromberg
p p p p p p p
, 2023), p p
Whichpbodypfluidpcompartmentpispconsideredpthep"thirdpspace?"
A.pExtracellularpfluidp
B.pIntracellularpfluidp
C.pInterstitialpfluidp
D.pBloodp(plasma)p-pANSWER:pC.
Thepextracellularpfluidpincludespbothpthepbloodp(plasma)pvolumepandpthepinterstitialpfl
uid.pAnotherptermpforpthepinterstitialpfluidpispthepthirdpspace,pwhichpispbetweenpthepcell
spratherpthanpinsidepthepcellsporpinpthepbloodp(plasma).
Whatpimmediatepresponsepdoespthepnursepexpectpaspapresultpofpinfusingp1pliterpofpanpis
otonicpintravenouspsolutionpintopapclientpoverpap3-
hourptimepperiodpifpurinepoutputpremainspatp100pmLpperphour?p
A.pExtracellularpfluidp(ECF)posmolaritypincreases;pbodypweightpincreasesp
B.pExtracellularpfluidp(ECF)posmolaritypdecreases;pbodypweightpdecreasesp
C.pExtracellularpfluidp(ECF)posmolaritypispunchanged;pbodypweightpincreasesp
D.pExtracellularpfluidp(ECF)posmolaritypispunchanged;pbodypweightpdecreasesp-
pANSWER:pC.
Isotonicpsolutionsphavepthepsameptonicitypaspplasmapandpotherpextracellularpfluids.pTh
erefore,pthepintravenouspfluidpwouldpnotpchangepthepECFposmolarity.pWhenp1000pmLpi
spinfusedpwithinp3phourspandpthepclientponlypurinatesp300pmL,pthepextrapfluidpwouldpinc
reasepthepclient'spweight.pRememberpthatp1pliterpofpfluidpispequalptop2.2plb.
WhichpIVpfluidpdoespthepnursepexpectptopadministerptopapclientpwhopispprescribedptopre
ceivephypotonicpfluids?p
A.p9%psalinep
B.p3%psalinep
C.p0.9%psalinep
D.p0.45%psalinep-pANSWER:pD.
Isotonicpsalinepisp0.9%.pThepoptionspofp9%psalinepandp3%psalineparephypertonic.pOnlyp0.
45%psalinepispaphypotonicpsolution.
Forpwhichpindicationpofpapfluidpbalancepproblempwillpthepnursepassesspinpanpolderpclient
patpriskpforpfluidpandpelectrolytepproblems?p
A.pFeverp
,B.pElevatedpbloodppressurep
C.pPoorpskinpturgorp
D.pMentalpstatuspchangesp-pANSWER:pD.
Althoughpallpofpthepassessmentpfindingsplistedpmaypappearpwithpapfluidpbalancepproble
m,pthepfirstpindicationpinpolderpclientspispapchangepinpmentalpstatus.
Whichptypespofpfluidplossparepconsideredp"insensiblepfluidploss?"pSelectpallpthatpapply.p
A.pSweatp
B.pSalivationp
C.pUrinep
D.pDiarrheap
E.pVomitp
F.pWoundpdrainagep-pANSWER:pA,pB,pD,pE,pFp
Ofpallpthesepfluidplossproutes,ptheponlyponepthatpadjustsporpispregulatedpispurinepoutput.p
Thepothersprepresentpfluidplosspthatphaspnopregulatoryporpcontrolpmechanisms,palsopkn
ownpaspinsensible.
Whichpclientpfactorspaffectpthepamountpandpdistributionpofpbodypfluids?pSelectpallpthatp
apply.p
A.pRacep
B.pAgep
C.pGenderp
D.pHeight
E.pBodypfatp
F.pMusclepmassp-pANSWER:pB,pC,pE,pFp
Totalpbodypwaterpinpadultspvariespbypage,pgender,pdegreepofpmusclepmass,pandppercent
pofpbodypfat.pWaterpmakespuppaboutp55%ptop60%pofptotalpweightpforpyoungerpadultspan
dp50%ptop55%pofptotalpweightpforpolderpadults.pWomenpofpallpagespusuallyphavepaplower
ppercentagepofpbodypwaterpthanpdopmenpofpthepsamepagespbecausepofpgreaterpmusclep
mass.pFatpcellspcontainplittleporpnopwater.pThephigherptheppercentagepofpbodypfat,pthepl
owerptheppercentagepofptotalpbodypwater.pNeitherpracepnorpheightpaffectptotalpbodypw
ater.
Whichppotentialpproblemspdoespthepnursepassesspforpwhenpcaringpforpapclientpwhosepu
rinepoutputpisplesspthanpwhatpispneededpaspthepobligatorypurinepoutput?pSelectpallpthatp
apply.p
A.pLethalpelectrolytepimbalancesp
B.pAlkalosisp
C.pUrinepbecomespdiluted
D.pToxicpbuilduppofpnitrogenp
F.pIncreasedpinfectionpriskp
,F.pAcidosisp-pANSWER:pA,pD,pFp
Thepkidneypispthepmainpwaypexcesspwastepproductspandpelectrolytesparepeliminatedpfro
mpthepbody.pItpmustpcausepap500ptop600pmLpoutputpdailypforpadequatepeliminationpofpt
hesepproductspdaily.pWhenpthesepproductsparepretained,pthepconsequencespincludeplet
halplevelspofpelectrolytes,ptoxicpbuilduppofpnitrogen,pandpretentionpofphydrogenpionspca
usingpacidosis.
Withpwhichpclientpdoespthepnursepremainpmostpalertpforpanpelectrolytepimbalance?p
A.p49-year-oldpwithpintermittentpasthmapwhopalsopusespanpalbuterolpinhalerpPRNp
B.p60-yearpoldpwithpapsprainedpwristpwhopalsoptakespacetaminophenpforppainp
C.p72-year-oldpwithpdiabetespmellituspwhopalsoptakespapdiureticpdailyp
D.p80-year-oldpanemiapwhopalsoptakepanpironpsupplementp-pANSWER:pC.p
Thispclientphaspthreepriskpfactorspforpanpelectrolytepimbalance:polderpadult,pendocrinep
disorder,pandptakespapdiureticpdaily,pwhichpalterspfluidpandpelectrolytepexcretion.pAltho
ughpthep80-year-
oldphaspanpincreasedpriskpbecausepofpage,pheporpshephaspnopotherpspecificpriskpfactorspli
sted.
Whichpelectrolytepchangepdoespthepnursepexpectptopseepinpapclientpwhopproducespexce
ssivepamountspofpaldosterone?p
A.pLowpserumpsodiumplevelp
B.pHighpserumppotassiumplevelp
C.pLowpserumpcalciumplevelp
D.pHighpserumpsodiumplevelp-pANSWER:pD.
Aldosteronepincreasespsodiumpandpwaterpreabsorptionpinpthepkidney.pHigherpthanpnor
malplevelspofpthisphormonepusuallypresultpinphighpserumpsodiumplevels
Whichpserumpelectrolytepfindingponpapnewlypadmittedpclientpdoespthepnursepreportpim
mediatelyptopthephealthpcarepprovider?pSelectpallpthatpapply.p
A.pPotassiump2.8pmEq/Lp(mmol/L)p
B.pSodiump143pmEq/Lp(mmol/Lp
C.pCalciump9.9pmg/dLp(2.59pmmol/L)p
D.pChloridep101pmEq/Lp(mmol/L)p
E.pChloridep98pmEq/Lp(mmol/L)p
F.pMagnesiump1.2pmEq/Lp(0.7pmmol/Lp-pANSWER:pA,pFp
Thepserumppotassiumpandpserumpmagnesiumplevelsparepbothplowerpthanpnormalp(pota
ssiump5p3.5ptop5.0pmEq/Lporpmmol/L;pmagnesiump5p1.8ptop2.6pmEq/Lporp0.74ptop1.07pm
mol/L).pLowplevelspofpthesepelectrolytespcanphavepprofoundpeffectsponpheartpfunction.p
Allpotherpelectrolytesplistedparepwithinpthepnormalprange.
, Withpwhichpclientpconditionpwillpthepnursepremainpmostpalertpforpinsensiblepwaterploss
?p
A.pContinuouspGIpsuctioningp
B.pDeepprespirationsp
C.pReceivingpoxygenptherapy.p
D.pHypothermiap-pANSWER:pA.
Continuouspgastricpsuctioningpremovespfluidpbeforepitpispabsorbedpintopthepbody,pwhic
hpdecreasespfluidpintakepbyptheporalproute.pThispongoingpfluidploss,pifpnotpmeasuredpaspr
eplacedpbypanotherproute,pcanpresultpinpapfluidpvolumepdeficit.
Whichphealthpproblemsparepmostplikelyptopactivateptheprenin-angiotensin-
aldosteronepsystemp(RAAS)?pSelectpallpthatpapply.p
A.pShockp
B.pUrinaryptractpinfectionp
C.pConstipationp
D.pDehydrationp
E.pSeverepasthmap
F.pHypertensionp-pANSWER:pA,pDp
ThepRAASpsystempispactivatedpbypanypconditionpthatpcausespreducedpbloodpvolume,phy
potension,porpreducedpserumpsodiumplevels,psuchpaspcouldphappenpwithpshockpandpde
hydration.pWhenpactivated,pRAASpincreasespsodiumpandpreabsorptionptopincreasepblo
odpvolumepandpse-
rumpsodiumplevels.pItpalsopincreasespvasoconstrictionptophelppincreasepbloodppressure.
pAsthma,purinaryptractpinfection,phypertension,pandpconstipationpdopnotpinducepsympt
omspofpshockporpdehydration.
Whichpelectrolytepplaysptheplargestprolepinpmaintainingpbloodposmolarity?p
A.pCalciump
B.pChloridep
C.pPotassiump
D.pSodiump-pANSWER:pD.
Sodiumpispthepelectrolytepwithpthephighestpconcentrationpinpthepblood.pThisphighpconce
ntrationpkeepspmorepofpthepchloridepionspinpthepblood.pAspapresult,psodiumpkeepspthepb
loodposmolaritypwithinpthepnormalprange.pBothpcalciumpandppotassiumphaveplowpbloo
dplevels.
Thepelectrolytepmagnesiumpispresponsiblepforpwhichpfunctions?pSelectpallpthatpapply.p
A.pFormationpofphydrochloricpacidp
B.pCarbohydratepmetabolismp
C.pContractionpofpskeletalpmusclep
p p p
Surgical Nursing, Concepts and Practice, 5th Edition (Stromberg
p p p p p p p
, 2023), p p
Whichpbodypfluidpcompartmentpispconsideredpthep"thirdpspace?"
A.pExtracellularpfluidp
B.pIntracellularpfluidp
C.pInterstitialpfluidp
D.pBloodp(plasma)p-pANSWER:pC.
Thepextracellularpfluidpincludespbothpthepbloodp(plasma)pvolumepandpthepinterstitialpfl
uid.pAnotherptermpforpthepinterstitialpfluidpispthepthirdpspace,pwhichpispbetweenpthepcell
spratherpthanpinsidepthepcellsporpinpthepbloodp(plasma).
Whatpimmediatepresponsepdoespthepnursepexpectpaspapresultpofpinfusingp1pliterpofpanpis
otonicpintravenouspsolutionpintopapclientpoverpap3-
hourptimepperiodpifpurinepoutputpremainspatp100pmLpperphour?p
A.pExtracellularpfluidp(ECF)posmolaritypincreases;pbodypweightpincreasesp
B.pExtracellularpfluidp(ECF)posmolaritypdecreases;pbodypweightpdecreasesp
C.pExtracellularpfluidp(ECF)posmolaritypispunchanged;pbodypweightpincreasesp
D.pExtracellularpfluidp(ECF)posmolaritypispunchanged;pbodypweightpdecreasesp-
pANSWER:pC.
Isotonicpsolutionsphavepthepsameptonicitypaspplasmapandpotherpextracellularpfluids.pTh
erefore,pthepintravenouspfluidpwouldpnotpchangepthepECFposmolarity.pWhenp1000pmLpi
spinfusedpwithinp3phourspandpthepclientponlypurinatesp300pmL,pthepextrapfluidpwouldpinc
reasepthepclient'spweight.pRememberpthatp1pliterpofpfluidpispequalptop2.2plb.
WhichpIVpfluidpdoespthepnursepexpectptopadministerptopapclientpwhopispprescribedptopre
ceivephypotonicpfluids?p
A.p9%psalinep
B.p3%psalinep
C.p0.9%psalinep
D.p0.45%psalinep-pANSWER:pD.
Isotonicpsalinepisp0.9%.pThepoptionspofp9%psalinepandp3%psalineparephypertonic.pOnlyp0.
45%psalinepispaphypotonicpsolution.
Forpwhichpindicationpofpapfluidpbalancepproblempwillpthepnursepassesspinpanpolderpclient
patpriskpforpfluidpandpelectrolytepproblems?p
A.pFeverp
,B.pElevatedpbloodppressurep
C.pPoorpskinpturgorp
D.pMentalpstatuspchangesp-pANSWER:pD.
Althoughpallpofpthepassessmentpfindingsplistedpmaypappearpwithpapfluidpbalancepproble
m,pthepfirstpindicationpinpolderpclientspispapchangepinpmentalpstatus.
Whichptypespofpfluidplossparepconsideredp"insensiblepfluidploss?"pSelectpallpthatpapply.p
A.pSweatp
B.pSalivationp
C.pUrinep
D.pDiarrheap
E.pVomitp
F.pWoundpdrainagep-pANSWER:pA,pB,pD,pE,pFp
Ofpallpthesepfluidplossproutes,ptheponlyponepthatpadjustsporpispregulatedpispurinepoutput.p
Thepothersprepresentpfluidplosspthatphaspnopregulatoryporpcontrolpmechanisms,palsopkn
ownpaspinsensible.
Whichpclientpfactorspaffectpthepamountpandpdistributionpofpbodypfluids?pSelectpallpthatp
apply.p
A.pRacep
B.pAgep
C.pGenderp
D.pHeight
E.pBodypfatp
F.pMusclepmassp-pANSWER:pB,pC,pE,pFp
Totalpbodypwaterpinpadultspvariespbypage,pgender,pdegreepofpmusclepmass,pandppercent
pofpbodypfat.pWaterpmakespuppaboutp55%ptop60%pofptotalpweightpforpyoungerpadultspan
dp50%ptop55%pofptotalpweightpforpolderpadults.pWomenpofpallpagespusuallyphavepaplower
ppercentagepofpbodypwaterpthanpdopmenpofpthepsamepagespbecausepofpgreaterpmusclep
mass.pFatpcellspcontainplittleporpnopwater.pThephigherptheppercentagepofpbodypfat,pthepl
owerptheppercentagepofptotalpbodypwater.pNeitherpracepnorpheightpaffectptotalpbodypw
ater.
Whichppotentialpproblemspdoespthepnursepassesspforpwhenpcaringpforpapclientpwhosepu
rinepoutputpisplesspthanpwhatpispneededpaspthepobligatorypurinepoutput?pSelectpallpthatp
apply.p
A.pLethalpelectrolytepimbalancesp
B.pAlkalosisp
C.pUrinepbecomespdiluted
D.pToxicpbuilduppofpnitrogenp
F.pIncreasedpinfectionpriskp
,F.pAcidosisp-pANSWER:pA,pD,pFp
Thepkidneypispthepmainpwaypexcesspwastepproductspandpelectrolytesparepeliminatedpfro
mpthepbody.pItpmustpcausepap500ptop600pmLpoutputpdailypforpadequatepeliminationpofpt
hesepproductspdaily.pWhenpthesepproductsparepretained,pthepconsequencespincludeplet
halplevelspofpelectrolytes,ptoxicpbuilduppofpnitrogen,pandpretentionpofphydrogenpionspca
usingpacidosis.
Withpwhichpclientpdoespthepnursepremainpmostpalertpforpanpelectrolytepimbalance?p
A.p49-year-oldpwithpintermittentpasthmapwhopalsopusespanpalbuterolpinhalerpPRNp
B.p60-yearpoldpwithpapsprainedpwristpwhopalsoptakespacetaminophenpforppainp
C.p72-year-oldpwithpdiabetespmellituspwhopalsoptakespapdiureticpdailyp
D.p80-year-oldpanemiapwhopalsoptakepanpironpsupplementp-pANSWER:pC.p
Thispclientphaspthreepriskpfactorspforpanpelectrolytepimbalance:polderpadult,pendocrinep
disorder,pandptakespapdiureticpdaily,pwhichpalterspfluidpandpelectrolytepexcretion.pAltho
ughpthep80-year-
oldphaspanpincreasedpriskpbecausepofpage,pheporpshephaspnopotherpspecificpriskpfactorspli
sted.
Whichpelectrolytepchangepdoespthepnursepexpectptopseepinpapclientpwhopproducespexce
ssivepamountspofpaldosterone?p
A.pLowpserumpsodiumplevelp
B.pHighpserumppotassiumplevelp
C.pLowpserumpcalciumplevelp
D.pHighpserumpsodiumplevelp-pANSWER:pD.
Aldosteronepincreasespsodiumpandpwaterpreabsorptionpinpthepkidney.pHigherpthanpnor
malplevelspofpthisphormonepusuallypresultpinphighpserumpsodiumplevels
Whichpserumpelectrolytepfindingponpapnewlypadmittedpclientpdoespthepnursepreportpim
mediatelyptopthephealthpcarepprovider?pSelectpallpthatpapply.p
A.pPotassiump2.8pmEq/Lp(mmol/L)p
B.pSodiump143pmEq/Lp(mmol/Lp
C.pCalciump9.9pmg/dLp(2.59pmmol/L)p
D.pChloridep101pmEq/Lp(mmol/L)p
E.pChloridep98pmEq/Lp(mmol/L)p
F.pMagnesiump1.2pmEq/Lp(0.7pmmol/Lp-pANSWER:pA,pFp
Thepserumppotassiumpandpserumpmagnesiumplevelsparepbothplowerpthanpnormalp(pota
ssiump5p3.5ptop5.0pmEq/Lporpmmol/L;pmagnesiump5p1.8ptop2.6pmEq/Lporp0.74ptop1.07pm
mol/L).pLowplevelspofpthesepelectrolytespcanphavepprofoundpeffectsponpheartpfunction.p
Allpotherpelectrolytesplistedparepwithinpthepnormalprange.
, Withpwhichpclientpconditionpwillpthepnursepremainpmostpalertpforpinsensiblepwaterploss
?p
A.pContinuouspGIpsuctioningp
B.pDeepprespirationsp
C.pReceivingpoxygenptherapy.p
D.pHypothermiap-pANSWER:pA.
Continuouspgastricpsuctioningpremovespfluidpbeforepitpispabsorbedpintopthepbody,pwhic
hpdecreasespfluidpintakepbyptheporalproute.pThispongoingpfluidploss,pifpnotpmeasuredpaspr
eplacedpbypanotherproute,pcanpresultpinpapfluidpvolumepdeficit.
Whichphealthpproblemsparepmostplikelyptopactivateptheprenin-angiotensin-
aldosteronepsystemp(RAAS)?pSelectpallpthatpapply.p
A.pShockp
B.pUrinaryptractpinfectionp
C.pConstipationp
D.pDehydrationp
E.pSeverepasthmap
F.pHypertensionp-pANSWER:pA,pDp
ThepRAASpsystempispactivatedpbypanypconditionpthatpcausespreducedpbloodpvolume,phy
potension,porpreducedpserumpsodiumplevels,psuchpaspcouldphappenpwithpshockpandpde
hydration.pWhenpactivated,pRAASpincreasespsodiumpandpreabsorptionptopincreasepblo
odpvolumepandpse-
rumpsodiumplevels.pItpalsopincreasespvasoconstrictionptophelppincreasepbloodppressure.
pAsthma,purinaryptractpinfection,phypertension,pandpconstipationpdopnotpinducepsympt
omspofpshockporpdehydration.
Whichpelectrolytepplaysptheplargestprolepinpmaintainingpbloodposmolarity?p
A.pCalciump
B.pChloridep
C.pPotassiump
D.pSodiump-pANSWER:pD.
Sodiumpispthepelectrolytepwithpthephighestpconcentrationpinpthepblood.pThisphighpconce
ntrationpkeepspmorepofpthepchloridepionspinpthepblood.pAspapresult,psodiumpkeepspthepb
loodposmolaritypwithinpthepnormalprange.pBothpcalciumpandppotassiumphaveplowpbloo
dplevels.
Thepelectrolytepmagnesiumpispresponsiblepforpwhichpfunctions?pSelectpallpthatpapply.p
A.pFormationpofphydrochloricpacidp
B.pCarbohydratepmetabolismp
C.pContractionpofpskeletalpmusclep
