Med Surg Exam 1
Which patients are at risk for fluid volume excess?
A. 64 year old male with a diagnosis of kidney failure
B. 46 year old male who is training for a marathon
C. 35 year old male with diarrhea and vomiting for the past 2 days
D. 83 year old female with a diagnosis of a stroke and has trouble talking - ANS A
Which solution is considered a hypertonic IV solution?
A. 0.9% sodium chloride
B. Total parenteral nutrition
C. 0.45% sodium chloride
D. Lactated Ringers solution - ANS B
What happens to the size of cells within the tissues when an isotonic IV solution is
administered?
A. Cells enlarge
B. Cells shrink
C. The size of the cells remain unchanged - ANS C
True or False: The principle intracellular cation in the body is sodium. - ANS False
A nurse is planning care for a client with a fluid volume deficit. Which of the following
are appropriate nursing actions? (Select all that apply)
A. Administer a diuretic
B. Turn the patient at least ever two hours
C. infuse a hypertonic IV solution as ordered
D. Teach the patient to sit on the side of bed first before standing
E. Assess the patient's level of consciousness and mental status - ANS B, D, E
The nurse recognizes which of the following statements are true regarding Fluid Volume
Deficit/dehydration in older adults? (Select all that apply)
A. The kidneys are less able to concentrate urine
B. Diuretics and laxative use can increase fluid loss
C. The perception of thirst increases with age in older adults
D. Poor skin turgor is a reliable indicator of dehydration in the elderly
, E. Lack of air conditioning in hot weather is a risk factor for fluid volume deficit - ANS A,
B, E
Tachycardia is present in which type of fluid imbalance?
A. Fluid volume excess
B. Fluid volume deficit
C. Both fluid volume excess and fluid volume deficit - ANS C
Decreased serum osmolality is present in which type of fluid imbalance?
A. Fluid volume excess
B. Fluid volume deficit
C. Both fluid volume excess and fluid volume deficit - ANS A
Jugular vein distention is present in which type of fluid imbalance?
A. Fluid volume excess
B. Fluid volume deficit
C. Both fluid volume excess and fluid volume deficit - ANS A
Mr. Smith is a patient who has been admitted to a nursing unit with a diagnosis of heart
failure resulting in fluid volume excess. Upon entering his room Mr. Smith complains of
difficulty breathing. What should be the nurse's first action?
A. Contact the primary care provider
B. Assess his fluid status by obtaining a daily weight
C. Elevate the head of bed and obtain an oxygen saturation level
D. Administer a diuretic to help correct his diagnosis of a fluid volume excess - ANS C
The nurse is assigned to care for all of the following patients. Which patient is at risk for
hypokalemia? (select all that apply)
A. 64 year old with a diagnosis of kidney failure
B. 35 year old with diarrhea and vomiting for the past 2 days
C. 83 year old with a hypertension who uses salt substitutes
D. 26 year old in a motor vehicle accident who received 3 units of blood
E. 19 year old with a history of anorexia, laxative abuse, and diuretic use - ANS B, E
Which body system is associated with the most severe consequences due to
imbalances in sodium?
A. Renal
B. Respiratory
C. Neurologic
D. Gastrointestinal - ANS C
Which patients are at risk for fluid volume excess?
A. 64 year old male with a diagnosis of kidney failure
B. 46 year old male who is training for a marathon
C. 35 year old male with diarrhea and vomiting for the past 2 days
D. 83 year old female with a diagnosis of a stroke and has trouble talking - ANS A
Which solution is considered a hypertonic IV solution?
A. 0.9% sodium chloride
B. Total parenteral nutrition
C. 0.45% sodium chloride
D. Lactated Ringers solution - ANS B
What happens to the size of cells within the tissues when an isotonic IV solution is
administered?
A. Cells enlarge
B. Cells shrink
C. The size of the cells remain unchanged - ANS C
True or False: The principle intracellular cation in the body is sodium. - ANS False
A nurse is planning care for a client with a fluid volume deficit. Which of the following
are appropriate nursing actions? (Select all that apply)
A. Administer a diuretic
B. Turn the patient at least ever two hours
C. infuse a hypertonic IV solution as ordered
D. Teach the patient to sit on the side of bed first before standing
E. Assess the patient's level of consciousness and mental status - ANS B, D, E
The nurse recognizes which of the following statements are true regarding Fluid Volume
Deficit/dehydration in older adults? (Select all that apply)
A. The kidneys are less able to concentrate urine
B. Diuretics and laxative use can increase fluid loss
C. The perception of thirst increases with age in older adults
D. Poor skin turgor is a reliable indicator of dehydration in the elderly
, E. Lack of air conditioning in hot weather is a risk factor for fluid volume deficit - ANS A,
B, E
Tachycardia is present in which type of fluid imbalance?
A. Fluid volume excess
B. Fluid volume deficit
C. Both fluid volume excess and fluid volume deficit - ANS C
Decreased serum osmolality is present in which type of fluid imbalance?
A. Fluid volume excess
B. Fluid volume deficit
C. Both fluid volume excess and fluid volume deficit - ANS A
Jugular vein distention is present in which type of fluid imbalance?
A. Fluid volume excess
B. Fluid volume deficit
C. Both fluid volume excess and fluid volume deficit - ANS A
Mr. Smith is a patient who has been admitted to a nursing unit with a diagnosis of heart
failure resulting in fluid volume excess. Upon entering his room Mr. Smith complains of
difficulty breathing. What should be the nurse's first action?
A. Contact the primary care provider
B. Assess his fluid status by obtaining a daily weight
C. Elevate the head of bed and obtain an oxygen saturation level
D. Administer a diuretic to help correct his diagnosis of a fluid volume excess - ANS C
The nurse is assigned to care for all of the following patients. Which patient is at risk for
hypokalemia? (select all that apply)
A. 64 year old with a diagnosis of kidney failure
B. 35 year old with diarrhea and vomiting for the past 2 days
C. 83 year old with a hypertension who uses salt substitutes
D. 26 year old in a motor vehicle accident who received 3 units of blood
E. 19 year old with a history of anorexia, laxative abuse, and diuretic use - ANS B, E
Which body system is associated with the most severe consequences due to
imbalances in sodium?
A. Renal
B. Respiratory
C. Neurologic
D. Gastrointestinal - ANS C
