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Medical-Surgical Nursing
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Medical-Surgical Nursing
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TEST BANK For Medical-Surgical Nursing, Concepts andPractice, 5th Edition (Stromberg, 2023), Verified Chapters 1 -
49, Complete Newest Version
Which body fluid compartment is considered the "third space?"
A. Extracellular fluid
B. Intracellular fluid
C. Interstitial fluid
D. Blood (plasma) - ANSWER: C.
The extracellular fluid includes both the blood (plasma) volume and the interstitial
fluid. Another term for the interstitial fluid is the third space, which is between the
cells rather than inside the cells or in the blood (plasma).
What immediate response does the nurse expect as a result of infusing 1 liter of an
isotonic intravenous solution into a client over a 3-hour time period if urine output
remains at 100 mL per hour?
A. Extracellular fluid (ECF) osmolarity increases; body weight increases
B. Extracellular fluid (ECF) osmolarity decreases; body weight decreases
C. Extracellular fluid (ECF) osmolarity is unchanged; body weight increases
D. Extracellular fluid (ECF) osmolarity is unchanged; body weight decreases -
ANSWER: C.
Isotonic solutions have the same tonicity as plasma and other extracellular fluids.
Therefore, the intravenous fluid would not change the ECF osmolarity. When 1000
mL is infused within 3 hours and the client only urinates 300 mL, the extra fluid
would increase the client's weight. Remember that 1 liter of fluid is equal to 2.2 lb.
Which IV fluid does the nurse expect to administer to a client who is prescribed to
receive hypotonic fluids?
A. 9% saline
B. 3% saline
C. 0.9% saline
D. 0.45% saline - ANSWER: D.
Isotonic saline is 0.9%. The options of 9% saline and 3% saline are hypertonic. Only
0.45% saline is a hypotonic solution.
For which indication of a fluid balance problem will the nurse assess in an older
client at risk for fluid and electrolyte problems?
A. Fever
,B. Elevated blood pressure
C. Poor skin turgor
D. Mental status changes - ANSWER: D.
Although all of the assessment findings listed may appear with a fluid balance
problem, the first indication in older clients is a change in mental status.
Which types of fluid loss are considered "insensible fluid loss?" Select all that apply.
A. Sweat
B. Salivation
C. Urine
D. Diarrhea
E. Vomit
F. Wound drainage - ANSWER: A, B, D, E, F
Of all these fluid loss routes, the only one that adjusts or is regulated is urine output.
The others represent fluid loss that has no regulatory or control mechanisms, also
known as insensible.
Which client factors affect the amount and distribution of body fluids? Select all that
apply.
A. Race
B. Age
C. Gender
D. Height
E. Body fat
F. Muscle mass - ANSWER: B, C, E, F
Total body water in adults varies by age, gender, degree of muscle mass, and percent
of body fat. Water makes up about 55% to 60% of total weight for younger adults
and 50% to 55% of total weight for older adults. Women of all ages usually have a
lower percentage of body water than do men of the same ages because of greater
muscle mass. Fat cells contain little or no water. The higher the percentage of body
fat, the lower the percentage of total body water. Neither race nor height affect total
body water.
Which potential problems does the nurse assess for when caring for a client whose
urine output is less than what is needed as the obligatory urine output? Select all
that apply.
A. Lethal electrolyte imbalances
B. Alkalosis
C. Urine becomes diluted
D. Toxic buildup of nitrogen
F. Increased infection risk
,F. Acidosis - ANSWER: A, D, F
The kidney is the main way excess waste products and electrolytes are eliminated
from the body. It must cause a 500 to 600 mL output daily for adequate elimination
of these products daily. When these products are retained, the consequences
include lethal levels of electrolytes, toxic buildup of nitrogen, and retention of
hydrogen ions causing acidosis.
With which client does the nurse remain most alert for an electrolyte imbalance?
A. 49-year-old with intermittent asthma who also uses an albuterol inhaler PRN
B. 60-year old with a sprained wrist who also takes acetaminophen for pain
C. 72-year-old with diabetes mellitus who also takes a diuretic daily
D. 80-year-old anemia who also take an iron supplement - ANSWER: C.
This client has three risk factors for an electrolyte imbalance: older adult, endocrine
disorder, and takes a diuretic daily, which alters fluid and electrolyte excretion.
Although the 80-year-old has an increased risk because of age, he or she has no
other specific risk factors listed.
Which electrolyte change does the nurse expect to see in a client who produces
excessive amounts of aldosterone?
A. Low serum sodium level
B. High serum potassium level
C. Low serum calcium level
D. High serum sodium level - ANSWER: D.
Aldosterone increases sodium and water reabsorption in the kidney. Higher than
normal levels of this hormone usually result in high serum sodium levels
Which serum electrolyte finding on a newly admitted client does the nurse report
immediately to the health care provider? Select all that apply.
A. Potassium 2.8 mEq/L (mmol/L)
B. Sodium 143 mEq/L (mmol/L
C. Calcium 9.9 mg/dL (2.59 mmol/L)
D. Chloride 101 mEq/L (mmol/L)
E. Chloride 98 mEq/L (mmol/L)
F. Magnesium 1.2 mEq/L (0.7 mmol/L - ANSWER: A, F
The serum potassium and serum magnesium levels are both lower than normal
(potassium 5 3.5 to 5.0 mEq/L or mmol/L; magnesium 5 1.8 to 2.6 mEq/L or 0.74 to
1.07 mmol/L). Low levels of these electrolytes can have profound effects on heart
function. All other electrolytes listed are within the normal range.
, With which client condition will the nurse remain most alert for insensible water
loss?
A. Continuous GI suctioning
B. Deep respirations
C. Receiving oxygen therapy.
D. Hypothermia - ANSWER: A.
Continuous gastric suctioning removes fluid before it is absorbed into the body,
which decreases fluid intake by the oral route. This ongoing fluid loss, if not
measured as replaced by another route, can result in a fluid volume deficit.
Which health problems are most likely to activate the renin-angiotensin-aldosterone
system (RAAS)? Select all that apply.
A. Shock
B. Urinary tract infection
C. Constipation
D. Dehydration
E. Severe asthma
F. Hypertension - ANSWER: A, D
The RAAS system is activated by any condition that causes reduced blood volume,
hypotension, or reduced serum sodium levels, such as could happen with shock and
dehydration. When activated, RAAS increases sodium and reabsorption to increase
blood volume and se-rum sodium levels. It also increases vasoconstriction to help
increase blood pressure. Asthma, urinary tract infection, hypertension, and
constipation do not induce symptoms of shock or dehydration.
Which electrolyte plays the largest role in maintaining blood osmolarity?
A. Calcium
B. Chloride
C. Potassium
D. Sodium - ANSWER: D.
Sodium is the electrolyte with the highest concentration in the blood. This high
concentration keeps more of the chloride ions in the blood. As a result, sodium
keeps the blood osmolarity within the normal range. Both calcium and potassium
have low blood levels.
The electrolyte magnesium is responsible for which functions? Select all that apply.
A. Formation of hydrochloric acid
B. Carbohydrate metabolism
C. Contraction of skeletal muscle
D. Regulation of intracellular osmolarity
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