medical surgical testbank
Exam Study Guide: GRADED
A+. Questions and Verified
Answers. Latest 2026 Update
fluid and electrolyres, acid base, thermoregulation
Chapter 17: Fluid, Electrolyte, and Acid-Base Imbalances
1. The nurse obtains all of the following assessment data about a patient with
deficient fluid volume caused by a massive burn injury. Which of the following
assessment data will be of greatest concern?
a.
The blood pressure is 90/40 mm Hg.
b.
Urine output is 30 ml over the last hour.
,c.
Oral fluid intake is 100 ml for the last 8 hours.
d.
There is prolonged skin tenting over the sternum. - Ans✔✔-The blood pressure
is 90/40 mm Hg.
Rationale: The blood pressure indicates that the patient may be developing
hypovolemic shock as a result of fluid loss. This will require immediate
intervention to prevent the complications associated with systemic
hypoperfusion. The poor oral intake, decreased urine output, and skin tenting
all indicate the need for increasing the patients fluid intake but not as urgently
as the hypotension.
2. A recently admitted patient has a small cell carcinoma of the lung, which is
causing the syndrome of inappropriate antidiuretic hormone (SIADH). The
nurse will monitor carefully for
a.
increased total urinary output.
b.
,elevation of serum hematocrit.
c.
decreased serum sodium level.
d.
rapid and unexpected weight loss. - Ans✔✔-decreased serum sodium level.
Rationale: SIADH causes water retention and a decrease in serum sodium level.
Weight loss, increased urine output, and elevated serum hematocrit may be
associated with excessive loss of water, but not with SIADH and water
retention.
3. When the nurse is evaluating the fluid balance for a patient admitted for
hypovolemia associated with multiple draining wounds, the most accurate
assessment to include is
a.
skin turgor.
b.
daily weight.
, c.
presence of edema.
d.
hourly urine output. - Ans✔✔-daily weight.
Rationale: Daily weight is the most easily obtained and accurate means of
assessing volume status. Skin turgor varies considerably with age. Considerable
excess fluid volume may be present before fluid moves into the interstitial
space and causes edema. Hourly urine outputs do not take account of fluid
intake or of fluid loss through insensible loss, sweating, or loss from the
gastrointestinal tract or wounds.
4. When caring for an alert and oriented elderly patient with a history of
dehydration, the home health nurse will teach the patient to increase fluid
intake
a.
in the late evening hours.
b.
if the oral mucosa feels dry.
Exam Study Guide: GRADED
A+. Questions and Verified
Answers. Latest 2026 Update
fluid and electrolyres, acid base, thermoregulation
Chapter 17: Fluid, Electrolyte, and Acid-Base Imbalances
1. The nurse obtains all of the following assessment data about a patient with
deficient fluid volume caused by a massive burn injury. Which of the following
assessment data will be of greatest concern?
a.
The blood pressure is 90/40 mm Hg.
b.
Urine output is 30 ml over the last hour.
,c.
Oral fluid intake is 100 ml for the last 8 hours.
d.
There is prolonged skin tenting over the sternum. - Ans✔✔-The blood pressure
is 90/40 mm Hg.
Rationale: The blood pressure indicates that the patient may be developing
hypovolemic shock as a result of fluid loss. This will require immediate
intervention to prevent the complications associated with systemic
hypoperfusion. The poor oral intake, decreased urine output, and skin tenting
all indicate the need for increasing the patients fluid intake but not as urgently
as the hypotension.
2. A recently admitted patient has a small cell carcinoma of the lung, which is
causing the syndrome of inappropriate antidiuretic hormone (SIADH). The
nurse will monitor carefully for
a.
increased total urinary output.
b.
,elevation of serum hematocrit.
c.
decreased serum sodium level.
d.
rapid and unexpected weight loss. - Ans✔✔-decreased serum sodium level.
Rationale: SIADH causes water retention and a decrease in serum sodium level.
Weight loss, increased urine output, and elevated serum hematocrit may be
associated with excessive loss of water, but not with SIADH and water
retention.
3. When the nurse is evaluating the fluid balance for a patient admitted for
hypovolemia associated with multiple draining wounds, the most accurate
assessment to include is
a.
skin turgor.
b.
daily weight.
, c.
presence of edema.
d.
hourly urine output. - Ans✔✔-daily weight.
Rationale: Daily weight is the most easily obtained and accurate means of
assessing volume status. Skin turgor varies considerably with age. Considerable
excess fluid volume may be present before fluid moves into the interstitial
space and causes edema. Hourly urine outputs do not take account of fluid
intake or of fluid loss through insensible loss, sweating, or loss from the
gastrointestinal tract or wounds.
4. When caring for an alert and oriented elderly patient with a history of
dehydration, the home health nurse will teach the patient to increase fluid
intake
a.
in the late evening hours.
b.
if the oral mucosa feels dry.
