MEDICAL-SURGICAL 09/27/2026
NURSING
BRUNNER & SUDDARTH’S MEDICAL-
SURGICAL NURSING 15TH EDITION | ALL 68
CHAPTERS WITH ANSWER KEYS AT END OF
EACH CHAPTER
A client in the emergency department is bleeding profusely from a gunshot wound to the
abdomen. What action should the nurse immediately take to promote maintenance of the
client's blood pressure above a systolic pressure of 90 mm Hg?
JOYCEWWALES 1
, MEDICAL-SURGICAL 09/27/2026
NURSING
A. Place the client in a 45-degree Trendelenburg position to promote cerebral blood flow.
B. Turn the client prone to place pressure on the abdominal wound to help staunch the
bleeding.
C. Maintain the client in a supine position to reduce diaphragmatic pressure and visualize the
wound.
D. Put the client on the right side to apply pressure to the liver and spleen to stop
hemorrhaging.
C
Rationale:
Placing the client in a supine position reduces diaphragmatic pressure, thereby enhancing
oxygenation, and allows for visualization of the abdominal wound. Option A compromises
diaphragmatic expansion and inhibits pressoreceptor activity. Option B places the client at
risk of evisceration of the abdominal wound and increased bleeding. Option D will not stop
internal bleeding in the liver and spleen caused by the gunshot wound.
A patient is admitted for hypovolemia associated with multiple draining wounds. Which
assessment finding would be the most accurate way for the nurse to evaluate fluid balance?
A. Skin turgor
B. Daily weight
C. Presence of edema
D. Hourly urine output
B
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. Although very important, hourly
JOYCEWWALES 2
, MEDICAL-SURGICAL 09/27/2026
NURSING
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.
A newly admitted patient is diagnosed with hyponatremia. When making room assignments,
the charge nurse should take which action?
A. Assign the patient a room near the nurse's station.
B. Place the patient in a room nearest to the water fountain.
C. Place the patient on telemetry to monitor for peaked T waves.
D. Assign the patient to a semi-private room and place an order for a low-salt diet
A
RATIONALE:
The patient should be placed near the nurse's station if confused in order for the staff to
closely monitor the patient. To help improve serum sodium levels, water intake is restricted.
Therefore a confused patient should not be placed near a water fountain. Peaked T waves are
a sign of hyperkalemia, not hyponatremia. A confused patient could be distracting and
disruptive for another patient in a semiprivate room. This patient needs sodium replacement,
not restriction.
A patient receives 3% NaCl solution for correction of hyponatremia. Which assessment is most
important for the nurse to monitor for while the patient is receiving this infusion?
A.Lung sounds
B. Urinary output
C. Peripheral pulses
D. Peripheral edema
A
RATIONALE:
JOYCEWWALES 3
, MEDICAL-SURGICAL 09/27/2026
NURSING
Hypertonic solutions cause water retention, so the patient should be monitored for
symptoms of fluid excess. Crackles in the lungs may indicate the onset of pulmonary edema
and are a serious manifestation of fluid excess. Bounding peripheral pulses, peripheral edema,
or changes in urine output are also important to monitor when administering hypertonic
solutions, but they do not indicate acute respiratory or cardiac decompensation.
The nurse assess a patient who has been hospitalized for 2 days. The patient has been
receiving normal saline (0.9% NaCl) IV at 100 mL/hr, has a nasogatric tube to low suction, and
is NPO. Which assessment finding would be a priority for the nurse to report to the health
care provider?
A. Oral temperature of 100.1 F
B. Serum sodium level of 138 mEq/L
C. Gradually decreasing level of consciousness
D. Weight gain of 2 pounds (1 kg) above the admission weight
C
RATIONALE:
The patient's history and change in LOC could be indicative of fluid and electrolyte
disturbances: extracellular fluid (ECF) excess, ECF deficit, hyponatremia, hypernatremia,
hypokalemia, or metabolic alkalosis. Further diagnostic information is needed to determine
the cause of the change in LOC and the appropriate interventions. The weight gain, elevated
temperature, crackles, and serum sodium level also will be reported, but do not indicate a
need for rapid action to avoid complications.
A nurse is planning care for a client who is hyperventilating. The client's arterial blood gas
values are pH 7.30, PaCO2 31 mmHg, and HCO3 26 mEq/L. Which question should the nurse
ask when developing this client's plan of care?
A. "Do you take any over-the counter medications?"
B. "You appear anxious. What is causing your distress?"
JOYCEWWALES 4
NURSING
BRUNNER & SUDDARTH’S MEDICAL-
SURGICAL NURSING 15TH EDITION | ALL 68
CHAPTERS WITH ANSWER KEYS AT END OF
EACH CHAPTER
A client in the emergency department is bleeding profusely from a gunshot wound to the
abdomen. What action should the nurse immediately take to promote maintenance of the
client's blood pressure above a systolic pressure of 90 mm Hg?
JOYCEWWALES 1
, MEDICAL-SURGICAL 09/27/2026
NURSING
A. Place the client in a 45-degree Trendelenburg position to promote cerebral blood flow.
B. Turn the client prone to place pressure on the abdominal wound to help staunch the
bleeding.
C. Maintain the client in a supine position to reduce diaphragmatic pressure and visualize the
wound.
D. Put the client on the right side to apply pressure to the liver and spleen to stop
hemorrhaging.
C
Rationale:
Placing the client in a supine position reduces diaphragmatic pressure, thereby enhancing
oxygenation, and allows for visualization of the abdominal wound. Option A compromises
diaphragmatic expansion and inhibits pressoreceptor activity. Option B places the client at
risk of evisceration of the abdominal wound and increased bleeding. Option D will not stop
internal bleeding in the liver and spleen caused by the gunshot wound.
A patient is admitted for hypovolemia associated with multiple draining wounds. Which
assessment finding would be the most accurate way for the nurse to evaluate fluid balance?
A. Skin turgor
B. Daily weight
C. Presence of edema
D. Hourly urine output
B
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. Although very important, hourly
JOYCEWWALES 2
, MEDICAL-SURGICAL 09/27/2026
NURSING
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.
A newly admitted patient is diagnosed with hyponatremia. When making room assignments,
the charge nurse should take which action?
A. Assign the patient a room near the nurse's station.
B. Place the patient in a room nearest to the water fountain.
C. Place the patient on telemetry to monitor for peaked T waves.
D. Assign the patient to a semi-private room and place an order for a low-salt diet
A
RATIONALE:
The patient should be placed near the nurse's station if confused in order for the staff to
closely monitor the patient. To help improve serum sodium levels, water intake is restricted.
Therefore a confused patient should not be placed near a water fountain. Peaked T waves are
a sign of hyperkalemia, not hyponatremia. A confused patient could be distracting and
disruptive for another patient in a semiprivate room. This patient needs sodium replacement,
not restriction.
A patient receives 3% NaCl solution for correction of hyponatremia. Which assessment is most
important for the nurse to monitor for while the patient is receiving this infusion?
A.Lung sounds
B. Urinary output
C. Peripheral pulses
D. Peripheral edema
A
RATIONALE:
JOYCEWWALES 3
, MEDICAL-SURGICAL 09/27/2026
NURSING
Hypertonic solutions cause water retention, so the patient should be monitored for
symptoms of fluid excess. Crackles in the lungs may indicate the onset of pulmonary edema
and are a serious manifestation of fluid excess. Bounding peripheral pulses, peripheral edema,
or changes in urine output are also important to monitor when administering hypertonic
solutions, but they do not indicate acute respiratory or cardiac decompensation.
The nurse assess a patient who has been hospitalized for 2 days. The patient has been
receiving normal saline (0.9% NaCl) IV at 100 mL/hr, has a nasogatric tube to low suction, and
is NPO. Which assessment finding would be a priority for the nurse to report to the health
care provider?
A. Oral temperature of 100.1 F
B. Serum sodium level of 138 mEq/L
C. Gradually decreasing level of consciousness
D. Weight gain of 2 pounds (1 kg) above the admission weight
C
RATIONALE:
The patient's history and change in LOC could be indicative of fluid and electrolyte
disturbances: extracellular fluid (ECF) excess, ECF deficit, hyponatremia, hypernatremia,
hypokalemia, or metabolic alkalosis. Further diagnostic information is needed to determine
the cause of the change in LOC and the appropriate interventions. The weight gain, elevated
temperature, crackles, and serum sodium level also will be reported, but do not indicate a
need for rapid action to avoid complications.
A nurse is planning care for a client who is hyperventilating. The client's arterial blood gas
values are pH 7.30, PaCO2 31 mmHg, and HCO3 26 mEq/L. Which question should the nurse
ask when developing this client's plan of care?
A. "Do you take any over-the counter medications?"
B. "You appear anxious. What is causing your distress?"
JOYCEWWALES 4
