Study Guide for Understanding Medical Surgical Nursing 6th Edition best in 2021

Answers 1 CHAPTER 1 CRITICAL THINKING AND THE NURSING PROCESS AUDIO CASE STUDY Jane and the Nursing Process 1. Assessment/data collection, diagnosis, planning, implementation, and evaluation. 2. Jane was exhausted, failed a test, and was pulled in too many directions. 3. Jane’s resources included a good friend, sick time from work, and wasted time between classes that she could better utilize. Your resources will be different, but they’re there! VOCABULARY Nursing Process Definition: An organizing framework that links thinking with nursing actions. Steps include assessment/data collection, nursing diagnosis, planning, implementation, and evaluation. Critical Thinking Definition: The use of those cognitive (knowledge) skills or strategies that increase the probability of a desirable outcome. Also involves reflection, problem-solving, and related thinking skills. Assessment Definition: Gathering subjective and objective data to plan care. Objective Data Definition: Factual information obtained through physical assessment and diagnostic tests. Objective data are observable or knowable through the health care worker’s five senses. Referred to as signs. Subjective Data Definition: Information that is provided verbally by the patient and referred to as symptoms. Nursing Diagnosis Definition: Per NANDA International, a nursing diagnosis is a ―clinical judgment concerning a human response to health conditions/life processes, or a vulnerability for that response, by an individual, family, group or community. A nursing diagnosis provides the basis for selection of nursing interventions to achieve outcomes for which the nurse has accountability‖ (from Evaluation Definition: Examination of outcomes and interventions to determine progresstoward desired outcomes and effectiveness of interventions. Vigilance Definition: The act of being attentive, alert, and watchful. SUBJECTIVE AND OBJECTIVE DATA 1. Subjective (symptom) 2. Subjective (symptom) 3. Objective (sign) 4. Objective (sign) 5. Subjective (symptom) 6. Objective (sign) 7. Subjective (symptom) 8. Objective (sign) 9. Subjective (symptom) 10. Subjective (symptom) 11. Objective (sign) 12. Objective (sign) 13. Subjective (symptom) 14. Objective (sign) 15. Objective (sign) 2 Chapter 1 Answers Could it be low Am I diabetic? blood sugar? Frontal area "Sick" feeling Hard Tylenol helps Hunger makes it worse Patient's perception Where is it? Quality Aggravating and alleviating factors Food helps Headache Useful other data Severity Timing Sometimes feel sick to stomach Mother is diabetic 7–8 on 0–10 scale Lasts 1–2 hours once starts Before meals Early in the morning CRITICAL THINKING This is just one possible way to complete a cognitive map. REVIEW QUESTIONS—CONTENT REVIEW The correct answers are in boldface. 1. (3) is a nursing diagnosis. (1, 2, 4) are medical diagnoses. 2. (1) is a medical diagnosis. (2, 3, 4) are nursing diagnoses. 3. (1) is correct. The nurse who keeps trying until the problem is solved is exhibiting perseverance. (2, 3, 4) are incorrect. 4. (3, 4, 5, 1, 2) is the correct order. 5. (1) is the best definition. (2, 3, 4) do not define critical thinking but are examples of good thinking. REVIEW QUESTIONS—TEST PREPARATION The correct answers are in boldface. 6. (4) is correct. Evaluation determines whether goals are achieved and interventions effective. (2) is the role of the physician. (1, 3) encompass data collection and implementation, which are earlier steps in the nursing process. 7. (1) is correct. The licensed practical nurse/licensed vocational nurse can collect data, which includes taking vital signs; assessment is the first step in the nursing process. (2, 3, 4) are all steps in the nursing process, for which the registered nurse is responsible; the licensed practical nurse/licensed vocational nurse may assist the registered nurse with these. 8. (1, 4, 5) can be observed through use of the five senses. (2, 3) are subjective data that the patient must report. 9. (2) indicates that the patient is concerned about freedom from injury and harm. (1) relates to basic needs such as air, oxygen, and water. (3) relates to feeling loved. (4) is related to having positive self-esteem. 10. (4) is objective, realistic, and measurable with a time frame. (1, 2, 3) are all good outcomes, but they relate to airway clearance, nutrition, and strength, not directly to swallowing. 11. (2) is correct. The three parts of a diagnosis include the problem (from the NANDA International [NANDA-I] list), etiology (―related to‖), and symptoms (―as evidenced by‖). (1) does not include symptoms. (3) is a medical diagnosis. (4) is not a NANDA-I diagnosis, and the evidence is not related to dyspnea. Answers 1 CHAPTER 2 EVIDENCE-BASED PRACTICE AUDIO CASE STUDY Marie and Evidence-Based Practice 1. Thirdhand smoke is the dangerous toxins of smoke that linger on hair, clothing, furniture, and other surfaces in an area after a cigarette is put out. Marie learned that exposure to these toxins can be neurotoxic to children and can trigger asthma attacks in sensitive people. 2. Evidence-based practice is considered the gold standard of health care. 3. Step 1: Ask the burning question. Step 2: Search and collect the most relevant and best evidence available. Step 3: Think critically. Appraise the evidence for validity, relevance to the situation, and applicability. Step 4: Measure the outcomes before and after instituting the change. Step 5: Make it happen. Step 6: Evaluate the practice decision or change. 4. Combination therapy with a nicotine patch and nicotine lozenges worked best, although bupropion (Zyban) and nicotine lozenges worked well, too. A Cochrane Review found that advice and support from nursing staff can increase patients’ success in quitting smoking, especially in a hospital setting. VOCABULARY 1. Evidence-based practice: A systematic process that uses current evidence in making decisions about patient care. 2. Evidence-informed practice: Consideration of patient factors along with the use of evidence for shared decisionmaking between the health care provider and the patient. 3. Randomized controlled trials: True experimental studies in which as many factors as possible that could falsely change the results are controlled. 4. Research: Scientific study, investigation, or experimentation to establish facts and analyze their significance. 5. Systematic review: A review of relevant research using guidelines. 6. Health literacy: Degree to which a person has the capacity to obtain, process, and understand basic health information and services to make the best-informed health decisions. EVIDENCE-BASED PRACTICE 1. proof 2. context 3. quality 4. care 5. randomized 6. outcomes 7. gold 8. nursing 9. patient’s 10. information CRITICAL THINKING 1. By questioning the existing way of doing things to ensure that the patient receives the best care possible. 2. A thorough search of the literature in the area of music therapy. 3. Cumulative Index to Nursing and Allied Health Literature (CINAHL) Database, Joanna Briggs Institute evidence-based resources, Cochrane Reviews, Medline/PubMed. 4. Measure patient outcomes before instituting the evidence-based change in practice so comparisons can be made after implementation to determine if the intervention worked. 5. Evaluate the results to determine whether the change made a significant difference and if it was worthwhile in terms of cost and time. REVIEW QUESTIONS—CONTENT REVIEW The correct answers are in boldface. 1. (2) is Level I evidence. (1, 3, 4) are not examples of the best evidence. 2. (1) is a nursing database. (2, 3, 4) are primarily medical databases. 2 Chapter 2 Answers 3. (3) is the website for the Joint Commission, where you can find the National Patient Safety Goals. (1, 2, 4) are incorrect. 4. (2) is the definition of a randomized clinical trial. (1, 3, 4) are incorrect. 5. (1) is correct. Evidence-based practice begins with a burning question designed to solve a clinical problem. (2, 3, 4) are incorrect. REVIEW QUESTIONS—TEST PREPARATION The correct answers are in boldface. 6. (2, 3, 4, 5, 6) are all independent nursing interventions because no health care provider’s order is required. (1) is a dependent function because it requires a health care provider’s order. 7. (1, 5) are Level I research. (2, 3, 4) are not systematic reviews of randomized controlled trials. 8. (1, 3, 5, 6) because the evidence-based practice process involves ―ASKMME!‖: ask, search, think, measure, make it happen, and evaluate. (2, 4) are not steps in the process. 9. (2, 3, 5) are correct, as they have been found to be best practice for oral care. (1, 4) do not remove plaque and only freshen the mouth. 10. (4) is correct. The search should be narrowed to include the focus on the question. (1, 2, 3) do not focus on the question being asked. Answers 1 CHAPTER 3 ISSUES IN NURSING PRACTICE AUDIO CASE STUDY Jim and the Health Care System 1. The use of information technology in nursing practice. 2. Ambulation, teaching leg exercises to prevent blood clots, and using sterile technique to prevent surgical site infections. 3. To avoid violating the Health Insurance and Portability and Accountability Act (HIPAA). VOCABULARY 1. (3) 2. (1) 3. (4) 4. (2) 5. (8) 6. (5) 7. (6) 8. (7) 9. (10) 10. (9) NURSING PRACTICE AND ETHICAL AND LEGAL PRINCIPLES 1. high, poor 2. state, protect, quality 3. Veracity 4. beneficence, fidelity, justice 5. knowledgeable, role, humor, respect VALUES CLARIFICATION There are no correct answers to this section because this is an exercise requiring personal responses. CRITICAL THINKING There are no correct answers to this section because this is an ethical exercise that has many choices to be considered for the best outcome for the patient. REVIEW QUESTIONS—CONTENT REVIEW The correct answers are in boldface. 1. (3) is correct. (1, 2, 4) are incorrect. 2. (1) is correct. (2, 3, 4) are incorrect. 3. (4) is correct. (1, 2, 3) are incorrect. 4. (2) is the first step. (1, 3, 4) are incorrect. 5. (1) is correct. (2, 3, 4) are incorrect. 6. (3) is correct. (1, 2, 4) are incorrect. 7. (4) is correct. (1, 2, 3) are incorrect. 8. (1) is correct. (2, 3, 4) are incorrect. REVIEW QUESTIONS—TEST PREPARATION The correct answers are in boldface. 9. (4) is correct. The patient is chronically ill but able to meet most goals and so has moderate wellness. (1) is incorrect. The patient is not near death. (2) is incorrect. The patient cannot meet all goals, so high-level wellness is not being achieved. (3) is incorrect. The patient is not in poor health because most goals are met through adaptation. 10. (2) is correct. The nurse–patient relationship is based on trust that the nurse will maintain all patients’rights. (1) is a constitutional right, not an ethical issue. (3) is a legal issue. (4) is not an ethical principle. 11. (3) is correct. Paternalism occurs when a health care provider tries to prevent patients from making autonomous decisions or decides what is best for patients without regard for their preferences. (1) is incorrect. The nurse might be nonresponsive about the purpose of the medication due to lack of knowledge, but there are no indications that this is true. (2) is incorrect. Advocacy supports providing the medication information so that the patient is informed to make autonomous decisions. (4) is incorrect. Telling the patient not to worry is not therapeutic communication, as it does not address the patient’s concerns. 12. (1) is correct. Knowing the patient’s wishes helps the nurse advocate for and act in the best interest of the patient. (2, 3, 4) are incorrect. They are not the wishes of the patient. 13. (1, 2, 4, 5) are correct. These are all part of the five steps of delegation. See 2 Chapter 3 Answers (3) is incorrect. In delegation, it is the right person not the right patient that is considered. (6) is incorrect. The right route relates to medication administration. 14. (2, 3, 4, 6) is correct. The patient is a likely victim of human trafficking; after completing data collection (ideally but unlikely in private), suspicions should be reported to the health care team and then local law enforcement should be called. (1) is incorrect. Confrontation should not occur for the safety of all. (5) is incorrect. The patient should not be alerted to impending assistance, as this might alert the trafficker. Answers 1 CHAPTER 4 CULTURAL INFLUENCES ON NURSING CARE AUDIO CASE STUDY Dan and Cultural Assessment 1. Mrs. Basiouny did not want a male caregiver to bathe her or provide her personal care. She wanted her husband to be present during the health history. She did not like touch but did respond to eye contact. She preferred her own traditional foods. 2. Patients can appear noncompliant when in reality they are not receiving culturally appropriate care. 3. Assess and learn from each patient and avoid stereotyping. VOCABULARY 1. (2) 2. (10) 3. (3) 4. (11) 5. (4) 6. (1) 7. (8) 8. (5) 9. (7) 10. (6) 11. (12) 12. (9) CULTURAL CHARACTERISTICS 1. Primary characteristics of culture include nationality, race, skin color, gender, age, spirituality, and religious affiliation. 2. Secondary characteristics of culture include socioeconomic status, education, occupation, military status, political beliefs, length of time away from one’s country of origin, urban versus rural residence, marital status, parental status, physical characteristics, sexual orientation, and gender issues. 3. Traditional practitioners are health care providers from a patient’s native culture. They are typically native to another country, although they may practice in the United States. 4. Present-oriented people accept the day as it comes with little regard for the past and see the future as unpredictable. Past-oriented people may worship ancestors. Future-oriented people anticipate a better future and place a high value on change. Some individuals balance all three views; they respect the past, enjoy living in the present, and plan for the future. CRITICAL THINKING: IMMIGRANTS AND PERSONAL INSIGHTS There are no correct or incorrect answers for these sections because these are exercises requiring personal responses. CRITICAL THINKING: BATHING 1. In some cultures, it is improper for someone of the opposite sex to help with bathing. It is important to assess whether this is the case with this gentleman. 2. Find a male nurse’s aide, ask a family member to help, or skip the bath again. 3. Having a male aide do the bath is the best solution. If no male aide is available, the family may be approached for help, although this is not the best solution. Because this is the fourth day without a bath, skipping the bath is not the best option. REVIEW QUESTIONS—CONTENT REVIEW The correct answers are in boldface. 1. (4) is correct. Tay-Sachs disease is an inherited disease most common among people of Eastern European Jewish (Ashkenazi) heritage. (1, 2, 3) are incorrect. 2. (3) is correct. Ethnocentrism is the tendency for human beings to think that their culture’s ways of thinking, acting, and believing are the only right, proper, and natural ways. (1, 2, 4) are incorrect. 3. (1) is correct. Hispanic Americans and American Indians generally have a higher glucose level than whites. They also have a higher than average risk of diabetes. (2) is incorrect. REVIEW QUESTION—TEST PREPARATION The correct answers are in boldface. 4. (3) is correct. Initially you must assess what the family’s food practices are before an eating plan can be set up. (1) is incorrect. Giving a patient who has just moved to 2 Chapter 4 Answers the United States an exchange list of foods does not ensure that the patient will change dietary practices. (2) is incorrect. Being able to calculate carbohydrates does not respect the family’s cultural preferences. (4) is incorrect. Although this is certainly an option for the future, the initial step is to obtain a dietary assessment. 5. (4) is correct. Patients can have religious counselors visit as long as the counselor does not do anything to interfere with treatment or cause a safety problem. (1) is incorrect. It is not necessary to get the supervisor’s permission. However, it is a good idea to let the supervisor know that a religious counselor is going to visit. (2) is incorrect. Religious counselors are allowed to visit. (3) is incorrect. The patient has the right to see a religious counselor. 6. (4) is correct. Extended family may be very important to members of some cultures, and it may help these patients to have them nearby. (1) is incorrect. Large numbers of family members in the cafeteria may cause further disruption in the cafeteria. (2) is incorrect. Large groups in the lobby may cause overcrowding for other families. (3) is incorrect. All family members should be allowed to visit. It may help to have them choose a spokesperson to control visiting for this patient. 7. (2) is correct. Reducing portion size decreases the overall calorie and fat consumption but will still allow the patient to cook and enjoy traditional foods in her culture. (1) is incorrect. Telling a patient to not purchase lard does not mean she will comply. (3) is incorrect. Rarely does a person bake two separate pies. The goal is to reduce overall fat and calorie consumption. (4) is incorrect. It is inconsistent with the goal of reducing fat and calories. 8. (2) is correct. The patient must make her own decision, but she should be fully aware of the consequences. (1) is incorrect. Scare tactics are not appropriate; she may live whether or not she receives radiation therapy. (3) is incorrect. It borders on harassment by the staff. (4) is incorrect. Radiation therapy may be the best choice for this type of cancer. 9. (2) is correct. Changing the schedule slightly is preferable to omitting the medication. (1) is incorrect. Blood levels can be maintained on a different schedule, as long as the doses are reasonably spread out. (3) is incorrect. Omitting the medication will alter blood levels. (4) is incorrect. It does not respect the patient’s religious beliefs. 10. (3) is correct. This response seeks to discover the patient’s pastspiritual practices. (1) isincorrect. Questionnaires are not appropriate when assessing patient’s spirituality. (2) is incorrect. Although it is important to be self-aware of one’s own spirituality and beliefs, it is not appropriate to share those beliefs with patients when they can cause distress, as in this case. (4) is incorrect. ―Why‖ questions tend to feel critical and attribute blame. Answers 1 CHAPTER 5 COMPLEMENTARY AND ALTERNATIVE MODALITIES AUDIO CASE STUDY Susan and Complementary Therapy 1. Complementary modalities are added on to traditional therapies. Alternative modalities are used instead of traditional therapies. 2. Susan used biofeedback, progressive muscle relaxation, and imagery. 3. Patients should learn everything they can about a therapy before trying it. They should find information from reliable sources—not dot-com websites that are selling products. Before trying something new, they should check with their health care providers to make sure there are no interactions or contraindications. VOCABULARY 1. (5) 2. (4) 3. (6) 4. (2) 5. (1) 6. (3) COMPLEMENTARY MODALITY: GUIDED IMAGERY Purpose: To help the patient use mental imagesto reduce stress and promote changes in attitude or behavior. May be useful in treating stress-related conditions, such as high blood pressure or insomnia, and may even boost the immune system. Teaching Plan: See Box 5-1 in textbook. CRITICAL THINKING 1. Feverfew is used for migraine headaches, inflammation, and menstrual problems, among other things. 2. Capsaicin is used for pain associated with a variety of disorders. 3. St. John’s wort is used for depression. 4. Several sources should be consulted before taking herbs. The Internet has a lot of good information, but the source should be carefully evaluated. The Mayo Clinic website () is an excellent resource. A pharmacist knowledgeable in herbs and herb–drug interactions as well as the health care provider should be consulted. 5. ―Mrs. Lawless, I am concerned that these herbs could interact with your heart failure medications. I will check with your doctor and the hospital pharmacist to be sure they are safe before you take them.‖ REVIEW QUESTIONS—CONTENT REVIEW The correct answers are in boldface. 1. (4) is correct. Progressive muscle relaxation is being added to a traditional therapy, making it complementary. (1) is incorrect. Inhalers and oral medications are both traditional therapies for asthma. (2) is incorrect. Cardiac rehabilitation is a traditional therapy. (3) would be considered an alternative modality because echinacea is being used in place of a traditional therapy. 2. (1) is correct. Hydrotherapy would be considered an alternative modality because it is being used in place of nonsteroidal anti-inflammatory drugs. (2) is incorrect. Because chemotherapy is still being used, the addition of the spiritual healer would be considered complementary. (3) is incorrect. Antibiotics and bronchodilators are both traditional medical therapy. (4) is incorrect. Aspirin is traditional therapy for a headache. 3. (3) is correct. Allopathy is the proper term for traditional Western medicine. (1, 2, 4) are all nontraditional medical practices. 4. (1) is correct. Echinacea has been shown in some studiesto be potentially effective against colds and viruses. (2) is incorrect. Feverfew is used for headaches and inflammation, among other things. (3) isincorrect. Chamomile is used for anxiety. (4) isincorrect. Ginger is used for nausea. 5. (1, 2, 6) are correct. Energetic modalities include biofeedback, magnet therapy, Reiki, spiritual healing, and therapeutic touch. (3, 5) are incorrect. Music therapy and yoga are mind–body therapies. (4) is incorrect. Hydrotherapy is considered a miscellaneous therapy and is not designed to alter energy fields. REVIEW QUESTIONS—TEST PREPARATION The correct answers are in boldface. 6. (4) is correct. The patient should keep his or her eyes closed during imagery, so this statement indicates that more teaching is needed. (1, 2, 3) are all parts of guided imagery. 2 Chapter 5 Answers 7. (2) is correct. Chiropractors do not perform surgery. (1, 3, 4) are potentially true, but the nurse needs to safeguard the patient by informing the patient that a chiropractor is not trained or qualified to do surgery. 8. (2) is correct. The health care provider can help determine which alternative modalities are safe. (1) is incorrect. Any therapy can be potentially safe or unsafe. (3) is incorrect. Many alternative modalities are safe when used correctly. (4) is incorrect. Alternative and complementary modalities can be effective for chronic pain. 9. (3) is correct. It is least appropriate to tell the patient he will be able to reduce his pain medications; this is a possibility but not a guarantee. (1, 2, 4) are all appropriate measures to take before beginning to practice any new alternative modality. 10. (4) is correct. Ginseng can lower blood glucose and can interfere with warfarin and aspirin. The patient needs to be aware of the risks and then be encouraged to speak with the health care provider. (1) is incorrect. Ginseng can lower glucose, but it should not be encouraged without health care provider approval. (2) is incorrect. While the patient may check out a website before taking the ginseng, he must be educated while he is still in the hospital. (3) is incorrect. It might be safe to take some herbal agents with the prescribed medications; the patient needs to understand how to exercise caution. Answers 1 CHAPTER 6 NURSING CARE OF PATIENTS WITH FLUID, ELECTROLYTE, AND ACID–BASE IMBALANCES AUDIO CASE STUDY Grandma Lois Is Dehydrated 1. Grandma Lois was lethargic and had altered mental status; low-grade temperature; concentrated urine; dry, sticky mucous membranes; tachycardia; and poor skin turgor. 2. Shortness of breath with elevated respiratory rate, crackles in lungs, and edema. 3. Older adults have a lower percentage of body water to begin with and so are more easily dehydrated than younger people. Their kidneys also do not work as efficiently as younger people’s. VOCABULARY 1. diffusion 2. isotonic 3. hypertonic 4. hypovolemia 5. cations 6. hypernatremia 7. hypokalemia 8. hypocalcemia 9. Acidosis 10. alkalosis DEHYDRATION Corrections are in boldface. Mrs. White is a 78-year-old woman admitted to the hospital with a diagnosis of severe dehydration. The licensed practical nurse/licensed vocational nurse (LPN/LVN) assigned to Mrs. White is asked to collect data related to fluid status. The LPN/LVN expects Mrs. White’s blood pressure to be low because of fluid loss. The nurse also finds Mrs. White’s skin turgor to be poor, and the nurse notes that the urine output is scant and dark amber. The nurse asks Mrs. White if she knows where she is and what day it is, because severe dehydration may cause confusion. In addition, the nurse initiates taking daily weights because this is the most accurate way to monitor fluid balance. ELECTROLYTE IMBALANCES 1. (4) 2. (5) 3. (2) 4. (3) 5. (1) CRITICAL THINKING 1. Check Mr. James’s vital signs. Elevated blood pressure, bounding pulse, and shallow, rapid respirations are common signs of fluid overload. If he is able to stand, weigh him to see if his weight has increased since yesterday. Auscultation of his lungs may reveal new-onset or worsening crackles. (He may have had crackles on admission related to his bronchitis.) 2. Kidney function declines in the older adult, and the intravenous (IV) fluids may have been too much for him. Regular assessment and caution with IV therapy can prevent overload from occurring. 3. The registered nurse may decide to reduce the IV infusion rate until orders are obtained. The LPN/LVN can do the following: Elevate the patient’s head to ease breathing. Make sure oxygen therapy is being administered as ordered. Stay with him to help him feel less anxious. Anticipate a possible diuretic order. Continue to monitor fluid balance. 4. If a diuretic is administered, urine output should increase, but this does not signal resolution of the problem. It is probably unrealistic to expect Mr. James’s lungs to clear completely because he was admitted with bronchitis. However, return of lung sounds to admission baseline would signal resolution of the acute overload. Other signs would include return to admission vital signs and weight and the ability to walk to the bathroom again without excessive shortness of breath. REVIEW QUESTIONS—CONTENT REVIEW The correct answers are in boldface. 1. (2) is correct. 0.9% is isotonic, making 0.45% hypotonic. (1) is isotonic; (3, 4) are hypertonic. 2. (1) is correct. Antidiuretic hormones retain water. (2, 3, 4) do not affect water balance. 2 Chapter 6 Answers 3. (2) is correct. Deli meats are high in sodium. (1, 3, 4) are not high in sodium. 4. (3) is correct. Potatoes are high in potassium. (1, 2, 4) are not high in potassium. 5. (2) is correct. Fluid gains and losses are evidenced in weight gains and losses. (1, 3, 4) are all ways to monitor fluid balance, but they are not as reliable. Intake and output may be inaccurate, vitalsigns may be affected by other factors, and measurement of skin turgor issubjective. 6. (2) is correct. Vomiting, diarrhea, and profuse sweating can cause dehydration that may manifest itself by thirst, a rapid heartbeat but weak pulse, low blood pressure, dark urine, dry skin and mucous membranes, and elevated blood urea nitrogen and hematocrit levels. Temperature often increases in cases of dehydration but may not be apparent in older people who often have a lower normal body temperature than younger people. (1) is incorrect. Hypervolemia, or overhydration, is the opposite of dehydration. Excess fluid may result in (3) edema in the lower extremities and elevated blood pressure; increased rate of respiration; pale, cool skin; and diluted urine. (4) is incorrect. Hyponatremia, or low sodium level, may occur with dehydration but can be confirmed only by laboratory tests. In any case, the fluid imbalance must be assessed and treated first. REVIEW QUESTIONS—TEST PREPARATION The correct answers are in boldface. 7. (2) is correct. Failing kidneys cannot effectively excrete water, making the patient at risk for overload. (1, 3, 4) do not cause fluid retention. Influenza can cause fluid loss if vomiting or diarrhea is present. 8. (1, 4, 6) are correct. The patient with an ileostomy loses large amounts of water with continuous liquid stools. Fever is associated with an increased risk of dehydration. Diuretic therapy increases the risk for dehydration. (2) Asthma, (3) diabetes (as long as it is stable), and (5) fractures do not cause fluid loss. 9. (1) is correct. Hyponatremia accompanied by fluid loss resultsin dehydration and mentalstatus changes. (2, 3, 4) are not aslikely to affect fluid balance and mental status. 10. (3) is correct. Ambulation can help prevent bone loss. Because the patient is weak and is at risk for falls and fractures, assistance should be provided. (1) is incorrect. Bedrest promotes bone loss. (2) is incorrect. Fluids will not help bone or calcium levels. (4) is incorrect. The patient needs calcium, not protein. 11. (2) is correct. The patient is probably hyperventilating because of the anxiety. Rebreathing carbon dioxide exhaled into a paper bag can temporarily relieve symptoms of alkalosis until the underlying cause is corrected. (1, 3, 4) all help increase oxygenation, which is not needed at this time. 12. (2) is correct. Hypoventilation related to lung disease leads to retention of carbon dioxide, which causes acidosis. (1) is incorrect. Hyperventilation causes alkalosis. (3) is incorrect. Loss of acid causes alkalosis. (4) is incorrect. Loss of base causes acidosis, but it is not the cause in this case. 13. (3, 4, 6) are correct. Potassium supplements should be taken with food. Slow-K should not be crushed. Diarrhea is not expected and should be reported to the physician. If the patient makes these statements, more teaching is needed. (1, 2, 5) are incorrect