MEDICAL SURGICAL TESTBANK QUESTIONS AND ANSWERS WITH SOLUTIONS 2024

MEDICAL SURGICAL TESTBANK
QUESTIONS AND ANSWERS WITH
SOLUTIONS 2024
ExamT1T-TANSWERTfluidTandTelectrolyres

acidTbase

thermoregulation



ChapterT17:TFluid,TElectrolyte,TandTAcid-BaseTImbalancesT-TANSWERT---



1.TTheTnurseTobtainsTallTofTtheTfollowingTassessmentTdataTaboutTaTpatientTwithTdeficientTfluidTvolumeTcaus
edTbyTaTmassiveTburnTinjury.TWhichTofTtheTfollowingTassessmentTdataTwillTbeTofTgreatestTconcern?



a.



TheTbloodTpressureTisT90/40TmmTHg.



b.



UrineToutputTisT30TmlToverTtheTlastThour.



c.



OralTfluidTintakeTisT100TmlTforTtheTlastT8Thours.



d.



ThereTisTprolongedTskinTtentingToverTtheTsternum.T-TANSWERTTheTbloodTpressureTisT90/40TmmTHg.

,Rationale:TTheTbloodTpressureTindicatesTthatTtheTpatientTmayTbeTdevelopingThypovolemicTshockTasTaTresul
tTofTfluidTloss.TThisTwillTrequireTimmediateTinterventionTtoTpreventTtheTcomplicationsTassociatedTwithTsyste
micThypoperfusion.TTheTpoorToralTintake,TdecreasedTurineToutput,TandTskinTtentingTallTindicateTtheTneedTf
orTincreasingTtheTpatientsTfluidTintakeTbutTnotTasTurgentlyTasTtheThypotension.



2.TATrecentlyTadmittedTpatientThasTaTsmallTcellTcarcinomaTofTtheTlung,TwhichTisTcausingTtheTsyndromeTofTin
appropriateTantidiureticThormoneT(SIADH).TTheTnurseTwillTmonitorTcarefullyTfor



a.



increasedTtotalTurinaryToutput.



b.



elevationTofTserumThematocrit.



c.



decreasedTserumTsodiumTlevel.



d.



rapidTandTunexpectedTweightTloss.T-TANSWERTdecreasedTserumTsodiumTlevel.



Rationale:TSIADHTcausesTwaterTretentionTandTaTdecreaseTinTserumTsodiumTlevel.TWeightTloss,TincreasedTur
ineToutput,TandTelevatedTserumThematocritTmayTbeTassociatedTwithTexcessiveTlossTofTwater,TbutTnotTwithT
SIADHTandTwaterTretention.



3.TWhenTtheTnurseTisTevaluatingTtheTfluidTbalanceTforTaTpatientTadmittedTforThypovolemiaTassociatedTwithT
multipleTdrainingTwounds,TtheTmostTaccurateTassessmentTtoTincludeTis

,a.



skinTturgor.



b.



dailyTweight.



c.



presenceTofTedema.



d.



hourlyTurineToutput.T-TANSWERTdailyTweight.



Rationale:TDailyTweightTisTtheTmostTeasilyTobtainedTandTaccurateTmeansTofTassessingTvolumeTstatus.TSkinTt
urgorTvariesTconsiderablyTwithTage.TConsiderableTexcessTfluidTvolumeTmayTbeTpresentTbeforeTfluidTmovesTi
ntoTtheTinterstitialTspaceTandTcausesTedema.THourlyTurineToutputsTdoTnotTtakeTaccountTofTfluidTintakeTorTo
fTfluidTlossTthroughTinsensibleTloss,Tsweating,TorTlossTfromTtheTgastrointestinalTtractTorTwounds.



4.TWhenTcaringTforTanTalertTandTorientedTelderlyTpatientTwithTaThistoryTofTdehydration,TtheThomeThealthTn
urseTwillTteachTtheTpatientTtoTincreaseTfluidTintake



a.



inTtheTlateTeveningThours.



b.

, ifTtheToralTmucosaTfeelsTdry.



c.



whenTtheTpatientTfeelsTthirsty.



d.



asTsoonTasTchangesTinTlevelTofTconsciousnessT(LOC)Toccur.T-TANSWERTifTtheToralTmucosaTfeelsTdry.



Rationale:TAnTalert,TelderlyTpatientTwillTbeTableTtoTself-
assessTforTsignsTofToralTdrynessTsuchTasTthickToralTsecretionsTorTdry-
appearingTmucosa.TTheTthirstTmechanismTdecreasesTwithTageTandTisTnotTanTaccurateTindicatorTofTvolumeT
depletion.TManyTolderTpatientsTpreferTtoTrestrictTfluidsTslightlyTinTtheTeveningTtoTimproveTsleepTquality.TTh
eTpatientTwillTnotTbeTlikelyTtoTnoticeTandTactTappropriatelyTwhenTchangesTinTLOCToccur.



5.TATpatientTisTtakingTaTpotassium-
wastingTdiureticTforTtreatmentTofThypertension.TTheTnurseTwillTteachTtheTpatientTtoTreportTsymptomsTofTa
dverseTeffectsTsuchTas



a.



personalityTchanges.



b.



frequentTlooseTstools.



c.



facialTmuscleTspasms.