Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) - Fluid and Electrolytes: Balance and Disturbance

Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) - Fluid and Electrolytes: Balance and Disturbance Related

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The nurse is providing care for a patient with chronic obstructive pulmonary disease. When describing the process of respiration the nurse explains how oxygen and carbon dioxide are exchanged between the pulmonary capillaries and the alveoli. The nurse is describing what process?

  • A. Diffusion
  • B. Osmosis
  • C. Active transport
  • D. Filtration
Correct Answer: A

Rationale: Diffusion is the natural tendency of a substance to move from an area of higher concentration to one of lower concentration. It occurs through the random movement of ions and molecules. Examples of diffusion are the exchange of oxygen and carbon dioxide between the pulmonary capillaries and alveoli and the tendency of sodium to move from the ECF compartment, where the sodium concentration is high, to the ICF, where its concentration is low. Osmosis occurs when two different solutions are separated by a membrane that is impermeable to the dissolved substances; fluid shifts through the membrane from the region of low solute concentration to the region of high solute concentration until the solutions are of equal concentration. Active transport implies that energy must be expended for the movement to occur against a concentration gradient. Movement of water and solutes occurring from an area of high hydrostatic pressure to an area of low hydrostatic pressure is filtration.

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A patient with a longstanding diagnosis of generalized anxiety disorder presents to the emergency room. The triage nurse notes upon assessment that the patient is hyperventilating. The triage nurse is aware that hyperventilation is the most common cause of which acidbase imbalance?

  • A. Respiratory acidosis
  • B. Respiratory alkalosis
  • C. Increased PaCO2
  • D. CNS disturbances
Correct Answer: B

Rationale: The most common cause of acute respiratory alkalosis is hyperventilation. Extreme anxiety can lead to hyperventilation. Acute respiratory acidosis occurs in emergency situations, such as pulmonary edema, and is exhibited by hypoventilation and decreased PaCO2. CNS disturbances are found in extreme hyponatremia and fluid overload.

A gerontologic nurse teaching students about the high incidence and prevalence of dehydration in older adults. What factors contribute to this phenomenon? Select all that apply.

  • A. Decreased kidney mass
  • B. Increased conservation of sodium
  • C. Decreased renal blood flow
  • D. Decreased excretion of potassium
Correct Answer: A, D, E

Rationale: Dehydration in the elderly is common as a result of decreased kidney mass, decreased glomerular filtration rate, decreased renal blood flow, decreased ability to concentrate urine, inability to conserve sodium, decreased excretion of potassium, and a decrease of total body water. Increased water volume and sodium conservation are not typical contributors to dehydration in older adults.

The community health nurse is performing a home visit to an 84-year-old woman recovering from hip surgery. The nurse notes that the woman seems uncharacteristically confused and has dry mucous membranes. When asked about her fluid intake, the patient states, I stop drinking water early in the day because it is just too difficult to get up during the night to go to the bathroom. What would be the nurses best response?

  • A. I will need to have your medications adjusted so you will need to be readmitted to the hospital for a complete workup.
  • B. Limiting your fluids can create imbalances in your body that can result in confusion. Maybe we need to adjust the timing of your fluids.
  • C. It is normal to be a little confused following surgery, and it is safe not to urinate at night.
  • D. If you build up too much urine in your bladder, it can cause you to get confused, especially when your body is under stress.
Correct Answer: B

Rationale: In elderly patients, the clinical manifestations of fluid and electrolyte disturbances may be subtle or atypical. For example, fluid deficit may cause confusion or cognitive impairment in the elderly person. There is no mention of medications in the stem of the question or any specific evidence given for the need for readmission to the hospital. Confusion is never normal, common, or expected in the elderly. Urinary retention does normally cause confusion.

You are caring for a patient with a secondary diagnosis of hypermagnesemia. What assessment finding would be most consistent with this diagnosis?

  • A. Hypertension
  • B. Kussmaul respirations
  • C. Increased DTRs
  • D. Shallow respirations
Correct Answer: D

Rationale: If hypermagnesemia is suspected, the nurse monitors the vital signs, noting hypotension and shallow respirations. The nurse also observes for decreased DTRs and changes in the level of consciousness. Kussmaul breathing is a deep and labored breathing pattern associated with severe metabolic acidosis, particularly diabetic ketoacidosis (DKA), but also renal failure. This type of patient is associated with decreased DTRs, not increased DTRs.

A nurse educator is reviewing peripheral IV insertion with a group of novice nurses. How should these nurses be encouraged to deal with excess hair at the intended site?

  • A. Leave the hair intact.
  • B. Shave the area.
  • C. Clip the hair in the area.
  • D. Remove the hair with a depilatory.
Correct Answer: C

Rationale: Hair can be a source of infection and should be removed by clipping; it should not be left at the site. Shaving the area can cause skin abrasions, and depilatories can irritate the skin.

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