Textbook of Medical-Surgical Nursing

BRUNNER & SUDDARTH'S TEXTBOOK OF MEDICAL-SURGICAL NURSING 15TH EDITION HINKLE TEST BANK
KEY: Integrated Process: Nursing Process
NOT: Multiple Choice
BLM: Cognitive Level: Apply
30. Diagnostic testing has been prescribed to differentiate between normal anion gap acidosis and high
anion gap acidosis in an acutely ill client. What health problem often precedes normal anion gap
acidosis?
A. Metastases
B. Excessive potassium intake
C. Water intoxication
D. Excessive administration of chloride
ANS: D
Rationale: Normal anion gap acidosis results from the direct loss of bicarbonate, as in diarrhea, lower
intestinal fistulas, ureterostomies, and use of diuretics; early renal insufficiency; excessive
administration of chloride; and the administration of parenteral nutrition without bicarbonate or
bicarbonate-producing solutes (e.g., lactate). Based on these facts, the other listed options are
incorrect.
PTS: 1 REF: p. 260
NAT: Client Needs: Physiological Integrity: Physiological Adaptation
TOP: Chapter 10: Principles of Fluid and Electrolytes
KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Understand
NOT: Multiple Choice
31. The nurse is caring for a client with a diagnosis of pancreatitis. The client was admitted from a
homeless shelter and is a vague historian. The client appears malnourished and on day 3 of the client's
admission, total parenteral nutrition (TPN) has been started. Why should the nurse start the infusion of
TPN slowly?
A. Clients receiving TPN are at risk for hypercalcemia if calories are started too rapidly.
B. Malnourished clients receiving parenteral nutrition are at risk for hypophosphatemia if
calories are started too aggressively.
C. Malnourished clients who receive fluids too rapidly are at risk for hypernatremia.
D. Clients receiving TPN need a slow initiation of treatment in order to allow digestive
enzymes to accumulate.
ANS: B
Rationale: The nurse identifies clients who are at risk for hypophosphatemia and monitors them.
Because malnourished clients receiving parenteral nutrition are at risk when calories are introduced too
aggressively, preventive measures involve gradually introducing the solution to avoid rapid shifts of
phosphorus into the cells. Clients receiving TPN are not at risk for hypercalcemia or hypernatremia if
calories or fluids are started to rapidly. Digestive enzymes are not a relevant consideration.
PTS: 1 REF: p. 256
NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies
TOP: Chapter 10: Principles of Fluid and Electrolytes
KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Apply
NOT: Multiple Choice
32. The nurse is caring for a client 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
C L I C K H E R E T O D O W N L O A D C O M P L E T E T E S T B A N K S