Ch. 14 EAQ
when caring for a patient with a pulse oximetry level of 90%, which action would the nurse take first?
apply oxygen as prescribed applying oxygen is the first priority for a patient with hypoxemia. it is unclear whether the patient is stable to be out of bed; elevating the head of bed (HOB) would be more appropriate to improve respiratory expansion. notifying the health care provider is an appropriate action after initiation of oxygen therapy; delaying intervention while waiting for the health care provider delays treatment. breath sounds can be auscultated after initiation of oxygen therapy; hypoxemia may be present in the absence of adventitious breath sounds
which nursing assessment would be included in the plan of care for a patient with chronic respiratory acidosis?
assessing the color of the nail beds, checking for the use of accessory muscles, assessing for cyanosis of mucous membranes for a patient with chronic respiratory acidosis, the nurse should assess the color of nail beds and mucous membranes and assess for the use of accessory muscles when breathing. assessment of breathing status should be done at least every 2 hours, and lung sounds should be assessed for grunting or wheezing, not crackles.
after reviewing assessment data for a patient who was admitted for emergency treatment of an acute episode of emphysema, the nurse understands that which data suggest the patient is in an uncompensated acid-base imbalance?
bicarbonate (HCO3-) of 24 mEq/L kidney compensation for respiratory acid-base imbalance (PaCO 2 30 mm Hg) from the acute emphysema episode is not yet evident in the arterial blood gas analysis (HCO3- 24 mEq/L), resulting in an uncompensated acid-base imbalance state. the fever is most likely associated with increased metabolism and work of breathing. anxiety is common and related to hypoxia (PaO 2 80 mm Hg) and difficulty breathing (wheezing). the decreased PaCO2 of 30 mm Hg is associated with the increased respiratory rate and the cause of the respiratory alkalosis.
the nurse would anticipate which laboratory finding when caring for a patient who has taken a large quantity of a loop diuretic to promote weight loss?
bicarbonate (HCO3-) of 34 mEq/L loop diuretics, evidenced by a finding of HCO3- of 34 mEq/L, cause metabolic alkalosis. a PaO2 of 78 mm Hg demonstrates mild hypoxemia consistent with respiratory disorders, not with diuretic use. carbon dioxide (CO2) retention (PaCO2 of 56 mm Hg) results from hypoventilation, which is not consistent with diuretic use. a pH of 7.31 is acidotic; diuretics promote metabolic alkalosis
which condition places a patient at risk for developing metabolic alkalosis?
blood transfusion, nasogastric suctioning, total parenteral nutrition conditions placing a patient at risk for metabolic alkalosis result from an overproduction or under elimination of base. blood transfusion, administration of total parenteral nutrition, and nasogastric suctioning increase a patient's risk for metabolic alkalosis. hypovolemic shock with result in respiratory alkalosis. diarrhea and fever will cause metabolic acidosis
which assessment finding would require priority nursing interventions in a patient with metabolic or respiratory acidosis?
bradycardia with widened QRS complex cardiovascular manifestations that require priority nursing interventions are related to delayed electrical conduction, specifically bradycardia that may progress to heart block, tall T waves, widened QRS complex, and prolonged PR interval. other changes like lethargy, confusion, rapid respiratory rate, and dry skin are important to address but may not require priority interventions
which condition can cause metabolic acidosis?
diarrhea, liver failure, kidney failure diarrhea, liver failure, and kidney failure can result in metabolic acidosis. prolonged vomiting and nasogastric suctioning may result in metabolic alkalosis.
a postoperative patient has the following arterial blood gas (ABG) results: pH 7.30; partial pressure of arterial carbon dioxide (PaCO2) 60 mm Hg; partial pressure of arterial oxygen (PaO2) 80 mm Hg; bicarbonate 24 mEq/L; and oxygen (O2) saturation 96%. which action would the nurse take?
encourage the patient to do deep breathing, and assist with repositioning postoperative respiratory acidosis is caused by carbon dioxide (CO2) retention and impaired chest expansion secondary to anesthesia. the nurse takes steps to promote CO2 elimination, including maintaining a patent airway and expanding the lungs through respiratory interventions such as repositioning the patient and encouraging deep breathing. after anesthesia, the patient will need interventions related to promoting CO2 elimination, or the patient may progress to a state of somnolence and unresponsiveness. supplemental oxygen is not indicated because PaO2 and oxygen saturation are within the normal range. sodium bicarbonate is not indicated because the bicarbonate level is in the normal range.
which manifestation would the nurse anticipate finding when assessing a patient with metabolic and respiratory acidosis?
flaccid paralysis, Kussmaul respiration, delayed electrical conduction an increase in carbon dioxide and hydrogen ion levels causes respiratory acidosis, and reduced elimination of hydrogen ions causes metabolic acidosis. acidosis causes neuromuscular manifestations such as flaccid paralysis, which is associated with muscle tenderness and severe hypokalemia. acidosis causes Kussmaul respiration, which is associated with respiratory compensation. acidosis slows down the electrical conduction by prolonging the atrioventricular node delay. acidosis causes a decrease in blood pressure, or hypotension, not hypertension. the integumentary manifestations of acidosis include warm, flushed, and dry skin.
which concept is accurate regarding acid-base chemistry in acidosis?
fluids with lower pH have higher acidity fluids with lower pH have a higher level of free hydrogen ions and therefore have higher acidity. acids release hydrogen ions rather than bind with them when dissolved in water. strong acids readily dissociate in water and release all of their hydrogen ions. CH3COOH is a week acid. when dissolved in water, it releases only one of its four hydrogen molecules. normally, blood has a pH of between 7.35 and 7.45, so it is slightly alkaline
which electrolyte abnormality would the nurse anticipate when reviewing laboratory data for a patient admitted with metabolic acidosis?
hyperkalemia serum potassium (hyperkalemia) occurs during metabolic acidosis as the body attempts to maintain pH by moving potassium ions from the cell in exchange with hydrogen ions moving into the cell. hypokalemia may occur as the cause of the metabolic acidosis is corrected. sodium concentrations (hypernatremia and hyponatremia) are not affected in the buffering process of acid-base balance
which nursing intervention takes priority for a patient admitted with severe metabolic acidosis?
initiate cardiac monitoring the nurse follows the ABCs and initiates cardia monitoring to observe for signs of hyperkalemia or cardiac arrest. medication reconciliation should be performed as soon as possible; however, this patient is at risk for cardiac and neurologic complications of acidosis. starvation may precipitate ketosis/acidosis, but this is not the priority. assessing the patient's strength in the extremities is an important intervention because of the neurologic complications of acidosis, but it is not the priority over initiating cardiac monitoring
which cause is associated with acidosis?
kidney failure causes of acidosis include kidney failure, pancreatitis, liver failure, and dehydration. high altitudes, ingestion of antacids, and prolonged vomiting are causes of alkalosis.
which condition or symptom is likely responsible for this acid-base imbalance: pH 7.32; partial pressure of arterial oxygen (PaO2) 82 mm Hg; partial pressure of arterial carbon dioxide (PaCO2) 33 mm Hg; and bicarbonate (HCO3) 18 mEq/L?
liver failure, dehydration, respiratory rate of 8 breaths/min the instance of acid-base imbalance is caused by metabolic acidosis, which is indicated by an HCO3 of 18 mEq/L. conditions that may cause metabolic acidosis are liver failure and dehydration. prolonged vomiting and anxiety would result in an alkalosis imbalance. constipation would not cause an acid-base imbalance; however, diarrhea would place the patient at risk for acidosis. hypoventilation (respiration rate of 8 breaths/min) would cause respiratory acidosis, and an increased PaCO2
which acid-base imbalance would be expected in a patient who has been having acute diarrhea for more than 24 hours?
metabolic acidosis diarrhea results in excessive elimination of bicarbonate, creating an imbalance between hydrogen ions and bicarbonate, leading to metabolic acidosis. diarrhea would not cause a respiratory acid-base imbalance. metabolic alkalosis is incorrect because the patient is losing base rather than experiencing higher concentrations of base, which is seen with alkaline conditions
deep and rapid breaths consistent with Kussmaul respiration are found in patients with which type of acid-base imbalance?
metabolic acidosis in metabolic acidosis, the rate and depth of breathing increase as the hydrogen ion levels rise. the breathing pattern becomes deep and rapid and not under voluntary control. this type of breathing is known as Kussmaul respiration, which is not present in respiratory alkalosis, respiratory acidosis, or metabolic alkalosis
which acid-base disturbance would be associated with a serum lactate level of 6.2 mmol/L in a critically ill patient?
metabolic acidosis patients with critical illness can be considered to have normal lactate concentrations at less than 2 mmol/L. increased lactate levels are associated with hypoxia and metabolic acidosis secondary to anaerobic metabolism. metabolic alkalosis is related to bicarbonate therapy, diuretic use, vomiting, and nasogastric suction. respiratory acidosis is caused by carbon dioxide (CO2) retention and impaired pulmonary function, which is inconsistent with elevated lactate levels. respiratory alkalosis is caused by excessive loss of CO2 through hyperventilation, which is inconsistent with elevated lactate levels.
which clinical manifestation would the nurse likely assess in a patient with metabolic alkalosis?
numbness around the mouth, hyperactivity of deep tendon reflexes alkalosis overexcites the nervous system, leading to tingling or numbness around the mouth. hypercalcemia occurs with alkalosis, which can cause hyperactivity of deep tendon reflexes. overstimulation of the nerves may cause contraction of skeletal muscles, but the contractions are weaker because of hypokalemia. therefore there is a decrease in handgrip strength. alkalosis increases myocardial irritability and increases the heart rate. kussmaul respiration (deep and rapid involuntary breathing) is seen in metabolic acidosis with respiratory compensation
which mechanism causes acidosis in a patient in diabetic ketoacidosis?
overproduction of hydrogen ions in diabetic ketoacidosis, there is an excessive breakdown of fatty acids. this produces strong acids (ketoacids) with the release of large amount of hydrogen ions. under elimination of hydrogen ions occurs when hydrogen ions are produced at normal rates, but their elimination is reduced. this is seen in patients with lung and kidney problems. bicarbonate ions are made in the kidney or in the pancreas. in patients with impaired kidney or pancreatic function, there is underproduction of bicarbonate ions, leading to acidosis. over elimination of bicarbonate ions occurs when there is an excessive loss of bicarbonate ions. this occurs in diarrhea
which arterial blood gas result would be expected in a patient diagnosed with acute kidney failure?
pH 7.33 PaO2 82 mm Hg PaCO2 25 mm Hg HCO3-19 mEq/L most hydrogen ion excretion occurs through the lungs and the kidneys. kidney failure causes acidosis when the kidney tubules cannot secrete hydrogen ions into the urine, causing metabolic acidosis. the other options are not indicative of metabolic acidosis because they represent a normal pH (7.37) or elevated pH (7.48 and 7.49)
which arterial blood gas laboratory values would be seen in metabolic alkalosis?
pH 7.49, bicarbonate (HCO 3-) 32 in metabolic alkalosis, pH is greater than 7.45, and HCO3- is greater than 28. a pH of 7.28 and a CO2 of 54 indicates respiratory acidosis. a pH of 7.53 and a CO2 of 28 indicates respiratory alkalosis. a pH of 7.31 and an HCO3- of 18 indicated metabolic acidosis.
while the nurse is assessing a patient with metabolic acidosis, which finding supports that the patient has lactic acidosis?
symptoms of hypoxia lactic acidosis occurs when the body has too little oxygen to meet metabolic oxygen demands, such as during heavy exercise, seizure activity, fever, and reduced oxygen intake. insufficient blood glucose causes the breakdown of fatty acids and accumulation of ketones, resulting in ketoacidosis. oral antacids contain sodium bicarbonate or calcium carbonate. therefore excess intake of oral antacids increases the risk for metabolic alkalosis. if the patient's kidney tubules cannot secrete hydrogen ions into the urine, it causes the underelimination of hydrogen ions, leading to metabolic acidosis but not lactic acidosis.
the nurse is assessing the laboratory profiles of patients with acid-base imbalances. which patient diagnosis correctly correlates to the appropriate laboratory values? Patient A: arterial bicarbonate is 16 mEq/L Patient B: arterial pH value is 7.36 Patient C: arterial PaCO2 value is 31 mm Hg Patient D: arterial PaO2 value is 60 mm Hg
patient D has respiratory depression the normal laboratory value of arterial PaO2 is 80 to 100 mm Hg. an arterial PaO2 value of 60 mm Hg indicated respiratory depression, so patient D is correctly diagnosed. the normal laboratory value of arterial bicarbonate if 21 to 28 mEq/L. the nurse anticipates that patient A has metabolic acidosis because the arterial bicarbonate value of 16 mEq/L indicated a decrease in the bicarbonate levels. the normal pH is 7.35 to 7.45. the nurse suspects that patient B is in homeostasis because the pH is within normal limits. the normal laboratory value of PaCO2 is 35-45 mm Hg. the arterial PaCO2 value of 30 mm Hg indicates that patient C has a risk for respiratory alkalosis.
which patient would exhibit the following arterial blood gas (ABG) results; pH 7.30; partial pressure of arterial carbon dioxide (PaCO2) 49; bicarbonate (HCO3-) 26; and partial pressure of arterial oxygen (PaO2) 76?
patient taking opioids opioids can cause respiratory depression, hypoventilation, and respiratory acidosis, as this blood gas reading demonstrates. kidney failure causes metabolic acidosis. anxiety will cause hyperventilation and subsequent respiratory alkalosis. although hyperkalemia can be caused by acidosis, it is not a cause of acidosis.
when caring for a patient with kidney failure who has metabolic acidosis, which symptom would the nurse expect as evidence of the body's compensatory effort?
rapid and deep respirations kussmaul respiration (rapid, deep respirations) represent the body's attempt to compensate for metabolic acidosis. the skin is warm, dry, and flushed in metabolic acidosis. cardiovascular symptoms may occur, but they are manifestations of acidosis, not evidence of compensation
a patient having continuous nasogastric (NG) suction after abdominal surgery has become irritable and anxious with hyperreflexia, tachycardia, and tachypnea. which action by the nurse is correct?
request an order to evaluate serum electrolytes and turning off the NG suction patients undergoing NG suction are at risk for metabolic alkalosis, which has central nervous system and cardiovascular signs such as these. the nurse should request an order for serum electrolytes to evaluate this and should disrupt the NG suction to prevent increased alkalosis. metabolic alkalosis would be increased with the administration of bicarbonate. until the patient's electrolyte levels are known, it is not correct to administer IV electrolytes. notifying the Rapid Response Team is not indicated
a laboratory report for a patient shows the following results: pH 7.32; bicarbonate 24 mEq/L; partial pressure of arterial oxygen (PaO2) 77 mm Hg; and partial pressure of arterial carbon dioxide (PaCO2) 48 mm Hg. these findings are consistent with which acid-base imbalance?
respiratory acidosis in respiratory acidosis, there is a decrease in pH (normal is 7.35 to 7.45), a normal bicarbonate (normal is 21 to 28 mEq/L), a decrease in PaO2 (normal is 80 to 100 mm Hg), and an increase in PaCO2 (normal is 35 to 45 mm Hg). the arterial blood gas results of pH 7.32, bicarbonate 24 mEq/L, PaO2 77 mm Hg, and PaCO2 48 mm Hg reflect respiratory acidosis. in respiratory alkalosis, there is an increase in pH, a normal bicarbonate, a normal PaO2, and a decrease in PaCO2. in metabolic alkalosis, there is an increase in pH, an increase in bicarbonate, a normal PaO2, and a normal PaCO2. in metabolic acidosis, there is a decrease in pH, a decrease in bicarbonate, a normal Pa2, and a normal PaCO2
which acid-base imbalance would the nurse anticipate that a patient with morbid obesity may develop?
respiratory acidosis respiratory acidosis is related to carbon dioxide (CO2) retention secondary to respiratory depression, inadequate chest expansion, airway obstruction, or reduced alveolar-capillary diffusion. respiratory acidosis is common in patients with morbid obesity who experience inadequate chest expansion because of their size and work of breathing. metabolic acidosis is related to overproduction of hydrogen ions, under elimination of hydrogen ions, underproduction of bicarbonate ions, and overelimination of bicarbonate ions. metabolic alkalosis is related to loss of bicarbonate or buffers (i.e., vomiting or nasogastric suction). respiratory alkalosis usually is caused by excessive loss of CO2 through hyperventilation secondary to fever, central nervous system lesions, and salicylates
a patient with diabetes mellitus is admitted after vomiting for several days and has rapid, deep respirations. which process does the nurse suspect is occurring with this patient?
respiratory compensation for metabolic acidosis patients with diabetes mellitus can develop metabolic acidosis. respiratory compensation occurs through the lungs as the rate and depth of respirations increase to reduce hydrogen ion levels. kidney compensation is not occurring
which condition may result in metabolic acidosis?
starvation, prolonged diarrhea prolonged diarrhea can cause overelimination of bicarbonate ions resulting in metabolic acidosis. starvation leads to excessive oxidation of fatty acids leading to overproduction of hydrogen ions and metabolic acidosis. prolonged vomiting and nasogastric suctioning can lead to acid deficits cause metabolic alkalosis. blood transfusion and total parenteral nutrition increase the base components by parenteral base administration, which also causes metabolic alkalosis.
