Chapter 8: Disorders of Fluid, Electrolyte, and Acid-Base Balance - ML4

Which of the following is an anion?

Chloride

What assessment would a nurse expect when caring for a client with metabolic alkalosis? Select all that apply.

Hyperactive reflexes Dysrhythmias

A client tells the nurse that the client has been taking Alka-Seltzer (bicarbonate—antacid) four times a day for the past 2 weeks for an upset stomach. Upon assessment of the client, the nurse notes hyperactive reflexes, tetany, and mental confusion. Arterial blood gases reveal pH 7.55; serum HCO3− 37 mEq/L (37 mmol/L). The nurse suspects the client may be experiencing:

Metabolic alkalosis

The nurse evaluates the ECG of a client who has developed hypokalemia secondary to diuretic use. Which manifestation of hypokalemia does the nurse anticipate on the ECG?

A prominent U wave and a flattened T wave

The nurse is caring for a client with ketoacidosis who is complaining of increasing lethargy and occasional confusion following several weeks of rigid adherence to a carbohydrate-free diet. The nurse understands which phenomenon is most likely occurring?

In the absence of carbohydrate energy sources, her body is metabolizing fat and releasing ketoacids.

A client with ethylene glycol toxicity is restless, and stating he has flank pain. What intervention should the nurse perform to minimize complications?

Increase IV fluids

A client is diagnosed with syndrome of inappropriate antidiuretic hormone as a result of an inoperable brain tumor. When assessing the laboratory results for this client, which finding does the nurse anticipate?

Increase in urine osmolality

The nurse examining laboratory values for a client notes that both the plasma bicarbonate (HCO3-) and CO2 levels have increased. What is the expected impact on the pH levels?

pH would remain unchanged.

When caring for the client with hyperkalemia, the nurse recognizes the body should respond in which of these ways?

secrete potassium in the distal tubules for excretion

The nurse is caring for a client who is experiencing an increased level of aldosterone secretion. The nurse anticipates that the client may develop:

sodium and water retention.

The nurse is caring for the following group of clients. Select the client most likely to be diagnosed with respiratory alkalosis.

A 26-year-old female with anxiety who has been hyperventilating

Which fluid is most likely to contain edema fluid with high protein content?

Inflammatory edema

Lymph fluid arises directly from which space?

Interstitial

A client has these arterial blood gas values: anion gap 20 mEq/L (20 mmol/L), pH 7.29, PCO2 37 mm Hg (4.92 mmol/L), HCO3- 11 mEq/L (11 mmol/L), base excess -6 mEq/L (-6 mmol/L). With what condition do these values correspond?

Lactic acidosis

The nurse is reviewing laboratory data for the client with an anion gap of 17. The nurse recognizes which condition is associated with an increased anion gap mEq/L (mmol/L)?

Lactic acidosis

A client is brought to the emergency department with reports of shortness of breath. Assessment reveals a full, bounding pulse, severe edema, and audible crackles in lower lung fields bilaterally. The nurse notifies the physician to obtain orders for which of these problems?

Fluid volume excess

The nurse volunteering in the medical tent for a road race on a hot, humid day is asked to see a runner who has collapsed on the road. The nurse notes he has sunken eyes, a temperature of 100°F (37.7°C), and dizziness. These are signs of a fluid volume deficit. Recognizing fluid volume deficit, which of these interventions does the nurse carry out first?

Give him an electrolyte solution by mouth.

A client's arterial blood gases reveal normal oxygen level, pH 7.50, PCO2 level of 50 mmHg (6.65 kPa) and HCO3 level of 30 (30 mmol/L). The client's respiratory rate is 12 breaths/min and all other vital signs are within normal range. What is this client's most likely diagnosis?

Metabolic alkalosis

For which acid-base imbalance will the nurse monitor for a client taking large doses of loop diuretics?

Metabolic alkalosis

The nurse is assessing a client for early manifestations of hyponatremia. The nurse would assess the client for:

Muscle weakness

The nurse is caring for a client with a longstanding diagnosis of hypocalcemia secondary to kidney disease. The nurse observes which clinical manifestations in this client?

Muscular spasms and reports of tingling in hands/feet

The nurse is administering a unit of packed red blood cells to a client and piggybacks the unit of blood through a solution of 0.9% NaCl. Blood cells placed in a solution of 0.9% saline will do which of the following?

Neither shrink nor swell

The nurse at a long-term care facility encourages the older adults to drink even though they may not feel thirsty at the time. Which statement supports the nurse's action?

Older adults often experience a decrease in the sensation of thirst, even when serum sodium levels are high.

Hypothalamic sensory neurons that promote thirst when stimulated are called:

Osmoreceptors

Water movement from the side of the membrane having a lesser number of particles and greater concentration of water to the side having a greater number of particles and lesser concentration of water is termed:

Osmosis

The nurse is caring for a client who complains of headache and blurred vision. The nurse recognizes that these symptoms, accompanied by increased plasma partial pressure carbon dioxide (PCO2) level and decreased pH level, are consistent with which diagnosis?

Respiratory acidosis

The nurse enters a client's hospital room and finds the client breathing rapidly, stating, "I must be having a stroke, my fingers are tingling!" Which acid-base balance disorder is this client experiencing due to hyperventilation?

Respiratory alkalosis

A 77-year-old female hospital client has contracted Clostridium difficile during her stay and is experiencing severe diarrhea. Which statement best conveys a risk that this woman faces?

She is susceptible to isotonic fluid volume deficit.

The effective circulating volume is the major regulator of water balance in the body. What else does it regulate?

Sodium

When caring for clients with disorders of sodium balance, the nurse know that which finding is consistent with hypernatremia?

Sodium 158 mEq/L (158 mmol/L) and serum osmolality of 320 mOsm/kg (320 mmol/kg)

The nurse is providing teaching to a student nurse about antidiuretic hormone (ADH) role in the reabsorption of water by the kidneys. Which components of the homeostatic action of ADH play a role in the release of ADH when the body requires this action? Select all that apply.

Stored ADH is released into circulation. ADH is transported along a neural pathway to the posterior pituitary gland. Aquaporins are inserted into tubular cell membranes. ADH is synthesized by cells in the supraoptic and paraventricular nuclei of the hypothalamus. Serum osmolality increases

A nurse is caring for a client with a low sodium level and increased water retention. Hematocrit and blood urea nitrogen levels are decreased, urine osmolality is high, and serum osmolality is low. A chest x-ray shows a possible lung mass. Based on these findings, which problem could the client be diagnosed with?

Syndrome of inappropriate antidiuretic hormone (SIADH)

Which unit of measure best describes the concentration of solute in a particular volume of fluid based on electrolyte equivalency?

mEq/L

The nurse caring for a client with metabolic acidosis examines arterial blood gas (ABG) results. Which change from the initial value indicates the client's metabolic acidosis is improving?

pH has increased

The nurse is reviewing a client's arterial blood gas (ABG) results. Which pH level would the nurse interpret as normal?

pH of 7.35 to 7.45

The nurse caring for a client with metabolic alkalosis should anticipate which laboratory results to confirm the diagnosis?

pH of 7.45 and HCO3 of 24 mEq/L (24 mmol/L)

The nurse is caring for a client with metabolic alkalosis. Which of these arterial blood gas results supports this diagnosis?

pH of 7.50 and HCO3 of 45 mEq/L (45 mmol/L)

Vitamin D, officially classified as a vitamin, functions as a hormone in the body. What other hormone is necessary in the body for vitamin D to work?

Parathyroid hormone

The nurse is caring for a client whose serum calcium level is 12 mg/dL (3.0 mmol/L). The nurse expects to find which mineral to be decreased?

Phosphate

A client with schizophrenia is admitted to the behavioral health department and is observed drinking copious amounts of water and voiding large amounts of dilute urine. The nurse recognizes this behavior is consistent with which problem?

Psychogenic polydipsia

The renal control mechanism of restoring the acid-base balance is accomplished through which process?

Reabsorption of HCO3 and excretion of H+ restores acid-base balance through the renal control mechanisms

A client has been diagnosed with a brain tumor that cannot be removed surgically. During each office visit the nurse will be assessing the client for syndrome of inappropriate antidiuretic hormone (SIADH). Which assessment would alert the clinic nurse that the client may be developing this complication?

Report of decreased urine output, no edema noted in ankles, increasing headache

A client has been diagnosed with metabolic acidosis. What assessment finding does the nurse expect?

Decreased pH below 7.35

The nurse is aware that the major role of the kidneys in regulating acid-base balance is to increase the production of which chemical component?

(HCO3-)

A client presents to the emergency room with symptoms of generalized muscle weakness, dyspnea, muscle cramps, vomiting, and diarrhea. Based on these symptoms, the nurse anticipates which type of monitoring will be required?

Cardiac monitoring

A male client with a history of heavy alcohol use has been admitted to the hospital for malnutrition and suspected pancreatitis. The client's diagnostic workup suggests alcoholic ketoacidosis as a component of his current health problems. He is somewhat familiar with the effect that drinking has had on his nutrition and pancreas, but is wholly unfamiliar with the significance of acid-base balance. How best could his care provider explain the concept to him?

"The chemical processes that take place throughout your body are thrown off very easily when your body is too acidic or not acidic enough.

The nurse teaches the client with end-stage kidney disease and hyperphosphatemia to take sevelamer HCl, a phosphate binder, with meals. How does the nurse explain the rationale for the timing of this medication?

"The medication should be taken at meal time to allow the binding of phosphate."

A client is admitted to the emergency department with possible internal bleeding after being involved in an automobile accident. What type of isotonic intravenous (IV) solution does the nurse prepare to infuse?

0.9% NaCl

A hospitalized client weights 70 kg. The nurse calculates approximately how much of this weight as intracellular fluid?

28 L

Body weight consists of which percentage of body water?

60%

The nurse has just received the lab results of a client's calcium level. The nurse identifies a normal calcium level as:

9.0 to 10.5 mg/dL (2.25 mmol/L to 2.63 mmol/L))

The nurse is caring for a client with an acid-base imbalance. Which of these does the nurse recognize is correct regarding compensation?

A pH moves toward the normal range.

A change in the pH of the body affects all organ systems. When the pH falls to less than 7.0, what can occur in the cardiovascular system? Select all that apply.

A reduction in cardiac contractility, causing cardiac dysrhythmias

A runner in a marathon who collapsed on the road is brought in with the following symptoms: sunken eyes, a body temperature of 37.8°C (100°F), and a report of dizziness while sitting to have his blood pressure taken (which subsides upon his lying down). Which treatment should be carried out first?

Administer an electrolyte solution by mouth.

The nurse is caring for a client who has developed hypoxemia and tissue hypoxia. Which of these interventions does the nurse set as a priority intervention?

Administration of supplemental oxygen

Which combination of ions are most likely to bind, forming molecules?

Anion and cation

The nurse recognizes the role of the lungs in acid-base balance is regulation of which of the following?

CO2

The nurse caring for a client with respiratory acidosis examines arterial blood gas (ABG) results. Which change from the initial value indicates the client's respiratory acidosis is improving?

CO2 has decreased

Serum phosphorus level has a reciprocal relationship with which serum electrolyte?

Calcium

When explaining how carbon dioxide combines with water to form carbonic acid as part of an acid-base lecture, the faculty instructor emphasizes that which enzyme is needed as a catalyst for this reaction?

Carbonic anhydrase

A client has an increase in respiratory rate. What assessment findings does the nurse expect?

Decreased PCO2

Which laboratory finding would the nurse anticipate when a client is experiencing hyperventilation?

Decreased PCO2

The nurse caring for the client with respiratory alkalosis and renal compensation determines that which diagnostic finding is consistent with this disorder?

Decreased PCO2 and HCO3, and increased pH

A middle-aged male with a history of cardiovascular disease has been admitted for cardiogenic shock. In the hours since admission, the client's arterial blood gases indicate acidosis. Which clinical manifestations and diagnostic findings should his care team anticipate before acid-base balance is restored? Select all that apply.

Decreased pH Cardiac dysrhythmias Decreased alertness and cognition Nausea and vomiting

A client arrives in the emergency department with hypovolemia related to excretion of "at least 3 gallon jugs of dilute, water-like urine in the past 24 hours." In collaboration with the physician, the nurse prepares to administer which medication?

Desmopressin acetate

Which medication is the preferred drug for treating chronic diabetes insipidus?

Desmopressin acetate (DDAVP)

The nurse is caring for a client who receives hemodialysis. The nurse knows that hemodialysis involves movement of charged or uncharged particles along a concentration gradient. Which function best describes this process?

Diffusion

A client staggers into the emergency department with his son who states that his father has not been well for a couple of weeks. The client's heart rate is 120 and lung sounds reveal crackles and a respiratory rate of 30. The client also reports right flank pain. The son says that his mother has been acting strangely and thinks she might be poisoning her husband. Which clinical manifestation indicates the type of poisoning involved?

Ethylene glycol (antifreeze)

The nurse is caring for a client with a tumor obstructing the lymphatic system. For which consequence does the nurse assess?

Fluid accumulating in the interstitial spaces distal to the tumor

The nurse caring for a client with metabolic alkalosis examines arterial blood gas (ABG) results. Which change from the initial value indicates the client's metabolic alkalosis is improving?

HCO3- has decreased

The nurse is aware that the major role of the kidneys in regulating acid-base balance is to increase the production of:

HCO3−

A middle-aged woman has presented to the emergency department following a panic attack. Her blood pressure, respiratory rate, and heart rate are all highly elevated, while her temperature and oxygen saturation are within normal ranges. What is the woman's body most likely doing to address the changes in pH associated with her situation?

Her kidneys will limit the amount of bicarbonate that they reabsorb.

A nurse observes peaked, narrow T waves on the electrocardiogram of a client suffering from renal failure. The nurse suspects that the client is experiencing which condition?

Hyperkalemia

Respiratory alkalosis can be caused by a respiratory rate in excess of that which maintains normal plasma PCO2 levels. What is a common cause of respiratory alkalosis?

Hyperventilation

A nurse is caring for a client with hypoparathyroidism. Which imbalance is a major concern for the client?

Hypocalcemia

The nurse is caring for a client who is 1 day postoperative for a thyroidectomy. The client complains of tingling of the hands and feet and around his mouth. The nurse suspects these symptoms are a manifestation of which electrolyte disturbance?

Hypocalcemia

A community health nurse who is attending a marathon recognizes that which types of hypotonic hyponatremia is likely when a client reports muscle weakness, cramping, and general fatigue in spite of adequate water hydration during the run?

Hypovolemic

A nurse is caring for a client whose serum potassium level is 2.6 mEq/L (2.6 mmol/L). The nurse anticipates which intervention will be prescribed?

IV infusion of 10 mEq potassium chloride in 100-mL normal saline solution over 1 hour times

The nurse is performing an assessment for a client who is experiencing shortness of breath. The nurse notes a full and bounding pulse, crackles in the lung fields, and jugular vein distention. The nurse recognizes symptoms of which problem?

Isotonic fluid volume excess

A client has an increase in her anion gap (AG). What does the nurse determine is the significance of this finding?

It indicates the client has metabolic acidosis.

The nurse is evaluating a client's blood gases. The client has a pH of 7.35. How does the nurse interpret this value?

It is within a normal range.

Edema is an excess in the interstitial fluid volume. What mechanisms play a part in the formation of edema? Select all that apply.

Mechanisms that increase capillary permeability Mechanisms that increase capillary filtration pressure Mechanisms that produce obstruction to the flow of lymph Mechanisms that decrease capillary colloidal osmotic pressure

A child accidentally consumes a container of wood alcohol. The ED physician knows that the child is at risk of developing which of the following?

Metabolic acidosis

The nurse is caring for a client who has excessive diarrhea. Which acid-base disturbance does the nurse anticipate uncovering during evaluation of the arterial blood gas?

Metabolic acidosis

The nurse is caring for a client with renal failure experiencing shortness of breath and increased respiratory rate. The arterial blood gas reflects a pH of 7.10 and HCO3 level of 18 mEq/L (18 mmol/L). How does the nurse interpret these findings?

Metabolic acidosis

The nurse is reviewing the following lab results of a client diagnosed with renal failure: pH: 7.24 PCO2: 38 mm Hg (5.05 kPa) HCO3:18 mEq/L (18 mmol/L) The nurse would interpret this as:

Metabolic acidosis

Pressure generated as water moves across a membrane is also known as which of the following?

Osmotic pressure

Following several days in an acidotic state, a hospitalized client has returned to a desired pH level. Which process could have contributed to the resolution of the client's health problem?

Phosphate and ammonia buffer systems in the renal tubules.

The physician has ordered an anion gap as a laboratory test for a client experiencing metabolic acidosis. What will this test measure?

Phosphates, sulfates, and proteins

The nurse is reviewing lab results of a client diagnosed with metabolic acidosis. The most important electrolyte for the nurse to assess would be:

Potassium (K+)

A nurse is resuscitating a client who is in cardiac arrest. The nurse understands that the rationale for replacing the infusing 5% IV dextrose solution with 0.9% IV saline solution is for which purpose?

Prevent cerebral edema in the client

The nurse is assessing a client with abnormal blood gas values. Which of these interpretations does the nurse make regarding the client's physiologic status?

The client has abnormalities in his buffer system.

A 56 year-old female hospital client with a history of alcohol abuse is receiving intravenous (IV) phosphate replacement. Which health problem will this IV therapy most likely resolve?

The client is acidotic and has impaired platelet function.

What is the nurse's expectation about a client's ability to compensate for a metabolic blood gas disorder?

The client will compensate with the respiratory system.

A client presents with signs and symptoms consistent with chronic acidemia. The nurse should prioritize what assessments when addressing the root cause of the client's health problem?

The client's renal function

Potassium is the major cation in the body. It plays many important roles, including the excitability of nerves and muscles. Where is this action particularly important?

The heart

The sodium-phosphate cotransporter (NPT2) creates the action by which phosphate is reabsorbed from the filtrate in the proximal tubule. Which condition can cause an overproduction of phosphatonin resulting in hypophosphatemia?

Tumor-induced osteomalacia

The nurse is assessing blood gas results for a client with diabetes and ketoacidosis and notes a pH level of 7.15. Which arrhythmias should the nurse closely monitor while treating this client?

Ventricular tachycardia

Which clinical manifestation would lead the nurse to suspect a client has developed fluid volume excess?

Weight gain

A client is admitted to the hospital with fluid volume deficit. The nurse should be aware that compensatory mechanisms will include:

activation of the renin-angiotensin-aldosterone system (RAAS).