Chapter 8

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

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 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

A nurse is providing care for several clients on an acute medicine unit. Which client should the nurse recognize as being at the highest risk for metabolic alkalosis?

A client on continuous nasogastric suction and whose hypertension is being treated with diuretics

The nurse who is providing care for several clients recognizes which client is at the highest risk for developing an acid-base imbalance?

A client who is being treated for acute kidney injury and who requires dialysis

In which client would the nurse be most likely to assess the signs and symptoms of an acid-base imbalance?

A client with chronic obstructive pulmonary disease (COPD) whose most recent arterial blood gases reveal a PCO2 of 51 mm Hg

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 nurse suspects that a client with a plasma magnesium level of 1.2 mg/dL (0.60 mmol/L) may have which condition in his or her history?

Abuse of alcohol

A client's most recent laboratory results suggest the presence of metabolic alkalosis. What action by the nurse best addresses a potential cause of this acid-base imbalance?

Administering an antiemetic to treat the client's frequent vomiting

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 caring for a client with hypomagnesemia, the nurse prioritizes assessment of which body system?

Cardiac

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

Which assessment should be prioritized in the care of a client who is being treated for a serum potassium level of 2.7 mEq/L (2.7 mmol/L)?

Cardiac monitoring looking for prolonged PR interval and flattening of the T wave

When caring for a client with hyperkalemia, the nurse prioritizes assessment of which body system?

Cardiovascular

By reabsorbing HCO3- from the glomerular filtrate and excreting H+ from the fixed acids that result from lipid and protein metabolism, the kidneys work to return or maintain the pH of the blood to normal or near-normal values. How long can this mechanism function when there is a change in the pH of body fluids?

Days

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

Which manifestation would the nurse anticipate in a client diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH)?

Decreased hematocrit

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

Decreased pH below 7.35

The nurse is caring for a client with diabetic ketoacidosis. Which assessment finding is characteristic of metabolic acidosis?

Deep and rapid respirations

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

A client is admitted after losing 44 lb (20 kg) over the past 3 months, largely due to frequent vomiting. What intervention should the nurse anticipate in the treatment of the client's resulting acid-base imbalance?

Fluid replacement with an intravenous solution containing electrolytes as prescribed

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-

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

An older adult client is admitted with elevated magnesium level related to a history of renal insufficiency and excess use of antacids and laxatives containing magnesium. On admission assessment, the nurse notes which clinical manifestations that correlate to hypermagnesemia? Select all that apply.

Hyporeflexia Muscle weakness causing shallow breathing

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 brought to the emergency department semicomatose and a blood glucose reading of 673. He is diagnosed with diabetic ketoacidosis (DKA). Blood gas results are as follows: serum pH 7.29; HCO3− level 19 mEq/dL (19 mmol/L); PCO2 level 32 mm Hg. The nurse should anticipate that which order may correct this diabetic ketosis?

Initiating an insulin IV infusion along with fluid replacement

A female client with a history of chronic renal failure has a total serum calcium level of 7.9 mg/dL (1.98 mmol/L). While performing an assessment, the nurse should focus on which clinical manifestation associated with this calcium level?

Intermittent muscle spasms and reports of numbness around her mouth

Lymph fluid arises directly from which space?

Interstitial

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.

When caring for a client with diabetes insipidus (DI), the nurse plans to evaluate which laboratory study?

Measurement of antidiuretic hormone (ADH) and plasma/urine osmolality

The nurse is caring for a client with worsening respiratory acidosis. Which of these interventions does the nurse anticipate if the client's condition continues to deteriorate?

Mechanical ventilation

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 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

Hypothalamic sensory neurons that promote thirst when stimulated are called:

Osmoreceptors

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

Osmotic pressure

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 suspects that a client who had a colon resection 4 days ago, is unable to pass flatus, and has no audible bowel sounds has a paralytic ileus. The nurse recognizes that which abnormal laboratory result is consistent with this problem?

Potassium level of 2.8 mEq/L (2.8 mmol/L)

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.

The nurse is teaching an older adult about adapting to age-related physiologic changes. Which instruction would be inappropriate to teach?

Reduce daily fluid intake

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

A client is brought to the emergency room after ingesting methanol. Which manifestations indicate possible complications? Select all that apply.

Seizures Diarrhea Blurred vision Elevated liver function tests

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)

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)

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.

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

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."

The family of a client with liver failure, ascites, and hepatic encephalopathy secondary to alcohol abuse questions the nurse as to why his abdomen is so large even though he is undernourished and emaciated. Which statement most accurately explains the problem?

The normally small transcellular fluid compartment, or third space, is becoming enlarged.

Of the following clients, who would be at highest risk for developing hyperkalemia?

a male admitted for acute renal failure following a drug overdose

A client with a diagnosis of liver cirrhosis secondary to alcohol abuse has a distended abdomen as a result of fluid accumulation in his peritoneal cavity (ascites). Which pathophysiologic process contributes to this third spacing?

abnormal increase in transcellular fluid volume

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).

Which of the following is an anion?

anion

Which is the primary mechanism for transporting carbon dioxide (CO2) in the body?

as bicarbonate in the plasma

As other mechanisms prepare to respond to a pH imbalance, immediate buffering is a result of increased:

bicarbonate/carbonic acid regulation.

A client develops interstitial edema as a result of decreased:

colloidal osmotic pressure

When caring for the client with hyponatremia secondary to SIADH, which of these alterations does the nurse anticipate?

decreased serum osmolarity

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 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

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

The nurse is caring for a client with acute primary respiratory acidosis. When determining the cause of the acidosis the nurse is aware that which imbalance is most common?

impaired alveolar ventilation

Which intervention is a priority for the nurse when caring for a client with hypokalemia?

initiating cardiac monitoring

Which volume represents the greatest percentage of water in the extracellular compartment?

interstitial

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

The nurse is administering the medications to a client on the cardiac unit. Giving which medication causes the nurse to be alert for hypokalemia?

loop diuretic

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 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

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

muscle weakness

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 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 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)

In isotonic fluid volume deficit, changes in total body water are accompanied by:

proportionate losses of sodium

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 condition of a client with metabolic acidosis from an intestinal fistula is not improving. The pulse is 125 beats/min and the BP 84/56 mm Hg. ABG values are: pH 7.1, HCO3- 18 mEq/L (18 mmol/L), PCO2 57 mm Hg (7.58 kPa). What IV medication should the nurse expect to provide next?

sodium bicarbonate

A client has developed ascites secondary to alcoholism. The client's abdominal girth is increased because:

the liver no longer produces enough plasma proteins to maintain osmotic pressure.