Chapter 8- PrepU
Body weight consists of which percentage of body water?
60%
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 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
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 An elevated PCO2 is commonly associated with respiratory acidosis because excess CO2 ultimately increases the concentration of H+ ions. Increased intracranial pressure, oxytocin infusion, and the administration of hypotonic fluids are not directly linked to common alterations in acid-base balance.
Of the following clients, who would be at highest risk for developing hyperkalemia
A male admitted for acute renal failure following a drug overdose.
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 Hypoxia and hypoxemia may be corrected by administration of supplemental oxygen. People with hyperventilation may benefit from reassurance, rebreathing from a paper bag during symptomatic attacks, and attention to the psychological stress.
Protein-dependent forces that promote fluid movement into the intravascular space are known as which pressure?
Capillary osmotic Plasma proteins exert the osmotic force needed to pull fluid back into the capillary from the tissue spaces. Capillary colloidal osmotic pressure pulls water back into the capillary.
A nurse is reviewing laboratory values for an older adult client admitted for changes in mental status. The laboratory values are a urine-serum ratio of 4:1 and urine osmolality of 1100 mOsm/kg H2O. Based on these lab results, the nurse anticipates treatment for which problem?
Dehydration A dehydrated person (one who has had a loss of water) may have a urine-serum ratio that approaches 4:1. In these persons, urine osmolality may exceed 1000 mOsm/kg H2O.
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 normally small amount of fluid remaining in the interstitium is removed by the lymphatic system and returned to the systemic circulation. Any excess fluids and osmotically active plasma proteins that may have leaked into the interstitium are picked up by vessels of the lymphatic system and returned to circulation.
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-
When interpreting the arterial blood gas, the nurse recognizes which of these reflects the value for bicarbonate?
HCO3- Bicarbonate is abbreviated as HCO3. H2CO3 is the abbreviation for carbonic acid, HCl is the abbreviation for hydrochloric acid, and H+ is the abbreviation for hydrogen.
The nurse is aware that the major role of the kidneys in regulating acid-base balance is to increase the production of:
HCO3− The kidneys play a critical role in maintaining acid-base balance. They accomplish this through the reabsorption of HCO3−, regulation of H+ secretion, and generation of new HCO3−.
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 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 Spasms and numbness are characteristic of hypocalcemia. Respiratory effects, tachycardia, and diaphoresis are not associated with low calcium levels, whereas decreased level of consciousness can be indicative of hypercalcemia.
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
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 Potassium is typically lost with the use of thiazide or loop diuretics. The other groups of medications may cause an increase in potassium levels.
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 client who has diarrhea has increased loss of bicarbonate from the intestinal tract, which results in metabolic acidosis.
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 Metabolic alkalosis is characterized by a serum pH greater than 7.45; serum HCO3− greater than 29 mEq/L; and a base excess greater than 3.0.
The physician examines a client who has been in a motor vehicle accident and sustained head and chest injuries. Which would be considered compensatory responses to this acid-base imbalance?
Renal compensation with increased H+ excretion and increased HCO3- reabsorption A client with head and chest injuries develops respiratory acidosis due to decreased ventilation. There is no respiratory compensation for respiratory acidosis. The renal compensation is an increased H+ excretion and increased HCO3- reabsorption.
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 is caring for a client with a serum sodium level of 128 mEq/L (128 mmol/L). Which physiologic event is an expected result of this blood value?
swelling of cells
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 Vomiting results in the loss of hydrogen ions, potentially resulting in metabolic alkalosis.
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 Vomiting ultimately results in the increase in pH that constitutes metabolic alkalosis; intravenous potassium chloride (KCl) solutions are a mainstay of treatment for this acid-base imbalance.
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 One of the most common causes of respiratory alkalosis is hyperventilation, which is characterized by episodes of overbreathing, often associated with anxiety.
A nurse is caring for a client who received furosemide 60 mg IV earlier in the day. The client is now reporting severe muscle cramping in his legs. The nurse suspects this symptom is a manifestation of:
Hypokalemia Diuretic therapy, including loop diuretics, is the most common cause for hypokalemia. Muscle cramps are a symptom of hypokalemia.
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 three doses
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
Which intervention is a priority for the nurse when caring for a client with hypokalemia?
Initiating cardiac monitoring Imbalances of potassium levels have potentially fatal cardiac implications, a fact that necessitates frequent electrocardiography or cardiac monitoring. This supersedes the importance of fluid balance monitoring, ABGs, or hemoglobin levels.
Lymph fluid arises directly from which space?
Interstitial The lymphatic system represents an accessory route whereby fluid from the interstitial spaces can return to circulation.
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 treatment of acute and chronic respiratory acidosis is directed toward improving ventilation. In severe cases, mechanical ventilation may be necessary. The remaining options would not effectively treat respiratory acidosis.
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 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 Respiratory acidosis is reflected in the ABG as an increased PCO2 and decreased pH level as well as headache, blurred vision, irritability, muscle twitching, and psychological disturbances.
Which clinical manifestation would lead the nurse to suspect a client has developed fluid volume excess?
Weight gain
As other mechanisms prepare to respond to a pH imbalance, immediate buffering is a result of increased:
bicarbonate/carbonic acid regulation.
Which unit of measure best describes the concentration of solute in a particular volume of fluid based on electrolyte equivalency?
mEq/L The amount of electrolytes and solutes in body fluids is expressed as a concentration or amount of solute in a given volume of fluid, such as milligrams per deciliter (mg/dL). The millequivalent is used to express the charge equivalency for a given weight of an electrolyte and is expressed as milliequivalents per liter (mEq/L).
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 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 Because of the key role that the kidneys play in the maintenance of acid-base balance, individuals with kidney disease are vulnerable to acid-base disorders. Anaphylaxis, syphilis, and fistulas do not present particular risks for acid-base imbalances.
The client with a small bowel obstruction has a nasogastric tube set to low, continuous suction. The nurse explains that this treatment places the client at risk for:
Metabolic alkalosis Metabolic alkalosis can be caused by factors that generate a loss of fixed acids, such as from the stomach by gastric suction.
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:
Respiratory acidosis -Respiratory acidosis: represents a decreased pH and an increased PCO2
Which conditions increase the risk for respiratory alkalosis? Select all that apply.
Salicylate toxicity Anxiety Respiratory alkalosis is caused by hyperventilation or an elevated respiratory rate beyond what the client needs to regulate CO2 levels. It may occur when there is salicylate toxicity, anxiety, pain, fever, or sepsis. It can also occur when ventilator settings are higher than needed.
The effective circulating volume is the major regulator of water balance in the body. What else does it regulate?
Sodium The major regulator of sodium and water balance is the maintenance of the effective circulating volume. Magnesium, calcium, and potassium are not regulated by the effective circulating volume.
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 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 When a client with acidosis has the pH drop to 7.1 to 7.2 there is a decrease in cardiac contractility and output. The heart is less responsive to catecholamines, and fatal ventricular dysrhythmias may occur. Sodium bicarbonate (NaHCO3) is used to partially correct the acidosis in this type of normal anion gap condition. This improves cardiovascular responsiveness
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 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)
A client who is postoperative day 1 following a total thyroidectomy is reporting "twitchy" muscles and tingling in his fingertips and around his lips. The nurse's assessment reveals a positive Chvostek sign. The nurse should:
prepare to administer IV calcium gluconate, as ordered.
Of the following clients, who would be at highest risk for developing hyperkalemia?
A male admitted for acute renal failure following a drug overdose
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.
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
The nurse recognizes the role of the lungs in acid-base balance is regulation of which of the following?
CO2
When caring for a client with hypomagnesemia, the nurse prioritizes assessment of which body system?
Cardiac Assessment of the cardiac system is essential as magnesium is needed for proper nervous system function and to maintain the tone of the blood vessels. Low magnesium levels produce an increase in irritability of the heart causing cardiac dysrhythmias. The nurse should assess for tachycardia, hypertension, and cardiac dysrhythmias.
When caring for a client with hyperkalemia, the nurse prioritizes assessment of which body system?
Cardiovascular
Which of the following is an anion?
Chloride The ions found in body fluids carry one charge (i.e., monovalent ion) or two charges (i.e., divalent ion). Negatively charged ions are called anions. Chlorine is a negatively charged ion, or anion.
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 77-year-old woman has been brought to the emergency department by her daughter because of a sudden and unprecedented onset of confusion. The client admits to ingesting large amounts of baking soda this morning to treat some "indigestion." How will the woman's body attempt to resolve this disruption in acid-base balance?
Hypoventilation When neurologic manifestations occur with metabolic alkalosis, they include mental confusion, hyperactive reflexes, tetany, and carpopedal spasm. Respiratory compensation will take place in an effort to counteract the client's metabolic alkalosis. This will involve hypoventilation.
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 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.
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 Isotonic fluid volume excess is manifested by an increase in interstitial and vascular fluids. It is characterized by weight gain over a short period of time. An increase in vascular volume may be evidenced by distended neck veins, slow-emptying peripheral veins, a full and bounding pulse, and an increase in central venous pressure.
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
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 Ingestion of methanol (wood alcohol) results in the production of metabolic acids and causes metabolic acidosis.
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 small, but vital, amount of ECF calcium, phosphate, and magnesium is directly or indirectly regulated by vitamin D and parathyroid hormone.
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) he syndrome of inappropriate ADH (SIADH) results from a failure of the negative feedback system that regulates the release and inhibition of ADH. In people with this syndrome, ADH secretion continues even when serum osmolality is decreased, causing marked water retention and dilutional hyponatremia. SIADH may occur as a transient condition, as in a stress situation, or, more commonly, as a chronic condition, resulting from disorders such as lung or brain tumors.
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