Metabolic Acidosis

A patient is diagnosed with diabetic ketoacidosis. Arterial blood gases reveal a pH of 7.28. Which manifestation or physiologic response should the nurse expect the body to exhibit in attempts to promote acid-base balance? Fluid volume excess Deep breathing Increased blood pressure Kussmaul respirations

Kussmaul respirations

A 10th-grade girl presents with an extremely low body mass index (BMI) of 16.7 and admits to overuse of laxatives for weight loss. The nurse should be concerned that the patient is at risk for which acid-base imbalance? Metabolic acidosis Respiratory alkalosis Metabolic alkalosis Respiratory acidosis

Metabolic acidosis

The nurse is reviewing a patient's lab report on serum electrolytes for a patient diagnosed with metabolic acidosis. Which electrolyte should concern the nurse most? Sodium Chloride Calcium Potassium

Potassium

A patient is admitted with excess fluid volume as a result of metabolic acidosis. Which assessment will provide the most accurate indicator of fluid balance? Dosage of diuretic Hourly urine output Body edema Daily weights

Daily weights

Which patient should the nurse recognize as being at risk for metabolic acidosis? Patient diagnosed with stroke Patient with hyperventilation Patient with diarrhea Patient experiencing vomiting

Patient with diarrhea

Which condition is appropriate for the nurse to identify as a risk factor that may lead to the patient's development of metabolic acidosis? Vomiting Chest trauma Opiate overdose Severe diarrhea

Severe diarrhea RATIONALE: Severe diarrhea is a precipitating factor for the development of metabolic acidosis. Vomiting is a precipitating factor for the development of metabolic alkalosis. Chest trauma and opiate overdose are both precipitating factors for respiratory acidosis.

A patient with chronic renal failure is admitted with metabolic acidosis. Which medication should the nurse expect to administer? Phenobarbital Baking soda Sodium bicarbonate Aspirin

Sodium bicarbonate

A patient with chronic renal failure is admitted with metabolic acidosis. The nurse should understand that the patient will be treated with sodium bicarbonate for which reason? To prevent hyponatremia To neutralize acids To prevent hypokalemia To prevent hypernatremia

To neutralize acids

Mental status changes may occur with metabolic acidosis. Which lab value is the most important to monitor in order to prevent a potential injury? Chloride pH Hemoglobin Potassium

pH

The nurse is caring for a patient who has been prescribed sodium bicarbonate as an antacid. Which statement should the nurse include when teaching the patient about side effects of this medication? "You can take sodium bicarbonate for up to 4 weeks." "You may experience an uptick in your mood when you take sodium bicarbonate." "If symptoms don't resolve, you can double your dose." "Contact your healthcare provider if you have chest pain or shortness of breath."

"Contact your healthcare provider if you have chest pain or shortness of breath."

The nurse is teaching a group of older adults about how to prevent the development of metabolic acidosis. Which patient statement indicates that teaching has been effective? "I don't have to be on a special diet." "I should walk every day to prevent osteoporosis." "I can modify my treatment plans as needed." "I should tell my provider all the medications I take, even the over-the-counter ones."

"I should tell my provider all the medications I take, even the over-the-counter ones."

The nurse is teaching the parents of a 6-year-old child about salicylate poisoning. Which statement by the mother indicates a correct understanding of salicylate poisoning prevention "I will keep the aspirin in a bowl so she doesn't have problems with the safety cap." "I will not give my daughter more aspirin than directed on the bottle." "If my daughter has a fever, I will alternate aspirin and Tylenol to keep her fever-free." "I will leave the bottle of aspirin on my daughter's nightstand so she can take it when she has a headache."

"I will not give my daughter more aspirin than directed on the bottle."

The nurse is teaching an older adult patient with arthritis about the use of prescribed aspirin for pain management. Which patient statement indicates effective teaching? "I can take more aspirin if I have more pain." "I need to get my blood drawn every week to monitor my aspirin levels." "I will take my aspirin as prescribed." "I have to be on a special diet when taking aspirin for my arthritis."

"I will take my aspirin as prescribed." RATIONALE: Accidental overdose of salicylic acid (aspirin) may cause metabolic acidosis. Older older patients should be taught about accidental overdose of aspirin symptoms, such as tinnitus. They should also be taught not to take more aspirin than directed by the healthcare provider. Patients do not need their blood drawn weekly while taking aspirin, and they do not need to be on a special diet.

The nurse is teaching the parents of a 10-year-old child with type 1 diabetes mellitus how to prevent the development of metabolic acidosis. Which statement by the parents indicates a need for further teaching? "My child can remove the insulin pump at any time." "I can teach my child how to check his blood sugar." "My child can try out for the soccer team." "I will meet with the school nurse to discuss my child's diabetes management plan."

"My child can remove the insulin pump at any time." RATIONALE: The parents should be instructed that their child cannot shut off the insulin pump at any time because there is no insulin being produced in the body. If the insulin pump is off, blood sugar will increase, which will put the child at risk for metabolic acidosis or diabetic ketoacidosis. If medically appropriate, a child can still play sports with an insulin pump, and the school nurse should be aware of the diabetes management plan.

The nurse is teaching an older adult patient about the adverse effects of taking too much aspirin. Which patient statement indicates effective teaching? "When I take the correct amount of aspirin, I do not have to worry that my body will produce more acid." "Taking aspirin may deplete acid in my body." "Too much aspirin can make my body have too much acid." "Acid in my body may prevent aspirin from working effectively."

"Too much aspirin can make my body have too much acid."

A 9-year-old patient with type 1 diabetes mellitus is admitted to the pediatric intensive care unit with a blood sugar of 590 mg/dL. Which lab value would indicate that this patient is exhibiting signs of metabolic acidosis? Serum bicarbonate 27 mEq/L Arterial blood pH 7.33 PaCO2 46 mmHg Arterial blood pH 7.47

Arterial blood pH 7.33

Which basic mechanism should the nurse expect to cause metabolic acidosis? Bicarbonate deficiency Deficient carbonic loss Bicarbonate excess Excess carbonic acid

Bicarbonate deficiency RATIONALE:Metabolic acidosis is the result of deficient bicarbonate. Bicarbonate alkalosis is caused by too much bicarbonate. Respiratory acidosis is caused by retaining CO2 and excess carbonic acid. Respiratory alkalosis is caused by a loss of CO2 and deficient carbonic acid.

Which condition or laboratory data indicates an adverse effect when administering sodium bicarbonate for treatment of metabolic acidosis? Hyperosmolality Hyperkalemia pH of 7.30 Hyponatremia

Hyperosmolality RATIONALE:Rapid correction of metabolic acidosis with sodium bicarbonate may lead to hyperosmolality, which can lead to water retention and fluid overload. Therefore, it is essential to administer sodium bicarbonate only for severe metabolic acidosis and to closely monitor the patient. Rapid correction of metabolic acidosis with sodium bicarbonate may lead to hypernatremia, not hyponatremia, which causes water retention and fluid overload. Rapid correction of metabolic acidosis with sodium bicarbonate may lead to metabolic alkalosis and hypokalemia, not hyperkalemia. Rapid correction of metabolic acidosis with sodium bicarbonate may lead to metabolic alkalosis and a pH greater than 7.45. A pH of 7.30 indicates metabolic acidosis and that the patient did not have an adverse reaction to the sodium bicarbonate.

The nurse is caring for a 69-year-old patient who is experiencing metabolic acidosis due to acute renal failure. In response to a primary acid-base imbalance of metabolic acidosis, which compensatory mechanism is the patient most likely to demonstrate? Increased rate and depth of respiration Increased renal excretion of bicarbonate (HCO3) Decreased rate and depth of respiration Increased renal reabsorption of bicarbonate (HCO3)

Increased rate and depth of respiration

In addition to sodium bicarbonate, which other treatment can resolve metabolic acidosis? Lactate Regular insulin Kayexalate Potassium chloride

Lactate

The nurse assesses a 13-year-old patient who is cachexic and admits to taking laxatives to lose weight for the swim team. The nurse should be concerned about which acid-base imbalance? Metabolic acidosis Hyponatremia Hypernatremia Metabolic alkalosis

Metabolic acidosis

The nurse is caring for an infant with diarrhea and dehydration. The nurse should be concerned about which potential problem? Metabolic acidosis Metabolic alkalosis Hyperkalemia Hypokalemia

Metabolic acidosis RATIONALE: Infants are more likely to develop metabolic acidosis from significant losses of bicarbonate due to diarrhea. The stool output can contain as much as 70-80 mEq/L of bicarbonate.

The nurse is caring for a patient with alcoholic ketoacidosis (AKA). Which treatment is expected with this diagnosis? Normal saline and glucose Short-acting insulin IV Potassium IV supplement Normal saline

Normal saline and glucose RATIONALE: The cause of AKA is abrupt alcohol cessation after chronic alcoholism with poor nutrition. The treatment for AKA is 5% dextrose in normal saline, magnesium and potassium replacements, and optional thiamine and folate treatment.

An older adult patient is exhibiting an altered mental status during treatment for metabolic acidosis. Which intervention would not be helpful to reduce the risk for injury? Preventing family and friends from visiting Maintaining call bell within reach Assuring calendar is on correct date Maintaining bed in lowest position

Preventing family and friends from visiting RATIONALE: Preventing family and friends from visiting will not be a helpful intervention for an older adult patient who has mental status changes or confusion. Visitors can help the patient with orientation during visits.

A 71-year-old woman is hospitalized with uncontrolled diabetic ketoacidosis, which has led to the development of metabolic acidosis. She has been placed on a heart monitor, which displays a dysrhythmia. Which solution should the nurse administer per standing orders to reduce the effects of metabolic acidosis on cardiac function? Potassium Ampicillin Kayexalate Sodium bicarbonate

Sodium bicarbonate RATIONALE: Sodium bicarbonate is an alkalinizing solution given to reduce the effects of metabolic acidosis and is the most commonly used alkalinizing solution. Ampicillin is an antibiotic used to treat infections such as pneumonia. Potassium is an electrolyte given when hypokalemia is present. Kayexalate is a medication given when hyperkalemia is present to reduce potassium levels.

A patient with type I diabetes mellitus who has not been compliant with measuring his blood glucose or treatment. He presents with disorientation, a high respiratory rate, and a report of abdominal pain. The healthcare provider orders an immediate arterial blood gas (ABG). Which ABG result should the nurse anticipate? pH 7.46, HCO3 24 mEq/L, CO2 35 mmHg pH 7.30, HCO3 15 mEq/L, CO2 45 mmHg pH 7.43, HCO3 23 mEq/L, CO2 36 mmHg pH 7.28, HCO3 24 mEq/L, CO2 50 mmHg

pH 7.30, HCO3 15 mEq/L, CO2 45 mmHg If the patient is not monitoring his blood glucose levels and is not administering his insulin as ordered, his blood sugar is most likely high. His symptoms of tachypnea, disorientation, and abdominal pain indicate he is probably in diabetic ketoacidosis, which has resulted in metabolic acidosis. Normal arterial blood gas (ABG) values are pH 7.35 to 7.45, HCO3 22 to 24 mEq/L, and CO2 35 to 45 mmHg. The nurse can expect his ABG values to be: pH low (7.30), HCO3 low (15 mEq/L), and CO2 normal (45 mmHg). He will not have a blood pH indicating alkalosis (7.46). His blood pH will not be normal (7.43). His blood pH will not be as low as 7.28 because he is still conscious.

The nurse is monitoring a patient for the development of an acid-base imbalance. When interpreting the patient's arterial blood gas (ABG) results, which data should the nurse recognize as being most consistent with uncompensated metabolic acidosis? pH 7.35, PaCO2 45 mmHg, HCO3 24 mEq/L pH 7.32, PaCO2 44 mmHg, HCO3 22 mEq/L pH 7.50, PaCO2 35 mmHg, HCO3 31 mEq/L pH 7.44, PaCO2 37 mmHg, HCO3 26 mEq/L

pH 7.32, PaCO2 44 mmHg, HCO3 22 mEq/L

A patient with metabolic acidosis is ready to be discharged. Which outcome should the nurse recognize as an indication that metabolic acidosis has resolve? Sodium 137 mEq/L Potassium 3.0 mEq/L pH 7.39 Serum glucose 92 mg/dL

pH 7.39 RATIONALE:The pH level of 7.39 is in within normal limits for the patient's arterial blood gas. All other lab values are within normal limits as well, but the pH is the best indicator of resolved metabolic acidosis.