SPC Level 2 Exam 2- Fluid, Electrolyte, and Acid-Base Imbalances Adaptive Quiz

When planning the care of a patient with dehydration, which data would the nurse instruct the unlicensed assistive personnel (UAP) to report? -60 mL urine output in 90 minutes -1200 mL urine output in 24 hours -300 mL urine output per 8-hour shift -20 mL urine output for two consecutive hours

-20 mL urine output for two consecutive hours The minimal urine output necessary to maintain kidney function is 30 mL/hr. If the output is less than this for two consecutive hours, the nurse should be notified so that additional fluid volume replacement therapy can be instituted.

When preparing to administer IV albumin 5% to a patient, the nurse understands the solution is used to treat which metabolic alteration? -Alkalosis -Hypovolemia -Hyperkalemia -Mixed acid-base disorder

-Hypovolemia Albumin is a colloid solution that pulls fluid into the blood vessels, which restores blood volume. This medication is used to treat hypovolemia. Albumin is not effective in the treatment of alkalosis, hyperkalemia, or a mixed acid-base disorder.

Which rationale would the nurse use to explain events occurring when the respiratory center, located in the medulla, senses an increased concentration of carbon dioxide (CO2) or H+? -The respiratory center stimulates hyperventilation to get rid of CO2. -The respiratory center stimulates a decreased rate of breathing to retain CO2. -The respiratory center stimulates an increased depth of breathing to retain H+. -The respiratory center stimulates a decreased depth of breathing to get rid of H+.

-The respiratory center stimulates hyperventilation to get rid of CO2. Increased CO2 or H+ signals acidosis, which triggers the respiratory center to hyperventilate and get rid of CO2 to balance the pH. CO2 retention occurs to correct alkalosis. A decreased depth of breathing occurs in respiratory dysfunction. An increased depth of breathing occurs in hyperventilation; in this case, the body will expel CO2 to decrease H+.

A patient's laboratory reports a sodium concentration of 143 mmol/L and the sum of chloride and bicarbonate ion concentration is 132 mmol/L. Which value would the nurse calculate for this patient's anion gap? Record your answer using a whole number. __________ mmol/L

11 The anion gap is calculated by subtracting the concentration of anions from the concentration of cations in the blood. The sum of chloride and bicarbonate ions yields an anion concentration of 132 mmol/L. The cation concentration is the sodium concentration: 143 mmol/L. Simply subtract 132 from 143 to get 11 mmol/L.

How much fluid retention would the nurse document a patient experienced when their admission weight was 60 kg, and the weight on day 2 was 62 kg? Record your answer using a whole number and no punctuation. _______ mL

2000 One liter of water weighs 2.2 lb (1 kg). Body weight change, especially sudden change, is an excellent indicator of overall fluid volume loss or gain. An increase in 1 kg is equal to 1000 mL of fluid retention. The patient gained 2 kg, which is equal to 2000 mL of fluid retention. 2 kg × 1000 mL = 2000 mL.

A patient has an IV infusion of D5W at a rate of 125 mL/hr. During the 4:00 p.m. assessment, the nurse determined 500 mL were left in the present IV bag. In how many hours would the nurse anticipate hanging the next bag of D5W? Fill in the blank using a whole number. ___ hours

4 The nurse must ensure administration of IV therapy correctly. Divide the 500 mL left in the IV bag by the hourly rate of 125 mL to calculate that the present solution will remain infusing for another four hours. If this notation was made at 4:00 p.m., the bag is due to be changed at 8:00 p.m.

A patient had 500 mL of urine output, vomited 100 mL of clear liquid, and 25 mL of drainage was removed from a wound vacuum device. What number would the nurse record as the total output for this patient? Record your answer as a whole number. _____ mL

625 The calculation of output includes excessive perspiration, urinary output, vomit, diarrhea, and wound drainage. Totaling 500 mL of urine, 100 mL of vomit, and 25 mL of wound drainage results in 625 mL for the shift.

The IV prescription reads "1000 mL of D5.45 normal saline (NS) with 40 mEq KCl/L at 125 mL/hour." The nurse needs to add KCl to the liter of D5.45 NS solution because no premixed solutions are available. The unit's medication supply has a stock of KCl 5 mEq/mL in multidose vials. The nurse would need to draw up __________ mL of KCl to add to the IV solution. Record your answer using a whole number.

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While obtaining a patient's BP, a nurse notices the patient's arm has a carpal spasm. Which laboratory test would the nurse review after assessing this finding? -Calcium -Sodium -Potassium -Magnesium

-Calcium Trousseau's sign (carpal spasm when BP cuff is inflated for a few minutes) is indicative of hypocalcemia. It does not occur with changes in sodium, potassium, or magnesium levels. The nurse should expect the health care provider to prescribe a calcium level be drawn.

Which laboratory finding indicates the nurse would withhold the scheduled dose of potassium phosphate? -Calcium 6.4 mg/dL -Sodium 133 mEq/L -Magnesium 1.8 mEq/L -Potassium 5.2 mEq/L

-Calcium 6.4 mg/dL Phosphorus and calcium have inverse or reciprocal relationships, meaning that when calcium levels are high, phosphorus levels tend to be low. Therefore administration of phosphorus will reduce a patient's already abnormally low calcium level, which can result in life-threatening complications. Potassium phosphate will not have any effect on sodium, magnesium, or potassium levels.

A patient with cancer has a serum phosphate level of 5.4 mg/dL. Which reason would the nurse determine is the probable cause for the patient's electrolyte imbalance? -Chemotherapy -Insulin therapy -Total parenteral nutrition -Phosphate-binding antacids

-Chemotherapy Phosphate levels greater than 4.4 mg/dL indicate hyperphosphatemia. Chemotherapy drugs increase the patient's phosphate levels. Insulin therapy decreases the phosphate levels to less than 2.4 mg/dL. Patients with total parenteral nutrition have decreased phosphate levels. Phosphate-binding antacids remove phosphates from the body, resulting in hypophosphatemia.

When assessing a patient with Cushing syndrome, which clinical manifestation would the nurse observe? -Dyspnea -Hypoglycemia -Weight loss -Hypotension

-Dyspnea The nurse would anticipate observing dyspnea in a patient with Cushing syndrome (hyperadrenocorticism) because this condition can cause excess extracellular volume accumulation, which blocks interstitial air and tissue spaces and results in dyspnea, crackles, and peripheral edema. Hypoglycemia, weight loss, and hypotension are the common manifestations of Addison's disease (hypoadrenocorticism).

The nurse prepares to administer a lactated Ringer's IV solution to a patient requiring supportive care after several days of vomiting and diarrhea. Clinical manifestations include a urine specific gravity of 1.040 with 15 mL urine output in one hour, BP 84/48 mm Hg upon standing, and a heart rate of 100 beats/min. The nurse would associate the clinical manifestations and the IV solution with treatment of which imbalance? -Hyponatremia -Hyperkalemia -Extracellular fluid volume deficit -Extracellular fluid volume excess

-Extracellular fluid volume deficit A patient history of vomiting and diarrhea for the past several days, postural hypotension, increased heart rate, and decreased urine output all indicate fluid volume deficit. Balanced IV solutions such as lactated Ringer's solution are commonly used to treat fluid volume deficit. The signs and symptoms do not support a diagnosis of hyponatremia, hyperkalemia, or fluid volume excess.

Which intervention would the nurse implement when unable to flush a central venous access device due to a suspected occlusion? Select all that apply. -Clamp the tubing immediately. -Obtain cultures of the insertion site. -Instruct the patient to change positions, raise arm, and cough. -Attempt to force flush 10 mL of normal saline into the device. -Assess the tubing for clamping or kinking, and alleviate as needed.

-Instruct the patient to change positions, raise arm, and cough. -Assess the tubing for clamping or kinking, and alleviate as needed. Catheter occlusion interventions include instructing the patient to change position, raise an arm, and cough; assessing for and alleviating clamping or kinking; flushing with normal saline using a 10-mL syringe (do not force flush); using fluoroscopy to determine cause and site; and instilling anticoagulant or thrombolytic agents. Clamping the tubing and culturing the site would not assist in flushing the line or resolve the occlusion. The nurse should not force flush the line.

A hospitalized patient reports abdominal pain, nausea, and vomiting. Suspecting a bowel obstruction, for which primary acid-base imbalance would the nurse plan the patient's care, if the obstruction is high in the intestinal tract? -Metabolic acidosis -Metabolic alkalosis -Respiratory acidosis -Mixed alkalosis

-Metabolic alkalosis Because gastric secretions are rich in hydrochloric acid, the patient who is vomiting will lose a significant amount of gastric acid and be at an increased risk for metabolic alkalosis. Metabolic acidosis is more likely with diarrhea than vomiting. Respiratory acidosis is associated with the lungs, not the gastrointestinal system. Mixed alkalosis may occur when a patient is hyperventilating because of pain and has a nasogastric (NG) tube to suction; each system is losing acid. The patient has metabolic alkalosis.

Which clinical manifestations support a patient's admitting diagnosis of fluid volume excess related to heart failure? Select all that apply. -Polyuria -Dizziness -Lung crackles -Muscle spasms -Peripheral edema -Increased respiratory rate

-Polyuria -Lung crackles -Muscle spasms -Peripheral edema Heart failure can cause fluid volume excess, which is characterized by polyuria, fluid in the lungs causing crackles, muscle spasms, and peripheral edema. Dizziness and increased respiratory rate are clinical manifestations of fluid volume deficit, not excess.

Which electrocardiogram (ECG) changes would the nurse observe when the patient exhibits polyuria; soft, flabby muscles; an irregular pulse; a blood glucose level of 165 mg/dL; and is receiving IV dextrose therapy? Select all that apply. -Loss of P wave -Prolonged QRS -Peaked T waves -Presence of U wave -ST segment depression

-Prolonged QRS -Presence of U wave -ST segment depression When the potassium levels in the blood are low, it is known as hypokalemia. Symptoms include fatigue, nausea, excessive urination, and muscle weakness. Hypokalemia alters the resting membrane potential, resulting in hyperpolarization and changes in electrolytes. Prolonged QRS complex, presence of a U wave, and ST segment depression are caused by hyperpolarization, which is found in hypokalemia. Loss of the P wave and peaked T waves are both seen in hyperkalemia.

Which serum bicarbonate ion (HCO3-) level would indicate a compensatory response in the patient experiencing respiratory acidosis? -24 mEq/L -25 mEq/L -26 mEq/L -27 mEq/L

-27 mEq/L The serum bicarbonate ion concentration increases as a compensatory response in patients with respiratory acidosis. The normal range of bicarbonate ion is 22 to 26 mEq/L. Therefore, 27 mEq/L indicates a compensatory response.

The nurse reviews several patients' serum potassium results. Which result supports the need to administer a stat does of potassium chloride 20 mEq in 250 mL of normal saline over two hours? -3.1 mEq/L -3.9 mEq/L -4.6 mEq/L -5.3 mEq/L

-3.1 mEq/L The normal range for serum potassium is 3.5 to 5.0 mEq/L. This IV prescription provides a substantial amount of potassium. Thus the patient's potassium level must be low. The only low value shown is 3.1 mEq/L; 3.9 mEq/L, 4.6 mEq/L, and 5.3 mEq/L are not low values.

When evaluating the partial pressure carbon dioxide (PaCO2) parameter within a patient's arterial blood gas report, which value indicates the compensatory response to a patient's metabolic alkalosis? -38 mm Hg -40 mm Hg -44 mm Hg -47 mm Hg

-47 mm Hg

Which statements would the emergency department nurse use to explain the cause of a patient's respiratory alkalosis to the patient and family? Select all that apply. -"This acid-base imbalance is not triggered by central nervous system disorders." -"Hyperventilation can occur without any physiologic need, such as pain or anxiety." -"This acid-base imbalance can be caused by hyperventilation as a result of increased body temperatures." -Hypoxemia from acute pulmonary disorders, such as pneumonia, is the primary cause of this acid-base imbalance." -"The primary cause of the acid-base imbalance is hypercarbia from an acute pulmonary disorder, such as a pulmonary embolism."

-"Hyperventilation can occur without any physiologic need, such as pain or anxiety." -"This acid-base imbalance can be caused by hyperventilation as a result of increased body temperatures." -Hypoxemia from acute pulmonary disorders, such as pneumonia, is the primary cause of this acid-base imbalance." Respiratory alkalosis is primarily caused by hypoxemia related to pulmonary disorders preventing appropriate gas exchange. Such examples of pulmonary disorders include pulmonary embolism or pneumonia. Hyperventilation decreases the level of CO2 in the blood; this condition can lead to respiratory alkalosis. Hyperventilation can occur with or without physiologic need from increased body temperatures (fevers), pain, or anxiety. Hypercarbia is an increase in CO2 in the blood, which is not associated with hyperventilation or hypoxemia. Some central nervous system disorders can cause hyperventilation without physiologic need and can lead to respiratory alkalosis.

Which patient statement indicates understanding of the information presented by the nurse on potassium supplementation for treatment of hypokalemia? -"I will eat a banana every day." -"I can crush my tablets, so I can shallow them easily." -"I may include my favorite licorice in my diet." -"I will take my medication with a glass of milk."

-"I will eat a banana every day." Eating foods rich in potassium (such as bananas) indicates understanding of potassium supplementation. Potassium supplements should be swallowed whole and not chewed or crushed. Including licorice in the diet and taking the potassium supplement with milk (instead of water) indicate a need for additional education.

Which statement by a patient indicates understanding of nursing instructions about their peripherally implanted catheters (PICC)? Select all that apply. -"I will need to watch for signs and symptoms of phlebitis for up to 10 days after the PICC is inserted." -"A PICC line is usually only used for access up to six months, but it can be left in longer." -"I can safely take my blood pressure in the arm with the PICC as long as the cuff is below the insertion site." -"A PICC has fewer side effects than a central venous catheter, such as a lower infection rate and fewer insertion complications." -"Because the dressing seals off the insertion site, I may continue to take showers or go swimming at the health club."

-"I will need to watch for signs and symptoms of phlebitis for up to 10 days after the PICC is inserted." -"A PICC line is usually only used for access up to six months, but it can be left in longer." -"A PICC has fewer side effects than a central venous catheter, such as a lower infection rate and fewer insertion complications." Patients need to check for phlebitis for up to 10 days after the PICC is inserted. PICC lines are typically used for access for up to six months, and they can be left longer. PICC lines have fewer side effects than central venous catheters. Blood pressure should not be taken on an arm with a PICC line because inflation of the cuff can lead to the risk of vein damage or thrombosis. Although the dressing seals the insertion site, the risk for infection is high and the patient should not keep the site submersed in water.

Which patient statements about their hypercalcemia indicate understanding of content taught by the nurse? Select all that apply. -"I can use Tums as needed for heartburn." -"I should restrict my fluid intake to less than 2000 mL/day." -"Increasing my daily fluid intake to 3000 to 4000 mL is good." -"Renal calculi may occur as a complication of hypercalcemia." -"Weight-bearing exercises can help keep my calcium in my bones."

-"Increasing my daily fluid intake to 3000 to 4000 mL is good." -"Renal calculi may occur as a complication of hypercalcemia." -"Weight-bearing exercises can help keep my calcium in my bones." A daily fluid intake of 3000 to 4000 mL is necessary to enhance calcium excretion and prevent the formation of renal calculi, a potential complication of hypercalcemia. Weight-bearing exercise does enhance bone mineralization. Tums are a calcium-based antacid that should not be used in patients with hypercalcemia.

A patient has a prescription to receive D5W with 20 mEq KCl/L at 100 mL/hour. The nurse would select which solution from the IV supply cart? -1000 mL of 5% dextrose in water with 20 mEq of KCl -100 mL of 5% dextrose in 0.9% sodium chloride with 20 mEq of KCl -200 mL of 5% dextrose lactated Ringer's solution with 20 mEq of KCl -250 mL of 5% dextrose in 0.45% sodium chloride with 20 mEq of KCl

-1000 mL of 5% dextrose in water with 20 mEq of KCl D5W stands for 5% dextrose in water, which is different from normal saline, half normal saline, or lactated Ringer's. The IV KCl infusion rate should not exceed 10 mEq/hour per a peripheral line, unless the patient is in a critical care setting with continuous electrocardiogram (ECG) monitoring and has a central line access for administration.

Which statement would the intensive care nurse use to address the family's concern about the patient's respiratory acidosis? -"This disease is treated with mechanical ventilation to ensure oxygenation of tissues." -"This disease is treated with medications such as bicarbonate because the kidneys are injured." -"Respiratory acidosis is not something to worry about within the overall treatment regimen." -"Respiratory acidosis is not a disease but a symptom of a larger disease process we will treat separately."

-"Respiratory acidosis is not a disease but a symptom of a larger disease process we will treat separately." An acid-base imbalance like respiratory acidosis is not a disease but a symptom of an underlying health problem that must be treated to correct the imbalance. Medications such as sodium bicarbonate may be used to treat acidosis in critically ill patients; however, the acidosis is related to respirations, not kidney injury. Also, the acidosis is not a disease, but a symptom. Mechanical ventilation may assist in correcting the respiratory components of acid-base imbalances, but acidosis is a symptom of respiratory dysfunction (in this case), not a disease. Respiratory acidosis is a potentially deadly imbalance that warrants monitoring and treatment to prevent further complications.

The patient with a nasogastric (NGT) on intermittent wall suction asks why they are not able to have something to drink. Which response would the nurse give? -"Drinking fluids will cause sodium retention." -"The suctioned secretions will be falsely elevated." -"Drinking fluids will increase your nausea and vomiting." -"The additional fluids will increase the loss of critical electrolytes."

-"The additional fluids will increase the loss of critical electrolytes." Allowing a patient with an NGT to drink water increases the loss of electrolytes. Drinking fluids will not cause sodium retention, but sodium depletion. The free water will pull electrolytes into the stomach and the NGT will suck the fluids and electrolytes out of the stomach. Depending on the patient's condition and amount of water being ingested, the action may increase nausea and vomiting. However, this would most likely happen if the suction was not working properly, and this is not the primary reason for withholding oral fluids. Oral intake of water would not falsely increase the amount of fluids suctioned and recorded for NGT tube output.

A patient with metabolic acidosis asks how the acid-base imbalance will be corrected. Which response would the nurse use? Select all that apply. -"Medications are the primary treatment for acute acid-base imbalances occurring in critically ill patients." -"The renal system compensates slowly, usually reacting to pH changes within 24 hours." -"The respiratory system can compensate quickly to changes in pH and reacts in a matter of minutes." -"The heart is vital in managing the acid-base balance and regulates perfusion to increase or decrease pH." -"The buffer system is the primary manner by which the body changes strong acids into weaker ones to maintain pH balance."

-"The renal system compensates slowly, usually reacting to pH changes within 24 hours." -"The respiratory system can compensate quickly to changes in pH and reacts in a matter of minutes." -"The buffer system is the primary manner by which the body changes strong acids into weaker ones to maintain pH balance." The buffer system is the primary method by which the body maintains acid-base balance. This system is also the quickest, often working within seconds of sensing an imbalance. The respiratory system can compensate by changing the rate and depth of breathing within minutes of sensing an acid-base derangement; the renal system is slower to react, often working within hours to days. The heart is vital in regulating perfusion but does not have a major role in managing acid-base balance. Medications can be used to regulate acid-base imbalances, but the primary treatment is to resolve the underlying cause of the imbalance.

For the patient exhibiting clinical manifestations of hypovolemic shock, which fluid replacement therapy would the nurse prepare to administer when responding to the health care provider's prescription? -Dextran -0.9% NaCl -0.45% saline -5% dextrose in 0.45% saline

-0.9% NaCl Isotonic saline (0.9% NaCl) may be used when a patient has experienced both fluid and sodium losses or as a vascular fluid replacement in hypovolemic shock. The nurse would not administer 0.45% saline, 5% dextrose in 0.45% saline, or dextran, as these are not appropriate for fluid replacement in hypovolemic shock.

The nurse admits a patient reporting severe diarrhea for several days from a Clostridium difficile infection. Which IV fluid would the nurse associate with the need to rapidly replace the patient's fluid volume? -0.9% sodium chloride -0.45% sodium chloride -5% dextrose in 0.9% sodium chloride -5% dextrose in 0.25% sodium chloride

-0.9% sodium chloride An isotonic fluid such as 0.9% sodium chloride is used to rapidly replace fluid volume. The solution 0.45% sodium chloride is hypotonic, 5% dextrose in 0.25% sodium chloride is isotonic, and 5% dextrose in 0.9% sodium chloride is hypertonic; therefore these solutions should not be used for rapid fluid volume replacement. Also, solutions containing dextrose do not keep their tonicity over time because the body metabolizes dextrose, which is a sugar. For example, 5% dextrose in water is isotonic initially, but becomes hypotonic over time as the body metabolizes the dextrose—so it is considered physiologically hypotonic and should not be used for rapid fluid volume replacement.

Which clinical manifestations would the nurse anticipate when providing care for a patient with hyperkalemia? Select all that apply. -1+ deep tendon reflexes -Rapid and shallow respirations -Serum blood glucose level of 250 mg/dL -Numbness and tingling in the hands and feet -Ventricular fibrillation noted on the electrocardiogram

-1+ deep tendon reflexes -Numbness and tingling in the hands and feet -Ventricular fibrillation noted on the electrocardiogram Clinical manifestations of hyperkalemia include decreased reflexes, paresthesia, and an irregular pulse. These are manifested in 1+ deep tendon reflexes, numbness and tingling in the hands and feet, and ventricular fibrillation noted on an electrocardiogram, respectively. Rapid and shallow respirations and hyperglycemia (serum blood glucose of 250 mg/dL) would be anticipated when providing care to a patient with hypokalemia, not hyperkalemia.

Which serum phosphate level would the nurse associate with the patient experiencing alcohol withdrawal symptoms? -1.4 mg/dL -2.4 mg/dL -3.8 mg/dL -4.8 mg/dL

-1.4 mg/dL Alcohol withdrawal can result in hypophosphatemia. Phosphate levels of less than 2.4 mg/dL indicate hypophosphatemia. The nurse would be likely to find the patient's phosphate level at 1.4 mg/dL. Phosphate levels of 2.4, 3.8, and 4.8 mg/dL indicate hyperphosphatemia. A patient with symptoms of alcohol withdrawal does not have hyperphosphatemia.

Upon review of the morning laboratory studies, which patient would have the risk of developing hypomagnesemia? -83-year-old man with lung cancer and hypertension -65-year-old homeless woman with a history of chronic alcoholism -32-year-old pregnant woman who has been treated for eclampsia -63-year-old man with benign prostatic hyperplasia (BPH) and a urinary tract infection (UTI)

-65-year-old homeless woman with a history of chronic alcoholism Causes of hypomagnesemia include chronic alcoholism, diarrhea, vomiting, malabsorption syndromes, prolonged malnutrition, and nasogastric (NG) suction. Lung cancer, hypertension, eclampsia, BPH, and UTIs are not causes of hypomagnesemia.

Upon review of blood pH values, which value would cause the nurse to determine that the patient is acidotic? -7.25 -7.35 -7.45 -7.55

-7.25 Blood pH normally ranges from 7.35 to 7.45, so acidosis occurs when the blood pH drops below 7.35. Though the patient will have acidosis if the blood pH is at 7.25 or lower, the patient will also have acidosis if the blood pH is lower than 7.35. Blood pH values of 7.35 and 7.45 are within the normal range. A blood pH of 7.55 indicates alkalosis, not acidosis.

Which reference interval is the normal range for the pH parameter of arterial blood? -7.05 to 7.15 -7.15 to 7.25 -7.25 to 7.35 -7.35 to 7.45

-7.35 to 7.45 The normal range of blood pH is 7.35 to 7.45. A pH less than 7.35 indicates acidosis.

The nurse finds that the patient with renal disease is irritable and has an irregular pulse. Electrocardiogram (ECG) changes suggest severe hyperkalemia. Which intervention would the nurse implement first? -Stop all sources of dietary potassium. -Administer IV calcium gluconate immediately. -Locate and administer ion-exchange resins. -Obtain and administer IV insulin with glucose.

-Administer IV calcium gluconate immediately. In the case of severe hyperkalemia, manifested by irritation, irregular pulse, and changes in ECG findings, the nurse should act immediately to prevent cardiac arrest. The nurse should administer IV calcium gluconate to reverse the membrane potential effects of extracellular fluid (ECF) potassium. Administering ion-exchange resins (to increase elimination of potassium) and IV insulin with glucose (to force potassium from ECF to intracellular fluid [ICF]) can be done once the patient is stable. Stopping all sources of dietary potassium is an important measure when hyperkalemia is mild.

Which interventions would the nurse implement when providing care for a patient with hypercalcemia? Select all that apply. -Administer furosemide. -Administer bisphosphonates. -Administer isotonic saline infusions. -Restrict oral fluid intake to 1000 mL. -Encourage the patient to breathe into a paper bag.

-Administer furosemide. -Administer bisphosphonates. -Administer isotonic saline infusions. Hypercalcemia is treated by hydrating the patient and promoting urinary excretion of calcium. Therefore the nurse would administer loop diuretics such as furosemide to promote diuresis and would keep the patient hydrated by administering isotonic saline infusions. The nurse can also administer bisphosphonates to inhibit the activity of osteoclasts. The patient should be encouraged to drink at least 3000 to 4000 mL of fluid to promote calcium excretion and prevent kidney stones. The patient is encouraged to breathe into a paper bag if signs of hypocalcemia are evident.

The nurse determines that a patient's multilumen central venous access device (CAVD) is missing one of the injection caps, and the patient is exhibiting clinical manifestations of respiratory distress, hypotension, and tachycardia. Which action would the nurse implement first? -Administer oxygen via nasal cannula. -Notify the health care provider. -Reposition patient to left side, head down. -Adjust the IV fluids via the CAVD.

-Administer oxygen via nasal cannula. The cap off the central line could potentially allow entry of air into the circulation. For an air embolus from any source, the priority is to administer oxygen. Next, clamp the CAVD catheter and position the patient on the left side with the head down. Then the health care provider is notified. IV fluid is not needed in this scenario and could worsen the patient's respiratory status. However, use of the CAVD and rate adjustments depend on provider orders.

Which actions would the nurse implement immediately when a patient with a central venous access device begins to experience chest pain, dyspnea, hypotension, and tachycardia? Select all that apply. -Administer oxygen. -Administer anticoagulants. -Clamp the central venous access catheter. -Place the patient on the left side with the head down. -Flush the central venous access device with normal saline using a 10 mL syringe.

-Administer oxygen. -Clamp the central venous access catheter. -Place the patient on the left side with the head down. Pulmonary embolism is a complication of central venous access devices. The nurse should start oxygen therapy to relieve dyspnea. The catheter should be clamped to prevent further formation of emboli. Because the signs suggest air embolism, the patient is placed on the left side with the head down. Administering anticoagulants and normal saline are required if the catheter is occluded, and they do not help in relieving a pulmonary embolus.

Which nursing interventions would the nurse implement when unable to infuse fluids via the patient's central venous access device? Select all that apply. -Assess the catheter for clamping and kinking and alleviate the cause. -Instruct the patient to remain supine in bed and not to move. -Force-flush the device with normal saline using a 10-mL syringe. -Notify radiology of need to perform fluoroscopy to determine the cause and evaluate the site. -Consult interventional radiology for administration of anticoagulant or thrombolytic agents.

-Assess the catheter for clamping and kinking and alleviate the cause. -Notify radiology of need to perform fluoroscopy to determine the cause and evaluate the site. -Consult interventional radiology for administration of anticoagulant or thrombolytic agents. Occlusion is a common problem with central venous catheters. If occlusion is suspected, the nurse would instruct the patient to change position, raise the arm, and cough, which helps move any blockage. The nurse must assess the catheter for clamping and kinking and undo it if found. The nurse would inform the health care provider about the catheter occlusion so fluoroscopy can be performed, if needed to determine the cause and site of occlusion. In addition, anticoagulants or antithrombolytic agents can be administered. Having the patient lie supine and motionless is not appropriate when assessing possible occlusion. Flushing is a very important step in maintaining the patency of the catheter. Flushing should be done with normal saline in a 10-mL syringe to avoid pressure on the catheter. Force should not be applied if resistance is felt.

Which laboratory results are consistent with a patient's diagnosis of milk-alkali syndrome from an excessive intake of antacids? -Calcium levels of 7 mg/dL -Calcium levels of 15 mg/dL -Phosphate levels of 2 mg/dL -Phosphate levels of 17 mg/dL

-Calcium levels of 15 mg/dL Milk-alkali syndrome is a condition in which large concentrations of calcium are found in the body. Calcium levels of more than 10.2 mg/dL indicate hypercalcemia. Calcium levels of 7 mg/dL indicate hypocalcemia. Phosphate levels of 2 mg/dL indicate hypophosphatemia. Phosphate levels of 17 mg/dL indicate hyperphosphatemia.

For the patient with a central venous access, which interventions would the nurse implement to maintain a safe, functioning device? Select all that apply. -Change the catheter dressing regularly. -Monitor the heart rate and BP. -Cleanse around the catheter insertion site. -Measure and record oral intake and output. -Change the injection caps at regular intervals.

-Change the catheter dressing regularly. -Cleanse around the catheter insertion site. -Change the injection caps at regular intervals. Nursing management of central venous access devices is important in keeping the devices safe and functioning and in reducing risk of infection. The catheter dressing and the injection caps should be regularly changed, and the catheter site should be regularly cleansed; these steps keep the site free from infection. Flushing is an important intervention to maintain the patency of the catheter and prevent occlusion. Monitoring vital parameters and assessing intake and output are general measures that are not specific to the care of central venous access devices.

Which task may a registered nurse (RN) on a general medical-surgical unit delegate to a licensed practical nurse (LPN), as permitted by the state nurse practice act? -Administering a saline infusion to a patient with diabetic ketoacidosis -Assessing a patient with heart failure who has signs of fluid overload -Determining if an IV infusion should be given to a patient with an acid-base imbalance -Decreasing the rate of an existing IV infusion for a patient about to be discharged home

-Decreasing the rate of an existing IV infusion for a patient about to be discharged home Depending on the state's nurse practice act, an LPN can adjust the IV infusion rate for stable patients. A patient about to be discharged home is considered stable. Clients with diabetic ketoacidosis, acid─base imbalance, and fluid overload are not considered stable, so tasks related to IV infusions and fluid status for these patients cannot be delegated to the LPN.

Which factors place the older patient at risk for developing the clinical manifestations of dehydration? Select all that apply. -Decreased taste sensation -Disorientation and confusion -Inability to hold a cup or glass -Decrease in thirst mechanisms -Fear of stomach bloating and discomfort

-Disorientation and confusion -Inability to hold a cup or glass -Decrease in thirst mechanisms Some older adults experience mental changes including confusion and disorientation, which may lead to a decrease in fluid intake. In addition, older adults may also have musculoskeletal disabilities, such as stiffness of the hands, which make it difficult for them to hold a cup or glass. Older adults may have decreased thirst mechanisms; therefore they may not feel like drinking water even if they are dehydrated and have increased osmolality and serum sodium levels. Fear of bloating and decreased taste sensation do not affect intake of fluid.

Which clinical manifestations would the nurse monitor when assessing a patient with primary hypoparathyroidism? Select all that apply. -Anorexia -Easy fatigability -Depressed reflexes -Circumoral numbness -Positive Trousseau's sign

-Easy fatigability -Circumoral numbness -Positive Trousseau's sign Primary hypoparathyroidism can result in a lack of parathyroid hormone, leading to hypocalcemia. Manifestations of low serum calcium levels include easy fatigability, depression, anxiety, confusion, numbness and tingling in extremities and the region around the mouth, hyperreflexia, muscle cramps, positive Chvostek's and Trousseau's signs, and others. Anorexia and depressed reflexes are manifestations of hypercalcemia.

Which acid-base mechanisms would the kidney use to buffer a patient's acidosis (serum pH < 7.35)? Select all that apply. -Eliminating excess H+ -Excreting excess water -Eliminating excess CO2 -Reabsorbing additional HCO3- -Reabsorbing additional sodium ions

-Eliminating excess H+ -Reabsorbing additional HCO3- As a compensatory mechanism, the pH of the urine can decrease to 4 or increase to 8. To compensate for acidosis, the kidneys can reabsorb additional HCO3- and eliminate excess H+. Thus, the pH of the blood increases and the pH of the urine decreases (more acidic). Eliminating excess water or CO2 or reabsorbing additional sodium ions are not mechanisms of acid-base buffers.

For the patient with recent removal of a pituitary tumor, which clinical manifestation would the nurse report immediately to the health care provider? -Excessive thirst -Calcium level of 8.6 mg/dL -Potassium level of 3.5 mEq/L -Urine output of 300 mL in eight hours

-Excessive thirst A patient who has had surgery on the pituitary gland is at risk for diabetes insipidus. Excessive thirst is an indicator of inadequate antidiuretic hormone (ADH) synthesis or release. The nurse should monitor the urine output closely and notify the health care provider of excessive thirst. One would expect large volumes of urine in the absences of ADH production. A urine output of 300 mL in eight hours would not be alarming. The calcium and potassium levels are at the low end of normal. The nurse should continue to monitor these electrolytes.

Which type of imbalance would the nurse associate with a patient who has second-degree (partial-thickness) burns over 30% of the total body surface area with poor skin turgor, urine output of <50 mL over the past two hours, a rapid and thready pulse, and restlessness? -Hyperkalemia -Metabolic acidosis -Hyperphosphatemia -Extracellular fluid volume deficit

-Extracellular fluid volume deficit Patients with burns are susceptible to third-space shifts, resulting in extracellular fluid volume deficit. Extracellular fluid volume deficit is characterized by poor skin turgor, decreased urine output, a rapid and thready pulse, and restlessness. Hyperkalemia is characterized by weakness, irregular pulse, and paresthesias. Hyperphosphatemia is characterized by numbness and tingling, hyperreflexia, tetany, and seizures. Metabolic acidosis is characterized by drowsiness, confusion, decreased BP, dysrhythmias, nausea, and vomiting.

A patient's treatment resulted in blood sugar levels decreasing from 210 mg/dL to 150 mg/dL. Which method of fluid movement between intracellular and extracellular fluids support the effectiveness of the patient's treatment? -Osmosis -Diffusion -Active transport -Facilitated diffusion

-Facilitated diffusion Facilitated diffusion is a process that involves the movement of molecules from higher concentrations to lower concentrations by a protein carrier across the membrane. It is a passive process in which the glucose molecules are transported into the cell by combining with the carrier molecule from extracellular fluid to intracellular fluid. Osmosis allows transport of molecules from lower concentration to higher concentration across the semipermeable membrane. It occurs mainly during urine formation in the kidneys. Diffusion is a simple process of movement of molecules from higher to lower concentration. Active transport is a process similar to diffusion but occurs in the presence of external energy.

Which clinical manifestations would indicate a patient with heart failure is at risk for developing fluid volume excess? -Full, bounding pulse -Flattened neck veins -Low blood pressure -Easily obliterated pulse

-Full, bounding pulse Any change in the fluid volume is reflected in changes in blood pressure, pulse rate force, and jugular venous distension. A fluid volume excess may cause a full, bounding pulse; increased blood pressure; and distended neck veins. The pulse in this case is not easily obliterated. Flattened neck veins, low blood pressure, and a weak and thready pulse that can be easily obliterated indicate fluid volume deficit.

Which clinical manifestation would the nurse associate with the patient's admitting problem of deficient fluid volume related to nausea and vomiting? -Polyuria -Decreased pulse -Difficulty breathing -General restlessness

-General restlessness Restlessness is an early cerebral sign that dehydration has progressed to the point where an intracellular fluid shift is occurring. If the dehydration is left untreated, cerebral signs could progress to confusion and later coma. Polyuria, decreased pulse, and difficulty breathing do not support a determination of deficient fluid volume.

The clinical manifestations of a patient with encephalitis led the nurse to suspect development of respiratory alkalosis. Which laboratory data supports the nurse's assessment? -HCO3- 18 mEq/L; PaCO2 30 mm Hg -HCO3- 22 mEq/L; PaCO2 35 mm Hg -HCO3- 24 mEq/L; PaCO2 43 mm Hg -HCO3- 26 mEq/L; PaCO2 45 mm Hg

-HCO3- 18 mEq/L; PaCO2 30 mm Hg The normal range of bicarbonate (HCO3-) ion concentration in blood is 22 to 26 mEq/L, and the normal range of partial pressure of carbon dioxide (PaCO2) is 35 to 45 mm Hg. When the respiratory center is stimulated, patients with encephalitis will hyperventilate. This condition causes a decrease in partial pressure of carbon dioxide, resulting in decreased carbonic acid concentration. Because the laboratory reports show a decreased partial pressure of carbon dioxide and bicarbonate ion concentration, the nurse suspects respiratory alkalosis.

A patient with chronic kidney disease is experiencing severe hyperphosphatemia. The nurse notifies the health care provider in anticipation of which ordered treatment? -Hemodialysis -Fluid restriction -Potassium supplementation -Loop diuretic therapy

-Hemodialysis For severe hyperphosphatemia, hemodialysis can decrease levels rapidly. Fluid restriction, potassium supplementation, and diuretic therapy without volume expansion are not treatment options for hyperphosphatemia.

Which assessment data would the nurse associate with the patient's serum potassium level of 6.8 mEq/L on admission. Select all that apply. -Insulin therapy initiated in the emergency room -Home medications include amiloride PO daily -History and treatment of chronic renal disease -Electrocardiogram reveals flattened T waves -Orders include normal saline with 40mEq potassium in AM

-Home medications include amiloride PO daily -History and treatment of chronic renal disease Potassium levels greater than 5.0 mEq/mL indicate hyperkalemia. Potassium-sparing diuretics, such as amiloride, increase the potassium levels. The kidneys excrete potassium, so renal disease can also lead to increased potassium levels. Insulin moves potassium into the cell and decreases serum potassium values. Hyperkalemia is manifested on an electrocardiogram as tall, peaked T waves, not flattened T waves. Potassium should not be added to IV fluids if the patient is already suffering from hyperkalemia.

An inadvertent removal of the parathyroid glands occurred during a patient's scheduled thyroidectomy. Which electrolyte disturbance would the nurse assess for the presence of Trousseau's sign and serum electrolyte results? -Hypocalcemia -Hypercalcemia -Hypermagnesemia -Hyperphosphatemia

-Hypocalcemia Trousseau's sign refers to carpal spasms induced by inflating a blood pressure cuff on the arm. Hypocalcemia can be identified by Trousseau's sign. Hypercalcemia, hypermagnesemia, and hyperphosphatemia cannot be identified by Trousseau's sign.

Which electrolyte imbalance would prompt the nurse to instruct a patient to consume more dairy products in their diet? Select all that apply. -Hyperkalemia -Hypocalcemia -Hypercalcemia -Hypophosphatemia -Hyperphosphatemia

-Hypocalcemia -Hypophosphatemia Hypocalcemia is decreased calcium levels, which can be alleviated by the consumption of dairy products. Hypophosphatemia is decreased levels of phosphates in the body, which also can be alleviated through the consumption of dairy products, because they are rich in phosphates. Patients with hyperkalemia, hypercalcemia, and hyperphosphatemia are instructed to avoid dairy products.

A patient has a blood sodium level of 170 mEq/L and is experiencing intense thirst, agitation, and decreased alertness. Which intervention would the nurse associate with the patient's clinical manifestations? -IV furosemide -IV cation-exchange resin -IV phosphate-binding agent -IV 0.45% sodium chloride saline solution

-IV 0.45% sodium chloride saline solution Hypernatremia is a condition in which water shifts out of the cells into the extracellular fluid, resulting in dehydration. The patient with hypernatremia would experience intense thirst, agitation, and decreased alertness. To reduce dehydration, fluid should be replaced by administering hypotonic IV fluids such as 5% dextrose in water or 0.45% sodium chloride saline solution (one-half of 0.9% normal saline to decrease the amount of sodium administered and still increase the amount of fluid). Administering IV furosemide may help treat hypercalcemia. A cation-exchange resin may be administered to treat hyperkalemia. A phosphate-binding agent may be administered to treat hyperphosphatemia.

Which health care provider order would the nurse associate with a patient's potassium level of 2.9 mEq/L? -Implement continuous electrocardiogram (ECG) monitoring. -Increase the patient's PO digoxin (Lanoxin) to 0.25 mg every day. -Add 20 mEq of KCl to the existing intravenous (IV) bag and give over four hours. -Infuse 40 mEq of KCl in 100 cc D5W IV piggyback (IVPB) over 30 minutes.

-Implement continuous electrocardiogram (ECG) monitoring. Hypokalemia can cause lethal ventricular rhythms. Therefore continuous cardiac monitoring should be expected. Patients with hypokalemia are at risk for digoxin toxicity. The nurse would watch for signs of digoxin toxicity and question an increase in dosage. KCl infusion must be diluted and given at a rate not to exceed 10 mEq/hour. 40 mEq KCl in 100 cc of fluid is too concentrated and should be given over at least two hours. To prevent administering a bolus, KCl should never be added to an existing IV bag (already hanging).

The nurse would assess for which common electrolyte imbalance while providing care for the patient with sickle cell anemia? -Increased calcium levels -Increased potassium levels -Increased phosphate levels -Increased magnesium levels

-Increased phosphate levels Sickle cell anemia leads to increased concentration of phosphates in the body because of renal damage caused by the sickle cells, thus causing hyperphosphatemia. Hypercalcemia, or increased calcium levels, is associated with hyperparathyroidism. Hyperkalemia, or increased potassium levels, is associated with tumor lysis syndrome. Hypermagnesemia, or increased magnesium levels, is associated with diabetic ketoacidosis.

A patient with heart failure accidentally overused the prescribed diuretics. For which potential respiratory manifestation would the nurse monitor? -Shortness of breath -Pulmonary congestion -Increased respiratory rate -Moist crackles on inspiration

-Increased respiratory rate Patients with deficient fluid volume experience decreased tissue perfusion and hypoxia resulting in an increased respiratory rate. Pulmonary congestion, shortness of breath, and moist crackles on inspiration are all characteristic of a fluid volume excess, not deficit.

Which intervention would the nurse implement first when providing care for a patient being treated for hypernatremia that developed slowly over several days? -Initiate seizure precautions. -Administer prescribed diuretics. -Monitor the patient's weight each day. -Restrict the patient's dietary sodium intake.

-Initiate seizure precautions. A rapid reduction in the sodium level can cause a rapid shift of water back into the cells, resulting in cerebral edema and neurologic complications. This risk is greatest in a patient who developed hypernatremia over several days or longer. The priority nursing action in this case is to implement seizure precautions due to the risk of neurologic complications. Monitoring the patient's weight each day, restricting dietary sodium intake, and administering prescribed diuretics are all appropriate nursing actions; however, these are not the priority given this patient's risk for neurologic complications.

Which action would the nurse perform to ensure the patient's safety when preparing to administer IV potassium chloride (KCl) to a patient? -Administer the KCl via IV push. -Add the KCl to the hanging (existing) IV bag. -Administer the IV KCl in concentrated amounts. -Invert the IV fluid with KCl several times prior to hanging.

-Invert the IV fluid with KCl several times prior to hanging. Hypokalemia is characterized by a decreased concentration of potassium in the body. Therefore, KCl should be administered to maintain normal potassium levels. Inverting the IV bags containing KCl several times ensures even distribution of the KCl medication in the bag. The nurse would administer KCl through an infusion pump, not by IV push, to ensure administration at an accurate rate. The nurse would not add KCl to the hanging (existing) IV bag because this would result in administering a bolus dose or incorrect dilution ratio. The nurse will give IV KCl in diluted forms, rather than in concentrated amounts, to ensure the patient's safety.

When extracellular fluid and intracellular fluid have the same osmolality, which term would the nurse use? -Isotonic -Hypotonic -Hypertonic -Oncotic pressure

-Isotonic Extracellular fluid and intracellular fluid have the same osmolality; this characteristic is termed isotonic, meaning that there is no net movement of fluids. Hypotonic refers to fluids with a lower osmolality, which results in water moving into the cell when the cell is surrounded by a hypotonic fluid. Hypertonic refers to fluids with a higher osmolality, which results in water moving out of the cells when they are surrounded by a hypertonic solution. Oncotic pressure refers to the pressure of plasma colloids in a solution.

Which assessments would the nurse perform to avoid risk factors associated with administration of a hypertonic solution to a patient with dehydration? Select all that apply. -Lung sounds -Bowel sounds -BP -Serum sodium level -Serum potassium level

-Lung sounds -BP -Serum sodium level BP, lung sounds, and serum sodium levels must be monitored frequently because of the risk for excess intravascular volume with hypertonic solutions. Bowel sounds and serum potassium levels do not need to be monitored frequently.

Which rationale supports the nurse's assessment of a patient's magnesium level? -The electrolyte may cause extracellular fluid overload. -Magnesium may affect neuromuscular excitability and contractility. -The electrolyte is the most abundant intracellular cation present in the body. -The patient is at risk for hypotension when the levels of magnesium decrease.

-Magnesium may affect neuromuscular excitability and contractility. Alterations in serum magnesium levels profoundly affect neuromuscular excitability and contractility because magnesium directly acts on the myoneural junction. The electrolyte is a cofactor in many enzyme systems such as regulation of blood glucose control and BP. Excess magnesium inhibits acetylcholine release at the myoneural junction and calcium movement into cells, impairing nerve and muscle function. Initial manifestations include hypotension. A decrease in blood magnesium levels increases the BP. Magnesium is the second most abundant intracellular cation. The majority of the body's magnesium is present in the bones. "Causing extracellular fluid overload," "being the most abundant intracellular cation," and "the patient being at risk for hypotension" are not relevant to this situation.

The patient with a chest wall abnormality is scheduled for a surgical intervention. For which condition would the nurse carefully monitor the patient's arterial blood gases? -Metabolic acidosis -Metabolic alkalosis -Respiratory acidosis -Respiratory alkalosis

-Respiratory acidosis A chest wall abnormality may cause difficulty in breathing, leading to hypoventilation. Hypoventilation may result in respiratory acidosis. Metabolic acidosis is caused by factors that increase the concentration of acid other than carbonic acid. Metabolic alkalosis occurs when contributing factors result in the loss of bicarbonate or a gain of acids. Respiratory alkalosis is caused by conditions triggering hyperventilation.

A patient reports a headache, nausea, and four episodes of vomiting in the last two hours. The patient is taking deep, rapid breaths, and BP is 90/60 mm Hg. The nurse suspects development of which patient condition? -Metabolic acidosis -Metabolic alkalosis -Respiratory acidosis -Respiratory alkalosis

-Metabolic acidosis Deep and rapid respirations are characteristic of Kussmaul respirations. Normal BP is 120/80 mm Hg. Kussmaul's respirations, low BP, nausea, vomiting, and headache are manifestations of metabolic acidosis. Therefore the nurse suspects that the patient has metabolic acidosis. Signs of metabolic alkalosis include tetany, nausea, and vomiting. Although headache and hypotension are seen in respiratory acidosis, clinical manifestations of nausea, vomiting, and rapid respirations are not observed. Respiratory alkalosis is characterized by tetany, anorexia, nausea, and vomiting.

A patient reports an inability to eat for the last 10 days and "feeling extremely weak and sick." Which acid-base imbalance would the nurse suspect when coordinating the clinical manifestations with the pending arterial blood gas (ABG) report? -Metabolic acidosis -Metabolic alkalosis -Respiratory acidosis -Respiratory alkalosis

-Metabolic acidosis Starvation leads to production of lactic acid from the cells, resulting in metabolic acidosis. Metabolic alkalosis is caused by severe vomiting, gastric suction, and diuretic therapy. Factors such as chest wall abnormality and chronic obstructive pulmonary disease may cause respiratory acidosis. Septicemia, hypoxia, and anxiety cause respiratory alkalosis.

A patient with diabetes mellitus has been fasting since midnight and reports feeling dizzy. The nurse observes the deep, rapid breathing of Kussmaul respirations. Which condition would the nurse associate with this clinical manifestation? -Metabolic acidosis -Metabolic alkalosis -Respiratory acidosis -Respiratory alkalosis

-Metabolic acidosis The patient has been fasting (NPO) and complains of dizziness. The patient has likely developed diabetic ketoacidosis, a type of metabolic acidosis. Kussmaul respiration is deep, rapid breathing developed in response to metabolic acidosis and is a compensatory mechanism to excrete excess carbon dioxide via the lungs. Metabolic alkalosis occurs when there is a loss of acid or a gain in bicarbonate and is not associated with Kussmaul respirations. Respiratory acidosis results when the person hypoventilates, carbonic acid accumulates in the blood, and the blood pH decreases. Respiratory alkalosis occurs when the person hyperventilates and expels carbon dioxide.

The patient's arterial blood gas (ABG) values are pH 7.30, PaCO2 35 mm Hg, and bicarbonate (HCO3-) 16 mEq/L. Which interpretation would the nurse use when updating the patient's plan of care? -Metabolic acidosis -Metabolic alkalosis -Respiratory acidosis -Respiratory alkalosis

-Metabolic acidosis Use the memory device ROME. For respiratory conditions, the pH and the PaCO2 go in opposite directions. Respiratory alkalosis: pH high and PaCO2 is low. Respiratory acidosis: pH is low and the PaCO2 is high. In metabolic conditions, the pH and HCO3- go in the same direction (equal). The PaCO2 may also go in the same direction. Metabolic alkalosis: pH and HCO3- are high. Metabolic acidosis: pH and HCO3- are high. Normal ABG values fall in the range of pH 7.35 to 7.45, PaCO2 35 to 45 mm Hg, and HCO3- 22 to 26 mEq/L. Bicarbonate and pH values are less than the normal values (same direction) and indicate metabolic acidosis. A pH value less than 7.35 and a high PaCO2 (opposite direction) indicates respiratory acidosis.

A patient admitted with gastroenteritis has an arterial blood gas (ABG) report of pH 7.30, PaO2 80 mm Hg, PaCO2 46 mm Hg, HCO3 14. Which interpretation would the nurse use to affirm nursing interventions? -Metabolic acidosis -Metabolic alkalosis -Respiratory acidosis -Respiratory alkalosis

-Metabolic acidosis Use the memory device ROME. For respiratory conditions, the pH and the PaCO2 go in opposite directions. Respiratory alkalosis: pH high and PaCO2 is low. Respiratory acidosis: pH is low and the PaCO2 is high. In metabolic conditions, the pH and HCO3- go in the same direction (equal). The PaCO2 may also go in the same direction. Metabolic alkalosis: pH and HCO3- are high. Metabolic acidosis: pH and HCO3- are low.A low pH (normal 7.35 to 7.45) indicates acidosis. In the patient with gastroenteritis and diarrhea, bicarbonate is lost from the excessive stool, which would result in a low bicarbonate level and resulting metabolic acidosis. There is not a respiratory component associated with gastroenteritis.

The arterial blood gas (ABG) report of a patient with diabetes mellitus indicates a bicarbonate level of 18 mEq/L and pH of 7.32. Which acid-base imbalance would the nurse document? -Metabolic acidosis -Metabolic alkalosis -Respiratory acidosis -Respiratory alkalosis

-Metabolic acidosis Use the memory device ROME. For respiratory conditions, the pH and the PaCO2 go in opposite directions. Respiratory alkalosis: pH high and PaCO2 is low. Respiratory acidosis: pH is low and the PaCO2 is high. In metabolic conditions, the pH and HCO3- go in the same direction (equal). The PaCO2 may also go in the same direction. Metabolic alkalosis: pH and HCO3- are high; Metabolic acidosis: pH and HCO3- are high. The normal pH range of blood is 7.35 to 7.45, and the normal value of bicarbonate is 23 to 30 mEq/L. The patient's ABG report indicates metabolic acidosis. Metabolic alkalosis is manifested by an increased pH. A decreased pH and elevated PaCO2 indicate respiratory acidosis. Respiratory alkalosis is manifested by increased plasma pH and decreased PaCO2.

When receiving long-term mineralocorticoid therapy, for which patient condition would the nurse evaluate associated clinical manifestations? -Metabolic acidosis -Metabolic alkalosis -Respiratory acidosis -Respiratory alkalosis

-Metabolic alkalosis Mineralocorticoids are used to maintain salt and water balance. Excessive use of mineralocorticoids may cause loss of strong acids, resulting in metabolic alkalosis. Metabolic acidosis is caused by conditions that increase the acid concentration in the body, such as diabetic ketoacidosis. Respiratory acidosis occurs as a result of hypoventilation. Respiratory alkalosis occurs because of hyperventilation.

Which conditions would the nurse associate with the patient being monitored for clinical manifestations of hyperkalemia? Select all that apply. -Alkalosis -Renal failure -Low blood volume -Large urine volume -Adrenal insufficiency

-Renal failure -Adrenal insufficiency Hyperkalemia is a condition in which there is an abnormal increase of potassium in the blood. Renal failure may cause hyperkalemia, because the kidneys cannot remove potassium from the body. Adrenal insufficiency causes aldosterone deficiency, which leads to the retention of potassium ions and also may result in hyperkalemia. Alkalosis is typically associated with hypocalcemia, not hyperkalemia. Low blood volume and a large urine volume can result in hypokalemia.

A patient, recovering from a surgical procedure, has a nasogastric (NG) tube draining copious secretions and reports surgical site pain of 10 on a scale of 0 to 10. The patient's respirations are 32 breaths/minute. Which condition would the nurse associate with these clinical manifestations? -Hypoxia and respiratory alkalosis -Mixed respiratory and metabolic alkalosis -Sedative overdose and respiratory acidosis -Diabetic ketoacidosis and metabolic acidosis

-Mixed respiratory and metabolic alkalosis A mixed acid-base disorder is a condition in which two or more disorders affecting the acid-base balance are present at the same time. Septicemia causes respiratory alkalosis, which causes an acid-base imbalance. Metabolic alkalosis also affects the acid-base balance. Thus septicemia and metabolic alkalosis are examples of a mixed acid-base disorder. Hypoxia causes respiratory alkalosis. Overdose of sedatives causes respiratory acidosis. Diabetic ketoacidosis results in metabolic acidosis. An example of a mixed acidosis is a patient in severe shock with poor perfusion and hypoventilation. Mixed alkalosis can occur in a patient hyperventilating because of postoperative pain and loss of acid secondary to NG suctioning.

Which patient outcome would the nurse use to evaluate the effectiveness of the treatment regimen for a patient's dehydration? -Oral intake balances output. -Oral intake is less than output. -Oral intake is greater than output. -No significant difference in fluid balance.

-Oral intake balances output. Oral intake should equal output if fluid balance has been restored and dehydration has been corrected. Less intake than output would result in dehydration. Greater intake than output may indicate decreased renal function or impaired ability to excrete urine.

Which clinical manifestation would the nurse relate to a patient's body temperature of 103° F (39.4° C)? -Muscle spasm -Bounding pulse -Jugular vein distention -Orthostatic hypotension

-Orthostatic hypotension Orthostatic or postural hypotension is the clinical manifestation the nurse should anticipate observing when assessing a patient with a body temperature of 103° F (39.4° C). The febrile patient will have reduced blood volume from fluid loss due to sweating and increased insensible water loss, as well as vasodilation from heat. Although a reduced blood volume with an elevated temperature would produce an increased pulse rate, it would not be a bounding pulse. Muscle spasm, a bounding pulse, and jugular vein distention are manifestations of an increase (not a decrease) in blood volume.

Which physical assessment finding is consistent with a patient's total serum calcium level of 6.4 mg/dL? -Polyuria -Bone pain -Paresthesias -Diminished deep tendon reflexes

-Paresthesias Signs of hypocalcemia include paresthesias, tetany, and muscle weakness. Bone pain, diminished reflexes, and polyuria are signs of hypercalcemia.

A patient with chronic obstructive pulmonary disease (COPD) has arterial blood gas (ABG) results of pH 7.33, PaO2 47 mm Hg, PaCO2 60 mm Hg, HCO3 32 mEq/L, and O2 saturation of 92%. Which interpretation of the data would the nurse report to the primary care provider? -Fully compensated respiratory alkalosis -Partially compensated respiratory acidosis -Normal acid-base balance with hypoxemia -Normal acid-base balance with hypercapnia

-Partially compensated respiratory acidosis Use the memory device ROME. For respiratory conditions, the pH and the PaCO2 go in opposite directions. Respiratory alkalosis: pH high and PaCO2 is low. Respiratory acidosis: pH is low and the PaCO2 is high. In metabolic conditions, the pH and HCO3- go in the same direction (equal). The PaCO2 may also go in the same direction. Metabolic alkalosis: pH and HCO3- are high. Metabolic acidosis: pH and HCO3- are high.A low pH (normal 7.35 to 7.45) indicates acidosis. In the patient with a respiratory disease such as COPD, the patient retains carbon dioxide (normal 35 to 45 mm Hg), which acts as an acid in the body. For this reason, the patient has respiratory acidosis. The "other value" assists in compensation: the elevated HCO3 indicates a partial compensation for the elevated PaCO2 because the pH remains abnormal.

After review of the laboratory reports of four patients, the health care provider writes orders to prepare one of the patients for intubation and mechanical ventilation. Which patient's reports indicate the need for this intervention? Patient A: pH= 7.44 PaCO2= 43 Patient B: pH= 7.36 PaCO2= 45 Patient C: pH= 7.34 PaCO2= 47 Patient D: pH= 7.42 PaCO2= 42 -Patient A -Patient B -Patient C -Patient D

-Patient C A need for mechanical ventilation arises when the patient is not able to breathe properly. This is manifested by decreased oxygen and increased carbon dioxide in blood. The normal partial pressure of carbon dioxide (PaCO2) value lies between 35 and 45 mm Hg, and the normal range of blood pH is 7.35 to 7.45. Patient C has an increased concentration of carbon dioxide (47; acidotic) in the blood and a low pH (7.34; acidotic), indicating that the patient has increased CO2 from hypoventilation and requires mechanical ventilation.

Which serum laboratory result would the nurse identify as an adverse effect of administering a patient calcium carbonate for the treatment of osteopenia? -Sodium falling to 138 mEq/L -Potassium rising to 4.1 mEq/L -Magnesium rising to 2.9 mg/dL -Phosphorus falling to 2.1 mg/dL

-Phosphorus falling to 2.1 mg/dL Calcium has an inverse relationship with phosphorus in the body. When phosphorus levels fall, calcium rises, and vice versa. Because hypercalcemia rarely occurs as a result of calcium intake, the patient's phosphorus falling to 2.1 mg/dL (normal 2.4-4.4 mg/dL) may be a result of the phosphate-binding effect of calcium carbonate. Sodium falling, potassium rising, and magnesium rising are not adverse reactions to the treatment.

A patient, with chronic kidney disease, reports eating many nuts, bananas, peanut butter, and chocolate. The nurse's assessment indicates loss of deep tendon reflexes, somnolence, and altered respiratory status. Which treatment option would the nurse associate with these clinical findings? -Renal dialysis -IV furosemide (Lasix) -IV potassium chloride -IV normal saline at 250 mL per hour

-Renal dialysis The patient will need renal dialysis to remove the excess serum magnesium from the increased intake of foods high in magnesium since renal function is not adequate. If renal function were adequate, IV potassium chloride would oppose the effects of magnesium on the cardiac muscle. IV furosemide and increased fluid would increase urinary output, which is the major route of excretion for magnesium

For which potential complication would the nurse monitor associated clinical manifestations when providing care for a patient with Guillian-Barré syndrome, an autoimmune disorder? -Metabolic acidosis -Metabolic alkalosis -Respiratory acidosis -Respiratory alkalosis

-Respiratory acidosis Guillain-Barré syndrome is a progressive autoimmune, neurological disorder affecting the peripheral nervous system and resulting in muscle weakness and eventual paralysis. The muscle weakness progresses to involvement of the diaphragm, which affects the respiratory system resulting in hypoventilation. Hypoventilation increases the concentration of retained carbonic acid, which results in respiratory acidosis. Metabolic acidosis, metabolic alkalosis, and respiratory alkalosis are not caused by Guillain-Barré syndrome.

After implementing prescribed therapy, the patient's arterial blood gas (ABG) report is pH 7.33, PaCO2 52 mm Hg, PaO2 81 mm Hg, HCO3- 24 mEq/L, and SaO2 84%. Which acid-base imbalance would the nurse report when updating the health care provider? -Metabolic acidosis -Metabolic alkalosis -Respiratory acidosis -Respiratory alkalosis

-Respiratory acidosis Use the memory device ROME. For respiratory conditions, the pH and the PaCO2 go in opposite directions. Respiratory alkalosis: pH high and PaCO2 is low. Respiratory acidosis: pH is low and the PaCO 2 is high (patient pH of 7.33 is low and PaCO2 of 52 is high = respiratory acidosis). In metabolic conditions, the pH and HCO3- go in the same direction (equal). The PaCO2 may also go in the same direction. Metabolic alkalosis: pH and HCO3- are high. Metabolic acidosis: pH and HCO3- are high (patient pH is low, HCO3- is normal, and PaCO2 is high = not metabolic).

A patient's blood gas results are pH 7.31, PaO2 75 mm Hg, PaCO2 50 mm Hg, and HCO3 25 mEq/L. Suspecting hypoxia, which acid-base imbalance would the nurse associate with the patient's data? -Metabolic acidosis -Respiratory acidosis -Respiratory alkalosis -Compensating respiratory acidosis

-Respiratory acidosis Use the memory device ROME. For respiratory conditions, the pH and the PaCO2 go in opposite directions. Respiratory alkalosis: pH high and PaCO2 is low. Respiratory acidosis: pH is low and the PaCO2 is high. In metabolic conditions, the pH and HCO3- go in the same direction ( equal). The PaCO2 may also go in the same direction. Metabolic alkalosis: pH and HCO3- are high. Metabolic acidosis: pH and HCO3- are high. This patient is not breathing effectively, and a build-up of carbon dioxide in the form of carbonic acid occurred. This action places the patient in an acidotic state because the pH < 7.35. Metabolic and respiratory alkalosis are therefore eliminated as possibilities. Because the PaCO2 is high at 50 mm Hg (normal range is 35 to 45 mm Hg) and the metabolic measure of HCO3- is normal at 25 mEq/L (normal range is 22 to 28 mEq/L), the patient is in respiratory acidosis. The patient is not compensated because the HCO3- is still within normal range. If the HCO3- were increased, then this would indicate compensation.

A patient with a chronic obstructive pulmonary disease (COPD) exacerbation has an arterial blood gas (ABG) report of pH 7.34, PaCO2 46, PaO2 87, and oxygen saturation 94%. Which interpretation would the nurse use for the patient's plan of care? -Metabolic acidosis -Respiratory acidosis -Respiratory alkalosis -Normal acid-base balance

-Respiratory acidosis Use the memory device ROME. For respiratory conditions, the pH and the PaCO2 go in opposite directions. Respiratory alkalosis: pH high and PaCO2 is low. Respiratory acidosis: pH is low and the PaCO2 is high. In metabolic conditions, the pH and HCO3- go in the same direction (equal). The PaCO2 may also go in the same direction. Metabolic alkalosis: pH and HCO3- are high. Metabolic acidosis: pH and HCO3- are high. The normal pH is 7.35 to 7.45. The normal PaCO2 is 35 to 45 mm Hg, and normal PaO2 is >80 mm Hg. Normal oxygen saturation is >95%. With the low pH and high PaCO2, the nurse can conclude respiratory acidosis, even without the bicarbonate level that usually is measured. This is not a normal ABG; the pH level is low, indicating acidosis. Because the patient is presenting with COPD and a slightly elevated PaCO2, this indicates that this is respiratory related.

A patient's arterial blood gas (ABG) results are pH 7.32; PaCO2 56 mm Hg; HCO3- 24 mEq/L. Which acid-base imbalance would the nurse use in development of the patient's plan of care? -Metabolic acidosis -Metabolic alkalosis -Respiratory acidosis -Respiratory alkalosis

-Respiratory acidosis Use the memory device ROME. For respiratory conditions, the pH and the PaCO2 go in opposite directions. Respiratory alkalosis: pH high and PaCO2 is low. Respiratory acidosis: pH is low and the PaCO2 is high. In metabolic conditions, the pH and HCO3- go in the same direction (equal). The PaCO2 may also go in the same direction. Metabolic alkalosis: pH and HCO3- are high. Metabolic acidosis: pH and HCO3- are high. The normal ranges are as follows: pH 7.35 to 7.45; PaCO2 35 to 45 mm Hg; HCO3- 22-26 mEq/L. Respiratory acidosis (carbonic acid excess) occurs whenever a person experiences hypoventilation. Hypoventilation leads to a build-up of CO2, resulting in an accumulation of carbonic acid in the blood. Carbonic acid dissociates, liberating H+, and there is a decrease in pH (< 7.35). The PaCO2 is > 45 (elevated) because the pH and PaCO2 are moving in opposite directions, the ABG report indicates respiratory acidosis. The patient is not experiencing a metabolic imbalance (acidosis or alkalosis) because the pH and the HCO3- are not moving in the same direction.

A patient with chronic obstructive pulmonary disease (COPD) has arterial blood gas (ABG) results of blood pH of 7.29, partial pressure of carbon dioxide (PaCO2) of 49 mm Hg, and a bicarbonate ion (HCO3) level of 25 mEq/L. When developing the patient's plan of care, which condition would the nurse use? -Metabolic acidosis -Metabolic alkalosis -Respiratory acidosis -Respiratory alkalosis

-Respiratory acidosis Use the memory device ROME. For respiratory conditions, the pH and the PaCO2 go in opposite directions. Respiratory alkalosis: pH high and PaCO2 is low. Respiratory acidosis: pH is low and the PaCO2 is high. In metabolic conditions, the pH and HCO3- go in the same direction (equal). The PaCO2 may also go in the same direction. Metabolic alkalosis: pH and HCO3- are high. Metabolic acidosis: pH and HCO3- are high. The normal ranges of blood pH, partial pressure of carbon dioxide, and bicarbonate ion levels are 7.35 to 7.45, 75 to 100 mm Hg, and 22 to 26 mEq/L, respectively. Patients with COPD have difficulty breathing, which leads to hypoventilation. This causes a build-up of carbon dioxide in the blood, which increases the concentration of carbonic acid, leading to a decrease in blood pH. Thus, the patient is expected to have respiratory acidosis. In respiratory alkalosis, partial pressure of carbon dioxide decreases. Metabolic acidosis is manifested by decreased concentration of bicarbonate in blood. Respiratory alkalosis is manifested by decreased carbonic acid concentration in blood and decreased PaCO2. Test-Taking Tip: Chronic obstructive pulmonary disease is associated with problems in breathing. Apply your knowledge and skill in answering the question.

A patient's arterial blood gas results are pH 7.33, PaCO2 50 mm Hg, PaO2 75 mm Hg, HCO3- 24 mEq/L, and SaO2 81%. Which interpretation of the ABG data would the nurse correlate to the patient's clinical manifestations? -Metabolic acidosis -Metabolic alkalosis -Respiratory acidosis -Respiratory alkalosis

-Respiratory acidosis Use the memory device ROME. For respiratory conditions, the pH and the PaCO2 go in opposite directions. Respiratory alkalosis: pH high and PaCO2 is low. Respiratory acidosis: pH is low and the PaCO2 is high. In metabolic conditions, the pH and HCO3- go in the same direction (equal). The PaCO2 may also go in the same direction. Metabolic alkalosis: pH and HCO3- are high. Metabolic acidosis: pH and HCO3- are high. The pH is < 7.35, indicating acidosis. This value eliminates metabolic and respiratory alkalosis as possibilities. Because the PaCO2 is high at 50 mm Hg (normal range is 35 to 45 mm Hg) and the metabolic measure of HCO3- is normal (range is 22 to 28 mEq/L), the patient is in respiratory acidosis, not alkalosis.

Which intervention would the nurse implement when a pregnant patient reports headaches and shortness of breath and the nurse auscultates crackles and a bounding pulse? -Apply hot and cold compresses. -Restrict the intake of dietary sodium. -Ask the patient to sit and then stand. -Provide ice chips to hydrate the patient.

-Restrict the intake of dietary sodium. A pregnant woman with increased extracellular fluid may develop hypertension and pregnancy-related complications. Restriction of dietary sodium helps to control the fluid accumulation and may help to maintain fluid balance. Application of warm and cold compresses will not relieve the patient's symptoms. Changing the position does not benefit the patient, and providing ice chips may increase the fluid volume and worsen the condition.

The nurse, providing care for an older adult patient admitted with pneumonia, closely monitors for fluid and electrolyte imbalances. Which rational supports the nurse's intervention? -An increased risk of impaired renal function exists with older adults. -An impaired level of consciousness and a need to be reminded to drink fluids occurs with older adults. -Older adults are more likely than younger adults to lose extracellular fluid during severe illnesses. -Small fluid losses are significant in older adults as their body water accounts for about 50% of their body weight.

-Small fluid losses are significant in older adults as their body water accounts for about 50% of their body weight. Older adults, with less muscle mass and more fat content, have less body water than younger adults. In the older adult, body water content averages 45% to 55% of body weight, leaving them at a higher risk for fluid-related problems than young adults. Regardless of the cause (renal function, level of consciousness, or severe illnesses) the nurse would monitor for any fluid changes, as they affect the electrolytes, and the fluid levels are affected much earlier in this population.

The nurse receives a health care provider's prescription to change a patient's IV from D5½ normal saline (NS) with 40 mEq KCl/L to D5NS with 20 mEq KCl/L. Which serum laboratory value on this same patient supports the rationale for this IV prescription change? -Sodium 136 mEq/L, potassium 4.5 mEq/L -Sodium 145 mEq/L, potassium 4.8 mEq/L -Sodium 135 mEq/L, potassium 3.6 mEq/L -Sodium 144 mEq/L, potassium 3.7 mEq/L

-Sodium 136 mEq/L, potassium 4.5 mEq/L The normal range for serum sodium is 135 to 145 mEq/L, and the normal range for potassium is 3.5 to 5.0 mEq/L. The change in the IV prescription decreases the amount of potassium and increases the amount of sodium. For this prescription to be appropriate, the potassium level must be near the high end and the sodium level near the low end of their respective ranges.

The nurse administers a prescribed parenteral nutrition of 10% dextrose solution with amino acids, electrolytes, vitamins, and trace elements to a patient. Which characteristic would the nurse need to understand regarding the prescribed solution? -The 10% dextrose is a hypertonic solution. -The parenteral nutrition is used as a plasma expander. -The solution expands the extracellular compartment. -Administration of this solution is through a central line only.

-The 10% dextrose is a hypertonic solution. A 10% dextrose solution with amino acids, electrolytes, vitamins, and trace elements is used in parenteral nutrition to provide additional calories. The solution is hypertonic, which provides free water, expanding both the extracellular and intracellular compartments. Solutions with a dextrose concentration of 10% or less should be administered through a peripheral line. Solutions with a higher dextrose concentration should be administered through a central line only. Hypertonic solutions are not used as plasma expanders because they do not stay in the vascular space.

A patient who sustained multiple injuries in a motor vehicle accident received multiple blood transfusions to replace blood lost from a wound hemorrhage. The nurse finds the patient has developed laryngeal stridor, dysphagia, and numbness and tingling around the mouth. Which rationale would the nurse associate with these changes? -The patient developed anemia secondary to the acute blood loss. -The identified clinical changes support development of hypocalcemia. -These manifestations indicate fluid overload from multiple transfusions. -The newly developed signs and symptoms indicate a hemolytic reaction.

-The identified clinical changes support development of hypocalcemia. Laryngeal stridor, dysphagia, and numbness and tingling around the mouth after multiple blood transfusions can be attributed to hypocalcemia. Blood and blood products have citrate in them, which can bind with calcium in the body and make it unavailable. Multiple blood transfusions have thus caused hypocalcemia. This usually manifests as laryngeal stridor, dysphagia, and numbness and tingling around the mouth. Such symptoms are not caused by fluid overload, which manifests as edema. Anemia can be the result of hemorrhage but does not present with laryngeal stridor and dysphagia. There are chances of hemolytic reactions, because the patient is receiving multiple transfusions. However, a hemolytic reaction manifests as severe anaphylaxis, so the patient is not having a hemolytic reaction.

After receiving several respiratory treatments for an exacerbation of asthma, the patient's arterial blood gas (ABG) results are pH 7.40, PaCO2 40 mm Hg, HCO3 24 mEq/L, PaO2 92 mm Hg, and O2 saturation 99%. Which respiratory change would the nurse report to the oncoming shift? -The patient's ABG's are within normal limits. -A slight metabolic acidosis is evident to buffer the pH. -The ABG report indicates mild respiratory acidosis. -Compensation resulted in a mild respiratory alkalosis.

-The patient's ABG's are within normal limits. Use the memory device ROME. For respiratory conditions, the pH and the PaCO2 go in opposite directions. Respiratory alkalosis: pH high and PaCO2 is low. Respiratory acidosis: pH is low and the PaCO2 is high. In metabolic conditions, the pH and HCO3- go in the same direction (equal). The PaCO2 may also go in the same direction. Metabolic alkalosis: pH and HCO3- are high. Metabolic acidosis: pH and HCO3- are high. The normal pH is 7.35 to 7.45. Normal PaCO2 levels are 35 to 45 mm Hg, and normal HCO3 levels are 22 to 26 mEq/L. A normal PaO2 level is > 80 mm Hg. Normal oxygen saturation is > 95%. Because the patient's results all fall within these normal ranges, the nurse can conclude the patient's blood gas results are within normal limits.

A patient with diabetes mellitus, malnutrition, and a massive gastrointestinal (GI) bleed is NPO, has a nasogastric tube, and received multiple units of packed red blood cells. The morning potassium level is 5.5 mEq/L. Which rationales would the nurse use to explain the morning's potassium level? Select all that apply. -The potassium level increase may be related to decreased renal perfusion associated with the fluid volume deficit. -The patient may be excreting extra sodium and retaining potassium because of malnutrition. -The elevated potassium may be due to high blood glucose levels produced when the body experiences physical stress. -The transfusion of multiple units of stored hemolyzed blood may increase the potassium levels. -The patient has been overeating raisins, baked beans, and salt substitute, which could increase the potassium level.

-The potassium level increase may be related to decreased renal perfusion associated with the fluid volume deficit. -The elevated potassium may be due to high blood glucose levels produced when the body experiences physical stress. -The transfusion of multiple units of stored hemolyzed blood may increase the potassium levels. Hyperkalemia may result from hyperglycemia, renal insufficiency, or cell death. Diabetes mellitus, along with the stress of hospitalization and illness, can lead to hyperglycemia. Renal insufficiency is a complication of diabetes. Stored hemolyzed blood can cause hyperkalemia when large amounts are transfused rapidly. Malnutrition does not cause sodium excretion accompanied by potassium retention. The body will experience hypernatremia due to a lack of fluid balance and decreased renal perfusion stimulates the Renin-Angiotensin-Aldosterone System (RASS) to retain fluids. Thus malnutrition is not a contributing factor to this patient's potassium level. The malnourished patient with a massive GI bleed has a nasogastric (NG) tube and would not be eating the items high in potassium.

Which statement describes the function of a buffer? -To excrete weak acids -To secrete hydrogen ions -To convert strong acids to weak acids -To convert ammonia to ammonium ions

-To convert strong acids to weak acids Buffers chemically convert strong acids to weak acids. Buffering is the primary regulator of acid-base balance in the body. Excretion of weak acids, secretion of hydrogen ions into the renal tubules of the nephron unit, and conversion of ammonia to ammonium ions are functions of the kidneys.

The presence of which clinical manifestations would confirm the nurse's interpretation of metabolic alkalosis from interpretation of the patient's arterial blood gas (ABG)? Select all that apply. -Tremors -Vomiting -Tachycardia -Epigastric pain -Numbness of limbs

-Tremors -Vomiting -Tachycardia Tremors, vomiting, and tachycardia are signs of metabolic alkalosis. Epigastric pain and numbness of limbs are signs of respiratory alkalosis.

A patient's arterial blood gases, obtained after intubation, are pH of 7.28, a PaCO2 level of 50 mm Hg, a bicarbonate level of 25 mm Hg, and a PaO2 level of 95 mm Hg. Which condition would the nurse report to the health care provider? -Compensated metabolic acidosis -Compensated respiratory alkalosis -Uncompensated metabolic acidosis -Uncompensated respiratory acidosis

-Uncompensated respiratory acidosis Use the memory device ROME. For respiratory conditions, the pH and the PaCO2 go in opposite directions. Respiratory alkalosis: pH high and PaCO2 is low. Respiratory acidosis: pH is low and the PaCO2 is high. In metabolic conditions, the pH and HCO3- go in the same direction (equal). The PaCO2 may also go in the same direction. Metabolic alkalosis: pH and HCO3- are high. Metabolic acidosis: pH and HCO3- are high.A pH of 7.28 implies acidosis because the lower range of blood pH is 7.35. An elevated PaCO2 level indicates the cause is respiratory, and a normal bicarbonate level indicates compensation has not yet occurred. Thus, this patient appears to be experiencing uncompensated respiratory acidosis. Uncompensated metabolic acidosis is associated with a low pH, a low bicarbonate level, and a low to normal PaCO2 level. Compensated respiratory alkalosis is associated with a mildly elevated pH, a decreased PaCO2 level, and a decreased bicarbonate level. Compensated metabolic acidosis is associated with a mildly decreased pH, a decreased bicarbonate level, and an increased PaCO2 level.

Which interventions would the nurse perform prior to removing a patient's central venous access device (CVAD)? Select all that apply. -Understand the scope of nursing practice. -Review the health care provider's prescription. -Request a second nurse to assist with the removal. -Review the health care organization's policy on the procedure. -Provide pharmacologic intervention prior to removing the CVAD.

-Understand the scope of nursing practice. -Review the health care provider's prescription. -Review the health care organization's policy on the procedure. Not all health care agencies allow a nurse to perform this procedure. Prior to removing a patient's CVAD, the nurse should know the health care organization's policy, confirm that the removal is in the scope of a registered nurse's practice to perform, and review the health care provider's prescription. It is not necessary to have another nurse assist with the removal of a CVAD or to routinely medicate the patient.

Which data findings would the nurse instruct the unlicensed assistive personnel (UAP) to report while providing care for an older adult patient with dehydration? -Temperature 97.1°F (36.2°C) -Frequent use of the urinal -Urine output of 350 mL in 24 hours -Ambulation in the hallway without assistance

-Urine output of 350 mL in 24 hours KCl is only administered when the urine output is at least 0.5 mL/kg of body weight per hour. Consider the situation if an adult patient weighed 150 lbs. Dividing this weight by 2.2 kg results in an outcome of 68.18 kg. Then multiply the body weight by the minimal urine output of 0.5 mL, which shows that the patient needs to put out approximately 34 mL/hr. Then divide the 350 mL by 24, which shows that the patient is only producing 14.58 mL/hr and is well below the minimal urine output required by an adult patient. The minimal urine output necessary to maintain kidney function is 30 mLs per hour, or 720 mL per 24 hours. The nurse should be notified of a decrease in urine output so that additional fluid volume-replacement therapy can be instituted. Ambulation is encouraged. The temperature is normal. Frequent use of the urinal would not indicate dehydration.

For which clinical manifestation would the nurse monitor closely in the patient experiencing respiratory acidosis from chronic obstructive respiratory disease (COPD)? -Diarrhea -Confusion -Abdominal pain -Ventricular fibrillation

-Ventricular fibrillation COPD complications may cause respiratory acidosis from hypoventilation and the buildup of carbon dioxide. Respiratory acidosis causes a compensatory hyperkalemia as the H+ move into the cells to maintain the pH of the blood; however, when H+ moves in, potassium is kicked out during the exchange. Increased serum K+ levels affect cardiac conduction and irritability as cardiac depolarization decreases, leading to the loss of P waves, prolonged PR interval, ST segment depression, and widening QRS complexes. Heart block, ventricular fibrillation, or cardiac standstill may occur. Diarrhea, confusion, and abdominal pain are manifestations of metabolic acidosis.

Which assessment finding is consistent with a phosphate level of 1.8 mg/dL? -Tetany -Diarrhea -Weakness -Muscle cramps

-Weakness Signs of hypophosphatemia include weakness, confusion, coma, and diminished reflexes. Tetany and muscle cramps are manifestations of hyperphosphatemia. Diarrhea is commonly seen with sodium and potassium imbalances.

Analysis of which arterial blood gas report led the health care provider to prescribed new orders for the patient with respiratory acidosis? -pH 7.40; PaCO2 44; HCO3- 26 -pH 7.29; PaCO2 47; HCO3- 25 -pH 7.36; PaCO2 41; HCO3- 23 -pH 7.42; PaCO2 42; HCO3- 24

-pH 7.29; PaCO2 47; HCO3- 25 Use the memory device ROME. For respiratory conditions, the pH and the PaCO2 go in opposite directions. Respiratory alkalosis: pH high and PaCO2 is low. Respiratory acidosis: pH is low and the PaCO2 is high. In metabolic conditions, the pH and HCO3- go in the same direction (equal). The PaCO2 may also go in the same direction. Metabolic alkalosis: pH and HCO3- are high. Metabolic acidosis: pH and HCO3- are high. Patients with respiratory acidosis have increased concentration of carbon dioxide (PaCO2) in the blood and decreased blood pH (opposite directions), whereas the bicarbonate ion concentration (HCO3-) is normal. The normal value range of pH is 7.37 to 7.45; PaCO2 35 to 45 mm Hg; and HCO3- 22 to 26 mEq/L. Thus a pH value of 7.29 (acid, low), PaCO2 of 47 (acid, high; pH and PaCO2 are moving in opposite directions), and HCO3- concentration of 25 (normal) indicate respiratory acidosis in this patient.