UNIT 2 EXAM: Acid-base Exemplars: Compensated and Uncompensated ABG's

pH: 7.22, PaO2: 86 PaCO2: 43 HCO3: 19 - Metabolic acidosis- compensated - Respiratory acidosis- compensated - Metabolic acidosis- uncompensated - Metabolic alkalosis- uncompensated

Metabolic acidosis- uncompensated

A client is in profound (late) hypovolemic shock. The nurse assesses the client's laboratory values. What does the nurse know that clients in late shock develop? 1.Hypokalemia 2.Metabolic acidosis 3.Respiratory alkalosis 4.Decreased Pco 2 levels

2 Decreased oxygen increases the conversion of pyruvic acid to lactic acid, resulting in metabolic acidosis. Hyperkalemia will occur because of renal shutdown; hypokalemia can occur in early shock. Respiratory alkalosis can occur in early shock because of rapid, shallow breathing, but in late shock metabolic or respiratory acidosis occurs. The Pco 2 level will increase in profound shock.

The nurse is caring for a client with diabetic ketoacidosis and documents that the client is experiencing Kussmaul's respirations. Which patterns did the nurse observe? Select all that apply. 1.Respirations that are shallow 2.Respirations that are increased in rate 3.Respirations that are abnormally slow 4.Respirations that are abnormally deep 5.Respirations that cease for several seconds

2,4 *Rationale*: Kussmaul's respirations are abnormally deep and increased in rate. These occur as a result of the compensatory action by the lungs. In bradypnea, respirations are regular but abnormally slow. Apnea is described as respirations that cease for several seconds

pH: 7.49 PaO2: 88 PaCO2: 41 HCO3: 29 - Metabolic alkalosis- uncompensated - Respiratory alkalosis- compensated - Metabolic acidosis- compensated - Metabolic alkalosis- compensated

Metabolic alkalosis- uncompensated

pH: 7.32 PaO2: 89 PaCO2: 53 HCO3: 24 - Metabolic acidosis- uncompensated - Respiratory acidosis- uncompensated - Respiratory alkalosis- compensated - Metabolic alkalosis- uncompensated

Respiratory acidosis- uncompensated

1. What is a patient who is severely scared or anxious likely to develop? - Respiratory acidosis - Metabolic acidosis - Respiratory alkalosis - Metabolic alkalosis

Respiratory alkalosis

pH: 7.47 PaO2: 87 PaCO2: 28 HCO3: 32 - Respiratory alkalosis- partially compensated - Metabolic alkalosis- partially compensated - Respiratory acidosis- partially compensated - Metabolic alkalosis- compensated

Respiratory alkalosis- partially compensated

A client with chronic obstructive pulmonary disease (COPD) has a blood pH of 7.25 and a PCO 2 of 60 mm Hg. What complication does the nurse conclude the client is experiencing? 1.Metabolic acidosis 2.Metabolic alkalosis 3.Respiratory acidosis 4.Respiratory alkalosis

3 The pH indicates acidosis; the PCO 2 level is the parameter for respiratory function. The expected PCO 2 is 40 mm Hg. These results do not indicate a metabolic disorder or indicate respiratory alkalosis.

After a gastrectomy, a client has a nasogastric tube to low continuous suction. The client begins to hyperventilate. How does the nurse anticipate that this breathing pattern will alter the client's arterial blood gases? 1.Increase the PO 2 level 2.Decrease the pH level 3.Increase the HCO 3 level 4.Decrease the Pco 2 level

4 *Rationale*: Hyperventilation results in the increased elimination of carbon dioxide from the blood. The PO 2 level is not affected. The pH level will increase. The carbonic acid level will decrease.

A 3-month-old infant who has a 3-day history of diarrhea is admitted to the pediatric unit. The nurse obtains the infant's vital signs, performs a physical assessment, and reviews the infant's arterial blood gas results. (pH 7.30 PCO2 35 HCO3 17) Which acid-base imbalance does the nurse suspect? 1. Metabolic acidosis 2.Metabolic alkalosis 3.Respiratory acidosis 4.Respiratory alkalosis

1 *Rationale*: The pH indicates acidosis, not alkalosis; the HCO 3 - level is further from the expected range than is the Pco 2 level, indicating a metabolic, not respiratory, origin (losses from diarrhea).

A specimen for arterial blood gases is obtained from a severely dehydrated 3-month-old infant with a history of diarrhea. The pH is 7.30, Pco 2 is 35 mm Hg, and HCO 3 - is 17 mEq/L (17 mmol/L). What complication does the nurse conclude has developed? 1.Metabolic acidosis 2.Metabolic alkalosis 3.Respiratory acidosis 4.Respiratory alkalosis

1 The blood pH indicates acidosis; the bicarbonate (HCO 3 -) level is further from the expected range than is the partial pressure of carbon dioxide (Pco 2), indicating a metabolic origin (losses from diarrhea), not a respiratory origin. The blood pH indicates acidosis, not alkalosis.

A nurse is assessing a client with diabetic ketoacidosis. Which clinical manifestations should the nurse expect? Select all that apply. 1.Dry skin 2.Abdominal pain 3.Kussmaul respirations 4.Absence of ketones in the urine 5.Blood glucose level of less than 72 mg/dL (3.3 mmol/L

1,2,3 *Rationale*:Dry skin is a sign of dehydration in response to polyuria associated with the osmotic effect of an elevated serum glucose level. Abdominal pain is associated with diabetic ketoacidosis. In the absence of insulin, glucose cannot enter the cell or be converted to glycogen, so it remains in the blood. Breakdown of fats as an energy source causes an accumulation of ketones, which results in acidosis. The lungs, in an attempt to compensate for lowered pH, will blow off CO 2 (Kussmaul respirations). An absence of ketones in the urine indicates adequate production of glucose for energy. Insulin deficiency stimulates production of ketones as a by-product of fat oxidation for energy. Blood glucose level of less than 72 mg/dL (4 mmol/L) indicates hypoglycemia, not ketoacidosis.

A 4-month-old infant is brought to the emergency department after 2 days of diarrhea. The infant is listless and has sunken eyeballs, a depressed anterior fontanel, and poor tissue turgor. The infant's breathing is deep, rapid, and unlabored. The mother states that the infant has had liquid stools and no obvious urine output. What problem does the nurse conclude that the infant is experiencing? 1.Kidney failure 2.Mild dehydration 3.Metabolic acidosis 4.Respiratory alkalosis

3 Metabolic acidosis occurs with loss of alkaline fluid through diarrhea and is manifested by lethargy and Kussmaul breathing; all of the assessments indicate severe dehydration. The infant has not urinated because excessive amounts of fluid have been lost in the loose stools; this indicates that the kidneys are functioning by compensating for the fluid loss. All data indicate a severe, not mild, fluid volume deficiency. Respiratory alkalosis is caused by an excessive loss of carbon dioxide, not diarrhea.

A 9-year-old child with type 1 diabetes is admitted to the hospital with deep, rapid respirations; flushed, dry cheeks; abdominal pain with nausea; and increased thirst. What laboratory findings is the nurse most likely to observe? 1.pH 7.25; glucose 60 mg/dL (3.3 mmol/L) 2.pH 7.50; glucose 60 mg/dL (3.3 mmol/L) 3.pH 7.25; glucose 460 mg/dL (25.5 mmol/L) 4.pH 7.50; glucose 460 mg/dL (25.5 mmol/L)

3 The clinical manifestations indicate ketoacidosis, so these values are expected; the pH of 7.25 indicates acidosis (metabolic or ketoacidosis), and the blood glucose level of 460 mg/dL (25.5 mmol/L), higher than the expected range of 70 to 105 mg/dL (3.9 to 5.8 mmol/L), indicates severe hyperglycemia. Although the blood pH of 7.25 indicates acidosis, the blood glucose level of 60 mg/dL (3.3 mmol/L) is below the expected range of 70 to 105 mg/dL (3.9 to 5.8 mmol/L); with ketoacidosis, the child will be hyperglycemic. Both the pH of 7.50 and the glucose level of 60 mg/dL (3.3 mmol/L) are unexpected with ketoacidosis; with ketoacidosis, the pH is decreased and the blood glucose level is increased. Although the blood glucose level is increased with ketoacidosis, the pH is decreased, not increased; a pH of 7.50 indicates alkalosis.

A client is admitted to the hospital with a diagnosis of restrictive airway disease. The nurse expects the client to exhibit which early signs of respiratory acidosis? Select all that apply. 1.Headache 2.Irritability 3.Restlessness 4.Hypertension 5.Lightheadedness

1,2,3 Headache is a symptom of cerebral hypoxia associated with early respiratory acidosis [1] [2]. Irritability is a sign of cerebral hypoxia associated with early respiratory acidosis. Restlessness is a sign of cerebral hypoxia associated with early respiratory acidosis. Hypotension, not hypertension, is a key feature of acidosis. Lightheadedness is a symptom of respiratory alkalosis, not acidosis.

The nurse reviews the arterial blood gas results of a client and notes the following: pH 7.45, Paco2 of 30 mm Hg (30 mmol/L), and HCO3- of 20 mEq/L (20 mmol/L). The nurse analyzes these results as indicating which condition? 1.Metabolic acidosis, compensated 2.Respiratory alkalosis, compensated 3.Metabolic alkalosis, uncompensated 4.Respiratory acidosis, uncompensated

2 *Rationale*: The normal pH is 7.35 to 7.45. In a respiratory condition, an opposite effect will be seen between the pH and the Paco2. In this situation, the pH is at the high end of the normal value and the Pco2 is low. In an alkalotic condition, the pH is elevated. Therefore, the values identified in the question indicate a respiratory alkalosis that is compensated by the kidneys through the renal excretion of bicarbonate. Because the pH has returned to a normal value, compensation has occurred.

A nurse addresses the needs of a client who is hyperventilating to prevent what complication? 1.Cardiac arrest 2.Carbonic acid deficit 3.Reduction in serum pH 4.Excess oxygen saturation

2 Hyperventilation causes excessive loss of carbon dioxide, leading to carbonic acid deficit and respiratory alkalosis. Cardiac arrest is unlikely; the client may experience dysrhythmias but will lose consciousness and begin breathing regularly. Hyperventilation causes alkalosis; the pH is increased. Excess oxygen saturation cannot occur; the usual oxygen saturation of hemoglobin is 95% to 98%.

The nurse is teaching a group of students about neuromuscular manifestations of alkalosis with hypocalcemia. Which statements provided by a student nurse indicate the need for further learning? Select all that apply. 1."The client would show signs of twitching." 2."The client would show signs of hyporeflexia." 3."The client would show signs of paresthesias." 4."The client would show signs of muscle cramping." 5."The client would show signs of skeletal muscle weakness."

2,3 The neuromuscular manifestation of alkalosis with hypocalcemia is hyperreflexia, not hyporeflexia. Paresthesias is a symptom of alkalosis, which is manifested in the central nervous system not the neuromuscular system. The manifestation of alkalosis is neuromascular and can be observed through twitching, muscle cramping, and skeletal muscle weakness.

A child has been admitted to the pediatric unit with a severe asthma attack. What type of acid-base imbalance should the nurse expect the child to develop? 1.Metabolic alkalosis caused by excessive production of acid metabolites 2.Respiratory alkalosis caused by accelerated respirations and loss of carbon dioxide 3.Respiratory acidosis caused by impaired respirations and increased formation of carbonic acid 4.Metabolic acidosis caused by the kidneys' inability to compensate for increased carbonic acid formation

3 The restricted ventilation accompanying an asthma attack limits the body's ability to blow off carbon dioxide. As carbon dioxide accumulates in the body fluids, it reacts with water to produce carbonic acid; the result is respiratory acidosis. The problem basic to asthma is respiratory, not metabolic. Respiratory alkalosis is caused by the exhalation of large amounts of carbon dioxide; asthma attacks cause carbon dioxide retention. Asthma is a respiratory problem, not a metabolic one; metabolic acidosis can result from an increase of nonvolatile acids or from a loss of base bicarbonate.

The nurse is teaching a group of students about the manifestation of alkalosis in the central nervous system. Which statements by a student nurse are accurate? Select all that apply. 1. "The client's Chvostek sign would be negative." 2. "The client's Trousseau sign would be positive." 3. "The client would be suffering from paresthesias." 4. "The client would show signs of anxiety and irritability." 5. "The client's central nervous system should have a decrease activity in case alkalosis."

3,4 *Rationale*: If clients suffer from the alkalosis, the manifestation in the nervous system would involve paresthesias. The client will also have a positive Trousseau sign and have anxiety and irritability. The Chvostek sign would also be positive, not negative. The client would show signs of anxiety and irritability. The central nervous system should have increased activity with alkalosis, not decreased.

The nurse is teaching a group of nursing students how to gather historic data for a client experiencing acid-base imbalance. Which statements indicate the student nurses need further teaching? Select all that apply. 1."I should assess for drugs, chronic health problems, and acute health problems." 2."I should ask the client to list all the drugs, especially the diuretics and the antacids." 3."I should compare the mental status of the client with that of the family statement." 4."I should ask the client to recall all the liquids that have been taken by the client in the last 24 hours." 5."I should compare the mental status of the client with the statement provided in the health record of the client."

3,5 When the nurse compares the mental status with that of the family statement, it comes under the assessment of the client. Comparing mental status with the family statement does not mean assessing client's history. The nurse is assessing the client, not the client's history, when a comparison is made between the mental status of the client and the statement provided in the health record of the client. Assessing the client for drugs, chronic health problems, and acute health problems along with other risk factors for an acid-base imbalance helps obtain the client's history. Asking the client to list all the drugs especially the diuretics and the antacids helps the nurse assessing the client's history of acid base imbalance. The nurse asking for recall of all the liquid taken during the last 24 hours helps assessing the history of the client.

A client who is found unresponsive has arterial blood gases drawn and the results indicate the following: pH is 7.12, Paco2 is 90 mm Hg (90 mmol/L), and HCO3- is 22 mEq/L (22 mmol/L). The nurse interprets the results as indicating which condition? 1.Metabolic acidosis with compensation 2.Respiratory acidosis with compensation 3.Metabolic acidosis without compensation 4.Respiratory acidosis without compensation

4 *Rationale*: The acid-base disturbance is respiratory acidosis without compensation. The normal pH is 7.35 to 7.45. The normal Paco2 is 35 to 45 mm Hg. In respiratory acidosis the pH is decreased and the Pco2 is elevated. The normal bicarbonate HCO3- level is 22 to 26 mEq/L (21 to 28 mmol/L). Because the bicarbonate is still within normal limits, the kidneys have not had time to adjust for this acid-base disturbance. In addition, the pH is not within normal limits. Therefore, the condition is without compensation. The remaining options are incorrect interpretations.

Respiratory alkalosis can affect other electrolyte levels in the body. Which of the following electrolyte levels can also be affected in this condition? A. Calcium and sodium levels B. Potassium and sodium levels C. Calcium and potassium levels D. Potassium and phosphate levels

C. Calcium and potassium levels Respiratory alkalosis precipitates hypocapnia which causes hypocalcemia and hypokalemia.

A 2-year-old child was brought into the emergency department after ingesting several morphine tabletsfrom a bottle in his mother's purse. The nurse knows that the child is at greatest risk for which acid-base imbalance? a) Respiratory acidosis b) Respiratory alkalosis c) Metabolic acidosis d) Metabolic alkalosis

a) Respiratory acidosis Morphine overdose can cause respiratory depression and hypoventilation. Hypoventilation results in retention of CO2 and respiratory acidosis. Respiratory alkalosis would result from hyperventilation, causing a decrease in CO2 levels. Metabolic acid-base imbalance would be a result of kidney dysfunction, vomiting, diarrhea, or other conditions that affect metabolic acids.

The nurse would not expect full compensation to occur for which acid-base imbalance? a) Respiratory acidosis b) Respiratory alkalosis c) Metabolic acidosis d) Metabolic alkalosis

b) Respiratory alkalosis The events that precede respiratory alkalosis are often acute and short lived (i.e. anxiety attack, fear, pain) so full compensation is not achieved in this time.

The nurse reviews the blood gas results of a client with atelectasis. The nurse analyzes the results and determines that the client is experiencing respiratory acidosis. Which result validates the nurse's findings? 1.pH 7.25, Paco2 50 mm Hg 2.pH 7.35, Paco2 40 mm Hg 3.pH 7.50, Paco2 52 mm Hg 4.pH 7.52, Paco2 28 mm Hg

1 *Rationale*: Atelectasis is a condition characterized by the collapse of alveoli, preventing the respiratory exchange of oxygen and carbon dioxide in a part of the lungs. The normal pH is 7.35 to 7.45. The normal Paco2 is 35 to 45 mm Hg. In respiratory acidosis, the pH is decreased and the Paco2 is elevated. Option 2 identifies normal values. Option 3 identifies an alkalotic condition, and option 4 identifies respiratory alkalosis.

A client on diuretic therapy developed metabolic alkalosis. What does the nurse consider to be the priority nursing care while correcting alkalosis? 1.Preventing falls 2.Monitoring electrolytes 3.Administering antiemetics 4.Adjusting the diuretic therapy

1 A client with alkalosis has hypotension and muscle weakness, which increases the risk for injury due to falls; therefore, to prevent injury, the priority nursing care is to prevent falls. Monitoring electrolytes daily until they return to normal is not the priority nursing care. Antiemetics are prescribed for vomiting and are given low priority. Once the client is protected from the risk of injury, diuretic therapy is adjusted.

The nurse is teaching a group of students about assessing for respiratory system manifestations of alkalosis as a nursing priority. Which statement made by the student nurse indicates the need for further teaching? Select all that apply. 1."I should assess for low blood pressure." 2."I should assess for increased digitalis toxicity." 3."I should assess for a decreased rate of ventilation in respiratory alkalosis." 4."I should assess for an increased depth of ventilation in respiratory alkalosis." 5."I should assess for a decreased respiratory effort associated with skeletal muscle weakness in metabolic alkalosis."

1,2,3 The nurse should assess for low blood pressure and increased digitalis toxicity as cardiovascular manifestations of alkalosis, not respiratory manifestation. The nurse should assess for increased rate of ventilation in respiratory alkalosis. The nurse should assess for increased depth of ventilation in respiratory alkalosis. It is imperative that the nurse check for decreased respiratory effort associated with skeletal muscle weakness in metabolic alkalosis.

The nurse is caring for a client with a nasogastric tube that is attached to low suction. The nurse monitors the client for manifestations of which disorder that the client is at risk for? 1.Metabolic acidosis 2.Metabolic alkalosis 3.Respiratory acidosis 4.Respiratory alkalosis

2 *Rationale*: Metabolic alkalosis is defined as a deficit or loss of hydrogen ions or acids or an excess of base (bicarbonate) that results from the accumulation of base or from a loss of acid without a comparable loss of base in the body fluids. This occurs in conditions resulting in hypovolemia, the loss of gastric fluid, excessive bicarbonate intake, the massive transfusion of whole blood, and hyperaldosteronism. Loss of gastric fluid via nasogastric suction or vomiting causes metabolic alkalosis as a result of the loss of hydrochloric acid. The remaining options are incorrect interpretations

The nurse is caring for a client who is on a mechanical ventilator. Blood gas results indicate a pH of 7.50 and a Paco2 of 30 mm Hg (30 mm Hg). The nurse has determined that the client is experiencing respiratory alkalosis. Which laboratory value would most likely be noted in this condition? 1.Sodium level of 145 mEq/L (145 mmol/L) 2.Potassium level of 3.0 mEq/L (3.0 mmol/L) 3.Magnesium level of 1.8 (0.74 mmol/L) 4.Phosphorus level of 3.0 mg/dL (0.97 mmol/L)

2 *Rationale*: Respiratory alkalosis is defined as a deficit of carbonic acid or a decrease in hydrogen ion concentration that results from the accumulation of base or from a loss of acid without a comparable loss of base in the body fluids. This occurs in conditions that cause overstimulation of the respiratory system. Some clinical manifestations of respiratory alkalosis include lightheadedness, confusion, tachycardia, dysrhythmias related to hypokalemia, nausea, vomiting, diarrhea, epigastric pain, and numbness and tingling of the extremities. All three incorrect options identify normal laboratory values. The correct option identifies the presence of hypokalemia.

The nurse is teaching a group of students about the manifestation of alkalosis in the central nervous system. Which statements by a student nurse are accurate? Select all that apply. 1."The client's Chvostek sign would be negative." 2."The client's Trousseau sign would be positive." 3."The client would be suffering from paresthesias." 4."The client would show signs of anxiety and irritability." 5."The client's central nervous system should have a decrease activity in case alkalosis."

2,3,4 If clients suffer from the alkalosis, the manifestation in the nervous system would involve paresthesias. The client will also have a positive Trousseau sign and have anxiety and irritability. The Chvostek sign would also be positive, not negative. The client would show signs of anxiety and irritability. The central nervous system should have increased activity with alkalosis, not decreased.

A nurse is caring for an infant with severe dehydration. Which blood gas report most likely reflects the acid-base balance of this infant? 1. pH of 7.50 and Pco 2 of 34 mm Hg 2. pH of 7.23 and Pco 2 of 70 mm Hg 3. pH of 7.20 and HCO 3 - of 20 mEq/L (20 mmol/L) 4. pH of 7.56 and HCO 3 - of 30 mEq/L (30 mmol/L

3 *Rationale*: Low blood pH and bicarbonate levels indicate metabolic acidosis, which occurs with severe dehydration because the reduced urine output causes retention of hydrogen ions. The other options include findings that indicate respiratory alkalosis, respiratory acidosis, and metabolic alkalosis, respectively.

The nurse reviews the arterial blood gas results of a client with emphysema and notes that the laboratory report indicates a pH of 7.30, PaCO2 of 58 mm Hg, PaO2 of 80 mm Hg, and HCO3 of 27 mEq/L (27 mmol/L). The nurse interprets that the client has which acid-base disturbance? 1.Metabolic acidosis 2.Metabolic alkalosis 3.Respiratory acidosis 4.Respiratory alkalosis

3 *Rationale*: The normal pH is 7.35 to 7.45. Normal PaCO2 is 35 to 45 mm Hg. In respiratory acidosis, the pH is low and PaCO2 is elevated. Options 1, 2, and 4 are incorrect interpretations of the values identified in the question.

A client is hospitalized after four days of epigastric pain, nausea, and vomiting. The nurse reviews the laboratory test results: plasma pH 7.51, Pco 2 50 mm Hg, bicarbonate 58 mEq/L (58 mmol/L), chloride 55 mEq/L (55 mmol/L), sodium 132 mEq/L (132 mmol/L), and potassium 3.8 mEq/L (3.8 mmol/L). What condition does the nurse determine the results to indicate? 1.Hypernatremia 2.Hyperchloremia 3.Metabolic alkalosis 4.Respiratory acidosis

3 *Rationale*: The normal plasma pH value is 7.35 to 7.45; the client is in alkalosis. The normal plasma bicarbonate value is 23 to 25 mEq/L (23 to 25 mmol/L); the client has an excess of base bicarbonate, indicating a metabolic cause for the alkalosis. The normal plasma sodium value is 135 to 145 mEq/L (135 to 145 mmol/L); the client has hyponatremia. The normal plasma chloride value is 95 to 105 mEq/L (95 to 105 mmol/L); the client has hypochloremia because of vomiting of gastric secretions. With respiratory acidosis the pH is decreased to less than 7.35

A client with a history of lung disease is at risk for developing respiratory acidosis. The nurse should assess the client for which signs and symptoms characteristic of this disorder? 1.Bradycardia and hyperactivity 2.Decreased respiratory rate and depth 3.Headache, restlessness, and confusion 4.Bradypnea, dizziness, and paresthesias

3 *Rationale*: When a client is experiencing respiratory acidosis, the respiratory rate and depth increase in an attempt to compensate. The client also experiences headache; restlessness; mental status changes, such as drowsiness and confusion; visual disturbances; diaphoresis; cyanosis as the hypoxia becomes more acute; hyperkalemia; rapid, irregular pulse; and dysrhythmias. Options 1, 2, and 4 are not specifically associated with this disorder.

A nurse is caring for a client with severe gastritis who vomited a large amount of blood. A lavage is prescribed by the healthcare provider. Which response does the nurse expect when using a room temperature irrigating solution? 1. Coagulation of blood 2. Neutralization of acids 3. Constriction of blood vessels 4. Stimulation of the vagus nerve

3 *Rationalization*: Lavage removes blood from the stomach, and the irrigating solution produces vascular constriction, which helps control bleeding by limiting blood flow to the area. Lavage does not cause the blood to clot. Neutralization of acid by water irrigation will take time; antacids may be instilled to alter the pH. Stimulation of the vagus nerve is not the purpose of a lavage for gastric hemorrhage.

A client presenting to the emergency department with chest pain and dizziness is found to be having a myocardial infarction and subsequently suffers cardiac arrest. The healthcare team is able to successfully resuscitate the client. Lab work shows that the client now is acidotic. How does the nurse interpret the cause of the acidosis? 1.The fat-forming ketoacids were broken down. 2.The irregular heartbeat produced oxygen deficit. 3.The decreased tissue perfusion caused lactic acid production. 4.The client received too much sodium bicarbonate during resuscitation efforts

3 Cardiac arrest causes decreased tissue perfusion, which results in ischemia and cardiac insufficiency. Cardiac insufficiency causes anaerobic metabolism, which leads to lactic acid production. Fat-forming ketoacids occur in diabetes. An irregular heartbeat does not cause acidosis. Too much sodium bicarbonate causes alkalosis, not acidosis.

A nurse is caring for an infant with severe dehydration. Which blood gas report most likely reflects the acid-base balance of this infant? 1.pH of 7.50 and Pco 2 of 34 mm Hg 2.pH of 7.23 and Pco 2 of 70 mm Hg 3.pH of 7.20 and HCO 3 - of 20 mEq/L (20 mmol/L) 4.pH of 7.56 and HCO 3 - of 30 mEq/L (30 mmol/L)

3 Low blood pH and bicarbonate levels indicate metabolic acidosis, which occurs with severe dehydration because the reduced urine output causes retention of hydrogen ions. The other options include findings that indicate respiratory alkalosis, respiratory acidosis, and metabolic alkalosis, respectively.

A nurse is caring for a client admitted to the hospital for diabetic ketoacidosis. Which clinical findings related to this event should the nurse document in the client's clinical record? Select all that apply. 1.Sweating 2.Retinopathy 3.Acetone breath 4.Increased arterial bicarbonate level 5.Decreased arterial carbon dioxide level

3,5 *Rationale*: A fruity odor to the breath (acetone breath) occurs when the ketone level is elevated in ketoacidosis. Metabolic acidosis initiates respiratory compensation in the form of Kussmaul respirations to counteract the effects of ketone buildup, resulting in a decreased arterial carbon dioxide level. As the glucose level decreases in hypoglycemia, the sympathetic nervous system is activated, and epinephrine and norepinephrine are secreted, causing diaphoresis. Retinopathy is a long-term complication of diabetes caused by microvascular changes in the retina; it is not a sign of ketoacidosis. With ketoacidosis, the serum bicarbonate level is decreased, not increased, in an effort to neutralize ketones when seeking acid-base balance

A client with a 3-day history of nausea and vomiting presents to the emergency department. The client is hypoventilating and has a respiratory rate of 10 breaths per minute. The electrocardiogram (ECG) monitor displays tachycardia, with a heart rate of 120 beats per minute. Arterial blood gases are drawn and the nurse reviews the results, expecting to note which finding? 1.A decreased pH and an increased Paco2 2.An increased pH and a decreased Paco2 3.A decreased pH and a decreased HCO3- 4.An increased pH and an increased HCO3-

4 *Rationale*: Clients experiencing nausea and vomiting would most likely present with metabolic alkalosis resulting from loss of gastric acid, thus causing the pH and HCO3- to increase. Symptoms experienced by the client would include a decrease in the respiratory rate and depth, and tachycardia. Option 1 reflects a respiratory acidotic condition. Option 2 reflects a respiratory alkalotic condition, and option 3 reflects a metabolic acidotic condition.

The nurse is caring for a client having respiratory distress related to an anxiety attack. Recent arterial blood gas values are pH = 7.53, Pao2 = 72 mm (72 mmol/L), and HCO3− = 28 mEq/L (28 mmol/L). Which conclusion about the client should the nurse make? 1.The client has acidotic blood. 2.The client is probably overreacting. 3.The client is fluid volume overloaded. 4.The client is probably hyperventilating.

4 *Rationale*: The ABG values are abnormal, which supports a physiological problem. The ABGs indicate respiratory alkalosis as a result of hyperventilating, not acidosis. Concluding that the client is overreacting is an inaccurate analysis. No conclusion can be made about a client's fluid volume status from the information provided.

The nurse is caring for a hospitalized client who is retaining carbon dioxide (CO2) because of respiratory disease. The nurse anticipates which physical response will initially occur? 1.The client will lose consciousness. 2.The client's sodium and chloride levels will rise. 3.The client will complain of facial numbness and tingling. 4.The client's arterial blood gas results will reflect acidosis

4 *Rationale*: When the client with respiratory disease retains CO2, a rise in CO2 will occur. This results in a corresponding fall in pH, thus respiratory acidosis. This concept forms the basis for key aspects of acid-base balance. The other options are incorrect and are not associated with this initial physical response.

The nurse is caring for a client with several broken ribs. The client is most likely to experience what type of acid-base imbalance? 1.Respiratory acidosis from inadequate ventilation 2.Respiratory alkalosis from anxiety and hyperventilation 3.Metabolic acidosis from calcium loss due to broken bones 4.Metabolic alkalosis from taking analgesics containing base products

1 *Rationale*: Respiratory acidosis is most often caused by hypoventilation. The client with broken ribs will have difficulty with breathing adequately and is at risk for hypoventilation and resultant respiratory acidosis. The remaining options are incorrect. Respiratory alkalosis is associated with hyperventilation. There are no data in the question that indicate calcium loss or that the client is taking analgesics containing base products.

A 3-month-old infant who has a 3-day history of diarrhea is admitted to the pediatric unit. The nurse obtains the infant's vital signs, performs a physical assessment, and reviews the infant's arterial blood gas results. Which acid-base imbalance does the nurse suspect? (ABG: pH 7.30, PaCO2 35, HCO3 17) 1.Metabolic acidosis 2.Metabolic alkalosis 3.Respiratory acidosis 4.Respiratory alkalosis

1 The pH indicates acidosis, not alkalosis; the HCO 3 - level is further from the expected range than is the Pco 2 level, indicating a metabolic, not respiratory, origin (losses from diarrhea).

The nurse notes that a client's arterial blood gas (ABG) results reveal a pH of 7.50 and a Paco2 of 30 mm Hg (30 mm Hg). The nurse monitors the client for which clinical manifestations associated with these ABG results? Select all that apply 1.Nausea 2.Confusion 3.Bradypnea 4.Tachycardia 5.Hyperkalemia 6.Lightheadedness

1,2,4,6 *Rationale*: Respiratory alkalosis is defined as a deficit of carbonic acid or a decrease in hydrogen ion concentration that results from the accumulation of base or from a loss of acid without a comparable loss of base in the body fluids. This occurs in conditions that cause overstimulation of the respiratory system. Clinical manifestations of respiratory alkalosis include lethargy, lightheadedness, confusion, tachycardia, dysrhythmias related to hypokalemia, nausea, vomiting, epigastric pain, and numbness and tingling of the extremities. Hyperventilation (tachypnea) occurs. Bradypnea describes respirations that are regular but abnormally slow. Hyperkalemia is associated with acidosis.

A nurse is caring for an infant whose vomiting is intractable. Which complication is most likely to occur? 1.Acidosis 2.Alkalosis 3.Hyperkalemia 4.Hypernatremia

2 Excessive vomiting causes an increased loss of hydrogen ions (hydrochloric acid), leading to metabolic alkalosis, an excess of base bicarbonate. Acidosis is caused by retention of hydrogen ions and a loss of base bicarbonate, which is more likely to occur with diarrhea. Hypokalemia, not hyperkalemia, will occur. With the loss of chloride ions, hyponatremia is more likely to occur.

A nurse is caring for a toddler with severe dehydration and its associated acid-base imbalance. What compensatory mechanism within the body is activated to counteract the effects of the child's acid-base imbalance? 1.Profuse diaphoresis 2.Increased temperature 3.Increased respiratory rate 4.Renal retention of hydrogen ions

3 The child has metabolic acidosis; the lungs compensate by blowing off excess carbonic acid in the form of carbon dioxide. Diaphoresis is a compensatory mechanism to reduce fever by evaporation, not to compensate for metabolic acidosis. Fever is not a compensatory mechanism to counter metabolic acidosis; fever with dehydration results from inadequate fluid for perspiring and cooling. The kidneys excrete hydrogen and ammonium ions to compensate for metabolic acidosis.

Which would the nurse claim is a cardiovascular manifestation of alkalosis? 1.Anxiety 2.Seizures 3.Hyperreflexia 4.Increased digitalis toxicity

4 *Rationale*: Increased digitalis toxicity is one of the cardiovascular manifestations of alkalosis. Anxiety and seizures are central nervous system manifestations of alkalosis. Hyperreflexia is a neuromuscular manifestation of alkalosis.

A critically ill 5-year-old child exhibits Kussmaul respirations. What does the nurse suspect may be causing an increasing acid-base imbalance? 1.Metabolic alkalosis caused by an increase in base bicarbonate 2.Respiratory alkalosis caused by excess carbon dioxide output 3.Respiratory acidosis caused by an accumulation of carbon dioxide 4.Metabolic acidosis caused by a concentration of cations in body fluids

4 Metabolic acidosis results from an excess concentration of hydrogen cations. The kidneys cannot convert ammonium to ammonia, and there is inadequate base bicarbonate to maintain an appropriate acid-base balance. With Kussmaul respirations there is an excess of hydrogen ions, the opposite of an excess of base bicarbonate. Carbonic acid blown off as carbon dioxide is a compensatory mechanism to counter the present metabolic acidosis. There is an excess of hydrogen ions from a metabolic problem rather than an excess of carbonic acid resulting from retained carbon dioxide

A patient is experiencing respiratory acidosis due to brain trauma. Which of the following lab values correlates with this acid imbalance? A. Potassium level of 6.0 B. Potassium level of 2.5 C. Potassium level of 5.0 D. Potassium level of 3.5

A. Potassium level of 6.0

A patient has the following arterial blood gases: HCO3 38, pH 7.50, PaCO2 50. Which of the following signs may this patient exhibit as a compensatory mechanism? A. Hyperventilation (tachypnea) B. Hypoventilation (bradypnea) C. Increased potassium level (hyperkalemia) D. Constipation

B. Hypoventilation (bradypnea) The patient is experiencing metabolic alkalosis with partial compensation.

The nurse is assessing a patient who has diabetic ketoacidosis. Her assessment reveals tachycardia, lethargy, and hyperventilation. Treatment for the ketoacidosis has been initiated. What should the nurse do about the hyperventilation? A. Request an order for pain medication and oxygen at 6 L/min. B. Lubricate the patient's lips and allow continued hyperventilation. C. Have the patient breathe into a paper bag to stop hyperventilating. D. Contact the physician immediately regarding this complication.

B. Lubricate the patient's lips and allow continued hyperventilation. Lubricate the patient's lips and allow continued hyperventilation. Hyperventilation is a compensatory response to metabolic acidosis and should be allowed to continue because it helps move the blood pH toward the normal range. Lubricating the lips is a supportive nursing intervention that prevents drying and cracking of the lips during hyperventilation. Although pain and hypoxia can trigger hyperventilation, they are not the cause in this patient. Interventions to stop hyperventilation are not appropriate when it is a compensatory response. Hyperventilation is an expected beneficial compensatory response to metabolic acidosis and does not require contacting the physician

A patient is in metabolic alkalosis due to diuretic therapy. How do you expect the potassium level and bicarbonate level to be affected? A. Increased potassium level and increased bicarb level B. Decreased potassium level and decreased bicarb level C. Increased potassium level and decreased bicarb level D. Decreased potassium level and increase bicarb level

D. Decreased potassium level and increase bicarb level

1. What acid-base imbalance is COPD/severe asthma attack most likely to cause? - Metabolic acidosis - Metabolic alkalosis - Respiratory alkalosis - Respiratory acidosis

Respiratory acidosis

pH: 7.21 PaO2: 86 PaCO2: 55 HCO3: 34 - Respiratory acidosis partially compensated - Respiratory acidosis uncompensated - Metabolic acidosis compensated - Metabolic acidosis partially compensated

Respiratory acidosis partially compensated