Unit 2 exam-communication, asthma, COPD, RSV, and acid base imbalance QUESTIONS

The nurse is caring for a patient with metabolic acidosis. Which cardiac monitor change would indicate a potential alteration in cardiac output? ANSWER Normal sinus rhythm of 76 beats/min Widening QRS complex Peaked T wave Blood pressure 106/58 mmHg

Widening QRS complex

The nurse is caring for a patient with chronic emphysema. Which arterial blood gas result will the patient most likely have? ANSWER pH 7.37 and PaCO2 32 pH 7.37 and PaCO2 54 pH 7.31 and PaCO2 57 pH 7.32 and PaCO2 32

pH 7.37 and PaCO2 54

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

pH 7.39

Which arterial blood gas (ABG) result would indicate that respiratory alkalosis has been corrected and is not just compensated? ANSWER pH 7.40, CO2 44 mmHg pH 7.42, CO2 22 mmHg pH 7.35, CO2 60 mmHg pH 7.25, CO2 28 mmHg

pH 7.40, CO2 44 mmHg

The nurse is reviewing sets of arterial blood gases (ABGs) for the patients on the unit. Which set of ABGs would indicate fully compensated metabolic alkalosis? ANSWER pH 7.45; PaCO2 47 mmHg; HCO3 30 mEq/L pH 7.26; PaCO2 55 mmHg; HCO3 24 mEq/L pH 7.44; PaCO2 29 mmHg; HCO3 19 mEq/L pH 7.24; PaCO2 33 mmHg; HCO3 14 mEq/L

pH 7.45; PaCO2 47 mmHg; HCO3 30 mEq/L

Which atrial blood gas (ABG) result should the nurse interpret as indicating respiratory alkalosis? ANSWER pH 7.48, CO2 55 mmHg pH 7.32, CO2 45 mmHg pH 7.50, CO2 28 mmHg pH 7.31, CO2 52 mmHg

pH 7.50, CO2 28 mmHg

The nurse working in a pulmonary rehabilitation clinic facilitates a class on the prevention of acute respiratory acidosis to a group of patients with chronic lung disease. Which statement should the nurse include in the teaching? ANSWER "Breathe in through your nose and out through a narrow opening in your lips." "Breathe in deep while leaning forward and exhale sharply to remove secretions." "Increase the amount of fluids you drink in order to thin secretions." "Exercise as much as you can tolerate without exertion."

"Breathe in through your nose and out through a narrow opening in your lips."

The nurse is teaching the parents of a child with cystic fibrosis the correct technique for manual percussion. Which statement should the nurse include in the teaching? ANSWER "Clap forcefully with the steady beat of a cupped hand and wrist." "Gently shake the ribs with a flattened hand to mobilize secretions." "Percuss over the lower ribs and spine to mobilize secretions." "Clap gently and slowly with a closed hand."

"Clap forcefully with the steady beat of a cupped hand and wrist." Gently shaking the ribs with a flat hand is a technique called vibration. Percussion should never be performed over the lower ribs and spine and would never involve a closed hand.

The nurse is completing an assessment on a female teenager with suspected metabolic alkalosis and a history of an eating disorder. Which question should the nurse ask the family of the patient that could best help to identify a potential cause? ANSWER "Does your daughter use diuretics in an attempt to keep her weight down?" "Does your daughter frequently use laxatives? "Does your daughter purge frequently with her eating disorder?" "Does your daughter ingest enough calories in a 24-hour period to maintain adequate nutritional status?"

"Does your daughter purge frequently with her eating disorder?"

The nurse is teaching a group of older adults at a community center about behaviors that can help reduce the risk of development of acid-base imbalances, such as metabolic alkalosis. Which participant statement indicates a need for further clarification? ANSWER "I should drink 8-10 glasses of water a day even if I don't feel thirsty." "I should make sure to get enough potassium because I take furosemide." "I can use antacids as long as I don't overdo it." "I will weigh myself daily and let the healthcare provider know about significant changes."

"I can use antacids as long as I don't overdo it."

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

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

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

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

The nurse is caring for a patient with respiratory acidosis who is awake, alert, and oriented. Which statement by the nurse will help facilitate respiration and improve ventilation for the patient? ANSWER "Breathe into the paper bag." "Sit more upright in the bed." "Let's restrict the amount of visitors." "Breathe more slowly."

"Sit more upright in the bed."

The nurse is teaching the parents of an infant with bronchopulmonary dysplasia (BPD) about the prevention of respiratory acidosis. Which statement should the nurse include in the teaching? ANSWER "Swaddle tightly in order to splint the airways." "Record and monitor body temperature twice daily." "Suction airways in order to remove secretions." "Record and monitor the number of wet diapers per day."

"Suction airways in order to remove secretions." Suctioning the airways as needed allows for airway clearance and a decreased risk for respiratory acidosis due to mucus obstruction.

Which statement by the nurse indicates understanding of the response of the kidneys to alkalosis? ANSWER "The kidneys will retain hydrogen ions and excrete bicarbonate." "The kidneys will retain bicarbonate and excrete of hydrogen ions." "The kidneys will retain hydrogen and bicarbonate." "The kidneys will excrete excess hydrogen and bicarbonate."

"The kidneys will retain hydrogen ions and excrete bicarbonate."

The nurse is caring for a patient with metabolic alkalosis. A prescription has been received to begin a sodium chloride infusion. The family asks why this is being used. Which response by the nurse is best? ANSWER "The sodium chloride solution will help to replenish extracellular fluid volume and excrete bicarbonate, which is causing the problem." "The sodium chloride solution will help to correct all of the electrolyte imbalances that have occurred." "It is just being used for stabilization at this point; soon, something else will be added to address the metabolic alkalosis." "We just needed to establish intravenous access for now; this is a solution commonly used for that purpose."

"The sodium chloride solution will help to replenish extracellular fluid volume and excrete bicarbonate, which is causing the problem."

A patient has recently been diagnosed with a probable chronic lung disorder. The patient asks the nurse why the healthcare provider has ordered a pulmonary function test (PFT). Which response by the nurse is accurate? ANSWER "The test will help the healthcare provider determine the type of disorder you have." "The test will help visualize your airways in order to diagnose the disorder you have." "The procedure reveals your exercise tolerance, which may help in your diagnosis." "The procedure helps to clear your airways in order to help in your recovery."

"The test will help the healthcare provider determine the type of disorder you have."

A patient has a tendency to develop hyperventilation as a result of anxiety and asks the nurse to explain the signs of this reaction. Which response by the nurse is best? ANSWER "Your breathing is rapid, and you begin to feel dizzy. Your hands and feet may cramp, and you may feel like you're going to black out." "The most important thing is to control the hyperventilation before it gets really bad." "You will begin to have neuromuscular symptoms and may pass out. If you don't get your breathing under control, you could have a seizure." "Your breathing will become very rapid, and you will have trouble controlling your actions and motions."

"Your breathing is rapid, and you begin to feel dizzy. Your hands and feet may cramp, and you may feel like you're going to black out."

The nurse is caring for patient with chronic emphysema who uses supplemental oxygen. While performing exercises, the patient reports worsening shortness of breath on exertion that is not relieved with pursed-lip breathing. The patient states a desire to "turn up the oxygen level." Which response by the nurse will ensure proper safety regarding the patient's request? ANSWER "Your low levels of blood oxygen make you have an increased need for the oxygen." "Your high levels of blood carbon dioxide may make it dangerous to increase the oxygen." "Your kidneys will act as a buffer to make up for the low oxygen in the blood." "Your high levels of red blood cells may make it dangerous to increase the oxygen."

"Your high levels of blood carbon dioxide may make it dangerous to increase the oxygen."

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

Bicarbonate deficiency Metabolic acidosis is the result of deficient bicarbonate. Bicarbonate alkalosis is caused by too much bicarbonate.

The nurse is caring for a patient who is diagnosed with respiratory acidosis due to hypoventilation related to opiate medication overdose. Which therapy is most appropriate for the nurse to expect to be ordered for treatment of the patient's respiratory depression? ANSWER Sodium bicarbonate A narcotic antagonist Intravenous fluids Supplemental oxygen therapy

A narcotic antagonist

The nurse is admitting a patient with a diagnosis of respiratory alkalosis. During the interview, the nurse asks the patient about any previous health issues. Which historical data should the nurse consider to be pertinent to the current diagnosis? ANSWER A previous hospitalization for palpitations A tonsillectomy at age 6 A heart catheterization 2 years ago A hysterectomy

A previous hospitalization for palpitations

The nurse is providing discharge teaching to an older adult patient with chronic obstructive pulmonary disease (COPD). The nurse focuses teaching on prevention of future episodes of respiratory compromise and acidosis. Which factor should the nurse identify as being the earliest symptom of respiratory compromise? ANSWER Wheezing Headache Activity intolerance Severe shortness of breath

Activity intolerance

An older patient is admitted to an acute care hospital with a dual diagnosis of chronic obstructive pulmonary disease (COPD) and respiratory acidosis. He is having trouble expectorating his secretions. Which intervention should the nurse implement that best promotes the removal of respiratory secretions? ANSWER Administering a bronchodilator Applying supplemental oxygen as ordered Instructing on deep breathing and coughing Instructing on pursed-lip breathing

Administering a bronchodilator

The nurse is caring for a patient who experiences panic attacks frequently. Which intervention is appropriate for this patient? ANSWER Adjusting ventilator settings to regulate breathing Ordering oxygen supplementation Administering an antianxiety medication as ordered Having the patient rebreathe into a paper bag

Administering an antianxiety medication as ordered

The nurse is administering IV fluids rapidly to address deficient fluid volume in a patient with metabolic alkalosis. Which independent nursing intervention would best help to prevent fluid volume overload in this patient? ANSWER Administering the IV fluids via an infusion pump Monitoring frequently for indicators of fluid overload Assessing for signs and symptoms of pulmonary edema Maintaining the patient in a Fowler position

Administering the IV fluids via an infusion pump

A patient diagnosed with metabolic alkalosis is complaining of numbness and tingling around the mouth and in both upper extremities. The nurse should understand that which statement supports the etiology of this condition? ANSWER Hyperkalemia leads to a loss of hydrogen ions, making body fluids more alkaline. Toxic levels of salicylate increase acid loss, increasing alkalinity. Chronic kidney disease results in excess acid excretion, increasing alkalinity. Administration of sodium bicarbonate increases serum bicarbonate, making body fluids more alkaline.

Administration of sodium bicarbonate increases serum bicarbonate, making body fluids more alkaline.

The nurse is caring for a child with an acute exacerbation of asthma. For which reason should the nurse consider this child at risk for developing respiratory acidosis? ANSWER Bronchoconstriction decreases PaCO2, decreasing pH. Air trapping increases HCO3, increasing pH. Air trapping increases PaCO2 levels, decreasing pH. Bronchoconstriction increases HCO3, increasing pH.

Air trapping increases PaCO2 levels, decreasing pH.

The nurse is caring for a patient with a history of excessive snoring and breath sounds that indicate diffuse wheezing. The patient's laboratory data indicate respiratory acidosis. Which factor should the nurse suspect as the most likely cause of the patient's acid-base imbalance? ANSWER Opiate overdose Chest trauma Airway obstruction Neuromuscular disease

Airway obstruction

The nurse is obtaining a current medication list from a patient. Which medication should alert the nurse to a possible risk factor for respiratory alkalosis? ANSWER Antianxiety medication Anti-inflammatory medication Hypoglycemic medication Hormone replacement therapy

Antianxiety medication

Which diagnostic test assesses the ventilation status of a patient suspected of having respiratory acidosis? ANSWER Arterial blood gas (ABG) Pulmonary function test (PFT) Chest x-ray Computed tomography (CT) scan

Arterial blood gas (ABG)

A parent of a child with cystic fibrosis asks the nurse about when to perform chest percussion for the child. Which is the ideal time for the nurse to advise the parent to perform this procedure? ANSWER Before a meal Before bed After a meal After exercise

Before a meal

The excess of which electrolyte in relation to the amount of hydrogen ions contributes to the development of metabolic alkalosis? ANSWER Sodium Potassium Calcium Bicarbonate

Bicarbonate

The nurse is caring for a patient with chronic obstructive pulmonary disease (COPD). The patient's arterial blood gas (ABG) results reveal compensated chronic respiratory acidosis. The nurse should understand that which physiological mechanism is causing the compensated chronic respiratory acidosis in this patient? ANSWER Bicarbonate levels increase in response to increased carbon dioxide levels. Bicarbonate levels increase in response to increased pH. Carbon dioxide levels decrease in response to increased pH. Carbon dioxide levels increase in response to decreased bicarbonate levels.

Bicarbonate levels increase in response to increased carbon dioxide levels.

The nurse is caring for a patient admitted with respiratory alkalosis who reports numbness and tingling of the mouth and fingers. Based on this assessment, which of the patient's laboratory values should the nurse expect to be most likely altered? ANSWER Calcium Sodium Potassium Chloride

Calcium

The nurse is caring for a patient who is diagnosed with anxiety, panic attacks, and hyperventilation. Arterial blood gas (ABG) results reveal that the patient has developed respiratory alkalosis. Based on the relationship between carbon dioxide (CO2), hydrogen ion concentration, and respiration, which acid-base imbalance is most appropriate for the nurse to recognize as being the cause of the patient's respiratory alkalosis? ANSWER Bicarbonate (HCO3) deficit Carbonic acid (H2CO3) excess Carbonic acid (H2CO3) deficit Bicarbonate (HCO3) excess

Carbonic acid (H2CO3) deficit Hyperventilation causes a CO2 deficit, which leads to respiratory alkalosis due to a decreased concentration of carbonic acid (H2CO3) in the blood.

Which surgery, when performed with younger children, particularly predisposes them to metabolic alkalosis? ANSWER Cardiac Orthopedic Neurological Pulmonary

Cardiac

A child is treated after an accidental poisoning. Which assessment should lead the nurse to suspect respiratory acidosis? ANSWER Hyperventilation, decreasing PaCO2 levels, and increasing blood pH Hyperventilation, increasing PaCO2 levels, and decreasing blood pH Hypoventilation, decreasing PaCO2 levels, and increasing blood pH Hypoventilation, increasing PaCO2 levels, and decreasing blood pH

Hypoventilation, increasing PaCO2 levels, and decreasing blood pH

Which extracellular fluid anion is replaced by bicarbonate when depleted, leading to metabolic alkalosis? ANSWER Sodium Chloride Potassium Calcium

Chloride

A patient in severe respiratory distress is diagnosed with respiratory acidosis. In addition to arterial blood gases (ABGs), the patient has a chemistry panel drawn. Which clinical finding should the nurse correlate with the patient's diagnosis of acute respiratory acidosis? ANSWER Chloride 80 mEq/L Potassium 4.1 mEq/L Sodium 135 mEq/L Calcium 9 mg/dL

Chloride 80 mEq/L A chloride level less than 98 mEq/L is associated with respiratory acidosis.

The nurse is caring for a patient with emphysema, and the patient's arterial blood gas (ABG) reveals a pH of 7.36, PaCO2 of 56 mmHg, and HCO3 of 36 mEq/L. Which condition should the nurse determine from the patient's ABG results? ANSWER Uncompensated respiratory acidosis Compensated respiratory alkalosis Compensated respiratory acidosis Uncompensated respiratory alkalosis

Compensated respiratory acidosis

The nurse is implementing ordered treatment for a patient with metabolic alkalosis. As the treatment begins, the nurse should implement which intervention to best identify possible complications related to potential rapid changes in potassium? ANSWER Daily weights Hourly vital signs Constant cardiac monitoring Mental status and LOC assessments every hour

Constant cardiac monitoring

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

Daily weights

The nurse is caring for a patient who is receiving mechanical ventilation for the treatment of respiratory alkalosis. Which ventilator setting should the nurse anticipate for this patient? ANSWER Decrease in oxygen setting Decrease in tidal volume setting Increase in rate of respiration setting Increase in the PEEP setting

Decrease in tidal volume setting

The nurse is caring for a patient in acute respiratory distress. Which laboratory finding should indicate to the nurse that the patient has respiratory acidosis? ANSWER Decreased pH with decreased carbon dioxide Increased pH with increased carbon dioxide Decreased pH with increased carbon dioxide Increased pH with decreased carbon dioxide

Decreased pH with increased carbon dioxide

The nurse is caring for a patient with severe muscle spasm, metabolic alkalosis, and a history of primary hyperaldosteronism. Based on this diagnosis, which assessment should the nurse include in the physical examination of this patient? ANSWER Current medications Length of time patient has been experiencing dizziness Date of the last menstrual cycle Deep tendon reflexes

Deep tendon reflexes

Which pharmacologic treatment should the nurse expect to administer to a patient with respiratory alkalosis to restore balance? ANSWER IV insulin Diazepam Sodium bicarbonate A bronchodilator

Diazepam

A patient reports numbness and tingling in her fingers. The nurse notes that the individual has recently taken "a lot" of antacids due to "an upset stomach." Which additional clinical finding should the nurse anticipate when conducting the patient's assessment? ANSWER Hypertension Muscle weakness Dizziness Hyperkalemia

Dizziness

A preschool-age patient requires a nasogastric tube for gastric suctioning. Due to the risk of developing metabolic alkalosis, for which symptom should the nurse monitor? ANSWER Dysrhythmia Increased temperature Tachypnea Hypertension

Dysrhythmia Metabolic alkalosis may be caused by gastric suctioning due to the loss of hydrogen ions. Cardiac dysrhythmia, bradypnea, and hypotension would indicate the patient is experiencing metabolic alkalosis

The nurse is reviewing the results of a patient's arterial blood gas (ABG). Which ABG interpretation would indicate that this patient is experiencing metabolic alkalosis? ANSWER Decreased pH, normal HCO3 Elevated pH, elevated HCO3 Elevated pH, normal HCO3 Decreased pH, elevated HCO3

Elevated pH, elevated HCO3

The nurse places the patient experiencing metabolic alkalosis in semi-Fowler position. Which rationale supports placing the patient in this position to address impaired gas exchange? ANSWER Elevating the head of the bed facilitates alveolar ventilation and gas exchange. Elevating the head of the bed helps to conserve energy. Elevating the head of the bed facilitates secretion clearance. Elevating the head of the bed decreases dyspnea by allowing better contraction of the diaphragm.

Elevating the head of the bed facilitates alveolar ventilation and gas exchange.

The nurse is providing care to a patient who is diagnosed with respiratory alkalosis. Which intervention should the nurse implement first? ANSWER Having patient rebreathe into a paper bag Administering a sedative medication Encouraging slow, deep breaths Administering an antianxiety medication

Encouraging slow, deep breaths

A patient presents with a respiratory rate of 48 breaths/min. The patient has been hyperventilating for the past hour and is experiencing muscle spasms and tremors in her extremities, and cramping in her hands. Which process related to respiratory alkalosis should the nurse recognize as the cause of the neuromuscular symptoms? ANSWER Extracellular calcium binds with albumin, reducing ionized calcium levels and resulting in neuromuscular excitability. Ionized calcium levels increase, resulting in hyperreflexia and muscle spasms. Intravascular calcium levels increase, causing increased reabsorption of bicarbonate. This results in muscle excitability. Increased calcium levels cause a decrease in phosphate levels, causing muscle weakness and spasms.

Extracellular calcium binds with albumin, reducing ionized calcium levels and resulting in neuromuscular excitability.

A patient with chronic obstructive pulmonary disease (COPD) is admitted with respiratory acidosis. Which nursing assessment finding supports this diagnosis? ANSWER Headache Cool skin Heart rate of 62 beats/min Blood pressure of 110/60 mmHg

Headache

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

Hyperosmolality

A patient is diagnosed with pneumonia and is admitted for IV antibiotics and treatment for respiratory alkalosis. Which assessment finding most likely contributed to the patient's diagnosis of respiratory alkalosis? ANSWER Hyperthermia caused by infection Sinus tachycardia Urinalysis negative for bacteria Chest computed tomography (CT) scan negative for pulmonary embolism

Hyperthermia caused by infection

The nurse is caring for a patient with acute respiratory acidosis. The nurse should understand that the patient's blood pH initially falls in the development of acute respiratory acidosis because of which process? ANSWER Hypoventilation Hypercapnia Papilledema Vasodilation

Hypoventilation

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

Increased rate and depth of respiration

The nurse is caring for a patient with respiratory acidosis who is anxious and attempting to climb out of bed. Which nursing diagnosis is most appropriate for this patient? ANSWER Electrolyte Imbalance, Risk for Confusion, Risk for Injury, Risk for Emotional Control, Labile

Injury, Risk for

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

Kussmaul respirations Kussmaul respirations involve rapid, deep breathing, most often seen in acidosis as the body attempts to restore acid-base balance by ridding itself of carbon dioxide.

The nurse is providing care for a patient with metabolic alkalosis secondary to the excessive use of loop diuretics. Which amount of urine output should indicate to the nurse that the patient potentially has deficient fluid volume? ANSWER Less than 30 mL/hour 45 mL/hour Less than 1000 mL/24 hours Intake to output excess of 100 mL

Less than 30 mL/hour

The nurse instructs a patient with respiratory acidosis and retained airway secretions to increase fluid intake. What is the purpose of the nurse's instruction? ANSWER Liquefies secretions Reduces airway swelling Moistens airway Reduces respiratory effort

Liquefies secretions

Which focused assessments should be the priority for the nurse caring for a patient with respiratory acidosis? ANSWER Mental status and lung sounds Mental status and electrolyte balance Heart tones and lung sounds Acid-base balance and electrolyte balance

Mental status and lung sounds

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

Metabolic acidosis

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

Metabolic acidosis Young women with eating disorders who abuse laxatives or engage in severe diet restrictions to the point of cachexia are at risk for metabolic acidosis due to the resulting elimination of bicarbonate

A young female with a binging and purging disorder is admitted with complaints of numbness and tingling of the fingers and toes accompanied by dizziness. Which acid-base imbalance should the nurse suspect? ANSWER Metabolic alkalosis Respiratory alkalosis Metabolic acidosis Respiratory acidosis

Metabolic alkalosis

Which intervention is most important to implement for a patient with metabolic acidosis? ANSWER Monitoring vital signs Monitoring oxygenation levels Monitoring input and output Monitoring lab values

Monitoring vital signs

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

Normal saline and glucose

A patient presents with anxiety-induced hyperventilation. Which symptom should the nurse identify as being most consistent with an altered level of calcium due to respiratory alkalosis? ANSWER Dilated pupils Increased blood pressure Decreased urinary output Numbness and cramping in hands and feet

Numbness and cramping in hands and feet

The nurse is caring for a 72-year-old patient who is admitted to the emergency department. The patient reports repeated panic attacks during which she experiences a rapid heart rate and feelings of terror, as well as uncontrolled hyperventilation. Which arterial blood gas (ABG) results best correlate with an uncompensated acid-base imbalance that is directly related to the patient's hyperventilation? ANSWER PaCO2 of 52 mmHg and serum pH of 7.32 PaCO2 of 32 mmHg and serum pH of 7.32 PaCO2 of 52 mmHg and serum pH of 7.55 PaCO2 of 32 mmHg and serum pH of 7.55

PaCO2 of 32 mmHg and serum pH of 7.55

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

Patient with diarrhea Diarrhea causes increased bicarbonate loss, which can lead to metabolic acidosis. Vomiting can lead to metabolic alkalosis, not metabolic acidosis.

A child is being treated for metabolic alkalosis secondary to prolonged vomiting. While the vomiting has decreased due to medication administration, the child is still experiencing episodes of vomiting. Which instruction should the nurse include in teaching to the family to best prevent injury due to vomiting? ANSWER Postvomit oral care Signs and symptoms of aspiration Positioning Cutting food into small pieces

Positioning

A patient is experiencing shortness of breath following a heart attack. Which intervention should the nurse implement? ANSWER Having the patient breathe into a paper bag Engaging the patient in conversation as a distraction Instructing the patient to try to take slow, deep breaths Positioning the patient in an upright sitting position and applying oxygen

Positioning the patient in an upright sitting position and applying oxygen

The nurse is performing an assessment on a patient with respiratory alkalosis. Which assessment finding supports this diagnosis? ANSWER Positive Babinski reflex Negative patellar reflex Positive Chvostek sign Negative Trousseau reflex

Positive Chvostek sign A positive Chvostek (facial twitching upon tapping the cheek) is an indication of neuromuscular changes as a result of an imbalance in electrolytes related to respiratory alkalosis.

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

Potassium

The nurse is caring for a patient admitted for metabolic alkalosis. Which laboratory value does the nurse anticipate for a patient experiencing this acid-base imbalance? ANSWER Potassium of 3.0 mEq/L Chloride of 100 mEq/L Total calcium of 5.7 mEq/L Sodium of 136 mEq/L

Potassium of 3.0 mEq/L

The nurse is monitoring the input and output of a patient with respiratory acidosis. The nurse understands that this intervention addresses which potential problem in the patient? ANSWER Potential for compromised airway Increased risk for mental status changes Increased risk of injury Potential for dehydration

Potential for dehydration

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

Preventing family and friends from visiting

The nurse is caring for a patient diagnosed with respiratory acidosis. Which intervention is aimed at maintaining airway clearance? ANSWER Encouraging fluid intake Providing oral suctioning as needed Assessing neurological function Encouraging ambulation as tolerated

Providing oral suctioning as needed

The nurse is caring for a patient in acute respiratory distress and respiratory acidosis. The patient appears panicked and is grasping at the oxygen mask on his face. Which nursing intervention should the nurse implement to help reduce the patient's anxiety? ANSWER Remaining in the room and explaining all procedures Leaving the room to ask a family member to remain with the patient Removing the oxygen mask and asking the patient to calm down Asking the healthcare provider to order an antianxiety medication

Remaining in the room and explaining all procedures

The nurse is providing a teaching session to colleagues concerning the needs of older adults. Which should the nurse include in the teaching session concerning changes of aging that best addresses the risk for dehydration? ANSWER Keep older adults active to increase declining metabolism and stimulate appetite and thirst. Encourage older adults to eat foods rich in potassium because most are receiving diuretics secondary to decreasing renal function. Remind older adults to drink fluids throughout the day to address the decreased sense of thirst. Ensure easy access to drinking water to address changes in vision and mobility.

Remind older adults to drink fluids throughout the day to address the decreased sense of thirst.

The nurse should administer antianxiety medications cautiously in older adult patients for which reason? ANSWER Brain function is slower, and older adult patients are not able to quickly identify the cause of hyperventilation as anxiety. Older adult patients often have vision disturbances and are not able to properly read a medication label. Older adult patients are more likely to become addicted to antianxiety medications. Renal function is slower, and decreasing the rate and depth of respirations may result in inadequate oxygenation.

Renal function is slower, and decreasing the rate and depth of respirations may result in inadequate oxygenation.

Which is the desired overall outcome for a patient with metabolic alkalosis? ANSWER Resolve the underlying cause of the metabolic alkalosis. Prevent complications of metabolic alkalosis. Restore and maintain normal acid-base balance. Maintain adequate fluid volume balance.

Restore and maintain normal acid-base balance.

For which clinical manifestation should the nurse monitor when caring for a patient with metabolic alkalosis? ANSWER Tachypnea Muscle weakness Seizures Hypertension

Seizures

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

Severe diarrhea

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

Sodium bicarbonate

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

Sodium bicarbonate

Which solution is the most common alkalizing solution to treat metabolic acidosis? ANSWER Sodium bicarbonate Lactate Citrate Kayexalate

Sodium bicarbonate

A 7-year-old child is admitted with intractable nausea and vomiting. The patient's current arterial blood gas (ABG) results are as follows: pH 7.50; pCO2 46 mmHg; pO2 95 mmHg; HCO3 34 mEq/L. According to the patient's ABGs, what pharmacologic therapy should the nurse expect to be ordered? ANSWER Sodium bicarbonate Magnesium chloride Sodium chloride Calcium chloride

Sodium chloride

The nurse is preparing to discharge a patient who has been treated for metabolic alkalosis secondary to excessive use of bicarbonate antacids. Which outcome for the patient should the nurse consider to be most appropriate post-hospitalization? ANSWER The patient will identify the signs and symptoms of metabolic alkalosis. The patient will report the appropriate use of acceptable antacids. The patient will describe when to notify the healthcare provider related to changes in daily weight. The patient will verbalize when to contact the healthcare provider.

The patient will report the appropriate use of acceptable antacids. The patient developed metabolic alkalosis due to excessive use of bicarbonate antacids.

A patient is being treated for a panic attack. She is hyperventilating, so the nurse instructs her to breathe into a paper bag. The patient's family member asks why this will help. The nurse's response should be based on which understanding? ANSWER This causes the patient to rebreathe exhaled carbon dioxide, thus increasing PaO2 and reducing pH. This causes the patient to rebreathe exhaled nitrogen, thus increasing HCO3 and reducing pH. This causes the patient to rebreathe exhaled hydrogen, thus increasing HCO3 and reducing pH. This causes the patient to retain and breathe exhaled carbon dioxide, thus increasing PaO2 and reducing pH.

This causes the patient to retain and breathe exhaled carbon dioxide, thus increasing PaO2 and reducing pH.

The nurse is teaching a group of older adults about how to prevent the development of metabolic acidosis. Which advice should not be included in this presentation? ANSWER Encouraging a nutritious diet Taking medications as prescribed Understanding risk factors for osteoporosis Following treatment plans for chronic illnesses

Understanding risk factors for osteoporosis

Which diagnostic study reflects the kidney's ability to regulate hydrogen ion and bicarbonate concentrations in the blood? ANSWER Urine pH Urine specific gravity Urine protein levels Urine leukocyte esterase levels

Urine pH

Which intervention should the nurse include in the plan of care for an older adult patient experiencing metabolic alkalosis to most accurately reflect fluid balance? ANSWER Measuring intake and output balance at the end of each shift Monitoring serum electrolytes every 24 hours Weighing daily under standard conditions Assessing for hypotension and tachycardia every 4 hours

Weighing daily under standard conditions

Clinical manifestations of metabolic alkalosis include 4

dizziness, hypotension, muscle spasm, and hypokalemia.

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

pH

The nurse is providing care to a patient with pulmonary edema who is diagnosed with respiratory acidosis. Which arterial blood gas (ABG) finding should the nurse identify as supporting this diagnosis? ANSWER pH 7.21 pH 7.40 PaCO2 42 mmHg PaCO2 38 mmHg

pH 7.21

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

pH 7.30, HCO3 15 mEq/L, CO2 45 mmHg

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

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

Manifestations of metabolic alkalosis include 4

seizures, depressed respiratory drive, muscle spasm, and hypotension