ACID BASE
A nurse is reviewing the laboratory values of a client who has respiratory acidosis. Which of the following findings should the nurse expect? A. HCO3- 30 mEq/L B. PaCO2 50 mm Hg C. pH 7.45 D. Potassium 3.3 mEq/L
PaCO2 50 mm Hg This laboratory value is an expected finding for a client who has respiratory acidosis.
A nurse is reviewing the arterial blood gas values for a client. The pH is 7.32, PaCO2 48 mm Hg and the HCO3 is 23 mEq/L. The nurse should recognize that these findings indicate of which of the following acid base balances? Respiratory acidosis Respiratory alkalosis Metabolic acidosis Metabolic alkalosis
Respiratory acidosis A number of conditions can lead to respiratory acidosis, including COPD and pneumonia. In the presence of respiratory acidosis, the client's blood gas values meet the following criteria: a pH less than 7.35, a PaCO2 greater than greater 45 mg/Hg, and a HCO3 that is normal or slightly elevated (22 to 26 mEq/mL).
A nurse is reviewing the medical records of four clients who has an acid-base imbalance. The nurse should recognize that which of the following clients is at risk for metabolic acidosis? A. A client who has diarrhea B. A client who is vomiting C. A client who is taking a thiazide diuretic D. A client who has salicylate intoxication
A client who has diarrhea Diarrhea can cause metabolic acidosis due to the loss of bicarbonate
A nurse is reviewing the arterial blood gas values of a client who has chronic kidney disease. Which of the following sets of values should the nurse expect? A. pH 7.25, HCO3- 19 mEq/L, PaCO2 30 mm Hg B. pH 7.30, HCO3- 26 mEq/L, PaCO2 50 mm Hg C. pH 7.50, HCO3- 20 mEq/L, PaCO2 32 mm Hg D. pH 7.55, HCO3- 30 mEq/L, PaCO2 31 mm Hg
pH 7.25, HCO3- 19 mEq/L, PaCO2 30 mm Hg The nurse should expect a client who has renal failure to have metabolic acidosis, which is characterized by a low HCO3-, a low pH, and a low or normal PaCO2. Expected reference ranges for these laboratory values are as follows: pH 7.35 to 7.45, HCO3- 21 to 28 mEq/L, and PaCO2 35 to 45 mm Hg.
A nurse is reviewing the arterial blood gas (ABG) results of a client who the provider suspects has metabolic acidosis. Which of the following results should the nurse expect to see? A. pH below 7.35 B. HCO3 above 26 mEq/L C. PaO2 below 70 mm Hg D. PaCO2 above 45 mm Hg
pH below 7.35 With acidosis, the pH is below 7.35. However, the pH alone does not indicate whether the problem is metabolic or respiratory. A pH above 7.45 indicates alkalosis.
A nurse is caring for a female client in the emergency department who reports shortness of breath and pain in the lung area. She states that she started taking birth control pills 3 weeks ago and that she smokes. Her heart rate is 110/min, respiratory rate 40/min, and blood pressure 140/80 mm Hg. Her arterial blood gases are pH 7.50, PaCO2 29 mmHg, PaO2 60 mm Hg, HCO3 20 mEq/L, and SaO2 86%. Which of the following is the priority nursing interventions? A. Prepare for mechanical ventilation. B. Administer oxygen via face mask. C. Prepare to administer a sedative. D. Assess for indications of pulmonary embolism.
Administer oxygen via face mask. The pH reflects alkalosis, and the low PaCO2 indicates that the lungs are involved, so the client has respiratory alkalosis. The client's oxygen saturation is low, so one priority is to administer oxygen via mask attempting to achieve an oxygen saturation of at least 95%. The greatest risk to this client is hypoxia, thus the priority is to restore oxygenation.
A nurse is caring for a client who is postoperative and whose respirations are shallow and 9/min. Which of the following acid-based imbalances should the nurse identify the client as being at risk for developing initially? A. Respiratory acidosis B. Respiratory alkalosis C. Metabolic acidosis D. Metabolic alkalosis
Respiratory acidosis Respiratory acidosis represents an increase in the acid component, carbon dioxide, due to inadequate excretion of it, and an increase in the hydrogen ion concentration (decreased pH) of the arterial blood. A major cause of this imbalance is hypoventilation from anesthetics or opioids.
A nurse is caring for a client whose arterial blood gas results show a pH of 7.3 and a PaCO2 of 50 mm Hg. The nurse should identify that the client is experiencing which of the following acid-base imbalances? A. Metabolic acidosis B. Metabolic alkalosis C. Respiratory acidosis D. Respiratory alkalosis
Respiratory acidosis With uncompensated respiratory acidosis, the pH is less than 7.35 and the PaCO2 is greater than 45 mm Hg.
A nurse is caring for a client who has acute kidney injury (AKI). Which of the following arterial blood gas values would the nurse expect this client to have? A. pH 7.49, HCO3 24, PaCO2 30 B. pH 7.49, HCO3 30, PaCO2 40 C. pH 7.26, HCO3 24, PaCO2 46 D. pH 7.26, HCO3 14, PaCO2 30
pH 7.26, HCO3 14, PaCO2 30 AKI causes metabolic acidosis because the kidneys cannot adequately process and excrete the acidic substances the usual bodily functions produce every day. With metabolic acidosis, the pH is low, the bicarbonate is low, and the PaCO2 is low or in the expected range, as in these results.
A nurse is admitting a client who has influenza and is reporting numbness and tingling of the toes and fingers. The nurse should recognize the client is experiencing which of the following acid-base imbalances? A. Metabolic acidosis B. Metabolic alkalosis C. Respiratory acidosis D. Respiratory alkalosis
Metabolic alkalosis (CORRECT) A client who has influenza has experienced excessive vomiting leading to metabolic alkalosis. Manifestations include dizziness, Circumoral paresthesias, and numbness and tingling of the extremities. Metabolic acidosis A client who has metabolic acidosis has a low pH level and a low bicarbonate level with manifestations such as Kussmaul's respirations, lethargy and confusion. Respiratory acidosis A client who has respiratory acidosis has a low pH and a high bicarbonate level with manifestations such as warm, flushed skin, headache and tachycardia. Respiratory alkalosis A client who has respiratory alkalosis has high pH and a low bicarbonate level with manifestations such as tremulousness, blurred vision and difficulty concentrating.
A nurse is caring for a client who has metabolic alkalosis. For which of the following clinical manifestations should the nurse monitor? SATA A. Bicarbonate excess B. Kussmaul's respirations C. Flushing D.Circumoral paresthesia E. Lethargy
Bicarbonate excess is correct. Bicarbonate excess is a clinical manifestation for a client experiencing metabolic alkalosis. Kussmaul's respirations is incorrect. Kussmaul's respirations are a clinical manifestation for a client experiencing metabolic acidosis. Flushing is incorrect. Flushing is a clinical manifestation for a client experiencing respiratory acidosis. Circumoral paresthesia is correct. Circumoral paresthesia is a clinical manifestation for a client experiencing metabolic alkalosis. Lethargy is incorrect. Lethargy is a clinical manifestation for a client experiencing metabolic acidosis.
A client is admitted to the emergency room with a respiratory rate of 7/min. Arterial blood gases (ABG) reveal the following values. Which of the following is an appropriate analysis of the ABGs? pH 7.22 PaCO2 68 mm Hg Base excess -2 PaO2 78 mm Hg Saturation 80% Bicarbonate 26 mEq/L A. Respiratory acidosis B. Metabolic acidosis C. Metabolic alkalosis D. Respiratory alkalosis
Respiratory acidosis Respiratory acidosis occurs when there is retention of CO2 due to an impairment of respiratory function. It can be the result of respiratory depression, seen with anesthesia or opioid administration; inadequate chest expansion, due to a weakness of the respiratory muscles or constriction to the thorax; an obstruction of the airway, seen in aspiration, bronchoconstriction, or laryngeal edema; or from an inability of the lungs to adequately diffuse gases (O2 and CO2), resulting from conditions such as pneumonia, COPD, chest trauma, or pulmonary emboli. Arterial blood gases will reveal a pH that is lower than the normal reference range (7.35 - 7.45) and a CO2 level that is higher than the normal reference range (35 - 45 mm Hg). Metabolic acidosis Metabolic acidosis occurs when there is an alteration in the level of hydrogen ions or a reduction in the amount of bicarbonate available. It can be the result of diabetic ketoacidosis, starvation, hypoxia, renal or liver failure, dehydration, or diarrhea. Arterial blood gases will reveal a pH that is lower than the normal reference range (7.35 - 7.45) and a bicarbonate (HCO3) level that is lower than the normal reference range (21 - 28 mEq/mL). Metabolic alkalosis Metabolic alkalosis occurs when there is an alteration in the level of HCO3 along with an increase in the pH of the blood. It can be the result when a client ingests too much antacid from blood transfusions or total parenteral nutrition. It can also occur if the client has prolonged vomiting or NG suction, takes thiazide diuretics, or has a metabolic disorder such as hypercortisolism or hyper aldosteronism. Arterial blood gases will reveal a pH that is higher than the normal reference range (7.35 - 7.45) and an HCO3 level that is higher than the normal reference range (35 - 45 mm Hg). Respiratory alkalosis Respiratory alkalosis occurs when there is an excessive loss of CO2 through hyperventilation, mechanical ventilation, fever, overdose of salicylates, or lesions to the central nervous system. Arterial blood gases will reveal a pH that is higher than the normal reference range (7.35 - 7.45) and a CO2 level that is lower than the normal reference range (35 - 45 mm Hg).
