Acid Base Balance
Which lab value do physicians use to determine how to treat an acid base imbalance?
normal anion gap
Which set of arterial blood gas (ABG) results requires further investigation?
pH 7.49, PaCO2 30 mm Hg, PaO2 89 mm Hg, and HCO3- 18 mEq/L
What constitutes a fully compensated acid base imbalance?
pH is normal but CO2 and HCO3 are outside of range
A client with Guillain-Barré syndrome develops respiratory acidosis as a result of reduced alveolar ventilation. Which combination of arterial blood gas (ABG) values confirms respiratory acidosis?
pH, 7.25; PaCO2 50 mm Hg
What constitutes a partially compensated acid base imbalance?
pH, HCO3, and CO2 are all out of range
The nurse is analyzing the arterial blood gas (ABG) results of a client diagnosed with severe pneumonia. Which of the following ABG results indicates respiratory acidosis?
pH: 7.20, PaCO2: 65 mm Hg, HCO3-: 26 mEq/L
A client is admitted to the unit with diabetic ketoacidosis (DKA). Which insulin would the nurse expect to administer intravenously?
regular
A client who is being treated for pneumonia reports sudden shortness of breath. An arterial blood gas (ABG) is drawn. The ABG has the following values: pH 7.21, PaCO2 64 mm Hg, HCO3 24 mm Hg. Which condition does the ABG reflect?
respiratory acidosis
Which acid base imbalance is caused by COPD or emphysema?
respiratory acidosis
Which acid base imbalance is caused by anesthesia?
respiratory acidosis
Which acid base imbalance is caused by pleural edema or pleural effusion?
respiratory acidosis
Which acid base imbalance is caused by pneumonia?
respiratory acidosis
Which acid base imbalance is caused by fever?
respiratory alkalosis
Which acid base imbalance is caused by hyperventilation?
respiratory alkalosis
Which acid base imbalance is common in pregnant women?
respiratory alkalosis
Which acid base imbalance is likely when a patient has a pulmonary embolism followed by an impending feeling of doom?
respiratory alkalosis
Which medication can be given for acidosis?
sodium bicarbonate
What is normal HCO3?
22-26mEq/L
What is normal Bicarbonate?
22-28
What is normal paCO2?
35-45 mmHg
How long should you hold pressure after an ABG?
5 minutes, or 10 if on anticoagulant therapy
What is normal serum pH?
7.35-7.45
What is considered perfect pH?
7.4
A client experiencing a severe anxiety attack and hyperventilating presents to the emergency department. The nurse would expect the client's pH value to be
7.50
What is normal PaO2?
80-100mmHg
A client with a respiratory condition is receiving oxygen therapy. While assessing the client's PaO2, the nurse knows that the therapy has been effective based on which of the following readings?
84 mmHg
To evaluate a client for hypoxia, the physician is most likely to order which laboratory test?
ABD analysis
When a client's ventilation is impaired, the body retains which substance?
CO2
______ is excessive CO2 buildup in the body caused by bradypnea or dyspnea. pH will be <7.35, and CO2>45.
Respiratory Acidosis
Which acid base imbalance is caused by blood clots in the lungs?
Respiratory acidosis
Which acid base imbalance is caused by medications that cause respiratory depression like anesthesia, opioids, and anxiety medications?
Respiratory acidosis
A nurse correctly identifies a urine specimen with a pH of 4.3 as being which type of solution?
acidic
A young client is being treated for a femoral fracture suffered in a snowboarding accident. The nurse's most recent assessment reveals that the client is uncharacteristically confused. What diagnostic test should be performed on this client?
arterial blood gases
A nurse is providing client teaching about the body's plasma pH and the client asks the nurse what is the major chemical regulator of plasma pH. What is the best response by the nurse?
bicarbonate-carbonic acid buffer system
The physician has prescribed 0.9% sodium chloride IV for a hospitalized client in metabolic alkalosis. Which nursing actions are required to manage this client?
compare ABG findings with previous results. Maintain intake and output results. Document presenting signs and symptoms.
A client has a respiratory rate of 38 breaths/min. What effect does breathing faster have on arterial pH level?
increases arterial pH
The nurse is caring for a client with multiple organ failure and in metabolic acidosis. Which pair of organs is responsible for regulatory processes and compensation?
lungs and kidney
A client has the following arterial blood gas (ABG) values: pH, 7.12; partial pressure of arterial carbon dioxide (PaCO2), 40 mm Hg; and bicarbonate (HCO3-), 15 mEq/L. These ABG values suggest which disorder?
metabolic acidosis
The nurse is caring for a patient with diabetes type I who is having severe vomiting and diarrhea. What condition that exhibits blood values with a low pH and a low plasma bicarbonate concentration should the nurse assess for?
metabolic acidosis
Which acid base imbalance is caused by DKA?
metabolic acidosis
Which acid base imbalance is caused by carbonic anhydrase inhibitors?
metabolic acidosis
Which acid base imbalance is caused by fistulas?
metabolic acidosis
Which acid base imbalance is caused by intake of a high fat diet?
metabolic acidosis
Which acid base imbalance is caused by ostomy drainage?
metabolic acidosis
Which acid base imbalance is caused by starvation?
metabolic acidosis
A client who complains of an "acid stomach" has been taking baking soda (sodium bicarbonate) regularly as a self-treatment. This may place the client at risk for which acid-base imbalance?
metabolic alkalosis
Vomiting results in which of the following acid-base imbalances?
metabolic alkalosis
Which acid base imbalance is caused by Loop/ Thiazide diuretics?
metabolic alkalosis
Which acid base imbalance is caused by aldosterone production excess?
metabolic alkalosis
Which acid base imbalance is caused by loss of fluids by vomiting, NG tube suctioning, or bulimia?
metabolic alkalosis
______ is when you are losing base out the butt. CO2 is increased and HCO3 is decreased.
Metabolic Acidosis
______ is when you are losing acid out the mouth. This is characterized by an excessive loss of H+ ions and increase in bicarbonate.
Metabolic Alkalosis
Which of the following arterial blood gas results would be consistent with metabolic alkalosis?
Serum bicarbonate of 28 mEq/L
Which oncologic emergency involves the failure in the negative feedback mechanism that normally regulates the release of antidiuretic hormone (ADH)?
Syndrome of inappropriate antidiuretic hormone release (SIADH)
The nurse is studying for a physiology test over the respiratory system. What should the nurse know about central chemoreceptors in the medulla?
They respond to changes in CO2 levels and hydrogen ion concentrations (pH) in the cerebrospinal fluid.
What is the last resort treatment for respiratory acidosis?
intubation
Hypocalcemia is associated with which of the following manifestations?
muscle twitching
What is normal CO2?
35-45
The emergency department (ED) nurse is caring for a client with a possible acid-base imbalance. The physician has ordered an arterial blood gas (ABG). What is one of the most important indications of an acid-base imbalance that is shown in an ABG?
Bicarbonate
______ is the expelling of too much CO2 caused by tachypnea. CO2 will be <35, pH will be >7.45, and RR will be 20+.
Respiratory Alkalosis
A nurse is caring for a client admitted with a diagnosis of exacerbation of myasthenia gravis. Upon assessment of the client, the nurse notes the client has severely depressed respirations. The nurse would expect to identify which acid-base disturbance?
Respiratory acidosis
A client comes to the emergency department with status asthmaticus. His respiratory rate is 48 breaths/minute, and he is wheezing. An arterial blood gas analysis reveals a pH of 7.52, a partial pressure of arterial carbon dioxide (PaCO2) of 30 mm Hg, PaO2 of 70 mm Hg, and bicarbonate (HCO3??') of 26 mEq/L. What disorder is indicated by these findings?
Respiratory alkalosis
A client with a longstanding diagnosis of generalized anxiety disorder presents to the emergency room. The triage nurse notes upon assessment that the client is hyperventilating. The triage nurse is aware that hyperventilation is the most common cause of which acid-base imbalance?
Respiratory alkalosis
A nurse reviews the arterial blood gas (ABG) values of a client admitted with pneumonia: pH, 7.51; PaCO2, 28 mm Hg; PaO2, 70 mm Hg; and HCO3--, 24 mEq/L. What do these values indicate?
Respiratory alkalosis
What is the acid base maintenance mechanism that tries to compensate first?
chemical and protein buffers
What is the body's first line of defense for acid base imbalance?
chemical and protein buffers
A client with emphysema is at a greater risk for developing which acid-base imbalance?
chronic respiratory acidosis
A client recovering from an acute asthma attack experiences respiratory alkalosis. The nurse measures a respiratory rate of 46 breaths/minute, a heart rate of 110 beats/minute, a blood pressure of 162/90 mm Hg, and a temperature of 98.6° F (37° C). To help correct respiratory alkalosis, the nurse should:
instruct the client to breathe into a paper bag.
What is the body's last line of defense for acid base imbalance?
kidney buffers
A client in the emergency department reports that he has been vomiting excessively for the past 2 days. His arterial blood gas analysis shows a pH of 7.50, partial pressure of arterial carbon dioxide (PaCO2) of 43 mm Hg, partial pressure of arterial oxygen (PaO2) of 75 mm Hg, and bicarbonate (HCO3-) of 42 mEq/L. Based on these findings, the nurse documents that the client is experiencing which type of acid-base imbalance?
metabolic alkalosis
When evaluating arterial blood gases (ABGs), which value is consistent with metabolic alkalosis?
pH7.48
A client admitted with acute anxiety has the following arterial blood gas (ABG) values: pH, 7.55; partial pressure of arterial oxygen (PaO2), 90 mm Hg; partial pressure of arterial carbon dioxide (PaCO2), 27 mm Hg; and bicarbonate (HCO3-), 24 mEq/L. Based on these values, the nurse suspects:
respiratory alkalosis
Which acid base imbalance is caused by hysteria/ anxiety?
respiratory alkalosis
