Acid-Base Balance
Which medication would the nurse identify as being used both for cervical ripening during labor and as a stomach protectant? 1 Raloxifene 2 Clomiphene 3 Misoprostol 4 Dinoprostone
3 Misoprostol Misoprostol can be used for cervical ripening and as a stomach protectant. Raloxifene is used to prevent postmenopausal osteoporosis. Clomiphene is used for ovulation. Dinoprostone can be used for cervical ripening, but this medication does not act as a stomach protectant.
Which blood gas result would the nurse expect an adolescent with diabetic ketoacidosis to exhibit? 1 pH 7.30, CO 2 40 mm Hg, HCO 3 - 20 mEq/L (20 mmol/L) 2 pH 7.35, CO 2 47 mm Hg, HCO 3 - 24 mEq/L (24 mmol/L) 3 pH 7.46, CO 2 30 mm Hg, HCO 3 - 24 mEq/L (24 mmol/L) 4 pH 7.50, CO 2 50 mm Hg, HCO 3 - 22 mEq/L (22 mmol/L)
1 pH 7.30, CO 2 40 mm Hg, HCO 3 - 20 mEq/L (20 mmol/L) A client in diabetic ketoacidosis will have blood gas readings that indicate metabolic acidosis. The pH will be acidic (7.30), and the HCO 3 - will be low (20 mEq/L [20 mmol/L]). The normal pH is 7.35 to 7.45; CO 2 ranges from 35 to 45 mm Hg, and HCO 3 - ranges from 22 to 26 (22-26 mmol/L). A pH of 7.35 and a CO 2 of 47 mm Hg indicate respiratory acidosis. pH values of 7.46 and 7.50 represent alkalosis, not acidosis.
After cataract surgery, a client reports feeling nauseated. How can the nurse prevent vomiting? 1 Administer the prescribed antiemetic medication. 2 Provide some dry crackers for the client to eat. 3 Explain that this is expected after surgery. 4 Teach how to breathe deeply until the nausea subsides.
1 Administer the prescribed antiemetic medication. An antiemetic will prevent vomiting; vomiting increases intraocular pressure and should be avoided. Providing some dry crackers for the client to eat, explaining that this is expected after surgery, and teaching how to breathe deeply until the nausea subsides are unsafe; vomiting increases intraocular pressure, and aggressive intervention is required.
When a client with chronic obstructive pulmonary disease (COPD) reports a 5-lb (2.3-kg) weight gain in 1 week, the nurse will assess for other signs and symptoms of which complication? 1 Polycythemia 2 Cor pulmonale 3 Compensated acidosis 4 Left ventricular failure
2 Cor pulmonale Fluid retention and weight gain caused by right ventricular failure is a clinical manifestation of cor pulmonale, or right ventricular failure caused by pulmonary hypertension associated with COPD. Polycythemia may be caused by COPD, but it does not cause weight gain. Compensated respiratory acidosis is caused by COPD, but it would not lead to weight gain. Left ventricular failure may lead to weight gain, but it is not a complication of COPD.
A client is in a state of uncompensated acidosis. Which approximate arterial blood pH does the nurse expect the client to have? 1 7.20 2 7.35 3 7.45 4 7.48
1 7.20 The pH of blood is maintained within the narrow range of 7.35 to 7.45. When there is an increase in hydrogen ions, the respiratory, buffer, and renal systems attempt to compensate to maintain the pH. If compensation is not successful, acidosis results and is reflected in a lower pH. View Topics
A pathology report states a client's urinary calculus is composed of uric acid. Which food item would the nurse instruct the client to avoid? 1 Milk 2 Liver 3 Cheese 4 Vegetables
2 Liver A low-purine diet controls the development of uric acid stones. Clients with uric acid stones should avoid foods high in purine, such as organ meats and extracts. The client should avoid milk if he or she had calcium stones, not uric acid stones. The client should avoid cheese or animal protein if he or she had cysteine stones, not uric acid stones. The client does not need to avoid vegetables when on a low-purine diet.
The nurse teaches a client about the dangers of using sodium bicarbonate regularly. Which effect of sodium bicarbonate is the nurse trying to prevent? 1 Gastric distention 2 Metabolic alkalosis 3 Chronic constipation 4 Cardiac dysrhythmias
2 Metabolic alkalosis Prolonged use of sodium bicarbonate may cause systemic alkalosis, as well as retention of sodium and water. Gastric distention is not an effect of sodium bicarbonate. Chronic constipation is not an effect of sodium bicarbonate. Cardiac dysrhythmias are not an effect of sodium bicarbonate.
Which complication is the most serious for a client with kidney failure? 1 Anemia 2 Weight loss 3 Uremic frost 4 Hyperkalemia
4 Hyperkalemia Decreased glomerular filtration leads to hyperkalemia, which may cause lethal dysrhythmias such as cardiac arrest. Anemia may occur but is not the most serious complication and should be treated in relation to the client's clinical manifestation; erythropoietin and iron supplements usually are used. Weight loss alone is not life threatening. Uremic frost, a layer of urea crystals on the skin, causes itching, but it is not the most serious complication. View Topics
The nurse providing postoperative care for a client who had kidney surgery reviews the client's urinalysis report. Which urinary finding indicates the need to notify the primary health care provider? 1 Acidic pH 2 Glucose negative 3 Bacteria negative 4 Presence of large proteins
4 Presence of large proteins The glomeruli are not permeable to large proteins such as albumin or red blood cells, and finding them in the urine is abnormal; the nurse would report their presence to the primary health care provider to modify the client's treatment plan. The urine can be acidic; normal pH is 4.0 to 8.0. Glucose and bacteria should be negative and are normal findings.
A high school student arrives at the local blood drive center to donate blood for the first time. As the site is being prepared for needle insertion, the student becomes agitated, starts to hyperventilate, and complains of dizziness and tingling of the hands. Which would the nurse instruct the student to do? 1 Breathe into cupped hands. 2 Pant using rapid, shallow breaths. 3 Use a rapid deep-breathing pattern. 4 Hold the breath for as long as possible.
1 Breathe into cupped hands. Breathing into cupped hands allows carbon dioxide to reenter the lungs, which will increase the serum bicarbonate level, relieving the respiratory alkalosis that is occurring as a result of hyperventilation. A rapid breathing pattern will exacerbate the respiratory alkalosis because excess carbon dioxide will continue to be expelled with rapid breathing, lowering the serum bicarbonate level. A fast deep-breathing pattern will exacerbate the respiratory alkalosis because excess carbon dioxide will continue to be expelled with rapid breathing, lowering the serum bicarbonate level. A person who is experiencing a panic attack will not be able to hold his or her breath.
Which acid-base imbalance would the nurse anticipate in a client in the progressive stage of shock? 1 Metabolic acidosis 2 Metabolic alkalosis 3 Respiratory acidosis 4 Respiratory alkalosis
1 Metabolic acidosis Metabolic acidosis occurs during the progressive stage of shock as a result of accumulated lactic acid. Metabolic alkalosis cannot occur with the buildup of lactic acid associated with the progressive stage of shock. Respiratory acidosis can result from decreased respiratory function in late shock, further compounding metabolic acidosis. Respiratory alkalosis occurs as a result of hyperventilation during early shock.
A client is transferred to the postanesthesia care unit after abdominal surgery. The client begins vomiting. Which nursing action is most important when caring for this client? 1 Turning the client onto the side 2 Measuring the amount of vomitus 3 Assessing the wound for dehiscence 4 Administering the prescribed antiemetic to the client
1 Turning the client onto the side The side-lying position promotes drainage of emesis and secretions from the mouth, reducing the risk of aspiration. Although accurate assessment of intake and output is important, prevention of aspiration is the priority. Dehiscence is not probable at this time; it is more common 5 to 7 days after surgery. Although the antiemetic may prevent additional vomiting, the nurse's priority is to prevent aspiration.
The nurse is caring for an infant whose vomiting is intractable. Which complication is likely to occur? 1 Acidosis 2 Alkalosis 3 Hyperkalemia 4 Hypernatremia
2 Alkalosis 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 because of renal potassium excretion. With the loss of chloride ions, hyponatremia is more likely to occur.
Which complication would the nurse prevent by addressing the needs of a hyperventilating client? 1 Cardiac arrest 2 Carbonic acid deficit 3 Reduction in serum pH 4 Excess oxygen saturation
2 Carbonic acid deficit 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 eventually will lose consciousness and begin breathing regularly. Hyperventilation causes alkalosis, so the pH is increased rather than reduced. Excess oxygen saturation cannot occur; normal oxygen saturation of hemoglobin is 95% to 98%.
Which diagnosis is a client most likely to have who has an arterial blood gas report indicating that pH is 7.25, PCO 2 is 35 mm Hg, and HCO 3 is 20 mEq/L (20 mmol/L)? 1 Panic attack 2 Persistent vomiting 3 Diabetic ketoacidosis 4 Advanced emphysema
3 Diabetic ketoacidosis The low pH and bicarbonate levels are consistent with metabolic acidosis, which can be caused by excess ketones, a result of diabetic ketoacidosis. Persistent vomiting will cause metabolic alkalosis and high HCO 3 from loss of gastric hydrochloric acid. Panic attacks lead to hyperventilation and respiratory alkalosis with low PCO 2. Advanced emphysema causes elevated PCO 2 and respiratory acidosis.
When arterial blood gases done on a client who is being resuscitated after cardiac arrest show a low pH, which factor is the likely cause of the laboratory result? 1 Ketoacidosis 2 Irregular heartbeat 3 Lactic acid production 4 Sodium bicarbonate administration
3 Lactic acid production Cardiac arrest causes decreased tissue perfusion, which results in anaerobic metabolism and lactic acid production. Fat-forming ketoacids occur in diabetes. An irregular heartbeat does not cause acidosis. Sodium bicarbonate causes alkalosis, not acidosis.
A client with chronic obstructive pulmonary disease (COPD) has a blood pH of 7.25 and a partial pressure of carbon dioxide (PCO 2) of 60 mm Hg. Which complication would the nurse suspect the client is experiencing? 1 Metabolic acidosis 2 Metabolic alkalosis 3 Respiratory acidosis 4 Respiratory alkalosis
3 Respiratory acidosis 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.
Which pH value of amniotic fluid is indicated by a Nitrazine test strip that turns deep blue? 1 4.5 2 5.5 3 6.5 4 7.5
4 7.5 Amniotic fluid changes the color of a nitrazine strip from yellow to deep blue if the pH of the fluid is 7.5. A pH of 4.5, 5.5, or 6.5 would result in a test strip of yellow, olive yellow, or blue green, respectively.
Which clinical findings would the nurse expect when assessing a client with hyperthyroidism? Select all that apply. One, some, or all responses may be correct. 1 Diarrhea 2 Listlessness 3 Weight loss 4 Bradycardia 5 Decreased appetite
1 Diarrhea 3 Weight loss Excessive thyroid hormones increase the metabolic rate, causing an increase in intestinal peristalsis. Excessive thyroid hormones increase the metabolic rate, causing weight loss. Listlessness occurs with hypothyroidism because of a decreased metabolic rate. A slow pulse rate (bradycardia) accompanies hypothyroidism, not hyperthyroidism, because of a decreased metabolic rate. Appetite increases (polyphagia) with hyperthyroidism in an effort to meet metabolic needs.
Which initial intervention would the nurse expect the primary health care provider to order for a client admitted to the hospital with a diagnosis of diabetic ketoacidosis? 1 Intravenous (IV) fluids 2 Potassium 3 NPH insulin (Novolin N) 4 Sodium polystyrene sulfonate (Kayexalate)
1 Intravenous (IV) fluids IV fluids are given to combat dehydration in ketoacidosis and to keep an IV line open for administration of medications. After electrolyte levels are evaluated, potassium may be added along with insulin. In acidosis, potassium ions initially shift from the intracellular to extracellular compartment, resulting in hyperkalemia; as acidosis is corrected, hypokalemia may occur, and then potassium may be administered. NPH insulin is an intermediate-acting insulin; rapid-acting insulin is indicated in an emergency. Sodium polystyrene sulfonate is not indicated; abnormally high serum potassium levels will revert once dehydration is corrected.
Which independent nursing action would be included in the plan of care for a client after an episode of ketoacidosis? 1 Monitoring for signs of hypoglycemia resulting from treatment 2 Withholding glucose in any form until the situation is corrected 3 Giving fruit juices, broth, and milk as soon as the client is able to take fluids orally 4 Regulating insulin dosage according to the client's urinary ketone levels
1 Monitoring for signs of hypoglycemia resulting from treatment During treatment for acidosis, hypoglycemia may develop; careful observation for this complication will be made by the nurse. Withholding all glucose may cause insulin coma. Whole milk and fruit juices are high in carbohydrates, which are contraindicated immediately following ketoacidosis. The regulation of insulin depends on the prescription for coverage; the prescription usually depends on the client's blood glucose level rather than ketones in the urine.
Which is the regulator of extracellular osmolarity? 1 Sodium 2 Potassium 3 Chloride 4 Calcium
1 Sodium Sodium is the most abundant extracellular fluid cation and regulates serum (extracellular) osmolarity, as well as nerve impulse transmission and acid-base balance. Potassium is the major intracellular osmolarity regulator, and it also regulates metabolic activities, transmission and conduction of nerve impulses, cardiac conduction, and smooth and skeletal muscle contraction. Chloride is a major extracellular fluid anion and follows sodium. Calcium is an extracellular cation necessary for bone and teeth formation, blood clotting, hormone secretion, cardiac conduction, transmission of nerve impulses, and muscle contraction. View Topics
A client with chronic obstructive pulmonary disease (COPD) has a blood pH of 7.25 and Pco 2 of 60 mm Hg. These blood gas results require nursing attention because they indicate which condition? 1 Metabolic acidosis 2 Metabolic alkalosis 3 Respiratory acidosis 4 Respiratory alkalosis
3 Respiratory acidosis The normal blood pH range is 7.35 to 7.45; therefore, a blood pH of 7.25 indicates acidosis. The parameter for respiratory function is CO 2, and the acceptable range of arterial Pco 2 is 35 to 45 mm Hg; therefore, 60 mm Hg is elevated, resulting in respiratory acidosis. HCO 3 is the parameter for metabolic functions. A pH of 7.25 is acidic, indicating acidosis and not alkalosis.Test-Taking Tip: Stay away from other nervous students before the test. Stop reviewing at least 30 minutes before the test. Take a walk, go to the library and read a magazine, listen to music, or do something else that is relaxing. Go to the test room a few minutes before class time so that you are not rushed in settling down in your seat. Tune out what others are saying. Crowd tension is contagious, so stay away from it.