Acid-Base Balance Prep-U

A child who has type 1 diabetes mellitus is brought to the emergency department and diagnosed with diabetic ketoacidosis. What treatment would the nurse expect to administer? A. Lispro B. Regular insulin C. NPH D. Detemir

B. Regular insulin Insulin for diabetic ketoacidosis is given intravenously. Only regular insulin can be administered by this route.

Which is a true statement regarding pharmacologic aspects of aging? A. Potential for drug-drug reactions decreases with the number of drugs prescribed. B. Elderly have a decreased percentage of body fat. C. Absorption may be affected by changes in gastric pH. D. Aged population tends to be compliant with their medication regimen.

C. Absorption may be affected by changes in gastric pH. During the aging process, absorption may be affected by changes in gastric pH. The elderly have an increased percentage of body fat. The potential for drug-drug interaction increases with the number of drugs prescribed. The aged population tends to be less compliant with their medication regimen.

For which acid-base imbalance will the nurse monitor for a client taking large doses of loop diuretics? A. Metabolic acidosis B. Respiratory alkalosis C. Metabolic alkalosis D. Respiratory acidosis

C. Metabolic alkalosis Loop and thiazide diuretics commonly cause metabolic alkalosis as a result of hydrogen and potassium ion excretion in the urine. This leads to increased reabsorption of bicarbonate leading to metabolic alkalosis.

In chronic obstructive pulmonary disease (COPD), decreased carbon dioxide elimination results in increased carbon dioxide tension in arterial blood, leading to which of the following acid-base imbalances? A. Respiratory alkalosis B. Metabolic alkalosis C. Metabolic acidosis D. Respiratory acidosis

D. Respiratory acidosis Increased carbon dioxide tension in arterial blood leads to respiratory acidosis and chronic respiratory failure. In acute illness, worsening hypercapnia can lead to acute respiratory failure. The other acid-base imbalances would not correlate with COPD.

The nurse is caring for a client with ketoacidosis who is complaining of increasing lethargy and occasional confusion following several weeks of rigid adherence to a carbohydrate-free diet. The nurse understands which phenomenon is most likely occurring? A. In the absence of carbohydrate energy sources, her body is metabolizing fat and releasing ketoacids. B. Metabolism of dietary fats without the buffer action of carbohydrates results in the catabolism of ketoacids. C. High fat, low carbohydrate dietary intake is associated with respiratory acidosis. D. Decreased carbohydrate intake induces insulin deficiency and consequent ketoacidosis.

A. In the absence of carbohydrate energy sources, her body is metabolizing fat and releasing ketoacids. Low carbohydrate diets can induce the fat metabolism and consequent metabolic acidosis that is more commonly associated with diabetic ketoacidosis. The acidotic state is not classified as respiratory in nature, and does not involve a buffer role for carbohydrates or insulin deficiency.

A client with a blood glucose reading of 673 mg/dL (37.4 mmol/L) is diagnosed with diabetic ketoacidosis (DKA). Blood gas results are as follows: serum pH 7.29; HCO3− level 19 mEq/dL (19 mmol/L); PCO2 level 32 mm Hg. The nurse should prepare for which initial treatment orders? A. Initiating an insulin IV infusion along with fluid replacement B. Administering supplemental oxygen C. Instituting a cough-and-deep breathing schedule for every D. Administration of potassium chloride

A. Initiating an insulin IV infusion along with fluid replacement The treatment of metabolic acidosis focuses on correcting the condition that is causing the disorder and restoring the fluids and electrolytes that have been lost from the body. For example, insulin administration and fluid replacement are frequently sufficient to correct a low pH in persons with diabetic ketosis. Administration of potassium chloride may be required in DKA, but this is determined by the current potassium level, which is not offered in the scenario. Administering supplemental oxygen is used in the treatment of hypoxemia. Instituting a cough-and-deep breathing schedule for every hour while awake to improve ventilation is usual treatment for clients who may be experiencing atelectasis.

A client with a blood glucose reading of 673 mg/dL (37.4 mmol/L) is diagnosed with diabetic ketoacidosis (DKA). Blood gas results are as follows: serum pH 7.29; HCO3− level 19 mEq/dL (19 mmol/L); PCO2 level 32 mm Hg. The nurse should prepare for which initial treatment orders? A. Initiating an insulin IV infusion along with fluid replacement B. Instituting a cough-and-deep breathing schedule for every C. Administration of potassium chloride D. Administering supplemental oxygen

A. Initiating an insulin IV infusion along with fluid replacement The treatment of metabolic acidosis focuses on correcting the condition that is causing the disorder and restoring the fluids and electrolytes that have been lost from the body. For example, insulin administration and fluid replacement are frequently sufficient to correct a low pH in persons with diabetic ketosis. Administration of potassium chloride may be required in DKA, but this is determined by the current potassium level, which is not offered in the scenario. Administering supplemental oxygen is used in the treatment of hypoxemia. Instituting a cough-and-deep breathing schedule for every hour while awake to improve ventilation is usual treatment for clients who may be experiencing atelectasis.

The vagina is at risk for infection because of its location and because it opens to the outside of the body. What is a protective mechanism of the vagina to keep it from becoming infected? A. Normal vaginal pH is acidic (4 to 5), which protects from infection. B. It produces its own natural antibiotics. C. It maintains an alkaline pH of 7 to 8, which destroys invading bacteria. D. Normal vaginal flora act as phagocytes of invading bacteria.

A. Normal vaginal pH is acidic (4 to 5), which protects from infection. Normally, the vagina maintains an acidic pH of 4 to 5, which protects the vagina from infection.

A nurse is caring for a client with chronic renal failure. The nurse receives the arterial blood gas result pH-7.19, PCO2- 42mmHg (5.59 kPa), Po2- 88mm Hg (11.70 kPa), HCO3-15mEq/L (15.00 mmol/L). What are the priority action(s) by the nurse? Select all that apply. A. Record intake and output. B. Administer sodium bicarbonate. C. Encourage rest. D. Apply noninvasive positive-pressure ventilation. E. Prepare for possible seizures.

A. Record intake and output. B. Administer sodium bicarbonate. C. Encourage rest. E. Prepare for possible seizures. The priority action by the nurse is seizure precautions, administering sodium bicarbonate to act as a bronchodilator, encouraging rest, and recording intake and output. Appling noninvasive positive-pressure ventilation is used for respiratory acidosis.

The nurse is caring for several clients. Which clients most likely have primary metabolic acidosis? Select all that apply. A. The client who took an overdose of aspirin B. The client with chronic kidney disease C. The client with hyperglycemia D. The client who has difficulty breathing. E. The client with chronic obstructive pulmonary disease

A. The client who took an overdose of aspirin B. The client with chronic kidney disease C. The client with hyperglycemia Hyperglycemia, aspirin overdose and chronic kidney disease are common causes of metabolic acidosis. Breathing disorders often cause respiratory blood gas abnormalities; rapid respiratory rate may occur as compensation for metabolic acidosis.

The body regulates the pH of its fluids by what mechanism? Select all that apply. A. The lungs B. The kidneys C. The cardiovascular system D. Chemical buffer systems of the body fluids The liver

A. The lungs B. The kidneys D. Chemical buffer systems of the body fluids The liver The pH of body fluids is regulated by three major mechanisms: (1) chemical buffer systems of the body fluids, which immediately combine with excess acids or bases to prevent large changes in pH; (2) the lungs, which control the elimination of CO2; and (3) the kidneys, which eliminate H+ and both reabsorb and generate HCO3-.

Insulin deficiency, in association with increased levels of counter-regulatory hormones and dehydration, is the primary cause of: A. diabetic ketoacidosis. B. ketonuria. C. glucosuria. D. ketone bodies.

A. diabetic ketoacidosis. Insulin deficiency, in association with increased levels of counter-regulatory hormones (glucagon, growth hormone, cortisol, catecholamines) and dehydration, is the primary cause of diabetic ketoacidosis (DKA), a life-threatening form of metabolic acidosis that is a frequent complication of diabetes. Liver converts triglycerides (lipolysis) to fatty acids, which in turn change to ketone bodies. The accumulation and excretion of ketone bodies by the kidneys is called ketonuria. Glucosuria is glucose that is spilled into the urine.

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? A. Metabolic alkalosis B. Respiratory alkalosis C. Metabolic acidosis D. Respiratory acidosis

B. Respiratory alkalosis A client with pneumonia may hyperventilate in an effort to increase oxygen intake. Hyperventilation leads to excess carbon dioxide (CO2) loss, which causes alkalosis — indicated by this client's elevated pH value. With respiratory alkalosis, the kidneys' bicarbonate (HCO3-) response is delayed, so the client's HCO3- level remains normal. The below-normal value for the partial pressure of arterial carbon dioxide (PaCO2) indicates CO2 loss and signals a respiratory component. Because the HCO3- level is normal, this imbalance has no metabolic component. Therefore, the client is experiencing respiratory alkalosis.

The nurse is caring for a client with worsening respiratory acidosis. Which of these interventions does the nurse anticipate if the client's condition continues to deteriorate? A. Introduction of large muscle exercise B. Reducing the amount of supplemental oxygen C. Mechanical ventilation D. Resolution of the underlying emotional cause

C. Mechanical ventilation The treatment of acute and chronic respiratory acidosis is directed toward improving ventilation. In severe cases, mechanical ventilation may be necessary. The remaining options would not effectively treat respiratory 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? A. Respiratory alkalosis B. Respiratory acidosis C. Metabolic acidosis D. Metabolic alkalosis

C. Metabolic acidosis Metabolic acidosis is a common clinical disturbance characterized by a low pH (increased H+ concentration) and a low plasma bicarbonate concentration. Metabolic alkalosis is a clinical disturbance characterized by a high pH (decreased H+ concentration) and a high plasma bicarbonate concentration. Respiratory acidosis is a clinical disorder in which the pH is less than 7.35 and the PaCO2 is greater than 42 mm Hg and a compensatory increase in the plasma HCO3 occurs. Respiratory alkalosis is a clinical condition in which the arterial pH is greater than 7.45 and the PaCO2 is less than 38 mm Hg.

A client is admitted to the unit with a diagnosis of intractable vomiting for 3 days. What acid-base imbalance related to the loss of stomach acid does the nurse observe on the arterial blood gas (ABG)? A. Respiratory alkalosis B. Respiratory acidosis C. Metabolic alkalosis D. Metabolic acidosis

C. Metabolic alkalosis Metabolic alkalosis is associated with an excess of HCO3, a decrease in H+ ions, or both, in the extracellular fluid (ECF). This may be the result of excessive acid losses or increased base ingestion or retention. Loss of stomach acid may result in this condition. Metabolic acidosis is a proportionate deficit of bicarbonate in ECF. The deficit can occur as the result of an increase in acid components or an excessive loss of bicarbonate such as in diarrhea. Respiratory acidosis is when the carbon dioxide level is high and the ph is low. Respiratory alkalosis is when the carbon dioxide level is low and the ph is high.

Vomiting results in which of the following acid-base imbalances? A. Metabolic acidosis B. Respiratory alkalosis C. Metabolic alkalosis D. Respiratory acidosis

C. Metabolic alkalosis Vomiting results in loss of hydrochloric acid (HCl) and potassium from the stomach, leading to a reduction of chlorides and potassium in the blood and to metabolic alkalosis.

A client has meconium-stained amniotic fluid. Fetal scalp sampling indicates a blood pH of 7.12; fetal bradycardia is present. Based on these findings, the nurse should take which action? A. Administer amnioinfusion. B. Start I.V. oxytocin infusion as ordered. C. Prepare for cesarean birth. D. Reposition the client.

C. Prepare for cesarean birth. Fetal blood pH of 7.19 or lower signals severe fetal acidosis; meconium-stained amniotic fluid and bradycardia are further signs of fetal distress that warrant cesarean birth. Amnioinfusion is indicated when the only abnormal fetal finding is meconium-stained amniotic fluid. Client repositioning may improve uteroplacental perfusion, but only serves as a temporary measure because the risk of fetal asphyxia is imminent. Oxytocin administration increases contractions, exacerbating fetal stress.

A male client has cirrhosis and is receiving diuretic therapy. The nurse knows that what drug will help prevent metabolic alkalosis or hypokalemia in this client? A. Bumetanide B. Dyazide C. Spironolactone D. Hydrochlorothiazide

C. Spironolactone For clients with cirrhosis, diuretic therapy should be initiated in a hospital setting, with small doses and careful monitoring. To prevent hypokalemia and metabolic alkalosis, supplemental potassium or spironolactone may be needed.

The nurse is caring for a client diagnosed with chronic obstructive pulmonary disease (COPD) and experiencing respiratory acidosis. The client asks what is making the acidotic state. The nurse is most correct to identify which result of the disease process that causes the fall in pH? A. The lungs are unable to breathe in sufficient oxygen. B. The lungs have ineffective cilia from years of smoking. C. The lungs are not able to blow off carbon dioxide. D. The lungs are unable to exchange oxygen and carbon dioxide

C. The lungs are not able to blow off carbon dioxide In clients with chronic respiratory acidosis, the client is unable to blow off carbon dioxide leaving in increased amount of hydrogen in the system. The increase in hydrogen ions leads to acidosis. In COPD, the client is able to breathe in oxygen and gas exchange can occur, it is the lungs ability to remove the carbon dioxide from the system. Although individuals with COPD frequently have a history of smoking, cilia is not the cause of the acidosis.

A client with a brain tumor develops hyperpnea. What ABG values would the nurse expect to obtain? A. pH 7.32, PCO2 45mm Hg (5.99 kPa), HCO3- 18 mEq/L (18 mmol/L), PO2 85mm Hg (11.30 kPa) B. pH 7.29, PCO2 67mm Hg (8.91 kPa), HCO3- 26 mEq/L (26 mmol/L), PO2 64mm Hg (8.51 kPa) C. pH 7.41, PCO2 39mm Hg (5.19 kPa), HCO3- 23 mEq/L (23 mmol/L), PO2 91mm Hg (12.10 kPa) D. pH 7.56, PCO2 31mm Hg (4.12 kPa), HCO3- 22 mEq/L (22 mmol/L), PO2 99mm Hg (13.17 kPa)

D. pH 7.56, PCO2 31mm Hg (4.12 kPa), HCO3- 22 mEq/L (22 mmol/L), PO2 99mm Hg (13.17 kPa) When a client develops hyperpnea, whether from a panic attack, high ventilator settings, or a condition that increases respiratory rate, the rate of excretion of carbon dioxide increases. This creates respiratory alkalosis.

The nurse is testing the pH of contents aspirated from a gavage feeding tube to confirm placement. Which finding indicates likely intestinal placement? A. pH 3 B. pH 7.0 C. pH 2.5 D. pH 4.5

B. pH 7.0 A pH over 6 indicates an alkaline environment and likely intestinal placement; a pH less than 5 points toward gastric placement.

A client informs the nurse of a problem with acid indigestion, stating he has been taking large amounts of calcium carbonate antacids daily but still has no relief. The client states that he can consume a bottle of 100 antacids in 4 days. Which blood gas result does the nurse anticipate assessing? A. PCO2 38 mm Hg (5.05 kPa) B. pH 7.6 C. PO2 80 mm Hg (10.64 kPa) D. pH 7.25

B. pH 7.6 A condition called mild-alkali syndrome is a condition in which chronic ingestion of milk or calcium carbonate antacids leads to hypercalcemia and metabolic alkalosis. The client would be in metabolic alkalosis and have an elevated, not decreased, pH. PCO2 would be expected to be increased (not within normal range) as the respiratory system will retain PCO2 in compensation for the metabolic alkalosis. PO2 levels would not be affected in the metabolic state.

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? A. PO2 B. Carbonic acid C. Bicarbonate D. PaO2

C. Bicarbonate Arterial blood gas (ABG) results are the main tool for measuring blood pH, CO2 content (PaCO2), and bicarbonate. An acid-base imbalance may accompany a fluid and electrolyte imbalance. PaO2 and PO2 are not indications of acid-base imbalance. Carbonic acid levels are not shown in an ABG.

The nurse is reviewing the following lab results of a client diagnosed with renal failure:pH: 7.24PCO2: 38 mm Hg (5.05 kPa)HCO3:18 mEq/L (18 mmol/L)The nurse would interpret this as: A. Respiratory acidosis B. Respiratory alkalosis C. Metabolic acidosis D. Metabolic alkalosis

C. Metabolic acidosis Metabolic acidosis would be diagnosed based on the findings related to a low pH level (<7.3) and a low bicarbonate level. Respiratory acidosis represents a decreased pH and an increased PCO2, metabolic alkalosis represents an increased pH and a increased HCO3, and respiratory alkalosis represents an increased pH and a decreased PCO2.

A client is admitted to the unit with a diagnosis of intractable vomiting for 3 days. What acid-base imbalance related to the loss of stomach acid does the nurse observe on the arterial blood gas (ABG)? A. Respiratory alkalosis B. Metabolic acidosis C. Metabolic alkalosis D. Respiratory acidosis

C. Metabolic alkalosis Metabolic alkalosis is associated with an excess of HCO3, a decrease in H+ ions, or both, in the extracellular fluid (ECF). This may be the result of excessive acid losses or increased base ingestion or retention. Loss of stomach acid may result in this condition. Metabolic acidosis is a proportionate deficit of bicarbonate in ECF. The deficit can occur as the result of an increase in acid components or an excessive loss of bicarbonate such as in diarrhea. Respiratory acidosis is when the carbon dioxide level is high and the ph is low. Respiratory alkalosis is when the carbon dioxide level is low and the ph is high.

A nurse is reviewing a report of a client's routine urinalysis. Which value requires further investigation? A. specific gravity of 1.03 B. absence of protein C. urine pH of 3.0 D. absence of glucose

C. urine pH of 3.0 Normal urine pH is 4.5 to 8; therefore, a urine pH of 3.0 is abnormal and requires further investigation. Urine specific gravity normally ranges from 1.002 to 1.035, making this client's value normal. Normally, urine contains no protein, glucose, ketones, bilirubin, bacteria, casts, or crystals. Red blood cells should measure 0 to 3 per high-power field; white blood cells, 0 to 4 per high-power field. Urine should be clear, with color ranging from pale yellow to deep amber.

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? A. 120 mm Hg B. 58 mm Hg C. 45 mm Hg D. 84 mm Hg

D. 84 mm Hg In general, clients with respiratory conditions are given oxygen therapy only to increase the arterial oxygen pressure (PaO2) back to the client's normal baseline, which may vary from 60 to 95 mm Hg.

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? A. Respiratory acidosis B. Metabolic acidosis C. Respiratory alkalosis D. Metabolic alkalosis

D. Metabolic alkalosis A pH over 7.45 with a HCO3- level over 26 mEq/L indicates metabolic alkalosis. Metabolic alkalosis is always secondary to an underlying cause and is marked by decreased amounts of acid or increased amounts of base HCO3-. The client isn't experiencing respiratory alkalosis because the PaCO2 is normal. The client isn't experiencing respiratory or metabolic acidosis because the pH is greater than 7.35.

When evaluating arterial blood gases (ABGs), which value is consistent with metabolic alkalosis? A. HCO 21 mEq/L B. O saturation 95% C. PaCO 36 D. pH 7.48

D. pH 7.48 Metabolic alkalosis is a clinical disturbance characterized by a high pH and high plasma bicarbonate concentration. The HCO value is below normal. The PaCO value and the oxygen saturation level are within a normal range.

A client is admitted with a diagnosis of diabetic ketoacidosis. An insulin drip is initiated with 50 units of insulin in 100 ml of normal saline solution administered via an infusion pump set at 10 ml/hour. The nurse determines that the client is receiving how many units of insulin each hour? Record your answer using a whole number.

5 UNITS To determine the number of insulin units the client is receiving per hour, the nurse must first determine the number of units in each milliliter of fluid (50 units ÷ 100 ml = 0.5 units/ml). Next, multiply the units per milliliter by the rate of milliliters per hour (0.5 units × 10 ml/hr = 5 units).

The nurse is aware that fluid replacement is a hallmark treatment for shock. Which of the following is the crystalloid fluid that helps treat acidosis? A. Lactated Ringer's B. 0.9% sodium chloride C. Dextran D. Albumin

A. Lactated Ringer's Lactated Ringer's is an electrolyte solution that contains the lactate ion, which is converted by the liver to bicarbonate, thus assisting with acidosis.

One form of renal tubular acidosis (RTA) results from aldosterone deficiency or resistance to its action, which leads to impaired reabsorption of which electrolyte? A. Sodium B. Glucose C. Hydrogen D. Potassium

A. Sodium One type of RTA results from aldosterone deficiency or resistance to its action, which leads to impaired reabsorption of sodium ions with decreased elimination of hydrogen and potassium ions. Glucose is not an electrolyte.

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? A. 120 mm Hg B. 84 mm Hg C. 58 mm Hg D. 45 mm Hg

B. 84 mm Hg In general, clients with respiratory conditions are given oxygen therapy only to increase the arterial oxygen pressure (PaO2) back to the client's normal baseline, which may vary from 60 to 95 mm Hg.

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? A. 58 mm Hg B. 84 mm Hg C. 120 mm Hg D. 45 mm Hg

B. 84 mm Hg In general, clients with respiratory conditions are given oxygen therapy only to increase the arterial oxygen pressure (PaO2) back to the client's normal baseline, which may vary from 60 to 95 mm Hg.

Which of the following factors would a nurse identify as a most likely cause of diabetic ketoacidosis (DKA) in a client with diabetes? A. The client has not consumed sufficient calories. B. The client has eaten and has not taken or received insulin. C. The client continues medication therapy despite adequate food intake. D. The client has been exercising more than usual.

B. The client has eaten and has not taken or received insulin. If the client has eaten and has not taken or received insulin, DKA is more likely to develop. Hypoglycemia is more likely to develop if the client has not consumed food and continues to take insulin or oral antidiabetic medications, if the client has not consumed sufficient calories, or if client has been exercising more than usual.

Before weaning a client from a ventilator, which assessment parameter is the most important for the nurse to obtain? A. fluid intake for the past 24 hours B. baseline arterial blood gas (ABG) levels C. electrocardiogram (ECG) results D. prior outcomes of weaning

B. baseline arterial blood gas (ABG) levels Before weaning the client from mechanical ventilation, it's most important to have baseline ABG levels. During the weaning process, ABG levels will be checked to assess how the client is tolerating the procedure. Other assessment parameters are less critical. Measuring fluid volume intake and output is always important when a client is being mechanically ventilated. Prior attempts at weaning and ECG results are documented on the client's record, and the nurse can refer to them before the weaning process begins.

The nurse is conducting a review class for a group of perinatal nurses about factors that place a pregnant woman at risk for infection in the postpartum period. The nurse determines that additional teaching is needed when the group identifies which factor? A. prolonged labor with multiple vaginal examinations to evaluate progress B. loss of protection with premature rupture of membranes C. increased vaginal acidity leading to growth of bacteria D. retained placental fragments

C. increased vaginal acidity leading to growth of bacteria Vaginal acidity is decreased due to the presence of amniotic fluid, blood, and lochia, all of which are alkaline. An alkaline environment encourages the growth of bacteria. With rupture of membranes, the barrier is removed, allowing bacteria to ascend through the internal genital structures. A prolonged labor with multiple vaginal examinations provides opportunities for exposure to organisms, with time for the bacteria to multiply. Retained placental fragments provide an excellent medium for bacterial growth.

Which of these ions plays an important role in pH homeostasis? A. potassium B. chloride C. sodium D. bicarbonate

D. bicarbonate Bicarbonate is an important buffer in body fluids, maintaining pH homeostasis.

The nurse is reporting on the results of client blood work to the oncoming nurse. Upon reviewing the data, it is noted that the client has an elevated uric acid level. Which inflammatory process would the nurse screen for on shift rounds? A. Osteoporosis B. Gout C. Rheumatoid arthritis D. Lupus erythematosus

B. Gout Gout is a medical condition with symptoms of acute inflammatory arthritis that is caused by high levels of uric acid in the blood. The client has uric acid crystal deposits in the joint. The nurse would assess joint areas for pain, redness, and swelling. Rheumatoid arthritis is a chronic disease of joint inflammation and pain. Lupus erythematous is a chronic tissue disorder of the connective tissue and is known to have an elevated antinuclear antibody level. Osteoporosis has a deficiency in the serum calcium level.

The nurse tests the pH of fluid found on the vaginal exam and determines that the woman's membranes have ruptured based on which result? A. 5.5 B. 6.0 C. 6.5 D. 5.0

C. 6.5 Amniotic fluid is alkaline, so the membranes are probably ruptured if the pH ranges from 6.5 to 7.5.

A client's arterial blood gas analysis reveals an excess of carbon dioxide. The nurse should recognize that this is consistent with which condition? A. metabolic alkalosis B. respiratory alkalosis C. respiratory acidosis D. metabolic acidosis

C. respiratory acidosis An increased level of dissolved carbon dioxide (PaCO2) indicates respiratory acidosis. Metabolic acidosis and alkalosis are not correct because this is a respiratory issue, not a metabolic one. Respiratory alkalosis would have a PaCO2 deficit, not an increase.

A client comes to the emergency department with status asthmaticus. The client's respiratory rate is 48 breaths/minute, and the client 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? A. metabolic acidosis B. metabolic alkalosis C. respiratory acidosis D. respiratory alkalosis

D. respiratory alkalosis Respiratory alkalosis results from alveolar hyperventilation. It's marked by a decrease in PaCO2 to less than 35 mm Hg and an increase in blood pH over 7.45. Metabolic acidosis is marked by a decrease in HCO3-- to less than 22 mEq/L, and a decrease in blood pH to less than 7.35. In respiratory acidosis, the pH is less than 7.35 and the PaCO2 is greater than 45 mm Hg. In metabolic alkalosis, the HCO3-- is greater than 26 mEq/L and the pH is greater than 7.45.

A male client with a history of heavy alcohol use has been admitted to the hospital for malnutrition and suspected pancreatitis. The client's diagnostic workup suggests alcoholic ketoacidosis as a component of his current health problems. He is somewhat familiar with the effect that drinking has had on his nutrition and pancreas, but is wholly unfamiliar with the significance of acid-base balance. How best could his care provider explain the concept to him? A. "The chemical processes that take place throughout your body are thrown off very easily when your body is too acidic or not acidic enough. B. "The multitude of chemical reactions that take place in your body depend on your body fluids being slightly acidic." C. "Your body is highly dependent on what food and fluid you consume to keep itself at a functioning level of slight non-acidity." D. "The healthy function of your kidneys and your lungs requires a specific level of pH in your body."

A. "The chemical processes that take place throughout your body are thrown off very easily when your body is too acidic or not acidic enough. Metabolic activity is highly contingent on a narrow range of pH. Normal pH is slightly basic, not acidic; appropriate pH is maintained by the lungs and kidneys, not vice versa. The action of respiratory and renal systems, not particular food or fluid intake, has the most salient effect on acid-base balance.

A nurse is providing care for several clients on an acute medicine unit. Which client should the nurse recognize as being at the highest risk for metabolic alkalosis? A. A client on continuous nasogastric suction and whose hypertension is being treated with diuretics B. A client in alcohol withdrawal who is being treated with intravenous anticonvulsants C. A client with acquired immunodeficiency syndrome (AIDS) who has developed tuberculosis and is receiving antibiotics D. A postoperative client who developed sepsis after the dehiscence of an abdominal wound

A. A client on continuous nasogastric suction and whose hypertension is being treated with diuretics Nasogastric suction creates a significant risk for metabolic alkalosis due to the loss of gastric acids. This risk is compounded by the concurrent use of diuretics. Alcohol use is associated with metabolic acidosis. Infections are not directly linked with the development of metabolic alkalosis.

When explaining how carbon dioxide combines with water to form carbonic acid as part of an acid-base lecture, the faculty instructor emphasizes that which enzyme is needed as a catalyst for this reaction? A. Carbonic anhydrase B. Trypsin C. Hydrolases D. Phenylalanine hydroxylase

A. Carbonic anhydrase Although CO2 is a gas and not an acid, a small percentage of the gas combines with water to form H2CO3. The reaction that generates H2CO3 from CO2 and water is catalyzed by an enzyme called carbonic anhydrase.

A client with AIDS has developed cytomegalovirus (CMV) retinitis and is receiving treatment with foscarnet. The nurse would monitor for which possible adverse drug effects? Select all that apply. A. Hyperphosphatemia B. Seizures C. Hypomagnesemia D. Neutropenia E. Hypercalcemia

A. Hyperphosphatemia B. Seizures C. Hypomagnesemia Adverse reactions associated with foscarnet include nephrotoxicity, including acute renal failure, and electrolyte imbalances such as hypocalcemia, hyperphosphatemia, and hypomagnesemia, which can be life-threatening. Seizures also may occur. Neutropenia is an adverse effect associated with ganciclovir.

Trousseau's sign is elicited by which of the following? A. After making a clenched fist, the palm remains blanched when pressure is placed over the radial artery. B. Carpopedal spasm is induced by occluding the blood flow to the arm for 3 minutes with the use of a blood pressure cuff. C. The patient complains of pain in the calf when his foot is dorsiflexed. D. A sharp tapping over the facial nerve just in front of the parotid gland and anterior to the ear causes spasm or twitching of the mouth, nose, and eye.

B. Carpopedal spasm is induced by occluding the blood flow to the arm for 3 minutes with the use of a blood pressure cuff. A positive Trousseau's sign is suggestive of latent tetany. A positive Chvostek's sign is demonstrated when a sharp tapping over the facial nerve just in front of the parotid gland and anterior to the ear causes spasm or twitching of the mouth, nose, and eye. A positive Allen's test is demonstrated by the palm remaining blanched with the radial artery occluded. A positive Homans' sign is demonstrated when the patient complains of pain in the calf when his foot is dorsiflexed.

A client with poorly controlled diabetes mellitus presents to the emergency department with suspected ketoacidosis. Which diagnostic results would be most likely to confirm this diagnosis? A. Low O2 levels, increased anion gap, base excess B. Increased anion gap, base deficit C .Decreased anion gap, decrease urine ammonium level D. High ammonia levels, decreased anion gap, high potassium

B. Increased anion gap, base deficit Increased CO2 levels, an increased anion gap, and a base deficit are all associated with an acidotic state. Base excess, low oxygen, high potassium, high ammonia, and decreased anion gap would not suggest acidosis.

A client with a history of heavy alcohol use has been admitted to a hospital with ABGs that indicate an acid-base imbalance. Which situation is most likely to result in an inappropriate pH for this client? A. Renal excretion of HCO3- in the presence of excess base B. Low albumin and plasma globulin levels C. Transcompartmental exchange of H+ and potassium ions D. Conservation or formation of new HCO3- by the kidneys

B. Low albumin and plasma globulin levels Albumin and plasma globulins are key protein buffers in the vascular compartment; consequently, a low albumin level, as is common in liver failure, is apt to result in acid-base imbalances. The other statements all convey normal physiologic processes that help to maintain pH.

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? A. Respiratory acidosis B. Metabolic acidosis C. Metabolic alkalosis D. Respiratory alkalosis

B. Metabolic acidosis This client's pH value is below normal, indicating acidosis. The HCO3- value also is below normal, reflecting an overwhelming accumulation of acids or excessive loss of base, which suggests metabolic acidosis. The PaCO2 value is normal, indicating absence of respiratory compensation. These ABG values eliminate respiratory alkalosis, respiratory acidosis, and metabolic alkalosis.

A client has meconium-stained amniotic fluid. Fetal scalp sampling indicates a blood pH of 7.12; fetal bradycardia is present. Based on these findings, the nurse should take which action? A. Reposition the client. B. Prepare for cesarean birth. C. Start I.V. oxytocin infusion as ordered. D. Administer amnioinfusion.

B. Prepare for cesarean birth. Fetal blood pH of 7.19 or lower signals severe fetal acidosis; meconium-stained amniotic fluid and bradycardia are further signs of fetal distress that warrant cesarean birth. Amnioinfusion is indicated when the only abnormal fetal finding is meconium-stained amniotic fluid. Client repositioning may improve uteroplacental perfusion, but only serves as a temporary measure because the risk of fetal asphyxia is imminent. Oxytocin administration increases contractions, exacerbating fetal stress.

A client with a suspected overdose of an unknown drug is admitted to the emergency department. Arterial blood gas values indicate respiratory acidosis. What should the nurse do first? A. Monitor the client's heart rhythm. B. Prepare to assist with ventilation. C. Obtain a urine specimen for drug screening. D. Prepare for gastric lavage.

B. Prepare to assist with ventilation. Respiratory acidosis is associated with hypoventilation; in this client, hypoventilation suggests intake of a drug that has suppressed the brain's respiratory center. Therefore, the nurse should assume the client has respiratory depression and should prepare to assist with ventilation. After the client's respiratory function has been stabilized, the nurse can safely monitor the heart rhythm, prepare for gastric lavage, and obtain a urine specimen for drug screening.

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? A. renin-angiotensin-aldosterone system B. bicarbonate-carbonic acid buffer system C. sodium-potassium pump D. ADH-ANP buffer system

B. bicarbonate-carbonic acid buffer system The major chemical regulator of plasma pH is the bicarbonate-carbonic acid buffer system. The renin-angiotensin-aldosterone system regulates blood pressure. The sodium-potassium pump regulate homeostasis. The ADH-ANP buffer system regulates water balance in the body.

The nurse is caring for a client with liver failure. What process of conversion does the nurse know will be impaired due to the inability of the liver to remove lactic acid from the bloodstream? A. Krebs cycle B. Oxidative metabolism C. Gluconeogenesis D. Glycolysis

C. Gluconeogenesis The liver removes lactic acid from the bloodstream and converts it to glucose in a process called gluconeogenesis. This glucose is released into the bloodstream to be used again by the muscles or by the central nervous 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? Select all that apply. A. Administer IV bicarbonate. B. Suction the client's airway. C. Maintain intake and output records. D. Compare ABG findings with previous results. E. Document presenting signs and symptoms.

C. Maintain intake and output records. D. Compare ABG findings with previous results. E. Document presenting signs and symptoms. Metabolic alkalosis results in increased plasma pH because of accumulated base bicarbonate or decreased hydrogen ion concentrations. The result is retention of sodium bicarbonate and increased base bicarbonate. Nursing management includes documenting all presenting signs and symptoms to provide accurate baseline data, monitoring laboratory values, comparing ABG findings with previous results (if any), maintaining accurate intake and output records to monitor fluid status, and implementing prescribed medical therapy.

Which medication may be responsible for a client developing increased uric acid levels by decreasing ECF volume? A. Vitamin C B. Penicillin antibiotics C. Antacids D. Thiazide diuretics

D. Thiazide diuretics Because of its effect on uric acid secretion, aspirin is not recommended for treatment of gouty arthritis. Thiazide and loop diuretics also can cause hyperuricemia and gouty arthritis, presumably through a decrease in ECF volume and enhanced uric acid reabsorption.

A client in the emergency department reports that they have been vomiting excessively for the past 2 days. The client's 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? A. respiratory acidosis B. metabolic acidosis C. respiratory alkalosis D. metabolic alkalosis

D. metabolic alkalosis A pH over 7.45 with a HCO3- level over 26 mEq/L indicates metabolic alkalosis. Metabolic alkalosis is always secondary to an underlying cause and is marked by decreased amounts of acid or increased amounts of base HCO3-. The client isn't experiencing respiratory alkalosis because the PaCO2 is normal. The client isn't experiencing respiratory or metabolic acidosis because the pH is greater than 7.35.

A client presents to the emergency department, reporting that they have been vomiting every 30 to 40 minutes for the past 8 hours. Frequent vomiting puts this client at risk for which imbalances? A. metabolic alkalosis and hyperkalemia B. metabolic acidosis and hypokalemia C. metabolic acidosis and hyperkalemia D. metabolic alkalosis and hypokalemia

D. metabolic alkalosis and hypokalemia Gastric acid contains large amounts of potassium, chloride, and hydrogen ions. Excessive vomiting causes loss of these substances, which can lead to metabolic alkalosis and hypokalemia. Excessive vomiting doesn't cause metabolic acidosis or hyperkalemia.

A client is admitted to the psychiatric clinic for treatment of anorexia nervosa. At the beginning of the client's hospitalization, the most important nursing action is to: A. weigh the client daily, after the evening meal. B. instruct the client to keep an accurate record of food and fluid intake. C. severely restrict the client's physical activities. D. monitor the client's vital signs, serum electrolyte levels, and acid-base balance.

D. monitor the client's vital signs, serum electrolyte levels, and acid-base balance. An anorexic client who requires hospitalization is in poor physical condition as a result of starvation and may die as a result of arrhythmias, hypothermia, malnutrition, infection, or cardiac abnormalities secondary to electrolyte imbalances. Therefore, monitoring the client's vital signs, serum electrolyte level, and acid-base balance is crucial. Restricting the client's physical activities may worsen anxiety. A weight obtained after breakfast is more accurate than one obtained after the evening meal. Instructing the client to keep a record of food and fluid intake would reward the client with attention for not eating and would reinforce the control issues that are central to the underlying psychological problem; also, the client might record food and fluid intake inaccurately.