Acid /Base EAQ

Which statement by the patient indicates high risk for esophageal cancer?

"I eat a lot of pickles."

The nurse is providing teaching to a patient who is scheduled for esophageal dilation. Which statement by the patient indicates a need for further teaching?

"I won't have any difficulty swallowing anymore."

A patient is admitted with chronic anemia. What physiologic imbalance does the nurse suspect the patient is at risk of developing?

Acidosis

While assessing and reviewing the laboratory reports of a patient with cystic fibrosis, the nurse suspects that the disease has progressed to the end stage. Which findings support the nurse's suspicion? Select all that apply.

Acidosis Severe dyspnea Increased crackles

What assessment findings are consistent with advanced disease in a patient newly diagnosed with an esophageal tumor? Select all that apply.

Halitosis Vomiting Chronic hiccups

A patient is admitted from the emergency department for intravenous (IV) fluids to treat dehydration caused by several days of vomiting and diarrhea. The patient's admission venous blood work reveals a pH of 7.27 and bicarbonate of 26 mEq/L; potassium and chloride levels are within normal ranges. The provider has ordered adding bicarbonate to the IV fluids. Which action by the nurse is correct?

Hold the bicarbonate and report the laboratory values to the provider.

The nurse is reviewing the medical record for a patient with polycystic kidney disease who is scheduled for a computed tomography (CT) angiography with contrast: Which intervention is essential for the nurse to perform?

Hold the metformin 24 hours before and on the day of the procedure.

The nurse obtains lab results for a 50-year-old patient with the following results: pH 7.24; bicarbonate 20; Pao2 82; Paco2 35. These findings are consistent with which acid-base imbalance?

Metabolic acidosis

A 90-year-old patient with hypermagnesemia is seen in the emergency department (ED). The ED nurse prepares the patient for admission to which inpatient unit?

Telemetry/cardiac stepdown

While assessing a patient with metabolic acidosis, the nurse suspects that the patient has lactic acidosis. The nurse makes the conclusion based on what finding?

The patient has symptoms of hypoxia

Which acid-base imbalance does the nurse anticipate the patient with morbid obesity may develop?

Respiratory acidosis

A patient is admitted with hypokalemia and skeletal muscle weakness. Which assessment does the nurse perform first?

Respirations

The nurse is caring for a patient diagnosed with odynophagia. Which statement by the patient indicates a need for further teaching?

"Drinking cold fluids may help with the pain."

A patient currently taking acetazolamide develops metabolic acidosis. Which nursing interventions are appropriate for the nurse to include in the plan of care? Select all that apply.

-Administering IV fluids. -Monitoring electrolyte levels. -Placing the patient on fall precautions.

Which complications of gastroesophageal reflux disease (GERD) are more commonly seen in older adults? Select all that apply.

-Barrett's esophagus -Esophageal erosions -Aspiration pneumonia

Which conditions place a patient at risk for developing metabolic alkalosis? Select all that apply.

-Blood transfusion -Total parenteral nutrition -Nasogastric suctioning

A patient has been poisoned by botulinum toxins. What assessment findings suggest the patient has acidosis? Select all that apply

-Confusion -Warm, flushed, dry skin

What key features should be assessed when a patient is diagnosed with an esophageal tumor? Select all that apply.

-Dysphagia -Odynophagia -Regurgitation

To safely administer potassium to a patient with hypokalemia, which actions does the nurse perform? Select all that apply.

-Establish and evaluate the patency of a large vein. -Obtain an IV controller device (pump). -Plan to assess the respiratory rate and oxygen saturation every hour. -Evaluate the heart rate and regularity.

A nurse is assessing a patient with metabolic and respiratory acidosis. What manifestations does the nurse anticipate finding in the patient? Select all that apply.

-Flaccid paralysis -Kussmaul respirations -Delayed electrical conduction

The nurse is caring for a patient with metabolic alkalosis. What manifestations of metabolic alkalosis is the nurse likely to assess? Select all that apply.

-Hyperactivity of deep tendon reflexes -Numbness around the mouth

What factors are associated with esophageal cancer? Select all that apply.

-Malnutrition -Untreated gastroesophageal reflux disease (GERD)

An older patient is admitted with pneumonia. What changes in the patient does the nurse expect to assess when obtaining data about the patient's acid-base imbalance? Select all that apply.

-New-onset mental status changes -Dry mucous membranes -Dark, concentrated urine -Thready peripheral pulses

Which medications should the nurse ask if a patient is taking if the patient has a new diagnosis of gastroesophageal reflux disease (GERD)? Select all that apply.

-Nitrates -Oral contraceptives -Nonsteroidal anti-inflammatory drugs (NSAIDs)

The laboratory reports of a patient show the patient has metabolic alkalosis. What conditions may result in metabolic alkalosis? Select all that apply.

-Prolonged vomiting -Nasogastric suctioning -Blood transfusion -Total parenteral nutrition

The nurse has just received a report on a patient being admitted from the emergency department (ED). Which items from the report would contribute to the development of metabolic acidosis? Select all that apply.

-Reported heavy alcohol consumption -Chronic cirrhosis of the liver with liver failure -Seizure in the ambulance en route to the hospital

Which conditions and/or symptoms may be most likely responsible for this acid-base imbalance: pH 7.32, Pao2 82 mm Hg, Paco2 50 mm Hg, HCO3-18 mEq/L? Select all that apply.

-Respiratory rate of 8 breaths/min -Prolonged vomiting -Oliguria -Dehydration

The nurse suspects that a patient has developed metabolic acidosis because of an overproduction of hydrogen ions. The nurse makes the conclusion based on what assessment findings? Select all that apply.

-The patient has been fasting for 30 days. -The patient has diabetic ketoacidosis. -The patient has salicylate intoxication.

What history and assessment findings may be associated with hypocalcemia in a 22-year-old man? Select all that apply.

-wakening at night with muscle spasms in the calf -Recent blunt trauma to the throat during a football game -Tingling around the mouth

The nurse is teaching a patient about the production of thyroid hormone. Arrange the steps in the thyroid hormone production in the order in which they occur.

1. The thyroid gland withdraws and concentrates iodide in the blood. 2. Iodide combines with tyrosine. 3. Triiodothyronine (T4) and thyroxine (T3) are formed. 4. Hormones bind to thyroglobulin. 5. Hormones are stored in the follicular cells of the thyroid gland.

Which assessment data is the best indication of perfusion after a surgical procedure?

Urine output

After receiving change-of-shift report, which patient does the RN assess first?

46-year-old receiving IV diuretics whose blood pressure is 95/52 mm Hg

Which total urine output for the previous day would place a patient at risk for accumulating waste products?

500 mL

Which patient is at greatest risk for hypernatremia?

54-year old who is sweating profusely

The nurse is caring for four patients. Which patient should the nurse see first?

A patient diagnosed with an esophageal tumor with severe dysphagia

A 68-year-old man is admitted to the hospital with dehydration. He has a history of atrial fibrillation, congestive heart failure (CHF), and hypertension. His current medications are digoxin, chlorothiazide, and potassium supplements. He tells a nurse that he has had flulike symptoms for the past week and has been unable to drink for the past 48 hours. The nurse starts the patient's IV and receives laboratory results, which include a potassium level of 2.7 mEq/L. The physician orders an IV potassium supplement. How does the nurse administer this medication?

Added to an IV, not to exceed 20 mEq/hr

Which prescribed intervention does the nurse implement first for a patient with metabolic acidosis from shock?

Administer intravenous fluids.

The nurse is caring for a group of patients with acidosis. The nurse recognizes that Kussmaul respirations are consistent with which situation?

Aspirin overdose

A patient receiving insulin and glucose infusion therapy for hyperkalemia now has a serum potassium level of 3.6 mEq/L. What is the nurse's first action?

Assess the patient's heart rate, rhythm, and respiratory status.

A patient who has just undergone porfimer sodium therapy contacts the health care provider's office, concerned about particles in the sputum. What action by the nurse is priority?

Assure the patient that this is a normal finding after the procedure.

Which assessment finding requires priority nursing intervention in a patient with metabolic or respiratory acidosis?

Bradycardia with widened QRS complex

What teaching should be provided for a patient diagnosed with esophageal diverticula?

Avoid bending

Which parameter would assess acid-base balance in a patient?

Bicarbonate level

The nurse is reviewing assessment data for a patient who was admitted for emergency treatment of an acute asthmatic episode. Which assessment data suggest the patient is in an uncompensated acid-base imbalance?

Bicarbonate of 24 mEq/L

A 77-year-old woman is brought to the emergency department by her family after she has had diarrhea for 3 days. The family tells the nurse that she has not been eating or drinking well, but that she has been taking her diuretics for congestive heart failure (CHF). She is receiving lactated Ringer's solution IV for rehydration. What clinical manifestations does the nurse monitor during rehydration of the patient? Select all that apply.

Blood pressure Pulse rate and quality Urinary output Urine specific gravity levels

Which is the most critical fluid to prevent death?

Blood volume

A patient in acute respiratory distress from an asthma attack becomes more confused. Respirations remain rapid, but are more shallow. The most recent blood gas results are pH 7.29, Pao2 62 mm Hg, Paco2 56 mm Hg, HCO3- 25 mEq/L. What is the nurse's priority intervention?

Call the Rapid Response Team.

A patient with type 1 diabetes arrives in the emergency department breathing deeply and stating, "I can't catch my breath." The patient's vital signs are: T 98.4° F (36.9° C), P 112 beats/min, R 38/min, BP 91/54 mm Hg, and O2 saturation 99% on room air. Which action does the nurse take first?

Check the blood glucose.

Which conditions should a nurse identify in a patient as a cause of gram negative sepsis? Select all that apply.

Cirrhosis Metabolic acidosis Intravascular hemolysis

The nurse is providing care to a patient who is experiencing severe nausea, vomiting, and diarrhea. Which is the patient at risk of developing? Select all that apply.

Dehydration Hyperkalemia Hypernatremia

Which condition is least likely to cause fluid overload?

Diabetes insipidus

A patient has been diagnosed with hyperaldosteronism. What laboratory finding is used to confirm this diagnosis?

Elevated blood pH

A patient develops fluid overload while in the intensive care unit. Which nursing intervention does the nurse perform first?

Elevates the head of the bed

Which symptoms should be assessed for in a patient suspected of having gastroesophageal reflux disease (GERD)? Select all that apply

Eructation Flatulence

Which will the nurse include in the documentation for a patient's measurable output at the end of the shift? Select all that apply.

Feces Urine Emesis Chest tube drainage

What clinical finding does the nurse expect in a patient with reduced aldosterone secretion?

Hyperkalemia

Which electrolyte imbalance is the patient with metabolic acidosis at risk to develop?

Hyperkalemia

The nurse admits a patient with dehydration. Which electrolyte imbalances does the nurse anticipate based on this diagnosis? Select all that apply.

Hyperkalemia Hypernatremia

A patient who recently experienced an anterior neck injury reports frequent and painful muscle spasms in the calf during sleep. Which condition does the nurse suspect in the patient?

Hypocalcemia

A patient admitted with diabetic ketoacidosis was treated for metabolic acidosis with IV fluids and insulin. Which electrolyte imbalance does the nurse monitor for as the acid-base imbalance resolves?

Hypokalemia

The nurse is providing care to a patient who is experiencing tachypnea. Which intervention is most appropriate to maintain the patient's fluid balance?

Increase intravenous fluids

A patient with chronic kidney disease (CKD) has developed the Kussmaul pattern of respiration. What causes this breathing pattern?

Increased acid retention

What is a risk factor associated with tachypnea?

Increased insensible water loss

Which is the least likely effect of sleep apnea on body metabolism?

Increased pH

The nurse is caring for a patient with an oxygen saturation of 88% and accessory muscle use. The nurse provides oxygen and anticipates which of these health care provider orders?

Intubation and mechanical ventilation

A patient diagnosed with gastroesophageal reflux disease (GERD) is learning about lifestyle changes that can decrease the chance of developing esophageal cancer. What findings indicate that the teaching was effective? Select all that apply.

Losing 15 pounds Sleeping with the head elevated Using a continuous positive airway pressure (CPAP) machine to sleep

The nurse is admitting a patient with diabetic ketoacidosis to the intensive care unit (ICU). What arterial blood gas (ABG) result will the nurse likely find when reviewing the patient's laboratory results?

Low pH, low CO2, low HCO3

A patient is suspected of having muscular dystrophy (MD). Which laboratory test result does the nurse anticipate with this disease?

Moderately elevated aspartate aminotransferase (AST)

A patient is being discharged from the hospital before completely resolving the problem of fluid overload. What instructions should the nurse give to the caretaker in order to avoid the recurrence of fluid overload? Select all that apply.

Monitor the fluid intake Monitor the sodium intake Monitor the weight gain of the patient

A patient is recovering from an acute episode of chronic obstructive pulmonary disease (COPD). Which nursing action is the greatest priority in the plan of care?

Monitor the respiratory rate and effort hourly.

What would be the most appropriate intervention for a patient who developed metabolic acidosis as a consequence of burn injuries?

Monitoring bicarbonate levels

Which parameters should be monitored to assess a patient's response to fluid replacement therapy? Select all that apply.

Monitoring pulse quality Monitoring urine output Monitoring weight changes every 8 hours

What medications are provided to a patient who has experienced esophageal trauma? Select all that apply.

Morphine Lidocaine viscous Methylprednisolone

The nurse is assessing patients with acid-base imbalances. Which patient has a diagnosis that correctly correlates with the patient's manifestation?

Patient A has metabolic acidosis.

When caring for a group of patients at risk for respiratory acidosis, the nurse identifies which person as at highest risk?

Patient who smokes cigarettes

Which patient would be appropriate to assign to the new nurse working on the medical-surgical unit?

Patient with emphysema and cellulitis with a Paco2 level of 58 mm Hg

The health care provider writes orders for a patient who is admitted with a serum potassium (K) level of 6.9 mEq/L. What does the nurse implement first?

Place the patient on a cardiac monitor.

What is a consequence of fluid overload?

Pulmonary Edema

The nurse is administering sodium chloride 0.9% (normal saline) intravenously to a patient who is dehydrated. Which assessments does the nurse perform to evaluate the effectiveness of rehydration therapy? Select all that apply.

Pulse rate and quality Urinary output

Which nursing action is recommended when providing care to a patient with hypokalemia?

Question the continued administration of bumetanide.

A patient is admitted with an exacerbation of Guillain-Barré syndrome (GBS), presenting with dyspnea. Which intervention does the nurse perform first?

Raises the head of the bed to 45 degrees

What medications are administered to a patient with acute pancreatitis to decrease gastric acid secretion? Select all that apply.

Ranitidine Omeprazole

A patient with severe cirrhosis of the liver has a urine output of 400 mL for the past 2 days despite adequate intravenous fluid administration. What is the priority nursing action for this patient?

Request an order for blood urea nitrogen (BUN) and serum creatinine levels.

After a motor vehicle crash, the nurse is consoling a patient in the emergency department who is hysterical and hyperventilating after being notified of the death of a family member. What acid-base imbalance is this patient likely to develop?

Respiratory alkalosis

Lab results for a 62-year-old patient show the following results: pH 7.48; bicarbonate 26; Pao2 90; Paco2 32. These findings are consistent with which acid-base imbalance?

Respiratory alkalosis

A patient with diabetes mellitus is brought to the emergency department after vomiting for several days. The patient has rapid, deep respirations and a urine dipstick reveals ketonuria. Which process does the nurse suspect is occurring with this patient?

Respiratory compensation for metabolic acidosis

What symptoms are consistent with a large-bowel obstruction? Select all that apply.

Ribbon-like stool Metabolic acidosis Lower abdominal distention

When caring for a patient with hyponatremia, which intervention does the nurse implement?

Small-volume intravenous infusions of 3% normal saline

Which risk factors should be included when teaching about reducing the risk of proton pump inhibitors (PPIs) for a patient at risk for development of gastroesophageal reflux disease (GERD)? Select all that apply.

Smoking Peppermint Aged cheeses

The nurse is assessing a patient's serum electrolyte values upon admission to the medical-surgical unit. Which value would cause the nurse to monitor the patient for dehydration?

Sodium 150 mEq/L

A patient with swollen arms and legs was brought to the emergency department. Which laboratory parameter would help in the diagnosis of peripheral edema?

Specific gravity of urine

The trauma nurse is caring for a patient who sustained thoracic trauma with multiple rib fractures and flail chest. Which intervention may be considered to promote gas exchange and prevent respiratory acidosis in this patient?

Ventilatory assistance

A patient diagnosed with myocardial infarction has the following labs: potassium 3.5 mEq/L, calcium 8.5 mg/dL, magnesium 1.8 mEq/L, and pH 7.31. What value should be reported to the health care provider first?

pH 7.31

Which arterial blood gas result does the nurse anticipate in the care of a patient diagnosed with acute kidney failure?

pH 7.33, Pao2 82 mm Hg, Paco2 35 mm Hg, HCO3- 19 mEq/L

A patient diagnosed with gastroesophageal reflux disease (GERD) reports taking antacids multiple times a day for the last couple of months. What lab value should be assessed in this patient?

ph