acid/base

A client is brought to the emergency department semicomatose and a blood glucose reading of 673. He 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 anticipate that which order may correct this diabetic ketosis? -Administration of potassium chloride -Initiating an insulin IV infusion along with fluid replacement -Administering supplemental oxygen and rebreathing from a paper bag -Instituting a cough-and-deep breathing schedule for every hour while awake to improve ventilation

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 is used as a treatment of metabolic alkalosis. Administering supplemental oxygen and rebreathing from a paper bag are usual treatment of respiratory alkalosis. Instituting a cough-and-deep breathing schedule for every hour while awake to improve ventilation is usual treatment of respiratory acidosis.

A nurse caring for a client with metabolic acidosis should perform a focused assessment on which body systems to assist in determining causative factors for the acidosis? Select all that apply.

Renal GI

Respiratory alkalosis can be caused by a respiratory rate in excess of that which maintains normal plasma PCO2 levels. What is a common cause of respiratory alkalosis?

hyperventilation

A client hospitalized for treatment of a pulmonary embolism develops respiratory alkalosis. Which clinical findings commonly accompany respiratory alkalosis? -nausea or vomiting -abdominal pain or diarrhea -hallucinations or tinnitus -light-headedness or paresthesia

lightheadedness and parasthesia The client with respiratory alkalosis may complain of light-headedness or paresthesia (numbness and tingling in the arms and legs). Nausea, vomiting, abdominal pain, and diarrhea may accompany respiratory acidosis. Hallucinations and tinnitus rarely are associated with respiratory alkalosis or any other acid-base imbalance.

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

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.

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:

monitor the client's vital signs, serum electrolyte levels, and acid-base balance Rationale: watching stuff having to do with respiratory acidosis

A pregnant client has developed iron-deficiency anemia and has been prescribed 200 mg of elemental iron per day. The nurse should encourage the client to take this medication with which substance? -milk -a full meal -water -orange juice

orange juice Iron is absorbed best from an acid medium. Advise women, therefore, to take iron supplements with orange juice or a vitamin C supplement, which supplies ascorbic acid.

A client's arterial blood gas analysis reveals an excess of carbon dioxide. The nurse should recognize that this is consistent with which condition?

respiratory acidosis

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? -metabolic acidosis -respiratory acidosis -metabolic alkalosis -respiratory alkalosis

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.

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

the client has eaten and has not taken or received insulin

Diuretics that result in hypokalemia are

thiazides