Adaptive Quizzing chapter 16

A patient admitted with gastroenteritis has an arterial blood gas (ABG) report of pH 7.30, PaO2 80 mm Hg, PaCO2 46 mm Hg, HCO3 14. Which interpretation would the nurse use to affirm nursing interventions? 1 Metabolic acidosis 2 Metabolic alkalosis 3 Respiratory acidosis 4 Respiratory alkalosis

1 For respiratory conditions, the pH and the PaCO2 go in opposite directions. Respiratory alkalosis: pH high and PaCO2 is low. Respiratory acidosis: pH is low and the PaCO2 is high. In metabolic conditions, the pH and HCO3- go in the same direction (equal). The PaCO2 may also go in the same direction. Metabolic alkalosis: pH and HCO3- are high. Metabolic acidosis: pH and HCO3- are low.

After review of the morning laboratory reports, the nurse calculated a patient's anion gap because an arterial blood gas (ABG) was not available. Which acid-base imbalance would the nurse associate with an increased anion gap? 1 Metabolic acidosis 2 Metabolic alkalosis 3 Respiratory acidosis 4 Respiratory alkalosis

1 The anion gap = Na+ - (HCO3- + Cl-). The anion gap helps to determine the source of the acidosis when metabolic acidosis is present. The anion gap increases with metabolic acidosis due to increases in the concentration of acid (lactic acidosis, diabetic ketoacidosis), but the anion gap is normal when the metabolic acidosis is caused by the loss of bicarbonate (diarrhea). Metabolic alkalosis, respiratory acidosis, and respiratory alkalosis do not increase the anion gap.

The nurse determines that a patient's multilumen central venous access device (CAVD) is missing one of the injection caps, and the patient is exhibiting clinical manifestations of respiratory distress, hypotension, and tachycardia. Which action would the nurse implement first? 1 Administer oxygen via nasal cannula. 2 Notify the health care provider. 3 Reposition patient to left side, head down. 4 Adjust the IV fluids via the CAVD.

1 The cap off the central line could potentially allow entry of air into the circulation. For an air embolus from any source, the priority is to administer oxygen. Next, clamp the CAVD catheter and position the patient on the left side with the head down. Then the health care provider is notified. IV fluid is not needed in this scenario and could worsen the patient's respiratory status. However, use of the CAVD and rate adjustments depend on provider orders.

The presence of which clinical manifestations would confirm the nurse's interpretation of metabolic alkalosis from interpretation of the patient's arterial blood gas (ABG)? Select all that apply. 1 Tremors 2 Vomiting 3 Tachycardia 4 Epigastric pain 5 Numbness of limbs

1,2,3 Tremors, vomiting, and tachycardia are signs of metabolic alkalosis. Epigastric pain and numbness of limbs are signs of respiratory alkalosis.

For which clinical manifestations or disorders would the nurse monitor a patient for the development of respiratory alkalosis? Select all that apply. 1 Fever 2 Hypoxia 3 Pulmonary edema 4 Pulmonary emboli 5 Atelectasis

1,2,4 Respiratory alkalosis occurs when the plasma pH is increased and the PaCO2 is decreased (Remember ROME: Respiratory imbalances go in opposite directions). The most common causes of respiratory alkalosis are hypoxia, fever, and pulmonary emboli. These conditions are associated with hyperventilation. Pulmonary edema and chronic obstructive pulmonary disease (COPD) cause respiratory acidosis through hypoventilation.

Which acid-base mechanisms would the kidney use to buffer a patient's acidosis (serum pH < 7.35)? Select all that apply. Correct1 Eliminating excess H+ 2 Excreting excess water 3 Eliminating excess CO2 Correct4 Reabsorbing additional HCO3- 5 Reabsorbing additional sodium ions

1,4 As a compensatory mechanism, the pH of the urine can decrease to 4 or increase to 8. To compensate for acidosis, the kidneys can reabsorb additional HCO3- and eliminate excess H+. Thus, the pH of the blood increases and the pH of the urine decreases (more acidic). Eliminating excess water or CO2 or reabsorbing additional sodium ions are not mechanisms of acid-base buffers.

A hospitalized patient reports abdominal pain, nausea, and vomiting. Suspecting a bowel obstruction, for which primary acid-base imbalance would the nurse plan the patient's care, if the obstruction is high in the intestinal tract? 1 Metabolic acidosis 2 Metabolic alkalosis 3 Respiratory acidosis 4 Mixed alkalosis

2 Because gastric secretions are rich in hydrochloric acid, the patient who is vomiting will lose a significant amount of gastric acid and be at an increased risk for metabolic alkalosis. Metabolic acidosis is more likely with diarrhea than vomiting. Respiratory acidosis is associated with the lungs, not the gastrointestinal system. Mixed alkalosis may occur when a patient is hyperventilating because of pain and has a nasogastric (NG) tube to suction; each system is losing acid. The patient has metabolic alkalosis.

Which serum bicarbonate ion (HCO3-) level would indicate a compensatory response in the patient experiencing respiratory acidosis? 1 24 mEq/L 2 25 mEq/L 3 26 mEq/L Correct4 27 mEq/L

4 The serum bicarbonate ion concentration increases as a compensatory response in patients with respiratory acidosis. The normal range of bicarbonate ion is 22 to 26 mEq/L. Therefore, 27 mEq/L indicates a compensatory response.

Which arterial blood gas (ABG) data correspond with a patient's clinical manifestations of respiratory alkalosis? 1 pH 7.46, PaCO2 44 mm Hg, PaO2 95 mm Hg, and HCO3- 36 mEq/L 2 pH 7.27, PaCO2 70 mm Hg, PaO2 80 mm Hg, and HCO3- 26 mEq/L 3 pH 7.30, PaCO2 35 mm Hg, PaO2 70 mm Hg, and HCO3- 20 mEq/L 4 pH 7.52, PaCO2 24 mm Hg, PaO2 85 mm Hg, and HCO3- 24 mEq/L

4 Use the memory device ROME. For respiratory conditions, the pH and the PaCO2 go in opposite directions. Respiratory alkalosis: pH high and PaCO2 is low. Respiratory acidosis: pH is low and the PaCO2 is high. In metabolic conditions, the pH and HCO3- go in the same direction (equal). The PaCO2 may also go in the same direction. Metabolic alkalosis: pH and HCO3- are high. Metabolic acidosis: pH and HCO3- are high.