Chapter 9: Acid-Base Balance
2. The results of a patient's arterial blood gas sample indicate an oxygen level of 72 mm Hg. Based on this result the nurse needs to closely assess which parameter when providing care to this patient? 1. Perfusion 2. Level of consciousness 3. Urine output 4. Fluid and electrolytes
2. ANS: 2 Chapter number and title: 9, Acid-Base Balance Chapter learning objective: 6. Explaining nursing considerations related to patients with acid-base disorders Chapter page reference: 142 Heading: Acid-Base Balance Overview/Table 9.1 - Oxygenation Based Gas Values Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Analysis [Analyzing] Concept: Assessment Difficulty: Moderate Feedback 1 Perfusion is affected by a reduction in circulating fluids. 2 An oxygen level of less than 75 mm Hg can be due to hypoventilation. This drop in oxygen will change the patient's level of responsiveness. 3 Urine output is not impacted by oxygenation status and is more related to renal perfusion. 4 With a fluid and electrolyte imbalance, there is another disorder affecting acid-base balance. This might not be affected by oxygen level.
21. The nurse is providing care to a patient who has been vomiting for several days. Which acid-base disorder does the nurse assess for in this patient? 1. Metabolic alkalosis 2. Respiratory alkalosis 3. Metabolic acidosis 4. Respiratory acidosis
21. ANS: 1 Chapter number and title: 9, Acid-Base Balance Chapter learning objective: 4. Comparing and contrasting major acid-base disorders Chapter page reference: 151 Heading: Acid-Base Disorders/Metabolic Alkalosis Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Physiological Adaptation Cognitive Level: Comprehension [Understanding] Concept: pH Regulation Difficulty: Moderate Feedback 1 Metabolic alkalosis caused by loss of hydrogen ions usually occurs because of vomiting or gastric suction. Gastric secretions are highly acidic (pH 1-3). When these are lost through vomiting or gastric suction, the alkalinity of body fluids increases. This increased alkalinity results from the loss of acid and from selective retention of bicarbonate by the kidneys as chloride is depleted. 2 Respiratory alkalosis is an acid-base imbalance caused by an increase in the rate of alveolar ventilation. Acute alveolar hyperventilation is often the result of anxiety and is commonly referred to as hyperventilation syndrome. 3 Metabolic acidosis caused by an increased accumulation of metabolic acids that rise in proportion to a decrease in bicarbonate and result in decreased arterial pH. 4 Respiratory acidosis results from altered ventilation leading to CO2 retention.
26. In analyzing an arterial blood gas, the nurse correlates which findings to an uncompensated respiratory acidosis? Select all that apply. 1. pH 7.30 2. PaO2 82 mm Hg 3. PaCO2 48 mm Hg 4. HCO3 28 mEq/L 5. SaO2 90%
26. ANS: 1, 3 Chapter number and title: 9. Acid-Base Balance Chapter learning objective: 2. Stating the steps for arterial blood gas interpretation Chapter page reference: 146-147 Heading: Arterial Blood Gas Interpretation/Arterial Blood Gas Assessment Integrated Processes: Nursing Process: Assessment Client Need: Physiological Adaptation: Reduction of Risk Potential Cognitive Level: Comprehension [Understanding] Concept: pH Regulation Difficulty: Moderate Feedback 1 This is correct. pH 7.30 is observed in an acidotic state. The normal range is 7.35-7.45. 2 This is incorrect. The PaO2 measures the partial pressure of oxygen in arterial blood and is the most important factor in determining how oxygen binds to hemoglobin. The normal range is 80-95 mm Hg. 3 This is correct. Carbon dioxide is measured by the PaCO2 levels, which indicate the partial pressure of CO2 in the arterial blood. The PaCO2 is used to evaluate the respiratory component of acid-base balance. Primarily regulated by the ventilatory function of the lungs, normal arterial CO2 levels are 35 to 45 mm Hg. PaCO2 greater than 45 mm Hg is related to hypoventilation or excessive CO2 retention and therefore acidosis.
1. The nurse prepares the patient diagnosed with chronic obstructive pulmonary disease (COPD) for which diagnostic test to monitor acid-base balance? 1. Pulse oximetry 2. Bronchoscopy 3. Sputum studies 4. Arterial blood gases
1. ANS: 4 Chapter number and title: 9, Acid-Base Balance Chapter learning objective: 2. Stating the steps for arterial blood gas interpretation Chapter page reference: 142-143 Heading: Acid-Base Balance Overview: Oxygenation Integrated Processes: Nursing Process: Planning Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Comprehension [Understanding] Concept: Assessment Difficulty: Easy Feedback 1 Pulse oximetry is a noninvasive test that evaluates the oxygen saturation level of blood. 2 A bronchoscopy provides visualization of internal respiratory structures. 3 Sputum studies can provide specific information about bacterial organisms. 4 Arterial blood gas analysis is done to assess alterations in acid-base balance caused by respiratory disorders, metabolic disorders, or both.
10. The nurse is providing care to a patient admitted for a traumatic brain injury who has developed respiratory acidosis. Which action by the nurse is the priority? 1. Monitoring peripheral vascular status 2. Reassuring the patient to decrease anxiety 3. Assessing respiratory rate and depth closely 4. Administering sodium bicarbonate as ordered
10. ANS: 3 Chapter number and title: 9, Acid-Base Balance Chapter learning objective: 6. Explaining nursing considerations related to patients with acid-base disorders Chapter page reference: 149 Heading: Acid-Base Disorders/Respiratory Acidosis/Nursing Management/ Nursing Interventions Integrated Processes: Nursing Process: Implementation Client Need: Physiological Integrity: Physiological Adaptation Cognitive Level: Analysis [Analyzing] Concept: Assessment Difficulty: Moderate Feedback 1 This nursing action is more appropriate for the patient diagnosed with metabolic, not respiratory, acidosis. 2 Anxiety is more common for the patient diagnosed with respiratory alkalosis, not respiratory acidosis. 3 Nursing interventions for patients with respiratory acidosis include maintaining the patient's airway, monitoring arterial blood gas levels, monitoring vital signs (especially respiratory rate and depth), administering supplemental oxygen, assisting with intubation if necessary, monitoring potassium levels, administering sedatives cautiously, and providing patient reassurance and teaching as needed. 4 Sodium bicarbonate is prescribed for metabolic acidosis, not respiratory acidosis.
11. The nurse is providing care to a patient who is admitted to the hospital with sudden, severe abdominal pain. Which arterial blood gas supports the patient's current diagnosis of respiratory alkalosis? 1. pH is 7.35 and PaO2 is 88. 2. pH is 7.30 and HCO3 is 30. 3. pH is 7.47 and PaCO2 is 25. 4. pH is 7.33 and PaCO2 is 36.
11. ANS: 3 Chapter number and title: 9, Acid-Base Balance Chapter learning objective: 2. Stating the steps for arterial blood gas interpretation Chapter page reference: 149 Heading: Acid-Base Disorders/Respiratory Alkalosis/Arterial Blood Gas Results Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Analysis Concept: Assessment Difficulty: Difficult Feedback 1 This arterial blood gas value indicates a normal pH and PaO2, not respiratory alkalosis. 2 Respiratory alkalosis includes a high pH and decreased PaCO2. This PaCO2 is low. 3 Acute pain usually causes hyperventilation, which causes the CO2 to drop and the patient to experience respiratory alkalosis. The pH would denote alkalosis and would be higher than 7.45. HCO3 would trend downward as the kidneys begin to compensate for the alkalosis by excreting HCO3. The PaO2 is likely to be normal unless the patient has been hyperventilating for a long time and is beginning to tire. 4 The pH is normal; the PaCO2 is low and does not correlate with respiratory alkalosis.
12. The patient is admitted to the emergency department (ED) with symptoms of a panic attack. Based on this data, the nurse recognizes the patient is at risk for which acid-base disorder? 1. Metabolic alkalosis 2. Metabolic acidosis 3. Respiratory acidosis 4. Respiratory alkalosis
12. ANS: 4 Chapter number and title: 9, Acid-Base Balance Chapter learning objective: 4. Comparing and contrasting major acid-base disorders Chapter page reference: 149 Heading: Acid-Base Disorders/Respiratory Alkalosis/Box 9.4 Causes of Respiratory Alkalosis Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Reduction for Risk Potential Cognitive Level: Comprehension [Understanding] Concept: pH Regulation Difficulty: Easy Feedback 1 Metabolic alkalosis caused by loss of hydrogen ions usually occurs because of vomiting or gastric suction. Gastric secretions are highly acidic (pH 1-3). 2 Metabolic acidosis is caused by an increased accumulation of metabolic acids that rise in proportion to a decrease in bicarbonate and result in decreased arterial pH. 3 Anxiety and panic attacks will lead to hyperventilation, not hypoventilation. Respiratory acidosis results from altered ventilation leading to CO2 retention secondary to hypoventilation 4 Anxiety disorders increase the risk for the acid-base imbalance respiratory alkalosis because of hyperventilation that leads to loss of carbon dioxide.
13. The nurse completes discharge teaching for a patient with an anxiety disorder. Which patient statement indicates correct understanding of information related to respiratory alkalosis? 1. "I will eat more bananas at breakfast." 2. "I will practice stress reduction." 3. "I will not take antacids when I have heartburn." 4. "I will breathe faster when I am feeling anxious."
13. ANS: 2 Chapter number and title: 9, Acid-Base Balance Chapter learning objective: 6. Explaining nursing considerations related to patients with acid-base disorders Chapter page reference: 149 Heading: Acid-Base Disorders/Respiratory Alkalosis/Box 9.4 Causes of Respiratory Alkalosis Integrated Processes: Teaching and Learning Client Need: Physiological Integrity: Physiological Adaptation Cognitive Level: Analysis [Analyzing] Concept: pH Regulation Difficulty: Moderate Feedback 1 Eating bananas is more appropriate for the patient at risk for metabolic alkalosis who is on diuretics. 2 The patient understands that reducing anxiety can reduce hyperventilation and respiratory alkalosis. Practicing stress reduction can help the patient develop alternative strategies for dealing with anxiety. 3 Taking too many antacids is associated with metabolic alkalosis. 4 Breathing faster will increase hyperventilation and exacerbate respiratory alkalosis.
14. The nurse is reviewing the healthcare provider's orders for a patient who is diagnosed with respiratory alkalosis. Which order is appropriate for this patient's care needs? 1. Monitor arterial blood gas results. 2. Administer oxygen via face mask. 3. Restrict fluids to 2 L per day. 4. Infuse 1 ampule of sodium bicarbonate.
14. ANS: 1 Chapter number and title: 9, Acid-Base Balance Chapter learning objective: 6. Explaining nursing considerations related to patients with acid-base disorders Chapter page reference: 149-150 Heading: Acid-Base Disorders/Respiratory Alkalosis/Treatment Integrated Processes: Nursing Process: Planning Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Comprehension [Understanding] Concept: pH Regulation Difficulty: Easy Feedback 1 Management of respiratory alkalosis focuses on correcting the imbalance and treating the underlying cause. Arterial blood gases must be ordered before beginning medication or oxygen therapy. 2 Oxygen is not anticipated when providing care to a patient experiencing respiratory alkalosis. 3 A fluid restriction is not required in the treatment of respiratory alkalosis. 4 Sodium bicarbonate is used in the treatment of metabolic acidosis.
15. The nurse is providing care to a patient who is intubated and receiving mechanical ventilation after a motor vehicle accident. The patient is fighting the ventilator and attempting to remove the endotracheal tube. Which nursing action decreases the patient's risk for developing respiratory alkalosis? 1. Apply wrist restraints. 2. Administer a prescribed sedative. 3. Teach the patient to take slow, deep breaths. 4. Recommend to the healthcare provider to increase the tidal volume on the ventilator.
15. ANS: 2 Chapter number and title: 9, Acid-Base Balance Chapter learning objective: 6. Explaining nursing considerations related to patients with acid-base disorders Chapter page reference: 149-150 Heading: Acid-Base Disorders/Respiratory Alkalosis/Treatment Integrated Processes: Nursing Process: Implementation Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Application [Applying] Concept: pH Regulation Difficulty: Difficult Feedback 1 Applying wrist restraints to a patient who is demonstrating anxiety with an endotracheal tube might exacerbate the patient's condition. 2 For a patient being mechanically ventilated, the only way to reduce rapid respirations might be to provide a sedative. 3 The patient is being mechanically ventilated, which means there is a problem with maintaining the airway. The patient will not be able to take slow, deep breaths at this time. 4 Increasing the rate or tidal volume of the ventilator increases the risk of respiratory alkalosis.
16. The nurse is providing care for an adult patient who is admitted to the emergency department (ED) after losing consciousness. The patient has been fasting and currently has ketones in the urine. The nurse monitors for which acid-base imbalance? 1. Metabolic acidosis 2. Metabolic alkalosis 3. Respiratory acidosis 4. Respiratory alkalosis
16. ANS: 1 Chapter number and title: 9, Acid-Base Balance Chapter learning objective: 4. Comparing and contrasting major acid-base disorders Chapter page reference: 150 Heading: Acid-Base Disorders/Metabolic Acidosis Integrated Processes: Nursing Process: Analysis Client Need: Physiological Integrity: Physiological Adaptation Cognitive Level: Comprehension [Understanding] Concept: pH Regulation Difficulty: Easy Feedback 1 The patient who is fasting is at risk for metabolic acidosis. The body recognizes fasting as starvation and begins to metabolize its own proteins into ketones, which are metabolic acid. Metabolic acidosis is an acid-base imbalance caused by an increased accumulation of metabolic acids that rise in proportion to a decrease in bicarbonate and result in decreased arterial pH. 2 Metabolic alkalosis is an acid-base imbalance caused by an increased loss of acid. Most instances of this increased loss of acid are through the gastrointestinal tract, usually via vomiting or nasogastric suctioning, or through renal excretion. This patient is not at risk for metabolic alkalosis. 3 Respiratory acidosis results from altered ventilation leading to CO2 retention. This patient is not at risk for this acid-base disorder. 4 Respiratory alkalosis an acid-base imbalance caused by an increase in the rate of alveolar ventilation and is often the result of anxiety. This patient is not at risk for respiratory alkalosis.
17. The nurse assesses a patient admitted to the hospital for treatment of pneumonia. The patient's pulse oximetry reads 77%. After repositioning the patient and increasing oxygen per the healthcare provider's order, there is no change in the pulse oximeter reading. Which is the priority action for the nurse? 1. Reassessing the patient in 1 hour 2. Obtaining an arterial blood gas analysis 3. Consulting the unit respiratory therapist 4. Documenting the findings in the medical record
17. ANS: 2 Chapter number and title: 9, Acid-Base Balance Chapter learning objective: 6. Explaining nursing considerations related to patients with acid-base disorders Chapter page reference: 150 Heading: Acid-Base Disorders/Metabolic Acidosis: Safety Alert Integrated Processes: Nursing Process: Implementation Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Application [Applying] Concept: Oxygenation Difficulty: Moderate Feedback 1 This patient is experiencing hypoxia, which can negatively impact outcomes if no action is implemented. 2 Pulse oximetry is considered accurate for oxygen saturations greater than 80%. Arterial blood gas analysis is recommended for oxygen saturations less than 80%. Therefore, this is the best action by the nurse. 3 Although this is an appropriate action by the nurse, this is not the best action as the patient requires treatment for the hypoxia now. 4 Although documenting the findings in the patient's medical record is important, this is not the priority at this time.
18. The nurse is analyzing the patient's arterial blood gas report after a cardiac arrest. Based on a pH of 7.15, the nurse monitors for which clinical manifestation? 1. Dysrhythmias 2. Tetany 3. Convulsions 4. Muscle twitching
18. ANS: 1 Chapter number and title: 9, Acid-Base Balance Chapter learning objective: 1. Describing the significance of acid-base balance for normal function Chapter page reference: 150 Heading: Acid-Base Disorders/Metabolic Acidosis/Complications/ Box 9.7 - Clinical Manifestations of Metabolic Acidosis Integrated Processes: Nursing Process: Analysis Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Analysis Concept: Assessment Difficulty: Moderate Feedback 1 Metabolic acidosis results from an increased accumulation of metabolic acids that rise in proportion to bicarbonate and leads to a decreased arterial pH. If the pH falls below 7.0, cardiac dysrhythmia can occur. 2 Tetany is observed in patients with metabolic alkalosis. 3 Seizures are observed in patients with metabolic alkalosis. 4 Muscle twitching and cramping are observed in patients with metabolic alkalosis.
19. The nurse assesses a patient who is admitted for the treatment of anorexia nervosa based on a 15-pound weight loss over the last month. When assessing the patient, the nurse monitors for which clinical manifestation? 1. Dyspnea 2. Dry mouth 3. Dysrhythmia 4. Disorientation
19. ANS: 3 Chapter number and title: 9, Acid-Base Balance Chapter learning objective: 4. Comparing and contrasting major acid-base disorders Chapter page reference: 151 Heading: Acid-Base Disorders/Metabolic Acidosis/Complications Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Physiological Adaptation Cognitive Level: Analysis [Analyzing] Concept: Assessment Difficulty: Difficult Feedback 1 The nurse monitors a patient for dyspnea if the patient is at risk for respiratory acidosis, not metabolic acidosis. 2 Dry mouth is anticipated for the patient at risk for respiratory alkalosis secondary to hyperventilation, not metabolic acidosis. 3 The patient who is admitted for treatment of anorexia nervosa is likely to be experiencing metabolic acidosis caused by starvation. The nurse closely monitors this patient for dysrhythmias because they can occur as a result of metabolic acidosis. Other causes of metabolic acidosis include severe or chronic diarrhea, diabetic ketoacidosis, trauma and shock, and renal failure. 4 Disorientation is expected for the patient who is at risk for developing metabolic alkalosis, not acidosis.
20. A patient with elevated serum potassium is being treated with intravenous insulin and dextrose. The patient states, "I do not have diabetes. Why am I receiving insulin?" Which statement by the nurse is most appropriate? 1. "You may have early diabetes, and you will need further tests to rule this out." 2. "The insulin is given to counteract the glucose we are giving you to help lower your potassium level." 3. "Because your potassium is so high, the insulin helps to decrease the levels by moving potassium into your cells." 4. "The insulin will help decrease your potassium by making your kidneys get rid of potassium."
20. ANS: 3 Chapter number and title: 9, Acid-Base Balance Chapter learning objective: 6. Explaining nursing considerations related to patients with acid-base disorders Chapter page reference: 150-151 Heading: Acid-Base Disorders/Metabolic Acidosis/Treatment Integrated Processes: Teaching and Learning Client Need: Physiological Integrity: Physiological Adaptation Cognitive Level: Analysis [Analyzing] Concept: Fluid and Electrolyte Balance Difficulty: Difficult Feedback 1 The insulin is used to drive potassium into the cells. This patient does not have diabetes mellitus. 2 The insulin is used to drive the potassium into the cells and isn't given to counteract the glucose. 3 Rapid-acting insulin may be needed for patients with diabetes mellitus to reverse diabetic ketoacidosis and drive potassium back into the cells. 4 The insulin helps move potassium into the cells. It does not impact renal clearance of potassium.
22. The nurse provides care to a patient admitted for the treatment of vomiting. When assessing the patient, the nurse closely monitors the patient for which clinical manifestation(s)? 1. Paresthesia 2. Respiratory distress 3. Kussmaul's respirations 4. Muscle twitching and cramps
22. ANS: 4 Chapter number and title: 9, Acid-Base Balance Chapter learning objective: 4. Comparing and contrasting major acid-base disorders Chapter page reference: 152 Heading: Metabolic Alkalosis/ Box 9.9 - Clinical Manifestations of Metabolic Alkalosis Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Analysis [Analyzing] Concept: Assessment Difficulty: Moderate Feedback 1 Paresthesia is anticipated for the patient at risk for respiratory alkalosis. 2 Respiratory distress is anticipated for the patient at risk for respiratory acidosis. 3 Kussmaul's respirations are expected for the patient who experiences metabolic acidosis. This is not anticipated based on the patient's admitting diagnosis. 4 Vomiting necessitating admission to the hospital places the patient at risk for metabolic alkalosis. Clinical manifestations of this condition include muscle twitching and cramps.
23. The nurse monitors for clinical manifestation of metabolic alkalosis in the patient with which disorder? 1. Diarrhea 2. Prolonged vomiting 3. Renal failure 4. Salicylate intoxication
23. ANS: 2 Chapter number and title: 9, Acid-Base Balance Chapter learning objective: 4. Comparing and contrasting major acid-base disorders Chapter page reference: 152 Heading: Acid-Base Disorders/Metabolic Alkalosis/Box 9.8 - Causes of Metabolic Alkalosis Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Physiological Adaptation Cognitive Level: Application [Applying] Concept: pH Regulation Difficulty: Moderate Feedback 1 Loss of alkali secondary to severe diarrhea or intestinal malabsorption is associated with metabolic acidosis. 2 Most instances of metabolic alkalosis are due to an increased loss of acid through the gastrointestinal tract, usually via vomiting or nasogastric suctioning. 3 Decreased acid excretion by the kidneys in acute or chronic renal failure leads to metabolic acidosis. 4 Salicylate intoxication is associated with metabolic acidosis and respiratory alkalosis.
24. The nurse is reviewing the latest arterial blood gas results for a patient with metabolic alkalosis. Which result indicates that the metabolic alkalosis is compensated? 1. pH 7.32 2. HCO3 8 mEq/L 3. PaCO2 48 mm Hg 4. PaCO2 18 mm Hg
24. ANS: 3 Chapter number and title: 9, Acid-Base Balance Chapter learning objective: 3. Explaining the meaning of compensation. Chapter page reference: 151 Heading: Acid-Base Disorders/Metabolic Alkalosis: Arterial Blood Gas Results Integrated Processes: Nursing Process: Analysis Client Need: Physiological Integrity: Physiological Adaptation Cognitive Level: Analysis [Analyzing] Concept: pH Regulation Difficulty: Moderate Feedback 1 A normal pH level is 7.35 to 7.45. A pH of less than 7.35 indicates acidosis. 2 A HCO3 level of 8 mEq/L is low and is most likely associated with metabolic acidosis. In metabolic alkalosis, there is an excess of bicarbonate. 3 To compensate for this imbalance, the rate and depth of respirations decrease, leading to retention of carbon dioxide. With respiratory compensation, the PaCO2 is greater than 45 mm Hg. 4 A PaCO2 level of 18 mm Hg is low and is seen in respiratory alkalosis.
25. Which nursing actions are appropriate when conducting an Allen test? Select all that apply. 1. Rest the patient's arm on the mattress. 2. Support the patient's wrist with a rolled towel. 3. Tell the patient to relax the hand and then clench a fist. 4. Ensure that a second nurse is available to assist with the procedure. 5. Press the patient's radial and ulnar arteries using the index and middle fingers.
25. ANS: 1, 2, 5 Chapter number and title: 9, Acid-Base Balance Chapter learning objective: 2. Stating the steps for arterial blood gas interpretation Chapter page reference: 146 Heading: Arterial Blood Gas Interpretation/Obtaining an Arterial Blood Gas Integrated Processes: Nursing Process: Implementation Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Application [Applying] Concept: Assessment Difficulty: Moderate Feedback 1 This is correct. Rest the patient's arm on the mattress or bedside stand and support the wrist with a rolled towel. 2 This is correct. Rest the patient's arm on the mattress or bedside stand and support his wrist with a rolled towel. 3 This is incorrect. The nurse will tell the patient to first clench the fist, hold the position for a few seconds, and then hold the hand in a relaxed position. 4 This is incorrect. A second nurse is not required to perform this test. 5 This is correct. The nurse uses the index and middle fingers to press on the patient's radial and ulnar arteries.
27. The nurse provides care to a patient who is admitted to the hospital for an aspirin overdose. Which clinical manifestations does the nurse monitor for when assessing this patient? Select all that apply. 1. Confusion 2. Palpitations 3. Blurred vision 4. Respiratory distress 5. Decreased responsiveness
27. ANS: 1, 2, 3 Chapter number and title: 9, Acid-Base Balance Chapter learning objective: 4. Comparing and contrasting major acid-base disorders Chapter page reference: 149 Heading: Acid Base Disorders/Respiratory Alkalosis/ Box 9.5 - Clinical Manifestations of Respiratory Alkalosis Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Analysis [Analyzing] Concept: Assessment Difficulty: Difficult Feedback 1 This is correct. The patient admitted to the hospital for treatment of an aspirin overdose is at risk for developing respiratory alkalosis. Confusion is a clinical manifestation associated with this condition. 2 This is correct. The patient admitted to the hospital for treatment of an aspirin overdose is at risk for developing respiratory alkalosis. Palpitations are a clinical manifestation associated with this condition; therefore, it is appropriate for the nurse to monitor the patient for this symptom. 3 This is correct. The patient admitted to the hospital for treatment of an aspirin overdose is at risk for developing respiratory alkalosis. Blurred vision is a clinical manifestation associated with this condition; therefore, it is appropriate for the nurse to monitor the patient for this symptom. 4 This is incorrect. Respiratory distress is a clinical manifestation associated with respiratory acidosis. This patient is at risk for respiratory alkalosis, not acidosis. 5 This is incorrect. Decreased responsiveness is a clinical manifestation associated with respiratory acidosis. This patient is at risk for respiratory alkalosis, not acidosis.
28. Which risk factors exhibited by the patient presenting in the emergency department (ED) would place the patient at risk for metabolic acidosis? Select all that apply. 1. Pneumonia 2. Abdominal fistulas 3. Acute renal failure 4. Hypovolemic shock 5. Chronic obstructive pulmonary disease
28. ANS: 2, 3, 4 Chapter number and title: 9, Acid-Base Balance Chapter learning objective: 4. Comparing and contrasting major acid-base disorders Chapter page reference: 150 Heading: Acid Base Disorders/Metabolic Acidosis;/Box 9.6 - Causes of Metabolic Acidosis Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Physiological Adaptation Cognitive Level: Comprehension [Understanding] Concept: Assessment Difficulty: Moderate Feedback 1 This is incorrect. Chronic obstructive pulmonary disease and pneumonia place the patient at risk for respiratory acidosis with the increased retention of carbon dioxide in the blood. 2 This is correct. Abdominal fistulas that lead to loss of alkali can cause metabolic acidosis. 3 This is correct. Decreased acid excretion by the kidneys in acute or chronic renal failure can lead to metabolic acidosis. 4 This is correct. Hypovolemic shock can lead to anaerobic metabolism that can cause metabolic acidosis. 5 This is incorrect. Chronic obstructive pulmonary disease and pneumonia place the patient at risk for respiratory acidosis with the increased retention of carbon dioxide in the blood.
29. The nurse is caring for the patient experiencing hypovolemic shock and metabolic acidosis. Which nursing actions are appropriate for this patient? Select all that apply. 1. Limiting the intake of fluids 2. Administering sodium bicarbonate 3. Monitoring electrocardiogram for conduction problems 4. Keeping the bed in the locked and low position 5. Monitoring weight on admission and discharge
29. ANS: 2, 3, 4 Chapter number and title: 9, Acid-Base Balance Chapter learning objective: 6. Explaining nursing considerations related to patients with acid-base disorders Chapter page reference: 150 Heading: Acid-Base Disorders/Metabolic Acidosis: Treatment Integrated Processes: Nursing Process: Implementation Client Need: Physiological Integrity: Physiological Adaptation Cognitive Level: Application [Applying] Concept: pH Regulation Difficulty: Moderate Feedback 1 This is incorrect. The treatment for hypovolemic shock includes the administration of fluids, not limiting fluids. 2 This is correct. Administering sodium bicarbonate and monitoring electrocardiograms (ECGs) are appropriate for the patient with shock. 3 This is correct. Administering sodium bicarbonate and monitoring ECGs are appropriate for the patient with shock. 4 This is correct. The patient recovering from hypovolemic shock is at risk for injury, so the bed should be kept in the locked and low position. 5 This is incorrect. Patients being treated for hypovolemia will require daily weights, not a weight on admission and then discharge.
3. In caring for patients with acid-base disorders, it is important that the nurse understand what regarding the renal buffering system? 1. This is the fastest buffering system. 2. Levels of PaCO2 are regulated by the renal buffers. 3. Hydrogen ions are excreted if the body is in alkalosis. 4. Bicarbonate is excreted if the body is in alkalosis.
3. ANS: 4 Chapter number and title: 9, Acid-Base Balance Chapter learning objective: 1. Describing the significance of acid-base balance for normal function Chapter page reference: 143 Heading: Acid-Base Balance Overview/Renal Buffers Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Physiological Adaptation Cognitive Level: Comprehension [Understanding] Concept: pH Regulation Difficulty: Moderate Feedback 1 The renal buffers are the most effective, yet the slowest-acting, buffering system and buffer by regulating bicarbonate levels. 2 Levels of PaCO2 are regulated by the lungs. 3 If the body is in a state of acidosis, then the kidneys excrete hydrogen ions (H+) and reabsorb HCO3-. This results in urine becoming more acidic, bicarbonate levels increasing, and the pH increasing. 4 If the body is in a state of alkalosis, then the kidneys excrete HCO3- and reabsorb hydrogen ions (H+). This results in urine becoming more alkaline, a drop in the blood bicarbonate levels, and a decrease in pH.
30. The nurse is providing care to a patient who is admitted with manifestations of metabolic alkalosis. Which diagnostic test results are consistent with this? Select all that apply. 1. Serum glucose level 142 mg/dL 2. Blood pH 7.47 3. Arterial HCO3 34 mEq/L 4. Bilateral lower lobe infiltrates noted on chest x-ray 5. Electrocardiogram changes consistent with hypokalemia
30. ANS: 2, 3, 5 Chapter number and title: 9, Acid-Base Balance Chapter learning objective: 4. Comparing and contrasting major acid-base disorders Chapter page reference: 151 Heading: Acid-Base Disorders/Metabolic Alkalosis: Arterial Blood Gas Results Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Physiological Adaptation Cognitive Level: Analysis [Analyzing] Concept: Fluid and Electrolyte Balance Difficulty: Difficult Feedback 1 This is incorrect. Serum glucose level is not used to confirm the diagnosis of metabolic alkalosis. 2 This is correct. In metabolic alkalosis, the blood pH will be greater than 7.45 and the bicarbonate level greater than 28 mEq/L. 3 This is correct. In metabolic alkalosis, the blood pH will be greater than 7.45 and the bicarbonate level greater than 28 mEq/L. 4 This is incorrect. The presence of bilateral lower lobe infiltrates on chest x-ray would not contribute to the development of metabolic alkalosis. This finding might be the result of metabolic alkalosis if the client's respiratory status is compromised. 5 This is correct. The ECG pattern shows changes similar to those seen with hypokalemia. To increase serum hydrogen ion levels in metabolic alkalosis, serum potassium is pumped into the cell in exchange for the serum hydrogen ions. This decreases the serum potassium levels while the intracellular potassium levels increase, resulting in hypokalemia.
4. A patient is admitted for evaluation of a bowel obstruction and has a nasogastric tube placed to low intermittent suction. The physician orders arterial blood gases, and the following results are reported: pH 7.37 PaCO2 33 mm Hg PaO2 94 mm Hg HCO3 19 mm Hg SaO2 98% What is the nurse's interpretation of these results? 1. Fully compensated metabolic acidosis 2. Uncompensated metabolic acidosis 3. Uncompensated respiratory alkalosis 4. Partially compensated respiratory alkalosis
4. ANS: 1 Chapter number and title: 9, Acid-Base Balance Chapter learning objective: 2. Stating the steps for arterial blood gas interpretation Chapter page reference: 146-147 Heading: Arterial Blood Gas Assessment Integrated Processes: Nursing Process: Analysis Client Need: Physiological Integrity: Physiological Adaptation Cognitive Level: Application [Applying] Concept: pH Regulation Difficulty: Difficult Feedback 1 This is fully compensated metabolic acidosis because the pH is within normal limits but less than 7.40. The HCO3 of 19 indicates metabolic acidosis, and the decreased PaCO2 demonstrates compensation through increased respiratory rate (hyperventilation). 2 The patient has a metabolic acidosis, but it is fully compensated because the pH is within normal limits and the PaCO2 is low, which is consistent with compensation. 3 Although the PaCO2 is low, the pH is more on the acidotic end (less than 7.40), which is consistent with acidosis. 4 Although the PaCO2 is low, the pH is more on the acidotic end (less than 7.40), which is consistent with acidosis.
5. The nurse is providing care to patient with the following laboratory values: pH 7.31; PaCO2 48 mm Hg; and HCO3 24 mEq/L. The nurse correlates these values to which acid-base disorder? 1. Metabolic acidosis 2. Metabolic alkalosis 3. Respiratory acidosis 4. Respiratory alkalosis
5. ANS: 3 Chapter number and title: 9, Acid-Base Balance Chapter learning objective: 2. Stating the steps for arterial blood gas interpretation Chapter page reference: 148 Heading: Acid-Base Disorders/Respiratory Acidosis: Arterial Blood Gas Results Integrated Processes: Nursing Process: Planning Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Analysis Concept: pH Regulation Difficulty: Moderate Feedback 1 Arterial blood gas (ABG) results for metabolic acidosis are pH less than 7.35 and HCO3- less than 22 mEq/L. Uncompensated metabolic acidosis has a decreased pH, normal PaCO2, and normal HCO3. With respiratory compensation, the PaCO2 is less than 35 mm Hg. 2 ABG results for metabolic alkalosis are pH greater than 7.45 and HCO3- greater than 26 mEq/L. Uncompensated metabolic alkalosis has an increased pH, normal PaCO2 and increased HCO3. With respiratory compensation, the PaCO2 is greater than 45 mm Hg. 3 The ABG results for respiratory acidosis are pH less than 7.35 and PaCO2 greater than 45 mm Hg. If the pH is decreased and the PaCO2 is increased with a normal HCO3, it is uncompensated respiratory acidosis. With metabolic compensation, the HCO3- is greater than 26 mEq/L. 4 ABG results for respiratory alkalosis are pH greater than 7.45 and PaCO2 less than 35 mm Hg. Uncompensated respiratory alkalosis has an increased pH, decreased PaCO2, and normal HCO3. With metabolic compensation, then the HCO3- is less than 22 mEq/L.
6. The nurse is providing care for a patient admitted to the unit with respiratory failure and respiratory acidosis. The nurse correlates which data from the patient's history as the probable cause for the current diagnosis? 1. Recent severe pulmonary infection 2. A recent trip to South America 3. Recent recovery from a cold virus 4. Use of ibuprofen for the control of pain
6. ANS: 1 Chapter number and title: 9, Acid-Base Balance Chapter learning objective: 4. Comparing and contrasting major acid-base disorders Chapter page reference: 148 Heading: Acid-Base Disorders/Respiratory Acidosis/Box 9.2 Causes of Respiratory Acidosis Integrated Processes: Nursing Process: Analysis Client Need: Physiological Integrity: Physiological Adaptation Cognitive Level: Comprehension [Understanding] Concept: pH Regulation Difficulty: Moderate Feedback 1 Severe pulmonary infections, bronchial obstruction, and atelectasis increase the risk of respiratory acidosis because of decreased ventilation and carbon dioxide retention. 2 A recent trip to South America would not constitute a respiratory risk factor for acidosis. 3 Recent recovery from a cold would not likely put the patient at risk for respiratory acidosis. 4 Ibuprofen does not pose a threat to the respiratory health of the patient.
7. A patient is admitted to the emergency department for the treatment of a drug overdose causing acute respiratory acidosis. Which substance noted on the toxicology report is the most likely cause for the current diagnosis? 1. PCP 2. Cocaine 3. Marijuana 4. Oxycodone
7. ANS: 4 Chapter number and title: 9, Acid-Base Balance Chapter learning objective: 4. Comparing and contrasting major acid-base disorders Chapter page reference: 148 Heading: Acid-Base Disorders/Respiratory Acidosis/Box 9.2 Causes of Respiratory Acidosis Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Physiological Adaptation Cognitive Level: Comprehension [Understanding] Concept: Assessment Difficulty: Moderate Feedback 1 PCP is a hallucinogenic agent. 2 Cocaine is a stimulant. 3 Marijuana is not considered a drug that depresses the central nervous system or respiratory center. 4 Oxycodone is an opiate narcotic. Excessive use or overdose of narcotic substances can lead to respiratory depression and respiratory acidosis.
8. The nurse is providing care to a patient who is admitted after a morphine overdose. Which acid-base imbalance does the nurse assess for in this patient? 1. Metabolic acidosis 2. Metabolic alkalosis 3. Respiratory acidosis 4. Respiratory alkalosis
8. ANS: 3 Chapter number and title: 9, Acid-Base Balance Chapter learning objective: 4. Comparing and contrasting major acid-base disorders Chapter page reference: 148 Heading: Acid-Base Disorders/Respiratory Acidosis/Box 9.2 Causes of Respiratory Acidosis Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Physiological Adaptation Cognitive Level: Comprehension [Understanding] Concept: pH Regulation Difficulty: Moderate Feedback 1 Metabolic acidosis is related to an accumulation of hydrogen ions and not typically observed in the patient with an opiate overdose. 2 Metabolic alkalosis is associated with loss of hydrogen ions and not caused by an opiate overdose. 3 Morphine is a narcotic and generally acts to decrease or suppress respirations; therefore, this patient is probably hypoventilating. The expected acid-base imbalance would be respiratory acidosis. 4 Respiratory alkalosis is associated with hyperventilation. Morphine depresses respiratory rate.
9. The nurse is planning care for an older adult patient with respiratory acidosis. Which intervention does the nurse include in this patient's plan of care? 1. Perform chest physiotherapy. 2. Reduce environmental stimuli. 3. Administer intravenous sodium bicarbonate. 4. Administer prescribed intravenous fluids carefully.
9. ANS: 1 Chapter number and title: 9, Acid-Base Balance Chapter learning objective: 6. Explaining nursing considerations related to patients with acid-base disorders Chapter page reference: 148 Heading: Acid-Base Disorders/Respiratory Acidosis: Possible Respiratory Treatments Integrated Processes: Nursing Process: Implementation Client Need: Physiological Integrity: Physiological Adaptation Cognitive Level: Application [Applying] Concept: pH Regulation Difficulty: Moderate Feedback 1 Respiratory acidosis results in a drop in the blood pH, reduced level of oxygen, and retaining of carbon dioxide. Chest physiotherapy facilitates the removal of secretions from the lungs, which can encourage deep breathing to decrease carbon dioxide levels and improve oxygenation. 2 Reducing environmental stimuli would be more appropriate for the patient with respiratory alkalosis who is anxious and hyperventilating. 3 Sodium bicarbonate is indicated in the treatment of metabolic acidosis. 4 Careful administration of intravenous fluids is important in the older patient with metabolic alkalosis because this population is at risk as a result of their fragile fluid and electrolyte status.
