EAQ F/E Acid Base Balance

After a gastrectomy, a client has a nasogastric tube set to low continuous suction. The client begins to hyperventilate. How would the nurse anticipate that this breathing pattern will alter the client's arterial blood gases? 1-Increase the PO2 level 2-Decrease the pH level 3-Increase the HCO3 level 4-Decrease the pCO2 level

4-Decrease the pCO2 level Hyperventilation results in increased elimination of carbon dioxide from the blood. The PO2 level is not affected. The pH level will increase. The carbonic acid level will decrease.

Which clinical finding would the nurse anticipate when admitting a client with an extracellular fluid volume excess? 1- Rapid, thready pulse 2- Distended jugular veins 3- Elevated hematocrit level 4- Increased serum sodium level

2 - distended jugular veins Because of fluid overload in the intravascular space, the neck veins become visibly distended. Rapid, thready pulse and elevated hematocrit level occur with a fluid deficit. If sodium causes fluid retention, its concentration is unchanged; if fluid is retained independently of sodium, its concentration is decreased.

When caring for a client who has hypokalemia, which electrocardiogram change will the nurse expect to observe? 1-Inverted P waves 2-Flattened T waves 3-Absence of U waves 4-Elevated ST segment

2-Flattened T waves A flattened T wave is associated with hypokalemia. A depressed T wave indicates a problem with ventricular repolarization, a process involved in muscle contraction. Adequate potassium levels are needed for efficient muscle contraction. P waves may peak in hypokalemia. In hypokalemia, U waves appear. ST segment is depressed in hypokalemia.

When monitoring a client for hyponatremia, which assessment findings would the nurse consider significant? Select all that apply. One, some, or all responses may be correct. 1-Thirst 2-Seizures 3-Erythema 4-Confusion 5-Constipation

2-seizures 4-confusion Cellular swelling and cerebral edema are associated with hyponatremia; as the extracellular sodium level decreases, the cellular fluid becomes relatively more concentrated and pulls water into cerebral cells, leading to confusion and seizures. Thirst is a symptom of hypernatremia; it may indicate dehydration. Erythema is not associated with hyponatremia. Diarrhea, not constipation, is associated with hyponatremia.

The nurse is caring for a client with the following arterial blood gas (ABG) values: PO2 89 mm Hg, PCO2 35 mm Hg, and pH of 7.37. These findings indicate that the client is experiencing which condition? 1-Respiratory alkalosis 2-Poor oxygen perfusion 3-Normal acid-base balance 4-Compensated metabolic acidosis

3-Normal acid-base balance All data are within expected limits; PO2 is 80 to 100 mm Hg, PCO2 is 35 to 45 mm Hg, and the pH is 7.35 to 7.45. None of the data are indicators of fluid balance, but of acid-base balance. Oxygen (PO2) is within the expected limits of 80 to 100 mm Hg. With respiratory alkalosis, the blood pH is greater than 7.45 and the PCO2 is greatly decreased. With metabolic acidosis, the pH is less than 7.35.

A client with chronic obstructive pulmonary disease (COPD) has a blood pH of 7.25 and a partial pressure of carbon dioxide (PCO2) of 60 mm Hg. Which complication would the nurse suspect the client is experiencing? 1-Metabolic acidosis 2-Metabolic alkalosis 3-Respiratory acidosis 4-Respiratory alkalosis

3-Respiratory acidosis The pH indicates acidosis; the PCO2 level is the parameter for respiratory function. The expected PCO2 is 40 mm Hg. These results do not indicate a metabolic disorder or indicate respiratory alkalosis.

The nurse is evaluating the effectiveness of a treatment for a client with excessive fluid volume. Which clinical finding indicates that treatment was successful? 1- clear breath sounds 2- positive pedal pulses 3- normal potassium levels 4- decreased urine specific gravity

1- clear breath sounds Excess fluid can move into the lungs, causing crackles; clear breath sounds support that treatment was effective. Although it may make palpation more difficult, excess fluid will not diminish pedal pulses. A normal potassium level can be maintained independently of fluid excess correction. As the client excretes excess fluid, the urine specific gravity will increase, not decrease.

What is the sequence of events that occurs in the child's respiratory response to acidosis? Place the physiologic responses in the order in which they occur. 1.Hyperventilation 2.Increased CO2 elimination 3.Decreased blood H+ ions 4.Increased pH

1,2,3,4 Respiratory compensation to acidosis involves hyperventilation with increased CO2 elimination. As CO2 is blown off there is a decrease in the hydrogen ions in the blood, leading to an increase in pH to expected limits.

The laboratory data for a client with prolonged vomiting reveal arterial blood gases of pH 7.51, Pco2 of 45 mm Hg, HCO3 of 58 mEq/L (59 mmol/L), and a serum potassium level of 3.8 mEq/L (3.8 mmol/L). The nurse concludes that the findings support which diagnosis? 1-Hypocapnia 2-Hyperkalemia 3-Metabolic alkalosis 4-Respiratory acidosis

3-Metabolic alkalosis Elevated plasma pH and elevated bicarbonate levels support metabolic alkalosis. The arterial carbon dioxide level of 45 mm Hg is within the expected value of 35 mm Hg to 45 mm Hg; no hypocapnia is present. The client's serum potassium level is within the expected level of 3.5 mEq/L to 5 mEq/L (3.5-5 mmol/L). With respiratory acidosis the pH will be less than 7.35 and the Pco2 will be elevated.

Which instructions would the nurse include when providing teaching to the parents of a child prescribed diuretics? (SATA) 1- Fluid intake should be adequate 2- Diuretics should be taken on an empty stomach 3- Diuretics' should be taken at the same time each day 4- Diuretics may interfere with normal laboratory test values. 5- Sun or heat exposure should be avoided because of the risks of skin darkening.

1 - Fluid intake should be adequate 3 - Diuretics should be taken at the same time each day. 4 - Diuretics may interfere with normal laboratory test values The parents should ensure that their child has adequate fluid intake to prevent dehydration. The medication should be taken every day at the same time to facilitate maximum therapeutic action. The parents should be informed that diuretics may interfere with normal laboratory test values such as serum levels of sodium, potassium, magnesium, and chloride. Diuretics should be taken with food or milk to prevent gastric irritation. Sun and heat exposure may cause fluid loss and heat stroke.

A client who experienced extensive burns is receiving intravenous fluids to replace fluid loss. The nurse would monitor for which initial symptom of fluid overload? 1- crackles in the lungs 2- decreased heart rate 3- decreased blood pressure 4- cyanosis of nailbeds

1- crackles in the lungs Crackles, or rales, in the lungs are an early sign of pulmonary congestion and edema caused by fluid overload. Clients with fluid overload will usually demonstrate an increased heart rate and increased blood pressure. A decreased heart rate and decreased blood pressure and cyanosis in a client with fluid overload would be very late and fatal signs.

A client is admitted with severe diarrhea that resulted in hypokalemia. The nurse would monitor for which clinical manifestations of the electrolyte deficiency? (SATA) 1- Diplopia 2- Skin rash 3- Leg Cramps 4- Tachycardia 5- Muscle Weakness

3-leg cramps 5-muscle weakness Leg cramps occur with hypokalemia because of potassium deficit. Muscle weakness occurs with hypokalemia because of the alteration in the sodium-potassium pump mechanism. Diplopia does not indicate an electrolyte deficit. A skin rash does not indicate an electrolyte deficit. Tachycardia is not associated with hypokalemia; bradycardia is.

Which assessment finding in a client signifies a mild form of hypocalcemia? 1-Seizures 2-Hand spasms 3-Severe muscle cramps 4-Numbness around the mouth

4-Numbness around the mouth A numbness or tingling sensation around the mouth or in the hands and feet indicates mild to moderate hypocalcemia. Seizures, hand spasms, and severe muscle cramps are associated with severe hypocalcemia.

An 11-month-old is admitted with dehydration and a serum sodium level of 120 mEq/L (120 mmol/L). Which assessment finding would be the priority to report to the health care provider? 1-Weight loss of 1.5 kg in 3 days 2-Muscle twitching in all extremities 3-Temperature increase to 100°F (37.8°C) 4-Heart rate increasing from 100 to 120 beats per minute

2-Muscle twitching in all extremities The normal sodium level is 135 to 145 mEq/L (135-145 mmol/L). A priority symptom of hyponatremia (less than 135 mEq/L [135 mmol/L]) is seizure activity, which may manifest early on as muscle twitching. Although a client may exhibit an increase in temperature or heart rate or a loss of weight as a result of dehydration, none of these is the priority assessment finding.

A client arrives in the emergency department with epigastric pain and prolonged vomiting. Assessment findings include rapid and shallow respirations, dry and flushed skin, weakness, and lethargy. Which is the primary nursing concern? 1-Acute pain 2-Risk for injury 3-Metabolic alkalosis 4-Ineffective breathing

3-Metabolic alkalosis Prolonged vomiting results in fluid loss and acid (hydrochloric) loss; the client's symptoms reflect dehydration and metabolic alkalosis. Although it is important to address the client's pain, the fluid and electrolyte/acid/base imbalance must be addressed first because it can be life threatening. Although risk for injury is a potential problem, the priority is the fluid and electrolyte/acid/base problem. The ineffective breathing pattern most likely is caused by the metabolic alkalosis; the fluid and electrolyte/acid/base imbalance is a higher priority and must be addressed first.

A client with end-stage renal disease receiving hemodialysis has a prescribed diet restricting proteins, sodium, and potassium. Which client statement indicates an understanding of provided dietary instructions? 1-"I should avoid using salt substitutes." 2-"I should exclude meat from my diet." 3-"I may not add seasoning to my food." 4-"I may eat low-sodium canned vegetables."

1-"I should avoid using salt substitutes." Commercially prepared salt substitutes are high in potassium. Some complete protein foods must be included in the protein-restricted diet. The client may use seasonings not containing sodium or potassium. Lemon juice, pepper, and herbs can enhance food palatability. Low-sodium canned vegetables contain high potassium concentrations.

Which medications may be used to correct severe hyperkalemia resulting from intravenous (IV) administration? Select all that apply. One, some, or all responses may be correct. 1-Calcium chloride 2-Sodium chloride 3-Calcium gluconate 4-Sodium bicarbonate 5-Dextrose solution with insulin

1-Calcium chloride 3-Calcium gluconate 4-Sodium bicarbonate 5-Dextrose solution with insulin Hyperkalemia resulting from IV administration might be treated with calcium chloride, calcium gluconate, sodium bicarbonate, and dextrose solution with insulin. These substances lead to the rapid shifting of intracellular potassium ions, thereby reducing potassium concentration. Sodium chloride is primarily used to prevent or treat sodium losses.

The client's serum sodium is 123 mEq/L (123 mmol/L). Which prescription would the nurse question? 1-Add table salt to each meal. 2-Fluid restriction of 1000 mL per day. 3-Assess neurological status every 2 hours. 4-Provide 0.45% sodium chloride (NaCL) intravenously at 125 mL/h.

4-Provide 0.45% sodium chloride (NaCL) intravenously at 125 mL/h. Because 0.45 % NaCl (one-half normal saline) is a hypotonic solution, it is contraindicated. It would actually compound the issue instead of correcting the hyponatremia. Treatment for hyponatremia can include restricting fluid intake and increasing sodium intake either via oral intake or, in severe cases, intravenous fluids. The presence of hyponatremia, as well as correction of hyponatremia if done too quickly, can cause fluid shifts in the brain, resulting in altered mental status. It is important for the nurse to assess for neurological changes.

The arterial blood gases for a client with acute respiratory distress are pH 7.30, PaO2 80 mm Hg (10.64 kPa), PaCO2 55 mm Hg (7.32 kPa), and HCO3 23 mEq/L (23 mmol/L). How would the nurse interpret these findings? 1-Hypoxemia 2-Hypocapnia 3-Compensated metabolic acidosis 4-Uncompensated respiratory acidosis

4-Uncompensated respiratory acidosis The increased PaCO2 indicates respiratory acidosis and the low pH indicates that the respiratory acidosis is uncompensated. The PaO2 is normal, indicating that the client is not hypoxemic. The elevated PaCO2 indicates hypercapnia. The HCO3 is normal, indicating that there is no metabolic acidosis.

An arterial blood gas report indicates that pH is 7.25, Pco2 is 60 mm Hg, and HCO3 is 26 mEq/L (26 mmol/L). Which client is most likely to exhibit these blood gas results? 1-A client with pulmonary fibrosis 2-A client with uncontrolled type 1 diabetes 3-A client who has been vomiting for 3 days 4-A client who takes sodium bicarbonate for indigestion

1-A client with pulmonary fibrosis The low pH and elevated Pco2 are consistent with respiratory acidosis, which can be caused by pulmonary fibrosis, which impedes the exchange of oxygen and carbon dioxide in the lung. A client with uncontrolled type 1 diabetes most likely will experience metabolic acidosis from excess ketone bodies in the blood. A client who has been vomiting for 3 days most likely will experience metabolic alkalosis from the loss of hydrochloric acid from vomiting. A client who takes sodium bicarbonate for indigestion most likely will experience metabolic alkalosis from an excess of base bicarbonate.

Which clinical manifestation would the nurse associate with successful fluid replacement therapy? 1-A trended urinary output of at least 30 mL/h 2-Central venous pressure reading of 1.5 mm Hg 3-Baseline pulse rate of 120 beats per minute decreasing to 110 beats per minute within a 15-minute period 4-Baseline blood pressure of 50/30 mm Hg increasing to 70/40 mm Hg within a 30-minute period

1-A trended urinary output of at least 30 mL/h The nurse would consider a urinary output rate of 30 mL/h adequate for perfusion of the kidneys, heart, and brain. A central venous pressure reading of 1.5 mm Hg indicates hypovolemia. A baseline pulse rate of 120 beats per min decreasing to 110 beats per minute within a 15-minute period and a baseline blood pressure of 50/30 mm Hg increasing to 70/40 mm Hg within a 30-minute period indicates improved tissue perfusion, but not necessarily adequate tissue perfusion. Compensatory mechanisms such as the renin-angiotensin-aldosterone system may continue reabsorption of fluids. Clinical manifestations reflecting adequate tissue perfusion also means the client does not need the compensatory mechanisms any longer, and urinary output increases.

A client appears anxious, exhibiting 40 shallow respirations per minute. The client reports dizziness, light-headedness, and tingling sensations of the fingertips and around the lips. The nurse concludes that the client's symptoms are most likely related to which condition? 1-Eupnea 2-Hyperventilation 3-Kussmaul respirations 4-Carbon dioxide intoxication

2-Hyperventilation The client is hyperventilating and blowing off excessive carbon dioxide, which leads to these adaptations; if uninterrupted, this can result in respiratory alkalosis. Eupnea is normal, quiet breathing; the client has shallow, rapid breathing. Kussmaul respirations are deep, gasping respirations associated with diabetic acidosis and coma. These adaptations are related to a decreased carbon dioxide level in the body.

A client is hospitalized after 4 days of epigastric pain, nausea, and vomiting. The nurse reviews the laboratory test results: plasma pH 7.51, pCO2 50 mm Hg, bicarbonate 58 mEq/L (58 mmol/L), chloride 55 mEq/L (55 mmol/L), sodium 132 mEq/L (132 mmol/L), and potassium 3.8 mEq/L (3.8 mmol/L). Which condition does the nurse determine the results indicate? 1-Hypernatremia 2-Hyperchloremia 3-Metabolic alkalosis 4-Respiratory acidosis

3-Metabolic alkalosis The normal plasma pH value is 7.35 to 7.45; the client is in alkalosis. The normal plasma bicarbonate value is 23 to 25 mEq/L (23-25 mmol/L); the client has an excess of base bicarbonate, indicating a metabolic cause for the alkalosis. The normal plasma sodium value is 135 to 145 mEq/L (135-145 mmol/L); the client has hyponatremia. The normal plasma chloride value is 95 to 105 mEq/L (95-105 mmol/L); the client has hypochloremia because of vomiting of gastric secretions. With respiratory acidosis, the pH is decreased to less than 7.35.

The nurse identifies a decrease in serum sodium when reviewing the laboratory reports of an older client with diarrhea. A decrease in which additional electrolyte is a cause for great concern for this client? 1-Calcium 2-Chloride 3-Potassium 4-Phosphate

3-Potassium Sodium, potassium, and bicarbonate are the electrolytes most often lost with diarrhea because they are excreted before they can be absorbed. Hypokalemia can cause cardiac dysrhythmias, a life-threatening complication. Serum calcium levels are indicators of parathyroid function and calcium metabolism. They are unrelated to diarrhea. Although chloride accompanies sodium losses, it is not a priority concern. Phosphate levels are determined by calcium metabolism, parathormone, and to a lesser degree, intestinal absorption. They are not a priority concern.

Which test result would the nurse anticipate in the laboratory reports of a client with a diagnosis of end-stage renal disease? 1-Arterial pH of 7.5 2-Hematocrit of 54% 3-Potassium of 6.3 mEq/L (6.3 mmol/L) 4-Creatinine of 1.2 mg/dL (106 mcmol/L)

3-Potassium of 6.3 mEq/L (6.3 mmol/L) Clients with end-stage renal disease have impaired potassium excretion, so the nurse should anticipate a potassium level more than the expected range of 3.5 to 5 mEq/L (3.5-5 mmol/L). Clients with end-stage renal disease usually have a serum pH that is less than 7.35 because of metabolic acidosis. A pH of 7.5 that exceeds the expected range of 7.35 to 7.45 is not anticipated because this is alkalosis. Clients with end-stage renal disease have decreased erythropoietin, which leads to decreased red blood cell production and hematocrit; a hematocrit of 54% exceeds the expected range, which is 39% to 50% for males and 35% to 47% for females; therefore it is not anticipated. Clients with end-stage renal disease have a decreased ability to eliminate nitrogenous wastes, which leads to increased creatinine levels; a creatinine level of 1.2 mg/dL (106 mcmol/L) is within the expected range of 0.7 to 1.4 mg /dL (62-124 mcmol/L) and is not anticipated.

A client with chronic obstructive pulmonary disease (COPD) has a blood pH of 7.25 and Pco2 of 60 mm Hg. These blood gas results require nursing attention because they indicate which condition? 1-Metabolic acidosis 2-Metabolic alkalosis 3-Respiratory acidosis 4-Respiratory alkalosis

3-Respiratory acidosis The normal blood pH range is 7.35 to 7.45; therefore, a blood pH of 7.25 indicates acidosis. The parameter for respiratory function is CO2, and the acceptable range of arterial Pco2 is 35 to 45 mm Hg; therefore, 60 mm Hg is elevated, resulting in respiratory acidosis. HCO3 is the parameter for metabolic functions. A pH of 7.25 is acidic, indicating acidosis and not alkalosis.Test-Taking Tip: Stay away from other nervous students before the test. Stop reviewing at least 30 minutes before the test. Take a walk, go to the library and read a magazine, listen to music, or do something else that is relaxing. Go to the test room a few minutes before class time so that you are not rushed in settling down in your seat. Tune out what others are saying. Crowd tension is contagious, so stay away from it.

Which type of acid-base imbalance would the nurse expect in a child admitted with a severe asthma exacerbation? 1-Metabolic alkalosis caused by excessive production of acid metabolites 2-Respiratory alkalosis caused by accelerated respirations and loss of carbon dioxide 3-Respiratory acidosis caused by impaired respirations and increased formation of carbonic acid 4-Metabolic acidosis caused by the kidneys' inability to compensate for increased carbonic acid formation

3-Respiratory acidosis caused by impaired respirations and increased formation of carbonic acid The restricted ventilation accompanying an asthma attack limits the body's ability to blow off carbon dioxide. As carbon dioxide accumulates in the body fluids, it reacts with water to produce carbonic acid; the result is respiratory acidosis. The problem basic to asthma is respiratory, not metabolic. Respiratory alkalosis is caused by the exhalation of large amounts of carbon dioxide; asthma attacks cause carbon dioxide retention. Asthma is a respiratory problem, not a metabolic one; metabolic acidosis can result from an increase of nonvolatile acids or from a loss of base bicarbonate.Test-Taking Tip: You have at least a 25% chance of selecting the correct response in multiple-choice items. If you are uncertain about a question, eliminate the choices that you believe are wrong and then call on your knowledge, skills, and abilities to choose from the remaining responses.

The nurse determined a client's arterial blood gases reflected a compensated respiratory acidosis. The pH was 7.34; which additional laboratory value did the nurse consider? 1-The partial pressure of oxygen (PO2) value is 80 mm Hg. 2-The partial pressure of carbon dioxide (PCO2) value is 60 mm Hg. 3-The bicarbonate (HCO3) value is 50 mEq/L (50 mmol/L). 4-Serum potassium value is 4 mEq/L (4 mmol/L).

3-The bicarbonate (HCO3) value is 50 mEq/L (50 mmol/L). The HCO3 value is elevated. The urinary system compensates by retaining hydrogen (H+) ions, which become part of the bicarbonate ions; the bicarbonate level becomes elevated and increases the pH level to near the expected range. The expected HCO3 value is 21 to 28 mEq/L (21-28 mmol/L), and the expected pH value is 7.35 to 7.45. The body's usual PO2 value is 80 to 100 mm Hg; 80 mm Hg is within the expected range. The body's PCO2 value is 35 to 45 mm Hg; although in compensated respiratory acidosis the PCO2 level may be increased, it is the increased HCO3 level that indicates compensation. A potassium (K+) level of 4 mEq/L (4 mmol/L) is within the expected range of 3.5 to 5 mEq/L (3.5-5 mmol/L); the serum potassium level is not significant in identifying compensated respiratory acidosis.

A child with type 1 diabetes is admitted to the hospital with deep, rapid respirations; flushed, dry cheeks; abdominal pain with nausea; and increased thirst. Which laboratory findings are the nurse most likely to observe? 1-pH 7.25; glucose 60 mg/dL (3.3 mmol/L) 2-pH 7.50; glucose 60 mg/dL (3.3 mmol/L) 3-pH 7.25; glucose 460 mg/dL (25.5 mmol/L) 4-pH 7.50; glucose 460 mg/dL (25.5 mmol/L)

3-pH 7.25; glucose 460 mg/dL (25.5 mmol/L) The clinical manifestations indicate ketoacidosis, so these values are expected; the pH of 7.25 indicates acidosis (metabolic or ketoacidosis), and the blood glucose level of 460 mg/dL (25.5 mmol/L), higher than the expected range of 70 to 105 mg/dL (3.9-5.8 mmol/L), indicates severe hyperglycemia. Although the blood pH of 7.25 indicates acidosis, the blood glucose level of 60 mg/dL (3.3 mmol/L) is below the expected range of 70 to 105 mg/dL (3.9-5.8 mmol/L); with ketoacidosis, the child will be hyperglycemic. Both the pH of 7.50 and the glucose level of 60 mg/dL (3.3 mmol/L) are unexpected with ketoacidosis; with ketoacidosis, the pH is decreased and the blood glucose level is increased. Although the blood glucose level is increased with ketoacidosis, the pH is decreased, not increased; a pH of 7.50 indicates alkalosis.

A client's arterial blood gas report indicates the pH is 7.52, PCO2 is 32 mm Hg, and HCO3 is 24 mEq/L. Which does the nurse identify as a possible cause of these results? 1-Airway obstruction 2-Inadequate nutrition 3-Prolonged gastric suction 4-Excessive mechanical ventilation

4-Excessive mechanical ventilation The high pH and low carbon dioxide level are consistent with respiratory alkalosis, which can be caused by mechanical ventilation that is too aggressive. Airway obstruction causes carbon dioxide buildup, which leads to respiratory acidosis. Inadequate nutrition causes excess ketones, which can lead to metabolic acidosis. Prolonged gastric suction causes loss of hydrochloric acid, which can lead to metabolic alkalosis.