Imbalance - Acid-Base
partially compensated
pH, PaCO₂, and HCO₃ are all outside the expected reference range
Identify the acid-base imbalance represented by the following laboratory values: -pH 7.5 -PaCO₂ 30 mm Hg -HCO₃ 24 mEq/L -PaO₂ 79 mm Hg
respiratory alkalosis (uncompensated) -↑pH = alkalosis (7.35-7.45) -↓PaCO₂ = respiratory (35-45 mm Hg) -HCO₃ is normal (21-28 mEq/L) -↓PaO₂ = hypoxemia (cause of respiratory alkalosis) (>80 mm Hg) (↓HCO₃ would = compensation) MS ch 16 workbook
normal PaO₂
≥80 mm Hg
metabolic acidosis causes (5)
-ketoacidosis (DKA) -diarrhea -renal failure -malnutrition, starvation -salicylate overdose (aspirin)
uncompensated
-pH is outside the expected reference range -either the PaCO₂ or HCO₃ is outside the expected reference range
fully compensated
-pH is within the expected reference range -PaCO₂ and HCO₃ are both outside the expected reference range
Arrows indicating changes in ABGs for respiratory alkalosis (uncompensated): -pH -PaCO₂ -HCO₃
-pH ↑ -PaCO₂ ↓ -HCO₃ ↔
Arrows indicating changes in ABGs for metabolic alkalosis (uncompensated): -pH -PaCO₂ -HCO₃
-pH ↑ -PaCO₂ ↔ -HCO₃ ↑
Arrows indicating changes in ABGs for respiratory acidosis (uncompensated): -pH -PaCO₂ -HCO₃
-pH ↓ -PaCO₂ ↑ -HCO₃ ↔
Arrows indicating changes in ABGs for metabolic acidosis (uncompensated): -pH -PaCO₂ -HCO₃
-pH ↓ -PaCO₂ ↔ -HCO₃ ↓
A client is diagnosed with respiratory alkalosis induced by gram-negative sepsis. The nurse should plan to carry out which prescribed measure as the most effective means to treat the problem? 1. Administer prescribed antibiotics. 2. Have the client breathe into a paper bag. 3. Administer antipyretics as needed (on PRN basis). 4. Request a prescription for a partial rebreather oxygen mask.
1. Administer prescribed antibiotics. (Most effective way to treat acid-base disorder is treating underlying cause of the disorder-sepsis is treated with antibiotics) NCLEX
The nurse is caring for a client who is retaining carbon dioxide (CO₂) as a result of an obstructive respiratory disease. The nurse plans interventions knowing that as the client's CO₂ level rises, what will occur with the blood pH? 1. Fall 2. Rise 3. Double 4. Remain unchanged
1. Fall (CO₂ acts as an acid in the body - ↑ CO2 will result in ↓ pH) NCLEX
A client is determined to be in respiratory alkalosis by blood gas analysis. Which electrolyte disorder should the nurse monitor for that could accompany the acid-base balance? 1. Hypokalemia 2. Hypercalcemia 3. Hypochloremia 4. Hypernatremia
1. Hypokalemia NCLEX
A client with diabetes mellitus has a blood glucose level of 644 mg/dL (35.7 mmol/L). The nurse plans care knowing that the client is at risk for the development of which type of acid-base imbalance? 1. Metabolic acidosis 2. Metabolic alkalosis 3. Respiratory acidosis 4. Respiratory alkalosis
1. Metabolic acidosis (DKA) NCLEX
A client with diabetes mellitus is most likely to experience which type of acid-base imbalance as a complication of the disorder? 1. Metabolic acidosis 2. Metabolic alkalosis 3. Respiratory acidosis 4. Respiratory alkalosis
1. Metabolic acidosis (DKA) NCLEX
The nurse is caring for a client with hyperglycemia and diabetic ketoacidosis (DKA) who now has developed Kussmaul respirations. The nurse knows that the purpose of this type of breathing is to correct what imbalance? 1. Metabolic acidosis 2. Metabolic alkalosis 3. Respiratory acidosis 4. Metabolic acidosis
1. Metabolic acidosis NCLEX
The nurse notes that a client's arterial blood gas (ABG) results reveal a pH of 7.50 and a PaCO₂ of 30 mm Hg. The nurse monitors the client for which clinical manifestations associated with these ABG results? Select all that apply. 1. Nausea 2. Confusion 3. Bradypnea 4. Tachycardia 5. Hyperkalemia 6. Lightheadedness
1. Nausea 2. Confusion 4. Tachycardia 6. Lightheadedness (↑pH and ↓PaCO₂ = respiratory alkalosis) NCLEX
A client has a prescription for a set of arterial blood gas (ABGs) samples to be drawn on room air. The client currently is receiving oxygen by nasal cannula at a delivery rate of 3 L/min. After reading the prescription, the nurse should take which action? 1. Remove the nasal cannula for 15 minutes; then have the ABG samples drawn. 2. Change the nasal cannula to a shovel face mask; then have the ABG samples drawn. 3. Leave the nasal cannula in place for 15 minutes; then have the ABG samples drawn. 4. Change the nasal cannula to a Venturi face mask; then have the ABG samples drawn.
1. Remove the nasal cannula for 15 minutes; then have the ABG samples drawn. (pt should have supplemental O₂ removed for at least 15 minutes before ABGs are drawn if pt has a prescription for the ABGs to be drawn on room air - allows time for pt's system to equilibrate so ABG results will accurately reflect ventilatory status without supplemental O₂) NCLEX
The nurse is caring for a client with several broken ribs. The client is most likely to experience what type of acid-base imbalance? 1. Respiratory acidosis from inadequate ventilation 2. Respiratory alkalosis from anxiety and hyperventilation 3. Metabolic acidosis from calcium loss due to broken bones 4. Metabolic alkalosis from taking analgesics containing base products
1. Respiratory acidosis from inadequate ventilation (Respiratory acidosis is most often caused by hypoventilation. The client with broken ribs will have difficulty with breathing adequately and is at risk for hypoventilation and resultant respiratory acidosis.) NCLEX
The nurse is caring for a client whose arterial blood gas results reveal alkalosis. What client reactions would the nurse expect to see? Select all that apply. 1. Tetany 2. Lethargy 3. Tingling 4. Confusion 5. Numbness 6. Restlessness
1. Tetany 3. Tingling 5. Numbness 6. Restlessness (Alkalosis causes tingling and numbness of the fingers, restlessness, and tetany caused by irritability of the CNS. If the severity of alkalosis increases, convulsions and coma may occur.) NCLEX
The nurse reviews the blood gas results of a client with atelectasis. The nurse analyzes the results and determines that the client is experiencing respiratory acidosis. Which result validates the nurse's findings? 1. pH 7.25, PaCO₂ 50 mm Hg 2. pH 7.35, PaCO₂ 40 mm Hg 3. pH 7.50, PaCO₂ 52 mm Hg 4. pH 7.52, PaCO₂ 28 mm Hg
1. pH 7.25, PCO₂ 50 mm Hg respiratory acidosis = ↓pH, ↑PaCO₂ -normal pH = 7.35-7.45 -normal PaCO₂ = 35-45 mm Hg NCLEX
The nurse is performing a change-of-shift assessment on a client. The client had an arterial blood gas specimen drawn during an admission work-up on the previous day and has a hematoma at the puncture site. What is the priority nursing intervention? 1. Perform the Allen's test. 2. Apply a warm compress. 3. Administer the antidote for heparin. 4. Notify the hospital laboratory supervisor.
2. Apply a warm compress. (application of a warm compress enhances the absorption of blood in the hematoma) NCLEX
The nurse is caring for a client with diabetic ketoacidosis whose respirations are abnormally deep, regular, and increased in rate. What is the purpose of this type of respiration? Select all that apply. 1. Correct bradypnea 2. Blow off carbon dioxide 3. Correct metabolic acidosis 4. Correct an acid-base imbalance 5. Cause respiratory compensation 6. Stimulate Cheyne-Stokes respirations
2. Blow off carbon dioxide 3. Correct metabolic acidosis 4. Correct an acid-base imbalance 5. Cause respiratory compensation NCLEX
The nurse is caring for a client with metabolic alkalosis. The nurse plans care knowing that most problems of metabolic alkalosis are related to increased stimulation of what systems? Select all that apply. 1. Buffer 2. Cardiac 3. Nervous 4. Chemical 5. Respiratory 6. Neuromuscular
2. Cardiac 3. Nervous 6. Neuromuscular NCLEX
The nurse is reviewing the arterial blood gas analysis results for a client in the respiratory care unit who is receiving nasal oxygen and notes a pH of 7.38, PaCO₂ of 38 mm Hg, PaO₂ of 86 mm Hg, and HCO₃ of 23 mEq/L. What action should the nurse take in response to these results? 1. Discontinue the oxygen. 2. Continue monitoring the client. 3. Call 911 to have the client intubated immediately. 4. Have another set drawn because these results are not possible.
2. Continue monitoring the client. pH, PaCO₂, PaO₂, and HCO₃ are normal -normal pH = 7.35-7.45 -normal PaCO₂ = 35-45 mm Hg -normal PaO₂ = >80 mm Hg -normal HCO₃ = 21 to 28 mEq/L NCLEX
A client has been diagnosed with metabolic alkalosis as a result of excessive antacid use. The nurse should monitor this client, expecting to note which signs/symptoms? 1. Disorientation and dyspnea 2. Decreased respiratory rate and depth 3. Drowsiness, headache, and tachypnea 4. Tachypnea, dizziness, and paresthesias
2. Decreased respiratory rate and depth NCLEX
A nurse is caring for a client who overdosed on acetylsalicylic acid (aspirin) 24 hours ago. The nurse should expect to note which findings associated with an anticipated acid-base disturbance? 1. Disorientation and dyspnea 2. Drowsiness, headache, and tachypnea 3. Tachypnea, dizziness, and paresthesias 4. Decreased respiratory rate and depth, cardiac irregularities
2. Drowsiness, headache, and tachypnea (aspirin overdose = metabolic acidosis) NCLEX
A client experiencing metabolic acidosis is to be admitted to the nursing unit. The nurse plans care knowing that what reaction is the most powerful regulator of acid-base balance? 1. Buffer 2. Kidney 3. Cations 4. Respiratory
2. Kidney NCLEX
A client's blood gas results reveal acidosis. What are some signs and symptoms the nurse would expect to see? Select all that apply. 1. Seizures 2. Lethargy 3. Headache 4. Weakness 5. Confusion 6. Hyperactivity
2. Lethargy 3. Headache 4. Weakness 5. Confusion NCLEX
The client tells the nurse that he ingests large amounts of oral antacids on a daily basis. The nurse plans care knowing that the excessive use of oral antacids containing bicarbonate can result in which acid-base disturbance? 1. Metabolic acidosis 2. Metabolic alkalosis 3. Respiratory acidosis 4. Respiratory alkalosis
2. Metabolic alkalosis (excessive use of antacids containing bicarbonate can cause a metabolic alkalosis) NCLEX
A client is being treated for metabolic acidosis with medication therapy and other measures. The nurse should plan to monitor the results of which electrolyte, which could dramatically decline with effective treatment of the acidosis? 1. Sodium 2. Potassium 3. Magnesium 4. Phosphorus
2. Potassium (metabolic acidosis → hyperkalemia) NCLEX
The nurse is caring for a client who is on a mechanical ventilator. Blood gas results indicate a pH of 7.50 and a PaCO₂ of 30 mm Hg. The nurse has determined that the client is experiencing respiratory alkalosis. Which laboratory value would most likely be noted in this condition? 1. Sodium level of 145 mEq/L 2. Potassium level of 3.0 mEq/L 3. Magnesium level of 1.3 mEq/L 4. Phosphorus level of 3.0 mg/dL
2. Potassium level of 3.0 mEq/L respiratory alkalosis → hypokalemia NCLEX
The nurse is caring for a client with chronic kidney disease. Arterial blood gas (ABG) results indicate a pH of 7.30, a PaCO₂ of 32 mm Hg, and a bicarbonate concentration of 20 mEq/L. Which laboratory value should the nurse expect to note? 1. Sodium level of 145 mEq/L 2. Potassium level of 5.2 mEq/L 3. Phosphorus level of 3.0 mg/dL 4. Magnesium level of 1.3 mg/dL
2. Potassium level of 5.2 mEq/L ↓pH and ↓HCO₃ = metabolic acidosis → hyperkalemia NCLEX
An anxious client is experiencing respiratory alkalosis from hyperventilation caused by anxiety. The nurse should take which action to help the client experiencing this acid-base disorder? 1. Put the client in a supine position. 2. Provide emotional support and reassurance. 3. Withhold all sedative or antianxiety medications. 4. Tell the client to breathe very deeply but more slowly.
2. Provide emotional support and reassurance. NCLEX
The nurse is caring for a client with diabetic ketoacidosis and documents that the client is experiencing Kussmaul's respirations. Which patterns did the nurse observe? Select all that apply. 1. Respirations that are shallow 2. Respirations that are increased in rate 3. Respirations that are abnormally slow 4. Respirations that are abnormally deep 5. Respirations that cease for several seconds
2. Respirations that are increased in rate 4. Respirations that are abnormally deep NCLEX
The nurse reviews the arterial blood gas results of a client and notes the following: pH 7.45, PaCO₂ of 30 mm Hg, and HCO₃- of 20 mEq/L. The nurse analyzes these results as indicating which condition? 1. Metabolic acidosis, compensated 2. Respiratory alkalosis, compensated 3. Metabolic alkalosis, uncompensated 4. Respiratory acidosis, uncompensated
2. Respiratory alkalosis, compensated -high normal pH = alkalosis, compensated -↓PaCO₂ = respiratory NCLEX
A nurse is caring for a client who is experiencing metabolic alkalosis. The nurse plans to protect the client's safety knowing the risks of this imbalance, by carefully implementing which prescribed precaution? 1. Contact isolation 2. Seizure precautions 3. Bleeding precautions 4. Neutropenic precautions
2. Seizure precautions NCLEX
The nurse is caring for a client with a nasogastric tube that is attached to low suction. The nurse monitors the client for manifestations of which disorder that the client is at risk for? 1. metabolic acidosis 2. metabolic alkalosis 3. respiratory alkalosis 4. respiratory alkalosis
2. metabolic alkalosis (loss of gastric fluid via NG suction or vomiting causes metabolic alkalosis) NCLEX
The nurse caring for a client with COPD anticipates which ABG findings? 1. pH, 7.40; PaO2, 90 mm Hg; CO2, 39 mEq/L; HCO3, 23 mEq/L 2. pH, 7.32; PaO2, 85 mm Hg; CO2, 57 mEq/L; HCO3, 26 mEq/L 3. pH, 7.47; PaO2, 82 mm Hg; CO2, 30 mEq/L; HCO3, 31 mEq/L 4. pH, 7.31; PaO2, 95 mm Hg; CO2, 22 mEq/L; HCO3, 19 mEq/L
2. pH, 7.32; PaO2, 85 mm Hg; CO2, 57 mEq/L; HCO3, 26 mEq/L COPD = respiratory acidosis - ↓ pH, ↑ CO₂ NCLEX
normal HCO₃
22-26 mEq/L (MS text, Fund text, IV book, Hurst) 21-28 mEq/L (NCLEX, ATI)
The client with a history of lung disease is at risk for developing respiratory acidosis. The nurse asks this client about which symptoms that are characteristic of this disorder? 1. "Do you have shallow breathing?" 2. "Do you feel like you have a lot of energy?" 3. "Do you have a headache or become confused?" 4. "Do you feel dizzy or have tingling sensations?"
3. "Do you have a headache or become confused?" (In respiratory acidosis, respiratory rate and depth increase in an attempt to compensate. Pt also experiences headache, restlessness, and mental status changes such as drowsiness and confusion, visual disturbances, diaphoresis, and cyanosis as the hypoxia becomes more acute, along with hyperkalemia, a rapid irregular pulse, and dysrhythmias.) NCLEX
A client is about to have arterial blood gases drawn, and the nurse explains what an Allen's test is. What comment shows that the client understands the nurse's explanation? 1. "Blood is drawn from the ulnar artery." 2. "I know I have to lie down while blood is drawn." 3. "This test is done to ensure adequate collateral circulation." 4. "Direct pressure has to be placed over the site for 15 minutes after blood is drawn."
3. "This test is done to ensure adequate collateral circulation." NCLEX
The nurse is planning to obtain blood for arterial blood gas analysis from a client with chronic obstructive pulmonary disease. The nurse should plan time for which activity after the arterial blood specimen is drawn? 1. Holding a warm compress over the puncture site for 5 minutes 2. Encouraging the client to open and close the hand rapidly for 2 minutes 3. Applying pressure to the puncture site by applying a 2 × 2 gauze for 5 minutes 4. Having the client keep the radial pulse puncture site in a dependent position for 5 minutes
3. Applying pressure to the puncture site by applying a 2 × 2 gauze for 5 minutes (Applying pressure over the puncture site reduces the risk of hematoma formation and damage to the artery. A cold (not warm) compress would aid in limiting blood flow. Keeping the extremity still and out of a dependent position will aid in the formation of a clot at the puncture site.) NCLEX
A nurse is providing care to a client with the following arterial blood gas (ABG) results: pH 7.50; PaO₂ 90 mm Hg; PaCO₂ 40 mm Hg; and bicarbonate 35 mEq/L. When the nurse notifies the health care provider (HCP) about these levels, the nurse should anticipate receiving which prescription for this client from the HCP? 1. Obtain a serum alcohol level. 2. Obtain a serum salicylate level. 3. Discontinue nasogastric suctioning. 4. Discontinue the client's Fentanyl patch.
3. Discontinue nasogastric suctioning. ↑pH and ↑HCO₃ = metabolic alkalosis NG suctioning → metabolic alkalosis -normal pH = 7.35-7.45 -normal HCO₃ = 21-28 mEq/L NCLEX
A client is admitted to the hospital 24 hours following an aspirin (acetylsalicylic acid) overdose. The nurse assesses this client for which signs/symptoms, indicating the acid-base disturbance that could occur in the client? 1. Bradypnea, dizziness, and paresthesias 2. Bradycardia, listlessness, and hyperactivity 3. Headache, nausea, vomiting, and diarrhea 4. Restlessness, confusion, and a positive Trousseau's sign
3. Headache, nausea, vomiting, and diarrhea (aspirin overdose = metabolic acidosis) NCLEX
A client with a history of lung disease is at risk for developing respiratory acidosis. The nurse should assess the client for which signs and symptoms characteristic of this disorder? 1. Bradycardia and hyperactivity 2. Decreased respiratory rate and depth 3. Headache, restlessness, and confusion 4. Bradypnea, dizziness, and paresthesias
3. Headache, restlessness, and confusion NCLEX
A client is experiencing respiratory alkalosis as a result of hyperventilation. The nurse would expect the blood gas values to reflect what changes? 1. Decreased pH, decreased PCO₂ 2. Decreased pH, increased PCO₂ 3. Increased pH, decreased PCO₂ 4. Increased pH, increased PCO₂
3. Increased pH, decreased PCO₂ (respiratory alkalosis) Critical Thinking
A nurse is admitting a client with a diagnosis of Guillain-Barré syndrome to the hospital. The nurse knows that if the disease is severe enough, the client will be at risk for which acid-base imbalance? 1. Metabolic acidosis 2. Metabolic alkalosis 3. Respiratory acidosis 4. Respiratory alkalosis
3. Respiratory acidosis (Guillain-Barré is a neuromuscular disorder in which the client may experience weakening or paralysis of the muscles used for respiration. This could cause the client to retain carbon dioxide, leading to respiratory acidosis.) NCLEX
The nurse reviews the arterial blood gas (ABG) results of an assigned client and notes that the laboratory report indicates a pH of 7.30, a PaCO₂ of 58 mm Hg, a PaO₂ of 80 mm Hg, and an HCO₃ of 26 mEq/L. The nurse should interpret this to mean that the client has which acid-base disturbance? 1. Metabolic acidosis 2. Metabolic alkalosis 3. Respiratory acidosis 4. Respiratory alkalosis
3. Respiratory acidosis respiratory acidosis = ↓pH, ↑PaCO₂ -normal pH = 7.35-7.45 -normal PaCO₂ = 35-45 mm Hg NCLEX
The nurse is reviewing the arterial blood gas values of a client: -pH is 7.31 -PaCO₂ is 50 mm Hg -bicarbonate (HCO₃) level is 26 mEq/L The nurse concludes that which acid-base disturbance is present in this client? 1. Metabolic acidosis 2. Metabolic alkalosis 3. Respiratory acidosis 4. Respiratory alkalosis
3. Respiratory acidosis respiratory acidosis = ↓pH, ↑PaCO₂ -normal pH = 7.35-7.45 -normal PaCO₂ = 35-45 mm Hg -normal HCO₃ = 21 to 28 mEq/L NCLEX
The nurse reviews the arterial blood gas results of an assigned client and notes that the laboratory report indicates: -pH of 7.30 -PaCO₂ of 58 mm Hg -PaO₂ of 80 mm Hg -HCO₃ of 27 mEq/L The nurse interprets that the client has which acid-base disturbance? 1. Metabolic acidosis 2. Metabolic alkalosis 3. Respiratory acidosis 4. Respiratory alkalosis
3. Respiratory acidosis respiratory acidosis = ↓pH, ↑PaCO₂ -normal pH = 7.35-7.45 -normal PaCO₂ = 35-45 mm Hg -normal PaO₂ = >80 mm Hg -normal HCO₃ = 21 to 28 mEq/L NCLEX
A nurse reviews a client's arterial blood gas values and notes a pH of 7.50, a PaCO₂ of 30 mm Hg, and an HCO₃ of 25 mEq/L. The nurse should interpret these values as an indication of which condition? 1. Metabolic acidosis, uncompensated 2. Respiratory acidosis, uncompensated 3. Respiratory alkalosis, uncompensated 4. Metabolic acidosis, partially compensated
3. Respiratory alkalosis, uncompensated respiratory alkalosis = ↑pH, ↓PaCO₂ -normal pH = 7.35-7.45 -normal PaCO₂ = 35-45 mm Hg NCLEX
A client with a history of lung disease is at risk for developing respiratory acidosis. The nurse should assess the client for which signs and symptoms characteristic of this disorder? 1. bradycardia and hyperactivity 2. decreased respiratory rate and depth 3. headache, restlessness, and confusion 4. bradypnea, dizziness, and paresthesias
3. headache, restlessness, and confusion NCLEX
The nurse reviews the ABG results of an assigned client and notes that the laboratory report indicates a pH of 7.30, PaCO₂ of 58 mm Hg, PaO₂ of 80 mm Hg, and HCO₃ of 27 mEq/L. The nurse interprets that the client has which acid-base disturbance? 1. metabolic acidosis 2. metabolic alkalosis 3. respiratory acidosis 4. respiratory alkalosis
3. respiratory acidosis respiratory acidosis = ↓pH, ↑PaCO₂ -normal pH = 7.35-7.45 -normal PaCO₂ = 35-45 mm Hg -normal PaO₂ = >80 mm Hg -normal HCO₃ = 21 to 28 mEq/L NCLEX #937
normal PaCO₂
35-45 mm Hg
A client with a 3-day history of nausea and vomiting presents to the emergency department. The client is hypoventilating and has a respiratory rate of 10 breaths/minute. The electrocardiogram (ECG) monitor displays tachycardia, with a heart rate of 120 beats/minute. Arterial blood gases are drawn and the nurse reviews the results, expecting to note which finding? 1. A decreased pH and an increased CO₂ 2. An increased pH and a decreased CO₂ 3. A decreased pH and a decreased HCO₃- 4. An increased pH and an increased HCO₃-
4. An increased pH and an increased HCO₃- (Nausea and vomiting = metabolic alkalosis resulting from loss of gastric acid, causing ↑pH and ↑HCO₃. Symptoms experienced by the client would include hypoventilation and tachycardia.) NCLEX
A client with a chronic airflow limitation (CAL) is experiencing respiratory acidosis as a complication. A nurse who is trying to enhance the client's respiratory status should avoid which action? 1. Keeping the head of the bed elevated 2. Monitoring the flow rate of supplemental oxygen 3. Assisting the client to turn, cough, and breathe deeply 4. Encouraging the client to breathe slowly and shallowly
4. Encouraging the client to breathe slowly and shallowly (nurse would encourage the pt to breathe slowly and deeply to expand alveoli and promote better gas exchange) NCLEX
An anxious preoperative client is at risk for developing respiratory alkalosis. The nurse should assess the client for which signs and symptoms characteristic of this disorder? 1. Headache and tachypnea 2. Hyperactivity and dyspnea 3. Muscle twitches and cyanosis 4. Lightheadedness and paresthesias
4. Lightheadedness and paresthesias (Symptoms = ↓ respiratory rate and depth, headache, lightheadedness, vertigo, mental status changes, paresthesias of the fingers and toes, hypokalemia, hypocalcemia, tetany, and convulsions) NCLEX
A client who is found unresponsive has arterial blood gases drawn and the results indicate the following: pH is 7.12, PaCO₂ is 90 mm Hg, and HCO₃- is 22 mEq/L. The nurse interprets the results as indicating which condition? 1. Metabolic acidosis with compensation 2. Respiratory acidosis with compensation 3. Metabolic acidosis without compensation 4. Respiratory acidosis without compensation
4. Respiratory acidosis without compensation respiratory acidosis = ↓pH, ↑PaCO₂ -normal pH = 7.35-7.45 -normal PaCO₂ = 35-45 mm Hg NCLEX
The nurse reviews a client's arterial blood gas results and notes that the pH is 7.30, the PaCO₂ is 52 mm Hg, and the HCO₃ is 22 mEq/L. The nurse interprets these results as indicating which condition? 1. Metabolic acidosis, compensated 2. Respiratory alkalosis, compensated 3. Metabolic alkalosis, uncompensated 4. Respiratory acidosis, uncompensated
4. Respiratory acidosis, uncompensated respiratory acidosis = ↓pH, ↑PaCO₂ -normal pH = 7.35-7.45 -normal PaCO₂ = 35-45 mm Hg
The nurse is caring for a client having respiratory distress related to an anxiety attack. Recent arterial blood gas values are: -pH = 7.53 -PaO₂ = 72 mm Hg -PaCO₂ = 32 mm Hg -HCO₃ = 28 mEq/L Which conclusion about the client should the nurse make? 1. The client has acidotic blood. 2. The client is probably overreacting. 3. The client is fluid volume overloaded. 4. The client is probably hyperventilating.
4. The client is probably hyperventilating. ↑pH and ↓PaCO₂ = respiratory alkalosis hyperventilating → respiratory alkalosis -normal pH = 7.35-7.45 -normal PaCO₂ = 35-45 mm Hg -normal HCO₃ = 21-28 mEq/L NCLEX
normal pH
7.35-7.45
A nurse is assessing a client with COPD. Which finding should the nurse expect? A) Weight gain B) Decrease in anteroposterior diameter of the chest C) HCO3- 24 mEq/L D) pH 7.31
D) pH 7.31 (Respiratory acidosis is an expected finding for a client who has COPD) ATI
Your patient is hyperventilating from acute pain and hypoxia. Interventions to manage his pain and oxygenation will decrease his risk of which acid-base imbalance? A.) Metabolic acidosis B.) Metabolic alkalosis C.) Respiratory acidosis D.) Respiratory alkalosis
D.) Respiratory alkalosis -hyperventilation → respiratory alkalosis -interventions to decrease pain and hypoxia causing hyperventilation will decrease risk of respiratory alkalosis Fund ch 42
A patient is admitted with metabolic acidosis. Which system is not functioning normally? a. Renal system b. Buffer system c. Endocrine system d. Respiratory system
a. Renal system MS ch 16
A nurse has just drawn arterial blood gases on a pt. Which of the following is important for the nurse to do? a. apply pressure to the site for 5 min b. shake the vial of blood before transporting it to the lab c. keep the pt on bedrest for 1 hr d. encourage the pt to cough and deep-breathe
a. apply pressure to the site for 5 min Leadership and Management
The lungs act as an acid-base buffer by a. increasing respiratory rate and depth when CO₂ levels in the blood are high, reducing acid load b. increasing respiratory rate and depth when CO₂ levels in the blood are low, reducing base load c. decreasing respiratory rate and depth when CO₂ levels in the blood are high, reducing acid load d. decreasing respiratory rate and dpeth when CO₂ levels in the blood are low, increasing acid load
a. increasing respiratory rate and depth when CO₂ levels in the blood are high, reducing acid load MS ch 16
You are admitting a patient with complaints of abdominal pain, nausea, and vomiting. A proximal bowel obstruction is suspected. Which acid-base imbalance do you anticipate in this patient? a. Metabolic acidosis b. Metabolic alkalosis c. Respiratory acidosis d. Respiratory alkalosis
b. Metabolic alkalosis (vomiting leads to decreased gastric acid) MS ch 16
You are caring for a patient admitted with a diagnosis of chronic obstructive pulmonary disease (COPD) who has the following arterial blood gas results: pH 7.33, PaO₂ 47 mm Hg, PaCO₂ 60 mm Hg, HCO₃ 32 mEq/L, and O₂ saturation of 92%. What is the correct interpretation of these results? a. Fully compensated respiratory alkalosis b. Partially compensated respiratory acidosis c. Normal acid-base balance with hypoxemia d. Normal acid-base balance with hypercapnia
b. Partially compensated respiratory acidosis respiratory acidosis = ↓pH, ↑PaCO₂ -normal pH = 7.35-7.45 -normal PaCO₂ = 35-45 mm Hg MS ch 16
A nurse is reviewing ABG laboratory results of a client who is in respiratory distress. The results are pH 7.47, PaCO₂ 32 mm Hg, HCO₃ 22 mm Hg. The nurse should recognize that the client is experiencing which of the following acid-base imbalances? a. respiratory acidosis b. respiratory alkalosis c. metabolic acidosis d. metabolic alkalosis
b. respiratory alkalosis respiratory alkalosis = ↑pH, ↓PaCO₂ -normal pH = 7.35-7.45 -normal PaCO₂ = 35-45 mm Hg -normal HCO₃ = 21 to 28 mEq/L ATI MS
Client has COPD and his ABG: pH = 7.0, PaO₂ = 56, PaCO₂ = 54, HCO₃ = 26, SaO₂ = 87%. a. uncompensated metabolic acidosis b. uncompensated respiratory acidosis c. compensated respiratory acidosis d. compensated metabolic acidosis
b. uncompensated respiratory acidosis A pH of 7.30 is below the expected reference range and indicates the client has acidosis. The PaCO2 of 54 mm Hg is above the expected reference range, which, with the low pH indicates that the acidosis has a respiratory origin. The HCO3- of 26 mEq/L is within the expected reference range, indicating that the acidosis is not metabolic in origin and the body has not yet corrected the imbalance through compensation. ATI
The nurse is preparing to obtain an arterial blood gas specimen from a client and plans to perform the Allen's test on the client. The nurse would perform the steps in which order to conduct an Allen's test? Arrange the actions in the order that they should be performed. a. Apply pressure over the ulnar and radial arteries. b. Release pressure from the ulnar artery. c. Explain the procedure to the client. d. Document the findings. e. Ask the client to open and close the hand repeatedly. f. Assess the color of the extremity distal to the pressure point.
c, a, e, b, f, d c. Explain the procedure to the client. a. Apply pressure over the ulnar and radial arteries. e. Ask the client to open and close the hand repeatedly. b. Release pressure from the ulnar artery. f. Assess the color of the extremity distal to the pressure point. d. Document the findings. NCLEX
A patient is admitted to the hospital with severe dyspnea and wheezing. Arterial blood gas levels on admission are: -pH 7.26 -PaCO₂ 55 mm Hg -PaO₂ 68 mm Hg -HCO₃ 24 You interpret these laboratory values to indicate: a. metabolic acidosis b. metabolic alkalosis c. respiratory acidosis d. respiratory alkalosis
c. respiratory acidosis respiratory acidosis = ↓pH, ↑PaCO₂ -normal pH = 7.35-7.45 -normal PaCO₂ = 35-45 mm Hg -normal HCO₃ = 21 to 28 mEq/L Fund ch 42
The nurse on a medical-surgical unit identifies which patient as having the highest risk for metabolic alkalosis? a. A patient with a traumatic brain injury b. A patient with type 1 diabetes mellitus c. A patient with acute respiratory failure d. A patient with nasogastric tube suction
d. A patient with nasogastric tube suction (loss of stomach acid) MS ch 16
Arterial blood gas analysis yields the following results for a client seen in the health care clinic: -pH 7.48 -PaCO₂ 32 mm Hg -PaO₂ 94 mm Hg -HCO₃ 24 mEq/L The nurse interprets that the client has which acid-base disturbance? a. Metabolic acidosis b. Metabolic alkalosis c. Respiratory acidosis d. Respiratory alkalosis
d. Respiratory alkalosis respiratory alkalosis = ↑pH, ↓PaCO₂ -normal pH = 7.35-7.45 -normal PaCO₂ = 35-45 mm Hg -normal PaO₂ = >80 mm Hg -normal HCO₃ = 21 to 28 mEq/L
A nurse is obtaining arterial blood gases for a client who has vomited for 24 hr. The nurse should expect which of the following acid-base imbalances to result from vomiting for 24 hr? a. respiratory acidosis b. respiratory alkalosis c. metabolic acidosis d. metabolic alkalosis
d. metabolic alkalosis (excessive vomiting causes a loss of gastric acids and an accumulation of bicarbonate in the blood) ATI
A pt has the following arterial blood gas results: -pH 7.52 -PaCO₂ 30 mm Hg -HCO₃ 24 mEq/L The nurse determines that these results indicate: a. metabolic acidosis b. metabolic alkalosis c. respiratory acidosis d. respiratory alkalosis
d. respiratory alkalosis ↑pH and ↓PaCO₂ = respiratory alkalosis -normal pH = 7.35 to 7.45 -normal PaCO₂ = 35 to 45 mm Hg -normal HCO₃ = 22 to 26 mEq/L MS ch 16
You are caring for a patient admitted with an exacerbation of asthma. After several treatments, the ABG results are: -pH 7.40 -PaCO₂ 40 mm Hg -HCO₃ 24 mEq/L -PaO₂ 92 mm Hg -O₂ saturation of 99%. You interpret these results as: a. metabolic acidosis. b. respiratory acidosis. c. respiratory alkalosis. d. within normal limits.
d. within normal limits. -normal pH = 7.35 to 7.45 -normal PaCO₂ = 35 to 45 mm Hg -normal HCO₃ = 22 to 26 mEq/L -normal PaO₂ = >80 mm Hg -normal O₂ saturation = >95% MS ch 16
A nurse is assessing a client who has pancreatitis. The client's arterial blood gases reveal metabolic acidosis. Which of the following are expected findings? (Select all that apply) a. tachycardia b. hypertension c. bounding pulses d. hyperreflexia e. dysrhythmia f. tachypnea
e. dysrhythmia f. tachypnea -tachycardia = respiratory acidosis or metabolic alkalosis -hypertension = respiratory acidosis -bounding pulses = respiratory acidosis -hyperreflexia = metabolic alkalosis ATI
metabolic acidosis is associated with which electrolyte imbalance?
hyperkalemia (e.g. DKA)
respiratory alkalosis cause
hyperventilation: -anxiety, fear -pain -neurological problems (ex: stroke, meningitis, trauma)
metabolic alkalosis is associated with which electrolyte imbalance?
hypokalemia
respiratory acidosis cause
hypoventilation: -respiratory/CNS depression (ex: opioids, sedatives) -respiratory disease (ex: COPD, asthma) -neurological problems (ex: brain tumor, trauma)
metabolic alkalosis causes (4)
loss of acid, too much base: -vomiting -NG suctioning -hypokalemia -antacid overdose