Metabolic Alkalosis
A client is diagnosed with metabolic alkalosis. Which healthcare prescriber's order should the nurse expect to assist in restoring this imbalance? A. Administer a bronchodilator. B. Administer sodium bicarbonate. C. Administer IV insulin. D. Administer potassium chloride.
D. Administer potassium chloride. Rationale: In metabolic alkalosis, the administration of potassium restores serum and intracellular potassium levels, allowing the kidneys to conserve hydrogen ions. Sodium bicarbonate is used to treat metabolic acidosis, not metabolic alkalosis. IV insulin is used to treat diabetic ketoacidosis, which occurs with metabolic acidosis, not metabolic alkalosis. Bronchodilators are used to treat respiratory acidosis, not metabolic alkalosis.
The nurse is providing care for a client with suspected metabolic alkalosis. Which clinical manifestation would support a diagnosis of metabolic alkalosis? (Select all that apply.)A.HeadacheB.HypotensionC.SeizuresD.TetanyE.Hyperventilation
B.HypotensionC.SeizuresD.TetanyRationale: Hypotension, seizures, and tetany are all clinical manifestations of metabolic alkalosis. Additional clinical manifestations include confusion, decreasing level of consciousness (LOC), dysrhythmias, and respiratory failure. Headache and hyperventilation are clinical manifestations of metabolic acidosis.
The nurse is teaching the parents of an infant with pyloric stenosis about potential aciddash-base imbalances that may occur. Which aciddash-base imbalance is most likely for the infant with pyloric stenosis?A.Metabolic acidosisB.Respiratory acidosisC.Metabolic alkalosisD.Respiratory alkalosis
Metabolic alkalosisRationale: Infants with pyloric stenosis have prolonged vomiting, which can cause metabolic alkalosis due to the loss of hypochloric acid. The nurse should teach the parents the signs and symptoms of metabolic alkalosis.
What action supports the nurse's plan of care for treating impaired gas exchange in the client with metabolic alkalosis? (Select all that apply.) A. Assess skin color. B. Assess intake and output. C. Monitor respiratory rate, depth, and effort. D. Place the client in Fowler or semi-Fowler position. E. Monitor mental status and level of consciousness.
A. Assess skin color. C. Monitor respiratory rate, depth, and effort. D. Place the client in Fowler or semi-Fowler position. E. Monitor mental status and level of consciousness. Rationale: Actions that support the nurse's plan of care for the goal of treating impaired gas exchange in the client with metabolic alkalosis include monitoring respiratory depth and effort; assessing skin color; monitoring mental status and level of consciousness; and placing the client in Fowler or semi-Fowler position. Assessing the intake and output is not an intervention for treating impaired gas exchange but, rather, for treating fluid volume deficit.
Which laboratory or diagnostic test is used to diagnose metabolic alkalosis? (Select all that apply.) A. ECG B. ABGs C. Urine pH D. Serum CBC E. Serum electrolytes
A. ECG B. ABGs C. Urine pH E. Serum electrolytes Rationale: The laboratory or diagnostic tests used to diagnose metabolic alkalosis include: ABGs, ECG, serum electrolytes, and urine pH. A CBC (complete blood count) is not used to diagnose metabolic acidosis.
Which intervention should the nurse implement to monitor for fluid volume deficit in the client with metabolic alkalosis? (Select all that apply.) A. Monitor serum electrolytes, osmolality, and ABG values. B. Assess skin color; note and report cyanosis around the mouth. C. Assess intake and output accurately, monitoring fluid balance. D. Assess vital signs, CVP, and peripheral pulse volume once per shift. E. Weigh daily under standard conditions (time of day, clothing, and scale).
A. Monitor serum electrolytes, osmolality, and ABG values. C. Assess intake and output accurately, monitoring fluid balance. E. Weigh daily under standard conditions (time of day, clothing, and scale). Rationale: To monitor for fluid volume deficit, the nurse should monitor serum electrolytes, osmolality, and ABG values; assess intake and output accurately to monitor for fluid balance; and weigh the client daily under standard conditions. Assessment of skin color for cyanosis around the mouth helps to monitor for impaired gas exchange, not fluid volume deficit. Vital signs, CVP, and peripheral pulse volume to monitor for fluid volume deficit should be done every four hours, not just once a shift.
A nurse is caring for a client who is diagnosed with metabolic alkalosis. Which should the nurse include in the assessment of this client? (Select all that apply.) A. Oxygen saturation B. ABG interpretation C. Deep tendon reflexes D. Presence of muscle weakness E. Presence of numbness and tingling
A. Oxygen saturation B. ABG interpretation C. Deep tendon reflexes E. Presence of numbness and tingling Rationale: When assessing a client with metabolic alkalosis, the nurse will include ABG interpretation, deep tendon reflexes, oxygen saturation, and presence of numbness and tingling. The nurse would assess for the presence of muscle spasm, not weakness, for this client.
Which is an appropriate nursing outcome for a client with metabolic alkalosis? (Select all that apply.) A. Oxygen saturation is 93% or greater. B. Muscle weakness is identified and treated. C. Normal acid-base balance is restored and maintained. D. The underlying cause of metabolic alkalosis is identified and treated. E. Normal or near normal fluid and electrolyte volumes are restored and maintained.
A. Oxygen saturation is 93% or greater. C. Normal acid-base balance is restored and maintained. D. The underlying cause of metabolic alkalosis is identified and treated. E. Normal or near normal fluid and electrolyte volumes are restored and maintained. Rationale: Appropriate nursing outcomes for a client with metabolic alkalosis include the following: Normal acid-base balance is restored and maintained; underlying cause of metabolic alkalosis is identified and treated; normal or near normal fluid and electrolyte volumes are restored and maintained; and oxygen saturation is 93% or greater. Muscle weakness is not a symptom of metabolic alkalosis, so the nurse would not anticipate this as a goal for the client with metabolic alkalosis.
A nurse is caring for a client whose arterial blood gas (ABG) results are as follows: pH 7.47 PCO2 35 PO2 90 HCO3 35 Which pharmacological therapy will the nurse anticipate administering for this client to help restore the client's aciddash-base balance? (Select all that apply.) A. Sodium chloride B. Calcium chloride C. Potassium chloride D. Magnesium chloride E. Ammonium chloride
A. Sodium chloride C. Potassium chloride E. Ammonium chloride Rationale: This client has metabolic alkalosis. Pharmacological therapy for this condition includes potassium chloride, sodium chloride, and ammonium chloride. The potassium restores serum and intracellular potassium levels, allowing the kidneys to conserve hydrogen ions more effectively. Chloride promotes renal excretion of bicarbonate. Sodium chloride solutions restore fluid volume deficits that can contribute to metabolic alkalosis. In severe alkalosis, an acidifying solution such as ammonium chloride may be administered. While this client may have other electrolyte imbalances, magnesium chloride and calcium chloride are not typical therapies for the treatment of metabolic alkalosis.
The nurse is completing a teaching session for parents of a child who will be undergoing cardiac surgery to repair a birth defect. Which clinical manifestation should the nurse include when teaching the parents about an aciddash-base imbalance associated with postoperative pediatric cardiac surgery? (Select all that apply.)A.DysrhythmiasB.IrritabilityC.SeizuresD.Decreasing level of consciousness (LOC)E.Cardiac arrest
A.DysrhythmiasC.SeizuresD.Decreasing level of consciousness (LOC)Rationale: Metabolic alkalosis is seen with a higher incidence in children who undergo cardiac surgery. Clinical manifestations of metabolic alkalosis include dysrhythmias, seizures, and decreasing LOC; thus, these should be included. Irritability and cardiac arrest are manifestations of respiratory acidosis.
The nurse is caring for a client who is receiving massive blood transfusions secondary to hypovolemic shock. Which rationale supports assessing this client for metabolic alkalosis? A.Citrate toxicity decreases serum ionized calcium. B.Hypovolemic shock increases the serum pH. C.Excessive blood transfusions cause hypokalemia. D.Heparin found in blood products decreases serum potassium.
Citrate toxicity decreases serum ionized calcium. Rationale: Citrate is a preservative found in blood products. Citrate toxicity decreases serum ionized calcium, leading to metabolic alkalosis. Hypovolemic shock generally causes a decrease in the serum pH. Excessive blood transfusions are more likely to cause an allergic reaction not cause hypokalemia. Heparin found in blood products affects the coagulation of the blood and does not affect serum potassium.
Which assessment data should the nurse use to most accurately determine fluid balance for the client with metabolic alkalosis? A. Client weight gain of 2.4 lb in the past 24 hours B. Excess intake balance of 500 mL for the most recent 12-hour shift C. Decrease in client systolic blood pressure of 20 mmHg since last reading D. Lab values indicating hypokalemia
Client weight gain of 2.4 lb in the past 24 hours Rationale: Clients with metabolic alkalosis often have accompanying fluid volume deficit. The most accurate reflection of fluid balance is rapid weight changes. Thus the weight gain of 2.4 lb in the past 24 hours would be the most accurate indicator of fluid balance. Lab values, intake and output, and blood pressure can also reflect fluid balance changes but are not the most accurate indicators of fluid balance.
The long-term care nurse is teaching an orientation class concerning care of older adult clients to new assistive personnel. Which would the nurse include as important to ensure for the older adult clients to address a change in aging and to decrease the risk for development of metabolic alkalosis? A. Ensure high-protein shakes and supplements are offered frequently. B. Ensure that the older adult receives only small amounts of caffeinated fluids. C. Ensure that the older adult eats balanced meals. D. Ensure that the older adult has adequate fluid intake.
D. Ensure that the older adult has adequate fluid intake Rationale: Older adults have a diminished sense of thirst and can become volume depleted very quickly; thus, ensuring adequate fluid intake is important to help prevent the development of metabolic alkalosis. Ensuring balanced meals, limited caffeinated fluids, and frequent protein shakes/supplements neither address the change of age-related thirst nor directly affect the potential development of metabolic alkalosis.
The nurse is caring for a client admitted to a medical-surgical unit after a car crash. The client received several units of packed red blood cells while in surgery. The nurse begins to monitor this client for metabolic alkalosis due to receiving blood transfusions. Which other item in the client's health history would place this client at an increased risk for developing metabolic alkalosis? A.History of breast cancer B.History of low potassium C.History of two miscarriages D.History of depression
History of low potassium Rationale: A history of hypokalemia, or low potassium, in addition to the numerous blood transfusions, would place this client at risk for metabolic alkalosis. Histories including two miscarriages, breast cancer, or depression do not place this client at a higher risk for developing metabolic alkalosis.
A toddler-age client returns from the post-anesthesia care unit (PACU) after having an appendectomy. Upon assessment, the nurse notes a dysrhythmia on the child's ECG and a positive Trousseau sign. The client is diagnosed with metabolic alkalosis. Which nursing intervention is the most appropriate for this client? A. Place the client in high-Fowler position. B. Monitor for bradycardia. C. Assess respiratory status every shift. D. Weigh the client every other day.
Place the client in high-Fowler position. Rationale: A client who is diagnosed with metabolic alkalosis will require positioning in Fowler or high-Fowler position to decrease the work of breathing. Respiratory status should be monitored every 2 hours, the client should be weighed every day, and the nurse should monitor for tachycardia, not bradycardia.
The nurse is caring for a client diagnosed with metabolic alkalosis. Which intervention should the nurse include when establishing the plan of care? A. Encourage slow, deep respirations. B. Promote early ambulation. C. Administer antiemetics as prescribed. D. Monitor for pain.
administer antiemetics as prescribed. Rationale: One cause of metabolic alkalosis is vomiting. Antiemetics can help prevent this from occurring. Acute pain that might require medication is seen with respiratory, not metabolic, alkalosis. Encouraging slow, deep respirations would be indicated for a client with respiratory alkalosis. Early ambulation is encouraged with respiratory acidosis, not with metabolic alkalosis.
Which is a risk factor for the development of metabolic alkalosis? A.Hypokalemia B.Hospitalization C.Gastric suctioning D.Primary hypoaldosteronism E.Treatment with alkalinizing solution
A.Hypokalemia B.Hospitalization C.Gastric suctioning E.Treatment with alkalinizing solution Rationale: Risk factors for metabolic alkalosis include: hospitalization, hypokalemia, treatment with an alkalinizing solution, gastric suctioning, and primary hyperaldosteronism, not hypoaldosteronism. Metabolic alkalosis occurs when the body loses too much acid or gains too much base. Hypokalemia can contribute in more than one way to metabolic alkalosis; either secondary to the common causes of metabolic alkalosis such as vomiting and gastric suction, which result in acid loss or through further reabsorption ofHCO3when the body responds to hypokalemia. Metabolic alkalosis can occur more frequently in hospitalized clients due to various treatments or complications of the illness being treated.
The nurse is assessing the arterial blood gases and a metabolic panel for a client with suspected metabolic alkalosis. Which finding would support this diagnosis? (Select all that apply.)A.pH 7.52B.HCO330 mEq/LC.Serum potassium 4.6 mEq/LD.Serum chloride 90 mEq/LE.Urine pH 5
A.pH 7.52B.HCO330 mEq/LD.Serum chloride 90 mEq/LRationale: In metabolic alkalosis, the pH is greater than 7.45,HCO3is greater than 26 mEq/L, and serum chloride may be decreased (less than 95 mEq/L). Serum potassium may also be decreased, thus a serum potassium of 4.6 mEq/L would not support a diagnosis of metabolic alkalosis. In metabolic alkalosis, urine pH is usually low (1-3).
Which client being monitored for the potential development of metabolic alkalosis is the highest priority?A.A client experiencing ketoacidosisB.A client with continuous gastric suctioningC.A client with excessive diarrheaD.A client with a sodium chloride intravenous solution
B.A client with continuous gastric suctioningRationale: Continuous gastric suction results in acid loss/excretion, thus contributing to the potential development of metabolic alkalosis. The nurse should carefully monitor this client for metabolic alkalosis. Excessive diarrhea, ketoacidosis, and sodium chloride intravenous solutions can all contribute to the potential development of metabolic acidosis.
During a review of medications for an 83-year-old client, the nurse finds that the client has been frequently using sodium bicarbonate for heartburn. What action should the nurse take in response to this information?A.Inform the client that it is acceptable to use this antacid if fluid intake is adequate.B.Advise the client to use other antacid preparations without sodium bicarbonate.C.Immediately obtain diagnostic studies to ensure that metabolic alkalosis is not occurring.D.Alert the client to possible side effects related to the use of sodium bicarbonate
B.Advise the client to use other antacid preparations without sodium bicarbonate.Rationale: Use of sodium bicarbonate antacids can predispose clients to metabolic alkalosis. The nurse should advise the client to use a different antacid preparation. Alerting the client to possible side effects would not decrease the potential for metabolic alkalosis. Adequate fluid intake does not offset the risk of metabolic alkalosis with sodium bicarbonate use. There is no information in the scenario that would indicate the need for immediate diagnostic studies.
