NCLEX book questions CH 55 acid-base imbalances

The nurse would suspect that a client who frequently uses which medication is at risk for developing metabolic alkalosis? 1. calcium carbonate (TUMS) 2. ibuprofen (Motrin) 3. acetylsalicylic acid (Aspirin) 4. acetaminophen (Tylenol)

Answer: 1 Excessive use of oral antacids can lead to metabolic alkalosis.

A client has been admitted for dehydration after fasting for 5 days. For which acid-base imbalance would the nurse assess this client? 1. Metabolic acidosis 2. metabolic alkalosis 3. respiratory acidosis 4. respiratory alkalosis

Answer: 1 Fasting can lead to dehydration. During fast, the body reverts to cellular breakdown to maintain energy, and lactic and pyruvic acid builds up in the body. Accumulation of acids leads to metabolic acidosis

ABG results are pH 7.36; PaCO2 50; HCO3 28. What do these results indicate? 1. compensated respiratory acidosis 2. compensated metabolic acidosis 3. uncompensated metabolic acidosis 4. uncompensated respiratory acidosis

Answer: 1 pH is just WNL, so blood gas results are either normal or compensated. However, the PaCO2 is high, indicating a respiratory problem, and thus the ABGs cannot be normal. The HCO3 is also high, which along with a normal pH indicated complete compensation *Because pH is normal, eliminate the uncompensated options. Choose resp. over metabolic acidosis cause the pH is near the acidic end of the range and the high CO2 correlates with acidosis, where as a high HCO3, would correlate with an alkalotic state.

A client admitted to the hospital with a DX of respiratory acidosis secondary to overdose of barbiturates. Which assessment would the nurse anticipate? (SELECT ALL THAT APPLY) 1. Slow, shallow respirations 2. Tetany symptoms 3. Increased deep tendon reflexes 4. Palpitations 5. Headache

Answer: 1, 5 Pt with respiratory acidosis from this med would have slow and shallow respirations, leading to hypo-ventilation. Headace is associated because the increased CO2 level causes cerebral vasodilation, leading to headache. **tetany, ↑ deep tendon reflexes, and palpitations are with respiratory alkalosis

Pt admitted for sudden onset of severe abdominal pain. Which ABG value would the nurse expect to see with this pt? 1. PaCO2 48 2. HCO3 18 3. pH 7.32 4. SaO2 90

Answer: 2 Acute pain can lead to HYPERventilation, which causes CO2 to be blown off, leading to ↑ pH and ↓ CO2 level. IF the client has NOT compensated, the bicarbonate level will be normal. IF the client IS compensating, the bicarbonate level will ↓ in an attempt to restore the pH.

Pt with an NG tube on low suction for 5 days is at risk for developing which acid base imbalance? 1. respiratory acidosis 2. metabolic alkalosis 3. metabolic acidosis 4. respiratory alkalosis

Answer: 2 Pt with prolonged NG suction is apt to have higher levels of bicarb because of hydrogen ion loss. Bicarb excess leads to a metabolic disturbance and the development of metabolic acidosis

Pt admitted with DX of renal failure. Which ABG result would the nurse expect to see with this client? 1. pH 7.49; PaCO2 36; HCO3 30 2. pH 7.30; PaCO2 35; HCO3 18 3. pH 7.31; PaCO2 50; HCO3 23 4. pH 7.43; PaCO2 48; HCO3 30

Answer: 2 Pt with renal failure have difficulty synthesizing HCO3 in the renal tubules secondary to renal failure. They also retain K+, and develop metabolic acidosis

A client admitted to hospital after vomiting for 3 days. Which ABG result would the nurse expect? 1. pH 7.30; PaCO2 50; HCO3 27 2. pH 7.47; PaCO2 43; HCO3 28 3. pH 7.34; PaCO2 50; HCO3 28 4. pH 7.34; PaCO2 30; HCO3 23

Answer: 2 Vomiting leads to loss of GI acids.Metabolic alkalosis occurs and is relected by elevated pH and HCO3, and normal PaCO2.

The nurse would assess for which S/S of a pt who has metabolic acidosis? (SELECT ALL THAT APPLY) 1. Wt gain 2. rapid, deep respirations 3. drowsiness 4. ↓ respiratory rate and depth 5. Melena (dark tarry stools)

Answer: 2,3 Pt with metabolic acidosis develop Kussmaul's breathing (rapid and deep respirations). Drowsiness occurs because of the CNS depressant effect of acidosis

The nurse admitting a pt who has metabolic alkalosis. The nurse plans to assess for manifestations of which electrolyte imbalance? (SELECT ALL THAT APPLY) 1. hypernatremia 2. hypochloremia 3. hypermagnesemia 4. hypocalcemia 5. hypokalemia

Answer: 2,4,5 Clinical manifestations of metabolic alkalosis are associated with the presence of tetany-like symptoms and correlate with how levels of calcium.

Which statement by the pt indicates the discharge teaching for respiratory alkaosis is understood? (SELECT ALL THAT APPLY) 1. I will not take so many antacids anymore 2. i will take a stress managment class 3. I will not take my furosemide without taking my K+ supplements 4. I will tell the Dr the next time I have diarrhea for so long 5. I am more aware of how by breathing changes when I get nervous

Answer: 2,5 Respiratory alkalosis is caused by HYPERventalation, which can be stress and anxiety.

ABG results are pH 7.50; PaCO2 40; HCO3 29. Which question should the nurse ask the client to help determine an etiology for these results? 1. "have you had diarrhea lately? 2. "do you have a history of COPD? 3. "how long have you had nausea and vomiting?" 4. "do you smoke?"

Answer: 3 ABG results reflect ↑pH (alkalosis), and normal PaCO2, and ↑HCO3 indicating metabolic alkalosis. Vomiting is a common cause of this condition. ** Diarrhea is associate with METABOLIC ACIDOSIS

Which medication should the nurse review first for its potential interaction in a pt in a state of alkalosis? 1. Warfarin (Coumadin) 2. Metformin (Glucophage) 3. Digoxin (Lanoxin) 4. Ibuprofen (Motrin)

Answer: 3 Alkalosis, especially respiratory alkalosis, makes pt more sensitive to the effects of digoxin. Toxicity can develop at therapeutic levels. Serum dig level should be obtained, and pt evaluated for potential dig toxicity.

Pt's ABG results are pH 7.48; PaCO2 30; HCO3 23. How will the nurse interpret these results? 1. Compensated respiratory alkalosis 2. Uncompensated metabolic alkalosis 3. Uncompensated respiratory alkalosis 4. Compensated metabolic alkalosis

Answer: 3 Pts pH is high, indicating alkalosis. The PaCO2 is abnormal, indicating repiratory. The HCO3 is normal, indicating that compensation has not started.

Pt admitted with an acid-base imbalance. ABG results are pH 7.33; PaCO2 49; HCO3 28. How would the nurse interpret these results? 1. Uncompensated respiratory acidosis 2. Metabolic alkalosis, uncompensated 3. Partially compensated respiratory acidosis 4. Partially compensated metabolic acidosis

Answer: 3 The pH is low, indicating acidosis; the PaCO2 is elevated, indicating a respiratory basis; and the HCO3 is elevated, indicating that compensatory mechanisms are partially working.

The following ABG results are on pt chart. pH 7.50; PaCO2 36; HCO3 30. How will nurse interpret results? 1. partially compensated metabolic alkalosis 2. compensated respiratory alkalosis 3. uncompensated metabolic alkalosis 4. uncompensated respiratory alkalosis

Answer: 3 pH indicates alkalosis; HCO3 is high, indicating metabolic origin, and PaCO2 in normal indicating compensation has not taken place.

Pt admitted with respiratory acidosis. The nurse considers that which condition could be an etiology for this state? (SELECT ALL THAT APPLY) 1. severe diarrhea for several days 2. diabetic ketoacidosis 3. obesity 4. diuretics 5. sedative overdose

Answer: 3,5 Obesity can lead to chest wall abnormalities and hypoventilation, which can lead to respiratory acidosis. Sedative overdose depresses CNS, leading to hypoventilation and resp. acidosis.

Pt admitted with numerous episodes of muscle weakness and twitching. ABG results are pH 7.44; PaCO2 49; HCO3 30. How would the nurse interpret these findings? 1. Uncompensated metabolic acidosis 2. Compensated respiratory alkalosis 3. Uncompensated respiratory alkalosis 4. Compensated metabolic alkalosis

Answer: 4 The pH is just below the high limit, and the HCO3 is elevated, indicating a metabolic problem. The PaCO2 is elevated, indicating compensation, so the interpretation is compensated respiratory alkalosis. *Note pH is WNL, which indicates that condition is compensated, thus eliminating acidosis options. Note the high HCo3 is a metabolic indicator and is consistent with a pH near the high end of normal

Pt with atelectasis (collapsed lung) and reports of chest pain. For which acid-base imbalance would the nurse assess for? 1. respiratory alkalosis 2. metabolic acidosis 3. metabolic alkalosis 4. respiratory acidosis

Answer: 4 pt with a collapsed lung would retain CO2, which can lead to resp. acidosis. They would have hypoventilation