NUR 112 test 2 (Acid Base)

A client is transferred to the postanesthesia care unit after abdominal surgery. The client begins vomiting. What nursing action is most important when caring for this client? 1 Turning the client onto the side 2 Measuring the amount of vomitus 3 Checking the wound for dehiscence 4 Administering the prescribed antiemetic to the client

1 The side-lying position promotes drainage of emesis and secretions from the mouth, reducing the risk of aspiration. Although accurate assessment of intake and output is important, prevention of aspiration is the priority. Dehiscence is not probable at this time; it is more common five to seven days after surgery. Although the antiemetic may prevent additional vomiting, the nurse's priority is to prevent aspiration.

A client who was recently diagnosed with emphysema develops a malignancy in the right lower lobe of the lung, and a lobectomy is performed. After surgery, the client is receiving oxygen by nasal cannula at 2 L per minute. Blood gas results demonstrate respiratory acidosis. What should be the initial nursing intervention? 1 Administer oral fluids. 2 Encourage deep breathing. 3 Increase the oxygen flow rate. 4 Perform nasotracheal suctioning.

2 Hypoventilation because of pain is the usual cause of respiratory acidosis after lung surgery. Respiratory regulation corrects 50% to 75% of pH imbalances; this is accomplished by either increasing (for acidosis) or decreasing (for alkalosis) the rate and depth of respirations. Therefore, deep breathing will decrease carbon dioxide levels in the blood, thereby decreasing respiratory acidosis. Oral fluids are helpful in liquefying respiratory secretions but will not decrease carbon dioxide levels in the blood. The client has emphysema, and increasing delivery of oxygen if the client is not hypoxic may precipitate CO2 narcosis.

The serum potassium level of a client who has diabetic ketoacidosis is 5.4 mEq/L (5.4 mmol/L). What would the nurse expect to see on the ECG tracing monitor? 1 Abnormal P waves and depressed T waves 2 Peaked T waves and widened QRS complexes 3 Abnormal Q waves and prolonged ST segments 4 Peaked P waves and an increased number of T waves

2 Potassium is the principal intracellular cation, and during ketoacidosis it moves out of cells into the extracellular compartment to replace potassium lost as a result of glucose-induced osmotic diuresis; overstimulation of the cardiac muscle results. The T wave is depressed in hypokalemia. Initially, the QT segment is short, and as the potassium level rises, the QRS complex widens. P waves are abnormal because the PR interval may be prolonged and the P wave may be lost; however, the T wave is peaked, not depressed. The ST segment becomes depressed. The PR interval is prolonged, and the P wave may be lost. QRS complexes and thus T waves become irregular, and the rate does not necessarily change.

The patient has severe hyperthyroidism and will have surgery tomorrow. What assessment is most important for the nurse to assess in order to detect development of the acid-base imbalance for which the patient has highest risk? 1 Urine output and color 2 Level of consciousness 3 Heart rate and blood pressure 4 Lung sounds in lung bases

2 Thyroid hormone increases metabolic rate, causing a patient with severe hyperthyroidism to have high risk of metabolic acidosis from increased production of metabolic acids. Metabolic acidosis decreases level of consciousness. Changes in urine output, urine color, and lung sounds are not signs of metabolic acidosis. Although metabolic acidosis often causes tachycardia, many other factors influence heart rate and blood pressure, including thyroid hormone.

A nurse is caring for a client admitted to the hospital for diabetic ketoacidosis. Which clinical findings related to this event should the nurse document in the client's clinical record? Select all that apply. 1 Diaphoresis 2 Retinopathy 3 Acetone breath 4 Increased arterial bicarbonate level 5 Decreased arterial carbon dioxide level

3,5 A fruity odor to the breath (acetone breath) occurs when the ketone level is elevated in ketoacidosis. Metabolic acidosis initiates respiratory compensation in the form of Kussmaul respirations to counteract the effects of ketone buildup, resulting in a decreased arterial carbon dioxide level.

A client is hospitalized after four 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). What condition does the nurse determine the results to indicate? 1 Hypernatremia 2 Hyperchloremia 3 Metabolic alkalosis 4 Respiratory acidosis

3. 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 to 25 mmol/L); the client has an excess of base bicarbonate, indicating a metabolic cause for the alkalosis.

Which blood gas result should the nurse expect an adolescent with diabetic ketoacidosis to exhibit? 1 pH 7.30, CO2 40 mm Hg, HCO3- 20 mEq/L (20 mmol/L) 2 pH 7.35, CO2 47 mm Hg, HCO3- 24 mEq/L (24 mmol/L) 3 pH 7.46, CO2 30 mm Hg, HCO3- 24 mEq/L (24 mmol/L) 4 pH 7.50, CO2 50 mm Hg, HCO3- 22 mEq/L (22 mmol/L)

1 A client in diabetic ketoacidosis will have blood gas readings that indicate metabolic acidosis. The pH will be acidic (7.30), and the HCO3- will be low (20 mEq/L [20 mmol/L]). The normal pH is 7.35 to 7.45; CO2 ranges from 35 to 45 mm Hg, and HCO3- ranges from 22 to 26 (22 to 26 mmol/L). A pH of 7.35 and a CO2 of 47 mm Hg indicate respiratory acidosis. pH values of 7.46 and 7.50 represent alkalosis, not acidosis.

A client with colitis has had a hemicolectomy. Three days after surgery the nurse identifies that the client has abdominal distention and absent bowel sounds, and has vomited 300 mL of dark green viscous fluid. The nurse contacts the primary healthcare provider and recommends which intervention? 1 Nasogastric tube for decompression 2 Antiemetic for nausea/vomiting 3 Intravenous (IV) lactated Ringer for fluid replacement 4 Stat electrolytes to assess for probable electrolyte imbalance

1 Decompression removes collected secretions behind the nonfunctioning bowel segment (paralytic ileus), thus reducing pressure on the suture line and allowing healing. Vomiting will subside as the bowel is decompressed. Although IV lactated Ringer for fluid replacement is important, the primary concern is decompression of the bowel; the amount of fluid removed will direct fluid and electrolyte replacement therapy.

A 10-month-old infant has had watery green stool for 2 days and refuses the bottle. The nurse is aware that the primary concern for this baby is: 1 metabolic acidosis. 2 metabolic alkalosis. 3 weight loss. 4 diaper rash.

1 Loss of bowel contents leads to metabolic acidosis. The child will lose weight and will probably have diaper rash, but the primary concern is the electrolyte imbalance.

A nurse is caring for a client who is experiencing an underproduction of thyroxine (T4). Which client response is associated with an underproduction of thyroxine? Myxedema Acromegaly Graves disease Cushing disease

1 Myxedema is the severest form of hypothyroidism. Decreased thyroid gland activity means reduced production of thyroid hormones. Acromegaly results from excess growth hormone in adults once the epiphyses are closed. Graves disease results from an excess, not a deficiency, of thyroid hormones. Cushing disease results from excess glucocorticoids.

4. The nurse is making a home visit to a child who has a chronic disease. Which finding has the greatest implication for acid-base aspects of this patients care? 1 Urine output is very small today. 2 Whites of the eyes appear more yellow. 3 Skin around the mouth is very chapped. 4 Skin is sweaty under three blankets.

1 Oliguria decreases the excretion of metabolic acids and is a risk factor for metabolic acidosis. Jaundice requires follow-up but is not an acid-base problem. Perioral chapped skin needs intervention but is not an acid-base issue. With three blankets, diaphoresis is not unusual.

When assessing a client's fluid and electrolyte status, the nurse recalls that the regulator of extracellular osmolarity is what? 1 Sodium 2 Potassium 3 Chloride 4 Calcium

1 Sodium is the most abundant extracellular fluid cation and regulates serum (extracellular) osmolarity, as well as nerve impulse transmission and acid-base balance. Potassium is the major intracellular osmolarity regulator, and it also regulates metabolic activities, transmission and conduction of nerve impulses, cardiac conduction, and smooth and skeletal muscle contraction. Chloride is a major extracellular fluid anion and follows sodium. Calcium is an extracellular cation necessary for bone and teeth formation, blood clotting, hormone secretion, cardiac conduction, transmission of nerve impulses, and muscle contrac

A client's 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 should the nurse consider is most likely to exhibit these blood gas results? 1 A 65-year-old with pulmonary fibrosis 2 A 24-year-old with uncontrolled type 1 diabetes 3 A 45-year-old who has been vomiting for 3 days 4 A 54-year-old who takes sodium bicarbonate for indigestion

1 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 24-year-old with uncontrolled type 1 diabetes most likely will experience metabolic acidosis from excess ketone bodies in the blood. A 45-year-old who has been vomiting for 3 days most likely will experience metabolic alkalosis from the loss of hydrochloric acid from vomiting. A 54-year-old who takes sodium bicarbonate for indigestion most likely will experience metabolic alkalosis from an excess of base bicarbonate.

A 3-month-old infant who has a 3-day history of diarrhea is admitted to the pediatric unit. The nurse obtains the infant's vital signs, performs a physical assessment, and reviews the infant's arterial blood gas results. Which acid-base imbalance does the nurse suspect? ABG results: PH 7.30 PaCo2: 35 HCO3 : 17 1 Metabolic acidosis 2 Metabolic alkalosis 3 Respiratory acidosis 4 Respiratory alkalosis

1 The pH indicates acidosis, not alkalosis; the HCO3- level is further from the expected range than is the Pco2 level, indicating a metabolic, not respiratory, origin (losses from diarrhea).

Which of the following components of the arterial blood gas will the nurse focus when on determining a clients acid-base status? (Select all that apply.) 1 pH 2 PO2 3 PCO2 4 HCO3 5 O2 Sat 6 Hgb

1,3,4 Interpretation of the clients acid-base status involves the evaluation of three components of the arterial blood gas: pH, PCO2 and HCO3-.. PO2 and O2 Sat are not used to evaluate the clients acid-base status. Hgb level is not a component of the arterial blood gas.

The patient had diarrhea for 5 days and developed an acid-base imbalance. Which statement would indicate that the nurses teaching about the acid-base imbalance has been effective? 1 To prevent another problem, I should eat less sodium during diarrhea. 2 My blood became too acid because I lost some base in the diarrhea fluid. 3 Diarrhea removes fluid from the body, so I should drink more ice water. 4 I should try to slow my breathing so my acids and bases will be balanced.

2 Diarrhea causes metabolic acidosis through loss of bicarbonate, which is a base. Eating less sodium during diarrhea increases the risk of ECV deficit. Although diarrhea does remove fluid from the body, it also removes sodium and bicarbonate which need to be replaced. Rapid deep respirations are the compensatory mechanism for metabolic acidosis and should be encouraged rather than stopped.

A nurse is caring for an infant whose vomiting is intractable. Which complication is most likely to occur? 1 Acidosis 2 Alkalosis 3 Hyperkalemia 4 Hypernatremia

2 Excessive vomiting causes an increased loss of hydrogen ions (hydrochloric acid), leading to metabolic alkalosis, an excess of base bicarbonate. Acidosis is caused by retention of hydrogen ions and a loss of base bicarbonate, which is more likely to occur with diarrhea. Hypokalemia, not hyperkalemia, will occur. With the loss of chloride ions, hyponatremia is more likely to occur.

A patient with a history of severe chronic obstructive pulmonary disease (COPD) is most likely to have: 1 respiratory alkalosis. 2 respiratory acidosis. 3 metabolic alkalosis. 4 metabolic acidosis.

2 People with COPD are prone to chronic respiratory acidosis because of the retained CO2.

Which statements said by patients indicate that the nurses teaching regarding prevention of acid-base imbalances is successful? (Select all that apply.) 1 Baking soda is an effective inexpensive antacid. 2 I shall take my insulin on time every day. 3 My aspirin is on a high shelf away from children. 4 I have reliable transportation to dialysis sessions. 5 Fasting is a great way to lose weight rapidly.

2,3,4 Taking insulin as prescribed helps prevent diabetic ketoacidosis. Safeguarding aspirin from children prevents metabolic acidosis from increased acid intake. Regular dialysis reduces the risk of metabolic acidosis from decreased renal excretion of metabolic acid. Baking soda is sodium bicarbonate and should not be used as an antacid due to the risk of metabolic alkalosis. Fasting without carbohydrate intake is a risk factor for starvation ketoacidosis.

The patient is hyperventilating from anxiety and abdominal pain. Which assessment findings should the nurse attribute to respiratory alkalosis? (Select all that apply.) 1 Skin pale and cold 2 Tingling of fingertips 3 Heart rate of 102 4 Numbness around mouth 5 Cramping in feet

2,4,5 Hyperventilation is a risk factor for respiratory alkalosis. Respiratory alkalosis can cause perioral and digital paresthesias and pedal spasms. Pallor, cold skin, and tachycardia are characteristic of activation of the sympathetic nervous system, not respiratory alkalosis.

An anxious adult patient is experiencing a respiratory rate of 40 breaths/min. The most appropriate intervention that the nurse could do is to instruct the patient to: 1 sit up. 2 lie down. 3 breathe through a re-breather mask.. 4 pant with mouth open

3 Anxiety can lead to hyperventilation, causing respiratory alkalosis; the treatment is to have the patient breathe through a re-breather mask. In the home setting, the patient can be asked to breathe into a paper bag.

The laboratory data for a client with prolonged vomiting reveal arterial blood gases of pH 7.51, Pco2 of 50 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 what diagnosis? 1 Hypocapnia 2 Hyperkalemia 3 Metabolic alkalosis 4 Respiratory acidosis

3 Elevated plasma pH and elevated bicarbonate levels support metabolic alkalosis. The arterial carbon dioxide level of 50 mm Hg is elevated more than the expected value of 35 to 45 mm Hg; hypercapnia, not hypocapnia, is present. The client's serum potassium level is within the expected level of 3.5 to 5 mEq/L (3.5 to 5 mmol/L). With respiratory acidosis the pH will be less than 7.35.

Which insulin should the nurse prepare for the emergency treatment of ketoacidosis? 1 Glargine 2 NPH insulin 3 Insulin aspart 4 Insulin detemir

3 Insulin aspart is a rapid-acting insulin (within 10 to 20 minutes) and is used to meet a client's immediate insulin needs. Glargine is a long-acting insulin, which has an onset of 1.5 hours; for diabetic acidosis, the individual needs rapid-acting insulin. NPH insulin is an intermediate-acting insulin, which has an onset of 1 to 2 hours; for diabetic acidosis, the individual needs rapid-acting insulin. Insulin detemir is a long-acting insulin; for diabetic acidosis, the individual needs rapid-acting insulin.

A patient with healthy kidneys experiences metabolic alkalosis resulting from episodes of vomiting. The nurse takes into consideration that the kidneys can clear the alkaline substances and fully stabilize the patients pH in approximately: 1. 3 to 5 minutes. 2. 12 to 24 hours. 3. 3 days. 4. 1 week.

3 The compensatory ability of the kidneys takes more time to work than does the compensatory action of the lungs; 3 days are needed for the kidneys to stabilize pH within normal range.

A client with chronic obstructive pulmonary disease (COPD) has a blood pH of 7.25 and a PCO2 of 60 mm Hg. What complication does the nurse conclude the client is experiencing? 1 Metabolic acidosis 2 Metabolic alkalosis 3 Respiratory acidosis 4 Respiratory alkalosis

3 The pH indicates acidosis [1] [2]; 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 patient has type B chronic obstructive pulmonary disease (COPD) exacerbated by an acute upper respiratory infection. Which blood gas values should the nurse expect to see? 1 pH high, PaCO2 high, HCO3 high 2 pH low, PaCO2 low, HCO3 low 3 pH low, PaCO2 high, HCO3 high 4 pH low, PaCO2 high, HCO3 normal

3 Type B COPD is a chronic disease that causes impaired excretion of carbonic acid, thus causing respiratory acidosis, with PaCO2 high and pH low. This chronic disease exists long enough for some renal compensation to occur, manifested by high HCO3-. Answers that include low or normal bicarbonate are not correct, because the renal compensation for respiratory acidosis involves excretion of more hydrogen ions than usual, with retention of bicarbonate in the blood. High pH occurs with alkalosis, not acidosis.

A client begins rapid breathing and demonstrates anxiety after learning of a diagnosis of breast cancer. After a short while, the client complains of tingling lips and fingers. Which of the following should the nurse do to assist this client? 1 Provide oxygen. 2 Coach the client in the use of an incentive spirometer. 3 Help the client slow the respiratory rate or breathe into a paper bag. 4 Administer intravenous fluids.

3 With the clients rapid respirations, too much carbon dioxide is being excreted. This leads to alkalosis. Symptoms of respiratory alkalosis include tingling of the lips and fingers. If the client is unable to control the respiratory rate, the nurse may have the client breathe into a paper bag, which forces the rebreathing of carbon dioxide. Providing oxygen, using an incentive spirometer, and intravenous fluids is not going to help correct the clients rapid respiratory rate and respiratory alkalosis.

A client diagnosed with gastroesophageal reflux disease (GERD) is being treated with antacid therapy. When teaching the client about the therapy, what does the nurse reinforce? 1 Antacids should be taken 1 hour before meals. 2 These should be scheduled at 4-hour intervals. 3 Antacid tablets are just as fast and effective as the liquid form. 4 Antacids commonly interfere with the absorption of other drugs

4 Antacids interfere with absorption of drugs such as anticholinergics, barbiturates, tetracycline, and digoxin. Liquid antacids are faster acting and more effective than antacid tablets. Antacids should be taken 1 or 2 hours after meals and at bedtime. Antacid tablets may be taken more frequently than every 4 hours.

5. The nurse has telephone messages from four patients who requested information and assistance. Which one should the nurse refer to a social worker or community agency first? 1 Is there a place that I can dispose of my unused morphine pills? 2 I want to lose at least 20 pounds without getting sick this time. 3 I think I have asthma because I cough when dogs are near. 4 I ran out of money and am cutting my insulin dose in half.

4 Decreasing an insulin dose by half creates high risk of diabetic ketoacidosis, and this patient has the highest priority. The other patients have less priority due to lower risk situations with longer time course before development of an acid-base imbalance. The coughing when dogs are near is not a sign of a severe asthma episode that causes respiratory acidosis, although this patient does need attention after the insulin situation is handled. Disposing of morphine properly helps prevent respiratory acidosis from opioid overdose. Guidance regarding weight loss helps prevent starvation ketoacidosis.

Which would the nurse claim is a cardiovascular manifestation of alkalosis? 1 Anxiety 2 Seizures 3 Hyperreflexia 4 Increased digitalis toxicity

4 Increased digitalis toxicity is one of the cardiovascular manifestations of alkalosis. Anxiety and seizures are central nervous system manifestations of alkalosis. Hyperreflexia is a neuromuscular manifestation of alkalosis.

A patient who is experiencing severe diarrhea is losing excessive bicarbonate ions. This patient is at risk for developing: 1 respiratory alkalosis. 2 respiratory acidosis. 3 metabolic alkalosis. 4 metabolic acidosis.

4 Metabolic acidosis can be caused by either an excessive loss of bicarbonate ions or an excessive retention of hydrogen ions.

A client with a history of emphysema develops a respiratory infection and is admitted to the hospital in acute respiratory distress. The client's arterial blood studies indicate pH 7.30, PO2 60 mm Hg, PCO2 55 mm Hg, and HCO3 23 mEq/L (23 mmol/L). How should the nurse interpret these findings? 1 Hypocapnia 2 Hyperkalemia 3 Generalized anemia 4 Respiratory acidosis

4 The client is experiencing respiratory acidosis. The pH is less than the norm of 7.35 to 7.45, indicating acidosis. The PO2 is less than the norm of 80 to 100 mm Hg. The PCO2 is increased more than the norm of 35 to 45 mm Hg. The HCO3 is within the norm of 21 to 28 mEq/L (21 to 28 mmol/L). These results indicate a respiratory etiology.

what causes too much CO2, acute or chronic excess carbonic acid, obstruction of gas exchange, hypoventilation, pneumothorax, pulmonary edema, asthma, pneumonia, drug overdose, strong sleeping meds, head injuries, and chronic bronchitis?. pH ↓ <7.35. + PaCO2 ↑ > 45 1. respiratory alkalosis 2. respiratory acidosis 3. metabolic alkalosis 4. metabolic acidosis

Respiratory alkalosis

what causes Not enough base in the blood or too much acid - shock, DKA, cardiac arrest, starvation, diabetic ketoacidosis, renal failure, ASA (NSAIDs) overdose, loss of intestinal fluid, wound drainage, diarrhea (poop is alkalotic), diuretics, and ileostomy creation. pH. ↓ < 7.35 + HCO3. ↓ <22 1. respiratory alkalosis 2. respiratory acidosis 3. metabolic alkalosis 4. metabolic acidosis

metabolic acidosis

what causes excess base or decreased acid in the blood - excessive bicarbonate-containing drugs, antacids, diuretic therapy, vomiting (vomit is acidic), and gastric suctioning. pH ↑ > 7.45 + HCO3 ↑ > 26 1. respiratory alkalosis 2. respiratory acidosis 3. metabolic alkalosis 4. metabolic acidosis

metabolic alkalosis

what causes too little CO2, Hyperventilation, pain, fear, anxiety, fever - leads to elimination of CO2, overactive thyroid, ASA (NSAIDs) poisoning, + mechanical ventilation. pH ↑ > 7.45. + PaCO2 ↓ < 35 1. respiratory alkalosis 2. respiratory acidosis 3. metabolic alkalosis 4. metabolic acidosis

respiratory alkalosis