NURS 1355 Passpoint- ABGs

A client who has been recently extubated has shortness of breath. The nurse reports the client's discomfort and the results of the recently prescribed arterial blood gas analysis to the health care provider (HCP). After reviewing the report of the complete blood count (see lab report), the nurse should also report which result to the HCP? ~PT (13) -Hgb (9.8) & Hct (30.5) ~monocytes (7) ~Plt (302)

-Hgb (9.8) & Hct (30.5) The nurse should review the CBC with differential to evaluate the client's hemoglobin and hematocrit, which are abnormal and should be reported to the HCP. Anemia leads to decreased oxygen-carrying capacity of the blood. A client unable to compensate for the anemia may experience a profound sense of dyspnea. There has been a significant drop in the hemoglobin and hematocrit since the previous report, and these should be reported to the HCP.

A 75-year-old client who complains of a "sour stomach" has been taking baking soda (sodium bicarbonate) regularly as a self-treatment. This may place the client at risk for what acid-base imbalance? metabolic alkalosis metabolic acidosis respiratory acidosis respiratory alkalosis

Metabolic alkalosis Metabolic alkalosis results in increased plasma pH because of accumulated base bicarbonate or decreased hydrogen ion concentrations. Regular use of baking soda (sodium bicarbonate) may place the client at risk for this condition. Metabolic acidosis refers to decreased plasma pH because of increased organic acids (acids other than carbonic acid) or decreased bicarbonate. Respiratory acidosis, which may be either acute or chronic, is caused by excess carbonic acid. Respiratory alkalosis results from a carbonic acid deficit that occurs when rapid breathing releases more CO2 than necessary with expired air.

A client has the following arterial blood gas (ABG) values: pH, 7.12; partial pressure of arterial carbon dioxide (PaCO2), 40 mm Hg; and bicarbonate (HCO3), 15 mEq/L. These ABG values suggest which disorder? respiratory alkalósis respiratory acidosis metabolic alkalosis metabolic acidosis

metabolic acidosis This client's pH value is below normal, indicating acidosis. The HCO; value also is below normal, reflecting an overwhelming accumulation of acids or excessive loss of base, which suggests metabolic acidosis. The PaCO2 value is normal, indicating absence of respiratory compensation.

A client with a suspected overdose of an unknown drug is admitted to the emergency department. Arterial blood gas values indicate respiratory acidosis. What should the nurse do first? Prepare to assist with ventilation. Monitor the client's heart rhythm. Prepare for gastric lavage. Obtain a urine specimen for drug screening.

prepare to assist with ventilation Respiratory acidosis is associated with hypoventilation; in this client, hypoventilation suggests intake of a drug that has suppressed the brain's respiratory center. Therefore, the nurse should assume the client has respiratory depression and should prepare to assist with ventilation. After the client's respiratory function has been stabilized, the nurse can safely monitor the heart rhythm, prepare for gastric lavage, and obtain a urine specimen for drug screening.

A client has these arterial blood gas values: pH, 7.30; Pa02, 89 mm Hg; PaCO2, 50 mm Hg; and CO3, 26 mEq/L. Based on these values, the nurse should suspect which condition? respiratory acidosis respiratory alkalosis metabolic acidosis metabolic alkalosis

respiratory acidosis. This client has a below-normal (acidic) blood pH value and an above-normal partial pressure of arterial carbon dioxide (PaCO2) value, indicating respiratory acidosis. In respiratory alkalosis, the pH value is above normal and the PaCO2 value is below normal. In metabolic acidosis, the pH and bicarbonate (HCO3) values are below normal. In metabolic alkalosis, the pH and HCO; values are above normal.

Which statement made by a client who is taking misoprostol indicates a therapeutic outcome of therapy? ~"I can breathe easier." ~"My stomach feels better." ~"My blood pressure is normal." ~"My heart doesn't beat as fast now."

~"My stomach feels better." Misoprostol is used to protect the stomach's lining when a client has a peptic ulcer. Misoprostol does not affect the cardiac or respiratory systems.

A client is admitted with a diagnosis of diabetic ketoacidosis. An insulin drip is initiated with 50 units of insulin in 100 ml of normal saline solution administered via an infusion pump set at 10 ml/hour. The nurse determines that the client is receiving how many units of insulin each hour? Record your answer using a whole number.

~5 To determine the number of insulin units the client is receiving per hour, the nurse must first determine the number of units in each milliliter of fluid (50 units + 100 ml = 0.5 units/ml). Next, multiply the units per milliliter by the rate of milliliters per hour (0.5 units x 10 ml/hr = 5 units).

The nurse is caring for a lethargic but arousable preschooler who is a victim of a near-drowning accident. What should the nurse do first? ~Prepare for intubation ~Institute rewarming. ~Start an intravenous (IV) infusion. ~Administer oxygen.

~Administer oxygen. Near-drowning victims typically suffer hypoxia and mixed acidosis. The priority is to restore oxygenation and prevent further hypoxia. Here, the client has blunted sensorium but is not unconscious; therefore, delivery of supplemental oxygen with a mask is appropriate. Warming protocols and fluid resuscitation will most likely be needed to help correct acidosis, but these interventions are secondary to oxygen administration. Intubation is required if the child is comatose, shows signs of airway compromise, or does not respond adequately to more conservative therapies.

A client's arterial blood gas values are as follows: pH, 7.31; Pa02, 80mmHg; PaCO2, 65mmHg; HCO3, 36mEq/L. The nurse should assess the client for which symptom? ~irritability ~cyanosis ~anxiety ~flushed skin

~Flushed skin The high PaCO2 level causes flushing due to vasodilation. The client also becomes drowsy and lethargic because carbon dioxide has a depressant effect on the central nervous system.

A client has been diagnosed with metabolic alkalosis. The nurse should anticipate what finding from the client's arterial blood gases? ~pH 7.30 ~pH 7.26 ~HCO3, 21mEq/L ~HCO3, 28mEq/L

~HCO3, 28mEq/L Evaluation of arterial blood gases reveals a pH greater than 7.45 and a serum bicarbonat concentration greater than 26mEq/L

A client with leukemia received induction chemotherapy 2 days ago and is now reporting severe diarrhea, decreased urination, cardiac dysrhythmias, and paresthesia with tetany. Laboratory reports reveal hyperkalemia, hyperuricemia, and hypocalcemia. Which action would the nurse anticipate? ~tetanus immunization and neurovascular checks every two hours ~I.V. fluids to increase urine output and allopurinol to inhibit uric acid ~limit fluids and monitor output to assess for kidney failure ~I.V. fluids and loop diuretic to prevent fluid overload and restore acidity

~I.V. Fluids to increase urine output and allopurinol to inhibit urinary acid The client likely has tumor lysis syndrome, which occurs when a person with cancer (such as leukemia) initiates treatment, causing the rapid destruction and breakdown of large numbers of cells. The syndrome results in the signs and symptoms noted above as well as hyperuricemia, hyperkalemia, hyperphosphatemia, renal failure, and hypocalcemia. Early recognition is important to prevent renal damage. Increased I.V. fluids will flush the cellular debris from the system while increasing urine volume and restoring alkalinity, and allopurinol will decrease production of uric acid. Fluids should not contain potassium.

A client has been diagnosed with an intestinal obstruction and has a nasogastric tube set to low continuous suction. Which acid-base disturbance is this client at risk for developing? ~metabolic alkalosis ~respiratory alkalosis ~metabolic acidosis ~respiratory acidosis

~Metabolic alkalosis Metabolic alkalosis is a clinical disturbance characterized by a high pH and a high plasma bicarbonate concentration. The most common cause of metabolic alkalosis is vomiting or gastric suction with loss of hydrogen and chloride ions. Gastric fluid has an acid pH, and loss of this acidic fluid increases the alkalinity of body fluids.

The nurse on a surgical unit is caring for a client recovering from recent surgery with the Placement of a nasogastric tube on low continuous suction. Which acid-base imbalance is most likely to occur? ~Respiratory alkalosis ~Metabolic acidosis ~Metabolic alkalosis ~Respiratory acidosis

~Metabolic alkalosis Metabolic alkalosis results in increased plasma pH because of an accumulated base bicarbonate or decreased hydrogen ion concentration. Factors that increase base bicarbonate include excessive oral or parenteral use of bicarbonate-containing drugs, a rapid decrease in extracellular fluid volume and loss of hydrogen and chloride ions as with gastric suctioning.

A client has vomited several times over the past 12 hours. The nurse should recognize the risk of what complication? ~respiratory alkalosis ~metabolic alkalosis ~metabolic acidosis ~respiratory acidosis

~Metabolic alkalosis Vomiting results in loss of hydrochloric acid (HCl) and potassium from the stomach, leading to a reduction of chlorides and potassium in the blood and to metabolic alkalosis.

A neonate is born 8 weeks premature. At birth, the neonate has no spontaneous respirations but is successfully resuscitated. Within several hours the neonate developes respiratory grunting, cyanosis, tachypnea, nasal flaring, and retractions. The neonate is diagnosed with respiratory distress syndrome, intubated, and placed on a ventilator. Which nursing action should be included in the neonate's care plan to prevent retinopathy of prematurity? ~Cover the neonate's eyes while receiving oxygen. ~Keep the neonate's body temperature low. ~Monitor partial pressure of oxygen (Pa02) levels. ~Humidify the oxygen.

~Monitor partial pressure of oxygen (Pa02) levels. Monitoring Pa02 levels and reducing the oxygen concentration to keep Pa02 within normal limits reduces the risk of retinopathy of prematurity in a premature neonate receiving oxygen. Covering the neonate's eyes and humidifying the oxygen do not reduce the risk of retinopathy of prematurity. Because cooling increases the risk of acidosis, the neonate should be kept warm so that respiratory distress is not aggravated.

A primigravid client at 38 weeks' gestation comes to the labor room because "my water The health care provider (HCP) asks the nurse to verify spontaneous rupture of membr nitrazine paper. The nurse observes that the nitrazine paper turns bright blue. What action should the nurse take next? ~Notify the HCP that the membranes are ruptured. ~Perform a sterile vaginal examination to assess the cervix. ~Document the findings of the nitrazine test. ~Offer the client a sterile sanitary pad after performing perineal care

~Notify the HCP that the membranes are ruptured. Nitrazine paper responds to alkaline fluids by changing blue; amniotic fluid is alkaline so the color verifies that the membranes are ruptured. The nurse notifies the provider that membranes are ruptured so that a plan of action can be developed. Rupture of membranes in the absence of labor increases the risk of infection. Vaginal examinations are limited until labor is initiated. Wearing a sanitary pad increases potential for infection. Documentation of the Nitrazine test is completed after notifying the provider.

A client is receiving supplemental oxygen. When determining the effectiveness of oxygen therapy, which arterial blood gas value is most important? ~PaCO2 ~pH ~PaO2 ~HCO3

~PaO2 The most significant and direct indicator of the effectiveness of oxygen therapy is the Pa02 value. Based on the Pa02 value, the nurse may adjust the type of oxygen delivery (cannula, Venturi mask, or mechanical ventilator), flow rate, and oxygen percentage. The other options reflect the client's ventilation status, not oxygenation.

A client has meconium-stained amniotic fluid. Fetal scalp sampling indicates a blood pH of 7.12; fetal bradycardia is present. Based on these findings, the nurse should take which action? ~Administer amnioinfusion. ~Start I.V. oxytocin infusion as ordered. ~Prepare for cesarean birth. ~Reposition the client.

~Prepare for cesarean birth. Fetal blood pH of 7.19 or lower signals severe fetal acidosis; meconium-stained amniotic fluid and bradycardia are further signs of fetal distress that warrant cesarean birth. Amnioinfusion is indicated when the only abnormal fetal finding is meconium-stained amniotic fluid. Client repositioning may improve uteroplacental perfusion, but only serves as a temporary measure because the risk of fetal asphyxia is imminent. Oxytocin administration increases contractions, exacerbating fetal stress.

Oxygen at the rate of 2 liters per minute through nasal cannula is prescribed for a client with chronic obstructive pulmonary disease (COPD). Which of the following statements best describes why the oxygen therapy is maintained at a relatively low concentration? ~The client's long history of respiratory problems indicates that he would be unable to absorb oxygen given at a higher rate. ~The oxygen will be lost at the clients nostrils if given at a higher level with a nasal cannula . ~The cells in the alveoli are so damaged by the clients long history of respiratory problems that increased oxygen levels and reduced carbon dioxide levels likely will cause the cells to burst. ~The clients respiratory center is so used to high carbon dioxide and low oxygen levels that changing these levels may eliminate his stimulus for breathing.

~The client's respiratory center is so used to high carbon dioxide and low oxygen levels that changing these levels may eliminate his stimulus for breathing. Relatively low concentrations of oxygen are administered to clients with COPD so as not to eliminate their respiratory drive. Carbon dioxide content in the blood normally regulates respirations. Clients with COPD, though, are often accustomed to high carbon dioxide levels; the low oxygen blood level is their stimulus to breathe. If they receive excessive oxygen and experience a drop in the blood carbon dioxide level, they may stop breathing.

A client in the emergency department reports that they have been vomiting excessively for the past 2 days. The client's arterial blood gas analysis shows a pH 7.50; PaCO2, 43mmHg; Pa02, 75mmHg; HCO3, 42mEq/L. Based on these findings, the nurse documents that the client is experiencing which type of acid-base imbalance? ~metabolic alkalosis ~respiratory alkalosis ~metabolic acidosis ~respiratory acidosis

~metabolic alkalosis A pH over 7.45 with a HCO3; level over 26 mEq/L indicates metabolic alkalosis. Metabolic alkalosis is always secondary to an underlying cause and is marked by decreased amounts of acid or increased amounts of base HCO3

The nurse is reviewing the client's lab values. On admission, the client's arterial blood gas (ABG) values were ph, 7.20; Pa02, 64mmHg; PaCO2, 60mmHg; HCO3, 22mEq/L. A chest tube is inserted, and O2 at 4L/min, is started. Thirty minutes later, repeat ABG values are pH 7.30; Pa02, 76mmHg; PaCO2, 50mmHg; HCO3, 22mEq/L. Which judgment should the nurse make about the changes in the client's blood gases? ~The client is experiencing impending respiratory failure. ~The client is developing respiratory alkalosis. ~There is an obstruction in the chest tube. ~The client's respiratory status is improving.

~The client's respiratory status is improving. The ABG values after chest tube insertion are returning to normal, indicating that treatment is effective.

The nurse is concerned about the risks of hypoxemia and metabolic acidosis in a client who is in shock. What finding should the nurse analyze for evidence of hypoxemia and metabolic acidosis in a client with shock? ~red blood cells (RBCs) and hemoglobin count findings ~oxygen saturation level ~white blood cell differential ~arterial blood gas (ABG) findings

~arterial blood gas (ABG) findings Analysis of ABG findings is essential for evidence of hypoxemia and metabolic acidosis. Low RBCs and hemoglobin correlate with hypovolemic shock and can lead to poor oxygenation. An elevated white blood cell count supports septic shock. Oxygen saturation levels are usually affected by hypoxemia but cannot be used to diagnose acid-base imbalances such as metabolic acidosis.

A client with emphysema is at a greater risk for developing what acid-base imbalance? ~metabolic alkalosis ~chronic respiratory acidosis ~chronic metabolic acidosis ~respiratory alkalosis

~chronic respiratory acidosis Respiratory acidosis, which may be either acute or chronic, is caused by excess carbonic acid, which causes the blood pH to drop below 7.35. Chronic respiratory acidosis is associated with disorders such as emphysema, bronchiectasis, bronchial asthma, and cystic fibrosis.

A client presents with severe diarrhea and a history of chronic renal failure to the emergency department. Arterial blood gas results are: pH 7.30; Pa02, 97mmHg; PaCO2, 37mmHg; НС03, 18mmHg. The nurse would expect which set of assessment findings? ~confusion, Respiratory rate 8 breaths/min, dry skin ~headache, bp 90/54 mmHg, dry skin ~bp 188/120 mmHg, nausea, vomiting ~clammy skin, bp 86/46 mmHg, headache

~clammy skin, bp 86/46 mm Hg, headache Metabolic acidosis, a common clinical disturbance, is characterized by decreased pH and plasma bicarbonate concentration. Common causes of metabolic acidosis include diarrhea, chronic renal failure, use of diuretics, intestinal fistulas, and ureterostomies. The client will experience the following signs and symptoms: headache, confusion, increased respiratory rate, nausea, vomiting, cold and clammy skin, and decreased blood pressure.

A nurse is assessing a 6-month-old infant at a well-baby check. The parent says that the infant has been having diarrhea for the last 2 days. Which is the nurse's priority action? ~Collect more data from parent about the diarrhea. ~Complete designated teaching for the 6-month visit. ~Notify the healthcare provider. ~Instruct mother to bring the infant to the emergency department.

~collect more data from parent about diarrhea The nurse should obtain a more detailed history and assessment on the infant to determine the next steps in care. Routine teaching, use of the emergency department, or notifying the primary healthcare provider is not a priority until the diarrhea is evaluated.

The nurse assesses a child with ketoacidosis. What manifestation is supportive of the diagnosis of ketoacidosis? ~deep, rapid respirations ~slow, bounding pulse rate ~diaphoretic, warm skin ~elevated blood pressure

~deep, rapid respirations The accumulation of ketones, organic acids that readily release free hydrogen ions causing blood pH to fall, leads to ketoacidosis. To compensate, the respiratory buffering system is activated, which results in the child taking deep, rapid breaths to rid the body of excess carbon dioxide. This characteristic breathing pattern is known as Kussmaul respirations. Typically with ketoacidosis, the pulse rate would be more rapid and weak due to dehydration and loss of electrolytes. Typically with ketoacidosis, the skin would be dry due to dehydration. With ketoacidosis, hypotension results from the contracted blood volume secondary to dehydration.

Which physical sensation will the client who has had an abdominal hysterectomy most likely experience if she hyperventilates while performing deep-breathing exercises? ~dyspnea ~blurred vision ~dizziness ~mental confusion

~dizziness Hyperventilation occurs when the client breathes so rapidly and deeply that she exhales excessive amounts of carbon dioxide. A characteristic symptom of hyperventilation is dizziness. To avoid hyperventilation, the nurse should assist the client in the practice of slow, deep breathing in a regular breathing pattern. Dyspnea, blurred vision, and mental confusion are not associated with hyperventilation.

A client has been admitted to the hospital for the treatment of diabetic ketoacidosis, a problem that was accompanied by a random blood glucose reading of 575mg/dL, vomiting, and shortness of breath. This client has experienced which of the following phenomena? ~exacerbation ~morbidity ~risk factor ~infection

~exacerbation This client has experienced a significant exacerbation of a chronic disease (diabetes mellitus), which has manifested as an acute threat to the client's health. Morbidity is an epidemiological statistic of the frequency of a disease. The client's problem does not have an infectious etiology and while risk factors underlie the present condition, they are not the essence of the current state.

Before seeing a newly assigned client with respiratory alkalosis, a nurse quickly reviews the client's medical history. Which condition is a predisposing factor for respiratory alkalosis? ~myasthenia gravis ~opioid overdose ~type 1 diabetes mellitus ~extreme anxiety

~extreme anxiety Extreme anxiety may lead to respiratory alkalosis by causing hyperventilation, which results in excessive carbon dioxide (CO2) loss. Other conditions that may set the stage for respiratory alkalosis include fever, heart failure, injury to the brain's respiratory center, overventilation with mechanical ventilator, pulmonary embolism, and early salicylate intoxication. Type 1 diabetes ma lead to diabetic ketoacidosis; the deep, rapid respirations occurring in this disorder (Kussmaul respirations) don't cause excessive CO2 loss. Myasthenia gravis and opioid overdose suppress the respiratory drive, causing CO2 retention, not CO2 loss; this may lead to respiratory acidosis, not alkalosis.

A client is critically ill with sepsis. The nurse expects what assessment finding related to compensatory mechanisms attempting to maintain normal pH? ~increased urine output ~increased respiratory rate ~increased body temperature ~decreased blood pressure

~increased respiratory rate The critically ill client with sepsis is at risk for decreased perfusion of tissues and organs, which leads to lactic acid production. This causes the client to experience metabolic acidosis. To correct the acidosis, the lungs eliminate carbonic acid by blowing off more CO2 via an increased respiratory rate. It is the respiratory system that compensates for metabolic acidosis, not the renal system. Blood pressure will be low in the client with sepsis, but blood pressure is not a compensatory mechanism for pH imbalances. While body temperature can affect acid base balance, this is not how the body compensates for metabolic acidosis.

Which intervention is most appropriate for a client with an arterial blood gas (ABG) of pH 7.5; PaCO2, 26mmHg; Sp02 96%; HCO3, 24mEq/L; and Pa02 of 94mmHg? ~Administer ordered supplemental oxygen. ~Administer an ordered decongestant. ~Offer the client fluids frequently. ~Instruct the client to breathe into a paper bag.

~instruct the client to breathe into a paper bag. The ABG results reveal respiratory alkalosis. The best intervention to raise the PaCO2 level would be to have the client breathe into a paper bag. Administering a decongestant, offering fluids frequently, and administering supplemental oxygen wouldn't raise the lowered PaCO2 level.

A client is in a metabolic acidosis from severe diarrhea. What assessment finding would be most concerning? ~excoriated skin around the rectum ~abdominal cramping ~respiratory rate of 28 ~irregular heart rate

~irregular heart rate Diarrhea causes a bicarbonate deficit. With loss of the relative alkalinity of the lower GI tract, the relative acidity of the upper GI tract predominates, leading to metabolic acidosis. The diarrhea would result in skin breakdown. Abdominal cramping would be anticipated. Kussmaul respirations are anticipated as a compensatory response. Irregular heart rate could be a sign of electrolyte imbalances and is most concerning

A client hospitalized for treatment of a pulmonary embolism develops respiratory alkalosis. Which clinical findings commonly accompany respiratory alkalosis? ~hallucinations or tinnitus ~nausea or vomiting ~light-headedness or paresthesia ~abdominal pain or diarrhea

~light-headedness or paresthesia The client with respiratory alkalosis may complain of light-headedness or paresthesia (numbness and tingling in the arms and legs). Nausea, vomiting, abdominal pain, and diarrhea may accompany respiratory acidosis. Hallucinations and tinnitus rarely are associated with respiratory alkalosis or any other acid-base imbalance.

A client hospitalized for treatment of a pulmonary embolism develops respiratory alkalosis. Which clinical findings commonly accompany respiratory alkalosis? ~nausea or vomiting ~abdominal pain or diarrhea ~hallucinations or tinnitus ~light-headedness or paresthesia

~light-headedness or paresthesia The client with respiratory alkalosis may complain of light-headedness or paresthesia (numbness and tingling in the arms and legs). Nausea, vomiting, abdominal pain, and diarrhea may accompany respiratory acidosis. Hallucinations and tinnitus rarely are associated with respiratory alkalosis or any other acid-base imbalance.

The nurse is caring for a client with multiple organ failure who is in metabolic acidosis. Which pair of organs is responsible for regulatory processes and compensation? ~kidneys and liver ~lungs and kidneys ~pancreas and heart ~heart and lungs

~lungs and kidneys The lungs and kidneys facilitate the ratio of bicarbonate to carbonic acid. Carbon dioxide is one of the components of carbonic acid. The lungs regulate carbonic acid levels by releasing or conserving CO2 by increasing or decreasing the respiratory rate. The kidneys assist in acid-base balance by retaining or excreting bicarbonate ions.

The nurse should assess the client with severe diarrhea for which acid-base imbalance? ~respiratory alkalosis ~respiratory acidosis ~metabolic acidosis ~metabolic alkalosis

~metabolic acidosis A client with severe diarrhea loses large amounts of bicarbonate, resulting in metabolic acidosis. Metabolic alkalosis does not result in this situation. Diarrhea does not affect the respiratory system.

The nurse is caring for a client with severe diarrhea. The nurse recognizes that the client is at risk for developing which of the following acid-base imbalances? ~respiratory alkalosis ~respiratory acidosis ~metabolic acidosis ~metabolic alkalosis

~metabolic acidosis The client is at risk for developing metabolic acidosis. Metabolic acidosis is caused by diarrhea, lower intestinal fistulas, ureterostomies, and use of diuretics; early renal insufficiency; excessive administration of chloride; and the administration of parenteral nutrition without bicarbonate or bicarbonate-producing solutes (e.g., lactate).

A client's arterial blood gas values are: pH 7.24; PaCO2, 35mmHg; HCO3, 15mEq/L. These findings indicate which of the following acid-base imbalances? ~Metabolic alkalosis. ~Metabolic acidosis. ~Respiratory alkalosis. ~Respiratory acidosis.

~metabolic acidosis The pH of 7.24 indicates that the client is acidotic. The carbon dioxide level is normal, but the HCO3- level is decreased. These findings indicate that the client is in metabolic acidosis.

A client's arterial blood gas values are pH 7.24; PaCo2, 35 mmHg; HCO3, 15mEq/L. The nurse should develop a care plan based on the fact the client is experiencing which clinical situation? ~metabolic alkalosis ~metabolic acidosis ~respiratory acidosis ~respiratory alkalosis

~metabolic acidosis The pH of 7.24 indicates that the client is acidotic. The carbon dioxide level is normal, but the HCO; level is decreased. These findings indicate that the client is in metabolic acidosis.

A client has the following arterial blood gas (ABG) values: pH, 7.12; PaCO2, 40mmHg; & HCO3, 15mEq/L. These ABG values suggest which disorder? ~respiratory alkalosis ~respiratory acidosis ~metabolic acidosis ~metabolic alkalosis

~metabolic acidosis This client's pH value is below normal, indicating acidosis. The HCO3 value also is below normal, reflecting an overwhelming accumulation of acids or excessive loss of base, which suggests metabolic acidosis. The PaCO2, value is normal, indicating absence of respiratory compensation.

An adolescent is admitted for treatment of bulimia nervosa. When developing the care plan, the nurse anticipates including interventions that address which metabolic disorder? ~hypoglycemia ~hyperkalemia ~metabolic acidosis ~metabolic alkalosis

~metabolic alkalosis In a client with bulimia nervosa, metabolic alkalosis may occur secondary to hydrogen loss caused by frequent, self-induced vomiting. Typically, the blood glucose level is within normal limits, making hypoglycemia unlikely. In bulimia nervosa, hypokalemia is more common than hyperkalemia and typically results from potassium loss related to frequent vomiting.

The nurse should assess the child with excessive vomiting secondary to pyloric stenosis for which acid-base imbalance? ~metabolic alkalosis ~metabolic acidosis ~respiratory acidosis ~respiratory alkalosis

~metabolic alkalosis Metabolic alkalosis occurs because of the excessive loss of potassium, hydrogen, and chloride in the vomitus. Chloride loss leads to a compensatory increase in the number of bicarbonate ions. The bicarbonate side of the carbonic acid-base bicarbonate increases, and the pH becomes more alkaline.

A client presents to the emergency department, reporting that they have been vomiting every 30 to 40 minutes for the past 8 hours. Frequent vomiting puts this client at risk for which imbalances? ~metabolic acidosis and hyperkalemia ~metabolic alkalosis and hypokalemia ~metabolic alkalosis and hyperkalemia ~metabolic acidosis and hypokalemia

~metabolic alkalosis and hypokalemia Gastric acid contains large amounts of potassium, chloride, and hydrogen ions. Excessive vomiting causes loss of these substances, which can lead to metabolic alkalosis and hypokalemia. Excessive vomiting doesn't cause metabolic acidosis or hyperkalemia.

A client is admitted to the psychiatric clinic for treatment of anorexia nervosa. At the beginning of the client's hospitalization, the most important nursing action is to: ~Severely restrict the client's physical activities. ~instruct the client to keep an accurate record of food and fluid intake. ~weigh the client daily, after the evening meal. ~monitor the client's vital signs, serum electrolyte levels, and acid-base balance.

~monitor the client's vital signs, serum electrolyte levels, and acid-base balance. An anorexic client who requires hospitalization is in poor physical condition as a result of starvation and may die as a result of arrhythmias, hypothermia, malnutrition, infection, or cardiac abnormalities secondary to electrolyte imbalances. Therefore, monitoring the client's vital signs, serum electrolyte level, and acid-base balance is crucial.

A nurse is caring for a 12-month-old infant with dehydration with resulting metabolic acidosis. The infant exhibits lethargy and poor skin turgor. Which action by the nurse takes priority? ~offering the infant sucralose by bottle ~obtaining blood cultures ~obtaining a urine sample via catheterization ~obtaining a patent intravenous site

~obtaining a patent intravenous site The nurse's priority is to correct the dehydration by first obtaining a patent IV line for the administration of fluids and medications. Obtaining a blood sample for a white blood count and blood cultures and a urine sample will not change the outcome of the need for fluid and electrolyte correction.

The nurse is caring for a client with end-stage kidney disease. What arterial blood gas results are most closely associated with this disorder? ~pH 7.20; PaCO2, 36; HCO3, 14 ~pH 7.31; PaCO2, 48; HCO3, 24 ~pH 7.47; PaCO2, 45; HCO3, 33 ~pH 7.50; PaCO2, 29; HCO3, 22

~pH 7.20; PaCO2, 36; HCO3, 14 Metabolic acidosis occurs in ESKD because the kidneys are unable to excrete increased loads of acid. Decreased acid secretion results from the inability of the kidney tubules to excrete ammonia (NH3) and to reabsorb sodium bicarbonate (HCO3). There is also decreased excretion of phosphates and other organic acids.

The nurse is interpreting blood gases for a client with acute respiratory distress syndrome (ARDS). Which set of arterial blood gas values does the nurse expect for this client? ~pH 7.29; PaCO2, 36; HCO3, 19 ~pH 7.35; PaCO2, 46; HCO3, 30 ~pH 7.25; PaCO2, 48; HCO3, 24 ~pH7.30; PaCO2, 28; HCO3, 16

~pH 7.25; PaCO2, 48; HCO3, 24 The nurse would expect a client with ARDS to exhibit respiratory acidosis.

A client with Guillain-Barré syndrome develops respiratory acidosis as a result of reduced alveolar ventilation. Which combination of arterial blood gas (ABG) values confirms respiratory acidosis? ~pH, 7.35; PaCO, 70 mm Hg ~pH, 7.5; PaCO, 30 mm Hg ~pH, 7.25; PaCO, 50 mm Hg ~pH, 7.29; PaCO, 30 mm Hg

~pH 7.25; PaCO2, 50mmHg In respiratory acidosis, ABG analysis reveals an arterial pH below 7.35 and PaCO2 above 45mmHg.

A nurse working in the emergency department receives arterial blood gas results on four clients. Which laboratory result requires immediate nursing intervention? ~pH 7.28, PaCO2, 60mmHg, PaO2, 58mmHg ~pH 7.34, PaCO2, 33mmHg, PaO2, 80mmHg ~pH 7.48, PaCO2, 35mmHg, PaO2, 65mmHg ~pH 7.33, PaCO2, 58mmHg, PaO2, 64mmHg

~pH 7.28, PaCO2, 60mmHg, PaO2, 58mmHg The pH 7.28; PaCO2, 60mmHg; and Pa02, 58mmHg indicate that the client has severe uncompensated respiratory acidosis and hypoxemia. A Pa02 under 60 indicates respiratory failure. This client needs oxygen immediately to prevent further deterioration.

A nurse is reviewing arterial blood gas (ABG) results on four clients. Which results would the nurse report immediately to the healthcare provider? ~pH 7.31; PaO2, 84mmHg; PaCO2, 50mmHg; HCO3, 24mEq/L; SpO2 90% ~pH 7.35; PaO2, 82mmHg; PaCO2, 44mmHg; HCO3, 22mEq/L; SpO2 95% ~pH 7.45; PaO2, 90mmHg; PaCO2, 28mmHg; HCO3, 32mEq/L; SpO2 98% ~pH 7.36; PaO2, 86mmHg; PaCO2, 55mmHg; HCO3, 30mEq/L; SpO2 90%

~pH 7.31; PaO2, 84mmHg; PaCO2, 50mmHg; HCO3, 24mEq/L; SpO2 90% This ABG of pH 7.31; PaO, 84mmHg; PaCO2, 50mmHg; HCO3, 24mEq/L; and SpO2 90% indicates uncompensated respiratory acidosis and would be reported to the healthcare provider immediately.

When evaluating a client's arterial blood gases (ABGs), which value is consistent with metabolic alkalosis? ~PaCO2, 36 ~pH 7.48 ~HCO3, 21mEq/L ~Sp02 95%

~pH 7.48 Metabolic alkalosis is a clinical disturbance characterized by a high pH and high plasma bicarbonate concentration.

The nurse has received lab reports for several clients undergoing care. Which set of arterial blood gas (ABG) results will the nurse investigate first? ~pH 7.34; PaCO2, 36mmHg; Pa02, 95 mmHg; HCO3, 20mEq/L ~pH 7.35; PaCO2, 48mmHg; PaO2, 91mmHg; HCO3, 28mmHg ~pH 7.49; PaCO2, 30mmHg; PaO2, 75mmHg; HCO3, 22mmHg ~pH 7.47; PaCO2, 43mmHg; PaO2, 99mmHg; HCO3, 29mmHg

~pH 7.49; PaCO2, 30mmHg; PaO2, 75mmHg; HCO3, 22mmHg The ABG results pH 7.49; PaCO2, 30mmHg; Pa02, 75mmHg; & HCO3, 22mEq/L indicate respiratory alkalosis. The pH level is increased, the PaCO2 levels are decreased and the HCO3 is normal. The decreased PaO2 indicates this client is in respiratory distress. Therefore, the nurse would investigate this result first.

A neonate weighing 1870g (4.1 lb) with a respiratory rate of 46 breaths/minute, a pulse rate of 175 bpm, and a serum pH of 7.11, has received sodium bicarbonate intravenously. The drug has been effective if the neonate exhibits which finding? ~does not become edematous ~is not dehydrated ~develops respiratory alkalosis ~resolves the metabolic acidosis

~resolves the metabolic acidosis Metabolic acidosis results from the metabolic changes associated with cold stress. End products of metabolism increase the acidity of the blood, evidenced by a pH of 7.11. Therefore, sodium bicarbonate, which is a buffer base, is often used. Diuretics, not sodium bicarbonate, would be used to combat edema. Intravenous fluids would be used to treat dehydration. Respiratory alkalosis results from excessive carbon dioxide loss, a condition that would be unusual in this neonate. Additionally, because sodium bicarbonate is a base, administering it to a client with alkalosis would only further exacerbate the alkalotic condition.

As status asthmaticus worsens, the nurse would expect the client to experience which acid-base imbalance? ~respiratory alkalosis ~respiratory acidosis ~metabolic acidosis ~metabolic alkalosis

~respiratory acidosis As status asthmaticus worsens, the PaCO increases and the pH decreases, reflecting respiratory acidosis.

The nurse assesses an adolescent client with lethargy, retractions of the intercostal spaces, a persistent expiratory wheeze, diminished breath sounds, tachycardia, and tachypnea. Arterial blood gas results are pH 7.10; PCO2, 80mmHg; PO2, 35mmHg; HCO3, 29mEq/l. What is the priority condition the nurse must address? ~change in mental status ~breathing pattern ~increased heart rate ~respiratory acidosis

~respiratory acidosis Based on the results of the arterial blood gases, this client is in respiratory acidosis. The nurse must address this quickly because it could lead to respiratory failure. If the nurse addresses the respiratory acidosis quickly, which means also addressing the cause of the imbalance, the client may not experience respiratory failure.

A client has been hospitalized with myxedema coma. What acid-base imbalance would be expected in this client? ~respiratory alkalosis ~metabolic acidosis ~respiratory acidosis ~respiratory stress

~respiratory acidosis The client's respiratory drive is depressed, resulting in alveolar hypoventilation, progres carbon dioxide retention, narcosis, and coma. These symptoms, along with cardiovascular collapse and shock, require aggressive and intensive therapy if the client is to survive.

A client who is being treated for pneumonia reports sudden shortness of breath. An arterial blood gas (ABG) is drawn, yielding the following values: pH 7.21, PaCO2 64 mm Hg, HCO3 = 24 mm Hg. What does the ABG reflect? ~metabolic acidosis ~respiratory acidosis ~metabolic alkalosis ~respiratory alkalosis

~respiratory acidosis The pH is below 7.40, PaCO2 is greater than 40, and the HCO; is normal; therefore, respiratory acidosis exists and compensation by the kidneys has not begun, which indicates this was probably an acute event.

A client has a dull headache, is dizzy, and has an increased pulse rate. The results of arterial blood gas analysis are as follows: pH 7.26; PaCO2, 50mmHg; HCO3, 24mEq/L. These findings indicate which acid-base imbalance? ~respiratory alkalosis ~respiratory acidosis ~metabolic acidosis ~metabolic alkalosis

~respiratory acidosis The pH of 7.26 indicates that the body is in a state of acidosis. The elevated PaCO2 value accompanied by a normal HCO3 value indicates that the acid-base imbalance is respiratory acidosis. The additional clinical findings of headache, dizziness, and increased pulse rate, resulting from the elevated partial pressure of carbon dioxide, further support this diagnosis.

A client has these arterial blood gas values: pH, 7.30; Pa02, 89mmHg; PaCO2, 50mmHg; HCO3, 26mEq/L. Based on these values, the nurse should suspect which condition? ~metabolic acidosis ~respiratory alkalosis ~metabolic alkalosis ~respiratory acidosis

~respiratory acidosis This client has a below-normal (acidic) blood pH value and an above-normal partial pressure of arterial carbon dioxide (PaCO2) value, indicating respiratory acidosis.

A client's arterial blood gas analysis reveals an excess of carbon dioxide. The nurse should recognize that this is consistent with which condition? ~respiratory alkalosis ~respiratory acidosis ~metabolic acidosis ~metabolic alkalosis

~respiratory acidosis An increased level of dissolved carbon dioxide (PaCO2) indicates respiratory acidosis.

As status asthmaticus worsens, the nurse would expect the client to experience which acid-base imbalance? ~respiratory alkalosis ~respiratory acidosis ~metabolic alkalosis ~metabolic acidosis

~respiratory acidosis As status asthmaticus worsens, the PaCO increases and the pH decreases, reflecting respiratory acidosis

A nurse is reviewing arterial blood gas results on an assigned client. The pH is 7.32 with PCO2 of 49 mm Hg and a HCO3 of 28 mEq/L. The nurse reports to the physician which finding? ~metabolic acidosis ~metabolic alkalosis ~respiratory alkalosis ~respiratory acidosis

~respiratory acidosis Respiratory acidosis would be reported to the physician citing the lab values. Analysis of the blood gases reveals that the client is acidotic with a pH under 7.35. Also noted is the PCO2 above the normal range. The HCO3 is slightly elevated.

A client's arterial blood gas analysis reveals an excess of carbon dioxide. The nurse should recognize that this is consistent with which condition? ~respiratory alkalosis ~respiratory acidosis ~metabolic acidosis ~metabolic alkalosis

~respiratory alkalosis An increased level of dissolved carbon dioxide (PaCO2) indicates respiratory acidosis.

A client admitted with acute anxiety has the following arterial blood gas (ABG) values: pH, 7.55; Pa02, 90mmHg; PaCO2, 27mmHg; HCO3, 24mEq/L. Based on these values, the nurse suspects ~respiratory acidosis. ~respiratory alkalosis. ~metabolic acidosis. ~metabolic alkalosis.

~respiratory alkalosis. This client's above-normal pH value indicates alkalosis. The below-normal PaCO value indicates acid loss via hyperventilation; this type of acid loss occurs only in respiratory alkalosis.

A client with a diagnosis of respiratory acidosis is experiencing renal compensation. What function does the kidney perform to assist in restoring acid-base balance? ~sequestering free hydrogen ions in the nephrons ~returning bicarbonate to the body's circulation ~returning acid to the body's circulation ~excreting bicarbonate in the urine

~returning bicarbonate to the body's circulation The kidney performs two major functions to assist in acid-base balance. The first is to reabsorb and return to the body's circulation any bicarbonate from the urinary filtrate; the second is to excrete acid in the urine. Retaining bicarbonate will counteract an acidotic state. The nephrons do not sequester free hydrogen ions.

A nurse reviews the arterial blood gas (ABG) values of a client who reports difficulty breathing: pH 7.51; PaCO2, 28mmHg; Pa02, 70mmHg; & HCO3, 24mEq/L. What assessment finding would the nurse anticipate based on these blood gases? ~complaints of constipation ~nausea and vomiting ~bradypnea ~tachypnea

~tachypnea Hyperventilation/tachypnea leads to excess carbon dioxide (CO2) loss, which causes alkalosis - indicated by this client's elevated pH value. With respiratory alkalosis, the kidneys' bicarbonate (HCO3) response is delayed, so the client's HCO3 level remains normal. The below-normal value for the partial pressure of arterial carbon dioxide (PaCO2) indicates CO2 loss and signals a respiratory component. Because the HCO3 level is normal, this imbalance has no metabolic component. Therefore, the client is experiencing respiratory alkalosis.

A nurse is reviewing a report of a client's routine urinalysis. Which value requires further investigation? ~absence of protein ~urine pH of 3.0 ~absence of glucose ~specific gravity of 1.03

~urine pH of 3.0 Normal urine pH is 4.5 to 8; therefore, a urine pH of 3.0 is abnormal and requires further investigation.

The nurse is preparing a client for a cardiac catheterization. Which client statements would the nurse need to report to the health care provider immediately? • "I took my metformin this morning." • "I have not been able to eat since yesterday." • "I am allergic to penicillin and midazolam." • "I am very claustrophobic in small spaces."

• "I took my metformin this morning." The priority would be to notify the health care provider of the metformin because it cannot be taken 48 hours before or after contrast, as there is an increased risk of lactic acidosis and acute renal failure with iodinated contrast material. It would be appropriate for the client to take nothing by mouth. It is important to determine the client's allergies; however, it is not the priority. Claustrophobia would not be an issue during a cardiac catheterization.