Patho Course Point - Chapter 9: Altered Acid-Base Balance

The nurse is caring for the following group of clients. Select the client most likely to be diagnosed with respiratory alkalosis.

A 26-year-old female with anxiety who has been hyperventilating - Respiratory alkalosis is usually caused by over-breathing (called hyperventilation) that occurs when you breathe very deeply or rapidly. Causes of hyperventilation include: Anxiety or panic.

In which client would the nurse be most likely to assess the signs and symptoms of an acid-base imbalance?

A client with chronic obstructive pulmonary disease (COPD) whose most recent arterial blood gases reveal a PCO2 of 51 mm Hg

A client is admitted after losing 44 lb (20 kg) over the past 3 months, largely due to frequent vomiting. What intervention should the nurse anticipate in the treatment of the client's resulting acid-base imbalance?

Fluid replacement with an intravenous solution containing electrolytes as prescribed

The nurse is aware that the major role of the kidneys in regulating acid-base balance is to increase the production of which chemical component?

HCO3-

The renal control mechanism of restoring the acid-base balance is accomplished through which process?

Reabsorption of HCO3 and excretion of H+ restores acid-base balance through the renal control mechanisms.

The condition of a client with metabolic acidosis from an intestinal fistula is not improving. The pulse is 125 beats/min and the BP 84/56 mm Hg. ABG values are: pH 7.1, HCO3- 18 mEq/L (18 mmol/L), PCO2 57 mm Hg (7.58 kPa). What IV medication should the nurse expect to provide next?

Sodium bicarbonate

The nurse is evaluating a client's blood gases. The client has a pH of 7.35. How does the nurse interpret this value?

it is within normal range

A client's arterial blood gases indicate normal oxygen levels but increased carbon dioxide levels with elevated HCO3- levels and a pH of 7.43. The client's respiratory rate is12 breaths/min. How should the nurse interpret these findings?

metabolic alkalosis

The nurse is caring for a client with metabolic alkalosis. Which of these arterial blood gas results supports this diagnosis?

pH of 7.50 and HCO3 of 45 mEq/L (45 mmol/L)

The nurse is caring for a client with an acid-base imbalance. Which of these does the nurse recognize is correct regarding compensation?

A pH moves toward the normal range.

A client's most recent laboratory results suggest the presence of metabolic alkalosis. What action by the nurse best addresses a potential cause of this acid-base imbalance?

Administering an antiemetic to treat the client's frequent vomiting - Vomiting results in the loss of hydrogen ions, potentially resulting in metabolic alkalosis.

The nurse is caring for a client with dehydration who reports urine with a strong ammonia odor. How will the nurse explain this finding to the client?

Ammonia chloride is normally produced in the kidney's renal tubules to buffer acids. The odor is stronger because the urine is concentrated.

When explaining how carbon dioxide combines with water to form carbonic acid as part of an acid-base lecture, the faculty instructor emphasizes that which enzyme is needed as a catalyst for this reaction?

Carbonic anhydrase

The body regulates the pH of its fluids by what mechanism?

Chemical buffer systems of the body fluids The lungs The Kindeys

Respiratory alkalosis can be caused by a respiratory rate in excess of that which maintains normal plasma PCO2 levels. What is a common cause of respiratory alkalosis?

Hyperventilation

The nurse is caring for a client with ketoacidosis who is complaining of increasing lethargy and occasional confusion following several weeks of rigid adherence to a carbohydrate-free diet. The nurse understands which phenomenon is most likely occurring?

In the absence of carbohydrate energy sources, her body is metabolizing fat and releasing ketoacids.

A client has these arterial blood gas values: anion gap 20 mEq/L (20 mmol/L), pH 7.29, PCO2 37 mm Hg (4.92 mmol/L), HCO3- 11 mEq/L (11 mmol/L), base excess -6 mEq/L (-6 mmol/L). With what condition do these values correspond?

Lactic acidosis

The nurse is reviewing laboratory data for the client with an anion gap of 17. The nurse recognizes which condition is associated with an increased anion gap mEq/L (mmol/L)?

Lactic acidosis

The nurse is caring for a client with worsening respiratory acidosis. Which of these interventions does the nurse anticipate if the client's condition continues to deteriorate?

Mechanical ventilation

What is the nurse's expectation about a client's ability to compensate for a metabolic blood gas disorder?

The client will compensate with the respiratory system.

The nurse examines a client's laboratory results and notes an anion gap of 22 mEq/l (mmol/l). The nurse interprets this finding as evidence of which pathophysiologic process?

There is an accumulation of excess unmeasurable anions in the client's plasma.

A client with a long history of alcohol abuse has been admitted to the emergency department after several of days of heavy drinking. The nurse can best promote the restoration of the client's acid-base balance by:

administering intravenous sodium bicarbonate as prescribed.

As other mechanisms prepare to respond to a pH imbalance, immediate buffering is a result of increased:

bicarbonate/carbonic acid regulation. - Carbonic acid then dissociates into bicarbonate and a hydrogen ion. This reaction is one of the many buffer systems in the human body; it resists dramatic changes in pH to allow a person to remain within the narrow physiological pH range.

The nurse is examining a client's laboratory results and notes a decreased blood pH level. Which finding will the nurse apply as the best evidence that the client is experiencing metabolic acidosis?

decreased HCO3−