Respiratory Acidosis

If excessive administration of narcotics has caused respiratory acidosis, which drug will be given to reverse the effects? A. Naloxone B. NSAIDs C. Bronchodilators D. Antibiotics

A) Naloxone Rationale: Naloxone reverses the effects of narcotics. Antibiotics are prescribed to treat infections. Bronchodilators are used to open the airway. NSAIDs are​ anti-inflammatory analgesics.

A client with severe respiratory distress has a blood pH of less than 7.35. Which clinical manifestation will the nurse anticipate upon assessment? SATA A. Headache B. Irritability C. Hyperventilation D. Dizziness E. Tetany

A, B Headache Irritability Rationale: The client presented in the question has respiratory acidosis​ (blood pH less than 7.35 in acute respiratory​ distress). Headache and irritability may be present in clients with respiratory acidosis.​ Hyperventilation, dizziness, and tetany are symptoms of respiratory​ alkalosis, not acidosis

Why are children with asthma at risk for developing respiratory acidosis? A. Asthma causes hyperventilation B. Asthma causes decreased oxygenation C. Asthma causes airway constriction D. Asthma causes chronic cough

C) Asthma causes airway constriction Rationale: Children with asthma are at risk for developing respiratory acidosis because asthma constricts the​ airways, leading to air trapping and retained carbon dioxide. Hyperventilation would lead to respiratory​ alkalosis, not acidosis. Asthma may cause chronic cough and decreased​ oxygenation; however, these are not primary factors related to respiratory acidosis

The nurse is caring for a client who has been admitted to the unit with respiratory failure and respiratory acidosis. Which data from the nursing history would the nurse suspect contributed to the client's current state of health? A) Use of ibuprofen for the control of pain B) A recent trip to South America C) Aspiration pneumonia D) Recent recovery from a cold virus

Answer: C Aspiration of a foreign body and acute pneumonia would put the client at risk for respiratory acidosis. A recent trip to South America would not constitute a respiratory risk factor. Recent recovery from a cold would not likely put the client at risk. Ibuprofen does not pose a threat to the respiratory health of the client.

The nurse asks a new graduate to explain respiratory acidosis. Which statement by the new grad demonstrates understanding of the pathophysiology of respiratory acidosis? A. "It's caused by a deficiency of carbonic acid." B. "It's caused by an excess of carbonic acid." C. "It's caused by a deficiency of bicarb." D. "It's caused by an excess of bicarb."

B) "It's caused by an excess of carbonic acid." Rationale: Respiratory acidosis is caused by an excess of carbon dioxide​ (carbonic acid). A deficiency of carbonic acid would cause respiratory alkalosis. An excess of bicarbonate would cause metabolic​ alkalosis, whereas a deficiency of bicarbonate would cause metabolic acidosis

Which is a common cause of acute respiratory acidosis? SATA A. Anxiety B. Pneumonia C. Opiate overdose D. Pulmonary edema E. Foreign body aspiration

B, C, D, E Rationale: Respiratory acidosis is always caused by hypoventilation. The common acute causes of respiratory acidosis that lead to hypoventilation include pulmonary​ edema, pneumonia, acute​ asthma, opiate​ overdose, foreign body​ aspiration, and chest trauma. Anxiety is a common cause of respiratory​ alkalosis, not respiratory acidosis.

A client with chronic lung disease diagnosed with acute respiratory acidosis is being discharged home. In order to provided individualized care, which topic should be the priority focus of the nurse's teaching to the client and the client's family? A. Supplemental oxygen therapy guidelines B. Instruction on home-regimen instruction C. Prevention of further compromise D. Follow-up care within the community

C) Prevention of further compromise Rationale: Prevention of further compromise should be the​ nurse's priority teaching. The other answer choices may be​ correct; however, these are not the priority for teaching

A nurse cares for a client with acute respiratory acidosis. Which intervention will the nurse implement in order to promote the client's gas exchange? A. Place the client in postural drainage positions B. Encourage fluid intake C. Place the client in semi-fowler position D. Encourage huff breathing

C) Semi-Fowler's Rationale: Placing the client in​ semi-Fowler position promotes lung expansion and gas exchange. Huff​ breathing, increased fluid​ intake, and postural drainage are all interventions to promote effective airway​ clearance, not to promote gas exchange.

Excess levels of which class of medication can be a risk factor in the development of respiratory acidosis? A. Antibiotics B. Bronchodilators C. Salicylates D. Narcotics

D) Narcotics Rationale: An overdose of narcotics will depress respiratory drive and may cause respiratory acidosis. Excess levels of bronchodilators or antibiotics will not cause respiratory acidosis. An overdose of salicylates can cause respiratory​ alkalosis, not acidosis.

A client is diagnosed with metabolic alkalosis. Which action by the nurse will assist in restoring this imbalance? A. Administering potassium chloride B. Administering IV insulin C. Administering sodium bicarbonate D. Administering a bronchodilator

A) Administering 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, a type of metabolic​ acidosis, not metabolic alkalosis. Bronchodilators are used to treat respiratory​ acidosis, not metabolic alkalosis.

Which is the priority nursing diagnosis for a client with respiratory acidosis? A. Airway clearance, Ineffective B. Bleeding, Risk for C. Nutrition, Imbalanced: Less than Body Requirements D. Infection, Risk for

A) Airway clearance, Ineffective Rationale: The priority nursing diagnosis for the client with respiratory acidosis is Airway​ Clearance, Ineffective.. ​Infection, Risk​ for; Nutrition,​ Imbalanced: Less than Body​ Requirements; and ​Bleeding, Risk for are not appropriate nursing diagnoses for this client

Which intervention would be an effective pharmacologic treatment for improving ventilation for the client with severe respiratory acidosis? A. Bronchodilators B. Hydration C. Intubation D. Percussion and drainage

A) Bronchodilators Rationale: Bronchodilators are medications that are used to treat severe respiratory acidosis.​ Intubation, percussion and​ drainage, and hydration are nonpharmacologic interventions appropriate for severe respiratory acidosis

The nurse is providing discharge teaching to a 36-year-old client who was treated for respiratory acidosis caused by a narcotic overdose. Which would the nurse likely provide to the client to prevent a recurrence of respiratory acidosis? SATA A. Referral to counseling B. Referral to Narcotics Anonymous C. Resources for family support D. Recommendation for pneumococcal pneumonia vaccine E. Recommendation for influenza vaccine

A, B, C Rationale: Because the​ client's respiratory acidosis was caused by a narcotic​ overdose, the​ nurse's priority is to provide mental health support for the client and his family. This includes referral to Narcotics Anonymous and​ counseling, and providing the​ client's family with support resources. Recommending vaccines against influenza and pneumococcal pneumonia is more appropriate for clients with chronic lung disease

The nurse is caring for a client with a history of respiratory acidosis secondary to chronic lung disease. Which instruction would the nurse provide regarding prevention of a recurrence of respiratory acidosis? SATA A. Avoid crowds B. Get the flu vaccine C. Practice hand hygiene D. Use good cough etiquette E. Breathe into a paper bag when out of breath

A, B, C, D Rationale: Practicing good hand​ hygiene, using good cough​ etiquette, avoiding​ crowds, and getting the flu vaccine will all prevent infections and help prevent a recurrence of respiratory acidosis in the client with a chronic lung disease. Breathing into a paper bag does not prevent respiratory acidosis for a client with chronic lung disease

The nurse is reviewing the medication orders for a client with acute respiratory acidosis caused by narcotic overdose. Which medication would the nurse anticipate being prescribed for the client? SATA A. Naloxone B. Antibiotics C. Anesthetics D. Bronchodilators E. Sodium bicarbonate

A, D, E Rationale: Sodium bicarbonate is administered to remove excess acids and increase the pH. Naloxone is given to counter the narcotic overdose. Bronchodilators may also be prescribed to open the airways and improve ventilation. Antibiotics would not be given because this​ client's acidosis is not caused by a respiratory infection. Anesthetics would not be given because they would further depress respiration

Decreased level of consciousness in acute respiratory acidosis is often due to hypercapnia causing: A) decreased pulse rate. B) hyperventilation. C) cerebral vasodilation. D) neurotransmitter disturbances.

Answer: C Hypercapnia causes cerebral vasodilation, which results in headache, blurred vision, irritability, mental cloudiness, and decreased level of consciousness. The pulse rate is elevated in acute respiratory acidosis, not decreased. Respiratory acidosis is caused by hypoventilation, not hyperventilation. Neurotransmitter disturbances are unrelated to respiratory acidosis.

A client with pneumonia develops respiratory acidosis. Based on provider's orders, which medications should the nurse prepare to administer to this client? Select all that apply. A) The loop diuretic furosemide (Lasix), 20 mg by mouth twice a day B) The antibiotic amoxicillin, 1 gram intravenous every 6 hours C) The bronchodilator albuterol, inhaler 2 puffs every 4 hours D) The anxiolytic diazepam (Valium), 2 mg by mouth at bedtime for sleep E) Potassium chloride 20 mEq in 100 mL 0.9% normal saline intravenous every day

Answer B, C Bronchodilator drugs such as an albuterol inhaler may be administered to open the airways, and antibiotics such as amoxicillin may be prescribed to treat respiratory infections. Benzodiazepines such as diazepam are central nervous system depressants and would adversely affect this client's respiratory rate, adversely affecting respiratory acidosis. Potassium chloride is indicated in the treatment of metabolic alkalosis.

A client is admitted to the unit with chronic obstructive pulmonary disease. Blood gas analysis indicates respiratory acidosis. Based on this data, the nurse plans care based on which priority diagnosis? A) Impaired Gas Exchange B) Ineffective Airway Clearance C) Impaired Mobility D) Anxiety

Answer: A Impaired Gas Exchange is the priority nursing diagnosis for the client with respiratory acidosis. Interventions are aimed at restoring effective alveolar ventilation and gas exchange. Anxiety and Ineffective Airway Clearance are both appropriate nursing diagnoses but not priority for the client with respiratory acidosis. There is no evidence to support the nursing diagnosis Impaired Mobility for this client.

Acute respiratory acidosis can lead to ________, which affects neurological function and the cardiovascular system. A) hypercapnia B) carbon dioxide narcosis C) hypoventilation D) hyperventilation

Answer: A In acute respiratory acidosis, increased carbon dioxide levels, also called hypercapnia, can affect neurological function and the cardiovascular system. Carbon dioxide narcosis occurs in chronic respiratory acidosis. Hypoventilation causes respiratory acidosis; it doesn't result from respiratory acidosis. Hyperventilation is related to respiratory alkalosis, not respiratory acidosis.

The nurse is providing care to a client recently extubated for treatment of aspiration pneumonia and respiratory acidosis. Which action by the nurse provides an optimum environment for this client? A) Allowing family members to remain with client as much as possible B) Restraining the client C) Placing the client in a side-lying position D) Administering narcotics for pain

Answer: A The client with respiratory acidosis often experiences anxiety. This client would benefit from having a family member in the room to provide reassurance. Restraining the client will increase levels of agitation. The client with respiratory failure would benefit most from the semi-Fowler or Fowler position to increase ventilation. Narcotics will depress the respirations and increase respiratory acidosis. A nonnarcotic pain reliever would be considered if this client were experiencing pain.

The nurse is preparing discharge instructions for an older adult client recovering from respiratory acidosis caused by restrictive lung disease and pneumonia. Which topics should the nurse include in the discharge teaching for this client? Select all that apply. A) Obtain annual influenza immunization. B) Engage in frequent hand washing. C) Avoid crowds. D) Cover the nose and mouth when coughing. E) Restrict fluids.

Answer: A, B, C, D For the client with a history of chronic lung disease and pneumonia, the nurse should instruct on the importance of receiving annual influenza immunizations, frequent hand washing, avoiding crowds, and covering the nose and mouth when coughing. Fluids should be encouraged to ensure that respiratory secretions are thin.

The nurse is preparing to admit a client with acute pneumonia who is experiencing severe respiratory acidosis. Which treatments does the nurse anticipate as appropriate for this client? Select all that apply. A) Administer oxygen prn. B) Administer digoxin for heart failure. C) Encourage up to 3 L of fluids per day. D) Place in a prone position. E) Reposition frequently.

Answer: A, C, E The client with acute pneumonia and respiratory acidosis may require oxygen administration to improve gas exchange, increased fluid intake to thin secretions, and frequent repositioning to preventing the pooling of respiratory sections. There is not enough evidence to know whether the client is experiencing heart failure as a result of the acute pneumonia. The client should be placed in the Fowler or semi-Fowler rather than the prone position.

The nurse assumes care for a client who was brought to the hospital after a morphine overdose. What acid-base imbalance does the nurse expect to observe in this client? A) Respiratory alkalosis B) Respiratory acidosis C) Metabolic alkalosis D) Metabolic acidosis

Answer: B Morphine is a narcotic and generally acts to decrease or suppress respirations; therefore, this client is probably hypoventilating. The expected acid-base imbalance would be respiratory acidosis. Respiratory alkalosis, metabolic acidosis, and metabolic alkalosis are caused by many conditions, none of which are related to this client's morphine overdose.

The nurse is planning care for an older client with respiratory acidosis. Which intervention should the nurse include in this client's plan of care? A) Administer prescribed intravenous fluids carefully. B) Administer intravenous sodium bicarbonate. C) Maintain adequate hydration. D) Reduce environmental stimuli.

Answer: C In respiratory acidosis, there are a drop in the blood pH, a reduced level of oxygen, and retention of carbon dioxide. The body needs to be well-hydrated so that pulmonary secretions can be removed to improve oxygenation. Careful administration of intravenous fluids is important in the older client with metabolic alkalosis because older clients are at risk because of their fragile fluid and electrolyte status. Sodium bicarbonate is indicated in the treatment of metabolic acidosis. Reducing environmental stimuli would be appropriate for the client with respiratory alkalosis.

A client is admitted to the emergency department (ED) for treatment of an overdose. The client's arterial blood gas results indicate acute respiratory acidosis. Which substance found on the nurse's review of the toxicology analysis is most likely the cause for the client's current condition? A) Cocaine (a stimulatory anesthetic) B) Marijuana (a cannabinoid) C) Oxycodone (a narcotic) D) PCP (a dissociative anesthetic)

Answer: C Oxycodone is an opiate narcotic. Excessive use or overdose of narcotic substances can lead to respiratory depression and respiratory acidosis. Cocaine is a stimulant. Marijuana does not depress the central nervous system or respiratory center. PCP is a hallucinogenic agent.

The nurse is reviewing prescriptions written for a client with chronic respiratory acidosis. Which prescription should the nurse question prior to implementation? A) Keep head of the bed elevated to 40-degree angle. B) Dextrose 5% and 0.45% normal saline at 100 mL per hour C) Consult Respiratory Therapy for breathing treatments four times a day. D) Oxygen 6 liters per minute per nasal cannula

Answer: D In clients with chronic respiratory acidosis, oxygen is administered cautiously to prevent carbon dioxide narcosis. Adequate hydration such as intravenous fluids is important to promote removal of respiratory secretions. Pulmonary hygiene measures such as breathing treatments may be instituted. Elevating the head of the bed promotes oxygenation.

The nurse instructs a client with a history of acute respiratory acidosis and lung infections on ways to prevent further episodes of the health problem. Which client statement indicates that teaching has been effective? A) "I will limit drinking alcohol to the evening hours only." B) "I will limit my intake of bananas and oranges." C) "I will take prescribed antibiotics until my symptoms subside." D) "I will receive the annual influenza vaccination."

Answer: D The nurse should discuss ways to avoid future episodes of acute respiratory infections by encouraging the client to receive immunization against pneumococcal pneumonia and influenza. Alcohol is a central nervous system depressant, which can adversely affect respiratory status and lead to the development of respiratory acidosis. The ingestion of bananas and oranges will not promote the development of respiratory acidosis. The client should be instructed to complete a full course of antibiotics prescribed to treat infections.

The nurse is caring for a client with COPD who is anxious and short of breath. A supportive family member is at the bedside, but the client still appears anxious. How should the nurse respond? A. Call the healthcare provider for advice B. Allow the family member to stay with the client C. Politely ask the family member to leave D. Ask another nurse to sit with the client

B) Allow the family member to stay with the client Rationale: A client with COPD who is anxious and short of breath is at high risk for acute respiratory acidosis due to further impairment of alveolar ventilation and increased hypercapnia. A client who is experiencing acute anxiety should have a family member at the​ bedside, as long as the family member is supportive and does not impede the care of the client. There is no reason for the nurse to ask the family member to leave. Calling the healthcare provider or asking another nurse is inappropriate and unnecessary.

The nurse is caring for a client with respiratory acidosis with a nursing diagnosis of Injury, Risk for. What factor increases the client's risk for injury? A. Muscle atrophy B. Blurred vision C. Photophobia D. Muscle tetany

B) Blurred vision Rationale: A client with respiratory acidosis may experience blurred​ vision, increasing the risk for injury due to falls. Photophobia occurs in​ meningitis, not respiratory acidosis. Muscle tetany occurs in respiratory​ alkalosis, not acidosis. Muscle​ weakness, not​ atrophy, is associated with respiratory acidosis.​ (NANDA-I ©​ 2014)

*Shit Question alert* The nurse cares for a client with acute respiratory failure who presents with increased agitation, shortness of breath, and irritability. Which nursing diagnosis is most appropriate for this client? A. Fluid Volume: Deficit, Risk for B. Injury, Risk for C. Activity Intolerance, Risk for D. Cardiac Output, Decreased

B) Injury, Risk for Rationale: This client is at risk for injury because of the current​ state, and the nurse should remain at the​ client's bedside to avoid​ injury, such as falls. The client may have decreased cardiac​ output; however, there is not enough information in the question to support this. The client will have activity intolerance and may be at risk of fluid volume​ deficit, but these are not the priority.​

When planning care for the client with respiratory acidosis, which is the most appropriate intervention for the nurse to implement to promote the removal of excess carbon dioxide? A. Use of incentive spirometry B. Pursed-lip breathing C. Use of bronchodilators D. Huff coughing

B) Pursed lip breathing Rationale: Pursed-lip breathing is the most appropriate intervention because it promotes the removal of excess carbon dioxide. It maintains open airways throughout​ exhalation, promoting the removal of carbon dioxide. Huff coughing and the use of incentive spirometry are techniques used to remove excess​ secretions, not carbon dioxide. Bronchodilators are used to dilate the smooth muscles of the airway during airway constriction.

Which will the nurse include in the client interview portion of the nursing assessment for a client with respiratory acidosis? A. Vital signs B. Mental status C. Duration of symptoms D. Lung sounds

C) Duration of symptoms Rationale: The client interview portion of the nursing assessment for a client with respiratory acidosis will include an assessment of the duration of symptoms. Mental​ status, vital​ signs, and lung sounds are assessed during the physical​ examination, not the interview portion of the nursing assessment.

The nurse is caring for a client with emphysema who requires supplemental oxygen. Which technique would the nurse instruct the client to perform to promote the removal of excess carbon dioxide from the blood? A. Huff coughing B. Deep breathing and coughing C. Rapid, shallow breathing D. Pursed-lip breathing

D) Pursed lip breathing Rationale: Pursed-lip breathing promotes the removal of carbon dioxide from the blood because it allows the airways to remain open throughout the entire​ exhalation, removing more carbon dioxide than if the technique was not used. Huff coughing and deep breathing and coughing are techniques used to remove retained secretions from the airway.​ Rapid, shallow breathing is not recommended and is not a safe intervention