TERM 4 Ch 12 Assessment and Care of Patients with Acid-Base Imbalances

Deep and rapid breaths consistent with Kussmaul respirations are found in clients with which type of acid-base imbalance? 1 Respiratory alkalosis 2 Respiratory acidosis 3 Metabolic alkalosis 4 Metabolic acidosis

Metabolic acidosis In metabolic acidosis, the rate and depth of breathing increase as the hydrogen ion levels rise. The breathing pattern becomes deep and rapid and not under voluntary control. This type of breathing is known as Kussmaul respiration, which is not present in respiratory alkalosis, respiratory acidosis, or metabolic alkalosis.

A client currently taking acetazolamide (Diamox) develops metabolic acidosis. Which nursing interventions are appropriate for the nurse to include in the plan of care? Select all that apply. 1 Administering IV fluids. 2 Monitoring electrolyte levels. 3 Administering prescribed diuretics. 4 Placing the client on fall precautions. 5 Administering prescribed antiemetics.

-Administering IV fluids. -Monitoring electrolyte levels. -Placing the client on fall precautions. For a client with metabolic acidosis due to diuretic therapy, the client's diuretics should be stopped, the nurse should administer IV fluids and monitor electrolyte levels, and the client should be placed on fall precautions because hypotension and muscle weakness are common with metabolic acidosis. Antiemetics are used if metabolic acidosis is caused by vomiting.

The nurse is reviewing assessment data for a client who was admitted for emergency treatment of an acute asthmatic episode. Which assessment data suggest the client is in an uncompensated acid-base imbalance? 1 Temperature of 101.5° F (38.6° C) 2 Anxious 3 Bicarbonate of 24 mEq/L 4 Paco2 of 30 mm Hg

-Bicarbonate of 24 mEq/L Kidney compensation for respiratory acid-base imbalance (Paco2 30 mm Hg) from the acute asthma episode is not yet evident in the arterial blood gas analysis (HCO3- 24 mEq/L), resulting in an uncompensated acid-base imbalance state. The fever is most likely associated with increased metabolism and work of breathing. Anxiety is common and related to hypoxia (Pao2 80 mm Hg) and difficulty breathing (wheezing). The decreased Paco2 of 30 mm Hg is associated with the increased respiratory rate and cause of the respiratory alkalosis.

A client has been poisoned by botulinum toxins. What assessment findings suggest the client has acidosis? Select all that apply. 1 Hypertension 2 Confusion 3 Hyperreflexia 4 Warm, flushed, dry skin 5 Pounding peripheral pulse

-Confusion -Warm, flushed, dry skin If the client is confused and has a warm, flushed, and dry skin, it may indicate the client has acidosis. Acidosis decreases the ability of excitable tissues in the blood vessels to respond adequately. So, there is vasodilation leading to hypotension rather than hypertension. Decrease in the ability of the excitable tissues in the muscles to respond adequately to stimulus, and the hyperkalemia associated with acidosis reduce the muscle tone. This leads to hyporeflexia rather than hyperreflexia. Mild acidosis may increase the heart rate, but as the acidosis worsens and there is hyperkalemia, the heart rate decreases making the peripheral pulse hard to find. Therefore, the peripheral pulse is thready rather than pounding.

The nurse is caring for a client with metabolic alkalosis. What manifestations of metabolic alkalosis is the nurse likely to assess? Select all that apply. 1 Increase in handgrip strength 2 Decrease in heart rate 3 Hyperactivity of deep tendon reflexes 4 Numbness around the mouth 5 Presence of Kussmaul respiration

-Hyperactivity of deep tendon reflexes -Numbness around the mouth Hypocalcemia occurs with alkalosis, which can cause hyperactivity of deep tendon reflexes. Alkalosis overexcites the nervous system leading to tingling or numbness around the mouth. Overstimulation of the nerves may cause contraction of skeletal muscles, but the contractions are weaker because of hypokalemia. Therefore, there is a decrease in handgrip strength. Alkalosis increases myocardial irritability and increases the heart rate. Kussmaul respiration (deep and rapid involuntary breathing) is seen in metabolic acidosis with respiratory compensation.

An older client is admitted with pneumonia. What changes in the client does the nurse expect to assess when obtaining data about the client's acid-base imbalance? Select all that apply. 1 New-onset mental status changes 2 Dry mucous membranes 3 Dark, concentrated urine 4 Clear, straw-colored urine 5 Generalized edema 6 Thready peripheral pulses

-New-onset mental status changes -Dry mucous membranes -Dark, concentrated urine -Thready peripheral pulses Clients at increased risk of acidosis are older adults and those with impaired breathing. The nurse should assess for changes in mental status, pulse quality and rate, and signs of dehydration. Clear, straw-colored urine suggests the client is not conserving urine in response to dehydration. Generalized edema is not associated with dehydration.

The laboratory reports of a client show the client has metabolic alkalosis. What conditions may result in metabolic alkalosis? Select all that apply. 1 Prolonged vomiting 2 Prolonged diarrhea 3 Nasogastric suctioning 4 Blood transfusion 5 Starvation 6 Total parenteral nutrition

-Prolonged vomiting -Nasogastric suctioning -Blood transfusion -Total parenteral nutrition Prolonged vomiting and nasogastric suctioning can lead to acid deficits causing metabolic alkalosis. Blood transfusion and total parenteral nutrition increase the base components by parenteral base administration. Therefore, they also cause metabolic alkalosis. Prolonged diarrhea can cause overelimination of bicarbonate ions resulting in metabolic acidosis. Starvation leads to excessive oxidation of fatty acids leading to overproduction of hydrogen ions and metabolic acidosis.

Which conditions and/or symptoms may be most likely responsible for this acid-base imbalance: pH 7.32, Pao2 82 mm Hg, Paco2 50 mm Hg, HCO3- 18 mEq/L? Select all that apply. 1 Respiratory rate of 8 breaths/min 2 Prolonged vomiting 3 Oliguria 4 Dehydration 5 Anxiety 6 Constipation

-Respiratory rate of 8 breaths/min -Oliguria -Dehydration The acid-base imbalance is a combined respiratory (Paco2 50 mm Hg) and metabolic acidosis (HCO3- 18 mEq/L). Conditions that may cause a combined acidosis are a decreased respiratory rate, kidney dysfunction (oliguria), and dehydration (dry mucous membranes). Prolonged vomiting and anxiety would result in an alkalosis imbalance. Constipation would not cause an acid-base imbalance; however, diarrhea would place the client at risk for acidosis.

A client has chronic respiratory acidosis. Which nursing assessments are appropriate for this client? Select all that apply. 1 Checking respiratory status once per shift. 2 Assessing the color of nail beds. 3 Assessing for cyanosis of mucous membranes. 4 Checking for the use of accessory muscles. 5 Listening for crackles at lung bases

2, 3, 4 For a client with chronic respiratory acidosis, the nurse should assess the color of nail beds and mucous membranes, and assess for the use of accessory muscles when breathing. Assessment of breathing status should be done at least every 2 hours, and lung sounds should be assessed for grunting or wheezing.

A client is admitted with chronic anemia. What physiologic imbalance does the nurse suspect the client is at risk of developing? 1 Acidosis 2 Ineffective ventilation 3 Hypokalemia 4 Alkalosis

Acidosis Protein buffers, especially hemoglobin buffers, are the primary buffer of hydrogen ions. When clients are anemic, there is less hemoglobin to buffer hydrogen ions and a reduced ability for the body to prevent acidosis. There is no information that suggests the client is at risk for ineffective ventilation, hypokalemia, or alkalosis.

Which assessment finding requires priority nursing intervention in a client with metabolic or respiratory acidosis? 1 Lethargy and confusion 2 Bradycardia with widened QRS complex 3 Rapid respiratory rate 4 Dry skin

Bradycardia with widened QRS complex Cardiovascular manifestations that require priority nursing interventions are related to delayed electrical conduction; specifically bradycardia that may progress to heart block, tall T waves, widened QRS complex, and prolonged PR interval. Other changes like lethargy, confusion, rapid respiratory rate, and dry skin are important to address, but may not require priority interventions.

Which client is most likely to exhibit the following ABG results: pH, 7.30; Paco2, 49; HCO3-, 26; Pao2, 76? 1 Client with kidney failure 2 Client taking hydromorphone (Dilaudid) 3 Client with anxiety disorder 4 Client with hyperkalemia

Client taking hydromorphone (Dilaudid) Hydromorphone (Dilaudid), a narcotic analgesic, can cause respiratory depression, hypoventilation, and respiratory acidosis, as this blood gas reading demonstrates. Kidney failure causes metabolic acidosis. Anxiety will cause hyperventilation and subsequent respiratory alkalosis. Although hyperkalemia can be caused by acidosis, it is not a cause of acidosis.

A client admitted with diabetic ketoacidosis was treated for metabolic acidosis with IV fluids and insulin. Which electrolyte imbalance does the nurse monitor for as the acid-base imbalance resolves? 1 Hyponatremia 2 Hypokalemia 3 Hyperkalemia 4 Hypernatremia

Hypokalemia In acidosis, extracellular hydrogen ions move into the cell and potassium moves out, causing hyperkalemia. In diabetic ketoacidosis, by treating the elevated serum glucose with insulin and IV fluids, the acid-base imbalance resolves. As the acidosis resolves, the hydrogen ions move out of the cell, and potassium moves back into the cell, causing hypokalemia in the plasma. Sodium levels are not affected by diabetic ketoacidosis.

A client with diabetes mellitus is brought to the emergency department after vomiting for several days. The client has rapid, deep respirations and a urine dipstick reveals ketonuria. Which process does the nurse suspect is occurring with this client? 1 Kidney compensation for metabolic acidosis 2 Respiratory compensation for metabolic acidosis 3 Kidney compensation for metabolic alkalosis 4 Respiratory compensation for metabolic alkalosis

Respiratory compensation for metabolic acidosis Clients with diabetes mellitus can develop metabolic acidosis. Respiratory compensation occurs through the lungs as the rate and depth of respirations increase in order to reduce hydrogen ion levels. Kidney compensation is not occurring.