1601 Acid/Base balance adaptive quizing

A 60-year-old patient is admitted to the hospital with symptoms of a disturbance in acid-base balance. Which pH value would be consistent with an excessive amount of acids in the body? 1. 7.26 2. 7.36 3. 7.46 4. 7.56

1. 7.26 The normal pH for a patient younger than age 90 is 7.35 to 7.45. An acidic pH is one lower than 7.35 and an alkaline pH is one above 7.45. Test-Taking Tip: Make certain that the answer you select is reasonable and obtainable under ordinary circumstances and that the action can be carried out in the given situation.

What is one of the causes of respiratory alkalosis? 1 Anxiety 2 Antacid use 3 Kidney failure 4 Diuretic therapy

1. Anxiety Hyperventilation is one cause of respiratory alkalosis, which can result from fear and anxiety. Kidney failure and diuretic therapy are not causes of respiratory alkalosis. The use of antacids can result in metabolic alkalosis.

Which action does the nurse take first for the patient who is admitted to the emergency department (ED) with a panic attack and whose blood gases indicate respiratory alkalosis? 1 Encourage the patient to take slow breaths. 2 Obtain a prescription for a fluid and electrolyte infusion. 3 Administer oxygen using ED standard orders. 4 Place an emergency cart close to the patient's room.

1. Encourage the patient to take slow breaths. Because respiratory alkalosis is caused by hyperventilation, the nurse's first action should be to assist the patient in slowing the respiratory rate. Respiratory alkalosis is caused by hyperventilation; fluid and electrolyte replacement will not help correct hyperventilation. No evidence suggests that hypoxemia exists; therefore, oxygen is not needed at this time. Ongoing respiratory alkalosis may eventually cause fluid and electrolyte shifts requiring IV emergency drugs; however, slowing the breathing and rebreathing of CO2 are the priority interventions. Test-Taking Tip: Never leave a question unanswered. Even if answering is no more than an educated guess on your part, go ahead and mark an answer. You might be right, but if you leave it blank, you will certainly be wrong and lose precious points.

A patient is admitted with severe diabetic ketoacidosis. Arterial blood gas results reveal a pH of 7.21. What is this patient's acidosis most likely in response to? 1 Excessive breakdown of fatty acids 2 Anaerobic metabolism 3 Excessive intake of alcoholic beverages 4 Excessive intake of insulin

1. Excessive breakdown of fatty acids Metabolic acidosis can result from the overproduction of hydrogen ions, underelimination of hydrogen ions, or insufficient bicarbonate ions. Excessive breakdown of fatty acids that occurs with diabetic ketoacidosis or starvation results in overproduction of hydrogen ions and metabolic acidosis. Anaerobic metabolism produces lactic acid as a cause of metabolic acidosis. Excessive intake of alcoholic beverages will also cause metabolic acidosis because of the high concentration of hydrogen ions in alcohol. Excessive intake of insulin will not result in diabetic ketoacidosis. Test-Taking Tip: Read carefully and answer the question asked; pay attention to specific details in the question.

A morbidly obese patient has chosen gastric bypass surgery to promote weight loss. The nurse plans to teach the patient about the need to perform monitoring to detect what disturbance consistent with rapid weight loss associated with this procedure? 1 Ketosis 2 Hypoxemia 3 Urinary retention 4 Insufficient ventilation

1. Ketosis Starvation, fasting, or following a strict calorie-reduced diet with rapid weight loss contributes to ketone formation and metabolic acidosis. Weight loss should decrease the work of breathing and improve hypoxemia, if present, as well as hypoventilation. Urinary retention does not occur in acid-base imbalance.

The nurse obtains lab results for a 50-year-old patient with the following results: pH 7.24; bicarbonate 20; Pao2 82; Paco2 35. These findings are consistent with which acid-base imbalance? 1 Metabolic acidosis 2 Metabolic alkalosis 3 Respiratory acidosis 4 Respiratory alkalosis

1. Metabolic acidosis In metabolic acidosis , there is a decrease in pH (normal is 7.35-7.45), a decrease in bicarbonate (normal is 21-28), a normal Pao2 (normal is 80-100), and a normal or decreased Paco2 (normal is 35-45). STUDY TIP: Record the information you find to be most difficult to remember on 3" × 5" cards and carry them with you in your pocket or purse. When you are waiting in traffic or for an appointment, just pull out the cards and review again. This "found" time may add points to your test scores that you have lost in the past.

A diabetic patient shows symptoms of diabetic ketoacidosis. What mechanism causes acidosis in this patient? 1 Overproduction of hydrogen ions 2 Underelimination of hydrogen ions Incorrect3 Underproduction of bicarbonate ions 4 Overelimination of bicarbonate ions

1. Overproduction of hydrogen ions In diabetic ketoacidosis, there is an excessive breakdown of fatty acids. This produces strong acids (ketoacids) with the release of large amounts of hydrogen ions. Underelimination of hydrogen ions occurs when hydrogen ions are produced at normal rates, but their elimination is reduced. This is seen in patients with lung and kidney problems. Bicarbonate ion is made in the kidney or in the pancreas. In patients with impaired kidney or pancreatic function, there is underproduction of bicarbonate ions leading to acidosis. Overelimination of bicarbonate ions occurs when there is an excessive loss of bicarbonate ions. This occurs in diarrhea.

When caring for a patient with kidney failure who has metabolic acidosis, which symptom does the nurse expect as evidence of the body's compensatory effort? 1 Rapid and deep respirations 2 Pallor and diaphoresis 3 Bradycardia and bounding pulse 4 Hypotension and weak, thready pulse

1. Rapid and deep respirations Kussmaul respirations (rapid, deep respirations) represent the body's attempt to compensate for metabolic acidosis. The skin is warm, dry, and flushed in metabolic acidosis. Cardiovascular symptoms may occur, but they are manifestations of acidosis, not evidence of compensation.

Which arterial blood gas laboratory values would be seen in metabolic alkalosis? 1 pH 7.49, HCO3-32 2 pH 7.28, CO254 3 pH 7.53, CO228 4 pH 7.31, HCO3-18

1. pH 7.49, HCO3-32 In metabolic alkalosis, pH is greater than 7.45 and HCO3-is greater than 28. pH 7.28 and CO254 = respiratory acidosis (pH < 7.35, CO2>45). pH 7.53 and CO228 = respiratory alkalosis (pH > 7.45, CO2< 35). pH 7.31 and HCO3-18 = metabolic acidosis (pH < 7.35, HCO3-< 21).

A patient admitted to the emergency department is having an acute episode of asthmatic bronchitis. The nurse notes the pH on the most recent arterial blood gas is 7.31. What is the most likely explanation for this finding? 1 Acidosis in response to the presence of excessive ketoacids 2 Acidosis in response to the excessive retention of carbon dioxide 3 Alkalosis in response to the excessive loss of hydrogen ions 4 Alkalosis in response to the excessive retention of bicarbonate

2. Acidosis in response to the excessive retention of carbon dioxide Patients who have asthmatic bronchitis and resulting impaired respiratory function retain carbon dioxide, which leads to acidosis. This patient is not retaining bicarbonate. An increase of hydrogen ions would occur with acidosis

When caring for a patient with a pulse oximetry level of 89%, which action does the nurse take first? 1 Get the patient out of bed. 2 Apply oxygen as prescribed. 3 Notify the patient's health care provider. 4 Auscultate breath sounds.

2. Apply oxygen as prescribed. Applying oxygen is the first priority for a patient with hypoxemia. It is unclear whether the patient is stable to be out of bed; elevating the HOB (head of bed) would be more appropriate to improve respiratory expansion. Notifying the health care provider is an appropriate action after initiation of oxygen therapy; delaying intervention while waiting for the provider delays treatment. Breath sounds can be auscultated after initiation of oxygen therapy; hypoxemia may be present in the absence of adventitious breath sounds. Test-Taking Tip: Do not select answers that contain exceptions to the general rule, controversial material, or degrading responses.

What is one of the causes of acidosis? 1 Excessive body fluids 2 Kidney failure 3 Heart failure 4 Colitis

2. Kidney Failure Causes of acidosis include kidney failure, pancreatitis, liver failure, and dehydration. Excessive body fluids, heart failure, and colitis are causes of alkalosis.

A patient has been having acute diarrhea for more than 24 hours from a viral infection. Which acid-base imbalance is most likely to manifest? 1 Respiratory acidosis 2 Metabolic acidosis 3 Respiratory alkalosis 4 Metabolic alkalosis

2. Metabolic acidosis Diarrhea results in excessive elimination of bicarbonate, creating an imbalance between hydrogen ions and bicarbonate leading to metabolic acidosis. Diarrhea would not cause a respiratory acid-base imbalance. Metabolic alkalosis is incorrect because the patient is losing base rather than experiencing higher concentrations of base seen with alkaline conditions. Test-Taking Tip: Become familiar with reading questions on a computer screen. Familiarity reduces anxiety and decreases errors.

When evaluating the laboratory results of a patient with diabetic ketoacidosis, which lab value indicates the body has fully compensated from this acid-base imbalance? 1 Normal serum glucose 2 Normal pH on arterial blood gases 3 Normal serum potassium 4 Normal bicarbonate on arterial blood gases

2. Normal pH on arterial blood gases Arterial blood gas pH returns to normal when the body's compensatory efforts are fully effective. Glucose, potassium, and bicarbonate are affected by diabetic acidosis, but their return to normal is not an indicator of acid-base balance.

A lab report for a 47-year-old patient shows the following results: pH 7.32; bicarbonate 24; Pao2 77; Paco2 48. These findings are consistent with which acid-base imbalance? 1 Metabolic acidosis 2 Metabolic alkalosis 3 Respiratory acidosis 4 Respiratory alkalosis

3. Respiratory acidosis In respiratory acidosis, there is a decrease in pH (normal is 7.35-7.45), a normal bicarbonate (normal is 21-28), a decreased Pao2 (normal is 80-100), and an increased Paco2 (normal is 35-45). STUDY TIP: Answer every question. A question without an answer is the same as a wrong answer. Go ahead and guess. You have studied for the test and you know the material well. You are not making a random guess based on no information. You are guessing based on what you have learned and your best assessment of the question.

The nurse is caring for a patient with hypoxemia and metabolic acidosis. Which task can be delegated to the nursing assistant who is helping with the patient's care? 1 Assess the patient's respiratory pattern. 2 Increase the IV normal saline to 120 mL/hr. 3 Titrate O2 to maintain an O2 saturation of 95% to 100%. 4 Apply the pulse oximeter for continuous readings

4. Apply the pulse oximeter for continuous readings Placing a peripheral pulse oximeter is a standardized nursing skill that is within the scope of practice for unlicensed personnel. Assessment and intravenous therapy are skills performed by the professional nurse. Titration of O2 requires assessment and intervention beyond the scope of practice of an unlicensed individual. Test-Taking Tip: Be aware that information from previously asked questions may help you respond to other examination questions.

When caring for a patient with metabolic acidosis, what must the nurse keep in mind regarding acid-base chemistry? 1 Acids bind free hydrogen ions in solution. 2 Acetic acid (CH3COOH) is a strong acid. 3 Normally, blood is slightly acidic in nature. 4 Fluids with lower pH have higher acidity

4. Fluids with lower pH have higher acidity Fluids with lower pH have a higher level of free hydrogen ions and, therefore, have higher acidity. Acids release hydrogen ions rather than bind with them when dissolved in water. Strong acids readily dissociate in water and release all of their hydrogen ions. Acetic acid (CH3COOH) is a weak acid. When dissolved in water, it releases only one of its four hydrogen molecules. Normally, blood has a pH of between 7.35 and 7.45, so it is slightly alkaline.

Which nursing intervention takes priority for a patient admitted with severe metabolic acidosis? 1 Perform medication reconciliation. 2 Assess the patient's strength in the extremities. 3 Obtain a diet history for the past 3 days. 4 Initiate cardiac monitoring.

4. Initiate cardiac monitoring. The nurse follows the ABCs and initiates cardiac monitoring to observe for signs of hyperkalemia or cardiac arrest. Medication reconciliation should be performed as soon as possible; however, this patient is at risk for cardiac and neurologic complications of acidosis. Starvation may precipitate ketosis/acidosis, but this is not the priority. Test-Taking Tip: Do not read information into questions, and avoid speculating. Reading into questions creates errors in judgment.

To decrease the risk of acid-base imbalance, what goal must the patient with diabetes mellitus strive for? 1 Checking blood glucose levels once daily. 2 Drinking 3 L of fluid per day. 3 Eating regularly, every 4-8 hours. 4 Maintaining blood glucose level within normal limits.

4. Maintaining blood glucose level within normal limits. Maintaining blood glucose levels within normal limits is the best way to decrease the risk of acid-base imbalance. Blood glucose levels must be checked not once but several times a day. Drinking 3 L of fluid per day is not necessary to maintain acid-base balance. Eating regularly is a way to achieve acid-base balance but is not the goal itself.

The nurse reviews the arterial blood gas for the patient. The nurse is most concerned with which value? PH: 7.36 PaCO2: 35 HCO3: 26 PaO2: 62

PaO2 With a Pao2of 62, the patient has hypoxemia, consistent with pulmonary embolism and cyanosis. A pH of 7.36 is normal. A Paco2 of 35 is low-normal, reflecting hyperventilation secondary to hypoxemia. An HCO3-of 26 is normal. Test-Taking Tip: Be aware that information from previously asked questions may help you respond to other examination questions.