Acid-Base Imbalances

d. An increased pH with an increased HCO3

A client with a 3-day history of nausea and vomiting presents to the emergency department. The client is hypoventilating and has a respiratory rate of 10 breath/min. The electrocardiogram (ECG) monitor displays tachycardia, with a heart rate of 120 beats/min. Arterial blood gases are drawn and the nurse reviews the results, expecting to note which of the following? a. A decreased pH and an increased CO2. b. An increased pH and a decreased CO2 c. A decreased pH and a decreased HCO3 d. An increased pH with an increased HCO3

b. Metabolic alkalosis

A nurse is caring for a client with a nasogastric tube that is attached to low suction. The nurse monitors the client, knowing that the client is at risk for which acid-base disorder? a. Metabolic acidosis b. Metabolic alkalosis c. Respiratory acidosis d. Respiratory alkalosis

a. Metabolic acidosis

A nurse is caring for a client with an ileostomy understands that the client is most at risk for developing which acid-base disorder? a. Metabolic acidosis b. Metabolic alkalosis c. Respiratory acidosis d. Respiratory alkalosis

d. Respirations that are abnormally deep, regular, and increased rate

A nurse is caring for a client with diabetic ketoacidosis and documents that the client is experiencing Kussmaul's respirations. Based on this documentation, which of the following did the nurse observe? a. Respirations that cease for several seconds b. Respirations that are regular but abnormally slow c. Respirations that are labored and increased in depth and rate d. Respirations that are abnormally deep, regular, and increased rate.

b. Respiratory alkalosis, compensated

A nurse reviews the arterial blood gas results of a client and notes the following: pH 7.45, PCO2 of 30 mm Hg, and HCO3 of 22 mEq/L. The nurse analyzes these results as indicating which condition? a. Metabolic acidosis, compensated b. Respiratory alkalosis, compensated c. Metabolic alkalosis, uncompensated d. Respiratory acidosis, uncompensated

c. Keep the siderials in the up position

In order to ensure the safety of the patient with metabolic aldalosis, which task is best to delegate to the unlicensed assistive personnel (UAP)? a. Watch the patient when he or she eats or drinks anything b. Sit with the patient to prevent wandering c. Keep the siderails in the up position d. Remove all sharp objects from the bedside table

a. Sepsis, b. Hypovolemic shock, e. Respiratory depression

Incomplete breakdown of glucose occurs whenever cells metabolize under anaerobic conditions to form lactic acid. Based on this knowledge of pathophysiology, which patient conditions could cause the patient to develop acidosis? (Select all that apply) a. Sepsis b. Hypovolemic shock c. Use of a mechanical ventilator d. Prolonged nasogastric suctioning e. Respiratory depression

a. There is bilateral weakness

The nurse assesses the acidotic patient's lower extremities for strength as part of the shift assessment. What finding does the nurse expect to see? a. There is bilateral weakness b. There is weakness on the dominant side c. There is no change from baseline d. there is cramping, but no weakness

b. Activity-Exercise, d. Elimination, f. Cognitive-Perceptual

The nurse is assessing the patient with an acid-base imbalance by using Gordon's Functional Health Patterns. What primary areas are affected? (Select all that apply) a. Values/Beliefs b. Activity-Exercise c. Health Perception - Health Management d. Elimination e. Sleep-Rest f. Cognitive-Perceptual g. Coping-Stress Tolerance

b. IV catheter and IV start kit

The nurse is caring for the patient with metabolic alkalosis secondary to diuretic medication. Which equipment does the nurse obtain to administer the correct therapy to this patient? a. Oxygen tubing and cannula or mask b. IV catheter and IV start kit c. Foley catheter and drainage bag d. Antiemetic drug and emesis basin

b. The patient flexes the arms against the chest; the nurse tries to pull the arms from the chest.

The nurse is testing the muscle strength of the patient at risk for acid-base imbalance. Which technique does the nurse use to test arm strength? a. Ask the patient to hold the arms straight out in front and the nurse observes for drift. b. The patient flexes the arms against the chest; the nurse tries to pull the arms from the chest. c. Asks the patient to pick up an object that weighs at least 10 lbs. d. The patient clasps the hands together and pushes as hard as possible.

c. Serum potassium

The nurse observes tall peaked T waves on an ECG of the patient with metabolic acidosis. Before notifying the health care provider, the nurse also assesses the results of which laboratory test? a. Serum calcium b. Serum glucose c. Serum potassium d. Serum magnesium

c. Increased heart rate and increased cardiac output

The nurse reviews the ECG and cardiovascular status of the patient. Which findings are early changes associated with mild acidosis? a. Decreased heart rate with hypertension b. Hypotension and faint peripheral pulses c. Increased heart rate and increased cardiac output d. Peaked T waves and wide QRS complexes

b. Elevated serum potassium

The patient has a low pH level. Which other concurrent change does the nurse expect to see in this patient? a. Elevated serum sodium level b. Elevated serum potassium c. Decreased serum chloride level d. Decreased serum calcium level

b. Decreases

The patient has a new onset of shallow and slow respirations. While the patient's body attempts to compensate, what happens to the patient's pH level? a. Increases b. Decreases c. Stabilizes d. Fluctuates

d. pH = 7.30

The patient is at risk for acid-base imbalance. Which laboratory value indicates that the patient is acidotic? a. PaCO2 = 55 mm Hg b. CO3 = 25 mEq/L c. Lactate = 2.5 mmol/L d. pH = 7.30

a. Monitor ABG levels for decreasing pH level, as appropriate b. Maintain patent IV access c. Administer fluids as prescribed e. Monitor detterminants of tissue oxygen delivery, such as hemoglobin f. Monitor loss of bicarbonate through the GI tract such as diarrhea

What interventions are included in the plan of care for the patient with metabolic ketoacidosis? (Select all that apply) a. Monitor ABG levels for decreasing pH level, as appropriate. b. Maintain patent IV access c. Administer fluids as prescribed d. Monitor for irritability and muscle tetany e. Monitor determinants of tissue oxygen delivery, such as hemoglobin f. Monitor loss of bicarbonate through the GI tract such as diarrhea

c. Administer insulin

What is the priority intervention for the patient with diabetic ketoacidosis? a. Administer bicarbonate b. Give furosemide c. Administer insulin d. Administer potassium

b. Low-flow oxygen (2L/min) via nasal cannula

What is the safest way to administer oxygen to the patient with chronic respiratory acidosis? a. High-volume intermittent positive pressure b. Low-flow oxygen (2L/min) via nasal cannula c. High flow 40% oxygen via face mask d. Positive end-expiratory pressure (PEEP)

c. Expectorating clear, thin mucus

Which assessment finding indicates that the patient with chronic respiratory acidosis is responding favorably to treatment? a. Nail beds pale, extremities cool b. Respiratory stridor with inspiration c. Expectorating clear, thin mucus d. Diffuse crackles auscultated bilaterally

b. 7.37

Which blood pH value is within normal limits? a. 7.27 b. 7.37 c. 7.47 d. 7.5

a. Aspirin overdose

Which medication usage could cause metabolic acidosis? a. Aspirin overdose b. Overuse of antacids c. Prolonged use of antihistamines d. Vitamin overdose

c. Use of accessory respiratory muscles

Which nursing assessment finding indicates a worsening of respiratory acidosis? a. Decreased respiratory rate b. Decreased blood pressure c. Use of accessory respiratory muscles d. Pale nail beds

c. Patient who is having a seizure

Which patient has the highest risk for acidosis because of excess production of hydrogen ions? a. Patient with a kidney stone b. Patient with chronic obstructive pulmonary disease c. Patient who is having a seizure d. Patient with continuous diarrhea

d. Patient who had a massive blood transfusion

Which patient is most likely to develop metabolic alkalosis as a result of base excess? a. Patient taking thiazide diuretics b. Patient who is having nasogastric suction c. Patient with severe vomiting d. Patient who had a massive blood transfusion

a. Patient with pancreatitis

Which patient is most likely to have a decrease in bicarbonate? a. Patient with pancreatitis b. Patient with hypoventilation c. Patient who is vomiting d. Patient with emphysema

b. Patient with multiple rib fractures

Which patient is most likely to have respiratory acidosis? a. Patient who is anxious and breathing rapidly b. Patient with multiple rib fractures c. Patient with IV normal saline bolus d. Patient with increased urinary output

c. Patient with a panic attack

Which patient is most likely to have respiratory alkalosis? a. Hypoxic patient b. Patient with a body cast c. Patient with a panic attack d. Morbidly obese patient

c. Patient on prolonged bedrest

Which patient requires assessment related to inadequate chest expansion, which places the patient at risk for respiratory acidosis? a. Patient with lordosis b. Patient with emphysema c. Patient on prolonged bedrest d. Patient in the first trimester of pregnancy

b. "I have tingling in my fingers and toes."

Which statement made by the patient indicates that he or she may have an alkaline condition? a. "I am more and more tired and can't concentrate." b. "I have tingling in my fingers and toes." c. "My feet and ankles are swollen." d. "I am short of breath all of the time."

d. Hypocalcemia

Which type of electrolyte imbalance does the nurse expect to see in the patient with metabolic alkalosis? a. Hyperkalemia b. Hypophosphatemia c. Hyperchloremia d. Hypocalcemia

c. Diuretics

Which type of medication increases the older adult patient's risk for acid-base imbalances? a. Antilipemics b. Hormonal therapy c. Diuretics d. Antidysrhythmics

d. Tetany

the nurse is assessing the patient with metabolic alkalosis. Which neuromuscular finding is the most ominous and warrants immediate notification of the health care provider? a. Muslce cramps b. Muscle twitching c. Hyperactive deep tendon reflexes d. Tetany

c. Nasogastric sucktion

the patient's ABG results show an increase in pH. Which condition is most likely to contribute to this laboratory value? a. Mechanical ventilation b. Ketoacidosis c. Nasogastric suction d. Diarrhea