Acid/Base - Assignment - Exam 3
A client is admitted to the unit with a diagnosis of intractable vomiting for 3 days. What acid-base imbalance related to the loss of stomach acid does the nurse observe on the arterial blood gas (ABG)? Metabolic acidosis Respiratory acidosis Metabolic alkalosis Respiratory alkalosis
Metabolic alkalosis Explanation: Metabolic alkalosis is associated with an excess of HCO3, a decrease in H+ ions, or both, in the extracellular fluid (ECF). This may be the result of excessive acid losses or increased base ingestion or retention. Loss of stomach acid may result in this condition. Metabolic acidosis is a proportionate deficit of bicarbonate in ECF. The deficit can occur as the result of an increase in acid components or an excessive loss of bicarbonate such as in diarrhea. Respiratory acidosis is when the carbon dioxide level is high and the ph is low. Respiratory alkalosis is when the carbon dioxide level is low and the ph is high.
Vomiting results in which of the following acid-base imbalances? Metabolic alkalosis Metabolic acidosis Respiratory acidosis Respiratory alkalosis
Metabolic alkalosis Explanation: Vomiting results in loss of hydrochloric acid (HCl) and potassium from the stomach, leading to a reduction of chlorides and potassium in the blood and to metabolic alkalosis.
A 62-year-old male collapsed while unloading a truck of heavy sacks of feed for his cattle. When he arrived in the emergency department, blood gases revealed a slightly acidic blood sample. The nurse caring for this client is not surprised with this result based on which pathophysiologic rationale? The skeletal muscles are producing large amounts of lactic acid and release it into the bloodstream during heavy work/exercise. During exercise, catabolism will break down stored nutrients and body tissues to produce energy. Large amounts of free energy is released when ATP is hydrolyzed and then converted into adenosine diphosphate. Within the mitochondria, energy from reduction of oxygen is used for phosphorylation of ADP to ATP.
The skeletal muscles are producing large amounts of lactic acid and release it into the bloodstream during heavy work/exercise. Explanation: Heart muscle is efficient in converting lactic acid to pyruvic acid and then using the pyruvic acid for fuel. Pyruvic acid is an important source of fuel for the heart during heavy exercise, when the skeletal muscles are producing large amounts of lactic acid and releasing it into the bloodstream. Therefore, the blood sample would be acidic by nature. Catabolism will break down stored nutrients and body tissues to produce energy. ATP conversion into ADP and phosphorylation of ADP to ATP are both aerobic metabolism processes.
The nurse is admitting a client with newly diagnosed diabetes mellitus and left-sided heart failure. Assessment reveals low blood pressure, increased respiratory rate and depth, drowsiness, and confusion. The client reports headache and nausea. Based on the serum laboratory results, how would the nurse interpret the client's acid-base balance? metabolic alkalosis metabolic acidosis respiratory acidosis respiratory alkalosis
metabolic acidosis Explanation: This client has metabolic acidosis, which typically manifests with a low pH, low bicarbonate level, normal to low PaCO2, and normal PaO2. The client's serum electrolyte levels also support metabolic acidosis, which include an elevated potassium level, normal to elevated chloride level, and normal calcium level. The client's anion gap of 30 mEq/L is high, also indicative of metabolic acidosis. This kind of metabolic acidosis occurs with diabetic ketoacidosis and other disorders.
A client in the emergency department reports that they have been vomiting excessively for the past 2 days. The client's arterial blood gas analysis shows a pH of 7.50, partial pressure of arterial carbon dioxide (PaCO2) of 43 mm Hg, partial pressure of arterial oxygen (PaO2) of 75 mm Hg, and bicarbonate (HCO3-) of 42 mEq/L. Based on these findings, the nurse documents that the client is experiencing which type of acid-base imbalance? respiratory alkalosis metabolic alkalosis respiratory acidosis metabolic acidosis
metabolic alkalosis Explanation: A pH over 7.45 with a HCO3- level over 26 mEq/L indicates metabolic alkalosis. Metabolic alkalosis is always secondary to an underlying cause and is marked by decreased amounts of acid or increased amounts of base HCO3-. The client isn't experiencing respiratory alkalosis because the PaCO2 is normal. The client isn't experiencing respiratory or metabolic acidosis because the pH is greater than 7.35. Remediation: Vomiting ABG analysis
A client who complains of an "acid stomach" has been taking baking soda (sodium bicarbonate) regularly as a self-treatment. This may place the client at risk for which acid-base imbalance? metabolic alkalosis metabolic acidosis respiratory acidosis respiratory alkalosis
metabolic alkalosis Explanation: Metabolic alkalosis results in increased plasma pH because of accumulated base bicarbonate or decreased hydrogen ion concentrations. The client's regular use of baking soda (sodium bicarbonate) may create a risk for this condition. Metabolic acidosis refers to decreased plasma pH because of increased organic acids (acids other than carbonic acid) or decreased bicarbonate. Respiratory acidosis, which may be either acute or chronic, is caused by excess carbonic acid. Respiratory alkalosis results from a carbonic acid deficit that occurs when rapid breathing releases more CO2 than necessary with expired air.
The nurse cares for a client with end-stage kidney disease (ESKD). Which acid-base imbalance is associated with this disorder? pH 7.20, PaCO2 36, HCO3 14- pH 7.31, PaCO2 48, HCO3 24- pH 7.47, PaCO2 45, HCO3 33- pH 7.50, PaCO2 29, HCO3 22-
pH 7.20, PaCO2 36, HCO3 14- Explanation: Metabolic acidosis occurs in end-stage kidney disease (ESKD) because the kidneys are unable to excrete increased loads of acid. Decreased acid secretion results from the inability of the kidney tubules to excrete ammonia (NH3-) and to reabsorb sodium bicarbonate (HCO3-). There is also decreased excretion of phosphates and other organic acids.
A client with emphysema is at a greater risk for developing which acid-base imbalance? chronic respiratory acidosis metabolic alkalosis metabolic acidosis respiratory alkalosis
chronic respiratory acidosis Explanation: Respiratory acidosis, which may be either acute or chronic, is caused by excess carbonic acid, which causes the blood pH to drop below 7.35. Chronic respiratory acidosis is associated with disorders such as emphysema, bronchiectasis, bronchial asthma, and cystic fibrosis.
The nurse is reviewing the following lab results of a client diagnosed with renal failure: pH: 7.24 PCO2: 38 mm Hg (5.05 kPa) HCO3:18 mEq/L (18 mmol/L) The nurse would interpret this as: Metabolic acidosis Respiratory acidosis Metabolic alkalosis Respiratory alkalosis
Metabolic acidosis Explanation: Metabolic acidosis would be diagnosed based on the findings related to a low pH level (<7.3) and a low bicarbonate level. Respiratory acidosis represents a decreased pH and an increased PCO2, metabolic alkalosis represents an increased pH and a increased HCO3, and respiratory alkalosis represents an increased pH and a decreased PCO2.
A client tells the nurse that the client has been taking Alka-Seltzer (bicarbonate—antacid) four times a day for the past 2 weeks for an upset stomach. Upon assessment of the client, the nurse notes hyperactive reflexes, tetany, and mental confusion. Arterial blood gases reveal pH 7.55; serum HCO3− 37 mEq/L (37 mmol/L). The nurse suspects the client may be experiencing: Metabolic alkalosis Respiratory acidosis Metabolic acidosis Respiratory alkalosis
Metabolic alkalosis Explanation: Metabolic alkalosis is characterized by a serum pH greater than 7.45; serum HCO3− greater than 29 mEq/L (29 mmol/L); and a base excess greater than 3.0. Transient or acute alkalosis is common during or immediately following excess oral ingestion of bicarbonate antacids. Respiratory acidosis as well as metabolic acidosis would have a decrease in pH. Respiratory alkalosis would have an increase in pH and a HCO3− less than 24 mEq/L (24 mmol/L).
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. Regulation of the production of carbonic acid Reabsorption of hydrogen and excretion of carbonic acid Stimulation of the chemoreceptors in the brain stem
Reabsorption of HCO3 and excretion of H+ restores acid-base balance through the renal control mechanisms. Explanation: Reabsorption of HCO3 and excretion of H+ restores acid-base balance through the renal control mechanisms. Respiratory control mechanisms of restoring acid-base balance are done via regulation of production of carbonic acid and stimulation of the chemoreceptors in the brain.
A 70-year-old man who enjoys good health began taking low-dose aspirin several months ago based on recommendations that he read in a magazine article. During the man's most recent visit to his care provider, routine blood work was ordered and the results indicated an unprecedented rise in the man's serum creatinine and blood urea nitrogen (BUN) levels. How should a nurse best interpret these findings? The man may be experiencing a paradoxical effect of aspirin The man may be allergic to aspirin The man may be experiencing liver toxicity from the aspirin The man may be experiencing nephrotoxic effects of aspirin
The man may be experiencing nephrotoxic effects of aspirin Explanation: Damage to the kidneys is called nephrotoxicity. Decreased urinary output, elevated blood urea nitrogen, increased serum creatinine, altered acid-base balance, and electrolyte imbalances can all occur with kidney damage.
The nurse is aware that the major role of the kidneys in regulating acid-base balance is to increase the production of: HCO3− H2CO3 HCl H+
HCO3− Explanation: The kidneys play a critical role in maintaining acid-base balance. They accomplish this through the reabsorption of HCO3−, regulation of H+ secretion, and generation of new HCO3−. The hydrogen/bicarbonate exchange system regulates pH through the secretion of excess H+ and reabsorption of HCO3− by the renal tubules. Bicarbonate is freely filtered in the glomerulus and reabsorbed or reclaimed in the tubules. Each HCO3− that is reclaimed requires the secretion of an H+. H2CO3 is a weak acid. HCl is found in gastric fluid. The kidneys would eliminate, not increase, production of H ion.
A client in the emergency department reports that he has been vomiting excessively for the past 2 days. His arterial blood gas analysis shows a pH of 7.50, partial pressure of arterial carbon dioxide (PaCO2) of 43 mm Hg, partial pressure of arterial oxygen (PaO2) of 75 mm Hg, and bicarbonate (HCO3-) of 42 mEq/L. Based on these findings, the nurse documents that the client is experiencing which type of acid-base imbalance? Respiratory alkalosis Metabolic alkalosis Respiratory acidosis Metabolic acidosis
Metabolic alkalosis Explanation: A pH over 7.45 with a HCO3- level over 26 mEq/L indicates metabolic alkalosis. Metabolic alkalosis is always secondary to an underlying cause and is marked by decreased amounts of acid or increased amounts of base HCO3-. The client isn't experiencing respiratory alkalosis because the PaCO2 is normal. The client isn't experiencing respiratory or metabolic acidosis because the pH is greater than 7.35.
The nurse assesses an adolescent client with lethargy, retractions of the intercostal spaces, a persistent expiratory wheeze, diminished breath sounds, tachycardia, and tachypnea. Arterial blood gas results are pH 7.10; PCO2 80 mm Hg (10.64 kPa); PO2 35 mm Hg (4.66 kPa), HCO3 29 mEq/l (29 mmol/l). What is the priority condition the nurse must address? respiratory acidosis change in mental status increased heart rate breathing pattern
respiratory acidosis Explanation: Based on the results of the arterial blood gases, this client is in respiratory acidosis. The nurse must address this quickly because it could lead to respiratory failure. If the nurse addresses the respiratory acidosis quickly, which means also addressing the cause of the imbalance, the client may not experience respiratory failure. Additionally, assessment data, vital signs, and laboratory work will begin to normalize.
