ACID/BASE

A client is experiencing persistent vomiting, and serum electrolytes have been prescribed. The nurse should monitor which laboratory results? 1 Sodium and chloride levels 2 Bicarbonate and sulfate levels 3 Magnesium and protein levels 4 Calcium and phosphate levels

1 Sodium, which helps regulate the extracellular fluid volume, is lost with vomiting. Chloride, which balances cations in the extracellular compartment, also is lost with vomiting. Because sodium and chloride are parallel electrolytes, hyponatremia will accompany hypochloremia. Bicarbonate and sulfate levels, magnesium and protein levels, and calcium and phosphate levels do not provide significant information in relation to the effects of vomiting.

A nurse is assessing a client experiencing a diabetic coma. What unique response associated with diabetic coma that is not exhibited with hyperglycemic hyperosmolar nonketotic syndrome (HHNS) should the nurse identify when assessing this client? 1 Fluid loss 2 Glycosuria 3 Kussmaul respirations 4 Increased blood glucose level

3 Kussmaul respirations occur in diabetic coma as the body attempts to correct a low pH caused by accumulation of ketones (ketoacidosis). HHNS affects people with type 2 diabetes who still have some insulin production; the insulin prevents the breakdown of fats into ketones. Fluid loss is common to both because an increased blood glucose level ultimately leads to polyuria. Glycosuria is common to both conditions. Hyperglycemia is common to both conditions.

An intravenous solution of lactated Ringers is prescribed to replace the T-tube output of a client who had a cholecystectomy and common bile duct exploration. The nurse recalls that the condition that will improve if the administration of lactated Ringers solution is effective is: 1 Urinary stasis 2 Paralytic ileus 3 Metabolic acidosis 4 Increased potassium level

3 Lactated Ringers is an alkaline solution that replaces bicarbonate ions lost from T-tube bile drainage, thus preventing or treating acidosis. Urinary stasis is unrelated to the effectiveness of the administration of intravenous lactated Ringers solution. Paralytic ileus is unrelated to the effectiveness of the administration of intravenous lactated Ringers solution. An increased potassium level is unrelated to the effectiveness of the administration of intravenous lactated Ringers solution.

A client with type 1 diabetes who has been adhering to a prescribed insulin regimen is admitted to the hospital in ketoacidosis. Which factor may have precipitated the ketoacidosis? 1 Increased exercise 2 Decreased food intake 3 Working the night shift 4 Upper respiratory infection

4 Infection is a stress that increases adrenocortical secretion of glucocorticoids, which will increase the blood glucose level. Exercise requires glucose for muscle contraction, which decreases the blood glucose level. Decreased food intake will decrease the blood glucose level. Working the night shift will have no impact on the blood glucose level.

Which insulin should the nurse prepare for the emergency treatment of ketoacidosis? 1 Glargine (Lantus) 2 NPH insulin (Novolin N) 3 Insulin aspart (NovoLog) 4 Insulin detemir (Levemir)

3 Insulin aspart is a rapid-acting insulin (within 10 to 20 minutes) and is used to meet a client's immediate insulin needs. Glargine is a long-acting insulin, which has an onset of 1.5 hours; for diabetic acidosis the individual needs rapid-acting insulin. NPH insulin is an intermediate-acting insulin, which has an onset of one to two hours; for diabetic acidosis the individual needs rapid-acting insulin. Insulin detemir is a long-acting insulin; for diabetic acidosis the individual needs rapid-acting insulin.

A client's blood gases reflect diabetic ketoacidosis. Which clinical indicator should the nurse expect to identify when monitoring this client's laboratory values? 1 Increased pH 2 Decreased PO2 3 Increased PCO2 4 Decreased HCO3

4 The bicarbonate-carbonic acid buffer system helps maintain the pH of body fluids; in metabolic acidosis there is a decrease in bicarbonate because of an increase of metabolic acids. The pH is decreased. The PO2 is not decreased in diabetic acidosis. The PCO2 may be decreased by the body's attempt to eliminate CO2 to compensate for a decreased pH.