Ch.9 Altered Acid-Base Balance

The nurse is caring for the following group of clients. Select the client most likely to be diagnosed with respiratory alkalosis.

A 26-year-old female with anxiety who has been hyperventilating

Which individuals are at risk of developing metabolic alkalosis? Select all that apply.

A 70 year-old woman who has taken 2 tablespoons of baking soda to settle her "sour stomach" A hospital client who is on nasogastric suction following gastric surgery A 20 year-old male who has been regularly inducing himself to vomit following binge eating

A nurse is providing care for several clients on an acute medicine unit. Which client should the nurse recognize as being at the highest risk for metabolic alkalosis?

A client on continuous nasogastric suction and whose hypertension is being treated with diuretics

A client's most recent laboratory results suggest the presence of metabolic alkalosis. What action by the nurse best addresses a potential cause of this acid-base imbalance?

Administering an antiemetic to treat the client's frequent vomiting

A newly admitted client's diagnostic testing indicates metabolic acidosis. What action should the nurse take when working to determine the cause?

Assess the client's blood glucose levels

The nurse is examining the laboratory results of a client with lactic acidosis whose pH is 7.35. Which mechanism(s) has contributed to the pH being within normal range? Select all that apply.

Bicarbonate was retained by the kidneys. Hydrochloric acid was converted to carbonic acid. There was increased expiration of carbon dioxide. Hydrogen was moved into the intracellular space.

The nurse recognizes the role of the lungs in acid-base balance is regulation of which of the following?

CO2

A client is admitted to hospital with signs of acidosis. Compensation takes place in the kidney as well as in the lungs. Which action takes place specifically at the respiratory membrane?

CO2 is eliminated

When explaining how carbon dioxide combines with water to form carbonic acid as part of an acid-base lecture, the faculty instructor emphasizes that which enzyme is needed as a catalyst for this reaction?

Carbonic anhydrase

The body regulates the pH of its fluids by what mechanism? Select all that apply.

Chemical buffer systems of the body fluids The lungs The kidneys

A client has had jejunoileal bypass surgery for the treatment of morbid obesity. The client has lost over 100 pounds in 7 months and comes to the emergency department for treatment of "feeling like I am drunk" but has had no alcohol. A family member present says the client's memory seems impaired and the client has also been confused. For which condition/imbalance does the nurse anticipate the client will be assessed?

D-lactic acidosis

A client has been diagnosed with metabolic acidosis. What assessment finding does the nurse expect?

Decreased pH below 7.35

What assessment would a nurse expect when caring for a client with respiratory alkalosis? Select all that apply.

Dyspnea with short periods of apnea Palpitations Decreased urine acidity

A client is admitted after losing 44 lb (20 kg) over the past 3 months, largely due to frequent vomiting. What intervention should the nurse anticipate in the treatment of the client's resulting acid-base imbalance?

Fluid replacement with an intravenous solution containing electrolytes as prescribed

The nurse is aware that the major role of the kidneys in regulating acid-base balance is to increase the production of which chemical component?

HCO3-

When interpreting the arterial blood gas, the nurse recognizes which of these reflects the value for bicarbonate?

HCO3-

The nurse caring for a client with metabolic alkalosis examines arterial blood gas (ABG) results. Which change from the initial value indicates the client's metabolic alkalosis is improving?

HCO3- has decreased

Respiratory alkalosis can be caused by a respiratory rate in excess of that which maintains normal plasma PCO2 levels. What is a common cause of respiratory alkalosis?

Hyperventilation

When trying to explain the role of potassium and hydrogen related to acid-base, which statement is most accurate?

Hypokalemia stimulates H+ secretion.

The nurse is caring for a client with acute primary respiratory acidosis. When determining the cause of the acidosis the nurse is aware that which imbalance is most common?

Impaired alveolar ventilation

The nurse is caring for a client with ketoacidosis who is complaining of increasing lethargy and occasional confusion following several weeks of rigid adherence to a carbohydrate-free diet. The nurse understands which phenomenon is most likely occurring?

In the absence of carbohydrate energy sources, her body is metabolizing fat and releasing ketoacids.

Which arterial blood gas (ABG) values tell the nurse a client is in respiratory alkalosis? Select all that apply.

PCO2 of 27mm Hg (3.59 kPa) pH 7.52

The nurse is reviewing lab results of a client diagnosed with metabolic acidosis. The most important electrolyte for the nurse to assess would be:

Potassium (K+)

The condition of a client with metabolic acidosis from an intestinal fistula is not improving. The pulse is 125 beats/min and the BP 84/56 mm Hg. ABG values are: pH 7.1, HCO3- 18 mEq/L (18 mmol/L), PCO2 57 mm Hg (7.58 kPa). What IV medication should the nurse expect to provide next?

Sodium bicarbonate

The nurse is caring for a group of clients at risk for ketoacidosis. Which of these problems in the clients' histories does the nurse recognize can trigger ketoacidosis? Select all that apply.

Starvation state Alcoholism Extreme carbohydrate restriction Uncontrolled diabetes mellitus

The nurse is assessing a client with abnormal blood gas values. Which of these interpretations does the nurse make regarding the client's physiologic status?

The client has abnormalities in his buffer system.

What is the nurse's expectation about a client's ability to compensate for a metabolic blood gas disorder?

The client will compensate with the respiratory system

A client with generalized anxiety disorder has been hyperventilating and has developed an acid-base imbalance resulting in increased pH and decreased PCO2. The nurse should recognize that which compensatory mechanism is likely occurring?

The client's kidneys are excreting fewer H+ ions.

A client presents with signs and symptoms consistent with chronic acidemia. The nurse should prioritize what assessments when addressing the root cause of the client's health problem?

The client's renal function

The nurse is caring for a client whose current health status includes an arterial blood pH of 7.29. Which assessment finding should the nurse interpret as causing an improvement in status?

The client's respiratory rate is 28 breaths/min.

A 77-year-old client diagnosed with chronic obstructive pulmonary disease (COPD) is experiencing impaired gas exchange and CO2 retention, despite a rapid respiratory rate. Which pathophysiologic principle would the health care team expect if the client's compensatory mechanisms are working?

The kidneys will adapt with an increase in plasma HCO3- and the pH will increase.

The nurse is caring for a client who has a blood pH of 7.52 and a chloride level of 92 mEq/l (92 mmol/l) (normal, 96 to 106 mEq/l; 96 to 106 mmol/l). Which best describes the mechanism that most likely resulted in these results?

There was increased reabsorption of bicarbonate from the renal tubules due to low chloride levels.

The nurse is caring for a client who has developed lactic acidosis syndrome (LAS). Which intervention is the nurse's priority?

administering intravenous fluids

Arterial blood gases of a client with a diagnosis of acute renal failure reveal a pH of 7.25, HCO3- level of 21 mEq/L (21 mmol/L), and decreased PCO2 level accompanied by a respiratory rate of 32. This client is most likely experiencing which disorder of acid-base balance?

metabolic acidosis

A client with chronic obstructive pulmonary disease (COPD) receives oxygen in the emergency department at a rate of 4 L/min for acute respiratory distress. Later, the nurse finds the client unresponsive with a respiratory rate of 8 breaths/minute. What arterial blood gas (ABG) values would the nurse expect to obtain?

pH 7.29, PCO2 67 mm Hg (8.91 kPa), HCO3- 26 mEq/L (26 mmol/L), PO2 64 mm Hg (8.51 kPa)

A client informs the nurse of a problem with acid indigestion. The client notes taking large amounts of calcium carbonate antacids daily but still has no relief. The client consumes about 1 bottle of 100 antacids in 4 days. Which blood gas result does the nurse anticipate?

pH 7.6

The nurse caring for a client with respiratory alkalosis examines arterial blood gas (ABG) results. Which change from the initial value indicates the client's respiratory alkalosis is improving?

pH has decreased

The nurse caring for a client with metabolic acidosis examines arterial blood gas (ABG) results. Which change from the initial value indicates the cause of the client's metabolic acidosis is improving?

pH has increased

The nurse is caring for a client with metabolic alkalosis. Which of these arterial blood gas results supports this diagnosis?

pH of 7.50 and HCO3 of 45 mEq/L (45 mmol/L)

Which intravenous solution is appropriate to treat metabolic alkalosis that resulted from gastric suctioning?

potassium chloride (KCl)

A client arrives in the emergency department by ambulance with a family member stating, "He took an overdose of sleeping pills and I found him breathing very shallowly." For which type of acid-base disturbance will the nurse anticipate this client will be treated?

respiratory acidosis

The nurse is caring for a client who complains of headache and blurred vision. The nurse recognizes that these symptoms, accompanied by increased plasma partial pressure carbon dioxide (PCO2) level and decreased pH level, are consistent with which diagnosis?

respiratory acidosis

The nurse enters a client's hospital room and finds the client breathing rapidly, stating, "I must be having a stroke, my fingers are tingling!" Which acid-base balance disorder is this client experiencing due to hyperventilation?

respiratory alkalosis

The nurse is evaluating a client's blood gases. The client has a pH of 7.35. How does the nurse interpret this value?

It is within a normal range.

A client has these arterial blood gas values: anion gap 20 mEq/L (20 mmol/L), pH 7.29, PCO2 37 mm Hg (4.92 mmol/L), HCO3- 11 mEq/L (11 mmol/L), base excess -6 mEq/L (-6 mmol/L). With what condition do these values correspond?

Lactic acidosis

The nurse is reviewing laboratory data for the client with an anion gap of 17. The nurse recognizes which condition is associated with an increased anion gap mEq/L (mmol/L)?

Lactic acidosis

A male client with a history of heavy alcohol use has been admitted to the hospital for malnutrition and suspected pancreatitis. The client's diagnostic workup suggests alcoholic ketoacidosis as a component of his current health problems. He is somewhat familiar with the effect that drinking has had on his nutrition and pancreas, but is wholly unfamiliar with the significance of acid-base balance. How best could his care provider explain the concept to him?

"The chemical processes that take place throughout your body are thrown off very easily when your body is too acidic or not acidic enough.

The nurse who is providing care for several clients recognizes which client is at the highest risk for developing an acid-base imbalance?

A client who is being treated for acute kidney injury and who requires dialysis

In which client would the nurse be most likely to assess the signs and symptoms of an acid-base imbalance?

A client with chronic obstructive pulmonary disease (COPD) whose most recent arterial blood gases reveal a PCO2 of 51 mm Hg

The nurse is caring for a client with an acid-base imbalance. Which of these does the nurse recognize is correct regarding compensation?

A pH moves toward the normal range.

The nurse is caring for a client who has developed hypoxemia and tissue hypoxia. Which of these interventions does the nurse set as a priority intervention?

Administration of supplemental oxygen

A client with multiple trauma has developed metabolic acidosis. The nurse should interpret what assessment finding as suggesting resolution of this acid-base imbalance?

Arterial blood gases show an increase in pH

An older adult has had a "sour stomach" and has treated it at home by taking frequent doses of baking soda (sodium bicarbonate). What nursing action is most appropriate?

Assess the client for signs and symptoms of hypokalemia

The body has built-in compensatory mechanisms that take over when correction of pH is not possible or cannot be immediately achieved. What are these compensatory mechanisms considered?

Interim measures that permit survival while body tries to correct the primary problem

A nurse is providing care for a client who has been diagnosed with metabolic alkalosis after several days of antacid use. Which treatment should the nurse prepare to give?

Intravenous administration of a KCl solution

A client has an increase in her anion gap (AG). What does the nurse determine is the significance of this finding?

It indicates the client has metabolic acidosis.

The nurse is caring for a client who has excessive diarrhea. Which acid-base disturbance does the nurse anticipate will result from having excessive diarrhea?

Metabolic acidosis

The nurse is caring for a client with renal failure experiencing shortness of breath and increased respiratory rate. The arterial blood gas reflects a pH of 7.10 and HCO3 level of 18 mEq/L (18 mmol/L). How does the nurse interpret these findings?

Metabolic acidosis

For which acid-base imbalance will the nurse monitor for a client taking large doses of loop diuretics?

Metabolic alkalosis

The nurse is administering calcium carbonate, as a phosphate binder, to a client in chronic renal failure. The nurse explains that this chronic ingestion can lead to which imbalance?

Metabolic alkalosis

The nurse teaches a client with renal insufficiency to limit protein intake. What is an appropriate explanation for this restriction?

Protein metabolism increases the need for renal excretion of acids.

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.

A client develops diabetic ketoacidosis. What assessment indicates compensatory action?

Respirations deep at 30/min

A client with a long history of alcohol abuse has been admitted to the emergency department after several of days of heavy drinking. The nurse can best promote the restoration of the client's acid-base balance by:

administering intravenous sodium bicarbonate as prescribed.

As other mechanisms prepare to respond to a pH imbalance, immediate buffering is a result of increased:

bicarbonate/carbonic acid regulation.

The nurse is caring for a client with worsening respiratory acidosis. Which of these interventions does the nurse anticipate if the client's condition continues to deteriorate?

mechanical ventilation

A child accidentally consumes a container of wood alcohol. The ED physician knows that the child is at risk of developing which of the following?

metabolic acidosis

By reabsorbing HCO3- from the glomerular filtrate and excreting H+ from the fixed acids that result from lipid and protein metabolism, the kidneys work to return or maintain the pH of the blood to normal or near-normal values. How long can this mechanism function when there is a change in the pH of body fluids?

days

The nurse is examining a client's laboratory results and notes a decreased blood pH level. Which finding will the nurse apply as the best evidence that the client is experiencing metabolic acidosis?

decreased HCO3−

The nurse is caring for the client with respiratory alkalosis and renal compensation. The nurse determines this diagnosis was based on which diagnostic findings?

decreased PCO2 and decreased HCO3, with increased pH

The nurse is caring for a client who is diagnosed with mild hyperlactatemia. Which assessment finding(s) is expected with this diagnosis? Select all that apply.

evidence of fatty liver on ultrasound results weight loss gastrointestinal upset

The nurse is caring for a client being treated for lactic acidosis. Which finding(s) will the nurse report as evidence of progression to severe acidosis requiring a change in treatment? Select all the apply.

evidence of seizure activity new-onset arrhythmia

The nurse notes a client's laboratory results indicate a base deficit of 4 mEq/l (4 mmol/l). The nurse interprets this finding as evidence supporting the need for which intervention?

infusion of sodium bicarbonate

The nurse is caring for a client who has no urine output due to acute renal dysfunction. Which finding(s) is expected for this condition? Select all that apply.

lower-than-normal plasma bicarbonate level decrease in the CO2 level on an arterial blood gas test increase in plasma potassium level

Which systems regulate the pH of body fluids? Select all that apply.

lungs bone kidneys

The client has arterial blood gases (ABG) drawn. The results are a pH of 7.50, PCO2 30 mEq/L (30 mmol/L), and HCO3- 24. The nurse understands that which condition/action could cause these ABG results?

mechanical ventilation