Chapter 8 Disorders of Fluid and Electrolyte and Acid Base Imbalance

The nurse teaches the client with end-stage kidney disease and hyperphosphatemia to take sevelamer HCl, a phosphate binder, with meals. How does the nurse explain the rationale for the timing of this medication?

"The medication should be taken at meal time to allow the binding of phosphate."

To calculate the H2CO3 content of the blood, the nurse needs to measure the PCO2 (partial pressure of CO2) by its solubility coefficient. What is the solubility coefficient of CO2?

0.03

A client is admitted to the emergency department with possible internal bleeding after being involved in an automobile accident. What type of isotonic intravenous (IV) solution does the nurse prepare to infuse?

0.9% NaCl

A nurse observes that a client has gained 4.4 lb over the past two days. Based on this assessment, the nurse estimates that the client has experienced a fluid volume excess of how many mL of fluid? Record your answer using a whole number.

2000

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

Which individuals would be considered to be at risk for the development of edema? Select all that apply.

A client with right-sided heart failure and hypothyroidism, A client who has suffered extensive burns in a job-related accident

A client with a diagnosis of liver cirrhosis secondary to alcohol abuse has a distended abdomen as a result of fluid accumulation in his peritoneal cavity (ascites). Which pathophysiologic process contributes to this third spacing?

Abnormal increase in transcellular fluid volume

Which can result in a decrease in antidiuretic hormone (ADH) levels?

Alcohol

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

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 most reliable method for measuring body water or fluid volume increase is by assessing:

Body weight change

Serum phosphorus level has a reciprocal relationship with which serum electrolyte?

Calcium

When caring for a client with hypomagnesemia, the nurse prioritizes assessment of which body system?

Cardiac

Which assessment should be prioritized in the care of a client who is being treated for a serum potassium level of 2.7 mEq/L (2.7 mmol/L)?

Cardiac monitoring looking for prolonged PR interval and flattening of the T wave

In a person with fluid volume deficit, there is a dehydration of brain and nerve cells. What can occur if fluid volume deficit is corrected too rapidly?

Cerebral edema occurs with potentially severe neurologic impairment.

Which buffer system acts immediately?

Chemical buffer systems

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

Which of the following is an anion?

Chloride

A client develops interstitial edema as a result of decreased:

Colloidal osmotic pressure

A nurse is caring for a client with severe liver failure. Knowing that the client's condition has resulted in impaired synthesis of albumin, the nurse understands that the client's generalized edema is related to which of the following?

Decreased colloidal osmotic pressure

What assessment would a nurse expect when caring for a client with acute, uncompensated respiratory acidosis? Select all that apply.

Decreased level of consciousness, Decreased cardiac output, Warm, flushed skin

A middle-aged male with a history of cardiovascular disease has been admitted for cardiogenic shock. In the hours since admission, the client's arterial blood gases indicate acidosis. Which clinical manifestations and diagnostic findings should his care team anticipate before acid-base balance is restored? Select all that apply.

Decreased pH, Cardiac dysrhythmias, Decreased alertness and cognition, Nausea and vomiting

The nurse is caring for a client who receives hemodialysis. The nurse knows that hemodialysis involves movement of charged or uncharged particles along a concentration gradient. Which function best describes this process?

Diffusion

A client is being treated for chronic hypernatremia with 0.45% saline intravenously. Which action is the nurse's priority?

Ensure the client's sodium levels are being checked frequently to guide treatment.

The nurse is caring for a client with a tumor obstructing the lymphatic system. For which consequence does the nurse assess?

Fluid accumulating in the interstitial spaces distal to the tumor

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-

The nurse is aware that the major role of the kidneys in regulating acid-base balance is to increase the production of:

HCO3−

A nurse observes peaked, narrow T waves on the electrocardiogram of a client suffering from renal failure. The nurse suspects that the client is experiencing which condition?

Hyperkalemia

The nurse is caring for a client who is 1 day postoperative for a thyroidectomy. The client complains of tingling of the hands and feet and around his mouth. The nurse suspects these symptoms are a manifestation of which electrolyte disturbance?

Hypocalcemia

A nurse is caring for a client admitted with diabetic ketoacidosis who is being treated with intravenous (IV) insulin administration. The client develops symptoms of anorexia, nausea, vomiting, constipation, and abdominal distention. Bowel sounds are hypoactive. Based on these symptoms, which electrolyte alteration should the nurse monitor for?

Hypokalemia

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.

A client with ethylene glycol toxicity is restless, and stating he has flank pain. What intervention should the nurse perform to minimize complications?

Increase IV fluids

The nurse is caring for a client who has consistently been vomiting throughout several days. What will the nurse expect to find when evaluating the client's blood gas values?

Increased pH value

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

Which volume represents the greatest percentage of water in the extracellular compartment?

Interstitial

The nurse is performing an assessment for a client who is experiencing shortness of breath. The nurse notes a full and bounding pulse, crackles in the lung fields, and jugular vein distention. The nurse recognizes symptoms of which problem?

Isotonic fluid volume excess

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 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

The nurse is administering the medications to a client on the cardiac unit. Giving which medication causes the nurse to be alert for hypokalemia?

Loop diuretic

The nurse is caring for a client whose lab values reflect hypercalcemia. The nurse understands that which of these may cause hypercalcemia? Select all that apply.

Malignant neoplasm, Prolonged immobilization, Lithium therapy

When caring for a client with diabetes insipidus (DI), the nurse plans to evaluate which laboratory study?

Measurement of antidiuretic hormone (ADH) and plasma/urine osmolality

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

A client admitted to the hospital with severe diarrhea has a K+ level of 6.7 mEq/L (6.7 mmol/L), symptoms of paresthesia, restlessness, and dyspnea. What could have caused his condition?

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 is assessing a client for early manifestations of hyponatremia. The nurse would assess the client for:

Muscle weakness

The physician has ordered an anion gap as a laboratory test for a client experiencing metabolic acidosis. What will this test measure?

Phosphates, sulfates, and proteins

Which one of the following is associated with hydrostatic edema?

Pits to finger pressure

The nurse notifies the health care prescriber of a client's serum potassium level of 6.2 mEq/L (6.2 mmol/L). Which prescription will the nurse consider as having the first priority?

Placing the client on a cardiac monitor

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 nurse suspects that a client who had a colon resection 4 days ago, is unable to pass flatus, and has no audible bowel sounds has a paralytic ileus. The nurse recognizes that which abnormal laboratory result is consistent with this problem?

Potassium level of 2.8 mEq/L (2.8 mmol/L)

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.

A client with schizophrenia is admitted to the behavioral health department and is observed drinking copious amounts of water and voiding large amounts of dilute urine. The nurse recognizes this behavior is consistent with which problem?

Psychogenic polydipsia

The physician examines a client who has been in a motor vehicle accident and sustained head and chest injuries. Which would be considered compensatory responses to this acid-base imbalance?

Renal compensation with increased H+ excretion and increased HCO3- reabsorption

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

Which conditions increase the risk for respiratory alkalosis? Select all that apply.

Salicylate toxicity, Anxiety

A client with renal failure and severe hyperkalemia (K+ level 7.2 mEq/L [7.2 mmol/L]) has just been admitted to the nursing unit. The nurse anticipates administering which treatment to quickly lower potassium levels?

Short-acting insulin with glucose given intravenously as a bolus

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 client with a serum sodium level of 128 mEq/L (128 mmol/L). Which physiologic event is an expected result of this blood value?

Swelling of cells

A nurse is caring for a client with a low sodium level and increased water retention. Hematocrit and blood urea nitrogen levels are decreased, urine osmolality is high, and serum osmolality is low. A chest x-ray shows a possible lung mass. Based on these findings, which problem could the client be diagnosed with?

Syndrome of inappropriate antidiuretic hormone (SIADH)

An adult client presents to the emergency department with a pounding headache, heart failure, and pulmonary and peripheral edema. The pulse is bounding, blood pressure is elevated, and the urine is scant and concentrated. Which endocrine disorder is the likely cause of these manifestations?

Syndrome of inappropriate antidiuretic hormone secretion (SIADH)

A client hospitalized for dehydration has orders for daily weight. On admission, the client's weight was 68 kg. This morning the client's weight is 66.6 kg, which represents a weight loss of 1.4 kg or 2% of client body weight. Based on this calculation, the nurse determines which of the following?

The client has a mild extracellular fluid (ECF) deficit.

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.

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 family of a client with liver failure, ascites, and hepatic encephalopathy secondary to alcohol abuse questions the nurse as to why his abdomen is so large even though he is undernourished and emaciated. Which statement most accurately explains the problem?

The normally small transcellular fluid compartment, or third space, is becoming enlarged.

The nurse is assessing blood gas results for a client with diabetes and ketoacidosis and notes a pH level of 7.15. Which arrhythmias should the nurse closely monitor while treating this client?

Ventricular tachycardia

The nurse is explaining to a client about his parathyroid disorder. What information does the nurse relate to the client regarding the relationship between parathyroid hormone (PTH) and calcium (Ca+)?

When plasma Ca+ is increased, PTH is inhibited and Ca+ is deposited in the bones.

A client is admitted to the hospital with fluid volume deficit. The nurse should be aware that compensatory mechanisms will include:

activation of the renin-angiotensin-aldosterone system (RAAS).

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.

Of the following clients, who would be at highest risk for developing hyperkalemia?

client admitted for acute kidney injury following a drug overdose

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

When caring for the client with hyponatremia secondary to SIADH, which of these alterations does the nurse anticipate?

decreased serum osmolarity

A client arrives in the emergency department with hypovolemia related to excretion of "at least 3 gallon jugs of dilute, waterlike urine in the past 24 hours." In collaboration with the health care provider, the nurse prepares to administer which medication?

desmopressin acetate (DDAVP)

A client staggers into the emergency department with their child who states that the parent has not been well for a couple of weeks. The client's heart rate is 120 beats/min and lung sounds reveal crackles and a respiratory rate of 30 breaths/min. The client also reports right flank pain. The child says that their other parent has been acting strangely and thinks that parent might be poisoning the client. Which clinical manifestation indicates the type of poisoning involved?

ethylene glycol (antifreeze)

A client who has just completed running a marathon reports muscle weakness, cramping, and general fatigue despite drinking adequate amounts of water. The nurse suspects which type of hypotonic hyponatremia?

hypovolemic

A client with a blood glucose reading of 673 mg/dl (37.4 mmol/l) is diagnosed with diabetic ketoacidosis (DKA). Blood gas results are as follows: serum pH 7.29; HCO3− level 19 mEq/dl (19 mmol/l); PCO2 level 32 mm Hg. The nurse should prepare for which initial treatment orders?

initiation of an insulin IV infusion along with fluid replacement

Which unit of measure best describes the concentration of solute in a particular volume of fluid based on electrolyte equivalency?

mEq/L

Arterial blood gases of a client with a diagnosis of acute kidney injury 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 breaths/min. This client is most likely experiencing which disorder of acid-base balance?

metabolic acidosis

A client's arterial blood gases indicate normal oxygen levels but increased carbon dioxide levels with elevated HCO3- levels and a pH of 7.43. The client's respiratory rate is12 breaths/min. How should the nurse interpret these findings?

metabolic alkalosis

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 with Crohn's disease begins receiving intravenous hyperalimentation that includes acetate. When the client experiences tetany, what ABG values would the nurse expect to obtain?

pH 7.56, PCO2 38mm Hg (5.05 kPa), HCO3- 37 mEq/L (37 mmol/L), PO2 98mm Hg (13.03 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

A client with took too many "water pills" (diuretics) and presents with a serum potassium level of 2.6 mEq/l (2.6 mmol/l) (normal range 3.5 to 5.0 mEq/l; 3.5 to 5.0 mmol/l). The nurse reports which finding(s) as evidence the client is experiencing a manifestation of hypokalemia?

polyuria, hypoactive bowel sounds, prominent U wave on ECG

In isotonic fluid volume deficit, changes in total body water are accompanied by:

proportionate losses of sodium.

When caring for the client with hyperkalemia, the nurse recognizes the body should respond in which of these ways?

secrete potassium in the distal tubules for excretion

The nurse is caring for a client who is experiencing an increased level of aldosterone secretion. The nurse anticipates that the client may develop:

sodium and water retention.