Exam 1 Review: ABGs, Acid Base Balance, Electrolyte Imbalances
Which clients would the nurse determine is at risk for development of metabolic alkalosis? Select all that apply.
Client who has been vomiting for 2 days Client receiving oral furosemide 40 mg daily
The nurse would monitor for which initial sign of fluid overload, in a client receiving intravenous (IV) fluids to replace fluid loss from extensive burns?
Crackles in the lungs
What are some causes of metabolic acidosis?
DKA Acute/Chronic Kidney Injury Malnutrition Severe Diarrhea
What are some s/s of respiratory acidosis?
Decreased BP Decreased RR Increased HR Restlessness Confusion Headache Sleepy/coma
A client who has received sodium bicarbonate in large amounts is at risk for developing metabolic alkalosis. The nurse checks this client for which signs and symptoms characteristic of this disorder?
Decreased respiratory depth and rate and dysrhythmias
A client has the following laboratory values: a pH of 7.55, an HCO3- level of 22 mEq/L (22 mmol/L), and a Pco2 of 30 mm Hg (30 mm Hg). Which action would the nurse plan to take?
Encourage the client to slow down breathing.
A client with chronic kidney disease is receiving epoetin alfa. Which laboratory result would indicate a therapeutic effect of the medication
Hematocrit of 33% (0.33)
Which complication is most serious in a client with kidney failure and requires close monitoring by the nurse?
Hyperkalemia
What are s/s of metabolic alkalosis?
Hypoventilation <12 breaths per min Low K+ (dysrhythmias, muscle cramps weakness, vomiting) Tetany Tremors EKG changes
A client with untreated type 1 diabetes mellitus may lapse into a coma because of acidosis. Which component in the blood is a direct cause of this type of acidosis?
Ketones
What kind of problem is associated with Metabolic Acidosis?
Kidney problem because of too much hydrogen and too little bicarb. The lungs compensate by blowing off co2
What problem is associated with metabolic alkalosis?
Kidney problem too much bicarb, too little hydrogen the lungs compensate by retaining co2
The nurse observes that a client with diabetic ketoacidosis is experiencing abnormally deep, regular, rapid respirations. How would the nurse correctly document this observation in the medical record?
Kussmaul's respirations
What are s/s of metabolic acidosis?
Kussmauls Breathing (>20 breaths per minute) Hyperkalemia (muscle twitching, weakness, arrhythmias) Decreased BP Confusion
Which clinical finding most accurately identifies that the client has a fluid deficit?
Loss of body weight
What kind of problem is associated with Respiratory Acidosis?
Lung problem (retaining too much CO2) so the kidneys compensate by excreting excess hydrogen and retaining bicarb
The nurse is caring for a client with severe diarrhea. The nurse monitors the client closely, understanding that this client is at risk for developing which acid-base disorder?
Metabolic acidosis
The nurse is caring for a client with a nasogastric tube that is attached to low suction. The nurse monitors the client closely for which acid-base disorder that is most likely to occur in this situation?
Metabolic alkalosis
Which complication is the primary nursing concern when caring for a client with rapid and shallow respirations, dry and flushed skin, weakness, and lethargy who reports epigastric pain and prolonged vomiting?
Metabolic alkalosis
A 3-year-old child is hospitalized because of persistent vomiting. Which conditions would the nurse expect this child to be at high risk for? Select all that apply.
Metabolic alkalosis Dehydration
What are some interventions for a pt with Metabolic Acidosis?
Monitor I and O Admin IV solution to increase bases and decrease acids Initiate seizure precautions Monitor K+ levels
What are some interventions for a pt with metabolic alkalosis?
Monitor K+ and Ca levels Admin IV fluids to help the kidneys get rid of excess bicarbonate Replace K+ Administer antiemetics for vomiting (Zofran or Phenergan) Watch for s/s respiratory distress
Which clinical finding indicates that a postoperative client who has a nasogastric tube attached to low continuous suction may be experiencing hypokalemia?
Muscle weakness and cardiac dysrhythmias
The nurse reviews a client's electrolyte results and notes that the potassium level is 5.4 mEq/L. What would the nurse look for on the cardiac monitor as a result of this laboratory value?
Narrow, peaked T waves
The nurse is caring for a client with kidney failure. The nurse is told that the blood gas results indicate a pH of 7.30 and a HCO3- of 20 mm Hg, and that the client is experiencing metabolic acidosis. The nurse reviews the laboratory results and finds which value to be of concern?
Potassium level, 5.6 mEq/L
What are some interventions for a pt with Respiratory Alkalosis?
Provide emotional support Fix the breathing problem! Encourage good breathing patterns Rebreathing into a paper bag Give anti anxiety meds or sedatives to decrease breathing rate Monitor K+ and Ca levels
What are s/s of respiratory alkalosis?
RR > 20 Increased HR Confused and tired Tetany EKG changes Positive Chvostek sign
What are some causes of Respiratory Acidosis?
Remember "Depress" Drugs (opioids and sedatives) Edema (fluid in the lungs) Pneumonia Respiratory Center of brain is damaged Emboli Spasms of the bronchial (asthma) Sac Elasticity Damage (COPD and Emphysema)
What does ROME Stand for?
Respiratory Opposite Metabolic Equal
The nurse is caring for a client with a diagnosis of chronic obstructive pulmonary disease (COPD). The nurse would monitor the client for which acid-base imbalance?
Respiratory acidosis
The nurse is told that the arterial blood gas (ABG) results indicate a pH of 7.50 and a Pco2 of 32 mm Hg (32 mm Hg). The nurse determines that these results are indicative of which acid-base disturbance?
Respiratory alkalosis
What are some causes of respiratory alkalosis?
Tachypnea Increased temp Aspirin toxicity Hyperventilation
The nurse is reviewing the health records of assigned clients. The nurse would plan care knowing that which client is at risk for a potassium deficit?
The client receiving nasogastric suction
The nurse is reviewing the health records of assigned clients. The nurse would plan care knowing that which client is at risk for fluid volume deficit?
The client with an ileostomy
The nurse reviews electrolyte values and notes a sodium level of 130 mEq/L (130 mmol/L). The nurse expects that this sodium level would be noted in a client with which condition?
The client with the syndrome of inappropriate secretion of antidiuretic hormone
What kind of problem is associated with respiratory alkalosis?
The lungs are losing too much CO2 so the kidneys compensate by excreting excess Bicarb and retain hydrogen
What are some causes of metabolic alkalosis?
Too many antacids Diuretics Excess vomiting Hyperaldosteronism
Which nursing action would be appropriate to decrease carbon dioxide for a client with respiratory acidosis?
Using continuous positive airway pressure (CPAP)
The nurse is caring for a client with a suspected diagnosis of hypercalcemia. Which sign/symptom would be an indication of this electrolyte imbalance?
generalized muscle weakness
A client presents to the emergency department with lethargy; deep, regular respirations; and a fruity odor to the breath. The client's arterial blood gas (ABG) results are pH of 7.25, Pco2 of 34 mm Hg, Po2 of 86 mm Hg, and HCO3- of 14 mEq/L. The nurse interprets that the client has which acid-base disturbance?
metabolic acidosis
The nurse is collecting data from a client with a suspected diagnosis of gastric ulcer. The client tells the nurse that oral antacids are taken frequently throughout the day. The nurse continues to collect data from the client, understanding that the client is at risk for which acid-base disturbance?
metabolic alkalosis
The registered nurse (RN) reviews the results of the arterial blood gas (ABG) values with the licensed practical nurse (LPN) and tells the LPN that the client is experiencing respiratory acidosis. The LPN would expect to note which on the laboratory result report?
pH 7.25, Pco2 50 mm Hg
The nurse determines that which clients are at high risk for metabolic acidosis? Select all that apply.
-Diabetes clients -Kidney failure clients -Malnourishment clients
What is a normal HCO3 level and what does it measure?
22-26 (below 22 = acidosis ; above 26 = alkalosis); measures bicarbonate in the blood
What is a normal PACO2 level and what does it measure?
35-45; measures the CO2 in the blood
What is a normal PH level and what does it measure?
7.35-7.45; measures how acidic or alkalotic your blood is
What is a normal PAO2 level and what does it measure?
80-100; measures the amount of oxygen in the blood
The nurse is caring for a client with respiratory insufficiency. The arterial blood gas (ABG) results indicate a pH of 7.50 and a Pco2 of 30 mm Hg (30 mm Hg), and the nurse is told that the client is experiencing respiratory alkalosis. Which additional laboratory value would the nurse expect to note?
A potassium level of 3.0 mEq/L
What are some interventions for a patient with respiratory acidosis?
Admin o2 Semi Fowlers position TCDB Increase fluids for pneumonia pts Monitor K+ levels If co2 is > 50 may need an endotracheal tube
Which nursing assessment finding is consistent with fluid volume overload? Select all that apply. One, some, or all responses may be correct.
Bounding pulse Presence of dependent edema Neck vein distention in the upright position
The nurse is instructing a client on how to decrease the intake of calcium in the diet. The nurse would tell the client that which food item is least likely to contain calcium?
Butter
