Metabolic Acidosis

When a client with metabolic acidosis is placed on an ECG monitor and the nurse sees peaked T waves or absent P waves with a widened QRS, which physiological condition is the client experiencing A. Severe hyperkalemia B. Severe hypokalemia C. Severe hyponatremia D. Severe hypernatremia

A)Severe hyperkalemia Rationale: Severe hyperkalemia manifests as peaked T waves with widened QRS complexes in an electrocardiogram​ (ECG). Hyperkalemia is present with acidosis. Hypokalemia is present with alkalosis. ECG waveform patterns do not indicate sodium levels.

The nurse is teaching an adult client on the cause of metabolic acidosis. Which cause would the nurse include in the client education? SATA A. Acute diarrhea B. Tissue hypoxia C. Diabetes D. Chronic renal failure E. Potassium wasting diuretics

A, B, C, D Rationale: Diabetes mellitus can develop into diabetic ketoacidosis. Tissue hypoxia can alter electrolytes and cause metabolic acidosis. Chronic renal failure can lead to metabolic acidosis. Acute diarrhea alters the acid-base balance in the body and can cause metabolic acidosis. The use of​ potassium-wasting diuretics may cause metabolic​ alkalosis, not acidosis.

Which assessment finding would the nurse expect to find in a client with decreased cardiac output secondary to metabolic acidosis? SATA A. Hypotension B. Poor skin turgor C. CRT: >5 seconds D. Bounding peripheral pulses E. 3+ pitting lower extremity edema

A, C Hypotension CRT >5 seconds Rationale: Decreased cardiac output slows blood flow. This causes hypotension and delayed capillary refill. Poor skin turgor is a sign of dehydration. Bounding peripheral pulses would be noted in a client with good cardiac output.​ 3+ lower extremity pitting edema is a sign of fluid volume overload.

The. nurse is teaching a client with type 1 diabetes mellitus about disease management. What should the nurse include in the teaching plan to help the client prevent metabolic acidosis? SATA A. Take insulin as prescribed B. Monitor blood glucose levels weekly C. Notify healthcare provider when sick D. Drink 8, 8oz glasses of water per day E. Consume diet soft drinks when nauseated or vomiting

A, C, D Rationale: Many clients with type 1 diabetes mellitus believe if they are ill and unable to​ eat, they should not take their insulin. The nurse should instruct on the importance of taking insulin as prescribed and to notify their healthcare provider when sick. In order to maintain fluid volume and prevent​ imbalances, the diabetic client should take in eight​ 8-ounce glasses of water per day and even more when sick. Blood glucose levels should be checked more often than once a​ week, and diet soft drinks do not provide calories for the diabetic client when nauseated and vomiting

The nurse is assessing a client for metabolic acidosis. Which manifestation is the nurse likely to observe? SATA A. Bradycardia B. Hypokalemia C. Skeletal problems D. Warm, flushed skin E. Nausea and vomiting

A, C, D, E Rationale: Metabolic acidosis affects the function of several body systems. Symptoms of metabolic acidosis include​ bradycardia; warm, flushed​ skin; nausea and​ vomiting; and musculoskeletal problems. The client would not exhibit hypokalemia but​ hyperkalemia, as potassium is retained as the kidneys excrete excess hydrogen ions.

The nurse is assessing the client for conditions that may increase the client's risk for developing specific acid-base imbalances. Which condition is most appropriate for the nurse to identify as a risk factor that may lead to the client's development of metabolic acidosis? SATA A. Severe diarrhea B. Hyperventilation C. Chronic renal failure D. High-dose salicylate ingestion E. Insulin-dependent diabetes

A, C, D, E Rationale: Risk factors for the development of metabolic acidosis include​ insulin-dependent diabetes​ mellitus, chronic renal​ failure, severe​ diarrhea, and​ high-dose salicylate ingestion as these lead to bicarbonate loss. Hyperventilation is a risk factor for developing respiratory alkalosis due to loss of carbon dioxide because of rapid breathing.

Upon entering a room, the nurse quickly scans the environment and then immediately assesses the client for manifestations of metabolic acidosis. Which did the nurse observe to precipitate this client assessment? A) Client sleeping with the head of the bed flat B) Half of the client's lunch tray uneaten C) One formed stool in the bedside commode D) 2000 mL of intravenous 0.9% normal saline infused in 2 hours

Answer: D Excessive infusions of chloride-containing intravenous fluids can precipitate metabolic acidosis. The head of the bed's being flat might influence a client's oxygenation status; however, the client was not demonstrating a change in respiratory depth or rate. A reduction in oral intake does not cause metabolic acidosis. Eating half of a meal tray is not the same as starvation. Diarrhea can lead to the development of metabolic acidosis. One formed stool would not cause the nurse alarm.

Which factor places an infant with diarrhea at risk for metabolic acidosis? A. Calcium depletion B. Bicarbonate loss C. Sodium excess D. Potassium loss

B) Bicarbonate loss Rationale: Infants have a larger fluid volume than adults. When they develop​ diarrhea, this causes large amounts of bicarbonate​ loss, which causes metabolic acidosis.​ Sodium, potassium, and calcium changes do not lead to metabolic acidosis.

What should the nurse educator include in a presentation regarding the causes of metabolic acidosis? SATA A. Self-induced vomiting B. Salicylate intoxication C. Uncontrolled diabetes D. Rapid infusion of sodium bicarbonate E. COPD

B, C Salicylate intoxication Uncontrolled diabetes Rationale: Salicylate intoxication and uncontrolled diabetes mellitus are causes of metabolic acidosis.​ Self-induced vomiting and rapid infusion of sodium bicarbonate can lead to metabolic alkalosis. COPD can cause respiratory acidosis.

The nurse preceptor is discussing the causes of metabolic acidosis with a new graduate. Which diagnosis would the preceptor include as a cause of metabolic acidosis? A. Stroke B. Starvation C. Alcoholism D. Aspirin poisoning E. Excessive diarrhea

B, C, D, E Starvation, Alcoholism, Aspirin toxicity, Excessive diarrhea Rationale: Metabolic acidosis is rarely a primary disorder. Starvation and alcoholism lead to​ ketoacidosis, which causes an increase in acid production and can cause metabolic acidosis. Aspirin poisoning also causes increased acid​ production, which can lead to metabolic acidosis. Diarrhea causes increased bicarbonate​ loss, which can lead to metabolic acidosis. A stroke might cause acute respiratory acidosis or respiratory alkalosis but not metabolic acidosis.

The nurse is caring for four clients today? Which client would the nurse expect to be a highest risk for metabolic acidosis? A. 60-year-old with DVT B. 50-year-old with pneumonia C. 70-year-old with chronic kidney disease D. 80-year-old with COPD

C) 70-year-old with chronic kidney disease Rationale: Older adults have decreased renal​ function, and a​ 70-year-old with chronic kidney disease would be at the highest risk due to the inability to excrete hydrogen ions in the urine. A client with pneumonia and chronic obstructive pulmonary disease would have respiratory acidosis or alkalosis. Deep vein thrombosis does not cause metabolic acidosis.

The clinical nurse educator is explaining the primary concepts of metabolic acidosis. Which statement is most appropriate for inclusion in the discussion about metabolic acidosis? A. HCO3 excess may lead to the development of metabolic acidosis B. Metabolic acidosis is associated with a deficit of carbonic acid (H2CO3) C. HCO3 deficit may lead to the development of metabolic acidosis D. Metabolic acidosis is associated with an excess of carbonic acid

C) HCO3 deficit may lead to the development of metabolic acidosis Rationale: Bicarbonate ​(HCO3​) deficit may lead to the development of metabolic acidosis. An excess of bicarbonate ​(HCO3​) may lead to the development of metabolic alkalosis. Respiratory acidosis is associated with carbonic acid ​(H2CO3​) ​excess, while respiratory alkalosis is associated with a deficit of carbonic acid ​(H2CO3​).

Which condition or lab data indicates and adverse effect when administering sodium bicarbonate for treatment of metabolic acidosis? A. pH: 7.30 B. Hyperkalemia C. Hyperosmolality D. Hyponatremia

C) Hyperosmolality Rapid correction of metabolic acidosis with sodium bicarbonate may lead to​ hypernatremia, not​ hyponatremia, which causes water retention and fluid overload. Rapid correction of metabolic acidosis with sodium bicarbonate may lead to metabolic alkalosis and​ hypokalemia, not hyperkalemia. Rapid correction of metabolic acidosis with sodium bicarbonate may lead to​ hyperosmolality, which can lead to water retention and fluid overload.​ Therefore, it is essential to administer sodium bicarbonate only for severe metabolic acidosis and to closely monitor the client. Rapid correction of metabolic acidosis with sodium bicarbonate may lead to metabolic alkalosis and a pH greater than 7.45. A pH of 7.30 indicates metabolic acidosis and that the client did not have an adverse reaction to the sodium bicarbonate.

The nurse is caring for a client with metabolic acidosis who presents with respiratory distress. Which lab value indicates a need to intubate and mechanically ventilate the client? A. Bicarb: 25 mEq/L B. PaO2 greater than 60 mmHg C. PaCO2 greater than 77 mmHg D. pH greater than 7.10

C) PaCO2 greater than 77 mmHg Rationale: A client with metabolic acidosis in respiratory distress would require intubation with mechanical ventilation if the PaCO2 is greater than 77 mmHg. A pH greater than 7.10 would not require intubation. The normal bicarbonate level is​ 21-26 mEq/L, so the client has a normal level. If the PaO2 is less than 60​ mmHg, mechanical ventilation and intubation are required.

The nurse is administering sodium bicarbonate to a client with severe metabolic acidosis. As the pH begins to normalize, which lab value is most important to assess? A. Bicarbonate B. Sodium C. Potassium D. Creatinine

C) Potassium Rationale: As the pH begins to​ normalize, potassium begins to shift back into the​ cell, leading to severe hypokalemia. This can cause​ life-threatening cardiac dysrhythmias. Sodium and bicarbonate should be​ monitored, but they are not the most important. Serum creatinine is not as important as potassium.

Which preventable factor can cause metabolic acidosis in the older adult? A. Vomiting and diarrhea B. Type 1 diabetes C. Salicylate poisoning D. Cardiac arrest

C) Salicylate poisoning Rationale: Older adults may overuse salicylates in the treatment of arthritic pain. Salicylate poisoning is a cause of metabolic acidosis that can be prevented by taking the medication only as prescribed. Cardiac​ arrest, vomiting and​ diarrhea, and type 1 diabetes mellitus are not preventable causes of metabolic acidosis

Which collaborative care goal is most appropriate for the nurse to include in the plan of care for a client with metabolic acidosis secondary to influenza? A. The client will reach 1500 mL on the incentive spirometer B. The client will maintain the head of the bed in a high-Fowler position C. The client will have an oral fluid intake of 2000 mL in 24 hours D. The client will have serum electrolytes within normal limits

D) The client will have serum electrolytes within normal limits Rationale: Collaborative care goals are those that require orders from the healthcare provider or other disciplines to meet. Serum electrolyte status requires an order to implement. Oral fluid​ intake, incentive​ spirometer, and elevating the head of the bed are set by the nurse and are met by independent nursing interventions.

Which nursing intervention would be the most important for the nurse to implement in a client with confusion and mental status changes related to metabolic acidosis? A. Turn on the bed alarm B. Keep a calendar in the room C. Reorient the client frequently D. Have familiar objects close

A) Turn on the bed alarm Rationale: Client safety is the most important intervention. If the client is​ confused, the nurse should turn on the bed alarm to alert the nurse if the client tries to get out of bed. Having familiar objects​ close, keeping a calendar in the​ room, and frequently reorienting the client will help decrease​ confusion, but these actions do not maintain safety

An alkalinizing solution often given intravenously to clients with severe acute metabolic acidosis is A) sodium bicarbonate. B) sodium chloride. C) potassium chloride. D) dextrose.

Answer: A Sodium bicarbonate is an alkalinizing solution often given intravenously to clients with severe acute metabolic acidosis. Sodium chloride and potassium chloride may worsen metabolic acidosis by increasing the chloride concentration. Dextrose may also worsen metabolic acidosis, especially in clients with type 1 diabetes, by increasing blood glucose levels and causing ketoacidosis.

The nurse is caring for a client admitted with renal failure and metabolic acidosis. Which clinical manifestation would indicate to the nurse that planned interventions to relieve the metabolic acidosis have been effective? A) Decreased respiratory depth B) Palpitations C) Increased deep tendon reflexes D) Respiratory rate of 38

Answer: A The client with metabolic acidosis will have an increased respiratory rate and depth, called Kussmaul respirations. Signs that care has been effective would include a decrease in the rate and depth of respirations. An increased respiratory rate, as indicated by a respiratory rate of 38, would indicate continued metabolic acidosis. Increased deep tendon reflexes and palpitations are not associated with metabolic acidosis.

1) The nurse is analyzing the client's arterial blood gas report, which reveals a pH of 6.58. The client has just suffered a cardiac arrest. Which consequences of this pH value does the nurse consider for this client? A) Decreased cardiac output B) Increase magnesium levels C) Decreased free calcium in the ECT D) Increased myocardial contractility

Answer: A The nurse knows that severe acidosis (pH of 7.0 or less) depresses myocardial contractility, which leads to decreased cardiac output. Acid-base imbalances also affect electrolyte balance. In acidosis, calcium is released from its bonds with plasma proteins, increasing the amount of ionized (free) calcium in the blood. Magnesium levels may fall in acidosis.

The nurse is caring for the client experiencing hypovolemic shock and metabolic acidosis. Which therapies would the nurse question if planned for this client? Select all that apply. A) Monitor weight on admission and discharge. B) Monitor ECG for conduction problems. C) Limit the intake of fluids. D) Administer sodium bicarbonate. E) Keep the bed in the locked and low position.

Answer: A, C The treatment for hypovolemic shock would include the administration of fluids, not limiting fluids. Patients being treated for hypovolemia and metabolic acidosis will require daily weights, not a weight on admission and then discharge. Administering sodium bicarbonate and monitoring ECGs are appropriate for the client with metabolic acidosis. The client recovering from hypovolemic shock and metabolic acidosis is at risk for injury, so the bed should be kept in the locked and low position.

The nurse is caring for a client who has been admitted with persistent diarrhea lasting 3 days. Which are appropriate nursing diagnoses for this client during the acute phase of the illness? Select all that apply. A) Decreased Cardiac Output B) Ineffective Airway Clearance C) Overflow Urinary Incontinence D) Knowledge Deficit E) Risk for Injury

Answer: A, E Metabolic acidosis decreases cardiac output by decreasing contractility, slowing the heart rate, and increasing the risk for dysrhythmias. The client with metabolic acidosis is also at risk for injury due to altered mental status. Appropriate nursing diagnoses during the acute phase of illness are Risk for Injury and Decreased Cardiac Output. The client may have a knowledge deficit, but this is not an appropriate nursing diagnosis during the acute phase of the illness. The client with metabolic acidosis is not at risk for Ineffective Airway Clearance or Overflow Urinary Incontinence.

A common cause of metabolic acidosis is A) hyperventilation in a client with anxiety. B) high blood glucose in a client with type 1 diabetes. C) vomiting in a client with a gastrointestinal infection. D) opiate overdose in a client with depression.

Answer: B High blood glucose that leads to diabetic ketoacidosis is a common cause of metabolic acidosis. Vomiting can lead to metabolic alkalosis, hyperventilation can lead to respiratory alkalosis, and opiate overdose can lead to respiratory acidosis.

A compensatory mechanism that may indicate to a nurse that a client is experiencing metabolic acidosis includes: A) headache. B) Kussmaul respirations. C) vomiting. D) decreased level of consciousness.

Answer: B Kussmaul respirations are deep and rapid respirations that are a compensatory mechanism during metabolic acidosis. Headache, vomiting, and decreased level of consciousness are all clinical manifestations of metabolic acidosis, but they are not compensatory mechanisms that the body uses to maintain acid-base balance during metabolic acidosis.

A client with metabolic acidosis has been admitted to the unit from the emergency department (ED). The client is experiencing confusion and weakness. Which nursing intervention is the priority for this client? A) Placing the client in a high-Fowler position B) Protecting the client from injury C) Administering sodium bicarbonate D) Providing the client with appropriate skin care

Answer: B The client with metabolic acidosis may have symptoms of drowsiness, lethargy, confusion, and weakness. A priority of care would be preventing injury to the client. Medication administration is a physician order. Skin care would not be a priority on admission. The high-Fowler position would not be the safest position for the confused client.

The nurse is caring for a client with metabolic acidosis. Which goals are appropriate for this client? Select all that apply. A) The client will maintain a respiratory rate of 30 or more. B) The client will describe preventative measure for the underlying chronic illness. C) The client will maintain baseline cardiac rhythm. D) The client will remain in a pH range from 7.25 to 7.35. E) The client will take potassium supplements to increase potassium levels.

Answer: B, C Planning for the client with metabolic acidosis involves identification and treatment of the underlying cause and restoration and maintenance of acid-base balance. The client should be able to describe preventative measures for the underlying chronic illness that caused the metabolic acidosis to occur and maintain the baseline cardiac rhythm. The pH should be maintained between 7.35 and 7.45. The client's respiratory rate should be within normal range for age and condition. Taking a potassium supplement may cause hyperkalemia, which decreases cardiac output and worsens metabolic acidosis.

Which treatment modality would the nurse expect the healthcare provider to prescribe for a client admitted with alcoholic acidosis and a pH of 7.25? SATA A. IV insulin B. IV glucose C. IV potassium D. IV normal saline E. IV sodium bicarbonate

B, D IV glucose, IV normal saline Rationale: Intravenous glucose and normal saline are administered to a client with alcoholic acidosis. Intravenous insulin and potassium are given for diabetic ketoacidosis. Intravenous sodium bicarbonate is administered if the pH is less than 7.10.

The nurse identifies the diagnosis Risk for Injury as appropriate for a client with metabolic acidosis. Which strategies should the nurse use to support this diagnosis? Select all that apply. A) Apply wrist restraints and secure to the bed frame. B) Discuss chemical restraint use with the healthcare provider. C) Keep the bed in the lowest position. D) Keep bed side rails raised. E) Place a clock and calendar at the bedside.

Answer: C, D, E To reduce the client's risk for injury, the nurse should make sure the bed is kept in the lowest position and the side rails are raised. A clock and calendar at the bedside will help with orientation. Restraints are used in the event the client demonstrates harm to self or others. Confusion or a risk for injury is not a reason to use wrist or chemical restraints.

An older adult client has a history of heart disease and dementia and takes several medications. His wife states that sometimes he forgets to take his medications, or he takes multiple doses of his medications, due to his dementia. An accidental overdose of which medication could result in metabolic acidosis? A) Losartan (an angiotensin II receptor blocker to reduce hypertension) B) Simvastatin (a statin to reduce blood cholesterol levels) C) Rivastigmine (a cholinesterase inhibitor to reduce symptoms of dementia) D) Aspirin (a salicylate to decrease risk of heart attack)

Answer: D Aspirin is salicylic acid, which could decrease the blood pH if taken in high quantities. Diuretics, some antidepressants, antiseizure medications, and angiotensin-converting enzyme (ACE) inhibitors could all affect the acid-base balance in an older adult, but acid-base balance is less affected by angiotensin II receptor blockers, statins, and cholinesterase inhibitors.

Which assessment finding indicates the possibility of renal failure in a client with metabolic acidosis? A. Dysuria and hematuria B. Bradycardia and dysrhythmias C. 24 hour urine output of 600 mL D. Bilateral adventitious lung sounds

C) 24 hour urine output of 600 mL Rationale: Urine output should be 30​ mL/hour. When cardiac output decreases in metabolic​ acidosis, this can affect renal perfusion. A​ 24-hour urinary output of 600 mL indicates only 25​ mL/h. This decreased renal perfusion can cause renal failure. Dysuria and hematuria can indicate a urinary tract infection. Bradycardia can happen from decreased cardiac​ output; dysrhythmias from hyperkalemia. Bilateral adventitious lung sounds can indicate fluid overload.

Which independent nursing intervention is most appropriate for the nurse to include in the plan of care for a client to prevent metabolic acidosis? A. Administer IV sodium bicarbonate B. Obtain ABGs daily C. Perform continuous telemetry monitoring D. Assess renal and respiratory function

D) Assess renal and respiratory function Rationale: An independent nursing intervention is one that can be performed without a healthcare​ provider's order. The nurse can assess the​ client's renal and respiratory function without an order. Arterial blood​ gases, continuous telemetry​ monitoring, and intravenous fluids cannot be done without an order.