Metabolic Alkalosis

The nurse is caring for a client diagnosed with metabolic alkalosis. Which intervention should the nurse include when establishing the plan of care? A. Administer antiemetics as prescribed B. Promote early ambulation C. Encourage slow, deep respirations D. Monitor for pain

A) Administer antiemetics as prescribed Rationale: One cause of metabolic alkalosis is vomiting. Antiemetics can help prevent this from occurring. Acute pain that might require medication is seen with​ respiratory, not​ metabolic, alkalosis. Encouraging​ slow, deep respirations would be indicated for a client with respiratory alkalosis. Early ambulation is encouraged with respiratory​ acidosis, not with metabolic alkalosis.

Which is a risk factor for the development of metabolic alkalosis? SATA A. Hypokalemia B. Hospitalization C. Gastric suctioning D. Primary hypoaldosteronism E. Treatment with alkalinizing solution

A, B, C, E Rationale: Risk factors for metabolic alkalosis​ include: hospitalization,​ hypokalemia, treatment with an alkalinizing​ solution, gastric​ suctioning, and primary​ hyperaldosteronism, not hypoaldosteronism. Metabolic alkalosis occurs when the body loses too much acid or gains too much base. Hypokalemia can contribute in more than one way to metabolic​ alkalosis; either secondary to the common causes of metabolic alkalosis such as vomiting and gastric​ suction, which result in acid loss or through further reabsorption of HCO3 when the body responds to hypokalemia. Metabolic alkalosis can occur more frequently in hospitalized clients due to various treatments or complications of the illness being treated.

A nurse is caring for a client who is diagnosed with metabolic alkalosis. Which should the nurse include in the assessment of this client? SATA A. Oxygen Saturation B. ABGs C. Deep tendon reflexes D. Presence of muscle weakness E. Presence of numbness and tingling

A, B, C, E Rationale: When assessing a client with metabolic​ alkalosis, the nurse will include ABG​ interpretation, deep tendon​ reflexes, oxygen​ saturation, and presence of numbness and tingling. The nurse would assess for the presence of muscle​ spasm, not​ weakness, for this client.

Which of these tests is used to diagnose metabolic alkalosis? SATA A. ECG B. ABGs C. Urine pH D. Serum CBC E. Serum electrolytes

A, B, C, E Rationale: he laboratory or diagnostic tests used to diagnose metabolic alkalosis​ include: ABGs,​ ECG, serum​ electrolytes, and urine pH. A CBC​ (complete blood​ count) is not used to diagnose metabolic acidosis

The nurse is assessing the ABGs and a metabolic panel for a client with suspected metabolic alkalosis. Which finding would support this diagnosis? SATA A. pH 7.52 B. HCO3 30 C. Serum potassium 4.6 D. Serum chloride 90 E Urine pH: 5

A, B, D Rationale: In metabolic​ alkalosis, the pH is greater than​ 7.45, HCO3 is greater than 26​ mEq/L, and serum chloride may be decreased​ (less than 95​ mEq/L). Serum potassium may also be​ decreased, thus a serum potassium of 4.6​ mEq/L would not support a diagnosis of metabolic alkalosis. In metabolic​ alkalosis, urine pH is usually low​ (1-3)

The nurse is completing a teaching session for parents of a child who will be undergoing cardiac surgery to repair a birth defect. Which clinical manifestation should the nurse include when teaching the parents about an acid-base imbalance associated with postoperative pediatric cardiac surgery? SATA A. Dysrhythmias B. Irritability C. Seizures D. Decreasing LOC E. Cardiac arrest

A, C, D Rationale: Metabolic alkalosis is seen with a higher incidence in children who undergo cardiac surgery. Clinical manifestations of metabolic alkalosis include​ dysrhythmias, seizures, and decreasing​ LOC; thus, these should be included. Irritability and cardiac arrest are manifestations of respiratory acidosis.

Which action supports the nurse's plan of care for treating impaired gas exchange in the client with metabolic alkalosis? SATA A. Assess skin color B. Assess intake and output C. Monitor respiratory rate, depth and effort D. Place the client in Fowler or semi-Fowler position E. Monitor mental status and LOC

A, C, D, E Rationale: Actions that support the​ nurse's plan of care for the goal of treating impaired gas exchange in the client with metabolic alkalosis include monitoring respiratory depth and​ effort; assessing skin​ color; monitoring mental status and level of​ consciousness; and placing the client in Fowler or​ semi-Fowler position. Assessing the intake and output is not an intervention for treating impaired gas exchange​ but, rather, for treating fluid volume deficit.

Which is an appropriate nursing outcome for a client with metabolic alkalosis? SATA A. O2 sat is 93% or greater B. Muscle weakness is identified and treated C. Normal acid-base balance is restored and maintained D. The underlying cause of metabolic alkalosis is identified and treated E. Normal or near normal fluid and electrolyte volumes are restored and maintained

A, C, D, E Rationale: Appropriate nursing outcomes for a client with metabolic alkalosis include the​ following: Normal​ acid-base balance is restored and​ maintained; underlying cause of metabolic alkalosis is identified and​ treated; normal or near normal fluid and electrolyte volumes are restored and​ maintained; and oxygen saturation is​ 93% or greater. Muscle weakness is not a symptom of metabolic​ alkalosis, so the nurse would not anticipate this as a goal for the client with metabolic alkalosis.

Which intervention should the nurse implement to monitor for fluid volume deficit in the client with metabolic acidosis? SATA A. Monitor serum electrolytes, osmolality, and ABGs B. Assess skin color; note and report cyanosis around the mouth C. Assess intake and output accurately, monitoring fluid balance D. Assess vital signs, CVP, and peripheral pulse volume once per shift E. Weigh daily under standard conditions (time of day, clothing, and scale)

A, C, E Rationale: To monitor for fluid volume​ deficit, the nurse should monitor serum​ electrolytes, osmolality, and ABG​ values; assess intake and output accurately to monitor for fluid​ balance; and weigh the client daily under standard conditions. Assessment of skin color for cyanosis around the mouth helps to monitor for impaired gas​ exchange, not fluid volume deficit. Vital​ signs, CVP, and peripheral pulse volume to monitor for fluid volume deficit should be done every four​ hours, not just once a shift

An adolescent is hospitalized following several days of vomiting due to food poisoning. The nurse is planning to include which points when teaching the client's family at discharge? Select all that apply. A) Immunizations for the adolescent B) Nutritional patterns of the adolescent C) Signs and symptoms of metabolic alkalosis D) Proper food-handling techniques E) Normal laboratory values of the adolescent

Answer C, D The family of anyone experiencing prolonged vomiting should be taught the signs and symptoms of metabolic alkalosis. In this case, the nurse would include teaching about proper methods of food handling to prevent further episodes of food poisoning. Food patterns of the adolescent are not the precipitating factor of the food poisoning, and immunizations would not prevent this disease. Unless the family asks, it is not necessary to teach normal laboratory findings.

Clinical manifestations of metabolic alkalosis are similar to signs of A) hypocalcemia. B) hypokalemia. C) hypercalcemia. D) hyperkalemia.

Answer: A Manifestations of metabolic alkalosis result from decreased calcium ionization and are similar to those of hypocalcemia. They include numbness and tingling around the mouth, fingers, and toes; dizziness; Trousseau sign; and muscle spasm. Clinical manifestations of metabolic alkalosis are not similar to those of hypercalcemia or hyper- or hypokalemia.

A client with hyperaldosteronism is admitted to the unit and is at risk for impaired gas exchange. In which position should this client be placed to enhance gas exchange? A) Fowler position B) Prone position C) Left side-lying position D) Right Sims position

Answer: A The client with hyperaldosteronism with metabolic alkalosis will likely have reduced oxygenation. The Fowler position will facilitate alveolar ventilation with improved oxygenation. Side-lying and prone positions do not facilitate needed lung expansion.

The nurse identifies the diagnosis Risk for Impaired Gas Exchange to guide the care of a client with metabolic alkalosis. Which assessment data supports this nursing diagnosis? Select all that apply. A) Respiratory rate 8 per minute B) Oxygen saturation 89% C) Urine output 25 mL/hr D) Restlessness and agitation E) Weight loss of 3 kg overnight

Answer: A, B, D Respiratory compensation for metabolic alkalosis depresses the respiratory rate and reduces the depth of breathing to promote carbon dioxide retention. The depressed respiratory drive associated with metabolic alkalosis can lead to hypoxemia and impaired oxygenation of tissues. Oxygen saturation levels of less than 90% indicate significant oxygenation problems. Changes in mental status or behavior may be early signs of hypoxia. Urine output less than 30 mL/hr would indicate fluid volume deficit. Weight is used as an indicator of fluid balance. A rapid weight change would indicate fluid volume deficit.

The nurse is caring for a client who has been admitted to the hospital for congestive heart failure. Which data collected during the nursing assessment indicate that the client is at risk for metabolic alkalosis? Select all that apply. A) The client takes furosemide (Lasix) daily. B) The client takes a baby aspirin once daily. C) The client takes metformin daily. D) The client frequently uses calcium carbonate (Tums) for acid indigestion. E) The client takes acetaminophen as needed for pain.

Answer: A, D Excessive use of calcium carbonate and daily use of furosemide can cause metabolic alkalosis. Use of metformin is not associated with alkalosis. Overuse of aspirin can be associated with metabolic acidosis. Occasional use of acetaminophen is not associated with metabolic alkalosis.

The nurse is planning care for the client with Cushing syndrome who has been admitted for complications related to the disease process. Which intervention should the nurse plan for this client to improve the impaired gas exchange? A) Monitor serum electrolytes. B) Schedule nursing activities to allow for periods of rest. C) Assess input and output accurately. D) Administer IV fluids per practitioner order.

Answer: B The client with Cushing syndrome is at risk for developing severe metabolic alkalosis that causes hypoxemia and limits energy reserves. Spacing nursing activities throughout the day allows the client ample rest time. The other interventions are aimed at the deficient fluid volume that may occur with metabolic alkalosis.

A client with severe metabolic alkalosis is admitted to the unit. Which is the priority for the client? A) Administering medication for metabolic alkalosis B) Monitoring oxygen saturation C) Teaching the client the risk factors for metabolic alkalosis D) Setting goals for the client with metabolic alkalosis

Answer: B The priority for this client is monitoring oxygen saturation. The depressed respiratory drive that often accompanies metabolic alkalosis can lead to hypoxemia and impaired oxygenation of the tissues. Administering medications will be needed as a treatment, but the priority is to discover the cause. Teaching the client and setting goals are important aspects of nursing care but are not the priority.

A client is admitted with manifestations of metabolic alkalosis. Which diagnostic test findings support the admitting diagnosis? Select all that apply. A) Serum glucose level 142 mg/dL B) Blood pH 7.47 and bicarbonate 34 mEq/L C) Intravenous pyelogram shows kidney stones D) Bilateral lower lobe infiltrates noted on chest x-ray E) Electrocardiogram changes consistent with hypokalemia

Answer: B, E In metabolic alkalosis, the blood pH will be greater than 7.45 and the bicarbonate level greater than 26 mEq/L. The ECG pattern shows changes similar to those seen with hypokalemia. Serum glucose levels, kidney stones, and lower lobe infiltrates are not associated with metabolic alkalosis.

During an assessment, the nurse becomes concerned that a client is at risk for developing metabolic alkalosis. What did the nurse assess that caused this concern? A) Daily ingestion of a banana with breakfast B) Daily weight consistent C) Daily use of sodium bicarbonate for gastric upset D) Daily use of prescribed nonsteroidal anti-inflammatory drugs (NSAIDs) for arthritic pain

Answer: C Excess bicarbonate usually occurs as a result of ingesting antacids that contain bicarbonate, such as sodium bicarbonate or Alka-Seltzer. Daily ingestion of a banana would prevent the development of hypokalemia from the daily use of sodium bicarbonate. Consistent daily weights would indicate fluid balance. Daily use of NSAIDs would not support the development of metabolic alkalosis.

The client has been vomiting for several days. The nurse knows that the client is at risk for metabolic alkalosis because gastric secretions have which characteristic? A) Gastric secretions are green in color. B) Gastric secretions are alkaline. C) Gastric secretions are acidic. D) Gastric secretions have a foul smell.

Answer: C Metabolic alkalosis due to loss of hydrogen ions usually occurs because of vomiting or gastric suction. Gastric secretions are highly acidic (pH 1-3). When these are lost through vomiting or gastric suction, the alkalinity of body fluids increases. This increased alkalinity results from the loss of acid and from selective retention of bicarbonate by the kidneys as chloride is depleted. Gastric secretions are not alkaline. The color and odor of gastric secretions have no influence on the development of metabolic acidosis.

The nurse is preparing to discharge a client with congestive heart failure on furosemide (Lasix). The nurse determines that teaching has been effective if the client makes which statement? A) "I will use only sodium bicarbonate as my antacid." B) "I will restrict my intake of fluids." C) "I will use potassium supplements while I am taking Lasix." D) "I will take antacids only for my gastric discomforts."

Answer: C The client on furosemide (Lasix) may lose excess potassium, disposing the client toward metabolic alkalosis. The client is taught to refrain from the use of sodium antacids when prone to metabolic alkalosis. The client should consult with the primary care provider for gastric distress rather than self-medicate. The client who is prone to metabolic alkalosis is likely to have fluid deficits and would not be instructed to restrict fluids.

During a home visit, the nurse evaluates teaching provided to a client recently hospitalized for metabolic alkalosis. Which observation indicates that additional teaching is required? A) Drinks 2 cups of black coffee each day. B) Consumes one orange each day with breakfast. C) Ingests bicarbonate of soda after each meal. D) Monitors and tracks daily weights.

Answer: C The indiscriminate ingestion of sodium bicarbonate is a risk factor for the development of metabolic alkalosis. Black coffee is not associated with the development of metabolic alkalosis. Oranges contain potassium, which is beneficial to prevent the development of metabolic alkalosis. Tracking of daily weights would help detect a fluid imbalance, which is associated with metabolic alkalosis.

While reviewing laboratory results, the nurse notes that a client's potassium level is 2.8 mEq/L and chloride level is 100 mEq/L. Based on this data, which intervention does the nurse plan for this client? A) Preparing to administer 0.9% sodium chloride infusion B) Measuring for nasogastric tube insertion C) Discussing potassium chloride replacement therapy with the healthcare provider D) Reviewing implications of transfusing with ammonium chloride

Answer: C Treatment of metabolic alkalosis includes restoring normal fluid volume and administering potassium chloride. The potassium restores serum and intracellular potassium levels, allowing the kidneys to conserve hydrogen ions more effectively. Because the chloride level is within normal limits, an infusion of 0.9% sodium chloride is not indicated. A nasogastric tube is not indicated for this client. There is not enough information to support the use of ammonium chloride for this client, as it is indicated to treat severe metabolic alkalosis.

The nurse is planning care for the client who has been admitted with metabolic alkalosis. Which are appropriate nursing diagnoses for this client during the acute phase of the illness? Select all that apply. A) Ineffective Health Maintenance B) Risk for Hypothermia C) Deficient Fluid Volume D) Risk for Impaired Gas Exchange E) Risk for Injury

Answer: C, D, E Respiratory compensation for metabolic alkalosis includes depression of the respiratory rate and reduction of the depth of respirations, leading to the retention of carbon dioxide. Patients with metabolic alkalosis often have an accompanying fluid volume deficit. With the fluid volume deficit, the client would experience hyperthermia. Ineffective health maintenance would not be a priority during the acute phase of the disease but, rather, a teaching opportunity before discharge depending on the cause of the metabolic alkalosis. The client is at risk for injury because of the associated muscle spasms and dizziness.

The nurse is caring for a client who is receiving massive blood transfusions secondary to hypovolemic shock. Which rationale supports assessing this client for metabolic alkalosis? A. Excessive blood transfusions cause hypokalemia B. Citrate toxicity decreases serum ionized calcium C. Hypovolemic shock increases the serum pH D. Heparin found in blood products decreases serum potassium

B) Citrate toxicity decreases serum ionized calcium Rationale: Citrate is a preservative found in blood products. Citrate toxicity decreases serum ionized​ calcium, leading to metabolic alkalosis. Hypovolemic shock generally causes a decrease in the serum pH. Excessive blood transfusions are more likely to cause an allergic reaction not cause hypokalemia. Heparin found in blood products affects the coagulation of the blood and does not affect serum potassium.

Which assessment data should the nurse use to most accurately determine fluid balance for the client with metabolic alkalosis? A. Lab values indicating hypokalemia B. Client weight gain of 2.4 lb in the past 24 hours C. Excess intake balance of 500 mL for the most recent 12-hour shift D. Decrease in client systolic BP of 20 since the last reading

B) Client weight gain of 2.4 lbs in past 24 hours Rationale: Clients with metabolic alkalosis often have accompanying fluid volume deficit. The most accurate reflection of fluid balance is rapid weight changes. Thus the weight gain of 2.4 lb in the past 24 hours would be the most accurate indicator of fluid balance. Lab​ values, intake and​ output, and blood pressure can also reflect fluid balance changes but are not the most accurate indicators of fluid balance.

A toddler returns from the PACU after having an appendectomy. Upon assessment, the nurse notes a dysrhythmia on the child's ECG and a positive Trousseau sign. The client is diagnosed with metabolic alkalosis. Which nursing intervention is the most appropriate for this client? A. Weigh the client every other day B. Place the client in high-Fowler position C. Assess respiratory status every shift D. Monitory for bradycardia

B) Place the client in high-Fowler position Rationale: A client who is diagnosed with metabolic alkalosis will require positioning in Fowler or​ high-Fowler position to decrease the work of breathing. Respiratory status should be monitored every 2​ hours, the client should be weighed every​ day, and the nurse should monitor for​ tachycardia, not bradycardia. Next Question

The nurse is providing care for a client with suspected metabolic alkalosis. Which clinical manifestation would support diagnosis of metabolic alkalosis? SATA A. Headache B. Hypotension C. Seizures D. Tetany E. Hyper ventilation

B, C, D Hypotension Seizures Tetany Rationale: Hypotension,​ seizures, and tetany are all clinical manifestations of metabolic alkalosis. Additional clinical manifestations include​ confusion, decreasing level of consciousness​ (LOC), dysrhythmias, and respiratory failure. Headache and hyperventilation are clinical manifestations of metabolic acidosis.

During a review of medications for an 83 year old client, the nurse finds that the client has been frequently using sodium bicarbonate for heartburn. What action should the nurse take in response to this information? A. Immediately obtain diagnostic studies to ensure that metabolic alkalosis isn't occurring B. Inform client that it's acceptable to use this antacid if fluid intake is adequate C. Advise client to use other antacid preparations without sodium bicarb D. Alert the client to possible side effects related to the use of sodium bicarb

C) Advise client to use other antacid preparations without sodium bicarb Rationale: Use of sodium bicarbonate antacids can predispose clients to metabolic alkalosis. The nurse should advise the client to use a different antacid preparation. Alerting the client to possible side effects would not decrease the potential for metabolic alkalosis. Adequate fluid intake does not offset the risk of metabolic alkalosis with sodium bicarbonate use. There is no information in the scenario that would indicate the need for immediate diagnostic studies. Next Question

The long-term care nurse is teaching an orientation class concerning care of older adult clients to new assistive personnel. Which would the nurse include as important to ensure for the older adult clients to address a change in aging and to decrease the risk for development of metabolic alkalosis? A. Ensure high-protein shakes and supplements are offered frequently B. Ensure that the older adult eats balanced meals C. Ensure that the older adult has adequate fluid intake D. Ensure that the older adult receives only a small amount of caffeinated fluids

C) Ensure that the older adult has adequate fluid intake Rationale: Older adults have a diminished sense of thirst and can become volume depleted very​ quickly; thus, ensuring adequate fluid intake is important to help prevent the development of metabolic alkalosis. Ensuring balanced​ meals, limited caffeinated​ fluids, and frequent protein​ shakes/supplements neither address the change of​ age-related thirst nor directly affect the potential development of metabolic alkalosis

The nurse is teaching the parents of an infant with pyloric stenosis about potential acid-base imbalances that may occur. Which acid-base imbalance is most likely for the infant with pyloric stenosis? A. Respiratory acidosis B. Metabolic acidosis C. Metabolic alkalosis D. Respiratory alkalosis

C) Metabolic Alkalosis Rationale: Infants with pyloric stenosis have prolonged​ vomiting, which can cause metabolic alkalosis due to the loss of hypochloric acid. The nurse should teach the parents the signs and symptoms of metabolic alkalosis.

Which client being monitored for the potential development of metabolic alkalosis is the highest priority? A. A client with excessive diarrhea B. A client with a sodium chloride IV solution C. A client experiencing ketoacidosis D. A client with continuous gastric suctioning

D) A client with continuous GI suctioning Rationale: Continuous gastric suction results in acid​ loss/excretion, thus contributing to the potential development of metabolic alkalosis. The nurse should carefully monitor this client for metabolic alkalosis. Excessive​ diarrhea, ketoacidosis, and sodium chloride intravenous solutions can all contribute to the potential development of metabolic acidosis.

A client is diagnosed with metabolic alkalosis. Which healthcare prescriber's order should the nurse expect to assist in restoring this imbalance? A. Administer a bronchodilator B. Administer IV insulin C. Administer sodium bicarb D. Administer potassium chloride

D) Administer potassium chloride Rationale: In metabolic​ alkalosis, the administration of potassium restores serum and intracellular potassium​ levels, allowing the kidneys to conserve hydrogen ions. Sodium bicarbonate is used to treat metabolic​ acidosis, not metabolic alkalosis. IV insulin is used to treat diabetic​ ketoacidosis, which occurs with metabolic​ acidosis, not metabolic alkalosis. Bronchodilators are used to treat respiratory​ acidosis, not metabolic alkalosis.

The nurse is caring for a client admitted to a medical-surgical unit after a car-crash. The client received several units of packed red blood cells while in surgery. The nurse begins to monitor this client for metabolic alkalosis die to receiving blood transfusions. Which other item in the client's health history would place this client at an increased risk for developing metabolic alkalosis? A. History of depression B. History of breast cancer C. History of two miscarriages D. History of low potassium

D) History of low potassium Rationale: A history of​ hypokalemia, or low​ potassium, in addition to the numerous blood​ transfusions, would place this client at risk for metabolic alkalosis. Histories including two​ miscarriages, breast​ cancer, or depression do not place this client at a higher risk for developing metabolic alkalosis.