metabolic alkalosis nclex

A​ toddler-age client returns from the postanesthesia care unit​ (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?

​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.

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 due 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?

​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.

What action supports the​ nurse's plan of care for treating impaired gas exchange in the client with metabolic​ alkalosis? (Select all that​ apply.)

​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? (Select all that​ apply.)

​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.

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?

​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?

​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.

Which client being monitored for the potential development of metabolic alkalosis is the highest​ priority?

​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.

The nurse is providing care for a client with suspected metabolic alkalosis. Which clinical manifestation would support a diagnosis of metabolic​ alkalosis? (Select all that​ apply.)

​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.

A client is diagnosed with metabolic alkalosis. Which healthcare​ prescriber's order should the nurse expect to assist in restoring this​ imbalance?

​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 assessing the arterial blood gases and a metabolic panel for a client with suspected metabolic alkalosis. Which finding would support this​ diagnosis? (Select all that​ apply.)

​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). Next Question

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?

​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.

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? (Select all that​apply.)

​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.

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?

​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 caring for a client diagnosed with metabolic alkalosis. Which intervention should the nurse include when establishing the plan of​ care?

​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? (Select all that​ apply.)

​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

Which laboratory or diagnostic test is used to diagnose metabolic​ alkalosis? (Select all that​ apply.)

​Rationale: The 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.

A nurse is caring for a client whose arterial blood gas​ (ABG) results are as​ follows: pH 7.47 PCO2 35 PO2 90 HCO3 35 Which pharmacological therapy will the nurse anticipate administering for this client to help restore the​ client's aciddash-base ​balance? (Select all that​ apply.)

​Rationale: This client has metabolic alkalosis. Pharmacological therapy for this condition includes potassium​ chloride, sodium​ chloride, and ammonium chloride. The potassium restores serum and intracellular potassium​ levels, allowing the kidneys to conserve hydrogen ions more effectively. Chloride promotes renal excretion of bicarbonate. Sodium chloride solutions restore fluid volume deficits that can contribute to metabolic alkalosis. In severe​ alkalosis, an acidifying solution such as ammonium chloride may be administered. While this client may have other electrolyte​ imbalances, magnesium chloride and calcium chloride are not typical therapies for the treatment of metabolic alkalosis.

Which intervention should the nurse implement to monitor for fluid volume deficit in the client with metabolic​ alkalosis? (Select all that​ apply.)

​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.

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?

​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.

A nurse is caring for a client who is diagnosed with metabolic alkalosis. Which should the nurse include in the assessment of this​ client? (Select all that​ apply.)

​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.