NSG252 - EAQ Sherpath - Lewis Acid Base

A family member takes an older adult patient with dementia to the emergency room; the patient is found to be hypercarbic. The patient's advanced directive indicates use of noninvasive procedures only. Which statement would be the nurse's best response when the family asks if this issue will resolve by itself? "The kidneys will begin to compensate for increased levels of CO2 within 24 hours." "The kidneys sense increased levels of CO2 in the blood and conserve HCO3 and secrete increased H+ "Older adults have a harder time compensating because they have decreased respiratory and kidney functions. "The respiratory center senses increased levels of CO2, in the blood and stimulates hyperventilation to compensate.

"Older adults have a harder time compensating because they have decreased respiratory and kidney functions. Rationale All statements are true; however, the best response to the family's question addresses the difficulty older adults have with acid-base compensation because of the decreased respiratory and kidney functions. Hypercarbia is an increased level of CO2 in the blood, which is a hallmark of respiratory acidosis. Older adults have difficulty compensating for acid-base imbalances because of decreased functional capacity in the respiratory and renal systems. Hyperventilation is a normal physiologic response to hypercarbia; hyperventilation may not be possible with decreased functional respiratory reserves. Normal kidneys can sense hypercarbia and begin to reabsorb buffer to normalize pH; however, older adults may lack the functional capacity or have some degree of kidney disease. Normal renal compensation is slow and will often begin within 24 hours, if kidney function is normal.

Which statement would the intensive care nurse use to address the family's concern about the patient's respiratory acidosis? "This disease is treated with mechanical ventilation to ensure oxygenation of tissues." "This disease is treated with medications such as bicarbonate because the kidneys are injured." "Respiratory acidosis is not something to worry about within the overall treatment regimen." "Respiratory acidosis is not a disease but a symptom of a larger disease process we will treat separately.

"Respiratory acidosis is not a disease but a symptom of a larger disease process we will treat separately. Rationale An acid-base imbalance like respiratory acidosis is not a disease but a symptom of an underlying health problem that must be treated to correct the imbalance. Medications such as sodium bicarbonate may be used to treat acidosis in critically ill patients; however, the acidosis is related to respirations, not kidney injury. Also, the acidosis is not a disease, but a symptom. Mechanical ventilation may assist in correcting the respiratory components of acid-base imbalances, but acidosis is a symptom of respiratory dysfunction (in this case), not a disease. Respiratory acidosis is a potentially deadly imbalance that warrants monitoring and treatment to prevent further complications.

A patient with metabolic acidosis asks how the acid-base imbalance will be corrected. Which response would the nurse use? Select all that apply. "Medications are the primary treatment for acute acid-base imbalances occurring in critically ill patients." "The renal system compensates slowly, usually reacting to pH changes within 24 hours." "The respiratory system can compensate quickly to changes in pH and reacts in a matter of minutes." "The heart is vital in managing the acid-base balance and regulates perfusion to increase or decrease pH. "The buffer system is the primary manner by which the body changes strong acids into weaker ones to maintain pH balance"

"The renal system compensates slowly, usually reacting to pH changes within 24 hours." "The respiratory system can compensate quickly to changes in pH and reacts in a matter of minutes." "The buffer system is the primary manner by which the body changes strong acids into weaker ones to maintain pH balance" Rationale The buffer system is the primary method by which the body maintains acid-base balance. This system is also the quickest, often working within seconds of sensing an imbalance. The respiratory system can compensate by changing the rate and depth of breathing within minutes of sensing an acid-base derangement; the renal system is slower to react, often working within hours to days. The heart is vital in regulating perfusion but does not have a major role in managing acid-base balance. Medications can be used to regulate acid-base imbalances, but the primary treatment is to resolve the underlying cause of the imbalance.

An emergency department patient presents with lethargy and confusion, and arterial blood gases reflect metabolic acidosis. The family reports a history of "heart problems" and voices concern about the acidosis affecting the heart. Which response would the nurse use to address the family's concern? "Acidosis may affect the patient's blood pressure but not the heart's electrical pathways." "Acidosis is often temporary and never life-threatening; this situation is nothing to worry about." "Metabolic acidosis is a symptom of an underlying disorder for which we will evaluate and treat during this admission. "Uncompensated acidosis can cause hypotension and cardiac dysrhythmias; we will monitor and work to prevent these complications.

"Uncompensated acidosis can cause hypotension and cardiac dysrhythmias; we will monitor and work to prevent these complications. Rationale Uncompensated and untreated acidosis of any type can prove life-threatening because of its untoward downstream effects on the cardiac system in the form of hypotension and dysrhythmias. The nurse should assure the family that the medical team will monitor for and work to prevent these complications. Metabolic acidosis is a symptom of an underlying disease that must be treated; however, profound acidosis must be monitored and treated as well. Acidosis can in fact be life-threatening. Changes in blood pressure have a direct effect on the heart and the circulatory systems, both of which are affected in untreated and uncompensated acidosis.

A patient's laboratory reports a sodium concentration of 143 mmol/L and the sum of chloride and bicarbonate ion concentration is 132 mol/L. Which value would the nurse calculate for this patient's anion gap? Record your answer using a whole number.

11 Rationale The anion gap is calculated by subtracting the concentration of anions from the concentration of cations in the blood. The sum of chloride and bicarbonate ions yields an anion concentration of 132 mmol/L. The cation concentration is the sodium concentration: 143 mmol/L. Simply subtract 132 from 143 to get 11 mmol/L

Which reference interval indicates the normal arterial blood gas values for the partial pressure of carbon dioxide (PaCO2) parameter? 25 to 35 mm Hg 35 to 45 mm Hg 45 to 55 mm Hg 55 to 65 mm Hg

35 to 45 mm Hg Rationale The normal value of partial pressure of carbon dioxide (PaCO2) in arterial blood lies between 35 and 45 mm Hg.

When evaluating the partial pressure carbon dioxide (PaCO2) parameter within a patient's arterial blood gas report, which value indicates the compensatory response to a patient's metabolic alkalosis? 38 mm Hg 40 mm Hg 44 mm Hg 47 mm Hg

47 mm Hg Rationale Decreased amounts of carbonic acid (HCO3) (example: vomiting) results in the development of metabolic alkalosis. Therefore to increase the concentration of acid, the respiratory rate is reduced, and carbon dioxide (CO2) is retained. This respiration rate reduction leads to a rise in CO2 concentration in the blood. Normal values of partial pressure of carbon dioxide (PaCO2) range from 35 to 45 mm Hg; 47 mm Hg of PaCO2 indicates a compensatory response to a patient's metabolic alkalosis.

Upon review of blood pH values, which value would cause the nurse to determine that the patient is acidotic? 7.25 7.35 7.45 7.55

7.25 Rationale Blood pH normally ranges from 7.35 to 7.45, so acidosis occurs when the blood pH drops below 7.35. Though the patient will have acidosis if the blood pH is at 7.25 or lower, the patient will also have acidosis if the blood pH is lower than 7.35. Blood pH values of 7.35 and 7.45 are within the normal range. A blood pH of 7.55 indicates alkalosis, not acidosis.

Which reference interval is the normal range for the pH parameter of arterial blood? 7.05 to 7.15 7.15 to 7.25 7.25 to 7.35 7.35 to 7.45

7.35 to 7.45 Rationale The normal range of blood pH is 7.35 to 7.45. A pH less than 7.35 indicates acidosis.

The nurse determines that a patient's multilumen central venous access device (CAVD) is missing one of the injection caps, and the patient is exhibiting clinical manifestations of respiratory distress, hypotension, and tachycardia. Which action would the nurse implement first? Administer oxygen via nasal cannula. Notify the health care provider. Reposition patient to left side, head down. Adjust the IV fluids via the CAVD.

Administer oxygen via nasal cannula. Rationale The cap off the central line could potentially allow entry of air into the circulation. For an air embolus from any source, the priority is to administer oxygen. Next, clamp the CAVD catheter and position the patient on the left side with the head down. Then the health care provider is notified. IV fluid is not needed in this scenario and could worsen the patient's respiratory status. However, use of the CAVD and rate adjustments depend on provider orders.

Shortly after inserting a central venous assess device (CVAD) into the subclavian vein, the patient experiences shortness of breath, anxiety, and restlessness. Which intervention would the nurse implement? Administer a sedative. Advise the patient to relax. Auscultate patient breath sounds. Obtain an arterial blood gas analysis.

Auscultate patient breath sounds. Rationale Because this is an acute episode, the nurse should first listen to the patient's lungs to see whether anything has changed. In this situation, the probability is high that the patient sustained a pneumothorax during the subclavian IV catheter insertion procedure. The patient will need oxygen, and the health care provider should be notified of the findings. Administering a sedative is not appropriate. Advising the patient to relax does provide reassurance because the anxiety and restlessness are probably due to hypoxia. Obtaining an arterial blood gas analysis would likely be the next nursing action.

Which acid-base mechanisms would the kidney use to buffer a patient's acidosis (serum pH <7.35)? Select all that apply. Eliminating excess H+ Excreting excess water Eliminating excess CO2 Reabsorbing additional HCO3 Reabsorbing additional sodium ions

Eliminating excess H+ Reabsorbing additional HCO3 Rationale As a compensatory mechanism, the pH of the urine can decrease to 4 or increase to 8. To compensate for acidosis, the kidneys can reabsorb additional HCO3 and eliminate excess H *. Thus, the pH of the blood increases and the pH of the urine decreases (more acidic). Eliminating excess water or CO 2 or reabsorbing additional sodium ions are not mechanisms of acid-base buffers.

For which clinical manifestations or disorders would the nurse monitor a patient for the development of respiratory alkalosis? Select all that apply. Fever Hypoxia Pulmonary edema Pulmonary emboli Atelectasis

Fever Hypoxia Pulmonary emboli Rationale Respiratory alkalosis occurs when the plasma pH is increased and the PaCO2 is decreased (Remember ROME: Respiratory imbalances go in opposite directions). The most common causes of respiratory alkalosis are hypoxia, fever, and pulmonary emboli. These conditions are associated with hyperventilation. Pulmonary edema and chronic obstructive pulmonary disease (COPD) cause respiratory acidosis through hypoventilation.

The clinical manifestations of a patient with encephalitis led the nurse to suspect development of respiratory alkalosis. Which laboratory data supports the nurse's assessment? HCO3 18 mEg/L; PaCO2 30 mm Hg HCO3 22 mEq/L; PaCO2 35 mm Hg HCO3 24 mEg/L; PaCO2 43 mm Hg HCO3 26 mEg/L; PaCO2 45 mm Hg

HCO3 18 mEg/L; PaCO 2 30 mm Hg Rationale The normal range of bicarbonate (HCO3) ion concentration in blood is 22 to 26 mEq/L, and the normal range of partial pressure of carbon dioxide (PaCO2) is 35 to 45 mm Hg. When the respiratory center is stimulated, patients with encephalitis will hyperventilate. This condition causes a decrease in partial pressure of carbon dioxide, resulting in decreased carbonic acid concentration. Because the laboratory reports show a decreased partial pressure of carbon dioxide and bicarbonate ion concentration, the nurse suspects respiratory alkalosis.

Which primary acid-base imbalance would the nurse associate with a patient's clinical manifestations of abdominal pain, nausea, and severe diarrhea? Metabolic alkalosis Metabolic acidosis Respiratory alkalosis Respiratory acidosis

Metabolic acidosis Rationale Because gastric secretions are rich in hydrochloric acid, the patient with severe diarrhea will lose significant amounts of bicarbonate and is at increased risk for metabolic acidosis and a fall in pH. Metabolic alkalosis, respiratory alkalosis, and respiratory acidosis will not transpire when an increased loss of bicarbonate occurs.

A patient reports a headache, nausea, and four episodes of vomiting in the last two hours. The patient is taking deep, rapid breaths, and BP is 90/60 mm Hg. The nurse suspects development of which patient condition? Metabolic acidosis Metabolic alkalosis Respiratory acidosis Respiratory alkalosis

Metabolic acidosis Rationale Deep and rapid respirations are characteristic of Kussmaul respirations. Normal BP is 120/80 mm Hg. Kussmaul's respirations, low BP, nausea, vomiting, and headache are manifestations of metabolic acidosis. Therefore the nurse suspects that the patient has metabolic acidosis. Signs of metabolic alkalosis include tetany, nausea, and vomiting. Although headache and hypotension are seen in respiratory acidosis, clinical manifestations of nausea, vomiting, and rapid respirations are not observed. Respiratory alkalosis is characterized by tetany, anorexia, nausea, and vomiting.

A patient with diabetes mellitus presents to the emergency room with a blood sugar of 400 mg/dL. Which type of acid-base imbalance would the nurse monitor for the clinical manifestations? Metabolic acidosis Metabolic alkalosis Respiratory acidosis Respiratory alkalosis

Metabolic acidosis Rationale Diabetic ketoacidosis can occur in cases of uncontrolled hyperglycemia. This condition leads to acid accumulation, which causes metabolic acidosis. Respiratory acidosis is typically associated with chronic pulmonary diseases, such as chronic obstructive pulmonary disease. Respiratory alkalosis occurs in cases of hyperventilation; this condition leads to a decreased amount of acid in the blood and an elevated pH. Metabolic alkalosis occurs with the loss of acid and causes an elevated (alkalotic) pH.

Which condition would the nurse anticipate when waiting for arterial blood gas (ABG) results on a patient experiencing acute renal failure secondary to severe dehydration? Metabolic acidosis Metabolic alkalosis Respiratory acidosis Respiratory alkalosis

Metabolic acidosis Rationale Renal failure is the inability of the kidneys to excrete acid (H *). Therefore, the nurse suspects that the patient would develop metabolic acidosis. Metabolic alkalosis is caused by excess bicarbonate intake, nasogastric (NG) suctioning, or hypokalemia. Respiratory acidosis is caused by hypoventilation. Respiratory alkalosis is caused by hyperventilation.

A patient reports an inability to eat for the last 10 days and "feeling extremely weak and sick." Which acid-base imbalance would the nurse suspect when coordinating the clinical manifestations with the pending arterial blood gas (ABG) report? Metabolic acidosis Metabolic alkalosis Respiratory acidosis Respiratory alkalosis

Metabolic acidosis Rationale Starvation leads to production of lactic acid from the cells, resulting in metabolic acidosis. Metabolic alkalosis is caused by severe vomiting, gastric suction, and diuretic therapy. Factors such as chest wall abnormality and chronic obstructive pulmonary disease may cause respiratory acidosis. Septicemia, hypoxia, and anxiety cause respiratory alkalosis.

A patient with diabetes mellitus has been fasting since midnight and reports feeling dizzy. The nurse observes the deep, rapid breathing of Kussmaul respirations. Which condition would the nurse associate with this clinical manifestation? Metabolic acidosis Metabolic alkalosis Respiratory acidosis Respiratory alkalosis

Metabolic acidosis Rationale The patient has been fasting (NPO) and complains of dizziness. The patient has likely developed diabetic ketoacidosis, a type of metabolic acidosis. Kussmaul respiration is deep, rapid breathing developed in response to metabolic acidosis and is a compensatory mechanism to excrete excess carbon dioxide via the lungs. Metabolic alkalosis occurs when there is a loss of acid or a gain in bicarbonate and is not associated with Kussmaul respirations. Respiratory acidosis results when the person hypoventilates, carbonic acid accumulates in the blood, and the blood pH decreases. Respiratory alkalosis occurs when the person hyperventilates and expels carbon dioxide.

A patient admitted with gastroenteritis has an arterial blood gas (ABG) report of pH 7.30, PaO80 mm Hg, PaCO2 46 mm Hg, HCO3 14. Which interpretation would the nurse use to affirm nursing interventions? Metabolic acidosis Metabolic alkalosis Respiratory acidosis Respiratory alkalosis

Metabolic acidosis Rationale Use the memory device ROME. For respiratory conditions, the pH and the PaCO2 go in opposite directions. - Respiratory alkalosis: pH high and PaCO2 is low. - Respiratory acidosis: pH is low and the PaCO2 is high. In metabolic conditions, the pH and HCO3 go in the same direction ( equal). The PaCO2 may also go in the same direction. - Metabolic alkalosis: pH and HCO3 are high. - Metabolic acidosis: pH and HCO3 are high. A low pH (normal 7.35 to 7.45) indicates acidosis. In the patient with gastroenteritis and diarrhea, bicarbonate is lost from the excessive stool, which would result in a low bicarbonate level and resulting metabolic acidosis. There is not a respiratory component associated with gastroenteritis

The patient's arterial blood gas (ABG) values are pH 7.30, PaCO2 35 mm Hg, and bicarbonate (HCO3 ) 16 mEq/L. Which interpretation would the nurse use when updating the patient's plan of care? Metabolic acidosis Metabolic alkalosis Respiratory acidosis Respiratory alkalosis

Metabolic acidosis Rationale Use the memory device ROME. For respiratory conditions, the pH and the PaCO2 go in opposite directions. - Respiratory alkalosis: pH high and PaCO2 is low. - Respiratory acidosis: pH is low and the PaCO2 is high. In metabolic conditions, the pH and HCO3 go in the same direction ( equal). The PaCO2 may also go in the same direction. - Metabolic alkalosis: pH and HCO3 are high. - Metabolic acidosis: pH and HCO3 are high. Normal ABG values fall in the range of pH 7.35 to 7.45, PaCO2 35 to 45 mm Hg, and HCO3 22 to 26 mEq/L. Bicarbonate and pH values are less than the normal values (same direction) and indicate metabolic acidosis. A pH value less than 7.35 and a high PaCO2 (opposite direction) indicates respiratory acidosis.

The arterial blood gas (ABG) report of a patient with diabetes mellitus indicates a bicarbonate level of 18 mEg/L and pH of 7.32. Which acid-base imbalance would the nurse document? Metabolic acidosis Metabolic alkalosis Respiratory acidosis Respiratory alkalosis

Metabolic acidosis Rationale Use the memory device ROME. For respiratory conditions, the pH and the PaCO2 go in opposite directions. - Respiratory alkalosis: pH high and PaCO2 is low. - Respiratory acidosis: pH is low and the PaCO2 is high. In metabolic conditions, the pH and HCO3 go in the same direction ( equal). The PaCO2 may also go in the same direction. - Metabolic alkalosis: pH and HCO3 are high. - Metabolic acidosis: pH and HCO3 are high. The normal pH range of blood is 7.35 to 7.45, and the normal value of bicarbonate is 23 to 30 mEq/L. The patient's ABG report indicates metabolic acidosis. Metabolic alkalosis is manifested by an increased pH. A decreased pH and elevated PaCO2 indicate respiratory acidosis. Respiratory alkalosis is manifested by increased plasma pH and decreased PaCO2.

A hospitalized patient reports abdominal pain, nausea, and vomiting. Suspecting a bowel obstruction, for which primary acid-base imbalance would the nurse plan the patient's care, if the obstruction is high in the intestinal tract? Metabolic acidosis Metabolic alkalosis Respiratory acidosis Mixed alkalosis

Metabolic alkalosis Rationale Because gastric secretions are rich in hydrochloric acid, the patient who is vomiting will lose a significant amount of gastric acid and be at an increased risk for metabolic alkalosis. Metabolic acidosis is more likely with diarrhea than vomiting. Respiratory acidosis is associated with the lungs, not the gastrointestinal system. Mixed alkalosis may occur when a patient is hyperventilating because of pain and has a nasogastric (NG) tube to suction; each system is losing acid. The patient has metabolic alkalosis.

For the patient who sought medical treatment after vomiting for three days, which acid-base imbalance would the nurse determine the patient is at risk of developing? Metabolic acidosis Metabolic alkalosis Respiratory acidosis Respiratory alkalosis

Metabolic alkalosis Rationale Metabolic alkalosis can occur with prolonged vomiting secondary to the loss of strong gastric acids. Respiratory acidosis is caused by hypercarbia of respiratory origin. Metabolic acidosis is an increase in acid levels related to a metabolic dysfunction such as lactic acidosis, starvation, or diarrhea. Respiratory alkalosis occurs with hypocarbia related to hyperventilation.

When receiving long-term mineralocorticoid therapy, for which patient condition would the nurse evaluate associated clinical manifestations? Metabolic acidosis Metabolic alkalosis Respiratory acidosis Respiratory alkalosis

Metabolic alkalosis Rationale Mineralocorticoids are used to maintain salt and water balance. Excessive use of mineralocorticoids may cause loss of strong acids, resulting in metabolic alkalosis. Metabolic acidosis is caused by conditions that increase the acid concentration in the body, such as diabetic ketoacidosis. Respiratory acidosis occurs as a result of hypoventilation. Respiratory alkalosis occurs because of hyperventilation.

When admitting a patient with dehydration secondary to nausea and vomiting, which acid-base imbalance would the nurse use to plan the patient's care? Metabolic alkalosis Metabolic acidosis Respiratory acidosis Respiratory alkalosis

Metabolic alkalosis Rationale With nausea and vomiting, acid is lost from the gastrointestinal system, elevating the pH and causing metabolic alkalosis.There is not a respiratory component of this imbalance caused by nausea and vomiting. The pH would be low, resulting in an acidosis, not vomiting, if the patient had diarrhea.

A patient, recovering from a surgical procedure, has a nasogastric (NG) tube draining copious secretions and reports surgical site pain of 10 on a scale of 0 to 10. The patient's respirations are 32 breaths/minute. Which condition would the nurse associate with these clinical manifestations? Hypoxia and respiratory alkalosis Mixed respiratory and metabolic alkalosis Sedative overdose and respiratory acidosis Diabetic ketoacidosis and metabolic acidosis

Mixed respiratory and metabolic alkalosis Rationale A mixed acid-base disorder is a condition in which two or more disorders affecting the acid-base balance are present at the same time. Septicemia causes respiratory alkalosis, which causes an acid-base imbalance. Metabolic alkalosis also affects the acid-base balance. Thus septicemia and metabolic alkalosis are examples of a mixed acid-base disorder. Hypoxia causes respiratory alkalosis. Overdose of sedatives causes respiratory acidosis. Diabetic ketoacidosis results in metabolic acidosis. An example of a mixed acidosis is a patient in severe shock with poor perfusion and hypoventilation. Mixed alkalosis can occur in a patient hyperventilating because of postoperative pain and loss of acid secondary to NG suctioning.

A patient with chronic obstructive pulmonary disease (COPD) has arterial blood gas (ABG) results of pl 7.33, PaO2 47 mm Hg, PaCO2 60 mm Hg, HCO3 32 mEq/L, and O2 saturation of 92%. Which interpretation of the data would the nurse report to the primary care provider? Fully compensated respiratory alkalosis Partially compensated respiratory acidosis Normal acid-base balance with hypoxemia Normal acid-base balance with hypercapnia

Partially compensated respiratory acidosis Rationale Use the memory device ROME. For respiratory conditions, the pH and the PaCO2 go in opposite directions. - Respiratory alkalosis: pH high and PaCO2 is low. - Respiratory acidosis: pH is low and the PaCO2 is high. In metabolic conditions, the pH and HCO3 go in the same direction ( equal). The PaCO2 may also go in the same direction. - Metabolic alkalosis: pH and HCO3 are high. - Metabolic acidosis: pH and HCO3 are high. A low pH (normal 7.35 to 7.45) indicates acidosis. In the patient with a respiratory disease such as COPD, the patient retains carbon dioxide (normal 35 to 45 mm Hg), which acts as an acid in the body. For this reason, the patient has respiratory acidosis. The "other value" assists in compensation: the elevated HCO3 indicates a partial compensation for the elevated PaCO2 because the pH remains abnormal.

A patient, with chronic kidney disease, reports eating many nuts, bananas, peanut butter, and chocolate. The nurse's assessment indicates loss of deep tendon reflexes, somnolence, and altered respiratory status. Which treatment option would the nurse associate with these clinical findings? Renal dialysis IV furosemide (Lasix) IV potassium chloride IV normal saline at 250 mL per hour

Renal dialysis Rationale The patient will need renal dialysis to remove the excess serum magnesium from the increased intake of foods high in magnesium since renal function is not adequate. If renal function were adequate, IV potassium chloride would oppose the effects of magnesium on the cardiac muscle. IV furosemide and increased fluid would increase urinary output, which is the major route of excretion for magnesium.

After assessing four assigned patients, the nurse suspects a patient of developing respiratory alkalosis. Which patient's arterial blood gas values support the nurse's clinical findings? Patient A: pH 7.45, PaCO2 38, HCO3 24 Patient B: pH 7.62, PaCO2 30, HCO3 22 Patient C: pH 7.43, PaCO2 35, HCO3 25 Patient D: pH 7.37, PaCO2 39, HCO3 23

Patient B: pH 7.62, PaCO2 30, HCO3 22 Rationale Use the memory device ROME. For respiratory conditions, the pH and the PaCO2 go in opposite directions. - Respiratory alkalosis: pH high and PaCO2 is low. - Respiratory acidosis: pH is low and the PaCO2 is high. In metabolic conditions, the pH and HCO3 go in the same direction ( equal). The PaCO2 may also go in the same direction. - Metabolic alkalosis: pH and HCO3 are high. - Metabolic acidosis: pH and HCO3 are high. Potential clinical manifestations of a patient with respiratory alkalosis may include hyperventilation (e.g., hypoxia, anxiety, fear, pain, exercise, or fever), sepsis, stroke, brain injury, liver failure, or mechanical hyperventilation. Respiratory alkalosis is characterized by an increased pH and decreased carbon dioxide concentration (PaCO2) in blood. The normal values of blood pH, partial pressure of carbon dioxide (PaCO2), and bicarbonate ion (HO 3) are between 7.35 and 7.45, 35- and 45 mm Hg, and 22- and 26 mEg/L respectively. The increased pH and decreased PaCO2 in patient B are indicators of respiratory alkalosis.

After review of the laboratory reports of four patients, the health care provider writes orders to prepare one of the patients for intubation and mechanical ventilation. Which patient's reports indicate the need for this intervention? Patient A: pH 7.44, PaCO2 43 Patient B: pH 7.36, PaCO2 45 Patient C: pH 7.34, PaCO2 47 Patient D: pH 7.42, PaCO2 42

Patient C: pH 7.34, PaCO2 47 Rationale A need for mechanical ventilation arises when the patient is not able to breathe properly. This is manifested by decreased oxygen and increased carbon dioxide in blood. The normal partial pressure of carbon dioxide (PaCO2) value lies between 35 and 45 mm Hg, and the normal range of blood pH is 7.35 to 7.45. Patient C has an increased concentration of carbon dioxide (47; acidotic) in the blood and a low pH (7.34; acidotic), indicating that the patient has increased CO2 from hypoventilation and requires mechanical ventilation.

After assessing four assigned patients, the nurse suspects the patient receiving diuretic therapy for their chronic kidney disease has developed metabolic alkalosis. Which diagnostics support the nurse's assessment? Patient A: pH 7.30, PaCO2 37, HCO3 18 Patient B: pH 7.36, PaCO2 43, HCO3 22 Patient C: pH 7.40, PaCO2 45, HCO3 24 Patient D: pH 7.48, PaCO2 49, HCO3 26

Patient D: pH 7.48, PaCO2 49, HCO3 26 Rationale Use the memory device ROME. For respiratory conditions, the pH and the PaCO2 go in opposite directions. - Respiratory alkalosis: pH high and PaCO2 is low. - Respiratory acidosis: pH is low and the PaCO2 is high. In metabolic conditions, the pH and HCO3 go in the same direction ( equal). The PaCO2 may also go in the same direction. - Metabolic alkalosis: pH and HCO3 are high. - Metabolic acidosis: pH and HCO3 are high. The normal range of pH of blood ranges from 7.35 to 7.45, the normal partial pressure of carbon dioxide (PaCO2) ranges from 35 to 45 mm Hg, and the normal concentration of bicarbonate ion (HO 3) ranges from 22 to 26 mE/L. The laboratory reports of patient D indicate increased pH of blood and concentration of bicarbonate ion (HCO3). Because diuretic therapy causes loss of strong acids and retention of bases, there is a risk for metabolic alkalosis.

Which serum bicarbonate ion (HCO3 ) level would indicate a compensatory response in the patient experiencing respiratory acidosis? 24 mEg/L 25 mEg/L 26 mEg/L 27 mEg/L

Rationale The serum bicarbonate ion concentration increases as a compensatory response in patients with respiratory acidosis. The normal range of bicarbonate ion is 22 to 26 mE/L. Therefore, 27 mEg/L indicates a compensatory response.

The patient with a chest wall abnormality is scheduled for a surgical intervention. For which condition would the nurse carefully monitor the patient's arterial blood gases? Metabolic acidosis Metabolic alkalosis Respiratory acidosis Respiratory alkalosis

Respiratory acidosis Rationale A chest wall abnormality may cause difficulty in breathing, leading to hypoventilation. Hypoventilation may result in respiratory acidosis. Metabolic acidosis is caused by factors that increase the concentration of acid other than carbonic acid. Metabolic alkalosis occurs when contributing factors result in the loss of bicarbonate or a gain of acids. Respiratory alkalosis is caused by conditions triggering hyperventilation.

A patient reports a headache, dizziness, and fatigue and states, "I am not able to use this incentive spirometer anymore. Just too hard." Review of the electrocardiogram (ECG), X-rays, and laboratory reports indicate ventricular fibrillation, hypotension, and atelectasis. Which acid-base imbalance would the nurse associate with this patient's clinical manifestations? Metabolic acidosis Metabolic alkalosis Respiratory acidosis Respiratory alkalosis

Respiratory acidosis Rationale Clinical manifestations of respiratory acidosis include hypotension, headache, dizziness, and ventricular fibrillation. Atelectasis and decreased ability to use incentive spirometer also support hypoventilation and respiratory acidosis. Metabolic acidosis is manifested by headache, dizziness, and dysrhythmia. Metabolic alkalosis is manifested by tachycardia, anorexia, and tremors. Patients with respiratory alkalosis exhibit tachycardia, tetany, and epigastric pain.

For which potential complication would the nurse monitor associated clinical manifestations when providing care for a patient with Guillian-Barré syndrome, an autoimmune disorder? Metabolic acidosis Metabolic alkalosis Respiratory acidosis Respiratory alkalosis

Respiratory acidosis Rationale Guillain-Barré syndrome is a progressive autoimmune, neurological disorder affecting the peripheral nervous system and resulting in muscle weakness and eventual paralysis. The muscle weakness progresses to involvement of the diaphragm, which affects the respiratory system resulting in hypoventilation. Hypoventilation increases the concentration of retained carbonic acid, which results in respiratory acidosis. Metabolic acidosis, metabolic alkalosis, and respiratory alkalosis are not caused by Guillain-Barré syndrome.

The arterial blood gas (ABG) results for a patient who overdosed on barbiturates are pH 7.32, PaCO2 52, and HCO3 23. Which interpretation would the nurse use when planning the patient's care? Metabolic acidosis Metabolic alkalosis Respiratory acidosis Respiratory alkalosis

Respiratory acidosis Rationale Use the memory device ROME. For respiratory conditions, the pH and the PaCO2 go in opposite directions. - Respiratory alkalosis: pH high and PaCO2 is low. - Respiratory acidosis: pH is low and the PaCO2 is high. In metabolic conditions, the pH and HCO3 go in the same direction ( equal). The PaCO2 may also go in the same direction. - Metabolic alkalosis: pH and HCO3 are high. - Metabolic acidosis: pH and HCO3 are high. Normal pH is 7.35 to 7.45. pH values <7.35 indicates acidosis. Normal value for PaCO2 is 35 to 45 mm Hg. Because the HCO3 is low normal and the PaCO2 is elevated (opposite direction of pH), the source of the acidosis is respiratory. The patient is in respiratory acidosis. Kidneys are attempting compensation because the other value (HCO3 is low normal) and pH remains < 7.35.

A patient's arterial blood gas (ABG) results are pH 7.32; PaCO2 56 mm Hg; HCO3 24 mEg/L. Which acid-base imbalance would the nurse use in development of the patient's plan of care? Metabolic acidosis Metabolic alkalosis Respiratory acidosis Respiratory alkalosis

Respiratory acidosis Rationale Use the memory device ROME. For respiratory conditions, the pH and the PaCO2 go in opposite directions. - Respiratory alkalosis: pH high and PaCO2 is low. - Respiratory acidosis: pH is low and the PaCO2 is high. In metabolic conditions, the pH and HCO3 go in the same direction ( equal). The PaCO2 may also go in the same direction. - Metabolic alkalosis: pH and HCO3 are high. - Metabolic acidosis: pH and HCO3 are high. The normal ranges are as follows: pl 7.35 to 7.45; PaCO2 35 to 45 mm Hg; HCO3 22-26 mEq/L. Respiratory acidosis (carbonic acid excess) occurs whenever a person experiences hypoventilation. Hypoventilation leads to a build-up of CO2, resulting in an accumulation of carbonic acid in the blood. Carbonic acid dissociates, liberating H+, and there is a decrease in pH (<7.35). The PaCO2 is > 45 (elevated) because the pH and PaCO2 are moving in opposite directions, the ABG report indicates respiratory acidosis. The patient is not experiencing a metabolic imbalance (acidosis or alkalosis) because the pH and the HCO3 are not moving in the same direction.

A patient with chronic obstructive pulmonary disease (COPD) has arterial blood gas (ABG) results of blood pH of 7.29, partial pressure of carbon dioxide (PaCO2) of 49 mm Hg, and a bicarbonate ion (HCO3) level of 25 mE/L. When developing the patient's plan of care, which condition would the nurse use? Metabolic acidosis Metabolic alkalosis Respiratory acidosis Respiratory alkalosis

Respiratory acidosis Rationale Use the memory device ROME. For respiratory conditions, the pH and the PaCO2 go in opposite directions. - Respiratory alkalosis: pH high and PaCO2 is low. - Respiratory acidosis: pH is low and the PaCO2 is high. In metabolic conditions, the pH and HCO3 go in the same direction ( equal). The PaCO2 may also go in the same direction. - Metabolic alkalosis: pH and HCO3 are high. - Metabolic acidosis: pH and HCO3 are high. The normal ranges of blood pH, partial pressure of carbon dioxide, and bicarbonate ion levels are 7.35 to 7.45, 75 to 100 mm Hg, and 22 to 26 mEg/L, respectively. Patients with COPD have difficulty breathing, which leads to hypoventilation. This causes a build-up of carbon dioxide in the blood, which increases the concentration of carbonic acid, leading to a decrease in blood pH. Thus, the patient is expected to have respiratory acidosis. In respiratory alkalosis, partial pressure of carbon dioxide decreases. Metabolic acidosis is manifested by decreased concentration of bicarbonate in blood. Respiratory alkalosis is manifested by decreased carbonic acid concentration in blood and decreased PaCO2.

A patient's arterial blood gas results are pH 7.33, PaCO2 50 mm Hg, PaO2 75 mm Hg, HCO3 24 mEg/L, and Sa02 81%. Which interpretation of the ABG data would the nurse correlate to the patient's clinical manifestations? Metabolic acidosis Metabolic alkalosis Respiratory acidosis Respiratory alkalosis

Respiratory acidosis Rationale Use the memory device ROME. For respiratory conditions, the pH and the PaCO2 go in opposite directions. - Respiratory alkalosis: pH high and PaCO2 is low. - Respiratory acidosis: pH is low and the PaCO2 is high. In metabolic conditions, the pH and HCO3 go in the same direction ( equal). The PaCO2 may also go in the same direction. - Metabolic alkalosis: pH and HCO3 are high. - Metabolic acidosis: pH and HCO3 are high. The pH is <7.35, indicating acidosis. This value eliminates metabolic and respiratory alkalosis as possibilities. Because the PaCO2 is high at 50 mm Hg (normal range is 35 to 45 mm Hg) and the metabolic measure of HCO3 is normal (range is 22 to 28 mEq/L), the patient is in respiratory acidosis, not alkalosis.

A patient's blood gas results are pH 7.31, PaO2 75 mm Hg, PaCO2 50 mm Hg, and HCO3 25 mEq/L. Suspecting hypoxia, which acid-base imbalance would the nurse associate with the patient's data? Metabolic acidosis Respiratory acidosis Respiratory alkalosis Compensating respiratory acidosis

Respiratory acidosis Rationale Use the memory device ROME. For respiratory conditions, the pH and the PaCO2 go in opposite directions. - Respiratory alkalosis: pH high and PaCO2 is low. - Respiratory acidosis: pH is low and the PaCO2 is high. In metabolic conditions, the pH and HCO3 go in the same direction ( equal). The PaCO2 may also go in the same direction. - Metabolic alkalosis: pH and HCO3 are high. - Metabolic acidosis: pH and HCO3 are high. This patient is not breathing effectively, and a build-up of carbon dioxide in the form of carbonic acid occurred. This action places the patient in an acidotic state because the pH < 7.35. Metabolic and respiratory alkalosis are therefore eliminated as possibilities. Because the PaCO2 is high at 50 mm Hg (normal range is 35 to 45 mm Hg) and the metabolic measure of HCO3 is normal at 25 mE/L (normal range is 22 to 28 mEg/L), the patient is in respiratory acidosis. The patient is not compensated because the HCO3 is still within normal range. If the HCO3 were increased, then this would indicate compensation.

A patient with a chronic obstructive pulmonary disease (COPD) exacerbation has an arterial blood gas (ABG) report of pH 7.34, PaCO2 46, PaO2 87, and oxygen saturation 94%. Which interpretation would the nurse use for the patient's plan of care? Metabolic acidosis Respiratory acidosis Respiratory alkalosis Normal acid-base balance

Respiratory acidosis Rationale Use the memory device ROME. For respiratory conditions, the pH and the PaCO2 go in opposite directions. - Respiratory alkalosis: pH high and PaCO2 is low. - Respiratory acidosis: pH is low and the PaCO2 is high. In metabolic conditions, the pH and HCO3 go in the same direction ( equal). The PaCO2 may also go in the same direction. - Metabolic alkalosis: pH and HCO3 are high. - Metabolic acidosis: pH and HCO3 are high. The normal pH is 7.35 to 7.45. The normal PaCO2 is 35 to 45 mm Hg, and normal PaO2 is greater than 80 mm Hg. Normal oxygen saturation is > 95%. With the low pH and high PaCO , the nurse can conclude respiratory acidosis, even without the bicarbonate level that usually is measured. This is not a normal ABG; the pH level is low, indicating acidosis. Because the patient is presenting with COPD and a slightly elevated PaCO2 this indicates that this is respiratory related.

After implementing prescribed therapy, the patient's arterial blood gas (ABG) report is pH 7.33, PaCO2 52 mm Hg, PaO2 81 mm Hg, HCO3 24 mEq/L, and Sa02 84%. Which acid-base imbalance would the nurse report when updating the health care provider? Metabolic acidosis Metabolic alkalosis Respiratory acidosis Respiratory alkalosis

Respiratory acidosis Rationale Use the memory device ROME. For respiratory conditions, the pH and the PaCO2 go in opposite directions. Respiratory alkalosis: pH high and PaCO2 is low. Respiratory acidosis: pH is low and the PaCO2 is high (patient pH of 7.33 is low and PaCO2 of 52 is high = respiratory acidosis). In metabolic conditions, the pH and HCO3 go in the same direction ( equal). The PaCO2 may also go in the same direction. Metabolic alkalosis: pH and HCO3 are high. Metabolic acidosis: pH and HCO3 are high (patient pH is low, HCO3 is normal, and PaCO2 is high = not metabolic).

A patient admitted to the postanesthesia care unit (PACU) after a partial thyroidectomy has deep-tendon hyperreflexia, a positive Chvostek's sign, and tachypnea. Which acid-base imbalance would the nurse seek affirmation by reviewing the postoperative arterial blood gas (ABG) report? Metabolic acidosis Metabolic alkalosis Respiratory acidosis Respiratory alkalosis

Respiratory alkalosis Rationale The parathyroid glands control the balance of calcium and are located adjacent to the thyroid. The glands may become bruised or inadvertently removed during a thyroidectomy. Hyperreflexia is a clinical manifestation of hypocalcemia, which is associated with weakness, fatigue, muscle cramps, laryngeal and bronchial spasms, tetany, seizures, a positive Chvostek's sign, and hyperventilation. Respiratory alkalosis is manifested by hyperreflexia and tachypnea because of altered calcium levels. Metabolic acidosis is manifested by abdominal pain and Kussmaul respirations. Tachycardia, anorexia, and muscle cramps are the manifestations of metabolic alkalosis. Headache, seizures, and hypotension are the manifestations of respiratory acidosis.

When evaluating a patient for acid-base imbalances, which questions would the nurse pose? Select all that apply. Raise questions about the patient's vaccination status. Solicit the extent and intensity of a patient's exercise routines. Raise questions about any special dietary practices. Solicit the patient's historical and current use of tobacco and smoking. Inquire about any deviations from usual bowel and bladder habits.

Solicit the extent and intensity of a patient's exercise routines. Raise questions about any special dietary practices. Inquire about any deviations from usual bowel and bladder habits. Rationale Any alterations in elimination (such as diarrhea or oliguria) can cause metabolic acid-base derangements. Weight reduction, fad diets, or eating disorders can all lead to acid-base problems. Vigorous exercise can increase metabolic demands and cause fluid and electrolyte losses that may alter acid-base balance. Vaccination status is an important part of health maintenance, but it will not provide information regarding acid-base deviations. Smoking status or tobacco use is also an important part of health promotion; however, this information is unlikely to help to assess for acute acid-base imbalances.

After receiving several respiratory treatments for an exacerbation of asthma, the patient's arterial blood gas (ABG) results are pH 7.40, PaCO2 40 mm Hg, HCO3 24 mEq/L, PaO2 92 mm Hg, and O2 saturation 99%. Which respiratory change would the nurse report to the oncoming shift? The patient's ABG's are within normal limits. A slight metabolic acidosis is evident to buffer the pH. The ABG report indicates mild respiratory acidosis. Compensation resulted in a mild respiratory alkalosis.

The patient's ABG's are within normal limits. Rationale Use the memory device ROME. For respiratory conditions, the pH and the PaCO2 go in opposite directions. - Respiratory alkalosis: pH high and PaCO2 is low. - Respiratory acidosis: pH is low and the PaCO2 is high. In metabolic conditions, the pH and HCO3 go in the same direction ( equal). The PaCO2 may also go in the same direction. - Metabolic alkalosis: pH and HCO3 are high. - Metabolic acidosis: pH and HCO3 are high. The normal pH is 7.35 to 7.45. Normal PaCO2 levels are 35 to 45 mm Hg, and normal HCO3 levels are 22 to 26 mEq/L. A normal Pa0 2 level is > 80 mm Hg. Normal oxygen saturation is > 95%. Because the patient's results all fall within these normal ranges, the nurse can conclude the patient's blood gas results are within normal limits.

Which rationale would the nurse use to explain events occurring when the respiratory center, located in the medulla, senses an increased concentration of carbon dioxide (CO 2) or H+? The respiratory center stimulates hyperventilation to get rid of CO2. The respiratory center stimulates a decreased rate of breathing to retain CO2. The respiratory center stimulates an increased depth of breathing to retain H+ The respiratory center stimulates a decreased depth of breathing to get rid of H+.

The respiratory center stimulates hyperventilation to get rid of CO2. Rationale Increased CO2 or H+ signals acidosis, which triggers the respiratory center to hyperventilate and get rid of CO2 to balance the pH. CO2 retention occurs to correct alkalosis. A decreased depth of breathing occurs in respiratory dysfunction. An increased depth of breathing occurs in hyperventilation; in this case, the body will expel CO2 to decrease H+

Which statement describes the function of a buffer? To excrete weak acids To secrete hydrogen ions To convert strong acids to weak acids To convert ammonia to ammonmium Ions

To convert strong acids to weak acids Rationale Buffers chemically convert strong acids to weak acids. Buffering is the primary regulator of acid-base balance in the body. Excretion of weak acids, secretion of hydrogen ions into the renal tubules of the nephron unit, and conversion of ammonia to ammonium ions are functions of the kidneys

The presence of which clinical manifestations would confirm the nurse's interpretation of metabolic alkalosis from interpretation of the patient's arterial blood gas (ABG)? Select all that apply. Tremors Vomiting Tachycardia Epigastric pain Numbness of limbs

Tremors Vomiting Tachycardia Rationale Tremors, vomiting, and tachycardia are signs of metabolic alkalosis. Epigastric pain and numbness of limbs are signs of respiratory alkalosis.

A patient's arterial blood gases, obtained after intubation, are pH of 7.28, a PaCO2 level of 50 mm Hg, a bicarbonate level of 25 mm Hg, and a PaO 2 level of 95 mm Hg. Which condition would the nurse report to the health care provider? Compensated metabolic acidosis Compensated respiratory alkalosis Uncompensated metabolic acidosis Uncompensated respiratory acidosis

Uncompensated respiratory acidosis Rationale Use the memory device ROME. For respiratory conditions, the pH and the PaCO2 go in opposite directions. - Respiratory alkalosis: pH high and PaCO2 is low. - Respiratory acidosis: pH is low and the PaCO2 is high. In metabolic conditions, the pH and HCO3 go in the same direction ( equal). The PaCO2 may also go in the same direction. - Metabolic alkalosis: pH and HCO3 are high. - Metabolic acidosis: pH and HCO3 are high. A pH of 7.28 implies acidosis because the lower range of blood pH is 7.35. An elevated PaCO2 level indicates the cause is respiratory, and a normal bicarbonate level indicates compensation has not yet occurred. Thus, this patient appears to be experiencing uncompensated respiratory acidosis. Uncompensated metabolic acidosis is associated with a low pH, a low bicarbonate level, and a low to normal PaCO2 level. Compensated respiratory alkalosis is associated with a mildly elevated pH, a decreased PaCO2 level, and a decreased bicarbonate level. Compensated metabolic acidosis is associated with a mildly decreased pH, a decreased bicarbonate level, and an increased PaCO2 level.

Which arterial blood gas (ABG) data correspond with a patient's clinical manifestations of respiratory alkalosis? pH 7.46, PaCO2 44 mm Hg, PaO2 95 mm Hg, and HCO3 36 mEg/L pH 7.27, PaCO2 70 mm Hg, Pa02 80 mm Hg, and HCO3 26 mEq/L pH 7.30, PaCO2 35 mm Hg, Pa02 70 mm Hg, and HCO3 20 mEg/L pH 7.52, PaCO2 24 mm Hg, PaO2 85 mm Hg, and HCO3 24 mEg/L

pH 7.52, PaCO2 24 mm Hg, PaO2 85 mm Hg, and HCO3 24 mEg/L Rationale Use the memory device ROME. For respiratory conditions, the pH and the PaCO2 go in opposite directions. - Respiratory alkalosis: pH high and PaCO2 is low. - Respiratory acidosis: pH is low and the PaCO2 is high. In metabolic conditions, the pH and HCO3 go in the same direction ( equal). The PaCO2 may also go in the same direction. - Metabolic alkalosis: pH and HCO3 are high. - Metabolic acidosis: pH and HCO3 are high. The patient is experiencing alkalosis because the pH is > 7.45. The alkalosis is of a respiratory origin because the carbon dioxide is < 35 (pH and PaCO2 are moving in opposite directions) and the HCO3 is within normal range. Normal arterial blood gas values include pH 7.35 to 7.45, PaCO2 35 to 45, HCO 322 to 26. A pH of 7.46, PaCO 2 of 44 mm Hg, PaO2 of 95 mm Hg, and HCO3 of 36 mEq/L indicate metabolic alkalosis because pH is increased, the PaCO2 is normal, and the HCO3 is increased (moving in the same direction as the pH). A pH of 7.27, PaCO2 of 70 mm Hg, PaO2 of 80 mm Hg, and HCO3 of 26 mEq/L indicate respiratory acidosis because pH is low, PaCO2 is increased (moving in opposite directions), and HCO3 is normal. A pH of 7.30, PaCO2 of 35 mm Hg, PaO2 of 70 mm Hg, and HCO3 of 20 mEg/L indicate metabolic acidosis because the pH is low, PaCO2 is normal, and HCO3 is low (moving in the same direction).

Analysis of which arterial blood gas report led the health care provider to prescribed new orders for the patient with respiratory acidosis? pH 7.40; PaCO2 44; HCO3 26 pH7.29; PaCO2 47; HCO3 25 pH 7.36; PaCO2 41; HCO3 23 pH7.42; PaCO2 42; HCO3 24

pH7.29; PaCO2 47; HCO3 25 Rationale Patients with respiratory acidosis have increased concentration of carbon dioxide (PaCO2) in the blood and decreased blood pH (opposite directions), whereas the bicarbonate ion concentration (HCO3) is normal. The normal value range of pH is 7.37 to 7.45; PaCO2 35 to 45 mm Hg; and HCO3 22 to 26 mEg/L. Thus a pH value of 7.29 (acid, low), PaCO2 of 47 (acid, high; pH and PaCO2 are moving in opposite directions), and HCO3 concentration of 25 (normal) indicate respiratory acidosis in this patient.