Pathophysiology- Unit 4
The nurse is caring for the following group of clients. Select the client most likely to be diagnosed with respiratory alkalosis.
A 26-year-old female with anxiety who has been hyperventilating
The nurse is aware that the major role of the kidneys in regulating acid-base balance is to increase the production of:
HCO3-
The nurse is caring for a client with a longstanding diagnosis of hypocalcemia secondary to kidney disease. The nurse observes which clinical manifestations in this client?
Muscular spasms and complaints of tingling in hands/feet.
The nurse enters a client's hospital room and finds the client breathing rapidly, stating, "I must be having a stroke, my fingers are tingling!" Which acid-base balance disorder is this client experiencing due to hyperventilation?
Respiratory alkalosis
The condition of a client with metabolic acidosis from an intestinal fistula is not improving. The pulse is 125 beats/min and the BP 84/56 mm Hg. ABG values are: pH 7.1, HCO3- 18 mEq/L (18 mmol/L), PCO2 57 mm Hg (7.58 kPa). What IV medication should the nurse expect to provide next?
Sodium bicarbonate
Which unit of measure best describes the concentration of solute in a particular volume of fluid based on electrolyte equivalency?
mEq/L
The nurse is caring for a client with metabolic alkalosis. Which of these arterial blood gas results supports this diagnosis?
pH of 7.50 and HCO3 of 45 mEq/L (45 mmol/L)
A nurse is providing care for several clients on an acute medicine unit. Which client should the nurse recognize as being at the highest risk for metabolic alkalosis?
A client on continuous nasogastric suction and whose hypertension is being treated with diuretics
A client with a diagnosis of liver cirrhosis secondary to alcohol abuse has a distended abdomen as a result of fluid accumulation in his peritoneal cavity (ascites). Which pathophysiologic process contributes to this third spacing?
Abnormal increase in transcellular fluid volume
A client is brought to the emergency department reporting shortness of breath. Assessment reveals a full, bounding pulse; severe edema; and audible crackles in lower lung fields bilaterally. Which action by the nurse is most appropriate?
Administer diuretics as ordered
A client's most recent laboratory results suggest the presence of metabolic alkalosis. What action by the nurse best addresses a potential cause of this acid-base imbalance?
Administering an antiemetic to treat the client's frequent vomiting
As other mechanisms prepare to respond to a pH imbalance, immediate buffering is a result of increased:
Bicarbonate/ carbonic acid regulation
The nurse recognizes the role of the lungs in acid-base balance is regulation of which of the following?
CO2
Of the following clients, who would be at highest risk for developing hyperkalemia?
Client admitted for acute kidney injury following a drug overdose
A nurse is preparing to administer a potassium supplement to a client. The client states understanding the teaching about electrolytes. Which statement by the client would validate understanding of the teaching?
Clinical measurements of electrolytes are determined by their concentration in the fluid part of the blood.
The nurse is caring for the client with respiratory alkalosis and renal compensation. The nurse determines this diagnosis was based on which diagnostic findings?
Decreased PCO2 and decreased HCO3, with increased pH
The nurse is caring for a client with liver disease who has edema throughout the body. When reviewing the medical record, the nurse recognizes that which altered diagnostic test is consistent with development of edema?
Decreased albumin
A client has been diagnosed with metabolic acidosis. What assessment finding does the nurse expect?
Decreased pH below 7.35
The nurse is teaching a client with dependent edema the importance of elevating the lower legs several times a day. Which effect of elevating the legs will the nurse describe to the client as the primary reason this action reduces edema?
Decreases the amount of hydrostatic pressure at the venous end of capillaries
The nurse is caring for a client who receives hemodialysis. The nurse knows that hemodialysis involves movement of charged or uncharged particles along a concentration gradient. Which function best describes this process?
Diffusion
The nurse is caring for a client with advanced liver disease who has ascites. Which treatment will the nurse anticipate being used for the daily management of ascites?
Diuretics
A client is being treated for chronic hypernatremia with 0.45% saline intravenously. Which action is the nurse's priority?
Ensure the client's sodium levels are being checked frequently to guide treatment
The nurse is caring for a client with a tumor obstructing the lymphatic system. For which consequence does the nurse assess?
Fluid accumulating in the interstitial spaces distal to the tumor
A client is admitted after losing 44 lb (20 kg) over the past 3 months, largely due to frequent vomiting. What intervention should the nurse anticipate in the treatment of the client's resulting acid-base imbalance?
Fluid replacement with an intravenous solution containing electrolytes as prescribed
A client is brought to the emergency department with reports of shortness of breath. Assessment reveals a full, bounding pulse, severe edema, and audible crackles in lower lung fields bilaterally. The nurse notifies the physician to obtain orders for which of these problems?
Fluid volume excess
The nurse is aware that the major role of the kidneys in regulating acid-base balance is to increase the production of which chemical component?
HCO3-
A nurse observes peaked, narrow T waves on the electrocardiogram of a client suffering from renal failure. The nurse suspects that the client is experiencing which condition?
Hyperkalemia
A nurse is caring for a client with hypoparathyroidism. Which imbalance is a major concern for the client?
Hypocalcemia
A nurse is caring for a client who has the following electrolytes: sodium 125 mEq/L (125 mmol/L) and potassium 3.2 mEq/L (3.2 mmol/L). Which statement supports why these levels occurred?
Hyponatremia occurs by vomiting, diarrhea, and sweating
A client who has just completed running a marathon reports muscle weakness, cramping, and general fatigue despite drinking adequate amounts of water. The nurse suspects which type of hypotonic hyponatremia?
Hypovolemic
The nurse is caring for a client with acute primary respiratory acidosis. When determining the cause of the acidosis the nurse is aware that which imbalance is most common?
Impaired alveolar ventilation
Water movement from the side of the membrane having a lesser number of particles and greater concentration of water to the side having a greater number of particles and lesser concentration of water is termed:
Osmosis
Pressure generated as water moves across a membrane is also known as which of the following?
Osmotic pressure
Vitamin D, officially classified as a vitamin, functions as a hormone in the body. What other hormone is necessary in the body for vitamin D to work?
Parathyroid hormone
Which one of the following is associated with hydrostatic edema?
Pits to finger pressure
The nurse notifies the health care prescriber of a client's serum potassium level of 6.2 mEq/L (6.2 mmol/L). Which prescription will the nurse consider as having the first priority?
Placing the client on a cardiac monitor
What is the nurse's expectation about a client's ability to compensate for a metabolic blood gas disorder?
The client will compensate with the respiratory system.
A client with generalized anxiety disorder has been hyperventilating and has developed an acid-base imbalance resulting in increased pH and decreased PCO2. The nurse should recognize that which compensatory mechanism is likely occurring?
The client's kidneys are excreting fewer H+ ions
Potassium is the major cation in the body. It plays many important roles, including the excitability of nerves and muscles. Where is this action particularly important?
The heart
The pH of body fluids is regulated by three major mechanisms, one of which is the chemical buffer system. Which is a component of this buffer system?
The transcellular H+/K+ exchange system
The nurse caring for a client with metabolic acidosis examines arterial blood gas (ABG) results. Which change from the initial value indicates the cause of the client's metabolic acidosis is improving?
pH has increased
The nurse examining laboratory values for a client notes that both the plasma bicarbonate (HCO3-) and CO2 levels have increased. What is the expected impact on the pH levels?
pH would remain unchanged
When caring for the client with hyperkalemia, the nurse recognizes the body should respond in which of these ways?
secrete potassium in the distal tubules for excretion
A client has these arterial blood gas values: anion gap 20 mEq/L (20 mmol/L), pH 7.29, PCO2 37 mm Hg (4.92 mmol/L), HCO3- 11 mEq/L (11 mmol/L), base excess -6 mEq/L (-6 mmol/L). With what condition do these values correspond?
Lactic acidosis
The nurse is reviewing laboratory data for the client with an anion gap of 17. The nurse recognizes which condition is associated with an increased anion gap mEq/L (mmol/L)?
Lactic acidosis
Hypothalamic sensory neurons that promote thirst when stimulated are called:
Osmoreceptors
When trying to explain the role of potassium and hydrogen related to acid-base, which statement is most accurate?
Hypokalemia stimulates H+ secretion
Lymph fluid arises directly from which space?
Interstitial
A client with a history of cancer that metastasized to the liver has arrived at the outpatient clinic to have a paracentesis performed. The physician anticipates that the client will have more than 5 L of fluid removed. The physician has prescribed intravenous albumin following the procedure. The client asks why she needs "more fluids in my vein." The nurse responds:
"Albumin is a volume expander. Since a lot of fluid was removed, you have a decrease in your vascular volume, so without this albumin, your kidneys will try to reabsorb and hold onto water."
A male client with a history of heavy alcohol use has been admitted to the hospital for malnutrition and suspected pancreatitis. The client's diagnostic workup suggests alcoholic ketoacidosis as a component of his current health problems. He is somewhat familiar with the effect that drinking has had on his nutrition and pancreas, but is wholly unfamiliar with the significance of acid-base balance. How best could his care provider explain the concept to him?
"The chemical processes that take place throughout your body are thrown off very easily when your body is too acidic or not acidic enough"
A client with a long history of alcohol abuse has been admitted to the emergency department after several of days of heavy drinking. The nurse can best promote the restoration of the client's acid-base balance by:
Administering intravenous sodium bicarbonate as prescribed
The nurse is caring for a client who has developed hypoxemia and tissue hypoxia. Which of these interventions does the nurse set as a priority intervention?
Administration of supplemental oxygen
A client with pancreatic cancer is admitted for portal hypertension and is symptomatic with ascites. Following paracentesis and removal of 7.5 L of ascitic fluid, the nurse should anticipate that the physician will order which medication to assist in maintaining an effective circulating fluid volume?
Albumin (Human) 5%.
An older adult has had a "sour stomach" and has treated it at home by taking frequent doses of baking soda (sodium bicarbonate). What nursing action is most appropriate?
Assess the client for signs and symptoms of hypokalemia
The nurse is caring for a client who is admitted due to nausea and vomiting. Which finding(s) will the nurse interpret as evidence of compensation for decreased fluid volume? Select all that apply.
Increased heart rate, small amount of concentrated urine, delayed capillary refill time
An adult client has the following results of morning blood work:Potassium: 2.5 mEq/L (2.5 mmol/L)Sodium: 136 mEq/L (136 mmol/L)Calcium: 9.2 mg/dL (2.3 mmol/L)Magnesium: 2.02 mEq/L (1.01 mmol/L)How should the nurse best respond to these values?
Inform the care provider and monitor the client's cardiac status.
Which intervention is a priority for the nurse when caring for a client with hypokalemia?
Initiating cardiac monitoring
A female client with a history of chronic renal failure has a total serum calcium level of 7.9 mg/dL (1.98 mmol/L). While performing an assessment, the nurse should focus on which clinical manifestation associated with this calcium level?
Intermittent muscle spasms and reports of numbness around her mouth
The nurse is evaluating a client's blood gases. The client has a pH of 7.35. How does the nurse interpret this value?
It is within a normal range
Which condition is a cause of osmotic edema?
Low blood levels of albumin
The nurse is caring for a client who has no urine output due to acute kidney injury. Which finding(s) is expected for this condition? Select all that apply.
Lower-than-normal plasma bicarbonate level, decrease in the CO2 level on an arterial blood gas test, increase in plasma potassium level
A child accidentally consumes a container of wood alcohol. The ED physician knows that the child is at risk of developing which of the following?
Metabolic acidosis
The renal control mechanism of restoring the acid-base balance is accomplished through which process?
Reabsorption of HCO3 and excretion of H+ restores acid-base balance through the renal control mechanisms
