PrepU Ch. 9: Altered Acid-Base Balance

A client with chronic obstructive pulmonary disease (COPD) receives oxygen in the emergency department at a rate of 4 L/min for acute respiratory distress. Later, the nurse finds the client unresponsive with a respiratory rate of 8 breaths/minute. What arterial blood gas (ABG) values would the nurse expect to obtain? - pH 7.41, PCO2 39 mm Hg (5.19 kPa), HCO3- 23 mEq/L 923 mmol/L), PO2 91 mm Hg (12.10 kPa) - pH 7.32, PCO2 45 mm Hg (5.99 kPa), HCO3- 18 mEq/L (18 mmol/L), PO2 85 mm Hg (11.30 kPa) - pH 7.29, PCO2 67 mm Hg (8.91 kPa), HCO3- 26 mEq/L (26 mmol/L), PO2 64 mm Hg (8.51 kPa) - pH 7.56, PCO2 31 mm Hg (4.12 kPa), HCO3- 22 mEq/L (22 mmol/L), PO2 79 mm Hg (10.51 kPa)

pH 7.29, PCO2 67 mm Hg (8.91 kPa), HCO3- 26 mEq/L (26 mmol/L), PO2 64 mm Hg (8.51 kPa)

The nurse is caring for a client with metabolic alkalosis. Which of these arterial blood gas results supports this diagnosis? - pH of 7.25 and HCO3 of 18 mEq/L (18 mmol/L) - pH of 7.35 and HCO3 of 22 mEq/L (22 mmol/L) - pH of 7.45 and HCO3 of 24 mEq/L (24 mmol/L) - pH of 7.50 and HCO3 of 45 mEq/L (45 mmol/L)

pH of 7.50 and HCO3 of 45 mEq/L (45 mmol/L)

The nurse is caring for the following group of clients. Select the client most likely to be diagnosed with respiratory alkalosis. - An 18-year-old female who has overdosed on an opioid - A 63-year-old male with a 40-year history of smoking and chronic lung disease - A 26-year-old female with anxiety who has been hyperventilating - A 45-year-old male with pneumothorax after a car accident

A 26-year-old female with anxiety who has been hyperventilating

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? - Assessing the client's bowel sounds and administering scheduled stool softeners - Repositioning the client frequently to reduce pressure on dependent skin surfaces - Administering an antiemetic to treat the client's frequent vomiting - Assessing the client's level of consciousness using the Glasgow Coma Scale

Administering an antiemetic to treat the client's frequent vomiting

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? - Facilitate cardiac telemetry - Assess the client for signs and symptoms of hypokalemia - Administer a hypertonic intravenous solution as prescribed - Administer fomepizole as prescribed as an antidote

Assess the client for signs and symptoms of hypokalemia

A newly admitted client's diagnostic testing indicates metabolic acidosis. What action should the nurse take when working to determine the cause? - Assess the client's blood glucose levels - Test the client's stool for occult blood - Assess the client's pupillary light reflex - Auscultate the client's lungs for adventitious sounds

Assess the client's blood glucose levels

The nurse recognizes the role of the lungs in acid-base balance is regulation of which of the following? - CO2 - H2O - HCO3 - Hydrogen

CO2

A client is admitted to hospital with signs of acidosis. Compensation takes place in the kidney as well as in the lungs. Which action takes place specifically at the respiratory membrane? - CO2 and H2O are produced - Carbonic acid is produced - CO2 is eliminated - H+ combines with filtered HCO3-

CO2 is eliminated

When explaining how carbon dioxide combines with water to form carbonic acid in acid-base reactions, the faculty instructor emphasizes that which enzyme is needed as a catalysis for this reaction? - Trypsin - Hydrolases - Carbonic anhydrase - Phenylalanine hydroxylase

Carbonic anhydrase

The nurse is caring for a client who has an elevation of carbon dioxide (CO2) on an arterial blood gas test. The nurse will prioritize assessment for which condition? - Condition that increases basal metabolic rate and cellular respiration - Condition that leads to metabolic acidosis and respiratory compensation - Condition that affects the client's respiratory functioning - Condition that promotes increased conversion of bicarbonate into carbonic acid

Condition that affects the client's respiratory functioning

A client has had jejunoileal bypass surgery for the treatment of morbid obesity. The client has lost over 100 pounds in 7 months and comes to the emergency department for treatment of "feeling like I am drunk" but has had no alcohol. A family member present says the client's memory seems impaired and the client has also been confused. For which condition/imbalance does the nurse anticipate the client will be assessed? - Cirrhosis of the liver - Respiratory alkalosis - D-lactic acidosis - Cholecystitis

D-lactic acidosis

The nurse is examining a client's laboratory results and notes a decreased blood pH level. Which finding will the nurse apply as the best evidence that the client is experiencing metabolic acidosis? - Increased potassium - Increased anion gap - Decreased HCO3− - Decreased CO2

Decreased HCO3−

The nurse is caring for the client with respiratory alkalosis and renal compensation. The nurse determines this diagnosis was based on which diagnostic findings? - Normal PCO2, and decreased HCO3, with decreased pH - Increased PCO2 and increased HCO3, with decreased pH - Normal PCO2, and increased HCO3 with increased pH - Decreased PCO2 and decreased HCO3, with increased pH

Decreased PCO2 and decreased HCO3, with increased pH

A client has been diagnosed with metabolic acidosis. What assessment finding does the nurse expect? - Increased PCO2 above 45 mm/Hg (5.99 kPa) - Increased pH above 7.45 - Decreased pH below 7.35 - Decreased PCO2 below 35 mm/Hg (4.66 kPa)

Decreased pH below 7.35

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? - Mechanical ventilation and administration of supplementary oxygen - Supplementary oxygen using a non-rebreather mask - Administration of intravenous sodium bicarbonate as prescribed - Fluid replacement with an intravenous solution containing electrolytes as prescribed

Fluid replacement with an intravenous solution containing electrolytes as prescribed

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- - H+ - HCl - H2CO3

HCO3-

Respiratory alkalosis can be caused by a respiratory rate in excess of that which maintains normal plasma PCO2 levels. What is a common cause of respiratory alkalosis? - Hyperventilation - Hypoventilation - Kussmaul breathing - Cluster breathing

Hyperventilation

The nurse is caring for a client with ketoacidosis who is complaining of increasing lethargy and occasional confusion following several weeks of rigid adherence to a carbohydrate-free diet. The nurse understands which phenomenon is most likely occurring? - In the absence of carbohydrate energy sources, her body is metabolizing fat and releasing ketoacids. - High fat, low carbohydrate dietary intake is associated with respiratory acidosis. - Metabolism of dietary fats without the buffer action of carbohydrates results in the catabolism of ketoacids. - Decreased carbohydrate intake induces insulin deficiency and consequent ketoacidosis.

In the absence of carbohydrate energy sources, her body is metabolizing fat and releasing ketoacids.

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? - Metabolic alkalosis - Metabolic acidosis - Respiratory acidosis - Respiratory alkalosis

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? - Epinephrine - Potassium chloride - Sodium bicarbonate - Antibiotics

Sodium bicarbonate

The nurse is assessing a client with abnormal blood gas values. Which of these interpretations does the nurse make regarding the client's physiologic status? - The client has alterations in vital signs. - The client has a decreased hemoglobin. - The client has abnormalities in his cardiovascular system. - The client has abnormalities in his buffer system.

The client has abnormalities in his buffer system.

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 same system. - The client will not be able to compensate. - The client will compensate with the respiratory system. - The client's breathing will slow down.

The client will compensate with the respiratory system.

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? - Ammonia buffer system - Chloride-bicarbonate exchange - Phosphate buffer system - The transcellular H+/K+ exchange system

The transcellular H+/K+ exchange system

A client informs the nurse of a problem with acid indigestion. The client notes taking large amounts of calcium carbonate antacids daily but still has no relief. The client consumes about 1 bottle of 100 antacids in 4 days. Which blood gas result does the nurse anticipate? - pH 7.6 - pH 7.25 - PCO2 38 mm Hg (5.05 kPa) - PO2 80 mm Hg (10.64 kPa)

pH 7.6

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? - HCO3- has decreased - paO2 has increased - pH has increased - paCO2 has increased

pH has increased

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? - Hyperkalemia - Lactic acidosis - Lithium toxicity - Multiple myeloma

Lactic acidosis

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? - Multiple myeloma - Lactic acidosis - Lithium toxicity - Hyperkalemia

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)? - Hyperkalemia - Lactic acidosis - Hypermagnesemia - Multiple myeloma

Lactic acidosis

A client with a history of heavy alcohol use has been admitted for malnutrition and suspected pancreatitis. The client's diagnostic workup suggests alcoholic ketoacidosis as a component of the current health problems. The client is somewhat familiar with the effect that drinking has had on their nutrition and pancreas, but is wholly unfamiliar with the significance of acid-base balance. How best could the health care provider explain this concept? - "The multitude of chemical reactions that take place in your body depend on your body fluids being slightly acidic." - "Your body is highly dependent on what food and fluid you consume to keep itself at a functioning level of slight non-acidity." - "The chemical processes that take place throughout your body are thrown off very easily when your body is too acidic or not acidic enough." - "The healthy function of your kidneys and your lungs requires a speci

"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 pregnant client with a family history of Bartter syndrome asks the nurse if it can be known if the child will be born with the condition. Which information should the nurse include in the response? Select all that apply. - "You can have amniotic fluid assessed for the genetic marker of Bartter syndrome." - "An ultrasound of the fetus' kidneys can used to diagnose Bartter syndrome." - "A sample of the newborn's DNA can be collected after birth to diagnose the condition." - "A blood sample from the fetus is needed to diagnose the condition." - "A urine sample of your newborn is needed to diagnose the condition."

- "You can have amniotic fluid assessed for the genetic marker of Bartter syndrome." - "A sample of the newborn's DNA can be collected after birth to diagnose the condition."

A client has been diagnosed with respiratory alkalosis. What assessment finding should the nurse anticipate? Select all that apply. - PCO2 34 mm/hg (4.52 kPa) - HCO3- 19 mEq/L (19 mmol/L) - HCO3- 27 mEq/L (27 mmol/L) - pH above 7.45 - PCO2- 45 mm/hg (5.99 kPa)

- PCO2 34 mm/hg (4.52 kPa) - HCO3- 19 mEq/L (19 mmol/L) - pH above 7.45

The nurse notes a client has hyperkalemia. For which factor(s) that can contribute to hyperkalemia should the nurse assess? Select all that apply. - Prescribed an angiotensin-converting enzyme (ACE) inhibitor - Prolonged gastric suctioning - Decreased kidney function - Prescribed a loop diuretic - Adrenal insufficiency

- Prescribed an angiotensin-converting enzyme (ACE) inhibitor - Decreased kidney function - Adrenal insufficiency

The nurse is teaching a client about the typical tests performed to diagnose Gitelman syndrome. Which diagnostic test(s) will the nurse include? Select all that apply. - 24-hour urine for creatinine clearance - Urine electrolyte - Urine culture and sensitivity - Arterial blood gas - Ultrasound of the kidneys

- Urine electrolyte - Arterial blood gas - Ultrasound of the kidneys

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 postoperative client who developed sepsis after the dehiscence of an abdominal wound - A client in alcohol withdrawal who is being treated with intravenous anticonvulsants - A client with acquired immunodeficiency syndrome (AIDS) who has developed tuberculosis and is receiving antibiotics

A client on continuous nasogastric suction and whose hypertension is being treated with diuretics

In which client would the nurse be most likely to assess the signs and symptoms of an acid-base imbalance? - A client with chronic obstructive pulmonary disease (COPD) whose most recent arterial blood gases reveal a PCO2 of 51 mm Hg - A client with a fluid volume deficit who has been receiving intravenous 0.45% NaCl for over 48 hours - A client who has been admitted with a traumatic head injury and whose intracranial pressure is 18 mm Hg - A laboring client who is receiving an oxytocin infusion and who has been in the second stage of labor for 7 hours

A client with chronic obstructive pulmonary disease (COPD) whose most recent arterial blood gases reveal a PCO2 of 51 mm Hg

The nurse is caring for a client with an acid-base imbalance. Which of these does the nurse recognize is correct regarding compensation? - A pH moves toward the normal range. - An increased pH is demonstrated. - A decreased pH is demonstrated. - There is no alteration in the blood gas values.

A pH moves toward the normal range.

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 magnesium sulfate as prescribed. - Positioning the client in an upright position when in bed and mobilizing the client frequently. - Administering intravenous sodium bicarbonate as prescribed. - Encouraging pursed-lip breathing and deep breathing and coughing exercises.

Administering intravenous sodium bicarbonate as prescribed.

Which is the primary mechanism for transporting carbon dioxide (CO2) in the body? - Dissolved in the plasma - As bicarbonate in the plasma - As carbaminohemoglobin - Passive diffusion

As bicarbonate in the plasma

The nurse notes a client's laboratory results indicate a base deficit of 4 mEq/l (4 mmol/l). The nurse interprets this finding as evidence supporting the need for which intervention? - Ventilatory support - Treatment of vomiting - Potassium supplementation - Infusion of sodium bicarbonate

Infusion of sodium bicarbonate

A client has an increase in her anion gap (AG). What does the nurse determine is the significance of this finding? - It indicates the client has respiratory acidosis. - It indicates the client has respiratory alkalosis. - It indicates the client has metabolic acidosis. - It indicates the client has metabolic alkalosis.

It indicates the client has metabolic acidosis.

The nurse is caring for a client with worsening respiratory acidosis. Which of these interventions does the nurse anticipate if the client's condition continues to deteriorate? - Reducing the amount of supplemental oxygen - Mechanical ventilation - Resolution of the underlying emotional cause - Introduction of large muscle exercise

Mechanical ventilation

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? - Respiratory acidosis - Respiratory alkalosis - Metabolic alkalosis - Metabolic acidosis

Metabolic acidosis

The nurse is caring for a client who has excessive diarrhea. Which acid-base disturbance does the nurse anticipate will result from having excessive diarrhea? - An increase in bicarbonate - Metabolic acidosis - Increased pH value - No change in values from normal

Metabolic acidosis

The nurse is caring for a client experiencing metabolic acidosis due to acute kidney injury. The nurse monitors cardiac function carefully. If the client's blood pH falls to less than 7.0, which effect may occur? - Reduction in cardiac contractility, causing a decrease in cardiac output - Vasoconstriction of the vascular bed, preserving the primary organs - Increase in cardiac contractility, increasing the risk for myocardial infarction - Increase in cardiac output, leading to systemic fluid volume excess

Reduction in cardiac contractility, causing a decrease in cardiac output

A client arrives in the emergency department by ambulance with a family member stating, "He took an overdose of sleeping pills and I found him breathing very shallowly." For which type of acid-base disturbance will the nurse anticipate this client will be treated? - Metabolic acidosis - Metabolic alkalosis - Respiratory acidosis - Respiratory alkalosis

Respiratory acidosis

The nurse is caring for a client who complains of headache and blurred vision. The nurse recognizes that these symptoms, accompanied by increased plasma partial pressure carbon dioxide (PCO2) level and decreased pH level, are consistent with which diagnosis? - Metabolic alkalosis - Respiratory acidosis - Metabolic acidosis - Respiratory alkalosis

Respiratory acidosis

As other mechanisms prepare to respond to a pH imbalance, immediate buffering is a result of increased: - Intracellular albumin. - Bicarbonate/carbonic acid regulation. - Sodium/phosphate anion absorption. - Hydrogen/potassium binding.

bicarbonate/carbonic acid regulation.