Acid & Base
The nurse is caring for a client who is vomiting. When caring for this client, the nurse recalls that the vomiting reflex follows a set pattern. List the steps in the order that they occur. 1) Closure of the trachea to prevent aspiration 2) Initiation of reverse peristalsis in the stomach 3) Contraction of abdominal muscles 4) Relaxation of the upper esophageal sphincter
2, 3, 4, 1
Which mechanism of action explains how propylthiouracil (PTU) manages hyperthyroidism? a) It binds previously formed thyroid hormones. b) It decreases production of thyroid hormones. c) Vascularity of the thyroid gland is decreased. d) The need for thyroid iodine supplements is reduced.
b) It decreases production of thyroid hormones. PTU is a thyroid hormone antagonist that inhibits thyroid hormone synthesis by decreasing the use of iodine in the manufacture of these hormones. PTU does not affect the vascularity of the thyroid gland. Iodine-containing agents are given for severe hyperthyroidism and before a thyroidectomy. PTU does not affect the amount of already formed thyroid hormones.
The arterial blood gases for a client with acute respiratory distress are pH 7.30, PaO 2 80 mm Hg (10.64 kPa), PaCO 2 55 mm Hg (7.32 kPa), and HCO 3 23 mEq/L (23 mmol/L). How would the nurse interpret these findings? a) Hypoxemia b) Hypocapnia c) Compensated metabolic acidosis d) Uncompensated respiratory acidosis
d) Uncompensated respiratory acidosis The increased PaCO 2 indicates respiratory acidosis and the low pH indicates that the respiratory acidosis is uncompensated. The PaO 2 is normal, indicating that the client is not hypoxemic. The elevated PaCO 2 indicates hypercapnia. The HCO 3 is normal, indicating that there is no metabolic acidosis.
Which descriptors for maturity-onset diabetes of the young (MODY) would the nurse identify as accurate? Select all that apply. Autosomal dominant Characterized by young age of onset Associated with obesity and hypertension Polygenic (>25 genes affect susceptibility) Combination of inadequate insulin secretion and resistance Presents with fatigue, recurrent infection, and prolonged wound healing
Autosomal dominant Characterized by young age of onset MODY is an autosomal dominant disease that is characterized by the young age of onset, which is typically before the age of 25. MODY is not associated with obesity and hypertension as type 2 diabetes is. MODY is characterized by a single gene mutation that leads to beta cell dysfunction with an inability of the pancreas to produce sufficient amounts of insulin, which makes insulin necessary; it does not result from a combination of inadequate insulin secretion and resistance. Clients with MODY do not generally present with fatigue, recurrent infection, and prolonged wound healing, but rather with polyuria, polydipsia, polyphagia, weight loss, weakness and fatigue, and sometimes ketoacidosis.
Which laboratory results support the nurse's suspicion that a client diagnosed with type 1 diabetes is experiencing ketoacidosis? a) Blood glucose of 40 mg/100 mL (2.2 mmol/L), blood pH of 7.37 b) Blood glucose of 130 mg/100 mL (7.2 mmol/L), blood pH of 7.35 c) Blood glucose of 650 mg/100 mL (36.1 mmol/L), blood pH of 7.42 d) Blood glucose of 300 mg/100 mL (16.7 mmol/L), blood pH of 7.20
d) Blood glucose of 300 mg/100 mL (16.7 mmol/L), blood pH of 7.20 The blood glucose level of 300 mg/100 mL (16.7 mmol/L) is greater than the expected range of individuals with type 1 diabetes, indicating hyperglycemia. The normal serum pH is 7.35 to 7.45; therefore, 7.20 indicates acidosis. The blood glucose level of 40 mg/100 mL (2.2 mmol/L) is less than the expected range for all individuals, indicating hypoglycemia; the serum pH of 7.37 is within the expected range for pH. The blood glucose level of 130 mg/100 mL (7.2 mmol/L) is within the expected range for individuals with type 1 diabetes, and the pH of 7.35 is within the expected range for pH. The blood glucose level of 650 mg/100 mL (36.1 mmol/L) indicates hyperglycemia, but the serum pH is within the expected range for pH.
The nurse is caring for an infant whose vomiting is intractable. Which complication is likely to occur? a) Acidosis b) Alkalosis c) Hyperkalemia d) Hypernatremia
b) alkalosis Excessive vomiting causes an increased loss of hydrogen ions (hydrochloric acid), leading to metabolic alkalosis, an excess of base bicarbonate. Acidosis is caused by retention of hydrogen ions and a loss of base bicarbonate, which is more likely to occur with diarrhea. Hypokalemia, not hyperkalemia, will occur because of renal potassium excretion. With the loss of chloride ions, hyponatremia is more likely to occur.
Which nutrient causes elevated ketones in diabetic acidosis by incomplete oxidation?
Fats! Incomplete oxidation of fat results in fatty acids that further break down to ketones
Which situation associated with the physiological finding of ketones in the blood and urine would be the nurse's focus when collecting additional data about a client? a) Starvation b) Alcoholism c) Bone healing d) Positive nitrogen balance
a) Starvation In starvation there are inadequate carbohydrates available for immediate energy, and stored fats are used in excessive amounts, producing ketones. There is no fat in alcohol; fat oxidation does not occur. Bone healing does not require the use of great amounts of fat; calcium is deposited to form callus. A positive nitrogen balance does not require the use of great amounts of fat.
When a client who has had a thoracotomy develops respiratory acidosis, which action would the nurse take? a) Administer oral fluids. b) Encourage deep breathing. c) Increase the oxygen flow rate. d) Perform nasotracheal suctioning
b) Encourage deep breathing. Hypoventilation because of pain is the usual cause of respiratory acidosis after chest surgery and the nurse would encourage deep breathing to help eliminate excess carbon dioxide. Oral fluids are helpful in liquefying respiratory secretions, but will not increase respiratory rate or depth to eliminate carbon dioxide. Increasing oxygen flow rate would be used to treat hypoxemia, but will not decrease carbon dioxide levels in the blood. Suctioning would help eliminate excessive secretions if the client was unable to cough effectively, but would not decrease carbon dioxide levels.
Which postoperative feeding regimen is most appropriate for the infant who had surgery to correct hypertrophic pyloric stenosis? a) Thickened formula 24 hours after surgery b) Withholding of feedings for the first 24 hours c) Regular formula feeding within 24 hours of the surgery d) Additional glucose feedings as desired after the first 24 hours
c) Regular formula feeding within 24 hours of the surgery An initial feeding of glucose and electrolytes in water or breast milk is given 4 to 6 hours after surgery. Once clear fluids are being retained, formula feedings are begun within 24 hours. Thickened formula 24 hours after surgery is not necessary. Regular formula should be started within 24 hours after surgery in an attempt to gradually return the infant to a full feeding schedule. Withholding feedings for the first 24 hours and providing additional glucose feedings as desired after the first 24 hours are not necessary.
Which pH value of amniotic fluid is indicated by a Nitrazine test strip that turns deep blue? a) 4.5 b) 5.5 c) 6.5 d) 7.5
d) 7.5 This test involves putting a drop of fluid obtained from the vagina onto paper strips containing Nitrazine dye. The strips change color depending on the pH of the fluid. A pH of 4.5, 5.5, or 6.5 would result in a test strip of yellow, olive yellow, or blue green, respectively.
Which complication is the most serious for a client with kidney failure? a) Anemia b) Weight loss c) Uremic frost d) Hyperkalemia
d) Hyperkalemia Decreased glomerular filtration leads to hyperkalemia, which may cause lethal dysrhythmias such as cardiac arrest. Anemia may occur but is not the most serious complication and should be treated in relation to the client's clinical manifestation; erythropoietin and iron supplements usually are used. Weight loss alone is not life threatening. Uremic frost, a layer of urea crystals on the skin, causes itching, but it is not the most serious complication.
The clinic nurse is taking the sexual health history of an adolescent when the adolescent begins to perspire and hyperventilate. The client reports feeling dizzy and short of breath. Which condition would the nurse identify? a) Metabolic alkalosis b) Respiratory acidosis c) Pulmonary hypertension d) Hyperventilation syndrome
d) Hyperventilation syndrome Hyperventilation syndrome is respiratory alkalosis that occurs with deep, rapid breathing; the clinical findings are related to an increased pH and lowered bicarbonate and oxygen levels. Metabolic alkalosis is manifested by adaptations such as hypotension, tachycardia, confusion, hyperreflexia, and dysrhythmias. Respiratory acidosis is manifested by adaptations such as tachycardia, headache, altered mental status, muscle twitching, and warm, flushed skin. Pulmonary hypertension occurs when the pulmonary arterial pressure is increased; chronic pulmonary disorders are associated with pulmonary hypertension.
When caring for a client in late hypovolemic shock, which complication will the nurse anticipate? a) Hypokalemia b) Metabolic acidosis c) Respiratory alkalosis d) Decreased carbon dioxide level
b) Decreased cellular oxygen caused by poor perfusion increases the conversion of pyruvic acid to lactic acid, resulting in metabolic acidosis. Hyperkalemia will occur because of renal shutdown; hypokalemia can occur in early shock. Respiratory alkalosis can occur in early shock because of rapid, shallow breathing, but in late shock, metabolic or respiratory acidosis occurs. The Pco 2 level will increase in profound shock.
Which assessment would the nurse perform while caring for an infant with a tentative diagnosis of hypertrophic pyloric stenosis (HPS)? a) Quality of the cry b) Signs of dehydration c) Coughing up of feedings d) Characteristics of the stool
b) Signs of dehydration Hypertrophic pyloric stenosis causes partial and then complete obstruction. Nonprojectile vomiting progresses to projectile vomiting, which rapidly leads to dehydration. The infant's cry is not affected by HPS; pain, except for the pain of hunger, does not appear to be associated with this condition. An infant with a tracheoesophageal fistula, not HPS, is expected to cough up feedings. The characteristics of the stool are not relevant in the assessment of an infant with HPS.
Which insulin will the nurse prepare for the emergency treatment of ketoacidosis? a) Glargine b) NPH insulin c) Insulin aspart d) Insulin detemir
c) Insulin aspart Insulin aspart is a rapid-acting insulin (within 10-20 minutes) and is used to meet a client's immediate insulin needs. Glargine is a long-acting insulin, which has an onset of 1.5 hours; for diabetic acidosis, the individual needs rapid-acting insulin. NPH insulin is an intermediate-acting insulin, which has an onset of 1 to 2 hours; for diabetic acidosis, the individual needs rapid-acting insulin. Insulin detemir is a long-acting insulin; for diabetic acidosis, the individual needs rapid-acting insulin.
A client with esophageal varices experiences severe hematemesis, and a Sengstaken-Blakemore tube is inserted. Which design and purpose does the tube have? a) Single-lumen; for gastric lavage b) Double-lumen; for intestinal decompression c) Triple-lumen; for esophageal compression d) Multi-lumen; for gastric and intestinal decompression
c) Triple-lumen; for esophageal compression One lumen inflates the esophageal balloon that compresses the esophagus, the second inflates the gastric balloon, and the third is attached to suction to decompress the stomach
Which clinical findings would the nurse expect when assessing a client with hyperthyroidism? Select all that apply Diarrhea Listlessness Weight loss Bradycardia Decreased appetite
diarrhea weight-loss