ACID BASE

Mrs. Hogan is a 38-year-old patient brought to a walk-in health care center by her neighbor. Mrs. Hogan is in obvious respiratory distress. She is having difficulty breathing with audible high-pitched wheezing and is having difficulty speaking. Pausing after every few words to catch her breath, she tells the nurse, "I am having a really bad asthma attack. My chest feels very tight and I cannot catch my breath. I took my albuterol and Vanceril, but they are not helping" Mrs. Hogan hands her neighbor her cell phone and asks the neighbor to dial a telephone number. "that number is my husband's boss. My husband just started working for an asbestos removal company about a month ago. He is usually on the road somewhere. Can you ask his boss to get a message to him that I am here?" While auscultating Mrs. Hogan's lung sounds, the nurse hears expiratory wheezes and scattered rhonchi throughout. Mrs. Hogan is afebrile. Vitals signs are: Blood pressure 142/96, pulse 88, and respiratory rate of 34. Her oxygen saturation on room air is 86%. Arterial blood gasses are drawn. Mrs Hogan is placed on 2 liters of humidified oxygen via nasal cannula. She is started on intravenous (IV) fluids and receives an albuterol nebulizer treatment. List 6 other signs and symptoms the nurse might note during an assessment of Mrs. Hogan? Think asthma exacerbation (asthma attack).

-A cough that produces thick, clear, or yellow sputum -Accessory respiratory muscle use -Supraclavicular and intercostal muscle retraction -Nasal flaring -Diaphoresis -Increased anteroposterior (AP) thoracic diameter -Pursed-lip breathing -Hyperresonance on percussion -Local fremitus on palpation -Prolonged expiratory phase of respiration -The peak flow rate that is 50% below the patient's baseline -Cyanosis -Confusion -Lethargy -Complaints of feeling suffocated

You are working in an outpatient clinic when a mother brings in her 20-year-old daughter, C.J., who has type 1 diabetes mellitus (DM) and has just returned from a trip to Mexico. She has had a 3-day fever and diarrhea with nausea and vomiting (N/V). She has been unable to eat and has tolerated only sips of fluid. Because she was unable to eat, she did not take her insulin. Because C.J. is unsteady, you bring her to the examining room in a wheelchair. While assisting her onto the examining table, you note her skin is warm and flushed. Her respirations are deep and rapid, and her breath is fruity and sweet-smelling. C.J. is drowsy and unable to answer your questions. Her mother states, "She keeps telling me she's so thirsty, but she can't keep anything down." 1. List four pieces of additional information you need to elicit from C.J.'s mother.

-How often she has been taking BS and levels -Is her diabetes typically controlled? -What have her blood sugar readings been? -Has she been reporting abdominal pain -How much has she been vomiting? -Has her urine been checked for ketones? -When was the last insulin dose and how much -Has she been urinating frequently -Has she been drowsy persistently? -When did she return from Mexico? -When she was in Mexico did she have her insulin with her and taking as prescribed? -Any allergies to medications? -Any chance of being pregnant? -Is she excessively thirsty -Has she lost any weight recently? -Has she had any changes in mental status? -Has she had changes in breathing?

How would you tell Mrs. Hogan step by step to use her inhalers?

-Remove mouthpiece cap and shake inhaler for 3 - 5 second -Exhale slowly and completely -Holding the canister of the inhaler upside down, place the -mouthpiece directly in front of the mouth. (if a spacer is being used, place the mouthpiece in mouth and close lips firmly around) -Press and hold canister down while inhaling deeply for 3 - 5 seconds -hold breath for 10 seconds, release pressure on the canister and remove from mouth. Exhale. -Wait seconds before repeating if necessary. -Rinse mouth after using the inhaler -Rinse the inhaler mouthpiece and spacer after use -Store in a clean location.

C.J. is ready for transport to the medical ICU. C.J.'s mother is beginning to realize that C.J. is more acutely ill than she thought. She leaves the room and begins to cry. How would you handle this situation? 2. C.J.'s mother asks where she can get more information on how C.J. can manage her diabetes. What are some resources she might find useful?

1. Listen to mother Ensure patient safety Explain all procedures and treatments Show empathy Give information Stand by for comfort 2. Referrals American Diabetes Association Diabetic educator Provide educational pamphlets Dietician Care coordination/social worker referral Social Media online support groups Local groups with education/nutrition/cooking classes Juvenile Diabetes Research Foundation

The nurse is instructing a 12-year-old child with asthma to self-administer albuterol through a metered-dose inhaler with a spacer. After attaching the inhaler to the spacer, in which order does the nurse instruct the client to do the following? Place the steps from first to last.

1. Shake the canister 2. Press the canister on the inhaler to put medicine in the holding chamber 3. Place the mouthpiece of the spacer in the mouth and inhale 4. Hold breath for 2 to 3 s and exhale

The physician orders a change in the insulin drip infusion, decreasing it from 6 units to 4 units per hour. The label on the bag infusing reads, "100 units regular (Humulin R) insulin in 250 mL of normal saline." At how many milliliters per hour will you set the infusion pump?

10 ml = 250mL x 4 units = 1000 = 10mL/hr hr 100units hr 100

A nurse is preparing to administer a continuous insulin infusion to a client diagnosed with DKA. A physician orders an initial IV infusion of 10 units of regular insulin per hour. The pharmacy supplies 50 units of regular insulin in 100 mL of 0.9% saline solution. How many milliliters of a solution should the nurse infuse hourly? record your answer as a whole number.

20

What is the rationale behind using an infusion pump for the insulin drip?

Accuracy Easy to change units/hr Easier disease management

Mrs. Hogan states that she took her albuterol and beclomethasone prior to coming to the walk-in health care center. How do these medications work?

Albuterol - bronchodilator that provides relief from an asthma attack by relaxing the smooth muscles in your airways. Beclomethasone - a coricosteroid that works by preventing certain cells in the lungs and breathing passages from releasing substances that cause asthma symptoms.

The nurse is caring for a client who is demonstrating signs of increased respiratory distress related to laryngeal obstruction. The nurse is calling the physician to report on the client's condition. Which of the following will the nurse report? Select all that apply. A decreased respiratory rate Arterial blood gases reporting a PaCO2 of 48 and a PaO2 of 84 Nasal flaring with abdominal retractions Administration of a corticosteroid inhaler for quick relief Lung sounds of wheezing Increased respiratory effort

Arterial blood gases reporting a PaCO2 of 48 and a PaO2 of 84, Nasal flaring with abdominal retractions, Lung sounds of wheezing, and Increased respiratory effort The nurse would be calling to report signs of respiratory distress. This includes nasal flaring with abdominal retractions, stridor and an increased respiratory effort. Also arterial blood gases with an elevated CO2 and lower oxygen level indicates respiratory compromise

A nurse is caring for a client experiencing excessive vomiting. The nurse receives the arterial blood gas analysis of pH 7.55, PaCO2 40 mm Hg (5,32 kPa), PaO2 102 mm Hg (13.57 kPa), HCO3 39 mEq/L (39 mmol/L). What intervention(s) will the nurse apply in the plan of care? Select all that apply. Assess for cardiac dysrhythmias. Monitor vital signs frequently. Assess neurological status. Encourage client to breathe into a closed container. Administer intravenous fluids containing potassium salts.

Assess for cardiac dysrhythmias, Monitor vital signs frequently, Assess neurological status, and Administer intravenous fluids containing potassium salts.

A client presents with severe diarrhea and a history of chronic renal failure to the emergency department. Arterial blood gas results are as follows:pH 7.30, PaO2 97, PaCO2 37, HCO3 18. The nurse would expect which of the following sets of assessment findings? Headache, blood pressure 90/54, dry skin Blood pressure 188/120, nausea, vomiting Confusion, respiratory rate 8 breaths/min, dry skin Clammy skin, blood pressure 86/46, headache

Clammy skin, blood pressure 86/46, headache Metabolic acidosis, a common clinical disturbance, is characterized by decreased pH and plasma bicarbonate concentration. Common causes of metabolic acidosis include diarrhea, chronic renal failure, use of diuretics, intestinal fistulas, and ureterostomies. The client will experience the following signs and symptoms: headache, confusion, increased respiratory rate, nausea, vomiting, cold and clammy skin, and decreased blood pressure.

Side effects of nebulizer tratment? Briefly discuss the common adverse effects Mrs. Hogan may experience with the albuterol nebulizer treatment.

Common adverse effects include::: tremors restlessness anxiety tachycardia palpitations hypertension heartburn nausea vomiting mouth and throat dryness a cough

Describe the pathophysiology of diabetic ketoacidosis

DKA develops when your body doesn't have enough insulin to allow blood sugar into your cells for use as energy. Instead, your liver breaks down fat for fuel, a process that produces acids called ketones. When too many ketones are produced too fast, they can build up to dangerous levels in your body.

A middle-aged male with a history of cardiovascular disease has been admitted for cardiogenic shock. In the hours since admission, the client's arterial blood gases indicate acidosis. Which clinical manifestations and diagnostic findings should his care team anticipate before acid-base balance is restored? Select all that apply. Decreased pH Cardiac dysrhythmias Decreased alertness and cognition Hypoventilation Nausea and vomiting

Decreased pH, Cardiac dysrhythmias, Decreased alertness and cognition, and Nausea and vomiting As with any form of acidosis, pH is apt to be lower than normal. Metabolic acidosis is also associated with dysrhythmias, decreased alertness, and nausea and vomiting. Respiration is likely to be increased in both rate and depth.

Which client medication should the nurse review first for its potential interaction in a client admitted to the hospital in a state of alkalosis? Warfarin Metformin Digoxin Ibuprofen

Digoxin Alkalosis, especially respiratory alkalosis, makes the client more sensitive to the effects of digoxin: toxicity can develop even at therapeutic levels. A serum digoxin level should be obtained, and the client evaluated for potential digoxin toxicity.

Mrs. Hogan has responded well to the albuterol nebulizer treatment. Her breathing is less labored and she appears less anxious. The nurse asks Mrs. Hogan what she was doing when the asthma attack began. Mrs. Hogan says, "Nothing special. I was doing the laundry." What questions might the nurse ask to assess the cause of Mrs. Hogan's asthma exacerbation? List 4 questions. (Think about what triggers she might have been exposed to while doing laundry)

Does your husband wear his work clothes at home? Where are your husband's work clothes kept until they are washed? Who washes your husband's clothes? Did you use a different type of soap/fabric softener

A nurse is caring for a client with chronic renal failure. The nurse receives the arterial blood gas result pH-7.19, PCO2- 42mmHg (5.59 kPa), Po2- 88mm Hg (11.70 kPa), HCO3-15mEq/L (15.00 mmol/L). What are the priority action(s) by the nurse? Select all that apply. Encourage rest. Record intake and output. Prepare for possible seizures. Administer sodium bicarbonate. Apply noninvasive positive-pressure ventilation.

Encourage rest, Record intake and output, Prepare for possible seizures and Administer sodium bicarbonate.

A nurse is caring for an adult client with anxiety and chest pain. The nurse receives the arterial blood gas result pH-7.50, PCO2- 28 mmHg (3.72 kPa), Po2- 120mm Hg (15.96 kPa), HCO3-23mEq/L (23.00 mmol/L). What are the priority action(s) by the nurse? Select all that apply. Record intake and output. Monitor blood glucose levels. Encourage the client to verbalize fears. Keep the client warm and dry. Encourage the client to breathe into a closed container.

Encourage the client to verbalize fears, Keep the client warm and dry and Encourage the client to breathe into a closed container.

What are three nursing interventions to help decrease Mrs. Hogan's risk of another asthma exacerbation in general and 3 interventions related to asbestos fibers? Total of 6 interventions

General:: Help to identify her allergens and irritants (Triggers) so she can avoid the triggers Assess comprehension of her prescribed inhalers, give instructions Instruct to us her bronchodilator at least five minutes before her other inhaled medication since bronchodilation allows better penetration of other inhaled drugs Teach how to use her metered dose inhalers with a spacer device review diaphragmatic and pursed-lip breathing, as well as effective coughing techniques Urge to drink at least 3 liters of fluid every day to help loosen secretions and maintain hydration education about the risk of mesothelioma Asbestos exposure::: Mr. Hogan should follow OSHA regulations regarding asbestos at his job Should use all protective equipment provided by his employer should shower and change his clothing before leaving work should bring his work clothes home in a separate bag should keep his clothing in a garage or area of the home that does not pose a risk of direct contact with clothing Personnel who are trained and provided with the proper protective equipment should professionally launder

A 19-year-old student develops symptoms of respiratory alkalosis related to an anxiety attack. Which nursing intervention is most appropriate? Make sure his oxygen is being administered as ordered Have him breathe into a paper bag. Place him in a semi-Fowler's position Have him do coughing and deep-breathing exercises.

Have him breathe into a paper bag. The patient is probably hyperventilating because of the anxiety. Rebreathing carbon dioxide exhaled into a paper bag, can temporarily relieve symptoms of alkalosis until the underlying cause is corrected.

The ICU nurse is concerned with her client's arterial blood gas (ABG) results—especially the pH 7.30; and PCO2 49 mmHg (6.52 kPa). The nurse interprets these ABG results and assesses her client for which clinical manifestations of respiratory acidosis? Select all that apply. Headache with complaints of blurred vision Muscle twitching Hyperactive deep tendon reflexes Complaints of paresthesia sensations around lips/mouth

Headache with complaints of blurred vision and Muscle twitching Carbon dioxide readily crosses the blood-brain barrier, exerting its effects by changing the pH of brain fluids. Elevated levels of CO2 produce vasodilation of cerebral blood vessels, causing headache, blurred vision, irritability, muscle twitching, and psychological disturbances.

A patient has chronic respiratory acidosis related to long-standing lung disease. Which of the following problems in the cause? Hyperventilation Hypoventilation Loss of acid by kidneys Loss of base by kidneys

Hypoventilation Hypoventilation related to lung disease causes the retention of carbon dioxide, which causes acidosis.

In what position should the nurse place Mrs. Hogan and why?

In a semi-to high-Fowler's position since an upright position facilitates lung expansion and eases the work of breathing.

Identify at least four signs and symptoms that indicate that Mrs. Hogan is not responding to treatment and may be developing status asthmaticus. (A life-threatening condition).

Increasing difficulty breathing Increasing tachypnea Increasing tachycardia Hypertension Pulsus paradoxus (abnormal decrease in systolic blood pressure) of greater than 10mmHg during inspiration Decreasing oxygen saturation Absent lung sounds Chest wall contractions Cyanosis of lips, oral mucosa, or nail beds Increased anxiety Difficulty speaking Confusion Lethargy

The nurse is providing care for an adult patient who is admitted to the emergency department (ED) after losing consciousness. The patient has been fasting and currently has ketones in the urine. The nurse monitors for which acid-base imbalance? Metabolic acidosis Metabolic alkalosis Respiratory acidosis Respiratory alkalosis

Metabolic Acidosis

A client has been admitted for dehydration after fasting for 5 days. For which acid-base imbalance should the nurse assess this client? -metabolic acidosis -metabolic alkolosis -respiratory acidosis

Metabolic acidosis -A prolonged fasting state can lead to dehydration. During fasting, the body reverts to cellular breakdown to maintain energy, and lactic and pyruvic acids build up in the body. This accumulation of acids leads to the development of metabolic acidosis.

A client's arterial blood gases reveal normal oxygen level, pH 7.50, PCO2 level of 50 mmHg (6.65 kPa) and HCO3 level of 30 (30 mmol/L). The client's respiratory rate is 12 breaths/min and all other vital signs are within normal range. What is this client's most likely diagnosis? Respiratory alkalosis Metabolic acidosis Respiratory acidosis Metabolic alkalosis

Metabolic alkalosis In response to increased bicarbonate, the client is hypoventilating to increase carbon dioxide partial pressure. As well, renal compensation is aimed at lowering pH by both reducing H+ excretion and HCO3- reabsorption. Metabolic alkalosis is manifested with increased pH, increased HCO3, and increased PCO2 levels.

Based on C.J.'s lab results, what changes in her IV fluids do you anticipate, and why? Chart View Laboratory Test Results Na 149 mmol/L K 3.0 mmol/L Cl 119 mmol/L Total CO2 21 mmol/L BUN 12 mg/dL Creatinine 1.2 mg/dL Glucose 307 mg/dL

Na 149 (normal 135-145)would expect a change in NS solutionlower amount of NS or switch to LR Potassium 3.0 (normal 3.5-5.0 )would expect a Potassium IV supplement Glucose remains high 307would adjust insulin dripcontinue IV insulin infusion until between 200-250, then infuse dextrose/normal saline

A patient is admitted to the emergency department for the treatment of a drug overdose causing acute respiratory acidosis. Which substance noted on the toxicology report is the most likely cause for the current diagnosis? PCP Cocaine Marijuana Oxycodone

Oxycodone

A client is admitted to the hospital with atelectasis and reports of chest pain. For which acid-base imbalance should the nurse assess this client? -Respiratory alkalosis -Metabolic acidosis -Metabolic alkalosis -Respiratory acidosis

Respiratory Acidosis -A client with atelectasis has collapsed alveoli that retain CO2, which can lead to respiratory acidosis. The client most likely would have hypoventilation as a respiratory pattern, which would further contribute to the development of respiratory acidosis.

The nurse is teaching a client with asthma how to take fluticasone (Flovent) via MDI. Which client statement indicates teaching is successful? "I will monitor my heart rate before using this inhaler." "I will rinse my mouth after I use this inhaler." "I will use this inhaler before I administer my bronchodialtor." "I will use this inhaler with meals since nausea and vomiting are common side-effect."

The correct answer is: "I will rinse my mouth after I use this inhaler." Client teaching is effective when the client states the need to rinse the mouth after using states the need to rinse the mouth after using a corticosteroid inhaler: this prevents candidiasis from the drug's interference with natural defenses in the mouth and the throat.

The parents of a 7-year-old client who has been diagnosed with allergic asthma are being taught about their son's medication regimen. The nurse is teaching about the appropriate use of a "rescue drug" for acute exacerbations. What drug should the nurse suggests the parents to use in these situations? Theophylline Albuterol Beclomethasone Acetylcysteine

The correct answer is: Albuterol Albuterol is a rescue drug that should be used first for all acute symptoms of shortness of breath or wheezing.

The nurse is providing care to a patient admitted for a traumatic brain injury who has developed respiratory acidosis. Which action by the nurse is the priority? Monitoring peripheral vascular status Reassuring the patient to decrease anxiety Assessing respiratory rate and depth closely Administering sodium bicarbonate as ordered

The correct answer is: Assessing respiratory rate and depth closely Nursing interventions for patients with respiratory acidosis include maintaining the patient's airway, monitoring arterial blood gas levels, monitoring vital signs (especially respiratory rate and depth), administering supplemental oxygen, assisting with intubation if necessary, monitoring potassium levels, administering sedatives cautiously, and providing patient reassurance and teaching as needed.

A nurse is evaluating the laboratory values of a patient diagnosed with DKA. After reviewing the patient's serum sodium, chloride, and bicarbonate levels, the nurse calculates that the patient's anion gap is 25 mEq/L. How should the nurse interpret this value? Confirmation of metabolic acidosis Evidence of metabolic alkalosis Verification of respiratory acidosis Proof of respiratory alkalosis

The correct answer is: Confirmation of metabolic acidosis The nurse should interpret an anion gap of 25 mEq/L as confirmation of the presence of metabolic acidosis. The normal range for the anion gap is 8-16 mEq/L: an anion gap greater than 16 mEq/L indicates the presences of metabolic acidosis. If metabolic acidosis is identified, the anion gap may be used to help monitor the effectiveness of treatment and the underlying condition.

Naloxone will reverse the effects of which drug? Fentanyl Lorazepam Valproic Acid Warfarin

The correct answer is: Fentanyl Naloxone (Narcan) is an opioid antagonist, which means it will only reverse the effects of opioids like fentanyl (Duragesic).

The client has mild, persistent asthma. The nurse anticipates the healthcare provider prescribing which daily medications? Albuterol Levalbuterol Terbutaline Fluticasone

The correct answer is: Fluticasone Fluticasone is a daily inhaled corticosteroid. Terbutaline, albuterol, and levalbuterol are all short-acting beta-2 agonists that are used for ACUTE symptom relief.

A nurse is preparing to administer insulin to a patient diagnosed with DKA. Which agent should the nurse identify as the insulin of choice for this patient? Humalog Humulin R Novolin N Lantus

The correct answer is: Humulin R The nurse should identify Humulin R as the insulin of choice for this patient. Humulin R is regular insulin, which is the only insulin that can be administered intravenously to quickly correct the hyperglycemia associated with DKA.

A client with symptoms of mild persistent asthma is now initiating treatment. Which of the following is the preferred therapy that the nurse will teach the client to use at home? Inhaled beclomethasone Oral sustained-release albuterol Subcutaneous omalizumab Oral prednisone

The correct answer is: Inhaled beclomethasone For mild persistent asthma, the preferred treatment is an inhaled corticosteroid, such as beclomethasone (Beconase).

The nurse is planning care for an older adult patient with respiratory acidosis. Which intervention does the nurse include in this patient's plan of care? Perform chest physiotherapy. Reduce environmental stimuli. Administer intravenous sodium bicarbonate. Administer prescribed intravenous fluids carefully.

The correct answer is: Perform chest physiotherapy. Respiratory acidosis results in a drop in the blood pH, reduced level of oxygen, and retaining of carbon dioxide. Chest physiotherapy facilitates the removal of secretions from the lungs, which can encourage deep breathing to decrease carbon dioxide levels and improve oxygenation.

The nurse monitors for clinical manifestation of metabolic alkalosis in the patient with which disorder? Diarrhea Prolonged vomiting Renal failure Salicylate intoxication

The correct answer is: Prolonged vomiting Most instances of metabolic alkalosis are due to an increased loss of acid through the gastrointestinal tract, usually via vomiting or nasogastric suctioning.

A client is experiencing an acute asthmatic attack. Prior to treatment with levalbuterol (Xopenex), respiration were 40, pulse 132, oxygen saturation 86%, and wheezing was audible. Which of the following indicates that the desired outcome of asthma treatment is achieved? Decreased PEF rate Wheezing inaudible with dimnished breath sounds Pulse 96 and SpO2 92% on room air Inspiratory cycle twice as long as the expiratory cycle

The correct answer is: Pulse 96 and SpO2 92% on room air Quick-acting bronchodilators are used in acute asthma to improve airflow and relieve symptoms: following treatment, tachycardia resolves as gas exchange and work of breathing are improved, SpO2 and PEF rates improve and wheezing from a constricted airway resolves. The normal inspiratory to expiratory ration is 1:2

The nurse is providing care for a patient admitted to the unit with respiratory failure and respiratory acidosis. The nurse correlates which data from the patient's history as the probable cause for the current diagnosis? Recent severe pulmonary infection A recent trip to South America Recent recovery from a cold virus Use of ibuprofen for the control of pain

The correct answer is: Recent severe pulmonary infection Severe pulmonary infections, bronchial obstruction, and atelectasis increase the risk of respiratory acidosis because of decreased ventilation and carbon dioxide retention.

The nurse is providing care to patient with the following laboratory values: pH 7.31; PaCO2 48 mm Hg; and HCO3 24 mEq/L. The nurse correlates these values to which acid-base disorder? Metabolic acidosis Metabolic alkalosis Respiratory acidosis Respiratory alkalosis

The correct answer is: Respiratory Acidosis Respiratory Acidosis: The ABG results for respiratory acidosis are pH less than 7.35 and PaCO2 greater than 45 mm Hg. If the pH is decreased and the PaCO2 is increased with a normal HCO3, it is uncompensated respiratory acidosis. With metabolic compensation, the HCO3- is greater than 26 mEq/L

The nurse is providing care to a patient who is admitted after a morphine overdose. Which acid-base imbalance does the nurse assess for in this patient? Metabolic acidosis Metabolic alkalosis Respiratory acidosis Respiratory alkalosis

The correct answer is: Respiratory acidosis Morphine is a narcotic and generally acts to decrease or suppress respirations; therefore, this patient is probably hypoventilating. The expected acid-base imbalance would be respiratory acidosis.

An emergency department nurse admits a patient who has tried to commit suicide by taking an overdose of oxycodone. For which acid-base imbalance should the nurse assess this patient? Respiratory acidosis Metabolic acidosis Respiratory alkalosis Metabolic alkalosis

The correct answer is: Respiratory acidosis The nurse should assess the patient for respiratory acidosis because opioid analgesics cause respiratory depression, which increases CO2 retention and leads to a decrease in blood pH (Acidosis)

The nurse is providing care to a patient who is admitted to the hospital with sudden, severe abdominal pain. Which arterial blood gas supports the patient's current diagnosis of respiratory alkalosis? pH is 7.35 and PaO2 is 88. pH is 7.30 and HCO3 is 30. pH is 7.47 and PaCO2 is 25. pH is 7.33 and PaCO2 is 36

The correct answer is: pH is 7.47 and PaCO2 is 25. Acute pain usually causes hyperventilation, which causes the CO2 to drop and the patient to experience respiratory alkalosis. The pH would denote alkalosis and would be higher than 7.45. HCO3 would trend downward as the kidneys begin to compensate for the alkalosis by excreting HCO3. The PaO2 is likely to be normal unless the patient has been hyperventilating for a long time and is beginning to tire.

A client is admitted to the hospital with respiratory acidosis. Which condition could be an etiology for this state? Select all that apply. Severe diarrhea for several days Diabetic ketoacidosis Obesity Diuretics Sedative Overdose

The correct answers are: Obesity and Sedative Overdose A client with atelectasis has collapsed alveoli that retain CO2, which can lead to respiratory acidosis. The client most likely would have hypoventilation as a respiratory pattern, which would further contribute to the development of respiratory acidosis.

A child with asthma lives in a home in which both parents smoke. The nurse should encourage the family to establish which of the following "house rules" for smoking? Select all that apply. Do not allow visitors to smoke in the home Roll car windows down when smoking in the car Maintain a smoke-free home Do not smoke around children Wear one consistent piece of clothing (smoking jacket) when outside Pick one room in the house to reserve for smoking (the parents bedroom) When smoking with children nearby, blow smoke away fro the child

The correct answers are: Do not allow visitors to smoke in the home, Maintain a smoke-free home, Do not smoke around children, Wear one consistent piece of clothing (smoking jacket) when outside.

The nurse should assess for which signs and symptoms in a client who has metabolic acidosis? Select all that apply. Weight gain Rapid, deep respirations Drowsiness Decreased respiratory rate and depth Melana

The correct answers are: Rapid deep respirations and drowsiness Clients who have metabolic acidosis develop Kussmaul's breathing (Rapid and deep respiration) Drowsiness occurs because of the CNS depressant effect of acidosis.

A nurse should recognize the situations when naloxone (Narcan) should be used cautiously. What represents one of those situations? Select all that apply A client who is pregnant A client with cardiovascular disease A client with an alcohol dependency A client with an opioid dependency A client with chronic obstructive pulmonary disease

The correct answers are: A client who is pregnant, A client with cardiovascular disease, A client with an opioid dependency Opioid antagonists like naloxone (Narcan) should be used cautiously in those who are pregnant or lactating, in infants of opioid-dependent mothers, and in patients with an opioid dependency or cardiovascular disease.

Which risk factors exhibited by the patient presenting in the emergency department (ED) would place the patient at risk for metabolic acidosis? Select all that apply Pneumonia Abdominal fistulas Acute renal failure Hypovolemic shock Chronic obstructive pulmonary disease

The correct answers are: Abdominal fistulas, Acute renal failure, Hypovolemic shock Abdominal fistulas that lead to loss of alkali can cause metabolic acidosis. Decreased acid excretion by the kidneys in acute or chronic renal failure can lead to metabolic acidosis Hypovolemic shock can lead to anaerobic metabolism that can cause metabolic acidosis

The nurse is teaching a parent of a preschooler who was recently diagnosed with asthma. The nurse includes which of the following in the teaching plan? Select all that apply. Avoid potential indoor allergens such as mold and dust Wash all bedding in cold water to reduce and destroy dust mites Keep the humidity in the house at 50% to 60% Be sure the child wears warm clothing in cold weather Avoid foods prepared with sulfite preservatives

The correct answers are: Avoid potential indoor allergens such as mold and dust, Keep the humidity in the house at 50% to 60%, Be sure the child wears warm clothing in cold weather, Avoid foods prepared with sulfite preservatives.

The nurse is providing care to a patient who is admitted with manifestations of metabolic alkalosis. Which diagnostic test results are consistent with this? Select all that apply. Serum glucose level 142 mg/dL Blood pH 7.47 Arterial HCO3 34 mEq/L Bilateral lower lobe infiltrates noted on chest x-ray Arterial HCO3 34 mEq/L

The correct answers are: Blood pH 7.47, Arterial HCO3 34 mEq/L, Arterial HCO3 34 mEq/L In metabolic alkalosis, the blood pH will be greater than 7.45 and the bicarbonate level greater than 28 mEq/L. The ECG pattern shows changes similar to those seen with hypokalemia. To increase serum hydrogen ion levels in metabolic alkalosis, serum potassium is pumped into the cell in exchange for the serum hydrogen ions. This decreases the serum potassium levels while the intracellular potassium levels increase, resulting in hypokalemia

A child with type 1 diabetes is brought to the emergency department. The nurse suspects diabetic ketoacidosis (DKA) based on which assessment findings? Select all that apply. Fruity breath odor Decreased level of consciousness Poor skin turgor Increased urine output Quick capillary refill

The correct answers are: Fruity breath odor, Decreased level of consciousness, poor skin turgor, and increased urine output. If insulin deficiency persists and ketone bodies continue to be excreted, the child begins to experience stomach pains, vomiting, and continued weight loss. Dehydration quickly develops as DKA progresses. The degree of dehydration is assessed while the child is weighed and examined. Assessment includes examining the mucous membranes for moistness, the eyeballs for degree of depression, the skin for turgor, and the anterior fontanel (if present) for depression. The child may also show signs of impending shock: tachypnea, decreased output, decreased level of consciousness, slowed capillary refill, and tachycardia. A late sign of shock in children is hypotension. DKA is most commonly present in new-onset T1DM or during crises in children with known T1DM, but it may also be found in newly diagnosed T2DM in the adolescent age group. Kussmaul respirations and changes in mental status may ensue. The breath develops a fruity odor in all children with DKA. If the child becomes somnolent and advances into a coma, these are ominous signs of cerebral edema.

A nurse monitoring a client receiving naloxone (Narcan) should be cognizant for the development of which adverse reactions? Select all that apply Nausea Constipation Tachycardia Hypotension Tremors

The correct answers are: Nausea, Tachycardia and Tremors Generalized reactions that can occur with the use of opioid antagonists such as naloxone include nausea, vomiting, sweating, tachycardia, increased blood pressure, and tremors.

A nurse is managing the care of a patient who was just admitted with a diagnosis of DKA. A physician writes orders for the patient. Which physician orders should the nurse question? Select all that apply. Read this question carefully. It is looking for the wrong orders. Monitor neurological status every hour Place the patient on a potassium-restricted diet Check vital signs every 15 minutes until stable Administer regular insulin subcutaneously per sliding scale. Administer IV 0.45% saline solution at 1,000 mL/hr.

The correct answers are: Place the patient on a potassium-restricted diet, Administer regular insulin subcutaneously per sliding scale.

A client is admitted to the hospital with a diagnosis of respiratory acidosis secondary to an overdose of barbiturates Which assessment findings would the nurse anticipate? Select all that apply. Slow, shallow respiration Tetany symptoms Increased deep tendon reflexes Palpitations Headache

The correct answers are: Slow, shallow respiration and Headache Clients with respiratory acidosis from ingestion of barbiturates would have slow and shallow respirations, leading to hypoventilation. A headache is associated with respiratory acidosis because the increased CO2 level causes cerebral vasodilation, which leads to a headache.

A nurse working in the emergency department (ED) reviews arterial blood gas (ABG) values for a patient diagnosed with heatstroke. Blood gas values are pH 7.48, pCO2 34, pO2 95, CO2 23, HCO2 22, and SO2 98%. Which of the following nursing interventions demonstrate the nurse's understanding of the patient's ABG's and knowledge of Maslow's hierarchy of needs when providing care for this patient? -The nurse prepares for endotracheal intubation and mechanical ventilation for the patient -Lab values are within normal limits and contacts the patient's family to be with the patient while in the ED -The nurse completes a spiritual assessment and provides appropriate clergy support for the patient -The nurse immediately starts an intravenous line (IV) of dextrose 50% in a water solution (D50W)

The nurse prepares for endotracheal intubation and mechanical ventilation for the patient This patient is experiencing respiratory alkalosis related to heatstroke. The pH level is elevated in hyperventilation; the patient's hyperventilation will "blow-off" more CO2, leading to lower pCO2 levels. Decreased pCO2 is caused by hyperventilation. Decreased CO2 levels are seen in renal failure. Renal failure is a sign of heatstroke. With rapid breathing, SO2 can be increased with deep or rapid breathing. Acute airway management is indicated to improve tissue oxygenation. Airway support meets the patient's physiologic need for a clear airway. Spiritual support is a higher level (self-actualization) on Maslow's hierarchy. Providing IV management for circulatory support is a basic physiologic need; however, airway management is a priority.

Vital Signs Blood pressure 90/50 mm Hg A heart rate of 124 beats/min Respiratory rate 36 and deep Temperature 101.3° F (38.5° C) (tympanic) Laboratory Test Values Glucose 777 mg/dl Potassium 6.0 mEq/L 1. Are these VS appropriate for a woman of C.J.'s age? Why or why not? Discuss your rationale. 2. Explain the rationale for C.J.'s other presenting signs and symptoms and lab values

Vital signs Increased heart rate and decreased blood pressure indicate that she is hypovolemic. Temperature is elevated possibly due to dehydration or infection Kussmaul breathing: trying to compensate for metabolic acidosis Labs Serum glucose extremely high: Due to lack of insulin and dehydration Serum potassium extremely high Elevated blood levels, nausea, and vomiting are leading her to metabolic acidosis Elevated blood levels are symptoms of ketoacidosis Explain the rationale for C.J.'s other presenting signs and symptoms (3pts) Nausea, vomiting, drowsiness, diarrhea, fruity-smelling breath, and weakness are all associated with metabolic acidosis and ketoacidosis. Increased ketoacidosis has slowed down the CNS system which will alter the level of consciousness Sweet-smelling breath is due to the presence of ketones related to DKA

Which of these ABG results would you expect to see in C.J.? pH 7.40, Pao2 88, Paco2 34, HCO3 23 pH 7.48, Pao2 90, Paco2 30, HCO3 28 pH 7.27, Pao2 90, Paco2 50, HCO3 20 pH 7.26, Pao2 94, Paco2 23, HCO3 18

pH 7.27, Pao2 90, Paco2 50, HCO3 20

A client is admitted with a diagnosis of renal failure. What arterial blood gas (ABG) result should the nurse expect to see with this client? -pH 7.49: paCO2 36: HCO3 30 -pH 7.30: paCO2 35: HCO3 18 -pH 7.31: paCO2 50: HCO3 23 -pH 7.43: paCO2 48: HCO3 30

pH 7.30: paCO2 35: HCO3 18 -Clients with renal failure have difficulty synthesizing HCO3 in the renal tubules secondary to renal failure. These clients also retain K+ and subsequently develop metabolic acidosis. The ABG with the pH of 7.30 reflects uncompensated metabolic acidosis.

A client is admitted to the hospital after vomiting for 3 days. What arterial blood gas (ABG) results should the nurse expect? -pH 7.30; PaCO2 50: HCO3 27 -pH 7.47; PaCO2 43: HCO3 28 -pH 7.34; PaCO2 50: HCO3 28 -pH 7.48; PaCO2 30: HCO3 23

pH 7.47; PaCO2 43: HCO3 28 -Vomiting leads to the loss of hydrochloric acid from gastric acids. Hydrogen ions must leave the blood to replace this acidity in the stomach. Metabolic alkalosis occurs and is reflected by elevated pH and HCO3 and normal PaCO2.

The nursing is giving discharge instructions to a client with persistent asthma. The nurse should be sure the client understands to do which of the following? Use inhalers only when wheezing Avoid exposure to known triggers Reduce fluid intake Limit activity level

the correct answer is: Avoid exposure to known triggers The nurse ensures that the client understands to avoid exposure to known triggers and allergens.