Acid Base Balance, AKD and CKD NCLEX Questions

A 62-year-old client was admitted 2 days ago with traumatic injuries and hypovolemic shock. Which lab result is most important for the nurse to report to the health care provider immediately? A.Serum sodium 132 mEq/L (mmol/L) B.Serum potassium 6.9 mEq/L (mmol/L) C.Blood urea nitrogen 24 mg/dL (mmol/L) D.Hematocrit 32% (0.32 volume fraction); hemoglobin 9.2 g/dL (92 g/L)

B

•A specimen for arterial blood gases is obtained from a severely dehydrated 3-month-old infant with a history of diarrhea. The pH is 7.30, Pco2 is 35 mm Hg, and HCO3- is 17 mEq/L (17 mmol/L). What complication does the nurse conclude has developed? a.Respiratory acidosis b.Respiratory alkalosis c.Metabolic acidosis d.Metabolic alkalosis

•C- Metabolic acidosis •The blood pH indicates acidosis; the bicarbonate (HCO3-) level is further from the expected range than is the partial pressure of carbon dioxide (Pco2), indicating a metabolic origin (losses from diarrhea), not a respiratory origin. The blood pH indicates acidosis, not alkalosis.

•A client is in a state of uncompensated acidosis. What approximate arterial blood pH does the nurse expect the client to have? a.7.20 b.7.35 c.7.45 7.48

•A- 7.20 •The pH of blood is maintained within the narrow range of 7.35 to 7.45. When there is an increase in hydrogen ions, the respiratory, buffer, and renal systems attempt to compensate to maintain the pH. If compensation is not successful, acidosis results and is reflected in a lower pH.

•The nurse on a medical-surgical unit identifies that which patient has the highest risk for metabolic alkalosis? a.A patient with a traumatic brain injury b.A patient with type 1 diabetes mellitus c.A patient with acute respiratory failure d.A patient with nasogastric tube suction

•Answer: D •The patient with NG tube is losing gastric acid and therefore is at risk for metabolic alkalosis.

•To determine the presence of respiratory alkalosis in the laboring client, what should the nurse evaluate her for? a.A change in the respiratory rate b.A tingling sensation in the hands c.Periodic changes in the fetal heart rate d.A pulse oximetry reading of less than 98%

•B- A tingling sensation in the hands The presence of a tingling sensation in the hands indicates respiratory alkalosis due to a decrease in carbon dioxide. A change in respiratory rate is incorrect because although such a change may contribute to respiratory alkalosis, it is not evidence of an increase in pH. In the presence of maternal respiratory alkalosis, chemical changes in maternal erythrocytes facilitate oxygen release to the fetus, which assists in maintaining a normal fetal heart rate. A pulse oximetry reading of 98% is incorrect because this is a normal finding

The nurse is caring for a 74-year- old client scheduled for a cardiac catheterization with contrast dye. What nursing action is appropriate? Select all that apply. A.Assess creatinine clearance using a 24- hour urine collection test. B.Assess for co-existing conditions of diabetes, heart failure, and kidney disease. C.Collaborate with the provider about whether IV fluids should be infused before the test D.Notify the provider regarding changes in serum creatinine from 0.2 to 0.4 mg/dL in 24 hours. E.Alert the provider to a glomerular filtration rate (GFR) < 60 mL/min/1.73 m2

B,D,E

A client who performs home continuous ambulatory peritoneal dialysis reports that the drainage (effluent) has become cloudy in the past 24 hours. What is the priority nursing action? A.Remove the peritoneal catheter. B.Notify the nephrology health care provider. C.Obtain a sample of effluent for culture and sensitivity. D.Teach the client that effluent should be clear or slightly yellow.

C The client most likely has beginning peritonitis. This problem needs to be confirmed and interventions started quickly. A culture is needed to identify that an infection is indeed present. Although the health care provider does need to be notified, obtaining the culture is performed first. The peritoneal catheter should not be removed at this time because it may be needed to instill intraperitoneal antibiotics. Also, removal of this catheter in not within the scope of practice for registered nurses in most states. Dialysate for peritoneal dialysis is sterile and does not need to be refrigerated.Cognitive Level: Applying or higherClient Needs Category: Physiological IntegrityNursing Process Step: Implementation

•An arterial blood gas report indicates the client's pH is 7.25, PCO2 is 35 mm Hg, and HCO3 is 20 mEq/L. Which disturbance should the nurse identify based on these results? a.Metabolic acidosis b.Metabolic alkalosis c.Respiratory acidosis d.Respiratory alkalosis

•A- Metabolic acidosis A low pH and low bicarbonate level are consistent with metabolic acidosis. The pH indicates acidosis, not alkalosis. The CO2 concentration is within normal limits, which is inconsistent with respiratory acidosis; it is elevated with respiratory acidosis

A patient with an acid-base imbalance has an altered potassium level. The nurse recognizes that the potassium level is altered because a.Potassium is returned to extracellular fluid when metabolic acidosis is corrected. b.Hyperkalemia causes an alkalosis that results in potassium being shifted into the cells. c.Acidosis causes hydrogen ions in the blood to be exchanged for potassium from the cells. d.In alkalosis, potassium is shifted into extracellular fluid to bind excessive bicarbonate.

•Answer: C •Rationale: Changes in pH (hydrogen ion concentration) will affect potassium balance. In acidosis, hydrogen ions accumulate in the intracellular fluid (ICF), and potassium shifts out of the cell to the extracellular fluid to maintain a balance of cations across the cell membrane. In alkalosis, ICF levels of hydrogen diminish, and potassium shifts into the cell. If a deficit of H+ occurs in the extracellular fluid, potassium will shift into the cell. Acidosis is associated with hyperkalemia, and alkalosis is associated with hypokalemia.

A patient has the following ABG results: pH 7.48, PaO2 86 mm Hg, PaCO2 44 mm Hg, HCO3 29 mEq/L. When assessing the patient, the nurse would expect the patient to have a.Muscle cramping b.Warm, flushed skin c.Respiratory rate of 36 d.Blood pressure of 94/52

•Answer: a •Rationale: The patient is experiencing metabolic alkalosis (elevated pH and elevated HCO3). Clinical manifestations of metabolic alkalosis include hypertonic muscles and cramping and reduced respiratory rate. Hypotension and warm, flushed skin may occur with respiratory acidosis.

•A nurse is planning care for a school-aged child experiencing respiratory acidosis. What is the sequence of events that occurs in the child's respiratory response to acidosis? Place the physiologic responses in the order in which they occur. •Increased pH •Hyperventilation •Increased CO2 elimination •Decreased blood H+ ions

1. Hyperventilation 2. Increased CO2 elimination 3. Decreased blood H+ ions 4. Increased pH •Respiratory compensation to acidosis involves hyperventilation with increased CO2 elimination. As carbon dioxide is blown off there is a decrease in the hydrogen ions in the blood, leading to an increase in pH to expected limits.

The nurse is caring for a 38- year- old male with hypertension and Stage 1 CKD. The client reports lifestyle changes and feeling "better" and has stopped taking a prescribed diuretic. What is the appropriate nursing response? A."The diuretic will reduce your blood pressure which may slow or prevent progression of your chronic kidney disease." B."Your primary health care provider prescribed the diuretic because it will reverse the damage caused by kidney disease." C."Taking medications is a personal decision, and you have the right to decline this prescription." D."Since you have implemented lifestyle changes the diuretic is likely not needed."

A

The nurse is preparing a client with stage 3 CKD (Stage3, not on dialysis yet) for discharge. Which client statement indicates the need for further teaching? A."I will be sure to attend my follow up appointment with my nephrologist." B."I will increase my protein intake so my body can heal." C."I will weigh myself daily and call the doctor if my weight increases by 2 pounds or more. D."I will take my blood pressure each day and keep a daily log."

B

•The nurse is caring for a client with the following arterial blood gas (ABG) values: PO2 89 mm Hg, PCO2 35 mm Hg, and pH of 7.37. These findings indicate that the client is experiencing which condition? a.Acid-base balance b.Fluid balance c.Oxygen depletion d.Metabolic acidosis

•A- Acid-base balance •All data are within expected limits; PO2 is 80 to 100 mm Hg, PCO2 is 35 to 45 mm Hg, and the pH is 7.35 to 7.45. None of the data are indicators of fluid balance, but of acid-base balance. Oxygen is within expected limits of 80 to 100 mm Hg. With metabolic acidosis the pH is less than 7.35.

•A client develops respiratory alkalosis. When the nurse is reviewing the laboratory results, which finding is consistent with respiratory alkalosis? a.An elevated pH, elevated PCO2 b.A decreased pH, elevated PCO2 c.An elevated pH, decreased PCO2 d.A decreased pH, decreased PCO2

•C- An elevated pH, decreased PCO2 •In respiratory alkalosis the pH level is elevated because of loss of hydrogen ions; the PCO2 level is low because carbon dioxide is lost through hyperventilation. An elevated pH, elevated PCO2 is partially compensated metabolic alkalosis. A decreased pH, elevated PCO2 is respiratory acidosis. A decreased pH, decreased PCO2 is metabolic acidosis with some compensation.

•What is a nursing priority to prevent complications in clients with respiratory acidosis? a.Assessing the nail beds b.Listening to breath sounds c.Monitoring breathing status d.Checking muscle contractions

•C- Monitoring breathing status The nursing priority for preventing complications when caring for clients with respiratory acidosis is to monitor breathing status hourly and intervening changes. Assessing the nail beds for cyanosis, which is usually a late finding in acidosis, is not a priority intervention. Listening to breath sounds and assessing how easily air moves into and out of the lungs can be a second priority intervention. Checking muscle contractions in the neck region is a later priority intervention.

•A client is admitted with metabolic acidosis. The nurse considers that two body systems interact with the bicarbonate buffer system to preserve healthy body fluid pH. What two body systems should the nurse assess for compensatory changes? a.Skeletal and nervous b.Circulatory and urinary c.Respiratory and urinary d.Muscular and endocrine

•C- Respiratory and urinary •Increased respirations blow off carbon dioxide (CO2), which decreases the hydrogen ion concentration and the pH increases (less acidity). Decreased respirations result in CO2 buildup, which increases hydrogen ion concentration and the pH falls (more acidity). The kidneys either conserve or excrete bicarbonate and hydrogen ions, which helps to adjust the body's pH. The buffering capacity of the renal system is greater than that of the pulmonary system, but the pulmonary system is quicker to respond. Skeletal and nervous systems do not maintain the pH, nor do muscular and endocrine systems. Although the circulatory system carries fluids and electrolytes to the kidneys, it does not interact with the urinary system to regulate plasma pH.

•A nurse in the pediatric unit is reviewing the arterial blood gas values of a 4-year-old child recovering from severe dehydration. Which results most accurately reflect the child's recovery? a.pH 7.50, Po2 85 mm Hg,Pco2 35 mm Hg b.pH 7.25, Po2 60 mm Hg, Pco2 50 mm Hg c.pH 7.40, Po2 85 mm Hg, Pco2 40 mm Hg d.pH 7.45, Po2 70 mm Hg, Pco2 25 mm Hg

•C- pH 7.40, Po2 85 mm Hg, Pco2 40 mm Hg •Expected arterial blood gas values are pH of 7.35 to 7.45, Po2 of 83 to 108 mm Hg, and Pco2 of 35 to 45 mm Hg; thus these gases are within normal limits. A pH of 7.5 indicates alkalosis. A pH of 7.25 indicates acidosis, a Po2 of 60 mm Hg indicates hypoxia, and a Pco2 of 50 mm Hg indicates hypercapnia. A Po2 of 70 mm Hg indicates hypoxia, and a Pco2 of 25 indicates hypocapnia.