Acid-Base Balance Practice Questions

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11) The nurse is planning care for an older client with respiratory acidosis. Which intervention should the nurse include in this client's plan of care? A) Administer prescribed intravenous fluids carefully. B) Administer intravenous sodium bicarbonate. C) Maintain adequate hydration. D) Reduce environmental stimuli.

Answer: C Explanation: C) In respiratory acidosis, there are a drop in the blood pH, reduced level of oxygen, and retaining of carbon dioxide. The body needs to be well-hydrated so that pulmonary secretions can be removed to improve oxygenation. Careful administration of intravenous fluids is important in the older client with metabolic alkalosis because older clients are at risk because of their fragile fluid and electrolyte status. Sodium bicarbonate is indicated in the treatment of metabolic acidosis. Reducing environmental stimuli would be appropriate for the client with respiratory alkalosis.

12) The results of a client's arterial blood gas sample reveal an oxygen level of 72 mmHg. For which associated health problem should the nurse assess this client? A) Communication B) Perfusion C) Fluid and electrolyte imbalance D) Cognition

Answer: D Explanation: D) An oxygen level of less than 75 mmHg can be due to hypoventilation. This drop in oxygen will change the client's level of responsiveness. Although acid-base imbalances can alter communication, there is no direct link between a low oxygen level and changes in communication. Perfusion is affected by a reduction in circulating fluids. With a fluid and electrolyte imbalance, there is another disorder affecting acid-base balance. This might not be affected by oxygen level.

Which condition increases the anion gap in a patient? 1 Metabolic acidosis 2 Metabolic alkalosis 3 Respiratory acidosis 4 Respiratory alkalosis

1 The anion gap increases in patients with metabolic acidosis due to increase in the concentration of acid. Metabolic alkalosis, respiratory acidosis, and respiratory alkalosis do not increase the anion gap.

A patient's arterial blood gas results are: pH 7.48, PaCO2 38, HCO3- 30. The patient is in: 1. Metabolic acidosis 2. Metabolic alkalosis 3. Respiratory acidosis 4. Respiratory alkalosis

2 Normal pH is 7.35-7.45. Values greater than 7.45 indicate alkalosis. Normal value for HCO3- is 22-26 mEq/L. Because the PaCO2 is normal and the HCO3- is elevated, the source of the alkalosis is metabolic. The patient is in metabolic alkalosis.

What is the function of a buffer? 1. To excrete weak acids 2. To secrete hydrogen ions 3. To convert strong acids to weak acids 4. To convert ammonia to ammonium ions

3 Buffers convert strong acids to weak acids. Excretion of weak acids, secretion of hydrogen ions into the renal tubule, and conversion of ammonia to ammonium ions takes place in the kidneys.

What is the function of a buffer? 1 To excrete weak acids 2 To secrete hydrogen ions 3 To convert strong acids to weak acids 4 To convert ammonia to ammonium ions

3 Buffers convert strong acids to weak acids. Excretion of weak acids, secretion of hydrogen ions into the renal tubule, and conversion of ammonia to ammonium ions takes place in the kidneys.

Which condition is manifested by hyperreflexia? 1. Metabolic acidosis 2. Metabolic alkalosis 3. Respiratory acidosis 4. Respiratory alkalosis

4 Respiratory alkalosis is manifested by hyperreflexia. Metabolic acidosis is manifested by abdominal pain and Kussmaul respirations. Tachycardia, anorexia, and muscle cramps are the manifestations of metabolic alkalosis. Headache, seizures, and hypotension are the manifestations of respiratory acidosis.

What is your next nursing intervention for Ben (in #8)? a.Have him breathe into paper bag b. Give him O2 c. Check his temperature d. Ash him if he is alright

a. Have him breathe into paper bag Rationale: Ben has blown off too much CO2, so we would have him breathe into a paper bag to rebreathe his expired air to raise his CO2.

1After running an ABG on a patient and reviewing the results, which should nurse report to the physician? pH 7.50 PaCO2 40 mmHg HCO3 32 mEq/L PaO2 95 mmHg a. Respiratory rate b. HCO3 c. PaO2 d. PaCO2

b. HCO3 Rationale: The normal range for pH is 7.35 to 7.45. A value greater than 7.45 indicates alkalosis. The normal value for HCO3 is 22-26. This patient is experiencing metabolic alkalosis and the values should be reported to the physician.

A patient has bradypnea, with respirations stable at 10 breaths/min. How is this going to affect the patient's ABGs? a. Metabolic acidosis b. Metabolic alkalosis c. Respiratory acidosis d. Respiratory alkalosis

c. Respiratory acidosis Rationale: Slower respirations mean the patient is not breathing off enough CO2, and carbon dioxide is building up in the blood stream, which lowers the pH. This is now respiratory acidosis.

Interpret: pH 7.10, pCO2 70, HCO3 24

pH & CO2 both Acid - respiratory acidosis; HCO3 normal means body is not compensating (uncompensated)

Interpret: pH 7.61, pCO2 22, HCO3 25

pH & CO2 both Base - respiratory alkalosis; HCO3 normal means body is not compensating (uncompensated)

12) The nurse suspects a client with one functioning lung is developing chronic respiratory acidosis. Which manifestation did the nurse most likely assess in this client? A) Warm, flushed skin B) Daytime sleepiness C) Irritability D) Blurred vision

Answer: B Explanation: A) The manifestations of acute and chronic respiratory acidosis differ. The client with chronic respiratory acidosis will demonstrate daytime sleepiness. The client with acute respiratory acidosis may demonstrate warm, flushed skin, irritability, and blurred vision from the acute decline in oxygenation.

1) The nurse has admitted a client who was brought to the hospital after a morphine overdose. What acid-base imbalance does the nurse expect to observe in this client? A) Respiratory alkalosis B) Respiratory acidosis C) Metabolic alkalosis D) Metabolic acidosis

Answer: B Explanation: A) Morphine is a narcotic and generally acts to decrease or suppress respirations; therefore, this client is probably hypoventilating. The expected acid-base imbalance would be respiratory acidosis. Respiratory alkalosis, metabolic acidosis, and metabolic alkalosis are caused by many conditions, none of which are related to this client's morphine overdose.

13) A client begins to hyperventilate after learning that a breast biopsy was positive for cancer. After a few minutes, the client loses consciousness. What should the nurse do? A) Begin cardiopulmonary resuscitation. B) Raise the side rails on the bed. C) Notify the physician. D) Insert an intravenous access device.

Answer: B Explanation: A) The nurse should protect the client from injury. If hyperventilation continues to the point where the client loses consciousness, respirations will return to normal, as will acid-base balance. The nurse should ensure for the client's safety and raise the side rails on the bed. The client does not need cardiopulmonary resuscitation. The physician may need to be notified; however, the client's safety is a priority. The client is not critically ill and an intravenous access device is not indicated at this time.

4) The nurse is reviewing the latest arterial blood gas results for a client with metabolic alkalosis. Which result indicates that the metabolic alkalosis is compensated? A) pH 7.32 B) PaCO2 18 mmHg C) HCO3 8 mEq/L D) PaCO2 48 mmHg

Answer: D D) A normal pH level is 7.35-7.45. A pH of less than 7.35 is acidosis. A PaCO2 level of 18 mmHg is low and is seen in respiratory alkalosis. A HCO3 level of 8 mEq/L is low and is most likely associated with metabolic acidosis. In metabolic alkalosis, there is an excess of bicarbonate. To compensate for this imbalance, the rate and depth of respirations decrease, leading to retention of carbon dioxide. The PaCO2 will be elevated.

10) The nurse is reviewing orders written by the healthcare provider for a client with metabolic acidosis. Which order should the nurse question before implementing it for the client? A) Begin intravenous infusion of 0.9% normal saline. B) Draw serum potassium levels every 2 hours. C) Draw arterial blood gas samples every 2 hours. D) Administer 1 ampule of sodium bicarbonate now.

Answer: D Explanation: Administering bicarbonate to correct acidosis increases the risk for hypernatremia, hyperosmolality, and fluid volume excess. This is the order that the nurse should question before providing. Treatment of metabolic acidosis includes correction of fluid balance. An infusion of normal saline would be appropriate for this client. As metabolic acidosis is corrected, potassium shifts back into the intracellular space. This shift can lead to hypokalemia and cardiac dysrhythmias. Serum potassium levels should be carefully monitored during treatment. Arterial blood gases are used to evaluate treatment and guide additional therapies.

What intervention would the nurse do for the bradypnea patient in #6? (Select all that apply) a. Administer bronchodilators as ordered b. Apply oxygen to maintain SaO2 c. CPAP or BiPAP d. Encourage smoking cessation

a. Administer bronchodilators as ordered (can reverse some types of airway obstruction) b. Apply oxygen to maintain SaO2 (standard of care is to maintain oxygen levels) c. CPAP or BiPAP (assisting patient to breathe with less invasive ventilation can assist to blow off more CO2) d. Encourage smoking cessation (smoking can cause damage to respiratory system/lungs)

Patient has been diagnosed with acute renal failure. What acid-base imbalance would be expected when ABG results come back? a. Metabolic acidosis b. Metabolic alkalosis c. Respiratory acidosis d. Respiratory alkalosis

a. Metabolic acidosis Rationale: The initiating problem is not in the lungs, so it would be metabolic. When the kidneys are dysfunctional, they are not filtering out appropriate acids, causing a rise in acids in the body. So this would be metabolic acidosis.

A patient states they have been vomiting for the last 4 days. The patient is irritable, weak and reporting muscle cramping and weakness. On assessment, the patient is experiencing bradypnea with a respiratory rate of 10. The patient has the following ABG results: pH 7.52, pCO2 48 and HCO3 36. Which of the following conditions are presenting? a. Metabolic alkalosis partially compensated b. Metabolic alkalosis fully compensated c. Metabolic acidosis partially compensated d. Metabolic acidosis not compensated

a. Metabolic alkalosis partially compensated Rationale: We know that the imbalance likely started with the vomiting (metabolic), indicating acid being lost (alkalosis) = Metabolic alkalosis. Since the CO2 is also abnormal, we can see that the respiratory system is trying to compensate for this imbalance. However, it has not fully compensated yet, because the pH is still alkalotic/base.

Your patient is on a morphine PCA pump for pain following a cholecystectomy. Her respirations have dropped to 10/minute. What do you expect to see in this patient? a. Respiratory acidosis b. Respiratory alkalosis c. Metabolic acidosis d. Metabolic alkalosis

a. Respiratory acidosis Rationale: Because the problem is with the respiratory system, we know that the ABGs will show a respiratory issue. Bradypnea means slow breathing, which means that CO2 is not blowing off well = too much CO2 in the blood, making it acidic.

A patient with COPD has the following blood gases: pH 7.26, pCO2 59, HCO3 42. Which of the following conditions is presenting? a. Respiratory alkalosis b. Respiratory acidosis c. Metabolic alkalosis d. Metabolic acidosis

b. Respiratory acidosis Rationale: The patient has shallow breathing because of COPD, and is unable to blow off CO2. This build up of CO2 causes pH to become acidic (pH < 7.35). This is respiratory acidosis.

Ben has anxiety attack. He has just had a car accident. His ABGs: pH 7.46, pCO2 32, HCO3 23. This indicates that what is happening? a. Respiratory acidosis b. Respiratory alkalosis c. Metabolic acidosis d. Metabolic alkalosis

b. Respiratory alkalosis

What two organs in the body serve as a compensatory function to maintain acid base balance? a. Lungs and spleen b. Heart and liver c. Kidneys and lungs d. Gallbladder and appendix

c. Kidneys and lungs Rationale: If the imbalance starts with a problem in the lungs, the kidneys try to compensate for the problem. If the imbalance starts with a problem outside the lungs, the lungs try to compensate for the problem. Both of these organs compensate to try to return the body to homeostasis.

The nurse is caring for a patient admitted with an exacerbation of asthma. After several treatments, the arterial blood gas (ABG) results are pH 7.40, PaCO2 40 mm Hg, HCO3 24 mEq/L, PaO2 92 mm Hg, and O2 saturation 99%. The nurse interprets these results as 1 .Within normal limits 2. Slight metabolic acidosis 3. Slight respiratory acidosis 4. Slight respiratory alkalosis

1 The normal pH is 7.35 to 7.45. Normal PaCO2 levels are 35 to 45 mm Hg and normal HCO3 leverls are 22 to 26 mEq/L. A normal PaO2 level is >80 mm Hg. Normal oxygen saturation is >95%. Because the patient's results all fall within these normal ranges, the nurse can conclude that the patient's blood gas results are within normal limits.

The family of a patient being treated for acute pancreatitis hears the nurse referring to "third spacing" during the assessment and asks the nurse what that means. Which explanation provides the best description for the family? "This is just a term that we use to describe edema." "Third-spacing refers to how the fluids both inside and outside of the cells are distributed." "Third-spacing describes the places where fluids can be found in the cells, blood vessels, and lymph system." "The fluid normally in the cells becomes trapped in between the cells and has difficulty moving back into the cells."

"The fluid normally in the cells becomes trapped in between the cells and has difficulty moving back into the cells." Rationale Third spacing refers to the collection of excess fluid in the nonfunctional areas between the cells. The fluid becomes trapped and has difficulty moving back into the cells. First spacing describes the normal distribution of fluids in the intracellular fluid and extracellular fluid compartments. Second spacing refers to edema. "Extracellular" and "intracellular" are terms that describe places where fluids can be found in the cells, blood vessels, and lymph system.

Which value of blood pH indicates acidosis? 1. 7.25 2. 7.35 3. 7.45 4. 7.55

1 A pH below 7.35 indicates acidosis; thus a pH of 7.25 a sign of acidosis. Normal blood pH lies between 7.35 and 7.45. A pH of 7.55 indicates alkalosis.

Which condition does the nurse suspect in a patient with renal failure? 1 .Metabolic acidosis 2. Metabolic alkalosis 3. Respiratory acidosis 4. Respiratory alkalosis

1 Renal failure will make the blood more acidic because of the inability of the kidneys to excrete acid. Therefore, the nurse suspects that the patient would develop metabolic acidosis. Metabolic alkalosis is caused by excess bicarbonate intake and a potassium deficit. Respiratory acidosis is caused by hypoventilation. Respiratory alkalosis is caused by hyperventilation.

Which condition increases the anion gap in a patient? 1. Metabolic acidosis 2. Metabolic alkalosis 3. Respiratory acidosis 4. Respiratory alkalosis

A diabetic patient fasting before surgery reports feeling dizzy and deep rapid breathing. A nurse observes that the patient has developed Kussmaul respirations. What condition is the patient most likely experiencing? 1. Metabolic acidosis 2. Metabolic alkalosis 3. Respiratory acidosis 4. Respiratory alkalosis

1 The patient has been fasting and complains of dizziness. The patient has likely developed diabetic ketoacidosis, a type of metabolic acidosis. Kussmaul respiration is deep, rapid breathing that develops in response to metabolic acidosis. This type of breathing is a compensatory mechanism to excrete excess carbon dioxide from the lungs. Metabolic alkalosis occurs when there is a loss of acid or a gain in bicarbonate. It is not associated with Kussmaul respiration. Respiratory acidosis results when the person hypoventilates and carbonic acid accumulates in the blood. Respiratory alkalosis occurs when the person hyperventilates.

Which value of blood pH indicates acidosis? 1 7.25 2 7.35 3 7.45 4 7.55

1 A pH below 7.35 indicates acidosis; thus a pH of 7.25 a sign of acidosis. Normal blood pH lies between 7.35 and 7.45. A pH of 7.55 indicates alkalosis.

Which condition does the nurse suspect in a patient with renal failure? 1 Metabolic acidosis 2 Metabolic alkalosis 3 Respiratory acidosis 4 Respiratory alkalosis

A diabetic patient fasting before surgery reports feeling dizzy and deep rapid breathing. A nurse observes that the patient has developed Kussmaul respirations. What condition is the patient most likely experiencing? 1 Metabolic acidosis 2 Metabolic alkalosis 3 Respiratory acidosis 4 Respiratory alkalosis

The nurse is caring for a patient admitted with an exacerbation of asthma. After several treatments, the arterial blood gas (ABG) results are pH 7.40, PaCO2 40 mm Hg, HCO3 24 mEq/L, PaO2 92 mm Hg, and O2 saturation 99%. The nurse interprets these results as 1. Within normal limits 2. Slight metabolic acidosis 3. Slight respiratory acidosis 4. Slight respiratory alkalosis

1. Within normal limits The normal pH is 7.35 to 7.45. Normal PaCO2 levels are 35 to 45 mm Hg and normal HCO3 leverls are 22 to 26 mEq/L. A normal PaO2 level is >80 mm Hg. Normal oxygen saturation is >95%. Because the patient's results all fall within these normal ranges, the nurse can conclude that the patient's blood gas results are within normal limits.

The nurse is admitting a patient with complaints of abdominal pain, nausea, and vomiting. A bowel obstruction is suspected. The patient is assessed for which anticipated primary acid-base imbalance if the obstruction is high in the intestine? 1. Metabolic acidosis 2. Metabolic alkalosis 3. Respiratory acidosis 4. Metabolic respiration

2 Because gastric secretions are rich in hydrochloric acid, the patient who is vomiting will lose a significant amount of gastric acid and be at an increased risk for metabolic alkalosis. Metabolic acidosis is more likely with diarrhea than vomiting. Respiratory acidosis is associated with the lungs, not the gastrointestinal system. Metabolic respiration is not a real thing.

After performing gastric suctioning on a patient who has ingested pesticides, the nurse suspects that the patient has developed metabolic alkalosis. Which finding supports the nurse's suspicion? 1. pH, 7, partial pressure of carbon dioxide (PaCO2), 34 mm Hg 2. pH, 10, partial pressure of carbon dioxide (PaCO2), 52 mm Hg 3. pH, 8.3, partial pressure of carbon dioxide (PaCO2), 44 mm Hg 4. pH, 7.2, partial pressure of carbon dioxide (PaCO2), 38 mm Hg

2 Metabolic alkalosis is manifested by increased plasma pH and partial pressure of carbon dioxide (PaCO2). Normal pH of the blood ranges from 7.35 to 7.45 and the normal range of PaCO2 in blood ranges from 35 to 45 mm Hg. The laboratory findings of pH 10 and PaCO2 of 52 mm Hg support the nurse's suspicion. A pH of 7 and PaCO2 of 34 mm Hg do not indicate metabolic alkalosis. A pH of blood of 8.3 is higher than normal and indicates alkalinity, and a PaCO2 of 44 mm Hg is normal. A pH value of 7.2 and a PaCO2 value of 38 mm Hg are normal.

A nurse reviews the laboratory results of a patient. The arterial blood gas (ABG) values are: pH 7.30, PaCO2 35 mm Hg, and bicarbonate (HCO3-) 16 mEq/L. What is the correct interpretation of the values given? 1. Respiratory acidosis 2. Metabolic acidosis 3. Metabolic alkalosis 4. Respiratory Alkalosis Respiratory alkalosis

2 Normal ABG values fall in the range of pH 7.35 to 7.45, PaCO2 35 to 45 mm Hg, and HCO3- 22 to 26 mEq/L. Bicarbonate and pH values are less than the normal values and indicate metabolic acidosis. A pH value less than 7.35 and low PaCO2 indicate respiratory acidosis. Metabolic acidosis is indicated by a low pH and low bicarbonate levels. Respiratory alkalosis is indicated by decreased PaCO2. In Metabolic conditions, the pH and the HCO3 go in the same direction. The PaCO2 may also go in the same direction.

The nurse is admitting a patient with complaints of abdominal pain, nausea, and vomiting. A bowel obstruction is suspected. The patient is assessed for which anticipated primary acid-base imbalance if the obstruction is high in the intestine? Incorrect 1 Metabolic acidosis Correct 2 Metabolic alkalosis 3 Respiratory acidosis 4 Metabolic respiration

After performing gastric suctioning on a patient who has ingested pesticides, the nurse suspects that the patient has developed metabolic alkalosis. Which finding supports the nurse's suspicion? 1 pH, 7, partial pressure of carbon dioxide (PaCO2), 34 mm Hg 2 pH, 10, partial pressure of carbon dioxide (PaCO2), 52 mm Hg 3 pH, 8.3, partial pressure of carbon dioxide (PaCO2), 44 mm Hg 4 pH, 7.2, partial pressure of carbon dioxide (PaCO2), 38 mm Hg

A nurse reviews the laboratory results of a patient. The arterial blood gas (ABG) values are: pH 7.30, PaCO2 35 mm Hg, and bicarbonate (HCO3-) 16 mEq/L. What is the correct interpretation of the values given? 1 Respiratory acidosis 2 Metabolic acidosis 3 Metabolic alkalosis 4 Respiratory alkalosis

A patient has the following arterial blood gas results: pH 7.32; PaCO2 56 mm Hg; HCO3- 24 mEq/L. The nurse determines that these results indicate: 1. Metabolic acidosis 2. Metabolic alkalosis 3. Respiratory acidosis 4. Respiratory alkalosis

3 Respiratory acidosis (carbonic acid excess) occurs whenever a person experiences hypoventilation. Hypoventilation leads to a buildup of CO2, resulting in an accumulation of carbonic acid in the blood. Carbonic acid dissociates, liberating H+, and there is a decrease in pH. The patient is not experiencing metabolic acidosis. These results are not indicative of metabolic alkalosis or respiratory alkalosis (because the pH is high).

A patient's arterial blood gas results are: pH 7.48, PaCO2 38, HCO3- 30. The patient is in: 1. Metabolic acidosis 2. Metabolic alkalosis 3. Respiratory acidosis 4. Respiratory alkalosis

2. Metabolic alkalosis Normal pH is 7.35-7.45. Values greater than 7.45 indicate alkalosis. Normal value for HCO3- is 22-26 mEq/L. Because the PaCO2 is normal and the HCO3- is elevated, the source of the alkalosis is metabolic. The patient is in metabolic alkalosis.

The nurse is caring for a patient admitted with a diagnosis of chronic obstructive pulmonary disease (COPD) who has the following arterial blood gas results: pH 7.33, PaO2 47 mm Hg, PaCO2 60 mm Hg, HCO3 32 mEq/L, and O2 saturation of 92%. What is the correct interpretation of these results? 1. Fully compensated respiratory alkalosis 2. Partially compensated respiratory acidosis 3. Normal acid-base balance with hypoxemia 4. Normal acid-base balance with hypercapnia

2. Partially compensated respiratory acidosis A low pH (normal 7.35-7.45) indicates acidosis. In the patient with a respiratory disease such as COPD, the patient retains carbon dioxide (normal 35-45 mm Hg), which acts as an acid in the body. For this reason, the patient has respiratory acidosis. The elevated HCO3 indicates a partial compensation for the elevated CO2.

When planning the care of a patient with dehydration, what would the nurse instruct the unlicensed assistive personnel (UAP) to report? 60 mL urine output in 90 minutes 1200 mL urine output in 24 hours 300 mL urine output per 8-hour shift 20 mL urine output for two consecutive hours

20 mL urine output for two consecutive hours The minimal urine output necessary to maintain kidney function is 30 mL/hr. If the output is less than this for two consecutive hours, the nurse should be notified so that additional fluid volume replacement therapy can be instituted.

A patient had 5 liters of fluid removed during a paracentesis. What intravenous (IV) solution may be used to pull fluid into the intravascular space after the paracentesis? 0.9% sodium chloride 25% albumin solution Lactated Ringer's solution 5% dextrose in 0.45% saline

25% albumin solution After a paracentesis of 5 L or greater of ascites fluid, 25% albumin solution may be used as a volume expander. Normal saline, lactated Ringer's, and 5% dextrose in 0.45% saline will not be effective for this action.

A patient's arterial blood gas results are: pH 7.32; PaCO2 52; HCO3- 24. The patient is in: 1. Metabolic acidosis 2. Metabolic alkalosis 3. Respiratory acidosis 4. Respiratory alkalosis

3 Normal pH is 7.35 to 7.45. Values less than 7.35 indicate acidosis. Normal value for PaCO2 is 35 to 45 mm Hg. Because the HCO3- is normal and the PaCO2 is elevated, the source of the acidosis is respiratory. The patient is in respiratory acidosis.

A patient reports headache and dizziness. After reviewing the electrocardiogram (ECG) and blood reports of the patient, the nurse finds that the patient has ventricular fibrillation and hypotension. Which condition does the nurse suspect? 1. Metabolic acidosis 2. Metabolic alkalosis 3. Respiratory acidosis 4. Respiratory alkalosis

3 Signs of respiratory acidosis include hypotension, headache, dizziness, and ventricular fibrillation. Metabolic acidosis is manifested by headache, dizziness, and dysrhythmia. Metabolic alkalosis is manifested by tachycardia, anorexia, and tremors. Patients with respiratory alkalosis exhibit tachycardia, tetany, and epigastric pain.

While caring for a patient with chronic obstructive pulmonary disease, the nurse finds that the patient's arterial blood gas results show a blood pH of 7.29, partial pressure of carbon dioxide (PaCO2) of 49 mm Hg, and a bicarbonate ion (HCO3) level of 25 mEq/L. Which condition does the nurse suspect? 1. Metabolic acidosis 2. Metabolic alkalosis 3. Respiratory acidosis 4. Respiratory alkalosis

3 The normal ranges of blood pH, partial pressure of carbon dioxide, and bicarbonate ion levels are 7.35 to 7.45, 75 to 100 mm Hg, and 22 to 26 mEq/L, respectively. Patients with chronic obstructive pulmonary disease (COPD) have difficulty breathing, which leads to hypoventilation. This causes a buildup of carbon dioxide in the blood, which increases the concentration of carbonic acid, leading to a decrease in blood pH. Thus, the patient is expected to have respiratory acidosis. In respiratory alkalosis, partial pressure of carbon dioxide decreases. Metabolic acidosis is manifested by decreased concentration of bicarbonate in blood. Respiratory alkalosis is manifested by decreased carbonic acid concentration in blood and decreased PaCO2.

A patient's arterial blood gas results are: pH 7.32; PaCO2 52; HCO3- 24. The patient is in: 1 Metabolic acidosis 2 Metabolic alkalosis 3 Respiratory acidosis 4 Respiratory alkalosis

A patient has the following arterial blood gas results: pH 7.32; PaCO2 56 mm Hg; HCO3- 24 mEq/L. The nurse determines that these results indicate: 1 Metabolic acidosis 2 Metabolic alkalosis 3 Respiratory acidosis 4 Respiratory alkalosis

A patient reports headache and dizziness. After reviewing the electrocardiogram (ECG) and blood reports of the patient, the nurse finds that the patient has ventricular fibrillation and hypotension. Which condition does the nurse suspect? 1 Metabolic acidosis 2 Metabolic alkalosis 3 Respiratory acidosis 4 Respiratory alkalosis

While caring for a patient with chronic obstructive pulmonary disease, the nurse finds that the patient's arterial blood gas results show a blood pH of 7.29, partial pressure of carbon dioxide (PaCO2) of 49 mm Hg, and a bicarbonate ion (HCO3) level of 25 mEq/L. Which condition does the nurse suspect? 1 Metabolic acidosis 2 Metabolic alkalosis 3 Respiratory acidosis 4 Respiratory alkalosis

The patient has a prescription for lactated Ringer's intravenously (IV) at a rate of 200 mL/hr. An IV pump is not available. The IV tubing has a drop factor of 10 drops/mL. The nurse will administer the lactated Ringer's solution at ___________ drops per minute. Record your answer using a whole number.

33.333 Drops/hr. = 33drops/hr Rationale Use the following formula to calculate the rate of IV solutions: Volume multiplied by drop factor divided by time (in minutes). Multiply 200 by 10 to yield 2000 and divide this by 60 to yield 33.3 or 33 gtt/minute (because the nurse cannot count a fraction of a drop).

Which value of partial pressure of carbon dioxide (PaCO2) in arterial blood indicates a compensatory response in metabolic alkalosis? 1. 38 mm Hg 2. 40 mm Hg 3. 44 mm Hg 4. 47 mm Hg

4 Metabolic alkalosis results in decreased carbonic acid. Therefore, to increase its concentration, the respiratory rate is reduced. This reduction leads to a rise in carbon dioxide concentration in the blood. Normal values of partial pressure of carbon dioxide (PaCO2) range from 35 to 45 mm Hg; 47 mm Hg of PaCO2 indicates a compensatory response in metabolic alkalosis.

What is the normal range of blood pH? 1. 7.05 to 7.15 2. 7.15 to 7.25 3. 7.25 to 7.35 4. 7.35 to 7.45

4 The normal range of blood pH is 7.35 to 7.45. A pH less than 7.35 indicates acidosis

The nurse provides care for a patient with respiratory alkalosis. What arterial blood gas results correspond to this condition? 1. pH 7.46, pCO2 44 mm Hg, PO2 95 mm Hg, and HCO3- 36 mEq/L 2. pH 7.27, pCO2 70 mm Hg, PO2 80 mm Hg, and HCO3- 26 mEq/L 3. pH 7.30, pCO2 35 mm Hg, PO2 70 mm Hg, and HCO3- 20 mEq/L 4. pH 7.52, pCO2 24 mm Hg, PO2 85 mm Hg, and HCO3- 24 mEq/L

4 The patient is experiencing alkalosis because the pH is greater than 7.45. The alkalosis is of a respiratory origin because the carbon dioxide is below normal (reflecting that there is not enough acid) and the HCO3- is within normal range. Normal arterial blood gas values include pH 7.35 to 7.45, pCO2 35 to 45, HCO3- 22 to 26. A pH of 7.46, pCO2 of 44 mm Hg, pO2 of 95 mm Hg, and HCO3- of 36 mEq/L indicate metabolic alkalosis, because pH is increased, the pCO2 is normal, and the HCO3- is increased. A pH of 7.27, pCO2 of 70 mm Hg, pO2 of 80 mm Hg, and HCO3- of 26 mEq/L indicate respiratory acidosis, because pH is low, pCO2 is increased, and HCO3- is normal. A pH of 7.30, pCO2 of 35 mm Hg, pO2 of 70 mm Hg, and HCO3- of 20 mEq/L indicate metabolic acidosis, because the pH is low, pCO2 is normal, and HCO3- is low.

The nurse is caring for a patient admitted with dehydration because of nausea and vomiting. The nurse anticipates which acid-base imbalance based on this information? 1. Respiratory acidosis 2. Respiratory alkalosis 3. Metabolic acidosis 4. Metabolic alkalosis

4 With nausea and vomiting, acid is lost from the gastrointestinal system, elevating the pH, causing metabolic alkalosis. There is not a respiratory component of this imbalance caused by nausea and vomiting. The pH would be low, resulting in an acidosis, not vomiting, if the patient had diarrhea.

Which value of partial pressure of carbon dioxide (PaCO2) in arterial blood indicates a compensatory response in metabolic alkalosis? 1 38 mm Hg 2 40 mm Hg 3 44 mm Hg 4 47 mm Hg

Which condition is manifested by hyperreflexia? 1 Metabolic acidosis 2 Metabolic alkalosis 3 Respiratory acidosis 4 Respiratory alkalosis

The nurse is caring for a patient admitted with dehydration because of nausea and vomiting. The nurse anticipates which acid-base imbalance based on this information? 1 Respiratory acidosis 2 Respiratory alkalosis 3 Metabolic acidosis 4 Metabolic alkalosis

4. pH 7.52, pCO2 24 mm Hg, PO2 85 mm Hg, and HCO3- 24 mEq/L The patient is experiencing alkalosis because the pH is greater than 7.45. The alkalosis is of a respiratory origin because the carbon dioxide is below normal (reflecting that there is not enough acid) and the HCO3- is within normal range. Normal arterial blood gas values include pH 7.35 to 7.45, pCO2 35 to 45, HCO3- 22 to 26. A pH of 7.46, pCO2 of 44 mm Hg, pO2 of 95 mm Hg, and HCO3- of 36 mEq/L indicate metabolic alkalosis, because pH is increased, the pCO2 is normal, and the HCO3- is increased. A pH of 7.27, pCO2 of 70 mm Hg, pO2 of 80 mm Hg, and HCO3- of 26 mEq/L indicate respiratory acidosis, because pH is low, pCO2 is increased, and HCO3- is normal. A pH of 7.30, pCO2 of 35 mm Hg, pO2 of 70 mm Hg, and HCO3- of 20 mEq/L indicate metabolic acidosis, because the pH is low, pCO2 is normal, and HCO3- is low.

Interpret: pH 7.39, pCO2 27, HCO3 19

pH is normal, so either patient is balanced OR patient is fully compensating. CO2 is alkalotic. HCO3 is acidic. So fully compensating for imbalance. CO2 is off by 7; HCO3 is off by 3. The bigger imbalance is CO2; so the problem started with respiratory issues. CO2 is alkalotic, so these labs indicate respiratory alkalosis, fully compensated.

A patient with a tumor of the adrenal glands reports feeling unusually sleepy. After receiving the prescription from the health care provider, which nursing action is most appropriate considering the fact that the patient is at risk of hypernatremia due to primary aldosteronism? A patient with a tumor of the adrenal glands reports feeling unusually sleepy. After receiving the prescription from the health care provider, which nursing action is most appropriate considering the fact that the patient is at risk of hypernatremia due to primary aldosteronism? Administer furosemide Administer conivaptan Encourage sodium intake Give oral potassium supplements

Administer furosemide Rationale A tumor of the adrenal glands may cause hypersecretion of aldosterone, resulting in hypernatremia. Hypernatremia should be treated with a diuretic (to promote excretion of excess sodium) and with sodium-free intravenous fluids such as 5% dextrose in water (to dilute the sodium concentration). Sodium intake should also be restricted. Conivaptan is administered when treating hyponatremia. Potassium supplements are needed in cases of hypokalemia.

A nurse reviews the blood gas results of a client with atelectasis. The nurse analyzes the results and determines that the client is experiencing respiratory acidosis. Which of the following validates the nurse's findings? 1) pH 7.25, Pco2 50, 2) pH 7.35, Pco2 40 3) pH 7.50, Pco2 52 4) pH 7.52, Pco2 28

Answer: 1 Rational: Atelectasis is a condition characterized by the collapse of alveoli, preventing the respiratory exchange of oxygen and carbon dioxide in a part of the lungs. The normal pH is 7.35-7.45. The normal Pco2 is 32-48. In respiratory acidosis, the pH is decreased and the Pco2 is elevated. Option 2 identifies normal values. Option 3 identifies an alkalotic condition. Option 4 identifies respiratory alkalosis.

A nurse caring for a client with an ileostomy understands the the client is most at risk for developing which acid-base disorder? 1) Metabolic Acidosis 2) Metabolic Alkalosis 3) Respiratory Acidosis 4) Respiratory Alkalosis

Answer: 1 Rational: Metabolic Acidosis is defined as total concentration of buffer base that is lower than normal, with a relative increase in the hydrogen ion concentration. This results from loss of buffer bases or the retention of too many acids without sufficient bases, and occurs in conditions such as renal failure, diabetic ketoacidosis, from the production of lactic acid, from the ingestion of toxins (such as acetylsalicylic acid -aka- aspirin), malnutrition, or severe diarrhea. Intestinal secretions are high in bicarbonate and may e lost through enteric drainage tubes or an ileostomy, or with diarrhea. These conditions result in metabolic acidosis. Options 2, 3, & 4 are incorrect interpretations and do not occur in the client with an ileostomy. **(Base/Bicarbonate is lost through an ileostomy)

A nurse notes that a client's arterial blood gas reults reveal a pH of 7.50 and a Pco2 of 30. The nurse monitors the client for which clinical manifestations associated with these arterial blood gas results? Select all the apply: 1) Nausea 2) Confusion 3) Bradypnea 4) Tachycardia 5) Hyperkalemia 6) Lightheadedness

Answer: 1, 2, 4, 6 Rational: Respiratory alkalosis is defined as a deficit of carbonic acid or a decrease in hydrogen ion concentrations that results from the accumulations of base or from a loss of acid without a comparable loss of base in the body fluids. This occurs in conditions that cause overstimulation of the respiratory system. Clinical manifestations of repirtory alkalosis include lethargy, lightheadedness, confusion, tachycardia, dysrhythmias related to hypokalemai, nausea, vomiting, epigastric pain, and numbness and tingling of the extremities. Hyperventilation (tachypnea) occurs.

A nurse is caring for a client with a nasogastric tube that is attached to low suction. The nurse monitors the client, knowing that the client is at risk for which acid-base disorder? 1) Metabolic Acidosis 2) Metabolic Alkalosis 3) Respiratory Acidosis 4) Respiratory Alkalosis

Answer: 2 Rational: Metabolic Alkalosis is defined as a deficit or loss of hydrogen ions or acids or an excess of base (bicarbonate) that results from the accumulation of base or from a loss of acid without a comparable loss of base in the body fluids. This occurs in conditions resulting in hypovolemia, the loss of gastric fluid, excessive bicarbonate intake, the massive transfusion of whole blood, and hyperaldosteronism. Loss of gastric fluid via nasogastric suction or vomiting causes Metabolic Alkalosis as a result of the loss of hydrochloric acid. Options 1, 3, & 4 are incorrect interpretations.

A nurse is caring for a client who is on a mechanical ventilator. Blood gas results indicated a pH of 7.50 and a Pco2 of 30. The nurse has determines that the client is experience respiratory alkalosis. Which laboratory value would most likely be noted in this condition? 1) Sodium level of 145 2) Potassium level of 3 3) Magnesium level of 2 4) Phosphorus level of 4

Answer: 2 Rational: Respiratory alkalosis is defined as a deficit of carbonic acid or a decrease in hydrogen ion concentrations that results from the accumulations of base or from a loss of acid without a comparable loss of base in the body fluids. This occurs in conditions that cause overstimulation of the respiratory system. Clinical manifestations of repiratory alkalosis include headache, tachypnea, paresthesias, tetany, vertigo, convusions, hypkalemia, and hypocalcemia. Options 1, 3, & 4 identify normal laboratory values. Option 2 identifies the presence of hypokalemia.

A nurse reviews the arterial blood gas results of a client and notes the following: pH 7.45, Pco2 of 30, and HCO3- of 22. The nurse analyzes these results as indicating which condition? 1) Metabolic Acidosis, compensated 2) Respiratory Alkalosis, compensated 3) Metabolic Alkalosis, compensated 4) Respiratory Acidosis, compensated

Answer: 2 Rational: The normal pH is 7.3-7.45. In a respiratory condition, an opposite effect will be seen between the pH and the Pco2. In this condition, the pH is a the high end of normal and the Pco2 is low. In an alkalotic condition, the pH is elevated. Therefore the values identified in the question indicated a respiratory alkalosis. When the pH returns to a normal value, compensation has occurred.

9) The nurse is preparing to analyze a client's arterial blood gas results. List the steps in the order that the nurse should follow when analyzing this laboratory test. 1. Look at the PaCO2. 2. Look at the pH. 3. Evaluate the relationship between pH and PaCO2. 4. Look for compensation. 5. Evaluate the pH, HCO3, and base excess for a possible metabolic problem. 6. Look at the bicarbonate. 7. Evaluate oxygenation.

Answer: 2, 1, 3, 6, 5, 4, 7 1. The pH is the first step and is analyzed to determine if acidosis or alkalosis is present. A pH of less than 7.35 is acidosis. A pH greater than 7.45 is alkalosis. 2. If the PaCO2 is less than 35, then more carbon dioxide is being exhaled. If the PaCO2 is greater than 45, then more carbon dioxide is being retained. 3. This relationship could indicate a respiratory problem. If the pH is acidotic and the carbon dioxide level is greater than 45, then the client could be experiencing respiratory acidosis. If the pH is alkalotic and the carbon dioxide level is below 35, then the client could be experiencing respiratory alkalosis. 4. If the bicarbonate level is less than 24, then the levels are lower than normal. If the bicarbonate level is greater than 28, then the bicarbonate levels are higher than normal. 5. If the pH is < 7.35, the HCO3 is < 24 mEq/L, and the BE is < −2 mEq/L, then low bicarbonate levels and high H + concentrations are causing metabolic acidosis. If the pH is > 7.45, the HCO3 is > 28 mEq/L, and the BE is > +2 mEq/L, then high bicarbonate levels are causing metabolic alkalosis. 6. Two things can occur in renal compensation. In respiratory acidosis, the kidneys retain HCO3 to buffer the excess acid, so the HCO3 is > 28 mEq/L. In respiratory alkalosis, the kidneys excrete HCO3 to minimize the alkalosis, so the HCO3 is < 24 mEq/L. Two things can also occur in respiratory compensation. In metabolic acidosis the rate and depth of respirations increase, increasing carbon dioxide elimination, so the PaCO2 is < 35 mmHg. In metabolic alkalosis respirations slow and carbon dioxide is retained, so the PaCO2 is > 45 mmHg. 7. If the PaO2 is less than 75 mmHg, then the client is experiencing hypoxemia and possible hypoventilation. If the PaO2 is greater than 100 mmHg, then the client is hyperventilating.

9) The nurse is preparing to instruct a client with type 1 diabetes mellitus on the mechanism behind the development of ketoacidosis. List the order in which the nurse should provide this information. 1. Production of lactate and hydrogen ions 2. Development of lactic acidosis 3. Breakdown of fatty tissue 4. Reduction in intracellular glucose 5. Fatty acids converted to ketones

Answer: 2, 1, 4, 3, 5 Explanation: 1. Lactic acidosis develops due to tissue hypoxia and a shift to anaerobic metabolism by the cells. Lactate and hydrogen ions are produced, forming lactic acid. Starvation or lack of insulin leads to intracellular starvation of glucose. The lack of glucose or insulin to move glucose into the cells causes the body to break down fatty tissue to meet metabolic needs. When fatty acids are broken down, these acids are converted to ketones, leading to the development of ketoacidosis.

The nurse plans care for a client with chronic obstructive pulmonary disease (COPD), understanding that the client is most likely to experience what type of acid-bases imbalance: 1) Metabolic Acidosis 2) Metabolic Alkalosis 3) Respiratory Acidosis 4) Respiratory Alkalosis

Answer: 3 Rational: Respiratory Acidosis is most often caused by hypoventilation in a client with COPD. Other acid-base disturbances can occur in a client with COPD during exacerbation of the disease but the most likely imabalance is respiratory acidosis. Option 1, 2,& 4 are incorrect options.

A client with a 3-day history of nausea and vomiting presents to the emergency department. The client is hypoventilating and has a respiratory rate of 10 breaths/min. Arterial blood gases are drawn and the nurse reviews the results, expecting to note which of the following? 1) A decreased pH and an increased CO2 2) An increased pH and a decreased Co2 3) A decreased pH and a decreased HCO3- 4) An increased pH with an increased HCO3-

Answer: 4 Rational: Clients experiencing nausea and vomiting would most likely present with metabolic alkalosis resulting from loss of gastric acid, thus causing the pH and HCO3- to increase. Symptoms experienced by the client would include hypventilation and tachycardia. Option 2 reflects a respiratory acidotic condition. Option 2 reflects a respiratory alkalotic condition. Option 3 reflects a metabolic acidotic condition.

A nurse is caring for a client with diabetic ketoacidosis and documents the the client is experiencing Kussmaul's respirations. Based on this documentation, which of the following did the nurse observe? 1) Respirations that cease for several seconds 2) Respirations that are regular but abnormally slow 3) Respirations that are labored and increased in depth and rate 4) Respirations that are abnormally deep, regular, and increased in rate

Answer: 4 Rational: Kussmal's respirations are abnormally deep, regular, and increased in rate. Apnea is described as repirations that cease for several seconds. In bradypnea, respirations are regular but abnormally slow. In hyperpnea, respirations are labored and increased in depth and rate.

A client who is found unresponsive has arterial blood gases drawn and the results indicate dthe following: pH is 7.12, Pco2 is 90, and HCO3- is 22. the nurse interprets the results as indicating which condition? 1) Metabolic Acidosis with compensation 2) Respiratory Acidosis with compensation 3) Metabolic Acidosis without compensation 4) Respiratory Acidosis without compensation

Answer: 4 Rational: The acid-base disturbance is respiratory acidosis without compensation. The normal pH is 7.35-7.45. The normal Pco2 is 32-48. In respiratory acidosis the pH is decreased and the pco2 is elevated. The normal bicarbonate (HCO3-) level is 22-27. Because the bicarbonate is still within normal limits, the kidneys have not had time to adjust for this acid-base disturbance. Additionally, the pH is not within normal limits. Therefore the condition is without compensation. Options 1, 2, & 3 are incorrect interpretations.

1) A client is brought to the Emergency Department after passing out in a local department store. The client has been fasting and has ketones in the urine. Which acid-base imbalance would the nurse expect to assess in this client? A) Metabolic acidosis B) Respiratory alkalosis C) Metabolic alkalosis D) Respiratory acidosis

Answer: A Explanation: A) A client who is fasting is at risk for development of metabolic acidosis. The body recognizes fasting as starvation and begins to metabolize its own proteins into ketones, which are metabolic acids. Starvation would not result in respiratory acidosis or alkalosis or in metabolic alkalosis.

5) A client has been admitted with chronic obstructive pulmonary disease. Diagnostic tests have been ordered. Which of the tests will provide the most accurate indicator of the client's acid-base balance? A) Arterial blood gases (ABGs) B) Pulse oximetry C) Sputum studies D) Bronchoscopy

Answer: A Explanation: A) ABGs are done to assess alterations in acid-base balance caused by respiratory disorders, metabolic disorders, or both. A bronchoscopy provides visualization of internal respiratory structures. Sputum studies can provide specific information about bacterial organisms. Pulse oximetry is a noninvasive test that evaluates the oxygen saturation level of blood.

3) A 10-year-old boy has been admitted to the hospital with respiratory acidosis. The nurse suspects that which chronic lung disease most likely caused the child to develop this condition? A) Cystic fibrosis B) Aspiration C) Hyperthyroidism D) Pneumonia

Answer: A Explanation: A) Chronic lung disease such as asthma and cystic fibrosis put the child at risk for respiratory acidosis. Pneumonia and aspiration are both acute lung conditions. Hyperthyroidism is a disorder that results in metabolic acidosis.

10) A client with injuries from a motor vehicle crash is intubated for respiratory support. The nurse notes that the client is fighting the ventilator and attempting to pull out the endotracheal tube. What should the nurse do to reduce this client's risk of developing respiratory alkalosis? A) Administer a sedative as prescribed. B) Apply wrist restraints. C) Teach the client to take slow, deep breaths. D) Discuss removing the endotracheal tube with the healthcare provider.

Answer: A Explanation: A) For a client being mechanically ventilated, the only way to reduce rapid respirations might be to provide a sedative. Applying wrist restraints to a client who is demonstrating anxiety with an endotracheal tube might increase the client's anxiety. The client is being mechanically ventilated, which means there is a problem with maintaining the airway. The client will not be able to take slow, deep breaths at this time. The reason for the endotracheal tube is to maintain the client's airway after chest trauma. Removing the tube could lead to a collapse of the airway and a life-threatening situation.

4) A client has been admitted to the unit with chronic obstructive pulmonary disease. Blood gas analysis indicates respiratory acidosis. The nurse anticipates which diagnosis should be the priority for this client? A) Impaired Gas Exchange B) Ineffective Airway Clearance C) Impaired Mobility D) Anxiety

Answer: A Explanation: A) Impaired Gas Exchange is the priority nursing diagnosis for the client with respiratory acidosis. Interventions are aimed at restoring effective alveolar ventilation and gas exchange. Anxiety and Ineffective Airway Clearance are both appropriate nursing diagnoses but not priority for the client with respiratory acidosis. There is no evidence to support Impaired Mobility for this client.

10) The nurse is identifying a diagram to use to explain a client's acid-base balance. Which imbalance does the following diagram suggest is occurring with the client? A) Metabolic acidosis B) Metabolic alkalosis C) Respiratory acidosis D) Respiratory alkalosis

Answer: A Explanation: A) In metabolic acidosis, the amount of bicarbonate decreases in relation to the amount of acid in the body. In metabolic alkalosis, there is an excess of bicarbonate in relation to the amount of hydrogen ions. Respiratory acidosis occurs when carbon dioxide is retained, increasing the amount of carbonic acid in the body. Respiratory alkalosis can occur when too much carbon dioxide is lost and carbonic acid levels fall.

6) The nurse has completed discharge teaching for a client with an anxiety disorder. Which client statement indicates that client teaching about respiratory alkalosis has been effective? A) "I will see my counselor on a regular basis." B) "I will breather faster when I am feeling anxious." C) "I will eat more bananas at breakfast." D) "I will not take antacids when I have heartburn."

Answer: A Explanation: A) The client understands that reducing anxiety can reduce hyperventilation and respiratory alkalosis. Seeing a counselor can help the client develop alternative strategies for dealing with anxiety. Eating bananas is more appropriate for the client at risk for metabolic alkalosis who is on diuretics. Breathing faster will increase hyperventilation. Taking too many antacids is associated with metabolic alkalosis.

4) The nurse is planning care for a client who has been admitted to the unit with a salicylate overdose. When preparing the plan of care, the nurse considers which to be a priority nursing diagnosis? A) Ineffective Breathing Pattern B) Powerlessness C) Risk for Injury D) Impaired Mobility

Answer: A Explanation: A) The client with a salicylate overdose is at risk for hyperventilation, which can lead to respiratory alkalosis. There is not enough information to know whether the client's mobility is impaired. Risk for Injury and Powerlessness are diagnoses to be considered for this client, but the highest priority is respiratory function.

8) A client with hyperaldosteronism has been admitted to the unit. The nurse knows the client is at risk for impaired gas exchange. Which position should this client be placed to enhance gas exchange? A) Fowler's position B) Prone position C) Left side-lying position D) Right Sims position

Answer: A Explanation: A) The client with prolonged vomiting will likely have severe metabolic alkalosis with reduced oxygenation. The Fowler's position will facilitate alveolar ventilation with improved oxygenation. Side-lying and prone positions do not facilitate needed lung expansion.

8) The nurse is providing care to a client recently extubated for treatment of aspiration pneumonia and respiratory acidosis. Which action by the nurse provides an optimum environment for this client? A) Allowing family members to remain with client as much as possible B) Restraining the client C) Placing the client in a side-lying position D) Administering narcotics for pain

Answer: A Explanation: A) The client with respiratory acidosis often experiences anxiety. This client would benefit from having a family member in the room to provide reassurance. Restraining the client will increase levels of agitation. The client with respiratory failure would benefit most from the semi-Fowler's or Fowler's position to increase ventilation. Narcotics will depress the respirations and increase respiratory acidosis. A non-narcotic pain reliever would be considered if this client were experiencing pain.

1) The nurse is analyzing the client's arterial blood gas report, which reveals a pH of 6.58. The client has just suffered a cardiac arrest. Which of the following consequences does the nurse consider for this client? A) Decreased cardiac output B) Increase magnesium levels C) Decreased free calcium in the ECT D) Increased myocardial contractility

Answer: A Explanation: A) The nurse knows that severe acidosis (pH of 7.0 or less) depresses myocardial contractility, which leads to decreased cardiac output. Acid-base imbalances also affect electrolyte balance. In acidosis, potassium is retained as the kidney excretes excess hydrogen ion. Excess hydrogen ions also enter the cells, displacing potassium from the intracellular space to maintain the balance of cations and anions within the cells. The effect of both processes is to increase serum potassium levels. Also in acidosis, calcium is released from its bonds with plasma proteins, increasing the amount of ionized (free) calcium in the blood. Magnesium levels may fall in acidosis.

6) The nurse is caring for a client admitted with renal failure and metabolic acidosis. Which of the following signs would indicate to the nurse that planned interventions to relieve the metabolic acidosis have been effective? A) Decreased respiratory depth B) Palpitations C) Increased deep tendon reflexes D) Respiratory rate of 38

Answer: A Explanation: The client with metabolic acidosis will have an increased respiratory rate and depth. Signs that care has been effective would include a decrease in the rate and depth of respirations. An increased respiratory rate, as indicated by a respiratory rate of 38, would indicate continued metabolic acidosis. Increased deep tendon reflexes and palpitations are not associated with metabolic acidosis.

11) The nurse is evaluating care provided to a client with respiratory alkalosis. Which outcomes indicate that nursing care has been effective for this client? Select all that apply. A) Respiratory rate 18 and regular B) Sleeping through the night C) Gait steady D) Consistent body weight E) Using prescribed bronchodilators

Answer: A, B, C, D Explanation: A) Appropriate outcomes for the care of a client with respiratory alkalosis include normal respiratory rate and rhythm, no episodes of injuries, and maintenance of fluid balance. Ability to sleep through the night would indicate a reduction in anxiety, which is a risk factor for the development of respiratory alkalosis. Bronchodilators are not used to treat this acid-base imbalance.

5) The nurse is preparing discharge instructions for an older client recovering from respiratory acidosis caused by restrictive lung disease and pneumonia. What should the nurse include in this teaching? Select all that apply. A) Obtain annual influenza immunization. B) Engage in frequent hand washing. C) Avoid crowds. D) Cover the nose and mouth when coughing. E) Restrict fluids.

Answer: A, B, C, D Explanation: A) For the client with a history of chronic lung disease and pneumonia, the nurse should instruct on the importance of receiving annual influenza immunizations, frequent hand washing, avoiding crowds, and covering the nose and mouth when coughing. Fluids should be encouraged to ensure that respiratory secretions are thin.

3) The nurse is assessing an African-American client whose cultural background is different from the cultural background of the nurse. The client has symptoms of metabolic acidosis. Which of the following situations would illustrate stereotypical behavior on the nurse's part? Select all that apply. A) Understanding that all culture members will have the same beliefs B) Bringing previous negative information and experiences into this situation C) Making an assumption that all members of each culture are alike D) Taking general knowledge from literature and applying it to the situation E) Discussing the client's health status with family members

Answer: A, B, C, D Explanation: A,B,C,D) Options 1, 2, 3, and 4 describe stereotypical behavior, which is assuming that all members of a culture or ethnic group are alike. Option 2 describes prejudice. Prejudice is a negative belief or preference that is generalized about a group, which leads to "prejudgment." Prejudice occurs when the person making the judgment generalizes an experience of one individual from a culture to all members of that group. Discussing the client's health status with family members is not stereotypical behavior and would be considered a violation of the privacy laws if the client did not provide permission for disclosure of personal health information.

10) The nurse identifies the diagnosis Risk for Impaired Gas Exchange to guide the care of a client with metabolic alkalosis. What did the nurse assess to support this diagnosis? Select all that apply. A) Respiratory rate 8 per minute B) Oxygen saturation 89% C) Urine output 25 mL/hr D) Restlessness and agitation E) Weight loss of 3 kg overnight

Answer: A, B, D Explanation: A) Respiratory compensation for metabolic alkalosis depresses the respiratory rate and reduces the depth of breathing to promote carbon dioxide retention. The depressed respiratory drive associated with metabolic alkalosis can lead to hypoxemia and impaired oxygenation of tissues. Oxygen saturation levels of less than 90% indicate significant oxygenation problems. Changes in mental status or behavior may be early signs of hypoxia. Urine output less than 30 mL/hr would indicate Fluid Volume Deficit. Weight is used as an indicator of fluid balance. A rapid weight change would indicate Fluid Volume Deficit.

7) The nurse is caring for the client experiencing hypovolemic shock and metabolic acidosis. Which of the following therapies would the nurse question if planned for this client? Select all that apply. A) Monitor weight on admission and discharge. B) Monitor ECG for conduction problems. C) Limit the intake of fluids. D) Administer sodium bicarbonate. E) Keep the bed in the locked and low position.

Answer: A, C Explanation: The treatment for hypovolemic shock would include the administration of fluids, not limiting fluids. Patients being treated for hypovolemia will require daily weights, not a weight on admission and then discharge. Administering sodium bicarbonate and monitoring ECGs are appropriate for the client with shock. The client recovering from hypovolemic shock is at risk for injury, so the bed should be kept in the locked and low position.

5) The client with an anxiety disorder is ready to be discharged from the unit. What should the nurse plan to teach this client and family in preparation for discharge? Select all that apply. A) Refer the client for counseling. B) Instruct the client to eat foods high in acid. C) Teach the client the signs of impending panic attack. D) Advise the client to breathe into a paper bag when feeling anxious. E) Instruct the client to breathe slowly.

Answer: A, C, E Explanation: A) Teaching the client to breathe slowly helps the client manage hyperventilation at home. The client with an anxiety disorder should be referred to counseling to assist with management of the disorder and should be taught signs of an impending panic attack. Eating foods high in acid will not counteract the results of hyperventilation. The use of paper bags has been a recommended treatment for hyperventilation; however, it can also cause hypoxia.

7) The nurse is preparing to admit a client with acute pneumonia who is experiencing severe respiratory acidosis. The nurse anticipates that treatment for this client may include which actions? Select all that apply. A) Administer oxygen prn. B) Administer digoxin for heart failure. C) Encourage up to 3L of fluids per day. D) Place in a prone position. E) Reposition frequently.

Answer: A, C, E Explanation: A) The client with acute pneumonia and respiratory acidosis may require oxygen administration to improve gas exchange, increased fluid intake to thin secretions, and frequent repositioning to preventing the pooling of respiratory sections. There is not enough evidence to know whether the client is experiencing heart failure as a result of the acute pneumonia.

2) The nurse is caring for a client who has been admitted to the hospital for congestive heart failure. Which data collected during the nursing assessment indicates that the client is at risk for metabolic alkalosis? Select all that apply. A) The client takes furosemide (Lasix) daily. B) The client takes a baby aspirin once daily. C) The client takes metformin daily. D) The client frequently uses calcium carbonate (Tums®) for acid indigestion. E) The client takes acetaminophen as needed for pain.

Answer: A, D Explanation: A) Excessive use of calcium carbonate and daily use of furosemide can cause metabolic alkalosis. Use of metformin is not associated with alkalosis. Overuse of aspirin can be associated with metabolic acidosis. Occasional use of acetaminophen is not associated with metabolic alkalosis.

2) Which of the following risk factors exhibited by the client presenting in the Emergency Department would place the client at risk for metabolic acidosis? Select all that apply. A) Abdominal fistulas B) Chronic obstructive pulmonary disease C) Pneumonia D) Acute renal failure E) Hypovolemic shock

Answer: A, D, E Explanation: A, D, E) Metabolic acidosis is rarely a primary disorder. It usually develops during the course of another disease; presence of abdominal fistulas; which can cause excess bicarbonate loss; and acute renal failure. Chronic obstructive pulmonary disease and pneumonia place the client at risk for respiratory acidosis with the increased retention of carbon dioxide in the blood.

7) A client who was diagnosed with diabetes mellitus 1 year ago is hospitalized in diabetic ketoacidosis after a religious fast. The client tells the nurse, "I have fasted during this season every year since I became an adult. I am not going to stop now." The nurse is not knowledgeable about this particular religion. Which nursing action would be appropriate? Select all that apply. A) Request a consult from a diabetes educator. B) Tell the client that things are different now because of the diabetes. C) Ask family members of the same religion to discuss fasting with the client. D) Assess the meaning and context of fasting in the client's religion. E) Encourage the client to seek medical care if signs of ketoacidosis occur in the future.

Answer: A, D, E Explanation: A,D,E) The diabetes educator should be contacted to work with the client on strategies that might allow the fasting to occur in a safe manner. Assessing the meaning and context of fasting in the client's religion would be educative for the nurse and an appropriate action. Stressing the importance of promptly seeking care when signs of ketoacidosis occur helps to promote the client's health and is appropriate. Telling the client that life is different now does not support religious beliefs. Asking the family to talk to the client might help, but the diabetes educator would be able to provide more direct and helpful information for the client.

6) The nurse is preparing to discharge a client with congestive heart failure on furosemide (Lasix). The nurse determines that teaching has been effective if the client makes which statement? A) "I will use only sodium bicarbonate as my antacid." B) "I will restrict my intake of fluids." C) "I will use potassium supplements while I am taking Lasix." D) "I will take antacids only for my gastric discomforts."

Answer: C Explanation: A) The client on Lasix (furosemide) may lose excess potassium, disposing the client toward metabolic alkalosis. The client is taught to refrain from the use of sodium antacids when prone to metabolic alkalosis. The client should consult with the primary care provider for gastric distress rather than self-medicate. The client who is prone to metabolic alkalosis is likely to have fluid deficits and would not be instructed to restrict fluids.

4) The nurse is caring for a client who has been admitted with persistent diarrhea lasting 3 days. Which of the following are appropriate nursing diagnoses for this client during the acute phase of the illness? Select all that apply. A) Decreased Cardiac Output B) Ineffective Airway Clearance C) Deficient Fluid Volume D) Knowledge Deficit E) Risk for Injury

Answer: A, E Explanation: Metabolic acidosis affects cardiac output by decreasing contractility, slowing the heart rate, and increasing the risk for dysrhythmias. Appropriate nursing diagnoses during the acute phase of illness are Risk for Injury and Decreased Cardiac Output. The client may have a knowledge deficit but this is not an appropriate nursing diagnosis during the acute phase of the illness. The client with metabolic acidosis will be at risk for developing an Excessive Fluid Volume, not a Deficient Fluid Volume. The client with metabolic acidosis is not at risk for Ineffective Airway Clearance.

9) A client with metabolic alkalosis is experiencing numbness around the mouth and tingling of the fingers. What should the nurse explain as the reason for these manifestations? A) "Because you are breathing so fast, the oxygen is not getting to your nerve endings." B) "Your health problem affects calcium in your body, which causes the tingling around your mouth and fingers." C) "You have a build-up of carbon dioxide in your blood." D) "You don't have enough potassium in your body, so the tingling around your mouth and fingers will occur."

Answer: B Explanation: A) Alkalosis increases binding of extracellular calcium to albumin, reducing ionized calcium levels. As a result, neuromuscular excitability increases, and manifestations similar to hypocalcemia develop. These manifestations include circumoral and distal extremity paresthesias. Rapid breathing is not reducing the amount of oxygen reaching the nerve endings. Excessive carbon dioxide would lead to acidosis. Respiratory alkalosis is not caused by an imbalance of serum potassium.

12) A client is brought to the Emergency Department with rapid breathing after learning of a family member being killed in a house fire. What should the nurse do first to help this client? A) Coach to slow the breathing. B) Move to a quiet, calm environment. C) Provide a sedative. D) Ask for a psychiatric consultation.

Answer: B Explanation: A) Nursing care is focused on reducing anxiety through manipulation of the environment to reduce stimuli and to create a sense of peace. This restful environment will help the client breathe more slowly and effectively. Once the environment is controlled, the nurse can begin to implement interventions to help the client slow the breathing rate. A sedative may be prescribed; however, this would not be the first intervention. A psychiatric consult might be indicated for someone with a history of anxiety or panic attacks that lead to the development of respiratory alkalosis. Since this client has had a shock, a psychiatric consultation would not be indicated at this time.

5) The nurse is planning care for the client with Cushing's syndrome who has been admitted for complications related to the disease process. Which intervention should the nurse plan for this client to improve the impaired gas exchange? A) Monitor serum electrolytes. B) Schedule nursing activities to allow for periods of rest. C) Assess input and output accurately. D) Administer IV fluids per practitioner order.

Answer: B Explanation: A) The client with Cushing's syndrome is at risk for developing severe metabolic alkalosis that causes hypoxemia and limits energy reserves. Spacing nursing activities throughout the day allows the client ample rest time. The other interventions are aimed at the deficient fluid volume that may occur with metabolic alkalosis.

7) A client with severe metabolic alkalosis has been admitted to the unit and is being cared for by a nursing student along with the nurse. What should the nurse say is a priority for this client? A) Administering medication for metabolic alkalosis B) Monitoring oxygen saturation C) Teaching the client the risk factors for metabolic alkalosis D) Setting goals for the client with metabolic alkalosis

Answer: B Explanation: A) The priority for this client is monitoring oxygen saturation. The depressed respiratory drive that often accompanies metabolic alkalosis can lead to hypoxemia and impaired oxygenation of the tissues. Administering medications will be needed as a treatment, but the priority is to discover the cause. Teaching the client and setting goals are important aspects of nursing care but are not the priority.

8) A client with metabolic acidosis has been admitted to the unit from the Emergency Department. The client is experiencing confusion and weakness. Which of the following does the nurse implement as a priority of care for this client? A) Place the client in a high-Fowler's position. B) Protect the client from injury. C) Administer sodium bicarbonate. D) Give the client skin care.

Answer: B Explanation: The client with metabolic acidosis may have symptoms of drowsiness, lethargy, confusion, and weakness. A priority of care would be preventing injury to the client. Medication administration is a physician order. Skin care would not be a priority on admission. The high-Fowler's position would not be the safest position for the confused client.

10) A client with pneumonia develops respiratory acidosis. Which medications should the nurse prepare to administer to this client? Select all that apply. A) Furosemide (Lasix) 20 mg by mouth twice a day B) Amoxicillin 1 gram intravenous every 6 hours C) Albuterol inhaler 2 puffs every 4 hours D) Diazepam (Valium) 2 mg by mouth at bedtime for sleep E) Potassium chloride 20 mEq in 100 mL 0.9% normal saline intravenous every day

Answer: B, C Explanation: A) Bronchodilator drugs such as albuterol inhaler may be administered to open the airways and antibiotics such as amoxicillin may be prescribed to treat respiratory infections. Benzodiazepines such as diazepam are central nervous system depressants and would adversely affect this client's respiratory rate, adversely affecting respiratory acidosis. Potassium chloride is indicated in the treatment of metabolic alkalosis.

5) The nurse is caring for a client with metabolic acidosis. Which of the following are appropriate goals for this client? Select all that apply. A) The client will maintain a respiratory rate of 30 or more. B) The client will describe preventative measure for the underlying chronic illness. C) The client will maintain baseline cardiac rhythm. D) pH will range from 7.25 to 7.35. E) The client will take potassium supplements to increase potassium levels.

Answer: B, C Explanation: Planning for the client with metabolic acidosis involves identification and treatment of the underlying cause and restoration and maintenance of acid-base balance. The client should be able to describe preventative measures for the underlying chronic illness that caused the metabolic acidosis to occur and maintain the baseline cardiac rhythm. The pH should be maintained between 7.35 and 7.45. The client's respiratory rate should be within normal range for age and condition. Taking a potassium supplement may cause hyperkalemia, which decreases cardiac output and worsens metabolic acidosis.

11) A client is admitted with manifestations of metabolic alkalosis. Which diagnostic test findings should the nurse suspect will confirm this diagnosis? Select all that apply. A) Serum glucose level 142 mg/dL B) Blood pH 7.47 and bicarbonate 34 mEq/L C) Intravenous pyelogram shows kidney stones D) Bilateral lower lobe infiltrates noted on chest x-ray E) Electrocardiogram changes consistent with hypokalemia

Answer: B, E Explanation: A) 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. Serum glucose level is not used to confirm the diagnosis of metabolic alkalosis. The presence of kidney stones is not associated with the development of metabolic alkalosis. The presence of bilateral lower lobe infiltrates on chest x-ray would not contribute to the development of metabolic alkalosis. This finding might be the result of metabolic alkalosis if the client's respiratory status is compromised.

6) The nurse is instructing a client with a history of acidosis on the use of sodium bicarbonate. Which client statement indicates that additional teaching is needed? A) "I should contact the doctor if I have any gastric discomfort with chest pain." B) "I need to purchase antacids without salt." C) "I should use the antacid for at least 2 months." D) "I should call the doctor if I get short of breath or start to sweat with this medication."

Answer: C C) The client should be instructed to immediately contact the primary healthcare provider if gastric discomfort occurs with chest pain or if dyspnea or diaphoresis occurs. The client should be instructed to use non-sodium antacids to prevent the absorption of excess sodium or bicarbonate into systemic circulation and to not use any bicarbonate antacid for longer than 2 weeks.

1) A client is admitted to the hospital with sudden, severe abdominal pain. Which arterial blood gas value should the nurse expect with respiratory alkalosis? A) pH is 7.33 and PaCO2 is 36. B) pH is 7.30 and HCO3 is 30. C) pH is 7.47 and PaCO2 is 25. D) pH is 7.35 and PaO2 is 88.

Answer: C Explanation: A) Acute pain usually causes hyperventilation, which causes the CO2 to drop and the client to experience respiratory alkalosis. The pH would denote alkalosis and would be higher than 7.45. HCO3 would trend downwards as the kidneys begin to compensate for the alkalosis by excreting HCO3. The PaO2 is likely to be normal unless the client has been hyperventilating for a long time and is beginning to tire.

13) During a home visit, the nurse evaluates care provided to a client with type 1 diabetes mellitus and a history of metabolic acidosis. Which outcome indicates that the care of this client has been successful? A) The client is injecting insulin into thigh muscle. B) The client is taking laxatives three times a week to ensure adequate bowel movements. C) The client is eating three balanced meals per day with two snacks. D) The client is taking aspirin 325 mg every 6 hours to treat arthritis pain.

Answer: C Explanation: A) Adequate nutrition is necessary to prevent the buildup of acids in the blood. Incorrect administration of medication could cause a metabolic problem in the client with diabetes. The use of laxatives could cause diarrhea, which can lead to metabolic acidosis. Ingestion of high amounts of salicylate acid can lead to toxicity and the development of metabolic acidosis.

2) The client is seen in the Emergency Department with symptoms of a panic attack, including hyperventilation. The nurse suspects that the client may be at risk for which health problem on admission? A) Hypoventilation B) Vomiting C) Respiratory alkalosis D) Memory loss

Answer: C Explanation: A) Anxiety disorders increase the risk for the acid-base imbalance respiratory alkalosis, due to hyperventilation that accompanies anxiety and panic attacks. The client with anxiety does not necessarily have vomiting or memory loss as risk factors. Anxiety and panic attacks will lead to hyperventilation, not hypoventilation.

2) The nurse is caring for a client who has been admitted to the unit with respiratory failure and respiratory acidosis. What data from the nursing history would the nurse suspect contributed to the client's current state of health? A) Use of ibuprofen for the control of pain B) A recent trip to South America C) Aspiration pneumonia D) Recent recovery from a cold virus

Answer: C Explanation: A) Aspiration of a foreign body and acute pneumonia would put the client at risk for respiratory acidosis. A recent trip to South America would not constitute a respiratory risk factor. Recent recovery from a cold would not likely put the client at risk. Ibuprofen does not pose a threat to the respiratory health of the client.

12) During an assessment, the nurse becomes concerned that a client is at risk for developing metabolic alkalosis. What did the nurse assess that caused this concern? A) Daily ingestion of a banana with breakfast B) Daily weight consistent C) Daily use of sodium bicarbonate for gastric upset D) Daily use of prescribed NSAIDs for arthritic pain

Answer: C Explanation: A) Excess bicarbonate usually occurs as a result of ingesting antacids that contain bicarbonate, such as soda bicarbonate or Alka-SeltzerTM. Daily ingestion of a banana would prevent the development of hypokalemia from the daily use of sodium bicarbonate. Consistent daily weights would indicate fluid balance. Daily use of NSAIDs would not support the development of metabolic alkalosis.

1) The client has been vomiting for several days. The nurse knows that the client is at risk for metabolic alkalosis because gastric secretions have which of the following characteristics? A) Gastric secretions are green in color. B) Gastric secretions are alkaline. C) Gastric secretions are acidic. D) Gastric secretions have a foul smell.

Answer: C Explanation: A) Metabolic alkalosis due to loss of hydrogen ions usually occurs because of vomiting or gastric suction. Gastric secretions are highly acidic (pH 1-3). When these are lost through vomiting or gastric suction, the alkalinity of body fluids increases. This increased alkalinity results from the loss of acid and from selective retention of bicarbonate by the kidneys as chloride is depleted. Gastric secretions are now alkaline. The color and odor of gastric secretions have no influence on the development of metabolic acidosis.

11) A client brought to the Emergency Department for treatment of an overdose has arterial blood gas results that indicate acute respiratory acidosis. For which substance should the nurse plan care for this client? A) Cocaine B) Marijuana C) Oxycodone D) PCP

Answer: C Explanation: A) Oxycodone is an opiate narcotic. Excessive use or overdose of narcotic substances can lead to respiratory depression and respiratory acidosis. Cocaine is a stimulant. Marijuana is not considered as a drug that depresses the central nervous system or respiratory center. PCP is a hallucinogenic agent.

8) The nurse is caring for the client with a history of anxiety who is experiencing chest pain, palpitations and dyspnea. Which intervention would be a priority for this client? A) Providing educational material for the client's medical diagnosis B) Ordering a regular diet for the client C) Reassuring the client that symptoms will resolve D) Asking Respiratory Therapy to set up a mechanical ventilator

Answer: C Explanation: A) The client will require reassurance from the nurse that the symptoms being experienced are not those of a heart attack and that the symptoms will resolve when a normal breathing pattern returns to normal. Ordering the diet and instructing the respiratory therapist are done by the healthcare provider. Providing teaching for the client becomes a priority when the client is recovering from the illness.

13) During a home visit, the nurse evaluates teaching provided to a client recently hospitalized for metabolic alkalosis. Which observation indicates that additional teaching is required? A) Drinks 2 cups of black coffee each day. B) Consumes one orange each day with breakfast. C) Ingests bicarbonate of soda after each meal. D) Monitors and tracks daily weights.

Answer: C Explanation: A) The indiscriminate ingestion of sodium bicarbonate is a risk factor for the development of metabolic alkalosis. Black coffee is not associated with the development of metabolic alkalosis. Oranges contain potassium, which is beneficial to prevent the development of metabolic alkalosis. Tracking of daily weights would help detect a fluid imbalance, which is associated with metabolic alkalosis.

6) The nurse is caring for a client who is being mechanically ventilated. Arterial blood gas analysis reveals a pH of 7.20 and a PaCO2 of 49 mmHg. Which change in ventilator settings should the nurse anticipate? A) Increase in humidification of inspired air B) Decrease of FiO2 from 30% to 25% C) Increased respiratory rate to 30 breaths per minute D) Decreased tidal volume of each breath

Answer: C Explanation: A) This client is exhibiting respiratory acidosis. This client needs to "blow off" more CO2; therefore, the respiratory rate would be increased. No other option given would serve to decrease CO2 levels.

9) While reviewing laboratory results, the nurse notes that a client's potassium level is 2.8 mEq/L and chloride level is 100 mEq/L. How should the nurse plan to support this client's acid-base balance? A) Prepare to administer 0.9% sodium chloride infusion. B) Measure for nasogastric tube insertion. C) Discuss potassium chloride replace therapy with the healthcare provider. D) Review implications of transfusing with ammonia chloride.

Answer: C Explanation: A) Treatment of metabolic alkalosis includes restoring normal fluid volume and administering potassium chloride. The potassium restores serum and intracellular potassium levels, allowing the kidneys to conserve hydrogen ions more effectively. Since the chloride level is within normal limits, an infusion of 0.9% sodium chloride is not indicated. Removal of gastric secretions is one reason for the development of metabolic alkalosis. A nasogastric tube is not indicated for this client. There is not enough information to support the use of ammonia chloride for this client, as it is indicated to treat severe metabolic alkalosis.

13) The nurse is caring for a comatose client with respiratory acidosis. For which intervention will the nurse need to collaborate when caring for this client? A) Measuring vital signs B) Measuring intake and output C) The client's recent eating behaviors D) Identifying current oxygen saturation level

Answer: C Explanation: C) For clients in severe distress, family members may need to be consulted for critical information such as recent eating habits and history of vomiting. Measuring vital signs is an independent nursing action. Measuring intake and output is an independent nursing action. Identifying current oxygen saturation level is an independent nursing action.

3) A child with acute asthma has a PaCO2 of 48 mmHg, a pH of 7.31, and a normal HCO3 blood gas value. The nurse interprets this as which of the following? A) Metabolic acidosis B) Respiratory alkalosis C) Respiratory acidosis D) Metabolic alkalosis

Answer: C Explanation: C) If the pH is decreased and the PaCO2 is increased with a normal HCO3, it is uncompensated respiratory acidosis. In addition, croup can be a disease process that causes respiratory acidosis. Uncompensated respiratory alkalosis has an increased pH, decreased PaCO2, and normal HCO3. Uncompensated metabolic acidosis has a decreased pH, normal PaCO2, and normal HCO3. Uncompensated metabolic alkalosis has an increased pH, normal PaCO2, and increased HCO3.

8) The client is receiving sodium bicarbonate intravenously (IV) for correction of acidosis secondary to diabetic coma. The nurse assesses the client to be lethargic, confused, and breathing rapidly. What is the nurse's priority response to the situation? A) Stop the infusion and notify the physician because the client is in alkalosis. B) Decrease the rate of the infusion and continue to assess the client for symptoms of alkalosis. C) Continue the infusion, because the client is still in acidosis, and notify the physician. D) Increase the rate of the infusion and continue to assess the client for symptoms of acidosis.

Answer: C Explanation: C) The client receiving sodium bicarbonate is prone to alkalosis; monitor for cyanosis, slow respirations, and irregular pulse. The client's symptoms do not indicate alkalosis so infusion should not be stopped. The client continues to exhibit signs of acidosis; symptoms of acidosis include lethargy, confusion, CNS depression leading to coma, and a deep, rapid respiration rate that indicates an attempt by the lungs to rid the body of excess acid, and the physician should be notified. The infusion should not be increased or decreased without a practitioner order.

3) An Asian-American adolescent is hospitalized following several days of vomiting following food poisoning. The nurse is planning to include which points when teaching the client's family at discharge? Select all that apply. A) Immunizations for the adolescent B) Nutritional patterns of the adolescent C) Signs and symptoms of metabolic alkalosis D) Proper food-handling techniques E) Normal laboratory values of the adolescent

Answer: C, D Explanation: A) The family of anyone experiencing prolonged vomiting should be taught the signs and symptoms of metabolic alkalosis. In this case, the nurse would include teaching about proper methods of food handling to prevent further episodes of food poisoning. Food patterns of the adolescent are not the precipitating factor of the food poisoning, and immunizations would not prevent this disease. Unless the family asks, it is not necessary to teach normal laboratory findings.

4) The nurse is planning care for the client who has been admitted with metabolic alkalosis. Which are appropriate nursing diagnoses for this client during the acute phase of the illness? Select all that apply. A) Ineffective Health Maintenance B) Risk for Hypothermia C) Deficient Fluid Volume D) Risk for Impaired Gas Exchange E) Risk for Injury

Answer: C, D, E Explanation: A) Respiratory compensation for metabolic alkalosis includes depression of the respiratory rate and reduction of the depth of respirations, leading to the retention of carbon dioxide. Patients with metabolic alkalosis often have an accompanying fluid volume deficit. With the fluid volume deficit, the client would experience hyperthermia. Ineffective health maintenance would not be a priority during the acute phase of the disease but, rather, a teaching opportunity before discharge depending on the cause of the metabolic alkalosis. The client is at risk for injury because of the associated muscle spasms and dizziness.

11) The nurse identifies the diagnosis Risk for Injury as appropriate for a client with metabolic acidosis. Which strategies should the nurse use to support this diagnosis? Select all that apply. A) Apply wrist restraints and secure to the bed frame. B) Discuss chemical restraint use with the healthcare provider. C) Keep the bed in the lowest position. D) Keep bed side rails raised. E) Place a clock and calendar at the bedside.

Answer: C, D, E Explanation: A) To reduce the client's risk for injury, the nurse should make sure the bed is kept in the lowest position and the side rails are raised. A clock and calendar at the bedside will help with orientation. Restraints are used in the event the client demonstrates harm to self or others. Confusion or a Risk for Injury is not a reason to use wrist or chemical restraints.

7) The nurse is reviewing new orders written for a client experiencing respiratory alkalosis. Which orders would be appropriate for this client's care needs? Select all that apply. A) Oxygen 2 liters via face mask B) Restrict fluids to 2 liters per day. C) Admit to a private room. D) Infuse 1 ampule of sodium bicarbonate now. E) Draw arterial blood gases.

Answer: C, E Explanation: A) The client has respiratory alkalosis, which is caused by hyperventilation. Additional oxygen is not required. A fluid restriction is not required in the treatment of respiratory alkalosis. Management of respiratory alkalosis focuses on correcting the imbalance and treating the underlying cause. It is important to create a calm, quiet, low-stimulation environment to reduce the client's anxiety or panic. Sodium bicarbonate is used in the treatment of respiratory and metabolic acidosis. Arterial blood gases must be ordered prior to beginning medication or oxygen therapy.

12) Upon entering a room, the nurse quickly scans the environment and then immediately assesses the client for manifestations of metabolic acidosis. What observation did the nurse make that precipitated this assessment of the client? A) Client sleeping with the head of the bed flat B) Half of the client's lunch tray uneaten C) One formed stool in the bedside commode D) 1000 mL of intravenous 0.9% normal saline infused in 2 hours

Answer: D Explanation: A) Excessive infusions of chloride-containing intravenous fluids can precipitate metabolic acidosis. The head of the bed's being flat might influence a client's oxygenation status; however, the client was not demonstrating a change in respiratory depth or rate. A reduction in oral intake does not cause metabolic acidosis. Eating half of a meal tray is not the same as starvation. Diarrhea can lead to the development of metabolic acidosis. One formed stool would not cause the nurse alarm.

9) The nurse is reviewing orders written for a client with chronic respiratory acidosis. Which order should the nurse question before implementing for this client? A) Keep head of the bed elevated to 40-degree angle. B) Dextrose 5% and 0.45% normal saline at 100 mL per hour C) Consult Respiratory Therapy for breathing treatments four times a day. D) Oxygen 4 liters per nasal cannula

Answer: D Explanation: A) In clients with chronic respiratory acidosis, oxygen is administered cautiously to prevent carbon dioxide narcosis. Adequate hydration such as intravenous fluids is important to promote removal of respiratory secretions. Pulmonary hygiene measures such as breathing treatments may be instituted.

3) The nurse, caring for a Jewish client with respiratory alkalosis, tells another nurse that "Jewish families are so hard to deal with; all they do is complain." What behavior is the nurse demonstrating? A) Culture shock B) Discrimination C) Prejudice D) Stereotyping

Answer: D Explanation: A) The nurse is exhibiting stereotyping by assuming that all members of a culture or ethnic group are alike. Culture shock is a disorder that occurs in response to transition from one cultural setting to another. Prejudice is a negative belief or preconceived opinion that is not based on reason or actual experience. Discrimination occurs when a person acts on prejudice and denies another person one or more of the fundamental rights.

13) The nurse instructs a client with a history of acute respiratory acidosis and lung infections on ways to prevent further episodes of the health problem. Which client statement indicates that teaching has been effective? A) "I will limit drinking alcohol to the evening hours only." B) "I will limit my intake of bananas and oranges." C) "I will take prescribed antibiotics until my symptoms subside." D) "I will receive the annual influenza vaccination."

Answer: D Explanation: A) The nurse should discuss ways to avoid future episodes of acute respiratory infections by encouraging the client to receive immunization against pneumococcal pneumonia and influenza. Alcohol is a central nervous system depressant which can adversely affect respiratory status and lead to the development of respiratory acidosis. The ingestion of bananas and oranges will not promote the development of respiratory acidosis. The client should be instructed to complete a full course of antibiotics prescribed to treat infections.

2) The mother of a 1-month-old infant calls the nurse who works in the health clinic. The mother is concerned because the infant has had vomiting and diarrhea for 2 days. The nurse knows that this infant is at risk for metabolic acidosis. Which of the following is the priority nursing action? A) Instruct the mother to provide the infant with 50 mL of glucose water. B) Instruct the mother to measure the infant's urine output for 24 hours. C) Instruct the mother to give the infant at least 2 ounces of juice every 2 hours. D) Instruct the mother to bring the infant to the clinic for evaluation.

Answer: D Explanation: D) Parents and caregivers need to be taught the seriousness of vomiting or diarrhea in infants due to rapid fluid loss that can occur in this age group. They should also be taught the importance of bringing an infant in this situation to healthcare providers for evaluation. Encouraging fluids for an infant who is actively vomiting will not improve fluid balance status, and neither juice nor glucose water is the best choice of fluid. Simply monitoring the loss over the next 24 hours would increase the potential for the infant to become dehydrated.

A patient has been treated for dehydration. What outcome does the nurse determine demonstrates effectiveness of the treatment regimen? Oral intake balances output. Oral intake is less than output. Oral intake is greater than output. No significant difference in fluid balance.

Oral intake balances output. Oral intake should equal output if fluid balance has been restored and dehydration has been corrected. Less intake than output would result in dehydration. Greater intake than output may indicate decreased renal function or impaired ability to excrete urine.

The nurse is caring for a patient who has heart failure with 4+ edema in the lower legs and the sacral area. Which measures are important to include in the plan of care? Select all that apply. Elevate edematous extremities. Protect the patient's tissues from extreme heat or cold. Apply moisturizing creams or lotions to the skin frequently. Rotate the patient from left side-lying to right side-lying every two hours. Frequently assess for edema in areas where soft tissue covers bony areas. Encourage the patient to greatly increase fluid intake to improve tissue integrity.

Elevate edematous extremities. Protect the patient's tissues from extreme heat or cold. Apply moisturizing creams or lotions to the skin frequently. Frequently assess for edema in areas where soft tissue covers bony areas. Rationale Providing proper skin care is vitally important in patients dealing with edema to prevent impaired skin and tissue integrity. Elevating the edematous extremities helps promote venous return. Protecting the patient's tissues from extreme hot or cold decreases the possibility of skin or tissue impairment. Applying moisturizers to the skin frequently promotes moisture retention and stimulates circulation. Edema tends to accumulate in areas where tissue overlies bone such as the sacrum, tibia, and fibula and must be assessed frequently to avoid the risk of pressure ulcers. The patient's position should be frequently changed but is not restricted to side-lying. There is not enough data to determine the fluid needs of the patient, and this is not a standard intervention but based upon patient need.

The nurse is reviewing the laboratory data of a patient admitted for evaluation of a fluid and electrolyte imbalance. The lab results show Na + 132 mEq/L, BUN 5 mg/dL, and HCT 33%. What does the nurse infer from these findings? Hyperkalemia Hypernatremia Excess fluid volume Deficient fluid volume

Excess fluid volume A decreased sodium level (normal sodium ranges from 135 to 145 mEq/L), BUN (normal BUN ranges from 7-20 mg/dL), and HCT (normal level 35-47% for women and 39-50% for men) indicate fluid volume excess. The patient has hyponatremia, not hypernatremia, since the sodium level is below 135. There is no indication from the data that the patient is hyperkalemic. Because these values indicate excess, the patient is not at risk for a fluid volume deficit, nor does he or she have one.

When planning care for a patient with dehydration related to nausea and vomiting, the nurse would anticipate which fluid shift to occur because of the fluid volume deficit? Fluid movement from the blood vessels into the cells Fluid movement from the interstitial spaces into the cells Fluid movement from the blood vessels into interstitial spaces Fluid movement from the interstitial space into the blood vessels

Fluid movement from the interstitial space into the blood vessels Rationale In dehydration, fluid is lost first from the blood vessels. To compensate, fluid moves out of the interstitial spaces into the blood vessels to restore circulating volume in that compartment. As the interstitial spaces then become volume depleted, fluid moves out of the cells into the interstitial spaces.

The nurse is caring for an older patient who is receiving intravenous (IV) fluids postoperatively. During the 0800 assessment of this patient, the nurse notes that the IV solution, which was prescribed to infuse at 125 mL/hr, has infused 950 mL since it was hung at 0400. What is the priority nursing intervention? Notify the health care provider and complete an incident report. Obtain a new bag of IV solution to maintain patency of the site. Listen to the patient's lung sounds and assess respiratory status. Slow the rate to keep the vein open until the next bag is due at noon.

Listen to the patient's lung sounds and assess respiratory status. Rationale After four hours of infusion time, 500 mL of IV solution should have infused, not 950 mL. This patient is at risk for fluid volume excess, and the nurse should assess the patient's respiratory status and lung sounds as the priority action and then notify the health care provider for further prescriptions.

A patient has been admitted for dehydration. What is a priority nursing intervention? Perform daily weights. Reorient the patient hourly. Restrict sodium intake to 2 grams per day. Provide continuous oxygen saturation monitoring.

Perform daily weights. Rationale Measuring weight is the most reliable means of detecting changes in fluid balance. Weight loss would indicate that the dehydration is worsening, whereas weight gain would indicate restoration of fluid volume. The nurse would recall that a 1-kg weight gain indicates a gain of approximately 1000 mL of body water. This patient is not disoriented, and that is not a common assessment finding in the patient with dehydration. Continuous oxygen saturation monitoring is not indicated. Sodium intake does not need to be restricted. p. 276

A patient is diagnosed with Guillain-Barré syndrome. Which complication does the nurse anticipate? Metabolic acidosis Metabolic alkalosis Respiratory acidosis Respiratory alkalosis

Respiratory acidosis Rationale Guillain-Barré syndrome is a disease of the respiratory system that causes hypoventilation. Hypoventilation increases the concentration of carbonic acid, which results in respiratory acidosis. Metabolic acidosis, metabolic alkalosis, and respiratory alkalosis are not caused by Guillain-Barré syndrome.

What is the normal range of blood pH? 1 7.05 to 7.15 2 7.15 to 7.25 3 7.25 to 7.35 4 7.35 to 7.45

The normal range of blood pH is 7.35 to 7.45. A pH less than 7.35 indicates acidosis.

The nurse is caring for an older adult patient who has dehydration. The nurse would instruct the unlicensed assistive personnel (UAP) to report which finding? Temperature 97.1 oF Frequent use of the urinal Urine output of 350 mL in 24 hours Ambulation in the hallway without assistance

Urine output of 350 mL in 24 hours Rationale The minimal urine output necessary to maintain kidney function is 30 mLs per hour, or 720 mL per 24 hours. The nurse should be notified of a decrease in urine output so that additional fluid volume-replacement therapy can be instituted. Ambulation is encouraged. The temperature is normal. Frequent use of the urinal would not indicate dehydration. p. 276

A patient on mechanical ventilation has the following blood gases: pH 7.56, pCO2 29, HCO3 23. Which of the following conditions is the patient experiencing? a. Respiratory alkalosis not compensated b. Respiratory alkalosis partially compensated c. Respiratory alkalosis fully compensated d. Respiratory acidosis partially compensated

a. Respiratory alkalosis not compensated Rationale: The ventilator is causing patient to blow off too much CO2. Nursing intervention would be to adjust ventilator to slow down the respirations/ventilator until pCO2 is normal.

Interpret: pH 7.6, pCO2 31, HCO3 25

pH & CO2 both Base - respiratory alkalosis; HCO3 normal means body is not compensating (uncompensated)

Interpret: pH 7.0, pCO2 90, HCO3 12

pH & CO2 both acid = respiratory acidosis; HCO3 abnormal in opposite direction = partially compensated

Interpret: pH 7.3, pCO2 68, HCO3 28

pH & CO2 both acid = respiratory acidosis; HCO3 abnormal in opposite direction = partially compensated

Interpret: pH 7.57, pCO2 37, HCO3 30

pH & bicarb both base = metabolic alkalosis. CO2 is normal, so body is not compensating yet (uncompensated)

Interpret: pH 7.35, pCO2 72, HCO3 38

pH is normal, so either patient is balanced OR patient is fully compensating. CO2 is acidotic. HCO3 is alkalotic. So fully compensating for imbalance. pH is closer to the acid side AND the bigger imbalance is CO2 (CO2 is off by 27; HCO3 is off by 12), so the problem started with respiratory issues. CO2 is acidotic, so these labs indicate respiratory acidosis, fully compensated.

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