Chapter 9: Acid-Base Balance

Which patient statement indicates the need for additional education regarding the use of sodium bicarbonate to treat acidosis? 1) "I need to purchase antacids without salt." 2) "I should use the antacid for at least 2 months." 3) "I should contact the doctor if I have any gastric discomfort with chest pain." 4) "I should call the doctor if I get short of breath or start to sweat with this medication."

2) "I should use the antacid for at least 2 months." Bicarbonate antacid should not be used for longer than two weeks. This statement indicates the need for additional teaching.

The nurse completes discharge teaching for a patient with an anxiety disorder. Which patient statement indicates correct understanding of information related to respiratory alkalosis? 1) "I will eat more bananas at breakfast." 2) "I will see my counselor on a regular basis." 3) "I will not take antacids when I have heartburn." 4) "I will breathe faster when I am feeling anxious."

2) "I will see my counselor on a regular basis."

The results of a patient's arterial blood gas sample indicate an oxygen level of 72 mmHg. Which should the nurse closely assess when providing care to this patient? 1) Perfusion 2) Cognition 3) Communication 4) Fluid and electrolytes

2) Cognition An oxygen level of less than 75 mmHg can be due to hypoventilation. This drop in oxygen will change the patient's level of responsiveness

The nurse is reviewing new orders provided by the health-care provider for a critical care patient with metabolic acidosis. Which prescription should the nurse question? 1) Draw serum potassium levels every two hours. 2) Draw arterial blood gas samples every two hours. 3) Administer one ampule of sodium bicarbonate now. 4) Begin intravenous infusion of 0.9% normal saline.

3) Administer one ampule of sodium bicarbonate now. 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.

Which chronic lung condition noted in the patient's health history supports the current diagnosis of respiratory acidosis? 1) Aspiration 2) Pneumonia 3) Cystic fibrosis 4) Hyperthyroidism

3) Cystic fibrosis

Which clinical manifestation supports the nurse's plan of care focusing on chronic respiratory acidosis? 1) Irritability 2) Blurred vision 3) Daytime sleepiness 4) Warm, flushed skin

3) Daytime sleepiness

The nurse is caring for a comatose patient with respiratory acidosis. For which intervention will the nurse need to collaborate when caring for this patient? 1) Monitoring vital signs 2) Measuring intake and output 3) Determining recent eating behaviors 4) Identifying current oxygen saturation level

3) Determining recent eating behaviors For patients in severe distress, family members may need to be consulted for critical information such as recent eating habits and history of vomiting.

Which diagnostic test should the nurse anticipate when providing care to a patient diagnosed with chronic obstructive pulmonary disease (COPD) to monitor acid-base balance? 1) Pulse oximetry 2) Bronchoscopy 3) Sputum studies 4) Arterial blood gases

4) Arterial blood gases Arterial blood gas analysis is done to assess alterations in acid-base balance caused by respiratory disorders, metabolic disorders, or both.

The patient is receiving sodium bicarbonate intravenously (IV) for correction of acidosis secondary to diabetic coma. The nurse assesses the patient to be lethargic, confused, and breathing rapidly. Which is the nurse's priority response to the current situation? 1) Stop the infusion and notify the provider because the patient is in alkalosis. 2) Increase the rate of the infusion and continue to assess the patient for symptoms of acidosis. 3) Decrease the rate of the infusion and continue to assess the patient for symptoms of alkalosis. 4) Continue the infusion, because the patient is still in acidosis, and notify the provider.

4) Continue the infusion, because the patient is still in acidosis, and notify the provider. 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 provider should be notified.

The nurse is caring for a patient admitted with renal failure and metabolic acidosis. Which clinical manifestation would indicate to the nurse that planned interventions to relieve the metabolic acidosis have been effective? 1) Tachypnea 2) Palpitations 3) Increased deep tendon reflexes 4) Decreased depth of respirations

4) Decreased depth of respirations The patient 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.

A patient is admitted to the emergency department for the treatment of a drug overdose causing acute respiratory acidosis. Which substance noted on the toxicology report is the most likely cause for the current diagnosis? 1) PCP 2) Cocaine 3) Marijuana 4) Oxycodone

4) Oxycodone

The client is admitted to the emergency department (ED) with symptoms of a panic attack. Based on this data, the nurse plans care for which health problem? 1) Emesis 2) Memory loss 3) Hypoventilation 4) Respiratory alkalosis

4) Respiratory alkalosis

The nurse is providing care for a patient admitted to the unit with respiratory failure and respiratory acidosis. Which data from the nursing history is the probable cause for the patient's current diagnoses? 1) Aspiration pneumonia 2) A recent trip to South America 3) Recent recovery from a cold virus 4) Use of ibuprofen for the control of pain

1) Aspiration pneumonia Aspiration of a foreign body and acute pneumonia would put the patient at risk for respiratory acidosis.

The nurse is analyzing the patient's arterial blood gas report, which reveals a pH of 7.15. The patient has just suffered a cardiac arrest. Which consequences of this pH value does the nurse consider for this patient? 1) Decreased cardiac output 2) Decreased potassium levels 3) Increased magnesium levels 4) Decreased free calcium in the ECF

1) Decreased cardiac output The nurse knows that severe acidosis depresses myocardial contractility, which leads to decreased cardiac output.

The nurse is reviewing the health-care provider orders for a patient who is diagnosed with respiratory alkalosis. Which prescription is appropriate for this patient's care needs? 1) Draw arterial blood gas analysis. 2) Administer oxygen via face mask. 3) Restrict fluids to two liters per day. 4) Infuse one ampule of sodium bicarbonate.

1) Draw arterial blood gas analysis.

The nurse is providing care to a patient who has been vomiting for several days. The nurse knows that the patient is at risk for metabolic alkalosis because gastric secretions have which characteristic? 1) Gastric secretions are acidic. 2) Gastric secretions are alkaline. 3) Gastric secretions have a foul smell. 4) Gastric secretions are green in color.

1) Gastric secretions are acidic.

The nurse is planning care for an older adult patient with respiratory acidosis. Which intervention should the nurse include in this patient's plan of care? 1) Maintain adequate hydration. 2) Reduce environmental stimuli. 3) Administer intravenous sodium bicarbonate. 4) Administer prescribed intravenous fluids carefully.

1) Maintain adequate hydration. 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.

The nurse is providing care for an adult patient who is admitted to the emergency department (ED) after passing out. The patient has been fasting and currently has ketones in the urine. Which acid-based imbalance should the nurse monitor the patient for based on the current data? 1) Metabolic acidosis 2) Metabolic alkalosis 3) Respiratory acidosis 4) Respiratory alkalosis

1) Metabolic acidosis The patient who is fasting is at risk for metabolic acidosis. The body recognized fasting as starvation and begins to metabolize its own proteins into ketones, which are metabolic acid.

Which is the priority nursing action when providing care to a patient who is admitted with metabolic alkalosis? 1) Monitoring oxygen saturation 2) Setting goals for the plan of care 3) Administering prescribed medications 4) Teaching the family about risk factors

1) Monitoring oxygen saturation The priority for this patient is monitoring oxygen saturation. The depressed respiratory drive that often accompanies metabolic alkalosis can lead to hypoxemia and impaired oxygenation of the tissues.

A patient with metabolic acidosis has been admitted to the unit from the emergency department (ED). The patient is experiencing confusion and weakness. Which independent nursing intervention is the priority? 1) Protecting the patient from injury 2) Placing the patient in a high-Fowler's position 3) Administering sodium bicarbonate to the patient 4) Providing the patient with appropriate skin care

1) Protecting the patient from injury The patient with metabolic acidosis may have symptoms of drowsiness, lethargy, confusion, and weakness. A priority of care would be preventing injury.

A patient recently diagnosed with diabetes mellitus (DM) is hospitalized in diabetic ketoacidosis (DKA) after a religious fast. The patient 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 actions would be appropriate? Select all that apply. 1) Request a consult from a diabetes educator. 2) Assess the meaning and context of fasting for this religion. 3) Tell the patient that things are different now because of the new diagnosis. 4) Ask family members of the same religion to discuss fasting with the patient. 5) Encourage the patient to seek medical care if signs of ketoacidosis occur in the future.

1) Request a consult from a diabetes educator. 2) Assess the meaning and context of fasting for this religion. 5) Encourage the patient to seek medical care if signs of ketoacidosis occur in the future.

Which nursing actions are appropriate when conducting an Allen test? Select all that apply. 1) Rest the patient's arm on the mattress. 2) Support the patient's wrist with a rolled towel. 3) Tell the patient to relax the hand and then clench a fist. 4) Ensure that a second nurse is available to assist with the procedure. 5) Press the patient's radial and ulnar arteries using the index and middle fingers.

1) Rest the patient's arm on the mattress. 2) Support the patient's wrist with a rolled towel. 5) Press the patient's radial and ulnar arteries using the index and middle fingers.

Which risk factors exhibited by the patient presenting in the emergency department (ED) would place the patient at risk for metabolic acidosis? Select all that apply. 1) Pneumonia 2) Abdominal fistulas 3) Acute renal failure 4) Hypovolemic shock 5) Chronic obstructive pulmonary disease

2) Abdominal fistulas 3) Acute renal failure 4) Hypovolemic shock

The nurse is providing care to a patient who is intubated and receiving mechanical ventilation after a motor vehicle crash. The patient is fighting the ventilator and attempting to remove the endotracheal tube. Which nursing action decreases the patient's risk for developing respiratory alkalosis? 1) Apply wrist restraints. 2) Administer a prescribed sedative. 3) Teach the patient to take slow, deep breaths. 4) Discuss removing the endotracheal tube with the health-care provider.

2) Administer a prescribed sedative.

The nurse is caring for the patient experiencing hypovolemic shock and metabolic acidosis. Which nursing actions are appropriate for this patient? Select all that apply. 1) Limit the intake of fluids. 2) Administer sodium bicarbonate. 3) Monitor ECG for conduction problems. 4) Keep the bed in the locked and low position. 5) Monitor weight on admission and discharge.

2) Administer sodium bicarbonate. 3) Monitor ECG for conduction problems. 4) Keep the bed in the locked and low position. (The patient recovering from hypovolemic shock is at risk for injury, so the bed should be kept in the locked and low position.)

The nurse is providing care to a patient who is admitted with manifestations of metabolic alkalosis. Which diagnostic test findings support the admitting diagnosis? Select all that apply. 1) Serum glucose level 142 mg/dL 2) Blood pH 7.47 and bicarbonate 34 mEq/L 3) Intravenous pyelogram shows kidney stones 4) Bilateral lower lobe infiltrates noted on chest x-ray 5) Electrocardiogram changes consistent with hypokalemia

2) Blood pH 7.47 and bicarbonate 34 mEq/L (In metabolic alkalosis, the blood pH will be greater than 7.45 and the bicarbonate level greater than 28 mEq/L.) 5) Electrocardiogram changes consistent with hypokalemia

The nurse is reviewing the latest arterial blood gas results for a patient with metabolic alkalosis. Which result indicates that the metabolic alkalosis is compensated? 1) pH 7.32 2) HCO3 8 mEq/L 3) PaCO2 48 mmHg 4) PaCO2 18 mmHg

3) PaCO2 48 mmHg To compensate for this imbalance, the rate and depth of respirations decrease, leading to retention of carbon dioxide. The PaCO2 will be elevated

The nurse is providing care to patient with the following laboratory values: pH - 7.31; PaCO2 - 48 mmHg; and a normal HCO3. Which condition should the nurse plan care for based on the current data? 1) Metabolic acidosis 2) Metabolic alkalosis 3) Respiratory acidosis 4) Respiratory alkalosis

3) Respiratory acidosis If the pH is decreased and the PaCO2 is increased with a normal HCO3, it is uncompensated respiratory acidosis

The nurse is providing care to a patient who is admitted after a morphine overdose. Which acid-base imbalance should the nurse plan this patient's care to reflect? 1) Metabolic acidosis 2) Metabolic alkalosis 3) Respiratory acidosis 4) Respiratory alkalosis

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

The nurse is providing care to a patient who is admitted to the hospital with sudden, severe abdominal pain. Which arterial blood gas supports the patient's current diagnosis of respiratory alkalosis? 1) pH is 7.35 and PaO2 is 88. 2) pH is 7.30 and HCO3 is 30. 3) pH is 7.47 and PaCO2 is 25. 4) pH is 7.33 and PaCO2 is 36.

3) pH is 7.47 and PaCO2 is 25.