Chp. 8: Disorders of Fluid and Electrolyte and Acid Base Balance

The nurse has just received the lab results of a client's calcium level. The nurse identifies a normal calcium level as:

9.0 to 10.5 mg/dL (2.25 mmol/L to 2.63 mmol/L))

The nurse is caring for the following group of clients. Select the client most likely to be diagnosed with respiratory alkalosis.

A 26-year-old female with anxiety who has been hyperventilating

A nurse is providing care for several clients on an acute medicine unit. Which client should the nurse recognize as being at the highest risk for metabolic alkalosis?

A client on continuous nasogastric suction and whose hypertension is being treated with diuretics

What laboratory test is a good indicator of the how the buffer systems in the body are working?

Base excess or deficit test

The nurse caring for a client with respiratory acidosis examines arterial blood gas (ABG) results. Which change from the initial value indicates the client's respiratory acidosis is improving?

CO2 has decreased

A client is admitted to hospital with signs of acidosis. Compensation takes place in the kidney as well as in the lungs. Which action takes place specifically at the respiratory membrane?

CO2 is eliminated

When caring for a client with hypomagnesemia, the nurse prioritizes assessment of which body system?

Cardiac

When caring for a client with hyperkalemia, the nurse prioritizes assessment of which body system?

Cardiovascular

Which of the following is an anion?

Chloride

A client is admitted to the intensive care unit for cardiogenic shock. In the hours since admission, the client's arterial blood gases indicate acidosis, most likely acute lactic acidosis. Which clinical manifestations and diagnostic findings might his care team anticipate before acid--base balance is restored?

Dysrhythmias

The nurse is caring for a client with a tumor obstructing the lymphatic system. For which consequence does the nurse assess?

Fluid accumulating in the interstitial spaces distal to the tumor

A client is admitted after losing 44 lb (20 kg) over the past 3 months, largely due to frequent vomiting. What intervention should the nurse anticipate in the treatment of the client's resulting acid-base imbalance?

Fluid replacement with an intravenous solution containing electrolytes as prescribed

The nurse is aware that the major role of the kidneys in regulating acid-base balance is to increase the production of which chemical component?

HCO3-

The nurse is aware that the major role of the kidneys in regulating acid-base balance is to increase the production of:

HCO3−

Respiratory alkalosis can be caused by a respiratory rate in excess of that which maintains normal plasma PCO2 levels. What is a common cause of respiratory alkalosis?

Hyperventilation

A nurse is caring for a client with hypoparathyroidism. Which imbalance is a major concern for the client?

Hypocalcemia

The nurse is caring for a client who is 1 day postoperative for a thyroidectomy. The client complains of tingling of the hands and feet and around his mouth. The nurse suspects these symptoms are a manifestation of which electrolyte disturbance?

Hypocalcemia

A nurse working on a cardiac unit knows that monitoring magnesium levels is important for which reason?

Hypomagnesemia causes intracellular potassium depletion, creating risk for cardiac dysrhythmias.

Pressure generated as water moves across a membrane is also known as which of the following?

Osmotic pressure

Vitamin D, officially classified as a vitamin, functions as a hormone in the body. What other hormone is necessary in the body for vitamin D to work?

Parathyroid hormone

Which one of the following is associated with hydrostatic edema?

Pits to finger pressure

The nurse enters a client's hospital room and finds the client breathing rapidly, stating, "I must be having a stroke, my fingers are tingling!" Which acid-base balance disorder is this client experiencing due to hyperventilation?

Respiratory alkalosis

The effective circulating volume is the major regulator of water balance in the body. What else does it regulate?

Sodium

When caring for clients with disorders of sodium balance, the nurse know that which finding is consistent with hypernatremia?

Sodium 158 mEq/L (158 mmol/L) and serum osmolality of 320 mOsm/kg (320 mmol/kg)

The condition of a client with metabolic acidosis from an intestinal fistula is not improving. The pulse is 125 beats/min and the BP 84/56 mm Hg. ABG values are: pH 7.1, HCO3- 18 mEq/L (18 mmol/L), PCO2 57 mm Hg (7.58 kPa). What IV medication should the nurse expect to provide next?

Sodium bicarbonate

A nurse is caring for a client with a low sodium level and increased water retention. Hematocrit and blood urea nitrogen levels are decreased, urine osmolality is high, and serum osmolality is low. A chest x-ray shows a possible lung mass. Based on these findings, which problem could the client be diagnosed with?

Syndrome of inappropriate antidiuretic hormone (SIADH)

The nurse is assessing a client with abnormal blood gas values. Which of these interpretations does the nurse make regarding the client's physiologic status?

The client has abnormalities in his buffer system.

The nurse is assessing blood gas results for a client with diabetes and ketoacidosis and notes a pH level of 7.15. Which arrhythmias should the nurse closely monitor while treating this client?

Ventricular tachycardia

The nurse caring for a client with metabolic acidosis examines arterial blood gas (ABG) results. Which change from the initial value indicates the client's metabolic acidosis is improving?

pH has increased

The nurse caring for a client with metabolic alkalosis should anticipate which laboratory results to confirm the diagnosis?

pH of 7.45 and HCO3 of 24 mEq/L (24 mmol/L)

When caring for the client with hyperkalemia, the nurse recognizes the body should respond in which of these ways?

secrete potassium in the distal tubules for excretion

The nurse is caring for a client who is experiencing an increased level of aldosterone secretion. The nurse anticipates that the client may develop:

sodium and water retention.

The nurse is reviewing laboratory data for the client with an anion gap of 17. The nurse recognizes which condition is associated with an increased anion gap mEq/L (mmol/L)?

Lactic acidosis

The nurse is assessing a client for early manifestations of hyponatremia. The nurse would assess the client for:

Muscle weakness

Hypothalamic sensory neurons that promote thirst when stimulated are called:

Osmoreceptors

The nurse is teaching the client about Vitamin D. Which of these topics should the nurse include in the teaching plan? Select all that apply.

-Vitamin D is present in the skin or intestine. -Absorption of calcium from the intestine increases. -Vitamin D is transported to the kidneys. -Calcitriol is produced

To calculate the H2CO3 content of the blood, the nurse needs to measure the PCO2 (partial pressure of CO2) by its solubility coefficient. What is the solubility coefficient of CO2?

0.03

A client is admitted to the emergency department with possible internal bleeding after being involved in an automobile accident. What type of isotonic intravenous (IV) solution does the nurse prepare to infuse?

0.9% NaCl

The nurse who is providing care for several clients recognizes which client is at the highest risk for developing an acid-base imbalance?

A client who is being treated for acute kidney injury and who requires dialysis

The nurse is caring for a client with an acid-base imbalance. Which of these does the nurse recognize is correct regarding compensation?

A pH moves toward the normal range.

The nurse is caring for a client who has developed hypoxemia and tissue hypoxia. Which of these interventions does the nurse set as a priority intervention?

Administration of supplemental oxygen

A client is brought to the emergency department semicomatose and a blood glucose reading of 673. He is diagnosed with diabetic ketoacidosis (DKA). Blood gas results are as follows: serum pH 7.29; HCO3− level 19 mEq/dL (19 mmol/L); PCO2 level 32 mm Hg. The nurse should anticipate that which order may correct this diabetic ketosis?

Initiating an insulin IV infusion along with fluid replacement

Lymph fluid arises directly from which space?

Interstitial

The nurse is performing an assessment for a client who is experiencing shortness of breath. The nurse notes a full and bounding pulse, crackles in the lung fields, and jugular vein distention. The nurse recognizes symptoms of which problem?

Isotonic fluid volume excess

When caring for a client with diabetes insipidus (DI), the nurse plans to evaluate which laboratory study?

Measurement of antidiuretic hormone (ADH) and plasma/urine osmolality

The nurse is caring for a client with worsening respiratory acidosis. Which of these interventions does the nurse anticipate if the client's condition continues to deteriorate?

Mechanical ventilation

Magnesium levels are important indicators to a variety of bodily functions. What is severe hypermagnesemia associated with?

Muscle and respiratory paralysis

A child accidentally consumes a container of wood alcohol. The ED physician knows that the child is at risk of developing which of the following?

Metabolic acidosis

The nurse is reviewing the following lab results of a client diagnosed with renal failure:pH: 7.24PCO2: 38 mm Hg (5.05 kPa)HCO3:18 mEq/L (18 mmol/L)The nurse would interpret this as:

Metabolic acidosis

A client tells the nurse that the client has been taking Alka-Seltzer (bicarbonate—antacid) four times a day for the past 2 weeks for an upset stomach. Upon assessment of the client, the nurse notes hyperactive reflexes, tetany, and mental confusion. Arterial blood gases reveal pH 7.55; serum HCO3− 37 mEq/L (37 mmol/L). The nurse suspects the client may be experiencing:

Metabolic alkalosis

A client with schizophrenia is admitted to the behavioral health department and is observed drinking copious amounts of water and voiding large amounts of dilute urine. The nurse recognizes this behavior is consistent with which problem?

Psychogenic polydipsia

A client arrives in the emergency department by ambulance with a family member stating, "He took an overdose of sleeping pills and I found him breathing very shallowly." For which type of acid-base disturbance will the nurse anticipate this client will be treated?

Respiratory acidosis

A client with a long history of alcohol abuse has been admitted to the emergency department after several of days of heavy drinking. The nurse can best promote the restoration of the client's acid-base balance by:

administering intravenous sodium bicarbonate as prescribed.