Honan-Chapter 4: Fluid and Electrolyte and Acid--Base Imbalances

A nurse correctly identifies a urine specimen with a pH of 4.3 as being which type of solution? Neutral Alkaline Acidic Basic

Acidic Explanation: Normal urine pH is 4.5 to 8.0; a value of 4.3 reveals acidic urine pH. A pH above 7.0 is considered an alkaline or basic solution. A pH of 7.0 is considered neutral.

The nurse notes that a patient's urine osmolality is 980 mOsm/kg. What should the nurse assess as a possible cause of this finding? Acidosis Fluid volume excess Diabetes insipidus Hyponatremia

Acidosis Explanation: Normal urine osmolality is 200 to 800 mOsm/kg, so 980 mOsm/kg is elevated. Acidosis is a factor that increases urine osmolality. Fluid volume excess, diabetes insipidus, and hyponatremia are all factors that decrease urine osmolality.

A nurse working on a trauma unit is initiating IV fluids for a patient. For what condition would the nurse administer normal saline? A. Renal impairment B. Pulmonary edema C. Burns D. Heart failure

C. Burns RATIONALE Normal saline (0.9% sodium chloride) is used with blood transfusions and to replace large sodium losses, as in burn injuries. It is not used for heart failure, pulmonary edema, renal impairment, or sodium retention.

You are doing an admission assessment on an elderly patient newly admitted for end-stage liver disease. You must assess the patient's skin turgor. What should you remember when evaluating skin turgor? Overhydration causes the skin to tent. Dehydration causes the skin to appear edematous and spongy. Inelastic skin turgor is a normal part of aging. Normal skin turgor is moist and boggy.

Inelastic skin turgor is a normal part of aging. Explanation: Inelastic skin turgor is a normal part of aging. Dehydration, not overhydration, causes inelastic skin with tenting. Overhydration, not dehydration, causes the skin to appear edematous and spongy. Normal skin turgor is dry and firm.

A client hospitalized for treatment of a pulmonary embolism develops respiratory alkalosis. Which clinical findings commonly accompany respiratory alkalosis? Headache or blurry vision Abdominal pain or diarrhea Hallucinations or tinnitus Light-headedness or paresthesia

Light-headedness or paresthesia Explanation: The client with respiratory alkalosis may complain of light-headedness or paresthesia (numbness and tingling in the arms and legs). Headache, blurry vision, abdominal pain, and diarrhea may accompany respiratory acidosis. Hallucinations and tinnitus rarely are associated with respiratory alkalosis or any other acid-base imbalance.

Which is a correct route of administration for potassium? Subcutaneous Intramuscular Oral IV (intravenous) push

Oral Explanation: Potassium may be administered through the oral route. Potassium is never administered by IV push or intramuscularly to avoid replacing potassium too quickly. Potassium is not administered subcutaneously.

The nurse is caring for four clients on a medical unit. The nurse is most correct to review which client's laboratory reports first for an electrolyte imbalance? A 7-year-old with a fracture tibia A 65-year-old with a myocardial infarction A 52-year-old with diarrhea A 72-year-old with a total knee repair

A 52-year-old with diarrhea Explanation: Electrolytes are in both intracellular and extracellular water. Electrolyte deficiency occurs from an inadequate intake of food, conditions that deplete water such as nausea and vomiting, or disease processes that cause an excess of electrolyte amounts. The 52-year-old with diarrhea would be the client most likely to have an electrolyte imbalance. The orthopedic client will not likely have an electrolyte imbalance. Myocardial infarction clients will occasionally have electrolyte imbalance, but this is the exception rather than the rule.

A patient is diagnosed with SIADH. What disturbance should the nurse be aware of related to this diagnosis? A. Excess water loss B. Dilutional hyponatremia C. Serum sodium level of 148 mg/dL D. Decreased urine osmolality

B. Dilutional hyponatremia RATIONALE The basic physiologic disturbances in SIADH are excessive ADH activity, with water retention and dilutional hyponatremia, and inappropriate urinary excretion of sodium in the presence of hyponatremia. Serum sodium levels are decreased. Urine osmolality is increased in SIADH.

When entering a patient's room, the nurse notices blood clots in the IV line. What is the most appropriate nursing intervention at this time? A. Milk the tubing. B. Discontinue the infusion. C. Irrigate the tubing and catheter. D. Aspirate the clot from the tubing.

B. Discontinue the infusion. RATIONALE If blood clots occur in the IV line, the infusion must be discontinued and restarted in another site with a new cannula and administration set. The tubing should not be irrigated or milked. The clot should not be aspirated from the tubing.

What does the nurse expect to see on the ECG reading when serum potassium levels rise to greater than 6 mEq/L? A. Peaked, widened T waves B. ST-segment elevation C. Lengthened QT interval D. ST-segment depression

D. ST-segment depression RATIONALE When potassium levels are greater than 6 mEq/L, the earliest ECG changes are a peaked, narrow T wave, ST-segment depression, and a shortened QT interval. If the serum potassium level continues to increase, the PR interval becomes prolonged and is followed by disappearance of the P waves.

You are caring for a 72-year-old client who has been admitted to your unit for a fluid volume imbalance. You know which of the following is the most common fluid imbalance in older adults? Hypovolemia Dehydration Hypervolemia Fluid volume excess

Dehydration Explanation: The most common fluid imbalance in older adults is dehydration. Because of reduced thirst sensation that often accompanies aging, older adults tend to drink less water. Use of diuretic medications, laxatives, or enemas may also deplete fluid volume in older adults. Chronic fluid volume deficit can lead to other problems such as electrolyte imbalances. Therefore, options A, C, and D are incorrect.

A nurse assesses a patient's IV lines on an hourly basis. When checking the IVs this hour, the nurse finds localized pain, redness, warmth, and swelling around the insertion site of a 25-year-old female patient. What is the nurse's first priority? Elevate the extremity Apply a warm compress Restart the line in the opposite extremity Apply a cold compress Discontinue the IV infusion

Discontinue the IV infusion Explanation: Treatment for phlebitis includes discontinuing the IV infusion; applying a cold compress first, to decrease the flow of blood and increase platelet aggregation, followed by a warm compress; elevating the extremity; and restarting the line in the opposite extremity

A client was admitted to the unit with a diagnosis of hypovolemia. When it is time to complete discharge teaching, which of the following will the nurse teach the client and family? Select all that apply. Drink at least eight glasses of fluid each day. Drink caffeinated beverages to retain fluid. Drink carbonated beverages to help balance fluid volume. Drink water as an inexpensive way to meet fluid needs. Respond to thirst

Drink at least eight glasses of fluid each day. Drink water as an inexpensive way to meet fluid needs. Respond to thirst Explanation: In addition, the nurse teaches clients who have a potential for hypovolemia and their families to respond to thirst because it is an early indication of reduced fluid volume; consume at least 8 to 10 (8 ounce) glasses of fluid each day and more during hot, humid weather; drink water as an inexpensive means to meet fluid requirements; and avoid beverages with alcohol and caffeine because they increase urination and contribute to fluid deficits.

A patient with a diagnosis of colon cancer has undergone a bowel resection with the creation of an ileostomy. The patient's ileostomy output has been unexpectedly high in the 2 days since surgery, and the patient's most recent blood work indicates a K+ level of 2.7 mEq/L. This potassium level should prompt the nurse to assess for which of the following physical manifestations? Confusion and decreased level of consciousness Shortness of breath, rales, and peripheral edema Dysphagia, tetany, and emotional lability Fatigue, cramps, and weakness

Fatigue, cramps, and weakness Explanation: A serum potassium level of 2.7 mEq/L constitutes hypokalemia. Manifestations of hypokalemia include fatigue, anorexia, nausea, vomiting, muscle weakness, leg cramps, decreased bowel motility, paresthesias (numbness and tingling), arrhythmias, and increased sensitivity to digitalis. Respiratory symptoms, dysphagia, and tetany are not typically associated with hypokalemia.

A patient's scheduled dose of furosemide (Lasix) 20 mg IV has recently finished infusing, and the nurse is preparing to administer metoclopramide (Reglan) 10 mg IV, which has just been ordered. Before administering this drug, the nurse should: Reassess the patient's allergy status. Flush the patient's IV tubing. Aspirate 1 to 2 mL of blood. Clean the area around the patient's IV cannula with normal saline.

Flush the patient's IV tubing. Explanation: It is imperative to flush an IV device between doses of different medications to prevent the mixing of incompatible medications or solutions. Aspirating blood is not appropriate, and it is not necessary to reassess the patient's allergy status or clean the patient's IV site.

A nurse is caring for a client with metastatic breast cancer who is extremely lethargic and very slow to respond to stimuli. The laboratory report indicates a serum calcium level of 12.0 mg/dl, a serum potassium level of 3.9 mEq/L, a serum chloride level of 101 mEq/L, and a serum sodium level of 140 mEq/L. Based on this information, the nurse determines that the client's symptoms are most likely associated with which electrolyte imbalance? Hyperkalemia Hypocalcemia Hypokalemia Hypercalcemia

Hypercalcemia Explanation: The normal reference range for serum calcium is 8.6 to 10.2 mg/dl. A serum calcium level of 12 mg/dl clearly indicates hypercalcemia. The client's other laboratory findings are within their normal ranges, so the client doesn't have hypernatremia, hypochloremia, or hypokalemia.

You are called to your patient's room by a family member who voices concern about the patient's status. On assessment, you find the patient tachypneic, lethargic, weak, and exhibiting a diminished cognitive ability. You also find 3+ pitting edema. What electrolyte imbalance would you suspect? Hypercalcemia Hyponatremia Hyperchloremia Hypophosphatemia

Hyperchloremia Explanation: The signs and symptoms of hyperchloremia are the same as those of metabolic acidosis: hypervolemia and hypernatremia. Tachypnea; weakness; lethargy; deep, rapid respirations; diminished cognitive ability; and hypertension occur. If untreated, hyperchloremia can lead to a decrease in cardiac output, dysrhythmias, and coma. A high chloride level is accompanied by a high sodium level and fluid retention. With hypercalcemia, you would expect tetany. There would not be edema with hyponatremia. Signs/symptoms of hypophosphatemia are mainly neurologic in origin.

The nurse is assessing residents at a summer picnic at the nursing facility. The nurse expresses concern due to the high heat and humidity of the day. Although the facility is offering the residents plenty of fluids for fluid maintenance, the nurse is most concerned about which? Lung function Summer allergies Cardiovascular compromise Insensible fluid loss

Insensible fluid loss Explanation: Due to the high heat and humidity, geriatric clients are at a high risk for insensible fluid loss through perspiration and vapor in the exhaled air. These losses are noted as unnoticeable and unmeasurable. Those with respiratory deficits and allergies may be only able to be outside for a limited period. Those with cardiovascular compromise may need to alternate outdoor activities with indoor rest.

Which intervention is most appropriate for a client with an arterial blood gas (ABG) of pH 7.5, a partial pressure of arterial carbon dioxide (PaCO2) of 26 mm Hg, oxygen (O2) saturation of 96%, bicarbonate (HCO3-) of 24 mEq/L, and a PaO2 of 94 mm Hg? Administer an ordered decongestant. Instruct the client to breathe into a paper bag. Offer the client fluids frequently. Administer ordered supplemental oxygen.

Instruct the client to breathe into a paper bag. Explanation: The ABG results reveal respiratory alkalosis. The best intervention to raise the PaCO2 level would be to have the client breathe into a paper bag. Administering a decongestant, offering fluids frequently, and administering supplemental oxygen wouldn't raise the lowered PaCO2 level.

The nurse is caring for a client with severe diarrhea. The nurse recognizes that the client is at risk for developing which acid-base imbalance? Metabolic acidosis Respiratory acidosis Metabolic alkalosis Respiratory alkalosis

Metabolic acidosis Explanation: The client is at risk for developing metabolic acidosis. Metabolic acidosis is caused by diarrhea, lower intestinal fistulas, ureterostomies, and use of diuretics; early renal insufficiency; excessive administration of chloride; and the administration of parenteral nutrition without bicarbonate or bicarbonate-producing solutes (e.g., lactate).

A nurse reviews the arterial blood gas (ABG) values of a client admitted with pneumonia: pH, 7.51; PaCO2, 28 mm Hg; PaO2, 70 mm Hg; and HCO3--, 24 mEq/L. What do these values indicate? Metabolic acidosis Metabolic alkalosis Respiratory acidosis Respiratory alkalosis

Respiratory alkalosis Explanation: A client with pneumonia may hyperventilate in an effort to increase oxygen intake. Hyperventilation leads to excess carbon dioxide (CO2) loss, which causes alkalosis — indicated by this client's elevated pH value. With respiratory alkalosis, the kidneys' bicarbonate (HCO3-) response is delayed, so the client's HCO3- level remains normal. The below-normal value for the partial pressure of arterial carbon dioxide (PaCO2) indicates CO2 loss and signals a respiratory component. Because the HCO3- level is normal, this imbalance has no metabolic component. Therefore, the client is experiencing respiratory alkalosis.

A client comes to the emergency department with status asthmaticus. His respiratory rate is 48 breaths/minute, and he is wheezing. An arterial blood gas analysis reveals a pH of 7.52, a partial pressure of arterial carbon dioxide (PaCO2) of 30 mm Hg, PaO2 of 70 mm Hg, and bicarbonate (HCO3??') of 26 mEq/L. What disorder is indicated by these findings? Metabolic acidosis Respiratory acidosis Metabolic alkalosis Respiratory alkalosis

Respiratory alkalosis Explanation: Respiratory alkalosis results from alveolar hyperventilation. It's marked by a decrease in PaCO2 to less than 35 mm Hg and an increase in blood pH over 7.45. Metabolic acidosis is marked by a decrease in HCO3? to less than 22 mEq/L, and a decrease in blood pH to less than 7.35. In respiratory acidosis, the pH is less than 7.35 and the PaCO2 is greater than 45 mm Hg. In metabolic alkalosis, the HCO3? is greater than 26 mEq/L and the pH is greater than 7.45.

The nurse assesses a cardiac patient's urinary output. The patient weighs 175 pounds. Based on the normal daily range of urine volume, the nurse expects a 4-hour output of: 40 mL to 80 mL. 80 mL to 160 mL. 120 mL to 240 mL. 160 mL to 320 mL.

160 mL to 320 mL. Explanation: A standard measurement is 0.5 to 1 mL/kg/hr. A 175 lb adult weighs 79.5 kg. Therefore, 79.5 × 0.5 mL = 39.75 or 40 mL/hr × 4 hours = 160 mL; 79.5 × 1 mL = 79.5 or 80 mL/hr × 4 hours = 320 mL.

A patient has been admitted to the medical unit from the emergency department with a peripheral IV in situ and normal saline infusing by gravity. How should the nurse best ensure that the patient's ordered solution infuses at the correct rate? Change from gravity infusion to an electronic IV pump. Monitor the patient's IV infusion hourly. Label the patient's bag of IV solution with a time-calibrated strip of tape. Assess the patient often for signs and symptoms of fluid overload.

Change from gravity infusion to an electronic IV pump. Explanation: Monitoring a patient's IV infusion, labeling gravity infusions, and assessing patients for fluid overload are all prudent measures in the care of a patient who is receiving IV fluids by gravity. However, the most accurate way to ensure that a patient's ordered fluid is infusing at the correct rate is to use an electronic IV pump.

When evaluating arterial blood gases (ABGs), which value is consistent with metabolic alkalosis? HCO 21 mEq/L pH 7.48 PaCO 36 O saturation 95%

Explanation: Metabolic alkalosis is a clinical disturbance characterized by a high pH and high plasma bicarbonate concentration. The HCO value is below normal. The PaCO value and the oxygen saturation level are within a normal range.

A physician orders an isotonic I.V. solution for a client. Which solution should the nurse plan to administer? 5% dextrose and normal saline solution Lactated Ringer's solution Half-normal saline solution 10% dextrose in water

Lactated Ringer's solution Explanation: Lactated Ringer's solution, with an osmolality of approximately 273 mOsm/L, is isotonic. The nurse shouldn't give half-normal saline solution because it's hypotonic, with an osmolality of 154 mOsm/L. Giving 5% dextrose and normal saline solution (with an osmolality of 559 mOsm/L) or 10% dextrose in water (with an osmolality of 505 mOsm/L) also would be incorrect because these solutions are hypertonic.

Which of the following arterial blood gas results would be consistent with metabolic alkalosis? Serum bicarbonate of 28 mEq/L PaCO2 less than 35 mm Hg Serum bicarbonate of 21 mEq/L pH 7.26

Serum bicarbonate of 28 mEq/L Explanation: Evaluation of arterial blood gases reveals a pH greater than 7.45 and a serum bicarbonate concentration greater than 26 mEq/L.

A nurse is conducting an initial assessment on a client with possible tuberculosis. Which assessment finding indicates a risk factor for tuberculosis? The client sees his physician for a check-up yearly. The client has never traveled outside of the country. The client had a liver transplant 2 years ago. The client works in a health care insurance office.

The client had a liver transplant 2 years ago. Explanation: A history of immunocompromised status, such as that which occurs with liver transplantation, places the client at a higher risk for contracting tuberculosis. Other risk factors include inadequate health care, traveling to countries with high rates of tuberculosis (such as southeastern Asia, Africa, and Latin America), being a health care worker who performs procedures in which exposure to respiratory secretions is likely, and being institutionalized.

Treatment of FVE involves dietary restriction of sodium. Which of the following food choices would be part of a low-sodium diet, mild restriction (2 to 3 g/day)? Three ounces of light or dark meat chicken, 1 cup of spaghetti and a garden salad Three ounces of sliced ham, beets, and a salad A frozen, packaged low-fat dinner with a side salad Tomato juice, low-fat cottage cheese, and three slices of bacon

Three ounces of light or dark meat chicken, 1 cup of spaghetti and a garden salad Explanation: Ham (1,400 mg Na for 3 oz) and bacon (155 mg Na/slice) are high in sodium as is tomato juice (660 mg Na/¾ cup) and low fat cottage cheese (918 mg Na/cup). Packaged meals are high in sodium.

A nurse is reviewing a report of a client's routine urinalysis. Which value requires further investigation? Specific gravity of 1.02 Urine pH of 3.0 Absence of protein Absence of glucose

Urine pH of 3.0 Explanation: Normal urine pH is 4.5 to 8; therefore, a urine pH of 3.0 is abnormal and requires further investigation. Urine specific gravity normally ranges from 1.010 to 1.025, making this client's value normal. Normally, urine contains no protein, glucose, ketones, bilirubin, bacteria, casts, or crystals. Red blood cells should measure 0 to 3 per high-power field; white blood cells, 0 to 4 per high-power field. Urine should be clear, with color ranging from pale yellow to deep amber.

A client with emphysema is at a greater risk for developing which acid-base imbalance? chronic respiratory acidosis metabolic alkalosis metabolic acidosis respiratory alkalosis

chronic respiratory acidosis Explanation: Respiratory acidosis, which may be either acute or chronic, is caused by excess carbonic acid, which causes the blood pH to drop below 7.35. Chronic respiratory acidosis is associated with disorders such as emphysema, bronchiectasis, bronchial asthma, and cystic fibrosis.

A client with severe hypervolemia is prescribed a loop diuretic and the nurse is concerned with the client experiencing significant sodium and potassium losses. What drug was most likely prescribed? furosemide hydrochlorothiazide metolazone spironolactone

furosemide Explanation: Furosemide is the only loop diuretic choice. Hydrochlorothiazide and metolazone are thiazide diuretics that block sodium reabsorption. Spironolactone is a potassium-sparing diuretic that prevents sodium absorption.

Oncotic pressure refers to the number of dissolved particles contained in a unit of fluid. excretion of substances such as glucose through increased urine output. amount of pressure needed to stop the flow of water by osmosis. osmotic pressure exerted by proteins.

osmotic pressure exerted by proteins. Explanation: Oncotic pressure is a pulling pressure exerted by proteins such as albumin. Osmolality refers to the number of dissolved particles contained in a unit of fluid. Osmotic diuresis occurs when urine output increases as a result of excretion of substances such as glucose. Osmotic pressure is the amount of pressure needed to stop the flow of water by osmosis.

To confirm an acid-base imbalance, it is necessary to assess which findings from a client's arterial blood gas (ABG) results? Select all that apply. pH PaCO2 HCO3 Glucose Na+ K+

pH PaCO2 HCO3 Explanation: Arterial blood gas (ABG) results are the main tool for measuring blood pH, CO2 content (PaCO2), and bicarbonate (HCO3). The two types of acid-base imbalances are acidosis and alkalosis.

The nurse is analyzing the arterial blood gas (ABG) results of a client diagnosed with severe pneumonia. Which of the following ABG results indicates respiratory acidosis? pH: 7.20, PaCO2: 65 mm Hg, HCO3-: 26 mEq/L pH: 7.32, PaCO2: 40 mm Hg, HCO3-: 18 mEq/L pH: 7.50, PaCO2: 30 mm Hg, HCO3-: 24 mEq/L pH: 7.42, PaCO2: 45 mm Hg, HCO3-: 22 mEq /L

pH: 7.20, PaCO2: 65 mm Hg, HCO3-: 26 mEq/L Explanation: Respiratory acidosis is a clinical disorder in which the pH is less than 7.35 and the PaCO2 is greater than 42 mm Hg and a compensatory increase in the plasma HCO3- occurs. It may be either acute or chronic. The ABG of pH: 7.32, PaCO2: 40 mm Hg, HCO3-: 18 mEq/L indicates metabolic acidosis. The ABGs of pH: 7.50, PaCO2: 30 mm Hg, and HCO3-: 24 mEq/L indicate respiratory alkalosis. The ABGs of pH 7.42, PaCO2: 45 mm Hg, and HCO3-: 22 mEq/L indicate a normal result/no imbalance. Reference:

A client is to receive hypotonic IV solution in order to provide free water replacement. Which solution does the nurse anticipate administering? Lactated Ringer solution 0.45% NaCl 0.9% NaCl 5% NaCl

0.45% NaCl Explanation: Half-strength saline (0.45%) is hypotonic. Hypotonic solutions are used to replace cellular fluid because it is hypotonic compared with plasma. Another is to provide free water to excrete body wastes. At times, hypotonic sodium solutions are used to treat hypernatremia and other hyperosmolar conditions. Lactated Ringer solution and normal saline (0.9% NaCl) are isotonic. A solution that is 5% NaCl is hypertonic.

The physician has prescribed a hypotonic IV solution for a patient. Which IV solution should the nurse administer? 0.45% sodium chloride 0.9% sodium chloride 5% glucose in water 5% glucose in normal saline solution

0.45% sodium chloride Explanation: Half-strength saline (0.45% sodium chloride) solution is frequently used as an IV hypotonic solution.

A patient is admitted with severe vomiting for 24 hours as well as weakness and "feeling exhausted." The nurse observes flat T waves and ST-segment depression on the electrocardiogram. Which potassium level does the nurse observe when the laboratory studies are complete? 4.5 mEq/L 5.5 mEq/L 2.5 mEq/L 3.5 mEq/L

2.5 mEq/L Explanation: Symptoms of hypokalemia (<3.0 mEq/L) include fatigue, anorexia, nausea and vomiting, muscle weakness, polyuria, decreased bowel motility, ventricular asystole or fibrillation, paresthesias, leg cramps, hypotension, ileus, abdominal distention, and hypoactive reflexes. Electrocardiogram findings associated with hypokalemia include flattened T waves, prominent U waves, ST depression, and prolonged PR interval.

A nurse is analyzing her patient's ABG values. Which result is inconsistent with the diagnosis of respiratory acidosis? A. pH 7.3 B. PaCO2 50 C. Hyperventilation (PaCO2 25) D. Hypoventilation (PaCO2 60)

C. Hyperventilation (PaCO2 25) RATIONALE Respiratory acidosis is always due to inadequate excretion of CO2 with inadequate ventilation, resulting in elevated plasma CO2. Any condition that causes hypoventilation is associated with an elevated PaCO2. Hyperventilation, causes a decrease in CO2 and is associated with respiratory alkalosis.

A nurse is caring for a client admitted with a diagnosis of exacerbation of myasthenia gravis. Upon assessment of the client, the nurse notes the client has severely depressed respirations. The nurse would expect to identify which acid-base disturbance? Metabolic acidosis Metabolic alkalosis Respiratory acidosis Respiratory alkalosis

Respiratory acidosis Explanation: Respiratory acidosis is always from inadequate excretion of CO2 with inadequate ventilation, resulting in elevated plasma CO2 concentrations. Respiratory acidosis can occur in diseases that impair respiratory muscles such as myasthenia gravis.

A client admitted with acute anxiety has the following arterial blood gas (ABG) values: pH, 7.55; partial pressure of arterial oxygen (PaO2), 90 mm Hg; partial pressure of arterial carbon dioxide (PaCO2), 27 mm Hg; and bicarbonate (HCO3-), 24 mEq/L. Based on these values, the nurse suspects: metabolic acidosis. metabolic alkalosis. respiratory acidosis. respiratory alkalosis.

respiratory alkalosis. Explanation: This client's above-normal pH value indicates alkalosis. The below-normal PaCO2 value indicates acid loss via hyperventilation; this type of acid loss occurs only in respiratory alkalosis. These ABG values wouldn't occur in metabolic acidosis, respiratory acidosis, or metabolic alkalosis.

A client experiencing a severe anxiety attack and hyperventilating presents to the emergency department. The nurse would expect the client's pH value to be 7.50 7.45 7.35 7.30

7.50 Explanation: The patient is experiencing respiratory alkalosis. Respiratory alkalosis is a clinical condition in which the arterial pH is >7.45 and the PaCO2 is <38 mm Hg. Respiratory alkalosis is always caused by hyperventilation, which causes excessive "blowing off" of CO2 and, hence, a decrease in the plasma carbonic acid concentration. Causes include extreme anxiety, hypoxemia, early phase of salicylate intoxication, gram-negative bacteremia, and inappropriate ventilator settings.

A client in the emergency department reports that he has been vomiting excessively for the past 2 days. His arterial blood gas analysis shows a pH of 7.50, partial pressure of arterial carbon dioxide (PaCO2) of 43 mm Hg, partial pressure of arterial oxygen (PaO2) of 75 mm Hg, and bicarbonate (HCO3-) of 42 mEq/L. Based on these findings, the nurse documents that the client is experiencing which type of acid-base imbalance? Respiratory alkalosis Metabolic alkalosis Respiratory acidosis Metabolic acidosis

Metabolic alkalosis Explanation: A pH over 7.45 with a HCO3- level over 26 mEq/L indicates metabolic alkalosis. Metabolic alkalosis is always secondary to an underlying cause and is marked by decreased amounts of acid or increased amounts of base HCO3-. The client isn't experiencing respiratory alkalosis because the PaCO2 is normal. The client isn't experiencing respiratory or metabolic acidosis because the pH is greater than 7.35.

A client has been admitted to the hospital unit with signs and symptoms of hypovolemia; however, the client has not lost weight. The client exhibits a localized enlargement of her abdomen. What condition could the client be presenting? third-spacing pitting edema anasarca hypovolemia

third-spacing Explanation: Third-spacing describes the translocation of fluid from the intravascular or intercellular space to tissue compartments, where it becomes trapped and useless. The client manifests signs and symptoms of hypovolemia with the exception of weight loss. There may be signs of localized enlargement of organ cavities (such as the abdomen) if they fill with fluid, a condition referred to as ascites. Pitting edema occurs when indentations remain in the skin after compression. Anasarca is another term for generalized edema, or brawny edema, in which the interstitial spaces fill with fluid. Hypovolemia (fluid volume deficit) refers to a low volume of extracellular fluid.