metabolic acidosis nclex review Pearson

Rationale: Bicarbonate (HCO3) deficit may lead to the development of metabolic acidosis. An excess of bicarbonate (HCO3) may lead to the development of metabolic alkalosis. Respiratory acidosis is associated with carbonic acid (H2CO3) excess, while respiratory alkalosis is associated with a deficit of carbonic acid (H2CO3).

The clinical nurse educator is explaining the primary concepts of metabolic acidosis. Which statement is most appropriate for inclusion in the discussion about metabolic acidosis? a. Bicarbonate (HCO3) excess may lead to the development of metabolic acidosis. b. Bicarbonate (HCO3) deficit may lead to the development of metabolic acidosis. c. Metabolic acidosis is associated with a deficit of carbonic acid (H2CO3). d. Metabolic acidosis is associated with an excess of carbonic acid (H2CO3).

Rationale: As the pH begins to normalize, potassium begins to shift back into thecell, leading to severe hypokalemia. This can cause life-threatening cardiac dysrhythmias. Sodium and bicarbonate should bemonitored, but they are not the most important. Serum creatinine is not as important as potassium.

The nurse is administering sodium bicarbonate to a client with severe metabolic acidosis. As the pH begins to normalize, which laboratory value is most important to assess? a. Sodium B. Creatinine C. Bicarbonate D. Potassium

Rationale: Metabolic acidosis affects the function of several body systems. Symptoms of metabolic acidosis include bradycardia; warm, flushed skin; nausea and vomiting; and musculoskeletal problems. The client would not exhibit hypokalemia but hyperkalemia, as potassium is retained as the kidneys excrete excess hydrogen ions.

The nurse is assessing a client for metabolic acidosis. Which manifestation is the nurse likely to observe? (Select all that apply.) a. Bradycardia b. Hypokalemia c. Skeletal problems d. Warm, flushed skin e. Nausea and vomiting

Rationale: Risk factors for the development of metabolic acidosis includeinsulin-dependent diabetesmellitus, chronic renal failure, severe diarrhea, andhigh-dose salicylate ingestion as these lead to bicarbonate loss. Hyperventilation is a risk factor for developing respiratory alkalosis due to loss of carbon dioxide because of rapid breathing.

The nurse is assessing the client for conditions that may increase the client's risk for developing specific acid-base imbalances. Which condition is most appropriate for the nurse to identify as a risk factor that may lead to the client's development of metabolic acidosis? (Select all that apply.) a. Severe diarrhea b. Hyperventilation c. Chronic renal failure d. High-dose salicylate ingestion e.Insulin-dependent diabetes mellitus

Rationale: A client with metabolic acidosis in respiratory distress would require intubation with mechanical ventilation if the PaCO2 is greater than 77 mmHg. A pH greater than 7.10 would not require intubation. The normal bicarbonate level is21-26 mEq/L, so the client has a normal level. If the PaO2 is less than 60 mmHg, mechanical ventilation and intubation are required.

The nurse is caring for a client with metabolic acidosis who presents with respiratory distress. Which laboratory value indicates a need to intubate and mechanically ventilate the client? a.PaO2 greater than 60 mmHg B.Bicarbonate 25 mEq/L C.pH greater than 7.10 D.PaCO2 greater than 77 mmHg

Rationale: Older adults have decreased renal function, and a 70-year-old with chronic kidney disease would be at the highest risk due to the inability to excrete hydrogen ions in the urine. A client with pneumonia and chronic obstructive pulmonary disease would have respiratory acidosis or alkalosis. Deep vein thrombosis does not cause metabolic acidosis.

The nurse is caring for four clients today. Which client would the nurse expect to be at highest risk for metabolic acidosis? a. 60-year-old with deep vein thrombosis B. 50-year-old with pneumonia C. 80-year-old with chronic obstructive pulmonary disease D. 70-year-old with chronic kidney disease

Rationale: Many clients with type 1 diabetes mellitus believe if they are ill and unable to eat, they should not take their insulin. The nurse should instruct on the importance of taking insulin as prescribed and to notify their healthcare provider when sick. In order to maintain fluid volume and prevent imbalances, the diabetic client should take in eight 8-ounce glasses of water per day and even more when sick. Blood glucose levels should be checked more often than once a week, and diet soft drinks do not provide calories for the diabetic client when nauseated and vomiting.

The nurse is teaching a client with type 1 diabetes mellitus about disease management. What should the nurse include in the teaching plan to help the client prevent metabolic acidosis? (Select all that apply.) a. Take insulin as prescribed. b. Monitor blood glucose levels weekly. c. Notify healthcare provider when sick. d. Drink eight 8-ounce glasses of water per day. e. Consume diet soft drinks when nauseated or vomiting.

Rationale: Diabetes mellitus can develop into diabetic ketoacidosis. Tissue hypoxia can alter electrolytes and cause metabolic acidosis. Chronic renal failure can lead to metabolic acidosis. Acute diarrhea alters the acid-base balance in the body and can cause metabolic acidosis. The use of potassium-wasting diuretics may cause metabolic alkalosis, not acidosis.

The nurse is teaching an adult client on the cause of metabolic acidosis. Which cause would the nurse include in the client education? (Select all that apply.) a. Acute diarrhea b. Tissue hypoxia c. Diabetes mellitus d. Chronic renal failure e. Potassium-wasting diuretics

Rationale: Metabolic acidosis is rarely a primary disorder. Starvation and alcoholism lead to ketoacidosis, which causes an increase in acid production and can cause metabolic acidosis. Aspirin poisoning also causes increased acidproduction, which can lead to metabolic acidosis. Diarrhea causes increased bicarbonate loss, which can lead to metabolic acidosis. A stroke might cause acute respiratory acidosis or respiratory alkalosis but not metabolic acidosis.

The nurse preceptor is discussing the causes of metabolic acidosis with a new graduate. Which diagnosis would the preceptor include as a cause of metabolic acidosis? (Select all that apply.) a. Stroke b. Starvation c. Alcoholism d. Aspirin poisoning e. Excessive diarrhea

Rationale: Salicylate intoxication and uncontrolled diabetes mellitus are causes of metabolic acidosis. Self-induced vomiting and rapid infusion of sodium bicarbonate can lead to metabolic alkalosis. COPD can cause respiratory acidosis.

What should the nurse educator include in a presentation regarding the causes of metabolic acidosis? (Select all that apply.) a. Self-induced vomiting B. Salicylate intoxication C. Uncontrolled diabetes mellitus D. Rapid infusion of sodium bicarbonate E. Chronic obstructive pulmonary disease (COPD)

Rationale: Severe hyperkalemia manifests as peaked T waves with widened QRS complexes in an electrocardiogram (ECG). Hyperkalemia is present with acidosis. Hypokalemia is present with alkalosis. ECG waveform patterns do not indicate sodium levels.

When a client with metabolic acidosis is placed on an electrocardiogram (ECG) monitor and the nurse sees peaked T waves or absent P waves with a widened QRS complex, which physiological condition is the client experiencing? a. Severe hyponatremia B. Severe hypernatremia C. Severe hypokalemia D. Severe hyperkalemia

Rationale: Urine output should be 30 mL/hour. When cardiac output decreases in metabolic acidosis, this can affect renal perfusion. A 24-hour urinary output of 600 mL indicates only 25 mL/h. This decreased renal perfusion can cause renal failure. Dysuria and hematuria can indicate a urinary tract infection. Bradycardia can happen from decreased cardiac output; dysrhythmias from hyperkalemia. Bilateral adventitious lung sounds can indicate fluid overload.

Which assessment finding indicates the possibility of renal failure in a client with metabolic acidosis? a. Bilateral adventitious lung sounds B. 24-hour urine output of 600 mL C. Bradycardia and dysrhythmias D. Dysuria and hematuria

Rationale: Decreased cardiac output slows blood flow. This causes hypotension and delayed capillary refill. Poor skin turgor is a sign of dehydration. Bounding peripheral pulses would be noted in a client with good cardiac output. 3+ lower extremity pitting edema is a sign of fluid volume overload.

Which assessment finding would the nurse expect to find in a client with decreased cardiac output secondary to metabolic acidosis? (Select all that apply.) a. Hypotension B. Poor skin turgor C. Capillary refill > 5 seconds D. Bounding peripheral pulses E. 3+ pitting lower extremity edema

Rationale: Collaborative care goals are those that require orders from the healthcare provider or other disciplines to meet. Serum electrolyte status requires an order to implement. Oral fluid intake, incentive spirometer, and elevating the head of the bed are set by the nurse and are met by independent nursing interventions.

Which collaborative care goal is most appropriate for the nurse to include in the plan of care for a client with metabolic acidosis secondary to influenza? a. The client will maintain the head of the bed in a high-Fowler position. B. The client will have an oral fluid intake of 2000 mL in 24 hours. C. The client will reach 1500 mL on incentive spirometer. D. The client will have serum electrolytes within normal limits.

Rationale: Rapid correction of metabolic acidosis with sodium bicarbonate may lead to hypernatremia, nothyponatremia, which causes water retention and fluid overload. Rapid correction of metabolic acidosis with sodium bicarbonate may lead to metabolic alkalosis and hypokalemia, not hyperkalemia. Rapid correction of metabolic acidosis with sodium bicarbonate may lead to hyperosmolality, which can lead to water retention and fluid overload. Therefore, it is essential to administer sodium bicarbonate only for severe metabolic acidosis and to closely monitor the client. Rapid correction of metabolic acidosis with sodium bicarbonate may lead to metabolic alkalosis and a pH greater than 7.45. A pH of 7.30 indicates metabolic acidosis and that the client did not have an adverse reaction to the sodium bicarbonate.

Which condition or laboratory data indicates an adverse effect when administering sodium bicarbonate for treatment of metabolic acidosis? a. pH of 7.30 B. Hyponatremia C. Hyperosmolality D. Hyperkalemia

Rationale: Infants have a larger fluid volume than adults. When they developdiarrhea, this causes large amounts of bicarbonate loss, which causes metabolic acidosis. Sodium, potassium, and calcium changes do not lead to metabolic acidosis.

Which factor places an infant with diarrhea at risk for metabolic acidosis? a. Potassium loss b. Sodium excess c. Calcium depletion d. Bicarbonate loss

Rationale: An independent nursing intervention is one that can be performed without a healthcareprovider's order. The nurse can assess the client's renal and respiratory function without an order. Arterial blood gases, continuous telemetrymonitoring, and intravenous fluids cannot be done without an order.

Which independent nursing intervention is most appropriate for the nurse to include in the plan of care for a client to prevent metabolic acidosis? a. Obtain arterial blood gases daily. B. Administer intravenous sodium bicarbonate. C. Assess renal and respiratory function. D. Perform continuous telemetry monitoring.

Rationale: Client safety is the most important intervention. If the client is confused, the nurse should turn on the bed alarm to alert the nurse if the client tries to get out of bed. Having familiar objects close, keeping a calendar in the room, and frequently reorienting the client will help decrease confusion, but these actions do not maintain safety.

Which nursing intervention would be most important for the nurse to implement in a client with confusion and mental status changes related to metabolic acidosis? A. Turn on the bed alarm. B. Reorient the client frequently. C. Have familiar objects close. D. Keep a calendar in the room.

Rationale: Older adults may overuse salicylates in the treatment of arthritic pain. Salicylate poisoning is a cause of metabolic acidosis that can be prevented by taking the medication only as prescribed. Cardiac arrest, vomiting and diarrhea, and type 1 diabetes mellitus are not preventable causes of metabolic acidosis.

Which preventable factor can cause metabolic acidosis in the older adult? a. Type 1 diabetes mellitus B. Salicylate poisoning C. Vomiting and diarrhea D. Cardiac arrest

Rationale: Intravenous glucose and normal saline are administered to a client with alcoholic acidosis. Intravenous insulin and potassium are given for diabetic ketoacidosis. Intravenous sodium bicarbonate is administered if the pH is less than 7.10.

Which treatment modality would the nurse expect the healthcare provider to prescribe for a client admitted with alcoholic acidosis and a pH of 7.25? (Select all that apply.) a. Intravenous insulin B. Intravenous glucose C. Intravenous potassium D. Intravenous normal saline E. Intravenous sodium bicarbonate