Part 2 Acid/Base Questions
How many organs does MODS (multi-organ disfunction syndrome) involve?
2 or more
Prone positioning is being used for a patient with acute respiratory distress syndrome (ARDS). Which information obtained by the nurse indicates that the positioning is effective? A. The patient's PaO2 is 89 mm Hg, and the SaO2 is 91%. B. Endotracheal suctioning results in clear mucous return. C. Sputum and blood cultures show no growth after 48 hours. D. The skin on the patient's back is intact and without redness.
A
The 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 result validates the nurse's findings? A.pH 7.25, Pco2 50 mm Hg B.pH 7.35, Pco2 40 mm Hg C.pH 7.50, Pco2 52 mm Hg D.pH 7.52, Pco2 28 mm Hg
A
oxygen toxicity
A condition of excessive oxygen consumption resulting in cellular and tissue damage. They can develop ARDs
What two things can start Chronic Kidney Disorder? (select all that apply) A. Diabetes B. High blood pressure C. Low Blood pressure D. Being 60 or older
A, B
Volutrauma
Alveolar fractures and movement of fluid an proteins into alveoli due to large tidal volumes from mechanical ventilation
A nurse is caring for a client who is nervous and is hyperventilating. The nurse would monitor the client for signs of which of the following acid-base imbalances? A. Respiratory acidosis B. Respiratory alkalosis C. Metabolic alkalosis D. Metabolic acidosis
B
A 55-year-old female presents to her primary care provider and reports dizziness, confusion, and tingling in the extremities. Blood tests reveal an elevated pH, decreased PCO2, and slightly decreased HCO3. Which of the following is the most likely diagnosis? A. Respiratory alkalosis with renal compensation B. Respiratory acidosis with renal compensation C. Metabolic alkalosis with respiratory compensation D. Metabolic acidosis with respiratory compensation
A
A client with diabetes mellitus has a blood glucose on admission of 596 mg/dL. The nurse anticipates that this client would be experiencing which of the following types of acid-base imbalance? A. Metabolic acidosis B. Metabolic alkalosis C. Respiratory acidosis D. Respiratory alkalosis
A
The nurse notes that a client's arterial blood gas results reveal a pH of 7.50 and a Pco2 of 30 mm Hg. The nurse monitors the client for which clinical manifestations associated with these arterial blood gas results? Select all that apply. A.Nausea B.Confusion C.Bradypnea D.Tachycardia E.Hyperkalemia F.Lightheadedness
A, B, D, F They are in respiratory alkalosis
A 19-year-old male presents to his primary care provider reporting restlessness, muscle cramping, and diarrhea. Lab tests reveal that he is hyperkalemic. Which of the following could have caused his condition? A. Primary hyperaldosteronism B. Acidosis C. Insulin secretion D. Diuretic use
B
A client is being treated for metabolic acidosis with medication therapy and other measures. The nurse would plan to most carefully note the levels of which of the following electrolytes, which could dramatically decline with effective treatment of the acidosis? A. Sodium B. Potassium C. Magnesium D. Phosphorus
B
A nurse is caring for a patient with ARDS who is being treated with mechanical ventilation and high levels of positive end-expiratory pressure (PEEP). Which assessment finding by the nurse indicates that the PEEP may need to be reduced? A. The patient's PaO2 is 50 mm Hg and the SaO2 is 88%. B. The patient has subcutaneous emphysema on the upper thorax. C. The patient has bronchial breath sounds in both the lung fields. D. The patient has a first-degree atrioventricular heart block with a rate of 58 beats/min.
B
For a patient experiencing metabolic acidosis, the body will compensate by: a. excreting H+ through the kidneys. b. Hyperventilating. c. retaining CO2 in the lungs. d. secreting aldosterone.
B
The client tells the nurse that he ingests large amounts of oral antacids on a daily basis. The nurse plans care knowing that the excessive use of oral antacids containing bicarbonate can result in which acid-base disturbance? A. Metabolic acidosis B. Metabolic alkalosis C. Respiratory acidosis D. Respiratory alkalosis
B
The nurse is caring for a client who is on a mechanical ventilator. Blood gas results indicate a pH of 7.50 and a Pco2 of 30 mm Hg. The nurse has determined that the client is experiencing respiratory alkalosis. Which laboratory value would most likely be noted in this condition? A.Sodium level of 145 mEq/L B.Potassium level of 3.0 mEq/L C.Magnesium level of 2.0 mg/dL D.Phosphorus level of 4.0 mg/dL
B
When the nursing team consists of a registered nurse (RN), a licensed practical nurse (LPN), and two unlicensed assistive personnel (UAPs), which assignment for a patient receiving mechanical ventilation may the RN delegate to the LPN? A. Measuring the patient's urine output B. Administering prescribed enteral nutrition C. Teaching the patient about weaning procedures D. Providing passive and active range-of-motion (ROM) exercises
B
Which of the following buffer pairs is considered the major plasma buffering system? A. Protein/fat B. Carbonic acid/bicarbonate C. Sodium/potassium D. Amylase/albumin
B
Which of the following conditions would cause the nurse to monitor for hyperkalemia? A. Excess aldosterone B. Acute acidosis C. Insulin usage D. Metabolic alkalosis
B
A 54-year-old male with a long history of smoking complains of excessive tiredness, shortness of breath, and overall ill feelings. Lab results reveal decreased pH, increased CO2, and normal bicarbonate ion. These findings help to confirm the diagnosis of: A. respiratory alkalosis. B. metabolic acidosis. C. respiratory acidosis. D. metabolic alkalosis.
C
A nurse recalls that regulation of acid-base balance through removal or retention of volatile acids is accomplished by the: A. buffer systems. B. skin. C. lungs. D. liver.
C
A patient with chronic obstructive pulmonary disease (COPD) arrives in the emergency department reporting shortness of breath on minimal exertion. Which assessment finding by the nurse is most important to report to the health care provider? A. The patient has bibasilar lung crackles. B. The patient is sitting in the tripod position. C. The patient's respiratory rate is 10 breaths/min. D. The patient's pulse oximetry shows a 91% O2 saturation.
C
The client with a history of lung disease is at risk for developing respiratory acidosis. The nurse assesses this client for which signs/symptoms that are characteristic of this disorder? A. Bradycardia and hyperactivity B. Decreased respiratory rate and depth C. Headache, restlessness, and confusion D. Bradypnea, dizziness, and paresthesias
C
The diet of a child with chronic renal failure is usually characterized as: a. High in protein. b. Low in vitamin D. c. Low in phosphorus. d. Supplemented with vitamins A, E, and K.
C
Which finding would support the diagnosis of respiratory acidosis? a. Vomiting b. Hyperventilation c. Pneumonia d. An increase in noncarbonic acids
C
Which of the following patients is the most at risk for developing hypernatremia? A patient with: A. vomiting. B. diuretic use. C. dehydration. D. hypoaldosteronism.
C
The nurse observes a new onset of agitation and confusion in a patient with chronic obstructive pulmonary disease (COPD). Which action should the nurse take first? A. Observe for facial symmetry. B. Notify the health care provider. C. Attempt to calm and reorient the patient. D. Assess oxygenation using pulse oximetry.
D
A client is determined to be in respiratory alkalosis by blood gas analysis. The nurse would monitor this client for signs of which of the following electrolyte disorders that could accompany the acid-base imbalance? A. Hypercalcemia B. Hypochloremia C. Hypernatremia D. Hypokalemia
D
A patient develops increasing dyspnea and hypoxemia 2 days after heart surgery. What procedure should the nurse anticipate assisting with to determine whether the patient has acute respiratory distress syndrome (ARDS) or pulmonary edema caused by heart failure? A. Obtaining a ventilation-perfusion scan B. Drawing blood for arterial blood gases C. Positioning the patient for a chest x-ray D. Insertion of a pulmonary artery catheter
D
Which nursing interventions included in the care of a mechanically ventilated patient with acute respiratory failure can the registered nurse (RN) delegate to an experienced licensed practical/vocational nurse (LPN/VN) working in the intensive care unit? A. Assess breath sounds every hour. B. Monitor central venous pressures. C. Place patient in the prone position. D. Insert an indwelling urinary catheter.
D
Which patient should the nurse assess for both hyperkalemia and metabolic acidosis? A patient diagnosed with: A. diabetes insipidus. B. pulmonary disorders. C. Cushing syndrome. D. renal failure.
D
Ventilation bundle
Elevation of HOB to 30-45 degree Daily sedation holidays and assessment of readiness for extubation (decrease sedation and wean off) Peptic ulcer disease prophylaxis Venous thromboembolism prophylaxis Daily oral care with chlorhexidine (0.12% solution)
Does MODS have a high or low mortality rate?
High (there is a slim chance you will live) sepsis-SIRS-MODS-ARDs
Why do we use erythropoietin for CKD and why a patient with CKD may need frequent blood transfusions?
Kidneys do not make enough erythropoietin as needed. This can cause them to be anemic thus they need blood transfusions. This increases the RBC.
Barotrauma
rupture of over distended alveoli during mechanical ventilation alveolar air reaching locations where it is not usually found
A licensed practical nurse (LPN) is assisting in the care of a client who overdosed on aspirin 24 hours ago. The LPN would report to the registered nurse (RN) which of the following findings associated with an anticipated acid-base disturbance? A. Drowsiness, headache, and tachypnea B. Decreased respiratory rate and depth, cardiac irregularities C. Disorientation and dyspnea D. Tachypnea, dizziness, and paresthesias
A
A nurse is caring for a patient who is orally intubated and receiving mechanical ventilation. To decrease the risk for ventilator-associated pneumonia, which action will the nurse include in the plan of care? A. Elevate head of bed to 30 to 45 degrees. B. Give enteral feedings at no more than 10 mL/hr. C. Suction the endotracheal tube every 2 to 4 hours. D. Limit the use of positive end-expiratory pressure.
A
A patient with acute respiratory distress syndrome (ARDS) and acute kidney injury has several drugs prescribed. Which drug should the nurse discuss with the health care provider before giving? A. Gentamicin 60 mg IV B. Pantoprazole (Protonix) 40 mg IV C. Sucralfate (Carafate) 1 gram per NG tube D. Methylprednisolone (Solu-Medrol) 60 mg IV
A
For a patient with respiratory acidosis, chronic compensation by the body will include: A. kidney excretion of H+. B. kidney excretion of HCO3. C. prolonged exhalations to blow off CO2. D. protein buffering.
A
Which organ system should the nurse monitor when the patient has long-term potassium deficits? A. Central nervous system (CNS) B. Lungs C. Kidneys D. Gastrointestinal tract
C
Which patient is most prone to metabolic alkalosis? A patient with: a. retention of metabolic acids. b. Hypoaldosteronism. c. excessive loss of chloride (Cl). d. Hyperventilation.
C
A patient with acute respiratory distress syndrome (ARDS) who is intubated and receiving mechanical ventilation develops a right pneumothorax. Which collaborative action will the nurse anticipate next? A. Increase the tidal volume and respiratory rate. B. Decrease the fraction of inspired oxygen (FIO2). C. Perform endotracheal suctioning more frequently. D. Lower the positive end-expiratory pressure (PEEP).
D
An advantage of peritoneal dialysis is that: a. Treatments are done in hospitals. b. Protein loss is less extensive. c. Dietary limitations are not necessary. d. Parents and older children can perform treatments.
D
