Prep U Mastery, Acid-Base Balance

The gastric mucosal barrier works to prevent acids secreted by the stomach from actually damaging the wall of the stomach. What are factors that make up the gastric mucosal barrier? (Select all that apply.)

-An impermeable epithelial cell surface covering -Characteristics of gastric mucus -Mechanisms for selective transport of hydrogen and bicarbonate ions (The stomach lining usually is impermeable to the acid it secretes, a property that allows the stomach to contain acid and pepsin without having its wall digested. Several factors contribute to the protection of the gastric mucosa, including an impermeable epithelial cell surface covering, mechanisms for the selective transport of hydrogen and bicarbonate ions, and the characteristics of gastric mucus. These mechanisms are collectively referred to as the gastric mucosal barrier. The other answers are incorrect.)

The nurse is caring for a client with chronic obstructive pulmonary disease. The client reports that he is having difficulty breathing and is feeling fatigued. The nurse realizes that this client is at high risk for which condition?

...

The nurse is caring for a client in active labor who has had a fetal blood sampling to check for fetal hypoxia. The nurse determines that the fetus has acidosis when the pH is

7.15 or less (In the hypoxic fetus, the pH will fall below 7.2, which is indicative of fetal distress)

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 (Respiratory alkalosis can occur with hyperventilating and the loss of CO2.The other three clients are more at risk for respiratory acidosis as a result of retaining CO2)

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

Acidic (Normal=4.5-8.0)

Which of the following clients is at highest risk for peptic ulcer disease?

Client with blood type O

A client is receiving a diuretic as the first-line treatment of mild hypertension. The nurse monitors the client for signs and symptoms of hypokalemia with which agent?

Hydrochlorothiazide (Hydrochlorothiazide is a thiazide diuretic that promotes the loss of sodium as well as potassium from the body)

On admission, the client's arterial blood gas (ABG) values were: pH, 7.20; PaO2, 64 mm Hg (8.5 kPa); PaCO2, 60 mm Hg (8 kPa); and HCO3-, 22 mEq/L (22 mmol/L). A chest tube is inserted, and oxygen at 4 L/minute is started. Thirty minutes later, repeat blood gas values are: pH, 7.30; PaO2, 76 mm Hg (10.1 kPa); PaCO2, 50 mm Hg (6.7 kPa); and HCO3-, 22 mEq/L (22 mmol/L). This change would indicate:

Improving respiratory status (The ABG values after chest tube insertion are returning to normal, indicating that treatment is effective. Impending respiratory failure would be indicated by a decreasing PaO2 or an increasing PaCO2.)

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?

Metabolic alkalosis (A pH over 7.45 with a HCO3- level over 26 mEq/L indicates metabolic alkalosis)

A pregnant client has developed iron-deficiency anemia and has been prescribed 200 mg of elemental iron per day. The nurse should encourage the client to take this medication with which substance?

Orange juice (Iron is absorbed best from an acid medium. Advise women, therefore, to take iron supplements with orange juice or a vitamin C supplement, which supplies ascorbic acid)

The nurse is caring for a client with chronic obstructive pulmonary disease. The client reports that he is having difficulty breathing and is feeling fatigued. The nurse realizes that this client is at high risk for which condition?

Respiratory acidosis (Respiratory acidosis occurs when the body is unable to blow off CO2 due to the hypoventilation of disease processes such as COPD. An increase in blood carbon dioxide concentration occurs and a decreased pH causing acidosis.)

Which of the following arterial blood gas results would be consistent with metabolic alkalosis?

Serum bicarbonate of 28 mEq/L (Normal bicarb= 23-29, bicarb in the scenario is "high" resulting in alkalotic conditions since bicarbonate is a Base)

The nurse working with the child diagnosed with type 2 diabetes mellitus recognizes that most often the disorder can be managed by:

Taking oral hypoglycemic agents

A nurse working in the emergency department (ED) reviews arterial blood gas (ABG) values for a patient diagnosed with heatstroke. Blood gas values are pH 7.48, pCO2 34, pO2 95, CO2 23, HCO2 22, and SO2 98%. Which of the following nursing interventions demonstrate the nurse's understanding of the patient's ABG's and knowledge of Maslow's hierarchy of needs when providing care for this patient?

The nurse prepares for endotracheal intubation and mechanical ventilation for the patient (ABG's signify respiratory alkalosis= controlled ventilation due to decrease in respiratory functions)

The nurse is caring for a client receiving an aminoglycoside (antibiotic) that can be nephrotoxic. Which will alert the nurse that the client may be experiencing nephrotoxicity?

a decrease in urine output (Decreased urinary output, elevated blood urea nitrogen, increased serum creatinine, altered acid-base balance, and electrolyte imbalances can occur with nephrotoxicity)

A client experiencing a severe asthma attack has the following arterial blood gas results: pH 7.33; Pco2 48 mm Hg (6.4 kPa); Po2 58 mm Hg (7.7 kPa); HCO3 26 mEq/L (26 mmol/L). Which prescription should the nurse implement first?

albuterol nebulizer (The arterial blood gas reveals a respiratory acidosis with hypoxia. A quick-acting bronchodilator, albuterol, should be administered via nebulizer to improve gas exchange. Ipratropium is a maintenance treatment for bronchospasm that can be used with albuterol.)

A neonate weighing 1,870 g with a respiratory rate of 46 breaths/minute, a pulse rate of 175 bpm, and a serum pH of 7.11 has received sodium bicarbonate intravenously. The drug has been effective if the neonate:

does not go into metabolic acidosis.

The nurse is interpreting blood gases for a client with acute respiratory distress syndrome (ARDS). Which set of blood gas values indicates respiratory acidosis?

pH 7.25, PaCO2 48, HCO3 24 (both pH and CO2 are acidic while HCO3 is WNL)

A nurse assesses arterial blood gas results for a patient in acute respiratory failure (ARF). Which results are consistent with this disorder?

pH 7.28, PaO2 50 mm Hg (pH was acidic)