RN- ACID BASE

Metabolic alkalosis- baking soda (sodium bicarbonate) regularly as a self-treatment.

A 75-year-old client who complains of a "sour stomach" has been taking baking soda (sodium bicarbonate) regularly as a self-treatment. This may place the client at risk for what acid-base imbalance? Metabolic alkalosis Explanation: Metabolic alkalosis results in increased plasma pH because of accumulated base bicarbonate or decreased hydrogen ion concentrations. The client's regular use of baking soda (sodium bicarbonate) may place him at risk for this condition. Metabolic acidosis refers to decreased plasma pH because of increased organic acids (acids other than carbonic acid) or decreased bicarbonate. Respiratory acidosis, which may be either acute or chronic, is caused by excess carbonic acid. Respiratory alkalosis results from a carbonic acid deficit that occurs when rapid breathing releases more CO2 than necessary with expired air.

child complains of leg pain

A child, age 8, complains of leg pain shortly after being admitted with a fractured tibia sustained in a fall. When the nurse assesses his pain, the child states, "My pain is a 7 out of 10." What action by the nurse would be most appropriate? Administer pain medication as ordered.

Respiratory alkalosis- status asthmaticus

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? 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.

Metabolic alkalosis- increased restlessness- pH 7.52; partial pressure of carbon dioxide, 38 mm Hg (5.1 kPa); bicarbonate, 34 mg/L (34 mmol/L)

A client exhibits increased restlessness. The results of the arterial blood gas test are as follows: pH, 7.52; partial pressure of carbon dioxide, 38 mm Hg (5.1 kPa); bicarbonate, 34 mg/L (34 mmol/L). The nurse should plan care based on the fact that these findings indicate which of the following acid-base imbalances? Metabolic alkalosis. Explanation: The pH of 7.52 indicates that the body is in a state of alkalosis. The partial pressure of carbon dioxide value is normal and the bicarbonate value is elevated. The increased bicarbonate value indicates that the acid-base imbalance is metabolic alkalosis. Restlessness can be a clinical finding in metabolic alkalosis

severe asthma attack- pH 7.33; PCO2 48 (6.4 kPa); PO2 58 (7.7 kPa); HCO3 26 (26 mmol/L)

A client experiencing a severe asthma attack has the following arterial blood gas results: pH 7.33; PCO2 48 (6.4 kPa); PO2 58 (7.7 kPa); HCO3 26 (26 mmol/L). Which prescriptions should the nurse implement first? albuterol nebulizer Explanation: 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 chest x-ray and sputum sample can be obtained once the client is stable.

asthma attack

A client experiencing a severe asthma attack has the following arterial blood gas results: pH 7.33; PCO2 48 (6.4 kPa); PO2 58 (7.7 kPa); HCO3 26 (26 mmol/L). Which prescriptions 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 chest x-ray and sputum sample can be obtained once the client is stable.

exacerbation of his chronic disease (diabetes mellitus)- diabetic ketoacidosis

A client has been admitted to the hospital for the treatment of diabetic ketoacidosis, a problem that was accompanied by a random blood glucose reading of 31.9 mmol/L (575 mg/dL), vomiting, and shortness of breath. This client has experienced which of the following phenomena? Exacerbation Explanation: This client has experienced a significant exacerbation of his chronic disease (diabetes mellitus), which has manifested as an acute threat to his health. Morbidity is an epidemiological statistic of the frequency of a disease. His problem does not have an infectious etiology and while risk factors underlie his present condition, they are not the essence of his current state.

myxedema coma-acid-base imbalance would be expected- Respiratory acidosis

A client has been hospitalized with myxedema coma. What acid-base imbalance would be expected in this client? Respiratory acidosis Explanation: The client's respiratory drive is depressed, resulting in alveolar hypoventilation, progressive carbon dioxide retention, narcosis, and coma. These symptoms, along with cardiovascular collapse and shock, require aggressive and intensive therapy if the client is to survive.

respiratory alkalosis- status asthmaticus.

A client has just been diagnosed as being in status asthmaticus. The nurse understands that this client will likely initially exhibit symptoms of: respiratory alkalosis Explanation: During status asthmaticus, there is a reduced PaCO2 and initial respiratory alkalosis, with a decreased PaCO2 and an increased pH. As status asthmaticus worsens, the PaCO2 increases and the pH decreases, reflecting respiratory acidosis.

meconium-stained amniotic fluid

A client has meconium-stained amniotic fluid. Fetal scalp sampling indicates a blood pH of 7.12; fetal bradycardia is present. Based on these findings, the nurse should take which action? Prepare for cesarean birth. Fetal blood pH of 7.19 or lower signals severe fetal acidosis; meconium-stained amniotic fluid and bradycardia are further signs of fetal distress that warrant cesarean birth. Amnioinfusion is indicated when the only abnormal fetal finding is meconium-stained amniotic fluid. Client repositioning may improve uteroplacental perfusion, but only serve as a temporary measure because the risk of fetal asphyxia is imminent. Oxytocin administration increases contractions, exacerbating fetal stress.

Metabolic acidosis- pH, 7.12; partial pressure of arterial carbon dioxide (PaCO2), 40 mm Hg; and bicarbonate (HCO3-), 15 mEq/L

A client has the following arterial blood gas (ABG) values: pH, 7.12; partial pressure of arterial carbon dioxide (PaCO2), 40 mm Hg; and bicarbonate (HCO3-), 15 mEq/L. These ABG values suggest which disorder? Metabolic acidosis Explanation: This client's pH value is below normal, indicating acidosis. The HCO3- value also is below normal, reflecting an overwhelming accumulation of acids or excessive loss of base, which suggests metabolic acidosis. The PaCO2 value is normal, indicating absence of respiratory compensation. These ABG values eliminate respiratory alkalosis, respiratory acidosis, and metabolic alkalosis.

Respiratory acidosis- pH, 7.30; PaO2, 89 mm Hg; PaCO2, 50 mm Hg; and HCO3-, 26 mEq/L

A client has the following arterial blood gas values: pH, 7.30; PaO2, 89 mm Hg; PaCO2, 50 mm Hg; and HCO3-, 26 mEq/L. Based on these values, the nurse should suspect which condition? Respiratory acidosis Explanation: This client has a below-normal (acidic) blood pH value and an above-normal partial pressure of arterial carbon dioxide (PaCO2) value, indicating respiratory acidosis. In respiratory alkalosis, the pH value is above normal and the PaCO2 value is below normal. In metabolic acidosis, the pH and bicarbonate (HCO3-) values are below normal. In metabolic alkalosis, the pH and HCO3- values are above normal

Pulmonary embolus- pH, 7.52; PaO2, 50 mm Hg (6.7 kPa); PaCO2, 28 mm Hg (3.7 kPa); HCO3-, 24 mEq/L (24 mmol/l)

A client has the following arterial blood gas values: pH, 7.52; PaO2, 50 mm Hg (6.7 kPa); PaCO2, 28 mm Hg (3.7 kPa); HCO3-, 24 mEq/L (24 mmol/l). The nurse determines that which of the following is a possible cause for these findings? Pulmonary embolus. Explanation: A PaCO2 of 28 mm Hg (3.7 kPa) and PaO2 of 50 mm Hg (6.7 kPa) are both abnormal; the PaO2 of 50 mm Hg (6.7 kPa) signifies acute respiratory failure. In evaluating possible causes for this disorder, the nurse should consider conditions that lead to hypoxia and hyperventilation, such as pulmonary embolus. COPD is typically associated with respiratory acidosis and elevated PaCO2. The client with diabetic ketoacidosis most often has metabolic acidosis. A myocardial infarction does not often cause an acid-base imbalance because the primary problem is cardiac in origin.

hypoxic- pH, 7.52; PaO2, 50 mm Hg (6.7 kPa); PaCO2, 28 mm Hg (3.72 kPa); HCO3-, 24 mEq/L (24 mmol/L).- Normal PaO2 level ranges from 80 to 100 mm Hg

A client has the following arterial blood gas values: pH, 7.52; PaO2, 50 mm Hg (6.7 kPa); PaCO2, 28 mm Hg (3.72 kPa); HCO3-, 24 mEq/L (24 mmol/L). Based upon the client's PaO2, which conclusion would be accurate? The client is severely hypoxic. Explanation: Normal PaO2 level ranges from 80 to 100 mm Hg (10.6 to 13.3 kPa). When the PaO2 value falls to 50 mm Hg (6.7 kPa), the nurse should be alert for signs of hypoxia and impending respiratory failure. An oxygen level this low poses a severe risk for respiratory failure. The PaO2 is not within normal range. The client will require oxygenation at a concentration that maintains the PaO2 at 55 to 60 mm Hg or more (7.3 to 8 kPa).

Metabolic alkalosis- Vomiting

A client has vomited several times over the past 12 hours. The nurse should recognize the risk of what complication? Metabolic alkalosis Explanation: Vomiting results in loss of hydrochloric acid (HCl) and potassium from the stomach, leading to a reduction of chlorides and potassium in the blood and to metabolic alkalosis. Remediation: Arterial blood gas analysis

respiratory alkalosis- symptoms

A client hospitalized for treatment of a pulmonary embolism develops respiratory alkalosis. Which clinical findings commonly accompany respiratory alkalosis? 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). Nausea, vomiting, abdominal pain, and diarrhea may accompany respiratory acidosis. Hallucinations and tinnitus rarely are associated with respiratory alkalosis or any other acid-base imbalance.

diabetic ketoacidosis- insulin

A client is admitted with a diagnosis of diabetic ketoacidosis. An insulin drip is initiated with 50 units of insulin in 100 ml of normal saline solution. The I.V. is being infused via an infusion pump and the pump is currently set at 10 ml/hour. The nurse determines that the client is receiving how many units of insulin each hour? Record your answer using a whole number. 5

metabolic alkalosis because of persistent vomiting irritability

A client is at risk for development of metabolic alkalosis because of persistent vomiting. The nurse should assess the client specifically for: irritability. Explanation: A client with metabolic alkalosis may exhibit irritability or nervousness. Hyperventilation is a clinical manifestation of respiratory alkalosis. Diarrhea is a possible clinical finding in metabolic acidosis. Edema is not specifically associated with an acid-base imbalance.

lactic acidosis- developed from use of metformin

A client is taking metformin. To prevent lactic acidosis resulting from use of this drug, the nurse should instruct the client to report which symptoms? Select all that apply. • hyperventilation • muscle discomfort • dizziness Explanation: There is a high risk of lactic acidosis when using metformin; 50% of the cases may be fatal. A black box warning for metformin is to instruct the client to stop the drug and immediately notify the prescriber about unexplained hyperventilation, muscle pain, malaise, dizziness, light-headedness, unusual sleepiness, unexplained stomach pain, feelings of coldness, slow or irregular heart rate, or other nonspecific symptoms of early lactic acidosis. Headache, hunger, and tingling in the fingertips are not signs of lactic acidosis.

vomiting. Assessment findings include irregular pulse of 120 bpm, blood pressure 88/48 mm Hg- suggest dehydration therefore fluids with dextrose, ns and potassium is necessary

A client receiving chemotherapy for metastatic colon cancer is admitted to the hospital because of prolonged vomiting. Assessment findings include irregular pulse of 120 bpm, blood pressure 88/48 mm Hg, respiratory rate of 14 breaths/min, serum potassium of 2.9 mEq/L (2.9 mmol/L), and arterial blood gas—pH 7.46, PCO2 45 mm Hg (6.0 kPA), PO2 95 mm Hg (12.6 kPa), bicarbonate level 29 mEq/L (29 mmol/L). The nurse should implement which prescription first? 5% Dextrose in 0.45% normal saline with KCl 40 mEq/L at 125 mL/h The vital signs suggest that the client is dehydrated from the vomiting, and the nurse should first infuse the IV fluids with the addition of potassium. There is no indication that the client needs oxygen at this time since the PO2 is 95 (12.6 kPa). Although the client has a rapid and irregular pulse, the infusion of fluids may cause the heart rate to return to normal, and the 12-lead ECG can be prescribed after starting the intravenous fluids.

vomiting • Metabolic alkalosis • Hypokalemia

A client reports vomiting every hour for the past 8 to 10 hours. The nurse should assess the client for risk of which of the following? Select all that apply: • Metabolic alkalosis • Hypokalemia Explanation: Gastric acid contains a substantial amount of potassium, hydrogen ions, and chloride ions. Frequent vomiting can induce an excessive loss of these acids to alkalosis. Excessive loss of potassium produces hypokalemia. Frequent vomiting does not lead to the condition of too much potassium (hyperkalemia) or too little sodium (hyponatremia).

colon cancer- colostomy- appropriate interventions included in an a preoperative teaching plan

A client who is experiencing colon cancer is scheduled to undergo a colostomy. Which interventions would be appropriate to include in a preoperative teaching plan? Select all that apply. • Demonstrate turning, coughing, deep breathing, splinting, and leg ROM exercises, and provide rationales for each procedure. • Arrange for an ET to speak with the client about colostomy care. • Explain the need for early postoperative ambulation. • Encourage the client to express feelings about changes in body image. Preoperatively, the client will require instruction regarding the need for turning, coughing, deep breathing, splinting, and leg ROM exercises. The client will also need to learn about colostomy care and the reason for early postoperative ambulation. Addressing feelings about body image changes is also appropriate at this time. Rating pain and discomfort and instructing the client about signs and symptoms of intestinal obstruction are part of the postoperative care.

respiratory acidosis- renal compensation- Returning bicarbonate to the body's circulation- to assist in restoring acid-base balance

A client with a diagnosis of respiratory acidosis is experiencing renal compensation. What function does the kidney perform to assist in restoring acid-base balance? Returning bicarbonate to the body's circulation Explanation: The kidney performs two major functions to assist in acid-base balance. The first is to reabsorb and return to the body's circulation any bicarbonate from the urinary filtrate; the second is to excrete acid in the urine. Retaining bicarbonate will counteract an acidotic state. The nephrons do not sequester free hydrogen ions.

Respiratory acidosis- is associated with hypoventilation

A client with a suspected overdose of an unknown drug is admitted to the emergency department. Arterial blood gas values indicate respiratory acidosis. What should the nurse do first?P repare to assist with ventilation. Explanation: Respiratory acidosis is associated with hypoventilation; in this client, hypoventilation suggests intake of a drug that has suppressed the brain's respiratory center. Therefore, the nurse should assume the client has respiratory depression and should prepare to assist with ventilation. After the client's respiratory function has been stabilized, the nurse can safely monitor the heart rhythm, prepare for gastric lavage, and obtain a urine specimen for drug screening.

ARDS low level of PaCO2- normal range for PaCO2 is 35 to 45 mm Hg (4.7 to 6 kPa)

A client with acute respiratory distress syndrome (ARDS) is showing signs of increased dyspnea. The nurse reviews a report of blood gas values that recently arrived (see accompanying figure). Which finding is abnormal? PaCO2 Explanation: The normal range for PaCO2 is 35 to 45 mm Hg (4.7 to 6 kPa). Thus, this client's PaCO2 level is low. The client is experiencing respiratory alkalosis (carbonic acid deficit) due to hyperventilation. The nurse should report this finding to the health care provider (HCP) because it requires intervention. The increase in ventilation decreases the PaCO2 level, which leads to decreased carbonic acid and alkalosis. The bicarbonate level is normal in uncompensated respiratory alkalosis along with the normal PaO2 level. Normal serum pH is 7.35 to 7.45; in uncompensated respiratory alkalosis, the serum pH is greater than 7.45.

Chronic respiratory acidosis- can be a result of emphysema

A client with emphysema is at a greater risk for developing what acid-base imbalance? 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.

excess of carbon dioxide- respiratory acidosis

A client's arterial blood gas analysis reveals an excess of carbon dioxide. The nurse should recognize that this is consistent with which of the following? Respiratory acidosis An increased level of dissolved carbon dioxide (PaCO2) indicates respiratory acidosis. Metabolic acidosis and alkalosis are not correct because this is a respiratory issue, not a metabolic one. Respiratory alkalosis would have a PaCO2 deficit, not an increase.

Respiratory acidosis- excess of CO2 revealed through an ABG

A client's arterial blood gas analysis reveals an excess of carbon dioxide. The nurse should recognize that this is consistent with which of the following? Respiratory acidosis Explanation: An increased level of dissolved carbon dioxide (PaCO2) indicates respiratory acidosis. Metabolic acidosis and alkalosis are not correct because this is a respiratory issue, not a metabolic one. Respiratory alkalosis would have a PaCO2 deficit, not an increase.

Metabolic acidosis- pH of 7.24 indicates that the client is acidotic. The carbon dioxide level is normal, but the HCO3- level is decreased.

A client's arterial blood gas values are as shown on the accompanying chart. These findings indicate which of the following acid-base imbalances? Metabolic acidosis Explanation: The pH of 7.24 indicates that the client is acidotic. The carbon dioxide level is normal, but the HCO3- level is decreased. These findings indicate that the client is in metabolic acidosis.

diabetes mellitus- Obtain a fingerstick test for blood glucose. Notify the health care provider (HCP). Start an IV infusion with normal saline solution. Administer insulin lispro.

A hospitalized adolescent with type 1 diabetes mellitus is weak and nauseated with poor skin turgor. The nurse notes a fruity odor to the client's breath. The client uses insulin lispro. The last meal was lunch, 2 hours ago. Place the nursing actions in the order in which the nurse should perform them. All options must be used. Obtain a fingerstick test for blood glucose. Notify the health care provider (HCP). Start an IV infusion with normal saline solution. Administer insulin lispro. Explanation: The client is experiencing ketoacidosis. The nurse should first obtain the blood glucose level and then notify the HCP who will then prescribe the appropriate dose of insulin. Prior to administering the insulin, the nurse will start the IV infusion.

mother spoiling baby

A mother expresses concern that picking up the infant whenever he cries will spoil him. What is the nurse's best response? "Babies need comforting and cuddling; meeting these needs will not spoil him."

A neonate is born 8 weeks premature- Monitor partial pressure of oxygen (PaO2) levels.

A neonate is born 8 weeks premature. At birth, he has no spontaneous respirations, but he is successfully resuscitated. Within several hours he develops respiratory grunting, cyanosis, tachypnea, nasal flaring, and retractions. He's diagnosed with respiratory distress syndrome, intubated, and placed on a ventilator. Which nursing action should be included in the neonate's care plan to prevent retinopathy of prematurity? Monitor partial pressure of oxygen (PaO2) levels. Explanation: Monitoring PaO2 levels and reducing the oxygen concentration to keep PaO2 within normal limits reduces the risk of retinopathy of prematurity in a premature neonate receiving oxygen. Covering the neonate's eyes and humidifying the oxygen don't reduce the risk of retinopathy of prematurity. Because cooling increases the risk of acidosis, the neonate should be kept warm so that his respiratory distress isn't aggravated.

neonate-Metabolic acidosis results from the metabolic changes associated with cold stress

A neonate weighing 1870 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. Metabolic acidosis results from the metabolic changes associated with cold stress. End products of metabolism increase the acidity of the blood, evidenced by a pH of 7.11. Therefore, sodium bicarbonate, which is a buffer base, is often used. Diuretics, not sodium bicarbonate, would be used to combat edema. Intravenous fluids would be used to treat dehydration. Respiratory alkalosis results from excessive carbon dioxide loss, a condition that would be unusual in this neonate. Additionally, because sodium bicarbonate is a base, administering it to client with alkalosis would only further exacerbate the alkalotic condition.

acute respiratory failure (ARF)- pH 7.28, PaO2 50 mm Hg

A nurse assesses arterial blood gas results for a client in acute respiratory failure (ARF). Which of the following results are consistent with this disorder? pH 7.28, PaO2 50 mm Hg Explanation: ARF is defined as a decrease in the arterial oxygen tension (PaO2) to less than 50 mm Hg (hypoxemia) and an increase in arterial carbon dioxide tension (PaCO2) to greater than 50 mm Hg (hypercapnia), with an arterial pH of less than 7.35.

pH balance- 7.35-7.45 potassium level- 3.5 mEq/L-5.2 mEq/L.

A nurse is caring for an older adult client who is admitted with an electrolyte imbalance. Which laboratory values should be a priority concern for the nurse? Select all that apply. • pH 7.32 • Potassium 5.8 mEq/L Explanation: The pH value represents the amount of hydrogen ion or concentration of acid in the blood. The normal pH is 7.35-7.45. The CO2 level is still within the normal range. The sodium level is also within the normal range. The normal potassium levels range from 3.5 mEq/L-5.2 mEq/L.

pH- reflects the acid concentration

A nurse is reviewing a client's arterial blood gas (ABG) report. Which ABG value reflects the acid concentration in the client's blood? pH Explanation: The pH value in an ABG report reflects the acid concentration in the blood. The partial pressure of arterial oxygen (PaO2) value indicates the amount of oxygen dissolved in the blood; the partial pressure of arterial carbon dioxide (PaCO2) value represents the amount of carbon dioxide dissolved in the blood. The bicarbonate (HCO3-) value indicates the amount of bicarbonate, or base, in the blood.

Normal urine pH is 4.5 to 8

A nurse is reviewing a report of a client's routine urinalysis. Which value requires further investigation? 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 1.002 to 1.035, 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.

Respiratory acidosis from airway obstruction- emphysema-

A nursing student understands that emphysema is directly related to which of the following? Respiratory acidosis from airway obstruction Explanation: In the later stages of emphysema, carbon dioxide elimination is impaired, resulting in increased carbon dioxide tension in arterial blood (hypercapnia) leading to respiratory acidosis.

hemoglobin and hematocrit

A recently extubated client has shortness of breath. The nurse reports the client's discomfort and the results of the recently prescribed arterial blood gas analysis to the health care provider (HCP). After reviewing the report of the complete blood count (see report), the nurse should also report which results to the HCP? hemoglobin and hematocrit Explanation: The nurse should review the CBC with differential to evaluate the client's hemoglobin and hematocrit, which are abnormal and should be reported to the HCP. Anemia leads to decreased oxygen-carrying capacity of the blood. A client unable to compensate for the anemia may experience a profound sense of dyspnea. There has been a significant drop in the hemoglobin and hematocrit since the previous report, and these should be reported to the HCP. The monocytes are within normal range. HA1c is a laboratory test evaluating glycosylated hemoglobin and is in the normal range. This test is used to diagnose diabetes and/or monitor diabetic glucose control over time. PT is a coagulation study reflecting liver function and clotting time and is in the normal range.

Respiratory acidosis- pH 7.10; PCO2 80; PO2 35, HCO3 29

An adolescent child assessed by the nurse is found to have extreme lethargy, retractions of the intercostal spaces, a persistent expiratory wheeze, diminished breath sounds, tachycardia, and tachypnea. Arterial blood gas results are as follows: pH 7.10; PCO2 80; PO2 35, HCO3 29. What is the priority problem the nurse must address immediately? Respiratory acidosis Explanation: Based on the results of these blood gases, this client is in respiratory acidosis. The nurse must address this quickly as it could lead to respiratory failure.

bulimia nervosa- Metabolic alkalosis

An adolescent is admitted for treatment of bulimia nervosa. When developing the care plan, the nurse anticipates including interventions that address which metabolic disorder? Metabolic alkalosis Explanation: In a client with bulimia nervosa, metabolic alkalosis may occur secondary to hydrogen loss caused by frequent, self-induced vomiting. Typically, the blood glucose level is within normal limits, making hypoglycemia unlikely. In bulimia nervosa, hypokalemia is more common than hyperkalemia and typically results from potassium loss related to frequent vomiting.

acute respiratory failure- ABG of pH 7.24

Arterial blood gas analysis would reveal which of the following related to acute respiratory failure? pH 7.24 Explanation: Acute respiratory failure (ARF) is defined as a decrease in the arterial oxygen tension (PaO2) to less than 50 mm Hg (hypoxemia) and an increase in arterial carbon dioxide tension (PaCO2) to greater than 50 mm Hg (hypercapnia), with a decreased arterial pH.

Respiratory acidosis- asthmaticus worsens,

As status asthmaticus worsens, the nurse would expect the client to experience which acid-base imbalance? Respiratory acidosis Explanation: As status asthmaticus worsens, the PaCO increases and the pH decreases, reflecting respiratory acidosis.

Respiratory acidosis- status asthmaticus

As status asthmaticus worsens, the nurse would expect which acid-base imbalance? Respiratory acidosis Explanation: As staticus asthmaticus worsens, the PaCO2 increases and the pH decreases, reflecting respiratory acidosis.

Baseline arterial blood gas (ABG) levels- Before weaning the client from mechanical ventilation, it's most important to have baseline ABG levels.

Before weaning a client from a ventilator, which assessment parameter is the most important for the nurse to obtain? Baseline arterial blood gas (ABG) levels Explanation: Before weaning the client from mechanical ventilation, it's most important to have baseline ABG levels. During the weaning process, ABG levels will be checked to assess how the client is tolerating the procedure. Other assessment parameters are less critical. Measuring fluid volume intake and output is always important when a client is being mechanically ventilated. Prior attempts at weaning and ECG results are documented on the client's record, and the nurse can refer to them before the weaning process begins.

Esophagitis- Cimetidine used

Cimetidine may also be used to treat hiatal hernia. The nurse should understand that this drug is used to prevent which of the following? Esophagitis. Explanation: Cimetidine is a histamine receptor antagonist that decreases the quantity of gastric secretions. It may be used in hiatal hernia therapy to prevent or treat the esophagitis and heartburn associated with reflux. Cimetidine is not used to prevent reflux, dysphagia, or ulcer development.

Administer a saline bolus as needed- rapid, deep (Kussmaul) respirations are compensatory and indicate metabolic acidosis.

During an initial shift assessment, a nurse finds a diabetic client who is lethargic and who has rapid, deep respirations. Which of the following actions should the nurse take? Administer a saline bolus as needed Explanation: The rapid, deep (Kussmaul) respirations are compensatory and indicate metabolic acidosis. There is an immediate need for correction of the acidosis with a saline bolus to prevent hypovolemia. This will be followed by assessment of glucose level and insulin administration to allow the glucose to reenter the cells. Oxygen therapy is not indicated because there is no indication that the increased respiratory rate is related to hypoxemia. Administration of glucagon will further increase the blood sugar levels.

ICP- promote carbon dioxide elimination.

For a client with suspected increased intracranial pressure (ICP), an appropriate respiratory goal is to: promote carbon dioxide elimination. Explanation: The goal of treatment for ICP is to prevent acidemia by eliminating carbon dioxide because an acid environment in the brain causes cerebral vessels to dilate and therefore increases ICP. Preventing respiratory alkalosis and lowering arterial pH may bring about acidosis, an undesirable condition in this client. It isn't necessary to maintain a PaO2 as high as 80 mm Hg; 60 mm Hg will adequately oxygenate most clients.

Metabolic alkalosis- pyloric stenosis

For the child experiencing excessive vomiting secondary to pyloric stenosis, the nurse should assess the child for which of the following acid--base imbalances? Metabolic alkalosis. Explanation: Metabolic alkalosis occurs because of the excessive loss of potassium, hydrogen, and chloride in the vomitus. Chloride loss leads to a compensatory increase in the number of bicarbonate ions. The bicarbonate side of the carbonic acid--base bicarbonate increases, and the pH becomes more alkaline. Respiratory alkalosis is caused by conditions such as hyperventilation that result in loss of partial pressure of arterial carbon dioxide (PaCO2). Respiratory acidosis is caused by conditions such as inadequate ventilation that result in excessive retention of PaCO2. Metabolic acidosis results from the loss of large amounts of bicarbonate such as with severe diarrhea.

Respiratory acidosis- COPD- chronic obstructive pulmonary disease

In chronic obstructive pulmonary disease (COPD), decreased carbon dioxide elimination results in increased carbon dioxide tension in arterial blood, leading to what acid-base imbalance? Respiratory acidosis Explanation: Increased carbon dioxide tension in arterial blood leads to respiratory acidosis and chronic respiratory failure. In acute illness, worsening hypercapnia can lead to acute respiratory failure. The other acid-base imbalances would not correlate with COPD. (less) Remediation: Chronic obstructive pulmonary disease

Impaired gas exchange- PaO2, 50 mm Hg; PaCO2, 70 mm Hg; pH, 7.20; HCO3-, 28 mEq/L

On admission, a client has the following arterial blood gas (ABG) values: PaO2, 50 mm Hg; PaCO2, 70 mm Hg; pH, 7.20; HCO3-, 28 mEq/L. Based on these values, the nurse should prioritize which nursing diagnosis for this client? Impaired gas exchange Explanation: The client's below-normal value for the partial pressure of arterial oxygen (PaO2) and an above-normal value for the partial pressure of arterial carbon dioxide (PaCO2) support the nursing diagnosis of Impaired gas exchange. ABG values can't indicate a diagnosis of Ineffective airway clearance (or excess) or Risk for deficient fluid volume. Metabolic acidosis is a medical, not nursing, diagnosis; in any event, these ABG values indicate respiratory, not metabolic, acidosis.

mixed acid-base disorder- dyspnea and abdominal pain- pH 7.28, PaCO2 50 mm Hg, HCO3- 23 mEq/L.

The ICU nurse is caring for a client who experienced trauma in a workplace accident. The client reports dyspnea and abdominal pain. An ABG reveals the following results: pH 7.28, PaCO2 50 mm Hg, HCO3- 23 mEq/L. The nurse should recognize the likelihood of what acid-base disorder? Mixed acid-base disorder Explanation: Clients can simultaneously experience two or more independent acid-base disorders. A normal pH in the presence of changes in the PaCO2 and plasma HCO3- concentration immediately suggests a mixed disorder, making the other options incorrect.

Respiratory acidosis

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 (Atrovent) is a maintenance treatment for bronchospasm that can be used with albuterol. A chest x-ray and sputum sample can be obtained once the client is stable.

Bicarbonate- one of the most important indications of an acid-base imbalance

The emergency department (ED) nurse is caring for a client with a possible acid-base imbalance. The physician has ordered an arterial blood gas (ABG). What is one of the most important indications of an acid-base imbalance that is shown in an ABG? Bicarbonate Explanation: Arterial blood gas (ABG) results are the main tool for measuring blood pH, CO2 content (PaCO2), and bicarbonate. An acid-base imbalance may accompany a fluid and electrolyte imbalance. Carbonic acid, lactate and nitrogen levels are not shown in an ABG.

morphine overdose

The nurse discovers that a young client has been given a dose of morphine four times the ordered dose. Which of the following is the immediate priority action for the nurse to take? Obtain an order for naloxone and administer it promptly. Naloxone is an opioid antagonist that is given as an antidote for morphine. An antidote is an agent that neutralizes a poison or counteracts its effects. This should be the immediate priority for the nurse.

acute respiratory distress syndrome (ARDS)- hypoxia not responsive to oxygen therapy

The nurse interprets which finding as an early sign of acute respiratory distress syndrome (ARDS) in a client at risk? hypoxia not responsive to oxygen therapy Explanation: A hallmark of early ARDS is refractory hypoxemia. The client's PaO2 level continues to fall, despite higher concentrations of administered oxygen. Elevated carbon dioxide and metabolic acidosis occur late in the disorder. Severe electrolyte imbalances are not indicators of ARDS.

Metabolic acidosis- diabetes mellitus and left-sided heart failure

The nurse is admitting a client with newly diagnosed diabetes mellitus and left-sided heart failure. Assessment reveals low blood pressure, increased respiratory rate and depth, drowsiness, and confusion. The client complains of headache and nausea. Based on the serum laboratory results below, how would the nurse interpret the client's acid-base balance? Metabolic acidosis. Explanation: This client has metabolic acidosis, which typically manifests with a low pH, low bicarbonate level, normal to low PaCO2, and normal PaO2. The client's serum electrolyte levels also support metabolic acidosis, which include an elevated potassium level, normal to elevated chloride level, and normal calcium level. The client's anion gap of 30 mEq/L is high, also indicative of metabolic acidosis. This kind of metabolic acidosis occurs with diabetic ketoacidosis and other disorders.

severe pneumonia- pH: 7.20, PaCO2: 65 mm Hg, HCO3-: 26 mEq/L- Respiratory acidosis

The nurse is analyzing the arterial blood gas (AGB) results of a client diagnosed with severe pneumonia. What ABG results are most consistent with this diagnosis? 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.

Ketoacidosis- Deep, rapid respirations- buffering system

The nurse is assessing a child with ketoacidosis. The nurse should particulary determine if the client has: Deep, rapid respirations. Explanation: The accumulation of ketones, organic acids that readily release free hydrogen ions causing blood pH to fall, leads to ketoacidosis. To compensate, the respiratory buffering system is activated, which results in the child taking deep, rapid breaths to rid the body of excess carbon dioxide. This characteristic breathing pattern is known as Kussmaul's respirations. Typically with ketoacidosis, the pulse rate would be more rapid and weak due to dehydration and loss of electrolytes. Also, the skin would be dry due to dehydration. Hypotension results from the contracted blood volume secondary to dehydration

labor- transitional stage- interventions

The nurse is caring for a client who is in the transitional stage of labor. The client's partner is concerned and asks, "What else can I do for my wife? She is so irritable." Which of the following interventions would the nurse suggest? Select all that apply. • "Continue to praise your wife and give her encouragement." • "Stay by your wife's side. It is important that she know you are there to support her." • "Encourage your wife to rest in between contractions."

Anion gap- acidosis is due to acid gain or to bicarbonate loss- result is metabolic acidosis (pH 7.25)

The nurse is caring for a client with a metabolic acidosis (pH 7.25). Which of the following values is most useful to the nurse in determining whether the cause of the acidosis is due to acid gain or to bicarbonate loss? Anion gap Explanation: Metabolic acidosis is a common clinical disturbance characterized by a low pH (increased H+ concentration) and a low plasma bicarbonate concentration. It can be produced by a gain of hydrogen ion or a loss of bicarbonate. It can be divided clinically into two forms, according to the values of the serum anion gap: high anion gap acidosis and normal anion gap acidosis. A patient diagnosed with metabolic acidosis is determined to have normal anion gap metabolic acidosis if the anion gap is within this normal range. An anion gap greater than 16 mEq (16 mmol/L) (the normal value for an anion gap is 8-12 mEq/L (8-12 mmol/L) without potassium in the equation. If potassium is included in the equation, the normal value for the anion gap is 12-16 mEq/L (12-16 mmol/L) and suggests an excessive accumulation of unmeasured anions and would indicate high anion gap metabolic acidosis as the type. An anion gap occurs because not all electrolytes are measured. More anions are left unmeasured than cations. A low or negative anion gap may be attributed to hypoproteinemia. Disorders that cause a decreased or negative anion gap are less common compared to those related to an increased or high anion gap.

acute respiratory distress syndrome- Partial pressure of arterial oxygen (PaO2) of 69 mm Hg

The nurse is caring for a client with acute respiratory distress syndrome. What portion of arterial blood gas results does the nurse find most concerning, requiring intervention? Partial pressure of arterial oxygen (PaO2) of 69 mm Hg Explanation: In acute respiratory failure, administering supplemental oxygen elevates the PaO2. In acute respiratory distress syndrome, elevation of the PaO2 requires positive end-expiratory pressure. In both situations, the PaCO2 is elevated and the pH and HCO3- are depressed.

Respiratory acidosis - COPD

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 Explanation: 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. Respiratory alkalosis is a decrease in acidity of the blood and often caused by hyperventilation. Metabolic acidosis and alkalosis are not directly caused by respiratory disorders.

end-stage kidney disease- pH 7.20, PaCO2 36, HCO3 14-

The nurse is caring for a client with end-stage kidney disease. What arterial blood gas results are most closely associated with this disorder? pH 7.20, PaCO2 36, HCO3 14- Explanation: Metabolic acidosis occurs in ESKD because the kidneys are unable to excrete increased loads of acid. Decreased acid secretion results from the inability of the kidney tubules to excrete ammonia (NH3-) and to reabsorb sodium bicarbonate (HCO3-). There is also decreased excretion of phosphates and other organic acids

metabolic acidosis- lungs and kidneys are the pair of organs is responsible for regulatory processes and compensation

The nurse is caring for a client with multiple organ failure who is in metabolic acidosis. Which pair of organs is responsible for regulatory processes and compensation? Lungs and kidneys Explanation: The lungs and kidneys facilitate the ratio of bicarbonate to carbonic acid. Carbon dioxide is one of the components of carbonic acid. The lungs regulate carbonic acid levels by releasing or conserving CO2 by increasing or decreasing the respiratory rate. The kidneys assist in acid-base balance by retaining or excreting bicarbonate ions.

Metabolic acidosis- severe diarrhea

The nurse is caring for a client with severe diarrhea. The nurse recognizes that the client is at risk for developing which of the following acid-base imbalances? 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).

near drowning victim- first

The nurse is caring for a lethargic 4-year-old who is a victim of a near-drowning accident. The nurse should first: administer oxygen. Near-drowning victims typically suffer hypoxia and mixed acidosis. The priority is to restore oxygenation and prevent further hypoxia. Here, the client has blunted sensorium, but is not unconscious; therefore, delivery of supplemental oxygen with a mask is appropriate. Warming protocols and fluid resuscitation will most likely be needed to help correct acidosis, but these interventions are secondary to oxygen administration. Intubation is required if the child is comatose, shows signs of airway compromise, or does not respond adequately to more conservative therapies.

Shock- ABG findings hypoxemia and metabolic acidosis-

The nurse is concerned about the risks of hypoxemia and metabolic acidosis in a client who is in shock. What finding should the analyze for evidence of hypoxemia and metabolic acidosis in a client with shock? Arterial blood gas (ABG) findings Explanation: Analysis of ABG findings is essential for evidence of hypoxemia and metabolic acidosis. Low RBCs and hemoglobin correlate with hypovolemic shock and can lead to poor oxygenation. An elevated white blood cell count supports septic shock. Oxygen saturation levels are usually affected by hypoxemia but cannot be used to diagnose acid-base imbalances such as metabolic acidosis.

cardiac catheterization- NPO

The nurse is preparing a client for a cardiac catheterization. Which of the following client statements would the nurse need to report to the healthcare provider immediately? "I took my metformin this morning." Explanation: The priority would be to notify the healthcare provider of the metformin because it cannot be taken 48 hours before or after contrast, as there is an increased risk of lactic acidosis and acute renal failure with iodinated contrast material. It would be appropriate for the client to take nothing by mouth. It is important to determine the client's allergies; however, it is not the priority. Claustrophobia would not be an issue during a cardiac catheterization

hyperventilating. The nurse should?

The nurse observes a client with a history of panic attacks is hyperventilating. The nurse should: have the client breathe into a paper bag. Explanation: The best way to ease symptoms caused by hyperventilation is to have the client breathe into a paper bag. This helps to raise carbon dioxide level, which encourages deeper, slower breathing. The symptoms of hyperventilation will not be alleviated by having the client put his head between his knees, giving the client low concentrations of oxygen, or having the client take deep, slow breaths and exhaling normally. (l

Respiratory alkalosis- heart failure having rapid, shallow breathing at a rate of 32 breaths/minute

The nurse observes a client with an onset of heart failure having rapid, shallow breathing at a rate of 32 breaths/minute. What blood gas analysis does the nurse anticipate finding initially? Respiratory alkalosis Explanation: At first, arterial blood gas analysis may reveal respiratory alkalosis as a result of rapid, shallow breathing. Later, there is a shift to metabolic acidosis as gas exchange becomes more impaired. Respiratory acidosis and metabolic alkalosis are incorrect distractors

metabolic acidosis- severe diarrhea

The nurse should assess the client with severe diarrhea for which acid-base imbalance? metabolic acidosis Explanation: A client with severe diarrhea loses large amounts of bicarbonate, resulting in metabolic acidosis. Metabolic alkalosis does not result in this situation. Diarrhea does not affect the respiratory system.

dehydration and metabolic acidosis- tachypnea

When caring for a 12-month-old infant with dehydration and metabolic acidosis, the nurse expects to see: tachypnea. Explanation: The nurse would expect to see tachypnea because the body compensates for metabolic acidosis via the respiratory system, which tries to eliminate the buffered acids by increasing alveolar ventilation through deep, rapid respirations. Altered WBC and platelet counts aren't specific signs of metabolic imbalance.

acute renal failure- assess for • Hyperkalemia. • Metabolic acidosis. • Hypermagnesemia.

When caring for a client with acute renal failure, the nurse should assess the client carefully for which of the following? Select all that apply. • Hyperkalemia. • Metabolic acidosis. • Hypermagnesemia. Explanation: Hyperkalemia (elevated serum potassium) is the most life-threatening electrolyte imbalance that can develop as a result of acute renal failure. Additional electrolyte imbalances include a decrease in serum calcium levels (hypocalcemia) and elevated magnesium levels (hypermagnesemia). Acute renal failure also leads to the development of metabolic acidosis.

metabolic alkalosis- ph 7.48

When evaluating a client's arterial blood gases (ABGs), which value is consistent with metabolic alkalosis? pH 7.48 Explanation: Metabolic alkalosis is a clinical disturbance characterized by a high pH and high plasma bicarbonate concentration. The HCO3 value is below normal. The PaCO2 value and the oxygen saturation level are within a normal range.

Hyperventilation- dizziness

Which physical sensation will the client who has had an abdominal hysterectomy most likely experience if she hyperventilates while performing deep-breathing exercises? dizziness Explanation: Hyperventilation occurs when the client breathes so rapidly and deeply that she exhales excessive amounts of carbon dioxide. A characteristic symptom of hyperventilation is dizziness. To avoid hyperventilation, the nurse should assist the client in the practice of slow, deep breathing in a regular breathing pattern. Dyspnea, blurred vision, and mental confusion are not associated with hyperventilation.