276 Arnold Acid Base Balance
The nurse is caring for a client diagnosed with chronic obstructive pulmonary disease (COPD) and experiencing respiratory acidosis. The decrease in pH exists because the client's lungs: have ineffective cilia from years of smoking. are unable to blow off carbon dioxide. are unable to exchange oxygen and carbon dioxide. are unable to inspire sufficient oxygen.
are unable to blow off carbon dioxide. Explanation: In clients with chronic respiratory acidosis, the client is unable to blow off carbon dioxide leaving in increased amount of hydrogen in the system. The increase in hydrogen ions leads to acidosis. In COPD, the client is able to breathe in oxygen and gas exchange can occur, but the lungs' ability to remove carbon dioxide from the system is compromised. Although individuals with COPD frequently have a history of smoking, impaired ciliary function is not the cause of the acidosis.
A client presents with severe diarrhea and a history of chronic renal failure to the emergency department. Arterial blood gas results are:pH 7.30PaO2 97PaCO2 37HCO3 18The nurse would expect which set of assessment findings? headache, blood pressure 90/54 mm Hg, dry skin confusion, respiratory rate 8 breaths/min, dry skin clammy skin, blood pressure 86/46 mm Hg, headache blood pressure 188/120 mm Hg, nausea, vomiting
clammy skin, blood pressure 86/46 mm Hg, headache Metabolic acidosis, a common clinical disturbance, is characterized by decreased pH and plasma bicarbonate concentration. Common causes of metabolic acidosis include diarrhea, chronic renal failure, use of diuretics, intestinal fistulas, and ureterostomies. S/S: headache, confusion, increased respiratory rate, nausea, vomiting, cold and clammy skin, and decreased blood pressure.
The nurse is caring for a client with emphysema. The client asks about the reason for persistent respiratory acidosis. What is the best response by the nurse? "Your alveoli have lost elasticity, which causes retained carbon dioxide." "Your respiratory acidosis is caused by narrowed bronchioles and decreased oxygen." "You experience this because you have an increased work of breathing." "You have an increase in production of mucus, which causes a lack of oxygen."
"Your alveoli have lost elasticity, which causes retained carbon dioxide." Explanation: Emphysema causes a loss of alveolar elasticity. The alveoli become hyperinflated with retained carbon dioxide, which leads to chronic respiratory acidosis. While the client with emphysema will experience increased work of breathing, it is the retained carbon dioxide that causes the respiratory acidosis. Narrowed bronchioles and increased mucus production are characteristic of chronic bronchitis, which causes hypoxemia, not respiratory acidosis.
A nurse is caring for a preschool-age client with a neuroblastoma who has been receiving chemotherapy for the last 4 weeks. His laboratory test results indicate a Hgb of 12.5 g/dL (125 g/L), HCT of 36.8% (0.37), WBC of 2000 mm3 (2 X 109/L), and platelet count of 150,000/μL (150 X 109/L). Based on the child's values, what is the highest priority nursing intervention? Encourage meticulous handwashing by the client and visitors. Prepare to give the child a transfusion of packed red blood cells. Prepare to give the child a transfusion of platelets. Encourage mouth care with a soft toothbrush.
Encourage meticulous handwashing by the client and visitors. Explanation: A WBC of 2000 mm3 (2 X 109/L) is low and increases the child's risk for infection. Meticulous handwashing is a standard/routine precaution and the first line of defense in combating infection. A platelet count of 150,000 ?L (150 X 109/L) is within normal range, so there is no need to transfuse the child with platelets. Mouth care will help decrease the risk of infection. However, handwashing is the priority because it will have the greatest effects on diminishing the risk of infection. A Hgb of 12.5 g/dL (125 g/L) and a HCT of 36.8% (0.37) are within normal range so there is no need to transfuse packed red blood cells.
A client is admitted to the emergency department with a broken humerus after a motor vehicle collision. Significant assessment findings include respiratory rate 28 breaths/min and arterial blood gas (ABG) readings of pH 7.51, PaCO2 30 mm Hg (3.99 kPa), HCO3 23 mEq/L (23 mmol/L), and PaO2 90 mm Hg (11.97 kPa). Which nursing action would be a priority? Administer lorazepam sublingually. Offer reassurance, and treat the client's pain. Continuously assess pulse oximetry. Administer albuterol (salbutamol) inhaler.
Offer reassurance, and treat the client's pain. Explanation: The client is hyperventilating and exhibiting respiratory alkalosis. The priority action is to reduce the client's respiratory rate by reducing anxiety and pain. The client's PaO2 on the blood gas analysis is within normal range, so pulse oximetry is not an immediate priority. Administering albuterol is not required in respiratory alkalosis and could increase the client's anxiety. Pharmacologic control of anxiety is used only if nonpharmacologic interventions are not effective.
A client with acute respiratory distress syndrome is showing signs of increased dyspnea. The nurse reviews a reportterm-24 of blood gas values (see report). Which finding is abnormal? PaCO2 HCO3-. pH PaO2.
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.
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? Reposition the client. Administer amnioinfusion. Prepare for cesarean birth. Start I.V. oxytocin infusion as ordered.
Prepare for cesarean birth. Explanation: 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 serves as a temporary measure because the risk of fetal asphyxia is imminent. Oxytocin administration increases contractions, exacerbating fetal stress.
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: impending respiratory failure. obstruction in the chest tubes. improving respiratory status. developing respiratory alkalosis.
improving respiratory status. Explanation: 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.The client is not alkalotic because the pH values are below 7.35.If the chest tubes were obstructed, the client's respiratory status would deteriorate.
A client is critically ill with sepsis. The nurse expects what assessment finding related to compensatory mechanisms attempting to maintain normal pH? increased urine output decreased blood pressure increased body temperature increased respiratory rate
increased respiratory rate Explanation: The critically ill client with sepsis is at risk for decreased perfusion of tissues and organs, which leads to lactic acid production. This causes the client to experience metabolic acidosis. To correct the acidosis, the lungs eliminate carbonic acid by blowing off more CO2 via an increased respiratory rate. It is the respiratory system that compensates for metabolic acidosis, not the renal system. Blood pressure will be low in the client with sepsis, but blood pressure is not a compensatory mechanism for pH imbalances. While body temperature can affect acid base balance, this is not how the body compensates for metabolic acidosis.
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 alkalosis respiratory alkalosis respiratory acidosis metabolic acidosis
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.
An adolescent is admitted for treatment of bulimia nervosa. When developing the care plan, the nurse anticipates including interventions that address which metabolic disorder? hyperkalemia metabolic acidosis hypoglycemia metabolic alkalosis
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.
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 acidosis respiratory acidosis metabolic alkalosis respiratory alkalosis
metabolic alkalosis Explanation: Metabolic alkalosis results in increased plasma pH because of accumulated base bicarbonate or decreased hydrogen ion concentrations. Regular use of baking soda (sodium bicarbonate) may place the client 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.
A client presents to the emergency department, reporting that they have been vomiting every 30 to 40 minutes for the past 8 hours. Frequent vomiting puts this client at risk for which imbalances? metabolic alkalosis and hypokalemia metabolic acidosis and hypokalemia metabolic acidosis and hyperkalemia metabolic alkalosis and hyperkalemia
metabolic alkalosis and hypokalemia Gastric acid contains large amounts of potassium, chloride, and hydrogen ions. Excessive vomiting causes loss of these substances, which can lead to metabolic alkalosis and hypokalemia. Excessive vomiting doesn't cause metabolic acidosis or hyperkalemia.
A client is admitted to the psychiatric clinic for treatment of anorexia nervosa. At the beginning of the client's hospitalization, the most important nursing action is to: -monitor the client's vital signs, serum electrolyte levels, and acid-base balance. -instruct the client to keep an accurate record of food and fluid intake. -severely restrict the client's physical activities. -weigh the client daily, after the evening meal.
monitor the client's vital signs, serum electrolyte levels, and acid-base balance. Explanation: An anorexic client who requires hospitalization is in poor physical condition as a result of starvation and may die as a result of arrhythmias, hypothermia, malnutrition, infection, or cardiac abnormalities secondary to electrolyte imbalances. Therefore, monitoring the client's vital signs, serum electrolyte level, and acid-base balance is crucial. Restricting the client's physical activities may worsen anxiety. A weight obtained after breakfast is more accurate than one obtained after the evening meal. Instructing the client to keep a record of food and fluid intake would reward the client with attention for not eating and would reinforce the control issues that are central to the underlying psychological problem; also, the client might record food and fluid intake inaccurately.
A nurse working in the emergency department receives arterial blood gas results on four clients. Which laboratory result requires immediate nursing intervention? pH 7.34, PaCO2 33 mm Hg, and PaO2 80 mm Hg pH 7.48, PaCO2 35 mm Hg, and PaO2 65 mm Hg pH 7.28, PaCO2 60 mm Hg, and PaO2 58 mm Hg pH 7.33, PaCO2 58 mm Hg, and PaO2 64 mm Hg
pH 7.28, PaCO2 60 mm Hg, and PaO2 58 mm Hg Explanation: The pH 7.28, PaCO2 60 mm Hg, and PaO2 58 mm Hg indicate t severe uncompensated respiratory acidosis & hypoxemia. A PaO2 under 60 indicates respiratory failure. This client needs oxygen immediately to prevent further deterioration. The remaining ABG's pH 7.48, PaCO2 35 mm Hg, and PaO2 65 mm Hg is indicative of uncompensated metabolic alkalosis, pH 7.34, PaCO2 33 mm Hg, and PaO2 80 mm Hg slight respiratory acidosis and pH 7.33, PaCO2 58 mm Hg, and PaO2 64 mm Hg uncompensated respiratory acidosis with hypoxemia are all not as severely hypoxemic as the client with a PaO2 of 58.
A nurse working in the emergency department receives arterial blood gas results on four clients. Which laboratory result requires immediate nursing intervention? pH 7.28, PaCO2 60 mm Hg, and PaO2 58 mm Hg pH 7.48, PaCO2 35 mm Hg, and PaO2 65 mm Hg pH 7.33, PaCO2 58 mm Hg, and PaO2 64 mm Hg pH 7.34, PaCO2 33 mm Hg, and PaO2 80 mm Hg
pH 7.28, PaCO2 60 mm Hg, and PaO2 58 mm Hg Explanation: The pH 7.28, PaCO2 60 mm Hg, and PaO2 58 mm Hg indicate that the client has severe uncompensated respiratory acidosis and hypoxemia. A PaO2 under 60 indicates respiratory failure. This client needs oxygen immediately to prevent further deterioration. The remaining ABG's pH 7.48, PaCO2 35 mm Hg, and PaO2 65 mm Hg is indicative of uncompensated metabolic alkalosis, pH 7.34, PaCO2 33 mm Hg, and PaO2 80 mm Hg slight respiratory acidosis and pH 7.33, PaCO2 58 mm Hg, and PaO2 64 mm Hg uncompensated respiratory acidosis with hypoxemia are all not as severely hypoxemic as the client with a PaO2 of 58.
A nurse assesses arterial blood gas results for a client in acute respiratory failure (ARF). Which result is consistent with this disorder? pH 7.46, PaO2 80 mm Hg pH 7.36, PaCO2 32 mm Hg pH 7.35, PaCO2 48 mm Hg pH 7.28, PaO2 50 mm Hg
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.
A nurse is reviewing arterial blood gas (ABG) results on four clients. Which results would the nurse report immediately to the healthcare provider? pH 7.45, PaO2 90 mmHg, PaCO2 28 mmHg, HCO3 32 mEq/L, and O2 sat 98% pH 7.36, PaO2 86 mmHg, PaCO2 55 mmHg, HCO3 30 mEq/L, and O2 sat 90% pH 7.31, PaO2 84 mmHg, PaCO2 50 mmHg, HCO3 24 mEq/L, and O2 sat 90% pH 7.35, PaO2 82 mmHg, PaCO2 44 mmHg, HCO3 22 mEq/L, and O2 sat 95%
pH 7.31, PaO2 84 mmHg, PaCO2 50 mmHg, HCO3 24 mEq/L, and O2 sat 90% Explanation: This ABG indicates uncompensated respiratory acidosis & to be reported to the healthcare provider immediately. The results pH 7.35, PaO2 82 mmHg, PaCO2 44 mmHg, HCO3 22 mEq/L, and O2 sat 95% are normal values. The results pH 7.45, PaO2 90 mmHg, PaCO2 28 mmHg, HCO3 32 mEq/L, and O2 sat 98% and pH 7.36, PaO2 86 mmHg, PaCO2 55 mmHg, HCO3 30 mEq/L, and O2 sat 90% both indicate fully compensated acid-base imbalances; they would not be the priority for reporting to the healthcare provider.
A nurse is reviewing arterial blood gas (ABG) results on four clients. Which results would the nurse report immediately to the healthcare provider? pH 7.45, PaO2 90 mmHg, PaCO2 28 mmHg, HCO3 32 mEq/L, and O2 sat 98% pH 7.36, PaO2 86 mmHg, PaCO2 55 mmHg, HCO3 30 mEq/L, and O2 sat 90% pH 7.35, PaO2 82 mmHg, PaCO2 44 mmHg, HCO3 22 mEq/L, and O2 sat 95% pH 7.31, PaO2 84 mmHg, PaCO2 50 mmHg, HCO3 24 mEq/L, and O2 sat 90%
pH 7.31, PaO2 84 mmHg, PaCO2 50 mmHg, HCO3 24 mEq/L, and O2 sat 90% Explanation: This ABG of pH 7.31, PaO2 84 mmHg, PaCO2 50 mmHg, HCO3 24 mEq/L, and O2 sat 90% indicates uncompensated respiratory acidosis & would be reported to the HCP immediately. The results pH 7.35, PaO2 82 mmHg, PaCO2 44 mmHg, HCO3 22 mEq/L, and O2 sat 95% are normal values. The results pH 7.45, PaO2 90 mmHg, PaCO2 28 mmHg, HCO3 32 mEq/L, and O2 sat 98% and pH 7.36, PaO2 86 mmHg, PaCO2 55 mmHg, HCO3 30 mEq/L, and O2 sat 90% indicate fully compensated acid-base imbalances; not be the priority for reporting to the
Which statement made by a client who is taking misoprostol indicates a therapeutic outcome of therapy? "I can breathe easier." "My blood pressure is normal." "My heart doesn't beat as fast now." "My stomach feels better."
"My stomach feels better." Explanation: Misoprostol is used to protect the stomach's lining when a client has a peptic ulcer. Misoprostol does not affect the cardiac or respiratory systems.
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 administered via an infusion pump 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 Explanation: To determine the number of insulin units the client is receiving per hour, the nurse must first determine the number of units in each milliliter of fluid (50 units ÷ 100 ml = 0.5 units/ml). Next, multiply the units per milliliter by the rate of milliliters per hour (0.5 units × 10 ml/hr = 5 units).
A nurse is assessing a 6-month-old infant at a well-baby check. The parent says that the infant has been having diarrhea for the last 2 days. Which is the nurse's priority action? Complete designated teaching for the 6-month visit. Instruct mother to bring the infant to the emergency department. Notify the healthcare provider. Collect more data from parent about the diarrhea.
Collect more data from parent about the diarrhea. Explanation: The nurse should obtain a more detailed history and assessment on the infant to determine the next steps in care. Routine teaching, use of the emergency department, or notifying the primary healthcare provider is not a priority until the diarrhea is evaluated.
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.
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 nursing clinical judgment should the nurse make? The oxygen level is low but poses no risk for the client. The client's PaO2 level is within normal range. `The client is severely hypoxic. The client requires oxygen therapy with very low oxygen concentrations.
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).
The student nurse asks why a client is receiving an I.V. of lactated Ringer's with potassium following an episode of diabetic ketoacidosis. What is the best response by the nurse? In acidosis, the sodium moves into the cells to buffer the acid and displaces the potassium. The lactated Ringer's helps restore the alkaline pH. With acidosis, the intracellular potassium switches places with the plasma hydrogen ions to buffer the acidosis; the lactated Ringer's helps restore the bicarbonate reserves. Hypokalemia is associated with uncontrolled diabetes, and the lactated Ringer's is isotonic fluid replacement. Lactated Ringer's will help lower the blood pH when hypokalemia is related to ketoacidosis.
With acidosis, the intracellular potassium switches places with the plasma hydrogen ions to buffer the acidosis; the lactated Ringer's helps restore the bicarbonate reserves. Explanation: In diabetic ketoacidosis, the cellular buffers will be activated. Potassium will move out of the cell and hydrogen will move inside the cells to lessen the impact on the plasma pH. Once the acidosis is corrected by bicarbonate injections and I.V. lactated Ringer's, potassium will move back into the cells, resulting in hypokalemia. Potassium levels will be monitored closely, and replacement will be initiated. Lactated Ringer's helps increase the blood pH and provides a source of bicarbonate replacement to replenish the base portion of the 1:20 acid-to-base relationship that helps maintain the blood at the pH of 7.35 to 7.45. Sodium does not switch with potassium in an acidotic state.
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? sputum culture ipratropium inhaler chest X-ray albuterol nebulizer
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.
A client is diagnosed with diabetic ketoacidosis. Which finding would the nurse anticipate? arterial pH 7.33 platelets 309 potassium 4.5 mEq/L fasting blood glucose 70 mg/dL (3.89 mmol/L)
arterial pH 7.33 Explanation: In diabetic ketoacidosis, the pt is acidic w/ pH below 7.35; potassium is typically ↓; hyperglycemic. Potassium level may be high or low depending upon renal function and potassium replacement. Also, blood glucose will be elevated. Platelet count should be within normal limits.
Which physical sensation will the client who has had an abdominal hysterectomy most likely experience if she hyperventilates while performing deep-breathing exercises? blurred vision dizziness dyspnea mental confusion
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.
Before seeing a newly assigned client with respiratory alkalosis, a nurse quickly reviews the client's medical history. Which condition is a predisposing factor for respiratory alkalosis? type 1 diabetes mellitus myasthenia gravis opioid overdose extreme anxiety
extreme anxiety Explanation: Extreme anxiety may lead to respiratory alkalosis by causing hyperventilation, which results in excessive carbon dioxide (CO2) loss. Other conditions that may set the stage for respiratory alkalosis include fever, heart failure, injury to the brain's respiratory center, overventilation with a mechanical ventilator, pulmonary embolism, and early salicylate intoxication. Type 1 diabetes may lead to diabetic ketoacidosis; the deep, rapid respirations occurring in this disorder (Kussmaul respirations) don't cause excessive CO2 loss
A client has vomited several times over the past 12 hours. The nurse should recognize the risk of what complication? metabolic alkalosis respiratory acidosis respiratory alkalosis metabolic acidosis
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.
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 metabolic alkalosis metabolic acidosis respiratory alkalosis
respiratory acidosis ↑ 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.
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 respiratory acidosis metabolic alkalosis 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 nurse is reviewing a report of a client's routine urinalysis. Which value requires further investigation? specific gravity of 1.03 absence of glucose absence of protein urine pH of 3.0
urine pH of 3.0 Normal urine pH is 4.5 to 8; therefore, a urine pH of 3.0 is abnormal and requires further investigation. Urine specific gravity ranges 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.
The physician has prescribed sodium chloride for a hospitalized 51-year-old client in metabolic alkalosis. Which nursing actions are required to manage this client? Select all that apply. Maintain intake and output records. Compare ABG findings with previous results. Document presenting signs and symptoms. Suction the client's airway. Administer I.V. bicarbonate.
Compare ABG findings with previous results. Maintain intake and output records. Document presenting signs and symptoms. Explanation: Metabolic alkalosis results in increased plasma pH because of accumulated base bicarbonate or decreased hydrogen ion concentrations. The result is retention of sodium bicarbonate and increased base bicarbonate. Nursing management includes documenting all presenting signs and symptoms to provide accurate baseline data, monitoring laboratory values, comparing ABG findings with previous results (if any), maintaining accurate intake and output records to monitor fluid status, and implementing prescribed medical therapy.
The nurse observes that a client with a history of panic attacks is hyperventilating. What action should the nurse take? Have the client breathe into a paper bag. Tell the client to take several deep, slow breaths and exhale normally. Instruct the client to put the head between the knees. Give the client a low concentration of oxygen by nasal cannula.
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 the head between the knees, giving the client low concentrations of oxygen, or having the client take deep, slow breaths and exhaling normally.
Which physical sensation will the client who has had an abdominal hysterectomy most likely experience if she hyperventilates while performing deep-breathing exercises? mental confusion dizziness dyspnea blurred vision
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.
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? heart and lungs kidneys and liver pancreas and heart lungs and kidneys
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.
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. increased hunger muscle discomfort dizziness tingling in the fingertips headache hyperventilation
muscle discomfort dizziness hyperventilation
The nurse is interpreting blood gases for a client with acute respiratory distress syndrome (ARDS). Which set of arterial blood gas values does the nurse expect for this client? pH 7.25, PaCO2 48, HCO3 24 pH 7.30, PaCO2 28, HCO3 16 pH 7.29 PaCO2 36, HCO3 19 pH 7.35, PaCO2 46, HCO3 30
pH 7.25, PaCO2 48, HCO3 24 Explanation: The nurse would expect a client with ARDS to exhibit respiratory acidosis. The results of pH 7.25, PaCO2 48, HCO3 24 indicate respiratory acidosis. Results of pH 7.29, PaCO2 36, HCO3 19 indicate metabolic acidosis and results of pH 7.30, PaCO2 28, HCO3 16 indicate metabolic acidosis with partial compensation, which would be expected in a client with a metabolic problem such as diabetic ketoacidosis. Results of pH 7.35, PaCO2 46, HCO3 30 indicate fully compensated respiratory acidosis, which would be expected for client with a chronic respiratory problem.
Arterial blood gas analysis would reveal which finding related to acute respiratory failure? PaO2 80 mm Hg pH 7.35 pH 7.24 PaCO2 32 mm Hg
pH 7.24 Explanation: Acute respiratory failure (ARF) is defined as a 1) ↓ in arterial oxygen tension (PaO2) < 50 mm Hg (hypoxemia) 2) ↑ in arterial carbon dioxide tension (PaCO2) > 50 mm Hg (hypercapnia), & a ↓ arterial pH.
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 pH: 7.32, PaCO2: 40 mm Hg, HCO3-: 18 mEq/L pH: 7.42, PaCO2: 45 mm Hg, HCO3-: 22 mEq /L pH: 7.50, PaCO2: 30 mm Hg, HCO3-: 24 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.
A client comes to the emergency department with status asthmaticus. The client's respiratory rate is 48 breaths/minute, and the client 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 acidosis respiratory alkalosis metabolic acidosis metabolic 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.
A client with a longstanding diagnosis of generalized anxiety disorder presents to the emergency room. The triage nurse notes upon assessment that the patient is hyperventilating. The triage nurse is aware that hyperventilation is the most common cause of: acute CNS disturbances. increased PaCO2. metabolic acidosis. respiratory alkalosis.
respiratory alkalosis. Explanation: Extreme anxiety can lead to hyperventilation, which is the most common cause of acute respiratory alkalosis. Hyperventilation may be a response to metabolic acidosis, as the body attempts to rid itself of excess CO2; hyperventilation does not cause metabolic acidosis. Increased CO2 levels are associated with acidosis, not alkalosis. There are a number of potential causes of acute CNS disturbances.
A client has been diagnosed with metabolic alkalosis. The nurse should anticipate what finding from the client's arterial blood gases? pH 7.26 pH 7.30 serum bicarbonate of 28 mEq/L serum bicarbonate of 21 mEq/L
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 client has been diagnosed with metabolic alkalosis. The nurse should anticipate what finding from the client's arterial blood gases? pH 7.26 serum bicarbonate of 21 mEq/L serum bicarbonate of 28 mEq/L pH 7.30
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.
As status asthmaticus worsens, the nurse would expect the client to experience which acid-base imbalance? respiratory acidosis metabolic alkalosis respiratory alkalosis metabolic acidosis
respiratory acidosis Explanation: As status asthmaticus worsens, the PaCO increases and the pH decreases, reflecting respiratory acidosis.
A nurse is reviewing arterial blood gas results on an assigned client. The pH is 7.32 with PCO2 of 49 mm Hg and a HCO3−of 28 mEq/L. The nurse reports to the physician which finding? metabolic alkalosis respiratory acidosis respiratory alkalosis metabolic acidosis
respiratory acidosis Explanation: Respiratory acidosis would be reported to the physician citing the lab values. Analysis of the blood gases reveals that the client is acidotic with a pH under 7.35. Also noted is the PCO2above the normal range of 30 to 40 mm Hg. The HCO3− is slightly elevated because the normal level is 22 to 26 mEq/L.
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? metabolic acidosis respiratory acidosis respiratory alkalosis metabolic alkalosis
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 options.
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 respiratory alkalosis. metabolic alkalosis. respiratory acidosis. metabolic acidosis.
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 with respiratory acidosis is admitted to the intensive care unit for close observation. The nurse should stay alert for which complication associated with respiratory acidosis? hyperglycemia shock stroke seizures
shock Complications of respiratory acidosis include shock and cardiac arrest. Seizures may complicate respiratory alkalosis
A client has been diagnosed with an intestinal obstruction and has a nasogastric tube set to low continuous suction. Which acid-base disturbance is this client at risk for developing? respiratory alkalosis metabolic alkalosis metabolic acidosis respiratory acidosis
metabolic alkalosis Explanation: Metabolic alkalosis is a clinical disturbance characterized by a high pH and a high plasma bicarbonate concentration. The most common cause of metabolic alkalosis is vomiting or gastric suction with loss of hydrogen and chloride ions. Gastric fluid has an acid pH, and loss of this acidic fluid increases the alkalinity of body fluids.
The nurse assesses an adolescent client with lethargy, retractions of the intercostal spaces, a persistent expiratory wheeze, diminished breath sounds, tachycardia, and tachypnea. Arterial blood gas results are pH 7.10; PCO2 80 mm Hg (10.64 kPa); PO2 35 mm Hg (4.66 kPa), HCO3 29 mEq/l (29 mmol/l). What is the priority condition the nurse must address? change in mental status breathing pattern increased heart rate respiratory acidosis
respiratory acidosis Labs show resp acid: The nurse must address this quickly because it could lead to respiratory failure. If the nurse addresses the respiratory acidosis quickly, which means also addressing the cause of the imbalance, the client may not experience respiratory failure. Additionally, assessment data, vital signs, and laboratory work will begin to normalize.
A client's arterial blood gas analysis reveals an excess of carbon dioxide. The nurse should recognize that this is consistent with which condition? metabolic alkalosis respiratory acidosis metabolic acidosis respiratory alkalosis
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.
