Acid base balance EAQ

A 4-month-old infant is brought to the emergency department after 2 days of diarrhea. The infant is listless and has sunken eyeballs, a depressed anterior fontanel, and poor tissue turgor. The infant's breathing is deep, rapid, and unlabored. The mother states that the infant has had liquid stools and no obvious urine output. What problem does the nurse conclude that the infant is experiencing?

Metabolic acidosis (occurs with loss of alkaline fluid through diarrhea and is manifested by lethargy and Kussmaul breathing; all assessments indicate severe dehydration.)

Which priority nursing intervention would the nurse implement for a client on diuretic therapy who has developed metabolic alkalosis? a) fall prevention measures b) Monitoring electrolytes c) Administering antiemetics d) Adjusting the diuretic therapy

a) fall prevention measure A client with alkalosis has hypotension and muscle weakness, which increases the risk for injury due to falls; therefore, to prevent injury, the priority nursing care is to prevent falls. Monitoring electrolytes daily until they return to normal is not the priority nursing care. Antiemetics are prescribed for vomiting and are given low priority. Once the client is protected from the risk for injury, diuretic therapy is adjusted.

which manifestation would the nurse include when teaching the client about ketoacidosis? Sata A. Confusion B. Hyperactivity C. excessive thirst D. fruity scented breath E. Decrease urinary output

A, C, D

When ammonia is excreted by healthy kidneys, what mechanism usually is maintained? a. osmotic pressure of the body b. acid-base balance of the body c. low bacterial levels in the urine d. normal red blood cell production

b. acid-base balance of the body excreted ammonia combines with hydrogen ions in the glomerular filtrate to form ammonium ions, which are excreted from the body. mechanism helps rid the body of excess hydrogen, maintaining the a-b balance

A client arrives in the emergency department with epigastric pain and prolonged vomiting. Assessment findings include rapid and shallow respirations, dry and flushed skin, weakness, and lethargy. Which is the primary nursing concern?

metabolic alkalosis

How can the nurse prevent vomiting in a client who reports feeling nauseated after cataract surgery?

Administer the prescribed antiemetic medication

Which statement made by the nurses accurate about the manifestation of alkalosis in the central nervous system? SATA A:"The client's Chvostek sign would be negative." B:"The client's Trousseau sign would be positive." C:"The client would be suffering from paresthesias." D:"The client would show signs of anxiety and irritability." E:"The client's central nervous system should have a decrease activity in case alkalosis."

B C D

Which assessment finding would the nurse associate with a client with DKA? Select all that apply. A. Diaphoresis B. Retinopathy C. Acetone breath D. Increased arterial bicarbonate level E. Decreased arterial carbon dioxide level

C, E

The nurse determined a client's arterial blood gases reflected a compensated respiratory acidosis. The pH was 7.34; which additional laboratory value did the nurse consider? A. partial pressure of oxygen (PO 2) value is 80 mm Hg B. partial pressure of carbon dioxide value is 60 mm hg C. bicarbonate value is 50 mEq/L D. Serum potassium value is 4 mEq/L

C. bicarbonate (HCO 3) value is 50 mEq/L (50 mmol/L)(The HCO 3 value is elevated. The urinary system compensates by retaining hydrogen (H +) ions, which become part of the bicarb ions; the bicarb level becomes elevated and increases pH level to near expected range)

A nurse is caring for a client after abdominal surgery and encourages the client to turn from side to side and to engage in deep-breathing exercises. What complication is the nurse trying to prevent? A. Metabolic acidosis B. Metabolic alkalosis C. Respiratory acidosis D. Respiratory alkalosis

C. Respiratory acidosis (Shallow respirations, bronchial tree obstruction, and atelectasis compromise gas exchange in the lungs; an increased carbon dioxide level leads to respiratory acidosis.)

A critically ill 5-year-old child exhibits Kussmaul respirations. The nurse suspects an increasing acid-base imbalance related to what condition? Metabolic alkalosis caused by an increase in base bicarbonate Respiratory alkalosis caused by excess carbon dioxide output Respiratory acidosis caused by an accumulation of carbon dioxide Metabolic acidosis caused by a concentration of cations in body fluids

Metabolic acidosis cause by a concentration of cations in body fluids

Which is the regulator of extracellular osmolarity?

Sodium Potassium is the major intracellular osmolarity regulator, and it also regulates metabolic activities, transmission and conduction of nerve impulses, cardiac conduction, and smooth and skeletal muscle contraction Chloride is a major extracellular anion and follows sodium Calcium is an extracellular cation necessary for bone and teeth formation, blood clotting, hormone secretion, cardiac conduction, transmission of nerve impulses, and muscle contraction

A 9-year-old child with type 1 diabetes is admitted to the hospital with deep, rapid respirations; flushed, dry cheeks; abdominal pain with nausea; and increased thirst. What laboratory findings is the nurse most likely to observe? pH 7.25; glucose 60 mg/dL (3.3 mmol/L) pH 7.50; glucose 60 mg/dL (3.3 mmol/L) pH 7.25; glucose 460 mg/dL (25.5 mmol/L) pH 7.50; glucose 460 mg/dL (25.5 mmol/L)

pH 7.25; glucose 460 mg/dL (25.5 mmol/L)

which information would the nurse include when teaching a client a client about the administration of ranitidine? 1 Ranitidine increases gastrointestinal peristalsis. 2 Ranitidine reduces gastric acidity in the stomach. 3 Ranitidine neutralizes the acid that is present in the stomach .4 Ranitidine stops production of hydrochloric acid in the stomach

2

A nurse is caring for a toddler with severe dehydration and its associated acid-base imbalance. What compensatory mechanism within the body is activated to counteract the effects of the child's acid-base imbalance?

Increased respiratory rate b/c the child has metabolic acidosis; the lungs compensate by blowing off excess carbonic acid in the form of carbon dioxide.

The nurse providing postoperative care for a client who had kidney surgery reviews the client's urinalysis results. Which urinary finding should the nurse conclude needs to be reported to the primary healthcare provider?

Presence of large proteins

What is the origin of the metabolic acidosis caused by aspirin toxicity?

Rapid absorption of salicylate

A client has a fractured mandible that is immobilized with wires. For which life-threatening postoperative problem should the nurse monitor this client? Infection Vomiting Osteomyelitis Bronchospasm

Vomiting Vomiting may result in aspiration of vomitus, because it cannot be expelled; this may cause pneumonia or asphyxia. Infection, osteomyelitis, and bronchospasm generally are not life-threatening problems.

Which initial change in acid-base balance will the nurse expect when a client is in the progressive stage of shock? a) Metabolic acidosis b) Metabolic alkalosis c) Respiratory acidosis d) Respiratory alkalosis

a) Metabolic acidosis Metabolic acidosis occurs during the progressive stage of shock as a result of accumulated lactic acid. Metabolic alkalosis cannot occur with the buildup of lactic acid. As shock progresses, eventually respiratory acidosis can result from decreased respiratory function in late shock. Respiratory alkalosis may occur as a result of hyperventilation during early shock.

Which is an independent nursing action that should be included in the plan of care for a client after an episode of ketoacidosis?

Monitoring for signs of hypoglycemia as a result of treatment RationaleDuring treatment for acidosis, hypoglycemia may develop; careful observation for this complication should be made by the nurse. Withholding all glucose may cause insulin coma. Whole milk and fruit juices are high in carbohydrates, which are contraindicated immediately following ketoacidosis. The regulation of insulin depends on the prescription for coverage; the prescription usually depends on the client's blood glucose level rather than ketones in the urine.

Which condition will improve if an intravenous IV solution of lactated ringer solution to replace the T tube output of a client who had a cholecystectomy and a common bile duct exploration is effective? -Urinary stasis -Paralytic ileus -Metabolic acidosis -Increased potassium level

metabolic acidosis Lactated Ringers is an alkaline solution that replaces bicarbonate ions lost from T-tube bile drainage, thus preventing or treating acidosis. Urinary stasis is unrelated to the effectiveness of the administration of intravenous lactated Ringers solution. Paralytic ileus is unrelated to the effectiveness of the administration of intravenous lactated Ringers solution. An increased potassium level is unrelated to the effectiveness of the administration of intravenous lactated

A client is transferred to the postanesthesia care unit after abdominal surgery. The client begins vomiting. What nursing action is most important when caring for this client? A. Turning the client onto the side B. Measuring the amount of vomitus C. Checking the wound for dehiscence D. Administering the prescribed antiemetic to the client

A. The side-lying position promotes drainage of emesis and secretions from the mouth, reducing the risk of aspiration. Although accurate assessment of intake and output is important, prevention of aspiration is the priority. Dehiscence is not probable at this time; it is more common five to seven days after surgery. Although the antiemetic may prevent additional vomiting, the nurse's priority is to prevent aspiration.

Which type of acid-base imbalance would the nurse expect in a child admitted with a severe asthma exacerbation? A. Metabolic acidosis caused by excessive production of acid metabolites B. respiratory alkalosis caused by accelerated respirations and loss of carbon dioxide C. respiratory acidosis caused by impaired respirations and increased formation of carbonic acid D. metabolic acidosis caused by the kidneys inability to compensate for increased carbonic acid formation

C. Respiratory acidosis caused by impaired respirations and increased formation of carbonic acid (restricted ventilation accompanying an asthma attack limits body's ability to blow off CO2, as CO2 accumulates in body fluids, it reacts w water to make carbonic acid; the result is respiratory acidosis)

A client is hospitalized after four days of epigastric pain, nausea, and vomiting. The nurse reviews the laboratory test results: plasma pH 7.51, Pco2 50 mm Hg, bicarbonate 58 mEq/L (58 mmol/L), chloride 55 mEq/L (55 mmol/L), sodium 132 mEq/L (132 mmol/L), and potassium 3.8 mEq/L (3.8 mmol/L). What condition does the nurse determine the results to indicate?

Metaboloic Alkalosis

A client with chronic obstructive pulmonary disease (COPD) has a blood pH of 7.25 and PCO2 of 60 mm Hg. These blood gases require nursing attention because they indicate which condition? 1. Metabolic acidosis 2. Metabolic alkalosis 3. Respiratory acidosis 4. Respiratory alkalosis

3. Respiratory acidosis Rationale:The normal blood pH range is 7.35 to 7.45; therefore, a blood pH of 7.25 indicates acidosis. The parameter for respiratory function is CO2 and the acceptable range of arterial PCO2 is 35 to 45 mm Hg; therefore, 60 mm Hg is elevated, resulting in respiratory acidosis. HCO3 is the parameter for metabolic functions. A pH of 7.25 is acidic, indicating acidosis and not alkalosis.

The arterial blood gases for a client with acute respiratory distress are pH 7.30, PaO2 80 mm Hg (10.64 kPa), PaCO2 55 mm Hg (7.32 kPa), and HCO3 23 mEq/L (23 mmol/L). How would the nurse interpret these findings? a) Hypoxemia b) Hypocapnia c) Compensated metabolic acidosis d) Uncompensated respiratory acidosis

d) Uncompensated respiratory acidosis The increased PaCO2 indicates respiratory acidosis and the low pH indicates that the respiratory acidosis is uncompensated. The PaO2 is normal, indicating that the client is not hypoxemic. The elevated PaCO2 indicates hypercapnia. The HCO3 is normal, indicating that there is no metabolic acidosis.

Which statements are true regarding the pharmacokinetic changes observed in infants? Select all that apply.. 1An infant's fat content is higher 2An infant's gastric pH is less acidic 3An infant's gastric emptying is slow 4An infant's first-pass metabolism is slow 5An infant's transdermal absorption is rapid

2 An infant's gastric pH is less acidic 3 An infant's gastric emptying is slow 4 An infant's first-pass metabolism is slow

A client is experiencing persistent vomiting, and serum electrolytes have been prescribed. The nurse should monitor which laboratory results? 1Sodium and chloride levels 2Bicarbonate and sulfate levels 3Magnesium and protein levels 4Calcium and phosphate levels

1 Sodium, which helps regulate the extracellular fluid volume, is lost with vomiting. Chloride, which balances cations in the extracellular compartment, also is lost with vomiting. Because sodium and chloride are parallel electrolytes, hyponatremia will accompany hypochloremia. Bicarbonate and sulfate levels, magnesium and protein levels, and calcium and phosphate levels do not provide significant information in relation to the effects of vomiting.

An infant with persistent diarrhea is subject to significant fluid and electrolyte alterations. Which physiologic imbalances would the nurse most likely encounter? Select all that apply. One, some, or all responses may be correct. 1Hypovolemia 2Hyperkalemia 3Hypercalcemia 4Metabolic acidosis 5Decreased hematocrit

1, 4 Fluid loss causes hypovolemia. Loss of bicarbonate and sodium in the stools causes metabolic acidosis. Potassium will be lost with diarrhea. Sodium may be increased, decreased, or unchanged. Hypercalcemia does not occur. The hematocrit is increased because of fluid loss (hemoconcentration).

What is the sequence of events that occurs in the child's respiratory response to acidosis? Place the physiological responses in the order in which they occur. - Hyperventilation -increased CO2 elimination -decreased blood H+ ions -Increased PH

1. Hyperventilation 2. Increased CO2 elimination 3. Decreased blood H+ ions 4. Increased pH Respiratory compensation to acidosis involves hyperventilation with increased CO2 elimination. As carbon dioxide is blown off there is a decrease in the hydrogen ions in the blood, leading to an increase in pH to expected limits.

An increase in which blood component is responsible for the acidosis related to untreated diabetes mellitus? 1. Ketones 2. Glucose 3. Lactic acid 4. Glutamic acid

1. Ketones

Which complication would the nurse monitor for when caring for an infant with intractable vomiting? 1 Acidosis 2 Alkalosis 3 Hyperkalemia 4 Hypernatremia

2 Alkalosis Excessive vomiting causes an increased loss of hydrogen ions (hydrochloric acid), leading to metabolic alkalosis, an excess of base bicarbonate. Acidosis is caused by retention of hydrogen ions and a loss of base bicarbonate, which is more likely to occur with diarrhea. Hypokalemia, not hyperkalemia, will occur. With the loss of chloride ions, hyponatremia is more likely to occur.

Which statement made by the client identifies a regulatory function of the kidneys? 1. Erythropoiesis 2. acid base balance 3. vitamin D activation 4. blood pressure control 5. fluid and electrolyte balance

2, 5

What effect of sodium bicarbonate is the nurse trying to prevent when teaching a client about the dangers of using sodium bicarbonate regularly? 1. Gastric distention 2. Metabolic alkalosis 3.Chronic constipation 4. Cardiac dysrhythmias

2. Metabolic alkalosis Prolonged use of sodium bicarbonate may cause systemic alkalosis, as well as retention of sodium and water.

For a client admitted with metabolic acidosis which two body systems would the nurse assess for compensatory changes? 1. Skeletal nervous 2. circulatory and urinary 3. respiratory and urinary 4. muscular and endocrine

3

Which blood gas report most likely reflects the acid-base balance of this infant? 1. pH of 7.50 and Pco 2 of 34 mm Hg. 2. pH of 7.23 and Pco 2 of 70 mm Hg 3. pH of 7.20 and HCO 3 - of 20 mEq/L (20 mmol/L) 4. pH of 7.56 and HCO 3 - of 30 mEq/L (30 mmol/L

3 Rationale: Low blood pH and bicarbonate levels indicate metabolic acidosis, which occurs with severe dehydration because the reduced urine output causes retention of hydrogen ions. The other options include findings that indicate respiratory alkalosis, respiratory acidosis, and metabolic alkalosis, respectively.

Which information would the nurse include in response to a client's questioning a protein-restricted dietary change required for his or her acute kidney injury? 1"A high-protein intake ensures an adequate daily supply of amino acids to compensate for losses." 2"Essential and nonessential amino acids are necessary in the diet to supply materials for tissue protein synthesis." 3"This diet supplies only essential amino acids, reducing the amount of metabolic waste products, thus decreasing stress on the kidneys." 4"Currently, your body is unable to synthesize amino acids, so the nitrogen for amino acid synthesis must come from the dietary protein."

3"This diet supplies only essential amino acids, reducing the amount of metabolic waste products, thus decreasing stress on the kidneys."

The assessment of a newly admitted client reveals malnourishment, nausea, distension, and a firm abdomen with ascites. The client has tachycardia and is hypotensive. Which physiological change occurred that resulted in the client's development of ascites?

A decrease in plasma protein to maintain adequate capillary-tissue circulation rationale: malnutrition and liver damage lead to reduced serum albumin level and failure of the capillary fluid shift mechanism resulting ascites.

Which statement made by the nurse about neuromuscular manifestations of alkalosis with hypocalcemia is correct? SATA A. "The client would show signs of twitching." B. "The client would show signs of hyporeflexia." C. "The client would show signs of paresthesias." D. "The client would show signs of muscle cramping." E. "The client would show signs of skeletal muscle weakness.

A. "The client would show signs of twitching." D. "The client would show signs of muscle cramping." E. "The client would show signs of skeletal muscle weakness.

A nurse is caring for a client who is vomiting. When caring for this client, the nurse considers the fact that the vomiting reflex follows a set pattern. List the following steps in the order that they occur 1.Contraction of abdominal muscles 2.Closure of the trachea to prevent aspiration 3.Initiation of reverse peristalsis in the stomach 4.Relaxation of the upper esophageal sphincter

Ans: 3, 1, 4, 2 Reverse peristalsis starts the sequence; with contraction of the abdominal muscles, gastric contents are propelled into the esophagus, and the upper esophageal sphincter relaxes so vomiting can occur. Finally, the trachea closes to prevent aspiration.

A client appears anxious, with respirations that are shallow and 40 per minute. The client reports feeling dizzy and light-headed and having tingling sensations of the fingertips and around the lips. What does the nurse determine is the probable cause of these clinical manifestations? A. Eupnea B. Hyperventilation C. Kussmaul respirations D. Carbon dioxide intoxication

B. Hyperventilation The client is hyperventilating and is blowing off excessive carbon dioxide, which leads to these symptoms; if uninterrupted, this can lead to respiratory alkalosis. Shortness of breath is a sign of dyspnea. There is no evidence that the client is having difficulty breathing. Kussmaul respirations are deep, gasping respirations associated with diabetic acidosis and coma, not hyperventilation associated with anxiety. These clinical manifestations are related to a decreased, not increased, carbon dioxide level in the body.

A high school student arrives at the local blood drive center to donate blood for the first time. As the site is being prepared for needle insertion, the student becomes agitated, starts to hyperventilate and complains of dizziness and tingling of the hands. Which would the nurse instruct the student to do?

Breathe into cupped hands Breathing into cup pans allow carbon dioxide to reenter the lungs which will increase the serum bicarbonate level relieving the respiratory alkalosis that is occurring as a result of hyperventilation

The nurse is caring for a client with the following arterial blood gas (ABG) values: PO2 89 mm Hg, PCO2 35 mm Hg, and pH of 7.37. These findings indicate that the client is experiencing which condition? A. Respiratory alkalosis B. Poor oxygen perfusion C. Normal acid-base balance D. Compensated metabolic acidosis

C All data are within expected limits; PO2 is 80 to 100 mm Hg, PCO2 is 35 to 45 mm Hg, and the pH is 7.35 to 7.45. None of the data are indicators of fluid balance, but of acid-base balance. Oxygen (PO2) is within the expected limits of 80 to 100 mm Hg. With respiratory alkalosis, the blood pH is greater than 7.45 and the PCO2 is greatly decreased. With metabolic acidosis, the pH is less than 7.35.

Which unique response associated with DKA that is not exhibited with hyperglycemic hyperosmolar nonketotic syndrome (HHNS) should the nurse identify when assessing this client? A. Fluid loss B. Glycosuria C. Kussmaul respirations D. Increased blood glucose level

C. Kussmaul respirations Kussmaul respirations occur in diabetic ketoacidosis (DKA) as the body attempts to correct a low pH caused by accumulation of ketones (ketoacidosis). HHNS affects people with type 2 diabetes who still have some insulin production; the insulin prevents the breakdown of fats into ketones. Fluid loss is common to both because an increased blood glucose level ultimately leads to polyuria. Glycosuria is common to both conditions. Hyperglycemia is common to both conditions.

An infant has been vomiting after each feeding. Physical assessment reveals poor skin turgor, a sunken anterior fontanel, and tremors. The infant's acid-base balance is outside the expected range. What does the nurse suspect as the cause of this imbalance? A: Retention of potassium in the cells B: Loss of fluid by way of the kidneys C: Loss of chloride ions through vomiting D: Reduction of blood supply to body cells

C: Loss of chloride ions through vomiting electrolyte deficits rather than urinary excretion precipitate an acid-base balance. loss of gastric secretions, which contain sodium chloride and potassium usually result in metabolic alkalosis.

which medication corrects for deleterious effects of anaerobic energy production when a client's cells are deprived of oxygen during a cardiac arrest? Regular insulin Calcium gluconate Potassium chloride Sodium bicarbonate

Sodium bicarbonate In the absence of oxygen, the body derives its energy anaerobically; this results in buildup of lactic acid. Sodium bicarbonate, an alkaline drug, will help neutralize the acid, raising the pH. Insulin is used to treat diabetes; it lowers blood sugar by facilitating transport of glucose across cell membranes. Calcium gluconate is used to treat hypocalcemia. Although potassium is essential for cardiac function, it will not correct acidosis. With acidosis, serum hydrogen ions will exchange with intracellular potassium, leading to a temporary hyperkalemic state; therefore, potassium chloride is contraindicated until acidosis is corrected.

which chemical buffers excessive acetoacetic acid?

Sodium bicarbonate Sodium bicarbonate is a base and one of the major buffers in the body. Potassium, a cation, is not a buffer; only a base can buffer an acid. Carbon dioxide is carried in aqueous solution as carbonic acid (H2CO3); an acid does not buffer another acid. Sodium chloride is not a buffer; it is a salt.

The nurse has 100 units regular insulin in 100-mL normal saline for infusion. There is a prescription to calculate the infusion rate based on the client's glucose levels using the formula: glucose mg/dL ÷ 100 = __ units/h. The client's glucose level is 350 mg/dL. The insulin will need to infuse at how many milliliters per hour?

The client's glucose = 350 mg/dL.350 ÷ 100 = 3.5 units/h. The pharmacy dispensed 100 units regular insulin in 100 mL normal saline. 100/100 = 1:1 ratio. Therefore 3.5 units/hour = 3.5 mL/h.

which conditions are cardiovascular manifestations of alkalosis? Increased HR Decreased HR widened QRA complex Increased digital toxicity Prolonged PR interval

increased heart rate and increased digitalis toxicity

Which complication does the nurse prevent by addressing the needs of a hyperventilating client? a. Cardiac arrest b. Carbonic acid deficit c. Reduction in serum pH d. Excess oxygen saturation

b. Carbonic acid deficit Hyperventilation causes excessive loss of carbon dioxide, leading to carbonic acid deficit and respiratory alkalosis.