Acid-Base Imbalances NCLEX (Ch55)

The nurse determines that a client with a nasogastric tube on low suction for five days is at risk for developing which acid-base imbalance? 1. Respiratory acidosis 2. Metabolic alkalosis 3. Metabolic acidosis 4. Respiratory alkalosis

2 A client who has prolonged nasogastric suction is apt to have higher levels of bicarbonate because of hydrogen ion loss. Bicarbonate excess leads to a metabolic disturbance and the development of metabolic alkalosis. Respiratory and metabolic acidosis are incorrect because the client will not experience acidosis. Respiratory alkalosis is incorrect because the primary disturbance is caused by retained levels of bicarbonate (not elimination of carbon dioxide) in the body.

A client is admitted to the hospital with sudden onset of severe abdominal pain. Which arterial blood gas (ABG) value would the nurse expect to see with this client? 1. PaCO2 48 2. HCO3- 18 3. pH 7.32 4. SaO2 90

2 Acute pain usually leads to hyperventilation, which causes CO2 to be blown off, leading to an increased pH and decreased CO2 level. If the client has not compensated, the bicarbonate level will be normal. If the client is compensating, then the bicarbonate level will decrease in an attempt to restore the pH. A PaCO2 of 48 is incorrect because it reflects a slight elevation; if the client were in severe pain, the level would likely be lower as the client would have increased respirations. A pH of 7.32 is incorrect because the pH is slightly acidotic. An SaO2 of 90 is incorrect because the oxygen saturation should be within normal limits.

A client is admitted with a diagnosis of renal failure. Which arterial blood gas (ABG) result would the nurse expect to see with this client? 1. pH 7.49; PaCO2 36; HCO3- 30 2. pH 7.30; PaCO2 35; HCO3- 18 3. pH 7.31; PaCO2 50; HCO3- 23 4. pH 7.43; PaCO2 48; HCO3- 30

2 Clients with renal failure have difficulty synthesizing HCO3- in the renal tubules secondary to the renal failure. These clients also retain K+, and subsequently develop metabolic acidosis. The ABG with the pH of 7.30 reflects uncompensated metabolic acidosis. The ABG with the pH of 7.49 is incorrect because it reflects metabolic alkalosis (increased pH and HCO3-) and normal PaCO2. The ABG with the pH of 7.31 is incorrect because it reflects respiratory acidosis (decreased pH, increased PaCO2) and normal HCO3-. The ABG with the pH of 7.43 is incorrect because it reflects a mixed acid-base imbalance metabolic alkalosis with a respiratory acidosis (normal pH, and increased PaCO2 and HCO3-)

A client is admitted to the hospital after vomiting for three days. Which arterial blood gas (ABG) result would the nurse expect? 1. pH 7.30; PaCO2 50; HCO3- 27 2. pH 7.47; PaCO2 43; HCO3- 28 3. pH 7.34; PaCO2 50; HCO3- 28 4. pH 7.48; PaCO2 30; HCO3- 23

2 Vomiting leads to the loss of hydrochloric acid from gastric acids. Hydrogen ions must leave the blood to replace this acidity in the stomach. Metabolic alkalosis occurs and is reflected by elevated pH and HCO3-, and normal PaCO2. The ABG with the pH of 7.30 is incorrect because it reflects respiratory acidosis with partial compensation (decreased pH, and elevated PaCO2 and HCO3-). The ABG with the pH of 7.34 is incorrect because it reflects a mixed acid-base imbalance (metabolic alkalosis with respiratory acidosis) with a normal pH, and elevated PaCO2 and HCO3-. The ABG with the pH of 7.48 is incorrect because it reflects respiratory alkalosis (increased pH, decreased PaCO2, and normal HCO3-)

The nurse would assess for which signs and symptoms in a client who has metabolic acidosis? Select all that apply. 1. Weight gain 2. Rapid, deep respirations 3. Drowsiness 4. Decreased respiratory rate and depth 5. Melena

2, 3 Clients who have metabolic acidosis develop Kussmaul's breathing (rapid and deep respirations). Drowsiness occurs because of the CNS depressant effect of acidosis. Weight gain is not an associated finding with metabolic acidosis. Shallow breathing is associated with the development of metabolic alkalosis. Melena (blood in stool) is not associated with metabolic acidosis.

The nurse is admitting a client who has metabolic alkalosis. The nurse plans to assess for manifestations of which electrolyte imbalance? Select all that apply. 1. Hypernatremia 2. Hypochloremia 3. Hypermagnesemia 4. Hypocalcemia 5. Hypokalemia

2, 4, 5 Clinical manifestations of metabolic alkalosis are associated with the presence of tetany-like symptoms. Clients should be monitored for the presence of these symptoms because they usually correlate with low levels of calcium. Hypomagnesemia (not hypermagnesmia) can occur with hypocalcemia. Hyponatremia, hypochloremia, and hypokalemia can occur with metabolic alkalosis.

Which statement by the client indicates that discharge teaching for respiratory alkalosis is understood? Select all that apply. 1. "I will not take so many antacids anymore." 2. "I will take a stress management class." 3. "I will not take my furosemide (Lasix) without taking my potassium supplement." 4. "I will tell the doctor the next time I have diarrhea for so long." 5. "I am more aware of how my breathing changes when I get nervous."

2, 5 Respiratory alkalosis is caused by hyperventilation, which can be caused by stress and anxiety, as examples. It is important that clients who are prone to develop respiratory alkalosis be aware of how to manage causative factors. Antacids and diuretics are associated with metabolic alkalosis. Diarrhea is associated with metabolic acidosis.

A client is admitted to the hospital. Arterial blood gas (ABG) results are pH 7.50; PaCO2 40; HCO3- 29. Which question should the nurse ask the client to help determine an etiology for these results? 1. "Have you had diarrhea lately?" 2. "Do you have a history of COPD?" 3. "How long have you had nausea and vomiting?" 4. "Do you smoke?"

3 ABG results reflect elevated pH, indicating alkalosis, and normal PaCO2 and an increased HCO3-, indicating metabolic alkalosis. Vomiting is a common cause of this condition. The presence of diarrhea is associated with metabolic acidosis. COPD is associated with respiratory acidosis. Smoking can be associated with respiratory acidosis if it leads to respiratory disease.

A client is admitted to the hospital with atelectasis and reports of chest pain. For which acid-base imbalance would the nurse assess this client? 1. Respiratory alkalosis 2. Metabolic acidosis 3. Metabolic alkalosis 4. Respiratory acidosis

4 A client with atelectasis has collapsed alveoli that retain CO2, which can lead to respiratory acidosis. The client most likely would have hypoventilation as a respiratory pattern, which would further contribute to the development of respiratory acidosis. Respiratory and metabolic alkalosis are incorrect because the client would not be in an alkalotic state. Metabolic acidosis is incorrect because the primary disturbance is respiratory.

A client has been admitted for dehydration after fasting for five days. For which acid-base imbalance would the nurse assess this client? 1. Metabolic acidosis 2. Metabolic alkalosis 3. Respiratory acidosis 4. Respiratory alkalosis

1 A prolonged fasting state can lead to dehydration. During fasting, the body reverts to cellular breakdown to maintain energy, and lactic and pyruvic acids build up in the body. This accumulation of acids leads to the development of metabolic acidosis. Metabolic and respiratory alkalosis are incorrect because alkalosis would not occur. Respiratory acidosis is incorrect because the primary disturbance is not respiratory.

The nurse would suspect that a client who frequently uses which medication is at risk for developing metabolic alkalosis? 1. Calcium carbonate (Tums) 2. Ibuprofen (Motrin) 3. Acetylsalicylic acid (aspirin) 4. Acetaminophen (Tylenol)

1 Excessive use of oral antacids can lead to metabolic alkalosis. Use of ibuprofen and Tylenol is not associated with the development of metabolic alkalosis. Overdoses of aspirin can be associated with the development of respiratory alkalosis, and eventually can lead to metabolic acidosis.

A client is admitted with severe diarrhea. Arterial blood gas (ABG) results are pH 7.33; PaCO2 42; HCO3- 20. The nurse concludes this client has which acid-base imbalance? 1. Uncompensated metabolic acidosis 2. Compensated respiratory acidosis 3. Compensated metabolic acidosis 4. Uncompensated respiratory acidosis

1 The pH and HCO3- are decreased, indicating metabolic acidosis. The PaCO2 is normal, indicating that compensatory mechanisms have not started working. Compensated or uncompensated respiratory acidosis is incorrect because the primary disturbance is metabolic, as indicated by the low bicarbonate level. Compensated metabolic acidosis is incorrect because with compensation, a decrease in PaCO2 to restore balance would be expected.

A client's arterial blood gas (ABG) results are pH 7.36; PaCO2 50; HCO3- 28. What do these results indicate to the nurse? 1. Compensated respiratory acidosis 2. Compensated metabolic acidosis 3. Uncompensated metabolic acidosis 4. Uncompensated respiratory acidosis

1 The pH is just within normal range, so the blood gas results are either normal or compensated. However, the PaCO2 is high, indicating a respiratory problem, and thus the ABGs cannot be normal. The HCO3- is also high, which along with a normal pH indicates complete compensation. The metabolic acidosis options are incorrect because the primary disturbance is respiratory, as reflected by the correlation between an elevated PaCO2 and a pH toward the low end of normal. Uncompensated respiratory acidosis is incorrect because the HCO3- level would be normal if no compensation is taking place.

A client is admitted to the hospital with a diagnosis of respiratory acidosis secondary to overdose of barbiturates. Which assessment would the nurse anticipate? Select all that apply. 1. Slow, shallow respirations 2. Tetany symptoms 3. Increased deep tendon reflexes 4. Palpitations 5. Headache

1, 5 Clients with respiratory acidosis from ingestion of barbiturates would have slow and shallow respirations, leading to hypoventilation. Tetany symptoms, increased deep tendon reflexes, and palpitations are associated with respiratory alkalosis. Headache is associated with respiratory acidosis because the increased CO2 level causes cerebral vasodilation, which leads to headache.

Which client medication should the nurse review first for its potential interaction in a client admitted to the hospital in a state of alkalosis? 1. Warfarin (Coumadin) 2. Metformin (Glucophage) 3. Digoxin (Lanoxin) 4. Ibuprofen (Motrin)

3 Alkalosis, especially respiratory alkalosis, makes the client more sensitive to the effects of digoxin; toxicity can develop even at therapeutic levels. A serum digoxin level should be obtained, and the client evaluated for potential digoxin toxicity. Warfarin affects clotting factors. Metformin can cause the development of lactic acidosis. Ibuprofen can cause gastric irritation.

A client's arterial blood gas (ABG) results are pH 7.48; PaCO2 30; HCO3- 23. How will the nurse interpret these results? 1. Compensated respiratory alkalosis 2. Uncompensated metabolic alkalosis 3. Uncompensated respiratory alkalosis 4. Compensated metabolic alkalosis

3 The client's pH is high, indicating alkalosis. The PaCO2 is abnormal, indicating a respiratory basis. The HCO3- is normal, indicating that compensation has not started. Compensated respiratory alkalosis is incorrect because the HCO3- level would decrease with compensation. Uncompensated metabolic alkalosis is incorrect because the primary disturbance is respiratory, as indicated by the decrease in the CO2 parameter. Compensated metabolic alkalosis is incorrect because the primary disturbance is respiratory, as indicated by the decrease in the CO2 parameter.

The following arterial blood gas (ABG) results are on the client's chart: pH 7.50; PaCO2 36; HCO3- 30. How will the nurse interpret this report? 1. Partially compensated metabolic alkalosis 2. Compensated respiratory alkalosis 3. Uncompensated metabolic alkalosis 4. Uncompensated respiratory alkalosis

3 The pH indicates alkalosis; HCO3- is high, indicating a metabolic origin, and the PaCO2 is normal, which indicates that compensation has not taken place. Partially compensated metabolic acidosis is incorrect because with compensation, the PaCO2 level would be increased. Compensated and uncompensated respiratory alkalosis options are incorrect because the primary disturbance is metabolic, as reflected by the increased bicarbonate level.

A client is admitted to the hospital with an acid-base imbalance. Arterial blood gas (ABG) results are pH 7.33; PaCO2 49; HCO3- 28. How would the nurse interpret these results? 1. Uncompensated respiratory acidosis 2. Metabolic alkalosis, uncompensated 3. Partially compensated respiratory acidosis 4. Partially compensated metabolic acidosis

3 The pH is low, indicating acidosis; the PaCO2 is elevated, indicating a respiratory basis; and the HCO3- is elevated, indicating that compensatory mechanisms are partially working. Uncompensated respiratory acidosis is incorrect because compensation is taking place due to increased HCO3- level. Uncompensated metabolic alkalosis is incorrect because the client is not alkalotic. Partially compensated metabolic acidosis is incorrect because the primary disturbance is respiratory. The change in the PaCO2 level is greater than the change in the HCO3- level, which indicates a respiratory disturbance.

A client is admitted to the hospital with respiratory acidosis. The nurse considers that which condition could be an etiology for this state? Select all that apply. 1. Severe diarrhea for several days 2. Diabetic ketoacidosis 3. Obesity 4. Diuretics 5. Sedative overdose

3, 5 Obesity can lead to chest wall abnormalities and hypoventilation, which can lead to respiratory acidosis. Sedative overdose depresses the central nervous system, which leads to hypoventilation and respiratory acidosis. Prolonged diarrhea can lead to the development of metabolic acidosis. DKA leads to the development of metabolic acidosis. Diuretic administration leads to the development of metabolic alkalosis.

A client is admitted to the hospital with numerous epiodes of muscle weakness and twitching. Arterial blood gas (ABG) results are pH 7.44; PaCO2 49; HCO3- 30. How would the nurse interpret these findings? 1. Uncompensated metabolic acidosis 2. Compensated respiratory alkalosis 3. Uncompensated respiratory alkalosis 4. Compensated metabolic alkalosis

4 The pH is just below the high limit, and the HCO3- is elevated, indicating a metabolic problem. The PaCO2 is elevated, indicating compensation, so the correct interpretation is compensated respiratory alkalosis. Uncompensated metabolic acidosis is incorrect because the client is not acidotic. Compensated respiratory alkalosis is incorrect because the CO2 would be decreased rather than elevated. Uncompensated respiratory alkalosis is incorrect because the primary disturbance is metabolic, and the CO2 is elevated rather than decreased.