NURS 309 Acid-Base

A client is in a state of uncompensated acidosis. What approximate arterial blood pH does the nurse expect the client to have? A. 7.20 B. 7.35 C. 7.45 D. 7.48

A. 7.20

Which system should be assessed first for a patient at risk for acidosis? A. Cardiovascular system B. Neuromuscular system C. Central nervous system D. Respiratory system

A. Cardiovascular system

Which signs and symptoms would the nurse expect to assess in a patient with metabolic acidosis? SATA A. Kussmaul respirations B. Shallow, rapid respirations C. Warm, flushed skin D. Skin pale to cyanotic E. Elevated PaCO2 F. Decreased bicarbonate

A. Kussmaul respirations C. Warm, flushed skin F. Decreased bicarbonate

Which patient is most likely to have a decrease in bicarbonate? A. Patient with pancreatitis B. Patient with hypoventilation C. Patient who is vomiting D. Patient with emphysema

A. Patient with pancreatitis

A client is admitted to the oncology unit for chemotherapy. To prevent an acid-base problem, which finding would the nurse instruct the unlicensed assistive personnel (UAP) to report? A. Repeated episodes of nausea and vomiting B. Reports of pain associated with exertion C. Failure to eat all the food on the breakfast tray D. Client hair loss during morning bath

A. Repeated episodes of nausea and vomiting

Which arterial blood gas (ABGs) results indicate that a patient's acid-base imbalance is a respiratory acidosis? SATA A. pH 7.31 B. PaCO2 58 mm Hg C. Bicarbonate 17 mEq/L D. PaO2 75 mm Hg E. Serum potassium 4.5 mEq/L F. PaCO2 31 mm Hg

A. pH 7.31 B. PaCO2 58 mm Hg D. PaO2 75 mm Hg

Which blood pH value does the nurse interpret as within normal limits? A. 7.27 B. 7.37 C. 7.47 D. 7.5

B. 7.37

The nurse is testing the muscle strength of a patient at risk for acid-base imbalance. Which technique does the nurse use to test arm strength? A. Asks the patient to hold the arms straight out in front, and the nurse observes for drift B. Asks the patient to squeeze the nurse's hand C. Asks the patient to pick up an object that weighs at least 10 lb D. Tries to separate the patient's clasped hands

B. Asks the patient to squeeze the nurse's hand

The nurse is admitting a patient with acute kidney injury to the medical unit. Which ABG results would she expect for this patient? A. Respiratory acidosis B. Metabolic acidosis C. Respiratory alkalosis D. Metabolic alkalosis

B. Metabolic acidosis

Which statement about compensation for acid-base imbalance is accurate? A. The respiratory system is less sensitive to acid-base changes B. The respiratory system can begin compensation within seconds to minutes C. The renal system is less powerful than the respiratory system D. The renal system is more sensitive to acid-base changes

B. The respiratory system can begin compensation within seconds to minutes

What arterial blood gas results would the nurse interpret as within normal limits? A. pH 7.28, PaCO2 24, bicarbonate 15, PaO2 95 B. pH 7.45, PaCO2 41, bicarbonate 25, PaO2 97 C. pH 7.35, PaCO2 24, bicarbonate 15, PaO2 95 D. pH 7.30, PaCO2 66, bicarbonate 38, PaO2 70

B. pH 7.45, PaCO2 41, bicarbonate 25, PaO2 97

Which ABG results would the nurse interpret as metabolic alkalosis? A. pH 7.30, PaCO2 66, bicarbonate 38, PaO2 70 B. pH 7.45, PaCO2 41, bicarbonate 25, PaO2 97 C. pH 7.35, PaCO2 24, bicarbonate 15, PaO2 95 D. pH 7.30, PaCO2 66, bicarbonate 38, PaO2 70

B. pH 7.45, PaCO2 41, bicarbonate 25, PaO2 97

What is the priority intervention for a patient with diabetic ketoacidosis? A. Administer bicarbonate B. Administer oxygen C. Administer insulin D. Administer potassium

C. Administer insulin

To ensure safety of a patient with metabolic alkalosis, which task is best delegated to the unlicensed assistive personnel (UAP)? A. Watch the patient when he or she eats or drinks anything B. Sit with the patient to prevent wandering C. Assist the patient to the bathroom as needed D. Remove all sharp objects from the bedside table

C. Assist the patient to the bathroom as needed

Which patient is most likely to develop respiratory alkalosis? A. Hypoxic patient B. Patient with a body cast C. Fearful patient having a panic attack D. Morbidly obese patient

C. Fearful patient having a panic attack

The nurse reviews the electrocardiogram (ECG) and cardiovascular status of a patient. Which findings are early changes associated with acidosis? A. Decreased heart rate with hypertension B. Hypotension and faint peripheral pulses C. Increased heart rate and increased cardiac output D. Peaked T waves and wide QRS complexes

C. Increased heart rate and increased cardiac output

The nurse is caring for a patient with excessive alcohol ingestion and salicylate intoxication. What is the most likely acid-base imbalance this patient will have? A. Bicarbonate underelimination B. Bicarbonate loss C. Metabolic acidosis D. Metabolic Alkalosis

C. Metabolic acidosis

A patient has taken antacids for the past 3 days to relieve "heartburn." What alteration in acid-base balance would the nurse expect for this patient? A. Respiratory alkalosis B. Metabolic acidosis C. Metabolic alkalosis D. Respiratory acidosis

C. Metabolic alkalosis

A patient's arterial blood gas (ABG) results show an increase in pH. Which condition is most likely to contribute to this laboratory value? A. Mechanical ventilation B. Diabetic ketoacidosis C. Nasogastric suction D. Diarrhea

C. Nasogastric suction

Which occurrence can be a result of hyperventilation? A. Hypocalcemia B. Anxiety C. Respiratory alkalosis D. Respiratory acidosis

C. Respiratory alkalosis

Which nursing assessment finding indicates a worsening of respiratory acidosis? A. Decreased respiratory rate B. Decreased blood pressure C. Use of accessory respiratory muscles D. Pale nail beds

C. Use of accessory respiratory muscles

Which arterial blood gas (ABG) value indicates an alkaline condition? A. PaCO2= 66 B. Bicarbonate= 16 C. pH= 7.55 D. pH= 7.32

C. pH= 7.55

Which body pH level can be fatal? A. 7.22 B. 7.11 C. 7.05 D. 6.85

D. 6.85

A patient's ABG results reveal respiratory acidosis. How does the body compensate for this imbalance? A. Loss of bicarbonate B. Regular, unlabored respirations C. Hypoventilation D. Renal reabsorption of bicarbonate

D. Renal reabsorption of bicarbonate

A patient has had diarrhea for the past 2 days. Which acid-base abnormalities would the nurse monitor for? SATA A. Overelimination of bicarbonate B. Respiratory alkalosis C. Metabolic acidosis D. Underelimination of hydrogen ions E. Overproduction of hydrogen ions F. Elevated potassium

A. Overelimination of bicarbonate C. Metabolic acidosis

Which patient is most likely to develop respiratory acidosis? A. Patient who is anxious and breathing rapidly B. Patient with multiple rib fractures C. Patient with IV normal saline bolus D. Patient with increased urinary output

B. Patient with multiple rib fractures

Which type of medication increases older adult patient's risk for acid-base imbalance? A. Antilipidemics B. Hormonal therapy C. Diuretics D. Antidysrhythmics

C. Diuretics

Which assessment finding indicates that a patient with chronic respiratory acidosis is responding favorably to treatment? A. Nail beds pale, extremities cool B. Respiratory stridor with inspiration C. Expectorating clear, thin mucus D. Diffuse crackles auscultated bilaterally

C. Expectorating clear, thin mucus

A client is admitted with metabolic acidosis. The nurse considers that two body systems interact with the bicarbonate buffer system to preserve healthy body fluid pH. What two body systems should the nurse assess for compensatory changes? A. Skeletal and nervous B. Circulatory and urinary C. Respiratory and urinary D. Muscular and endocrine

C. Respiratory and urinary

The nurse is admitting an older adult client to the acute care medical unit. Which assessment factor alerts the nurse that this client has a risk for acid-base imbalance? A. History of myocardial infarction (MI) 1 year ago B. Antacid use for occasional indigestion C. Shortness of breath with extreme exertion D. Chronic renal insufficiency

D. Chronic renal insufficiency

Which type of electrolyte imbalance does the nurse expect to see in a patient with metabolic alkalosis? A. Hyperkalemia B. Hypophosphatemia C. Hyperchloremia D. Hypocalcemia

D. Hypocalcemia

The student nurse, under the supervision of an RN, is reviewing a client's arterial blood gas results and notes an acute increase in arterial partial pressure of carbon dioxide to 51 mm Hg compared with the previous results. Which statement by the student nurse indicates accurate understanding of acid-base balance for this client? A. "When the PaCO2 is acutely elevated, the blood pH should be lower than normal" B. "This client should be taught to breath and rebreathe in a paper bag" C. "An elevated PaCO2 always means the client has an acidosis" D. "When a client's PaCO2 is increased, the respiratory rate should decrease to compensate

A. "When the PaCO2 is acutely elevated, the blood pH should be lower than normal"

The nurse is complete a history for an older client at risk for an acidosis imbalance. Which questions would the nurse be sure to ask? SATA A. "Which drugs do you take on a daily basis?" B. "Do you have any problems with breathing?" C. "When was your last bowel movement? D. "Have you experienced any activity intolerance or fatigue in the past 24 hours?" E. "Over the past month have you had any dizziness or tinnitus?" F. "Do you have episodes of drowsiness or decreased alertness?"

A. "Which drugs do you take on a daily basis?" B. "Do you have any problems with breathing?" D. "Have you experienced any activity intolerance or fatigue in the past 24 hours?" F. "Do you have episodes of drowsiness or decreased alertness?"

The nurse is providing care for several clients who are at risk for acid-base imbalance. Which client is most at risk for respiratory acidosis? A. A 68-year-old client with chronic emphysema B. A 58-year-old client who uses antacids every day C. A 48-year-old client with an anxiety disorder D. A 28-year-old client with salicylate intoxication

A. A 68-year-old client with chronic emphysema

Changes from normal pH can have what effects on which body functions? SATA A. Alter fluid and electrolyte balance B. Increase effectiveness of drugs C. Reduce function of hormones D. Increase function of enzymes E. Increase excitability of the heart muscle F. Cause increased activity of the GI tract

A. Alter fluid and electrolyte balance C. Reduce function of hormones E. Increase excitability of the heart muscle F. Cause increased activity of the GI tract

The nurse assesses an acidotic patient's lower extremities for strength as part of the nursing shift assessment. What finding does the nurse expect to see? A. Bilateral weakness B. Weakness on the dominant side C. No change from baseline D. Cramping, but no weakness

A. Bilateral weakness

The nurse is interpreting the arterial blood gas (ABG) results of a patient with acute respiratory insufficiency. As the PaCO2 level increases, which result would the nurse expect? A. Decreased pH B. Decreased bicarb C. Increased PaO2 D. Increase pH

A. Decreased pH

A patient who has a decreased amount of hydrogen ions and a decreased amount of carbon dioxide in the body will have what response? A. Decreased rate and depth of respirations B. Decreased renal absorption of hydrogen ions C. Increased rate and depth of respirations D. Decreased renal excretions of bicarbonate

A. Decreased rate and depth of respirations

The client with respiratory failure is receiving mechanical ventilation and continues to produce arterial blood gas results indicating respiratory acidosis. Which change in ventilator setting should the nurse expect to correct this problem? A. Increase the ventilator rate from 6 to 10 breaths/min B. Decrease in ventilator rate from 10 to 6 breaths/min C. Increase in oxygen concentration from 30% to 40% D. Decrease in oxygen concentration from 40% to 30%

A. Increase the ventilator rate from 6 to 10 breaths/min

A patient with chronic obstructive pulmonary disease (COPD) has just developed respiratory distress. Vital signs are pulse oximetry 88% on 2 L nasal cannula oxygen, dyspnea at rest, and respirations 32 per minute. The patient reports shortness of breath. Which statements apply to this clinical situation? SATA A. Interference in alveolar-capillary diffusion results in carbon dioxide retention B. The nurse should instruct the patient to use pursed-lip breathing C. Position the patient with the head of the bed at less than 20 degrees D. Interference in alveolar-capillary diffusion results in acidemia E. The nurse should explain to the patient that rapid breathing will relieve the shortness of breath F. Use of an as-needed bronchodilatory may relieve the shortness of breath

A. Interference in alveolar-capillary diffusion results in carbon dioxide retention B. The nurse should instruct the patient to use pursed-lip breathing D. Interference in alveolar-capillary diffusion results in acidemia F. Use of an as-needed bronchodilatory may relieve the shortness of breath

An arterial blood gas report indicates the pH is 7.25, PCO2 is 35 mm Hg, and HCO3 is 20 mEq/L. What disturbance should the nurse identify based on these results? A. Metabolic acidosis B. Metabolic alkalosis C. Respiratory acidosis D. Respiratory alkalosis

A. Metabolic acidosis

A patient with anemia has completed a blood transfusion of 2 units of packed red blood cells. Which imbalance should the nurse monitor for after the blood transfusions? A. Metabolic alkalosis B. Respiratory acidosis C. Metabolic acidosis D. Respiratory alkalosis

A. Metabolic alkalosis

Which statements correctly apply to acid-base balance in the body? SATA A. Renal mechanisms are stronger in regulating acid-base balance but slower to respond than respiratory mechanisms B. The immediate binding of excess hydrogen ions occurs primarily in red blood cells C. Combined acidosis is less severe than either metabolic acidosis or respiratory acidosis alone D. Respiratory acidosis is caused by a patent airway E. Acid-base balance occurs through control of hydrogen ion production and elimination F. Buffers are the third-line defense against acid-base imbalances

A. Renal mechanisms are stronger in regulating acid-base balance but slower to respond than respiratory mechanisms B. The immediate binding of excess hydrogen ions occurs primarily in red blood cells E. Acid-base balance occurs through control of hydrogen ion production and elimination

Which conditions could cause a patient to develop acidosis? SATA A. Sepsis B. Hypovolemic shock C. Use of mechanical ventilator D. Prolonged nasogastric suctioning E. Hypoventilation F. Severe diarrhea

A. Sepsis B. Hypovolemic shock E. Hypoventilation

A patient with bilateral lower lobe pneumonia is diagnosed with respiratory acidosis based on arterial blood gas (ABG) results. What is the likely cause of the patient's respiratory acidosis? A. Underelimination of carbon dioxide from the lungs B. Buffering of extracellular fluid by ammonium C. Overelimination of carbon dioxide from the lungs D. An increased bicarbonate level due to respiratory elimination of acid

A. Underelimination of carbon dioxide from the lungs

A patient is admitted to the hospital for diabetic ketoacidosis. Which arterial blood gas (ABG) results should the nurse expect? SATA A. pH 7.32 B. PaCO2 55 mm Hg C. Bicarbonate 18 mEq/L D. pH 7.46 E. Bicarbonate 29 mEq/L F. PaCO2 44 mm Hg

A. pH 7.32 C. Bicarbonate 18 mEq/L

Which statement made by the patient indicates that he or she may have an alkaline condition? A. "I am more and more tired and can't concentrate" B. "I have tingling in my fingers and toes" C. "My feet and ankles are swollen" D. "I am short of breath all of the time"

B. "I have tingling in my fingers and toes"

A patient has been admitted to the emergency department (ED) with diabetic ketoacidosis. On intake assessment, the patient cannot recall the mediations she takes. What first action does the nurse take? A. Instruct the patient to compare a hospital list of medications to her home medications B. Ask the patient's significant other to bring the patient's medications from home C. Request that the patient complete a meal recall for the past 24 hours D. Teach the patient about the importance of keeping a list of current medications in her purse

B. Ask the patient's significant other to bring the patient's medications from home

What complication is prevented when a nurse addresses the needs of a client who is hyperventilating? A. Cardiac arrest B. Carbonic acid deficit C. Reduction in serum pH D. Excess oxygen saturation

B. Carbonic acid deficit

A patient has a new onset of shallow and slow respirations. While the patient's body attempts to compensate, what happens to the patient's pH level? A. Increases B. Decreases C. Stabilizes D. Fluctuates

B. Decreases

A patient has a low pH level. Which other concurrent change does the nurse expect to see in this patient? A. Elevated serum sodium level B. Elevated serum potassium C. Decreased serum chloride level D. Decreased serum calcium level

B. Elevated serum potassium

A patient is at risk for acid-base imbalance. Which laboratory value indicates that the patient has metabolic acidosis? A. PaCO2= 55 mm Hg B. HCO3= 17 mEq/L C. Lactate= 2.5 mmol/L D. pH= 7.35

B. HCO3= 17 mEq/L

A patient who has advanced muscular dystrophy may develop which complication related to the disease? SATA A. Hyperventilation B. Hypoventilation C. Underproduction of bicarbonate D. Respiratory acidosis E. Underelimination of hydrogen ions F. Decreased chest wall movement

B. Hypoventilation D. Respiratory acidosis F. Decreased chest wall movement

The nurse is caring for a patient with metabolic alkalosis secondary to diuretic medication. Which equipment does the nurse obtain to administer the correct therapy to this patient? A. Oxygen tubing and cannula or mask B. IV catheter and IV start kit C. Foley catheter and drainage bag D. Antiemetic drug and emesis basin

B. IV catheter and IV start kit

Which specific instruction does the charge nurse give to the unlicensed assistive personnel (UAP) helping to provide care for a client who is at risk for metabolic acidosis? A. Check to see that the client keeps his oxygen in place at all times B. Inform the nurse immediately if the client's respiratory rate and depth increases C. Record any episodes of reflux or constipation D. Keep the client's ice water pitcher filled at all times

B. Inform the nurse immediately if the client's respiratory rate and depth increases

A patient who has pancreatitis with nausea and vomiting will likely have which related alterations in acid-base balance? SATA A. Overproduction of hydrogen ions B. Metabolic acidosis C. Serum pH value that is directly related to the concentration of hydrogen ions D. Underproduction of bicarbonate E. Metabolic alkalosis F. Respiratory acidosis

B. Metabolic acidosis C. Serum pH value that is directly related to the concentration of hydrogen ions D. Underproduction of bicarbonate

Which patient showing symptoms of an acid-base imbalance must the nurse see first? A. Patient who exhibits increased heart rate of 110/min and increased cardiac output B. Patient showing activity weakness and lethargy C. Patient who has reduced attention span D. Patient who has asymptomatic bradycardia with a heart rate of 57/min

B. Patient showing activity weakness and lethargy

Which patient with the highest risk for acidosis must the nurse care for first? A. Patient in mild pain with a kidney stone B. Patient with COPD and pulse oximeter 88% on 2 L oxygen C. Patient who had a seizure prior to admission with pulse oximetry of 91% D. Patient with rectal tube in place for frequent diarrhea

B. Patient with COPD and pulse oximeter 88% on 2 L oxygen

Which patients require assessments related to inadequate chest expansion that would place them at risk for respiratory acidosis? SATA A. Patient with lordosis B. Patient with emphysema C. Severely obese patient on prolonged bedrest D. Patient in the first trimester of pregnancy E. Patient 2 days postoperative for laparoscopic cholecystectomy F. Patient with ascites

B. Patient with emphysema C. Severely obese patient on prolonged bedrest F. Patient with ascites

The unlicensed assistive personnel (UAP) reports to the nurse that a client seems very anxious, and vital sign measurement included a respiratory rate of 38 breaths/min. Which acid-base imbalance should the nurse suspect? A. Respiratory acidosis B. Respiratory alkalosis C. Metabolic acidosis D. Metabolic alkalosis

B. Respiratory alkalosis

The nurse observes tall peaked T waves on the ECG of a patient with metabolic acidosis. Before notifying the health care provider, the nurse would assess the results of which laboratory test? A. Serum calcium B. Serum glucose C. Serum potassium D. Serum magnesium

C. Serum potassium

A client's arterial blood gas report indicates the pH is 7.52, PCO2 is 32 mm Hg, and HCO3 is 24 mEq/L. What does the nurse identify as a possible cause of these results? A. Airway obstruction B. Inadequate nutrition C. Prolonged gastric suctioning D. Excessive mechanical ventilation

D. Excessive mechanical ventilation

The nurse is caring for a client who experiences frequent generalized tonic-clonic seizures associated with periods of apnea. The nurse must be alert for which acid-base imbalance? A. Respiratory alkalosis B. Respiratory acidosis C. Metabolic alkalosis D. Metabolic acidosis

D. Metabolic acidosis

Which patient is most likely to develop metabolic alkalosis as a result of base excess? A. Patient taking thiazide diuretics B. Patient who is having nasogastric suction C. Patient with severe vomiting D. Patient who had a massive blood transfusion

D. Patient who had a massive blood transfusion

Which patient is most likely to develop metabolic alkalosis as a result of base excess? A. Muscle cramps B. Muscle twitching C. Hyperactive deep tendon reflexes D. Tetany

D. Tetany

Which medication usage could cause metabolic acidosis? A. Aspirin overdose B. Overuse of antacids C. Prologned use of antihistamines D. Vitamin overdose

A. Aspirin overdose

What interventions are included in the plan of care for a patient with metabolic ketoacidosis? SATA A. Monitor ABG levels for decreasing pH level B. Maintain patent IV access C. Administer fluids as prescribed D. Monitor for irritability and muscle tetany E. Monitor loss of bicarbonate through the gastrointestinal tract such as with diarrhea F. Administer IV 50% dextrose as needed

A. Monitor ABG levels for decreasing pH level B. Maintain patent IV access C. Administer fluids as prescribed E. Monitor loss of bicarbonate through the gastrointestinal tract such as with diarrhea

The unlicensed assistive personnel (UAP) notifies the nurse that the patient with emphysema receiving oxygen at 2 L via nasal cannula is short of breath after morning care. What is the nurse's first action? A. Notify the health care provider immediately B. Ask the UAP to check the patient's SaO2 level C. Instruct the UAP to check vital signs D. Document the incident in the patient's chart

B. Ask the UAP to check the patient's SaO2 level

What are the hallmark laboratory findings of respiratory alkalosis? A. High pH and low PaO2 B. High pH and low PaCO2 C. High pH and high bicarbonate D. High pH and High PaCO2

B. High pH and low PaCO2

Which conditions cause the underproduction of bicarbonate? SATA A. Heavy exercise B. Kidney failure C. Liver failure D. Seizure activity E. Dehydration F. Diarrhea

B. Kidney failure C. Liver failure E. Dehydration