PrepU MedSurg: Acid-Base Balance
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
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?
Extreme anxiety
Before weaning a client from a ventilator, which assessment parameter is the most important for the nurse to obtain?
baseline arterial blood gas (ABG) levels
A client with emphysema is at a greater risk for developing what acid-base imbalance?
Chronic respiratory acidosis
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?
Collect more data from parent about the diarrhea
The nurse assesses a child with ketoacidosis. What manifestations are supportive of the diagnosis of ketoacidosis?
Deep, rapid respirations
Which physical sensation will the client who has had an abdominal hysterectomy most likely experience if she hyperventilates while performing deep-breathing exercises?
Dizziness
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 hand washing by the client and visitors
A nurse is caring for a client with chronic renal failure. The nurse receives the arterial blood gas result: pH-7.19 PCO2- 42mmHg (5.59 kPa) Po2- 88mm Hg (11.70 kPa) HCO3-15mEq/L (15.00 mmol/L) What are the priority action(s) by the nurse?
Encourage rest. Record intake and output. Prepare for possible seizures. Administer sodium bicarbonate.
For the child experiencing excessive vomiting secondary to pyloric stenosis, the nurse should assess the child for which acid-base imbalance?
metabolic alkalosis
A client's arterial blood gas analysis reveals an excess of carbon dioxide. The nurse should recognize that this is consistent with which condition?
respiratory acidosis
The nurse is analyzing the arterial blood gas (AGB) results of a client diagnosed with severe pneumonia. What ABG results are most consistent with this diagnosis?
- pH: 7.20 - PaCO2: 65 mm Hg - HCO3: 26 mEq/L
A client with Guillain-Barré syndrome develops respiratory acidosis as a result of reduced alveolar ventilation. Which combination of arterial blood gas (ABG) values confirms respiratory acidosis?
- pH: 7.25 - PaCO2: 50 mm Hg
A nurse assesses arterial blood gas results for a client in acute respiratory failure (ARF). Which result is consistent with this disorder?
- pH: 7.28 - PaO2: 50 mm Hg
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.
A client who has been recently extubated has shortness of breath. The nurse reports the client's discomfort and the results of the recently prescribed arterial blood gas analysis to the health care provider (HCP). After reviewing the report of the complete blood count (see report), the nurse should also report which results to the HCP?
Hemoglobin and hematocrit
The nurse interprets which finding as an early sign of acute respiratory distress syndrome (ARDS) in a client at risk?
Hypoxia not responsive to oxygen therapy
A client has meconium-stained amniotic fluid. Fetal scalp sampling indicates a blood pH of 7.12; fetal bradycardia is present. Based on these findings, the nurse should take which action?
Prepare for cesarean birth
A client with a suspected overdose of an unknown drug is admitted to the emergency department. Arterial blood gas values indicate respiratory acidosis. What should the nurse do first?
Prepare to assist with ventilation.
For a client with suspected increased intracranial pressure (ICP), an appropriate respiratory goal is to
Promote carbon dioxide elimination
What factor has the potential to lead to chronic respiratory acidosis in older adults?
Thoracic skeletal changes
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:
are unable to blow off carbon dioxide.
A client presents to the ED in shock. During what phase of shock does the nurse know that metabolic acidosis is going to most likely occur?
decompensation
A client hospitalized for treatment of a pulmonary embolism develops respiratory alkalosis. Which clinical findings commonly accompany respiratory alkalosis?
light-headedness or paresthesia
A client has the following arterial blood gas (ABG) values: pH, 7.12; partial pressure of arterial carbon dioxide (PaCO2), 40 mm Hg; and bicarbonate (HCO3-), 15 mEq/L. These ABG values suggest which disorder?
metabolic acidosis
The nurse on a surgical unit is caring for a client recovering from recent surgery with the placement of a nasogastric tube on low continuous suction. Which acid-base imbalance is most likely to occur?
metabolic alkalosis
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
A nurse is reviewing arterial blood gas (ABG) results on four clients. Which results would the nurse report immediately to the healthcare provider?
pH 7.31, PaO2 84 mmHg, PaCO2 50 mmHg, HCO3 24 mEq/L, and O2 sat 90%
The nurse has received lab reports for several clients undergoing care. Which set of arterial blood gas (ABG) results will the nurse investigate first?
pH 7.49, PaCO2 30 mmHg, PaO2 75 mmHg, and HCO3- 22 mEq/L
A neonate weighing 1,870 g with a respiratory rate of 46 breaths/minute, a pulse rate of 175 bpm, and a serum pH of 7.11 has received sodium bicarbonate intravenously. The drug has been effective if the neonate exhibits which finding?
resolves the metabolic acidosis
A client appears flushed and has shallow respirations. The arterial blood gas report shows the following: pH, 7.24; partial pressure of arterial carbon dioxide (PaCO2), 49 mm Hg (6.5 kPa); bicarbonate (HCO3-), 24 mEq/L (24 mmol/L). These findings are indicative of which acid-base imbalance?
respiratory acidosis
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
Which respiratory pattern indicates increasing intracranial pressure in the brain stem?
slow, irregular respirations
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?
Respiratory acidosis
As status asthmaticus worsens, the nurse would expect the client to experience which acid-base imbalance?
Respiratory acidosis
A nurse teaches a client experiencing heartburn to take 1½ oz of Maalox when symptoms appear. How many milliliters should the client take?
45 mL
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?
5 units
A client is diagnosed with diabetic ketoacidosis. Which finding would the nurse anticipate?
Arterial pH 7.33
Which finding may occur with respiratory acidosis?
Increased intracranial pressure (ICP)
A client experiencing an acute panic attack develops respiratory alkalosis. The nurse measures a respiratory rate of 46 breaths/minute, a heart rate of 110 beats/minute, a blood pressure of 162/90 mm Hg, and a temperature of 98.6°F (37°C). Which action will the nurse implement first to help improve respiratory alkalosis?
Instruct the client to breathe into a paper bag
The nurse is caring for a client with multiple organ failure who is in metabolic acidosis. Which pair of organs is responsible for regulatory processes and compensation?
Lungs and kidneys
A client's arterial blood gas values are as shown on the accompanying chart. These findings indicate which of the following acid-base imbalances?
Metabolic acidosis
A client's arterial blood gas values are shown. The nurse should develop a care plan based on the fact the client is experiencing which clinical situation?
Metabolic acidosis
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?
Metabolic alkalosis
A client in the emergency department reports that they have been vomiting excessively for the past 2 days. The client's arterial blood gas analysis shows a pH of 7.50, partial pressure of arterial carbon dioxide (PaCO2) of 43 mm Hg, partial pressure of arterial oxygen (PaO2) of 75 mm Hg, and bicarbonate (HCO3-) of 42 mEq/L. Based on these findings, the nurse documents that the client is experiencing which type of acid-base imbalance?
Metabolic alkalosis
An adolescent is admitted for treatment of bulimia nervosa. When developing the care plan, the nurse anticipates including interventions that address which metabolic disorder?
Metabolic alkalosis
A primigravid client at 38 weeks' gestation comes to the labor room because "my water broke." The health care provider (HCP) asks the nurse to verify spontaneous rupture of membranes using nitrazine paper. The nurse observes that the nitrazine paper turns bright blue. What action should the nurse take next?
Notify the HCP that the membranes are ruptured
A client has these arterial blood gas values: pH, 7.30; PaO2, 89 mm Hg; PaCO2, 50 mm Hg; and HCO3-, 26 mEq/L. Based on these values, the nurse should suspect which condition?
Respiratory acidosis
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?
Respiratory acidosis
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
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:
Respiratory alkalosis
A client with a diagnosis of respiratory acidosis is experiencing renal compensation. What function does the kidney perform to assist in restoring acid-base balance?
Returning bicarbonate to the body's circulation
The nurse is caring for a lethargic but arousable preschooler who is a victim of a near-drowning accident. What should the nurse do first?
Administer oxygen.
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?
Albuterol nebulizer
A nurse reviews the arterial blood gas (ABG) values of a client who reports difficulty breathing: pH, 7.51; PaCO2, 28 mm Hg; PaO2, 70 mm Hg; and HCO3, 24 mEq/L. What assessment finding would the nurse anticipate based on these blood gases?
Tachypnea
Oxygen at the rate of 2 liters per minute through nasal cannula is prescribed for a client with chronic obstructive pulmonary disease (COPD). Which of the following statements best describes why the oxygen therapy is maintained at a relatively low concentration?
The client's respiratory center is so used to high carbon dioxide and low oxygen levels that changing these levels may eliminate his stimulus for breathing.
