Sem 3 Acid-Base Adaptive

A 3-month-old infant who has a 3-day history of diarrhea is admitted to the pediatric unit. The nurse obtains the infant's vital signs, performs a physical assessment, and reviews the infant's arterial blood gas results. Which acid-base imbalance does the nurse suspect? A. Metabolic acidosis B. Metabolic alkalosis C. Respiratory acidosis D. Respiratory alkalosis

A. Metabolic acidosis The pH indicates acidosis, not alkalosis; the HCO 3 - level is further from the expected range than is the Pco 2 level, indicating a metabolic, not respiratory, origin (losses from diarrhea).

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? A. Kidney failure B. Mild dehydration C. Metabolic acidosis D. Respiratory alkalosis

C. Metabolic acidosis Metabolic acidosis occurs with loss of alkaline fluid through diarrhea and is manifested by lethargy and Kussmaul breathing; all of the assessments indicate severe dehydration. The infant has not urinated because excessive amounts of fluid have been lost in the loose stools; this indicates that the kidneys are functioning by compensating for the fluid loss. All data indicate a severe, not mild, fluid volume deficiency. Respiratory alkalosis is caused by an excessive loss of carbon dioxide, not diarrhea.

A critically ill 5-year-old child exhibits Kussmaul respirations. What does the nurse suspect may be causing an increasing acid-base imbalance? A. Metabolic acidosis caused by an increase in base bicarbonate B. Respiratory alkalosis caused by excess carbon dioxide output C. Respiratory acidosis caused by an accumulation of carbon dioxide D. Metabolic acidosis caused by a concentration of cations in body fluids

D. Metabolic acidosis caused by a concentration of cations in body fluids Metabolic acidosis results from an excess concentration of hydrogen cations. The kidneys cannot convert ammonium to ammonia, and there is inadequate base bicarbonate to maintain an appropriate acid-base balance. With Kussmaul respirations there is an excess of hydrogen ions, the opposite of an excess of base bicarbonate. Carbonic acid blown off as carbon dioxide is a compensatory mechanism to counter the present metabolic acidosis. There is an excess of hydrogen ions from a metabolic problem rather than an excess of carbonic acid resulting from retained carbon dioxide.

The nurse is teaching a group of nursing students how to gather historic data for a client experiencing acid-base imbalance. Which statements indicate the student nurses need further teaching? Select all that apply. A. "I should assess for drugs, chronic health problems, and acute health problems." B. "I should ask the client to list all the drugs, especially the diuretics and the antacids." C. "I should compare the mental status of the client with that of the family statement." D. "I should ask the client to recall all the liquids that have been taken by the client in the last 24 hours." E. "I should compare the mental status of the client with the statement provided in the health record of the client."

C, E When the nurse compares the mental status with that of the family statement, it comes under the assessment of the client. Comparing mental status with the family statement does not mean assessing client's history. The nurse is assessing the client, not the client's history, when a comparison is made between the mental status of the client and the statement provided in the health record of the client. Assessing the client for drugs, chronic health problems, and acute health problems along with other risk factors for an acid-base imbalance helps obtain the client's history. Asking the client to list all the drugs especially the diuretics and the antacids helps the nurse assessing the client's history of acid base imbalance. The nurse asking for recall of all the liquid taken during the last 24 hours helps assessing the history of the client.

EThe nurse is teaching a group of students about neuromuscular manifestations of alkalosis with hypocalcemia. Which statements provided by a student nurse indicate the need for further learning? Select all that apply. 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, B The neuromuscular manifestation of alkalosis with hypocalcemia is hyperreflexia, not hyporeflexia. Paresthesias is a symptom of alkalosis, which is manifested in the central nervous system not the neuromuscular system. The manifestation of alkalosis is neuromascular and can be observed through twitching, muscle cramping, and skeletal muscle weakness.

A client is admitted to the hospital with a diagnosis of restrictive airway disease. The nurse expects the client to exhibit which early signs of respiratory acidosis? Select all that apply. A. Headache B. Irritability C. Restlessness D. Hypertension E. Lightheadedness

A, B, C Headache is a symptom of cerebral hypoxia associated with early respiratory acidosis [1] [2]. Irritability is a sign of cerebral hypoxia associated with early respiratory acidosis. Restlessness is a sign of cerebral hypoxia associated with early respiratory acidosis. Hypotension, not hypertension, is a key feature of acidosis. Lightheadedness is a symptom of respiratory alkalosis, not acidosis.

The nurse is teaching a group of students about assessing for respiratory system manifestations of alkalosis as a nursing priority. Which statement made by the student nurse indicates the need for further teaching? Select all that apply. A. "I should assess for low blood pressure." B. "I should assess for increased digitalis toxicity." C. "I should assess for a decreased rate of ventilation in respiratory alkalosis." D. "I should assess for an increased depth of ventilation in respiratory alkalosis." E. "I should assess for a decreased respiratory effort associated with skeletal muscle weakness in metabolic alkalosis."

A, B, C The nurse should assess for low blood pressure and increased digitalis toxicity as cardiovascular manifestations of alkalosis, not respiratory manifestation. The nurse should assess for increased rate of ventilation in respiratory alkalosis. The nurse should assess for increased depth of ventilation in respiratory alkalosis. It is imperative that the nurse check for decreased respiratory effort associated with skeletal muscle weakness in metabolic alkalosis.

A specimen for arterial blood gases is obtained from a severely dehydrated 3-month-old infant with a history of diarrhea. The pH is 7.30, Pco 2 is 35 mm Hg, and HCO 3 - is 17 mEq/L (17 mmol/L). What complication does the nurse conclude has developed? A. Metabolic acidosis B. Metabolic alkalosis C. Respiratory acidosis D. Respiratory alkalosis

A. Metabolic acidosis The blood pH indicates acidosis; the bicarbonate (HCO 3 -) level is further from the expected range than is the partial pressure of carbon dioxide (Pco 2), indicating a metabolic origin (losses from diarrhea), not a respiratory origin. The blood pH indicates acidosis, not alkalosis.

A client on diuretic therapy developed metabolic alkalosis. What does the nurse consider to be the priority nursing care while correcting alkalosis? A. Preventing falls B. Monitoring electrolytes C. Administering antiemetics D. Adjusting the diuretic therapy

A. Preventing falls 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 of injury, diuretic therapy is adjusted.

The nurse is teaching a group of students about the manifestation of alkalosis in the central nervous system. Which statements by a student nurse are accurate? Select all that apply. 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 If clients suffer from the alkalosis, the manifestation in the nervous system would involve paresthesias. The client will also have a positive Trousseau sign and have anxiety and irritability. The Chvostek sign would also be positive, not negative. The client would show signs of anxiety and irritability. The central nervous system should have increased activity with alkalosis, not decreased.

A nurse is caring for an infant whose vomiting is intractable. Which complication is most likely to occur? A. Acidosis B. Alkalosis C. Hyperkalemia D. Hypernatremia

B. 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.

A nurse addresses the needs of a client who is hyperventilating to prevent what complication? 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. Cardiac arrest is unlikely; the client may experience dysrhythmias but will lose consciousness and begin breathing regularly. Hyperventilation causes alkalosis; the pH is increased. Excess oxygen saturation cannot occur; the usual oxygen saturation of hemoglobin is 95% to 98%.

A client is in profound (late) hypovolemic shock. The nurse assesses the client's laboratory values. What does the nurse know that clients in late shock develop? A. Hypokalemia B. Metabolic acidosis C. Respiratory alkalosis D. Decreased PCO2 levels

B. Metabolic acidosis Decreased oxygen increases the conversion of pyruvic acid to lactic acid, resulting in metabolic acidosis. Hyperkalemia will occur because of renal shutdown; hypokalemia can occur in early shock. Respiratory alkalosis can occur in early shock because of rapid, shallow breathing, but in late shock metabolic or respiratory acidosis occurs. The Pco 2 level will increase in profound shock.

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? A. Profuse diaphoresis B. Increased temperature C. Increased respiratory rate D. Renal retention of hydrogen ions

C. Increased respiratory rate The child has metabolic acidosis; the lungs compensate by blowing off excess carbonic acid in the form of carbon dioxide. Diaphoresis is a compensatory mechanism to reduce fever by evaporation, not to compensate for metabolic acidosis. Fever is not a compensatory mechanism to counter metabolic acidosis; fever with dehydration results from inadequate fluid for perspiring and cooling. The kidneys excrete hydrogen and ammonium ions to compensate for metabolic acidosis.

A client with chronic obstructive pulmonary disease (COPD) has a blood pH of 7.25 and a PCO 2 of 60 mm Hg. What complication does the nurse conclude the client is experiencing? A. Metabolic acidosis B. Metabolic alkalosis C. Respiratory acidosis D. Respiratory alkalosis

C. Respiratory acidosis The pH indicates acidosis [1] [2]; the PCO 2 level is the parameter for respiratory function. The expected PCO 2 is 40 mm Hg. These results do not indicate a metabolic disorder or indicate respiratory alkalosis.

A child has been admitted to the pediatric unit with a severe asthma attack. What type of acid-base imbalance should the nurse expect the child to develop? A. Metabolic alkalosis 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 The restricted ventilation accompanying an asthma attack limits the body's ability to blow off carbon dioxide. As carbon dioxide accumulates in the body fluids, it reacts with water to produce carbonic acid; the result is respiratory acidosis. The problem basic to asthma is respiratory, not metabolic. Respiratory alkalosis is caused by the exhalation of large amounts of carbon dioxide; asthma attacks cause carbon dioxide retention. Asthma is a respiratory problem, not a metabolic one; metabolic acidosis can result from an increase of nonvolatile acids or from a loss of base bicarbonate.

A client presenting to the emergency department with chest pain and dizziness is found to be having a myocardial infarction and subsequently suffers cardiac arrest. The healthcare team is able to successfully resuscitate the client. Lab work shows that the client now is acidotic. How does the nurse interpret the cause of the acidosis? A. The fat-forming ketoacids were broken down B. The irregular hearbeat produced oxygen deficit C. The decreased tissue perfusion caused lactic acid production D. The client received too much sodium bicarbonate during resuscitation efforts

C. The decreased tissue perfusion caused lactic acid production Cardiac arrest causes decreased tissue perfusion, which results in ischemia and cardiac insufficiency. Cardiac insufficiency causes anaerobic metabolism, which leads to lactic acid production. Fat-forming ketoacids occur in diabetes. An irregular heartbeat does not cause acidosis. Too much sodium bicarbonate causes alkalosis, not acidosis.

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? A. pH 7.25; glucose 60 mg/dL (3.3 mmol/L) B. pH 7.50; glucose 60 mg/dL (3.3 mmol/L) C. pH 7.25; glucose 460 mg/dL (25.5 mmol/L) D. pH 7.50; glucose 460 mg/dL (25.5 mmol/L)

C. pH 7.25; glucose 460 mg/dL (25.5 mmol/L) The clinical manifestations indicate ketoacidosis, so these values are expected; the pH of 7.25 indicates acidosis (metabolic or ketoacidosis), and the blood glucose level of 460 mg/dL (25.5 mmol/L), higher than the expected range of 70 to 105 mg/dL (3.9 to 5.8 mmol/L), indicates severe hyperglycemia. Although the blood pH of 7.25 indicates acidosis, the blood glucose level of 60 mg/dL (3.3 mmol/L) is below the expected range of 70 to 105 mg/dL (3.9 to 5.8 mmol/L); with ketoacidosis, the child will be hyperglycemic. Both the pH of 7.50 and the glucose level of 60 mg/dL (3.3 mmol/L) are unexpected with ketoacidosis; with ketoacidosis, the pH is decreased and the blood glucose level is increased. Although the blood glucose level is increased with ketoacidosis, the pH is decreased, not increased; a pH of 7.50 indicates alkalosis.

A nurse is caring for an infant with severe dehydration. Which blood gas report most likely reflects the acid-base balance of this infant? A. pH of 7.50 and Pco 2 of 34 mm Hg B. pH of 7.23 and Pco 2 of 70 mm Hg C. pH of 7.20 and HCO 3 - of 20 mEq/L (20 mmol/L) D. pH of 7.56 and HCO 3 - of 30 mEq/L (30 mmol/L)

C. pH of 7.20 and HCO 3 - of 20 mEq/L (20 mmol/L) 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 would the nurse claim is a cardiovascular manifestation of alkalosis? A. Anxiety B. Seizures C. Hyperreflexia D. Increased digitalis toxicity

D. Increased digitalis toxicity Increased digitalis toxicity is one of the cardiovascular manifestations of alkalosis. Anxiety and seizures are central nervous system manifestations of alkalosis. Hyperreflexia is a neuromuscular manifestation of alkalosis.