520 Acid-Base
A client with a pulmonary embolus has the following arterial blood gas (ABG) values: pH, 7.49; partial pressure of arterial oxygen (PaO2), 60 mm Hg; partial pressure of arterial carbon dioxide (PaCO2), 30 mm Hg; bicarbonate (HCO3-) 25 mEq/L. What should the nurse do first?
Administer oxygen by nasal cannula as ordered.
What function does the kidney perform to assist in maintaining acid-base balance within the necessary normal range?
Return bicarbonate to the body's circulation
The nurse observes a client with an onset of heart failure having rapid, shallow breathing at a rate of 32 breaths/minute. What blood gas analysis does the nurse anticipate finding initially?
respiratory alkalosis
Arterial blood gases should be obtained at which timeframe following the initiation of continuous mechanical ventilation?
20 minutes
Which of these ions plays an important role in pH homeostasis?
bicarbonate
Which finding would be expected in a client with chest trauma, rib fractures, and respiratory acidosis?"
hypoventilation due to inability to take deep breaths because of pain
For the child diagnosed with an asthma attack, which manifestation would best correlate with the child's arterial blood gas results, which include pH of 7.46, bicarbonate of 21 mEq/L (21 mmol/L), and a partial pressure of carbon dioxide (PCO2) of 33 mm Hg (4.4 kPa)?
tingling sensation in the fingertips
A client with emphysema is at a greater risk for developing what acid-base imbalance?
chronic respiratory acidosis
During shift report, the nurse learns the following laboratory values: pH, 7.44; PCO2, 30mmHg; and HCO3,21 mEq/L for a client with noted acid-base disturbances. Which acid-base imbalance is the client most likely experiencing?
compensated respiratory alkalosis
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
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
The nurse is caring for a 12-month-old infant with dehydration and metabolic acidosis. What symptom does the nurse document as congruent with dehydration and metabolic acidosis?
Tachypnea.
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
As status asthmaticus worsens, the nurse would expect the client to experience which acid-base imbalance?
respiratory acidosis
As status asthmaticus worsens, the nurse would expect which acid-base imbalance?
respiratory acidosis
A patient presents to the Emergency Department experiencing a severe anxiety attack and is hyperventilating. The nurse would expect the patient's pH value to be which of the following?
7.50
The nurse is caring for a client who has a compromised cardiopulmonary system and needs to assess the client's tissue oxygenation. The nurse would use which appropriate method to assess this client's oxygenation?
Arterial blood gas
Trousseau's sign is elicited by which of the following?
Carpopedal spasm is induced by occluding the blood flow to the arm for 3 minutes with the use of a blood pressure cuff.
Which of the following would be a potential cause of respiratory acidosis?
Hypoventilation
On admission, a client has the following arterial blood gas (ABG) values: PaO2, 50 mm Hg; PaCO2, 70 mm Hg; pH, 7.20; HCO3-, 28 mEq/L. Based on these values, the nurse should prioritize which nursing diagnosis for this client?
Impaired gas exchange
Which finding may occur with respiratory acidosis?
Increased intracranial pressure (ICP)
A client has a respiratory rate of 38 breaths/min. What effect does breathing faster have on arterial pH level?
Increases arterial pH
Which intervention is most appropriate for a client with an arterial blood gas (ABG) of pH 7.5, a partial pressure of arterial carbon dioxide (PaCO2) of 26 mm Hg, oxygen (O2) saturation of 96%, bicarbonate (HCO3-) of 24 mEq/L, and a PaO2 of 94 mm Hg?
Instruct the client to breathe into a paper bag.
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.
A client has the following arterial blood gas values: pH, 7.52; PaO2, 50 mm Hg (6.7 kPa); PaCO2, 28 mm Hg (3.7 kPa); HCO3-, 24 mEq/L (24 mmol/l). The nurse determines that which of the following is a possible cause for these findings?
Pulmonary embolus.
In a patient who loses bicarbonate from the body, how does it get replaced?
Renal tubular cells generate new bicarbonate.
Bicarbonate is stored in which structure when the body needs a buffer?
Renal tubule
The nurse is caring for a client with chronic obstructive pulmonary disease. The client reports that he is having difficulty breathing and is feeling fatigued. The nurse realizes that this client is at high risk for which condition?
Respiratory acidosis
A nurse working in the emergency department (ED) reviews arterial blood gas (ABG) values for a client diagnosed with heatstroke. Blood gas values are pH 7.48, pCO2 34, pO2 95, CO2 23, HCO3 22, and SO2 98%. What nursing interventions demonstrate the nurse's understanding of the patient's ABG's and knowledge of Maslow's hierarchy of needs when providing care for this patient?
The nurse prepares for endotracheal intubation and mechanical ventilation for the client.
A client has the following arterial blood gas values: pH, 7.52; PaO2, 50 mm Hg (6.7 kPa); PaCO2, 28 mm Hg (3.72 kPa); HCO3- 24 mEq/L (24 mmol/L). Based upon the client's PaO2, which nursing clinical judgment should the nurse make?
`The client is severely hypoxic.
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.
Upon analysis of a client's arterial blood gas results, the nurse determines that the concentration of carbon dioxide and hydrogen ions are elevated and the oxygen in the arterial blood is decreased. What respiratory assessment findings would the nurse anticipate in a client with these arterial blood gas results?
increase in rate and depth of respirations
A client is at risk for development of metabolic alkalosis because of persistent vomiting. The nurse should assess the client specifically for which symptom?
irritability
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 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
A client has vomited several times over the past 12 hours. The nurse should recognize the risk of what complication?
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 client presents to the emergency department, reporting that they have been vomiting every 30 to 40 minutes for the past 8 hours. Frequent vomiting puts this client at risk for which imbalances?
metabolic alkalosis and hypokalemia
A male client tells the nurse that he takes antacid tablets several times each day. Knowing that the brand of antacid he uses contains calcium carbonate, the nurse cautions the client that overuse could place him at risk for:
metabolic alkalosis.
A nurse is reviewing a client's arterial blood gas (ABG) report. Which ABG value reflects the acid concentration in the client's blood?
pH
The nurse is caring for a client with end-stage kidney disease. What arterial blood gas results are most closely associated with this disorder?
pH 7.20, PaCO2 36, HCO3 14-
Arterial blood gas analysis would reveal which finding related to acute respiratory failure?
pH 7.24
The nurse is reviewing the results of a patient's arterial blood gas and pH analysis. Normal findings include: (Select all that apply.)
pH 7.45 PCO2 40 mm Hg Base excess or deficit +2 mmol/L
When evaluating a client's arterial blood gases (ABGs), which value is consistent with metabolic alkalosis?
pH 7.48
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
Which of the following arterial blood gas (ABG) results would the nurse anticipate for a client with a 3-day history of vomiting?
pH: 7.55, PaCO2: 60 mm Hg, HCO3-: 28
The nurse is caring for a client with acute respiratory distress syndrome. What portion of arterial blood gas results does the nurse find most concerning, requiring intervention?
partial pressure of arterial oxygen (PaO2) of 69 mm Hg
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 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
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
A client has just been diagnosed as being in status asthmaticus. The nurse understands that this client will likely initially exhibit symptoms of:
respiratory alkalosis.
A client with respiratory acidosis is admitted to the intensive care unit for close observation. The nurse should stay alert for which complication associated with respiratory acidosis?
shock
The body of a critically ill client may use which of the following mechanisms to maintain normal pH?
The lungs eliminate carbonic acid by blowing off more CO2.
Which of the following may be the first sign of respiratory acidosis in an anesthetized client?
ventricular fibrillation
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
The nurse is admitting a client with newly diagnosed diabetes mellitus and left-sided heart failure. Assessment reveals low blood pressure, increased respiratory rate and depth, drowsiness, and confusion. The client reports headache and nausea. Based on the serum laboratory results, how would the nurse interpret the client's acid-base balance?
metabolic acidosis
The nurse is caring for a client with severe diarrhea. The nurse recognizes that the client is at risk for developing which of the following acid-base imbalances?
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
For the child experiencing excessive vomiting secondary to pyloric stenosis, the nurse should assess the child for which acid-base imbalance?
metabolic alkalosis
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 client is receiving supplemental oxygen. When determining the effectiveness of oxygen therapy, which arterial blood gas value is most important?
partial pressure of arterial oxygen (PaO2)
A nurse is reviewing arterial blood gas results on an assigned client. The pH is 7.32 with PCO2 of 49 mm Hg and a HCO3−of 28 mEq/L. The nurse reports to the physician which finding?
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
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 has been diagnosed with metabolic alkalosis. The nurse should anticipate what finding from the client's arterial blood gases?
serum bicarbonate of 28 mEq/L