ACID-BASE
A nurse is overseeing the care of numerous clients. Which client is at the highest risk of developing metabolic alkalosis?
A 20-year-old man who has been regularly inducing himself to vomit following binge eating Rationale: Ingestion of bicarbonate, gastric suction, and vomiting are causes of metabolic alkalosis. Clients on mechanical ventilation are at risk of respiratory alkalosis, while heavy alcohol use and renal failure are associated with acidosis.
There are both metabolic and respiratory effects on the acid-base balance in the body. How do metabolic disorders change the pH of the body?
Alter the plasma HCO3- Rationale: Metabolic disorders produce an alteration in the plasma HCO3- concentration and result from the addition or loss of nonvolatile acid or alkali to or from the extracellular fluids.
A client has sudden severe dyspnea, fear, asymmetrical chest movement and decreased lung sounds on the right side. Which intervention is most appropriate?
Assist to high-Fowler's position and prepare for chest tube insertion. Rationale: Spontaneous pneumothorax can occur in healthy people and tends to occur most often in tall boys and young men between the ages of 10 and 30 years. It is treated with insertion of chest tubes to reinflate the affected lung
For a patient with a Spinal Cord Injury (SCI), why is it beneficial to administer oxygen to maintain a high partial pressure of oxygen (PaO2)?
Because hypoxemia can create or worsen a neurologic deficit of the spinal cord. Rationale: Oxygen is administered to maintain a high partial pressure of arterial oxygen (PaO2) because hypoxemia can create or worsen a neurologic deficit of the spinal cord.
Which area of the brain is responsible for respiration?
Brain stem Rationale: The respiratory center is located in the brain stem.
By reabsorbing HCO3- from the glomerular filtrate and excreting H+ from the fixed acids that result from lipid and protein metabolism, the kidneys work to return or maintain the pH of the blood to normal or near-normal values. How long can this mechanism function when there is a change in the pH of body fluids?
Days Rationale: The renal mechanisms for regulating acid-base balance cannot adjust the pH within minutes, as respiratory mechanisms can, but they continue to function for days, until the pH has returned to normal or near-normal range.
A nurse is trying to explain to a nursing student the differences between diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar syndrome (HHS). Which symptom(s) is/are associated with HHS?
Disorientation, extreme dehydration, blood glucose >600 mg/dl. Rationale: confusion is associated with HHS, but is not associated with DKA. Hyperglycemic hyperosmolar syndrome (HHS) is a serious complication of type 2 diabetes mellitus. It occurs when a client has extremely high blood glucoses (> 600 mg/dl) for an extended time. The interesting characteristics is there are no elevation of ketones in this situation. The condition leads to serious dehydration, excessive thirst, and confusion. It is often caused or triggered by a recent infection or sickness.
You are caring for a client who is 42-years-old and status post adenoidectomy. You find the client in respiratory distress when you enter their room. You ask another nurse to call the physician and bring an endotracheal tube into the room. What do you suspect?
Edema of the upper airway. Rationale: An endotracheal tube is inserted through the mouth or nose into the trachea to provide a patent airway for clients who cannot maintain an adequate airway on their own. The scenario does not indicate infection, post operative bleeding, or a plugged tracheostomy tube.
When stimulating the fetus via an acoustic vibrator, which action indicates fetal well-being?
Fetal heart rate acceleration occurs. Rationale: The fetus is stimulated via an acoustic vibrator. From the stimulation, the fetal heart rate accelerates. If the acceleration occurs, fetal acidosis is not present.
Which statement made by a client who was recently admitted to the medical unit with a diagnosis of pneumonia indicates a physical inability to learn?
I am having difficulty breathing. Rationale: The statement "I am having difficulty breathing" indicates that the client is not physically well and that the client is unable to learn effectively until comfort is restored.
The nurse is aware that fluid replacement is a hallmark treatment for shock. Which of the following is the crystalloid fluid that helps treat acidosis?
Lactated Ringer's Rationale: Lactated Ringer's is an electrolyte solution that contains the lactate ion, which is converted by the liver to bicarbonate, thus assisting with acidosis.
A client who has been on a high-protein diet comes to the emergency department with respiratory symptoms. Upon analysis of arterial blood gases (ABGs), the client is diagnosed with hypercapnia. Which ABG results confirm this diagnosis? Select all that apply.
PCO2 58 mm Hg (7.71 kPa) [Normal 35-45 mm Hg, 4.7 - 5.9 kPa] pH 7.31 (Normal 7.35-7.45) Serum HCO3 33 mEq/L (33 mmol/L) [Normal 22-28 mEq/L, 22-28 mmol/L] Rationale: Hypercapnia affects a number of body functions, including acid-base balance and renal, neurological, and cardiovascular function. Elevated PCO2 (35-45) produce decreased pH (7.35-7.45) and respiratory acidosis. Compensatory mechanisms result in increase in serum HCO3 (22-28).
A client with a peptic ulcer is diagnosed with Helicobacter pylori infection. The nurse is teaching the client about the medications prescribed, including metronidazole, omeprazole, and clarithromycin. Which statement by the client indicates the best understanding of the medication regimen?
The medications will kill the bacteria and stop the acid production. Rationale: Currently, the most commonly used therapy for peptic ulcers is a combination of antibiotics, proton-pump inhibitors, and bismuth salts that suppress or eradicate H. pylori. Recommended therapy for 10 to 14 days includes triple therapy with two antibiotics (e.g., metronidazole [Flagyl] or amoxicillin [Amoxil] and clarithromycin [Biaxin]) plus a proton-pump inhibitor (e.g., lansoprazole [Prevacid], omeprazole [Prilosec], or rabeprazole [Aciphex]), or quadruple therapy with two antibiotics (metronidazole and tetracycline) plus a proton-pump inhibitor and bismuth salts (Pepto-Bismol). Research is being conducted to develop a vaccine against H. pylori.
A nurse is caring for a client in the compensatory stage of shock. What clinical finding would the client exhibit?
compensatory respiratory alkalosis RATIONALE: In the compensatory stage of shock, a client will have a compensatory respiratory alkalosis with the rise of the respiratory rate, causing removal of CO2 and a rise the blood pH. The Pa CO2 would be increased in compensatory stage of shock. The client's heart rate would be tachycardic in the compensatory stage of shock.
The nurse is caring for a client just admitted to the intensive care unit for diabetic ketoacidosis (DKA). Which three priority treatments are critical during diabetic ketoacidosis?
fluid replacement, insulin therapy, and electrolyte correction. Rationale: diabetic ketoacidosis (DKA) occurs when ketones or blood acids increase in the bloodstream in response to elevated blood glucose levels and inadequate insulin. DKA can occur due to illness, infection, or insufficient insulin. The client has to be treated in the hospital and often in the ICU to address the metabolic acidosis. Priority treatments are fluid replacement, insulin therapy, and electrolyte correction.
A nurse is caring for a newborn whose chest X-ray reveals marked hyperaeration mixed with areas of atelectasis. The infant's arterial blood gas analysis indicates metabolic acidosis. For which dangerous condition should the nurse prepare when providing care to this newborn?
meconium aspiration syndrome Rationale: The nurse should assess for meconium aspiration syndrome in the newborn. Meconium aspiration involves patchy, fluffy infiltrates unevenly distributed throughout the lungs and marked hyperaeration mixed with areas of atelectasis that can be seen through chest X-rays. Direct visualization of the vocal cords for meconium staining using a laryngoscope can confirm aspiration. Lung auscultation typically reveals coarse crackles and rhonchi. Arterial blood gas analysis will indicate metabolic acidosis with a low blood pH, decreased PaO2, and increased PaCO2.
Which arterial blood gas (ABG) result would the nurse anticipate for a client with a 3-day history of vomiting?
pH: 7.55, PaCO2: 60 mm Hg, HCO3-: 28 Rationale: The client's ABG would likely demonstrate metabolic alkalosis. Metabolic alkalosis is a clinical disturbance characterized by a high pH (decreased H+ concentration) and a high plasma bicarbonate concentration. It can be produced by a gain of bicarbonate or a loss of H+. A common cause of metabolic alkalosis is vomiting or gastric suction with loss of hydrogen and chloride ions. The disorder also occurs in pyloric stenosis, where only gastric fluid is lost.
A client with diabetes mellitus type 1 admitted with DKA asks the nurse, "What causes DKA to happen?" The nurse correctly explains which common causes of DKA? Select all that apply.
stress, serious infection (sepsis), stomach virus. Rationale: correct because having personal stress, an illness, such a stomach virus, can cause the blood glucose to rise and cause DKA. More insulin should be given during this time. Diabetic ketoacidosis (DKA) is a very serious complication of diabetes mellitus. It occurs when ketones or blood acids increase in the bloodstream in response to elevated blood glucose levels and inadequate insulin. DKA can occur due to illness, infection, or insufficient insulin.
