Acid/Base

When pH, PaCO2 & HCO3 are outside the expected reference range

Partially Compensated

When pH outside the expected reference range & either PaCO2 or HCO3 is outside the normal range

Uncompensated

A nurse is caring for a client who is retaining carbon dioxide (CO2) as a result of an obstructive respiratory disease. The nurse understands that as the client's CO2 level rises, what will occur with the blood pH? A. Fall B. Rise C. Double D. Remain unchanged

A. Fall Rationale: CO2 acts as an acid in the body. A rise in blood CO2 will result in a fall in pH.

When pH is within expected reference range but both PaCO2 & HCO3 are outside the expected reference range

Fully Compensated

The nurse caring for a client with metabolic alkalosis examines arterial blood gas (ABG) results. Which change from the initial value indicates the client's metabolic alkalosis is improving? A. CO2 has decreased B. pH has increased C. O2 has increased D. HCO3- has decreased

D. HCO3- has decreased Rationale: In metabolic alkalosis, the client has a net gain of bicarbonate (HCO3-) which creates a rise in pH. The pH needs to move away from alkalosis, which is the high end of the pH scale, for the client's condition to demonstrate improvement. To lower the pH, either the bicarbonate level needs to decrease, or the carbon dioxide (CO2) level needs to increase. Oxygen (O2) concentration is reported on ABG results but does not indicate acid-base balance.

An anxious preoperative client is at risk for developing respiratory alkalosis. The nurse should assess the client for which signs and symptoms characteristic of this disorder? A. Headache and tachypnea B. Hyperactivity and dyspnea C. Muscle twitches and cyanosis D. Lightheadedness and paresthesia

D. Lightheadedness and paresthesia Rationale: Clinical manifestations of respiratory alkalosis include a decrease in the respiratory rate and depth, headache, lightheadedness, vertigo, mental status changes, paresthesia such as tingling of the fingers and toes, hypokalemia, hypocalcemia, tetany, and convulsions.

A nurse is reviewing the laboratory results of a client who has metabolic alkalosis. Which of the following laboratory values should the nurse expect? A. pH 7.31, HCO3- 22 mEq/L, PaCO2 50 mmHg B. pH 7.48, HCO3- 23 mEq/L, PaCO2 25 mmHg C. pH 7.32, HCO3- 18 mEq/L, PaCO2 40 mmHg D. pH 7.49, HCO3- 32 mEq/L, PaCO2 40 mmHg

D. pH 7.49, HCO3- 32 mEq/L, PaCO2 40 mmHg Rationale: The nurse should identify that these laboratory values reflect metabolic alkalosis. The pH and bicarbonate values are greater than the expected reference range, and the PaCO2 is within the expected reference range.

A client in the emergency department reports that he has been vomiting excessively for the past 2 days. His 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? A. Metabolic Alkalosis B. Respiratory Alkalosis C. Metabolic Acidosis D. Respiratory Acidosis

A. Metabolic Alkalosis Rationale: A pH over 7.45 with a HCO3- level over 26 mEq/L indicates metabolic alkalosis. Metabolic alkalosis is always secondary to an underlying cause and is marked by decreased amounts of acid or increased amounts of base HCO3-.

A nurse is reviewing a client's lab report. The client's ABG levels are pH 7.5, PaCO2 32 mmHg, & HCO3 24 mEq/L. The nurse should determine that the client has which of the following acid-base imbalances? A. Respiratory alkalosis B. Metabolic acidosis C. Respiratory acidosis D. Metabolic alkalosis

A. Respiratory alkalosis Rationale: Client's pH is elevated above the expected reference range of 7.35 to 7.45, indicting alkalosis. Client's PaCO2 is below the expected reference range of 35 to 45 mmHg, which indicates a respiratory origin.

An anxious client is experiencing respiratory alkalosis from hyperventilation caused by anxiety. The nurse should take which action to help the client experiencing this acid-base disorder? A. Put the client in a supine position B. Provide emotional support and reassurance C. Withhold all sedative or antianxiety medications. D. Tell the client to breathe very deeply but more slowly.

B. Provide emotional support and reassurance Rationale: An anxious client benefits from emotional support and reassurance, which in turn reduces anxiety and may lower the respiratory rate. The client may benefit from the administration of a sedative or antianxiety medication, if it is prescribed. The client should try to breathe more slowly and shallowly. Lying supine provides no benefit to the client.

The client with a history of lung disease is at risk for developing respiratory acidosis. The nurse assesses this client for which signs/symptoms that are characteristic of this disorder? A. Bradycardia and hyperactivity B. Decreased respiratory rate and depth C. Headache, restlessness, and confusion D. Bradypnea, dizziness, and paresthesia

C. Headache, restlessness, and confusion Rationale: When a client is experiencing respiratory acidosis, the respiratory rate and depth increase in an attempt to compensate. The client also experiences headache, restlessness, and mental status changes such as drowsiness and confusion, visual disturbances, diaphoresis, and cyanosis as the hypoxia becomes more acute, hyperkalemia, a rapid irregular pulse, and dysrhythmias.

A client with a chronic airflow limitation is experiencing respiratory acidosis as a complication. A nurse who is trying to enhance the client's respiratory status should avoid which action? A. Keeping the head of the bed elevated B. Monitoring the flow rate of supplemental oxygen C. Assisting the client to turn, cough, and breathe deeply D. Encouraging the client to breathe slowly and shallowly

D. Encouraging the client to breathe slowly and shallowly Rationale: The client with respiratory acidosis is experiencing elevated carbon dioxide levels due to insufficient ventilation. The nurse would encourage the client to breathe slowly and deeply (not shallowly) to expand alveoli and to promote better gas exchange. The actions listed in options A, B, and C are helpful actions on the part of the nurse.

A client suffering from prolonged vomiting has developed metabolic alkalosis. The nurse plans care, knowing that this imbalance will be corrected primarily when the kidneys do which function? A. Secrete sufficient water B. Retain sufficient chloride C. Secrete sufficient potassium D. Retain sufficient hydrogen ions.

D. Retain sufficient hydrogen ions

A charge nurse is teaching a group of nurses about conditions related to metabolic acidosis. Which of the following statements by a unit nurse indicates the teaching has been effective? A. "Metabolic acidosis can occur due to diabetic ketoacidosis." B. "Metabolic acidosis can occur in a client who has myasthenia gravis." C. "Metabolic acidosis can occur in a client who has asthma." D. "Metabolic acidosis can occur due to cancer."

A. "Metabolic acidosis can occur due to diabetic ketoacidosis." Rationale: Metabolic acidosis results from an excess production of hydrogen ions, which occurs in diabetic ketoacidosis.

A client has been diagnosed with metabolic alkalosis as a result of excessive antacid use. The nurse should monitor this client, expecting to note which signs/symptoms? A. Disorientation and dyspnea B. Decreased respiratory rate and depth C. Drowsiness, headache, and tachypnea D. Tachypnea, dizziness, and paresthesia

B. Decreased respiratory rate and depth Rationale: A client with metabolic alkalosis is likely to exhibit decreased respiratory rate and depth as a compensatory mechanism. A client with metabolic acidosis would display the symptoms noted in option C. The client with respiratory acidosis and alkalosis would display the symptoms noted in options A and D

A client is being treated for metabolic acidosis with medication therapy and other measures. The nurse should plan to monitor the results of which electrolyte, which could dramatically decline with effective treatment of the acidosis? A. Sodium B. Potassium C. Magnesium D. Phosphorus

B. Potassium Rationale: During treatment of metabolic acidosis, potassium moves out of the bloodstream and back into the cells. This can cause a rapid drop in the serum potassium level. Because of the effects of potassium on the heart, this electrolyte should be monitored closely as the client is treated.

A nurse is caring for a client who is experiencing metabolic alkalosis. The nurse plans to protect the client's safety knowing the risks of this imbalance, by carefully implementing which prescribed precaution? A. Contact isolation B. Seizure precautions C. Bleeding precautions D. Neutropenic precautions

B. Seizure precautions Rationale: The client with metabolic alkalosis is at risk for tetany and seizures. The nurse would maintain client safety by using seizure precautions with this client. Options A, C, and D are unnecessary in the care of the client experiencing metabolic alkalosis.

A nurse is preparing to assist a provider with an arterial blood withdrawal from a client's radial artery for ABG measurement. Which of the following actions should the nurse plan to take? A. Hyperventilate the client with 100% oxygen prior to obtaining the specimen B. Apply ice to the site after obtaining the specimen C. Perform an Allen's test prior to obtaining the specimen D. Release the pressure applied to the puncture site 1 min after the needle is withdrawn

C. Perform an Allen's test prior to obtaining the specimen Explanation: The nurse should ensure that circulation to the hand is adequate from the ulnar artery in case the radial artery is injured from the blood draw. The most common site for withdrawal of arterial blood gases is the radial artery.

A nurse is caring for a client admitted with confusion and lethargy. The client was found at home unresponsive with an empty bottle of aspirin lying next to her bed. Vital signs reveal blood pressure 104/72 mm Hg, heart rate 116/min with regular rhythm, and respiratory rate 42/min and deep. Which of the following arterial blood gas findings should the nurse expect? A. pH 7.68, PaO2 96 mmHg, PaCO2 38 mmHg, HCO3− 28 mEq/L B. pH 7.48, PaO2 100 mmHg, PaCO2 28 mmHg, HCO3− 23 mEq/L C. pH 6.98, PaO2 100 mmHg, PaCO2 30 mmHg, HCO3− 18 mEq/L D. pH 7.58, PaO2 96 mmHg, PaCO2 38 mmHg, HCO3− 29 mEq/L

C. pH 6.98, PaO2 100 mmHg, PaCO2 30 mmHg, HCO3− 18 mEq/L Rationale: An aspirin overdose would result in arterial blood gas findings of metabolic acidosis.

A nurse is obtaining arterial blood gases for a client who has vomited for 24 hr. The nurse should expect which of the following acid‑base imbalances to result from vomiting for 24 hr? A. Respiratory acidosis B. Respiratory alkalosis C. Metabolic acidosis D. Metabolic alkalosis

D. Metabolic alkalosis Rationale: Excessive vomiting causes a loss of gastric acids and an accumulation of bicarbonate in the blood, resulting in metabolic alkalosis.

The nurse is caring for a client with diabetic ketoacidosis and documents that the client is experiencing Kussmaul's respirations. Based on this documentation, which did the nurse observe? A. Respirations that cease for several seconds B. Respirations that are regular but abnormally slow C. Respirations that are labored and increased in depth and rate D. Respirations that are abnormally deep, regular, and increased in rate

D. Respirations that are abnormally deep, regular, and increased in rate Rationale: Kussmaul's respirations are abnormally deep, regular, and increased in rate. Apnea is described as respirations that cease for several seconds. In bradypnea, respirations are regular but abnormally slow. In hyperpnea, respirations are labored and increased in depth and rate.

A nurse is assessing a client who has pancreatitis. The client's arterial blood gases reveal metabolic acidosis. Which of the following are expected findings? (Select all that apply.) A. Tachycardia B. Hypertension C. Bounding pulses D. Hyperreflexia E. Dysrhythmia F. Tachypnea

E. Dysrhythmia F. Tachypnea Explanation: Dysrhythmia & Tachypnea is an expected finding in a client who has pancreatitis and metabolic acidosis. Tachycardia is an expected finding for a client who has respiratory acidosis or metabolic alkalosis. Hypertension & Bounding pulses is an expected finding of respiratory acidosis. Hyperreflexia is an expected finding for a client who has metabolic alkalosis.

A client with a 3-day history of nausea and vomiting presents to the emergency department. The client is hypoventilating and has a respiratory rate of 10 breaths/minute. The electrocardiogram (ECG) monitor displays tachycardia, with a heart rate of 120 beats/minute. Arterial blood gases are drawn and the nurse reviews the results, expecting to note which finding? A. A decreased pH and an increased CO2 B. An increased pH and a decreased CO2 C. A decreased pH and a decreased HCO3 D. An increased pH with an increased HCO3

D. An increased pH with an increased HCO3 Rationale: Clients experiencing nausea and vomiting would most likely present with metabolic alkalosis resulting from loss of gastric acid, thus causing the pH and HCO3 to increase. Symptoms experienced by the client would include hypoventilation and tachycardia. Option A reflects a respiratory acidotic condition. Option B reflects a respiratory alkalotic condition, and option C reflects a metabolic acidotic condition.

As status asthmaticus worsens, the nurse would expect which acid-base imbalance? A. Metabolic Alkalosis B. Respiratory Alkalosis C. Metabolic Acidosis D. Respiratory Acidosis

D. Respiratory Acidosis Rationale: As status asthmaticus worsens, the PaCO2 increases and the pH decreases, reflecting respiratory acidosis.

A nurse is caring for an older client who has COPD with pneumonia. The nurse should monitor the client for which of the following acid-base imbalances? A. Respiratory alkalosis B. Metabolic acidosis C. Metabolic alkalosis D. Respiratory acidosis

D. Respiratory acidosis Rationale: Respiratory acidosis is common complication of COPD. This complication occurs because clients who have COPD are unable to exhale CO2 due to a loss of elastic recoil in the lungs

Respiratory alkalosis can be caused by a respiratory rate in excess of that which maintains normal plasma PCO2 levels. What is a common cause of respiratory alkalosis? A. Hyperventilation B. Kussmaul breathing C. Cluster breathing D. Hypoventilation

A. Hyperventilation Rationale: One of the most common causes of respiratory alkalosis is hyperventilation, which is characterized by episodes of over breathing, often associated with anxiety.

A nurse is caring for a client who has chronic kidney disease. The kidneys regulate body fluids as well as assisting with which of the following functions? A. Regulation of acid base balance B. Reabsorption of nutrients for cellular growth C. Regulation of body temperature D. Secretions of hormones needed for growth

A. Regulation of acid base balance Rationale: The nurse should identify that the kidneys assist with the regulation of acid base balance in the body by retaining bicarbonate as they excrete hydrogen ions

A nurse is caring for a client who overdosed on acetylsalicylic acid (aspirin) 24 hours ago. The nurse should expect to note which findings associated with an anticipated acid-base disturbance? A. Disorientation and dyspnea B. Drowsiness, headache, and tachypnea C. Tachypnea, dizziness, and paresthesia D. Decreased respiratory rate and depth, cardiac irregularities

B. Drowsiness, headache, and tachypnea Rationale: The client who ingests a large amount of aspirin (acetylsalicylic acid) is at risk for developing metabolic acidosis 24 hours later. If metabolic acidosis occurs, the client is likely to exhibit drowsiness, headache, and tachypnea. In the very early hours following aspirin overdose, the client may exhibit respiratory alkalosis as a compensatory mechanism. By 24 hours post overdose, however, the compensatory mechanism fails and the client reverts to metabolic

The nurse is planning to obtain blood for arterial blood gas (ABG) analysis from a client with chronic obstructive pulmonary disease. The nurse should plan time for which activity after the arterial blood specimen is drawn? A. Holding a warm compress over the puncture site for 5 minutes B. Encouraging the client to open and close the hand rapidly for 2 minutes C. Applying pressure to the puncture site by applying a 2 × 2 gauze for 5 minutes D. Having the client keep the radial pulse puncture site in a dependent position for 5 minutes

C. Applying pressure to the puncture site by applying a 2 × 2 gauze for 5 minutes Rationale: Applying pressure over the puncture site reduces the risk of hematoma formation and damage to the artery. A cold (not warm) compress would aid in limiting blood flow. Keeping the extremity still and out of a dependent position will aid in the formation of a clot at the puncture site.

A nurse is providing care to a client with the following arterial blood gas (ABG) results: pH 7.50; Pao2 90 mm Hg; Paco2 40 mm Hg; and bicarbonate 35 mEq/L. When the nurse notifies the health care provider (HCP) about these levels, the nurse should anticipate receiving which prescription for this client from the HCP? A. Obtain a serum alcohol level B. Obtain a serum salicylate level C. Discontinue nasogastric suctioning D. Discontinue the client's Fentanyl patch.

C. Discontinue nasogastric suctioning Rationale: The ABG results indicate metabolic alkalosis as the pH and bicarbonate are elevated. Nasogastric suctioning may cause metabolic alkalosis by decreasing the acid components in the stomach. Excess alcohol ingestion and salicylate toxicity may cause metabolic acidosis. Fentanyl (an opioid) may cause respiratory acidosis.

A client is determined to be in respiratory alkalosis by blood gas analysis. The nurse would monitor this client for signs of which of the following electrolyte disorders that could accompany the acid-base imbalance? A. Hypercalcemia B. Hypochloremia C. Hypernatremia D. Hypokalemia

D. Hypokalemia Rationale: Clinical manifestations of respiratory alkalosis include tachypnea, hyperpnea, weakness, paresthesia, tetany, dizziness, convulsions, coma, hypokalemia, and hypocalcemia.

A client tells the nurse that the client has been taking Alka-Seltzer (bicarbonate—antacid) four times a day for the past 2 weeks for an upset stomach. Upon assessment of the client, the nurse notes hyperactive reflexes, tetany, and mental confusion. Arterial blood gases reveal pH 7.55; serum HCO3− 37 mEq/L. The nurse suspects the client may be experiencing? A. Respiratory acidosis B. Respiratory alkalosis C. Metabolic alkalosis D. Metabolic acidosis

D. Metabolic alkalosis Rationale: Metabolic alkalosis is characterized by a serum pH greater than 7.45; serum HCO3− greater than 26 mEq/L; Transient or acute alkalosis is common during or immediately following excess oral ingestion of bicarbonate antacids. Respiratory acidosis as well as metabolic acidosis would have a decrease in pH.

The nurse is caring for the following group of clients. Select the client most likely to be diagnosed with respiratory alkalosis. A. A 26-year-old female with anxiety who has been hyperventilating B. A 63-year-old male with a 40-year history of smoking and chronic lung disease C. A 45-year-old male with pneumothorax after a car accident D. An 18-year-old female who has overdosed on narcotics

A. A 26-year-old female with anxiety who has been hyperventilating Rationale: Respiratory alkalosis can occur with hyperventilating and the loss of CO2. The other three clients are more at risk for respiratory acidosis as a result of retaining CO2.

As other mechanisms prepare to respond to a pH imbalance, immediate buffering is a result of increased A. Bicarbonate/carbonic acid regulation B. Intracellular albumin C. Sodium/phosphate anion absorption D. Hydrogen/potassium binding.

A. Bicarbonate/carbonic acid regulation Rationale: The bicarbonate buffering system, which is the principal ECF buffer, uses H2CO3 as its weak acid and bicarbonate salt such as sodium bicarbonate (NaHCO3) as its weak base. It substitutes the weak H2CO3 for a strong acid such as hydrochloric acid or the weak bicarbonate base for a strong base such as sodium hydroxide. The bicarbonate buffering system is a particularly efficient system because its components can be readily added or removed from the body. Hydrogen and potassium exchange freely across the cell membrane to regulate acid-base balance. Sodium is not part of the buffering system. Intracellular protein is part of the body protein buffer system; albumin is extracellular.

A nurse is assisting in the care of a client who had an ileostomy created a few days ago. Owing to the normally high output of drainage from this type of ostomy, the nurse monitors the client for signs of A. Metabolic acidosis B. Metabolic alkalosis C. Respiratory acidosis D. Respiratory alkalosis

A. Metabolic acidosis Rationale: Intestinal secretions are high in bicarbonate because of the effects of pancreatic secretions. These fluids may be lost from the body before they can be reabsorbed in conditions such as diarrhea or creation of ileostomy. The decreased bicarbonate level creates the actual base deficit of metabolic acidosis.

The nurse is caring for a client with chronic kidney disease. Arterial blood gas (ABG) results indicate a pH of 7.30, a Pco2 of 32 mm Hg, and a bicarbonate concentration of 20 mEq/L. Which laboratory value should the nurse expect to note? A. Sodium level of 145 mEq/L B. Potassium level of 5.2 mEq/L C. Phosphorus level of 4.0 mg/dL D. Magnesium level of 2.0 mg/dL

B. Potassium level of 5.2 mEq/L Rationale: Interpretation of the ABG indicates metabolic acidosis with partial compensation by the respiratory system. Clinical manifestations of metabolic acidosis include hyperpnea with Kussmaul's respirations; headache; nausea, vomiting, and diarrhea; fruity-smelling breath resulting from improper fat metabolism; central nervous system depression, including mental dullness, drowsiness, stupor, and coma; twitching; and convulsions. Hyperkalemia will occur.

The nurse is caring for a client with metabolic alkalosis whose breathing rate is 8 breaths/min. Which arterial blood gas data does the nurse anticipate finding? A. pH 7.28, PaCO2: 52 mmHg, HCO3- 32 mEq/l B. pH 7.60, PaCO2 64 mmHg, HCO3- 42 mEq/l C. pH 7.32, PaCO2 26 mmHg, HCO3- 18 mEq/l D. pH 7.32, PaCO2 28 mmHg, HCO3- 24 mEq/l

B. pH 7.60 PaCO2 64 mmHg HCO3- 42 mEq/l Rationale: In metabolic alkalosis, arterial blood gas results are anticipated to reflect pH greater than 7.45; a high PaCO2 such as 64 mm Hg and a high HCO3 such as 42 mEq/l. The numbers correlate with metabolic alkalosis, which is indicated by the hypoventilation and the retention of CO2.

A client with diabetes mellitus has a blood glucose level of 644 mg/dL. The nurse should develop a plan of care because the client is at risk for the development of which type of acid-base imbalance? A. Metabolic acidosis B. Metabolic alkalosis C. Respiratory acidosis D. Respiratory alkalosis

A. Metabolic acidosis Rationale: Diabetes mellitus can lead to metabolic acidosis. When the body does not have sufficient circulating insulin, the blood glucose level rises. At the same time, the cells of the body use all available glucose. The body then breaks down glycogen and fat for fuel. The by-products of fat metabolism are acidotic, potentially leading to the condition known as diabetic ketoacidosis.

A client with diabetes mellitus has a blood glucose on admission of 596 mg/dL. The nurse anticipates that this client would be experiencing which of the following types of acid-base imbalance? A. Metabolic acidosis B. Metabolic alkalosis C. Respiratory acidosis D. Respiratory alkalosis

A. Metabolic acidosis Rationale: Diabetes mellitus can lead to metabolic acidosis. When the body does not have sufficient circulating insulin, the blood glucose level rises while the cells of the body use all available glucose and then break down glycogen and fat for fuel. The by-products of fat metabolism are acidotic, leading to the complication called diabetic ketoacidosis.

The nurse is performing a change-of-shift assessment on a client. The client had an arterial blood gas specimen drawn during an admission work-up on the previous day and has a hematoma at the puncture site. What is the priority nursing intervention? A. Perform the Allen's test B. Apply a warm compress C. Administer the antidote for heparin D. Notify the hospital laboratory supervisor.

B. Apply a warm compress Rationale: The application of a warm compress enhances the absorption of blood in the hematoma. Allen's test is performed before the collection of the specimen to assess collateral blood flow. Heparinized syringes are used for the collection of an arterial blood gas, but no heparin is administered to a client. The antidote for heparin is not administered at this time unless prescribed. The laboratory department is not responsible for collecting the ABG specimen. Additionally, there is no useful reason to notify the hospital laboratory supervisor.

A client has a prescription for a set of arterial blood gas (ABGs) samples to be drawn on room air. The client currently is receiving oxygen by nasal cannula at a delivery rate of 3 L/min. After reading the prescription, the nurse should take which action? A. Remove the nasal cannula for 15 minutes; then have the ABG samples drawn B. Change the nasal cannula to a shovel face mask; then have the ABG samples drawn C. Leave the nasal cannula in place for 15 minutes; then have the ABG samples drawn D. Change the nasal cannula to a Venturi face mask; then have the ABG samples drawn.

A. Remove the nasal cannula for 15 minutes; then have the ABG samples drawn Rationale: The client should have oxygen supplementation removed for at least 15 minutes before ABGs are drawn if the client has a prescription for the ABGs to be drawn on room air. This allows time for the client's system to equilibrate so that the ABG results will accurately reflect ventilatory status without the supplemental oxygen. This prescription may be given when the health care provider is trying to decide whether to discontinue oxygen therapy, and it allows staff to observe how the client tolerates oxygen removal.

A nurse is assisting to admit a client with a diagnosis of Guillain-Barré syndrome. The nurse knows that if the disease is severe enough, the client will be at risk for which of the following acid-base imbalances? A. Metabolic acidosis B. Metabolic alkalosis C. Respiratory acidosis D. Respiratory alkalosis

C. Respiratory acidosis Rationale: Guillain-Barré is a neuromuscular disorder in which the client may experience weakening or paralysis of the muscles used for respiration. This could cause the client to retain carbon dioxide, leading to respiratory acidosis due to ventilatory failure as the paralysis ensues.

A nurse is caring for a client who is extremely anxious and is hyperventilating. The client's ABG results are pH 7.50, PaCO2 27 mmHg, and HCO3- 25 mEq/L. The nurse should identify that the client has which of the following acid-base imbalances? A. Respiratory acidosis B. Metabolic acidosis C. Respiratory alkalosis D. Metabolic alkalosis

C. Respiratory alkalosis Rationale: Because of rapid breathing, the client is exhaling excessive amounts of carbon dioxide. This loss of carbon dioxide decreases the hydrogen ion level of the blood, which causes the pH to increase and results in respiratory alkalosis.

A client is diagnosed with diabetic ketoacidosis (DKA) in the emergency department. Which clinical manifestations will the client likely exhibit? A. Weakness, severe dehydration, and hemiparesis B. Polyuria, polydipsia, vomiting, and fatigue C. Headache, difficulty with problem solving and disturbed behavior, and seizures D. Ankle edema, headache, stomach bloating, and high blood pressure

B. Polyuria, polydipsia, vomiting, and fatigue Rationale: Diabetic ketoacidosis (DKA) is characterized by hyperglycemia, ketosis, osmotic diuresis, dehydration, and metabolic acidosis. It is an acute life-threatening complication of uncontrolled diabetes. Weakness, severe dehydration, and hemiparesis are signs of hyperosmolar hyperglycemic states. Headache, difficulty problem solving, and disturbed behavior and seizures are signs of hypoglycemia. The signs of hypervolemia include edema (most often in the feet, ankles, wrists, and face); discomfort in the body (causing cramping, headache, stomach bloating); and high blood pressure caused by excess fluid in the bloodstream.

A nurse is caring for a client who was in a motor‑vehicle accident. The client reports chest pain and difficulty breathing. A chest x‑ray reveals the client has a pneumothorax. Which of the following arterial blood gas findings should the nurse expect? A. pH 7.06, PaO2 86 mmHg, PaCO2 52 mmHg, HCO3− 24 mEq/L B. pH 7.42, PaO2 100 mmHg, PaCO2 38 mmHg, HCO3− 23 mEq/L C. pH 6.98, PaO2 100 mmHg, PaCO2 30 mmHg, HCO3− 18 mEq/L D. pH 7.58, PaO2 96 mmHg, PaCO2 38 mmHg, HCO3− 29 mEq/L

A. pH 7.06, PaO2 86 mm Hg, PaCO2 52 mm Hg, HCO3 − 24 mEq/L Rationale: A pneumothorax can cause alveolar hyperventilation and increased carbon dioxide levels, resulting in a state of respiratory acidosis.

A client experiencing metabolic acidosis is to be admitted to the nursing unit. The nurse develops a plan of care to support the client physiologically until the tubular cells secrete a sufficient amount of which substance? A. Phosphates B. Hydrogen ions C. Ammonium ions D. Carbon dioxide molecules

B. Hydrogen ions Rationale: Hydrogen ions are cations that contribute to a state of acidosis in the body. The renal tubules secrete hydrogen ions and potassium effectively, and in lesser amounts they secrete ammonia and uric acid. Phosphates are anions that tend to neutralize cations. The tubules reabsorb carbon dioxide molecules.

The client tells the nurse that he ingests large amounts of oral antacids on a daily basis. The nurse plans care knowing that the excessive use of oral antacids containing bicarbonate can result in which acid-base disturbance? A. Metabolic acidosis B. Metabolic alkalosis C. Respiratory acidosis D. Respiratory alkalosis

B. Metabolic alkalosis Rationale: Increases in base components occur as a result of oral or parenteral intake of bicarbonates, carbonates, acetates, citrates, or lactates. Excessive use of oral antacids containing bicarbonate can cause a metabolic alkalosis.

A nurse on a medical unit is caring for a client who aspirated gastric contents prior to admission. The nurse administers 100% oxygen by nonrebreather mask after the client reports severe dyspnea. Which of the following findings is a clinical manifestation of acute respiratory distress syndrome (ARDS)? A. Tympanic temperature 38°C (100.4°F) B. PaO2 50 mmHg C. Rhonchi D. Hypopnea

B. PaO2 50 mmHg Rationale: This client who has manifestations of ARDS has a low PaO2 level, even after the administration of oxygen. Hypoxemia after treatment with oxygen is a manifestation of ARDS.