Exam 2

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The nurse is caring for a client with laboratory values indicating dehydration. Which clinical symptom is consistent with the dehydration?

Dark, concentrated urine

Common cause of respiratory alkalosis: A.Intense exercise B.Chronic Kidney problems C.Ingestion of large amounts of water D.Hyperventilation

D.Hyperventilation

You are caring for a 72-year-old client who has been admitted to your unit for a fluid volume imbalance. You know which of the following is the most common fluid imbalance in older adults?

Dehydration The most common fluid imbalance in older adults is dehydration. Because of reduced thirst sensation that often accompanies aging, older adults tend to drink less water. Use of diuretic medications, laxatives, or enemas may also deplete fluid volume in older adults. Chronic fluid volume deficit can lead to other problems such as electrolyte imbalances. Therefore, options A, C, and D are incorrect.

Which of the following electrolytes is the primary determinant of extracellular fluid (ECF) osmolality? Potassium Calcium Sodium Magnesium

Sodium Sodium is the primary determinant of ECF osmolality. Sodium plays a major role in controlling water distribution throughout the body because it does not easily cross the intracellular wall membrane and because of its abundance and high concentration in the body. Potassium, calcium, and magnesium are not primary determinants of ECF osmolality.

Treatment of FVE involves dietary restriction of sodium. Which of the following food choices would be part of a low-sodium diet, mild restriction (2 to 3 g/day)?

Three ounces of light or dark meat chicken, 1 cup of spaghetti and a garden salad Ham (1,400 mg Na for 3 oz) and bacon (155 mg Na/slice) are high in sodium as is tomato juice (660 mg Na/¾ cup) and low fat cottage cheese (918 mg Na/cup). Packaged meals are high in sodium.

Trousseau's sign

arm/carpal spasm associated with hypocalcemia

The community health nurse is performing a home visit to an older client recovering from hip surgery. The nurse notes that the client seems uncharacteristically confused and has dry mucous membranes. When asked about fluid intake, the client states, "I stop drinking water early in the day because it is just too difficult to get up during the night to go to the bathroom." What would be the nurse's best response?

"Limiting your fluids can create imbalances in your body that can result in confusion. Maybe we need to adjust the timing of your fluids."

Which is considered an isotonic solution? 0.9% normal saline Dextran 0.45% normal saline 3% NaCl

0.9% normal saline An isotonic solution is 0.9% normal saline (NaCl). Dextran in normal saline is a colloid solution, 0.45% normal saline is a hypotonic solution, and 3% NaCl is a hypertonic solution.

The weight of a client with congestive heart failure is monitored daily and entered into the medical record. In a 24-hour period, the client's weight increased by 2 lb. How much fluid is this client retaining? 1500mL 800mL 1L 200mL

1 L A 2-lb weight gain in 24 hours indicates that the client is retaining 1L of fluid.

1.Low plasma PCO2 = 2.High plasma PCO2 = 3.Decreased plasma bicarbonate (HCO3-) = 4.Increased plasma bicarbonate (HCO3) =

1.Low plasma PCO2 = Respiratory alkalosis 2.High plasma PCO2 = Respiratory acidosis 3.Decreased plasma bicarbonate (HCO3-) = Metabolic acidosis 4.Increased plasma bicarbonate (HCO3) = Metabolic alkalosis

Below which serum sodium concentration might convulsions or coma occur? 135 mEq/L 140 mEq/L 142 mEq/L 145 mEq/L

135 mEq/L (135 mmol/L) Normal serum concentration level ranges from 135 to 145 mEq/L (135-145 mmol/L). When the level dips below 135 mEq/L (135 mmol/L), hyponatremia occurs. Manifestations of hyponatremia include mental confusion, muscular weakness, anorexia, restlessness, elevated body temperature, tachycardia, nausea, vomiting, and personality changes. Convulsions or coma can occur if the deficit is severe. Values of 140, 142, and 145 mEq/L (mmol/L) are within the normal range.

normal ranges for Na+

135-145

what is the ratio of H2CO3:HCO3-

1:20

normal ranges for HCO3

22-25

normal ranges for K+

3.5-5.3

normal ranges for PaCO2

35-45

normal ranges for pH

7.35-7.45

A client experiencing a severe anxiety attack and hyperventilating presents to the emergency department. The nurse would expect the client's pH value to be 7.35 7.30 7.50 7.45

7.50 The patient is experiencing respiratory alkalosis. Respiratory alkalosis is a clinical condition in which the arterial pH is >7.45 and the PaCO2 is <38 mm Hg. Respiratory alkalosis is always caused by hyperventilation, which causes excessive "blowing off" of CO2 and, hence, a decrease in the plasma carbonic acid concentration. Causes include extreme anxiety, hypoxemia, early phase of salicylate intoxication, gram-negative bacteremia, and inappropriate ventilator settings.

normal ranges for PaO2

75/80-100

normal ranges for Cl-

96-106

>"Thrill" on palpation/ bruit with auscultation = turbulence mixing of blood between artery and vein >Caution taking BP/ too tight clothes etc. on this arm > Protect site (site takes months to develop and get the site right (ripe) for dialysis)

>Caution: most drugs are excreted by the kidneys; many drugs may reach toxic level >Diuretic drugs: Lasix (help fluid, HTN and remove potassium ) >HTN meds (ACE) preferred >Meds to regulate electrolyte imbalances >Potassium lowering drugs as needed (insulin with glucose / bicarbonate (not safest choice), (kayexalate) sodium polystyrene sulfonate (orally or rectally) binds with K+ and removes through GI >Calcium acetate: binds with serum phosphorus to lower levels >Epoetin injections: hormone typically created by kidneys; signals bone marrow to produce more RBC's >Multi vitamin >Calcium Acetate: Binds with serum phosphates to lower the level > >Other item to discuss >Leading cause of ESRD is diabetes

>J.B is a 38 year old woman admitted to your medical floor. She is complaining of dehydration and fatigue. >Her medical history revealed Diabetes I since the age of 8. She has been undergoing hemodialysis for the past 2 years. >She presents as a thin, pale and drowsy female. She is warm to touch with dry skin and mucus membranes with poor skin turgor. > She has experienced severe diarrhea for the past few days with nausea and little to eat or drink. She has an arteriovenous (AV) fistula in her left arm for dialysis. Over the next 48 hours J.B starts to feel better, You begin to discuss her renal diet to access compliance and home discharge when she tells you, " my dialysis dietitian speaks in big words and I just don't understand the diet." >List the main points of a renal diet with rationale to review with J.B (use additional paper as needed )

>Dietary/ fluid modifications can slow progress of disease >More carbs/fats... restrict protein because: (proteins not used are degraded into urea and other nitrogenous wastes and eliminated via kidneys, and they contain inorganic ions eliminated by kidneys...taxing the kidneys. 0.6g/kg body weight of daily protein is allowed or 40 grams average for male client >Regulate sodium intake so no extra fluid retained with it (restricted to 2 grams. a day) >Water intake of 1 - 2 L day; more restriction as kidneys decline >Potassium and phosphorous intake restriction/ in later stages of ESRD >Avoid SALT Substitute, due to high potassium content & some sodium is still present >Watch intake of sodium bicarbonate/ (baking soda) high in sodium

S/Sx's of magnesium deficiency include

>Hyperexcitability >Muscle weakness/fatigue/ muscle twitching /Sleepiness >Cognition: poor memory, irritability, confusion, apathy, Moderate to severe deficiency: Heart arrhythmias Deficiency of magnesium can occur in people who abuse alcohol or in those who absorb less magnesium due to: >Burns >Certain medications >Low blood levels of calcium >Problems absorbing nutrients from the intestinal tract (malabsorption) >Surgery

>J.B is a 38 year old woman admitted to your medical floor. She is complaining of dehydration and fatigue. >Her medical history revealed Diabetes I since the age of 8. She has been undergoing hemodialysis for the past 2 years. >She presents as a thin, pale and drowsy female. She is warm to touch with dry skin and mucus membranes with poor skin turgor. > She has experienced severe diarrhea for the past few days with nausea and little to eat or drink. She has an arteriovenous (AV) fistula in her left arm for dialysis. 7. Renal Failure patients have multisystem effects of uremia. List several of the effects: and any patient education for health promotion related to the effects:

>Labs: Hyperkalemia (muscle weakness, paresthesia, EKG changes, GI (diarrhea) /Hyperphosphatemia, hypocalcemia , anemia: lethargic, fatigue >Metabolic acidosis (Kussmaul respirations to compensate) >Uremia (early s/s: nausea, apathy, weakness, fatigue ...worse; vomiting, weakness, lethargy confusion >HTN Excess fluid/ heart failure/ pulmonary edema / cardiac arrhythmias = electrolyte imbalances, >Metabolic toxins = pericarditis >ANEMIA = erythropoietin production declines (controls RBC production)retain toxins further suppress RBC production = fatigue, weakness, depression, impaired cognition >Impaired platelet function = increase risk bleeding disorders >Impaired Immune system = delay diagnosis of infection, fever suppressed >GI = ulceration (increased rink of GI bleeding) uremic fetor (urine like breath odor) metallic taste in mouth >Neuro: cognitive processing, difficulty concentrating, fatigue, insomnia, ....psychotic symptoms, seizures, coma as it advances/ paresthesia's/ motor function, muscle weakness, DTR decreased > Musculoskeletal: high phosphate leads to low calcium/ stimulate PTH & causes calcium resorption from bone = osteodystopy and renal rickets softening of bones and osteoporosis (decreased bone mass) = spontaneous fractures (safety concerns for the nurse) >Endocrine: risk of gout, insulin resistance, high triglyceride levels accelerated atherosclerotic process, pregnancies rarely carried to term, other male/female irregular hormone levels >Skin: pigmented metabolites = pallor and yellowish hue, dry skin poor turgor, seat gland atrophy, bruising and excoriations, metabolic wastes deposited on skin (uremic frost) = itch

>J.B is a 38 year old woman admitted to your medical floor. She is complaining of dehydration and fatigue. >Her medical history revealed Diabetes I since the age of 8. She has been undergoing hemodialysis for the past 2 years. >She presents as a thin, pale and drowsy female. She is warm to touch with dry skin and mucus membranes with poor skin turgor. > She has experienced severe diarrhea for the past few days with nausea and little to eat or drink. She has an arteriovenous (AV) fistula in her left arm for dialysis. 1.List all the items above in the case study which support the diagnosis of dehydration:

>Little to eat or drink >Skin warm and dry >Poor skin turgor >Dry mucous membranes >Fluid may be restricted if she is on dialysis (contributing to dehydration) >BUN/ creatinine (poor indicators...may already be elevated due to CKD/ESRD) >Which Vital Signs indicate dehydration? >Temp/ elevated pulse, BP would be low in some one NO kidney disease >Elevated K+ could reflect need for dialysis or dehydration/ K+ is elevated in CKD Any other?

Food Sources for Magnesium:

>Most dietary magnesium comes from vegetables, such as dark green, leafy vegetables.

>J.B is a 38 year old woman admitted to your medical floor. She is complaining of dehydration and fatigue. >Her medical history revealed Diabetes I since the age of 8. She has been undergoing hemodialysis for the past 2 years. >She presents as a thin, pale and drowsy female. She is warm to touch with dry skin and mucus membranes with poor skin turgor. > She has experienced severe diarrhea for the past few days with nausea and little to eat or drink. She has an arteriovenous (AV) fistula in her left arm for dialysis. >J.B is concerned about her renal failure and asks you, "is there any way I could have avoided this disease.. I want to help my friend who has a history of chronic renal failure in her family" 6.Your answer - Risk factors are:

>No smoking >Keep blood glucose down (DM), (reduced blood flow , clogged vessels & other pathways) >Exercise regularly/ watch BMI >Manage HTN (decreased blood flow harms kidneys) >Limit alcohol (remodels kidney)

>Systemic hypertension is common in CKD : >Excess fluid volume, (not in this case) >Increased renin-angiotensin activity >Increased peripheral vascular resistance >Decreased prostaglandins >Accelerated atherosclerosis >NOTE: Normally with dehydration it would be low/ or at least (orthostatic hypotension)

Patients with which conditions are at greater risk for deficient fluid volume? (Select all that apply) A.Fever of 103 B.Extensive burns C.Thyroid crisis D.Water intoxication E.Continuous fistula drainage F.Diabetes insipidus

A.Fever of 103 B.Extensive burns C.Thyroid crisis E.Continuous fistula drainage F.Diabetes insipidus

The nurse is caring for four clients on a medical unit. The nurse is most correct to review which client's laboratory reports first for an electrolyte imbalance? A 65-year-old with a myocardial infarction A 52-year-old with diarrhea A client who just had a knee replacement

A 52-year-old with diarrhea Electrolytes are in both intracellular and extracellular water. Electrolyte deficiency occurs from an inadequate intake of food, conditions that deplete water such as nausea and vomiting, or disease processes that cause an excess of electrolyte amounts. The 52-year-old with diarrhea would be the client most likely to have an electrolyte imbalance. The orthopedic client will not likely have an electrolyte imbalance. Myocardial infarction clients will occasionally have electrolyte imbalance, but this is the exception rather than the rule.

What can cause H+ concentration to increase or pH to lower? (Select all that apply) A.Accumulation of acids B. Increase of Bases C.Loss of Bases D.Deep Fast breathing

A. Accumulation of acids C. Loss of Bases

When there is an abnormal pH and change in one blood parameter, it is: A.Uncompensated B.Partially compensated C.Fully compensated D. Corrected

A. Uncompensated

Which parenteral potassium order is safe for the nurse to implement? A.Add 20 mEq of KCl to 1,000 mL of IV fluid B.10 mEq KCl IV over 1-2 minutes C.Dilute 20 mEq KCl in 3 mL of NS and give IV push D.10 mEq KCl SQ

A.Add 20 mEq of KCl to 1,000 mL of IV fluid Parenteral potassium should be well diluted and given IV. It is not given SQ, by IV push, or in limited dilution (such as 20 mEq in 25 mL of fluid). If given in concentrated form, parenteral potassium is lethal to the client.

The client has been placed on a 1,200 mL oral fluid restriction. How should the nurse plan for this restriction? A.Allow 600 mL from 7-3, 400 mL from 3-11, and 200 mL from 11-7. B.Instruct the client the 1,200 mL of fluid placed in the bedside pitcher must last until tomorrow. C.Offer the client softer, cold foods such as sherbet and custard. D.Remove fluids from diet trays and offer them only between meals.

A.Allow 600 mL from 7-3, 400 mL from 3-11, and 200 mL from 11-7. The amount of fluid allowed should be divided between the three major times of the day (7-3, 3-11, 11-7). GIVE 50% to daytime hours. This helps by taking into consideration meals and medication administration. Sherbet and custard are counted as liquids and should be avoided. The client should be given a choice regarding consumption of fluids at mealtime.

The mother of a 1-month-old infant calls the nurse who works in the health clinic. The mother is concerned because the infant has had vomiting and diarrhea for 2 days. What instruction should the nurse give this infant's mother? A.Bring the infant to the clinic for evaluation. B.Give the infant at least 2 ounces of juice every 2 hours. C.Measure the infant's urine output for 24 hours. D.Provide the infant with 50 mL of glucose water.

A.Bring the infant to the clinic for evaluation. Parents and caregivers need to be taught the seriousness of vomiting or diarrhea in infants due to rapid fluid loss which can occur in this age group as well as the importance of bringing an infant in this situation to health care providers for evaluation. Encouraging fluids for an infant who is actively vomiting will not improve fluid balance status, nor is juice or glucose water the best choice of fluid. Simply monitoring the loss over the next 24 hours would increase the potential for the infant to become dehydrated.

Which of the following situations can cause an increased serum sodium and chloride level? A.Excessive use of table salt B.Continuous use of canned vegetables and soups C.Increased water intake D.Use of Intravenous 3% saline solutions E.Use of diuretics F. Large does or prolonged uses of oral cortisone therapy G.Severe vomiting

A.Excessive use of table salt B.Continuous use of canned vegetables and soups D.Use of Intravenous 3% saline solutions F. Large does or prolonged uses of oral cortisone therapy

The client has been vomiting and has weak flabby muscles with cramping. The client's pulse is irregular. The nurse would correctly suspect what type of imbalance? A.Hypokalemia B.Hyperkalemia C.Hypocalcemia D.Hypercalcemia

A.Hypokalemia Hypokalemia is generally defined as a serum potassium level of less than 3.5 mEq/L (3.5 mmol/L). Severe hypokalemia is a level of less than 2.5 mEq/L. Patients are often asymptomatic, particularly those with mild hypokalemia. Symptoms present are often from the underlying cause of the hypokalemia rather than the hypokalemia itself. The symptoms of hypokalemia are nonspecific and predominantly are related to muscular or cardiac function. Signs and Symptoms may include:: >Weakness and fatigue (most common) >Muscle cramps and pain (severe cases) >Worsening diabetes control or polyuria >Palpitations >Possibly even: Psychological symptoms (ie, psychosis, delirium, hallucinations, depression)

High PCO2 (respiratory acidosis) indicates: A.Hypoventilation B.Hyperventilation

A.Hypoventilation

Which findings indicate a patient may have hypervolemia? (select all that apply) A.Increased, bounding pulse B.JVD C.Diminished peripheral pulses D.Presence of crackles E.Excessive thirst F.Elevated blood pressure G.Orthostatic hypotension H.Skin pale and cool to touch

A.Increased, bounding pulse B.JVD D.Presence of crackles F.Elevated blood pressure

Pick 4 functions of Calcium in the body: A.Maintain normal cell permeability B.Formation of bones/ teeth C.Maintain gastric pH D.Assist with insulin production E.Normal clotting mechanism F.Normal muscle and nerve activity

A.Maintain normal cell permeability B.Formation of bones/ teeth E.Normal clotting mechanism F.Normal muscle and nerve activity

What impacts does sodium have on body function? (Select all that apply): A.Maintains electroneutrality B.Maintains electrical membrane excitability C.Aids in carbohydrate and lipid metabolism D.Regulates water Balance E.Regulates plasma osmolality

A.Maintains electroneutrality D.Regulates water Balance E.Regulates plasma osmolality

The client is receiving fluid replacement. The nurse's health teaching with this client includes which suggestions? (Select all that apply) A.Measure weight daily B.Know that thirst means a mild fluid deficit C.Monitor fluid intake D.Avoid the use of calcium supplements

A.Measure weight daily B.Know that thirst means a mild fluid deficit C.Monitor fluid intake

The most sensitive assessment parameter[s] for the early detection of fluid volume deficit : A.Orthostatic hypotension and tachycardia B.Blood pressure of 100/70 in the supine position C.Lassitude, weakness, and fatigue D.Prolonged filling time in the hand veins E.Decreased serum sodium concentration

A.Orthostatic hypotension and tachycardia

Which patients are at risk for developing hyponatremia? (Select all that apply): A.Postoperative patient who has been NPO for 24 hours with no IV fluid infusing B.Patient with slight decreased fluid intake for several days C.Patient with excessive intake of 5% dextrose solution D.Diabetic patient with blood glucose of 250 mg/dl E.Patient with overactive adrenal glands F.Tennis player in 100 degree F weather who has been drinking water

A.Postoperative patient who has been NPO for 24 hours with no IV fluid infusing C.Patient with excessive intake of 5% dextrose solution D.Diabetic patient with blood glucose of 250 mg/dl F.Tennis player in 100 degree F weather who has been drinking water >Sodium is an essential electrolyte that maintains the balance of water in and around your cells. Important for proper muscle and nerve function. Helps to maintain stable blood pressure levels Common symptoms of low blood sodium include: >Weakness/fatigue or low energy >Headache >Nausea and vomiting >Muscle cramps or spasms >Confusion/irritability (SAFETY issues)

The nurse has admitted a client brought to the hospital after a narcotic overdose. What acid-base imbalance does the nurse expect to observe in this client? A.Respiratory acidosis B.Respiratory alkalosis C.Metabolic acidosis D.Metabolic alkalosis

A.Respiratory acidosis

pH = 7.31 PaCo2 = 50mmHg HCO3 = 22mEq/L A.Respiratory acidosis/ Uncompensated B.Respiratory Alkalosis/ Partially compensated C.Metabolic acidosis/ Fully compensated D.Metabolic Alkalosis/ Uncompensated

A.Respiratory acidosis/ Uncompensated

One of the main functions of sodium is to influence the distribution of in the body A.Water B.Glucose C.CO2 D.Bicarbonate

A.Water Water accompanies sodium and chief regulation of sodium occurs within the kidneys...adrenal glands and posterior pituitary gland (hypothalamus = ADH), helps regulate too.

common causes for respiratory acidosis

Acute respiratory acidosis: acute respiratory conditions (pulmonary edema, pneumonia, acute asthma), opiate overdose, foreign body aspiration, chest trauma chronic respiratory acidosis: chronic respiratory diseases (COPD, cystic fibrosis), MS, neuromuscular diseases, stroke

Which is the most common cause of symptomatic hypomagnesemia? Intravenous drug use Sedentary lifestyle Alcoholism Burns

Alcoholism Alcoholism is currently the most common cause of symptomatic hypomagnesemia. Intravenous drug use, sedentary lifestyle, and burns are not the most common causes of hypomagnesemia.

The nurse is reviewing lab work on a newly admitted client. Which of the following diagnostic studies confirm the nursing diagnosis of Deficient Fluid Volume? Select all that apply. Low urine specific gravity An elevated hematocrit level Electrolyte imbalance Hematocrit level of 48 Elevated protein ketones present

An elevated hematocrit level Electrolyte imbalance Dehydration is a common primary or secondary diagnosis in health care. An elevated hematocrit level reflects low fluid level and a hemoconcentration. Electrolytes are in an imbalance as sodium and potassium levels are excreted together in client with dehydration. The urine specific gravity, due to concentrated particle level, is high. Protein is not a common sign of dehydration. Ketones are always present in the urine.

A client with chronic renal failure has a serum potassium level of 6.8 mEq/L. What should the nurse assess first? Blood pressure Pulse Respiration Temperature

An elevated serum potassium level may lead to a life-threatening cardiac arrhythmia, which the nurse can detect immediately by palpating the pulse. In addition to assessing the client's pulse, the nurse should place the client on a cardiac monitor because an arrythmia can occur suddenly. The client's blood pressure may change, but only as a result of the arrhythmia. Therefore, the nurse should assess blood pressure later. The nurse also may delay assessing respirations and temperature because these aren't affected by the serum potassium level.

>J.B is a 38 year old woman admitted to your medical floor. She is complaining of dehydration and fatigue. >Her medical history revealed Diabetes I since the age of 8. She has been undergoing hemodialysis for the past 2 years. >She presents as a thin, pale and drowsy female. She is warm to touch with dry skin and mucus membranes with poor skin turgor. > She has experienced severe diarrhea for the past few days with nausea and little to eat or drink. She has an arteriovenous (AV) fistula in her left arm for dialysis. >5. What laboratory values are abnormal? And rationale/ possible reasons they are abnormal? See above on labs >Do any of her symptoms correspond to the lab abnormalities?

Anemia = weakness, fatigue (also dehydration) Her laboratoryvalues show: >K+ 6.2 mmol/L high due to ESRD - need dialysis may be higher due to dehydration; if constipated will increase level even more! >Na+ 145 mmol/L normal but on edge of high >Cl- 93 mmol/L normal but on edge of low >HCO3 27 mmol/L normal >BUN 48 mg/dl high ESRD/ kidney BAD >Creatinine 5.0 mg/dl high ESRD, kidney BAD >Glucose 238 mg/dl high = DM, stress >WBC 7.6 thou/cmm, normal >HGB 8.1 g/dl HCT 24.3% low ESRD / erythroprotien makes RBC, simulates bone marrow to reproduce RBCs/ and low in ESRD >Platelets 333 thousand/cmm normal >Awaiting for Ca+ / Phosphate / magnesium levels****calcium will be low and phosphate high >Vital signs: >BP 152/ 92 High H.R. 102 / dehydration or temp. related to >Temp: 99.9 F dehydration/ virus or illness >Respirations 18 normal

common causes for respiratory alkalosis

Anxiety-induced hyperventilation, fever, early salicylate intoxication, hyperventilation with mechanical ventilator

The nurse is caring for a patient with a diagnosis of hyponatremia. What nursing intervention is appropriate to include in the plan of care for this patient? (Select all that apply.) Assessing for symptoms of nausea and malaise Monitoring neurologic status Encouraging the intake of low-sodium liquids Restricting tap water intake

Assessing for symptoms of nausea and malaise Monitoring neurologic status Restricting tap water intake For patients at risk, the nurse closely laboratory values (i.e., sodium) and be alert for GI manifestations such as anorexia, nausea, vomiting, and abdominal cramping. The nurse must be alert for central nervous system changes, such as lethargy, confusion, muscle twitching, and seizures. Neurologic signs are associated with very low sodium levels that have fallen rapidly because of fluid overloading. For a patient with abnormal losses of sodium who can consume a general diet, the nurse encourages foods and fluids with high sodium content to control hyponatremia. For example, broth made with one beef cube contains approximately 900 mg of sodium; 8 oz of tomato juice contains approximately 700 mg of sodium. If the primary problem is water retention, it is safer to restrict fluid intake than to administer sodium.

The prevalence of hyperkalemia in the hospital setting is: A. Improperly documented B. 1%-10% C. 10% - 20% D. None of the above

B. 1%-10%

Which disorder is NOT associated with hyperkalemia? A. Addison's disease B. Asthma C. Chronic Kidney disease D. Systemic lupus erythematosus

B. Asthma

Acid/Base imbalances caused by the pulmonary system are characterized by an excess or deficiency of: A.Base Bicarbonate (HCO3) B.Carbon Dioxide (CO2) C.Serum PH D. Ketone Bodies

B. Carbon Dioxide CO2

Isaac, 63 years old, was admitted to the hospital with confusion, rapid respirations and signs of dehydration. Arterial blood gas values are pH 7.32, HCO3 19 mEq/L, PaCO2 40. These values are consistent with: A. Metabolic acidosis - partial compensation. B. Metabolic acidosis - uncompensated. C. Respiratory acidosis - partial compensation. D. Respiratory acidosis - compensated.

B. Metabolic acidosis - uncompensated.

Mrs. Right has the following values: pH = 7.48 pCO2 = 40 HCO3 = 30These values are consistent with: Metabolic alkalosis - with compensation. B. Metabolic alkalosis - uncompensated. C. Metabolic acidosis - with partial compensation. D. Metabolic acidosis - uncompensated.

B. Metabolic alkalosis- uncompensated

Which factors affect the amount and distribution of body fluids? (Select all that apply) A.Race B.Age C.Gender D.Height E.Body Fat

B.Age C.Gender E.Body Fat

You are caring for Mr. Brown, a 75-year-old patient with congestive heart failure who is receiving IV fluid. You notice he is becoming increasingly restless and short of breath. His blood pressure and respiratory rate are increasing and he has a moist cough. You also note he has neck vein distention up to the jaw angle in the sitting position. You hear medium crackles throughout both posterior lung fields. Mr. Brown's symptoms are most likely caused by: A.Decreased venous return to the right ventricle B.Circulatory overload and pulmonary edema C.Increased tissue hydrostatic pressure in the alveoli D.Decreased tissue hydrostatic pressure in the pulmonary capillaries

B.Circulatory overload and pulmonary edema

Factors which may cause the risk of hyperkalemia to become chronic include: A.Blood transfusion B.Declining renal function in CKD C.An Injury D.Excessive Exercise

B.Declining renal function in CKD

The nurse is caring for an elderly client who has been receiving intravenous fluids at 175 mL/hr. The nurse assesses the client and discovers crackles, shortness of breath, and distended neck veins. The nurse would recognize these findings indicative of which complication of IV fluid therapy? A.An allergic reaction to the antibiotics in the fluid B.Fluid volume excess C.Pulmonary embolism D.Speed shock

B.Fluid volume excess

The Nurse caring for a child at risk for dehydration secondary to diarrhea, vomiting and fever. The child is alert, quiet and clinging to the parent. What is the best nursing intervention to rehydrate this patient? A Give an oral rehydration solution such as oralyte or Gatroade B.Have the parent give small sips of preferred dilute fluids every 5 to 10 minutes C.Obtain an order for IV access and an isotonic solution such as normal saline D.Encourage the child to take as much water as possible and offer popsicles

B.Have the parent give small sips of preferred dilute fluids every 5 to 10 minutes

In which compartment is the largest portion of body fluid found? A.Extracellular B.Intracellular C.Intravascular D.Interstitial

B.Intracellular 2/3's of all fluid is intracellular

An older adult patient at risk for fluid and electrolyte problems is vigilantly monitored by the nurse for the first indication of a fluid balance problem. What is this indication? A.Fever B.Mental Status changes C.Poor Skin turgor D.Dry Mucous membranes

B.Mental Status changes

A nursing student is extremely excited they scored a 100% on the acid-base balance exam. What imbalance would they be at risk for: A.Respiratory acidosis B.Respiratory alkalosis C.Metabolic acidosis D.Metabolic alkalosis

B.Respiratory alkalosis

Which electrolyte is a major cation in body fluid? Chloride Bicarbonate Phosphate Potassium

Potassium Potassium is a major cation that affects cardiac muscle functioning. Chloride, bicarbonate, and phosphate are anions.

Magnesium is responsible for which functions: (Select all that apply): A.Formation of hydrochloric acid B.Stabilization of excitable membranes C.Contraction of cardiac muscle D.Regulation of intracellular osmolality E.Formation of adenosine triphosphate (ATP)

B.Stabilization of excitable membranes C.Contraction of cardiac muscle E.Formation of adenosine triphosphate (ATP) Magnesium is needed for more than 300 biochemical reactions in the body. It helps to maintain normal nerve and muscle function, supports a healthy immune system, keeps the heart beat steady, and helps bones remain strong. It also helps regulate blood glucose levels and aid in the production of energy and protein. There is ongoing research into the role of magnesium in preventing and managing disorders such as high blood pressure, heart disease, and diabetes. However, taking magnesium supplements is not currently recommended. Diets high in protein, calcium, or vitamin D will increase the need for magnesium.

A climber attempts an assault on a high mountain in the Andes and reaches an altitude of 5000 meters (16,400 feet) above sea level. What will happen to his arterial PCO2 and pH? A.Both will be lower than normal B.The pH will rise and PCO2 will fall C.Both will be higher than normal due to the physical exertion D.The pH will fall and the PCO2 will rise

B.The pH will rise and PCO2 will fall

The client's arterial blood gas report reveals a pH of 6.58. How does the nurse evaluate this value? A.There is a slight elevation. B.This value is incompatible with life. C.This is a low normal value. D. This value is extremely elevated

B.This value is incompatible with life.

A client is admitted to the hospital after vomiting for 3 days. Which arterial blood gas results would the nurse expect to find in this client? A.pH 7.30; PaCO2 50; HCO3 27 B.pH 7.47; PaCO2 43; HCO3 28 C.pH 7.43; PaCO2 50; HCO3 28 D.pH 7.47; PaCO2 30; HCO3 23

B.pH 7.47; PaCO2 43; HCO3 28

The Emergency Department (ED) nurse is caring for a client with a possible acid-base imbalance. The physician has ordered an arterial blood gas (ABG). What is one of the most important indications of an acid-base imbalance that is shown in an ABG? Carbonic acid PaO2 Bicarbonate PO2

Bicarbonate Arterial blood gas (ABG) results are the main tool for measuring blood pH, CO2 content (PaCO2), and bicarbonate. An acid-base imbalance may accompany a fluid and electrolyte imbalance. PaO2 and PO2 are not indications of acid-base imbalance. Carbonic acid levels are not shown in an ABG.

The emergency department (ED) nurse is caring for a client with a possible acid-base imbalance. The physician has ordered an arterial blood gas (ABG). What is one of the most important indications of an acid-base imbalance that is shown in an ABG? Bicarbonate Carbonic acid PaO2 PO2

The nurse is caring for a client who was admitted with fluid volume excess (FVE). Which nursing assessments should the nurse include in the ongoing monitoring of the client? Select all that apply. Blood pressure, heart rate, and rhythm Strength testing for muscle wasting Intake and output, urine volume, and color Nutritional status and diet

Blood pressure, heart rate, and rhythm Intake and output, urine volume, and color Skin assessment for edema and turgor To assess for FVE the nurse measures blood pressure, heart rate and rhythm, and breath sounds; inspects the skin to look for edema and turgor; and inspects neck veins. Intake and output, daily weight, urine volume and color, dyspnea, and thirst are assessments that will assist the nurse in identifying improvement or worsening of the fluid volume excess. In addition, the nurse will be able to identify potential fluid volume deficit from overtreatment of the fluid volume excess.

A 54-year-old male patient is admitted to the hospital with a case of severe dehydration. The nurse reviews the patient's laboratory results. Which of the following results are consistent with the diagnosis? Select all that apply. Blood urea nitrogen (BUN) of 23 mg/dL Serum osmolality of 310 mOsm/kg Serum potassium of 3.6mEq/L Serum sodium of 148 mEq/L Urine specific gravity of 1.03

Blood urea nitrogen (BUN) of 23 mg/dL Serum osmolality of 310 mOsm/kg Serum sodium of 148 mEq/L Urine specific gravity of 1.03 Severe dehydration is associated with an increased BUN (N = 10 to 20 mg/dL), serum osmolality (N = 275 to 300 mOsm/kg), serum sodium (N = 135 to 145 mEq/L) and urine specific gravity (N = 1.01 to 1.025). Glucose and hematocrit levels would also be elevated but are within normal range for this question.

Which is an insensible mechanism of fluid loss? urination bowel elimination Breathing Nausea

Breathing Loss of fluid from sweat or diaphoresis is referred to as insensible loss because it is unnoticeable and immeasurable. Losses from urination and bowel elimination are measurable. Nausea does not result in fluid loss, however if the client would develop emesis ( vomiting) this would be considered loss of body fluids and would need measured.

The nurse is caring for a client who is 3-days postoperative. Which intervention should the nurse implement to decrease the client's possibility of developing hypercalcemia? A. Measure vital signs every 4 hours B. Assist the client to turn, cough, and deep breathe every 2 hours. C. Assist the client to ambulate around the room at least three times daily. D. Irrigate the client's nasogastric tube every 2 hours.

C. Assist the client to ambulate around the room at least three times daily. Hypercalcemia can occur from immobility. Ambulation of the client helps to prevent leaching of calcium from the bones into the serum. None of the other options are related to the development of hypercalcemia.

What buffers lactic acid during normal exercise? A. CO2 B. Gatorade C. Bicarbonate D. H2O

C. Bicarbonate

According to the arterial blood gas results, a highly anxious patient is experiencing respiratory alkalosis. What is the most likely cause of this acid-base imbalance? A. Chronic lung disease B. Intubation C. Hyperventilation D. Drug therapy

C. Hyperventilation

The client who has been taking a diuretic has a serum potassium of 3.4. Which food would the nurse encourage this client to choose from the dinner menu? A.Baked chicken B.Green beans C.Cantaloupe D.Iced tea

C.Cantaloupe

The nurse is caring for an 80-year-old client with a medical diagnosis of heart failure. The client has edema, orthopnea, and confusion. Which nursing diagnosis is most appropriate for this client? A.Heart Failure related to edema, as evidenced by confusion B.Fluid Volume Deficit related to loss of fluids as evidenced by edema C.Excess Fluid Volume related to retention of fluids as evidenced by edema and orthopnea D.Excess Fluid Volume related to congestive heart failure as evidenced by edema and confusion

C.Excess Fluid Volume related to retention of fluids as evidenced by edema and orthopnea

The nurse caring for a patient with hypovolemia secondary to severe diarrhea and vomiting. In evaluating the respiratory system for this patient, what does the nurse expect to assess? A.No changes because the respiratory system is not involved. B.Hypoventilation because the respiratory system is trying to compensate for low pH. C.Increased respiratory rate because the body perceives hypovolemia as hypoxia. Normalrespiratoryrate,butadecreasedoxygensaturation

C.Increased respiratory rate because the body perceives hypovolemia as hypoxia.

A client is brought to the emergency department after passing out in a local department store. The client reports dieting by fasting for the last 5 days. Which acid-base imbalance would the nurse expect to assess in this client? A.Respiratory acidosis B.Respiratory alkalosis C.Metabolic acidosis D.Metabolic alkalosis

C.Metabolic acidosis

A person was admitted to hospital in a coma. Analysis of the arterial blood gave the following values: PCO2 = 16 mm Hg HCO3- = 5 mmol/l pH = 7.1. What is the underlying acid-base disorder? A.Respiratory acidosis B.Respiratory alkalosis C.Metabolic acidosis D.Metabolic alkalosis

C.Metabolic acidosis

The nurse is providing discharge instructions to a client who has been started on furosemide (Lasix) once daily. What information is essential to include in this information? A.Take the medication at bedtime. B.Avoid high-potassium foods. C.Stand up slowly from a sitting position. D.Do not take this medication on the days you take digitalis (Lanoxin).

C.Stand up slowly from a sitting position.

The 154-pound adult client has had vomiting and diarrhea for 4 days secondary to a viral infection. What hourly urine measurement would indicate efforts to rehydrate this client have not yet been successful and should continue? A.35 mL per hour B.80 mL per hour C.50 mL per hour D. 30 mL per hour

D. 30 mL per hour

A patient complains of tingling in the fingers as well as feeling depressed. The nurse assesses positive Trousseau's and Chvostek's signs. Which decreased laboratory results does the nurse observe when the patient's laboratory work has returned? Magnesium Calcium Potassium Sodium Chloride

Calcium Calcium deficit is associated with the following symptoms: numbness and tingling of the fingers, toes, and circumoral region; positive Trousseau's sign and Chvostek's sign; seizures, carpopedal spasms, hyperactive deep tendon reflexes, irritability, bronchospasm, anxiety, impaired clotting time, decreased prothrombin, diarrhea, and hypotension. Electrocardiogram findings associated with hypocalcemia include prolonged QT interval and lengthened ST.

When a client's ventilation is impaired, the body retains which substance? Sodium bicarbonate Nitrous oxide Carbon dioxide Oxygen

Carbon dioxide When ventilation is impaired, the body retains carbon dioxide (CO2) because the carbonic acid level increases in the blood. Sodium bicarbonate is used to treat acidosis. Nitrous oxide, which has analgesic and anesthetic properties, commonly is administered before minor surgical procedures. When ventilation is impaired, the body doesn't retain oxygen. Instead, the tissues use oxygen and CO2 results.

Chvostek's sign

Cheek, facial spasm when Cheek is tapped associates with hypocalcemia

Hypervolemia

Chronic stimulus to kidney to conserve sodium & water: ·Heart failure ·Cirrhosis ·glucocorticosteroids ·↑ aldosterone Renal function abnormal: ·↓excretion of sodium/hangs on to water ·renal failure Fluid shifts: interstitial to plasma Stress: ie: surgery =: Stress ie: major surgery = ADH hormone increased in response to the stress of surgery (before, during and immediately after) Age related changes: ·Cardiovascular ·Renal function Sodium intake excessive or given too rapidly for altered regulatory mechanisms Nurses: IV's/ blood or blood products: too much, too fast for amount patient can handle: ·Oral (diet)·ie: alka seltzer (sodium bicarbonate) ·IV ·Hypertonic enemas

A client presents with severe diarrhea and a history of chronic renal failure to the emergency department. Arterial blood gas results are as follows :pH 7.30 PaO2 97 PaCO2 37 HCO3 18 The nurse would expect which of the following sets of assessment findings? Headache, blood pressure 90/54, dry skin Confusion, respiratory rate 8 breaths/min, dry skin Clammy skin, blood pressure 86/46, headache Blood pressure 188/120, nausea, vomiting

Clammy skin, blood pressure 86/46, headache Metabolic acidosis, a common clinical disturbance, is characterized by decreased pH and plasma bicarbonate concentration. Common causes of metabolic acidosis include diarrhea, chronic renal failure, use of diuretics, intestinal fistulas, and ureterostomies. The client will experience the following signs and symptoms: headache, confusion, increased respiratory rate, nausea, vomiting, cold and clammy skin, and decreased blood pressure.

Upon shift report, the nurse states 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 do both nurses agree is the client's current state? Uncompensated respiratory alkalosis Compensated metabolic alkalosis Compensated respiratory alkalosis Compensated metabolic acidosis

Compensated respiratory alkalosis The question states that the client has a history of acid-base disturbance. The nurse would first note that the pH has returned to close to normal indicating compensation. The nurse then assess the PCO2 (normal: 35 to 45 mm Hg) and HCO3 (normal: 22 to 27mEq/L) levels. In a respiratory condition, the pH and the PCO2 move in opposite direction; thus, the pH rises and the PCO2 drops (alkalosis) or vice versa (acidosis). In a metabolic condition, the pH and the bicarbonate move in the same direction; if the pH is low, the bicarbonate level will be low, also. In this client, the pH is at the high end of normal, indicating compensation and alkalosis. The PCO2 is low, indicating a respiratory condition (opposite direction of the pH).

A 73-year-old female patient with cirrhosis of the liver is evaluated for clinical manifestations of FVE. Which of the following signs are consistent with that diagnosis? Select all that apply. Crackles Hematocrit level of 32% Central venous pressure (CVP) reading of 4 mm Hg Blood pressure of 140/110 BUN of 8 mg/dL

Crackles Hematocrit level of 32% Blood pressure of 140/110 BUN of 8 mg/dL The blood pressure is increased with FVE. Crackles are abnormal lung sounds found in fluid retention. Hematocrit and BUN may be decreased due to plasma dilution.

Patient undergoing surgery needs to have contents of the upper gastro-intestinal tract aspirated. After surgery, the following values were obtained from an arterial blood sample: pH = 7.55 PCO2 = 52 mm Hg HCO3- = 40 mmol/l. What is the underlying disorder? A.Respiratory acidosis B.Respiratory alkalosis C.Metabolic acidosis D.Metabolic alkalosis

D.Metabolic alkalosis

Potassium from dietary intake is primarily distributed to: A.Bones B.Red Blood Cells C.Liver D.Skeletal muscles

D.Skeletal muscles

A client was admitted to the hospital unit after 2 days of vomiting and diarrhea. The client's spouse became alarmed when the client demonstrated confusion and elevated temperature, and reported "dry mouth." The nurse suspects the client is experiencing which condition?

Dehydration results when the volume of body fluid is significantly reduced in both extracellular and intracellular compartments. In dehydration, all fluid compartments have decreased volumes; in hypovolemia, only blood volume is low. The most common fluid imbalance in older adults is dehydration. Hypervolemia is caused by fluid intake that exceeds fluid loss, such as from excessive oral intake or rapid IV infusion of fluid. Early signs of hypervolemia are weight gain, elevated BP, and increased breathing effort. Hypercalcemia occurs when the serum calcium level is higher than normal. Some of its signs include tingling in the extremities and the area around the mouth (circumoral paresthesia) and muscle and abdominal cramps. Hyperkalemia is an excess of potassium in the blood. Symptoms include diarrhea, nausea, muscle weakness, paresthesias, and cardiac dysrhythmias.

Which of the following is a clinical manifestation of fluid volume excess (FVE)? Select all that apply. Distended neck veins Bradycardia Crackles in the lung fields Shortness of breath

Distended neck veins Crackles in the lung fields Shortness of breath Clinical manifestations of FVE include distended neck veins, crackles in the lung fields, shortness of breath, increased blood pressure, and tachycardia.

signs and symptoms/clinical manifestations of hypervolemia.FVE

Electrolytes, BUN/ creatinine: ↑electrolytes, BUN / creatine CV: Tachycardia, bounding full pulse, hypertension, tachypnea, increased CVP, distended neck and peripheral veins, heart failure Neuromusculoskeletal: Confusion, muscle weakness, edema GI: Weight gain, 2% gain = mild FVE; 5% gain = moderate; 8% gain = severe abdominal swelling (ascites) Respiratory: Pulmonary edema: Dyspnea, orthopnea, moist

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? Type 1 diabetes mellitus Myasthenia gravis Opioid overdose Extreme anxiety

Extreme anxiety Extreme anxiety may lead to respiratory alkalosis by causing hyperventilation, which results in excessive carbon dioxide (CO2) loss. Other conditions that may set the stage for respiratory alkalosis include fever, heart failure, injury to the brain's respiratory center, overventilation with a mechanical ventilator, pulmonary embolism, and early salicylate intoxication. Type 1 diabetes may lead to diabetic ketoacidosis; the deep, rapid respirations occurring in this disorder (Kussmaul respirations) don't cause excessive CO2 loss. Myasthenia gravis and opioid overdose suppress the respiratory drive, causing CO2 retention, not CO2 loss; this may lead to respiratory acidosis, not alkalosis.

FVD/ hypovolemia causes

GI losses: Vomiting, diarrhea, NG suctioning Skin: Diaphoresis/ fever/ high drainage wound loss Renal losses: Diuretic therapy, diabetes insipidus, renal disease, adrenal insufficiency, osmotic diuresis (↑B.S.) Third spacing: Peritonitis, ascites, burns, intestinal obstruction ·May not manifest as apparent fluid loss or weight loss; monitor - can become hypervolemia if shifts Other losses: Hemorrhage (blood / plasma loss); high drainage from wounds Altered intake: Anorexia, Nausea Inability to access fluids Impaired swallowing Confusion/Depression NPO status

signs and symptoms/clinical manifestations of overhydration

Hemoglobin (Hgb) hematocrit (Hct):↓ hemodilution Serum osmolarity: ↓ hemodilution <270 mOsm/L/ ↓protein & electrolytes,↓sodium Electrolytes, BUN/ creatinine: ↓protein & electrolytes CV: Tachycardia, bounding full pulse, hypertension, tachypnea, increased CVP, distended neck and peripheral veins, heart failure Neuromusculoskeletal: Confusion, muscle weakness, edema GI: Weight gain, 2% gain = mild FVE; 5% gain = moderate; 8% gain = severe abdominal swelling (ascites) Respiratory: Pulmonary edema: Dyspnea, orthopnea, moist

dehydration causes

Hyperventilation DKA, HHNK (high B.S) Enteral feeding without sufficient water Decreased thirst sensation Prolonged fever Term: dehydration is interchangeably used with FVD and hypovolemia frequently/ even though it is different

An elderly client takes 40 mg of furosemide twice a day. Which electrolyte imbalance is the most serious adverse effect of diuretic use? Hypokalemia Increased phosphorus levels hypernatremia Hyperkalemia

Hypokalemia Hypokalemia (potassium level below 3.5 mEq/L) usually indicates a deficit in total potassium stores. Potassium-losing diuretics, such as furosemide, can induce hypokalemia. Hyperkalemia refers to increased potassium levels. Loop diuretics can bring about lower sodium levels, not hypernatremia. Furosemide does not affect phosphorus levels.

Which could be a potential cause of respiratory acidosis? Hyperventilation Diarrhea Hypoventilation Vomiting

Hypoventilation Respiratory acidosis is always due to inadequate excretion of CO2, with inadequate ventilation, resulting in elevated plasma CO concentration, which causes increased levels of carbonic acid. In addition to an elevated PaCO2, hypoventilation usually causes a decrease in PaO2.

The nurse is working on a burns unit and an acutely ill client is exhibiting signs and symptoms of third spacing. Based on this change in status, the nurse should expect the client to exhibit signs and symptoms of what imbalance? Increased calcium levels Alkalosis Hypovolemia Increased magnesium levels

Hypovolemia Third-spacing fluid shift, which occurs when fluid moves out of the intravascular space but not into the intracellular space, can cause hypovolemia. Increased calcium and magnesium levels are not indicators of third-spacing fluid shift. Burns typically cause acidosis, not alkalosis.

A nurse caring for a patient with metabolic alkalosis knows to assess for the primary, compensatory mechanism of: Decreased PaCO2. Increased serum HCO3. Increased PaCO2. Decreased serum HCO3.

Increased PaCO2. The respiratory system compensates by decreasing ventilation to conserve CO2 and increase the PaCO2.

A client has a respiratory rate of 38 breaths/min. What effect does breathing faster have on arterial pH level? Increases arterial pH Provides long-term pH regulation No effect Decreases arterial pH

Increases arterial pH Respiratory alkalosis is always caused by hyperventilation, which is a decrease in plasma carbonic acid concentration. The pH is elevated above normal as a result of a low PaCO2.

The nurse is performing an admission assessment on an older adult client newly admitted for end-stage liver disease. What principle should guide the nurse's assessment of the client's skin turgor?

Inelastic skin turgor is a normal part of aging. Inelastic skin is a normal change of aging. However, this does not mean that skin turgor cannot be assessed in older clients. Dehydration, not overhydration, causes inelastic skin with tenting. Overhydration, not dehydration, causes the skin to appear edematous and spongy.

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? Administer an ordered decongestant. Instruct the client to breathe into a paper bag. Administer ordered supplemental oxygen. Offer the client fluids frequently.

Instruct the client to breathe into a paper bag. The ABG results reveal respiratory alkalosis. The best intervention to raise the PaCO2 level would be to have the client breathe into a paper bag. Administering a decongestant, offering fluids frequently, and administering supplemental oxygen wouldn't raise the lowered PaCO2 level.

When caring for a client who has risk factors for fluid and electrolyte imbalances, which assessment finding is the highest priority for the nurse to follow up? Minor mental status change Irregular heart rate Weight loss BP of 100/60

Irregular heart rate Irregular heart rate may indicate a potentially life-threatening cardiac dysrhythmia. Potassium, magnesium, and calcium imbalances may cause dysrhythmias. Weight loss is a good indicator of the amount of fluid lost, confusion may occur with dehydration and hyponatremia, and blood pressure is slightly lower than normal (though not life threatening); in each case, following up on potential cardiac dysrhythmias is a higher priority.

what solution is used to restore metabolic balance in respiratory acidosis?

Lactate ringer (used for both metabolic and respiratory acidosis), ventilation, treat underlying cause,

A client hospitalized for treatment of a pulmonary embolism develops respiratory alkalosis. Which clinical findings commonly accompany respiratory alkalosis? Hallucinations or tinnitus Light-headedness or paresthesia Abdominal pain or diarrhea Nausea or vomiting

Light-headedness or paresthesia The client with respiratory alkalosis may complain of light-headedness or paresthesia (numbness and tingling in the arms and legs). Nausea, vomiting, abdominal pain, and diarrhea may accompany respiratory acidosis. Hallucinations and tinnitus rarely are associated with respiratory alkalosis or any other acid-base imbalance.

Your client has a diagnosis of hypervolemia. What would be an important intervention that you would initiate? A. Assess for dehydration. B. Give medications that promote fluid retention. C. Limit sodium and water intake. D. Teach client behaviors that decrease urination.

Limit sodium and water intake. Implement prescribed interventions such as limiting sodium and water intake and administering ordered medications that promote fluid elimination. Assessing for dehydration and teaching to decrease urination would not be appropriate interventions.

The nurse is caring for a client with multiple organ failure and in metabolic acidosis. Which pair of organs is responsible for regulatory processes and compensation? Kidney and liver Lungs and kidney Pancreas and stomach Heart and lungs

Lungs and kidney The lungs and kidneys facilitate the ratio of bicarbonate to carbonic acid. Carbon dioxide is one of the components of carbonic acid. The lungs regulate carbonic acid levels by releasing or conserving CO2 by increasing or decreasing the respiratory rate. The kidneys assist in acid-base balance by retaining or excreting bicarbonate ions.

The nurse is caring for a patient with diabetes type I who is having severe vomiting and diarrhea. What condition that exhibits blood values with a low pH and a low plasma bicarbonate concentration should the nurse assess for? Respiratory alkalosis Respiratory acidosis Metabolic alkalosis Metabolic acidosis

Metabolic acidosis Metabolic acidosis is a common clinical disturbance characterized by a low pH (increased H+ concentration) and a low plasma bicarbonate concentration. Metabolic alkalosis is a clinical disturbance characterized by a high pH (decreased H+ concentration) and a high plasma bicarbonate concentration. Respiratory acidosis is a clinical disorder in which the pH is less than 7.35 and the PaCO2 is greater than 42 mm Hg and a compensatory increase in the plasma HCO3 occurs. Respiratory alkalosis is a clinical condition in which the arterial pH is greater than 7.45 and the PaCO2 is less than 38 mm Hg.

The nurse is caring for a client with severe diarrhea. The nurse recognizes that the client is at risk for developing which acid-base imbalance? Respiratory alkalosis Metabolic alkalosis Respiratory acidosis Metabolic acidosis

Metabolic acidosis The client is at risk for developing metabolic acidosis. Metabolic acidosis is caused by diarrhea, lower intestinal fistulas, ureterostomies, and use of diuretics; early renal insufficiency; excessive administration of chloride; and the administration of parenteral nutrition without bicarbonate or bicarbonate-producing solutes (e.g., lactate).

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 Metabolic alkalosis Respiratory acidosis Respiratory alkalosis

Metabolic acidosis This client's pH value is below normal, indicating acidosis. The HCO3- value also is below normal, reflecting an overwhelming accumulation of acids or excessive loss of base, which suggests metabolic acidosis. The PaCO2 value is normal, indicating absence of respiratory compensation. These ABG values eliminate respiratory alkalosis, respiratory acidosis, and metabolic alkalosis.

The emergency-room nurse is caring for a trauma client who has the following arterial blood gas results: pH 7.26, PaCO2 28, HCO3 11 mEq/L. How should the nurse interpret these results? Respiratory acidosis with no compensation Metabolic alkalosis with a compensatory alkalosis Metabolic acidosis with no compensation Metabolic acidosis with a compensatory respiratory alkalosis

Metabolic acidosis with a compensatory respiratory alkalosis A low pH indicates acidosis (normal pH is 7.35 to 7.45). The PaCO2 is also low, which causes alkalosis. The bicarbonate is low, which causes acidosis. The pH bicarbonate more closely corresponds with a decrease in pH, making the metabolic component the primary problem.

A priority nursing intervention for a client with hypervolemia involves which of the following? measuring intake and output Monitoring respiratory status for signs and symptoms of pulmonary complications monitoring edema promoting rest

Monitoring respiratory status for signs and symptoms of pulmonary complications. Hypervolemia, or fluid volume excess (FVE), refers to an isotonic expansion of the extracellular fluid. Nursing interventions for FVE include measuring intake and output, monitoring weight, assessing breath sounds, monitoring edema, and promoting rest. The most important intervention in the list involves monitoring the respiratory status for any signs of pulmonary congestion. Breath sounds are assessed at regular intervals.

what makes water move

Na+ water follows sodium

A 64-year-old client is brought in to the clinic with thirsty, dry, sticky mucous membranes, decreased urine output, fever, a rough tongue, and lethargy. Serum sodium level is above 145 mEq/L. Should the nurse start salt tablets when caring for this client?

No, sodium intake should be restricted.

Which is a correct route of administration for potassium? IV push Subcutaneous Oral Intramuscular

Oral Potassium may be administered through the oral route. Potassium is never administered by IV push or intramuscularly to avoid replacing potassium too quickly. Potassium is not administered subcutaneously.

A nurse in the neurologic ICU has received a prescription to infuse a hypertonic solution into a client with increased intracranial pressure. This solution will increase the number of dissolved particles in the client's blood, creating pressure for fluids in the tissues to shift into the capillaries and increase the blood volume. This process is best described as which of the following? Diffusion Hydrostatic pressure Osmosis and osmolality Active transport

Osmosis and osmolality Osmosis is the movement of fluid from a region of low solute concentration to a region of high solute concentration across a semipermeable membrane. Hydrostatic pressure refers to changes in water or volume related to water pressure. Diffusion is the movement of solutes from an area of greater concentration to lesser concentration; the solutes in an intact vascular system are unable to move so diffusion normally should not be taking place. Active transport is the movement of molecules against the concentration gradient and requires adenosine triphosphate (ATP) as an energy source; this process typically takes place at the cellular level and is not involved in vascular volume changes.

The calcium concentration in the blood is regulated by which mechanism? Thyroid hormone Parathyroid hormone (PTH) Adrenal gland Androgens

Parathyroid hormone (PTH) The serum calcium concentration is controlled by PTH and calcitonin. The thyroid hormone, adrenal gland, or androgens do not regulate the calcium concentration in the blood.

A client with pancreatic cancer has the following blood chemistry profile: Glucose, fasting: 204 mg/dl; blood urea nitrogen (BUN): 12 mg/dl; Creatinine: 0.9 mg/dl; Sodium: 136 mEq/L; Potassium: 2.2 mEq/L; Chloride: 99 mEq/L; CO2: 33 mEq/L. Which result should the nurse identify as critical and report immediately?

Potassium The nurse should identify potassium: 2.2 mEq/L as critical because a normal potassium level is 3.5 to 5.0 mEq/L. Severe hypokalemia can cause cardiac and respiratory arrest, possibly leading to death. Hypokalemia also depresses the release of insulin and results in glucose intolerance. The glucose level is above normal (normal is 75 to 110 mg/dl) and the chloride level is a bit low (normal is 100 to 110 mEq/L). Although these levels should be reported, neither is life-threatening. The BUN (normal is 8 to 26 mg/dl) and creatinine (normal is 0.8 to 1.4 mg/dl) are within normal range.

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? Obtain a urine specimen for drug screening. Prepare to assist with ventilation. Prepare for gastric lavage. Monitor the client's heart rhythm.

Prepare to assist with ventilation. Respiratory acidosis is associated with hypoventilation; in this client, hypoventilation suggests intake of a drug that has suppressed the brain's respiratory center. Therefore, the nurse should assume the client has respiratory depression and should prepare to assist with ventilation. After the client's respiratory function has been stabilized, the nurse can safely monitor the heart rhythm, prepare for gastric lavage, and obtain a urine specimen for drug screening.

ROME:

Respiratory = Opposite: - pH is high, PCO2 is down = Alkalosis - pH is low, PCO2 is up = Acidosis Metabolic = Equal: - pH is high, HCO3 is high = Alkalosis - pH is low, HCO3 is low = Acidosis

A client who is being treated for pneumonia reports sudden shortness of breath. An arterial blood gas (ABG) is drawn. The ABG has the following values: pH 7.21, PaCO2 64 mm Hg, HCO3 = 24 mm Hg. What does the ABG reflect? Metabolic alkalosis Respiratory acidosis Respiratory alkalosis Metabolic acidosis

Respiratory acidosis The pH is below 7.40, PaCO2 is greater than 40, and the HCO3 is normal; therefore, it is a respiratory acidosis, and compensation by the kidneys has not begun, which indicates this was probably an acute event. The HCO3 of 24 is within the normal range so it is not metabolic alkalosis. The pH of 7.21 indicates an acidosis, not alkalosis. The pH of 7.21 indicates it is an acidosis but the HCO3 of 24 is within the normal range, ruling out metabolic acidosis.

A nurse reviews the arterial blood gas (ABG) values of a client admitted with pneumonia: pH, 7.51; PaCO2, 28 mm Hg; PaO2, 70 mm Hg; and HCO3--, 24 mEq/L. What do these values indicate? Respiratory acidosis Respiratory alkalosis Metabolic acidosis Metabolic alkalosis

Respiratory alkalosis A client with pneumonia may hyperventilate in an effort to increase oxygen intake. Hyperventilation leads to excess carbon dioxide (CO2) loss, which causes alkalosis — indicated by this client's elevated pH value. With respiratory alkalosis, the kidneys' bicarbonate (HCO3-) response is delayed, so the client's HCO3- level remains normal. The below-normal value for the partial pressure of arterial carbon dioxide (PaCO2) indicates CO2 loss and signals a respiratory component. Because the HCO3- level is normal, this imbalance has no metabolic component. Therefore, the client is experiencing respiratory alkalosis.

Which of the following arterial blood gas results would be consistent with metabolic alkalosis? pH 7.26 Serum bicarbonate of 21 mEq/L Serum bicarbonate of 28 mEq/L PaCO2 less than 35 mm Hg

Serum bicarbonate of 28 mEq/L Evaluation of arterial blood gases reveals a pH greater than 7.45 and a serum bicarbonate concentration greater than 26 mEq/L.

A client with nausea, vomiting, and abdominal cramps and distention is admitted to the health care facility. Which test result is most significant? BUN level of 29 mg/dl serum sodium level of 132 mEq/L serum potassium level of 3 mEq/L urine specific gravity of 1.025

Serum potassium level of 3 mEq/L A serum potassium level of 3 mEq/L is below normal, indicating hypokalemia. Because hypokalemia may cause cardiac arrhythmias and asystole, it's the most significant finding. In a client with a potential fluid volume imbalance, such as from vomiting, the other options are expected but none are as life-threatening as hypokalemia. A BUN level of 29 mg/dl indicates slight dehydration. A serum sodium level of 132 mEq/L is slightly below normal but not life-threatening. A urine specific gravity of 1.025 is normal.

A patient has been involved in a traumatic accident and is hemorrhaging from multiple sites. The nurse expects that the compensatory mechanisms associated with hypovolemia would cause what clinical manifestations? (Select all that apply.) Tachypnea Bradycardia Tachycardia Oliguria Distended jugular artery

Tachypnea Tachycardia Oliguria Hypovolemia, or fluid volume deficit, is indicated by decreased, not increased, blood pressure (hypotension), oliguria, tachycardia (not bradycardia), and tachypnea.

A 22 year old female, Barb Thees comes to your walk-in clinic, assisted by her mother. Barb has had type I Diabetes since age 11 and has just returned from a 5 day trip to Mexico. She has had a fever for 3 days with diarrhea, nausea and vomiting. She has been unable to eat or drink fluids without vomiting. She states "I did not take my insulin because I was not eating. That was the right thing to do, right?" Barb is shaky and needs assistance on to the exam table; she appears drowsy and lethargic. On examination, you note her skin is warm and flushed. Respirations are deep and rapid; her breath has a fruity odor. Her mother states she complains of thirst, but cannot keep anything down when fluids are given. She says she took her blood sugar before coming into the clinic; reading was 485. She has not voided today and went very little yesterday. Urine specimen is obtained with a mini cath; tests 3 + positive for ketones. Urine specific gravity = 1.06. Lab blood gas levels are pending. Vital Signs: 101.3 F; BP 90/50; Pulse = 124; respirations = 36 and deep Give rationale for her vital signs and lab values ketones, urine specific gravity, blood glucose:

Temperature is high: infection/ dehydration Heart rate is high: compensation for low fluid volume (hypovolemia) BP also reflects low fluid volume Respirations rapid and deep: Compensation for acidosis; Kussmal respirations: attempting too blow off CO2 which makes carbonic acid in body; help less acid in body have too much with ketones and lactic acid

The surgical nurse is caring for a client who is postoperative day 1 following a thyroidectomy. The client reports tingling in her lips and fingers. She states that she has an intermittent spasm in her wrist and hand and she exhibits increased muscle tone. What electrolyte imbalance should the nurse first suspect? Hypocalcemia Hypophosphatemia Hypermagnesemia hyperkalemia

Tetany is the most characteristic manifestation of hypocalcemia and hypomagnesemia. Sensations of tingling may occur in the tips of the fingers, around the mouth, and, less commonly, in the feet. Hypophosphatemia creates central nervous dysfunction, resulting in seizures and coma. Hypermagnesemia creates hypoactive reflexes and somnolence. Signs of hyperkalemia include paresthesias and anxiety.

A nurse is planning care for a nephrology client with a new nursing graduate. The nurse states, "A client with kidney disease partially loses the ability to regulate changes in pH." What is the cause of this partial inability? The kidneys combine carbonic acid and bicarbonate to maintain a stable pH. The kidneys regulate and reabsorb carbonic acid to change and maintain pH. The kidneys regenerate and reabsorb bicarbonate to maintain a stable pH. The kidneys buffer acids through electrolyte changes.

The kidneys regenerate and reabsorb bicarbonate to maintain a stable pH. The kidneys regulate the bicarbonate level in the ECF; they can regenerate bicarbonate ions as well as reabsorb them from the renal tubular cells. In respiratory acidosis and most cases of metabolic acidosis, the kidneys excrete hydrogen ions and conserve bicarbonate ions to help restore balance. The lungs regulate and reabsorb carbonic acid to change and maintain pH. The kidneys do not buffer acids through electrolyte changes; buffering occurs in reaction to changes in pH. Carbonic acid works as the chemical medium to exchange O2 and CO2 in the lungs to maintain a stable pH whereas the kidneys use bicarbonate as the chemical medium to maintain a stable pH by moving and eliminating H+.

The nurse is caring for a client diagnosed with chronic obstructive pulmonary disease (COPD) and experiencing respiratory acidosis. The client asks what is making the acidotic state. The nurse is most correct to identify which result of the disease process that causes the fall in pH? The lungs are not able to blow off carbon dioxide. The lungs have ineffective cilia from years of smoking. The lungs are unable to breathe in sufficient oxygen. The lungs are unable to exchange oxygen and carbon dioxide.

The lungs are not able to blow off carbon dioxide. In clients with chronic respiratory acidosis, the client is unable to blow off carbon dioxide leaving in increased amount of hydrogen in the system. The increase in hydrogen ions leads to acidosis. In COPD, the client is able to breathe in oxygen and gas exchange can occur, it is the lungs ability to remove the carbon dioxide from the system. Although individuals with COPD frequently have a history of smoking, cilia is not the cause of the acidosis.

A client has a serum calcium level of 7.2 mg/dl (1.8 mmol/L). During the physical examination, the nurse expects to assess:

Trousseau's sign. This client's serum calcium level indicates hypocalcemia, an electrolyte imbalance that causes Trousseau's sign (carpopedal spasm induced by inflating the blood pressure cuff above systolic pressure). Homans' sign (pain on dorsiflexion of the foot) indicates deep vein thrombosis. Hegar's sign (softening of the uterine isthmus) and Goodell's sign (cervical softening) are probable signs of pregnancy.

What does the nurse understand is the primary method by which fluid volume is regulated?

Urine excretion Fluid volume is regulated primarily by the excretion of water in the form of urine and the promotion of thirst. Breathing, bowel elimination, and perspiration are methods the body uses to excrete fluid, but they are not the primary regulatory method for fluid volume.

A newly graduated nurse is admitting a client with a long history of emphysema. The nurse learns that the client's PaCO2 has been between 56 and 64 mm Hg for several months. Why should the nurse be cautious administering oxygen? The client's calcium will rise dramatically due to pituitary stimulation. Oxygen may cause the client to hyperventilate and become acidotic. Using oxygen may result in the client developing carbon dioxide narcosis and hypoxemia. Oxygen will increase the client's intracranial pressure and create confusion.

Using oxygen may result in the client developing carbon dioxide narcosis and hypoxemia. When PaCO2 chronically exceeds 50 mm Hg, it creates insensitivity to CO2 in the respiratory medulla, and the use of oxygen may result in the client developing carbon dioxide narcosis and hypoxemia. No information indicates the client's calcium will rise dramatically due to pituitary stimulation. No feedback system that oxygen stimulates would create an increase in the client's intracranial pressure and create confusion. Increasing the oxygen would not stimulate the client to hyperventilate and become acidotic; rather, it would cause hypoventilation and acidosis.

signs and symptoms of FVD/hypovolemia

Vital signs: CV: Hyperthermia, tachycardia, thready (weak) pulse, hypotension,(syncope) orthostatichypotension,tachypnea, decreased CVP, cap refilldiminished Neuro / musculoskeletal: Dizziness, syncope, confusion, weakness, fatigue GI: Thirst, dry furrowed tongue, N/V, anorexia, acute weight loss Renal: Oliguria, decreased urine volume, <30 ml an hour, (body trying to retain as much fluid as possible) Skin: Cool clammy skin, diaphoresis, pale (unless fever present) (drawing fluid to needed areas for perfusion) decreased tissue turgor, dry mucous membranes and skin Other: Decreased level of consciousness, sunken eyeballs, decreased tearing, flattened neck veins, intake less than output Lab values: Hypovolemia: (blood loss): Low Hgb & Hct FVD/hypovolemia/Dehydration: High Hgb & Hct & sodium (hemoconcentration) High urine specific gravity (concentrated) serum osmolarity, BUN

Overhydration

Water replacement without electrolytes: -strenuous exercise with profuse diaphoresis and only water taken in SIADH (syndrome of inappropriate ADH) Malignant tumors AIDS Head injury Medication Barbiturates Anesthetics Head injury/Brain/ cerebral edema/ impaired neurological functioning

Which laboratory result does the nurse identify as a direct result of the client's hypovolemic status with hemoconcentration?

When hemoconcentration occurs due to a hypovolemic state, a high ratio of blood components in relation to watery plasma occurs, thus causing an elevated hematocrit level. A high white blood cell count and urine specific gravity is also noted. Other causes of an abnormal potassium level may be present.

A client with emphysema is at a greater risk for developing which acid-base imbalance? respiratory alkalosis chronic respiratory acidosis metabolic acidosis metabolic alkalosis

chronic respiratory acidosis Respiratory acidosis, which may be either acute or chronic, is caused by excess carbonic acid, which causes the blood pH to drop below 7.35. Chronic respiratory acidosis is associated with disorders such as emphysema, bronchiectasis, bronchial asthma, and cystic fibrosis.

common causes for metabolic acidosis

increased acid production: Lactic acidosis, ketoacidosis related to; diabetes, starvation, alcoholism decreased acid production: Renal failure increased bicarbonate loss: diarrhea, ileosomy leakage, intestinal, biliary or pancreatic fistula increased chloride: sodium chloride IV solutions, Renal tubular acidosis, Carbonic anhydrase inhibitors

common causes for metabolic alkalosis

increased acid loss or excretion: vomiting, gastric suction, hypokalemia increased bicarbonate: alkali ingestion or administration( bicabonate of soda)

Following a unilateral adrenalectomy, a nurse should assess for hyperkalemia as indicated by: tremors. muscle weakness

muscle weakness Muscle weakness, bradycardia, nausea, diarrhea, and paresthesia of the hands, feet, tongue, and face are findings associated with hyperkalemia, which is transient and results from transient hypoaldosteronism when the adenoma is removed. Tremors, diaphoresis, and constipation aren't seen in hyperkalemia.

Isotonic solution

normal body osmolality Normal Saline NS .9% NS, LR, D5W fluid in each body compartment stays put

hypotonic solution

osmolality of solution is less than normal body osmolality 0.45% saline and 0.33% saline shifts fluid from intravascular to ICF; making the cells swell

To confirm an acid-base imbalance, it is necessary to assess which findings from a client's arterial blood gas (ABG) results? Select all that apply. pH HCO3 PaCO2 Na+ Glucose K+

pH HCO3 PaCO2 Arterial blood gas (ABG) results are the main tool for measuring blood pH, CO2 content (PaCO2), and bicarbonate (HCO3). The two types of acid-base imbalances are acidosis and alkalosis.

When evaluating arterial blood gases (ABGs), which value is consistent with metabolic alkalosis? PaCO 36 pH 7.48 HCO 21 mEq/L O saturation 95%

pH 7.48 Metabolic alkalosis is a clinical disturbance characterized by a high pH and high plasma bicarbonate concentration. The HCO value is below normal. The PaCO value and the oxygen saturation level are within a normal range.

Which set of arterial blood gas (ABG) results requires further investigation? pH 7.49, PaCO2 30 mm Hg, PaO2 89 mm Hg, and HCO3- 18 mEq/L pH 7.38, partial pressure of arterial carbon dioxide (PaCO2) 36 mm Hg, partial pressure of arterial oxygen (PaO2) 95 mm Hg, bicarbonate (HCO3-) 24 mEq/L pH 7.44, PaCO2 43 mm Hg, PaO2 99 mm Hg, and HCO3- 26 mEq/L pH 7.35, PaCO2 40 mm Hg, PaO2 91 mm Hg, and HCO3- 22 mEq/L

pH 7.49, PaCO2 30 mm Hg, PaO2 89 mm Hg, and HCO3- 18 mEq/L The ABG results pH 7.49, PaCO2 30 mm Hg, PaO2 89 mm Hg, and HCO3- 18 mEq/L indicate respiratory alkalosis. The pH level is increased, and the HCO3- and PaCO2 levels are decreased. Normal values are pH 7.35 to 7.45; PaCO2 35 to 45 mm Hg; HCO3- 22 to 26 mEq/L.

The nurse is analyzing the arterial blood gas (ABG) results of a client diagnosed with severe pneumonia. Which of the following ABG results indicates respiratory acidosis? pH: 7.42, PaCO2: 45 mm Hg, HCO3-: 22 mEq /L pH: 7.50, PaCO2: 30 mm Hg, HCO3-: 24 mEq/L pH: 7.32, PaCO2: 40 mm Hg, HCO3-: 18 mEq/L pH: 7.20, PaCO2: 65 mm Hg, HCO3-: 26 mEq/L

pH: 7.20, PaCO2: 65 mm Hg, HCO3-: 26 mEq/L Respiratory acidosis is a clinical disorder in which the pH is less than 7.35 and the PaCO2 is greater than 42 mm Hg and a compensatory increase in the plasma HCO3- occurs. It may be either acute or chronic. The ABG of pH: 7.32, PaCO2: 40 mm Hg, HCO3-: 18 mEq/L indicates metabolic acidosis. The ABGs of pH: 7.50, PaCO2: 30 mm Hg, and HCO3-: 24 mEq/L indicate respiratory alkalosis. The ABGs of pH 7.42, PaCO2: 45 mm Hg, and HCO3-: 22 mEq/L indicate a normal result/no imbalance.

lab values again (cuz its improtant)

pH: 7.35 - 7.45 PaCo2: 35 - 45 HCO3: 21 - 28 PaO2: 75/80 - 100 K+: 3.5 - 5.3 mEq/L Na+: 135 - 145 mEq/L Cl-: 95 - 105 mEq/L

Which arterial blood gas (ABG) result would the nurse anticipate for a client with a 3-day history of vomiting? pH: 7.34, PaCO2: 60 mm Hg, HCO3: 34 pH: 7.45, PaCO2: 32 mm Hg, HCO3-: 21 pH: 7.55, PaCO2: 60 mm Hg, HCO3-: 28 pH: 7.28, PaCO2: 25 mm Hg, HCO3: 15

pH: 7.55, PaCO2: 60 mm Hg, HCO3-: 28 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. The other results do not represent metabolic alkalosis.

A client presents with fatigue, nausea, vomiting, muscle weakness, and leg cramps. The laboratory values are as follows: sodium 142 mEq/L (142 mmol/L) potassium 3.0 mEq/L (3.0 mmol/L) chloride 106 mEq/L (106 mmol/L) Magnesium 2.3 mg/dL (0.95 mmol/L) What laboratory value is consistent with the client's symptoms?

potassium 3.0 mEq/L (3.0 mmol/L) Potassium is the major intracellular electrolyte. Hypokalemia (potassium levels lower than 3.5 mEq/L) usually indicates a deficit in total potassium stores. Potassium deficiency can result in derangements in physiology. Clinical signs include fatigue, anorexia, nausea, vomiting, muscles weakness, leg cramps, decreased bowel motility, and paresthesias. The sodium, chloride, and magnesium levels listed are within normal limits.

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: metabolic acidosis. metabolic alkalosis. respiratory alkalosis. respiratory acidosis.

respiratory alkalosis. This client's above-normal pH value indicates alkalosis. The below-normal PaCO2 value indicates acid loss via hyperventilation; this type of acid loss occurs only in respiratory alkalosis. These ABG values wouldn't occur in metabolic acidosis, respiratory acidosis, or metabolic alkalosis.

what solution is used to restore metabolic balance in respiratory alkalosis?

solution containing chloride (used for both respiratory alkalosis and metabolic alkalosis), breath into paper bag to inhale more CO2

A client is diagnosed with hypocalcemia and the nurse is teaching the client about symptoms. What symptom would the nurse include in the teaching? tingling sensation in the fingers Flank pain polyuria hypertension

tingling sensation in the fingers Tingling or numbness in the fingers is a symptom of hypocalcemia. Flank pain, polyuria, and hypertension are symptoms of hypercalcemia.

A nurse is providing an afternoon shift report and relates morning assessment findings to the oncoming nurse. Which daily assessment data is necessary to determine changes in the client's hypervolemia status? Vital signs Edema Intake and output Weight

weight Daily weight provides the ability to monitor fluid status. A 2-lb (0.9 kg) weight gain in 24 hours indicates that the client is retaining 1 L of fluid. Also, the loss of weight can indicate a decrease in edema. Vital signs do not always reflect fluid status. Edema could represent a shift of fluid within body spaces and not a change in weight. Intake and output do not account for unexplainable fluid loss.

Hypertonic solution

when comparing two solutions, the solution with the greater concentration of solutes osmolality of solution is greater than the body's normal osmolality 3% D5 with 0.45NS shifts fluid into the blood plasma by moving out of ICF; making the cells shrink

•Chloride (Cl-)

•Chloride (Cl-) •Normal serum level: 95-105 mEq/L •Major anion of ECF •Regulates serum osmolality •Regulates ECF balance •Regulates acid-base balance •Major component of stomach fluids •Buffer in oxygen-carbon dioxide exchange

•Magnesium (Mg2+)

•Normal serum level: 1.5-2.5 mEq/L •Found in skeletal system, ICF •Second most abundant ICF cation •Intracellular metabolism •Protein, DNA synthesis •Operates sodium-potassium pump •Regulates cardiac, neuromuscular function •Relaxes muscle contractions Magnesium is used in the body to synthesize ingested protein.

•Sodium (Na+)

•Normal serum level: 135-145 mEq/L •Most abundant cation in ECF •Contributes to serum osmolality •Regulating ECF volume and distribution

•Phosphate (PO4-)

•Normal serum level: 2.4-4.5 mg/dL in adults •Much higher in children •Major anion of ICF •Forms bones and teeth •Metabolism of protein, fat, carbohydrates, •Cellular metabolism •Muscle, nerve, RBC function •Regulates acid-base balance •Regulates calcium levels Hypophosphatemia: The client will need additional dietary phosphorus. Providing phosphorus-rich foods such as milk and yogurt is a good way to provide that additional phosphorus..

•Potassium (K+)

•Normal serum level: 3.5-5.3 mEq/L •Major cation in ICF •Maintains ICF osmolality •Transmits nerve and other electrical impulses •Skeletal, cardiac, smooth muscle function •Regulates acid-base balance •Must be ingested daily Serum potassium levels may be temporarily lowered by administering glucose and insulin, which cause potassium to leave the extracellular fluid and enter cells./ other medications are available that will help lower potassium as well. Giving insulin to decrease serum potassium levels is not considered a safer method than other medications that can be used. Insulin does not promote renal excretion of potassium. Serum potassium is lowered by entering the cells Excess potassium loss through the kidneys is often caused by such medications as corticosteroids i.e. cortisol, potassium-wasting (loop) diuretics, amphotericin B, and large doses of some antibiotics. Thiazide diuretics are OK,

•Calcium (Ca2+)

•Normal serum level: 9-11 mg/dL •Most is found in skeletal system •Cation •Skeletal maintenance •Regulates muscle contractions (cardiac) •Neuromuscular function •Cardiac function •Blood clotting •Activates enzymes Hypercalcemia can occur from immobility. Ambulation of the client helps to prevent leaching of calcium from the bones into the serum

Exam 2

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