Fundamentals

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Which clients would the nurse determine is at risk for development of metabolic alkalosis? Select all that apply.

Client who has been vomiting for 2 days

A client has the following lab values: a pH of 7.55, an HCO3 level of 22 and a PCO2 of 30. Which action should the nurse plan to take?

Encourage the client to slow down breathing

The nurse reviews the the client's serum calcium level and notes the level is 8.0. The nurse understands that which condition would cause this serum calcium level?

Prolonged bed rest

The nurse is instructing a client on how to decrease the intake of calcium in the diet. The nurse should tell the client that which food item is least likely to contain calcium?

butter

The nurse is caring for a client with a suspected diagnosis of hypercalcemia. Which sign/symptom would be an indication of this electrolyte imbalance?

generalized muscle weakness

The nurse is caring for a client with severe diarrhea. The nurse monitors the client closely, understanding that this client is at risk for developing which acid-base disorder?

metabolic acidosis

The nurse is caring for a client with a nasogastric tube that is attached to low suction. The nurse monitors the client closely for which acid-base disorder that is most likely to occur in this situation?

metabolic alkalosis

The RN reviews the results of the arterial blood gas values with the LVN and tells the LVN that the client is experiencing respiratory acidosis. The LVN should expect to note which on the lab result report?

pH 7.25, PCO2 50

The nurse is caring for a client with a diagnosis of COPD. The nurse should monitor the client for which acid-base imbalance?

respiratory acidosis

A client has been admitted to the hospital for UTI and dehydration. The nurse determines that the client has received adequate volume replacement if the blood urea nitrogen level drops to which value?

15 (normal 6-20)

The nurse is caring for a group of clients who are taking herbal medications at home. Which client should be given instructions with regard to avoiding the use of herbal medications?

A 10-year-old female client with a urinary tract infection

The nurse is caring for a client with respiratory insufficiency. The arterial blood gas results indicate a pH of 7.50 and a PCO2 of 30 and the nurse is told that the client is experiencing respiratory alkalosis. Which additional lab value should the nurse expect to note?

A potassium level of 3.0

The nurse is preparing to assist a client of Orthodox Jewish faith with eating lunch. A kosher meal is delivered to the client. Which nursing action is appropriate when assisting the client with the meal?

Allowing the client to unwrap the utensils and prepare his own meal for eating

The nurse is caring for a client with hyperparathyroidism and notes that the client's serum calcium level is 13. Which prescribed medication should the nurse plan to assist in administering to the client?

Calcitonin

The nurse is caring for a client who has been taking diuretics on a long-term basis. Which finding should the nurse expect to note as a result of this long term use?

Increased specific gravity of the urine

The nurse is caring for a client with a diagnosis of hyperparathyroidism. Lab studies are performed and the serum calcium level is 12.0. Based on this lab value the nurse should take which action?

Inform the RN of this lab value

The nurse observes that a client with diabetic ketoacidosis is experiencing abnormally deep, regular, rapid respirations. How should the nurse correctly document this observation in the medical record?

Kussmaul's respirations

The nurse reviews a client's electrolyte results and notes that the potassium level is 5.4. What should the nurse look for on the cardiac monitor as a result of this lab value?

Narrow, peaked T waves

The nurse is caring for a client with leukemia and notes that the client has poor skin turgor and flat neck and hand veins. The nurse suspects hyponatremia. Which additional signs/symptoms should the nurse expect to note in this client if hyponatremia is present?

Postural blood pressure changes

The nurse is told that the arterial blood gas results indicate a pH of 7.50 and a PCO2 of 32. The nurse determines that these results are indicative of which acid-base disturbance?

Respiratory alkalosis

The nurse who is caring for a client with kidney failure notes that the client is dyspneic and crackles are heard when listening to breath sounds in the lungs. Which additional sign/symptom should the nurse expect to note in this client?

an increase in blood pressure

The nurse is reviewing the heath records of assigned clients. The nurse should plan care knowing that which client is at risk for a potassium deficit?

The client receiving nasogastric suction

The nurse is reviewing the health records of assigned clients. The nurse should plan care knowing that which client is at risk for fluid volume deficit?

The client with a ileostomy

The nurse reviews electrolyte values and notes a sodium level of 130. The nurse expects that this sodium level would be noted in a client with which condition?

The client with the syndrome of inappropriate secretion of antidiuretic hormone

The nurse reviews a client's electrolyte results and notes a potassium level of 5.5. The nurse understands that a potassium value at this level would be noted with which condition?

Traumatic burn

A client is scheduled for blood to be drawn from the radial artery for an arterial blood gas determination. The nurse assists with performing Allen's test before drawing the blood to determine the adequacy of which?

Ulnar circulation


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