HESI concept- Acid/Base

Which diagnostic test result will the nurse review after noticing large U waves on the electrocardiogram (ECG) for a client who was just admitted to the cardiac unit?

Hypokalemia may result in large U waves- K= imbalances cause dysrhythmias

Two weeks after sustaining a spinal cord injury, a client begins vomiting thick, coffee-ground material and appears restless and apprehensive. Which is the most important initial nursing action?

NG tube insertion for suctioning to decompress stomach. coffee ground emesis = blood influenced gastric contents

Potassium

Potassium is the major intracellular osmolarity regulator, and it also regulates metabolic activities, transmission and conduction of nerve impulses, cardiac conduction, and smooth and skeletal muscle contraction.

Calcium

Calcium is an extracellular cation necessary for bone and teeth formation, blood clotting, hormone secretion, cardiac conduction, transmission of nerve impulses, and muscle contraction.

Chloride

Chloride is a major extracellular fluid anion and follows sodium.

Which factor may have precipitated ketoacidosis in a client with type 1 diabetes who has been adhering to a prescribed insulin regimen

URI- increased metabolism= increased adrenocortical release of glucocorticoid

Hypertropic Pyloric Stenosis (HPS) sx in newborns

White vomitus- due to milk feed, peristaltic waves, insatiable hunger

Which assessment finding in a laboring client indicates respiratory alkalosis

a tingling sensation in the hands

The postanesthesia care unit (PACU) receives a client postabdominal surgery with a nasogastric tube with low-intermittent wall suction in place. Which initial action would the nurse implement when the client vomits 90 mL of bile-colored fluid?

check tube patency. gastric suctioning should remove contents but if tube is obstructed then build up can occur

The assessment of a newly admitted client reveals malnourishment, nausea, distension, and a firm abdomen with ascites. The client has tachycardia and is hypotensive. Which physiological change occurred that resulted in the client's development of ascites?

decrease in plasma proteins to maintain adequate capillary-tissue circulation

A client with chronic obstructive pulmonary disease (COPD) reports chest congestion, especially upon awakening in the morning. To address the concern, the nurse would make which suggestion?

use a humidifier in the bedroom

The laboratory data for a client with prolonged vomiting reveal arterial blood gases of pH 7.51, Pco2 of 45 mm Hg, HCO3 of 58 mEq/L (59 mmol/L), and a serum potassium level of 3.8 mEq/L (3.8 mmol/L). The nurse concludes that the findings support which diagnosis?

metabolic alkolosis- vomiting metabolic origin- alkalosis due to loss of gastric acid via vomiting. ph high, bicarb high

Intravenous (IV) insulin is prescribed for a client in. Which insulin can be administered IV? Select all that apply. One, some, or all responses may be correct.

Four insulins are approved for IV administration: regular, aspart, lispro, and glulisine insulin can be administered intravenously. Glargine insulin is long acting not approved for IV

The nurse determined a client's arterial blood gases reflected a compensated respiratory acidosis. The pH was 7.34; which additional laboratory value did the nurse consider?

HCO3 50 - bicarb levels increase indicating compensation

An infant has been vomiting after each feeding, and the physical assessment reveals poor skin turgor, a sunken anterior fontanel, and tremors. Which process would the nurse suspect as causing the infant's acid-base imbalance?

Loss of gastric secretions, which contain sodium, chloride, and potassium, usually results in metabolic alkalosis.

The nurse prepares an intravenous (IV) solution of lactated Ringer solution to replace the T-tube output of a client who had a cholecystectomy and common bile duct exploration. Which condition will improve if the administration of lactated Ringer solution is effective?

metabolic acidosis - LRs are alkaline, replaces bicarbonate ions lost from T-tube bile drainage

Which is the regulator of extracellular osmolarity?

Sodium is the most abundant extracellular fluid cation and regulates serum (extracellular) osmolarity, as well as nerve impulse transmission and acid-base balance.

The arterial blood gas for a 3-month-old infant with diarrhea showed that the pH is 7.30, Pco2 is 35 mm Hg, and HCO3- is 17 mEq/L (17 mmol/L). Which would the nurse conclude has developed?

metabolic acidosis- ph is acidotic, paCO2 is not elevated, diarrhea= metabolic in origin

A child with type 1 diabetes is admitted to the hospital with deep, rapid respirations; flushed, dry cheeks; abdominal pain with nausea; and increased thirst. Which laboratory findings are the nurse most likely to observe?

acidosis 7.25 and serum glucose level 460

A 3-month-old infant with a 3-day history of diarrhea has an arterial blood gas drawn. Which acid-base imbalance would the nurse suspect?

metabolic acidosis- ph low, CO2 low, bicarb low

When arterial blood gas results for an alert client who is in the postanesthesia care unit (PACU) after abdominal surgery are pH 7.37, PaCO2 42 mm Hg (5.59 kPa), HCO3 25 mEq (25 mmol/L), PaO2 65 mm Hg (8.64 kPa), and SaO2 90% (0.90), which action would the nurse take

increase O2. patient is showing mild hypoxemia. acid-base is normal. insertion of a NG tube is unnecessary because the patient is alert and oriented and may activate gag reflex. patient needs to stabilize(further monitoring and anesthesia recovery) before being moved out of the PACU.

After a gastrectomy, a client has a nasogastric tube set to low continuous suction. The client begins to hyperventilate. How would the nurse anticipate that this breathing pattern will alter the client's arterial blood gases?

decrease the CO2 level due to hypoventilation. PaO2 not affected, ph will increase, carbonic level will decrease

Which arterial blood gas (ABG) value would indicate diabetic ketoacidosis?

decreased HCO3 due to overwhelming metabolic acids

A client is hospitalized after 4 days of epigastric pain, nausea, and vomiting. The nurse reviews the laboratory test results: plasma pH 7.51, pCO2 50 mm Hg, bicarbonate 58 mEq/L (58 mmol/L), chloride 55 mEq/L (55 mmol/L), sodium 132 mEq/L (132 mmol/L), and potassium 3.8 mEq/L (3.8 mmol/L). Which condition does the nurse determine the results indicate?

metabolic alkolosis- vomiting= loss of gastric content. this patient has increased bicarb, low chloride due to loss of gastric contents, low sodium to vomiting/hypovolemia. K+ normal

A client had a laparoscopic cholecystectomy. Postoperatively, the client experiences nausea and vomiting and is admitted overnight for observation and hydration. What would the nurse include in the teaching plan when preparing this client for discharge? Select all that apply. One, some, or all responses may be correct.

report fever over 100F for 2 or more days, report redness, swelling, tenderness or drainage

Which factors can predispose a client with type 1 diabetes to a diabetic ketoacidotic coma? Select all that apply. One, some, or all responses may be correct.

emotional stress can trigger the sympathetic system increasing the production of glucocorticoid which raises blood sugar, running a fever with the flu- stress of infection increases metabolism increasing glucocorticoid

After an acute episode of upper gastrointestinal (GI) bleeding, a client vomits undigested antacids and reports having severe epigastric pain. The nursing assessment reveals an absence of bowel sounds, a pulse rate of 134, and shallow respirations of 32 per minute. In addition to calling the health care provider, what action should the nurse take?

prepare patient for surgery these are sx of perforated ulcer

A client arrives in the emergency department with epigastric pain and prolonged vomiting. Assessment findings include rapid and shallow respirations, dry and flushed skin, weakness, and lethargy. Which is the primary nursing concern?

encourage patient to deep breath and cough. low ph and high CO2 due to hypoventilation post surgery

Which unique response is associated with diabetic ketoacidosis (DKA) that is not exhibited with hyperglycemic hyperosmolar nonketotic syndrome (HHNS)

kussmaul respirations- attempt to correct low ph caused by accumulation of ketones

When a client is newly diagnosed with chronic obstructive pulmonary disease (COPD), which action by the nurse has the highest priority

asksmokingcessation

A 4-month-old infant is brought to the emergency department after 2 days of diarrhea. The infant is listless and has sunken eyeballs, a depressed anterior fontanel, and poor tissue turgor. Breathing is deep, rapid, and unlabored. Stools are liquid and there has been no obvious urine output. Which problem would the nurse be concerned about?

dehydration, metabolic acidosis due to loss of alkaline fluid via diarrhea

Which interventions are appropriate for a child poisoned by ingestion of cleaning products? Select all that apply. One, some, or all responses may be correct.

gastric lavage, activated charcoal. * whole bowel irrigation would be used to remove foreign substances or heavy metal poisoning. chelation therapy used for heavy metal poisoning- it carries a high risk of electrolyte imbalance. Hemodialysis is reserved for rare instances of severe acidosis from ingestion of toxic substances such as aspirin.