Med-Surg 1: Ch.14 EAQ: Acid-Base Balance and Imbalance

Which acid-based disturbance would be associated with a serum lactate level of 6.2 mmol/L in a critically ill patient?

Metabolic acidosis

Which assessment finding suggests a patient has acidosis? Select all that apply.

→ Confusion → Warm, flushed, dry skin

Which cause is associated with the development of metabolic acidosis because of an overproduction of hydrogen ions? Select all that apply.

→ DKA → Salicylate intoxication → Excessive fasting for 30 days

Which condition can cause metabolic acidosis? Select all that apply.

→ Diarrhea → Liver failure → Kidney failure

Which change associated with an acid-base imbalance does the nurse assess for in an older adult patient admitted with pneumonia? Select all that apply.

→ Dry mucous membranes → Dark, concentrated urine → Thready peripheral pulses → New-onset mental status changes

Which manifestation would the nurse anticipate finding when assessing a patient with metabolic and respiratory acidosis? Select all that apply.

→ Flaccid paralysis → Kussmaul respiration → Delayed electrical conduction

Which condition or symptom is likely responsible for this acid-base imbalance: pH = 7.32; PaO2 = 82 mm Hg; PaCO2 = 33 mm Hg; HCO3- = 18 mEq/L? Select all that apply.

→ Liver failure → Dehydration → RR of 8 BPM

Which organ plays a major role in maintaining pH balance in the body? Select all that apply.

→ Lungs → Kidneys

Which nursing intervention would be included in the plan of care for a patient who is in metabolic alkalosis because of overuse of diuretics? Select all that apply.

→ Monitoring electrolyte levels → Administering IV fluids → Placing the patient on fall precautions

Which clinical manifestation would the nurse likely assess in a patient with metabolic alkalosis? Select all that apply.

→ Numbness around the mouth → Hyperactivity of deep tendon reflexes

Which factor contributes to the development of metabolic acidosis? Select all that apply.

→ Reported heavy alcohol consumption → Chronic cirrhosis of the liver with liver failure → Seizure in the ambulance on the way to the hospital

Which condition may result in metabolic acidosis? Select all that apply.

→ Starvation → Prolonged diarrhea

Which person is at risk for developing respiratory acidosis?

A patient with TB

Which factor is associated with a cause of respiratory alkalosis?

Anxiety

Which cause is associated with acidosis?

Kidney failure

Which acid-base imbalance would be expected in a patient who has been having acute diarrhea for more than 24 hours?

Metabolic acidosis

Deep and rapid breaths consistent with Kussmaul respiration are found in patients with which type of acid-base imbalance?

Metabolic acidosis

Kussmaul respiration would be seen as a compensatory mechanism with which situation?

ASA overdose

Which physiologic imbalance is the patient at risk for developing if he or she has chronically low Hgb?

Acidosis

A patient admitted to the ER is in acute respiratory distress syndrome and has an ABG drawn. Which finding would explain the laboratory value of a pH of 7.31?

Acidosis in response to the excessive retention of CO2

When caring for a patient with a pulse oximetry level of 90%, which action would the nurse take first?

Apply O2 as prescribed

Which assessment finding would require priority nursing intervention s in a patient with metabolic or respiratory acidosis?

Bradycardia with widened QRS complex

Which prescribed treatment would the nurse administer to a patient admitted for an exacerbation of COPD whose laboratory values reveal a pH of 7.29 with a PaO2 and an elevated PaCO2?

Bronchodilator therapy

Which increased blood arterial level causes a compensatory increase in RR?

CO2

A patient with emphysema is in acute respiratory distress and is becoming more confused. Respirations remain rapid but are shallower. The most recent blood gas results are pH = 7.29, PaO2 = 62 mm Hg, PaCO2 = 56 mm Hg, and HCO3- = 25 mEq/L. Which intervention would the nurse take?

Call the RRT

After successful CPR of cardiopulmonary arrest, the patient has the following ABG reading: pH = 7.28, PaCO2 = 52; HCO3- = 16. Which interpretation of these values is accurate?

Combined respiratory and metabolic acidosis

Which change would indicate that a patient with impaired kidney function is in metabolic acidosis?

Decrease in serum bicarbonate level

A postoperative patient has the following ABG results: pH = 7.30; PaCO2 = 60 mm Hg; PaO2 = 80 mm Hg; HCO3- = 24 mEq/L; O2 saturation = 96%. Which action would the nurse take?

Encourage the patient to do deep breathing, and assist with repositioning

Which priority action would the nurse take for the patient who is admitted to the ER with a panic attack and whose blood gases indicate respiratory alkalosis?

Encourage the patient to take slow breaths

A patient who is admitted with severe diabetic ketoacidosis has an ABG result that reveals a pH of 7.21. Which factor is causing this patient's acidosis?

Excessive breakdown of fatty acids

Which concept is accurate regarding acid-base chemistry in acidosis?

Fluids with lower pH have higher acidity

After reviewing assessment data for a patient who was admitted for emergency treatment of an acute episode of emphysema, the nurse understandings that which data suggest the patient is in an uncompensated acid-base imbalance? Vital signs: RR 32 BPM Temperature 101.5ºF (38.6ºC) HR 110 BPM BP 130/76 mm Hg Respiratory assessment: On auscultation wheezing in all lung fields and diminished breath sounds in bilateral bases Laboratory studies: ABGs: pH = 7.48 PaO2 = 8 mm Hg PaCO2 = 30 mm Hg HCO3- = 24 mEq/L Cognitive assessment: Alert, anxious

HCO3- of 24 mEq/L

The nurse would anticipate which laboratory finding when caring for a patient who has taken a large quantity of a loop diuretic to promote weight loss?

HCO3- of 34 mEq/L

A patient is admitted for IV fluids to treat dehydration caused by several days of vomiting and diarrhea. The patient's admission blood work reveals a pH of 7.27 and HCO3- 26 mEq/L; potassium and chloride levels are within normal ranges. The HCP has prescribed adding HCO3- to the IV fluids. Which action by the nurse is correct?

Hold the HCO3-, and report the laboratory values to the HCP

Which electrolyte abnormality would the nurse anticipate when reviewing laboratory data for a patient admitted with metabolic acidosis?

Hyperkalemia

A patient admitted with DKA was treated for metabolic acidosis with IV fluids and insulin. Which electrolyte imbalance would the nurse monitor for as the acid-base imbalance resolves?

Hypokalemia

Which mechanism in the body compensates for a low pH?

Increases RR

Which nursing intervention takes priority for a patient admitted with severe metabolic acidosis?

Initiate cardiac monitoring

Which disturbance is consistent with rapid weight loss because of starvation?

Ketosis

The nurse obtains laboratory results for a patient that show the following: pH = 7.24; HCO3- = 20; PaO2 = 82; PaCO2 = 35. These findings are consistent with which acid-base imbalance?

Metabolic acidosis

Which goal must the patient with DM strive for to decrease the risk for acid-base imbalance?

Maintain blood glucose level WNLs

Which nursing action is the greatest priority in the plan of care for a patient recovering from an acute episode of COPD?

Monitor the RR and effort hourly

When evaluating the laboratory results of a patient with DKA, which laboratory value indicates the body has fully compensated from this acid-base imbalance?

Normal pH on ABGs

Which mechanism causes acidosis in a patient in diabetic ketoacidosis?

Overproduction of hydrogen ions

After reviewing a patient's chart, about which laboratory value would the nurse need to call the HCP? Laboratory studies: ABGs: pH = 7.36 PaCO2 = 35 HCO3- = 26 PaO2 = 62 Diagnostic studies: CT of chest: Large PE ECG: Sinus tachycardia Physical assessment: SOB, pale, circumoral, cyanosis

PaO2

The nurse is assessing the laboratory profiles of patients with acid-base imbalances. Which patient diagnosis correctly correlates to the appropriate laboratory values? Patient A: Arterial HCO3- is 16 mEq/L Patient B: Arterial pH value is 7.36 Patient C: Arterial PaCO2 value is 31 mm Hg Patient D: Arterial PaO2 value is 60 mm Hg

Patient D has respiratory depression

Which patient would exhibit the following ABGs results: pH = 7.30; PaCO2 = 49; HCO3- = 26; PaO2 = 76?

Patient taking opioids

Which patient would be appropriate to assign to the new nurse working on the medical-surgical unit?

Patient with COPD with PaCO2 level of 50 mm Hg

When caring for a patient with kidney failure who has metabolic acidosis, which symptom would the nurse expect as evidence of the body's compensatory effort?

Rapid and deep respirations

A patient having contiuous NG suction after ABD surgery has become irritable and anxious with hperreflexia, tachycardia, and tachypnea. Which action by the nurse is correct?

Request an order to evaluate serum electrolytes and turning off the NG suction

A laboratory report for a patient shows the following results: pH = 7.32; HCO3- = 24 mEq/L; PaO2 = 77 mm Hg; PaCO2 = 48 mm Hg. These findings are consistent with which acid-base imbalance?

Respiratory acidosis

Which acid-base imbalance would the nurse anticipate that a patient with morbid obesity may develop?

Respiratory acidosis

After a motor vehicle crash, the nurse is consoling a patient in the ER who is hysterical and hyperventilating after being notified of the death of a family member. Which acid-base imbalance is this patient likely to develop?

Respiratory alkalosis

Laboratory results for a patient show the following: pH = 7.48; HCO3- = 26; PaO2 = 90; PaCO2 = 32. These findings are consistent with which acid-base imbalance?

Respiratory alkalosis

A patient with DM is admitted after vomiting for several days and has rapid, deep respirations. Which process does the nurse suspect is occurring with this patient?

Respiratory compensation for metabolic acidosis

While the nurse is assessing a patient with metabolic acidosis, which finding supports that the patient has lactic acidosis?

Symptoms of hypoxia

Which intervention may be considered to promote gas exchange and prevent respiratory acidosis in a patient with a constricting chest injury?

Ventilatory assistance

Which ABG laboratory values would be seen in metabolic alkalosis?

pH 7.49, HCO3- 32

Which ABGs result would be expected in a patient diagnosed with acute kidney failure?

pH = 7.33; PaO2 = 82 mm Hg; PaCO2 = 35 mm Hg; HCO3- = 19 mEq/L

Which ABG reading would be expected in a patient who has had COPD for the last 15 years?

pH = 7.36; PaO2 = 63 mm Hg; PaCO2 = 52 mm Hg; HCO3- = 32 mEq/L

Which nursing assessment would be included in the plan of care for a patient with chronic respiratory acidosis? Select all that apply.

→ Assessing the color of nail beds → Checking for the use accessory muscles → Assessing for cyanosis of mucous membranes

Which condition places a patient at risk for developing metabolic alkalosis? Select all that apply.

→ Blood transfusion → NG suctioning → TPN