NCO Acid-Base Balance Self-Assessment Quiz

The nurse is caring for a patient who suddenly becomes lethargic and has an increase in the depth and rate of respirations has the following arterial blood gas (ABG) results: pH 7.32, PaO2 88 mm Hg, PaCO2 37 mm Hg, and HCO3 16 mEq/L. How should the nurse interpret these results? a. Metabolic acidosis b. Metabolic alkalosis c. Respiratory acidosis d. Respiratory alkalosis

a. Metabolic acidosis (The pH and HCO3 indicate that the patient has a metabolic acidosis. The other options are incorrect.)

The patient has severe metabolic alkalosis. Which intervention has the highest priority? a. Raise the side rails on the patient's bed. b. Measure the urine output and skin turgor. c. Teach the family about metabolic alkalosis. d. Administer intravenous NaHCO3 as ordered.

a. Raise the side rails on the patient's bed. (Severe metabolic alkalosis causes a decreased level of consciousness; raising the side rails is a safety intervention in that situation. Safety interventions are a higher priority than teaching. An order to administer intravenous NaHCO3 to a patient with metabolic alkalosis should be questioned because it would make the alkalosis worse. Urine output and skin turgor are part of the assessment for extracellular fluid volume (ECV) deficit, but this is not a high priority in this situation.)

The nurse is assessing a patient who has diabetic ketoacidosis. Her assessment reveals tachycardia, lethargy, and hyperventilation. Treatment for the ketoacidosis has been initiated. What should the nurse do about the hyperventilation? a. Request an order for pain medication and oxygen at 6 L/min. b. Lubricate the patient's lips and allow continued hyperventilation. c. Have the patient breathe into a paper bag to stop hyperventilating. d. Contact the physician immediately regarding this complication.

b. Lubricate the patient's lips and allow continued hyperventilation. (Hyperventilation is a compensatory response to metabolic acidosis and should be allowed to continue because it helps move the blood pH toward the normal range. Lubricating the lips is a supportive nursing intervention that prevents drying and cracking of the lips during hyperventilation. Although pain and hypoxia can trigger hyperventilation, they are not the cause in this patient. Interventions to stop hyperventilation are not appropriate when it is a compensatory response. Hyperventilation is an expected beneficial compensatory response to metabolic acidosis and does not require contacting the physician.)

A patient is admitted to the emergency department with dehydration. Arterial blood gas (ABG) results reveal that the patient has metabolic acidosis. Which of the following signs or symptoms is the most likely cause of this imbalance? a. Hypoventilation b. Vomiting and diarrhea c. Serum potassium is 5.1 mEq/L. d. Arterial oxygen saturation is 91%.

b. Vomiting and diarrhea (Vomiting and diarrhea cause too much acid, the buffers have been overwhelmed, and body fluids have too much acid. Acid excretion is not able to keep up with acid production or intake. Hypoventilation leads to respiratory acidosis. Hyperventilation leads to respiratory alkalosis. Oxygen saturations below 95% indicate that the patient may need supplemental oxygen and may contribute to imbalance; however, a low reading alone is not enough to determine the cause.)

The nurse should ask which of the following questions to detect the risk factors for metabolic acidosis? (Select all that apply.) a. Have you been vomiting today? b. When did your kidneys stop working? c. How long have you had diarrhea? d. Are you still feeling short of breath? e. What type of antacid did you take? f. Which weight loss diet are you using?

b. When did your kidneys stop working? c. How long have you had diarrhea? f. Which weight loss diet are you using? (Risk factors for metabolic acidosis include decreased excretion of metabolic acid from oliguria or anuria (kidneys are not working); excessive production of metabolic acid from starvation ketoacidosis (inappropriate weight loss diet); and loss of bicarbonate from diarrhea. Vomiting (loss of acid) causes metabolic alkalosis, as does overusing bicarbonate antacids. Shortness of breath might be related to a cause of respiratory acidosis.)

Which diagnosis indicates that the nurse should assess the patient most carefully for development of metabolic acidosis? a. Type B chronic obstructive pulmonary disease (COPD) and pneumonia b. Acute meningococcal meningitis c. A pancreatic fistula that is draining d. Severe hyperaldosteronism

c. A pancreatic fistula that is draining (The pancreas secretes bicarbonate; a draining pancreatic fistula could cause metabolic acidosis from bicarbonate loss. Type B COPD and pneumonia cause respiratory acidosis by impairing carbonic acid excretion. Meningitis can stimulate hyperventilation, which causes respiratory alkalosis. Aldosterone facilitates renal excretion of hydrogen ions; hyperaldosteronism would cause metabolic alkalosis.)

The nurse in the emergency department is caring for a patient who is on a ventilator. The patient's blood gases report reveals a pH 7.48, PaO2 85 mm Hg, a PaCO2 32 mm Hg, and a HCO3 25 mEq/L. What is the nurse's interpretation of these results? a. Metabolic acidosis b. Metabolic alkalosis c. Respiratory acidosis d. Respiratory alkalosis

d. Respiratory alkalosis (The pH indicates that the patient has alkalosis and the low PaCO2 indicates a respiratory cause. The other responses are incorrect based on the pH and the normal HCO3.)

A patient is having her first severe, acute asthma episode. It began 2 hours ago. What blood gas values should the nurse expect to see? a. pH high, PaCO2 high, HCO3- high b. pH low, PaCO2 low, HCO3- low c. pH low, PaCO2 high, HCO3- high d. pH low, PaCO2 high, HCO3- normal

d. pH low, PaCO2 high, HCO3- normal (A severe acute asthma episode impairs the excretion of carbonic acid, causing respiratory acidosis with a high PaCO2 and a low pH. Renal compensation takes longer than 2 hours to occur, so the respiratory acidosis is uncompensated, leaving the HCO3- normal. A high pH occurs with alkalosis, not acidosis. ANSs that include abnormal levels of HCO3- are not correct for the 2-hour time frame.)