Pathophysiology Chapter 08: Disorders of Fluid and Electrolyte and Acid Base Balance

The nurse is caring for the following group of clients. Select the client most likely to be diagnosed with respiratory alkalosis.

A 26-year-old female with anxiety who has been hyperventilating

A nurse is caring for a client with hypoparathyroidism. Which imbalance is a major concern for the client?

Hypocalcemia

A client tells the nurse that the client has been taking Alka-Seltzer (bicarbonate—antacid) four times a day for the past 2 weeks for an upset stomach. Upon assessment of the client, the nurse notes hyperactive reflexes, tetany, and mental confusion. Arterial blood gases reveal pH 7.55; serum HCO3− 37 mEq/L (37 mmol/L). The nurse suspects the client may be experiencing:

Metabolic alkalosis

The effective circulating volume is the major regulator of water balance in the body. What else does it regulate?

Sodium

The condition of a client with metabolic acidosis from an intestinal fistula is not improving. The pulse is 125 beats/min and the BP 84/56 mm Hg. ABG values are: pH 7.1, HCO3- 18 mEq/L (18 mmol/L), PCO2 57 mm Hg (7.58 kPa). What IV medication should the nurse expect to provide next?

Sodium bicarbonate

In a person with fluid volume deficit, there is a dehydration of brain and nerve cells. What can occur if fluid volume deficit is corrected too rapidly?

Cerebral edema occurs with potentially severe neurologic impairment.

A client has been diagnosed with metabolic acidosis. What assessment finding does the nurse expect?

Decreased pH below 7.35

The nurse is aware that the major role of the kidneys in regulating acid-base balance is to increase the production of which chemical component?

HCO3-

A nurse observes peaked, narrow T waves on the electrocardiogram of a client suffering from renal failure. The nurse suspects that the client is experiencing which condition?

Hyperkalemia

The nurse is caring for a client who is 1 day postoperative for a thyroidectomy. The client complains of tingling of the hands and feet and around his mouth. The nurse suspects these symptoms are a manifestation of which electrolyte disturbance?

Hypocalcemia

A client is admitted to the hospital with fluid volume deficit. The nurse should be aware that compensatory mechanisms will include:

activation of the renin-angiotensin-aldosterone system (RAAS).

A client informs the nurse of a problem with acid indigestion. The client notes taking large amounts of calcium carbonate antacids daily but still has no relief. The client consumes about 1 bottle of 100 antacids in 4 days. Which blood gas result does the nurse anticipate?

pH 7.6

An adult client has the following results of morning blood work:Potassium: 2.5 mEq/L (2.5 mmol/L)Sodium: 136 mEq/L (136 mmol/L)Calcium: 9.2 mg/dL (2.3 mmol/L)Magnesium: 2.02 mEq/L (1.01 mmol/L)How should the nurse best respond to these values?

Inform the health care provider and monitor the client's cardiac status.

Lymph fluid arises directly from which space?

Interstitial

The nurse is performing an assessment for a client who is experiencing shortness of breath. The nurse notes a full and bounding pulse, crackles in the lung fields, and jugular vein distention. The nurse recognizes symptoms of which problem?

Isotonic fluid volume excess

A client has been ill for several days and has not had anything to eat, consuming only about 6 oz of water per day. The client has been vomiting and having diarrhea. Which condition is the nurse most concerned about the client developing?

Ketoacidosis

A client has these arterial blood gas values: anion gap 20 mEq/L (20 mmol/L), pH 7.29, PCO2 37 mm Hg (4.92 mmol/L), HCO3- 11 mEq/L (11 mmol/L), base excess -6 mEq/L (-6 mmol/L). With what condition do these values correspond?

Lactic acidosis

The nurse notifies the health care prescriber of a client's serum potassium level of 6.2 mEq/L (6.2 mmol/L). Which prescription will the nurse consider as having the first priority?

Placing the client on a cardiac monitor

The renal control mechanism of restoring the acid-base balance is accomplished through which process?

Reabsorption of HCO3 and excretion of H+ restores acid-base balance through the renal control mechanisms.

A client's arterial blood gases include the following:pH: 7.29HCO3-: 18 mEq/L (18 mmol/L)PCO2: 36 mm Hg (4.79 kPa)PO2: 94 mm Hg (12.50 kPa)What response by the nurse is most appropriate?

Replace fluids and electrolytes as ordered.

A client arrives in the emergency department by ambulance with a family member stating, "He took an overdose of sleeping pills and I found him breathing very shallowly." For which type of acid-base disturbance will the nurse anticipate this client will be treated?

Respiratory acidosis

The nurse is caring for a client who complains of headache and blurred vision. The nurse recognizes that these symptoms, accompanied by increased plasma partial pressure carbon dioxide (PCO2) level and decreased pH level, are consistent with which diagnosis?

Respiratory acidosis

The pH of body fluids is regulated by three major mechanisms, one of which is the chemical buffer system. Which is a component of this buffer system?

The transcellular H+/K+ exchange system

The nurse is teaching an older adult about adapting to age-related physiologic changes. Which statement by the client prompts the nurse to provide additional teaching?

"I will reduce my total daily fluid intake."

The nurse teaches the client with end-stage kidney disease and hyperphosphatemia to take sevelamer HCl, a phosphate binder, with meals. How does the nurse explain the rationale for the timing of this medication?

"The medication should be taken at meal time to allow the binding of phosphate."

A client is admitted to the emergency department with possible internal bleeding after being involved in an automobile accident. What type of isotonic intravenous (IV) solution does the nurse prepare to infuse?

0.9% NaCl

Which arterial blood gas (ABG) values tell the nurse a client is in metabolic acidosis? Select all that apply.

1. HCO3- of 19 mEq/L (19 mmol/L) 2. Base excess of -6 mEq/L (-6 mmol/L) 3. Anion gap of 20 mEq/L (20 mmol/L) 4. pH 7.25

The nurse who is providing care for several clients recognizes which client is at the highest risk for developing an acid-base imbalance?

A client who is being treated for acute kidney injury and who requires dialysis

A client's most recent laboratory results suggest the presence of metabolic alkalosis. What action by the nurse best addresses a potential cause of this acid-base imbalance?

Administering an antiemetic to treat the client's frequent vomiting

A newly admitted client's diagnostic testing indicates metabolic acidosis. What action should the nurse take when working to determine the cause?

Assess the client's blood glucose levels

When caring for a client with hypomagnesemia, the nurse prioritizes assessment of which body system?

Cardiac

A client staggers into the emergency department with his son who states that his father has not been well for a couple of weeks. The client's heart rate is 120 and lung sounds reveal crackles and a respiratory rate of 30. The client also reports right flank pain. The son says that his mother has been acting strangely and thinks she might be poisoning her husband. Which clinical manifestation indicates the type of poisoning involved?

Ethylene glycol (antifreeze)

A client is admitted after losing 44 lb (20 kg) over the past 3 months, largely due to frequent vomiting. What intervention should the nurse anticipate in the treatment of the client's resulting acid-base imbalance?

Fluid replacement with an intravenous solution containing electrolytes as prescribed

The nurse is caring for a client with worsening respiratory acidosis. Which of these interventions does the nurse anticipate if the client's condition continues to deteriorate?

Mechanical ventilation

Arterial blood gases of a client with a diagnosis of acute renal failure reveal a pH of 7.25, HCO3- level of 21 mEq/L (21 mmol/L), and decreased PCO2 level accompanied by a respiratory rate of 32. This client is most likely experiencing which disorder of acid-base balance?

Metabolic acidosis

The nurse is caring for a client with renal failure experiencing shortness of breath and increased respiratory rate. The arterial blood gas reflects a pH of 7.10 and HCO3 level of 18 mEq/L (18 mmol/L). How does the nurse interpret these findings?

Metabolic acidosis

The nurse is administering a unit of packed red blood cells to a client and piggybacks the unit of blood through a solution of 0.9% NaCl. Blood cells placed in a solution of 0.9% saline will do which of the following?

Neither shrink nor swell

Hypothalamic sensory neurons that promote thirst when stimulated are called:

Osmoreceptors

A nurse is caring for a client with a low sodium level and increased water retention. Hematocrit and blood urea nitrogen levels are decreased, urine osmolality is high, and serum osmolality is low. A chest x-ray shows a possible lung mass. Based on these findings, which problem could the client be diagnosed with?

Syndrome of inappropriate antidiuretic hormone (SIADH)

What is the nurse's expectation about a client's ability to compensate for a metabolic blood gas disorder?

The client will compensate with the respiratory system.