Prep U CH.8
The nurse is administering a unit of packed red blood cells to a patient 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
Pressure generated as water moves across a membrane is also known as which of the following?
osmotic pressure
Which arterial blood gas (ABG) values tell the nurse a client is in respiratory alkalosis? Select all that apply.
pH 7.52 pCO2 of 27 mm Hg
The nurse is caring for a client with an acid base imbalance. Which of these does the nurse recognize is correct regarding compensatio
A pH moves toward the normal range
The nurse is caring for a client with an acid base imbalance. Which of these does the nurse recognize is correct regarding compensation?
A pH moves toward the normal range
The nurse caring for a client with respiratory acidosis examines arterial blood gas (ABG) results. Which change from the initial value indicates the client's respiratory acidosis is improving?
CO2 has decreased
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.
The body regulates the pH of its fluids by what mechanism? (Select all that apply.)
Chemical buffer systems, of the body fluids, the lungs, and the kidneys
Which of the following is an anion?
Chloride
A client has an increase in respiratory rate. What assessment findings does the nurse expect?
Decreased PCO2
Which of the following is the preferred drug for treating chronic diabetes insipidus?
Desmopressin acetate(DDAVP)
The nurse is caring for a patient with a tumor obstructing the lymphatic system. For which of the following consequences does the nurse assess?
Fluid accumulating in the interstitial spaces distal to the tumor
A client with ethylene glycol toxicity is restless, and stating he has flank pain. What intervention should the nurse perform to minimize complications?
Increase IV fluids
Lymph fluid arises directly from which one of the following spaces?
Interstitial
The nurse at a long term care facility encourages the older adults to drink even though they may not feel thirsty at the time. Which of the following statements supports the nurse's action?
Older adults often experience a decrease in the sensation of thirst, even when serum sodium levels are high.
Vitamin D, officially classified as a vitamin, functions as a hormone in the body. What other hormone is necessary in the body for vitamin D to work?
Parathyroid hormone
The nurse is reviewing lab results of a client diagnosed with metabolic acidosis. The most important electrolyte for the nurse to assess would be:
Potassium (K+)
The nurse suspects a client who had a colon resection 4 days ago, is unable to pass flatus, and has no audible bowel sounds has a paralytic ileus. The nurse recognizes which of these abnormal laboratory results is consistent with this problem?
Potassium level of 2.8 mEq/L
The nurse enters a patient's hospital room and finds the patient breathing rapidly, stating, " I must be having a stroke, my fingers are tingling!" Which of the following acid-base balance disorders is this patient experiencing due to hyperventilation?
Respiratory alkalosis
When caring for patients with disorders of sodium balance, the nurse asks the provider which of the following findings are consistent with hypernatremia?
Sodium 158 mEq/L and serum osmolality of 320 mOsm/kg
A client with anemia is showing signs of acidosis. How can a decline in red blood cells cause someone to be acidotic?
The RBCs are potent buffers and their loss results in less bicarbonate production.
Potassium is the major cation in the body. It plays many important roles, including the excitability of nerves and muscles. Where is this action particularly important?
The heart
Body weight consists of which of the following percentages of body water?
60%
A male patient with a history of heavy alcohol use has been admitted to hospital for malnutrition and suspected pancreatitis. The patient's diagnostic workup suggests alcoholic ketoacidosis as a component of his current health problems. He is somewhat familiar with the effect that drinking has had on his nutrition and pancreas, but is wholly unfamiliar with the significance of acid-base balance. How best could his care provider explain the concept to him?
"The chemical processes that take place throughout your body are thrown off very easily when your body is too acidic or not acidic enough.
The nurse teaches the client with end-stage kidney disease and hyperphosphatemia to take sevelamer HCl (Renagel), 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."
To calculate the H2CO3 content of the blood, the nurse needs to measure the Pco2 (partial pressure of CO2) by its solubility coefficient. What is the solubility coefficient of CO2?
0.03
A patient is admitted to the emergency department after being involved in an automobile accident with possible internal bleeding. What type of isotonic intravenous (IV) solution does the nurse prepare to infuse?
0.9% NaCl
During a period of extreme excess fluid volume, a renal dialysis patient may be administered which type of IV solution to shrink the swollen cells by pulling water out of the cell?
3% sodium chloride.
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
Which of the following is a condition that can cause decreased antidiuretic hormone (ADH) level or action?
Alcohol
Protein-dependent forces that promote fluid movement into the intravascular space are known as which of the following pressures?
Capillary osmotic
When explaining how carbon dioxide combines with water to form carbonic acid as part of acid-base lecture, the faculty instructor emphasized that which enzyme is needed as a catalysis for this reaction?
Carbonic anhydrase.
The nurse is providing teaching to a student nurse about how antidiuretic hormone (ADH) plays a central role in the reabsorption of water by the kidneys. The nursing student is correct to place the following components of the homeostatic action of ADH in the correct sequence. Use all the options.
D, B, E, A, C A) Stored ADH is released into circulation. B) ADH is transported along a neural pathway to the posterior pituitary gland. C) Aquaporins are inserted into tubular cell membranes. D) ADH is synthesized by cells in the supraoptic and paraventricular nuclei of the hypothalamus. E) Serum osmolality increases.
The nurse caring for the client with respiratory alkalosis and renal compensation determines which of these diagnostic findings is consistent with this disorder?
Decreased PCO2 and HCO3, and increased pH
A client has been diagnosed with metabolic acidosis. What assessment finding does the nurse expect?
Decreased pH below 7.35
The nurse is caring for a patient who receives hemodialysis. The nurse knows that hemodialysis involves movement of charged or uncharged particles along a concentration gradient. Which of the following best describe this process?
Diffusion
A patient staggers into the emergency department with his son who states that his father has not been well for a couple of weeks. The patient's heart rate is 120 and lung sounds reveal crackles and a respiratory rate of 30. The patient also complains of right flank pain. The son says that his mother has been acting strangely and thinks she might be poisoning her husband. Which of the following clinical manifestations indicate the type of poisoning involved?
Ethylene glycol (antifreeze)
A patient is brought to the emergency department with complaints of shortness of breath. Assessment reveals a full, bounding pulse, severe edema, and audible crackles in the lower lung fields bilaterally. What is the patient's most likely diagnosis?
Fluid volume excess
A 14-year-old boy, appearing to be intoxicated, is brought to the emergency room by ambulance. The EMTs report that the boy has denied consuming anything out of the ordinary, but an open antifreeze container was found in the boy's room.
Fomepizole
The nurse is aware that the major role of the kidneys is regulated acid-base balance is to increase the production of?
HCO3-
Which of the following volumes represents the greatest percentage of water in the extracellular compartment?
Interstitial
A nurse is providing care for a client who has been diagnosed with metabolic alkalosis after several days of antacid use. Which of the following treatments should the nurse prepare to give?
Intravenous administration of a KCl solution.
A client has an increase in her anion gap (AG). What does the nurse determine is the significance of this finding?
It indicates the client has metabolic acidosis.
The nurse is administering the medications to a patient on the cardiac unit. Giving which of the following medications causes the nurse to be alert for hypokalemia?
Loop Diuretics
When caring for a patient with diabetes insipidus (DI), the nurse plans to evaluate which of the following laboratory studies?
Measurement of antidiuretic hormone (ADH) and plasma/urine osmolality
A child accidentally consumes a container of wood alcohol. The ED physician knows that the child is at risk of developing which of the following?
Metabolic acidosis
The nurse is assessing a client for early manifestations of hyponatremia. The nurse would assess the client for:
Muscle weakness
Hypothalamic sensory neurons that promote thirst when stimulated are called which of the following?
Osmoreceptors
Which one of the following is associated with hydrostatic edema?
Pits to finger pressure
A patient with schizophrenia is admitted to the behavioral health department and is observed drinking copious amounts of water and voiding large amounts of dilute urine. The nurse recognizes this behavior is consistent with which of these problems?
Psychogenic polydipsia
The nurse is assessing blood gas results for a patient with diabetes and ketoacidosis and notes a pH level of 7.15. Which of the following dysrhythmias should the nurse closely monitor while treating this patient?
Ventricular tachycardia
The nurse has just received the lab results of a client's calcium level. The nurse identifies a normal calcium level as? a) 9.0 to 10.5 mg/dL b) 3.5 to 5.3 mg/dL c) 13.5 to 14.5 mg/dL d) 12.0 to 15.0 mg/dL
a) 9.0 to 10.5 mg/dL
A client is admitted to hospital with fluid volume deficit. The nurse should be aware that compensatory mechanisms will include:
activation of the renin--angiotensin--aldosterone system.
The nurse is assessing a client with fluid volume excess. The nurse anticipates the client would manifest? a) decreased blood pressure b) weak, rapid pulse c) increased BUN d) weight gain
d) weight gain
Which of the following best describes the concentration of solute in a particular volume of fluid based on electrolyte equivalency?
mEq/L
The nurse is reviewing the following lab results of a client diagnosed with renal failure: pH: 7.24 PCO2: 38 mm Hg HCO3: 18 mEq/L The nurse would interpret this as? a) metabolic alkalosis b) respiratory alkalosis c) metabolic acidosis d) respiratory acidosis
metabolic acidosis
The nurse is caring for a client with metabolic alkalosis. Which of these arterial blood gas results supports this diagnosis?
pH of 7.50 and HCO3 of 45 mEq/L
A 77 year-old female hospital patient has contracted Clostridium difficile during her stay, and is experiencing severe diarrhea. Which of the following statements best conveys a risk that this woman faces?
she is susceptible ti isotonic fluid volume deficit
The nurse is caring for a client who is experiencing an increased level of aldosterone secretion. The nurse anticipates that the client may develop:
sodium and water retention
A patient has been diagnosed with a brain tumor that cannot be removed surgically. During each office visit, the nurse will be assessing the patient for syndrome of inappropriate antidiuretic hormone (SIADH). Which of the following assessments would alert the clinic nurse that the patient may be developing this complication?
A) Complaints that his urine output is decreased, no edema noted in ankles, and increasing headache
The nurse is caring for a patient with ketoacidosis, who is complaining of increasing lethargy and occasional confusion following several weeks of rigid adherence to a carbohydrate-free diet. The nurse understands which of the following phenomena is most likely occurring?
In the absence of carbohydrate energy sources, her body is metabolizing fat and releasing ketoacids
The nurse is performing an assessment for a patient that 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 of these problems?
Isotonic fluid volume excess
A client has these arterial blood gas values: anion gap 20 mEq/L, pH 7.29, pCO2 37mm Hg, HCO3- 11 mEq/L, base excess -6 mEq/L. With what condition do these values correspond?
Lactic acidosis
The nurse is reviewing laboratory data for the client with an anion gap of 17. The nurse recognizes which of these conditions are associated with an increased anion gap mEq/L?
Lactic acidosis
Which conditions increase the risk for respiratory alkalosis? Select all that apply.
Last trimester of pregnancy Salicylate toxicity Anxiety
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
The nurse is caring for a client who has excessive diarrhea. Which of these acid base disturbances does the nurse anticipate uncovering during evaluation of the arterial blood gas?
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 a HCO3 level of 18 mEq/L. How does the nurse interpret these findings?
Metabolic acidosis
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.
The nurse is caring for a client who complains of headache and blurred vision. The nurse recognizes these symptoms, accompanied by increased plasma partial pressure carbon dioxide (PCO2) level and decreased pH level are consistent with which of these diagnoses?
Respiratory acidosis
The condition of a client with metabolic acidosis from an intestinal fistula is not improving. The pulse is 125 beats/min and the BP 84/56mm Hg. ABG values are: pH 7.1, HCO3- 18 mEq/L, PCO2 57mm Hg. What IV medication should the nurse expect to provide next?
Sodium bicarbonate
A nurse is caring for a patient with a low sodium level and increased water retention. Hematocrit and blood urea nitrogen levels are decreased, urine osmolality is low. A chest x-ray shows a possible lung mass. Based on these findings, which of the following problems could the patient be diagnose with ?
Syndrome of inappropriate antidiuretic hormone (ADH)
The nurse caring for a client with metabolic alkalosis examines arterial blood gas (ABG) results. Which change from the initial value indicates the client's metabolic alkalosis is improving?
HCO3- has decreased
The nurse is aware that the major role of the kidneys in regulating acid-base balance is to increase the production of:
HCO3−
The nurse on the cardiac unit has noted that the client's potassium level is 6.1 mEq/L. The nurse has notified the physician and removed the banana from the client's meal tray. When explaining the nursing actions to the client, which of these statements is appropriate?
"Your potassium level is high so I need you let me know if you feel numbness, tingling or weakness"
Which of the following individuals would be considered to be at risk for the development of edema? Select all that apply. A. A 22-year-old female with hypoalbuminemia secondary to malnutrition and anorexia nervosa B. A 77-year-old woman who has an active gastrointestinal bleed and consequent anemia C. An 81-year-old man with right-sided heart failure and hypothyroidism D. A 34-year-old industrial worker who has suffered extensive burns in a job-related accident E. A 60-year-old obese female with a diagnosis of poorly controlled diabetes mellitus
C. An 81-year-old man with right-sided heart failure and hypothyroidism D. A 34-year-old industrial worker who has suffered extensive burns in a job-related accident A. A 22-year-old female with hypoalbuminemia secondary to malnutrition and anorexia nervosa
Serum phosphorus level has a reciprocal relationship with which of the following serum electrolytes?
Calcium
A nurse is reviewing laboratory values for an elderly patient admitted for changes in mental status. The laboratory values are a urine-serum ratio of 4:1 and urine osmolality of 1100 mOsm/kg H2O. Based on these lab results, the nurse anticipates treatment for which of the following problems?
Dehydration
The nurse volunteering in the medical tent for a road race on a hot, humid day is asked to see a runner who has collapsed on the road. The nurse notes he has sunken eyes, a temperature of 100 degrees Fahrenheit, and dizziness. These are signs of a fluid volume deficit. Recognizing fluid volume deficit, which of these interventions does the nurse carry out first?
Give him an electrolyte solution by mouth.
A nurse observes peaked, narrow T waves on the electrocardiogram of a patient suffering from renal failure. The nurse suspects that the client is experiencing which of the following conditions?
Hyperkalemia
Respiratory alkalosis is caused by hyperventilation, which is recognized as a respiratory rate in excess of that which maintains normal plasma Pco2 levels. What is a common cause of respiratory alkalosis?
Hyperventilation
A nurse is caring for a patient with hypoparathyroidism. Which of the following is a major concern for the patient?
Hypocalcemia
The nurse is caring for a patient who is 1 day postoperative for a thyroidectomy. The patient 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 community health nurse who is attending a marathon recognizes which of the following types of hypotonic hyponatremia is likely when a patient reports muscle weakness, cramping, and general fatigue in spite of adequate water hydration during the run?
Hypovolemic
The nurse is caring for a client with a longstanding diagnosis of hypocalcemia secondary to kidney disease. For which of the following clinical manifestations does the observe in this patient?
Muscular spasms and complaints of tingling in hands/feet.
Water movement from the side of the membrane having a lesser number of particles and greater concentration of water to the side having a greater number of particles and lesser concentration of water is termed?
osmosis
A client with chronic obstructive pulmonary disease (COPD) receives oxygen in the emergency department at a rate of 4 L/min for acute respiratory distress. Later, the nurse finds the client unresponsive with a respiratory rate of 8/minute. What ABG values would the nurse expect to obtain?
pH 7.29, pCO2 67mm Hg, HCO3- 26 mEq/L, pO2 64mm Hg
The nurse caring for a client with respiratory alkalosis examines arterial blood gas (ABG) results. Which change from the initial value indicates the client's respiratory alkalosis is improving?
pH has decreased
The nurse caring for a client with metabolic acidosis examines arterial blood gas (ABG) results. Which change from the initial value indicates the client's metabolic acidosis is improving?
pH has increased
When caring for the client with a hyperkalemia, the nurse recognizes the body should respond in which of these ways?
secrete potassium in the distal tubules for excretion