Quiz 1 Gas Exchange and Acid-Base

A client has meconium-stained amniotic fluid. Fetal scalp sampling indicates a blood pH of 7.12; fetal bradycardia is present. Based on these findings, the nurse should take which action? Prepare for cesarean birth. Reposition the client. Administer amnioinfusion. Start I.V. oxytocin infusion as ordered.

Prepare for cesarean birth.

Which condition is caused by improper catheter placement and inadvertent puncture of the pleura? sepsis pneumothorax fluid overload air embolism

pneumothorax

The nurse is assessing a client who has been in a car accident. The client reports sore ribs and painful breathing on the left side of the chest wall. A chest X-ray confirms fracture of two ribs and left-sided hemopneumothorax. What can the nurse anticipate? Oxygen will be initiated and a bronchoscopy will be performed to identify the area of damage. Aspirational thoracentesis will be performed to remove the accumulated bloody fluid. A chest tube will be inserted into the left pleural space and attached to a pleural evacuation device. Splinting of the affected ribs will be initiated and limitation of upper body activity recommended.

A chest tube will be inserted into the left pleural space and attached to a pleural evacuation device.

On auscultation, which findings suggests a right pneumothorax? Bilateral inspiratory and expiratory crackles Absence of breath sounds in the right thorax Inspiratory wheezes in the right thorax Bilateral pleural friction rub

Absence of breath sounds in the right thorax

The ICU nurse is caring for a client who was admitted with a diagnosis of smoke inhalation. The nurse knows that this client is at increased risk for which of the following? Bronchitis Tracheobronchitis Acute respiratory distress syndrome Lung cancer

Acute respiratory distress syndrome

The nurse is caring for a client following a wedge resection. While the nurse is assessing the client's chest tube drainage system, constant bubbling is noted in the water seal chamber. This finding indicates which problem? Increased drainage Air leak Tidaling Tension pneumothorax

Air leak

The emergency department (ED) nurse is caring for a client with a possible acid-base imbalance. The physician has ordered an arterial blood gas (ABG). What is one of the most important indications of an acid-base imbalance that is shown in an ABG? PaO2 Bicarbonate PO2 Carbonic acid

Bicarbonate

A client diagnosed with acute respiratory distress syndrome (ARDS) is restless and has a low oxygen saturation level. If the client's condition does not improve and the oxygen saturation level continues to decrease, what procedure will the nurse expect to assist with in order to help the client breathe more easily? Schedule the client for pulmonary surgery Increase oxygen administration Intubate the client and control breathing with mechanical ventilation Administer a large dose of furosemide (Lasix) IVP stat

Intubate the client and control breathing with mechanical ventilation

Which would the nurse most likely expect as treatment for a pneumothorax? Chest tube insertion Allergy exposure control Surfactant replacement Anti-infective therapy

Chest tube insertion

You are an ICU nurse who has just admitted a new client with an acid/base imbalance. What would you do to provide accurate baseline data for this client? Record intake and output Monitor lab values Document presenting signs and symptoms Implement medication ordered

Document presenting signs and symptoms

A nurse who works in a critical care setting is caring for an adult female patient who was diagnosed with acute respiratory distress syndrome (ARDS) and promptly placed on positive-end expiratory pressure (PEEP). When planning this patient's care, what nursing diagnosis should be prioritized? Risk for aspiration Anxiety Acute pain Impaired gas exchange

Impaired gas exchange

A client suffers acute respiratory distress syndrome as a consequence of shock. The client's condition deteriorates rapidly, and endotracheal (ET) intubation and mechanical ventilation are initiated. When the high-pressure alarm on the mechanical ventilator sounds, the nurse starts to check for the cause. Which condition triggers the high-pressure alarm? Kinking of the ventilator tubing A change in the oxygen concentration without resetting the oxygen level alarm An ET cuff leak A disconnected ventilator circuit

Kinking of the ventilator tubing

The nurse is caring for a client with multiple organ failure and in metabolic acidosis. Which pair of organs is responsible for regulatory processes and compensation? Kidney and liver Lungs and kidney Pancreas and stomach Heart and lungs

Lungs and kidney

A client has the following arterial blood gas (ABG) values: pH, 7.12; partial pressure of arterial carbon dioxide (PaCO2), 40 mm Hg; and bicarbonate (HCO3-), 15 mEq/L. These ABG values suggest which disorder? Metabolic acidosis Metabolic alkalosis Respiratory alkalosis Respiratory acidosis

Metabolic acidosis

A client has been diagnosed with an intestinal obstruction and has a nasogastric tube set to low continuous suction. Which acid-base disturbance is this client at risk for developing? Respiratory acidosis Respiratory alkalosis Metabolic acidosis Metabolic alkalosis

Metabolic alkalosis

The nurse on a surgical unit is caring for a client recovering from recent surgery with the placement of a nasogastric tube to low continuous suction Which acid-base imbalance is most likely to occur? Respiratory acidosis Respiratory alkalosis Metabolic alkalosis Metabolic acidosis

Metabolic alkalosis

A client suspected of developing acute respiratory distress syndrome (ARDS) is experiencing anxiety and agitation due to increasing hypoxemia and dyspnea. A nurse would implement which intervention to improve oxygenation and provide comfort for the client? Administer small doses of pancuronium Force fluids for the next 24 hours Position the client in the prone position Assist the client into a chair

Position the client in the prone position

Which would a nurse identify as being involved with acute respiratory distress syndrome? Progressive loss of lung compliance Permanent inflammation of the airways Collapse of the alveoli Hyperresponsiveness of the airways

Progressive loss of lung compliance

The nurse is assessing a client who, after an extensive surgical procedure, is at risk for developing acute respiratory distress syndrome (ARDS). The nurse assesses for which most common early sign of ARDS? Cyanosis Inspiratory crackles Rapid onset of severe dyspnea Bilateral wheezing

Rapid onset of severe dyspnea

The nurse is caring for a client with chronic obstructive pulmonary disease. The client reports that he is having difficulty breathing and is feeling fatigued. The nurse realizes that this client is at high risk for which condition? Respiratory alkalosis Metabolic alkalosis Metabolic acidosis Respiratory acidosis

Respiratory acidosis

A client with a chest tube in place has become increasingly short of breath throughout the shift and reports pain to the right chest wall. The nurse understands that the most likely cause is: an increase of blood in the pleural space. a bilateral pneumothorax. a tension pneumothorax. a decrease in pressure in the tube.

a tension pneumothorax.

A client admitted with multiple traumatic injuries receives massive fluid resuscitation. Later, the physician suspects that the client has aspirated stomach contents. The nurse knows to monitor closely for complications that include which of the following? bilateral wheezes bronchial asthma acute respiratory distress syndrome (ARDS) renal failure

acute respiratory distress syndrome (ARDS)

A client admitted with multiple traumatic injuries receives massive fluid resuscitation. Later, the physician suspects that the client has aspirated stomach contents. The nurse knows that this client is at highest risk for: renal failure. acute respiratory distress syndrome (ARDS). bronchial asthma. chronic obstructive pulmonary disease (COPD).

acute respiratory distress syndrome (ARDS).

Before weaning a client from a ventilator, which assessment parameter is the most important for the nurse to obtain? fluid intake for the past 24 hours electrocardiogram (ECG) results prior outcomes of weaning baseline arterial blood gas (ABG) levels

baseline arterial blood gas (ABG) levels

A client with emphysema is at a greater risk for developing which acid-base imbalance? metabolic alkalosis respiratory alkalosis chronic respiratory acidosis metabolic acidosis

chronic respiratory acidosis

A client is admitted to the emergency department with crushing chest injuries sustained in a car accident. Which sign indicates a possible pneumothorax? Cheyne-Stokes respirations increased fremitus decreased sensation on the affected side diminished or absent breath sounds on the affected side

diminished or absent breath sounds on the affected side

The nurse is admitting a client with newly diagnosed diabetes mellitus and left-sided heart failure. Assessment reveals low blood pressure, increased respiratory rate and depth, drowsiness, and confusion. The client reports headache and nausea. Based on the serum laboratory results, how would the nurse interpret the client's acid-base balance? metabolic acidosis respiratory alkalosis respiratory acidosis metabolic alkalosis ph 7.34 Paco2 35 Hco3 19

metabolic acidosis

A client who complains of an "acid stomach" has been taking baking soda (sodium bicarbonate) regularly as a self-treatment. This may place the client at risk for which acid-base imbalance? respiratory acidosis metabolic acidosis metabolic alkalosis respiratory alkalosis

metabolic alkalosis

Assessment of a child reveals a tension pneumothorax. The nurse would prepare the child for: intubation. suctioning. needle thoracotomy. defibrillation.

needle thoracotomy.

The nurse is caring for a 3-year-old client being treated for severe status asthmaticus. After comparing clinical manifestations with laboratory results (reported below), a nurse determines evidence that this client has progressed to which condition? respiratory acidosis respiratory alkalosis metabolic alkalosis metabolic acidosis Ph 7.28 Paco2 55 Hco3 26

respiratory acidosis

A client comes to the emergency department with status asthmaticus. The client's respiratory rate is 48 breaths/minute, and the client is wheezing. An arterial blood gas analysis reveals a pH of 7.52, a partial pressure of arterial carbon dioxide (PaCO2) of 30 mm Hg, PaO2 of 70 mm Hg, and bicarbonate (HCO3--) of 26 mEq/L. What disorder is indicated by these findings? respiratory alkalosis respiratory acidosis metabolic acidosis metabolic alkalosis

respiratory alkalosis

A client admitted with acute anxiety has the following arterial blood gas (ABG) values: pH, 7.55; partial pressure of arterial oxygen (PaO2), 90 mm Hg; partial pressure of arterial carbon dioxide (PaCO2), 27 mm Hg; and bicarbonate (HCO3-), 24 mEq/L. Based on these values, the nurse suspects: metabolic alkalosis. respiratory alkalosis. respiratory acidosis. metabolic acidosis.

respiratory alkalosis.

A nurse is caring for a client after an open lung biopsy. Which assessment finding requires immediate intervention? oral temperature 38.1°C (100.5°F) client's pain level remains 4 out of 10 after pain medication oxygen saturation level of 96% on 3 L of oxygen respiratory rate of 44 breaths/minute

respiratory rate of 44 breaths/minute

Which client requires frequent monitoring for symptomology associated with acute respiratory distress syndrome (ARDS)? A premature neonate An older adult diagnosed with chronic obstructive pulmonary disease (COPD) An adult with 3rd degree burns over 20% of the body A teenager diagnosed with cystic fibrosis

An adult with 3rd degree burns over 20% of the body

A client has a sucking stab wound to the chest. Which action should the nurse take first? Prepare to start an I.V. line. Prepare a chest tube insertion tray. Apply a dressing over the wound and tape it on three sides. Draw blood for a hematocrit and hemoglobin level.

Apply a dressing over the wound and tape it on three sides.

A client with a suspected overdose of an unknown drug is admitted to the emergency department. Arterial blood gas values indicate respiratory acidosis. What should the nurse do first? Prepare to assist with ventilation. Obtain a urine specimen for drug screening. Monitor the client's heart rhythm. Prepare for gastric lavage.

Prepare to assist with ventilation.

A client in the emergency department reports that they have been vomiting excessively for the past 2 days. The client's arterial blood gas analysis shows a pH of 7.50, partial pressure of arterial carbon dioxide (PaCO2) of 43 mm Hg, partial pressure of arterial oxygen (PaO2) of 75 mm Hg, and bicarbonate (HCO3-) of 42 mEq/L. Based on these findings, the nurse documents that the client is experiencing which type of acid-base imbalance? metabolic acidosis respiratory acidosis metabolic alkalosis respiratory alkalosis respiratory alkalosis

metabolic alkalosis

An adolescent is admitted for treatment of bulimia nervosa. When developing the care plan, the nurse anticipates including interventions that address which metabolic disorder? metabolic alkalosis hyperkalemia hypoglycemia metabolic acidosis

metabolic alkalosis

A client is admitted to the psychiatric clinic for treatment of anorexia nervosa. At the beginning of the client's hospitalization, the most important nursing action is to: severely restrict the client's physical activities. instruct the client to keep an accurate record of food and fluid intake. monitor the client's vital signs, serum electrolyte levels, and acid-base balance. weigh the client daily, after the evening meal.

monitor the client's vital signs, serum electrolyte levels, and acid-base balance.

A client with Guillain-Barré syndrome develops respiratory acidosis as a result of reduced alveolar ventilation. Which combination of arterial blood gas (ABG) values confirms respiratory acidosis? pH, 7.29; PaCO2 30 mm Hg pH, 7.5; PaCO2 30 mm Hg pH, 7.25; PaCO2 50 mm Hg pH, 7.35; PaCO2 70 mm Hg

pH, 7.25; PaCO2 50 mm Hg