ACID-BASE BALANCE

The nurse reviews the arterial blood gas results of a client and notes the following: pH 7.45, Paco2 of 30 mm Hg (30 mm Hg), and HCO3- of 20 mEq/L (20 mmol/L). The nurse analyzes these results as indicating which condition?

1. Metabolic acidosis, compensated

2. Respiratory alkalosis, compensated

3. Metabolic alkalosis, uncompensated

4. Respiratory acidosis, uncompensated

Respiratory alkalosis, compensated

The nurse is caring for a client with a nasogastric tube that is attached to low suction. The nurse monitors the client for manifestations of which disorder that the client is at risk for?

1. Metabolic acidosis

2. Metabolic alkalosis

3. Respiratory acidosis

4. Respiratory alkalosis

2. Metabolic alkalosis

A client with a 3-day history of nausea and vomiting presents to the emergency department. The client is hypoventilating and has a respiratory rate of 10 breaths/minute. The electrocardiogram (ECG) monitor displays tachycardia, with a heart rate of 120 beats/minute. Arterial blood gases are drawn and the nurse reviews the results, expecting to note which finding?

1. A decreased pH and an increased PaCO2

2. An increased pH and a decreased PaCO2

3. A decreased pH and a decreased HCO3-

4. An increased pH and an increased HCO3-

4. An increased pH and an increased HCO3-

The nurse is caring for a client having respiratory distress related to an anxiety attack. Recent arterial blood gas values are pH = 7.53, Pao2 = 72 mm Hg (72 mm Hg), Paco2 = 32 mmHg (32 mm Hg), and HCO3- = 28 mEq/L (28 mmol/L). Which conclusion about the client should the nurse make?

1. The client has acidotic blood.

2. The client is probably overreacting.

3. The client is fluid volume overloaded.

4. The client is probably hyperventilating.

4. The client is probably hyperventilating

The nurse is caring for a client with diabetic ketoacidosis and documents that the client is experiencing Kussmaul's respirations. Which patterns did the nurse observe? Select all that apply.

1. Respirations that are shallow

2. Respirations that are increased in rate

3. Respirations that are abnormally slow

4. Respirations that are abnormally deep

5. Respirations that cease for several seconds

3. Respirations that are increased in rate

4. Respirations that are abnormally deep

A client who is found unresponsive has arterial blood gases drawn and the results indicate the following: pH is 7.12, Paco2 is 90 mm Hg (90 mm Hg), and HCO3- is 22 mEq/L (22 mmol/L). The nurse interprets the results as indicating which condition?

1. Metabolic acidosis with compensation

2. Respiratory acidosis with compensation

3. Metabolic acidosis without compensation

4. Respiratory acidosis without compensation

4. Respiratory acidosis without compensation

The nurse notes that a client's arterial blood gas (ABG) results reveal a pH of 7.50 and a Paco2 of 30 mm Hg (30 mm Hg). The nurse monitors the client for which clinical manifestations associated with these ABG results? Select all that apply.

1. Nausea

2. Confusion

3. Bradypnea

4. Tachycardia

5. Hyperkalemia

6. Lightheadedness

1. Nausea

2. Confusion

4. Tachycardia

6. Lightheadedness

The nurse reviews the blood gas results of a client with atelectasis. The nurse analyzes the results and determines that the client is experiencing respiratory acidosis. Which result validates the nurse's findings?

1. pH 7.25, Paco2 50 mm Hg (50 mm Hg)

2. pH 7.35, Paco2 40 mm Hg (40 mm Hg)

3. pH 7.50, Paco2 52 mm Hg (52 mm Hg)

4. pH 7.52, Paco2 28 mm Hg (28 mm Hg)

1. pH 7.25, Paco2 50 mm Hg (50 mm Hg)

The nurse is caring for a client who is on a mechanical ventilator. Blood gas results indicate a pH of 7.50 and a Paco2 of 30 mm Hg (30 mm Hg). The nurse has determined that the client is experiencing respiratory alkalosis. Which laboratory value would most likely be noted in this condition

1. Sodium level of 145 mEq/L (145 mmol/L)

2. Potassium level of 3.0 mEq/L (3.0 mmol/L)

3. Magnesium level of 1.3 mEq/L (0.65 mmol/L)

4. Phosphorus level of 3.0 mg/dL (0.97 mmol/L)

2. Potassium level of 3.0 mEq/L (3.0 mmol/L)

The nurse is caring for a client with several broken ribs. The client is most likely to experience what type of acid-base imbalance?

1. Respiratory acidosis from inadequate ventilation

2. Respiratory alkalosis from anxiety and hyperventilation

3. Metabolic acidosis from calcium loss due to broken bones

4. Metabolic alkalosis from taking analgesics containing base products

1. Respiratory acidosis from inadequate ventilation

The nurse reviews the arterial blood gas results of an assigned client and notes that the laboratory report indicates a pH of 7.30, Paco2 of 58 mm Hg, Pao2 of 80 mm Hg, and Hco3 of 27 mEq/L (27 mmol/L). The nurse interprets that the client has which acid-base disturbance?

1. Metabolic acidosis

2. Metabolic alkalosis

3. Respiratory acidosis

4. Respiratory alkalosis

3. Respiratory acidosis

A client with a history of lung disease is at risk for developing respiratory acidosis. The nurse should assess the client for which signs and symptoms characteristic of this disorder?

1. Bradycardia and hyperactivity

2. Decreased respiratory rate and depth

3. Headache, restlessness, and confusion

4. Bradypnea, dizziness, and paresthesias

3. Headache, restlessness, and confusion

The nurse is reviewing the arterial blood gas analysis results for a client in the respiratory care unit who is receiving nasal oxygen and notes a pH of 7.38 (7.38), Paco2 of 38 mm Hg (38 mm Hg), Pao2 of 86 mm Hg (86 mm Hg), and HCO3 of 23 mEq/L (23 mmol/L). What action should the nurse take in response to these results?

1. Discontinue the oxygen.

2. Continue monitoring the client.

3. Call 911 to have the client intubated immediately.

4. Have another set drawn because these results are not possible.

2. Continue monitoring the client.

A client's blood gas results reveal acidosis. What are some signs and symptoms the nurse would expect to see? Select all that apply.

1. Seizures

2. Lethargy

3. Headache

4. Weakness

5. Confusion

6. Hyperactivity

2. Lethargy

3. Headache

4. Weakness

5. Confusion

The nurse is reviewing the arterial blood gas values of a client and notes that the pH is 7.31 (7.31), Paco2 is 50 mm Hg (50 mm Hg), and the bicarbonate (HCO3) level is 26 mEq/L (26 mmol/L). The nurse concludes that which acid-base disturbance is present in this client?

1. Metabolic acidosis

2. Metabolic alkalosis

3. Respiratory acidosis

4. Respiratory alkalosis

3. Respiratory acidosis

Arterial blood gas analysis yields the following results: pH 7.48 (7.48), Paco2 32 mm Hg (32 mm Hg), Pao2 94 mm Hg (94 mm Hg), HCO3 level 24 mEq/L (24 mmol/L) for a client seen in the health care clinic. The nurse interprets that the client has which acid-base disturbance?

1. Metabolic acidosis

2. Metabolic alkalosis

3. Respiratory acidosis

4. Respiratory alkalosis

4. Respiratory alkalosis

The nurse is caring for a client whose arterial blood gas results reveal alkalosis. What client reactions would the nurse expect to see? Select all that apply.

1. Tetany

2. Lethargy

3. Tingling

4. Confusion

5. Numbness

6. Restlessness

1. Tetany

3. Tingling

5. Numbness

6. Restlessness

An anxious preoperative client is at risk for developing respiratory alkalosis. The nurse should assess the client for which signs and symptoms characteristic of this disorder?

1. Headache and tachypnea

2. Hyperactivity and dyspnea

3. Muscle twitches and cyanosis

4. Lightheadedness and paresthesias

4. Lightheadedness and paresthesias

The nurse is performing a change-of-shift assessment on a client. The client had an arterial blood gas specimen drawn during an admission workup on the previous day and has a hematoma at the puncture site. What is the priority nursing intervention?

1. Perform the Allen's test.

2. Apply a warm compress.

3. Administer the antidote for heparin.

4. Notify the hospital laboratory supervisor.

2. Apply a warm compress.

A client has a prescription for a set of arterial blood gas (ABG) samples to be drawn on room air. The client currently is receiving oxygen by nasal cannula at a delivery rate of 3 L/min. After reading the prescription, the nurse should take which action?

1. Remove the nasal cannula for 15 minutes; then have the ABG samples drawn.

2. Change the nasal cannula to a shovel face mask; then have the ABG samples drawn.

3. Leave the nasal cannula in place for 15 minutes; then have the ABG samples drawn.

4. Change the nasal cannula to a Venturi face mask; then have the ABG samples drawn.

1. Remove the nasal cannula for 15 minutes; then have the ABG samples drawn.

The nurse is planning to obtain blood for arterial blood gas analysis from a client with chronic obstructive pulmonary disease. The nurse should plan time for which activity after the arterial blood specimen is drawn?

1. Holding a warm compress over the puncture site for 5 minutes

2. Encouraging the client to open and close the hand rapidly for 2 minutes

3. Applying pressure to the puncture site by applying a 2 × 2 gauze for 5 minutes

4. Having the client keep the radial pulse puncture site in a dependent position for 5 minutes

3. Applying pressure to the puncture site by applying a 2 × 2 gauze for 5 minutes

A client experiencing metabolic acidosis is to be admitted to the nursing unit. The nurse plans care knowing that what reaction is the most powerful regulator of acid-base balance?

1. Buffer

2. Kidney

3. Cations

4. Respiratory

2. Kidney

The nurse is caring for a client with metabolic alkalosis. The nurse plans care knowing that most problems of metabolic alkalosis are related to increased stimulation of what systems? Select all that apply.

1. Buffer

2. Cardiac

3. Nervous

4. Chemical

5. Respiratory

6. Neuromuscular

2. Cardiac

3. Nervous

6. Neuromuscular

The nurse is caring for a client who is retaining carbon dioxide (CO2) as a result of an obstructive respiratory disease. The nurse plans interventions knowing that as the client's CO2 level rises, what will occur with the blood pH?

1. Fall

2. Rise

3. Double

4. Remain unchanged

1. Fall

A client with diabetes mellitus has a blood glucose level of 644 mg/dL (35.7 mmol/L). The nurse plans care knowing that the client is at risk for the development of which type of acid-base imbalance?

1. Metabolic acidosis

2. Metabolic alkalosis

3. Respiratory acidosis

4. Respiratory alkalosis

1. Metabolic acidosis

A client is diagnosed with respiratory alkalosis induced by gram-negative sepsis. The nurse should plan to carry out which prescribed measure as the most effective means to treat the problem?

1. Administer prescribed antibiotics.

2. Have the client breathe into a paper bag.

3. Administer antipyretics as needed (on prn basis).

4. Request a prescription for a partial rebreather oxygen mask

1. Administer prescribed antibiotics.

The nurse is caring for a client with chronic kidney disease. Arterial blood gas results indicate a pH of 7.30 (7.30), a Paco2 of 32 mm Hg (32 mm Hg), and a bicarbonate concentration of 20 mEq/L (20 mmol/L). Which laboratory value should the nurse expect to note?

1. Sodium level of 145 mEq/L (145 mmol/L)

2. Potassium level of 5.2 mEq/L (5.2 mmol/L)

3. Phosphorus level of 3.0 mg/dL (0.97 mmol/L)

4. Magnesium level of 1.3 mg/dL (0.53 mmol/L)

2. Potassium level of 5.2 mEq/L (5.2 mmol/L)

The client tells the nurse that he ingests large amounts of oral antacids on a daily basis. The nurse plans care knowing that the excessive use of oral antacids containing bicarbonate can result in which acid-base disturbance?

1. Metabolic acidosis

2. Metabolic alkalosis

3. Respiratory acidosis

4. Respiratory alkalosis

2. Metabolic alkalosis

The nurse reviews the arterial blood gas results of an assigned client and notes that the laboratory report indicates a pH of 7.30 (7.30), a Paco2 of 58 mm Hg (58 mm Hg), a Pao2 of 80 mm Hg (80 mm Hg), and an HCO3 of 26 mEq/L (26 mmol/L). The nurse should interpret this to mean that the client has which acid-base disturbance?

1. Metabolic acidosis

2. Metabolic alkalosis

3. Respiratory acidosis

4. Respiratory alkalosis

3. Respiratory acidosis

The client with a history of lung disease is at risk for developing respiratory acidosis. The nurse asks this client about which symptoms that are characteristic of this disorder?

1. "Do you have shallow breathing?"

2. "Do you feel like you have a lot of energy?"

3. "Do you have a headache or become confused?"

4. "Do you feel dizzy or have tingling sensations?"

3. "Do you have a headache or become confused?"

The nurse is caring for a client with respiratory failure related to Guillain-Barré syndrome. The nurse plans care knowing that what other extrapulmonary causes can lead to respiratory failure? Select all that apply.

1. Stroke

2. Pneumonia

3. Sleep apnea

4. Myasthenia gravis

5. Obstructive lung disease

6. Opioid analgesics, sedatives, anesthetics

1. Stroke

3. Sleep apnea

4. Myasthenia gravis

6. Opioid analgesics, sedatives, anesthetics

A client is admitted to the hospital 24 hours following an aspirin (acetylsalicylic acid) overdose. The nurse assesses this client for which signs/symptoms indicating the acid-base disturbance that could occur in the client?

1. Bradypnea, dizziness, and paresthesias

2. Headache, nausea, vomiting, and diarrhea

3. Bradycardia, listlessness, and hyperactivity

4. Restlessness, confusion, and a positive Trousseau's sign

2. Headache, nausea, vomiting, and diarrhea

The nurse reviews a client's arterial blood gas values and notes a pH of 7.50 (7.50), a Paco2 of 30 mm Hg (30 mm Hg), and an HCO3 of 25 mEq/L (25 mmol/L). The nurse should interpret these values as an indication of which condition?

1. Metabolic acidosis, uncompensated

2. Respiratory acidosis, uncompensated

3. Respiratory alkalosis, uncompensated

4. Metabolic acidosis, partially compensated

3. Respiratory alkalosis, uncompensated

The nurse is preparing to obtain an arterial blood gas specimen from a client and plans to perform the Allen test on the client. The nurse would perform the steps in which order to conduct an Allen test? Arrange the actions in the order that they should be performed. All options must be used.

1. Explain the procedure to the client.

2 Apply pressure over the ulnar and radial arteries.

3 Ask the client to open and close the hand repeatedly.

4 Release pressure from the ulnar artery.

5 Assess the color of the extremity distal to the pressure point.

6 Document the findings

A client is about to have arterial blood gases drawn, and the nurse explains what an Allen's test is. What comment shows that the client understands the nurse's explanation?

1. "Blood is drawn from the ulnar artery."

2. "I know I have to lie down while blood is drawn."

3. "This test is done to ensure adequate collateral circulation."

4. "Direct pressure has to be placed over the site for 15 minutes after blood is drawn."

3. "This test is done to ensure adequate collateral circulation."

The nurse is caring for a client with diabetic ketoacidosis whose respirations are abnormally deep, regular, and increased in rate. What is the purpose of this type of respiration? Select all that apply.

1. Correct bradypnea

2. Blow off carbon dioxide

3. Correct metabolic acidosis

4. Correct an acid-base imbalance

5. Cause respiratory compensation

6. Stimulate Cheyne-Stokes respirations

2. Blow off carbon dioxide

3. Correct metabolic acidosis

4. Correct an acid-base imbalance

5. Cause respiratory compensation

The nurse reviews a client's arterial blood gas results and notes that the pH is 7.30 (7.30), the Paco2 is 52 mm Hg (50 mm Hg), and the HCO3 is 22 mEq/L (22 mmol/L). The nurse interprets these results as indicating which condition?

1. Metabolic acidosis, compensated

2. Respiratory alkalosis, compensated

3. Metabolic alkalosis, uncompensated

4. Respiratory acidosis, uncompensated

4. Respiratory acidosis, uncompensated

A client with diabetes mellitus is most likely to experience which type of acid-base imbalance as a complication of the disorder?

1. Metabolic acidosis

2. Metabolic alkalosis

3. Respiratory acidosis

4. Respiratory alkalosis

1. Metabolic acidosis

The nurse is admitting to the hospital a client with a diagnosis of Guillain-Barré syndrome. The nurse knows that if the disease is severe enough, the client will be at risk for which acid-base imbalance?

1. Metabolic acidosis

2. Metabolic alkalosis

3. Respiratory acidosis

4. Respiratory alkalosis

3. Respiratory acidosis

A client is determined by blood gas analysis to be in respiratory alkalosis. Which electrolyte disorder should the nurse monitor for that could accompany the acid-base imbalance?

1. Hypokalemia

2. Hypercalcemia

3. Hypochloremia

4. Hypernatremia

1. Hypokalemia

A client with a chronic airflow limitation is experiencing respiratory acidosis as a complication. The nurse who is trying to enhance the client's respiratory status should avoid which action?

1. Keeping the head of the bed elevated

2. Monitoring the flow rate of supplemental oxygen

3. Assisting the client to turn, cough, and breathe deeply

4. Encouraging the client to breathe slowly and shallowly

4. Encouraging the client to breathe slowly and shallowly

An anxious client is experiencing respiratory alkalosis from hyperventilation caused by anxiety. The nurse should take which action to help the client experiencing this acid-base disorder?

1. Put the client in a supine position.

2. Provide emotional support and reassurance.

3. Withhold all sedative or antianxiety medications.

4. Tell the client to breathe very deeply but more slowly.

2. Provide emotional support and reassurance

A client is being treated for metabolic acidosis with medication therapy and other measures. The nurse should plan to monitor the results of which electrolyte, which could dramatically decline with effective treatment of the acidosis?

1. Sodium

2. Potassium

3. Magnesium

4. Phosphorus

2. Potassium

The nurse is caring for a client who is experiencing metabolic alkalosis. Knowing the risks of this imbalance, the nurse plans to protect the client's safety by carefully implementing which prescribed precaution?

1. Contact isolation

2. Seizure precautions

3. Bleeding precautions

4. Neutropenic precautions

2. Seizure precautions

The nurse is caring for a client who overdosed on acetylsalicylic acid (aspirin) 24 hours ago. The nurse should expect to note which findings associated with an anticipated acid-base disturbance?

1. Disorientation and dyspnea

2. Drowsiness, headache, and tachypnea

3. Tachypnea, dizziness, and paresthesias

4. Decreased respiratory rate and depth, cardiac irregularities

2. Drowsiness, headache, and tachypnea

A client has been diagnosed with metabolic alkalosis as a result of excessive antacid use. The nurse monitoring this client should expect to note which signs/symptoms?

1. Disorientation and dyspnea

2. Decreased respiratory rate and depth

3. Drowsiness, headache, and tachypnea

4. Tachypnea, dizziness, and paresthesias

2. Decreased respiratory rate and depth

The nurse is providing care to a client with the following arterial blood gas results: pH of 7.50 (7.50), Pao2 of 90 mm Hg (90 mm Hg), Paco2 of 40 mm Hg (40 mm Hg), and bicarbonate of 35 mEq/L (35 mmol/L). When the nurse notifies the health care provider about these levels, the nurse should anticipate receiving from the HCP which prescription for this client?

1. Obtain a serum alcohol level.

2. Obtain a serum salicylate level.

3. Discontinue nasogastric suctioning.

4. Discontinue the client's fentanyl patch.

3. Discontinue nasogastric suctioning.

The nurse is caring for a client with hyperglycemia and diabetic ketoacidosis (DKA) who now has developed Kussmaul respirations. The nurse knows that the purpose of this type of breathing is to correct what imbalance?

1. Metabolic acidosis

2. Metabolic alkalosis

3. Respiratory acidosis

4. Respiratory alkalosis

1. Metabolic acidosis

A nurse is caring for a client admitted with confusion and lethargy. The client was found at home unresponsive with an empty bottle of aspirin lying next to her bed. Vital signs reveal blood pressure 104/72 mm Hg, heart rate 116/min with regular rhythm, and respiratory rate 42/min and deep. Which of the following arterial blood gas findings should the nurse expect?

A. pH 7.68, PaO2 96 mmHg, PaCO2 38 mmHg, HCO3 28 mEq/L

B. pH 7.48, PaO2 100 mmHg, PaCO2 28 mmHg, HCO3 23 mEq/L

C. pH 6.98, PaO2 100 mmHg, PaCO2 30mm Hg, НСО3 18 mEq/L

D. pH 7.58, PaO2 96 mmHg, PaCO2 38 mmHg, HСО3 29 mEq/L

C

Aspirin overdose would result in ABG findings of metabolic acidosis.

A nurse caring for a client who was in a motor vehicle accident. The client reports chest pain and difficulty breathing. A chest x ray reveals the client has a pneumothorax. Which of the following arterial blood gas findings should the nurse expect?

A. pH 7.06, PaO2 86 mmHg, PaCO2 55 mmHg, HCO3 24 mEq/L

B. pH 7.42, PaO2 100 mmHg, PaCO2 38 mmHg, HCO3 23 mEq/L

C. pH 6.98, PaO2 100 mmHg, PaCO2 30 mmHg, HCO3 18 mEq/L

D. pH 7.58, PaO2 96 mmHg, PaCO2 38 mmHg, HCO3 29 mEq/L

A

A pneumothorax can cause alveolar hyperventilation and increased carbon dioxide levels, resulting in respiratory acidosis.

A nurse is obtaining arterial blood gases for a client who has vomited for 24 hr. The nurse should expect which of the following acid-base imbalances to result from vomiting for 24 hr?

A. Respiratory acidosis

B. Respiratory alkalosis

C. Metabolic acidosis

D. Metabolic alkalosis

D

Excessive vomiting causes a loss of gastric acids and an accumulation of bicarbonate in the blood, resulting in metabolic alkalosis.

A charge nurse is teaching a group of nurses about conditions related to metabolic acidosis.Which of the following statements by a unit nurse indicates the teaching has been effective?

A. "Metabolic acidosis can occur due to diabetic ketoacidosis."

B. "Metabolic acidosis can occur in a client who has myasthenia gravis."

C. "Metabolic acidosis can occur in a client who has asthma."

D. "Metabolic acidosis can occur due to cancer."

A

Metabolic acidosis results from an excess production of hydrogen ions, which occurs in diabetic ketoacidosis

*REMEMBER metabolic ACIDOSIS = diabetic ketoACIDOSIS

A nurse is assessing a client who has pancreatitis. The client's arterial blood gases reveal metabolic acidosis.Which of the following are expected findings? (Select all that apply.)

A. Tachycardia

B. Hypertension

C. Bounding pulses

D. Hyperreflexia

E. Dysrhythmia

F. Tachypnea

E, F

Dysrhythmias and tachypnea are expected findings in a client who has pancreatitis and metabolic acidosis.

Rationale:

A. Tachycardia is found in respiratory acidosis or metabolic alkalosis

B. Hypertension is found in respiratory acidosis

C. Bounding pulses are found in respiratory acidosis

D. Hyperreflexia is found in metabolic alkalosis

Practice Scenario:

A nurse is caring for a client who has liver cancer. The clients ABGs reveal metabolic acidosis.

What nursing actions should the nurse include in the plan of care?

-If DKA, administer insulin

-If GI loss, administer antidiarrheals and provide rehydration

-If sodium bicarbonate is low, administer sodium bicarbonate 1 mEq/kg

A nurse is reviewing ABG laboratory results of a client who is in respiratory distress. The results are pH 7.47, PaCO2 33 mmHg, HCO3 33 mmHg. The nurse should recognize that the client is experiencing which of the following acid-base imbalances?

A. Respiratory acidosis

B. Respiratory alkalosis

C. Metabolic acidosis

D. Metabolic alkalosis

B

A client who is experiencing respiratory alkalosis will have an increased pH and a decreased PaCO2. Possible causes of respiratory alkalosis include hyperventilation, fever, and respiratory infections.

The nurse reviews the ABG results of a client and notes the following:

pH 7.45

PaCO2 30 mmHg

HCO3 20 mEq/L

The nurse analyzes these results as indicating which condition?

A. Metabolic acidosis, compensated

B. Respiratory alkalosis, compensated

C. Metabolic alkalosis, uncompensated

D. Respiratory acidosis, uncompensated

B

The pH is within normal limits, but mostly on the basic side. PaCO2 is acidic. In respiratory, pH and PaCO2 have an inverse relationship.

The nurse caring for a client with a nasogastric tube that is attached to a low suction. The nurse monitors the client for manifestations of which disorder that the client is at risk for?

A. Metabolic acidosis

B. Metabolic alkalosis

C. Respiratory acidosis

D. Respiratory alkalosis

B

Metabolic alkalosis is a deficit/loss of hydrogen ions or an excess of base. Nasogastric secretions are acidic. Removing that acidity will leave the client with base in the body.

A client who is found unresponsive has arterial blood gases drawn and the results indicate dthe following: pH is 7.12, PaCO2 is 90, and HCO3- is 22. the nurse interprets the results as indicating which condition?

A. Metabolic Acidosis with compensation

B. Respiratory Acidosis with compensation

C. Metabolic Acidosis without compensation

D. Respiratory Acidosis without compensation

D

pH is not within normal limits = not compensating. pH 7.12 is acidic. PaCO2 90 is basic. In respiratory, pH and PaCO2 have an inverse relationship.

1) A client is brought to the Emergency Department after passing out in a local department store. The client has been fasting and has ketones in the urine. Which acid-base imbalance would the nurse expect to assess in this client?

A) Metabolic acidosis

B) Respiratory alkalosis

C) Metabolic alkalosis

D) Respiratory acidosis

Answer: A

Explanation: A) A client who is fasting is at risk for development of metabolic acidosis. The body recognizes fasting as starvation and begins to metabolize its own proteins into ketones, which are metabolic acids. Starvation would not result in respiratory acidosis or alkalosis or in metabolic alkalosis.

2) Which of the following risk factors exhibited by the client presenting in the Emergency Department would place the client at risk for metabolic acidosis?

Select all that apply.

A) Abdominal fistulas

B) Chronic obstructive pulmonary disease

C) Pneumonia

D) Acute renal failure

E) Hypovolemic shock

Answer: A, D, E

Explanation: A, D, E) Metabolic acidosis is rarely a primary disorder. It usually develops during the course of another disease; presence of abdominal fistulas; which can cause excess bicarbonate loss; and acute renal failure. Chronic obstructive pulmonary disease and pneumonia place the client at risk for respiratory acidosis with the increased retention of carbon dioxide in the blood.

3) A child with acute asthma has a PaCO2 of 48 mmHg, a pH of 7.31, and a normal HCO3 blood gas value. The nurse interprets this as which of the following?

A) Metabolic acidosis

B) Respiratory alkalosis

C) Respiratory acidosis

D) Metabolic alkalosis

Answer: C

Explanation: C) If the pH is decreased and the PaCO2 is increased with a normal HCO3, it is uncompensated respiratory acidosis. In addition, croup can be a disease process that causes respiratory acidosis. Uncompensated respiratory alkalosis has an increased pH, decreased PaCO2, and normal HCO3. Uncompensated metabolic acidosis has a decreased pH, normal PaCO2, and normal HCO3. Uncompensated metabolic alkalosis has an increased pH, normal PaCO2, and increased HCO3.

4) The nurse is reviewing the latest arterial blood gas results for a client with metabolic alkalosis. Which result indicates that the metabolic alkalosis is compensated?

A) pH 7.32

B) PaCO2 18 mmHg

C) HCO3 8 mEq/L

D) PaCO2 48 mmHg

Answer: D

D) A normal pH level is 7.35-7.45. A pH of less than 7.35 is acidosis. A PaCO2 level of 18 mmHg is low and is seen in respiratory alkalosis. A HCO3 level of 8 mEq/L is low and is most likely associated with metabolic acidosis. In metabolic alkalosis, there is an excess of bicarbonate. To compensate for this imbalance, the rate and depth of respirations decrease, leading to retention of carbon dioxide. The PaCO2 will be elevated.

5) A client has been admitted with chronic obstructive pulmonary disease. Diagnostic tests have been ordered. Which of the tests will provide the most accurate indicator of the client's acid-base balance?

A) Arterial blood gases (ABGs)

B) Pulse oximetry

C) Sputum studies

D) Bronchoscopy

Answer: A

Explanation: A) ABGs are done to assess alterations in acid-base balance caused by respiratory disorders, metabolic disorders, or both. A bronchoscopy provides visualization of internal respiratory structures. Sputum studies can provide specific information about bacterial organisms. Pulse oximetry is a noninvasive test that evaluates the oxygen saturation level of blood.

6) The nurse is instructing a client with a history of acidosis on the use of sodium bicarbonate. Which client statement indicates that additional teaching is needed?

A) "I should contact the doctor if I have any gastric discomfort with chest pain."

B) "I need to purchase antacids without salt."

C) "I should use the antacid for at least 2 months."

D) "I should call the doctor if I get short of breath or start to sweat with this medication."

Answer: C

C) The client should be instructed to immediately contact the primary healthcare provider if gastric discomfort occurs with chest pain or if dyspnea or diaphoresis occurs. The client should be instructed to use non-sodium antacids to prevent the absorption of excess sodium or bicarbonate into systemic circulation and to not use any bicarbonate antacid for longer than 2 weeks.

7) A client who was diagnosed with diabetes mellitus 1 year ago is hospitalized in diabetic ketoacidosis after a religious fast. The client tells the nurse, "I have fasted during this season every year since I became an adult. I am not going to stop now." The nurse is not knowledgeable about this particular religion. Which nursing action would be appropriate?

Select all that apply.

A) Request a consult from a diabetes educator.

B) Tell the client that things are different now because of the diabetes.

C) Ask family members of the same religion to discuss fasting with the client.

D) Assess the meaning and context of fasting in the client's religion.

E) Encourage the client to seek medical care if signs of ketoacidosis occur in the future.

Answer: A, D, E

Explanation: A,D,E) The diabetes educator should be contacted to work with the client on strategies that might allow the fasting to occur in a safe manner. Assessing the meaning and context of fasting in the client's religion would be educative for the nurse and an appropriate action. Stressing the importance of promptly seeking care when signs of ketoacidosis occur helps to promote the client's health and is appropriate. Telling the client that life is different now does not support religious beliefs. Asking the family to talk to the client might help, but the diabetes educator would be able to provide more direct and helpful information for the client.

8) The client is receiving sodium bicarbonate intravenously (IV) for correction of acidosis secondary to diabetic coma. The nurse assesses the client to be lethargic, confused, and breathing rapidly. What is the nurse's priority response to the situation?

A) Stop the infusion and notify the physician because the client is in alkalosis.

B) Decrease the rate of the infusion and continue to assess the client for symptoms of alkalosis.

C) Continue the infusion, because the client is still in acidosis, and notify the physician.

D) Increase the rate of the infusion and continue to assess the client for symptoms of acidosis.

Answer: C

Explanation: C) The client receiving sodium bicarbonate is prone to alkalosis; monitor for cyanosis, slow respirations, and irregular pulse. The client's symptoms do not indicate alkalosis so infusion should not be stopped. The client continues to exhibit signs of acidosis; symptoms of acidosis include lethargy, confusion, CNS depression leading to coma, and a deep, rapid respiration rate that indicates an attempt by the lungs to rid the body of excess acid, and the physician should be notified. The infusion should not be increased or decreased without a practitioner order.

9) The nurse is preparing to analyze a client's arterial blood gas results. List the steps in the order that the nurse should follow when analyzing this laboratory test.

1. Look at the PaCO2.

2. Look at the pH.

3. Evaluate the relationship between pH and PaCO2.

4. Look for compensation.

5. Evaluate the pH, HCO3, and base excess for a possible metabolic problem.

6. Look at the bicarbonate.

7. Evaluate oxygenation.

Answer: 2, 1, 3, 6, 5, 4, 7

1. The pH is the first step and is analyzed to determine if acidosis or alkalosis is present. A pH of less than 7.35 is acidosis. A pH greater than 7.45 is alkalosis.

2. If the PaCO2 is less than 35, then more carbon dioxide is being exhaled. If the PaCO2 is greater than 45, then more carbon dioxide is being retained.

3. This relationship could indicate a respiratory problem. If the pH is acidotic and the carbon dioxide level is greater than 45, then the client could be experiencing respiratory acidosis. If the pH is alkalotic and the carbon dioxide level is below 35, then the client could be experiencing respiratory alkalosis.

4. If the bicarbonate level is less than 24, then the levels are lower than normal. If the bicarbonate level is greater than 28, then the bicarbonate levels are higher than normal.

5. If the pH is < 7.35, the HCO3 is < 24 mEq/L, and the BE is < −2 mEq/L, then low bicarbonate levels and high H + concentrations are causing metabolic acidosis. If the pH is > 7.45, the HCO3 is > 28 mEq/L, and the BE is > +2 mEq/L, then high bicarbonate levels are causing metabolic alkalosis.

6. Two things can occur in renal compensation. In respiratory acidosis, the kidneys retain HCO3 to buffer the excess acid, so the HCO3 is > 28 mEq/L. In respiratory alkalosis, the kidneys excrete HCO3 to minimize the alkalosis, so the HCO3 is < 24 mEq/L. Two things can also occur in respiratory compensation. In metabolic acidosis the rate and depth of respirations increase, increasing carbon dioxide elimination, so the PaCO2 is < 35 mmHg. In metabolic alkalosis respirations slow and carbon dioxide is retained, so the PaCO2 is > 45 mmHg.

7. If the PaO2 is less than 75 mmHg, then the client is experiencing hypoxemia and possible hypoventilation. If the PaO2 is greater than 100 mmHg, then the clie

10) The nurse is identifying a diagram to use to explain a client's acid-base balance. Which imbalance does the following diagram suggest is occurring with the client?

A) Metabolic acidosis

B) Metabolic alkalosis

C) Respiratory acidosis

D) Respiratory alkalosis

Answer: A

Explanation: A) In metabolic acidosis, the amount of bicarbonate decreases in relation to the amount of acid in the body. In metabolic alkalosis, there is an excess of bicarbonate in relation to the amount of hydrogen ions. Respiratory acidosis occurs when carbon dioxide is retained, increasing the amount of carbonic acid in the body. Respiratory alkalosis can occur when too much carbon dioxide is lost and carbonic acid levels fall.

11) The nurse is planning care for an older client with respiratory acidosis. Which intervention should the nurse include in this client's plan of care?

A) Administer prescribed intravenous fluids carefully.

B) Administer intravenous sodium bicarbonate.

C) Maintain adequate hydration.

D) Reduce environmental stimuli.

Answer: C

Explanation: C) In respiratory acidosis, there are a drop in the blood pH, reduced level of oxygen, and retaining of carbon dioxide. The body needs to be well-hydrated so that pulmonary secretions can be removed to improve oxygenation. Careful administration of intravenous fluids is important in the older client with metabolic alkalosis because older clients are at risk because of their fragile fluid and electrolyte status. Sodium bicarbonate is indicated in the treatment of metabolic acidosis. Reducing environmental stimuli would be appropriate for the client with respiratory alkalosis.

12) The results of a client's arterial blood gas sample reveal an oxygen level of 72 mmHg. For which associated health problem should the nurse assess this client?

A) Communication

B) Perfusion

C) Fluid and electrolyte imbalance

D) Cognition

Answer: D

Explanation: D) An oxygen level of less than 75 mmHg can be due to hypoventilation. This drop in oxygen will change the client's level of responsiveness. Although acid-base imbalances can alter communication, there is no direct link between a low oxygen level and changes in communication. Perfusion is affected by a reduction in circulating fluids. With a fluid and electrolyte imbalance, there is another disorder affecting acid-base balance. This might not be affected by oxygen level.

13) The nurse is caring for a comatose client with respiratory acidosis. For which intervention will the nurse need to collaborate when caring for this client?

A) Measuring vital signs

B) Measuring intake and output

C) The client's recent eating behaviors

D) Identifying current oxygen saturation level

Answer: C

Explanation: C) For clients in severe distress, family members may need to be consulted for critical information such as recent eating habits and history of vomiting. Measuring vital signs is an independent nursing action. Measuring intake and output is an independent nursing action. Identifying current oxygen saturation level is an independent nursing action.

1) The nurse is analyzing the client's arterial blood gas report, which reveals a pH of 6.58. The client has just suffered a cardiac arrest. Which of the following consequences does the nurse consider for this client?

A) Decreased cardiac output

B) Increase magnesium levels

C) Decreased free calcium in the ECT

D) Increased myocardial contractility

Answer: A

Explanation: A) The nurse knows that severe acidosis (pH of 7.0 or less) depresses myocardial contractility, which leads to decreased cardiac output. Acid-base imbalances also affect electrolyte balance. In acidosis, potassium is retained as the kidney excretes excess hydrogen ion. Excess hydrogen ions also enter the cells, displacing potassium from the intracellular space to maintain the balance of cations and anions within the cells. The effect of both processes is to increase serum potassium levels. Also in acidosis, calcium is released from its bonds with plasma proteins, increasing the amount of ionized (free) calcium in the blood. Magnesium levels may fall in acidosis.

2) The mother of a 1-month-old infant calls the nurse who works in the health clinic. The mother is concerned because the infant has had vomiting and diarrhea for 2 days. The nurse knows that this infant is at risk for metabolic acidosis. Which of the following is the priority nursing action?

A) Instruct the mother to provide the infant with 50 mL of glucose water.

B) Instruct the mother to measure the infant's urine output for 24 hours.

C) Instruct the mother to give the infant at least 2 ounces of juice every 2 hours.

D) Instruct the mother to bring the infant to the clinic for evaluation.

Answer: D

Explanation: D) Parents and caregivers need to be taught the seriousness of vomiting or diarrhea in infants due to rapid fluid loss that can occur in this age group. They should also be taught the importance of bringing an infant in this situation to healthcare providers for evaluation. Encouraging fluids for an infant who is actively vomiting will not improve fluid balance status, and neither juice nor glucose water is the best choice of fluid. Simply monitoring the loss over the next 24 hours would increase the potential for the infant to become dehydrated.

3) The nurse is assessing an African-American client whose cultural background is different from the cultural background of the nurse. The client has symptoms of metabolic acidosis. Which of the following situations would illustrate stereotypical behavior on the nurse's part?

Select all that apply.

A) Understanding that all culture members will have the same beliefs

B) Bringing previous negative information and experiences into this situation

C) Making an assumption that all members of each culture are alike

D) Taking general knowledge from literature and applying it to the situation

E) Discussing the client's health status with family members

Answer: A, B, C, D

Explanation: A,B,C,D) Options 1, 2, 3, and 4 describe stereotypical behavior, which is assuming that all members of a culture or ethnic group are alike. Option 2 describes prejudice. Prejudice is a negative belief or preference that is generalized about a group, which leads to "prejudgment." Prejudice occurs when the person making the judgment generalizes an experience of one individual from a culture to all members of that group. Discussing the client's health status with family members is not stereotypical behavior and would be considered a violation of the privacy laws if the client did not provide permission for disclosure of personal health information.

4) The nurse is caring for a client who has been admitted with persistent diarrhea lasting 3 days. Which of the following are appropriate nursing diagnoses for this client during the acute phase of the illness?

Select all that apply.

A) Decreased Cardiac Output

B) Ineffective Airway Clearance

C) Deficient Fluid Volume

D) Knowledge Deficit

E) Risk for Injury

Answer: A, E

Explanation: Metabolic acidosis affects cardiac output by decreasing contractility, slowing the heart rate, and increasing the risk for dysrhythmias. Appropriate nursing diagnoses during the acute phase of illness are Risk for Injury and Decreased Cardiac Output. The client may have a knowledge deficit but this is not an appropriate nursing diagnosis during the acute phase of the illness. The client with metabolic acidosis will be at risk for developing an Excessive Fluid Volume, not a Deficient Fluid Volume. The client with metabolic acidosis is not at risk for Ineffective Airway Clearance.

5) The nurse is caring for a client with metabolic acidosis. Which of the following are appropriate goals for this client?

Select all that apply.

A) The client will maintain a respiratory rate of 30 or more.

B) The client will describe preventative measure for the underlying chronic illness.

C) The client will maintain baseline cardiac rhythm.

D) pH will range from 7.25 to 7.35.

E) The client will take potassium supplements to increase potassium levels.

Answer: B, C

Explanation: Planning for the client with metabolic acidosis involves identification and treatment of the underlying cause and restoration and maintenance of acid-base balance. The client should be able to describe preventative measures for the underlying chronic illness that caused the metabolic acidosis to occur and maintain the baseline cardiac rhythm. The pH should be maintained between 7.35 and 7.45. The client's respiratory rate should be within normal range for age and condition. Taking a potassium supplement may cause hyperkalemia, which decreases cardiac output and worsens metabolic acidosis.

6) The nurse is caring for a client admitted with renal failure and metabolic acidosis. Which of the following signs would indicate to the nurse that planned interventions to relieve the metabolic acidosis have been effective?

A) Decreased respiratory depth

B) Palpitations

C) Increased deep tendon reflexes

D) Respiratory rate of 38

Answer: A

Explanation: The client with metabolic acidosis will have an increased respiratory rate and depth. Signs that care has been effective would include a decrease in the rate and depth of respirations. An increased respiratory rate, as indicated by a respiratory rate of 38, would indicate continued metabolic acidosis. Increased deep tendon reflexes and palpitations are not associated with metabolic acidosis.

7) The nurse is caring for the client experiencing hypovolemic shock and metabolic acidosis. Which of the following therapies would the nurse question if planned for this client?

Select all that apply.

A) Monitor weight on admission and discharge.

B) Monitor ECG for conduction problems.

C) Limit the intake of fluids.

D) Administer sodium bicarbonate.

E) Keep the bed in the locked and low position.

Answer: A, C

Explanation: The treatment for hypovolemic shock would include the administration of fluids, not limiting fluids. Patients being treated for hypovolemia will require daily weights, not a weight on admission and then discharge. Administering sodium bicarbonate and monitoring ECGs are appropriate for the client with shock. The client recovering from hypovolemic shock is at risk for injury, so the bed should be kept in the locked and low position.

8) A client with metabolic acidosis has been admitted to the unit from the Emergency Department. The client is experiencing confusion and weakness. Which of the following does the nurse implement as a priority of care for this client?

A) Place the client in a high-Fowler's position.

B) Protect the client from injury.

C) Administer sodium bicarbonate.

D) Give the client skin care.

Answer: B

Explanation: The client with metabolic acidosis may have symptoms of drowsiness, lethargy, confusion, and weakness. A priority of care would be preventing injury to the client. Medication administration is a physician order. Skin care would not be a priority on admission. The high-Fowler's position would not be the safest position for the confused client.

9) The nurse is preparing to instruct a client with type 1 diabetes mellitus on the mechanism behind the development of ketoacidosis. List the order in which the nurse should provide this information.

1. Production of lactate and hydrogen ions

2. Development of lactic acidosis

3. Breakdown of fatty tissue

4. Reduction in intracellular glucose

5. Fatty acids converted to ketones

Answer: 2, 1, 4, 3, 5

Explanation:

1. Lactic acidosis develops due to tissue hypoxia and a shift to anaerobic metabolism by the cells. Lactate and hydrogen ions are produced, forming lactic acid. Starvation or lack of insulin leads to intracellular starvation of glucose. The lack of glucose or insulin to move glucose into the cells causes the body to break down fatty tissue to meet metabolic needs. When fatty acids are broken down, these acids are converted to ketones, leading to the development of ketoacidosis.

10) The nurse is reviewing orders written by the healthcare provider for a client with metabolic acidosis. Which order should the nurse question before implementing it for the client?

A) Begin intravenous infusion of 0.9% normal saline.

B) Draw serum potassium levels every 2 hours.

C) Draw arterial blood gas samples every 2 hours.

D) Administer 1 ampule of sodium bicarbonate now.

Answer: D

Explanation: Administering bicarbonate to correct acidosis increases the risk for hypernatremia, hyperosmolality, and fluid volume excess. This is the order that the nurse should question before providing. Treatment of metabolic acidosis includes correction of fluid balance. An infusion of normal saline would be appropriate for this client. As metabolic acidosis is corrected, potassium shifts back into the intracellular space. This shift can lead to hypokalemia and cardiac dysrhythmias. Serum potassium levels should be carefully monitored during treatment. Arterial blood gases are used to evaluate treatment and guide additional therapies.

11) The nurse identifies the diagnosis Risk for Injury as appropriate for a client with metabolic acidosis. Which strategies should the nurse use to support this diagnosis?

Select all that apply.

A) Apply wrist restraints and secure to the bed frame.

B) Discuss chemical restraint use with the healthcare provider.

C) Keep the bed in the lowest position.

D) Keep bed side rails raised.

E) Place a clock and calendar at the bedside.

Answer: C, D, E

Explanation: A) To reduce the client's risk for injury, the nurse should make sure the bed is kept in the lowest position and the side rails are raised. A clock and calendar at the bedside will help with orientation. Restraints are used in the event the client demonstrates harm to self or others. Confusion or a Risk for Injury is not a reason to use wrist or chemical restraints.

12) Upon entering a room, the nurse quickly scans the environment and then immediately assesses the client for manifestations of metabolic acidosis. What observation did the nurse make that precipitated this assessment of the client?

A) Client sleeping with the head of the bed flat

B) Half of the client's lunch tray uneaten

C) One formed stool in the bedside commode

D) 1000 mL of intravenous 0.9% normal saline infused in 2 hours

Answer: D

Explanation: A) Excessive infusions of chloride-containing intravenous fluids can precipitate metabolic acidosis. The head of the bed's being flat might influence a client's oxygenation status; however, the client was not demonstrating a change in respiratory depth or rate. A reduction in oral intake does not cause metabolic acidosis. Eating half of a meal tray is not the same as starvation. Diarrhea can lead to the development of metabolic acidosis. One formed stool would not cause the nurse alarm.

13) During a home visit, the nurse evaluates care provided to a client with type 1 diabetes mellitus and a history of metabolic acidosis. Which outcome indicates that the care of this client has been successful?

A) The client is injecting insulin into thigh muscle.

B) The client is taking laxatives three times a week to ensure adequate bowel movements.

C) The client is eating three balanced meals per day with two snacks.

D) The client is taking aspirin 325 mg every 6 hours to treat arthritis pain.

Answer: C

Explanation: A) Adequate nutrition is necessary to prevent the buildup of acids in the blood. Incorrect administration of medication could cause a metabolic problem in the client with diabetes. The use of laxatives could cause diarrhea, which can lead to metabolic acidosis. Ingestion of high amounts of salicylate acid can lead to toxicity and the development of metabolic acidosis.

1) The client has been vomiting for several days. The nurse knows that the client is at risk for metabolic alkalosis because gastric secretions have which of the following characteristics?

A) Gastric secretions are green in color.

B) Gastric secretions are alkaline.

C) Gastric secretions are acidic.

D) Gastric secretions have a foul smell.

Answer: C

Explanation: A) Metabolic alkalosis due to loss of hydrogen ions usually occurs because of vomiting or gastric suction. Gastric secretions are highly acidic (pH 1-3). When these are lost through vomiting or gastric suction, the alkalinity of body fluids increases. This increased alkalinity results from the loss of acid and from selective retention of bicarbonate by the kidneys as chloride is depleted. Gastric secretions are now alkaline. The color and odor of gastric secretions have no influence on the development of metabolic acidosis.

2) The nurse is caring for a client who has been admitted to the hospital for congestive heart failure. Which data collected during the nursing assessment indicates that the client is at risk for metabolic alkalosis?

Select all that apply.

A) The client takes furosemide (Lasix) daily.

B) The client takes a baby aspirin once daily.

C) The client takes metformin daily.

D) The client frequently uses calcium carbonate (Tums®) for acid indigestion.

E) The client takes acetaminophen as needed for pain.

Answer: A, D

Explanation: A) Excessive use of calcium carbonate and daily use of furosemide can cause metabolic alkalosis. Use of metformin is not associated with alkalosis. Overuse of aspirin can be associated with metabolic acidosis. Occasional use of acetaminophen is not associated with metabolic alkalosis.

3) An Asian-American adolescent is hospitalized following several days of vomiting following food poisoning. The nurse is planning to include which points when teaching the client's family at discharge?

Select all that apply.

A) Immunizations for the adolescent

B) Nutritional patterns of the adolescent

C) Signs and symptoms of metabolic alkalosis

D) Proper food-handling techniques

E) Normal laboratory values of the adolescent

Answer: C, D

Explanation: A) The family of anyone experiencing prolonged vomiting should be taught the signs and symptoms of metabolic alkalosis. In this case, the nurse would include teaching about proper methods of food handling to prevent further episodes of food poisoning. Food patterns of the adolescent are not the precipitating factor of the food poisoning, and immunizations would not prevent this disease. Unless the family asks, it is not necessary to teach normal laboratory findings.

4) The nurse is planning care for the client who has been admitted with metabolic alkalosis. Which are appropriate nursing diagnoses for this client during the acute phase of the illness?

Select all that apply.

A) Ineffective Health Maintenance

B) Risk for Hypothermia

C) Deficient Fluid Volume

D) Risk for Impaired Gas Exchange

E) Risk for Injury

Answer: C, D, E

Explanation: A) Respiratory compensation for metabolic alkalosis includes depression of the respiratory rate and reduction of the depth of respirations, leading to the retention of carbon dioxide. Patients with metabolic alkalosis often have an accompanying fluid volume deficit. With the fluid volume deficit, the client would experience hyperthermia. Ineffective health maintenance would not be a priority during the acute phase of the disease but, rather, a teaching opportunity before discharge depending on the cause of the metabolic alkalosis. The client is at risk for injury because of the associated muscle spasms and dizziness.

5) The nurse is planning care for the client with Cushing's syndrome who has been admitted for complications related to the disease process. Which intervention should the nurse plan for this client to improve the impaired gas exchange?

A) Monitor serum electrolytes.

B) Schedule nursing activities to allow for periods of rest.

C) Assess input and output accurately.

D) Administer IV fluids per practitioner order.

Answer: B

Explanation: A) The client with Cushing's syndrome is at risk for developing severe metabolic alkalosis that causes hypoxemia and limits energy reserves. Spacing nursing activities throughout the day allows the client ample rest time. The other interventions are aimed at the deficient fluid volume that may occur with metabolic alkalosis.

6) The nurse is preparing to discharge a client with congestive heart failure on furosemide (Lasix). The nurse determines that teaching has been effective if the client makes which statement?

A) "I will use only sodium bicarbonate as my antacid."

B) "I will restrict my intake of fluids."

C) "I will use potassium supplements while I am taking Lasix."

D) "I will take antacids only for my gastric discomforts."

Answer: C

Explanation: A) The client on Lasix (furosemide) may lose excess potassium, disposing the client toward metabolic alkalosis. The client is taught to refrain from the use of sodium antacids when prone to metabolic alkalosis. The client should consult with the primary care provider for gastric distress rather than self-medicate. The client who is prone to metabolic alkalosis is likely to have fluid deficits and would not be instructed to restrict fluids.

7) A client with severe metabolic alkalosis has been admitted to the unit and is being cared for by a nursing student along with the nurse. What should the nurse say is a priority for this client?

A) Administering medication for metabolic alkalosis

B) Monitoring oxygen saturation

C) Teaching the client the risk factors for metabolic alkalosis

D) Setting goals for the client with metabolic alkalosis

Answer: B

Explanation: A) The priority for this client is monitoring oxygen saturation. The depressed respiratory drive that often accompanies metabolic alkalosis can lead to hypoxemia and impaired oxygenation of the tissues. Administering medications will be needed as a treatment, but the priority is to discover the cause. Teaching the client and setting goals are important aspects of nursing care but are not the priority.

8) A client with hyperaldosteronism has been admitted to the unit. The nurse knows the client is at risk for impaired gas exchange. Which position should this client be placed to enhance gas exchange?

A) Fowler's position

B) Prone position

C) Left side-lying position

D) Right Sims position

Answer: A

Explanation: A) The client with prolonged vomiting will likely have severe metabolic alkalosis with reduced oxygenation. The Fowler's position will facilitate alveolar ventilation with improved oxygenation. Side-lying and prone positions do not facilitate needed lung expansion.

9) While reviewing laboratory results, the nurse notes that a client's potassium level is 2.8 mEq/L and chloride level is 100 mEq/L. How should the nurse plan to support this client's acid-base balance?

A) Prepare to administer 0.9% sodium chloride infusion.

B) Measure for nasogastric tube insertion.

C) Discuss potassium chloride replace therapy with the healthcare provider.

D) Review implications of transfusing with ammonia chloride.

Answer: C

Explanation: A) Treatment of metabolic alkalosis includes restoring normal fluid volume and administering potassium chloride. The potassium restores serum and intracellular potassium levels, allowing the kidneys to conserve hydrogen ions more effectively. Since the chloride level is within normal limits, an infusion of 0.9% sodium chloride is not indicated. Removal of gastric secretions is one reason for the development of metabolic alkalosis. A nasogastric tube is not indicated for this client. There is not enough information to support the use of ammonia chloride for this client, as it is indicated to treat severe metabolic alkalosis.

10) The nurse identifies the diagnosis Risk for Impaired Gas Exchange to guide the care of a client with metabolic alkalosis. What did the nurse assess to support this diagnosis?

Select all that apply.

A) Respiratory rate 8 per minute

B) Oxygen saturation 89%

C) Urine output 25 mL/hr

D) Restlessness and agitation

E) Weight loss of 3 kg overnight

Answer: A, B, D

Explanation: A) Respiratory compensation for metabolic alkalosis depresses the respiratory rate and reduces the depth of breathing to promote carbon dioxide retention. The depressed respiratory drive associated with metabolic alkalosis can lead to hypoxemia and impaired oxygenation of tissues. Oxygen saturation levels of less than 90% indicate significant oxygenation problems. Changes in mental status or behavior may be early signs of hypoxia. Urine output less than 30 mL/hr would indicate Fluid Volume Deficit. Weight is used as an indicator of fluid balance. A rapid weight change would indicate Fluid Volume Deficit.

11) A client is admitted with manifestations of metabolic alkalosis. Which diagnostic test findings should the nurse suspect will confirm this diagnosis?

Select all that apply.

A) Serum glucose level 142 mg/dL

B) Blood pH 7.47 and bicarbonate 34 mEq/L

C) Intravenous pyelogram shows kidney stones

D) Bilateral lower lobe infiltrates noted on chest x-ray

E) Electrocardiogram changes consistent with hypokalemia

Answer: B, E

Explanation: A) In metabolic alkalosis, the blood pH will be greater than 7.45 and the bicarbonate level greater than 28 mEq/L. The ECG pattern shows changes similar to those seen with hypokalemia. Serum glucose level is not used to confirm the diagnosis of metabolic alkalosis. The presence of kidney stones is not associated with the development of metabolic alkalosis. The presence of bilateral lower lobe infiltrates on chest x-ray would not contribute to the development of metabolic alkalosis. This finding might be the result of metabolic alkalosis if the client's respiratory status is compromised.

12) During an assessment, the nurse becomes concerned that a client is at risk for developing metabolic alkalosis. What did the nurse assess that caused this concern?

A) Daily ingestion of a banana with breakfast

B) Daily weight consistent

C) Daily use of sodium bicarbonate for gastric upset

D) Daily use of prescribed NSAIDs for arthritic pain

Answer: C

Explanation: A) Excess bicarbonate usually occurs as a result of ingesting antacids that contain bicarbonate, such as soda bicarbonate or Alka-SeltzerTM. Daily ingestion of a banana would prevent the development of hypokalemia from the daily use of sodium bicarbonate. Consistent daily weights would indicate fluid balance. Daily use of NSAIDs would not support the development of metabolic alkalosis.

13) During a home visit, the nurse evaluates teaching provided to a client recently hospitalized for metabolic alkalosis. Which observation indicates that additional teaching is required?

A) Drinks 2 cups of black coffee each day.

B) Consumes one orange each day with breakfast.

C) Ingests bicarbonate of soda after each meal.

D) Monitors and tracks daily weights.

Answer: C

Explanation: A) The indiscriminate ingestion of sodium bicarbonate is a risk factor for the development of metabolic alkalosis. Black coffee is not associated with the development of metabolic alkalosis. Oranges contain potassium, which is beneficial to prevent the development of metabolic alkalosis. Tracking of daily weights would help detect a fluid imbalance, which is associated with metabolic alkalosis.

1) The nurse has admitted a client who was brought to the hospital after a morphine overdose. What acid-base imbalance does the nurse expect to observe in this client?

A) Respiratory alkalosis

B) Respiratory acidosis

C) Metabolic alkalosis

D) Metabolic acidosis

Answer: B

Explanation: A) Morphine is a narcotic and generally acts to decrease or suppress respirations; therefore, this client is probably hypoventilating. The expected acid-base imbalance would be respiratory acidosis. Respiratory alkalosis, metabolic acidosis, and metabolic alkalosis are caused by many conditions, none of which are related to this client's morphine overdose.

2) The nurse is caring for a client who has been admitted to the unit with respiratory failure and respiratory acidosis. What data from the nursing history would the nurse suspect contributed to the client's current state of health?

A) Use of ibuprofen for the control of pain

B) A recent trip to South America

C) Aspiration pneumonia

D) Recent recovery from a cold virus

Answer: C

Explanation: A) Aspiration of a foreign body and acute pneumonia would put the client at risk for respiratory acidosis. A recent trip to South America would not constitute a respiratory risk factor. Recent recovery from a cold would not likely put the client at risk. Ibuprofen does not pose a threat to the respiratory health of the client.

3) A 10-year-old boy has been admitted to the hospital with respiratory acidosis. The nurse suspects that which chronic lung disease most likely caused the child to develop this condition?

A) Cystic fibrosis

B) Aspiration

C) Hyperthyroidism

D) Pneumonia

Answer: A

Explanation: A) Chronic lung disease such as asthma and cystic fibrosis put the child at risk for respiratory acidosis. Pneumonia and aspiration are both acute lung conditions. Hyperthyroidism is a disorder that results in metabolic acidosis.