Acid Base Balance, AKD and CKD NCLEX Questions

Acid Base Balance, AKD and CKD NCLEX Questions ScienceMedicineNursing sarah_newyear Save Acid Base Quiz 27 terms Emma_Jennings45 Preview Care Management Medsurg Evolve ...31 terms mackhallmarkPreview Med Surg Cardiovascular, Hematolo...44 terms kissableeePreview ENDOC 64 term Ash •A client develops respiratory alkalosis. When the nurse is reviewing the laboratory results, which finding is consistent with respiratory alkalosis?a.An elevated pH, elevated PCO2 b.A decreased pH, elevated PCO2 c.An elevated pH, decreased PCO2 d.A decreased pH, decreased PCO2 •C- An elevated pH, decreased PCO2 •In respiratory alkalosis the pH level is elevated because of loss of hydrogen ions; the PCO2 level is low because carbon dioxide is lost through hyperventilation. An elevated pH, elevated PCO2 is partially compensated metabolic alkalosis. A decreased pH, elevated PCO2 is respiratory acidosis. A decreased pH, decreased PCO2 is metabolic acidosis with some compensation.•A client is in a state of uncompensated acidosis. What approximate arterial blood pH does the nurse expect the client to have?a.7.20 b.7.35 c.7.45 7.48

•A- 7.20

•The pH of blood is maintained within the narrow range of 7.35 to 7.45. When there is an increase in hydrogen ions, the respiratory, buffer, and renal systems attempt to compensate to maintain the pH. If compensation is not successful, acidosis results and is reflected in a lower pH.

•The nurse is caring for a client with the following arterial blood gas (ABG) values: PO2 89 mm Hg, PCO2 35 mm Hg, and pH of 7.37. These findings indicate that the client is experiencing which condition?a.Acid-base balance b.Fluid balance c.Oxygen depletion d.Metabolic acidosis •A- Acid-base balance •All data are within expected limits; PO2 is 80 to 100 mm Hg, PCO2 is 35 to 45 mm Hg, and the pH is 7.35 to 7.45. None of the data are indicators of fluid balance, but of acid-base balance. Oxygen is within expected limits of 80 to 100 mm Hg. With metabolic acidosis the pH is less than 7.35.•A nurse is planning care for a school-aged child experiencing respiratory acidosis. What is the sequence of events that occurs in the child's respiratory response to acidosis? Place the physiologic responses in the order in which they occur.•Increased pH •Hyperventilation •Increased CO2 elimination •Decreased blood H+ ions

• Hyperventilation
• Increased CO2 elimination
• Decreased blood H+ ions
• Increased pH

•Respiratory compensation to acidosis involves hyperventilation with increased CO2 elimination. As carbon dioxide is blown off there is a decrease in the hydrogen ions in the blood, leading to an increase in pH to expected limits.•A client is admitted with metabolic acidosis. The nurse considers that two body systems interact with the bicarbonate buffer system to preserve healthy body fluid pH. What two body systems should the nurse assess for compensatory changes?a.Skeletal and nervous b.Circulatory and urinary c.Respiratory and urinary d.Muscular and endocrine •C- Respiratory and urinary •Increased respirations blow off carbon dioxide (CO2), which decreases the hydrogen ion concentration and the pH increases (less acidity).Decreased respirations result in CO2 buildup, which increases hydrogen ion concentration and the pH falls (more acidity). The kidneys either conserve or excrete bicarbonate and hydrogen ions, which helps to adjust the body's pH. The buffering capacity of the renal system is greater than that of the pulmonary system, but the pulmonary system is quicker to respond. Skeletal and nervous systems do not maintain the pH, nor do muscular and endocrine systems. Although the circulatory system carries fluids and electrolytes to the kidneys, it does not interact with the urinary system to regulate plasma pH.

•The nurse on a medical-surgical unit identifies that which patient has the highest risk for metabolic alkalosis?a.A patient with a traumatic brain injury b.A patient with type 1 diabetes mellitus c.A patient with acute respiratory failure d.A patient with nasogastric tube suction

•Answer: D

•The patient with NG tube is losing gastric acid and therefore is at risk for metabolic alkalosis.•What is a nursing priority to prevent complications in clients with respiratory acidosis?a.Assessing the nail beds b.Listening to breath sounds c.Monitoring breathing status d.Checking muscle contractions •C- Monitoring breathing status The nursing priority for preventing complications when caring for clients with respiratory acidosis is to monitor breathing status hourly and intervening changes. Assessing the nail beds for cyanosis, which is usually a late finding in acidosis, is not a priority intervention. Listening to breath sounds and assessing how easily air moves into and out of the lungs can be a second priority intervention. Checking muscle contractions in the neck region is a later priority intervention.A patient with an acid-base imbalance has an altered potassium level. The nurse recognizes that the potassium level is altered because a.Potassium is returned to extracellular fluid when metabolic acidosis is corrected.b.Hyperkalemia causes an alkalosis that results in potassium being shifted into the cells.c.Acidosis causes hydrogen ions in the blood to be exchanged for potassium from the cells.d.In alkalosis, potassium is shifted into extracellular fluid to bind excessive bicarbonate.

•Answer: C

•Rationale: Changes in pH (hydrogen ion concentration) will affect potassium balance. In acidosis, hydrogen ions accumulate in the intracellular fluid (ICF), and potassium shifts out of the cell to the extracellular fluid to maintain a balance of cations across the cell membrane. In alkalosis, ICF levels of hydrogen diminish, and potassium shifts into the cell. If a deficit of H+ occurs in the extracellular fluid, potassium will shift into the cell. Acidosis is associated with hyperkalemia, and alkalosis is associated with hypokalemia.

A patient has the following ABG results: pH 7.48, PaO2 86 mm Hg, PaCO2 44 mm Hg, HCO3 29 mEq/L. When assessing the patient, the nurse would expect the patient to have a.Muscle cramping b.Warm, flushed skin c.Respiratory rate of 36 d.Blood pressure of 94/52

•Answer: a

•Rationale: The patient is experiencing metabolic alkalosis (elevated pH and elevated HCO3). Clinical manifestations of metabolic alkalosis include hypertonic muscles and cramping and reduced respiratory rate. Hypotension and warm, flushed skin may occur with respiratory acidosis.•An arterial blood gas report indicates the client's pH is 7.25, PCO2 is 35 mm Hg, and HCO3 is 20 mEq/L. Which disturbance should the nurse identify based on these results?a.Metabolic acidosis b.Metabolic alkalosis c.Respiratory acidosis d.Respiratory alkalosis •A- Metabolic acidosis A low pH and low bicarbonate level are consistent with metabolic acidosis. The pH indicates acidosis, not alkalosis. The CO2 concentration is within normal limits, which is inconsistent with respiratory acidosis; it is elevated with respiratory acidosis •A nurse in the pediatric unit is reviewing the arterial blood gas values of a 4-year-old child recovering from severe dehydration. Which results most accurately reflect the child's recovery?a.pH 7.50, Po2 85 mm Hg,Pco2 35 mm Hg b.pH 7.25, Po2 60 mm Hg, Pco2 50 mm Hg c.pH 7.40, Po2 85 mm Hg, Pco2 40 mm Hg d.pH 7.45, Po2 70 mm Hg, Pco2 25 mm Hg •C- pH 7.40, Po2 85 mm Hg, Pco2 40 mm Hg •Expected arterial blood gas values are pH of 7.35 to 7.45, Po2 of 83 to 108 mm Hg, and Pco2 of 35 to 45 mm Hg; thus these gases are within normal limits. A pH of 7.5 indicates alkalosis. A pH of 7.25 indicates acidosis, a Po2 of 60 mm Hg indicates hypoxia, and a Pco2 of 50 mm Hg indicates hypercapnia. A Po2 of 70 mm Hg indicates hypoxia, and a Pco2 of 25 indicates hypocapnia.