Chapter 9: Acid-Base Balance, NCLEX Fluids and Electrolytes Chapter 9, fundamentals Chapter 42: Fluid, Electrolyte, and Acid-Base Balance, Fluid & Electrolytes

Chapter 9: Acid-Base Balance, NCLEX Fluids and

Electrolytes Chapter 9, fundamentals Chapter 42: Fluid,

Electrolyte, and Acid-Base Balance, Fluid & Electrolytes Leave the first rating Students also studied Terms in this set (113) Science MedicineNursing Save

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Ma The nurse is providing care for an adult patient who is admitted to the emergency department (ED) after passing out. The patient has been fasting and currently has ketones in the urine. Which acid-based imbalance should the nurse monitor the patient for based on the current data?1) Metabolic acidosis 2) Metabolic alkalosis 3) Respiratory acidosis 4) Respiratory alkalosis 1) Metabolic acidosis The patient who is fasting is at risk for metabolic acidosis. The body recognized fasting as starvation and begins to metabolize its own proteins into ketones, which are metabolic acid.The nurse is providing care to patient with the following

laboratory values: pH - 7.31; PaCO2 - 48 mmHg; and a

normal HCO3. Which condition should the nurse plan care for based on the current data?1) Metabolic acidosis 2) Metabolic alkalosis 3) Respiratory acidosis 4) Respiratory alkalosis 3) Respiratory acidosis If the pH is decreased and the PaCO2 is increased with a normal HCO3, it is uncompensated respiratory acidosis The nurse is reviewing the latest arterial blood gas results for a patient with metabolic alkalosis. Which result indicates that the metabolic alkalosis is compensated?1) pH 7.32 2) HCO3 8 mEq/L 3) PaCO2 48 mmHg 4) PaCO2 18 mmHg 3) PaCO2 48 mmHg To compensate for this imbalance, the rate and depth of respirations decrease, leading to retention of carbon dioxide. The PaCO2 will be elevated

Which diagnostic test should the nurse anticipate when providing care to a patient diagnosed with chronic obstructive pulmonary disease (COPD) to monitor acid- base balance?1) Pulse oximetry 2) Bronchoscopy 3) Sputum studies 4) Arterial blood gases 4) Arterial blood gases Arterial blood gas analysis is done to assess alterations in acid-base balance caused by respiratory disorders, metabolic disorders, or both.Which patient statement indicates the need for additional education regarding the use of sodium bicarbonate to treat acidosis?1) "I need to purchase antacids without salt." 2) "I should use the antacid for at least 2 months." 3) "I should contact the doctor if I have any gastric discomfort with chest pain." 4) "I should call the doctor if I get short of breath or start to sweat with this medication." 2) "I should use the antacid for at least 2 months." Bicarbonate antacid should not be used for longer than two weeks. This statement indicates the need for additional teaching.The patient is receiving sodium bicarbonate intravenously (IV) for correction of acidosis secondary to diabetic coma. The nurse assesses the patient to be lethargic, confused, and breathing rapidly. Which is the nurse's priority response to the current situation?1) Stop the infusion and notify the provider because the patient is in alkalosis.2) Increase the rate of the infusion and continue to assess the patient for symptoms of acidosis.3) Decrease the rate of the infusion and continue to assess the patient for symptoms of alkalosis.4) Continue the infusion, because the patient is still in acidosis, and notify the provider.4) Continue the infusion, because the patient is still in acidosis, and notify the provider.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 provider should be notified.The nurse is planning care for an older adult patient with respiratory acidosis. Which intervention should the nurse include in this patient's plan of care?1) Maintain adequate hydration.2) Reduce environmental stimuli.3) Administer intravenous sodium bicarbonate.4) Administer prescribed intravenous fluids carefully.1) Maintain adequate hydration.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.The results of a patient's arterial blood gas sample indicate an oxygen level of 72 mmHg. Which should the nurse closely assess when providing care to this patient?1) Perfusion 2) Cognition 3) Communication 4) Fluid and electrolytes 2) Cognition An oxygen level of less than 75 mmHg can be due to hypoventilation. This drop in oxygen will change the patient's level of responsiveness

The nurse is caring for a comatose patient with respiratory acidosis. For which intervention will the nurse need to collaborate when caring for this patient?1) Monitoring vital signs 2) Measuring intake and output 3) Determining recent eating behaviors 4) Identifying current oxygen saturation level 3) Determining recent eating behaviors For patients in severe distress, family members may need to be consulted for critical information such as recent eating habits and history of vomiting.The nurse is analyzing the patient's arterial blood gas report, which reveals a pH of 7.15. The patient has just suffered a cardiac arrest. Which consequences of this pH value does the nurse consider for this patient?1) Decreased cardiac output 2) Decreased potassium levels 3) Increased magnesium levels 4) Decreased free calcium in the ECF 1) Decreased cardiac output The nurse knows that severe acidosis depresses myocardial contractility, which leads to decreased cardiac output.The nurse is caring for a patient admitted with renal failure and metabolic acidosis. Which clinical manifestation would indicate to the nurse that planned interventions to relieve the metabolic acidosis have been effective?1) Tachypnea 2) Palpitations 3) Increased deep tendon reflexes 4) Decreased depth of respirations 4) Decreased depth of respirations The patient 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.A patient with metabolic acidosis has been admitted to the unit from the emergency department (ED). The patient is experiencing confusion and weakness. Which independent nursing intervention is the priority?1) Protecting the patient from injury 2) Placing the patient in a high-Fowler's position 3) Administering sodium bicarbonate to the patient 4) Providing the patient with appropriate skin care 1) Protecting the patient from injury The patient with metabolic acidosis may have symptoms of drowsiness, lethargy, confusion, and weakness. A priority of care would be preventing injury.The nurse is reviewing new orders provided by the health-care provider for a critical care patient with metabolic acidosis. Which prescription should the nurse question?1) Draw serum potassium levels every two hours.2) Draw arterial blood gas samples every two hours.3) Administer one ampule of sodium bicarbonate now.4) Begin intravenous infusion of 0.9% normal saline.3) Administer one ampule of sodium bicarbonate now.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.The nurse is providing care to a patient who has been vomiting for several days. The nurse knows that the patient is at risk for metabolic alkalosis because gastric secretions have which characteristic?1) Gastric secretions are acidic.2) Gastric secretions are alkaline.3) Gastric secretions have a foul smell.4) Gastric secretions are green in color.1) Gastric secretions are acidic.

Which is the priority nursing action when providing care to a patient who is admitted with metabolic alkalosis?1) Monitoring oxygen saturation 2) Setting goals for the plan of care 3) Administering prescribed medications 4) Teaching the family about risk factors 1) Monitoring oxygen saturation The priority for this patient is monitoring oxygen saturation. The depressed respiratory drive that often accompanies metabolic alkalosis can lead to hypoxemia and impaired oxygenation of the tissues.The nurse is providing care to a patient who is admitted after a morphine overdose. Which acid-base imbalance should the nurse plan this patient's care to reflect?1) Metabolic acidosis 2) Metabolic alkalosis 3) Respiratory acidosis 4) Respiratory alkalosis 3) Respiratory acidosis Morphine is a narcotic and generally acts to decrease or suppress respirations; therefore, this patient is probably hypoventilating. The expected acid-base imbalance would be respiratory acidosis.The nurse is providing care for a patient admitted to the unit with respiratory failure and respiratory acidosis.Which data from the nursing history is the probable cause for the patient's current diagnoses?1) Aspiration pneumonia 2) A recent trip to South America 3) Recent recovery from a cold virus 4) Use of ibuprofen for the control of pain 1) Aspiration pneumonia Aspiration of a foreign body and acute pneumonia would put the patient at risk for respiratory acidosis.Which chronic lung condition noted in the patient's health history supports the current diagnosis of respiratory acidosis?1) Aspiration 2) Pneumonia 3) Cystic fibrosis 4) Hyperthyroidism 3) Cystic fibrosis A patient is admitted to the emergency department for the treatment of a drug overdose causing acute respiratory acidosis. Which substance noted on the toxicology report is the most likely cause for the current diagnosis?

1) PCP

2) Cocaine 3) Marijuana 4) Oxycodone 4) Oxycodone Which clinical manifestation supports the nurse's plan of care focusing on chronic respiratory acidosis?1) Irritability 2) Blurred vision 3) Daytime sleepiness 4) Warm, flushed skin 3) Daytime sleepiness