Nclex style questions acid base

Nclex style questions acid base 5.0 (2 reviews) Students also studied Terms in this set (57) Science MedicineNursing Save Acid-Base balance 54 terms arielleflu92Preview Mechanical Ventilation NCLEX quest...20 terms haannahsonPreview

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18 terms maddibui3Preview NCLEX 48 terms Xiu The nurse is caring for a hospitalized client who is retaining carbon dioxide (CO2) because of respiratory disease. The nurse anticipates which physical response will initially occur?

1.The client will lose consciousness. 2.The client's sodium and chloride levels will rise. 3.The client will complain of facial numbness and tingling. 4.The client's arterial blood gas results will reflect acidosis.

4.The client's arterial blood gas results will reflect acidosis.Rationale: When the client with respiratory disease retains CO2, a rise in CO2 will occur. This results in a corresponding fall in pH, thus respiratory acidosis. This concept forms the basis for key aspects of acid-base balance. The other options are incorrect and are not associated with this initial physical response.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 Rationale: Metabolic alkalosis is defined as a deficit or loss of hydrogen ions or acids or an excess of base (bicarbonate) that results from the accumulation of base or from a loss of acid without a comparable loss of base in the body fluids.This occurs in conditions resulting in hypovolemia, the loss of gastric fluid, excessive bicarbonate intake, the massive transfusion of whole blood, and hyperaldosteronism. Loss of gastric fluid via nasogastric suction or vomiting causes metabolic alkalosis as a result of the loss of hydrochloric acid. The remaining options are incorrect interpretations.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

Rationale: In respiratory acidosis, the pH is decreased and the Paco2 level is

increased. Options 1, 2, and 4 are incorrect. In respiratory alkalosis, the pH is elevated with a decrease in Paco2. In metabolic acidosis, both the pH and the HCO3 are decreased. In metabolic alkalosis, the pH and HCO3 are increased

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 1.8 (0.74 mmol/L) 4.Phosphorus level of 3.0 mg/dL (0.97 mmol/L) 1.Sodium level of 145 mEq/L (145 mmol/L)

Rationale: Respiratory alkalosis is defined as a deficit of carbonic acid or a

decrease in hydrogen ion concentration that results from the accumulation of base or from a loss of acid without a comparable loss of base in the body fluids.This occurs in conditions that cause overstimulation of the respiratory system.Some clinical manifestations of respiratory alkalosis include lightheadedness, confusion, tachycardia, dysrhythmias related to hypokalemia, nausea, vomiting, diarrhea, epigastric pain, and numbness and tingling of the extremities. All three incorrect options identify normal laboratory values. The correct option identifies the presence of hypokalemia.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 Rationale: The serum potassium level tends to rise with metabolic acidosis. This is because potassium moves out of the cells and into the bloodstream. When acidosis is corrected with treatment, the potassium will shift back into the cellular compartment. This can cause a rapid drop in the serum potassium level. Because of the effects of potassium on the heart, this electrolyte should be monitored closely while the client is treated.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 mmol/L), 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

Rationale: The acid-base disturbance is respiratory acidosis without

compensation. The normal pH is 7.35 to 7.45. The normal Paco2 is 35 to 45 mm Hg. In respiratory acidosis the pH is decreased and the Pco2 is elevated. The normal bicarbonate HCO3- level is 21 to 28 mEq/L (21 to 28 mmol/L). Because the bicarbonate is still within normal limits, the kidneys have not had time to adjust for this acid-base disturbance. In addition, the pH is not within normal limits.Therefore, the condition is without compensation. The remaining options are incorrect interpretations.The nurse is preparing to obtain an arterial blood gas specimen from a client and plans to perform the Allen's test on the client. The nurse would perform the steps in which order to conduct an Allen's test? Arrange the actions in the order that they should be performed. All options must be used. 1.Document the findings. 2.Explain the procedure to the client. 3.Release pressure from the ulnar artery. 4.Apply pressure over the ulnar and radial arteries. 5.Ask the client to open and close the hand repeatedly. 6.Assess the color of the extremity distal to the pressure point.

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

Rationale: The Allen's test is performed before an arterial blood gas specimen is obtained from the radial artery to determine the presence of collateral circulation and the adequacy of the ulnar artery. Failure to determine the presence of adequate collateral circulation could result in severe ischemic injury to the hand if damage to the radial artery occurs with arterial puncture. The nurse would first explain the procedure to the client. To perform the test, the nurse applies direct pressure over the client's ulnar and radial arteries simultaneously. While applying pressure, the nurse asks the client to open and close the hand repeatedly; the hand should blanch. The nurse then releases pressure from the ulnar artery while continuing to compress the radial artery and then assesses the color of the extremity distal to the pressure point. If pinkness fails to return within 6 seconds, the ulnar artery is insufficient, indicating that the radial artery should not be used for obtaining a blood specimen. Finally, the nurse documents the findings.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

Rationale: Diabetes mellitus can lead to metabolic acidosis. When the body does

not have sufficient circulating insulin, the blood glucose level rises while the cells of the body use all available glucose and then break down glycogen and fat for fuel. The by-products of fat metabolism are acidotic, leading to the complication called diabetic ketoacidosis. The acid-base disorders in the remaining options are not likely to occur in diabetes mellitus unless there is another existing disorder.

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

Rationale: Increases in base components occur as a result of oral or parenteral

intake of bicarbonates, carbonates, acetates, citrates, or lactates. Excessive use of oral antacids containing bicarbonate can cause a metabolic alkalosis. The remaining acid-base disturbances are incorrect.The nurse reviews the arterial blood gas results of a client

and notes the following: pH 7.45, Paco2 of 30 mm Hg (30

mmol/L), 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 2.Respiratory alkalosis, compensated Rationale: The normal pH is 7.35 to 7.45. In a respiratory condition, an opposite effect will be seen between the pH and the Paco2. In this situation, the pH is at the high end of the normal value and the Pco2 is low. In an alkalotic condition, the pH is elevated. Therefore, the values identified in the question indicate a respiratory alkalosis that is compensated by the kidneys through the renal excretion of bicarbonate. Because the pH has returned to a normal value, compensation has occurred.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

Rationale: Respiratory alkalosis is defined as a deficit of carbonic acid or a

decrease in hydrogen ion concentration that results from the accumulation of base or from a loss of acid without a comparable loss of base in the body fluids.This occurs in conditions that cause overstimulation of the respiratory system.Clinical manifestations of respiratory alkalosis include lethargy, lightheadedness, confusion, tachycardia, dysrhythmias related to hypokalemia, nausea, vomiting, epigastric pain, and numbness and tingling of the extremities. Hyperventilation (tachypnea) occurs. Bradypnea describes respirations that are regular but abnormally slow. Hyperkalemia is associated with acidosis.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 (72 mmol/L), 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.

Rationale: The ABG values are abnormal, which supports a physiological

problem. The ABGs indicate respiratory alkalosis as a result of hyperventilating, not acidosis. Concluding that the client is overreacting is an inaccurate analysis.No conclusion can be made about a client's fluid volume status from the information provided.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 Rationale: The normal pH is 7.35 to 7.45. The normal Paco2 is 35 to 45 mm Hg. In respiratory acidosis, the pH is low and the Paco2 is elevated. In respiratory alkalosis, an opposite effect occurs; the pH is elevated and the Paco2 is low. In metabolic acidosis, the pH is low and the bicarbonate is low; in metabolic alkalosis, the opposite effect occurs.

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

Rationale:

When a client is experiencing respiratory acidosis, the respiratory rate and depth increase in an attempt to compensate. The client also experiences headache; restlessness; mental status changes, such as drowsiness and confusion; visual disturbances; diaphoresis; cyanosis as the hypoxia becomes more acute; hyperkalemia; rapid, irregular pulse; and dysrhythmias. Options 1, 2, and 4 are not specifically associated with this disorder.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 Rationale: CO2 acts as an acid in the body. A rise in blood CO2 will result in a fall in pH. The other options are incorrect.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 and 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.Rationale: The client should have oxygen supplementation removed for at least 15 minutes before ABGs are drawn if the client has a prescription for the ABGs to be drawn on room air. This allows time for the client's system to equilibrate so that the ABG results will accurately reflect ventilatory status without the supplemental oxygen. This prescription may be given when the primary health care provider is trying to decide whether to discontinue oxygen therapy, and it allows staff to observe how the client tolerates oxygen removal. Therefore, the remaining options are incorrect.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

Rationale: The acid-base disturbance is respiratory acidosis without

compensation. The normal pH is 7.35 to 7.45. The normal Paco2 is 35 to 45 mm). In respiratory acidosis, the pH is decreased and the Pco2 is elevated. The normal bicarbonate (HCO3–) level is 21 to 28 mEq/L (21 to 28 mmol/L). Because the bicarbonate is still within normal limits, the kidneys have not had time to adjust for this acid-base disturbance. In addition, the pH is not within normal limits.Therefore, the condition is without compensation. The remaining options are incorrect interpretations.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 2.Respirations that are increased in rate 4.Respirations that are abnormally deep

Rationale: Kussmaul's respirations are abnormally deep and increased in rate.

These occur as a result of the compensatory action by the lungs. In bradypnea, respirations are regular but abnormally slow. Apnea is described as respirations that cease for several seconds.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

Rationale: Clinical manifestations of respiratory alkalosis include tachypnea,

hyperpnea, weakness, paresthesias, tetany, dizziness, convulsions, coma, hypokalemia, and hypocalcemia. The clinical picture does not include hypercalcemia, hypochloremia, or hypernatremia.