Question 1

A nurse assesses a client with diabetes mellitus who is admitted with an acid-base imbalance.The client's arterial blood gas values are pH 7.36,PaO₂ 98 mm Hg,PaCO₂ 33 mm Hg,and HCO₃- 18 mEq/L.Which manifestation should the nurse identify as an example of the client's compensation mechanism?

Accepted Answer

This client has metabolic acidosis.The respiratory system compensates by increasing its activity and blowing off excess carbon dioxide.Increased urinary output,thirst,and hunger are manifestations of hyperglycemia but are not compensatory mechanisms for acid-base imbalances.The kidneys do not release acids.

Question 2

A nurse is caring for a client who has just experienced a 90-second tonic-clonic seizure.The client's arterial blood gas values are pH 6.88,PaO₂ 50 mm Hg,PaCO₂ 60 mm Hg,and HCO₃- 22 mEq/L.Which action should the nurse take first?

Accepted Answer

The client has experienced a combination of metabolic and acute respiratory acidosis through heavy skeletal muscle contractions and no gas exchange.When the seizures have stopped and the client can breathe again,the fastest way to return acid-base balance is to administer oxygen.Applying a paper bag over the client's nose and mouth would worsen the acidosis.Sodium bicarbonate should not be administered because the client's arterial bicarbonate level is normal.Glucose and insulin are administered together to decrease serum potassium levels.This action is not appropriate based on the information provided.

Question 3

A nurse is caring for a client who has the following arterial blood values: pH 7.12,PaO₂ 56 mm Hg,PaCO₂ 65 mm Hg,and HCO₃- 22 mEq/L.Which clinical situation should the nurse correlate with these values?

Accepted Answer

Arterial blood gas values indicate that the client has acidosis with normal levels of bicarbonate,suggesting that the problem is not metabolic.Arterial concentrations of oxygen and carbon dioxide are abnormal,with low oxygen and high carbon dioxide levels.Thus,this client has respiratory acidosis from inadequate gas exchange.The fact that the bicarbonate level is normal indicates that this is an acute respiratory problem rather than a chronic problem,because no renal compensation has occurred.

Question 4

A nurse is planning care for a client who is anxious and irritable.The client's arterial blood gas values are pH 7.30,PaO₂ 96 mm Hg,PaCO₂ 43 mm Hg,and HCO₃- 19 mEq/L.Which questions should the nurse ask the client and spouse when developing the plan of care? (Select all that apply.)

Accepted Answer

This client's symptoms of anxiety and irritability are related to a state of metabolic acidosis.The nurse should ask the client's spouse or family members if the client's behavior is typical for him or her,and establish a baseline for comparison with later assessment findings.The nurse should also assess for alcohol intake because alcohol can change a client's personality and cause metabolic acidosis.The other options are not causes of metabolic acidosis.

Question 5

A nurse is planning care for a client who is hyperventilating.The client's arterial blood gas values are pH 7.30,PaO₂ 94 mm Hg,PaCO₂ 31 mm Hg,and HCO_3- 26 mEq/L.Which question should the nurse ask when developing this client's plan of care?

Accepted Answer

The nurse should assist the client who is experiencing anxiety-induced respiratory alkalosis to identify causes of the anxiety.The other questions will not identify the cause of the acid-base imbalance.

Question 6

A nurse is caring for a client who is experiencing excessive diarrhea.The client's arterial blood gas values are pH 7.28,PaO₂ 98 mm Hg,PaCO₂ 45 mm Hg,and HCO₃- 16 mEq/L.Which provider order should the nurse expect to receive?

Accepted Answer

This client's arterial blood gas values represent metabolic acidosis related to a loss of bicarbonate ions from diarrhea.The bicarbonate should be replaced to help restore this client's acid-base balance.Furosemide would cause an increase in acid fluid and acid elimination via the urinary tract; although this may improve the client's pH,the client has excessive diarrhea and cannot afford to lose more fluid.Mechanical ventilation is used to treat respiratory acidosis for clients who cannot keep their oxygen saturation at 90%,or who have respirator muscle fatigue.Mechanical ventilation and an indwelling urinary catheter would not be prescribed for this client.

Question 7

A nurse assesses a client who is experiencing an acid-base imbalance.The client's arterial blood gas values are pH 7.34,PaO₂ 88 mm Hg,PaCO₂ 38 mm Hg,and HCO₃- 19 mEq/L.Which assessment should the nurse perform first?

Accepted Answer

Early cardiovascular changes for a client experiencing moderate acidosis include increased heart rate and cardiac output.As the acidosis worsens,the heart rate decreases and electrocardiographic changes will be present.Central nervous system and neuromuscular system changes do not occur with mild acidosis and should be monitored if the acidosis worsens.Skin and mucous membrane assessment is not a priority now,but will change as acidosis worsens.

Question 8

A nurse is caring for a client who has chronic emphysema and is receiving oxygen therapy at 6 L/min via nasal cannula.The following clinical data are available:

Which action should the nurse take first?

Accepted Answer

The primary trigger for respiration in a client with chronic respiratory acidosis is a decreased arterial oxygen level (hypoxic drive).Oxygen therapy can inhibit respiratory efforts in this case,eventually causing respiratory arrest and death.The nurse could decrease the oxygen flow rate; eventually,this might improve the client's respiratory rate,but the priority action would be to call the Rapid Response Team whenever a client with chronic carbon dioxide retention has a respiratory rate less than 10 breaths/min.Changing the cannula to a mask does nothing to improve the client's hypoxic drive,nor would it address the client's most pressing need.Positioning will not help the client breathe at a normal rate or maintain client safety.

Question 9

A nurse is assessing clients who are at risk for acid-base imbalance.Which clients are correctly paired with the acid-base imbalance? (Select all that apply.)

Accepted Answer

Respiratory acidosis often occurs as the result of underventilation.The client who is taking opioids,especially IV opioids,is at risk for respiratory depression and respiratory acidosis.One cause of metabolic acidosis is a strict low-calorie diet or one that is low in carbohydrate content.Such a diet increases the rate of fat catabolism and results in the formation of excessive ketoacids.A ventilator set at a high respiratory rate or tidal volume will cause the client to lose too much carbon dioxide,leading to an acid deficit and respiratory alkalosis.Citrate is a substance used as a preservative in blood products.It is not only a base,it is also a precursor for bicarbonate.Multiple units of packed red blood cells could cause metabolic alkalosis.Sodium bicarbonate antacids may increase the risk of metabolic alkalosis.

Question 10

A nurse is caring for a client who is experiencing moderate metabolic alkalosis.Which action should the nurse take?

Accepted Answer

The priority nursing care for a client who is experiencing moderate metabolic alkalosis is providing client safety.Clients with metabolic alkalosis have muscle weakness and are at risk for falling.The other nursing interventions are not appropriate for metabolic alkalosis.

Question 11

A nurse is planning interventions that regulate acid-base balance to ensure the pH of a client's blood remains within the normal range.Which abnormal physiologic functions may occur if the client experiences an acid-base imbalance? (Select all that apply.)

Accepted Answer

Acid-base imbalances interfere with normal physiology,including reducing the function of hormones and enzymes,causing fluid and electrolyte imbalances,making heart membranes more excitable,and decreasing the effectiveness of many drugs.

Question 12

A nurse evaluates the following arterial blood gas values in a client: pH 7.48,PaO₂ 98 mm Hg,PaCO₂ 28 mm Hg,and HCO₃- 22 mEq/L.Which client condition should the nurse correlate with these results?

Accepted Answer

The elevated pH level indicates alkalosis.The bicarbonate level is normal,and so is the oxygen partial pressure.Loss of carbon dioxide is the cause of the alkalosis,which would occur in response to hyperventilation.Diarrhea and vomiting would cause metabolic alterations,COPD would lead to respiratory acidosis,and the client with emphysema most likely would have combined metabolic acidosis on top of a mild,chronic respiratory acidosis.

Question 13

After teaching a client who was malnourished and is being discharged,a nurse assesses the client's understanding.Which statement indicates the client correctly understood teaching to decrease risk for the development of metabolic acidosis?

Accepted Answer

Starvation or a diet with too few carbohydrates can lead to metabolic acidosis by forcing cells to switch to using fats for fuel and by creating ketoacids as a by-product of excessive fat metabolism.Eating sufficient calories from all food groups helps reduce this risk.

Question 14

A nurse evaluates a client's arterial blood gas values (ABGs): pH 7.30,PaO₂ 86 mm Hg,PaCO₂ 55 mm Hg,and HCO₃- 22 mEq/L.Which intervention should the nurse implement first?

Accepted Answer

All interventions are important for clients with respiratory acidosis; this is indicated by the ABGs.However,the priority is assessing and maintaining an airway.Without a patent airway,other interventions will not be helpful.

Question 15

After providing discharge teaching,a nurse assesses the client's understanding regarding increased risk for metabolic alkalosis.Which statement indicates the client needs additional teaching?

Accepted Answer

Excessive oral ingestion of sodium bicarbonate and other bicarbonate-based antacids can cause metabolic alkalosis.Avoiding milk,taking digoxin,and sweating would not lead to increased risk of metabolic alkalosis.

Question 16

A nurse assesses a client who is admitted with an acid-base imbalance.The client's arterial blood gas values are pH 7.32,PaO₂ 85 mm Hg,PaCO₂ 34 mm Hg,and HCO₃- 16 mEq/L.What action should the nurse take next?

Accepted Answer

Progressive skeletal muscle weakness is associated with increasing severity of acidosis.Muscle weakness can lead to severe respiratory insufficiency.Acidosis does lead to dysrhythmias (due to hyperkalemia),but these would best be assessed with cardiac monitoring.Findings should be documented,but simply continuing to monitor is not sufficient.Before notifying the physician,the nurse must have more data to report.

Question 17

A nurse assesses a client who is prescribed furosemide (Lasix)for hypertension.For which acid-base imbalance should the nurse assess to prevent complications of this therapy?

Accepted Answer

Many diuretics,especially loop diuretics,increase the excretion of hydrogen ions,leading to excess acid loss through the renal system.This situation is an acid deficit of metabolic origin.

Question 18

A nurse is assessing a client who has acute pancreatitis and is at risk for an acid-base imbalance.For which manifestation of this acid-base imbalance should the nurse assess?

Accepted Answer

The pancreas is a major site of bicarbonate production.Pancreatitis can cause a relative metabolic acidosis through underproduction of bicarbonate ions.Manifestations of acidosis include lethargy and Kussmaul respirations.Agitation,seizures,and a positive Chvostek's sign are manifestations of the electrolyte imbalances that accompany alkalosis.

Question 19

A nurse assesses a client who is receiving total parenteral nutrition.For which adverse effects related to an acid-base imbalance should the nurse assess? (Select all that apply.)

Accepted Answer

A client receiving total parenteral nutrition is at risk for metabolic alkalosis.Manifestations of metabolic alkalosis include positive Chvostek's sign,normal or low blood pressure,increased heart rate,skeletal muscle weakness,and anxiety and irritability.

Question 20

A nurse assesses a client who is experiencing an acid-base imbalance.The client's arterial blood gas values are pH 7.32,PaO₂ 94 mm Hg,PaCO₂ 34 mm Hg,and HCO₃- 18 mEq/L.For which clinical manifestations should the nurse assess? (Select all that apply.)

Accepted Answer

Metabolic acidosis causes neuromuscular changes,including reduced muscle tone and deep tendon reflexes.Clients usually present with lethargy and drowsiness.The respiratory system will attempt to compensate for the metabolic acidosis; therefore,respirations will increase rate and depth.A positive Trousseau's sign is associated with alkalosis.Decreased urine output is not a manifestation of metabolic acidosis.

Quiz 12: Assessment and Care of Patients with Acid-Base Imbalances

A nurse assesses a client with diabetes mellitus who is admitted with an acid-base imbalance.The client's arterial blood gas values are pH 7.36,PaO₂ 98 mm Hg,PaCO₂ 33 mm Hg,and HCO₃- 18 mEq/L.Which manifestation should the nurse identify as an example of the client's compensation mechanism?

A nurse is caring for a client who has just experienced a 90-second tonic-clonic seizure.The client's arterial blood gas values are pH 6.88,PaO₂ 50 mm Hg,PaCO₂ 60 mm Hg,and HCO₃- 22 mEq/L.Which action should the nurse take first?

A nurse is caring for a client who has the following arterial blood values: pH 7.12,PaO₂ 56 mm Hg,PaCO₂ 65 mm Hg,and HCO₃- 22 mEq/L.Which clinical situation should the nurse correlate with these values?

A nurse is planning care for a client who is anxious and irritable.The client's arterial blood gas values are pH 7.30,PaO₂ 96 mm Hg,PaCO₂ 43 mm Hg,and HCO₃- 19 mEq/L.Which questions should the nurse ask the client and spouse when developing the plan of care? (Select all that apply.)

A nurse is planning care for a client who is hyperventilating.The client's arterial blood gas values are pH 7.30,PaO₂ 94 mm Hg,PaCO₂ 31 mm Hg,and HCO_3- 26 mEq/L.Which question should the nurse ask when developing this client's plan of care?

A nurse is caring for a client who is experiencing excessive diarrhea.The client's arterial blood gas values are pH 7.28,PaO₂ 98 mm Hg,PaCO₂ 45 mm Hg,and HCO₃- 16 mEq/L.Which provider order should the nurse expect to receive?

A nurse assesses a client who is experiencing an acid-base imbalance.The client's arterial blood gas values are pH 7.34,PaO₂ 88 mm Hg,PaCO₂ 38 mm Hg,and HCO₃- 19 mEq/L.Which assessment should the nurse perform first?

A nurse is caring for a client who has chronic emphysema and is receiving oxygen therapy at 6 L/min via nasal cannula.The following clinical data are available: Which action should the nurse take first?

A nurse is assessing clients who are at risk for acid-base imbalance.Which clients are correctly paired with the acid-base imbalance? (Select all that apply.)

A nurse is caring for a client who is experiencing moderate metabolic alkalosis.Which action should the nurse take?

A nurse is planning interventions that regulate acid-base balance to ensure the pH of a client's blood remains within the normal range.Which abnormal physiologic functions may occur if the client experiences an acid-base imbalance? (Select all that apply.)

A nurse evaluates the following arterial blood gas values in a client: pH 7.48,PaO₂ 98 mm Hg,PaCO₂ 28 mm Hg,and HCO₃- 22 mEq/L.Which client condition should the nurse correlate with these results?

After teaching a client who was malnourished and is being discharged,a nurse assesses the client's understanding.Which statement indicates the client correctly understood teaching to decrease risk for the development of metabolic acidosis?

A nurse evaluates a client's arterial blood gas values (ABGs) : pH 7.30,PaO₂ 86 mm Hg,PaCO₂ 55 mm Hg,and HCO₃- 22 mEq/L.Which intervention should the nurse implement first?

After providing discharge teaching,a nurse assesses the client's understanding regarding increased risk for metabolic alkalosis.Which statement indicates the client needs additional teaching?

A nurse assesses a client who is admitted with an acid-base imbalance.The client's arterial blood gas values are pH 7.32,PaO₂ 85 mm Hg,PaCO₂ 34 mm Hg,and HCO₃- 16 mEq/L.What action should the nurse take next?

A nurse assesses a client who is prescribed furosemide (Lasix) for hypertension.For which acid-base imbalance should the nurse assess to prevent complications of this therapy?

A nurse is assessing a client who has acute pancreatitis and is at risk for an acid-base imbalance.For which manifestation of this acid-base imbalance should the nurse assess?

A nurse assesses a client who is receiving total parenteral nutrition.For which adverse effects related to an acid-base imbalance should the nurse assess? (Select all that apply.)

A nurse assesses a client who is experiencing an acid-base imbalance.The client's arterial blood gas values are pH 7.32,PaO₂ 94 mm Hg,PaCO₂ 34 mm Hg,and HCO₃- 18 mEq/L.For which clinical manifestations should the nurse assess? (Select all that apply.)

Quiz 12: Assessment and Care of Patients with Acid-Base Imbalances

A nurse assesses a client with diabetes mellitus who is admitted with an acid-base imbalance.The client's arterial blood gas values are pH 7.36,PaO2 98 mm Hg,PaCO2 33 mm Hg,and HCO3- 18 mEq/L.Which manifestation should the nurse identify as an example of the client's compensation mechanism?

A nurse is caring for a client who has just experienced a 90-second tonic-clonic seizure.The client's arterial blood gas values are pH 6.88,PaO2 50 mm Hg,PaCO2 60 mm Hg,and HCO3- 22 mEq/L.Which action should the nurse take first?

A nurse is caring for a client who has the following arterial blood values: pH 7.12,PaO2 56 mm Hg,PaCO2 65 mm Hg,and HCO3- 22 mEq/L.Which clinical situation should the nurse correlate with these values?

A nurse is planning care for a client who is anxious and irritable.The client's arterial blood gas values are pH 7.30,PaO2 96 mm Hg,PaCO2 43 mm Hg,and HCO3- 19 mEq/L.Which questions should the nurse ask the client and spouse when developing the plan of care? (Select all that apply.)

A nurse is planning care for a client who is hyperventilating.The client's arterial blood gas values are pH 7.30,PaO2 94 mm Hg,PaCO2 31 mm Hg,and HCO3- 26 mEq/L.Which question should the nurse ask when developing this client's plan of care?

A nurse is caring for a client who is experiencing excessive diarrhea.The client's arterial blood gas values are pH 7.28,PaO2 98 mm Hg,PaCO2 45 mm Hg,and HCO3- 16 mEq/L.Which provider order should the nurse expect to receive?

A nurse assesses a client who is experiencing an acid-base imbalance.The client's arterial blood gas values are pH 7.34,PaO2 88 mm Hg,PaCO2 38 mm Hg,and HCO3- 19 mEq/L.Which assessment should the nurse perform first?

A nurse is caring for a client who has chronic emphysema and is receiving oxygen therapy at 6 L/min via nasal cannula.The following clinical data are available: Which action should the nurse take first?

A nurse is assessing clients who are at risk for acid-base imbalance.Which clients are correctly paired with the acid-base imbalance? (Select all that apply.)

A nurse is caring for a client who is experiencing moderate metabolic alkalosis.Which action should the nurse take?

A nurse is planning interventions that regulate acid-base balance to ensure the pH of a client's blood remains within the normal range.Which abnormal physiologic functions may occur if the client experiences an acid-base imbalance? (Select all that apply.)

A nurse evaluates the following arterial blood gas values in a client: pH 7.48,PaO2 98 mm Hg,PaCO2 28 mm Hg,and HCO3- 22 mEq/L.Which client condition should the nurse correlate with these results?

After teaching a client who was malnourished and is being discharged,a nurse assesses the client's understanding.Which statement indicates the client correctly understood teaching to decrease risk for the development of metabolic acidosis?

A nurse evaluates a client's arterial blood gas values (ABGs) : pH 7.30,PaO2 86 mm Hg,PaCO2 55 mm Hg,and HCO3- 22 mEq/L.Which intervention should the nurse implement first?

After providing discharge teaching,a nurse assesses the client's understanding regarding increased risk for metabolic alkalosis.Which statement indicates the client needs additional teaching?

A nurse assesses a client who is admitted with an acid-base imbalance.The client's arterial blood gas values are pH 7.32,PaO2 85 mm Hg,PaCO2 34 mm Hg,and HCO3- 16 mEq/L.What action should the nurse take next?

A nurse assesses a client who is prescribed furosemide (Lasix) for hypertension.For which acid-base imbalance should the nurse assess to prevent complications of this therapy?

A nurse is assessing a client who has acute pancreatitis and is at risk for an acid-base imbalance.For which manifestation of this acid-base imbalance should the nurse assess?

A nurse assesses a client who is receiving total parenteral nutrition.For which adverse effects related to an acid-base imbalance should the nurse assess? (Select all that apply.)

A nurse assesses a client who is experiencing an acid-base imbalance.The client's arterial blood gas values are pH 7.32,PaO2 94 mm Hg,PaCO2 34 mm Hg,and HCO3- 18 mEq/L.For which clinical manifestations should the nurse assess? (Select all that apply.)

A nurse assesses a client with diabetes mellitus who is admitted with an acid-base imbalance.The client's arterial blood gas values are pH 7.36,PaO₂ 98 mm Hg,PaCO₂ 33 mm Hg,and HCO₃- 18 mEq/L.Which manifestation should the nurse identify as an example of the client's compensation mechanism?

A nurse is caring for a client who has just experienced a 90-second tonic-clonic seizure.The client's arterial blood gas values are pH 6.88,PaO₂ 50 mm Hg,PaCO₂ 60 mm Hg,and HCO₃- 22 mEq/L.Which action should the nurse take first?

A nurse is caring for a client who has the following arterial blood values: pH 7.12,PaO₂ 56 mm Hg,PaCO₂ 65 mm Hg,and HCO₃- 22 mEq/L.Which clinical situation should the nurse correlate with these values?

A nurse is planning care for a client who is anxious and irritable.The client's arterial blood gas values are pH 7.30,PaO₂ 96 mm Hg,PaCO₂ 43 mm Hg,and HCO₃- 19 mEq/L.Which questions should the nurse ask the client and spouse when developing the plan of care? (Select all that apply.)

A nurse is planning care for a client who is hyperventilating.The client's arterial blood gas values are pH 7.30,PaO₂ 94 mm Hg,PaCO₂ 31 mm Hg,and HCO_3- 26 mEq/L.Which question should the nurse ask when developing this client's plan of care?

A nurse is caring for a client who is experiencing excessive diarrhea.The client's arterial blood gas values are pH 7.28,PaO₂ 98 mm Hg,PaCO₂ 45 mm Hg,and HCO₃- 16 mEq/L.Which provider order should the nurse expect to receive?

A nurse assesses a client who is experiencing an acid-base imbalance.The client's arterial blood gas values are pH 7.34,PaO₂ 88 mm Hg,PaCO₂ 38 mm Hg,and HCO₃- 19 mEq/L.Which assessment should the nurse perform first?

A nurse evaluates the following arterial blood gas values in a client: pH 7.48,PaO₂ 98 mm Hg,PaCO₂ 28 mm Hg,and HCO₃- 22 mEq/L.Which client condition should the nurse correlate with these results?

A nurse evaluates a client's arterial blood gas values (ABGs) : pH 7.30,PaO₂ 86 mm Hg,PaCO₂ 55 mm Hg,and HCO₃- 22 mEq/L.Which intervention should the nurse implement first?

A nurse assesses a client who is admitted with an acid-base imbalance.The client's arterial blood gas values are pH 7.32,PaO₂ 85 mm Hg,PaCO₂ 34 mm Hg,and HCO₃- 16 mEq/L.What action should the nurse take next?

A nurse assesses a client who is experiencing an acid-base imbalance.The client's arterial blood gas values are pH 7.32,PaO₂ 94 mm Hg,PaCO₂ 34 mm Hg,and HCO₃- 18 mEq/L.For which clinical manifestations should the nurse assess? (Select all that apply.)