Deck 9: Inflammation, Tissue Repair, and Wound Healing

Question 1

A male patient with a history of heavy alcohol use has been admitted to hospital for malnutrition and suspected pancreatitis. The patient's diagnostic workup suggests alcoholic ketoacidosis as a component of his current health problems. He is somewhat familiar with the effect that drinking has had on his nutrition and pancreas but is wholly unfamiliar with the significance of acid-base balance. How best could his care provider explain the concept to him?

A) "The chemical processes that take place throughout your body are thrown off very easily when your body is too acidic or not acidic enough.
B) "The multitude of chemical reactions that take place in your body depend on your body fluids being slightly acidic."
C) "The healthy function of your kidneys and your lungs requires a specific level of pH in your body."
D) "Your body is highly dependent on what food and fluid you consume to keep itself at a functioning level of slight nonacidity."

Answer 1

"The chemical processes that take place throughout your body are thrown off very easily when your body is too acidic or not acidic enough.

Question 2

When explaining how carbon dioxide combines with water to form carbonic acid as part of acid-base lecture, the faculty instructor emphasized that which enzyme is needed as a catalyst for this reaction?

A) Carbonic anhydrase
B) Phenylalanie hdroxylase
C) Hydrolases
D) Trypsin

Answer 2

Carbonic anhydrase

Question 3

A 31-year-old client with a diagnosis of end-stage liver failure has been admitted to the intensive care unit of a hospital. Arterial blood sampling indicates that the man has an acid-base imbalance. Which of the following situations is most likely to result in an inappropriate pH?

A) Conservation or formation of new HCO ^- by the kidneys
B) Low albumin and plasma globulin levels
C) Transcompartmental exchange of H⁺ and potassium ions
D) Renal excretion of HCO ^- in the presence of excess base

Answer 3

Low albumin and plasma globulin levels

Question 4

A patient with ESRD comes into the emergency department in severe acidosis. The nurse notes that the respiratory rate is 36 breaths/minute. The nurse understands the pathophysiology of this response and explains to the student nurse that the patient's

A) anxiety level is high, and the body is trying to release endorphins.
B) chemoreceptors in the carotid and aortic bodies have noticed the pH change and altered the ventilator rate.
C) kidneys are not able to buffer the acid and require the help from the lungs.
D) lungs are trying to excrete excess hydrogen.

Question 5

Place the following stages of the hydrogen ion elimination and bicarbonate conservation in the proximal tubules of the nephrons in the ascending chronological order. Use all the options.

A) ^CO2 ^{and H}2^{O are produced.}
B) H⁺ is secreting into the tubular fluid.
C) Carbonic acid is produced.
D) H⁺ combines with filtered HCO ^-.

Question 6

Following several days in an acidotic state, a hospital patient has returned to desired pH. Which of the following processes could have contributed to the resolution of the patient's health problem?

A) Exchange of Na⁺ and H⁺ ions
B) ^{Selective renal secretion and reabsorption of CO}2
C) The phosphate and ammonia buffer systems in the renal tubules
D) Excretion of HCO_-3 by the kidneys

Question 7

When trying to explain the role of potassium and hydrogen related to acid-base balance, which of the following statements is accurate?

A) Hypokalemia stimulates H⁺ secretion.
B) ^{Hyperkalemia will cause the reabsorption of HCO}3^.
C) Acidosis causes an increase in K⁺ elimination.
D) Alkalosis tends to increase H⁺ elimination.

Question 8

A client with poorly controlled diabetes mellitus presents to the emergency department with suspected ketoacidosis. Which of the following diagnostic results would most likely confirm this diagnosis?

A) ^{Low O}2 ^{levels, increased anion gap, base excess}
B) High ammonia levels, decreased anion gap, high potassium
C) Increased anion gap, base deficit
D) Decreased anion gap, decreased urine ammonium level

Question 9

A patient who has just had her first postoperative dinner out to celebrate her recovery from an intestinal bypass is brought to the emergency room by her spouse. He reports that the patient seems disoriented and is slurring her words. The patient did not have any alcohol with her pasta dinner. Which of the following might be the cause of her symptoms?

A) Ketoacidosis
B) Lactic acidosis
C) Hypercapnia
D) Hypothalemia

Question 10

The nurse is caring for a patient with ketoacidosis, who is complaining of increasing lethargy and occasional confusion following several weeks of rigid adherence to a carbohydrate-free diet. The nurse understands which of the following phenomena is most likely occurring?

A) High-fat, low-carbohydrate dietary intake is associated with respiratory acidosis.
B) In the absence of carbohydrate energy sources, her body is metabolizing fat and releasing ketoacids.
C) Metabolism of dietary fats without the buffer action of carbohydrates results in the catabolism of ketoacids.
D) Decreased carbohydrate intake induces insulin deficiency and consequent ketoacidosis.

Question 11

A 14-year-old boy, appearing to be intoxicated, is brought to the emergency room by ambulance. The EMTs report that the boy has denied consuming anything out of the ordinary, but an open antifreeze container was found in the boy's room. Which of the following is likely to be used to treat the patient's symptoms?

A) Gastric lavage
B) Syrup of ipecac
C) Fomepizole
D) Sodium bicarbonate

Question 12

A patient who overdosed on aspirin is brought to the emergency department. The nurse caring for this patient should anticipate which of the following clinical manifestations? Select all that apply.

A) Respiratory rate of 40
B) BP 100/72
C)ABG report: pH 7.50, PCO₂ 31 mm Hg , and HCO₃ level 19 mmol/L.
D)Urine output approximately 100 mL/hour
E) Bilateral crackles (fluid) in the lungs

Question 13

Which of the following individuals are at risk of developing metabolic alkalosis? Select all that apply.

A) A 70-year-old woman who has taken two tablespoons of baking soda to settle her "sour stomach"
B) A hospital patient who is on nasogastric suction following gastric surgery
C) A 20-year-old male who has been regularly inducing himself to vomit following binge eating
D) A 33-year-old male patient who is on mechanical ventilation in the intensive care unit following a head injury
E) A 58-year-old alcoholic male who has been foregoing food for several weeks while drinking heavily F) A 60-year-old female who has chronic renal failure secondary to hypertension

Question 14

A 55-year-old male client with a history of cardiovascular disease has been admitted to the intensive care unit after recovering from cardiogenic shock. In the hours since admission, the client's arterial blood gases indicate acidosis, most likely acute lactic acidosis. Which of the following signs, symptoms, and diagnostic findings might his care team anticipate before the acid-base balance is restored? Select all that apply.

A) Decreased pH
B) Cardiac dysrhythmias
C) Decreased alertness and cognition
D) Hypoventilation
E) Nausea and vomiting

Question 15

A nurse is providing care for a client who has been diagnosed with metabolic alkalosis after several days of antacid use. Which of the following treatments should the nurse prepare to give?

A) Intravenous or oral administration of free hydrogen ions
B) Intravenous administration of KCl solution
C) ^{Administration of oxygen and NaHCO}3 ^solution
D) Supplementary oxygen and possible mechanical ventilation

Question 16

A hospital patient's arterial blood gases indicate normal levels of oxygen and increasedcarbon dioxide. The patient's respiratory rate is 12 breaths/minute (normal 14 to 20breaths/minute) with all other vital signs within normal range. While not evident from assessment and diagnostics, the patient's kidneys are minimizing both H+ excretion and HCO3-reabsorption. What is this client'smost likelydiagnosis?

A)Respiratory alkalosis
B)Metabolic acidosis
C)Respiratory acidosis
D)Metabolic alkalosis

Question 17

A 77-year-old female diagnosed with chronic obstructive pulmonary disease (COPD) is ^{experiencing impaired gas exchange and CO}2 ^{retention, despite a rapid respiratory rate.} Which of the following pathophysiological principles would her health care team expect if her compensatory mechanisms are working?

A) Arterial blood gas sampling indicates a pH in the range of 7.45 to 7.55.
B) Her kidneys are likely to reabsorb H⁺ and secrete HCO ^-
C) ^{Her body will produce excess metabolic CO}2^.
D) Her kidneys will adapt with an increase in plasma HCO ^- and her pH will

Question 18

The ICU nurse is concerned with her patient's arterial blood gas (ABG) results- ^{especially the pH 7.30; and PCO}2 ^{49 mm Hg. The nurse interprets these ABG results to} mean respiratory acidosis. The nurse knows which of the following are clinical manifestations of respiratory acidosis? Select all that apply.

A) Headache with complaints of blurred vision
B) Muscle twitching
C) Hyperactive deep tendon reflexes
D) Complaints of paresthesia sensations around the lips/mouth
E) Numbness in the fingers and toes

Question 19

A 55-year-old woman has presented to the emergency department following a panic attack. Her blood pressure, respiratory rate, and heart rate are all highly elevated, while her temperature and oxygen saturation are within normal ranges. What is the woman's body most likely doing to address the changes in pH associated with her situation?

A) Her kidneys will limit the amount of bicarbonate that they reabsorb.
B) She will be retaining Cl^- ions in an effort to lower pH.
C) ^{Her respiratory center will attempt to lower her CO}2 ^levels.
D) The patient's kidneys will excrete more hydrogen ions than they normally do.

Question 20

In the neurotrauma unit, a teenager with a closed head injury related to an automobile accident is experiencing high intracranial pressure (ICP). He is intubated and is on a ventilator. One treatment for this is to allow him to progress into which acid-base imbalance in an attempt to lower ICP?

A) Metabolic acidosis
B) Metabolic alkalosis
C) Respiratory acidosis
D) Respiratory alkalosis