Deck 14: Assessment and Care of Patients With Acid-Base Imbalances

Question 1

The nurse monitors for which acid-base problem in a client who is taking furosemide (Lasix)for hypertension?

A) Acid excess secondary to respiratory acidosis
B) Acid deficit secondary to respiratory alkalosis
C) Acid excess secondary to metabolic acidosis
D) Acid deficit secondary to metabolic alkalosis

Answer 1

Acid deficit secondary to metabolic alkalosis

Question 2

The nurse monitors for which acid-base imbalance in a client who has hypoxemia?

A) Reduced carbon dioxide production leading to alkalosis
B) Reduced carbon dioxide retention leading to alkalosis
C) Excess carbon dioxide production leading to acidosis
D) Excess carbon dioxide retention leading to acidosis

Answer 2

Excess carbon dioxide production leading to acidosis

Question 3

Which response is an example of compensation for an acid-base imbalance?

A) Increase in the rate and depth of respirations when exercising
B) Increased urinary output when blood pressure increases during exercise
C) Increased thirst when spending time in an excessively dry environment
D) Increased release of acids from kidneys during exacerbation of chronic obstructive pulmonary disease (COPD)

Answer 3

Increase in the rate and depth of respirations when exercising

Question 4

A client has moderate acidosis.Which assessment does the nurse perform first?

A) Take the client's pulse and blood pressure, and analyze the electrocardiogram (ECG) strip.
B) Assess respiratory rate and depth and work of breathing.
C) Perform assessments of musculoskeletal strength.
D) Determine whether the client is awake, alert, and oriented.

Question 5

Which client does the nurse assess for potential metabolic acidosis?

A) Client admitted after collapsing during a marathon run
B) Young adult following a carbohydrate-free diet
C) Older adult with asthma who is on long-term steroid therapy
D) Older client on antacids for gastroesophageal reflux disease

Question 6

The nurse assesses for acidosis in the client with which assessment data?

A) Serum sodium level of 130 mEq per liter and peripheral edema
B) Serum sodium level of 144 mEq per liter and tachycardia
C) Serum potassium level of 6.5 mEq per liter and flaccid paralysis
D) Serum potassium level of 4.5 mEq per liter and hyperactive deep tendon reflexes

Question 7

A client has the following arterial blood results: pH 7.12,HCO₃^- 22 mEq/L,PCO₂ 65 mm Hg,PO₂ 56 mm Hg.The nurse correlates these values with which clinical situation?

A) Diabetic ketoacidosis in a person with emphysema
B) Tracheal obstruction related to aspiration of a hot dog
C) Anxiety-induced hyperventilation in an adolescent
D) Diarrhea for 36 hours in an older, frail woman

Question 8

A client has an arterial blood gas pH of 7.48.How does the nurse interpret this client's acid-base status?

A) An unknown acid-base balance status
B) A normal blood hydrogen ion concentration
C) A deficit in blood hydrogen ion concentration
D) An excess in blood hydrogen ion concentration

Question 9

A client has been placed on a ventilator.The physician has ordered that the ventilator be set to deliver a respiratory rate set of 28 breaths/min.The nurse questions the order,citing concerns about which acid-base problem?

A) Acid deficit: alkalosis
B) Base excess: alkalosis
C) Acid excess: acidosis
D) Base deficit: acidosis

Question 10

In evaluating the electrocardiogram (ECG)in a client with acidosis,the nurse correlates which ECG change with effectiveness of therapy?

A) Small U-waves present after each complex
B) Heart rate decreased to 62 beats/min
C) T-waves present, normal height
D) P-wave preceding the QRS complex

Question 11

The hand grasps of a client with acidosis have diminished since the previous assessment 1 hour ago.What action does the nurse take next?

A) Assess client's rate, rhythm, and depth of respiration.
B) Measure the client's pulse and blood pressure.
C) Document findings and continue to monitor.
D) Notify the physician as soon as possible.

Question 12

A client has moderate metabolic alkalosis.What is the priority intervention for the nurse?

A) Monitor daily laboratory values.
B) Assess the client's muscle strength.
C) Determine the cause of the problem.
D) Teach the client preventive measures.

Question 13

In the client with hypoventilation,which change in arterial blood gases does the nurse evaluate to determine whether treatment measures are being effective?

A) Decreased arterial blood pH
B) Decreased arterial blood carbon dioxide
C) Increased arterial blood bicarbonate
D) Increased arterial blood oxygen

Question 14

When a client has an arterial blood pH of 7.48,which buffer action will bring the pH back to normal?

A) Absorption of bicarbonate ions from the blood
B) Release of bicarbonate ions into the blood
C) Absorption of hydrogen ions from the blood
D) Release of hydrogen ions into the blood

Question 15

A client has mild acidosis but after a day has not compensated for it.Which action by the nurse is best?

A) Review the client's daily hemoglobin and hematocrit.
B) Ask the laboratory to rerun today's arterial blood gases.
C) Document the finding and notify the physician.
D) Apply 2 L of oxygen via nasal cannula.

Question 16

In a client 4 minutes post cardiac arrest,the nurse correlates the largest source of excess hydrogen ions with which cause?

A) Excess renal retention of carbon dioxide due to hypoxia
B) Release of intracellular acids due to widespread tissue destruction
C) Anaerobic metabolism, leading to the buildup of lactic acid
D) Using fat as a fuel source, resulting in increased fat degradation

Question 17

A client has acute pancreatitis and a risk for acid-base imbalance.The nurse plans to assess for which manifestation consistent with this condition?

A) Agitation
B) Kussmaul respirations
C) Seizures
D) Positive Chvostek's sign

Question 18

The nurse reads in the medical record that a client has Kussmaul respirations.Which assessment finding is consistent with this condition?

A) Deep, rapid respirations
B) Respirations with an irregular pattern
C) Shallow, grunting respirations
D) Use of accessory muscles when breathing

Question 19

In a client with less than the normal amount of bicarbonate in the blood and other extracellular fluids,what response does the nurse anticipate?

A) Increased risk for acidosis
B) Decreased risk for acidosis
C) Increased risk for alkalosis
D) Decreased risk for alkalosis

Question 20

The nurse expects to find renal compensation for an acid-base imbalance in which situation?

A) Mild to moderate dehydration in a middle-aged client who jogged for 2 hours
B) Acute asthma attack with wheezing of 6 hours' duration in an older man
C) Food poisoning with vomiting for 12 hours in a middle-aged woman
D) Hypoxemia for 4 days from pneumonia in an adult woman

Question 21

A client is being discharged and continues to be at risk for developing metabolic alkalosis.Which statement by the client indicates to the nurse that teaching has been effective?

A) "I will avoid excess use of antacids."
B) "I'll drink at least three glasses of milk daily."
C) "I'll avoid medications containing aspirin."
D) "I will not add salt to my food during meals."

Question 22

A postoperative client received six units of packed red blood cells (PRBCs)for intraoperative blood loss.The nurse monitors the client for which acid-base imbalance?

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

Question 23

A client is admitted with mixed respiratory and metabolic acidosis secondary to bronchitis and diabetic ketoacidosis.The nurse evaluates that teaching about the client's confusion was effective when a family member makes which statement?

A) "It is too early to tell if the ketoacidosis will cause permanent changes."
B) "Her memory will improve, but loss of some brain cells has occurred."
C) "The confusion should clear when oxygen and electrolyte levels are normal."
D) "The confusion should clear when blood glucose levels and other laboratory tests are normal."

Question 24

A client has respiratory acidosis.The nurse evaluates that treatment is being effective with which arterial blood gas values?

A) pH 7.28, HCO₃^- 12 mEq/L, PCO₂ 45 mm Hg, PO₂ 96 mm Hg
B) pH 7.32, HCO₃^- 17 mEq/L, PCO₂ 25 mm Hg, PO₂ 98 mm Hg
C) pH 7.35, HCO₃^- 36 mEq/L, PCO₂ 65 mm Hg, PO₂ 78 mm Hg
D) pH 7.48, HCO₃^- 12 mEq/L, PCO₂ 35 mm Hg, PO₂ 85 mm Hg

Question 25

A client has a prolonged fever.For which acid-base imbalance does the nurse assess the client further?

A) Metabolic acidosis from excess bicarbonate production
B) Metabolic alkalosis from dehydration and hyperkalemia
C) Metabolic acidosis from increased production of hydrogen ions
D) Respiratory alkalosis from impaired gas exchange

Question 26

A client has just experienced a 90-second tonic-clonic seizure and has these arterial blood gas values: pH 6.88,HCO₃^- 22 mEq/L,PCO₂ 60 mm Hg,PO₂ 50 mm Hg.Which intervention by the nurse is most appropriate?

A) Apply oxygen by mask or nasal cannula.
B) Apply a paper bag over the client's nose and mouth.
C) Administer 50 mL of sodium bicarbonate intravenously.
D) Administer 50 mL of 20% glucose and 20 units of regular insulin.

Question 27

The nurse assesses the client with which condition most carefully for the risk of developing acute respiratory acidosis?

A) Allergic rhinitis and sinusitis on sulfa antibiotics
B) Type 1 diabetes and urinary tract infection
C) Emphysema and undergoing nasogastric (NG) tube suctioning
D) On patient-controlled analgesia after abdominal surgery

Question 28

A client who was malnourished is being discharged.The nurse evaluates that teaching to decrease risk for the development of metabolic acidosis has been effective when the client states,"I will:

A) Increase my milk intake to at least three glasses daily."
B) Be sure to eat three well-balanced meals and a snack daily."
C) Avoid taking pain medication and antihistamines together."
D) Not add salt to food when cooking or during meals."

Question 29

The nurse correlates which condition with the following arterial blood gas values: pH 7.48,HCO₃^- 22 mEq/L,PCO₂ 28 mm Hg,PO₂ 98 mm Hg?

A) Diarrhea and vomiting for 36 hours
B) Anxiety-induced hyperventilation
C) Chronic obstructive pulmonary disease
D) Diabetic ketoacidosis and emphysema

Question 30

A client has severe metabolic alkalosis.Which nursing diagnosis does the nurse choose as the client's priority problem?

A) Fluid volume excess related to reduced kidney function
B) Fluid volume deficit related to increased insensitive fluid loss through lungs
C) Risk for impaired skin integrity related to accompanying peripheral edema
D) Risk for injury related to increased neuronal sensitivity from hypocalcemia

Question 31

The nurse prepares to administer bicarbonate intravenously to the client with which clinical manifestations?

A) pH 7.28, HCO₃^- 22 mEq/L, PCO₂ 52 mm Hg, PO₂ 82 mm Hg secondary to an acute asthma attack
B) pH 7.28, HCO₃^- 16 mEq/L, PCO₂ 45 mm Hg, PO₂ 98 mm Hg secondary to excessive diarrhea
C) Client with chronic emphysema and bronchitis who has the following arterial blood gases: pH 7.30, HCO₃^- 30 mEq/L, PCO₂ 60 mm Hg, PO₂ 72 mm Hg secondary to chronic bronchitis and emphysema
D) pH 7.31, HCO₃^- 20 mEq/L, PCO₂ 34 mm Hg, PO₂ 96 mm Hg secondary to a urinary tract infection and type 2 diabetes

Question 32

The nurse monitors the client with which condition most carefully for metabolic alkalosis?

A) A critical illness receiving total parenteral nutrition
B) Type 1 diabetes on once-daily insulin therapy
C) Metastatic breast cancer on continuous IV morphine
D) Asthma using an adrenergic agonist inhaler

Question 33

A client has acidosis.Which laboratory finding is of greatest concern to the nurse?

A) Sodium 154 mEq/L
B) Potassium 5.9 mEq/L
C) Calcium 8.9 mg/dL
D) Magnesium 2.1 mg/dL

Question 34

In clients with any type of acid-base imbalance,the nurse places the priority on monitoring which electrolyte?

A) Sodium
B) Calcium
C) Potassium
D) Magnesium

Question 35

A client is being discharged from the emergency department with several broken ribs.For which acid-base imbalance does the nurse provide discharge teaching?

A) Respiratory alkalosis from anxiety and hyperventilation
B) Respiratory acidosis from inadequate ventilation
C) Metabolic acidosis from calcium loss from broken bones
D) Metabolic alkalosis from taking base-containing analgesics

Question 36

The nurse is providing discharge teaching.Which statement by the client indicates the need for further teaching regarding increased risk for metabolic alkalosis?

A) "I don't drink milk because it gives me gas and diarrhea."
B) "I have been taking digoxin every day for the last 15 years."
C) "I take sodium bicarbonate after every meal to prevent heartburn."
D) "In hot weather, I sweat so much that I drink six glasses of water each day."

Question 37

A client with chronic respiratory acidosis is receiving oxygen by nasal cannula at 6 L/min.The client's respiratory rate is 8 breaths/min.Which action by the nurse is the priority?

A) Notify the Rapid Response Team and prepare for intubation.
B) Change the nasal cannula to a mask and reassess in 10 minutes.
C) Place the client in Fowler's position if he or she is able to tolerate it.
D) Decrease the flow rate of oxygen to 2 to 4 L/min, and reassess.

Question 38

A client has metabolic alkalosis.Which laboratory results is the nurse most likely to assess as consistent with this condition?

A) Na⁺ 134 mg/dL
B) Mg²⁺ 1.5 mg/dL
C) K⁺ 3.1 mEq/L
D) Ca²⁺ 11.5 mg/dL

Question 39

A client is in the emergency department after an overdose of an unknown substance.Which assessment findings does the nurse correlate with possible salicylate poisoning?

A) Increased deep tendon reflexes
B) Increased rate and depth of respiration
C) Decreased capillary refill
D) Decreased intestinal motility and paralytic ileus

Question 40

The nurse interprets which arterial blood gas values as partially compensated metabolic acidosis?

A) pH 7.28, HCO₃^- 19 mEq/L, PCO₂ 45 mm Hg, PO₂ 96 mm Hg
B) pH 7.45, HCO₃^- 22 mEq/L, PCO₂ 40 mm Hg, PO₂ 98 mm Hg
C) pH 7.32, HCO₃^- 17 mEq/L, PCO₂ 25 mm Hg, PO₂ 98 mm Hg
D) pH 7.48, HCO₃^- 28 mEq/L, PCO₂ 45 mm Hg, PO₂ 92 mm Hg

Question 41

In the client with alkalosis,the nurse assesses for which clinical manifestations?

A) Positive Chvostek's sign
B) Positive Trousseau's sign
C) Hyporeflexia
D) Bradycardia
E) Elevated blood pressure
F) Elevated urinary output

Question 42

A client has been NPO after a colectomy with nasogastric (NG)suction in place.On assessment,the nurse finds the client reporting cramps in the calves.Which action by the nurse is most appropriate?

A) Document findings and notify the physician.
B) Stop suction and request that the laboratory draw arterial blood gases.
C) Prepare to administer lorazepam (Ativan).
D) Raise the siderails and notify the physician.

Question 43

A client has the following arterial blood gases (ABGs): pH 7.30,HCO₃^- 22 mEq/L,PCO₂ 55 mm Hg,PO₂ 86 mm Hg.Which intervention by the nurse takes priority?

A) Assessing the airway
B) Administering bronchodilators
C) Administering mucolytics
D) Providing oxygen

Question 44

A client has the following arterial blood gases: pH 7.30,HCO₃^- 17 mEq/L,PCO₂ 25 mm Hg,PO₂ 98 mm Hg.Which intervention by the nurse is most appropriate?

A) Prepare to give intravenous sodium bicarbonate.
B) Document the findings and continue to assess.
C) Assist the physician in determining the cause.
D) Administer oxygen at 2 L per nasal cannula.