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

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?

A) Increased rate and depth of respirations
B) Increased urinary output
C) Increased thirst and hunger
D) Increased release of acids from the kidneys

Answer 1

Increased rate and depth of respirations

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?

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.

Answer 2

Apply oxygen by mask or nasal cannula.

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?

A) Diabetic ketoacidosis in a person with emphysema
B) Bronchial 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

Answer 3

Bronchial obstruction related to aspiration of a hot dog

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.)

A) "Are you taking any antacid medications?"
B) "Is your spouse's current behavior typical?"
C) "Do you drink any alcoholic beverages?"
D) "Have you been experiencing any vomiting?"
E) "Are you experiencing any shortness of breath?"

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?

A) "Do you take any over-the-counter medications?"
B) "You appear anxious.What is causing your distress?"
C) "Do you have a history of anxiety attacks?"
D) "You are breathing fast.Is this causing you to feel light-headed?

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?

A) Furosemide (Lasix) 40 mg intravenous push
B) Sodium bicarbonate 100 mEq diluted in 1 L of D₅W
C) Mechanical ventilation
D) Indwelling urinary catheter

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?

A) Cardiac rate and rhythm
B) Skin and mucous membranes
C) Musculoskeletal strength
D) Level of orientation

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?

A) Notify the Rapid Response Team and provide ventilation support.
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 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.)

A) Metabolic alkalosis - Young adult who is prescribed intravenous morphine sulfate for pain
B) Metabolic acidosis - Older adult who is following a carbohydrate-free diet
C) Respiratory alkalosis - Client on mechanical ventilation at a rate of 28 breaths/min
D) Respiratory acidosis - Postoperative client who received 6 units of packed red blood cells
E) Metabolic alkalosis - Older client prescribed antacids for gastroesophageal reflux disease

Question 10

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

A) Monitor daily hemoglobin and hematocrit values.
B) Administer furosemide (Lasix) intravenously.
C) Encourage the client to take deep breaths.
D) Teach the client fall prevention measures.

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.)

A) Reduction in the function of hormones
B) Fluid and electrolyte imbalances
C) Increase in the function of selected enzymes
D) Excitable cardiac muscle membranes
E) Increase in 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?

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

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?

A) "I will drink at least three glasses of milk each day."
B) "I will eat three well-balanced meals and a snack daily."
C) "I will not take pain medication and antihistamines together."
D) "I will avoid salting my food when cooking or during meals."

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?

A) Assess the airway.
B) Administer prescribed bronchodilators.
C) Provide oxygen.
D) Administer prescribed mucolytics.

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?

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 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?

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

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?

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

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?

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

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.)

A) Positive Chvostek's sign
B) Elevated blood pressure
C) Bradycardia
D) Increased muscle strength
E) 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.)

A) Reduced deep tendon reflexes
B) Drowsiness
C) Increased respiratory rate
D) Decreased urinary output
E) Positive Trousseau's sign