Question 1

The nurse is caring for a client with metabolic acidosis.Which goals are appropriate for this client? Select all that apply.

Accepted Answer

A)Planning for the client with metabolic acidosis involves identification and treatment of the underlying cause and restoration and maintenance of acid-base balance. The client should be able to describe preventative measures for the underlying chronic illness that caused the metabolic acidosis to occur and maintain the baseline cardiac rhythm. The pH should be maintained between 7.35 and 7.45. The client's respiratory rate should be within normal range for age and condition. Taking a potassium supplement may cause hyperkalemia, which decreases cardiac output and worsens metabolic acidosis.
B)Planning for the client with metabolic acidosis involves identification and treatment of the underlying cause and restoration and maintenance of acid-base balance. The client should be able to describe preventative measures for the underlying chronic illness that caused the metabolic acidosis to occur and maintain the baseline cardiac rhythm. The pH should be maintained between 7.35 and 7.45. The client's respiratory rate should be within normal range for age and condition. Taking a potassium supplement may cause hyperkalemia, which decreases cardiac output and worsens metabolic acidosis.
C)Planning for the client with metabolic acidosis involves identification and treatment of the underlying cause and restoration and maintenance of acid-base balance. The client should be able to describe preventative measures for the underlying chronic illness that caused the metabolic acidosis to occur and maintain the baseline cardiac rhythm. The pH should be maintained between 7.35 and 7.45. The client's respiratory rate should be within normal range for age and condition. Taking a potassium supplement may cause hyperkalemia, which decreases cardiac output and worsens metabolic acidosis.
D)Planning for the client with metabolic acidosis involves identification and treatment of the underlying cause and restoration and maintenance of acid-base balance. The client should be able to describe preventative measures for the underlying chronic illness that caused the metabolic acidosis to occur and maintain the baseline cardiac rhythm. The pH should be maintained between 7.35 and 7.45. The client's respiratory rate should be within normal range for age and condition. Taking a potassium supplement may cause hyperkalemia, which decreases cardiac output and worsens metabolic acidosis.
E)Planning for the client with metabolic acidosis involves identification and treatment of the underlying cause and restoration and maintenance of acid-base balance. The client should be able to describe preventative measures for the underlying chronic illness that caused the metabolic acidosis to occur and maintain the baseline cardiac rhythm. The pH should be maintained between 7.35 and 7.45. The client's respiratory rate should be within normal range for age and condition. Taking a potassium supplement may cause hyperkalemia, which decreases cardiac output and worsens metabolic acidosis.

Question 2

A client with severe metabolic alkalosis is admitted to the unit.Which is the priority for the client?

Accepted Answer

Monitoring the client's oxygen saturation is a priority because severe metabolic alkalosis can cause respiratory depression and hypoventilation, leading to decreased oxygen saturation levels. Administering medication, teaching risk factors, and setting goals can all be important aspects of care, but monitoring oxygen saturation is the priority in this situation.

Question 3

The nurse is preparing to discharge a client with congestive heart failure on furosemide (Lasix).The nurse determines that teaching has been effective if the client makes which statement?

Accepted Answer

A) The client on Lasix (furosemide) may lose excess potassium, disposing the client toward metabolic alkalosis. The client is taught to refrain from the use of sodium antacids when prone to metabolic alkalosis. The client should consult with the primary care provider for gastric distress rather than self-medicate. The client who is prone to metabolic alkalosis is likely to have fluid deficits and would not be instructed to restrict fluids.
B) The client on Lasix (furosemide) may lose excess potassium, disposing the client toward metabolic alkalosis. The client is taught to refrain from the use of sodium antacids when prone to metabolic alkalosis. The client should consult with the primary care provider for gastric distress rather than self-medicate. The client who is prone to metabolic alkalosis is likely to have fluid deficits and would not be instructed to restrict fluids.
C) The client on Lasix (furosemide) may lose excess potassium, disposing the client toward metabolic alkalosis. The client is taught to refrain from the use of sodium antacids when prone to metabolic alkalosis. The client should consult with the primary care provider for gastric distress rather than self-medicate. The client who is prone to metabolic alkalosis is likely to have fluid deficits and would not be instructed to restrict fluids.
D) The client on Lasix (furosemide) may lose excess potassium, disposing the client toward metabolic alkalosis. The client is taught to refrain from the use of sodium antacids when prone to metabolic alkalosis. The client should consult with the primary care provider for gastric distress rather than self-medicate. The client who is prone to metabolic alkalosis is likely to have fluid deficits and would not be instructed to restrict fluids.

Question 4

The nurse is caring for a client who has been admitted to the hospital for congestive heart failure.Which data collected during the nursing assessment indicate that the client is at risk for metabolic alkalosis? Select all that apply.

Accepted Answer

A)Excessive use of calcium carbonate and daily use of furosemide can cause metabolic alkalosis. Use of metformin is not associated with alkalosis. Overuse of aspirin can be associated with metabolic acidosis. Occasional use of acetaminophen is not associated with metabolic alkalosis.
B)Excessive use of calcium carbonate and daily use of furosemide can cause metabolic alkalosis. Use of metformin is not associated with alkalosis. Overuse of aspirin can be associated with metabolic acidosis. Occasional use of acetaminophen is not associated with metabolic alkalosis.
C)Excessive use of calcium carbonate and daily use of furosemide can cause metabolic alkalosis. Use of metformin is not associated with alkalosis. Overuse of aspirin can be associated with metabolic acidosis. Occasional use of acetaminophen is not associated with metabolic alkalosis.
D)Excessive use of calcium carbonate and daily use of furosemide can cause metabolic alkalosis. Use of metformin is not associated with alkalosis. Overuse of aspirin can be associated with metabolic acidosis. Occasional use of acetaminophen is not associated with metabolic alkalosis.
E)Excessive use of calcium carbonate and daily use of furosemide can cause metabolic alkalosis. Use of metformin is not associated with alkalosis. Overuse of aspirin can be associated with metabolic acidosis. Occasional use of acetaminophen is not associated with metabolic alkalosis.

Question 5

An adolescent is hospitalized following several days of vomiting due to food poisoning.The nurse is planning to include which points when teaching the client's family at discharge? Select all that apply.

Accepted Answer

A)The family of anyone experiencing prolonged vomiting should be taught the signs and symptoms of metabolic alkalosis. In this case, the nurse would include teaching about proper methods of food handling to prevent further episodes of food poisoning. Food patterns of the adolescent are not the precipitating factor of the food poisoning, and immunizations would not prevent this disease. Unless the family asks, it is not necessary to teach normal laboratory findings.
B)The family of anyone experiencing prolonged vomiting should be taught the signs and symptoms of metabolic alkalosis. In this case, the nurse would include teaching about proper methods of food handling to prevent further episodes of food poisoning. Food patterns of the adolescent are not the precipitating factor of the food poisoning, and immunizations would not prevent this disease. Unless the family asks, it is not necessary to teach normal laboratory findings.
C)The family of anyone experiencing prolonged vomiting should be taught the signs and symptoms of metabolic alkalosis. In this case, the nurse would include teaching about proper methods of food handling to prevent further episodes of food poisoning. Food patterns of the adolescent are not the precipitating factor of the food poisoning, and immunizations would not prevent this disease. Unless the family asks, it is not necessary to teach normal laboratory findings.
D)The family of anyone experiencing prolonged vomiting should be taught the signs and symptoms of metabolic alkalosis. In this case, the nurse would include teaching about proper methods of food handling to prevent further episodes of food poisoning. Food patterns of the adolescent are not the precipitating factor of the food poisoning, and immunizations would not prevent this disease. Unless the family asks, it is not necessary to teach normal laboratory findings.
E)The family of anyone experiencing prolonged vomiting should be taught the signs and symptoms of metabolic alkalosis. In this case, the nurse would include teaching about proper methods of food handling to prevent further episodes of food poisoning. Food patterns of the adolescent are not the precipitating factor of the food poisoning, and immunizations would not prevent this disease. Unless the family asks, it is not necessary to teach normal laboratory findings.

Question 6

The nurse is planning care for the client with Cushing syndrome who has been admitted for complications related to the disease process.Which intervention should the nurse plan for this client to improve the impaired gas exchange?

Accepted Answer

Impaired gas exchange is a potential complication of Cushing syndrome due to the increased risk of pulmonary edema and hypertension. Scheduling nursing activities to allow for periods of rest can help to reduce the client's oxygen demand and decrease their risk of experiencing respiratory distress. While monitoring serum electrolytes, accurately assessing input and output, and administering IV fluids may be important interventions for clients with Cushing syndrome, these interventions are not directly related to improving impaired gas exchange.

Question 7

An alkalinizing solution often given intravenously to clients with severe acute metabolic acidosis is

Accepted Answer

Sodium bicarbonate is an alkalinizing agent that has the ability to neutralize excess acids in the body. It is commonly used in the treatment of severe acute metabolic acidosis, which is a condition where the body produces too much acid or loses too much base. In this condition, the pH of the blood drops below the normal range, which can cause serious complications such as organ failure and death. Sodium bicarbonate works by reacting with the excess acid in the body to form carbon dioxide, which is then excreted through the lungs. This helps to raise the pH of the blood and restore normal acid-base balance.

Question 8

The nurse identifies the diagnosis Risk for Injury as appropriate for a client with metabolic acidosis.Which strategies should the nurse use to support this diagnosis? Select all that apply.

Accepted Answer

A client with metabolic acidosis is at risk for the development of confusion, lethargy, and even coma due to the accumulation of acids in the bloodstream. To support the diagnosis of Risk for Injury, the nurse should keep the bed in the lowest position, keep the bed side rails raised to prevent the client from falling out of bed, and provide a clock and calendar at the bedside to promote orientation and prevent confusion. Wrist restraints should not be used unless all other measures have failed, and chemical restraints should not be used unless all other measures have failed and the client's behavior poses an imminent danger to self or others.

Question 9

The client has been vomiting for several days.The nurse knows that the client is at risk for metabolic alkalosis because gastric secretions have which characteristic?

Accepted Answer

A) Metabolic alkalosis due to loss of hydrogen ions usually occurs because of vomiting or gastric suction. Gastric secretions are highly acidic (pH 1-3). When these are lost through vomiting or gastric suction, the alkalinity of body fluids increases. This increased alkalinity results from the loss of acid and from selective retention of bicarbonate by the kidneys as chloride is depleted. Gastric secretions are now alkaline. The color and odor of gastric secretions have no influence on the development of metabolic acidosis.
B) Metabolic alkalosis due to loss of hydrogen ions usually occurs because of vomiting or gastric suction. Gastric secretions are highly acidic (pH 1-3). When these are lost through vomiting or gastric suction, the alkalinity of body fluids increases. This increased alkalinity results from the loss of acid and from selective retention of bicarbonate by the kidneys as chloride is depleted. Gastric secretions are now alkaline. The color and odor of gastric secretions have no influence on the development of metabolic acidosis.
C) Metabolic alkalosis due to loss of hydrogen ions usually occurs because of vomiting or gastric suction. Gastric secretions are highly acidic (pH 1-3). When these are lost through vomiting or gastric suction, the alkalinity of body fluids increases. This increased alkalinity results from the loss of acid and from selective retention of bicarbonate by the kidneys as chloride is depleted. Gastric secretions are now alkaline. The color and odor of gastric secretions have no influence on the development of metabolic acidosis.
D) Metabolic alkalosis due to loss of hydrogen ions usually occurs because of vomiting or gastric suction. Gastric secretions are highly acidic (pH 1-3). When these are lost through vomiting or gastric suction, the alkalinity of body fluids increases. This increased alkalinity results from the loss of acid and from selective retention of bicarbonate by the kidneys as chloride is depleted. Gastric secretions are now alkaline. The color and odor of gastric secretions have no influence on the development of metabolic acidosis.

Question 10

An older adult client has a history of heart disease and dementia and takes several medications.His wife states that sometimes he forgets to take his medications,or he takes multiple doses of his medications,due to his dementia.An accidental overdose of which medication could result in metabolic acidosis?

Accepted Answer

Aspirin is a salicylate that, when taken in excess or prolonged periods, can cause metabolic acidosis. This can be especially dangerous for an older adult with a history of heart disease and dementia, as they may not be able to recognize the symptoms or seek medical help in time. Therefore, it's important to monitor their medication intake closely and store aspirin safely.

Question 11

A compensatory mechanism that may indicate to a nurse that a client is experiencing metabolic acidosis includes:

Accepted Answer

Kussmaul respirations, or deep and rapid breathing, are a compensatory mechanism in metabolic acidosis as the body attempts to rid itself of excess carbon dioxide and decrease acidity in the blood. The other options listed are indicative of other conditions, such as dehydration (headache) and neurological dysfunction (vomiting and decreased level of consciousness).

Question 12

Upon entering a room,the nurse quickly scans the environment and then immediately assesses the client for manifestations of metabolic acidosis.Which did the nurse observe to precipitate this client assessment?

Accepted Answer

Infusing 2000 mL of IV normal saline in 2 hours could result in metabolic acidosis due to dilutional effect on the blood bicarbonate levels. The nurse's immediate assessment would be to evaluate the client for manifestations of metabolic acidosis such as disorientation, headache, altered respirations, and changes in vital signs. The other options do not directly relate to the potential cause of metabolic acidosis.

Question 13

The nurse is caring for the client experiencing hypovolemic shock and metabolic acidosis.Which therapies would the nurse question if planned for this client? Select all that apply.

Accepted Answer

A) The treatment for hypovolemic shock would include the administration of fluids, not limiting fluids. Patients being treated for hypovolemia will require daily weights, not a weight on admission and then discharge. Administering sodium bicarbonate and monitoring ECGs are appropriate for the client with shock. The client recovering from hypovolemic shock is at risk for injury, so the bed should be kept in the locked and low position.
B) The treatment for hypovolemic shock would include the administration of fluids, not limiting fluids. Patients being treated for hypovolemia will require daily weights, not a weight on admission and then discharge. Administering sodium bicarbonate and monitoring ECGs are appropriate for the client with shock. The client recovering from hypovolemic shock is at risk for injury, so the bed should be kept in the locked and low position.
C) The treatment for hypovolemic shock would include the administration of fluids, not limiting fluids. Patients being treated for hypovolemia will require daily weights, not a weight on admission and then discharge. Administering sodium bicarbonate and monitoring ECGs are appropriate for the client with shock. The client recovering from hypovolemic shock is at risk for injury, so the bed should be kept in the locked and low position.
D) The treatment for hypovolemic shock would include the administration of fluids, not limiting fluids. Patients being treated for hypovolemia will require daily weights, not a weight on admission and then discharge. Administering sodium bicarbonate and monitoring ECGs are appropriate for the client with shock. The client recovering from hypovolemic shock is at risk for injury, so the bed should be kept in the locked and low position.
E) The treatment for hypovolemic shock would include the administration of fluids, not limiting fluids. Patients being treated for hypovolemia will require daily weights, not a weight on admission and then discharge. Administering sodium bicarbonate and monitoring ECGs are appropriate for the client with shock. The client recovering from hypovolemic shock is at risk for injury, so the bed should be kept in the locked and low position.

Question 14

A common cause of metabolic acidosis is

Accepted Answer

A)High blood glucose that leads to diabetic ketoacidosis is a common cause of metabolic acidosis. Vomiting can lead to metabolic alkalosis, hyperventilation can lead to respiratory alkalosis, and opiate overdose can lead to respiratory acidosis.
B)High blood glucose that leads to diabetic ketoacidosis is a common cause of metabolic acidosis. Vomiting can lead to metabolic alkalosis, hyperventilation can lead to respiratory alkalosis, and opiate overdose can lead to respiratory acidosis.
C)High blood glucose that leads to diabetic ketoacidosis is a common cause of metabolic acidosis. Vomiting can lead to metabolic alkalosis, hyperventilation can lead to respiratory alkalosis, and opiate overdose can lead to respiratory acidosis.
D)High blood glucose that leads to diabetic ketoacidosis is a common cause of metabolic acidosis. Vomiting can lead to metabolic alkalosis, hyperventilation can lead to respiratory alkalosis, and opiate overdose can lead to respiratory acidosis.

Question 15

The nurse is caring for a client admitted with renal failure and metabolic acidosis.Which clinical manifestation would indicate to the nurse that planned interventions to relieve the metabolic acidosis have been effective?

Accepted Answer

A) The client with metabolic acidosis will have an increased respiratory rate and depth. Signs that care has been effective would include a decrease in the rate and depth of respirations. An increased respiratory rate, as indicated by a respiratory rate of 38, would indicate continued metabolic acidosis. Increased deep tendon reflexes and palpitations are not associated with metabolic acidosis.
B) The client with metabolic acidosis will have an increased respiratory rate and depth. Signs that care has been effective would include a decrease in the rate and depth of respirations. An increased respiratory rate, as indicated by a respiratory rate of 38, would indicate continued metabolic acidosis. Increased deep tendon reflexes and palpitations are not associated with metabolic acidosis.
C) The client with metabolic acidosis will have an increased respiratory rate and depth. Signs that care has been effective would include a decrease in the rate and depth of respirations. An increased respiratory rate, as indicated by a respiratory rate of 38, would indicate continued metabolic acidosis. Increased deep tendon reflexes and palpitations are not associated with metabolic acidosis.
D) The client with metabolic acidosis will have an increased respiratory rate and depth. Signs that care has been effective would include a decrease in the rate and depth of respirations. An increased respiratory rate, as indicated by a respiratory rate of 38, would indicate continued metabolic acidosis. Increased deep tendon reflexes and palpitations are not associated with metabolic acidosis.

Question 16

The nurse is caring for a 3-month-old infant who presented to the emergency department (ED)with fever,diarrhea,vomiting,and diaper rash over the past 48 hours.Which symptom puts this client most at risk for metabolic acidosis?

Accepted Answer

Diarrhea can lead to an excess loss of bicarbonate, which can cause metabolic acidosis. Fever, vomiting, and diaper rash do not directly contribute to metabolic acidosis.

Question 17

A client with metabolic acidosis has been admitted to the unit from the emergency department (ED).The client is experiencing confusion and weakness.Which nursing intervention is the priority for this client?

Accepted Answer

A)The client with metabolic acidosis may have symptoms of drowsiness, lethargy, confusion, and weakness. A priority of care would be preventing injury to the client. Medication administration is a physician order. Skin care would not be a priority on admission. The high-Fowler position would not be the safest position for the confused client.
B)The client with metabolic acidosis may have symptoms of drowsiness, lethargy, confusion, and weakness. A priority of care would be preventing injury to the client. Medication administration is a physician order. Skin care would not be a priority on admission. The high-Fowler position would not be the safest position for the confused client.
C)The client with metabolic acidosis may have symptoms of drowsiness, lethargy, confusion, and weakness. A priority of care would be preventing injury to the client. Medication administration is a physician order. Skin care would not be a priority on admission. The high-Fowler position would not be the safest position for the confused client.
D)The client with metabolic acidosis may have symptoms of drowsiness, lethargy, confusion, and weakness. A priority of care would be preventing injury to the client. Medication administration is a physician order. Skin care would not be a priority on admission. The high-Fowler position would not be the safest position for the confused client.

Question 18

During a home visit,the nurse evaluates care provided to a client with type 1 diabetes mellitus and a history of metabolic acidosis.Which outcome indicates that the care of this client has been successful?

Accepted Answer

Eating three balanced meals per day with two snacks indicates that the client is following a proper meal plan for managing type 1 diabetes mellitus and preventing metabolic acidosis. Injecting insulin into the thigh muscle is a proper technique but it does not necessarily indicate successful care. Taking laxatives or aspirin is not relevant to the management of diabetes or metabolic acidosis.

Question 19

The nurse is preparing to teach a client with type 1 diabetes mellitus on the mechanism behind the development of ketoacidosis.List the order in which the nurse should provide this information.
1.Production of lactate and hydrogen ions
2.Tissue hypoxemia
3.Breakdown of fatty tissue
4.Reduction in intracellular glucose
5.Fatty acids converted to ketones

Accepted Answer

The answer of The nurse is preparing to teach a...

Question 20

The nurse is planning care for the client who has been admitted with metabolic alkalosis.Which are appropriate nursing diagnoses for this client during the acute phase of the illness? Select all that apply.

Accepted Answer

A) Respiratory compensation for metabolic alkalosis includes depression of the respiratory rate and reduction of the depth of respirations, leading to the retention of carbon dioxide. Patients with metabolic alkalosis often have an accompanying fluid volume deficit. With the fluid volume deficit, the client would experience hyperthermia. Ineffective health maintenance would not be a priority during the acute phase of the disease but, rather, a teaching opportunity before discharge depending on the cause of the metabolic alkalosis. The client is at risk for injury because of the associated muscle spasms and dizziness.
B) Respiratory compensation for metabolic alkalosis includes depression of the respiratory rate and reduction of the depth of respirations, leading to the retention of carbon dioxide. Patients with metabolic alkalosis often have an accompanying fluid volume deficit. With the fluid volume deficit, the client would experience hyperthermia. Ineffective health maintenance would not be a priority during the acute phase of the disease but, rather, a teaching opportunity before discharge depending on the cause of the metabolic alkalosis. The client is at risk for injury because of the associated muscle spasms and dizziness.
C) Respiratory compensation for metabolic alkalosis includes depression of the respiratory rate and reduction of the depth of respirations, leading to the retention of carbon dioxide. Patients with metabolic alkalosis often have an accompanying fluid volume deficit. With the fluid volume deficit, the client would experience hyperthermia. Ineffective health maintenance would not be a priority during the acute phase of the disease but, rather, a teaching opportunity before discharge depending on the cause of the metabolic alkalosis. The client is at risk for injury because of the associated muscle spasms and dizziness.
D) Respiratory compensation for metabolic alkalosis includes depression of the respiratory rate and reduction of the depth of respirations, leading to the retention of carbon dioxide. Patients with metabolic alkalosis often have an accompanying fluid volume deficit. With the fluid volume deficit, the client would experience hyperthermia. Ineffective health maintenance would not be a priority during the acute phase of the disease but, rather, a teaching opportunity before discharge depending on the cause of the metabolic alkalosis. The client is at risk for injury because of the associated muscle spasms and dizziness.
E) Respiratory compensation for metabolic alkalosis includes depression of the respiratory rate and reduction of the depth of respirations, leading to the retention of carbon dioxide. Patients with metabolic alkalosis often have an accompanying fluid volume deficit. With the fluid volume deficit, the client would experience hyperthermia. Ineffective health maintenance would not be a priority during the acute phase of the disease but, rather, a teaching opportunity before discharge depending on the cause of the metabolic alkalosis. The client is at risk for injury because of the associated muscle spasms and dizziness.

Quiz 1: Acid-Base Balance