Question 1

A client with hyperaldosteronism is admitted to the unit and is at risk for impaired gas exchange.In which position should this client be placed to enhance gas exchange?

Accepted Answer

Placing the client in Fowler position, which is a semi-upright position, will enhance gas exchange. This position helps to reduce pressure on the diaphragm, allowing for better chest expansion and improved ventilation. The semi-upright position also promotes drainage of secretions and reduces the risk of aspiration. Prone position, left side-lying position and right Sims position are not recommended for clients with impaired gas exchange.

Question 2

The nurse is providing care to a client recently extubated for treatment of aspiration pneumonia and respiratory acidosis.Which action by the nurse provides an optimum environment for this client?

Accepted Answer

Allowing family members to remain with the client can provide emotional support and promote a calm environment, which is beneficial for the client’s recovery. Restraining the client can cause further respiratory distress and anxiety. Placing the client in a side-lying position may be beneficial for some clients, but individual assessment is needed to determine if this is the best position for this client. Administering narcotics for pain management may cause respiratory depression and further exacerbate the respiratory acidosis.

Question 3

A client is admitted with manifestations of metabolic alkalosis.Which diagnostic test findings support the admitting diagnosis? Select all that apply.

Accepted Answer

Metabolic alkalosis is characterized by elevated blood pH and bicarbonate levels. Option B shows blood pH of 7.47 and bicarbonate level of 34 mEq/L which supports the diagnosis of metabolic alkalosis. Electrocardiogram changes consistent with hypokalemia can also be seen in metabolic alkalosis, which is shown in option E. The other options, A, C, and D do not support the diagnosis of metabolic alkalosis.

Question 4

The nurse is reviewing prescriptions written for a client with chronic respiratory acidosis.Which prescription should the nurse question prior to implementation?

Accepted Answer

Clients with chronic respiratory acidosis often retain carbon dioxide, resulting in a decreased sensitivity to hypoxemia. Administering high levels of oxygen can lead to further carbon dioxide retention and respiratory depression. Oxygen therapy should be carefully monitored in clients with chronic respiratory acidosis.

Question 5

The nurse is preparing to admit a client with acute pneumonia who is experiencing severe respiratory acidosis.Which treatments does the nurse anticipate as appropriate for this client? Select all that apply.

Accepted Answer

A) The client with acute pneumonia and respiratory acidosis may require oxygen administration to improve gas exchange, increased fluid intake to thin secretions, and frequent repositioning to preventing the pooling of respiratory sections. There is not enough evidence to know whether the client is experiencing heart failure as a result of the acute pneumonia.
B) The client with acute pneumonia and respiratory acidosis may require oxygen administration to improve gas exchange, increased fluid intake to thin secretions, and frequent repositioning to preventing the pooling of respiratory sections. There is not enough evidence to know whether the client is experiencing heart failure as a result of the acute pneumonia.
C) The client with acute pneumonia and respiratory acidosis may require oxygen administration to improve gas exchange, increased fluid intake to thin secretions, and frequent repositioning to preventing the pooling of respiratory sections. There is not enough evidence to know whether the client is experiencing heart failure as a result of the acute pneumonia.
D) The client with acute pneumonia and respiratory acidosis may require oxygen administration to improve gas exchange, increased fluid intake to thin secretions, and frequent repositioning to preventing the pooling of respiratory sections. There is not enough evidence to know whether the client is experiencing heart failure as a result of the acute pneumonia.
E) The client with acute pneumonia and respiratory acidosis may require oxygen administration to improve gas exchange, increased fluid intake to thin secretions, and frequent repositioning to preventing the pooling of respiratory sections. There is not enough evidence to know whether the client is experiencing heart failure as a result of the acute pneumonia.

Question 6

The nurse is caring for a client who has been admitted to the unit with respiratory failure and respiratory acidosis.Which data from the nursing history would the nurse suspect contributed to the client's current state of health?

Accepted Answer

Aspiration pneumonia can cause the aspiration of stomach contents into the lungs, leading to respiratory distress and potential respiratory failure. It is a known risk factor for respiratory acidosis. The other options may not be directly related to the client's current respiratory status.

Question 7

The nurse is preparing discharge instructions for an older adult client recovering from respiratory acidosis caused by restrictive lung disease and pneumonia.Which topics should the nurse include in the discharge teaching for this client? Select all that apply.

Accepted Answer

The nurse should include instructions on preventative measures for infections such as obtaining an annual influenza immunization, engaging in frequent hand washing, avoiding crowds, and covering the nose and mouth when coughing. Restricting fluids is not necessary unless there is a specific indication for it, and it is not listed as a common instruction for respiratory acidosis caused by restrictive lung disease and pneumonia.

Question 8

The nurse is caring for a client who is being mechanically ventilated.The current ventilator settings are: respiratory rate,25 breaths per minute;tidal volume,600 mL;FiO₂,30%;humidification 30 mg H₂O/L.After being ventilated for 2 hours,arterial blood gas analysis reveals a pH of 7.20 and a PaCO₂ of 49 mmHg.Which change in ventilator settings should the nurse anticipate?

Accepted Answer

A)This client is exhibiting respiratory acidosis that is not corrected by the current ventilator settings. This client needs to "blow off" more CO₂; therefore, the respiratory rate would be increased. Both decreasing the FiO₂ and decreasing the tidal volume would decrease the amount of CO₂ expelled. Humidification has no effect on the amount of CO₂ expelled. B)This client is exhibiting respiratory acidosis that is not corrected by the current ventilator settings. This client needs to "blow off" more CO₂; therefore, the respiratory rate would be increased. Both decreasing the FiO₂ and decreasing the tidal volume would decrease the amount of CO₂ expelled. Humidification has no effect on the amount of CO₂ expelled. C)This client is exhibiting respiratory acidosis that is not corrected by the current ventilator settings. This client needs to "blow off" more CO₂; therefore, the respiratory rate would be increased. Both decreasing the FiO₂ and decreasing the tidal volume would decrease the amount of CO₂ expelled. Humidification has no effect on the amount of CO₂ expelled. D)This client is exhibiting respiratory acidosis that is not corrected by the current ventilator settings. This client needs to "blow off" more CO₂; therefore, the respiratory rate would be increased. Both decreasing the FiO₂ and decreasing the tidal volume would decrease the amount of CO₂ expelled. Humidification has no effect on the amount of CO₂ expelled.

Question 9

The nurse suspects a client with one functioning lung is developing chronic respiratory acidosis.Which manifestation did the nurse most likely assess in this client?

Accepted Answer

A) The manifestations of acute and chronic respiratory acidosis differ. The client with chronic respiratory acidosis will demonstrate daytime sleepiness. The client with acute respiratory acidosis may demonstrate warm, flushed skin, irritability, and blurred vision from the acute decline in oxygenation.
B) The manifestations of acute and chronic respiratory acidosis differ. The client with chronic respiratory acidosis will demonstrate daytime sleepiness. The client with acute respiratory acidosis may demonstrate warm, flushed skin, irritability, and blurred vision from the acute decline in oxygenation.
C) The manifestations of acute and chronic respiratory acidosis differ. The client with chronic respiratory acidosis will demonstrate daytime sleepiness. The client with acute respiratory acidosis may demonstrate warm, flushed skin, irritability, and blurred vision from the acute decline in oxygenation.
D) The manifestations of acute and chronic respiratory acidosis differ. The client with chronic respiratory acidosis will demonstrate daytime sleepiness. The client with acute respiratory acidosis may demonstrate warm, flushed skin, irritability, and blurred vision from the acute decline in oxygenation.

Question 10

Clinical manifestations of metabolic alkalosis are similar to signs of

Accepted Answer

A)Manifestations of metabolic alkalosis result from decreased calcium ionization and are similar to those of hypocalcemia. They include numbness and tingling around the mouth, fingers, and toes; dizziness; Trousseau sign; and muscle spasm. Clinical manifestations of metabolic alkalosis are not similar to those of hypercalcemia or hyper- or hypokalemia.
B)Manifestations of metabolic alkalosis result from decreased calcium ionization and are similar to those of hypocalcemia. They include numbness and tingling around the mouth, fingers, and toes; dizziness; Trousseau sign; and muscle spasm. Clinical manifestations of metabolic alkalosis are not similar to those of hypercalcemia or hyper- or hypokalemia.
C)Manifestations of metabolic alkalosis result from decreased calcium ionization and are similar to those of hypocalcemia. They include numbness and tingling around the mouth, fingers, and toes; dizziness; Trousseau sign; and muscle spasm. Clinical manifestations of metabolic alkalosis are not similar to those of hypercalcemia or hyper- or hypokalemia.
D)Manifestations of metabolic alkalosis result from decreased calcium ionization and are similar to those of hypocalcemia. They include numbness and tingling around the mouth, fingers, and toes; dizziness; Trousseau sign; and muscle spasm. Clinical manifestations of metabolic alkalosis are not similar to those of hypercalcemia or hyper- or hypokalemia.

Question 11

A client with pneumonia develops respiratory acidosis.Based on provider's orders,which medications should the nurse prepare to administer to this client? Select all that apply.

Accepted Answer

A)Bronchodilator drugs such as an albuterol inhaler may be administered to open the airways, and antibiotics such as amoxicillin may be prescribed to treat respiratory infections. Benzodiazepines such as diazepam are central nervous system depressants and would adversely affect this client's respiratory rate, adversely affecting respiratory acidosis. Potassium chloride is indicated in the treatment of metabolic alkalosis.
B)Bronchodilator drugs such as an albuterol inhaler may be administered to open the airways, and antibiotics such as amoxicillin may be prescribed to treat respiratory infections. Benzodiazepines such as diazepam are central nervous system depressants and would adversely affect this client's respiratory rate, adversely affecting respiratory acidosis. Potassium chloride is indicated in the treatment of metabolic alkalosis.
C)Bronchodilator drugs such as an albuterol inhaler may be administered to open the airways, and antibiotics such as amoxicillin may be prescribed to treat respiratory infections. Benzodiazepines such as diazepam are central nervous system depressants and would adversely affect this client's respiratory rate, adversely affecting respiratory acidosis. Potassium chloride is indicated in the treatment of metabolic alkalosis.
D)Bronchodilator drugs such as an albuterol inhaler may be administered to open the airways, and antibiotics such as amoxicillin may be prescribed to treat respiratory infections. Benzodiazepines such as diazepam are central nervous system depressants and would adversely affect this client's respiratory rate, adversely affecting respiratory acidosis. Potassium chloride is indicated in the treatment of metabolic alkalosis.
E)Bronchodilator drugs such as an albuterol inhaler may be administered to open the airways, and antibiotics such as amoxicillin may be prescribed to treat respiratory infections. Benzodiazepines such as diazepam are central nervous system depressants and would adversely affect this client's respiratory rate, adversely affecting respiratory acidosis. Potassium chloride is indicated in the treatment of metabolic alkalosis.

Question 12

A client is admitted to the emergency department (ED)for treatment of an overdose.The client's arterial blood gas results indicate acute respiratory acidosis.Which substance found on the nurse's review of the toxicology analysis is most likely the cause for the client's current condition?

Accepted Answer

Narcotics such as oxycodone can cause respiratory depression, leading to a buildup of carbon dioxide and subsequent respiratory acidosis. Cocaine, marijuana, and PCP are not known to cause respiratory depression as a primary side effect.

Question 13

A school-age client is admitted to the hospital with respiratory acidosis.Which chronic lung illness in the client's health history does the nurse suspect is causing the current diagnosis?

Accepted Answer

Cystic fibrosis is a chronic lung disease that can lead to respiratory acidosis due to inadequate oxygenation and carbon dioxide elimination. Aspiration and pneumonia may cause respiratory distress and hypoxemia, but not necessarily respiratory acidosis. Hyperthyroidism is not typically associated with respiratory acidosis.

Question 14

During a home visit,the nurse evaluates teaching provided to a client recently hospitalized for metabolic alkalosis.Which observation indicates that additional teaching is required?

Accepted Answer

Ingesting bicarbonate of soda can worsen metabolic alkalosis as it is a base that can increase blood pH levels. The client should be taught to avoid consuming alkaline substances, like bicarbonate of soda, and encouraged to drink acidic fluids, like cranberry juice or lemonade, to help restore acid-base balance. The other options are not related to the client's condition and do not indicate a need for additional teaching.

Question 15

The nurse assumes care for a client who was brought to the hospital after a morphine overdose.What acid-base imbalance does the nurse expect to observe in this client?

Accepted Answer

A) Morphine is a narcotic and generally acts to decrease or suppress respirations; therefore, this client is probably hypoventilating. The expected acid-base imbalance would be respiratory acidosis. Respiratory alkalosis, metabolic acidosis, and metabolic alkalosis are caused by many conditions, none of which are related to this client's morphine overdose.
B) Morphine is a narcotic and generally acts to decrease or suppress respirations; therefore, this client is probably hypoventilating. The expected acid-base imbalance would be respiratory acidosis. Respiratory alkalosis, metabolic acidosis, and metabolic alkalosis are caused by many conditions, none of which are related to this client's morphine overdose.
C) Morphine is a narcotic and generally acts to decrease or suppress respirations; therefore, this client is probably hypoventilating. The expected acid-base imbalance would be respiratory acidosis. Respiratory alkalosis, metabolic acidosis, and metabolic alkalosis are caused by many conditions, none of which are related to this client's morphine overdose.
D) Morphine is a narcotic and generally acts to decrease or suppress respirations; therefore, this client is probably hypoventilating. The expected acid-base imbalance would be respiratory acidosis. Respiratory alkalosis, metabolic acidosis, and metabolic alkalosis are caused by many conditions, none of which are related to this client's morphine overdose.

Question 16

While reviewing laboratory results,the nurse notes that a client's potassium level is 2.8 mEq/L and chloride level is 100 mEq/L.Based on this data,which intervention does the nurse plan for this client?

Accepted Answer

The client has a low potassium level (hypokalemia) and a normal chloride level. This suggests the need for potassium chloride replacement therapy, which should be discussed with the healthcare provider. Option A (administering 0.9% sodium chloride infusion) is not indicated for this electrolyte imbalance. Option B (nasogastric tube insertion) is not directly related to the electrolyte imbalance. Option D (transfusing with ammonium chloride) is contraindicated in this case, as it can worsen the hypokalemia.

Question 17

A newborn with pyloric stenosis has symptoms of projectile vomiting,leading to significant weight loss,dehydration,and metabolic alkalosis.What client teaching is necessary for the parents in caring for the infant until surgery to correct the defect?

Accepted Answer

The infant with pyloric stenosis is at risk for aspiration due to frequent vomiting. Therefore, positioning the infant upright and monitoring closely during and after feedings is important to prevent aspiration. Options A, B, and D are not relevant in the care of an infant with pyloric stenosis.

Question 18

During an assessment,the nurse becomes concerned that a client is at risk for developing metabolic alkalosis.What did the nurse assess that caused this concern?

Accepted Answer

The daily use of sodium bicarbonate for gastric upset can lead to metabolic alkalosis by increasing the pH of the blood.

Question 19

The nurse identifies the diagnosis Risk for Impaired Gas Exchange to guide the care of a client with metabolic alkalosis.Which assessment data supports this nursing diagnosis? Select all that apply.

Accepted Answer

A) Respiratory compensation for metabolic alkalosis depresses the respiratory rate and reduces the depth of breathing to promote carbon dioxide retention. The depressed respiratory drive associated with metabolic alkalosis can lead to hypoxemia and impaired oxygenation of tissues. Oxygen saturation levels of less than 90% indicate significant oxygenation problems. Changes in mental status or behavior may be early signs of hypoxia. Urine output less than 30 mL/hr would indicate Fluid Volume Deficit. Weight is used as an indicator of fluid balance. A rapid weight change would indicate Fluid Volume Deficit.
B) Respiratory compensation for metabolic alkalosis depresses the respiratory rate and reduces the depth of breathing to promote carbon dioxide retention. The depressed respiratory drive associated with metabolic alkalosis can lead to hypoxemia and impaired oxygenation of tissues. Oxygen saturation levels of less than 90% indicate significant oxygenation problems. Changes in mental status or behavior may be early signs of hypoxia. Urine output less than 30 mL/hr would indicate Fluid Volume Deficit. Weight is used as an indicator of fluid balance. A rapid weight change would indicate Fluid Volume Deficit.
C) Respiratory compensation for metabolic alkalosis depresses the respiratory rate and reduces the depth of breathing to promote carbon dioxide retention. The depressed respiratory drive associated with metabolic alkalosis can lead to hypoxemia and impaired oxygenation of tissues. Oxygen saturation levels of less than 90% indicate significant oxygenation problems. Changes in mental status or behavior may be early signs of hypoxia. Urine output less than 30 mL/hr would indicate Fluid Volume Deficit. Weight is used as an indicator of fluid balance. A rapid weight change would indicate Fluid Volume Deficit.
D) Respiratory compensation for metabolic alkalosis depresses the respiratory rate and reduces the depth of breathing to promote carbon dioxide retention. The depressed respiratory drive associated with metabolic alkalosis can lead to hypoxemia and impaired oxygenation of tissues. Oxygen saturation levels of less than 90% indicate significant oxygenation problems. Changes in mental status or behavior may be early signs of hypoxia. Urine output less than 30 mL/hr would indicate Fluid Volume Deficit. Weight is used as an indicator of fluid balance. A rapid weight change would indicate Fluid Volume Deficit.
E) Respiratory compensation for metabolic alkalosis depresses the respiratory rate and reduces the depth of breathing to promote carbon dioxide retention. The depressed respiratory drive associated with metabolic alkalosis can lead to hypoxemia and impaired oxygenation of tissues. Oxygen saturation levels of less than 90% indicate significant oxygenation problems. Changes in mental status or behavior may be early signs of hypoxia. Urine output less than 30 mL/hr would indicate Fluid Volume Deficit. Weight is used as an indicator of fluid balance. A rapid weight change would indicate Fluid Volume Deficit.

Question 20

A client is admitted to the unit with chronic obstructive pulmonary disease.Blood gas analysis indicates respiratory acidosis.Based on this data,the nurse plans care based on which priority diagnosis?

Accepted Answer

The blood gas analysis indicating respiratory acidosis suggests that the client is not adequately exchanging gases, which can lead to further complications. Therefore, the priority diagnosis should be impaired gas exchange. Ineffective airway clearance, impaired mobility, and anxiety may also be present and should be addressed, but they are not the priority in this situation.

Quiz 1: Acid-Base Balance