Question 1

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?
A) Drinks 2 cups of black coffee each day.
B) Consumes one orange each day with breakfast.
C) Ingests bicarbonate of soda after each meal.
D) Monitors and tracks daily weights.

Accepted Answer

A) The indiscriminate ingestion of sodium bicarbonate is a risk factor for the development of metabolic alkalosis. Black coffee is not associated with the development of metabolic alkalosis. Oranges contain potassium, which is beneficial to prevent the development of metabolic alkalosis. Tracking of daily weights would help detect a fluid imbalance, which is associated with metabolic alkalosis.
B) The indiscriminate ingestion of sodium bicarbonate is a risk factor for the development of metabolic alkalosis. Black coffee is not associated with the development of metabolic alkalosis. Oranges contain potassium, which is beneficial to prevent the development of metabolic alkalosis. Tracking of daily weights would help detect a fluid imbalance, which is associated with metabolic alkalosis.
C) The indiscriminate ingestion of sodium bicarbonate is a risk factor for the development of metabolic alkalosis. Black coffee is not associated with the development of metabolic alkalosis. Oranges contain potassium, which is beneficial to prevent the development of metabolic alkalosis. Tracking of daily weights would help detect a fluid imbalance, which is associated with metabolic alkalosis.
D) The indiscriminate ingestion of sodium bicarbonate is a risk factor for the development of metabolic alkalosis. Black coffee is not associated with the development of metabolic alkalosis. Oranges contain potassium, which is beneficial to prevent the development of metabolic alkalosis. Tracking of daily weights would help detect a fluid imbalance, which is associated with metabolic alkalosis.

Question 2

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.
A) Apply wrist restraints and secure to the bed frame.
B) Discuss chemical restraint use with the healthcare provider.
C) Keep the bed in the lowest position.
D) Keep bed side rails raised.
E) Place a clock and calendar at the bedside.

Accepted Answer

A) To reduce the client's risk for injury, the nurse should make sure the bed is kept in the lowest position and the side rails are raised. A clock and calendar at the bedside will help with orientation. Restraints are used in the event the client demonstrates harm to self or others. Confusion or a Risk for Injury is not a reason to use wrist or chemical restraints.
B) To reduce the client's risk for injury, the nurse should make sure the bed is kept in the lowest position and the side rails are raised. A clock and calendar at the bedside will help with orientation. Restraints are used in the event the client demonstrates harm to self or others. Confusion or a Risk for Injury is not a reason to use wrist or chemical restraints.
C) To reduce the client's risk for injury, the nurse should make sure the bed is kept in the lowest position and the side rails are raised. A clock and calendar at the bedside will help with orientation. Restraints are used in the event the client demonstrates harm to self or others. Confusion or a Risk for Injury is not a reason to use wrist or chemical restraints.
D) To reduce the client's risk for injury, the nurse should make sure the bed is kept in the lowest position and the side rails are raised. A clock and calendar at the bedside will help with orientation. Restraints are used in the event the client demonstrates harm to self or others. Confusion or a Risk for Injury is not a reason to use wrist or chemical restraints.
E) To reduce the client's risk for injury, the nurse should make sure the bed is kept in the lowest position and the side rails are raised. A clock and calendar at the bedside will help with orientation. Restraints are used in the event the client demonstrates harm to self or others. Confusion or a Risk for Injury is not a reason to use wrist or chemical restraints.

Question 3

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?
A) Daily ingestion of a banana with breakfast
B) Daily weight consistent
C) Daily use of sodium bicarbonate for gastric upset
D) Daily use of prescribed NSAIDs for arthritic pain

Accepted Answer

A) Excess bicarbonate usually occurs as a result of ingesting antacids that contain bicarbonate, such as soda bicarbonate or Alka-Seltzer™. Daily ingestion of a banana would prevent the development of hypokalemia from the daily use of sodium bicarbonate. Consistent daily weights would indicate fluid balance. Daily use of NSAIDs would not support the development of metabolic alkalosis.
B) Excess bicarbonate usually occurs as a result of ingesting antacids that contain bicarbonate, such as soda bicarbonate or Alka-Seltzer™. Daily ingestion of a banana would prevent the development of hypokalemia from the daily use of sodium bicarbonate. Consistent daily weights would indicate fluid balance. Daily use of NSAIDs would not support the development of metabolic alkalosis.
C) Excess bicarbonate usually occurs as a result of ingesting antacids that contain bicarbonate, such as soda bicarbonate or Alka-Seltzer™. Daily ingestion of a banana would prevent the development of hypokalemia from the daily use of sodium bicarbonate. Consistent daily weights would indicate fluid balance. Daily use of NSAIDs would not support the development of metabolic alkalosis.
D) Excess bicarbonate usually occurs as a result of ingesting antacids that contain bicarbonate, such as soda bicarbonate or Alka-Seltzer™. Daily ingestion of a banana would prevent the development of hypokalemia from the daily use of sodium bicarbonate. Consistent daily weights would indicate fluid balance. Daily use of NSAIDs would not support the development of metabolic alkalosis.

Question 4

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?
A) Preparing to administer 0.9% sodium chloride infusion
B) Measuring for nasogastric tube insertion
C) Discussing potassium chloride replace therapy with the healthcare provider
D) Reviewing implications of transfusing with ammonia chloride

Accepted Answer

A) Treatment of metabolic alkalosis includes restoring normal fluid volume and administering potassium chloride. The potassium restores serum and intracellular potassium levels, allowing the kidneys to conserve hydrogen ions more effectively. Since the chloride level is within normal limits, an infusion of 0.9% sodium chloride is not indicated. Removal of gastric secretions is one reason for the development of metabolic alkalosis. A nasogastric tube is not indicated for this client. There is not enough information to support the use of ammonia chloride for this client, as it is indicated to treat severe metabolic alkalosis.
B) Treatment of metabolic alkalosis includes restoring normal fluid volume and administering potassium chloride. The potassium restores serum and intracellular potassium levels, allowing the kidneys to conserve hydrogen ions more effectively. Since the chloride level is within normal limits, an infusion of 0.9% sodium chloride is not indicated. Removal of gastric secretions is one reason for the development of metabolic alkalosis. A nasogastric tube is not indicated for this client. There is not enough information to support the use of ammonia chloride for this client, as it is indicated to treat severe metabolic alkalosis.
C) Treatment of metabolic alkalosis includes restoring normal fluid volume and administering potassium chloride. The potassium restores serum and intracellular potassium levels, allowing the kidneys to conserve hydrogen ions more effectively. Since the chloride level is within normal limits, an infusion of 0.9% sodium chloride is not indicated. Removal of gastric secretions is one reason for the development of metabolic alkalosis. A nasogastric tube is not indicated for this client. There is not enough information to support the use of ammonia chloride for this client, as it is indicated to treat severe metabolic alkalosis.
D) Treatment of metabolic alkalosis includes restoring normal fluid volume and administering potassium chloride. The potassium restores serum and intracellular potassium levels, allowing the kidneys to conserve hydrogen ions more effectively. Since the chloride level is within normal limits, an infusion of 0.9% sodium chloride is not indicated. Removal of gastric secretions is one reason for the development of metabolic alkalosis. A nasogastric tube is not indicated for this client. There is not enough information to support the use of ammonia chloride for this client, as it is indicated to treat severe metabolic alkalosis.

Question 5

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.
A) Ineffective Health Maintenance
B) Risk for Hypothermia
C) Deficient Fluid Volume
D) Risk for Impaired Gas Exchange
E) Risk for Injury

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.

Question 6

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 indicates that the client is at risk for metabolic alkalosis? Select all that apply.
A) The client takes furosemide (Lasix) daily.
B) The client takes a baby aspirin once daily.
C) The client takes metformin daily.
D) The client frequently uses calcium carbonate (Tums) for acid indigestion.
E) The client takes acetaminophen as needed for pain.

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 7

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.
A) Respiratory rate 8 per minute
B) Oxygen saturation 89%
C) Urine output 25 mL/hr
D) Restlessness and agitation
E) Weight loss of 3 kg overnight

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 8

The nurse is reviewing new prescriptions provided by the healthcare provider for a client with metabolic acidosis.Which prescription should the nurse question before implementing it for the client?
A) Begin intravenous infusion of 0.9% normal saline.
B) Draw serum potassium levels every 2 hours.
C) Draw arterial blood gas samples every 2 hours.
D) Administer 1 ampule of sodium bicarbonate now.

Accepted Answer

A) Administering bicarbonate to correct acidosis increases the risk for hypernatremia, hyperosmolality, and fluid volume excess. This is the order that the nurse should question before providing. Treatment of metabolic acidosis includes correction of fluid balance. An infusion of normal saline would be appropriate for this client. As metabolic acidosis is corrected, potassium shifts back into the intracellular space. This shift can lead to hypokalemia and cardiac dysrhythmias. Serum potassium levels should be carefully monitored during treatment. Arterial blood gases are used to evaluate treatment and guide additional therapies.
B) Administering bicarbonate to correct acidosis increases the risk for hypernatremia, hyperosmolality, and fluid volume excess. This is the order that the nurse should question before providing. Treatment of metabolic acidosis includes correction of fluid balance. An infusion of normal saline would be appropriate for this client. As metabolic acidosis is corrected, potassium shifts back into the intracellular space. This shift can lead to hypokalemia and cardiac dysrhythmias. Serum potassium levels should be carefully monitored during treatment. Arterial blood gases are used to evaluate treatment and guide additional therapies.
C) Administering bicarbonate to correct acidosis increases the risk for hypernatremia, hyperosmolality, and fluid volume excess. This is the order that the nurse should question before providing. Treatment of metabolic acidosis includes correction of fluid balance. An infusion of normal saline would be appropriate for this client. As metabolic acidosis is corrected, potassium shifts back into the intracellular space. This shift can lead to hypokalemia and cardiac dysrhythmias. Serum potassium levels should be carefully monitored during treatment. Arterial blood gases are used to evaluate treatment and guide additional therapies.
D) Administering bicarbonate to correct acidosis increases the risk for hypernatremia, hyperosmolality, and fluid volume excess. This is the order that the nurse should question before providing. Treatment of metabolic acidosis includes correction of fluid balance. An infusion of normal saline would be appropriate for this client. As metabolic acidosis is corrected, potassium
shifts back into the intracellular space. This shift can lead to hypokalemia and cardiac dysrhythmias. Serum potassium levels should be carefully monitored during treatment. Arterial blood gases are used to evaluate treatment and guide additional therapies.

Question 9

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?
A) Placing the client in a high-Fowler's position
B) Protecting the client from injury
C) Administering sodium bicarbonate
D) Providing the client with appropriate skin care

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's 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's 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's 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's position would not be the safest position for the confused client.

Question 10

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 11

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?
A) Gastric secretions are green in color.
B) Gastric secretions are alkaline.
C) Gastric secretions are acidic.
D) Gastric secretions have a foul smell.

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 12

An Asian-American 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.
A) Immunizations for the adolescent
B) Nutritional patterns of the adolescent
C) Signs and symptoms of metabolic alkalosis
D) Proper food-handling techniques
E) Normal laboratory values of the adolescent

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 13

The nurse is planning care for the client with Cushing's 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?
A) Monitor serum electrolytes.
B) Schedule nursing activities to allow for periods of rest.
C) Assess input and output accurately.
D) Administer IV fluids per practitioner order.

Accepted Answer

A) The client with Cushing's syndrome is at risk for developing severe metabolic alkalosis that causes hypoxemia and limits energy reserves. Spacing nursing activities throughout the day allows the client ample rest time. The other interventions are aimed at the deficient fluid volume that may occur with metabolic alkalosis.
B) The client with Cushing's syndrome is at risk for developing severe metabolic alkalosis that causes hypoxemia and limits energy reserves. Spacing nursing activities throughout the day allows the client ample rest time. The other interventions are aimed at the deficient fluid volume that may occur with metabolic alkalosis.
C) The client with Cushing's syndrome is at risk for developing severe metabolic alkalosis that causes hypoxemia and limits energy reserves. Spacing nursing activities throughout the day allows the client ample rest time. The other interventions are aimed at the deficient fluid volume that may occur with metabolic alkalosis.
D) The client with Cushing's syndrome is at risk for developing severe metabolic alkalosis that causes hypoxemia and limits energy reserves. Spacing nursing activities throughout the day allows the client ample rest time. The other interventions are aimed at the deficient fluid volume that may occur with metabolic alkalosis.

Question 14

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?
A) The client is injecting insulin into thigh muscle.
B) The client is taking laxatives three times a week to ensure adequate bowel movements.
C) The client is eating three balanced meals per day with two snacks.
D) The client is taking aspirin 325 mg every 6 hours to treat arthritis pain.

Accepted Answer

A) Adequate nutrition is necessary to prevent the buildup of acids in the blood. Incorrect administration of medication could cause a metabolic problem in the client with diabetes. The use of laxatives could cause diarrhea, which can lead to metabolic acidosis. Ingestion of high amounts of salicylate acid can lead to toxicity and the development of metabolic acidosis.
B) Adequate nutrition is necessary to prevent the buildup of acids in the blood. Incorrect administration of medication could cause a metabolic problem in the client with diabetes. The use of laxatives could cause diarrhea, which can lead to metabolic acidosis. Ingestion of high amounts of salicylate acid can lead to toxicity and the development of metabolic acidosis.
C) Adequate nutrition is necessary to prevent the buildup of acids in the blood. Incorrect administration of medication could cause a metabolic problem in the client with diabetes. The use of laxatives could cause diarrhea, which can lead to metabolic acidosis. Ingestion of high amounts of salicylate acid can lead to toxicity and the development of metabolic acidosis.
D) Adequate nutrition is necessary to prevent the buildup of acids in the blood. Incorrect administration of medication could cause a metabolic problem in the client with diabetes. The use of laxatives could cause diarrhea, which can lead to metabolic acidosis. Ingestion of high amounts of salicylate acid can lead to toxicity and the development of metabolic acidosis.

Question 15

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?
A) Client sleeping with the head of the bed flat
B) Half of the client's lunch tray uneaten
C) One formed stool in the bedside commode
D) 1000 mL of intravenous 0.9% normal saline infused in 2 hours

Accepted Answer

A) Excessive infusions of chloride-containing intravenous fluids can precipitate metabolic acidosis. The head of the bed's being flat might influence a client's oxygenation status; however, the client was not demonstrating a change in respiratory depth or rate. A reduction in oral intake does not cause metabolic acidosis. Eating half of a meal tray is not the same as starvation. Diarrhea can lead to the development of metabolic acidosis. One formed stool would not cause the nurse alarm.
B) Excessive infusions of chloride-containing intravenous fluids can precipitate metabolic acidosis. The head of the bed's being flat might influence a client's oxygenation status; however, the client was not demonstrating a change in respiratory depth or rate. A reduction in oral intake does not cause metabolic acidosis. Eating half of a meal tray is not the same as starvation. Diarrhea can lead to the development of metabolic acidosis. One formed stool would not cause the nurse alarm.
C) Excessive infusions of chloride-containing intravenous fluids can precipitate metabolic acidosis. The head of the bed's being flat might influence a client's oxygenation status; however, the client was not demonstrating a change in respiratory depth or rate. A reduction in oral intake does not cause metabolic acidosis. Eating half of a meal tray is not the same as starvation. Diarrhea can lead to the development of metabolic acidosis. One formed stool would not cause the nurse alarm.
D) Excessive infusions of chloride-containing intravenous fluids can precipitate metabolic acidosis. The head of the bed's being flat might influence a client's oxygenation status; however, the client was not demonstrating a change in respiratory depth or rate. A reduction in oral intake does not cause metabolic acidosis. Eating half of a meal tray is not the same as starvation. Diarrhea can lead to the development of metabolic acidosis. One formed stool would not cause the nurse alarm.

Question 16

A client with hyperaldosteronism is admitted to the unit and is at risk for impaired gas exchange.Which position should this client be placed to enhance gas exchange?
A) Fowler's position
B) Prone position
C) Left side-lying position
D) Right Sims position

Accepted Answer

A) The client with prolonged vomiting will likely have severe metabolic alkalosis with reduced oxygenation. The Fowler's position will facilitate alveolar ventilation with improved oxygenation. Side-lying and prone positions do not facilitate needed lung expansion.
B) The client with prolonged vomiting will likely have severe metabolic alkalosis with reduced oxygenation. The Fowler's position will facilitate alveolar ventilation with improved oxygenation. Side-lying and prone positions do not facilitate needed lung expansion.
C) The client with prolonged vomiting will likely have severe metabolic alkalosis with reduced oxygenation. The Fowler's position will facilitate alveolar ventilation with improved oxygenation. Side-lying and prone positions do not facilitate needed lung expansion.
D) The client with prolonged vomiting will likely have severe metabolic alkalosis with reduced oxygenation. The Fowler's position will facilitate alveolar ventilation with improved oxygenation. Side-lying and prone positions do not facilitate needed lung expansion.

Question 17

A client is admitted with manifestations of metabolic alkalosis.Which diagnostic test findings support the admitting diagnosis? Select all that apply.
A) Serum glucose level 142 mg/dL
B) Blood pH 7.47 and bicarbonate 34 mEq/L
C) Intravenous pyelogram shows kidney stones
D) Bilateral lower lobe infiltrates noted on chest x-ray
E) Electrocardiogram changes consistent with hypokalemia

Accepted Answer

A) In metabolic alkalosis, the blood pH will be greater than 7.45 and the bicarbonate level greater than 28 mEq/L. The ECG pattern shows changes similar to those seen with hypokalemia. Serum glucose level is not used to confirm the diagnosis of metabolic alkalosis. The presence of kidney stones is not associated with the development of metabolic alkalosis. The presence of bilateral lower lobe infiltrates on chest x-ray would not contribute to the development of metabolic alkalosis. This finding might be the result of metabolic alkalosis if the client's respiratory status is compromised.
B) In metabolic alkalosis, the blood pH will be greater than 7.45 and the bicarbonate level greater than 28 mEq/L. The ECG pattern shows changes similar to those seen with hypokalemia. Serum glucose level is not used to confirm the diagnosis of metabolic alkalosis. The presence of kidney stones is not associated with the development of metabolic alkalosis. The presence of bilateral lower lobe infiltrates on chest x-ray would not contribute to the development of metabolic alkalosis. This finding might be the result of metabolic alkalosis if the client's respiratory status is compromised.
C) In metabolic alkalosis, the blood pH will be greater than 7.45 and the bicarbonate level greater than 28 mEq/L. The ECG pattern shows changes similar to those seen with hypokalemia. Serum glucose level is not used to confirm the diagnosis of metabolic alkalosis. The presence of kidney stones is not associated with the development of metabolic alkalosis. The presence of bilateral lower lobe infiltrates on chest x-ray would not contribute to the development of metabolic alkalosis. This finding might be the result of metabolic alkalosis if the client's respiratory status is compromised.
D) In metabolic alkalosis, the blood pH will be greater than 7.45 and the bicarbonate level greater than 28 mEq/L. The ECG pattern shows changes similar to those seen with hypokalemia. Serum glucose level is not used to confirm the diagnosis of metabolic alkalosis. The presence of kidney stones is not associated with the development of metabolic alkalosis. The presence of bilateral lower lobe infiltrates on chest x-ray would not contribute to the development of metabolic alkalosis. This finding might be the result of metabolic alkalosis if the client's respiratory status is compromised.
E) In metabolic alkalosis, the blood pH will be greater than 7.45 and the bicarbonate level greater than 28 mEq/L. The ECG pattern shows changes similar to those seen with hypokalemia. Serum glucose level is not used to confirm the diagnosis of metabolic alkalosis. The presence of kidney stones is not associated with the development of metabolic alkalosis. The presence of bilateral lower lobe infiltrates on chest x-ray would not contribute to the development of metabolic alkalosis. This finding might be the result of metabolic alkalosis if the client's respiratory status is compromised.

Question 18

A client with severe metabolic alkalosis is admitted to the unit.Which is the priority for the client?
A) Administering medication for metabolic alkalosis
B) Monitoring oxygen saturation
C) Teaching the client the risk factors for metabolic alkalosis
D) Setting goals for the client with metabolic alkalosis

Accepted Answer

A) The priority for this client is monitoring oxygen saturation. The depressed respiratory drive that often accompanies metabolic alkalosis can lead to hypoxemia and impaired oxygenation of the tissues. Administering medications will be needed as a treatment, but the priority is to discover the cause. Teaching the client and setting goals are important aspects of nursing care but are not the priority.
B) The priority for this client is monitoring oxygen saturation. The depressed respiratory drive that often accompanies metabolic alkalosis can lead to hypoxemia and impaired oxygenation of the tissues. Administering medications will be needed as a treatment, but the priority is to discover the cause. Teaching the client and setting goals are important aspects of nursing care but are not the priority.
C) The priority for this client is monitoring oxygen saturation. The depressed respiratory drive that often accompanies metabolic alkalosis can lead to hypoxemia and impaired oxygenation of the tissues. Administering medications will be needed as a treatment, but the priority is to discover the cause. Teaching the client and setting goals are important aspects of nursing care but are not the priority.
D) The priority for this client is monitoring oxygen saturation. The depressed respiratory drive that often accompanies metabolic alkalosis can lead to hypoxemia and impaired oxygenation of the tissues. Administering medications will be needed as a treatment, but the priority is to discover the cause. Teaching the client and setting goals are important aspects of nursing care but are not the priority.

Question 19

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?
A) "I will use only sodium bicarbonate as my antacid."
B) "I will restrict my intake of fluids."
C) "I will use potassium supplements while I am taking Lasix."
D) "I will take antacids only for my gastric discomforts."

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 20

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

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.

Quiz 1: Acidbase Balance

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?

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.

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?

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?

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.

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 indicates that the client is at risk for metabolic alkalosis? Select all that apply.

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.

The nurse is reviewing new prescriptions provided by the healthcare provider for a client with metabolic acidosis.Which prescription should the nurse question before implementing it for the client?

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?

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?

An Asian-American 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.

The nurse is planning care for the client with Cushing's 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?

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?

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?

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

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

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

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?

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?