Question 1

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 furosemide (Lasix)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 furosemide (Lasix)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 furosemide (Lasix)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 furosemide (Lasix)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 2

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)2000 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 3

An alkalinizing solution often given intravenously to clients with severe acute metabolic acidosis is
A)sodium bicarbonate.
B)sodium chloride.
C)potassium chloride.
D)dextrose.

Accepted Answer

A)Sodium bicarbonate is an alkalinizing solution often given intravenously to clients with severe acute metabolic acidosis. Sodium chloride and potassium chloride may worsen metabolic acidosis by increasing the chloride concentration. Dextrose may also worsen metabolic acidosis, especially in clients with type 1 diabetes, by increasing blood glucose levels and causing ketoacidosis.
B)Sodium bicarbonate is an alkalinizing solution often given intravenously to clients with severe acute metabolic acidosis. Sodium chloride and potassium chloride may worsen metabolic acidosis by increasing the chloride concentration. Dextrose may also worsen metabolic acidosis, especially in clients with type 1 diabetes, by increasing blood glucose levels and causing ketoacidosis.
C)Sodium bicarbonate is an alkalinizing solution often given intravenously to clients with severe acute metabolic acidosis. Sodium chloride and potassium chloride may worsen metabolic acidosis by increasing the chloride concentration. Dextrose may also worsen metabolic acidosis, especially in clients with type 1 diabetes, by increasing blood glucose levels and causing ketoacidosis.
D)Sodium bicarbonate is an alkalinizing solution often given intravenously to clients with severe acute metabolic acidosis. Sodium chloride and potassium chloride may worsen metabolic acidosis by increasing the chloride concentration. Dextrose may also worsen metabolic acidosis, especially in clients with type 1 diabetes, by increasing blood glucose levels and causing ketoacidosis.

Question 4

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?
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 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 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 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 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 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

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 7

A common cause of metabolic acidosis is
A)hyperventilation in a client with anxiety.
B)high blood glucose in a client with type 1 diabetes.
C)vomiting in a client with a gastrointestinal infection.
D)opiate overdose in a client with depression.

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 8

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?
A)Decreased respiratory depth
B)Palpitations
C)Increased deep tendon reflexes
D)Respiratory rate of 38

Accepted Answer

A)The client with metabolic acidosis will have an increased respiratory rate and depth, called Kussmaul respirations. 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, called Kussmaul respirations. 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, called Kussmaul respirations. 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, called Kussmaul respirations. 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 9

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 10

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?
A)Fever
B)Diarrhea
C)Vomiting
D)Diaper rash

Accepted Answer

A)Infants are more susceptible to metabolic acidosis from diarrhea due to significant losses of bicarbonate in the feces. Vomiting is more likely to result in metabolic alkalosis from loss of stomach acids. Fever and diaper rash do not directly contribute to metabolic acidosis.
B)Infants are more susceptible to metabolic acidosis from diarrhea due to significant losses of bicarbonate in the feces. Vomiting is more likely to result in metabolic alkalosis from loss of stomach acids. Fever and diaper rash do not directly contribute to metabolic acidosis.
C)Infants are more susceptible to metabolic acidosis from diarrhea due to significant losses of bicarbonate in the feces. Vomiting is more likely to result in metabolic alkalosis from loss of stomach acids. Fever and diaper rash do not directly contribute to metabolic acidosis.
D)Infants are more susceptible to metabolic acidosis from diarrhea due to significant losses of bicarbonate in the feces. Vomiting is more likely to result in metabolic alkalosis from loss of stomach acids. Fever and diaper rash do not directly contribute to metabolic acidosis.

Question 11

A compensatory mechanism that may indicate to a nurse that a client is experiencing metabolic acidosis includes:
A)headache.
B)Kussmaul respirations.
C)vomiting.
D)decreased level of consciousness.

Accepted Answer

A)Kussmaul respirations are deep and rapid respirations that are a compensatory mechanism during metabolic acidosis. Headache, vomiting, and decreased level of consciousness are all clinical manifestations of metabolic acidosis, but they are not compensatory mechanisms that the body uses to maintain acid-base balance during metabolic acidosis.
B)Kussmaul respirations are deep and rapid respirations that are a compensatory mechanism during metabolic acidosis. Headache, vomiting, and decreased level of consciousness are all clinical manifestations of metabolic acidosis, but they are not compensatory mechanisms that the body uses to maintain acid-base balance during metabolic acidosis.
C)Kussmaul respirations are deep and rapid respirations that are a compensatory mechanism during metabolic acidosis. Headache, vomiting, and decreased level of consciousness are all clinical manifestations of metabolic acidosis, but they are not compensatory mechanisms that the body uses to maintain acid-base balance during metabolic acidosis.
D)Kussmaul respirations are deep and rapid respirations that are a compensatory mechanism during metabolic acidosis. Headache, vomiting, and decreased level of consciousness are all clinical manifestations of metabolic acidosis, but they are not compensatory mechanisms that the body uses to maintain acid-base balance during metabolic acidosis.

Question 12

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 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.
A)Monitor weight on admission and discharge.
B)Monitor ECG for conduction problems.
C)Limit the intake of fluids.
D)Administer sodium bicarbonate.
E)Keep the bed in the locked and low position.

Accepted Answer

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

Question 14

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.
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 15

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 not 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 not 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 not 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 not alkaline. The color and odor of gastric secretions have no influence on the development of metabolic acidosis.

Question 16

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?
A)Losartan (an angiotensin II receptor blocker to reduce hypertension)
B)Simvastatin (a statin to reduce blood cholesterol levels)
C)Rivastigmine (a cholinesterase inhibitor to reduce symptoms of dementia)
D)Aspirin (a salicylate to decrease risk of heart attack)

Accepted Answer

A)Aspirin is salicylic acid, which could decrease the blood pH if taken in high quantities. Diuretics, some antidepressants, antiseizure medications, and angiotensin-converting enzyme (ACE)inhibitors could all affect the acid-base balance in an older adult, but acid-base balance is less affected by angiotensin II receptor blockers, statins, and cholinesterase inhibitors.
B)Aspirin is salicylic acid, which could decrease the blood pH if taken in high quantities. Diuretics, some antidepressants, antiseizure medications, and angiotensin-converting enzyme (ACE)inhibitors could all affect the acid-base balance in an older adult, but acid-base balance is less affected by angiotensin II receptor blockers, statins, and cholinesterase inhibitors.
C)Aspirin is salicylic acid, which could decrease the blood pH if taken in high quantities. Diuretics, some antidepressants, antiseizure medications, and angiotensin-converting enzyme (ACE)inhibitors could all affect the acid-base balance in an older adult, but acid-base balance is less affected by angiotensin II receptor blockers, statins, and cholinesterase inhibitors.
D)Aspirin is salicylic acid, which could decrease the blood pH if taken in high quantities. Diuretics, some antidepressants, antiseizure medications, and angiotensin-converting enzyme (ACE)inhibitors could all affect the acid-base balance in an older adult, but acid-base balance is less affected by angiotensin II receptor blockers, statins, and cholinesterase inhibitors.

Question 17

The nurse is caring for a client with metabolic acidosis. Which goals are appropriate for this client? Select all that apply.
A)The client will maintain a respiratory rate of 30 or more.
B)The client will describe preventative measure for the underlying chronic illness.
C)The client will maintain baseline cardiac rhythm.
D)The client will remain in a pH range from 7.25 to 7.35.
E)The client will take potassium supplements to increase potassium levels.

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 18

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 19

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.
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 20

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 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 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.

Quiz 1: Acid-Base Balance

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?

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?

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

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?

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.

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 common cause of metabolic acidosis is

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?

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

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?

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

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.

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.

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.

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?

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

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.

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?