Question 1

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 26 mEq/L. The ECG pattern shows changes similar to those seen with hypokalemia. Serum glucose levels, kidney stones, and lower lobe infiltrates are not associated with metabolic alkalosis.
B)In metabolic alkalosis, the blood pH will be greater than 7.45 and the bicarbonate level greater than 26 mEq/L. The ECG pattern shows changes similar to those seen with hypokalemia. Serum glucose levels, kidney stones, and lower lobe infiltrates are not associated with metabolic alkalosis.
C)In metabolic alkalosis, the blood pH will be greater than 7.45 and the bicarbonate level greater than 26 mEq/L. The ECG pattern shows changes similar to those seen with hypokalemia. Serum glucose levels, kidney stones, and lower lobe infiltrates are not associated with metabolic alkalosis.
D)In metabolic alkalosis, the blood pH will be greater than 7.45 and the bicarbonate level greater than 26 mEq/L. The ECG pattern shows changes similar to those seen with hypokalemia. Serum glucose levels, kidney stones, and lower lobe infiltrates are not associated with metabolic alkalosis.
E)In metabolic alkalosis, the blood pH will be greater than 7.45 and the bicarbonate level greater than 26 mEq/L. The ECG pattern shows changes similar to those seen with hypokalemia. Serum glucose levels, kidney stones, and lower lobe infiltrates are not associated with metabolic alkalosis.

Question 2

A client is admitted to the unit with chronic obstructive pulmonary disease. Blood gas analysis indicates respiratory acidosis. Based on this data, the nurse plans care based on which priority diagnosis?
A)Impaired Gas Exchange
B)Ineffective Airway Clearance
C)Impaired Mobility
D)Anxiety

Accepted Answer

A)Impaired Gas Exchange is the priority nursing diagnosis for the client with respiratory acidosis. Interventions are aimed at restoring effective alveolar ventilation and gas exchange. Anxiety and Ineffective Airway Clearance are both appropriate nursing diagnoses but not priority for the client with respiratory acidosis. There is no evidence to support the nursing diagnosis Impaired Mobility for this client.
B)Impaired Gas Exchange is the priority nursing diagnosis for the client with respiratory acidosis. Interventions are aimed at restoring effective alveolar ventilation and gas exchange. Anxiety and Ineffective Airway Clearance are both appropriate nursing diagnoses but not priority for the client with respiratory acidosis. There is no evidence to support the nursing diagnosis Impaired Mobility for this client.
C)Impaired Gas Exchange is the priority nursing diagnosis for the client with respiratory acidosis. Interventions are aimed at restoring effective alveolar ventilation and gas exchange. Anxiety and Ineffective Airway Clearance are both appropriate nursing diagnoses but not priority for the client with respiratory acidosis. There is no evidence to support the nursing diagnosis Impaired Mobility for this client.
D)Impaired Gas Exchange is the priority nursing diagnosis for the client with respiratory acidosis. Interventions are aimed at restoring effective alveolar ventilation and gas exchange. Anxiety and Ineffective Airway Clearance are both appropriate nursing diagnoses but not priority for the client with respiratory acidosis. There is no evidence to support the nursing diagnosis Impaired Mobility for this client.

Question 3

A client with pneumonia develops respiratory acidosis. Based on provider's orders, which medications should the nurse prepare to administer to this client? Select all that apply.
A)The loop diuretic furosemide (Lasix), 20 mg by mouth twice a day
B)The antibiotic amoxicillin, 1 gram intravenous every 6 hours
C)The bronchodilator albuterol, inhaler 2 puffs every 4 hours
D)The anxiolytic diazepam (Valium), 2 mg by mouth at bedtime for sleep
E)Potassium chloride 20 mEq in 100 mL 0.9% normal saline intravenous every day

Accepted Answer

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

Question 4

The nurse is caring for a client who is being mechanically ventilated. The current ventilator settings are: respiratory rate, 25 breaths per minute; tidal volume, 600 mL; FiO₂, 30%; humidification 30 mg H₂O/L. After being ventilated for 2 hours, arterial blood gas analysis reveals a pH of 7.20 and a PaCO₂ of 49 mmHg. Which change in ventilator settings should the nurse anticipate? A)Increase in humidification of inspired air B)Decrease of FiO₂ from 30% to 25% C)Increased respiratory rate to 30 breaths per minute D)Decreased tidal volume of each breath

Accepted Answer

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

Question 5

The nurse is caring for a client who has been admitted to the unit with respiratory failure and respiratory acidosis. Which data from the nursing history would the nurse suspect contributed to the client's current state of health?
A)Use of ibuprofen for the control of pain
B)A recent trip to South America
C)Aspiration pneumonia
D)Recent recovery from a cold virus

Accepted Answer

A)Aspiration of a foreign body and acute pneumonia would put the client at risk for respiratory acidosis. A recent trip to South America would not constitute a respiratory risk factor. Recent recovery from a cold would not likely put the client at risk. Ibuprofen does not pose a threat to the respiratory health of the client.
B)Aspiration of a foreign body and acute pneumonia would put the client at risk for respiratory acidosis. A recent trip to South America would not constitute a respiratory risk factor. Recent recovery from a cold would not likely put the client at risk. Ibuprofen does not pose a threat to the respiratory health of the client.
C)Aspiration of a foreign body and acute pneumonia would put the client at risk for respiratory acidosis. A recent trip to South America would not constitute a respiratory risk factor. Recent recovery from a cold would not likely put the client at risk. Ibuprofen does not pose a threat to the respiratory health of the client.
D)Aspiration of a foreign body and acute pneumonia would put the client at risk for respiratory acidosis. A recent trip to South America would not constitute a respiratory risk factor. Recent recovery from a cold would not likely put the client at risk. Ibuprofen does not pose a threat to the respiratory health of the client.

Question 6

A client is admitted to the emergency department (ED)for treatment of an overdose. The client's arterial blood gas results indicate acute respiratory acidosis. Which substance found on the nurse's review of the toxicology analysis is most likely the cause for the client's current condition?
A)Cocaine (a stimulatory anesthetic)
B)Marijuana (a cannabinoid)
C)Oxycodone (a narcotic)
D)PCP (a dissociative anesthetic)

Accepted Answer

A)Oxycodone is an opiate narcotic. Excessive use or overdose of narcotic substances can lead to respiratory depression and respiratory acidosis. Cocaine is a stimulant. Marijuana does not depress the central nervous system or respiratory center. PCP is a hallucinogenic agent.
B)Oxycodone is an opiate narcotic. Excessive use or overdose of narcotic substances can lead to respiratory depression and respiratory acidosis. Cocaine is a stimulant. Marijuana does not depress the central nervous system or respiratory center. PCP is a hallucinogenic agent.
C)Oxycodone is an opiate narcotic. Excessive use or overdose of narcotic substances can lead to respiratory depression and respiratory acidosis. Cocaine is a stimulant. Marijuana does not depress the central nervous system or respiratory center. PCP is a hallucinogenic agent.
D)Oxycodone is an opiate narcotic. Excessive use or overdose of narcotic substances can lead to respiratory depression and respiratory acidosis. Cocaine is a stimulant. Marijuana does not depress the central nervous system or respiratory center. PCP is a hallucinogenic agent.

Question 7

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

Accepted Answer

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

Question 8

The nurse is providing care to a client recently extubated for treatment of aspiration pneumonia and respiratory acidosis. Which action by the nurse provides an optimum environment for this client?
A)Allowing family members to remain with client as much as possible
B)Restraining the client
C)Placing the client in a side-lying position
D)Administering narcotics for pain

Accepted Answer

A)The client with respiratory acidosis often experiences anxiety. This client would benefit from having a family member in the room to provide reassurance. Restraining the client will increase levels of agitation. The client with respiratory failure would benefit most from the semi-Fowler or Fowler position to increase ventilation. Narcotics will depress the respirations and increase respiratory acidosis. A nonnarcotic pain reliever would be considered if this client were experiencing pain.
B)The client with respiratory acidosis often experiences anxiety. This client would benefit from having a family member in the room to provide reassurance. Restraining the client will increase levels of agitation. The client with respiratory failure would benefit most from the semi-Fowler or Fowler position to increase ventilation. Narcotics will depress the respirations and increase respiratory acidosis. A nonnarcotic pain reliever would be considered if this client were experiencing pain.
C)The client with respiratory acidosis often experiences anxiety. This client would benefit from having a family member in the room to provide reassurance. Restraining the client will increase levels of agitation. The client with respiratory failure would benefit most from the semi-Fowler or Fowler position to increase ventilation. Narcotics will depress the respirations and increase respiratory acidosis. A nonnarcotic pain reliever would be considered if this client were experiencing pain.
D)The client with respiratory acidosis often experiences anxiety. This client would benefit from having a family member in the room to provide reassurance. Restraining the client will increase levels of agitation. The client with respiratory failure would benefit most from the semi-Fowler or Fowler position to increase ventilation. Narcotics will depress the respirations and increase respiratory acidosis. A nonnarcotic pain reliever would be considered if this client were experiencing pain.

Question 9

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 10

The nurse is reviewing prescriptions written for a client with chronic respiratory acidosis. Which prescription should the nurse question prior to implementation?
A)Keep head of the bed elevated to 40-degree angle.
B)Dextrose 5% and 0.45% normal saline at 100 mL per hour
C)Consult Respiratory Therapy for breathing treatments four times a day.
D)Oxygen 6 liters per minute per nasal cannula

Accepted Answer

A)In clients with chronic respiratory acidosis, oxygen is administered cautiously to prevent carbon dioxide narcosis. Adequate hydration such as intravenous fluids is important to promote removal of respiratory secretions. Pulmonary hygiene measures such as breathing treatments may be instituted. Elevating the head of the bed promotes oxygenation.
B)In clients with chronic respiratory acidosis, oxygen is administered cautiously to prevent carbon dioxide narcosis. Adequate hydration such as intravenous fluids is important to promote removal of respiratory secretions. Pulmonary hygiene measures such as breathing treatments may be instituted. Elevating the head of the bed promotes oxygenation.
C)In clients with chronic respiratory acidosis, oxygen is administered cautiously to prevent carbon dioxide narcosis. Adequate hydration such as intravenous fluids is important to promote removal of respiratory secretions. Pulmonary hygiene measures such as breathing treatments may be instituted. Elevating the head of the bed promotes oxygenation.
D)In clients with chronic respiratory acidosis, oxygen is administered cautiously to prevent carbon dioxide narcosis. Adequate hydration such as intravenous fluids is important to promote removal of respiratory secretions. Pulmonary hygiene measures such as breathing treatments may be instituted. Elevating the head of the bed promotes oxygenation.

Question 11

A newborn with pyloric stenosis has symptoms of projectile vomiting, leading to significant weight loss, dehydration, and metabolic alkalosis. What client teaching is necessary for the parents in caring for the infant until surgery to correct the defect?
A)Monitoring for hyperventilation to detect changes in health status
B)Breastfeeding techniques to reverse weight loss and dehydration
C)Positioning of the infant to prevent aspiration
D)Performing percussion and postural drainage to clear the airways

Accepted Answer

A)Complications related to aspiration of vomitus can be prevented by correct positioning of the infant. Parents should be taught correct positioning so they can care for the infant at home or when the nurse is not in the room. Hyperventilation leads to respiratory alkalosis and is usually unrelated to pyloric stenosis. Because pyloric stenosis blocks passage of food from the stomach to the small intestines, increasing oral intake will not be beneficial to the infant, so breastfeeding techniques are irrelevant at this time. Percussion and postural drainage are more relevant to lung diseases such as cystic fibrosis, not a gastrointestinal (GI)disorder such as pyloric stenosis.
B)Complications related to aspiration of vomitus can be prevented by correct positioning of the infant. Parents should be taught correct positioning so they can care for the infant at home or when the nurse is not in the room. Hyperventilation leads to respiratory alkalosis and is usually unrelated to pyloric stenosis. Because pyloric stenosis blocks passage of food from the stomach to the small intestines, increasing oral intake will not be beneficial to the infant, so breastfeeding techniques are irrelevant at this time. Percussion and postural drainage are more relevant to lung diseases such as cystic fibrosis, not a gastrointestinal (GI)disorder such as pyloric stenosis.
C)Complications related to aspiration of vomitus can be prevented by correct positioning of the infant. Parents should be taught correct positioning so they can care for the infant at home or when the nurse is not in the room. Hyperventilation leads to respiratory alkalosis and is usually unrelated to pyloric stenosis. Because pyloric stenosis blocks passage of food from the stomach to the small intestines, increasing oral intake will not be beneficial to the infant, so breastfeeding techniques are irrelevant at this time. Percussion and postural drainage are more relevant to lung diseases such as cystic fibrosis, not a gastrointestinal (GI)disorder such as pyloric stenosis.
D)Complications related to aspiration of vomitus can be prevented by correct positioning of the infant. Parents should be taught correct positioning so they can care for the infant at home or when the nurse is not in the room. Hyperventilation leads to respiratory alkalosis and is usually unrelated to pyloric stenosis. Because pyloric stenosis blocks passage of food from the stomach to the small intestines, increasing oral intake will not be beneficial to the infant, so breastfeeding techniques are irrelevant at this time. Percussion and postural drainage are more relevant to lung diseases such as cystic fibrosis, not a gastrointestinal (GI)disorder such as pyloric stenosis.

Question 12

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 replacement therapy with the healthcare provider
D)Reviewing implications of transfusing with ammonium 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. Because the chloride level is within normal limits, an infusion of 0.9% sodium chloride is not indicated. A nasogastric tube is not indicated for this client. There is not enough information to support the use of ammonium 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. Because the chloride level is within normal limits, an infusion of 0.9% sodium chloride is not indicated. A nasogastric tube is not indicated for this client. There is not enough information to support the use of ammonium 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. Because the chloride level is within normal limits, an infusion of 0.9% sodium chloride is not indicated. A nasogastric tube is not indicated for this client. There is not enough information to support the use of ammonium 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. Because the chloride level is within normal limits, an infusion of 0.9% sodium chloride is not indicated. A nasogastric tube is not indicated for this client. There is not enough information to support the use of ammonium chloride for this client, as it is indicated to treat severe metabolic alkalosis.

Question 13

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 nonsteroidal anti-inflammatory drugs (NSAIDs)for arthritic pain

Accepted Answer

A)Excess bicarbonate usually occurs as a result of ingesting antacids that contain bicarbonate, such as sodium 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 14

The nurse is preparing discharge instructions for an older adult client recovering from respiratory acidosis caused by restrictive lung disease and pneumonia. Which topics should the nurse include in the discharge teaching for this client? Select all that apply.
A)Obtain annual influenza immunization.
B)Engage in frequent hand washing.
C)Avoid crowds.
D)Cover the nose and mouth when coughing.
E)Restrict fluids.

Accepted Answer

A)For the client with a history of chronic lung disease and pneumonia, the nurse should instruct on the importance of receiving annual influenza immunizations, frequent hand washing, avoiding crowds, and covering the nose and mouth when coughing. Fluids should be encouraged to ensure that respiratory secretions are thin.
B)For the client with a history of chronic lung disease and pneumonia, the nurse should instruct on the importance of receiving annual influenza immunizations, frequent hand washing, avoiding crowds, and covering the nose and mouth when coughing. Fluids should be encouraged to ensure that respiratory secretions are thin.
C)For the client with a history of chronic lung disease and pneumonia, the nurse should instruct on the importance of receiving annual influenza immunizations, frequent hand washing, avoiding crowds, and covering the nose and mouth when coughing. Fluids should be encouraged to ensure that respiratory secretions are thin.
D)For the client with a history of chronic lung disease and pneumonia, the nurse should instruct on the importance of receiving annual influenza immunizations, frequent hand washing, avoiding crowds, and covering the nose and mouth when coughing. Fluids should be encouraged to ensure that respiratory secretions are thin.
E)For the client with a history of chronic lung disease and pneumonia, the nurse should instruct on the importance of receiving annual influenza immunizations, frequent hand washing, avoiding crowds, and covering the nose and mouth when coughing. Fluids should be encouraged to ensure that respiratory secretions are thin.

Question 15

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 16

A school-age client is admitted to the hospital with respiratory acidosis. Which chronic lung illness in the client's health history does the nurse suspect is causing the current diagnosis?
A)Cystic fibrosis
B)Aspiration
C)Hyperthyroidism
D)Pneumonia

Accepted Answer

A)Chronic lung disease such as asthma and cystic fibrosis put the child at risk for respiratory acidosis. Pneumonia and aspiration are both acute lung conditions. Hyperthyroidism is a disorder that results in metabolic acidosis.
B)Chronic lung disease such as asthma and cystic fibrosis put the child at risk for respiratory acidosis. Pneumonia and aspiration are both acute lung conditions. Hyperthyroidism is a disorder that results in metabolic acidosis.
C)Chronic lung disease such as asthma and cystic fibrosis put the child at risk for respiratory acidosis. Pneumonia and aspiration are both acute lung conditions. Hyperthyroidism is a disorder that results in metabolic acidosis.
D)Chronic lung disease such as asthma and cystic fibrosis put the child at risk for respiratory acidosis. Pneumonia and aspiration are both acute lung conditions. Hyperthyroidism is a disorder that results in metabolic acidosis.

Question 17

The nurse is preparing to admit a client with acute pneumonia who is experiencing severe respiratory acidosis. Which treatments does the nurse anticipate as appropriate for this client? Select all that apply.
A)Administer oxygen prn.
B)Administer digoxin for heart failure.
C)Encourage up to 3 L of fluids per day.
D)Place in a prone position.
E)Reposition frequently.

Accepted Answer

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

Question 18

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.

Question 19

The nurse suspects a client with one functioning lung is developing chronic respiratory acidosis. Which manifestation did the nurse most likely assess in this client?
A)Warm, flushed skin
B)Daytime sleepiness
C)Irritability
D)Blurred vision

Accepted Answer

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

Question 20

Clinical manifestations of metabolic alkalosis are similar to signs of
A)hypocalcemia.
B)hypokalemia.
C)hypercalcemia.
D)hyperkalemia.

Accepted Answer

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

Quiz 1: Acid-Base Balance

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

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

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

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

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

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

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

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

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

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?

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?

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

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

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

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?

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

Clinical manifestations of metabolic alkalosis are similar to signs of