Chapter 12 Assessment and Care of Patients with Acid Base Imbal PDF

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TestBank-Medical-SurgicalNursing:ConceptsforInterprofessionalCollaborativeCare9e

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Chapter12:AssessmentandCareofPatientswithAcid-BaseImbalances MULTIPLECHOICE 1.Anurseassessesaclientwithdiabetesmellituswhoisadmittedwithanacid-baseimbalance.Theclients arterialbloodgasvaluesarepH7.36,PaO298mmHg,PaCO233mmHg,andHCO318mEq/L.Which manifestationshouldthenurseidentifyasanexampleoftheclientscompensationmechanism? a.Increasedrateanddepthofrespirations b.Increasedurinaryoutput c.Increasedthirstandhunger d.Increasedreleaseofacidsfromthekidneys ANS:A Thisclienthasmetabolicacidosis.Therespiratorysystemcompensatesbyincreasingitsactivityandblowing offexcesscarbondioxide.Increasedurinaryoutput,thirst,andhungeraremanifestationsofhyperglycemiabut arenotcompensatorymechanismsforacid-baseimbalances.Thekidneysdonotreleaseacids. DIF:Applying/ApplicationREF:192 KEY:Acid-baseimbalance|laboratoryvalues MSC:IntegratedProcess:NursingProcess:Assessment NOT:ClientNeedsCategory:PhysiologicalIntegrity:PhysiologicalAdaptation 2.Anurseassessesaclientwhoisexperiencinganacid-baseimbalance.Theclientsarterialbloodgasvalues arepH7.34,PaO288mmHg,PaCO238mmHg,andHCO319mEq/L.Whichassessmentshouldthenurse performfirst? a.Cardiacrateandrhythm b.Skinandmucousmembranes c.Musculoskeletalstrength d.Leveloforientation ANS:A Earlycardiovascularchangesforaclientexperiencingmoderateacidosisincludeincreasedheartrateand cardiacoutput.Astheacidosisworsens,theheartratedecreasesandelectrocardiographicchangeswillbe present.Centralnervoussystemandneuromuscularsystemchangesdonotoccurwithmildacidosisandshould bemonitorediftheacidosisworsens.Skinandmucousmembraneassessmentisnotaprioritynow,butwill changeasacidosisworsens. DIF:Applying/ApplicationREF:192 KEY:Acid-baseimbalance MSC:IntegratedProcess:NursingProcess:Assessment NOT:ClientNeedsCategory:SafeandEffectiveCareEnvironment:ManagementofCare 3.Anurseassessesaclientwhoisprescribedfurosemide(Lasix)forhypertension.Forwhichacid-base imbalanceshouldthenurseassesstopreventcomplicationsofthistherapy? a.Respiratoryacidosis b.Respiratoryalkalosis c.Metabolicacidosis d.Metabolicalkalosis ANS:D Manydiuretics,especiallyloopdiuretics,increasetheexcretionofhydrogenions,leadingtoexcessacidloss throughtherenalsystem.Thissituationisanaciddeficitofmetabolicorigin. DIF:Applying/ApplicationREF:195 KEY:Acid-baseimbalance|diuretics MSC:IntegratedProcess:NursingProcess:Assessment NOT:ClientNeedsCategory:PhysiologicalIntegrity:PharmacologicalandParenteralTherapies 4.Anurseiscaringforaclientwhoisexperiencingmoderatemetabolicalkalosis.Whichactionshouldthe

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nursetake? a.Monitordailyhemoglobinandhematocritvalues. b.Administerfurosemide(Lasix)intravenously. c.Encouragetheclienttotakedeepbreaths. d.Teachtheclientfallpreventionmeasures. ANS:D Theprioritynursingcareforaclientwhoisexperiencingmoderatemetabolicalkalosisisprovidingclient safety.Clientswithmetabolicalkalosishavemuscleweaknessandareatriskforfalling.Theothernursing interventionsarenotappropriateformetabolicalkalosis. DIF:Remembering/KnowledgeREF:196 KEY:Acid-baseimbalance|falls|safety MSC:IntegratedProcess:NursingProcess:Implementation NOT:ClientNeedsCategory:SafeandEffectiveCareEnvironment:SafetyandInfectionControl 5.Anurseisassessingaclientwhohasacutepancreatitisandisatriskforanacid-baseimbalance.Forwhich manifestationofthisacid-baseimbalanceshouldthenurseassess? a.Agitation b.Kussmaulrespirations c.Seizures d.PositiveChvostekssign ANS:B Thepancreasisamajorsiteofbicarbonateproduction.Pancreatitiscancausearelativemetabolicacidosis throughunderproductionofbicarbonateions.ManifestationsofacidosisincludelethargyandKussmaul respirations.Agitation,seizures,andapositiveChvostekssignaremanifestationsoftheelectrolyteimbalances thataccompanyalkalosis. DIF:Applying/ApplicationREF:192 KEY:Acid-baseimbalance MSC:IntegratedProcess:NursingProcess:Assessment NOT:ClientNeedsCategory:PhysiologicalIntegrity:PhysiologicalAdaptation 6.Anurseassessesaclientwhoisadmittedwithanacid-baseimbalance.Theclientsarterialbloodgasvalues arepH7.32,PaO285mmHg,PaCO234mmHg,andHCO316mEq/L.Whatactionshouldthenursetake next? a.Assessclientsrate,rhythm,anddepthofrespiration. b.Measuretheclientspulseandbloodpressure. c.Documentthefindingsandcontinuetomonitor. d.Notifythephysicianassoonaspossible. ANS:A Progressiveskeletalmuscleweaknessisassociatedwithincreasingseverityofacidosis.Muscleweaknesscan leadtosevererespiratoryinsufficiency.Acidosisdoesleadtodysrhythmias(duetohyperkalemia),butthese wouldbestbeassessedwithcardiacmonitoring.Findingsshouldbedocumented,butsimplycontinuingto monitorisnotsufficient.Beforenotifyingthephysician,thenursemusthavemoredatatoreport. DIF:Applying/ApplicationREF:192 KEY:Acid-baseimbalance MSC:IntegratedProcess:NursingProcess:Implementation NOT:ClientNeedsCategory:SafeandEffectiveCareEnvironment:SafetyandInfectionControl 7.Anurseiscaringforaclientwhohasthefollowingarterialbloodvalues:pH7.12,PaO256mmHg,PaCO2 65mmHg,andHCO322mEq/L.Whichclinicalsituationshouldthenursecorrelatewiththesevalues? a.Diabeticketoacidosisinapersonwithemphysema b.Bronchialobstructionrelatedtoaspirationofahotdog c.Anxiety-inducedhyperventilationinanadolescent d.Diarrheafor36hoursinanolder,frailwoman

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ANS:B Arterialbloodgasvaluesindicatethattheclienthasacidosiswithnormallevelsofbicarbonate,suggestingthat theproblemisnotmetabolic.Arterialconcentrationsofoxygenandcarbondioxideareabnormal,withlow oxygenandhighcarbondioxidelevels.Thus,thisclienthasrespiratoryacidosisfrominadequategasexchange Thefactthatthebicarbonatelevelisnormalindicatesthatthisisanacuterespiratoryproblemratherthana chronicproblem,becausenorenalcompensationhasoccurred. DIF:Analyzing/AnalysisREF:193 KEY:Acid-baseimbalance|laboratoryvalues MSC:IntegratedProcess:NursingProcess:Analysis NOT:ClientNeedsCategory:PhysiologicalIntegrity:ReductionofRiskPotential 8.Anurseiscaringforaclientwhohasjustexperienceda90-secondtonic-clonicseizure.Theclientsarterial bloodgasvaluesarepH6.88,PaO250mmHg,PaCO260mmHg,andHCO322mEq/L.Whichactionshould thenursetakefirst? a.Applyoxygenbymaskornasalcannula. b.Applyapaperbagovertheclientsnoseandmouth. c.Administer50mLofsodiumbicarbonateintravenously. d.Administer50mLof20%glucoseand20unitsofregularinsulin. ANS:A Theclienthasexperiencedacombinationofmetabolicandacuterespiratoryacidosisthroughheavyskeletal musclecontractionsandnogasexchange.Whentheseizureshavestoppedandtheclientcanbreatheagain,the fastestwaytoreturnacid-basebalanceistoadministeroxygen.Applyingapaperbagovertheclientsnoseand mouthwouldworsentheacidosis.Sodiumbicarbonateshouldnotbeadministeredbecausetheclientsarterial bicarbonatelevelisnormal.Glucoseandinsulinareadministeredtogethertodecreaseserumpotassiumlevels. Thisactionisnotappropriatebasedontheinformationprovided. DIF:Applying/ApplicationREF:189 KEY:Acid-baseimbalance|laboratoryvalues|medicalemergency MSC:IntegratedProcess:NursingProcess:Implementation NOT:ClientNeedsCategory:SafeandEffectiveCareEnvironment:ManagementofCare 9.Afterteachingaclientwhowasmalnourishedandisbeingdischarged,anurseassessestheclients understanding.Whichstatementindicatestheclientcorrectlyunderstoodteachingtodecreaseriskforthe developmentofmetabolicacidosis? a.Iwilldrinkatleastthreeglassesofmilkeachday. b.Iwilleatthreewell-balancedmealsandasnackdaily. c.Iwillnottakepainmedicationandantihistaminestogether. d.Iwillavoidsaltingmyfoodwhencookingorduringmeals. ANS:B Starvationoradietwithtoofewcarbohydratescanleadtometabolicacidosisbyforcingcellstoswitchto usingfatsforfuelandbycreatingketoacidsasaby-productofexcessivefatmetabolism.Eatingsufficient caloriesfromallfoodgroupshelpsreducethisrisk. DIF:Applying/ApplicationREF:191 KEY:Acid-baseimbalance|nutritionMSC:IntegratedProcess:Teaching/Learning NOT:ClientNeedsCategory:HealthPromotionandMaintenance 10.Anurseevaluatesthefollowingarterialbloodgasvaluesinaclient:pH7.48,PaO298mmHg,PaCO228 mmHg,andHCO322mEq/L.Whichclientconditionshouldthenursecorrelatewiththeseresults? a.Diarrheaandvomitingfor36hours b.Anxiety-inducedhyperventilation c.Chronicobstructivepulmonarydisease(COPD) d.Diabeticketoacidosisandemphysema ANS:B

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TheelevatedpHlevelindicatesalkalosis.Thebicarbonatelevelisnormal,andsoistheoxygenpartial pressure.Lossofcarbondioxideisthecauseofthealkalosis,whichwouldoccurinresponseto hyperventilation.Diarrheaandvomitingwouldcausemetabolicalterations,COPDwouldleadtorespiratory acidosis,andtheclientwithemphysemamostlikelywouldhavecombinedmetabolicacidosisontopofamild chronicrespiratoryacidosis. DIF:Applying/ApplicationREF:194 KEY:Acid-baseimbalance|laboratoryvalues MSC:IntegratedProcess:NursingProcess:Assessment NOT:ClientNeedsCategory:PhysiologicalIntegrity:ReductionofRiskPotential 11.Afterprovidingdischargeteaching,anurseassessestheclientsunderstandingregardingincreasedriskfor metabolicalkalosis.Whichstatementindicatestheclientneedsadditionalteaching? a.Idontdrinkmilkbecauseitgivesmegasanddiarrhea. b.Ihavebeentakingdigoxineverydayforthelast15years. c.Itakesodiumbicarbonateaftereverymealtopreventheartburn. d.Inhotweather,IsweatsomuchthatIdrinksixglassesofwatereachday. ANS:C Excessiveoralingestionofsodiumbicarbonateandotherbicarbonate-basedantacidscancausemetabolic alkalosis.Avoidingmilk,takingdigoxin,andsweatingwouldnotleadtoincreasedriskofmetabolicalkalosis. DIF:Analyzing/AnalysisREF:195 KEY:Acid-baseimbalance|patienteducation MSC:IntegratedProcess:Teaching/Learning NOT:ClientNeedsCategory:HealthPromotionandMaintenance 12.Anurseiscaringforaclientwhoisexperiencingexcessivediarrhea.Theclientsarterialbloodgasvalues arepH7.28,PaO298mmHg,PaCO245mmHg,andHCO316mEq/L.Whichproviderordershouldthe nurseexpecttoreceive? a.Furosemide(Lasix)40mgintravenouspush b.Sodiumbicarbonate100mEqdilutedin1LofD5W c.Mechanicalventilation d.Indwellingurinarycatheter ANS:B Thisclientsarterialbloodgasvaluesrepresentmetabolicacidosisrelatedtoalossofbicarbonateionsfrom diarrhea.Thebicarbonateshouldbereplacedtohelprestorethisclientsacid-basebalance.Furosemidewould causeanincreaseinacidfluidandacideliminationviatheurinarytract;althoughthismayimprovetheclients pH,theclienthasexcessivediarrheaandcannotaffordtolosemorefluid.Mechanicalventilationisusedto treatrespiratoryacidosisforclientswhocannotkeeptheiroxygensaturationat90%,orwhohaverespirator musclefatigue.Mechanicalventilationandanindwellingurinarycatheterwouldnotbeprescribedforthis client. DIF:Applying/ApplicationREF:191 KEY:Acid-baseimbalance|laboratoryvalues|elimination MSC:IntegratedProcess:NursingProcess:Implementation NOT:ClientNeedsCategory:PhysiologicalIntegrity:PharmacologicalandParenteralTherapies 13.Anurseevaluatesaclientsarterialbloodgasvalues(ABGs):pH7.30,PaO286mmHg,PaCO255mm Hg,andHCO322mEq/L.Whichinterventionshouldthenurseimplementfirst? a.Assesstheairway. b.Administerprescribedbronchodilators. c.Provideoxygen. d.Administerprescribedmucolytics. ANS:A Allinterventionsareimportantforclientswithrespiratoryacidosis;thisisindicatedbytheABGs.However, thepriorityisassessingandmaintaininganairway.Withoutapatentairway,otherinterventionswillnotbe

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helpful. DIF:Applying/ApplicationREF:191 KEY:Acid-baseimbalance|laboratoryvalues MSC:IntegratedProcess:NursingProcess:Implementation NOT:ClientNeedsCategory:SafeandEffectiveCareEnvironment:ManagementofCare 14.Anurseisplanningcareforaclientwhoishyperventilating.TheclientsarterialbloodgasvaluesarepH 7.30,PaO294mmHg,PaCO231mmHg,andHCO326mEq/L.Whichquestionshouldthenurseaskwhen developingthisclientsplanofcare? a.Doyoutakeanyover-the-countermedications? b.Youappearanxious.Whatiscausingyourdistress? c.Doyouhaveahistoryofanxietyattacks? d.Youarebreathingfast.Isthiscausingyoutofeellight-headed? ANS:B Thenurseshouldassisttheclientwhoisexperiencinganxiety-inducedrespiratoryalkalosistoidentifycauses oftheanxiety.Theotherquestionswillnotidentifythecauseoftheacid-baseimbalance. DIF:Applying/ApplicationREF:195 KEY:Acid-baseimbalance|laboratoryvalues MSC:IntegratedProcess:CommunicationandDocumentation NOT:ClientNeedsCategory:PsychosocialIntegrity 15.Anurseiscaringforaclientwhohaschronicemphysemaandisreceivingoxygentherapyat6L/minvia nasalcannula.Thefollowingclinicaldataareavailable: ArterialBloodGasesVitalSigns pH=7.28Pulserate=96beats/min PaO2=85mmHgBloodpressure=135/45 PaCO2=55mmHgRespiratoryrate=6breaths/min HCO3=26mEq/LO2saturation=88% Whichactionshouldthenursetakefirst? a.NotifytheRapidResponseTeamandprovideventilationsupport. b.Changethenasalcannulatoamaskandreassessin10minutes. c.PlacetheclientinFowlerspositionifheorsheisabletotolerateit. d.Decreasetheflowrateofoxygento2to4L/min,andreassess. ANS:A Theprimarytriggerforrespirationinaclientwithchronicrespiratoryacidosisisadecreasedarterialoxygen level(hypoxicdrive).Oxygentherapycaninhibitrespiratoryeffortsinthiscase,eventuallycausingrespiratory arrestanddeath.Thenursecoulddecreasetheoxygenflowrate;eventually,thismightimprovetheclients respiratoryrate,butthepriorityactionwouldbetocalltheRapidResponseTeamwheneveraclientwith chroniccarbondioxideretentionhasarespiratoryratelessthan10breaths/min.Changingthecannulatoa maskdoesnothingtoimprovetheclientshypoxicdrive,norwoulditaddresstheclientsmostpressingneed. Positioningwillnothelptheclientbreatheatanormalrateormaintainclientsafety. DIF:Applying/ApplicationREF:194 KEY:Acid-baseimbalance|laboratoryvalues MSC:IntegratedProcess:NursingProcess:Implementation NOT:ClientNeedsCategory:SafeandEffectiveCareEnvironment:ManagementofCare MULTIPLERESPONSE 1.Anurseisplanninginterventionsthatregulateacid-basebalancetoensurethepHofaclientsbloodremains withinthenormalrange.Whichabnormalphysiologicfunctionsmayoccuriftheclientexperiencesanacidbaseimbalance?(Selectallthatapply.) a.Reductioninthefunctionofhormones b.Fluidandelectrolyteimbalances c.Increaseinthefunctionofselectedenzymes

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d.Excitablecardiacmusclemembranes e.Increaseintheeffectivenessofmanydrugs ANS:A,B,E Acid-baseimbalancesinterferewithnormalphysiology,includingreducingthefunctionofhormonesand enzymes,causingfluidandelectrolyteimbalances,makingheartmembranesmoreexcitable,anddecreasing theeffectivenessofmanydrugs. DIF:Remembering/KnowledgeREF:185 KEY:Acid-baseimbalance MSC:IntegratedProcess:NursingProcess:Assessment NOT:ClientNeedsCategory:PhysiologicalIntegrity:PhysiologicalAdaptation 2.Anurseassessesaclientwhoisexperiencinganacid-baseimbalance.Theclientsarterialbloodgasvalues arepH7.32,PaO294mmHg,PaCO234mmHg,andHCO318mEq/L.Forwhichclinicalmanifestations shouldthenurseassess?(Selectallthatapply.) a.Reduceddeeptendonreflexes b.Drowsiness c.Increasedrespiratoryrate d.Decreasedurinaryoutput e.PositiveTrousseaussign ANS:A,B,C Metabolicacidosiscausesneuromuscularchanges,includingreducedmuscletoneanddeeptendonreflexes. Clientsusuallypresentwithlethargyanddrowsiness.Therespiratorysystemwillattempttocompensateforthe metabolicacidosis;therefore,respirationswillincreaserateanddepth.ApositiveTrousseaussignisassociated withalkalosis.Decreasedurineoutputisnotamanifestationofmetabolicacidosis. DIF:Understanding/ComprehensionREF:192 KEY:Acid-baseimbalance MSC:IntegratedProcess:NursingProcess:Assessment NOT:ClientNeedsCategory:PhysiologicalIntegrity:PhysiologicalAdaptation 3.Anurseisassessingclientswhoareatriskforacid-baseimbalance.Whichclientsarecorrectlypairedwith theacid-baseimbalance?(Selectallthatapply.) a.MetabolicalkalosisYoungadultwhoisprescribedintravenousmorphinesulfateforpain b.MetabolicacidosisOlderadultwhoisfollowingacarbohydrate-freediet c.RespiratoryalkalosisClientonmechanicalventilationatarateof28breaths/min d.RespiratoryacidosisPostoperativeclientwhoreceived6unitsofpackedredbloodcells e.MetabolicalkalosisOlderclientprescribedantacidsforgastroesophagealrefluxdisease ANS:B,C,E Respiratoryacidosisoftenoccursastheresultofunderventilation.Theclientwhoistakingopioids,especially IVopioids,isatriskforrespiratorydepressionandrespiratoryacidosis.Onecauseofmetabolicacidosisisa strictlow-caloriedietoronethatislowincarbohydratecontent.Suchadietincreasestherateoffatcatabolism andresultsintheformationofexcessiveketoacids.Aventilatorsetatahighrespiratoryrateortidalvolume willcausetheclienttolosetoomuchcarbondioxide,leadingtoanaciddeficitandrespiratoryalkalosis. Citrateisasubstanceusedasapreservativeinbloodproducts.Itisnotonlyabase,itisalsoaprecursorfor bicarbonate.Multipleunitsofpackedredbloodcellscouldcausemetabolicalkalosis.Sodiumbicarbonate antacidsmayincreasetheriskofmetabolicalkalosis. DIF:Analyzing/AnalysisREF:192 KEY:Acid-baseimbalance MSC:IntegratedProcess:NursingProcess:Assessment NOT:ClientNeedsCategory:PhysiologicalIntegrity:PhysiologicalAdaptation 4.Anurseassessesaclientwhoisreceivingtotalparenteralnutrition.Forwhichadverseeffectsrelatedtoan acid-baseimbalanceshouldthenurseassess?(Selectallthatapply.) a.PositiveChvostekssign

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b.Elevatedbloodpressure c.Bradycardia d.Increasedmusclestrength e.Anxietyandirritability ANS:A,E Aclientreceivingtotalparenteralnutritionisatriskformetabolicalkalosis.Manifestationsofmetabolic alkalosisincludepositiveChvostekssign,normalorlowbloodpressure,increasedheartrate,skeletalmuscle weakness,andanxietyandirritability. DIF:Applying/ApplicationREF:194 KEY:Acid-baseimbalance|nutri...