ACID/BASE PART 2 Flashcards
A client with diabetic ketoacidosis (DKA) is admitted to the medical floor for observation. The nurse knows that a client with DKA is likely to have an acid base imbalance. Which acid base imbalance is this client most likely to have?
Diabetic ketoacidosis is most common among clients with type 1 diabetes mellitus and develops when insulin levels are insufficient to meet the body’s basic metabolic requirements. DKA is commonly triggered by a physiological stress, such as an acute infection, myocardial infarction, or stroke. METABOLIC ACIDODIS
A client presents to the walk in clinic, reporting that he has been vomiting “off and on” for the past 24 hours. The nurse is aware that this client is at risk for which of the following complications?
This question is asking the nurse to think about common conditions which might cause a disturbance in both acid base balance & electrolyte balance. With frequent vomiting, the client is most likely experiencing a metabolic alkalosis coupled with hypokalemia, as gastric acid contains large amounts of potassium, chloride, and hydrogen ions
Which of the following responses by the nurse is correct when trying to explain to a client the causes for development of a respiratory alkalosis?
The focus of this question is asking the nurse to determine the causes of respiratory alkalosis. Respiratory alkalosis is typically caused by hyperventilation, which is commonly seen in clients with anxiety or someone experiencing a panic attack. Remember, respiratory alkalosis is caused by rapid respirations, which causes the body to “blow off” too much carbon dioxide and retain too much base. The common treatment for respiratory alkalosis is simple; having the client to breathe using a paper bag over their mouth.
A client is admitted to the cardiac intensive care unit after presenting to the emergency room with an acute myocardial infarction. The latest arterial blood gases (ABGs) for this client are:
pH-7.36
CO2-28
HCO3-20
Which acid base imbalance is the client currently experiencing?
This question is asking the nurse to interpret ABGs. The first step in ABG interpretation is to look at the pH (which is normal in this example, indicating full compensation has occurred, but nearer the acidification side.) The next step is to look at the CO2 (which has decreased in this example, because compensation has occurred.) The final step is to look at the HCO3, which is decreased, indicating a metabolic acidosis, because the decreased HCO3 “matches up” with the pH, which is on the acidotic side of normal. Remember the key to determining if an acid base imbalance is fully compensated is to look at the pH and determine if it has returned to normal. If it has, the kidneys and lungs are both doing their jobs to help the body maintain homeostasis.
A client has just returned to the medical surgical unit from the post anesthesia care unit after undergoing a colon resection. The nurse is reminding him of the importance of using his incentive spirometer while awake to help prevent pneumonia. The client reports that it hurts too hard to breathe. The client’s respiratory rate is 12. Which of the following results would the nurse anticipate for this client’s arterial blood gases (ABGs?)
The focus of this question is asking the nurse to think about potential acid base problems that may result from a slow respiratory rate. The nurse should immediately correlate respiratory acidosis with any situation that would cause respirations to be slower than normal.
The nurse is working in an outpatient infusion unit at a local hospital. The client has just received a refill in her intrathecally implanted pain pump of 40 mL of morphine 10 mg/mL. The nurse notices shortly after the fill that the client has bradypnea & is very lethargic. The nurse calls respiratory therapy to have a set of arterial blood gases (ABGs) drawn. The results of the ABGs are:
pH-7.33
CO2-49
HCO3-25
How should the nurse interpret these ABGs?
This question is asking the nurse to interpret a set of ABGs. Based on the physical assessment alone, the nurse should suspect respiratory acidosis as the acid-base imbalance.
A client checks into a Convenient Care Clinic reporting, “I feel so nervous, like my heart is racing or flopping around in my chest.” Upon assessment, the nurse notes the client’s vital signs as follows: BP-138/78, P-118, R-28, T-99.8 F, oxygen saturation (by pulse oximeter)-95% on room air. Based upon this assessment, what should be the nurse’s first action? ( assuming that an order has been given by the health care provider for each action.)
This question is asking the nurse to prioritize actions, based on assessment data which strongly suggests the client has the acid base imbalance of respiratory alkalosis. All of the choices in this question are appropriate, but the priority action is to have the client rebreathe CO2, using a rebreather mask or a paper bag.
A student nurse asks his instructor about acid-base imbalances. Which response by the nursing instructor best explains respiratory alkalosis?
Respiratory alkalosis is associated with hyperventilation. Hyperventilation leads to a decreased CO2 & a rise in the pH.
