Chapter 12: Assessment and Care of Patients with Acid-Base Imbalances Flashcards
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?
Increased rate and depth of respirations
This client has metabolic acidosis. The respiratory system compensates by increasing its activity and blowing off excess carbon dioxide.
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?
Cardiac rate and rhythm
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.
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?
Metabolic alkalosis
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.
Note: pH of urine is about 4.5-6 which is acidic. Alkalotic urine would indicate possible infection unless it follows an alkaline meal (alkaline tide). If you excrete excess acid you will have a risk of developing metabolic alkalosis.
A nurse is caring for a client who is experiencing moderate metabolic alkalosis. Which action should the nurse take?
Teach the client fall prevention measures.
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
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?
Kussmaul respirations
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.
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?
Assess clients rate, rhythm, and depth of respiration.
Progressive skeletal muscle weakness is associated with increasing severity of acidosis. Muscle weakness can
lead to severe respiratory insufficiency.
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?
Bronchial obstruction related to aspiration of a hot dog
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.
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?
Apply oxygen by mask or nasal cannula
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.
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?
I will eat three well-balanced meals and a snack daily
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.
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?
Anxiety-induced hyperventilation
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.
After providing discharge teaching, a nurse assesses the clients understanding regarding increased risk for metabolic alkalosis. Which statement indicates the client needs additional teaching?
I take sodium bicarbonate after every meal to prevent heartburn.
Excessive oral ingestion of sodium bicarbonate and other bicarbonate-based antacids can cause metabolic
alkalosis.
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?
Sodium bicarbonate 100 mEq diluted in 1 L of D5W
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.
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?
Assess the airway.
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?
You appear anxious. What is causing your distress?
The nurse should assist the client who is experiencing anxiety-induced respiratory alkalosis to identify causes of the anxiety
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?
Notify the Rapid Response Team and provide ventilation support.
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.
