EAQs Chapter 16 Fluid and Electrolytes Flashcards
The nurse is reviewing magnesium levels for a patient. What does the nurse recognize is the importance of assessing this level for a patient?
It may cause extracellular fluid overload.
Can affect neuromuscular excitability and contractility.
It is the most abundant intracellular cation present in the body.
The patient is at risk for hypotension when the levels decrease.
Can affect neuromuscular excitability and contractility.
Alterations in serum magnesium levels profoundly affect neuromuscular excitability and contractility because magnesium directly acts on the myoneural junction. A decrease in blood magnesium levels increases the blood pressure. Magnesium is the second most abundant intracellular cation. The majority of the body’s magnesium is present in the bones. Causing extracellular fluid overload, being the most abundant intracellular cation, and the patient being at risk for hypotension are not relevant to this situation.
The nurse is caring for a patient with severe hyperphosphatemia. What type of treatment does the nurse anticipate administering to this patient?
Insulin infusion
Fluid restriction
Calcium supplements
Loop diuretic therapy
Insulin infusion
For severe hyperphosphatemia, hemodialysis or an insulin and glucose infusion can decrease levels rapidly. Fluid restriction, calcium supplements, and diuretic therapy are not treatment options for hyperphosphatemia.
The nurse is monitoring a patient with hyperkalemia. Which conditions should the nurse conclude may cause this condition? Select all that apply.
Alkalosis Renal failure Low blood volume Large urine volume Adrenal insufficiency
Renal failure
Adrenal insufficiency
Hyperkalemia is a condition in which there is an abnormal increase of potassium in the blood. Renal failure may cause hyperkalemia, because the kidneys cannot remove potassium from the body. Adrenal insufficiency causes aldosterone deficiency, which leads to the retention of potassium ions and also may result in hyperkalemia. Alkalosis is seen in hypocalcemia. Low blood volume and a large urine volume can result in hypokalemia.
The nurse is reviewing the serum potassium results for a patient. What level best supports the rationale for administering a stat dose of potassium chloride 20 mEq in 250 mL of normal saline over two hours?
- 1 mEq/L
- 9 mEq/L
- 6 mEq/L
- 3 mEq/L
3.1 mEq/L
The normal range for serum potassium is 3.5 to 5.0 mEq/L. This intravenous (IV) prescription provides a substantial amount of potassium. Thus the patient’s potassium level must be low. The only low value shown is 3.1 mEq/L; 3.9 mEq/L, 4.6 mEq/L, and 5.3 mEq/L are not low values.
A patient’s ECG tracing has a short QT interval and a high peaked T wave. Which prescription should the nurse question?
D5W with 20 meq KCL to run at 125 mL/hr
Sodium polystyrene sulfonate 30 grams by mouth
10 units regular insulin IVP and one-half ampule D50W IVP
2 grams calcium gluconate intravenous (IV) administered over two minutes
D5W with 20 meq KCL to run at 125 mL/hr
A short QT interval and a high peaked T wave are indicative of hyperkalemia. The prudent nurse should question any prescription that could increase the potassium level in the patient. IV insulin with D50W and calcium gluconate are given to force the potassium back into the cells, temporarily correcting the hyperkalemia. Polystyrene sulfonate binds with potassium in the gastrointestinal (GI) tract and excretes it via feces.
The nurse is providing care to a patient with hypocalcemia. Which clinical manifestation should the nurse anticipate for this patient?
Shortened ST segment
Prolonged QT segment
Ventricular dysrhythmia
Increased digitalis effect
Prolonged QT segment
A prolonged QT segment is a clinical manifestation the nurse would anticipate when providing care to a patient with hypocalcemia. A shortened ST segment, ventricular dysrhythmia, and increased digitalis effects are anticipated when providing care to a patient with hypercalcemia.
The nurse finds that the patient with renal disease is irritable and has an irregular pulse. ECG changes suggest severe hyperkalemia. What is the first nursing action?
Stop all sources of dietary potassium
Administer intravenous calcium gluconate
Administer ion-exchange resins
Administer intravenous insulin with glucose
Administer intravenous calcium gluconate
In the case of severe hyperkalemia, manifested by irritation, irregular pulse, and changes in ECG findings, the nurse should act immediately to prevent cardiac arrest. The nurse should administer intravenous calcium gluconate to reverse the membrane potential effects of extracellular fluid (ECF) potassium. Administering ion-exchange resins (to increase elimination of potassium) and intravenous insulin with glucose (to force potassium from ECF to intracellular fluid [ICF]) can be done once the patient is stable. Stopping all sources of dietary potassium is an important measure when hyperkalemia is mild.
The nurse is caring for a patient receiving calcium carbonate for the treatment of osteopenia. Which serum laboratory result would be identified as an adverse effect related to this therapy?
Sodium falling to 138 mEq/L
Potassium rising to 4.1 mEq/L
Magnesium rising to 2.9 mg/dL
Phosphorus falling to 2.1 mg/dL
Phosphorus falling to 2.1 mg/dL
Calcium has an inverse relationship with phosphorus in the body. When phosphorus levels fall, calcium rises, and vice versa. Because hypercalcemia rarely occurs as a result of calcium intake, the patient’s phosphorus falling to 2.1 mg/dL (normal 2.4-4.4 mg/dL) may be a result of the phosphate-binding effect of calcium carbonate. Sodium falling, potassium rising, and magnesium rising are not adverse reactions to the treatment.
A patient with cancer is found to have a serum phosphate level of 5.4 mg/dL. What does the nurse determine is the probable reason for the increase in phosphate levels in this patient?
Chemotherapy
Insulin therapy
Total parenteral nutrition
Phosphate-binding antacids
Chemotherapy
Phosphate levels greater than 4.4 mg/dL indicate hyperphosphatemia. Chemotherapy drugs increase the patient’s phosphate levels. Insulin therapy decreases the phosphate levels to less than 2.4 mg/dL. Patients with total parenteral nutrition have decreased phosphate levels. Phosphate-binding antacids remove phosphates from the body, resulting in hypophosphatemia.
An older adult patient is admitted with pneumonia. Why would it be important for the nurse to closely monitor fluid and electrolyte balance in this patient?
Older adults are at an increased risk of impaired renal function.
Older adults have an impaired level of consciousness and need to be reminded to drink fluids.
Older adults are more likely than younger adults to lose extracellular fluid during severe illnesses.
Small losses of fluid are more significant because body water accounts for only about 50% of body weight in older adults.
Small losses of fluid are more significant because body water accounts for only about 50% of body weight in older adults.
Older adults, with less muscle mass and more fat content, have less body water than younger adults. In the older adult, body water content averages 45% to 55% of body weight, leaving them at a higher risk for fluid-related problems than young adults. Renal function, level of consciousness, and severe illnesses are not relevant in this instance.
The nurse is administering regular insulin intravenously to a patient with moderate hyperkalemia. Which additional intravenous medication will the nurse administer to the patient?
Glucose
Furosemide
Pamidronate
Calcium gluconate
Glucose
While administering regular insulin intravenously to a hyperkalemic patient to help force potassium from extracellular fluid to intracellular fluid, the nurse also administers glucose to prevent hypoglycemia. Furosemide is administered if the patient has hypermagnesemia. Pamidronate is administered if the patient has hypercalcemia. Calcium gluconate is administered to treat hypocalcemia.
The nurse is caring for a patient with sickle cell anemia. What common electrolyte imbalance should the nurse carefully assess the patient for that is commonly associated with this disease?
Increased calcium levels
Increased potassium levels
Increased phosphate levels
Increased magnesium levels
Increased phosphate levels
Sickle cell anemia leads to increased concentration of phosphates in the body, thus causing hyperphosphatemia. Hypercalcemia, or increased calcium levels, is associated with hyperparathyroidism. Hyperkalemia, or increased potassium levels, is associated with tumor-lysis syndrome. Hypermagnesemia, or increased magnesium levels, is associated with diabetic ketoacidosis.
A patient sustains multiple injuries in a motor vehicle accident and is hypovolemic due to hemorrhage. Blood transfusions are given to replace the lost blood. The nurse finds that the patient has now developed laryngeal stridor, dysphagia, and numbness and tingling around the mouth. What could be the reason for these new manifestations?
The patient has developed anemia.
The patient has developed hypocalcemia.
The patient has developed fluid overload.
The patient has developed a hemolytic reaction.
The patient has developed hypocalcemia.
Laryngeal stridor, dysphagia, and numbness and tingling around the mouth after multiple blood transfusions can be attributed to hypocalcemia. Blood and blood products have citrate in them, which can bind with calcium in the body and make it unavailable. Multiple blood transfusions have thus caused hypocalcemia. This usually manifests as laryngeal stridor, dysphagia, and numbness and tingling around the mouth. Such symptoms are not caused by fluid overload, which manifests as edema. Anemia can be the result of hemorrhage but does not present with laryngeal stridor and dysphagia. There are chances of hemolytic reactions, because the patient is receiving multiple transfusions. However, a hemolytic reaction manifests as severe anaphylaxis, so the patient is not having a hemolytic reaction.
The nurse is caring for a patient and observes with a serum potassium of 2.8 mEq/L. What is the greatest risk for this patient that the nurse should monitor for?
Dysrhythmias
Acute renal failure
Metabolic alkalosis
Malignant hypertension
Dysrhythmias
Potassium exerts a direct effect on the excitability of cardiac muscle tissue. Therefore an increased or low serum level of potassium can alter cardiac function and heart rhythm, resulting in dysrhythmias. Acute renal failure is not a complication of hypokalemia, but it may be seen with hyperkalemia. Metabolic alkalosis and malignant hypertension are not associated with hypokalemia.
The nurse is caring for a patient that has a nasogastric tube (NGT) on intermittent suction. The patient asks why they cannot have something to drink. What is the best response by the nurse?
“It will cause sodium retention.”
“It will disrupt the intermittent suction.”
“It will increase nausea and vomiting.”
“It will increase the loss of electrolytes.”
“It will increase the loss of electrolytes.”
Allowing a patient with an NGT to drink water increases the loss of electrolytes. It will not cause sodium retention, but sodium depletion. The free water will pull electrolytes into the stomach and the NGT will suck the fluids and electrolytes out of the stomach. Depending on the patient’s condition and amount of water being ingested, it may increase nausea and vomiting. However, this would most likely happen if the suction was not working properly; it is not the primary reason for withholding oral fluids. Oral intake of water would not disrupt the intermittent suction.
The nurse receives a health care provider’s prescription to change a patient’s intravenous (IV) from D 5 ½ normal saline (NS) with 40 mEq KCl/L to D5 NS with 20 mEq KCl/L. Which serum laboratory value on this same patient best supports the rationale for this IV prescription change?
Sodium 136 mEq/L, potassium 4.5 mEq/L
Sodium 145 mEq/L, potassium 4.8 mEq/L
Sodium 135 mEq/L, potassium 3.6 mEq/L
Sodium 144 mEq/L, potassium 3.7 mEq/L
Sodium 136 mEq/L, potassium 4.5 mEq/L
The normal range for serum sodium is 135 to 145 mEq/L, and the normal range for potassium is 3.5 to 5.0 mEq/L. The change in the IV prescription decreases the amount of potassium and increases the amount of sodium. For this prescription to be appropriate, the potassium level must be near the high end and the sodium level near the low end of their respective ranges.
The nurse is caring for a group of patients with a variety of diagnoses. Which conditions would cause the nurse to include interventions in the plan of care to address anticipated hypophosphatemia? Select all that apply.
Renal failure Respiratory alkalosis Diabetic ketoacidosis Tumor lysis syndrome Malabsorption syndrome
Respiratory alkalosis
Diabetic ketoacidosis
Malabsorption syndrome
The nurse would include interventions to address hypophosphatemia when providing care to patients with respiratory alkalosis, diabetic ketoacidosis, and malabsorption syndrome. The nurse should create a care plan for hyperphosphatemia when providing care to patients with renal failure and tumor lysis syndrome.
The nurse suspects which possible conditions in a patient whose serum potassium level is 6.8 mEq/L on admission? Select all that apply.
The patient is on insulin therapy.
The patient is taking amiloride daily.
The patient suffers from renal disease.
The patient’s electrocardiogram reveals flattened T waves.
The patient’s orders will include intravenous fluids with added potassium.
The patient is taking amiloride daily.
The patient suffers from renal disease.
Potassium levels greater than 5.0 mEq/mL indicated hyperkalemia. Potassium-sparing diuretics, such as amiloride, increase the potassium levels. Insulin moves potassium into the cell and decreases serum potassium values. The kidneys excrete potassium, so renal disease can lead to increased potassium levels. Hyperkalemia is manifested on an electrocardiogram as tall, peaked T waves. Potassium should not be added to IV fluids if the patient suffers from hyperkalemia.
The nurse is preparing to administer intravenous (IV) potassium chloride (KCl) to a patient. Which action should the nurse perform to ensure the patient’s safety?
Give KCl via IV push.
Add KCl to the hanging IV bag.
Give IV KCl in concentrated amounts.
Invert IV bags containing KCl several times.
Invert IV bags containing KCl several times.
Hypokalemia is characterized by a decreased concentration of potassium in the body. Therefore KCl should be administered to maintain normal potassium levels. Inverting the IV bags containing KCl several times ensures even distribution of KCl medication in the bag. The nurse should administer KCl through an infusion pump, not by IV push, to ensure that it is administered at an accurate rate. The nurse should not add KCl to the hanging IV bag because this would result in administering a bolus dose. The nurse will give IV KCl in diluted forms, rather than in concentrated amounts, to ensure the patient’s safety.
The nurse is caring for a patient with a potassium level of 6.2 mEq/dl. What syndrome does the nurse suspect the patient may have?
Cushing syndrome
Milk-alkali syndrome
Tumor lysis syndrome
Malabsorption syndrome
Tumor lysis syndrome
Tumor lysis syndrome causes movement of potassium from the intracellular fluid (ICF) to the extracellular fluid (ECF), resulting in hyperkalemia. Cushing syndrome may cause hypernatremia. Milk-alkali syndrome may cause hypercalcemia. Malabsorption syndrome may cause hypophosphatemia.
The patient has a one-time prescription for potassium chloride 20 mEq in 250 mL of normal saline intravenous (IV) to be given immediately. The nurse would seek clarification for this prescription if the patient’s more recent potassium level is at what level?
- 7 mEq/L
- 9 mEq/L
- 6 mEq/L
- 5 mEq/L
4.5 mEq/L
The normal range for serum potassium is 3.5 to 5 mEq/L. The IV prescription provides a substantial amount of potassium, so the patient’s potassium level must be low. A level of 4.5 mEq/L would not warrant this medication.
The nurse is providing care to a patient whose serum potassium level is 5.1 mEq/L. Which change should the nurse make to the plan of care to address this finding?
Monitoring for digitalis toxicity
Adding bananas to the list of approved fruits
Implementing continuous monitoring of urine output
Ensuring that intravenous calcium gluconate is available at all times
Ensuring that intravenous calcium gluconate is available at all times
A patient with hyperkalemia, as indicated by the serum potassium level, is at risk for dysrhythmia. Therefore the nurse should ensure that intravenous calcium gluconate is available at all times. Monitoring for digitalis toxicity, adding bananas to the list of approved fruits, and implementing continuous monitoring of urine output are interventions the nurse should add to the plan of care for a patient who develops hypokalemia, not hyperkalemia.
The nurse reviews laboratory findings for a patient with milk-alkali syndrome. What laboratory results are consistent with this diagnosis?
Calcium levels of 7 mg/dL
Calcium levels of 15 mg/dL
Phosphate levels of 2 mg/dL
Phosphate levels of 17 mg/dL
Calcium levels of 15 mg/dL
Milk-alkali syndrome is a condition in which large concentrations of calcium are found in the body. Calcium levels of more than 10.2 mg/dL indicate hypercalcemia. Calcium levels of 7 mg/dL indicate hypocalcemia. Phosphate levels of 2 mg/dL indicate hypophosphatemia. Phosphate levels of 17 mg/dL indicate hyperphosphatemia.
The nurse is caring for a patient with a blood sodium level of 170 mEq/L and is experiencing intense thirst, agitation, and decreased alertness. What does the nurse anticipate administering?
Intravenous furosemide
Intravenous cation-exchange resin
Intravenous phosphate-binding agent
Intravenous 0.45% sodium chloride saline solution
Intravenous 0.45% sodium chloride saline solution
Hypernatremia is a condition in which water shifts out of the cells into the extracellular fluid, resulting in dehydration. Therefore the patient with hypernatremia would experience intense thirst, agitation, and decreased alertness. To reduce dehydration, fluid should be replaced by administering hypotonic intravenous fluids such as 5% dextrose in water or 0.45% sodium chloride saline solution. Administering intravenous furosemide may help treat hypercalcemia. A cation-exchange resin may be administered to treat hyperkalemia. A phosphate-binding agent may be administered to treat hyperphosphatemia.
Upon assessment of laboratory data, the nurse notes a calcium level of 6.4 mg/dL. Which physical assessment finding is consistent with this data?
Polyuria
Bone pain
Paresthesias
Diminished deep tendon reflexes
Paresthesias
Signs of hypocalcemia include paresthesias, tetany, and muscle weakness. Bone pain, diminished reflexes, and polyuria are signs of hypercalcemia.
While reviewing a patient’s laboratory reports, the nurse finds the plasma concentration of calcium to be 11.2 mg/dL. Which clinical manifestations does the nurse anticipate observing? Select all that apply.
Polyuria Seizures Nephrolithiasis Chvostek’s sign Trousseau’s sign
Polyuria
Nephrolithiasis
Plasma concentration of calcium greater than 10.2 mg/dL indicates hypercalcemia, which results in increased concentration of calcium in the urine. This impairs sodium and water reabsorption and causes polyuria. Hypercalcemia can cause kidney stones, or nephrolithiasis, because an increased concentration of calcium in the urine deposits crystals in the kidney, which combine to form kidney stones. Seizures, Chvostek’s sign, and Trousseau’s sign are clinical manifestations of hypocalcemia.
The nurse is caring for a patient admitted with heart failure. The morning laboratory results reveal a serum potassium level of 2.9 mEq/L. What classification of medications should be withheld until consulting with the health care provider?
Antibiotics
Loop diuretics
Bronchodilators
Antihypertensives
Loop diuretics
Loop diuretics are contraindicated during episodes of hypokalemia because these medications cause the kidneys to excrete sodium and potassium. Thus administration of this type of medication at this time would worsen the hypokalemia, putting the patient at risk for dysrhythmias. The prescribing health care provider should be consulted for potassium replacement therapy, and the drug should be withheld until the potassium has returned to normal range. Antibiotics, bronchodilators, and antihypertensives are not an issue in this case.
The nurse is preparing to administer a dose of potassium phosphate. What laboratory finding would indicate that the nurse should withhold the medication?
Calcium 6.4 mg/dL
Sodium 133 mEq/L
Magnesium 1.8 mEq/L
Potassium 5.2 mEq/L
Calcium 6.4 mg/dL
Phosphorus and calcium have inverse or reciprocal relationships, meaning that when calcium levels are high, phosphorus levels tend to be low. Therefore administration of phosphorus will reduce a patient’s already abnormally low calcium level, which can result in life-threatening complications. Potassium phosphate will not have any effect on sodium, magnesium, or potassium levels.
A patient is admitted with alcohol abuse. Laboratory data reveals a phosphate level of 1.8 mg/dL. Which assessment finding is consistent with this data?
Tetany
Diarrhea
Weakness
Seizure activity
Weakness
Signs of hypophosphatemia include weakness, confusion, coma, and diminished reflexes. Seizure activity, diarrhea, and tetany are not associated with this electrolyte imbalance.
Which medical diagnosis would cause the nurse to include nursing interventions appropriate for hyponatremia in the plan of care?
Diabetes insipidus
Cushing syndrome
Congestive heart failure
Uncontrolled diabetes mellitus
Congestive heart failure
Congestive heart failure increases the patient’s risk for developing hyponatremia; therefore this diagnosis would cause the nurse to include interventions specific to hyponatremia in the plan of care. Diabetes insipidus, Cushing syndrome, and uncontrolled diabetes mellitus increase the patient’s risk for hypernatremia, not hyponatremia.
Which is a priority nursing action when providing care to a patient who is being treated for hypernatremia that developed slowly over several days?
Initiating seizure precautions
Administering prescribed diuretics
Monitoring the patient’s weight each day
Restricting the patient’s dietary sodium intake
Initiating seizure precautions
A rapid reduction in the sodium level can cause a rapid shift of water back into the cells, resulting in cerebral edema and neurologic complications. This risk is greatest in a patient who developed hypernatremia over several days or longer. The priority nursing action in this case is to implement seizure precautions due to the risk of neurologic complications. Monitoring the patient’s weight each day, restricting dietary sodium intake, and administering prescribed diuretics are all appropriate nursing actions; however, these are not the priority given this patient’s risk for neurologic complications.
A patient’s potassium level is 2.9 meq/L. Which health care provider order should the nurse expect?
Continuous ECG monitoring
Increase digoxin (Lanoxin) to 0.25 mg every day
Add 20 meq KCL to the present IV bag hanging and give over four hours
40 meq KCL in 100 cc D5W intravenous piggyback (IVPB) to infuse over 30 minutes
Continuous ECG monitoring
Hypokalemia can cause lethal ventricular rhythms. Therefore continuous cardiac monitoring should be expected. Patients with hypokalemia are at risk for digoxin toxicity. The nurse should watch for signs of digoxin toxicity and question an increase in dosage. KCL infusion must be diluted and given at a rate not to exceed 10 meq/hour. 40 meq KCL in 100 cc of fluid is too concentrated and should be given over at least two hours. To prevent bolusing, KCL should never be added to an IV bag that already is hanging.
Which patient statements indicate the need for further education from the nurse regarding the use of potassium supplementation for the treatment of hypokalemia? Select all that apply.
"I will chew my tablets." "I will eat a banana every day." "I will include licorice in my diet." "I will take my medication with water." "I will tell my doctor if I develop constipation."
“I will chew my tablets.”
“I will include licorice in my diet.”
The patient statements regarding chewing the tablets and including licorice in the diet require additional education. The tablets should be swallowed whole and the patient should avoid, not include, licorice in the diet. The patient statements regarding eating a banana each day (a source of potassium), taking the medication with water (a full glass is recommended), and notifying the healthcare provider if constipation occurs (a clinical manifestation associated with hypokalemia) indicate correct understanding.
The nurse is planning care for a patient with a new diagnosis of hypercalcemia resulting from treatment for hypocalcemia. Which change to the plan of care should the nurse anticipate?
Encouraging weight-bearing exercises
Teaching the patient to breathe into a bag
Administering intravenous calcium gluconate
Administering a loop rather than a thiazide diuretic
Encouraging weight-bearing exercises
A patient with hypercalcemia as a result of treatment for hypocalcemia would require the addition of weight-bearing exercises to the plan of care. These exercises will facilitate the movement of extra calcium ions in the blood to the bone. Teaching the patient to breathe into a bag, administering calcium gluconate, and administering a loop diuretic are all appropriate for hypocalcemia; therefore these actions should be removed from the plan of care, not added.
A nurse is caring for a patient with malignant lung cancer who experiences weakness, lethargy, depressed reflexes, and bone pain. Which changes in the electrocardiogram evaluated by the nurse may indicate suspected hypercalcemia? Select all that apply.
Shortened QT interval Prolonged QT interval Shortened ST segment Elongation of ST segment Flattened or inverted T wave
Shortened QT interval
Shortened ST segment
Hypercalcemia may result from malignancies. Bone destruction due to tumor invasion may cause a release of calcium, leading to high levels of calcium in the blood. This causes altered transmembrane potentials affecting conduction time and is manifested as a shortened ST segment and QT interval. An elongated ST segment and a prolonged QT interval are manifestations of hypocalcemia. A flattened or inverted T wave is a manifestation of hypokalemia.
The nurse is preparing to cleanse the skin around a central venous access device. Which solution would the nurse select as the most effective means of killing harmful bacteria?
Sterile saline solution
Isopropyl alcohol solution
Povidone-alcohol solution
Chlorhexidine-based solution
Chlorhexidine-based solution
Chlorhexidine-based solutions such as chlorhexidine gluconate have been shown to be more effective at killing bacteria than povidone-alcohol or isopropyl alcohol solutions. Therefore chlorhexidine-based solutions should be used to cleanse around the central venous access device. A sterile saline solution does not have any antiseptic properties.
The nurse is caring for a patient diagnosed with heat stroke and with a urine output of 4000 mL per day. What is the most appropriate nursing action?
Transfusing blood
Applying moisturizer regularly
Administrating lactated Ringer’s solution
Administrating supplementary water in enteric formula
Administrating lactated Ringer’s solution
Heat stroke and an increased amount of urine output of about 4000 mL leads to a deficit in extracellular fluid volume, causing dehydration. Administering lactated Ringer’s solution to maintain fluid and electrolyte balance is beneficial. Blood transfusions are performed only when the fluid loss is due to blood loss. Moisturizers are applied to patients with dry skin to prevent the fluid loss.Tube feeding is preferred in the patient with severe extracellular fluid loss. The patient on tube feeding must be thereby supplemented with water added to the enteric formula.
A patient has been treated for dehydration. What outcome does the nurse determine demonstrates effectiveness of the treatment regimen?
Oral intake balances output.
Oral intake is less than output.
Oral intake is greater than output.
No significant difference in fluid balance.
Oral intake balances output.
Oral intake should equal output if fluid balance has been restored and dehydration has been corrected. Less intake than output would result in dehydration. Greater intake than output may indicate decreased renal function or impaired ability to excrete urine.
The nurse is unable to flush a central venous access device and suspects occlusion. Which of these would be appropriate interventions to undertake? Select all that apply.
Clamp the tubing immediately.
Obtain cultures of the insertion site.
Instruct the patient to change positions, raise arm, and Attempt to force flush 10 mL of normal saline into the device.
Assess the tubing for clamping or kinking, and alleviate as needed.
Instruct the patient to change positions, raise arm, and cough.
Assess the tubing for clamping or kinking, and alleviate as needed.
Catheter occlusion interventions include instructing the patient to change position, raise an arm, and cough; assessing for and alleviating clamping or kinking; flushing with normal saline using a 10-mL syringe (do not force flush); using fluoroscopy to determine cause and site; and instilling anticoagulant or thrombolytic agents. Clamping the tubing and culturing the site would not assist in flushing the line or resolve the occlusion. The nurse should not force flush the line.
A nurse is caring for a patient with a central venous access device. The patient is experiencing chest pain, dyspnea, hypotension, and tachycardia. What nursing actions are essential in the care of this patient? Select all that apply.
Administer oxygen.
Administer anticoagulants.
Clamp the central venous access catheter.
Place the patient on the left side with the head down.
Flush the central venous access device with normal saline using a 10 mL syringe.
Administer oxygen.
Clamp the central venous access catheter.
Place the patient on the left side with the head down.
Pulmonary embolism is a complication of central venous access devices. The nurse should start oxygen therapy to relieve dyspnea. The catheter should be clamped to prevent further formation of emboli. Because the signs suggest air embolism, the patient is placed on the left side with the head down. Administering anticoagulants and normal saline are required if the catheter is occluded, and they do not help in relieving a pulmonary embolus.
A patient admitted with dehydration is receiving a hypertonic solution. What assessments must be done to avoid risk factors of these solutions? Select all that apply.
Lung sounds Bowel sounds Blood pressure (BP) Serum sodium level Serum potassium level
Lung sounds
Blood pressure (BP)
Serum sodium level
BP, lung sounds, and serum sodium levels must be monitored frequently because of the risk for excess intravascular volume with hypertonic solutions. Bowel sounds and serum potassium level do not need to be monitored frequently.
The nurse must prepare the correct intravenous (IV) solution before administration. The prescription reads for the patient to receive D5 ½ NS with 40 mEq KCl/L at 125 mL/hr. The nurse must add KCl to the IV because no premixed solutions are available. The unit medication supply has a stock of KCl 3 mEq/mL in multidose vials. What amount of KCl should be added to a liter of D5 ½ NS to obtain the correct solution? Fill in the blank using one decimal place. \_\_\_ mL 40 mEq (dose desired) ÷ 3 mEq/ml (dose available) = 13.3 mL.
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The nurse is completing an assessment of a patient with heart failure who is being treated for accidental overuse of diuretics. For which potential respiratory issue should the nurse monitor the patient?
Shortness of breath
Pulmonary congestion
Increased respiratory rate
Moist crackles on inspiration
Increased respiratory rate
Patients with deficient fluid volume experience decreased tissue perfusion and hypoxia resulting in an increased respiratory rate. Pulmonary congestion, shortness of breath, and moist crackles on inspiration are all characteristic of a fluid volume excess, not deficit.
A patient with blood pressure of 160/90 mm Hg has pedal edema. Which process of transport of molecules would be in action?
Osmosis
Diffusion
Active transport
Facilitated diffusion
Osmosis
A patient with blood pressure of 160/90 mm Hg has hypertension and develops pedal edema due to excess sodium in the blood. This leads to movement of water down the gradient. Therefore the water from the blood vessels moves from higher concentrations to lower concentration across the semipermeable membrane with the help of osmotic pressure and leads to accumulation of water in the extracellular spaces. This movement of water across a semi-permeable membrane to balance the solute is called Osmosis. Diffusion and facilitated diffusion involve molecules moving from a higher to lower concentrations, and active transport involves molecules moving from a lower to higher concentration.
The patient has a prescription for lactated Ringer’s intravenously (IV) at a rate of 200 mL/hr. An IV pump is not available. The IV tubing has a drop factor of 10 drops/mL. The nurse will administer the lactated Ringer’s solution at drops per minute. Record your answer using a whole number.
Use the following formula to calculate the rate of IV solutions: Volume multiplied by drop factor divided by time (in minutes). Multiply 200 by 10 to yield 2000 and divide this by 60 to yield 33.3 or 33 gtt/minute (because the nurse cannot count a fraction of a drop).
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A patient has been admitted for dehydration. What is a priority nursing intervention?
Perform daily weights.
Reorient the patient hourly.
Restrict sodium intake to 2 grams per day.
Provide continuous oxygen saturation monitoring.
Perform daily weights.
Measuring weight is the most reliable means of detecting changes in fluid balance. Weight loss would indicate that the dehydration is worsening, whereas weight gain would indicate restoration of fluid volume. The nurse would recall that a 1-kg weight gain indicates a gain of approximately 1000 mL of body water. This patient is not disoriented, and that is not a common assessment finding in the patient with dehydration. Continuous oxygen saturation monitoring is not indicated. Sodium intake does not need to be restricted.
A patient’s insensible water loss is estimated at 900 mL per day. The nurse understands that this fluid is lost via which mechanism?
Excreted via urine
Excreted in the feces
Vaporized by the lungs and skin
Secreted into the digestive tract
Vaporized by the lungs and skin
Approximately 600-900 mL of water is lost each day via insensible water loss, which is vaporization by the lungs and skin. Approximately 1,500 mL is excreted in the urine and 100 mL in the feces. Approximately 8,000 mL of digestive fluids are secreted daily, but most is reabsorbed in the gastrointestinal tract.
When the nurse is caring for a patient with a central venous access device, which nursing interventions are important to maintain a safe, functioning device? Select all that apply.
Change the catheter dressing regularly.
Monitor the heart rate and blood pressure.
Cleanse around the catheter insertion site.
Measure and record oral intake and output.
Change the injection caps at regular intervals.
Change the catheter dressing regularly.
Cleanse around the catheter insertion site.
Change the injection caps at regular intervals.
Nursing management of central venous access devices is important in keeping the devices safe and functioning and in reducing risk of infection. The catheter dressing and the injection caps should be regularly changed, and the catheter site should be regularly cleansed; these steps keep the site free from infection. Flushing is an important intervention to maintain the patency of the catheter and prevent occlusion. Monitoring vital parameters and assessing intake and output are general measures that are not specific to the care of central venous access devices.
The nurse is reviewing the laboratory data of a patient admitted for evaluation of a fluid and electrolyte imbalance. The lab results show Na+ 132 mEq/L, BUN 5 mg/dL, and HCT 33%. What does the nurse infer from these findings?
Hyperkalemia
Hypernatremia
Excess fluid volume
Deficient fluid volume
Excess fluid volume
A decreased sodium level (normal sodium ranges from 135 to 145 mEq/L), BUN (normal BUN ranges from 7-20 mg/dL), and HCT (normal level 35-47% for women and 39-50% for men) indicate fluid volume excess. The patient has hyponatremia, not hypernatremia, since the sodium level is below 135. There is no indication from the data that the patient is hyperkalemic. Because these values indicate excess, the patient is not at risk for a fluid volume deficit, nor does he or she have one.
The nurse is preparing to document skin assessment findings for a patient being treated for renal failure. Assessment findings include cool, taut skin over the sternum with a 2-mm indentation when pressing with a thumb over the sternum. How does the nurse document the grade of the edema?
1+
2+
3+
4+
1+
Cool, taut and hard skin indicates fluid accumulation. An indentation of 2-mm after pressing with the thumb to assess edema indicates a grade of 1+. A 4-mm indentation warrants a grade of 2+, a 6-mm indentation a grade of 3+, and an 8-mm indentation a grade of 4+.
A patient with a tumor of the adrenal glands reports feeling unusually sleepy. After receiving the prescription from the health care provider, which nursing action is most appropriate considering the fact that the patient is at risk of hypernatremia due to primary aldosteronism?
Administer furosemide
Administer conivaptan
Encourage sodium intake
Give oral potassium supplements
Administer furosemide
A tumor of the adrenal glands may cause hypersecretion of aldosterone, resulting in hypernatremia. Hypernatremia should be treated with a diuretic (to promote excretion of excess sodium) and with sodium-free intravenous fluids such as 5% dextrose in water (to dilute the sodium concentration). Sodium intake should also be restricted. Conivaptan is administered when treating hyponatremia. Potassium supplements are needed in cases of hypokalemia.
A patient has a prescription to receive 0.9% sodium chloride (normal saline) intravenously (IV) at a rate of 100 mL per hour. The current bag of 1000 mL was hung at 1000. When making rounds at 1300, the nurse notes that the IV bag contains 900 mL of normal saline. How would the nurse document this incident report?
Wrong rate
Wrong route
Wrong solution
Wrong documentation
Wrong rate
After three hours of infusion time, 300 mL of IV solution should have infused, but the patient has received 100 mL. Therefore the patient has received the wrong rate. The solution, route, and documentation are correct.
A pregnant woman reports headaches and shortness of breath to the nurse. The nurse auscultates crackles and a bounding pulse. What is the appropriate nursing action?
Applying hot and cold compresses
Restricting the intake of dietary sodium
Asking the patient to sit and then stand
Providing ice chips to hydrate the patient
Restricting the intake of dietary sodium
A pregnant woman with increased extracellular fluid may develop hypertension and pregnancy-related complications. Restriction of dietary sodium helps to control the fluid accumulation and may help to maintain fluid balance. Application of warm and cold compresses will not relieve the patient’s symptoms. Changing the position does not benefit the patient, and providing ice chips may increase the fluid volume and worsen the condition.
The nurse is caring for an older patient who is receiving intravenous (IV) fluids postoperatively. During the 0800 assessment of this patient, the nurse notes that the IV solution, which was prescribed to infuse at 125 mL/hr, has infused 950 mL since it was hung at 0400. What is the priority nursing intervention?
Notify the health care provider and complete an incident report.
Obtain a new bag of IV solution to maintain patency of the site.
Listen to the patient’s lung sounds and assess respiratory status.
Slow the rate to keep the vein open until the next bag is due at noon.
Listen to the patient’s lung sounds and assess respiratory status.
After four hours of infusion time, 500 mL of IV solution should have infused, not 950 mL. This patient is at risk for fluid volume excess, and the nurse should assess the patient’s respiratory status and lung sounds as the priority action and then notify the health care provider for further prescriptions.
The emergency room nurse is caring for a patient with a severe fluid volume deficit who presented after several days of diarrhea secondary to C. difficile infection. Which intravenous (IV) fluid does the nurse anticipate will be used to rapidly replace the fluid volume?
0.9% sodium chloride
0.45% sodium chloride
5% dextrose in 0.9% saline
5% dextrose in 0.25% saline
0.9% sodium chloride
An isotonic fluid such as 0.9% sodium chloride is used to rapidly replace fluid volume. The solutions 0.45% sodium chloride, 5% dextrose in 0.25% saline, and 5% dextrose in 0.9% saline are all hypertonic solutions that are not used to rapidly increase fluid volume.
The nurse is caring for a patient who is febrile with a body temperature of 103 oF. What clinical manifestation does the nurse anticipate when assessing this patient?
Muscle spasm
Bounding pulse
Jugular vein distention
Orthostatic hypotension
Orthostatic hypotension
A patient with an elevated body temperature of 103oF may have a loss of body fluids leading to decreased blood volume and resulting in postural or orthostatic hypotension. Muscle spasm, a bounding pulse, and jugular vein distention are manifestations that occur due to an increase in the body fluid volume.
The nurse is caring for a patient with heart failure. What assessment data indicates the patient is at risk for developing fluid volume excess?
Full, bounding pulse
Flattened neck veins
Low blood pressure
Easily obliterated pulse
Full, bounding pulse
Any change in the fluid volume is reflected in changes in blood pressure, pulse rate force, and jugular venous distension. A fluid volume excess may cause a full bounding pulse, increased blood pressure, and distended neck veins. The pulse in this case is not easily obliterated. Flattened neck veins, low blood pressure, and a weak and thready pulse that can be easily obliterated indicate fluid volume deficit
Which term is used to describe the fact that extracellular fluid and intracellular fluid have the same osmolality?
Isotonic
Hypotonic
Hypertonic
Oncotic pressure
Isotonic
Extracellular fluid and intracellular fluid have the same osmolality; this characteristic is termed isotonic, meaning that there is no net movement of fluids. Hypotonic refers to fluids with a lower osmolality, which results in water moving into the cell when the cell is surrounded by a hypotonic fluid. Hypertonic refers to fluids with a higher osmolality, which results in water moving out of the cells when they are surrounded by a hypertonic solution. Oncotic pressure refers to the pressure of plasma colloids in a solution.
A nurse is completing an assessment on a patient with suspected fluid volume excess. Which cardiovascular changes would support this diagnosis? Select all that apply.
Full, bounding pulse Distended neck veins Orthostatic hypotension Increase in the heart rate Presence of an S3 heart sound
Full, bounding pulse
Distended neck veins
Presence of an S3 heart sound
Fluid volume excess results in a full, bounding pulse, presence of an S3 heart sound, and jugular venous distention (distended neck veins). Orthostatic hypotension and an increased heart rate are clinical manifestations of deficient, not excess, fluid volume.
A nurse is assessing a patient’s weight in order to evaluate fluid volume status. The patient’s weight on the day of admission was 60 kg. On day 2, the weight is 62 kg. What is the quantity of fluid retention in the patient? Record your answer using a whole number and no punctuation. _______ mL
An increase in 1 kg is equal to 1000 mL of fluid retention. The patient has gained 2 kg, which is equal to 2000 mL of fluid retention.
.
A patient is receiving intravenous albumin 5%. The nurse understands that albumin is commonly used to treat which metabolic alteration?
Alkalosis
Hypovolemia
Hyperkalemia
Mixed acid-base disorder
Hypovolemia
Albumin is a colloid solution that pulls fluid into the blood vessels, which restores blood volume. This medication is used to treat hypovolemia. Albumin is not effective in the treatment of alkalosis, hyperkalemia, or a mixed acid-base disorder.
A patient comes to the emergency department after three days of continuous vomiting. This patient is at risk for which acid-base imbalance?
Metabolic acidosis
Metabolic alkalosis
Respiratory acidosis
Respiratory alkalosis
Metabolic alkalosis
Metabolic alkalosis can occur with prolonged vomiting secondary to the loss of strong gastric acids. Respiratory acidosis is caused by hypercarbia of respiratory origin. Metabolic acidosis is an increase in acid levels related to a metabolic dysfunction such as lactic acidosis, starvation, or diarrhea. Respiratory alkalosis occurs with hypocarbia related to hyperventilation.
An older adult patient with dementia arrives in the emergency department with a family member; the patient is found to be hypercarbic. The patient has an advanced directive and does not want any invasive procedure. The family member asks if this issue will resolve by itself. Which is the nurse’s most appropriate response?
“The kidneys will compensate for increased levels of CO2 after about 24 hours.”
“The kidneys sense increased levels of CO2 in the blood and reabsorb additional bicarbonate.”
“Older adults have a harder time compensating because they have decreased respiratory and kidney functions.”
“The respiratory center senses increased levels of CO2 in the blood and stimulates hyperventilation to compensate.”
“Older adults have a harder time compensating because they have decreased respiratory and kidney functions.”
Hypercarbia is an increased level of CO2 in the blood, which is a hallmark of respiratory acidosis. Older adults have difficulty compensating for acid-base imbalances because of decreased functional capacity in the respiratory and renal systems. Hyperventilation is a normal physiologic response to hypercarbia; hyperventilation may not be possible with decreased functional respiratory reserves. Normal kidneys can sense hypercarbia and begin to reabsorb buffer to normalize pH; however, older adults may lack the functional capacity or have some degree of kidney disease. Normal renal compensation is slow and will often begin in 24 hours, if kidney function is normal
The nurse is evaluating a patient’s arterial blood gases. Which value of partial pressure of carbon dioxide (PaCO2) in arterial blood indicates a compensatory response in metabolic alkalosis?
38 mm Hg
40 mm Hg
44 mm Hg
47 mm Hg
47 mm Hg
Metabolic alkalosis results in decreased carbonic acid. Therefore, to increase its concentration, the respiratory rate is reduced. This reduction leads to a rise in carbon dioxide concentration in the blood. Normal values of partial pressure of carbon dioxide (PaCO2) range from 35 to 45 mm Hg; 47 mm Hg of PaCO2 indicates a compensatory response in metabolic alkalosis.
A patient with gastroenteritis has the following arterial blood gas results: pH 7.30, PaO2 80 mm Hg, PaCO2 46 mm Hg, HCO314. What does the nurse determine that these results indicate?
Metabolic acidosis
Metabolic alkalosis
Respiratory acidosis
Respiratory alkalosis
Metabolic acidosis
A low pH (normal 7.35-7.45) indicates acidosis. In the patient with gastroenteritis and diarrhea, bicarbonate is lost from the excessive stool, which would result in a low bicarbonate level and resulting metabolic acidosis. There is not a respiratory component associated with gastroenteritis.
The nurse is reviewing the mechanisms of acid-base buffers in the body. The kidneys act as an acid-base buffer by which of these mechanisms? Select all that apply.
Eliminating excess H +
Excreting excess water
Eliminating excess CO2
Reabsorbing additional HCO 3 -
Reabsorbing additional sodium ions
Eliminating excess H +
Reabsorbing additional HCO 3 -
As a compensatory mechanism, the pH of the urine can decrease to 4 or increase to 8. To compensate for acidosis, the kidneys can reabsorb additional HCO3-and eliminate excess H+. Thus the pH of the blood increases and the pH of the urine decreases. Eliminating excess water or CO2 or reabsorbing additional sodium ions are not mechanisms of acid-base buffers
The patient has chronic kidney disease and ate a lot of nuts, bananas, peanut butter, and chocolate. The patient is admitted with loss of deep tendon reflexes, somnolence, and altered respiratory status. What treatment should the nurse expect for this patient?
Renal dialysis
IV furosemide (Lasix)
Intravenous (IV) potassium chloride
IV normal saline at 250 mL per hour
Renal dialysis
Renal dialysis will need to be administered to remove the excess magnesium that is in the blood from the increased intake of foods high in magnesium. If renal function was adequate, IV potassium chloride would oppose the effects of magnesium on the cardiac muscle. IV furosemide and increased fluid would increase urinary output, which is the major route of excretion for magnesium.
The nurse is caring for a group of patients. Which patient should the nurse closely monitor for the development of respiratory acidosis?
The patient with severe vomiting
The patient with a pulmonary embolism
The patient being treated for severe pneumonia
A patient that has recovered from diabetic ketoacidosis
The patient being treated for severe pneumonia
A patient that has recovered from diabetic ketoacidosis
Pneumonia is an inflammatory condition that causes hypoventilation, which results in increased concentration of carbon dioxide in blood and precipitates respiratory acidosis. Severe vomiting may cause loss of strong acids from the body, resulting in metabolic alkalosis. A pulmonary embolism causes hyperventilation, resulting in respiratory alkalosis. Diabetic ketoacidosis causes accumulation of ketone bodies in the body, resulting in metabolic acidosis
What happens when the respiratory center in the medulla senses an increased concentration of carbon dioxide (CO2) or H+?
The respiratory center stimulates hyperventilation to get rid of CO2.
The respiratory center stimulates a decreased rate of breathing to retain CO2.
The respiratory center stimulates an increased depth of breathing to retain H+.
The respiratory center stimulates a decreased depth of breathing to get rid of H+.
The respiratory center stimulates hyperventilation to get rid of CO2.
Increased CO2 or H+ signals acidosis, which triggers the respiratory center to hyperventilate and get rid of CO2 to balance the pH. CO2 retention occurs to correct alkalosis. A decreased depth of breathing occurs in respiratory dysfunction. An increased depth of breathing occurs in hyperventilation; in this case, the body will expel CO2 to decrease H+
The arterial blood gas (ABG) analysis of a patient with diabetes shows a partial pressure of carbon dioxide (PaCO2) of 43 mm Hg and pH of 5.1. What would be the nurse’s interpretation of these ABG results?
Metabolic acidosis
Metabolic alkalosis
Respiratory acidosis
Respiratory alkalosis
Metabolic acidosis
Metabolic acidosisis characterized by increased levels of acid in the blood. As a result, pH of the blood decreases. The normal range of pH of blood is 7.35 to 7.45, and the normal value of partial pressure of carbon dioxide (PaCO2) lies between 35 and 45 mm Hg. The patient’s numbers indicate metabolic acidosis. Metabolic alkalosis is manifested by an increased pH. A decreased pH and elevated PaCO2 indicate respiratory acidosis. Respiratory alkalosis is manifested by increased plasma pH and decreased PaCO2.
What is the normal range of partial pressure of carbon dioxide (PaCO2) in arterial blood?
25 to 35 mm Hg
35 to 45 mm Hg
45 to 55 mm Hg
55 to 65 mm Hg
35 to 45 mm Hg
The normal value of partial pressure of carbon dioxide (PaCO2) in arterial blood lies between 35 and 45 mmHg.
A patient in the emergency department presents with lethargy and confusion and is found to have metabolic acidosis. The patient’s family alerts the nurse that the patient has a history of “heart problems” and is concerned about whether the acidosis will affect his cardiac system. Based on the nurse’s knowledge of acid-base imbalances, what is the best response to the family?
“Acidosis may affect the patient’s blood pressure but not his or her heart.”
“Acidosis is often temporary and never life-threatening; it is nothing to worry about.”
“Metabolic acidosis is a symptom of an underlying disorder for which we will evaluate and treat during this admission.”
“Uncompensated acidosis can cause hypotension and cardiac dysrhythmias; we will monitor for and work to prevent these complications.”
“Uncompensated acidosis can cause hypotension and cardiac dysrhythmias; we will monitor for and work to prevent these complications.”
Uncompensated and untreated acidosis of any type can prove life-threatening because of its untoward downstream effects on the cardiac system in the form of hypotension and dysrhythmias. The nurse should assure the family that the medical team will monitor for and work to prevent these complications. Metabolic acidosis is a symptom of an underlying disease that must be treated; however, profound acidosis must be monitored and treated as well. Acidosis can in fact be life-threatening. Changes in blood pressure have a direct effect on the heart and the circulatory system as a whole, both of which are affected in untreated and uncompensated acidosis.
A patient reports headache and dizziness. After reviewing the electrocardiogram (ECG) and blood reports of the patient, the nurse finds that the patient has ventricular fibrillation and hypotension. Which condition does the nurse suspect?
Metabolic acidosis
Metabolic alkalosis
Respiratory acidosis
Respiratory alkalosis
Respiratory acidosis
Signs of respiratory acidosis include hypotension, headache, dizziness, and ventricular fibrillation. Metabolic acidosis is manifested by headache, dizziness, and dysrhythmia. Metabolic alkalosis is manifested by tachycardia, anorexia, and tremors. Patients with respiratory alkalosis exhibit tachycardia, tetany, and epigastric pain.
A patient has the following arterial blood gas results: pH 7.16, PaCO2 80 mm Hg, PaO2 46 mm Hg, HCO3- 24 mEq/L, and SaO2 81%. How does the nurse interpret this information?
Metabolic acidosis
Metabolic alkalosis
Respiratory acidosis
Respiratory alkalosis
Respiratory acidosis
The pH is less than 7.35, indicating acidosis. This eliminates metabolic and respiratory alkalosis as possibilities. Because the PaCO2 is high at 80 mm Hg (normal range is 35 to 45 mm Hg) and the metabolic measure of HCO3– is normal (range is 22 to 28 mEq/L), the patient is in respiratory acidosis, not alkalosis
A diabetic patient fasting before surgery reports feeling dizzy with deep, rapid breathing. A nurse observes that the patient has developed Kussmaul respirations. What condition is the patient most likely experiencing?
Metabolic acidosis
Metabolic alkalosis
Respiratory acidosis
Respiratory alkalosis
Metabolic acidosis
The patient has been fasting and complains of dizziness. The patient has likely developed diabetic ketoacidosis, a type of metabolic acidosis. Kussmaul respiration is deep, rapid breathing that develops in response to metabolic acidosis. This type of breathing is a compensatory mechanism to excrete excess carbon dioxide from the lungs. Metabolic alkalosis occurs when there is a loss of acid or a gain in bicarbonate. It is not associated with Kussmaul respiration. Respiratory acidosis results when the person hypoventilates and carbonic acid accumulates in the blood. Respiratory alkalosis occurs when the person hyperventilates.
