Final Exam Review ABG’s (2-4 Q’s)

Question 1

Which patients most commonly develop acid base imbalance problems?

Answer 1

COPD
Diabetes
Kidney disease

Question 2

The nurse would recognize the following manifestations of Respiratory Alkalosis in a patient

Answer 2

Neurologic
Dizziness
Light-headedness
Confusion 
Headache 

Cardio
Tachycardia
Dysrhythmias (related to hypokalemia from compensation)

GI
Nausea
Vomiting
Diarrhea 
Epigastric pain

Neuromuscular 
Tetany 
numbness
Tingling of extremities 
Hyperreflexia
Seizures

Respiratory
Hyperventilation
(Lungs are unable to compensate if there is a respiratory problem)

Question 3

pH = 7.32 
PaCO2 = 30
HCO3- = 16
PaO2 = 95

What is the interpretation of this?

Answer 3

This ABG is interpreted as metabolic acidosis with partial compensation. Partial compensation is occurring bc the pH remains abnormal. Full compensation would occur after the pH returns within normal limits.

Question 4

In respiratory Conditions, the pH and the PACO2 to go in opposite directions

Answer 4

In respiratory alkalosis, the pH is up ⬆️and the PAC02 ⬇️is down.

In respiratory acidosis, the pH is down ⬇️and the PAC02 ⬆️is up.

Question 5

In metabolic conditions, the pH and the HCO3 (-) go in the same direction equal the PaCO2 may also go in the same direction.

Answer 5

In metabolic alkalosis, pH and HCO3- are up and the PaCO2 is up ⬆️ or normal.

In metabolic acidosis, the pH and HCO3-are down ⬇️ and the PaCO2 is up ⬆️ or normal.

Question 6

Proritization

Large Part of what a nurse does. In addition many NCLEX questions focus on prioritization.

Answer 6

Question 7

Parameters for normal ABG’s

Answer 7

pH 7.35-7.45
PaCO2 35-45
Bicarbonate (HCO3-) 22-26
PaO2 80-100
SaO2 > 95%
Base excess + or - 2.0 mEq/L

Question 8

What type of medication should we assess a patient for regarding ingredients that may counter act with fluid electrolyte an acid-base imbalances

Answer 8

A nurse should assess the patient’s current and past use of medication. The ingredients in many drugs especially over-the-counter drugs are often hidden sources of sodium, potassium, calcium, magnesium, and other electrolytes. Many prescription drugs, including diuretics, cortical steroids, and electrolyte supplements, can cause fluid and electrolyte imbalances.

Question 9

Surgery your other treatments and its effect on fluid, electrolyte, and acid-base imbalances

Answer 9

A nurse Should ask the patient about past present renal dialysis, kidney surgery, or bowel surgery resulting in a temporary or permanent external collecting system, such as an ileostomy.

Question 10

A nurse should assess what about past health history regarding acid-base imbalances?

Answer 10

Question the patient about any history of problems involving the Kidneys, heart, G.I. system, or lungs that could affect the present fluid, etc. Ask about specific diseases such as diabetes, diabetes insipidus, COPD, renal failure, ulcerative colitis, and Crohn’s disease. Access for any prior fluid, electrolyte or acid base disorders.

Question 11

Nutritional metabolic pattern

Answer 11

Ask the patient about diet and any special dietary practices diet fad diet’s any eating disorders such as anorexia or bulimia, can lead to fluid and electrolyte problems.

Question 12

Elimination pattern

Answer 12

Make note of the patients usual bowel and bladder habits. Carefully document any deviations from the expected elimination pattern, such as diarrhea, oliguria, Polyuria, or incontinence

Question 13

What is third spacing fluid and how does it occur?

Answer 13

It occurs when excess fluid collects in the non-functional area between cells. This fluid is trapped where it is difficult or impossible for it to move back into the cells or blood vessels. Third spacing occurs with ascites; fluid leaking into the abdominal cavity with peritonitis or pancreatitis; and edema associated with burns, trauma, or sepsis.

Question 14

What are the Gerontologic considerations?

Answer 14

Structural changes in kidneys decrease ability to conserve water.

Hormonal changes including decreasing renin and aldosterone and increase in ADH and ANP.

Loss of subcutaneous tissue leads to increased moisture lost.

Question 15

Other fluid and electrolyte imbalances

Answer 15

Result of therapeutic measures such as colonoscopy preparation and diuretics

Question 16

What is ECF volume deficit?

Answer 16

It is also known as hypovolemia

Due to abnormal loss of body fluids, in adequate fluid intake, or plasma to interstitial fluid shift

Question 17

Clinical manifestations related to loss of vascular volume as well as CNS effects

Answer 17

Lower blood pressure

Question 18

As a nurse how do you treat fluid volume imbalances?

Answer 18

Correct the underlying cause and replace water and electrolytes
Orally
Blood products
Balanced IV solutions

Question 19

What is fluid volume excess?

Answer 19

Hypervolemia

Excess Inteca fluids, abnormal retention of fluids, or interstitial to plasma fluid shift

Question 20

How would a nurse care for extra cellular fluid volume and balances hypervolemia?

Answer 20

Remove fluid without changing electrolyte composition or osmolality of ECF
Diuretics
Fluid restriction
Restriction of sodium intake to treat ascites or pleural effusion

Question 21

What is a complication in hypovolemia?

Answer 21

Hypovolemic shock

Question 22

What are potential complications of hypervolemia?

Answer 22

Potential complications are pulmonary edema, and ascites

Question 23

Nursing management and nursing implementation

Answer 23

Daily weights input an output, laboratory findings, cardiovascular care
Respiratory care, patient safety, skincare

Question 24

Assessment in fluid volume and balances are

Answer 24

Assess for skin turgor

Question 25

Fluid therapy for fluid volume Imbalances

Answer 25

The nurse will want to administer IV fluids as ordered

Maintain adequate oral intake assess ability to express thirst and swallow assist those with physical limitations

Question 26

In a patient with prolonged vomiting, the nurse monitors for fluid volume deficit because vomiting results in?

Answer 26

Fluid movement from the cells into the interstitial space and the blood vessels

This results in Hypovolemia

Question 27

What is fluid volume deficit

Answer 27

When a patient loses both sodium plus water

Question 28

What is dehydration?

Answer 28

Dehydration only loses water

Question 29

What are symptoms of fluid volume deficit?

Answer 29

Restlessness, drowsiness, lethargy, confusion, decreased skin turgor decreased capillary refill postural hypotension increased pulse decreased urine output, concentrated urine increase respiratory rate, weakness, dizziness, weight loss, seizures, coma

Question 30

What are symptoms of fluid volume excess?

Answer 30

Headache, confusion, lethargy, peripheral edema, jugular venous distention, S3 heart sound, bounding pulse, increase blood pressure increased cardiovascular pressure Polyuria, dyspnea, crackles, pulmonary edema, muscle spasms, weight gain, seizures, coma

Question 31

Assessment abnormalities for fluid and electrolyte imbalances blood pressure

Answer 31

Hypotension possible cause is fluid volume deficit, low calcium, high magnesium

Hypertension possible cause fluid volume excess, high calcium, low magnesium

Question 32

Fluid and electrolyte imbalances respirations

Answer 32

Crackles possible cause fluid volume excess,

dyspnea cause fluid volume excess,

rapid respirations cause is fluid volume deficit,

restricted airway cause is low calcium high phosphate

Question 33

During the postoperative care of a 76-year-old patient, the nurse monitor the patient intake and output carefully, Knowing that the patient is at risk for fluid and electrolyte imbalances primarily because?

Answer 33

Small Losses of Fluid are significant because body fluids account for 45% of 50% of body weight in older adults.

Question 34

During administration of a hypertonic IV solution, the mechanism involved in equalizing the fluid concentration between ECF and the cells is?

Answer 34

Osmosis

Question 35

An older woman is admitted to the medical unit with G.I. bleeding. Assessment findings that indicate fluid volume deficit include?

Answer 35

Weight loss and dry oral mucosa and decreased central venous pressure CVP

Question 36

The nursing Care for a patient with hyponatremia and fluid volume excess includes?

Answer 36

Fluid restriction

Question 37

The nurse should be alert for which manifestations in a patient receiving a loop diuretic?

Answer 37

Week, irregular pulse and poor muscle tone

Question 38

Which patient is at greatest risk for developing hypermagnesemia?

Answer 38

A 42-year-old woman with systemic lupus erythematosus and renal failure

Question 39

It is important for the nurse to assess for which manifestation in a patient who has just undergone a total thyroidectomy?

Answer 39

Confusion,
Circumoral numbness,
positive Chvostek’s sign (contraction of facial muscle in response to a light tap over the Facial nerve in front of the ear).

Question 40

The nurse expect the long-term treatment of a patient with hyperphosphatemia from Renal failure will include

Answer 40

Calcium supplements

Question 41

The lungs act as an acid base buffer by?

Answer 41

Increasing respiratory rate and depth when CO2 levels in the blood are high, reducing acid load.

Question 42

A patient has the following arterial blood gas results

PH 7.52 (high) up to 7.45 for normal
PaCO2 =30 normal =35-45
HCO3 24
The nurse determines that these results indicate what?

Answer 42

Respiratory alkalosis

Why? The pH is high and the PaCO2 is low

Question 43

The typical fluid replacement for the patient with a fluid volume deficit is

Answer 43

Lactated ringer’s solution

Question 44

The nurse is unable to flush a central venous access device and suspects occlusion. The best nursing intervention would be too?

Answer 44

Have the patient change positions, raise their arm, and cough