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MSN Exam for Fluid, Electrolyte, and Acid Base Problems (PM)
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Question 1
You are the charge nurse. Which client is most appropriate to assign to the step-down unit nurse pulled to the intensive care unit for the day?
A
A 38-year-old client on a ventilator with narcotic overdose and respiratory alkalosis
B
A 56-year-old new admission client with diabetic ketoacidosis (DKA) on a n insulin drip
C
A 72-year-old client with COPD and normal arterial blood gases (ABGs) who is ventilator-dependent
D
A 68-year-old client on ventilator with acute respiratory failure and respiratory acidosis
Question 1 Explanation:
The client with COPD, although ventilator dependent, is the most stable of this group. Clients with acid-base imbalances often require frequent laboratory assessment and changes in therapy to correct their disorders. In addition, the client with DKA is a new admission and will require an in-depth admission assessment. All three of these clients need care from an experienced critical care nurse.
Question 2
Anne, who is drinking beer at a party, falls and hits her head on the ground. Her friend Liza dials “911” because Anne is unconscious, depressed ventilation (shallow and slow respirations), rapid heart rate, and is profusely bleeding from both ears. Which primary acid-base imbalance is Anne at risk for if medical attention is not provided?
A
Metabolic Acidosis
B
Metabolic Alkalosis
C
Respiratory Acidosis
D
Respiratory Alkalosis
Question 2 Explanation:
One of the risk factors of having respiratory acidosis is hypoventilation which may be due to brain trauma, coma, and hypothyroidism or myxedema. Other risk factors include COPD, Respiratory conditions such as pneumothorax, pneumonia and status asthmaticus. Drugs such as Morphine and MgSO4 toxicity are also risk factors of respiratory acidosis.
Question 3
A client’s nursing diagnosis is Deficient Fluid Volume related to excessive fluid loss. Which action related to the fluid management should be delegated to a nursing assistant?
A
Teach family members to assist client with fluid intake
B
Administer IV fluids as prescribed by the physician.
C
Develop plan for added fluid intake over 24 hours
D
Provide straws and offer fluids between meals.
Question 3 Explanation:
The nursing assistant can reinforce additional fluild intake once it is part of the care plan. Administering IV fluids, developing plans, and teaching families require additional education and skills that are within the scope of practice for the RN.
Question 4
In a patient undergoing surgery, it was vital to aspirate the contents of the upper gastrointestinal tract. After the operation, the following values were acquired from an arterial blood sample: pH 7.55, PCO2 52 mm Hg and HCO3- 40 mmol/l. What is the underlying disorder?
A
Metabolic Alkalosis
B
Respiratory Alkalosis
C
Respiratory Acidosis
D
Metabolic Acidosis
Question 4 Explanation:
NGT suctioning, vomiting, hypokalemia and overdosage of NaHCO3 are considered risk factors of metabolic alkalosis.
Question 5
A patient who is hospitalized due to vomiting and a decreased level of consciousness displays slow and deep (Kussmaul breathing), and he is lethargic and irritable in response to stimulation. The doctor diagnosed him of having dehydration. Measurement of arterial blood gas shows pH 7.0, PaO2 90 mm Hg, PaCO2 22 mm Hg, and HCO3 14 mmol/L; other results are Na+ 120 mmol/L, K+ 2.5 mmol/L, and Cl- 95 mmol/L. As a knowledgeable nurse, you know that the normal value for PaCO2 is:
A
36 mm Hg
B
48 mm Hg
C
50 mm Hg
D
22 mm Hg
Question 5 Explanation:
The normal range for PaCO2 is from 35 to 35 mm Hg.
Question 6
The physician has written the following orders for the client with Excess Fluid volume. The client’s morning assessment includes bounding peripheral pulses, weight gain of 2 pounds, pitting ankle edema, and moist crackles bilaterally. Which order takes priority at this time?
A
Administer furosemide (Lasix) 40 mg IV push
B
Weight client every morning.
C
Maintain accurate intake and output.
D
Restrict fluid to 1500 mL per day
Question 6 Explanation:
Bilateral moist crackles indicate fluid-filled alveoli, which interferes with gas exchange. Furosemide is a potent loop diuretic that will help mobilize the fluid in the lungs. The other orders are important but not urgent.
Question 7
You are preparing to discharge a client whose calcium level was low but is now just slightly within the normal range (9-10.5 mg/dL). Which statement by the client indicates the need for additional teaching?
A
“I will call my doctor if I experience muscle twitching or seizures.”
B
“I will avoid dairy products, broccoli, and spinach when I eat.”
C
“I will take my calcium pill every morning before breakfast.”
D
“I will make sure to take my vitamin D with my calcium each day.”
Question 7 Explanation:
Clients with low calcium levels should be encouraged to consume dairy products, seafood, nuts, broccoli, and spinach. Which are all good sources of dietary calcium.
Question 8
The client also has the nursing diagnosis Decreased Cardiac Output related to decrease plasma volume. Which finding on assessment supports this nursing diagnosis?
A
Flattened neck veins when client is in supine position
B
Full and bounding pedal and post-tibial pulses
C
Shallow respirations with crackles on auscultation
D
Pitting edema located in feet, ankles, and calves
Question 8 Explanation:
Normally, neck veins are distended when the client is in the supine position. The veins flatten as the client moves to a sitting position. The other three responses are characteristic of Excess Fluid Volume.
Question 9
A client has a nasogastric tube connected to intermittent wall suction. The student nurse asks why the client’s respiratory rate has increased. What your best response?
A
“The client may have a metabolic alkalosis due to the NG suctioning and the increased respiratory rate is a compensatory mechanism.”
B
“The client is hyperventilating because of anxiety and we will have to stay alert for development of a respiratory acidosis.”
C
“It’s common for clients with uncomfortable procedures such as nasogastric tubes to have a higher rate to breathing.”
D
“Whenever a client develops a respiratory acid-base problem, increasing the respiratory rate helps correct the problem.”
Question 9 Explanation:
Nasogastric suctioning can result in a decrease in acid components and metabolic alkalosis. The client’s increase in rate and depth of ventilation is an attempt to compensate by blowing off CO2. the first response maybe true but does not address all the components of the question. The third and fourth answers are inaccurate.
Question 10
A client is admitted to the unit with a diagnosis of syndrome of inappropriate antidiuretic hormone secretion (SIADH). For which electrolyte abnormality will you be sure to monitor?
A
Hyperkalemia
B
Hypernatremia
C
Hypokalemia
D
Hyponatremia
Question 10 Explanation:
SIADH causes a relative sodium deficit due to excessive retention of water.
Question 11
You are reviewing a client’s morning laboratory results. Which of these results is of most concern?
A
Serum calcium 10.6 mg/dL
B
Serum magnesium 0.8 mEq/L
C
Serum sodium 134 mEq/L
D
Serum potassium 5.2 mEq/L
Question 11 Explanation:
While all of these laboratory values are outside of the normal range, the magnesium is most outside of normal. With a magnesium level this low, the client is at risk for
ECG changes and life-threatening ventricular dysrhythmias.
Question 12
A nursing assistant asks why the client with a chronically low phosphorus level needs so much assistance with activities of daily living. What is your best response?
A
“The client’s low phosphorus is probably due to malnutrition.”
B
“The client will do more for herself when her phosphorus is normal”
C
“The client’s skeletal muscles are weak because of the low phosphorus.”
D
“The client is just worn out form not getting enough rest.”
Question 12 Explanation:
A musculoskeletal manifestation of low phosphorous is generalized muscle weakness that may lead to acute muscle breakdown (rhabdomyolysis). Even though the other statements are true, they do not answer the nursing assistant’s question.
Question 13
Mr. Wales, who underwent post-abdominal surgery, has a nasogastric tube. The nurse on duty notes that the nasogastric tube (NGT) is draining a large amount (900 cc in 2 hours) of coffee ground secretions. The client is not oriented to person, place, or time. The nurse contacts the attending physician and STAT ABGs are ordered. The results from the ABGs show pH 7.57, PaCO2 37 mmHg and HCO3 30 mEq/L. What is your assessment?
A
Metabolic Alkalosis, Partially Compensated
B
Respiratory Alkalosis, Uncompensated
C
Metabolic Alkalosis, Uncompensated
D
Metabolic Acidosis, Uncompensated
Question 13 Explanation:
The postoperative client’s ABG results show that he has metabolic alkalosis because of an increased pH and HCO3. It is uncompensated due to the normal PaCO2 which is within 35 to 45 mmHg.
Question 14
Client Z is admitted to the hospital and is to undergo brain surgery. The client is very anxious and scared of the upcoming surgery. He begins to hyperventilate and becomes very dizzy. The client loses consciousness and the STAT ABGs reveal pH 7.61, PaCO2 22 mmHg and HCO3 25 mEq/L. What is the ABG interpretation based on the findings?
A
Respiratory Alkalosis, Uncompensated
B
Metabolic Alkalosis, Partially Compensated
C
Respiratory Alkalosis, Partially Compensated
D
Metabolic Acidosis, Uncompensated
Question 14 Explanation:
The results show that client Z has respiratory alkalosis since there is an increase in the pH value and a decrease in PaCO2 which are both basic. It is uncompensated due to the normal HCO3 which is within 22-26 mEq/L.
Question 15
A cigarette vendor was brought to the emergency department of a hospital after she fell into the ground and hurt her left leg. She is noted to be tachycardic and tachypneic. Painkillers were carried out to lessen her pain. Suddenly, she started complaining that she is still in pain and now experiencing muscle cramps, tingling, and paraesthesia. Measurement of arterial blood gas reveals pH 7.6, PaO2 120 mm Hg, PaCO2 31 mm Hg, and HCO3 25 mmol/L. What does this mean?
A
Respiratory Acidosis, Partially Compensated
B
Respiratory Alkalosis, Uncompensated
C
Metabolic Alkalosis, Uncompensated
D
Metabolic Alkalosis, Partially Compensated
Question 15 Explanation:
The primary disorder is acute respiratory alkalosis (low CO2) due to the pain and anxiety causing her to hyperventilate. There has not been time for metabolic compensation.
Question 16
An old beggar was admitted to the emergency department due to shortness of breath, fever, and a productive cough. Upon examination, crackles and wheezes are noted in the lower lobes; he appears to be tachycardic and has a bounding pulse. Measurement of arterial blood gas shows pH 7.2, PaCO2 66 mm Hg, HCO3 27 mmol/L, and PaO2 65 mm Hg. As a knowledgeable nurse, you know that the normal value for pH is:
A
7.50
B
7.20
C
7.40
D
7.30
Question 16 Explanation:
Normal blood pH must be maintained within a narrow range of 7.35-7.45 to ensure the proper functioning of metabolic processes and the delivery of the right amount of oxygen to tissues. Acidosis refers to an excess of acid in the blood that causes the pH to fall below 7.35, and alkalosis refers to an excess of base in the blood that causes the pH to rise above 7.45.
Question 17
Which action should you delegate to the nursing assistant for the client with diabetic ketoacidosis? (Choose all that apply.)
A
Check vital signs every 15 minutes.
B
Check fingerstick glucose every hour.
C
Assess for indicators of fluid imbalance.
D
Record intake and output every hour.
Question 17 Explanation:
The nursing assistant’s training and education include how to take vital signs and record intake and output. The need to take vital signs this frequently indicates that the client maybe unstable. The nurse should give the nursing assistant reporting parameters when delegating this action, should also check the vital signs for indications in instability. Performing fingerstick glucose checks and assessing clients require additional education and skill that are appropriate to licensed nurses. Some facilities may train experienced nursing assistants to perform fingerstick glucose checks and change their role descriptions to designate their new skills, but this is beyond the normal scope of practice for a nursing assistant.
Question 18
The experienced LPN/LVN reports that a client’s blood pressure and heart rate have decreased and that when the face is assessed, one side twitches. What action should you take at this time?
A
Review the client’s morning calcium level
B
Check the client’s papillary reaction to light
C
Reassess the client’s blood pressure and heart rate
D
Request a neurologic consult today
Question 18 Explanation:
A positive Chvostek’s sign (facial twitching of one side of the mouth, nose, and cheek in response to tapping the face just below and in front of the ear) is a neurologic manifestation of hypocalcemia. The LPN/LVN is experienced and possesses the skills to take accurate vital signs.
Question 19
Mrs. Johansson, who had undergone surgery in the post-anesthesia care unit (PACU), is difficult to arouse two hours following surgery. Nurse Florence in the PACU has been administering Morphine Sulfate intravenously to the client for complaints of post-surgical pain. The client’s respiratory rate is 7 per minute and demonstrates shallow breathing. The patient does not respond to any stimuli! The nurse assesses the ABCs (remember Airway, Breathing, Circulation!) and obtains ABGs STAT! Measurement of arterial blood gas shows pH 7.10, PaCO2 70 mm Hg and HCO3 24 mEq/L. What does this mean?
A
Respiratory Alkalosis, Partially Compensated
B
Respiratory Acidosis, Uncompensated
C
Metabolic Alkalosis, Partially Compensated
D
Metabolic Acidosis, Uncompensated
Question 19 Explanation:
The results show that Mrs. Johansson has respiratory acidosis because of decreased pH and increased PaCO2 which mean acidic in nature. Meanwhile, it is uncompensated because HCO3 is within the normal range.
Question 20
A client with respiratory failure is receiving mechanical ventilation and continues to produce ABG results indicating respiratory acidosis. Which action should you expect to correct this problem?
A
Increase the oxygen concentration fro 30% to 40%
B
Increase the ventilator rate from 6 to 10 per minute
C
Decrease the ventilator rate from 10 to 6 per minute
D
Decrease the oxygen concentration fro 40% to 30%
Question 20 Explanation:
the blood gas component responsible for respiratory acidosis is CO2 (Carbon dioxide). Increasing the ventilator rate will blow off more CO2 and decrease the acidosis. Changes in the oxygen setting may improve oxygenation but will not affect respiratory acidosis.
Question 21
The nursing care plan for the client with dehydration includes interventions for oral health. Which interventions is NOT within the scope of practice for the LPN/LVN being supervised by the nurse?
A
Provide mouth care every 2 hours while client is awake
B
Seek dietary consult to increase fluids on meal trays.
C
Remind client to avoid commercial mouthwashes.
D
Assess lips, tongue, and mucous membranes
E
Encourage mouth rinsing with warm saline.
Question 21 Explanation:
The LPN/LVN’s scope of practice and educational preparation includes oral care and routine observation. State practice acts vary as to whether LPN/LVNs are permitted to perform assessment. The client should be reminded to avoid most commercial mouthwashes that contain alcohol, a drying agent. Initiating a dietary consult is within the purview of the RN or physician.
Question 22
A young woman is found comatose, having taken an unknown number of sleeping pills an unknown time before. An arterial blood sample yields the following values: pH 6.90, HCO3- 13 meq/liter and PaCO2 68 mmHg. This patient’s acid-base status is most accurately described as:
A
Respiratory Acidosis
B
Metabolic Acidosis
C
Respiratory Acidosis with Complete Renal Compensation
D
Simultaneous Respiratory and Metabolic Acidosis
Question 22 Explanation:
Whenever the PCO2 and HCO3 are abnormal in opposite directions, ie, one above normal while the other is reduced, a mixed respiratory and metabolic acid-base disorder exists. When the PCO2 is elevated and the [HCO3-] reduced, respiratory acidosis and metabolic acidosis coexist.
Question 23
Ricky’s grandmother is suffering from persistent vomiting for two days now. She appears to be lethargic and weak and has myalgia. She is noted to have dry mucus membranes and her capillary refill takes >4 seconds. She is diagnosed as having gastroenteritis and dehydration. Measurement of arterial blood gas shows pH 7.5, PaO2 85 mm Hg, PaCO2 40 mm Hg, and HCO3 34 mmol/L. What acid-base disorder is shown?
A
Metabolic Alkalosis, Uncompensated
B
Metabolic Alkalosis, Partially Compensated
C
Respiratory Alkalosis, Uncompensated
D
Respiratory Acidosis, Partially Compensated
Question 23 Explanation:
The primary disorder is uncompensated metabolic alkalosis (high HCO3 -). As CO2 is the strongest driver of respiration, it generally will not allow hypoventilation as compensation for metabolic alkalosis.
Question 24
A mountaineer attempts an assault on a high mountain in the Andes and reaches an altitude of 5000 meters (16,400 ft) above sea level. What will happen to his arterial PCO2 and pH?
A
The pH will fall and PCO2 will rise
B
Both will be higher than normal due to the physical exertion.
C
Both will be lower than normal.
D
The pH will rise and PCO2 will fall.
Question 24 Explanation:
The mountaineer will suffer from a respiratory alkalosis. The decline in the PO2 with altitude will stimulate breathing to offset the hypoxia. Carbon dioxide is driven from the blood faster than it is produced in the tissues so PCO2 falls and pH rises.
Question 25
You are admitting an elderly client to the medical unit. Which factor indicates that this client has a risk for acid-base imbalances?
A
Myocardial infarction 1 year ago
B
Shortness of breath with extreme exertion
C
Occasional use of antacids
D
Chronic renal insufficiency
Question 25 Explanation:
Risk factors for acid-base imbalances in the older adult include chronic renal disease and pulmonary disease. Occasional antacid use will not cause imbalances, although antacid abuse is a risk factor for metabolic alkalosis.
Question 26
A client is admitted to the unit for chemotherapy. To prevent an acid-base problem, which of the following would you instruct the nursing assistant to report?
A
Failure to eat all food on breakfast tray
B
Client hair loss during morning bath
C
Repeated episodes of nausea and vomiting
D
Complaints of pain associated with exertion
Question 26 Explanation:
Prolonged nausea and vomiting can result in acid deficit that can lead to metabolic alkalosis. The other findings are important and need to be assessed but are not related to acid-base imbalances.
Question 27
The client’s potassium level is 6.7 mEq/L. Which intervention should you delegate to the student nurse under your supervision?
A
Administer spironolactone 25 mg orally
B
Administer potassium 10 mEq orally
C
Assess WCG strip for tall T waves
D
Administer Kayexalate 15 g orally
Question 27 Explanation:
The client’s potassium level is high (normal range 3.5-5.0). Kayexalate removes potassium from the body through the gastrointestinal system. Spironolactone is a potassium-sparing diuretic that may cause the client’s potassium level to go even higher. The nursing student may not have the skill to assess ECG strips and this should be done by the RN.
Question 28
Dave, a 6-year-old boy, was rushed to the hospital following her mother’s complaint that her son has been vomiting, nauseated and has overall weakness. After series of tests, the nurse notes the laboratory results: potassium: 2.9 mEq. Which primary acid-base imbalance is this boy at risk for if medical intervention is not carried out?
A
Metabolic Alkalosis
B
Respiratory Alkalosis
C
Metabolic Acidosis
D
Respiratory Acidosis
Question 28 Explanation:
Vomiting, hypokalemia, overdosage of NaHCO3 and NGT suctioning are considered risk factors of metabolic alkalosis.
Question 29
Baby Angela was rushed to the Emergency Room following her mother’s complaint that the infant has been irritable, difficult to breastfeed and has had diarrhea for the past 3 days. The infant’s respiratory rate is elevated and the fontanels are sunken. The Emergency Room physician orders ABGs after assessing the ABCs. The results from the ABG results show pH 7.39, PaCO2 27 mmHg and HCO3 19 mEq/L. What does this mean?
A
Metabolic Acidosis, Fully Compensated
B
Respiratory Acidosis, Uncompensated
C
Respiratory Alkalosis, Fully Compensated
D
Metabolic Acidosis, Uncompensated
Question 29 Explanation:
Baby Angela has metabolic acidosis due to decreased HCO3 and slightly acidic pH. Her pH value is within the normal range which made the result fully compensated.
Question 30
A client with lung cancer has received oxycodone 10 mg orally for pain. When the student nurse assesses the client, which finding should you instruct the student to report immediately?
A
Respiratory rate of 8 to 10 per minute
B
Pain level decreased from 6/10 to 2/10
C
Heart rate 90-100 per minute
D
Client requests room door be closed.
Question 30 Explanation:
A decreased respiratory rate indicates respiratory depression which also puts the client at risk for respiratory acidosis, All of the other findings are important and should be reported to the RN, but the respiratory rate is urgent.
Question 31
Carl, an elementary student, was rushed to the hospital due to vomiting and a decreased level of consciousness. The patient displays slow and deep (Kussmaul breathing), and he is lethargic and irritable in response to stimulation. He appears to be dehydrated—his eyes are sunken and mucous membranes are dry—and he has a two week history of polydipsia, polyuria, and weight loss. Measurement of arterial blood gas shows pH 7.0, PaO2 90 mm Hg, PaCO2 23 mm Hg, and HCO3 12 mmol/L; other results are Na+ 126 mmol/L, K+ 5 mmol/L, and Cl- 95 mmol/L. What is your assessment?
A
Metabolic Acidosis, Partially, Compensated
B
Respiratory Acidosis, Partially Compensated
C
Metabolic Alkalosis, Uncompensated
D
Respiratory Acidosis, Uncompensated
Question 31 Explanation:
The student was diagnosed having diabetes mellitus. The results show that he has metabolic acidosis (low HCO3 -) with respiratory compensation (low CO2).
Question 32
Three-year-old Adrian is admitted to the hospital with a diagnosis of asthma and respiratory distress syndrome. The mother of the child reports to the nurse on duty that she has witnessed slight tremors and behavioral changes in her child over the past four days. The attending physician orders routine ABGs following an assessment of the ABCs. The ABG results are pH 7.35, PaCO2 72 mmHg and HCO3 38 mEq/L. What acid-base disorder is shown?
A
Metabolic Alkalosis, Partially Compensated
B
Respiratory Acidosis, Uncompensated
C
Respiratory Alkalosis, Fully Compensated
D
Respiratory Acidosis, Fully Compensated
Question 32 Explanation:
The patient has respiratory acidosis (raised carbon dioxide) resulting from asthma and respiratory distress syndrome, with compensation having normal pH value within 7.35to 7.45, increased PaCO2 which is acidic and increased HCO3 which is basic.
Question 33
A company driver is found at the scene of an automobile accident in a state of emotional distress. He tells the paramedics that he feels dizzy, tingling in his fingertips, and does not remember what happened to his car. Respiratory rate is rapid at 34/minute. Which primary acid-base disturbance is the young man at risk for if medical attention is not provided?
A
Respiratory Acidosis
B
Respiratory Alkalosis
C
Metabolic Alkalosis
D
Metabolic Acidosis
Question 33 Explanation:
Hyperventilation is typically the underlying cause of respiratory alkalosis. Hyperventilation is also known as overbreathing. When someone is hyperventilating, they tend to breathe very deeply or very rapidly.
Question 34
George Kent is a 54 year old widower with a history of chronic obstructive pulmonary disease and was rushed to the emergency department with increasing shortness of breath, pyrexia, and a productive cough with yellow-green sputum. He has difficulty in communicating because of his inability to complete a sentence. One of his sons, Jacob, says he has been unwell for three days. Upon examination, crackles and wheezes can be heard in the lower lobes; he has a tachycardia and a bounding pulse. Measurement of arterial blood gas shows pH 7.3, PaCO2 68 mm Hg, HCO3 28 mmol/L, and PaO2 60 mm Hg. How would you interpret this?
A
Respiratory Acidosis, Uncompensated
B
Metabolic Acidosis, Partially Compensated
C
Metabolic Alkalosis, Uncompensated
D
Respiratory Acidosis, Partially Compensated
Question 34 Explanation:
The patient has respiratory acidosis (raised carbon dioxide) resulting from an acute exacerbation of chronic obstructive pulmonary disease, with partial compensation.
Question 35
Liza’s mother is seen in the emergency department at a community hospital. She admits that her mother is taking many tablets of aspirin (salicylates) over the last 24-hour period because of a severe headache. Also, the mother complains of an inability to urinate. The nurse on duty took her vital signs and noted the following: Temp = 97.8 °F; apical pulse = 95; respiration = 32 and deep. Which primary acid-base imbalance is the gentleman at risk for if medical attention is not provided?
A
Metabolic Acidosis
B
Respiratory Alkalosis
C
Metabolic Alkalosis
D
Respiratory Acidosis
Question 35 Explanation:
Salicylate overdose causes a high anion gap metabolic acidosis in both children and adults. Adults commonly develop a mixed acid-base disorder as a respiratory alkalosis due to direct respiratory centre stimulation occurs as well. This second disorder is uncommon in children.
Question 36
A mother is admitted in the emergency department following complaints of fever and chills. The nurse on duty took her vital signs and noted the following: Temp = 100 °F; apical pulse = 95; respiration = 20 and deep. Measurement of arterial blood gas shows pH 7.37, PaO2 90 mm Hg, PaCO2 40 mm Hg, and HCO3 24 mmol/L. What is your assessment?
A
Hyperthermia
B
Hypothermia and Respiratory Alkalosis
C
Hypothermia
D
Hyperthermia and Respiratory Alkalosis
Question 36 Explanation:
An individual is considered to have hyperthermia if he or she has a temperature of >37.5 or 38.3 °C (99.5 or 100.9 °F). Measurement of arterial blood gases are normal.
Question 37
An elderly client was admitted to hospital in a coma. Analysis of the arterial blood gave the following values: PCO2 16 mm Hg, HCO3- 5 mmol/L and pH 7.1. As a well-rounded nurse, you know that the normal value for HCO3 is:
A
24 mmol/L
B
29 mmol/L
C
31 mmol/L
D
20 mmol/L
Question 37 Explanation:
The normal value for bicarbonate (HCO3) is 22-26 mmol/L or mEq/L. It may vary slightly among different laboratories. The given values show the common measurement range of results for these tests. Some laboratories use different measurements or may test different specimens.
Question 38
The nursing assistant reports to you that a client seems very anxious and that vital signs included a respiratory rate of 38 per minute. Which acid-base imbalance should you suspect?
A
Respiratory alkalosis
B
Metabolic alkalosis
C
Respiratory acidosis
D
Metabolic acidosis
Question 38 Explanation:
The client is most likely hyperventilating and blowing off CO2. This decrease in CO2 will lead to an increase in pH, causing respiratory alkalosis. Respiratory acidosis results from respiratory depression and retained CO2. Metabolic acidosis and alkalosis result from problems related to renal acid-base control.
Question 39
You have been pulled to the telemetry unit for the day. The monitor informs you that the client has developed prominent U waves. Which laboratory value should you check immediately?
A
Potassium
B
Magnesium
C
Calcium
D
Sodium
Question 39 Explanation:
Suspect hypokalemia and check the client’s potassium level. Common ECG changes with hypokalemia include ST depression, inverted T waves, and prominent U waves. Client with hypokalemia may also develop heart block.
Question 40
The charge nurse assigned in the care for a client with acute renal failure and hypernatremia to you, a newly graduated RN. Which actions can you delegate to the nursing assistant?
A
Provide oral care every 3-4 hours
B
Administer 0.45% saline by IV line
C
Assess daily weights for trends
D
Monitor for indications of dehydration
Question 40 Explanation:
Providing oral care is within the scope of practice for the nursing assistant. Monitoring and assessing clients, as well as administering IV fluids, require the additional education and skill of the RN.
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MSN Exam for Fluid, Electrolyte, and Acid Base Problems (EM)
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Question 1
The charge nurse assigned in the care for a client with acute renal failure and hypernatremia to you, a newly graduated RN. Which actions can you delegate to the nursing assistant?
A
Administer 0.45% saline by IV line
B
Assess daily weights for trends
C
Monitor for indications of dehydration
D
Provide oral care every 3-4 hours
Question 1 Explanation:
Providing oral care is within the scope of practice for the nursing assistant. Monitoring and assessing clients, as well as administering IV fluids, require the additional education and skill of the RN.
Question 2
Liza’s mother is seen in the emergency department at a community hospital. She admits that her mother is taking many tablets of aspirin (salicylates) over the last 24-hour period because of a severe headache. Also, the mother complains of an inability to urinate. The nurse on duty took her vital signs and noted the following: Temp = 97.8 °F; apical pulse = 95; respiration = 32 and deep. Which primary acid-base imbalance is the gentleman at risk for if medical attention is not provided?
A
Respiratory Alkalosis
B
Metabolic Alkalosis
C
Metabolic Acidosis
D
Respiratory Acidosis
Question 2 Explanation:
Salicylate overdose causes a high anion gap metabolic acidosis in both children and adults. Adults commonly develop a mixed acid-base disorder as a respiratory alkalosis due to direct respiratory centre stimulation occurs as well. This second disorder is uncommon in children.
Question 3
A client’s nursing diagnosis is Deficient Fluid Volume related to excessive fluid loss. Which action related to the fluid management should be delegated to a nursing assistant?
A
Administer IV fluids as prescribed by the physician.
B
Provide straws and offer fluids between meals.
C
Teach family members to assist client with fluid intake
D
Develop plan for added fluid intake over 24 hours
Question 3 Explanation:
The nursing assistant can reinforce additional fluild intake once it is part of the care plan. Administering IV fluids, developing plans, and teaching families require additional education and skills that are within the scope of practice for the RN.
Question 4
An old beggar was admitted to the emergency department due to shortness of breath, fever, and a productive cough. Upon examination, crackles and wheezes are noted in the lower lobes; he appears to be tachycardic and has a bounding pulse. Measurement of arterial blood gas shows pH 7.2, PaCO2 66 mm Hg, HCO3 27 mmol/L, and PaO2 65 mm Hg. As a knowledgeable nurse, you know that the normal value for pH is:
A
7.20
B
7.30
C
7.50
D
7.40
Question 4 Explanation:
Normal blood pH must be maintained within a narrow range of 7.35-7.45 to ensure the proper functioning of metabolic processes and the delivery of the right amount of oxygen to tissues. Acidosis refers to an excess of acid in the blood that causes the pH to fall below 7.35, and alkalosis refers to an excess of base in the blood that causes the pH to rise above 7.45.
Question 5
The client’s potassium level is 6.7 mEq/L. Which intervention should you delegate to the student nurse under your supervision?
A
Administer potassium 10 mEq orally
B
Assess WCG strip for tall T waves
C
Administer Kayexalate 15 g orally
D
Administer spironolactone 25 mg orally
Question 5 Explanation:
The client’s potassium level is high (normal range 3.5-5.0). Kayexalate removes potassium from the body through the gastrointestinal system. Spironolactone is a potassium-sparing diuretic that may cause the client’s potassium level to go even higher. The nursing student may not have the skill to assess ECG strips and this should be done by the RN.
Question 6
Ricky’s grandmother is suffering from persistent vomiting for two days now. She appears to be lethargic and weak and has myalgia. She is noted to have dry mucus membranes and her capillary refill takes >4 seconds. She is diagnosed as having gastroenteritis and dehydration. Measurement of arterial blood gas shows pH 7.5, PaO2 85 mm Hg, PaCO2 40 mm Hg, and HCO3 34 mmol/L. What acid-base disorder is shown?
A
Respiratory Acidosis, Partially Compensated
B
Metabolic Alkalosis, Uncompensated
C
Respiratory Alkalosis, Uncompensated
D
Metabolic Alkalosis, Partially Compensated
Question 6 Explanation:
The primary disorder is uncompensated metabolic alkalosis (high HCO3 -). As CO2 is the strongest driver of respiration, it generally will not allow hypoventilation as compensation for metabolic alkalosis.
Question 7
A client has a nasogastric tube connected to intermittent wall suction. The student nurse asks why the client’s respiratory rate has increased. What your best response?
A
“The client is hyperventilating because of anxiety and we will have to stay alert for development of a respiratory acidosis.”
B
“Whenever a client develops a respiratory acid-base problem, increasing the respiratory rate helps correct the problem.”
C
“The client may have a metabolic alkalosis due to the NG suctioning and the increased respiratory rate is a compensatory mechanism.”
D
“It’s common for clients with uncomfortable procedures such as nasogastric tubes to have a higher rate to breathing.”
Question 7 Explanation:
Nasogastric suctioning can result in a decrease in acid components and metabolic alkalosis. The client’s increase in rate and depth of ventilation is an attempt to compensate by blowing off CO2. the first response maybe true but does not address all the components of the question. The third and fourth answers are inaccurate.
Question 8
A client with respiratory failure is receiving mechanical ventilation and continues to produce ABG results indicating respiratory acidosis. Which action should you expect to correct this problem?
A
Decrease the ventilator rate from 10 to 6 per minute
B
Increase the oxygen concentration fro 30% to 40%
C
Decrease the oxygen concentration fro 40% to 30%
D
Increase the ventilator rate from 6 to 10 per minute
Question 8 Explanation:
the blood gas component responsible for respiratory acidosis is CO2 (Carbon dioxide). Increasing the ventilator rate will blow off more CO2 and decrease the acidosis. Changes in the oxygen setting may improve oxygenation but will not affect respiratory acidosis.
Question 9
The nursing assistant reports to you that a client seems very anxious and that vital signs included a respiratory rate of 38 per minute. Which acid-base imbalance should you suspect?
A
Respiratory acidosis
B
Metabolic alkalosis
C
Respiratory alkalosis
D
Metabolic acidosis
Question 9 Explanation:
The client is most likely hyperventilating and blowing off CO2. This decrease in CO2 will lead to an increase in pH, causing respiratory alkalosis. Respiratory acidosis results from respiratory depression and retained CO2. Metabolic acidosis and alkalosis result from problems related to renal acid-base control.
Question 10
Which action should you delegate to the nursing assistant for the client with diabetic ketoacidosis? (Choose all that apply.)
A
Record intake and output every hour.
B
Check vital signs every 15 minutes.
C
Assess for indicators of fluid imbalance.
D
Check fingerstick glucose every hour.
Question 10 Explanation:
The nursing assistant’s training and education include how to take vital signs and record intake and output. The need to take vital signs this frequently indicates that the client maybe unstable. The nurse should give the nursing assistant reporting parameters when delegating this action, should also check the vital signs for indications in instability. Performing fingerstick glucose checks and assessing clients require additional education and skill that are appropriate to licensed nurses. Some facilities may train experienced nursing assistants to perform fingerstick glucose checks and change their role descriptions to designate their new skills, but this is beyond the normal scope of practice for a nursing assistant.
Question 11
A nursing assistant asks why the client with a chronically low phosphorus level needs so much assistance with activities of daily living. What is your best response?
A
“The client will do more for herself when her phosphorus is normal”
B
“The client is just worn out form not getting enough rest.”
C
“The client’s low phosphorus is probably due to malnutrition.”
D
“The client’s skeletal muscles are weak because of the low phosphorus.”
Question 11 Explanation:
A musculoskeletal manifestation of low phosphorous is generalized muscle weakness that may lead to acute muscle breakdown (rhabdomyolysis). Even though the other statements are true, they do not answer the nursing assistant’s question.
Question 12
You are the charge nurse. Which client is most appropriate to assign to the step-down unit nurse pulled to the intensive care unit for the day?
A
A 72-year-old client with COPD and normal arterial blood gases (ABGs) who is ventilator-dependent
B
A 68-year-old client on ventilator with acute respiratory failure and respiratory acidosis
C
A 38-year-old client on a ventilator with narcotic overdose and respiratory alkalosis
D
A 56-year-old new admission client with diabetic ketoacidosis (DKA) on a n insulin drip
Question 12 Explanation:
The client with COPD, although ventilator dependent, is the most stable of this group. Clients with acid-base imbalances often require frequent laboratory assessment and changes in therapy to correct their disorders. In addition, the client with DKA is a new admission and will require an in-depth admission assessment. All three of these clients need care from an experienced critical care nurse.
Question 13
The nursing care plan for the client with dehydration includes interventions for oral health. Which interventions is NOT within the scope of practice for the LPN/LVN being supervised by the nurse?
A
Remind client to avoid commercial mouthwashes.
B
Encourage mouth rinsing with warm saline.
C
Assess lips, tongue, and mucous membranes
D
Seek dietary consult to increase fluids on meal trays.
E
Provide mouth care every 2 hours while client is awake
Question 13 Explanation:
The LPN/LVN’s scope of practice and educational preparation includes oral care and routine observation. State practice acts vary as to whether LPN/LVNs are permitted to perform assessment. The client should be reminded to avoid most commercial mouthwashes that contain alcohol, a drying agent. Initiating a dietary consult is within the purview of the RN or physician.
Question 14
Carl, an elementary student, was rushed to the hospital due to vomiting and a decreased level of consciousness. The patient displays slow and deep (Kussmaul breathing), and he is lethargic and irritable in response to stimulation. He appears to be dehydrated—his eyes are sunken and mucous membranes are dry—and he has a two week history of polydipsia, polyuria, and weight loss. Measurement of arterial blood gas shows pH 7.0, PaO2 90 mm Hg, PaCO2 23 mm Hg, and HCO3 12 mmol/L; other results are Na+ 126 mmol/L, K+ 5 mmol/L, and Cl- 95 mmol/L. What is your assessment?
A
Respiratory Acidosis, Uncompensated
B
Metabolic Acidosis, Partially, Compensated
C
Respiratory Acidosis, Partially Compensated
D
Metabolic Alkalosis, Uncompensated
Question 14 Explanation:
The student was diagnosed having diabetes mellitus. The results show that he has metabolic acidosis (low HCO3 -) with respiratory compensation (low CO2).
Question 15
A client with lung cancer has received oxycodone 10 mg orally for pain. When the student nurse assesses the client, which finding should you instruct the student to report immediately?
A
Client requests room door be closed.
B
Pain level decreased from 6/10 to 2/10
C
Heart rate 90-100 per minute
D
Respiratory rate of 8 to 10 per minute
Question 15 Explanation:
A decreased respiratory rate indicates respiratory depression which also puts the client at risk for respiratory acidosis, All of the other findings are important and should be reported to the RN, but the respiratory rate is urgent.
Question 16
You are reviewing a client’s morning laboratory results. Which of these results is of most concern?
A
Serum potassium 5.2 mEq/L
B
Serum sodium 134 mEq/L
C
Serum calcium 10.6 mg/dL
D
Serum magnesium 0.8 mEq/L
Question 16 Explanation:
While all of these laboratory values are outside of the normal range, the magnesium is most outside of normal. With a magnesium level this low, the client is at risk for
ECG changes and life-threatening ventricular dysrhythmias.
Question 17
A client is admitted to the unit with a diagnosis of syndrome of inappropriate antidiuretic hormone secretion (SIADH). For which electrolyte abnormality will you be sure to monitor?
A
Hypernatremia
B
Hyperkalemia
C
Hyponatremia
D
Hypokalemia
Question 17 Explanation:
SIADH causes a relative sodium deficit due to excessive retention of water.
Question 18
Three-year-old Adrian is admitted to the hospital with a diagnosis of asthma and respiratory distress syndrome. The mother of the child reports to the nurse on duty that she has witnessed slight tremors and behavioral changes in her child over the past four days. The attending physician orders routine ABGs following an assessment of the ABCs. The ABG results are pH 7.35, PaCO2 72 mmHg and HCO3 38 mEq/L. What acid-base disorder is shown?
A
Respiratory Acidosis, Fully Compensated
B
Respiratory Alkalosis, Fully Compensated
C
Respiratory Acidosis, Uncompensated
D
Metabolic Alkalosis, Partially Compensated
Question 18 Explanation:
The patient has respiratory acidosis (raised carbon dioxide) resulting from asthma and respiratory distress syndrome, with compensation having normal pH value within 7.35to 7.45, increased PaCO2 which is acidic and increased HCO3 which is basic.
Question 19
Baby Angela was rushed to the Emergency Room following her mother’s complaint that the infant has been irritable, difficult to breastfeed and has had diarrhea for the past 3 days. The infant’s respiratory rate is elevated and the fontanels are sunken. The Emergency Room physician orders ABGs after assessing the ABCs. The results from the ABG results show pH 7.39, PaCO2 27 mmHg and HCO3 19 mEq/L. What does this mean?
A
Respiratory Alkalosis, Fully Compensated
B
Metabolic Acidosis, Uncompensated
C
Respiratory Acidosis, Uncompensated
D
Metabolic Acidosis, Fully Compensated
Question 19 Explanation:
Baby Angela has metabolic acidosis due to decreased HCO3 and slightly acidic pH. Her pH value is within the normal range which made the result fully compensated.
Question 20
A young woman is found comatose, having taken an unknown number of sleeping pills an unknown time before. An arterial blood sample yields the following values: pH 6.90, HCO3- 13 meq/liter and PaCO2 68 mmHg. This patient’s acid-base status is most accurately described as:
A
Metabolic Acidosis
B
Simultaneous Respiratory and Metabolic Acidosis
C
Respiratory Acidosis
D
Respiratory Acidosis with Complete Renal Compensation
Question 20 Explanation:
Whenever the PCO2 and HCO3 are abnormal in opposite directions, ie, one above normal while the other is reduced, a mixed respiratory and metabolic acid-base disorder exists. When the PCO2 is elevated and the [HCO3-] reduced, respiratory acidosis and metabolic acidosis coexist.
Question 21
In a patient undergoing surgery, it was vital to aspirate the contents of the upper gastrointestinal tract. After the operation, the following values were acquired from an arterial blood sample: pH 7.55, PCO2 52 mm Hg and HCO3- 40 mmol/l. What is the underlying disorder?
A
Respiratory Alkalosis
B
Metabolic Acidosis
C
Metabolic Alkalosis
D
Respiratory Acidosis
Question 21 Explanation:
NGT suctioning, vomiting, hypokalemia and overdosage of NaHCO3 are considered risk factors of metabolic alkalosis.
Question 22
Client Z is admitted to the hospital and is to undergo brain surgery. The client is very anxious and scared of the upcoming surgery. He begins to hyperventilate and becomes very dizzy. The client loses consciousness and the STAT ABGs reveal pH 7.61, PaCO2 22 mmHg and HCO3 25 mEq/L. What is the ABG interpretation based on the findings?
A
Metabolic Alkalosis, Partially Compensated
B
Respiratory Alkalosis, Uncompensated
C
Respiratory Alkalosis, Partially Compensated
D
Metabolic Acidosis, Uncompensated
Question 22 Explanation:
The results show that client Z has respiratory alkalosis since there is an increase in the pH value and a decrease in PaCO2 which are both basic. It is uncompensated due to the normal HCO3 which is within 22-26 mEq/L.
Question 23
You are admitting an elderly client to the medical unit. Which factor indicates that this client has a risk for acid-base imbalances?
A
Occasional use of antacids
B
Chronic renal insufficiency
C
Shortness of breath with extreme exertion
D
Myocardial infarction 1 year ago
Question 23 Explanation:
Risk factors for acid-base imbalances in the older adult include chronic renal disease and pulmonary disease. Occasional antacid use will not cause imbalances, although antacid abuse is a risk factor for metabolic alkalosis.
Question 24
Anne, who is drinking beer at a party, falls and hits her head on the ground. Her friend Liza dials “911” because Anne is unconscious, depressed ventilation (shallow and slow respirations), rapid heart rate, and is profusely bleeding from both ears. Which primary acid-base imbalance is Anne at risk for if medical attention is not provided?
A
Metabolic Acidosis
B
Respiratory Acidosis
C
Respiratory Alkalosis
D
Metabolic Alkalosis
Question 24 Explanation:
One of the risk factors of having respiratory acidosis is hypoventilation which may be due to brain trauma, coma, and hypothyroidism or myxedema. Other risk factors include COPD, Respiratory conditions such as pneumothorax, pneumonia and status asthmaticus. Drugs such as Morphine and MgSO4 toxicity are also risk factors of respiratory acidosis.
Question 25
A mountaineer attempts an assault on a high mountain in the Andes and reaches an altitude of 5000 meters (16,400 ft) above sea level. What will happen to his arterial PCO2 and pH?
A
Both will be lower than normal.
B
The pH will fall and PCO2 will rise
C
Both will be higher than normal due to the physical exertion.
D
The pH will rise and PCO2 will fall.
Question 25 Explanation:
The mountaineer will suffer from a respiratory alkalosis. The decline in the PO2 with altitude will stimulate breathing to offset the hypoxia. Carbon dioxide is driven from the blood faster than it is produced in the tissues so PCO2 falls and pH rises.
Question 26
You have been pulled to the telemetry unit for the day. The monitor informs you that the client has developed prominent U waves. Which laboratory value should you check immediately?
A
Magnesium
B
Calcium
C
Sodium
D
Potassium
Question 26 Explanation:
Suspect hypokalemia and check the client’s potassium level. Common ECG changes with hypokalemia include ST depression, inverted T waves, and prominent U waves. Client with hypokalemia may also develop heart block.
Question 27
You are preparing to discharge a client whose calcium level was low but is now just slightly within the normal range (9-10.5 mg/dL). Which statement by the client indicates the need for additional teaching?
A
“I will take my calcium pill every morning before breakfast.”
B
“I will avoid dairy products, broccoli, and spinach when I eat.”
C
“I will make sure to take my vitamin D with my calcium each day.”
D
“I will call my doctor if I experience muscle twitching or seizures.”
Question 27 Explanation:
Clients with low calcium levels should be encouraged to consume dairy products, seafood, nuts, broccoli, and spinach. Which are all good sources of dietary calcium.
Question 28
The client also has the nursing diagnosis Decreased Cardiac Output related to decrease plasma volume. Which finding on assessment supports this nursing diagnosis?
A
Full and bounding pedal and post-tibial pulses
B
Shallow respirations with crackles on auscultation
C
Flattened neck veins when client is in supine position
D
Pitting edema located in feet, ankles, and calves
Question 28 Explanation:
Normally, neck veins are distended when the client is in the supine position. The veins flatten as the client moves to a sitting position. The other three responses are characteristic of Excess Fluid Volume.
Question 29
A company driver is found at the scene of an automobile accident in a state of emotional distress. He tells the paramedics that he feels dizzy, tingling in his fingertips, and does not remember what happened to his car. Respiratory rate is rapid at 34/minute. Which primary acid-base disturbance is the young man at risk for if medical attention is not provided?
A
Metabolic Alkalosis
B
Respiratory Acidosis
C
Metabolic Acidosis
D
Respiratory Alkalosis
Question 29 Explanation:
Hyperventilation is typically the underlying cause of respiratory alkalosis. Hyperventilation is also known as overbreathing. When someone is hyperventilating, they tend to breathe very deeply or very rapidly.
Question 30
An elderly client was admitted to hospital in a coma. Analysis of the arterial blood gave the following values: PCO2 16 mm Hg, HCO3- 5 mmol/L and pH 7.1. As a well-rounded nurse, you know that the normal value for HCO3 is:
A
29 mmol/L
B
20 mmol/L
C
24 mmol/L
D
31 mmol/L
Question 30 Explanation:
The normal value for bicarbonate (HCO3) is 22-26 mmol/L or mEq/L. It may vary slightly among different laboratories. The given values show the common measurement range of results for these tests. Some laboratories use different measurements or may test different specimens.
Question 31
The experienced LPN/LVN reports that a client’s blood pressure and heart rate have decreased and that when the face is assessed, one side twitches. What action should you take at this time?
A
Review the client’s morning calcium level
B
Request a neurologic consult today
C
Reassess the client’s blood pressure and heart rate
D
Check the client’s papillary reaction to light
Question 31 Explanation:
A positive Chvostek’s sign (facial twitching of one side of the mouth, nose, and cheek in response to tapping the face just below and in front of the ear) is a neurologic manifestation of hypocalcemia. The LPN/LVN is experienced and possesses the skills to take accurate vital signs.
Question 32
The physician has written the following orders for the client with Excess Fluid volume. The client’s morning assessment includes bounding peripheral pulses, weight gain of 2 pounds, pitting ankle edema, and moist crackles bilaterally. Which order takes priority at this time?
A
Restrict fluid to 1500 mL per day
B
Administer furosemide (Lasix) 40 mg IV push
C
Maintain accurate intake and output.
D
Weight client every morning.
Question 32 Explanation:
Bilateral moist crackles indicate fluid-filled alveoli, which interferes with gas exchange. Furosemide is a potent loop diuretic that will help mobilize the fluid in the lungs. The other orders are important but not urgent.
Question 33
George Kent is a 54 year old widower with a history of chronic obstructive pulmonary disease and was rushed to the emergency department with increasing shortness of breath, pyrexia, and a productive cough with yellow-green sputum. He has difficulty in communicating because of his inability to complete a sentence. One of his sons, Jacob, says he has been unwell for three days. Upon examination, crackles and wheezes can be heard in the lower lobes; he has a tachycardia and a bounding pulse. Measurement of arterial blood gas shows pH 7.3, PaCO2 68 mm Hg, HCO3 28 mmol/L, and PaO2 60 mm Hg. How would you interpret this?
A
Respiratory Acidosis, Uncompensated
B
Metabolic Acidosis, Partially Compensated
C
Respiratory Acidosis, Partially Compensated
D
Metabolic Alkalosis, Uncompensated
Question 33 Explanation:
The patient has respiratory acidosis (raised carbon dioxide) resulting from an acute exacerbation of chronic obstructive pulmonary disease, with partial compensation.
Question 34
Dave, a 6-year-old boy, was rushed to the hospital following her mother’s complaint that her son has been vomiting, nauseated and has overall weakness. After series of tests, the nurse notes the laboratory results: potassium: 2.9 mEq. Which primary acid-base imbalance is this boy at risk for if medical intervention is not carried out?
A
Metabolic Acidosis
B
Respiratory Acidosis
C
Metabolic Alkalosis
D
Respiratory Alkalosis
Question 34 Explanation:
Vomiting, hypokalemia, overdosage of NaHCO3 and NGT suctioning are considered risk factors of metabolic alkalosis.
Question 35
A mother is admitted in the emergency department following complaints of fever and chills. The nurse on duty took her vital signs and noted the following: Temp = 100 °F; apical pulse = 95; respiration = 20 and deep. Measurement of arterial blood gas shows pH 7.37, PaO2 90 mm Hg, PaCO2 40 mm Hg, and HCO3 24 mmol/L. What is your assessment?
A
Hyperthermia and Respiratory Alkalosis
B
Hypothermia and Respiratory Alkalosis
C
Hypothermia
D
Hyperthermia
Question 35 Explanation:
An individual is considered to have hyperthermia if he or she has a temperature of >37.5 or 38.3 °C (99.5 or 100.9 °F). Measurement of arterial blood gases are normal.
Question 36
Mr. Wales, who underwent post-abdominal surgery, has a nasogastric tube. The nurse on duty notes that the nasogastric tube (NGT) is draining a large amount (900 cc in 2 hours) of coffee ground secretions. The client is not oriented to person, place, or time. The nurse contacts the attending physician and STAT ABGs are ordered. The results from the ABGs show pH 7.57, PaCO2 37 mmHg and HCO3 30 mEq/L. What is your assessment?
A
Metabolic Alkalosis, Uncompensated
B
Metabolic Alkalosis, Partially Compensated
C
Respiratory Alkalosis, Uncompensated
D
Metabolic Acidosis, Uncompensated
Question 36 Explanation:
The postoperative client’s ABG results show that he has metabolic alkalosis because of an increased pH and HCO3. It is uncompensated due to the normal PaCO2 which is within 35 to 45 mmHg.
Question 37
A cigarette vendor was brought to the emergency department of a hospital after she fell into the ground and hurt her left leg. She is noted to be tachycardic and tachypneic. Painkillers were carried out to lessen her pain. Suddenly, she started complaining that she is still in pain and now experiencing muscle cramps, tingling, and paraesthesia. Measurement of arterial blood gas reveals pH 7.6, PaO2 120 mm Hg, PaCO2 31 mm Hg, and HCO3 25 mmol/L. What does this mean?
A
Metabolic Alkalosis, Uncompensated
B
Respiratory Acidosis, Partially Compensated
C
Respiratory Alkalosis, Uncompensated
D
Metabolic Alkalosis, Partially Compensated
Question 37 Explanation:
The primary disorder is acute respiratory alkalosis (low CO2) due to the pain and anxiety causing her to hyperventilate. There has not been time for metabolic compensation.
Question 38
A patient who is hospitalized due to vomiting and a decreased level of consciousness displays slow and deep (Kussmaul breathing), and he is lethargic and irritable in response to stimulation. The doctor diagnosed him of having dehydration. Measurement of arterial blood gas shows pH 7.0, PaO2 90 mm Hg, PaCO2 22 mm Hg, and HCO3 14 mmol/L; other results are Na+ 120 mmol/L, K+ 2.5 mmol/L, and Cl- 95 mmol/L. As a knowledgeable nurse, you know that the normal value for PaCO2 is:
A
50 mm Hg
B
48 mm Hg
C
36 mm Hg
D
22 mm Hg
Question 38 Explanation:
The normal range for PaCO2 is from 35 to 35 mm Hg.
Question 39
A client is admitted to the unit for chemotherapy. To prevent an acid-base problem, which of the following would you instruct the nursing assistant to report?
A
Failure to eat all food on breakfast tray
B
Complaints of pain associated with exertion
C
Client hair loss during morning bath
D
Repeated episodes of nausea and vomiting
Question 39 Explanation:
Prolonged nausea and vomiting can result in acid deficit that can lead to metabolic alkalosis. The other findings are important and need to be assessed but are not related to acid-base imbalances.
Question 40
Mrs. Johansson, who had undergone surgery in the post-anesthesia care unit (PACU), is difficult to arouse two hours following surgery. Nurse Florence in the PACU has been administering Morphine Sulfate intravenously to the client for complaints of post-surgical pain. The client’s respiratory rate is 7 per minute and demonstrates shallow breathing. The patient does not respond to any stimuli! The nurse assesses the ABCs (remember Airway, Breathing, Circulation!) and obtains ABGs STAT! Measurement of arterial blood gas shows pH 7.10, PaCO2 70 mm Hg and HCO3 24 mEq/L. What does this mean?
A
Respiratory Alkalosis, Partially Compensated
B
Metabolic Acidosis, Uncompensated
C
Respiratory Acidosis, Uncompensated
D
Metabolic Alkalosis, Partially Compensated
Question 40 Explanation:
The results show that Mrs. Johansson has respiratory acidosis because of decreased pH and increased PaCO2 which mean acidic in nature. Meanwhile, it is uncompensated because HCO3 is within the normal range.
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1. A client’s nursing diagnosis is Deficient Fluid Volume related to excessive fluid loss. Which action related to the fluid management should be delegated to a nursing assistant?
Administer IV fluids as prescribed by the physician.
Provide straws and offer fluids between meals.
Develop plan for added fluid intake over 24 hours
Teach family members to assist client with fluid intake
2. The client also has the nursing diagnosis Decreased Cardiac Output related to decrease plasma volume. Which finding on assessment supports this nursing diagnosis?
Flattened neck veins when client is in supine position
Full and bounding pedal and post-tibial pulses
Pitting edema located in feet, ankles, and calves
Shallow respirations with crackles on auscultation
3. The nursing care plan for the client with dehydration includes interventions for oral health. Which interventions are within the scope of practice for the LPN/LVN being supervised by the nurse? (Choose all that apply.)
Remind client to avoid commercial mouthwashes.
Encourage mouth rinsing with warm saline.
Assess lips, tongue, and mucous membranes
Provide mouth care every 2 hours while client is awake
Seek dietary consult to increase fluids on meal trays.
4. The physician has written the following orders for the client with Excess Fluid volume. The client’s morning assessment includes bounding peripheral pulses, weight gain of 2 pounds, pitting ankle edema, and moist crackles bilaterally. Which order takes priority at this time?
Weight client every morning.
Maintain accurate intake and output.
Restrict fluid to 1500 mL per day
Administer furosemide (Lasix) 40 mg IV push
5. You have been pulled to the telemetry unit for the day. The monitor informs you that the client has developed prominent U waves. Which laboratory value should you check immediately?
Sodium
Potassium
Magnesium
Calcium
6. The client’s potassium level is 6.7 mEq/L. Which intervention should you delegate to the student nurse under your supervision?
Administer Kayexalate 15 g orally
Administer spironolactone 25 mg orally
Assess WCG strip for tall T waves
Administer potassium 10 mEq orally
7. A client is admitted to the unit with a diagnosis of syndrome of inappropriate antidiuretic hormone secretion (SIADH). For which electrolyte abnormality will you be sure to monitor?
Hypokalemia
Hyperkalemia
Hyponatremia
Hypernatremia
8. The charge nurse assigned in the care for a client with acute renal failure and hypernatremia to you, a newly graduated RN. Which actions can you delegate to the nursing assistant?
Provide oral care every 3-4 hours
Monitor for indications of dehydration
Administer 0.45% saline by IV line
Assess daily weights for trends
9. The experienced LPN/LVN reports that a client’s blood pressure and heart rate have decreased and that when the face is assessed, one side twitches. What action should you take at this time?
Reassess the client’s blood pressure and heart rate
Review the client’s morning calcium level
Request a neurologic consult today
Check the client’s papillary reaction to light
10.You are preparing to discharge a client whose calcium level was low but is now just slightly within the normal range (9-10.5 mg/dL). Which statement by the client indicates the need for additional teaching?
“I will call my doctor if I experience muscle twitching or seizures.”
“I will make sure to take my vitamin D with my calcium each day.”
“I will take my calcium pill every morning before breakfast.”
“I will avoid dairy products, broccoli, and spinach when I eat.”
11.A nursing assistant asks why the client with a chronically low phosphorus level needs so much assistance with activities of daily living. What is your best response?
“The client’s low phosphorus is probably due to malnutrition.”
“The client is just worn out form not getting enough rest.”
“The client’s skeletal muscles are weak because of the low phosphorus.”
“The client will do more for herself when her phosphorus is normal”
12.You are reviewing a client’s morning laboratory results. Which of these results is of most concern?
Serum potassium 5.2 mEq/L
Serum sodium 134 mEq/L
Serum calcium 10.6 mg/dL
Serum magnesium 0.8 mEq/L
13. You are the charge nurse. Which client is most appropriate to assign to the step-down unit nurse pulled to the intensive care unit for the day?
A 68-year-old client on ventilator with acute respiratory failure and respiratory acidosis
A 72-year-old client with COPD and normal arterial blood gases (ABGs) who is ventilator-dependent
A 56-year-old new admission client with diabetic ketoacidosis (DKA) on a n insulin drip
A 38-year-old client on a ventilator with narcotic overdose and respiratory alkalosis
14.A client with respiratory failure is receiving mechanical ventilation and continues to produce ABG results indicating respiratory acidosis. Which action should you expect to correct this problem?
Increase the ventilator rate from 6 to 10 per minute
Decrease the ventilator rate from 10 to 6 per minute
Increase the oxygen concentration fro 30% to 40%
Decrease the oxygen concentration fro 40% to 30%
15.Which action should you delegate to the nursing assistant for the client with diabetic ketoacidosis? (Choose all that apply.)
Check fingerstick glucose every hour.
Record intake and output every hour.
Check vital signs every 15 minutes.
Assess for indicators of fluid imbalance.
16.You are admitting an elderly client to the medical unit. Which factor indicates that this client has a risk for acid-base imbalances?
Myocardial infarction 1 year ago
Occasional use of antacids
Shortness of breath with extreme exertion
Chronic renal insufficiency
17.A client with lung cancer has received oxycodone 10 mg orally for pain. When the student nurse assesses the client, which finding should you instruct the student to report immediately?
Respiratory rate of 8 to 10 per minute
Pain level decreased from 6/10 to 2/10
Client requests room door be closed.
Heart rate 90-100 per minute
18.The nursing assistant reports to you that a client seems very anxious and that vital signs included a respiratory rate of 38 per minute. Which acid-base imbalance should you suspect?
Respiratory acidosis
Respiratory alkalosis
Metabolic acidosis
Metabolic alkalosis
19.A client is admitted to the unit for chemotherapy. To prevent an acid-base problem, which of the following would you instruct the nursing assistant to report?
Repeated episodes of nausea and vomiting
Complaints of pain associated with exertion
Failure to eat all food on breakfast tray
Client hair loss during morning bath
20.A client has a nasogastric tube connected to intermittent wall suction. The student nurse asks why the client’s respiratory rate has increased. What your best response?
“It’s common for clients with uncomfortable procedures such as nasogastric tubes to have a higher rate to breathing.”
“The client may have a metabolic alkalosis due to the NG suctioning and the increased respiratory rate is a compensatory mechanism.”
“Whenever a client develops a respiratory acid-base problem, increasing the respiratory rate helps correct the problem.”
“The client is hyperventilating because of anxiety and we will have to stay alert for development of a respiratory acidosis.”
21. George Kent is a 54 year old widower with a history of chronic obstructive pulmonary disease and was rushed to the emergency department with increasing shortness of breath, pyrexia, and a productive cough with yellow-green sputum. He has difficulty in communicating because of his inability to complete a sentence. One of his sons, Jacob, says he has been unwell for three days. Upon examination, crackles and wheezes can be heard in the lower lobes; he has a tachycardia and a bounding pulse. Measurement of arterial blood gas shows pH 7.3, PaCO2 68 mm Hg, HCO3 28 mmol/L, and PaO2 60 mm Hg. How would you interpret this?
Respiratory Acidosis, Uncompensated
Respiratory Acidosis, Partially Compensated
Metabolic Alkalosis, Uncompensated
Metabolic Acidosis, Partially Compensated
22. Carl, an elementary student, was rushed to the hospital due to vomiting and a decreased level of consciousness. The patient displays slow and deep (Kussmaul breathing), and he is lethargic and irritable in response to stimulation. He appears to be dehydrated—his eyes are sunken and mucous membranes are dry—and he has a two week history of polydipsia, polyuria, and weight loss. Measurement of arterial blood gas shows pH 7.0, PaO2 90 mm Hg, PaCO2 23 mm Hg, and HCO3 12 mmol/L; other results are Na+ 126 mmol/L, K+ 5 mmol/L, and Cl- 95 mmol/L. What is your assessment?
Respiratory Acidosis, Uncompensated
Respiratory Acidosis, Partially Compensated
Metabolic Alkalosis, Uncompensated
Metabolic Acidosis, Partially, Compensated
23. A cigarette vendor was brought to the emergency department of a hospital after she fell into the ground and hurt her left leg. She is noted to be tachycardic and tachypneic. Painkillers were carried out to lessen her pain. Suddenly, she started complaining that she is still in pain and now experiencing muscle cramps, tingling, and paraesthesia. Measurement of arterial blood gas reveals pH 7.6, PaO2 120 mm Hg, PaCO2 31 mm Hg, and HCO3 25 mmol/L. What does this mean?
Respiratory Alkalosis, Uncompensated
Respiratory Acidosis, Partially Compensated
Metabolic Alkalosis, Uncompensated
Metabolic Alkalosis, Partially Compensated
24. Ricky’s grandmother is suffering from persistent vomiting for two days now. She appears to be lethargic and weak and has myalgia. She is noted to have dry mucus membranes and her capillary refill takes >4 seconds. She is diagnosed as having gastroenteritis and dehydration. Measurement of arterial blood gas shows pH 7.5, PaO2 85 mm Hg, PaCO2 40 mm Hg, and HCO3 34 mmol/L. What acid-base disorder is shown?
Respiratory Alkalosis, Uncompensated
Respiratory Acidosis, Partially Compensated
Metabolic Alkalosis, Uncompensated
Metabolic Alkalosis, Partially Compensated
25. Mrs. Johansson, who had undergone surgery in the post-anesthesia care unit (PACU), is difficult to arouse two hours following surgery. Nurse Florence in the PACU has been administering Morphine Sulfate intravenously to the client for complaints of post-surgical pain. The client’s respiratory rate is 7 per minute and demonstrates shallow breathing. The patient does not respond to any stimuli! The nurse assesses the ABCs (remember Airway, Breathing, Circulation!) and obtains ABGs STAT! Measurement of arterial blood gas shows pH 7.10, PaCO2 70 mm Hg and HCO3 24 mEq/L. What does this mean?
Respiratory Alkalosis, Partially Compensated
Respiratory Acidosis, Uncompensated
Metabolic Alkalosis, Partially Compensated
Metabolic Acidosis, Uncompensated
26. Baby Angela was rushed to the Emergency Room following her mother’s complaint that the infant has been irritable, difficult to breastfeed and has had diarrhea for the past 3 days. The infant’s respiratory rate is elevated and the fontanels are sunken. The Emergency Room physician orders ABGs after assessing the ABCs. The results from the ABG results show pH 7.39, PaCO2 27 mmHg and HCO3 19 mEq/L. What does this mean?
Respiratory Alkalosis, Fully Compensated
Metabolic Acidosis, Uncompensated
Metabolic Acidosis, Fully Compensated
Respiratory Acidosis, Uncompensated
27. Mr. Wales, who underwent post-abdominal surgery, has a nasogastric tube. The nurse on duty notes that the nasogastric tube (NGT) is draining a large amount (900 cc in 2 hours) of coffee ground secretions. The client is not oriented to person, place, or time. The nurse contacts the attending physician and STAT ABGs are ordered. The results from the ABGs show pH 7.57, PaCO2 37 mmHg and HCO3 30 mEq/L. What is your assessment?
Metabolic Acidosis, Uncompensated
Metabolic Alkalosis, Uncompensated
Respiratory Alkalosis, Uncompensated
Metabolic Alkalosis, Partially Compensated
28. Client Z is admitted to the hospital and is to undergo brain surgery. The client is very anxious and scared of the upcoming surgery. He begins to hyperventilate and becomes very dizzy. The client loses consciousness and the STAT ABGs reveal pH 7.61, PaCO2 22 mmHg and HCO3 25 mEq/L. What is the ABG interpretation based on the findings?
Metabolic Acidosis, Uncompensated
Respiratory Alkalosis, Partially Compensated
Respiratory Alkalosis, Uncompensated
Metabolic Alkalosis, Partially Compensated
29. Three-year-old Adrian is admitted to the hospital with a diagnosis of asthma and respiratory distress syndrome. The mother of the child reports to the nurse on duty that she has witnessed slight tremors and behavioral changes in her child over the past four days. The attending physician orders routine ABGs following an assessment of the ABCs. The ABG results are pH 7.35, PaCO2 72 mmHg and HCO3 38 mEq/L. What acid-base disorder is shown?
Respiratory Acidosis, Uncompensated
Respiratory Acidosis, Fully Compensated
Respiratory Alkalosis, Fully Compensated
Metabolic Alkalosis, Partially Compensated
30. Anne, who is drinking beer at a party, falls and hits her head on the ground. Her friend Liza dials “911” because Anne is unconscious, depressed ventilation (shallow and slow respirations), rapid heart rate, and is profusely bleeding from both ears. Which primary acid-base imbalance is Anne at risk for if medical attention is not provided?
Metabolic Acidosis
Metabolic Alkalosis
Respiratory Acidosis
Respiratory Alkalosis
31. Dave, a 6-year-old boy, was rushed to the hospital following her mother’s complaint that her son has been vomiting, nauseated and has overall weakness. After series of tests, the nurse notes the laboratory results: potassium: 2.9 mEq. Which primary acid-base imbalance is this boy at risk for if medical intervention is not carried out?
Respiratory Acidosis
Respiratory Alkalosis
Metabolic Acidosis
Metabolic Alkalosis
32. An old beggar was admitted to the emergency department due to shortness of breath, fever, and a productive cough. Upon examination, crackles and wheezes are noted in the lower lobes; he appears to be tachycardic and has a bounding pulse. Measurement of arterial blood gas shows pH 7.2, PaCO2 66 mm Hg, HCO3 27 mmol/L, and PaO2 65 mm Hg. As a knowledgeable nurse, you know that the normal value for pH is:
7.20
7.30
7.40
7.50
33. Liza’s mother is seen in the emergency department at a community hospital. She admits that her mother is taking many tablets of aspirin (salicylates) over the last 24-hour period because of a severe headache. Also, the mother complains of an inability to urinate. The nurse on duty took her vital signs and noted the following: Temp = 97.8 °F; apical pulse = 95; respiration = 32 and deep. Which primary acid-base imbalance is the gentleman at risk for if medical attention is not provided?
Respiratory Acidosis
Respiratory Alkalosis
Metabolic Acidosis
Metabolic Alkalosis
34. A patient who is hospitalized due to vomiting and a decreased level of consciousness displays slow and deep (Kussmaul breathing), and he is lethargic and irritable in response to stimulation. The doctor diagnosed him of having dehydration. Measurement of arterial blood gas shows pH 7.0, PaO2 90 mm Hg, PaCO2 22 mm Hg, and HCO3 14 mmol/L; other results are Na+ 120 mmol/L, K+ 2.5 mmol/L, and Cl- 95 mmol/L. As a knowledgeable nurse, you know that the normal value for PaCO2 is:
22 mm Hg
36 mm Hg
48 mm Hg
50 mm Hg
35. A company driver is found at the scene of an automobile accident in a state of emotional distress. He tells the paramedics that he feels dizzy, tingling in his fingertips, and does not remember what happened to his car. Respiratory rate is rapid at 34/minute. Which primary acid-base disturbance is the young man at risk for if medical attention is not provided?
Respiratory Acidosis
Respiratory Alkalosis
Metabolic Acidosis
Metabolic Alkalosis
36. An elderly client was admitted to hospital in a coma. Analysis of the arterial blood gave the following values: PCO2 16 mm Hg, HCO3- 5 mmol/L and pH 7.1. As a well-rounded nurse, you know that the normal value for HCO3 is:
20 mmol/L
24 mmol/L
29 mmol/L
31 mmol/L
37. In a patient undergoing surgery, it was vital to aspirate the contents of the upper gastrointestinal tract. After the operation, the following values were acquired from an arterial blood sample: pH 7.55, PCO2 52 mm Hg and HCO3- 40 mmol/l. What is the underlying disorder?
Respiratory Acidosis
Respiratory Alkalosis
Metabolic Acidosis
Metabolic Alkalosis
38. A mountaineer attempts an assault on a high mountain in the Andes and reaches an altitude of 5000 meters (16,400 ft) above sea level. What will happen to his arterial PCO2 and pH?
Both will be lower than normal.
The pH will rise and PCO2 will fall.
Both will be higher than normal due to the physical exertion.
The pH will fall and PCO2 will rise
39. A young woman is found comatose, having taken an unknown number of sleeping pills an unknown time before. An arterial blood sample yields the following values: pH 6.90, HCO3- 13 meq/liter and PaCO2 68 mmHg. This patient’s acid-base status is most accurately described as:
Metabolic Acidosis
Respiratory Acidosis
Simultaneous Respiratory and Metabolic Acidosis
Respiratory Acidosis with Complete Renal Compensation
40. A mother is admitted in the emergency department following complaints of fever and chills. The nurse on duty took her vital signs and noted the following: Temp = 100 °F; apical pulse = 95; respiration = 20 and deep. Measurement of arterial blood gas shows pH 7.37, PaO2 90 mm Hg, PaCO2 40 mm Hg, and HCO3 24 mmol/L. What is your assessment?
Hyperthermia
Hyperthermia and Respiratory Alkalosis
Hypothermia
Hypothermia and Respiratory Alkalosis
Answers and Rationales
ANSWER B – The nursing assistant can reinforce additional fluild intake once it is part of the care plan. Administering IV fluids, developing plans, and teaching families require additional education and skills that are within the scope of practice for the RN.
ANSWER A – Normally, neck veins are distended when the client is in the supine position. The veins flatten as the client moves to a sitting position. The other three responses are characteristic of Excess Fluid Volume.
ANSWER A, B, C, D – The LPN/LVN’s scope of practice and educational preparation includes oral care and routine observation. State practice acts vary as to whether LPN/LVNs are permitted to perform assessment. The client should be reminded to avoid most commercial mouthwashes that contain alcohol, a drying agent. Initiating a dietary consult is within the purview of the RN or physician.
ANSWER D – Bilateral moist crackles indicate fluid-filled alveoli, which interferes with gas exchange. Furosemide is a potent loop diuretic that will help mobilize the fluid in the lungs. The other orders are important but not urgent.
ANSWER B – Suspect hypokalemia and check the client’s potassium level. Common ECG changes with hypokalemia include ST depression, inverted T waves, and prominent U waves. Client with hypokalemia may also develop heart block.
ANSWER A – The client’s potassium level is high (normal range 3.5-5.0). Kayexalate removes potassium from the body through the gastrointestinal system. Spironolactone is a potassium-sparing diuretic that may cause the client’s potassium level to go even higher. The nursing student may not have the skill to assess ECG strips and this should be done by the RN.
ANSWER C – SIADH causes a relative sodium deficit due to excessive retention of water.
ANSWER A – Providing oral care is within the scope of practice for the nursing assistant. Monitoring and assessing clients, as well as administering IV fluids, require the additional education and skill of the RN.
ANSWER B – A positive Chvostek’s sign (facial twitching of one side of the mouth, nose, and cheek in response to tapping the face just below and in front of the ear) is a neurologic manifestation of hypocalcemia. The LPN/LVN is experienced and possesses the skills to take accurate vital signs.
ANSWER D – Clients with low calcium levels should be encouraged to consume dairy products, seafood, nuts, broccoli, and spinach. Which are all good sources of dietary calcium.
ANSWER C – A musculoskeletal manifestation of low phosphorous is generalized muscle weakness that may lead to acute muscle breakdown (rhabdomyolysis). Even though the other statements are true, they do not answer the nursing assistant’s question.
ANSWER D – While all of these laboratory values are outside of the normal range, the magnesium is most outside of normal. With a magnesium level this low, the client is at risk for ECG changes and life-threatening ventricular dysrhythmias.
ANSWER B – The client with COPD, although ventilator dependent, is the most stable of this group. Clients with acid-base imbalances often require frequent laboratory assessment and changes in therapy to correct their disorders. In addition, the client with DKA is a new admission and will require an in-depth admission assessment. All three of these clients need care from an experienced critical care nurse.
ANSWER A – the blood gas component responsible for respiratory acidosis is CO2 (Carbon dioxide). Increasing the ventilator rate will blow off more CO2 and decrease the acidosis. Changes in the oxygen setting may improve oxygenation but will not affect respiratory acidosis.
ANSWER B, C – The nursing assistant’s training and education include how to take vital signs and record intake and output. The need to take vital signs this frequently indicates that the client maybe unstable. The nurse should give the nursing assistant reporting parameters when delegating this action, should also check the vital signs for indications in instability. Performing fingerstick glucose checks and assessing clients require additional education and skill that are appropriate to licensed nurses. Some facilities may train experienced nursing assistants to perform fingerstick glucose checks and change their role descriptions to designate their new skills, but this is beyond the normal scope of practice for a nursing assistant.
ANSWER D – Risk factors for acid-base imbalances in the older adult include chronic renal disease and pulmonary disease. Occasional antacid use will not cause imbalances, although antacid abuse is a risk factor for metabolic alkalosis.
ANSWER A – A decreased respiratory rate indicates respiratory depression which also puts the client at risk for respiratory acidosis, All of the other findings are important and should be reported to the RN, but the respiratory rate is urgent.
ANSWER B – The client is most likely hyperventilating and blowing off CO2. This decrease in CO2 will lead to an increase in pH, causing respiratory alkalosis. Respiratory acidosis results from respiratory depression and retained CO2. Metabolic acidosis and alkalosis result from problems related to renal acid-base control.
ANSWER A – Prolonged nausea and vomiting can result in acid deficit that can lead to metabolic alkalosis. The other findings are important and need to be assessed but are not related to acid-base imbalances.
ANSWER B – Nasogastric suctioning can result in a decrease in acid components and metabolic alkalosis. The client’s increase in rate and depth of ventilation is an attempt to compensate by blowing off CO2. the first response maybe true but does not address all the components of the question. The third and fourth answers are inaccurate.
Answer: B. Respiratory Acidosis, Partially Compensated. The patient has respiratory acidosis (raised carbon dioxide) resulting from an acute exacerbation of chronic obstructive pulmonary disease, with partial compensation.
Answer: D. Metabolic Acidosis, Partially, Compensated. The student was diagnosed having diabetes mellitus. The results show that he has metabolic acidosis (low HCO3 -) with respiratory compensation (low CO2).
Answer: A. Respiratory Alkalosis, Uncompensated. The primary disorder is acute respiratory alkalosis (low CO2) due to the pain and anxiety causing her to hyperventilate. There has not been time for metabolic compensation.
Answer: C. Metabolic Alkalosis, Uncompensated. The primary disorder is uncompensated metabolic alkalosis (high HCO3 -). As CO2 is the strongest driver of respiration, it generally will not allow hypoventilation as compensation for metabolic alkalosis.
Answer: B. Respiratory Acidosis, Uncompensated. The results show that Mrs. Johansson has respiratory acidosis because of decreased pH and increased PaCO2 which mean acidic in nature. Meanwhile, it is uncompensated because HCO3 is within the normal range.
Answer: C. Metabolic Acidosis, Fully Compensated. Baby Angela has metabolic acidosis due to decreased HCO3 and slightly acidic pH. Her pH value is within the normal range which made the result fully compensated.
Answer: B. Metabolic Alkalosis, Uncompensated. The postoperative client’s ABG results show that he has metabolic alkalosis because of an increased pH and HCO3. It is uncompensated due to the normal PaCO2 which is within 35 to 45 mmHg.
Answer: C. Respiratory Alkalosis, Uncompensated. The results show that client Z has respiratory alkalosis since there is an increase in the pH value and a decrease in PaCO2 which are both basic. It is uncompensated due to the normal HCO3 which is within 22-26 mEq/L.
Answer: B. Respiratory Acidosis, Fully Compensated. The patient has respiratory acidosis (raised carbon dioxide) resulting from asthma and respiratory distress syndrome, with compensation having normal pH value within 7.35to 7.45, increased PaCO2 which is acidic and increased HCO3 which is basic.
Answer: C. Respiratory Acidosis. One of the risk factors of having respiratory acidosis is hypoventilation which may be due to brain trauma, coma, and hypothyroidism or myxedema. Other risk factors include COPD, Respiratory conditions such as pneumothorax, pneumonia and status asthmaticus. Drugs such as Morphine and MgSO4 toxicity are also risk factors of respiratory acidosis.
Answer: D. Metabolic Alkalosis. Vomiting, hypokalemia, overdosage of NaHCO3 and NGT suctioning are considered risk factors of metabolic alkalosis.
Answer: C. 7.40. Normal blood pH must be maintained within a narrow range of 7.35-7.45 to ensure the proper functioning of metabolic processes and the delivery of the right amount of oxygen to tissues. Acidosis refers to an excess of acid in the blood that causes the pH to fall below 7.35, and alkalosis refers to an excess of base in the blood that causes the pH to rise above 7.45.
Answer. C. Metabolic Acidosis. Salicylate overdose causes a high anion gap metabolic acidosis in both children and adults. Adults commonly develop a mixed acid-base disorder as a respiratory alkalosis due to direct respiratory centre stimulation occurs as well. This second disorder is uncommon in children.
Answer: B. 36 mm Hg. The normal range for PaCO2 is from 35 to 35 mm Hg.
Answer: B. Respiratory Alkalosis. Hyperventilation is typically the underlying cause of respiratory alkalosis. Hyperventilation is also known as overbreathing. When someone is hyperventilating, they tend to breathe very deeply or very rapidly.
Answer: B. 24 mmol/L. The normal value for bicarbonate (HCO3) is 22-26 mmol/L or mEq/L. It may vary slightly among different laboratories. The given values show the common measurement range of results for these tests. Some laboratories use different measurements or may test different specimens.
Answer: D. Metabolic Alkalosis. NGT suctioning, vomiting, hypokalemia and overdosage of NaHCO3 are considered risk factors of metabolic alkalosis.
Answer: B. The pH will rise and PCO2 will fall. The mountaineer will suffer from a respiratory alkalosis. The decline in the PO2 with altitude will stimulate breathing to offset the hypoxia. Carbon dioxide is driven from the blood faster than it is produced in the tissues so PCO2 falls and pH rises.
Answer: C. Simultaneous Respiratory and Metabolic Acidosis. Whenever the PCO2 and HCO3 are abnormal in opposite directions, ie, one above normal while the other is reduced, a mixed respiratory and metabolic acid-base disorder exists. When the PCO2 is elevated and the [HCO3-] reduced, respiratory acidosis and metabolic acidosis coexist.
Answer: A. Hyperthermia. An individual is considered to have hyperthermia if he or she has a temperature of >37.5 or 38.3 °C (99.5 or 100.9 °F). Measurement of arterial blood gases are normal.