Deck 1: Acidbase Balance

Question 1

The nurse is instructing a client with a history of acidosis on the use of sodium bicarbonate.Which client statement indicates that additional teaching is needed?

A) "I should contact the doctor if I have any gastric discomfort with chest pain."
B) "I need to purchase antacids without salt."
C) "I should use the antacid for at least 2 months."
D) "I should call the doctor if I get short of breath or start to sweat with this medication."

Answer 1

"I should use the antacid for at least 2 months."

Question 2

The mother of a 1-month-old infant calls the nurse who works in the health clinic.The mother is concerned because the infant has had vomiting and diarrhea for 1 days.The nurse knows that this infant is at risk for metabolic acidosis.Which is the priority nursing action?

A) Instruct the mother to provide the infant with 50 mL of glucose water.
B) Instruct the mother to measure the infant's urine output for 24 hours.
C) Instruct the mother to give the infant at least 2 ounces of juice every 2 hours.
D) Instruct the mother to bring the infant to the clinic for evaluation.

Answer 2

Instruct the mother to bring the infant to the clinic for evaluation.

Question 3

A client is brought to the emergency department (ED)after passing out in a local department store.The client has been fasting and has ketones in the urine.Which acid-base imbalance would the nurse expect to assess in this client?

A) Metabolic acidosis
B) Respiratory alkalosis
C) Metabolic alkalosis
D) Respiratory acidosis

Answer 3

Metabolic acidosis

Question 4

The nurse is caring for a client with metabolic acidosis.Which goals are appropriate for this client? Select all that apply.

A) The client will maintain a respiratory rate of 30 or more.
B) The client will describe preventative measure for the underlying chronic illness.
C) The client will maintain baseline cardiac rhythm.
D) pH will range from 7.25 to 7.35.
E) The client will take potassium supplements to increase potassium levels.

Question 5

The client is receiving sodium bicarbonate intravenously (IV)for correction of acidosis secondary to diabetic coma.The nurse assesses the client to be lethargic,confused,and breathing rapidly.Which is the nurse's priority response to the current situation?

A) Stop the infusion and notify the physician because the client is in alkalosis.
B) Decrease the rate of the infusion and continue to assess the client for symptoms of alkalosis.
C) Continue the infusion, because the client is still in acidosis, and notify the healthcare provider.
D) Increase the rate of the infusion and continue to assess the client for symptoms of acidosis.

Question 6

Which risk factors exhibited by the client presenting in the emergency department (ED)would place the client at risk for metabolic acidosis? Select all that apply.

A) Abdominal fistulas
B) Chronic obstructive pulmonary disease
C) Pneumonia
D) Acute renal failure
E) Hypovolemic shock

Question 7

The nurse is planning care for an older client with respiratory acidosis.Which intervention should the nurse include in this client's plan of care?

A) Administer prescribed intravenous fluids carefully.
B) Administer intravenous sodium bicarbonate.
C) Maintain adequate hydration.
D) Reduce environmental stimuli.

Question 8

The nurse is caring for a comatose client with respiratory acidosis.For which intervention will the nurse need to collaborate when caring for this client?

A) Measuring vital signs
B) Measuring intake and output
C) The client's recent eating behaviors
D) Identifying current oxygen saturation level

Question 9

The nurse is assessing an African-American client.The client is diagnosed with metabolic acidosis secondary to renal failure.Which nursing actions are culturally appropriate for this client? Select all that apply.

A) Assessing dietary intake of sodium
B) Assessing dietary intake of potassium
C) Monitoring for cardiac dysrhythmias
D) Planning care based on the noncompliance that is often associated with this ethnic group
E) Telling the client that ethnic foods must be avoided

Question 10

The results of a client's arterial blood gas sample reveal an oxygen level of 72 mmHg.For which associated health problem should the nurse assess this client?

A) Communication
B) Perfusion
C) Fluid and electrolyte imbalance
D) Cognition

Question 11

The nurse is caring for a client who has been admitted with persistent diarrhea lasting 3 days.Which are appropriate nursing diagnoses for this client during the acute phase of the illness? Select all that apply.

A) Decreased Cardiac Output
B) Ineffective Airway Clearance
C) Deficient Fluid Volume
D) Knowledge Deficit
E) Risk for Injury

Question 12

A child with acute asthma has a PaCO₂ of 48 mmHg,a pH of 7.31,and a normal HCO₃ blood gas value.The nurse interprets these findings as indicative of which condition?

A) Metabolic acidosis
B) Respiratory alkalosis
C) Respiratory acidosis
D) Metabolic alkalosis

Question 13

The nurse is analyzing the client's arterial blood gas report,which reveals a pH of 6.58.The client has just suffered a cardiac arrest.Which consequences of this pH value does the nurse consider for this client?

A) Decreased cardiac output
B) Increase magnesium levels
C) Decreased free calcium in the ECT
D) Increased myocardial contractility

Question 14

A client who was diagnosed with diabetes mellitus 1 year ago is hospitalized in diabetic ketoacidosis after a religious fast.The client tells the nurse,"I have fasted during this season every year since I became an adult.I am not going to stop now." The nurse is not knowledgeable about this particular religion.Which nursing actions would be appropriate? Select all that apply.

A) Request a consult from a diabetes educator.
B) Tell the client that things are different now because of the diabetes.
C) Ask family members of the same religion to discuss fasting with the client.
D) Assess the meaning and context of fasting in the client's religion.
E) Encourage the client to seek medical care if signs of ketoacidosis occur in the future.

Question 15

The nurse is caring for the client experiencing hypovolemic shock and metabolic acidosis.Which therapies would the nurse question if planned for this client? Select all that apply.

A) Monitor weight on admission and discharge.
B) Monitor ECG for conduction problems.
C) Limit the intake of fluids.
D) Administer sodium bicarbonate.
E) Keep the bed in the locked and low position.

Question 16

The nurse is reviewing the latest arterial blood gas results for a client with metabolic alkalosis.Which result indicates that the metabolic alkalosis is compensated?

A) pH 7.32
B) PaCO₂ 18 mmHg
C) HCO₃ 8 mEq/L
D) PaCO₂ 48 mmHg

Question 17

The nurse is identifying a diagram to use to explain a client's acid-base balance.Which imbalance does the following diagram suggest is occurring with the client?

A) Metabolic acidosis
B) Metabolic alkalosis
C) Respiratory acidosis
D) Respiratory alkalosis

Question 18

The nurse is caring for a client admitted with renal failure and metabolic acidosis.Which clinical manifestation would indicate to the nurse that planned interventions to relieve the metabolic acidosis have been effective?

A) Decreased respiratory depth
B) Palpitations
C) Increased deep tendon reflexes
D) Respiratory rate of 38

Question 19

A client has been admitted with chronic obstructive pulmonary disease.Diagnostic tests have been ordered.Which of the tests will provide the most accurate indicator of the client's acid-base balance?

A) Arterial blood gases (ABGs)
B) Pulse oximetry
C) Sputum studies
D) Bronchoscopy

Question 20

The nurse is preparing to analyze a client's arterial blood gas results.List the steps in the order that the nurse should follow when analyzing this laboratory test.
1) Look at the PaCO₂.
2) Look at the pH.
3) Evaluate the relationship between pH and PaCO₂.
4) Look for compensation.
5) Evaluate the pH,HCO₃,and base excess for a possible metabolic problem.
6) Look at the bicarbonate.
7) Evaluate oxygenation.

Question 21

During a home visit,the nurse evaluates teaching provided to a client recently hospitalized for metabolic alkalosis.Which observation indicates that additional teaching is required?

A) Drinks 2 cups of black coffee each day.
B) Consumes one orange each day with breakfast.
C) Ingests bicarbonate of soda after each meal.
D) Monitors and tracks daily weights.

Question 22

The nurse identifies the diagnosis Risk for Injury as appropriate for a client with metabolic acidosis.Which strategies should the nurse use to support this diagnosis? Select all that apply.

A) Apply wrist restraints and secure to the bed frame.
B) Discuss chemical restraint use with the healthcare provider.
C) Keep the bed in the lowest position.
D) Keep bed side rails raised.
E) Place a clock and calendar at the bedside.

Question 23

During an assessment,the nurse becomes concerned that a client is at risk for developing metabolic alkalosis.What did the nurse assess that caused this concern?

A) Daily ingestion of a banana with breakfast
B) Daily weight consistent
C) Daily use of sodium bicarbonate for gastric upset
D) Daily use of prescribed NSAIDs for arthritic pain

Question 24

While reviewing laboratory results,the nurse notes that a client's potassium level is 2.8 mEq/L and chloride level is 100 mEq/L.Based on this data,which intervention does the nurse plan for this client?

A) Preparing to administer 0.9% sodium chloride infusion
B) Measuring for nasogastric tube insertion
C) Discussing potassium chloride replace therapy with the healthcare provider
D) Reviewing implications of transfusing with ammonia chloride

Question 25

The nurse is planning care for the client who has been admitted with metabolic alkalosis.Which are appropriate nursing diagnoses for this client during the acute phase of the illness? Select all that apply.

A) Ineffective Health Maintenance
B) Risk for Hypothermia
C) Deficient Fluid Volume
D) Risk for Impaired Gas Exchange
E) Risk for Injury

Question 26

The nurse is caring for a client who has been admitted to the hospital for congestive heart failure.Which data collected during the nursing assessment indicates that the client is at risk for metabolic alkalosis? Select all that apply.

A) The client takes furosemide (Lasix) daily.
B) The client takes a baby aspirin once daily.
C) The client takes metformin daily.
D) The client frequently uses calcium carbonate (Tums) for acid indigestion.
E) The client takes acetaminophen as needed for pain.

Question 27

The nurse identifies the diagnosis Risk for Impaired Gas Exchange to guide the care of a client with metabolic alkalosis.Which assessment data supports this nursing diagnosis? Select all that apply.

A) Respiratory rate 8 per minute
B) Oxygen saturation 89%
C) Urine output 25 mL/hr
D) Restlessness and agitation
E) Weight loss of 3 kg overnight

Question 28

The nurse is reviewing new prescriptions provided by the healthcare provider for a client with metabolic acidosis.Which prescription should the nurse question before implementing it for the client?

A) Begin intravenous infusion of 0.9% normal saline.
B) Draw serum potassium levels every 2 hours.
C) Draw arterial blood gas samples every 2 hours.
D) Administer 1 ampule of sodium bicarbonate now.

Question 29

A client with metabolic acidosis has been admitted to the unit from the emergency department (ED).The client is experiencing confusion and weakness.Which nursing intervention is the priority for this client?

A) Placing the client in a high-Fowler's position
B) Protecting the client from injury
C) Administering sodium bicarbonate
D) Providing the client with appropriate skin care

Question 30

The nurse is preparing to teach a client with type 1 diabetes mellitus on the mechanism behind the development of ketoacidosis.List the order in which the nurse should provide this information.
1) Production of lactate and hydrogen ions
2) Tissue hypoxemia
3) Breakdown of fatty tissue
4) Reduction in intracellular glucose
5) Fatty acids converted to ketones

Question 31

The client has been vomiting for several days.The nurse knows that the client is at risk for metabolic alkalosis because gastric secretions have which characteristic?

A) Gastric secretions are green in color.
B) Gastric secretions are alkaline.
C) Gastric secretions are acidic.
D) Gastric secretions have a foul smell.

Question 32

An Asian-American adolescent is hospitalized following several days of vomiting due to food poisoning.The nurse is planning to include which points when teaching the client's family at discharge? Select all that apply.

A) Immunizations for the adolescent
B) Nutritional patterns of the adolescent
C) Signs and symptoms of metabolic alkalosis
D) Proper food-handling techniques
E) Normal laboratory values of the adolescent

Question 33

The nurse is planning care for the client with Cushing's syndrome who has been admitted for complications related to the disease process.Which intervention should the nurse plan for this client to improve the impaired gas exchange?

A) Monitor serum electrolytes.
B) Schedule nursing activities to allow for periods of rest.
C) Assess input and output accurately.
D) Administer IV fluids per practitioner order.

Question 34

During a home visit,the nurse evaluates care provided to a client with type 1 diabetes mellitus and a history of metabolic acidosis.Which outcome indicates that the care of this client has been successful?

A) The client is injecting insulin into thigh muscle.
B) The client is taking laxatives three times a week to ensure adequate bowel movements.
C) The client is eating three balanced meals per day with two snacks.
D) The client is taking aspirin 325 mg every 6 hours to treat arthritis pain.

Question 35

Upon entering a room,the nurse quickly scans the environment and then immediately assesses the client for manifestations of metabolic acidosis.Which did the nurse observe to precipitate this client assessment?

A) Client sleeping with the head of the bed flat
B) Half of the client's lunch tray uneaten
C) One formed stool in the bedside commode
D) 1000 mL of intravenous 0.9% normal saline infused in 2 hours

Question 36

A client with hyperaldosteronism is admitted to the unit and is at risk for impaired gas exchange.Which position should this client be placed to enhance gas exchange?

A) Fowler's position
B) Prone position
C) Left side-lying position
D) Right Sims position

Question 37

A client is admitted with manifestations of metabolic alkalosis.Which diagnostic test findings support the admitting diagnosis? Select all that apply.

A) Serum glucose level 142 mg/dL
B) Blood pH 7.47 and bicarbonate 34 mEq/L
C) Intravenous pyelogram shows kidney stones
D) Bilateral lower lobe infiltrates noted on chest x-ray
E) Electrocardiogram changes consistent with hypokalemia

Question 38

A client with severe metabolic alkalosis is admitted to the unit.Which is the priority for the client?

A) Administering medication for metabolic alkalosis
B) Monitoring oxygen saturation
C) Teaching the client the risk factors for metabolic alkalosis
D) Setting goals for the client with metabolic alkalosis

Question 39

The nurse is preparing to discharge a client with congestive heart failure on furosemide (Lasix).The nurse determines that teaching has been effective if the client makes which statement?

A) "I will use only sodium bicarbonate as my antacid."
B) "I will restrict my intake of fluids."
C) "I will use potassium supplements while I am taking Lasix."
D) "I will take antacids only for my gastric discomforts."

Question 40

The nurse assumes care for a client who was brought to the hospital after a morphine overdose.What acid-base imbalance does the nurse expect to observe in this client?

A) Respiratory alkalosis
B) Respiratory acidosis
C) Metabolic alkalosis
D) Metabolic acidosis

Question 41

The nurse is preparing to admit a client with acute pneumonia who is experiencing severe respiratory acidosis.Which treatments does the nurse anticipate as appropriate for this client? Select all that apply.

A) Administer oxygen prn.
B) Administer digoxin for heart failure.
C) Encourage up to 3L of fluids per day.
D) Place in a prone position.
E) Reposition frequently.

Question 42

The nurse is reviewing new orders written for a client experiencing respiratory alkalosis.Which orders would be appropriate for this client's care needs? Select all that apply.

A) Oxygen 2 liters via face mask
B) Restrict fluids to 2 liters per day.
C) Admit to a private room.
D) Infuse 1 ampule of sodium bicarbonate now.
E) Draw arterial blood gases.

Question 43

A client with pneumonia develops respiratory acidosis.Which medications should the nurse prepare to administer to this client? Select all that apply.

A) Furosemide (Lasix) 20 mg by mouth twice a day
B) Amoxicillin 1 gram intravenous every 6 hours
C) Albuterol inhaler 2 puffs every 4 hours
D) Diazepam (Valium) 2 mg by mouth at bedtime for sleep
E) Potassium chloride 20 mEq in 100 mL 0.9% normal saline intravenous every day

Question 44

The client is admitted to the emergency department (ED)with symptoms of a panic attack,including hyperventilation.Based on this data,the nurse plans care for which health problem?

A) Hypoventilation
B) Vomiting
C) Respiratory alkalosis
D) Memory loss

Question 45

A client is admitted to the unit with chronic obstructive pulmonary disease.Blood gas analysis indicates respiratory acidosis.Based on this data,the nurse plans care based on which priority diagnosis?

A) Impaired Gas Exchange
B) Ineffective Airway Clearance
C) Impaired Mobility
D) Anxiety

Question 46

The nurse is preparing discharge instructions for an older adult client recovering from respiratory acidosis caused by restrictive lung disease and pneumonia.Which topics should the nurse include in the discharge teaching for this client? Select all that apply.

A) Obtain annual influenza immunization.
B) Engage in frequent hand washing.
C) Avoid crowds.
D) Cover the nose and mouth when coughing.
E) Restrict fluids.

Question 47

The nurse is caring for a client who is being mechanically ventilated.Arterial blood gas analysis reveals a pH of 7.20 and a PaCO₂ of 49 mmHg.Which change in ventilator settings should the nurse anticipate?

A) Increase in humidification of inspired air
B) Decrease of FiO₂ from 30% to 25%
C) Increased respiratory rate to 30 breaths per minute
D) Decreased tidal volume of each breath

Question 48

A client with metabolic alkalosis is experiencing numbness around the mouth and tingling of the fingers.What should the nurse explain as the reason for these manifestations?

A) "Because you are breathing so fast, the oxygen is not getting to your nerve endings."
B) "Your health problem affects calcium in your body, which causes the tingling around your mouth and fingers."
C) "You have a build-up of carbon dioxide in your blood."
D) "You don't have enough potassium in your body, so the tingling around your mouth and fingers will occur."

Question 49

The nurse is providing care to an older adult Asian-American client diagnosed with respiratory alkalosis.The nurse states to the client,"look into my eyes and breathe with me so that we can slow down your breathing rate." The client continues to look down and refuses to make eye contact with the nurse.The client's daughter later asks you to teach her how to help her mother to control her breathing.When documenting this client's care,which statement is appropriate for the nurse to include?

A) "The client is noncompliant with suggested treatment plan."
B) "The client does not understanding the English language."
C) "The client's culture does not allow for direct eye contact with the nurse during care."
D) "The client's daughter may be abusive."

Question 50

The nurse is caring for the client with a history of anxiety who is experiencing chest pain,palpitations and dyspnea.Which intervention would be a priority for this client?

A) Providing educational material for the client's medical diagnosis
B) Ordering a regular diet for the client
C) Reassuring the client that symptoms will resolve
D) Asking Respiratory Therapy to set up a mechanical ventilator

Question 51

A client is admitted to the emergency department for treatment of an overdose.The client's arterial blood gas results indicate acute respiratory acidosis.Which substance found on the nurse's review of the toxicology analysis is most likely the cause for the client's current condition?

A) Cocaine
B) Marijuana
C) Oxycodone
D) PCP

Question 52

The nurse suspects a client with one functioning lung is developing chronic respiratory acidosis.Which manifestation did the nurse most likely assess in this client?

A) Warm, flushed skin
B) Daytime sleepiness
C) Irritability
D) Blurred vision

Question 53

The client with an anxiety disorder is ready to be discharged from the unit.What should the nurse plan to teach this client and family in preparation for discharge? Select all that apply.

A) Refer the client for counseling.
B) Instruct the client to eat foods high in acid.
C) Teach the client the signs of impending panic attack.
D) Advise the client to breathe into a paper bag when feeling anxious.
E) Instruct the client to breathe slowly.

Question 54

The nurse instructs a client with a history of acute respiratory acidosis and lung infections on ways to prevent further episodes of the health problem.Which client statement indicates that teaching has been effective?

A) "I will limit drinking alcohol to the evening hours only."
B) "I will limit my intake of bananas and oranges."
C) "I will take prescribed antibiotics until my symptoms subside."
D) "I will receive the annual influenza vaccination."

Question 55

The nurse has completed discharge teaching for a client with an anxiety disorder.Which client statement indicates that client teaching about respiratory alkalosis has been effective?

A) "I will see my counselor on a regular basis."
B) "I will breather faster when I am feeling anxious."
C) "I will eat more bananas at breakfast."
D) "I will not take antacids when I have heartburn."

Question 56

The nurse is providing care to a client recently extubated for treatment of aspiration pneumonia and respiratory acidosis.Which action by the nurse provides an optimum environment for this client?

A) Allowing family members to remain with client as much as possible
B) Restraining the client
C) Placing the client in a side-lying position
D) Administering narcotics for pain

Question 57

A client is admitted to the hospital with sudden,severe abdominal pain.The client is diagnosed with respiratory alkalosis.Which arterial blood gas value does the nurse document to support this diagnosis?

A) pH is 7.33 and PaCO₂ is 36.
B) pH is 7.30 and HCO₃ is 30.
C) pH is 7.47 and PaCO₂ is 25.
D) pH is 7.35 and PaO₂ is 88.

Question 58

The nurse is caring for a client who has been admitted to the unit with respiratory failure and respiratory acidosis.Which data from the nursing history would the nurse suspect contributed to the client's current state of health?

A) Use of ibuprofen for the control of pain
B) A recent trip to South America
C) Aspiration pneumonia
D) Recent recovery from a cold virus

Question 59

The nurse is reviewing prescriptions written for a client with chronic respiratory acidosis.Which prescription should the nurse question prior to implementation?

A) Keep head of the bed elevated to 40-degree angle.
B) Dextrose 5% and 0.45% normal saline at 100 mL per hour
C) Consult Respiratory Therapy for breathing treatments four times a day.
D) Oxygen 4 liters per nasal cannula

Question 60

The nurse is planning care for a client who has been admitted to the unit with a salicylate overdose.When preparing the plan of care,the nurse considers which to be a priority nursing diagnosis?

A) Ineffective Breathing Pattern
B) Powerlessness
C) Risk for Injury
D) Impaired Mobility

Question 61

A client is brought to the emergency department with rapid breathing after learning of a family member being killed in a house fire.What should the nurse do first to help this client?

A) Coach to slow the breathing.
B) Move to a quiet, calm environment.
C) Provide a sedative.
D) Ask for a psychiatric consultation.

Question 62

A client with injuries from a motor vehicle crash is intubated for respiratory support.The nurse notes that the client is fighting the ventilator and attempting to pull out the endotracheal tube.What should the nurse do to reduce this client's risk of developing respiratory alkalosis?

A) Administer a sedative as prescribed.
B) Apply wrist restraints.
C) Teach the client to take slow, deep breaths.
D) Discuss removing the endotracheal tube with the healthcare provider.

Question 63

The nurse is evaluating care provided to a client with respiratory alkalosis.Which outcomes indicate that nursing care has been effective for this client? Select all that apply.

A) Respiratory rate 18 and regular
B) Sleeping through the night
C) Gait steady
D) Consistent body weight
E) Using prescribed bronchodilators

Question 64

A client begins to hyperventilate after learning that a breast biopsy was positive for cancer.After a few minutes,the client loses consciousness.Which action by the nurse is the priority?

A) Begin cardiopulmonary resuscitation.
B) Raise the side rails on the bed.
C) Notify the physician.
D) Insert an intravenous access device.