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Chapter 14: Concepts of Acid–Base Balance
Ignatavicius: Medical-Surgical Nursing, 10th Edition
MULTIPLE CHOICE
1. A nurse assesses a client with diabetes mellitus who is admitted with an acid–base imbalance. The client’s arterial blood gas values
are pH 7.36, PaO2 98 mm Hg, PaCO2 33 mm Hg, and HCO3
−
18 mEq/L (18 mmol/L). Which sign or symptom does the nurse
identify as an example of the client’s compensatory mechanisms?
a.Increased rate and depth of respirations
b.Increased urinary output
c.Increased thirst and hunger
d.Increased release of acids from the kidneys
ANS: A
This client has metabolic acidosis. The respiratory system compensates by increasing its activity and blowing off excess carbon
dioxide. Increased urinary output, thirst, and hunger are signs and symptoms of hyperglycemia but are not compensatory
mechanisms for acid–base imbalances. The kidneys do not release acids.
DIF: Applying TOP: Integrated Process: Nursing Process: Assessment
KEY: Acid-base imbalances, Acidosis
MSC: Client Needs Category: Physiological Integrity: Physiological Adaptation
2.
A nurse assesses a client who is experiencing an acid–base imbalance. The client’s arterial blood gas values are pH 7.2, PaO2 88
mm Hg, PaCO2 38 mm Hg, and HCO3
−
19 mEq/L (19 mmol/L). Which assessment would the nurse perform first?
a.Cardiac rate and rhythm
b. Skin and mucous membranes
c.Musculoskeletal strength
d.Level of orientation
ANS: A
Early cardiovascular changes for a client experiencing moderate acidosis include increased heart rate and cardiac output. As the
acidosis worsens, the heart rate decreases and electrocardiographic changes will be present. The nurse responds by performing a
thorough cardiovascular assessment. Changes will occur in the integumentary system, musculoskeletal system, and neurologic
system, but assessing for the cardiovascular complications comes first.
DIF: Applying TOP: Integrated Process: Nursing Process: Assessment
KEY: Acid-base imbalance, Nursing assessment
MSC: Client Needs Category: Physiological Integrity: Reduction of Risk Potential
3.
A nurse assesses a client who is prescribed furosemide for hypertension. For which acid–base imbalance does the nurse assess to
prevent complications of this therapy?
a.Respiratory acidosis
b.Respiratory alkalosis
c.Metabolic acidosis
d.Metabolic alkalosis
ANS: D
Many diuretics, especially loop and thiazide diuretics, increase the excretion of hydrogen ions, leading to excess acid loss through
the renal system. This situation is an actual acid deficit.
DIF: Applying TOP: Integrated Process: Nursing Process: Assessment
KEY: Acid-base imbalance, Nursing assessment
MSC: Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies
4.
A nurse is caring for a client who is experiencing moderate metabolic alkalosis. What action would the nurse take?
a.Monitor daily hemoglobin and hematocrit values.
b.Administer furosemide intravenously.
c.Encourage the client to take deep breaths.
d.Teach the client fall prevention measures.
ANS: D
The most important nursing care for a client who is experiencing moderate metabolic alkalosis is providing client safety. Client’s
with metabolic alkalosis have muscle weakness and are at risk for falling. The other nursing interventions are not appropriate for
metabolic alkalosis.
DIF: Remembering
TOP: Integrated Process: Nursing Process: Implementation
KEY: Acid-base imbalance, Client safety
MSC: Client Needs Category: Safe and Effective Care Environment: Safety and Infection Control
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