A specimen for arterial blood gases is obtained from a severely dehydrated 3-month-old infant with a history of diarrhea. The pH is 7.30, Pco 2 is 35 mm Hg, and HCO 3 - is 17 mEq/L (17 mmol/L). What complication does the nurse conclude has developed?
1 Metabolic acidosis
2 Metabolic alkalosis
3 Respiratory acidosis
4 Respiratory alkalosis
1 Metabolic acidosis
The blood pH indicates acidosis; the bicarbonate (HCO 3 -) level is further from the expected range than is the partial pressure of carbon dioxide (Pco 2), indicating a metabolic origin (losses from diarrhea), not a respiratory origin. The blood pH indicates acidosis, not alkalosis.
A client with chronic obstructive pulmonary disease (COPD) has a blood pH of 7.25 and a PCO 2 of 60 mm Hg. What complication does the nurse conclude the client is experiencing?
1 Metabolic acidosis
2 Metabolic
alkalosis
3 Respiratory acidosis
4 Respiratory alkalosis
3 Respiratory Acidosis
The pH indicates acidosis [1] [2]; the PCO 2 level is the parameter for respiratory function. The expected PCO 2 is 40 mm Hg. These results do not indicate a metabolic disorder or indicate respiratory alkalosis.
A nurse addresses the needs of a client who is hyperventilating to prevent what complication?
1 Cardiac
arrest
2 Carbonic acid deficit
3 Reduction in serum pH
4 Excess oxygen saturation
2 Carbonic acid deficit
Hyperventilation causes excessive loss of carbon dioxide, leading to carbonic acid deficit and respiratory alkalosis. Cardiac arrest is unlikely; the client may experience dysrhythmias but will lose consciousness and begin breathing regularly. Hyperventilation causes alkalosis; the pH is increased. Excess oxygen saturation cannot occur; the usual oxygen saturation of hemoglobin is 95% to 98%.
The nurse is teaching a group of students about the manifestation of alkalosis in the central nervous system. Which statements by a student nurse are accurate? Select all that apply.
1 "The client's Chvostek sign would be negative."
2 "The client's Trousseau sign would be positive."
3 "The client would be suffering from paresthesias."
4 "The client would show signs of anxiety and
irritability."
5 "The client's central nervous system should have a decrease activity in case alkalosis."
2 "The client's Trousseau sign would be positive."
3 "The client would be suffering from paresthesias."
4 "The client would show signs of anxiety and irritability."
If clients suffer from the alkalosis, the manifestation in the nervous system would involve paresthesias. The client will also have a positive Trousseau sign and have anxiety and irritability. The Chvostek sign would also be positive, not negative. The client would show signs of anxiety and irritability. The central nervous system should have increased activity with alkalosis, not decreased.
An arterial blood gas report indicates the client's pH is 7.25, PCO 2 is 35 mm Hg, and HCO 3 is 20 mEq/L. Which disturbance should the nurse identify based on these results?
1 Metabolic acidosis
2 Metabolic alkalosis
3
Respiratory acidosis
4 Respiratory alkalosis
1 Metabolic acidosis
A low pH and low bicarbonate level are consistent with metabolic acidosis. The pH indicates acidosis, not alkalosis. The CO 2 concentration is within normal limits, which is inconsistent with respiratory acidosis; it is elevated with respiratory acidosis.
the nurse is assessing a client's arterial blood gases and determines that the client is in compensated respiratory acidosis. The pH value is 7.34; which other result helped the nurse reach this conclusion?
1 PO 2 value is 80 mm Hg.
2 PCO 2 value is 60 mm Hg.
3 HCO 3 value is 50 mEq/L (50 mmol/L).
4 Serum potassium value is 4 mEq/L (4 mmol/L).
3 HCO 3 value is 50 mEq/L (50 mmol/L).
The HCO 3 value is elevated. The urinary system compensates by retaining H + ions, which become part of the bicarbonate ions; the bicarbonate level becomes elevated and increases the pH level to near the expected range. The expected HCO 3 value is 21 to 28 mEq/L (21 to 28 mmol/L), and the expected pH value is 7.35 to 7.45. The body's usual PO 2 value is 80 to 100 mm Hg; 80 mm Hg is within the expected range. The body's PCO 2 value is 35 to 45 mm Hg; although in compensated respiratory acidosis [1] [2] the PCO 2 level may be increased, it is the increased HCO 3 level that indicates compensation. A K + level of 4 mEq/L (4 mmol/L) is within the expected range of 3.5 to 5 mEq/L (3.5 to 5 mmol/L); the serum potassium level is not significant in identifying compensated respiratory acidosis.
A 4-month-old infant is brought to the emergency department after 2 days of diarrhea. The infant is listless and has sunken eyeballs, a depressed anterior fontanel, and poor tissue turgor. The infant's breathing is deep, rapid, and unlabored. The mother states that the infant has
had liquid stools and no obvious urine output. What problem does the nurse conclude that the infant is experiencing?
1 Kidney failure
2 Mild dehydration
3 Metabolic acidosis
4 Respiratory alkalosis
3 Metabolic acidosis
Metabolic acidosis occurs with loss of alkaline fluid through diarrhea and is manifested by lethargy and Kussmaul breathing; all of the assessments indicate severe dehydration. The infant has not urinated because excessive
amounts of fluid have been lost in the loose stools; this indicates that the kidneys are functioning by compensating for the fluid loss. All data indicate a severe, not mild, fluid volume deficiency. Respiratory alkalosis is caused by an excessive loss of carbon dioxide, not diarrhea.
The nurse is teaching a group of students about assessing for respiratory system manifestations of alkalosis as a nursing priority. Which statement made by the
student nurse indicates the need for further teaching? Select all that apply.
1 "I should assess for low blood pressure."
2 "I should assess for increased digitalis toxicity."
3 "I should assess for a decreased rate of ventilation in respiratory alkalosis."
4 "I should assess for an increased depth of ventilation in respiratory alkalosis."
5 "I should assess for a decreased respiratory effort associated with skeletal muscle weakness in metabolic alkalosis."
1 "I should assess for low blood pressure."
2 "I should assess for increased digitalis toxicity."
3 "I should assess for a decreased rate of ventilation in respiratory alkalosis."
The nurse should assess for low blood pressure and increased digitalis toxicity as cardiovascular manifestations of alkalosis, not respiratory manifestation. The nurse should assess for increased rate of ventilation in respiratory alkalosis. The nurse should assess for increased depth of ventilation in respiratory alkalosis. It is imperative that the nurse check for decreased respiratory effort associated with skeletal muscle weakness in metabolic alkalosis.
The nurse is caring for a client with the following arterial blood gas (ABG) values: PO 2 89 mm Hg, PCO 2 35 mm Hg, and pH of 7.37. These findings indicate that the client is experiencing which condition?
1 Fluid balance
2 Oxygen depletion
3 Acid-base balance
4
Metabolic acidosis
3 Acid-base balance
All data are within expected limits; PO 2 is 80 to 100 mm Hg, PCO 2 is 35 to 45 mm Hg, and the pH is 7.35 to 7.45. None of the data are indicators of fluid balance, but of acid-base balance. Oxygen is within expected limits of 80 to 100 mm Hg. With metabolic acidosis the pH is less than 7.35.
Which would the nurse claim is a cardiovascular manifestation of
alkalosis?
1 Anxiety
2 Seizures
3 Hyperreflexia
4 Increased digitalis toxicity
4 Increased digitalis toxicity
Increased digitalis toxicity is one of the cardiovascular manifestations of alkalosis. Anxiety and seizures are central nervous system manifestations of alkalosis. Hyperreflexia is a neuromuscular manifestation of alkalosis.
To determine the presence of respiratory alkalosis in the
laboring client, what should the nurse evaluate her for?
1 A change in the respiratory rate
2 A tingling sensation in the hands
3 Periodic changes in the fetal heart rate
4 A pulse oximetry reading of less than 98%
2 A tingling sensation in the hands
The presence of a tingling sensation in the hands indicates respiratory alkalosis due to a decrease in carbon dioxide. A change in respiratory rate is incorrect because although such a change may
contribute to respiratory alkalosis, it is not evidence of an increase in pH. In the presence of maternal respiratory alkalosis, chemical changes in maternal erythrocytes facilitate oxygen release to the fetus, which assists in maintaining a normal fetal heart rate. A pulse oximetry reading of 98% is incorrect because this is a normal finding.
The nurse plans interventions for a client with smoke inhalation based on a negative chest x-ray and arterial blood gases that show a PO 2 of 85 mm Hg, a PCO 2 of 45 mm Hg, and a pH of 7.35. Which interventions should the nurse anticipate will be prescribed? Select all that apply.
1 Coughing
2 Deep breathing
3 Bronchodilators
4 Humidified oxygen
5 Bronchial suctioning
1 Coughing
2 Deep breathing
4 Humidified oxygen
Coughing moves secretions toward the mouth to be expectorated. Deep breathing expands the alveoli and increases the amount of oxygen being delivered to the alveolar capillary beds. Humidified oxygen increases the amount of oxygen that is being delivered to the alveolar capillary beds. Bronchodilators are not indicated at this time because the x-ray, PCO 2, and pH are still within acceptable limits. Bronchial suctioning is not indicated at this time because the x-ray, PCO 2, and pH results are still within acceptable limits.
A client on diuretic therapy developed metabolic alkalosis. What does the nurse consider to be the priority nursing care while correcting alkalosis?
1 Preventing falls
2 Monitoring electrolytes
3 Administering antiemetics
4 Adjusting the diuretic therapy
1 Preventing Falls
A client with alkalosis has hypotension and muscle weakness, which increases the risk for injury due to falls; therefore, to prevent injury, the priority nursing care is to prevent falls. Monitoring electrolytes daily until they return to normal is not the priority nursing care. Antiemetics are prescribed for vomiting and are given low priority. Once the client is protected from the risk of injury, diuretic therapy is adjusted.
A child has been admitted to the pediatric unit with a severe asthma attack. What type of acid-base imbalance should the nurse expect the child to develop?
1 Metabolic alkalosis caused by excessive production of acid metabolites
2 Respiratory alkalosis caused by accelerated respirations and loss of carbon dioxide
3 Respiratory acidosis caused by impaired respirations and increased formation of carbonic acid
4 Metabolic acidosis caused by the kidneys' inability to compensate for increased carbonic acid formation
3 Respiratory acidosis caused by impaired respirations and increased formation of carbonic acid
The restricted ventilation accompanying an asthma attack limits the body's ability to blow off carbon dioxide. As carbon dioxide accumulates in the body fluids, it reacts with water to produce carbonic acid; the result is respiratory acidosis. The problem basic to asthma is respiratory, not metabolic. Respiratory alkalosis is caused by the exhalation of large amounts of carbon dioxide; asthma attacks cause carbon dioxide retention. Asthma is a respiratory problem, not a metabolic one; metabolic acidosis can result from an increase of nonvolatile acids or from a loss of base bicarbonate.
A nurse is caring for an infant whose vomiting is intractable. Which complication is most likely to occur?
1 Acidosis
2 Alkalosis
3 Hyperkalemia
4 Hypernatremia
2 Alkalosis
Excessive vomiting causes an increased loss of hydrogen ions (hydrochloric acid), leading to metabolic alkalosis, an excess of base bicarbonate. Acidosis is caused by retention of hydrogen ions and a loss of base bicarbonate, which is more likely to occur with diarrhea. Hypokalemia, not hyperkalemia, will occur. With the loss of chloride ions, hyponatremia is more likely to occur.