Chapter 12 - Assessment and Care of Patients with Problems of Acid-Base Balance

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Chapter 12 - Assessment and Care of Patients with Problems of Acid-Base Balance
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1

The nurse is caring for a client with acute respiratory failure and PaCO2 level of 88 mm Hg For which of these signs and symptoms will the nurse assess? Select all that apply.

  1. Hyperactivity
  2. Headache
  3. Shallow breathing
  4. pH 7.49
  5. Fatigue

B. Headache

C. Shallow breathing

E. Fatigue

2

The nursing assistant reports that the client with metabolic acidosis due to kidney failure is breathing rapidly and deeply. The nurse explains this to the nursing assistant in which of these manners?

  1. “The client is acting out and we should pay him no mind”
  2. “Rapid breathing is a way to compensate for acidosis caused by his condition”
  3. “Normally a client with this disorder will breathe slowly, I will go assess him”
  4. “Deep breathing is a symptom of diabetes, I will check his blood glucose”

B. “Rapid breathing is a way to compensate for acidosis caused by his condition”

3

The nurse is caring for a client who has developed postoperative respiratory acidosis. Which of these interventions will the nurse use to help correct this problem?

  1. Medicate for pain.
  2. Encourage use of incentive spirometer.
  3. Perform fingerstick blood glucose.
  4. Encourage protein intake.

B. Encourage use of incentive spirometer.

4

The nurse and nursing student are caring for a client with a new diagnosis of diabetes whose blood glucose is 974 mg/dL (54.1 mmol/L). Which of these statements indicates the student understands the relationship between blood glucose and acid base balance?

  1. “The excess glucose in the blood causes the client to hypoventilate and retain carbon dioxide resulting in respiratory acidosis”
  2. “The hyperglycemia is caused by inability of glucose to enter the cell causing a starvation state and break down of fats”
  3. “The client has a hyperosmolar condition causing polyuria and polyphagia, but the acid base balance is normal”
  4. “The client is retaining carbon dioxide which led to respiratory acidosis and somnolence”

B. “The hyperglycemia is caused by inability of glucose to enter the cell causing a starvation state and break down of fats”

5

When caring for a client who has the following blood gas results, which of these interventions does the nurse plan to use to correct the acid base disturbance? pH 7.47—pCO2 37 mm hg- HCO3 30 mEq/L (30 mmol/L)—pO2 88mm hg

  1. Endotracheal suctioning
  2. Applying oxygen
  3. Administering an antiemetic
  4. Administering sodium bicarbonate

C. Administering an antiemetic

6

The nurse is caring for a client with long standing emphysema and respiratory acidosis. For which of these compensatory mechanisms will the nurse assess?

  1. Decreased rate of breathing
  2. Increased loss of bicarbonate through the kidney
  3. Decreased depth of breathing
  4. Decreased loss of bicarbonate through the kidney

D. Decreased loss of bicarbonate through the kidney

7

Which of these findings causes the critical care nurse to notify the primary care provider (PCP) for evaluation for intubation?

  1. Increasing somnolence
  2. Pallor
  3. Deep respirations
  4. Bounding pulsE

A. Increasing somnolence

8

When caring for a client with a burn injury and eschar banding the chest, the nurse plans to observe the client for which of these acid base disturbances?

  1. Respiratory acidosis
  2. Respiratory alkalosis
  3. Metabolic acidosis
  4. Metabolic alkalosis

A. Respiratory acidosis

9

The nurse is caring for a client with sepsis and impending septic shock. Which of these interventions will help prevent lactic acidosis?

  1. Ensure adequate oxygenation
  2. Restrict carbohydrates
  3. Supplement potassium
  4. Monitor hemoglobin

A. Ensure adequate oxygenation

10

The nurse is caring for a group of clients. Which client will the nurse carefully observe for signs and symptoms of hyperkalemia?

  1. The client who has metabolic acidosis
  2. The client receiving total parenteral nutrition
  3. The client who has profuse vomiting
  4. The client taking a thiazide diuretic

A. The client who has metabolic acidosis