Acid-Imbalances Quiz (PDF)

## ACID IMBALANCES QUIZLET 1) A client is brought to the Emergency Department 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) Res...

## ACID IMBALANCES QUIZLET 1) A client is brought to the Emergency Department 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 (Explanation: A) A client who is fasting is at risk for development of metabolic acidosis. The body recognizes fasting as starvation and begins to metabolize its own proteins into ketones, which are metabolic acids. Starvation would not result in respiratory acidosis or alkalosis or in metabolic alkalosis.) 2) Which of the following risk factors exhibited by the client presenting in the Emergency Department 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** (Explanation: A, D, E Metabolic acidosis is rarely a primary disorder. It usually develops during the course of another disease; presence of abdominal fistulas; which can cause excess bicarbonate loss; and acute renal failure. Chronic obstructive pulmonary disease and pneumonia place the client at risk for respiratory acidosis with the increased retention of carbon dioxide in the blood.) 3) 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 this as which of the following? * A) Metabolic acidosis * B) Respiratory alkalosis * **C) Respiratory acidosis** * D) Metabolic alkalosis (If the pH is decreased and the PaCO2 is increased with a normal HCO3, it is uncompensated respiratory acidosis. In addition, croup can be a disease process that causes respiratory acidosis. Uncompensated respiratory alkalosis has an increased pH, decreased PaCO2, and normal HCO3. Uncompensated metabolic acidosis has a decreased pH, normal PaCO2, and normal HCO3. Uncompensated metabolic alkalosis has an increased pH, normal PaCO2, and increased HCO3.) 5) 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 (ABGs are done to assess alterations in acid-base balance caused by respiratory disorders, metabolic disorders, or both. A bronchoscopy provides visualization of internal respiratory structures. Sputum studies can provide specific information about bacterial organisms. Pulse oximetry is a noninvasive test that evaluates the oxygen saturation level of blood.) 6) 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."** (The client should be instructed to immediately contact the primary healthcare provider if gastric discomfort occurs with chest pain or if dyspnea or diaphoresis occurs. The client should be instructed to use non-sodium antacids to prevent the absorption of excess sodium or bicarbonate into systemic circulation and to not use any bicarbonate antacid for longer than 2 weeks.) 7) 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 action 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.** (Explanation: A,D,E The diabetes educator should be contacted to work with the client on strategies that might allow the fasting to occur in a safe manner. Assessing the meaning and context of fasting in the client's religion would be educative for the nurse and an appropriate action. Stressing the importance of promptly seeking care when signs of ketoacidosis occur helps to promote the client's health and is appropriate. Telling the client that life is different now does not support religious beliefs. Asking the family to talk to the client might help, but the diabetes educator would be able to provide more direct and helpful information for the client.) 8) 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. What is the nurse's priority response to the 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 physician. * D) Increase the rate of the infusion and continue to assess the client for symptoms of acidosis. (The client receiving sodium bicarbonate is prone to alkalosis; monitor for cyanosis, slow respirations, and irregular pulse. The client's symptoms do not indicate alkalosis so infusion should not be stopped. The client continues to exhibit signs of acidosis; symptoms of acidosis include lethargy, confusion, CNS depression leading to coma, and a deep, rapid respiration rate that indicates an attempt by the lungs to rid the body of excess acid, and the physician should be notified. The infusion should not be increased or decreased without a practitioner order.) 11) 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. (In respiratory acidosis, there are a drop in the blood pH, reduced level of oxygen, and retaining of carbon dioxide. The body needs to be well-hydrated so that pulmonary secretions can be removed to improve oxygenation. Careful administration of intravenous fluids is important in the older client with metabolic alkalosis because older clients are at risk because of their fragile fluid and electrolyte status. Sodium bicarbonate is indicated in the treatment of metabolic acidosis. Reducing environmental stimuli would be appropriate for the client with respiratory alkalosis.) 12) 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** (Explanation: D) An oxygen level of less than 75 mmHg can be due to hypoventilation. This drop in oxygen will change the client's level of responsiveness. Although acid-base imbalances can alter communication, there is no direct link between a low oxygen level and changes in communication. Perfusion is affected by a reduction in circulating fluids. With a fluid and electrolyte imbalance, there is another disorder affecting acid-base balance. This might not be affected by oxygen level.) 13) 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 (Explanation: C For clients in severe distress, family members may need to be consulted for critical information such as recent eating habits and history of vomiting. Measuring vital signs is an independent nursing action. Measuring intake and output is an independent nursing action. Identifying current oxygen saturation level is an independent nursing action.) 1) 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 of the following consequences 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 (Explanation: A The nurse knows that severe acidosis 7 OR LESS.. depresses myocardial contractility, which leads to decreased cardiac output. Acid-base imbalances also affect electrolyte balance. In acidosis, potassium is retained as the kidney excretes excess hydrogen ion. Excess hydrogen ions also enter the cells, displacing potassium from the intracellular space to maintain the balance of cations and anions within the cells. The effect of both processes is to increase serum potassium levels. Also in acidosis, calcium is released from its bonds with plasma proteins, increasing the amount of ionized (free) calcium in the blood. Magnesium levels may fall in acidosis.) 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 2 days. The nurse knows that this infant is at risk for metabolic acidosis. Which of the following 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.** (Parents and caregivers need to be taught the seriousness of vomiting or diarrhea in infants due to rapid fluid loss that can occur in this age group. They should also be taught the importance of bringing an infant in this situation to healthcare providers for evaluation. Encouraging fluids for an infant who is actively vomiting will not improve fluid balance status, and neither juice nor glucose water is the best choice of fluid. Simply monitoring the loss over the next 24 hours would increase the potential for the infant to become dehydrated.) 3) The nurse is assessing an African-American client whose cultural background is different from the cultural background of the nurse. The client has symptoms of metabolic acidosis. Which of the following situations would illustrate stereotypical behavior on the nurse's part? Select all that apply. * **A) Understanding that all culture members will have the same beliefs** * **B) Bringing previous negative information and experiences into this situation** * **C) Making an assumption that all members of each culture are alike** * **D) Taking general knowledge from literature and applying it to the situation** * E) Discussing the client's health status with family members (Explanation: A,B,C,D) Options 1, 2, 3, and 4 describe stereotypical behavior, which is assuming that all members of a culture or ethnic group are alike. Option 2 describes prejudice. Prejudice is a negative belief or preference that is generalized about a group, which leads to "prejudgment." Prejudice occurs when the person making the judgment generalizes an experience of one individual from a culture to all members of that group. Discussing the client's health status with family members is not stereotypical behavior and would be considered a violation of the privacy laws if the client did not provide permission for disclosure of personal health information.) 5) The nurse is caring for a client with metabolic acidosis. Which of the following are appropriate goals 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. (Explanation: Planning for the client with metabolic acidosis involves identification and treatment of the underlying cause and restoration and maintenance of acid-base balance. The client should be able to describe preventative measures for the underlying chronic illness that caused the metabolic acidosis to occur and maintain the baseline cardiac rhythm. The pH should be maintained between 7.35 and 7.45. The client's respiratory rate should be within normal range for age and condition. Taking a potassium supplement may cause hyperkalemia, which decreases cardiac output and worsens metabolic acidosis.) 7) The nurse is caring for the client experiencing hypovolemic shock and metabolic acidosis. Which of the following 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. (Explanation: The treatment for hypovolemic shock would include the administration of fluids, not limiting fluids. Patients being treated for hypovolemia will require daily weights, not a weight on admission and then discharge. Administering sodium bicarbonate and monitoring ECGs are appropriate for the client with shock. The client recovering from hypovolemic shock is at risk for injury, so the bed should be kept in the locked and low position.) 8) A client with metabolic acidosis has been admitted to the unit from the Emergency Department. The client is experiencing confusion and weakness. Which of the following does the nurse implement as a priority of care for this client? * A) Place the client in a high-Fowler's position. * **B) Protect the client from injury.** * C) Administer sodium bicarbonate. * D) Give the client skin care. (Explanation: The client with metabolic acidosis may have symptoms of drowsiness, lethargy, confusion, and weakness. A priority of care would be preventing injury to the client. Medication administration is a physician order. Skin care would not be a priority on admission. The high-Fowler's position would not be the safest position for the confused client.) 6) The nurse is caring for a client admitted with renal failure and metabolic acidosis. Which of the following signs 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** (Explanation: The client with metabolic acidosis will have an increased respiratory rate and depth. Signs that care has been effective would include a decrease in the rate and depth of respirations. An increased respiratory rate, as indicated by a respiratory rate of 38, would indicate continued metabolic acidosis. Increased deep tendon reflexes and palpitations are not associated with metabolic acidosis.) 9) The nurse is preparing to instruct 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. Development of lactic acidosis 3. Breakdown of fatty tissue 4. Reduction in intracellular glucose 5. Fatty acids converted to ketones Answer: 2, 1, 4, 3, 5 Explanation: 1. Lactic acidosis develops due to tissue hypoxia and a shift to anaerobic metabolism by the cells. -Lactate and hydrogen ions are produced, forming lactic acid. Starvation or lack of insulin leads to intracellular starvation of glucose. - The lack of glucose or insulin to move glucose into the cells causes the body to break down fatty tissue to meet metabolic needs. - When fatty acids are broken down, these acids are converted to ketones, leading to the development of ketoacidosis. 10) The nurse is reviewing orders written by the healthcare provider for a client with metabolic acidosis. Which order 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.** (Administering bicarbonate to correct acidosis increases the risk for hypernatremia, hyperosmolality, and fluid volume excess. This is the order that the nurse should question before providing. Treatment of metabolic acidosis includes correction of fluid balance. An infusion of normal saline would be appropriate for this client. As metabolic acidosis is corrected, potassium shifts back into the intracellular space. This shift can lead to hypokalemia and cardiac dysrhythmias. Serum potassium levels should be carefully monitored during treatment. Arterial blood gases are used to evaluate treatment and guide additional therapies.) 11) 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 .** (To reduce the client's risk for injury, the nurse should make sure the bed is kept in the lowest position and the side rails are raised. A clock and calendar at the bedside will help with orientation. Restraints are used in the event the client demonstrates harm to self or others. Confusion or a Risk for Injury is not a reason to use wrist or chemical restraints.) 12) Upon entering a room, the nurse quickly scans the environment and then immediately assesses the client for manifestations of metabolic acidosis. What observation did the nurse make that precipitated this assessment of the client? * 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** (Excessive infusions of chloride-containing intravenous fluids can precipitate metabolic acidosis. The head of the bed's being flat might influence a client's oxygenation status; however, the client was not demonstrating a change in respiratory depth or rate. A reduction in oral intake does not cause metabolic acidosis. Eating half of a meal tray is not the same as starvation. Diarrhea can lead to the development of metabolic acidosis. One formed stool would not cause the nurse alarm.) 13) 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. (Explanation: A.. Adequate nutrition is necessary to prevent the buildup of acids in the blood. Incorrect administration of medication could cause a metabolic problem in the client with diabetes. The use of laxatives could cause diarrhea, which can lead to metabolic acidosis. Ingestion of high amounts of salicylate acid can lead to toxicity and the development of metabolic acidosis.) 1) 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 of the following characteristics? * A) Gastric secretions are green in color. * B) Gastric secretions are alkaline. * **C) Gastric secretions are acidic.** * D) Gastric secretions have a foul smell. (Metabolic alkalosis due to loss of hydrogen ions usually occurs because of vomiting or gastric suction. Gastric secretions are highly acidic (pH 1-3). When these are lost through vomiting or gastric suction, the alkalinity of body fluids increases. This increased alkalinity results from the loss of acid and from selective retention of bicarbonate by the kidneys as chloride is depleted. Gastric secretions are now alkaline. The color and odor of gastric secretions have no influence on the development of metabolic acidosis.) 4) 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** (Explanation: A- Respiratory compensation for metabolic alkalosis includes depression of the respiratory rate and reduction of the depth of respirations, leading to the retention of carbon dioxide. Patients with metabolic alkalosis often have an accompanying fluid volume deficit. With the fluid volume deficit, the client would experience hyperthermia. Ineffective health maintenance would not be a priority during the acute phase of the disease but, rather, a teaching opportunity before discharge depending on the cause of the metabolic alkalosis. The client is at risk for injury because of the associated muscle spasms and dizziness.) 2) 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. (Explanation: A) Excessive use of calcium carbonate and daily use of furosemide can cause metabolic alkalosis. Use of metformin is not associated with alkalosis. Overuse of aspirin can be associated with metabolic acidosis. Occasional use of acetaminophen is not associated with metabolic alkalosis.) 7) A client with severe metabolic alkalosis has been admitted to the unit and is being cared for by a nursing student along with the nurse. What should the nurse say is a priority for this 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 (Explanation: A) The priority for this client is monitoring oxygen saturation. The depressed respiratory drive that often accompanies metabolic alkalosis can lead to hypoxemia and impaired oxygenation of the tissues. Administering medications will be needed as a treatment, but the priority is to discover the cause. Teaching the client and setting goals are important aspects of nursing care but are not the priority.) 8) A client with hyperaldosteronism has been admitted to the unit. The nurse knows the client 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 (The client with prolonged vomiting will likely have severe metabolic alkalosis with reduced oxygenation. The Fowler's position will facilitate alveolar ventilation with improved oxygenation. Side-lying and prone positions do not facilitate needed lung expansion.) 9) 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. How should the nurse plan to support this client's acid-base balance? * A) Prepare to administer 0.9% sodium chloride infusion. * B) Measure for nasogastric tube insertion. * **C) Discuss potassium chloride replace therapy with the healthcare provider.** * D) Review implications of transfusing with ammonia chloride. (Treatment of metabolic alkalosis includes restoring normal fluid volume and administering potassium chloride. The potassium restores serum and intracellular potassium levels, allowing the kidneys to conserve chloride more effectively. Since the chloride level is within normal limits, an infusion of 0.9% sodium chloride is not indicated. Removal of gastric secretions is one reason for the development of metabolic alkalosis. A nasogastric tube is not indicated for this client. There is not enough information to support the use of ammonia chloride for this client, as it is indicated to treat severe metabolic alkalosis.) 10) The nurse identifies the diagnosis Risk for Impaired Gas Exchange to guide the care of a client with metabolic alkalosis. What did the nurse assess to support this 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** (Respiratory compensation for metabolic alkalosis depresses the respiratory rate and reduces the depth of breathing to promote carbon dioxide retention. The depressed respiratory drive associated with metabolic alkalosis can lead to hypoxemia and impaired oxygenation of tissues. Oxygen saturation levels of less than 90% indicate significant oxygenation problems. Changes in mental status or behavior may be early signs of hypoxia. Urine output less than 30 mL/hr would indicate Fluid Volume Deficit. Weight is used as an indicator of fluid balance. A rapid weight change would indicate Fluid Volume Deficit.) 11) A client is admitted with manifestations of metabolic alkalosis. Which diagnostic test findings should the nurse suspect will confirm this 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** (In metabolic alkalosis, the blood pH will be greater than 7.45 and the bicarbonate level greater than 28 mEq/L. The ECG pattern shows changes similar to those seen with hypokalemia. Serum glucose level is not used to confirm the diagnosis of metabolic alkalosis. The presence of kidney stones is not associated with the development of metabolic alkalosis. The presence of bilateral lower lobe infiltrates on chest x-ray would not contribute to the development of metabolic alkalosis. This finding might be the result of metabolic alkalosis if the client's respiratory status is compromised.) 12) 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** (Explanation: A) Excess bicarbonate usually occurs as a result of ingesting antacids that contain bicarbonate, such as soda bicarbonate or Alka-SeltzerTM. Daily ingestion of a banana would prevent the development of hypokalemia from the daily use of sodium bicarbonate. Consistent daily weights would indicate fluid balance. Daily use of NSAIDs would not support the development of metabolic alkalosis.) 13) 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. (The indiscriminate ingestion of sodium bicarbonate is a risk factor for the development of metabolic alkalosis. Black coffee is not associated with the development of metabolic alkalosis. Oranges contain potassium, which is beneficial to prevent the development of metabolic alkalosis. Tracking of daily weights would help detect a fluid imbalance, which is associated with metabolic alkalosis.) 1) The nurse has admitted 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 (Morphine is a narcotic and generally acts to decrease or suppress respirations; therefore, this client is probably hypoventilating. The expected acid-base imbalance would be respiratory acidosis. Respiratory alkalosis, metabolic acidosis, and metabolic alkalosis are caused by many conditions, none of which are related to this client's morphine overdose.) 2) The nurse is caring for a client who has been admitted to the unit with respiratory failure and respiratory acidosis. What 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 (Aspiration of a foreign body and acute pneumonia would put the client at risk for respiratory acidosis. A recent trip to South America would not constitute a respiratory risk factor. Recent recovery from a cold would not likely put the client at risk. Ibuprofen does not pose a threat to the respiratory health of the client.) 3) A 10-year-old boy has been admitted to the hospital with respiratory acidosis. The nurse suspects that which chronic lung disease most likely caused the child to develop this condition? * **A) Cystic fibrosis** * B) Aspiration * C) Hyperthyroidism * D) Pneumonia (Chronic lung disease such as asthma and cystic fibrosis put the child at risk for respiratory acidosis. Pneumonia and aspiration are both acute lung conditions. Hyperthyroidism is a disorder that results in metabolic acidosis.) 5) The nurse is preparing discharge instructions for an older client recovering from respiratory acidosis caused by restrictive lung disease and pneumonia. What should the nurse include in this teaching? 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. (For the client with a history of chronic lung disease and pneumonia, the nurse should instruct on the importance of receiving annual influenza immunizations, frequent hand washing, avoiding crowds, and covering the nose and mouth when coughing. Fluids should be encouraged to ensure that respiratory secretions are thin.) 6) 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 (Explanation: A) This client is exhibiting respiratory acidosis. This client needs to "blow off" more CO2; therefore, the respiratory rate would be increased. No other option given would serve to decrease CO2 levels.) 7) The nurse is preparing to admit a client with acute pneumonia who is experiencing severe respiratory acidosis. The nurse anticipates that treatment for this client may include which actions? 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.** (Explanation: A) The client with acute pneumonia and respiratory acidosis may require oxygen administration to improve gas exchange, increased fluid intake to thin secretions, and frequent repositioning to preventing the pooling of respiratory sections. There is not enough evidence to know whether the client is experiencing heart failure as a result of the acute pneumonia.) 8) 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 (The client with respiratory acidosis often experiences anxiety. This client would benefit from having a family member in the room to provide reassurance. Restraining the client will increase levels of agitation. The client with respiratory failure would benefit most from the semi-Fowler's or Fowler's position to increase ventilation. Narcotics will depress the respirations and increase respiratory acidosis. A non-narcotic pain reliever would be considered if this client were experiencing pain.) 10) 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** (Bronchodilator drugs such as albuterol inhaler may be administered to open the airways and antibiotics such as amoxicillin may be prescribed to treat respiratory infections. Benzodiazepines such as diazepam are central nervous system depressants and would adversely affect this client's respiratory rate, adversely affecting respiratory acidosis. Potassium chloride is indicated in the treatment of metabolic alkalosis.) 11) A client brought to the Emergency Department for treatment of an overdose has arterial blood gas results that indicate acute respiratory acidosis. For which substance should the nurse plan care for this client? * A) Cocaine * B) Marijuana * **C) Oxycodone** * D) PCP (Oxycodone is an opiate narcotic. Excessive use or overdose of narcotic substances can lead to respiratory depression and respiratory acidosis. Cocaine is a stimulant. Marijuana is not considered as a drug that depresses the central nervous system or respiratory center. PCP is a hallucinogenic agent.) 12) 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 (The manifestations of acute and chronic respiratory acidosis differ. The client with chronic respiratory acidosis will demonstrate daytime sleepiness. The client with acute respiratory acidosis may demonstrate warm, flushed skin, irritability, and blurred vision from the acute decline in oxygenation.) 13) 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."** (The nurse should discuss ways to avoid future episodes of acute respiratory infections by encouraging the client to receive immunization against pneumococcal pneumonia and influenza. Alcohol is a central nervous system depressant which can adversely affect respiratory status and lead to the development of respiratory acidosis. The ingestion of bananas and oranges will not promote the development of respiratory acidosis. The client should be instructed to complete a full course of antibiotics prescribed to treat infections.) 9) The nurse is reviewing orders written for a client with chronic respiratory acidosis. Which order should the nurse question before implementing for this client? * 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** (Explanation: A) In clients with chronic respiratory acidosis, oxygen is administered cautiously to prevent carbon dioxide narcosis. Adequate hydration such as intravenous fluids is important to promote removal of respiratory secretions. Pulmonary hygiene measures such as breathing treatments may be instituted.) 1) A client is admitted to the hospital with sudden, severe abdominal pain. Which arterial blood gas value should the nurse expect with respiratory alkalosis? * 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.' (Explanation: A) Acute pain usually causes hyperventilation, which causes the CO2 to drop and the client to experience respiratory alkal