Chapter 12: Assessment and Care of Patients with Acid-Base Imbalances

Chapter 12: Assessment and Care of Patients with Acid-Base Imbalances

Complete Chapter Questions With Answers

Sample Questions Are Posted Below

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. Which manifestation should the nurse identify as an example of the client’s compensation mechanism?
   1. Increased rate and depth of respirations
   2. Increased urinary output
   3. Increased thirst and hunger
   4. 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 manifestations of hyperglycemia but are not compensatory mechanisms for acid-base imbalances. The kidneys do not release acids.

DIF:     Applying/Application                         REF: 181                     KEY: Acid-base imbalance| laboratory values                                                         MSC:             Integrated Process: Nursing Process: Assessment                                       NOT: 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 7.34, PaO₂ 88 mm Hg, PaCO₂ 38 mm Hg, and HCO₃^– 19 mEq/L. Which assessment should the nurse perform first?
   1. Cardiac rate and rhythm
   2. Skin and mucous membranes
   3. Musculoskeletal strength
   4. 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. Central nervous system and neuromuscular system changes do not occur with mild acidosis and should be monitored if the acidosis worsens. Skin and mucous membrane assessment is not a priority now, but will change as acidosis worsens.

DIF:     Applying/Application                         REF: 181

KEY:   Acid-base imbalance

MSC:   Integrated Process: Nursing Process: Assessment                 NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care

3. A nurse assesses a client who is prescribed furosemide (Lasix) for hypertension. For which acid-base imbalance should the nurse assess to prevent complications of this therapy?
   1. Respiratory acidosis
   2. Respiratory alkalosis
   3. Metabolic acidosis
   4. Metabolic alkalosis

ANS:           D

Many diuretics, especially loop diuretics, increase the excretion of hydrogen ions, leading to excess acid loss through the renal system. This situation is an acid deficit of metabolic origin.

DIF:            Applying/Application                         REF:    184

KEY:          Acid-base imbalance| diuretics

MSC:          Integrated Process: Nursing Process: Assessment                 NOT: Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

4. A nurse is caring for a client who is experiencing moderate metabolic alkalosis. Which action should the nurse take?
   1. Monitor daily hemoglobin and hematocrit values.
   2. Administer furosemide (Lasix) intravenously.
   3. Encourage the client to take deep breaths.
   4. Teach the client fall prevention measures.

ANS:           D

The priority nursing care for a client who is experiencing moderate metabolic alkalosis is providing client safety. Clients with metabolic alkalosis have muscle weakness and are at risk for falling. The other nursing interventions are not appropriate for metabolic alkalosis.

DIF:            Remembering/Knowledge                 REF:    185

KEY:          Acid-base imbalance| falls| safety

MSC:          Integrated Process: Nursing Process: Implementation           NOT: Client Needs Category: Safe and Effective Care Environment: Safety and Infection Control