Chapter 14: Assessment and Care of Patients with Acid-Base Imbalances

Chapter 14: Assessment and Care of Patients with Acid-Base Imbalances

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

MULTIPLE CHOICE

 

1. In a client with less than the normal amount of bicarbonate in the blood and other extracellular fluids, what response does the nurse anticipate?

a.	Increased risk for acidosis
b.	Decreased risk for acidosis
c.	Increased risk for alkalosis
d.	Decreased risk for alkalosis

 

 

ANS:  A

Bicarbonate (H₂CO₃^–) is a weak base with an overall negative charge. When hydrogen ions are present in slight or mild excess (mild acidosis), bicarbonate can buffer or absorb the excess hydrogen ions, reducing the hydrogen ion concentration and bringing the pH back up to normal. If the total body bicarbonate concentration is low, especially in the blood, the action of buffering or absorbing excess hydrogen ions is reduced, and the person is at increased risk for acidosis.

 

DIF:    Cognitive Level: Comprehension/Understanding               REF:   p. 202

TOP:   Client Needs Category: Physiological Integrity (Physiological Adaptation—Pathophysiology)

MSC:  Integrated Process: Nursing Process (Assessment)

 

2. Which response is an example of compensation for an acid-base imbalance?

a.	Increase in the rate and depth of respirations when exercising
b.	Increased urinary output when blood pressure increases during exercise
c.	Increased thirst when spending time in an excessively dry environment
d.	Increased release of acids from kidneys during exacerbation of chronic obstructive pulmonary disease (COPD)

 

 

ANS:  A

The respiratory system increases its activity by blowing off excess carbon dioxide. This occurs as a result of the occurrence of lactic acidosis in skeletal muscle, when blood flow and oxygenation are insufficient to meet the increased demand for oxygen (oxygen debt) created during increased skeletal muscle metabolism. The other three options are not compensatory mechanisms for acid-base imbalances.

 

DIF:    Cognitive Level: Comprehension/Understanding               REF:   p. 200

TOP:   Client Needs Category: Physiological Integrity (Physiological Adaptation—Pathophysiology)

MSC:  Integrated Process: Nursing Process (Assessment)

 

3. When a client has an arterial blood pH of 7.48, which buffer action will bring the pH back to normal?

a.	Absorption of bicarbonate ions from the blood
b.	Release of bicarbonate ions into the blood
c.	Absorption of hydrogen ions from the blood
d.	Release of hydrogen ions into the blood

 

 

ANS:  D

Buffers can act as an acid (releasing a hydrogen ion) or as a base (absorbing a hydrogen ion) to assist in keeping the pH and hydrogen ion concentration of body fluids within the normal range. An arterial pH of 7.48 indicates a deficiency of hydrogen ions. This situation would cause buffers to act like acids and release hydrogen ions into the blood.

 

DIF:    Cognitive Level: Comprehension/Understanding               REF:   p. 200

TOP:   Client Needs Category: Physiological Integrity (Physiological Adaptation—Pathophysiology)

MSC:  Integrated Process: Nursing Process (Analysis)

 

4. A client has moderate acidosis. Which assessment does the nurse perform first?

a.	Take the client’s pulse and blood pressure, and analyze the electrocardiogram (ECG) strip.
b.	Assess respiratory rate and depth and work of breathing.
c.	Perform assessments of musculoskeletal strength.
d.	Determine whether the client is awake, alert, and oriented.

 

 

ANS:  A

Priority assessments for the client with acidosis relate to the cardiovascular system. Acidosis can lead to lethal cardiac dysrhythmias.

 

DIF:    Cognitive Level: Application/Applying or higher               REF:   N/A

TOP:   Client Needs Category: Safe and Effective Care Environment (Management of Care—Establishing Priorities)           MSC:              Integrated Process: Nursing Process (Assessment)