Acid-Base Imbalance Sherpath: Chapter 42, Fluid, Electrolyte, and Acid-Base Balance

Question 1 of 7

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Which acid-base imbalance would the nurse anticipate in a patient after a motor vehicle accident in which the steering wheel hit the patient’s chest and trapped the patient in the car until rescue workers arrived?

• Correct
  • Respiratory acidosisTrauma to the chest decreases ventilation and impairs gas exchange, placing the patient at risk for respiratory acidosis.
• • Chronic acidosisThis patient has an acute injury; therefore the patient is not at risk for chronic acidosis.
• • Respiratory alkalosisThe patient is not hyperventilating, so this patient is not at risk for respiratory alkalosis.
• • Compensatory alkalosisCompensatory mechanisms happen after the initial imbalance has occurred; therefore the patient is not at risk for compensatory alkalosis.

Question 2 of 7

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The nurse is caring for a patient who fell and is receiving treatment for a fractured arm. The nurse reviews the patient’s laboratory results, which indicate an elevated pH and a decreased PaCO₂. Which condition is the patient experiencing based on the current data?

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  • Respiratory alkalosisAn elevated pH value and a decreased PaCO₂ value are consistent with respiratory alkalosis.
• • Metabolic acidosisThis scenario is not indicative of metabolic acidosis because the pH is elevated and reflecting alkalosis.
• • Renal compensationThe laboratory results do not indicate renal compensation.
• • HypoxemiaThe laboratory results do not indicate hypoxemia. Hypoxemia would be indicated by a PaO₂ less than 80 mm Hg.

Question 3 of 7

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Which patients would the nurse identify as being at risk for respiratory acidosis secondary to impaired gas exchange?

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  • A patient experiencing an asthma attackAsthma constricts the airways and decreases exhalation, placing the patient at risk for respiratory acidosis secondary to impaired gas exchange.
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  • A patient diagnosed with Guillain-Barré syndromeNeurologic disorders such as myasthenia gravis, Guillain-Barré syndrome, and amyotrophic lateral sclerosis affect the muscles of respiration, placing the patient at risk for respiratory acidosis secondary to impaired gas exchange.
• Correct
  • A patient who is 2 hours postoperative for thoracic surgeryChest trauma/surgery impairs ventilation, placing the patient at risk for respiratory acidosis secondary to impaired gas exchange.
• • A patient with a fear of being hospitalizedFear causes hyperventilation and increases the risk for respiratory alkalosis, not acidosis.
• • A patient with a nicotine overdoseNicotine overdose leads to hyperventilation and increases the risk for respiratory alkalosis, not acidosis.

Question 4 of 7

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Which conditions in the medical history would the nurse identify as a risk factor for metabolic acidosis?

• • AsthmaAsthma places the patient at risk for respiratory, not metabolic, acidosis.
• • HypertensionHypertension is not an underlying factor of acid-base imbalance.
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  • Type I diabetesType I diabetes can cause ketoacidosis, which leads to acid accumulation and metabolic acidosis.
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  • SepsisIn sepsis, lack of oxygen available to the cells results in anaerobic metabolism and the accumulation of lactic acid.
• • VomitingVomiting results in loss of stomach acid, which places the patient at risk for alkalosis, not acidosis.

Question 5 of 7

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Which data in the medical history of a patient who is awake, but lethargic, and taking rapid, deep breaths would the nurse suspect as the cause of the following laboratory values: pH 7.31, PaO₂ 59.2 mm Hg, PaCO₂ 38.6 mm Hg, HCO₃^– 17.5 mEq/L, and oxygen saturation 88%?

• • AsthmaThese data are not indicative of asthma. Asthma can cause respiratory acidosis.
• • Antacid useThese data are not indicative of antacid use. Antacids would be associated with metabolic alkalosis.
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  • Diabetes mellitusThe pH and HCO₃^– values indicate metabolic acidosis, and the Kussmaul respirations are consistent with diabetic ketoacidosis.
• • Diuretic useThese data are not indicative of diuretic use. Diuretics can cause metabolic alkalosis.

Question 6 of 7

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Which ABG data would the nurse identify as supporting the diagnosis of metabolic alkalosis in a patient admitted with dehydration and lethargy?

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  • Increased pHDehydration and lethargy coupled with an increased pH support the diagnosis of metabolic alkalosis.
• • Decreased pHDecreased pH with the current data does not support the diagnosis of metabolic alkalosis. The decreased pH is consistent with acidosis.
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  • Increased bicarbonateDehydration and lethargy coupled with an increased bicarbonate level support the diagnosis of metabolic alkalosis.
• • Decreased bicarbonateDecreased bicarbonate with the current data does not support the diagnosis of metabolic alkalosis. Metabolic alkalosis would be associated with increased bicarbonate.
• • Decreased PaO₂Decreased PaO₂ may be associated with respiratory acidosis, not metabolic acidosis.

Question 7 of 7

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Which change in respiratory pattern observed in a type I diabetic patient with metabolic acidosis indicates to the nurse that compensation is occurring?

• • BradypneaBradypnea (regular, slow respirations) typically indicates that the patient is asleep. This does not indicate compensation.
• • TachypneaTachypnea is rapid, short breathing. This does not indicate compensation.
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  • Kussmaul respirationsKussmaul respirations remove excess carbon dioxide from the system. This is an indication of compensation.
• • Cheyne-Stokes respirationsCheyne-Stokes respirations, or periodic breathing, are present at the end of life. This does not indicate compensation.