Sherpath: Electrolytes and the Acid-Base System

Question 1 of 6

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Severe burn injury puts a patient at increased risk for which electrolyte imbalance? Select all that apply. One, some, or all responses may be correct.

• Correct
  • HyponatremiaBurn wounds result in the loss of sodium, which can lead to hyponatremia.
• • HypernatremiaBurn wounds result in the loss of sodium, which can lead to hyponatremia, not hypernatremia.
• • HypokalemiaThe body produces extra potassium in response to severe burns. This increases the risk for hyperkalemia, not hypokalemia.
• Correct
  • HyperkalemiaWhen a severe burn occurs, serum potassium is increased. This can lead to hyperkalemia.
• • HypermagnesemiaBurns can increase the risk for hypomagnesemia, not hypermagnesemia.
• • HypercalcemiaBurns can increase the risk for hypocalcemia, not hypercalcemia.

Question 2 of 6

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Which electrolyte imbalance would the nurse assess for in an older adult patient experiencing vomiting, diarrhea, dehydration, weakness, abdominal pain, and fatigue?

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  • HypokalemiaWeakness, abdominal pain, and fatigue are all symptoms of hypokalemia, which is caused by a loss of potassium-rich gastrointestinal fluids.
• • HyperkalemiaHyperkalemia is associated with weakness and fatigue but is unlikely to occur with vomiting and diarrhea.
• • HypernatremiaHypernatremia is associated with hypotension and dry mucous membranes.
• • HypophosphatemiaClinical manifestations of hypophosphatemia include confusion, seizure, and numbness.

Question 3 of 6

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Which finding will the nurse assess for in a patient with a calcium level of 8.2 mg/dL?

• • OliguriaOliguria, a decrease in overall urine output, is a sign of hypercalcemia (calcium level >10.6 mg/dL). A calcium level of 8.2 mg/dL indicates hypocalcemia.
• • Elevated vitamin D levelsSerum calcium levels are directly proportional to the intake of vitamin D. Therefore in a patient who is hypocalcemic, the nurse would assess for depleted rather than elevated vitamin D levels.
• • Renal calculiThe presence of renal calculi is associated with hypercalcemia (calcium level >10.6 mg/dL), not hypocalcemia.
• Correct
  • Trousseau signThe nurse would assess for a positive Trousseau sign because this is a symptom of hypocalcemia (calcium level <8.4 mg/dL).

Question 4 of 6

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Which physiological response would the nurse anticipate in a patient with respiratory acidosis?

• • The kidneys will manufacture less bicarbonate.A physiological response to acid-base imbalance is a compensatory mechanism where the body is trying to maintain a pH within the normal range. The kidneys will manufacture more bicarbonate to neutralize the excess acid associated with respiratory acidosis.
• Correct
  • More bicarbonate than normal will be retained by the kidneys.A physiological response to acid-base imbalance is a compensatory mechanism where the body is trying to maintain a pH within the normal range. The kidneys are responsible for maintaining a normal pH by manufacturing and retaining more bicarbonate than normal to neutralize the excess acid associated with respiratory acidosis.
• • Too much carbonic acid is eliminated to maintain a normal pH.This is not a physiological response of the body to respiratory acidosis. Carbonic acid must be maintained at a normal ratio to maintain a pH within normal limits; if too much is eliminated by the lungs, it may contribute to respiratory alkalosis.
• • Less carbonic acid is produced to restore acid-base balance.This is not a physiological response of the body to respiratory acidosis. Carbonic acid is produced and maintained at a normal ratio to maintain/restore acid-base balance; if less is produced as a result of the metabolic activities in the body, it may contribute to respiratory alkalosis.

Question 5 of 6

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Which blood gas result would the nurse document as metabolic alkalosis?

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  • pH >7.45 and HCO₃⁻ >26 mEq/LpH greater than 7.45 and HCO₃⁻ greater than 26 mEq/L is consistent with metabolic alkalosis. Vomiting along with excessive antacid intake and hypokalemia are all possible causes of metabolic alkalosis.
• • pH <7.35 and HCO₃⁻ <22 mEq/LpH less than 7.35 and HCO₃⁻ less than 22 mEq/L is consistent with metabolic acidosis, not metabolic alkalosis.
• • pH <7.35 and Paco₂ >45 mm HgpH less than 7.35 and Paco₂ greater than 45 mm Hg is consistent with respiratory acidosis. This patient is not experiencing metabolic alkalosis.
• • pH >7.45 and Paco₂ <35 mm HgpH greater than 7.45 and Paco₂ less than 35 mm Hg is consistent with respiratory alkalosis, not metabolic alkalosis.

Question 6 of 6

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Which action will the nurse take for a patient with Paco₂ of 30 mm Hg?

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  • Assess the patient’s respiratory rate.A patient with Paco₂ of 30 mm Hg is likely experiencing respiratory alkalosis. It is important for the nurse to monitor and address any abnormalities in respiratory rate, specifically hyperventilation.
• • Measure the patient’s urine output.Alterations in urine output are associated with metabolic acid-based imbalances. These are most often reflected as changes in the bicarbonate ion level rather than carbon dioxide level.
• • Assess the patient for oversedation or somnolence.A patient who is somnolent or oversedated is at risk for respiratory acidosis, including retention of Paco2. This patient would have Paco₂ greater than 45 mm Hg.
• • Evaluate the patient for frequency of loose stools.Diarrhea is a causative factor for metabolic acidosis, leading to abnormalities in pH and HCO₃^–, rather than the low Paco₂ this patient is experiencing.