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NurseDive Free Nursing Practice Question
A nurse is reviewing the arterial blood gas values of a client who has chronic kidney disease. Which of the following sets of values should the nurse expect?
A. pH 7.25, HCO3- 19mEq / L PaCO2 30 mm Hg
In a client with chronic kidney disease (CKD), metabolic acidosis is a common acid-base disorder due to impaired excretion of acid and decreased bicarbonate reabsorption in the kidneys. The arterial blood gas values associated with metabolic acidosis in CKD are a low pH (acidemia), low bicarbonate (HCO3-), and normal or low partial pressure of carbon dioxide (PaCO2). Option A fits this pattern, with a pH of 7.25 (acidic), HCO3- of 19 mEq/L (low), and a PaCO2 of 30 mm Hg (within the normal to low range).
B. pH 7.30, HCO3-26 26mEq / L PaCO2 50 mm Hg
Option B shows a pH of 7.30 (acidic) but with a higher bicarbonate level of 26 mEq/L, which is not consistent with metabolic acidosis. The elevated bicarbonate level suggests metabolic alkalosis, which is not expected in a client with CKD.
C. pH 7.50 0. HCO * 3 - 20mE /L, PaCO2 32 mm Hg
Option C has a pH of 7.50 (alkaline) with an elevated bicarbonate level of 20 mEq/L and a low PaCO2 of 32 mm Hg. This set of values is indicative of metabolic alkalosis, which is not expected in a client with CKD.
D. pH 7.55, HCO3- 30mEq / L PaCO2 31 mm Hg
Option D has a pH of 7.55 (alkaline) with an elevated bicarbonate level of 30 mEq/L and a low PaCO2 of 31 mm Hg.
This question is an excerpt from Nurse Dive's nursing test bank - NUR390 Med Surg 390 Proctored Exam. Take the full exam now
Full Explanation
In a client with chronic kidney disease (CKD), metabolic acidosis is a common acid-base disorder due to impaired excretion of acid and decreased bicarbonate reabsorption in the kidneys. The arterial blood gas values associated with metabolic acidosis in CKD are a low pH (acidemia), low bicarbonate (HCO3-), and normal or low partial pressure of carbon dioxide (PaCO2). Option A fits this pattern, with a pH of 7.25 (acidic), HCO3- of 19 mEq/L (low), and a PaCO2 of 30 mm Hg (within the normal to low range).
Option B shows a pH of 7.30 (acidic) but with a higher bicarbonate level of 26 mEq/L, which is not consistent with metabolic acidosis. The elevated bicarbonate level suggests metabolic alkalosis, which is not expected in a client with CKD.
Option C has a pH of 7.50 (alkaline) with an elevated bicarbonate level of 20 mEq/L and a low PaCO2 of 32 mm Hg. This set of values is indicative of metabolic alkalosis, which is not expected in a client with CKD.
Option D has a pH of 7.55 (alkaline) with an elevated bicarbonate level of 30 mEq/L and a low PaCO2 of 31 mm Hg. This set of values is indicative of metabolic alkalosis, which is not expected in a client with CKD.
Similar Questions
Which assessment finding of a patient with chronic kidney disease indicates to the nurse that hemodialysis is having the desired effect?
A. Decreased hematocrit and diuresis
B. Decreased serum creatinine and weight loss
Hemodialysis is a treatment used to remove waste products and excess fluids from the blood in individuals with kidney failure or chronic kidney disease. The primary purpose of hemodialysis is to filter and clear the blood of waste products that the kidneys can no longer remove adequately. As a result, one of the key indicators that hemodialysis is having the desired effect is a decrease in serum creatinine levels. Creatinine is a waste product that builds up in the blood when the kidneys are not functioning properly. A decrease in serum creatinine indicates that the dialysis treatment is effectively removing waste products from the blood.
C. Increased potassium level and improved appetite
D. Decreased white blood cell count and diaphoresis
Full Explanation
Hemodialysis is a treatment used to remove waste products and excess fluids from the blood in individuals with kidney failure or chronic kidney disease. The primary purpose of hemodialysis is to filter and clear the blood of waste products that the kidneys can no longer remove adequately. As a result, one of the key indicators that hemodialysis is having the desired effect is a decrease in serum creatinine levels. Creatinine is a waste product that builds up in the blood when the kidneys are not functioning properly. A decrease in serum creatinine indicates that the dialysis treatment is effectively removing waste products from the blood.
Weight loss is also a positive sign after hemodialysis since it indicates that excess fluid is being removed from the body. In individuals with kidney failure, the kidneys cannot adequately remove extra fluid, leading to fluid retention and weight gain. Hemodialysis helps to eliminate this excess fluid, leading to weight loss and reducing the risk of fluid overload-related complications.
The other options listed (decreased hematocrit and diuresis, increased potassium level and improved appetite, and decreased white blood cell count and diaphoresis) are not direct indicators of the effectiveness of hemodialysis in removing waste products and excess fluid from the blood.
Which patient is most likely to develop chronic kidney disease (CKD) and should be taught preventive measures by the nurse?
A. A 50-year-old white female with hypertension
B. A 61-year-old Native American male with diabetes
C. 40-year-old Hispanic female with cardiovascular disease
D. A 28-year-old African American female with a urinary tract infection
Full Explanation
Chronic kidney disease (CKD) is a condition where the kidneys are damaged or unable to filter blood effectively over time, leading to a gradual loss of kidney function. Several risk factors can increase the likelihood of developing CKD, and among them, diabetes and hypertension are the most common.
Diabetes is a significant risk factor for developing CKD. It can cause damage to the small blood vessels in the kidneys, impairing their ability to filter waste and fluid from the blood properly. Native Americans, along with other racial and ethnic minorities, are at a higher risk of developing diabetes compared to the general population.
While hypertension (high blood pressure) is also a risk factor for CKD, diabetes carries a higher risk. However, it's important to note that hypertension is often a comorbidity associated with CKD and can further worsen kidney function when present.
The other options listed (a 50-year-old white female with hypertension, a 40-year-old Hispanic female with cardiovascular disease, and a 28-year-old African American female with a urinary tract infection) are also at risk for CKD, but the 61-year-old Native American male with diabetes is at the highest risk based on the information provided. All patients should be educated about preventive measures to protect their kidney health, but special attention should be given to individuals with diabetes due to its significant impact on kidney function.
The nurse identifies that a patient with chronic kidney disease is at risk for which electrolyte disturbance?
A. Hypokalemia
B. Hyponatremia
C. Hypercalcemia
D. Hyperphosphatemia
A patient with chronic kidney disease is at risk for hyperphosphatemia. In chronic kidney disease, the kidneys' ability to excrete phosphate is impaired, leading to elevated levels of phosphate in the blood. This can further lead to calcium-phosphate imbalances, bone problems, and other complications associated with kidney disease. Managing phosphate levels is an essential aspect of the treatment plan for patients with chronic kidney disease.
Full Explanation
A patient with chronic kidney disease is at risk for hyperphosphatemia. In chronic kidney disease, the kidneys' ability to excrete phosphate is impaired, leading to elevated levels of phosphate in the blood. This can further lead to calcium-phosphate imbalances, bone problems, and other complications associated with kidney disease. Managing phosphate levels is an essential aspect of the treatment plan for patients with chronic kidney disease.