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NurseDive Free Nursing Practice Question
Ms. Jackson has been suffering from persistent vomiting for two days now. She appears to be lethargic and weak and has myalgia. She is noted to have dry mucus membranes and her capillary refill takes >4 seconds. She is diagnosed as having gastroenteritis and dehydration. Measurement of arterial blood gas shows pH 7.5. PaO2 85 mm Hg, PaCO2 40 mm Hg, and HCO3 34 mmol/L What acid-base disorder is shown?
A. Metabolic Alkalosis. Partially Compensated
Metabolic Alkalosis, Partially Compensated, is incorrect because there is no evidence of respiratory compensation (normal PaCO2).
B. Respiratory Acidosis, Partially Compensated
Respiratory Acidosis, Partially Compensated, is incorrect because the pH is high, not low as would be expected in acidosis, and the PaCO2 is normal, not high.
C. Respiratory Alkalosis. Uncompensated
Respiratory Alkalosis, Uncompensated, is incorrect because the primary problem is metabolic (high HCO3), not respiratory, and the PaCO2 is normal, not low as would be seen in respiratory alkalosis.
D. Metabolic Alkalosis. Uncompensated
Metabolic alkalosis is characterized by elevated pH and bicarbonate levels. In this scenario, the pH is elevated (7.5) and the bicarbonate (HCO3) level is high (34 mmol/L), indicating alkalosis. Vomiting leads to loss of gastric acid (hydrochloric acid), causing metabolic alkalosis. The respiratory system has not yet compensated fully for the alkalosis, as indicated by the normal PaCO2 (40 mm Hg).
This question is an excerpt from Nurse Dive's nursing test bank - Ati Med Surg Proctored Exam 8. Take the full exam now
Full Explanation
A. Metabolic Alkalosis, Partially Compensated, is incorrect because there is no evidence of respiratory compensation (normal PaCO2).
B. Respiratory Acidosis, Partially Compensated, is incorrect because the pH is high, not low as would be expected in acidosis, and the PaCO2 is normal, not high.
C. Respiratory Alkalosis, Uncompensated, is incorrect because the primary problem is metabolic (high HCO3), not respiratory, and the PaCO2 is normal, not low as would be seen in respiratory alkalosis.
D. Metabolic alkalosis is characterized by elevated pH and bicarbonate levels. In this scenario, the pH is elevated (7.5) and the bicarbonate (HCO3) level is high (34 mmol/L), indicating alkalosis. Vomiting leads to loss of gastric acid (hydrochloric acid), causing metabolic alkalosis. The respiratory system has not yet compensated fully for the alkalosis, as indicated by the normal PaCO2 (40 mm Hg).
Similar Questions
A nurse is planning care for a client who has hypernatremia. Which of the following IV solutions should the nurse plan to initiate?
A. Dextran 40
Dextran 40 is a plasma volume expander and not used for correcting hypernatremia.
B. Dextrose 5 in water
Hypernatremia indicates a deficit of water relative to sodium. Providing hypotonic solutions like Dextrose 5 in water helps to dilute the sodium concentration in the body fluids, effectively treating hypernatremia.
C. Dextrose 10% in water
Dextrose 10% in water is a hypertonic solution and would exacerbate hypernatremia by increasing the concentration of sodium in the body fluids.
D. 25% albumin
25% albumin is a hypertonic solution and would exacerbate hypernatremia by increasing the concentration of sodium in the body fluids.
Full Explanation
A. Dextran 40 is a plasma volume expander and not used for correcting hypernatremia.
B. Hypernatremia indicates a deficit of water relative to sodium. Providing hypotonic solutions like Dextrose 5 in water helps to dilute the sodium concentration in the body fluids, effectively treating hypernatremia.
C. Dextrose 10% in water is a hypertonic solution and would exacerbate hypernatremia by increasing the concentration of sodium in the body fluids.
D. 25% albumin is a hypertonic solution and would exacerbate hypernatremia by increasing the concentration of sodium in the body fluids.
A nurse is caring for a client who has metabolic alkalosis. Which of the following actions should the nurse take?
A. Obtain a prescription for insulin for the client.
Insulin administration is not indicated for metabolic alkalosis.
B. Have the client breath into a paper bag.
Breathing into a paper bag is a treatment for respiratory alkalosis, not metabolic alkalosis.
C. Place the client on continuous cardiac monitoring,
Metabolic alkalosis can lead to cardiac dysrhythmias due to electrolyte imbalances, particularly hypokalemia. Continuous cardiac monitoring is essential to promptly identify and manage any dysrhythmias that may occur.
D. Plan to administer sodium bicarbonate to the client.
Administering sodium bicarbonate would exacerbate metabolic alkalosis and is not indicated.
Full Explanation
A. Insulin administration is not indicated for metabolic alkalosis.
B. Breathing into a paper bag is a treatment for respiratory alkalosis, not metabolic alkalosis.
C. Metabolic alkalosis can lead to cardiac dysrhythmias due to electrolyte imbalances, particularly hypokalemia. Continuous cardiac monitoring is essential to promptly identify and manage any dysrhythmias that may occur.
D. Administering sodium bicarbonate would exacerbate metabolic alkalosis and is not indicated.
A nurse is assessing a preschooler who has a calcium level of 8.0 mg/dL. Which of the following findings should the nurse expect?
A. Polyuria
Polyuria (excessive urination) is not typically associated with low calcium levels. It may occur in conditions such as diabetes mellitus or diabetes insipidus.
B. Muscle tremors
Hypocalcemia (low calcium levels) can lead to neuromuscular irritability, which may manifest as muscle tremors or spasms. This is a classic sign of hypocalcemia.
C. Dry, sticky mucous membranes
Dry, sticky mucous membranes are more indicative of dehydration rather than hypocalcemia.
D. Negative Chvostek's sign
Negative Chvostek's sign means the absence of facial muscle twitching upon tapping the facial nerve, which is not expected in hypocalcemia.
Full Explanation
A. Polyuria (excessive urination) is not typically associated with low calcium levels. It may occur in conditions such as diabetes mellitus or diabetes insipidus.
B. Hypocalcemia (low calcium levels) can lead to neuromuscular irritability, which may manifest as muscle tremors or spasms. This is a classic sign of hypocalcemia.
C. Dry, sticky mucous membranes are more indicative of dehydration rather than hypocalcemia.
D. Negative Chvostek's sign means the absence of facial muscle twitching upon tapping the facial nerve, which is not expected in hypocalcemia.