ABGs
A nurse reviews an ABG with a pH of 7.50, PaCO2 of 28 mm Hg, and HCO3- of 24 mEq/L. What acid-base imbalance does this suggest?
Uncompensated Respiratory Alkalosis
*Increased pH, low CO2, bicarb normal, so uncompensated.
Which scenario would most likely result in metabolic alkalosis?
A. Kidney failure
B. Hyperventilation
C. Diarrhea
D. Excessive vomiting
D. Excessive vomiting
*Excessive vomiting can lead to a loss of stomach acid, resulting in metabolic alkalosis.
A patient exhibiting Kussmaul respirations is a classic sign of which imbalance?
Metabolic Acidosis
The nurse would closely monitor a client with diabetic ketoacidosis (DKA) for which primary acid–base imbalance?
Metabolic acidosis
(DKA is associated with an increase in acid production. Diabetic clients with DKA are unable to metabolize glucose, and the liver responds with an increase in fatty acid metabolism. These fatty acids are oxidized, leading to ketone body formation and increased acidity.)
A nurse is reviewing the laboratory values of a client who has respiratory acidosis. Which of the following findings should the nurse expect?
A. HCO3- 30 mEq/L
B. PaCO2 50 mm Hg
C. pH 7.45
D. Potassium 3.3 mEq/L
B. PaCO2 50 mm Hg
A patient arrived to your unit after receiving pain medications Q3H for the last several days. Her ABG reveals pH 7.36, PaCO2 48, HCO3- 28. The nurse correctly interprets the ABG as...
Compensated Respiratory Acidosis
*pH within normal range, so compensated, but lower than 7.40, so patient was in acidosis; high PaCO2, and HCO3- high, further showing compensation.
A nurse is reviewing the medical records of four clients who have an acid-base imbalance. The nurse should recognize that which of the following clients is at risk for metabolic acidosis?
A. A client who has diarrhea
B. A client who is vomiting
C. A client who is taking a thiazide diuretic
A. A client who has diarrhea
*Diarrhea can cause metabolic acidosis due to the loss of bicarbonate.
A patient complaining of numbness and tingling around the mouth, fingers, and toes is indicative of...
A. acidosis due to high potassium level
B. acidosis due to low potassium level
C. alkalosis due to low calcium level
D. alkalosis due to high calcium level
C. alkalosis due to low calcium level
The nurse determines that a client with a nasogastric tube on low suction for five days is at risk for developing which acid–base imbalance?
Metabolic alkalosis
What is a priority nursing intervention immediately after an ABG is drawn?
A. Perform Allen Test
B. Keep hand/wrist in a dependent position
C. Apply pressure to the site
D. Apply warm compress
C. Apply pressure to the site.
*Because blood is drawn from a high-pressure artery, it is important to apply pressure to the puncture site for 10 minutes (or longer if the patient is receiving anticoagulant therapy) after the procedure to reduce the risk of bleeding or bruising.
Which of the following ABG results is most indicative of metabolic acidosis?
A. pH 7.30, PaCO2 40 mm Hg, HCO3- 18 mEq/L
B. pH 7.35, PaCO2 50 mm Hg, HCO3- 22 mEq/L
C. pH 7.50, PaCO2 30 mm Hg, HCO3- 24 mEq/L
D. pH 7.46, PaCO2 38 mm Hg, HCO3- 26 mEq/L
A. pH 7.30, PaCO2 40 mm Hg, HCO3- 18 mEq/L
Which of the following would most likely cause metabolic acidosis?
A. Excessive antacid use
B. Severe anxiety
C. Chronic vomiting
D. Diabetic ketoacidosis
D. Diabetic ketoacidosis
*Diabetic ketoacidosis leads to an accumulation of acids in the body, resulting in metabolic acidosis.
Due to cerebral vasoconstriction and decreased cerebral blood flow, a patient in respiratory alkalosis will typically manifest which clinical symptom?
A. increased concentration
B. lightheadedness
C. chest pain
D. decreased respiratory rate
B. lightheadedness
*Clinical signs of respiratory alkalosis consist of lightheadedness related to vasoconstriction and decreased cerebral blood flow, as well as decreased concentration.
A patient with COPD is most likely to experience which acid-base imbalance?
Respiratory acidosis
(COPD can lead to CO2 retention, causing respiratory acidosis)
The purpose of performing an Allen Test is to...
A. determine if hypocalcemia is present.
B. eliminate the risk of bleeding after puncture.
C. ensure adequate perfusion to the hand.
D. obtain a patient's acid-base balance.
C. ensure adequate perfusion to the hand.
A patient with a history of vomiting has the following ABG values: pH 7.48, PaCO2 43 mm Hg, HCO3- 30 mEq/L. What condition do these values suggest?
Uncompensated Metabolic Alkalosis
*high pH, normal CO2, high bicarb
A nurse is caring for a client who is postoperative and whose respirations are shallow and 9/min. Which acid-based imbalance should the nurse identify the client as being at risk for developing initially?
Respiratory Acidosis
*Respiratory acidosis represents an increase in the acid component, carbon dioxide, due to inadequate excretion of it. A major cause of this imbalance is hypoventilation from anesthetics or opioids.
A patient with long-standing COPD, may exhibit which manifestation?
A. blurred vision
B. cold, clammy skin
C. daytime sleepiness
D. baseline PaCO2 <35 mmHg
C. daytime sleepiness
The nurse carefully assesses a client with a new ileostomy for development of which acid–base imbalance?
Metabolic acidosis
(Lower gastrointestinal (GI) tract fluid loss leads to a loss of HCO3-, resulting in the development of metabolic acidosis.)
How does the body compensate for respiratory alkalosis?
A. The kidneys produce more bicarbonate.
B. The kidneys excrete more bicarbonate.
C. The lungs will increase respiratory rate
D. Oxygen saturation will decrease.
B. The kidneys excrete more bicarbonate.
(To compensate for respiratory alkalosis, the kidneys excrete bicarbonate to lower blood pH.)
A nurse is caring for a client with pneumonia. Arterial blood gas (ABG) results are pH 7.49; PaCO2 32 mmHg; HCO3- 30 mEq/L; PaO2 89 mmHg. This nurse analyzes these results as which imbalance?
Mixed respiratory and metabolic alkalosis
*The pH is elevated, HCO3- - is elevated, and PaCO2- is low. This indicates that there is a mixed respiratory and metabolic alkalosis.
Obesity and sedative overdose put a patient at risk for which acid-base imbalance?
Respiratory Acidosis
*Obesity can lead to chest wall abnormalities and hypoventilation, which can lead to respiratory acidosis. Sedative overdose depresses the central nervous system, which leads to hypoventilation and respiratory acidosis.
When caring for a patient in metabolic acidosis, a priority nursing intervention would be to...
A. regulate temperature with cooling blanket
B. place Foley catheter for accurate I&O
C. place patient on cardiac monitor
D. Administer furosemide (Lasix)
C. place patient on cardiac monitor
(due to hyperkalemia, life-threatening dysrhythmias)
An oncoming nurse gets report on her assigned patient. She was told that the patient received 4L of intravenous 0.9% normal saline infused over that last hour. She immediately went into the room to assess for which imbalance?
Metabolic Acidosis
*Excessive infusions of chloride-containing IVF can precipitate metabolic acidosis.
Which ABG result indicates compensated respiratory acidosis?
A. pH 7.50, PaCO2 40 mm Hg, HCO3- 28 mEq/L
B. pH 7.30, PaCO2 50 mm Hg, HCO3- 24 mEq/L
C. pH 7.38, PaCO2 48 mm Hg, HCO3- 28 mEq/L
D. pH 7.45, PaCO2 30 mm Hg, HCO3- 20 mEq/L
C. pH 7.38, PaCO2 48 mm Hg, HCO3- 28 mEq/L
(Normal pH with elevated PaCO2 and HCO3- indicates compensation)