Nokea
The nurse is instructing on the body's negative feedback loop to ensure homeostasis to a group of students. Which action by bases keeps the blood $\mathrm{pH}$ nearly neutral?
- A. Bases cast off acids.
- B. Bases bind with hydrogen.
- C. Bases hold acidic properties.
- D. Bases have no contact with acids.
Correct Answer: B
Rationale: Acids are substances that release hydrogen into fluid, bases are substances that bind with hydrogen. The delicate balance between acids and bases, as well as fluids and electrolytes, maintains the nearly neutral blood $\mathrm{pH}$.
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Upon shift report, the nurse states the following laboratory values: $\mathrm{pH}, 7.44 ; \mathrm{PCO}_2, 30 \mathrm{mmHg}$; and $\mathrm{HCO}_3, 21 \mathrm{mEq} / \mathrm{L}$ for a client with noted acid-base disturbances. Which acid-base imbalance do both nurses agree is the client's current state?
- A. Compensated respiratory alkalosis
- B. Uncompensated respiratory alkalosis
- C. Compensated metabolic acidosis
- D. Compensated metabolic alkalosis
Correct Answer: A
Rationale: The question states that the client has a history of acid-base disturbance. The nurse would first note that the $\mathrm{pH}$ has returned to close to normal indicating compensation. The nurse then assess the $\mathrm{PCO}_2$ (normal: 35 to $45 \mathrm{~mm} \mathrm{Hg}$ ) and $\mathrm{HCO}_3$ (normal: 22 to $27 \mathrm{mEq} / \mathrm{L}$ ) levels. In a respiratory condition, the $\mathrm{pH}$ and the $\mathrm{PCO}_2$ move in opposite directions; thus, the $\mathrm{pH}$ rises and the $\mathrm{PCO}_2$ drops (alkalosis) or vice versa (acidosis). In a metabolic condition, the $\mathrm{pH}$ and the bicarbonate move in the same direction; if the $\mathrm{pH}$ is low, the bicarbonate level will be low, also. In this client, the $\mathrm{pH}$ is at the high end of normal, indicating compensation and alkalosis. The $\mathrm{PCO}_2$ is low, indicating a respiratory condition (opposite direction of the $\mathrm{pH}$ ).
The nurse on a surgical unit is caring for a client recovering from recent surgery with the placement of a nasogastric tube to low continuous suction. Which acid-base imbalance is most likely to occur?
- A. Respiratory alkalosis
- B. Metabolic alkalosis
- C. Respiratory acidosis
- D. Metabolic acidosis
Correct Answer: B
Rationale: Metabolic alkalosis results in increased plasma $\mathrm{pH}$ because of an accumulated base bicarbonate or decreased hydrogen ion concentration. Factors that increase base bicarbonate include excessive oral or parenteral use of bicarbonate- containing drugs, a rapid decrease in extracellular fluid volume and loss of hydrogen and chloride ions as with gastric suctioning. Acidotic states are from excess carbonic acid and hydrogen ions in the system. Respiratory alkalosis results from a carbonic acid deficit that occurs when rapid breathing releases more $\mathrm{CO}_2$ than necessary.
The nurse is documenting assessment findings of a client diagnosed with anasarca. Which nursing documentation best shows improvement in disease progression?
- A. Decreased abdominal girth
- B. Increased level of consciousness
- C. Weight maintenance
- D. Pulse rate decrease
Correct Answer: A
Rationale: Third-spacing is the translocation of fluid from the intravascular to intercellular space to tissue compartment. Anasarca is the general edema in the organ cavities such as the abdomen. Monitoring the abdominal girth provides data on the localization of the fluid in the interstitial space. A decrease in girth, in particular, notes improvement. Level of consciousness is not affected unless shock occurs. Weight remains the same as there is a shifting in fluid; pulse rate could fluctuate according to fluid movement.
A client with hypervolemia asks the nurse what mechanism in the sodium potassium pump will move the excess body fluid. What is the correct answer from the nurse?
- A. Passive osmosis
- B. Free flow
- C. Passive elimination
- D. Active transport
Correct Answer: D
Rationale: Active transport is the physiologic pump that moves fluid from an area of lower concentration to one of higher concentration. Active transport requires adenosine triphosphate for energy. Passive osmosis does not require energy for transport. Free flow is transport of water naturally. Passive elimination is a filter process carried out in the kidneys.
The client's lab values are sodium $166 \mathrm{mEq} / \mathrm{L}$, potassium $5.0 \mathrm{mEq} / \mathrm{L}$, chloride $115 \mathrm{mEq} / \mathrm{L}$, and bicarbonate $35 \mathrm{mEq} / \mathrm{L}$. What condition is this client likely to have, judging by anion gap?
- A. Metabolic acidosis
- B. Respiratory alkalosis
- C. Metabolic alkalosis
- D. Respiratory acidosis
Correct Answer: A
Rationale: The anion gap is the difference between sodium and potassium cations and the sum of chloride and bicarbonate anions. An anion gap that exceeds $16 \mathrm{mEq} / \mathrm{L}$ indicates metabolic acidosis. In this case, the anion gap is $(166+5)-(115+35)$, yielding $21 \mathrm{mEq} / \mathrm{L}$, which suggests metabolic acidosis. Anion gap is not used to check for respiratory alkalosis, metabolic alkalosis, or respiratory acidosis.