Test Bank for Nursing A Concept-Based Approach to Learning 4th Edition Pearson Education

Nursing: A Concept-Based Approach to Learning Vol. 1 & 2, 4e (Pearson) Module 1 Acid-Base Balance The Concept of Acid-Base Balance 1) A client who has been fasting and has ketones in the urine is brought to the emergency department (ED) unconscious. Which acid-base imbalance would the nurse expect to assess in this client? A) Metabolic acidosis B) Respiratory alkalosis C) Metabolic alkalosis D) Respiratory acidosis Answer: A Explanation: A) A client who is fasting is at risk for development of metabolic acidosis. The body recognizes fasting as starvation and begins to metabolize its own fatty acids into ketones, which are metabolic acids. B) A client who is fasting is at risk for development of metabolic acidosis. The body recognizes fasting as starvation and begins to metabolize its own fatty acids into ketones, which are metabolic acids. Starvation would not result in respiratory alkalosis. C) A client who is fasting is at risk for development of metabolic acidosis. The body recognizes fasting as starvation and begins to metabolize its own fatty acids into ketones, which are metabolic acids. Starvation would not result in metabolic alkalosis. D) A client who is fasting is at risk for development of metabolic acidosis. The body recognizes fasting as starvation and begins to metabolize its own fatty acids into ketones, which are metabolic acids. Starvation would not result in respiratory acidosis. Page Ref: 5 Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1. Demonstrate knowledge of basic scientific methods and processes. | AACN Domains and Competencies: 2.4 Diagnose actual or potential health problems and needs. | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care. | Nursing Process: Assessment Learning Outcome: 1.2. Differentiate alterations in acid-base balance. MNL LO: Analyze the concept of acid-base balance and its application to nursing care.   2) The nurse is caring for a client in the emergency department. Which factors will the nurse identify that increase the client's risk for metabolic acidosis? Select all that apply. A) Abdominal fistulas B) Chronic obstructive pulmonary disease C) Pneumonia D) Chronic renal failure E) Hypovolemic shock Answer: A, D, E Explanation: A) Metabolic acidosis is rarely a primary disorder. It usually develops during the course of another condition such as an abdominal fistula which can cause the loss of bicarbonate from the intestine. B) Chronic obstructive pulmonary disease places the client at risk for respiratory acidosis with the increased retention of carbon dioxide in the blood. C) Pneumonia places the client at risk for respiratory acidosis with the increased retention of carbon dioxide in the blood. D) Metabolic acidosis is rarely a primary disorder. It usually develops during the course of another condition such as chronic renal failure. In this health problem, the kidneys are unable to excrete a normal amount of hydrogen ions in the urine. This results in an excessive amount of hydrogen ions in the blood, which produces metabolic acidosis. E) Metabolic acidosis is rarely a primary disorder. It usually develops during the course of another condition such as hypovolemic shock. With a severe blood loss, there is a lack of blood flow throughout the body and a lack of oxygen in every cell. Adenosine triphosphate (ATP) must produce energy anaerobically without the presence of oxygen; lactic acid is a by-product. This produces systemic lactic acidosis, a type of metabolic acidosis. Page Ref: 5-6 Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1. Demonstrate knowledge of basic scientific methods and processes. | AACN Domains and Competencies: 2.4 Diagnose actual or potential health problems and needs. | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care. | Nursing Process: Assessment Learning Outcome: 1.2. Differentiate alterations in acid-base balance. MNL LO: Analyze the concept of acid-base balance and its application to nursing care.   3) A client with acute asthma has a PaCO2 of 48 mmHg, a pH of 7.31, and a normal HCO3 arterial blood gas value. Which condition will the nurse associate with these values? A) Metabolic acidosis B) Respiratory alkalosis C) Respiratory acidosis D) Metabolic alkalosis Answer: C Explanation: A) Uncompensated metabolic acidosis has a decreased pH, normal PaCO2, and decreased HCO3. B) Uncompensated respiratory alkalosis has an increased pH, decreased PaCO2, and normal HCO3. C) If the pH is decreased and the PaCO2 is increased with a normal HCO3, it is uncompensated respiratory acidosis. D) Uncompensated metabolic alkalosis has an increased pH, normal PaCO2, and increased HCO3. Page Ref: 7 Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1. Demonstrate knowledge of basic scientific methods and processes. | AACN Domains and Essential Competencies: 2.4 Diagnose actual or potential health problems and needs. | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care. | Nursing Process: Assessment Learning Outcome: 1.2. Differentiate alterations in acid-base balance. MNL LO: Analyze the concept of acid-base balance and its application to nursing care.   4) The nurse is reviewing the latest arterial blood gas results for a client with metabolic alkalosis. Which result indicates that the metabolic alkalosis is compensated? A) pH 7.32 B) PaCO2 18 mmHg C) HCO3 8 mEq/L D) PaCO2 48 mmHg Answer: D Explanation: A) A normal pH level is 7.35-7.45. A pH of less than 7.35 is acidosis. B) A PaCO2 level of 18 mmHg is low and is seen in respiratory alkalosis. C) A HCO3 level of 8 mEq/L is low and is most likely associated with metabolic acidosis. D) In metabolic alkalosis, there is an excess of bicarbonate. To compensate for this imbalance, the rate and depth of respirations decrease, leading to retention of carbon dioxide. The PaCO2 will be elevated. Page Ref: 8 Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1. Demonstrate knowledge of basic scientific methods and processes. | AACN Domains and Essential Competencies: 2.4 Diagnose actual or potential health problems and needs. | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care. | Nursing Process: Evaluation Learning Outcome: 1.2. Differentiate alterations in acid-base balance. MNL LO: Analyze the concept of acid-base balance and its application to nursing care.   5) A client is diagnosed with chronic obstructive pulmonary disease. Which test provides the most accurate indicator of the client's acid-base balance? A) Arterial blood gases (ABGs) B) Pulse oximetry C) Sputum studies D) Bronchoscopy Answer: A Explanation: A) Acid-base balance is assessed primarily by measuring arterial blood gases (ABGs). Arterial blood is most often used because it reflects acid-base balance throughout the entire body better than venous or capillary blood that has dispersed oxygen into the tissues and has collected carbon dioxide. B) Pulse oximetry is a noninvasive test that evaluates the oxygen saturation level of blood. C) Sputum studies can provide specific information about bacterial organisms. D) A bronchoscopy provides visualization of internal respiratory structures. Page Ref: 10 Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1. Demonstrate knowledge of basic scientific methods and processes. | AACN Domains and Competencies: 2.3 Integrate assessment skills in practice. | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care. | Nursing Process: Assessment Learning Outcome: 1.5. Differentiate common assessment procedures and tests used to examine acid-base balance. MNL LO: Analyze the concept of acid-base balance and its application to nursing care.   6) The nurse is instructing a client with a history of acidosis on the use of sodium bicarbonate. Which client statement indicates that additional teaching is needed? A) "I should contact the doctor if I have any gastric discomfort with chest pain." B) "I need to purchase antacids without salt." C) "I should use the antacid for at least 2 months." D) "I should call the doctor if I get short of breath or start to sweat with this medication." Answer: C Explanation: A) The client should be instructed to immediately contact the primary healthcare provider if gastric discomfort occurs with chest pain. B) The client should be instructed to use non-sodium antacids to prevent the absorption of excess sodium or bicarbonate into systemic circulation. C) The client should be instructed to not use any bicarbonate antacid for longer than 2 weeks. D) The client should be instructed to immediately contact the primary healthcare provider if dyspnea or diaphoresis occurs. Page Ref: 6 Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care: patient/family/community preferences, values; coordination and integration of care; information, communication, and education; physical comfort and emotional support; involvement of family and friends; Transition and continuity. | AACN Domains and Competencies: 5.2 Contribute to a culture of patient safety. | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care. | Nursing Process: Evaluation Learning Outcome: 1.7. Summarize collaborative therapies used by interdisciplinary teams for clients with alterations in acid-base balance. MNL LO: Analyze the concept of acid-base balance and its application to nursing care.