A client is brought to the Emergency Department after passing out in a local department store. The client has been fasting and has ketones in the urine. Which acid-base imbalance would the nurse expect to assess in this client?
Metabolic acidosis
Metabolic alkalosis
Respiratory alkalosis
Respiratory acidosis
The Correct Answer is A
A. Metabolic acidosis: Fasting can lead to the production of ketones as the body breaks down fat for energy in the absence of sufficient glucose. Ketones are acidic, and their accumulation in the blood leads to a decrease in pH, causing metabolic acidosis.
B. Metabolic alkalosis: This condition occurs when there is an excessive loss of acid or an increase in bicarbonate levels. It is not typically associated with fasting or the production of ketones.
C. Respiratory alkalosis: Respiratory alkalosis occurs when excessive CO2 is exhaled, leading to an increase in blood pH. This is typically due to hyperventilation and is not related to fasting or ketone production.
D. Respiratory acidosis: Respiratory acidosis results from the retention of CO2 due to hypoventilation, which leads to a decrease in blood pH. This condition is not associated with fasting or ketosis and is not likely to be the cause of the client’s symptoms.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. Pulse oximetry: Pulse oximetry measures the oxygen saturation of hemoglobin in the blood, but it does not provide information about the acid-base balance or the levels of carbon dioxide (CO2) or bicarbonate (HCO3), which are critical to understanding the acid-base status of a client.
B. Bronchoscopy: A bronchoscopy is a diagnostic procedure used to view the airways and obtain tissue samples. While it is useful in evaluating airway obstruction or lung pathology, it does not assess acid-base status.
C. Arterial blood gases (ABGs): ABGs provide the most accurate and direct measurement of acid-base balance. They assess the levels of oxygen (O2), carbon dioxide (CO2), and bicarbonate (HCO3) in the blood, and provide information on respiratory function and the body’s ability to maintain acid-base homeostasis.
D. Sputum studies: Sputum studies are helpful for diagnosing infections or analyzing secretions, but they do not provide information about the client's acid-base balance or the respiratory status regarding CO2 levels.
Correct Answer is D
Explanation
A. Respirations that cease for several seconds: This describes periodic breathing or Cheyne-Stokes respirations, which are not characteristic of Kussmaul’s respirations. Kussmaul’s respirations are marked by rapid and deep breathing, not cessation of breathing.
B. Respirations that are regular but abnormally slow: This describes bradypnea, which is not associated with diabetic ketoacidosis (DKA). Kussmaul’s respirations are fast and deep, not slow.
C. Respirations that are labored, and decreased in depth and rate: Labored, shallow breathing is not characteristic of Kussmaul’s respirations. Instead, Kussmaul’s respirations are deep and rapid, a compensatory mechanism for metabolic acidosis in DKA.
D. Respirations that are abnormally deep, regular, and increased in rate: Kussmaul’s respirations are deep, rapid, and regular, which are a physiological response to help decrease CO2 levels and correct the acidosis seen in DKA.
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