A nurse is caring for a client who has acute kidney injury.
The client's arterial blood gases are: pH: 7.26, PaCO_2: 30 mm Hg, HCO_3: 14 mEq/L. Which of the following acid-base imbalances should the nurse identify the client is experiencing?

Metabolic alkalosis.

Metabolic acidosis.

Respiratory acidosis.

Respiratory alkalosis.

Answer and Explanation

The Correct Answer is B

Choice A rationale

Metabolic alkalosis is characterized by a high pH (normal range 7.35-7.45), indicating alkalinity, and a high HCO_3- (normal range 22-26 mEq/L), indicating a primary metabolic disturbance. The client's pH of 7.26 is acidic, and the HCO_3- of 14 mEq/L is low, which contradicts the parameters for metabolic alkalosis.

Choice B rationale

Metabolic acidosis is defined by a low pH (7.26, acidic) and a low HCO_3- (14 mEq/L). Acute kidney injury often leads to this imbalance because the kidneys are unable to excrete hydrogen ions (H+) and reabsorb or generate bicarbonate (HCO_3-), resulting in a net accumulation of acid in the body. The low PaCO_2 (30 mm Hg, normal range 35-45 mm Hg) indicates a compensatory hyperventilation.

Choice C rationale

Respiratory acidosis is marked by a low pH and a high PaCO_2 (partial pressure of carbon dioxide), reflecting impaired CO_2 excretion by the lungs. The client's PaCO_2 (30 mm Hg) is low, not high, ruling out a primary respiratory acidosis. HCO_3- levels are not the primary disturbance in this case.

Choice D rationale

Respiratory alkalosis is characterized by a high pH and a low PaCO_2. The client's pH (7.26) is low (acidic), not high, which immediately rules out respiratory alkalosis as the primary imbalance. The low PaCO_2 in this scenario is a compensatory mechanism for the metabolic problem.

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Correct Answer is ["50"]

Explanation

Step 1 is to calculate the total time for the infusion in minutes:. 8 hr × 60 min/hr = 480 min.

Step 2 is to calculate the gtt/min using the formula Volume in mL÷Time in min/Drop factor. (400 mL ÷ 480 min) × 60 gtt/mL.

Step 3 is to calculate the intermediate value of the mL/min:. 400 mL ÷ 480 min = 0.8333 mL/min.

Step 4 is to calculate the gtt/min:. 0.8333 mL/min × 60 gtt/mL = 49.998 gtt/min.

Step 5 is to round the answer to the nearest whole number:. 49.998 gtt/min rounds to 50 gtt/min. The final calculated answer is 50 gtt/min.

A. To treat urinary retention. B. To treat nausea. C. Block the effects of opioids on the central nervous system. D. To suppress respiratory secretions.

Correct Answer is C

Explanation

Choice A rationale

Naloxone, an opioid antagonist, is not indicated for treating urinary retention, which can be a side effect of opioid agonists like fentanyl due to increased tone of the detrusor muscle and sphincter. While discontinuing the opioid may resolve retention, naloxone's primary action is to reverse acute opioid-induced central nervous system and respiratory depression by competitive antagonism at opioid receptors, not to manage genitourinary dysfunction.

Choice B rationale

Nausea and vomiting are common side effects of opioid analgesics, mediated by stimulation of the chemoreceptor trigger zone in the medulla. While reversing the opioid effects with naloxone will subsequently reduce this symptom, naloxone is generally reserved for life-threatening opioid toxicity. Antiemetics like ondansetron or prochlorperazine are the standard pharmacological treatment for opioid-induced nausea.

Choice C rationale

Naloxone is a potent, rapid-acting opioid antagonist that competitively binds to and blocks opioid receptors, particularly μ (mu) receptors, in the central nervous system. This action effectively reverses the agonistic effects of opioids, such as respiratory depression, sedation, and analgesia, making it the essential treatment for acute opioid overdose.

Choice D rationale

Opioids can cause dryness of respiratory secretions due to their anticholinergic-like effects, not increased secretion. Naloxone's mechanism of action does not involve suppressing secretions; it specifically reverses the central nervous system depression caused by opioid agonists by competitively binding to opioid receptors. Standard treatments for excessive respiratory secretions involve suctioning or anticholinergic agents like atropine.

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A nurse is caring for a client who has acute kidney injury. The client's arterial blood gases are: pH: 7.26, PaCO_2: 30 mm Hg, HCO_3: 14 mEq/L. Which of the following acid-base imbalances should the nurse identify the client is experiencing?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Correct Answer is ["50"]

Explanation

A nurse is caring for a client who is postoperative and receiving fentanyl via patient-controlled analgesia. The client has a prescription for naloxone. The nurse understands that the purpose of naloxone is which of the following?

Correct Answer is C

Explanation

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A nurse is caring for a client who has acute kidney injury.
The client's arterial blood gases are: pH: 7.26, PaCO_2: 30 mm Hg, HCO_3: 14 mEq/L. Which of the following acid-base imbalances should the nurse identify the client is experiencing?