Maria, an elementary student, was rushed to the hospital due to vomiting and a decreased level of consciousness. The patient displays slow and deep (Kussmaul breathing), and he is lethargic and irritable in response to stimulation. He appears to be dehydrated-his eyes are sunken and mucous membranes are dry-and he has a two-week history of polydipsia, polyuria, and weight loss. Measurement of arterial blood gas shows pH 7.0, Pa02 90 mm Hg. PaCO2 23 mm Hg, and HCO3 12 mmol/L; other results are Na+ 126 mmol/L. K+ 5 mmol/L, and Cl-95 mmol/L.

What is your assessment?

Respiratory Acidosis, Partially Compensated

Metabolic Acidosis, Partially, Compensated

Metabolic Alkalosis. Uncompensated

Respiratory Acidosis, Uncompensated

Answer and Explanation

The Correct Answer is B

A.   This option can be ruled out because the pH and PaCO2 levels indicate acidosis, but the compensation is not partial as the HCO3 is also low.
B.   Maria's symptoms and the arterial blood gas values support this diagnosis. Metabolic acidosis is indicated by a low pH and a decreased bicarbonate (HCO3) level. The body attempts to compensate for this acidosis by hyperventilating, which is evidenced by her Kussmaul breathing, to decrease PaCO2. This compensation is partial because, despite the body's efforts, the pH is still significantly lower than normal.
C.   This option can be ruled out because the pH is low (acidosis) rather than high (alkalosis), and the HCO3 is low rather than high.
D.   Respiratory Acidosis, Uncompensated is ruled out because the pH is low (acidosis), but the PaCO2 is normal, indicating metabolic rather than respiratory involvement.

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Correct Answer is C

Explanation

A. Insulin administration is not indicated for metabolic alkalosis.
B. Breathing into a paper bag is a treatment for respiratory alkalosis, not metabolic alkalosis.
C. Metabolic alkalosis can lead to cardiac dysrhythmias due to electrolyte imbalances, particularly hypokalemia. Continuous cardiac monitoring is essential to promptly identify and manage any dysrhythmias that may occur.
D. Administering sodium bicarbonate would exacerbate metabolic alkalosis and is not indicated.

A. Constipation B. Muscle spasms C. Metallic taste D. Headache

Correct Answer is A

Explanation

A. Constipation is a common adverse effect of aluminum hydroxide, an antacid often used to bind phosphate in patients with renal failure to prevent hyperphosphatemia.
B. Muscle spasms are not typically associated with aluminum hydroxide.
C. Metallic taste is not a common adverse effect of aluminum hydroxide.
D. Headache is not a common adverse effect of aluminum hydroxide.

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Naxlex Comprehensive Predictor Exams

A nurse is caring for a client who has metabolic alkalosis. Which of the following actions should the nurse take?

Correct Answer is C

Explanation

A nurse is providing teaching to a client who has renal failure and an elevated phosphorous level. The provider instructed the client to take aluminum hydroxide 300 mg PO three times daily. For which of the following adverse effects should the nurse inform the client?

Correct Answer is A

Explanation

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 nurse is caring for a client who has syndrome of inappropriate antidiuretic hormone (SIADH) and a sodium level of 123 mEq/L. Which of the following prescriptions should the nurse anticipate?

A nurse is caring for a client who has Addison's disease and is at risk for Addisonian crisis. Which of the following actions should the nurse take?

A nurse is discussing kidney transplant with a client who has end-stage renal disease (ESRD). Which of the following should the nurse identify as a contraindication for this treatment?

A nurse is caring for a client who has a postoperative ileus and an NG tube that has drained 2,500 mL in the past 6 hr. Which of the following electrolyte imbalances should the nurse monitor the client for?

A nurse is caring for a female client who has recurrent kidney stones and is scheduled for an intravenous pyelogram. Which of the following statements by the client should the nurse report to the provider?

A nurse is reviewing the BUN and creatinine levels of an older adult client who has chronic kidney disease. The nurse should expect which of the following findings?

A nurse is teaching a client who has a new diagnosis of hyperparathyroidism. The nurse should include in the teaching that the client is at risk for which of the following complications?