Mrs. Kalen is a 70-year-old female who has arrived at the ER due to persistent vomiting for two days now. She appears to be lethargic and weak and has myalgia. She is noted to have dry mucus membranes and her capillary refill takes >4 seconds. She is diagnosed as having gastroenteritis and dehydration. Measurement of arterial blood gas shows pH 7.5, PaO2 85 mm Hg, PaCO2 40 mm Hg, and HCO3 34 mmol/L. Based on the acid-base interruption from Mrs. Kalen, what can the nurse anticipate the treatment will be for correcting this imbalance?

administration of antiemetics

administration of diuretics

Possible Electrolyte replacement if warranted

Administration of IV 0.9 Saline Solution infusion

Have the patient go home and rest. It will resolve itself shortly.

Answer and Explanation

The Correct Answer is D

Mrs. Kalen is diagnosed with gastroenteritis and dehydration, and the arterial blood gas results indicate metabolic alkalosis (elevated pH and HCO3-). This suggests that there is an excessive loss of gastric acid and chloride ions from vomiting, leading to an imbalance of electrolytes and an increase in bicarbonate levels.

To correct the imbalance and treat dehydration, the primary intervention is fluid replacement. Administration of IV 0.9 Saline Solution, also known as normal saline, is commonly used for fluid resuscitation and rehydration. This isotonic solution helps restore fluid balance and electrolyte levels in the body.

Administration of antiemetics may help control vomiting, but the primary treatment focus in this case is fluid and electrolyte replacement to correct dehydration and the associated metabolic alkalosis.

Administration of diuretics, which increase urine output, would not be appropriate in this case as the patient is already experiencing dehydration.

Electrolyte replacement may be necessary if there are specific electrolyte imbalances identified, but the primary treatment is fluid replacement with IV saline solution.

Having the patient go home and rest without addressing the underlying dehydration and metabolic alkalosis would not be appropriate as it can lead to further complications.

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Correct Answer is D

Explanation

Administration of diuretics, which increase urine output, would not be appropriate in this case as the patient is already experiencing dehydration.

Electrolyte replacement may be necessary if there are specific electrolyte imbalances identified, but the primary treatment is fluid replacement with IV saline solution.

Having the patient go home and rest without addressing the underlying dehydration and metabolic alkalosis would not be appropriate as it can lead to further complications.

A. Sodium level 144 B. Potassium level 1.5 mEq/L C. Blood pressure 102/78 D. Calcium level 9 mg/L

Correct Answer is B

Explanation

Loop diuretics, such as furosemide, are known to cause potassium loss as they increase urine output. A potassium level of 1.5 mEq/L indicates severe hypokalemia (low potassium levels), which can be potentially dangerous and lead to various complications, including cardiac arrhythmias.

Hence, it is important to hold the dose of the loop diuretic and notify the physician so that appropriate interventions can be taken to address the low potassium level, such as prescribing potassium supplementation or adjusting the dosage of the loop diuretic.

A sodium level of 144 is within the normal range (135-145 mEq/L) and does not require immediate action.

A blood pressure of 102/78, although it may indicate hypotension, does not necessarily require holding the dose of the loop diuretic unless it is accompanied by other significant symptoms or clinical concerns.

A calcium level of 9 mg/dL falls within the normal range (8.5-10.5 mg/dL) and does not necessitate holding the loop diuretic dose.

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Naxlex Comprehensive Predictor Exams

Correct Answer is D

Explanation

Your patient is ordered a loop diuretic at 1000. Which finding below would require you to hold the dose and notify the physician for further orders?

Correct Answer is B

Explanation

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