Ms. Jackson has been suffering from 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 What acid-base disorder is shown?

Metabolic Alkalosis. Partially Compensated

Respiratory Acidosis, Partially Compensated

Respiratory Alkalosis. Uncompensated

Metabolic Alkalosis. Uncompensated

Answer and Explanation

The Correct Answer is D

A.   Metabolic Alkalosis, Partially Compensated, is incorrect because there is no evidence of respiratory compensation (normal PaCO2).
B.   Respiratory Acidosis, Partially Compensated, is incorrect because the pH is high, not low as would be expected in acidosis, and the PaCO2 is normal, not high.
C.   Respiratory Alkalosis, Uncompensated, is incorrect because the primary problem is metabolic (high HCO3), not respiratory, and the PaCO2 is normal, not low as would be seen in respiratory alkalosis.
D.   Metabolic alkalosis is characterized by elevated pH and bicarbonate levels. In this scenario, the pH is elevated (7.5) and the bicarbonate (HCO3) level is high (34 mmol/L), indicating alkalosis. Vomiting leads to loss of gastric acid (hydrochloric acid), causing metabolic alkalosis. The respiratory system has not yet compensated fully for the alkalosis, as indicated by the normal PaCO2 (40 mm Hg).

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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. Serum magnesium levels B. Serum phosphorus levels C. Serum potassium levels D. Serum calcium levels

Correct Answer is B

Explanation

A. Aluminum hydroxide can lead to increased serum magnesium levels, but this is not the reason for its preference in chronic kidney disease.
B. Aluminum hydroxide is preferred because it binds to dietary phosphate, reducing serum phosphorus levels in patients with chronic kidney disease who are prone to hyperphosphatemia.
C. Aluminum hydroxide does not significantly affect serum potassium levels.
D. Aluminum hydroxide can lead to decreased serum calcium levels due to binding, but this is not the primary reason for its preference in chronic kidney disease.

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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

Correct Answer is B

Explanation

A nurse is teaching a client who has acute kidney injury about the oliguric phase. Which of the following information should the nurse include in the teaching?

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 planning care for a client who has a new diagnosis of diabetes insipidus. Which of the following interventions should the nurse include in the plan of care?

A nurse is assessing four clients on a medical unit. The nurse should identify which of the following clients as exhibiting positive manifestations of hypercortisolism?

A nurse is collecting the medical history from a client who has manifestations of syndrome of inappropriate antidiuretic hormone (SIADH). The nurse should ask the client if he has a history of which of the following conditions that can cause SIADH?

A nurse is caring for a client who has the following arterial blood gas results: HCO3-, 18 mEq, PaCO, 28 mm Hg and pH 7.30. The nurse recognizes the client is experiencing which of the following acid base imbalances?

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?