The nurse is caring for a client that has had a nasogastric tube to low wall suction for 5 days. Which acid/base imbalance would the nurse expect to see in this client?

Metabolic acidosis

Respiratory acidosis

Metabolic alkalosis

Respiratory alkalosis

Answer and Explanation

The Correct Answer is C

A. Metabolic acidosis: Metabolic acidosis occurs when there is an excess of hydrogen ions or a loss of bicarbonate, as seen in conditions like diarrhea or renal failure. Nasogastric suction primarily removes gastric hydrochloric acid, which does not cause acidosis, this is not the expected imbalance.

B. Respiratory acidosis: Respiratory acidosis results from hypoventilation, leading to CO₂ retention and decreased pH. NG suction does not directly affect respiratory function or CO₂ levels, so this is unlikely.

C. Metabolic alkalosis: Prolonged nasogastric suction removes hydrochloric acid from the stomach. The loss of H⁺ ions leads to a rise in blood pH, creating a metabolic alkalosis. This is a classic complication of continuous or prolonged NG suction, especially over several days.

D. Respiratory alkalosis: Respiratory alkalosis is caused by hyperventilation, resulting in decreased CO₂ levels. NG suction does not induce hyperventilation or CO₂ loss, this imbalance is not expected.

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Correct Answer is B

Explanation

A. Respiratory acidosis: Respiratory acidosis is characterized by a low pH (<7.35) and elevated PaCO2 (>45 mm Hg), typically due to hypoventilation or impaired gas exchange. In this ABG, the pH is elevated at 7.58 and PaCO2 is within normal limits (37.5 mm Hg), which does not indicate respiratory acidosis.

B. Metabolic alkalosis: Metabolic alkalosis presents with an elevated pH (>7.45) and increased bicarbonate (HCO3 >28 mEq/L). The patient’s pH is 7.58 and HCO3 is 31.2 mEq/L, consistent with metabolic alkalosis. The mild increase in base excess (+6.4) supports metabolic alkalosis, while the near-normal PaCO2 reflects partial respiratory compensation through hypoventilation.

C. Normal ABG results: Normal arterial blood gas values are: pH 7.35–7.45, PaCO2 35–45 mm Hg, HCO3 22–28 mEq/L, PaO2 80–100 mm Hg, and O2 saturation 95–100%. This patient’s ABG shows an elevated pH and HCO3, which are outside normal ranges.

D. Metabolic acidosis: Metabolic acidosis is indicated by a low pH (<7.35) and decreased HCO3 (<22 mEq/L). The patient’s pH is high (7.58) and HCO3 is elevated, which is opposite the pattern seen in metabolic acidosis, making this option inconsistent with the ABG results.

A. "Client found on floor despite repeated reminders to use call light. No injuries noted. Soft wrist restraints applied per provider orders." B. "Client discovered lying on floor in room. Provider called to bedside. No injuries noted. Client returned to bed with bed alarm on, call light in reach." C. "Client fell out of bed. Provider notified. No apparent injuries. Client reminded to use call light. Side rails up x 4." D. "Client discovered out of bed on the floor after side rails left down. Client not injured. See incident report." E. Nausea

Correct Answer is B

Explanation

A. "Client found on floor despite repeated reminders to use call light. No injuries noted. Soft wrist restraints applied per provider orders.": Documenting the use of restraints without clear justification or physician orders specific to fall prevention may imply inappropriate use, and this wording also introduces judgment about the patient’s behavior (“despite repeated reminders”), which is not objective or professional documentation.

B. "Client discovered lying on floor in room. Provider called to bedside. No injuries noted. Client returned to bed with bed alarm on, call light in reach.": This entry objectively describes the event, the immediate clinical response, and the interventions implemented to prevent recurrence. It avoids judgmental language and focuses on factual, patient-centered actions, aligning with professional standards for incident documentation in nursing notes.

C. "Client fell out of bed. Provider notified. No apparent injuries. Client reminded to use call light. Side rails up x 4.": While factual, this documentation includes assumptions (“fell out of bed”) and focuses more on restraint or safety devices rather than emphasizing objective observation and immediate care. “No apparent injuries” is slightly less precise than “no injuries noted” in clinical reporting.

D. "Client discovered out of bed on the floor after side rails left down. Client not injured. See incident report.": Including blame or speculative cause (“after side rails left down”) is inappropriate for nursing progress notes, which should remain objective and free from judgment. Referring to an incident report without documenting the nursing assessment and immediate interventions provides incomplete information for continuity of care.

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The nurse is caring for a client that has had a nasogastric tube to low wall suction for 5 days. Which acid/base imbalance would the nurse expect to see in this client?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The following arterial blood gas (ABG) results indicate? pH-7.58 PaCO2-37.5 Pa02-80 HCO3-31.2 BE-(+6.4) 02 Sat - 93%

Correct Answer is B

Explanation

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Correct Answer is B

Explanation

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