A nurse is planning care for a client who is anxious and ...

[leilurhhh]

A nurse is planning care for a client who is anxious and irritable. The client's arterial blood gas values are pH 7.30, PaO2 96 mm Hg, PaCO2 43 mm Hg, and HCO3- 19 mEq/L. Which questions should the nurse ask the client and spouse when developing the plan
 
  a. Are you taking any antacid medications?
  b. Is your spouse's current behavior typical?
  c. Do you drink any alcoholic beverages?
  d. Have you been experiencing any vomiting?
  e. Are you experiencing any shortness of breath?

Question 2

A nurse is assessing clients who are at risk for acid-base imbalance. Which clients are correctly paired with the acid-base imbalance? (Select all that apply.)
 
  a. Metabolic alkalosis - Young adult who is prescribed intravenous morphine sulfate for pain
  b. Metabolic acidosis - Older adult who is following a carbohydrate-free diet
  c. Respiratory alkalosis - Client on mechanical ventilation at a rate of 28 breaths/min
  d. Respiratory acidosis - Postoperative client who received 6 units of packed red blood cells
  e. Metabolic alkalosis - Older client prescribed antacids for gastroesophageal reflux disease

[31809pancho]

Answer to Question 1

ANS: B, C
This client's symptoms of anxiety and irritability are related to a state of metabolic acidosis. The nurse should ask the client's spouse or family members if the client's behavior is typical for him or her, and establish a baseline for comparison with later assessment findings. The nurse should also assess for alcohol intake because alcohol can change a client's personality and cause metabolic acidosis. The other options are not causes of metabolic acidosis.

Answer to Question 2

ANS: B, C, E
Respiratory acidosis often occurs as the result of underventilation. The client who is taking opioids, especially IV opioids, is at risk for respiratory depression and respiratory acidosis. One cause of metabolic acidosis is a strict low-calorie diet or one that is low in carbohydrate content. Such a diet increases the rate of fat catabolism and results in the formation of excessive ketoacids. A ventilator set at a high respiratory rate or tidal volume will cause the client to lose too much carbon dioxide, leading to an acid deficit and respiratory alkalosis. Citrate is a substance used as a preservative in blood products. It is not only a base, it is also a precursor for bicarbonate. Multiple units of packed red blood cells could cause metabolic alkalosis. Sodium bicarbonate antacids may increase the risk of metabolic alkalosis.

[leilurhhh]

Excellent

[Jossy]

Gracias!