A nurse is planning interventions that regulate acid-base balance ...

[Melani1276]

A nurse is planning interventions that regulate acid-base balance to ensure the pH of a client's blood remains within the normal range. Which abnormal physiologic functions may occur if the client experiences an acid-base imbalance? (Select all that apply
 
  a. Reduction in the function of hormones
  b. Fluid and electrolyte imbalances
  c. Increase in the function of selected enzymes
  d. Excitable cardiac muscle membranes
  e. Increase in the effectiveness of many drugs

Question 2

A nurse is caring for a client who has chronic emphysema and is receiving oxygen therapy at 6 L/min via nasal cannula. The following clinical data are available:
 
  Arterial Blood Gases
  Vital Signs
  pH = 7.28
  Pulse rate = 96 beats/min
  PaO2 = 85 mm Hg
  Blood pressure = 135/45
  PaCO2 = 55 mm Hg
  Respiratory rate = 6 breaths/min
  HCO3- = 26 mEq/L
  O2 saturation = 88
  Which action should the nurse take first?
  a.
  Notify the Rapid Response Team and provide ventilation support.
  b.
  Change the nasal cannula to a mask and reassess in 10 minutes.
  c.
  Place the client in Fowler's position if he or she is able to tolerate it.
  d.
  Decrease the flow rate of oxygen to 2 to 4 L/min, and reassess.

[Harbringer]

Answer to Question 1

ANS: A, B, E
Acid-base imbalances interfere with normal physiology, including reducing the function of hormones and enzymes, causing fluid and electrolyte imbalances, making heart membranes more excitable, and decreasing the effectiveness of many drugs.

Answer to Question 2

ANS: A
The primary trigger for respiration in a client with chronic respiratory acidosis is a decreased arterial oxygen level (hypoxic drive). Oxygen therapy can inhibit respiratory efforts in this case, eventually causing respiratory arrest and death. The nurse could decrease the oxygen flow rate; eventually, this might improve the client's respiratory rate, but the priority action would be to call the Rapid Response Team whenever a client with chronic carbon dioxide retention has a respiratory rate less than 10 breaths/min. Changing the cannula to a mask does nothing to improve the client's hypoxic drive, nor would it address the client's most pressing need. Positioning will not help the client breathe at a normal rate or maintain client safety.