TEST BANK: NURSINGA CONCEPT-BASED APPROACH TO LEARNING, VOLUMESI, II & III, 3RD EDITION, PEARSON EDUCATION

TEST BANK: NURSINGA CONCEPT-BASED APPROACH TO LEARNING, VOLUMESI, II & III, 3RD EDITION, PEARSON EDUCATION TEST BANK: NURSINGA CONCEPT-BASED APPROACH TO LEARNING, VOLUMESI, II & III, 3RD EDITION, PEARSON EDUCATION TEST BANK: NURSINGA CONCEPT-BASED APPROACH TO LEARNING, VOLUMESI, II & III, 3RD EDITION, PEARSON EDUCATION Nursing: A Concept-Based Approach to Learning Vol. 1 2 & 3, 3e (Pearson) Module 1 Acid-Base Balance The Concept of Acid-Base Balance 1) A client is brought to the emergency department (ED) after passing out in a local department store. The client has been fasting and has ketones in the urine. Which acid-base imbalance would the nurse expect to assess in this client? A) Metabolic acidosis B) Respiratory alkalosis C) Metabolic alkalosis D) Respiratory acidosis Answer: A Explanation: A) A client who is fasting is at risk for development of metabolic acidosis. The body recognizes fasting as starvation and begins to metabolize its own fatty acids into ketones, which are metabolic acids. Starvation would not result in respiratory acidosis or alkalosis or in metabolic alkalosis. B) A client who is fasting is at risk for development of metabolic acidosis. The body recognizes fasting as starvation and begins to metabolize its own fatty acids into ketones, which are metabolic acids. Starvation would not result in respiratory acidosis or alkalosis or in metabolic alkalosis. C) A client who is fasting is at risk for development of metabolic acidosis. The body recognizes fasting as starvation and begins to metabolize its own fatty acids into ketones, which are metabolic acids. Starvation would not result in respiratory acidosis or alkalosis or in metabolic alkalosis. D) A client who is fasting is at risk for development of metabolic acidosis. The body recognizes fasting as starvation and begins to metabolize its own fatty acids into ketones, which are metabolic acids. Starvation would not result in respiratory acidosis or alkalosis or in metabolic alkalosis. Page Ref: 6 Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1. Demonstrate knowledge of basic scientific methods and processes. | AACN Essential Competencies: IX.3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care. | Nursing Process: Assessment Learning Outcome: 1.2. Differentiate alterations in acid-base balance. MNL LO: Analyze the concept of acid-base balance and its application to nursing care. 2) Which risk factors exhibited by the client presenting in the emergency department (ED) would place the client at risk for metabolic acidosis? Select all that apply. A) Abdominal fistulas B) Chronic obstructive pulmonary disease C) Pneumonia D) Acute renal failure E) Hypovolemic shock Answer: A, D, E Explanation: A) Metabolic acidosis is rarely a primary disorder. It usually develops during the course of another disease; presence of abdominal fistulas, which can cause excess bicarbonate loss; acute renal failure; and hypovolemic shock. Chronic obstructive pulmonary disease and pneumonia place the client at risk for respiratory acidosis with the increased retention of carbon dioxide in the blood. B) Metabolic acidosis is rarely a primary disorder. It usually develops during the course of another disease; presence of abdominal fistulas, which can cause excess bicarbonate loss; acute renal failure; and hypovolemic shock. Chronic obstructive pulmonary disease and pneumonia place the client at risk for respiratory acidosis with the increased retention of carbon dioxide in the blood. C) Metabolic acidosis is rarely a primary disorder. It usually develops during the course of another disease; presence of abdominal fistulas, which can cause excess bicarbonate loss; acute renal failure; and hypovolemic shock. Chronic obstructive pulmonary disease and pneumonia place the client at risk for respiratory acidosis with the increased retention of carbon dioxide in the blood. D) Metabolic acidosis is rarely a primary disorder. It usually develops during the course of another disease; presence of abdominal fistulas, which can cause excess bicarbonate loss; acute renal failure; and hypovolemic shock. Chronic obstructive pulmonary disease and pneumonia place the client at risk for respiratory acidosis with the increased retention of carbon dioxide in the blood. E) Metabolic acidosis is rarely a primary disorder. It usually develops during the course of another disease; presence of abdominal fistulas, which can cause excess bicarbonate loss; acute renal failure; and hypovolemic shock. Chronic obstructive pulmonary disease and pneumonia place the client at risk for respiratory acidosis with the increased retention of carbon dioxide in the blood. Page Ref: 6, 14 Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1. Demonstrate knowledge of basic scientific methods and processes. | AACN Essential Competencies: IX.3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care. | Nursing Process: Assessment Learning Outcome: 1.2. Differentiate alterations in acid-base balance. MNL LO: Analyze the concept of acid-base balance and its application to nursing care. 3) A child with acute asthma has a PaCO2 of 48 mmHg, a pH of 7.31, and a normal HCO3 blood gas value. The nurse interprets these findings as indicative of which condition? A) Metabolic acidosis B) Respiratory alkalosis C) Respiratory acidosis D) Metabolic alkalosis Answer: C Explanation: A) If the pH is decreased and the PaCO2 is increased with a normal HCO3, it is uncompensated respiratory acidosis. Uncompensated respiratory alkalosis has an increased pH, decreased PaCO2, and normal HCO3. Uncompensated metabolic acidosis has a decreased pH, normal PaCO2, and decreased HCO3. Uncompensated metabolic alkalosis has an increased pH, normal PaCO2, and increased HCO3. B) If the pH is decreased and the PaCO2 is increased with a normal HCO3, it is uncompensated respiratory acidosis. Uncompensated respiratory alkalosis has an increased pH, decreased PaCO2, and normal HCO3. Uncompensated metabolic acidosis has a decreased pH, normal PaCO2, and decreased HCO3. Uncompensated metabolic alkalosis has an increased pH, normal PaCO2, and increased HCO3. C) If the pH is decreased and the PaCO2 is increased with a normal HCO3, it is uncompensated respiratory acidosis. Uncompensated respiratory alkalosis has an increased pH, decreased PaCO2, and normal HCO3. Uncompensated metabolic acidosis has a decreased pH, normal PaCO2, and decreased HCO3. Uncompensated metabolic alkalosis has an increased pH, normal PaCO2, and increased HCO3. D) If the pH is decreased and the PaCO2 is increased with a normal HCO3, it is uncompensated respiratory acidosis. Uncompensated respiratory alkalosis has an increased pH, decreased PaCO2, and normal HCO3. Uncompensated metabolic acidosis has a decreased pH, normal PaCO2, and decreased HCO3. Uncompensated metabolic alkalosis has an increased pH, normal PaCO2, and increased HCO3. Page Ref: 24 Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1. Demonstrate knowledge of basic scientific methods and processes. | AACN Essential Competencies: IX.3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care. | Nursing Process: Diagnosis Learning Outcome: 1.2. Differentiate alterations in acid-base balance. MNL LO: Analyze the concept of acid-base balance and its application to nursing care. 4) The nurse is reviewing the latest arterial blood gas results for a client with metabolic alkalosis. Which result indicates that the metabolic alkalosis is compensated? A) pH 7.32 B) PaCO2 18 mmHg C) HCO3 8 mEq/L D) PaCO2 48 mmHg Answer: D Explanation: A) A normal pH level is 7.35-7.45. A pH of less than 7.35 is acidosis. A PaCO2 level of 18 mmHg is low and is seen in respiratory alkalosis. A HCO3 level of 8 mEq/L is low and is most likely associated with metabolic acidosis. In metabolic alkalosis, there is an excess of bicarbonate. To compensate for this imbalance, the rate and depth of respirations decrease, leading to retention of carbon dioxide. The PaCO2 will be elevated. B) A normal pH level is 7.35-7.45. A pH of less than 7.35 is acidosis. A PaCO2 level of 18 mmHg is low and is seen in respiratory alkalosis. A HCO3 level of 8 mEq/L is low and is most likely associated with metabolic acidosis. In metabolic alkalosis, there is an excess of bicarbonate. To compensate for this imbalance, the rate and depth of respirations decrease, leading to retention of carbon dioxide. The PaCO2 will be elevated. C) A normal pH level is 7.35-7.45. A pH of less than 7.35 is acidosis. A PaCO2 level of 18 mmHg is low and is seen in respiratory alkalosis. A HCO3 level of 8 mEq/L is low and is most likely associated with metabolic acidosis. In metabolic alkalosis, there is an excess of bicarbonate. To compensate for this imbalance, the rate and depth of respirations decrease, leading to retention of carbon dioxide. The PaCO2 will be elevated. D) A normal pH level is 7.35-7.45. A pH of less than 7.35 is acidosis. A PaCO2 level of 18 mmHg is low and is seen in respiratory alkalosis. A HCO3 level of 8 mEq/L is low and is most likely associated with metabolic acidosis. In metabolic alkalosis, there is an excess of bicarbonate. To compensate for this imbalance, the rate and depth of respirations decrease, leading to retention of carbon dioxide. The PaCO2 will be elevated. Page Ref: 8 Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1. Demonstrate knowledge of basic scientific methods and processes. | AACN Essential Competencies: IX.3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care. | Nursing Process: Evaluation Learning Outcome: 1.2. Differentiate alterations in acid-base balance. MNL LO: Analyze the concept of acid-base balance and its application to nursing care. 5) A client has been admitted with chronic obstructive pulmonary disease. Diagnostic tests have been ordered. Which of the tests will provide the most accurate indicator of the client's acid-base balance? A) Arterial blood gases (ABGs) B) Pulse oximetry C) Sputum studies D) Bronchoscopy Answer: A Explanation: A) ABGs are done to assess alterations in acid-base balance caused by respiratory disorders, metabolic disorders, or both. A bronchoscopy provides visualization of internal respiratory structures. Sputum studies can provide specific information about bacterial organisms. Pulse oximetry is a noninvasive test that evaluates the oxygen saturation level of blood. B) ABGs are done to assess alterations in acid-base balance caused by respiratory disorders, metabolic disorders, or both. A bronchoscopy provides visualization of internal respiratory structures. Sputum studies can provide specific information about bacterial organisms. Pulse oximetry is a noninvasive test that evaluates the oxygen saturation level of blood. C) ABGs are done to assess alterations in acid-base balance caused by respiratory disorders, metabolic disorders, or both. A bronchoscopy provides visualization of internal respiratory structures. Sputum studies can provide specific information about bacterial organisms. Pulse oximetry is a noninvasive test that evaluates the oxygen saturation level of blood. D) ABGs are done to assess alterations in acid-base balance caused by respiratory disorders, metabolic disorders, or both. A bronchoscopy provides visualization of internal respiratory structures. Sputum studies can provide specific information about bacterial organisms. Pulse oximetry is a noninvasive test that evaluates the oxygen saturation level of blood. Page Ref: 9 Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1. Demonstrate knowledge of basic scientific methods and processes. | AACN Essential Competencies: IX.3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care. | Nursing Process: Assessment Learning Outcome: 1.5. Differentiate common assessment procedures and tests used to examine acid-base balance. MNL LO: Analyze the concept of acid-base balance and its application to nursing care. 6) The nurse is instructing a client with a history of acidosis on the use of sodium bicarbonate. Which client statement indicates that additional teaching is needed? A) "I should contact the doctor if I have any gastric discomfort with chest pain." B) "I need to purchase antacids without salt." C) "I should use the antacid for at least 2 months." D) "I should call the doctor if I get short of breath or start to sweat with this medication." Answer: C Explanation: A) The client should be instructed to immediately contact the primary healthcare provider if gastric discomfort occurs with chest pain or if dyspnea or diaphoresis occurs. The client should be instructed to use non-sodium antacids to prevent the absorption of excess sodium or bicarbonate into systemic circulation and to not use any bicarbonate antacid for longer than 2 weeks. B) The client should be instructed to immediately contact the primary healthcare provider if gastric discomfort occurs with chest pain or if dyspnea or diaphoresis occurs. The client should be instructed to use non-sodium antacids to prevent the absorption of excess sodium or bicarbonate into systemic circulation and to not use any bicarbonate antacid for longer than 2 weeks. C) The client should be instructed to immediately contact the primary healthcare provider if gastric discomfort occurs with chest pain or if dyspnea or diaphoresis occurs. The client should be instructed to use non-sodium antacids to prevent the absorption of excess sodium or bicarbonate into systemic circulation and to not use any bicarbonate antacid for longer than 2 weeks. D) The client should be instructed to immediately contact the primary healthcare provider if gastric discomfort occurs with chest pain or if dyspnea or diaphoresis occurs. The client should be instructed to use non-sodium antacids to prevent the absorption of excess sodium or bicarbonate into systemic circulation and to not use any bicarbonate antacid for longer than 2 weeks. Page Ref: 12 Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care: patient/family/community preferences, values; coordination and integration of care; information, communication, and education; physical comfort and emotional support; involvement of family and friends transition and continuity. | AACN Essential Competencies: IX.3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care. | Nursing Process: Evaluation Learning Outcome: 1.7 Summarize collaborative therapies used by interdisciplinary teams for clients with alterations in acid-base balance. MNL LO: Analyze the concept of acid-base balance and its application to nursing care. 7) The client is receiving sodium bicarbonate intravenously (IV) for correction of acidosis secondary to diabetic coma. The nurse assesses the client to be lethargic, confused, and breathing rapidly. Which is the nurse's priority response to the current situation? A) Stop the infusion and notify the physician because the client is in alkalosis. B) Decrease the rate of the infusion and continue to assess the client for symptoms of alkalosis. C) Continue the infusion, because the client is still in acidosis, and notify the healthcare provider. D) Increase the rate of the infusion and continue to assess the client for symptoms of acidosis. Answer: C Explanation: A) The client receiving sodium bicarbonate is prone to alkalosis; monitor for cyanosis, slow respirations, and irregular pulse. The client's symptoms do not indicate alkalosis so infusion should not be stopped. The client continues to exhibit signs of acidosis; symptoms of acidosis include lethargy, confusion, CNS depression leading to coma, and a deep, rapid respiration rate that indicates an attempt by the lungs to rid the body of excess acid, and the physician should be notified. The infusion should not be increased or decreased without a practitioner order. B) The client receiving sodium bicarbonate is prone to alkalosis; monitor for cyanosis, slow respirations, and irregular pulse. The client's symptoms do not indicate alkalosis so infusion should not be stopped. The client continues to exhibit signs of acidosis; symptoms of acidosis include lethargy, confusion, CNS depression leading to coma, and a deep, rapid respiration rate that indicates an attempt by the lungs to rid the body of excess acid, and the physician should be notified. The infusion should not be increased or decreased without a practitioner order. C) The client receiving sodium bicarbonate is prone to alkalosis; monitor for cyanosis, slow respirations, and irregular pulse. The client's symptoms do not indicate alkalosis so infusion should not be stopped. The client continues to exhibit signs of acidosis; symptoms of acidosis include lethargy, confusion, CNS depression leading to coma, and a deep, rapid respiration rate that indicates an attempt by the lungs to rid the body of excess acid, and the physician should be notified. The infusion should not be increased or decreased without a practitioner order. D) The client receiving sodium bicarbonate is prone to alkalosis; monitor for cyanosis, slow respirations, and irregular pulse. The client's symptoms do not indicate alkalosis so infusion should not be stopped. The client continues to exhibit signs of acidosis; symptoms of acidosis include lethargy, confusion, CNS depression leading to coma, and a deep, rapid respiration rate that indicates an attempt by the lungs to rid the body of excess acid, and the physician should be notified. The infusion should not be increased or decreased without a practitioner order. Page Ref: 9—11, 12 Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care: Patient/family/community preferences, values; Coordination and integration of care; Information, communication, and education; Physical comfort and emotional support; Involvement of family and friends Transition and continuity. | AACN Essential Competencies: IX.7. Provide appropriate patient teaching that reflects developmental state, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Relationship Centered Care: Effective communication. | Nursing Process: Evaluation Learning Outcome: 1.7 Summarize collaborative therapies used by interdisciplinary teams for clients with alterations in acid-base balance. MNL LO: Analyze the concept of acid-base balance and its application to nursing care. 8) The nurse is preparing to analyze a client's arterial blood gas results. List the steps in the order that the nurse should follow when analyzing this laboratory test. 1. Look at the PaCO2. 2. Look at the pH. 3. Evaluate the relationship between pH and PaCO2. 4. Look for compensation. 5. Evaluate the pH, HCO3, and base excess for a possible metabolic problem. 6. Look at the bicarbonate. 7. Evaluate oxygenation Answer: 2, 1, 3, 6, 5, 4, 7