MED SURG CHAPTER 14

Chapter 14 Mastery Quiz Graded Due Oct 23, 2022 by 8:59 pm Passed 33 out of 33 questions answered correctly Completed on Oct 11, 2022 7:04 pm Incorrect (0) Correct (33) Which cause is associated with acidosis? High altitudes Ingestion of antacids Kidney failure Elsevier Adaptive Quizzing - Quiz performance 1 of 27 10/11/2022, 7:05 PM MED SURG CHAPTER 14 Rationale Causes of acidosis include kidney failure, pancreatitis, liver failure, and dehydration. High altitudes, ingestion of antacids, and prolonged vomiting are causes of alkalosis. pp. 267, 272 A patient who is admitted with severe diabetic ketoacidosis has an arterial blood gas result that reveals a pH of 7.21. Which factor is causing this patient's acidosis? Rationale Metabolic acidosis can result from the overproduction of hydrogen ions, underelimination of hydrogen ions, or insufficient bicarbonate ions. Excessive breakdown of fatty acids that occurs with diabetic ketoacidosis or starvation results in overproduction of hydrogen ions and metabolic acidosis. Anaerobic metabolism produces lactic acid as a cause of metabolic acidosis. Excessive intake of alcoholic beverages will also cause metabolic acidosis because of the high concentration of hydrogen ions in alcohol, but there is nothing in the question that states the patient has taken any alcohol. Excessive intake of insulin will not result in diabetic ketoacidosis. Test-Taking Tip: Read carefully, and answer the question asked; pay attention to Prolonged vomiting Anaerobic metabolism Excessive intake of insulin Excessive breakdown of fatty acids Excessive intake of alcoholic beverages Elsevier Adaptive Quizzing - Quiz performance 2 of 27 10/11/2022, 7:05 PM specific details in the question. p. 268 Which mechanism causes acidosis in a patient in diabetic ketoacidosis? Rationale In diabetic ketoacidosis, there is an excessive breakdown of fatty acids. This produces strong acids (ketoacids) with the release of large amounts of hydrogen ions. Underelimination of hydrogen ions occurs when hydrogen ions are produced at normal rates, but their elimination is reduced. This is seen in patients with lung and kidney problems. Bicarbonate ions are made in the kidney or in the pancreas. In patients with impaired kidney or pancreatic function, there is underproduction of bicarbonate ions, leading to acidosis. Overelimination of bicarbonate ions occurs when there is an excessive loss of bicarbonate ions. This occurs in diarrhea. p. 268 Which increased blood arterial level causes a compensatory increase in respiration rate? Overproduction of hydrogen ions Underelimination of hydrogen ions Overelimination of bicarbonate ions Underproduction of bicarbonate ions pH Lactate Bicarbonate Carbon dioxide Elsevier Adaptive Quizzing - Quiz performance 3 of 27 10/11/2022, 7:05 PM Rationale When the amount of carbon dioxide in arterial blood rises, the central nervous system compensates for the imbalance by increasing the rate and depth of breathing. An increased respiration rate is not a response to rising lactate, pH, or bicarbonate. Test-Taking Tip: Attempt to select the answer that is most complete and includes the other answers within it. For example, a stem might read, "A child's intelligence is influenced by:" and three options might be genetic inheritance, environmental factors, and past experiences. The fourth option might be multiple factors, which is a more inclusive choice and therefore the correct answer. p. 266 Which arterial blood gas laboratory values would be seen in metabolic alkalosis? Rationale In metabolic alkalosis, pH is greater than 7.45, and HCO is greater than 28. A pH of 7.28 and a CO of 54 indicates respiratory acidosis. A pH of 7.53 and a CO of 28 indicates respiratory alkalosis. A pH of 7.31 and an HCO of 18 indicates metabolic acidosis. p. 271 pH 7.49, bicarbonate (HCO ) 32 3 - pH 7.28, carbon dioxide (CO ) 2 54 pH 7.53, CO 28 2 pH 7.31, HCO 18 3 – 3 - 2 2 3 – Elsevier Adaptive Quizzing - Quiz performance 4 of 27 10/11/2022, 7:05 PM Deep and rapid breaths consistent with Kussmaul respiration are found in patients with which type of acid-base imbalance? Rationale In metabolic acidosis, the rate and depth of breathing increase as the hydrogen ion levels rise. The breathing pattern becomes deep and rapid and not under voluntary control. This type of breathing is known as Kussmaul respiration, which is not present in respiratory alkalosis, respiratory acidosis, or metabolic alkalosis. Test-Taking Tip: Because few things in life are absolute without exceptions, avoid selecting answers that include words such as always, never, all, every, and none. Answers containing these key words are rarely correct. p. 269 Which electrolyte abnormality would the nurse anticipate when reviewing laboratory data for a patient admitted with metabolic acidosis? Metabolic acidosis Metabolic alkalosis Respiratory acidosis Respiratory alkalosis Hyponatremia Hypernatremia Hypokalemia Hyperkalemia Elsevier Adaptive Quizzing - Quiz performance 5 of 27 10/11/2022, 7:05 PM Rationale Serum potassium (hyperkalemia) occurs during metabolic acidosis as the body attempts to maintain pH by moving potassium ions from the cell in exchange with hydrogen ions moving into the cell. Hypokalemia may occur as the cause of the metabolic acidosis is corrected. Sodium concentrations (hypernatremia and hyponatremia) are not affected in the buffering process of acid-base balance. Test-Taking Tip: Avoid spending excessive time on any one question. Most questions can be answered in 1 to 2 minutes. pp. 269-270 Which condition can cause metabolic acidosis? Select all that apply. One, some, or all responses may be correct. Rationale Diarrhea, liver failure, and kidney failure can result in metabolic acidosis. Prolonged vomiting and nasogastric suctioning may result in metabolic alkalosis. pp. 267, 272 Which physiologic imbalance is the patient at risk for developing if he or she has chronically low hemoglobin? Diarrhea Liver failure Kidney failure Prolonged vomiting Nasogastric suctioning Acidosis Elsevier Adaptive Quizzing - Quiz performance 6 of 27 10/11/2022, 7:05 PM Rationale Protein buffers, especially hemoglobin buffers, are the primary buffer of hydrogen ions. When there is less hemoglobin to buffer hydrogen ions, the body has a reduced ability to prevent acidosis. There is no information that suggests the patient is at risk for ineffective ventilation, hypokalemia, or alkalosis. Test-Taking Tip: Watch for grammatical inconsistencies. If one or more of the options is not grammatically consistent with the stem, the alert test taker can identify it as a probable incorrect option. When the stem is in the form of an incomplete sentence, each option should complete the sentence in a grammatically