Acid-Base Balance Practice Questions and Correct Answers with Rational

Acid-Base Balance Practice Questions and Correct Answers with Rational A patient had 5 liters of fluid removed during a paracentesis. What intravenous (IV) solution may be used to pull fluid into the intravascular space after the paracentesis? 0.9% sodium chloride 25% albumin solution Lactated Ringer's solution 5% dextrose in 0.45% saline - ANSWER 25% albumin solution After a paracentesis of 5 L or greater of ascites fluid, 25% albumin solution may be used as a volume expander. Normal saline, lactated Ringer's, and 5% dextrose in 0.45% saline will not be effective for this action. A nurse reviews the arterial blood gas results of a client and notes the following: pH 7.45, Pco2 of 30, and HCO3- of 22. The nurse analyzes these results as indicating which condition? 1) Metabolic Acidosis, compensated 2) Respiratory Alkalosis, compensated 3) Metabolic Alkalosis, compensated 4) Respiratory Acidosis, compensated - ANSWER Answer: 2 Rational: The normal pH is 7.3-7.45. In a respiratory condition, an opposite effect will be seen between the pH and the Pco2. In this condition, the pH is a the high end of normal and the Pco2 is low. In an alkalotic condition, the pH is elevated. Therefore the values identified in the question indicated a respiratory alkalosis. When the pH returns to a normal value, compensation has occurred. A nurse is caring for a client with a nasogastric tube that is attached to low suction. The nurse monitors the client, knowing that the client is at risk for which acid-base disorder? 1) Metabolic Acidosis 2) Metabolic Alkalosis 3) Respiratory Acidosis 4) Respiratory Alkalosis - ANSWER Answer: 2 Rational: Metabolic Alkalosis is defined as a deficit or loss of hydrogen ions or acids or an excess of base (bicarbonate) that results from the accumulation of base or from a loss of acid without a comparable loss of base in the body fluids. This occurs in conditions resulting in hypovolemia, the loss of gastric fluid, excessive bicarbonate intake, the massive transfusion of whole blood, and hyperaldosteronism. Loss of gastric fluid via nasogastric suction or vomiting causes Metabolic Alkalosis as a result of the loss of hydrochloric acid. Options 1, 3, & 4 are incorrect interpretations. A client with a 3-day history of nausea and vomiting presents to the emergency department. The client is hypoventilating and has a respiratory rate of 10 breaths/min. Arterial blood gases are drawn and the nurse reviews the results, expecting to note which of the following? 1) A decreased pH and an increased CO2 2) An increased pH and a decreased Co2 3) A decreased pH and a decreased HCO3- 4) An increased pH with an increased HCO3- - ANSWER Answer: 4 Rational: Clients experiencing nausea and vomiting would most likely present with metabolic alkalosis resulting from loss of gastric acid, thus causing the pH and HCO3- to increase. Symptoms experienced by the client would include hypventilation and tachycardia. Option 2 reflects a respiratory acidotic condition. Option 2 reflects a respiratory alkalotic condition. Option 3 reflects a metabolic acidotic condition. A nurse caring for a client with an ileostomy understands the the client is most at risk for developing which acid-base disorder? 1) Metabolic Acidosis 2) Metabolic Alkalosis 3) Respiratory Acidosis 4) Respiratory Alkalosis - ANSWER Answer: 1 Rational: Metabolic Acidosis is defined as total concentration of buffer base that is lower than normal, with a relative increase in the hydrogen ion concentration. This results from loss of buffer bases or the retention of too many acids without sufficient bases, and occurs in conditions such as renal failure, diabetic ketoacidosis, from the production of lactic acid, from the ingestion of toxins (such as acetylsalicylic acid -aka- aspirin), malnutrition, or severe diarrhea. Intestinal secretions are high in bicarbonate and may e lost through enteric drainage tubes or an ileostomy, or with diarrhea. These conditions result in metabolic acidosis. Options 2, 3, & 4 are incorrect interpretations and do not occur in the client with an ileostomy. **(Base/Bicarbonate is lost through an ileostomy)