Acid-Base

Which of the following is not indicative that a patient may be in diabetic ketoacidosis?

A nurse is taking care of a patient who has been on longstanding total parenteral nutrition (TPN). The provider orders the TPN to be discontinued. Shortly after the TPN is stopped, the patient becomes altered and combative. The nurse attributes the change in this patient to which condition?

The nurse is assessing a patient with hypoparathyroidism. Which assessment finding does the nurse expect to see in this patient?

A teenager with type 1 diabetes mellitus presents to the emergency department with worsening illness, vomiting, and fatigue. Upon assessment, the nurse notes a sweet, fruity odor on the patient’s breath and suspects diabetic ketoacidosis (DKA). Which additional symptom(s) would confirm the diagnosis of diabetic ketoacidosis? Select all that apply.

A client with a history of severe diarrhea presents to the emergency department. Vital signs reveal a respiratory rate of 36 breaths per minute, heart rate 110 bpm, and blood pressure 90/60 mm Hg. Arterial blood gas results include: pH 7.30, PaCO2 29 mm Hg, PaO2 100 mm Hg, and HCO3- 21 mEq/L. How does the nurse interpret these findings?

Which finding in a client receiving a continuous magnesium sulfate infusion for preeclampsia indicates toxicity?

The patient presents to the emergency department with a probable cervical spinal cord injury following a diving accident one hour ago. The nurse anticipates this patient’s labs will most likely show which of the following acid-base disturbances?

The nurse is performing an electrocardiogram on a patient with rhabdomyolysis. The patient asks the nurse what the rationale is for this test, since he is young and has no cardiac history. Which of the following responses by the nurse is most appropriate?

A 75-year-old male patient presents with altered mental status and lethargy secondary to chronic severe hyponatremia due to syndrome of inappropriate antidiuretic hormone (SIADH). Which treatment is the most appropriate for this patient’s condition?

A patient presents to the emergency department with respiratory distress syndrome. The patient’s respiratory rate is 28 breaths per minute and oxygen saturation is 80% on room air. At the cellular level, the nurse knows which molecule is present in relative overabundance?

The nurse uses an understanding of which physiologic process to explain why the patient feels out of breath at high altitudes?

The provider orders hypertonic saline for a patient. The patient’s wife wants to know why this therapy is being given. Which of the following is the best statement regarding the rationale for this therapy?

A child with maple syrup urine disease presents to the emergency department with vomiting, diarrhea, lethargy and seizures for the past two days. Which of the following treatments should be started first for this patient?

The 42-year-old male patient presents with the following arterial blood gas results: pH = 7.29, PCO2 = 40 mmHg, HCO3- = 15 mmol/L. Additional laboratory results are significant for a sodium of 154 mEq/L, chloride of 120 mmol/L, a glucose of 245 mg/dL, albumin of 4 g/dL. Which of the following is the most accurate interpretation of these results?

The nurse is attempting to interpret the arterial blood gas results of an adult male patient with metabolic acidosis who has a bicarbonate (HCO3-) level of 18. Using the Winter formula, determine the expected pCO2 that would indicate this patient is compensating for the metabolic acidosis. Enter your answer using a whole number.

The nurse is assigned to a patient who has long-standing type 1 diabetes mellitus who is being hospitalized for severe pneumonia. During the course of the patient’s hospitalization, he acutely develops polydipsia, polyuria, fatigue, generalized weakness, abdominal pain and nausea, as well as significantly elevated blood glucose level, hyperkalemia, and urine ketones. Which of the following best describes this patient’s condition?

A nurse is assigned a patient who is scheduled for a thyroidectomy. Which one of the following electrolyte imbalances typically occur immediately post-procedure as a result of surgical error?

A patient in the ICU following a motor vehicle accident has been intubated for 72 hours. Over the previous 12 hours, the patient’s oxygen requirement has increased, tidal volumes have decreased, and the patient’s endotracheal secretions have increased in quantity, thickness, and the color has changed from cloudy to green. The patient’s lab values are significant for a worsening respiratory acidosis and leukocytosis. Which diagnosis is most appropriate for this patient?

The nurse is reviewing the arterial blood gas results of a patient in the ICU. They are as follows: pH = 7.30 PaCO2 = 52 mmHg PaO2 = 70 mmHg HCO3 = 24 mEq/L SaO2 = 90% How does the nurse interpret these results?

A patient’s arterial blood gas results are as follows: pH = 7.52 PaCO2 = 29 mmHg PaO2 = 94 mmHg HCO3 = 25 mEq/L SaO2 = 96% How does the nurse interpret these results?

A patient’s arterial blood gas results are as follows: pH = 7.50 PaCO2 = 40 mmHg PaO2 = 94 mmHg HCO3 = 32 mEq/L SaO2 = 96% How does the nurse interpret these results?

A patient’s arterial blood gas results are as follows: pH = 7.25 PaCO2 = 40 mmHg PaO2 = 94 mmHg HCO3 = 18 mEq/L SaO2 = 96% How does the nurse interpret these results?

A patient is undergoing continuous gastric decompression due to a bowel obstruction. Which arterial blood gas result indicates the patient is experiencing a complication of gastric decompression?

A patient presents to the emergency department after 4 days of severe diarrhea. Which arterial blood gas result indicates a complication of severe diarrhea?

A mechanically ventilated patient has an arterial blood gas result as follows: pH = 7.50 PaCO2 = 34 mmHg PaO2 = 70 mmHg HCO3 = 30 mEq/L The nurse anticipates which changes will be made to the patient’s ventilator settings?

The nurse is preparing to obtain an arterial blood gas sample from a patient. Which intervention does the nurse perform first?

A patient is brought to the emergency department unresponsive following an opioid overdose. The nurse anticipates the patient’s arterial blood gas results will reflect which condition?

A 3-day-old premature neonate was born at 24-weeks estimated gestational age. The patient is mechanically ventilated with a fraction of inspired oxygen (FiO2) of 30%, rate of 40 breaths per minute, positive end expiratory pressure of 5, and peak inspiratory pressure of 20. The arterial blood gas results are as follows: pH = 7.34, PaCO2 = 48 mmHg, PaO2 = 70 mmHg, and HCO3 = 25 mEq/L. The nurse anticipates which changes will be made to the patient’s ventilator settings?

A 13-year-old patient presents to the emergency department in a disoriented state with tachycardia, tachypnea, hypotension, and hypothermia. Upon assessment, the nurse notes the patient’s breath smells like acetone, the mucous membranes are dry, and the patient has poor skin turgor. The nurse knows which test is the priority?

A patient presents to the emergency department in diabetic ketoacidosis. The nurse is aware that which intervention is the priority?

A patient with type 1 diabetes mellitus has food poisoning and develops vomiting and anorexia. Which statement by the nurse is most important?

A child with type 1 diabetes is undergoing treatment for diabetic ketoacidosis. For which life-threatening complications of treatment should the nurse be vigilant? Select all that apply.

A patient with diabetic ketoacidosis who is undergoing fluid resuscitation and normal insulin infusion had a brief period of improved level of consciousness followed by a decrease in level of consciousness. Lab studies show the patient’s metabolic condition is improving. Which medication does the nurse anticipate administering to this patient immediately?

A nurse is performing tests to aid in the confirmation or exclusion of a stroke. Which tests may indicate the patient is experiencing a stroke mimic? Select all that apply.

The nurse is reviewing the lab results of a patient with heart failure and notes a sodium of 126 mEq/dL. Which action by the nurse would be appropriate, if agreed to by the provider?

The nurse notes the patient’s electrocardiogram shows peaked T waves with a prolonged PR interval. Which lab test does the nurse expect the provider to order?

A pregnant patient with pre-eclampsia is receiving a magnesium sulfate infusion. Which early symptom, if present in the patient, indicates the patient’s magnesium level is becoming toxic?

The nurse is caring for a patient who develops severe hyperkalemia accompanied by ECG changes. Which medication(s) does the nurse anticipate administering? Select all that apply.

The patient has experienced a subarachnoid hemorrhage. The nurse is vigilant for signs of which electrolyte imbalance?

The patient is receiving hydrochlorothiazide. Which arterial blood gas values indicate the patient is experiencing an adverse effect from this medication?

The nurse is reviewing the arterial blood gas results of a healthy 12-year-old patient in the emergency department in acute respiratory distress due to smoke inhalation during a house fire. Which lab value does the nurse anticipate from this patient?

The nurse on the telemetry floor is reviewing EKG readings of the patients. The nurse notes one patient, who is taking digoxin, to have peaked T waves and a prolonged PR interval. The nurse contacts the provider to report concerns for which possible impending condition?

Which finding is expected in the patient with diabetic ketoacidosis (DKA)?

Which statement by a patient with type 1 diabetes mellitus indicates understanding of teaching about the recommended diet?

The nurse receives report on a 76-year-old patient who is recovering from surgery for creation of an ileal pouch-anal anastomosis. The nurse plans care to prevent which complication that is most specific to this patient?

The patient with type I diabetes mellitus has contracted influenza A. Which lab must be most closely monitored in this patient to prevent a life-threatening complication?

Which nursing intervention is the highest priority for the patient admitted with a chronic obstructive pulmonary disease (COPD) exacerbation?

The patient with chronic malnourishment is started on total parenteral nutrition (TPN). The nurse is vigilant for signs of which complication?

The patient with tears of the right medial meniscus asks the nurse about the use of therapeutic massage. Which response by the nurse is appropriate?

Which lab value is most concerning for a patient who is being treated for hyperosmolar hyperglycemic nonketotic syndrome (HHNS)?