NURS 3320 Chapter 40- Disorders of Acid-Base Balance

1. A male patient with a history of heavy alcohol use has been admitted to hospital for malnutrition and suspected pancreatitis. The patient's diagnostic workup suggests alcoholic ketoacidosis as a component of his current health problems. He is somewhat familiar with the effect that drinking has had on his nutrition and pancreas but is wholly unfamiliar with the significance of acid–base balance. How best could his care provider explain the concept to him? A) “The chemical processes that take place throughout your body are thrown off very easily when your body is too acidic or not acidic enough. B) “The multitude of chemical reactions that take place in your body depend on your body fluids being slightly acidic.” C) “The healthy function of your kidneys and your lungs requires a specific level of pH in your body.” D) “Your body is highly dependent on what food and fluid you consume to keep itself at a functioning level of slight nonacidity.” Ans: A Feedback: Metabolic activity is highly contingent on a narrow range of pH. Normal pH is slightly basic, not acidic, and appropriate pH is maintained by the lungs and kidneys, not vice versa. The action of the respiratory and renal systems, not particular food or fluid intake, has the most salient effect on the acid–base balance. 2. When explaining how carbon dioxide combines with water to form carbonic acid as part of acid–base lecture, the faculty instructor emphasized that which enzyme is needed as a catalyst for this reaction? A) Carbonic anhydrase B) Phenylalanie hdroxylase C) Hydrolases D) Trypsin Ans: A Feedback: Although CO2 is a gas and not an acid, a small percentage of the gas combines with water to form H2CO3. The reaction that generates H2CO3 from CO2 and water is catalyzed by an enzyme called carbonic anhydrase. 3. A 31-year-old client with a diagnosis of end-stage liver failure has been admitted to the intensive care unit of a hospital. Arterial blood sampling indicates that the man has an acid–base imbalance. Which of the following situations is most likely to result in an inappropriate pH? A) Conservation or formation of new HCO3– by the kidneys B) Low albumin and plasma globulin levels C) Transcompartmental exchange of H+ and potassium ions D) Renal excretion of HCO3– in the presence of excess base Ans: B Feedback: Albumin and plasma globulins are key protein buffers in the vascular compartment; consequently, a low albumin level, as is common in liver failure, is apt to result in acid–base imbalances. Answer choices A, C, and D all convey normal physiological processes that help to maintain pH. 4. A patient with ESRD comes into the emergency department in severe acidosis. The nurse notes that the respiratory rate is 36 breaths/minute. The nurse understands the pathophysiology of this response and explains to the student nurse that the patient's