MDC 2 Exam 2 Questions with Verified Answers

Normal pH values - Answer- 7.35-7.45 How does the respiratory system compensate for acid-base imbalances? - Answer- Hyperventilation and hypoventilation What body system compensates for acid-base imbalances of metabolic origin? - Answer- Lungs Which body system is most sensitive to acid-base changes? - Answer- Respiratory system How quickly does the respiratory system begin to compensate for changes in the acid-base balance? - Answer- Seconds to minutes What is the pathophysiology for acidosis? - Answer- There is an excess of H+ ions What is the pH level when it is acidic? - Answer- Below 7.35 What is the normal PaCO2 level? - Answer- 45 - 35 What is the normal PO2 level? - Answer- 80-100 mmHg What is the normal HCO3 level? - Answer- 22-26 mEq/L What are the signs and symptoms of metabolic acidosis? - Answer- Headache Decreased BP (Hypotension) Decreased HR (Bradycardia) Decreased LOC Hyperkalemia Muscle twitching Nausea/ vomiting/ diarrhea Kussmaul respirations Warm, flushed dry skin What causes respiratory acidosis? - Answer- Respiratory depression Inadequate chest expansion Airway obstruction Reduced avelor-capillary diffusion What diseases/ illnesses commonly cause respiratory acidosis? - Answer- COPD Pneumonia Asthma Drug overdose What are the signs and symptoms of respiratory acidosis? - Answer- Hypoventilation leading to hypoxia Rapid, shallow respirations Dyspnea Decreased HR (Bradycardia, thready & weak pulse) Hyperkalemia Headache Decreased LOC (lethargy, confusion, disorientation) Decreased BP with vasodilation (hypotension) Dysrhythmia Pale to cyanotic dry skin (Low & Slow) What is the priority problem for a patient experiencing respiratory acidosis? - Answer- Reduced gas exchange What are the treatments for respiratory acidosis? - Answer- Bronchodilators Oxygen therapy Pulmonary hygiene Ventilation support What does the body do to compensate for respiratory acidosis? - Answer- Increases respirations to increase pH What is the pathophysiology of alkalosis? - Answer- Decrease in free H+ ions Blood pH above 7.45 What is the first step when interpreting ABG? - Answer- Look at pH to determine if acidosis or alkalosis What acid-base imbalance would be expected from an asthmatic patient? - Answer- Respiratory acidosis What is the primary nursing diagnosis for a patient with respiratory acidosis? - Answer- Impaired gas exchange What are the primary causes for metabolic acidosis? - Answer- Aspirin toxicity/ overdose Excessive NaHCO3 Kidney failure, liver failure, pancreatitis Diabetic ketoacidosis Diarrhea What are the primary causes of respiratory alkalosis? - Answer- Hyperventilation/ tachypnea from anxiety, fear, fever Improper vent settings CNS lesions Excess loss of CO2 Signs and Symptoms of alkalosis (Respiratory and Metabolic are the same) - Answer- Hypocalcemia Hypokalemia Positive Chvostek's and Trousseau's signs Hyperreflexia, Tetany Tachypnea, tachycardia, fever, increased rate and depth of ventilation Tremors, muscle cramps, paresthesia What are the treatments for respiratory alkalosis? - Answer- Encourage coughing and deep breathing Ventilation Treat the underlying cause Restore fluid and electrolyte balance Monitor changes and provide safety Stop any gastric suctioning The body will compensate by increasing acidity What are the treatments for metabolic acidosis? - Answer- Administer sodium bicarbonate Administer insulin (if treating DKA) Replace fluids and electrolytes Treat the underlying cause What is the priority nursing intervention for metabolic acidosis? - Answer- Provide nutritional support What happens to potassium levels in acidosis? - Answer- K+ levels increase in acidosis What are the primary causes of metabolic alkalosis? - Answer- Loss of gastric secretions Overuse of antacids K+ wasting diuretics Prolonged NG suction Increased bases/ decreased acids What acid-base imbalances can be caused by aspirin? - Answer- Respiratory alkalosis Metabolic acidosis What intervention does not treat metabolic acidosis? - Answer- Mechanical ventilation How does the EKG change with metabolic acidosis? - Answer- Tall/ peaked T waves Wide QRS complex Prolonged PR interval What are the nursing interventions for metabolic acidosis? - Answer- Monitor electrolytes and ABG (Especially K+) Monitor for neurological decline Monitor I&O Enact seizure precautions Drug therapy- insulin, rehydration, antidiarrheal, bicarbonate if pH is less than 7.2 What is the acid-base imbalance when the pH is low and the CO2 is high? - Answer- Respiratory acidosis What is the acid-base imbalance when the pH is low and the HCO3 is low? - Answer- Metabolic acidosis What is the acid-base imbalance when the pH is high and the CO2 is low? - Answer- Respiratory alkalosis What is the acid-base imbalance when the pH is high and the HCO3 is high? - Answer- Metabolic alkalosis What is the compensation level when the pH and one other value are abnormal? - Answer- Uncompensated What is the compensation level when the pH is normal and the other 2 values are abnormal? - Answer- Fully compensated What is the compensation when all three values are abnormal? - Answer- Partially compensated Which patient statement alerts the nurse to perform a thorough GI history and focused assessment? A."I don't like the taste of spicy foods." B."I got dentures four years ago." C."I experience occasional constipation." D."I take ibuprofen three times daily for arthritis." - Answer- ANS: D Large amounts of aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, can predispose the patient to peptic ulcer disease and GI bleeding. After abdominal surgery, which question should the nurse ask the patient to determine whether peristaltic movement is returning? - Answer- "Have you passed flatus?" Evidence indicates that the patient's report of passing flatus is the best indicator of whether peristaltic movement is returning after surgery. When administering a new GI medication to an older patient, the nurse anticipates what? - Answer- Close monitoring is needed because toxic levels may develop. What patient is most at risk for developing stomatitis? - Answer- A cancer patient without access to dental care A patient is scheduled to start chemotherapy. What oral cavity problem does the nurse teach the patient that may occur? A. Stomatitis B. Candidiasis C. Xerostomia D. Oral abscess - Answer- A. Stomatitis What is the treatment for GERD? - Answer- Sit upright for one hour after eating PPIs Limit fried, fatty, and spicy foods Limit caffeine Consume small, frequent meals What is a surgical complication for oral cancer? - Answer- The airway may need an endotracheal tube Who are the members of the interprofessional team that collaborates to care for patients with upper GI problems? - Answer- Health care provider Nurse Surgeon Dietician Spiritual leader What tests are used to diagnose hernias? - Answer- Barium swallow study with fluoroscopy is the most specific test for diagnosing hiatal hernias EGD may be performed to visualize sliding hernias What is the common endings for PPIs? - Answer- -azole What are the treatment options for hiatal hernia? - Answer- Antacids and PPIs Lose weight Lapraroscopic Nissen fundoplication (LNF) surgery Deep breath and use incentive spironometer Elevate head of bed Support incisions What are the primary factors for esophageal cancer? - Answer- Obesity and smoking What is the condition that is premalignant to esophageal cancer? - Answer- Barrett's esophagus What is the most common symptom of esophageal cancer? - Answer- Dysphagia What is the priority patient teaching for esophageal cancer? - Answer- Monitor weight for weight loss What is the most common upper GI test? - Answer- EGD What type of pain may occur with GERD or a hiatal hernia? - Answer- Chest pain What is the effect of CPAP treatment on GERD? - Answer- CPAP treatment can improve sleeping and decrease reflux episodes at night Are antacids considered a long-term GERD therapy? - Answer- No. Antacids may be effective for occasional episodes of heartburn discomfort. They should not be used long-term because they increase LES pressure, their length of action is too short, and they are not very effective at night What type of medication is aluminum hydroxide? - Answer- Antacid Which type of medications are the main treatment for severe GERD? - Answer- PPI What is the minimally invasive surgery for GERD called? - Answer- Laparoscopic Nissen fundoplication (LNF) What can increase reflux symptoms? - Answer- Bending or lying down Coughing Obesity Does hiatal hernia symptoms get better or worse with meals? - Answer- Worse What is the primary focus of care after conventional surgery for a hiatal hernia repair? - Answer- Prevent reparatory complications -Elevate head of bed -Begin ambulation ASAP -Support the incision when coughing to reduce pain and prevent excessive strain on the suture line How often should the nurse check an NG tube after surgery? - Answer- Every 4 to 8 hours What is the earliest sign of oral carcinoma? - Answer- Mucosal erythroplasia What is the main complication with oral cancer surgery? - Answer- The patient may have a tracheostomy which requires intensive nursing care to promote airway clearance. What is xerostomia? - Answer- Dry mouth What is gastritis? - Answer- Inflammation of the gastric mucosa (stomach lining) What bacteria can cause gastritis? - Answer- Helicobacter pylori How is gastritis diagnosed? - Answer- EGC via endoscope What are the key patient education points for peptic ulcer disease ? - Answer- Limit caffeine Avoid highly acidic foods Avoid alcohol and tobacco Teach stress reduction techniques