NURSING 101 Pathophysiology Practice with Answers & Rationale

NURSING 101 Pathophysiology Practice with Answers & Rationale Question 1: (see full question) The nurse is caring for a client with renal failure experiencing shortness of breath and increased respiratory rate. The arterial blood gas reflects a pH of 7.10 and a HCO3 level of 18 mEq/L. How does the nurse interpret these findings? You selected: Metabolic acidosis Correct Explanation: Metabolic acidosis would be diagnosed based on the findings related to a low pH level and a low bicarbonate level. The other conditions would not result from the findings provided (more) Reference: Grossman S, Porth CM (2014). Porth’s Pathophysiology: Concepts of Altered Health States. 9th ed. Philadelphia: Lippincott Williams & Wilkins, Chapter 40, Disorders of Acid-Base Balance, p. 1071. Question 2: (see full question) When interpreting the arterial blood gas, the nurse recognizes which of these reflects the value for bicarbonate? You selected: HCO3- Correct Explanation: Bicarbonate is abbreviated as HCO3. H2CO3 is the abbreviation for carbonic acid, HCl is the abbreviation for hydrochloric acid, and H+ is the abbreviation for hydrogen (more) Reference: Grossman S, Porth CM (2014). Porth’s Pathophysiology: Concepts of Altered Health States. 9th ed. Philadelphia: Lippincott Williams & Wilkins, Chapter 40, Disorders of Acid-Base Balance, p. 1072. Question 3: (see full question) A client's most recent laboratory results suggest the presence of metabolic alkalosis. What action by the nurse best addresses a potential cause of this acid-base imbalance? You selected: Administering an antiemetic to treat the client's frequent vomiting Correct Explanation: Vomiting results in the loss of hydrogen ions, potentially resulting in metabolic alkalosis. Constipation and skin breakdown are not among the most common causes of metabolic alka ... (more) Reference: Grossman S, Porth CM (2014). Porth’s Pathophysiology: Concepts of Altered Health States. 9th ed. Philadelphia: Lippincott Williams & Wilkins, Chapter 40, Disorders of Acid-Base Balance, p. 1076. Question 4: (see full question) The nurse recognizes the role of the lungs in acid-base balance is regulation of which of the following? You selected: CO2 Correct Question 5: (see full question) A client has these arterial blood gas values: anion gap 20 mEq/L, pH 7.29, pCO2 37mm Hg, HCO3- 11 mEq/L, base excess -6 mEq/L. With what condition do these values correspond? You selected: Lactic acidosis Correct Explanation: Anion gap (AG) is the difference between the plasma concentration of sodium ions and the sum of the measured anions (chloride and bicarbonate). Normally, the AG value should be bet ... (more) Reference: Grossman S, Porth CM (2014). Porth’s Pathophysiology: Concepts of Altered Health States. 9th ed. Philadelphia: Lippincott Williams & Wilkins, Chapter 40, Disorders of Acid-Base Balance, pp. , 1072. Question 6: (see full question) The nurse is reviewing the following lab results of a client diagnosed with renal failure: pH: 7.24 PCO2: 38 mm Hg HCO3:18 mEq/L The nurse would interpret this as: You selected: Metabolic alkalosis Incorrect Correct response: Metabolic acidosis Explanation: Metabolic acidosis would be diagnosed based on the findings related to a low pH level ( ... (more) Reference: Grossman S, Porth CM (2014). Porth’s Pathophysiology: Concepts of Altered Health States. 9th ed. Philadelphia: Lippincott Williams & Wilkins, Chapter 40, Disorders of Acid-Base Balance, p. 1071. Question 7: (see full question) What is the nurse’s expectation about a client’s ability to compensate for a metabolic blood gas disorder? You selected: The client will compensate with the respiratory system. Correct Explanation: The one thing that a nurse can expect is that a client with a metabolic disorder will compensate with the respiratory system. The client cannot compensate with the same system. The ... (more) Reference: Grossman S, Porth CM (2014). Porth’s Pathophysiology: Concepts of Altered Health States. 9th ed. Philadelphia: Lippincott Williams & Wilkins, Chapter 40, Disorders of Acid Base Balance, p. 1071. Question 8: (see full question) A client with ethylene glycol toxicity is restless, and stating he has flank pain. What intervention should the nurse perform to minimize complications? You selected: Increase IV fluids Correct Question 9: (see full question) A 77-year-old woman has been brought to the emergency department by her daughter because of a sudden and unprecedented onset of confusion. The client admits to ingesting large amounts of baking soda this morning to treat some “indigestion.” How will the woman's body attempt to resolve this disruption in acid–base balance? You selected: Increased renal HCO3- reabsorption Incorrect Correct response: Hypoventilation Explanation: When neurologic manifestations occur with metabolic alkalosis, they include mental confusion, hyperactive reflexes, tetany, and carpopedal spasm. Respiratory compensation will take ... (more) Reference: Grossman S, Porth CM (2014). Porth’s Pathophysiology: Concepts of Altered Health States. 9th ed. Philadelphia: Lippincott Williams & Wilkins, Chapter 40, Disorders of Acid-Base Balance, p. 1076. Question 10: (see full question) The nurse is caring for the following group of clients. Select the client most likely to be diagnosed with respiratory alkalosis. You selected: A 26-year-old female with anxiety who has been hyperventilating Correct Explanation: Respiratory alkalosis can occur with hyperventilating and the loss of CO2.The other three clients are more at risk for respiratory acidosis as a result of retaining CO2 (more) Question 1: (see full question) The nurse is caring for a client with acute primary respiratory acidosis. When determining the cause of the acidosis the nurse is aware that which of these is most common? You selected: Impaired alveolar ventilation Correct Explanation: Acute respiratory acidosis is frequently caused by impaired alveolar ventilation with CO2 retention. Increased metabolic acids, such as lactic acid, are characteristic of metabolic ... (more) Reference: Grossman S, Porth CM (2014). Porth’s Pathophysiology: Concepts of Altered Health States. 9th ed. Philadelphia: Lippincott Williams & Wilkins, Chapter 40, Disorders of Acid-Base Balance, p. 1071. Question 2: (see full question) As other mechanisms prepare to respond to a pH imbalance, immediate buffering is a result of increased: You selected: Bicarbonate/carbonic acid regulation Correct Explanation: The bicarbonate buffering system, which is the principal ECF buffer, uses H2CO3 as its weak acid and bicarbonate salt such as sodium bicarbonate (NaHCO3) as its weak base. It subst ... (more) Reference: Grossman S, Porth CM (2014). Porth’s Pathophysiology: Concepts of Altered Health States. 9th ed. Philadelphia: Lippincott Williams & Wilkins, Chapter 40, Disorders of Acid-Base Balance, p. 1063. Question 3: (see full question) A client has been admitted to the hospital after losing 20 kg (44 lb) over the past 3 months, largely due to frequent induction of vomiting. What intervention should the nurse anticipate in the treatment of the client's resulting acid-base imbalance? You selected: Fluid replacement with an intravenous solution containing KCl as prescribed Correct Explanation: Vomiting ultimately results in the increase in pH that constitutes metabolic alkalosis; intravenous KCl solutions are a mainstay of treatment for this acid- base imbalance. Respirat ... (more) Question 4: (see full question) The nurse is caring for a client with metabolic alkalosis. Which of these arterial blood gas results supports this diagnosis? You selected: pH of 7.50 and HCO3 of 45 mEq/L Correct Explanation: Metabolic alkalosis is diagnosed based on increased pH and HCO3 levels, which is represented in the first option. pH of 7.25 and HCO3 of 18 mEq/L represents metabolic acidosis, whil ... (more) Reference: Grossman S, Porth CM (2014). Porth’s Pathophysiology: Concepts of Altered Health States. 9th ed. Philadelphia: Lippincott Williams & Wilkins, Chapter 40, Disorders of Acid-Base Balance, p. 1071 Question 5: (see full question) The nurse caring for a client with respiratory acidosis examines arterial blood gas (ABG) results. Which change from the initial value indicates the client’s respiratory acidosis is improving? You selected: CO2 has decreased Correct Explanation: In respiratory acidosis, the client has a net gain of carbon dioxide (CO2) which creates a drop in pH. The pH needs to move away from acidosis, which is the low end of the pH scale ... (more) Reference: Grossman S, Porth CM (2014). Porth’s Pathophysiology: Concepts of Altered Health States. 9th ed. Philadelphia: Lippincott Williams & Wilkins, Chapter 40, Disorders of Acid-Base Balance, pp. . Question 6: (see full question) To calculate the H2CO3 content of the blood, the nurse needs to measure the Pco2 (partial pressure of CO2) by its solubility coefficient. What is the solubility coefficient of CO2? You selected: 0.3 Incorrect Correct response: 0.03 Question 7: (see full question) A client has these arterial blood gas values: anion gap 20 mEq/L, pH 7.29, pCO2 37mm Hg, HCO3- 11 mEq/L, base excess -6 mEq/L. With what condition do these values correspond? You selected: Hyperkalemia Incorrect Correct response: Lactic acidosis Explanation: Anion gap (AG) is the difference between the plasma concentration of sodium ions and the sum of the measured anions (chloride and bicarbonate). Normally, the AG value should be bet ... (more) Reference: Grossman S, Porth CM (2014). Porth’s Pathophysiology: Concepts of Altered Health States. 9th ed. Philadelphia: Lippincott Williams & Wilkins, Chapter 40, Disorders of Acid-Base Balance, pp. , 1072. Question 8: (see full question) A client with ethylene glycol toxicity is restless, and stating he has flank pain. What intervention should the nurse perform to minimize complications? You selected: Encourage ambulation Incorrect Correct response: Increase IV fluids Explanation: Symptoms of ethylene glycol toxicity appear in stages. Within the first 12 hours, the client may appear drunk or comatose. In the second stage the client may develop tachycardia or ... (more) Reference: Grossman S, Porth CM (2014). Porth’s Pathophysiology: Concepts of Altered Health States. 9th ed. Philadelphia: Lippincott Williams & Wilkins, Chapter 40, Disorders of Acid-Base Balance, p. 1074. Question 9: (see full question) In which client would the nurse be most likely to assess the signs and symptoms of an acid-base imbalance? You selected: A client with chronic obstructive pulmonary disease whose most recent arterial blood gasses reveal a PCO2 of 51 mm Hg Correct Explanation: An elevated PCO2 is commonly associated with respiratory acidosis because excess CO2 ultimately increases the concentration of H+ ions. Increased intracranial pressure, oxytocin in ... (more) Reference: Grossman S, Porth CM (2014). Porth’s Pathophysiology: Concepts of Altered Health States. 9th ed. Philadelphia: Lippincott Williams & Wilkins, Chapter 40, Disorders of Acid-Base Balance, p. 1069. Question 10: (see full question) The nurse is assessing blood gas results for a patient with diabetes and ketoacidosis and notes a pH level of 7.15. Which of the following dysrhythmias should the nurse closely monitor while treating this patient? You selected: First-degree heart block Incorrect Correct response: Ventricular tachycardia Question 1: (see full question) A client with a long history of alcohol abuse has been admitted to the emergency department after several of days of heavy drinking. The nurse can best promote the restoration of the client's acid-base balance by: You selected: encouraging pursed lip breathing and deep breathing and coughing exercises. Incorrect Correct response: administering intravenous sodium bicarbonate as prescribed. Explanation: Sodium bicarbonate is among the more common treatments for the metabolic acidosis that results for high alcohol intake. Breathing exercises do not have appreciable effect, though r ... (more) Reference: Grossman S, Porth CM (2014). Porth’s Pathophysiology: Concepts of Altered Health States. 9th ed. Philadelphia: Lippincott Williams & Wilkins, Chapter 40, Disorders of Acid-Base Balance, p. 1076. Question 2: (see full question) The nurse is caring for a client who has developed hypoxemia and tissue hypoxia. Which of these interventions does the nurse set as a priority intervention? You selected: Administration of supplemental oxygen Correct Explanation: Hypoxia and hypoxemia may be corrected by administration of supplemental oxygen. People with hyperventilation may benefit from reassurance, rebreathing from a paper bag during sym ... (more) Reference: Grossman S, Porth CM (2014). Porth’s Pathophysiology: Concepts of Altered Health States. 9th ed. Philadelphia: Lippincott Williams & Wilkins, Chapter 40, Disorders of Acid-Base Balance, p. 1080. Question 3: (see full question) The renal control mechanism of restoring the acid-base balance is accomplished through which process? You selected: Reabsorption of HCO3 and excretion of H+ restores acid-base balance through the renal control mechanisms. Correct Explanation: Reabsorption of HCO3 and excretion of H+ restores acid-base balance through the renal control mechanisms. Respiratory control mechanisms of restoring acid-base balance are done via ... (more) Question 4: (see full question) The nurse is evaluating a client’s blood gases. The client has a pH of 7.35. How does the nurse interpret this value? You selected: It indicates acidosis. Incorrect Correct response: It is within a normal range. Explanation: The normal body range of pH is 7.35 to 7.45. The other answers are incorrect. An acidotic value would be indicated by a pH less than 7.35 and an alkalotic level would be indicated ... (more) Reference: Grossman S, Porth CM (2014). Porth’s Pathophysiology: Concepts of Altered Health States. 9th ed. Philadelphia: Lippincott Williams & Wilkins, Chapter 40, Disorders of Acid-Base Balance, p. 1070. Question 5: (see full question) A client's most recent laboratory results suggest the presence of metabolic alkalosis. What action by the nurse best addresses a potential cause of this acid-base imbalance? You selected: Assessing the client's bowel sounds and administering scheduled stool softeners Incorrect Correct response: Administering an antiemetic to treat the client's frequent vomiting Explanation: Vomiting results in the loss of hydrogen ions, potentially resulting in metabolic alkalosis. Constipation and skin breakdown are not among the most common causes of metabolic alka ... (more) Reference: Grossman S, Porth CM (2014). Porth’s Pathophysiology: Concepts of Altered Health States. 9th ed. Philadelphia: Lippincott Williams & Wilkins, Chapter 40, Disorders of Acid-Base Balance, p. 1076. Question 6: (see full question) The body regulates the pH of its fluids by what mechanism? (Select all that apply.) You selected: • Chemical buffer systems of the body fluids • The kidneys • The liver Incorrect Correct response: • Chemical buffer systems of the body fluids • The lungs • The kidneys Explanation: The pH of body fluids is regulated by three major mechanisms: (1) chemical buffer systems of the body fluids, which immediately combine with excess acids or bases to prevent ... (more) Question 7: (see full question) A client has been diagnosed with metabolic acidosis. What assessment finding does the nurse expect? You selected: Increased PC02 above 45 mm/hg Incorrect Correct response: Decreased pH below 7.35 Explanation: In metabolic acidosis, the client's pH will decrease below 7.35 or normal range. In addition , the client's HC03- will decrease to below 22 mEq/L. Reference: Grossman S, Porth CM (2014). Porth’s Pathophysiology: Concepts of Altered Health States. 9th ed. Philadelphia: Lippincott Williams & Wilkins, Chapter 40, Disorders of Acid-Base Balance, p. 1070. Question 8: (see full question) A client with chronic obstructive pulmonary disease (COPD) receives oxygen in the emergency department at a rate of 4 L/min for acute respiratory distress. Later, the nurse finds the client unresponsive with a respiratory rate of 8/minute. What ABG values would the nurse expect to obtain? You selected: pH 7.41, pCO2 39mm Hg, HCO3- 23 mEq/L, pO2 91mm Hg Incorrect Correct response: pH 7.29, pCO2 67mm Hg, HCO3- 26 mEq/L, pO2 64mm Hg Explanation: The respiratory center in clients with COPD may have lost sensitivity to carbon dioxide (CO2) as a result of their disease. Thus, hypoxia becomes the stimulus to breathe. When give ... (more) Reference: Grossman S, Porth CM (2014). Porth’s Pathophysiology: Concepts of Altered Health States. 9th ed. Philadelphia: Lippincott Williams & Wilkins, Chapter 40, Disorders of Acid-Base Balance, pp. . Question 9: (see full question) To calculate the H2CO3 content of the blood, the nurse needs to measure the Pco2 (partial pressure of CO2) by its solubility coefficient. What is the solubility coefficient of CO2? You selected: 0.03 Correct Explanation: The H2CO3 content of the blood can be calculated by multiplying the partial pressure of CO2 (Pco2) by its solubility coefficient, which is 0.03. Reference: Grossman S, Porth CM (2014). Porth's Pathophysiology: Concepts of Altered Health States. 9th ed. Philadelphia: Lippincott Williams & Wilkins, Chapter 40: Disorders of Acid-Base Balance, p. 1064. Question 10: (see full question) As other mechanisms prepare to respond to a pH imbalance, immediate buffering is a result of increased: You selected: Hydrogen/potassium binding Incorre ct Correct respons e: Bicarbonate/carbonic acid regulation Explana tion: The bicarbonate buffering system, which is the principal ECF buffer, uses H2CO3 as its weak acid and bicarbonate salt such as sodium bicarbonate (NaHCO3) as its weak base. It subst ... (more) Question 2: (see full question) There are both metabolic and respiratory effects on the acid–base balance in the body. How do metabolic disorders change the pH of the body? You selected: Alter the plasma Hco3– Correct Explanation: Metabolic disorders produce an alteration in the plasma HCO3– concentration and result from the addition or loss of nonvolatile acid or alkali to or from the extracell ... (more) Reference: Grossman S, Porth CM (2014). Porth's Pathophysiology: Concepts of Altered Health States. 9th ed. Philadelphia: Lippincott Williams & Wilkins, Chapter 40: Disorders of Acid-Base Balance, p. 1071. Question 3: (see full question) The renal control mechanism of restoring the acid-base balance is accomplished through which process? You selected: Reabsorption of HCO3 and excretion of H+ restores acid-base balance through the renal control mechanisms. Correct Explanation: Reabsorption of HCO3 and excretion of H+ restores acid-base balance through the renal control mechanisms. Respiratory control mechanisms of restoring acid-base balance are done via ... (more) Reference: Grossman S, Porth CM (2014). Porth’s Pathophysiology: Concepts of Altered Health States. 9th ed. Philadelphia: Lippincott Williams & Wilkins, Chapter 40, Disorders of Acid-Base Balance, p. 1068. Question 4: (see full question) Which conditions could cause the anion gap to fall below normal? Select all that apply. You selected: • Lithium intoxication • Ketoacidosis • Hyperkalemia Incorrect Correct response: • Hyperkalemia • Lithium intoxication • Multiple myeloma Explanation: Anion gap (AG) is the difference between the plasma concentration of sodium ions and the sum of the measured anions (chloride and bicarbonate). Normally, the AG value should be bet ... (more) Question 5: (see full question) The nurse caring for a client with respiratory alkalosis examines arterial blood gas (ABG) results. Which change from the initial value indicates the client’s respiratory alkalosis is improving? You selected: pH has decreased Correct Explanation: In respiratory alkalosis, the client has a net loss of carbon dioxide (CO2) which creates a rise in pH. The pH needs to move away from alkalosis, which is the high end of the pH sc ... (more) Reference: Grossman S, Porth CM (2014). Porth’s Pathophysiology: Concepts of Altered Health States. 9th ed. Philadelphia: Lippincott Williams & Wilkins, Chapter 40, Disorders of Acid-Base Balance, pp. . Question 6: (see full question) The physician is treating a client in lactic acidosis due to cardiac arrest. Which of the following treatments will be effective in correcting this acidosis? You selected: Administration of sodium bicarbonate Incorrect Correct response: Treatments to improve tissue perfusion and oxygenation