NUR 2392/MDC II Multidimensional Care II EXAM 2 2024 LATEST EXAM QUESTION AND ANSWERS WITH RATIONALE
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Course
NUR 2392/MDC II Multidimensional Care II
Institution
NUR 2392/MDC II Multidimensional Care II
The nurse is evaluating the laboratory work of a patient who has uncontrolled metabolic
acidosis. Which outcome would result from this condition?
A.pH 7.40
B.Pao2 98 mm Hg
C.Bicarbonate 38 mEq/L
Serum potassium 5.7 mEq/L
ANS: D
Metabolic acidosis is reflected by several changes in ABG values...
NUR 2392/MDC II Multidimensional Care II EXAM 2 2024
LATEST EXAM QUESTION AND ANSWERS WITH RATIONALE
The nurse is evaluating the laboratory work of a patient who has uncontrolled metabolic
acidosis. Which outcome would result from this condition?
A.pH 7.40
B.Pao2 98 mm Hg
C.Bicarbonate 38 mEq/L
Serum potassium 5.7 mEq/L
ANS: D
Metabolic acidosis is reflected by several changes in ABG values. The pH is low (<7.35). The
bicarbonate level is low (<21 mEq/L). The partial pressure of arterial oxygen (Pao2) is normal
because gas exchange is adequate. The serum potassium level is often high in acidosis as the
body attempts to maintain electroneutrality during buffering.
The nurse is reviewing the standing orders for a patient who was admitted for evaluation of
chest pain. The patient has a history of chronic obstructive pulmonary disease (COPD) and his
laboratory results and assessment reveal that he has mild respiratory acidosis. The nurse would
question which order?
A.Encourage oral fluids
B.Keep head of bed elevated
C.Oxygen therapy at 4 L/min as needed
Bedrest with bathroom privileges only
ANS: C
The bedrest order will help the patient conserve energy. The upright position (mid-Fowler's to
high-Fowler's position) helps increase lung expansion. Increasing fluid intake may reduce the
thickness of lung secretions and assist in their removal. Oxygen therapy helps promote gas
exchange for patients with respiratory acidosis. However, use caution when giving oxygen to
patients with COPD and CO2 retention as evidenced by a high Paco2 level. The only breathing
trigger for these patients is a decreased arterial oxygen level. Giving too much oxygen to these
patients decreases their respiratory drive and may lead to respiratory arrest.
,What is the third line of defense against pH changes?
Kidneys
Acid-base Control Actions and Mechanisms: Kidney
-Stronger for regulation acid-base balance; takes longer than chemical and respiratory.
-Kidneys move bicarbonate.
-Formation of acids and ammonium
-Kidneys can correct/compensate for pH changes when respiratory system is overwhelmed or
unhealthy.
Compensation
Body attempts to correct blood pH chan
What pH is considered fatal?
<6.9
>7.8
What system is more sensitive to acid-base changes?
Respiratory system: can begin compensating in seconds to minutes.
Which system is more powerful when compensating?
Kidneys: can result in rapid changes in ECF composition. Fully triggered for imbalance of several hours to
days.
, List the 5 possible acid-base imbalances
Metabolic acidosis
Respiratory acidosis
Combined metabolic and respiratory acidosis
Metabolic alkalosis
Respiratory alkalosis
Molecular causes of Metabolic acidosis
Hydrogen ions: overproduction or under-elimination.
Bicarbonate ions: under productions or over elimination
Causes of metabolic acidosis
•Diabetic Ketoacidosis
•Renal failure
•Starvation
•Diarrhea
•Ileostomy
•Hyperthyroidism
•Pancreatitis
•Liver failure
•Dehydration
•Seizure activity
•Ethanol intoxication
•Aspirin toxicity
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