A client is diagnosed with metabolic acidosis, which would the nurse expect the health care provider to order?
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Solution
Sodium bicarbonate
Metabolic acidosis results from excessive absorption or retention of acid or excessive excretion of bicarbonate. A base is needed. Sodium bicarbonate is a base and is used to treat documented metabolic acidosis. Potassium, serum sodium determinations, and a bronchodilator would be inappropriate orders for this client.
Mr. Salcedo has the following arterial blood gas (ABG) values: pH of 7.34, partial pressure of arterial oxygen of 80 mm Hg, partial pressure of arterial carbon dioxide of 49 mm Hg, and a bicarbonate level of 24 mEq/L. Based on these results, which intervention should the nurse implement?
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Solution
Encouraging the client to cough and deep breathe
The ABG results indicate respiratory acidosis requiring improved ventilation and increased oxygen to the lungs. Coughing and deep breathing can accomplish this. The nurse would administer high oxygen levels because the client does not have chronic obstructive pulmonary disease. Breathing into a paper bag is appropriate for a client hyperventilating and experiencing respiratory alkalosis. Some action is necessary, because the ABG results are not within normal limits.
Joshua is receiving furosemide and Digoxin, which laboratory data would be the most important to assess in planning the care for the client?
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Solution
Potassium level
Diuretics such as furosemide may deplete serum potassium, leading to hypokalemia. When the client is also taking digoxin, the subsequent hypokalemia may potentiate the action of digoxin, placing the client at risk for digoxin toxicity. Diuretic therapy may lead to the loss of other electrolytes such as sodium, but the loss of potassium in association with digoxin therapy is most important. Hypocalcemia is usually associated with inadequate vitamin D intake or synthesis, renal failure, or use of drugs, such as aminoglycosides and corticosteroids. Hypomagnesemia generally is associated with poor nutrition, alcoholism, and excessive GI or renal losses, not diuretic therapy.
Which clinical manifestation would lead the nurse to suspect that a client is experiencing hypermagnesemia?
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Solution
Hot, flushed skin and diaphoresis
Hypermagnesemia is manifested by hot, flushed skin and diaphoresis. The client also may exhibit hypotension, lethargy, drowsiness, and absent deep tendon reflexes. Muscle pain and acute rhabdomyolysis are indicative of hypophosphatemia. Soft-tissue calcification and hyperreflexia are indicative of hyperphosphatemia. Increased respiratory rate and depth are associated with metabolic acidosis.
Which electrolyte would the nurse identify as the major electrolyte responsible for determining the concentration of the extracellular fluid?
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Solution
Sodium
Sodium is the electrolyte whose level is the primary determinant of the extracellular fluid concentration. Sodium a cation (e.g., positively charged ion), is the major electrolyte in extracellular fluid. Chloride, an anion (e.g., negatively charged ion), is also present in extracellular fluid, but to a lesser extent. Potassium (a cation) and phosphate (an anion) are the major electrolytes in the intracellular fluid.
Genevieve is diagnosed with hypomagnesemia, which nursing intervention would be appropriate?
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Solution
Instituting seizure precaution to prevent injury
Instituting seizure precaution is an appropriate intervention, because the client with hypomagnesemia is at risk for seizures. Hypophosphatemia may produce changes in granulocytes, which would require the nurse to instruct the client about measures to prevent infection. Avoiding the use of a tight tourniquet when drawing blood helps prevent pseudohyperkalemia. Early ambulation is recommended to reduce calcium loss from bones during hospitalization.
Which client situation requires the nurse to discuss the importance of avoiding foods high in potassium?
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Solution
Albert who has renal disease
Clients with renal disease are predisposed to hyperkalemia and should avoid foods high in potassium. Clients receiving diuretics, with ileostomies, or with metabolic acidosis may be hypokalemic and should be encouraged to eat foods high in potassium.
A client with very dry mouth, skin and mucous membranes is diagnosed of having dehydration. Which intervention should the nurse perform when caring for a client diagnosed with fluid volume deficit?
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Solution
Assessing urinary intake and output
For the client with fluid volume deficit, assessing the client’s urine output (using a urometer if necessary) is essential to ensure an output of at least 30 ml/hour. The client should be weighed daily, not weekly, and at same time each day, usually in the morning. Monitoring ABGs is not necessary for this client. Rather, serum electrolyte levels would most likely be evaluated. The client also would have an I.V. rate at least 75 ml/hour, if not higher, to correct the fluid volume deficit.
Mang Teban has a history of chronic obstructive pulmonary disease and has the following arterial blood gas results: partial pressure of oxygen (PO2), 55 mm Hg, and partial pressure of carbon dioxide (PCO2), 60 mm Hg. When attempting to improve the client’s blood gas values through improved ventilation and oxygen therapy, which is the client’s primary stimulus for breathing?
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Solution
Low PO2
A chronically elevated PCO2 level (above 50 mmHg) is associated with inadequate response of the respiratory center to plasma carbon dioxide. The major stimulus to breathing then becomes hypoxia (low PO2). High PCO2 and normal pH and HCO3 levels would not be the primary stimuli for breathing in this client.