A nurse is caring for a client in the emergency department (ED) who has high anxiety and shallow respirations at a rate of 30/min. Which of the following acid-base disturbances is the client most likely experiencing?
Respiratory acidosis
Respiratory alkalosis
Metabolic acidosis
Metabolic alkalosis
The Correct Answer is B
A. Respiratory acidosis occurs due to hypoventilation, resulting in carbon dioxide retention. This condition is characterized by slow, shallow breathing and confusion, which is not consistent with the client's rapid respiratory rate of 30/min.
B. Respiratory alkalosis is typically caused by hyperventilation, where excessive breathing leads to a decrease in carbon dioxide levels. The client's symptoms of high anxiety and rapid, shallow respirations are indicative of hyperventilation, making respiratory alkalosis the most likely diagnosis.
C. Metabolic acidosis is characterized by deep, rapid breathing (Kussmaul respirations) as the body attempts to expel excess acid. The client's shallow respirations are inconsistent with the breathing pattern seen in metabolic acidosis.
D. Metabolic alkalosis usually presents with symptoms such as dizziness and tingling, often with compensatory slow respirations. The rapid respiratory rate in this case does not suggest metabolic alkalosis, making this option unlikely.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. Respiratory alkalosis: Respiratory alkalosis is more commonly associated with hyperventilation and is not directly linked to the physiological effects of a tension pneumothorax, where the primary concern is intrathoracic pressure changes.
B. Increased venous return: In tension pneumothorax, intrathoracic pressure increases significantly, compressing the great vessels and the heart, leading to decreased venous return, not an increase.
C. Decreased cardiac output: Tension pneumothorax causes a rise in intrathoracic pressure, which compresses the heart and great vessels, leading to decreased venous return and, consequently, reduced cardiac output. This is a critical finding and requires immediate intervention.
D. Dilated ventricles: Ventricular dilation is generally associated with chronic heart conditions, not acute issues like tension pneumothorax, where decreased filling pressures are more of a concern than dilation.
Correct Answer is A
Explanation
A. Diarrhea: Diarrhea leads to the loss of bicarbonate, an important buffer in the blood, which can contribute to the development of metabolic acidosis as the body loses bicarbonate faster than it can replace it.
B. Vomiting: Vomiting typically leads to metabolic alkalosis due to the loss of stomach acid, which reduces the amount of hydrogen ions in the body.
C. Salicylate intoxication: This condition primarily causes a mixed acid-base disturbance, including metabolic acidosis and respiratory alkalosis, due to its effects on both the metabolic and respiratory systems.
D. Hyperventilation: This condition causes respiratory alkalosis due to excessive loss of carbon dioxide, not metabolic acidosis.
Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.
Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today
Report Wrong Answer on the Current Question
Do you disagree with the answer? If yes, what is your expected answer? Explain.
Kindly be descriptive with the issue you are facing.