A nurse is caring for a client who has metabolic acidosis and is receiving sodium bicarbonate IV bolus and infusion to correct the pH imbalance. Which of the following laboratory values should the nurse monitor to evaluate the effectiveness of the therapy?
Serum sodium.
Serum potassium.
Serum chloride.
Serum bicarbonate.
The Correct Answer is D
Choice A reason:
Serum sodium is not directly related to the acid-base balance of the body. Sodium bicarbonate therapy does not affect the serum sodium level significantly. Therefore, monitoring serum sodium is not an effective way to evaluate the effectiveness of the therapy.
Choice B reason:
Serum potassium is inversely related to the serum pH. As the pH increases, the potassium level decreases, and vice versa. Sodium bicarbonate therapy raises the pH and lowers the potassium level. Therefore, monitoring serum potassium is important to prevent hypokalemia, but it does not directly reflect the acid-base balance of the body.
Choice C reason:
Serum chloride is inversely related to the serum bicarbonate level. As the bicarbonate level increases, the chloride level decreases, and vice versa. Sodium bicarbonate therapy increases the bicarbonate level and decreases the chloride level. Therefore, monitoring serum chloride is important to prevent hypochloremia, but it does not directly reflect the acid-base balance of the body.
Choice D reason:
Serum bicarbonate is directly related to the acid-base balance of the body. The normal range of serum bicarbonate is 22 to 26 mEq/L. In metabolic acidosis, the bicarbonate level is low, and in metabolic alkalosis, it is high. Sodium bicarbonate therapy aims to increase the bicarbonate level and correct metabolic acidosis. Therefore, monitoring serum bicarbonate is the most effective way to evaluate the effectiveness of the therapy.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A reason:
Crystalloid solutions are fluids that contain electrolytes and can diffuse across semipermeable membranes. They are used to treat dehydration, electrolyte imbalances, and hypovolemia. However, they are not as effective as colloids in expanding the intravascular volume and maintaining the blood pressure. Therefore, choice A is incorrect.
Choice B reason:
Colloid solutions are fluids that contain large molecules such as proteins, starches, or gelatin that cannot cross the capillary membrane. They exert an osmotic pressure that draws fluid from the interstitial and intracellular spaces into the intravascular space. They are used to treat hypovolemic shock, burns, and hemorrhage. Albumin is a type of colloid solution that is derived from human plasma and contains 5% or 25% protein. It increases the plasma volume and the blood pressure by increasing the oncotic pressure. Therefore, choice B is correct.
Choice C reason:
Hypertonic solutions are fluids that have a higher osmolarity than the blood plasma. They draw water out of the cells and into the intravascular space. They are used to treat hyponatremia, cerebral edema, and severe dehydration. However, they can cause fluid overload, hypertension, and cellular dehydration if given in excess. Therefore, choice C is incorrect.
Choice D reason:
Hypotonic solutions are fluids that have a lower osmolarity than the blood plasma. They provide free water and electrolytes to the cells and the interstitial space. They are used to treat hypernatremia, cellular dehydration, and fluid loss due to burns or diuresis. However, they can cause fluid shifts from the intravascular space to the interstitial and intracellular spaces, resulting in hypovolemia, hypotension, and edema. Therefore, choice D is incorrect.
Correct Answer is ["A","C","E"]
Explanation
Choice A reason:
Administer magnesium sulfate IV. This is correct because magnesium sulfate is the treatment of choice for severe hypomagnesemia. It can rapidly increase the blood level of magnesium and correct the symptoms of deficiency.
Choice B reason:
Monitor the client's blood pressure and heart rate. This is incorrect because monitoring vital signs is not a specific intervention for hypomagnesemia. However, it is important to monitor the client for signs of hypotension and bradycardia, which can occur as adverse effects of magnesium sulfate therapy.
Choice C reason:
Encourage the client to increase intake of green leafy vegetables. This is correct because green leafy vegetables are rich sources of dietary magnesium. Increasing the intake of magnesium-rich foods can help prevent or treat mild hypomagnesemia.
Choice D reason:
Prepare to administer calcium gluconate IV. This is incorrect because calcium gluconate is not indicated for hypomagnesemia. Calcium gluconate is used to treat hypocalcemia, which can occur as a complication of hypomagnesemia. However, calcium gluconate should not be given until the magnesium level is corrected, as low magnesium can impair the response to calcium.
Choice E reason:
Assess the client for Chvostek's sign and Trousseau's sign. This is correct because Chvostek's sign and Trousseau's sign are clinical tests for neuromuscular irritability, which can occur in hypomagnesemia. Chvostek's sign is elicited by tapping the facial nerve in front of the ear and observing for facial twitching. Trousseau's sign is elicited by inflating a blood pressure cuff above the systolic pressure for 3 minutes and observing for carpal spasm.
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