An adolescent who is brought to the emergency department (ED) with a fever and persistent lower right quadrant abdominal pain is anxious, fearful, and hyperventilating.
The nurse anticipates the client developing which acid-base imbalance?
Metabolic alkalosis.
Respiratory alkalosis.
Metabolic acidosis.
Respiratory acidosis.
The Correct Answer is C
Choice A rationale:
Metabolic alkalosis is unlikely in this scenario because the client is experiencing anxiety, fear, and hyperventilation, which typically result in increased respiratory rate, leading to the loss of carbon dioxide (CO2) through exhalation. This loss of CO2 would cause a decrease in bicarbonate (HCO3-) levels and result in metabolic acidosis, not metabolic alkalosis.
Choice B rationale:
Respiratory alkalosis occurs when there is excessive loss of CO2 due to hyperventilation, as seen in this client's case. However, the primary disturbance here is metabolic in nature. The hyperventilation is the body's response to compensate for the underlying metabolic acidosis by attempting to blow off CO2 to increase pH. Therefore, metabolic acidosis is the primary imbalance.
Choice D rationale:
Respiratory acidosis is characterized by increased levels of CO2 in the blood due to inadequate ventilation. In this scenario, the client is hyperventilating, which would lead to a decrease in CO2 levels and not an increase, as seen in respiratory acidosis. Additionally, the primary acid-base disturbance is metabolic acidosis in this case.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","B","D"]
Explanation
Choice A rationale:
Slower reaction time is a common age-related change in the neurological system. The processing of sensory information and response time may become slower in older adults due to changes in neural pathways and decreased neurotransmitter activity.
Choice B rationale:
Older adults may experience some difficulty with learning new things due to changes in cognitive function and neural plasticity. This is a common age-related effect on the neurological system.
Choice C rationale:
This statement is incorrect. Older adults typically have fewer neurotransmitters in their brains as they age, which can contribute to cognitive changes and a decline in cognitive function.
Choice D rationale:
Loss of some sense of smell and taste is an age-related change. Older adults may experience a decreased ability to detect and differentiate smells and tastes due to changes in olfactory and gustatory receptors.
Choice E rationale:
This statement is incorrect. Aging does not necessarily lead to an increase in oxygen delivery to brain cells. In fact, there may be a decrease in cerebral blood flow with age in some individuals.
Correct Answer is B
Explanation
The correct answer is B
Choice A reason: Vasopressin is not typically associated with decreasing GI cramping and nausea. It is used to treat diabetes insipidus and to reduce stomach bloat for some procedures and after some surgeries.
Choice B reason: Vasopressin can cause chest pain or pressure, and fast, slow, or abnormal heartbeat, which are indicative of dysrhythmia. These are known side effects of vasopressin and should be monitored during IV infusion.
Choice C reason: Vasopressin causes vasoconstriction, not vasodilation. It tightens small blood vessels, which is the opposite of vasodilation.
Choice D reason: While vasopressin can cause bradycardia (slow heart rate), hypotension is not a common effect as it is used to treat low blood pressure. Tachycardia (fast heart rate) is not a typical side effect of vasopressin.
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