Anna's mother has been suffering from persistent vomiting for two days now. She appears to be lethargic and weak and has myalgia. She is noted to have dry mucus membranes and her capillary refill takes >4 seconds. She is diagnosed as having gastroenteritis and dehydration. Measurement of arterial blood gas shows pH 7.5, PaO2 85 mm Hg, PaCO2 40 mm Hg, and HCO3 34 mmol/L.

What acid-base disorder is shown?

Respiratory Acidosis. Partially Compensated

Metabolic Alkalosis, Partially Compensated

Respiratory Alkalosis. Uncompensated

Metabolic Alkalosis, Uncompensated

Answer and Explanation

The Correct Answer is B

A.   Respiratory Acidosis, both compensated and uncompensated, is characterized by an elevated PaCO2, which is not present in this case.
B.   The elevated pH (7.5) and HCO3 (34 mmol/L) indicate metabolic alkalosis. The elevated pH and the slightly elevated PaCO2 (40 mm Hg) suggest the partially compensated state, which is the respiratory compensation attempting to correct the alkalosis.
C.   The fact that the PaCO2 is not low rules out respiratory alkalosis.
D.   The arterial blood gas values indicate a high pH (7.5), a normal PaCO2 (40 mm Hg), and an elevated HCO3 (34 mmol/L), which are indicative of metabolic alkalosis. However, the elevated pH and the slightly elevated PaCO2 (40 mm Hg) suggest a partially compensated state.

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Correct Answer is D

Explanation

A. Furosemide use is more commonly associated with hyponatremia rather than hypernatremia due to its diuretic effect.
B. Furosemide does not typically cause hypercalcemia; instead, it may lead to hypocalcemia.
C. Hyperchloremia is not a primary concern with furosemide, as the drug can cause a loss of chloride ions alongside sodium.
D. Furosemide can cause an increase in uric acid levels by reducing its excretion through the kidneys.

A. Administer oral corticosteroids. B. Weigh the client daily. C. Provide a low-carbohydrate diet. D. Restrict fluid intake

Correct Answer is B

Explanation

A. Administering corticosteroids is crucial during an Addisonian crisis but typically involves intravenous corticosteroids (not oral) during the crisis to quickly restore hormone levels. Oral corticosteroids are part of regular maintenance therapy but not an immediate intervention in the crisis.

B. Weighing the client daily is important to monitor for potential fluid loss, dehydration, or weight changes related to Addison's disease and Addisonian crisis. Clients with Addison’s disease may experience fluid and electrolyte imbalances, so daily weight tracking helps detect early signs of fluid shifts, which are critical in crisis prevention and management.

C. A low-carbohydrate diet is not recommended for clients with Addison’s disease, as they may need a balanced diet with sufficient carbohydrates to prevent hypoglycemia.

D. Fluid intake should not be restricted; rather, maintaining adequate hydration is vital. Clients in Addisonian crisis are often at risk for dehydration due to fluid losses and low aldosterone levels, making fluid replacement essential.

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Naxlex Comprehensive Predictor Exams

A nurse is caring for a client who has heart failure and is receiving IV furosemide. The nurse should monitor the client for which of the following electrolyte imbalances?

Correct Answer is D

Explanation

A nurse is caring for a client who has Addison's disease and is at risk for Addisonian crisis. Which of the following actions should the nurse take?

Correct Answer is B

Explanation

A nurse is assessing a client who had a craniotomy and has developed syndrome of inappropriate antidiuretic hormone (SIADH). Which of the following manifestations should the nurse anticipate?

A nurse is caring for a client who has syndrome of inappropriate antidiuretic hormone (SIADH) and a sodium level of 123 mEq/L. Which of the following prescriptions should the nurse anticipate?

A nurse is assessing four clients on a medical unit. The nurse should identify which of the following clients as exhibiting positive manifestations of hypercortisolism?

A nurse is assisting with the care of a client who has metabolic alkalosis. Which of the following actions should the nurse take?

A nurse is assessing a client who is admitted for elective surgery and has a history of Addison's disease. Which of the following findings should the nurse expect?

A nurse is discussing laboratory values associated with the renal system with a newly licensed nurse. Which of the following statements by the newly licensed nurse indicates an understanding of the values?

A nurse is caring for a client who has metabolic alkalosis. Which of the following actions should the nurse take?