Maria, an elementary student, was rushed to the hospital due to vomiting and a decreased level of consciousness. The patient displays slow and deep (Kussmaul breathing), and he is lethargic and irritable in response to stimulation. He appears to be dehydrated-his eyes are sunken and mucous membranes are dry-and he has a two-week history of polydipsia, polyuria, and weight loss. Measurement of arterial blood gas shows pH 7.0, Pa02 90 mm Hg. PaCO2 23 mm Hg, and HCO3 12 mmol/L; other results are Na+ 126 mmol/L. K+ 5 mmol/L, and Cl-95 mmol/L.

What is your assessment?

Respiratory Acidosis, Partially Compensated

Metabolic Acidosis, Partially, Compensated

Metabolic Alkalosis. Uncompensated

Respiratory Acidosis, Uncompensated

Answer and Explanation

The Correct Answer is B

A.   This option can be ruled out because the pH and PaCO2 levels indicate acidosis, but the compensation is not partial as the HCO3 is also low.
B.   Maria's symptoms and the arterial blood gas values support this diagnosis. Metabolic acidosis is indicated by a low pH and a decreased bicarbonate (HCO3) level. The body attempts to compensate for this acidosis by hyperventilating, which is evidenced by her Kussmaul breathing, to decrease PaCO2. This compensation is partial because, despite the body's efforts, the pH is still significantly lower than normal.
C.   This option can be ruled out because the pH is low (acidosis) rather than high (alkalosis), and the HCO3 is low rather than high.
D.   Respiratory Acidosis, Uncompensated is ruled out because the pH is low (acidosis), but the PaCO2 is normal, indicating metabolic rather than respiratory involvement.

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Correct Answer is D

Explanation

A. Constipation is not typically associated with hypocalcemia.
B. Shortened QT intervals are not characteristic of hypocalcemia; rather, prolongation of QT intervals is more common.
C. Hypoactive deep tendon reflexes, would suggest a decrease in neuromuscular excitability, which is contrary to the increased excitability seen in hypocalcemia. Therefore, hypoactive deep tendon reflexes is more commonly associated with hypercalcemia and not hypocalcemia.
D. Tingling of the extremities is a common symptom of hypocalcemia.

A. Hypernatremia B. Hypercalcemia C. Hyperchloremia D. Hyperuricemia

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.

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Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for a client who had total thyroidectomy and a serum calcium level of 7.6 mg/dL. Which of the following findings should the nurse expect?

Correct Answer is D

Explanation

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 severe preeclampsia and is receiving magnesium sulfate IV at 2 g/hr. Which of the following findings indicates that it is safe for the nurse to continue the infusion?

A nurse is caring for a client who has respiratory alkalosis and is hyperventilating Which of the following actions should the nurse take?

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 caring for a client who has diabetes insipidus and is receiving vasopressin. The nurse should identify which of the following findings as an indication that the medication is effective?

A nurse is teaching a client who has chronic kidney failure about planning a low-protein diet. The client states, "Why do I have to be concerned about protein?" Which of the following responses should the nurse make?

A nurse is reviewing the arterial blood gas results for a client in the ICU who has kidney failure and determines the client has respiratory acidosis. Which of the following findings should the nurse expect?

A nurse is talking to a client who is taking a calcium supplement for osteoporosis. The client tells the nurse she is experiencing flank pain. Which of the following adverse effects should the nurse suspect?

A nurse is collecting the medical history from a client who has manifestations of syndrome of inappropriate antidiuretic hormone (SIADH). The nurse should ask the client if he has a history of which of the following conditions that can cause SIADH?