Ms. Jackson 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?

Metabolic Alkalosis. Partially Compensated

Respiratory Acidosis, Partially Compensated

Respiratory Alkalosis. Uncompensated

Metabolic Alkalosis. Uncompensated

Answer and Explanation

The Correct Answer is D

A.   Metabolic Alkalosis, Partially Compensated, is incorrect because there is no evidence of respiratory compensation (normal PaCO2).
B.   Respiratory Acidosis, Partially Compensated, is incorrect because the pH is high, not low as would be expected in acidosis, and the PaCO2 is normal, not high.
C.   Respiratory Alkalosis, Uncompensated, is incorrect because the primary problem is metabolic (high HCO3), not respiratory, and the PaCO2 is normal, not low as would be seen in respiratory alkalosis.
D.   Metabolic alkalosis is characterized by elevated pH and bicarbonate levels. In this scenario, the pH is elevated (7.5) and the bicarbonate (HCO3) level is high (34 mmol/L), indicating alkalosis. Vomiting leads to loss of gastric acid (hydrochloric acid), causing metabolic alkalosis. The respiratory system has not yet compensated fully for the alkalosis, as indicated by the normal PaCO2 (40 mm Hg).

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Correct Answer is A

Explanation

A. A urine output of 175 ml over 8 hours indicates oliguria, which can be concerning in a client with impaired renal function. It suggests decreased kidney function and inadequate elimination of waste products and fluids, necessitating prompt notification of the healthcare provider.
B. This amount of urine output over 24 hours is within normal range and does not typically warrant immediate notification unless there are other concerning symptoms.
C. Cloudy urine may indicate the presence of urinary tract infection or other issues, but it alone may not require immediate notification of the provider.
D. While strong-smelling urine can be indicative of various conditions, it alone may not necessitate immediate provider notification unless accompanied by other concerning symptoms.

A. Lung cancer B. Osteoarthritis C. Dyspepsia D. Liver cirrhosis

Correct Answer is A

Explanation

A. Certain malignancies, particularly lung cancer, can produce ectopic antidiuretic hormone (ADH) or ADH-like substances, leading to SIADH. It's important to inquire about a history of lung cancer due to its association with SIADH.

B. Osteoarthritis is a degenerative joint disease and is not known to cause SIADH.

C. Dyspepsia refers to upper gastrointestinal discomfort and is not associated with SIADH.

D. Liver cirrhosis can lead to various complications, including hepatic encephalopathy and ascites, but it is not typically associated with SIADH.

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Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for a client who has impaired renal function. For which of the following findings should the nurse notify the provider?

Correct Answer is A

Explanation

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?

Correct Answer is A

Explanation

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 assessing a client who has hypothyroidism. Which of the following findings should the nurse expect?

A nurse is reviewing the medication record for a client who has chronic kidney disease. Which of the following medications should the nurse identify as having the potential to cause nephrotoxicity?

A primary care nurse is reviewing the medical history of a client. Which of the following chronic conditions should the nurse identify as risk factors for developing kidney disease?

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?