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 C

Explanation

A. Respiratory acidosis typically presents with cool, clammy skin due to compensatory peripheral vasoconstriction.
B. Peripheral pulses may be weak or thready in respiratory acidosis due to decreased cardiac output.
C. Respiratory acidosis can lead to electrolyte imbalances, particularly hyperkalemia, which can manifest as widened QRS complexes on an electrocardiogram (ECG).
D. Respiratory acidosis can lead to hyperkalemia, but hyperactive deep tendon reflexes are not a characteristic finding.

A. Sodium B. Iron C. Potassium D. Protein

Correct Answer is B

Explanation

A. Increasing sodium intake is generally not recommended in chronic kidney disease, as it can exacerbate hypertension and fluid retention.
B. Epoetin alfa is a medication used to treat anemia associated with chronic kidney disease, and iron supplementation is often necessary to support erythropoiesis.
C. Potassium intake may need to be restricted in chronic kidney disease, especially in later stages when kidney function declines.
D. Protein intake may need to be adjusted in chronic kidney disease, but it's not directly related to the prescription of epoetin alfa.

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Naxlex Comprehensive Predictor Exams

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?

Correct Answer is C

Explanation

A nurse is teaching a client who has chronic kidney disease and a new prescription for epoetin alfa. The nurse should instruct the client to increase dietary intake of which of the following substances?

Correct Answer is B

Explanation

A nurse is caring for a client who has metabolic alkalosis. For which of the following clinical manifestations should the nurse monitor? (Select all that apply.)

A nurse is caring for a client who has nephrotic syndrome and is receiving high-dose corticosteroid therapy. For which of the following electrolyte imbalances should the nurse monitor?

A nurse is caring for a client who has preeclampsia and is being treated with magnesium sulfate IV. The client's respiratory rate is 10/min and deep-tendon reflexes are absent. Which of the following actions should the nurse take?

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

A nurse is caring for a client who is 1 day postoperative following a subtotal thyroidectomy. The client reports a tingling sensation in the hands, the soles of the feet, and around the lips. For which of the following findings should the nurse assess the client?

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?