Respiratory Medications Flashcards
(127 cards)
1
Q
increased fluid helps to liquefy secretions for more effective coughing.
TRUE OR FALSE
A
TRUE
2
Q
Guaifenesin
(Mucinex)
A
Cold medication and cough medicine
It can thin mucus. This may make it easier to clear from the head, throat, and lungs.
Guaifenesin is an expectorant. It helps loosen congestion in your chest and throat, making it easier to cough out through your mouth. Guaifenesin is used to reduce chest congestion caused by the common cold, infections, or allergies.
3
Q
The nurse is preparing to administer a dose of naloxone intravenously to a client with an opioid overdose. Which supportive medical equipment should the nurse plan to have at the client’s bedside if needed?
A
The nurse administering naloxone for suspected opioid overdose should have resuscitation equipment readily available to support naloxone therapy if it is needed. Other adjuncts that may be needed include oxygen, a mechanical ventilator, and vasopressors.
4
Q
Diphenhydramine
(Benadryl)
A
Diphenhydramine is an antihistamine that reduces the effects of natural chemical histamine in the body. Histamine can produce symptoms of sneezing, itching, watery eyes, and runny
nose. Diphenhydramine is used to treat sneezing, runny nose, watery eyes, hives, skin rash, itching, and other cold or allergy symptoms
5
Q
Diphenhydramine has several uses, including as an antihistamine, antitussive, antidyskinetic, and sedative-hypnotic. Instructions for use include taking with___________ or milk to decrease gastrointestinal upset and using oral rinses, sugarless gum, or hard candy to minimize dry mouth. Because the medication causes ____________the client should avoid use of alcohol or central nervous system depressants, operating a car, or engaging in other activities requiring mental awareness during use.
A
food; drowsiness
6
Q
Cromolyn sodium is an inhaled nonsteroidal antiallergy agent and a mast cell stabilizer. Undesirable effects associated with inhalation therapy of cromolyn sodium are _______spasm, cough, __________congestion, throat irritation, and wheezing.
Clients receiving this medication orally may experience pruritus, nausea, diarrhea, and myalgia.
A
bronchospasm; nasal
7
Q
__________is a bronchodilator and is contraindicated in clients with hypersensitivity to sympathomimetics. It should be used with caution in clients with impaired cardiac function, diabetes mellitus, hypertension, hyperthyroidism, or a history of seizures. The medication may increase blood glucose levels.
A
Terbutaline
8
Q
Zafirlukast is a leukotriene receptor antagonist used in the prophylaxis and long-term treatment of bronchial asthma. Zafirlukast is used with caution in clients with impaired ______________
A
hepatic function.;
Liver function laboratory tests should be performed to obtain a baseline, and the levels should be monitored during administration of the medication.
9
Q
A common side effect of Isoniazid is peripheral neuritis, manifested by numbness, tingling, and paresthesias in the extremities. This can be minimized with _______________
A
pyridoxine (vitamin B6) intake
10
Q
Isoniazid is _____________, and therefore the client is taught to report signs and symptoms of hepatitis immediately, which include ________________.
A
hepatotoxic; yellow skin and sclera
11
Q
A client has been started on long-term therapy with rifampin. The nurse should provide which information to the client about the medication?
1.
Should always be taken with food or antacids
2.
Should be double-dosed if 1 dose is forgotten
3.
Causes orange discoloration of sweat, tears, urine, and feces
4.
May be discontinued independently if symptoms are gone in 3 months
A
Rifampin causes orange-red discoloration of body secretions and will stain soft contact lenses permanently. Rifampin should be taken exactly as directed. Doses should not be doubled or skipped. The client should not stop therapy until directed to do so by a health care provider. It is best to administer the medication on an empty stomach unless it causes gastrointestinal upset, and then it may be taken with food. Antacids, if prescribed, should be taken at least 1 hour before the medication.
12
Q
The nurse has given a client taking ethambutol information about the medication. The nurse determines that the client understands the instructions if the client states that he or she will immediately report which finding?
1.
Impaired sense of hearing
2.
Gastrointestinal side effects
3.
Orange-red discoloration of body secretions
4.
Difficulty in discriminating the color red from green
A
Ethambutol causes optic neuritis, which decreases visual acuity and the ability to discriminate between the colors red and green. This poses a potential safety hazard when a client is driving a motor vehicle. The client is taught to report this symptom immediately. The client also is taught to take the medication with food if gastrointestinal upset occurs.
Impaired hearing results from antitubercular therapy with streptomycin. Orange-red discoloration of secretions occurs with rifampin
13
Q
Isoniazid therapy can cause an elevation of _____________-enzyme levels and hepatitis.
A
hepatic
Therefore, liver enzyme levels are monitored when therapy is initiated and during the first 3 months of therapy. They may be monitored longer in the client who is older than 50 years or abuses alcohol.
14
Q
The nurse has a prescription to give a client salmeterol, 2 puffs, and beclomethasone dipropionate, 2 puffs, by metered-dose inhaler. The nurse should administer the medication using which procedure?
1.
Beclomethasone first and then the salmeterol
2.
Salmeterol first and then the beclomethasone
3.
Alternating a single puff of each, beginning with the salmeterol
4.
Alternating a single puff of each, beginning with the beclomethasone
A
Salmeterol is an adrenergic type of bronchodilator and beclomethasone dipropionate is a glucocorticoid. Bronchodilators are always administered before glucocorticoids when both are to be given on the same time schedule. This allows for widening of the air passages by the bronchodilator, which then makes the glucocorticoid more effective.
15
Q
Bronchodilators are always administered before glucocorticoids when both are to be given on the same time schedule.
TRUE OR FALSE
A
TRUE
This allows for widening of the air passages by the bronchodilator, which then makes the glucocorticoid more effective.
16
Q
Rifabutin - what is it for and what are three side effects ?
A
Rifabutin may be prescribed for a client with active MAC disease and tuberculosis. It inhibits mycobacterial DNA-dependent RNA polymerase and suppresses protein synthesis.
Side and adverse effects include rash, gastrointestinal disturbances, neutropenia (low neutrophil count), red-orange–colored body secretions, uveitis (blurred vision and eye pain), myositis, arthralgia, hepatitis, chest pain with dyspnea, and flulike syndrome.
17
Q
Theophylline is a methylxanthine bronchodilator. The nurse teaches the client to limit the intake of xanthine-containing foods while taking this medication. These foods include ______________________-
A
These foods include coffee, cola, and chocolate
18
Q
The nurse has just administered the first dose of omalizumab to a client. Which statement by the client would alert the nurse that the client may be experiencing a life-threatening effect?
“I have a severe headache.”
2.
“My feet are quite swollen.”
3.
“I am nauseated and may vomit.”
4.
“My lips and tongue are swollen.”
A
Omalizumab is an antiinflammatory used for long-term control of asthma. Anaphylactic reactions can occur with the administration of omalizumab. The nurse administering the medication should monitor for adverse reactions of the medication. Swelling of the lips and tongue are an indication of an anaphylaxis.
19
Q
Antiviral medications for influenza must be taken exactly as ______________. These medications do not prevent the spread of influenza and clients are usually contagious for up to ____________days after the initiation of antiviral medications. Secondary ___________infections may occur despite antiviral treatment. Side effects occur with these medications and may necessitate a change in activities, especially when driving or operating machinery if dizziness occurs.
A
prescribed; 2; bacterial
20
Q
___________________may be used to treat allergic rhinitis. The medication works locally and decreases _______________. The client should be instructed to clear the nasal passages _________________-use for best medication effectiveness. The client should take the medication regularly as prescribed in order for the effect to be achieved. The medication may take several days to achieve maximal effect because it works by decreasing inflammation.
A
Intranasal corticosteroids; inflammation; before
21
Q
Pirbuterol is an adrenergic ______________. Side and adverse effects include ___________________
A
bronchodilator; tachycardia, hypertension, chest pain, dysrhythmias, nervousness, restlessness, and headache
22
Q
What is Ribavirin and what is special about its administration ?
A
Ribavirin is an antiviral respiratory medication used mainly for hospitalized children with severe RSV. Administration is via hood, face mask, or oxygen tent. Ribavirin is not administered orally, intramuscularly, or subcutaneously.
23
Q
Isoniazid is prescribed for a child with human immunodeficiency virus (HIV) infection who has a positive tuberculin skin test result. The mother of the child asks the nurse how long the child will need to take the medication. For how long should the nurse tell the mother the medication will need to be taken?
1.
4 months
2.
6 months
3.
9 months
4.
12 months
A
For children with HIV infection who demonstrate a positive tuberculin skin test result, a minimum of 12 months of treatment with isoniazid is recommended.
24
Q
tapering of a glucocorticoid could result in adrenal insufficiency
TRUE OR FALSE
A
TRUE
25
The client being changed from oral to inhalation glucocorticoids could experience signs of \_\_\_\_\_\_\_\_\_\_\_insufficiency.
adrenal
26
A client with an exacerbation of chronic obstructive pulmonary disease (COPD) has been on oral glucocorticoids and is currently being weaned to triamcinolone by inhalation. The nurse determines that the client understands the potential adverse effects to watch for during this medication change when the client states the need to report which signs and symptoms?
1.
Chills, fever, and generalized rash
2.
Vomiting, diarrhea, and increased thirst
3.
Blurred vision, headache, and insomnia
4.
Anorexia, nausea, weakness, and fatigue
The client being changed from oral to inhalation glucocorticoids could experience signs of adrenal insufficiency. The nurse teaches the client to report anorexia, nausea, weakness, and fatigue. Other signs that can be detected and are objective include hypotension and hypoglycemia.
27
A client diagnosed with active tuberculosis has been prescribed a combination of isoniazid and rifampin for treatment. The nurse teaches the client to perform which action?
## Footnote
1.
Report any change in urine color.
2.
Take both medications with food.
3.
Take both medications together once a day.
4.
Expect to take the medications for 2 to 3 weeks.
Rifampin in combination with isoniazid prevents the emergence of medication-resistant organisms. This combination, taken together daily, **eliminates the tubercle bacilli from the sputum and improves clinical status**.
***Rifampin produces a harmless red-orange color in all body fluids and should be taken along with the isoniazid 1 hour before or 2 hours after eating to maximize absorption.***
The treatment regimen is maintained for at least 6 months for effectiveness, and the therapeutic effect may be evident in 2 to 3 weeks.
28
What is Cycloserine and what is special about it ?
Cycloserine is an antituberculosis medication that **requires weekly serum medication level determinations to monitor for neurotoxicity** and other adverse effects.
## Footnote
***Peak concentrations are measured 2 hours after dosing and should be between 25 and 35 mcg/mL***
29
isoniazid is \_\_\_\_\_\_\_\_\_\_\_\_-toxic;
***hepatotoxic***
30
A client with a documented exposure to tuberculosis is on medication therapy with isoniazid. The nurse is monitoring laboratory results and determines that which laboratory value indicates the need for follow-up?
1.
Platelet count 325,000 mm3 (325 × 109/L)
2.
Serum creatinine 1.0 mg/dL (88.3 mcmol/L)
3.
Blood urea nitrogen (BUN) 20 mg/dL (7.1 mmol/L)
4.
Aspartate aminotransferase (AST) 55 U/L (55 U/L)
Because ***isoniazid therapy can cause elevated hepatic enzymes and hepatitis, liver enzymes are monitored when therapy is initiated and during the first 3 months of therapy.*** They may be monitored longer in the client who is older than 50 years of age or who abuses alcohol. The normal AST level is 0 to 35 U/L (0 to 30 U/L). The other options are not monitored routinely and are also normal.
31
Rifampin causes \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_of body secretions and will permanently stain light clothing as well as soft contact lenses. The medication should be taken on an \_\_\_\_\_\_\_\_\_\_\_\_\_\_unless it causes gastrointestinal upset, and then it may be taken with food. Antacids, if prescribed, should be taken at least 1 hour before the medication.
orange-red discoloration; empty stomach
32
Ethambutol causes this significant adverse effect ?
**optic neuritis**, which decreases visual acuity and impairs the ability to discriminate between red and green
33
Orange-red discoloration of secretions occurs with this tuberculosis medication ?
Orange-red discoloration of secretions occurs with rifampin.
34
Impaired hearing results from antituberculosis therapy with
streptomycin
35
The nurse is caring for a client with chronic obstructive pulmonary disease (COPD) who is receiving theophylline. The nurse monitors the serum theophylline level and concludes that the medication dosage may need to be increased if which value is noted?
1.
5 mg/mL (20 mcmol/L)
2.
10 mg/mL (40 mcmol/L)
3.
15 mg/mL (60 mcmol/L)
4.
20 mg/mL (79 mcmol/L)
Theophylline is a **bronchodilator.** The nurse monitors the theophylline blood serum level daily when a client is on this medication to ensure that a therapeutic range is present and monitor for the potential for toxicity.
**The therapeutic serum level range is 10 to 20 mg/mL** (40 to 79 mcmol/L). If the laboratory result indicated a level of 5 mg/mL (20 mcmol/L), the dosage of the medication would need to be increased.
36
The nurse is administering a dose of morphine sulfate to a client via an epidural catheter after nephrectomy. Before administering the medication, what should the nurse plan to do?
1.
Place the head of the bed flat.
2.
Ensure that naloxone is readily available.
3.
Flush the catheter with 6 mL of sterile water.
4.
Aspirate with a syringe to ensure a cerebrospinal fluid (CSF) return.
**Epidural analgesia is used for clients with expected high levels of postoperative pain.** The nurse carefully checks the medication, notes the client's level of sedation, and **makes sure that the head of bed is elevated 30 degrees** unless contraindicated. ***The nurse aspirates with a syringe to make sure that no CSF return occurs.*** If CSF returns with aspiration, the catheter has migrated from the epidural space into the subarachnoid space. ***The catheter is not flushed with 6 mL of sterile water.***
## Footnote
**Naloxone should be readily available for use if respiratory depression should occur.**
37
Antitussive medication is used to
**prevent or relieve a cough.**
38
Benzonatate is a locally acting \_\_\_\_\_\_\_\_\_\_\_\_\_\_that decreases the intensity and frequency of cough without eliminating the cough reflex.
antitussive
39
A client has begun using a methylxanthine bronchodilator. What beverage should the nurse plan to teach the client to avoid while taking this medication?
1.
Coffee
2.
Orange juice
3.
Mineral water
4.
Cranberry juice
**Cola, coffee, and chocolate** contain methylxanthine and should be avoided by the client taking a methylxanthine bronchodilator. **The additional methylxanthine could lead to increased incidence of cardiovascular and central nervous system side effects.**
Orange juice, mineral water, and cranberry juice are fluids that are allowed.
40
A client taking albuterol by inhalation cannot cough up secretions. What should the nurse suggest that the client do to assist in expectoration of secretions?
1.
Get more exercise each day.
2.
Use a dehumidifier in the home.
3.
Drink increased amounts of fluids every day.
4.
Take an extra dose of albuterol before bedtime.
**A client should drink increased fluids (2000 to 3000 mL/day) to decrease viscosity and increase expectoration of secretions.**
This is standard advice for clients receiving any of the adrenergic bronchodilators, unless the client has another health problem that contraindicates an increased fluid intake.
**Additional exercise will not effectively clear bronchial secretions**. **A dehumidifier will dry secretions, making the situation worse.** The client should not take additional medication.
41
A client who has been receiving theophylline by the intravenous (IV) route has the medication prescription changed to an immediate-release oral form of the medication. After discontinuing the IV medication, when should the nurse schedule the first dose of the oral medication?
1.
Just after the next meal
2.
Just before the next meal
3.
4 hours after discontinuing the IV form
4.
Immediately on discontinuing the IV form
***With immediate-release preparations, oral theophylline should be administered 4 to 6 hours after discontinuing the IV form of the medication.***
If the sustained-release form is used, the first oral dose should be administered immediately on discontinuation of the IV infusion.
42
A client with a prescription to take theophylline daily has been given medication instructions by the nurse. What statement by the client indicates the need for further education regarding the prescription?
1.
"I will take the daily dose at bedtime."
2.
"I need to drink at least 2 liters of fluid per day."
3.
"I know to avoid changing brands of the medication without my health care provider's approval."
4.
"I'll avoid over-the-counter cough and cold medications unless approved by my health care provider."
The client taking a single daily dose of theophylline, a xanthine bronchodilator, should
***take the medication early in the morning. This enables the client to have maximal benefit from the medication during daytime activities. In addition, this medication causes insomnia***.
**The client should take in at least 2 L of fluid per day to decrease viscosity of secretions.** The client should check with the health care provider (HCP) before changing brands of the medication because levels of bioavailability may vary for different preparations. The client also should check with the HCP before taking over-the-counter cough, cold, or other respiratory preparations because they could have interactive effects, increasing the side and adverse effects of theophylline and causing dysrhythmias.
43
Soft contact lenses may be permanently damaged by the orange discoloration in body fluids caused by \_\_\_\_\_\_\_\_\_\_.
If rifampin is not tolerated on an empty stomach, it may be \_\_\_\_\_\_\_\_\_\_\_\_\_.
The client may be on the medication for 12 months even if cultures give negative results.
rifampin; taken with food
44
Cromolyn sodium is an anti\_\_\_\_\_\_\_\_. anti \_\_\_\_\_\_\_\_\_\_\_\_\_, and and \_\_\_\_\_\_\_\_\_\_\_cell stabilizer that inhibits the release of mediators from mast cells after exposure to an antigen. It can also interrupt the migration of eosinophils into the inflammatory site and decrease the number of eosinophils. These actions decrease airway ___________________ in some clients with asthma. It has no bronchodilating action
antiasthmatic, antiallergic, and mast cell stabilizer; hyperresponsiveness
45
Sustained-release preparations can be broken open, crushed, or chewed.
TRUE OR FALSE
FALSE
Sustained-release preparations ***should not be broken open, crushed, or chewed.***
46
Guaifenesin is an expectorant and should be taken with \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_to decrease the viscosity of secretions
a full glass of water
47
Albuterol is an adrenergic \_\_\_\_\_\_\_\_\_\_\_\_\_\_. The nurse assesses
bronchodilator
respiratory pattern, lung sounds, pulse, and blood pressure before and during therapy. The nurse also notes the color, character, and amount of sputum.
48
The client taking adrenergic bronchodilators may experience \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_, which is evidenced by the client's wheezing. This can occur with excessive use of \_\_\_\_\_\_\_\_\_\_\_\_-. Further medication should be withheld and the HCP should be notified.
paradoxical bronchospasm; inhalers
49
Dose-related peripheral\_\_\_\_\_\_\_\_\_\_\_\_\_ is one of the more common adverse effects of isoniazid
neuropathy
50
Dry Powdered Inhalers vs Metered Dose Inhalers
DPIs are used to deliver medications in the form of a dry, micronized powder directly to the lungs. DPIs do not require the hand-to-lung coordination needed with MDIs; thus, **DPIs are much easier to use.** Compared with MDIs, **DPIs deliver more medication to the lungs** (20% of the total released versus 10%) and less to the oropharynx. Because **DPIs do not require propellant, they are not a risk to the environment.**
**Both types of inhalers have side effects**. Frequency of use is prescribed by the health care provider.
51
Which statement made by a client taking montelukast indicates the need for further teaching?
## Footnote
1.
"I will need to have my liver function checked."
2.
"I can take the medication with food or without."
3.
"I may be able to decrease the use of my metered-dose inhaler."
4.
"I will take the medication when I first notice I am having trouble breathing."
***Montelukast cannot be used for quick relief of an asthma attack because effects of the medication develop too slowly***. For prophylaxis and maintenance therapy of asthma, maximal effects develop within 24 hours of the first dose and are maintained with once-daily dosing in the evening.
52
When evaluating an asthmatic client's knowledge of self-care, the nurse recognizes that additional instruction is needed when the client makes which statement?
1.
"I use my corticosteroid inhaler each time I feel short of breath."
2.
"I see my doctor if I have an upper respiratory infection and always get a flu shot."
3.
"I use my bronchodilator inhaler before walking so I don't become short of breath."
4.
"I use my bronchodilator inhaler before I visit places like the zoo because of my allergies."
Most asthma medications are administered via inhalation because of their fast action via this route. **Inhaled corticosteroids are preferred for long-term control of persistent asthma.** They decrease inflammation and reduce bronchial hyperresponsiveness. Bronchodilator medications are considered "rescue" types because their onset is faster. Clients would use this type of medication to provide rapid relief of symptoms such as bronchospasm, which can be caused by a variety of triggers. Clients need to be evaluated for understanding of their disease, identifying triggers, and the proper use of equipment and medications.
53
Dark urine is a sign of liver injury.
TRUE OR FALSE
TRUE
54
Which is the nurse's priority assessment for monitoring for adverse effects for the client taking isoniazid?
1.
Skin color
2.
Urine color
3.
Hydration status
4.
Respiratory effort
Isoniazid is an antituberculosis medication. The most serious adverse effect associated with isoniazid is hepatic injury, which on rare occasions has been fatal; therefore, monitoring of liver function tests and for signs and symptoms of liver injury is the priority. Dark urine is a sign of liver injury and the client should be taught to report this, and the nurse should assess for this. Skin color, hydration status, and respiratory effort are not directly related to adverse effects of this medication.
55
Isoniazid is an antituberculosis medication. Clients receiving isoniazid can develop neuropathy, and the agent of choice to help prevent this adverse effect is \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
pyridoxine, vitamin B6.
56
The nurse would anticipate that the health care provider (HCP) would add which medication to the regimen of the client receiving isoniazid?
1.
Niacin
2.
Pyridoxine
3.
Gabapentin
4.
Cyanocobalamin
Focus on the subject, medication regimen for a client taking isoniazid. **Niacin is used to treat cholesterol elevations**, so eliminate option 1. **Gabapentin is used to treat seizure**s and peripheral neuropathy, so eliminate option 3. Remembering that **cyanocobalamin is used to treat anemia** and that this is not related to isoniazid helps you eliminate option 4. To answer this question, it is important to know that **the adverse effect of isoniazid is neuropathy, which is prevented by administration of pyridoxine.**
57
A postpartum nurse is caring for a client with an epidural catheter in place for opioid analgesic administration following cesarean birth. The client develops respiratory depression and requires naloxone administration. Which finding should the nurse anticipate as a result of the naloxone administration?
1.
Bradycardia
2.
Decrease in sensation
3.
Increase in pain level
4.
Sudden onset of itching
Opioids are used for epidural analgesia. **Naloxone is an opioid antagonist, which reverses the effects of opioids. If it is given, the client may complain of an increase in her pain level**.
One of the side effects of naloxone is rapid pulse or tachycardia, not bradycardia. Sudden onset of itching would not be a typical reaction. Naloxone would not affect sensation
58
The nurse should monitor the client receiving the first dose of albuterol for which side or adverse effects of this medication?
tachycardia, hypertension, chest pain, dysrhythmias, nervousness, restlessness, and headache
59
Bronchodilators are administered before glucocorticoids when both are to be given on the same time schedule. This allows for \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
widening of the air passages by the bronchodilator, which then makes the glucocorticoid more effective.
60
TRUE OR FALSE
inhaled glucocorticoids are not absorbed systemically
TRUE
61
A client with chronic obstructive pulmonary disease (COPD) is being changed from an oral glucocorticoid to triamcinolone by inhalation. The client asks why this change is necessary; what would you tell them ?
**Inhaled glucocorticoids are preferable for long-term management because there is a decreased incidence of adverse effects since the medication is not absorbed systemically**
62
Inhaled glucocorticoids are preferable for long-term management because \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
there is a decreased incidence of adverse effects since the medication is not absorbed systemically
63
A client is taking cetirizine. The nurse should inform the client of which side effect of this medication?
1.
Diarrhea
2.
Excitability
3.
Drowsiness
4.
Excess salivation
**DROWSINESS**
Cetirizine is an antihistamine; frequent side effects are drowsiness or sedation. Others include blurred vision, hypertension (and sometimes hypotension), dry mouth, constipation, urinary retention, and sweating
64
Cetirizine - what kind of medication is it ?
name 3 side effects
Cetirizine is an antihistamine; frequent side effects are drowsiness or sedation. Others include blurred vision, hypertension (and sometimes hypotension), dry mouth, constipation, urinary retention, and sweating
65
Acetylcysteine is administered to \_\_\_\_\_\_\_\_\_bronchial secretions and is considered a \_\_\_\_\_\_\_\_\_\_\_.
thin; **mucolytic**
66
Cromolyn has these 3 kinds of therapeutic classes
mast cell stabilizer, antiasthmatic, and antiallergic
67
The nurse is teaching a client about the effects of diphenhydramine, an ingredient in the cough suppressant prescribed for the client. The nurse should plan to tell the client to take which measure while taking this medication?
1.
Take it on an empty stomach.
2.
Avoid activities requiring mental alertness.
3.
Use alcohol for additional effect in reducing cough.
4.
Avoid chewing sugarless gum or using oral rinses mouth.
Diphenhydramine has several uses, including antihistamine, antitussive, antidyskinetic, and sedative-hypnotic. Because **the medication causes drowsiness,** the client should avoid use of alcohol or central nervous system depressants, operating a car, or engaging in other activities that require mental acuity. It should be taken with food or milk to decrease gastrointestinal upset, and oral rinses, sugarless gum, or hard candy may be used to minimize dry mouth.
68
Which supplies should the nurse obtain for the administration of ribavirin to a hospitalized child with respiratory syncytial virus (RSV)?
## Footnote
1.
A mask and pair of goggles
2.
Isolation gown and sterile gloves
3.
An intravenous (IV) pole and hood
4.
Intramuscular (IM) syringe and needle
Ribavirin is administered *via hood, face mask, or oxygen tent and is not administered by the IV or IM route.*
***Some caregivers experience headaches, burning nasal passages and eyes, and crystallization of soft contact lenses as a result of administration of ribavirin. Specific to this medication is the use of goggles.*** **A mask may be worn**. A gown is not necessary. The medication used for the prevention of RSV is palivizumab, a monoclonal antibody, which is given monthly in an IM injection to prevent hospitalization associated with RSV.
69
The nurse reviews the arterial blood gas results of a client and notes the following: pH 7.45, Paco2 of 30 mm Hg (30 mm Hg), and HCO3– of 20 mEq/L (20 mmol/L). The nurse analyzes these results as indicating which condition?
1.
Metabolic acidosis, compensated
2.
Respiratory alkalosis, compensated
3.
Metabolic alkalosis, uncompensated
4.
Respiratory acidosis, uncompensated
Respiratory Alkalosis
**The normal pH is 7.35 to 7.45. In a respiratory condition, an opposite effect will be seen between the pH and the Paco2.** In this situation, the pH is at the high end of the normal value and the Pco2 is low. In an alkalotic condition, the pH is elevated. Therefore, the values identified in the question indicate a respiratory alkalosis that is compensated by the kidneys through the renal excretion of bicarbonate. Because the pH has returned to a normal value, compensation has occurred.
Remember that **in a respiratory imbalance you will find an opposite response between the pH and the Pco2** as indicated in the question. Therefore, you can eliminate the options reflective of a primary metabolic problem. Also, remember that **the pH increases in an alkalotic condition and compensation can be evidenced by a normal pH**. The correct option reflects a respiratory alkalotic condition and compensation and describes the blood gas values as indicated in the question.
70
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_defined as a deficit or loss of hydrogen ions or acids or an excess of base (bicarbonate) that results from the accumulation of base or from a loss of acid without a comparable loss of base in the body fluids.
Metabolic alkalosis
71
Loss of gastric fluid via nasogastric suction or vomiting causes\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ as a result of the loss of hydrochloric acid.
metabolic alkalosis
72
Metabolic alkalosis occurs in conditions resulting in \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_-
hypovolemia, the loss of gastric fluid, excessive bicarbonate intake, the massive transfusion of whole blood, and hyperaldosteronism
73
A client with a 3-day history of nausea and vomiting presents to the emergency department. The client is hypoventilating and has a respiratory rate of 10 breaths/minute. The electrocardiogram (ECG) monitor displays tachycardia, with a heart rate of 120 beats/minute. Arterial blood gases are drawn and the nurse reviews the results, expecting to note which finding?
1.
A decreased pH and an increased PaCO2
2.
An increased pH and a decreased PaCO2
3.
A decreased pH and a decreased HCO3–
4.
An increased pH and an increased HCO3–
An increased pH and an increased HCO3–
**Clients experiencing nausea and vomiting would most likely present with metabolic alkalosis** resulting from loss of gastric acid, thus causing the pH and HCO3– to increase. **Symptoms experienced by the client would include hypoventilation and tachycardia**
74
vomiting most likely causes whick kind of acid base imbalance?
Metabolic alkalosis
75
The nurse is caring for a client having respiratory distress related to an anxiety attack. Recent arterial blood gas values are pH = 7.53, Pao2 = 72 mm Hg (72 mm Hg), Paco2 = 32 mmHg (32 mm Hg), and HCO3– = 28 mEq/L (28 mmol/L). Which conclusion about the client should the nurse make?
1.
The client has acidotic blood.
2.
The client is probably overreacting.
3.
The client is fluid volume overloaded.
4.
The client is probably hyperventilating.
The ABG values are abnormal, which supports a physiological problem. The ABGs indicate respiratory alkalosis as a result of hyperventilating, not acidosis.
76
Kussmaul's respirations are abnormally \_\_\_\_\_\_\_\_\_\_\_\_and \_\_\_\_\_\_\_\_\_\_\_\_in rate. These occur as a result of the compensatory action by the lungs
deep; increased
77
this type of respiration occurs in diabetic ketoacidosis
Kussmaul's respirations
they are abnormanlly deep and increased in rate
78
The normal bicarbonate (HCO3–) level is \_\_\_\_\_\_\_\_\_mEq/L
21 to 28
79
A client who is found unresponsive has arterial blood gases drawn and the results indicate the following: pH is 7.12, Paco2 is 90 mm Hg (90 mm Hg), and HCO3– is 22 mEq/L (22 mmol/L). The nurse interprets the results as indicating which condition?
1.
Metabolic acidosis with compensation
2.
Respiratory acidosis with compensation
3.
Metabolic acidosis without compensation
4.
Respiratory acidosis without compensation
The acid-base disturbance is respiratory acidosis without compensation. The normal pH is 7.35 to 7.45. The normal Paco2 is 35 to 45 mm). **In respiratory acidosis the pH is decreased and the Pco2 is elevated.** The normal bicarbonate (HCO3–) level is 21 to 28 mEq/L (21 to 28 mmol/L). Because the bicarbonate is still within normal limits, **the kidneys have not had time to adjust for this acid-base disturbance. In addition, the pH is not within normal limits. Therefore, the condition is without compensation**
80
\_\_\_\_\_\_\_\_kalemia is associated with acidosis.
Hyperkalemia
81
The nurse notes that a client's arterial blood gas (ABG) results reveal a pH of 7.50 and a Paco2 of 30 mm Hg (30 mm Hg). The nurse monitors the client for which clinical manifestations associated with these ABG results? Select all that apply.
1.
Nausea
2.
Confusion
3.
Bradypnea
4.
Tachycardia
5.
Hyperkalemia
6.
Lightheadedness
**Rationale:**
Respiratory alkalosis is defined as a deficit of carbonic acid or a decrease in hydrogen ion concentration that results from the accumulation of base or from a loss of acid without a comparable loss of base in the body fluids. This **occurs in conditions that cause overstimulation of the respiratory system.** Clinical manifestations of respiratory alkalosis include ***lethargy, lightheadedness, confusion, tachycardia, dysrhythmias related to hypokalemia, nausea, vomiting, epigastric pain, and numbness and tingling of the extremities. Hyperventilation (tachypnea) occurs***.
Hyperkalemia is associated with acidosis.
82
occurs in conditions that cause overstimulation of the respiratory system.
Respiratory Alkalosis
83
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_is a condition characterized by the collapse of alveoli, preventing the respiratory exchange of oxygen and carbon dioxide in a part of the lungs.
Atelectasis
84
Respiratory acidosis is most often caused by\_\_\_\_\_\_\_\_\_\_\_\_
Respiratory alkalosis is associated with \_\_\_\_\_\_\_\_ventilation
hypoventilation
hyperventilation
85
The nurse is caring for a client with several broken ribs. The client is most likely to experience what type of acid-base imbalance?
## Footnote
1.
Respiratory acidosis from inadequate ventilation
2.
Respiratory alkalosis from anxiety and hyperventilation
3.
Metabolic acidosis from calcium loss due to broken bones
4.
Metabolic alkalosis from taking analgesics containing base products
**Respiratory acidosis is most often caused by hypoventilation**. The client with broken ribs will have difficulty with breathing adequately and is at risk for hypoventilation and resultant respiratory acidosis.
the client will have difficulty breathing adequately.
hypoventilation results in respiratory acidosis
86
headache, restlessness, and confusion occur in respiratory \_\_\_\_\_\_\_\_\_\_\_\_\_
acidosis.
87
A client with a history of lung disease is at risk for developing respiratory acidosis. The nurse should assess the client for which signs and symptoms characteristic of this disorder?
headache, restlessness and confusion
88
In both respiratory and metabolic acidosis, the central nervous system (CNS) is \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_. \_\_\_\_\_\_\_\_\_\_\_\_, \_\_\_\_\_\_\_\_\_\_\_, \_\_\_\_\_\_\_\_\_\_\_, and \_\_\_\_\_\_\_\_\_\_\_\_develop, leading eventually to coma and death.
depressed; headache; lethargy; confusion; weakness
89
acidosis is related to CNS depression and not irritability.
TRUE OR FALSE
TRUE
90
in metabolic conditions the pH and the HCO3 move\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
in the same direction
91
In a respiratory condition, an \_\_\_\_\_\_\_\_\_\_\_\_\_effect will be seen between the pH and the Paco2. In a metabolic condition, the pH and the bicarbonate \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_-
opposite; move in the same direction.
92
alkalosis is caused by \_\_\_\_\_\_\_\_\_\_\_of the CNS and not depression of that system.
irritability
93
The nurse is caring for a client whose arterial blood gas results reveal alkalosis. What client reactions would the nurse expect to see? Select all that apply.
1.
Tetany
2.
Lethargy
3.
Tingling
4.
Confusion
5.
Numbness
6.
Restlessness
A client's reaction to alkalosis causes **tingling and numbness of the fingers, restlessness, and tetany caused by irritability of the central nervous system (CNS) results**. If the severity of alkalosis increases, convulsions and coma may occur.
94
paresthesias are a feature of respiratory alkalosis
TRUE OR FALSE
TRUE
95
Clinical manifestations of \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_include a decrease in the respiratory rate and depth, headache, lightheadedness, vertigo, mental status changes, paresthesias such as tingling of the fingers and toes, hypokalemia, hypocalcemia, tetany, and convulsions
respiratory alkalosis
96
The nurse is performing a change-of-shift assessment on a client. The client had an arterial blood gas specimen drawn during an admission workup on the previous day and has a hematoma at the puncture site. What is the priority nursing intervention?
1.
Perform the Allen's test.
2.
Apply a warm compress.
3.
Administer the antidote for heparin.
4.
Notify the hospital laboratory supervisor.
**The application of a warm compress enhances the absorption of blood in the hematoma**.
Allen's test is performed before the collection of the specimen to assess collateral blood flow. Heparinized syringes are used for the collection of an arterial blood gas, but no heparin is administered to a client. The antidote for heparin is not administered at this time unless prescribed. The laboratory department is not responsible for collecting the arterial blood gas specimen. Additionally, there is no useful reason to notify the hospital laboratory supervisor.
97
A client has a prescription for a set of arterial blood gas (ABG) samples to be drawn on room air. The client currently is receiving oxygen by nasal cannula at a delivery rate of 3 L/min. After reading the prescription, the nurse should take which action?
1.
Remove the nasal cannula for 15 minutes; then have the ABG samples drawn.
2.
Change the nasal cannula to a shovel face mask; then have the ABG samples drawn.
3.
Leave the nasal cannula in place for 15 minutes; then have the ABG samples drawn.
4.
Change the nasal cannula to a Venturi face mask; then have the ABG samples drawn.
***The client should have oxygen supplementation removed for at least 15 minutes before ABGs are drawn if the client has a prescription for the ABGs to be drawn on room air***.
This allows time for the client's system to equilibrate so that the ABG results will accurately reflect ventilatory status without the supplemental oxygen. This prescription may be given when the health care provider is trying to decide whether to discontinue oxygen therapy, and it allows staff to observe how the client tolerates oxygen removal. Therefore, the remaining options are incorrect.
98
A client experiencing metabolic acidosis is to be admitted to the nursing unit. The nurse plans care knowing that what reaction is the most powerful regulator of acid-base balance?
1.
Buffer
2.
Kidney
3.
Cations
4.
Respiratory
**The renal reaction is the most powerful regulator of acid-base balance.** Renal tubules secrete hydrogen ions and potassium effectively, and in lesser amounts they secrete ammonia and uric acid. They respond to large or chronic fluctuations in hydrogen ion production or elimination and also reabsorb carbon dioxide molecules. **However, the kidney tubules have the slowest response (hours to days).**
99
Most problems of alkalosis are related to increased stimulation of the \_\_\_\_\_\_\_\_\_\_, \_\_\_\_\_\_\_\_\_\_and\_\_\_\_\_\_\_\_\_\_\_\_- systems
cardiac, nervous,neuromuscular
100
The nurse is caring for a client with metabolic alkalosis. The nurse plans care knowing that most problems of metabolic alkalosis are related to increased stimulation of what systems? Select all that apply.
1.
Buffer
2.
Cardiac
3.
Nervous
4.
Chemical
5.
Respiratory
6.
Neuromuscular
***Most problems of alkalosis are related to increased stimulation of the cardiac, nervous, and neuromuscular systems.*** Chemical reactions are also called buffer systems and are not related to most problems of alkalosis. **The respiratory system is related to respiratory alkalosis and not metabolic alkalosis.**
101
The nurse is planning to obtain blood for arterial blood gas analysis from a client with chronic obstructive pulmonary disease. The nurse should plan time for which activity after the arterial blood specimen is drawn?
1.
Holding a warm compress over the puncture site for 5 minutes
2.
Encouraging the client to open and close the hand rapidly for 2 minutes
3.
Applying pressure to the puncture site by applying a 2 × 2 gauze for 5 minutes
4.
Having the client keep the radial pulse puncture site in a dependent position for 5 minutes
***Applying pressure over the puncture site reduces the risk of hematoma formation and damage to the artery.***
A cold (not warm) compress would aid in limiting blood flow. Keeping the extremity still and out of a dependent position will aid in the formation of a clot at the puncture site.
Focus on the subject, **preventing bleeding after a blood draw. Options 1, 2, and 4 promote bleeding**. The correct option aids in the prevention of bleeding into the surrounding tissues.
102
A client with diabetes mellitus has a blood glucose level of 644 mg/dL (35.7 mmol/L). The nurse plans care knowing that the client is at risk for the development of which type of acid-base imbalance?
1.
Metabolic acidosis
2.
Metabolic alkalosis
3.
Respiratory acidosis
4.
Respiratory alkalosis
**Diabetes mellitus can lead to metabolic acidosis.** When the body does not have sufficient circulating insulin, the blood glucose level rises. At the same time, the cells of the body use all available glucose. The body then breaks down glycogen and fat for fuel. The by-products of fat metabolism are acidotic, potentially leading to the condition known as diabetic ketoacidosis. The remaining options are incorrect.
103
the client with diabetes mellitus is **at risk for the development of \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**
**metabolic acidosis.**
104
the most effective treatment of acid-base imbalances involves treatment of the \_\_\_\_\_\_\_\_\_\_\_\_cause will direct you to the correct option.
primary
105
Clinical manifestations of metabolic acidosis include
hyperpnea with Kussmaul's respirations; headache; nausea, vomiting, and diarrhea; fruity-smelling breath resulting from improper fat metabolism; central nervous system depression, including mental dullness, drowsiness, stupor, and coma; twitching; and convulsions. Hyperkalemia will occur.
106
Excessive use of oral antacids containing bicarbonate can cause a \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
metabolic alkalosis
107
Increases in base components occur as a result of oral or parenteral intake of \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_---
bicarbonates, carbonates, acetates, citrates, or lactates
108
The client tells the nurse that he ingests large amounts of oral antacids on a daily basis. The nurse plans care knowing that the excessive use of oral antacids containing bicarbonate can result in which acid-base disturbance?
1.
Metabolic acidosis
2.
Metabolic alkalosis
3.
Respiratory acidosis
4.
Respiratory alkalosis
Focus on the subject, causes of acid-base imbalances. Eliminate options indicating a respiratory condition first since ingestion has occurred. Regarding the remaining choices, remembering that antacids contain bicarbonate and that an excess oral intake will increase bicarbonate will assist in directing you to the correct option
**Metabolic alkalosis**
109
The client with a history of lung disease is at risk for developing respiratory acidosis. The nurse asks this client about which symptoms that are characteristic of this disorder?
1.
"Do you have shallow breathing?"
2.
"Do you feel like you have a lot of energy?"
3.
"Do you have a headache or become confused?"
4.
"Do you feel dizzy or have tingling sensations?"
When a client is experiencing respiratory acidosis, the respiratory rate and depth increase in an attempt to compensate.
The client also experiences **headache,** restlessness, and mental status changes such as drowsiness and **confusion**, visual disturbances, diaphoresis, and cyanosis as the hypoxia becomes more acute, along with hyperkalemia, a rapid irregular pulse, and dysrhythmias.
110
The nurse is caring for a client with respiratory failure related to Guillain-Barré syndrome. The nurse plans care knowing that what other extrapulmonary causes can lead to respiratory failure? Select all that apply.
1.
Stroke
2.
Pneumonia
3.
Sleep apnea
4.
Myasthenia gravis
5.
Obstructive lung disease
6.
Opioid analgesics, sedatives, anesthetics
Extrapulmonary causes of respiratory failure include the following: stroke, sleep apnea, myasthenia gravis, and opioid analgesics, sedatives, and anesthetics. Both obstructive lung disease and pneumonia are intrapulmonary causes of respiratory failure.
111
The \_\_\_\_\_\_\_\_\_\_\_test is performed before an arterial blood gas specimen is obtained from the radial artery to determine the \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Allen; presence of collateral circulation and the adequacy of the ulnar artery.
**Failure to determine the presence of adequate collateral circulation could result in severe ischemic injury to the hand if damage to the radial artery occurs with arterial puncture**. The nurse would first explain the procedure to the client. To perform the test, the nurse applies direct pressure over the client's ulnar and radial arteries simultaneously. While applying pressure, the nurse asks the client to open and close the hand repeatedly; the hand should blanch. The nurse then releases pressure from the ulnar artery while continuing to compress the radial artery and then assesses the color of the extremity distal to the pressure point. If pinkness fails to return within 6 seconds, the ulnar artery is insufficient, indicating that the radial artery should not be used for obtaining a blood specimen. Finally, the nurse documents the findings.
112
Steps to Perform the Allen Test
1. Explain the procedure to the client
2. Apply Pressure over the radial/ulnar arteries
3. Ask the client to open and close the hand repeatedly
4. Release pressure from the ulnar artery
5. Assess the color of the extremity distal to the pressure point
6. Document the findings
113
A client is about to have arterial blood gases drawn, and the nurse explains what an Allen's test is. What comment shows that the client understands the nurse's explanation?
1.
"Blood is drawn from the ulnar artery."
2.
"I know I have to lie down while blood is drawn."
3.
"This test is done to ensure adequate collateral circulation."
4.
"Direct pressure has to be placed over the site for 15 minutes after blood is drawn."
The Allen test is important because **it ensures collateral circulation to the hand if thrombosis of the radial artery occurs after the puncture.** Failure to determine the presence of adequate collateral circulation could result in severe ischemic injury to the hand if damage to the radial artery occurs with arterial puncture.
Eliminate option 1 because if circulation is adequate, blood is drawn from the radial artery. Eliminate option 2 because it is not necessary to lie down for the test. Also, eliminate option 4 because ***direct pressure must be applied for only 3 to 5 minutes. If the client is on blood thinners, then pressure must be applied for 15 minutes.***
114
The nurse is caring for a client with diabetic ketoacidosis whose respirations are abnormally deep, regular, and increased in rate. What is the purpose of this type of respiration? Select all that apply.
1.
Correct bradypnea
2.
Blow off carbon dioxide
3.
Correct metabolic acidosis
4.
Correct an acid-base imbalance
5.
Cause respiratory compensation
6.
Stimulate Cheyne-Stokes respirations
2,3,4,5
***Abnormally deep, regular, and increased in rate respirations enable respiratory compensation in an effort to help correct metabolic acidosis***. These respirations are called Kussmaul's respirations, and they occur by exhaling excess carbon dioxide. Bradypnea is abnormally slow but regular respirations. Cheyne-Stokes respirations have rhythmic crescendo and decrescendo of rate and depth, including brief periods of apnea. Kussmaul's respirations do not stimulate Cheyne-Stokes respirations.
115
this type of respiration occurs in diabetic ketoacidosis
Kussmaul's respirations
these abnormal respirations help correct acid-base imbalance by blowing off carbon dioxide (an acid) from the lungs in an attempt to correct metabolic acidosis.
116
A client with diabetes mellitus is most likely to experience which type of acid-base imbalance as a complication of the disorder?
1.
Metabolic acidosis
2.
Metabolic alkalosis
3.
Respiratory acidosis
4.
Respiratory alkalosis
**Diabetes mellitus can lead to metabolic acidosis.**
When the body does not have sufficient circulating insulin, the blood glucose level rises while the cells of the body use all available glucose and then break down glycogen and fat for fuel. The by-products of fat metabolism are acidotic, leading to the complication called diabetic ketoacidosis. The acid-base disorders in the remaining options are not likely to occur in diabetes mellitus unless there is another existing disorder
117
The nurse is admitting to the hospital a client with a diagnosis of Guillain-Barré syndrome. The nurse knows that if the disease is severe enough, the client will be at risk for which acid-base imbalance?
## Footnote
1.
Metabolic acidosis
2.
Metabolic alkalosis
3.
Respiratory acidosis
4.
Respiratory alkalosis
Guillain-Barré is a neuromuscular disorder in which the client may experience weakening or paralysis of the muscles used for respiration. This could cause the client to retain carbon dioxide, leading to **respiratory acidosis** and ventilatory failure as the paralysis develops.
***this disorder impairs the client's respiratory function***, so eliminate options 1 and 2 first. Thinking through the effects of reduced ventilation will help you choose correctly between the remaining two options.
118
Clinical manifestations of \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_include tachypnea, hyperpnea, weakness, paresthesias, tetany, dizziness, convulsions, coma, **hypokalemia, and hypocalcemia.**
respiratory alkalosis
serum potassium reduction occurs in an attempt to maintain electroneutrality in the presence of alkalosis
119
A client with a chronic airflow limitation is experiencing respiratory acidosis as a complication. The nurse who is trying to enhance the client's respiratory status should avoid which action?
1.
Keeping the head of the bed elevated
2.
Monitoring the flow rate of supplemental oxygen
3.
Assisting the client to turn, cough, and breathe deeply
4.
Encouraging the client to breathe slowly and shallowly
**Encouraging the client to breathe slowly and shallowly**
The client with respiratory acidosis is experiencing elevated carbon dioxide levels caused by insufficient ventilation. The nurse would encourage the client to breathe slowly and deeply to expand alveoli and to promote better gas exchange.
choose the option that would cause further impairment. Noting the word shallowly in option 4 will direct you to this choice.
120
An anxious client is experiencing respiratory alkalosis from hyperventilation caused by anxiety. The nurse should take which action to help the client experiencing this acid-base disorder?
1.
Put the client in a supine position.
2.
Provide emotional support and reassurance.
3.
Withhold all sedative or antianxiety medications.
4.
Tell the client to breathe very deeply but more slowly.
**An anxious client benefits from emotional support and reassurance, which in turn reduces anxiety and may lower the respiratory rate.** The client may benefit from the administration of a sedative or antianxiety medication if it is prescribed. The client should try to breathe more slowly. Lying supine provides no benefit to the client and may cause problems with breathing.
121
the serum potassium level tends to \_\_\_\_\_\_\_\_\_\_\_with metabolic acidosis.
rise
This is because potassium moves out of the cells and into the bloodstream. When acidosis is corrected with treatment, the potassium will shift back into the cellular compartment. This can cause a rapid drop in the serum potassium level. Because of the effects of potassium on the heart, this electrolyte should be monitored closely while the client is treated.
122
The client with metabolic alkalosis is at risk for tetany and seizures.
TRUE OR FALSE
TRUE
123
The nurse is caring for a client who is experiencing metabolic alkalosis. Knowing the risks of this imbalance, the nurse plans to protect the client's safety by carefully implementing which prescribed precaution?
1.
Contact isolation
2.
Seizure precautions
3.
Bleeding precautions
4.
Neutropenic precautions
The client with metabolic alkalosis is at risk for tetany and seizures. The nurse would maintain client safety by using seizure precautions with this client. The remaining options are unnecessary in the care of the client experiencing metabolic alkalosis.
124
The nurse is caring for a client who overdosed on acetylsalicylic acid (aspirin) 24 hours ago. The nurse should expect to note which findings associated with an anticipated acid-base disturbance?
1.
Disorientation and dyspnea
2.
Drowsiness, headache, and tachypnea
3.
Tachypnea, dizziness, and paresthesias
4.
Decreased respiratory rate and depth, cardiac irregularities
**The client who ingests a large amount of acetylsalicylic acid (aspirin) is at risk for developing metabolic acidosis 24 hours later.** If metabolic acidosis occurs, **the client is likely to exhibit drowsiness, headache, and tachypnea**.
In the very early hours following aspirin overdose, the client may exhibit respiratory alkalosis as a compensatory mechanism. However, by 24 hours post overdose, the compensatory mechanism fails, and the client reverts to metabolic acidosis. The client with metabolic alkalosis (option 4) is likely to experience cardiac irregularities and a compensatory decreased respiratory rate and depth. Options 1 and 3 indicate respiratory acidosis and alkalosis, respectively.
125
A client has been diagnosed with metabolic alkalosis as a result of excessive antacid use. The nurse monitoring this client should expect to note which signs/symptoms?
1.
Disorientation and dyspnea
2.
Decreased respiratory rate and depth
3.
Drowsiness, headache, and tachypnea
4.
Tachypnea, dizziness, and paresthesias
***A client with metabolic alkalosis is likely to exhibit decreased respiratory rate and depth as a compensatory mechanism.***
A client with metabolic acidosis would display the symptoms noted in option 3. The client with respiratory acidosis and alkalosis would display the symptoms noted in options 1 and 4, respectively.
126
The nurse is providing care to a client with the following arterial blood gas results: pH of 7.50 (7.50), Pao2 of 90 mm Hg (90 mm Hg), Paco2 of 40 mm Hg (40 mm Hg), and bicarbonate of 35 mEq/L (35 mmol/L). When the nurse notifies the health care provider about these levels, the nurse should anticipate receiving from the HCP which prescription for this client?
## Footnote
1.
Obtain a serum alcohol level.
2.
Obtain a serum salicylate level.
3.
Discontinue nasogastric suctioning.
4.
Discontinue the client's fentanyl patch.
The arterial blood gas (ABG) results indicate metabolic alkalosis, as the pH and bicarbonate are elevated. **Nasogastric suctioning may cause metabolic alkalosis by decreasing the acid components in the stomach**. Excess alcohol ingestion and salicylate toxicity may cause metabolic acidosis. Fentanyl (an opioid) may cause respiratory acidosis.
**Nasogastric suctioning decreases the acid components of the stomach, which can increase pH by decreasing the free hydrogen ion level in the blood.**
127
The nurse is caring for a client with hyperglycemia and diabetic ketoacidosis (DKA) who now has developed Kussmaul respirations. The nurse knows that the purpose of this type of breathing is to correct what imbalance?
1.
Metabolic acidosis
2.
Metabolic alkalosis
3.
Respiratory acidosis
4.
Respiratory alkalosis
***Kussmaul respirations cause respiratory compensation in an attempt to correct metabolic acidosis by exhaling carbon dioxide.***
**This breathing pattern is very deep and rapid** and is the respiratory system's attempt to correct metabolic acidosis by exhaling carbon dioxide.
