Boost Skills: NCLEX Daily Questions #28

November 28, 2024

Thursday

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A client is receiving IV sodium bicarbonate for acute metabolic acidosis. Which of these laboratory values would best indicate that the sodium bicarbonate has been effective?

Serum pH 7.32, HCO3 26 mEq/L (26 mmol/L), potassium 4.9 mEq/L (4.9 mmol/L)

Serum pH 7.41, HCO 18 mEq/L (18 mmol/L), potassium 4.3 mEq/L. (4.3 mmol/L)

Serum pH 7.39, HCO 24 mEq/L (24 mmol/L), potassium 3.8 mEq/L (3.8 mmol/L)

Serum pH 7.34, HCO3 21 mEq/L (21 mmol/L), potassium 5.1 mEq/L (5.1 mmol/L)

Metabolic acidosis is due to an increase in the production or retention of acid (eg, lactic acidosis, ketoacidosis, renal failure) or the depletion of bicarbonate (HCO3) the kidneys or gastrointestinal tract. In metabolic acidosis, there is a decrease in pH (< 7.35 ) and HCO₂ (< 22 mEq [22 mmol/L]). Acidosis damages cells, causing them to release intracellular contents (eg, potassium). Hyperkalemia (potassium > 5mEq / L | 5 mmol/L]) frequently occurs with acidosis, putting the client at risk for cardiac arrhythmias. Depending on the cause and severity of acidosis, the client can exhibit altered mental status and tachypnea. Management focuses on treating the underlying cause and administering IV sodium bicarbonate to correct the imbalance. Arterial blood gas pH 7.39, HCO, 24 mEq/L (24 mmol/L), and serum potassium 3.8 mEq/L (3.8 mmol/L) are within normal limits, indicating the sodium bicarbonate has effectively corrected acidosis.

(Options 1, 2, and 4) These laboratory values are not within normal limits and do not indicate that the sodium bicarbonate has effectively corrected acidosis.

Educational objective: Metabolic acidosis is an acid-base imbalance that occurs when the pH level drops from excess acid accumulation or bicarbonate ( HCO3) loss. Interventions focus on treating the underlying cause and administering IV HCO3

Metabolic acidosis is due to an increase in the production or retention of acid (eg, lactic acidosis, ketoacidosis, renal failure) or the depletion of bicarbonate (HCO3) the kidneys or gastrointestinal tract. In metabolic acidosis, there is a decrease in pH (< 7.35 ) and HCO₂ (< 22 mEq [22 mmol/L]). Acidosis damages cells, causing them to release intracellular contents (eg, potassium). Hyperkalemia (potassium > 5mEq / L | 5 mmol/L]) frequently occurs with acidosis, putting the client at risk for cardiac arrhythmias. Depending on the cause and severity of acidosis, the client can exhibit altered mental status and tachypnea. Management focuses on treating the underlying cause and administering IV sodium bicarbonate to correct the imbalance. Arterial blood gas pH 7.39, HCO, 24 mEq/L (24 mmol/L), and serum potassium 3.8 mEq/L (3.8 mmol/L) are within normal limits, indicating the sodium bicarbonate has effectively corrected acidosis.

(Options 1, 2, and 4) These laboratory values are not within normal limits and do not indicate that the sodium bicarbonate has effectively corrected acidosis.

Educational objective: Metabolic acidosis is an acid-base imbalance that occurs when the pH level drops from excess acid accumulation or bicarbonate ( HCO3) loss. Interventions focus on treating the underlying cause and administering IV HCO3

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