Nursing Prioritization Delegation Assignment Q 61
A 56-year-old male is newly admitted to the medical unit. Which factor alerts the nurse that this client has a risk for acid-base imbalances?
A. The client takes antacids for occasional indigestion.
B. The client gets short of breath with extreme exertion.
C. The client has a history of myocardial infarction 1 year ago.
D. The client has chronic renal insufficiency.
Correct Answer: D. The client has chronic renal insufficiency.
Chronic renal disease and pulmonary disease are risk factors for acid-base imbalances in the older adult. Renal failure patients have an altered acid-base balance; most commonly, a mixed type of metabolic acidosis (hyperchloremic, and of a high anion gap) is observed.
Option A: Although antacid abuse is a risk factor for metabolic alkalosis, occasional antacid use will not cause imbalances. Antacid use won’t normally lead to metabolic alkalosis. But if the patient has a weak or failing kidneys and uses a nonabsorbable antacid, it can bring on alkalosis. Nonabsorbable antacids contain aluminum hydroxide or magnesium hydroxide.
Option B: A typical respiratory response to all types of metabolic alkalosis is hypoventilation leading to a pH correction towards normal. Increases in arterial blood pH depress respiratory centers. The resulting alveolar hypoventilation tends to elevate PaCO2 and restore arterial pH toward normal.
Option C: MI is not related to metabolic alkalosis. Metabolic alkalosis is caused by too much bicarbonate in the blood. It can also occur due to certain kidney diseases. Hypochloremic alkalosis is caused by an extreme lack or loss of chloride, such as from prolonged vomiting.