1. Acid base imbalance ➢ While checking arterial blood gas results, a nurse finds respiratory acidosis. What does the nurse suspect is occurring in the patient? reduced tidal volumes ➢ A 20-year-old male is in acute pain. An arterial blood gas reveals decreased carbon dioxide (CO2 ) levels. Which of the following does the nurse suspect is the most likely cause? Hyperventilation ➢ The nurse is assessing a client with suspected respiratory acidosis. Which assessment items are priority for the nurse to collect? Rate and depth of respirations, Skin color and temperature, Appearance of the optic nerve ➢ The nurse is administering sodium bicarbonate to the client with respiratory acidosis. The nurse understands that which is the primary goal of treatment for this client? Removing excess acids in blood ➢ ➢ The student nurse is assisting in the care for a client with acute respiratory acidosis. The nurse explains to the student nurse that the client's blood pH initially falls in the development of acute respiratory acidosis because of which process? Hypoventilation 2. ACTH ➢ The nurse is preparing a client for testing to determine if the client has Cushing syndrome. What tests are included in the screening process 24-hour urine secretion of cortisol Dexamethasone suppression test Plasma levels of ACTH ➢ A client comes to the clinic with fatigue and muscle weakness. The client also states she has been having diarrhea. The nurse observes the skin of the client has a bronze tone and when asked, the client says she has not had any sun exposure. The mucous membranes of the gums are bluish-black. When reviewing laboratory results from this client, what does the nurse anticipate seeing? Increased levels of ACTH ➢ A client is diagnosed with adrenocorticotropic hormone deficiency (ACTH) and is to begin replacement therapy. Regarding which type of replacement will the nurse educate the client? Cortisol replacement therapy lOMoARcPSD|12263423 Downloaded by Anna Maina ([email protected]) 1 lOMoARcPSD|12263423 Downloaded by Anna Maina ([email protected]) ➢ Following destruction of the pituitary gland, ACTH stimulation stops. Without ACTH to stimulate the adrenal glands, the adrenals' production of cortisol drops. This is an example of which type of endocrine disorder? Secondary ➢ The nurse is preparing a client for a test that will measure negative feedback suppression of ACTH. Which medication will the nurse administer in conjunction for this test? Dexamethasone ➢ ACTH deficiency results in secondary hypocortisolism ➢ ACTH deficiency is most commonly caused by? glucocorticoid withdrawal ➢ 6 symptoms of an ACTH deficiency tiredness weakness anorexia N/V hypoglycemia orthostatic hypotension ➢ interpretation of ACTH levels requires simultaneous assessment of plasma cortisol levels ➢ ACTH levels are normal to high in primary adrenal insufficiency ➢ ACTH levels are low to absent in secondary adrenal insufficiency ➢ The client has been taking an oral cortisol preparation for 2 years to manage an autoimmune disease. What effects does the nurse expect this therapy to have on this client's circulating levels of ACTH and aldosterone? Decreased ACTH, decreased aldosterone ➢ A nurse checks lab results as both Cushing syndrome and Addison disease can manifest with elevated levels of: Adrenocorticotropic hormone (ACTH) 3. Acute epiglottitis ➢ A caregiver calls the pediatrician's office and reports to the nurse that her 4-year-old, who was fine the previous day, complained of a sore throat early in the morning and now has a temperature of 102.6° F (39.2° C). The caregiver has tried to get the child to nap but the child gets panicky, immediately sits back up, and leans forward with her mouth open and tongue out when the caregiver encourages her to lie down. The nurse suspects the child has which of the following conditions?