A Nasogastric (NG) tube is inserted preoperatively and is attached to low, intermittent suction. A client with an NG tube exhibits these symptoms: He is restless; serum electrolytes are Na 138, K 4.0, and blood pH 7.53. This client is most likely experiencing?

Appeared in: NORCET 5 mains

Explanation

The primary cause is the removal of gastric acid (hydrochloric acid) via the NG tube.
Loss of acid (H+ ions) from the body leads to a relative excess of bicarbonate (HCO3−), a base.
This increase in bicarbonate raises the blood's pH, resulting in metabolic alkalosis.
The client's pH of 7.53 is above the normal upper limit of 7.45, confirming an alkalotic state.
Restlessness can be a neurological sign of metabolic alkalosis.

Option A: The client's serum potassium level is 4.0 mEq/L, which is within the normal range (3.5-5.0 mEq/L). Therefore, hyperkalemia (high potassium) is not present.
Option B: The client's serum sodium level is 138 mEq/L, which is within the normal range (135-145 mEq/L). Therefore, hyponatremia (low sodium) is not present.
Option C: Metabolic acidosis is characterized by a low blood pH (below 7.35). The client's pH is high (7.53), indicating alkalosis, the opposite condition.

Clinical Relevance

Nursing practice connection: Knowing Interpretation of clinical data and lab values to identify acid-base imbalances helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
Nurses are responsible for monitoring patients with NG tubes for complications, including electrolyte and acid-base imbalances.
Early recognition of metabolic alkalosis through assessment of vital signs, level of consciousness (e.g., restlessness, confusion), and lab results is critical to prevent severe complications like seizures and cardiac arrhythmias.
Nursing interventions include notifying the provider, preparing to administer IV fluids with electrolytes (like potassium chloride), and potentially reducing or stopping suction as ordered.

How to Approach the Question

First, analyze the clinical scenario: a patient has an NG tube on suction, a known risk factor for acid-base imbalance.
Next, evaluate the provided lab values against their normal ranges. pH: 7.53 (High), Na: 138 (Normal), K: 4.0 (Normal).
Identify the primary imbalance based on the pH. A pH > 7.45 indicates alkalosis.
Determine if the cause is metabolic or respiratory. The NG suction points to a metabolic cause (loss of stomach acid).
Synthesize the findings: a high pH due to a metabolic cause is metabolic alkalosis.
Eliminate other options based on the normal electrolyte levels and the high pH value.

Concept Tested & Keywords

Concept Tested: Interpretation of clinical data and lab values to identify acid-base imbalances.
Stem keywords: Nasogastric (NG) tube, low, intermittent suction, restless, serum electrolytes, blood pH 7.53
Lead-in keywords: most likely experiencing
Clinical cues: NG tube suction is a key clue for loss of gastric acid.
Clinical cues: Blood pH of 7.53 is significantly above the normal range of 7.35-7.45, indicating alkalosis.

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E6 Nursing Fundamentals Potter Perry 12e Part 5 p. 57-59

E6 Textbook of Biochemistry for medical StudentsDM Vasudevan Part 2 — Subpart A (pp 1-239 of 478) p. 82-84

E6 Ghai Essential Pediatrics(pp 26-904 of 913) p. 70-72

Practise the full NORCET 5 mains

Attempt every question from this paper in a timed mock, then review the full solution for each one.