PRACTICE NCLEX QUESTIONS RELATED TO ACID-BASE IMBALANCE Part 2

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KEY POINTS TO REMEMBER:

  • The normal pH is 7.35-7.45
  • The underlying cause of an acid base imbalance needs to be identified and the cause needs to be treated to resolve the imbalance
  • Monitor the patient’s respiratory status closely
  • During acidosis, the respiratory rate and depth increase in an attempt to exhale acids.
  • During alkalosis, the respiratory rate and depth decrease; carbon dioxide is retained to neutralize and decrease the strength of excess bicarbonate.
  • When client experiences an acid-base imbalance, monitor the potassium level closely, because the potassium moves in or out of the cells in an attempt to maintain acid-base balance. The resulting hypokalemia or hyperkalemia predisposes the client to associated complications.
  • For any acid-base imbalance, it is necessary to monitor level of consciousness of the patient, use protective measures to ensure safety, monitor electrolyte levels and follow-up ABG test results.
  • If the client has a condition that causes an obstruction of the airway or depresses the respiratory system, monitor the client for respiratory acidosis.
  • An insufficient supply of insulin in a client with diabetes mellitus can result in metabolic acidosis known as diabetic ketoacidosis
  • Monitor the patient experiencing severe diarrhea for manifestations of metabolic acidosis
  • Monitor the patient experiencing excessive vomiting or the clients with gastrointestinal suctioning for manifestations of metabolic alkalosis
  • In a respiratory imbalance, the ABG result indicates an opposite relationship between the pH and the PaCO2.
  • In a metabolic imbalance, the ABG result indicates a corresponding relationship between the pH and the HCO3
  • Metabolic alkalosis is defined as a deficit or loss of hydrogen ions or acids or an excess of base (bicarbonate) that results from the accumulation of the base or from a loss of acid without a comparable loss of base in the body fluids.
  • In acidosis, the pH is decreased
  • In alkalosis, the pH is increased
  • The respiratory function indicator is the PaCO2
  • The metabolic function indicator is the HCO3
  • Normal arterial blood gas values:
LABORATORY TESTNORMAL RANGE OF
CONVENTIONAL UNITS
NORMAL RANGE OF
SI UNITS
ARTERIAL
pH7.35-7.457.35-7.45
PaCO2
partial pressure of carbon dioxide
in arterial blood		35-45mm Hg35-45mm Hg
Bicarbonate HCO321-28 mEq/L21-28mmol/L
PaO2
partial pressure of oxygen in arterial
blood		80-100mmHg80-100mmHg
VENOUS
pH (venous)7.31-7.417.31-7.41
PvO2
partial pressure of oxygen in
venous blood		40-50mmHg40-50mmHg

PRACTICE NCLEX QUESTION ANSWERS RELATED TO ACID-BASE IMBALANCE

  1. The nurse reviews the arterial blood gas results of a client and notes the following: pH 7.45, PaCO2 of 30mmHg, and HCO3 of 20mEq/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
  2. The nurse is caring for a client with a nasogastric tube that is attached to low suction. The nurse monitors the client for manifestations of which disorder that the client is at risk for?
    1. Metabolic acidosis
    2. Metabolic alkalosis
    3. Respiratory acidosis
    4. Respiratory alkalosis
  3. A client with a 3-day history of nausea and vomiting presents to the emergency department. The client is hypo ventilating and has a respiratory rate of 10 breaths per minute. The electrocardiogram (ECG) monitor displays tachycardia, with a heart rate of 120 beats per 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
  4. 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=72mmHg, PaCo2=32mmHg, and HCO3=28mEq/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
  5. The nurse is caring for a client with diabetic ketoacidosis and documents that the client is experiencing Kussmaul’s respirations. Which patterns did the nurse observe? Select all that apply.
    1. Respirations that are shallow
    2. Respirations that are increased in rate
    3. Respirations that are abnormally slow
    4. Respirations that are abnormally deep
    5. Respirations that cease for several seconds
  6. A client who is found unresponsive has arterial blood gases drawn and the results indicate the following: pH is 7.12, PaCO2 is 90mmHg and HCO3 is 22mEq/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
  7. The nurse notes that a client’s arterial blood gas (ABG) results reveal a pH of 7.50 and a PaCO2 of 30mm 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
  8. The nurse reviews the blood gas results of a client with atelectasis. The nurse analyzes the results and determines that the client is experiencing respiratory acidosis, which result validates the nurse’s finding?
    1. pH 7.25, PaCO2 50mm Hg
    2. pH 7.35, PaCO2 40mm Hg
    3. pH 7.50, PaCO2 52mmHg
    4. pH 7.52, PaCO2 28mm Hg
  9. The nurse is caring for a client who is on a mechanical ventilator. Blood gas results indicate a pH of 7.50 and a PaCO2 of 30mm Hg. The nurse has determined that the client is experiencing respiratory alkalosis. Which laboratory value would most likely be noted in this condition?
    1. Sodium level of 145 mEq/L
    2. Potassium level of 3.0 mEq/L
    3. Magnesium level of 1.8
    4. Phosphorus level of 3.0 mg/dL
  10. The nurse is caring for a client with several broken ribs. The client is most likely to experience what type of acid base imbalance?
    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.

ANSWERS

  1. 2
  2. 2
  3. 4
  4. 4
  5. 2,4
  6. 4
  7. 1,2,4,6
  8. 1
  9. 2
  10. 1

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