Deck 13: Acid-Base Balance

Question 1

The nurse is assigned to a client with insulin-dependent diabetes who was brought to the emergency department because of shortness of breath and confusion. On admission, the client's blood glucose level is 720 mg/ml, and ABG values are pH of 7.28, PaCO₂ of 35 mm Hg, and bicarbonate level of 15 mEq/L. The nurse interprets these readings as indicating

A) compensated metabolic acidosis.
B) compensated respiratory acidosis.
C) uncompensated metabolic acidosis.
D) uncompensated respiratory acidosis.

Answer 1

uncompensated metabolic acidosis.

Question 2

The nurse is caring for an 80-year-old client admitted to the hospital with pneumonia and who is becoming progressively more confused. Her vital signs are as follows: T, 101° F; P, 112 beats/min; R, 28 breaths/min; BP, 100/70 mm Hg. ABG results are pH 7.50, PaCO₂ 25 mm Hg, and bicarbonate level 18 mEq/L. The nurse interprets these findings to indicate

A) metabolic acidosis secondary to fever.
B) metabolic alkalosis secondary to bicarbonate excess.
C) respiratory acidosis secondary to anxiety.
D) respiratory alkalosis secondary to hypoxemia.

Answer 2

respiratory alkalosis secondary to hypoxemia.

Question 3

For a 34-year-old client in renal failure who develops acidosis, the nurse would assess for

A) drowsiness.
B) hypoventilation.
C) muscle hyperactivity.
D) paresthesias.

Answer 3

drowsiness.

Question 4

The nurse caring for a trauma victim who has received massive transfusions of whole blood is diligent in assessment for metabolic alkalosis because

A) multiple transfusions of whole blood cause a decrease in serum potassium level.
B) the anticoagulant in the blood is metabolized to bicarbonate.
C) transfused blood is less stable, releasing bicarbonate from the blood cells.
D) whole blood utilizes bicarbonate as a preservative.

Question 5

The nurse performs Allen's test before obtaining an ABG specimen to determine

A) if an allergy to heparin is present.
B) if ulnar circulation is adequate.
C) the patency of the radial artery.
D) the presence of neuromuscular weakness.

Question 6

A client is admitted to the hospital with severe vomiting and is diagnosed with metabolic alkalosis. The nurse anticipates that the laboratory value that would support this diagnosis is

A) arterial carbon dioxide tension (PaCO₂) of 30 mm Hg.Q
B) arterial pH of 7.30.
C) serum calcium level of 9.0 mEq/L.
D) serum potassium level of 3.0 mEq/L.

Question 7

The nurse teaching a 32-year-old man with renal failure about the pathophysiologic mechanism of acid-base balance recognizes that the instructions have been understood when the client says

A) "Acidic foods must be eliminated from my diet."
B) "I lose too much acid through my kidneys."
C) "My breathing increases to correct imbalances."
D) "My urine output will increase when my pH falls."

Question 8

To prevent error in sampling arterial blood gases (ABGs), the nurse will

A) place the sample immediately in ice water.
B) shake the sample to mix in heparin.
C) transfer the sample from syringe to air-tight glass test tube.
D) use a large beveled needle to withdraw the sample.

Question 9

The nurse caring for a client who experienced cardiopulmonary arrest and has a mixed respiratory/metabolic acidosis explains to a concerned family member that the mechanical ventilator can eliminate

A) carbonic acid.
B) lactic acid.
C) phosphoric acid.
D) sulfuric acid.

Question 10

The nurse explains to a concerned family member of a client who has developed respiratory acidosis that the kidneys

A) achieve optimal compensation immediately.
B) are unable to compensate.
C) can achieve optimal compensation in about 3 days.
D) will compensate within 24 hours.

Question 11

Receiving a client's ABG report with pH of 7.40, PaCO₂ of 55 mm Hg, and bicarbonate level of 20 mEq/L, the nurse interprets these values to indicate

A) erroneous blood gas data.
B) metabolic alkalosis.
C) mixed acid-base disorder.
D) respiratory alkalosis.

Question 12

Age-related physiologic changes the nurse would consider when planning care for an elderly client admitted with an acid-base abnormality include (Select all that apply)

A) decreased pulmonary and renal function limit the ability to compensate.
B) hypermetabolism predisposes the elderly to metabolic acidosis.
C) hypoventilation can easily cause respiratory acidosis in the elderly.
D) renal perfusion is diminished because of decreased cardiac output.
E) there is decreased alveolar surface area for gas exchange.

Question 13

In an assessment of current clients, the nurse recognizes that the client most likely to develop respiratory acidosis has

A) chronic obstructive pulmonary disease.
B) hypokalemia.
C) salicylate overdose.
D) pulmonary fibrosis.

Question 14

The nurse is caring for a client who has developed metabolic acidosis and has an anion gap of 12 mEq/L. The nurse informs a family member that this finding indicates that the client's acidosis is caused by

A) accelerated lipid metabolism.
B) an increase of fixed acid.
C) increases in carbonic acid.
D) loss of bicarbonate.

Question 15

When an individual's serum pH begins to fall below 7.35, the mechanism that responds instantaneously to return the serum pH to normal level is

A) ammonia gas combining with H+.
B) excretion of acid by the lungs.
C) plasma bicarbonate buffering the acid.
D) secretion of hydrogen ions (H+) by the kidneys.

Question 16

A client with a diagnosis of chronic renal failure has pH of 7.35, PaCO₂ of 29 mm Hg, and bicarbonate level of 16 mEq/L. The nurse interprets these ABG results as

A) compensated metabolic acidosis.
B) compensated respiratory acidosis.
C) uncompensated metabolic acidosis.
D) uncompensated respiratory acidosis.

Question 17

A client has a blood pH of 7.30 and is being treated with an infusion of sodium bicarbonate. The nurse should assess this client for a possible delayed reaction of increasing levels of which component in the blood?

A) Bicarbonate
B) Calcium
C) Carbon dioxide
D) Glucose

Question 18

A client in diabetic ketoacidosis has an elevated serum potassium ion (K⁺) level. The nurse explains to the client that this is caused by

A) bicarbonate loss in the urine instead of K+ loss.
B) binding of H+ to blood proteins.
C) increased reabsorption of K+ in the distal tubule of the nephron.
D) secretion by the kidneys of H⁺ and retention of K+.

Question 19

The nurse assesses that the client admitted in respiratory acidosis has compensated when the arterial blood gas (ABG) readings are

A) carbon dioxide level of 50 mm Hg and bicarbonate level of 30 mEq/L.
B) carbon dioxide level of 50 mm Hg and bicarbonate level of 20 mEq/L.
C) carbon dioxide level of 30 mm Hg and bicarbonate level of 30 mEq/L.
D) carbon dioxide level of 30 mm Hg and bicarbonate level of 24 mEq/L.

Question 20

A client is brought to the emergency department in cardiac arrest. The nurse is aware that the associated acid-base imbalance that will require treatment is

A) both respiratory and metabolic acidosis.
B) both respiratory and metabolic alkalosis.
C) respiratory acidosis.
D) respiratory alkalosis.