Acid Base Practice Questions
Metabolic acidosis
A 4-month-old infant is brought to the emergency department after 2 days of diarrhea. The infant is listless and has sunken eyeballs, a depressed anterior fontanel, and poor tissue turgor. The infant's breathing is deep, rapid, and unlabored. The mother states that the infant has had liquid stools and no obvious urine output. What problem does the nurse conclude that the infant is experiencing? 1 Kidney failure 2 Mild dehydration 3 Metabolic acidosis 4 Respiratory alkalosis
Respiratory acidosis caused by impaired respirations and increased formation of carbonic acid
A child has been admitted to the pediatric unit with a severe asthma attack. What type of acid-base imbalance should the nurse expect the child to develop? 1 Metabolic alkalosis caused by excessive production of acid metabolites 2 Respiratory alkalosis caused by accelerated respirations and loss of carbon dioxide 3 Respiratory acidosis caused by impaired respirations and increased formation of carbonic acid 4 Metabolic acidosis caused by the kidneys' inability to compensate for increased carbonic acid formatio
Hyperventilation
A client appears anxious, exhibiting 40 shallow respirations per minute. The client complains of feeling dizzy and lightheaded and of having tingling sensations of the fingertips and around the lips. What does the nurse conclude that the client's complaints probably are related to? 1 Eupnea 2 Hyperventilation 3 Kussmaul respirations 4 Carbon dioxide intoxication
Metabolic alkalosis Prolonged vomiting results in fluid loss and acid (hydrochloric) loss; the client's adaptations reflect dehydration and metabolic alkalosis. Although it is important to address the client's pain, the fluid and electrolyte/acid/base imbalance must be addressed first because this imbalance can be life threatening. Although risk for injury is a potential problem, the priority is the fluid and electrolyte/acid/base problem. The ineffective breathing pattern most likely is caused by the metabolic alkalosis; the fluid and electrolyte/acid/base imbalance is a higher priority and must be addressed first.
A client arrives in the emergency department with epigastric pain and prolonged vomiting. Assessment findings include rapid and shallow respirations, dry and flushed skin, weakness, and lethargy. Which is the primary nursing concern? 1 Acute pain 2 Risk for injury 3 Metabolic alkalosis 4 Ineffective breathing
1 Headache 2 Irritability 3 Restlessness
A client is admitted to the hospital with a diagnosis of restrictive airway disease. The nurse expects the client to exhibit which early signs of respiratory acidosis? Select all that apply. 1 Headache 2 Irritability 3 Restlessness 4 Hypertension 5 Lightheadedness
Metabolic acidosis
A client is in profound (late) hypovolemic shock. The nurse assesses the client's laboratory values. What does the nurse know that clients in late shock develop? 1 Hypokalemia 2 Metabolic acidosis 3 Respiratory alkalosis 4 Decreased Pco 2 levels
Preventing falls
A client on diuretic therapy developed metabolic alkalosis. What does the nurse consider to be the priority nursing care while correcting alkalosis? 1 Preventing falls 2 Monitoring electrolytes 3 Administering antiemetics 4 Adjusting the diuretic therapy
The decreased tissue perfusion caused lactic acid production.
A client presenting to the emergency department with chest pain and dizziness is found to be having a myocardial infarction and subsequently suffers cardiac arrest. The healthcare team is able to successfully resuscitate the client. Lab work shows that the client now is acidotic. How does the nurse interpret the cause of the acidosis? 1 The fat-forming ketoacids were broken down. 2 The irregular heartbeat produced oxygen deficit. 3 The decreased tissue perfusion caused lactic acid production. 4 The client received too much sodium bicarbonate during resuscitation efforts.
Elevated U and flattened T waves
A client who has been experiencing chest pain and vomiting for several hours is admitted to the hospital with a diagnosis of myocardial infarction. The client is transferred immediately to the cardiac intensive care unit. The client's potassium level is below the expected range. Considering this laboratory result, what should the nurse monitor the client's electrocardiogram (ECG) for? 1 Tall, peaked P waves 2 Increased P-R intervals 3 Elevated U and flattened T waves 4 Multiple trigeminy and bigeminy runs
Use a humidifier in the bedroom.
A client with chronic obstructive pulmonary disease (COPD) reports chest congestion, especially upon awakening in the morning. What should the nurse suggest to the client? 1 Use a humidifier in the bedroom. 2 Sleep with two or more pillows. 3 Cough regularly even if the cough does not produce sputum. 4 Cough and deep breathe each night before going to sleep.
Nasogastric tube for decompression Decompression removes collected secretions behind the nonfunctioning bowel segment (paralytic ileus), thus reducing pressure on the suture line and allowing healing. Vomiting will subside as the bowel is decompressed. Although IV lactated Ringer for fluid replacement is important, the primary concern is decompression of the bowel; the amount of fluid removed will direct fluid and electrolyte replacement therapy.
A client with colitis has had a hemicolectomy. Three days after surgery the nurse identifies that the client has abdominal distention and absent bowel sounds, and has vomited 300 mL of dark green viscous fluid. The nurse contacts the primary healthcare provider and recommends which intervention? 1 Nasogastric tube for decompression 2 Antiemetic for nausea/vomiting 3 Intravenous (IV) lactated Ringer for fluid replacement 4 Stat electrolytes to assess for probable electrolyte imbalance
A 24-year-old with diabetic ketoacidosis
A client's arterial blood gas report indicates that pH is 7.25, Pco 2 is 35 mm Hg, and HCO 3 is 20 mEq/L (20 mmol/L). Which client should the nurse consider is most likely to exhibit these results? 1 A 54-year-old with vomiting 2 A 17-year-old with panic attacks 3 A 24-year-old with diabetic ketoacidosis 4 A 65-year-old with advanced emphysema
A 65-year-old with pulmonary fibrosis
A client's arterial blood gas report indicates that pH is 7.25, Pco 2 is 60 mm Hg, and HCO 3 is 26 mEq/L (26 mmol/L). Which client should the nurse consider is most likely to exhibit these blood gas results? 1 A 65-year-old with pulmonary fibrosis 2 A 24-year-old with uncontrolled type 1 diabetes 3 A 45-year-old who has been vomiting for 3 days 4 A 54-year-old who takes sodium bicarbonate for indigestion
Excessive mechanical ventilation
A client's arterial blood gas report indicates the pH is 7.52, PCO 2 is 32 mm Hg, and HCO 3 is 24 mEq/L. What does the nurse identify as a possible cause of these results? 1 Airway obstruction 2 Inadequate nutrition 3 Prolonged gastric suction 4 Excessive mechanical ventilation
Respiratory acidosis
A nurse is caring for a client after abdominal surgery and encourages the client to turn from side to side and to engage in deep-breathing exercises. What complication is the nurse trying to prevent? 1 Metabolic acidosis 2 Metabolic alkalosis 3 Respiratory acidosis 4 Respiratory alkalosis
Increased respiratory rate
A nurse is caring for a toddler with severe dehydration and its associated acid-base imbalance. What compensatory mechanism within the body is activated to counteract the effects of the child's acid-base imbalance? 1 Profuse diaphoresis 2 Increased temperature 3 Increased respiratory rate 4 Renal retention of hydrogen ions
Alkalosis
A nurse is caring for an infant whose vomiting is intractable. Which complication is most likely to occur? 1 Acidosis 2 Alkalosis 3 Hyperkalemia 4 Hypernatremia
Signs of dehydration
A nurse is caring for an infant with a tentative diagnosis of hypertrophic pyloric stenosis (HPS). What is most important for the nurse to assess? 1 Quality of the cry 2 Signs of dehydration 3 Coughing up of feedings 4 Characteristics of the stool
pH of 7.20 and HCO 3 - of 20 mEq/L (20 mmol/L) Low blood pH and bicarbonate levels indicate metabolic acidosis, which occurs with severe dehydration because the reduced urine output causes retention of hydrogen ions. The other options include findings that indicate respiratory alkalosis, respiratory acidosis, and metabolic alkalosis, respectively.
A nurse is caring for an infant with severe dehydration. Which blood gas report most likely reflects the acid-base balance of this infant? 1 pH of 7.50 and Pco 2 of 34 mm Hg 2 pH of 7.23 and Pco 2 of 70 mm Hg 3 pH of 7.20 and HCO 3 - of 20 mEq/L (20 mmol/L) 4 pH of 7.56 and HCO 3 - of 30 mEq/L (30 mmol/L)
Liver
A pathology report states that a client's urinary calculus is composed of uric acid. Which food item should the nurse instruct the client to avoid? 1 Milk 2 Liver 3 Cheese 4 Vegetables
Metabolic acidosis
A specimen for arterial blood gases is obtained from a severely dehydrated 3-month-old infant with a history of diarrhea. The pH is 7.30, Pco 2 is 35 mm Hg, and HCO 3 - is 17 mEq/L (17 mmol/L). What complication does the nurse conclude has developed? 1 Metabolic acidosis 2 Metabolic alkalosis 3 Respiratory acidosis 4 Respiratory alkalosis
Decrease the Pco 2 level
After a gastrectomy, a client has a nasogastric tube to low continuous suction. The client begins to hyperventilate. How does the nurse anticipate that this breathing pattern will alter the client's arterial blood gases? 1 Increase the PO 2 level 2 Decrease the pH level 3 Increase the HCO 3 level 4 Decrease the Pco 2 level
Loss of chloride ions through vomiting loss of K all together
An infant has been vomiting after each feeding. Physical assessment reveals poor skin turgor, a sunken anterior fontanel, and tremors. The infant's acid-base balance is outside the expected range. What does the nurse suspect as the cause of this imbalance? 1 Retention of potassium in the cells 2 Loss of fluid by way of the kidneys 3 Loss of chloride ions through vomiting 4 Reduction of blood supply to body cells
Assessing the IV site for infiltration Assessment of the IV site is a priority. The infant will need IV fluids until oral feedings are possible. Restraints are not needed. Administering a sedative is not necessary and should not be done until a full assessment is completed. If the infant has a nasogastric tube in place, it should not be removed until an assessment of bowel sounds and nausea and vomiting is done.
Corrective surgery for hypertrophic pyloric stenosis is completed, and the infant is returned to the pediatric unit with an intravenous (IV) infusion in progress. What is the priority nursing action? 1 Applying adequate restraints 2 Administering a mild sedative 3 Removing the nasogastric tube 4 Assessing the IV site for infiltration
Metabolic acidosis
During the progressive stage of shock, anaerobic metabolism occurs. The nurse expects that initially the anaerobic metabolism will cause what? 1 Metabolic acidosis 2 Metabolic alkalosis 3 Respiratory acidosis 4 Respiratory alkalosis
Deep and rapid respirations
On admission to the intensive care unit, a client is diagnosed with compensated metabolic acidosis. During the assessment, what is the nurse most likely to identify? 1 Muscle twitching 2 Mental instability 3 Deep and rapid respirations 4 Tachycardia and cardiac dysrhythmias
1 "I should assess for low blood pressure." 2 "I should assess for increased digitalis toxicity." 3 "I should assess for a decreased rate of ventilation in respiratory alkalosis." The nurse should assess for low blood pressure and increased digitalis toxicity as cardiovascular manifestations of alkalosis, not respiratory manifestation. The nurse should assess for increased rate of ventilation in respiratory alkalosis. The nurse should assess for increased depth of ventilation in respiratory alkalosis. It is imperative that the nurse check for decreased respiratory effort associated with skeletal muscle weakness in metabolic alkalosis.
The nurse is teaching a group of students about assessing for respiratory system manifestations of alkalosis as a nursing priority. Which statement made by the student nurse indicates the need for further teaching? Select all that apply. 1 "I should assess for low blood pressure." 2 "I should assess for increased digitalis toxicity." 3 "I should assess for a decreased rate of ventilation in respiratory alkalosis." 4 "I should assess for an increased depth of ventilation in respiratory alkalosis." 5 "I should assess for a decreased respiratory effort associated with skeletal muscle weakness in metabolic alkalosis."
2 "The client's Trousseau sign would be positive." 3 "The client would be suffering from paresthesias." 4 "The client would show signs of anxiety and irritability."
The nurse is teaching a group of students about the manifestation of alkalosis in the central nervous system. Which statements by a student nurse are accurate? Select all that apply. 1 "The client's Chvostek sign would be negative." 2 "The client's Trousseau sign would be positive." 3 "The client would be suffering from paresthesias." 4 "The client would show signs of anxiety and irritability." 5 "The client's central nervous system should have a decrease activity in case alkalosis."
1 Coughing 2 Deep breathing Humidified oxygen Coughing moves secretions toward the mouth to be expectorated. Deep breathing expands the alveoli and increases the amount of oxygen being delivered to the alveolar capillary beds. Humidified oxygen increases the amount of oxygen that is being delivered to the alveolar capillary beds. Bronchodilators are not indicated at this time because the x-ray, PCO 2, and pH are still within acceptable limits. Bronchial suctioning is not indicated at this time because the x-ray, PCO 2, and pH results are still within acceptable limits.
The nurse plans interventions for a client with smoke inhalation based on a negative chest x-ray and arterial blood gases that show a PO 2 of 85 mm Hg, a PCO 2 of 45 mm Hg, and a pH of 7.35. Which interventions should the nurse anticipate will be prescribed? Select all that apply. 1 Coughing 2 Deep breathing 3 Bronchodilators 4 Humidified oxygen 5 Bronchial suctioning
Peaked T waves and widened QRS complexes Potassium is the principal intracellular cation, and during ketoacidosis it moves out of cells into the extracellular compartment to replace potassium lost as a result of glucose-induced osmotic diuresis; overstimulation of the cardiac muscle results. The T wave is depressed in hypokalemia. Initially, the QT segment is short, and as the potassium level rises, the QRS complex widens. P waves are abnormal because the PR interval may be prolonged and the P wave may be lost; however, the T wave is peaked, not depressed. The ST segment becomes depressed. The PR interval is prolonged, and the P wave may be lost. QRS complexes and thus T waves become irregular, and the rate does not necessarily change.
The serum potassium level of a client who has diabetic ketoacidosis is 5.4 mEq/L (5.4 mmol/L). What would the nurse expect to see on the ECG tracing monitor? 1 Abnormal P waves and depressed T waves 2 Peaked T waves and widened QRS complexes 3 Abnormal Q waves and prolonged ST segments 4 Peaked P waves and an increased number of T waves
pH 7.30, CO 2 40 mm Hg, HCO 3 - 20 mEq/L (20 mmol/L)
Which blood gas result should the nurse expect an adolescent with diabetic ketoacidosis to exhibit? 1 pH 7.30, CO 2 40 mm Hg, HCO 3 - 20 mEq/L (20 mmol/L) 2 pH 7.35, CO 2 47 mm Hg, HCO 3 - 24 mEq/L (24 mmol/L) 3 pH 7.46, CO 2 30 mm Hg, HCO 3 - 24 mEq/L (24 mmol/L) 4 pH 7.50, CO 2 50 mm Hg, HCO 3 - 22 mEq/L (22 mmol/L)
Monitoring for signs of hypoglycemia resulting from treatment
Which is an independent nursing action that should be included in the plan of care for a client after an episode of ketoacidosis? 1 Monitoring for signs of hypoglycemia resulting from treatment 2 Withholding glucose in any form until the situation is corrected 3 Giving fruit juices, broth, and milk as soon as the client is able to take fluids orally 4 Regulating insulin dosage according to the amount of ketones found in the client's urine
Increased digitalis toxicity
Which would the nurse claim is a cardiovascular manifestation of alkalosis? 1 Anxiety 2 Seizures 3 Hyperreflexia 4 Increased digitalis toxicity