Acid Base Nclex Questions

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NCLEX: Acid-Base

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12 terms vanie_jaiPreview 75 Free NCLEX Questions - c/o Brilli...75 terms carey47Preview NCLEX 19 terms med 1) A client is brought to the Emergency Department after passing out in a local department store. The client has been fasting and has ketones in the urine. Which acid- base imbalance would the nurse expect to assess in this client?

• Metabolic acidosis
• Respiratory alkalosis
• Metabolic alkalosis
• Respiratory acidosis

Answer: A

Explanation: A) A client who is fasting is at risk for development of metabolic

acidosis. The body recognizes fasting as starvation and begins to metabolize its own proteins into ketones, which are metabolic acids. Starvation would not result in respiratory acidosis or alkalosis or in metabolic alkalosis.2) Which of the following risk factors exhibited by the client presenting in the Emergency Department would place the client at risk for metabolic acidosis?Select all that apply.

• Abdominal fistulas
• Chronic obstructive pulmonary disease
• Pneumonia
• Acute renal failure
• Hypovolemic shock

Answer: A, D, E

Explanation: A, D, E) Metabolic acidosis is rarely a primary disorder. It usually develops during the course of another disease; presence of abdominal fistulas; which can cause excess bicarbonate loss; and acute renal failure. Chronic obstructive pulmonary disease and pneumonia place the client at risk for respiratory acidosis with the increased retention of carbon dioxide in the blood.

3) A child with acute asthma has a PaCO2 of 48 mmHg, a pH of 7.31, and a normal HCO3 blood gas value. The nurse interprets this as which of the following?

• Metabolic acidosis
• Respiratory alkalosis
• Respiratory acidosis
• Metabolic alkalosis

Answer: C

Explanation: C) If the pH is decreased and the PaCO2 is increased with a normal

HCO3, it is uncompensated respiratory acidosis. In addition, croup can be a disease process that causes respiratory acidosis. Uncompensated respiratory alkalosis has an increased pH, decreased PaCO2, and normal HCO3.Uncompensated metabolic acidosis has a decreased pH, normal PaCO2, and normal HCO3. Uncompensated metabolic alkalosis has an increased pH, normal PaCO2, and increased HCO3.4) The nurse is reviewing the latest arterial blood gas results for a client with metabolic alkalosis. Which result indicates that the metabolic alkalosis is compensated?

• pH 7.32
• PaCO2 18 mmHg
• HCO3 8 mEq/L
• PaCO2 48 mmHg

Answer: D

• A normal pH level is 7.35-7.45. A pH of less than 7.35 is acidosis. A PaCO2 level

of 18 mmHg is low and is seen in respiratory alkalosis. A HCO3 level of 8 mEq/L is low and is most likely associated with metabolic acidosis. In metabolic alkalosis, there is an excess of bicarbonate. To compensate for this imbalance, the rate and depth of respirations decrease, leading to retention of carbon dioxide. The PaCO2 will be elevated.5) A client has been admitted with chronic obstructive pulmonary disease. Diagnostic tests have been ordered.Which of the tests will provide the most accurate indicator of the client's acid-base balance?

• Arterial blood gases (ABGs)
• Pulse oximetry
• Sputum studies
• Bronchoscopy

Answer: A

Explanation: A) ABGs are done to assess alterations in acid-base balance caused

by respiratory disorders, metabolic disorders, or both. A bronchoscopy provides visualization of internal respiratory structures. Sputum studies can provide specific information about bacterial organisms. Pulse oximetry is a noninvasive test that evaluates the oxygen saturation level of blood.6) The nurse is instructing a client with a history of acidosis on the use of sodium bicarbonate. Which client statement indicates that additional teaching is needed?

• "I should contact the doctor if I have any gastric

discomfort with chest pain."

• "I need to purchase antacids without salt."
• "I should use the antacid for at least 2 months."
• "I should call the doctor if I get short of breath or start

to sweat with this medication."

Answer: C

• The client should be instructed to immediately contact the primary healthcare

provider if gastric discomfort occurs with chest pain or if dyspnea or diaphoresis occurs. The client should be instructed to use non-sodium antacids to prevent the absorption of excess sodium or bicarbonate into systemic circulation and to not use any bicarbonate antacid for longer than 2 weeks.

7) A client who was diagnosed with diabetes mellitus 1 year ago is hospitalized in diabetic ketoacidosis after a religious fast. The client tells the nurse, "I have fasted during this season every year since I became an adult. I am not going to stop now." The nurse is not knowledgeable about this particular religion. Which nursing action would be appropriate?Select all that apply.

• Request a consult from a diabetes educator.
• Tell the client that things are different now because of

the diabetes.

• Ask family members of the same religion to discuss

fasting with the client.

• Assess the meaning and context of fasting in the

client's religion.

• Encourage the client to seek medical care if signs of

ketoacidosis occur in the future.

Answer: A, D, E

Explanation: A,D,E) The diabetes educator should be contacted to work with the

client on strategies that might allow the fasting to occur in a safe manner.Assessing the meaning and context of fasting in the client's religion would be educative for the nurse and an appropriate action. Stressing the importance of promptly seeking care when signs of ketoacidosis occur helps to promote the client's health and is appropriate. Telling the client that life is different now does not support religious beliefs. Asking the family to talk to the client might help, but the diabetes educator would be able to provide more direct and helpful information for the client.8) The client is receiving sodium bicarbonate intravenously (IV) for correction of acidosis secondary to diabetic coma. The nurse assesses the client to be lethargic, confused, and breathing rapidly. What is the nurse's priority response to the situation?

• Stop the infusion and notify the physician because the

client is in alkalosis.

• Decrease the rate of the infusion and continue to

assess the client for symptoms of alkalosis.

• Continue the infusion, because the client is still in

acidosis, and notify the physician.

• Increase the rate of the infusion and continue to

assess the client for symptoms of acidosis.

Answer: C

Explanation: C) The client receiving sodium bicarbonate is prone to alkalosis;

monitor for cyanosis, slow respirations, and irregular pulse. The client's symptoms do not indicate alkalosis so infusion should not be stopped. The client continues to exhibit signs of acidosis; symptoms of acidosis include lethargy, confusion, CNS depression leading to coma, and a deep, rapid respiration rate that indicates an attempt by the lungs to rid the body of excess acid, and the physician should be notified. The infusion should not be increased or decreased without a practitioner order.

9) The nurse is preparing to analyze a client's arterial blood gas results. List the steps in the order that the nurse should follow when analyzing this laboratory test.

• Look at the PaCO2.
• Look at the pH.
• Evaluate the relationship between pH and PaCO2.
• Look for compensation.
• Evaluate the pH, HCO3, and base excess for a possible

metabolic problem.

• Look at the bicarbonate.
• Evaluate oxygenation.

Answer: 2, 1, 3, 6, 5, 4, 7

• The pH is the first step and is analyzed to determine if acidosis or alkalosis is

present. A pH of less than 7.35 is acidosis. A pH greater than 7.45 is alkalosis.

• If the PaCO2 is less than 35, then more carbon dioxide is being exhaled. If the

PaCO2 is greater than 45, then more carbon dioxide is being retained.

• This relationship could indicate a respiratory problem. If the pH is acidotic and

the carbon dioxide level is greater than 45, then the client could be experiencing respiratory acidosis. If the pH is alkalotic and the carbon dioxide level is below 35, then the client could be experiencing respiratory alkalosis.

• If the bicarbonate level is less than 24, then the levels are lower than normal. If

the bicarbonate level is greater than 28, then the bicarbonate levels are higher than normal.

• If the pH is < 7.35, the HCO3 is < 24 mEq/L, and the BE is < −2 mEq/L, then low

bicarbonate levels and high H + concentrations are causing metabolic acidosis. If the pH is > 7.45, the HCO3 is > 28 mEq/L, and the BE is > +2 mEq/L, then high bicarbonate levels are causing metabolic alkalosis.

• Two things can occur in renal compensation. In respiratory acidosis, the kidneys

retain HCO3 to buffer the excess acid, so the HCO3 is > 28 mEq/L. In respiratory alkalosis, the kidneys excrete HCO3 to minimize the alkalosis, so the HCO3 is < 24 mEq/L. Two things can also occur in respiratory compensation. In metabolic acidosis the rate and depth of respirations increase, increasing carbon dioxide elimination, so the PaCO2 is < 35 mmHg. In metabolic alkalosis respirations slow and carbon dioxide is retained, so the PaCO2 is > 45 mmHg.

• If the PaO2 is less than 75 mmHg, then the client is experiencing hypoxemia and

possible hypoventilation. If the PaO2 is greater than 100 mmHg, then the client is hyperventilating.10) The nurse is identifying a diagram to use to explain a client's acid-base balance. Which imbalance does the following diagram suggest is occurring with the client?

• Metabolic acidosis
• Metabolic alkalosis
• Respiratory acidosis
• Respiratory alkalosis

Answer: A

Explanation: A) In metabolic acidosis, the amount of bicarbonate decreases in

relation to the amount of acid in the body. In metabolic alkalosis, there is an excess of bicarbonate in relation to the amount of hydrogen ions. Respiratory acidosis occurs when carbon dioxide is retained, increasing the amount of carbonic acid in the body. Respiratory alkalosis can occur when too much carbon dioxide is lost and carbonic acid levels fall.