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1 Copyright © 2023 Pearson Education, Inc.
Nursing: A Concept-Based Approach to Learning Vol. 1 & 2, 4e (Pearson)
Module 1 Acid-Base Balance
The Concept of Acid-Base Balance
1) A client who has been fasting and has ketones in the urine is brought to the emergency department (ED) unconscious. 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 fatty acids into ketones, which are metabolic acids.
- A client who is fasting is at risk for development of metabolic acidosis. The body recognizes
- A client who is fasting is at risk for development of metabolic acidosis. The body recognizes
- 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 fatty acids into ketones, which are metabolic acids. Starvation would not result in respiratory alkalosis.
fasting as starvation and begins to metabolize its own fatty acids into ketones, which are metabolic acids. Starvation would not result in metabolic alkalosis.
fasting as starvation and begins to metabolize its own fatty acids into ketones, which are metabolic acids. Starvation would not result in respiratory acidosis.
Page Ref: 5
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1. Demonstrate knowledge of basic scientific methods and processes. | AACN Domains and Competencies: 2.4 Diagnose actual or potential health problems and needs. | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care. | Nursing Process: Assessment
Learning Outcome: 1.2. Differentiate alterations in acid-base balance.
MNL LO: Analyze the concept of acid-base balance and its application to nursing care.
(Clinical Nursing Skills A Concept-Based Approach, (Volume 1, 2, 3) 4e By Pearson) (Test Bank all Chapters) 1 / 4
2 Copyright © 2023 Pearson Education, Inc.2) The nurse is caring for a client in the emergency department. Which factors will the nurse identify that increase the client's risk for metabolic acidosis? Select all that apply.
- Abdominal fistulas
- Chronic obstructive pulmonary disease
- Pneumonia
- Chronic renal failure
- Hypovolemic shock
Answer: A, D, E
Explanation: A) Metabolic acidosis is rarely a primary disorder. It usually develops during the course of another condition such as an abdominal fistula which can cause the loss of bicarbonate from the intestine.
- Chronic obstructive pulmonary disease places the client at risk for respiratory acidosis with
- Pneumonia places the client at risk for respiratory acidosis with the increased retention of
- Metabolic acidosis is rarely a primary disorder. It usually develops during the course of
- Metabolic acidosis is rarely a primary disorder. It usually develops during the course of
the increased retention of carbon dioxide in the blood.
carbon dioxide in the blood.
another condition such as chronic renal failure. In this health problem, the kidneys are unable to excrete a normal amount of hydrogen ions in the urine. This results in an excessive amount of hydrogen ions in the blood, which produces metabolic acidosis.
another condition such as hypovolemic shock. With a severe blood loss, there is a lack of blood flow throughout the body and a lack of oxygen in every cell. Adenosine triphosphate (ATP) must produce energy anaerobically without the presence of oxygen; lactic acid is a by-product. This produces systemic lactic acidosis, a type of metabolic acidosis.
Page Ref: 5-6
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1. Demonstrate knowledge of basic scientific methods and processes. | AACN Domains and Competencies: 2.4 Diagnose actual or potential health problems and needs. | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care. | Nursing Process: Assessment
Learning Outcome: 1.2. Differentiate alterations in acid-base balance.
MNL LO: Analyze the concept of acid-base balance and its application to nursing care.
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3 Copyright © 2023 Pearson Education, Inc.3) A client with acute asthma has a PaCO2 of 48 mmHg, a pH of 7.31, and a normal HCO3 arterial blood gas value. Which condition will the nurse associate with these values?
- Metabolic acidosis
- Respiratory alkalosis
- Respiratory acidosis
- Metabolic alkalosis
Answer: C
Explanation: A) Uncompensated metabolic acidosis has a decreased pH, normal PaCO2, and decreased HCO3.
- Uncompensated respiratory alkalosis has an increased pH, decreased PaCO2, and normal
- If the pH is decreased and the PaCO2 is increased with a normal HCO3, it is uncompensated
- Uncompensated metabolic alkalosis has an increased pH, normal PaCO2, and increased
HCO3.
respiratory acidosis.
HCO3.
Page Ref: 7
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1. Demonstrate knowledge of basic scientific methods and processes. | AACN Domains and Essential Competencies: 2.4 Diagnose actual or potential health problems and needs. | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care. | Nursing Process: Assessment
Learning Outcome: 1.2. Differentiate alterations in acid-base balance.
MNL LO: Analyze the concept of acid-base balance and its application to nursing care.
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4 Copyright © 2023 Pearson Education, Inc.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
Explanation: A) 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.
Page Ref: 8
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1. Demonstrate knowledge of basic scientific methods and processes. | AACN Domains and Essential Competencies: 2.4 Diagnose actual or potential health problems and needs. | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care. | Nursing Process: Evaluation
Learning Outcome: 1.2. Differentiate alterations in acid-base balance.
MNL LO: Analyze the concept of acid-base balance and its application to nursing care.
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