Blood Gas Analysis/ABG Interpretation NCLEX questions
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Simple Questions & Answers
1.What does the arterial gas value HCO3 indicate?
The bicarbonate contents in the blood plasma which
indicates alkaline reserve
2.What is could arterial blood gas results indicate?
1. Respiratory and lung problems
2. Efficacy of oxygen therapy
3. Acid-base levels (kidney failure, heart failure,
uncontrolled diabetes, shock, etc)
3.What is a state of low blood pH?
Acidemia pH < 7.35
4.What refers to an excess of acid in the blood that
causes pH to fall below 7.35?
Acidosis
5.What is a state of high blood pH?
Alkalemia pH > 7.45
6.What is the normal pH range for blood?
7.35 - 7.45
7.Which 3 systems regulate normal acid-base levels?
1. Chemical Buffer System
2. Respiratory system
3. Renal system
8.What are the 3 major chemical buffer systems in the
body?
1. Carbonic acid-bicarbonate buffet system
(extracellular)
2. Phosphate buffer system (intracellular)
3. Protein buffer system (intercellular)
9.What is a limitation to the carbonic
acid-bicarbonate buffer system?
Only functions when the respiratory system is
functioning normally
10.What happens to the blood pH if the respiratory
system is not functioning properly?
1. Excess CO2 combines with H2O to make carbonic acid
(H2CO3)
2. Increase in H2CO3 cause increase depth and rate of
respiration, reducing carbonic acid and increasing blood pH (alkalosis)
3. Decreased H2CO3 causes decrease and shallow
respiration, thereby retaining CO2, increasing carbonic acid and decreasing
blood pH (acidosis)
4. Activation of the lungs to compensate occurs within
1 to 3 minutes
11.What is the effect of the renal system on blood pH?
1. Kidneys retain or excrete bicarbonate ions (HCO3-)
which neutralices excess acid in the blood
2. As blood pH decreases, kidneys compensate by
retaining HCO3-
3. As pH rises, kidneys excrete HCO3-
4. Kidneys can also generate additional bicarbonate
ions or Elina te excess H+ to compensate during acidosis
5. This takes hours to days to correct the imbalance
12.What blood pH values are fatal?
pH < 6.8
pH > 7.8
13.What are the manifestations if acidosis?
1. pH < 7.35
2. CNS depressions through decreased synaptic
transmission
3. Increased rate and depth of respiration
4. Weakness and disorientation
5. Seizures
6. Coma and death
14.What are the manifestations of alkalosis?
1. pH > 7.45
2. Over-excitability of CNS and PNS
3. Numbness
4. Irritability, lightheaded, nervousness
5. Muscle spasms/tetany
6. Cramping
7. Convulsions
8. Loss of consciousness and death
15.What is the normal range of PaO2?
80 - 100 mmHg
Decreases with age:
PaO2 = 102 - 1/3age
Healthy lungs = oxygen% x 5
16.What is the normal range for PaCO2?
35 - 45 mmHg
Elevated = acidity
Reduced = alkalinity
17.What is the normal range for HCO3- arterial blood
gas values?
22-26 mmol/L
Increased = alkalinity
Decreased = acidity
18.Condition of lowered blood pH due to decreased
respiratory rate (hypoventilation) or volume
Respiratory Acidosis
19.Condition of lowered blood pH due to reduction in
bicarbonate
Metabolic Acidosis
20. A condition of increased blood pH due to increase
in bicarbonate (HCO3-)
Metabolic Alkalosis
21. In acid-base balance, the normal plasma PCO2 and
bicarbonate levels are disturbed. Match the changes in this parameter with the
disorders in the given choices: Low plasma PaCO2
A. Metabolic Acidosis
B. Respiratory Alkalosis
C. Metabolic Alkalosis
D. Respiratory Acidosis
Correct Answer: B. Respiratory Alkalosis
Excessive pulmonary ventilation decreases hydrogen ion
concentration and thus causes respiratory alkalosis. It can become dangerous
when it leads to cardiac dysrhythmias caused partly by a decrease in serum
potassium levels.
22. In acid-base balance, the normal plasma PCO2 and
bicarbonate levels are disturbed. Match the changes in this parameter with the
disorders in the given choices: High plasma PaCO2
A. Metabolic Acidosis
B. Respiratory Alkalosis
C. Metabolic Alkalosis
D. Respiratory Acidosis
Correct Answer: D. Respiratory Acidosis
An excess of carbon dioxide (hypercapnia) can cause
carbon dioxide narcosis. In this condition, carbon dioxide levels are so high
that they no longer stimulate respirations but depress them.
23. In acid-base balance, the normal plasma PCO2 and
bicarbonate levels are disturbed. Match the changes in this parameter with the
disorders in the given choices: Decreased plasma bicarbonate (HCO3)
A. Metabolic Acidosis
B. Respiratory Alkalosis
C. Metabolic Alkalosis
D. Respiratory Acidosis
Correct Answer: A. Metabolic Acidosis
The body compensates by using body fat for energy, producing
abnormal amounts of ketone bodies. In an effort to neutralize the ketones and
maintain the acid-base balance of the body, plasma bicarbonate is exhausted.
This condition can develop in anyone who does not eat an adequate diet and
whose body fat must be burned for energy. Symptoms include headache and mental
dullness.
24. In acid-base balance, the normal plasma PCO2 and
bicarbonate levels are disturbed. Match the changes in this parameter with the
disorders in the given choices: Increased plasma bicarbonate (HCO3-)
A. Metabolic Acidosis
B. Respiratory Alkalosis
C. Metabolic Alkalosis
D. Respiratory Acidosis
Correct Answer: C. Metabolic Alkalosis
In metabolic alkalosis, breathing becomes depressed in
an effort to conserve carbon dioxide for combination with water in the blood to
raise the blood level of carbonic acid. Symptoms include confusion, dizziness,
numbness or tingling of fingers or toes.
25. What two organs in the body serve as a
compensatory function to maintain acid-base balance?
A. Kidneys and Lungs
B. Lungs and Spleen
C. Heart and Liver
D. Gallbladder and Appendix
Correct Answer: A. Kidneys and Lungs
The carbonic acid concentration is controlled by the
amount of carbon dioxide excreted by the lungs. The bicarbonate concentration
is controlled by the kidneys, which selectively retain or excrete bicarbonate
in response to the body’s needs.
26. Arterial blood gas (ABG) measurement will give the
information needed to determine if the primary disturbance of acid-base balance
is respiratory or metabolic in nature.
A. True
B. False
C. Both Carbonic Acid Excess and Deficit Only
D. Both Bicarbonate Excess and Deficit Only
Correct Answer: A. True
ABG’s are blood tests that are useful in identifying
the cause and extent of the acid-base disturbance and in guiding and monitoring
treatment.
27. The major effect of acidosis is overexcitement of
the central nervous system.
A. True
B. False
C. Maybe
D. Both Acidosis and Alkalosis result in
overexcitement of the central nervous system.
Correct Answer: B. False
The major effect is a depression of the central
nervous system, as evidenced by disorientation followed by coma.
28. Alkalosis is characterized by overexcitement of
the nervous system.
A. True
B. False
C. The major effect of Alkalosis is a depression of
the central nervous system.
D. Both Acidosis and Alkalosis result in
overexcitement of the central nervous system.
Correct Answer: A. True
The muscles may go into a state of tetany and
convulsions.
29. The human body functions optimally in a state of
homeostasis.
A. True
B. False
C. Maybe
D. Homeostasis has nothing to do with metabolic
balance.
Correct Answer: A. True
The maintenance of acid-base balance, which in one
part of homeostasis, is evidenced by an arterial plasma pH value of 7.35-7.45.
Many mechanisms in the body work together to achieve and maintain this delicate
narrow range of pH that is essential for normal cell function.
30. Acids have no hydrogen ions and are able to bind
in a solution.
A. True
B. False
C. Acid is a substance that is not capable of donating
hydrogen ions.
D. Acids and bases have nothing to do with hydrogen
ions.
Correct Answer: B. False
Acids are substances having one or more hydrogen ions
that can be liberated into a solution.
Bases are substances that can bind hydrogen ions in a
solution.
NCLEX type Questions & Answers
1. Match the acid-base status of the following blood
samples to the disorders in the given choices. (PaCO2 values are in mm Hg and
bicarbonate values in mmol/l).
pH 7.57, PaCO2 22, HCO3- 17
A. Respiratory Acidosis, Partially Compensated
B. Respiratory Alkalosis, Uncompensated
C. Metabolic Acidosis, Partially Compensated
D. Respiratory Alkalosis, Partially Compensated
Correct Answer: D. Respiratory Alkalosis, Partially
Compensated
Based on the given ABG values, pH is 7.57. For pH, the
normal range is 7.35 to 7.45. Any blood pH above 7.45 (7.46, 7.47, 7.48, and so
on…) is ALKALOSIS.
PaCO2 is 22. The normal range for PaCO2 is from 35 to
45. If PaCO2 is below 35, it is alkalosis. Based on the given ABG values, PaCO2
is below 35, so it is considered ALKALOSIS.
HCO3- is 17. The normal range for HCO3 is from 22 to
26. If HCO3 is below 22, it is acidosis. Based on the given ABG values, HCO3 is
below 22, so it is considered ACIDOSIS.
For these ABG values, pH is ALKALOSIS and lines up
with PaCO2 which is RESPIRATORY. Therefore, this group of ABG values is
considered RESPIRATORY ALKALOSIS.
Lastly, it is PARTIALLY COMPENSATED because all three
(3) values are abnormal. It is considered partially compensated if all three
(3) values are abnormal.
2. Match the acid-base status of the following blood
samples to the disorders in the given choices. (PaCO2 values are in mm Hg and
bicarbonate values in mmol/l).
pH 7.39, PaCO2 44, HCO3- 26
A. Respiratory Acidosis
B. Metabolic Acidosis
C. Respiratory Alkalosis
D. Metabolic Alkalosis
E. Normal
Correct Answer: E. Normal
Based on the given ABG values, pH is 7.39. For pH, the
normal range is 7.35 to 7.45. So it is NORMAL.
PaCO2 is 44. The normal range for PaCO2 is from 35 to
45. It is also NORMAL.
HCO3- is 26. The normal range for HCO3 is from 22 to
26. It is also NORMAL.
For these ABG values, pH, PACO2, and HCO3 are NORMAL.
Therefore, this group of ABG values is considered NORMAL.
3. Match the acid-base status of the following blood
samples to the disorders in the given choices. (PaCO2 values are in mm Hg and
bicarbonate values in mmol/l).
pH 7.55, PaCO2 25, HCO3- 22
A. Respiratory Acidosis, Partially Compensated
B. Respiratory Alkalosis, Uncompensated
C. Metabolic Alkalosis, Partially Compensated
D. Metabolic Acidosis, Uncompensated
Correct Answer: B. Respiratory Alkalosis,
Uncompensated
Based on the given ABG values, pH is 7.55. For pH, the
normal range is 7.35 to 7.45. Any blood pH above 7.45 (7.46, 7.47, 7.48, and so
on…) is ALKALOSIS.
PaCO2 is 25. The normal range for PaCO2 is from 35 to
45. If PaCO2 is below 35, it is alkalosis. Based on the given ABG values, PaCO2
is below 35, so it is considered ALKALOSIS.
HCO3- is 22. The normal range for HCO3 is from 22 to
26. It is NORMAL.
For these ABG values, pH is ALKALOSIS and lines up
with PaCO2 which is RESPIRATORY. Therefore, this group of ABG values is
considered RESPIRATORY ALKALOSIS.
Lastly, it is UNCOMPENSATED because HCO3 is normal and
PaCO2 is abnormal. It is uncompensated if PaCO2 or HCO3 is normal and the other
is abnormal.
4. Match the acid-base status of the following blood
samples to the disorders in the given choices. (PaCO2 values are in mm Hg and
bicarbonate values in mmol/l).
pH 7.17, PaCO2 48, HCO3- 36
A. Respiratory Acidosis, Uncompensated
B. Metabolic Acidosis, Partially Compensated
C. Respiratory Alkalosis, Partially Compensated
D. Respiratory Acidosis, Partially Compensated
Correct Answer: D. Respiratory Acidosis, Partially
Compensated
Based on the given ABG values, pH is 7.17. For pH, the
normal range is 7.35 to 7.45. Any blood pH below 7.35 (7.34, 7.33, 7.32, and so
on…) is ACIDOSIS.
PaCO2 is 48. The normal range for PaCO2 is from 35 to
45. If PaCO2 is above 45, it is acidosis. Based on the given ABG values, PaCO2
is above 45, so it is considered ACIDOSIS.
HCO3- is 36. The normal range for HCO3 is from 22 to
26. If HCO3 is above 26, it is alkalosis. Based on the given ABG values, HCO3
is above 26, so it is considered ALKALOSIS.
For these ABG values, pH is ACIDOSIS and lines up with
PaCO2 which is RESPIRATORY. Therefore, this group of ABG values is considered
RESPIRATORY ACIDOSIS.
Lastly, it is PARTIALLY COMPENSATED because all three
(3) values are abnormal. It is considered partially compensated if all three
(3) values are abnormal.
5. Match the acid-base status of the following blood
samples to the disorders in the given choices. (PaCO2 values are in mm Hg and
bicarbonate values in mmol/l).
pH 7.34, PaCO2 24, HCO3- 20
A. Respiratory Acidosis, Partially Compensated
B. Metabolic Acidosis, Partially Compensated
C. Metabolic Acidosis, Uncompensated
D. Metabolic Alkalosis, Partially Compensated
Correct Answer: B. Metabolic Acidosis, Partially
Compensated
Based on the given ABG values, pH is 7.34. For pH, the
normal range is 7.35 to 7.45. Any blood pH below 7.35 (7.34, 7.33, 7.32, and so
on…) is ACIDOSIS.
PaCO2 is 24. The normal range for PaCO2 is from 35 to
45. If PaCO2 is below 35, it is alkalosis. Based on the given ABG values, PaCO2
is below 35, so it is considered ALKALOSIS.
HCO3- is 20. The normal range for HCO3 is from 22 to
26. If HCO3 is below 22, it is acidosis. Based on the given ABG values, HCO3 is
below 22, so it is considered ACIDOSIS.
For these ABG values, pH is ACIDOSIS and lines up with
HCO3 which is METABOLIC. Therefore, this group of ABG values is considered
METABOLIC ACIDOSIS.
Lastly, it is PARTIALLY COMPENSATED because all three
(3) values are abnormal. It is considered partially compensated if all three
(3) values are abnormal.
6. Match the acid-base status of the following blood
samples to the disorders in the given choices. (PaCO2 values are in mm Hg and
bicarbonate values in mmol/l).
pH 7.64, PaCO2 25, HCO3- 19
A. Respiratory Acidosis, Uncompensated
B. Respiratory Alkalosis, Partially Compensated
C. Respiratory Alkalosis, Uncompensated
D. Metabolic Alkalosis, Partially Compensated
Correct Answer: B. Respiratory Alkalosis, Partially
Compensated
Based on the given ABG values, pH is 7.64. For pH, the
normal range is 7.35 to 7.45. Any blood pH above 7.45 (7.46, 7.47, 7.48, and so
on…) is ALKALOSIS.
PaCO2 is 25. The normal range for PaCO2 is from 35 to
45. If PaCO2 is below 35, it is alkalosis. Based on the given ABG values, PaCO2
is below 35, so it is considered ALKALOSIS.
HCO3- is 19. The normal range for HCO3 is from 22 to
26. If HCO3 is below 22, it is acidosis. Based on the given ABG values, HCO3 is
below 22, so it is considered ACIDOSIS.
For these ABG values, pH is ALKALOSIS and lines up
with PaCO2 which is RESPIRATORY. Therefore, this group of ABG values is
considered RESPIRATORY ALKALOSIS.
Lastly, it is PARTIALLY COMPENSATED because all three
(3) values are abnormal. It is considered partially compensated if all three
(3) values are abnormal.
7. Match the acid-base status of the following blood
samples to the disorders in the given choices. (PaCO2 values are in mm Hg and
bicarbonate values in mmol/l).
pH 7.45, PaCO2 50, HCO3- 30
A. Metabolic Alkalosis, Fully Compensated
B. Respiratory Alkalosis, Fully Compensated
C. Metabolic Alkalosis, Partially Compensated
D. Respiratory Acidosis, Partially Compensated
Correct Answer: A. Metabolic Alkalosis, Fully
Compensated
Based on the given ABG values, pH is 7.45. For pH, the
normal range is 7.35 to 7.45. So it is NORMAL.
PaCO2 is 50. The normal range for PaCO2 is from 35 to
45. If PaCO2 is above 45, it is acidosis. Based on the given ABG values, PaCO2
is above 45, so it is considered ACIDOSIS.
HCO3- is 30. The normal range for HCO3 is from 22 to
26. If HCO3 is above 26, it is alkalosis. Based on the given ABG values, HCO3
is above 26, so it is considered ALKALOSIS.
For these ABG values, pH is NORMAL but slightly
alkalosis and lines up with HCO3 which is METABOLIC. Therefore, this group of
ABG values is considered METABOLIC ALKALOSIS.
Lastly, it is FULLY COMPENSATED because pH is normal.
It is considered fully compensated if pH is normal.
8. Match the acid-base status of the following blood
samples to the disorders in the given choices. (PaCO2 values are in mm Hg and
bicarbonate values in mmol/l).
pH 7.6, PaCO2 53, HCO3- 38
A. Metabolic Alkalosis, Partially Compensated
B. Metabolic Alkalosis, Fully Compensated
C. Respiratory Acidosis, Partially Compensated
D. Respiratory Alkalosis, Fully Compensated
Correct Answer: A. Metabolic Alkalosis, Partially
Compensated
Based on the given ABG values, pH is 7.6. For pH, the
normal range is 7.35 to 7.45. Any blood pH above 7.45 (7.46, 7.47, 7.48, and so
on…) is ALKALOSIS.
PaCO2 is 53. The normal range for PaCO2 is from 35 to
45. If PaCO2 is above 45, it is acidosis. Based on the given ABG values, PaCO2
is above 45, so it is considered ACIDOSIS.
HCO3- is 38. The normal range for HCO3 is from 22 to
26. If HCO3 is above 26, it is alkalosis. Based on the given ABG values, HCO3
is above 26, so it is considered ALKALOSIS.
For these ABG values, pH is ALKALOSIS and lines up
with HCO3 which is METABOLIC. Therefore, this group of ABG values is considered
METABOLIC ALKALOSIS.
Lastly, it is PARTIALLY COMPENSATED because all three
(3) values are abnormal. It is considered partially compensated if all three
(3) values are abnormal.
9. Match the acid-base status of the following blood
samples to the disorders in the given choices. (PaCO2 values are in mm Hg and
bicarbonate values in mmol/l).
pH 7.5, PaCO2 19, HCO3- 22
A. Respiratory Alkalosis, Partially Compensated
B. Metabolic Alkalosis, Partially Compensated
C. Respiratory Acidosis, Uncompensated
D. Respiratory Alkalosis, Uncompensated
Correct Answer: D. Respiratory Alkalosis,
Uncompensated
Based on the given ABG values, pH is 7.5. For pH, the
normal range is 7.35 to 7.45. Any blood pH above 7.45 (7.46, 7.47, 7.48, and so
on…) is ALKALOSIS.
PaCO2 is 19. The normal range for PaCO2 is from 35 to
45. If PaCO2 is below 35, it is alkalosis. Based on the given ABG values, PaCO2
is below 35, so it is considered ALKALOSIS.
HCO3- is 22. The normal range for HCO3 is from 22 to
26. It is NORMAL.
For these ABG values, pH is ALKALOSIS and lines up
with PaCO2 which is RESPIRATORY. Therefore, this group of ABG values is
considered RESPIRATORY ALKALOSIS.
Lastly, it is UNCOMPENSATED because HCO3 is normal and
PaCO2 is abnormal. It is uncompensated if PaCO2 or HCO3 is normal and the other
is abnormal.
10. Match the acid-base status of the following blood
samples to the disorders in the given choices. (PaCO2 values are in mm Hg and
bicarbonate values in mmol/l).
pH 7.39, PaCO2 59, HCO3- 35
A. Respiratory Acidosis, Uncompensated
B. Metabolic Alkalosis, Uncompensated
C. Respiratory Acidosis, Fully Compensated
D. Metabolic Alkalosis, Partially Compensated
Correct Answer: C. Respiratory Acidosis, Fully
Compensated
Based on the given ABG values, pH is 7.39. For pH, the
normal range is 7.35 to 7.45. So it is NORMAL.
PaCO2 is 59. The normal range for PaCO2 is from 35 to
45. If PaCO2 is above 45, it is acidosis. Based on the given ABG values, PaCO2
is above 45, so it is considered ACIDOSIS.
HCO3- is 35. The normal range for HCO3 is from 22 to
26. If HCO3 is above 26, it is alkalosis. Based on the given ABG values, HCO3
is above 26, so it is considered ALKALOSIS.
For these ABG values, pH is NORMAL but slightly acidic
and lines up with PACO2 which is RESPIRATORY. Therefore, this group of ABG
values is considered RESPIRATORY ACIDOSIS.
Lastly, it is FULLY COMPENSATED because pH is normal.
It is considered fully compensated if pH is normal.
11. A client with diabetes mellitus has a blood
glucose on admission of 596 mg/dL. The nurse anticipates that this client would
be experiencing which of the following types of acid-base imbalance?
1. Metabolic acidosis
2. Metabolic alkalosis
3. Respiratory acidosis
4. Respiratory alkalosis
Metabolic acidosis
**Rationale: Diabetes mellitus can lead to metabolic
acidosis. When the body does not have sufficient circulating insulin, the blood
glucose level rises while the cells of the body use all available glucose and
then break down glycogen and fat for fuel. The by-products of fat metabolism
are acidotic, leading to the complication called diabetic ketoacidosis.
Test-Taking Strategy: The strategic words in the
question are “diabetes mellitus.” This tells you that the primary problem is
metabolic in nature rather than respiratory. Therefore, eliminate options 3 and
4. Use knowledge of acid-base concepts to choose correctly between the two
remaining options, remembering that metabolic acidosis is a concern in diabetes
mellitus. Review the complications of diabetes mellitus if you had difficulty
with this question.
12. A nurse is assisting to admit a client with a
diagnosis of Guillain-Barré syndrome. The nurse knows that if the disease is
severe enough, the client will be at risk for which of the following acid-base
imbalances?
1. Metabolic acidosis
2. Metabolic alkalosis
3. Respiratory acidosis
4. Respiratory alkalosis
Respiratory acidosis
**Rationale: Guillain-Barré is a neuromuscular
disorder in which the client may experience weakening or paralysis of the
muscles used for respiration. This could cause the client to retain carbon
dioxide, leading to respiratory acidosis due to ventilatory failure as the
paralysis ensues.
Test-Taking Strategy: Recall that this disorder
impairs the client’s respirations to eliminate options 1 and 2 first. Thinking
through the effects of reduced ventilation will help you choose correctly
between the remaining two options. Review the complications of Guillain-Barré
syndrome if you had difficulty with this question.
13. A client is determined to be in respiratory
alkalosis by blood gas analysis. The nurse would monitor this client for signs
of which of the following electrolyte disorders that could accompany the
acid-base imbalance?
1. Hypercalcemia
2. Hypochloremia
3. Hypernatremia
4. Hypokalemia
Hypokalemia
**Rationale: Clinical manifestations of respiratory
alkalosis include tachypnea, hyperpnea, weakness, paresthesias, tetany,
dizziness, convulsions, coma, hypokalemia, and hypocalcemia. The clinical
picture does not include hypernatremia, hypercalcemia, or hypochloremia.
Test-Taking Strategy: Focus on the subject,
respiratory alkalosis. Remember that the clinical manifestations of respiratory
alkalosis include tachypnea, hyperpnea, weakness, paresthesias, tetany,
dizziness, convulsions, coma, hypokalemia, and hypocalcemia. If this question
was difficult, review this acid-base disorder.
14. A nurse is caring for a client who is nervous and
is hyperventilating. The nurse would monitor the client for signs of which of
the following acid-base imbalances?
1. Respiratory acidosis
2. Respiratory alkalosis
3. Metabolic alkalosis
4. Metabolic acidosis
Respiratory alkalosis
**Rationale: A client who hyperventilates blows off
excessive carbon dioxide. This would have the effect of inducing alkalosis.
Because a respiratory problem is triggering the alteration, it is called a
respiratory alkalosis.
Test-Taking Strategy: Note the strategic word
“hyperventilating” in the question. This tells you that the correct option is
more likely to be respiratory in origin. Recalling that blowing off carbon
dioxide triggers alkalosis will help you choose correctly from the remaining
two options. Review the basics of acid-base imbalance if you had difficulty
with this question.
15. A nurse is assisting in the care of a client for
whom an arterial blood gas (ABG) must be drawn. The nurse notes that the person
who draws the blood sample from the radial artery performs Allen’s test first.
The nurse understands that this is being done to determine the adequacy of the:
1. Carotid circulation
2. Ulnar circulation
3. Femoral circulation
4. Brachial circulation
Ulnar circulation
**Rationale: Allen’s test is done to test the adequacy
of the ulnar circulation before drawing an ABG. This is necessary to ensure
that the client has adequate circulation to the hand in case the radial artery
becomes occluded. Failure to assess collateral circulation could result in
severe ischemic injury to the hand if damage to the radial artery occurs with
arterial puncture.
Test-Taking Strategy: Recall the concepts of anatomy
to answer this question. Recalling that the two blood vessels that supply the
hand are the radial and the ulnar arteries will help you choose correctly.
Review the purpose and procedure of Allen’s test if you had difficulty with
this question.
16. A nurse is assisting in the care of a client who
had an ileostomy created a few days ago. Owing to the normally high output of
drainage from this type of ostomy, the nurse monitors the client for signs of:
1. Metabolic acidosis
2. Metabolic alkalosis
3. Respiratory acidosis
4. Respiratory alkalosis
Metabolic acidosis
**Rationale: Intestinal secretions are high in
bicarbonate because of the effects of pancreatic secretions. These fluids may
be lost from the body before they can be reabsorbed in conditions such as
diarrhea or creation of ileostomy. The decreased bicarbonate level creates the actual
base deficit of metabolic acidosis.
Test-Taking Strategy: Begin to answer this question by
eliminating options 2 and 4 first. Intestinal fluids are alkaline in nature,
and their loss would produce an acidotic state. Note that the client condition
is a gastrointestinal disorder to eliminate the option that deals with a
respiratory problem. If you had difficulty with this question, review the
causes of metabolic acidosis.
17. A client with a chronic airflow limitation is
experiencing respiratory acidosis as a complication. The nurse who is trying to
enhance the client’s respiratory status would avoid doing which of the
following?
1. Keeping the head of the bed elevated
2. Monitoring the flow rate of supplemental oxygen
3. Assisting the client to turn, cough, and deep
breathe
4. Encouraging the client to breathe slowly and
shallowly
Encouraging the client to breathe slowly and shallowly
**Rationale: The client with respiratory acidosis is
experiencing elevated carbon dioxide levels due to insufficient ventilation.
The nurse would encourage the client to breathe slowly and deeply (not
shallowly) to expand alveoli and to promote better gas exchange. The actions
listed in options 1, 2, and 3 are helpful actions on the part of the nurse.
Test-Taking Strategy: Note that the question contains
the strategic word “avoid.” With this in mind, eliminate options that are
beneficial to airway status, and choose the one that would cause further
impairment. Review care of the client with respiratory acidosis if you had difficulty
with this question.
18. An anxious client is experiencing respiratory
alkalosis from hyperventilation due to anxiety. The nurse would do which of the
following to help the client experiencing this acid-base disorder?
1. Withhold all sedative or antianxiety medications.
2. Provide emotional support and reassurance.
3. Tell the client to breathe very deeply but more
slowly.
4. Put the client in a supine position.
Provide emotional support and reassurance.
**Rationale: An anxious client benefits from emotional
support and reassurance, which in turn reduces anxiety and may lower the
respiratory rate. The client may benefit from the administration of a sedative
or antianxiety medication, if it is prescribed. The client should try to
breathe more slowly and shallowly. Lying supine provides no benefit to the
client.
Test-Taking Strategy: Visualize the items in each of
the options and their anticipated effect on the client’s respiratory status.
Use the process of elimination to choose the umbrella option, which is
providing support and reassurance. If you had difficulty with this question,
review care of the client with respiratory alkalosis.
19. A client is being treated for metabolic acidosis
with medication therapy and other measures. The nurse would plan to most
carefully note the levels of which of the following electrolytes, which could
dramatically decline with effective treatment of the acidosis?
1. Sodium
2. Potassium
3. Magnesium
4. Phosphorus
Potassium
**Rationale: During treatment of metabolic acidosis,
potassium moves out of the bloodstream and back into the cells. This can cause
a rapid drop in the serum potassium level. Because of the effects of potassium
on the heart, this electrolyte should be monitored closely as the client is treated.
Test-Taking Strategy: Specific knowledge about
electrolyte changes that accompany acid-base disturbances is needed to answer
the question. In the question, note the strategic words “most carefully,” which
tell you that more than one option may be partially correct. Recall the roles
of the various electrolytes in the body, and remember that during treatment of
metabolic acidosis, potassium moves out of the bloodstream and back into the
cells. Review metabolic acidosis if you had difficulty with this question.
20. A licensed practical nurse (LPN) is assisting in
the care of a client who overdosed on aspirin 24 hours ago. The LPN would
report to the registered nurse (RN) which of the following findings associated
with an anticipated acid-base disturbance?
1. Drowsiness, headache, and tachypnea
2. Decreased respiratory rate and depth, cardiac
irregularities
3. Disorientation and dyspnea
4. Tachypnea, dizziness, and paresthesias
Drowsiness, headache, and tachypnea
**Rationale: The client who ingests a large amount of
aspirin (acetylsalicylic acid) is at risk for developing metabolic acidosis 24
hours later. If metabolic acidosis occurs, the client is likely to exhibit
drowsiness, headache, and tachypnea. In the very early hours following aspirin
overdose, the client may exhibit respiratory alkalosis as a compensatory
mechanism. By 24 hours postoverdose, however, the compensatory mechanism fails
and the client reverts to metabolic acidosis. The client with metabolic
alkalosis (option 2) is likely to experience cardiac irregularities and a
compensatory decreased respiratory rate and depth. Options 3 and 4 indicate
respiratory acidosis and alkalosis, respectively.
Test-Taking Strategy: Note that the strategic words in
the question are “24 hours later.” To answer this question accurately, you must
be familiar with signs of aspirin poisoning and the signs and symptoms
exhibited with various acid-base disturbances. Remember that if metabolic
acidosis occurs, the client is likely to exhibit drowsiness, headache, and
tachypnea. Review the manifestations of metabolic acidosis if you had
difficulty with this question.
21. George Kent is a 54-year-old widower with a
history of chronic obstructive pulmonary disease and was rushed to the
emergency department with increasing shortness of breath, pyrexia, and a
productive cough with yellow-green sputum. He has difficulty communicating
because of his inability to complete a sentence. One of his sons, Jacob, says
he has been unwell for three days. Upon examination, crackles and wheezes can
be heard in the lower lobes; he has tachycardia and a bounding pulse.
Measurement of arterial blood gas shows pH 7.3, PaCO2 68 mm Hg, HCO3 28 mmol/L,
and PaO2 60 mm Hg. How would you interpret this?
A. Respiratory Acidosis, Uncompensated
B. Respiratory Acidosis, Partially Compensated
C. Metabolic Alkalosis, Uncompensated
D. Metabolic Acidosis, Partially Compensated
Correct Answer: B. Respiratory Acidosis, Partially
Compensated
The patient has respiratory acidosis (raised carbon
dioxide) resulting from an acute exacerbation of chronic obstructive pulmonary
disease, with partial compensation.
22. Carl, an elementary student, was rushed to the
hospital due to vomiting and a decreased level of consciousness. The patient
displays slow and deep (Kussmaul breathing), and he is lethargic and irritable
in response to stimulation. He appears to be dehydrated—his eyes are sunken and
mucous membranes are dry—and he has a two-week history of polydipsia, polyuria,
and weight loss. Measurement of arterial blood gas shows pH 7.0, PaO2 90 mm Hg,
PaCO2 23 mm Hg, and HCO3 12 mmol/L; other results are Na+ 126 mmol/L, K+ 5
mmol/L, and Cl- 95 mmol/L. What is your assessment?
A. Respiratory Acidosis, Uncompensated
B. Respiratory Acidosis, Partially Compensated
C. Metabolic Alkalosis, Uncompensated
D. Metabolic Acidosis, Partially, Compensated
Correct Answer: D. Metabolic Acidosis, Partially,
Compensated
The student was diagnosed with diabetes mellitus. The
results show that he has metabolic acidosis (low HCO3 -) with respiratory
compensation (low CO2).
23. A cigarette vendor was brought to the emergency
department of a hospital after she fell into the ground and hurt her left leg.
She is noted to be tachycardic and tachypneic. Painkillers were carried out to
lessen her pain. Suddenly, she started complaining that she is still in pain
and now experiencing muscle cramps, tingling, and paraesthesia. Measurement of
arterial blood gas reveals pH 7.6, PaO2 120 mm Hg, PaCO2 31 mm Hg, and HCO3 25
mmol/L. What does this mean?
A. Respiratory Alkalosis, Uncompensated
B. Respiratory Acidosis, Partially Compensated
C. Metabolic Alkalosis, Uncompensated
D. Metabolic Alkalosis, Partially Compensated
Correct Answer: A. Respiratory Alkalosis,
Uncompensated
The primary disorder is acute respiratory alkalosis
(low CO2) due to the pain and anxiety causing her to hyperventilate. There has
not been time for metabolic compensation.
24. Ricky’s grandmother has been suffering from
persistent vomiting for two days now. She appears to be lethargic and weak and
has myalgia. She is noted to have dry mucus membranes and her capillary refill
takes >4 seconds. She is diagnosed as having gastroenteritis and
dehydration. Measurement of arterial blood gas shows pH 7.5, PaO2 85 mm Hg,
PaCO2 40 mm Hg, and HCO3 34 mmol/L. What acid-base disorder is shown?
A. Respiratory Alkalosis, Uncompensated
B. Respiratory Acidosis, Partially Compensated
C. Metabolic Alkalosis, Uncompensated
D. Metabolic Alkalosis, Partially Compensated
Correct Answer: C. Metabolic Alkalosis, Uncompensated
The primary disorder is uncompensated metabolic
alkalosis (high HCO3 -). As CO2 is the strongest driver of respiration, it
generally will not allow hypoventilation as compensation for metabolic
alkalosis.
25. Mrs. Johansson, who had undergone surgery in the
post-anesthesia care unit (PACU), is difficult to arouse two hours following
surgery. Nurse Florence in the PACU has been administering Morphine Sulfate
intravenously to the client for complaints of post-surgical pain. The client’s
respiratory rate is 7 per minute and demonstrates shallow breathing. The
patient does not respond to any stimuli. The nurse assesses the ABCs (remember
Airway, Breathing, Circulation!) and obtains ABGs STAT! Measurement of arterial
blood gas shows pH 7.10, PaCO2 70 mm Hg, and HCO3 24 mEq/L. What does this
mean?
A. Respiratory Alkalosis, Partially Compensated
B. Respiratory Acidosis, Uncompensated
C. Metabolic Alkalosis, Partially Compensated
D. Metabolic Acidosis, Uncompensated
Correct Answer: B. Respiratory Acidosis, Uncompensated
The results show that Mrs. Johansson has respiratory
acidosis because of decreased pH and increased PaCO2 which means acidic in
nature. Meanwhile, it is uncompensated because HCO3 is within the normal range.
26. Baby Angela was rushed to the Emergency Room
following her mother’s complaint that the infant has been irritable, difficult
to breastfeed, and has had diarrhea for the past 3 days. The infant’s
respiratory rate is elevated and the fontanels are sunken. The Emergency Room
physician orders ABGs after assessing the ABCs. The results from the ABG
results show pH 7.39, PaCO2 27 mmHg, and HCO3 19 mEq/L. What does this mean?
A. Respiratory Alkalosis, Fully Compensated
B. Metabolic Acidosis, Uncompensated
C. Metabolic Acidosis, Fully Compensated
D. Respiratory Acidosis, Uncompensated
Correct Answer: C. Metabolic Acidosis, Fully
Compensated
Baby Angela has metabolic acidosis due to decreased
HCO3 and slightly acidic pH. Her pH value is within the normal range which made
the result fully compensated.
27. Mr. Wales, who underwent post-abdominal surgery,
has a nasogastric tube. The nurse on duty notes that the nasogastric tube (NGT)
is draining a large amount (900 cc in 2 hours) of coffee ground secretions. The
client is not oriented to person, place, or time. The nurse contacts the
attending physician and STAT ABGs are ordered. The results from the ABGs show
pH 7.57, PaCO2 37 mmHg and HCO3 30 mEq/L. What is your assessment?
A. Metabolic Acidosis, Uncompensated
B. Metabolic Alkalosis, Uncompensated
C. Respiratory Alkalosis, Uncompensated
D. Metabolic Alkalosis, Partially Compensated
Correct Answer: B. Metabolic Alkalosis, Uncompensated
The postoperative client’s ABG results show that he
has metabolic alkalosis because of an increased pH and HCO3. It is
uncompensated due to the normal PaCO2 which is within 35 to 45 mmHg.
28. Client Z is admitted to the hospital and is to
undergo brain surgery. The client is very anxious and scared of the upcoming
surgery. He begins to hyperventilate and becomes very dizzy. The client loses
consciousness and the STAT ABGs reveal pH 7.61, PaCO2 22 mmHg, and HCO3 25
mEq/L. What is the ABG interpretation based on the findings?
A. Metabolic Acidosis, Uncompensated
B. Respiratory Alkalosis, Partially Compensated
C. Respiratory Alkalosis, Uncompensated
D. Metabolic Alkalosis, Partially Compensated
Correct Answer: C. Respiratory Alkalosis,
Uncompensated
The results show that client Z has respiratory
alkalosis since there is an increase in the pH value and a decrease in PaCO2
which are both basic. It is uncompensated due to the normal HCO3 which is
within 22-26 mEq/L.
29. Three-year-old Adrian is admitted to the hospital
with a diagnosis of asthma and respiratory distress syndrome. The mother of the
child reports to the nurse on duty that she has witnessed slight tremors and
behavioral changes in her child over the past four days. The attending
physician orders routine ABGs following an assessment of the ABCs. The ABG
results are pH 7.35, PaCO2 72 mmHg, and HCO3 38 mEq/L. What acid-base disorder
is shown?
A. Respiratory Acidosis, Uncompensated
B. Respiratory Acidosis, Fully Compensated
C. Respiratory Alkalosis, Fully Compensated
D. Metabolic Alkalosis, Partially Compensated
Correct Answer: B. Respiratory Acidosis, Fully
Compensated
The patient has respiratory acidosis (raised carbon
dioxide) resulting from asthma and respiratory distress syndrome, with
compensation having normal pH value within 7.35to 7.45, increased PaCO2 which
is acidic and increased HCO3 which is basic.
30. Anne, who is drinking beer at a party, falls and
hits her head on the ground. Her friend Liza dials “911” because Anne is
unconscious, depressed ventilation (shallow and slow respirations), rapid heart
rate, and is profusely bleeding from both ears. Which primary acid-base
imbalance is Anne at risk for if medical attention is not provided?
A. Metabolic Acidosis
B. Metabolic Alkalosis
C. Respiratory Acidosis
D. Respiratory Alkalosis
Correct Answer: C. Respiratory Acidosis
One of the risk factors of having respiratory acidosis
is hypoventilation which may be due to brain trauma, coma, and hypothyroidism
or myxedema. Other risk factors include COPD, Respiratory conditions such as
pneumothorax, pneumonia, and status asthmaticus. Drugs such as Morphine and
MgSO4 toxicity are also risk factors of respiratory acidosis.
31. Dave, a 6-year-old boy, was rushed to the hospital
following her mother’s complaint that her son has been vomiting, nauseated and
has overall weakness. After a series of tests, the nurse notes the laboratory
results: potassium: 2.9 mEq. Which primary acid-base imbalance is this boy at
risk for if medical intervention is not carried out?
A. Respiratory Acidosis
B. Respiratory Alkalosis
C. Metabolic Acidosis
D. Metabolic Alkalosis
Correct Answer: D. Metabolic Alkalosis
Vomiting, hypokalemia, overdosage of NaHCO3 and NGT
suctioning are considered risk factors of metabolic alkalosis.
32. An old beggar was admitted to the emergency
department due to shortness of breath, fever, and a productive cough. Upon
examination, crackles and wheezes are noted in the lower lobes; he appears to
be tachycardic and has a bounding pulse. Measurement of arterial blood gas
shows pH 7.2, PaCO2 66 mm Hg, HCO3 27 mmol/L, and PaO2 65 mm Hg. As a
knowledgeable nurse, you know that the normal value for pH is:
A. 7.20
B. 7.30
C. 7.40
D. 7.50
Correct Answer: C. 7.40
Normal blood pH must be maintained within a narrow
range of 7.35-7.45 to ensure the proper functioning of metabolic processes and
the delivery of the right amount of oxygen to tissues. Acidosis refers to an
excess of acid in the blood that causes the pH to fall below 7.35, and
alkalosis refers to an excess of base in the blood that causes the pH to rise
above 7.45
33. Liza’s mother is seen in the emergency department
at a community hospital. She admits that her mother is taking many tablets of
aspirin (salicylates) over the last 24-hour period because of a severe
headache. Also, the mother complains of an inability to urinate. The nurse on
duty took her vital signs and noted the following: Temp = 97.8 °F; apical pulse
= 95; respiration = 32 and deep. Which primary acid-base imbalance is the
client at risk for if medical attention is not provided?
A. Respiratory Acidosis
B. Respiratory Alkalosis
C. Metabolic Acidosis
D. Metabolic Alkalosis
Correct Answer. C. Metabolic Acidosis
Salicylate overdose causes a high anion gap metabolic
acidosis in both children and adults. Adults commonly develop a mixed acid-base
disorder as a respiratory alkalosis due to direct respiratory center
stimulation occurs as well. This second disorder is uncommon in children.
34. A patient who is hospitalized due to vomiting and
a decreased level of consciousness displays slow and deep (Kussmaul breathing),
and he is lethargic and irritable in response to stimulation. The doctor
diagnosed him of having dehydration. Measurement of arterial blood gas shows pH
7.0, PaO2 90 mm Hg, PaCO2 22 mm Hg, and HCO3 14 mmol/L; other results are Na+
120 mmol/L, K+ 2.5 mmol/L, and Cl- 95 mmol/L. As a knowledgeable nurse, you
know that the normal value for PaCO2 is:
A. 22 mm Hg
B. 36 mm Hg
C. 48 mm Hg
D. 50 mm Hg
Correct Answer: B. 36 mm Hg
The normal range for PaCO2 is from 35 to 45 mm Hg.
35. A company driver is found at the scene of an
automobile accident in a state of emotional distress. He tells the paramedics
that he feels dizzy, tingling in his fingertips, and does not remember what
happened to his car. Respiratory rate is rapid at 34/minute. Which primary
acid-base disturbance is the young man at risk for if medical attention is not
provided?
A. Respiratory Acidosis
B. Respiratory Alkalosis
C. Metabolic Acidosis
D. Metabolic Alkalosis
Correct Answer: B. Respiratory Alkalosis
Hyperventilation is typically the underlying cause of
respiratory alkalosis. Hyperventilation is also known as overbreathing. When
someone is hyperventilating, they tend to breathe very deeply or very rapidly.
36. An elderly client was admitted to hospital in a
coma. Analysis of the arterial blood gave the following values: PCO2 16 mm Hg,
HCO3- 5 mmol/L and pH 7.1. As a well-rounded nurse, you know that the normal
value for HCO3 is:
A. 20 mmol/L
B. 24 mmol/L
C. 29 mmol/L
D. 31 mmol/L
Correct Answer: B. 24 mmol/L
The normal value for bicarbonate (HCO3) is 22-26
mmol/L or mEq/L. It may vary slightly among different laboratories. The given
values show the common measurement range of results for these tests. Some
laboratories use different measurements or may test different specimens.
37. In a patient undergoing surgery, it was vital to
aspirate the contents of the upper gastrointestinal tract. After the operation,
the following values were acquired from an arterial blood sample: pH 7.55, PCO2
52 mm Hg and HCO3- 40 mmol/l. What is the underlying disorder?
A. Respiratory Acidosis
B. Respiratory Alkalosis
C. Metabolic Acidosis
D. Metabolic Alkalosis
Correct Answer: D. Metabolic Alkalosis
NGT suctioning, vomiting, hypokalemia and overdosage
of NaHCO3 are considered risk factors of metabolic alkalosis.
38. A mountaineer attempts an assault on a high
mountain in the Andes and reaches an altitude of 5000 meters (16,400 ft) above
sea level. What will happen to his arterial PCO2 and pH?
A. Both will be lower than normal.
B. The pH will rise and PCO2 will fall.
C. Both will be higher than normal due to physical
exertion.
D. The pH will fall and PCO2 will rise
Correct Answer: B. The pH will rise and PCO2 will
fall.
The mountaineer will suffer from a respiratory
alkalosis. The decline in the PO2 with altitude will stimulate breathing to
offset the hypoxia. Carbon dioxide is driven from the blood faster than it is
produced in the tissues so PCO2 falls and pH rises.
39. A young woman is found comatose, having taken an
unknown number of sleeping pills an unknown time before. An arterial blood
sample yields the following values: pH 6.90, HCO3- 13 meq/liter, and PaCO2 68
mmHg. This patient’s acid-base status is most accurately described as:
A. Metabolic Acidosis
B. Respiratory Acidosis
C. Simultaneous Respiratory and Metabolic Acidosis
D. Respiratory Acidosis with Complete Renal
Compensation
Correct Answer: C. Simultaneous Respiratory and
Metabolic Acidosis
Whenever the PCO2 and HCO3 are abnormal in opposite
directions, ie, one above normal while the other is reduced, a mixed
respiratory and metabolic acid-base disorder exists. When the PCO2 is elevated
and the [HCO3-] reduced, respiratory acidosis and metabolic acidosis coexist.
40. A mother is admitted to the emergency department
following complaints of fever and chills. The nurse on duty took her vital
signs and noted the following: Temp = 100 °F; apical pulse = 95; respiration =
20 and deep. Measurement of arterial blood gas shows pH 7.37, PaO2 90 mm Hg,
PaCO2 40 mm Hg, and HCO3 24 mmol/L. What is your assessment?
A. Hyperthermia
B. Hyperthermia and Respiratory Alkalosis
C. Hypothermia
D. Hypothermia and Respiratory Alkalosis
Correct Answer: A. Hyperthermia
An individual is considered to have hyperthermia if he
or she has a temperature of >37.5 or 38.3 °C (99.5 or 100.9 °F). The
measurement of arterial blood gases are normal.
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