NUR 2243 Exam 1
A nurse assesses a client who is admitted with an acid-base imbalance. The clients
arterial blood gas values are pH 7.32, PaO2 85 mm Hg, PaCO2 34 mm Hg, and HCO3
16 mEq/L. What action should the nurse take next?
a. Assess clients rate, rhythm, and depth of respiration.
b. Measure the clients pulse and blood pressure.
c. Document the findings and continue to monitor.
d. Notify the physician as soon as possible. - ✔️✔️ANS: A
Progressive skeletal muscle weakness is associated with increasing severity of
acidosis. Muscle weakness can lead to severe respiratory insufficiency. Acidosis does
lead to dysrhythmias (due to hyperkalemia), but these would best be assessed with
cardiac monitoring. Findings should be documented, but simply continuing to monitor is
not sufficient. Before notifying the physician, the nurse must have more data to report
A nurse assesses a client who is experiencing an acid-base imbalance. The clients
arterial blood gas values are pH 7.34, PaO2 88 mm Hg, PaCO2 38 mm Hg, and HCO3
19 mEq/L. Which assessment should the nurse perform first?
a. Cardiac rate and rhythm
b. Skin and mucous membranes
c. Musculoskeletal strength
d. Level of orientation - ✔️✔️ANS: A
Early cardiovascular changes for a client experiencing moderate acidosis include
increased heart rate and cardiac output. As the acidosis worsens, the heart rate
decreases and electrocardiographic changes will be present. Central nervous system
and neuromuscular system changes do not occur with mild acidosis and should be
monitored if the acidosis worsens. Skin and mucous membrane assessment is not a
priority now, but will change as acidosis worsens.
A nurse assesses a client who is prescribed furosemide (Lasix) for hypertension. For
which acid-base imbalance should the nurse assess to prevent complications of this
therapy?
a. Respiratory acidosis
b. Respiratory alkalosis
c. Metabolic acidosis
d. Metabolic alkalosis - ✔️✔️ANS: D
Many diuretics, especially loop diuretics, increase the excretion of hydrogen ions,
leading to excess acid loss through the renal system. This situation is an acid deficit of
metabolic origin.
A nurse is caring for a client who is experiencing moderate metabolic alkalosis. Which
action should the nurse take?
a. Monitor daily hemoglobin and hematocrit values.
b. Administer furosemide (Lasix) intravenously.
,c. Encourage the client to take deep breaths.
d. Teach the client fall prevention measures. - ✔️✔️ANS: D
The priority nursing care for a client who is experiencing moderate metabolic alkalosis is
providing client safety. Clients with metabolic alkalosis have muscle weakness and are
at risk for falling. The other nursing interventions are not appropriate for metabolic
alkalosis
A nurse is caring for a client who has the following arterial blood values: pH 7.12, PaO2
56 mm Hg, PaCO2 65 mm Hg, and HCO3 22 mEq/L. Which clinical situation should the
nurse correlate with these values?
a. Diabetic ketoacidosis in a person with emphysema
b. Bronchial obstruction related to aspiration of a hot dog
c. Anxiety-induced hyperventilation in an adolescent
d. Diarrhea for 36 hours in an older, frail woman - ✔️✔️ANS: B
Arterial blood gas values indicate that the client has acidosis with normal levels of
bicarbonate, suggesting that the problem is not metabolic. Arterial concentrations of
oxygen and carbon dioxide are abnormal, with low oxygen and high carbon dioxide
levels. Thus, this client has respiratory acidosis from inadequate gas exchange. The
fact that the bicarbonate level is normal indicates that this is an acute respiratory
problem rather than a chronic problem, because no renal compensation has occurred.
A nurse is caring for a client who has just experienced a 90-second tonic-clonic seizure.
The clients arterial blood gas values are pH 6.88, PaO2 50 mm Hg, PaCO2 60 mm Hg,
and HCO3 22 mEq/L. Which action should the nurse take first?
a. Apply oxygen by mask or nasal cannula.
b. Apply a paper bag over the clients nose and mouth.
c. Administer 50 mL of sodium bicarbonate intravenously.
d. Administer 50 mL of 20% glucose and 20 units of regular insulin. - ✔️✔️ANS: A
The client has experienced a combination of metabolic and acute respiratory acidosis
through heavy skeletal muscle contractions and no gas exchange. When the seizures
have stopped and the client can breathe again, the fastest way to return acid-base
balance is to administer oxygen. Applying a paper bag over the clients nose and mouth
would worsen the acidosis. Sodium bicarbonate should not be administered because
the clients arterial bicarbonate level is normal. Glucose and insulin are administered
together to decrease serum potassium levels. This action is not appropriate based on
the information provided
After teaching a client who was malnourished and is being discharged, a nurse
assesses the clients understanding. Which statement indicates the client correctly
understood teaching to decrease risk for the development of metabolic acidosis?
a. I will drink at least three glasses of milk each day.
b. I will eat three well-balanced meals and a snack daily.
c. I will not take pain medication and antihistamines together.
d. I will avoid salting my food when cooking or during meals. - ✔️✔️ANS: B
,Starvation or a diet with too few carbohydrates can lead to metabolic acidosis by forcing
cells to switch to using fats for fuel and by creating ketoacids as a by-product of
excessive fat metabolism. Eating sufficient calories from all food groups helps reduce
this risk.
A nurse evaluates the following arterial blood gas values in a client: pH 7.48, PaO2 98
mm Hg, PaCO2 28 mm Hg, and HCO3 22 mEq/L. Which client condition should the
nurse correlate with these results?
a. Diarrhea and vomiting for 36 hours
b. Anxiety-induced hyperventilation
c. Chronic obstructive pulmonary disease (COPD)
d. Diabetic ketoacidosis and emphysema - ✔️✔️ANS: B
The elevated pH level indicates alkalosis. The bicarbonate level is normal, and so is the
oxygen partial pressure. Loss of carbon dioxide is the cause of the alkalosis, which
would occur in response to hyperventilation. Diarrhea and vomiting would cause
metabolic alterations, COPD would lead to respiratory acidosis, and the client with
emphysema most likely would have combined metabolic acidosis on top of a mild,
chronic respiratory acidosis.
After providing discharge teaching, a nurse assesses the clients understanding
regarding increased risk for metabolic alkalosis. Which statement indicates the client
needs additional teaching?
a. I dont drink milk because it gives me gas and diarrhea.
b. I have been taking digoxin every day for the last 15 years.
c. I take sodium bicarbonate after every meal to prevent heartburn.
d. In hot weather, I sweat so much that I drink six glasses of water each day. -
✔️✔️ANS: C
Excessive oral ingestion of sodium bicarbonate and other bicarbonate-based antacids
can cause metabolic alkalosis. Avoiding milk, taking digoxin, and sweating would not
lead to increased risk of metabolic alkalosis.
A nurse is caring for a client who is experiencing excessive diarrhea. The clients arterial
blood gas values are pH 7.28, PaO2 98 mm Hg, PaCO2 45 mm Hg, and HCO3 16
mEq/L. Which provider order should the nurse expect to receive?
a. Furosemide (Lasix) 40 mg intravenous push
b. Sodium bicarbonate 100 mEq diluted in 1 L of D5W
c. Mechanical ventilation
d. Indwelling urinary catheter - ✔️✔️ANS: B
This clients arterial blood gas values represent metabolic acidosis related to a loss of
bicarbonate ions from diarrhea. The bicarbonate should be replaced to help restore this
clients acid-base balance. Furosemide would cause an increase in acid fluid and acid
elimination via the urinary tract; although this may improve the clients pH, the client has
excessive diarrhea and cannot afford to lose more fluid. Mechanical ventilation is used
to treat respiratory acidosis for clients who cannot keep their oxygen saturation at 90%,
or who have respirator muscle fatigue. Mechanical ventilation and an indwelling urinary
catheter would not be prescribed for this client.
, A nurse evaluates a clients arterial blood gas values (ABGs): pH 7.30, PaO2 86 mm Hg,
PaCO2 55 mm Hg, and HCO3 22 mEq/L. Which intervention should the nurse
implement first?
a. Assess the airway.
b. Administer prescribed bronchodilators.
c. Provide oxygen.
d. Administer prescribed mucolytics. - ✔️✔️ANS: A
All interventions are important for clients with respiratory acidosis; this is indicated by
the ABGs. However, the priority is assessing and maintaining an airway. Without a
patent airway, other interventions will not be helpful.
A nurse is planning care for a client who is hyperventilating. The clients arterial blood
gas values are pH 7.30, PaO2 94 mm Hg, PaCO2 31 mm Hg, and HCO3 26 mEq/L.
Which question should the nurse ask when developing this clients plan of care?
a. Do you take any over-the-counter medications?
b. You appear anxious. What is causing your distress?
c. Do you have a history of anxiety attacks?
d. You are breathing fast. Is this causing you to feel light-headed? - ✔️✔️ANS: B
The nurse should assist the client who is experiencing anxiety-induced respiratory
alkalosis to identify causes of the anxiety. The other questions will not identify the cause
of the acid-base imbalance.
A nurse is caring for a client who has chronic emphysema and is receiving oxygen
therapy at 6 L/min via nasal cannula. The following clinical data are available:
Arterial Blood Gases Vital Signs
pH = 7.28 Pulse rate = 96 beats/min
PaO2 = 85 mm Hg Blood pressure = 135/45
PaCO2 = 55 mm Hg Respiratory rate = 6 breaths/min
HCO3 = 26 mEq/L O2 saturation = 88%
Which action should the nurse take first?
a. Notify the Rapid Response Team and provide ventilation support.
b. Change the nasal cannula to a mask and reassess in 10 minutes.
c. Place the client in Fowlers position if he or she is able to tolerate it.
d. Decrease the flow rate of oxygen to 2 to 4 L/min, and reassess. - ✔️✔️ANS: A
The primary trigger for respiration in a client with chronic respiratory acidosis is a
decreased arterial oxygen level (hypoxic drive). Oxygen therapy can inhibit respiratory
efforts in this case, eventually causing respiratory arrest and death. The nurse could
decrease the oxygen flow rate; eventually, this might improve the clients respiratory
rate, but the priority action would be to call the Rapid Response Team whenever a client
with chronic carbon dioxide retention has a respiratory rate less than 10 breaths/min.
Changing the cannula to a mask does nothing to improve the clients hypoxic drive, nor
would it address the clients most pressing need. Positioning will not help the client
breathe at a
