TEST BANK FOR NURSING A CONCEPT-BASED
pneumonia place the client at risk for respiratory acidosis with the increased retention of
carbon dioxide in the blood.
APPROACH TO LEARNING, VOLUMES I, II & III EXAM WITH E) Metabolic acidosis is rarely a primary disorder. It usually develops during the course of
VERIFIED QUESTIONS AND ANSWERS
another disease; presence of abdominal fistulas, which can cause excess bicarbonate loss;
acute renal failure; and hypovolemic shock. Chronic obstructive pulmonary disease and
pneumonia place the client at risk for respiratory acidosis with the increased retention of
carbon dioxide in the blood.
Page Ref: 6, 14
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Physiological Adaptation
1) Which risk factors exhibited by the client presenting in the emergency department (ED) Standards: QSEN Competencies: III.A.1. Demonstrate knowledge of basic scientific methods
would place the client at risk for metabolic acidosis? Select all that apply. and processes. | AACN Essential Competencies: IX.3. Implement holistic, patient-centered
care that reflects an understanding of human growth and development, pathophysiology,
A) Abdominal fistulas pharmacology, medical
B) Chronic obstructive pulmonary disease management and nursing management across the health-illness continuum, across lifespan,
and in all healthcare settings. | NLN Competencies: Knowledge and Science: Relationships
C) Pneumonia
between knowledge/science and quality and safe patient care. | Nursing Process:
D) Acute renal failure Assessment
Learning Outcome: 1.2. Differentiate alterations in acid-base balance.
E) Hypovolemic shock Answer: A, D, E
MNL LO: Analyze the concept of acid-base balance and its application to nursing care.
Explanation: A) 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; acute renal failure; and hypovolemic shock. Chronic obstructive pulmonary 2) A client is brought to the emergency department (ED) after passing out in a local
disease and pneumonia place the client at risk for respiratory acidosis with the increased department store. The client has been fasting and has ketones in the urine. Which acid-base
retention of carbon dioxide in the blood. imbalance would the nurse expect to assess in this client?
B) Metabolic acidosis is rarely a primary disorder. It usually develops during the course of A) Metabolic acidosis
another disease; presence of abdominal fistulas, which can cause excess bicarbonate loss;
acute renal failure; and hypovolemic shock. Chronic obstructive pulmonary disease and B) Respiratory alkalosis
pneumonia place the client at risk for respiratory acidosis with the increased retention of C) Metabolic alkalosis
carbon dioxide in the blood.
D) Respiratory acidosis Answer: A
C) 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;
acute renal failure; and hypovolemic shock. Chronic obstructive pulmonary disease and
Explanation: A) A client who is fasting is at risk for development of metabolic acidosis. The body
pneumonia place the client at risk for respiratory acidosis with the increased retention of
recognizes fasting as starvation and begins to metabolize its own fatty acids into ketones,
carbon dioxide in the blood.
which are metabolic acids. Starvation would not result in respiratory acidosis or alkalosis or
D) Metabolic acidosis is rarely a primary disorder. It usually develops during the course of in metabolic alkalosis.
another disease; presence of abdominal fistulas, which can cause excess bicarbonate loss;
B) A client who is fasting is at risk for development of metabolic acidosis. The body
acute renal failure; and hypovolemic shock. Chronic obstructive pulmonary disease and
recognizes fasting as starvation and begins to metabolize its own fatty acids into ketones,
,which are metabolic acids. Starvation would not result in respiratory acidosis or alkalosis B) If the pH is decreased and the PaCO2 is increased with a normal HCO3, it is
or in metabolic alkalosis. uncompensated respiratory acidosis. Uncompensated respiratory alkalosis has an increased
pH, decreased PaCO2, and normal HCO3. Uncompensated metabolic acidosis has a decreased
C) A client who is fasting is at risk for development of metabolic acidosis. The body
pH, normal PaCO2, and decreased HCO3. Uncompensated metabolic alkalosis has an
recognizes fasting as starvation and begins to metabolize its own fatty acids into ketones,
increased pH, normal PaCO2, and increased HCO3.
which are metabolic acids. Starvation would not result in respiratory acidosis or alkalosis
or in metabolic alkalosis. C) If the pH is decreased and the PaCO2 is increased with a normal HCO3, it is
uncompensated respiratory acidosis. Uncompensated respiratory alkalosis has an increased
D) A client who is fasting is at risk for development of metabolic acidosis. The body
pH, decreased PaCO2, and normal HCO3. Uncompensated metabolic acidosis has a decreased
recognizes fasting as starvation and begins to metabolize its own fatty acids into ketones,
pH, normal PaCO2, and decreased HCO3. Uncompensated metabolic alkalosis has an
which are metabolic acids. Starvation would not result in respiratory acidosis or alkalosis
increased pH, normal PaCO2, and increased HCO3.
or in metabolic alkalosis.
D) If the pH is decreased and the PaCO2 is increased with a normal HCO3, it is
Page Ref: 6
uncompensated respiratory acidosis. Uncompensated respiratory alkalosis has an increased
Cognitive Level: Analyzing pH, decreased PaCO2, and normal HCO3. Uncompensated metabolic acidosis has a decreased
pH, normal PaCO2, and decreased HCO3. Uncompensated metabolic alkalosis has an
Client Need/Sub: Physiological Integrity: Physiological Adaptation increased pH, normal PaCO2, and increased HCO3.
Standards: QSEN Competencies: III.A.1. Demonstrate knowledge of basic scientific methods Page Ref: 24
and processes. | AACN Essential Competencies: IX.3. Implement holistic, patient-centered
care that reflects an understanding of human growth and development, pathophysiology, Cognitive Level: Analyzing
pharmacology, medical management and nursing management across the health-illness
Client Need/Sub: Physiological Integrity: Physiological Adaptation
continuum, across lifespan, and in all healthcare settings. | NLN Competencies: Knowledge
and Science: Relationships between knowledge/science and quality and safe patient care. | Standards: QSEN Competencies: III.A.1. Demonstrate knowledge of basic scientific methods
Nursing Process: Assessment and processes. | AACN Essential Competencies: IX.3. Implement holistic, patient-centered
care that reflects an understanding of human growth and development, pathophysiology,
Learning Outcome: 1.2. Differentiate alterations in acid-base balance.
pharmacology, medical
MNL LO: Analyze the concept of acid-base balance and its application to nursing care.
management and nursing management across the health-illness continuum, across lifespan,
and in all healthcare settings. | NLN Competencies: Knowledge and Science: Relationships
between knowledge/science and quality and safe patient care. | Nursing Process: Diagnosis
3) A child with acute asthma has a PaCO2 of 48 mmHg, a pH of 7.31, and a normal HCO3 Learning Outcome: 1.2. Differentiate alterations in acid-base balance.
blood gas value. The nurse interprets these findings as indicative of MNL LO: Analyze the concept of acid-base balance and its application to nursing care.
which condition?
A) Metabolic acidosis
4) The nurse is reviewing the latest arterial blood gas results for a client with metabolic
B) Respiratory alkalosis alkalosis. Which result indicates that the metabolic alkalosis is compensated?
C) Respiratory acidosis A) pH 7.32
D) Metabolic alkalosis Answer: C B) PaCO2 18 mmHg
Explanation: A) If the pH is decreased and the PaCO2 is increased with a normal HCO3, it is
C) HCO3 8 mEq/L
uncompensated respiratory acidosis. Uncompensated respiratory alkalosis has an increased
pH, decreased PaCO2, and normal HCO3. Uncompensated metabolic acidosis has a decreased D) PaCO2 48 mmHg Answer: D
pH, normal PaCO2, and decreased HCO3. Uncompensated metabolic alkalosis has an
Explanation: A) A normal pH level is 7.35-7.45. A pH of less than 7.35 is acidosis. A PaCO2
increased pH, normal PaCO2, and increased HCO3.
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 B) Pulse oximetry
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. C) Sputum studies
B) A normal pH level is 7.35-7.45. A pH of less than 7.35 is acidosis. A PaCO2 level of 18 D) Bronchoscopy Answer: A
mmHg is low and is seen in respiratory alkalosis. A HCO3 level of 8 mEq/L is low and Explanation: A) ABGs are done to assess alterations in acid-base balance caused by
is most likely associated with metabolic acidosis. In metabolic alkalosis, there is an respiratory disorders, metabolic disorders, or both. A bronchoscopy provides visualization of
excess of bicarbonate. To compensate for this imbalance, the rate and depth of internal respiratory structures.
respirations decrease, leading to retention of carbon dioxide. The PaCO2 will be Sputum studies can provide specific information about bacterial organisms. Pulse
elevated. oximetry is a noninvasive test that evaluates the oxygen saturation level of blood.
C) A normal pH level is 7.35-7.45. A pH of less than 7.35 is acidosis. A PaCO2 level of 18 B) ABGs are done to assess alterations in acid-base balance caused by respiratory
mmHg is low and is seen in respiratory alkalosis. A HCO3 level of 8 mEq/L is low and disorders, metabolic disorders, or both. A bronchoscopy provides visualization of internal
is most likely associated with metabolic acidosis. In metabolic alkalosis, there is an respiratory structures. Sputum studies can provide specific information about bacterial
excess of bicarbonate. To compensate for this imbalance, the rate and depth of organisms. Pulse oximetry is a noninvasive test that evaluates the oxygen saturation level of
respirations decrease, leading to retention of carbon dioxide. The PaCO2 will be blood.
elevated.
C) ABGs are done to assess alterations in acid-base balance caused by respiratory
D) A normal pH level is 7.35-7.45. A pH of less than 7.35 is acidosis. A PaCO2 level of 18 disorders, metabolic disorders, or both. A bronchoscopy provides visualization of internal
mmHg is low and is seen in respiratory alkalosis. A HCO3 level of 8 mEq/L is low and is most respiratory structures. Sputum studies can provide specific information about bacterial
likely associated with metabolic acidosis. In metabolic alkalosis, there is an excess of organisms. Pulse oximetry is a noninvasive test that evaluates the oxygen saturation level of
bicarbonate. To compensate for this imbalance, the rate and depth of respirations decrease, blood.
leading to retention of carbon dioxide. The PaCO2 will be elevated.
D) ABGs are done to assess alterations in acid-base balance caused by respiratory
Page Ref: 8 disorders, metabolic disorders, or both. A bronchoscopy provides visualization of internal
respiratory structures. Sputum studies can provide specific information about bacterial
Cognitive Level: Analyzing
organisms. Pulse oximetry is a noninvasive test that evaluates the oxygen saturation level of
Client Need/Sub: Physiological Integrity: Physiological Adaptation blood.
Standards: QSEN Competencies: III.A.1. Demonstrate knowledge of basic scientific methods Page Ref: 9
and processes. | AACN Essential Competencies: IX.3. Implement holistic, patient-centered
Cognitive Level: Applying
care that reflects an understanding of human growth and development, pathophysiology,
pharmacology, medical management and nursing management Client Need/Sub: Physiological Integrity: Physiological Adaptation
across the health-illness continuum, across lifespan, and in all
Standards: QSEN Competencies: III.A.1. Demonstrate knowledge of basic scientific methods
healthcare settings. | NLN Competencies: Knowledge and Science:
and processes. | AACN Essential Competencies: IX.3. Implement holistic, patient-centered
Relationships between knowledge/science and quality and safe
care that reflects an understanding of human growth and development, pathophysiology,
patient care. | Nursing Process: Evaluation
pharmacology, medical management and nursing management across the health-illness
Learning Outcome: 1.2. Differentiate alterations in acid-base balance. continuum, across lifespan, and in all healthcare settings. | NLN Competencies: Knowledge
and Science: Relationships between knowledge/science and quality and safe patient care. |
MNL LO: Analyze the concept of acid-base balance and its application to nursing care. Nursing Process: Assessment
Learning Outcome: 1.5. Differentiate common assessment procedures and tests used to
5) A client has been admitted with chronic obstructive pulmonary disease. Diagnostic examine acid- base balance.
tests have been ordered. Which of the tests will provide the most accurate indicator of the MNL LO: Analyze the concept of acid-base balance and its application to nursing care.
client's acid-base balance?
A) Arterial blood gases (ABGs)
, 6) The nurse is instructing a client with a history of acidosis on the use of sodium IX.3. Implement holistic, patient-centered care that reflects an understanding of human
bicarbonate. Which client statement indicates that additional teaching is needed? growth and development, pathophysiology, pharmacology, medical management and nursing
management across the health-illness continuum, across
A) "I should contact the doctor if I have any gastric discomfort with chest pain."
lifespan, and in all healthcare settings. | NLN Competencies: Knowledge and Science:
B) "I need to purchase antacids without salt." Relationships between knowledge/science and quality and safe patient care. | Nursing
Process: Evaluation
C) "I should use the antacid for at least 2 months."
Learning Outcome: 1.7 Summarize collaborative therapies used by interdisciplinary teams for
D) "I should call the doctor if I get short of breath or start to sweat with this medication." clients with alterations in acidbase balance.
Answer: C
MNL LO: Analyze the concept of acid-base balance and its application to nursing care.
Explanation: A) 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 7) The client is receiving sodium bicarbonate intravenously (IV) for correction of acidosis
sodium or bicarbonate into systemic circulation and to not use any bicarbonate antacid for secondary to diabetic coma. The nurse assesses the client to be lethargic, confused, and
longer than 2 weeks. breathing rapidly. Which is the nurse's priority response to the current situation?
B) The client should be instructed to immediately contact the primary healthcare provider A) Stop the infusion and notify the physician because the client is in alkalosis.
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 B) Decrease the rate of the infusion and continue to assess the client for symptoms of
or bicarbonate into systemic circulation and to not use any bicarbonate antacid for longer alkalosis.
than 2 weeks.
C) Continue the infusion, because the client is still in acidosis, and notify the healthcare
C) The client should be instructed to immediately contact the primary healthcare provider provider.
if gastric discomfort occurs with chest pain or if dyspnea or diaphoresis occurs. The client
D) Increase the rate of the infusion and continue to assess the client for symptoms of
should be instructed to use non-sodium antacids to prevent the absorption of excess sodium
acidosis. Answer: C
or bicarbonate into systemic circulation and to not use any bicarbonate antacid for longer
than 2 weeks. Explanation: A) The client receiving sodium bicarbonate is prone to alkalosis; monitor for
cyanosis, slow respirations, and irregular pulse. The client's symptoms do not indicate
D) The client should be instructed to immediately contact the primary healthcare provider
alkalosis so infusion should not be stopped. The client continues to exhibit signs of acidosis;
if gastric discomfort occurs with chest pain or if dyspnea or diaphoresis occurs. The client
symptoms of acidosis include lethargy, confusion, CNS depression leading to coma, and a
should be instructed to use non-sodium antacids to prevent the absorption of excess sodium
deep, rapid respiration rate that indicates an attempt by the lungs to rid the body of excess
or bicarbonate into systemic circulation and to not use any bicarbonate antacid for longer
acid, and the physician should be notified. The infusion should not be increased or decreased
than 2 weeks.
without a practitioner order.
Page Ref: 12
B) The client receiving sodium bicarbonate is prone to alkalosis; monitor for cyanosis,
Cognitive Level: Analyzing 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
Client Need/Sub: Physiological Integrity: Pharmacological and acidosis include lethargy, confusion, CNS depression leading to coma, and a deep, rapid
Parenteral Therapies Standards: QSEN Competencies: I.A.1. Integrate respiration rate that indicates an attempt by the lungs to rid the body of excess acid, and the
understanding of multiple dimensions of patient-centered care: patient/family/community physician should be notified. The infusion should not be increased or decreased without a
preferences, values; coordination and practitioner order.
integration of care; information, communication, and education; physical comfort and
C) The client receiving sodium bicarbonate is prone to alkalosis; monitor for cyanosis,
emotional support; involvement of family and friends transition and continuity. | AACN
slow respirations, and irregular pulse. The client's symptoms do not indicate alkalosis so
Essential Competencies:
infusion should not be stopped. The client continues to exhibit signs of acidosis; symptoms of
pneumonia place the client at risk for respiratory acidosis with the increased retention of
carbon dioxide in the blood.
APPROACH TO LEARNING, VOLUMES I, II & III EXAM WITH E) Metabolic acidosis is rarely a primary disorder. It usually develops during the course of
VERIFIED QUESTIONS AND ANSWERS
another disease; presence of abdominal fistulas, which can cause excess bicarbonate loss;
acute renal failure; and hypovolemic shock. Chronic obstructive pulmonary disease and
pneumonia place the client at risk for respiratory acidosis with the increased retention of
carbon dioxide in the blood.
Page Ref: 6, 14
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Physiological Adaptation
1) Which risk factors exhibited by the client presenting in the emergency department (ED) Standards: QSEN Competencies: III.A.1. Demonstrate knowledge of basic scientific methods
would place the client at risk for metabolic acidosis? Select all that apply. and processes. | AACN Essential Competencies: IX.3. Implement holistic, patient-centered
care that reflects an understanding of human growth and development, pathophysiology,
A) Abdominal fistulas pharmacology, medical
B) Chronic obstructive pulmonary disease management and nursing management across the health-illness continuum, across lifespan,
and in all healthcare settings. | NLN Competencies: Knowledge and Science: Relationships
C) Pneumonia
between knowledge/science and quality and safe patient care. | Nursing Process:
D) Acute renal failure Assessment
Learning Outcome: 1.2. Differentiate alterations in acid-base balance.
E) Hypovolemic shock Answer: A, D, E
MNL LO: Analyze the concept of acid-base balance and its application to nursing care.
Explanation: A) 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; acute renal failure; and hypovolemic shock. Chronic obstructive pulmonary 2) A client is brought to the emergency department (ED) after passing out in a local
disease and pneumonia place the client at risk for respiratory acidosis with the increased department store. The client has been fasting and has ketones in the urine. Which acid-base
retention of carbon dioxide in the blood. imbalance would the nurse expect to assess in this client?
B) Metabolic acidosis is rarely a primary disorder. It usually develops during the course of A) Metabolic acidosis
another disease; presence of abdominal fistulas, which can cause excess bicarbonate loss;
acute renal failure; and hypovolemic shock. Chronic obstructive pulmonary disease and B) Respiratory alkalosis
pneumonia place the client at risk for respiratory acidosis with the increased retention of C) Metabolic alkalosis
carbon dioxide in the blood.
D) Respiratory acidosis Answer: A
C) 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;
acute renal failure; and hypovolemic shock. Chronic obstructive pulmonary disease and
Explanation: A) A client who is fasting is at risk for development of metabolic acidosis. The body
pneumonia place the client at risk for respiratory acidosis with the increased retention of
recognizes fasting as starvation and begins to metabolize its own fatty acids into ketones,
carbon dioxide in the blood.
which are metabolic acids. Starvation would not result in respiratory acidosis or alkalosis or
D) Metabolic acidosis is rarely a primary disorder. It usually develops during the course of in metabolic alkalosis.
another disease; presence of abdominal fistulas, which can cause excess bicarbonate loss;
B) A client who is fasting is at risk for development of metabolic acidosis. The body
acute renal failure; and hypovolemic shock. Chronic obstructive pulmonary disease and
recognizes fasting as starvation and begins to metabolize its own fatty acids into ketones,
,which are metabolic acids. Starvation would not result in respiratory acidosis or alkalosis B) If the pH is decreased and the PaCO2 is increased with a normal HCO3, it is
or in metabolic alkalosis. uncompensated respiratory acidosis. Uncompensated respiratory alkalosis has an increased
pH, decreased PaCO2, and normal HCO3. Uncompensated metabolic acidosis has a decreased
C) A client who is fasting is at risk for development of metabolic acidosis. The body
pH, normal PaCO2, and decreased HCO3. Uncompensated metabolic alkalosis has an
recognizes fasting as starvation and begins to metabolize its own fatty acids into ketones,
increased pH, normal PaCO2, and increased HCO3.
which are metabolic acids. Starvation would not result in respiratory acidosis or alkalosis
or in metabolic alkalosis. C) If the pH is decreased and the PaCO2 is increased with a normal HCO3, it is
uncompensated respiratory acidosis. Uncompensated respiratory alkalosis has an increased
D) A client who is fasting is at risk for development of metabolic acidosis. The body
pH, decreased PaCO2, and normal HCO3. Uncompensated metabolic acidosis has a decreased
recognizes fasting as starvation and begins to metabolize its own fatty acids into ketones,
pH, normal PaCO2, and decreased HCO3. Uncompensated metabolic alkalosis has an
which are metabolic acids. Starvation would not result in respiratory acidosis or alkalosis
increased pH, normal PaCO2, and increased HCO3.
or in metabolic alkalosis.
D) If the pH is decreased and the PaCO2 is increased with a normal HCO3, it is
Page Ref: 6
uncompensated respiratory acidosis. Uncompensated respiratory alkalosis has an increased
Cognitive Level: Analyzing pH, decreased PaCO2, and normal HCO3. Uncompensated metabolic acidosis has a decreased
pH, normal PaCO2, and decreased HCO3. Uncompensated metabolic alkalosis has an
Client Need/Sub: Physiological Integrity: Physiological Adaptation increased pH, normal PaCO2, and increased HCO3.
Standards: QSEN Competencies: III.A.1. Demonstrate knowledge of basic scientific methods Page Ref: 24
and processes. | AACN Essential Competencies: IX.3. Implement holistic, patient-centered
care that reflects an understanding of human growth and development, pathophysiology, Cognitive Level: Analyzing
pharmacology, medical management and nursing management across the health-illness
Client Need/Sub: Physiological Integrity: Physiological Adaptation
continuum, across lifespan, and in all healthcare settings. | NLN Competencies: Knowledge
and Science: Relationships between knowledge/science and quality and safe patient care. | Standards: QSEN Competencies: III.A.1. Demonstrate knowledge of basic scientific methods
Nursing Process: Assessment and processes. | AACN Essential Competencies: IX.3. Implement holistic, patient-centered
care that reflects an understanding of human growth and development, pathophysiology,
Learning Outcome: 1.2. Differentiate alterations in acid-base balance.
pharmacology, medical
MNL LO: Analyze the concept of acid-base balance and its application to nursing care.
management and nursing management across the health-illness continuum, across lifespan,
and in all healthcare settings. | NLN Competencies: Knowledge and Science: Relationships
between knowledge/science and quality and safe patient care. | Nursing Process: Diagnosis
3) A child with acute asthma has a PaCO2 of 48 mmHg, a pH of 7.31, and a normal HCO3 Learning Outcome: 1.2. Differentiate alterations in acid-base balance.
blood gas value. The nurse interprets these findings as indicative of MNL LO: Analyze the concept of acid-base balance and its application to nursing care.
which condition?
A) Metabolic acidosis
4) The nurse is reviewing the latest arterial blood gas results for a client with metabolic
B) Respiratory alkalosis alkalosis. Which result indicates that the metabolic alkalosis is compensated?
C) Respiratory acidosis A) pH 7.32
D) Metabolic alkalosis Answer: C B) PaCO2 18 mmHg
Explanation: A) If the pH is decreased and the PaCO2 is increased with a normal HCO3, it is
C) HCO3 8 mEq/L
uncompensated respiratory acidosis. Uncompensated respiratory alkalosis has an increased
pH, decreased PaCO2, and normal HCO3. Uncompensated metabolic acidosis has a decreased D) PaCO2 48 mmHg Answer: D
pH, normal PaCO2, and decreased HCO3. Uncompensated metabolic alkalosis has an
Explanation: A) A normal pH level is 7.35-7.45. A pH of less than 7.35 is acidosis. A PaCO2
increased pH, normal PaCO2, and increased HCO3.
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 B) Pulse oximetry
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. C) Sputum studies
B) A normal pH level is 7.35-7.45. A pH of less than 7.35 is acidosis. A PaCO2 level of 18 D) Bronchoscopy Answer: A
mmHg is low and is seen in respiratory alkalosis. A HCO3 level of 8 mEq/L is low and Explanation: A) ABGs are done to assess alterations in acid-base balance caused by
is most likely associated with metabolic acidosis. In metabolic alkalosis, there is an respiratory disorders, metabolic disorders, or both. A bronchoscopy provides visualization of
excess of bicarbonate. To compensate for this imbalance, the rate and depth of internal respiratory structures.
respirations decrease, leading to retention of carbon dioxide. The PaCO2 will be Sputum studies can provide specific information about bacterial organisms. Pulse
elevated. oximetry is a noninvasive test that evaluates the oxygen saturation level of blood.
C) A normal pH level is 7.35-7.45. A pH of less than 7.35 is acidosis. A PaCO2 level of 18 B) ABGs are done to assess alterations in acid-base balance caused by respiratory
mmHg is low and is seen in respiratory alkalosis. A HCO3 level of 8 mEq/L is low and disorders, metabolic disorders, or both. A bronchoscopy provides visualization of internal
is most likely associated with metabolic acidosis. In metabolic alkalosis, there is an respiratory structures. Sputum studies can provide specific information about bacterial
excess of bicarbonate. To compensate for this imbalance, the rate and depth of organisms. Pulse oximetry is a noninvasive test that evaluates the oxygen saturation level of
respirations decrease, leading to retention of carbon dioxide. The PaCO2 will be blood.
elevated.
C) ABGs are done to assess alterations in acid-base balance caused by respiratory
D) A normal pH level is 7.35-7.45. A pH of less than 7.35 is acidosis. A PaCO2 level of 18 disorders, metabolic disorders, or both. A bronchoscopy provides visualization of internal
mmHg is low and is seen in respiratory alkalosis. A HCO3 level of 8 mEq/L is low and is most respiratory structures. Sputum studies can provide specific information about bacterial
likely associated with metabolic acidosis. In metabolic alkalosis, there is an excess of organisms. Pulse oximetry is a noninvasive test that evaluates the oxygen saturation level of
bicarbonate. To compensate for this imbalance, the rate and depth of respirations decrease, blood.
leading to retention of carbon dioxide. The PaCO2 will be elevated.
D) ABGs are done to assess alterations in acid-base balance caused by respiratory
Page Ref: 8 disorders, metabolic disorders, or both. A bronchoscopy provides visualization of internal
respiratory structures. Sputum studies can provide specific information about bacterial
Cognitive Level: Analyzing
organisms. Pulse oximetry is a noninvasive test that evaluates the oxygen saturation level of
Client Need/Sub: Physiological Integrity: Physiological Adaptation blood.
Standards: QSEN Competencies: III.A.1. Demonstrate knowledge of basic scientific methods Page Ref: 9
and processes. | AACN Essential Competencies: IX.3. Implement holistic, patient-centered
Cognitive Level: Applying
care that reflects an understanding of human growth and development, pathophysiology,
pharmacology, medical management and nursing management Client Need/Sub: Physiological Integrity: Physiological Adaptation
across the health-illness continuum, across lifespan, and in all
Standards: QSEN Competencies: III.A.1. Demonstrate knowledge of basic scientific methods
healthcare settings. | NLN Competencies: Knowledge and Science:
and processes. | AACN Essential Competencies: IX.3. Implement holistic, patient-centered
Relationships between knowledge/science and quality and safe
care that reflects an understanding of human growth and development, pathophysiology,
patient care. | Nursing Process: Evaluation
pharmacology, medical management and nursing management across the health-illness
Learning Outcome: 1.2. Differentiate alterations in acid-base balance. continuum, across lifespan, and in all healthcare settings. | NLN Competencies: Knowledge
and Science: Relationships between knowledge/science and quality and safe patient care. |
MNL LO: Analyze the concept of acid-base balance and its application to nursing care. Nursing Process: Assessment
Learning Outcome: 1.5. Differentiate common assessment procedures and tests used to
5) A client has been admitted with chronic obstructive pulmonary disease. Diagnostic examine acid- base balance.
tests have been ordered. Which of the tests will provide the most accurate indicator of the MNL LO: Analyze the concept of acid-base balance and its application to nursing care.
client's acid-base balance?
A) Arterial blood gases (ABGs)
, 6) The nurse is instructing a client with a history of acidosis on the use of sodium IX.3. Implement holistic, patient-centered care that reflects an understanding of human
bicarbonate. Which client statement indicates that additional teaching is needed? growth and development, pathophysiology, pharmacology, medical management and nursing
management across the health-illness continuum, across
A) "I should contact the doctor if I have any gastric discomfort with chest pain."
lifespan, and in all healthcare settings. | NLN Competencies: Knowledge and Science:
B) "I need to purchase antacids without salt." Relationships between knowledge/science and quality and safe patient care. | Nursing
Process: Evaluation
C) "I should use the antacid for at least 2 months."
Learning Outcome: 1.7 Summarize collaborative therapies used by interdisciplinary teams for
D) "I should call the doctor if I get short of breath or start to sweat with this medication." clients with alterations in acidbase balance.
Answer: C
MNL LO: Analyze the concept of acid-base balance and its application to nursing care.
Explanation: A) 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 7) The client is receiving sodium bicarbonate intravenously (IV) for correction of acidosis
sodium or bicarbonate into systemic circulation and to not use any bicarbonate antacid for secondary to diabetic coma. The nurse assesses the client to be lethargic, confused, and
longer than 2 weeks. breathing rapidly. Which is the nurse's priority response to the current situation?
B) The client should be instructed to immediately contact the primary healthcare provider A) Stop the infusion and notify the physician because the client is in alkalosis.
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 B) Decrease the rate of the infusion and continue to assess the client for symptoms of
or bicarbonate into systemic circulation and to not use any bicarbonate antacid for longer alkalosis.
than 2 weeks.
C) Continue the infusion, because the client is still in acidosis, and notify the healthcare
C) The client should be instructed to immediately contact the primary healthcare provider provider.
if gastric discomfort occurs with chest pain or if dyspnea or diaphoresis occurs. The client
D) Increase the rate of the infusion and continue to assess the client for symptoms of
should be instructed to use non-sodium antacids to prevent the absorption of excess sodium
acidosis. Answer: C
or bicarbonate into systemic circulation and to not use any bicarbonate antacid for longer
than 2 weeks. Explanation: A) The client receiving sodium bicarbonate is prone to alkalosis; monitor for
cyanosis, slow respirations, and irregular pulse. The client's symptoms do not indicate
D) The client should be instructed to immediately contact the primary healthcare provider
alkalosis so infusion should not be stopped. The client continues to exhibit signs of acidosis;
if gastric discomfort occurs with chest pain or if dyspnea or diaphoresis occurs. The client
symptoms of acidosis include lethargy, confusion, CNS depression leading to coma, and a
should be instructed to use non-sodium antacids to prevent the absorption of excess sodium
deep, rapid respiration rate that indicates an attempt by the lungs to rid the body of excess
or bicarbonate into systemic circulation and to not use any bicarbonate antacid for longer
acid, and the physician should be notified. The infusion should not be increased or decreased
than 2 weeks.
without a practitioner order.
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B) The client receiving sodium bicarbonate is prone to alkalosis; monitor for cyanosis,
Cognitive Level: Analyzing 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
Client Need/Sub: Physiological Integrity: Pharmacological and acidosis include lethargy, confusion, CNS depression leading to coma, and a deep, rapid
Parenteral Therapies Standards: QSEN Competencies: I.A.1. Integrate respiration rate that indicates an attempt by the lungs to rid the body of excess acid, and the
understanding of multiple dimensions of patient-centered care: patient/family/community physician should be notified. The infusion should not be increased or decreased without a
preferences, values; coordination and practitioner order.
integration of care; information, communication, and education; physical comfort and
C) The client receiving sodium bicarbonate is prone to alkalosis; monitor for cyanosis,
emotional support; involvement of family and friends transition and continuity. | AACN
slow respirations, and irregular pulse. The client's symptoms do not indicate alkalosis so
Essential Competencies:
infusion should not be stopped. The client continues to exhibit signs of acidosis; symptoms of
