TEST BANK FOR NURSING A CONCEPT-BASED
APPROACH TO LEARNING, VOLUMES I, II & III EXAM WITH
VERIFIED QUESTIONS AND ANSWERS
1) Which risk factors exhibited by the client presenting in the emergency department (ED)
would place the client at risk for metabolic acidosis? Select all that apply.
A) Abdominal fistulas
B) Chronic obstructive pulmonary disease
C) Pneumonia
D) Acute renal failure
E) Hypovolemic shock Answer: A, D, E
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
disease and pneumonia place the client at risk for respiratory acidosis with the increased
retention of carbon dioxide in the blood.
B) 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
pneumonia place the client at risk for respiratory acidosis with the increased retention of
carbon dioxide in the blood.
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
pneumonia place the client at risk for respiratory acidosis with the increased retention of
carbon dioxide in the blood.
D) 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
,pneumonia place the client at risk for respiratory acidosis with the increased retention of
carbon dioxide in the blood.
E) Metabolic acidosis is rarely a primary disorder. It usually develops during the course of
another disease; presence of abdominal fistulas, which can cause excess bicarbonate loss;
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
Standards: QSEN Competencies: III.A.1. Demonstrate knowledge of basic scientific methods
and processes. | AACN Essential Competencies: IX.3. Implement holistic, patient-centered
care that reflects an understanding of human growth and development, pathophysiology,
pharmacology, medical
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:
Assessment
Learning Outcome: 1.2. Differentiate alterations in acid-base balance.
MNL LO: Analyze the concept of acid-base balance and its application to nursing care.
2) A client is brought to the emergency department (ED) after passing out in a local
department store. The client has been fasting and has ketones in the urine. Which acid-base
imbalance would the nurse expect to assess in this client?
A) Metabolic acidosis
B) Respiratory alkalosis
C) Metabolic alkalosis
D) Respiratory acidosis Answer: A
Explanation: A) A client who is fasting is at risk for development of metabolic acidosis. The body
recognizes fasting as starvation and begins to metabolize its own fatty acids into ketones,
which are metabolic acids. Starvation would not result in respiratory acidosis or alkalosis or
in metabolic alkalosis.
B) A client who is fasting is at risk for development of metabolic acidosis. The body
recognizes fasting as starvation and begins to metabolize its own fatty acids into ketones,
,which are metabolic acids. Starvation would not result in respiratory acidosis or alkalosis
or in metabolic alkalosis.
C) A client who is fasting is at risk for development of metabolic acidosis. The body
recognizes fasting as starvation and begins to metabolize its own fatty acids into ketones,
which are metabolic acids. Starvation would not result in respiratory acidosis or alkalosis
or in metabolic alkalosis.
D) A client who is fasting is at risk for development of metabolic acidosis. The body
recognizes fasting as starvation and begins to metabolize its own fatty acids into ketones,
which are metabolic acids. Starvation would not result in respiratory acidosis or alkalosis
or in metabolic alkalosis.
Page Ref: 6
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Physiological Adaptation
Standards: QSEN Competencies: III.A.1. Demonstrate knowledge of basic scientific methods
and processes. | AACN Essential Competencies: IX.3. Implement holistic, patient-centered
care that reflects an understanding of human growth and development, pathophysiology,
pharmacology, medical 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: Assessment
Learning Outcome: 1.2. Differentiate alterations in acid-base balance.
MNL LO: Analyze the concept of acid-base balance and its application to nursing care.
3) A child with acute asthma has a PaCO2 of 48 mmHg, a pH of 7.31, and a normal HCO3
blood gas value. The nurse interprets these findings as indicative of
which condition?
A) Metabolic acidosis
B) Respiratory alkalosis
C) Respiratory acidosis
D) Metabolic alkalosis Answer: C
Explanation: A) 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
pH, decreased PaCO2, and normal HCO3. Uncompensated metabolic acidosis has a decreased
pH, normal PaCO2, and decreased HCO3. Uncompensated metabolic alkalosis has an
increased pH, normal PaCO2, and increased HCO3.
, B) 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
pH, decreased PaCO2, and normal HCO3. Uncompensated metabolic acidosis has a decreased
pH, normal PaCO2, and decreased HCO3. Uncompensated metabolic alkalosis has an
increased pH, normal PaCO2, and increased HCO3.
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
pH, decreased PaCO2, and normal HCO3. Uncompensated metabolic acidosis has a decreased
pH, normal PaCO2, and decreased HCO3. Uncompensated metabolic alkalosis has an
increased pH, normal PaCO2, and increased HCO3.
D) 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
pH, decreased PaCO2, and normal HCO3. Uncompensated metabolic acidosis has a decreased
pH, normal PaCO2, and decreased HCO3. Uncompensated metabolic alkalosis has an
increased pH, normal PaCO2, and increased HCO3.
Page Ref: 24
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Physiological Adaptation
Standards: QSEN Competencies: III.A.1. Demonstrate knowledge of basic scientific methods
and processes. | AACN Essential Competencies: IX.3. Implement holistic, patient-centered
care that reflects an understanding of human growth and development, pathophysiology,
pharmacology, medical
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
Learning Outcome: 1.2. Differentiate alterations in acid-base balance.
MNL LO: Analyze the concept of acid-base balance and its application to nursing care.
4) The nurse is reviewing the latest arterial blood gas results for a client with metabolic
alkalosis. Which result indicates that the metabolic alkalosis is compensated?
A) pH 7.32
B) PaCO2 18 mmHg
C) HCO3 8 mEq/L
D) PaCO2 48 mmHg Answer: D
Explanation: A) A normal pH level is 7.35-7.45. A pH of less than 7.35 is acidosis. A PaCO2
level of 18 mmHg is low and is seen in respiratory alkalosis. A HCO3 level of 8 mEq/L is low
APPROACH TO LEARNING, VOLUMES I, II & III EXAM WITH
VERIFIED QUESTIONS AND ANSWERS
1) Which risk factors exhibited by the client presenting in the emergency department (ED)
would place the client at risk for metabolic acidosis? Select all that apply.
A) Abdominal fistulas
B) Chronic obstructive pulmonary disease
C) Pneumonia
D) Acute renal failure
E) Hypovolemic shock Answer: A, D, E
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
disease and pneumonia place the client at risk for respiratory acidosis with the increased
retention of carbon dioxide in the blood.
B) 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
pneumonia place the client at risk for respiratory acidosis with the increased retention of
carbon dioxide in the blood.
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
pneumonia place the client at risk for respiratory acidosis with the increased retention of
carbon dioxide in the blood.
D) 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
,pneumonia place the client at risk for respiratory acidosis with the increased retention of
carbon dioxide in the blood.
E) Metabolic acidosis is rarely a primary disorder. It usually develops during the course of
another disease; presence of abdominal fistulas, which can cause excess bicarbonate loss;
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
Standards: QSEN Competencies: III.A.1. Demonstrate knowledge of basic scientific methods
and processes. | AACN Essential Competencies: IX.3. Implement holistic, patient-centered
care that reflects an understanding of human growth and development, pathophysiology,
pharmacology, medical
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:
Assessment
Learning Outcome: 1.2. Differentiate alterations in acid-base balance.
MNL LO: Analyze the concept of acid-base balance and its application to nursing care.
2) A client is brought to the emergency department (ED) after passing out in a local
department store. The client has been fasting and has ketones in the urine. Which acid-base
imbalance would the nurse expect to assess in this client?
A) Metabolic acidosis
B) Respiratory alkalosis
C) Metabolic alkalosis
D) Respiratory acidosis Answer: A
Explanation: A) A client who is fasting is at risk for development of metabolic acidosis. The body
recognizes fasting as starvation and begins to metabolize its own fatty acids into ketones,
which are metabolic acids. Starvation would not result in respiratory acidosis or alkalosis or
in metabolic alkalosis.
B) A client who is fasting is at risk for development of metabolic acidosis. The body
recognizes fasting as starvation and begins to metabolize its own fatty acids into ketones,
,which are metabolic acids. Starvation would not result in respiratory acidosis or alkalosis
or in metabolic alkalosis.
C) A client who is fasting is at risk for development of metabolic acidosis. The body
recognizes fasting as starvation and begins to metabolize its own fatty acids into ketones,
which are metabolic acids. Starvation would not result in respiratory acidosis or alkalosis
or in metabolic alkalosis.
D) A client who is fasting is at risk for development of metabolic acidosis. The body
recognizes fasting as starvation and begins to metabolize its own fatty acids into ketones,
which are metabolic acids. Starvation would not result in respiratory acidosis or alkalosis
or in metabolic alkalosis.
Page Ref: 6
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Physiological Adaptation
Standards: QSEN Competencies: III.A.1. Demonstrate knowledge of basic scientific methods
and processes. | AACN Essential Competencies: IX.3. Implement holistic, patient-centered
care that reflects an understanding of human growth and development, pathophysiology,
pharmacology, medical 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: Assessment
Learning Outcome: 1.2. Differentiate alterations in acid-base balance.
MNL LO: Analyze the concept of acid-base balance and its application to nursing care.
3) A child with acute asthma has a PaCO2 of 48 mmHg, a pH of 7.31, and a normal HCO3
blood gas value. The nurse interprets these findings as indicative of
which condition?
A) Metabolic acidosis
B) Respiratory alkalosis
C) Respiratory acidosis
D) Metabolic alkalosis Answer: C
Explanation: A) 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
pH, decreased PaCO2, and normal HCO3. Uncompensated metabolic acidosis has a decreased
pH, normal PaCO2, and decreased HCO3. Uncompensated metabolic alkalosis has an
increased pH, normal PaCO2, and increased HCO3.
, B) 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
pH, decreased PaCO2, and normal HCO3. Uncompensated metabolic acidosis has a decreased
pH, normal PaCO2, and decreased HCO3. Uncompensated metabolic alkalosis has an
increased pH, normal PaCO2, and increased HCO3.
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
pH, decreased PaCO2, and normal HCO3. Uncompensated metabolic acidosis has a decreased
pH, normal PaCO2, and decreased HCO3. Uncompensated metabolic alkalosis has an
increased pH, normal PaCO2, and increased HCO3.
D) 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
pH, decreased PaCO2, and normal HCO3. Uncompensated metabolic acidosis has a decreased
pH, normal PaCO2, and decreased HCO3. Uncompensated metabolic alkalosis has an
increased pH, normal PaCO2, and increased HCO3.
Page Ref: 24
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Physiological Adaptation
Standards: QSEN Competencies: III.A.1. Demonstrate knowledge of basic scientific methods
and processes. | AACN Essential Competencies: IX.3. Implement holistic, patient-centered
care that reflects an understanding of human growth and development, pathophysiology,
pharmacology, medical
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
Learning Outcome: 1.2. Differentiate alterations in acid-base balance.
MNL LO: Analyze the concept of acid-base balance and its application to nursing care.
4) The nurse is reviewing the latest arterial blood gas results for a client with metabolic
alkalosis. Which result indicates that the metabolic alkalosis is compensated?
A) pH 7.32
B) PaCO2 18 mmHg
C) HCO3 8 mEq/L
D) PaCO2 48 mmHg Answer: D
Explanation: A) A normal pH level is 7.35-7.45. A pH of less than 7.35 is acidosis. A PaCO2
level of 18 mmHg is low and is seen in respiratory alkalosis. A HCO3 level of 8 mEq/L is low
