,TESTBANK FOR Nursing A Concept-Based Approach
to Learning, Volume 1, 4th edition
Notes
1- The file is chapter after chapter.
2- We have shown you few pages sample.
3- The file contains all Appendix and Excel sheet
if it exists.
4- We have all what you need, we make update
at every time. There are many new editions
waiting you.
5- If you think you purchased the wrong file You
can contact us at every time, we can replace it
with true one.
Our email:
,Nursing: A Concept-Based Approach to Learning Vol. 1 & 2, 4e (Pearson)
Module 1 Acid-Base Balance
The Concept of Acid-Base Balance
1) A client who has been fasting and has ketones in the urine is brought to the emergency
department (ED) unconscious. Which acid-base imbalance would the nurse expect to assess in
this client?
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.
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 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 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.
Page Ref: 5
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Physiological Adaptation
Standards: QSEN Competencies: III.A.1. Demonstrate knowledge of basic scientific methods
and processes. | AACN Domains and Competencies: 2.4 Diagnose actual or potential health
problems and needs. | NLN Competencies: Knowledge and Science: Relationships between
knowledge/science and quality and safe patient care. | Nursing Process: Assessment
Learning Outcome: 1.2. Differentiate alterations in acid-base balance.
MNL LO: Analyze the concept of acid-base balance and its application to nursing care.
1
Copyright © 2023 Pearson Education, Inc.
,2) The nurse is caring for a client in the emergency department. Which factors will the nurse
identify that increase the client's risk for metabolic acidosis? Select all that apply.
A) Abdominal fistulas
B) Chronic obstructive pulmonary disease
C) Pneumonia
D) Chronic 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 condition such as an abdominal fistula which can cause the loss of bicarbonate
from the intestine.
B) Chronic obstructive pulmonary disease places the client at risk for respiratory acidosis with
the increased retention of carbon dioxide in the blood.
C) Pneumonia places 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 condition such as chronic renal failure. In this health problem, the kidneys are unable to
excrete a normal amount of hydrogen ions in the urine. This results in an excessive amount of
hydrogen ions in the blood, which produces metabolic acidosis.
E) Metabolic acidosis is rarely a primary disorder. It usually develops during the course of
another condition such as hypovolemic shock. With a severe blood loss, there is a lack of blood
flow throughout the body and a lack of oxygen in every cell. Adenosine triphosphate (ATP) must
produce energy anaerobically without the presence of oxygen; lactic acid is a by-product. This
produces systemic lactic acidosis, a type of metabolic acidosis.
Page Ref: 5-6
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Physiological Adaptation
Standards: QSEN Competencies: III.A.1. Demonstrate knowledge of basic scientific methods
and processes. | AACN Domains and Competencies: 2.4 Diagnose actual or potential health
problems and needs. | NLN Competencies: Knowledge and Science: Relationships between
knowledge/science and quality and safe patient care. | Nursing Process: Assessment
Learning Outcome: 1.2. Differentiate alterations in acid-base balance.
MNL LO: Analyze the concept of acid-base balance and its application to nursing care.
2
Copyright © 2023 Pearson Education, Inc.
,3) A client with acute asthma has a PaCO2 of 48 mmHg, a pH of 7.31, and a normal HCO3
arterial blood gas value. Which condition will the nurse associate with these values?
A) Metabolic acidosis
B) Respiratory alkalosis
C) Respiratory acidosis
D) Metabolic alkalosis
Answer: C
Explanation: A) Uncompensated metabolic acidosis has a decreased pH, normal PaCO2, and
decreased HCO3.
B) Uncompensated respiratory alkalosis has an increased pH, decreased PaCO2, and normal
HCO3.
C) If the pH is decreased and the PaCO2 is increased with a normal HCO3, it is uncompensated
respiratory acidosis.
D) Uncompensated metabolic alkalosis has an increased pH, normal PaCO2, and increased
HCO3.
Page Ref: 7
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Physiological Adaptation
Standards: QSEN Competencies: III.A.1. Demonstrate knowledge of basic scientific methods
and processes. | AACN Domains and Essential Competencies: 2.4 Diagnose actual or potential
health problems and needs. | NLN Competencies: Knowledge and Science: Relationships
between knowledge/science and quality and safe patient care. | Nursing Process: Assessment
Learning Outcome: 1.2. Differentiate alterations in acid-base balance.
MNL LO: Analyze the concept of acid-base balance and its application to nursing care.
3
Copyright © 2023 Pearson Education, Inc.
,4) The nurse is reviewing the latest arterial blood gas results for a client with metabolic alkalosis.
Which result indicates that the metabolic alkalosis is compensated?
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.
B) A PaCO2 level of 18 mmHg is low and is seen in respiratory alkalosis.
C) A HCO3 level of 8 mEq/L is low and is most likely associated with metabolic acidosis.
D) In metabolic alkalosis, there is an excess of bicarbonate. To compensate for this imbalance,
the rate and depth of respirations decrease, leading to retention of carbon dioxide. The PaCO2
will be elevated.
Page Ref: 8
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Physiological Adaptation
Standards: QSEN Competencies: III.A.1. Demonstrate knowledge of basic scientific methods
and processes. | AACN Domains and Essential Competencies: 2.4 Diagnose actual or potential
health problems and needs. | NLN Competencies: Knowledge and Science: Relationships
between knowledge/science and quality and safe patient care. | Nursing Process: Evaluation
Learning Outcome: 1.2. Differentiate alterations in acid-base balance.
MNL LO: Analyze the concept of acid-base balance and its application to nursing care.
4
Copyright © 2023 Pearson Education, Inc.
,5) A client is diagnosed with chronic obstructive pulmonary disease. Which test provides the
most accurate indicator of the client's acid-base balance?
A) Arterial blood gases (ABGs)
B) Pulse oximetry
C) Sputum studies
D) Bronchoscopy
Answer: A
Explanation: A) Acid-base balance is assessed primarily by measuring arterial blood gases
(ABGs). Arterial blood is most often used because it reflects acid-base balance throughout the
entire body better than venous or capillary blood that has dispersed oxygen into the tissues and
has collected carbon dioxide.
B) Pulse oximetry is a noninvasive test that evaluates the oxygen saturation level of blood.
C) Sputum studies can provide specific information about bacterial organisms.
D) A bronchoscopy provides visualization of internal respiratory structures.
Page Ref: 10
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Reduction of Risk Potential
Standards: QSEN Competencies: III.A.1. Demonstrate knowledge of basic scientific methods
and processes. | AACN Domains and Competencies: 2.3 Integrate assessment skills in practice. |
NLN Competencies: Knowledge and Science: Relationships between knowledge/science and
quality and safe patient care. | Nursing Process: Assessment
Learning Outcome: 1.5. Differentiate common assessment procedures and tests used to
examine acid-base balance.
MNL LO: Analyze the concept of acid-base balance and its application to nursing care.
5
Copyright © 2023 Pearson Education, Inc.
,6) The nurse is instructing a client with a history of acidosis on the use of sodium bicarbonate.
Which client statement indicates that additional teaching is needed?
A) "I should contact the doctor if I have any gastric discomfort with chest pain."
B) "I need to purchase antacids without salt."
C) "I should use the antacid for at least 2 months."
D) "I should call the doctor if I get short of breath or start to sweat with this medication."
Answer: C
Explanation: A) The client should be instructed to immediately contact the primary healthcare
provider if gastric discomfort occurs with chest pain.
B) The client should be instructed to use non-sodium antacids to prevent the absorption of excess
sodium or bicarbonate into systemic circulation.
C) The client should be instructed to not use any bicarbonate antacid for longer than 2 weeks.
D) The client should be instructed to immediately contact the primary healthcare provider if
dyspnea or diaphoresis occurs.
Page Ref: 6
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of
patient-centered care: patient/family/community preferences, values; coordination and
integration of care; information, communication, and education; physical comfort and emotional
support; involvement of family and friends; Transition and continuity. | AACN Domains and
Competencies: 5.2 Contribute to a culture of patient safety. | NLN Competencies: Knowledge
and Science: Relationships between knowledge/science and quality and safe patient care. |
Nursing Process: Evaluation
Learning Outcome: 1.7. Summarize collaborative therapies used by interdisciplinary teams for
clients with alterations in acid-base balance.
MNL LO: Analyze the concept of acid-base balance and its application to nursing care.
6
Copyright © 2023 Pearson Education, Inc.
,7) A client is receiving sodium bicarbonate intravenously (IV) for correction of acidosis
secondary to diabetic coma. The nurse assesses the client to be lethargic, confused, and breathing
rapidly. Which action will the nurse take?
A) Stop the infusion and notify the physician because the client is in alkalosis.
B) Decrease the rate of the infusion and continue to assess the client for symptoms of alkalosis.
C) Continue the infusion, because the client is still in acidosis, and notify the healthcare provider.
D) Increase the rate of the infusion and continue to assess the client for symptoms of acidosis.
Answer: C
Explanation: A) The client's symptoms do not indicate alkalosis so infusion should not be
stopped.
B) The client receiving sodium bicarbonate is prone to alkalosis; monitor for cyanosis, slow
respirations, and irregular pulse.
C) The client continues to exhibit signs of acidosis; symptoms of acidosis include lethargy,
confusion, CNS depression leading to coma, and a deep, rapid respiration rate that indicates an
attempt by the lungs to rid the body of excess acid, and the physician should be notified.
D) The infusion should not be increased or decreased without a practitioner order.
Page Ref: 5-6
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of
patient-centered care: Patient/family/community preferences, values; Coordination and
integration of care; Information, communication, and education; Physical comfort and emotional
support; Involvement of family and friends; Transition and continuity. | AACN Domains and
Competencies: 2.3 Integrate assessment skills in practice. | NLN Competencies: Knowledge and
Science: Relationships between knowledge/science and quality and safe patient care. | Nursing
Process: Implementation
Learning Outcome: 1.7. Summarize collaborative therapies used by interdisciplinary teams for
clients with alterations in acid-base balance.
MNL LO: Analyze the concept of acid-base balance and its application to nursing care.
7
Copyright © 2023 Pearson Education, Inc.
, 8) The nurse is preparing to analyze an arterial blood gas to determine if a client has an acid-base
imbalance. In which order will the nurse analyze this laboratory test?
1. Look at the PaCO2.
2. Look at the pH.
3. Evaluate the relationship between pH and PaCO2.
4. Look at the bicarbonate in relation to the pH.
Answer: 2, 1, 3, 4
Explanation: 1. The second step is to look at the PaCO2. If the PaCO2 is <40, then more
carbon dioxide is being exhaled. If the PaCO2 is >40, then more carbon dioxide is being
retained.
2. The pH is the first step and is analyzed to determine if acidosis or alkalosis is present. A pH of
<7.35 is acidosis. A pH of >7.45 is alkalosis.
3. The third step is to evaluate the relationship between the pH and the PaCO2. This relationship
could indicate a respiratory problem. If the pH is acidotic and the carbon dioxide level is greater
than 40, then the client could be experiencing respiratory acidosis. If the pH is alkalotic and the
carbon dioxide level is below 40, then the client could be experiencing respiratory alkalosis.
4. The fourth step is to look at the bicarbonate level in relation to the pH. If both the pH and
bicarbonate level is decreased, then the client has metabolic acidosis. If the pH and bicarbonate
levels are increased, the client has metabolic alkalosis.
Page Ref: 11
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Physiological Adaptation
Standards: QSEN Competencies: III.A.1. Demonstrate knowledge of basic scientific methods
and processes. | AACN Domains and Competencies: 2.3 Integrate assessment skills in practice. |
NLN Competencies: Knowledge and Science: Relationships between knowledge/science and
quality and safe patient care. | Nursing Process: Assessment
Learning Outcome: 1.5. Differentiate common assessment procedures and tests used to
examine acid-base balance.
MNL LO: Analyze the concept of acid-base balance and its application to nursing care.
8
Copyright © 2023 Pearson Education, Inc.
to Learning, Volume 1, 4th edition
Notes
1- The file is chapter after chapter.
2- We have shown you few pages sample.
3- The file contains all Appendix and Excel sheet
if it exists.
4- We have all what you need, we make update
at every time. There are many new editions
waiting you.
5- If you think you purchased the wrong file You
can contact us at every time, we can replace it
with true one.
Our email:
,Nursing: A Concept-Based Approach to Learning Vol. 1 & 2, 4e (Pearson)
Module 1 Acid-Base Balance
The Concept of Acid-Base Balance
1) A client who has been fasting and has ketones in the urine is brought to the emergency
department (ED) unconscious. Which acid-base imbalance would the nurse expect to assess in
this client?
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.
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 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 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.
Page Ref: 5
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Physiological Adaptation
Standards: QSEN Competencies: III.A.1. Demonstrate knowledge of basic scientific methods
and processes. | AACN Domains and Competencies: 2.4 Diagnose actual or potential health
problems and needs. | NLN Competencies: Knowledge and Science: Relationships between
knowledge/science and quality and safe patient care. | Nursing Process: Assessment
Learning Outcome: 1.2. Differentiate alterations in acid-base balance.
MNL LO: Analyze the concept of acid-base balance and its application to nursing care.
1
Copyright © 2023 Pearson Education, Inc.
,2) The nurse is caring for a client in the emergency department. Which factors will the nurse
identify that increase the client's risk for metabolic acidosis? Select all that apply.
A) Abdominal fistulas
B) Chronic obstructive pulmonary disease
C) Pneumonia
D) Chronic 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 condition such as an abdominal fistula which can cause the loss of bicarbonate
from the intestine.
B) Chronic obstructive pulmonary disease places the client at risk for respiratory acidosis with
the increased retention of carbon dioxide in the blood.
C) Pneumonia places 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 condition such as chronic renal failure. In this health problem, the kidneys are unable to
excrete a normal amount of hydrogen ions in the urine. This results in an excessive amount of
hydrogen ions in the blood, which produces metabolic acidosis.
E) Metabolic acidosis is rarely a primary disorder. It usually develops during the course of
another condition such as hypovolemic shock. With a severe blood loss, there is a lack of blood
flow throughout the body and a lack of oxygen in every cell. Adenosine triphosphate (ATP) must
produce energy anaerobically without the presence of oxygen; lactic acid is a by-product. This
produces systemic lactic acidosis, a type of metabolic acidosis.
Page Ref: 5-6
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Physiological Adaptation
Standards: QSEN Competencies: III.A.1. Demonstrate knowledge of basic scientific methods
and processes. | AACN Domains and Competencies: 2.4 Diagnose actual or potential health
problems and needs. | NLN Competencies: Knowledge and Science: Relationships between
knowledge/science and quality and safe patient care. | Nursing Process: Assessment
Learning Outcome: 1.2. Differentiate alterations in acid-base balance.
MNL LO: Analyze the concept of acid-base balance and its application to nursing care.
2
Copyright © 2023 Pearson Education, Inc.
,3) A client with acute asthma has a PaCO2 of 48 mmHg, a pH of 7.31, and a normal HCO3
arterial blood gas value. Which condition will the nurse associate with these values?
A) Metabolic acidosis
B) Respiratory alkalosis
C) Respiratory acidosis
D) Metabolic alkalosis
Answer: C
Explanation: A) Uncompensated metabolic acidosis has a decreased pH, normal PaCO2, and
decreased HCO3.
B) Uncompensated respiratory alkalosis has an increased pH, decreased PaCO2, and normal
HCO3.
C) If the pH is decreased and the PaCO2 is increased with a normal HCO3, it is uncompensated
respiratory acidosis.
D) Uncompensated metabolic alkalosis has an increased pH, normal PaCO2, and increased
HCO3.
Page Ref: 7
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Physiological Adaptation
Standards: QSEN Competencies: III.A.1. Demonstrate knowledge of basic scientific methods
and processes. | AACN Domains and Essential Competencies: 2.4 Diagnose actual or potential
health problems and needs. | NLN Competencies: Knowledge and Science: Relationships
between knowledge/science and quality and safe patient care. | Nursing Process: Assessment
Learning Outcome: 1.2. Differentiate alterations in acid-base balance.
MNL LO: Analyze the concept of acid-base balance and its application to nursing care.
3
Copyright © 2023 Pearson Education, Inc.
,4) The nurse is reviewing the latest arterial blood gas results for a client with metabolic alkalosis.
Which result indicates that the metabolic alkalosis is compensated?
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.
B) A PaCO2 level of 18 mmHg is low and is seen in respiratory alkalosis.
C) A HCO3 level of 8 mEq/L is low and is most likely associated with metabolic acidosis.
D) In metabolic alkalosis, there is an excess of bicarbonate. To compensate for this imbalance,
the rate and depth of respirations decrease, leading to retention of carbon dioxide. The PaCO2
will be elevated.
Page Ref: 8
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Physiological Adaptation
Standards: QSEN Competencies: III.A.1. Demonstrate knowledge of basic scientific methods
and processes. | AACN Domains and Essential Competencies: 2.4 Diagnose actual or potential
health problems and needs. | NLN Competencies: Knowledge and Science: Relationships
between knowledge/science and quality and safe patient care. | Nursing Process: Evaluation
Learning Outcome: 1.2. Differentiate alterations in acid-base balance.
MNL LO: Analyze the concept of acid-base balance and its application to nursing care.
4
Copyright © 2023 Pearson Education, Inc.
,5) A client is diagnosed with chronic obstructive pulmonary disease. Which test provides the
most accurate indicator of the client's acid-base balance?
A) Arterial blood gases (ABGs)
B) Pulse oximetry
C) Sputum studies
D) Bronchoscopy
Answer: A
Explanation: A) Acid-base balance is assessed primarily by measuring arterial blood gases
(ABGs). Arterial blood is most often used because it reflects acid-base balance throughout the
entire body better than venous or capillary blood that has dispersed oxygen into the tissues and
has collected carbon dioxide.
B) Pulse oximetry is a noninvasive test that evaluates the oxygen saturation level of blood.
C) Sputum studies can provide specific information about bacterial organisms.
D) A bronchoscopy provides visualization of internal respiratory structures.
Page Ref: 10
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Reduction of Risk Potential
Standards: QSEN Competencies: III.A.1. Demonstrate knowledge of basic scientific methods
and processes. | AACN Domains and Competencies: 2.3 Integrate assessment skills in practice. |
NLN Competencies: Knowledge and Science: Relationships between knowledge/science and
quality and safe patient care. | Nursing Process: Assessment
Learning Outcome: 1.5. Differentiate common assessment procedures and tests used to
examine acid-base balance.
MNL LO: Analyze the concept of acid-base balance and its application to nursing care.
5
Copyright © 2023 Pearson Education, Inc.
,6) The nurse is instructing a client with a history of acidosis on the use of sodium bicarbonate.
Which client statement indicates that additional teaching is needed?
A) "I should contact the doctor if I have any gastric discomfort with chest pain."
B) "I need to purchase antacids without salt."
C) "I should use the antacid for at least 2 months."
D) "I should call the doctor if I get short of breath or start to sweat with this medication."
Answer: C
Explanation: A) The client should be instructed to immediately contact the primary healthcare
provider if gastric discomfort occurs with chest pain.
B) The client should be instructed to use non-sodium antacids to prevent the absorption of excess
sodium or bicarbonate into systemic circulation.
C) The client should be instructed to not use any bicarbonate antacid for longer than 2 weeks.
D) The client should be instructed to immediately contact the primary healthcare provider if
dyspnea or diaphoresis occurs.
Page Ref: 6
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of
patient-centered care: patient/family/community preferences, values; coordination and
integration of care; information, communication, and education; physical comfort and emotional
support; involvement of family and friends; Transition and continuity. | AACN Domains and
Competencies: 5.2 Contribute to a culture of patient safety. | NLN Competencies: Knowledge
and Science: Relationships between knowledge/science and quality and safe patient care. |
Nursing Process: Evaluation
Learning Outcome: 1.7. Summarize collaborative therapies used by interdisciplinary teams for
clients with alterations in acid-base balance.
MNL LO: Analyze the concept of acid-base balance and its application to nursing care.
6
Copyright © 2023 Pearson Education, Inc.
,7) A client is receiving sodium bicarbonate intravenously (IV) for correction of acidosis
secondary to diabetic coma. The nurse assesses the client to be lethargic, confused, and breathing
rapidly. Which action will the nurse take?
A) Stop the infusion and notify the physician because the client is in alkalosis.
B) Decrease the rate of the infusion and continue to assess the client for symptoms of alkalosis.
C) Continue the infusion, because the client is still in acidosis, and notify the healthcare provider.
D) Increase the rate of the infusion and continue to assess the client for symptoms of acidosis.
Answer: C
Explanation: A) The client's symptoms do not indicate alkalosis so infusion should not be
stopped.
B) The client receiving sodium bicarbonate is prone to alkalosis; monitor for cyanosis, slow
respirations, and irregular pulse.
C) The client continues to exhibit signs of acidosis; symptoms of acidosis include lethargy,
confusion, CNS depression leading to coma, and a deep, rapid respiration rate that indicates an
attempt by the lungs to rid the body of excess acid, and the physician should be notified.
D) The infusion should not be increased or decreased without a practitioner order.
Page Ref: 5-6
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of
patient-centered care: Patient/family/community preferences, values; Coordination and
integration of care; Information, communication, and education; Physical comfort and emotional
support; Involvement of family and friends; Transition and continuity. | AACN Domains and
Competencies: 2.3 Integrate assessment skills in practice. | NLN Competencies: Knowledge and
Science: Relationships between knowledge/science and quality and safe patient care. | Nursing
Process: Implementation
Learning Outcome: 1.7. Summarize collaborative therapies used by interdisciplinary teams for
clients with alterations in acid-base balance.
MNL LO: Analyze the concept of acid-base balance and its application to nursing care.
7
Copyright © 2023 Pearson Education, Inc.
, 8) The nurse is preparing to analyze an arterial blood gas to determine if a client has an acid-base
imbalance. In which order will the nurse analyze this laboratory test?
1. Look at the PaCO2.
2. Look at the pH.
3. Evaluate the relationship between pH and PaCO2.
4. Look at the bicarbonate in relation to the pH.
Answer: 2, 1, 3, 4
Explanation: 1. The second step is to look at the PaCO2. If the PaCO2 is <40, then more
carbon dioxide is being exhaled. If the PaCO2 is >40, then more carbon dioxide is being
retained.
2. The pH is the first step and is analyzed to determine if acidosis or alkalosis is present. A pH of
<7.35 is acidosis. A pH of >7.45 is alkalosis.
3. The third step is to evaluate the relationship between the pH and the PaCO2. This relationship
could indicate a respiratory problem. If the pH is acidotic and the carbon dioxide level is greater
than 40, then the client could be experiencing respiratory acidosis. If the pH is alkalotic and the
carbon dioxide level is below 40, then the client could be experiencing respiratory alkalosis.
4. The fourth step is to look at the bicarbonate level in relation to the pH. If both the pH and
bicarbonate level is decreased, then the client has metabolic acidosis. If the pH and bicarbonate
levels are increased, the client has metabolic alkalosis.
Page Ref: 11
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Physiological Adaptation
Standards: QSEN Competencies: III.A.1. Demonstrate knowledge of basic scientific methods
and processes. | AACN Domains and Competencies: 2.3 Integrate assessment skills in practice. |
NLN Competencies: Knowledge and Science: Relationships between knowledge/science and
quality and safe patient care. | Nursing Process: Assessment
Learning Outcome: 1.5. Differentiate common assessment procedures and tests used to
examine acid-base balance.
MNL LO: Analyze the concept of acid-base balance and its application to nursing care.
8
Copyright © 2023 Pearson Education, Inc.
